Meaning of leprosy for people who have experienced treatment during the sulfonic and multidrug therapy periods.

OBJECTIVE: to analyze the meanings of leprosy for people treated during the sulfonic and multidrug therapy periods. METHOD: qualitative nature study based on the Vigotski's historical-cultural approach, which guided the production and analysis of data. It included eight respondents who have had leprosy and were submitted to sulfonic and multidrug therapy treatments. The participants are also members of the Movement for Reintegration of People Affected by Leprosy. RESULTS: the meanings were organized into three meaning cores: spots on the body: something is out of order; leprosy or hanseniasis? and leprosy from the inclusion in the Movement for Reintegration of People Affected by Leprosy. CONCLUSION: the meanings of leprosy for people submitted to both regimens point to a complex construction thereof, indicating differences and similarities in both treatments. Health professionals may contribute to the change of the meanings, since these are socially constructed and the changes are continuous.

[Attitudes towards physical disability in the Middle Ages]. / Postawy wobec niepelnosprawnosci fizycznej w okresie sredniowiecza.

The article describes attitudes to disability and physically disabled people, taking into account the aspect of ethical and social location, what physically disabled meant in societies, and ways to solve the problems of disability. The article is based on studies of disability and historical sources. Christ's attitude shown in the Gospels changed the traditional cultures of the ancient treatment of disability in terms of it being seen as a penalty of the divine. The development of Christianity caused a gradual expansion of the ideas of charity, at the same time stepping up care and material support to all those physically disabled in need. Care of the disabled is based mostly on charity. Church activities supported, by the structure of the State and private individuals, was of paramount importance. Medieval society felt responsible for disabled people.

The pathway to foot ulceration in diabetes.

It should now be possible to achieve a reduction in the incidence of foot ulceration and amputations as knowledge about pathways that result in both these events increases. However, despite the universal use of patient education and the hope of reducing the incidence of ulcers in high-risk patients, there are no appropriately designed large, randomized controlled trials actually confirming that education works. It has been recognized for some years that education as part of a multidisciplinary approach to care of the diabetic foot can help to reduce the incidence of amputations in certain settings. Ultimately, however, a reduction in neuropathic foot problems will only be achieved if we remember that the patients with neuropathic feet have lost their prime warning signal­pain­that ordinarily brings patients to their doctor. Very little training is offered to health care professionals as to how to deal with such patients. Much can be learned about the management of such patients from the treatment of individuals with leprosy: if we are to succeed, we must realize that with loss of pain there is also diminished motivation in the healing of and prevention of injury.

Leprosy and its dental management guidelines.

OBJECTIVES: Leprosy is a chronic, non-fatal disease caused by Mycobacterium leprae. It can cause cutaneous lesions, peripheral nerve lesions and orofacial manifestations, including destruction of the alveolar premaxillary process associated with loss of the maxillary incisors. The aims of this study were to assess orofacial manifestations of disease in patients attending the Bombay Leprosy Project clinics and develop clinical guidelines for dentists. MATERIALS AND METHODS: A cross-sectional questionnaire based study was administered to 43 diagnosed leprosy patients. This included questions on perceived oral health status and oral hygiene habits. An extra-oral and intra-oral examination was also performed. RESULTS: Eighty-four per cent of patients were male with a mean age of 35.9 years. Forty-nine per cent had extra-oral cutaneous lesions. Twenty-eight per cent had intra-oral lesions including hyperpigmented patches. Twenty-one per cent had cranial nerve involvement and the trigeminal nerve was most commonly affected. CONCLUSIONS: From this data a clinical dental pathway protocol for managing patients with leprosy was developed. It highlights dental issues when managing leprosy patients. Nerve involvement may mean patients are unable to give an accurate account of their symptoms. Special tests should include cranial nerve examination and swabs of intra-oral ulcers. Low rates of infectivity means that normal infection control measures can be taken when treating these patients.

[Self-perception of people afflicted with leprosy regarding their oral health and the need for treatment]. / Autopercepção de pessoas acometidas pela hanseníase sobre sua saúde bucal e necessidade de tratamento.

