| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 91.63 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Introdução: A Onicomicose (OM) é uma infeção fúngica das unhas. A prevalência estimada no mundo varia de 0,5-26%, com uma tendência crescente. É um fator de risco, promotor das úlceras do pé e celulite bacteriana aguda, em particular nas pessoas com diabetes. Provoca alterações na qualidade de vida (QV) desencadeando problemas físicos, mentais, sociais e compromisso no autocuidado e atividades de vida diária (AVD). As anomalias morfológicas nas unhas, os traumatismos ungueais, o calçado desadequado, a utilização frequente de balneários públicos e as reduzidas condições de higiene promovem o seu aparecimento. Os casos de maior gravidade ocorrem em pessoas com doenças crónicas e/ou estados de imunossupressão. A OM apresenta resistência aos tratamentos e recidivas frequentes. Objetivos: Pretende-se descrever a prevalência da OM na amostra em estudo; avaliar a QV através da tradução para a população portuguesa do questionário (OnyCOE-t TM); caraterizar o estilo de autocuidado e gestão do regime terapêutico (GRT) e testar a atividade fungicida dos antisséticos em espécies clínicas e American Type Culture Collection (ATCC). Metodologia: Foram realizados quatro estudos com materiais e métodos diferentes. Um estudo transversal para avaliar a prevalência da OM. Um estudo em subamostra para traduzir e adaptar o questionário (OnyCOE-t TM). Um estudo em subamostra para identificar estilos de GRT e as caraterísticas associadas. Um estudo in vitro para testar atividade fungicida dos antisséticos, nos fungos identificados no estudo de prevalência. Como critérios de inclusão, consideraram-se os indivíduos com idade superior a 18 anos, com suspeita clínica de OM. Excluíram-se os doentes que utilizaram antifúngicos nos últimos três meses e que tinham alterações cognitivas. Foi solicitado parecer à comissão de ética e o consentimento livre e esclarecido aos participantes, tendo sido informados sobre a sua participação neste estudo. Resultados: Verificou-se uma taxa de prevalência de OM de 53,3% através de confirmação laboratorial. O fungo mais prevalente foi o T. rubrum (38,6%). Os participantes apresentaram dificuldades no autocuidado dos pés (74,4%), desconforto (66,0%), espessamento ungueal (90,0%), vergonha e constrangimento devido a esta situação (37,8%). A maioria (54,4%) apresentava OM há mais de 5 anos. No processo de tradução do questionário (OnyCOE-t TM) obteve-se boa consistência interna (Alfa de Cronbach >0,725). Verificou-se que 12,5% apresentavam um estilo de autocuidado predominantemente responsável, com caraterísticas de controlo e flexibilidade e afastamento do estilo negligente. A dificuldade no autocuidado não estava associada ao estilo de GRT (p=0,493). O estudo in vitro demonstrou que as soluções antisséticas de PVP-I e OCT-D foram as mais eficazes contra as espécies clínicas T. rubrum, T. interdigitale e C. parapsilosis, com redução de 99,99% (log> 4). Discussão/Conclusão: Com o presente estudo contribuiu-se para uma melhor descrição da epidemiologia da OM. Os resultados da tradução do questionário OnyCOE-t TM sugerem que esta é uma ferramenta útil e fiável para a realização de estudos de QV nestes doentes, na população portuguesa. O elevado número de indeterminados revelou um aglomerado de caraterísticas comuns a todos os estilos de GRT. Os antisséticos PVP-I e OCT-D evidenciaram potencialidades in vitro para a utilização na OM. Deverão ser realizados estudos experimentais, tendo em consideração o conhecimento da prática clínica dos enfermeiros na utilização dos antisséticos, perspetivando a melhoria da QV e promoção do autocuidado das pessoas com OM.
