A clinical prediction rule for nerve-function impairment in leprosy patients

Croft, Rosemary A.; Nicholls, Peter; Steyerberg, Ewout W.; Richardus, Jan Hendrik; Smith, W. C.

doi:10.1016/s0140-6736(00)02216-9

Cited by 103 publications

(77 citation statements)

References 2 publications

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“…Isso ocorre principalmente com as cirurgias de neurólise. A indicação de tratamento cirúr-gico para neurites é em geral para pacientes com contraindicações do uso de corticoide, com abscesso de nervo; pacientes que não responderam ao tratamento clínico para neurite dentro de quatro semanas; pacientes com dor não controlada e/ou crônica e ainda para aqueles com neurite subentrante 21,22 . Em pacientes resistentes ao tratamento clínico com corticoides, a neurólise é efetiva na redução do déficit sensitivo e motor dos nervos periféricos comumente atingidos na hanseníase.…”

Section: Discussionunclassified

Atenção pós-alta em hanseníase no Sistema Único de Saúde: aspectos relativos ao acesso na região Nordeste

et al. 2014

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Cad. Saúde Colet., 2014, Rio de Janeiro, 22 (4): 351-8Resumo O acesso universal aos serviços de saúde representa um processo complexo de inter-relações. Em um sentido mais amplo, incorpora dimensões que passam por aspectos econômicos, técnicos, políticos e simbólicos. Para doenças negligenciadas, como a hanseníase, por exemplo, reverte-se em maiores desafios. Este estudo objetivou caracterizar o acesso aos serviços de saúde por pessoas atingidas pela hanseníase em pós-alta de poliquimioterapia (PQT) nos municípios de Fortaleza e Sobral. Estudo transversal descritivo que incluiu 10% da população que recebeu alta entre 2003 e 2005 (304 pessoas), com caracterização sociodemográfica e clínica, bem como exploração de modalidades e contextos relativos ao acesso no pós-alta. A população era em sua maioria masculina (58%), com alta proporção de incapacidades físicas (34%) e estados reacionais (37%). A abordagem biomédica dos estados reacionais contemplou, em grande parte, a busca e a oferta de atenção nesse período. O acesso à atenção pós-alta foi frágil principalmente em intervenções como cirurgias reabilitadoras e atenção psicológica. Foram identificadas importantes lacunas em termos da operacionalização da atenção às pessoas atingidas no momento do pós-alta em ambos os municípios, o que traduz a relativa negligência em relação à hanseníase como condição crônica e o consequente distanciamento para a abordagem integral a essas pessoas no Sistema Único de Saúde (SUS).Palavras-chave: hanseníase; acesso aos serviços de saúde; atenção à saúde. AbstractUniversal access to health services represents a complex process of inter-relationships between users and health services. In a broader sense it includes economic, technical, political and symbolic aspects. For neglected diseases such as leprosy, this is a major challenge. This cross-sectional study aims to characterize access to health care services for people affected by leprosy after release from treatment in the cities of Sobral and Fortaleza. The study included a representative sample 10% of those concluding treatment from 2003 to 2005 (304 cases). Participants were characterized regarding socio demographic and clinical variables and access to health services after release from treatment. The study population was mostly male (58%), physical disabilities (34%) and with leprosy reactions (37%). The biomedical approach of leprosy reactions contemplated in large part to search for and supply of care in this period. The access to care after discharge was particularly weak in rehabilitative interventions such as surgery and psychological attention. We identified important gaps in the operationalization of attention to people affected after release from treatment in both cities. The date also shows the negligence of leprosy as a chronic condition and the resulting difficulties regarding on integrated distance to the comprehensive approach to people with leprosy after release from treatment in the Unified Health System (SUS).

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Section: Discussionunclassified

Atenção pós-alta em hanseníase no Sistema Único de Saúde: aspectos relativos ao acesso na região Nordeste

et al. 2014

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“…15 Patients and professionals equate fi nishing the treatment with a discharge from the Prevention and Rehabilitation of Disability due to Leprosy service (PRD), which is mistaken. 8 Croft et al 3 showed that in multibacillary cases, which treatment begins with nerve function already altered, there is a risk of up to 65% of presenting new damage during treatment; in paucibacillary leprosy, the risk is 16%.…”

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confidence: 99%

Deficiências após a alta medicamentosa da hanseníase: prevalência e distribuição espacial

et al. 2012

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OBJECTIVE:To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS:Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Student's t-test, chi-square test (χ2), and Fisher's test were used as appropriate at a 5% signifi cance level. RESULTS:Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS:There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.

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“…Ramadan et al 14 found higher frequency of physical deformities in people suffering from Virchowian leprosy (multibacillary) possibly due to the long duration of the disease and frequent reactions. To Croft et al, 5 people with paucibacillary leprosy have less tendency to present impairment of the nerve function in relation to people with multibacillary leprosy. Saunderson et al 17 followed up leprosy patients without physical deformities at the moment of the diagnosis and observed lower occurrence of neuropathy in people with paucibacillary leprosy in the fi rst year, compared to those with multibacillary leprosy.…”

Section: Discussionmentioning

confidence: 92%

Validação do questionário de avaliação funcional das mãos em hanseníase

Ferreira¹,

Alvarez

Virmond

2012

Rev. Saúde Pública

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OBJECTIVE:To validate the psychometric properties of the questionnaire on hand function assessment in leprosy. METHODS:Study conducted with a convenience sample of 101 consecutive patients in Brasília (Central-Western Brazil), from June 2008 to July 2009. The individuals were adults affected by leprosy, with impairment of the ulnar, median and radial nerves. Interobservers and intraobserver reproducibility was analyzed through successive interviews, and construct validity was analyzed through association between age, clinical form of leprosy, duration of nerve injury, grip and pinch strength measured with a dynamometer, sensibility test performed with Semmes-Weinstein monofi laments and manual ability assessment using the Jebsen test of hand function. Pondered kappa coeffi cient was calculated and a Bland-Altman plot was constructed to assess the reproducibility of the instrument. For internal consistency, Cronbach's alpha coeffi cient was utilized. Pearson's correlation coeffi cient was calculated and a multiple regression model was used. RESULTS:The pondered kappa values for interobservers and intraobserver assessments ranged from 0.86 to 0.97 and from 0.85 to 0.97, respectively. The value of Cronbach's alpha coeffi cient was 0.967. Pearson's correlation coeffi cient showed an association (p < 0.001) among duration of nerve injury, grip and pinch strength, cutaneous sensibility and mean score in the Jebsen Test. The mean score of the questionnaire on hand functional assessment in leprosy was associated with operational classifi cation of leprosy, duration of nerve injury, grip strength, cutaneous sensibility and manual ability (p < 0.0001 for the model as a whole). CONCLUSIONS:The questionnaire on hand functional assessment in leprosy presents almost perfect interobservers and intraobserver reproducibility, high internal consistency and correlation with operational classifi cation of leprosy, duration of nerve injury, grip strength, cutaneous sensibility in the hands and manual ability.

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A clinical prediction rule for nerve-function impairment in leprosy patients

Cited by 103 publications

References 2 publications

Atenção pós-alta em hanseníase no Sistema Único de Saúde: aspectos relativos ao acesso na região Nordeste

Atenção pós-alta em hanseníase no Sistema Único de Saúde: aspectos relativos ao acesso na região Nordeste

Deficiências após a alta medicamentosa da hanseníase: prevalência e distribuição espacial

Validação do questionário de avaliação funcional das mãos em hanseníase

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