Type D personality is associated with poor quality of life, social performance, and psychological impairment in patients with moderate to severe psoriasis: A cross-sectional study of 130 patients.

BACKGROUND: Psoriasis is a systemic autoinflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D personality has been related to poor quality of life and worse physical and psychological outcomes in different diseases. AIMS: The aim of this study is to explore whether type D personality is associated with an increased risk of presenting physical and/or psychological comorbidities, their relationship with the capacity of social adaptation, and health-related quality of life (HRQOL) in patients with psoriasis. METHODS: This was a cross-sectional study. In all, 130 patients with moderate to severe psoriasis were included in this study. Participants completed the DS14 test and different validated questionnaires regarding quality of life and psychological morbidities. RESULTS: Type D personality was present in 38.4% (50/130) of the participants of the study. Patients with psoriasis and type D personality presented a higher risk of depression and anxiety. We observed that type D personality was associated with a lower educational level. These patients also presented a worse HRQOL in different dimensions of the Short Form Health Survey-36 questionnaire, more sleep problems, poor social adaptation, and a higher frequency of sexual disturbances. LIMITATIONS: Due to the cross-sectional design of the study, we could not confirm causality. Selection of sample was not random. Diagnoses of physical comorbidity were collected through clinical interview of patients under active treatment, which may imply a classification bias. CONCLUSION: Type D personality could represent a frequent personality profile in patients with psoriasis that could identify subjects with poor coping abilities to the disease with poorer levels of quality of life, increased psychological comorbidities, and inadequate social adaptation mechanisms.

As altas e o problema social dos egressos / The medical release and the social problem of this patients

O uso das salfonas antes de proporcionar a cura clínica, inibia a liberação do bacilo de Hansen, diminuindo os riscos de contágio. Dessa forma, o leproso, mesmo sem estar curado, poderia retornar ao convívio social mais amplo, sem oferecer maiores perigos aos sadios. Ao mesmo tempo que existe um saber científico que define, delimita, sistematiza a doença, há um saber cultural que também produz significados acerca das enfermidades. Nesse sentido, a cura biológica, simplesmente, não seria suficiente para erradicar a doença. Esta "contraface cultural da lepra vai definir, de certa forma, os rumos das políticas de combate à doença. Assim, o texto traz o problema social do egresso; o reajustamento social do egresso, com as ações e conflitos; a produção de discursos acerca da lepra. (AU)

A process report on physical and psychological determiners of social functioning in leprosy patients.

Management and rehabilitation of leprosy patients needs information aoout the social acceptance and its association with physical and psychological problems of the affected person. Ninety three leprosy patients (72 male and 21 female) were selected from outpatient department of the hospitals/clinics and their demographic and clinical informations were recorded. The patients were screened for common menta diseases using GHQ-60 (Bengali version). The social functioning was assessed using SSFI. Mean age was 35.19 +/- 12.5 years, 69.9% of the subjects were from urban areas. Multibacillary cases accounted for 60.2% of the cases, 21.5% of the patients had deformity, 53.8% of the patients screened positive for common psychiatric diseases. Social functioning impairment of mild, moderate and severe level was 9.7%, 82.8, and 7.5% respectively. On Univariate analysis, presence of deformity was the only variable showing significant association with moderate to severe degree of social impairment. Using decision tree (Exhaustive CHAID) analysis, presence of deformity along with urban residence was strongly predicted severe social functioning impairment. The results of the study show the need to formulate suitable psychosocial intervention strategy especially in the context of high psychiatric morbidity.

[Amputation in low-income countries: particularities in epidmiological features and management practices]. / Les amputations dans les pays à faibles revenus: particularités de l'épidémiologie, de l'appareillage et de la rééducation.

The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally.

