Baciloscopia para hanseníase no Sistema Único de Saúde do Brasil entre 2013 e 2022 / Bacilloscopy for leprosy in Brazil's public health system between 2013 and 2022

Objetivo: Avaliar a quantidade anual de baciloscopias para hanseníase realizadas no Sistema Único de Saúde (SUS) nos últimos dez anos. Métodos: Foi realizado um estudo ecológico, longitudinal, retrospectivo e quantitativo, utilizando dados do Sistema de InformaçõesAmbulatoriais (SIA/SUS). A quantidade de baciloscopias para hanseníase a cada 100.000 residentes foi estimada para o Brasil e suas cinco macrorregiões, avaliada entre 2013 e 2022 com nível de significância (a) de 5%. Resultados:Mais de 1,3 milhões de baciloscopias foram notificadas nos últimos dez anos no SUS. A mediana da incidência anual foi de 67 baciloscopias para hanseníase por 100.000 residentes, sendo a máxima observada em 2013 (82) e a mínima em 2022 (46). As incidências anuais nas macrorregiões Norte, Centro-oeste e Nordeste foram significativamente superiores à estimativa nacional, enquanto no Sul e Sudeste foram inferiores (p<0,05). A tendência temporal foi considerada decrescente para a estimativa nacional (p= 0,002), com variação percentualanual de -5,6% (IC95% = -3,8%; -8,2%). Entretanto, após desconsiderar os anos da pandemia de COVID-19 (2020-2022), a tendência tornou-se estacionária (p= 0,181). Além disso, a incidência durante o período pré-pandêmico foi significativamente maior quandocomparada ao terceiro ano após o advento da pandemia em todas as macrorregiões do Brasil (p<0,05). Conclusão:Foi possível concluir que o SUS realizou um número expressivo de baciloscopias para hanseníase nos últimos dez anos, mas existem disparidades macrorregionais no Brasil, bem como um impacto significativo da pandemia de COVID-19

Objective:To evaluate the annual number of skin smear microscopies for leprosy performed in the Unified Health System (SUS) in the last decade. Methods:An ecological, longitudinal, retrospective, and quantitative study was conducted using data from the Ambulatory Information System (SIA/SUS). The number of skin smear microscopies for leprosy per 100,000 residents was estimated for Brazil and its five macroregions, between 2013 and 2022, with a significance level (a) of 5%.Results:More than 1.3 million skin smear microscopies were reported in the last decade in the SUS. The median annual incidence was 67 skin smear microscopies for leprosy per 100,000 residents, with the maximum observed in 2013 (82) and the minimum in 2022 (46). Annual incidences in the North, Central-West, and Northeast macro-regions were significantly higher than the national estimate, whereas in the South and Southeast, they were lower (p <0.05). The temporal trend was considered decreasing for the national estimate (p = 0.002), with an annual percentage variation of -5.6% (95%CI = -3.8%; -8.2%). However, after disregarding the years of the COVID-19 pandemic (2020-2022), the trend became stationary (p = 0.181). Furthermore, the incidence during the pre-pandemic period was significantly higher compared with the third year after the advent of the pandemic in all macro-regions of Brazil (p<0.05).Conclusion:It was possible to conclude that the SUS performed a significant number of skin smear microscopies for leprosy in the last ten years, but there are macro-regional disparities in Brazil and a significant impact of the COVID-19 pandemic

Large-scale epidemiological analysis of common skin diseases to identify shared and unique comorbidities and demographic factors.

