Background Social protection interventions might improve tuberculosis outcomes and could help to control the epidemic in Brazil. The aim of this study was to evaluate the independent effect of the Bolsa Familia Programme (BFP) on tuberculosis treatment outcomes in Brazil. Methods We prospectively recruited and followed up individuals (aged ≥18 years) who initiated tuberculosis treatment at 42 health-care centres across seven cities in Brazil, between March 1, 2014, and April 30, 2017. Patients were interviewed at health-care centres and information about individual characteristics, socioeconomic status, living conditions, lifestyle, and comorbidities was recorded. Patients were separated into two groups according to BFP beneficiary status: BFP (exposed) or non-BFP (not exposed). Treatment outcome (cure, dropout, death, or development of drug-resistant tuberculosis or treatment failure) was recorded after 6 months of therapy. Pearson's χ² test and ANOVA were used to compare tuberculosis treatment outcomes between the two groups, and we estimated the propensity score of being a beneficiary of the BFP using a logit model. We used multinomial regression models to evaluate the effect of the BFP on tuberculosis treatment outcomes. Findings 1239 individuals were included in the study, of whom 196 (16%) were beneficiaries of the BFP and 1043 (84%) were not. After 6 months of treatment, 912 (87%) of 1043 patients in the non-BFP group and 173 (88%) of 196 patients in the BFP group were cured of tuberculosis, 103 (10%) patients in the non-BFP group and 17 (9%) patients in the BFP group had dropped out, and 25 (3%) patients in the non-BFP group and six (3%) patients in the BFP group had died. Three (<1%) of 1043 patients in the non-BFP group developed drug-resistant tuberculosis. Being a BFP beneficiary had a positive effect for cure (average effect 0•076 [95% CI 0•037 to 0•11]) and a negative effect for dropout (-0•070 [-0•105 to 0•036]) and death (-0•002 [-0•021 to 0•017]). Interpretation BFP alone had a direct effect on tuberculosis treatment outcome and could greatly contribute to the goals of the WHO End TB Strategy. Funding Brazilian National Council for Scientific and Technological Development (CNPq) and Brazilian Ministry of Health Department of Science and Technology (DECIT).
Objective: To describe the repercussions, from the perspectives of caregiver mothers, of confirmed congenital Zika syndrome (CZS) in their offspring. Methods:A descriptive-exploratory study with a qualitative approach was carried out in the state of Espírito Santo in southeastern Brazil, with 25 women who had a child diagnosed with CZS.Results: Emerging themes from the content analysis were grouped into two categories:(1) inequalities experienced by mothers, including social inequality, poverty, and gender inequality; (2) the impact of a child with CZS on mothering, including feelings at the time of diagnosis, maternal isolation and mental health, experiences of stigma and prejudice, and exhausting itineraries searching for therapeutic care. Conclusion:The repercussions of CZS were a huge burden on already vulnerable women, and social inequalities and poverty were important markers in the mothers' reports.Many of the families affected by CZS already lived in precarious social conditions and these conditions were exacerbated further. Robust public and social policies to support these mothers need effective implementation given that babies born with CZS need long-term care and support.
Introduction Tuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculosis (TB) treatment cure rates. Methods We conducted a longitudinal database study including people ≥18 years old with confirmed incident TB in Brazil in 2015. We treated missing data with multiple imputation. Poisson regression models with robust variance were carried out to assess the effect of TB determinants on cure rates. The average effect of being beneficiary of cash transfer was estimated by propensity-score matching. Results In 2015, 25,084 women and men diagnosed as new tuberculosis case, of whom 1,714 (6.8%) were beneficiaries of a national cash transfer. Among the total population with pulmonary tuberculosis several determinants were associated with cure rates. However, among the cash transfer group, this association was vanished in males, blacks, region of residence, and people not deprived of their freedom and who smoke tobacco. The average treatment effect of cash transfers on TB cure rates, based on propensity score matching, found that being beneficiary of cash transfer improved TB cure rates by 8% [Coefficient 0.08 (95% confidence interval 0.06–0.11) in subjects with pulmonary TB]. Conclusion Our study suggests that, in Brazil, the effect of cash transfer on the outcome of TB treatment may be achieved by the indirect effect of other determinants. Also, these results suggest the direct effect of being beneficiary of cash transfer on improving TB cure rates.
Resumo Estudo descritivo, de abordagem quantitativa, para avaliar as estratégias realizadas pelo enfermeiro no ambiente escolar de um Centro
Introduction:This proof-of-concept study aims to demonstrate that quantitative texture analysis of magnetic resonance imaging (MRI) of orbital tumours can produce a unique footprint as an adjunct to histology and as a reference guide.Methods:‘MaZda’ texture analysis software programme version 4.6 and MedCalc software (18.10.2) were used for data procuring and analysis. The following statistical analyses were performed: analysis of variance (ANOVA) to compare histogram means; Wilcoxon signed rank sum test to compare intra-lesion variability; Mann-Whitney U test to compare inter-lesion feature differences; area under curve to test sensitivity and specificity in differentiating abnormal from normal tissue; and Fisher’s coefficient and linear discriminant analysis to reduce data vector dimensions.Results:Thirteen cases were assessed. Eleven cases were imaged with similar protocols. The software produced characteristic histograms and other quantitative parameters for a variety of orbital pathologies. The mean of histograms differed significantly between pathologies as well as other texture features and there were significant minimal misclassifications on inter-tumour analysis. Though the test showed 100% sensitivity in detecting abnormal tissues, it was not specific in differentiating some of the adnexal normal tissues from certain types of orbital tumours.Conclusions:This proof-of-concept study confirms that the non-invasive classification of orbital tumours is achievable. Further studies are needed to create a larger reference framework.
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