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.

Canada's neglected tropical disease research network: who's in the core-who's on the periphery?

BACKGROUND: This study designed and applied accessible yet systematic methods to generate baseline information about the patterns and structure of Canada's neglected tropical disease (NTD) research network; a network that, until recently, was formed and functioned on the periphery of strategic Canadian research funding. METHODOLOGY: MULTIPLE METHODS WERE USED TO CONDUCT THIS STUDY, INCLUDING: (1) a systematic bibliometric procedure to capture archival NTD publications and co-authorship data; (2) a country-level "core-periphery" network analysis to measure and map the structure of Canada's NTD co-authorship network including its size, density, cliques, and centralization; and (3) a statistical analysis to test the correlation between the position of countries in Canada's NTD network ("k-core measure") and the quantity and quality of research produced. PRINCIPAL FINDINGS: Over the past sixty years (1950-2010), Canadian researchers have contributed to 1,079 NTD publications, specializing in Leishmania, African sleeping sickness, and leprosy. Of this work, 70% of all first authors and co-authors (n = 4,145) have been Canadian. Since the 1990s, however, a network of international co-authorship activity has been emerging, with representation of researchers from 62 different countries; largely researchers from OECD countries (e.g. United States and United Kingdom) and some non-OECD countries (e.g. Brazil and Iran). Canada has a core-periphery NTD international research structure, with a densely connected group of OECD countries and some African nations, such as Uganda and Kenya. Sitting predominantly on the periphery of this research network is a cluster of 16 non-OECD nations that fall within the lowest GDP percentile of the network. CONCLUSION/SIGNIFICANCE: The publication specialties, composition, and position of NTD researchers within Canada's NTD country network provide evidence that while Canadian researchers currently remain the overall gatekeepers of the NTD research they generate; there is opportunity to leverage existing research collaborations and help advance regions and NTD areas that are currently under-developed.

Sustainability of integrated leprosy services in rural India: perceptions of community leaders in Uttar Pradesh.

As part of a community-based action research to reduce leprosy stigma, village committees were formed in 3 hyper endemic states of India. From a total of 10 village committees with nearly 200 members from Uttar Pradesh, a systematic random sample of 69 men and 23 women were interviewed in-depth regarding their views on sustainability of integrated leprosy services, as currently adopted. Their recommendations were also sought for further enhancement. Percentages were computed and compared for statistical significance using the z-normal test. The findings show that less than 50% of the respondents were confident that the present trend in voluntary early reporting for MDT and management of complications was adequate to sustain the integrated leprosy services. There were no differences by men or women members and they felt that lack of proper facilities, training and orientation of staff are most influencing factors. Many suggestions were given for improving the sustainability.

[Effect of physician shortage on today's Hansen's disease management].

In recent years, the total patient population of Hansen's disease has been rapid declining throughout Japan by as many as 200 - 250 each year. This decline is due to the aging of existing patients, and scarcity of new cases. Less patients are a welcome phenomenon. However, existing treatment facilities are now confronted with problems. The most serious problem is shortage of treating physicians. The causes of the shortage are (1) the aging of the existing patient population that creates mounting need for medical-surgical care and (2) the nation-wide shortage of physician in national sanatoria all over Japan. Let me present a sketch of the current situation at Amamiwakouen Hospital as an illustration. Amamiwakouen is a government-run sanatorium. It is responsible to take care of inpatient as well as out patients. Currently, there are 70 long term inpatients, who are handicapped by Hansen's disease sequela of various degrees. 11 minimally former inpatients are followed at the outpatient clinic. The clinic is also open to all community citizens. The number of annual clinic visitors averages 6,500 - 7,000. They come with wide range of problems requiring a dermatologist. While the total number of full-time staff is 100, only two are licensed physicians at present. This is indeed a disastrous situation. Therefore a number of contract physicians are recruited from nearby medical institutes to meat the demand.

Pace of leprosy elimination and support teams in Bihar state, India.

Despite the extensive implementation of multiple drug therapy (MDT) in most leprosy-endemic countries world-wide since 1982, bringing about a remarkable reduction in prevalence, there are still regions at the sub-national level where the implementation of MDT remains difficult. The state of Bihar (population 86.3 million) in India is a good example of such a region. Previously rated as one of the most highly endemic states, it still contributes about 21% of the total caseload in India and about 12% of the global caseload. For various reasons, case-finding and drug treatment have lagged behind the progress made in most other states in the country and in 1996, the Damien Foundation India Trust (DFIT) volunteered technical support to increase the pace of elimination. Sixteen out of the 39 districts in the state were allocated, with a population of 41.8 million. Support teams, including a Medical Advisor and a Non-Medical Supervisor, both with over 10 years experience of leprosy work and control programmes, were provided to assist and work alongside government staff in case detection, treatment delivery, case-holding and discharge in their respective areas of operation. New case detection by intensive survey increased by 394% and total new case detection by 226% during the year 1996-1997, with similar trends in the following year. Striking improvements were also observed in MDT coverage, treatment regularity, monitoring and discharge of patients and in the training of local staff. This collaboration between a non-government agency (DFIT) and the staff of the National Leprosy Eradication Programme in 16 out of 39 districts in the State of Bihar has clearly been extremely successful. Similar approaches in the remaining districts of Bihar, and in other parts of India, where the infrastructure is available but inadequate, may contribute significantly to achieving the elimination goal at national and sub-national levels.

