Magnitude and temporal trend of leprosy indicators in Goiás, Brazil: an ecological study 2001-2017. / Magnitude e tendência temporal dos indicadores da hanseníase em Goiás: um estudo ecológico do período 2001-2017.

OBJECTIVE: To analyze the trend of leprosy indicators in Goiás between 2001 and 2017. METHODS: An ecological time series study was conducted. Leprosy morbidity and operational indicators were calculated using Notifiable Health Conditions Information System data. Prais-Winsten regression was used for trend analysis. RESULTS: There was a falling trend in the detection rate in the general population (Annual Percent Change [APC] = -6.8 - 95%CI -8.2;-5.4) and in children under 15 years old (APC = -7.2 - 95%CI -8.5;-5.9); a rising trend in the proportion of grade 2 disability (APC = 3.7 - 95%CI 2.0;5.3) and in the proportion of examined physical disability (APC = 0.6 - 95%CI 0.3;0.8); healing and examined contacts proportions were stable. CONCLUSION: Detection rates decreased while the proportions of grade 2 physical disability and examined physical disability increased.

Magnitude e tendência temporal dos indicadores da hanseníase em Goiás: um estudo ecológico do período 2001-2017 / Magnitud y tendencia temporal de los indicadores de lepra en Goiás, Brasil: un estudio ecológico en 2001-2017 / Magnitude and temporal trend of leprosy indicators in Goiás, Brazil: an ecological study 2001-2017

Objetivo: Analisar a tendência dos indicadores da hanseníase em Goiás no período de 2001 a 2017. Métodos: Foi realizado estudo ecológico de séries temporais. Indicadores de morbidade e operacionais da hanseníase foram calculados a partir de dados do Sistema de Informação de Agravos de Notificação (Sinan). Utilizou-se regressão de Prais-Winsten para análise de tendência. Resultados: Verificou-se tendência decrescente na taxa de detecção na população geral (variação percentual anual [VPA] = -6,8 - IC95% -8,2;-5,4) e em menores de 15 anos de idade (VPA = -7,2 - IC95% -8,5;-5,9); e tendência crescente na proporção de grau 2 de incapacidade física (VPA = 3,7 - IC95% 2,0;5,3) e na proporção de incapacidade física examinada (VPA = 0,6 - IC95% 0,3;0,8); as proporções de cura e de contatos examinados mostraram-se estáveis. Conclusão: As taxas de detecção diminuíram, enquanto as proporções de grau 2 de incapacidade física e de incapacidade física examinada cresceram.

Objetivo: Analizar la tendencia de los indicadores de lepra en Goiás entre 2001 y 2017. Métodos: Se realizó un estudio ecológico de series temporales. La morbilidad y los indicadores operativos se calcularon a partir de los datos del Sistema de información de Agravamientos de Notificación (Sinan). Se utilizó la regresión de Prais-Winsten para el análisis de tendencias. Resultados: Se confirmó una tendencia de disminución de la tasa de detección en la población general (Variación Porcentual Anual [VPA] = -6,8 - IC95% -8,2;-5,4) y en niños menores de 15 años (VPA = -7,2 - IC95% -8,5;-5,9); proporción creciente de incapacidad grado 2 (VPA = 3,7 - IC95% 2,0;5,3) y proporción creciente de incapacidad física examinada (VPA = 0,6 - IC95% 0,3;0,8); las proporciones de cura y contactos examinados fueron estables. Conclusión: Las tasas de detección disminuyeron mientras que aumentaron las proporciones de incapacidad física de grado 2 e incapacidad física examinada.

Objective: To analyze the trend of leprosy indicators in Goiás between 2001 and 2017. Methods: An ecological time series study was conducted. Leprosy morbidity and operational indicators were calculated using Notifiable Health Conditions Information System data. Prais-Winsten regression was used for trend analysis. Results: There was a falling trend in the detection rate in the general population (Annual Percent Change [APC] = -6.8 - 95%CI -8.2;-5.4) and in children under 15 years old (APC = -7.2 - 95%CI -8.5;-5.9); a rising trend in the proportion of grade 2 disability (APC = 3.7 - 95%CI 2.0;5.3) and in the proportion of examined physical disability (APC = 0.6 - 95%CI 0.3;0.8); healing and examined contacts proportions were stable. Conclusion: Detection rates decreased while the proportions of grade 2 physical disability and examined physical disability increased.

