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1.
Rev. méd. panacea ; 8(2): 58-63, mayo-ago. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1015872

RESUMO

Objetivo: Determinar la influencia de la sintomatología depresiva en la adherencia al tratamiento antituberculoso en pacientes del Hospital Santa Maria del Socorro de Ica, (HSMSI), 2018. Materiales y métodos: Estudio de tipo transversal, observacional y analítico. La variable independiente fue el nivel de sintomatología depresiva medida con el Test de depresión de Zung; la variable dependiente fue la adherencia al tratamiento recibido mediante el Test de Morisky- Green, se incluyeron todos los pacientes mayores de 18 años atendidos en la Estrategia Sanitaria de Prevención y Control de Tuberculosis del HSMS registrados en el Libro de seguimiento del año 2018. Resultados: La mediana de edad fue de 30 años, RIQ (21 a 44). El 58,6% de los pacientes fueron hombres; el, 58,6% lleva recibiendo más de tres meses tratamiento, el 10,3% presentaban otras comorbilidades como Diabetes Mellitus y VIH/SIDA; el 17,2% refieren como habito nocivo consumo de alcohol. El grado de sintomatología depresiva leve fue del 37,9%, seguido de un grado moderado y severo con el 34.5% y 10,3% respectivamente. El 65,5% de los pacientes presentaron mala adherencia al tratamiento. Se encontró que conforme aumenta los grados de sintomatología depresiva la probabilidad de no adherencia al tratamiento se incrementa, sin embargo, no existe asociación significativamente estadística tanto en el análisis crudo como en el ajustado por edad y sexo. Conclusiones: Los grados de manifestación de sintomatología depresiva se incrementan con una mala adherencia al tratamiento antituberculoso en los pacientes atendidos en el Hospital Santa María de Socorro de Ica- 2018. (AU)


Objective: To determine if depressive symptomatology influences the adherence to antituberculous treatment in HSMS-Ica patients, 2018. Materials and methods: It is a cross-sectional, observational, analytical and prospective study. The Zung depression test was used to measure the level of depression; while the Morisky-Green Test was used to measure adherence to antituberculous treatment, and the population of patients treated in the Health Strategy for Prevention and Control of Tuberculosis of the HSMS registered in the follow-up book was studied. year 2018, over 18 years. Results: Patients without depressive symptomatology 60% are adhered and 40% are not adherent to antituberculous treatment. Among patients with mild depressive symptoms, the highest percentage is 63.6% and 36.4% adheres to treatment. Patients with moderate depressive symptomatology 70% are not adherent to the treatment and 30% if they are adherent to the treatment. Finally, 100% of patients with severe depressive symptoms are not adherent to the treatment. As the degree of depressive symptomatology increases, the probability of non-adherence to treatment increases, however, there is no statistically significant association in both the crude analysis and that adjusted for age and sex. (p = 0.425). Conclusions: According to the results of the study, depressive symptomatology is associated with poor adherence to antituberculous treatment in patients of Santa Maria de Socorro Hospital in Ica- 2018. (AU)


Assuntos
Humanos , Masculino , Feminino , Tuberculose/terapia , Depressão , Cooperação e Adesão ao Tratamento , Estudos Transversais , Estudos Observacionais como Assunto
2.
Stud Health Technol Inform ; 262: 101-104, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349276

RESUMO

Tuberculosis (TB) represents a global challenge in terms of prevention, care and control. Decision support systems (DSS) can supply the necessary knowledge basis to underpin investigators, policy makers and health personnel actions and to provide crucial elements that can help reducing TB burden. Thus, the objectives of this work are to present the protocol to be followed for carrying out a scoping review to identify topics where DSSs are used, to define appropriate categories and to clarify main outcomes and research gaps. As part of the protocol, five electronic bibliographic databases will be searched for articles from 2006 to 2019 and two investigators will independently screen each work using the study inclusion criteria. Data extraction will be performed, and findings will be reported. The results will be used to provide a broad understanding of how DSSs for TB are being used.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Tuberculose , Assistência à Saúde , Pessoal de Saúde , Humanos , Projetos de Pesquisa , Pesquisadores , Literatura de Revisão como Assunto , Tuberculose/terapia
4.
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 555-559, abr.-maio 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-987456

