The Centenary of the Leprosy Relief Association (Lepra)-a moment for celebration and reflection†.

The year 2024 is the Centenary of the foundation of the Leprosy Relief Association (Lepra), formerly the British Empire Leprosy Relief Association (BELRA). The name of the organization changed to the LEProsy Relief Association (LEPRA) in 1976 but has been known as Lepra since 2008. Over the years it has worked closely with members and office holders of the Royal Society of Tropical Medicine and Hygiene. Its work has encompassed activities from the earliest initiatives to ensure appropriate living conditions for those with the disease to the development of leprosy chemotherapy. However, this has now evolved into a strong partnership between the UK- and India-based Lepra hubs, which are carrying out research and public health initiatives ranging from elimination of prejudice against those with leprosy to adopting the recently launched WHO programme for skin NTDs to facilitate integrated control and management regimens. The fight against leprosy has always been a partnership between a wide variety of disease-specific NGOs, health-care workers and international health agencies. The story of Lepra illustrates the central role of these partnerships and national as well as international collaboration.

¿Han afectado las restricciones sanitarias del COVID-19 la carga de entrenamiento de pretemporada de los futbolistas Sub-20? / Have the COVID-19 health restrictions affected the preseason training load of U-20 footballers?

Objetivo: Las restricciones de salud pública por el COVID-19 han jugado un papel central en la gestión de los programas de entrenamiento, en los que son escasos los estudios enfocados en la cuantificación de las cargas de entrenamiento en pretemporada, especialmente en futbolistas jóvenes. Por lo tanto, este estudio monitoreó la carga de entrenamiento interno (CEI) durante la pretemporada 2020/2021 durante la pandemia de COVID-19 de los jugadores de fútbol Sub-20. Método: Catorce futbolistas Sub-20 fueron monitoreados durante 7 semanas durante la pretemporada 2020/2021. El CEI de todas las sesiones de entrenamiento se estimó, en unidades arbitrarias, multiplicando el índice de esfuerzo percibido (IEP) para la sesión de entrenamiento completa por la duración de cada sesión de entrenamiento en minutos (IEP-sesión). También se estimaron la monotonía y la tensión de entrenamiento. Un ANOVA unidireccional de medidas repetidas comparó las variables dependientes a lo largo del tiempo. Resultados: En la cuarta semana, la CEI y la tensión de entrenamiento fueron estadísticamente más bajas en comparación con las otras semanas (P<0,05). El índice de monotonía de la semana 7 fue mayor en comparación con las semanas 1, 3 y 4 (P<0,05). Conclusión: Las restricciones sanitarias por el COVID-19 han afectado negativamente la carga de entrenamiento de pretemporada de los futbolistas Sub-20. Sin embargo, el índice de monotonía mostró que las cargas de entrenamiento estaban bien distribuidas durante las 7 semanas. (AU)

Basel: A Hotspot for Drug Discovery and Development Against Poverty-Related Diseases.

In discussion with Lukas Meier from the Swiss Tropical and Public Health Institute (Swiss TPH), Lutz Hegemann, Head of Novartis Global Health and Sustainability and Marcel Tanner, President of the Swiss Academies of Arts and Sciences, give their opinions on the changes that occurred in drug discovery and development for poverty-related diseases over the past 30 years. They emphasise the power of public-private partnerships and provide their points of views on what needs to be done in the future to ensure that the poorest of the poor also have access to important therapies.

Socio-historical representations of a disease: a study of posters from campaigns against Hansen's disease during the second half of the twentieth century. / Representações sócio-históricas de uma doença: um estudo sobre cartazes de campanhas para o combate à hanseníase na segunda metade do século XX.

This article analyzes the use of iconographic sources in the context of educational campaigns to combat Hansen's disease from a socio-historical perspective at four points in time: the 1950s, 1960s, 1980s, and 1990s. Four posters are analyzed to identify the elements (textual, visual or graphic) used to develop discourse on this disease and those it affected and transformations and permanences in this discourse, as well as to verify how they became part of a narrative of institutional memory linked to public health in the state of São Paulo. These were produced by various public health institutions and are part of the Health Campaign Poster Collection held by the Emílio Ribas Public Health Museum.

Este artigo analisa o uso de fontes iconográficas no contexto das campanhas educativas para o combate à hanseníase numa perspectiva sócio-histórica em quatro momentos: décadas de 1950, 1960, 1980 e 1990. São analisados quatro cartazes para identificar os elementos (textuais, visuais ou gráficos) utilizados para elaborar um discurso sobre a doença e os doentes; suas transformações discursivas e permanências, além de verificar como se tornaram parte de uma narrativa de memória institucional ligada à saúde pública paulista. As fontes estudadas fazem parte da coleção Cartazes de Campanhas de Saúde, cujos itens foram produzidos por diversas instituições ligadas à saúde pública e integram o acervo do Museu de Saúde Pública Emílio Ribas.

