Tuberculose pulmonar: estudo do abandono do tratamento na visão de profissionais de saúde de Belo Horizonte, MG

Submitted by Nuzia Santos ([email protected]) on 2015-04-14T17:35:49Z No. of bitstreams: 1 Tese SC AnaPaulaBarbosaWendling Atualizada.pdf: 377784 bytes, checksum: d4881bc58e07b8f2a759ba52f130e4b1 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-04-14T17:35:57Z (GMT) No. of bitstreams: 1 Tese SC AnaPaulaBarbosaWendling Atualizada.pdf: 377784 bytes, checksum: d4881bc58e07b8f2a759ba52f130e4b1 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-04-14T17:36:06Z (GMT) No. of bitstreams: 1 Tese SC AnaPaulaBarbosaWendling Atualizada.pdf: 377784 bytes, checksum: d4881bc58e07b8f2a759ba52f130e4b1 (MD5)Made available in DSpace on 2015-04-14T17:36:06Z (GMT). No. of bitstreams: 1 Tese SC AnaPaulaBarbosaWendling Atualizada.pdf: 377784 bytes, checksum: d4881bc58e07b8f2a759ba52f130e4b1 (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.A tuberculose é um importante problema de saúde pública no que se refere à mortalidade e morbidade do mundo. O Brasil é o décimo quinto país em número de casos entre os 22 países responsáveis por 80% do total de casos de tuberculose no mundo. Apesar de todas as ações governamentais para o combate da doença como medicações gratuitas, orientações aos pacientes e a implantação do tratamento supervisionado, ocorre uma alta incidência de abandono do tratamento, o que torna desfavoráveis os índices atuais do quadro epidemiológico de tuberculose no país. Assim, atualmente, a tuberculose é considerada o mais significativo problema na prática médica em comparação com outros desafios da área. Diversos estudos abordam o problema da adesão e/ou abandono do tratamento e o cumprimento das diretrizes do Programa Nacional de Controle da Tuberculose (PNCT). A literatura aponta vários aspectos que contribuem para o abandono, bem como diversos fatores que podem promover uma maior adesão ao tratamento. Contudo, há ainda lacunas relevantes a serem investigadas, uma delas, caracterizada pela ação dos profissionais de saúde e estrutura dos serviços de saúde para o cumprimento do PNCT. Neste contexto, o presente estudo teve por objetivo analisar o abandono do tratamento por pacientes com tuberculose pulmonar na visão de nove gerentes de diferentes Centros de Saúde de três regiões administrativas de saúde de Belo Horizonte, Minas Gerais, identificadas como locais onde o fenômeno é mais freqüente. Optou-se por um estudo qualitativo através da abordagem da pesquisa estratégica, utilizando-se a entrevista semi-estruturada como instrumento de investigação. A Análise de Conteúdo, segundo Bardin, possibilitou organizar os relatos dos entrevistados e identificar as categorias mais relevantes e diversas subcategorias, sistematizadas em oito grandes eixos temáticos: (1) organização do Serviço de Saúde em relação ao registro e acompanhamento dos pacientes com tuberculose; (2) o Sistema Único de Saúde (SUS), as equipes de saúde da família e os processos de atendimento e tratamento dos pacientes; (3) o abandono do tratamento; (4) estigma e preconceito em relação à doença e ao paciente; (5) comportamento dos pacientes e de suas famílias em relação à doença; (6) propostas ou perspectivas para solucionar problemas; (7) material educativo e ações de educação em saúde; (8) reflexos das políticas públicas na estruturação do serviço e intercâmbio de experiências. Em geral, as causas do abandono na visão dos gerentes se referem a problemas pessoais dos pacientes, cujo perfil é associado a desestrutura familiar, vícios, complicações psicológicas e dificuldades econômicas. Como agravante são apontados estigmas quanto à doença pelo próprio paciente e nas atitudes de alguns profissionais de saúde e familiares dos mesmos. Com menor importância são também associados como causa do abandono a falta de infraestrutura dos serviços e de alguns especialistas nas equipes multidisciplinares, aspectos dos próprios serviços de saúde. Compreender os motivos do abandono possibilita sugerir e elaborar alternativas para ampliar a adesão e conclusão do tratamento, como políticas públicas específicas, ações de educação em saúde e de mobilização social, de forma que a assistência seja integrada à família e aos profissionais de saúde.Tuberculosis is a major public health problem with regard to mortality and morbidity in the world. Among the 22 countries responsible for 80% of all cases of tuberculosis worldwide, Brazil ranks at the fifteenth place in number of cases. Despite all government actions to combat the disease, such as free medication, guidelines for patients and supervised treatment plan, incidence of noncompliance remains high, which makes the current epidemiological situation of tuberculosis in the country unfavorable. Therefore actually tuberculosis is considered the most significant problem in medical practice compared to other challenges in the area. Several studies address the issue of treatment abandonment and compliance to the guidelines of the National Tuberculosis Control Program (PNCT). The literature reports several aspects that contribute to the abandonment, as well as various factors that may promote greater adherence to treatment. However, there are still important gaps to be investigated, one of which characterized by the action of health professionals and by health service infrastructure to comply with the PNCT. In this context, the current study aimed to analyze the treatment abandonment of patients with pulmonary tuberculosis in the perception of nine managers from different health centers in three administrative health regions of Belo Horizonte, Minas Gerais, Brazil, identified as places where the phenomenon is more frequent. A qualitative study based on strategic research using the semi-structured interview as a research tool was carried out. The Content Analysis Technique according to Bardin made it possible to organize the reports of interviewers and to identify the most relevant categories and several subcategories, systematized into eight major themes: (1) organization of the Health Service in relation to registration and monitoring of patients with tuberculosis; (2) the Unified Health System (SUS – Sistema Único de Saúde), the Family Health Teams (named Estratégia de Saúde da Família) and the processes of care and treatment of patients, (3) the abandonment of treatment, (4) stigma and prejudice against the disease and the patient, (5) behavior of patients and their families in relation to the disease, (6) proposals of problem solving or perspectives, (7) educational materials and health education activities, (8) reflections about public policy in shaping the service and exchange of experiences. In general, the reasons for treatment abandonment in the perception of managers refer to personal problems of patients, whose profile is associated with family disruption, addiction, economic difficulties and psychological complications. As aggravating factors are also pointed out stigmas about the disease by the proper patients and attitudes of some health professionals and family members of these patients. The lack of infrastructure and absence of some specialists in multidisciplinary teams are also associated as a cause of abandonment, but with minor importance. The understanding of the motives for the abandonment makes it possible to suggest and develop new alternatives to improve treatment adherence and compliance, such as specific public policies, permanent actions of health education and social mobilization, in order to integrate this form of assistance into the family and health professionals’ support

