Dificuldades no enfrentamento da hanseníase no tratamento e pós-alta / Difficulties coping with leprosy during treatment and post-discharge

Objetivo: Identificar as principais dificuldades durante o tratamento e pós-alta de pacientes com hanseníase atendidos na Atenção Secundária em Teresina-Piauí e seu perfil epidemiológico. Métodos: Trata-se de um estudo transversal, quantitativo, que identificou necessidades e levantou dados de pacientes em tratamento de hanseníase em um serviço de referência localizado em Teresina-Piauí. Resultados: Na amostra, observou-se predomínio de pacientes do sexo masculino (58,5%), casados ou em união estável (54,7%), com ensino fundamental completo (62,3%), renda de 1 a 2 salários mínimos (66,0%) e residentes em Teresina-Piauí (90,6%). A idade média dos pacientes foi 53 anos. 9,4% abandonaram o tratamento. No pós-alta, 90,6% dos pacientes apresentaram algum tipo de sequela. Notou-se que a ausência de conhecimento sobre a hanseníase retardou o acesso ao sistema de saúde. Verificou-se associação significativa entre a variável presença de sequela e alteração de sensibilidade (p=0,014). Os relatos de preconceito foram mais frequentes durante o tratamento (41,5%), em relação ao pós-alta (15,1%). Conclusão: A hanseníase ainda é uma doença negligenciada, estigmatizada e de difícil diagnóstico, sendo necessário maiores investimentos em políticas públicas para a difusão de conhecimentos sobre a doença. Descritores: Hanseníase; Terapêutica; Perfil de Saúde; Conhecimento; Estigma Social.

Objective: To identify the main difficulties and the epidemiological profile during treatment and post-discharge in patients with leprosy treated at the Secondary Care level in Teresina-Piauí.Methods: This is a cross-sectional and quantitative study that identified needs and surveyed data from patients undergoing leprosy treatment in a reference service located in Teresina-Piauí.Results: In the sample, there was predominance of male patients (58.5%), married or in a stable union (54.7%), with complete Elementary School (62.3%), incomes of 1 to 2 minimum wages (66.0%) and residents of Teresina-Piauí (90.6%). The mean age of the patients was 53years old. 9.4% abandoned the treatment. 90.6% of the patients presented some type of sequelae post-discharge. It was noticed that lack of knowledge about leprosy delayed access to the health system. A significant association was verified between the "presence of sequelae" variable and change in sensitivity (p = 0.014). The reports about prejudice were more frequent during the treatment (41.5%) than in the post-discharge period(15.1%). Conclusion: Leprosy is still a neglected, stigmatized and difficult to diagnose disease, with a need for greater investments in public policies to disseminate knowledge about the disease. Descriptors: Leprosy; Therapy; Health Profile; Knowledge; Social Stigma.

Path model on decision-making ability of clinical nurses.

AIMS AND OBJECTIVES: To identify and examine the relationship between the factors influencing the decision-making ability of clinical nurses in hospitals, South Korea, and to establish a model, to verify the fit and the effect. BACKGROUND: Clinical nurses are exposed to environments and situations where they make continuous decisions according to the need of direct treatment and nursing. DESIGN: This study used a cross-sectional descriptive design, relation prediction modelling and adheres to the STROBE guidelines. METHODS: The model construction was based on the information processing theory by Hansen and Thomas (Nursing Research, 17, 436, 1968). The model consists of 5 exogenous variables (expertise, critical thinking disposition, knowledge-sharing behaviour, nursing work environment, and decision-making stress) and 3 endogenous variables (analytic-systematic decision-making type, intuitive-interpretive decision-making type and decision-making ability). Participants were 274 clinical nurses, who were working at two hospitals in Seoul, South Korea. The data was analysed using SPSS WIN 18.0 and AMOS 20.0 program. Path analysis to verify the hypothetical model was used, and the fit was evaluated by χ2 /df, GFI, AGFI, NFI, CFI and RMSEA. Data were collected from March to May 2017. RESULTS: The fit index of the modified path model was χ2 /df = 2.25, GFI = .972, AGFI = .929, NFI = .967, CFI = .981 and RMSEA = .068. The analytic-systematic decision-making type had the greatest direct effect on the clinical nurses' decision-making ability, which is the final outcome variable, followed by significant direct and indirect effects on critical thinking disposition. CONCLUSION: This study suggests that the clinical nurses' decision-making ability in hospitals were leadingly influenced by analytic-systematic decision-making type and critical thinking disposition. RELEVANCE TO CLINICAL PRACTICE: In the nursing practice, nurses need to pay attention the analytic-systematic decision-making type and critical thinking disposition for improving decision-making ability of clinical nurses in hospitals.

Conhecimento de adolescentes sobre hanseníase após intervenção educativa / Adolescents' knowledge about leprosy after an educational intervention / El conocimiento de los adolescentes sobre la lepra después de una intervención educative

Objetivo: Avaliar o efeito de uma intervenção educativa no conhecimento de adolescentes sobre a hanseníase. Métodos: Trata-se de um estudo quase-experimental, com um componente avaliativo do conhecimento de adolescentes, antes e após a aplicação de uma oficina educativa sobre hanseníase com 53 adolescentes de 10 a 14 anos. Resultados: Observou-se aumento no percentual do conhecimento ótimo imediatamente após a intervenção (p<0,01), mantendo-se no pós-teste tardio (p=0,24). A média da quantidade de acertos foi estatisticamente diferente entre o pré e pós-teste imediato (p<0,01) e foi estatisticamente igual entre o pós-teste imediato e tardio (p=0,99). Verificou-se aumento no número de acertos em todos os itens do instrumento após a intervenção (p<0,01). Conclusão: Conclui-se que houve melhora no conhecimento dos adolescentes entre o pré e o pós-teste imediato. Ainda, o conhecimento manteve-se estatisticamente similar entre o pós-teste imediato e tardio, sugerindo um efeito positivo da intervenção tanto imediatamente, quanto tardiamente (AU).

