RESUMO
Introducción: La tuberculosis es una enfermedad infectocontagiosa de fácil tras-misión. Para su control, los conocimientos, actitudes y prácticas adecuadas son indis-pensables, así como los factores relevantes para la adherencia al tratamiento. Objetivo: Caracterizar las definiciones o los conceptos de las dimensiones de cono-cimientos, actitudes y prácticas en tuberculosis reportados en la literatura durante los últimos diez años. Materiales y métodos: Se realizó una revisión sistemática de la literatura bajo la metodología "Preferred Reporting Items for Systematic Reviews and Meta-Analy-ses". Inicialmente, se encontraron 1.720 posibles publicaciones, de las cuales, luego de la aplicación de los criterios de exclusión, quedaron 34 para ser incluidas en el análisis de esta revisión. Resultados: La mayoría de los estudios fueron publicados en el año 2018 y pre-dominaron las publicaciones en el continente africano. La caracterización de las di-mensiones se relaciona así: los conocimientos se definen como características de la enfermedad, las actitudes se relacionan con el estigma social hacia el paciente y las prácticas corresponden con la búsqueda de atención médica por parte del paciente. Conclusión: Se identificó la escasez de producción científica en donde se especifi-quen los conceptos de las dimensiones de conocimientos, actitudes y prácticas, que a su vez permitan el desarrollo de investigaciones de alto rigor y alcance metodológico, ya que las publicaciones realizadas e incluidas para este estudio tuvieron una evalua-ción de baja calidad.
Introduction: Tuberculosis is an infectious disease of easy transmission. For tuber-culosis's control, appropriate knowledge, attitudes, and practices are essential, as well as relevant factors for treatment adherence. Objective: To characterize the concepts of three dimensions knowledge, atti-tudes, and practices in tuberculosis reported in the literature during the last ten years. Materials and methods: A systematic review of the literature was carried out under the methodology "Preferred Reporting Items for Systematic Reviews and Me-ta-Analyzes". Initially, 1.720 possible publications were found, of which, after apply-ing the exclusion criteria, 34 remained to be included in this review. Results: Most studies were published in 2018, and publications on the African con-tinent predominated. The characterization of the dimensions is related as follows: knowledge was defined as the characteristics of the disease, attitudes were related with the social stigma towards the patient with TB, and practices were associated with seeking medical care by the patients with TB. Conclusion: There is a lack of publications on the definition of knowledge, atti-tudes and practices on tuberculosis, which hampers developing high impact research.
Assuntos
Tuberculose , Tuberculose/reabilitação , Revisão Sistemática , Pacientes , Tuberculose/psicologia , Atitude , Conhecimento , Cooperação e Adesão ao TratamentoRESUMO
Tuberculosis is a worldwide public health problem, which, even with available treatment, continues to cause deaths worldwide. One of the obstacles to control the disease is the multifactorial difficulty of patients to adhere to treatment, in addition to the difficulty of health workers in circumventing barriers to implement strategies such as the directly observed treatment (DOT). The aim of this study is to analyze the performance and challenges faced by health workers in the use of DOT in tuberculosis. This is a descriptive, quali-quantitative study using data from interviews with primary-care professionals working in nine municipalities of Parana State, Brazil. The professionals answered a questionnaire containing four closed questions about DOT and an open question related to their professional opinion about the strategy. Quantitative data were entered into a spreadsheet and statistically propagated. Qualitative data were treated from the transcription of statements, subsequently submitted to content analysis. Of the 387 professionals interviewed, at least 58.9% had some knowledge about DOT. Among the main challenges faced by the professionals are: lack of user commitment to treatment (48.3%), users' difficulty in attending the basic health clinics (BHC) (31.4%), professionals' difficulty to reach the place where patients are treated (8.8 %), insufficient staff / lack of human resources (4.1%) and use of illicit drugs by patients (3.9%). Blaming the user and the lack of resources are the main highlights, in addition to issues such as the professionals' lack of access and knowledge that are highlighted by the difficulty of patients to adhere to the treatment of tuberculosis according to the participants' statements. The issues were raised by health workers manifestations involving adherence to treatment according to the DOT in the studied health region. It is possible, in this context, to observe the need for improvement in the knowledge of professionals with regard to the DOT, the importance of their bond with patients and families and the recognition of the part of responsibility that belongs to the health team on guaranteeing treatment.
