Leprosy in the context of the Family Health Strategy in an endemic scenario in Maranhão: prevalence and associated factors. / Hanseníase no contexto da Estratégia Saúde da Família em cenário endêmico do Maranhão: prevalência e fatores associados.

This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.

Este estudo objetivou descrever a prevalência da hanseníase e verificar os fatores associados às formas clínicas multibacilares em cenário da Estratégia Saúde da Família, prioritário para o controle e a vigilância da doença no nordeste brasileiro. Trata-se de estudo transversal, que utilizou dados do Sistema de Informação de Agravos de Notificação relativos aos casos de hanseníase notificados em Imperatriz, Maranhão, entre 2008 e 2017. Determinaram-se as prevalências a cada ano e para o período. Para associar as variáveis e as formas clínicas multibacilares, utilizaram-se modelos de regressão de Poisson, com nível de significância de 5%. Dos 2.476 casos de hanseníase analisados, a maioria referiu-se às formas clínicas multibacilares. A prevalência variou entre 15,6 e 7,8/10 mil habitantes, encontrando-se níveis alto e muito alto de endemicidade. As variáveis sexo masculino, faixas etárias entre 30 e 59 anos e ≥60 anos, escolaridade <8 anos, grau 2 de incapacidade física, episódio reacional tipos 1 e 2 e zona de residência urbana apresentaram associações significativas (p≤0,05) com as formas clínicas multibacilares. Tais achados podem servir de base para elaboração e implementação de medidas de controle e vigilância da hanseníase, direcionando as ações para os grupos mais vulneráveis e tornando-se mais efetivas.

Hanseníase no contexto da estratégia saúde da família em cenário endêmico do maranhão: prevalência e fatores associados / Leprosy in the context of the family health strategy in an endemic scenario in maranhão: prevalence and associated factors

Resumo Este estudo objetivou descrever a prevalência da hanseníase e verificar os fatores associados às formas clínicas multibacilares em cenário da Estratégia Saúde da Família, prioritário para o controle e a vigilância da doença no nordeste brasileiro. Trata-se de estudo transversal, que utilizou dados do Sistema de Informação de Agravos de Notificação relativos aos casos de hanseníase notificados em Imperatriz, Maranhão, entre 2008 e 2017. Determinaram-se as prevalências a cada ano e para o período. Para associar as variáveis e as formas clínicas multibacilares, utilizaram-se modelos de regressão de Poisson, com nível de significância de 5%. Dos 2.476 casos de hanseníase analisados, a maioria referiu-se às formas clínicas multibacilares. A prevalência variou entre 15,6 e 7,8/10 mil habitantes, encontrando-se níveis alto e muito alto de endemicidade. As variáveis sexo masculino, faixas etárias entre 30 e 59 anos e ≥60 anos, escolaridade <8 anos, grau 2 de incapacidade física, episódio reacional tipos 1 e 2 e zona de residência urbana apresentaram associações significativas (p≤0,05) com as formas clínicas multibacilares. Tais achados podem servir de base para elaboração e implementação de medidas de controle e vigilância da hanseníase, direcionando as ações para os grupos mais vulneráveis e tornando-se mais efetivas.

Abstract This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.

Strengthening individual and family resilience against leprosy-related discrimination: A pilot intervention study.

BACKGROUND: Leprosy and leprosy-related stigma can have a major impact on psychosocial wellbeing of persons affected and their family members. Resilience is a process that incorporates many of the core skills and abilities which may enable people to address stigma and discrimination. The current study aimed to develop and pilot an intervention to strengthen individual and family resilience against leprosy-related discrimination. METHODOLOGY: We used a quasi-experimental, before-after study design with a mixed methods approach. The 10-week family-based intervention was designed to strengthen the resilience of individuals and families by enhancing their protective abilities and capacity to overcome adversity. The study was conducted in two sites, urban areas in Telangana state, and in rural areas in Odisha state, India. Persons affected and their family members were included using purposive sampling. Two questionnaires were used pre-and post-intervention: the Connor-Davidson Resilience Scale (CD-RISC, maximum score 100, with high scores reflecting greater resilience) and the WHOQOL-BREF (maximum score of 130, with higher scores reflecting higher quality of life). In addition, semi-structured interviews were conducted post-intervention. Data were collected at baseline, a few weeks after completion of the intervention, and in the Odisha cohort again at six months after completion. Paired t-tests measured differences pre- and post- intervention. Qualitative data were thematically analysed. FINDINGS: Eighty participants across 20 families were included in the study (23 persons affected and 57 family members). We found a significant increase in CD-RISC scores for persons affected and family members from Odisha state (baseline 46.5, first follow-up 77.0, second follow-up 70.0), this improvement was maintained at six-month follow-up. There was no increase in CD-RISC scores post-intervention among participants from Telangana state. WHOQOL-BREF scores were significantly higher at follow-up for persons affected in both states, and for family members in Odisha state. No families dropped out of the study. In the qualitative feedback, all participants described drawing benefit from the programme. Participants especially appreciated the social dimensions of the intervention. CONCLUSION: This pilot study showed that the 10-week family-based intervention to strengthen resilience among persons affected by leprosy and their family members was feasible, and has the potential to improve resilience and quality of life. A large-scale efficacy trial is necessary to determine the effectiveness and long-term sustainability of the intervention.