RESUMO

Objetivo: Conhecer a adesão dos idosos às formas de administração do tratamento da tuberculose. Métodos: Estudo exploratório-descritivo, transversal e quantitativo, desenvolvido no Distrito Sanitário Oeste de Natal, com os idosos que fizeram tratamento entre janeiro de 2010 a dezembro de 2015. Resultados: Observou-se que os idosos utilizam tanto o regime autoadministrado (51,1%) quanto o diretamente observado (48,9%). Em ambos os grupos prevaleceu a faixa etária de 60 a 69 anos (29,8%; 35,1%), a forma pulmonar da doença (41,5%; 44,7%) e o caso novo como tipo de entrada para o tratamento (31,9%; 27,7%). Quanto ao encerramento, destacou-se a conclusão do tratamento (33,0%; 25,5%). Conclusão: A tuberculose ainda é prevalente no Brasil, destacando-se a importância do diagnóstico e tratamento adequados, além da adoção de medidas de controle e capacitação dos profissionais de saúde frente ao cuidado desses pacientes


The study's purpose has been to know the adherence of elderly people to the different forms of management of tuberculosis treatment. Methods: It is a descriptive-exploratory and cross-sectional study with a quantitative approach that was carried out in the Western Sanitary District at Natal city, and counted with elderly patients who underwent treatment from January 2010 to December 2015. Results: It was observed that the elderly people use both the self-administered regimen (51.1%) and directly observed (48.9%). In both groups the participants were within the age group from 60 to 69 years old (29.8%, 35.1%), the pulmonary form of the disease (41.5%, 44.7%) prevailed, and the new case as the type of entry for the treatment (31.9%, 27.7%). Regarding the treatment termination, the accomplishment of the treatment conclusion was highlighted among the studied cases (33.0%, 25.5%). Conclusion: Tuberculosis is still prevalent in Brazil, highlighting the importance of both adequate diagnosis and treatment, as well as the adoption of measures to control and train health professionals with regards to the care of these patients


Objetivo: Conocer la adhesión de los ancianos a las formas de administración del tratamiento de la tuberculosis. Métodos: Estudio exploratoriodescriptivo, transversal y cuantitativo, desarrollado en el Distrito Sanitario Oeste de Natal, con los ancianos que hicieron tratamiento entre enero de 2010 a diciembre de 2015. Resultados: Se observó que los ancianos utilizan tanto el régimen autoadministrado (51, 1%) como el directamente observado (48,9%). En ambos grupos prevaleció el grupo de edad de 60 a 69 años (29,8%, 35,1%), la forma pulmonar de la enfermedad (41,5%, 44,7%) y el caso nuevo como tipo de entrada para El tratamiento (31,9%, 27,7%). En cuanto al cierre, se destacó la conclusión del tratamiento (33,0%, 25,5%). Conclusión: La tuberculosis sigue siendo prevalente en Brasil, destacándose la importancia del diagnóstico y tratamiento adecuados, además de la adopción de medidas de control y capacitación de los profesionales de salud frente al cuidado de esos pacientes


Assuntos
Humanos , Masculino , Feminino , Idoso , Tuberculose/terapia , Tuberculose/epidemiologia , Adesão à Medicação/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos
5.
BMC Health Serv Res ; 19(1): 217, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953502

RESUMO

BACKGROUND: Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania. METHODS: In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU. RESULTS: Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08-7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16-0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98-2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62-8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01-2.17). CONCLUSION: Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women's health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tuberculose/terapia , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Conscientização , Diagnóstico Tardio/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Farmácias/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Distribuição por Sexo , Tanzânia/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/psicologia , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 233, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999913

