Barriers That Interfere with Access to Tuberculosis Diagnosis and Treatment across Countries Globally: A Systematic Review.

This study evaluated the barriers that interfere with access to diagnosis and treatment of tuberculosis (TB) from the perspective of the patient and health professionals globally. Using the PICo acronym, the question we asked was "What are the barriers that interfere with access to tuberculosis diagnosis and treatment (I) from the perspective of patients and/or health professionals (P) across countries globally (Co)?". We searched the following databases: EMBASE, Scopus, MEDLINE, Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science. On Rayyan, duplicates were removed and extraction was done afterward by two authors independently, followed by a tiebreaker. Using a Critical Appraisal Tool proposed by the Joanna Briggs Institute, the methodological quality of the article was assessed. From 36 published articles, the barriers to tuberculosis diagnosis as obtained from our study include information scarcity/low TB knowledge, exorbitant cost of transport, sample collection challenges, long distance to health facility, gender limitations, lack of decentralized diagnostic services, payment for diagnosis and testing, medication side effects, multiple visits during therapy, delayed diagnosis, poor human resources, low knowledge of medical practitioners, concerns regarding the efficacy of treatment, poor facility coordination, poor socioeconomic factors, fear and stigmatization of TB, and wrong initial diagnosis. The review of studies on TB diagnosis and treatment barriers evidences the diverse barriers to the eradication of tuberculosis. Eliminating these barriers is an onus that lies on policy makers, citizens, and health workers alike, with the joint aim of reducing the global TB burden.

Operational indicators for pulmonary tuberculosis diagnosis in people living with HIV before and after Xpert MTB/RIF implementation in the state of São Paulo, Brazil.

Tuberculosis (TB) in people living with HIV (PLHIV) is usually paucibacillary and the smear microscopy has limitations and may lead to high proportions of non-confirmed pulmonary tuberculosis (NC-PTB). Despite culture being the reference method, it usually takes 6 to 8 weeks to produce the results. This study aimed to analyze the effect of a rapid molecular test (Xpert) in the confirmatory rate of PTB among PLHIV, from 2010 to 2020, in São Paulo state, Brazil. This is an ecological study with time series analysis of the trend and the NC-PTB rates before and after Xpert implementation in 21 municipalities. The use of Xpert started and gradually increased after 2014, while the rate of NC-PTB in PLHIV decreased over this time, being more significant between late 2015 and mid-2017. The city of Ribeirão Preto stands out for having the highest percentage (75.0%) of Xpert testing among PLHIV and for showing two reductions in the NC-PTB rate. The cities with low Xpert coverage had a slower and smaller decrease in the NC-PTB rate. Despite being available since 2014, a significant proportion of PLHIV suspected of PTB in the state of São Paulo did not have an Xpert ordered by the doctors. The implementation of Xpert reduced the NC-PTB rates with growing effect as the coverage increased in the municipality.

Risk Factors for Death among Hospitalized and Nonhospitalized Patients due to COVID-19 in a Triple International Border Municipality.

Introduction: The severity of COVID-19 in the general population ranges from minimally symptomatic disease to critical illness, which may require hospitalization and progress to death. Methods: A retrospective cohort study carried out with all positive cases of COVID-19 reported in the municipality of Foz do Iguaçu (PR) between the period from March 2020 to December 2021. Data were collected from Bank Notifies COVID-19 is the name of the information system that provides notifications by professionals of suspected and confirmed cases of the disease. Data were analyzed using descriptive statistical techniques and calculation of relative risk. Results: 24,647 confirmed cases were identified in the study; among these, 22,211 (90.1%) were not hospitalized and 2436 (9.9%) were hospitalized. Among the 2436 patients hospitalized for COVID-19, 947 (38.9%) died and 1489 (61.1%) recovered. Among the 22,211 outpatients, 93 (0.4%) died and 22,118 (99.6%) recovered. An association between death and the following characteristics was identified among the cases that were hospitalized: male gender, all age groups over 40 years, indigenous race/color, hospital staylength of more than 10 days,hospitalization in a Unified Health System (SUS) bed and in an Intensive Care Unit (ICU). According to the clinical characteristics of symptoms and comorbidities, the following prevailed:ities dyspnea, intercostal retraction, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, smoking, lung disease, kidneydisease, neurological disease, neoplasia, and immunodeficiency. Among the cases that were not hospitalized, death was associated with: malegender, all age groups over 50 years, dyspnea, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, kidney disease, neurological disease, neoplasia, and liver disease. Conclusions: Older adults, male, and Caucasian people are commonly affected by COVID-19 and can evolve with aggravation when they have modifiable risk factors such as obesity and smoking, as well as nonmodifiable risk factors such as: cardiovascular disease, neurological disease, renal, hypertension, diabetes, and immunosuppression.

Tuberculosis treatment during the COVID-19 pandemic: actions offered and case profile.

