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This article sought to present a study of an automatic feeder for domestic animals in cases of absence of the owner, serving water and feed, using an open-source software and hardware electronic prototyping platform, that is, without any obstacle related to patents and generally relatively low cost. The motivation for this work is due to the fact that we are looking for a low-cost open-source solution for an efficient system with functions to guarantee the ability to control and monitor this feeding, being an essential security method and can be used for every domestic pet. The methodology consists of approaching the functions of each component of this system and their integration, resulting in a demonstration by simulation with the assembly of the project, executing the feeding of food and water as planned. It concludes with the demonstration that the project is feasible, making it an incipient solution for others, such as feeding systems for larger animals, using appropriate programs and components.

O artigo visa apresentar um estudo sobre o desenvolvimento de um controlador automático para aquários capaz de medir e controlar alguns parâmetros importantes para a manutenção do sistema em questão, utilizando a plataforma de prototipagem eletrônica open source, denominada Arduino. O objetivo deste artigo é detalhar este estudo, com a medição de três parâmetros principais: pH (potencial hidrogeniônico), temperatura e nível, controlando os dois últimos citados e a comprovação de seu funcionamento por meio de demonstração em um aquário de pequena escala.Deste modo, constata-se a exequibilidade do projeto e que a aplicação desta solução pode ser estendida, servindo de base para diversos outros sistemas, como projetos de tratamento de água ou outras substâncias, como óleos, bebidas em geral e solventes, dependendo da programação realizada em seu software de controle e inclusão de sensores e atuadores adequados, com custos potencialmente reduzidos pelo uso de ferramentas open source.

Resumo Introdução A mortalidade por tuberculose é um indicador sensível às desigualdades em saúde, considerando-se que o risco para sua ocorrência está relacionado à vulnerabilidade dos territórios. Objetivo Investigar se as variações espaciais dos determinantes sociais afetam as mortes por tuberculose em um município da região amazônica. Método Estudo ecológico com medidas múltiplas de análise, composto por óbitos por tuberculose como causa básica em Manaus, Amazonas, Brasil, notificados no Sistema de Informação sobre Mortalidade (2006-2015). Nas análises, foram calculadas as taxas bruta e padronizada, e usado o Índice de Moran para verificar a autocorrelação espacial da mortalidade e, posteriormente, foi aplicada a regressão geograficamente ponderada para aferir a relação da desigualdade com as mortes por tuberculose. Resultados Foram identificados 731 óbitos pela doença. A distribuição da mortalidade ocorreu de forma heterogênea, sendo que as altas taxas de óbito por tuberculose estavam em áreas mais socialmente vulneráveis. Foram confirmadas a autocorrelação e a dependência espacial. O modelo final apresentou as variáveis indicadoras de iniquidades (baixa renda, pobreza e escolaridade), mostrando relação destas com a mortalidade. Conclusão Ficou evidente que os determinantes sociais no espaço urbano influenciam a mortalidade por tuberculose na região. Portanto, avançar em políticas públicas para corrigir as iniquidades em saúde pode influenciar positivamente esse cenário. Abstract Background Mortality from tuberculosis is a sensitive indicator of health inequalities, given that the risk for its occurrence is related to the vulnerability of the territories. Objective To investigate whether the spatial variations of social determinants affect deaths from tuberculosis in a municipality in the Amazon region. Method Ecological study with multiple measures of analysis. The study was composed of deaths from tuberculosis as a basic cause in Manaus, Amazonas, Brazil, reported in the Brazilian Mortality Information System (2006-2015). In the analyzes, the crude and standardized rate was calculated, Moran Index was used to verify the spatial autocorrelation of mortality, and subsequently, the geographically weighted regression was applied to assess the inequality relationship of deaths from tuberculosis. Results 731 deaths from the disease were identified. The distribution of mortality was heterogeneous, with high rates of death from tuberculosis in more socially vulnerable areas. The autocorrelation and spatial dependence was confirmed. The final model presented variables that indicate inequities: low income, poverty and education, showing their relationship with mortality. Conclusion It was evident that social determinants in the urban space influence mortality from tuberculosis in the region. Therefore, advancing public policies to correct health inequities can positively impact this scenario.

