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)

Work and Leprosy: women in their pains, struggles and toils.

OBJECTIVE: To analyze the interference of leprosy in women's life regarding work and daily life activities. METHOD: Exploratory qualitative study developed from semi-structured interviews and with the use of field diaries. The strategy of the organization of data was a thematic analysis of content and referential of the work process in health and gender. RESULTS: The themes presented are: "The leprosy pains", "Changes with the disease and adaptation at work and activities" and "Being a woman with leprosy". On them, we present the aspects that changed in women's life from the leprosy, especially regarding work and daily activities. Beyond physical limitation, there are impacts on social relations and above all on formal work, there may even be dismission. FINAL CONSIDERATIONS: In women affected by leprosy, work and daily activities are directly affected; this deepens the social difficulties and requires attention of health professionals.

Work and Leprosy: women in their pains, struggles and toils / El trabajo y la lepra: las mujeres en sus dolores, luchas y esfuerzos / Trabalho e hanseníase: as mulheres em suas dores, lutas e labutas

ABSTRACT Objective: To analyze the interference of leprosy in women's life regarding work and daily life activities. Method: Exploratory qualitative study developed from semi-structured interviews and with the use of field diaries. The strategy of the organization of data was a thematic analysis of content and referential of the work process in health and gender. Results: The themes presented are: "The leprosy pains", "Changes with the disease and adaptation at work and activities" and "Being a woman with leprosy". On them, we present the aspects that changed in women's life from the leprosy, especially regarding work and daily activities. Beyond physical limitation, there are impacts on social relations and above all on formal work, there may even be dismission. Final considerations: In women affected by leprosy, work and daily activities are directly affected; this deepens the social difficulties and requires attention of health professionals.

RESUMEN Objetivo: Analizar la interferencia de la lepra en la vida de mujeres en relación al trabajo y las actividades de la vida diaria. Método: Estudio cualitativo exploratorio desarrollado a partir de entrevistas semiestructuras y con el uso de diario de campo. La estrategia de organización de los datos fue el análisis temático de contenido y referencial del proceso de trabajo en salud y género. Resultados: Los temas presentados son: "Los dolores de la lepra", "Cambios con la enfermedad y adaptaciones en el trabajo y en las actividades" y "Ser mujer con lepra". En ellos, presentamos los aspectos que cambiaron en la vida de las mujeres a partir de la lepra, especialmente con relación al trabajo y a las actividades diarias. Además de la limitación física, hay impactos en las relaciones sociales y sobre todo en el trabajo formal, con posibilidad incluso de dimisión. Consideraciones finales: En mujeres contagiadas por la lepra, el trabajo y las actividades diarias son directamente afectados, lo que profundiza las dificultades sociales y requiere atención de los profesionales de la salud.

RESUMO Objetivo: Analisar a interferência da hanseníase na vida de mulheres em relação ao trabalho e atividades de vida diária. Método: Estudo qualitativo exploratório desenvolvido a partir de entrevistas semiestruturadas e com uso de diário de campo. A estratégia de organização dos dados foi análise temática de conteúdo e referencial do processo de trabalho em saúde e gênero. Resultados: Os temas apresentados são: "As dores da hanseníase", "Mudanças com a doença e adaptações no trabalho e nas atividades" e "Ser mulher com hanseníase". Neles, apresentamos os aspectos que mudaram na vida das mulheres a partir da hanseníase, especialmente com relação ao trabalho e às atividades diárias. Além da limitação física, há impactos nas relações sociais e sobretudo no trabalho formal, podendo haver inclusive demissão. Considerações finais: Em mulheres acometidas pela hanseníase, o trabalho e as atividades diárias são diretamente afetados; isso aprofunda as dificuldades sociais e requer atenção dos profissionais de saúde.

Establishing the reliability and construct validity of the Igbo version of Screening Activity Limitation and Safety Awareness scale in persons with Hansen disease.