A modelling analysis of a new multi-stage pathway for classifying achievement of public health milestones for leprosy.

Several countries have come close to eliminating leprosy, but leprosy cases continue to be detected at low levels. Due to the long, highly variable delay from infection to detection, the relationship between observed cases and transmission is uncertain. The World Health Organization's new technical guidance provides a path for countries to reach elimination. We use a simple probabilistic model to simulate the stochastic dynamics of detected cases as transmission declines, and evaluate progress through the new public health milestones. In simulations where transmission is halted, 5 years of zero incidence in autochthonous children, combined with 3 years of zero incidence in all ages is a flawed indicator that transmission has halted (54% correctly classified). A further 10 years of only occasional sporadic cases is associated with a high probability of having interrupted transmission (99%). If, however, transmission continues at extremely low levels, it is possible that cases could be misidentified as historic cases from the tail of the incubation period distribution, although misleadingly achieving all three milestones is unlikely (less than 1% probability across a 15-year period of ongoing low-level transmission). These results demonstrate the feasibility and challenges of a phased progression of milestones towards interruption of transmission, allowing assessment of programme status. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Leprosy in French Guiana, 2015 to 2021: Dynamics of a Persistent Public Health Problem.

A resurgence of leprosy as a public health problem in French Guiana was reported over the period 2007 to 2014, particularly among Brazilians gold miners. Prolonged multidrug therapy and reversal reactions represent a therapeutic challenge. The objective of this study was to assess the evolution of leprosy in this European overseas territory. All patients with leprosy confirmed in histopathology between 1 January 2015 and 31 December 2021 were included. A total of 86 patients were included, including 64 new cases and 22 previously diagnosed cases. Sixty patients (70%) were male, 6 cases were paediatric. Brazilian gold miners represented 44.1% of reported occupations (15/34). Maroons represented the second community (13 patients, 15%). Multibacillary and paucibacillary forms were found in 53 (71%) and 22 (29%) patients, respectively. The annual prevalence never exceeded the threshold of 1/10,000. The mean incidence and prevalence were significantly lower than during the period 2007 to 2014 (p < 0.0001). Reversal reactions were found in 29 patients and almost always required a long course of steroids. Infliximab allowed a reduction in the length of treatment with steroids in 2/2 cases. In conclusion, the prevalence of leprosy has decreased significantly in French Guiana, but remains driven by the population of illegal gold miners. Anti-tumour necrosis factor (anti-TNF) drugs represent a promising option in the management of reversal reactions.

[Leprosy and vulnerability: a scoping review]. / Hanseníase e vulnerabilidade: uma revisão de escopo.

The objective of this work was to review published scientific works on leprosy as a public health problem in Brazil, and the marker of vulnerability for people with the disease. A scoping review was carried out with the descriptor 'leprosy AND vulnerability', on the Virtual Health Library (BVS) database. A total of 29 articles published between January 2016 and December 2020 that met the inclusion criteria were selected. The results pointed to scientific papers published in indexed journals and with different impact factors, with emphasis on the fact that most of the selected publications appear in journals with impact metrics that are not very significant in the eyes of the international community, even though they have national impact. The majority of the studies had municipal coverage, with emphasis on cities in the North and Northeast of Brazil. The works addressed vulnerability in leprosy using different typologies.

O estudo teve como objetivo a revisão de trabalhos científicos publicados sobre a hanseníase como problema de saúde pública no Brasil e o marcador de vulnerabilidade para os portadores da enfermidade. Foi realizada uma scoping review com o descritor "hanseníase AND vulnerabilidade" na base de dados da Biblioteca Virtual em Saúde (BVS). Foram selecionados 29 artigos publicados entre janeiro de 2016 e dezembro de 2020 que atenderam aos critérios de inclusão. Os resultados apontaram para trabalhos científicos publicados em revistas indexadas e com diferentes fatores de impacto, com destaque para a maioria das publicações selecionadas constarem em periódicos com métricas de impacto pouco significativas aos olhos da comunidade internacional, ainda que elas tenham impacto nacional. A maioria dos estudos teve abrangência municipal, com destaque para cidades do Norte e do Nordeste brasileiro. Os trabalhos trataram a vulnerabilidade na hanseníase utilizando distintas tipologias.

