Factors associated with smoking among tuberculosis patients in Spain

BACKGROUND: To determine the prevalence of smoking and analyze associated factors in a cohort of patients diagnosed with tuberculosis (TB) in Spain between 2006 and 2013. METHODS: Multicenter, cross-sectional, descriptive, observational study using a national database of TB patients, using logistic regression to calculate odds ratios (OR) and confidence intervals (CI). RESULTS: We analyzed 5,846 cases (62 % men, mean age 39 years, 33 % foreigners). 23.4 % were alcohol abuser, 1.3 % were injected drug users (IDU), 4.6 % were co-infected with HIV, and 7.5 % had a history of TB treatment. 6.6 % and 0.8 % showed resistance to one and multiple drugs, respectively. The predominant clinical presentation was pulmonary (71 %) with a cavitary radiological pattern in 32.8 % of cases. 82 % of cases were confirmed microbiologically, and 54 % were smear-positive microscopy. 2,300 (39.3 %) patients were smokers. The following factors were associated with smoking: male sex (OR = 2.26;CI:1.97;2.60), Spanish origin (OR = 2.79;CI:2.40–3.24), alcoholism (OR = 2.85;CI:2.46;3.31), IDU (OR = 2.78;CI:1.48;5.52), homelessness (OR = 1.99;CI:1.14–3.57), pulmonary TB (OR = 1.61;CI:1.16;2.24), cavitary radiological pattern (OR = 1.99;CI:1.43;2.79) and a smear-positive microscopy at the time of diagnosis (OR = 1.39;CI:1.14;1.17). CONCLUSIONS: The prevalence of smoking among TB patients is high. Smokers with TB have a distinct sociodemographic, clinical, radiological and microbiological profile to non-smokers

Atraso na busca por serviço de saúde para o diagnóstico da tuberculose em Ribeirão Preto (SP) Delay in the search for health services for the diagnosis of tuberculosis in Ribeirao Preto, Sao Paulo

Foi analisado o atraso na busca por serviço de saúde para o diagnóstico da Tuberculose (TB) em Ribeirão Preto, 2009, em um estudo epidemiológico, transversal, realizado com 94 doentes. Utilizou-se questionário baseado no Primary Care Assessment Tool, adaptado para avaliar a atenção à TB. Estabeleceu-se a mediana (15 dias ou mais) para caracterizar atraso na busca pelo primeiro atendimento. Através da Razão de Prevalência, identificaram-se as variáveis relacionadas ao maior atraso. O primeiro serviço de saúde procurado foi o de pronto atendimento (57,4%). Verificou-se um maior tempo na procura pelos serviços de saúde entre os doentes: do sexo masculino; com idade entre 50 a 59 anos; com renda familiar inferior a cinco salários mínimos; forma pulmonar; casos novos; não coinfecção TB/HIV; não consumiam bebida alcoólica, conhecimento satisfatório sobre TB (apresentou significância estatística na associação com o atraso) e que não procuravam o serviço de saúde próximo do domicílio antes de ter TB. Verificou-se a necessidade de capacitação para os profissionais de saúde quanto aos sinais e sintomas da doença, reduzindo as barreiras de acesso ao diagnóstico oportuno da TB e divulgação ampla para a comunidade em geral.<br>The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general