Comprometimento da saúde no pós-alta de pacientes tratados por hanseníase e fatores relacionados: revisão de escopo / Post-discharge health impairment of patients treated for leprosy and related factors: scope review / Deterioro de la salud tras el alta en pacientes tratados por lepra y factores re-lacionados: una revisión general

Objetivo: mapear evidências na literatura científica sobre o comprometimento de saúde no pós-alta de pacientes tratados por Hanseníase e fatores relacionados. Materiais e Método: revisão de escopo realizada a partir das bases de dados CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS e Web of Science em março de 2021, norteados pela estratégia mnemônica que auxilia na identificação do Problema, Conceito e Contexto propostos pelo Instituto Joanna Briggs, sistematizados por meio do fluxograma PRISMA-ScR e registrados na Open Science Framework (osf.io/vmdc6). Foram incluídos estudos sobre a temática publicados até fevereiro de 2021 no cenário nacional e internacional. Resultados: dos dez artigos incluídos na amostra final, nove evidenciaram algum grau de comprometimento funcional, demonstrando fragilidades no acompanhamento desde o diagnóstico até o período pós-alta. Conclusões: evidencia-se acometimentos com maior frequência sobretudo de ordem física, que impactam diretamente a funcionalidade nas atividades de vida diária e social dessas pessoas. As fragilidades no monitoramento pós-alta foram relacionadas ao déficit de profissionais capacitados, ao desconhecimento de técnicas de avaliação e classificação do grau de incapacidade, à carência na oferta de educação em saúde, à dificuldade de acesso aos serviços de saúde, ao atraso no tratamento dos episódios reacionais e reabilitação biopsicossocial e à ausência da sistematização do cuidado.(AU)

Objective: to map evidence in the scientific literature on the post-discharge health impairment of patients treated for leprosy and related factors. Materials and Method: scope review carried out from the CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS and Web of Science databases in March 2021, guided by the mnemonic strategy that helps to identify the Problem, Concept and Context proposed by the Joanna Institute Briggs, systematized through the PRISMA-ScR flowchart, and registered in the Open Science Framework (osf.io/vmdc6). Studies on the subject published until February 2021 in the national and international scenario were included. Results: of the ten articles included in the final sample, nine showed some degree of functional impairment, demonstrating weaknesses in follow-up from diagnosis to the post-discharge period. Conclusions: there is evidence of more frequent involvement, especially of a physical nature, which directly impact the functionality of these people's daily and social activities. Weaknesses in post-discharge monitoring were related to the lack of trained professionals, lack of knowledge of assessment techniques and classification of the degree of disability, lack of health education provision, difficulty in accessing health services, delay in treatment of reactional episodes and biopsychosocial rehabilitation and the absence of systematization of care.(AU)

Objetivo: mapear en la literatura científica las evidencias sobre el deterioro de la salud post-alta en pacientes tratados por lepra y factores relacionados. Materiales y Métodos: revisión de alcance realizada a partir de las bases de datos CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS y Web of Science en marzo de 2021, guiada por la estrategia mnemotécnica que ayu-da a identificar el Problema, Concepto y Contexto propuesta por el Instituto Joanna Briggs, sistematizada a través del flujograma PRISMA-ScR y registrada en el Open Science Framework (osf.io/vmdc6). Fueron incluidos estudios sobre el tema, publicados hasta febrero de 2021, en el escenario nacional e internacional. Resultados: de los diez artículos incluidos en la muestra final, nueve mostraron algún grado de deterioro funcional, demostrando debilidades en el seguimiento desde el diagnóstico hasta el período posterior al alta. Conclusiones: se evidencia con mayor frecuencia ataques sobre todo de orden físico que impactan directamente en la funcionalidad en las actividades de la vida diaria y social de las personas. Fragilidades en el seguimiento postoperatorio relacionadas con el déficit de profesionales capacitados, el desco-nocimiento de las técnicas de evaluación y clasificación del grado de incapacidad, la carencia en la oferta de educación en salud, la dificultad de acceso a los servicios de salud, el retraso en el tratamiento de los episodios reaccionarios y la rehabilitación biopsicosocial y la ausencia de...(AU)

Activity limitation and social participation restriction among leprosy patients in Boru Meda Hospital, Amhara Region, Ethiopia.