Identifying clusters of leprosy patients in India: A comparison of methods.

BACKGROUND: Preventive interventions with post-exposure prophylaxis (PEP) are needed in leprosy high-endemic areas to interrupt the transmission of Mycobacterium leprae. Program managers intend to use Geographic Information Systems (GIS) to target preventive interventions considering efficient use of public health resources. Statistical GIS analyses are commonly used to identify clusters of disease without accounting for the local context. Therefore, we propose a contextualized spatial approach that includes expert consultation to identify clusters and compare it with a standard statistical approach. METHODOLOGY/PRINCIPAL FINDINGS: We included all leprosy patients registered from 2014 to 2020 at the Health Centers in Fatehpur and Chandauli districts, Uttar Pradesh State, India (n = 3,855). Our contextualized spatial approach included expert consultation determining criteria and definition for the identification of clusters using Density Based Spatial Clustering Algorithm with Noise, followed by creating cluster maps considering natural boundaries and the local context. We compared this approach with the commonly used Anselin Local Moran's I statistic to identify high-risk villages. In the contextualized approach, 374 clusters were identified in Chandauli and 512 in Fatehpur. In total, 75% and 57% of all cases were captured by the identified clusters in Chandauli and Fatehpur, respectively. If 100 individuals per case were targeted for PEP, 33% and 11% of the total cluster population would receive PEP, respectively. In the statistical approach, more clusters in Chandauli and fewer clusters in Fatehpur (508 and 193) and lower proportions of cases in clusters (66% and 43%) were identified, and lower proportions of population targeted for PEP was calculated compared to the contextualized approach (11% and 11%). CONCLUSION: A contextualized spatial approach could identify clusters in high-endemic districts more precisely than a standard statistical approach. Therefore, it can be a useful alternative to detect preventive intervention targets in high-endemic areas.

Hansen's disease (leprosy) in Japan, 1947-2020: an epidemiologic study during the declining phase to elimination.

OBJECTIVES: Leprosy, or Hansen's disease was a major public health problem in Japan in the early 20th century. Today, the number of new cases has decreased significantly. We aimed to investigate the trends of leprosy in Japan over the past 73 years and the challenges faced in recent years. METHODS: We assessed the data on newly registered cases of leprosy from 1947 to 2020. RESULTS: A total of 10,796 newly registered cases of leprosy were reported during the study period, of which 7573 were registered in mainland Japan, 2962 in Okinawa, and 250 were of foreign origin. Most autochthonous cases were born before 1950 in mainland Japan and before 1975 in Okinawa. The number of nonautochthonous cases surpassed that of autochthonous cases in 1992. Nonautochthonous cases originated from 26 countries, particularly Brazil and the Philippines. Three cases of antimicrobial resistance have been detected among nonautochthonous cases since 2004. CONCLUSION: Our data suggest that ongoing transmission of leprosy likely ceased in the 1940s in mainland Japan and in the 1970s in Okinawa. With the recent rise of nonautochthonous cases with globalization, continuous surveillance and efforts to maintain leprosy services within the country are necessary even after reaching the state of elimination.

Perfil clínico-epidemiológico de pacientes diagnosticados com hanseníase / Clinical-epidemiological profile of patients diagnosed with leprosy / Perfil clínico-epidemiológico de los pacientes diagnosticados de lepra

hanseníase no Brasil ainda apresenta como um problema de saúde pública. A posição epidemiológica da doença no país é considerada diversificada devido ao alto coeficiente e variação de prevalência nas diversas regiões do país. O objetivo desse estudo é conhecer o perfil epidemiológico da população acometida pela hanseníase na cidade de General Carneiro, no interior do Mato Grosso, durante os anos de 2006 e 2021. A coleta de dados foi realizada nos meses de julho e agosto do ano de 2021. Trata-se de uma pesquisa retrospectiva, documental do tipo descritiva, com abordagem quantitativa. No período em estudo notificou-se 50 casos, sendo 62% do sexo masculino, com faixa etária entre 48 a 69 anos de idade, de cor branca, com predominância da forma dimorfa. Os resultados demonstram que a cidade de General Carneiro, está com o número de casos de hanseníase na média do preconizado pela Organização Mundial de Saúde e também, inferior à média brasileira.

