Vânia Del´Arco Paschoal

Criação de banco de dados para sustentação da pós-eliminação em hanseníase

São José do Rio Preto reached the World Health Organization goal eliminating leprosy as a Public Health problem in the year 2006, with a prevalence of 0.79/10,000 inhabitants. In order to warrant reliable information to promote management measures that keep this status, the aim of this study was to create a leprosy data bank in the city with information from 1998 to 2006. A data collection protocol was used and it contained 74 clinical-epidemiological variables that were gathered from primary and secondary sources. This work was initiated with 442 cases registered in the municipal control program database, from those 168 were excluded and 85 were inserted. There were 24 cases not notified in the National Information System (SINAN). The 74 variables collected will allow further studies about themes: epidemiological profiles, household contacts control, reactions and deficiencies, and others. The difficulties faced during the elaboration of the database were related to decoding medical files data and inconsistency in the SINAN. The frequent mistakes while entering the data weaken the information system and difficult the plan of precise actions regarding health. These facts are relevant to the quality of attention and the maintenance of the leprosy elimination status.

Escala salsa e grau de incapacidades da Organização Mundial de Saúde: avaliação da limitação de atividades e deficiência na hanseníase

Verificar o grau de incapacidades da OMS (GI-OMS) e a limitacao de atividades avaliada pela escala Screening of Activity Limitation and Safety Awareness (SALSA) pos-alta medicamentosa dos pacientes que tiveram hanseniase. Estudo transversal que incluiu pacientes tratados entre 2007 a 2009, em Sao Jose do Rio Preto-SP, Brasil. Utilizouse protocolo proprio para coletar dados gerais e clinicos, construido com base no Check List da Classificacao Internacional Funcionalidade, Incapacidade e Saude. A deficiencia foi medida pelo GI-OMS e a limitacao de atividades pelo SALSA que tem variacao de 10 a 80 e ponto de corte ≥25. De 84 pessoas tratadas no periodo, 54(64,3%) foram entrevistadas, sendo 31(57,4%) homens, idade 53,8(dp16,3) e 33(61,2 %) possuia ate 6 anos de educacao formal. A forma clinica dimorfa predominou 17(32,1%), 21(38,9%) considerou sua saude fisica “boa”. A analise dos escores SALSA e variaveis estudadas resultou em significância aos que relataram lesao significante (valor-p=0,04), baixa renda familiar (valor-p=0,04), baixa escolaridade (valor-p=0,00), formas clinicas multibacilares (valor-p=0,01) e deficiencias avaliadas pelo GI-OMS (valor-p=0,01). As limitacoes de atividades sao frequentes (57,4%), assim como as deficiencias medidas pelo GI-OMS (68,5%), atingem as formas multibacilares, pessoas que relataram lesao significante, de baixa renda e escolaridade.1 Terapeuta Ocupacional, Instituto de Psiquiatria do Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. 2 Terapeuta Ocupacional, Instituto Lauro de Souza Lima, Centro de Laboratorios Regionais Instituto Adolfo Lutz, Sao Jose do Rio Preto. 3 Terapeuta Ocupacional, Docente da Universidade Federal de Sao Carlos-UFSCar. 4 Centro de Laboratorios Regionais Instituto Adolfo Lutz, Sao Jose do Rio Preto. 5 Doutora, Departamento de Enfermagem e Saude Coletiva. Faculdade de Medicina de Sao Jose do Rio Preto. Verificar o grau de incapacidades da OMS (GI-OMS) e a limitacao de atividades avaliada pela escala Screening of Activity Limitation and Safety Awareness (SALSA) pos-alta medicamentosa dos pacientes que tiveram hanseniase. Estudo transversal que incluiu pacientes tratados entre 2007 a 2009, em Sao Jose do Rio Preto-SP, Brasil. Utilizouse protocolo proprio para coletar dados gerais e clinicos, construido com base no Check List da Classificacao Internacional Funcionalidade, Incapacidade e Saude. A deficiencia foi medida pelo GI-OMS e a limitacao de atividades pelo SALSA que tem variacao de 10 a 80 e ponto de corte ≥25. De 84 pessoas tratadas no periodo, 54(64,3%) foram entrevistadas, sendo 31(57,4%) homens, idade 53,8(dp16,3) e 33(61,2 %) possuia ate 6 anos de educacao formal. A forma clinica dimorfa predominou 17(32,1%), 21(38,9%) considerou sua saude fisica “boa”. A analise dos escores SALSA e variaveis estudadas resultou em significância aos que relataram lesao significante (valor-p=0,04), baixa renda familiar (valor-p=0,04), baixa escolaridade (valor-p=0,00), formas clinicas multibacilares (valor-p=0,01) e deficiencias avaliadas pelo GI-OMS (valor-p=0,01). As limitacoes de atividades sao frequentes (57,4%), assim como as deficiencias medidas pelo GI-OMS (68,5%), atingem as formas multibacilares, pessoas que relataram lesao significante, de baixa renda e escolaridade.