Assuntos
Antituberculosos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Brasil , Terapia Diretamente Observada , Humanos , Entrevistas como Assunto , Adesão à Medicação , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Tuberculose/psicologia , Adulto JovemRESUMO
BACKGROUND: The Guarani-Kaiowá are Brazil's second-largest indigenous group. Average annual tuberculosis (TB) incidence rates among the Guarani-Kaiowá are nearly 400/100,000 in Mato Grosso do Sul state, ten times the national average. Although stigma is considered crucial for TB control in indigenous communities, few studies have investigated TB stigma among indigenous populations. This study sought to understand the role of TB-related stigma and perceptions of TB in maintaining hyperendemic TB transmission in the Guarani-Kaiowá communities. METHODS: Various forms of stigma were explored through semi-structured interviews with 19 patients, 11 relatives, and 23 community members. Patients were identified from the registry of the healthcare service. Community members, selected by snowball sampling, were matched by gender and village of residence. Interviews were conducted in Guarani and Portuguese and later translated into English. Framework analysis was performed using NVivo. RESULTS: Traditional beliefs of a weakening of the body allowing the disease to enter were common, but the exact mechanism of transmission was unknown. Strong community/public stigma associated TB with uncleanliness, abuse, and irresponsibility. Anticipated stigma led to significant treatment delays for fear of exclusion and losing employment. While most patients felt supported by their families, nearly all patients related experienced/enacted stigma in the community such as gossip, avoidance, and social exclusion, leading to long-lasting internalized/self-stigma. Secondary stigmatization of relatives was widespread, and blanket latent TB infection (LTBI) treatment of patients' households was a contributing factor in treatment delay. The healthcare service unnecessarily added to stigmatization by enforcing separate utensils and sleeping arrangements for patients. CONCLUSIONS: Our findings suggest that stigma is a driver for treatment delay and continued transmission of TB in the community. The stigmatization of TB was rooted in a poor understanding of TB transmission, partly because of incorrect orientation by the healthcare service. Interventions to reduce TB-associated stigma are urgently needed.
Assuntos
Povos Indígenas/psicologia , Estigma Social , Tuberculose/psicologia , Adulto , Brasil , Feminino , Humanos , Masculino , Isolamento de Pacientes/psicologia , Isolamento Social , Tuberculose/prevenção & controle , Tuberculose/terapiaRESUMO
INTRODUCCIÓN: La resistencia antibiótica y una inadecuada adherencia terapéutica son fenómenos que favorecen la proliferación de la tuberculosis. Los cambios sociodemográficos nos desafían a conocer la realidad actual de la enfermedad a través de antecedentes que nos permitan contextualizar un nuevo escenario. OBJETIVO: Caracterizar el perfil biopsicosocial del paciente con tuberculosis y su relación con la adherencia terapéutica. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, correlacional. Muestra de 90 pacientes tratados en 35 Centros de Salud Familiar de los Servicios de Salud de Iquique, Metropolitano Norte, Concepción y Reloncaví. RESULTADOS: los componentes biopsicosociales como edad, antecedentes de enfermedad mental, autoestima, situación sentimental, pertenencia a grupos de riesgo, alcoholismo, drogadicción y situación de calle presentaron una relación estadísticamente significación con la adherencia terapéutica. CONCLUSIONES: La caracterización biopsicosocial del paciente con tuberculosis visibiliza nuevos factores relacionados con la adherencia que deben ser considerados para una atención interdisciplinaria.
BACKGROUND: Antibiotic resistance and inadequate therapeutic adherence are phenomena that promote the proliferation of tuberculosis. Sociodemographic changes challenge us to know the real situation of the disease and allows us to contextualize a new scenario. OBJECTIVE: To characterize the biopsychosocial profile of the patient with tuberculosis and its relationship to therapeutic adherence. MATERIAL AND METHOD: Descriptive, cross-sectional, correlational study. Sample of 90 patients treated at 35 Family Health Centers from the following Chilean Public Health Services: Iquique, Metropolitan northern (Santiago), Concepción and Reloncaví. RESULTS: Biopsychosocial components such as age, history of mental illness, self-esteem, sentimental status, belonging to risk groups, alcoholism, drug addiction and homeless situation presented a statistically significant relationship with therapeutic adherence. CONCLUSIONS: The biopsychosocial characterization of the TB patient evidence a new adherence-related factors that should be considered for interdisciplinary care.
