Avaliação da limitação das atividades, participação social e estratégias de enfrentamento em idosos na hanseníase / Evaluation of the limitation of activities, social participation and strategies for counseling in elderly people in leprosy

O modo como os idosos enfrentam os obstáculos após o diagnóstico da hanseníase (comprometimento funcional, participação social na vida familiar, profissional e comunitária) pode direcionar o planejamento das ações de prevenção de incapacidades e do programa de reabilitação a qual o idoso está inserido, de acordo com as necessidades individuais. Portanto, o objetivo deste estudo consiste em avaliar a limitação na realização de atividades de vida diária (AVDs), participação social e as estratégias de enfrentamento em idosos afetados pela hanseníase. Fizeram parte desse estudo 70 idosos afetados pela doença, em acompanhamento no Instituto Lauro de Souza Lima, com idade igual ou superior a 60 anos. Foram utilizados cinco instrumentos de avaliação, a saber: Questionário com dados sociodemográficos e clínicos, Avaliação do grau de incapacidade (GI), SALSA, Escala de Participação Social e Inventário de Coping. Foi utilizada análise estatística descritiva para a caracterização da casuística. Houve um predomínio de pacientes do sexo masculino (67,14%), multibacilares (87,14%), com tempo de diagnóstico maior de 20 anos (42,85%), GI 2 (64,28%), idosos com alguma limitação nas AVDs (91,43%), sem restrição significativa (51,43%) e com restrições a participação social de leve à grave (48,57%). Quanto às estratégias de enfrentamento, as estratégias positivas mais utilizadas foram “reavaliação positiva” (70%), “resolução de problemas” (65,7%) e “suporte social” (65,7%), e, as negativas mais utilizadas foram “autocontrole” (67,2%) e “afastamento” (62,9%). Embora tenham predominado GI 2 , limitações na realização das AVDs e restrição participação social, houve predomínio de estratégias de enfrentamento positivas, o que poderia ser justificado pelo tempo de convivência e evolução da doença, durante o processo de ressignificação da doença e das limitações adquiridas. A identificação das estratégias de enfrentamento em idosos pode auxiliar na investigação de fatores psicológicos e sociais que interferem no seu cotidiano e, com isso, todos os profissionais da saúde poderão planejar ações mais eficazes de prevenção e reabilitação em hanseníase, de posse a esses conhecimentos

The way in which the elderly face obstacles after diagnosis of leprosy (functional impairment, social participation in family, professional and community life) can guide the planning of the disability prevention actions and the rehabilitation program to which the elderly are inserted, according to individual needs. There for, the objective of this study is to evaluate the limitation of daily living activities (ADLs), social participation and coping strategies in elderly people affected by leprosy. This study included 70 elderly people affected by the disease, who were followed up at the Lauro de Souza Lima Institute, aged 60 or over. Five evaluation instruments were used: questionnaire with sociodemographic and clinical data, assessment of the degree of incapacity (GI), SALSA, Social Participation Scale and Coping Inventory. Descriptive statistical analysis was used to characterize the sample. There was a predominance of male patients (67,14%), multibacillary patients (87,14%), diagnosed over 20 years (42,85%), GI 2 (64,28%), elderly patients with some limitation in ADLs (91,43%), without significant restriction (51.43%) and with restrictions on social participation from mild to severe (48,57%). As for coping strategies, the most commonly used positive strategies were "positive reassessment" (70%), "problem solving" (65,7%) and "social support" (65,7%), were "self-control" (67,2%) and "remoteness" (62,9%). Although GI 2 predominated, limitations in performing ADLs and social participation restriction, there was a predominance of positive coping strategies, which could be justified by the time of coexistence and evolution of the disease, during the process of re-signification of the disease and acquired limitations. The identification of coping strategies in the elderly can help in the investigation of psychological and social factors that interfere with their daily life, and with this, all health professionals can plan more effective actions of prevention and rehabilitation in leprosy, in possession of this knowledge

Limitation of activity and restriction of social participation in relation to age range, gender, and education in people with leprosy.

