Práticas coletivas e individuais associadas à dificuldade dos enfermeiros da atenção primária à saúde / Collective and individual practices associated with the difficulty of primary health care nurses / Prácticas coletivas e individuais asociadas a la dificultad de las enfermeras de atención primaria de salud

Objetivo: analisar as práticas individuais e coletivas que estão associadas as dificuldades dos enfermeiros que atuam na Atenção Primária à Saúde da região Norte. Métodos: observacional de prevalência e analítico. Foram incluídos enfermeiros da atenção básica. A coleta ocorreu entre novembro de 2019 a agosto de 2021, nos sete estados do Norte, através de um formulário eletrônico, analisados pelos testes binomial, quiquadrado e G no programa Bioestat. Resultados: Entre os 626 enfermeiros do estudo, 15,7% (98/626) afirmaram ter dificuldade no exercício de suas práticas, quanto à autonomia das suas responsabilidades normativas legais. O Amapá teve menor proporção (8,3%; 9/108) de enfermeiros com dificuldade em relação a região. As práticas associadas a dificuldade foram: a não participação do enfermeiro no gerenciamento dos insumos (p=0,03), realizar consulta eventualmente (p=0,03) e nunca prescrever medicamentos (p=0,02); resolutividade insuficiente na consulta pré-natal (p=0,000), acompanhamento de crescimento e desenvolvimento infantil (p=0,001); planejamento familiar (p=0,000); hanseníase (p=0,005); tuberculose (p=0,031); hipertensão arterial (p<0,0001); diabetes (p<0,0001). Conclusão: As dificuldades quanto à autonomia das responsabilidades normativas legais estão associadas a práticas individuais e coletivas que são privativas do enfermeiro e estão regulamentadas nos programas de saúde pública. (AU)

Objective: to analyze the individual and collective practices that are associated with the difficulties of nurses who work in Primary Health Care in the North region. Methods: observational of prevalence and analytical. Primary care nurses were included. The collection took place between November 2019 and August 2021, in the seven states of the North, through an electronic form, analyzed by the binomial, chi-square and G tests in the Bioestat program. Results: Among the 626 nurses in the study, 15.7% (98/626) stated that they had difficulty in exercising their practices, regarding the autonomy of their legal normative responsibilities. Amapá had a lower proportion (8.3%; 9/108) of nurses with difficulties in relation to the region. The practices associated with the difficulty were: the non-participation of nurses in the management of supplies (p=0.03), occasional consultations (p=0.03) and never prescribing medication (p=0.02); insufficient resolution in the prenatal consultation (p=0.000), monitoring of child growth and development (p=0.001); family planning (p=0.000); leprosy (p=0.005); tuberculosis (p=0.031); arterial hypertension (p<0.0001); diabetes (p<0.0001). Conclusion: Difficulties regarding the autonomy of legal normative responsibilities are associated with individual and collective practices that are exclusive to nurses and are regulated in public health programs. (AU)

Objetivo: analizar las prácticas individuales y colectivas que están asociadas a las dificultades de los enfermeros que actúan en la Atención Primaria de Salud de la región Norte. Métodos: observacional de prevalencia y analítico. Se incluyeron enfermeras de atención primaria. La colecta se realizó entre noviembre de 2019 y agosto de 2021, en los siete estados del Norte, a través de un formulario electrónico, analizado por las pruebas binomial, chi-cuadrado y G en el programa Bioestat. Resultados: Entre los 626 enfermeros del estudio, 15,7% (98/626) afirmaron tener dificultad en el ejercicio de sus prácticas, en cuanto a la autonomía de sus responsabilidades normativas legales. Amapá tuvo menor proporción (8,3%; 9/108) de enfermeros con dificultades en relación a la región. Las prácticas asociadas a la dificultad fueron: la no participación de los enfermeros en la gestión de los insumos (p=0,03), consultas ocasionales (p=0,03) y nunca recetar medicamentos (p=0,02); resolución insuficiente en la consulta prenatal (p=0,000), seguimiento del crecimiento y desarrollo infantil (p=0,001); planificación familiar (p=0,000); lepra (p=0,005); tuberculosis (p=0,031); hipertensión arterial (p<0,0001); diabetes (p<0,0001). Conclusión: Las dificultades en cuanto a la autonomía de las responsabilidades normativas legales están asociadas a las prácticas individuales y colectivas, exclusivas de los enfermeros y reguladas em los programas de salud pública. (AU)

Leprosy and tuberculosis control scenario of the national program for the improvement of access and quality of primary care in Brazil.

BACKGROUND: In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. OBJECTIVE: To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care. METHODS: In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3. RESULTS: Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p < 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p < 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p < 0.0001) and urban (p < 0.0001); collection of the first sputum sample in urban (p < 0.0001) and adjacent rural areas (p < 0.0001); directly observed treatment (p < 0.0001) in adjacent rural municipalities. CONCLUSION: There are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities.

Negligência no diagnóstico precoce de hanseníase na atenção primária: um relato de caso / Negligence in the early diagnosis of leprosy in primary care: a case report

A hanseníase é uma doença infecciosa, transmissível, de caráter crônico, com potencial grau de incapacidade, que ainda persiste como problema de saúde pública no Brasil. A demora e a falta de conhecimento técnico para realizar o diagnóstico resulta em inúmeros prejuízos aos pacientes acometidos pela doença, sendo que, a prevenção das incapacidades está relacionada diretamente com o diagnóstico precoce da doença. Com a finalidade de evitar a negligência diagnóstica e o desenvolvimento de incapacidades físicas, ressaltamos a importância do conhecimento técnico sobre o diagnóstico e o manejo da hanseníase por profissionais da saúde em qualquer nível de atenção à saúde ou especialidade.