Assuntos
Humanos , Masculino , Feminino , Adulto , Tuberculose/psicologia , Tuberculose/tratamento farmacológico , Adesão à Medicação/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Autoimagem , Fatores Socioeconômicos , Grupos de Risco , Pessoas Mal Alojadas , Chile , Saúde da Família , Estudos Transversais , Inquéritos e Questionários , Transtornos Relacionados ao Uso de Substâncias/psicologia , Farmacorresistência Bacteriana , Alcoolismo/psicologia , Adesão à Medicação/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Correlação de Dados , Antituberculosos/uso terapêuticoRESUMO
OBJECTIVES: to understand the health promotion skills found in the speeches of health practitioners in care for TB patients. METHODS: qualitative study, developed with seven practitioners involved in care for TB patients, identified from a sociocentric approach, whose speeches were submitted to analysis based on the health promotion skills model in the Galway Consensus. RESULTS: there were four domains: Catalyzing change; Leadership; Planning; and Partnerships. These domains resulted from health education actions, contribution of management nursing practitioners, seeking to meet patients' needs and articulation of professional sectors. FINAL CONSIDERATIONS: there were some skill domains in the speeches of health practitioners, with the nurse being quoted in the development of essential skills for health promotion activities, such as catalyzing change and leading care for TB patients.
Assuntos
Empatia , Promoção da Saúde/métodos , Profissionalismo , Tuberculose/enfermagem , Brasil , Competência Clínica/normas , Humanos , Liderança , Atenção Primária à Saúde/métodos , Pesquisa Qualitativa , Tuberculose/psicologiaRESUMO
Abstract INTRODUCTION: Adverse drug reactions can develop when using anti-tuberculosis medication, and the effects of the drugs can also significantly hinder the treatment of patients. METHODS: A cross-sectional survey was conducted in 73 patients using two standardized questionnaires and the World Health Organization Quality of Life-Bref. RESULTS: All patients reported the presence of adverse drug reactions, 71.6% of which are minor and 28.3% both major and minor. The global quality of life analysis showed that patients with tuberculosis have a good average (67.3%). CONCLUSIONS: There is an association between quality of life and adverse drug reaction, educational level, and vulnerability.
Assuntos
Humanos , Masculino , Feminino , Idoso , Qualidade de Vida/psicologia , Tuberculose/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Antituberculosos/efeitos adversos , Fatores Socioeconômicos , Tuberculose/psicologia , Estudos Transversais , Inquéritos e Questionários , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Centros de Atenção Terciária , Pessoa de Meia-Idade , Antituberculosos/administração & dosagemRESUMO
INTRODUCTION: Adverse drug reactions can develop when using anti-tuberculosis medication, and the effects of the drugs can also significantly hinder the treatment of patients. METHODS: A cross-sectional survey was conducted in 73 patients using two standardized questionnaires and the World Health Organization Quality of Life-Bref. RESULTS: All patients reported the presence of adverse drug reactions, 71.6% of which are minor and 28.3% both major and minor. The global quality of life analysis showed that patients with tuberculosis have a good average (67.3%). CONCLUSIONS: There is an association between quality of life and adverse drug reaction, educational level, and vulnerability.
Assuntos
Antituberculosos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Qualidade de Vida/psicologia , Tuberculose/tratamento farmacológico , Idoso , Antituberculosos/administração & dosagem , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Centros de Atenção Terciária , Tuberculose/psicologiaRESUMO
ABSTRACT Objective: To analyze the influence of social incentives for adherence to tuberculosis (TB) treatment. Method: Qualitative study, in which 26 primary health care professionals of São Paulo were interviewed in 2015.Their testimonies were submitted to the speech analysis technique. The theoretical reference was the social determination of the health-disease process. Ethical procedures were observed. Results: TB is related to precarious living conditions. Incentives such as the basic food basket and transportation stipends are relevant for patients' adherence to treatment, as well as to the create bonds between the patient and the health team. Final considerations: The incentives strengthened adherence to TB treatment. However, interventions in the context of public measures must transcend the remedial dimension and be guided towards the transformation of the TB situation, which means supporting processes that modify living conditions.
RESUMEN Objetivo: Analizar la influencia de los incentivos sociales en la adhesión al tratamiento de la tuberculosis (TB). Método: Estudio cualitativo, en el que 26 profesionales de la Atención Primaria a la Salud del municipio de São Paulo fueron entrevistados en 2015, y sus testimonios fueron sometidos a la técnica de análisis de discurso. El referencial teórico fue la determinación social del proceso salud-enfermedad. Se han resguardado los procedimientos éticos. Resultados: La TB se relaciona con las condiciones precarias de la vida, siendo que los incentivos como la canasta básica y la ayuda para el transporte son relevantes para la adhesión del paciente al tratamiento, así como para el vínculo entre el paciente y el equipo de salud. Consideraciones finales: Los incentivos fortalecen la adhesión al tratamiento de la TB. Sin embargo, las intervenciones en el marco de medidas públicas deben trascender la dimensión paliativa y orientarse para transformar la situación de la TB, lo que significa apoyar procesos que modifiquen las condiciones de vida.
