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de Aguiar RM, da Silva Vieira MAM, de Almeida IN, de Paula Ramalho DM, Ruffino-Netto A, Carvalho ACC, Kritski AL. Factors associated with non-completion of latent tuberculosis infection treatment in Rio de Janeiro, Brazil: A non-matched case control study. Pulmonology 2020; 28:350-357. [PMID: 32513638 DOI: 10.1016/j.pulmoe.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION There are scarce data on the routine latent tuberculosis infection treatment (LTBIT) and factors associated with a non-completion in high tuberculosis burden countries. Therefore, in this study we aimed to evaluate the factors associated with non-completion of LTBIT. MATERIALS AND METHODS This was a non-matched case control study conducted at a University Hospital in Rio de Janeiro, Brazil. A total of 114 cases and 404 controls were enrolled between January/1999 and December/2009. Cases were close contacts who did not complete the LTBIT and controls were the contacts that completed it. Multivariate analysis was used to investigate risk factors associated with non-completion of LTBIT among contacts in two different periods of recruitment. RESULTS Factors associated with non-completion LTBIT included: drug use (OR 23.33, 95% CI 1.83-296.1), TB treatment default by the index case (OR 16.97, 95% CI 3.63-79.24) and drug intolerance. TB disease rates after two years of follow up varied from 0.4% to 1.9%. The number necessary to treat to prevent one TB case among contacts was 116. CONCLUSIONS Non-completion treatment by the index case and illicit drug use were associated with not completing latent tuberculosis infection treatment and no tuberculosis disease was identified among those who completed latent tuberculosis infection treatment.
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Affiliation(s)
- R M de Aguiar
- Tuberculosis Academic Program of Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M A M da Silva Vieira
- Tuberculosis Academic Program of Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - I N de Almeida
- Laboratory of Mycobacteria Research of Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - D M de Paula Ramalho
- Tuberculosis Academic Program of Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Ruffino-Netto
- Department of Social Medicine, Faculty of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - A C C Carvalho
- Laboratory of Innovation in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - A L Kritski
- Tuberculosis Academic Program of Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Teixeira EG, Kritski A, Ruffino-Netto A, Steffen R, Lapa e Silva JR, Belo M, Luiz R, Menzies D, Trajman A. Medical students at risk of nosocomial tuberculosis. J Hosp Infect 2010; 77:80-1. [PMID: 20971527 DOI: 10.1016/j.jhin.2010.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 07/29/2010] [Indexed: 10/18/2022]
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Motta MCS, Villa TCS, Golub J, Kritski AL, Ruffino-Netto A, Silva DF, Harter RG, Scatena LM. Access to tuberculosis diagnosis in Itaboraí City, Rio de Janeiro, Brazil: the patient's point of view. Int J Tuberc Lung Dis 2009; 13:1137-1141. [PMID: 19723404 PMCID: PMC3697920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING Itaboraí Municipality in Rio de Janeiro, Brazil. OBJECTIVE To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing 'almost always' and 'always', or 'good' and 'very good', were used as a cut-off point to define high quality access to diagnosis. RESULTS FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION In Itaboraí, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaboraí.