Desempenho da pesquisa de anticorpos antiTrypanosoma cruzi, por citometria de fluxo, na monitoração precoce de cura pósterapêuticaetiológica da doença de Chagas

Exportado OPUSMade available in DSpace on 2019-08-10T17:48:49Z (GMT). No. of bitstreams: 1 ana_paula_barbosa_wendling.pdf: 1811254 bytes, checksum: f15a811cd8512d3c4d1ff2cb85271784 (MD5) Previous issue date: 28O objetivo da terapeutica especifica da fase cronica da doenca de Chagas e a reducao da parasitemia, alem da prevencao e reducao dos sintomas. Entretanto, a monitoracao da eficacia do tratamento ainda e insatisfatoria, devido a ausencia de metodos laboratoriais quecertifiquem a cura. Atualmente, o criterio de cura utilizado por diversos pesquisadores baseiase na negativacao de testes sorologicos e parasitologicos. Diversos estudos mostram que apos a terapia especifica, os testes sorologicos podem permanecer positivos por decadas. A introducao de tecnicas mais sensiveis como a pesquisa de anticorpos por citometria de fluxo trouxe novas perspectivas no monitoramento de cura da doenca de Chagas. Neste contexto,realizamos dois estudos que objetivaram avaliar o desempenho das tecnicas de FC-AFEA e FC-ALTA na avaliacao pos-terapeutica. Nossos resultados mostraram que, em um estudo retrospectivo em uma populacao com 10 a 15 anos de acompanhamento pos-terapeutico(n=60), a FC-AFEA foi capaz de discriminar pacientes chagasicos curados daqueles nao curados. Em virtude da alta sensibilidade do metodo, foram necessarias modificacoes do criterio de positividade da tecnica original utilizado para diagnostico, como o emprego dediluicoes mais altas e elevacao do ponto de corte. Em outro estudo, prospectivo, ao longo de cinco anos de acompanhamento pos-terapeutico (n=44), nenhum dos metodos sorologicos utilizados (FC-AFEA, FC-ALTA, IFI, HAI, ELISA, PaGIA) evidenciou soronegatividade.Entretanto, observou-se que o tratamento etiologico induziu queda na reatividade de FCAFEA e FC-ALTA. Ainda, no grupo de pacientes tratados que apresentavam hemoculturas pos-tratamento negativas (TEA), foi possivel identificar dois subgrupos de pacientes de acordo com a magnitude da queda na reatividade, sendo provavel que pacientes com sucesso terapeutico estejam compreendidos entre aqueles que evoluiram com maior queda de reatividade. Dentre os testes sorologicos convencionais empregados tambem nesta populacao, a HAI mostrou maior variacao dos titulos, dificultando seu emprego na monitoracao recente de cura e mostrando-se insatisfatorio no controle de cura. A IFI foi capaz de identificar queda na reatividade . 2 titulos em alguns pacientes do grupo TEA. A ELISA e o PaGIA, da forma como estao padronizados para uso no diagnostico, nao foram capazes de segregar pacientes tratados ou nao, indicando que para seu uso na monitoracao de cura, os criterios de positividade devam ser adequados. Conclui-se que o uso de testes sorologicos apresenta limitacoes na definicao de cura precoce apos tratamento etiologico da forma cronica da doenca de Chagas. A verificacao de ausencia de anticorpos anti-proteinas derivadas do agente infeccioso parece ser um criterio inadequado de cura. Devem-se incentivar estudos objetivando a procura de outros marcadores associados a presenca ativa da infeccao que nao apresenca de anticorpos anti-T. cruzi.Specific therapy of chronic Chagas disease aims mainly to reduce parasitemia, besides preventing and reducing symptoms. However, monitoring treatment efficacy still remains unclear due to the lack of laboratorial methods that could certify a complete parasitologicalcure. Currently, the cure criteria used by various researchers is based on repeated serological and parasitological negative tests. Several studies have shown that serology can remain positive for decades after specific therapeutics. The introduction of highly sensitive techniques such as specific antibodies detection by flow citometry brought new perspectivesin Chagas disease cure monitoring. Herein, we developed