Impact of health interventions on epidemiological and operational leprosy indicators in a hyperendemic municipality of Brazil

O estudo teve como objetivo analisar o impacto das intervenções de saúde realizadas na cidade de Palmas, Brasil, sobre os indicadores epidemiológicos e operacionais da hanseníase entre 2007 e 2017. A intervenção consistiu na capacitação de profissionais de saúde no diagnóstico e acompanhamento de pacientes e organizar o encaminhamento dos pacientes às unidades de saúde. As estimativas do impacto foram calculadas tomando as diferenças entre os indicadores reportados em dois períodos iguais de 1,5 anos pré e pós-intervenção, com um período de transição de seis meses. No período do estudo, o banco de dados continha 1.875 notificações, com 66% dos casos diagnosticados no período pós-intervenção. Houve predomínio do sexo masculino (52%); com 50 anos ou mais (34,9%); com etnia mista (63,5%). A baixa escolaridade foi perceptível, com mais da metade dos casos (51. 7%) relatando analfabetismo ou ≤ 7 anos de estudo. A intervenção resultou em um aumento nos indicadores epidemiológicos e operacionais, sugerindo um impacto positivo da intervenção na detecção e tratamento da hanseníase. Nossos resultados também enfatizam a necessidade de mais estudos que abordem o impacto de intervenções pragmáticas em saúde com o objetivo de controlar e eliminar a doença(AU).

The study aimed to analyze the impact of health interventions carried out in the city of Palmas, Brazil, on the epidemiological and operational indicators of leprosy between 2007 and 2017. The intervention consisted of training healthcare personnel on the diagnosis and follow-up of patients and organizing the referral of patients to health units. Estimates of the impact were calculated by taking the differences between indicators reported in two equal periods of 1.5 years pre- and post-intervention, with a transition period of six months. During the study period, the database contained 1,875 notifications, with 66% of cases diagnosed in the post-intervention period. There was a predominance of males (52%); aged 50 years or more (34.9%); with mixed ethnicity (63.5%). The low level of education was noticeable, with more than half of the cases (51.7%) reporting illiteracy or ≤ 7 years of education. The intervention resulted in an increase in both, epidemiological and operational indicators, suggesting a positive impact of the intervention on leprosy detection and treatment. Our results also emphasize the need for further studies addressing the impact of pragmatic health interventions aiming at controlling and eliminating the disease(AU).

Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001-2015.

OBJECTIVE: To analyze the temporal trend of leprosy indicators in a hyperendemic state of Brazil, from 2001-2015. METHODS: This is a time-series study of leprosy indicators in the state of Maranhão, Northeastern region of Brazil. The study used data from the Brazilian National System of Reportable Diseases, for the period between 2001 and 2015. The following indicators were evaluated: (i) detection coefficient in the general population; (ii) detection coefficient in people under 15 years old; (iii) rate of cases with grade 2 physical disability in the diagnosis; (iv) rate of examined contacts, and (v) proportion of healing . The Prais-Winsten regression model was used for trend analysis. Analyses were performed for the state and by each health region. RESULTS: 77,697 leprosy cases were analyzed in the general population and 7,599 in individuals under 15 years old. The detection coefficient in the general population ranged from 80.7/100 thousand inhabitants in 2001 to 51.2/100 thousand inhabitants in 2015. The coefficient in the general population presented a downward trend (annual percentage variation [APV] = -2.98; 95%CI -4.15- -1.79). For the population under 15 years old, the rate was 24.9/100 thousand inhabitants in 2001, and 19.9/100 thousand inhabitants in 2015, with downward trend (APV = -3.07; 95%CI -4.95- -1.15). It was observed upward trend in rate of contacts examined (APV = 2.35; 95%CI 0.58-4.15) and rate of cases with grade 2 disability (APV = 2.19; 95%CI 0.23-4.19). Stationary trend was observed in the proportion of healing (APV = -0.10; 95%CI -0.50-0.30). Regional differences were found in the performance of the indicators. CONCLUSIONS: A downward trend for the detection coefficients in the general population and in individuals under 15 years old was found in Maranhão. Despite this result, the rates are still very high, demanding efforts from all spheres of public administration and health professionals to reduce the burden of the disease in the state.

Spatial modeling of leprosy in the state of Bahia and its social determinants: a study of health inequities.

BACKGROUND: Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES: To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS: An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS: The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS: The use of synthetic indicators is a limitation of the study. CONCLUSIONS: Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.

Spatial modeling of leprosy in the state of Bahia and its social determinants: a study of health inequities

Abstract BACKGROUND: Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES: To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS: An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS: The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS: The use of synthetic indicators is a limitation of the study. CONCLUSIONS: Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.

Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001-2015 / Análise da tendência dos indicadores da hanseníase em estado brasileiro hiperendêmico, 2001-2015

ABSTRACT OBJECTIVE To analyze the temporal trend of leprosy indicators in a hyperendemic state of Brazil, from 2001-2015. METHODS This is a time-series study of leprosy indicators in the state of Maranhão, Northeastern region of Brazil. The study used data from the Brazilian National System of Reportable Diseases, for the period between 2001 and 2015. The following indicators were evaluated: (i) detection coefficient in the general population; (ii) detection coefficient in people under 15 years old; (iii) rate of cases with grade 2 physical disability in the diagnosis; (iv) rate of examined contacts, and (v) proportion of healing . The Prais-Winsten regression model was used for trend analysis. Analyses were performed for the state and by each health region. RESULTS 77,697 leprosy cases were analyzed in the general population and 7,599 in individuals under 15 years old. The detection coefficient in the general population ranged from 80.7/100 thousand inhabitants in 2001 to 51.2/100 thousand inhabitants in 2015. The coefficient in the general population presented a downward trend (annual percentage variation [APV] = -2.98; 95%CI -4.15- -1.79). For the population under 15 years old, the rate was 24.9/100 thousand inhabitants in 2001, and 19.9/100 thousand inhabitants in 2015, with downward trend (APV = -3.07; 95%CI -4.95- -1.15). It was observed upward trend in rate of contacts examined (APV = 2.35; 95%CI 0.58-4.15) and rate of cases with grade 2 disability (APV = 2.19; 95%CI 0.23-4.19). Stationary trend was observed in the proportion of healing (APV = -0.10; 95%CI -0.50-0.30). Regional differences were found in the performance of the indicators. CONCLUSIONS A downward trend for the detection coefficients in the general population and in individuals under 15 years old was found in Maranhão. Despite this result, the rates are still very high, demanding efforts from all spheres of public administration and health professionals to reduce the burden of the disease in the state.

RESUMO OBJETIVO Analisar a tendência temporal dos indicadores da hanseníase em estado brasileiro hiperendêmico, no período de 2011 a 2015. MÉTODOS Trata-se de um estudo de série temporal dos indicadores de hanseníase no estado do Maranhão, região Nordeste, que utilizou dados do Sistema Nacional de Agravos de Notificação, no período de 2001 a 2015. Foram avaliados os seguintes indicadores: (i) coeficiente de detecção na população em geral; (ii) coeficiente de detecção em menores de 15 anos; (iii) proporção de casos com grau 2 de incapacidade física no diagnóstico; (iv) proporção de contatos examinados e (v) proporção de cura. Para análise da tendência foi utilizado o modelo de regressão de Prais Winsten . As análises foram realizadas para o Estado e por região de saúde. RESULTADOS Foram analisados 77.697 casos de hanseníase na população geral e 7.599 em menores de 15 anos. O coeficiente de detecção na população geral variou de 80,7/100 mil habitantes em 2001 para 51,2/100 mil habitantes em 2015. Verificou-se tendência decrescente do coeficiente na população geral (variação percentual anual [VPA] = -2,98; IC95% -4,15- -1,79). Na população menor de 15 anos, o coeficiente foi de 24,9/100 mil habitantes em 2001 para 19,9/100 mil habitantes em 2015, com tendência decrescente (VPA = -3,07; IC95% -4,95- -1,15). Observou-se tendência crescente na proporção de contatos examinados (VPA = 2,35; IC95%: 0,58-4,15) e na proporção de casos com grau 2 de incapacidade (VPA = 2,19; IC95% 0,23-4,19). Verificou-se tendência estacionária na proporção de cura de hanseníase (VPA = -0,10; IC95% -0,50-0,30). Observaram-se diferenças regionais no desempenho dos indicadores. CONCLUSÕES A tendência dos coeficientes de detecção na população geral e em menores de 15 anos mostrou-se decrescente no Maranhão. Apesar disso, as taxas ainda são muito elevadas, o que exige esforços de todas as esferas de gestão e profissionais da saúde para redução da carga da doença no estado.

Tendência temporal da hanseníase em Aracaju, Sergipe, Brasil / Temporal trend of leprosy in Aracaju, Sergipe, Brazil / Tendencia temporal de la lepra en Aracaju, Sergipe, Brasil

Justificativa e Objetivos: A hanseníase é uma doença infectocontagiosa crônica, com potencial incapacitante que mantém altas taxas de incidência mesmo com tratamento eficaz e gratuito. Desta forma, este estudo objetiva analisar os dados epidemiológicos e operacionais da hanseníase em Aracaju-SE, a fim de diagnosticar a tendência da endemia e orientar o aprimoramento de políticas públicas que visem à sua eliminação. Métodos: Trata-se de um estudo ecológico, tipo série temporal, que analisou indicadores epidemiológicos e operacionais da Hanseníase no município de Aracaju, capital do estado de Sergipe,de 2003 a 2017. Resultados: Entre 2003 e 2017, a taxa de detecção da hanseníase manteve-se decrescente, com tendência anual de queda de 8,63% na população geral e 9,32% em menores de 15 anos. Durante este período, houve tendência a aumento do diagnóstico e tratamento da hanseníase pela Atenção Primária. A cura dos casos manteve-se estável e a proporção de contatos examinados apresentou um significativo incremento, saindo de 20,6%, em 2003, para 82,9%, em 2017. Identifica-se também uma tendência progressiva da queda na detecção das formas paucibacilares em detrimento das multibacilares. Conclusão: Há uma tendência de redução da detecção da hanseníase em Aracaju em todas as faixas etárias, porém, a região ainda é considerada de alta endemicidade. É possível perceber o crescimento do papel da Atenção Primária entre 2003 e 2017, além do aumento significativo do exame dos contatos, ferramenta importante no diagnóstico e tratamento precoce. Embora os indicadores de saúde tenham mostrado melhorias, esse avanço permanece insuficiente para adequado controle da doença.(AU)

