Limited activity and social participation after hospital discharge from leprosy treatment in a hyperendemic area in north Brazil

Abstract

Introduction: Neural damages are among the main factors that contribute to physical disability in leprosy. Systematic monitoring using a broad physical, psychological and social approach is necessary. Objective: The objective of this study was to characterize the limitation of activity and social participation and its correlation with disabilities and/or impairment in individuals after being discharged from a multidrug leprosy therapy. Method: A cross-sectional study conducted in Araguaína, state of Tocantins, which is a leprosy hyperendemic municipality. We included cases of patients who were discharged from treatment considered as cured from January 2004 to December 2009. We performed dermatological examination and applied the Screening Activity Limitation and Safety Awareness (SALSA) and social participation scales. Results: We included 282 individuals (mean age: 45.8 years old). The paucibacillary operational classification was more common (170; 60.3%). The eye-hand-foot score ranged from 0 to 12 (mean: 0.7). A total of 84 (29.8%) individuals presented limited activity. A slight restriction in social participation occurred in 18 (6.3%) cases. There was a statistically significant correlation between activity limitation, age (r = 0.40; p < 0.0001) and degree of functional limitation (r = 0.54; p < 0.0001), as well as of restricted social participation, activity limitation (r = 0.56, p < 0.0001) and functional limitations (r = 0.54, p < 0.0001). Conclusion: Functional limitation due to leprosy had an impact on the conduct of activities and social participation after the discharge from a leprosy treatment. The association between Screening of Activity Limitation and Safety Awareness and participation scales will assist in designing evidence-based assistance measures.

Análise contextual da atenção à saúde na alta em hanseníase: uma revisão integrativa

“…The selected articles (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) to compose the present integrative review present different levels of evidence. According to the level of evidence proposed by Melnyk and Fineout-Overholt (35) , two studies were classified in level IV (related to evidence from a cohort study) (14,24) and 12 studies were considered at the level of evidence VI, i.e., those that include evidence derived from a single descriptive or qualitative study (15)(16)(17)(18)(19)(20)(21)(22)(23)(25)(26)(27) .…”

“…The search was made without using a temporal cut-off related to the year of publication of the studies and was performed using the indexed descriptors Leprosy and dis-charge (or Leprosy and Patient Discharge, for selection via MeSH), associated with the Boolean operator AND, obtaining a total of 145 publications. After exclusion according to the eligibility criteria and repeated publications, 14 articles (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) were included for the study, as explained in Flowchart 1. In order to carry out the analysis, in addition to the articles selected, we also searched for convenience, in a non-systematized way, publications (4,(28)(29)(30)(31)(32)(33)(34) of the authors' knowledge, because it is seen necessary and relevant for contextual analysis.…”

“…On the one hand, the MOH emphasizes the importance of returning to the health unit if new skin lesions are observed, neuralgia with or without worsening of the sensory function, associated or not with changes in motor function, for prevention and treatment of disabilities, and as a differential diagnosis between leprosy reactions and recurrences (4) . On the other hand, the literature cites the inexistence of well-defined actions in the care network focused on the operationalization of care in the continuity of care directed to the egresses of PCT (16,18,(21)(22) .…”

Myelination key factor krox‐20 is downregulated in Schwann cells and murine sciatic nerves infected by Mycobacterium leprae

“…Leprosy affects sensory, motor and autonomic functions, but sensitive nerve fibres are compromised earlier . Neural damage in leprosy leads to physical disabilities leading to stigma and high morbidity in the individuals affected by the disease …”

“…4,5 Neural damage in leprosy leads to physical disabilities leading to stigma and high morbidity in the individuals affected by the disease. 6,7 The glial cells of the peripheral nervous system (PNS) constitute distinct classes of Schwann cells (SCs) closely associated with different types of neurons. 8,9 The development of the glial lineage encompasses a rich sequence of molecular and cellular events in which neural crest stem cells differentiate into precursor SCs, followed by immature cells that generate non-myelinating and myelinating SCs.…”