BACKGROUND: Although Ethiopia eliminated leprosy as public health problem 20 years ago, still more than 3000 new cases are reported annually. Leprosy related disability affects patients' day to day physical activities and their participation in social activities. Assessing the degree of activity limitation and social participation is recommended to show disability and assess the efficacy of rehabilitation efforts. METHODOLOGY AND PRINCIPAL FINDING: A hospital based cross sectional study was conducted among a total of 305 leprosy patients. Data were collected by face to face interview using Screening of Activity Limitation and Safety Awareness (SALSA) scale and participation scale. The analysis was done with SPSS version 25. Descriptive statistics was done and then binary logistic regression was used to identify factors associated with activity limitation as well as participation limitation. Most patients (219, 71.8%) had activity limitation; 41 (13.4%) with severe and 25 (8.2%) with extreme limitations. More than half of patients (168, 55.1%) were suffering from participation restriction; with 43 (14.1%) having severe restriction and 30 (9.8%) extreme restriction. Older age, low educational status, distance from treatment center, time of treatment and higher Eye, Hand, Foot disability score were associated with activity limitation. Similarly, older age, low educational status and being unmarried were significantly associated with participation restriction. CONCLUSION: This study revealed that activity limitation and participation restriction are common among leprosy patients. Earlier diagnosis and improved rehabilitative services may help to decrease activity limitation, whereas community rehabilitation may improve social participation. The old and centralized leprosy rehabilitation services need to be decentralized and backed with modern equipment and trained staffs.

Association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale in hand functional evaluation of patients with leprosy diagnosis.

PURPOSE: To evaluate the association of results from the Rosén and Lundborg Score and the screening activity limitation and Safety Awareness scale for the assessment of hand in patients diagnosed with leprosy. METHOD: An association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale for hand was evaluated in a cross-section study with 25 people of a mean age of 51 years old (SD 14), undergoing drug treatment for leprosy. RESULTS: The mean quantitative score in the Screening Activity Limitation and Safety Awareness scale was 27.9 (SD 10.5). Rosén and Lundborg Score for the median nerve were 2.43 (SD 0.38) on the right hand and 2.41 (SD 0.54) on the left hand whilst for the ulnar nerve, the scores observed were 2.33 (SD 0.42) for the right hand and 2.31 (SD 0.61) for the left hand. Significant correlations between the two instruments in assessment of the median and ulnar nerves on both hands were found. CONCLUSIONS: Due to the association found between the scales, the Rosén and Lundborg Score may be used in assessment of the hand in patients diagnosed with leprosy, as a tool to assist the result evaluation after the drug treatment, surgical treatment, rehabilitation and follow-up in the hand dysfunction in leprosy. Implications for Rehabilitation The leprosy inflammatory neuropathy may cause limitations and disabilities related to hand functions of patients. Instruments with quantitative scores provide a reliable basis for therapeutic intervention prognosis. New evaluation methods promote a better monitoring of treatment and hand function evolution of people with leprosy.

Desempenho funcional de pacientes com deformidades visíveis na hanseníase / Functional performance of patients with visible deformities in leprosy

Esse estudo tem por objetivo avaliar a capacidade funcional da mão das pessoas atingidas pela hanseníase na realização das atividades básicas e instrumentais da vida diária. A amostra foi constituída por 50 pacientes, maiores de 18 anos, que estavam sendo acompanhados no ambulatório do Instituto Lauro de Souza Lima. Para avaliação das características sociodemográficas e clínicas foi elaborado um questionário próprio. As dificuldades manuais para realizar atividades nas áreas de vestuário, alimentação, higiene pessoal, cuidados com a casa, escrita e outros foram avaliados por meio da Avaliação Funcional das Mãos em Hanseníase. Os resultados demonstram que em todas as atividades houve algum grau de dificuldade, porém, a maioria dos pacientes as realiza com independência. As atividades consideradas mais difíceis de serem executadas pelos pacientes com garra ulnar foram: pegar objetos pequenos em superfície plana, abrir/fechar fecho de corrente e cortar unhas. Na população de pacientes com garra ulnar/mediano foram: pegar objetos pequenos em superfície plana, abotoar/desabotoar, dar laço/ amarrar cadarço e abrir/fechar fecho de corrente. As atividades são realizadas com algum grau de dificuldade, porém, com independência pela maioria dos indivíduos que tem ou tiveram hanseníase e apresentam deformidades visíveis. Muitas dessas dificuldades podem ser minimizadas por meio de transferências tendinosas ou pela indicação, confecção e uso de tecnologia assistiva(AU).