Leprosy in Brazil still presents as a public health problem. The epidemiological position of the disease in the country is considered diversified due to the high coefficient and variation in prevalence in different regions of the country. The aim of this study is to know the epidemiological profile of the population affected by leprosy in the city of General Carneiro, in the interior of Mato Grosso, during the years 2006 and 2021. Data collection was carried out in July and August of 2021 This is a retrospective, descriptive documentary research with a quantitative approach. During the study period, 50 cases were reported, 62% male, aged between 48 and 69 years old, white, with a predominance of the borderline form. The results show that the city of General Carneiro has the number of cases of leprosy in the average recommended by the World Health Organization and also below the Brazilian average.

La lepra en Brasil sigue siendo un problema de salud pública. La posición epidemiológica de la enfermedad en el país se considera diversificada debido al alto coeficiente y a la variación de la prevalencia en diferentes regiones del país. El objetivo de este estudio es conocer el perfil epidemiológico de la población afectada por la lepra en la ciudad de General Carneiro, en el interior de Mato Grosso, durante los años 2006 y 2021. La recogida de datos se realizó en julio y agosto del año 2021. Se trata de una investigación retrospectiva, documental y descriptiva, con un enfoque cuantitativo. En el período de estudio se notificaron 50 casos, siendo el 62% de sexo masculino, con una edad entre 48 y 69 años, de color blanco, con predominio de la forma dimorfa. Los resultados muestran que la ciudad de General Carneiro, está con el número de casos de lepra en la media recomendada por la Organización Mundial de la Salud y también por debajo de la media brasileña.

Suspicious symptom monitoring for leprosy: an optimal practice for early detection under a low endemic situation in Zhejiang Province, China.

BACKGROUND: Leprosy is a chronic infectious disease that causes disabilities and deformities. Early detection is a major strategy for leprosy control. This study reported a new practice of suspicious symptom monitoring for early detection of leprosy. METHODS: A descriptive and comparative analysis between a non-strategy group of pre-implementation of suspicious symptom monitoring in 2005-2011 and a strategy group of strategy implementation in 2012-2018 was conducted through indicators of the number of times of misdiagnoses, delayed period, proportion of early detected cases, and proportion of disabilities. RESULT: Compared with the non-strategy group in 2005-2011, the median number of times of misdiagnoses was decreased from two times to zero times (z = 4.387, P < 0.001), and the median delayed period of newly detected cases were shortened from 24 months to 13 months (z = 2.381, P < 0.001), the proportion of early detected cases was increased from 43.7% to 75.2% (χ2 = 29.464, P < 0.001), the proportion of grade 2 disabilities was decreased from 28.6% in the highest year of 2005 to 4.0% in the lowest year of 2014, and the average proportion of disabilities was decreased from 33.5% to 17.6% (χ2 = 9.421, P = 0.002) in the strategy group in 2012-2018, respectively. CONCLUSION: Suspicious symptom monitoring promoted early detection of cases by reducing the number of times misdiagnosis of leprosy patients, shortening the delayed period, increasing the proportion of early detection, and decreasing the proportion of disabilities. It is an important and recommendable public health strategy for leprosy prevention and control in a low epidemic condition.

Local tips, global impact: community-driven measures as avenues of promoting inclusion in the control of neglected tropical diseases: a case study in Kenya.

BACKGROUND: Neglected tropical diseases (NTDs) affect poor populations with little or no 'political voice' to influence control activities. While most NTDs have interventions that work, the biggest challenge remains in delivering targeted interventions to affected populations residing in areas experiencing weak health systems. Despite the upward development trends in most countries of sub-Saharan Africa (SSA), the healthcare worker to population ratio remains exceptionally low, with some areas not served at all; thus, there is a need to involve other personnel for school and community-based healthcare approaches. Nonetheless, the current community-based programs suffer from inconsistent community participation due to a lack of coordinated response, and an expanded intervention agenda that lacks context-specific solutions applicable to rural, urban, and marginalized areas. METHODS: This research investigated the capacity of local communities to address the burden of NTDs. Informed by the social theory of human capability, the research collected primary qualitative data by conducting key informant interviews and focus group discussions of people infected or affected by NTDs. The interview data were collected and transcribed verbatim for thematic analysis using Nvivo version 12. RESULTS: Our findings reveal, first, a need for intersectoral collaboration between governments and affected populations for inclusive and sustainable NTD solutions. Second, a 'bottom-up' approach that enhances capacity building, sensitization, and behaviour change for improved uptake of NTD interventions. Third, the enforcement of Public Health Legislative Acts that mandates the reporting and treatment of NTDs such as leprosy. Fourth, the establishment of support groups and counseling services to assist persons suffering from debilitating and permanent effects of NTDs. CONCLUSIONS: Our research demonstrates the importance of human agency in encouraging new forms of participation leading to the co-production of inclusive and sustainable solutions against NTDs.

