135 research outputs found

    The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review

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    Background Brazil has the largest public health-system in the world, with 120 million people covered by its free primary care services. The Family Health Strategy (FHS) is the main primary care model, but there is no consensus on its impact on health outcomes. We systematically reviewed published evidence regarding the impact of the Brazilian FHS on selective primary care sensitive conditions (PCSC). Methods We searched Medline, Web of Science and Lilacs in May 2016 using key words in Portuguese and English, without language restriction. We included studies if intervention was the FHS; comparison was either different levels of FHS coverage or other primary health care service models; outcomes were the selected PCSC; and results were adjusted for relevant sanitary and socioeconomic variables, including the national conditional cash transfer program (Bolsa Familia). Due to differences in methods and outcomes reported, pooling of results was not possible. Results Of 1831 records found, 31 met our inclusion criteria. Of these, 25 were ecological studies. Twenty-one employed longitudinal quasi-experimental methods, 27 compared different levels the FHS coverage, whilst four compared the FHS versus other models of primary care. Fourteen studies found an association between higher FHS coverage and lower post-neonatal and child mortality. When the effect of Bolsa Familia was accounted for, the effect of the FHS on child mortality was greater. In 13 studies about hospitalizations due to PCSC, no clear pattern of association was found. In four studies, there was no effect on child and elderly vaccination or low-birth weight. No included studies addressed breast-feeding, dengue, HIV/AIDS and other neglected infectious diseases. Conclusions Among these ecological studies with limited quality evidence, increasing coverage by the FHS was consistently associated with improvements in child mortality. Scarce evidence on other health outcomes, hospitalization and synergies with cash transfer was found

    Record linkage under suboptimal conditions for data-intensive evaluation of primary care in Rio de Janeiro, Brazil

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    Background Linking Brazilian databases demands the development of algorithms and processes to deal with various challenges including the large size of the databases, the low number and poor quality of personal identifiers available to be compared (national security number not mandatory), and some characteristics of Brazilian names that make the linkage process prone to errors. This study aims to describe and evaluate the quality of the processes used to create an individual-linked database for data-intensive research on the impacts on health indicators of the expansion of primary care in Rio de Janeiro City, Brazil. Methods We created an individual-level dataset linking social benefits recipients, primary health care, hospital admission and mortality data. The databases were pre-processed, and we adopted a multiple approach strategy combining deterministic and probabilistic record linkage techniques, and an extensive clerical review of the potential matches. Relying on manual review as the gold standard, we estimated the false match (false-positive) proportion of each approach (deterministic, probabilistic, clerical review) and the missed match proportion (false-negative) of the clerical review approach. To assess the sensitivity (recall) to identifying social benefits recipients’ deaths, we used their vital status registered on the primary care database as the gold standard. Results In all linkage processes, the deterministic approach identified most of the matches. However, the proportion of matches identified in each approach varied. The false match proportion was around 1% or less in almost all approaches. The missed match proportion in the clerical review approach of all linkage processes were under 3%. We estimated a recall of 93.6% (95% CI 92.8–94.3) for the linkage between social benefits recipients and mortality data. Conclusion The adoption of a linkage strategy combining pre-processing routines, deterministic, and probabilistic strategies, as well as an extensive clerical review approach minimized linkage errors in the context of suboptimal data quality

    Shortened first-line TB treatment in Brazil: potential cost savings for patients and health services.

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    BACKGROUND: Shortened treatment regimens for tuberculosis are under development to improve treatment outcomes and reduce costs. We estimated potential savings from a societal perspective in Brazil following the introduction of a hypothetical four-month regimen for tuberculosis treatment. METHODS: Data were gathered in ten randomly selected health facilities in Rio de Janeiro. Health service costs were estimated using an ingredient approach. Patient costs were estimated from a questionnaire administered to 126 patients. Costs per visits and per case treated were analysed according to the type of therapy: self-administered treatment (SAT), community- and facility-directly observed treatment (community-DOT, facility-DOT). RESULTS: During the last 2 months of treatment, the largest savings could be expected for community-DOT; on average USD 17,351-18,203 and USD 43,660-45,856 (bottom-up and top-down estimates) per clinic. Savings to patients could also be expected as the median (interquartile range) patient-related costs during the two last months were USD 108 (13-291), USD 93 (36-239) and USD 11 (7-126), respectively for SAT, facility-DOT and community-DOT. CONCLUSION: Introducing a four-month regimen may result in significant cost savings for both the health service and patients, especially the poorest. In particular, a community-DOT strategy, including treatment at home, could maximise health services savings while limiting patient costs. Our cost estimates are likely to be conservative because a 4-month regimen could hypothetically increase the proportion of patients cured by reducing the number of patients defaulting and we did not include the possible cost benefits from the subsequent prevention of costs due to downstream transmission averted and rapid clinical improvement with less side effects in the last two months

