Objective: The demanding nature and psychosocial burdens of directly observed treatment (DOT) have opened a path to alternative strategies such as video-observed therapy (VOT), which offers comparable treatment outcomes and patient satisfaction while potentially saving time and reducing costs. The objective of this study was to evaluate the perceptions and experiences of patients and health care professionals regarding DOT and other treatment strategies implemented in Portugal. Methods: Patients with a confirmed diagnosis of tuberculosis, treated at the Vila Nova de Gaia Outpatient Tuberculosis Centre in the last two years, were asked to complete a brief questionnaire, as were health care professionals working in the northern region of Portugal. Differences were analysed with chi-square tests, complemented by thematic analysis. Results: A total of 62 individuals completed the questionnaire: 29 health care professionals and 33 patients. There were significant differences between the two groups in their views regarding the impact of DOT on treatment outcomes, with health care professionals perceiving a higher degree of negative effects and patients expressing greater satisfaction. Long travel distances, transportation issues and high costs were some of the challenges mentioned by the patients. Significant differences were also found regarding the role DOT plays in ensuring treatment adherence, with patients emphasising personal responsibility and its importance in preventing loss to follow-up and strengthening relationships with health care professionals. Dose dispensing was favoured for its convenience in specific situations, and VOT was generally preferred to reduce constant travelling. Both parties raised some concerns. Conclusions: Existing discrepancies suggest a misalignment between patient experiences and health care provider perceptions, underscoring the need for enhanced communication and a more nuanced understanding of patient perspectives when designing and implementing different tuberculosis treatment adherence strategies.

Keywords: Treatment adherence and compliance; Directly observed therapy; Patient satisfaction; Tuberculosis.

Objective: To describe treatment outcomes (cure, noncompliance or death) after the implementation of the Directly Observed Treatment, Short-course (DOTS) strategy for tuberculosis control in the city of São José do Rio Preto, Brazil, between 1998 and 2003. Methods: A descriptive study, based on secondary data (National Case Registry database, Tuberculosis Epidemiology database, and the 'Black Book' Registry), was conducted using a specific instrument. The data were analyzed using descriptive statistics. Results: After the implementation of the DOTS strategy, there was a decrease in noncompliance and case detection rates as well as an increase in cure and death rates. The increase in the number of tuberculosis-related deaths might be attributable to three factors: the predominance of the disease in individuals over 50 years of age, tuberculosis/HIV co-infection, and the presence of accompanying diseases. Conclusion: The implementation of the DOTS strategy strengthened the decentralization of the tuberculosis control plans as well as the integration of the Basic Health Care Clinic teams with the Tuberculosis Control Program team. Political commitment of the administrator to tuberculosis control, in conjunction with the policy of benefits and incentives, is essential for the sustainability of the DOTS strategy.

Keywords: Tuberculosis; Epidemiology; Health services; Politics; Directly observed therapy.

Objective: To determine the compliance with tuberculosis treatment among patients enrolled the tuberculosis control program in the city of Carapicuíba, Brazil, before and after the implementation of the directly observed treatment, short-course (DOTS) strategy. Methods: A retrospective historical cohort study of operational aspects based on records of attendance and treatment evolution of patients in self-administered treatment (SAT) and of those submitted to DOTS. Monthly treatment outcome tables were created, and the probability of compliance with the treatment was calculated for both groups of patients. Results: A total of 360 patients with tuberculosis met the inclusion criteria: 173 (48.1%) in the SAT group; and 187 (51.9%) in the DOTS group. Treatment compliance was 6.1% higher in the DOTS group than in the SAT group. The proportion of patients completing the six months of treatment was 91.6% and 85.5% in the DOTS group and in the SAT group, respectively. Conclusions: The results of this study show that DOTS can be successfully implemented at primary health care clinics. In this population of patients, residents of a city with low incomes and a high burden of tuberculosis infection, DOTS was more effective than was SAT.

Keywords: Tuberculosis; Mycobacterium tuberculosis; Treatment outcome; Medication adherence.