RESUMO

BACKGROUND: Tuberculosis (TB) is still a major global health problem. The increasing number of cases observed among foreign-born populations contrasts with the decreasing trends observed in later years in some high-income countries. Healthcare providers are key interveners in the control of TB and HIV-TB infections. In this study, we aimed to explore the perspectives of healthcare providers working in primary care in Portugal about the provision of TB care for migrant patients with TB or HIV-TB co-infection. METHODS: We applied a mixed-methods approach using an online survey and semi-structured interviews with primary healthcare providers. A total of 120 Portuguese healthcare providers participated in the survey, and 17 were interviewed. Survey and interview data were analysed applying descriptive statistics and thematic analysis, respectively. RESULTS: Migrants' lack of knowledge on TB disease and its symptoms was the main reason for advanced-stage presentation of cases. Their high mobility and social isolation affect adherence to treatment. The providers also listed several barriers to migrants' access and use of TB care. The most frequently referred were limited socioeconomic resources, complex bureaucracy at the point of access and registration for healthcare services, especially for undocumented migrants, and obstacles for social protection. Providers also advocated more training initiatives on migrants' health, social and cultural contexts, on HIV and TB integrated care, and on TB scientific update for general practitioners and nurses working at primary healthcare centres. CONCLUSIONS: Future efforts should provide measures to overcome social, economic and administrative obstacles to care for TB-infected migrants, and promote regular training initiatives for national healthcare providers in order to raise awareness and facilitate better care to culturally diverse populations with TB.


Assuntos
Migrantes/estatística & dados numéricos , Tuberculose/terapia , Adulto , Coinfecção/epidemiologia , Coinfecção/terapia , Feminino , Infecções por HIV/terapia , Pessoal de Saúde , Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Tuberculose Latente/epidemiologia , Tuberculose Latente/terapia , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Inquéritos e Questionários , Tuberculose/epidemiologia
7.
West Afr J Med ; 36(1): 54-60, 2019 Jan-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924117

RESUMO

BACKGROUND AND OBJECTIVES: One third of the world population are at risk of developing active tuberculosis (TB), resulting in significant mortality and morbidity. The reported low patronage in many TB clinics may not be unrelated to the quality of services received by clients. The objective of this study was to determine clients' perception of and satisfaction with quality of DOTs treatments in private and public health facilities in Oyo State. MATERIALS AND METHODS: A descriptive cross sectional study among 410 eligible clients selected using the multistage sampling method was conducted in Oyo State. Research instrument used were a structured pre-tested interviewer-administered questionnaire. Data was analyzed using the SPSS software version 17.0. RESULTS: Mean age of respondents was 39.0 + 0.68 years, 211(51.5%) were male while 199 (48.5%) were females. 321(78.3%) worked in public health facilities. Majority of the respondents, 385 (94.0%), had good perception of quality of DOTs treatment received. These include good perception of communication (96.0%); of quality of care (90.4%), and good perception of staff attitude among 93.9% of respondents About 97% of the respondents had good satisfaction with the quality of DOTs treatment received. Good satisfaction was found among 98.3% in terms of adherence counseling received, 98.7% on TB treatment received and 98.7%, on waiting time spent, and these were far higher among private than public health facilities. Statistically significant association was found between the type of facility attended by respondents and having adherence counseling service and waiting period experienced (P-values < 0.05). Having received services in a private health facility is the major predictor of favourable perception and good satisfaction with quality of DOTS treatment among respondents studied. CONCLUSION: Though perception of and satisfaction with service delivery were good, this was better in private than in public; thus stressing the need for better monitoring and evaluation of services rendered by health care workers in order to encourage patronage by clients.