OBJECTIVE: Leprosy or Hansen's disease is an infectious disease affecting skin and peripheral nerves. The World Health Organization (WHO) Recent Report reveals Africa as having 20,599 new cases, America 36, 178, Eastern Asia 166,445, Western pacific 5,400; totally up to 232,875 new cases. Nigeria as at 2012 had 3,805 new cases. Nerve dysfunction can lead to severe impairments, such as wounds, clawing and shortening of digits, and visual impairments that are often indicated as WHO Grade 2 disabilities. The Screening Activity Limitation Safety Awareness (SALSA) scale however, was developed to-measure self-reported activity limitation in people affected by peripheral neuropathy, and has been translated into several languages world-wide, including two of the three major indigenous languages in Nigeria (i.e. Yoruba and Hausa), leaving the Igbo language yet to be translated. This resulted in the present study, in which the scale was translated into Igbo and the psychometric properties also established to help in data collection and to promote research among the Igbo speaking people living with disabilities from Hansen's disease. DESIGN: The research design was a cross-sectional survey, facility based with 70% RFT and 30% on MDT. Data were analysed using Cronbach's alpha and factor analyses. RESULT: A quantitative exploration of participants' characteristics revealed that of the 40 respondents that participated in the study; 87.5% of them were predominantly from a rural population; 42.5% were males and 57.5% females. Their ages ranged between 15 and 64 years; 55% were uneducated; while 45% were educated. The SALSA Scale was interviewer-administered to the participants. Reliability analysis conducted on the data revealed high Cronbach's alpha co-efficient of 0.93 - 0.94 for the entire items on the scale. Firstly, most of the scale items correlated at least 0.3 with at least one other item on the scale, Secondly, the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.71, Bartlett's test of sphericity was significant (Χ2 (190) = 482.63, P < 0.001). Finally, the communalities were all above 0.3. The principal factor analysis of the scale revealed a five factor scale, having fulfilled all the necessary conditions. CONCLUSION: It can be concluded that the Igbo version of SALSA is reliable and valid for use among the Igbo speaking group in Nigeria.

Limitations in activities of people affected by leprosy after completing multidrug therapy: application of the SALSA scale.

OBJECTIVES: To identify people affected by leprosy with impairments after completing multidrug therapy for leprosy, and to assess their limitations in conducting daily activities by applying the Screening of Activity Limitation and Safety Awareness (SALSA) scale. METHODS: A cross-sectional study was performed of all residents of a medium-sized city who were treated for leprosy from 1998 to 2006. A specific questionnaire was applied to obtain general and clinical data and the SALSA scale was used to assess limitations in activities. Impairments were assessed using the 'World Health Organization leprosy disability grading system' (WHO-DG). FINDINGS: Of the 335 people affected by leprosy treated in the period, 223 (62.1%) were located and interviewed. A total of 51.6% were female with a mean age of 54 years (SD +/- 15.72) and 67.9% had up to 6 years formal education. The borderline form predominated among interviewees (39.9%) and 54.3% suffer from associated diseases with hypertension (29.1%) and diabetes (10.3%) being the most common. Pain was reported by 54.7% of interviewees. By multiple logistic regression analysis, associations were found between limitations in activities and being female (P < 0.025), family income < or = 3 minimum wages (P-value < 0.003), reports of major lesions (P-value < 0.004), pain (P-value < 0.001), associated diseases (P-value < 0.023) and the WHO-DG (P-value < 0.001). Disabilities, as identified using the WHO-DG, were less common (32%) than limitations in activities as evaluated by the SALSA scale (57.8%). CONCLUSION: Limitations in activities proved to be common in people affected by leprosy and were associated with low income, being female, reported major lesions, disability, disease and pain.