Leprosy is an infectious disease that has an impact from a physical, social and psychological standpoint. The scope of this study was to assess the self-perception on oral health and need for treatment in leprosy patients in the city of Fortaleza, State of Ceará, Brazil. This is a cross-sectional and descriptive study, where 100 leprosy patients were given a semi-structured questionnaire to fill out. The results of the bivariate analysis between need for treatment and socio-economic characteristics showed that only education revealed a statistical association (p=0.000). An association was verified between the classification of oral health and self-perception of need for treatment (p=0.05). With respect to the self-perception of oral health, 36% of the researched subjects classified their oral health as good. The self-perception of leprosy patients regarding their oral health and need for treatment, together with a clinical evaluation, should serve as a guide for the drafting of public policies that aim to foment more effective dental treatment for these patients.

Disease-avoidance processes and stigmatization: cues of substandard health arouse heightened discomfort with physical contact.

An evolutionary approach to stigmatization suggests that disease-avoidance processes contribute to some instances of social exclusion. Disease-avoidance processes are over-inclusive, targeting even non-threatening individuals who display cues of substandard health. We investigated whether such cues motivate avoidance of physical contact in particular. In Studies 1 and 2, targets with disease (e.g., leprosy) or atypical morphologies (e.g., amputated leg, obesity) were found to arouse differentially heightened discomfort with physical (versus nonphysical) contact, whereas a criminal target (stigmatized for disease-irrelevant reasons) was found to arouse elevated discomfort for both types of contact. Study 3 used a between-subjects design that eliminated the influence of extraneous factors. A diseased target was found to arouse differentially heightened discomfort with physical (versus nonphysical) contact, and to do so more strongly than any other type of target.

Autopercepção de pessoas acometidas pela hanseníase sobre sua saúde bucal e necessidade de tratamento / Self-perception of people afflicted with leprosy regarding their oral health and the need for treatment

A hanseníase é uma doença infecciosa que produz impacto do ponto de vista físico, social e psicológico. O propósito deste estudo foi avaliar a autopercepção sobre saúde bucal e a necessidade de tratamento em pacientes com hanseníase no Município de Fortaleza (CE), Brasil. Trata-se de um estudo transversal e descritivo, onde 100 pacientes com hanseníase foram submetidos a questionário semiestruturado. Os resultados da análise bivariada entre necessidade de tratamento e características socioeconômicas mostrou que apenas a escolaridade apresentou associação estatística (p = 0,000). Verificou-se associação entre a classificação da saúde bucal e autopercepção da necessidade de tratamento (p = 0,05). Com relação à autopercepção em saúde bucal, 36% dos sujeitos pesquisados classificaram sua saúde bucal como boa. A autopercepção do paciente com hanseníase quanto a sua saúde bucal e necessidade de tratamento deve, juntamente com uma avaliação clínica, servir de guia para a execução de políticas públicas que visem a favorecer um tratamento odontológico mais efetivo para esses pacientes.

Leprosy is an infectious disease that has an impact from a physical, social and psychological standpoint. The scope of this study was to assess the self-perception on oral health and need for treatment in leprosy patients in the city of Fortaleza, State of Ceará, Brazil. This is a cross-sectional and descriptive study, where 100 leprosy patients were given a semi-structured questionnaire to fill out. The results of the bivariate analysis between need for treatment and socio-economic characteristics showed that only education revealed a statistical association (p=0.000). An association was verified between the classification of oral health and self-perception of need for treatment (p=0.05). With respect to the self-perception of oral health, 36% of the researched subjects classified their oral health as good. The self-perception of leprosy patients regarding their oral health and need for treatment, together with a clinical evaluation, should serve as a guide for the drafting of public policies that aim to foment more effective dental treatment for these patients.

Photoprotection and vitamin D status: a study on awareness, knowledge and attitude towards sun protection in general population from Kuwait, and its relation with vitamin D levels.

BACKGROUND: The primary cause of skin cancers is exposure to ultraviolet (UV) radiation. And, for decades sun protection has been promoted in various public health education campaigns. Recently, however, vitamin D deficiency has been related to increased risk of skin cancers. And, skin being the primary site for the synthesis of active form of vitamin D, excessive sun protection could lead to vitamin D-deficient states. But, the results have so far been conflicting. AIMS: To study the level of awareness, knowledge and attitude of representative groups from the general population from Kuwait towards sun protection. And, also study the correlation of the level of sun protective measures used and vitamin D levels in these groups. METHODS: The study constituted of two main parts. First part comprised a questionnaire-based survey of representative group of people aged 18 and above to assess their knowledge, awareness and attitude towards sun protection. The second part consisted of measuring serum vitamin D levels in 150 volunteers amongst the responders of the questionnaire, who had been regularly using sunscreens for at least 2 years and compare to the levels seen in 150 age and sex-matched responders of similar skin phototypes, who had never used sunscreens. RESULTS: Out of the total of 1044 responders, 80% of them had adequate knowledge of the beneficial and harmful effects of sun exposure, and had been using sunscreens regularly, and adopting other sun protective measures in their daily life. The levels of vitamin D were found to be deficient in both sunscreen users and those who had never used sunscreens. The difference between the two groups was statistically insignificant (60.67% vs 54.67%; P value>0.001). CONCLUSION: Population at large seems to be adequately informed about the beneficial and deleterious effects of sun exposure. Vitamin D levels are deficient in majority of our people, and there is a need to do larger surveys covering all parts of the country and give supplemental doses of vitamin D to those found deficient.