Hansen is an infectious disease, transmissible, of a chronic nature, with serious potential for disability, which still persists as a public health problem in Brazil. The delay and the lack of technical knowledge to carry out the diagnosis with numerous prejudices to the patients affected by the disease, since the prevention of disabilities is directly related to the early diagnosis of the disease. In order to avoid diagnostic negligence and the development of physical disabilities, we highlight the importance of technical knowledge about the diagnosis and management of training by health professionals at any level of health care or special care.

Capacitação profissional em hanseníase na Atenção Primária à Saúde: protocolo de revisão de escopo / Professional training in leprosy in Primary Health Care: a scoping review protocol

OBJETIVO: Descrever a sistematização do desenvolvimento de uma revisão de escopo para mapear evidências científicas relativas à capacitação profissional da equipe de assistência ao paciente em hanseníase na Atenção Primária à Saúde. MÉTODO: Fundamentar-se-á nas recomendações do Preferred Reporting Items for Systematic and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR), atendendo às orientações do Instituto Joanna Briggs. Espera-se que as evidências encontradas na literatura nacional e internacional possam direcionar profissionais e gestores na implementação de ações de controle e eliminação da hanseníase como problema de saúde pública, por meio da educação.

OBJECTIVE: To describe the systematization of a scoping review to map scientific evidence related to the professional training of the members of the leprosy primary health care team. METHOD: The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) will be met, as well as the Joanna Briggs Institute's guidelines. It is expected that the evidence found in the national and international literature can guide professionals and managers in implementing actions to control and eliminate leprosy, a public health problem, through education.

Avaliação de uma ferramenta de ensino no tratamento da hanseníase para profissionais da saúde na atenção básica / Evaluation of a teaching tool in the treatment of leprosy for health professionals in primary care

O uso de materiais didáticos sobre o tratamento da hanseníase pode auxiliar os profissionais de atenção básica a esclarecer as dúvidas dos usuários e ampliar o conhecimento.O objetivo consistiu em validar uma ferramenta educativa sobre o tratamento da hanseníase com a poliquimioterapia. O estudo consistiu em pesquisa realizada com 10 profissionais da rede de atenção básica em hanseníase, município de Fernandópolis. Foi confeccionada uma cartilha educativa com a participação de pesquisadores e docentes nas áreas da hanseníase e design. O estudo consistiu na execução de três fases: preparação; coleta de dados e interpretação; concretização e descrição dos resultados. Foi aplicado um questionário com 23 perguntas (relativas ao design e ao conteúdo). Verificou-se que os eixos temáticos com sugestões de mudanças foram relacionados à compreensão do tratamento; cartelas pauci ou multibacilares; local de aquisição dos medicamentos; horário dos medicamentos; consumo de bebida alcoólica; benefícios e reações do tratamento; abandono do tratamento; tratamento na gravidez, uso de pílula anticoncepcional e propostas de alterações em poucas figuras e no formato da cartilha. Os profissionais de saúde foram capazes de apontar melhorias e possíveis falhas com a finalidade de melhorar a qualidade do referido produto gráfico. Convém ampliar essa investigação para os usuários do programa de hanseníase que realizam ou realizaram a poliquimioterapia e vivenciaram aspectos positivos e dificuldades com o tratamento.

Perfil epidemiológico da hanseníase em um município do Nordeste Brasileiro frente aos desafios dos acometidos / Epidemiological profile of leprosy in a municipality of northeastern Brazil in the face of the challenges of those affected

Objetivo: Caracterizar através de dados obtidos de fonte secundaria o perfil epidemiológico de acometidos por hanseníase em Teresina, Piauí de 2017 a 2021 em relação aos desafios como as incapacidades, ao acometimento em crianças e ao índice de óbitos relacionados a hanseníase.Métodos:Trata-se de um estudo observacional, analítico do tipo ecológico, através de dados do Sistema de Informação de Agravosde Notificação(SINAN). Foram investigadas as variáveis sexo, gênero, idade, escolaridade, índice de endemicidade, Grau de Incapacidade Física (GIF), formas clínicas e óbitos, através do teste qui-quadrado, do teste de Shapiro-wilk e do cálculo de odds ratio.Resultados: Houve predominâncias do perfil clínico e epidemiológicocom gênero predominantemente masculino, cor/raça parda, com nível de escolaridade até o ensino médio, com características clínicas dimorfa, no entanto sem reações predominantes, mas com alto índice de GIF I.Conclusão: Através dos dados coletados no SINANfoi possível identificar que a população de Teresina atualmente enfrenta desafios quanto a detecção da hanseníase em crianças, está oscilando parâmetros entre hiperendêmica e muito alta endemicidade, 9% da população acometida desenvolveu algum GIF e foram identificados óbitos com maior prevalência em idosos, no entanto, foi observado escassez de grande número de informações provenientes do SINAN

Objective: To characterize through data obtained from secondary sources the epidemiological profile of leprosy patients in Teresina, Piauí, from 2017 to 2021 in relation to challenges such as disabilities, involvement in children and the rate of deaths related to leprosy.Methods:This is an observational, analytical study of the ecological type, through data from the Notifiable Diseases Information System (SINAN). The variables gender, gender, age, schooling, endemicity index, Physical Disability Degree (DPD), clinical forms and deaths were investigated, through the chi-square test, the Shapiro-wilk test and the odds ratio calculation.Results: There was predominance of the clinical and epidemiological profile with predominantly male gender, color/mixed race, with educational level up to high school, with dimorphous clinical characteristics, however without predominant reactions, but with high DPDIndex I.Conclusion: Through the data collected in SINANit was possible to identify that the population of Teresina currently faces challenges regarding the detection of leprosy in children, is oscillating parametersbetween hyperendemic and very high endemicity, 9% of the affected population developed some DPDand deaths with higher prevalence were identified in the elderly, however, a scarcity of large number of information from SINAN was observed.