Introduction: Prisons are high-risk settings for drug-resistant tuberculosis because the prevalence of the tuberculosis (TB) is much higher than in the general population. This study to investigated the factors associated with drug-resistant tuberculosis in prisons in the state of São Paulo, Brazil. Methodology: Retrospective cohort of drug-resistant TB cases for incarcerated people in São Paulo state, reported in the Tuberculosis Patient Control System between 2006 and 2016. To analyze the factors associated with drug-resistant TB, the backward method (likelihood ratio) was used, determining the adjusted odds ratio and respective 95%CI coefficients. Multiple models were proposed to adjust for potential confusion and interaction. The best fit model was selected based on the lowest Akaike information criterion coefficient. Results: In total, 473 drug-resistant tuberculosis cases were reported in the prison population of Sāo Paulo state, the majority were male. The cases that presented negative results for sputum smear and sputum culture had, respectively, an aOR=0.6 and aOR=0.16 for drug-resistant tuberculosis in relation to the cases with positive results. The cases where the patient had AIDS and reported alcoholism, respectively, an aOR=1.47 and aOR=1.60 for drug-resistant TB. Individuals with a background treatment history for TB presented a stronger association with drug-resistant tuberculosis, aOR=35.08. Conclusions: Sputum spear, sputum culture, chest X-ray, AIDS, alcoholism and background treatment history for TB were factors associated with resistance to antituberculosis drugs among prisoners. This is useful for the implementation of disease control measures related to the detection and monitoring of cases in the prison system.

Background Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. Methods We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study’s theoretical framework. Results The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. Conclusion The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.

Background Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and is a public health problem worldwide. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources, such as individuals living in correctional facilities. This study aimed to identify the consumption of alcohol, tobacco, and other drugs among prisoners diagnosed with tuberculosis and the spatial determinants and time trends of the phenomenon in southern Brazil. Methods An ecological study using data from the Brazilian Notifiable Diseases Information System. Tuberculosis cases confirmed from 2014 to 2018 in prisons located in Paraná, Brazil, were selected. The Prais-Winsten procedure was performed to identify time trends by calculating monthly rates and the percentage of monthly variation. The Seasonal-Trend by Loess decomposition method was used to verify the time series and trends. The spatial association was verified with the Getis-Ord Gi* technique, and risk areas were identified using spatial scan statistics. Results A total of 1,099 TB cases were found in the studied population. The consumption of tobacco (n = 460; 41.9%), illegal drugs (n = 451; 41.0%), and alcohol (n = 179; 16.3%) stand out. An ascending trend was found for the consumption of alcohol [+ 19.4%/mo. (95%CI: 12.20-23.03)], tobacco [+ 20.2% (95%CI: 12.20-28.82)], and illegal drugs [+ 62.2%/mo. (95%CI: 44.54–81.97)]. Spatial analysis revealed clusters for the use of alcohol, tobacco, and illegal drugs. Conclusions This study advances knowledge presenting the burden of drug use and its typology among individuals diagnosed with tuberculosis in the prison system. There is a growing trend among patients to use drugs, especially illegal drugs. The clusters show differences between the places where the prisons are located. Tuberculosis within the prison system is already a complex disease, and it is even more challenging when drugs are consumed. The consumption of drugs increased threefold when tobacco and alcohol were considered.

Background Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is a public health problem worldwide. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources, such as individuals living in correctional facilities. This study aimed to identify the consumption of alcohol, tobacco, and other drugs among prisoners diagnosed with TB and the spatial determinants and time trends of the phenomenon in southern Brazil. Methods A cross-sectional study using data from the Brazilian Notifiable Diseases Information System was carried out. TB cases confirmed from 2014 to 2018 in prisons located in Paraná, Brazil, were selected. The Prais-Winsten procedure was performed to identify time trends by calculating monthly rates and the percentage of monthly variation. The Seasonal-Trend by Loess decomposition method was used to verify the time series and trends. The spatial association was verified with the Getis-Ord Gi* technique, and the risk areas were identified using spatial scan statistics. Results A total of 1,099 TB cases were found in the studied population. The consumption of tobacco (n = 460; 41.9%), illegal drugs (n = 451; 41.0%), and alcohol (n = 179; 16.3%) stood out. An ascending trend was found for the consumption of alcohol (+ 19.4%/mo. (95%CI: 12.20–23.03)), tobacco (+ 20.2%/mo. (95%CI: 12.20–28.82)), and illegal drugs (+ 62.2%/mo. (95%CI: 44.54–81.97)). Spatial analysis revealed clusters for the use of alcohol, tobacco, and illegal drugs. Conclusions This study advances knowledge presenting the burden of drug use and its typology among individuals diagnosed with TB in the prison system. There is a growing trend among patients to use drugs, especially illegal drugs. The clusters show differences between the places where the prisons are located.