National Health Survey reveals high percentage of signs and symptoms of leprosy in Brazil. / Pesquisa Nacional de Saúde revela alto percentual de sinais e sintomas de hanseníase no Brasil.

Leprosy is a debilitating, infectious, systemic or localized dermato-neurological disease caused by Mycobacterium lepra. In Brazil, the magnitude and high disabling power keep the disease as a public health problem. Skin spotting and numbness are pathognomonic signs and symptoms in leprosy. The Instituto Brasileiro de Geografia e Estatística (IBGE) 2019 National Health Survey (PNS-2019) considered the following question as a proxy to estimate its magnitude in the country. "Do you have a spot with numbness or part of the skin with numbness?". In Brazil, 1,921,289 adults reported having a patch or part of the skin with numbness, with no regional differences. As for the age group, the older, the higher the prevalence, for example, between 18 to 29 years old (235,445) and 30 to 39 years old (236,485), 0.7% had the condition, between 40 to 59 years old (827,887), 1.5% and among the elderly, 1.8% (621,472). Being able to estimate, in population-based surveys, with statistical representativeness, a reported morbidity such as leprosy is essential to support the formulation of public policies, notably those related to primary health care actions. In this way, the IBGE fulfills its constitutional role of portraying the reality of the Brazilian population and today it is the main external evaluator of the Unified Health System (SUS) and of public policies developed by the federal level.

A hanseníase é uma doença dermato-neurológica, infecciosa, sistêmica ou localizada, debilitante, causada por Mycobacterium leprae. No Brasil, a magnitude e o alto poder incapacitante mantêm a doença como um problema de saúde pública. Mancha na pele e dormência são sinais e sintomas patognomônicos na hanseníase. A Pesquisa Nacional de Saúde de 2019 (PNS-2019), do Instituto Brasileiro de Geografia e Estatística (IBGE), considerou a seguinte pergunta como proxy para estimar sua magnitude no país. "O(a) sr(a). tem mancha com dormência ou parte da pele com dormência?". No Brasil, 1.921.289 adultos referiram ter mancha ou parte da pele com dormência, sem diferenças regionais. Com relação ao grupo etário, quanto mais velho, maior a prevalência. Por exemplo, entre os de 18 a 29 anos (235.445) e de 30 a 39 anos (236.485), 0,7% possuía a condição, entre 40 e 59 anos (827.887), 1,5%, e entre os idosos, 1,8% (621.472). Poder estimar, em pesquisas de base populacional, com representatividade estatística, uma morbidade referida tal como a hanseníase é fundamental para apoiar a formulação de políticas públicas, notadamente as relativas às ações da atenção primária à saúde. Dessa forma, o IBGE cumpre seu papel constitucional de retratar a realidade da população brasileira e hoje é o principal avaliador externo do Sistema Único de Saúde (SUS) e das políticas públicas instituídas no âmbito federal.

Looking back to move forward: A travel rule underlined by the current pandemic.

Learning from the past - is easier said than done. In this narrative, "travel" refers to the forward movement of the society at large on the path of health and development. It is suggested that looking back and learning from the lived experiences of the past outbreaks could help generating public health insights and incorporating them in planning for a better future. In the process, a country may choose to revisit what took place in the recent past during the COVID-19 pandemic within its boundary and beyond. However, unfolding of events in the past, which is not as immediate as COVID neither too far as the flu pandemic of 1918, also has lessons to offer. Recognizably, a few alarms, that rang in the recent past and cried for mass attention towards beefed up public health preparedness, were missed. It is therefore necessary now to critically examine the past-efforts to eradicate, eliminate or control diseases such as small pox, polio, HIV, tuberculosis, leprosy, measles or malaria. Results of such evaluation could inform the future courses of actions around disease elimination science and health (DESH) and help develop better nations.

Epidemiological characteristics of leprosy during the period 2005-2020: A retrospective study based on the Chinese surveillance system.

