Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-19T17:03:43Z No. of bitstreams: 1 HermaziaLoiola.pdf: 4894190 bytes, checksum: c163f75b82f94680b305cf03540053bc (MD5) / Made available in DSpace on 2017-05-19T17:03:43Z (GMT). No. of bitstreams: 1 HermaziaLoiola.pdf: 4894190 bytes, checksum: c163f75b82f94680b305cf03540053bc (MD5) Previous issue date: 2016-09-30 / Leprosy is still a serious public health problem in Brazil, still has high rates of leprosy patients under the age of 15 years. The disease can have an impact on the lives of patients, which may affect the quality of life for them. Descriptive study aimed to analyze the epidemiological, clinical and quality of life of children affected by leprosy in a hyperendemic county of Maranhao. The study population consisted of children 5- 14 years old of both sexes, residents in Sao Luis - MA who were in treatment for the disease. For the analysis of the epidemiological and clinical profile, we used a form, and the quality of life, we used the Quality Score of life of child dermatology. 40 cases were analyzed, showed higher frequencies of males (55.0%), aged 12 to 14 years (45.0%), brown color (48.78%), 1st to 4th of education incomplete series of teaching fundamental (62.50%), residents Cohab district (47.50%) and family income above 01 minimum wage (72.50%). As the clinical features were 37.50% of Borderline way, 55.0% were classified as multibacillary operationally and 55.0% had degree of disability equal to 0. When evaluating the quality of life results were: no commitment (25%), mild (18%), moderate (40%) and severe (17%). And domain, it was observed that there was a higher frequency in mild impairment grade (60%) in symptoms and feelings during sleep and treatment. / A hanseníase ainda é um grave problema de saúde pública no Brasil, por ainda apresentar alto índices de pacientes portadores de hanseníase com idade inferior a 15 anos. A doença pode gerar impacto na vida dos pacientes, os quais podem interferir na qualidade de vida dos mesmos. Estudo descritivo com o objetivo de analisar o perfil epidemiológico, clinico e qualidade de vida de crianças afetadas pela hanseníase em um município hiperendêmico do Maranhão. A população do estudo foi constituída por crianças de 5 a 14 anos de idade de ambos os sexos, residentes em São Luís – MA que se encontravam em tratamento para a doença. Para a análise do perfil epidemiológico e clinico, utilizou-se um formulário, e para a qualidade de vida, foi utilizado o Índice de qualidade de vida da dermatologia infantil. Foram analisados 40 casos, sendo observadas maiores frequências do sexo masculino (55,0%), idade de 12 a 14 anos (45,0%), cor parda (48,78%), escolaridade de 1ª a 4ª serie incompleta do ensino fundamental (62,50%), residentes no distrito Cohab (47,50%) e com renda familiar acima de 01 salário mínimo (72,50%). Quanto as características clinicas 37,50% eram da forma Dimorfa, 55,0% foram classificadas operacionalmente como multibacilares e 55,0% apresentaram grau de incapacidade física igual a 0. Ao se avaliar a qualidade de vida os resultados foram: sem comprometimento (25%), leve (18%), moderado (40%) e grave (17%). Ao se considerar a qualidade de vida por domínio, observou-se que houve uma maior frequência no grau de comprometimento leve (60%) no domínio sintomas e sentimentos, sono e tratamento

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-19T17:17:02Z No. of bitstreams: 1 YaraAndrade.pdf: 1215213 bytes, checksum: eaf7b580c9f8c4d49e455d48065297e3 (MD5) / Made available in DSpace on 2017-05-19T17:17:02Z (GMT). No. of bitstreams: 1 YaraAndrade.pdf: 1215213 bytes, checksum: eaf7b580c9f8c4d49e455d48065297e3 (MD5) Previous issue date: 2016-11-17 / Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM) / The Leprosy Control Program is the principle strategy in Brazil that consolidates follow-up actions of the endemic municipalities, promoting the monitoring, prevention, and control of leprosy by means of the evaluation of health indicators, which include epidemiological and operational indicators capable of measuring the magnitude of the problem and the progress achieved in the program. Therefore, the present study aimed to assess the indicators of quality of the actions and health services of the Leprosy Control Program in the hyperendemic capital of Brazil. The research was guided by the type of descriptive evaluative study, carried out in all health care institutions which operate the Leprosy Control Program in the city of São Luiz, Maranhão. The population of the study consisted