Compreendendo o sentido de ser-com reações hansênicas: implicações para o cuidado de Enfermagem / Understanding the meaning of being with hansenic reactions: implications for nursing care / Comprender el significado de estar con reacciones hansénicas: implicaciones para el cuidado de enfermería

Objetivo: compreender o sentido de ser-com reações hansênicas. Método: Estudo alicerçado no método fenomenológico hermenêutico de Martin Heidegger, realizado a partir de 25 entrevistas individuais com pacientes em tratamento ambulatorial para reações hansênicas, em uma unidade de saúde especializada localizada no estado do Pará, Brasil. Resultados: Duas unidades temáticas foram organizadas: "Significando as reações hansênicas" e "Convivendo com as reações hansênicas". Para os participantes, viver com reações hansênicas significa dor, vergonha, desesperança, medo, incerteza e preocupações que transformam profundamente o cotidiano. O sentido de ser-com reações hansênicas se desvela quase sempre na impessoalidade, ambiguidade, curiosidade e na publicidade da vida, em que o ser-aí se vê a partir dos outros e não de si mesmo. Considerações finais: Este estudo proporciona conhecimentos importantes para o cuidado de enfermagem às pessoas que vivem com reações hansênicas, na medida em que compreender significados e sentidos é importante para impulsionar a prática de um cuidado de enfermagem sensível, empático e preocupado com o diálogo e com as necessidades do ser-aí no mundo, onde a cura se desvela nas práticas de cuidado com-o-outro e não para-o-outro. (AU)

Objective: To understand the meaning of being-with leprosy reactions. Methods: Study based on Martin Heidegger's hermeneutical phenomenological method, conducted from 25 individual interviews with patients undergoing treatment for leprosy reactions, in a specialized health unit located in the state of Pará, Brazil. Results: Two thematic units were organized: "Signifying leprosy reactions" and "Living with leprosy reactions". For the participants, living with leprosy reactions means pain, shame, hopelessness, fear, uncertainty and concerns that profoundly transform daily life. The sense of being-with leprosy reactions is almost always revealed in the impersonality, ambiguity, curiosity and publicity of life, in which the being-there is seen from other beings and not from oneself. Conclusion: This study provides important knowledge for nursing care to people living with leprosy reactions, as understanding meanings and senses is important to boost the practice of sensitive, empathic and concerned with dialogue and with nursing care. the needs of the being-there in the world, where the cure is revealed in the care practices with-the-other and not for the-other. (AU)

Objetivo: Comprender el significado de las reacciones de estar-con lepra. Métodos: Estudio basado en el método fenomenológico hermenéutico de Martin Heidegger, realizado a partir de 25 entrevistas individuales a pacientes en tratamiento ambulatorio por reacciones leprosas, en una unidad de salud especializada ubicada en el estado de Pará, Brasil. Resultados: Se organizaron dos unidades temáticas: "Significando reacciones leprosas" y "Viviendo con reacciones leprosas". Para los participantes, vivir con reacciones leprosas significa dolor, vergüenza, desesperanza, miedo, incertidumbre y preocupaciones que transforman profundamente la vida diaria. La sensación de ser-con reacciones leprosas se revela casi siempre en la impersonalidad, ambigüedad, curiosidad y publicidad de la vida, en la que el ser-allí se ve desde los demás y no desde uno mismo. Conclusion: Este estudio aporta conocimientos importantes para el cuidado de enfermería a las personas que viven con reacciones leprosas, ya que la comprensión de significados y sentidos es importante para impulsar la práctica de la sensibilidad, la empatía y la preocupación por el diálogo y el cuidado de enfermería. el mundo, donde la cura se revela en las prácticas de cuidado con el otro y no para el otro. (AU)

Women and leprosy: interferences and experiences.

