Path model on decision-making ability of clinical nurses.

AIMS AND OBJECTIVES: To identify and examine the relationship between the factors influencing the decision-making ability of clinical nurses in hospitals, South Korea, and to establish a model, to verify the fit and the effect. BACKGROUND: Clinical nurses are exposed to environments and situations where they make continuous decisions according to the need of direct treatment and nursing. DESIGN: This study used a cross-sectional descriptive design, relation prediction modelling and adheres to the STROBE guidelines. METHODS: The model construction was based on the information processing theory by Hansen and Thomas (Nursing Research, 17, 436, 1968). The model consists of 5 exogenous variables (expertise, critical thinking disposition, knowledge-sharing behaviour, nursing work environment, and decision-making stress) and 3 endogenous variables (analytic-systematic decision-making type, intuitive-interpretive decision-making type and decision-making ability). Participants were 274 clinical nurses, who were working at two hospitals in Seoul, South Korea. The data was analysed using SPSS WIN 18.0 and AMOS 20.0 program. Path analysis to verify the hypothetical model was used, and the fit was evaluated by χ2 /df, GFI, AGFI, NFI, CFI and RMSEA. Data were collected from March to May 2017. RESULTS: The fit index of the modified path model was χ2 /df = 2.25, GFI = .972, AGFI = .929, NFI = .967, CFI = .981 and RMSEA = .068. The analytic-systematic decision-making type had the greatest direct effect on the clinical nurses' decision-making ability, which is the final outcome variable, followed by significant direct and indirect effects on critical thinking disposition. CONCLUSION: This study suggests that the clinical nurses' decision-making ability in hospitals were leadingly influenced by analytic-systematic decision-making type and critical thinking disposition. RELEVANCE TO CLINICAL PRACTICE: In the nursing practice, nurses need to pay attention the analytic-systematic decision-making type and critical thinking disposition for improving decision-making ability of clinical nurses in hospitals.

[Hospital admissions due to neglected tropical diseases in Piauí, in the Northeast region of Brazil: costs, time trends, and spatial patterns, 2001-2018]. / Hospitalizações por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: custos, tendências temporais e padrões espaciais, 2001-2018.

To characterize the magnitude of hospital admissions and costs of patients with neglected tropical diseases, their time trends, and spatial patterns in Piauí, in the Northeast Region of Brazil, in 2001-2018. Ecological study of mixed designs, with calculation of relative risk (RR), time-trend analysis by Poisson regression, and inflection points, using data from neglected tropical diseases Hospital Admission Authorizations available in the Hospital Information System of the Brazilian Unified National Health System (SIH/SUS). Data showed 49,832 hospital admissions due to neglected tropical diseases in the period (rate: 86.70/100,000 inhabitants; 95%CI: 83.47; 89.93); of these, dengue (78.2%), leishmaniasis (8.6%), and leprosy (6.4%). The total cost was BRL 34,481,815.43, 42.8% of which referred to medium complexity cases. Higher risks of hospitalization occurred among people ≥ 60 years (RR = 1.8; 95%CI: 1.5; 2.2), mixed race/color (RR = 1.7; 95%CI: 1.1; 2.4), residents of municipalities presenting medium social vulnerability (RR = 1.5; 95% CI: 1.3; 1.6), and population size (RR = 1.6; 95%CI: 1.4; 1.9). The time trend showed a reduction in hospital admissions due to neglected tropical diseases, 2003-2018 (annual percent change - APC: -10.3; 95%CI: -14.7; -5.6). The spatial pattern showed clusters with higher rates of hospital admission in border municipalities located south of the Mid-north macroregion, north of the Semiarid macroregion, and south of the Cerrados macroregion. Piauí remains with high hospital admission rates and costs for neglected tropical diseases. Despite the reduction in time trends, knowledge burden, population groups, and municipalities at greater risk and vulnerability reinforce the importance of monitoring and strengthening control actions to maintain the reduction of the burden and costs of hospital admission due to neglected tropical diseases in the state.

