Role of cultural factors in the biopsychosocial model of psychosomatic skin diseases: an Indian perspective.

Cultural factors can influence the experience and presentation of diseases, including psychosomatic diseases. Psychosomatic dermatology refers to skin diseases in which psychogenic causes, consequences, or concomitant circumstances have an essential and therapeutically important influence. Indian culture is one of the oldest and most diverse, and encompasses the various traditions and beliefs of people all over the vast Indian subcontinent. This paper discusses how cultural factors can influence the clinical course of some dermatologic problems and reviews the cultural dimension of some common skin conditions in India, including vitiligo, facial hypermelanosis, acne, atopic dermatitis, psoriasis, and leprosy. The paper illustrates some examples of the contributions of a patient's cultural values, beliefs, and practices to the biopsychosocial model of psychosomatic skin disorders.

Awareness and attitudes towards leprosy in urban slums of Kolkata, India.

Urban slums have proliferated in India with poor health and socio-economic status with no organized health system. They are at high risk for contracting communicable diseases including leprosy. In order to obtain reliable data on knowledge, attitudes and treatment of leprosy; a random sample cluster survey was done in Kolkata slums. House to house screening for leprosy was done in 6 representative random samples of slums, each with a population of at least 5000, using accepted methods for detection. Suspects were confirmed by medical officers. Intensive interviews were done by qualified male and female investigators. A majority had some knowledge of leprosy but hardly any knew early signs or symptoms or where to get proper diagnosis and treatment. Half the respondents felt leprosy must be treated separately from general patients but stated they had no hesitation in working with or visiting a leprosy patient. There were 11 suspects of which 9 were confirmed for leprosy and sent to nearest centre for MDT. Glaring gaps are noticed between knowledge and practice of slum population regarding leprosy. An integrated health program is needed urgently in urban slums to control leprosy and other diseases using a variety of resources including medical colleges.

Leprosy control activities in India: integration into general health system.

Integration of leprosy control into the general health system is an essential element of a leprosy elimination strategy. In India, the process has been undertaken with the assistance of World Bank in a phased manner. In the first phase (2001-2002), 24 low/moderately endemic provinces for leprosy were targeted. Operational research was undertaken in these low/moderate endemic provinces to assess the progress of integration of leprosy control in general health system using defined categories, viz. structural integration, training status, availability of MDT and recording/reporting of cases. Selection of nine provinces, 18 districts, 86 health facilities and 108 sub-centres was performed using multistage stratified random sampling technique. Data were collected by interviewing GHS/vertical staff, scrutiny of records and spot checking of MDT stock by Health officers of three leprosy institutions of the Government of India. The result showed that district leprosy nuclei had formed in 16 of 18 districts. In 56% of health facilities vertical staff were redeployed for delivering general health care. Forty-five percent of medical officers, 71% of health supervisors and 75% of multipurpose workers were trained in leprosy. MDT treatment was available in >80% of health facilities. In only 2% of health facilities 3 months MDT stock of all types was present. Forty-four percent of sub-centres were delivering subsequent doses (second dose onward) of MDT. Reporting through a simplified information system was universal. This study emphasizes the need for reorientation training of Medical Officers, better MDT stock management and decentralized management of cases up to sub-centre level.

Leprosy and tuberculosis in Iron Age Southeast Asia?

The recent excavation of a sample of 120 human skeletons from an Iron Age site in the valley of the Mun River, a tributary of the Mekong River on the Khorat Plateau in northeast Thailand, has provided the largest sample from this period in the region to date. This paper reviews three individuals from the sample with pathological changes for which the differential diagnosis includes systemic infectious disease. In two of these, both males with lesions of the hands and feet, leprosy and psoriatic arthritis are discussed as differential diagnoses, with leprosy the most probable. In the third, a female with lesions of the spine, the differential diagnosis includes tuberculosis and nonspecific osteomyelitis. Tuberculosis is the most probable diagnosis. Although the focus of this paper is a presentation of the evidence for infectious disease at Noen U-Loke, the significance of probable diagnoses of mycobacterial diseases for the history of the diseases and for prehistory in mainland Southeast Asia is also briefly discussed.