Background: Jiangsu Province is located in the Yangtze River Delta region, with a total area of 107,200 square kilometers. Since 1949, over 55,000 cases have been registered, with Taixing accounting for the highest number of patients. The proportion of new cases with MB and G2D was higher compared to other regions. As a result, Jiangsu has been considered a priority area for public health interventions in China. Methods: This paper mainly described the population, time, and spatial distribution of the newly detected leprosy cases in Jiangsu Province between 2005 and 2020. In this study, all the data were entered into Microsoft Excel and SPSS for the descriptive analysis. ArcGIS was applied to create statistical maps, and Geoda was used to conduct spatial autocorrelation analysis with local Moran's I statistics (LISA). The epidemiological data were obtained from LEPMIS. In addition, population data were obtained from the Statistical Yearbook of Jiangsu Province. Results: During the study period, 363 new cases were reported. Of these, 232 were men and 131 were women (1.77:1). The mean age at diagnosis was 60.56 years, and no adolescent cases were identified. Three hundred and twenty-seven (90.08%) were diagnosed with MB and 36 (9.92%) with PB. 31.68% (115/363) of the patients presented with G2D. Farmers accounted for 74.9%, and most cases were identified in skin clinics (248, 68.32%). We observed a decreasing trend in detection rate, with a higher concentration of new cases diagnosed between July and October. Spatial analysis showed that the new cases were primarily distributed in the northwest of Jiangsu province, and Suqian has the highest incidence of leprosy. Special attention should be paid to Wuzhong, a county with a potential risk of inter-provincial transmission. Furthermore, 55 new cases came from other Chinese provinces but lived in Jiangsu. Conclusion: The NCDR of leprosy decreased, but the new cases showed disabilities, a sign of the late diagnosis. The results indicated that some regions were still suffering from the burden of leprosy. Thus, we recommend that the government should adopt effective strategies to promote leprosy control. The main priorities for eliminating new cases were to provide sustainable financial support, improve the quality of clinical services, strengthen preventive intervention and rehabilitation services for disabilities, provide health education among high-risk populations, and explore new approaches.

As ramificações do cuidado em liberdade como potência instituinte para (re)pensar a participação social em saúde e os diferentes modos culturais das coletividades / The ramifications of care in freedom as an instituting power to (re)think social participation in health and the different cultural modes of collectivities

Esta dissertação é fruto de um itinerário que foi se construindo no andar e no corpo da pesquisadora como fio condutor de um processo cartográfico. Em cada uma das aproximações empíricas apresentadas nos capítulos da dissertação, foi se constituindo um percurso cartográfico durante o mestrado que processou as aproximações com o campo empírico da participação e que desenvolveu a capacidade de pesquisar. O objetivo desta dissertação foi compreender ramificações que o cuidado em liberdade produz ao (re)pensar os efeitos da participação social em saúde em diferentes expressões da cultura em saúde de coletividades. Há uma dobra entre participar e produzir saúde, que desperta potência instituinte na afirmação da autonomia das pessoas e capacidade das coletividades de interferir nas políticas de saúde. A pesquisa fez aproximações empíricas com a 16a Conferência Nacional de Saúde e com populações tradicionais amazônicas, analisando documentos sobre diferentes aspectos da participação, seja na definição da política nacional de saúde, seja no enfrentamento à pandemia de COVID-19 na Amazônia. É necessário destacar que a "potência" não poderia ser "medida" com técnicas e métodos da pesquisa representacional. Então, o deslocamento entre uma experimentação e outra, permitiu enxergar linhas de força e expressões, muitas vezes lábeis, outras vezes apenas diversas daquelas encontradas nas pesquisas representacionais sobre os conselhos e conferências de saúde. A potência também se expressou como espaço de protagonismo, como autonomia para ocupar lugares de fala singulares e como reconhecimento da capacidade de expressar ideias válidas para a formulação da política e do cuidado. A condição do cuidado em liberdade se verifica na compreensão de que a saúde mental não está dissociada do corpo e da existência mesma das pessoas, que está associada com o contexto em que se vive e que se agudizam as condições de sofrimento diante de uma pandemia que interfere nos modos de ir e vir, sobretudo em um contexto em que o discurso governamental coloca segmentos da sociedade e a vida em si em vulnerabilidade. Mas o cuidado em liberdade também se expressa na capacidade de protagonismo das pessoas e coletividades para fortalecer formas de cuidar inclusivas e respeitosas às diferenças sociais e culturais. As ramificações da presente pesquisa referem-se à saúde como direito de todos, no encontro à "outras saúdes" e a liberdade em fazer parte de uma cultura com base no seu modo particular de viver através da integralidade enquanto um dos princípios do SUS, a políticas públicas que respeitem o outro e tanto nas coletividades quanto na confiança em um estado sem negacionismos. A pesquisa mostrou que a participação de todos se faz necessária quando se trata de defender o Sistema Único de Saúde (SUS), a saúde como direito, a produção de saúdes próprias de cada território e, principalmente, de exercer a democracia nos tempos atuais em que existem constantes ameaças em relação à saúde, ao cuidado e à vida.