Objective: To evaluate the effect of an educational intervention on the knowledge of adolescents about leprosy. Methods: This is a quasi-experimental study, with an evaluative component of the knowledge of adolescents, before and after the application of an educational workshop on leprosy with 53 adolescents aged 10 to 14 years. Results: There was an increase in the percentage of optimal knowledge immediately after the intervention (p<0.01), remaining in the late post-test (p=0.24). The mean number of correct answers was statistically different between the immediate pre- and post-test (p<0.01) and was statistically equal between the immediate and late post-test (p=0.99). There was an increase in the number of correct answers in all items of the instrument after the intervention (p<0.01). Conclusion: It is concluded that there was an improvement in the adolescents' knowledge between the pre- and post-test immediately. Furthermore, knowledge remained statistically similar between the immediate and late post-test, suggesting a positive effect of the intervention both immediately and later (AU).

Objetivo: Evaluar el efecto de una intervención educativa sobre el conocimiento de los adolescentes sobre la lepra. Métodos: Se trata de un estudio cuasi-experimental, con un componente evaluativo del conocimiento de los adolescentes, antes y después de la aplicación de un taller educativo sobre lepra con 53 adolescentes de 10 a 14 años. Resultados: Hubo un aumento en el porcentaje de conocimiento óptimo inmediatamente después de la intervención (p <0.01), permaneciendo en el post-test tardío (p = 0.24). La media del número de respuestas correctas fue estadísticamente diferente entre la prueba previa y posterior inmediata (p <0.01) y fue estadísticamente igual entre la prueba posterior inmediata y tardía (p = 0.99). Hubo un aumento en el número de respuestas correctas en todos los ítems del instrumento luego de la intervención (p <0.01). Conclusión: Se concluye que hubo una mejora en el conocimiento de los adolescentes entre el pre y post test de forma inmediata. Además, el conocimiento se mantuvo estadísticamente similar entre la prueba posterior inmediata y tardía, lo que sugiere un efecto positivo de la intervención tanto inmediatamente como más tarde (AU).

Knowledge and attitude about disabilities in leprosy: Effects of an intervention grounded on the Meaningful Learning Theory / Conocimiento y actitud en relación a las incapacidades en casos de lepra: efectos de una intervención basada en la Teoría del Aprendizaje Significativo / Conhecimento e atitude sobre incapacidades na hanseníase: efeitos de intervenção fundamentada na Teoria da Aprendizagem Significativa

Abstract Objective: To analyze the effects of an educational intervention in the light of the Meaningful Learning Theory on the knowledge and attitude of Primary Health Care physicians and nurses in the assessment of the degree of physical disability in leprosy. Method: An intervention study of the before-and-after type, conducted with 122 professionals (84 nurses and 38 physicians) from the Primary Health Care of João Pessoa, Paraíba, in a training course on the assessment of the degree of physical disability in leprosy. The data were collected with the research's own instrument validated and analyzed by the chi-square adherence and proportion test, with a 5% significance level. Results: There was an increase in the scores of all items of the instrument, with a statistically significant difference (p < 0.05) in 20 of the 32 items, with emphasis on those related to the professional's technical ability to conduct the stages of anamnesis, palpation of peripheral nerves, sensory and motor evaluation. It is also noteworthy that, after the intervention, 5 items obtained 100% of correct answers. Conclusion: The educational intervention grounded on the Meaningful Learning Theory improved the health professionals' knowledge and attitude in the assessment of the degree of physical disability in people with leprosy.

RESUMEN Objetivo: Analizar los efectos de una intervención educativa a la luz de la Teoría del Aprendizaje Significativo sobre el conocimiento y la actitud de los médicos y enfermeros de la Atención Primaria de la Salud en la evaluación del grado de discapacidad física en casos de lepra. Método: Estudio de intervención antes y después, realizado con 122 profesionales, 84 enfermeras y 38 médicos, de Atención Primaria de la Salud en João Pessoa, Paraíba, en un curso de capacitación sobre la evaluación del grado de discapacidad física en lepra. Los datos se recolectaron mediante un instrumento validado y se analizaron mediante la prueba de chi-cuadrado de adherencia y proporción, con nivel de significancia del 5%. Resultados: Hubo un aumento en las puntuaciones de todos los ítems del instrumento, con diferencia estadísticamente significativa (p < 0.05) en 20 de los 32 ítems, con énfasis en los ítems referentes a la capacidad técnica del profesional para realizar los pasos de la anamnesis, palpación de los nervios periféricos, evaluación sensorial y motora. Además, es de destacar que luego de la intervención, 5 ítems obtuvieron respuestas 100% correctas. Conclusión: La intervención educativa basada en la Teoría del Aprendizaje Significativo mejoró el conocimiento y la actitud de los profesionales de la salud en la evaluación del grado de discapacidad física de las personas con lepra.

