OBJETIVO: Estimar o tempo decorrido entre início dos sintomas e diagnóstico de tuberculose pulmonar (tempo do paciente, desde o início dos sintomas até a primeira visita médica, e tempo do sistema de saúde, desde a primeira visita até o diagnóstico) e analisar os fatores associados ao atraso no diagnóstico da tuberculose pulmonar no estado do Rio de Janeiro. MÉTODOS: Inquérito baseado em questionário com 218 pacientes com tuberculose pulmonar, no 2º mês de tratamento, em 20 unidades de saúde e 3 hospitais de oito municípios do estado do Rio de Janeiro. Dados socioeconômicos, dados demográficos, dados sobre o serviço de saúde e história clínica foram coletados. RESULTADOS: A mediana do tempo do início dos sintomas até o diagnóstico foi de 68 dias [intervalo interquartil (II): 35-119 dias]. A mediana do tempo dos pacientes foi de 30 dias (II: 15-60 dias) e a do tempo do sistema de saúde foi de 21 dias (II: 8-47 dias). Um ponto de corte de 21 dias foi adotado para atraso. Os fatores independentes associados ao atraso do paciente foram sexo feminino, tosse e desemprego [OR ajustada (IC95%) = 2,7 (1,3-5,6); 11,6 (2,3-58,8); e 2,0 (1,0-3,8), respectivamente], enquanto aquele associado ao atraso do sistema de saúde foi apenas sexo feminino (OR = 3,2; IC95%: 1,7-6,0). CONCLUSIONS: O diagnóstico tardio da tuberculose pulmonar continua sendo um problema no Rio de Janeiro, possivelmente colaborando para a transmissão e a mortalidade. Mulheres e desprivilegiados socioeconomicamente são mais vulneráveis. Tosse crônica talvez seja subestimada como um problema de saúde pelos pacientes. Campanhas educacionais sobre os sintomas da doença e direcionadas às mulheres podem colaborar para reduzir esse atraso.

OBJECTIVE: To estimate the total time elapsed between symptom onset and diagnosis of pulmonary tuberculosis (patient delay plus health care system delay), analyzing the factors associated with delayed diagnosis in the state of Rio de Janeiro, Brazil. METHODS: We conducted a questionnaire-based survey involving 218 pulmonary tuberculosis patients treated for two months at 20 health care clinics and 3 hospitals in eight cities within the state of Rio de Janeiro. We collected socioeconomic and demographic data, as well as data regarding the health care system and the medical history of the patients. RESULTS: The median time elapsed from the onset of symptoms to diagnosis was 68 days (interquartile range [IQR]: 35-119 days). The median patient delay (time from symptom onset to initial medical visit) was 30 days (IQR: 15-60 days), and the median health care system delay (time from initial medical visit to diagnosis) was 21 days (IQR: 8-47 days). A cut-off point of 21 days was adopted. The factors independently associated with patient delay were female gender, cough, and unemployment [adjusted OR (95% CI) = 2.7 (1.3-5.6); 11.6 (2.3-58.8); and 2.0 (1.0-3.8), respectively], whereas only female gender was independently associated with health care system delay (OR= 3.2; 95% CI: 1.7-6.0). CONCLUSIONS: Delayed diagnosis of pulmonary tuberculosis remains a problem in Rio de Janeiro, increasing the risk of transmission and mortality, that risk being greater for women and the socioeconomically disadvantaged. Patients might not recognize the significance of chronic cough as a health problem. Tuberculosis education programs targeting women might improve this situation.

OBJECTIVES: To describe knowledge, practices, and associated factors of medical students to prevent transmission of tuberculosis (TB) in five medical schools. METHODS: Cross-sectional survey of undergraduate medical students in preclinical and in early and late clinical years. Information was obtained on sociodemographic profile, previous lectures on TB, knowledge about TB transmission, exposure to patients with active pulmonary TB, and use of respiratory protective masks. RESULTS: Among 1 094 respondents, 575 (52.6%) correctly answered that coughing, speaking, and sneezing can transmit TB. Early [adjusted odds ratio = 4.0 (3.0, 5.5)] and late [adjusted odds ratio = 4.2 (3.1, 5.8)] clinical years were associated with correct answers, but having had previous lectures on TB was not. Among those who had previous lectures on TB, the rate of correct answers increased from 42.1% to 61.6%. Among 332 medical students who reported exposure to TB patients, 194 (58.4%) had not used protective masks. More years of clinical experience was associated with the use of masks [adjusted odds ratio = 2.9 (1.4, 6.1)], while knowledge was inversely associated with the use of masks [adjusted odds ratio = 0.4 (0.2, 0.6)]. CONCLUSIONS: Many medical students are not aware of the main routes of TB infection, and lectures on TB are not sufficient to change knowledge and practices. Regardless of knowledge about TB transmission, students engage in risky behaviors: more than two-thirds do not use a protective mask when examining an active TB case. We suggest innovative, effective active learning experiences to change this scenario.

OBJETIVOS: Describir los conocimientos y las prácticas de los estudiantes de medicina para prevenir la transmisión de la tuberculosis (TB) en cinco escuelas de medicina y sus factores asociados. MÉTODOS: Estudio transversal mediante encuesta a estudiantes de medicina de cursos preclínicos, clínicos iniciales y clínicos avanzados. Se obtuvo información del perfil sociodemográfico, las conferencias recibidas sobre TB, el conocimiento sobre la transmisión de la TB, la exposición a pacientes con TB pulmonar activa y el uso de máscaras respiratorias de protección. RESULTADOS: De los 1 094 encuestados, 575 (52,6%) respondieron correctamente que toser, hablar y estornudar pueden transmitir la TB. Estar en los cursos clínicos iniciales (razón de posibilidades ajustada [ORa] = 4,0; intervalo de confianza de 95% [IC95%]: 3,0 a 5,5) y avanzados (ORa = 4,2; IC95%: 3,1 a 5,8) se asociaron con las respuestas correctas, no así haber recibido conferencias sobre TB. La tasa de respuestas correctas aumentó de 42,1% a 61,6% en los estudiantes que habían recibido conferencias sobre TB. De los 332 estudiantes de medicina que informaron haber estado expuestos a pacientes con TB, 194 (58,4%) no usaron máscaras protectoras. El mayor número de años de experiencia clínica se asoció con el uso de máscaras (ORa = 2,9; IC95%: 1,4 a 6,1), mientras que el conocimiento sobre el tema se asoció inversamente con el uso de máscaras (ORa = 0,4; IC95%: 0,2 a 0,6). CONCLUSIONES: Muchos estudiantes de medicina no conocen las vías principales de infección de la TB y las conferencias sobre TB no son suficientes para modificar sus conocimientos y actitudes. Independientemente del conocimiento sobre la transmisión de la TB, los estudiantes incurrieron en conductas de riesgo: más de dos terceras partes no usó máscaras protectoras al examinar casos activos de TB. Se recomienda establecer prácticas docentes innovadoras, efectivas y activas para cambiar este escenario.