Background and Objectives: Leprosy is a chronic infectious disease that has a disabling potential and maintains high incidence rates even with effective and free treatment. Thus, this study aims to analyze the epidemiological and operational data of leprosy in the city of Aracaju, Sergipe, Brazil, in order to diagnose the endemic disease trend and guide the improvement of public policies aimed at its elimination. Methods: This is an ecological and time series study that analyzed the epidemiological and operational indicators of leprosy in the municipality of Aracaju, capital of the state of Sergipe, from 2003 to 2017. Results: Between 2003 and 2017, detection rate of leprosy remained decreasing, with an annual decline of 8.63% in the general population and 9.32% in children under 15 years. During this period, there was a trend to increase the diagnosis and treatment of leprosy by Primary Care. The cure of the cases remained stable and the proportion of contacts examined showed significant increase, rising from 20.6% in 2003 to 82.9% in 2017. There is also a progressive trend to decrease the detection rate of paucibacillary forms due to multibacillary forms. Conclusion: There is a trend to reduce the detection of leprosy in Aracaju in all age groups, but the region is still considered to be highly endemic. It is possible to perceive the growth of the Primary Care role between 2003 and 2017, in addition to the significant increase in the examination of contacts as an important tool in the diagnosis and early treatment. Although health indicators have shown improvements, this progress remains insufficient for adequate control of the disease.(AU)

Justificación y Objetivos: La lepra es una enfermedad infectocontagiosa crónica, con potencial discapacitante y que mantiene altas tasas de detección incluso con tratamiento eficaz y gratuito. De esta forma, este estudio objetiva analizar los datos epidemiológicos y operativos de lepra en la ciudad de Aracaju, Sergipe, Brasil, a fin de diagnosticar la tendencia de la endemia y orientar el perfeccionamiento de políticas públicas que apunten a su eliminación. Métodos: Se trata de un estudio ecológico, tipo serie temporal, que analizó indicadores epidemiológicos y operativos de la lepra en el municipio de Aracaju, capital del estado de Sergipe, entre 2003 y 2017. Resultados: Entre 2003 y 2017, la detección de la lepra se mantuvo decreciente, con una tendencia anual de caída del 8,63% en la población general y el 9,32% en los menores de 15 años. Durante ese período, hubo una tendencia al aumento del diagnóstico y tratamiento de la lepra por la Atención Primaria; la cura de los casos se mantuvo estable; y la proporción de contactos examinados presentó un significativo incremento saliendo del 20,6%, en 2003, al 82,9%, en 2017. Se identifica también una tendencia progresiva a la caída en la detección de las formas paucibacilares en detrimento de las multibacilares. Conclusión: Hay una tendencia a reducir la detección de la lepra para Aracaju en todas las edades, pero la región todavía se considera de alta endemicidad. Es posible percibir el crecimiento del papel de la Atención Primaria entre 2003 y 2017, además del aumento significativo del examen de los contactos, una herramienta importante en el diagnóstico y tratamiento precoz. Aunque los indicadores de salud han mostrado mejoras, este avance sigue siendo insuficiente para un adecuado control de la enfermedad.(AU)

Saúde nas metrópoles – doenças infecciosas / Health in metropolises - Infectious Diseases

A urbanização é um processo irreversível em escala mundial e estima-se que o número de pessoas que vivem em cidades deverá atingir 67% da população do planeta até 2050. Os países de baixa ou média renda, por sua vez, possuem 30% a 40% da população urbana vivendo atualmente em favelas, em situação de risco para diversos agravos de saúde. No Brasil, embora 84,3% da população residissem em áreas urbanas já em 2010, não se verificam no momento ações consistentes voltadas ao enfrentamento das questões de saúde urbana. Neste artigo discute-se a situação epidemiológica de agravos infecciosos de interesse para a saúde pública (dengue, infecção por HIV/aids, leptospirose, hanseníase e tuberculose) a partir do ano 2000 nas 17 metrópoles do país, de modo a esclarecer o papel atual das doenças infecciosas no contexto da saúde urbana brasileira...

Urbanization is an irreversible global process and the number of people living in cities is estimated to reach 67% of the world population by 2050. In low- and middle-income countries, 30% to 40% of the population currently lives in slum areas, under risk of several diseases. Even though 84.3% of the Brazilian population already lived in urban areas in 2010, no consistent initiatives have been implemented to address urban health issues. We discuss here the epidemiological features of communicable diseases that are relevant to public health (dengue, HIV/aids, leptospirosis, leprosy and tuberculosis) in Brazil’s 17 metropolitan areas since 2000 to help clarify the current role of infections in the context of Brazilian urban health...

