scholarly journals Determinants of multidrug‐resistant tuberculosis in São Paulo—Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services

2020 ◽  
Vol 25 (7) ◽  
pp. 839-849
Author(s):  
Luiz Henrique Arroyo ◽  
Mellina Yamamura ◽  
Antônio Carlos Vieira Ramos ◽  
Laura Terenciani Campoy ◽  
Juliane de Almeida Crispim ◽  
...  
Author(s):  
Valdes Roberto BOLLELA ◽  
Fernanda Guioti PUGA ◽  
Maria Janete MOYA ◽  
Mauro ANDREA ◽  
Maria de Lourdes Viude OLIVEIRA

2013 ◽  
Vol 29 (10) ◽  
pp. 2017-2027 ◽  
Author(s):  
Cássio Silveira ◽  
Nivaldo Carneiro Junior ◽  
Manoel Carlos Sampaio de Almeida Ribeiro ◽  
Rita de Cássia Barradas Barata

Bolivian immigrants in Brazil experience serious social problems: precarious work conditions, lack of documents and insufficient access to health services. The study aimed to investigate inequalities in living conditions and access to health services among Bolivian immigrants living in the central area of São Paulo, Brazil, using a cross-sectional design and semi-structured interviews with 183 adults. According to the data, the immigrants tend to remain in Brazil, thus resulting in an aging process in the group. Per capita income increases the longer the immigrants stay in the country. The majority have secondary schooling. Work status does not vary according to time since arrival in Brazil. The immigrants work and live in garment sweatshops and speak their original languages. Social networks are based on ties with family and friends. Access to health services shows increasing inclusion in primary care. The authors conclude that the immigrants' social exclusion is decreasing due to greater access to documentation, work (although precarious), and the supply of health services from the public primary care system.


2012 ◽  
Vol 107 (6) ◽  
pp. 760-766 ◽  
Author(s):  
Andréa Gobetti Vieira Coelho ◽  
Liliana Aparecida Zamarioli ◽  
Maria Alice Telles ◽  
Lucilaine Ferrazoli ◽  
Eliseu Alves Waldman

2019 ◽  
Vol 45 (2) ◽  
Author(s):  
Marcia Telma Guimarães Savioli ◽  
Nelson Morrone ◽  
Ilka Santoro

ABSTRACT Objective: To identify transmitted or primary resistance among cases of multidrug-resistant tuberculosis and predictive factors for cure in multidrug-resistant tuberculosis after the first treatment. Method: Descriptive study of a cohort from 2006 to 2010, in a reference unit of tuberculosis in São Paulo, Brazil. The data were obtained by the revision of medical records. Clinical criteria were used to classify transmitted and acquired resistance. Extended primary resistance was also defined, in this study, as cases initially treated with a standardized scheme, but with no therapeutic success, and the pre-treatment drug susceptibility test (DST) showed presence of resistance. Results: 156 patients with multidrug-resistant tuberculosis and their respective sputum samples were eligible for the study. Only 7% of the patients were positive for the human immunodeficiency virus (HIV). Previous treatment occurred in 95% of the sample. The cure rate after the first treatment was 54%. The median bacteriological conversion time of those who healed was one month. Bacillary resistance was considered acquired resistance in 100 (64%) and transmitted resistance in 56 (36%). By logistic regression, patients who presented primary multidrug-resistant tuberculosis (odds ratio-OR = 6,29), without comorbidity (OR = 3,37) and with higher initial weight (OR = 1.04) were associated with cure after the first treatment. Conclusion: The early detection of bacillary resistance and appropriate treatment are in favor of healing. Thus, it is crucial to know exactly the primary resistance rate avoiding the use of inadequate treatments, amplification of bacillary resistance and its transmission.


PLoS ONE ◽  
2020 ◽  
Vol 15 (7) ◽  
pp. e0236250
Author(s):  
Chador Tenzin ◽  
Natkamol Chansatitporn ◽  
Tashi Dendup ◽  
Tandin Dorji ◽  
Karma Lhazeen ◽  
...  

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Geisa Fregona ◽  
Lorrayne Belique Cosme ◽  
Cláudia Maria Marques Moreira ◽  
José Luis Bussular ◽  
Valdério do Valle Dettoni ◽  
...  

ABSTRACT OBJECTIVE To analyze the prevalence and factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil. METHODS This is a cross-sectional study of cases of tuberculosis tested for first-line drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin) in Espírito Santo between 2002 and 2012. We have used laboratory data and registration of cases of tuberculosis – from the Sistema Nacional de Agravos de Notificação and Sistema para Tratamentos Especiais de Tuberculose. Individuals have been classified as resistant and non-resistant and compared in relation to the sociodemographic, clinical, and epidemiological variables. Some variables have been included in a logistic regression model to establish the factors associated with resistance. RESULTS In the study period, 1,669 individuals underwent anti-tuberculosis drug susceptibility testing. Of these individuals, 10.6% showed resistance to any anti-tuberculosis drug. The rate of multidrug resistance observed, that is, to rifampicin and isoniazid, has been 5%. After multiple analysis, we have identified as independent factors associated with resistant tuberculosis: history of previous treatment of tuberculosis [recurrence (OR = 7.72; 95%CI 4.24–14.05) and re-entry after abandonment (OR = 3.91; 95%CI 1.81–8.43)], smoking (OR = 3.93; 95%CI 1.98–7.79), and positive culture for Mycobacterium tuberculosis at the time of notification of the case (OR = 3.22; 95%CI 1.15–8.99). CONCLUSIONS The partnership between tuberculosis control programs and health teams working in the network of Primary Health Care needs to be strengthened. This would allow the identification and monitoring of individuals with a history of previous treatment of tuberculosis and smoking. Moreover, the expansion of the offer of the culture of tuberculosis and anti-tuberculosis drug susceptibility testing would provide greater diagnostic capacity for the resistant types in Espírito Santo.


