Arquivos marginais e suas trajetórias subalternas em manicômios e nas prisões / Marginal archives and their subaltern trajectories in psychiatric hospitals and in the prisons / Archivos marginales y sus trayectorias subalternas en manicomios y en las prisiones

Em entrevista à Reciis, Viviane Trindade Borges conta sobre sua trajetória acadêmica norteada pelas práticas, histórias de vida e experiências em instituições de internamento/confinamento ­ como manicômios, leprosários e prisões ­ que ela estuda por meio de arquivos nelas encontrados. Para a pesquisadora, os documentos provenientes desses lugares "de sequestro", como se refere Foucault a essas instituições, dizem respeito a memórias não reivindicadas e a eventos controversos marcados por traumas e violações de direitos humanos. Em suas pesquisas, a historiadora traz à tona trajetórias obscuras, anônimas e trágicas de sujeitos colocados à margem, ao descaso e levados ao esquecimento. Na entrevista, a cientista ressalta a exigência de um posicionamento ético na recuperação de histórias reveladas em arquivos marginais, de modo que não se limite à estigmatização e/ou à exotização; comenta sobre o seu entendimento do conceito de arquivo marginal e a importância da comunicação histórica que permite ativar memórias, interagir e elaborar visões sobre o passado que ainda reverberam no presente. Viviane Trindade Borges é Professora Associada da Universidade do Estado de Santa Catarina (Udesc)

In an interview given to Reciis, Viviane Trindade Borges tells us about her academic trajetory guided by her practices, life histories and experiences in places where minors are not allowed to leave for a period of time and in others confinement institutions ­ as psychiatric hospitals, lazar houses and prisons ­ which she studies by means of archives found in them. For the researcher, the documents coming from the "kidnapping institutions", as Foucault refers to these places, relate to unclaimed memories and to controversial events characterized by traumas and violations of humain rights. Through her researches, the historian brings up gloomy, anonymous, tragic and marginal trajectories of subjects placed on the margins of the society, treated with disregard and led to the forgetfulness. In the interview, the scientist emphasizes the ethical behaviour required for the recovery of stories revealed in marginal archives, so that it is not limited to stigmatisation and/or exoticisation; she comments on her understanding of the concept of marginal archives and on the importance of historical communication that enables activating memories, interacting and elaborating images about the past that stil reverberate in present. Viviane Trindade Borges is Associate Professor at UDESC ­ Universidade do Estado de Santa Catarina (Santa Catarina State University)

En una entrevista concedida a la Reciis, Viviane Trindade Borges nos cuenta acerca de su trayectoria académica guiada por sus prácticas, historias de vida y experiencias en instituciones de encierro/confinamiento ­ como manicomios, lazaretos y prisiones ­ que estudia a través de archivos encontrados en ellas. Para la investigadora, los documentos provenientes de estas "instituciones de secuestro", como Focault se refiere a esos lugares, son concernientes a memorias no reivindicadas y a eventos controvertidos caracterizados por traumas y violaciones de derechos humanos. En sus investigaciones, la historiadora descubre trayectorias oscuras, anónimas, trágicas y marginales de sujetos puestos al margen, tratados con desprecio y entregues al olvido. En la entrevista, la científica resalta el deber de una posición ética en la recuperación de las historias reveladas en archivos marginales, para que no se limite a la estigmatización y/o a la exotización; comenta su forma de entender el concepto de archivo marginal y la importancia de la comunicación histórica que permite activar memorias, interactuar y elaborar visiones sobre el pasado que aún resuenan en el presente. Viviane Trindade Borges es Profesora Asociada en la UDESC ­ Universidade do Estado de Santa Catarina (Universidad del estado de Santa Catarina)

Leprosy among female prisoners in Brazil.

To estimate the prevalence of leprosy among Brazilian female prisoners and identify factors associated with the disease. Cross-sectional study conducted between 2014 and 2015 in 15 Brazilian female prisons. The data of 1,327 women were collected using Audio Computer-Assisted Self-Interviewing and dermatological and neurological examination to identify suspicious lesions of leprosy. The average age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and lifetime self-reported prevalence was 7.5%. The variables that were associated with lifetime self-reported leprosy were: women in prison once being twice as likely to have leprosy; white women were 1.4 time more likely to have leprosy than non-white women; women who knew someone with leprosy was 1.9 time more likely to have leprosy; and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people. The leprosy prevalence among female prisoners in Brazil were greater than that found in a Brazilian woman of the general population and show the extremely high vulnerability of this population generated through pre-incarceration poverty, as well as potential transmission in prison.

Innovative tracking, active search and follow-up strategies for new leprosy cases in the female prison population.

