Practices in the healthcare of children and adolescents with leprosy: the discourse of professionals.

OBJECTIVE: To analyze the health care practices of children and adolescents with leprosy from the speeches of health professionals. METHOD: Qualitative research conducted with 23 health professionals who attended children and adolescents with leprosy in primary and secondary care in a municipality in the state of Pernambuco, from April to July 2018, through semi-structured interviews. Data were subjected to content analysis. RESULTS: The practice of health care was apprehended from the following categories of analysis: "Embracement in leprosy", "Clinical practice" and "Education in Health", with limitations in meeting the particularities of the studied population. CONCLUSIONS: Limiting aspects in health care practice contribute to the difficulties in controlling the disease, requiring the development of best practice recommendations that address the needs of children and adolescents.

Practices in the healthcare of children and adolescents with leprosy: the discourse of professionals / Prácticas de atención médica para niños y adolescentes: discursos profesionales / Práticas de atenção à saúde de crianças e adolescentes com hanseníase: discursos de profissionais

ABSTRACT Objective: To analyze the health care practices of children and adolescents with leprosy from the speeches of health professionals. Method: Qualitative research conducted with 23 health professionals who attended children and adolescents with leprosy in primary and secondary care in a municipality in the state of Pernambuco, from April to July 2018, through semi-structured interviews. Data were subjected to content analysis. Results: The practice of health care was apprehended from the following categories of analysis: "Embracement in leprosy", "Clinical practice" and "Education in Health", with limitations in meeting the particularities of the studied population. Conclusions: Limiting aspects in health care practice contribute to the difficulties in controlling the disease, requiring the development of best practice recommendations that address the needs of children and adolescents.

RESUMEN Objetivo: Analizar las prácticas de atención de la salud de niños y adolescentes con lepra, a partir de los discursos de los profesionales de la salud. Método: Investigación cualitativa realizada con 23 profesionales de la salud que atendieron niños y adolescentes con lepra en atención primaria y secundaria en un municipio del estado de Pernambuco, de abril a julio de 2018, a través de entrevistas semiestructuradas. Los datos fueron sometidos a análisis de contenido. Resultados: La práctica de la atención de la salud fue aprehendida de las siguientes categorías de análisis: "Recepción en la lepra", "Práctica clínica" y "Educación en salud", con limitaciones para satisfacer las especificidades de la población estudiada. Conclusiones: Los aspectos limitantes en la práctica del cuidado de la salud contribuyen a las dificultades para controlar la enfermedad, lo que requiere el desarrollo de recomendaciones de mejores prácticas que aborden las necesidades de los niños y adolescentes.

RESUMO Objetivo: Analisar as práticas de atenção à saúde de crianças e adolescentes com hanseníase, a partir dos discursos de profissionais de saúde. Método: Pesquisa qualitativa, realizada com 23 profissionais de saúde que atendiam crianças e adolescentes com hanseníase na atenção básica e secundária de um município do Estado de Pernambuco, de abril a julho de 2018, mediante entrevistas semiestruturadas. Os dados foram submetidos a análise de conteúdo. Resultados: A prática de atenção à saúde foi apreendida a partir das seguintes categorias de análise: "Acolhimento em hanseníase", "A prática clínica" e "Educação em saúde", com limitações no atendimento às especificidades do público estudado. Conclusões: Os aspectos limitantes na prática de atenção à saúde contribuem para as dificuldades no controle da doença, requerendo o desenvolvimento de recomendações de boas práticas que contemplem as necessidades de crianças e adolescentes.

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

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

Guidelines for management of rheumatic diseases in developing countries from basics to real-world situation: relevance, need, and processes for development.

Guidelines or recommendations help to provide uniform standards in medical practice. The development of guidelines requires adherence to pre-defined norms prescribed by different international organizations such as the European League against Rheumatism (EULAR). We searched Pubmed and LILACS to identify published papers in five major rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies, osteoarthritis, and scleroderma) from different countries based on their economic prosperity and could find a lack of published literature from most economically weaker regions. Similarly, published guidelines in these rheumatic diseases were sparse from Asia and Africa, which are economically developed to a lesser extent than other regions of the world. Considering differing economic realities driving patient care in different regions of the world, unique challenges in certain geographic areas such as musculoskeletal manifestations of infectious diseases like leprosy and tuberculosis, as well as distinct risk of malignancies and other comorbid conditions, National Rheumatology societies should work towards developing more guidelines for rheumatic diseases from regions such as Asia and Africa, while following strictly the prescribed norms for the same. With a paucity of guidelines for such regions currently, an alternative (although less preferable) suggestion would be that major international societies, whose guidelines are widely read and followed the world over, should consider inputs from experts from diverse regions of the world while developing these guidelines.

