The use of information and communication technology in continuing education in tuberculosis.

Introduction: The use of information and communication technologies (ICT) tools has been impacting health care. Distance learning has been used for the continuing improvement of healthcare workers (HCWs). In this systematic review, we evaluated the use of ICT in tuberculosis (TB) continuing education. Methods: We searched Medline and Embase for cross-sectional studies that included HCWs or students, and that reported participants' learning level. Results: Four studies proved eligible. Three used online educational tools, and another one used CDroms and live video conferencing. All studies evaluated participants' learning level through online pre- and post-tests. The quality of the studies was high. Conclusions: There is a paucity of studies evaluating distance learning in TB training. Continuing education of students and HCWs is essential for TB control. Accomplishing this is critical in increasing the skills and the numbers of qualified HCWs capable of meeting the health care needs of the population.

Knowledge, attitudes, and practices of primary health care professionals in coping with COVID-19 in Brazil: a cross-sectional study.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has posed challenges to healthcare professionals, who needed to quickly adjust impacts on their work processes. Primary health care has become key to fighting the pandemic, as most mild cases seek primary care services as their point of first contact. Objectives: To ascertain the knowledge, attitudes, and practices of health professionals working in primary health care in Brazil early in the COVID-19 pandemic. Methods: Cross-sectional study of a convenience sample. An online questionnaire was made available from May 1 through May 31, 2020. The sole criterion for inclusion was a response rate greater than 30 respondents per Brazilian state. Data were treated descriptively and statistically. Results: Overall, 293 responses were obtained, and the states of Paraná (n = 86), Mato do Grosso do Sul (n = 50) and São Paulo (n = 48) were included in the study. There was a predominance of female respondents (89.1%). Physical therapy (31.6%) and nursing (12.4%) were the most represented occupations. Respondents generally reported moderate knowledge (54.3%) and preparedness (57.6%), with daily information seeking (63.5%) in handbooks and technical guidance publications (89.6%). There was no statistically significant difference between states for the variables knowledge (p = 0.28) and preparedness (p = 0.19). Conclusions: The participating states showed similar, positive results regarding knowledge, attitudes, and practices. Previous experiences seem to generate cumulative knowledge; however, greater readiness in training professionals is needed in emergency situations.

Predictors of In-Hospital Mortality among Patients with Pulmonary Tuberculosis: A Systematic Review and Meta-analysis.

BACKGROUND: There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB (PTB). The aim of this systematic review and meta-analysis is to identify predictors of in-hospital mortality among patients with PTB. METHODS: We searched MEDLINE, EMBASE, and Global Health, for cohort and case-control studies that reported risk factors for in-hospital mortality in PTB. We pooled all factors that were assessed for an association, and presented relative associations as pooled odds ratios (ORs). RESULTS: We identified 2,969 records, of which we retrieved 51 in full text; 11 cohort studies that evaluated 5,468 patients proved eligible. Moderate quality evidence suggested an association with co-morbid malignancy and in-hospital mortality (OR 1.85; 95% CI 1.01-3.40). Low quality evidence showed no association with positive sputum smear (OR 0.99; 95% CI 0.40-2.48), or male sex (OR 1.09, 95% CI 0.84-1.41), and very low quality evidence showed no association with diabetes mellitus (OR 1.31, 95% IC 0.38-4.46), and previous TB infection (OR 2.66, 95% CI 0.48-14.87). CONCLUSION: Co-morbid malignancy was associated with increased risk of in-hospital death among pulmonary TB patients. There is insufficient evidence to confirm positive sputum smear, male sex, diabetes mellitus, and previous TB infection as predictors of in-hospital mortality in TB patients.

Distance Learning Course for Healthcare Professionals: Continuing Education in Tuberculosis.

BACKGROUND: Continuing education of healthcare workers (HCWs) is an essential strategy for the control of tuberculosis (TB) transmission, enabling HCWs in early detection and appropriate treatment of TB cases. METHODS: We developed a distance learning (DL) course on TB for nurses. We conducted a quasi-experimental before and after study to evaluate the DL community at the participant's learning level. In addition, to evaluate the DL community at the level of participant satisfaction, a cross-sectional study was carried out after the course. Nurses involved in active inpatient or outpatient care of patients were recruited to participate in the study. RESULTS: Sixty-six participants started and completed the course and they were included in the analysis. The overall mean pretest and post-test scores were 10.3 ± 2.2 and 11.4 ± 2.7, respectively. Participants increased their knowledge to a statistically significant degree (p < 0.0001). At baseline, the frequency of correct answers was very low in some questions: number of people infected by Mycobacterium tuberculosis in the world (10.6%); number of TB cases in Brazil (36.4%); contagiousness of latent TB infection (LTBI) (28.8%); and definition of active case finding (45.5%). Course feedback was mostly positive, with majority of users saying they were satisfied or totally satisfied. CONCLUSIONS: A brief DL course on TB was associated with some improvement in knowledge among nurses. The baseline knowledge was low regarding TB epidemiologic data, concepts on LTBI, and active case finding. This finding emphasizes the need to further improve the competencies and knowledge of nurses.

Pulmonary tuberculosis and lung cancer: simultaneous and sequential occurrence.

OBJECTIVE: Lung cancer (LC) is the leading cause of cancer-related death and represents a major public health problem worldwide. Another major cause of morbidity and mortality, especially in developing countries, is tuberculosis. The simultaneous or sequential occurrence of pulmonary tuberculosis and LC in the same patient has been reported in various case series and case-control studies. The objective of this study was to describe the characteristics of patients developing tuberculosis and LC, either simultaneously or sequentially. METHODS: This was a cross-sectional study based on the review of medical charts. RESULTS: The study involved 24 patients diagnosed with tuberculosis and LC between 2009 and 2012. The diagnoses of tuberculosis and LC occurred simultaneously in 10 patients, whereas tuberculosis was diagnosed prior to LC in 14. The median time between the two diagnoses was 5 years (interquartile range: 1-30 years). Fourteen patients (58.3%) were male, 20 (83.3%) were White, and 22 (91.7%) were smokers or former smokers. The most common histological type was adenocarcinoma, identified in 14 cases (58.3%), followed by epidermoid carcinoma, identified in 6 (25.0%). Seven patients (29.2%) presented with distant metastases at diagnosis; of those 7 patients, 5 (71%) were diagnosed with LC and tuberculosis simultaneously. CONCLUSIONS: In the present study, most of the patients with tuberculosis and LC were smokers or former smokers, and tuberculosis was diagnosed either before or simultaneously with LC. Non-small cell lung cancer, especially adenocarcinoma, was the most common histological type.