Doenças transmissíveis e situação socioeconômica no Brasil: análise espacial

O presente estudo tem como objetivo descrever a distribuição espacial dos indicadores epidemiológicos das doenças transmissíveis relacionadas à pobreza nos municípios brasileiros, visando demarcar áreas geográficas com concentração de morbidades e condições socioeconômicas precárias para o direcionamento de ações integradas de políticas públicas de saúde e sociais. Trata-se de estudo ecológico descritivo com abordagem espacial, tendo como unidades de análise os municípios brasileiros. A partir de dados dos sistemas de informação do Ministério da Saúde (MS) e do Instituto Brasileiro de Geografia e Estatística (IBGE), foram calculados indicadores de incidência das seguintes doenças transmissíveis relacionadas à pobreza, segundo sua relevância para a saúde pública e disponibilidade de dados: tuberculose, hanseníase, leishmaniose tegumentar, leishmaniose visceral e malária.

Physical disabilities at diagnosis of leprosy in a hyperendemic area of Brazil: trends and associated factors.

INTRODUCTION: Tocantins State in north Brazil remains endemic for leprosy, with high detection rates and occurrence of disabilities at diagnosis. We analyzed trends and identified factors associated with the occurrence of disability at diagnosis. METHODS: We analyzed data from the Notifiable Diseases Information System (SINAN). We included new leprosy cases resident in Tocantins, diagnosed between 2001 and 2012. RESULTS: During the study period, there were 14,532 new leprosy cases residing in Tocantins. Of these, 12,328 (84.9%) were assessed for degree of disability at diagnosis: 9,166 (74.4%) with Grade 0; 2,498 (20.3%) with Grade 1; and 664 (5.4%) with Grade 2 disability. The proportion of disability Grade 2 remained stable over time. Factors associated with Grade 2 at diagnosis included: male gender (RR = 2.24; CI: 1.89 - 2.65), age ≥ 45 years (RR = 5.31; CI: 3.21 - 8, 29), illiteracy (RR = 6.70; CI: 3.75 - 11.95), diagnosis made through mass campaigns (RR = 2.40; CI: 1.50 - 3.85), and residency in rural areas (RR = 1.28; CI: 1.06 - 1.5). Grade 2 disabilities at diagnosis were also more common in the presence of ≥ 5 five skin lesions (RR = 4.42, CI: 3.74 - 5.21), leprosy reactions (RR = 2.78; CI: 2.31 - 3.33), multibacillary disease (RR = 7.43; CI: 6.11 - 9.04), and lepromatous clinical form (RR = 16.53, CI: 12.10 - 20.60). CONCLUSIONS: The leprosy control programme should focus on socio-economically disadvantaged and difficult-to-reach population groups. Leprosy mass campaigns and other collective examinations, to be integrated with other disease control programmes, may be an effective means to reduce disability degree at diagnosis.

Avaliação dos indicadores epidemiológicos e operacionais para a hanseníase em municípios prioritários no estado do Paraná, 2001 a 2010 / Evaluation of leprosy epidemiological and operational indicators in priority municipalities in the state of Paraná, 2001 to 2010 / Evaluación de indicadores epidemiológicos y operativos para hanseniasis en municipios de prioridad en el estado de Paraná, 2001 a 2010

OBJETIVO: descrever os indicadores epidemiológicos e operacionais da hanseníase nos municípios de Curitiba, Londrina e Foz do Iguaçu, estado do Paraná, Brasil. MÉTODOS: estudo ecológico descritivo de série temporal com dados do Sistema de Informação de Agravos de Notificação, sobre o período de 2001 a 2010; a análise dos indicadores seguiu os parâmetros indicados no Guia de Controle da Hanseníase do Ministério da Saúde, 2002. RESULTADOS: no período estudado, houve redução do coeficiente de prevalência da hanseníase por 10.000 habitantes em Foz do Iguaçu (de 4,3 para 2,6) e Londrina (de 1,7 para 1,2); Curitiba apresentou menos de 1 caso por 10.000 habitantes no período; a proporção de cura e consequente efetividade do tratamento mostrou-se regular nos três municípios. CONCLUSÃO: os indicadores epidemiológicos sinalizaram redução do diagnóstico de hanseníase mas sugerem a existência de casos ocultos; os indicadores operacionais apontaram discreta melhoria na qualidade do atendimento aos portadores da doença.