Os contatos de portadores de Hanseníase em Paracatu (MG): perfil, conhecimentos e percepções / The leprosy bearers' contacts in Paracatu (MG), profile, understandings and perceptions

A hanseníase representa ainda um grave problema de saúde pública no Brasil e, sobretudo, em Paracatu-MG(detecção de 17,9/100.000 hab. em 2010). Uma parte importante dos contatos de crianças previamente tratadas não havia comparecido ao serviço de saúde para realização do exame dermato neurológico. Objetivos: conhecer o perfil socioeconômico dos contatos de escolares tratados de hanseníase em Paracatu (MG), de 2004 a 2006, identificar o conhecimento sobre a doença, a percepção sobre os serviços de saúde do município e identificar os motivos do não comparecimento para a realização do exame dermato neurológico preconizado. Foi desenvolvido um roteiro de entrevista semi estruturada, aplicado em visitas domiciliárias, no ano de 2009, a 46 sujeitos de 33 famílias. Resultados: Do total de 46 contatos pesquisados, 61% eram homens e 24% encontram-se entre a faixa etária de 21 a 28 anos; 33% eram os pais das crianças tratadas, 54% analfabetos funcionais, com renda familiar de 1 a 2 salários mínimos. Entre os entrevistados, 78% residiam em bairros periféricos pobres. O principal motivo referido por 38% dos contatos para a não realização do exame dermato neurológico foi falta de tempo devido ao horário trabalho. O risco de adquirir a doença era desconhecido por 50,0% dos entrevistados, que sugeriram ampliação dos horários de atendimento, visitas domiciliárias da equipe de saúde com informações e divulgações da doença como melhorias ao acesso aos serviços de saúde. Conclusão: a reorientação dos serviços de saúde pode ampliar as ações de promoção de saúde, de prevenção da doença e adesão ao tratamento da hanseníase.

Leprosy is a serious public health problem in Brazil and especially in the county of Paracatu (MG), a site of priority for the disease control according to the National Program of Leprosy Control due to a high detection rate (17.9%/ 100,000 inhabitants – detection rate in 2008). A significant part of intra domiciliary contacts of the school children treated for leprosy previously (2004 to 2006) were not submitted to the dermato neurological examination. Aims: Identify leprosy intra domiciliary contacts socio economic profile, their awareness about the disease, their perceptions about local health services, and the reasons of not being exanimate. We have developed a semi-structured interview, applied in home visits for 46 subjects from 33 families in Paracatu (MG), performed during 2009. Results: Among the 46 intra domiciliary contacts, 61.0% were male, 24.0% aged from 21 to 28 years, 33.0% were fathers of a treated child, 54.0% functionally illiterates, with a low familiar income; 78.0% were residents of periphery neigh borhood, with low socio economic conditions and insufficient coverage of sanitary infrastructure. The main reason given for not being submitted to the dermato neurologic examination, by 38.0% of the contacts, was due to work period. About 50.0% of the interviewed referred not know about the risk of acquiring the disease. They suggested an enlargement of the timetables for health services and domiciliary visits, information about the disease, as well as the improvement of health services access. Conclusion: health services reorientation can enhance health promotion actions, disease prevention and adhesion to leprosy treatment.

Stigma and social participation in Southern India: differences and commonalities among persons affected by leprosy and persons living with HIV/AIDS.