Objective: To determine treatment noncompliance rates among patients participating in a municipal tuberculosis control program and to identify the variables related to noncompliance depending on the type of treatment strategy used. Methods: A longitudinal non-concurrent cohort study was carried out involving two cohorts of patients participating in the Tuberculosis Control Program of the city of Carapicuíba, Brazil. The first cohort comprised 173 patients with tuberculosis treated from January 1, 2003 to December 31, 2003 using self administration of treatment, and the second comprised 187 patients with tuberculosis treated from July 1, 2004 to June 30, 2005 using the directly observed therapy, short-course strategy. Results: Noncompliance rates decreased from 13.3% (self administration of treatment) to 5.9% (directly observed therapy, short-course), a significant difference (p < 0.05). For the self administration of treatment strategy, the variables significantly associated with treatment noncompliance were as follows: being an unregistered worker (relative risk [RR] = 3.06); retreatment (RR = 2.73); alcoholism (RR = 3.10); and no investigation of contacts (RR = 8.94). For the directly observed therapy, short-course strategy, no variables were significantly associated with noncompliance. Conclusion: The directly observed therapy, short-course strategy decreased noncompliance rates and produced better treatment outcomes, even when the risk factors for noncompliance were the same.

Keywords: Tuberculosis; Self administration; Directly observed therapy; Treatment refusal.

Objective: To evaluate the use of family members as supervisors of directly observed therapy (DOT) in patients with tuberculosis.Methods: This was a prospective descriptive study involving patients diagnosed with pulmonary tuberculosis. The sample comprised 98 patients. A standardized protocol was implemented in order to train the patient and their families. After the training, the patient was allowed to choose either a family member or a health care worker as a supervisor. Absolute and relative frequencies were used in descriptive data analysis. Results: A family member supervisor was chosen by 94 patients (96%). The cure rate was 99%. The partner was chosen by 49% of the patients, and other family members were chosen by 28%. The heath care team needed to take over DOT in 3% of the cases. Regular attendance at follow-up appointments was 67%. It was observed that 24% of the problems in this DOT model referred to the family supervisor forgetting to administer the medication or to the patient forgetting to take it; 39% of the patients forgot to take the medication for one day, and 31% forgot to take it for two days. There was change of supervisor in 9% of the sample, medication was lost by the patient sometime during treatment in 9%, and patient drug intolerance occurred in 8%. Conclusions: DOT supervised by a family member has proven an effective and low-cost technique. However, compliance is not due to one single factor but to the combination of strategies adopted: bus passes; educational measures and especially the individualized approach.

Keywords: Directly observed therapy; Tuberculosis; Patient compliance.

Objective: Respiratory syncytial virus (RSV) is a major cause of severe respiratory infections in older adults, particularly those with comorbidities. Despite its clinical impact, RSV remains underdiagnosed and underreported. We sought to assess the burden of RSV in older adults (= 60 years of age) in Brazil using national surveillance data for the 2022-2023 period. Methods: We analyzed RSV cases reported in the Sistema de Informação de Vigilância Epidemiológica, identifying them among reported cases of SARS. Cases were examined by demographic characteristics, seasonal trends, and clinical outcomes. RSV cases were compared across defined etiologies. Results: Among 355,230 reported cases of SARS in older adults, 201,965 (56.8%) had a defined etiology, and 1,465 (0.7%) were confirmed as RSV cases. Cases peaked in the second quarter of each year, with the highest incidence in the southern and southeastern regions. Despite a low hospitalization rate (2.3 per 100,000 population), severe outcomes were common: 30.4% required ICU admission, and 24.9% resulted in death, with mortality being highest in those = 90 years of age. Conclusions: RSV-related hospitalizations in Brazil appear underestimated, with reported cases likely representing the most severe spectrum due to underreporting and diagnostic limitations. Seasonal patterns peaked in April-May, and regional differences highlight a higher incidence in the southern and southeastern regions, likely due to epidemiological factors and diagnostic disparities. Although the recent approval of RSV vaccines offers an opportunity to reduce disease burden, successful implementation requires broader access and inclusion in the Brazilian National Immunization Program. Strengthening surveillance, diagnostic capacity, and reporting processes is critical for better disease assessment and public health planning.