RESUMO Objetivo: Analisar a influência de incentivos sociais na adesão ao tratamento da tuberculose (TB). Método: Estudo qualitativo, em que 26 profissionais da Atenção Primária à Saúde do município de São Paulo foram entrevistados em 2015, e seus depoimentos foram submetidos à técnica de análise de discurso. O referencial teórico foi a determinação social do processo saúde-doença. Os procedimentos éticos foram resguardados. Resultados: A TB está relacionada às condições precárias de vida, sendo que incentivos como a cesta básica e o vale-transporte são relevantes para a adesão do paciente ao tratamento, assim como para o vínculo entre o paciente e a equipe de saúde. Considerações finais: Os incentivos fortalecem a adesão ao tratamento da TB. Contudo, intervenções no âmbito de medidas públicas devem transcender a dimensão paliativa e orientarem-se para transformar a situação da TB, o que significa apoiar processos que modifiquem as condições de vida.
Assuntos
Humanos , Masculino , Feminino , Adulto , Reforço Social , Apoio Social , Tuberculose/terapia , Cooperação e Adesão ao Tratamento/psicologia , Tuberculose/psicologia , Brasil , Entrevistas como Assunto/métodos , Terapia Diretamente Observada/métodos , Terapia Diretamente Observada/normas , Pesquisa Qualitativa , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Pessoa de Meia-Idade , MotivaçãoRESUMO
ABSTRACT Objective: to ascertain the epidemiological profile of TB/HIV co-infection in Brazilian scenarios. Method: this is a systematic review conducted via electronic search in databases PubMed, EMBASE, LILACS and SciELO, having as inclusion criterion articles based on the Brazilian scenario of TB/HIV co-infection. Results: of the total 174 studies, 15 were selected, revealing the epidemiological profile of the co-infection in different scenarios: male, economically active age, low education level, brown/black ethnicity, low income, heterosexual, pulmonary clinical form, alcoholism and Directly Observed Therapy. Conclusion: the sociodemographic and epidemiological profile of people with TB/HIV co-infection has an expected occurrence pattern, which corroborates articles found in the literature, either at national level or by grouping the studies according to region or state.
RESUMEN Objetivo: conocer la manera en que se presenta el perfil epidemiológico de la coinfección tuberculosis/VIH en escenarios brasileños. Método: se trata de una revisión sistemática realizada por medio de búsqueda electrónica en las bases de datos PubMed, EMBASE, LILACS y SciELO, y tiene como criterio de inclusión artículos de base nacional sobre la coinfección tuberculosis/VIH. Resultados: de un total de 174 estudios, se seleccionaron 15 que revelan el perfil epidemiológico de la coinfección en diferentes escenarios brasileños: sexo masculino, edad económicamente activa, baja escolaridad, color de piel pardo/negro, baja renta, heterosexual, forma clínica pulmonar, alcoholismo y realización de Tratamiento Directamente Observado. Conclusión: el perfil sociodemográfico y epidemiológico de personas que presentan la coinfección TB/VIH tiene un estándar de incidencia esperado, corroborado por hallazgos en la literatura, ya sea en el ámbito nacional o por agrupamiento de los estudios por región o estado.
RESUMO Objetivo: conhecer como se apresenta o perfil epidemiológico da coinfecção tuberculose/HIV em cenários brasileiros. Método: trata-se de uma revisão sistemática realizada por meio de busca eletrônica nos bancos de dados PubMed, EMBASE, LILACS e SciELO, tendo como critério de inclusão artigos de base nacional sobre a coinfecção tuberculose/HIV. Resultados: do total de 174 estudos, 15 foram selecionados, revelando o perfil epidemiológico da coinfecção em diferentes cenários brasileiros: sexo masculino, idade economicamente ativa, baixa escolaridade, cor parda/negra, baixa renda, heterossexual, forma clínica pulmonar, alcoolismo e realização de Tratamento Diretamente Observado. Conclusão: o perfil sociodemográfico e epidemiológico de pessoas que apresentam a coinfecção TB/HIV possui um padrão de ocorrência esperado, que corrobora com achados da literatura, seja em nível nacional ou por agrupamento dos estudos por região ou estado.
