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The aim of this study was to comprehend the experiences of family members regarding the oral health care of children. This was a qualitative study, conducted in 2007, the health district of Ribeirâo Preto, with 12 caregivers. The theoretical framework of vulnerability and the hermeneutical perspective were used. Three empirical categories were established: the meanings of oral health care, in search of the causes and prevention of oral diseases, and the reality of oral health services. Among other potentiating factors of infantile vulnerability to oral diseases, the overvaluation of biological causality, of high complexity care and of esthetic dentistry emerged, and among the protective factors, the valorization of popular knowledge and the integration of professional actions and knowledge were observed. This study indicates the necessity for a review of prevention and oral health promotion strategies and provides elements to assist health services to reorganize oral health care for children. [ABSTRACT FROM AUTHOR]

The author reflects on global health. He suggests that global health and equality in health care should be the paramount objectives of social and economic policies seen across the globe. He argues that to achieve global health, governments, civil society, companies and other bodies need to be included in efforts to focus on health and equality in urban planning to achieve social justice.

There are nearly 7 million nursing professionals in the Region of the Americas, representing more than 56% of human health resources. The regulation of professional practices promotes and protects professional integrity, ensuring professionals are competent and well qualified. The Forum on Nursing Practice Regulation in the Region of the Americas aimed to present the regulatory frameworks for the professional practice of nursing; discuss strategic actions to support professional regulatory bodies; analyze requirements for licensing and renovating licenses; and share successful experiences in nursing regulation. The Forum counted on the participation of 83 guests in-person, with representatives from 17 countries from Latin America and the Caribbean. The COFENplay platform registered the participation of 6,906 spectators. The debates in the event led to the proposal of the following recommendations: promote a national discussion with key-actors, including the Ministries of Health, Education, and Work and Employment, to advance regulation in the countries; recommend an intersectoral articulation with the topic of Human Health Resource regulation; generate a common base for the identification of information on regulation; and broaden the research about these topics, as well as the ability to generate and analyze data. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the temporal trend of tuberculosis cases according to sex and age group and evidence the level of disease before the Covid-19 pandemic in a TB high endemic city.Methods: This was a time series study carried out in a city in northeast Brazil. The population was composed of cases of tuberculosis, excluding those with HIV-positive status, reported between the years 2002 and 2018. An exploratory analysis of the monthly rates of tuberculosis detection, smoothed according to sex and age group, was performed. Subsequently, the progression of the trend and prediction of the disease were also characterized according to these aspects. For the trends forecast, the seasonal autoregressive linear integrated moving average (ARIMA) model and the usual Box-Jenkins method were used to choose the most appropriate models.Results: A total of 1620 cases of tuberculosis were reported, with an incidence of 49.7 cases per 100,000 inhabitants in men and 34.0 per 100,000 in women. Regarding the incidence for both sexes, there was a decreasing trend, which was similar for age. Evidence resulting from the application of the time series shows a decreasing trend in the years 2002-2018, with a trend of stability.Conclusions: The study evidenced a decreasing trend in tuberculosis, even before the Covid-19 pandemic, for both sex and age; however, in a step really slow from that recommended by the World Health Organization. According to the results, the disease would have achieved a level of stability in the city next years, however it might have been aggravated by the pandemic. These findings are relevant to evidence the serious behavior and trends of TB in a high endemic scenario considering a context prior to the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. Methods: We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient's diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox's regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied. Results: One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days. Conclusion: Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health. [ABSTRACT FROM AUTHOR]

Objective: to translate and culturally adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire to the Brazilian context and to develop and evaluate a sociodemographic and occupational characterization questionnaire to compose the adapted questionnaire. Method: five stages were conducted to adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire, namely: translation, synthesis of the translations, evaluation by a committee of judges, back translation and pre-test. As for the complementary questionnaire, it was elaborated and evaluated by a committee of judges and a pre-test was carried out. Results: the questionnaires were validated and the pre-test stage was conducted with health workers and students. Conclusion: the final version adapted to the Brazilian context was called Questionário de avaliação de risco e gestão da exposição de trabalhadores e estudantes de saúde no contexto da covid-19 and is available for use, together with the final version of the Sociodemographic and occupational questionnaire: Risk assessment and management of exposure of health care workers and students in the context of covid-19. These questionnaires may assist in mitigating the risks of infection, illness and death of health workers and students due to covid-19. [ABSTRACT FROM AUTHOR]