BACKGROUND: Regarding the leprosy transmission through the upper airways, overcrowded locations such as prisons can become a risk to get sick. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene also among confined women. METHODS: A prospective descriptive study conducted at Female Penitentiary, Brazil. Leprosy Suspicion Questionnaire (LSQ) were applied to the participants, and submitted to specialized dermatoneurological exam, peripheral nerve ultrasonography, and anti-PGL-I serology. FINDINGS: 404 female inmates were evaluated, 14 new cases were diagnosed (LG-leprosy group), a new case detection rate (NCDR) of 3.4%, 13 multibacillary, while another 390 constituted the Non-Leprosy group (NLG). Leprosy cases were followed up during multidrug therapy with clinical improvement. The confinement time median was 31 months in LG, similar to NLG, less than the time of leprosy incubation. Regarding LSQ, the neurological symptoms reached the highest x2 values as Q1-numbness (5.6), Q3-anesthetizes areas in the skin (7.5), Q5-Stinging sensation (5.8), and Q7-pain in the nerves (34.7), while Q4-spots on the skin was 4.94. When more than one question were marked in the LSQ means a 12.8-fold higher to have the disease than a subject who marked only one or none. The high 34% rate of anti-PGL-I seropositivity in the penitentiary, higher levels in LG than NLG. Three additional leprosy cases each were diagnosed on the second (n = 66) and third (n = 14) reevaluations 18 and 36 months after the initial one. Semmes-Weinstein monofilaments demonstrated lower limbs (32.2%) more affected than the upper limbs (25%) with improvement during the follow-up. INTERPRETATION: The NCDR in this population showed an hidden endemic of leprosy as well as the efficacy of a search action on the part of a specialized team with the aid of the LSQ and anti-PGL-I serology as an auxiliary tracking tools.

Leprosy in a prison population: A new active search strategy and a prospective clinical analysis.

BACKGROUND: This study evaluates an active search strategy for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzing the clinical, immunoepidemiological and follow-up aspects for individuals living in a prison population. METHODS: A cross-sectional study based on a questionnaire posing 14 questions about leprosy symptoms and signs that was distributed to 1,400 prisoners. This was followed by dermatoneurological examination, anti-PGL-I serology and RLEP-PCR. Those without leprosy were placed in the Non-leprosy Group (NLG, n = 1,216) and those diagnosed with clinical symptoms of leprosy were placed in the Leprosy Group (LG, n = 34). FINDINGS: In total, 896 LSQ were returned (64%), and 187 (20.9%) of the responses were deemed as positive for signs/symptoms, answering 2.7 questions on average. Clinically, 1,250 (89.3%) of the prisoners were evaluated resulting in the diagnosis of 34 new cases (LG), based on well-accepted clinical signs and symptoms, a new case detection rate of 2.7% within this population, while the NLG were comprised of 1,216 individuals. The confinement time medians were 39 months in the LG while it was 36 months in the NLG (p>0.05). The 31 leprosy cases who responded to the questionnaire (LSQ+) had an average of 1.5 responses. The symptoms "anesthetized skin area" and "pain in nerves" were most commonly mentioned in the LG while "tingling, numbness in the hands/feet", "sensation of pricks and needles", "pain in nerves" and "spots on the skin" responses were found in more than 30% of questionnaires in the NLG. Clinically, 88.2% had dysesthetic macular skin lesions and 97.1% presented some peripheral nerve impairment, 71.9% with some degree of disability. All cases were multibacillary, confirming a late diagnosis. Anti-PGL-I results in the LG were higher than in the NLG (p<0.0001), while the RLEP-PCR was positive in 11.8% of the patients. INTERPRETATION: Our findings within the penitentiary demonstrated a hidden prevalence of leprosy, although the individuals diagnosed were likely infected while living in their former communities and not as a result of exposure in the prison. The LSQ proved to be an important screening tool to help identify leprosy cases in prisons.

Prevalência de hanseníase em mulheres privadas de liberdade na região metropolitana do Recife em 2013 / Prevalence of imprisoned females with hansen´s disease in the metropolitan region of Recife in 2013

O objetivo desse estudo é conhecer a prevalência da hanseníase e o perfil epidemiológico das mulheres privadas de liberdade na Região Metropolitana do Recife. Trata-se de um estudo de corte transversal, censitário, mediante coleta de dados por entrevistas e exames dermatológicos. Foram estudadas 1.154 mulheres, destas 81,8% são brancas, 19,5% são analfabetas, 32,4% são pertencentes às classes econômicas D e E. Detectaram-se 45 portadoras de hanseníase (forma indeterminada = 1; tuberculóide = 16; dimorfa = 28), obtendo-se prevalência de 3,9%. A maior prevalência ocorreu nas analfabetas (4,9%); a unidade prisional com mais tempo de confinamento apresentou maior prevalência. A cor da pele escura é fator de risco para ocorrência da hanseníase (p-valor: < 0,001); as portadoras de hanseníase eram mais jovens que as não portadoras da doença, no entanto não apresentando significância estatística. As mulheres privadas de liberdade apresentam elevada prevalência para a hanseníase, caracterizando-se por ser uma população de alta vulnerabilidade, conduzindo a necessidade de priorizar ações de vigilância à saúde nessa população.