Relato de intervenções educativas desenvolvidas durante estágio supervisionado de enfermagem na atenção básica / Report of educational interventions developed during supervised nursing internship in primary care

Objetivo:Relatar intervenções educativas desenvolvidas durante estágio supervisionado de enfermagem na Atenção Básica.Métodos:Trata-se de um relato de experiência de ações,durante o estágio curricular obrigatório do curso de enfermagem de uma universidade federal brasileira,no período de marçoa maio de 2022.Resultados:Foi realizado o reconhecimento inicial da unidade e, em seguida, foi inseridoem um plano de estágio atividades de educação em saúde, humanização e acolhimento. Assim, foram produzidos dez materiais educativos: cuidados íntimosmasculinos e femininos, prevenção de infecções sexualmente transmissíveis, combate ao Aedes aegypti, tuberculose, hanseníase, hipertensão, diabetes, alimentação infantil e saúde mental, junto a um suporte de parede personalizado para alocá-los e um painelinfantil decorativo para o consultório de enfermagem. Houve ainda distribuição de barras de doce para clientes após a realização de exames na sala de coleta do serviço. Conclusão:Aexperiência permitiu a aproximação da rotina dos profissionais na AtençãoBásica e participação das etapas relacionadas ao cuidado e gerenciamento em enfermagem. O estágio contribuiu para o desenvolvimento da autonomia e construção de identidade acadêmica da discente, agregandonovos aprendizados para os profissionais e beneficiandodiretamente a comunidade, mediante as intervenções de educação em saúde, humanização e acolhimento.

Objective: To report educational interventions developed during a supervised nursing internship in Primary Care. Methods:This is an experience report of actions, during the mandatory curricular internship of a nursing course at a Brazilian federal university, from March to May 2022. Results: The initial recognition of the unit was carried out and, then, health education, humanization and reception activities were includedin an internship plan. Thus, ten educational materials were produced: male and female intimate care, sexually transmitted infection prevention, fight against Aedes aegypti, tuberculosis, leprosy, hypertension, diabetes, child nutrition and mental health, along with a personalized wall bracket to place them and a decorative children's panel for the nursing office. There was also distribution of candy bars to clients after carrying out tests in the service's collection room.Conclusion: The experience allowed approaching the routine of professionals in Primary Care and participation in the steps related to care and management in nursing. The internship contributed to the development of autonomy and construction of students' academic identity, adding new learning for professionals and directly benefiting the community, through interventions in health education, humanization and reception

Perfil epidemiológico da hanseníase no município de Divinópolis, Minas Gerais, 2011 a 2019 / Epidemiological profile of leprosy in the municipality of Divinópolis, Minas Gerais, 2011 to 2019

Objetivo: Analisar o perfil epidemiológico da hanseníase no município de Divinópolis, Minas Gerais, entre os anos de 2011 a 2019. Método: Trata-se de um estudo ecológico, descritivo, que utilizou dados secundários disponíveis em acesso aberto na Sala de Apoio à Gestão Estratégica e no Departamento de Informática do Sistema Único de Saúde referentes aos casos confirmados e notificados da hanseníase de residentes no município de Divinópolis, Minas Gerais, no período de 2011 a 2019. Resultados: No período do estudo foram notificados 57 casos de hanseníase, todos em pessoas acima de 20 anos, sendo a maioria em homens (50,9%), de raça/cor parda (49,1%) e com ensino fundamental incompleto (26,3%). A forma clínica predominante foi a dimorfa (38,4%) seguido pela tuberculoide (29,8%), classificação operacional multibacilar (56,2%), sendo que a maioria dos casos (93%) deram entrada no Sistema de Informação de Agravos de Notificação (SINAN) como caso novo. Quanto à avaliação do grau de incapacidade física no diagnóstico, 7% (n=4) dos casos foram notificados com grau 2. No que se refere ao tipo de saída, 87,9% dos casos tiveram alta por cura. Conclusão: Os dados epidemiológicos apontam que o diagnóstico da hanseníase em Divinópolis está sendo realizado tardiamente, o que contribui para manutenção de uma prevalência oculta (AU)

Objective: to analyze the epidemiological profile of leprosy in the municipality of Divinópolis, Minas Gerais, between the years 2011 to 2019. Method: this is an ecological, descriptive study, which used secondary data available in open access in the Strategic Management Support Room and the Department of Informatics of the Unified Health System regarding the confirmed and notified cases of leprosy of residents in the municipality of Divinópolis, Minas Gerais, in the period from 2011 to 2019. Results: during the study period, 57 cases of leprosy were reported, all in people over 20 years old, mostly in men (50.9%), of brown race/color (49.1%) and with incomplete elementary school education (26.3%). The predominant clinical form was dimorphic (38.4%) followed by tuberculoid (29.8%), multibacillary operational classification (56.2%), and most cases (93%) were entered in the Sistema de Informação de Agravos de Notificação (SINAN) as new cases. As for the evaluation of the degree of physical disability at diagnosis, 7% (n=4) of cases were reported as grade 2. Regarding the type of output, 87.9% of cases were discharged for cure. Conclusion: the epidemiological data indicate that the diagnosis of leprosy in Divinópolis is being made late, which contributes to the maintenance of a hidden prevalence (AU)