Association of MICA and HLA-B alleles with leprosy in two endemic populations in Brazil.

Leprosy is a prevalent disease in Brazil, which ranks as the country with the second highest number of cases in the world. The disease manifests in a spectrum of forms, and genetic differences in the host can help to elucidate the immunopathogenesis. For a better understanding of MICA association with leprosy, we performed a case-control and a family-based study in two endemic populations in Brazil. MICA and HLA-B alleles were evaluated in 409 leprosy patients and in 419 healthy contacts by PCR-SSOP-Luminex-based technology. In the familial study, analysis of 46 families was completed by direct sequencing of all exons and 3'/5'untranslated regions, using the Ilumina MiSeq platform. All data were collected between 2006 and 2009. Statistical analysis was performed using the Chi-square or Fisher's exact test together with a multivariate analysis. Family-based association was assessed by transmission disequilibrium test (TDT) software FBAT 2.0.4. We found associations between the haplotype MICA*002-HLA-B*35 with leprosy in both the per se and the multibacillary (MB) forms when compared to healthy contacts. The MICA allele *008 was associated with the clinical forms of paucibacillary (PB). Additionally, MICA*029 was associated with the clinical forms of MB. The association of MICA*029 allele (MICA-A4 variant) with the susceptibility to the MB form suggests this variant for the transmembrane domain of the MICA molecule may be a risk factor for leprosy. Two MICA and nine HLA-B variants were found associated with leprosy per se in the Colônia do Prata population. Linkage disequilibrium analysis revealed perfect linkage disequilibrium (LD) between HLA-B markers rs2596498 and rs2507992, and high LD (R2  = .92) between these and the marker rs2442718. This familial study demonstrates that MICA association signals are not independent from those observed for HLA-B. Our findings contribute the knowledge pool of the immunogenetics of Hansen's disease and reveals a new association of the MICA*029 allele.

Functional biomarker signatures of circulating T-cells and its association with distinct clinical status of leprosy patients and their respective household contacts.

BACKGROUND: Leprosy is a chronic infectious disease classified into two subgroups for therapeutic purposes: paucibacillary (PB) and multibacillary (MB), closely related to the host immune responses. In this context it is noteworthy looking for immunological biomarkers applicable as complementary diagnostic tools as well as a laboratorial strategy to follow-up leprosy household contacts. METHODS: The cross-sectional study enrolled 49 participants, including 19 patients and 30 healthy controls. Peripheral blood mononuclear cells (PBMC) were isolated and incubated in the presence of Mycobacterium leprae bacilli. The cells were prepared for surface (CD4+ and CD8+) and intracytoplasmic cytokine staining (IFN-γ, IL-4 and IL-10). Multiple comparisons amongst groups were carried out by ANOVA, Kruskal-Wallis, Student T or Mann-Whitney test. Comparative analysis of categorical variables was performed by Chi-square. Functional biomarker signature analysis was conducted using the global median values for each biomarker index as the cut-off edge to identify the proportion of subjects with high biomarker levels. RESULTS: The cytokine signature analysis demonstrated that leprosy patients presented a polyfunctional profile of T-cells subsets, with increased frequency of IFN-γ+ T-cell subsets along with IL-10+ and IL-4+ from CD4+ T-cells, as compared to health Controls (Venn diagram report). Moreover, statistical analysis was carried out using parametric or non-parametric variance analysis followed by pairwise multiple comparisons, according to the data normality distribution. L(PB) displayed a polyfunctional profile characterized by enhanced percentage of IFN-γ+, IL-10+ and IL-4+ produced by most T-cell subsets, as compared to L(MB) that presented a more restricted cytokine functional profile mediated by IL-10+ and IL-4+ T-cells with minor contribution of IFN-γ produced by CD4+ T-cells. Noteworthy was that HHC(MB) exhibited enhanced frequency of IFN-γ+ T-cells, contrasting with HHC(PB) that presented a cytokine profile limited to IL-10 and IL-4. CONCLUSIONS: Our data demonstrated that L(PB) displayed enhanced percentage of IFN-γ+, IL-10+ and IL-4+ as compared to L(MB) that presented functional profile mediated by IL-10+ and IL-4+ T-cells and HHC(MB) exhibited enhanced frequency of IFN-γ+ T-cells, contrasting with HHC(PB). Together, our findings provide additional immunological features associated with leprosy and household contacts. These data provide evidence that biomarkers of immune response can be useful complementary diagnostic/prognostic tools as well as insights that household contacts should be monitored to access putative subclinical infection.