OBJECTIVE: To analyze the association between the provision of tuberculosis treatment actions and the sociodemographic and clinical characteristics of cases during the COVID-19 pandemic. METHOD: Cross-sectional study conducted with data from secondary sources of 134 tuberculosis cases that underwent treatment in 2020 in the city of Pelotas, RS, Brazil. Data were analyzed using descriptive statistics, Chi-square test, and Fisher's exact test. RESULTS: The least frequently offered actions in the period were: three or more control smear microscopies (12.7%), smear microscopy at the end of treatment (16.7%), chest X-ray at sixth month (48.5%) and sputum culture (49%). The number of medical and nursing consultations did not reach six in 52.9% and 83.3% of cases, respectively. The lower offer of treatment actions was associated with: retreatment (p<0.001); comorbidities (p=0.023); HIV infection (p<0.001); mental disorder (p=0.013); illicit substance use (p=0.018); normal chest X-ray (p=0.024); and special treatment regimen (p=0.009). CONCLUSION: After the COVID-19 pandemic, it is essential to invest in cases follow-up, especially those undergoing retreatment, with comorbidities, drug use, normal chest X-ray results, and special treatment regimens.

Tuberculosis treatment during the COVID-19 pandemic: actions offered and case profile / Tratamiento de Tuberculosis durante Pandemia de COVID 19: acciones ofrecidas y perfil de casos / Tratamento da tuberculose durante a pandemia de COVID-19: ações ofertadas e perfil dos casos

ABSTRACT Objective: To analyze the association between the provision of tuberculosis treatment actions and the sociodemographic and clinical characteristics of cases during the COVID-19 pandemic. Method: Cross-sectional study conducted with data from secondary sources of 134 tuberculosis cases that underwent treatment in 2020 in the city of Pelotas, RS, Brazil. Data were analyzed using descriptive statistics, Chi-square test, and Fisher's exact test. Results: The least frequently offered actions in the period were: three or more control smear microscopies (12.7%), smear microscopy at the end of treatment (16.7%), chest X-ray at sixth month (48.5%) and sputum culture (49%). The number of medical and nursing consultations did not reach six in 52.9% and 83.3% of cases, respectively. The lower offer of treatment actions was associated with: retreatment (p<0.001); comorbidities (p=0.023); HIV infection (p<0.001); mental disorder (p=0.013); illicit substance use (p=0.018); normal chest X-ray (p=0.024); and special treatment regimen (p=0.009). Conclusion: After the COVID-19 pandemic, it is essential to invest in cases follow-up, especially those undergoing retreatment, with comorbidities, drug use, normal chest X-ray results, and special treatment regimens.

RESUMEN Objetivo: Analizar la asociación entre la oferta de acciones de tratamiento para tuberculosis con las características sociodemográficas y clínicas de los casos durante la pandemia de COVID-19. Método: Estudio transversal realizado con datos de fuente secundaria de 134 casos de tuberculosis que realizaron tratamiento en 2020 en Pelotas-RS. Los datos fueron analizados por estadística descriptiva, Chi-cuadrado y prueba exacta de Fisher. Resultados: Las acciones ofertadas en el periodo fueron: radiografía de tórax al sexto mes (48,5%), cultivo de esputo (49%), tres o más microscopía de frotis (12,7%) y microscopía al final del tratamiento (16,7%). El número de consultas médicas y de enfermería no alcanzó seis en 52,9% y 83,3% de los casos, respectivamente. La menor oferta de acciones de tratamiento se asoció a: retratamiento (p=0,001); comorbilidades (p=0,023); VIH (p<0,001); trastorno mental (p=0,013); uso de sustancias ilícitas (p=0,018); resultado normal de la radiografía de tórax (p=0,024); y régimen especial de tratamiento farmacológico (p=0,009). Conclusión: Después de la pandemia de COVID-19, es esencial invertir en el seguimiento de los casos, especialmente aquellos en retratamiento, con comorbilidades, radiografía normal y régimen de tratamiento especial.

RESUMO Objetivo: Analisar a associação entre a oferta de ações de tratamento para tuberculose com as características sociodemográficas e clínicas dos casos durante a pandemia da COVID-19. Método: Estudo transversal, realizado com dados de fontes secundárias de 134 casos de tuberculose que realizaram tratamento em 2020 em Pelotas-RS. Os dados foram analisados por estatística descritiva, teste Qui-quadrado e exato de Fisher. Resultados: As ações menos ofertadas no período foram: três ou mais baciloscopia de controle (12,7%), baciloscopia ao final do tratamento (16,7%), radiografia de tórax no sexto mês (48,5%) e cultura de escarro (49%). O número de consultas médicas e de enfermagem não atingiram seis em 52,9% e 83,3% dos casos, respectivamente. A menor oferta de ações de tratamento esteve associada à: retratamento (p<0,001); comorbidades (p=0,023); infecção por HIV (p<0,001); transtorno mental (p=0,013); uso de substâncias ilícitas (p=0,018); imagem de tórax normal (p=0,024); e esquema especial de tratamento (p=0,009). Conclusão: Após a pandemia da COVID-19, é imprescindível investir no acompanhamento dos casos, principalmente daqueles em retratamento, com comorbidades, uso de drogas, radiografia normal e esquema especial de tratamento.

