Limitação de atividade e consciência de risco em clientes acometidos pela hanseníase / Activities limitation and risk awareness in leprosy patients

Objetivo: Caracterizar a limitação de atividade e a consciência de risco entre pacientes com hanseníase e analisar a correla-ção entre os escores da escala SALSA para limitação com a Classificação Operacional, Forma Clínica, Reação Hansênica e Consciência de Risco. Material e Métodos: Estudo descritivo, seccional, quantitativo realizado com indivíduos com hanse-níase utilizando a Screening of Activity Limitation and Safety Awarenes (Escala SALSA) para diagnóstico situacional. Para análise dos dados adotou-se o software estatístico SPSS 20.0. Resultados: O perfil sociodemográfico da amostra aponta ele-vados índices de detecção da doença na população masculina (70,5%), com escolaridade de nível fundamental (58,8%), baixa renda, em faixa etária economicamente produtiva. A faixa etária oscilou entre 15 e 69 anos. Identificou-se leve limitação (escores 25 a 39) e baixa consciência de risco (escores 0 a 5), havendo forte significância estatística entre as mesmas (p=0,001). Ve-rificou-se correlação positiva da limitação de atividade com a reação hansênica (r=0,068) e a consciência de risco (r=0,801). Observou-se ainda que a consciência de risco foi baixa em to-dos os aspectos, contudo estiveram correlacionadas as formas mais graves da doença e aos clientes que já apresentavam alguma limitação. Conclusão: A existência de limitação para AVD's, embora em categoria leve, bem como nenhuma e baixa consciência de risco sinalizam para a necessidade de fortale-cimento de ações de prevenção das incapacidades, dentre as quais, a educação em saúde consolida-se como ferramenta relevante, mediadora de reversibilidade destas consequências. (AU)

Objective: To characterize activity limitation and risk awareness among leprosy patients and analyze the correlation between the SALSA scale scores for limitation with the Operational Classi-fication, Clinical Form, Hansen Reaction and Risk Awareness. Material and Methods: Descriptive, sectional, quantitative study carried out with individuals with leprosy using the Screening of Activity Limitation and Safety Awareness (SALSA Scale) for situational diagnosis. Data analysis was performed using the statistical software SPSS 20.0. Results: The sociodemographic profile of the sample shows high rates of detection of the disease in the male population (70.5%), with a low level of schooling (58.8%), in an economically productive age range. The age ranged from 15 to 69 years. A slight limitation was identified (scores 25 to 39) and low risk awareness (scores 0 to 5), with a strong statistical significance between them (p = 0.001). There was a positive correlation of the activity limitation with the leprosy reaction (r = 0.068) and risk awareness (r = 0.801). It was also observed that the risk awareness was low in all aspects, but the most severe forms of the disease were correlated with the clients that already had some limitation. Conclusion: The existence of limitations for ADLs, although in a mild category, as well as none and low risk awareness, point to the need to strengthen actions to prevent disabilities, among them, health education is consolidated as a relevant tool, mediator of reversibility of these consequences. (AU)

Valor da biópia de nervo periférico para o diagnóstico e acompanhamento dos pacientes com hanseníase. A experiência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP através de um estudo retrospectivo / ?