Assuntos
Terapia Diretamente Observada , Hospitais Privados , Hospitais Públicos , Satisfação Pessoal , Garantia da Qualidade dos Cuidados de Saúde , Tuberculose/terapia , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Nigéria , Avaliação de Resultados (Cuidados de Saúde) , Satisfação do Paciente/estatística & dados numéricos , Percepção , Inquéritos e Questionários
9.
Rev Mal Respir ; 36(3): 396-404, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30902444

RESUMO

Airborne isolation is the main confinement measure used to limit human-to-human transmission of tuberculosis. If implemented early, precisely as soon as the patient is clinically diagnosed with tuberculosis, this measure will protect the population, particularly the health workers who are exposed. A patient suspected of being infected with tuberculosis can create a difficult situation if microbiological examination of his respiratory secretions is negative. This is a complex laboratory technique and sensitivity varies from one test to another. Thus, a false negative result is possible; meaning that a patient can have positive results on a microbiological culture performed later. This patient would still have low, but not no, contagiousness as long as a treatment has not been initiated. This situation can extend the period of respiratory isolation while further diagnostic investigations are carried out. This extended isolation can reduce the quality of health care delivered and patients can show signs of depression and anxiety. The use in routine clinical investigation of gene amplification tools should allow a rethinking of respiratory isolation rules. These tools, which are very sensitive and with a short reporting time, could drastically reduce the duration of respiratory isolation for patients suspected of being infected with tuberculosis.


Assuntos
Controle de Infecções/métodos , Respiração , Escarro/microbiologia , Tuberculose/diagnóstico , Tuberculose/terapia , Microbiologia do Ar , Ambiente Controlado , Reações Falso-Negativas , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Isolamento de Pacientes/métodos , Saúde Pública/métodos
10.
Microb Pathog ; 130: 156-168, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30876870

RESUMO

Mycobacterium tuberculosis (Mtb) has coevolved with a human host to evade and exploit the immune system in multiple ways. Mtb is an enormously successful human pathogen that can remain undetected in hosts for decades without causing clinical disease. While tuberculosis (TB) represents a perfect prototype of host-pathogen interaction, it remains a major challenge to develop new therapies to combat mycobacterial infections. Additionally, recent studies emphasize on comorbidity of TB with different non-communicable diseases (NCDs), highlighting the impact of demographic and lifestyle changes on the global burden of TB. In the recent past, host-directed therapies have emerged as a novel and promising approach to treating TB. Drugs modulating host responses are likely to avoid the development of bacterial resistance which is a major public health concern for TB treatment. Interestingly, many of these drugs also form treatment strategies for non-communicable diseases. In general, technological advances along with novel host-directed therapies may open an exciting and promising research area, which can eventually deliver effective TB treatment as well as curtail the emergent synergy with NCDs.


Assuntos
Interações Hospedeiro-Patógeno , Imunomodulação , Doenças não Transmissíveis/terapia , Tuberculose/complicações , Tuberculose/terapia , Humanos
11.
Glob Health Sci Pract ; 7(1): 41-53, 2019 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-30926737

RESUMO

BACKGROUND: Private physicians in India see and treat more than half of all people with tuberculosis (TB) each year and thus have potential to make significant contributions to TB control. The EQUIP project was designed as a prospective cohort study to assess the potential of private providers to diagnose and appropriately treat drug-resistant TB (DR-TB) in the Central and South districts of Chennai, India. METHODS: The private-sector engagement model consisted of free access to rapid diagnostics; choice of free daily or thrice-weekly treatment regimens; support for notification of patients; and patient support including directly observed therapy through EQUIP centers staffed by a community-based interface agency. Data were collected on provider participation; referral results; treatment regimens prescribed; and treatment outcomes. RESULTS: From October 2015 through June 2017, 227 of the 466 (48.7%) private providers approached referred at least 1 patient to an EQUIP center for evaluation. A total of 2,621 patients received testing and 1,232 (47.0%) were diagnosed with TB. Of those, 727 (59.0%) were bacteriologically confirmed, including 694 (56.3%) using GeneXpert and 33 (2.7%) using smear microscopy. A total of 26 (3.7% of GeneXpert diagnosed) patients were confirmed as rifampicin-resistant cases. EQUIP-related notifications comprised approximately 10% of TB and DR-TB notifications in Chennai during the project period. The project initiated 1,167 (96.8%) drug-sensitive TB patients on treatment. Of those, 691 (59.2%) received standard daily regimens with EQUIP support and 288 (24.7%) received standard intermittent regimens. At the time of writing, 89.4% of 868 drug-susceptible TB patients receiving EQUIP support had treatment success. Of the 26 rifampicin-resistant TB cases notified, 20 (77%) started and continued on second-line treatment; 2 died and 4 were lost to follow-up prior to treatment initiation. CONCLUSION: Private providers can make a substantial contribution to detection and appropriate treatment of patients with TB and DR-TB in India when provided with access to rapid diagnostics, support for notification and patient treatment through interface agencies, and free, quality anti-TB drugs.