Caracterizar a magnitude das internações hospitalares e custos por doenças tropicais negligenciadas, suas tendências temporais e padrões espaciais no Piauí, Nordeste do Brasil, 2001-2018. Estudo ecológico misto, com cálculo de risco relativo (RR) e análise de tendência temporal por regressão de Poisson, pontos de inflexão, utilizando-se dados de Autorizações de Internações Hospitalares por doenças tropicais negligenciadas via Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Verificaram-se 49.832 internações hospitalares por doenças tropicais negligenciadas (taxa: 86,70/100 mil habitantes; IC95%: 83,47; 89,93) no período, principalmente dengue (78,2%), leishmanioses (8,6%) e hanseníase (6,4%). O custo total foi de R$ 34.481.815,43, sendo 42,8% de média complexidade. Maiores riscos de hospitalizações ocorreram em: pessoas ≥ 60 anos (RR = 1,8; IC95%:1,5; 2,2), etnia/cor parda (RR = 1,7; IC95%: 1,1; 2,4), residentes em municípios de média vulnerabilidade social (RR = 1,5; IC95%: 1,3; 1,6) e porte populacional (RR = 1,6; IC95%: 1,4; 1,9). A tendência temporal foi de redução nas taxas de internações hospitalares por doenças tropicais negligenciadas, 2003-2018 (variação percentual anual - APC: -10,3; IC95%: -14,7; -5,6). O padrão espacial apresentou aglomerados com maiores taxas de internações hospitalares nos municípios limítrofes ao sul da macrorregião Meio-norte, norte do Semiárido e sul dos Cerrados. O Piauí persiste com elevadas taxas de hospitalizações e custos por doenças tropicais negligenciadas. Apesar da redução nas tendências temporais, o conhecimento de sua carga, seus grupos populacionais e municípios de maior risco e vulnerabilidade reforçam a importância do monitoramento e fortalecimento das ações de controle para manutenção na redução da carga e custos de internações hospitalares por doenças tropicais negligenciadas no estado.

Caracterizar la magnitud de las internaciones hospitalarias y los costos por las enfermedades tropicales desatendidas, sus tendencias temporales y patrones espaciales en Piauí, Nordeste de Brasil, 2001-2018. Estudio ecológico mixto, con cálculo de riesgo relativo (RR), y análisis de tendencia temporal por regresión de Poisson, puntos de inflexión, utilizando datos de Autorizaciones de Internaciones Hospitalarias por enfermedades tropicales desatendidas a través del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS). Se verificó 49.832 internaciones hospitalarias por enfermedades tropicales desatendidas (tasa: 86,70/100.000 habitantes; IC95%: 83,47; 89,93) en el periodo, las más frecuentes dengue (78,2 %), leishmaniasis (8,6%) y lepra (6,4%). El costo total fue de BRL 34.481.815,43, siendo 42,8 %, fueron de mediana complejidad. Los mayores riesgos de hospitalización se dieron en: personas ≥ 60 años (RR = 1,8; IC95%: 1,5; 2,2), etnia/color pardo (RR = 1,7; IC95%: 1,1; 2,4), residentes en municipios de vulnerabilidad social media (RR = 1,5; IC95%: 1,3; 1,6) y tamaño de la población (RR = 1,6; IC95%: 1,4; 1,9). La tendencia temporal fue de reducción en las tasas de internaciones hospitalarias por enfermedades tropicales desatendidas, 2003-2018 (cambio porcentual anual - APC: -10,3; IC95%: -14,7; -5,6). El patrón espacial presentó conglomerados con mayores tasas de internaciones hospitalarias en los municipios limítrofes al sur de la macrorregión del Medio-norte, el norte del Semiárido, y sur de los Cerrados. El Piauí persiste con elevadas tasas de hospitalizaciones y costos por enfermedades tropicales desatendidas. A pesar de la reducción de las tendencias temporales, el conocimiento de su carga, los grupos poblacionales y los municipios de mayor riesgo y vulnerabilidad refuerzan la importancia del monitoreo y fortalecimiento de las acciones de control para mantenimiento en la reducción de la carga y los costos de internaciones hospitalarias por enfermedades tropicales desatendidas en el estado.

Factors Affecting Hospital Length of Stay in Geriatric Patients With a Surgically Treated Fragility Ankle Fracture.