To identify factors correlated with the incidence and mortality from COVID-19 and investigate syndemic situations at the global level.An ecologic study of confirmed COVID-19 cases and deaths was performed using information collected from the European Center for Disease Prevention and Control in 2019 and 2020. World Bank indicators and information obtained from Worldometer Coronavirus were used to characterize the countries. Descriptive analyses and correlations between independent variables were performed, followed by multiple linear regression analysis to identify factors correlated with COVID-19 incidence and mortality.Data were obtained for 185 countries. Mean case incidence was 16 482/1,000 population, whereas mean COVID-19 mortality was 291/1,000 population, with the highest and lowest rates recorded in North America and East Asia and Pacific respectively. A positive correlation was identified between incidence rate and percent population aged 15 to 64 years, urban population, inequality measured by the Gini coefficient, and six out of the seven regions analyzed (except East Asia and Pacific). Mortality rate was negatively correlated with population aged 0 to 14 years and positively correlated with urban population, inequality measured by the Gini coefficient, and all regions analyzed except East Asia and Pacific.COVID-19 morbidity and mortality were correlated with the burden of chronic diseases, aging population, and low capacity of healthcare services for testing and providing hospital beds, a scenario complicated by social inequality in countries and regions, indicating a syndemic effect.Identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa y verificar las situaciones de sindemia a escala mundial.Se realizó un estudio ecológico de casos de COVID-19 y de defunciones confirmadas por esa causa a partir de la información obtenida del Centro Europeo para la Prevención y el Control de las Enfermedades en el 2019 y el 2020. Para caracterizar a los países, se utilizaron indicadores del Banco Mundial y del sitio web de referencia Worldometer Coronavirus. Se hicieron análisis descriptivos y de correlación entre las variables independientes para crear posteriormente un modelo de regresión lineal múltiple con el fin de identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa.Se obtuvieron datos de 185 países. La tasa media de incidencia de casos de COVID-19 fue de 16 482 por mil habitantes y la tasa media de mortalidad por esa causa fue de 291 por mil habitantes. Las regiones de América del Norte y de Asia oriental y el Pacífico presentaron los mayores y menores índices, respectivamente. Se observó una correlación positiva de la tasa de incidencia con la proporción del grupo de 15 a 64 años de edad, la población urbana, la desigualdad medida por el coeficiente de Gini y seis de las siete regiones analizadas (excepto Asia oriental y el Pacífico). La tasa de mortalidad presentó una correlación negativa con el grupo de 0 a 14 años de edad y positiva con la población urbana, la desigualdad medida por el coeficiente de Gini y todas las regiones analizadas, excepto Asia oriental y el Pacífico.La morbimortalidad por COVID-19 guardó una correlación con la carga de problemas crónicos de salud, el envejecimiento de la población y la poca capacidad de realizar pruebas en los servicios de salud y de ofrecer camas de hospital, cuadro agravado en los países o regiones con una elevada tasa de desigualdad social y característico de una situación de sindemia.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) itself is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perception of health professionals about multidrug-resistant tuberculosis, their strategies to ensure adherence to treatment and the challenges in the context of the COVID-19 pandemic, in a priority municipality for disease control in the state of São Paulo, Brazil. METHODS: We conducted a qualitative study and recruited fourteen health professionals, four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker, working in the Ribeirão Preto health system. Remote semi-structured interviews were conducted with these professionals. For data analysis, Thematic Content Analysis was applied according to the theoretical framework defined for the study. RESULTS: The findings showed the relationship between poverty, inequality and MDR-TB. Concerning the COVID-19 pandemic, reports from professionals show an interference in the monitoring of patients. As for social protection and the benefits that covered the patients, they were cut. Professionals also reported concerns about obtaining COVID-19 and adopting strategies to ensure adherence, as well as reinforcements of the DOTS strategy. CONCLUSION: The study advances in knowledge by highlighting the challenges faced by the health system for the adherence of MDR-TB patients in a context aggravated by Pandemic. The strategies defined by these health professionals have somehow guaranteed the achievement of equity and avoided the catastrophic encounter between TB-MDR and COVID-19.