OBJECTIVE: to assess the epidemiological and operational indicators of leprosy in the cities of Curitiba, Londrina and Foz do Iguaçu, in Paraná state, Brazil. METHODS: this was a descriptive ecological time-series study using Notifiable Diseases Information System data, for the period 2001-2010. Indicator analysis was performed as per the parameters listed in the 2002 version of the Health Ministry's Leprosy Control Guide. RESULTS: prevalence decreased from 4.3 to 2.6 in Foz do Iguaçu and from 1.7 to 1.2 in Londrina, whilst Curitiba had less than 1 case per 10,000 inhabitants in the period. The cure rate and consequent treatment effectiveness was regular in the three municipalities. CONCLUSION: although the cities studied have shown improvement, this is not yet sufficient to control the disease. The work already begun needs to be fully implemented in forthcoming years.

OBJETIVO: describir los indicadores epidemiológicos y operacionales de la hanseniasis en las ciudades de Curitiba, Londrina y Foz de Iguazú, estado de Paraná, Brasil. MÉTODOS: estudio ecológico descriptivo de series temporales, con datos del Sistema de Información de Enfermedades de Declaración Obligatoria, para el período de 2001 - 2010; el análisis de indicadores siguió los parámetros indicados en la Guía de Control de Hanseniasis, del Ministerio de Salud, 2002. RESULTADOS: en el periodo estudiado, hubo una reducción de la prevalencia de hanseniasis por cada 10 000 habitantes, en las ciudades de Foz do Iguaçu (de 4,3 para 2,6) y Londrina (de 1,7 para 1,2); Curitiba mostró una prevalencia de 1 caso por 10.000 habitantes en ese periodo; la proporción de cura y por consiguiente la eficacia del tratamiento fue regular en los tres municipios. CONCLUSIÓN: los indicadores epidemiológicos mostraron reducción en el diagnóstico de hanseniasis, pero sugieren la existencia de casos ocultos; los indicadores operacionales muestran a una discreta mejoría en la calidad de atención a los portadores de esta enfermedad.

[Leprosy trends in Tocantins, a hyperendemic State in the North of Brazil, 2001-2012]. / Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012.

Leprosy is hyperendemic in the State of Tocantins, Brazil. The aim of the study was to analyze trends in leprosy indicators in Tocantins from 2001 to 2012, based on analysis of data from the Information System for Notifiable Diseases (SINAN), including incident cases living in Tocantins. The study calculated leprosy indicators and analyzed time trends using polynomial regression. There was a significant downward trend in overall case detection (R2 = 0.40; p < 0.05) and proportion of paucibacillary cases (R2 = 0.81). Detection rates remained stable in individuals < 15 years (R2 = 0.48; p > 0.05) and cases with grade 2 physical disability (R2 = 0.37; p > 0.05), as did the proportion of grade 2 cases (R2 = 0.49; p > 0.05). There were significant increases in the proportions of cases with grade 1 disability (R2 = 0.82; p < 0.05) and multibacillary cases (R2 = 0.81; p < 0.05). Tocantins has regions with high transmission and late diagnosis of leprosy, indicating heterogeneous dissemination of the disease in the time trend analysis.

Correlation of visual analogue scale foot and ankle (VAS-FA) to AOFAS score in malleolar fractures using Indian language questionnare.

BACKGROUND: Visual analogue scale foot and ankle (VAS-FA score) is a new score, validated in previous studies, but never compared to AOFAS score. OBJECTIVE: Analysis of the two scores using Indian language questionnaire. METHODS: Fifty patients with Malleolar fractures were assessed for functional outcome, time for calculation of scores, difficulty in correlation and comprehension of the questionnaire, in Malayalam language. The score parameters were compared by SSPSS. RESULTS: There was similarity in pattern of score values in both systems but also a difference between values in each category, with VAS-FA having lower values, reflecting its efficacy. There was significant correlation, similar sensitivity and agreement between the scoring systems. VAS-FA correlated better with patient's outcome and required less time for assessment. CONCLUSION: This study shows that Indian language VAS-FA has a similar pattern of extracting scores as AOFAS and can be an efficient tool in ankle outcome assessment in Indian patients.

Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012 / Leprosy trends in Tocantins, a hyperendemic State in the North of Brazil, 2001-2012 / Tendencias de la lepra en Tocantins, un estado hiperendémico del norte de Brasil, 2001-2012

A hanseníase é hiperendêmica no Estado do Tocantins, Brasil. O objetivo do estudo foi analisar as tendências dos indicadores da hanseníase no Tocantins em 2001-2012. Análise de dados advindos do Sistema de Informação de Agravos de Notificação (SINAN). Incluíram-se casos novos de residentes no Tocantins. Calcularam-se os indicadores da hanseníase e analisaram-se as tendências temporais por meio de regressão polinomial. Houve tendência significativa e decrescente para a detecção geral (R2 = 0,40; p < 0,05) e proporção de casos paucibacilares (R2 = 0,81). Foi estável a detecção em < 15 anos (R2 = 0,48; p > 0,05), detecção de casos com grau 2 de incapacidade física (R2 = 0,37; p > 0,05) e proporção de casos com grau 2 (R2 = 0,49; p > 0,05). Houve aumento significativo para a proporção de casos com grau 1 de incapacidade (R2 = 0,82; p < 0,05) e proporção de casos multibacilares (R2 = 0,81; p < 0,05). O Tocantins apresenta regiões com alta transmissão e diagnóstico tardio da hanseníase, apontando a expansão da doença de forma heterogênea na análise temporal.