RESUMO Objetivo: Analisar os efeitos de uma intervenção educativa à luz da Teoria da Aprendizagem Significativa sobre o conhecimento e a atitude de médicos e enfermeiros da atenção básica de saúde na avaliação do grau de incapacidade física na hanseníase. Método: Estudo de intervenção do tipo antes e depois, realizado com 122 profissionais, sendo 84 enfermeiros e 38 médicos, da Atenção Básica de Saúde de João Pessoa, Paraíba, em curso de capacitação sobre avaliação do grau de incapacidade física na hanseníase. Os dados foram coletados com instrumento próprio validado e analisados pelo teste qui-quadrado aderência e de proporção, com nível de significância de 5%. Resultados: Houve aumento dos escores de todos os itens do instrumento, com diferença estatisticamente significativa (p < 0,05) em 20 dos 32 itens, com destaque para os itens referentes à capacidade técnica do profissional para conduzir as etapas de anamnese, palpação dos nervos periféricos, avaliação sensitiva e motora. Destaca-se também que após a intervenção 5 itens obtiveram 100% de acertos. Conclusão: Intervenção educativa pautada na Teoria da Aprendizagem Significativa aperfeiçoou o conhecimento e a atitude dos profissionais de saúde na avaliação do grau de incapacidade física de pessoas com hanseníase.

Nursing care for the Amazon population: knowledge production and human resource development.

OBJECTIVES: to analyze knowledge production adherence from a master's course in nursing in the Amazon to care and health demands in the region, with an emphasis on neglected tropical diseases and traditional populations in the Amazon. METHODS: a descriptive study, with a quantitative approach and documentary basis, analyzing dissertations defended in a Graduate Program in Nursing at the Universidade do Estado do Pará in association with the Universidade Federal do Amazonas, from 2012-2019. A descriptive statistical analysis was performed. RESULTS: of the 105 dissertations analyzed, 30 (28.6%) were related to neglected tropical diseases. Of these, 11 (10.5%) dealt with Chagas disease, leishmaniasis, tuberculosis, malaria, and leprosy. Traditional populations in the Amazon participated in only 11 (10.5%) studies. CONCLUSIONS: knowledge production in a master's course has adherence to care and health demands in the region; however, it needs to enhance its production to strengthen its identity.

Improving treatment outcomes for leprosy in Pernambuco, Brazil: a qualitative study exploring the experiences and perceptions of retreatment patients and their carers.

BACKGROUND: Brazil has a high leprosy burden and poor treatment outcomes (TOs), manifesting in high relapse rates. Pernambuco, an impoverished Brazilian state suffering notable geographical health inequalities, has 'hyperendemic' leprosy. Although current literature identifies barriers and facilitators influencing leprosy treatment compliance, inadequate investigation exists on other factors influencing TOs, including carers' roles and psycho-dermatological impact. This qualitative study explores experiences and perceptions of leprosy patients and their carers in Pernambuco, Brazil; to identify location-specific factors influencing TOs, and consequently inform future management. METHODS: 27, semi-structured, in-depth interviews were conducted with 14 patients and 13 carers. Participants were recruited using maximum variation and snowball sampling from three clinics in Petrolina, Pernambuco. Transcripts and field notes from both participant groups were separately analysed using conventional thematic and deviant case analysis. The University of Birmingham Internal Research Ethics Committee and Instituto Lauro de Souza Lima provided ethical approval. RESULTS: Two homologous sets of four, primary, interdependent themes influencing leprosy TOs emerged: 'personal factors'; 'external factors'; 'clinical factors'; and 'the healthcare professional (HCP)-patient-carer relationship'. Poor participant knowledge and lack of symptomatic relief caused patients to distrust treatment. However, because participants thought HCP-led interventions were vital for optimal TOs, patients were effectively persuaded to adhere to pharmaceutical treatments. High standard patient and population education facilitated treatment engagement by encouraging evidence-based medicine belief, and dispelling health myths and stigma. Healthcare, on occasions, was perceived as disorganised, particularly in resource-scarce rural areas, and for those with mental health needs. Participants additionally experienced incorrect/delayed diagnoses and poor contact tracing. Leprosy's negative socio-economic impact on employment - together with stigma, dependency and changing relationships - caused altered senses of identity, negatively impacting TOs. Better dialogue between patients, HCPs and carers facilitated individualised patient support. CONCLUSION: This study highlights the importance of: effective evidence-based leprosy education; communication between HCPs, patients and carers; state-funded support; and healthcare resource distribution. These findings, if prioritised on governmental scales, provide the valuable insight needed to inform location-specific management strategies, and consequently improve TOs. Future research should evaluate the effectiveness of these implementations. Failure to address these findings will hinder regional elimination efforts.

Baixo conhecimento de doadores de sangue sobre a hanseníase como fator de vulnerabilidade para a disseminação da doença / Low knowledge of blood donors about leprosy as a vulnerability factor for the spread of the disease

Objetivo: caracterizar o doador de sangue e seu conhecimento sobre a hanseníase, visando contribuir para identificar pontos de vulnerabilidade sobre a doença. Metodologia: foram entrevistados doadores de sangue (n=199) através de um questionário estruturado abordando características socioeconômicas e o conhecimento sobre a hanseníase. Para a análise dos dados foi utilizado o método de Goodman e considerado significativo p<0,05. Resultados: dentre as perguntas sobre a hanseníase, a maioria dos participantes (65,83%) não tinha conhecimento da doença e nem o seu modo de transmissão (75,88%) e quando computado o conhecimento da Hanseníase, 1,51% conheciam, 39,70% conheciam pouco e 58,79% não conheciam a doença. Nossos resultados demonstraram que somente a escolaridade teve associação significativa com a falta de conhecimento sobre a hanseníase (p=0,0273). Conclusão: verificou-se déficit de conhecimento da população geral quanto à hanseníase. Sugerimos um aprimoramento da divulgação das informações quanto à doença a fim de promover melhoras nos serviços de saúde, acompanhamento dos doentes e prevenção da população saudável.