Modified leprosy elimination campaign in Mumbai (Bombay), India--a report.

With appropriate planning and preparation, a modified leprosy elimination campaign (MLEC) was undertaken in Brihan Mumbai (Bombay), which has a population of around 11 million. For the campaign, 4879 non-leprosy paramedical and non-medical personnel were trained and utilized as searchers. The MLEC revealed 1410 new leprosy cases, with a new case detection rate of 1.83/10,000. Over 80% of all cases detected were either single-lesion or paucibacillary (PB), and thus of limited significance with regard to transmission. Further efforts are required to detect and treat cases of consequence (those with more than five lesions and those with positive skin smears) and to identify reservoirs of infection.

An investigation of attitudes, beliefs and behaviour of leprosy patients, family members and PHC workers towards multidrug therapy in Yangzhou and Dongtai Districts of China.

To improve the operational efficiency of multidrug therapy (MDT) implementation in rural areas, an investigation into the attitudes, beliefs and behaviour of leprosy patients and their family members as well as primary health care (PHC) workers towards MDT was carried out in Yangzhou and Dongtai Districts of China. A sample of 370 leprosy patients, 594 family members and 730 PHC workers was interviewed or investigated individually using questionnaires. The results showed that: 1, the presently used MDT is acceptable to a wide range of patients although a small number of patients have various problems in their treatment; 2, the patients' habit in daily drug administration, their awareness of the risk of default and confidence in MDT have a positive influence in increasing drug compliance; and 3, the supervision and encouragement of family members to patients' treatment which is associated with their knowledge on MDT is also beneficial to patients' drug compliance. However, only half of the PHC workers had a basic knowledge of MDT and a desire to participate in MDT implementation, a finding which clearly calls for urgent attention and improvement. In order to ensure the effective implementation of MDT, there is a need to educate leprosy patients and their family members as well as PHC workers to establish the patients' correct awareness of MDT, obtain the family support and motivate the PHC workers.

[Vicissitudes of treating leprosy handicaps in Kapolowé, Zaïre]. / Vicissitudes du traitement des handicaps hanséniens à Kapolowé (Zaïre).

In 1990 Kapolowé was, without a doubt, the site of the only surgical centre in Zaire dealing with handicaps which developed in as an after-effect of leprosy. It would be useful to explain the hazards involved in such a venture for reasons which do not pertain to medicine but, rather, to particularly trying socio-political circumstances. The best surgical expertise was thrown out for political reasons. Insecurity and economic hardships practically halted movement and, consequently, the wider application of such expertise. During a mission in 1994, there was a partial resumption of activities. The surgical team was reinstalled and made operational. It had been possible to state that multidrug therapy (MDT) had always ensured that the disabled leprosy patients, living in groups, and treated before 1990 under regular supervision, did not experience serious relapses. That fact corroborates earlier information relating particularly to surgical decompression. Although most of them were able to resume a certain measure of professional activity, social factors must still be borne in mind and the concept of partial permanent disability must be applied.

[An original experience through the creation of a new functional rehabilitation center for Vietnamese lepers]. / Une expérience originale à travers la création d'un nouveau centre de réhabilitation fonctionnelle pour les lépreux vietnamiens.

Since 1990, the creation of a Rehabilitation Center for Vietnamese leprosy patients under the aegis of "Oeuvres Hospitalières Françaises de l'Ordre de Malte" is the result of emphasized collaboration between governmental and non-governmental organizations, and between medical and paramedical specialists. This humanitarian action is not "a present home delivery". The end of this action is to set progressively a realist enterprise that depends on preliminary epidemiologic investigations on the spot to analyse means and necessities. Frequency of disabilities (49.6%) and predominance of grades 1 and 2 (83.5%) require aids. The realisation of technology transfer at all medical care levels is necessary. But at the same time, it is essential to build surroundings adapted infrastructure, to equip with effective material giving comfort and security for patients, and even to supply with pharmaceutic drugs in order to continue rehabilitation's activities. In short range, patient's selection and regular control give first objective results.

Health and human resource mobilization: an assessment of staffing pattern in NLEP at operational level.

In this paper the staffing pattern, training and infrastructural facilities of the National Leprosy Eradication Programme (NLEP) at operational level as well as the attendant problems in mobilising human resources are discussed. The study shows that the major portion of the work of the NLEP is being shared by the PMWs (72%), followed by NMS (14%) and Medical Officers (5%). The population served by the PMW in all the high and moderate endemic regions is more than the prescribed limit except in Nagaland and Sikkim. In the same areas, the Medical Officer serves a population more than the norm in Andhra Pradesh, West Bengal, Maharashtra, Karnataka and Bihar. Regarding case load, in no state the M.O. serves more than 2500 cases except in Bihar and Kerala, in moderate endemic and low endemic regions respectively. The PMW in Haryana and Punjab states attends more than 250 cases. In NLEP every one out of four sanctioned posts is vacant. There is also an urgent need to rationalize the training programme so that there is optimal utilization of the training centres.