This study aims to assess the functional capacity of the hand of people affected by leprosy in carrying out basic and instrumental activities of daily living. The sample consisted of 50 patients, aged over 18, who were being followed up at the outpatient clinic of the Instituto Lauro de Souza Lima. A questionnaire was developed to assess sociodemographic and clinical characteristics. Manual difficulties in carrying out activities in the areas of clothing, food, personal hygiene, home care, writing and others were assessed through the Functional Hand Assessment in Leprosy. The results show that in all activities there was some degree of difficulty, however, most patients perform them independently. The activities considered most difficult to be performed by patients with an ulnar claw were: picking up small objects on a flat surface, opening / closing the chain clasp and cutting nails. In the population of patients with an ulnar / median claw were: picking up small objects on a flat surface, buttoning / unbuttoning, looping / tying shoelaces and opening / closing chain fastening. The activities are performed with some degree of difficulty, however, independently by the majority of individuals who have or have had leprosy and have visible deformities. Many of these difficulties can be minimized by means of tendon transfers or by the indication, preparation and use of assistive technology(AU).

Avaliação da prática do autocuidado domiciliar em hanseníase / Evaluation of household self-care pratice in leprosy

O objetivo deste estudo foi verificar se indivíduos acometidos pela hanseníase realizavam adequadamente a prática do autocuidado e possíveis fatores interferentes. Trata-se de um estudo documental, observacional e descritivo de inquérito domiciliar. A amostra abrangeu todos os onze pacientes detectados durante um ano, em um município com 120.000 habitantes no interior do estado de SP. Foram coletados os dados clínicos e cuidados prescritos dos prontuários. A entrevista e a observação das práticas de autocuidado foram realizadas no domicílio. Foi solicitado aos participantes para identificarem os problemas decorrentes da doença, descreverem quais, como e quando faziam o autocuidado, o qual foi classificado como: realizado adequadamente, parcialmente ou não realizado. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (Nº 06/2007). Dos cinco que apresentavam grau 2 de incapacidades, três realizavam parcialmente e dois não realizavam o autocuidado. Demonstraram dificuldades em aceitar o comprometimento físico e de incorporar as práticas diárias por fatores multicausal o mesmo aconteceu com aqueles com grau 1. A necessidade da manutenção do trabalho laboral, com exposição a traumas físicos e em período integral, pode levar a ocultação da doença, seja para si ou para a sociedade, e dificultar as ações de autocuidado, tanto pela falta de tempo quanto pela não aceitação da doença. O modelo paternalista, fragmentador e mecânico da assistência em saúde, sugere uma tendência à dependência dos serviços institucionais, desconstruindo a autonomia e a responsabilidade individual sobre seu estado de saúde, desmotivando as ações do autocuidado domiciliar.

This study aimed to determine whether individuals affected by leprosy properly performed self-carepractice and possible interfering factors. It is a documentary, observational and descriptive study of household survey.The sample covered all the eleven patients during one year, of a municipality with120.000 inhabitants in SP state. Clinical data and prescription care records were obtained from the medical forms. The interview and observation of self-care practices were held at home.The participants were asked to identify the problems resulting from the disease, describing which, how and when theydid the necessary self-care, being classified as: held properly, partially or not performed. The study was approved by the Committee of Ethics in Research (Nº 06/2007). Of the five who presented level 2 disabilities, three partially performed; two did not perform self-care. They demonstrated difficulties in accepting the physical commitment and incorporate the daily practices for multiple causes factors, sodid those with level 1. The need for maintaining labor work, with full-time exposure to physical trauma, can lead to concealment of disease, either for themselves or for society, and hinder self-careactions, either by lack of time as for not accepting the disease.The paternalistic model, fragmenting andmechanical of health care, suggests a tendency by leading to rely on institutional services, deconstructing the autonomy and individual responsibility for their health status, discouraging self-careactions at home.

Dehabilitation in the era of elimination and rehabilitation: a study of 100 leprosy patients from a tertiary care hospital in India.