Objective: to characterize the blood donor and his knowledge about leprosy, aiming to contribute to identify vulnerability points about the disease. Methodology: blood donors (n=199) were interviewed through a structured questionnaire addressing socioeconomic characteristics and knowledge about leprosy. For the data analysis, the Goodman method was used and considered significant p<0.05. Results: Among the questions about leprosy, most participants (65.83%) did not know about the disease and its mode of transmission (75.88%) and when computing the knowledge of leprosy, 1.51% knew, 39,70% knew little and 58.79% did not know the disease. Our results showed that only schooling had a significant association with the lack of knowledge about leprosy (p=0,0273). Conclusion: there was a lack of knowledge of the general population regarding leprosy. We suggest an improved dissemination of information about the disease to promote improvements in health services, patient monitoring and prevention of the healthy population.

Validação de instrumento para avaliação do conhecimento de adolescentes sobre hanseníase / Validación del instrumento para la evaluación del conocimiento de los adolescentes sobre la hanseniasis / Validation of an instrument for the evaluation of adolescents' knowledge about Hansen's disease

Resumo Objetivo: Construir e validar instrumentos para avaliação do conhecimento de adolescentes sobre hanseníase e caracterização dos sujeitos. Métodos: Pesquisa metodológica, desenvolvida em três etapas, a saber: construção dos instrumentos; validação de face e conteúdo com sete juízes; e validação semântica com 20 adolescentes, de 10 a 14 anos. Resultados: Houve concordância superior a 80% entre os juízes quanto a todos os domínios, itens e componentes avaliados. A concordância geral entre os juízes para o instrumento de avaliação do conhecimento de adolescentes sobre hanseníase, com 14 itens, foi de 89% e do instrumento para caracterização dos participantes, com 17 itens, foi de 93%. Na validação semântica, os instrumentos foram considerados com boa compreensão, e não houve dificuldades para seu preenchimento. Entre os adolescentes, 10% afirmaram ter ou ter tido casos de hanseníase na família. A maioria dos adolescentes (55%) nunca tinha ouvido falar ou tinha recebido informações sobre hanseníase, assim como a maioria (60%) afirmou não saber o que era a hanseníase. Conclusão: Os instrumentos construídos para avaliar o conhecimento de adolescentes sobre hanseníase e caracterizar a população estudada foram considerados válidos quanto à face, ao conteúdo e à semântica. Ambos os instrumentos apresentaram aparência, compreensão e relevância consideradas muito boas ou excelentes, podendo ser aplicados ao público de estudo.

Resumen Objetivo: Construir y validar instrumentos para evaluar el conocimiento de adolescentes sobre hanseniasis y caracterización de los sujetos. Métodos: Investigación metodológica desarrollada en tres etapas, a saber: construcción de los instrumentos, validación de cara y contenido con siete jueces y validación semántica con 20 adolescentes de 10 a 14 años. Resultados: Hubo correspondencia superior al 80% entre los jueces en cuanto a todos los elementos, ítems y componentes evaluados. La correspondencia general entre los jueces para el instrumento de evaluación del conocimiento de adolescentes sobre hanseniasis, con 14 ítems, fue del 89%, y del instrumento para caracterización de los participantes, con 17 ítems, fue del 93%. En la validación semántica los instrumentos fueron considerados con buena comprensión y no hubo dificultades para su diligenciamiento. Entre los adolescentes, el 10% afirmó tener o haber tenido casos de hanseniasis en la familia. La mayoría de los adolescentes (55%) nunca había oído hablar o había recibido información sobre la hanseniasis, así como la mayoría (60%) afirmó no saber lo que era la hanseniasis. Conclusión: Los instrumentos construidos para evaluar el conocimiento de adolescentes sobre hanseniasis y caracterizar a la población estudiada fueron considerados válidos en cuanto a la cara, el contenido y la semántica. Ambos instrumentos presentaron apariencia, comprensión y relevancia consideradas muy buenas o excelentes, por lo que se pudieron aplicar al público estudiado.

Abstract Objective: To construct and validate instruments for the evaluation of adolescents' knowledge about Hansen's disease and characterization of these subjects. Methods: Methodological study developed in three steps, namely: construction of instruments; face and content validation with seven judges; and semantic validation with 20 adolescents aged from 10 to 14 years. Results: There was more than 80% agreement among judges in all domains, items and components evaluated. The general agreement among judges for the instrument for evaluation of adolescents' knowledge on Hansen's disease with 14 items was 89%, and for the instrument for characterization of participants with 17 items, agreement was 93%. In the semantic validation, the instruments were considered of good understanding, and there were no difficulties for completing them. Among adolescents, 10% reported having or having had cases of Hansen's disease in the family. Most adolescents (55%) had never heard of or received information about Hansen's disease, and most (60%) also said they did not know what Hansen's disease was. Conclusion: The instruments constructed to evaluate adolescents' knowledge about Hansen's disease and to characterize the studied population were considered valid regarding face, content and semantics. The appearance, comprehension and relevance were considered as very good or excellent in both instruments, and they can be applied to the target population.