Leprosy is hyperendemic in the State of Tocantins, Brazil. The aim of the study was to analyze trends in leprosy indicators in Tocantins from 2001 to 2012, based on analysis of data from the Information System for Notifiable Diseases (SINAN), including incident cases living in Tocantins. The study calculated leprosy indicators and analyzed time trends using polynomial regression. There was a significant downward trend in overall case detection (R2 = 0.40; p < 0.05) and proportion of paucibacillary cases (R2 = 0.81). Detection rates remained stable in individuals < 15 years (R2 = 0.48; p > 0.05) and cases with grade 2 physical disability (R2 = 0.37; p > 0.05), as did the proportion of grade 2 cases (R2 = 0.49; p > 0.05). There were significant increases in the proportions of cases with grade 1 disability (R2 = 0.82; p < 0.05) and multibacillary cases (R2 = 0.81; p < 0.05). Tocantins has regions with high transmission and late diagnosis of leprosy, indicating heterogeneous dissemination of the disease in the time trend analysis.

La lepra es hiperendémica en el estado de Tocantins, Brasil. El objetivo del estudio fue analizar las tendencias de los indicadores de la lepra en Tocantins, 2001-2012. El análisis de los datos procedentes de las enfermedades de declaración obligatoria en el Sistema de Información sobre Dolencias Notificables (SINAN) incluía nuevos casos que viven en Tocantins. Se calcularon los indicadores de la lepra y se analizaron las tendencias temporales de regresión polinómica. Hubo una significativa tendencia a la baja, la detección general (R2 = 0,40; p < 0,05) y el número de casos paucibacillar (R2 = 0,81). Fue una detección estable en < 15 años (R2 = 0,48; p > 0,05), la detección de los casos con discapacidad grado 2 (R2 = 0,37; p > 0,05) y la proporción de casos con grado 2 (R2 = 0,49; p > 0,05 ). Hubo un aumento significativo en la proporción de casos con discapacidad grado 1 (R2 = 0,82; p < 0,05) y la proporción de casos multibacilares (R2 = 0,81; p < 0,05).Tocantins cuenta con regiones de alta transmisión y un diagnóstico tardío de la lepra que apunta a la expansión heterogénea de la enfermedad en el análisis temporal.

Quality of life of leprosy sequelae patients living in a former leprosarium under home care: univariate analysis.

INTRODUCTION: Quality of life (QoL) is a broad concept that has become more important during the last decades. Despite this fact, few studies have been conducted to evaluate leprosy patients, none of which has specifically addressed patients with leprosy sequels submitted to home care. PURPOSE: To evaluate the QoL of leprosy sequel bearers and the factors that may affect their perception of their condition. METHODS: WHOQoL-BREF, a questionnaire developed by the World Health Organization, was administered to 32 people living in the coverage area of a former leprosarium. Patient socio-demographic and care-related caregiver data were collected. Activities of daily living and Instrumental Activities of Daily Living Scales were used to evaluate autonomy. Mini-Mental Status Examination was used to evaluate cognitive status. Simple linear regression analyses were conducted using SPSS Statistical Software and the non-standardized beta values were presented. RESULTS: The patients were mainly female, widowed, elderly, with bone sequels; all had impairment of at least one Instrumental Daily Living Activity. QoL scores were 12.35 in a 4-20 scale (52.18 %) in the physical domain, 12.95 (55.94 %) in the psychological health domain, 13.18 (57.40 %) in the environment domain, and 16.09 (75.56 %) in the social domain. Univariate analysis suggests that instrumental daily activity "capacity of shopping," marital status, and caregiver age were associated with self-perceived QoL. Data were also compared to those from other studies. CONCLUSION: Individuals affected by leprosy had low QoL scores in the physical and psychological health domains and high scores in the social domain. The factors that impact their QoL seem to be related to specific conditions found in the leprosarium and the previous isolation practices.

[Quality of life of leprosy patients' group in Vietnam].