OBJECTIVE: to know the interferences of leprosy in women's lives and how they reinvent themselves in coping with the disease. METHOD: a descriptive study with a qualitative approach. The theoretical-methodological framework adopts an approximation to the cartographic method and some concepts of schizoanalysis, which were used to analyze the data. The tools used to produce the data were the interview and the logbook. The interviews were conducted from July to November 2019, at the participants' homes. RESULTS: the group consisted of nine women. To display the data, we were inspired by Deleuze's ideas about difference and repetition. The results were organized in three thematic axes that address the lives of these women affected by leprosy, which accompany concerns, anxieties and worries about the effects of the disease. The transformations in the female body, the financial maintenance itself due to the comorbidities caused by leprosy and its difficulties in guaranteeing rights are elements strongly pointed out by women. CONCLUSION: there is overlap and interference of the female condition in a patriarchal society that still accompanies it. We bet on the strength of becoming-a-woman and the need to consider them in their singularities and in their context for producing care permeated by meetings of the affirmation of the power of life.

Burden of depression and anxiety among leprosy affected and associated factors-A cross sectional study from India.

BACKGROUND: Leprosy is a Neglected Tropical Diseases (NTDs) known to cause stigma and discrimination in low-and middle-income countries. It often results in visible impairments, thus pre-disposing to poor mental health. Aim of the study was to estimate the prevalence of depression and anxiety among people affected by Leprosy and to determine the associated factors. METHODOLOGY/PRINCIPAL FINDINGS: A multi-centric, cross-sectional study was carried out in four leprosy endemic states of India-Chhattisgarh, Maharashtra, West Bengal and Tamil Nadu in randomly selected blocks (a sub-unit of district), from one district in each state. From selected blocks those registered for leprosy treatment at public health or referral centres, people above the age of 18 years were interviewed with PHQ-9 and GAD-7 questionnaires for Depression and Anxiety, respectively. Disease profile like leprosy classification, deformity grade, number and site of the patches and socio-economic status were collected along with individual data. Of the total 220 respondents, prevalence of depression and anxiety symptoms was, 33% (73) and 19% (42), respectively. Presence of disability (47%) and Female gender (46%) were significantly associated with depression. Presence of disability (32%), Lower income group (27%) and low education (22%) were significantly associated with symptoms of anxiety. As the severity of disability increased, risk of developing depression and anxiety increased. CONCLUSION: The study indicates that more than 30% of people affected by leprosy have mental health problems, which emphasizes the importance of mental health care services in leprosy. Women, those who had lower level of education, those belonging to lower socio-economic status and those with any level of disability due to leprosy are at risk of developing depression and/or anxiety. The study concludes more attention to be paid to the categories identified to be at risk.

Women and leprosy: interferences and experiences / Mujeres y enfermedad de Hansen: interferencias y experiencias / Mulheres e hanseníase: interferências e vivências

Objective: to know the interferences of leprosy in women's lives and how they reinvent themselves in coping with the disease. Method: a descriptive study with a qualitative approach. The theoretical-methodological framework adopts an approximation to the cartographic method and some concepts of schizoanalysis, which were used to analyze the data. The tools used to produce the data were the interview and the logbook. The interviews were conducted from July to November 2019, at the participants' homes. Results: the group consisted of nine women. To display the data, we were inspired by Deleuze's ideas about difference and repetition. The results were organized in three thematic axes that address the lives of these women affected by leprosy, which accompany concerns, anxieties and worries about the effects of the disease. The transformations in the female body, the financial maintenance itself due to the comorbidities caused by leprosy and its difficulties in guaranteeing rights are elements strongly pointed out by women. Conclusion: there is overlap and interference of the female condition in a patriarchal society that still accompanies it. We bet on the strength of becoming-a-woman and the need to consider them in their singularities and in their context for producing care permeated by meetings of the affirmation of the power of life.