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Affiliation(s)
- M C S Motta
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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da Costa PA, Trajman A, Mello FCDQ, Goudinho S, Silva MAMV, Garret D, Ruffino-Netto A, Kritski AL. Administrative measures for preventing Mycobacterium tuberculosis infection among healthcare workers in a teaching hospital in Rio de Janeiro, Brazil. J Hosp Infect 2009; 72:57-64. [PMID: 19278753 DOI: 10.1016/j.jhin.2009.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 01/16/2009] [Indexed: 11/18/2022]
Abstract
Tuberculosis (TB) is an occupational disease of healthcare workers (HCWs). Administrative and engineering interventions simultaneously implemented in hospitals of developed countries have reduced the risk of nosocomial transmission of M. tuberculosis. We studied the impact of administrative infection control measures on the risk for latent TB infection (LTBI) among HCWs in a resource-limited, high-burden country. An intervention study was undertaken in a university-affiliated, inner-city hospital in Rio de Janeiro, where routine serial tuberculin skin testing (TST) is offered to all HCWs. From October 1998 to February 2001, the following infection control measures were progressively implemented: isolation of TB suspects and confirmed TB inpatients, quick turnaround for acid-fast bacilli sputum tests and HCW education in use of protective respirators. Among 1336 initially tested HCWs, 599 were retested. The number of TST conversions per 1000 person-months during and after the implementation of these measures was reduced from 5.8/1000 to 3.7/1000 person-months (P=0.006). The most significant reductions were observed in the intensive care unit (from 20.2 to 4.5, P<0.001) and clinical wards (from 10.3 to 6.0, P<0.001). Physicians and nurses had the highest reductions (from 7.6 to 0, P<0.001; from 9.9 to 5.8, P=0.001, respectively). We conclude that administrative measures for infection control can significantly reduce LTBI among HCWs in high-burden countries and should be implemented even when resources are not available for engineering infection control measures.
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Cailleaux-Cezar M, de A Melo D, Xavier GM, de Salles CLG, de Mello FCQ, Ruffino-Netto A, Golub JE, Efron A, Chaisson RE, Conde MB. Tuberculosis incidence among contacts of active pulmonary tuberculosis. Int J Tuberc Lung Dis 2009; 13:190-195. [PMID: 19146746 PMCID: PMC3713782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Treatment of latent tuberculosis (TB) infection (LTBI) in Brazil is recommended only in the case of contacts of pulmonary smear-positive TB patients aged<or=15 years with a tuberculin skin test (TST)>or=10 mm and no previous bacille Calmette-Guérin (BCG) vaccination or with a TST>or=15 mm regardless of previous BCG vaccination. OBJECTIVE To evaluate the 2-year incidence and predictors of TB among contacts who did not meet the Brazilian criteria for LTBI treatment. DESIGN Retrospective cohort study. Contacts aged between 12 and 15 years and those aged>or=15 years who did not meet the Brazilian criteria for LTBI treatment were enrolled in the study. RESULTS TB incidence was 3.2% (22/667), with an estimated TB rate of 1649 per 100000 population. Risk of TB was greater among the 349 contacts with TST>or=5 mm (5.4%) compared to the 318 contacts with TST<5 mm (0.9%; RR 6.04, 95%CI 1.7-20.6). CONCLUSION The high incidence of TB among contacts who did not meet the Brazilian criteria for LTBI treatment strongly suggests that these criteria should be reviewed. Furthermore, even among BCG-vaccinated contacts, TST induration>or=5 mm was the only variable that predicted the development of TB disease within 2years.
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Affiliation(s)
- M Cailleaux-Cezar
- Instituto de Doenças do Torax, Hospital Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Teixeira EG, Kritski A, Ruffino-Netto A, Steffen R, Lapa E Silva JR, Belo M, Luiz RR, Menzies D, Trajman A. Two-step tuberculin skin test and booster phenomenon prevalence among Brazilian medical students. Int J Tuberc Lung Dis 2008; 12:1407-1413. [PMID: 19017450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
SETTING Five medical schools in three cities in Rio de Janeiro State, Brazil, with different tuberculosis (TB) incidence rates. OBJECTIVE To evaluate the prevalence of the booster phenomenon and its associated factors in a young universally BCG-vaccinated TB-exposed population. DESIGN A two-step tuberculin skin test (TST) was performed among undergraduate medical students. Boosting was defined as an induration > or =10 mm in the second TST (TST2), with an increase of at least 6 mm over the first TST (TST1). The association of boosting with independent variables was evaluated using multivariate analysis. RESULTS Of the 764 participants (mean age 21.9 +/- 2.7 years), 672 (87.9%) had a BCG scar. The overall booster phenomenon prevalence was 8.4% (95%CI 6.5-10.6). Boosting was associated with TST1 reactions of 1-9 mm (aOR 2.5, 95%CI 1.04-5.9) and with BCG vaccination, mostly after infancy, i.e., after age two years (aOR 9.1, 95%CI 1.2-70.7). CONCLUSION The prevalence of the booster phenomenon was high. A two-step TST in young BCG-vaccinated populations, especially in those with TST1 reactions of 1-9 mm, can avoid misdiagnosis as a false conversion and potentially reduce unnecessary treatment for latent TB infection.