Use of the rapid molecular test for tuberculosis among people deprived of liberty: a scoping review / Uso de la prueba molecular rápida de tuberculosis en personas privadas de libertad: revisión de alcance / Utilização do teste rápido molecular para tuberculose entre pessoas privadas de liberdade: revisão de escopo

ABSTRACT Objective: to map the repercussions of using the rapid molecular test for diagnosing tuberculosis among people deprived of liberty in the scientific literature. Method: this is a scoping review following the recommendations of the Joanna Briggs Institute and PRISMA for Scoping Reviews. The search was conducted using controlled and free vocabulary in the following databases: EMBASE, Scopus, MEDLINE, Cinahl, Academic Search Premier, LILACS and Web of Science, in the Brazilian Digital Library of Theses and Dissertations and Google Scholar. The materials which answered the review question were selected by two independent reviewers based on reading the titles, abstracts and publications. All types of studies and publications were included. The extracted data was subjected to narrative synthesis and presented graphically. Results: a total of 13 among the 461 publications found were included in the review. The studies pointed out the following repercussions of using the rapid molecular test in the prison population: increase in the diagnosis of cases compared to sputum smear microscopy; reduction in diagnosis time, initiating treatment and isolation; identification of strains resistant to antibiotic therapy; reducing the prevalence and occurrence of tuberculosis; high agreement of test results with culture results; lower cost of the test when carried out in groups of samples or when screening is carried out by radiography. Conclusion: the literature indicated that the rapid molecular test is relevant for combating tuberculosis in prison units, so its use should be considered by authorities and managers as a strategic tool for controlling the disease.

RESUMEN Objetivo: mapear las repercusiones del uso de la prueba molecular rápida para el diagnóstico de tuberculosis en personas privadas de libertad en la literatura científica. Método: scoping review, siguiendo las recomendaciones del Joanna Briggs Institute y PRISMA for Scoping Reviews. La búsqueda se realizó utilizando vocabularios controlados y libres en las siguientes bases de datos: EMBASE, Scopus, MEDLINE, Cinahl, Academic Search Premier, LILACS y Web of Science, en la Biblioteca Digital Brasileña de Tesis y Disertaciones y en Google Scholar. Los materiales que respondieron a la pregunta de revisión fueron seleccionados por dos revisores independientes, basándose en la lectura de títulos, resúmenes y publicaciones. Se incluyeron todo tipo de estudios y publicaciones. Los datos extraídos fueron sometidos a síntesis narrativa y presentados gráficamente. Resultados: entre las 461 publicaciones encontradas, 13 fueron incluidas en la revisión. Los estudios señalaron las siguientes repercusiones del uso de la prueba molecular rápida en la población penitenciaria: aumento del diagnóstico de casos en comparación con la baciloscopia de esputo; reducción del tiempo de diagnóstico, inicio de tratamiento y aislamiento; identificación de cepas resistentes a la terapia con antibióticos; reducir la prevalencia y aparición de la tuberculosis; alta concordancia de los resultados de las pruebas con los resultados del cultivo; menor coste de la prueba cuando se realiza en grupos de muestras o cuando el cribado se realiza mediante radiografía. Conclusión: la literatura indicó que la prueba molecular rápida es relevante para el combate a la tuberculosis en las unidades penitenciarias, por lo que su uso debe ser considerado por autoridades y gestores como una herramienta estratégica para el control de la enfermedad.

RESUMO Objetivo: mapear as repercussões da utilização do teste rápido molecular para o diagnóstico de tuberculose entre as pessoas privadas de liberdade junto à literatura científica. Método: revisão de escopo seguiram-se as recomendações do Joanna Briggs Institute e do PRISMA for Scoping Reviews. A busca foi realizada com vocabulários controlados e livres nas bases de dados: EMBASE, Scopus, MEDLINE, Cinahl, Academic Search Premier, LILACS e Web of Science, na Biblioteca Digital Brasileira de Teses e Dissertações e no Google Scholar. Foram selecionados por dois revisores independentes, os materiais que respondiam à pergunta da revisão, a partir da leitura dos títulos, resumos e publicações. Foram incluídos todos os tipos de estudo e publicações. Os dados extraídos foram submetidos à síntese narrativa e apresentados graficamente. Resultados: entre as 461 publicações encontradas, 13 foram incluídas na revisão. Os estudos apontaram as seguintes repercussões da utilização do teste rápido molecular na população prisional: aumento no diagnóstico de casos comparado à baciloscopia; redução no tempo de diagnóstico, início do tratamento e isolamento; identificação de cepas resistentes à antibioticoterapia; redução da prevalência e ocorrência da tuberculose; alta concordância dos resultados do teste com os da cultura; menor custo do teste quando realizado em grupos de amostras ou quando o rastreamento é realizado por radiografia. Conclusão: a literatura apontou que o teste rápido molecular é relevante para o enfrentamento da tuberculose nas unidades prisionais, de modo que a sua utilização deve ser considerada pelas autoridades e gestores como uma ferramenta estratégica para o controle da doença.

Social protection as a right of people affected by tuberculosis: a scoping review and conceptual framework.