Fragility ankle fractures in elderly have a rising incidence and hospitalization may be prolonged due to pre-existing comorbidities, compromised soft tissue and postoperative difficulties in the rehabilitation process. The aim of this retrospective cohort study was to investigate risk factors for longer total hospitalization duration in elderly patients with surgically treated fragility (Lauge Hansen supination external rotation type 4) fractures. We included all patients ≥ 70 years with a fragility fracture, who were treated surgically between 2011 and 2019 (n = 97) in a level 1 and 2 trauma center. Data on patient demographics, fracture characteristics, surgical treatment strategies and postoperative complications were retrieved from medical records. Multivariate regression analysis was performed to identify independent risk factors for longer hospitalization duration. The mean age of the included patients was 78.27 (± 6.56) years; 71 patients (73.20%) were female. Ten fractures (10.30%) were classified as open and 49 (50.50%) as a luxation type fracture. Fifty-nine patients (60.80%) were hospitalized after admission to the emergency department. External fixation was performed in 34 patients (35.10%) and served as bridge to definitive fixation in 29 patients (85.30%). The mean total hospital length of stay of all patients was 7.04 (± 6.58) days. Multivariate regression analysis demonstrated that the use of external fixation (p < .001) and the postoperative discharge destination (p < .001) were independently associated with a prolonged hospital stay. External fixation and discharge destination were independent risk factors for a prolonged hospital stay in elderly patients with a fragility fracture.

Hanseníase e envelhecimento: representações sociais dos moradores de um hospital colônia / Hansen's disease and aging: social representations of the residents of a colony hospital / Hanseníasis y envejecimiento: representaciones sociales de los habitantes de un hospital colonia

Este estudo teve o objetivo de identificar e analisar as representações sociais dos moradores de um hospital colônia sobre a hanseníase, sobre o envelhecimento, bem como sobre a própria instituição. O estudo contou com a participação de 16 pessoas, com idade entre 48 e 85 anos (M = 67,0 anos; DP = 9,7). Para a coleta de dados, utilizou-se um questionário sociodemográfico e o Teste de Associação Livre de Palavras. Os resultados indicaram que o estímulo hanseníase associou-se a elementos negativos que remetem à representação social da lepra. O estímulo envelhecimento ancorou-se em um esquema conceitual associado à fase da velhice e à figura do velho. Já o estímulo hospital colônia ancorou-se mais em componentes positivos, dentre os quais se destacam a comunidade e a família. Almeja-se que este estudo contribua para uma mudança nos elementos associados à representação da hanseníase e do envelhecimento.

This study aimed to identify and analyze the social representations of the residents of a colony hospital about the Hansen's disease, about aging, as well as about the institution itself. There was a participation of 16 people, aged between 48 and 85 years (M = 67.0 years, SD = 9.7). For a data collection, we used a sociodemographic questionnaire and the Free Word Association Test. The results indicated that the Hansen's disease stimulus is associated with negative elements that refer to the social representation of leprosy. The aging stimulus was anchored in a conceptual scheme associated with the old age phase and the figure of the old. On the other hand, the stimulus Colony Hospital was more anchored in positive components, among which, community and family stand out. It is hoped that this study will contribute to a change in the elements associated to the representation of Hansen's disease and aging.

Este estudio tuvo como objetivo identificar y analizar las representaciones sociales de los habitantes de un hospital colonia sobre la hanseníasis, sobre el envejecimiento, así como sobre la propia institución. Se contó con una participación de 16 personas, con edad entre 48 a 85 años (M = 67,0 años, DP = 9,7). Para una recolección de datos, se utilizó un cuestionario sociodemográfico y la Prueba de Asociación Libre de Palabras. Los resultados indicaron que el estímulo hanseníasis se asociaba a elementos negativos que remiten a la representación social de la lepra. El estímulo envejecimiento se ancló en un esquema conceptual asociado a la fase de la vejez y la figura del viejo. El estímulo Hospital Colonia, se ancló más en componentes positivos, entre los cuales, comunidad y familia. Se espera que este estudio contribuya a un cambio en los elementos asociados a la representación de la lepra y del envejecimiento.

Ancient and modern pathologies and therapies: St. Gallicanus Hospital in Rome between the 18th and 20th centuries.