Objective: to analyze how the social isolation measures and closed borders affected the health and economy in an international border region. Method: descriptive cross-sectional study conducted in the western region of Paraná, Brazil, using an electronic form created using Google® forms. A sample of 2,510 people was addressed. Descriptive analysis and the Chi-square test were performed, with a level of significance established at 5%. This public opinion survey, addressing unidentified participants, is in accordance with Resolutions 466/2012 and 510/2016. Results: the participants were 41.5 years old on average, most were women and worked in the education sector; 41.9% reported that the closing of borders/ commercial businesses negatively influenced income; 17.7% reported the possibility of losing their jobs; 89.0% consider that a larger number of people would be sick if the borders/ commercial had not been closed; 63.7% believe the health services are not prepared to deal with the pandemic; 74.9% realize that the Brazilian Unified Health System may not have sufficient service capacity; 63.4% reported anxiety; and 75.6% of commercial workers will experience changes in their income level. Conclusion: the closing of international borders and commercial businesses was related to a perception of physical and mental changes, job loss, and decreased income. [ABSTRACT FROM AUTHOR]

Background: Although preventable and curable, tuberculosis (TB) still occurs in poor or developing countries, mainly in metropolitan regions of larger cities. The disease is a serious public health problem, and is directly linked to social issues. We analyzed temporal trend variations in areas at risk for concomitant TB, and characterized the clinical and epidemiological profiles of cases in a hyperendemic municipality in the Amazon region of Brazil. Methods: This ecological study was performed in the municipality of Manaus, in northern Brazil. The population comprised cases with concomitant pulmonary and extrapulmonary TB, registered on the Notifiable Diseases Information System (SINAN), between January 1, 2009 and December 31, 2018. For risk cluster detection, spatial and spatiotemporal scanning statistical techniques were used. The Spatial Variation in Temporal Trends (SVTT) approach was used to detect and infer clusters for significantly different time trends. Results: Between 2009 and 2018, 873 concomitant TB cases were registered in Manaus. By using purely spatial scanning statistics, we identified two risk clusters. The relative risk (RR) of the clusters was 2.21 (95% confidence interval [CI]: 1.57–2.88; P = 0.0031) and 2.03 (95% CI: 1.58–2.58; P = 0.0029). Using space-time scanning, we identified a risk cluster with an RR of 3.57 (95% CI: 2.84–4.41; P = 0.014), between 2017 and 2018. For SVTT analyses, three clusters with spatial variations were detected in the significant temporal trends: SVTT 1 (P = 0.042), SVTT 2 (P = 0.046) and SVTT 3 (P = 0.036). Conclusions: In Brazil, several TB-determining factors such as race/color, gender, low educational level and low income overlap in needy urban areas and communities, demonstrating that it is unlikely to reach the goals, agreed and launched with the END TB Strategy within the deadlines of international agreements, if there is no reduction in existing inequities determinants and risk of illness in the country. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) is the primary cause of death among infectious diseases affecting groups in extreme poverty. Social improvements could reverse this situation in Brazil. This study aims to demonstrate the spatial relationship between social development (SD) and TB mortality in Natal, a city in northeastern Brazil. Methodology: Ecological study. The study population comprised TB deaths recorded in the Mortality Information System between 2008 and 2014. The units of analysis were 59 human development units (HDUs). Raw and smoothed mortality rates were calculated using the global empirical Bayes method. Primary components analysis was used to develop the SD indicators. An association between TB mortality and SD was verified using multiple linear regression analysis. Spatial autocorrelation was verified using models with global spatial effects. Analyses were performed using Statistica version 12.0, ArcGIS version 10.2, Statistical Package for the Social Sciences version 20.0, and OpenGeoDa 1.0.1. The significance level was established at 5% (p < 0.05). Results: The TB mortality rate with non-random spatial distribution ranged between 0.52 and 8.90 per 100,000 inhabitants. The spatial lag model was chosen because it presented the highest log-likelihood value, lowest AIC, and highest R2. A negative association was found between TB mortality and SD (R2 = 0.207; p = 0.03). Conclusions: The results show a negative association between TB mortality and the high SD indicator. This study can support decision-making in terms of collective projects within public health in order to link the health field to other sectors, aiming for social well-being and human development. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the association between access to mammography and coverage by private health insurance or by the public healthcare system through the Family Health Strategy (FHS). Method. An ecological study was performed with data obtained from the Unified Health System Data Processing Department (DATASUS). Time trends were analyzed using the Prais-Winsten method, having the Brazilian federal units as units of analysis. Multiple linear regression was used to investigate the relationship between the dependent variable -- women aged 50 to 69 years who never had a mammogram -- and the independent variables (coverage by the FHS or private health care and socioeconomic aspects). Results. Acre was the only Brazilian state for which an increasing growth trend in private health care was not observed. Roraima, Tocantins, Maranhão, Piauí, Rio Grande do Norte, and Paraíba showed a stable trend for FHS coverage, whereas all other federal units had increasing coverage. A significant association was observed between never having had a mammogram at 50 to 69 years of age and the variables mean per capita income and FHS and private health care coverage (R2=0.77; P < 0.001). Conclusion. Unequal access to mammography is a reality in Brazil. Both private health care and the FHS have contributed to improve health care accessibility for Brazilian women. [ABSTRACT FROM AUTHOR]