two studies aiming to evaluate the performance of FC-AFEA and FC-ALTA techniques on post therapeutic evaluation. Our results showed that in a retrospective study using a population with 10 to 15 years of followup after specific therapeutics (n=60), FC-AFEA was capable to segregate cured chagasicpatients from non cured ones. Since the method presents a very high sensitivity, some modifications on the original technique, like the utilization of higher dilutions and higher cutoffs, were shown to be necessary. In a prospective study along five years of post therapeuticfollow-up (n=44), none of the serological methods used (FC-AFEA, FC-ALTA, IIF, IHA, ELISA, PaGIA) evidenced seronegativity. Nevertheless, we observed that the etiological treatment induced a decrease on FC-AFEA and FC-ALTA reactivity intensity. In addition, in patients presenting post therapy negative hemocultures (TEA), we could identify two subgroups of patients based on their magnitude of reactivity decrease. It is possible that patients with therapeutic success are included in the subgroup presenting higher reactivity decrease. Among the conventional serological tests applied in this study, IHA showed moretiter variations, creating difficulties for its use on cure monitoring. IIF was capable to identify reactivity decrease in more than 2 titers in some patients of TEA group. ELISA and PaGIA, in the way they are standardized for diagnostic proposal, were not able to segregate treated andnon-treated patients, indicating that modifications on the criterion have to be made for cure monitoring. Therefore, we conclude serology presents important limitations on early cure definition after etiological treatment of chronic Chagas disease. Seroreversion seems to be an inadequate approach for this purpose. Studies should be supported in order to investigate other markers associated to the presence of active infection other than searching for anti-T. cruzi antibodies

Abandonment of tuberculosis treatment in the perspective of Health Centers managers in Belo Horizonte-MG, Brazil

Made available in DSpace on 2014-12-10T10:37:47Z (GMT). No. of bitstreams: 1 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2012Submitted by Gilvan Almeida ([email protected]) on 2016-08-09T17:28:07Z No. of bitstreams: 1 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5)Approved for entry into archive by Leandro Borges ([email protected]) on 2016-08-11T18:31:39Z (GMT) No. of bitstreams: 2 Wendling_Ana_etal_CPqRR_2012.pdf: 249531 bytes, checksum: 262f1731cda608a82ee5929970b03bc6 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5)Made available in DSpace on 2016-08-11T18:31:39Z (GMT). No. of bitstreams: 2 Wendling_Ana_etal_CPqRR_2012.pdf: 249531 bytes, checksum: 262f1731cda608a82ee5929970b03bc6 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Centro de Pesquisa René Rachou. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisa René Rachou. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisa René Rachou. Belo Horizonte, MG, Brasil.The Brazilian National Tuberculosis Control Program requires the organization and proper functioning of health services to meet the principle of intregality, one of the pillars of the Brazilian Unified Health System and the most important orientation for tuberculosis control. This study aims to investigate, in the perspective of nine managers of health centers in Belo Horizonte, MG, Brazil, aspects concerning the functioning of the services they coordinated, associated to noncompliance with tuberculosis treatment and the feasibility of meeting Program guidelines. Data were collected through semi-structured interviews and interpreted by means of thematic content analysis. Reports indicate that health services did not comply with the integrality orientation, requiring better organization and continuing education processes of health professionals to deal with abandonment and to develop new alternatives to improve treatment adherence and compliance

