Leprosy: The age-old companion of humans - Re-evaluation and comparative analysis of Avar-period cases with Hansen's disease from the Danube-Tisza Interfluve, Hungary.

In recent years, our knowledge of leprosy in the past has substantially been enriched. Nonetheless, much still remains to be discovered, especially in regions and periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of eight Avar-period leprosy cases from the Danube-Tisza Interfluve (Hungary). In every case, to reconstruct the biological consequences of leprosy, the detected bony changes were linked with palaeopathological and modern medical information. To reconstruct the social consequences of being affected by leprosy, conceptualisation of the examined individuals' treatment in death was conducted. In every case, the disease resulted in deformation and disfigurement of the involved anatomical areas (rhinomaxillary region, feet, and/or hands) with difficulties in conducting certain physical activities. These would have been disadvantageous for the examined individuals and limited or changed their possibilities to participate in social situations. The most severe cases would have required continuous support from others to survive. Our findings indicate that, despite their very visible disease and associated debility, the examined communities did not segregate leprosy sufferers but provided and cared for them, and maintained a strong enough social network that made their survival possible even after becoming incapable of self-sufficiency.

Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned.

BACKGROUND: Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. METHODS: This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. RESULTS: A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0%) and reported knowledge on health care routes (46.0%). Unemployment (87.9%) and inadequate housing (57.8%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). CONCLUSION: People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.

Scientific literature on neglected tropical diseases: a bibliometric analysis.

Neglected tropical diseases (NTDs) are a group of diseases mainly affecting people in low- and middle-income Countries. The aim of this study was to perform a bibliometric analysis of the scientific literature on NTDs. Using the MeSH database, we quantified the number of publications on MEDLINE targeting each NTD, which were published from 1 January 1999 to 31 January 2019. In order to weight the number of publications targeting a given NTD according to the total number of publications/year, we calculated a Yearly Publication Index (YPI) for each NTD/year. Linear regression was used to determine if there was a significant increase or decrease of YPI over time. In order to weight the number of publications according to disease burden (expressed in Disability-adjusted life years - DALYs) we calculated a DALYs-weighted Publication Index (DWPI) for each NTD. The highest absolute number of publications focused on leishmaniasis, dengue and Chagas disease; the lowest on tungiasis, dracunculiasis, chromoblastomycosis and yaws. The number of publications significantly increased for chikungunya, chromoblastomycosis, dengue, leishmaniasis, snakebite envenoming, and yaws. It significantly decreased for ascariasis, cysticercosis, echinococcosis, leprosy, lymphatic filariasis, mycetoma, onchocerciasis. Leprosy had the highest DWPI (i.e. the highest number of publication considering the burden of disease), followed by Chagas disease; lymphatic filariasis had the lowest, followed by onchocerciasis. Overall, lymphatic filariasis, onchocerciasis and ascariasis presented the worst scenario, with both very few publications compared with their disease burden and a decreasing number of publications.

Debaryomyces hansenii supplementation in low fish meal diets promotes growth, modulates microbiota and enhances intestinal condition in juvenile marine fish.

BACKGROUND: The development of a sustainable business model with social acceptance, makes necessary to develop new strategies to guarantee the growth, health, and well-being of farmed animals. Debaryomyces hansenii is a yeast species that can be used as a probiotic in aquaculture due to its capacity to i) promote cell proliferation and differentiation, ii) have immunostimulatory effects, iii) modulate gut microbiota, and/or iv) enhance the digestive function. To provide inside into the effects of D. hansenii on juveniles of gilthead seabream (Sparus aurata) condition, we integrated the evaluation of the main key performance indicators coupled with the integrative analysis of the intestine condition, through histological and microbiota state, and its transcriptomic profiling. RESULTS: After 70 days of a nutritional trial in which a diet with low levels of fishmeal (7%) was supplemented with 1.1% of D. hansenii (17.2 × 105 CFU), an increase of ca. 12% in somatic growth was observed together with an improvement in feed conversion in fish fed a yeast-supplemented diet. In terms of intestinal condition, this probiotic modulated gut microbiota without affecting the intestine cell organization, whereas an increase in the staining intensity of mucins rich in carboxylated and weakly sulphated glycoconjugates coupled with changes in the affinity for certain lectins were noted in goblet cells. Changes in microbiota were characterized by the reduction in abundance of several groups of Proteobacteria, especially those characterized as opportunistic groups. The microarrays-based transcriptomic analysis found 232 differential expressed genes in the anterior-mid intestine of S. aurata, that were mostly related to metabolic, antioxidant, immune, and symbiotic processes. CONCLUSIONS: Dietary administration of D. hansenii enhanced somatic growth and improved feed efficiency parameters, results that were coupled to an improvement of intestinal condition as histochemical and transcriptomic tools indicated. This probiotic yeast stimulated host-microbiota interactions without altering the intestinal cell organization nor generating dysbiosis, which demonstrated its safety as a feed additive. At the transcriptomic level, D. hansenii promoted metabolic pathways, mainly protein-related, sphingolipid, and thymidylate pathways, in addition to enhance antioxidant-related intestinal mechanisms, and to regulate sentinel immune processes, potentiating the defensive capacity meanwhile maintaining the homeostatic status of the intestine.