Com o objetivo de verificar a importância da biópsia de nervo periférico no diagnóstico e avaliação da efetividade do tratamento, analisar as alterações morfológicas em níveis de microscopia óptica (MO) e eletrônica (ME) e correlacionar os achados no nervo com os da pele, realizamos um estudo retrospectivo em trinta e sete pacientes com a hanseníase. Os nervos biopsiados foram o sural, o ulnar ou o ramo superficial do fibular, todos fixados e processados para inclusão em parafina e em resina. Constatamos as alterações morfológicas classicamente descritas na neuropatia hansênica, como infiltrado inflamatório principalmente linfo-histiocitário envolvendo epi, peri e endoneuro em 86,48 por cento dos casos, variando de acordo com a forma da hanseníase, por vezes formando granulomas, vários graus de fibrose endoneural em 91,89 por cento dos casos, em quase todos com perda axonal total ou quase total, além de neoformação vascular no endoneuro em 10,81 por cento dos casos. Espessamento fibroso do perineuro e fasciculação do endoneuro pelas células perineurais também foram observados em alguns casos. Predominou uma neuropatia axonal de graus variados, por vezes em atividade e com uma perda predominantede fibras mielínicas de pequeno calibre, em muitos casos com uma distribuição irregular entre os fascículos e dentro de um mesmo fascículo. Desmielinização e remielinização foram os achados principais em 35,13 por cento. A regeneração de fibras foi vista em 5,40 por cento dos casos. Os bacilos estavam presentes de acordo com a forma da doença e com o tratamento, sendo escassos no pólo Tuberculóide e abundantes no Virchowiano. O exame ultra-estrutural, realizado em casos selecionados, com o objetivo de identificar bacilos não observados à MO, mostrou intensa perda de fibras, sobretudo as amielínicas, além de densa proliferação colágena endoneural, sendo os bacilos observados em apenas um caso. O diagnóstico de hanseníase foi feito pela biópsia de nervo em 37,83 por cento dos casos; esta apenas confirmou o diagnóstico prévio feito pela biópsia de pele em 8,10 por cento, serviu para se avaliar a eficácia do tratamento em 27,02 por cento e não confirmou, mas foi altamente sugestiva de hanseníase em 27,02 por cento. Concluimos que a biópsia de nervo periférico foi um meio importante de diagnosticar a hanseníase nas formas neurais puras.

Social marketing to eliminate leprosy in Sri Lanka.

PIP: Leprosy is a chronic infectious disease which, if untreated, can lead to permanent and progressive nerve damage and thus to deformities of the limbs, eyes, and face. People with leprosy have long been ostracized by society. The clinical signs of leprosy include insensitive skin lesions and thickened peripheral nerves. Untreated infectious leprosy cases are the main source of infection, transmitting the disease through nasal secretions. People with low cell-mediated immunity are at risk of developing clinically active leprosy irrespective of gender, age, or social class. The World Health Organization (WHO) has, since 1982, recommended multiple drug therapy (MDT) against leprosy, an approach capable of curing the disease within 1 year and interrupting its transmission. According to WHO, leprosy is currently a public health problem in 55 countries and more than 20% of the estimated 1.15 million cases of leprosy worldwide remain undetected. Although Sri Lanka was the first country in South Asia to provide MDT to all registered leprosy patients, first making it available in 1984, the disease continues to be transmitted due to the large number of undetected cases in the country. An ongoing social marketing program was therefore launched in 1990 by the local health ministry and the Novartis Foundation for Sustainable Development to eliminate leprosy from Sri Lanka. The program encourages people with suspicious skin lesions to seek diagnosis and care, teaches health care providers to recognize leprosy and refer cases for treatment, and helps the general public to understand that leprosy is just a normal disease. The socially marketed product is MDT, provided free-of-charge by the Novartis Foundation to all leprosy patients.^ieng

Health promotion in South East Asia.

PIP: The countries of the South East Asia region, which includes Bangladesh, Bhutan, Pakistan, Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, and Thailand, have undertaken a variety of strategies to address the health challenges in the region. The ever-growing pressure of population in the region has allowed rapid transmission of communicable diseases like malaria, tuberculosis (TB), leprosy, and HIV/AIDS. One of the innovative community-based health initiatives in response to this problem is Indonesia's Primary Health Care Project. This project aimed to develop a sustainable health infrastructure by training medical staff, coordinators, village cadres, midwives and those working for TB programs; provision of ongoing guidance and education in this area; and provision of medicines and funds. The project has pioneered a process towards positive changes. Another strategy is the collaboration of youth groups, island development committees, and health workers in Maldives which has led to the declaration of two islands (Madifushi and Haa Alif Berinmadhoo) as 'no smoking' islands. In addition, Sarvodaya has successfully developed a methodology to involve Buddhist monks in AIDS prevention and control through "the Buddhist approach to AIDS prevention in Sri Lanka."^ieng

The social implications of population displacement and resettlement: an overview with a focus on the Arab Middle East.