Introduction: Onychomycosis (OM) is a fungal nail infection with an estimated prevalence between 0.5-26% in the world and with an increasing trend. OM is a risk factor for foot ulcers and acute bacterial cellulitis, particularly in diabetics. OM is associated with changes in quality of life (QOL), triggering physical, mental, social problems, and compromising activities of daily living. OM onset is facilitated by morphological anomalies in the nails, nail trauma, inadequate footwear, frequent use of public spas and poor hygiene conditions. The most severe cases tend to occur in people with chronic diseases and / or immunosuppression states. OM is often resistant to current treatments. Objectives: Describe the prevalence of OM in a clinical sample. Evaluate QOL and translate the questionnaire (OnyCOE-t TM) to be used with the Portuguese population. Characterize the style of therapeutic management regime (TMR). Test the in vitro fungicidal activity of antiseptics in clinical species and American Type Culture Collection (ATCC). Methodology: Four studies were carried out with different materials and methods. A cross-sectional study was conducted to assess the prevalence of OM. A subsample of the prevalence study was used to translate and adapt the questionnaire (OnyCOE-t TM). A subsample of the prevalence study was used to identify Therapeutic Management Regimen (TRM) styles and associated features. Lastly, an in vitro study of fungicidal activity of antiseptics, was performed on the clinical fungi identified in the prevalence study. Inclusion criteria were: individuals over 18 years old with clinical suspicion of OM. Exclusion criteria were: Patients who used antifungals in the last three months, patients with cognitive impairments. The present study was approved by the ethics committee and all patients gave free and informed consent to participate. Results: The prevalence of OM was of 53.3% confirmed through laboratory testing. The most prevalent fungus was T. rubrum (38.6%). Participants reported difficulties in feet self-care (74.4%), discomfort (66%), nail thickening (90.0%), as well as shame and embarrassment due to OM (37.8%). The majority of the sample (54.4%) had had OM for more than 5 years. The translation of the OnyCOE-t TM questionnaire revealed good internal consistency (Cronbach's alpha> 0.725). Analysis of therapeutic regimen management (TRM) style showed that 12.5% of the sample had a predominantly responsible style, with characteristics of control and flexibility and remoteness from the negligent style. Difficulty in self-care was not associated with the TRM style (p = 0.493). The in vitro study demonstrated that the antiseptic solutions of Povidone iodine (PVP-I) and Octenidine (OCT-D) were the most effective against the clinical species T. rubrum, T. interdigitale, and C. parapsilosis, with a reduction of 99.99% (log> 4). Discussion/Conclusion: The present study contributed to a better description of the epidemiology of OM. The translation of the OnyCOE-t TM questionnaire suggests that this is a useful and reliable tool for carrying out QOL studies in the Portuguese population. A cluster of common characteristics was found for all TMR. The antiseptics PVP-I and OCT-D demonstrated potential in vitro for use in OM. Experimental studies should be carried out, considering nurses' knowledge of the clinical practice of using antiseptics, in order to improve QOL and promote self-care for people with OM.
Introduction: Onychomycosis (OM) is a fungal nail infection with an estimated prevalence between 0.5-26% in the world and with an increasing trend. OM is a risk factor for foot ulcers and acute bacterial cellulitis, particularly in diabetics. OM is associated with changes in quality of life (QOL), triggering physical, mental, social problems, and compromising activities of daily living. OM onset is facilitated by morphological anomalies in the nails, nail trauma, inadequate footwear, frequent use of public spas and poor hygiene conditions. The most severe cases tend to occur in people with chronic diseases and / or immunosuppression states. OM is often resistant to current treatments. Objectives: Describe the prevalence of OM in a clinical sample. Evaluate QOL and translate the questionnaire (OnyCOE-t TM) to be used with the Portuguese population. Characterize the style of therapeutic management regime (TMR). Test the in vitro fungicidal activity of antiseptics in clinical species and American Type Culture Collection (ATCC). Methodology: Four studies were carried out with different materials and methods. A cross-sectional study was conducted to assess the prevalence of OM. A subsample of the prevalence study was used to translate and adapt the questionnaire (OnyCOE-t TM). A subsample of the prevalence study was used to identify Therapeutic Management Regimen (TRM) styles and associated features. Lastly, an in vitro study of fungicidal activity of antiseptics, was performed on the clinical fungi identified in the prevalence study. Inclusion criteria were: individuals over 18 years old with clinical suspicion of OM. Exclusion criteria were: Patients who used antifungals in the last three months, patients with cognitive impairments. The present study was approved by the ethics committee and all patients gave free and informed consent to participate. Results: The prevalence of OM was of 53.3% confirmed through laboratory testing. The most prevalent fungus was T. rubrum (38.6%). Participants reported difficulties in feet self-care (74.4%), discomfort (66%), nail thickening (90.0%), as well as shame and embarrassment due to OM (37.8%). The majority of the sample (54.4%) had had OM for more than 5 years. The translation of the OnyCOE-t TM questionnaire revealed good internal consistency (Cronbach's alpha> 0.725). Analysis of therapeutic regimen management (TRM) style showed that 12.5% of the sample had a predominantly responsible style, with characteristics of control and flexibility and remoteness from the negligent style. Difficulty in self-care was not associated with the TRM style (p = 0.493). The in vitro study demonstrated that the antiseptic solutions of Povidone iodine (PVP-I) and Octenidine (OCT-D) were the most effective against the clinical species T. rubrum, T. interdigitale, and C. parapsilosis, with a reduction of 99.99% (log> 4). Discussion/Conclusion: The present study contributed to a better description of the epidemiology of OM. The translation of the OnyCOE-t TM questionnaire suggests that this is a useful and reliable tool for carrying out QOL studies in the Portuguese population. A cluster of common characteristics was found for all TMR. The antiseptics PVP-I and OCT-D demonstrated potential in vitro for use in OM. Experimental studies should be carried out, considering nurses' knowledge of the clinical practice of using antiseptics, in order to improve QOL and promote self-care for people with OM.
Description
Keywords
Antisséticos Autocuidado Onicomicose Qualidade de vida Regime terapêutico Antiseptics Self-care Onychomycosis Quality of life Therapeutic regime