Resumo Objetivo: conocer las interferencias de la enfermedad de Hansen en la vida de las mujeres y cómo se reinventan en el afrontamiento de la enfermedad. Método: estudio de abordaje cualitativo. El marco teórico-metodológico adopta un acercamiento al método cartográfico y algunos conceptos de esquizoanálisis, que fueron utilizados para analizar los datos. Las herramientas utilizadas para producir los datos fueron la entrevista y el libro de registro. Las entrevistas se realizaron de julio a noviembre de 2019, en los domicilios de las participantes. Resultados: el grupo estuvo compuesto por nueve mujeres. Para presentar los datos, nos inspiramos en las ideas de Deleuze sobre la diferencia y la repetición. Los resultados se organizaron en tres ejes temáticos que abordan la vida de estas mujeres afectadas por la enfermedad de Hansen, que acompañan inquietudes, angustias y preocupaciones sobre los efectos de la enfermedad. Los cambios en el cuerpo femenino, la manutención económica propiamente dicha debido a las comorbilidades provocadas por la enfermedad de Hansen y sus dificultades para garantizar los derechos son elementos fuertemente señalados por las mujeres. Conclusión: hay una superposición e interferencia de la condición femenina en una sociedad patriarcal que aún la acompaña. Apostamos por la fuerza del devenir-mujer y la necesidad de considerarla en sus singularidades y en su contexto para la producción de cuidados forjados por encuentros para afirmar el poder de la vida.

Objetivo: conhecer as interferências da hanseníase na vida das mulheres e como elas se reinventam no enfrentamento da doença. Método: estudo de abordagem qualitativa. O referencial teórico-metodológico adota uma aproximação ao método cartográfico e alguns conceitos da esquizoanálise, que foram utilizados para analisar os dados. As ferramentas utilizadas para produção dos dados foram a entrevista e o diário de bordo. As entrevistas foram realizadas no período de julho a novembro de 2019, no domicílio das participantes. Resultados: o grupo foi composto por nove mulheres. Para apresentar os dados, nos inspiramos nas ideias de Deleuze relativas à diferença e repetição. Os resultados foram organizados em três eixos temáticos que abordam a vida dessas mulheres afetadas pela hanseníase, os quais acompanham inquietações, angústias e preocupações frente aos efeitos da doença. As alterações no corpo feminino, a própria manutenção financeira devido às comorbidades causadas pela hanseníase e as suas dificuldades nas garantias de direitos são elementos fortemente apontados pelas mulheres. Conclusão: há sobreposição e interferência da condição feminina em uma sociedade patriarcal que ainda a acompanha. Apostamos na força do devir-mulher e na necessidade de considerá-la em suas singularidades e em seu contexto para a produção do cuidado permeado por encontros de afirmação da potência da vida.

[The visitor : Roald Dahl on phobic anxiety of infections and delusion of hygiene]. / Der Besucher : Roald Dahl über Krankheitsfurcht und Hygienewahn.

In his both highly amusing and thrilling story Roald Dahl describes an adventure of his fictive uncle Oswald Hendryk Cornelius, a snobby Englishman and womanizer, suffering from delusional anxiety of infections and hygienic compulsions. Forced by the breakdown of his car in the Sinai desert, he accepts the invitation of a noble Arab to spend the night in his palace, situated like a mirage in the middle of the desert. Oswald is plagued by erotic obsessions at the sight of the beautiful wife as well as the likewise beautiful daughter. The night rewards him with the desired amorous adventure but without knowing with whom he had spent the night. Oswald's satisfaction changes to pure horror when, the next morning, the owner of the house reveals that the visitor during the night was neither his wife nor daughter.

Type D personality is associated with poor quality of life, social performance, and psychological impairment in patients with moderate to severe psoriasis: A cross-sectional study of 130 patients.

BACKGROUND: Psoriasis is a systemic autoinflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D personality has been related to poor quality of life and worse physical and psychological outcomes in different diseases. AIMS: The aim of this study is to explore whether type D personality is associated with an increased risk of presenting physical and/or psychological comorbidities, their relationship with the capacity of social adaptation, and health-related quality of life (HRQOL) in patients with psoriasis. METHODS: This was a cross-sectional study. In all, 130 patients with moderate to severe psoriasis were included in this study. Participants completed the DS14 test and different validated questionnaires regarding quality of life and psychological morbidities. RESULTS: Type D personality was present in 38.4% (50/130) of the participants of the study. Patients with psoriasis and type D personality presented a higher risk of depression and anxiety. We observed that type D personality was associated with a lower educational level. These patients also presented a worse HRQOL in different dimensions of the Short Form Health Survey-36 questionnaire, more sleep problems, poor social adaptation, and a higher frequency of sexual disturbances. LIMITATIONS: Due to the cross-sectional design of the study, we could not confirm causality. Selection of sample was not random. Diagnoses of physical comorbidity were collected through clinical interview of patients under active treatment, which may imply a classification bias. CONCLUSION: Type D personality could represent a frequent personality profile in patients with psoriasis that could identify subjects with poor coping abilities to the disease with poorer levels of quality of life, increased psychological comorbidities, and inadequate social adaptation mechanisms.