The prevalence of Hansen´s disease and the epidemiological profile of imprisoned females in the metropolitan region of Recife, Brazil, are investigated. Current transversal and census study was undertaken by data collection derived from interviews and dermatological tests. One thousand, one hundred and fifty-four females were studied, featuring 81.8% white people, 19.5% illiterate; 32.4% from economic classes D and E. Forty-five were suffering from Hansen´s disease (undetermined=1; tuberculoid=16; dimorphous=28), with 3.9% prevalence. Greater prevalence occurred with illiterate females (4.9%) and in those with more confinement time. Black skin is a risk factor for Hansen´s disease (p-rate: <0.001) and younger females with the disease were more numerous than those without, albeit with no significantly statistical difference. Imprisoned females had a high prevalence for Hansen´s disease due to high vulnerability, requiring priority in health care in this population.

Prevenção à hanseníase em unidades prisionais: relatando a experiência de atividades extensionistas / Leprosy prevention in prison units: reporting the experience of extension activities / Prevención de la lepra en unidades prisionales: reportar la experiencia de las actividades de extensión

Objetivo: relatar a experiência sobre atividades educativas e investigação epidemiológica da hanseníase em unidades prisionais. Método: estudo descritivo, do tipo relato de experiência, desenvolvido em duas instituições carcerárias de Petrolina/PE. Resultados: evidenciou-se a lacuna de informações referente à hanseníase entre os detentos, bem como o elevado índice da doença e a carência de profissionais da saúde trabalhando neste meio. A educação em saúde corroborou uma ferramenta importante para a prevenção da hanseníase neste ambiente, tendo como estratégia o diálogo e o empoderamento dos envolvidos. Conclusão: é relevante o acompanhamento dos detentos com práticas extensionistas em saúde, no intuito de prevenir os elevados índices de hanseníase na comunidade carcerária e romper a cadeia de transmissão da doença por meio do diagnóstico precoce e realização correta do tratamento.(AU)

Objective: reporting the experience about educational activities and epidemiological investigation of leprosy in prisons. Method: a descriptive study of type experience report developed in two prison institutions of Petrolina/PE. Results: it was evidenced the information gap related to leprosy among the detainees, as well as the high rate of the disease and the lack of health professionals working in this place. Health education corroborated an important tool for the prevention of leprosy in this environment, with the strategy of dialogue and empowerment of those involved. Conclusion: it is relevant monitoring of inmates with extension practices in health, in order to preventing the high leprosy rates in the prison community and break the chain of transmission of the disease through early diagnosis and correct completion of the treatment.(AU)

Objetivo: presentar la experiencia en actividades educativas y de investigación epidemiológica de la lepra en las cárceles. Método: es un estudio descriptivo, del tipo de informe de experiencia, desarrollado en dos instituciones de prisión de Petrolina/PE. Resultados: se presentaron el vacío de información relacionada con la lepra entre los detenidos, así como el alto índice de la enfermedad y la falta de profesionales de la salud que trabajan en este medio. Educación para la salud corroboró una herramienta importante para la prevención de la lepra en este entorno, con estrategia de diálogo y el empoderamiento de las personas involucradas. Conclusión: es relevante el control correspondiente de los reclusos con las prácticas de extensión en salud, con el fin de evitar que las altas tasas de lepra en la comunidad penitenciaria y romper la cadena de transmisión de la enfermedad mediante el diagnóstico precoz y correcta realización del tratamiento.(AU)

Hidden cases of leprosy (in prison)

Leprosy survey conducted in eight prisons in seven districts of Bihar State revealed a prevalence of 13.3 per 1000 which was 12 times more than the recorded prevalence of leprosy in the State. Thus this finding supports the view that prisons could form a hyperendemic pocket for leprosy. Regular NLEP services need to be extended to the inmates of the prisons.

Leprosy among inmates of a prison.

A leprosy survey carried out in a district prison revealed a gross prevalence of 20 cases per 1000, and active prevalence of 10 cases per 1000 whereas, prevalence of leprosy in the state was 1.12 per 1000. Such prisons thus form hyperendemic pockets. The inmates are a closed community and there is a risk of cases among inmates spreading infection to others inside the prison during their sojourn there and to the community when they are released from the prison. Special efforts are required to identify and eliminate all identifiable sources of infection, especially at this point of time when we are aiming at elimination of leprosy as a public health problem.