Background: Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina. Methods: This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05). Results: Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (β = 0.025, p = 0.036) and people of brown race (β = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy. Conclusion: The social determinants income and race/color were associated with the risk of leprosy. The study’s highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region. [ABSTRACT FROM AUTHOR]

Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization. [ABSTRACT FROM AUTHOR]

Background: Stigma associated with tuberculosis (TB) has been an object of interest in several regions of the world. The behaviour presented by patients as a result of social discrimination has contributed to delays in diagnosis and the abandonment of treatment, leading to an increase in the cases of TB and drug resistance. The identification of populations affected by stigma and its measurement can be assessed with the use of valid and reliable instruments developed or adapted to the target culture. This aim of this study was to analyse the initial psychometric properties of the Tuberculosis-Related Stigma scale in Brazil, for TB patients.Methods: The Tuberculosis-Related Stigma scale is a specific scale for measuring stigma associated with TB, originally validated in Thailand. It presents two dimensions to be assessed, namely Community perspectives toward tuberculosis and Patient perspectives toward tuberculosis. The first has 11 items regarding the behaviour of the community in relation to TB, and the second is made up of 12 items related to feelings such as fear, guilt and sorrow in coping with the disease. A pilot test was conducted with 83 TB patients, in order to obtain the initial psychometric properties of the scale in the Brazilian Portuguese version, enabling simulation of the field study.Results: As regards its psychometric properties, the scale presented acceptable internal consistency for its dimensions, with values ≥0.70, the absence of floor and ceiling effects, which is favourable for the property of scale responsiveness, satisfactory converging validity for both dimensions, with values over 0.30 for initial studies, and diverging validity, with adjustment values different from 100%.Conclusion: The results found show that the Tuberculosis-Related Stigma scale can be a valid and reliable instrument for the Brazilian context. [ABSTRACT FROM AUTHOR]

Background: Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. Methods: Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. Results: A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919). Conclusion: These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting. [ABSTRACT FROM AUTHOR]