St. Gallicanus Hospital in Rome, Italy, created by the will of Pope Benedict XIII (1649-1730) in 1725, was the first dermatologic hospital in the world. The strong bond between science and faith, humanitarian spirit and scientific research, and the profoundness and legacy of its entire history have all contributed to its legacy. We have traced its development by examining archival documents to understand the life of the institute and the diseases that were diagnosed and treated from the 18th century to the first half of the 20th century. Some of the main diseases were leprosy, mange, scabies, ringworm, and syphilis, which were widespread in Rome during the 18th and 19th centuries and were creating a mortal threat for much of the population. St. Gallicanus Hospital was dedicated to the diagnosis, treatment, and prevention of these diseases where possible. Special attention has been directed to syphilis and the use of penicillin therapy after its introduction in 1943, especially for curbing the extensive problems created by prostitution.

Reviewing the therapeutic management of leprosy in primary care: demand case series referred to a University Hospital in the Midwest region of Brazil

Abstract Background: Leprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. Objective: To analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service. Methods: An analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. Results: Two-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ2= 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ2= 7.23; 4 degrees of freedom; p = 0.12). Study limitations: Use of recorded data, with incomplete medical records and lack of patient follow-up. Conclusions: The study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.

The outcome of laparoscopic assisted orchidopexy in very young children: A single hospital experience.

INTRODUCTION: Early orchidopexy has been linked to improved long term outcomes of fertility and reduced malignancy rates. However, the optimal age of intervention has been subject to change over the years. OBJECTIVE: This study aims to study males aged 6 months or less who undergo laparoscopic assisted orchidopexy for intraabdominal testes to establish the safety, efficacy, and benefit in the defined age group. STUDY DESIGN: We prospectively assessed 19 boys at or below 6 months of age, who had laparoscopic assisted orchidopexy for intraabdominal undescended testes at Salmaniya Medical Complex in Bahrain between January 2014 and December 2018. We examined: demographics, laterality, testicular locations, testicular volumes, operative time, complications, and durations of hospitalization and follow-up. Ultrasound-derived testicular volumes were assessed before and after orchidopexy. They were calculated using the Hansen formula (Testicular volume = 0.52 × length [L] × width [W]2 [1]. They were then compared with reference ranges from a Dutch cohort study of 769 healthy boys. Successful outcomes were correct intrascrotal position with minimal complications and normal testicular volumes. RESULTS: A total of 19 males were operated at a mean age of 5.6 months and followed for a mean of 2.35 years. Of these, 7 had left-sided and 12 had right-sided cryptorchidism. Testicular locations were noted intra-operatively; 10 were above the internal ring, 5 near the iliac vessels, and 4 close to the kidney. The mean operative time was 59.58 minutes. Only 2 minor complications occurred and no cases of testicular atrophy. None of the patients required hospital-stay beyond 24 hours. The success rate was 89.46% in achieving correct scrotal position. Testicular volumes were normal before and after orchidopexy. They significantly increased after orchidopexy (P ≤ 0.05). The testicular growth rate after 24 months was slightly higher than normal. DISCUSSION: In line with previous studies we were 89.46% successful in re-positioning testes [2]. In contrast to studies intervening at older ages which associated intra-abdominal testes with greater risks of complications, we found few minor complications and no testicular atrophy [3,4]. Testicular volumes in the affected testes were normal, contrary to decreased volumes found by other researchers [5]. Limitations of this study are the small number of patients and short follow-up which limits assessment of long-term outcomes. CONCLUSION: Early orchiopexy is safe and effective. Laparoscopic assisted orchidopexy at an early age was beneficial and resulted in normal testicular volumes before and after surgery.

Reviewing the therapeutic management of leprosy in primary care: demand case series referred to a University Hospital in the Midwest region of Brazil.

BACKGROUND: Leprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. OBJECTIVE: To analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service. METHODS: An analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. RESULTS: Two-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ2 = 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ2 = 7.23; 4 degrees of freedom; p = 0.12). STUDY LIMITATIONS: Use of recorded data, with incomplete medical records and lack of patient follow-up. CONCLUSIONS: The study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.

History of the Santa Maria and San Gallicano Dermatological Hospital.

