Ocorrência de incapacidade física em hanseníase: uma análise epidemiológica
Data
2015-04-29
Autores
Fernandes, Denise Ortiz Hering 
Orientadores
Gamba, Monica Antar Gamba
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Estudos demonstram que cerca de 20% das pessoas acometidas ou tratadas pela hanseníase, podem apresentar incapacidades físicas e restrições psicossociais, chegando a necessitar de algum tipo de intervenção na reabilitação e/ou continuidade da assistência clínica. O reconhecimento das características manifestadas pelas incapacidades físicas, decorrentes da hanseníase é fundamental para ampliar a vigilância epidemiológica e ancorar as políticas públicas na área. Objetivo: Identificar as variáveis associadas à ocorrência das incapacidades físicas em pessoas que foram tratadas de hanseníase em uma área da regional sul de São Paulo. Método: trata-se de um estudo epidemiológico do tipo transversal para análise de pessoas diagnosticadas com hanseníase e a presença de incapacidades físicas associadas, na admissão e na alta medicamentosa, notificadas na Supervisão de Vigilância em Saúde (SUVIS) no distrito do Jabaquara, no período entre 2008 a 2011. As variáveis independentes investigadas foram: sócio-demográficas, clínicas, terapêuticas, laboratoriais e epidemiológicas. A avaliação da presença da incapacidade foi detectada pela a escala estabelecida pelo Ministério da Saúde (MS). Para a análise estatística foi utilizado o teste Quiquadrado considerando significantes valores de p? 0,05, teste Whole Model e Odds ratio. Resultados: foram identificados 130 casos, com predominância do sexo masculino (52%), faixa etária entre 30 a 39 anos (28%), 54,6% eram ocupados segundo Classificação Brasileira de Ocupações (CBO), 46% da raça parda, 55% foram atendidos na unidade do Jabaquara, 39% tinham ensino fundamental completo e 29% eram moradores da região do Tremembé. A forma clínica dimorfa foi a mais frequente (44%) entre os casos novos diagnosticados, e a classificação operacional de destaque foi a multibacilar (74%). A maioria dos pacientes recebeu alta por cura. No diagnóstico, 46% dos pacientes apresentaram grau zero de incapacidade física, 34% grau I e 16% grau II, na alta medicamentosa esse número elevou-se para 47%, 26%, e 19% graus zero, I e II, respectivamente. Temeroso apontar que no diagnóstico 7,7% dos pacientes não foram avaliados. Resultados da análise de associação não mostraram diferenças estatísticas, apontando apenas a maior proporção de incapacidades funcionais na classificação operacional multibacilar. Houve estabilidade de grau de incapacidade (p<0,0001). Na unidade de atendimento geral havia somente um profissional médico e uma enfermeira e não dispunha de uma equipe multidisciplinar o que contribuiu com evolução para piora do grau de incapacidade (p=0,0215). O grau de incapacidade aumenta com a idade (p=0,0128) e com o número de lesões cutâneas que o paciente apresenta (p=0,0066). O conhecimento dos fatores relacionado à incapacidade física na hanseníase e sua possível evolução durante o tratamento demonstra a relevância deste estudo e evidenciam a necessidade de um maior controle no registro correto do preenchimento das informações das notificações do SINAN e maior monitoramento dos pacientes com risco para desenvolver incapacidades.
Studies show that about 20% of people affected by leprosy or treated, may have physical disabilities and psychosocial restrictions, and they often need some kind of intervention in rehabilitation and / or continued clinical care. The recognition of the characteristics expressed by physical disabilities, due to leprosy is important for increasing epidemiological surveillance and anchor public policy in the area. Objective: To identify the variables associated with the occurrence of physical disabilities in leprosy in an area of the Sao Paulo. Method: This is an epidemiological cross-sectional study for analysis of people diagnosed with leprosy and the presence of associated physical disabilities in admission and discharge medication, reported in Supervision of Health Surveillance (SUVIS) in period from 2008 to 2011. the independent variables investigated were: socio-demographic, clinical, therapeutic, laboratory and epidemiological. The evaluation of the presence of disability was detected by the scale established by the Ministry of Health (MOH). Statistical analysis was performed using ANOVA with numeric variables, the Z test to compare two samples, the chi-square test for comparisons considering significant p ? 0.05 values, test Whole Model and Odds ratio (attached). Results: We identified 130 cases, with a predominance of males (52%), aged 30-39 years (28%), 54.6% were occupied according to the Brazilian Classification of Occupations (CBO), 46% of mixed race, 55% were seen in the specialized unit , 39% had completed elementary school and 29% were residents of Tremembe region. Clinical dimorfa was the most frequent (44%) among new cases diagnosed, and the highlight was the operational classification multibacillary (74%). Most patients were discharged after cure. At diagnosis, 46% of patients had zero degree of physical disability, 34% grade I and grade II 16%, at high drug that number increased to 47%, 25% and 16% levels 1, 2 and 3, respectively . Fearful that point in the diagnosis 4% of patients were not evaluated and this high percentage rose to 12%. Association analysis of the results showed no statistical difference, just pointing the highest proportion of functional disabilities in multibacillary operational classification. Knowledge of the factors related to disability in leprosy and its possible evolution during treatment demonstrates the relevance of this study and highlight the need for greater control in the correct ecord the supply of information of SINAN notifications and greater monitoring of risk patients to develop disabilities.
Studies show that about 20% of people affected by leprosy or treated, may have physical disabilities and psychosocial restrictions, and they often need some kind of intervention in rehabilitation and / or continued clinical care. The recognition of the characteristics expressed by physical disabilities, due to leprosy is important for increasing epidemiological surveillance and anchor public policy in the area. Objective: To identify the variables associated with the occurrence of physical disabilities in leprosy in an area of the Sao Paulo. Method: This is an epidemiological cross-sectional study for analysis of people diagnosed with leprosy and the presence of associated physical disabilities in admission and discharge medication, reported in Supervision of Health Surveillance (SUVIS) in period from 2008 to 2011. the independent variables investigated were: socio-demographic, clinical, therapeutic, laboratory and epidemiological. The evaluation of the presence of disability was detected by the scale established by the Ministry of Health (MOH). Statistical analysis was performed using ANOVA with numeric variables, the Z test to compare two samples, the chi-square test for comparisons considering significant p ? 0.05 values, test Whole Model and Odds ratio (attached). Results: We identified 130 cases, with a predominance of males (52%), aged 30-39 years (28%), 54.6% were occupied according to the Brazilian Classification of Occupations (CBO), 46% of mixed race, 55% were seen in the specialized unit , 39% had completed elementary school and 29% were residents of Tremembe region. Clinical dimorfa was the most frequent (44%) among new cases diagnosed, and the highlight was the operational classification multibacillary (74%). Most patients were discharged after cure. At diagnosis, 46% of patients had zero degree of physical disability, 34% grade I and grade II 16%, at high drug that number increased to 47%, 25% and 16% levels 1, 2 and 3, respectively . Fearful that point in the diagnosis 4% of patients were not evaluated and this high percentage rose to 12%. Association analysis of the results showed no statistical difference, just pointing the highest proportion of functional disabilities in multibacillary operational classification. Knowledge of the factors related to disability in leprosy and its possible evolution during treatment demonstrates the relevance of this study and highlight the need for greater control in the correct ecord the supply of information of SINAN notifications and greater monitoring of risk patients to develop disabilities.
Descrição
Citação
FERNANDES, Denise Ortiz Hering. Ocorrência de incapacidade física em hanseníase: uma análise epidemiológica. 2015. 92 f. Dissertação (Mestrado) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.