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Affiliation(s)
- E G Teixeira
- Gama Filho University, Rio de Janeiro, Rio de Janeiro, Brazil.
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Arcêncio RA, Oliveira MF, Cardozo-Gonzales RI, Ruffino-Netto A, Pinto IC, Villa TCS. City tuberculosis control coordinators' perspectives of patient adherence to DOT in São Paulo State, Brazil, 2005. Int J Tuberc Lung Dis 2008; 12:527-531. [PMID: 18419888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING Thirty-six priority cities in São Paulo State, Brazil, with a high incidence of tuberculosis (TB) cases, deaths and treatment default. OBJECTIVE To identify the perspectives of city TB control coordinators regarding the most important components of adherence strategies adopted by health care teams to ensure patient adherence in 36 priority cities in the State of São Paulo, Brazil. DESIGN Qualitative research with semi-structured interviews conducted with the coordinators of the National TB Control Programme involved in the management of TB treatment services in the public sector. RESULTS The main issues thought to influence adherence to directly observed treatment (DOT) by coordinators include incentives and benefits delivered to patients, patient-health care worker bonding and comprehensive care, the encouragement given by others to follow treatment (family, neighbours and health professionals), and help provided by health professionals for patients to recover their self-esteem. CONCLUSION The main aspects mentioned by city TB control coordinators regarding patient adherence to treatment and to DOT in São Paulo are improvements in communications, relationships based on trust, a humane approach and including the patients in the decision-making process concerning their health.
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Affiliation(s)
- R A Arcêncio
- College of Nursing, University of São Paulo at Ribeirão Preto, São Paulo, Brazil
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Trajman A, Correia N, Venturi M, Kritski A, Ruffino-Netto A, Scatena Villa TC, Luiz do Amaral J. Tuberculosis teaching in Brazilian medical schools. Int J Tuberc Lung Dis 2007; 11:703-5. [PMID: 17519105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
To achieve tuberculosis (TB) control, National Tuberculosis Programme guidelines should be implemented effectively. In a survey conducted in 2005-2006, 33 Brazilian medical school coordinators answered a questionnaire about TB education. The median time dedicated to TB was 27 h (4-119 h), spread over several disciplines, mainly biological and clinical. This included 12 h (0-88 h) of practical activities, mainly in university hospitals (53%). The recommendation to offer human immunodeficiency virus testing for TB patients was taught in only 54% of the schools. TB education in Brazil is fragmented and restricted to a biological approach, while field activities are insufficient and carried out in inadequate settings. Important changes to the TB curriculum are necessary.
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Affiliation(s)
- A Trajman
- Gama Filho University, Rio de Janeiro, Brazil
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Bastos LGV, Fonseca LS, Mello FCQ, Ruffino-Netto A, Golub JE, Golub JL, Conde MB. Prevalence of pulmonary tuberculosis among respiratory symptomatic subjects in an out-patient primary health unit. Int J Tuberc Lung Dis 2007; 11:156-60. [PMID: 17263285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
SETTING Out-patient primary health unit (OPHU) in Rio de Janeiro City, Brazil. OBJECTIVE To evaluate the impact on the detection of tuberculosis (TB) cases of reducing the time of respiratory symptoms from 'cough > or = 3 weeks' to 'cough > or = 1 week' as a criteria for TB case finding among individuals visiting an OPHU for any other reason. DESIGN Cross-sectional study. RESULTS During the period of the study, 10.7% (765/ 7174) of subjects reported cough > or = 1 week. Among 542 subjects enrolled in the study with cough > or = 1 week, 15 (2.7%) cases were diagnosed with pulmonary tuberculosis (PTB, 2767/100000). The probability of detecting TB in the OPHU setting among subjects seeking care for respiratory symptoms was significantly higher than among those presenting to the OPHU for other reasons (OR 31.5, 95% CI 4.1-241.9; P < 0.0001). The probability of identifying TB among patients seeking care due to respiratory symptoms was not influenced by the duration of cough (P = 0.7). CONCLUSION These findings suggest that the screening criteria for TB case finding of cough for less than the usual 3 weeks among patients who attend a health facility due to respiratory symptoms in settings with a high prevalence of TB may significantly improve the proportion of TB cases diagnosed.