BACKGROUND: In Brazil, 38,000 new cases of leprosy are discovered each year, making it a public health problem. OBJECTIVE: To identify whether or not there is an association between activity limitations and the restriction of social participation with some demographic data (age range, gender, and education) of the patients in a Basic Health Unit (BHU), diagnosed with leprosy. METHODS: The SALSA scale was used to assess activity limitations, whereas the Participation scale was used to assess the restriction of social participation. RESULTS: The assessments were conducted with 31 BHU patients diagnosed with leprosy. Males were the most affected by leprosy, the multibacillary was the most prevalent, and education proved to be an important factor when related to the disease injuries among the evaluated individuals. Regarding activity limitations and the restriction of social participation, the percentage of individuals without limitations and without restrictions was greater in both scales. STUDY LIMITATIONS: The main limitation is the small study sample. CONCLUSION: It can be concluded that, for the studied sample, no association was observed between the activity limitations, evaluated by the Salsa scale, nor the restriction of social participation, evaluated by the Participation Scale, with the analyzed demographic data.

Limitation of activity and restriction of social participation in relation to age range, gender, and education in people with leprosy

Abstract Background: In Brazil, 38,000 new cases of leprosy are discovered each year, making it a public health problem. Objective: To identify whether or not there is an association between activity limitations and the restriction of social participation with some demographic data (age range, gender, and education) of the patients in a Basic Health Unit (BHU), diagnosed with leprosy. Methods: The SALSA scale was used to assess activity limitations, whereas the Participation scale was used to assess the restriction of social participation. Results: The assessments were conducted with 31 BHU patients diagnosed with leprosy. Males were the most affected by leprosy, the multibacillary was the most prevalent, and education proved to be an important factor when related to the disease injuries among the evaluated individuals. Regarding activity limitations and the restriction of social participation, the percentage of individuals without limitations and without restrictions was greater in both scales. Study limitations: The main limitation is the small study sample. Conclusion: It can be concluded that, for the studied sample, no association was observed between the activity limitations, evaluated by the Salsa scale, nor the restriction of social participation, evaluated by the Participation Scale, with the analyzed demographic data.

Psychometric properties of the participation scale among former buruli ulcer patients in Ghana and Benin.

BACKGROUND: Buruli ulcer is a stigmatising disease treated with antibiotics and wound care, and sometimes surgical intervention is necessary. Permanent limitations in daily activities are a common long term consequence. It is unknown to what extent patients perceive problems in participation in social activities. The psychometric properties of the Participation Scale used in other disabling diseases, such as leprosy, was assessed for use in former Buruli ulcer patients. METHODS: Former Buruli ulcer patients in Ghana and Benin, their relatives, and healthy community controls were interviewed using the Participation Scale, Buruli Ulcer Functional Limitation Score, and the Explanatory Model Interview Catalogue to measure stigma. The Participation Scale was tested for the following psychometric properties: discrimination, floor and ceiling effects, internal consistency, inter-item correlation, item-total correlation and construct validity. RESULTS: In total 386 participants (143 former Buruli ulcer patients with their relatives (137) and 106 community controls) were included in the study. The Participation Scale displayed good discrimination between former Buruli ulcer patients and healthy community controls. No floor and ceiling effects were found. Internal consistency (Cronbach's alpha) was 0.88. In Ghana, mean inter-item correlation of 0.29 and item-total correlations ranging from 0.10 to 0.69 were found while in Benin, a mean inter-item correlation of 0.28 was reported with item-total correlations ranging from -0.08 to 0.79. With respect to construct validity, 4 out of 6 hypotheses were not rejected, though correlations between various constructs differed between countries. CONCLUSION: The results indicate the Participation Scale has acceptable psychometric properties and can be used for Buruli ulcer patients in Ghana and Benin. Future studies can use this Participation Scale to evaluate the long term restrictions in participation in daily social activities of former BU patients.

Quality of life among schoolchildren with acne: results of a cross-sectional study.