Introduction: The utilization of large-scale claims databases has greatly improved the management, accessibility, and integration of extensive medical data. However, its potential for systematically identifying comorbidities in the context of skin diseases remains unexplored. Methods: This study aims to assess the capability of a comprehensive claims database in identifying comorbidities linked to 14 specific skin and skin-related conditions and examining temporal changes in their association patterns. This study employed a retrospective case-control cohort design utilizing 13 million skin/skin-related patients and 2 million randomly sampled controls from Optum's de-identified Clinformatics® Data Mart Database spanning the period from 2001 to 2018. A broad spectrum of comorbidities encompassing cancer, diabetes, respiratory, mental, immunity, gastrointestinal, and cardiovascular conditions were examined for each of the 14 skin and skin-related disorders in the study. Results: Using the established type-2 diabetes (T2D) and psoriasis comorbidity as example, we demonstrated the association is significant (P-values<1x10-15) and stable across years (OR=1.15-1.31). Analysis of the 2014-2018 data reveals that celiac disease, Crohn's disease, and ulcerative colitis exhibit the strongest associations with the 14 skin/skin-related conditions. Systemic lupus erythematosus (SLE), leprosy, and hidradenitis suppurativa show the strongest associations with 30 different comorbidities. Particularly notable associations include Crohn's disease with leprosy (odds ratio [OR]=6.60, 95% confidence interval [CI]: 3.09-14.08), primary biliary cirrhosis with SLE (OR=6.07, 95% CI: 4.93-7.46), and celiac disease with SLE (OR=6.06, 95% CI: 5.49-6.69). In addition, changes in associations were observed over time. For instance, the association between atopic dermatitis and lung cancer demonstrates a marked decrease over the past decade, with the odds ratio decreasing from 1.75 (95% CI: 1.47-2.07) to 1.02 (95% CI: 0.97-1.07). The identification of skin-associated comorbidities contributes to individualized healthcare and improved clinical management, while also enhancing our understanding of shared pathophysiology. Moreover, tracking these associations over time aids in evaluating the progression of clinical diagnosis and treatment. Discussion: The findings highlight the potential of utilizing comprehensive claims databases in advancing research and improving patient care in dermatology.

Socio-demographic and clinical factors of leprosy cases associated with the performance of the evaluation of their contacts in Ceará, Brazil, 2008-2019. / Fatores sociodemográficos e clínicos de casos de hanseníase associados ao desempenho da avaliação de seus contatos no Ceará, 2008-2019.

OBJECTIVE: To analyze the effect of sociodemographic and clinical characteristics of new leprosy cases as determinants in the performance of the evaluation of their contacts. METHODS: This was a cross-sectional study, with a temporal approach to the evaluation indicator of 100% of contacts examined of each new case (NC) registered in the state of Ceará, Brazil, on the Notifiable Diseases Information System (SINAN), in 2008-2019. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (95%CI). The temporal trends were analyzed using joinpoint regression. RESULTS: 23,675 NCs, 65.4% with contacts examined were analyzed. It was less likely to evaluate 100% of the registered contacts when the new cases were multibacillary (OR=1.19 - 95%CI 1.11;1.28) and with examination of contacts as an entry mode (OR=1.71 - 95%CI 1.35;2.18). There was an increasing temporal trend of the indicator (Annual Percentage Change: 2.1 - 95%CI 1.2;3.0). CONCLUSION: Distinct dimensions of individual and social vulnerability among new leprosy cases influenced the persistent unsatisfactory performance of the evaluation of contacts.

Epidemiology of leprosy in Italy (1920 - 2019): a comprehensive review on existing data.

BACKGROUND AND AIMS: Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy. METHODS: The following keywords were used to explore PubMed and Embase: leprosy, Hansen's disease, (Mycobacterium) leprae, Italy, without any chronological restriction. RESULTS: We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases. CONCLUSION: Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.

Spatial modeling of leprosy in the state of Bahia and its social determinants: a study of health inequities.

BACKGROUND: Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES: To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS: An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS: The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS: The use of synthetic indicators is a limitation of the study. CONCLUSIONS: Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.

Spatial modeling of leprosy in the state of Bahia and its social determinants: a study of health inequities

Abstract BACKGROUND: Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES: To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS: An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS: The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS: The use of synthetic indicators is a limitation of the study. CONCLUSIONS: Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.

The arms race between man and Mycobacterium tuberculosis: Time to regroup.