Culture circle with community health workers about (lack of) knowledge and stigma of leprosy.

OBJECTIVE: To describe the construction aboutthe (lack of) knowledge and stigma of leprosy by Community Health Workers participating in the Culture Circle. METHOD: Qualitative, action-research type study supported by the Paulo Freire Culture Circle framework, carried out with 21 Community Health Workers. Data collected in November 2021, in the municipality of São Luís, Maranhão. The following categories were evidenced: knowledge about leprosy, signs and symptoms, stigma. RESULTS: The participants had knowledge about the disease, but they verbalized people's disinformation about leprosy, disbelief in relation to the cure, and situations of prejudice and stigma that are still present today. FINAL CONSIDERATIONS: The culture circle enabled the intertwining of scientific and empirical knowledge in the construction of a critical and reflective knowledge committed to welcoming and comprehensive care for people and families affected by leprosy.

Financialisation and income inequality: An investigation of the financial Kuznets curve hypothesis among developed and developing countries.

The Financial Kuznets Curve (FKC) is a variant of the renowned Kuznets Curve and a counterpart to the Environmental Kuznets Curve. In this paper, we examine the financial Kuznets curve hypothesis-based on annual data for 20 developed and developing countries-using the Phillips and Hansen (1990) fully modified ordinary least square (FMOLS) and the unobserved components model (UCM). The results correspond to the current divergence in the empirical literature and show support for the inverted U-shaped curve as well as the U-shaped curve, in more than half of the sample countries. The estimated turning points differ significantly across countries and depending on the measure of financialisation used. Overall, the findings of this research suggest that there is no uniform effect of financialisation on income inequality. The results vary according to the level of economic development, financial structure, and potentially other factors that have not been considered in the empirical analysis provided in this paper.

Prevalence of post kala-azar dermal leishmaniasis (PKDL) and treatment seeking behavior of PKDL patients in Nepal.

BACKGROUND: In Nepal, the burden of post kala-azar dermal leishmaniasis (PKDL) is not known since there is no active case detection of PKDL by the national programme. PKDL patients could pose a challenge to sustain visceral leishmaniasis (VL) elimination. The objective of this study was to determine the prevalence of PKDL and assess PKDL patients' knowledge on VL and PKDL, and stigma associated with PKDL. METHODOLOGY/PRINCIPAL FINDINGS: Household surveys were conducted in 98 VL endemic villages of five districts that reported the highest number of VL cases within 2018-2021. A total of 6,821 households with 40373 individuals were screened for PKDL. Cases with skin lesions were referred to hospitals and examined by dermatologists. Suspected PKDL cases were tested with rK39 and smear microscopy from skin lesions. An integrated diagnostic approach was implemented in two hospitals with a focus on management of leprosy cases where cases with non-leprosy skin lesions were tested for PKDL with rK39. Confirmed PKDL patients were interviewed to assess knowledge and stigma associated with PKDL, using explanatory model interview catalogue (EMIC) with maximum score of 36. Among 147 cases with skin lesions in the survey, 9 (6.12%) were confirmed as PKDL by dermatologists at the hospital. The prevalence of PKDL was 2.23 per 10,000 population. Among these 9 PKDL cases, 5 had a past history of VL and 4 did not. PKDL cases without a past history of VL were detected among the "new foci", Surkhet but none in Palpa. None of the cases negative for leprosy were positive for PKDL. There was very limited knowledge of PKDL and VL among PKDL cases. PKDL patients suffered to some degree from social and psychological stigma (mean ± s.d. score = 17.89 ± 12.84). CONCLUSIONS/SIGNIFICANCE: Strengthening the programme in PKDL case detection and management would probably contribute to sustenance of VL elimination. Awareness raising activities to promote knowledge and reduce social stigma should be conducted in VL endemic areas.