OBJECTIVES: To study the clinical profile of leprosy patients; to assess dehabilitation in leprosy patients and to study the factors affecting dehabilitation. DESIGN: A cross-sectional questionnaire-based study was carried out on 100 leprosy patients visiting the All India Institute of Medical Sciences (AIIMS), New Delhi between February 2009 and February 2010. Demographic and clinical data were collected and subjects were administered the 52-item Anandaraj Dehabilitation scale which measures the negative impact of leprosy on family relationships, vocational condition, social interaction and self-esteem. RESULTS: The mean patient age was 30.9 years, 81% were males, 51% were at the lepromatous end of the spectrum, 87% had multibacillary leprosy, 22% each had Type 1 and Type 2 reactions, 22% had Grade 1 disability and 39% had Grade 2 disability. The mean duration of symptoms before diagnosis was 20 months. On the Anandaraj scale, 23% had high levels of dehabilitation; on an average, scores were in the range of medium level dehabilitation. Nearly 80% of patients avoided meeting friends, one-third hid the diagnosis from their families and worried about losing their jobs due to the disease, while around a quarter avoided sexual relations, used separate utensils and avoided touching children. Over 40% of unmarried patients faced matrimonial difficulty due to leprosy. Anxiety and guilt were common and incidence of suicidal ideas was much higher than the lifetime incidence in general population. Lack of education, Type 2 reactions, Grade 2 disability and lower age were predictors of greater dehabilitation. CONCLUSIONS: Dehabilitation of leprosy patients continues in this post-elimination era of rehabilitation. A large segment of preventable disability and resultant dehabilitation is likely being missed. There is an urgent need for corrective and preventive measures.

Funcionalidade e deficiencia na hanseniase / Functioning and disabilities in leprosy

Objetivos: investigar a frequência de sintomas osteomusculares e identificar suas relações com a capacidade funcional para atividades de vida diária e de trabalho em pacientes atingidos pela hanseníase. Procedimentos Metodológicos: trata-se de um estudo descritivo tipo inquérito realizado com 100 pacientes em acompanhamento no Instituto Lauro de Souza Lima, Bauru/S.P. Os participantes responderam a um questionário para caracterização da amostra – dados pessoais e clínicos; questionário Nórdico de Sintomas Osteomusculares (QNSO) e o Questionário de disfunção do ombro, braço e mão (DASH). Resultados: a maioria era homem (67%), com baixa escolaridade (53%), renda familiar entre 0 a 2 salários mínimos (71%) e multibacilares (84%). As deficiências físicas acometeram 95% dos entrevistados e 92% indicou algum episódio de dor e/ou parestesia nos membros superiores com interferência na capacidade funcional. Os entrevistados com sintomas osteomusculares apresentam mais dificuldade em desempenhar as atividades de vida diária e de trabalho comparado aos que não apresentam sintomas osteomusculares (valor -p <0,05). A presença de deficiências não sinalizou, nesse estudo, dificuldades para desempenhar atividades cotidianas (valor-p=0,29) e laborais (valor-p=0,87). Discussão: Considerando ser a hanseníase uma doença incapacitante, investimentos se fazem necessários para o diagnóstico precoce e o cuidado integral objetivando manutenção da capacidade funcional. Conclusão: A maioria dos pacientes apresentou dor e/ou parestesia em membros superiores. Esses resultados associados demonstraram que nessa população, as dificuldades na execução das atividades de vida diária e de trabalho foram mais evidentes. Contudo, a presença de deficiência física parece não causar impedimentos e ou limitações no desempenho dessas atividades.

Objectives: to investigate the frequency of musculoskeletal symptoms and identify its relationship with functional capacity for daily living and working activities in patients with leprosy. Methodological procedures: this is a descriptive inquiry study with 100 patients from Lauro de Souza Lima Institute, Bauru/SP. Participants answered a questionnaire to characterize the sample - personal and clinical data; Nordic Musculoskeletal questionnaire (NMQ) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Results: the most of the patients were men (67%), with low education (53%), family income between 0-2 minimum wages (71%) and multibacillary (84%). Physical disabilities reached 95% of interviewed and 92% indicated an episode of pain and/or paresthesia in the upper limbs with interference in functional capacity. Respondents with musculoskeletal symptoms have more difficulty in performing daily living and working activities compared with those without musculoskeletal symptoms (p value <0.05). The presence of disabilities not signaled, in this study, difficulties to perform daily activities (p = 0.29) and labor (p = 0.87). Discussion: considering the leprosy as a disabling disease, investments are needed for early diagnosis and comprehensive care for the maintenance functional capacity. Conclusion: most of patients had pain and/or paresthesia in the upper limbs. These results associated demonstrated that in this population, the difficulties in daily living and working activities were more evident. However, the presence of physical disability does not seem to cause impediments and/or limitations in performance these activities.