Keywords: Respiratory syncytial virus infections; Severe acute respiratory syndrome; Hospitalization; Epidemiology; Aged; Surveillance.

Objective: To evaluate the impact of smoking on pulmonary tuberculosis (PTB) treatment outcomes and the two-month conversion rates for Mycobacterium tuberculosis sputum cultures among patients with culture-confirmed PTB in an area with a moderate incidence of tuberculosis in Brazil. Methods: This was a retrospective cohort study of PTB patients diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 2004 and 2012. Results: Of the 298 patients diagnosed with PTB during the study period, 174 were included in the outcome analysis: 97 (55.7%) were never-smokers, 31 (17.8%) were former smokers, and 46 (26.5%) were current smokers. Smoking was associated with a delay in sputum culture conversion at the end of the second month of TB treatment (relative risk = 3.58 [95% CI: 1.3-9.86]; p = 0.01), as well as with poor treatment outcomes (relative risk = 6.29 [95% CI: 1.57-25.21]; p = 0.009). The association between smoking and a positive culture in the second month of treatment was statistically significant among the current smokers (p = 0.027). Conclusions: In our sample, the probability of a delay in sputum culture conversion was higher in current smokers than in never-smokers, as was the probability of a poor treatment outcome.

Keywords: Tuberculosis; Treatment outcome; Smoking.

Objective: To assess nicotine product use among incoming students at public and private universities in Brazil. Methods: This was a multicenter cross-sectional study including a convenience sample of incoming university students (= 18 years of age). Current use of conventional cigarettes, electronic cigarettes, and other nicotine products, as well as indicators of dependence and knowledge of the consequences of active use of or passive exposure to nicotine products were investigated with the use of a 38-item questionnaire. Descriptive statistics were used to analyze the data. Results: A total of 863 students completed the questionnaire. Of those, most (61%) were female, and most (76.6%) identified themselves as White. In addition, most (86%) were in the 18- to 24-year age bracket, and most (88.6%) attended a public university. In the past 30 days, 20.7% reported using electronic cigarettes, 23.2% reported using conventional cigarettes, and more than 50% reported using other nicotine products. More than 80% agreed that electronic cigarettes are harmful to health and are as damaging as other types of smoking. Over half of the respondents reported using the product shortly after waking up, and, paradoxically, 81% stated that they would quit whenever they wanted. Passive exposure was reported by 21.6%, occurring at home (in 33.6%), in other indoor environments (in 41.7%), and in open environments (in 87.5%). Conclusions: Experimentation and current use of nicotine products are high among incoming students at public and private universities in Brazil. Passive exposure to nicotine products is commonplace. Advanced communication tools are needed, particularly to emphasize the dangers of nicotine dependence. Being a legal drug, nicotine is often perceived as harmless, reinforcing the misconception that it can be used without consequences.

Keywords: Cigarette smoking; Electronic nicotine delivery systems; Tobacco use disorder; Tobacco smoke pollution.

Objective: To determine the association between smoking and pulmonary tuberculosis treatment failure. Methods: This was a case-control study conducted at the Brazilian Institute for Tuberculosis Research in the city of Salvador, Brazil, between 2007 and 2015. We evaluated 284 patients treated for pulmonary tuberculosis, comparing 50 cases of treatment failure with 234 control cases in which the final outcome was cure. Results: Treatment failure was attributed to smoking and age rather than to gender, income, level of education, alcohol consumption, or marital status. Therefore, even after adjustment for age, the risk of treatment failure was 2.1 times (95% CI: 1.1-4.1) higher among the patients with a history of smoking. In addition, being over 50 years of age was found to increase the likelihood of treatment failure by 2.8 times (95% CI: 1.4-6.0). Conclusions: Smoking and aging are both associated with pulmonary tuberculosis treatment failure. Therefore, as part of a tuberculosis control program, health personnel should be prepared to offer strategies to promote smoking cessation and should be more careful with older patients.

Keywords: Tobacco use disorder; Tuberculosis; Treatment failure.