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Affiliation(s)
- L G V Bastos
- Instituto de Doenças do Tórax/Hospital Universitario Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Vendramini SHF, Santos MLSG, Gazetta CE, Chiaravalloti-Neto F, Ruffino-Netto A, Villa TCS. Tuberculosis risks and socio-economic level: a case study of a city in the Brazilian south-east, 1998-2004. Int J Tuberc Lung Dis 2006; 10:1231-5. [PMID: 17131781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To explore tuberculosis (TB) risks in relation to potential determinants in the city of São José do Rio Preto, São Paulo State, Brazil; to analyse morbidity and mortality indicators in São José do Rio Preto, and to determine the relationship between the risk of TB and socio-economic level (SEL) using a geo-referenced information system (GIS) and the national census for 2000. METHOD Standardised incidence rates and TB incidence and mortality rates were calculated. Socio-economic variables were determined using the statistical technique of principal component analysis. Data sources were the São Paulo State Data Analysis System (SEADE), the TB Notification Database (EPI-TB), the Information Department of the Brazilian Health Ministry (DATASUS), and the Brazilian Institute of Geography and Statistics (IBGE). New cases reported in 1998-1999 and 2003-2004 in the urban area of the city were geo-referenced and analysed. RESULTS TB risk in the city is twice as high in areas of lower SEL than in areas with higher SEL. CONCLUSION The identification of areas with different levels of risk enables the Municipal Health Department to propose innovative interventions to minimise the risk of disease at both individual and population level.
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Affiliation(s)
- S H F Vendramini
- Department of Nursing in Collective Health and Professional Orientation, College of Nursing, University of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
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Villa TCS, Ruffino-Netto A, Andrade RLP, Alarcón EA, Montero CV, Firmino DR. Survey on tuberculosis teaching in Brazilian nursing schools, 2004. Int J Tuberc Lung Dis 2006; 10:323-7. [PMID: 16562714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVE To characterise tuberculosis (TB) teaching in Brazilian nursing schools by state and region and its theoretical and practical contents. METHODOLOGY In an educational research survey in 2004, 347 nursing schools were identified. Questionnaires were posted to faculties providing training in TB. Data were compiled in a database with a view to descriptive result analysis. Replies to the questionnaire were received by 32% of the nursing schools contacted. RESULTS Undergraduate TB teaching is heterogeneous. For training in theory, the principle teaching method is through classes in 102 (91.9%) nursing schools. Practical TB teaching is carried out at the primary care level (89.2%). Teachers update their knowledge through events and internet; little reference is made to manuals. The time devoted to practical TB teaching ranges from 10 to 20 hours, although this is not always included in student training. CONCLUSION Teaching in TB should go beyond the traditional model that focuses only on biological aspects. It should introduce tools that lead to permanent behavioural change, such as a more human approach and social and psychological aspects, such as living conditions, habits and customs. It should involve new partners, such as families, communities and other health professionals, and identify obstacles within the university.
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Affiliation(s)
- T C S Villa
- College of Nursing, University of Sao Paulo at Ribeirão Preto, Brazilian TB Research Network (REDE-TB), Sao Paulo, Brazil.