The following dissertation is result of a schedule that had been created by the researcher as a guide of a mapping process. At each stage of experiential approach presented on the thesis' chapters, a cartographic pathway during the masters degree that has processed the proxies with the empiric field of the participation and developed the capacity of search. This essay aimed to understand branches that the freedom care produces by (re)think the effects of social engagement on health at different expressions of the wellbeing culture of communities. There is a gap between participate and produce health that awakens instituing output at the autonomy statements of people and public ability of disrupt at the health policies. This research made empirical approaches with the 16o National Conference of Health and the amazonic traditional groups, analyzing documents about different aspects of participation, both in the definition of national politics of health and in the confrontation to COVID-19 in Amazônia. Is necessary to detach that "power" couldn't be "measured" with techniques and methods of the representational research. Thus, the displacement between two trials allowed to perceive lines of force and expressions, many times labile, other times just several those found in the representational researchers about the council and conferences of health. The power also conveyed as protagonism, as self-sufficiency to occupy singular places of speech and as reconnaissance of ability to express valid ideas to the formulation of politic and care. The condition of liberty caution is verified in the comprehension that the mental health isn't decoupled from the body and the existance of people, which is associated to the inserted environment and that is aggravated the conditions of suffering before a pandemic that interfere in the right to come and go, mainly on the context which the governamental speech puts segments of society and life itself in susceptibility. But the precaution on freedom also is expressed on the ability of people's protagonism to fortify ways of taking care inclusive and reverents to the social and cultural differences ramifications of the current study are alluded to health as common right concerning other healthinesses and the possibility of making part of a culture based on its particular way of living thru the completeness as one of the SUS' principles, the public policies that preserve another and as in the collectivity as in trust on a state without negationisms. The present search showed the importance of everyone's participation in terms of defending the Single Health System (SUS), the health as a right, the production of specific soundness of each territory and specially of pursuing the democracy in current times on which health, care and life are frequently threatened.

Democracia e controle social: participação dos trabalhadores da saúde do Rio Grande do Sul nas Conferências de Saúde em 2019 / Democracy and social control: |b participation of health workers in Rio Grande do Sul in the Health Conferences in 2019

A Participação social e a Democracia são elementos fundamentais na organização do sistema de saúde brasileiro. As conferências e os conselhos de saúde foram regulamentados em 1990, o que possibilitou a criação dos espaços de participação da população e de controle social no Sistema Único de Saúde (SUS). Estas são experiências reconhecidas pela literatura como inovadoras, entretanto, ainda temos muitos desafios para seu fortalecimento. Objetivos: Este estudo se propôs a analisar a participação dos trabalhadores da saúde na Conferência Estadual de Saúde no Rio Grande do Sul. Etapa preparatória da 16a Conferência Nacional de Saúde. Metodologia: Estudo de abordagem qualitativa, que usou como método Estudo de Caso, para consolidar suas conclusões a respeito do fenômeno que foi investigado. Resultados e Discussões: Os achados buscaram ampliar o conhecimento sobre a temática da participação social e as políticas produzidas nesse espaço, especialmente sobre a inserção dos trabalhadores da saúde na construção do controle social do SUS no Estado do Rio Grande do Sul. O perfil sociodemográfico das/dos participantes da 16a CNS e da 8a CES/RS foram de mulheres, trabalhadoras na saúde e advindas de serviços públicos, sendo brancas no Rio Grande do Sul e pardas no Brasil. A faixa etária ficou entre 20 e 39 anos nos dois grupos. Em relação às propostas retiradas das conferências, todas as propostas da 8a CES/RS foram absorvidas pela 16a CNS/BR. Na discussão dos eixos, democracia era o tema central. Financiamento esteve presente nas discussões de todos os eixos. Apesar das diferentes bandeiras e grupos participantes, houve convergência na defesa da luta pelo Referendo de revogação das EC 85 e 96, além da contrarreforma Trabalhista e Previdenciária. Principais debates se deram em torno de propostas em defesa da democracia e manutenção dos conselhos de saúde. Defesa dos planos de carreira e atualização da tabela SUS. Além da discussão das políticas de saúde, num período pré-pandemia. Conclusões: O papel de controle social e seus posicionamentos se mostraram relevantes, e a participação dos trabalhadores foi fundamental, tendo em vista este segmento ter sido o maior em número absoluto de pessoas presentes na 8a CES. Ou seja, sua participação na discussão e elaboração de propostas foi expressiva.