Objective: To estimate the time elapsed between the onset of symptoms and the initiation of treatment of pulmonary tuberculosis among treatment-naïve patients with positive results in sputum smear microscopy, and to evaluate the variables associated with delays in diagnosis and in treatment initiation. Methods: This was a descriptive exploratory study involving 199 treatment-naïve tuberculosis patients ≥ 12 years of age with AFB-positive sputum smear microscopy results between 2006 and 2008. At their first (treatment initiation) visit to a primary health care clinic in the city of Nova Iguaçu, Brazil, the patients were interviewed and their ancillary test results were reviewed. Results: The medians (and respective interquartile ranges) of the time from symptom onset to the initiation of treatment of pulmonary tuberculosis, from symptom onset to seeking medical attention, from entry into care to diagnosis, and from entry into care to treatment initiation, in weeks, were 11 (6-24), 8 (4-20), 2 (1-8), and 1 (1-1), respectively. The variables gender, age, level of education, previous use of antibiotics, HIV status, site of first medical visit, and radiological extent of tuberculosis showed no associations with the time from entry into care to diagnosis or to treatment initiation. The main reason for the delay in seeking medical attention reported by the patients was their inability to recognize their symptoms as indicators of a disease. Conclusions: Among the patients studied, there was an unacceptably long delay between the onset of symptoms and the initiation of tuberculosis treatment.

Keywords: Tuberculosis/diagnosis; Tuberculosis/therapy; Delayed diagnosis.

Abstract Objective: To compare four laboratory methods in the diagnosis of pulmonary tuberculosis. Methods: Respiratory secretion specimens were collected from 160 patients suspected of having pulmonary tuberculosis. Direct testing for Mycobacterium tuberculosis was carried out using Ziehl-Neelsen staining, auramine staining, culture on Löwenstein-Jensen (LJ) medium and polymerase chain reaction (PCR). The strains isolated were identified by means of a radiometric method using p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) and classical methods. The sensitivity of the methods was compared to the gold standard for the diagnosis of pulmonary tuberculosis, based on clinical, radiological and microbiological criteria. Results: Of the 160 patients, 142 were diagnosed with pulmonary tuberculosis according to the gold standard. The sensitivity of Ziehl-Neelsen staining, auramine staining, culture on LJ medium and PCR was 54.2%, 58.4%, 67.6% and 77.5%, respectively, when compared with the diagnostic criterion adopted. All four methods presented 100% specificity. In the identification of mycobacteria, there was high (96.8%) concordance between PCR and the radiometric method using NAP. The sensitivity of PCR was 50.8% in samples with negative sputum smear microscopy results and 98.8% in those with positive results. The sensitivity of PCR was lower in specimens with negative results in sputum smear microscopy and culture than in those with positive results (25.6% and 99.0%, respectively). Conclusions: We found PCR to be a promising method for the diagnosis of pulmonary tuberculosis, even in paucibacillary specimens. Simultaneous identification and faster results are additional advantages of this method.

Keywords: Tuberculosis, pulmonary/diagnosis; Culture media; Polymerase chain reaction; Sputum/microbiology.

Objective: To determine the spatial distribution of tuberculosis in the city of Ribeirão Preto, located in the state of São Paulo, Brazil, between 1998 and 2002, with a focus on the potential spatially-dependent nature of its occurrence. Methods: The secondary Epi-Tb database of the Ribeirão Preto Municipal Secretary of Health. Georeferencing of tuberculosis cases was performed using MapInfo 6.5 software, and the Spring program was used for statistical analysis of spatial data. Results: Through analysis of the existing spatial pattern and those of the previous years analyzed, we found a consistent pattern of spatial distribution of tuberculosis in Ribeirão Preto. Although there are areas that were homogeneous in terms of risk, the highest concentrations of cases were found in one zone, consisting of middle- to lower middle-class neighborhoods, located in the northeast part of the city. Conclusion: These results add to the store of knowledge regarding the spatial distribution of tuberculosis in Ribeirão Preto in various periods, emphasizing the importance of space as a methodological alternative to aid the planning, monitoring and evaluation of health care programs, allowing interventions to be more appropriately directed in order to decrease inequalities in the allocation of health care resources.