Resumo Tendo em vista a rápida disseminação do novo coronavírus no sistema prisional, o presente trabalho teve como objetivos identificar aglomerados espaciais para ocorrência da COVID-19 na população privada de liberdade (PPL) e analisar a tendência temporal dos casos confirmados no sistema penitenciário do Brasil. Estudo ecológico que considerou como unidades de análise as cinco macrorregiões do Brasil, seus 26 estados e o Distrito Federal. A população foi composta por todos os casos de COVID-19 confirmados, no período de 14 de abril a 31 de agosto de 2020. A fonte de dados utilizada foi o Painel de Monitoramento dos casos de COVID-19 nos sistemas prisionais do Departamento Penitenciário Nacional. Realizou-se análise descritiva, estatística de varredura e análise da tendência temporal. Foram notificados 18.767 casos de COVID-19 na PPL, dos quais 4.724 ocorreram no estado de São Paulo. A estatística de varredura possibilitou a identificação de 14 clusters espaciais de risco para COVID-19 na PPL, sendo o aglomerado de maior risco formado pelo Distrito Federal. Embora o país finalize a série com um comportamento decrescente, observa-se que no período de investigação a tendência apresentou um comportamento maioritariamente crescente. Evidencia-se a necessidade de testagem em massa, monitoramento e registro contínuo dos casos de COVID-19 na PPL do país.

This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants’ discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.

Objective To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of Sao Paulo, Brazil. Methods This ecological study was carried out in the city of Ribeirao Preto, state of Sao Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. Results The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). Conclusion The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.

Given the rapid spread of new coronavirus within the prison system, this study's objective was to identify spatial clusters for the occurrence of COVID-19 in the incarcerated population and analyze temporal trends of confirmed cases in the Brazilian prison system. This ecological study considered the five Brazilian macro-regions to be units of analysis, with its 26 states and the Federal District. The population was composed of all COVID-19 cases confirmed from April 14th to August 31st, 2020. The source used to collect data was the COVID-19 Monitoring Panel from the National Prison Department. Descriptive analysis, scan statistics, and time series were performed. A total of 18,767 COVID-19 cases were reported among the incarcerated population, 4,724 in São Paulo. The scan statistic analysis resulted in 14 spatial risk clusters for COVID-19 among persons deprived of liberty; the highest-risk cluster was in the Federal District. Although the country ends the series with a decreasing behavior, a growing trend was verified in most of the study period. The conclusion is that there is a need to implement mass testing among the incarcerated population while continually monitoring and recording COVID-19 cases.Tendo em vista a rápida disseminação do novo coronavírus no sistema prisional, o presente trabalho teve como objetivos identificar aglomerados espaciais para ocorrência da COVID-19 na população privada de liberdade (PPL) e analisar a tendência temporal dos casos confirmados no sistema penitenciário do Brasil. Estudo ecológico que considerou como unidades de análise as cinco macrorregiões do Brasil, seus 26 estados e o Distrito Federal. A população foi composta por todos os casos de COVID-19 confirmados, no período de 14 de abril a 31 de agosto de 2020. A fonte de dados utilizada foi o Painel de Monitoramento dos casos de COVID-19 nos sistemas prisionais do Departamento Penitenciário Nacional. Realizou-se análise descritiva, estatística de varredura e análise da tendência temporal. Foram notificados 18.767 casos de COVID-19 na PPL, dos quais 4.724 ocorreram no estado de São Paulo. A estatística de varredura possibilitou a identificação de 14 clusters espaciais de risco para COVID-19 na PPL, sendo o aglomerado de maior risco formado pelo Distrito Federal. Embora o país finalize a série com um comportamento decrescente, observa-se que no período de investigação a tendência apresentou um comportamento maioritariamente crescente. Evidencia-se a necessidade de testagem em massa, monitoramento e registro contínuo dos casos de COVID-19 na PPL do país.

