[Current status of dementia in admitions to national leprosariums nationwide].

The purpose of this study was to get an overview of the following aspects of people admitted to 13 national leprosariums in Japan: the prevalence of dementia, medical and nursing systems, and facilities and equipment. Subjects included 1733 people admitted to wards for patients or disabled people in these leprosariums. Subjects were examined for cognitive function using Nishimura's behavioral rating scale for the mental states of the elderly (NMS), and for the prevalence of behavioral and psychological symptoms of dementia (BPSD). We also investigated medical and nursing systems, facilities and equipment, and status of nursing education. The results showed that, 288 subjects (16.6%) had a diagnosis of dementia. According to the NMS, 47.5% of the subjects were categorized as mild to severe dementia, while cognitive dysfunction was observed in 63.5% if borderline cases were included. Non-specialist physicians managed 30.8% of the subjects in 4 institutions, and there were no certified nurses specialized in dementia management. Results from this study suggest that there is need for the placement of dementia specialists', improvement of specialized medical services, and human resource development of specialized nurses in leprosariums where many elderly people live.

Leprosy, the key to another kingdom.

OBJECTIVE: In India, many people affected by leprosy still live in self-established settlements, commonly referred to as leprosy colonies. Aid organisations generally attribute the social segregation of colony members to the stigma attached to leprosy. In this article, I argue that the common approach towards leprosy colonies is actually based on a limited understanding of social relations between colony members and others. The insights from this study will hopefully facilitate re-thinking current approaches to stigma reduction in leprosy. DESIGN: An ethnographic study conducted over a period of three months in and around a leprosy colony in India. With the help of a local research assistant, I carried out semi-structured interviews, informal conversations, and participant as well as non-participant observation. I conducted interviews with 22 colony members and 25 residents from the adjacent neighbourhoods of the colony. RESULTS: This study reveals that the differentiation between colony members and others derived at least as much from community membership as from stigma. Leprosy-affected people living outside the colony, for example, perceived the colony members as widely different from themselves, whilst stigma affected both groups. Programmes with the aim of reducing stigma need to approach stigma relations as embedded in various interrelated physio-emotional and socio-cultural processes, rather than approaching social aspects of leprosy by focusing exclusively on the notion of stigma.

[Tendencies of prescriptions for neuralgic pain in National Suruga Sanatorium (leprosy), Japan during last 11 years].

The number of ex-leprosy patients has reduced rapidly who were forced to be admitted under leprosy prevention/segregation law and are staying at national sanatoriums with different disabilities due to different physical and social reasons for long time in Japan. Most of them have been of clinically cured status for decades after effective chemotherapy. Some have still been suffering from acute or chronic neuralgic pains which are supposed to be long standing consequences of nerve damage of leprosy and getting medications for long period. Pharmacy department of National Suruga Sanatorium has studied the amount of prescriptions of some medicines for last 11 years, which were thought to be prescribed for pain including neuralgic pain. There seem to be some tendencies of medications during last decade. VitaminB12 (Mecobalamine) is one of the commonest drugs for neuralgic pain at this sanatorium and the amount of prescription had almost been unchanged through the years. Prescription of non-steroid anti-inflammatory drugs (NSAIDs) increased year by year, which may reflect the increasing age of ex-patients who need more pain killers for their painful joints or back. Loxoprofen is the most popular pain killer here and increased by ten times for last decade. The number of prescription for Pentazocine and Hydroxyzine Hydrochloride injection increased for last several years, which reflects a few patients who were still suffering from severe chronic neuralgia for years. It is desirable that a standard regimen for chronic neuralgic pain as a consequence of nerve impairment in leprosy will be developed as soon as possible.

The sustainability of self-care in two counties of Guizhou Province, Peoples' Republic of China.

This paper presents the findings of a follow-up survey conducted in two rural counties of Guizhou Province, PRC where a programme to prevent disabilities amongst leprosy affected people had been conducted. An initial 3-year programme had been conducted. One year after the final evaluation of the programme, a team was deployed to conduct a survey in the area. The objective of the survey was to establish the level of adherence to self-care. It was found that 87% of the sample of people living in leprosy villages that were surveyed (n = 31) and 50% of the sample of people living in general communities (n = 50) had continued to apply self-care. Interviews with family members suggested that 18 of the 27 self-care practising subjects living in the leprosy villages received encouragement or active support from family members (9 were single people). Twenty three of the 25 self-care practising subjects living in the communities also received family support (2 were single people). Family support was a highly significant factor influencing adherence in the community (OR = 15.8, CI = 3.0 to 83) but it may not have been the primary motivating factor in the leprosy villages where single people were just as likely to have adhered to self-care than people who were living in families (OR 0.5, CI = 0.06 to 4.2). The prevalence of foot ulceration among that population was recorded but a hypothetical association between the prevalence of foot ulceration and self-care adherence could not be investigated due to insufficient data to address the potential effects of confounding variables. Thirty-eight percent of subjects who did not practice self-care presented with ulceration or foot cracks (n = 29) compared with only 25% of people who did (n = 52).