Deficiências após a alta medicamentosa da hanseníase: prevalência e distribuição espacial

OBJECTIVE To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Students t-test, chi-square test (χ2), and Fishers test were used as appropriate at a 5% significance level. RESULTS Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.OBJETIVO: Estimar la frecuencia de las deficiencias fisicas, en pacientes tratados por hanseniasis, posteriores a alta medicamentosa y analizar su distribucion espacial METODOS: Estudio descriptivo transversal con 232 personas tratadas por hanseniasis de 1998 a 2006. Las deficiencias fisicas fueron evaluadas por el Grado de Incapacidades de la Organizacion Mundial de Salud (GI/OMS) y por el Eyes-Hand-Feet (EHF). Los ex -pacientes fueron geocodificados por la direccion de residencia y los servicios de rehabilitacion por la direccion de su sede. Se presentaron las frecuencias para el total y para los grupos grado 0, grado 1 y grado 2 del GI-OMS, considerandose las variables clinicas y sociodemograficas en el analisis descriptivo. Se utilizaron las pruebas t de Student, Chi-cuadrado (?2) o de Fisher, conforme apropiado, considerandose significativos p= 0,05. RESULTADOS: Cerca de 51,6% eran del sexo femenino, con promedio de edad de 54 anos (de 15,7); 30,5% tenian menos de dos anos de educacion formal; 43,5% trabajaban y 26,9% estaban jubilados; la forma dimorfa predomino (39,9%). Las deficiencias evaluadas por el GI-OMS y por el EHF alcanzaron 32% de los ex -pacientes La presencia de deficiencias fue mayor con el aumento de la edad (p=0,029), en casos multibacilares (p=0,005) y con diagnostico equivocado del paciente sobre su salud fisica (p?0,001). Los que necesitaban de prevencion/rehabilitacion recorrieron distancia promedio de 5,5km hasta el servicio de rehabilitacion. Las personas con deficiencia fisica estaban distribuidas en todo el municipio, pero se concentraban en el area mas populosa y de mayor carencia socioeconomica. CONCLUSIONES: La frecuencia de deficiencias es elevada posterior al alta medicamentosa. Los ex -pacientes mas viejos, los que tuvieron formas multibacilares de la enfermedad, los de baja escolaridad y los que presentaron diagnostico equivocado de la propia salud fisica merecen atencion especial para la prevencion y rehabilitacion de deficiencias. La distancia entre los servicios de rehabilitacion y las residencias de los pacientes requiere reorganizacion de la red de atencion en el municipio.

NINJURIN1 single nucleotide polymorphism and nerve damage in leprosy

UNLABELLED Leprosy, a chronic infectious disease caused by Mycobacterium leprae, can damage the peripheral nervous system and represents one of the leading causes of nontraumatic neuropathy in some developing countries. The NINJURIN1 is a cell adhesion molecule that provides suitable substrates for repair of Schwann cells after peripheral nerve injury. The single nucleotide polymorphism NINJ1, is the result of a transversion of an adenine to a nucleotide polymorphic cytokine (A→C), responsible for an amino acid exchange of asparagine to alanine at position 110 of the protein (asp110ala). OBJECTIVES The aim of this study was to investigate the importance of the polymorphism in the NINJ1 gene for neural impairment during leprosy course. METHODS A single nucleotide polymorphism (asp110ala) was searched in 218 leprosy patients and 244 non-leprosy subjects using a polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) method. RESULTS No statistical differences were observed in the frequency of the asp110ala SNP between leprosy patients versus non-leprosy and multibacillary versus paucibacillary clinical forms. The C allele (ala110) is increased among patients exhibiting nerve impairment (p=0.0379). Also, leprosy patients with the CC genotype (ala/ala) had a higher risk (OR=4.21) of developing nerve disability when compared those carrying the AA genotype (asp/asp) (OR=0.69). CONCLUSION Our results show an association between the studied C allele (ala110) and damage nerve in leprosy patients. SIGNIFICANCE Ninjurin analysis showed that asp110ala could be a valuable prognostic marker, since C allele (ala110) have increased susceptibility to nerve damage.