Social Participation and Democracy are fundamental elements in the organization of the Brazilian health system. Conferences and health councils were regulated in 1990, which made it possible to create spaces for population participation and social control in the Unified Health System (SUS). These are experiences recognized by the literature as innovative, however, we still have many challenges for their strengthening. OBJECTIVE: This study aimed to analyze the participation of health workers in the State Health Conference in Rio Grande do Sul. Preparatory stage of the 16th National Health Conference. METHODOLOGY: Study with a qualitative approach, that used the Case Study method, to consolidate its conclusions about the phenomenon that was investigated. RESULTS AND DISCUSSIONS: The findings sought to expand knowledge on the subject of social participation and the policies produced in this space, especially on the insertion of health workers in the construction of social control of the SUS in the State of Rio Grande do Sul. The sociodemographic profile of the participants of the 16th CNS and the 8th CES/RS were women, health workers and coming from public services, being white in Rio Grande do Sul and brown in Brazil. The age group was between 20 and 39 years old in both groups. Regarding the proposals withdrawn from the conferences, all the proposals from the 8oCES/RS were absorbed by the 16th CNS/BR. In the discussion of the axes, democracy was the central theme. Financing was present in the discussions on all axes. Despite the different flags and participating groups, there was convergence in the defense of the fight for the referendum to repeal EC 85 and 96, in addition to the counter-reform of Labor and Social Security. Main debates took place around proposals in defense of democracy and maintenance of health councils. Defense of career plans and updating of the SUS table. In addition to the discussion of health policies, in a pre-pandemic period. CONCLUSIONS: The role of social control and its positions proved to be relevant and the participation of workers was fundamental, considering that this segment was the largest in absolute number of people present at the 8th CES. In other words, their participation in the discussion and elaboration of proposals was expressive.

Ensino e pesquisa na atenção à hanseníase no estado de São Paulo / Teaching and research in leprosy care in the state of São Paulo

Ao se abrir a temática da hanseníase como um problema de saúde pública grave e atual no Brasil, uma pergunta se faz de forma incisiva: por que esse problema persiste, se ele dispõe de tratamento medicamentoso gratuito e eficaz há mais de quatro décadas?A hanseníase tem uma longa trajetória e carrega em sua história heranças dramáticas, desde aquelas pré-bíblicas até as provindas das práticas de internação compulsória, ocorrida mais recentemente.Com o avanço e o menor custo das tecnologias baseadas em biologia molecular, em 2022, foram aprovados pela CONITEC a disponibilização do teste rápido na atenção básica para casos suspeitos/contatos e o PCR para serviços de referências, auxiliando, assim, na confirmação do diagnóstico e na pesquisa de resistência medicamentosa.

A comparison of three types of targeted, community-based methods aimed at promoting early detection of new leprosy cases in rural parts of three endemic states in India.

BACKGROUND: India achieved elimination of leprosy nationally in 2005, but since then the number of patients with grade 2 disability at diagnosis increased steadily indicating delay in diagnosis. Therefore, there was a need for public health interventions which can increase case finding in their earlier stage. The objective of this study is to compare the effectiveness of three such community-based interventions; 1) Enhancement of community awareness on leprosy; 2) Education and motivation of "Index" leprosy cases; and 3) Involvement of Non-Formal Health Practitioners (NFHPs) to promote early detection of new cases of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: Three community-based interventions were implemented between April 2016 and March 2018, embedded within the National Leprosy Eradication Program (NLEP) of India. Interventions were 1) increasing awareness through involvement of Gram Panchayat (local government) in the community regarding early signs of leprosy (Awareness), 2) providing health education and motivating newly diagnosed leprosy patients to bring suspects from their contacts (Index) and 3) training local non-formal health practitioners (NFHP). Each intervention was implemented in a group of ten blocks (sub-division of district) with an additional ten blocks as control (with no intervention). The main outcomes were number of new cases detected and number of grade 2 disability among them. They were obtained from the routine NLEP information system and compared between these interventions. On an average, there was an addition of 1.98 new cases in Awareness blocks, 1.13 in NFHP blocks and 1.16 cases in Index intervention blocks per month per block after adjusting for changes in control blocks during the same period. In terms of ratio, there was a 61%, 40% and 41% increase in case notification in awareness, Index and NFHP intervention, respectively. Overall, the percentage of grade 2 disability across intervention blocks declined. CONCLUSION: The Awareness intervention appears to be more effective in detection of new cases, compared to Index case motivation and sensitization of NFHPs. However, it is important to stress that while selecting strategies to increase early diagnosis it is important to determine, which is the most appropriate for each context or area and must be decided depending on the local context.