    Disseminated tuberculosis presenting with polymorphonuclear effusion and septic shock in an HIV-seropositive patient: a case report

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    <p>Abstract</p> <p>Introduction</p> <p>Because a substantial number of patients present with few or atypical symptoms, the recognition of tuberculosis remains challenging. Disseminated tuberculosis presenting with septic shock has already been described in some case reports, but, to the best of our knowledge, it has never been associated with polymorphonuclear effusion.</p> <p>Case presentation</p> <p>We describe the case of a 27-year-old man from western Africa who was seropositive for human immunodeficiency virus. He presented with pleural and abdominal polymorphonuclear effusions and quickly developed septic shock due to disseminated <it>Mycobacterium tuberculosis </it>infection leading to multiple organ failure and death.</p> <p>Conclusion</p> <p>In high-risk patients, <it>Mycobacterium tuberculosis </it>infection should be considered even in exceptional clinical presentations, such as septic shock and polymorphonuclear effusions.</p

    Duas décadas de pesquisa em tuberculose no Brasil: estado da arte das publicações científicas

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    The trends of scientific articles about tuberculosis in Brazil published between 1986 and 2006 were analyzed. This analysis included Capes database-indexed dissertations and theses and papers indexed in Medline and SciELO. Papers containing the word "tuberculosis" and authors affiliated to Brazilian institutions were included in the assessment. The analysis showed initially case report and review publications, and later it shifted to original articles on science, technology and innovation. These changes may reflect the strengthening of scientific research activities and new attitudes regarding tuberculosis research objectives in academic institutions in recent years. Although many theses used qualitative methodology, few qualitative publications were found, possibly because of the quantitative orientation of many journals. Qualitative versus quantitative research and education versus research-oriented publications are discussed, together with public policies and strategies to include research as a tool to control diseases. The use of the same methodology is suggested to assess the trends in research on other neglected diseases.A tendência das publicações brasileiras em tuberculose referente ao período de foi analisada no período 1986 a 2006. Esta análise incluiu dissertações e teses registradas da Capes e artigos indexados na base de dados Medline e no SciELO. A seleção das publicações foi realizada por busca pela palavra "tuberculose" e instituições brasileiras a que se afiliavam os autores. A análise mostrou inicialmente publicações do tipo relatos de caso e revisões, e posteriormente artigos originais em ciência, tecnologia e inovação científica. Estas mudanças podem refletir o incremento das atividades de pesquisa nas instituições acadêmicas e novas atitudes relativas aos objetivos da pesquisa em tuberculose nos últimos anos. Embora muitas teses tenham utilizado metodologia qualitativa, poucos artigos nessa modalidade foram encontrados, possivelmente refletindo a orientação quantitativa das revistas. Discutem-se pesquisa quantitativa versus qualitativa e educação versus pesquisa, assim como políticas públicas e estratégias para incluir a pesquisa como instrumento de controle das doenças. Sugere-se a utilização da mesma metodologia para analisar as tendências da pesquisa em outras doenças negligenciadas

    Patients' Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil

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    Costs of tuberculosis diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries.The aim of this study was to analyze patients' costs of tuberculosis care and to estimate the incremental cost-effectiveness ratio (ICER) of the directly observed treatment (DOT) strategy per completed treatment in Rio de Janeiro, Brazil.We interviewed 218 adult patients with bacteriologically confirmed pulmonary tuberculosis. Information on direct (out-of-pocket expenses) and indirect (hours lost) costs, loss in income and costs with extra help were gathered through a questionnaire. Healthcare system additional costs due to supervision of pill-intake were calculated considering staff salaries. Effectiveness was measured by treatment completion rate. The ICER of DOT compared to self-administered therapy (SAT) was calculated.DOT increased costs during the treatment phase, while SAT increased costs in the pre-diagnostic phase, for both the patient and the health system. Treatment completion rates were 71% in SAT facilities and 79% in DOT facilities. Costs per completed treatment were US194forpatientsandU 194 for patients and U 189 for the health system in SAT facilities, compared to US336andUS 336 and US 726 in DOT facilities. The ICER was US$ 6,616 per completed DOT treatment compared to SAT.Costs incurred by TB patients are high in Rio de Janeiro, especially for those under DOT. The DOT strategy doubles patients' costs and increases by fourfold the health system costs per completed treatment. The additional costs for DOT may be one of the contributing factors to the completion rates below the targeted 85% recommended by WHO
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