Author(s):  
Alice Botelho de Mesquita ◽  
Mariana Matos de Vasconcelos ◽  
Aline Borges Moreira da Rocha ◽  
Letícia Coelho Altevato ◽  
Nivaldo Carneiro Junior

Introdução: A extensão universitária é uma missão estratégica para a educação profissional e interprofissional, pois possibilita ao aluno vivenciar ações concretas, voltadas a determinadas realidades socio-sanitárias. O Programa de Expedições Científicas e Assistenciais (PECA), fundado em 2004, é uma das importantes atuações nessa área da Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), desenvolvendo ações de assistência integral à saúde em municípios paulistas, através de parcerias com os gestores municipais de saúde. Conhecer os determinantes sociais de saúde dos usuários do PECA emerge como um eixo importante na atuação desse Programa. Objetivo: Este artigo tem como objetivo analisar aspectos relacionados às condições de vida, acesso aos serviços e possíveis implicações no estado de saúde da população adulta, usuária do PECA, na cidade de Araraquara, São Paulo, no ano de 2019. Método: Para tanto, realizou-se estudo transversal, abordagem quantitativa e amostra de conveniência. Aplicou-se questionário estruturado, contendo perguntas sobre condições sociocomunitárias, fatores de risco e de proteção à saúde, acesso aos serviços socioculturais e de saúde. A população amostral foi composta por adultos (igual a e/ou maior de 18 anos de idade), atendidos no PECA, realizado na cidade de Araraquara, São Paulo, no mês de janeiro 2019. As informações coletadas foram digitadas na plataforma digital REDCap (https://redcap.fcmsantacasasp. edu.br). Foi realizada análise de prevalência e associação, empregando o teste Odds Ratio (OR), com intervalo de confiança 95%. Resultado: Participaram 338 usuários, 69% do total atendidos no PECA na faixa etária elegível por essa pesquisa. A maioria é do sexo feminino com idades entre 18 a 59 anos. Branco é a cor autodeclarada mais observada e 42,6% referem-se casados. Metade dos entrevistados afirma não ter acesso a bens culturais. Constata-se baixa frequência de práticas físicas nessa população. A maioria utiliza a rede assistencial do Sistema Único de Saúde (SUS), sendo a Unidade Básica de Saúde o serviço mais acessado. Conclusão: O baixo consumo de bens culturais expressa potencialmente condições de vulnerabilidade social. A não realização de atividade física é fator de não proteção para a saúde. São usuários dos serviços públicos de saúde, particularmente os de atenção primária, fato que corrobora a importância do Sistema Único de Saúde (SUS) na garantia do acesso universal. As dimensões envolvidas com os modos de andar a vida da população adulta e idosa que utilizaram os serviços ofertados pelo PECA, na cidade de Araraquara, ampliam o olhar sobre os sujeitos cuidados, contribuindo, desse modo, para qualificar a atuação da extensão universitária da FCMSCSP.Palavras-chave: Extensão universitária, Determinação social, Autopercepção de saúde, Condições de vida ABSTRACTIntroduction: The university extension course is a strategic task to professional and interprofessional education as it allows the student to experience concrete action towards specific social-sanitary conditions. The “Programa de Expedições Científicas e Assistenciais” (PECA), founded in 2004, it is one of the most important initiative by Faculdade de Ciências Médicas da Santa Casa de São Paulo in this field. PECA implements actions of integral health assistance in cities of State of São Paulo through partnership with cities health officials. It is a significant aspect of PECA to know the social factors which affect users’ health. Aim: This article aims to analyze features related to life conditions, access to health services and potential health effects on an adult population from Araraquara (São Paulo) in 2019. Method: The research is a transversal study with quantitative approach and convenience sampling. A structured questionnaire was applied asking about social conditions, access to sociocultural and health services, factors of risk and health protection. The sample includes adults (18 years old or more) attended by PECA in Araraquara in January 2019. Data gathered were recorded on digital platform REDCap (https://redcap.fcmsantacasasp.edu.br). It was done an analysis of prevalence and association through Odds Ratio (OR) test, with 95% confidence interval. Result: Took part of the research 338 users, which equals 69% of PECA users within the research rage age. Most are female, between the ages of 18 and 59. White is the most self-declared color and 42.6% are married. Half claims to not have access to cultural goods. There is a low frequency of physical activities and the majority uses the Sistema Único de Saúde (SUS) (Unidade Básica de Saúde is the most demanded service). Conclusion: The low levels of cultural goods consumption express potential condition of social vulnerability and the lack of physical activity is a risk factor to health. These people are users of health public services, particularly of primary attention. This fact shows the importance of the Sistema Único de Saúde (SUS) to secure universal access to health. The several aspects of the way of life of the population which has made use of PECA in Araraquara broad the perspective on them and may improve initiatives from university extension courses of FCMSCSP.Keywords: University extension courses, Social determinants, Health status, Life conditions -


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