“El dinero es el vehículo de interacción”: perspectivas de integración social de las personas afectadas por la lepra en e norte de Nigeria / No disponible

Objetivo: Este estudio propone un planteamiento mediante el cual la rehabilitación socio-económica (SER) puede conseguir reducir el estigma relacionado con la lepra en el norte de Nigeria, después de analizar las entrevistas llevadas a cabo para evaluar el impacto de la SER. Metodología: La evaluación combina un cuestionario cuantitativo (escala P) con entrevistas cualitativas de 20 individuos afectados de lepra, cinco grupos de discusión y 10 entrevistas a individuos considerados importantes. A partir de nuestra información desarrollamos un marco de trabajo de estigma relacionado con la lepra integrando los temas emergentes y que puedan constituir una posible amenaza para el funcionamiento de los grupos, para describir como se percibe el estigma por las personas afectadas de lepra en el norte de Nigeria. Resultados: Los resultados revelan que las personas afectadas por lepra están menos estigmatizadas por las discapacidades causadas por la enfermedad que por su incapacidad de contribuir al sostenimiento familiar/comunitario. También, se identificaron los microcréditos y la formación profesional como elementos del SER que reducen el estigma a través de un mecanismo de protección de individuos frente a la pérdida del valor social al facilitar su compromiso social continuado en las tareas sociales cotidianas de la familia/comunidad. Conclusión: Se propone que la SER estimula los cambios de actitud y la inclusión de personas afectadas por lepra al proteger a los individuos frente a la pérdida del valor social e incrementar su capacidad de participación. Se propone una mayor evaluación empírica del marco propuesto para evaluar su utilidad en otras culturas (AU)

Objective: This paper proposes a mechanism by which socio-economic rehabilitation (SER) reduces stigma in northern Nigeria following a re-analysis of the transcripts of interviews conducted to evaluate the impact of SER on leprosy-related stigma. Design: the evaluation combined quantitative questionnaire (P-scale) with qualitative interviews of 20 individuals affected by leprosy, five focus group discussions and 10 key informant interviews. Form our data, we developed a leprosy related stigma framework by integrating emerging themes with the construct of threat to group functioning to describe stigma processes experienced by people affected by leprosy in northern Nigeria. Results: Finding revealed people affected by leprosy are less likely to be stigmatized because of leprosy impairments than for their incapacity to contribute to family/community finances. We also identified micro-credit loans and vocational training as elements of SER for reducing stigma through the mechanism of protecting individuals against the loss of social value, and by facilitating their continued engagement in daily social roles in the family/community. Conclusion: We propose that SER stimulates attitudinal change towards, and inclusion of people affected by leprosy by protecting individuals against the loss of social value and increasing their contributive capacity. We recommend further empirical testing of the proposed framework to ascertain its utility in other cultures (AU)

Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil.

In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called 'United-States-of-Sobral', in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30% increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A 'contextualized semantic interpretation' revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. 'Skin Spot Day' discriminates more than educates. Patients' 'non-compliance' with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. 'Social leprosy' in Northeast Brazil deforms patients' moral reputations and personal dignity.

Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil / Estigma, metáforas deformadoras e experiência moral de pacientes com hanseníase multibacilar em Sobral, Ceará, Brasil

In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called "United-States-of-Sobral", in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30 percent increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A "contextualized semantic interpretation" revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. "Skin Spot Day" discriminates more than educates. Patients' "non-compliance" with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. "Social leprosy" in Northeast Brazil deforms patients' moral reputations and personal dignity.