Antidepressants plus benzodiazepines for adults with major depression.

BACKGROUND: Anxiety frequently coexists with depression and adding benzodiazepines to antidepressant treatment is common practice to treat people with major depression. However, more evidence is needed to determine whether this combined treatment is more effective and not any more harmful than antidepressants alone. It has been suggested that benzodiazepines may lose their efficacy with long-term administration and their chronic use carries risks of dependence.This is the 2019 updated version of a Cochrane Review first published in 2001, and previously updated in 2005. This update follows a new protocol to conform with the most recent Cochrane methodology guidelines, with the inclusion of 'Summary of findings' tables and GRADE evaluations for quality of evidence. OBJECTIVES: To assess the effects of combining antidepressants with benzodiazepines compared with antidepressants alone for major depression in adults. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO to May 2019. We searched the World Health Organization (WHO) trials portal and ClinicalTrials.gov to identify any additional unpublished or ongoing studies. SELECTION CRITERIA: All randomised controlled trials that compared combined antidepressant plus benzodiazepine treatment with antidepressants alone for adults with major depression. We excluded studies administering psychosocial therapies targeted at depression and anxiety disorders concurrently. Antidepressants had to be prescribed, on average, at or above the minimum effective dose as presented by Hansen 2009 or according to the North American or European regulations. The combination therapy had to last at least four weeks. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. We entered data into Review Manager 5. We used intention-to-treat data. We combined continuous outcome variables of depressive and anxiety severity using standardised mean differences (SMD) with 95% confidence intervals (CIs). For dichotomous efficacy outcomes, we calculated the risk ratio (RR) with 95% CI. Regarding the primary outcome of acceptability, only overall dropout rates were available for all studies. MAIN RESULTS: We identified 10 studies published between 1978 to 2002 involving 731 participants. Six studies used tricyclic antidepressants (TCAs), two studies used selective serotonin reuptake inhibitors (SSRIs), one study used another heterocyclic antidepressant and one study used TCA or heterocyclic antidepressant.Combined therapy of benzodiazepines plus antidepressants was more effective than antidepressants alone for depressive severity in the early phase (four weeks) (SMD -0.25, 95% CI -0.46 to -0.03; 10 studies, 598 participants; moderate-quality evidence), but there was no difference between treatments in the acute phase (five to 12 weeks) (SMD -0.18, 95% CI -0.40 to 0.03; 7 studies, 347 participants; low-quality evidence) or in the continuous phase (more than 12 weeks) (SMD -0.21, 95% CI -0.76 to 0.35; 1 study, 50 participants; low-quality evidence). For acceptability of treatment, there was no difference in the dropouts due to any reason between combined therapy and antidepressants alone (RR 0.76, 95% CI 0.54 to 1.07; 10 studies, 731 participants; moderate-quality evidence).For response in depression, combined therapy was more effective than antidepressants alone in the early phase (RR 1.34, 95% CI 1.13 to 1.58; 10 studies, 731 participants), but there was no evidence of a difference in the acute phase (RR 1.12, 95% CI 0.93 to 1.35; 7 studies, 383 participants) or in the continuous phase (RR 0.97, 95% CI 0.73 to 1.29; 1 study, 52 participants). For remission in depression, combined therapy was more effective than antidepressants alone in the early phase (RR 1.39, 95% CI 1.03 to 1.90, 10 studies, 731 participants), but there was no evidence of a difference in the acute phase (RR 1.27, 95% CI 0.99 to 1.63; 7 studies, 383 participants) or in the continuous phase (RR 1.31, 95% CI 0.80 to 2.16; 1 study, 52 participants). There was no evidence of a difference between combined therapy and antidepressants alone for anxiety severity in the early phase (SMD -0.76, 95% CI -1.67 to 0.14; 3 studies, 129 participants) or in the acute phase (SMD -0.48, 95% CI -1.06 to 0.10; 3 studies, 129 participants). No studies measured severity of insomnia. In terms of adverse effects, the dropout rates due to adverse events were lower for combined therapy than for antidepressants alone (RR 0.54, 95% CI 0.32 to 0.90; 10 studies, 731 participants; moderate-quality evidence). However, participants in the combined therapy group reported at least one adverse effect more often than participants who received antidepressants alone (RR 1.12, 95% CI 1.01 to 1.23; 7 studies, 510 participants; moderate-quality evidence).Most domains of risk of bias in the majority of the included studies were unclear. Random sequence generation, allocation concealment, blinding and selective outcome reporting were problematic due to insufficient details reported in most of the included studies and lack of availability of the study protocols. The greatest limitation in the quality of evidence was issues with attrition. AUTHORS' CONCLUSIONS: Combined antidepressant plus benzodiazepine therapy was more effective than antidepressants alone in improving depression severity, response in depression and remission in depression in the early phase. However, these effects were not maintained in the acute or the continuous phase. Combined therapy resulted in fewer dropouts due to adverse events than antidepressants alone, but combined therapy was associated with a greater proportion of participants reporting at least one adverse effect.The moderate quality evidence of benefits of adding a benzodiazepine to an antidepressant in the early phase must be balanced judiciously against possible harms and consideration given to other alternative treatment strategies when antidepressant monotherapy may be considered inadequate. We need long-term, pragmatic randomised controlled trials to compare combination therapy against the monotherapy of antidepressant in major depression.