Conhecimento de estudantes de medicina sobre hanseníase em uma região endêmica do Brasil / Knowledge of medical students from a Brazilian endemical region regarding leprosy / El conocimiento de estudiantes de medicina sobre la lepra en una región endémica de Brasil

A hanseníase é uma doença infecciosa, crônica, de grande importância para a saúde pública devido à sua prevalência e ao seu alto poder incapacitante. A Amazônia brasileira é região endêmica dessa moléstia. Este estudo teve como objetivo avaliar o conhecimento acerca da hanseníase dos estudantes do último ano do curso de Medicina de universidades públicas da capital do estado do Pará, comparando-o com variáveis da formação acadêmica. Trata-se de um estudo observacional de corte transversal. Para a coleta de dados, utilizaram-se questionários de perfil do acadêmico e avaliação em hanseníase. Os resultados apontaram que 55% dos acadêmicos tiveram índice de acertos maior que 50%. O menor índice de acertos ocorreu em questões sobre o contato intradomiciliar, diagnóstico e formas clínicas, nesta ordem. Não se evidenciou influência significativa/correlação entre as variáveis de participações em Iniciação Científica, Curso Preparatório de Residência Médica ou Ligas Acadêmicas com o nível de conhecimento dos acadêmicos em hanseníase. Concluiu-se que os estudantes avaliados apresentaram nível de conhecimento regular, o que aponta para a necessidade de aperfeiçoamento das estratégias de ensino-aprendizado em hanseníase.

Leprosy is a chronic infectious disease of great importance to public health because of its prevalence and its high incapacitating power. Brazilian Amazon is an endemic region for this disease. The objective of this study was to evaluate public universities last year medical students knowledge about leprosy Pará state capital, comparing it to variables of academic formation. It is an observational cross-sectional study. Academic profile and evaluation on leprosy questionnaires were used for data collection. The results showed that 55% of the students had scores higher than 50%. Questions about home contact, diagnosis and clinical forms, in this order, had the lowest rate of correct answers. There was no significant influence/correlation among the variables of participation in Scientific Initiation, Preparatory Course of Medical Residency or Academic Leagues with the level of knowledge on leprosy students. In conclusion, the students evaluated presented a regular level of knowledge, which points to the need of improvement to the teaching-learning strategies on leprosy.

La lepra es una enfermedad infecciosa crónica de gran importancia para la salud pública debido a su prevalencia y su alto poder incapacitante. La Amazonia brasileña es región endémica de esta enfermedad. Este estudio tuvo como objetivo evaluar el conocimiento de la lepra de los estudiantes de último año de la escuela de medicina de la universidad pública en la capital del estado de Pará, comparándolo con variables de la formación académica. Se trata de un estudio observacional transversal. Para recolectar los datos, utilizaron se cuestionarios de perfil académico y evaluación en la lepra. Los resultados mostraron que el 55% de los estudiantes había alcanzado tasa superior al 50%. Las puntuaciones más bajas se produjeron en preguntas sobre el contacto en el hogar, el diagnóstico y formas clínicas, en ese orden. No se muestra una influencia/correlación significativa entre las variables de participación en la Iniciación Científica, Curso Preparatorio de Residencia Médica y ligas académicas con el nivel de conocimiento de los estudiantes en la lepra. Se concluyó que los estudiantes evaluados tenían nivel regular de conocimientos, lo que apunta a la necesidad de mejorar las estrategias de enseñanza-aprendizaje en la lepra.

A Cluster-Randomized Controlled Intervention Study to Assess the Effect of a Contact Intervention in Reducing Leprosy-Related Stigma in Indonesia.

BACKGROUND: Can deliberate interaction between the public and persons affected by leprosy reduce stigmatization? The study described in this paper hypothesises that it can and assesses the effectiveness of a 'contact intervention'. METHODS/PRINCIPAL FINDINGS: This cluster-randomized controlled intervention study is part of the Stigma Assessment and Reduction of Impact (SARI) project conducted in Cirebon District, Indonesia. Testimonies, participatory videos and comics given or made by people affected by leprosy were used as methods to facilitate a dialogue during so-called 'contact events'. A mix of seven quantitative and qualitative methods, including two scales to assess aspects of stigma named the SDS and EMIC-CSS, were used to establish a baseline regarding stigma and knowledge of leprosy, monitor the implementation and assess the impact of the contact events. The study sample were community members selected using different sampling methods. The baseline shows a lack of knowledge about leprosy, a high level of stigma and contrasting examples of support. In total, 91 contact events were organised in 62 villages, directly reaching 4,443 community members (mean 49 per event). The interview data showed that knowledge about leprosy increased and that negative attitudes reduced. The adjusted mean total score of the EMIC-CSS reduced by 4.95 points among respondents who had attended a contact event (n = 58; p < 0.001, effect size = 0.75) compared to the score at baseline (n = 213); for the SDS this was 3.56 (p < 0.001, effect size = 0.81). About 75% of those attending a contact event said they shared the information with others (median 10 persons). CONCLUSIONS/SIGNIFICANCE: The contact intervention was effective in increasing knowledge and improving public attitudes regarding leprosy. It is relatively easy to replicate elsewhere and does not require expensive technology. More research is needed to improve scalability. The effectiveness of a contact intervention to reduce stigma against other neglected tropical diseases and conditions should be evaluated.

The patient perspective of the diagnostic process for leprosy in Brazil. An exploratory study.

OBJECTIVES: To explore the patient experience of being diagnosed with leprosy and the support provided during this process in selected populations in Brazil. To understand the information needs of patients during diagnosis. To identify characteristics of patients with different diagnostic experiences. To add to the evidence base used for improving the diagnostic process for leprosy patients. DESIGN: A self-constructed questionnaire delivered to 116 participants, at three leprosy health centres, across three states in Brazil. RESULTS: Most participants felt under-informed during diagnosis; 68.1% wanted more information about leprosy. Nearly one-quarter of patients reported feeling unable to ask questions at diagnosis. Almost half of patients reported being worried about treatment, yet 43.3% reported not having the chance to talk about their concerns. Younger participants were significantly more likely to report feeling unable to ask questions and talk about their worries. The majority of participants (59.5%) reported not being given any written information to take away with them. 36.5% reported not being given advice about how to reduce the chance of other family members becoming ill with leprosy. Older males were most likely to be given this advice despite females being in most contact with family members in most cultures. CONCLUSIONS: It is recommended that patients are encouraged to ask questions and invited to talk about their concerns, particularly younger patients. It is recommended that a simple information leaflet be provided to all patients. These suggestions may require some financial input, more staff and longer consultations but should significantly improve the diagnostic process.