An arms race is an appropriate metaphor to use for the interaction of man and Mycobacterium tuberculosis (M.tb) through the millennia. Estimates of the time of infection of modern humans with M.tb often pre-date the Out-of-Africa migration. Humans have adapted to the changing environment during the migration with respect to climate, food sources and encounters with local pathogens. More recently, there has been adaptation to the demographic changes brought about in the majority of the human population by the Neolithic revolution. By chance and/or selection, specific variants in immune defence have arisen in different population groups. These select for M.tb strains more fit to cause disease and be transmitted, sometimes by exploiting defence systems effective on other bacteria. The different selection pressures on the M.tb lineages carried by specific human groups have resulted in a worldwide M.tb population that is geographically structured according to the humans historically found there. A similar structure is seen with pathogens such as M. leprae and Helicobacter pylori. Modern M.tb strains have emerged which may be more fit, such as the Beijing lineage, leading to their rapid spread both in the areas where they arose, and into new areas after recent introduction. The speed at which this is occurring is outpacing coevolution for the time being. By using the results of genome wide and other association studies, as well as admixture mapping and 'natural experiments' in areas where both a number of populations, admixed populations, and a variety of M.tb strains occur, we can investigate the forces that have driven the coevolution of man and M.tb. The diversity of human and bacterial genetic background may be used in the future to discover and target the specific host-pathogen interactions leading to tuberculosis diseases, which suggests the potential for rational design of vaccines and host-directed therapies.

Hanseníase: incapacidades físicas e distribuição espacial em um município do Vale do Jequitinhonha/Minas Gerais / Leprosy: physical disabilities and spatial distribution in a municipality of Vale do Jequitinhonha/Minas Gerais

Introdução: A hanseníase no Brasil ainda é considerada como doença de saúde pública. É cada vez mais necessária a adoção de medidas profiláticas para o controle e prevenção da doença. A análise espacial tem se despontado como eficaz para estratégia de planejamento das ações. Objetivos: analisar as características epidemiológicas da hanseníase relacionadas à ocorrência de incapacidades físicas e descrever a distribuição espacial de casos novos de hanseníase no município de Diamantina-MG entre os anos de 2001 a 2014. Material e Métodos: Trata-se de um estudo epidemiológico, transversal, descritivo e analítico. Os dados clínicos e socioeconômicos foram coletados no Sistema de Informação de Agravos de Notificação. Os endereços foram georreferenciados através de técnicas de geoprocessamento, utilizando o software de acesso livre Qgis 2.18.0. Resultados: Foram diagnosticados 91 casos no período de estudo. As características que se associaram às incapacidades físicas foram: ser adulto (p=0,039), menos anos de estudo (p<0,001), forma clínica dimorfa (p<0,001) e modo de detecção passivo (p=0,024). Existe uma área de adoecimento na cidade. Conclusão: Sugere-se que existem dificuldades nos serviços de saúde para o controle e diagnóstico precoce da hanseníase. O estudo pode contribuir com gestores no planejamento das ações e com profissionais de saúde para busca ativa e diagnóstico precoce da hanseníase.

Introduction: Leprosy in Brazil is still considered a public health disease. It is increasingly necessary to adopt prophylactic measures for the control and prevention of the disease. Spatial analysis has emerged as an effective strategy for action planning. Objectives: To analyze the epidemiological characteristics of leprosy related to the occurrence of physical disabilities and to describe the spatial distribution of new cases of leprosy in the municipality of Diamantina-MG between the years 2001 and 2014. Material and Methods: This is an epidemiological study, descriptive and analytical. The clinical and socioeconomic data were collected in the Notification of Injury Information System. The addresses were georeferenced using geoprocessing techniques, using the free access software Qgis 2.18.0. Results: A total of 91 cases were diagnosed during the study period. The characteristics that were associated to the physical disabilities were: adult (p = 0.039), less years of study (p <0.001), dimorphic clinical form (p<0.001) and passive detection mode (p = 0.024). There is a area of illness in the city. Conclusion: It is suggested that there are difficulties in the health services for the control and early diagnosis of leprosy. The study can contribute with managers in the planning of actions and with health professionals for active search and early diagnosis of leprosy.