The Santa Maria and San Gallicano Hospital represents one of the first dermatological centers founded in the world; since its establishment its aim is to treat widespread skin diseases such as leprosy, scabies, ringworm, prurigo and mange. Its construction began on March 14, 1725 with a ceremony held for the laying of the foundation stone. Its official inauguration, however, is dated October 6, 1726 when Pope Benedict XIII issued the Bonus ille Seal. The hospital's origins stem from the apostolic and charitable work by Father Emilio Lami, who was its first prior, and by the tenacious will of Cardinal Pietro Marcellino Corradini who was its protector. As can be seen by the marble plaque, still preserved and dated 1725, the health facility was intended for people with skin diseases. Venereal affections, such as syphilis and gonorrhea, were instead treated starting from the second half of the 19th century under the direction of Dr. Pietro Shilling and subsequently Dr. Gaetano Ciarrocchi. Since the 18th century, the hospital, built initially by architect Filippo Raguzzini, underwent expansion work including the construction of the "Nuova Corsia dei ragazzi tignoselli" ward, the "Anatomical Theater" of great artistic value and of the "Celtic Rooms." More recently, from the 1939, the hospital obtained, and still maintains today, the recognition as an Institute for Hospitalization and Care of a Scientific Nature (IRCCS); a clear indication of its authoritativeness and value during almost three centuries of history.

Trends and Determinants of Polypharmacy and Potential Drug-Drug Interactions at Discharge From Hospital Between 2009-2015.

BACKGROUND: Polypharmacy (PP) and excessive polypharmacy (EPP) are increasingly common and associated with risk of drug-drug interactions (DDIs). We aimed to measure the trends and determinants of PP and DDIs among patients discharged from the Department of Internal Medicine of the Lausanne University Hospital. METHODS: The retrospective study included 17,742 adult patients discharged between 2009 and 2015. Polypharmacy and EPP were defined as the concomitant prescription of five or more and ten or more drugs, respectively. Drug-drug interactions were defined as any combination of a drug metabolized by a cytochrome P450 or P-glycoprotein, and a drug considered as strong inductor or inhibitor of the corresponding enzyme was defined as a potential interaction. RESULTS: Three most commonly classes of drugs prescribed were "alimentary tract and metabolism (including insulins)," "nervous system," and "blood and blood forming organs." Polypharmacy decreased from 45% in 2009 to 41% in 2015, whereas EPP increased from 40% to 46%. In 2015, 13% of patients received 15 or more drugs. Age, coming from other health care settings, higher Charlson Index, number of comorbidities, and quartiles of length of stay were significantly and independently associated with PP and EPP. The risk of having at least one DDI decreased from 67.0% (95% confidence interval = 64.8-69.0) in 2009 to 59.3% (57.6-62.0) in 2015 (P < 0.001). Multivariate analysis showed number of drugs (odds ratio and 95% confidence interval = 3.68 [3.3-4.1], 9.39 [8.3-10.6], and 20.5 [17.3-28.4] for [5-9], [10-14], and 15+ drugs, respectively), gastrointestinal disease (3.13 [2.73-3.58]), and cancer (1.37 [1.18-1.58]) to be positively associated, and lung (0.82 [0.74-0.90]) and endocrinological (0.62 [0.52-0.74]) diseases to be negatively associated with risk of DDI. CONCLUSIONS: The pattern of drug prescription has changed and most prescribed groups increased during the study period. Excessive polypharmacy is increasing among hospital patients. The decrease in the overall risk of DDI could be due to an improved management of multidrug therapy.

[The history and influence of Losheng Sanatorium in Taiwan area].

Losheng Sanatorium, as a prophylactic-therapeutic institution for isolation, treatment, rehabilitation and social control of leprosy patients, was established by the Japanese colonial government in Taiwan in 1930. Losheng Sanatorium effectively carried out the compulsory isolation of leprosy patients, under the assistance of the public medical system with the help of police and the Bao-Jia management in the Japanese colonial period in Taiwan. Losheng sanatorium imported DDS, a therapeutic drug for leprosy, popularised an outpatient treatment model of leprosy, and developed mobile medical services after the Second World War. Losheng detected and treated leprosy patients successfully through the support of special skin clinics in public hospitals and missionary hospitals after Multi-drug Therapy was introduced in Taiwan in 1984. The Department of Health, Executive Yuan of the Taiwan area in commenced administration of Losheng Sanatorium in 1999 transformed it into a community-based general hospital. Losheng sanatorium adopted different control strategies in different historical periods based on the requirements of health, epidemic prevention systems and leprology developments to achieve its goals of leprosy control. The Sanatorium provides an example to understand and further study epidemical control and public health practice in the Taiwan area.