BACKGROUNDAccording to the World Health Organization, there are approximately one million cases of tuberculosis in the world's child population, and the disease is responsible for 130.000 deaths per year, which makes tuberculosis one of the top 10 causes of death in children in the world. The objective of the study was to identify areas of risk for the appearance of tuberculosis in children and their association with social inequalities in a municipality in southeastern Brazil.METHODSEcological study conducted in Ribeirão Preto, Brazil. To identify areas of spatial risk for tuberculosis in children, we use the technique of spatial scanning statistics. To analyze the association of cases of childhood tuberculosis with social vulnerability, the Social Vulnerability Index of São Paulo was used and four explanatory statistical models were listed.RESULTS96 cases of childhood tuberculosis were reported, of which 90 were geocoded. A risk area was identified in the municipality, where children under 15 years old have 3.14 times more risk of contracting tuberculosis than outside this area. Of the models tested, the Zero-Inflated Poisson probability distribution was the one that best suited the nature of the variables. The variables identified as risk factors were: number of private and collective households; Proportion of children aged 0 to 5 in the population; Proportion of households without per capita income; Proportion of private households with monthly nominal incomes of up to 1/4 minimum wages. The variables identified as possible protection factors, there was a proportion of women responsible for the household under 30 and an average income of women responsible for the household.CONCLUSIONThe study showed areas of risk for the occurrence of tuberculosis in children. Although the study was conducted in a city with satisfactory social indicators, income distribution is quite uneven, as the findings reveal. The study is in line with the End TB Strategy and the 2030 agenda, which aims to support strategic actions and, therefore, save the lives of children through the systematic, intensified and comprehensive search of children with tuberculosis respiratory symptoms in the community.

ObjectiveTo identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants.MethodsEcological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil’s electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified.ResultsA total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25).ConclusionsThe results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.

This study’s objective was to estimate the temporal trends of leprosy according to sex and age groups, as well as to estimate and predict the progression of the disease in a hyperendemic city located in the northeast of Brazil. This ecological time-series study was conducted in Imperatriz, Maranhão, Brazil. Leprosy cases diagnosed between 2006 and 2016 were included. Detection rates stratified by sex and age groups were estimated. The study of temporal trends was accomplished using the Seasonal-Trend Decomposition method and temporal modeling of detection rates using linear seasonal autoregressive integrated moving average model according to Box and Jenkins method. Trend forecasts were performed for the 2017–2020 period. A total of 3,212 cases of leprosy were identified, the average incidence among men aged between 30 and 59 years old was 201.55/100,000 inhabitants and among women in the same age group was 135.28/100,000 inhabitants. Detection rates in total and by sex presented a downward trend, though rates stratified according to sex and age presented a growing trend among men aged less than 15 years old and among women aged 60 years old or over. The final models selected in the time-series analysis show the forecasts of total detection rates and rates for men and women presented a downward trend for the 2017–2020 period. Even though the forecasts show a downward trend in Imperatriz, the city is unlikely to meet a significant decrease of the disease burden by 2020.

Background Tuberculosis (TB) is one of the top 10 causes of death worldwide; in 2016, over 95% of TB deaths occurred in low- and middle-income countries. Although the incidence and deaths from TB have decreased in Brazil in recent years, the disease has increased in the vulnerable population, whose diagnosis is more delayed and the chances for abandonment and deaths are significantly higher. This study aimed to identify high-risk areas for TB mortality and evidence their social determinants through a sensitive tailored social index, in a context of high inequality in South Brazil. Methods A multistep statistical methodology was developed, based on spatial clustering, categorical principal components analysis, and receiver operating characteristic curves (ROC). This study considered 138 spatial units in Curitiba, South Brazil. TB deaths (2008–2015) were obtained from the National Information Mortality System and social variables from the Brazilian Human Development Atlas (2013). Results There were 128 TB deaths recorded in the study: the mortality rate was 0.9/100,000 inhabitants, minimum–maximum: 0–25.51/100,000, with a mean (standard deviation) of 1.07 (2.71), and 78 space units had no deaths. One risk cluster of TB mortality was found in the south region (RR = 2.64, p = 0.01). Considering the social variables, several clusters were identified in the social risk indicator (SRI): income (899.82/1752.94; 0.024), GINI Index (0.41/0.45; 0.010), and overcrowding (25.07/15.39; 0.032). The SRI showed a high capacity to discriminate the TB mortality areas (area under ROC curve 0.865, 95% CI: 0.796–0.934). Conclusions A powerful risk map (SRI) was developed, allowing tailored and personalised interventions. The south of Curitiba was identified as a high-risk area for TB mortality and the majority of social variables. This methodological approach can be generalised to other areas and/or other public health problems.