Assuntos
Humanos , Masculino , Feminino , Adulto , Tuberculose/psicologia , Infecções por HIV/psicologia , Nível de Saúde , Tuberculose/epidemiologia , Brasil/epidemiologia , Infecções por HIV/epidemiologia , Terapia Diretamente ObservadaRESUMO
ABSTRACT Objective: To identify people's way of acting after the diagnosis of tuberculosis, through their social representations about the disease. Method: Qualitative and descriptive study based on the Theory of Social Representations, in which 23 patients of a school health center in Belém, PA, Brazil, participated. The software ALCESTE was used to generate a class concerning the impact of the diagnosis in people's lives. Results: The dimension of a new reality caused by the diagnosis of tuberculosis is linked with the image of dirt, (process of objectification) communicable/mortal disease that exclude, causing sorrow, despair and revolt (dimension of the affections), reverberating in the patients' actions (dimension of action). Final considerations: global knowledge about tuberculosis, linking the knowledge of everyday life with the reified universe, pointing the multidimensionality of the phenomenon. The conclusion is that investing in the deconstruction of archaic beliefs about the tuberculosis that kills, replacing it with the curable tuberculosis, is necessary.
RESUMEN Objetivo: Identificar el modo de actuar de las personas ante el diagnóstico de la tuberculosis, a partir de sus representaciones sociales sobre la enfermedad. Método: Investigación cualitativa y descriptiva basada en la Teoría de las Representaciones Sociales, en que participaron 23 pacientes de un Centro de Salud Escuela en Belém (Pará, Brasil). Se utilizó el programa informático ALCESTE, que generó una clase referente al impacto del diagnóstico en la vida de las personas. Resultados: La dimensión de lo nuevo, derivada del diagnóstico de la tuberculosis, se articula a la imagen de suciedad, de enfermedad transmisible/mortal y que excluye (proceso de objetivación), causando tristeza, desespero e indignación (dimensión de los afectos), lo que repercute en las acciones (dimensión de la acción) de los pacientes. Consideraciones finales: Los pacientes tienen un conocimiento global sobre la tuberculosis, que articula saberes del cotidiano a los del universo reificado, señalando la multidimensionalidad del fenómeno. Se concluye acerca de la necesidad de invertir en la desconstrucción de creencias arcaicas de la tuberculosis que mata a la tuberculosis que tiene cura.
RESUMO Objetivo: Identificar o modo de agir das pessoas ante o diagnóstico da tuberculose, a partir de suas representações sociais sobre a doença. Método: Pesquisa qualitativa e descritiva embasada na Teoria das Representações Sociais, em que participaram 23 pacientes de um Centro de Saúde Escola em Belém (PA). Utilizou-se o software ALCESTE, gerando uma classe referente ao impacto do diagnóstico na vida das pessoas. Resultados: A dimensão do novo, decorrente do diagnóstico da tuberculose, se articula à imagem de sujeira, de doença transmissível/mortal e que exclui (processo de objetivação), causando tristeza, desespero e revolta (dimensão dos afetos), repercutindo nas ações (dimensão da ação) dos pacientes. Considerações finais: Os pacientes têm um conhecimento global sobre a tuberculose, articulando saberes do cotidiano aos do universo reificado, apontando a multidimensionalidade do fenômeno. Conclui-se sobre a necessidade de se investir na desconstrução de crenças arcaicas sobre a tuberculose que mata para a tuberculose que tem cura.
Assuntos
Humanos , Masculino , Feminino , Adulto , Identificação Social , Tuberculose/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Tuberculose/psicologia , Brasil , Distribuição de Qui-Quadrado , Pesquisa QualitativaRESUMO
ABSTRACT Objectives: To describe and analyze the coverage profile of directly observed treatment for tuberculosis in 59 priority municipalities in the state of São Paulo, Brazil, through the creation and comparison of groups homogenized by the number of people in each municipality from 2006 to 2012. Method: Quantitative, epidemiological and descriptive study based on the data available in the EPI-TB and the Statistica 7.0 software databases. Results: The mean and standard deviation of directly observed treatment for the 59 priority municipalities of the state of São Paulo were 77.0 ± 24.3%. The coverage of directly observed treatment increased in 34 municipalities (57.6%) but decreased in 25 (42.4%). Conclusion: Some municipalities could not keep the coverage reached at some point. This coverage heterogeneity should be examined in detail by searching for possible reasons in political-management, technical-operational and funding dimensions.
