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Souza RS, Moreira JAM, Dias AAL, Coelho ADCO, Amendoeira JJP, Lanza FM. Simulation-based training in Leprosy: development and validation of a scenario for community health workers. Rev Bras Enferm 2023; 76Suppl 2:e20230114. [PMID: 38088662 PMCID: PMC10704687 DOI: 10.1590/0034-7167-2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection. METHODS Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed. RESULTS A simulated scenario with a simulated participant was developed - a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components. CONCLUSIONS The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.
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Affiliation(s)
- Raíssa Silva Souza
- Universidade Federal de São João del-Rei. Divinópolis, Minas Gerais, Brazil
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de Oliveira Serra MAA, da Silva RAA, Monari FF, Silva JOE, de Sá Junior JX, Silva RDAE, Fontoura IG, Neto MS, de Araújo MFM. Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study. Trans R Soc Trop Med Hyg 2023; 117:852-858. [PMID: 37615659 DOI: 10.1093/trstmh/trad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. METHODS Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. RESULTS Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. CONCLUSIONS Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.
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Affiliation(s)
| | | | - Flavia Ferreira Monari
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
- Faculdade de Imperatriz (FACIMP-Wyden), Imperatriz, Maranhão 65.910.140, Brazil
| | | | | | | | | | - Marcelino Santos Neto
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
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Bueno IDC, Lages DDS, Lana FCF. Spatial analysis of the epidemiological risk of leprosy in the municipalities of Minas Gerais. PLoS Negl Trop Dis 2023; 17:e0011381. [PMID: 37276221 DOI: 10.1371/journal.pntd.0011381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Leprosy remains a significant public health problem of high importance. This investigation aims to analyze the spatial distribution of the leprosy epidemiological risk in the municipalities of Minas Gerais. METHODS This ecological study was conducted with new leprosy cases diagnosed from 2004 to 2019 in the municipalities of the state of Minas Gerais. Based on the epidemiological indicators, a composite indicator called the leprosy epidemiological risk index was estimated, classifying municipalities as high, medium, low and very low risk. For the spatial analysis, the global and local spatial autocorrelation statistics were used to identify the spatial distribution of the leprosy epidemiological risk in the periods 2004-2011 and 2012-2019 and classified as High/High, Low/Low, High/Low and Low /High. RESULTS Although leprosy is declining in the state of Minas Gerais, the Global Moran Index confirmed the spatial dependence between municipalities for the two analyzed periods, characterizing the formation of clusters. When performing the local spatial autocorrelation, it was found that the macroregions with the highest number of municipalities with high indices, surrounded by other municipalities with high indices (high-high), were Northwest, East, South East, North, and Northeast. The low risk macroregions were Southeast, Center, South-Center and South. CONCLUSION Leprosy has a heterogeneous spatial pattern and remains concentrated in historically endemic areas of the state. It underscores the importance of intensifying actions to combat leprosy in these municipalities and macroregions. Promote improved access to health services and combat stigma and prejudice to eliminate leprosy as a public health problem.
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Affiliation(s)
- Isabela de Caux Bueno
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Daniele Dos Santos Lages
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco Carlos Felix Lana
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Minas Gerais, Brazil
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Matos DP, Torres MD, da Silva LSR, Dos Santos CAAS, de Oliveira FJF, de Araújo MFM, de Oliveira Serra MAA. Hansenapp: development of a mobile application to assist primary healthcare providers to control leprosy. Trop Med Int Health 2022; 27:719-726. [PMID: 35761478 DOI: 10.1111/tmi.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the development and validation of a mobile application to assist health professionals in the management of patients with leprosy and surveillance of contacts in primary healthcare. METHOD A methodological and developmental study was conducted in three phases: integrative literature review, mobile application development, and application validation by health professionals. The construction of the application was supported by the literature review, Nielsen's heuristics, and expert validation. Five experts individually analyzed the prototype draft and performed two rounds of iterations to refine their recommendations. The validation step was performed by consulting health professionals working in primary healthcare, who evaluated the application for relevance, clarity and usability using a questionnaire based on task-technology fit theory. RESULTS The mobile app's content, navigation methods, and interaction were refined based on the discussions with experts. Their recommendations were applied, and the mobile app was revised until the final version was approved. Content validity indexes of 0.94 (p = 0.007), 0.99 (p > 0.0001), and 0.93 (p = 0.01) were obtained. CONCLUSION The developed application is a technological tool that could assist primary healthcare providers in dealing with leprosy patients and their contacts in terms of management, planning, monitoring, evaluation, treatment, and follow-up, in addition to leprosy control actions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Mateus Dantas Torres
- Federal University of Maranhão, Brazil.,Federal University of Maranhão Postgraduate Program in Health and Technology, Brazil
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Corrêa CM, Lanza FM, Carvalho APM, Lana FCF. Diálogos sobre a descentralização do programa de controle da hanseníase em município endêmico: uma avaliação participativa. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo avaliar a descentralização do Programa de Controle da Hanseníase (PCH) em Governador Valadares. Método o referencial teórico-metodológico foi a Avaliação de Quarta Geração, de abordagem qualitativo-participativa. O estudo envolveu 30 sujeitos divididos em quatro grupos: gestores do PCH; profissionais do Centro de Referência (CR); profissionais da atenção básica e usuários. Os dados foram coletados por entrevistas, utilizando-se a técnica do Círculo Hermenêutico-Dialético. Posteriormente, realizaram-se três oficinas de validação e negociação dos dados. Utilizou-se o Método Comparativo Constante para a análise. Resultados evidenciou-se a manutenção do modelo vertical de atenção à hanseníase, sustentado por determinantes sócio-histórico-culturais que se expressam: na permanência da porta de entrada à demanda espontânea no CR; no encaminhamento rotineiro do usuário para a atenção secundária; na ineficiência da contrarreferência; na centralização da poliquimioterapia; na crença na necessidade do atendimento especializado e no estigma. Evidenciaram-se fragilidades no vínculo com a atenção primária. Conclusão a descentralização do PCH envolve a tensão entre os atores de cada ponto de atenção à saúde, gerando disputas de saberes e práticas de saúde. Implicações para a prática a sustentabilidade da descentralização requer envolvimento político e institucional focado no fortalecimento da atenção primária, na reorientação do papel dos serviços na rede de atenção à hanseníase e na educação em saúde.
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Lopes FDC, Ramos ACV, Pascoal LM, Santos FS, Rolim ILTP, Serra MAADO, Santos LHD, Santos Neto M. Leprosy in the context of the Family Health Strategy in an endemic scenario in Maranhão: prevalence and associated factors. CIENCIA & SAUDE COLETIVA 2021; 26:1805-1816. [PMID: 34076121 DOI: 10.1590/1413-81232021265.04032021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/20/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.
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Affiliation(s)
- Fernanda de Castro Lopes
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | | | - Lívia Maia Pascoal
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil. .,Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão. Imperatriz MA Brasil
| | - Floriacy Stabnow Santos
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão. Imperatriz MA Brasil
| | | | | | | | - Marcelino Santos Neto
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil. .,Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão. Imperatriz MA Brasil
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