Tuberculosis: Still an emerging threat.

Primary care providers must be aggressive in their assessment and screening of tuberculosis (TB) infection, which is still a major cause of mortality and morbidity worldwide. This article highlights the overall management of TB infection including the appropriate screening, diagnosis, and treatment of both latent and active infection.

La importancia de una adherencia correcta al tratamiento antituberculoso / The importance of proper adherence to anti-tuberculosis treatment

Introducción. La tuberculosis (TB) sigue siendo una de las principales causas de morbimortalidad en muchos países y esto comporta un problema grave de salud pública. La adherencia al tratamiento antituberculoso es un eje fundamental para el control de esta enfermedad. Desarrollo. A nivel mundial existen grandes diferencias en función del territorio en cuanto a las tasas de prevalencia e incidencia de la enfermedad y su mortalidad. España presenta una tasa de incidencia superior a la de otros países de su entorno socioeconómico. El tratamiento es prolongado y con efectos secundarios importantes. La adherencia al tratamiento es fundamental para que este sea eficaz, para evitar las resistencias a los fármacos y controlar la enfermedad. Los niños son más vulnerables a desarrollar la enfermedad que el resto de la población. Existen distintos tipos de métodos, directos e indirectos, para medir esta adherencia al tratamiento, aunque ninguno es ideal. Están descritos una serie de factores de riesgo de tipo sociodemográfico que influyen en la adherencia, como la inmigración. A los factores que dificultan el seguimiento del tratamiento en el adulto se tienen que sumar otros más específicos a nivel infantil. Conclusiones. La literatura revisada destaca la importancia de un adecuado seguimiento de los pacientes para aumentar la adherencia al tratamiento antituberculoso. El rol de la enfermera y sus intervenciones son muy importantes (AU)

Introduction. Tuberculosis (TB) remains a major cause of morbidity and mortality in many countries. This involves a serious public health problem. Adherence to TB treatment is a cornerstone for the control of this disease. Development: Globally, there are major differences between countries as to the prevalence, incidence and mortality tuberculosis. Spain has a incidence rate higher than that of other countries in their socio-economic background. Treatment is prolonged, with significant side effects. Adherence to treatment is essential to be effective, prevent drug resistance and disease control. Children are more vulnerable to developing the disease than the rest of the population. Several direct and indirect methods measure the adherence to treatment, but none is ideal. Some socio-demographic risk factors that influence on adherence are described (immigration…). In addition, there are another more specific child factors to have been add. Conclusions: The literature reviewed highlights the importance of proper monitoring of patients to increase adherence to TB treatment. The role of the nurse and their interventions are very important (AU)

Barreiras no tratamento da infecção latente por tuberculose (ILTB) na criança: um estudo de caso / Barriers in the treatment of latent tuberculosis infection (LTBI) in children: a case study

Objetivo: Analisar as barreiras enfrentadas pelo familiar no tratamento da infecção latente por tuberculose (ILTB) na criança. Métodos: Estudo descritivo, em duas etapas. Na primeira, analisados prontuários de crianças de 0 a 11 anos tratadas para ILTB em um centro municipal de saúde no Município do Rio de Janeiro. Na segunda, entrevista com os familiares. Nas duas etapas buscou-se identificar barreiras pessoais, familiares, econômicas, sociais e do serviço. Resultados: Primeira etapa; houve barreiras (47/228): no serviço - 4 (8,5%); pessoais - 4 (8,5%); familiares - 21 (44,7%); fisiológicas - 12 (25,5%). Na segunda; houve barreiras (50/85): econômicas - 19 (38%); sociais - 13 (26%); pessoais e familiares - 18 (36%). Conclusão: Fatores socioeconômicos desfavoráveis afetaram o cuidado da criança nas duas etapas do estudo. Repensar na forma de lidar com os determinantes sociais associados à tuberculose pode ser o caminho para evitar abandono e interrupções deste tratamento.

Education-service partnership to promote best practices in a latent tuberculosis infection program.

The education-service partnership described addresses the challenges presented to local health departments and public health nurses in completing required latent tuberculosis (LTBI) follow-up in population groups. A service learning partnership between the local health department and a Midwestern university school of nursing resulted in the development of an LTBI follow-up program that completed contacts with 193 subjects. Populations served by the program included immigrants to the community and workers from several occupational settings. Outcome data from the project included recommendations for the management of the information database for local health department LTBI follow-up. Nursing students gained an appreciation for the complexities involved in TB surveillance, and improved their cultural competence in the interface with Latino, African, and East European immigrant populations. Students gained first-hand experience with the current health care system, which resulted in communication challenges between health care providers and economic barriers in compliance with the CDC protocol for LTBI follow-up. The program demonstrated a successful partnership between service and education with positive results for the LTBI clients and the local health department nurses.

The effect of a cultural intervention on adherence to latent tuberculosis infection therapy in Latino immigrants.

OBJECTIVE: The purpose of this study was to examine the effect of a cultural intervention (CI) on increasing adherence to latent tuberculosis infection (LTBI) therapy among Latino immigrants. DESIGN AND SAMPLE: This clinical study used a preexperimental design. A nonprobability sample of 86 Latino immigrant clients who were starting LTBI therapy were enrolled in the intervention. The comparison group was an historical sample of 131 clients' records randomly selected from the previous year. INTERVENTION: The CI, designed by the principal investigator, was delivered by 2 Spanish-speaking interventionist nurses at each of 9 clinic visits. The intervention was based on Latino cultural values and included 5 components. MEASURES: The patients' adherence was measured by a self-report of the number of pills taken. RESULTS: The findings of this study were that clients in the CI group took a significantly greater number of doses of INH than those in the historical sample. CONCLUSIONS: Using a CI to increase adherence to LTBI therapy shows promise for public health nursing practice.