Objective: to analyze scientific production on the evaluation of Primary Health Care services in the control of tuberculosis. Method: this is a bibliographical study, including an integrative review, which included complete articles available in the LILACS, CINAHL, SCOPUS, Web of Science and MEDLINE databases, "published in Brazil between January 2013 and September 2017. The results were presented in the form of figures. Results: 12 articles were selected and classified in two thematic categories: "Evaluation of services from the perspective of health professionals" and "Evaluation of services from the perspective of users". Conclusion: the synthesis of the studies confirms the weaknesses, suggesting the complementary training to the professionals, besides the rescue of the expanded concept of health, mainly, in relation to the family and the community, contributing to the base of management conduits for the improvement of health interventions. Descriptors: Primary health care; Tuberculosis; Research on Health Services; Nursing; Brazil; Basic Health Services. RESUMO Objetivo: analisar producoes cientificas sobre a avaliacao dos servicos da Atencao Primaria a Saude no controle da tuberculose. Metodo: trata-se de estudo bibliografico, tipo revisao integrativa, que incluiu artigos completos disponibilizados nas Bases de Dados LILACS, CINAHL, SCOPUS, Web of Science e MEDLINE, publicados no Brasil entre janeiro de 2013 a setembro de 2017. Apresentaram-se os resultados em forma de figuras. Resultados: selecionaram-se e classificaram-se 12 artigos em duas categorias tematicas: “Avaliacao dos servicos na perspectiva dos profissionais de saude” e “Avaliacao dos servicos na perspectiva dos usuarios”. Conclusao: ratificam-se, pela sintese dos estudos, as fragilidades, sugerindo a formacao complementar aos profissionais, alem do resgate do conceito expandido de saude, principalmente, com relacao a familia e a comunidade, contribuindo para o embasamento de condutas de gestao para a melhoria das intervencoes em saude. Descritores : Atencao Primaria a Saude; Tuberculose; Pesquisa sobre Servicos de Saude; Enfermagem; Brasil; Servicos Basicos de Saude. RESUMEN Objetivo: analizar producciones cientificas sobre la evaluacion de los servicios de la Atencion Primaria a la Salud en el control de la tuberculosis. Metodo: se trata de un estudio bibliografico, tipo revision integrativa, que incluyo articulos completos disponibles en las Bases de Datos LILACS, CINAHL, SCOPUS, Web of Science y MEDLINE, publicados en Brasil entre enero de 2013 a septiembre de 2017. Se presentaron los resultados en forma de figuras. Resultados: se seleccionaron y se clasificaron 12 articulos en dos categorias tematicas: "Evaluacion de los servicios en la perspectiva de los profesionales de salud" y "Evaluacion de los servicios en la perspectiva de los usuarios". Conclusion: se ratifican, por la sintesis de los estudios, las fragilidades, sugiriendo la formacion complementaria a los profesionales, ademas del rescate del concepto ampliado de salud, principalmente, con relacion a la familia y a la comunidad, contribuyendo para el basamento de conductas de gestion para la mejora de las intervenciones en salud. Descritores : Atencion Primaria a la Salud; Tuberculosis; Investigacion sobre Servicios de Salud; Enfermeira; Brasil; Servicios Basicos de Salud.

BackgroundTo evaluate the effectiveness of a rapid molecular test for the detection of tuberculosis (TB) and to predict the rates of disease in a municipality of Brazil where TB is endemic.MethodsAn ecological study was carried out in Ribeirão Preto-SP on a population of TB cases notified between 2006 and 2017. Monthly TB incidence rates and the average monthly percentage change (AMPC) were calculated. In order to identify changes in the series, the breakpoint technique was performed; the rates were modelled and predictions of the incidence of TB until 2025 were made.ResultsAMPC showed a fall of 0.69% per month in TB and human immunodeficiency virus (TB-HIV) co-infection, a fall of 0.01% per month in general and lung TB and a fall of 0.33% per month in extrapulmonary TB. With the breakpoint technique, general and pulmonary TB changed in structure in late 2007, and extrapulmonary TB and TB-HIV co-infection changed in structure after 2014, which is considered the cut-off point. The IMA(3) models were adjusted for general and pulmonary TB and TB-HIV co-infection, and the AR(5) models for extrapulmonary TB, and predictions were performed.ConclusionsThe rapid molecular test for TB is the method currently recommended by the WHO for the diagnosis of the disease and its main advantage is to provide faster, more accurate results and to already check for drug resistance. It is necessary that professionals encourage the use of this technology in order to optimize the diagnosis so that the treatment begins as quickly as possible and in an effective way. Only by uniting professionals from all areas with health policies aimed at early case identification and rapid treatment initiation it is possible to break the chain of TB transmission so that its rates decrease and the goals proposed by the WHO are achieved.