Health services performance for TB treatment in Brazil: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions.</p> <p>Methods</p> <p>This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the <it>Primary Care Assessment Tool </it>adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites.</p> <p>Results</p> <p>"Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP.</p> <p>Conclusions</p> <p>Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.</p

Efetividade no diagnóstico da tuberculose em Foz do Iguaçu, tríplice fronteira Brasil, Paraguai e Argentina

Objetivou-se avaliar a efetividade dos serviços de saúde no diagnóstico da tuberculose em Foz do Iguaçu-PR. Realizou-se uma pesquisa avaliativa, com desenho epidemiológico transversal. Foram entrevistados 101 doentes de tuberculose em 2009, utilizando um instrumento baseado no Primary Care Assessment Tool . A análise ocorreu a partir de proporções e respectivos intervalos de confiança (95%) e mediana. O Pronto Atendimento (37%) e a Atenção Básica à Saúde (ABS) (36%) foram os locais mais buscados. O acesso à consulta no mesmo dia alcançou 70%, mas a suspeição da doença foi menor que 47%; a baciloscopia realizada em 50% dos doentes. Concluiu-se que apesar desses serviços atenderem rapidamente, isso não determinou alcance do diagnóstico, levando o doente a procurar os serviços especializados, mais efetivos na descoberta dos casos. A busca pela ABS gerou maior tempo e maior número de retornos para o diagnóstico da tuberculose na tríplice fronteira

Pampean lizard assemblage from subtropical Brazil: a temporal analysis

The increasing human occupation of natural environments is one of the greatest threats to biodiversity. To mitigate the negative anthropogenic effects, it is necessary to understand the characteristics of natural populations and the natural history of species. A study was conducted with an assemblage of lizards from a disturbed area of the Pampa biome, from February 2001 to January 2004. The assemblage showed a unimodal seasonal pattern, with the recruitment period occurring during the warmer months. The captures were seasonal for two of the three monitored years, and concentrated within warmer months. The minimum temperature explained the number of catches for the assemblage as a whole. However, when the species were analyzed individually, the temperature only explained the seasonal occurrence of Teius oculatus. The abundance of species was significantly different in the third year of study for Cercosaura schreibersii and Ophiodes striatus. This latter species was no longer registered in the study area from May 2003 until the end of the study. Therefore, O. striatus may be more sensitive to environmental changes, considering the events of change in vegetation during the study. With frequent and increasing environmental disturbances, it is necessary to take conservation measures and encourage the increase of knowledge on Pampean lizards.O crescimento da ocupação humana sobre ambientes naturais é uma das maiores ameaças à biodiversidade. Para amenizar os efeitos negativos antropogênicos, é necessário entender as características das populações naturais, e a história natural das espécies. Um estudo foi conduzido com uma assembeia de lagartos de uma área perturbada do Pampa, de fevereiro de 2002 a janeiro de 2004. A assembleia apresentou padrão sazonal unimodal, com recrutamento ocorrendo durante os meses mais quentes. As capturas foram sazonais durante dois dos três anos monitorados, e concentradas nos meses mais quentes. A temperatura mínima explica o número de capturas para a assembleia como um todo. Entretanto, quando as espécies foram analisadas individualmente, a variável explica apenas a ocorrência sazonal de Teius oculatus. A abundância das espécies foi significativamente distinta no terceiro ano de estudo para Cercosaura schreibersii e Ophiodes striatus. Essa última espécie não teve mais registros na área de maio de 2003 até o final do estudo. Assim, O. striatus pode ser mais sensível às udanças abientais, considerando os eventos de udança na vegetação ocorridas durante o estudo. Com as frequentes e crescentes perturbações ambientais que o bioma vem sofrendo, são necessárias ações de conservação, e dar suporte para o aumento do conhecimento dos lagartos pampeanos

Spider species richness and sampling effort at Cracraft´S Belém Area of Endemism

ABSTRACT A list of spider species is presented for the Belém Area of Endemism, the most threatened region in the Amazon Basin, comprising portions of eastern State of Pará and western State of Maranhão, Brazil. The data are based both on records from the taxonomic and biodiversity survey literature and on scientific collection databases. A total of 319 identified species were recorded, with 318 occurring in Pará and only 22 in Maranhão. About 80% of species are recorded at the vicinities of the city of Belém, indicating that sampling effort have been strongly biased. To identify potentially high-diversity areas, discounting the effect of variations in sampling effort, the residues of a linear regression between the number of records and number of species mapped in each 0.25°grid cells were analyzed. One grid, representing the Alto Turiaçu Indigenous land, had the highest deviation from the expected from the linear regression, indicating high expected species richness. Several other grid cells showed intermediate values of the regression residuals, indicating species richness moderately above to the expected from the model

Survey for Leptospira and Brucella in Amazonian manatees, Amazon river dolphins, and a tucuxi in the Brazilian Amazon

Leptospirosis and brucellosis are zoonotic diseases with global distributions that represent severe hazards to humans and animals. We investigated exposure to Leptospira spp. and Brucella spp. in samples from Amazonian manatees Trichechus inunguis, Amazon river dolphins Inia geoffrensis, and a tucuxi Sotalia fluviatilis. The animals were free-ranging or undergoing in situ rehabilitation in the mid-Solimões River region, Brazilian Amazon. Serum samples from 19 Amazonian manatees were tested by microscopic agglutination test, Rose Bengal test, and 2-mercaptoethanol Brucella agglutination test. Antibodies against Leptospira spp. were detected in 63% of the manatees tested and serovar Patoc was considered the infecting serovar in all positive samples. Titers were generally low, indicating chronic exposure, but higher titers indicative of an active infection were detected in 3 animals. Anti-Brucella spp. antibodies were not detected. Tissue and/or body fluid samples from 12 Amazon river dolphins, a tucuxi, and 2 Amazonian manatees were investigated by multiplex PCR and bacteriology for Leptospira spp. and Brucella spp. All samples were negative. However, Enterococcus faecalis was isolated from uterine fluid, lymph node, and lung of 3 Amazon river dolphins. Bacillus spp. were isolated from milk and synovial fluid from 2 Amazon river dolphins and from a milk sample from 1 Amazonian manatee. Knowledge of the pathogens present in Amazonian manatees, Amazon river dolphins, and tucuxis is of great relevance to species conservation and environmental health. Although no clinical signs were noted, further research is needed to elucidate the clinical relevance of infection by Leptospira sp. serovar Patoc in Amazonian aquatic mammals.</jats:p