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Teixeira EG, Menzies D, Comstock GW, Cunha AJLA, Kritski AL, Soares LC, Bethlem E, Zanetti G, Ruffino-Netto A, Belo MTCT, Selig L, Branco MMC, Cherri D, Maia S, Marandino R, Luiz RR, Chaisson RE, Trajman A. Latent tuberculosis infection among undergraduate medical students in Rio de Janeiro State, Brazil. Int J Tuberc Lung Dis 2005; 9:841-7. [PMID: 16104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
SETTING Five medical schools in three cities with different tuberculosis (TB) incidence rates in Rio de Janeiro State, Brazil. OBJECTIVE To estimate prevalence of and associated factors for latent tuberculosis infection (LTBI) among medical students. DESIGN A cross-sectional survey was conducted among undergraduate students in pre-clinical, early and late clinical years from schools in cities with low (28/100,000), intermediate (63/100,000) and high (114/100,000) TB incidence rates. Information on socio-demographic profile, previous BCG vaccination, potential TB exposure, co-morbidity and use of respiratory protective masks was obtained. A tuberculin skin test (TST) was performed using the Mantoux technique by an experienced professional. A positive TST, defined as induration > or = 10 mm, was considered LTBI. RESULTS LTBI prevalence was 6.9% (95%CI 5.4-8.6). In multivariate analysis, male sex (adjusted odds ratio [aOR] 1.8; 95% CI 1.1-3.0), late clinical years (aOR 1.9; 95% CI 1.01-3.5), intermediate TB incidence (aOR 4.3; 95% CI 1.3-14.6) and high TB incidence in the city of medical school (aOR 5.1; 95% CI 1.6-16.8) were significantly associated with LTBI. CONCLUSIONS The higher prevalence of LTBI in late clinical years suggests that medical students are at increased risk for nosocomial Mycobacterium tuberculosis infection. The implementation of a TB control program may be necessary in medical schools, particularly in cities with higher TB incidence.
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Affiliation(s)
- E G Teixeira
- Department of Internal Medicine, Gama Filho University, Rio de Janeiro, Brazil.
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Abstract
OBJECTIVE To summarize the epidemiological situation of tuberculosis (TB) in Brazil, especially as it relates to the evolution of the health sector in recent decades, the process of health sector reform, and current proposals of the Brazilian Ministry of Health. METHODS A review was conducted of data from the Ministry of Health of Brazil on tuberculosis in the country over the last 20 years, as well as of the history of changes in the health sector. RESULTS There have been major changes in the epidemiological situation of TB and also in the structure of the health system in Brazil. CONCLUSIONS The overall prospects are promising for Brazil's National Plan for Tuberculosis Control.
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Affiliation(s)
- A Ruffino-Netto
- Brazil, Ministry of Health, National Tuberculosis Program, Brasília, DF, Brazil.
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Kritski AL, Ruffino-Netto A. Health sector reform in Brazil: impact on tuberculosis control. Int J Tuberc Lung Dis 2000; 4:622-6. [PMID: 10907764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
This paper comments on the reform process of the health sector policies that took place after 1986 in Brazil, and its negative impact on the National Tuberculosis Control Programme (NTP). Decentralisation was followed by a slow transition from a vertical programme to an integrated programme. In 1990, the NTP was dismantled due to fiscal constraints, and in 1992, the NTP component was reorganised, with national and regional coordinators and subsequent increased support to state programmes. In 1996, the health sector reform continued its process, but this consisted mainly of cuts in health budgets and rapid decentralisation from federal level to unprepared states and municipalities, leading to the weakening of local tuberculosis control programmes. Only recently has government commitment been secured, with a new National Plan on Tuberculosis Control which includes the World Health Organization strategy for TB control--the implementation of the DOTS strategy (directly-observed treatment, short-course)--and efforts are being concentrated in 5500 municipalities. The programme has a centralised administration which supports decentralised implementation through out-patient clinics, and resources will be focused on local service delivery.