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

Resumo 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.

Abstract 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.

Perfil epidemiológico dos casos de hanseníase em um estado do nordeste brasileiro de 2018 a 2022 / Epidemiological profile of the cases of leprosy in a state in the northeast of brazil from 2018 to 2022 / Perfil epidemiológico de los casos de hanseniasis en un estado del noreste de brasil de 2018 a 2022

A hanseníase é uma doença crônica, infectocontagiosa, de notificação compulsória e investigação obrigatória no Brasil, de evolução lenta, causada pelo bacilo Mycobacterium leprae que acomete predominantemente pele e nervos periféricos causando incapacidades funcionais permanentes de diversos graus, além de ser uma patologia ainda cercada por estigma e discriminação social. O objetivo do artigo consiste em avaliar o perfil epidemiológico da hanseníase no Estado do Rio Grande do Norte entre 2018 a 2022, estado que ocupa, atualmente, o 3° lugar a nível nacional de registro geral de casos de hanseníase. Trata-se de um estudo epidemiológico, descritivo, retrospectivo e de abordagem quantitativa, com base em dados obtidos no Departamento de Informática do Sistema Único de Saúde (DATASUS) e analisados com auxílio do software livre Jamovi 2.3.21 solid. O perfil epidemiológico da hanseníase no período de 2018 a 2022, no Estado do Rio Grande do Norte, apresentou predomínio pelo sexo feminino, acometendo adultos entre 50 a 69 anos de idade, com registro ignorado ou em branco no grau de escolaridade, predominando a forma multibacilar do tipo Virchowiana, causando grau 0 de incapacidade e a grande parte dos casos evoluindo para a cura. Portanto, faz-se relevante conhecer melhor o perfil epidemiológico e a realidade de cada município, visto que é uma patologia fortemente relacionada a condições econômicas, sociais e ambientais desfavoráveis passíveis de intervenção.

Leprosy is a chronic, contagious infectious disease, compulsorily notifiable and compulsory research in Brazil, of slow evolution, caused by the bacillus Mycobacterium leprae that predominantly affects skin and peripheral nerves causing permanent functional impairments of various degrees, besides being a pathology still surrounded by stigma and social discrimination. The objective of the article is to evaluate the epidemiological profile of leprosy in the State of Rio Grande do Norte between 2018 and 2022, which currently occupies the 3rd place at the national level of general registration of cases of leprosy. This is an epidemiological, descriptive, retrospective and quantitative approach study, based on data obtained in the Department of Information Technology of the Unified Health System (DATASUS) and analyzed with the help of free software Jamovi 2.3.21 solid. The epidemiological profile of leprosy in the period from 2018 to 2022, in the state of Rio Grande do Norte, showed predominance by the female sex, affecting adults between 50 and 69 years of age, with ignored or blank registration in the level of schooling, predominating the multibacillary form of the Virchowiana type, causing grade 0 disability and the great majority of cases evolving to cure. Therefore, it is important to know better the epidemiological profile and reality of each municipality, since it is a pathology strongly related to unfavorable economic, social and environmental conditions that can intervene.

La Hanseniasis es una enfermedad crónica, una enfermedad contagiosa, una notificación obligatoria e investigación obligatoria en Brasil, de evolución lenta, causada por el bacilo Mycobacterium leprae, que ataca predominantemente la piel y los nervios periféricos, causando discapacidades funcionales permanentes de diversos grados, además de ser una enfermedad aún rodeada de estigma y discriminación social. El propósito del artículo es evaluar el perfil epidemiológico de la lepra en el estado de Río Grande del Norte entre 2018 y 2022, un estado que actualmente ocupa el tercer lugar en el registro general nacional de casos de lepra. Se trata de un estudio de enfoque epidemiológico, descriptivo, retrospectivo y cuantitativo basado en datos obtenidos del Departamento de Datos del Sistema de Salud Pública (DATASUS) y analizado con la ayuda del software sólido Jamovi 2.3.21 libre. El perfil epidemiológico de la lepra en el período 2018-2022, en el estado de Rio Grande do Norte, mostró predominio del sexo femenino, atacando a adultos de 50 a 69 años, con un registro desconocido o en blanco en el grado de escolaridad, predominando en la forma multibacible del tipo Virchowiana, causando un grado de discapacidad y el gran número de casos. evolucionando hacia la curación. Por lo tanto, es importante conocer mejor el perfil epidemiológico y la realidad de cada municipio, ya que se trata de una enfermedad que está fuertemente relacionada con condiciones económicas, sociales y ambientales desfavorables que pueden ser intervenidas.