Distribuição dos casos de hanseníase com incapacidade física no estado da Paraíba de 2001 a 2011 / Distribución de los casos de lepra con discapacidad física en el estado de Paraíba, en Brasil, desde 2001 hasta 2011 / The distribution of leprosy cases with physical disability in the state of Paraiba, Brazil, from 2001 to 2011

Objective: To identify the spatial pattern of disabilities occurrence by leprosy in the state of Paraíba, Brazil, from 2001 to 2011. Methods: This is an ecological, retrospective and evidence-based study, which has as a unit of analysis the regions of the State of Paraiba, from aggregated data. 3,408 leprosy cases with physical disability, and their distribution from the construction of tables and thematic maps were analyzed. Results: The results showed high detection rates in the regions of Cajazeiras, Guarabira, Esperança, Itaporanga, João Pessoa and Eastern Seridó. Only Western Seridó had no reported cases of physical disability. Conclusion: It is suggested in the study the need for deeper studies about the pathology’s spatial distribution.

Objetivo: Identificar o padrão espacial da ocorrência de incapacidades físicas por hanseníase no estado da Paraíba, entre os anos de 2001 a 2011. Métodos: Realizou-se um estudo ecológico, retrospectivo, de base documental, que apresenta como unidade de análise as microrregiões do estado da Paraíba, a partir de dados agregados. Foram analisados 3.408 casos de hanseníase com incapacidade física e sua distribuição a partir da construção de tabelas e mapa temático. Resultados: Os resultados evidenciaram altas taxas de detecção de casos com grau de incapacidade física I ou II nas microrregiões de Cajazeiras, Guarabira, Esperança, Itaporanga, João Pessoa e Seridó Oriental. Apenas a microrregião do Seridó Ocidental não teve registro de casos. Conclusão: Sugere-se com este estudo que há uma maior necessidade de vigilância nas áreas endêmicas da Paraíba com o intuito de enfatizar as ações de saúde para estas regiões.

Objetivo: Identificar el patrón espacial de la aparición de discapacidades por la lepra en el estado de Paraíba, entre los años 2001 y 2011.Métodos: Se realizó un estudio ecológico, la base documental retrospectivo, que tiene como unidad de análisis las microrregiones del estado de Paraiba, a partir de los datos agregados. Se analizaron 3.408 casos de lepra con discapacidad física y su distribución desde la construcción de tablas y mapas temáticos. Resultados: Los resultados mostraron tasas de detección de casos con un grado de discapacidad I o II en las regiones de Cajazeiras, Guarabira, Esperanza, Itaporanga, Joao Pessoa y Seridó Oriental. Sólo la micro-región de West Seridó no tenía constancia de casos. Conclusión: Se sugiere en este estudio que existe una mayor necesidad de vigilancia en las zonas endémicas de Paraiba con el fin de enfatizar las acciones de salud para estas regiones.

Leprosy in a Lombard-Avar cemetery in central Italy (Campochiaro, Molise, 6th-8th century AD): ancient DNA evidence and demography.

BACKGROUND: The study of past infectious diseases increases knowledge of the presence, impact and spread of pathogens within ancient populations. AIM: Polymerase chain reaction (PCR) was used to examine bones for the presence of Mycobacterium leprae ancient DNA (aDNA) as, even when leprosy is present, bony changes are not always pathognomonic of the disease. This study also examined the demographic profile of this population and compared it with two other populations to investigate any changes in mortality trends between different infectious diseases and between the pre-antibiotic and antibiotic eras. SUBJECTS AND METHODS: The individuals were from a site in Central Italy (6th-8th CE) and were examined for the presence of Mycobacterium leprae aDNA. In addition, an abridged life mortality table was constructed. RESULTS: Two individuals had typical leprosy palaeopathology, and one was positive for Mycobacterium leprae aDNA. However, the demographic profile shows a mortality curve similar to that of the standard, in contrast to a population that had been subjected to bubonic plague. CONCLUSIONS: This study shows that, in the historical population with leprosy, the risk factors for health seem to be constant and distributed across all age classes, similar to what is found today in the antibiotic era. There were no peaks of mortality equivalent to those found in fatal diseases such as the plague, probably due to the long clinical course of leprosy.

Quality of life in acne vulgaris: Relationship to clinical severity and demographic data.

