RESUMO

Atraso na busca por serviço de saúde para o diagnóstico da Tuberculose em Ribeirão Preto (SP)Delay in the search for health services for the diagnosis of tuberculosis in Ribeirao Preto, Sao PauloResumo Foi analisado o atraso na busca por serviço de saúde para o diagnóstico da Tuberculose (TB) em Ribeirão Preto, 2009, em um estudo epidemiológico, transversal, realizado com 94 doentes. Utilizou-se questionário baseado no Primary Care Assessment Tool, adaptado para avaliar a atenção à TB. Estabeleceu-se a mediana (15 dias ou mais) para caracterizar atraso na busca pelo primeiro atendimento. Através da Razão de Prevalência, identificaram-se as variáveis relacionadas ao maior atraso. O primeiro serviço de saúde procurado foi o de pronto atendimento (57,4%). Verificou-se um maior tempo na procura pelos serviços de saúde entre os doentes: do sexo masculino; com idade entre 50 a 59 anos; com renda familiar inferior a cinco salários mí-nimos; forma pulmonar; casos novos; não coinfecção TB/HIV; não consumiam bebida alcoóli-ca, conhecimento satisfatório sobre TB (apresentou significância estatística na associação com o atraso) e que não procuravam o serviço de saúde próximo do domicílio antes de ter TB. Verificouse a necessidade de capacitação para os profissionais de saúde quanto aos sinais e sintomas da doença, reduzindo as barreiras de acesso ao diagnóstico oportuno da TB e divulgação ampla para a comunidade em geral. Palavras-chave Tuberculose, Diagnóstico tardio, Acesso aos serviços de saúde Abstract The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general.

Objective: Analyze the actions developed in Primary Health Care (PHC) to promote adherence to tuberculosis (TB) treatment in the perception of patients and nursing team. Methods: Cross-sectional epidemiological study conducted at the PHC of Campinas-SP, through structured interviews with 18 corresponding questions on the perception of professionals (183) and patients (165). Chi-square test and Fisher's exact test were used. Results: Actions such as the promotion of autonomy and time for the patient to talk about doubts and concerns, guidance to seek information in books and/or on the Internet on the disease, and for the family to perform TB tests, undergo directly observed treatment, schedule monthly consultations, delivery of written information on treatment and incentive were actions more perceived by the professionals than patients reported receiving. Conclusions: The identification of gaps in the offer of actions for adherence to TB treatment can help health services to change and improve the practice and the epidemiological scenario of the disease.

Objective:To evaluate the performance of Primary Health Care (PHC) in treatment of TB patients in a triple international border municipality.Methods:The present study was an evaluative survey of cross-sectional and quantitative approach conducted with 225 PHC healthcare professionals. Data was collected through a structured and validated instrument, which provided five indicators of "structure" and four indicators of "process" classified as unsatisfactory, regular or satisfactory.Results:The "structure" component was unsatisfactory for the indicator of professionals involved in TB care and training, and regular for the indicator of connection between the units and other levels of care. The "process" component was regular for the indicators of TB information, directly observed treatment and reference and counter reference on TB, and unsatisfactory for external actions on TB control.Conclusion:The "structure" and "process" components points out some weaknesses in terms of management and organization of human resources. Low frequency of training and the turnover influenced the involvement of professionals. Elements of "structure" and "process" show the need for investing in the PHC team and improving the clinical management of cases.

RESUMO Estudo descritivo de corte transversal que buscou descrever a estrutura dos serviços de atenção primária à saúde e a atenção proporcionada pelo agente comunitário de saúde para detecção da tuberculose em Natal. Foram entrevistados 108 Agentes Comunitários no período de setembro a dezembro de 2009, utilizando instrumento estruturado com escala Likert (1 a 5) para criar indicadores de Estrutura e Atenção Proporcionada, classificados em: insatisfatório, regular e satisfatório. Quanto à Estrutura, os agentes comunitários avaliaram como regular o recebimento de capacitação em tuberculose. Na Atenção Proporcionada, foram considerados regulares os indicadores ensinar como coletar, armazenar e encaminhar a amostra de escarro e como insatisfatória a solicitação de baciloscopia durante as visitas domiciliares, bem como a discussão e parceria com a comunidade para identificar sintomáticos respiratórios.Conclui-se que nenhum indicador foi considerado satisfatório e que a ação do Agente Comunitário de Saúde é complexa, por envolver a sua formação, a estrutura e a organização do serviço de saúde,exigindo a supervisão do enfermeiro desde as visitas domiciliares até as atividades comunitárias.