Aspectos sociodemográficos e epidemiológicos dos casos de hanseníase em uma área endêmica: conhecimentos e experiências de cirurgiões-dentistas / Demographic and epidemiological aspects of leprosy cases in an endemic area: knowledge and experience of dentists

A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que acomete preferencialmente pele e nervos periféricos, com um grande potencial para desenvolver incapacidades físicas. A redução da transmissibilidade e do número de doentes com lesões incapacitantes depende do incremento do diagnóstico precoce da doença. Os objetivos do presente trabalho foram conhecer as principais características epidemiológicas de indivíduos notificados com hanseníase, no período de 2013 a 2014, e o conhecimento e atuação do cirurgião-dentista no controle da endemia, no município de Cuiabá-MT. Trata-se de um estudo epidemiológico transversal, dividido em duas etapas, que incluem: análise de 434 Ficha Individual de Notificação/Investigação de Hanseniase, inquérito com 242 cirurgiões-dentistas (CD’s) atuantes no Sistema Único de Saúde (SUS) de Cuiabá, para analisar o conhecimento sobre a forma de contágio, características clínicas e tratamento; além das experiências em relação a suspeita diagnóstica e encaminhamento de casos. A análise de dados foi realizada através do Program Statistical Package for Social Sciense (SPSS) versão 21.0 e da análise bivariada utilizando o teste qui-quadrado e nível de significância de 5%. Do total de 434 Fichas de Investigação avaliadas a maior parte era do sexo feminino (52,5%), com idade acima de 60 anos (26,3%), pardos (48,4%), com ensino fundamental incompleto (32,7%). A forma clínica e classe operacional mais prevalentes foram dimorfa e multibacilar esta última mais frequente no sexo feminino. Quanto ao estudo dos CD’s os resultados mostraram a predominância do sexo feminino (65,7%), idade entre 30 e 39 anos (43%) e profissionais com 6 a 10 anos de formados (23,6%). No tocante ao tempo de trabalho no SUS, o maior percentual (28,1%) apresentava mais de 10 anos de trabalho. Quanto ao conhecimento sobre a doença, 30,6% não sabiam a eficácia do tratamento da hanseníase, 47% não tinham conhecimento que a doença era de notificação...

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which mainly affects the skin and peripheral nerves, with great potential to develop physical disabilities. Reducing the transmission and the number of patients with disabling injuries depends on the increase in early diagnosis. The objectives of this study were to know the main epidemiological characteristics of individuals with leprosy reported in the period 2013-2014, and the knowledge and performance of the dentist in leprosy control in the city of Cuiaba-MT. It is an epidemiological study, divided into two steps, which include: analysis of 434 Individual Forms of Leprosy Notification/Investigation, and survey of 242 dentists (CDs) working at the Unified Health System (SUS) in Cuiabá, to analyze their knowledge about the ways of transmission, clinical features and treatment, besides analyzing their experiences in relation to diagnostic suspicion and referral of cases. Data analysis was performed using the Statistical Package Program for Social Sciences (SPSS), version 21.0, and bivariate analysis using the chi-square test and 5% significance level. Of the total of 434 Investigation forms analyzed, the majority of the patients were female (52.5%), aged over 60 (26.3%), of mixed race (48.4%), with incomplete primary education (32.7%). The most prevalent clinical form and operating class were borderline and multibacillary, the latter more frequent in females. As for the study of CDs, the results showed a predominance of females (65.7%), aged between 30 and 39 years old (43%) and professionals graduated 6-10 years earlier (23.6%). With regard to time working at SUS, the highest percentage (28.1%) had worked for over 10 years. Regarding knowledge about the disease, 30.6% did not know the effectiveness of the treatment of leprosy, 47% were unaware that the disease was reportable and only 8.3% obtained information about leprosy at work. It was concluded that there was a higher prevalence of...

Aspectos sociodemográficos e epidemiológicos dos casos de hanseníase em uma área endêmica: conhecimentos e experiências de cirurgiões-dentistas / Demographic and epidemiological aspects of leprosy cases in an endemic area: knowledge and experience of dentists

A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que acomete preferencialmente pele e nervos periféricos, com um grande potencial para desenvolver incapacidades físicas. A redução da transmissibilidade e do número de doentes com lesões incapacitantes depende do incremento do diagnóstico precoce da doença. Os objetivos do presente trabalho foram conhecer as principais características epidemiológicas de indivíduos notificados com hanseníase, no período de 2013 a 2014, e o conhecimento e atuação do cirurgião-dentista no controle da endemia, no município de Cuiabá-MT. Trata-se de um estudo epidemiológico transversal, dividido em duas etapas, que incluem: análise de 434 Ficha Individual de Notificação/Investigação de Hanseniase, inquérito com 242 cirurgiões-dentistas (CD’s) atuantes no Sistema Único de Saúde (SUS) de Cuiabá, para analisar o conhecimento sobre a forma de contágio, características clínicas e tratamento; além das experiências em relação a suspeita diagnóstica e encaminhamento de casos. A análise de dados foi realizada através do Program Statistical Package for Social Sciense (SPSS) versão 21.0 e da análise bivariada utilizando o teste qui-quadrado e nível de significância de 5%. Do total de 434 Fichas de Investigação avaliadas a maior parte era do sexo feminino (52,5%), com idade acima de 60 anos (26,3%), pardos (48,4%), com ensino fundamental incompleto (32,7%). A forma clínica e classe operacional mais prevalentes foram dimorfa e multibacilar esta última mais frequente no sexo feminino. Quanto ao estudo dos CD’s os resultados mostraram a predominância do sexo feminino (65,7%), idade entre 30 e 39 anos (43%) e profissionais com 6 a 10 anos de formados (23,6%). No tocante ao tempo de trabalho no SUS, o maior percentual (28,1%) apresentava mais de 10 anos de trabalho. Quanto ao conhecimento sobre a doença, 30,6% não sabiam a eficácia do tratamento da hanseníase, 47% não tinham conhecimento que a doença era de notificação...