BACKGROUND: Acne vulgaris is known to impair many aspects of quality of life. However, the correlation of this impairment with clinical severity remains equivocal despite various school, community and hospital-based studies. AIM: A hospital-based study was undertaken to measure the impairment of quality of life of patients of acne vulgaris and correlate it with the severity of lesions. METHODS: This was a cross-sectional, questionnaire-based study in a cohort of 100 patients of acne vulgaris attending the outpatient department of our referral hospital. A physician measured the severity of lesions using the global acne grading system, and patients assessed quality of life by completing a questionnaire (Cardiff acne disability index). A correlation of these two was done; some additional correlations were brought out through demographic data collected from the patients. RESULTS: There was no correlation between the severity of acne vulgaris and an impaired quality of life. Patients who consumed alcohol and/or smoked cigarettes were found to have an impaired quality of life. While the severity of acne progressively lessened in older patients, the impact on quality of life increased. LIMITATIONS: The sample size was small and there was a lack of guaranteed reliability on the self-reported quality of life. CONCLUSION: The severity of acne vulgaris does not correlate with impairment in quality of life.

Leprosy in Denmark 1980-2010: a review of 15 cases.

BACKGROUND: Leprosy, caused by Mycobacterium leprae, is a chronic and progressive granulomatous disease affecting mainly the skin and the peripheral nervous system. If left unrecognized, the infection can lead to permanent nerve damage and disability. The clinical presentation depends on the immune response of the patient and can result in a wide spectrum of symptoms. Leprosy is a rare encounter in Scandinavia but remains endemic in some parts of the world, with some areas reporting an increasing incidence. We performed a retrospective record review of leprosy cases in Denmark from 1980 to 2010 with the purpose of presenting the most common geographical, demographic and clinical findings and to discuss the diagnostic and therapeutic challenges of patients with leprosy. CASE PRESENTATION: In total 15 cases were reviewed. The majority (87%) of leprosy patients in Denmark were born in South- and Southeast Asia, and were presumed to have contracted the infection in their countries of origin. Patients were predominately young males (mean age: 28.6 years). Anaesthetic skin lesion with or without nerve enlargement were the most common clinical presentations (73%). Immunological leprosy reactions were seen in 40% of the cases. Diagnoses were based on clinical findings and skin biopsies. Treatment length varied but all patients received multidrug regimens. CONCLUSION: Leprosy should be kept in mind when encountering patients with suspicious skin lesions originating from leprosy endemic areas or with history of travel or work in the tropics. Due to the long incubation period with symptoms presenting long after immigration or return, clinicians often do not have the diagnosis in mind. The wide spectrum of symptoms and immunological reactions further complicates the diagnostic process. Treatment of leprosy and the complicated immunological reactions, which frequently accompanies the infection, should be performed in collaboration with a specialist.

Taxonomic, bioacoustic and faunistic data on a collection of Tettigonioidea from Eastern Congo (Insecta: Orthoptera).

During a 14-day excursion in March 1990, 28 species of tettigonioids were found at Irangi (1º54'S, 28º27'E), ca.100 km north west of Bukavu at Lake Kivu (Democratic Republic of the Congo, formerly Zaire), and at other localities near Bukavu. One species -Arantia (Arantia) gracilicercata Heller sp. n. - is new to science, another one-Pantecphyllus helleri Schmidt et al. 2004-was already described as new in a generic revision. All our specimens of the morphologically quite diverse and sexually dimorphic phaneropterine genus Arantia were studied using molecular methods. We propose a new subgenus Arantia (Euarantia) Heller subgen. n. based on relative tegmen width. Songs and stridulatory organs were studied in 9 species. Two phaneropterines, Horatosphaga leggei and Pardalota asymmetrica, showed remarkable calling songs lasting more than 10 s and produced by quite complicated stridulatory movements. The song of the large phaneropterine Zeuneria biramosa is noteworthy because of its unusually low carrier frequency of 3.7 kHz. Based on the examination of other specimens and species, some taxonomic changes are proposed (Phaneropteridae Burmeister, 1838 stat. rev.; Afromecopoda monroviana (Karsch, 1886) stat. rev.; Leproscirtus ebneri Karny, 1919, syn. n., Leproscirtus karschi Karny, 1919, syn. n., Leproscirtus granulosus aptera Karny, 1919, syn. n., all synonyms of Leproscirtus granulosus (Karsch, 1886); Lanistoides Sjöstedt, 1913 stat. rev.; Plastocorypha cabrai Griffini, 1909 stat. n.).