Qualidade de vida e condição clínica de indivíduos com hanseníase / Calidad de vida y estado clínico de las personas con lepra / Quality of life and clinical condition of individuals with leprosy

RESUMO Objetivo: analisar a qualidade de vida dos indivíduos com hanseníase em tratamento na rede de Atenção Básica e Especializada de saúde e realizar uma comparação de acordo com as condições clínicas dos pacientes. Método: estudo transversal, de caráter analítico, realizado na Atenção Básica e Especializada de saúde em João Pessoa, Paraíba, Brasil. A amostra foi coletada entre os meses de janeiro e março de 2017, sendo composta por 96 indivíduos em tratamento para doença, na faixa etária acima de 18 anos de idade. As informações foram coletadas a partir de um formulário semiestruturado contendo variáveis sociodemográficas e clínicas e o instrumento validado World Health Organization Quality of life Assessment bref. Os dados foram analisados com base nas técnicas de análise descritiva, tendo sido aplicados os testes de Normalidade (Kolmogorov-Smirnov), Levene, t paramétrico e ANOVA (teste post hoc tukey). Resultados: o escore geral para qualidade de vida entre os 96 participantes da pesquisa se manteve intermediário ( x ¯=57,04) sendo o domínio físico mais afetado negativamente ( x ¯=54,09). As questões contidas nos domínios "Recreação e lazer" ( x ¯=31,41), "Sentimentos negativos" ( x ¯=35,16), "Recursos Financeiros" ( x ¯=35,68) e "Dor e desconforto" ( x ¯=35,68) apresentaram menor escore médio. Pacientes com condições clínicas "osteoporose e artrose" (p = 0,011) e "neurite atual" (p = 0,001) obtiveram qualidade de vida em nível intermediário. Conclusão: evidenciou-se que pessoas com hanseníase têm qualidade de vida em nível intermediário, principalmente quando associada à neurite e a comorbidades, o que ressalva a necessidade de acompanhamento contínuo dos participantes da pesquisa.

RESUMEN Objetivo: analizar la calidad de vida de los individuos con lepra en tratamiento en la red de Atención Primaria y Especializada y su comparación según las condiciones clínicas de los pacientes. Método: estudio transversal, de carácter analítico, realizado en la Asistencia Sanitaria Básica y Especializada de João Pessoa, Paraíba, Brasil. La muestra se recogió entre enero y marzo de 2017, formada por 96 individuos en tratamiento por la enfermedad, mayores de 18 años. La información se recogió mediante un formulario semiestructurado que contenía variables sociodemográficas y clínicas, y el instrumento validado World Health Organization Quality of life Assessment bref. Los datos se analizaron a partir de las técnicas de análisis descriptivo y se aplicaron las pruebas de normalidad (Kolmogorov-Smirnov), Levene, t paramétrica y ANOVA (prueba de tukey post hoc). Resultados: la puntuación global de la calidad de vida entre los 96 participantes en la investigación se mantuvo en un nivel intermedio ( x ¯=57,04) y el dominio físico fue el más afectado negativamente ( x ¯=54,09). En cuanto a las preguntas contenidas en los dominios, "Recreación y ocio" ( x ¯=31,41), "Sentimientos negativos" ( x ¯=35,16), "Recursos económicos" ( x ¯=35,68) y "Dolor y malestar" ( x ¯=35,68) mostraron puntuaciones medias más bajas. Los pacientes con condiciones clínicas de "osteoporosis y artrosis" (p = 0,011) y "neuritis actual" (p = 0,001) obtuvieron una calidad de vida de nivel intermedio. Conclusión: se evidenció que las personas con lepra tienen un nivel intermedio de calidad de vida, especialmente cuando se asocia a neuritis y comorbilidades, lo que pone de manifiesto la necesidad de un seguimiento continuo de los participantes en la investigación.

ABSTRACT Objective: to analyze the quality of life of individuals with leprosy undergoing treatment in the Basic and Specialized Health Care network and to perform a comparison according to the clinical conditions of the patients. Method: cross-sectional, analytical study carried out in Primary and Specialized Health Care in João Pessoa, Paraíba, Brazil. The sample was collected between January and March 2017, consisting of 96 individuals undergoing treatment for the disease, aged over 18 years. Information was collected using a semi-structured form containing sociodemographic and clinical variables and the validated instrument World Health Organization Quality of life Assessment bref. Data were analyzed based on descriptive analysis techniques, using the Normality (Kolmogorov-Smirnov), Levene, parametric t and ANOVA (post hoc Tukey test) tests. Results: the overall score for quality of life among the 96 research subjects remained intermediate ( x ¯=57.04), with the Physical domain being most negatively affected ( x ¯=54.09). The questions contained in the domains "recreation and leisure" ( x ¯=31.41), "negative feelings" ( x ¯=35.16), "Financial Resources" ( x ¯=35.68) and "Pain and distress" ( x ¯= 35.68) had a lower mean score. Patients with clinical conditions "osteoporosis and arthrosis" (p = 0.011) and "current neuritis" (p = 0.001) had an intermediate quality of life. Conclusion: it was shown that people with leprosy have an intermediate quality of life, especially when associated with neuritis and comorbidities, which highlights the need for continuous monitoring of research subjects.

