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BackgroundIn Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income.Methodology/Principal FindingsA cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community.Conclusions/SignificanceThe patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.

À minha esposa "Lívia Fernanda Siqueira Santos" que com sabedoria se alojou no meu coração e tornou-se a mola propulsora do meu viver. Tê-la ao meu lado, contando sempre com seu amor, carinho, respeito, admiração e compreensão, indubitavelmente, é um presente de Deus! AGRADECIMENTOS ESPECIAIS A Deus, por ter me guiado e me abençoado ao longo de toda minha existência. Sua concessão de saúde, paz, força e determinação em todos os momentos foram essenciais para que eu chegasse até aqui. Toda honra e toda glória a Ti Senhor! Ao Prof. Dr. Ricardo Alexandre Arcêncio, não somente pelo incentivo, motivação e entusiasmo dispensados desde que o conhecí, mas também por todo esteio e orientações realizadas, e ainda por ter compartilhado suas experiências profissionais/acadêmicas, seus conhecimentos e por ser um exemplo de profissional dedicado e competente que tem conduzido um grupo de pesquisa com sabedoria, desenvolvendo um verdadeiro trabalho em equipe. Ao Prof. Dr. Francisco Chiaravaloti Neto e à Profª Drª Inês Fronteira pela parceria estabelecida no planejamento e execução desta pesquisa. À minha família -esposa, mãe, irmãos, sobrinhos -pelo apoio incondicional em todas as etapas desta jornada e por compreenderem minha ausência e serem meus maiores incentivadores. Às "amigas-irmãs" que adquiri em Ribeirão Preto -Mell e Concy, sempre atenciosas e dispostas a colaborar. A luta foi grande, mas ter a parceria de ambas foi fundamental para a realização deste estudo. Mell , de forma peculiar, esteve presente em todas etapas deste processo e foi uma das maiores incentivadoras. Concy, por todo empenho e colaboração, indispensáveis na reta final.

ABSTRACT:Objective: To investigate the knowledge regarding tuberculosis among relatives of patients with tuberculosis and the possible factors associated with this event and also to conduct comparative analyses between groups of relatives with or with few knowledge regarding tuberculosis, considering their attitudes in both groups. Methods: Cross-sectional study in which the sample was obtained through simple and randomized method. The data were collected by trained interviewers and validated tool. Logistic regression analyses were done using statistical software SPSS, version 22.0. Results: Among the 110 subjects recruited for the study, 85 (87.5%) were women, and the mean age was 49 years. Regarding common symptoms of tuberculosis, 102 relatives (90.9%) pointed the chronic cough; regarding the knowledge about tuberculosis transmission modes, 100 (90.9%) of them pointed symptomatic respiratory as the probable infection source. The relatives also reported other tuberculosis transmission models: sharing of clothes (n = 87; 79.1%) and household utensils (n = 66; 60%); sexual relations (n = 50; 50%). Illiterate relatives (adjusted OR = 4.39; 95%CI 1.11 -17.36), those who do not watch or watch little television (adjusted OR = 3.99; 95%CI 1.2 -13.26), and also those who do not have the Internet access (adjusted OR = 5.01; 95%CI 1.29 -19.38) were more likely to have low knowledge regarding tuberculosis. Regardless the group, with or without tuberculosis knowledge, the attitudes of both were satisfactory. Conclusion: There are evidences that social inequity is associated to the tuberculosis knowledge of patient relatives.

Introduction: Adherence in allergen immunotherapy is crucial for its efficacy. At least 3 years of treatment are recommended for achieving a long-term modifying effect. Objectives: To assess patient's adherence and to identify determinant factors for allergen subcutaneous immunotherapy (SCIT) suspension in patients with respiratory allergy. Methods: Retrospective analysis of the medical record of patients submitted to SCIT between January 2013 and December 2016 in our Department. Results: 323 patients were included: 52% female; mean age 30±13 years; average treatment time 19±13 months. 52 patients (16%) stopped SCIT: 54% female; mean age 30±9 years; average treatment time 12±6 months; 67% dropped the treatment during the 1 st year, 27% in the 2 nd and 6% during the 3rd year of treatment. Adherence rate determined was 77%. The most frequent reasons for withdrawal were due to economic reasons (47.9%), followed by patients' perception of no clinical improvement (23%) and change to sublingual immunotherapy (11.6%). Conclusion: Adherence rate in our study was 77%. Economic reasons were the main cause of abandonment in the first year, while the perception of non-improvement was the main reason for abandonment in subsequent years. Adequate information on SCIT prescribing and rigorous monitoring of patients during the treatment can improve adherence.