No intuito de criar uma Ciência do Estigma, este estudo antropológico investiga a experiência moral de pacientes diagnosticados com a hanseníase multibacilar. De 2003 a 2006, a pesquisa foi conduzida nos "Estados Unidos do Sobral", Estado do Ceará, Brasil, altamente endêmico para hanseníase apesar da intensificação de erradicação e o aumento de 30 por cento na cobertura de saúde desde 1999. Entre 329 casos de hanseníase, 279 foram identificados como multibacilar e seis casos "ricos em informação" foram selecionados para aprofundamento. Narrativas da enfermidade, entrevistas etnográficas, visitas domiciliares, observação-participante de consultas clínicas e entrevistas semi-estruturadas com médicos foram realizadas. A "interpretação semântica contextualizada" revelou quatro metáforas de "lepra" - uma repulsiva doença de rato, uma infecção de pele com conotações racistas, uma praga bíblica, e uma leucemia letal. Essas metáforas "multivocálicas" contestam o discurso biomédico. A lepra é repleta de significados morais. O "Dia da Mancha" descrimina mais do que educa. A falta de aderência à eficaz poliquimoterapia é causada mais pelo estigma desmoralizante do que pela rejeição ao tratamento em si. A "lepra social" no nordeste brasileiro deforma a reputação moral e a dignidade do paciente.

Assistive devices for people affected by leprosy: underutilised facilitators of functioning?

OBJECTIVES: People affected by leprosy and their families face social and economic problems. The focus of interventions is often on prevention of disabilities and socioeconomic rehabilitation. The objective of this study was to explore to what extent the potential of assistive devices to facilitate activities and participation of people affected by leprosy has been utilised. DESIGN: Published literature was reviewed and the findings analysed. RESULTS: Considerable attention has been given to the protecting role of assistive devices. The focus of assistive devices facilitating functioning has been on mobility aspects of self-care and domestic life. CONCLUSIONS: The findings indicate that the potential of assistive devices to facilitate activities and participation in life areas such as work and employment is still waiting to be utilised on a broad scale.

[Post-treatment of Leprosy in Ceará: activity and functional limitation, safety awareness and social participation]. / Pós-alta em Hanseníase no Ceará: limitação da atividade funcional, consciência de risco e participação social.

To characterize the functional limitation, activity limitation, risk conscience, and the social participation in people reached by hansen's disease in the post-MDT period. Cross-sectional, descriptive study, accomplished in 2006. Sixty-nine residents in Sobral that had discharge from MDT between 2003-2005 participated. The subjects were interviewed: demographic evaluation, dermato-neurological exams, evaluation of functional limitation-activity-risk conscience and the restriction in social participation. Twenty (28.9%) presented SALSA scores 19 and 20 and EHF score zero. The largest EHF score was reached by two participants, with scores 25 and 28 in the SALSA scale. In the participation scale 37 (53.6%) didn't present restriction and had EHF scores zero. Two (2.9%) with EHF score zero had mild restriction, and 1 (1.5%) severe restriction. This study reaffirms the potentiality of these tools for integral care of people reached.

Pós-alta em Hanseníase no Ceará: limitação da atividade funcional, consciência de risco e participação social / Pos-alta hospitalária en Lepra en Ceará: limitación de actividad funcional, conciencia de riesgo y participación social / Post-treatment of Leprosy in Ceará: activity and functional limitation, safety awareness and social participation

Caracterizar a limitação funcional, de atividade, consciência de risco, e restrição à participação social em pessoas atingidas pela hanseníase no pós-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceará, com alta entre 2003 a 2005. Foram realizados exame físico dermato-neurológico, avaliação demográfica, de limitação funcional-atividade-consciência de risco e de restrição à participação social. Vinte (28,9 por cento) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcançado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participação 37 (53,6 por cento) não apresentaram restrição e tinham escore EHF zero. Dois (2,9 por cento) com escore EHF zero tinham leve restrição e 1 (1,5 por cento), grande restrição. Reafirma-se a potencialidade destas ferramentas para a atenção integral aos portadores.

To characterize the functional limitation, activity limitation, risk conscience, and the social participation in people reached by hansen's disease in the post-MDT period. Cross-sectional, descriptive study, accomplished in 2006. Sixty-nine residents in Sobral that had discharge from MDT between 2003-2005 participated. The subjects were interviewed: demographic evaluation, dermato-neurological exams, evaluation of functional limitation-activity-risk conscience and the restriction in social participation. Twenty (28.9 percent) presented SALSA scores 19 and 20 and EHF score zero. The largest EHF score was reached by two participants, with scores 25 and 28 in the SALSA scale. In the participation scale 37 (53.6 percent) didn't present restriction and had EHF scores zero. Two (2.9 percent) with EHF score zero had mild restriction, and 1 (1.5 percent) severe restriction. This study reaffirms the potentiality of these tools for integral care of people reached.