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which mainly affects the skin and peripheral nerves, with great potential to develop physical disabilities. Reducing the transmission and the number of patients with disabling injuries depends on the increase in early diagnosis. The objectives of this study were to know the main epidemiological characteristics of individuals with leprosy reported in the period 2013-2014, and the knowledge and performance of the dentist in leprosy control in the city of Cuiaba-MT. It is an epidemiological study, divided into two steps, which include: analysis of 434 Individual Forms of Leprosy Notification/Investigation, and survey of 242 dentists (CDs) working at the Unified Health System (SUS) in Cuiabá, to analyze their knowledge about the ways of transmission, clinical features and treatment, besides analyzing their experiences in relation to diagnostic suspicion and referral of cases. Data analysis was performed using the Statistical Package Program for Social Sciences (SPSS), version 21.0, and bivariate analysis using the chi-square test and 5% significance level. Of the total of 434 Investigation forms analyzed, the majority of the patients were female (52.5%), aged over 60 (26.3%), of mixed race (48.4%), with incomplete primary education (32.7%). The most prevalent clinical form and operating class were borderline and multibacillary, the latter more frequent in females. As for the study of CDs, the results showed a predominance of females (65.7%), aged between 30 and 39 years old (43%) and professionals graduated 6-10 years earlier (23.6%). With regard to time working at SUS, the highest percentage (28.1%) had worked for over 10 years. Regarding knowledge about the disease, 30.6% did not know the effectiveness of the treatment of leprosy, 47% were unaware that the disease was reportable and only 8.3% obtained information about leprosy at work. It was concluded that there was a higher prevalence of...

Conhecimento da população do bairro Farolândia sobre o programa saúde da família ( PSF) / Population of knowledge about the neighborhood Farolândia family health program (PSF)

Desde sua criação, em 1988, o Sistema Único de Saúde - SUS - tem tido como um de seus objetivos integralizar a atenção à saúde da população, deixando de lado o caráter curativo dos serviços de saúde para assumir uma nova postura de prevenção e promoção da saúde. O presente estudo teve como objetivo verificar o conhecimento da população sobre o Programa de Saúde da Família (PSF). Pesquisa de campo, exploratória, quantitativa e descritiva. A coleta de dados foi realizada através da aplicação de formulário a 20 moradores do bairro Farolândia, constituído de 10 questões objetivas, que foram analisadas por estatística descritiva simples e demonstradas através de gráficos e tabelas. Apesar de o bairro Farolândia estar localizado na zona sul e possuir uma unidade de saúde que é referência em Aracaju, a grande maioria da população (75%) desconhece a sigla PSF. Dos entrevistados, 75% não souberam responder qual a função do PSF. Observamos que 75% das pessoas entrevistadas são leigas em relação ao conhecimento da equipe que compõe o PSF e das 25% que souberam responder, todas citaram os agentes comunitários de saúde, pois estes sempre estão fazendo visitas domiciliares, principalmente durante os surtos de dengue. 90% dos entrevistados necessitam dos serviços prestados pelo posto, uma vez que elas não dispõem de planos de saúde ou por outros motivos, como campanhas de vacinação. Com uma estrutura física considerada satisfatória para boa parte dos entrevistados (70%), a UBS ainda precisa melhorar o atendimento ao público, pois 39% dos entrevistados sentem-se insatisfeitos. Com relação às atividades desenvolvidas pelo PSF, a resposta mais citada foi consultas, com 90% do total esperado, sendo seguida das visitas domiciliares que ficaram com 80%. Foram consideradas também atividades do PSF: a distribuição de medicamentos por 75%; o acompanhamento de pacientes crônicos, como hipertensos e diabéticos (65%), de pacientes com hanseníase e tuberculose (40%) e de pessoas acometidas por DST?s (35%); 60% responderam distribuição de anticoncepcionais. Com 55%, empataram a distribuição das camisinhas, as consultas de pré-natal e os exames de lâmina; 50% acreditam que o PSF acompanha o crescimento e desenvolvimento infantil e com 10% das citações ficou a vacinação. Conclui-se que a população do bairro Farolândia desconhece o PSF e os trabalhos desenvolvidos por ele, sendo que há a necessidade de informar a população e despertar nas pessoas o interesse de conhecer um projeto tão importante que foi implantado para assegurar uma melhor qualidade na saúde da população.