Crutch art painting in the middle age as orthopaedic heritage (part I: the lepers, the poliomyelitis, the cripples).

Throughout time from antiquity, the major objective of crutches was to restore, as close as possible, the functional capacity formerly held by a limb deficient person. The crutch is probably the oldest tool of the orthopaedist. It is probably also the most neglected in terms of progress from antiquity until the 20th century. The aim of this paper is to give a view of the different crutches used in this period by different people and to observe the influence of this period on the progress of the design of crutches.

Avaliação das incapacidades físicas em ex-portadores de hanseníase da época do isolamento compulsório / Evaluation of physical disabilities in ex-patients with leprosy the time of isolation compulsory

A hanseníase afeta milhares de brasileiros anualmente, destes um número significativo apresenta graus de incapacidade física I e II. O Objetivo deste estudo foi conhecer o perfil sociodemográfico e as principais incapacidades físicas instaladas em pessoas que tiveram hanseníase na época do isolamento compulsório.Trata-se de uma pesquisa descritiva com abordagem quantitativa, que avaliou 26 residentes de um ex-hospital colônia, hoje designado Centro de Convivência,localizado na cidade de Maracanaú - CE. Foi utilizado um questionário para definir o perfil socio demográfico e o formulário de avaliação neurológica simplificado, preconizado pela OMS para identificar o grau de incapacidade física. Os dados foram coletados e armazenados em uma planilha do software Excel. Após esta etapa o banco de dados foi importado e processado pelo programa EPI-INFO (versão 6). Observou-se predomínio de pessoas do sexo masculino (57,7%), ensino fundamental incompleto (50,0%), a faixa etária variou entre 40 a 80 anos, com renda de até um salário mínimo, quanto ao estado civil, (38,5%) eram casados e (30,8%) viúvos. A maioria (88,5%) apresentou o Grau II de incapacidade. Os segmentos mais afetados foram pés e mãos constatando-se uma perda de sensibilidade nos membros inferiores de (50,0%)e superiores (38,46%) na maioria dos avaliados. Conclui-se que as principais incapacidades presentes nas pessoas atingidas pela hanseníase, são decorrentes de lesões secundárias, principalmente à perda da sensibilidade, como também a insuficiência e ou ausência de ações de prevenção e reabilitação física.

Leprosy affects thousands of Brazilians annually presentsa significant number of these degrees of physicaldisability I and II. The aim of this study was to identifythe sociodemographic profile and major physicaldisabilities installed in people who had leprosy at thetime of compulsory isolation. This is a descriptive researchwith quantitative approach, which evaluated26 residents of a former hospital colony, now calledLiving Center, located in the town of Maracanaú -EC. A questionnaire was used to define the sociodemographicprofile and the Short Form neurologicalassessment, recommended by WHO to identify thedegree of disability. Data were collected and storedin an Excel spreadsheet software. After this step thedatabase was imported and processed by the EPI-INFO(version 6) program. There was a predominance ofmales (57.7%), incomplete primary education (50.0%),the age ranged between 40-80 years with income belowthe poverty level, as marital status, (38.5%) andwere married (30.8%) were widowed. The majority(88.5%) presented grade II disability. The most affectedsectors were the feet and hands indicating a lossof sensation in the lower limbs (50.0%) and higher(38.46%) in most evaluated. It is concluded that themain disability present in people affected by leprosyare due to secondary injuries mainly due to the loss ofsensitivity, as well as the insufficiency or absence ofprevention and physical rehabilitation.

WHO Expert Committee on Leprosy.

Since the introduction of multidrug therapy for leprosy in 1981, an estimated 15 million patients have been cured of the disease and disabilities have been prevented in some 2-3 million individuals. These remarkable results have been brought about by the synergistic efforts of WHO, governmental and nongovernmental bodies, academia, industry and affected communities throughout the world. Nevertheless, much remains to be done--both to sustain this progress and to effect a further reduction in the impact of leprosy on patients and their families. This report presents the conclusions and recommendations of the WHO Expert Committee on Leprosy, whose eighth meeting reflected the recent shift in emphasis of leprosy elimination to reducing of the impairments and disabilities caused by the disease and ensuring the quality and sustainability of leprosy services. The Committee analysed the global leprosy situation, discussed elements of epidemiology, and reviewed developments in treatment of the disease and management of complications. Sociocultural issues were addressed, as was the need for community care, accessibility of health services, and effective referral systems. Indicators for monitoring and evaluation were outlined and research priorities were set out.