Culture circle with community health workers about (lack of) knowledge and stigma of leprosy / Círculo de cultura con agentes comunitarios de salud sobre (des)conocimiento y estigma de lepra / Círculo de cultura com agentes comunitários de saúde sobre (des)conhecimentos e estigma da hanseníase

ABSTRACT Objective: To describe the construction aboutthe (lack of) knowledge and stigma of leprosy by Community Health Workers participating in the Culture Circle. Method: Qualitative, action-research type study supported by the Paulo Freire Culture Circle framework, carried out with 21 Community Health Workers. Data collected in November 2021, in the municipality of São Luís, Maranhão. The following categories were evidenced: knowledge about leprosy, signs and symptoms, stigma. Results: The participants had knowledge about the disease, but they verbalized people's disinformation about leprosy, disbelief in relation to the cure, and situations of prejudice and stigma that are still present today. Final considerations: The culture circle enabled the intertwining of scientific and empirical knowledge in the construction of a critical and reflective knowledge committed to welcoming and comprehensive care for people and families affected by leprosy.

RESUMEN Objetivo: Describir la construcción sobre (des)conocimiento y estigma de la lepra por parte de los Agentes Comunitarios de Salud participantes del Círculo de Cultura. Método: Estudio cualitativo, de tipo investigación-acción, apoyado en el marco del Círculo de Cultura Paulo Freire, realizado con 21 Agentes Comunitarios de Salud. Datos recolectados en noviembre de 2021, en el municipio de São Luís, Maranhão. Se evidenciaron las categorías conocimientos sobre la lepra; signos y síntomas; estigma. Resultados: Los participantes tenían conocimiento sobre la enfermedad, pero verbalizaban la desinformación de las personas sobre la lepra, la incredulidad con relación a la cura y situaciones de prejuicio y estigma que aún hoy están presentes. Consideraciones finales: El círculo de cultura posibilitó entrelazar saberes científicos y empíricos en la construcción de un saber crítico y reflexivo comprometido con la acogida y atención integral de las personas y familias afectadas por la lepra.

RESUMO Objetivo: Descrever a construção sobre o (des)conhecimento e estigma da hanseníase pelos Agentes Comunitários de Saúde participantes do Círculo de Cultura. Método: Estudo qualitativo de tipo pesquisa-ação apoiado pelo referencial do Círculo de Cultura de Paulo Freire, realizado com 21 Agentes Comunitários de Saúde. Dados coletados em novembro de 2021, no município de São Luís, Maranhão. Foram evidenciadas as categorias conhecimento sobre a hanseníase; sinais e sintomas; estigma. Resultados: Os participantes possuíam conhecimento sobre a doença, mas verbalizaram a existência de desinformação das pessoas sobre a hanseníase, descrenças em relação à cura, além de situações de preconceito e estigma ainda presentes atualmente. Considerações finais: O círculo de cultura possibilitou o entrelace dos saberes científicos e empíricos na construção de um conhecimento crítico e reflexivo comprometido com o acolhimento e atenção integral às pessoas e famílias afetadas pela hanseníase.

Determinação social da hanseníase e o racismo brasileiro / Social determination of leprosy and Brazilian racism