BACKGROUND: Tuberculosis is an infectious disease strongly influenced by social determinants closely associated with cycles of poverty and social exclusion. Within this context, providing social protection for people affected by the disease constitutes a powerful instrument for reducing inequalities and enhancing inclusion and social justice. This study aimed to identify and synthesize strategies and measures aimed at ensuring social protection as a right of people affected by tuberculosis. METHODS: This is a scoping review, with searches conducted in six databases in February 2023. We included publications from 2015 onwards that elucidate strategies and measures of social protection aimed at safeguarding the rights to health, nutrition, employment, income, housing, social assistance, and social security for people affected by tuberculosis. These strategies could be implemented through policies, programs, and/or governmental agreements in any given context. The data extracted from the articles underwent descriptive analysis and a narrative synthesis of findings based on the dimensions of social protection. Additionally, we developed a conceptual framework illustrating the organizational and operational aspects of measures and strategies related to each dimension of social protection identified in this review. RESULTS: A total of 9317 publications were retrieved from the databases, of which sixty-three publications were included. The study's results highlighted measures and strategies concerning the social protection of people affected by tuberculosis. These measures and strategies revolved around the rights to proper nutrition and nourishment, income, housing, and health insurance, as well as expanded rights encompassing social assistance and social welfare. It was reported that ensuring these rights contributes to improving nutritional status and the quality of life for individuals with tuberculosis, along with reducing catastrophic costs, expanding access to healthcare interventions and services, and fostering TB treatment adherence, thereby leading to higher rates of TB cure. CONCLUSIONS: Our findings identify social protection measures as a right for people affected by tuberculosis and have the potential to guide the development of evidence-based social and health policies through collaboration between tuberculosis control programs and governmental entities.

Geo-spatial high-risk clusters of Tuberculosis in the global general population: a systematic review.

INTRODUCTION: The objective of this systematic review is to identify tuberculosis (TB) high-risk among the general population globally. The review was conducted using the following steps: elaboration of the research question, search for relevant publications, selection of studies found, data extraction, analysis, and evidence synthesis. METHODS: The studies included were those published in English, from original research, presented findings relevant to tuberculosis high-risk across the globe, published between 2017 and 2023, and were based on geospatial analysis of TB. Two reviewers independently selected the articles and were blinded to each other`s comments. The resultant disagreement was resolved by a third blinded reviewer. For bibliographic search, controlled and free vocabularies that address the question to be investigated were used. The searches were carried out on PubMed, LILACS, EMBASE, Scopus, and Web of Science. and Google Scholar. RESULTS: A total of 79 published articles with a 40-year study period between 1982 and 2022 were evaluated. Based on the 79 studies, more than 40% of all countries that have carried out geospatial analysis of TB were from Asia, followed by South America with 23%, Africa had about 15%, and others with 2% and 1%. Various maps were used in the various studies and the most used is the thematic map (32%), rate map (26%), map of temporal tendency (20%), and others like the kernel density map (6%). The characteristics of the high-risk and the factors that affect the hotspot's location are evident through studies related to poor socioeconomic conditions constituting (39%), followed by high population density (17%), climate-related clustering (15%), high-risk spread to neighbouring cities (13%), unstable and non-random cluster (11%). CONCLUSION: There exist specific high-risk for TB which are areas that are related to low socioeconomic conditions and spectacular weather conditions, these areas when well-known will be easy targets for intervention by policymakers. We recommend that more studies making use of spatial, temporal, and spatiotemporal analysis be carried out to point out territories and populations that are vulnerable to TB.

Influence of COVID-19 on the notification of drug-resistant pulmonary tuberculosis cases.

BACKGROUND: To analyze the influence of the COVID-19 pandemic on the process of diagnosis and monitoring of drug-resistant pulmonary tuberculosis (TB) cases reported in the state of Paraná, Brazil, from 2015 to 2020. METHODS: Ecological study with quantitative approach. This study was based on diagnosed cases of pulmonary TB reported in the Notifiable Disease Information System in residents of Paraná; as well as through the number of confirmed cases of COVID-19 in the state epidemiological bulletin for the year 2020. The study data were analyzed using descriptive statistics. RESULTS: It was found that, although the number of reported pulmonary TB cases (drug-resistant and general) increased between 2015 and 2019, there was a drop in notification in 2020, the first year of the COVID-19 pandemic. The notification of TB cases was also influenced monthly during the year according to the increase in the number of COVID-19 cases. For cases of drug-resistant pulmonary TB, the provision of diagnostic tests and Directly Observed Treatment decreased by more than half in 2020, especially when compared to 2019. CONCLUSIONS: In view of these findings, the influence of COVID-19 on the diagnosis and monitoring of drug-resistant and general pulmonary TB cases is evident, showing that the pandemic has compromised the advances of recent decades in achieving the goals established for its eradication by 2035.

Effect of implementing care protocols on acute ischemic stroke outcomes: a systematic review.

BACKGROUND: Implementing stroke care protocols has intended to provide better care quality, favor early functional recovery, and achieving long-term results for the rehabilitation of the patient. OBJECTIVE: To analyze the effect of implementing care protocols on the outcomes of acute ischemic stroke. METHODS: Primary studies published from 2011 to 2020 and which met the following criteria were included: population should be people with acute ischemic stroke; studies should present results on the outcomes of using protocols in the therapeutic approach to acute ischemic stroke. The bibliographic search was carried out in June 2020 in 7 databases. The article selection was conducted by two independent reviewers and the results were narratively synthesized. RESULTS: A total of 11,226 publications were retrieved in the databases, of which 30 were included in the study. After implementing the protocol, 70.8% of the publications found an increase in the rate of performing reperfusion therapy, such as thrombolysis and thrombectomy; 45.5% identified an improvement in the clinical prognosis of the patient; and 25.0% of the studies identified a decrease in the length of hospital stay. Out of 19 studies that addressed the rate of symptomatic intracranial hemorrhage, 2 (10.5%) identified a decrease. A decrease in mortality was mentioned in 3 (25.0%) articles out of 12 that evaluated this outcome. CONCLUSIONS: We have identified the importance of implementing protocols in increasing the performance of reperfusion therapies, and a good functional outcome with improved prognosis after discharge. However, there is still a need to invest in reducing post-thrombolysis complications and mortality.