The impact of leprosy, podoconiosis and lymphatic filariasis on family quality of life: A qualitative study in Northwest Ethiopia.

BACKGROUND: Several studies have shown that leprosy, podoconiosis and lymphatic filariasis impact individual quality of life. In contrast, family quality of life has not received as much attention despite evidence that families are also affected. This is especially relevant given the crucial role of the family in most societies around the world. This study looks at the impact of leprosy, podoconiosis and lymphatic filariasis on family quality of life. METHODOLOGY: The study used a cross-sectional design with a qualitative approach. Both semi-structured interviews and focus group discussions were conducted. Participants, persons affected and their family members, were selected by purposive sampling. Data were collected between August and November 2017 in Awi zone, Northwest Ethiopia and analysed by three independent researchers using open, inductive coding and content analysis. RESULTS: A total of 86 participants were included in this study: 56 participants in the in-depth interviews and 30 participants in the focus group discussions. We found that participation restrictions, reduced productivity and marginalisation were common. In addition, discrimination in the communities occurred often, often extending to family members of persons affected. Divorce and difficulties in finding a spouse were common for persons affected and their family members. Many persons affected reported mental health problems. While most people got social and physical support from their families, there were a few exceptions. In particular, persons with younger children seemed to lack social support. Having to provide for their affected family member sometimes caused stress, school dropouts and an additional workload. Financial problems and loss of livelihood were reported by almost all participants. CONCLUSION: This study revealed that leprosy, lymphatic filariasis and podoconiosis have an effect on several dimensions of family quality of life. Many problems reported related to stigma and poverty.

A novel integrated molecular and serological analysis method to predict new cases of leprosy amongst household contacts.

BACKGROUND: Early detection of Mycobacterium leprae is a key strategy for disrupting the transmission chain of leprosy and preventing the potential onset of physical disabilities. Clinical diagnosis is essential, but some of the presented symptoms may go unnoticed, even by specialists. In areas of greater endemicity, serological and molecular tests have been performed and analyzed separately for the follow-up of household contacts, who are at high risk of developing the disease. The accuracy of these tests is still debated, and it is necessary to make them more reliable, especially for the identification of cases of leprosy between contacts. We proposed an integrated analysis of molecular and serological methods using artificial intelligence by the random forest (RF) algorithm to better diagnose and predict new cases of leprosy. METHODS: The study was developed in Governador Valadares, Brazil, a hyperendemic region for leprosy. A longitudinal study was performed, including new cases diagnosed in 2011 and their respective household contacts, who were followed in 2011, 2012, and 2016. All contacts were diligently evaluated by clinicians from Reference Center for Endemic Diseases (CREDEN-PES) before being classified as asymptomatic. Samples of slit skin smears (SSS) from the earlobe of the patients and household contacts were collected for quantitative polymerase chain reaction (qPCR) of 16S rRNA, and peripheral blood samples were collected for ELISA assays to detect LID-1 and ND-O-LID. RESULTS: The statistical analysis of the tests revealed sensitivity for anti-LID-1 (63.2%), anti-ND-O-LID (57.9%), qPCR SSS (36.8%), and smear microscopy (30.2%). However, the use of RF allowed for an expressive increase in sensitivity in the diagnosis of multibacillary leprosy (90.5%) and especially paucibacillary leprosy (70.6%). It is important to report that the specificity was 92.5%. CONCLUSION: The proposed model using RF allows for the diagnosis of leprosy with high sensitivity and specificity and the early identification of new cases among household contacts.