Knowledge and attitude about disabilities in leprosy: Effects of an intervention grounded on the Meaningful Learning Theory / Conocimiento y actitud en relación a las incapacidades en casos de lepra: efectos de una intervención basada en la Teoría del Aprendizaje Significativo / Conhecimento e atitude sobre incapacidades na hanseníase: efeitos de intervenção fundamentada na Teoria da Aprendizagem Significativa

Abstract Objective: To analyze the effects of an educational intervention in the light of the Meaningful Learning Theory on the knowledge and attitude of Primary Health Care physicians and nurses in the assessment of the degree of physical disability in leprosy. Method: An intervention study of the before-and-after type, conducted with 122 professionals (84 nurses and 38 physicians) from the Primary Health Care of João Pessoa, Paraíba, in a training course on the assessment of the degree of physical disability in leprosy. The data were collected with the research's own instrument validated and analyzed by the chi-square adherence and proportion test, with a 5% significance level. Results: There was an increase in the scores of all items of the instrument, with a statistically significant difference (p < 0.05) in 20 of the 32 items, with emphasis on those related to the professional's technical ability to conduct the stages of anamnesis, palpation of peripheral nerves, sensory and motor evaluation. It is also noteworthy that, after the intervention, 5 items obtained 100% of correct answers. Conclusion: The educational intervention grounded on the Meaningful Learning Theory improved the health professionals' knowledge and attitude in the assessment of the degree of physical disability in people with leprosy.

RESUMEN Objetivo: Analizar los efectos de una intervención educativa a la luz de la Teoría del Aprendizaje Significativo sobre el conocimiento y la actitud de los médicos y enfermeros de la Atención Primaria de la Salud en la evaluación del grado de discapacidad física en casos de lepra. Método: Estudio de intervención antes y después, realizado con 122 profesionales, 84 enfermeras y 38 médicos, de Atención Primaria de la Salud en João Pessoa, Paraíba, en un curso de capacitación sobre la evaluación del grado de discapacidad física en lepra. Los datos se recolectaron mediante un instrumento validado y se analizaron mediante la prueba de chi-cuadrado de adherencia y proporción, con nivel de significancia del 5%. Resultados: Hubo un aumento en las puntuaciones de todos los ítems del instrumento, con diferencia estadísticamente significativa (p < 0.05) en 20 de los 32 ítems, con énfasis en los ítems referentes a la capacidad técnica del profesional para realizar los pasos de la anamnesis, palpación de los nervios periféricos, evaluación sensorial y motora. Además, es de destacar que luego de la intervención, 5 ítems obtuvieron respuestas 100% correctas. Conclusión: La intervención educativa basada en la Teoría del Aprendizaje Significativo mejoró el conocimiento y la actitud de los profesionales de la salud en la evaluación del grado de discapacidad física de las personas con lepra.

RESUMO Objetivo: Analisar os efeitos de uma intervenção educativa à luz da Teoria da Aprendizagem Significativa sobre o conhecimento e a atitude de médicos e enfermeiros da atenção básica de saúde na avaliação do grau de incapacidade física na hanseníase. Método: Estudo de intervenção do tipo antes e depois, realizado com 122 profissionais, sendo 84 enfermeiros e 38 médicos, da Atenção Básica de Saúde de João Pessoa, Paraíba, em curso de capacitação sobre avaliação do grau de incapacidade física na hanseníase. Os dados foram coletados com instrumento próprio validado e analisados pelo teste qui-quadrado aderência e de proporção, com nível de significância de 5%. Resultados: Houve aumento dos escores de todos os itens do instrumento, com diferença estatisticamente significativa (p < 0,05) em 20 dos 32 itens, com destaque para os itens referentes à capacidade técnica do profissional para conduzir as etapas de anamnese, palpação dos nervos periféricos, avaliação sensitiva e motora. Destaca-se também que após a intervenção 5 itens obtiveram 100% de acertos. Conclusão: Intervenção educativa pautada na Teoria da Aprendizagem Significativa aperfeiçoou o conhecimento e a atitude dos profissionais de saúde na avaliação do grau de incapacidade física de pessoas com hanseníase.

Diálogos sobre a descentralização do programa de controle da hanseníase em município endêmico: uma avaliação participativa / Diálogos sobre la descentralización del programa de control de la lepra en un municipio endémico: una evaluación participativa / Dialogues on the decentralization of the leprosy control program in an endemic municipality: a participatory evaluation

Resumo Objetivo avaliar a descentralização do Programa de Controle da Hanseníase (PCH) em Governador Valadares. Método o referencial teórico-metodológico foi a Avaliação de Quarta Geração, de abordagem qualitativo-participativa. O estudo envolveu 30 sujeitos divididos em quatro grupos: gestores do PCH; profissionais do Centro de Referência (CR); profissionais da atenção básica e usuários. Os dados foram coletados por entrevistas, utilizando-se a técnica do Círculo Hermenêutico-Dialético. Posteriormente, realizaram-se três oficinas de validação e negociação dos dados. Utilizou-se o Método Comparativo Constante para a análise. Resultados evidenciou-se a manutenção do modelo vertical de atenção à hanseníase, sustentado por determinantes sócio-histórico-culturais que se expressam: na permanência da porta de entrada à demanda espontânea no CR; no encaminhamento rotineiro do usuário para a atenção secundária; na ineficiência da contrarreferência; na centralização da poliquimioterapia; na crença na necessidade do atendimento especializado e no estigma. Evidenciaram-se fragilidades no vínculo com a atenção primária. Conclusão a descentralização do PCH envolve a tensão entre os atores de cada ponto de atenção à saúde, gerando disputas de saberes e práticas de saúde. Implicações para a prática a sustentabilidade da descentralização requer envolvimento político e institucional focado no fortalecimento da atenção primária, na reorientação do papel dos serviços na rede de atenção à hanseníase e na educação em saúde.

