Predicting smear negative pulmonary tuberculosis with classification trees and logistic regression: a cross-sectional study

BACKGROUND: Smear negative pulmonary tuberculosis (SNPT) accounts for 30% of pulmonary tuberculosis cases reported yearly in Brazil. This study aimed to develop a prediction model for SNPT for outpatients in areas with scarce resources. METHODS: The study enrolled 551 patients with clinical-radiological suspicion of SNPT, in Rio de Janeiro, Brazil. The original data was divided into two equivalent samples for generation and validation of the prediction models. Symptoms, physical signs and chest X-rays were used for constructing logistic regression and classification and regression tree models. From the logistic regression, we generated a clinical and radiological prediction score. The area under the receiver operator characteristic curve, sensitivity, and specificity were used to evaluate the model's performance in both generation and validation samples. RESULTS: It was possible to generate predictive models for SNPT with sensitivity ranging from 64% to 71% and specificity ranging from 58% to 76%. CONCLUSION: The results suggest that those models might be useful as screening tools for estimating the risk of SNPT, optimizing the utilization of more expensive tests, and avoiding costs of unnecessary anti-tuberculosis treatment. Those models might be cost-effective tools in a health care network with hierarchical distribution of scarce resources

Desenvolvimento de habilidades: estratégia de promoção da saúde e prevenção da gravidez na adolescência Desarrollo de habilidades: estrategia de promoción de la salud y la prevención del embarazo en la adolescencia Skills development: strategy for health promotion and prevention of pregnancy in adolescence

Trabalhar com desenvolvimento de habilidades em saúde sexual e reprodutiva do adolescente, na perspectiva da promoção da saúde para a prevenção da gravidez precoce, constitui um desafio para o enfermeiro. Para atender ao grupo em transformação biológica e psicossocial, há que considerar suas particularidades e exige crescimento para os protagonistas enfermeiros e adolescentes. O estudo teve como objetivo analisar as práticas do enfermeiro na prevenção da gravidez precoce na perspectiva do desenvolvimento de habilidades. Pesquisa descritivo-exploratória, com abordagem qualitativa, desenvolvida em Fortaleza, Ceará, tendo como técnica o grupo focal, cuja análise foi realizada por meio das práticas discursivas e mapas de associação de ideias. Os resultados revelaram que a promoção da saúde do adolescente é trabalhada na consulta de enfermagem e grupo de adolescentes, sendo este o espaço criativo, interativo e oportuno para o desenvolvimento de habilidades quanto à sexualidade e à prevenção da gravidez precoce.<br>Trabajar con desarrollo de habilidades en la salud sexual y reproductiva de los adolescentes desde la perspectiva de promoción de la salud en la prevención del embarazo se constituye un reto. Para asistir el grupo en transformación biológica y psicosocial, hay que tener en cuenta sus peculiaridades y se requiere madurez de los protagonistas enfermera y adolescentes. El objetivo fue examinar las prácticas de los enfermeros en la prevención del embarazo desde la perspectiva del desarrollo de competencias. Estudio descriptivo-exploratorio, cualitativo realizado en Fortaleza, Ceará, Brasil, con la técnica del grupo focal y análisis en las prácticas discursivas con el mapa de asociación de ideas. Los resultados revelaron que la promoción de la salud ocurre en la consulta de enfermería y en el grupo de adolescentes, cuyo espacio creativo e interactivo es adecuado para el desarrollo de habilidades relacionadas a la sexualidad y a la prevención del embarazo.<br>Work with the development of skills in sexual and reproductive health of adolescents from the perspective of health promotion for the prevention of the precocious pregnancy is a challenge to the nurse. To attend the group on psychosocial and biological transformation, we must consider their particular demands and growth for the protagonists: nurse and adolescent. The study had as objective to analyze the practice of the nurse in the prevention of the precocious pregnancy in view of skills development. Descriptive and exploratory research, with a qualitative approach, developed in Fortaleza, Ceará, Brazil, using the technique of the focal group, whose analysis was performed by means of discursive practices and maps of association of ideas. The results revealed that the promotion of adolescent health is worked out in the nursing consultation and adolescents groups, being this, a creative and interactive space and appropriate for the development of skills regarding sexuality and the prevention of precocious pregnancy