Activity limitation and social participation restriction among leprosy patients in Boru Meda Hospital, Amhara Region, Ethiopia.

BACKGROUND: Although Ethiopia eliminated leprosy as public health problem 20 years ago, still more than 3000 new cases are reported annually. Leprosy related disability affects patients' day to day physical activities and their participation in social activities. Assessing the degree of activity limitation and social participation is recommended to show disability and assess the efficacy of rehabilitation efforts. METHODOLOGY AND PRINCIPAL FINDING: A hospital based cross sectional study was conducted among a total of 305 leprosy patients. Data were collected by face to face interview using Screening of Activity Limitation and Safety Awareness (SALSA) scale and participation scale. The analysis was done with SPSS version 25. Descriptive statistics was done and then binary logistic regression was used to identify factors associated with activity limitation as well as participation limitation. Most patients (219, 71.8%) had activity limitation; 41 (13.4%) with severe and 25 (8.2%) with extreme limitations. More than half of patients (168, 55.1%) were suffering from participation restriction; with 43 (14.1%) having severe restriction and 30 (9.8%) extreme restriction. Older age, low educational status, distance from treatment center, time of treatment and higher Eye, Hand, Foot disability score were associated with activity limitation. Similarly, older age, low educational status and being unmarried were significantly associated with participation restriction. CONCLUSION: This study revealed that activity limitation and participation restriction are common among leprosy patients. Earlier diagnosis and improved rehabilitative services may help to decrease activity limitation, whereas community rehabilitation may improve social participation. The old and centralized leprosy rehabilitation services need to be decentralized and backed with modern equipment and trained staffs.

Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine.

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.

Delayed diagnosis and ongoing transmission of leprosy in the post-elimination era in Boru Meda hospital, Ethiopia.

INTRODUCTION: Following the recommendation of the Global Leprosy Strategy, Ethiopia targeted to reduce the incidence of new leprosy cases, and the proportion with severe disability (grade 2) from 13.6% in 2016 to < 1% in 2020. This study assessed the clinical profile of new leprosy cases and the sequelae of previously treated ones 20 years after leprosy was eliminated as a public health problem in the country. METHODOLOGY: Hospital based cross sectional study was conducted  by reviewing the medical records of all leprosy patients seen at the dermatology clinic of Boru Meda Hospital from August to December 2018.The  data were captured using a standard data collection form. RESULTS: Over the study period, 57 (27.4%) new cases and 151 (72.6%) previously treated cases were seen.The median age was 44 years (interquartile range 32-57). Among the newly diagnosed cases, two were under the age of 15 years , 51 (89.5%) were multibacillary and 34 (59.6%) had grade 2 disability. This included visual impairment in 10 (17.5%) and neurological complications in 44 (77.2%). Of the 151 previously treated cases, 104 (68.9%) presented with disabilities, including 97 (64.2%) with grade 2. Amongst previously treated cases, 130 (86.1%) had neurological complications. In addition, 53 (35.1%) had vision impairment. CONCLUSIONS: This study showed evidence of ongoing leprosy transmission and delayed diagnosis in the country. This calls for operational research to determine the underlying reasons and provide ways forward. At the same time, the high burden of disabilities in previously treated cases should be addressed.

Looking for NTDs in the skin; an entry door for offering patient centered holistic care.

INTRODUCTION: The majority of neglected tropical diseases (NTDs) have established primary skin manifestations or associated clinical feature. Skin NTDs often result in physical impairment and disfigurement, which can lead to disability. Skin diseases have been proposed as an entry point for integrated NTDs control. However, the magnitude and overlap of skin NTDs is poorly understood. METHODOLOGY: An institution-based cross-sectional study was done using medical records of dermatology patients between July 2017 and June 2018 in a dermatology service in Northeast Ethiopia. A total of 661 patient records were selected using simple random sampling. RESULTS: A total of 656 complete records were included in analysis. Skin NTDs constituted 17.2% (n = 113) of the overall of skin diseases. Of skin NTDS, cutaneous leishmaniasis (n = 40; 35.4%), leprosy (n = 38; 33.6%), and scabies (n = 31; 27.4%) were the most common. Additionally, there were four cases of mycetoma. Of the non NTDs, poverty-related infections such as superficial fungal (n = 118; 21.1%) and bacterial (n = 33; 5.2%) infections were also frequent. Tinea capitis was the most common superficial fungal infections. Impetigo and cellulitis were the predominant bacterial infections. CONCLUSIONS: Skin NTDsand other poverty related skin infections were common at the dermatology service. Dermatological services could act as a good entry point for integrated management of skin NTDs. Future studies should assess how different preventive strategies like contact tracing, early diagnosis and mass drug administration can be integrated.