PIP: Involuntary migration is broadly defined as displacement due to development projects, due to war or political upheaval or persecution, or due to natural disasters. The Middle East is considered as having its share of displacement. Migration of an involuntary nature is not covered very well in the literature. This article focuses on Sudanese or Nubian experiences, the Lebanese civil war, the Palestinian diaspora, and relief efforts. The literature review merges studies of refugee populations, victims of disasters, and relocation into a common theoretical orientation and examines the implications for displacement. Initial studies of population movements are identified as having a focus on the necessity and inevitability of dislocation resulting from development and modernization. Relief efforts receive more attention than group movements, and certain populations are at greater risk of migration. Migration is considered to be a demographic regulator as well as part of a natural process of adaptation. Movement within modernization theory is viewed as healthy and based on Western experiences. Case studies of displaced populations refute some of the assumed beneficial effects. Hansen and Oliver-Smith's articles reveal some of the problems with displacement theories. Attention is drawn to involuntary migration as a social event rather than a passive reaction to events, and several distinctions are made about types of migration and resettlement as a process. A new term for displacement from natural disasters is added (environmental refugees). A number of good case studies on involuntary migration are noted. The author posits that the relationship between push forces and strategies of adaptation should be analyzed as an interactive process that continuously informs decision making on national and local levels. Geographers are recognized by Oliver-Smith as among the first to clarify the role of development in creating environmental hazards. The analyses point to underdevelopment as a condition that forces the poor and most vulnerable to move into vulnerable and hazardous economic and geographic circumstances. The Middle East experience emphasize war refugees. The Nubian experience reflects the unnoticed impact of development and the role of the state. The crossover between labor migration and displacement and the pastoral economy is not adequately addressed.^ieng

Health and development of mothers through system of ICDS.

PIP: In order to accelerate welfare and nutrition programs for women and children in tribal, hilly, and backward areas of India, the government of India has accepted the National Program of Integrated Services. Delivery of these services is coordinated by the Integrated Child Development Services (ICDS). The package of services for prenatal women include physical and obstetrical exams; serial recording of weight, blood pressure, hemoglobin, and urinalysis; tetanus immunization; iron (60 mg) and folic acid (.5 mg) tablets; food supplements; identification and referral of high-risk mothers; and health education on antenatal care, breast feeding, child rearing, and family planning. Postnatal women received 2 home visits within 10 days of delivery and make 1 visit after 1 month of delivery. These visits cover general health, breast feeding, delivery records, infant health, and birth control measures. Food supplementation continues for nursing mothers. All women 15-44 years of age receive health and nutrition education. Specially organized courses, campaigns, home visits by anganwadi workers, cooking demonstrations, and mass media emphasize simple messages regarding health and nutrition. Areas that are covered include family welfare; antenatal, intranatal, and postnatal care; breast feeding; immunization; prevention of such common communicable diseases as malaria, tuberculosis, and leprosy; weaning and supplementary feeding; improvement of children's nutritional status; balanced diet; food storage, preparation, cooking, and serving; eye and ear care; personal and environmental hygiene; sanitation; management of acute respiratory infections; management of diarrhea; and control and treatment of internal parasites. The mobile food and extension units of the Department of Food are utilized. Pregnant and nursing mothers belonging to families of landless agricultural laborers, of marginal farmers, of the scheduled caste, of the scheduled tribe, and of poorer sections of the community are chosen for this program. Special care is given to pregnant women who: are pregnant for the 1st, 3rd, or 4th time; have gained less than 6 kg; are younger than 18 or older than 35; have had frequent or twin pregnancies; have a history of miscarriage or preterm delivery; are anemic; or have a history of edema, hypertension, or seizure. Personnel, who are monitored, receive training supplemented by reorientation and continuing education.^ieng

Assistência de enfermagem a clientes hansenianos: modelo de adaptaçäo de Roy / Nursing assistance to leprosy patients: the roy adaptation model