Stigma is a common phenomenon worldwide and infectious diseases like HIV/AIDS and leprosy are often associated with high levels of stigma. Several studies have been conducted concerning the effects of stigma and the impact on social participation, but comparative studies are rare. The objective of this study was to identify differences and similarities between HIV/AIDS and leprosy-related stigma. From April till July 2009, 190 questionnaire-based interviews were conducted to assess the levels of internalized stigma (Internalized Stigma of Mental Illness scale), perceived stigma (Explanatory Model Interview Catalogue stigma scale) and social participation (Participation scale) in a cross-sectional sample of people affected by leprosy (PL) and people living with HIV/AIDS (PLHA). Respondents were selected from several hospitals, charity projects and during home visits in Vellore district, Tamil Nadu. Our results showed that both PLHA (n = 95) and leprosy-affected respondents (n = 95) faced a substantial burden of internalized and perceived stigma, with the former reporting a significantly higher level of stigma. As a result, PLHA faced more frequent and also more severe participation restrictions than PL. Especially, restrictions in work-related areas were reported by the majority of the respondents. In conclusion, PLHA faced a significantly higher level of stigma and participation restriction than PL. However, the latter also reported a substantial burden of stigma and participation restrictions. The study suggests that it may be possible to develop joint interventions based on the commonalities found. More research is needed to define these more precisely and to test the effectiveness of such joint interventions in reducing stigma and improving social participation.

Correlates of human immunodeficiency virus (HIV) related knowledge among HIV infected people.

BACKGROUND: The current adult prevalence of HIV in India is 0.34%. HIV infected persons should have adequate knowledge about the modes of transmission of infection. This is essential for reducing the risk of secondary infection, preventing coinfection from other viruses such as hepatitis B and for protecting the uninfected. Identification of the correlates of poor knowledge among HIV positive subjects will aid in planning effective measures to improve their health knowledge about HIV. AIMS: To explore HIV related knowledge among HIV positive subjects and to determine the correlates of their knowledge. METHODS: The study was conducted between November 2005 and May 2007. Two hundred HIV positive subjects attending a tertiary care hospital and three non-governmental organizations in Puducherry, South India, were recruited for the study. They were interviewed using a pre-tested structured questionnaire regarding their knowledge about HIV and were divided into those with HIV knowledge score > 90% and those with score ≤ 90%. The data were analyzed using Chi-square test and logistic regression. Odds ratio (OR) and 95% confidence intervals were also calculated. RESULTS: The median knowledge score was 90%. Knowledge on the modes of HIV transmission was better than that on the modes by which it does not spread. Subjects who had received counseling (OR: 16.78), studied above class 10 (OR: 4.13), and those with duration of more than 1 year since diagnosis (OR: 3.12) had better HIV knowledge score (>90%). Persons counseled by HIV positive peers had a better knowledge. CONCLUSION: This study revealed the importance of counseling in improving the HIV related knowledge among HIV positive individuals. It also highlights the beneficial effect of peer counseling.

The inclusivity of exclusion: isolation and community among leprosy-affected people in the South Pacific.

From 1911 to 1969 those people diagnosed with leprosy in the South Pacific were gradually isolated and received medical treatment at the Central Lepers' Hospital, Makogai Island, Fiji. Until the discovery of sulfones in the 1940s leprosy was largely incurable and it was expected that those who went to the island would never return. This paper assumes that the stigma attendant on leprosy which provoked the isolation order is itself a form of disability. The paper draws on patients'stories to explore their individual and collective experience of isolation and suggests that for many, collective isolation on Makogai was an enabling experience. On Makogai, leprosy was the 'norm', the social disability of stigma was removed and people were able to be self-sufficient, to build community and social relationships and to live a fairly ordinary island life.

Mental illness: a modern-day leprosy?

Leprosy in the ancient world involved quarantine from family and society and great stigma. Similarly, mental illness today can involve separation, lost potential, and stigma. As with leprosy, most people misunderstand etiology, treatment, and prognosis in mental illness. Nurses are in a key position to educate, intervene, and improve mental health outcomes.

Study on differences and similarities in the concept and origin of leprosy stigma in relation to other health-related stigma.

While the experienced or enacted stigma may be the same for all health related stigma, in terms of isolation, discrimination and social participation restrictions of the affected persons; the concept and origin of stigma varies from one disease to another. An understanding of the cause of stigma is, therefore, essential to formulate effective strategies for its reduction/elimination. This is especially imperative in the case of leprosy where the basis of stigma is significantly different from other health related stigma. In this paper, a comparison is made between the concept and origin of leprosy stigma with that of other stigmatised diseases.

Stigma in leprosy: miles to go!