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Affiliation(s)
- A L Kritski
- Discipline of Pneumology, School of Medicine and University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
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Pontes RJ, Ruffino-Netto A. [Surveillance and active search of suspected cases of hemorrhagic dengue in Ribeirão Preto, São Paulo]. Rev Panam Salud Publica 1997; 1:186-92. [PMID: 9162587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A clinical-epidemiological case study was carried out to evaluate a surveillance and active search system for suspect cases of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) during a dengue epidemic in the Ribeirão Preto municipality, State of São Paulo, Brazil, between November 1990 and March 199. This was the first dengue epidemic ever recorded in this region. Although dengue is a growing public health problem in Brazil, and DHF/DSS has been reported to be evolving in the Americas, health officials have shown a passive attitude towards the disease, partly due to lack of experience. Reporting dengue occurrences, both of isolated cases and of epidemics, is essential to reduce mortality. The data analyzed were collected through the official epidemiological surveillance system during the 1990-1991 epidemic. Out of 2,521 confirmed cases of dengue, 34 cases of febrile acute illness with hemorrhagic manifestations were identified as possible cases of DHF/DSS, as well as two deaths associated to dengue. From these 36 cases, 12 cases were confirmed by laboratory exams as dengue with hemorrhagic manifestations. Examinations of clinical and laboratory data, and results of the autopsies suggested that the two deaths were cases of primary DHF/DSS. The difficulty of the health system in establishing the clinical suspicion of DHF/DSS was confirmed in the study. This resulted in delayed and inadequate clinical procedure. The present study also confirmed the need for a permanent active epidemiological surveillance system for the early identification of DHF/DSS suspect cases thus enabling quick and adequate control actions.
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Affiliation(s)
- R J Pontes
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Centro de Ciências de Saúde, Fortaleza, Cear, Brasil
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Abstract
An exercise for the estimation of the percentage risk of cases of tuberculosis attributable to co-infection HIV/AIDS, using the following formula, is propounded: RA%=p[m2r(hR-h)] + (1-p)[m3r (hR-h)]/p[m1+m2r (hR+1-h)] + (1-p)[m3r (hR+1-h)] x 100 where: p= proportion of BK infected, r= risk of tuberculosis infection, h= proportion of persons infected with HIV, m1= breakdown rate of endogenous tuberculosis, m2= breakdown rate of exogenous tuberculosis, m3= breakdown rate of primary tuberculosis, R= relative risk of morbidity among persons infected with HIV.
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Affiliation(s)
- A Ruffino-Netto
- Departamento de Medicina Social-Faculdade de Medicina de Ribeirao Preto-Universidade de Sao Paulo-Brasil
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Abstract
A dengue fever epidemic which occurred in Ribeirão Preto County, S. Paulo State, Brazil, during the period November, 1990 to March, 1991 has been analysed elsewhere. The general aspects of dengue epidemiology and control have been reviewed in this article. Emphasis is given to the analysis of some factors involved in the risk of dengue haemorrhagic fever and ecological aspects of the vector, as well as to the appropriateness of strategies for dengue eradication or control. Epidemiological characteristics of dengue, mainly those related to its occurrence in different geographical areas and periods of time are described. The Ribeirão Preto epidemic has thus, been set within the context of the spread of the disease at global level, in the Americas, and particularly in Brazil and S. Paulo State.
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Affiliation(s)
- R J Pontes
- Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Kerr-Pontes LR, Ruffino-Netto A. [Epidemiological study of Brazilian purpuric fever. Epidemic in a locality of São Paulo state (Brazil), 1986]. Rev Saude Publica 1991; 25:375-80. [PMID: 1820627 DOI: 10.1590/s0034-89101991000500009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A case control model was used in the study of an outbreak of Brazilian purpuric fever BPF which occurred in Serrana, S. Paulo State, Brazil, in 1986. Three hypotheses were raised: 1--purulent conjunctivitis is associated with BPF; 2--a cluster effect occurs in BPF; 3--respiratory symptoms may be a variation of the clinical picture of the disease. Numerical values were attributed to different findings, as follows: fever = 5; diarrhea and/or vomiting = 1; haemorrhagic findings = 3; thrombocytopenia and/or leukopenia = 3; Haemophilus aegyptius positive hemoculture and/or Haemophilus aegyptius positive cerebrospinal fluid culture and/or H. a. oropharynx culture = 7; Waterhouse Friedrichsen syndrome = 7. Those cases for which the sum total of points reached or exceeded 13 were considered as confirmed and those obtaining between 8 and 12 were considered as suspect. Children with a score below 5 were taken as control cases. Cases and controls were matched according to sex, age and socioeconomic level. The total groups studied included 14 confirmed cases, 38 suspect cases and 78 controls. It was concluded that purpuric fever is strongly associated with previous and/or present purulent conjunctivities; a cluster effect seems to occur; respiratory symptoms such as coughing and/or coryza were not associated with BPF.