[Family health nursing care: weaknesses and strengths in the Unified Health System]. / A visão de profissionais da Estratégia Saúde da Família sobre os efeitos do treinamento de hanseníase.

OBJECTIVE: To analyze the weaknesses and strengths of nursing care in the Family Health Strategy and its interfaces with the Unified Health System network. METHOD: A qualitative study performed by means of semi-structured interviews and systematic observations, with the participation of a nursing team of 15 people from October of 2012 to January of 2013. RESULTS: Strengths that were emphasized: the nurse's versatility in conducting users within the unit and the health system, therefore directly acting upon access to these services. The nurse is the main subject that participates in the care processes for the person, family and social groups. Weaknesses that were highlighted: fragile embracement and low resolution of users' and families' problems. CONCLUSION: The nursing care process in health units still lacks collective articulation, involvement of the team, and decentralization of the decisions.

[Public policies in Leprosy: contribution in reduction of social exclusion]. / Políticas públicas na Hanseníase: contribuição na redução da exclusão social.

The study examines the performance of the sector of leprosy as a municipality of Minas Gerais, from January 1996 to December 2004, through a descriptive and retrospective study of medical records of patients who started multi-drug therapy in this period. It was the frequent presence of the state technical supervision, with attention to the most severe cases, courses of training for professionals and constant support in the face of difficulties. The result was increasing the number of cases detected and improvement in quality of care to the diseased of leprosy. Currently, 100% of cases are assessed on the degree of disability, in addition to monitoring the reactions and neuritis, thus preventing deformities.

[Nursing consultation for leprosy patients in the territory of the Family Health Strategy: perceptions of nurses and patients]. / Consulta de enfermagem ao portador de hanseníase no território da Estratégia da Saúde da Família: percepções de enfermeiro e pacientes.

The present study aims to identify difficulties for the nurse so that he can reflect and create strategies to improve the quality of the nursing consultation and follow-up for patients with leprosy and to understand the perception of the patient in relation to the attendance structure and nursing follow-up. From the results we note that in the nursing consultation, the creation of a bond of confidence was sought with the client with the objective of receiving information on their treatment as well as on any disabilities. Regarding the difficulties confirmed by the nurses, they are related to the organization conditions of health services which causes a high demand. In relation to the perception of patients regarding the nursing consultation it was shown, in general, quite satisfactory.

Políticas públicas na Hanseníase: contribuição na redução da exclusão social / La política pública en la Lepra: contribución en la reducción de la exclusión social / Public policies in Leprosy: contribution in reduction of social exclusion

O estudo analisa o desempenho do setor de hanseníase de um município do estado de Minas Gerais, no período de janeiro de 1996 a dezembro de 2004, por meio de um estudo descritivo e retrospectivo dos prontuários dos pacientes que iniciaram poliquimioterapia neste período. Verificou-se a freqüente presença da supervisão técnica estadual, com atendimento aos casos mais graves, cursos de capacitação aos profissionais e o constante apoio frente às dificuldades. O resultado foi o aumento do número de casos detectados e a melhoria na qualidade do atendimento ao portador de hanseníase. Atualmente, 100 por cento dos casos são avaliados quanto ao grau de incapacidade, além do monitoramento das reações hansênicas e neurites, prevenindo assim as deformidades.

The study examines the performance of the sector of leprosy as a municipality of Minas Gerais, from January 1996 to December 2004, through a descriptive and retrospective study of medical records of patients who started multi-drug therapy in this period. It was the frequent presence of the state technical supervision, with attention to the most severe cases, courses of training for professionals and constant support in the face of difficulties. The result was increasing the number of cases detected and improvement in quality of care to the diseased of leprosy. Currently, 100 percent of cases are assessed on the degree of disability, in addition to monitoring the reactions and neuritis, thus preventing deformities.

El estudio examina el desempeño del sector de la lepra de un municipio de estado de Minas Gerais, a partir de enero de 1996 a diciembre de 2004, a través de un estudio descriptivo y retrospectivo de historias clínicas de los pacientes que iniciaron poli quimioterapia en este período. Fue verificada a frecuente presencia de la supervisión técnica del Estado, con atención a los casos más graves, cursos de formación para los profesionales y apoyo constante ante las dificultades. El resultado fue el aumento del número de casos detectados y la mejora en la calidad de la atención al portador de la lepra. Actualmente, el 100 por ciento de los casos son evaluados por el grado de discapacidad, además de supervisar las reacciones y neuritis, evitando así deformaciones.