Assuntos
Resistência a Múltiplos Medicamentos , Médicos , Prática Privada , Avaliação de Programas e Projetos de Saúde , Saúde Pública/normas , Parcerias Público-Privadas , Tuberculose/terapia , Comunicação , Serviços de Diagnóstico , Revelação , Humanos , Índia , Setor Privado , Estudos Prospectivos , Melhoria de Qualidade , Encaminhamento e Consulta , Rifampina , Tuberculose/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/terapia
12.
Glob Health Sci Pract ; 7(1): 103-115, 2019 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-30926739

RESUMO

Among the many challenges facing health systems grappling with the explosive growth of chronic disease in Africa are continuity of care, particularly in poor, rural areas. We report the strategy, field experience, and results of an ongoing 6-year follow-up program operating in a rural district hospital in Kisoro, Uganda, that attempts to locate and reengage patients lost to follow-up (LTFU) from communities that are largely without phones, addresses, or paved roads. The program works with diverse hospital clinics, including chronic diseases, HIV, tuberculosis (TB), nutrition, and women's health, to identify patients who have not returned to care, employing a modest staff who spend about 20 days monthly making outreach visits by motorcycle in search of approximately 130 patients. We describe the organization of this unique "horizontal" program and report on follow-up outcomes between November 2015 to October 2016. Between 30% and 60% of patients were found to have lapses in care. The follow-up program was able to locate 64% of patients, with a reengagement rate of 54% to 92% (average, 69%) depending on the clinic. The program costs approximately US$5 per patient LTFU but about US$40 per patient maintained in care. The hospital-based follow-up program that cuts across diverse clinics and wards was novel and feasible in this rural sub-Saharan African setting.


Assuntos
Continuidade da Assistência ao Paciente , Hospitais de Distrito , Perda de Seguimento , Aceitação pelo Paciente de Cuidados de Saúde , Pobreza , Avaliação de Programas e Projetos de Saúde , População Rural , Adulto , Instituições de Assistência Ambulatorial , Doença Crônica/terapia , Análise Custo-Benefício , Custos e Análise de Custo , Infecções por HIV/terapia , Visita Domiciliar , Humanos , Desnutrição/terapia , Motocicletas , Tuberculose/terapia , Uganda , Saúde da Mulher
13.
Global Health ; 15(1): 19, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836960

RESUMO

BACKGROUND: Tuberculosis (TB) was declared a global emergency in 1993 by the World Health Organization (WHO). Despite available interventions initiated by the WHO and some countries, the disease remains a key public health problem. The rates of TB infection and its associated burden is unevenly distributed across the globe with greater severity in low-to-middle income countries. This paper therefore explored the experiences of TB patients and health care providers pertaining to patients' care and support during treatment, in the Accra Metropolis of Ghana. METHODS: A qualitative approach using phenomenology was employed to explore participants' experiences. Maximum variation sampling, a type of purposive sampling was employed in selecting participants who exhibit a wide range of behaviours and experiences. Thirty (30) In-depth Interviews and three (3) Key Informant Interviews were conducted in selected facilities within a period of three months in 2018. The data was audio-recorded, transcribed, and transported into Nvivo version 11, for data management and coding. Content analysis of data was carried out for the generation of themes. RESULTS: The findings revealed that good knowledge of TB treatment practices did not spontaneously shape perceptions towards treatment. Factors including prevailing cultural beliefs, physical and psychological stress, consequences of patient's interrupted labour and health system challenges were hindrances in caring for TB patients. Physical, mental and spiritual mechanisms were adopted to cope with challenges. CONCLUSION: Personal patient-related challenges and health system bottlenecks were major influencing factors in providing care and support to TB clients. The National Tuberculosis control Program (NTP) of Ghana should adopt measures and provide the required financial, infrastructural and human resources for the augmentation of patients' treatment.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Pessoal de Saúde/psicologia , Apoio Social , Tuberculose/terapia , Adulto , Idoso , Estudos Transversais , Feminino , Gana , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Tuberculose/psicologia , Adulto Jovem
14.
Infect Dis Poverty ; 8(1): 10, 2019 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-30709415