The Explanatory Model Interview Catalogue (EMIC). Contribution to cross-cultural research methods from a study of leprosy and mental health.

The Explanatory Model Interview Catalogue (EMIC) has been developed to elicit illness-related perceptions, beliefs, and practices in a cultural study of leprosy and mental health in Bombay. Leprosy is an especially appropriate disorder for studying the inter-relationship of culture, mental health and medical illness because of deeply rooted cultural meanings, the emotional burden, and underuse of effective therapy. Fifty per cent of 56 recently diagnosed leprosy out-patients, 37% of 19 controls with another stigmatised dermatological condition (vitiligo), but only 8% of 12 controls with a comparable non-stigmatised condition (tinea versicolor) met DSM-III-R criteria for an axis I depressive, anxiety or somatoform disorder. Belief in a humoral (traditional) cause of illness predicted better attendance at clinic.

Hanseníase indeterminada: evoluçao clínico-patológica / ?

Foi estudada, em um período de 2 meses a 24 anos, a evoluçao de 51 doentes de hanseníase indeterminada, para formas pauci ou multibacilares da moléstia. O objetivo do estudo foi o de procurar critérios para facilitar a comprovaçao diagnóstica das formas iniciais e o de buscar parâmetros - clínicos, histopatológicos e imunohistoquímicos - que permitissem inferir, desde o início dos sintomas, o sentido evolutivo da doença. Foram examinados os prontuários dos doentes, analisando-se, em relaçao ao quadro inicial da moléstia, o número e características morfológicas das lesoes, a história pregressa, a reaçao de Mitsuda e o tratamento recebido. Nos exames histopatológicos, na coloraçao pela hematoxilina-eosina, foram estudadas as alteraçoes epidérmicas e o infiltrado dermico - sua intensidade, constituiçao e localizaçao

Hypothesis of leprosy, tuberculosis and urbanization in Africa.

Leprosy today is a problem of global magnitude affecting possibly up to 15 million people. Its rise and fall in medieval Europe is an historically fascinating enigma. Partial cross-immunization by epidemic tuberculosis, reinforced by the growth of cities, has been proposed as a mechanism in leprosy's European disappearance, but evidence is lacking. In the case of Africa in recent decades, analysis of leprosy and tuberculosis rates, and of levels of urbanization, albeit with imperfect data, suggests a possible environmental health for leprosy, the existence of some cross-interference between tuberculosis and the milder, paucibacillary form of leprosy, and a negative correlation between leprosy and urbanization. It is argued that the rise of the city in Africa, acting through a combination of influences, including tuberculosis, is leading to a decline of leprosy.

Juzam (leprosy) and its treatment in Unani medicine.

Juzam (leprosy) is attributed to excessive accumulation, infiltration and dispersal of sauda (burnt humours) throughout the body disturbing the normal temperament of the organs. A variety of causative factors responsible for excessive production or retention of sauda are enumerated. Unani simple plants, animals and minerals and formulations used for the treatment of leprosy are tabulated with recipes, methods of preparation, does and modes of administration.

Estudo comparativo entre a reação de Mantoux e a de Mitsuda nas diversas formas clínicas da lepra

O autor estudou comparativamente as reações de Mantoux com a de Mitsuda em 210 casos de lepra; 122 lepromatosos (com Mitsuda negativo), 33 nervosos-tuberculóides (com Mitsuda positivo) sendo todos pessoas adultas e desta cidade. Depois de uma serie de considerações sobre os resultados observados, chega à seguintes conclusões: (a) que a porcentagem de anergia tuberculinica (reação de Mantoux negativa a 1/10) é evidentemente mais elevada nos casos lepromatosos (19 por cento) que nos tuberculóide (31/2 por cento); (b) que a discordancia entre as reações de Mantoux e a de Mitsuda se observa unicamente nos casos lepromatosos (Mantoux positiva e Mitsuda positiva) enquanto que nos enfermos de lepra tuberculóide há concordancia em mais de 96 por cento entre ambas as reações (as 2 positivas); (c) que essa discordancia entre a reação tuberculinica e a de Mitsuda, propria das formas lepromatosas, explica-se pela anergia inespecifica que tem essa classe de enfermos ao Mycobacterium leprae.