ANTECEDENTES: A implementação de protocolos de acidente vascular cerebral (AVC) visa proporcionar uma melhor qualidade da assistência, favorecer a recuperação funcional precoce e alcançar resultados para a reabilitação do paciente. OBJETIVO: Analisar o efeito da implantação de protocolos nos desfechos do AVC isquêmico agudo. MéTODOS: Foram incluídos estudos primários publicados entre 2011 e 2020 e que atendiam aos seguintes critérios: população deveria ser constituída de pessoas com AVC isquêmico agudo; apresentar resultados sobre os desfechos do uso de protocolos na abordagem terapêutica ao AVC isquêmico agudo. A busca bibliográfica foi realizada em junho de 2020 em 7 bases de dados. A seleção dos artigos foi feita por dois revisores independentes e a síntese dos resultados foi feita de forma narrativa. RESULTADOS: Foram recuperadas 11.226 publicações, das quais 30 foram incluídas no estudo. Após a implementação do protocolo, 70,8% das publicações constataram aumento na taxa de realização de terapia de reperfusão, como a trombólise e a trombectomia; 45,5% identificaram melhora no prognóstico clínico do paciente; e 25,0% dos estudos identificaram diminuição no tempo de internação hospitalar. De 19 estudos que abordaram a taxa de hemorragia intracraniana sintomática, 2 (10,5%) identificaram diminuição nesta taxa. A diminuição da mortalidade foi citada em 3 (25,0%) artigos de 12 que avaliaram tal desfecho. CONCLUSõES: Identificou-se a importância da implantação de protocolos no aumento da realização das terapias de reperfusão, e ao bom desfecho funcional com melhora do prognóstico após a alta. No entanto, ainda há que se investir na diminuição das complicações pós trombólise e da mortalidade.

Care for people living with HIV in the time of COVID-19: scoping review

T his study aimed to analyze the scientific productions involving the repercussions of the COVID-19 pandemic on the actions and health services offered to people living with HIV. To this end, a scoping review was carried out following the recommendations of the Joanna Briggs Institute and PRISMA-ScR. The search took place in March 2022 in seven databases and the gray literature, with the descriptors: pandemic, COVID-19, SARS-CoV-2, HIV, HIV infections, health strategies, and health services, combined with operators booleans "AND" and "OR". Two researchers independently searched for the data sources. With the search, 1,032 publications were identified, of which 42 were included. Difficulties in accessing and linking to health services were evidenced, such as reduced service hours, scarcity of materials, and reduction or overload of human resources, which weakened the offer of actions to monitor treatment, dispensing of medicines, and clinical follow-up. On the other hand, digital care and follow-up systems were employed, in addition to the use of long-term medication dispensing methods, resorting to places close to the affected people or even in their homes. In short, it was possible to verify that, despite the negative effects of the pandemic on health actions and services, threatening the achievements of the last 40 years in confronting the HIV epidemic, promising strategies to provide comprehensive, proactive, and continuous care were implemented in times of COVID-19.

Effect of implementing care protocols on acute ischemic stroke outcomes: a systematic review / Efeito da implementação de protocolos nos desfechos do AVC isquêmico agudo: revisão sistemática

Abstract Background Implementing stroke care protocols has intended to provide better care quality, favor early functional recovery, and achieving long-term results for the rehabilitation of the patient. Objective To analyze the effect of implementing care protocols on the outcomes of acute ischemic stroke. Methods Primary studies published from 2011 to 2020 and which met the following criteria were included: population should be people with acute ischemic stroke; studies should present results on the outcomes of using protocols in the therapeutic approach to acute ischemic stroke. The bibliographic search was carried out in June 2020 in 7 databases. The article selection was conducted by two independent reviewers and the results were narratively synthesized. Results A total of 11,226 publications were retrieved in the databases, of which 30 were included in the study. After implementing the protocol, 70.8% of the publications found an increase in the rate of performing reperfusion therapy, such as thrombolysis and thrombectomy; 45.5% identified an improvement in the clinical prognosis of the patient; and 25.0% of the studies identified a decrease in the length of hospital stay. Out of 19 studies that addressed the rate of symptomatic intracranial hemorrhage, 2 (10.5%) identified a decrease. A decrease in mortality was mentioned in 3 (25.0%) articles out of 12 that evaluated this outcome. Conclusions We have identified the importance of implementing protocols in increasing the performance of reperfusion therapies, and a good functional outcome with improved prognosis after discharge. However, there is still a need to invest in reducing post-thrombolysis complications and mortality.