[Elderly depression in a Japanese leprosarium].

This report described the distribution of the patients who had been treated by psychiatrist in the National Tamazenshouen Sanatorium, a major leprosarium in Japan. We also investigated the characteristics of patients who had suffered a depressive episode during the last 5 years. Somatic symptoms were the predominant symptoms and were not limited to clinical signs unique to leprosy. The period of isolation was not significantly correlated with the geriatric depression scale. Forty-two residents had committed suicide since the leprosarium was established in 1909. The findings of this study emphasize the importance of psychosocial intervention to the residents.

[Survey on the present conditions of the residents regarding aging, aftereffects and subsequent complication].

A survey of present conditions of the residents regarding aging, aftereffects and subsequent complication was conducted and its data were analyzed in the National Leprosarium Osima Seisho-en; located on an isolated island of the Seto Inland Sea. The results showed that they have become older with a various type of disease and most of them suffered from aftereffects caused leprosy, although after therapy. This survey also suggests that future problems in the management of our leprosarium will no doubt be to cope with the aging and to reducing our scale.

[Effect of physician shortage on today's Hansen's disease management].

In recent years, the total patient population of Hansen's disease has been rapid declining throughout Japan by as many as 200 - 250 each year. This decline is due to the aging of existing patients, and scarcity of new cases. Less patients are a welcome phenomenon. However, existing treatment facilities are now confronted with problems. The most serious problem is shortage of treating physicians. The causes of the shortage are (1) the aging of the existing patient population that creates mounting need for medical-surgical care and (2) the nation-wide shortage of physician in national sanatoria all over Japan. Let me present a sketch of the current situation at Amamiwakouen Hospital as an illustration. Amamiwakouen is a government-run sanatorium. It is responsible to take care of inpatient as well as out patients. Currently, there are 70 long term inpatients, who are handicapped by Hansen's disease sequela of various degrees. 11 minimally former inpatients are followed at the outpatient clinic. The clinic is also open to all community citizens. The number of annual clinic visitors averages 6,500 - 7,000. They come with wide range of problems requiring a dermatologist. While the total number of full-time staff is 100, only two are licensed physicians at present. This is indeed a disastrous situation. Therefore a number of contract physicians are recruited from nearby medical institutes to meat the demand.

Censo imunológico no Lazareto de Contratación (Colômbia)

Foram revistos 1.282 menores de 18 anos, tendo sido encontrados apenas 67 casos de lepra, dos quais 25 do grupo indeterminado, 14 do tipo lepromatoso, sendo os demais do tipo tuberculóide. Comparando os resultados com os dados de 1954 em Agua de Dios e Contratación, verifica-se que diminuiram os casos em comunicantes em relação ao número de doentes nessas coletividades; em 1954 oscilaram entre 7,79% (Agua de Dios) e 8,06% (Contratación). Atualmente chegam a 5,7% em Contratación. Se, porém, tomar-se como espec¡ficas as cicatrizes referidas nos casos citados, o percentual duplica com o aumento das formas benignas de prognóstico mais favorável. de 67 doentes e 73 casos com cicatrizes, se obtém o total de 140, o que equivale a 11,26% sobre a população infantil. Dêsses 140 doentes, 101 são tuberculóides, isto é, 72,14% sobre o total de doentes menores de 18 anos, o que corresponde a uma elevada percentagem de formas benignas. Os casos TNI (tuberculóides nodulares infantis), sem tratamento, evoluem até a cura espontânea, por serem portadores de uma alta imunidade ou resistência. Estes dados falam de uma grande contagiosidade da moléstia, especialmente entre os conviventes, porém, ao mesmo tempo, falam de uma grande resistência ou imunidade frente à infecção. Foram estudados 7 casos de forma infantil tuberculóide com seus caracteres cl¡nicos, histológicos, imunológicos, de prognóstico benigno, que evoluiram lentamente, sem nenhuma terapêutica. Todos os casos eram contatos de focos lepromatosos profudamente bacil¡feros, com convivência ¡ntima e prolongada. A incidência de lepra entre os conviventes revisados em dispensário em 1959 foi de 4,2%, enquanto que o censo realizado por nós foi de 5,7%, ascendendo a 11,20%, se agregarmos as formas cicatriciais, abortivas.