Expressão diferencial de biomarcadores imunológicos de infecção subclínica em casos multibacilares de hanseníase e seus contatos domiciliares / Differential expression of immunological biomarkers of subclinical infection in multibacillary leprosy cases and their home contacts

A hanseníase é uma doença infectocontagiosa, causada pelo bacilo Mycobacterium leprae, com sintomatologia dermatoneurológica. Várias estratégias têm sido adotadas para o controle da hanseníase, porém o diagnóstico da hanseníase é essencialmente clínico. O desafio atual é identificar biomarcadores que possibilitem a identificação de parâmetros imunológicos de infecção subclínica e, em última análise, o diagnóstico precoce da hanseníase em indivíduos infectados e assintomáticos, para realização de imunoprofilaxia de forma oportuna quebrando, assim, a cadeia de transmissão do bacilo. Aprofundar nas diferenças entre casos índice multibacilares e seus contatos domiciliares foi a estratégia deste estudo, através da avaliação conjunta de parâmetros imunológicos gerais e específicos. Objetivo: o objetivo deste trabalho foi avaliar o perfil da resposta imune inata e adaptativa de casos multibacilares de hanseníase e seus contatos domiciliares para a identificação de parâmetros imunológicos de infecção subclínica. Metodologia: Para mensurar a expressão de moléculas de superfície foi realizada imunofenotipagem por citometria de fluxo. Para dosar os níveis de citocinas e quimiocinas séricas as foi utilizada a técnica de Cytometric Bead Array (CBA). Os níveis de IgM anti PGL-1 de foram mensurados pela técnica de ELISA. Resultados: Os níveis de IgM/IgG anti PGL-1, de linfócitos ativados T CD4+ e CD8+ e a frequência de monócitos circulantes estavam mais elevados em casos índice em relação aos seus contatos. A frequência de linfócitos T estava menor em casos índice MB. A distância imunológica entre casos e contatos domiciliares não foi significativa quando se avaliou em conjunto todos os parâmetros imunológicos. Conclusão: Nós inferimos, a partir dos parâmetros diferencialmente expressos em casos índice MB e contatos domiciliares, que a elevação da resposta humoral específica, o maior nível de ativação de linfócitos (com provável proliferação e diferenciação em células T efetoras e/ou de memória), a maior frequência de monócitos em trânsito no sangue periférico, podem ser opções de biomarcadores preditores de infecção subclínica em contatos domiciliares.(AU)

Leprosy is an infectious disease caused by the bacillus Mycobacterium leprae, with dermatoneurological symptoms. Several strategies have been adopted for leprosy control, but the diagnosis of leprosy is essentially clinical. The current challenge is to identify biomarkers that enable the identification of immunological parameters of subclinical infection and, ultimately, the early diagnosis of leprosy in infected and asymptomatic individuals, to perform immunoprophylaxis in a timely manner, thus breaking the bacillus transmission chain. Deepening the differences between multibacillary index cases and their household contacts was the strategy of this study, through the joint evaluation of general and specific immunological parameters. Objective: The aim of this study was to evaluate the profile of the innate and adaptive immune response of multibacillary leprosy cases and their household contacts for the identification of immunological parameters of subclinical infection. Methodology: To measure the expression of surface molecules, immunophenotyping was performed by flow cytometry. To measure serum cytokine and chemokine levels, the Cytometric Bead Array (CBA) technique was used. Anti-PGL-1 IgM/IgG levels were measured by ELISA. Results: Anti-PGL-1 IgM/IgG levels, CD4 + and CD8 + activated T lymphocytes and the frequency of circulating monocytes were higher in index cases compared to their contacts. The frequency of T lymphocytes was lower in MB index cases. The immunological distance between cases and home contacts was not significant when all immunological parameters were evaluated together. Conclusion: We infer from the differentially expressed parameters in MB index cases and household contacts that the elevation of specific humoral response, the highest level of lymphocyte activation (with probable proliferation and differentiation in effector and / or memory T cells), the higher frequency of peripheral blood transit monocytes, may be predictive biomarker options for subclinical infection in household contacts.

Health education and promotion actions among teams of the National Primary Care Access and Quality Improvement Program, Rio Grande do Sul state, Brazil. / Ações educativas e de promoção da saúde em equipes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, Rio Grande do Sul, Brasil.