A hanseníase permanece sendo um problema de saúde pública e com alta taxa de transmissibilidade e incidência em países de baixa e média renda, tornando-os endêmicos. Por serem poucos os estudos sobre a epidemiologia, ainda há grande dificuldade na intervenção e definição dos grupos alvo da doença, assim, aprofundar sobre se mostra importante para o combatê-la. O Brasil é o segundo maior país com números de casos de hanseníase, ficando atrás apenas da Índia, por isso, estudos no país são cruciais. A partir de uma revisão narrativa, foi investigado o perfil epidemiológico da hanseníase no Brasil e a sua relação com a desigualdade social. Partindo disso, foram relacionados dados sobre a vulnerabilidade social de pessoas negras no Brasil e o fato disto coincidir com os dados epidemiológicos de risco de hanseníase no país. Para isso, utilizou-se como orientação deste trabalho, os conceitos de determinação social da saúde e racismo estrutural. Por fim, a partir do conceito de necropolítica, a revisão relacionou esses dados coincidentes intencionando discutir se a hanseníase é uma doença negligenciada ou são as pessoas acometidas os negligenciados. As conclusões foram que há possibilidade de conexão entre os dados da epidemiologia da hanseníase no Brasil e a desigualdade social e racial do país; que o conceito de necropolítica é válido e possibilita um aprofundamento na discussão sobre hanseníase e negligência; e que é importante que hajam medidas de reparação histórica quando falamos de desigualdade racial, como a busca por um cenário político mais equitativo

Leprosy remains a public health problem and with a high rate of transmissibility and incidence in low- and middle-income countries, making them endemic. Because there are few studies on epidemiology, there is still great difficulty in intervening and defining the target groups of the disease, thus, going deeper into it is important to combat it. Brazil is the second largest country with numbers of leprosy cases, second only to India, therefore, studies in the country are crucial. Based on a narrative review, the epidemiological profile of leprosy in Brazil and its relationship with social inequality were investigated. Based on this, data on the social vulnerability of black people in Brazil were related and the fact that this coincides with epidemiological data on the risk of leprosy in the country. For this, the concepts of social determination of health and structural racism were used as guidelines for this work. Finally, from the concept of necropolitics, the review related these coincident data intending to discuss whether is leprosy a neglected disease or are the people affected the neglected. The conclusions were that there is a possibility of connection between data on the epidemiology of leprosy in Brazil and the country's social and racial inequality; that the concept of necropolitics is valid and allows for a deeper discussion on leprosy and neglect; and that it is important that there are historical reparation measures when we talk about racial inequality as the search for a more equitable political scenario

Minha cor não é essa, essa é a cor do remédio: imagem corporal de menores de 15 anos que tiveram hanseníase em Petrolina-PE e Juazeiro-BA / My color is not like this, this is the color of the medicine: body image of individuals under 15 years old who had leprosy in Petrolina, PE and Juazeiro, BA

Este artigo teve por objetivo compreender as repercussões da hanseníase na imagem corporal em menores de 15 anos afetados pela hanseníase. Participaram do estudo quatorze crianças e adolescentes menores de 15 anos que estavam cadastrados no programa de controle da Hanseníase de Petrolina-PE e Juazeiro-BA e que tiveram alta por cura. Utilizou-se a técnica de entrevista semiestruturada, que abrangeu questões norteadoras sobre a vivência da criança e do adolescente com a doença, abordando aspectos familiares, sociais e percepções advindas da experiência. Os dados obtidos foram analisados a partir do interacionismo simbólico e da sociologia de Erving Goffman, levando-se também em consideração leituras mais contemporâneas sobre performatividade. A partir das narrativas produzidas, buscou-se destacar os aspectos da imagem corporal da criança e do adolescente que tiveram hanseníase, organizados em eixos temáticos: imagem corporal, efeitos da hanseníase, racialização da doença e seus desdobramentos. Verifica-se que o elemento predominante da pesquisa ancora-se no corpo adoecido e marcado, imagens presentes em todas as entrevistas. Desse modo, para os participantes adoecidos pela hanseníase, o corpo é tido como "feio", "doente" e "rejeitado", sendo tal imagem corporal associada a repercussão negativa na sua autoimagem.

This article aimed to understand the repercussions of leprosy on body image in individuals under 15 years old affected by leprosy. Fourteen children and adolescents under 15 years old who were registered in the Leprosy Control Program of Petrolina-PE and Juazeiro-BA and who had been discharged as cured participated in the study. A semi-structured interview technique was used, covering guiding questions about the experiences of the child and adolescent with the disease, addressing family, social aspects, and perceptions arising from the experience. The data obtained were analyzed using symbolic interactionism and Erving Goffman's sociology, also taking into consideration more contemporary readings on performativity. Based on the narratives produced, the aspects of body image of children and adolescents with leprosy were highlighted and organized into thematic axes: body image, effects of leprosy, racialization of the disease, and its consequences. It is evident that the predominant element of the research is anchored in the diseased and marked body images present in all interviews. Thus, for participants afflicted by leprosy, the body is perceived as "ugly," "sick," and "rejected," and such body image is associated with a negative impact on their self-image.