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Affiliation(s)
- L R Kerr-Pontes
- Departamento de Medicina Social da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brasil
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Flores-Cardoso JC, Costa-Passos AD, Ruffino-Netto A. [Association of abreugraphic findings of the respiratory tract and clinical manifestations]. Rev Saude Publica 1989; 23:368-73. [PMID: 2636455 DOI: 10.1590/s0034-89101989000500002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A retrospective study of hospital charts was conducted for the purpose of analysing the association of roent-genphotographs obtained routinely at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Brazil, since 1967, with the records of respiratory symptoms and pneumopathic diagnosis found in the medical case histories as from the patients' first clinical out-patient consultation at that hospital. For this purpose, 997 patients with abnormal pulmonary roentgenphotography findings were matched according to sex and age with the same number of controls (normal roentgenphotography). It was observed that in one third of the medical histories there was no record of any anamnesis of the respiratory system. A greater proportion of respiratory symptoms and pneumopathic diagnoses was registered in the case group. The same finding separated the patients into two groups according to the severity of the lesions. Hemoptysis and thoracic pain were the symptoms that better differentiated sick from normal patients. A selective utilization of roentgenphotography is recommended, with the method being applied only to patients presenting hemoptysis, thoracic pain and cough/expectoration, either alone or in combination.
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Costa-Passos AD, Flores-Cardoso JC, Ruffino-Netto A. [Association of abreuographic findings of cardiomegaly and clinical manifestations]. Rev Saude Publica 1987; 21:29-36. [PMID: 2962269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Bechelli LP, Ruffino-Netto A, Hetem G. A double-blind controlled trial of pipotiazine, haloperidol and placebo in recently-hospitalized acute schizophrenic patients. Braz J Med Biol Res 1983; 16:305-11. [PMID: 6143579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Ninety recently-admitted acute schizophrenic patients, aged 18 to 40 years (mean age: 29) were stratified by schizophrenic subgroups, distributed at random among three groups (pipotiazine, haloperidol and placebo), and evaluated for 27 days by the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI). All groups received 20 mg of haloperidol and 50 mg of chlorpromazine im during the first 3 days, followed by wash-out for 2 days and then oral pipotiazine, haloperidol or placebo for the following 21 days. The dosage was adjusted to the clinical response of the patients and the mean dose was 21.4 mg for pipotiazine and 11.5 mg for haloperidol. At the end of the trial on the 27th day there was no significant difference between pipotiazine and haloperidol, but the effect of both active drugs was significantly different from that of the placebo. In the period corresponding to the 6th to 27th day, extrapyramidal side effects (EPS) occurred to the same extent in the pipotiazine and haloperidol groups, with predominance of Parkinsonian reactions, and no EPS were observed in the placebo group. Our data for a Brazilian population confirm the only other double-blind study of these drugs reported in the literature.