Associação entre sintomas depressivos, ocupação atual e grau de incapacidade na hanseníase / Association between depressive symptoms, work and disability grade in leprosy

Introdução: A depressão é o transtorno psiquiátrico mais comum na hanseníase e com alto índice de sintomas depressivos. O objetivo desse estudo é verificar a prevalência e frequência dos sintomas depressivos e sua relação com o grau de incapacidade (GI) da OMS e variáveis sociodermográficas. Métodos: Aplicou-se um questionário, contendo questões fechadas (aspectos sociodermográficos e clínicos). Foi avaliado o GI que indica a diminuição ou perda da sensibilidade protetora e deformidades visíveis e o Beck Depression Inventory (BDI) com 21 itens. Os 13 primeiros itens foram analisados por meio do Beck Depression Inventory - Short Form (BDI-SF), considerando deprimidos os que tiveram pontuação igual ou acima de dez. Os 21 itens foram avaliados para identificar a frequência dos sintomas depressivos; o escore zero indicou ausência de sintoma; os escores um, dois e três, a presença de sintoma. Foi utilizada análise estatística descritiva, com distribuição de frequência para a caracterização de casuística. Em relação à combinação de variáveis das respostas dos protocolos BDI-SF, GI e outras variáveis, foi utilizado o Teste Chi-square-corrected (Yates), considerando resultados significantes valor-p,0,05. Resultados: Foram avaliados 130 pacientes em tratamento para hanseníase no Instituto Lauro de Souza Lima, Bauru, SP, Brasil. A idade dos pacientes various entre 18 e 78 anos, sendo a média de 49,64 +- (SD14,04). A maioria pertence ao sexo masculino (64,6%), vive com familiares (87,7%), possui ensino fundamental incompleto (66,2%), união civil estavel (61,6%), não trabalham (75,4%) e recebem aposentadoria ou auxílio saúde (63,9%)...

Introduction: Depression is the most common psychiatric disorder in leprosy and with high depressive symptoms. The aim of this study was to assess the frequency of depressive symptoms and their relationship to the WHO grade of disability (GI) and sociodemographic variables. Methods: A structured questionnaire containing sociodemographic and clinical questions was used. The GI indicates which indicates decrease or loss of protective sensation and visible deformities was evaluated. The Beck Depression Inventory (BDI) containing 21 items was applied. The first 13 items were analyzed using the Beck Depression Inventory – Short Form (BD - SF) considering an individuals with depressions that who scored 10 or above. The 21 items were evaluated to identify the frequency of depressive symptoms; a score of zero indicates absence of symptom; scores one, two and three, the present of symptoms. Data was analyzed using descriptive statistics, with frequency distribution symptoms. Data was analyzed using descriptive statistics, with frequency distribution to characterize the sample. /the corrected Chi-square test – (Yates), considering significant results p-value<0,05 was used for the combination of variables of protocol BDI-SF, GI and other response variables. Results: We evaluated 130 patients undergoing treatment for leprosy in the Lauro de Souza Lima Institute, Bauru, SP, Brazil. The age of patients ranged from 18 and 78 years, with mean 49.64+ - (SD 14,04). The majority were males (64,6%), living with their family (87,7%), and who had completed elementary school (66,2%), stable civil union (61,6%), unemployed (75,4%) and retired or receiving health aid (63,9%)…

Pride and prejudice--identity and stigma in leprosy work.

This article sets out to expand the way stigma, and those affected by it, are understood within leprosy discourse and to apply these insights to the analysis of the experiences of leprosy workers. The term stigma is often used simply as shorthand for 'negative social experience'. However, to reduce the negative aspects of complex everyday life experiences to a single word is often overly simplistic and can serve to objectify, rather than illuminate, the experiences of those affected. This article argues that in order to understand the lived experience of stigma we must come to understand stigma as an ongoing, dialectical social process and develop an approach to stigma that analytically separates stigma from its negative social consequences. The article applies these insights to data collected during 14 months of fieldwork with front-line leprosy workers in India, which suggests that falling leprosy prevalence rates and a rapidly changing policy landscape have led to leprosy workers feeling marginalised and stigmatised within their own organisation. The article argues that, rather than seeing stigma merely as a negative process in which leprosy workers are passive victims, we must recognise that stigma also plays a key role in the creation and maintenance of leprosy workers' identity and is utilised as a strategic tool in the struggle for influence between different groups within the organisation. Finally, the article argues for the benefit of expanding our understanding of stigma across public health and of applying these insights to designing future interventions.

Leprosy and stigma in the context of international migration.