Development and structural validation of a shortened version of the Participation Scale.

PURPOSE: To validate a shortened version of the Participation Scale (P-scale) that will be quicker to use and to describe the factor structure found in the P-scale data in various study samples. METHODS: A large multi-country and multi-cultural database was compiled consisting of 5125 respondents. Item analysis, explanatory factor analysis and confirmatory factor analysis were applied to identify items for deletion and investigate the factor structure of the P-scale. RESULTS: The multi-country database included 11 databases from six different countries. Respondents were affected by a range of health conditions, including leprosy, HIV/AIDS, dermatological conditions and various disabilities. Of the respondents included 57% were male. The P-scale Short (PSS) contains 13 items. A two-factor structure, with factors named "work-related participation" (three items) and "general participation" (10 items), showed the best model fit (Comparative Fit Index = 0.983, Tucker Lewis Index = 0.979, Rooted Mean Square Error of Approximation = 0.061). The Cronbach's alphas were very good for both the whole scale and the subscales, 0.91, 0.83 and 0.90, respectively. Correlation between the two factors was high (r = 0.75) indicating that interpreting the P-scale as measuring an overall factor "participation" is still valid. A very high correlation (r = 0.99) was found between the full P-scale and the PSS. CONCLUSIONS: The findings suggest good validity of the P-scale across a range of languages and cultures. However, field testing needs to confirm the validity of the PSS to measure the level of social participation restrictions across cultures and health conditions.

Deficiências e incapacidades por hanseníase: avaliação clínica e epidemiológica dos pacientes atendidos em um Centro de Referência Nacional do Brasil / Disabilities and impairments in leprosy: clinical and epidemiological survey of patients seen in a National Reference Center in Brazil

A classificação de incapacidades nos graus 0, 1 e 2 nos pacientes com hanseníase é usada como indicador da qualidade dos métodos preventivos e curativos da doença,entretanto, algumas deficiências e incapacidades não estão contempladas nesse sistema. Esta pesquisa realizou um levantamento de incapacidades decorrentes da hanseníase em um Centro de Referência Nacional do Brasil, por meio de estudo retrospectivo, com análise de prontuários de 318 pacientes atendidos no período de 2003 a 2008 e software específico. Houve predomínio de casos multibacilares (63%), de formas clínicas dimorfas-tuberculóides (41,5%) e do sexo masculino(58,5%). Os nervos mais acometidos foram ulnar (22,3%), tibial (21,7%) e fibular (20,7%). Dos casos analisados, 41,5% apresentavam algum tipo de deficiência, sendo 81,1% multibacilar. Os sítios mais acometidos foram os pés (51,8%), seguidos pelas mãos (29%), olhos (10,9%) e nariz (8,3%). As deficiências mais comuns foram artelhos em martelo (2,8%) e lesões tróficas (2,5%) no pé; garra móvel (3,1%) e lesões tróficas (2,8%) na mão; madarose superciliar (2,8%) e perfuração do septo nasal (1,2%). Na alta houve diminuição do número pacientes com deficiências por sítio, exceto oculares, com aumento de 2,5%.Os resultados enfatizam a necessidade de promover assistência detalhada no atendimento realizado no SUS e de adequar os parâmetros utilizados no estadiamento dos pacientes, que atualmente omite alterações funcionais e estéticas dos sítios orgânicos representativas de obstáculos à integração social. A reprodução desse tipo de estudo fornecerá subsídios para que a gestão do SUS desenvolva estratégias que tratem a hanseníase como doença crônica e incapacitante.

The classification of disabilities in grades 0, 1 and 2 in patients with leprosy is used as an indicator of the quality of preventive and curative methods of the disease, however, some deficiencies and disabilities are not included in this system. This research conducted a survey of disability due to leprosy in a National Reference Center of Brazil, through a retrospective study with analysis of records of 318 patients treated between 2003 to 2008 and specific software. There was a predominance of multibacillary cases (63%), clinical forms of borderline tuberculoid (41.5%) and male (58.5%). The most affected nerves were ulnar (22.3%), tibial (21.7%) and fibular (20.7%). Of these cases, 41.5% had sometype of disability, with 81.1% multibacillary. The most affected sites were the feet (51.8%), followed by hands (29%), eyes (10.9%) and nose (8.3%). The most common deficiencies were clawed toes (2.8%) and trophic lesions (2.5%) in thefoot, mobile claw (3.1%) and trophic lesions (2.8%) in thehand; eyebrow madarosis (2 8%) and nasal septum perforation(1.2%). The number of disabilities decreased atdischarge, except at the eye, which increased 2.5%. The results emphasize the need to promote comprehensive care in the NHS and to adjust the parameters used in the staging of patients, that currently omit functional and aesthetic lesions, which represent organic obstacles to social integration. Reproduction of this type of study will provide data for the NHS management to develop strategies in order to deal with leprosy as a chronicand disabling disease.