RESUMO

BACKGROUND: The World Health Organization's End Tuberculosis Strategy states that no tuberculosis (TB)-affected households should endure catastrophic costs due to TB. To achieve this target, it is essential to provide adequate social protection. As only a few studies in many countries have evaluated social-protection programs to determine whether the target is being reached, we assessed the effect of financial support on reducing the incidence of catastrophic costs due to TB in Indonesia. METHODS: From July to September 2016, we interviewed adult patients receiving treatment for TB in 19 primary health centres in urban, sub-urban and rural area of Indonesia, and those receiving multidrug-resistant (MDR) TB treatment in an Indonesian national referral hospital. Based on the needs assessment, we developed eight scenarios for financial support. We assessed the effect of each simulated scenario by measuring reductions in the incidence of catastrophic costs. RESULTS: We analysed data of 282 TB and 64 MDR-TB patients. The incidences of catastrophic costs in affected households were 36 and 83%, respectively. Patients' primary needs for social protection were financial support to cover costs related to income loss, transportation, and food supplements. The optimum scenario, in which financial support would be provided for these three items, would reduce the respective incidences of catastrophic costs in TB and MDR-TB-affected households to 11 and 23%. The patients experiencing catastrophic costs in this scenario would, however, have to pay high remaining costs (median of USD 910; [interquartile range (IQR) 662] in the TB group, and USD 2613; [IQR 3442] in the MDR-TB group). CONCLUSIONS: Indonesia's current level of social protection is not sufficient to mitigate the socioeconomic impact of TB. Financial support for income loss, transportation costs, and food-supplement costs will substantially reduce the incidence of catastrophic costs, but financial support alone will not be sufficient to achieve the target of 0% TB-affected households facing catastrophic costs. This would require innovative social-protection policies and higher levels of domestic and external funding.


Assuntos
Apoio Financeiro , Custos de Cuidados de Saúde/estatística & dados numéricos , Tuberculose/economia , Adolescente , Adulto , Idoso , Características da Família , Humanos , Indonésia , Pessoa de Meia-Idade , Modelos Econômicos , Tuberculose/terapia , Tuberculose Resistente a Múltiplos Medicamentos/economia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Adulto Jovem
15.
Thorac Surg Clin ; 29(1): 1-17, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454916

RESUMO

Tuberculosis (TB) parallels the history of human development from the Stone Age to the present. TB continues to be in the top 10 causes of global human mortality over that period. This article highlights the history of pulmonary TB from the onset of human existence to the present. Despite its long history, TB was slowly identified as a major cause of disease, and defined causation and significant treatment strategies advances over the past 150 years. TB remains a major challenge for definitive global prevention and cure. This article gives a brief overview of the history of TB.