Consulta de enfermagem ao portador de hanseníase no território da Estratégia da Saúde da Família: percepções de enfermeiro e pacientes / Consulta de enfermería al portador de la lepra en lo território de la Estrategia de Salud de la Familia: percepciones de enfermeros y pacientes / Nursing consultation for leprosy patients in the territory of the Family Health Strategy: perceptions of nurses and patients

O presente estudo visa identificar as dificuldades do enfermeiro para que ele possa refletir e criar estratégias para melhorar a qualidade da consulta e acompanhamento de enfermagem aos portadores de hanseníase e conhecer a percepção do cliente em relação à estrutura do atendimento e o acompanhamento de enfermagem. A partir dos resultados notamos que na consulta de enfermagem busca-se criar um vínculo de confiança com cliente com objetivo do mesmo receber as informações sobre seu tratamento bem como sobre de incapacidades. No que diz respeito às dificuldades afirmadas pelas enfermeiras, elas estão relacionadas às condições de organização dos serviços de saúde o que acarreta uma alta demanda. Com relação à percepção dos pacientes quanto à consulta de enfermagem mostrou-se, no geral, bem satisfatória.

The present study aims to identify difficulties for the nurse so that he can reflect and create strategies to improve the quality of the nursing consultation and follow-up for patients with leprosy and to understand the perception of the patient in relation to the attendance structure and nursing follow-up. From the results we note that in the nursing consultation, the creation of a bond of confidence was sought with the client with the objective of receiving information on their treatment as well as on any disabilities. Regarding the difficulties confirmed by the nurses, they are related to the organization conditions of health services which causes a high demand. In relation to the perception of patients regarding the nursing consultation it was shown, in general, quite satisfactory.

El presente studio objetiva identificar las dificuldades para los enfermeros de modo que ellos puedan refexionar y crear estrategias para mejorar la calidad de la consulta de enfermería y el seguimiento de los pacientes con la Lepra y endtender la percepción del paciente en relación a la esctructura de atención y el seguimiento de enfermería. De los resultados nosotros hemos notado que en la consulta de enfermería se busca la creación de un vínculo de confianza con el paciente con el objetivo de que el reciba las informaciones sobre su tratamiento así cómo sus limitaciones. En lo que tanje a las dificuldades presentadas por las enfermeras, ellas están relacionadas a las condiciones de organización de los servicios de salud lo que produce una alta demanda. Con relación a la percepción de los paciente a la consulta de enfermería, ha sido demonstrado, en general, bien satisfatoria.

A survey on knowledge and skills in the early diagnosis of leprosy in general health services at different levels in Shandong Province, The People's Republic of China.

In the late phase of a leprosy control programme, problems arise with regard to the early detection and treatment of a small number of new incident cases. We describe a study in the province of Shandong, People's Republic of China, on the knowledge and skills regarding leprosy of general health service staff, including rural doctors, paramedical doctors at township level, doctors from county general and provincial hospitals and dermatologists. The results showed that there is a continuing need for suitable training programmes for medical staff in the general health services. Most dermatologists had good levels of knowledge and skills and more than 80% of new cases have been diagnosed in skin clinics in this province since 1990. Their participation in early diagnosis and training of staff should be strengthened.

A communication on health and development in the Kainji Lake area of Nigeria.

A study of the health care delivery facilities in the Kainji Lake area of Nigeria (an artificial lake created in 1968) showed that hospitals, a health centre, maternal and child health centres, public health units, dispensaries and leper institutions, controlled by various organizations, are available. Dispensaries and leper settlements/clinics form the most numerous health providers in the rural areas. Analysis of 1973 data from eight dispensaries around Lake Kainji showed that malaria, gastroenteritis, chest and skin infections, venereal diseases and shistosomiasis constitute the major health problems. Observations of the environmental sanitation in the study area by the author support the idea that the diseases emanate particularly from the low standard of environmental health. A suggestion is made for the establishment of a central organization charged with the responsibilities for health planning and development. The evaluation of the impact of hte dispensaries as health providers is needed for future health planning. A health care delivery system supported by operational research should be initiated at the village level.