Aglomerados de risco para ocorrência de hanseníase e as incapacidades em menores de 15 anos em Cuiabá: um estudo geoespacial / Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study

RESUMO Objetivo: Este estudo teve como objetivo analisar a distribuição espacial da hanseníase e as incapacidades em menores de 15 anos de idade em Cuiabá. Métodos: Estudo ecológico realizado na cidade de Cuiabá, Mato Grosso, Brasil. A população do estudo foi composta de casos de hanseníase em menores de 15 anos notificados no Sistema de Informações de Agravos de Notificação, entre os anos de 2008 e 2018. Com base nos endereços residenciais, os casos foram georreferenciados. Na análise da distribuição espacial dos casos, foi utilizada a estimativa da densidade de Kernel e, posteriormente, aplicada a estatística de varredura espacial, espaço-temporal e variação espacial nas tendências temporais. Resultados: Foram notificados 514 casos de hanseníase em menores de 15 anos em Cuiabá, com percentual de 10,1% de casos com grau de incapacidade física 1 e 2,3% com grau de incapacidade física 2 no momento do diagnóstico. Com as técnicas de varredura espacial e espaço-temporal, foram identificados aglomerados de risco para hanseníase nas regiões norte, oeste, leste e sul de Cuiabá, e com a técnica de variação espacial nas tendências temporais foi identificado um aglomerado na região oeste de Cuiabá. Conclusão: Em Cuiabá, os casos de hanseníase em menores de 15 anos com incapacidades estavam distribuídos em toda a extensão urbana da cidade, com maior densidade de casos nas regiões norte e oeste, seguida da região leste. Os aglomerados de maior risco relativo foram identificados nas regiões leste e oeste, caracterizadas por apresentar baixo e médio níveis de renda.

ABSTRACT Objective This study aimed to analyze the spatial distribution of leprosy and disabilities in children under 15 years of age in Cuiabá. Methods Ecological study carried out in the city of Cuiabá, Mato Grosso, Brazil. The study population consisted of leprosy cases in children under 15 years old notified in the Notifiable Diseases Information System, between 2008 and 2018. Based on residential addresses, cases were georeferenced. In the analysis of the spatial distribution of the cases, the estimation of the Kernel density was used and, later, the statistics of spatial, spatio-temporal and Spatial Variation in Temporal Trends were applied. Results 514 cases of leprosy were reported in children under 15 years of age in Cuiabá, with a percentage of 10.1% of cases with degree of physical disability 1 and 2.3% with degree of physical disability 2 at the time of diagnosis. With the techniques of spatial and spatio-temporal scanning, clusters of risk for leprosy were identified in the North, West, East and South regions of Cuiabá, and with the technique of Spatial Variation in Temporal Trends, a cluster was identified in the West region of Cuiabá. Conclusion In Cuiabá, cases of leprosy in children under 15 years of age with disabilities were distributed throughout the urban area of the city, with the highest density of cases in the North and West regions, followed by the East region. The clusters with the highest Relative Risk were identified in the East and West regions, characterized by having low and medium income levels

Inequality, population growth, and hunger in Sub-Saharan Africa.

Despite increasing population and inequality in most countries in Sub-Saharan Africa (SSA) and their tendencies to aggravate hunger there is still dearth of knowledge on their effects on hunger in the region. Therefore, the study used data for 46 SSA countries from 2007 to 2017 to examine the effects of inequality and population on hunger by adopting the System Generalized Method of Moment approach as it is specifically applicable in this situation. Results showed that inequality (p < 0.01) and population growth (p < 0.1) significantly increased the level of hunger, while GDP per capita (p < 0.01) and Food Production index (p < 0.1) significantly reduced hunger in the region. Arellano-Bond test confirmed the validity of the GMM results by rejecting the null hypothesis of non-existence of autocorrelation of the first order and accepting that of the second order in the disturbance term, while the Hansen and Sargan tests affirmed that variables used as instruments were valid in line with expectations. Robustness of the result was also confirmed as the coefficient of the lagged response variable (0.8701) fell between the fixed effect model estimate (0.5165) and pooled OLS estimate (0.9571) in line with theory. The study recommended policies capable of reducing inequality, boosting economic growth, and controlling excessive population growth, while food production and value addition are encouraged in order to avert hunger in the region.

Social disparities in the use of ART treatment: a national register-based cross-sectional study among women in Denmark.

STUDY QUESTION: How are educational level, labor market attachment and income associated with receiving a first ART treatment in either the public or private healthcare sector among women in Denmark? SUMMARY ANSWER: Higher educational level and income as well as labor market attachment were associated with higher probability of initiating ART treatment at public and private fertility clinics among women in Denmark. WHAT IS KNOWN ALREADY: Infertility is common in populations worldwide, and the approach to this issue differs between societies and healthcare systems. In the public Danish healthcare system, ART treatment is free of charge, and the direct cost for patients is therefore low. In the private healthcare sector in Denmark, ART treatment is self-financed. There is limited knowledge about the association between socioeconomic factors and seeking ART treatment, although previous studies have indicated that higher socioeconomic status is associated with seeking ART treatment. STUDY DESIGN, SIZE, DURATION: Women undergoing ART treatment during 1994-2016 registered in the Danish IVF register were individually linked with data from sociodemographic population registers using the Danish Personal Identification number. The study population consisted of 69 018 women treated with ART and 670 713 age-matched comparison women from the background population with no previous history of ART treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS: The women included in the analyses were aged 18-45 years. The associations between attained educational level, labor market attachment and income and receiving a first ART treatment attempt were investigated for women either initiating treatment in the public sector or in the private sector, respectively. Information on age and origin was included as potential confounders, and odds ratios (ORs) were estimated in logistic regression models. In addition, analyses were stratified by age group to investigate potential differences across the age span. MAIN RESULTS AND THE ROLE OF CHANCE: Adjusted results showed increased odds of receiving a first ART treatment in either the public or private sector among women with a higher educational level. Furthermore, women in employment were more likely to receive a first ART treatment in the public or private sector compared to women outside the workforce. The odds of receiving a first ART treatment increased with increasing income level. Surprisingly, income level had a greater impact on the odds of receiving a first ART treatment in the public sector than in the private sector. Women in the highest income group had 10 times higher odds of receiving a first ART treatment in the public sector (OR: 10.53 95% CI: 10.13, 10.95) compared to women in the lowest income group. Sub-analyses in different age groups showed significant associations between ART treatment and income level and labor market attachment in all age groups. LIMITATIONS, REASONS FOR CAUTION: Our study does not include non-ART treatments, as the national IVF register did not register these types of fertility treatments before 2007. WIDER IMPLICATIONS OF THE FINDINGS: In Denmark, there is equal access to medically assisted reproduction treatment in the publicly funded healthcare system, and since there is no social inequality in the prevalence of infertility, social inequality in the use of ART treatment would not be expected as such. However, our results show that social inequality is found for a first ART treatment attempt across publicly and privately funded ART treatment across the socioeconomic indicators, educational level, labor market attachment and income. STUDY FUNDING/COMPETING INTEREST(S): The funding for the establishment of the Danish National ART-Couple II Cohort (DANAC II Cohort) was obtained from the Rosa Ebba Hansen Foundation. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Stigma towards leprosy across seven life domains in Indonesia: a qualitative systematic review.

OBJECTIVE: To provide knowledge about the domains of life affected by stigma towards leprosy in Indonesia, including its manifestations, driving factors and consequences. DESIGN: Qualitative systematic review. STUDY SELECTION: PubMed, CINAHL, ProQuest, Taylor&Francis and Google Scholar were used to systematically search studies with qualitative component that were conducted in Indonesia and published from January 2000 to December 2020 in English or Indonesian language. The search was started in November 2020 and reran in April 2021. Quality assessment and thematic synthesis were applied. DATA EXTRACTION: Of the 3184 studies, 37 manuscripts were reviewed. Information relating to study characteristics, stigma domains and types following Weiss Extended Scambler's Hidden Stress Model, stigma consequences and drivers were extracted. RESULTS: Seven themes were identified. Three themes-community, domestic and intimate relationships-impacted private domains. Four themes-health, economics, education and public entitlements-concerned public domains. Studies mainly discussed enacted stigma rather than anticipated and internalised stigma. Ten stigma-driving factors were found, ranging from negative and positive concepts linked with the condition to aspects not related to the disease process. Five areas of consequences were shown. Impact on public rights, such as education, was very minimally explored, although school absence was often mentioned. Stigma manifestation, drivers and consequences in most public domains were least explored. CONCLUSION: Leprosy-affected persons in Indonesia experienced and felt stigma in private and public domains. Disease-related aspects, the culture and history of a particular region are linked with stigma manifestations. Approaches in one domain can affect another domain. More exploratory studies are needed in the endemic areas outside Java, especially considering both the lack of studies there and the unique culture of each Indonesian region.