RESUMEN Objetivo: Describir y analizar el perfil de cobertura del Tratamiento Directamente Observado (TDO) en 59 municipios relevantes del Estado de São Paulo/Brasil, mediante formación y comparación de subgrupos, homogeneizados por el número de habitantes/municipio, de 2006 a 2012. Método: Estudio cuantitativo, epidemiológico y descriptivo, utilizándose el Banco EPI-TB y el Statistica 7.0. Resultados: La media y el desvío estándar del TDO para los 59 municipios relevantes del Estado de São Paulo/Brasil fue del 77,0% ± 24,3. La cobertura del TDO resultó creciente en treinta y cuatro municipios (57,6%), aunque en veinticinco (42,4%) hubo una disminución del porcentaje de cobertura. Conclusión: Algunos municipios no consiguieron mantener la sustentabilidad de la cobertura alcanzada en algún momento. Esta heterogeneidad de cobertura necesita profundizarse, buscando las posibles explicaciones en las dimensiones político-gerenciales, técnico-operativas y de financiamiento de acciones en TB.
RESUMO Objetivo: Descrever e analisar o perfil da cobertura do Tratamento Diretamente Observado (TDO) em 59 municípios prioritários do Estado de São Paulo/Brasil, por meio da formação e comparação de subgrupos homogeneizados pelo número de habitantes/município, de 2006 a 2012. Método: Estudo quantitativo, epidemiológico e descritivo, utilizando-se o Banco EPI-TB e do Statistica 7.0. Resultados: A média e o desvio-padrão do TDO para os 59 municípios prioritários do Estado de São Paulo/Brasil foi de 77,0% ± 24,3. A cobertura do TDO foi crescente em trinta e quatro municípios (57,6%), porém, em vinte e cinco (42,4,houve uma diminuição da porcentagem de cobertura. Conclusão: Alguns municípios não conseguiram manter a sustentabilidade da cobertura alcançada em algum momento. Essa heterogeneidade de cobertura precisa ser aprofundada, buscando as possíveis explicações nas dimensões político-gerencial, técnico-operacional e do financiamento das ações em tuberculose (TB).
Assuntos
Humanos , Tuberculose/terapia , Terapia Diretamente Observada/métodos , Tuberculose/psicologia , Tuberculose/epidemiologia , Brasil/epidemiologia , Cidades/epidemiologia , Cidades/estatística & dados numéricosRESUMO
OBJECTIVES: To describe and analyze the coverage profile of directly observed treatment for tuberculosis in 59 priority municipalities in the state of São Paulo, Brazil, through the creation and comparison of groups homogenized by the number of people in each municipality from 2006 to 2012. METHOD: Quantitative, epidemiological and descriptive study based on the data available in the EPI-TB and the Statistica 7.0 software databases. RESULTS: The mean and standard deviation of directly observed treatment for the 59 priority municipalities of the state of São Paulo were 77.0 ± 24.3%. The coverage of directly observed treatment increased in 34 municipalities (57.6%) but decreased in 25 (42.4%). CONCLUSION: Some municipalities could not keep the coverage reached at some point. This coverage heterogeneity should be examined in detail by searching for possible reasons in political-management, technical-operational and funding dimensions.
Assuntos
Terapia Diretamente Observada/métodos , Tuberculose/terapia , Brasil/epidemiologia , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Humanos , Tuberculose/epidemiologia , Tuberculose/psicologiaRESUMO
OBJECTIVE: To analyze the influence of social incentives for adherence to tuberculosis (TB) treatment. METHOD: Qualitative study, in which 26 primary health care professionals of São Paulo were interviewed in 2015.Their testimonies were submitted to the speech analysis technique. The theoretical reference was the social determination of the health-disease process. Ethical procedures were observed. RESULTS: TB is related to precarious living conditions. Incentives such as the basic food basket and transportation stipends are relevant for patients' adherence to treatment, as well as to the create bonds between the patient and the health team. FINAL CONSIDERATIONS: The incentives strengthened adherence to TB treatment. However, interventions in the context of public measures must transcend the remedial dimension and be guided towards the transformation of the TB situation, which means supporting processes that modify living conditions.