O presente estudo teve como objetivo aplicar o Modelo de Adaptaçäo em Enfermagem proposto por Callista Roy, na assistência a 15 clientes portadores de hanseníase em condiçäo hospitalar e asilar, em um hospital de Dermatologia Sanitária em uma cidade do sul do Brasil. A assistência de enfermagem visou promover a adaptaçäo do cliente hanseniano, através da implementaçäo do processo de enfermagem, após identificar as respostas adaptativas e/ou inefetivas e manipulaçäo dos estímulos (focal, contextual e residual) dentro dos 4 (quatro) modos adaptativos, ou seja, necessidades fisiológicas, auto-conceito, funçäo do papel e interdependência. Constatou-se que: 1) é possível aplicar tal modelo assistencial, desde que se possua conhecimentos e habilidades na área específica de hanseníase, bem como no processo de enfermagem e no Modelo de Adaptaçäo de Roy; 2) Os clientes portadores de hanseníase em condiçäo asilar, independente de terem ou näo deformidades incapacitantes irreversíveis, manifestam comportamentos adaptativos à sua atual condiçäo de vida; 3) os clientes portadores de hanseníase em condiçäo hospitalar que näo possuem deformidades físicas têm o potencial de reverter os comportamentos inefetivos em adaptativos e continuar morando no seio da família e da sociedade, desde que recebam orientaçäo e assistência adequada; 4) os clientes portadores de hanseníase em condiçäo hospitalar com início de lesöes incapacitantes, apresentaram dificuldades de se aceitarem com a doença, manifestam comportamentos inefetivos, os quais poderiam ser revertidos se o cliente decidisse assumir responsabilidades na conduçäo da sua própria vida.

'Frustration--anxiety behaviour as a function of leprosy patients age and personality'.

The paper incorporates five studies (i.e., four of frustration and one of anxiety). The design is 'Multi-group-Control-group'. Each one of the five studies has four '3 X 3 X 2' factorial experiments. Each experiment has 360 elements. These are three groups (of lepromatous, non-lepromatous and of disease-free normals). Each group consists of 120 elements (equally distributed among adolescents, adults and senescents). The particulars of the patients have been obtained from the Central JALMA Institute for Leprosy and the Kushta Seva Sadan (Agra). The disease-free normal elements are drawn freely from the population of the Agra town. The sample possesses statistical justification for size and representativeness. Data are collected with the help of reliable tools and the 'F' test is run for verification of the 'null hypotheses'. Results show that experiences of 'fixation-regression' frustration, atypically belong to normal senescence. Resignation and anxiety experiences, as growing hazards, specifically relate to leprosy patients. Personality factors that normally demote 'frustration-anxiety' behaviour exhibit 'role-negation' in the leprosy patients. Age shows 'role-reversion'. Implications of such 'role' changes relate to the 'self-eroding' process of personality in the patients.

[The new marriage law and planned birth].

PIP: The New Marriage Law was passed during the Fifth National People's Congress. It raised the minimum marriage age from 20 years for men and 18 years for women stipulated by the Old Marriage Law to 22 years for men and 20 years for women. It also differs from the Old Marriage Law in that it strengthens its encouragement of late marriage, late births and birth control, emphasizes that birth planning is the duty of both husband and wife, and prohibits marriage of collateral blood relations within 3 generations (the Old Marriage Law's standard was "to follow custom"). A third of the provisions of the New Marriage Law concern family planning, of which the first 3 clauses are the most important: 1) To set guidelines for the relationship between marriage and family: the New Marriage Law is concerned with not just the family, but also marriage and birth and expects all citizens to comply with and protect these standards. 2) To implement freedom in marriage--equality for men and women; to protect the rights of women, children, and the aged; to implement planned birth. 3) To prohibit any action that prevents freedom of marriage, such as marriage on a mercenary basis and to prohibit financial profit from marriages. Other clauses include: 1) direct blood relations and victims of leprosy or other diseases determined unmarriageable by the medical profession are prohibited from marriage; 2) after marriage registration and with the mutual agreement of both parties, either partner can become a member of the other's family; children can take either parent's surname; both partners have mutual rights of inheritance, as do parents and children. In Heilungjiang Province, data from September 1980 show that 87.5% of its fertile women used contraceptives. From January to September 1980 85.6% married late; the rate of applications for One Child Certificates was 80%. By 1979 the rate of natural population increase was 10.14/1000.^ieng

Apomorphine-induced stereotyped biting in the tortoise in relation to dopaminergic mechanisms.

A biting behavior in the Moroccan pond tortoise (Clemmys caspica leprósa) after apomorphine administration is described. The biting behavior was antagonized by the specific anti-dopaminergic drug haloperidol (10 mg/kg) and trifluperazine (15 mg/kg). The behavior was compared to similar behaviors in birds and mammals. The dopamine metabolites, homovanillic acid and 3,4-dihydroxyphenylacetic acid, were measured by a gas chromatographic method in the tortoise brain. From the effects on behavior and the changes in the level of these metabolites upon drug administration it was concluded that the dopamine system in the tortoise is qualitatively similar to that in birds and mammals but less sensitive to blockade.