BACKGROUND: Acne is a common problem in adolescent children and has a considerable impact on their quality of life. AIMS: The purpose of this study was to assess health-related quality of life (HRQoL) among Serbian adolescents with acne, using 2 questionnaires: The Children's Dermatology Life Quality Index (CDLQI) and the Cardiff Acne Disability Index (CADI) and to provide a cross validation of 2 scales. METHODS: This cross-sectional study was conducted among the pupils of the secondary railway-technical school in Belgrade, Serbia. 478 pupils (aged 15 - 18 years) completed 2 HRQoL questionnaires: CDLQI and CADI. We used t-test for differences between mean values of CDLQI and CADI and Spearman's rho coefficient for correlation between 2 questionnaires. RESULTS: Self-reported acne was present in 71.6% of pupils (64.3% boys and 35.7% girls). The overall mean CDLQI score (4.35 of max. 30) and the overall mean CADI score (3.57 of max. 15) were low, indicating a mild impairment of HRQoL among adolescants. There was good correlation between the 2 questionnaires (Spearman' rho = 0.66). CONCLUSION: The CADI and the CDLQI questionnaires represent simple and reliable instruments for the assesment of HRQoL among schoolchildren with acne. In this study, we identified 17% of boys and 18% of girls perceived their acne as a major problem. It is important to detect and treat such adolescents on time to reduce the psychosocial burden associated with acne.

Stigma and social participation in Southern India: differences and commonalities among persons affected by leprosy and persons living with HIV/AIDS.

Stigma is a common phenomenon worldwide and infectious diseases like HIV/AIDS and leprosy are often associated with high levels of stigma. Several studies have been conducted concerning the effects of stigma and the impact on social participation, but comparative studies are rare. The objective of this study was to identify differences and similarities between HIV/AIDS and leprosy-related stigma. From April till July 2009, 190 questionnaire-based interviews were conducted to assess the levels of internalized stigma (Internalized Stigma of Mental Illness scale), perceived stigma (Explanatory Model Interview Catalogue stigma scale) and social participation (Participation scale) in a cross-sectional sample of people affected by leprosy (PL) and people living with HIV/AIDS (PLHA). Respondents were selected from several hospitals, charity projects and during home visits in Vellore district, Tamil Nadu. Our results showed that both PLHA (n = 95) and leprosy-affected respondents (n = 95) faced a substantial burden of internalized and perceived stigma, with the former reporting a significantly higher level of stigma. As a result, PLHA faced more frequent and also more severe participation restrictions than PL. Especially, restrictions in work-related areas were reported by the majority of the respondents. In conclusion, PLHA faced a significantly higher level of stigma and participation restriction than PL. However, the latter also reported a substantial burden of stigma and participation restrictions. The study suggests that it may be possible to develop joint interventions based on the commonalities found. More research is needed to define these more precisely and to test the effectiveness of such joint interventions in reducing stigma and improving social participation.

Evaluation of activity limitation and social participation, and the effects of reconstructive surgery in people with disability due to leprosy: a prospective cohort study.

PURPOSE: To assess how activity limitation and social participation of individuals with leprosy-related disability change over time, and to quantify the effect of reconstructive surgery. METHOD: Individuals with disability due to leprosy who accepted invitations for assessment at a leprosy clinic between March and July 2007 were interviewed using the SALSA Scale (measuring activity limitation) and the Participation Scale (assessing social participation). All participants were offered reconstructive surgery. Follow-up interviews were done 1 year after the first interview or 1 year after surgery. The main outcomes were changes in SALSA score and Participation score. We used analysis of variance to identify the effects of independent factors on mean SALSA and Participation scores. RESULTS: We interviewed 222 participants, 15 of whom took up the offer of surgery and 207 who did not. Comparison of SALSA Scale scores at baseline and 1 year revealed that activity limitation did not significantly change over time in individuals who declined surgery; however, participants who had surgery showed a significant improvement at 1 year (p < 0.001). Social participation improved over time in both groups, but the difference was significant only in the non-surgery group (p < 0.001). CONCLUSIONS: The findings suggest that reconstructive surgery has beneficial effects on functioning. Evaluation of the need for, and effect of, surgery in larger studies is recommended.