Jaqueline Caracas Barbosa

Hanseníase no município de Fortaleza, CE, Brasil: aspectos epidemiológicos e operacionais em menores de 15 anos (1995-2006)

This is a sectional study that aims to analyze the occurrence of Hansens disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 anos de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidemicos en esta poblacion se presentaron hiperendemicos. En la operacinalizacion, se observa el mantenimiento de la concentracion de atencion en algunas unidades recomendables, a pesar de algunos avances. Diagnosticos muy tardes, gran grado de incapacidad en el diagnostico y bajo grado de evaluacion de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta asi la posibilidad de error de diagnostico delante de las caracteristicas de la infeccion en esta poblacion. La ocurrencia de casos de lepra en esta poblacion representa un indicador epidemico de gran importancia y su analisis amplia la discusion sobre los problemas operacionales en la red de servicios publicos.

Pós-alta em Hanseníase no Ceará: limitação da atividade funcional, consciência de risco e participação social

Caracterizar a limitacao funcional, de atividade, consciencia de risco, e restricao a participacao social em pessoas atingidas pela hanseniase no pos-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceara, com alta entre 2003 a 2005. Foram realizados exame fisico dermato-neurologico, avaliacao demografica, de limitacao funcional-atividade-consciencia de risco e de restricao a participacao social. Vinte (28,9%) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcancado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participacao 37 (53,6%) nao apresentaram restricao e tinham escore EHF zero. Dois (2,9%) com escore EHF zero tinham leve restricao e 1 (1,5%), grande restricao. Reafirma-se a potencialidade destas ferramentas para a atencao integral aos portadores.

O significado de conviver com a insuficiência renal crônica

Este estudo e parte integrante do resultado de inquietacoes relacionadas ao viver do doente renal cronico, tema de minha dissertacao de mestrado. Para tanto, utilizei a pesquisa qualitativa - modalidade fenomenologica, que possibilitou-me compreender o ser doente renal cronico e responder minha interrogacao: O que e ser doente renal cronico? A analise das descricoes desvelou o olhar do doente renal cronico com relacao a doenca, tratamento e possibilidade de cura. Entretanto neste trabalho darei enfoque ao significado do conviver com a insuficiencia renal cronica.This study is part integrant of result of my inquietude in relationship to the ill person with renal chronic illness, subject of my dissertation. For that, I used qualitative research phenomenological modality, that allowed me to understand the ill and to answer my interrogation: What is to be a renal chronically ill person? The analysis of descriptions revealed the look of the renal chronically ill in relationship with the disease, treatment and the possibility of cure. However in this study I emphasize the meaning to live with chronic renal failure.

Incapacidades físicas em pessoas acometidas pela hanseníase no período pós-alta da poliquimioterapia em um município no Norte do Brasil

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaina, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

Limited activity and social participation after hospital discharge from leprosy treatment in a hyperendemic area in north Brazil

INTRODUCTION Neural damages are among the main factors that contribute to physical disability in leprosy. Systematic monitoring using a broad physical, psychological and social approach is necessary. OBJECTIVE The objective of this study was to characterize the limitation of activity and social participation and its correlation with disabilities and/or impairment in individuals after being discharged from a multidrug leprosy therapy. METHOD A cross-sectional study conducted in Araguaína, state of Tocantins, which is a leprosy hyperendemic municipality. We included cases of patients who were discharged from treatment considered as cured from January 2004 to December 2009. We performed dermatological examination and applied the Screening Activity Limitation and Safety Awareness (SALSA) and social participation scales. RESULTS We included 282 individuals (mean age: 45.8 years old). The paucibacillary operational classification was more common (170; 60.3%). The eye-hand-foot score ranged from 0 to 12 (mean: 0.7). A total of 84 (29.8%) individuals presented limited activity. A slight restriction in social participation occurred in 18 (6.3%) cases. There was a statistically significant correlation between activity limitation, age (r = 0.40; p < 0.0001) and degree of functional limitation (r = 0.54; p < 0.0001), as well as of restricted social participation, activity limitation (r = 0.56, p < 0.0001) and functional limitations (r = 0.54, p < 0.0001). CONCLUSION Functional limitation due to leprosy had an impact on the conduct of activities and social participation after the discharge from a leprosy treatment. The association between Screening of Activity Limitation and Safety Awareness and participation scales will assist in designing evidence-based assistance measures.

Diagnóstico da hanseníase fora do município de residência: uma abordagem espacial, 2001 a 2009

Caracterizar o fluxo de pessoas afetadas pela hanseniase, do municipio de residencia para o de diagnostico, em area de alta endemicidade no Brasil. Estudo baseado em dados do Sistema de Informacao de Agravos e Notificacao de 2001-2009, nos estados do Maranhao, Para, Tocantins e Piaui. Dos 373 municipios, 349 (93,6%) tiveram pelo menos um residente afetado pela hanseniase notificado em outro municipio (4.325 casos, 5,2% dos notificados). Os municipios com maior numero de casos notificados fora de sua residencia foram Timon (248) e Sao Jose de Ribamar (201), no Maranhao. Os municipios que mais receberam casos para diagnostico foram Sao Luis (719) e Teresina (516). Destacam-se Goiânia (146) e o Distrito Federal (42) como polos de notificacoes de casos residentes no agregado, mesmo a mais de 1.000km de distância da area. O fluxo observado indica lacunas na descentralizacao do processo de atencao integral a pessoa afetada pela hanseniase e chama atencao para as dificuldades e desafios associados com o acompanhamento durante e apos a poliquimioterapia.