Nursing interventions to manage anxiety levels of female inpatients admitted first time in a leprosy hospital.

Leprosy causes not just physical disabilities but mental and psycho social problems which are further more enhanced in women due to their submissive and secondary role in an Indian culture. This is reflected in their reluctance and delay in seeking hospitalization and generates great anxiety while admitted as inpatients. Appropriate nursing care can relieve much anxiety and help in faster healing. This paper presents the findings from such research carried out at a leprosy referral hospitalin north India. Adult female leprosy patients newly admitted for the first time in a leprosy referral hospital were interviewed in depth using Hamilton Anxiety Rating Scale and observed before and after implementing a customized nursing care plan. On admission, out of 40 women admitted more than 80% showed moderate or severe anxiety. After well planned nursing interventions only 2 continued to have severe anxiety, and a majority in all age groups showed significant reductions in anxiety levels, and responded well to leprosy care at the hospital. Well planned nursing care reduces or minimizes anxiety levels of female leprosy patients admitted first time in the hospital, and should become a standard practice in all hospital admissions.

"They treated me like a leper". Stigmatization and the quality of life of patients with hepatitis C.

OBJECTIVE: Hepatitis C virus is the most prevalent chronic blood-borne infection in the United States, typically acquired through contaminated blood products or needle sharing. We hypothesized that patients with chronic hepatitis C infection experience stigmatization independent of mode of acquisition and that it negatively affects quality of life. DESIGN: Cross-sectional observation study. SETTING: Specialty clinic in a tertiary referral hospital. PATIENTS: Two hundred and ninety outpatients diagnosed with chronic hepatitis C infection and seen in a hepatology clinic. Thirty participants were excluded because of missing data. MEASUREMENTS AND MAIN RESULTS: Patients were asked to complete a demographic profile, a semistructured interview, the Sickness Impact Profile, and the Hospital Anxiety Depression Scale. A team of two blinded coders analyzed the interviews. A total of 147 of the 257 study patients experienced stigmatization that they attributed to the disease. Women were more likely to report perceived stigmatization than men (P <.05). Age, education, professional status, and mode of infection did not influence the likelihood of stigmatization. Stigmatization was associated with higher anxiety (P <.01) and depression (P <.01), worsened quality of life (P <.01), loss of control (P <.01), and difficulty coping (P <.01). Individuals who experienced stigmatization also mentioned problems in their health care (P <.01) and work environment (P <.01) as well as with family members (P <.01). CONCLUSION: Stigmatization is a very common emotionally burdensome experience for patients with hepatitis C, which can erode social support. As it penetrates even into the health care environment, physicians and other care providers should be aware of the existence and impact of such negative stereotyping.

