Objective: Early tuberculosis diagnosis and treatment are determinants of better outcomes and effective disease control. Although tuberculosis should ideally be managed in a primary care setting, a proportion of patients are diagnosed in emergency facilities (EFs). We sought to describe patient characteristics by place of tuberculosis diagnosis and determine whether the place of diagnosis is associated with treatment outcomes. A secondary objective was to determine whether municipal indicators are associated with the probability of tuberculosis diagnosis in EFs. Methods: We analyzed data from the São Paulo State Tuberculosis Control Program database for the period between January of 2010 and December of 2013. Newly diagnosed patients over 15 years of age with pulmonary, extrapulmonary, or disseminated tuberculosis were included in the study. Multiple logistic regression models adjusted for potential confounders were used in order to evaluate the association between place of diagnosis and treatment outcomes. Results: Of a total of 50,295 patients, 12,696 (25%) were found to have been diagnosed in EFs. In comparison with the patients who had been diagnosed in an outpatient setting, those who had been diagnosed in EFs were younger and more socially vulnerable. Patients diagnosed in EFs were more likely to have unsuccessful treatment outcomes (adjusted OR: 1.54; 95% CI: 1.42-1.66), including loss to follow-up and death. At the municipal level, the probability of tuberculosis diagnosis in EFs was associated with low primary care coverage, inequality, and social vulnerability. In some municipalities, more than 50% of the tuberculosis cases were diagnosed in EFs. Conclusions: In the state of São Paulo, one in every four tuberculosis patients is diagnosed in EFs, a diagnosis of tuberculosis in EFs being associated with poor treatment outcomes. At the municipal level, an EF diagnosis of tuberculosis is associated with structural and socioeconomic indicators, indicating areas for improvement.

Keywords: Tuberculosis/diagnosis; Emergency treatment; Treatment outcome; Delivery of health care.

Validation of the Saint George's Respiratory Questionnaire in patients with chronic obstructive pulmonary disease in Brazil

Validação do Questionário do Hospital Saint George na Doença Respiratória (SGRQ) em pacientes portadores de doença pulmonar obstrutiva crônica no Brasil

Thais Costa de Sousa, José Roberto Jardim, Paul Jones

J Bras Pneumol.2000;26(3):119-128

Introduction: The term quality of life has gained increasing importance in the scientific context. This study describes the adaptation of a disease-specific questionnaire developed by Paul Jones et al. in 1991, the St. George's Respiratory Questionnaire (SGRQ), to the Brazilian language and culture. This questionnaire evaluates the quality of life in patients with chronic obstructive pulmonary disease (COPD) and contains three domains (symptoms, activity, and impacts) divided in 76 items. The questionnaire is self-administrated, but it may be read to illiterate persons. Goal: To verify if the St. George's Respiratory Questionnaire is a valid tool to measure quality of life in patients with chronic obstructive pulmonary disease in Brazil. Methods: In order to validate the questionnaire in Brazil, it was initially translated into Portuguese and afterwards a back-translation into English, that was compared to the original version. A final Portuguese version was then written. This final version was, then, answered by 30 clinically stable COPD patients, according to the spirometry and oximetry values. Patients answered the questionnaire twice, within a 15 day interval. The length of time the patients took to answer the questionnaire and their doubts were noted. Wilcoxon test was used for the calculation of r probability between every single question between the two days; interclass correlation ratio was calculated to test the trustworthiness and reliability of the questionnaire. Results: Among the 30 participant patients, 10 were female and 20 were male. Mean age was 65.9 years. Most of the patients were found to be in stage 2 (56.7 %) of COPD, according to the American Thoracic Society classification. The interclass correlation ratio for the total score of the questionnaire was a = 0.79 and Wilcoxon p = 0.2110 (not statistically significant). The mean answering time for the two days of interview was, respectively, 11 minutes and 50 seconds and 10 minutes and 31 seconds. As concerns the doubts about the questions, the patients reported difficulties in answering Sections 4 and 5, each one of these questions written in a negative form. Conclusion: It can be concluded that the Brazilian version of the St. George's Respiratory Questionnaire is a valid and reliable tool to measure quality of life in patients with COPD in Brazil.