(24,44%). Houve predomínio de casos no sexo masculino (51,06%), cor parda (55,65%), faixa etária de 10-14 anos (60,22%) e com escolaridade média de 6-11 anos (59,8%). A maioria das formas clínicas notificadas foi do tipo indeterminada (40,13 %), tendo como predominante o grau de incapacidade física II (21,1 %). Não foram estatisticamente significantes as diferenças proporcionais entre as formas clínicas (p-valor=0,056); ao passo que a escolaridade apresentou associação significativa (p<0,0001) com a ocorrência da doença entre menores de 15 anos de idade. Conclui-se que a hanseníase continua uma doença de fácil disseminação, considerando a frequência de casos novos. PALAVRAS-CHAVE: Hanseníase. Incidência. Menores de 15 anos. INCIDENCE OF LEPROSY IN PATIENTS AGED 15 OR YOUNGER CARED IN THE MUNICIPALITY OF IMPERATRIZ, MARANHÃO, BETWEEN 2004 AND 2010ABSTRACT: The purpose of this study was to estimate the global incidence and cases indexes of leprosy and to design the socio--demographic profile in children under 15 years of age in the municipality of Imperatriz, in the state of Maranhão, Brazil. A longitudinal retrospective study of leprosy cases in the municipality was performed, using information generated by the disease reports in SINAN NET. There was a predominance of male (51.06%), brown color (55.65%), aged between 10-14 years (60.22%), and average schooling of 6-11 years (59.8%). Most of the clinical forms reported were of the indeterminate type (40.13%), with predominance of physical incapacity degree II (21.1%). The proportional differences between the clinical forms (p-value = 0.056) were not statistically significant, while schooling presented a significant association (p <0.0001) with the occurrence of the disease among children under 15 years of age. It can be concluded that leprosy remains a disease with easy spread when considering the rate of new cases.

BackgroundDiarrhea is a waterborne disease that affects children, especially those under 5 years of age. The objective of this study was to identify the spatial patterns of distribution of diarrheal disease in under 5-year-old children in the State of Tocantins, Brazil, from 2008 to 2013.MethodsGeoprocessing tools were used to carry out an epidemiological study, to prepare thematic maps in the TerraView 4.2.2 software based on secondary data. General indicators of the disease, presence of spatial dependence through the Global Moran’s Index (I) and the Spatial Association Index (LISA) were described.ResultsThere were 3,015 cases of under 5-year-old children hospitalized for diarrhea, with an average annual rate (AAR) of 4.10/1,000 inhabitants (inhab.). Among the main characteristics were: increasing rates in under 1-year-old children (6.16 to 9.66/1,000 inhabitants); children aged 1 to 4 full years (63%); males (55%); 8 deaths of under one-year-old children (75%); county of Araguaína (67%); incidence in the county of Nazaré (63.97/1,000 inhab.); prevalence and incidence in the Araguaína microregion (45%, AAR 9.38/1,000 inhab.). The presence of a cluster with spatial autocorrelation was found in the Araguaína microregion, which was statistically significant (I = 0.11, p-value < 0.03), with priority of intervention (Moran Map).ConclusionsThere was an increase in the number of hospitalizations for diarrhea in under 5–year-old children in the state of Tocantins. The spatial analysis identified clusters of priority areas for measures of maintenance and control of diarrheal diseases.

Background. Leprosy is an infectious disease that can lead to physical disabilities and stigmatization. It remains an important public health problem, especially in Brazil. Objective. To analyse sociodemographic and clinical factors associated with multibacillary leprosy in a hyperendemic region of the disease in northeastern Brazil. Method. This is a retrospective observational study with secondary data acquired from 2012 to 2015, from a group of leprosy cases reported in a reference outpatient clinic for the treatment and followup of leprosy in the city of Imperatriz, Maranhao, in northeastern Brazil. Results. From 905 new cases of leprosy studied, 656 (72.5%) were classified as multibacillary leprosy and 249 (27.5%) as paucibacillary leprosy. We observed that men were more likely to present 5 to 15 skin lesions (OR: 1.32; 95% CI: 1.18-1.49; p <0.0001) and >15 skin lesions (OR: 1.26; 95% CI: 1.09 -1.45; p = 0.005) and a lower chance of having <5 skin lesions (OR: 0.67; 95% CI: 0.59-0.76; p <0.0001). Women were more likely to have no affected nerves compared to men (OR: 1.46; 95% CI: 1.20-1.77; p <0.0001). The age range of 16 to 60 years showed a greater chance of having <5 skin lesions (OR: 1.01; 95% CI: 1.007-1.20; p = 0.03) and a lower chance of having 5 to 15 skin lesions (OR: 1.12, 95% CI: 1.03-1.23; p= 0.008) and a lower chance of being a grade I disability ( CI= 0.73-0.94; p=0.83) and II (OR: 0.82; 95% CI: 0.77-0.98; p=000.1). Conclusion. Cases of multibacillary leprosy were associated with male gender, low educational level, and clinical variables such as number of skin lesions and grade I or II disability.