Patients help other patients: Qualitative study on a longstanding community cooperative to tackle leprosy in India.

BACKGROUND: Although leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world's newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India's official declaration of 'elimination', which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds. METHODS AND FINDINGS: This qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital's sustainability. Open coding, axial coding and selective coding were conducted, and Glaser's Six C's model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients' strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a 'consumer-provider cooperative', where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients' occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study. CONCLUSIONS: This study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well.

[From relief to life, the last memory of leprosy sanatorium: investigation and patient interview in Wukang sanatorium].

Zhejiang Wukang sanatorium evolved from Hangchow C. M.S. Hospital, which was founded in 1887. It is the leprosy prevention and treatment center of Zhejiang Province after the founding of the People's Republic of China. Most of the leprosy patients (convalescents)in sanatoriums entered the hospital successively in 1960s. Due to the limitation of dapsone monotherapy and the poor living conditions, the convalescents need to receive long-term isolation treatment and engage in collective production. After the implementation of Reform and Opening-up policy, the leprosy patients' health care has been greatly improved. The leprosy prevention and treatment course has been gradually reduced; the widespread knowledge of leprosy gradually freed leprosy patients from the dilemma of being stigmatized. In the post-leprosy era, Wukang sanatorium changed from the original focus on disease treatment to strengthening the psychological construction of patients. Its function changed from isolation and prevention to rest and pension, and the status of leprosy patients changed from "patients" to "convalescents" . These changes reflect the humanistic care and guidance of destigmatization in the process of leprosy isolation and epidemic prevention from prevention to treatment to the aged.

Clinico-pathological features of erythema nodosum leprosum: A case-control study at ALERT hospital, Ethiopia.

BACKGROUND: Leprosy reactions are a significant cause of morbidity in leprosy population. Erythema nodosum leprosum (ENL) is an immunological complication affecting approximately 50% of patients with lepromatous leprosy (LL) and 10% of borderline lepromatous (BL) leprosy. ENL is associated with clinical features such as skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. ENL is treated mainly with corticosteroids and corticosteroids are often required for extended periods of time which may lead to serious adverse effects. High mortality rate and increased morbidity associated with corticosteroid treatment of ENL has been reported. For improved and evidence-based treatment of ENL, documenting the systems affected by ENL is important. We report here the clinical features of ENL in a cohort of patients with acute ENL who were recruited for a clinico-pathological study before and after prednisolone treatment. MATERIALS AND METHODS: A case-control study was performed at ALERT hospital, Ethiopia. Forty-six LL patients with ENL and 31 non-reactional LL matched controls were enrolled to the study and followed for 28 weeks. Clinical features were systematically documented at three visits (before, during and after predinsolone treatment of ENL cases) using a specifically designed form. Skin biopsy samples were obtained from each patient before and after treatment and used for histopathological investigations to supplement the clinical data. RESULTS: Pain was the most common symptom reported (98%) by patients with ENL. Eighty percent of them had reported skin pain and more than 70% had nerve and joint pain at enrolment. About 40% of the patients developed chronic ENL. Most individuals 95.7% had nodular skin lesions. Over half of patients with ENL had old nerve function impairment (NFI) while 13% had new NFI at enrolment. Facial and limb oedema were present in 60% patients. Regarding pathological findings before treatment, dermal neutrophilic infiltration was noted in 58.8% of patients with ENL compared to 14.3% in LL controls. Only 14.7% patients with ENL had evidence of vasculitis at enrolment. CONCLUSION: In our study, painful nodular skin lesions were present in all ENL patients. Only 58% patients had dermal polymorphonuclear cell infiltration showing that not all clinically confirmed ENL cases have neutrophilic infiltration in lesions. Very few patients had histological evidence of vasculitis. Many patients developed chronic ENL and these patients require inpatient corticosteroid treatment for extended periods which challenges the health service facility in resource poor settings, as well as the patient's quality of life.