Perfil clínico-epidemiológico das pessoas acometidas por hiv/aids, tuberculose e hanseníase no paraná, brasil, 2010-2019 / Perfil clínico-epidemiológico de las personas afectadas por vih/sida, tuberculosis y lepra en paraná, brasil, 2010-2019 / Clinical-epidemiological profile of people affected by hiv/aids, tuberculosis and leprosy in paraná, brazil, 2010-2019

RESUMO Objetivo: caracterizar o perfil cínico-epidemiológico das pessoas acometidas por HIV/AIDS, tuberculose e hanseníase no Paraná, entre 2010 e 2019. Método: estudo descritivo, de abordagem quantitativa, com dados provenientes do Sistema de Informação de Agravos de Notificação. A população foi definida como os casos novos de HIV/AIDS, tuberculose e hanseníase notificados entre 2010e 2019, no Paraná. Para a análise, foram utilizadas técnicas de estatística descritiva. Resultados: entre 2010 e 2019, foram registrados 14.149 casos de HIV/AIDS, 7.868 de hanseníase e 22.147 de tuberculose. Houve predomínio de casosentre homens, com raça/cor branca e ensino fundamental (in)completo para os três agravos. Evidenciou-se maior número de notificações do HIV/AIDS entre adolescentes e adultos com até 39 anos, da tuberculose entre adultos em fase economicamente ativa e da hanseníase entre adultos com mais de 50 anos. Ademais, observou-se aumento do HIV/AIDS entrehomossexuais e bissexuais, dos óbitos por tuberculose e de crianças/adolescentes com hanseníase. Conclusão: o perfil de homens adultos com baixa escolaridade evidenciado neste estudofoi semelhante à literatura, o que sugere possibilidades de atuação para profissionais da assistência, vigilância e gestão, com vistas à proposição de estratégias direcionadas ao controle do HIV/AIDS, da tuberculose e da hanseníasea nível estadual.

RESUMEN Objetivo: caracterizar el perfil clínico-epidemiológico de las personas afectadas por VIH/sida, tuberculosis y lepra en Paraná/Brasil, entre 2010 y 2019. Método: estudio descriptivo, de abordaje cuantitativo, con datos provenientes del Sistema de Información de Agravios de Notificación. La población fue definida como los casos nuevos de VIH/sida, tuberculosis y lepra notificados entre 2010 y 2019, en Paraná/Brasil. Para el análisis, se utilizaron técnicas de estadística descriptiva. Resultados: entre 2010 y 2019 se registraron 14.149 casos de VIH/sida, 7.868 de lepra y 22.147 de tuberculosis. Hubo predominio de casos entre hombres, con raza/color blanco y enseñanza primaria (in)completa para los tres agravios. Se evidenció mayor número de notificaciones del VIH/sida entre adolescentes y adultos de hasta 39 años, de la tuberculosis entre adultos en fase económicamente activa y de la lepra entre adultos de más de 50 años. Además, se observó aumento del VIH/sida entre homosexuales y bisexuales, de los óbitos por tuberculosis y de niños/adolescentes con lepra. Conclusión: el perfil de hombres adultos con baja escolaridad evidenciado en este estudio fue similar a la literatura, lo que sugiere posibilidades de actuación para profesionales de la asistencia, vigilancia y gestión, con vistas a proponer estrategias dirigidas al control del VIH/sida, la tuberculosis y la lepra a nivel estatal.

ABSTRACT Objective: to characterize the clinical-epidemiological profile of people affected by HIV/AIDS, tuberculosis and leprosy in Paraná, between 2010 and 2019. Method: descriptive study, quantitative approach, with data from the Information System of Notifiable Diseases. The population was defined as new cases of HIV/AIDS, tuberculosis and leprosy reported between 2010 and 2019 in Paraná. For the analysis, descriptive statistical techniques were used. Results: between 2010 and 2019, 14,149 cases of HIV/AIDS, 7,868 of leprosy and 22,147 of tuberculosis were registered. There was a predominance of cases among men, with white race/color and (in)complete elementary school for the three diseases. There was a higher number of HIV/AIDS notifications among adolescents and adults up to 39 years old, tuberculosis among adults in an economically active phase and leprosy among adults over 50 years old. In addition, there was an increase in HIV/AIDS among homosexuals and bisexuals, deaths from tuberculosis and children/adolescents with leprosy. Conclusion: the profile of adult men with low schooling evidenced in this study was similar to the literature, which suggests possibilities of management, with a view to proposing strategies aimed at controlling HIV/AIDS, tuberculosis and leprosy at the state level.

Sangue e fígado: a persistência das imagens simbólicas sobre a lepra a partir do mito do Papa-Figo / Blood and liver: the persistence of the leprosy symbolic images considering the Papa-Figo myth / Sangre e hígado: la persistencia de las imágenes simbólicas de la lepra a partir del mito de Papa-Figo

Este artigo volta-se para os processos simbólicos que, frente à iminência do adoecimento e da morte, fazem emergir no imaginário poderosas narrativas que se dinamizam em mitos. Elege, para isso, as imagens simbólicas sobre a lepra que circundam o mito do Papa-Figo ­ criatura fantástica, ele é representado por ricos e poderosos que, contaminados, fariam de tudo para recuperar sua saúde; inclusive consumir vísceras de crianças sequestradas. Em um percurso sincrônico e diacrônico, relacionamos relatos históricos e folclóricos com narrativas contemporâneas: vídeos de exploração à casa da 'viúva Papa-Figo'. Nesta leitura simbólica, exploramos a recorrência dos símbolos de sangue, fígado, poço, poder, dinheiro e de um Outro misterioso, mostrando que o medo da doença e suas consequências físicas e sociais nos movimentam arquetipicamente, despertando relações ancestrais que nos conectam com o plano da experiência humana.

This article is focused on the symbolic processes that, in the face of the imminence of illness and death, make powerful narratives emerge in the imaginary, which are symbolized by myths. For this purpose, we center on the symbolic images on leprosy that surround the Brazilian myth of the Papa-Figo - a fantastic creature represented by the rich and powerful people which were contaminated and would do anything to recover from the illness and back to their health; including consuming the entrails of kidnapped children. In a synchronic and diachronic journey, we related historical and folkloric reports to contemporary narratives: urban exploration videos exploring the abandoned house of the 'Papa-Figo widow'. In this symbolic reading, we explore the recurrence of symbols linked to blood, liver, well, power, money and the mysterious Other, showing that the fear of disease and its physical and social consequences move us archetypically, awakening ancestral relationships that connect us to the experience human level.

Este artículo se centra en los procesos simbólicos que, en vista de la inminencia de la enfermedad y de la muerte, hacen que surjan narrativas poderosas en el imaginario simbolizadas en mitos. Para este propósito, elegimos las imágenes simbólicas sobre la lepra que rodean el mito brasileño llamado Papa-Figo, una criatura fantástica representada por personas ricas y poderosas que, contaminadas con la enfermedad, harían cualquier cosa para recuperar su salud; incluyendo el consumo de las entrañas de niños secuestrados. En un camino sincrónico y diacrónico, relacionamos los relatos históricos y folclóricos con narrativas contemporáneas: vídeos de exploración urbana a la casa de la 'viuda Papa-Figo'. En esta lectura simbólica exploramos la recurrencia de símbolos vinculados a la sangre, al hígado, al pozo, al poder, al dinero y al Otro misterioso, mostrando que el miedo a la enfermedad y sus consecuencias físicas y sociales nos mueven arquetípicamente, despertando relaciones ancestrales por las cuales nos conectamos con el plano de la experiencia humana.

Indonesians Human Leukocyte Antigen (HLA) Distributions and Correlations with Global Diseases.

In Human, Major Histocompatibility Complex known as Human Leukocyte Antigen (HLA). The HLA grouped into three subclasses regions: the class I region, the class II region, and the class III region. There are thousands of polymorphic HLAs, many of them are proven to have correlations with diseases. Indonesia consists of diverse ethnicity people and populations. It carries a unique genetic diversity between one and another geographical positions. This paper aims to extract Indonesians HLA allele data, mapping the data, and correlating them with global diseases. From the study, it is found that global diseases, like Crohn's disease, rheumatoid arthritis, Graves' disease, gelatin allergy, T1D, HIV, systemic lupus erythematosus, juvenile chronic arthritis, and Mycobacterial disease (tuberculosis and leprosy) suspected associated with the Indonesian HLA profiles.

Características de la enfermedad de Hansen y contagio a familiares en El Oro. Estudio descriptivo / Characteristics of Hansen's disease and contagion to relatives in El Oro Province. Descriptive study

Introducción:La incidencia de la Enfermedad de Hansen registrada en Ecuador es de 0.71 por 10,000 habitantes en 2006, se encuentra dentro del parámetro mundial de eliminación. La provincia de El Oro aún presenta casos positivos para la enfermedad. Objetivo:Determinar las características de la enfermedad de Hansen en pacientes de la Provincia de el Oro y el diagnóstico del contagio a familia-res.Material y métodos:El estudio es de tipo cuantitativo descriptivo, en la provincia de El Oro en personas con diagnóstico de la enfermedad de Hansen registrados en el Centro de Epidemiologia de esta provincia en el periodo Julio 2012 ­ Junio 2013 y sus familiares que convivan con estos.Se realizó la toma de muestra de la linfa del pabellón auricular e hisopadonasal para el diagnóstico mediante la tinción de Ziehl Neelsen y llenado de un formulario. En el análisis de la información se aplicó estadística descriptiva utilizando el sofware SPSS. Resultados:Se registró 32 pacientes con enfermedad de Hansen, un 59.4% correspondía al tipo lepromatoso, el 81.3% de individuos presentan lesiones cutáneas, representando las manchas un 50% y los nódulos el12.5% de los casos. La localización preferente de las lesiones fue las extremidades. El 53.1% de los pacientes presentaron perdida de la sensibilidad en extremidades. El 15.6% presentan deformidad y un 9.4% presentan discapacidad debido a la enfermedad. El 11.8% de los familiares presento un test positivo de baciloscopía, de quienes el 60% correspondía al subtipo lepromatoso. Conclusiones:Aún se encuentran casos de Hansen en la provincia del Oro y persiste el contagio a familiares que conviven con los pacientes.

Introduction:The incidence of Hansen's disease re-gistered in Ecuador is 0.71 per 10,000 inhabitants in2006; it is within the global elimination parameter.The Province of El Oro still presents positive cases forthe disease. Objective:To determine the characteristics of Hansen'sdisease in the Province of El Oro and diagnosis of thecontagion to relatives.Material and Methods:It is a quantitative descriptivestudy which was carried out in the Province of El Oroin people who were diagnosed with Hansen's diseaseregistered in the Epidemiology Center of this provincein the period July 2012 to June 2013 and theirrelatives who were living with them. The sample ofthe lymph of the auricular pavilion and nasal swabfor the diagnosis was made by means of the stainingof Ziehl Neelsen and filling out a form. In the analysisof the information, a descriptive statistics wereapplied using the SPSS software.Results:A total of 32 patients with Hansen's diseasewere registered, 59.4% were lepromatous, 81.3%had skin lesions, the spots were 50% and the noduleswere 12.5%. The preferred location of the lesionswas the extremities. The 53.1% of the patients hadloss of sensation in extremities. The 15.6% presenteddeformity and 9.4% presented disability due to illness.The 11.8% of the relatives presented a positivesputum smear test, of which 60% corresponded tothe lepromatous subtype.Conclusions:There are still cases of Hansen in theprovince of El Oro and the contagion persists torelatives who live with the patients.

Debating diseases in Nineteenth-Century Colombia: causes, interests, and the Pasteurian therapeutics

This article explores the medical conceptualization of the causes of diseases in nineteenth-century Colombia. It traces the history of some of the pathologies that were of major concern among nineteenth-century doctors: periodic fevers (yellow fever and malaria), continuous fevers (typhoid fever), and leprosy (Greek elephantiasis). By comparing the transforming conceptualizations of these diseases, this article shows that their changing pattern, the idea of climatic determinism of diseases (neo-Hippocratism and medical geography), the weak standind of the medical community in Colombian society, as well as Pasteurian germ practices were all crucial in the uneven and varied reshaping of their understanding. (AU)

Uma história brasileira das doenças / A Brazilian history of diseases

Da mesma forma que nos volumes anteriores, aqui se reúne a contribuição de pesquisadores de universidades e centros de pesquisa de diferentes regiões do país. Alguns já conhecidos e reconhecidos na área acadêmica por suas publicações sobre temáticas relacionadas à saúde e às doenças, bem como de outros pesquisadores que iniciaram suas pesquisas nesse campo de investigação - a História das Doenças - mais recentemente. O século XIX é contemplado com a análise das condições de saúde dos escravos no Brasil, passando pelas epidemias de febre amarela, de varíola e de cólera, adentrando hospitais e iluminando os acalorados debates entre alopatas e homeopatas, quando da disseminação da homeopatia. As discussões das políticas públicas para a saúde no Brasil também são contempladas neste volume. Seja o processo político que resultou no SUS, sejam as políticas públicas voltadas para doenças específicas como a tuberculose e a lepra. As pandemias do século XX não poderiam faltar nas análises constantes neste livro, como a gripe espanhola, de 1918, na sua ocorrência na Bahia, e uma das mais marcantes do século XX, que o fechou e o ultrapassou - a AIDS. (AU)

Pesquisa, desenvolvimento e inovação para o controle das doenças negligenciadas / Research, development and innovation for the control of neglected diseases

O fluxo contínuo de novos produtos no mercado é fruto da inovação tecnológica apresentada pela Indústria Farmacêutica. O governo Brasileiro tem investido em iniciativas promissoras de inovação através do desenvolvimento de medicamentos para os programas públicos de saúde, instituindo o Programa de Pesquisa e Desenvolvimento em Doenças Negligenciadas, o qual foca sete doenças: dengue, doenças de Chagas, leishmaniose, hanseníase, malária, esquistossomose e tuberculose. O artigo foca uma revisão sobre P&D aplicada à prevenção e controle das doenças negligenciadas no Brasil e no mundo. Com base nos dados levantados, percebeu-se que são grandes as dificuldades para o desenvolvimento de P&D em tecnologias e produtos para combater as doenças negligenciadas e que são poucos os investimentos financeiros nesse segmento quando comparados aos de pesquisas que focam outras enfermidades. Diante disso, pode-se enfatizar a importância de investimentos em pesquisas nesse setor, em saneamento básico e programas educativos que orientem a população sobre combate à proliferação dos vetores e agentes causadores.

The steady stream of new products on the market is the result of technological innovation in the pharmaceutical industry. The Brazilian government has invested in promising initiatives for innovation through the development of drugs for public health programs, setting up the Program for Research and Development on Neglected Diseases, which focuses on seven diseases: dengue fever, Chagas? disease, leishmaniasis, Hansen?s disease, malaria, schistosomiasis and tuberculosis. The article reviews the R&D applied to the prevention and control of neglected diseases in Brazil and worldwide. On the basis of survey data, we note that there are great obstacles to the development of the technology and products needed to fight neglected diseases and there are few investments in this segment in comparison with research that focuses on other diseases. In this light, we stress the importance of investment in research in this area and in sanitation and educational programs to guide the population in combating the proliferation of vectors and causative agents.

Cadastramento e acompanhamento de pacientes com doenças infecciosas e tabagismo

O objeto começa abordando o cadastramento e o acompanhamento de pacientes com doenças infecciosas, como a tuberculose e a hanseníase. Explica que em relação à tuberculose, em que o tratamento é de média duração, é preciso se preocupar com o tratamento preconizado e que não basta realizar a consulta, fazer o diagnóstico e fornecer a medicação, pois o sucesso do tratamento dependerá de como o doente segue o que lhe foi recomendado e também do apoio familiar. Sobre a hanseníase, menciona que é uma doença que, se não for tratada e controlada, pode provocar mutilações prejudiciais à capacidade física e à autoestima do paciente, além de causar sua estigmatização dentro da sociedade. Aborda questões importantes sobre abandono do tratamento pelo paciente e como prevenir tal situação, inclusive através de um processo de educação em saúde. Finaliza detalhando as consequências da dependência do tabaco e lembrando que o tabagismo é reconhecido hoje, em todo o mundo, como um grave caso de saúde pública, explicando políticas de saúde dirigidas ao tema e repassando orientações de ações contra o tabagismo. Unidade 1 do módulo 7 que compõe o Curso de Especialização em Saúde da Família.

Disease versus disease: how one disease may ameliorate another.

Systemic disease, either genetic or acquired, may prevent or decrease the severity of another disease. These observations have led to important therapeutic advances. The best-known examples are Edward Jenner's use in 1798 of cowpox to prevent smallpox and J.B. Haldane's 1942 observation that erythrocyte disorders such as thalassemia and sickle cell disease modify the severity of malaria. Patients with and carriers of cystic fibrosis may have genetic resistance to tuberculosis and/or secretory diarrhea. The beneficial effects of undernutrition have led to therapeutic diets for seizures, celiac disease, type 2 diabetes, and inflammatory bowel disease. Finasteride for prostatic hypertrophy was developed after the observation that patients with male pseudohermaphrodism resulting from 5-alpha-reductase mutations do not develop prostatic hypertrophy. Rh immunoglobulin for Rh hemolytic disease prevention followed the observation that ABO incompatibility prevented Rh sensitization. The natural immunosuppression of measles may cause remission of nephrosis, and that of leprosy prevents psoriasis. Patients with one form of agammaglobulinemia (X-linked) never get Epstein-Barr virus infection, and patients with another form (common variable) are seemingly cured by HIV infection. HIV/AIDS is prevented or modified by co-receptor mutations (notably the CCRDelta32 chemokine mutation), HIV-2, or GB virus C infection. Additional exploration of these genetic, infectious, and metabolic influences on disease severity may provide new therapeutic approaches to HIV and other diseases.

[Preparation of a "chronological table of main diseases in Japanese history" for pharmacy students of the 6-year program].

A chronological table of the main diseases that have appeared throughout Japanese history was prepared for pharmacy students, especially for students of clinical pharmacy in the new 6-year system. In ancient times (even in the 8th century), smallpox and measles prevailed in Japan. Japanese people prayed to gods and Buddha to cure the sick. New infectious diseases, like ruebella, pest, typhoid fever, dysentery, cholera, leprosy, etc., prevailed with the increasing exchange of culture from foreign countries. After the vaccines and the toxides were prepared, these infectious diseases were gradually stamped out in Japan early in the Meiji Era. While, public nuisances like the Minamata disease (CH3HgCl), Itaiitai disease (Cd), and atmospheric pollution with sulfurous acid gas, drug-induced suffering (Thalidomide, Sumon, AIDS, etc.) and toxin contaminations in foods have recently increased and produced new diseases. However, these diseases can be prevented if the workers in factories and government officers keep in mind the medical ethics and the ethics for pharmacists to protect the health of people from diseases. Today, cancer, diseases of cerebral vessels, heart diseases, and pneumonia are the four most important causes of death related to aging.

Health in Bihar -- an overview.

PIP: This article presents an overview of the health situation in Bihar for the last 50 years. Although demographic improvements have been noted in the past years, the incidence of various diseases remains high and socioeconomic status low in Bihar. Protein-energy malnutrition, nutritional anemia and blindness are common. Safe drinking water and sanitary facilities are still not available to a large number of people. Furthermore, a number of communicable diseases are prevalent in the country. This is exemplified in the Kala-azar or visceral leishmaniasis epidemic in 1992, which reported 75,523 cases and 1417 deaths. Kala-azar cases have started rising again since 1996, and it is estimated that there might be another epidemic in the first decade of the 21st century if the situation is allowed to continue. Other infectious diseases, which threaten the health situation in Bihar, are malaria, tuberculosis, leprosy, and HIV/AIDS. Moreover, population and decadal growth rate have more than doubled over the last 40 years. Maternal mortality remains very high, but survival chances of children have increased due to immunization and other programs. In general, it was demonstrated that the present health situation in Bihar is a matter of grave concern, and requires an urgent solution.^ieng

O estigma na realidade intrafamiliar do adolescente com hanseníase / Stigma in intrafamily reality of teenage girl with leprosy

Objetivou-se pesquisar como o estigma se expressa na realidade intrafamiliar do adolescente, portador de hanseníase com incapacidade física e manchas visíveis, hiperpigmentadas pelos efeitos colaterais da clofazemina e suas reações, desde o momento do diagnóstico até a alta e compreender o comportamento do adolescente com Hanseníase, como age com a própria doença e sua vivencia, no ambiente familiar. A pesquisa foi realizada no Centro de Saúde D. Libânia - Fortaleza-CE-Brasil. Entrevistaram-se 22 adolescentes de 13 a 21 anos, em tratamento para hanseníase ou específico para reações hansênicas. Os procedimentos envolveram entrevistas, grupos de encontro e consulta aos prontuários. Referencial teórico usado - Modelo de Kübler-Ross (1992) e análise de conteúdo de Bardin (1992). Nos resultados, percebeu-se a presença forte do estigma subjetivo e intrafamiliar, centrado em membros que não a mãe, nem o pai...

In sickness or in health: TDR's partners. 8. Kenya Medical Research Institute (KEMRI).

PIP: Since its establishment in 1979, the Kenya Medical Research Institute (KEMRI) has been one of the partner agencies working with the UN Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases (TDR). KEMRI consists of a secretariat and eight separate research centers devoted to alupe leprosy and skin diseases; biomedical, clinical, virus, microbiology, and medical research; vector biology and control; and traditional medicines and drugs. KEMRI also has a model clinic, an animal house, a library, a conference area, and a computer center serving 250 technical staff and 600 administrative staff. TDR has supported about 30 trainees, and KEMRI conducts research programs on all TDR diseases except trypanosomiasis, which is the responsibility of a sister institution. KEMRI's malaria research focuses on the vector, on control through the use of bednets impregnated with insecticide, and on clinical management. KEMRI is currently researching development of hard-wearing and cheaper bednets and alternatives to chloroquine. TDR has provided funding for KEMRI studies that focus on schistosomiasis treatment, prevention, and control; the distribution and impact of filariasis as well as treatment with ivermectin and anthelminthics; and control and treatment of leishmaniasis. Research into leprosy is seeking better drugs, better diagnostic tools, and ways to increase patient treatment compliance.^ieng

New tools for leprosy control.

PIP: The World Health Organization (WHO) is working to reduce the prevalence of leprosy to under 1 case/10,000 people in all endemic countries by 2000. Efforts are underway to eliminate leprosy rather than eradicate it because of the current lack of tools with which to eradicate leprosy. The major problem with existing skin test reagents to identify carriers of Mycobacterium leprae, the causative agent of leprosy, is their lack of specificity and tendency to cross-react. With a long-term view toward eradicating leprosy, the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been supporting the development of a skin test which will be specific for only leprosy. One immediate benefit of developing and using such a test would be the ability to immediately monitor the effect of multidrug therapy upon the circulation of M. leprae in given communities. A potential problem for the peptide-based skin tests being pursued is the genetic variation in antigen recognition which may exist in different human populations. Candidate peptides will be tested in different leprosy-endemic areas of Asia, Africa, and Latin America, with the skin test eventually either tailor-made for a given geographic area or containing a mix of several peptides representing all regional preferences.^ieng

In sickness or in health: TDR's parners. 7. Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

PIP: Mahidol University's Faculty of Tropical Medicine, Bangkok, Thailand, established in 1960, is one of 14 faculties, 5 institutions, 5 centers, and 2 colleges within Mahidol University. It consists of the following departments: Helminthology, Medical Entomology, Microbiology and Immunology, Protozoology, Social and Environmental Medicine, Tropical Hygiene, Tropical Medicine, Tropical Nutrition and Food Science, Tropical Pediatrics, Tropical Pathology, and Tropical Radioisotopes. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been associated with the Faculty since 1977, collaborating mainly upon malaria research, but also in filariasis, leprosy, and schistosomiasis research. Early TDR support was directed at research training and institutional strengthening, although by the early 1980s, the Faculty played an increasingly important role in TDR's research and development program. In recent years, the Faculty has focused upon researching malaria, parasitic and bacterial diseases, nutrition and food sciences, and environmental health. The Faculty's malaria-related research is described. The Faculty also conducts research in many other areas of tropical medicine outside of those of interest to TDR.^ieng

Social marketing to eliminate leprosy in Sri Lanka.

PIP: Leprosy is a chronic infectious disease which, if untreated, can lead to permanent and progressive nerve damage and thus to deformities of the limbs, eyes, and face. People with leprosy have long been ostracized by society. The clinical signs of leprosy include insensitive skin lesions and thickened peripheral nerves. Untreated infectious leprosy cases are the main source of infection, transmitting the disease through nasal secretions. People with low cell-mediated immunity are at risk of developing clinically active leprosy irrespective of gender, age, or social class. The World Health Organization (WHO) has, since 1982, recommended multiple drug therapy (MDT) against leprosy, an approach capable of curing the disease within 1 year and interrupting its transmission. According to WHO, leprosy is currently a public health problem in 55 countries and more than 20% of the estimated 1.15 million cases of leprosy worldwide remain undetected. Although Sri Lanka was the first country in South Asia to provide MDT to all registered leprosy patients, first making it available in 1984, the disease continues to be transmitted due to the large number of undetected cases in the country. An ongoing social marketing program was therefore launched in 1990 by the local health ministry and the Novartis Foundation for Sustainable Development to eliminate leprosy from Sri Lanka. The program encourages people with suspicious skin lesions to seek diagnosis and care, teaches health care providers to recognize leprosy and refer cases for treatment, and helps the general public to understand that leprosy is just a normal disease. The socially marketed product is MDT, provided free-of-charge by the Novartis Foundation to all leprosy patients.^ieng

Health promotion in South East Asia.

PIP: The countries of the South East Asia region, which includes Bangladesh, Bhutan, Pakistan, Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, and Thailand, have undertaken a variety of strategies to address the health challenges in the region. The ever-growing pressure of population in the region has allowed rapid transmission of communicable diseases like malaria, tuberculosis (TB), leprosy, and HIV/AIDS. One of the innovative community-based health initiatives in response to this problem is Indonesia's Primary Health Care Project. This project aimed to develop a sustainable health infrastructure by training medical staff, coordinators, village cadres, midwives and those working for TB programs; provision of ongoing guidance and education in this area; and provision of medicines and funds. The project has pioneered a process towards positive changes. Another strategy is the collaboration of youth groups, island development committees, and health workers in Maldives which has led to the declaration of two islands (Madifushi and Haa Alif Berinmadhoo) as 'no smoking' islands. In addition, Sarvodaya has successfully developed a methodology to involve Buddhist monks in AIDS prevention and control through "the Buddhist approach to AIDS prevention in Sri Lanka."^ieng

Overcoming prejudice.

PIP: People of African descent comprise a large proportion of Brazil's population. While racism exists in the country, it is commonly denied. Most Afro-Brazilians live in poor areas, with poor health care services, sanitation, schools, and transport. Since HIV is linked to poverty, Afro-Brazilians are more affected by HIV than is the overall population. Although Afro-Brazilians contribute to Brazil's culture, they do not benefit from that contribution. Recognizing this considerable social problem, Project Araye was created in 1996 to address issues of race and HIV. Building upon religious and cultural traditions, the project is staffed by Afro-Brazilians who are knowledgeable in both health issues and Afro-Brazilian culture. Project Araye supports a wide range of diverse community leaders in linking sexual health and HIV with other health concerns which affect Afro-Brazilians such as sickle-cell anemia, diabetes, and leprosy. One important challenge has been overcoming the target population's denial of HIV and encouraging Afro-Brazilians to accept that HIV also affects them. Community leaders include religious leaders, rap musicians, artists, and other people respected by various communities. Activities include visits to samba dance schools, Umbanda and Candomble temples, and street youth groups to provide HIV-related information.^ieng

[Historiography of diseases in Finland]. / "Ovatko taudit itsenäisiä, eläväisiä olentoja?" - eli voimmeko kirjoittaa niiden historian.

The 19th century was a period of comprehensive, "big" histories of diseases. German historiographers of diseases were especially prominent. World-famous is August Hirsch's Handbuch der historisch-geographischen Pathologie (the second edition appeared in three volumes in 1881-1886). The first volume of the Finn Immanuel Ilmoni's (1797-1856) Bidrag till Nordens sjukdoms-historia (A History of Diseases in the Nordic Countries) was published in 1846, the second volume in 1849 and the third in 1853. In this book Ilmoni treated the history of disease up to the year 1800. He planned a fourth volume, dealing with the 19th century, but this book was never published. Ilmoni was strongly influenced by the ideas of Thomas Sydenham and the German exponents of Naturphilosophie. Ilmoni's "ontological" concept of disease was rejected by Erik Alexander Ingman, a contemporary Finnish representative of "modern" medical ideas. After Ilmoni, nobody has attempted to write a comprehensive history of diseases in Finland, but histories of cholera (Carl Qvist, 1872) lepra (Lars Fagerlund, 1886), malaria (Richard Sievers, 1891) and pulmonary tuberculosis (Woldemar Backman and Severi Savonen, 1934) have been published. Diseases in Finland received very little attention in the "world histories" of diseases. After Hirsch only one comprehensive "world history" of diseases has been published (1993).