Assuntos
Reforço Social , Apoio Social , Cooperação e Adesão ao Tratamento/psicologia , Tuberculose/terapia , Adulto , Brasil , Terapia Diretamente Observada/métodos , Terapia Diretamente Observada/normas , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Tuberculose/psicologiaRESUMO
OBJECTIVE: To identify people's way of acting after the diagnosis of tuberculosis, through their social representations about the disease. METHOD: Qualitative and descriptive study based on the Theory of Social Representations, in which 23 patients of a school health center in Belém, PA, Brazil, participated. The software ALCESTE was used to generate a class concerning the impact of the diagnosis in people's lives. RESULTS: The dimension of a new reality caused by the diagnosis of tuberculosis is linked with the image of dirt, (process of objectification) communicable/mortal disease that exclude, causing sorrow, despair and revolt (dimension of the affections), reverberating in the patients' actions (dimension of action). FINAL CONSIDERATIONS: global knowledge about tuberculosis, linking the knowledge of everyday life with the reified universe, pointing the multidimensionality of the phenomenon. The conclusion is that investing in the deconstruction of archaic beliefs about the tuberculosis that kills, replacing it with the curable tuberculosis, is necessary.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Identificação Social , Tuberculose/diagnóstico , Adulto , Brasil , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Tuberculose/psicologiaRESUMO
OBJECTIVE: to ascertain the epidemiological profile of TB/HIV co-infection in Brazilian scenarios. METHOD: this is a systematic review conducted via electronic search in databases PubMed, EMBASE, LILACS and SciELO, having as inclusion criterion articles based on the Brazilian scenario of TB/HIV co-infection. RESULTS: of the total 174 studies, 15 were selected, revealing the epidemiological profile of the co-infection in different scenarios: male, economically active age, low education level, brown/black ethnicity, low income, heterosexual, pulmonary clinical form, alcoholism and Directly Observed Therapy. CONCLUSION: the sociodemographic and epidemiological profile of people with TB/HIV co-infection has an expected occurrence pattern, which corroborates articles found in the literature, either at national level or by grouping the studies according to region or state.
Assuntos
Infecções por HIV/psicologia , Nível de Saúde , Tuberculose/psicologia , Adulto , Brasil/epidemiologia , Terapia Diretamente Observada , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Tuberculose/epidemiologiaRESUMO
BACKGROUND: Tuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients' perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment. METHODS: A qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP). RESULTS: A total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment. CONCLUSIONS: According to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them to the adhere to tuberculosis treatment.
Assuntos
Cooperação do Paciente/psicologia , Tuberculose/terapia , Populações Vulneráveis , Adulto , Brasil , Estudos Transversais , Família/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Distância Psicológica , Pesquisa Qualitativa , Estigma Social , Apoio Social , Tuberculose/psicologia , Adulto JovemRESUMO
OBJETIVO: Identificar e analisar as causas de abandono do tratamento da tuberculose entre pacientes em retratamento, por abandono anterior. MÉTODOS: Estudo descritivo, transversal, constituído por análise qualitativa, realizado por meio de análise de prontuários, entrevistas e aplicação de questionários a pacientes que reingressaram no tratamento de tuberculose após abandono, no período de abril de 2013 a abril de 2014, no município de Belém (PA). RESULTADOS: Os fatores mais citados pelos pacientes como motivadores do abandono do tratamento de tuberculose foram: melhora dos sintomas após o início do uso dos medicamentos (seis respostas), uso de drogas ilícitas (cinco respostas), falta de conhecimento da tuberculose e de seu tratamento (três respostas), uso de bebidas alcoólicas (três respostas), falta de dinheiro para ir ao posto (3 respostas), problemas familiares e falta de apoio familiar (três respostas). Essas causas foram apontadas como os principais motivadores do não seguimento do tratamento, o que correspondeu a 63,9% de todas as respostas. CONCLUSÃO: Diversos fatores ocasionaram o abandono do tratamento da tuberculose. São necessárias mais ações que aumentem a compreensão e conhecimento da doença pelo paciente.(AU)
OBJECTIVE: To identify and analyze the causes of treatment abandonment among tuberculosis patients in retreatment due to previous abandonment. METHODS: A descriptive, cross-sectional study consisting of qualitative analysis, carried out through an analysis of medical records, interviews and questionnaires applied to patients who rejoined treatment of tuberculosis after abandonment, from April 2013 to April 2014, in the city of Belem, state of Para. RESULTS: The factors that are most cited by patients as causes of abandonment of TB treatment were: improvement of symptoms after the start of drug use (six answers), illicit drug use (five answers), lack of knowledge about tuberculosis and its treatment (three answers), the use of alcohol (three answers), lack of money to go to the hospital (three answers), family problems and lack of Family support (three answers). These causes are cited as the main reasons for not following the treatment, which corresponded to 63.9% of all responses. CONCLUSION: There are several factors that cause abandonment of tuberculosis treatment. More actions to increase patient understanding and knowledge of the disease are needed.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Equipe de Assistência ao Paciente , Pacientes Desistentes do Tratamento/psicologia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Tuberculose/psicologia , Falha de TratamentoRESUMO