Resumen Objetivo evaluar la descentralización del Programa de Control de la Lepra (PCL) en Governador Valadares. Método el marco teórico-metodológico fue la Evaluación de Cuarta Generación, con un enfoque cualitativo-participativo. El estudio involucró a 30 sujetos, divididos en cuatro grupos: gerentes del PCL; profesionales del Centro de Referencia (CR); profesionales de atención primaria y usuarios. Los datos fueron recolectados a través de entrevistas, utilizando la técnica del Círculo Hermenéutico-Dialéctico. Posteriormente se realizaron tres talleres de validación y negociación de los datos. Para el análisis se utilizó el Método Comparativo Constante. Resultados se evidenció el mantenimiento del modelo vertical de atención a la lepra, sustentado en determinantes socio-histórico-culturales que se expresan en la permanencia del ingreso a la demanda espontánea en el CR; en la derivación rutinaria del usuario a atención secundaria; en la ineficiencia de la contrarreferencia; en la centralización de la poliquimioterapia; en la creencia en la necesidad de atención especializada y en el estigma. Se evidenciaron debilidades en el vínculo con la atención primaria. Conclusión la descentralización del PCH involucra la tensión entre los actores en cada punto de la atención en salud, generando disputas sobre conocimientos y prácticas de salud. Implicaciones para la práctica la sostenibilidad de la descentralización requiere de una participación política e institucional, enfocada en el fortalecimiento de la atención primaria, reorientando el rol de los servicios en la red de atención a la lepra y en la educación para la salud.

Abstract Objective to evaluate the decentralization of the Leprosy Control Program (LCP) in Governador Valadares. Method the theoretical and methodological framework was the Fourth Generation Evaluation, with a qualitative-participatory approach. The study involved 30 subjects divided into four groups: managers of the LCP; professionals of the Reference Center (RC); primary care professionals and users. Data were collected through interviews, using the Hermeneutic-Dialectic Circle technique. Subsequently, three workshops were held for data validation and negotiation. The Constant Comparative Method was used for the analysis. Results the maintenance of the vertical model of leprosy care was evidenced, sustained by social-historical-cultural determinants that are expressed in: the permanence of the gateway to spontaneous demand in the RC; the routine referral of the user to secondary care; the inefficiency of counter-reference; the centralization of multidrug therapy; the belief in the need for specialized care, and stigma. Weaknesses in the link with primary care were evidenced. Conclusion and implications for practice The sustainability of decentralization requires political and institutional involvement focused on strengthening primary care, reorienting the role of the services in the leprosy care network, and health education. The decentralization of the LCP involves tension between the actors of each health care point, generating disputes of knowledge and health practices.

Intervention with a Pilates program in the primary health care of leprosy patients: an experimental study.

OBJECTIVE: The aim of this study was to evaluate the influence of a Pilates program on the perception of quality of life of leprosy patients suffering from physical disabilities and who are undergoing treatment or who have been discharged. METHODS: This is an experimental study in which 48 participants were included; however, the final sample consisted of 5 participants. We performed a standardized and systematic dermatological­neurological examination to define the Eye-Hand-Foot score. Comparisons between preintervention and postintervention were performed using the paired t and Wilcoxon tests with a significance level of 0.05. RESULTS: We did not find significant values for the quality-of-life outcome in the domains and skills observed. We identified a significant value for the level of physical activity after the intervention. CONCLUSIONS: Quality of life between preintervention and postintervention with the Pilates program did not show significant improvement through self-report.

Intervention with a Pilates program in the primary health care of leprosy patients: an experimental study

SUMMARY OBJECTIVE The aim of this study was to evaluate the influence of a Pilates program on the perception of quality of life of leprosy patients suffering from physical disabilities and who are undergoing treatment or who have been discharged. METHODS This is an experimental study in which 48 participants were included; however, the final sample consisted of 5 participants. We performed a standardized and systematic dermatological-neurological examination to define the Eye-Hand-Foot score. Comparisons between preintervention and postintervention were performed using the paired t and Wilcoxon tests with a significance level of 0.05. RESULTS We did not find significant values for the quality-of-life outcome in the domains and skills observed. We identified a significant value for the level of physical activity after the intervention. CONCLUSIONS Quality of life between preintervention and postintervention with the Pilates program did not show significant improvement through self-report.

Reviewing the therapeutic management of leprosy in primary care: demand case series referred to a University Hospital in the Midwest region of Brazil

Abstract Background: Leprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. Objective: To analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service. Methods: An analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. Results: Two-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ2= 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ2= 7.23; 4 degrees of freedom; p = 0.12). Study limitations: Use of recorded data, with incomplete medical records and lack of patient follow-up. Conclusions: The study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.

Development of an integrated, holistic care package for people with lymphoedema for use at the level of the Primary Health Care Unit in Ethiopia.

