RESUMO
Introdução: A estratégia de saúde da família é vista como um modelo de reorientação da assistência, entretanto há pouca discussão abordando as pessoas com deficiências no território. Objetivo: Caracterizar o perfil de usuários com deficiências físicas e sensoriais numa unidade de saúde da família no município do Rio de Janeiro. Métodos: Dados sociodemográficos e nível de independência funcional (índice de Barthel) foram coletados respectivamente, por meio de prontuário eletrônico e entrevista domiciliar com posterior estatística descritiva e inferencial (correlação de Spearman, P<.05) entre as variáveis índice de Barthel e idade, gênero, presença do cuidador e escolaridade. Resultados: Setenta e seis pessoas com deficiências foram avaliadas e o perfil da amostra caracterizou-se por: gênero feminino (53,9%), casados (39,5%), idosos (67,1%), brancos (42,1%), aposentados (53,9%), sem trabalho de carteira assinada (94,7%), morando com cuidador (73,7%) e baixa escolaridade declarada (48,7%). O fator causal de deficiências físicas e sensoriais mais prevalente foi o acidente vascular cerebral, correspondendo a 23,8%, seguido da condição de idoso frágil (15,9%) e deficiências visuais (11,8%). O coeficiente de Spearman mostrou apenas fraca correlação positiva entre as variáveis: presença do cuidador e índice de Barthel (r=0.4452; P=0,0001). Conclusão: Há provável associação entre as deficiências e o acidente vascular cerebral com destacada prevalência entre as mulheres idosas, desempregadas, baixa escolaridade e dependente de cuidadores, além de fraca correlação entre a presença do cuidador e melhores atividades de vida diária. Políticas de prevenção de doenças cardiovasculares e melhoria do acesso ao usuário deficiente nas unidades básicas de saúde devem ser enfatizadas.(AU)
Introduction: A program centered on Family health has become a model for care from Brazilian people, moreover there are few discussions involving disability persons on territory. Objective: To characterize persons with physical and/or sensorial disabilities registered in roll of a primary health care unit in the city of Rio de Janeiro. Methods: Sociodemographic data and functional independence level (Barthel Index) were collected through electronic medical records and home interviews with subsequent descriptive and inferential statistical analysis (Spearman correlation test; p <.05) between Barthel and gender, age, caregivers and education level. Results: Seventy-six people with disabilities were evaluated and the most prevalent profile found in the sample was female (53.9%), married status (39.5%), elderly (67.1%), Caucasians (42.1%), retired (53.9%) without informal work (94.7%) with caregiver (73.7%) and with low education degree (48.7%). The most prevalent cause of disabilities found was stroke (23.8%) followed by the elderly frail condition (15.9%) and visually impaired (11.8%). The Spearman correlation only was statistically significant (r=0.4452;P=0.0001) between Barthel index and caregivers. Conclusion: The main cause of physical and/or sensory disabilities found was the stroke. The prevalent profile observed was older women, without formal labor with low education degree and dependent from caregivers. Policies to prevent cardiovascular diseases and improve access to disabled users should be emphasized.(AU)
RESUMO
BACKGROUND: Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS). METHODS: In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p<0.05. FINDINGS: Dynamometry performance of the patients' most affected hand (MAH), was worse than that of the less affected hand (LAH) and of healthy controls participants (p = 0.031), confirming handgrip impairment. Motor threshold (MT) of the FDS muscle was higher in both hemispheres in patients as compared to controls, and lower in the hemisphere contralateral to the MAH when compared to that of the LAH. Moreover, motor evoked potential (MEP) amplitudes collected in the FDS of the MAH were higher in comparison to those of controls. Strikingly, MEPs in the intrinsic hand muscle FDI had lower amplitudes in the hemisphere contralateral to MAH as compared to those of the LAH and the control group. Taken together, these results are suggestive of a more robust representation of an extrinsic hand flexor and impaired intrinsic hand muscle function in the hemisphere contralateral to the MAH due to leprosy. CONCLUSION: Decreased sensory-motor function induced by leprosy affects handgrip muscle representation in M1.