BACKGROUND: Stigma associated with tuberculosis (TB) has been an object of interest in several regions of the world. The behaviour presented by patients as a result of social discrimination has contributed to delays in diagnosis and the abandonment of treatment, leading to an increase in the cases of TB and drug resistance. The identification of populations affected by stigma and its measurement can be assessed with the use of valid and reliable instruments developed or adapted to the target culture. This aim of this study was to analyse the initial psychometric properties of the Tuberculosis-Related Stigma scale in Brazil, for TB patients. METHODS: The Tuberculosis-Related Stigma scale is a specific scale for measuring stigma associated with TB, originally validated in Thailand. It presents two dimensions to be assessed, namely Community perspectives toward tuberculosis and Patient perspectives toward tuberculosis. The first has 11 items regarding the behaviour of the community in relation to TB, and the second is made up of 12 items related to feelings such as fear, guilt and sorrow in coping with the disease. A pilot test was conducted with 83 TB patients, in order to obtain the initial psychometric properties of the scale in the Brazilian Portuguese version, enabling simulation of the field study. RESULTS: As regards its psychometric properties, the scale presented acceptable internal consistency for its dimensions, with values ≥0.70, the absence of floor and ceiling effects, which is favourable for the property of scale responsiveness, satisfactory converging validity for both dimensions, with values over 0.30 for initial studies, and diverging validity, with adjustment values different from 100%. CONCLUSION: The results found show that the Tuberculosis-Related Stigma scale can be a valid and reliable instrument for the Brazilian context.
Assuntos
Psicometria/métodos , Discriminação Social/psicologia , Tuberculose/psicologia , Infecções Oportunistas Relacionadas com a AIDS/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/etnologia , Estudos Transversais , Emoções , Etnicidade , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Tuberculose Pulmonar/psicologiaRESUMO
OBJECTIVES: The purpose herein was to describe the meanings on tuberculosis (TB) in rural indigenous communities from a municipality in the Colombian Amazon. METHODS: This was an ethnographic study with theoretical reference of dialectical hermeneutics, which created focus groups, one for each rural community of Puerto Nariño, for a total of 15 focus groups. The participants were community leaders and health referents. RESULTS: Seventy-nine subjects participated, mostly midwives, kurakas, traditional physicians, and shamans. The analysis yielded four categories: knowledge of TB, attitudes regarding TB, community practices of TB, and the intervention proposal on TB by the participants. It was found that community leaders recognize TB as a disease that can cause death, but which can be cured if timely care is secured. The study also identified the need to conjugate western medicine with traditional medicine. CONCLUSIONS: It is recognized that meanings may impact upon knowledge, attitudes, and practices that affect early detection and treatment of the disease. In addition, this work corroborates the need to strengthen and develop educational programs on tuberculosis supported by the real needs of the communities to enhance their knowledge, attitudes, and practices on the disease.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Indígenas Sul-Americanos/psicologia , População Rural , Tuberculose/psicologia , Antropologia Cultural , Colômbia , Feminino , Grupos Focais , Humanos , Masculino , Pesquisa Qualitativa , Tuberculose/etnologiaRESUMO
The Texas-Mexico border incidence rate of tuberculosis (TB) is 10 times the rate of TB in the United States. Additionally, this area is plagued by antibiotic-resistant TB at a rate that is 70% higher among those living along the border than among nonborder residents. Both the high rate of TB and the emergence of drug-resistant TB increases the importance of controlling TB along the U.S.-Mexico border. Men have higher rates of TB than women, which can be attributed to biological differences and increased environmental exposure. The purpose of this article is to describe the experience of TB for Mexican American men living on the Texas-Mexico border. This a qualitative descriptive study, using participants from a larger study. A purposeful sample was recruited through two south Texas TB clinics. Interviews were audio recorded, transcribed, and translated into English. Data analysis consisted of line-by-line coding, labeling, organizing, and discovering common codes to describe participants' experience of TB and TB treatment. The participants include 13 Mexican American men. Ages ranged from 22 to 76 years. Only one participant was employed during treatment. Years of education ranged from no school to an associate's degree. Five themes were discovered: misinformation, delayed diagnosis, stigma, depression, and loss of community. Participants without social support were further isolated and felt a greater burden of treatment. Two participants contemplated suicide and two others told their families to leave them because they were a burden and infectious. The burden of treatment on the patient is great, especially for Hispanic men.