RESULTS:Of all tuberculosis deaths identifi ed, 78% had pulmonary form. Tuberculosis diagnosis was made after death in 30% and in primary health care units in 14%. Of them, 44% had not started treatment; 49% were not notifi ed; and 76% were men. The median age was 51 years; 52% had up to four years of schooling; 4% were probably living in the streets. Mortality rate increased with age; it was 5.0/100,000 for the entire city, ranging between zero to 35 according to the district. Previous treatment was reported for 82 out of 232 patients, and of them, 41 defaulted treatment. Diabetes (16%), chronic obstructive pulmonary disease (19%), HIV infection (11%), smoking (71%), and alcohol abuse (64%) were also reported. CONCLUSIONS:Adult males over 50, migrants and living in lower Human Development Index districts were more likely to die of tuberculosis. Low schooling and comorbidities are relevant characteristics. Low involvement of primary care units in tuberculosis diagnosis and high underreporting of cases were also seen.

Abstractobjectives To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of Sã o Paulo, Brazil.methods Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 1998-2008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders.results We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1% vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5% vs. 28.5%; P < 0.001), a higher proportion of individuals receiving supervised treatment (81.5% vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6% vs. 63.2%; P < 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality.conclusions Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.

A existência de tuberculose na infância é um bom indicador da extensão da doença bacilífera e daineficiência do controle do agravo na população adulta. Objetivo: descrever o perfil clínico eepidemiológico de crianças e adolescentes que evoluíram clinicamente com tuberculose. Método:Realizou-se um estudo retrospectivo de levantamento de dados de prontuários envolvendo todos ospacientes com o diagnóstico de tuberculose, assistidos na unidade de internação e ambulatório depneumologia de um Hospital Infantil da Secretaria Estadual da Saúde de São Paulo, SP, Brasil, noperíodo de 31/07/2005 a 31/07/2010. Resultados: Foram diagnosticados 45 casos de tuberculose,a maioria na faixa etária de menores de 4 anos de idade e adolescentes, todos vacinados com BCGID. A forma clínica mais comum foi a pulmonar seguida da pleural e meníngea. Dos casos atendidos,98% procuraram o hospital espontaneamente para investigação diagnóstica. Tosse e febre foram ossintomas mais relatados. Dos casos levantados, 18 (40%) possuíam contatos intradomiciliares comadultos portadores de tuberculose pulmonar. As características radiológicas mais encontradas forama opacidade e o derrame pleural. Dos casos investigados 32,5% apresentaram positividade paraidentificação de micobactéria. A maioria dos pacientes era fortes reatores à prova tuberculínica. Atuberculose na infância é um aspecto negligenciado, na maioria das vezes, na avaliação decomunicantes de um adulto com tuberculose pulmonar bacilífera. Frequentemente as crianças sãoassistidas quando apresentam sintomas da doença já instalada. O controle de comunicantes é umaforma precoce e eficiente de diagnosticar e tratar crianças com tuberculose, reduzindo o sofrimentoe diminuindo a chance de aparecimento de formas graves da doença.

In many cases, environmental measures by the local government, the project has been evaluated using the CVM. This technique is also used in the green space preservation and creation project. Recently, the citizens to participate in greening activities have increased. But the public works of volunteer training has not been properly evaluated. Therefore, in this study, Evaluated by the CVM for the value of conservation and green space that has been created by people who have been training. That clarifies the effect of the value; also verify the effectiveness of the method. In this study, because the normal procedure of the CVM, it will take time and cost. So we try to implement in a way that simplifies the CVM. In particular, increase the accuracy of the preliminary investigation, the main survey was omitted. As a result, there are no particularly problems in comparison with other methods and precedents. It is valid in terms of being able to encourage the application of the CVM personnel to easily. And also this approach is considered, and was able to show the effect of the multi-faceted volunteer training projects.

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