Facilidades e dificuldades na implantação do Programa Saúde na Escola em um município do nordeste do Brasil Facilities and difficulties in implementing the Health at School Program in a municipality in northeastern Brazil Facilidades y dificultades en la implantación del Programa Salud en la Escuela en un municipio del nordeste de Brasil

This study analyzed the Community Health Workers' activity in active case finding in Ribeirão Preto-SP. Cross sectional study, conducted in [2009][2010], with the use of a structured form, which was applied to 105 Community Health Workers and research of secondary data. Indicators were created based on the variable means that used the Likert scale for the answers, being dissatisfactory (scores 1 and 2), regular (3) and satisfactory (4 and 5). Deficiencies in the activity of the Community Workers in the active case finding were identified (mean=3.0), in the discussion with the community about the tuberculosis (mean=1.5) and in the establishment of partnership in the region for the active case finding (mean=1.9). Only 6% of the expected respiratory symptoms in the areas where the units of the participants are located were examined. The results reinforced the need for nursing supervision, a new work logic, with advances in the intersectional articulation, aimed at increasing the detection of tuberculosis cases. KEYWORDS:Community health workers. Epidemiological surveillance. Tuberculosis. Nursing. Scatolin BE, Pinto ESG, Arcênio RA, Andrade RLP, Wysocki AD, Ponce MAS, et al. BUSCA DE PACIENTES SINTOMÁTICOS RESPIRATÓRIOS BÚSQUEDA DE PACIENTES SINTOMÁTICOS RESPIRATORIOS: ACTUACIÓN DEL AGENTE COMUNITARIO DE SALUD EN EL CONTROL DE LA TUBERCULOSIS EN UNA MUNICIPALIDAD GRANDE DE BRASIL RESUMEN:Este estudio examinó el papel del Agente Comunitario de Salud en la búsqueda de pacientes sintomáticos respiratorios en Ribeirão Preto-SP. Estudio transversal, realizado en 2009 utilizando formulario aplicado a 105 Agentes Comunitarios de Salud y consulta de datos secundarios. Los indicadores fueron creados a partir de medias de cuestiones que presentaron escala de respuesta tipo Likert, que se evaluó como insatisfactorio (valor de 1 y 2), regular (3), satisfactorio (4 y 5). Hubo deficiencias en el desempeño en búsqueda de sintomáticos respiratorios (media=3,0), discusión con la comunidad (media=1,5) y establecimiento de asociaciones en el territorio para búsqueda de sintomáticos respiratorios (media=1,9). Sólo 6% de los sintomáticos respiratorios esperados en las áreas de estudio fueron examinados. Se refuerza la necesidad de la enfermería en supervisión de los Agentes Comunitarios, una nueva lógica de trabajo, con avances en la coordinación intersectorial, teniendo como objetivo el aumento de detección de casos.

STRATEGIES FOR TUBERCULOSIS CARE TRAININGABSTRACT: Quantitative study that aimed to describe the components related to tuberculosis training that make health teams able to identify care strategies.A structured questionnaire was applied with 100 professionals in 27 Health Units of Natal, Rio Grande do Norte, between November 2013 and January 2014. The data were analyzed using the Statistical Package for the Social Sciencesversion 22.0. The results showed that 60% (n = 60) of the professionals often used the guidelines for the control of tuberculosis manual in the everyday practice; 73% (n = 73) stated that the involvement of tuberculosis specialists is accomplished by referral; 68% (n = 68) pass on the information about TB to all users and 44% (n = 44) of the training programs are carried out sporadically.It was concluded that there is the need to invest in systematic training involving specialists, aimed at the management and control of tuberculosis. DESCRIPTORS: In service training; Tuberculosis; Primary healthcare; Health education; Patient care. ESTRATEGIAS PARA CAPACITACIÓN AL CUIDADO EN TUBERCULOSIS RESUMEN: Investigación cuantitativa con objeto de describir los componentes vinculados a la capacitación en tuberculosis que hacen los equipos de salud capaces de identificar estrategias de cuidado. Fue aplicado un cuestionario estructurado a 100 profesionales en 27 Unidades de Salud en el municipio de Natal, estado de Rio Grande do Norte, Brasil, entre noviembre del 2013 y enero del 2014. Los datos fueron analizados en el programa estadístico Statistical Package for Social Sciences versión 22.0. Los resultados mostraron que 60% (n=60) de los profesionales utilizaron frecuentemente el manual de directivas para el control de la tuberculosis integrando la práctica cotidiana; 73% (n=73) afirmaron que el involucramiento de especialistas en tuberculosis se hace mediante referencia; 68% (n=68) transmiten las informaciones sobre tuberculosis a todos los usuarios y 44% (n=44) de las capacitaciones ocurren esporádicamente. Se concluye que son necesarias inversiones en capacitación sistemática, involucrando también especialistas, visando al manoseo y control de la tuberculosis. DESCRIPTORES: Capacitación en servicio; Tuberculosis; Atención Primaria de salud: Educación en salud; Atención al paciente.