Keywords: Tuberculosis/epidemiology; Health status indicators; Residence characteristics; Urban health/ statistics & numerical data; Topography, medical

Objective: To compare inpatient and outpatient treatment of tuberculosis, in terms of outcomes, in the city of São Paulo, Brazil, as well to determine which variables are most frequently associated with hospitalization. Methods: A prospective, longitudinal study carried out between January and December of 2007, at two large hospitals and at outpatient clinics, in two regions of the city of São Paulo. For inpatients, data were collected with a structured questionnaire. Additional data were obtained from the São Paulo State Department of Health Tuberculosis Database. Results: Of the 474 patients included in the study, 166 were inpatients, and 308 were outpatients. The multivariate analysis showed that hospitalization for tuberculosis was associated with hospital/emergency room diagnosis of tuberculosis (OR = 55.42), with HIV co-infection (OR = 18.57), with retreatment (OR = 18.51), and with having previously sought treatment at another health care facility (OR = 12.32). For the inpatient and outpatient groups, the overall cure rates were 41.6% and 78.3%, respectively, compared with 30.4% and 58.5% for those who were co-infected with HIV, whereas the overall mortality rates were 29.5% and 2.6%, respectively, compared with 45.7% and 9.8% for those who were co-infected with HIV. Conclusions: Among inpatients, tuberculosis appears to be more severe and more difficult to diagnose, resulting in lower cure rates and higher mortality rates, than among outpatients. In addition, tuberculosis patients co-infected with HIV have less favorable outcomes.

Keywords: Tuberculosis; Hospitalization; Primary health care; Treatment outcome.

Objective: To compare the frequency of unfavorable outcome (death or default and treatment failure) between tuberculosis (TB)/HIV co-infected patients treated for TB after laboratory confirmation of the diagnosis and TB/HIV co-infected patients who were so treated without diagnostic confirmation. Methods: A retrospective cohort of TB/HIV co-infected patients who started TB treatment between July of 2002 and June of 2004 at an HIV/AIDS referral center in Recife, Brazil. The main exposure variable, laboratory confirmation of TB, was adjusted for three different sets of variables: sociodemographic variables; HIV/AIDS-related variables; and TB-related variables. In order to evaluate the statistical significance of the results, we calculated odds ratios, with 95% confidence intervals, and p values (from chi-square tests and likelihood ratio tests). Results: A total of 262 patients were studied. No association was found between laboratory confirmation of the diagnosis of TB at treatment outset and unfavorable outcome, even after adjustment for confounders. In the final multiple logistic regression model, the following variables remained: the presence of other opportunistic diseases; CD4 lymphocyte count below 50 cells/mm3; viral load between 10,000 and 100,000 copies/mL; dyspnea; the disseminated form of TB; and change in the TB treatment regimen due to adverse reactions or intolerance. Conclusions: Our results suggest that TB treatment in TB/HIV co-infected patients without etiologic confirmation of TB, at the discretion of experienced physicians in referral centers, did not increase the risk of unfavorable outcomes. In addition, it allowed the identification of groups that should be closely monitored due to a greater risk of unfavorable outcomes.

Keywords: Tuberculosis; Diagnosis; Therapeutics; Treatment outcome; HIV infections.

Background: Lobectomy is still considered the most effective method of controlling primary lung tumors. Method: During the period from 1995 to 2000, 733 cases of non-small cell bronchial carcinoma. After clinical evaluation and surgical staging, 191 patients were submitted to surgical resection. Of those 191 surgeries, 63 were for locally advanced tumors and 128 (69 segmentectomies and 59 lobectomies) for primary tumors. Post-operative FEV1 of at least 800 ml was used as a measure of surgical success. Extended segmentectomies, in which the resection passes the intersegmental line, including the parenchyma of the adjoining segment, were used. Results: Among the 128 patients with primary tumors, there were 3 deaths and 10 patients fell out of contact. Therefore, 62 segmentectomies and 53 lobectomies were evaluated. There were 72 adenocarcinomas and 43 epidermoid carcinomas. The 5-year survival of lobectomy patients was 80% (T1N0), 72.7% (T2N0), 50% (T1N1) and 31.8% (T2N1), whereas that of segmentectomy patients was 80% (T1N0), 66.6% (T2N0), 41.1% (T1N1) and 30% (T2N1) (p > 0.05). Tumor size and enlarged interlobar lymph nodes were prognostically significant (p < 0.001), although method of resection influenced neither survival nor local or remote recurrence (p > 0.05). Conclusion: Extended segmentectomy represents an alternative treatment for primary tumors in patients with limited lung reserve.