WHO disability grade does not influence physical activity in Brazilian leprosy patients.

Disability caused by leprosy may be associated with stigma. The aim of this work is to describe the degree of disability, quality of life and level of physical activity of individuals with leprosy and to identify possible correlations between these factors. Ninety-seven patients from two referral centres were studied. A complete medical history was taken and the World Health Organization degree of physical disability classification (WHO-DG), the International Physical Activity Questionnaire (IPAQ) and the Medical Outcome Study 36-item Short-form health Survey (SF36) were applied. The mean age of patients was 51 +/- 14.9 years old; participants were predominantly men, married, unemployed, had concluded treatment and had had lepromatous leprosy. The WHO-DG and the level of physical activity (P-value = 0.36) were not correlated. The WHO-DG showed that 72.2% of patients had disabilities, 37.1% of whom performed vigorous physical activities. No significant association was observed between the WHO-DG and the domains of the QoL SF-36 except for functional capacity (P-value = 0.02); the physical capacity is generally 'very good' when individuals have no disabilities and 'bad' with severe disabilities. In conclusion, the WHO-DG of leprosy patients does not affect the level of physica activities or quality of life except functional capacity. There is no significan association between physical activities and quality of life in these individuals.

Transfer of disability care of leprosy to the affected persons and the community members.

Bargarh district in the western Orissa had high leprosy burden and LEPRA India supported in control activities. Its main focus was on POD care with community participation. After motivation and capacity building, it transferred the responsibility of POD care to affected persons, family, community partners and GHS staff in 2006. The effectiveness of this approach was evaluated in 2009. With personal contact responses from 112 (17%) persons with disability and 18 stakeholders were obtained. Result shows 98% affected persons are staying with family; 92% are practicing self-care; 92% felt self-care is beneficial; 57% and 36% are using commercial and MCR footwear respectively. Surgical correction of deformity is maintained in 80% of cases. Difficulty in activity and in community participation was experienced in about one third of affected persons the latter is mostly due to self stigma. The facilitators were happy with their beneficiaries.

An attempt towards prevention and management of disabilities and deformities in leprosy.

History of prevention of deformities is practically as old as the appearance of the deformities themselves, unfortunately without much understanding to start with. In medieval era and even earlier, leprosy and deformities were treated synonymously and the disease's infectivity too was closely associated with appearance of deformities. Hence, to reduce chances of deformities caused by leprosy in healthy population, the patients having deformities were driven away from the society presuming that only deformed patients spread the disease. Unfortunately, it never worked. However, in later period, factors behind the deformities and disabilities were recognized and understood. These are basically limited to involvement of peripheral nerves and their proper management (medical treatment, surgical interventions, physiotherapy, ergonomics and counseling) by one rule of thumb i.e. early, timely and adequately.

Prevention of disability in leprosy: the different levels.

Prevention of disability in people affected by leprosy is primarily seen as prevention and management of impairments secondary to nerve function impairment. This article describes four different levels at which appropriate interventions may lead to the overall prevention of disability. These are--prevention of disease, timely diagnosis and adequate treatment of the disease, early recognition and adequate treatment of nerve function impairment and finally, prevention and treatment of secondary impairments due to nerve function loss.

Leprosy in the Philippines: a review.

Leprosy is a skin disease that accounts for serious deformities and disabilities, leading to stigmatization and psychosocial suffering. It is included in "The Neglected Tropical Diseases". Not surprisingly, its management is increasingly reported as a function of Dermatology Departments, with a strong community-orientated bias. Prompt and accurate diagnosis of leprosy is crucial in the control of leprosy. Its management requires a multidisciplinary team of skilled physicians, laboratory staff, and nurses. All members of the health sectors should remain vigilant to combat this battle against leprosy.