Assuntos
Mycobacterium tuberculosis/patogenicidade , Procedimentos Cirúrgicos Torácicos/história , Tuberculose Pulmonar/história , Animais , Antituberculosos/história , Antituberculosos/uso terapêutico , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , História Medieval , Humanos , Procedimentos Cirúrgicos Torácicos/métodos , Tuberculose/etiologia , Tuberculose/história , Tuberculose/microbiologia , Tuberculose/terapia , Tuberculose Resistente a Múltiplos Medicamentos/história , Tuberculose Pulmonar/etiologia , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/terapia
16.
Thorac Surg Clin ; 29(1): 109-121, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454917

RESUMO

Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from TB in children.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/epidemiologia , Antituberculosos/uso terapêutico , Criança , Efeitos Psicossociais da Doença , Progressão da Doença , Humanos , Internacionalidade , Tuberculose/diagnóstico , Tuberculose/microbiologia , Tuberculose/terapia
17.
Thorac Surg Clin ; 29(1): 19-25, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454918

RESUMO

An estimated 1.7 billion (23%) of the world's population is infected with Mycobacterium tuberculosis leading to more than 10 million new tuberculosis (TB) cases each year. TB is one of the top 10 causes of death globally and is the leading cause of death from a single infectious disease agent. The World Health Organization's ambitious End TB Strategy aims to achieve a 95% reduction in TB deaths and 90% reduction in TB incidence rates by 2035.


Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose/terapia , Humanos , Internacionalidade , Tuberculose/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
18.
Rev. enferm. UERJ ; 26: e31643, jan.-dez. 2018. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-967837

RESUMO

Objetivo: avaliar o desempenho dos serviços de saúde na atenção à tuberculose, na percepção das equipes da estratégia saúde da família. Método: estudo transversal de abordagem quantitativa, realizado com 210 profissionais das equipes da estratégia de saúde da família de uma área de planejamento do Rio de Janeiro. Foi aplicado o questionário PCATool ­ tuberculose, no período de agosto a novembro de 2015. Os dados foram tratados e analisados, no programa epi info versão 7.1.5. Projeto aprovado no comitê de ética em pesquisa da Escola de Enfermagem Anna Nery e da Secretaria Municipal de Saúde. Resultados: observou-se que para o diagnóstico de tuberculose o desempenho das unidades foi razoável e para o tratamento o resultado foi satisfatório. Conclusão: o desempenho dos serviços de saúde apresenta fragilidades e atende parcialmente a clientela.


Objective: to evaluate health service performance in tuberculosis care as perceived by family health strategy teams. Methods: in this quantitative, cross-sectional study, the PCATool-tuberculosis was applied between August and November 2015, to 210 professionals from family health strategy teams in a planning area in Rio de Janeiro. Data were processed and analyzed using Epi Info software, version 7.1.5. The project was approved by the research ethics committees of the Anna Nery School of Nursing and Municipal Health Secretariat. Results: the units' performance was observed to be reasonable in tuberculosis diagnosis, and satisfactory in treatment. Conclusion: health service performance displays weaknesses and meets client needs partially.


Objetivo: evaluar el rendimiento de los servicios de salud en la atención a la tuberculosis, bajo la percepción de los equipos de la estrategia de salud de la familia. Método: estudio transversal de abordaje cuantitativo, realizado junto a 210 profesionales de los equipos de la estrategia de salud de la familia de un área de planificación de Río de Janeiro. Fue aplicado el cuestionario PCATool ­tuberculosis, en el periodo de agosto a noviembre de 2015. Los dados fueron tratados y analizados en el programa epi info versión 7.1.5. Proyecto aprobado en el comité de ética en investigación de la Escuela de Enfermaría Anna Nery y de la Secretaría Municipal de Salud. Resultados: se verificó que, para el diagnóstico de tuberculosis, el rendimiento de las unidades fue adecuado y, para el tratamiento de los resultados, fue satisfactorio. Conclusión: el rendimiento de los servicios de salud presenta fragilidades y atiende parcialmente la clientela.