Keywords: obstructive lung diseases, questionnaire, quality of life, reproducibility of results, evolution studies

Brief Communication

Analysis and comparison of tuberculosis treatment outcomes in the homeless population and in the general population of Brazil

Análise e comparação dos desfechos do tratamento de tuberculose na população em situação de rua e na população geral do Brasil

Andresa Cristine Estrella dos Santos1a, Camila Brunfentrinker1a, Larissa da Silva Pena2a, Suélen dos Santos Saraiva3a, Antonio Fernando Boing4a

J Bras Pneumol.2021;47(2):e20200178

Original Article

Analysis of the treatment of pulmonary tuberculosis in elderly patients at a university hospital in Rio de Janeiro, Brazil

Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

João Paulo Cantalice Filho, Márcio Neves Bóia, Clemax Couto Sant`Anna

J Bras Pneumol.2007;33(6):691-698

Validation of the Airways questionnaire 20 - AQ20 in patients with chronic obstructive pulmonary disease (COPD) in Brazil

Validação do questionário de vias aéreas 20 ("Airways questionnaire 20" - AQ20) em pacientes portadores de doença pulmonar obstrutiva crônica (DPOC) no Brasil

Aquiles Camelier, Fernanda Rosa, Paul Jones, José Roberto Jardim

J Bras Pneumol.2003;29(1):28-35

Noncompliance with treatment for pulmonary tuberculosis in Cuiabá, in the State of Mato Grosso - Brazil

Abandono do tratamento da tuberculose pulmonar em Cuiabá - MT - Brasil

Silvana Margarida Benevides Ferreira, Ageo Mário Cândido da Silva, Clóvis Botelho

J Bras Pneumol.2005;31(5):427-435

Compliance with tuberculosis treatment after the implementation of the directly observed treatment, short-course strategy in the city of Carapicuíba, Brazil

Adesão ao tratamento da tuberculose após a instituição da estratégia de tratamento supervisionado no município de Carapicuíba, Grande São Paulo

Amadeu Antonio Vieira, Sandra Aparecida Ribeiro

J Bras Pneumol.2011;37(2):223-231

Analysis of treatment outcomes related to the tuberculosis control program in the city of Campinas, in the state of São Paulo, Brazil

Análise do programa de controle da tuberculose em relação ao tratamento, em Campinas - SP

Helenice Bosco de Oliveira, Leticia Marin-León, Jovana Gardinali

J Bras Pneumol.2005;31(2):133-138

Background: Tuberculosis cure is dependent upon treatment adherence. Objective: To analyze the results of tuberculosis treatment in public health clinics in the city of Campinas, in the state of São Paulo, Brazil, during 2002. Method: From a cohort of 484 patients diagnosed with tuberculosis, we evaluated 436. Treatment outcomes were described for all patients, whether new patients or patients in retreatment, including those presenting the pulmonary form, with or without acquired immunodeficiency syndrome (AIDS) comorbidity. Results: The success rate was 68.6% (72.3% among non-AIDS patients and 57.6% among AIDS patients). Among new cases, the non-AIDS group presented a 2.2-times greater chance of presenting favorable results. In the AIDS group, no differences were observed between new patients and those in retreatment. Among the unfavorable outcomes, only lethality presented a difference (18.9% among AIDS patients and 8.0% among non-AIDS patients). In patients presenting the pulmonary form, the success rate was similar between those who were initially acid-fast bacilli positive and those who were not. Conclusion: The tuberculosis control program in Campinas presented low effectiveness. In comparison to the 2001 national cohort, success rates were higher for non-AIDS patients but lower for AIDS patients. The higher success rate among cases of tuberculosis without AIDS was primarily derived from the treatment of new cases. The unfavorable profile of tuberculosis patients co-infected with AIDS, characterized by the (18.9%) lethality and the (15.3%) noncompliance, were partially responsible for the lower success rate seen among such patients. It is notable that such high proportions of noncompliant patients were seen in a city providing easy access to treatment. In order to improve the program, medical teams should receive further training in supervised treatment, health education and techniques for interacting with patients, all of which will require considerable investment.

Keywords: Key words: Tuberculosis. Treatment Refusal. Retreatment. Acquired Immunodeficiency Syndrome. Comorbidity