The quality of life of people with leprosy-related residual impairment and disability in Malawi--is there a difference between people living in a leprosarium and those re-integrated into their communities?

INTRODUCTION: To compare the quality of life of people affected by leprosy living in a leprosarium and those reintegrated in communities in the southern region of Malawi. DESIGN: A translated version of the World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF) was administered among two groups of people with leprosy-related residual impairment and disability living in either a leprosarium (male 47, female 53) or re-integrated into communities (male 41, female 57). The cross-sectional quantitative survey was conducted by trained Leprosy Control Assistants (LCAs). Descriptive statistics of mean and standard deviation were used to summarise the data while differences between the groups were evaluated using independent t-test. Level of significance was set at P < 0.05. RESULTS: Demographic data revealed that there were more residents of an older age in the leprosarium. There was no statistically significant differences in the WHOQOL-BREF mean scores between by those affected by leprosy living in the two contexts. Statistically significant differences existed in the psychological, physical and environmental domains when age and gender were used as confounding factors. CONCLUSIONS: We conclude that there is need to provide interventions that will encompass age and gender to all those affected by leprosy to improve their quality of life in both contexts.

Deficiências após a alta medicamentosa da hanseníase: prevalência e distribuição espacial / Leprosy-related disabilities after release from multidrug treatment: prevalence and spatial distribution / Deficiencias posteriores a alta medicamentosa de hanseniasis: prevalencia y distribución espacial

OBJETIVO: Estimar a frequência das deficiências físicas em pacientes tratados de hanseníase após alta medicamentosa e analisar sua distribuição espacial. MÉTODOS: Estudo descritivo transversal com 232 pessoas tratadas de hanseníase de 1998 a 2006. As deficiências físicas foram avaliadas pelo Grau de Incapacidades da Organização Mundial da Saúde (GI/OMS) e pelo Eye-Hand-Foot (EHF). Os ex-pacientes foram geocodificados pelo endereço de residência e os serviços de reabilitação pelo endereço de sua sede. Foram apresentadas as frequências para o total e para os grupos grau 0, grau 1 e grau 2 do GI-OMS, considerando-se as variáveis clínicas e sociodemográficas na análise descritiva. Foram utilizados os testes t de Student, qui-quadrado (χ2) ou de Fisher, conforme apropriado, considerando-se significativos p < 0,05. RESULTADOS: Cerca de 51,6% era do sexo feminino, com média de idade de 54 anos (dp15,7); 30,5% tinha menos de dois anos de educação formal; 43,5% trabalhava e 26,9% estava aposentado; a forma dimorfa predominou (39,9%). As deficiências avaliadas pelo GI-OMS e pelo EHF atingiram 32% dos ex-pacientes. A presença de deficiências foi maior com o aumento da idade (p = 0,029), em casos multibacilares (p = 0,005) e com julgamento ruim do paciente sobre sua saúde física (p < 0,001). Os que necessitavam de prevenção/reabilitação percorreram distância média de 5,5 km até o serviço de reabilitação. As pessoas com deficiência física estavam distribuídas em todo o município, mas concentravam-se na área mais populosa e de maior carência socioeconômica. CONCLUSÕES: A frequência de deficiências é elevada após a alta medicamentosa. Os ex-pacientes mais velhos, os que tiveram formas multibacilares da doença, os de baixa escolaridade e os que julgam mal a própria saúde física merecem atenção especial para a prevenção e reabilitação de deficiências. A distância entre os serviços de reabilitação e as residências dos pacientes requer reorganização da rede de atendimento no município.

OBJECTIVE: To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS: Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Student's t-test, chi-square test (χ2), and Fisher's test were used as appropriate at a 5% significance level. RESULTS: Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS: There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.