Autopercepção de pessoas acometidas pela hanseníase sobre sua saúde bucal e necessidade de tratamento

A hanseniase e uma doenca infecciosa que produz impacto do ponto de vista fisico, social e psicologico. O proposito deste estudo foi avaliar a autopercepcao sobre saude bucal e a necessidade de tratamento em pacientes com hanseniase no Municipio de Fortaleza (CE), Brasil. Trata-se de um estudo transversal e descritivo, onde 100 pacientes com hanseniase foram submetidos a questionario semiestruturado. Os resultados da analise bivariada entre necessidade de tratamento e caracteristicas socioeconomicas mostrou que apenas a escolaridade apresentou associacao estatistica (p = 0,000). Verificou-se associacao entre a classificacao da saude bucal e autopercepcao da necessidade de tratamento (p = 0,05). Com relacao a autopercepcao em saude bucal, 36% dos sujeitos pesquisados classificaram sua saude bucal como boa. A autopercepcao do paciente com hanseniase quanto a sua saude bucal e necessidade de tratamento deve, juntamente com uma avaliacao clinica, servir de guia para a execucao de politicas publicas que visem a favorecer um tratamento odontologico mais efetivo para esses pacientes.Trata-se de caracterizar a evolucao da serie historica quanto ao tipo de parto, normal, cesarea e forceps, no periodo de 1960 a 2001, nas tres maternidades mais antigas e conveniadas ao Sistema Unico de Saude (SUS) de Juiz de Fora. O metodo utilizado denomina-se historia serial e permite a comparabilidade entre eventos historicos em determinado periodo de tempo. Foi identificado o aumento de incorporacao tecnologica nesta trajetoria e o crescente uso da cesariana ate 1998, quando se identifica o impacto da portaria no 2816, proposta pelo Ministerio da Saude, atraves de inversao dessa tendencia com elevacao do numero de partos normais. A diferenciacao constatada do tipo de parto de acordo com a categoria de internacao aponta para uma discussao marcadamente politica, que diz respeito as relacoes sociais em que se entrelacam desigualdades de diversas ordens, entre elas as de genero e de classe social. Conhecer as desigualdades e problematizar sua existencia, traduzida em perfis de morbimortalidade e padroes desiguais de assistencia, e precondicao para obter o encaminhamento da solucao.

Physical disabilities in leprosy patients after discharge from multidrug therapy in Northern Brazil

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaína, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

Towards a toolkit for cross-neglected tropical disease morbidity and disability assessment

BACKGROUND Neglected tropical diseases (NTDs) are a group of often chronic and disabling infectious conditions, closely related to poverty and inequities. While it is estimated that millions of people are affected, accurate and internationally comparable data about NTD-related morbidity and disability are lacking. Therefore we aimed to develop and pilot a toolkit to assess and monitor morbidity and disability across NTDs. METHODS A cross-sectional, non-random survey design with a mixed methods approach was used. We conducted a literature review on existing tools to assess and monitor disability, followed by a Delphi study with NTD experts to compile a prototype toolkit. A first-phase validation study was conducted in Northeast Brazil among people with Chagas disease, leishmaniasis, leprosy and schistosomiasis. RESULTS Instruments included were the clinical profile, WHODAS, P-scale, SRQ, WHOQOL-BREF and WHOQOL-DIS. Most questions in the various instruments were readily understood with the exception of the WHOQOL-BREF, where additional explanations and examples were often needed. The respondents were very appreciative of the instruments and found it valuable to have the opportunity to talk about these aspects of their condition. CONCLUSIONS Our findings support the acceptability and relevance of five of the six instruments tested and the concept of a cross-NTD toolkit.

Atenção pós-alta em hanseníase no Sistema Único de Saúde: aspectos relativos ao acesso na região Nordeste

Universal access to health services represents a complex process of inter-relationships between users and health services. In a broader sense it includes economic, technical, political and symbolic aspects. For neglected diseases such as leprosy, this is a major challenge. This cross-sectional study aims to characterize access to health care services for people affected by leprosy after release from treatment in the cities of Sobral and Fortaleza. The study included a representative sample 10% of those concluding treatment from 2003 to 2005 (304 cases). Participants were characterized regarding socio demographic and clinical variables and access to health services after release from treatment. The study population was mostly male (58%), physical disabilities (34%) and with leprosy reactions (37%). The biomedical approach of leprosy reactions contemplated in large part to search for and supply of care in this period. The access to care after discharge was particularly weak in rehabilitative interventions such as surgery and psychological attention. We identified important gaps in the operationalization of attention to people affected after release from treatment in both cities. The date also shows the negligence of leprosy as a chronic condition and the resulting difficulties regarding on integrated distance to the comprehensive approach to people with leprosy after release from treatment in the Unified Health System (SUS).