of all the new cases of leprosy reported in the year 2012, and their respective contacts. The data were collected by means of instruments using the variables contained in the SINAN reporting forms, registry and records of patients reported in 2012. The data were processed and analyzed using the Epi-Info program, version 7, and presented in the form of absolute and relative frequency tables, using the parameters established by the Ministry of Health to evaluate the actions and services provided by healthcare professionals to the individual with leprosy (operational indicators). In 2012, there were 1055 cases and 3310 contacts reported. In the reported cases, it was verified that 51.1% were male, between the ages of 21 and 45 (35.3%), Caucasian (62.6%), with a high school diploma (26%), residents in the state capital (80.6%). The program obtained satisfactory results, being classified as "Good" according to the proportion of discharges by cure (71.6%), abandonment rates (4%), and the evaluation of the degree of physical disability at the moment of the diagnosis (94.5%). The indicators classified as precarious were: the proportion of examined contacts of new cases of leprosy (32.5%) and the proportion of cured cases in the year with a degree of disability evaluated at the moment of discharge (41.2%). The predominant input mode was classified as "new case" (79.1%), and the method of detection was of the type "spontaneous demand" prevailing with 52%. The most prevalent clinical form and operational classification was dimorphic (58.8) and multibacillary (74%) respectively. Based on the above, it can be concluded that the Leprosy Control Program in the city of São Luiz has been working satisfactorily, where 3 of the 5 indicators responsible for evaluating the quality of the actions and services provided by healthcare professionals to the population were classified as "Good", according to the parameters established by the Ministry of Health, suggesting an efficiency in the quality of the follow-up and monitoring of cases until the completion of treatment. The indicators considered "precarious " can indicate that the actions are not being carried out in an effective and resolving manner, contributing to the continuation of high rates of the endemic in the city, considered as hyperendemic. / O Programa de Controle da Hanseníase é a principal estratégia no Brasil para consolidação de ações de acompanhamento dos municípios endêmicos, promovendo a vigilância, prevenção e controle da hanseníase por meio da avaliação dos indicadores de saúde, que incluem indicadores epidemiológicos e operacionais, capazes de mensurar a magnitude do problema e os progressos alcançados no programa. O presente estudo objetivou avaliar os indicadores de qualidade das ações e serviços de saúde do programa de controle da hanseníase em capital hiperendêmica no Brasil. Pesquisa avaliativo-descritiva, realizada em todas as instituições de saúde que operacionam o Programa de Controle da Hanseníase no município de São Luís - MA. A população de estudo foram todos os casos novos de hanseníase notificados no ano de 2012 e seus respectivos contatos. Os dados foram coletados por meio de um instrumento utilizando as variáveis contidas nas fichas de notificação do SINAN, livro de registro e prontuários de pacientes notificados em 2012. Utilizou-se os parâmetros estabelecidos pelo Ministério da Saúde para avaliar as ações e serviços prestados por profissionais de saúde ao indivíduo com hanseníase (indicadores operacionais). No ano de 2012 foram notificados 1.055 casos e 3.310 contatos. Nos casos notificados, verificou-se que 51,1% pertenciam ao sexo masculino, com idade entre 21 e 40 anos (35,3%), pardos (62,6%), com ensino médio completo (26,0%), residentes na capital do Estado (80,6%). O programa obteve resultados satisfatórios, sendo classificado como “Bom” quanto às taxas de abandono (3,4%) e quanto à avaliação do grau de incapacidade física no momento do diagnóstico (94,6%). Os indicadores classificados como “Precário” foram: proporção de alta por cura (42,5%) e proporção de contatos examinados de casos novos de hanseníase (29,1%). O indicador proporção de casos curados no ano com grau de incapacidade física avaliado no momento da alta foi classificado como “Regular” (82,5%). O modo de entrada predominante foi classificado como “caso novo” (79,1%) e o modo de detecção foi do tipo “demanda espontânea”, (52,0%). A forma clínica e classificação operacional mais prevalentes foram a dimorfa (58,8%) e multibacilar (74,0%), respectivamente. