Effectiveness of social skills training for reduction of self-perceived stigma in leprosy patients in rural India--a preliminary study.

OBJECTIVES: To assess the effectiveness of social skills training in leprosy patients to raise self-esteem and reduce self-perceived stigma. DESIGN: Five leprosy patients were given 10 day-long group-sessions of social skills training over 3 weeks. Training involved: identification of the emotions and concerns of patients when interacting socially; analysis of positive and negative social interactions and non-verbal and verbal skills training. Role-plays, videos and live models were used. Self-esteem and a reduction in self-perceived stigma were assessed qualitatively before and after training using semi-structured interviews. Assessment of change was scored under the indicators: self-perception, family, wider community and job. Patients were assessed for displaying new ways of interacting with people and changes in expectations for the future. RESULTS: Qualitative analysis of the interviews before and after training suggested that social skills training could raise the self-esteem of leprosy patients and combat self-perceived stigma. Increase in self-esteem, as evident through the verbal interactions with the interviewers and behavioural changes in the community, were noted in the majority of patients. CONCLUSION: Social skills training along with counseling may be able to increase the self-esteem of leprosy patients, and so be a useful part of leprosy rehabilitation schemes to try and combat the stigma of leprosy.

The validity and reliability of a simple semantic classification of foot posture.

INTRODUCTION: The Simple Semantic Classification (SSC) is described as a pragmatic method to assist in the assessment of the weight bearing foot. It was designed for application by therapists and technicians working in underdeveloped situations, after they have had basic orientation in foot function. OBJECTIVE: To present evidence of the validity and inter observer reliability of the SSC. METHOD: 13 physiotherapists from LEPRA India projects and 12 physical therapists functioning within the National Programme for the Elimination of Hansen's Disease (PNEH), Brazil, participated in an inter-observer exercise. Inter-observer agreement was gauged using the Kappa statistic. The results of the inter-observer exercise were dependent on observations of foot posture made from photographs. This was necessary to ensure that the procedure was standardised for participants in different countries. The method had limitations which were partly reflected in the results. RESULTS: The level of agreement between the principle investigator and Indian physiotherapists was Kappa = 058. The level of agreement between Brazilian physical therapists and the principle investigator was Kappa = 0.70. CONCLUSION: The authors opine that the results were sufficiently compelling to suggest that the Simple Semantic Classification can be used as a field method to identify people at increased risk of foot pathologies.

Alteraçöes posturais das pressöes intra-ocular e arterial em portadores da doença de Hansen / The postural changes on intraocular and blood pressure in patients with Hansen's disease

Os autores verificaram as pressöes intra-ocular e arterial de 40 pacientes com doença de Hansen que residem em colônia de hansenianos e 20 indivíduos voluntários sadios. Os pacientes e o grupo controle tiveram as pressöes intra-ocular e arterial verificadas 6 vezes. As pressöes intra-ocular e arterial foram tomadas após os pacientes deitarem em decúbito dorsal e todo o procedimento foi repetido 5 e 10 minutos após deitarem. Foi pedido aos pacientes para sentarem e novas medidas foram tomadas, isto é, imediatamente, 5 e 10 minutos após sentarem. A média de Po foi significantemente maior na posiçäo deitada do que sentada, para todos os tempos estudados, em ambos os grupos (p<0,001). Näo foi encontrada diferença significante entre indivíduos normais e portadores da Doença de Hansen. Também näo foi encontrada alteraçäo da pressäo arterial nas diferentes posiçöes estudadas em ambos os grupos

Intraocular pressure changes and postural changes of intraocular pressure in experimentally induced Hansen's disease of rhesus, mangabey, and African green monkeys.

In our long term evaluation of patients with Hansen's disease we have frequently found reduction of their intraocular pressure. Furthermore, we noted changes in their intraocular pressure on change of posture. To determine if these changes have any significance we measured the intraocular pressures of 24 experimentally infected and 39 control monkeys in both sitting and reclining positions. We found significant reduction of intraocular pressure in 66.7% compared with controls in the sitting position, and a significant increase in intraocular pressure in 79% when checked first in the sitting then in the reclining position. We offer a possible pathophysiological explanation as to why the changes occur.

Intraocular pressure and iris denervation in Hansen's disease.

We retrospectively analyzed 255 Hansen's disease patients and found low intraocular pressure (less than 7 mm Hg) in 12% of them. We showed a correlation between low intraocular pressure and avascular keratitis and iritis. We also found that patients with low intraocular pressures had abnormally large postural changes in intraocular pressure. We speculate that abnormalities in the autonomic innervation of the anterior segment of the eye may be related to the intraocular pressure abnormalities. Further investigations along this line may increase our understanding not only of the pathophysiology of Hansen's disease but also of the mechanisms regulating homeostasis of intraocular pressure.

Ocular autonomic dysfunction and intraocular pressure in leprosy.

We examined 241 leprosy patients and 135 age-matched healthy controls in central South Korea, measuring intraocular pressure in the supine and the upright positions and measuring the size of the pupils in darkness as an indication of ocular autonomic dysfunction. The mean intraocular pressure was significantly lower in the patients and the mean size of pupils was significantly smaller in the patients than in the controls. However, there was no correlation between pupil size and intraocular pressure in our patients. Our findings show that leprosy patients have ocular autonomic dysfunction, but do not support previous speculation that this dysfunction is the primary cause for low intraocular pressure in leprosy.

Low intraocular pressure and postural changes in intraocular pressure in patients with Hansen's disease.

We found intraocular pressures of less than 7 mm Hg in 11 of 72 patients (15%) with early Hansen's disease. Furthermore, significant postural changes in intraocular pressure (greater than 30%) occurred in 43 of 72 patients (60%). This loss of intraocular pressure homeostasis, which results from reduced aqueous humor production or increased uveoscleral outflow with reduced local adrenergic control in the ciliary body-iris-trabecular meshwork region, suggests that early autonomic neuropathy of the eye may occur in Hansen's disease. The only predictive value for significant postural change in intraocular pressure was the presence of immunologically unstable disease.

Lauge-Hansen classification: a clockwork injury.

The purpose of this article is to present the Lauge-Hansen classification of ankle injuries, in a simplified system according to clockwork function. By familiarization with this classification system, one will gain an invaluable tool in evaluating and treating ankle injuries.