If it can be argued that no single attribute or condition (leprosy included) is inherently or universally considered to be 'deeply discrediting,' to quote Goffman, then we must consider how external factors shape stigma associated with that condition in different cultural and socioeconomic contexts. Often, an analysis of what is perceived to be stigma towards people affected by leprosy uncovers other prejudices or stigmatising attitudes associated with class, gender, and/or ethnic inequalities in that society. The movement of people across international borders adds new dimensions to the experience of leprosy, as affected individuals confront different sets of understandings of the disease among healthcare professionals, friends, family, and employers in host and sending countries. Preconceptions of the immigrant 'other' in host countries may be bound up with notions of disease and danger, further complicating the experience of leprosy treatment for immigrants. Drawing on the work of others and on early stage qualitative research on leprosy among Brazilian immigrants to the United States, this paper will consider the ways in which immigration and transnational processes could affect the experience of stigma among immigrants affected by leprosy.

The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes.

PURPOSE: The purpose of this study was to develop and validate a method of measuring activity limitation in leprosy and diabetes. The resulting questionnaire should be quick and simple to use in basic clinical settings, not require any testing skills or equipment, be validated across a number of cultures in order to be widely applicable, be relevant for anyone with long-standing peripheral neuropathy and be sensitive to changes in clients' capabilities. Because of impaired sensibility in hands or feet, persons affected by leprosy or diabetes are expected to be aware that many activities carry a risk of injury, particularly repetitive stress, excess pressure, friction or burns. They are expected to avoid these risky activities, or modify how they are carried out, in order to prevent injury. An additional aim of the study was therefore to find ways of assessing how far clients were aware of safety issues and how much they limited their activities voluntarily because of safety concerns. METHOD: Lists of activities of daily living relevant for the target populations were generated through individual interviews and focus group discussions. A questionnaire of 374 items was compiled and administered to 436 persons affected by leprosy and 132 affected by diabetes in five countries in four continents. A total of 76% of respondents had impairments. Occupational therapists not otherwise involved in this study gave an independent assessment of the degree of activity limitation of 207 respondents. The process of item selection from this database is presented step by step. Items for the SALSA scale were practised by at least 70% of respondents in all participating populations, were easy to perform for some but difficult for others, correlated well with the assessment of independent practitioners and had good item-total correlation. The present set of 20 items is well represented by a single principal component and had a high scale reliability coefficient. RESULTS: On a 20-item scale, one would expect a score of 20 if the respondents practiced all the activities listed without difficulty. Higher scores reflect increasing activity limitation. The SALSA score varied from 10 to 75 with a mean of 32. The distribution of the scores was not different between men and women or between disease groups. There was a consistent increase of the SALSA score with age and with the level of impairment. Compared to India and Nigeria, the average SALSA scores, adjusted for age and impairment level, were higher in Israel and Brazil, but lower in China. The spearman correlation coefficient between the SALSA scores and the scores assigned by the independent experts was 0.67. Among 23 respondents without overt disease, the SALSA score had a median of 19 and half the respondents scored between 18 and 20. CONCLUSIONS: The present research has resulted in the SALSA scale, a short questionnaire which can be administered within 10 min and which provides a standardized measure of activity limitation in clients with a peripheral neuropathy. It can be used to make comparisons between (groups of) individuals in different countries and in the same person (or group) over time. General health workers can use SALSA to screen clients and refer those with high scores to specialised services. In addition, the scale will assist service providers in designing appropriate interventions.

Manual para prevención y rehabilitación basada en la comunidad para personas ciegas y con otros impedimentos / Manual for prevention and rehabilitation based on the community for blind people and with other disabilities

Contiene: 1.Detección y evaluación: fichas. 2.Desarrollo psicomotor. 3.Ejercicios. 4.Actividades de la vida diaria. 5.Parálisis cerebral. 6.Poliomielitis. 7.Lesiones medulares. 8.Poliomielitis. 9.Lesiones medulares. 10.Parálisis braquial obstétrica. 11.Articulaciones dolorosas. 12.Retardo mental. 13.Ciegos. 14.Problemas en la comunicación. 15.Educación especial. 16.Ataques. 17.Lepra. 18.Ayudas biomecánicas. 19.Trabajo y las personas discapacitadas