OBJETIVO: Estimar la frecuencia de las deficiencias físicas, en pacientes tratados por hanseniasis, posteriores a alta medicamentosa y analizar su distribución espacial MÉTODOS: Estudio descriptivo transversal con 232 personas tratadas por hanseniasis de 1998 a 2006. Las deficiencias físicas fueron evaluadas por el Grado de Incapacidades de la Organización Mundial de Salud (GI/OMS) y por el Eyes-Hand-Feet (EHF). Los ex -pacientes fueron geocodificados por la dirección de residencia y los servicios de rehabilitación por la dirección de su sede. Se presentaron las frecuencias para el total y para los grupos grado 0, grado 1 y grado 2 del GI-OMS, considerándose las variables clínicas y sociodemográficas en el análisis descriptivo. Se utilizaron las pruebas t de Student, Chi-cuadrado (?2) o de Fisher, conforme apropiado, considerándose significativos p= 0,05. RESULTADOS: Cerca de 51,6% eran del sexo femenino, con promedio de edad de 54 años (de 15,7); 30,5% tenían menos de dos años de educación formal; 43,5% trabajaban y 26,9% estaban jubilados; la forma dimorfa predominó (39,9%). Las deficiencias evaluadas por el GI-OMS y por el EHF alcanzaron 32% de los ex -pacientes La presencia de deficiencias fue mayor con el aumento de la edad (p=0,029), en casos multibacilares (p=0,005) y con diagnóstico equivocado del paciente sobre su salud física (p?0,001). Los que necesitaban de prevención/rehabilitación recorrieron distancia promedio de 5,5km hasta el servicio de rehabilitación. Las personas con deficiencia física estaban distribuidas en todo el municipio, pero se concentraban en el área más populosa y de mayor carencia socioeconómica. CONCLUSIONES: La frecuencia de deficiencias es elevada posterior al alta medicamentosa. Los ex -pacientes más viejos, los que tuvieron formas multibacilares de la enfermedad, los de baja escolaridad y los que presentaron diagnóstico equivocado de la propia salud física merecen atención especial para la prevención y rehabilitación de deficiencias. La distancia entre los servicios de rehabilitación y las residencias de los pacientes requiere reorganización de la red de atención en el municipio.

Impact of migration on new case detection rates in leprosy in Gudiyatham Taluk, Tamil Nadu, India.

Migration of persons affected by leprosy was hinted at as early as 1929 (Bhaskara Rao 1930). All new cases of leprosy in Isfahan Province (Iran) were found to be migrants (Asilian et al 2005). Chudasama (2007) suspected increase in leprosy cases in Surat district to migration. These suggest migration contributes to new cases. This study was done to find out 1. Extent of migration among new cases, 2. Characteristics of migrants, 3. Occupational pattern 4.Reasons for migration. 5. Place of origin of migrants 6. Assimilation of migrants into the society. Trained staff collected information regarding migration using special questionnaire from all 222 new untreated cases from the field area of Community Health department during 2004 to 2008. Migrants were 10.4%. Distribution of place of residence, age, gender, marital status, education, mode of detection, Ridley-Jopling and MB/PB classifications of migrants were not significantly different from that of nonmigrants. Grade 2 deformities were more among migrants. All migrants found occupation. Mostly men migrated for job and women for joining their husbands. The role of migration in increasing the number of new cases cannot be minimized. Enhanced efforts should be made to provide adequate medical, health and rehabilitation services for them also.

[Leprosy-related disabilities after release from multidrug treatment: prevalence and spatial distribution]. / Deficiências após a alta medicamentosa da hanseníase: prevalência e distribuição espacial.

OBJECTIVE: To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS: Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Student's t-test, chi-square test (χ2), and Fisher's test were used as appropriate at a 5% significance level. RESULTS: Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS: There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.

Hansen disease among Micronesian and Marshallese persons living in the United States.

An increasing proportion of Hansen disease cases in the United States occurs among migrants from the Micronesian region, where leprosy prevalence is high. We abstracted surveillance and clinical records of the National Hansen's Disease Program to determine geographic, demographic, and clinical patterns. Since 2004, 13% of US cases have occurred in this migrant population. Although Hawaii reported the most cases, reports have increased in the central and southern states. Multibacillary disease in men predominates on the US mainland. Of 49 patients for whom clinical data were available, 37 (75%) had leprosy reaction, neuropathy, or other complications; 17 (37%) of 46 completed treatment. Comparison of data from the US mainland with Hawaii and country-of-origin suggests under-detection of cases in pediatric and female patients and with paucibacillary disease in the United States. Increased case finding and management, and avoidance of leprosy-labeled stigma, is needed for this population.

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

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