The Silences Framework: A Method for researching sensitive themes and marginalized health perspectives (English version)

Objective: To describe the experience of applying of The Silences Framework to underpin health research investigating Tuberculosis/HIV/AIDS coinfection . Method: The Silences Framework originally developed following a study exploring the decisions and silences surrounding black Caribbean men living in England, discussing the themes 'sexual health' and 'ethnicity'. Following this study a conceptual a theory for research on sensitive issues and health care of marginalized populations was developed called 'Screaming Silences' which forms the foundation of The Silences Framework. Screaming Silences define research areas and experiences that are poorly studied, little understood or silenced. Results: The Silences Framework supports researchers in revealing "silences" in the subjects they study - as such results may reflect how beliefs, values, and experiences of some groups influence their health. This framework provides the application of four complementary stages: working the silences, hearing silences, voicing silences and working with the silences. The analysis occurs cyclically and can be repeated as long as the silences inherent in a study are not revealed. Conclusion: this article presents The Silences Framework and the application of the notion of "sounds of silence", mapping an antiessentialist theoretical framework for its use in sensitive research in health and nursing areas, being a reference for other researchers in studies involving marginalized populations. KEYWORDS: Inequalities in health. Methods. Nursing. Coinfection. Research. Tuberculosis. Acquired immunodeficiency syndrome

Representações sociais das pessoas com tuberculose sobre o abandono do tratamento

Objetivo: Compreender as representações sociais das pessoas com tuberculose sobre o abandono do tratamento em um Programa de Controle da Tuberculose.Método: Estudo descritivo, de abordagem qualitativa, realizado num município de Lima, Peru. Os dados foram coletados de outubro a novembro de 2012, através de entrevistas semiestruturadas, com oito pessoas, e analisados conforme a técnica de análise temática de conteúdo.Resultados: As categorias levaram à construção da representação social de que a doença e o tratamento trazem sofrimento. Esta representação influencia na não adesão ao tratamento, podendo gerar um incremento de casos de abandono.Conclusão: São necessárias estratégias educativas ligadas a processos de interação social, à subjetividade e ao contexto do paciente, direcionadas a diminuir o abandono do tratamento da tuberculose, as recidivas, a multirresistência. Novos desafios são apontados diante das avaliações frente ao alcance dos Objetivos de Desenvolvimento do Milênio.Palavras-chave: Recusa do paciente ao tratamento. Enfermagem. Tuberculose. Objetivos de Desenvolvimento do Milênio

Tuberculosis recurrence in a high incidence setting for HIV and tuberculosis in Brazil

Background: To compare epidemiological data between recurrent cases after cure (RC), distinguishing relapse from reinfection, after dropout (RD) and new cases (NC) in an ambulatory setting in a TB-endemic country. Methods: Records of patients who started treatment for pulmonary TB between 2004 and 2010 in a TB clinic were reviewed. Epidemiological data were analyzed. Spoligotyping and MIRU patterns were used to determine relapse or reinfection in 13 RC available. Results: Of the eligible group (1449), 1060 were NC (73.2%), among the recurrent cases, 203 (14%) were RC and 186 (12.8%) were RD. Of RC, 171 (84.2%) occurred later than 6 months after a previous episode, 13 had available DNA, in 4 (30.7%) the disease was attributed to reinfection and in 9 (69.3%), to relapse. Comparing RC to NC, HIV (p < 0.0001) was independent risk factor for RC. When RC and RD were compared, alcohol abuse (p = 0.001) and treatment noncompliance (p = 0.006) were more frequent in RD. Conclusions: HIV is the sole more important associated factor for RC. This finding points the need to improve the approach to manage TB in order to decrease the chance for exposure especially in vulnerable people with increased risk of developing disease and to improve DOTS strategy to deal with factors associated to treatment noncompliance