BACKGROUND: Neglected Tropical Diseases (NTDs) are a group of several communicable and non-communicable diseases prevalent in tropical and subtropical areas. The co-endemicity of these diseases, the similarity of their clinical signs, and the need to maximize limited financial and human resources suggest the importance of adoptingan integratedapproach to their prevention and treatment. AIMS: This study describes the development of a comprehensive package of physical, mental health and psychosocial care for people with lower-limb lymphoedema caused bypodoconiosis, lymphatic filariasis (LF)or leprosy as part of the EnDPoINT program in Ethiopia. METHOD: The care package was developed using a mixed-methods approach, consisting of a literature review, situational analysis, Theory of Change (ToC) workshops, qualitative research, and additional workshops to fine-tune the draft care package. The care package was developed between March 2018 and January 2020 in Addis Ababa and the implementation research site, Awi zone in the North-West of Ethiopia. RESULTS: The holistic care package includes components implemented at three levels of the health care system:health organization, facility, and community. Sections of the care package are directed at strengthening capacity building, program management, community engagement, awareness-raising, stigma-reduction, morbidity management, disability prevention, follow-up visits, referral linkage, community-based rehabilitation, and monitoring and evaluation. CONCLUSIONS: The study developed a holistic integrated care package for lower limb disorder and co-morbid mental health problems caused by podoconiosis, LF or leprosy. The approach has the potential to significantly reduce lower limb disorder-associated morbidity, disability, and psychosocial problems. It also standardizes a scalable approach appropriate for the Ethiopian setting and, most likely, other countries where these NTDs are present.

Reviewing the therapeutic management of leprosy in primary care: demand case series referred to a University Hospital in the Midwest region of Brazil.

BACKGROUND: Leprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. OBJECTIVE: To analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service. METHODS: An analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. RESULTS: Two-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ2 = 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ2 = 7.23; 4 degrees of freedom; p = 0.12). STUDY LIMITATIONS: Use of recorded data, with incomplete medical records and lack of patient follow-up. CONCLUSIONS: The study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.

Cases of leprosy notified in the municipality of Parnaíba, state of Piauí, Brazil, 2007-2016

This study aimed to describe the epidemiological and clinical characteristics of leprosy cases reported in the municipality of Parnaíba, State of Piauí. This was a cross-sectional study of leprosy cases, living in Parnaíba, State of Piauí, reported to the National System of Notifiable Diseases (SINAN), from 2007 to 2016. There were 582 cases of leprosy with hyperendemic detection in the general population in 2008, 2009 and 2016; and under < 15 years of age in 2008, 2014 and 2016, with a predominance of females (53.1%), brown (62.2%), aged 20-64 years (74.7%), complete and incomplete elementary school (56.4%), housewives (20.7%), living in the urban area (87.1%), reported by primary care (69.2%). The most frequent clinical and therapeutic findings were: multibacillary operational classification (53.8%); clinical forms: undetermined (30.6%) and virchowian (24.3%); single lesion (34.8%); no affected nerves (86.7%); degree of disability zero (70.6%); bacilloscopy not performed (26.7%); therapeutic regimen 12 doses (53.7%) and no reaction (70.8%). Regarding the mode of input, predominated new case (88.8%); mode of output, cure (87.9%) and detection mode: spontaneous demand (45.8%). Out of 2,106 registered contacts, 60.6% were examined. Leprosy is endemic to Parnaíba, State of Piauí. It is noteworthy that the hyperendemic detection rates occurred during years when there was intensification of active search for contacts and cases in the population.

Caracterización clinicoepidemiológica de pacientes con lepra en un área de salud de Santiago de Cuba / Clinical epidemiological characterization of patients with leprosy in a health area from Santiago de Cuba

Introducción: La lepra es una enfermedad infectocontagiosa crónica, producida por el Mycobacterium leprae, y constituye uno de los males más antiguos de la humanidad. Objetivo: Describir algunas características clínicas y epidemiológicas de los pacientes con lepra pertenecientes al Policlínico Docente Ramón López Peña de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo de los 11 pacientes diagnosticados con la enfermedad de Hansen en la mencionada área de salud en el período 2005-2019. Para el procesamiento de la información se creó una base de datos mediante el sistema SPSS, versión 11.5 para Windows, donde se tabularon los datos de las encuestas. El análisis de los resultados se expresó en números absolutos y porcentajes para su mejor interpretación. Resultados: Predominaron el grupo etario de 35-44 años (54,5 %), el sexo masculino (54,6 %) y la lepra dimorfa, en su forma clínica multibacilar. La mayoría de los pacientes fueron diagnosticados precozmente y solo se observó algún grado de discapacidad en los diagnósticos tardíos; asimismo, las condiciones higiénicas desfavorables y el hacinamiento fueron los factores de riesgo de mayor relevancia. Conclusiones: A pesar de la existencia de pacientes con lepra en dicha área de salud, se observó un período de silencio epidemiológico, que unido a los factores de riesgo presentes, aumenta la posibilidad de contagio y pone en peligro los objetivos establecidos para su erradicación.

Introduction: Leprosy is an infectious chronic disease, produced by the Mycobacterium leprae, and constitutes one of the oldest ills of humanity. Objective: To describe some clinical and epidemiological characteristics of the patients with leprosy belonging to Ramón López Peña Teaching Polyclinic in Santiago de Cuba. Methods: A descriptive and retrospective study of the 11 patients diagnosed with Hansen disease in the mentioned health area during 2005-2019 was carried out. A database was created by means of the SPSS system, version 11.5 for Windows, for processing the information, where the data of the surveys were tabulated. The analysis of the results was expressed in absolute numbers and percentages for its best interpretation. Results: There was a prevalence of the 35-44 age group (54.5 %), the male sex (54.6 %) and the borderline lepromatous leprosy, in its multibacilar clinical form. Most of the patients were early diagnosed and certain degree of disability was just observed in the late diagnoses; also, the unfavorable hygienic conditions and overcrowding were the risk factors of more relevance. Conclusions: In spite of the existence of patients with leprosy in this health area, a period of epidemiological silence was observed that along with the existing risk factors, increases the infection possibility and puts in danger the established objectives for its eradication.