Tuberculosis: stigma in the view of health centers managers of Belo Horizonte, MG, Brazil

Made available in DSpace on 2014-12-10T10:37:50Z (GMT). No. of bitstreams: 1 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2010Submitted by Gilvan Almeida ([email protected]) on 2016-08-09T17:27:55Z No. of bitstreams: 1 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5)Approved for entry into archive by Leandro Borges ([email protected]) on 2016-08-17T05:00:04Z (GMT) No. of bitstreams: 2 ANA_WENDLING_etal_CPqRR_2010.pdf: 69212 bytes, checksum: 98f92dd248ce989b46d6b45646f373e4 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5)Made available in DSpace on 2016-08-17T05:00:04Z (GMT). No. of bitstreams: 2 ANA_WENDLING_etal_CPqRR_2010.pdf: 69212 bytes, checksum: 98f92dd248ce989b46d6b45646f373e4 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Belo Horizonte, MG, BrasilO presente artigo buscou analisar como gerentes de diferentes Centros de Saúde de Belo Horizonte, MG, percebem a tuberculose. Trata-se de um estudo qualitativo a partir de entrevistas semi-estruturadas com nove gerentes. Os dados transcritos foram categorizados e interpretados com base na técnica de Análise de Conteúdo. A análise das categorias indicou que é recorrente a referência ao estigma e ao preconceito quanto à própria doença, ao paciente, bem como nas atitudes de alguns profissionais de saúde e familiares dos pacientes. Os relatos foram pontuados por diversos exemplos de como os doentes, seus familiares e a sociedade lidam com essa questão. A presença do estigma, a responsabilização da doença associada ao perfil do paciente e falta de apoio familiar, a ausência de processos de educação permanente e de troca de experiência entre os diversos serviços de saúde indicam prejuízo à atenção à saúde. Tais evidências direcionam para a necessidade de políticas públicas mais efetivas para o controle da doença.This paper analyses the view of health centers managers from three health administrative areas of Belo Horizonte, MG, Brazil about the stigma associated with tuberculosis and their consequences for the health of the patient and disease control. The qualitative analysis considers the opinions of nine managers interviewed and interprets them based on the Content Analysis Technique. The analysis indicated that the interviewed reported the presence of stigma related to the disease itself, the patient, as well as in the attitudes of some health professionals and patients' relatives. The reports included several examples of how patients, their families and society deal with this issue. The presence of stigma, the association of the disease with the patient's profile and lack of family support, lack of strategies for continuing education and exchange of experience between the various health services indicate failures in health care. Such evidences indicate the need for more effective public policies and permanent educative process to control the disease

Systemic Immunological changes in patients with distinct clinical outcomes during Mycobacterium tuberculosis infection.

Background: The lung lesions in an individual infected with tuberculosis (TB) are surprisingly variable and independent of each other. However, there is no circulating biomarker yet able to segregate patients according to the extent of lung lesions. Materials and methods: In this study, the phenotypic and functional profile of leukocytes of patients with active pulmonary tuberculosis (TB) and controls (CO) were fully scrutinized by immunophenotyping assays and in vitro short-term whole blood culture. The TB group was subdivided according to the extent of lung lesions as unilateral (UNI) and bilateral (BI). Results: The results show that TB group display an altered leukocyte profile in the peripheral blood with significant lower counts of NK-cells, CD3+CD56+CD16+/− NKT-cells, CD4+T-cells, CD19+B-cells when compared to CO. Increased CD4+T-cells and CD8+T-cell activation was observed by the upregulation of activation markers (HLA-DR) as well as of chemokine receptors (CCR2, CCR3, and CXCR4). In addition, TB group presented a significant decrease proportion of CD14LowCD16+ monocytes despite the increase in HLA-DR expression. Regarding the severity of the disease, in the BI group a reduction in frequency of CD19+CD5+ B-cells and expression of HLA-DR in CD14LowCD16+ monocytes was observed. Furthermore, the extent of lung lesions influences the production of molecules as observed by significantly larger production of IL-4 by neutrophils, total T-cells, CD4+T-cells, CD8+T-cells and CD19+B-cells in UNI as compared to BI. By contrast, in BI group the frequency of high producers of both IL-17+CD4+T-cells and IL-17+CD8+T-cells were significantly increased than UNI, suggesting the deleterious role of these subsets during active pulmonary Mtb infection. Conclusion: The immunophenotypic characterization of unilateral and bilateral active TB performed in the present study indicates that the extent of lung lesion could be associated with a fine-tuning between immunological responses during untreated Mtb infection