Assuntos
Humanos , Masculino , Feminino , Tuberculose/terapia , Administração de Serviços de Saúde , Estratégia Saúde da Família , Enfermagem de Atenção Primária , Brasil , Estudos Transversais
19.
BMC Infect Dis ; 18(1): 690, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30572830

RESUMO

BACKGROUND: Prompt diagnosis of active tuberculosis (TB) has paramount importance to reduce TB morbidity and mortality and to prevent the spread of Mycobacterium tuberculosis. Few studies so far have assessed the diagnostic delay of TB and its risk factors in low-incidence countries. METHODS: We present a cross-sectional multicentre observational study enrolling all consecutive patients diagnosed with TB in seven referral centres in Italy. Information on demographic and clinical characteristics, health-seeking trajectories and patients' knowledge and awareness of TB were collected. Diagnostic delay was assessed as patient-related (time between symptoms onset and presentation to care) and healthcare-related (time between presentation to care and TB diagnosis). Factors associated with patient-related and healthcare-related delays in the highest tertile were explored using uni- and multivariate logistic regression analyses. RESULTS: We enrolled 137 patients, between June 2011 and May 2012. The median diagnostic delay was 66 days (Interquartile Range [IQR] 31-146). Patient-related and healthcare-related delay were 14.5 days (IQR 0-54) and 31 days (IQR: 7.25-85), respectively. Using multivariable analysis, patients living in Italy for < 5 years were more likely to have longer patient-related delay (> 3 weeks) than those living in Italy for > 5 years (Odds Ratio [OR] 3.47; 95% Confidence Interval [CI] 1.09-11.01). The most common self-reported reasons to delay presentation to care were the mild nature of symptoms (82%) and a good self-perceived health (76%). About a quarter (26%) of patients had wrong beliefs and little knowledge of TB, although this was not associated with longer diagnostic delay. Regarding healthcare-related delay, multivariate analysis showed that extra-pulmonary TB (OR 4.3; 95% CI 1.4-13.8) and first contact with general practitioner (OR 5.1; 95% CI 1.8-14.5) were both independently associated with higher risk of healthcare-related delay > 10 weeks. CONCLUSIONS: In this study, TB was diagnosed with a remarkable delay, mainly attributable to the healthcare services. Delay was higher in patients with extra-pulmonary disease and in those first assessed by general practitioners. We suggest the need to improve knowledge and raise awareness about TB not only in the general population but also among medical providers. Furthermore, specific programs to improve access to care should be designed for recent immigrants, at significantly high risk of patient-related delay. TRIAL REGISTRATION: The study protocol was registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT01390987 . Study start date: June 2011.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose , Adulto , Conscientização , Estudos Transversais , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Fatores de Risco , Tempo para o Tratamento/normas , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/terapia
20.
Cad Saude Publica ; 34(12): e00173917, 2018 12 20.
Artigo em Português | MEDLINE | ID: mdl-30570040

RESUMO

This study aimed to validate a method for classification of healthcare services in Brazil (basic care vs. other levels) and describe the decentralization of tuberculosis (TB) care to basic services (2002 to 2016). The healthcare services that reported and followed TB cases were classified as either "basic care" or "other levels" based on the type of establishment registered in the Brazilian National Registry of Healthcare Establishments (CNES, in Portuguese). The study estimated the agreement between this classification with a previous classification performed in 2013 by Brazil's state and local tuberculosis programs. Using the CNES registry, the authors then calculated the percentage of TB patients treated in basic care from 2002 to 2016. Agreement was 94.4%, and overall kappa index was 0.86. There was a relative increment of 31.2% in TB care provided by basic services (from 50.9% in 2002 to 66.8% in 2016). All regions of Brazil showed an increase in this percentage, except the South. The classification based on the CNES registry allowed analyzing the trend in decentralization of TB treatment to basic healthcare services in Brazil.


Assuntos
Assistência Integral à Saúde , Sistemas de Informação em Saúde/instrumentação , Política , Atenção Primária à Saúde/organização & administração , Tuberculose/terapia , Brasil/epidemiologia , Assistência Integral à Saúde/organização & administração , Administração de Serviços de Saúde , Humanos , Programas Nacionais de Saúde , Características de Residência , Tuberculose/diagnóstico , Tuberculose/epidemiologia
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