Resumo Antecedentes A implementação de protocolos de acidente vascular cerebral (AVC) visa proporcionar uma melhor qualidade da assistência, favorecer a recuperação funcional precoce e alcançar resultados para a reabilitação do paciente. Objetivo Analisar o efeito da implantação de protocolos nos desfechos do AVC isquêmico agudo. Métodos Foram incluídos estudos primários publicados entre 2011 e 2020 e que atendiam aos seguintes critérios: população deveria ser constituída de pessoas com AVC isquêmico agudo; apresentar resultados sobre os desfechos do uso de protocolos na abordagem terapêutica ao AVC isquêmico agudo. A busca bibliográfica foi realizada em junho de 2020 em 7 bases de dados. A seleção dos artigos foi feita por dois revisores independentes e a síntese dos resultados foi feita de forma narrativa. Resultados Foram recuperadas 11.226 publicações, das quais 30 foram incluídas no estudo. Após a implementação do protocolo, 70,8% das publicações constataram aumento na taxa de realização de terapia de reperfusão, como a trombólise e a trombectomia; 45,5% identificaram melhora no prognóstico clínico do paciente; e 25,0% dos estudos identificaram diminuição no tempo de internação hospitalar. De 19 estudos que abordaram a taxa de hemorragia intracraniana sintomática, 2 (10,5%) identificaram diminuição nesta taxa. A diminuição da mortalidade foi citada em 3 (25,0%) artigos de 12 que avaliaram tal desfecho. Conclusões Identificou-se a importância da implantação de protocolos no aumento da realização das terapias de reperfusão, e ao bom desfecho funcional com melhora do prognóstico após a alta. No entanto, ainda há que se investir na diminuição das complicações pós trombólise e da mortalidade.

Determinantes sociais da saúde e desfecho desfavorável do tratamento da tuberculose no sistema prisional / Social determinants of health and unfavourable outcome of tuberculosis treatment in the prison system

Resumo O objetivo deste artigo é analisar o desfecho desfavorável do tratamento da tuberculose entre a população privada de liberdade segundo os determinantes sociais de saúde. Coorte retrospectiva realizada nos estados de Rondônia e São Paulo, Brasil, com detentos com tuberculose notificados entre 2008 e 2017. Os dados foram coletados do SINAN e do TB-WEB e analisados pelo risco relativo (RR), com intervalos de confiança (IC95%), testando a associação entre a variável dependente [desfecho desfavorável (óbitos por tuberculose e outras causas, assim como os abandonos, primários ou não) x favorável (cura)] e os determinantes estruturais e intermediários da saúde. Foram registrados 158 desfechos desfavoráveis em Rondônia e 2.227 em São Paulo. Para Rondônia, tal desfecho esteve associado a sexo masculino (RR 3,09; IC95% 1,03-9,27) e Aids (RR 2,46; IC95% 1,63-3,71). Em São Paulo, idade superior a 30 anos (RR 1,36; IC95% 1,26-1,47), Aids (RR 3,08; IC95% 2,81-3,38), alcoolismo (RR 1,54; IC95% 1,35-1,76), diabetes (RR 1,70; IC95% 1,27-2,28) e tratamento autoadministrado (RR 2,55; IC95% 2,27-2,86) constituíram fatores de risco para o desfecho desfavorável. O estudo contribui com elementos para a estratificação de risco das pessoas com tuberculose nas unidades de saúde prisionais, fornecendo subsídios para qualificar a assistência para o desfecho favorável dos casos.

Abstract This article aims to analyze the unfavorable outcome of tuberculosis treatment among the population deprived of liberty by social determinants of health. This retrospective cohort was conducted in the states of Rondônia and São Paulo, Brazil, with inmates with tuberculosis notified between 2008 and 2017. Data were collected from SINAN and TB-WEB and analyzed by relative risk (RR) and confidence intervals (95%CI), which tested the association between the dependent variable (unfavorable outcome (deaths from tuberculosis and other causes, and primary and non-primary lost to follow-up) vs. favorable outcome (cure)) and the structural and intermediary determinants of health. One hundred fifty-eight unfavorable outcomes were registered in Rondônia and 2,227 in São Paulo. For Rondônia, this outcome was associated with gender (RR 3.09; 95%CI 1.03-9.27) and AIDS (RR 2.46; 95%CI 1.63-3.71). In São Paulo, aged over 30 years (RR 1.36; 95%CI 1.26-1.47), AIDS (RR 3.08; 95%CI 2.81-3.38), alcohol abuse (RR 1.54; 95%CI 1.35-1.76), diabetes (RR 1.70; 95%CI 1.27-2.28) and self-administered treatment (RR 2.55; 95%CI 2.27-2.86) were risk factors for the unfavorable outcome. The study contributes with elements to the risk stratification of people with tuberculosis in prison units and, thus, improves health care towards a favorable outcome.

Social determinants of health and unfavourable outcome of tuberculosis treatment in the prison system. / Determinantes sociais da saúde e desfecho desfavorável do tratamento da tuberculose no sistema prisional.

This article aims to analyze the unfavorable outcome of tuberculosis treatment among the population deprived of liberty by social determinants of health. This retrospective cohort was conducted in the states of Rondônia and São Paulo, Brazil, with inmates with tuberculosis notified between 2008 and 2017. Data were collected from SINAN and TB-WEB and analyzed by relative risk (RR) and confidence intervals (95%CI), which tested the association between the dependent variable (unfavorable outcome (deaths from tuberculosis and other causes, and primary and non-primary lost to follow-up) vs. favorable outcome (cure)) and the structural and intermediary determinants of health. One hundred fifty-eight unfavorable outcomes were registered in Rondônia and 2,227 in São Paulo. For Rondônia, this outcome was associated with gender (RR 3.09; 95%CI 1.03-9.27) and AIDS (RR 2.46; 95%CI 1.63-3.71). In São Paulo, aged over 30 years (RR 1.36; 95%CI 1.26-1.47), AIDS (RR 3.08; 95%CI 2.81-3.38), alcohol abuse (RR 1.54; 95%CI 1.35-1.76), diabetes (RR 1.70; 95%CI 1.27-2.28) and self-administered treatment (RR 2.55; 95%CI 2.27-2.86) were risk factors for the unfavorable outcome. The study contributes with elements to the risk stratification of people with tuberculosis in prison units and, thus, improves health care towards a favorable outcome.