OBJETIVO: to investigate the provision of health education and promotion actions in primary care, and their association with demographic characteristics and Family Health Strategy (FHS) coverage in Rio Grande do Sul state, Brazil. METHODS: this is a cross-sectional study conducted with 816 teams that adhered to the 2012 Primary Care Access and Quality Improvement Program. RESULTS: the most frequent actions were directed towards people with diabetes (91.2%), hypertension (90.8%) as well as antenatal and postnatal care (84.6%). The least frequent were directed to wards crack, alcohol and other drug users (32.4%), anxiolytic/benzodiazepine users (20.3%), people with tuberculosis (31.4%) and leprosy (21.0%). The greatest provision of health promotion and education actions occurred in smaller municipalities and with greater Family Health coverage. CONCLUSION: actions aimed at the reproductive period and chronic morbidities were the focus of primary care. FHS implementation strengthens health promotion.

Disfiguring facial lesions and loss of sensation.

Hansen disease (leprosy) continues to be prevalent in some regions of Africa, Asia, and South America, and each year 100 to 300 cases are reported in the United States, especially in immigrants and patients exposed to armadillos. Treatment depends on patient presentation. Hansen disease remains highly stigmatized, though it is now clear that it is not readily transmitted through casual physical contact.

CHEMOPROPHYLAXIS TO CONTROL LEPROSY AND THE PERSPECTIVE OF ITS IMPLEMENTATION IN BRAZIL: A PRIMER FOR NON-EPIDEMIOLOGISTS / Quimioprofilaxia para prevenção de hanseníase e sua implantação no Brasil: uma explicação introdutória para não epidemiologistas

The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention.

A ocorrência de hanseníase tem diminuído no mundo apesar de que a perspectiva de sua eliminação tem sido questionada. Uma proposta para o controle da endemia é a quimioprofilaxia pós-exposição entre contatos (post-exposure chemoprophylaxis, PEP), embora ainda existam dúvidas quanto aos seus aspectos operacionais e generalização de resultados. Nesse texto nós discutimos as evidências disponíveis na literatura, explicamos alguns conceitos epidemiológicos comumente encontrados em pesquisa sobre PEP e a implantação da PEP no contexto brasileiro. Nós argumentamos que: (1) a estimativa em diferentes estudos do numero de contatos necessário para receber PEP para prevenir um novo caso de hanseníase (number needed to treat, NNT) não é facilmente generalizável; (2) áreas cobertas pelo programa de saúde da família são as áreas prioritárias onde PEP poderia ser implantado; (3) não existe necessidade de segunda dose da quimioprofilaxia; (4) o risco de resistência à droga usada na PEP parece ser muito pequeno; (5) questionamos a necessidade de teste sorológico para identificar indivíduos entre os contatos que tenham maior risco de doença. Nós opinamos que, se houver uma decisão para se iniciar PEP no Brasil, essa intervenção deveria ser iniciada em pequena escala e, à proporção que novas evidências são geradas sobre a factibilidade, sustentabilidade e impacto da intervenção, a intervenção com PEP poderia ou não ser usada em larga escala.

[Family Health Strategy professionals' view on the effects of Hansen's disease training]. / A visão de profissionais da Estratégia Saúde da Família sobreos efeitos do treinamento de hanseníase.

OBJECTIVE: Evaluating how professionals of family health teams from three municipalities of Pernambuco perceive and interpret the effects of Hansen's disease training. METHODS: A qualitative study using the perspective of Habermas. Six focus groups, totaling 33 nurses and 22 doctors were formed. The guide consisted of: reactions to training, learning, transfer of knowledge and organizational results. RESULTS: There were recurrent positive opinions on instructor performance, course materials, and an alert attitude to the occurrence of cases; the negative points were about lack of practical teaching, a lot of information in a short period of time and little emphasis on basic content. Low perceived self-efficacy and low locus of control, ambiguity, conflict of skills and the lack of support for the learning application. Nurses showed greater dissatisfaction with the organizational support. CONCLUSION: The low effectiveness of training reveals the need to negotiate structured training from work problematization, considering performance conditions.

Family Health Strategy professionals' view on the effects of Hansen's disease training / La visión de los profesionales de la Estrategia Salud de la Familia acerca de los efectos del entrenamiento de hanseniasis / A visão de profissionais da Estratégia Saúde da Família sobre os efeitos do treinamento de hanseníase

OBJECTIVEEvaluating how professionals of family health teams from three municipalities of Pernambuco perceive and interpret the effects of Hansen's disease training.METHODSA qualitative study using the perspective of Habermas. Six focus groups, totaling 33 nurses and 22 doctors were formed. The guide consisted of: reactions to training, learning, transfer of knowledge and organizational results.RESULTSThere were recurrent positive opinions on instructor performance, course materials, and an alert attitude to the occurrence of cases; the negative points were about lack of practical teaching, a lot of information in a short period of time and little emphasis on basic content. Low perceived self-efficacy and low locus of control, ambiguity, conflict of skills and the lack of support for the learning application. Nurses showed greater dissatisfaction with the organizational support.CONCLUSIONThe low effectiveness of training reveals the need to negotiate structured training from work problematization, considering performance conditions.