Leprosy-related disabilities after release from multidrug treatment: prevalence and spatial distribution

OBJECTIVE To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Students t-test, chi-square test (χ2), and Fishers test were used as appropriate at a 5% significance level. RESULTS Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.OBJETIVO: Estimar la frecuencia de las deficiencias fisicas, en pacientes tratados por hanseniasis, posteriores a alta medicamentosa y analizar su distribucion espacial METODOS: Estudio descriptivo transversal con 232 personas tratadas por hanseniasis de 1998 a 2006. Las deficiencias fisicas fueron evaluadas por el Grado de Incapacidades de la Organizacion Mundial de Salud (GI/OMS) y por el Eyes-Hand-Feet (EHF). Los ex -pacientes fueron geocodificados por la direccion de residencia y los servicios de rehabilitacion por la direccion de su sede. Se presentaron las frecuencias para el total y para los grupos grado 0, grado 1 y grado 2 del GI-OMS, considerandose las variables clinicas y sociodemograficas en el analisis descriptivo. Se utilizaron las pruebas t de Student, Chi-cuadrado (?2) o de Fisher, conforme apropiado, considerandose significativos p= 0,05. RESULTADOS: Cerca de 51,6% eran del sexo femenino, con promedio de edad de 54 anos (de 15,7); 30,5% tenian menos de dos anos de educacion formal; 43,5% trabajaban y 26,9% estaban jubilados; la forma dimorfa predomino (39,9%). Las deficiencias evaluadas por el GI-OMS y por el EHF alcanzaron 32% de los ex -pacientes La presencia de deficiencias fue mayor con el aumento de la edad (p=0,029), en casos multibacilares (p=0,005) y con diagnostico equivocado del paciente sobre su salud fisica (p?0,001). Los que necesitaban de prevencion/rehabilitacion recorrieron distancia promedio de 5,5km hasta el servicio de rehabilitacion. Las personas con deficiencia fisica estaban distribuidas en todo el municipio, pero se concentraban en el area mas populosa y de mayor carencia socioeconomica. CONCLUSIONES: La frecuencia de deficiencias es elevada posterior al alta medicamentosa. Los ex -pacientes mas viejos, los que tuvieron formas multibacilares de la enfermedad, los de baja escolaridad y los que presentaron diagnostico equivocado de la propia salud fisica merecen atencion especial para la prevencion y rehabilitacion de deficiencias. La distancia entre los servicios de rehabilitacion y las residencias de los pacientes requiere reorganizacion de la red de atencion en el municipio.

Deficiencias posteriores a alta medicamentosa de hanseniasis: prevalencia y distribución espacial

OBJECTIVE To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Students t-test, chi-square test (χ2), and Fishers test were used as appropriate at a 5% significance level. RESULTS Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.OBJETIVO: Estimar la frecuencia de las deficiencias fisicas, en pacientes tratados por hanseniasis, posteriores a alta medicamentosa y analizar su distribucion espacial METODOS: Estudio descriptivo transversal con 232 personas tratadas por hanseniasis de 1998 a 2006. Las deficiencias fisicas fueron evaluadas por el Grado de Incapacidades de la Organizacion Mundial de Salud (GI/OMS) y por el Eyes-Hand-Feet (EHF). Los ex -pacientes fueron geocodificados por la direccion de residencia y los servicios de rehabilitacion por la direccion de su sede. Se presentaron las frecuencias para el total y para los grupos grado 0, grado 1 y grado 2 del GI-OMS, considerandose las variables clinicas y sociodemograficas en el analisis descriptivo. Se utilizaron las pruebas t de Student, Chi-cuadrado (?2) o de Fisher, conforme apropiado, considerandose significativos p= 0,05. RESULTADOS: Cerca de 51,6% eran del sexo femenino, con promedio de edad de 54 anos (de 15,7); 30,5% tenian menos de dos anos de educacion formal; 43,5% trabajaban y 26,9% estaban jubilados; la forma dimorfa predomino (39,9%). Las deficiencias evaluadas por el GI-OMS y por el EHF alcanzaron 32% de los ex -pacientes La presencia de deficiencias fue mayor con el aumento de la edad (p=0,029), en casos multibacilares (p=0,005) y con diagnostico equivocado del paciente sobre su salud fisica (p?0,001). Los que necesitaban de prevencion/rehabilitacion recorrieron distancia promedio de 5,5km hasta el servicio de rehabilitacion. Las personas con deficiencia fisica estaban distribuidas en todo el municipio, pero se concentraban en el area mas populosa y de mayor carencia socioeconomica. CONCLUSIONES: La frecuencia de deficiencias es elevada posterior al alta medicamentosa. Los ex -pacientes mas viejos, los que tuvieron formas multibacilares de la enfermedad, los de baja escolaridad y los que presentaron diagnostico equivocado de la propia salud fisica merecen atencion especial para la prevencion y rehabilitacion de deficiencias. La distancia entre los servicios de rehabilitacion y las residencias de los pacientes requiere reorganizacion de la red de atencion en el municipio.