Objective: to propose a discussion about traces of the derivation of meanings, the subjects' discomfort and resistance when they are called upon to signify a questionnaire on the transfer of the Directly Observed Treatment of Tuberculosis policy, in order to reveal the limitations of closed questionnaires in the subject's interpretation process. Method: health professionals from a Primary Health Care Unit in Porto Alegre/RS were interviewed and some excerpts from the interviews were investigated in the light of French Discourse Analysis. Results: resistance, discomfort, slips, silencing and the derivation of meanings were observed In the subjects' interpretation. Conclusion: the interpretation process has multiple meanings and varies from subject to subject. The questionnaire, as a prototype of the logically stabilized universe, fails when the purpose is to control the interpretation. Its isolated use in health research can entail inexactness or incompleteness of the collected data. Therefore, its use associated with qualitative research techniques is ideal. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is the infectious disease that kills the most people worldwide. The use of geoepidemiological techniques to demonstrate the dynamics of the disease in vulnerable communities is essential for its control. Thus, this study aimed to identify risk clusters for TB deaths and their variation over time.Methods: This ecological study considered cases of TB deaths in residents of Londrina, Brazil between 2008 and 2015. We used standard, isotonic scan statistics for the detection of spatial risk clusters. The Poisson discrete model was adopted with the high and low rates option used for 10, 30 and 50% of the population at risk, with circular format windows and 999 replications considered the maximum cluster size. Getis-Ord Gi* (Gi*) statistics were used to diagnose hotspot areas for TB mortality. Kernel density was used to identify whether the clusters changed over time.Results: For the standard version, spatial risk clusters for 10, 30 and 50% of the exposed population were 4.9 (95% CI 2.6-9.4), 3.2 (95% CI: 2.1-5.7) and 3.2 (95% CI: 2.1-5.7), respectively. For the isotonic spatial statistics, the risk clusters for 10, 30 and 50% of the exposed population were 2.8 (95% CI: 1.5-5.1), 2.7 (95% CI: 1.6-4.4), 2.2 (95% CI: 1.4-3.9), respectively. All risk clusters were located in the eastern and northern regions of the municipality. Additionally, through Gi*, hotspot areas were identified in the eastern and western regions.Conclusions: There were important risk areas for tuberculosis mortality in the eastern and northern regions of the municipality. Risk clusters for tuberculosis deaths were observed in areas where TB mortality was supposedly a non-problem. The isotonic and Gi* statistics were more sensitive for the detection of clusters in areas with a low number of cases; however, their applicability in public health is still restricted. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) launched the "End TB Strategy", which aims to reduce tuberculosis (TB) mortality by 95% by 2035, Brazil has made a commitment to this, however, one challenge is achieving the goal in the border region, where the TB situation is more critical. The proposal was to analyse the spatial mortality due to TB and its socio-economic determinants in the general population, around the border areas of Brazil, Paraguay and Argentina, as well as the temporal trend in this region.Method: This ecological study considered the cases of TB deaths of residents of Foz do Iguaçu (BR), with its units of analysis being the census sectors. The standardized mortality rate was calculated for each area. Socioeconomic variables data were obtained from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). The scan statistic was applied to calculate the spatial relative risk (RR), considering a 95% confidence interval (CI). Spatial dependence was analysed using the Global Bivariate Moran I and Local Bivariate Moran I (LISA) to test the relationship between the socioeconomic conditions of the urban areas and mortality from TB. Analysis of the temporal trend was also performed using the Prais-Winsten test.Results: A total of 74 cases of TB death were identified, of which 53 (71.6%) were male and 51 (68.9%) people of white skin colour. The mortality rate ranged from 0.28 to 22.75 cases per 100,000 inhabitants. A spatial relative risk area was identified, RR = 5.07 (95% CI 1.79-14.30). Mortality was associated with: proportion of people of brown skin colour (I: 0.0440, p = 0.033), income (low income I: - 0.0611, p = 0.002; high income I: - 0.0449, p = 0.026) and density of residents (3 and 4 residents, I: 0.0537, p = 0.007; 10 or more residents, I: - 0.0390, p = 0.035). There was an increase in the mortality rate in people of brown skin colour (6.1%; 95% CI = 0.029, 0.093).Conclusion: Death due to TB was associated with income, race resident density and social conditions. Although the TB mortality rate is stationary in the general population, it is increasing among people of brown skin colour. [ABSTRACT FROM AUTHOR]