OBJETIVOEvaluar cómo los profesionales de los equipos de salud de la familia de tres municipios de Pernambuco perciben e interpretan los efectos del entrenamiento de hanseniasis.MÉTODOEstudio cualitativo que utiliza la perspectiva habermasiana. Se formalizaron seis grupos focales, totalizando 33 enfermeras y 22 médicos. Figuraron en el guión: reacciones al entrenamiento, aprendizaje, transferencia de aprendizaje y resultados organizativos.RESULTADOSFueron recurrentes las opiniones positivas acerca del desempeño del instructor, el material didáctico, la actitud de alerta a la ocurrencia de casos, negativas sobre falta de enseñanza práctica, mucha información a corto plazo y poca énfasis a los contenidos básicos. Notaron baja autoeficacia y bajo locus de control, ambigüedad, conflicto de competencias y la falta de soporte a la aplicación de lo aprendido. Las enfermeras mostraron mayor insatisfacción con el soporte organizativo.CONCLUSIÓNLa baja efectividad del entrenamiento revela la necesidad de negociar la capacitación desde la problematización del trabajo, considerando las condiciones para el desempeño.

OBJETIVOAvaliar como os profissionais das equipes de saúde da família de três municípios de Pernambuco percebem e interpretam os efeitos do treinamento de hanseníase.MÉTODOEstudo qualitativo que utiliza perspectiva habermasiana. Formalizaram-se seis grupos focais, perfazendo 33 enfermeiras e 22 médicos. Constaram do roteiro: reações ao treinamento, aprendizagem, transferência de aprendizagem e resultados organizacionais.RESULTADOSForam recorrentes as opiniões positivas sobre o desempenho do instrutor, o material didático, a atitude de alerta à ocorrência de casos, negativas sobre falta de ensino prático, muita informação em curto tempo e pouca ênfase em conteúdos básicos. Perceberam baixa autoeficácia e baixo locus de controle, ambiguidade, conflito de competências e a falta de suporte à aplicação do aprendido. As enfermeiras mostraram maior insatisfação com o suporte organizacional.CONCLUSÃOA baixa efetividade do treinamento revela a necessidade de negociar a capacitação a partir da problematização do trabalho, considerando as condições para o desempenho.

CHEMOPROPHYLAXIS TO CONTROL LEPROSY AND THE PERSPECTIVE OF ITS IMPLEMENTATION IN BRAZIL: A PRIMER FOR NON-EPIDEMIOLOGISTS.

The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention.

Indeterminate leprosy and lepromatous index case: four cases in the same family.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. Brazil remains as the country with the second largest number of cases in the world. We report the case of three patients diagnosed with indeterminate leprosy in the same family. Two patients were HIV positive. An active search led to the discovery of the index case. It was crucial to persist in the search of the index case. This report shows how important it is to teach physicians and the general population about the signs and symptoms of leprosy. Early diagnosis and treatment are necessary to prevent sequelae and to eliminate the disease as a public health problem.

Indeterminate leprosy and lepromatous index case: four cases in the same family / Hanseniase indeterminada e caso indice virchowiano: 4 casos na mesma familia

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. Brazil remains as the country with the second largest number of cases in the world. We report the case of three patients diagnosed with indeterminate leprosy in the same family. Two patients were HIV positive. An active search led to the discovery of the index case. It was crucial to persist in the search of the index case. This report shows how important it is to teach physicians and the general population about the signs and symptoms of leprosy. Early diagnosis and treatment are necessary to prevent sequelae and to eliminate the disease as a public health problem.

A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que afeta principalmente a pele e nervos periféricos. O Brasil continua sendo o segundo país do mundo com maior número de casos. Aqui relatamos três pacientes diagnosticados com hanseníase indeterminada, pertencentes à mesma família, cuja busca ativa levou à descoberta do caso índice. Dois pacientes eram HIV positivos. Foi de imensa importância a insistência na procura pelo caso índice. Este relato ilustra a importância do ensino sobre sinais e sintomas de hanseníase na formação médica e à população. O pronto reconhecimento e tratamento são necessários para prevenir sequelas e eliminar a doença como problema de saúde pública.