Dificuldades enfrentadas pelos enfermeiros no manejo dos pacientes com hanseníases / Difficulties faced by nurses in the management of leprosy patient

Objetivo: conhecer as dificuldades enfrentadas pelos enfermeiros no manejo dos pacientes com hanseníase. Método: estudo exploratório, de caráter descritivo e qualitativo. A amostra é composta por nove enfermeiros que atuam na Estratégia Saúde da Família, emregião endêmica do sul do Ceará, Brasil. A coleta de dados foi realizada com um roteiro de entrevista semiestruturada, nos meses de agosto a setembro de 2015, com posterior análise de conteúdo temático. Resultados: embasando-se nos resultados obtidos emergiram três categorias: dificuldades elencadas na realização do exame dermatoneurológico pelos enfermeiros da estratégia saúde da família; intercorrências no atendimento ao paciente com hanseníase; detecção precoce versus educação permanente.Considerações finais: oestudo revelou as dificuldades enfrentadas como a falta de instrumentos para realizar os testes dermatoneurológicos; estigma e preconceito manifestos pela população; detecção precoce com falhas de domínio; educação permanente pouco estruturada para atender a demanda dos profissionais. Ressalta-se a importância de mais investimento em pesquisas de inovação no manejo da hanseníase

Objective:know the difficulties faced by nurses in the management of patients with leprosy. Method:exploratory, descriptive and qualitative study. The sample is composed of nine nurses who work in the Family Health Strategy, in an endemic region of southern Ceará, Brazil. Data collection was performed using a semi-structured interview script, from august to september 2015, with subsequent analysis of thematic content. Results:based on the results obtained, three categories emerged: difficulties listed in the performance of the dermato-neurological examination by nurses of the family health strategy; complications in the care of patients with leprosy; early detection versus continuing education. Final Considerations:the study revealed the difficulties faced, such as the lack of instruments to perform dermato-neurological tests; stigma and prejudicemanifestsby the population; early detection with domain failures; permanent education poorly structured to meet the demands of professionals. The importance of more investment in innovation research in the management of leprosy is highlighted.

Epidemiologia da hanseníase e a descentralização das ações de controle no brasil / La epidemiología de la lepra y la descentralización de las acciones de control en brasil / Leprosy epidemiology and the decentralization of control actions in brazil

Objetivo analisar a situação epidemiológica da hanseníase no Brasil e sua associação com a descentralização das ações de controle. Método estudo ecológico misto com dados secundários do Sistema de Informação de Agravos de Notificação dos municípios brasileiros. Utilizou-se modelo de regressão binomial negativo entre 2001 e 2015. Resultados a análise das variações geográficas e temporais mostrou comportamentos heterogêneos dos três indicadores epidemiológicos de hanseníase. O aumento significativo desses foi associado à proporção de casos diagnosticados na Atenção Primária à Saúde (p<0,001; p=0,003; p=0,015); já a proporção da cobertura populacional estimada por Estratégia Saúde da Família foi associada somente à redução significativa do indicador taxa de detecção entre menores de quinze anos (p=0,017). Conclusão a interpretação simultânea dos principais indicadores epidemiológicos da hanseníase no Brasil reforçou a gravidade da situação e evidenciou que a satisfatória disponibilidade da ESF é insuficiente para o controle da doença.

Objetivo analizar la situación epidemiológica de la lepra en Brasil y su asociación con la descentralización de las acciones de control. Método estudio ecológico misto con datos secundarios del Sistema de Información de Agravamientos de Notificación de los municipios brasileños. Se utilizó un modelo de regresión binomial negativa entre 2001 y 2015. Resultados el análisis de las variaciones geográficas y temporales mostró un comportamiento heterogéneo de los tres indicadores epidemiológicos de la lepra. El aumento significativo se asoció a la proporción de casos diagnosticados en Atención Primaria de Salud (p<0,001, p=0,003, p=0,015), mientras que la proporción de cobertura poblacional estimada por la Estrategia de Salud Familiar (ESF) se asoció únicamente a la reducción significativa de la tasa de detección del indicador entre los menores de quince años (p=0,017). Conclusión la interpretación simultánea de los principales indicadores epidemiológicos de la lepra en Brasil reforzó la gravedad de la situación y evidenció que la satisfactoria disponibilidad del ESF es insuficiente para el control de la enfermedad.

Objective to analyze the epidemiological situation of leprosy in Brazil and its association with the decentralization of control actions. Method mixed ecological study with secondary data from the Sistema de Informação de Agravos de Notificação (Brazilian Information System on Notifiable Diseases) of Brazilian municipalities. A negative binomial regression model was used between 2001 and 2015. Results The analysis of geographic and temporal variations showed heterogeneous behavior of the three epidemiological indicators of leprosy. The significant increase in these was associated with the proportion of cases diagnosed in Primary Health Care (p<0.001; p=0.003; p=0.015); whereas the proportion of population coverage estimated by the Family Health Strategy (FHS) was associated only with the significant reduction in the indicator detection rate among children under fifteen (p=0.017). Conclusion the simultaneous interpretation of the main epidemiological indicators of leprosy in Brazil reinforced the gravity of the situation and evidenced that the satisfactory availability of the FHS is insufficient for the control of the disease.