Vietnam has achieved WHO's leprosy elimination goal at a national level, but there are a lot ofex-leprosy patients who have severe physical disabilities in the leprosy treatment centers and resettlement villages. The purpose of this study is to analyze the quality of life (QOL) of ex-leprosy patients in Vietnam. The study was conducted in two leprosy treatment centers in Vietnam. The SF-36v2 QOL survey was used to evaluate the leprosy patients' health related conditions, and as a comparison group, SF-36v2 QOL survey was provided to a random group from the general population to measure the general groups' health related conditions. For those participants aged from 10 to 29 years old, the patients' group scored lower than the general group in each of the following categories; Role physical, Bodily pain, General health perceptions, Vitality, Social functioning, Role emotional. On the other hand, middle aged and elderly participants were found to show no significant difference between the patients' group and the general group. In comparing the two leprosy treatment centers, the score of Role physical and Role emotional were significantly higher in the leprosy treatment center where vocational training programs for leprosy patients are offered. From these results, the use of vocational training program is one of the effective methods for improving the QOL of the patients' group.

Desempenho de indicadores nos municípios com alta cobertura da Estratégia Saúde da Família no Estado de São Paulo / Performance of Indicators in municipalities with High Coverage of the Family Health Strategy in the State of São Paulo / Desempeño de indicadores en los municipios con una alta cobertura de la "Estrategia de Salud Familiar" en el Estado de São Paulo

Introdução: A avaliação do desempenho da Estratégia Saúde da Família tem se mostrado difícil no Estado de São Paulo por razões diversas, como a baixa cobertura da população, associada paradoxalmente a indicadores de saúde acima da média nacional. Objetivo: Avaliar o desempenho de alguns indicadores do "Pacto pela Atenção Básica" e do "Pacto pela Saúde" em municípios do Estado de São Paulo com alta cobertura da Estratégia Saúde da Família em comparação ao restante do Estado. Métodos: Indicadores do "Pacto pela Atenção Básica" e do "Pacto pela Saúde" foram acompanhados nos 110 municípios que alcançaram 90% ou mais de cobertura da Estratégia Saúde da Família em um período mínimo de sete anos e comparados com os indicadores do restante do Estado. Resultados: A taxa de mortalidade infantil apresentou uma tendência de queda muito mais importante em relação ao Estado. A taxa de internação por acidente vascular cerebral mostrou-se maior nos municípios em relação ao Estado. A razão de exames citopatológicos dos municípios da amostra foi quase o dobro da encontrada no Estado; a taxa de alta dos pacientes com tuberculose foi superior em pouco mais de 13% em comparação à média do Estado e a taxa de cura de hansênicos apresentou variação menor (5%), mas favorável à amostra. Conclusões: Os achados sugerem que a estratégia esteja contribuindo para a melhora dos indicadores de processo, bem como de alguns indicadores de resultado, demandando maior seguimento dos últimos.

Objective: It has been difficult to evaluate the performance of the Family Health Strategy in the State of São Paulo due to several reasons, such as the low population covered, which is paradoxically associated to health indicators above the national average. On this basis, this study tries to evaluate the strategy effectiveness in the State of São Paulo. Methods: The indicators of the Primary Care Pact and Health Pact were investigated in the municipalities that achieved 90% or more coverage of the Family Health Strategy for the past seven years. Results: Infant mortality presented a more important downward trend within the sample. The hospitalization rate for stroke was higher within the sample, but presented stability that opposes the growth in the state. The cytopathologic exams ratio was nearly double the amount found elsewhere in the State. The cure rate for tuberculosis patients was 13% higher than the state pattern and the cure rate of leprosy showed minor variation (5%), but favorable to the cities of the sample. Conclusions: The findings have led to the conclusion that the strategy demonstrated improvement in the process indicators, as well as in the results of some of the indicators studied, demanding a longer follow-up for better conclusions.

Introducción: Evaluar el desempeño de la "Estrategia de Salud Familiar" (ESF) en el estado de São Paulo ha sido difícil por diversas razones, como por ejemplo la baja cobertura de la población, asociada, paradójicamente, a indicadores de salud superiores al promedio nacional. Objetivo: Evaluar el desempeño de algunos indicadores del "Pacto por la Atención Básica" y del "Pacto por La Salud" en municipios del Estado de São Paulo con alta cobertura de la ESF con relación a otros municipios del Estado. Métodos: Los indicadores del "Pacto por la Atención Básica" y del "Pacto por La Salud" fueron seguidos en 110 municipios con 90% o más de cobertura de la ESF, durante un período mínimo de siete años y fueron comparados con los indicadores de los demás municipios del Estado. Resultados: La taxa de mortalidad infantil decreció en la muestra mucho más que en el resto del Estado. La tasa de hospitalización por accidente cerebrovascular fue mayor en la muestra que en el resto del Estado. La proporción de exámenes citopatológicos de los municipio de la muestra fue casi el doble que la encontrada en el resto del Estado; la tasa de alta de los pacientes con tuberculosis fue superior en poco más del 13% cuando comparada a la media del resto del Estado y la tasa de cura de leprosos mostró una menor variación (5%), más favorable a la muestra. Conclusiones: Los resultados sugieren que la ESF puede contribuir con la mejora en los indicadores de procesos, así como de algunos de los indicadores de resultados, requiriendo estos últimos mayor seguimiento.