O objetivo deste artigo é analisar o desfecho desfavorável do tratamento da tuberculose entre a população privada de liberdade segundo os determinantes sociais de saúde. Coorte retrospectiva realizada nos estados de Rondônia e São Paulo, Brasil, com detentos com tuberculose notificados entre 2008 e 2017. Os dados foram coletados do SINAN e do TB-WEB e analisados pelo risco relativo (RR), com intervalos de confiança (IC95%), testando a associação entre a variável dependente [desfecho desfavorável (óbitos por tuberculose e outras causas, assim como os abandonos, primários ou não) x favorável (cura)] e os determinantes estruturais e intermediários da saúde. Foram registrados 158 desfechos desfavoráveis em Rondônia e 2.227 em São Paulo. Para Rondônia, tal desfecho esteve associado a sexo masculino (RR 3,09; IC95% 1,03-9,27) e Aids (RR 2,46; IC95% 1,63-3,71). Em São Paulo, idade superior a 30 anos (RR 1,36; IC95% 1,26-1,47), Aids (RR 3,08; IC95% 2,81-3,38), alcoolismo (RR 1,54; IC95% 1,35-1,76), diabetes (RR 1,70; IC95% 1,27-2,28) e tratamento autoadministrado (RR 2,55; IC95% 2,27-2,86) constituíram fatores de risco para o desfecho desfavorável. O estudo contribui com elementos para a estratificação de risco das pessoas com tuberculose nas unidades de saúde prisionais, fornecendo subsídios para qualificar a assistência para o desfecho favorável dos casos.

Integral health care for transgender adolescents: subsidies for nursing practice.

OBJECTIVE: to analyze the integral health care for transgender adolescents from the perspective of their guardians. METHOD: qualitative research based on the Social Network framework proposed by Lia Sanicola, developed with 22 guardians of transgender adolescents in Brazil through semi-structured individual online interviews. The empirical material was analyzed using the content analysis technique, thematic modality. RESULTS: lack of ambience was observed, in addition to technical unpreparedness of health professionals in relation to the theme at all levels of care, transphobia, centralization of care in scarce qualified services for transgender children and youth, absence of family support, lack of health promotion actions within the community, especially in the school environment, and the common support from non-governmental initiatives. CONCLUSION: the centralization of actions in scarce specialized services in the country, and the structural transphobia can compromise the integral health care for transgender adolescents. There is an urgent need for a network of care capable of assisting the joint action by multi and interdisciplinary teams, with greater proactivity of the nurse with the transgender adolescent and their guardians in individual and collective actions; ambience; health promotion in schools for visibility and support in Primary Health Care since childhood. HIGHLIGHTS: (1) Need for a network of care concerning integral health care for transgender adolescents.(2) Centralization and scarce qualified services for transgender children and youth.(3) Invisible families, lack of health promotion within the community.(4) Unpreparedness of health professionals and disarticulation of the health care network.(5) Need for qualification of nurses when caring for transgender people.

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review.

BACKGROUND: The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. OBJECTIVE: To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. METHODS: Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. INCLUSION CRITERIA: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. RESULTS: A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. CONCLUSIONS: Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

ANTECEDENTES: O tratamento do acidente vascular cerebral (AVC) isquêmico com terapia de reperfusão requer rápido atendimento e reconhecimento dos sintomas. OBJETIVO: Analisar a efetividade da implementação de protocolos para AVC isquêmico agudo na redução do tempo de atendimento. MéTODOS: Revisão sistemática realizada com estudos primários em português, inglês e espanhol publicados entre 2011 e 2020. Critérios de inclusão: a população do estudo foi constituída por pessoas com AVC isquêmico agudo e estudos que apresentassem resultados sobre a efetividade da implantação de protocolos no tempo de atendimento. A pesquisa bibliográfica foi realizada em junho de 2020 nas bases de dados LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier e SocINDEX. A seleção dos artigos e a extração dos dados foram feitas por dois revisores independentes; a síntese dos resultados foi feita de forma narrativa. A qualidade metodológica dos artigos foi avaliada por meio de instrumentos do Joanna Briggs Institute. RESULTADOS: Foram encontradas 11.226 publicações, das quais 35 foram incluídas no estudo. Apenas um estudo relatou melhora no tempo início dos sintomas-porta após a implementação do protocolo, no entanto, foi efetiva na melhora dos tempos porta-imagem, imagem-agulha, porta-agulha e início dos sintomas-agulha. A principal limitação encontrada nos artigos diz respeito à falta de clareza quanto à população de estudo. CONCLUSõES: Vários avanços foram identificados no atendimento intra-hospitalar com implantação de protocolo; porém, é necessário melhorar o tempo de reconhecimento dos sintomas do AVC entre aqueles que têm o primeiro contato com a pessoa acometida e entre os profissionais envolvidos com o atendimento pré-hospitalar.