Keywords: Lung Neoplasms, surgery. Pulmonary Surgical Procedures. Carcinoma, Non-Small-Cell Lung.

Background: In recent decades, the prevalence of asthma has increased. Objectives: To determine the prevalence of asthma symptoms in children and adolescents from 2 to 14 years of age living in Porto Alegre (in the state of Rio Grande do Sul, Brazil) and to determine any potential correlations with socioeconomic profile, treatment and smoking in the home. Methods: A transversal study based on interviews of all families seeking medical attention in June of 2000. Results: The prevalence of asthma symptoms was 49.5%. In 66.8% of families, total income was less than four times the minimum wage, and in more than 50% of homes, the parents had had less than five years of schooling. In 98.5%, prophylactic asthma treatment was not used. In the 174 families studied, 38.7% of mothers and 43.7% of fathers were smokers (32.7% overall). Correlations were found between the following variables: exposure to smoking in the home and number of asthma attacks in the last year (p = 0.02; RR = 2.9; CI: 1.1 - 4.5); maternal level of education and number of attacks in the last year (p = 0.03; RR = 2.03; CI: 1.01 - 4.19); close living quarters and number of attacks in the last year among children exposed to second-hand smoke (p = 0.04; RR = 2.7; CI: 1.4 - 5.1); hospitalization and number of attacks in the last year (p = 0.004; RR = 1.46; CI: 1.15 -1.86); hospitalization and close living quarters (p = 0.03; RR = 1.47; CI: 1.15 -1.86). In children below the age of five, there was correlation between maternal smoking and number of attacks in the last year (p = 0.03; RR = 1.79; CI: 1.04 - 3.08). Conclusion: The prevalence of asthma symptoms was high. The community studied has limited socioeconomic resources, and there is therefore a lack of adequate treatment for asthma. Our results demonstrate the need for prioritized, standardized treatment programs that would give healthcare workers access to the appropriate materials and means of evaluation necessary for asthma control.

Keywords: Key words: Asthma. Prevalence. Smoking in the home. Treatment between episodes of asthma.

Setting: Philanthropic health center specialized in lung diseases, including tuberculosis. Background: Directly-observed treatment (DOT) is the chief measure to insure improvement in cure levels and to reduce acquired resistance. This unit adopted DOT in the past, but financial difficulties prevent its maintenance. Objectives: Compare abandon levels in DOT and auto-administered treatment (AT) and identify predictive factors associated to abandonment. Type of study: Retrospective; patients observed in different years and selected at random. Material and methods: 1,226 patients were selected (613 patients in DOT and 613 in AT). Abandonment was compared in DOT and TA; in each group, abandonment was compared to sex, age, alcoholism, previous treatment, direction of symptoms, sputum and extension of the disease. Main results: Patients in DOT and in AT differ in some aspects. In AT, males, older age, positive sputum and more extensive disease were detected, previous treatment predominantly DOT. No difference was detected in relation to duration of symptoms, race, alcoholism and call up. Abandon was more frequent in AT (5.0% vs. 17.0%), p < 0.01, OR 3.90, CI 95% (2.50-5.88); one abandom in AT may be prevented by treating 8.4 patients in DOT. In AT, abandonment was related to male, black race, previous treatment, duration of symptoms, alcoholism and to age; duration of symptoms in DOT. Conclusion and proposal: 1) As abandonment is more common in AT, it is necessary to begin DOT immediately in structured units. 2) Cooperation with company medical facilities, community leaders and pharmacist will make it easier DOT adoption. 3) Punitive measures must be adopted for uncooperative patients.

Keywords: Tuberculosis. Abandonment. Directly-observed treatment (DOT).