Caracterizar la limitación funcional de actividad, conciencia de riesgo y restricción a la participación social en personas atingidas por la lepra en el post-alta. Estudio seccional y descriptivo con 69 sitiados en Sobral, Ceará, con alta entre 2003 y 2005. Fueron hechos examen físico dermatológico y además neurológico, evaluación demográfica, de limitación funcional, actividad y conciencia de riesgo y de restricción a la participación social. Veinte (28,9 por ciento) presentaron escores SALSA 19 y 20 escore EHF cero. La mayor EHF fue alcanzada por dos participantes, con 25 y 28 años en la escala SALSA. En la categoría participación, 37 (53,6 por ciento) no presentaron restricción y tenían escore EHF cero. Dos (2,9 por ciento) con EHF cero tenían poca restricción y 1 (1,5 por ciento), gran restricción. Delante de eso, se afirma una vez más la potencialidad de éstas herramientas para la atención integral a los portadores.

[Social rehabilitation experiences of people with a history of Hansen's disease: interviews of readmitted residents in a sanatorium].

PURPOSE: This study focused on the reflections of people with a history of Hansen's disease who once experienced social life and then returned to their sanatorium again. The purpose was to clarify what they think about their experiences of social life outside of institutions. METHOD: Study participants were people with a history of Hansen's disease who had experienced social life outside of the sanatorium and are now living in a national sanatorium with good ADL. The study was based on a semi-structured interview, the data being categorized with the focus on "situations or topics affect by Hansen's disease". Thirteen people agreed to participate in the study. RESULTS AND DISCUSSION: Six categories were abstracted: "maintaining a good condition," "anxiety about relapse or illness," "medical service," "coping with Hansen's disease in social life," "relationships with others," and "means of livelihood." Hansen's disease affected their lives in 2 aspects; one was "sawagu (recurrence of the disease)" and the other "kakusu (concealing the disease)." "Sawagu" was related to "anxiety of the disease" and "intention of maintaining a good condition." "Kakusu" affected the way of "coping with the disease in social life" and "the relationship with others." "Medical service" was important for both "sawagu" and "kakusu." Patients were visiting hospitals and taking medicine to avoid "sawagu," while trying to "kakusu" when they consulted with physicians. Similarly, both "sawagu" and "kakusu" interacted with each other when the participants needed to work and earn a living. All participants looked back at their social life as a "good experience" because they were satisfied with the sense of accomplishment or fulfillment the experience had given them. CONCLUSION: Participants of the study looked back at their social life as a "good experience." Hansen's disease affected their social life in 2 aspects; "sawagu" and "kakusu." It is necessary to alleviate difficulties with both of these so that people with stigmatized disease such as Hansen's disease can maintain normal lives in society.

Depressive status of leprosy patients in Bangladesh: association with self-perception of stigma.

Stigmatization by the general population and their negative attitudes towards leprosy negatively impacts on patients' mental health, and so too does patients' perception of that stigma. The objective of this present study is to assess the depressive status of leprosy patients, the patient perception of that stigma, and its association with their depressive status in Dhaka, Bangladesh. Subjects were 140 patients, and a selected comparison group of 135 local people without any chronic diseases. To evaluate depressive status, the Center for Epidemiologic Studies Depression scale (CES-D) Bengali version was applied. The patient group's depressive status was significantly more severe than that of the comparison group. Depressive status of those who answered affirmatively was significantly more severe than that of those who answered negatively for three responses to questions: 1) 'I have been physically attacked by people', 2) 'I feel people regard me as strange' and 3) 'I have been refused the purchase of something by a shopkeeper'. The results showed that the depressive status in leprosy patients was greater than that of the general public. Further, actual experiences of discrimination based on stigma associated with the depressive status of leprosy patients. Mental health care for patients, regulation of discriminatory action and education that would decrease social stigma among the general population, especially people who might often have contact with patients, seem necessary to improve the mental health of Bangladeshi leprosy patients.