Risk factors for HIV infection among adolescents and the youth: a systematic review. / Fatores de risco à infecção pelo HIV entre adolescentes e jovens: revisão sistemática.

OBJECTIVE: to identify and analyze HIV infection risk factors among adolescents and the youth. METHOD: this is a systematic review whose guide question is: what are the risk factors for HIV infection among adolescents and the youth?" In total, five databases and Google Scholar were searched in December 2021 and the found publications between 2012-2022 were filtered without language restriction. Studies were selected by two independent reviewers. The included materials were subjected to methodological quality evaluation and narrative synthesis. RESULTS: overall, we included seven studies out of the 26,191 retrieved. All studies were conducted in Africa. We found that the female gender, older age, low schooling, Black ethnicity, multiple sexual partners, inconsistent use of condoms, alcohol consumption, and early sexual onset constituted risk factors for HIV infection in adolescents and the youth. CONCLUSION: understanding risk factors underscores the provision of health policies and intervention strategies to strengthen the responsiveness of health services and nursing teams' care to reduce HIV transmission among adolescents and the youth.(1) Our knowledge synthesis contributes to the care provided in health services. (2) The main factors for HIV are related to risk behaviors. (3) Our results point to the purpose of health policies to prevent HIV. (4) IWe assessed the importance of different social actors and management bodies to cope with HIV. (5) This study strengthens the role of nursing in preventing HIV transmission.

Dynamics of Primary Social Networks to Support Mothers, Fathers, or Guardians of Transgender Children and Adolescents: A Systematic Review.

Mothers, fathers, or guardians of children and adolescents who do not identify with the gender they were assigned at birth face barriers in their social network to recognize their children's gender identity. This study aimed to analyze the scientific evidence on the dynamics of primary social networks to support mothers, fathers, or guardians of transgender children and adolescents. This is a systematic review of qualitative studies guided by the PRISMA guidelines. Controlled and free vocabulary were used to survey the studies in the EMBASE, Scopus, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science databases. A total of 21 studies composed the final sample. Primary social networks were described as fragile and conflicting family/blood relationship ties with disapproval, isolation, rejection, a lack of understanding, and feelings of exclusion were expressed. Some have lost friends, reported tension in marriage and with relatives, and were commonly treated with hostility and harassment. Social transition does take place in the mutual context of struggle and resistance which demands a support network for parents or guardians.

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review / Tempo de atendimento após implementação de protocolos para AVC isquêmico agudo: revisão sistemática

Abstract Background The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. Objective To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Methods Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. Inclusion criteria: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. Results A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Conclusions Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

Resumo Antecedentes O tratamento do acidente vascular cerebral (AVC) isquêmico com terapia de reperfusão requer rápido atendimento e reconhecimento dos sintomas. Objetivo Analisar a efetividade da implementação de protocolos para AVC isquêmico agudo na redução do tempo de atendimento. Métodos Revisão sistemática realizada com estudos primários em português, inglês e espanhol publicados entre 2011 e 2020. Critérios de inclusão: a população do estudo foi constituída por pessoas com AVC isquêmico agudo e estudos que apresentassem resultados sobre a efetividade da implantação de protocolos no tempo de atendimento. A pesquisa bibliográfica foi realizada em junho de 2020 nas bases de dados LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier e SocINDEX. A seleção dos artigos e a extração dos dados foram feitas por dois revisores independentes; a síntese dos resultados foi feita de forma narrativa. A qualidade metodológica dos artigos foi avaliada por meio de instrumentos do Joanna Briggs Institute. Resultados Foram encontradas 11.226 publicações, das quais 35 foram incluídas no estudo. Apenas um estudo relatou melhora no tempo início dos sintomas-porta após a implementação do protocolo, no entanto, foi efetiva na melhora dos tempos porta-imagem, imagem-agulha, porta-agulha e início dos sintomas-agulha. A principal limitação encontrada nos artigos diz respeito à falta de clareza quanto à população de estudo. Conclusões Vários avanços foram identificados no atendimento intra-hospitalar com implantação de protocolo; porém, é necessário melhorar o tempo de reconhecimento dos sintomas do AVC entre aqueles que têm o primeiro contato com a pessoa acometida e entre os profissionais envolvidos com o atendimento pré-hospitalar.

Tuberculosis in international immigrants: Profile and vulnerability of cases residing in the municipality of São Paulo, Brazil.

OBJECTIVE: To analyze the profile of immigrants with tuberculosis (TB) and to identify the associated vulnerability characteristics. METHODS: A cross-sectional study which used TB-WEB data from cases residing in São Paulo in 2016 (203 immigrants and 6,069 non-immigrants). The variables were analyzed using prevalence ratio and confidence intervals. RESULTS: Among the immigrant cases, 67% were Bolivians. When compared to non-immigrants, immigrants were younger and frequently indigenous or presenting yellow ethnicity. They were also associated with a higher education level. We observed less immigrants having extrapulmonary TB and comorbidities, such as HIV/AIDS, diabetes mellitus, or drug use. Compared to cured cases, immigrants were not associated with treatment default and death, but they were associated with transfer to another state/country. CONCLUSIONS: Younger individuals and higher education levels were identified among immigrants, as well as a lower occurrence of comorbidities and drug use. It is believed that these results have led immigrants to more favorable outcomes of TB treatment.