Psychiatric morbidity in leprosy and psoriasis--a comparative study.

The psychiatric morbidity of 30 leprosy patients was compared with that of psoriasis in a clinic set-up. The prevalence of psychiatric morbidity was significantly less among leprosy patients (122/1000) than among those with psoriasis (476/1000); but the severity of the problem, as measured by General Health Questionnaire (GHQ), was significantly greater among leprosy patients (p < 0.05). There was no difference in the pattern of psychopathology diagnosis between the two groups. Depressive neurosis was the most common diagnosis in both the groups. The relevance of these findings in relation to leprosy is discussed.

'Frustration--anxiety behaviour as a function of leprosy patients age and personality'.

The paper incorporates five studies (i.e., four of frustration and one of anxiety). The design is 'Multi-group-Control-group'. Each one of the five studies has four '3 X 3 X 2' factorial experiments. Each experiment has 360 elements. These are three groups (of lepromatous, non-lepromatous and of disease-free normals). Each group consists of 120 elements (equally distributed among adolescents, adults and senescents). The particulars of the patients have been obtained from the Central JALMA Institute for Leprosy and the Kushta Seva Sadan (Agra). The disease-free normal elements are drawn freely from the population of the Agra town. The sample possesses statistical justification for size and representativeness. Data are collected with the help of reliable tools and the 'F' test is run for verification of the 'null hypotheses'. Results show that experiences of 'fixation-regression' frustration, atypically belong to normal senescence. Resignation and anxiety experiences, as growing hazards, specifically relate to leprosy patients. Personality factors that normally demote 'frustration-anxiety' behaviour exhibit 'role-negation' in the leprosy patients. Age shows 'role-reversion'. Implications of such 'role' changes relate to the 'self-eroding' process of personality in the patients.

Leprosy--a case for mental health care.

One hundred twenty institutionalized cases of leprosy were tested for anxiety and depression on standard scales before and after psychiatric treatment. The latter seems to be effective in reducing both anxiety and depression after a course of treatment of three months. This appears to be a sound justification to advocate mental health care in institutions of leprosy in conjunction with physical care. Leprosy is a chronic and disabling disease entity. With the social stigma associated to the disease the psychiatric hazards of the disease are as bad as its physical manifestations. However, usually, only the latter attract attention. Ignorance about the disease and social values about the disease can at once land a person in depression on utterance of the diagnosis. Further, anxiety about the outcome of the disease in particular and future in general are known to exist in sufferers of leprosy.

[Absenteeism during treatment for leprosy. Analysis of causes as apparent from a survey in southern India]. / L'absentéisme au cours du traitement de la lèpre. Analyse des causes révélées par une enquête en Inde du Sud.

The reasons for absenteeism during leprosy treatment were investigated in a rural area of southern India. 120 patients known as "absents" to most controls were first interviewed and the major causes for absenteeism thus determined. A questionnaire was then elaborated in view to reveal these principal causes with efficiency and was applied by 8 investigators to 1200 patients, mostly absents or irregular to medical visits. 620 were selected at random for computer analysis. Results suggest that anxiety for loss of income while attending the medical control and erroneous impression of cure as soon as skin lesions have improved could be of first importance. Nevertheless no relation appears between absenteeism and income level, number of persons depending on the patient, or type of leprosy. Adverse reactions attributed to DDS are also frequently reported, especially fever, because of confusion with leprosy reactions, malaria and any other febrile condition. Assiduity to medical visits could be determined during the year following this study in 1191 of the 1200 patients showing clear beneficial effect over this period.