Fundación Neumológica Colombiana 30 años de una institución con espíritu / Fundación Neumológica Colombiana 30 years of an institution with spirit

Hablar de la Neumología moderna en Colombia y de la Fundación Neumológica Colombiana es hablar de Darío Maldonado Gómez. Nacido en Pamplona, Norte de Santander, llegó a Bogotá siendo un adolescente, cuando sus padres se vieron obligados a salir de su ciudad natal hacia la capital, con todos sus hijos, producto de la violencia encendida a finales de la década de los 40´s. Con el ejemplo de su padre, Darío Maldonado Romero, médico que se especializó en la lepra y consagró sus esfuerzos al desarrollo de políticas de salud pública. Así, con la ambición de aprender y apropiar la ciencia, el arte y el humanismo que sustentan la medicina, ingresó a la Universidad Nacional en Bogotá y obtuvo su título de médico en 1959. Su ánimo de aprender y de poder ofrecer siempre las mejores opciones a sus pacientes, lo llevaron pronto a Chicago y Milwaukee, Estados Unidos, donde, en la década de los 60´s, se entrenó en Medicina Interna y Neumología con el profesor Gordon Snider, pionero y figura de la Neumología moderna en el mundo.

Talking about modern Pulmonology in Colombia and the Colombian Pulmonary Foundation is talking about Darío Maldonado Gómez. Born in Pamplona, Norte de Santander, he came to Bogotá as a teenager, when his parents were forced to leave their hometown for the capital, with all their children, as a result of the violence inflamed at the end of the 1940s. With the example of his father, Darío Maldonado Romero, a doctor who specialized in leprosy and devoted his efforts to the development of public health policies. Thus, with the ambition of learning and appropriating the science, art and humanism that sustain medicine, he entered the National University in Bogotá and obtained his medical degree in 1959. His desire to learn and to always be able to offer the best options to his patients, they soon took him to Chicago and Milwaukee, United States, where, in the 1960s, he trained in Internal Medicine and Pulmonology with Professor Gordon Snider, pioneer and figure of modern Pulmonology in the world.

Risk Factors for Disability Upgrading Among Leprosy Patients During Treatment: Multilevel Modeling Analysis.

Background: Leprosy not only brings about bodily incapacity but also creates a nasty image of affected individuals, triggering discrimination and social stigma. The purpose of this study was to evaluate the status of leprosy disability in patients registered at the All African TB and Leprosy Rehabilitation and Training Center. Methods: The study consists of 205 leprosy patients who were undergoing treatment at the All African TB and Leprosy Rehabilitation and Training Center from January 2015 to December 2019. Regional states of the patients were used as a clustering effect in the multilevel logistic regression model. Results: In total, 205 (66.3%) completed records revealed patients with leprosy were disabled. Among these, 64.88% of them were males. In multilevel binary logistic regression analysis, the individual-level variables, such as median age (AOR = 1.1; 95% CI: 1.043, 1.13) of patients, patients with duration of symptom [7-12 months (AOR = 2.26; 95% CI: 1.50, 3.39), 13-24 months (AOR = 2.13; 95% CI: 1.44, 3.15), and more than 24 months (AOR = 2.67; 95% CI: 1.8, 4.02)], the absence of sensory loss (AOR = 0.84; 95% CI: 0.72, 0.96), and patients with asymmetry lesion distribution (AOR = 0.74; 95% CI: 0.65, 0.85), were the most significant determinant factors of disability. The default leprosy patient (AOR = 15.53; 95% CI: 1.82, 134.96) and new leprosy patient (AOR = 0.51; 95% CI: 0.33, 1.68) were the significant determinant factors of disability due to leprosy patients. Conclusion: An individual-level factor on the risk of disability was higher as age increased and for patients with a longer duration of symptoms. The risk of disability was lower for patients who do not lose their sensation and for patients whose lesion distribution is asymmetrical. The community-level factor, patient categories, was also a significant factor in disability due to leprosy. Furthermore, programs should emphasize raising community awareness, focusing on key messages and early case detection campaigns, such as active surveys, as well as the availability of leprosy care in a public health facility.