[Social reproduction of leprosy: a study of patients profile with leprosy in the city of São Paulo]. / A reprodução social da hanseníase: um estudo do perfil de doentes com hanseníase no Município de São Paulo.

This study discusses the relationship between work and living conditions among leprosy patients enrolled in the São Paulo municipal public health system in 1996. Social patterns were studied based on the theory of social determination of the health-disease process. The main purpose of the study was to emphasize evidence of the disease determination network, seeking new knowledge to improve public policies on leprosy. Data were gathered from a sample of leprosy patients registered in the city's public health system. Although patients' families are characterized by a common social thread, different work/life possibilities allow for a classification of patients into three social groups. The majority belong to groups that are marginalized from social production, living in areas where social exclusion is more extreme, on the outskirts of the city. If the trends in this study persist, incident leprosy cases will result from the social exclusion of migrants from Brazil's Southeast and Northeast. The study also discusses the position of young people and female patients in the determination network of this infectious disease in the city of São Paulo.

Gender differentials in the social and family life of leprosy patients.

A study was carried out at the Leprosy Control Unit, Government Medical College, Nagpur, India, to investigate gender differentials in the social and family life of leprosy patients. The study included 486 (268 males and 218 females) leprosy patients, who were diagnosed and registered at least 1 year prior to the data collection. It was observed that leprosy patients were isolated and refrained from various activities in the family. However, the effect of disease on this isolation was significantly greater in females as compared to males. Similarly, although, men and women were both affected in terms of their social life, women suffered more isolation and rejection from the society. The current study describes the gender differentials in the social and family life of leprosy patients in Central India.

Public communication campaigns in the destigmatization of leprosy; a comparative analysis of diffusion and participatory approaches. A case study in Gwalior, India

This was an experimental study designed to determine the relative effectiveness of diffusion and participatory strategies (in health campaigns) and the effect of caste on the dependent variables of knowledge, perception of risk, and behavioral involvement that were conceptualized as contributing to leprosy destigmatization in Madhya Pradesh state, India. The multivariate analysis of covariance (MANCOVA) procedure found significant difference between the communication treatments on the dependent variables. The discriminate analysis procedure was used to locate the source of the difference. Yhis procedure identified two significant discriminant functions; cognitive-affective and behavior-affective dimensions. The participatory treatment showed higher knoeledge and lower perception of risk on the cognitive-affective dimension, and higher behavioral involvement on the behavior-affective dimension, but the diffusion treatment showed only lower self-perception of risk on the behavior-affective dimension. The study concluded that participatory strategies promoting dialogue and interaction and incorporating people's knowlwdge and action component result in increased knowledge, lower percption of risk, higher bahavioral involvement, and, hence, destigmatization.

[Organization of a program for the prevention of disabilities and physical rehabilitation at the center of a national program in the campaign against leprosy: practical advice]. / Organisation d'un programme de prévention des invalidités et de réadaptation physique (PIRP) au sein d'un programme national de lutte contre la lèpre (PNL): conseils pratiques.

Patients treated and cured on the bacteriological level by multidrug therapy may nevertheless present handicaps, such as deformities resulting from the disease, which have personal and social consequences. It is actually the handicap and disability from which most patients suffer and which concern populations. The number of persons suffering from such handicaps worldwide has been estimated at 4 million. Therefore, the main goal is to gradually integrate the activities of the prevention of disabilities and physical rehabilitation programme (PIRP) into the national leprosy control programme (PNL). The persons involved in the implementation of the programme outline the activities planned under the PIRP, detailed objectives, priorities, the means by which they will be implemented, the content of training programmes, assessment criteria and documents available.