No disease has been more closely associated with stigma than leprosy such that it has become a metaphor for stigma. Stigma has been difficult to measure and little research has been done on this issue. Stigma reduction has not been an important component of anti-leprosy program. The study was undertaken to measure the stigma associated with leprosy by using P scale which is used for assessing participation restriction of those affected by the disease. This comparative questionnaire based study was carried out in two sets of patients. Two groups of 30 patients each were studied. First group belonged to a Government run Leprosarium and group two from a tertiary care skin and leprosy centre. The study used the Participation (P) scale and data was collected by interviewing the patients. Participation restriction was defined as any score equal to and more than 13. Participation restriction was observed in 27 (90%) cases of group 1while participation restriction was present in only 7 (23.3%) subjects of group 2. It was observed that mean score of participation restriction in group 1 was quite high at 31.9 while it was only 8.3 for group 2. The participation restriction was directly related to the duration of disease and the grade of disability. Longer the duration of disease, greater was the likelihood of restriction. The participation restriction was found to be negatively correlated with the education. Recommendation about prevention of disability would require program about early diagnosis of nerve damage and subsequent action at the patient-family-community level and health care providers.

La différence: condition of exclusion or of reconnaissance?

From the Middle Ages onto the 19th century, following the trend set in leper hospitals, madness was to be hidden, secluded in dark places, far away from the mainstream of society. The emergence of the mad person, perceived as inevitably different, allows to make the boundaries between reason and folly, between human and inhuman, irrelevant. If leper hospitals have almost emptied out, if there are much fewer confinement facilities, the values and images related to the leper or the mad person, as well as the sense of exclusion, continue to persist. The purpose of this paper is to show clearly that this matter of exclusion is a serious legacy that could very well apply nowadays to other figures that, each in their own way, symbolize menace or mockery. It applies notably to the aged and the dying who both appear as the opposite of modern society and its values of efficiency, productivity and profitability. The multiplication of places where old people are left to die, and the elderly who are crowded in old folks homes, stand as proof of their exclusion from society. Nevertheless, youth and old age coexist, as well as life and death. If care of others is the trait of a humane civilization, must it be understood that barbarism consists in ignoring its own humanity as well as that of others? In view of such practices of exclusion, policy statements based on recognition of human dignity, where ethical obligation rests on recognition of others and humanism, are rather paradoxical. Is this a paradox or a deadlock; a condition of exclusion or of reconnaissance?

Healthcare seeking behaviour and delay in diagnosis of leprosy in a low endemic area of China.

Delay in diagnosis of leprosy can increase the risk of nerve function impairments and promote the transmission of the infection in a community. In order to understand the factors associated with the delays in diagnosis of leprosy, a questionnaire-based interview was conducted to collect information on the delays among 88 newly diagnosed leprosy patients. The results showed that delay was common and associated with the high rate of disability in the study population. The total mean delay was 50.18 months (median 36 months). The mean patient delay was 24-4 months (median 9.5 months) and the mean health service delay was 257 months (median 12 months). Patients with leprosy reported a variety of symptoms/signs at an early stage of the disease, particularly numbness and tingling. Ignorance of the illness was reported to be the main reason for the patient's delay. Health seeking actions ranged from 1 to 50 with a mean of 7.2 after becoming aware of the first symptom/sign. The effectiveness of early diagnosis of leprosy through health promotion in the population needs to be validated and continuous training on leprosy among healthcare providers is needed.

Formas de aislamiento físico y simbólico: la lepra, sus espacios de reclusión y el discurso médico-legal en Argentina / Ways of physical and symbolic isolation: leprosy, its isolation spaces and the medical-legal discourse in Argentina

Durante la primera mitad del siglo XX la presencia de la lepra en sociedades modernas suscitó variadas reacciones. Aun sin que desaparecieran ancestrales prejuicios, el discurso médico-legal abordó un problema que excedía el marco estrictamente sanitario. El trabajo analiza el modo en que, desde una perspectiva científica, fueron gestadas en Argentina respuestas que creyeron hallar en el aislamiento físico y simbólico del leproso una forma proteger la población y el futuro de la raza. En ese contexto, la eugenesia legitimó fuertes restricciones de derechos a enfermos sobre los que siguió pesando aquel estigma ancestral (AU)

During the first half of the twentieth century, the presence of leprosy in modern societies provoked various reactions. As ancient prejudices had not disappeared yet, the medical-legal discourse dealt with a problem that exceeded the strictly sanitary framework. From a scientific perspective, this paper analyzes the way in which answers find that seemed the population and the future of the race in the physical and symbolic isolation of the leper, were developed in Argentina. In that context, the eugenics legitimated strong restrictions of rights to sick persons on whom this ancestral stigma continued to carry much weight (AU)