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Arantes GR, Ruffino-Netto A. [Case-finding in pulmonary tuberculosis. Photofluorography respiratory symptoms, followed by bacteriological examinations in suspected cases]. Rev Saude Publica 1980; 14:185-93. [PMID: 7013014 DOI: 10.1590/s0034-89101980000200004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Todos os 32.225 adultos matriculados durante um ano no Centro de Saúde de Ribeirão Preto, Estado de São Paulo, Brasil, foram interrogados quanto à presença de sintomas respiratórios e abreugrafados. Aos sintomáticos foi dada orientação para a colheita de escarro com vistas à baciloscopia e à cultura para bacilo da tuberculose. O exame abreugráfico selecionou 230 portadores de sombras anormais (0,75%) entre os 30.846 assintomáticos e 328 (23,8%) entre os 1.379 sintomáticos. Dos 90 doentes descobertos, 57 eram sintomóticos bacilíferos, 28 sintomáticos não-bacilíferos e 5 assintomáticos. Se a busca de casos tivesse sido realizada somente nos sintomáticos respiratórios, sem utilização da abreugrafia, 33 doentes deixariam de ser descobertos. Por sua vez a pesquisa apenas em sintomáticos portadores de sombras anormais teria economizado 30.846 abreugrafias deixando de descobrir só 5 casos assintomáticos, ou seja, clinicamente inexpressivos. Foi qualificado o potencial epidemiológíco desse tipo de caso concluindo-se que o mesmo é desprezível.
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Abstract
Estudou-se a associação entre o hábito de ingestão alcoólica e tuberculose pulmonar. Foi desenvolvida pesquisa utilizando metodologia do tipo caso-controle. Para cada caso (paciente portador de tuberculose pulmonar) tomou-se um controle (paciente não portador de tuberculose pulmonar), que foram pareados com respeito a idade, sexo, procedência e estado civil. Foram entrevistados 427 casos e 427 controles obtendo-se informações sobre o hábito de ingestão alcoólica (qualitativa e quantitativa). Concluiu-se que: 1. há associação entre alcoolismo e tuberculose pulmonar; 2. no período menor de 2 anos que precede a doença, é mais forte a associação entre tuberculose pulmonar e bebedores excessivos; 3. no período de dois a quatro anos que precede a doença, é mais forte a associação entre tuberculose pulmonar e bebedores adictos; 4. entre os alcoólatras, não há diferença significante quanto ao tipo de bebida consumida e/ou o ritmo de ingestão entre casos e controles.
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Ruffino-Netto A. [Tuberculin test]. AMB Rev Assoc Med Bras 1979; 25:257-9. [PMID: 317684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Estudou-se o possível sinergismo dos fatores alcoolismo e tabagismo na tuberculose pulmonar, a partir de dados de um estudo caso-controle onde 854 pessoas foram entrevistadas (sendo 427 casos-pacientes portadores de tuberculose pulmonar e 427 controles) e questionadas quanto ao hábito de ingestão alcoólica e o de fumar em períodos precedendo ao diagnóstico da doença. Concluiu-se que existe pequena interação destes fatores na tuberculose pulmonar; o hábito de fumar estaria relacionado com a doença tuberculose através de sua associação com a ingestão de bebidas alcoólicas.
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Mauad-Filho F, Silva RO, de Morais EN, Ruffino-Netto A, da Cunha SP, Jorge SM, Baruffi I, Martinez AR. [Value of meconium emission during labor]. AMB Rev Assoc Med Bras 1978; 24:179-83. [PMID: 308680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ruffino-Netto A, Sanches O, Arantes GR. [Application of the Bhattacharya method in the analysis of results of the tuberculin test]. Rev Saude Publica 1977; 11:322-9. [PMID: 601490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Arantes GR, Ruffino-Netto A. [Trends in the under-reporting of cases during the outbreak of meningococcal meningitis occurring in the State of São Paulo, Brazil, in the period 1971/75]. Rev Saude Publica 1977; 11:182-7. [PMID: 905746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Ruffino-Netto A. [Epidemiometric models in tuberculosis. Definition of "states" and risk of infection]. Rev Saude Publica 1977; 11:188-98. [PMID: 905747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Steagall-Gomes DL, Messias-Mendes IJ, Almeida MC, Ruffino-Netto A. [Centripetal and operational research of a focus of tuberculosis beginning with a tuberculin survey]. Rev Bras Enferm 1976; 29:106-14. [PMID: 1052005 DOI: 10.1590/0034-716719760004000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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