Since its inception in 1988, the Health System - SUS - has had as one of its objectives fully paid health care for the population, leaving aside the curative health services to take a new approach to prevention and promotion health. This study aimed to determine the population?s knowledge about the Family Health Program (PSF). Field research, exploratory, descriptive and quantitative. Data collection was performed by applying a form Farolândia 20 residents of the neighborhood, consisting of 10 objective questions, which were analyzed by descriptive statistics and demonstrated through graphs and tables. Although the neighborhood Farolândia be located in an area that has a reference in Aracaju, the vast majority of the population (75%) know the acronym PSF. Of the respondents, 75% answer to what function the PSF. We observed that 75% of respondents are in relation to lay knowledge of the team that makes up the PSF and 25% who know how to answer, all cited the community health workers, because they are always making home visits, especially during outbreaks of dengue. 90% of respondents require the services provided by post, since they do not have health insurance or other reasons, such as vaccination campaigns. With a physical structure satisfactory for most of the respondents (70%), UBS still needst to improve service to the public, because 39% of respondents feel dissatisfied. Regarding the activities of the PSF: the function most remembered were the consultations, cited by 90% of respondents, being followed by home visits were 80%, 75% answered about the distribution of medicines, 65% believe that activity is also PSF monitor chronically patients, such as hypertension and diabetes 40% leprosy and tuberculosis and 35% people suffering from STDs, 60% responded distribution of contraceptives, with 55% tie the distribution of condoms, queries prenatal exams and blade, 50 % believe that the PSF accompanying child growth and development and 10% of the citations was vaccination. It is conclude that the population of the district Farolândia don ?t know in detail the PSF and the work he, and there is a need to inform the public and arouse people?s interest in knowing such an important project that has been deployed to ensure a better quality population health.

Bringing physics to bear on the phenomenon of life: the divergent positions of Bohr, Delbrück, and Schrödinger.

The received view on the contributions of the physics community to the birth of molecular biology tends to present the physics community as sharing a basic level consensus on how physics should be brought to bear on biology. I argue, however, that a close examination of the views of three leading physicists involved in the birth of molecular biology, Bohr, Delbrück, and Schrödinger, suggests that there existed fundamental disagreements on how physics should be employed to solve problems in biology even within the physics community. In particular, I focus on how these three figures differed sharply in their assessment of the relevance of complementarity, the potential of chemical methods, and the relative importance of classical physics. In addition, I assess and develop Roll-Hansen's attempt to conceptualize this history in terms of models of scientific change advanced by Kuhn and Lakatos. Though neither model is fully successful in explaining the divergence of views among these three physicists, I argue that the extent and quality of difference in their views help elucidate and extend some themes that are left opaque in Kuhn's model.

Conhecimento científico e controle social: a institucionalizaçäo do campo da hanseníase (1897-2000) / Scientific knowledge and social control: institutionalization in the field of leprosy from 1897 to 2000

Analisa as concepçöes e práticas de controle social da hanseníase, mediante estudo das fontes documentais de domínio público na perspectiva socioconstrucionista da psicologia social. O processo de institucionalizaçäo da hanseníase é analisado a partir da noçäo de campo científico de Bourdieu e dos conceitos e definiçöes cristalizadas em livros, revistas e índices bibliográficos. A perspectiva diacrônica aponta as transformaçöes ocorridas ao longo dos anos: do paradigma da hereditariedade ao bacteriano e à imunogenética atual. A série histórica analisada (1879-2000) mostra que o discurso hegemônico, rejeitando os discursos marginais, tratou a doença, näo o doente, ao qual näo deu voz. A institucionalizaçäo do campo da hanseníase ocorreu por movimento mais amplo da Medicina Social que objetivava a promoçäo da saúde mediante o controle dos doentes por meio de estratégias de governamentalidade. A especializaçäo progressiva no campo da hanseníase reduziu as possibilidades de reflexäo sobre o doença pela hegemonia discursiva

Effectiveness of training of basic health workers in Leprosy Control Programme.

This study was undertaken in two adjacent districts (Rautahat and Parsa) in Nepal to measure the impact of training of basic health workers on Leprosy Control Programme. Knowledge, attitude and leprosy service delivery by them were studied before and after training. There was an improvement in all the three components after training. However, improvement was also seen in the control group as well. Possible reasons for this are discussed. Improper selection of the area and an inadequate methodology were the identified drawbacks of the study.

Factors that make difficult the implementation of an integrated leprosy control programme in health zone II, Santa Fe Province, Argentina.

With the help of a pre-tested, structured questionnaire and participatory observation, effects of several variables that have a bearing on the process of integration were studied in Zone II of the Santa Fe Province of Argentina. Patient's knowledge and the presence of an NGO were identified as factors facilitating integration. The presence of a vertical programme staff and insufficient commitment towards integration were identified as factors hindering integration.

Japanese government takes steps toward approving birth control pill.

PIP: On September 12, 1995, the Central Pharmaceutical Affairs Council of Japan recommended approval of low-dose oral contraceptives as a method of family planning. Doctors should be able to prescribe the pills after the standing members of the Council, part of the Ministry of Health and Family Welfare, meet next March. High-dose oral contraceptives can be obtained currently to treat menstrual irregularities, although many of the 200,000 prescriptions written annually are used for family planning. Approval for the low-dose contraceptives has been slow because of concerns regarding a possible relaxation of sexual mores (1965); adverse side effects (until 1987 when the Japanese Ministry of Health initiated clinical trials that established the safety and efficacy of the contraceptives); increased rates of human immunodeficiency virus (HIV) infection (1992); a higher number of drug reimbursement claims under the national health insurance system; and a decline in Japan's birthrate. Japan's birthrate fell from 4.5 children per woman in 1947 to 1.5 in 1993. 80% of contraceptive users rely on condom; 22% use the rhythm method, usually in conjunction with the condom; 7% use the IUD; and less than 2% use sterilization. Sterilization is only permitted for married couples and only when the woman's life or health is in danger, or either spouse has a mental illness, leprosy, or a hereditary disorder.^ieng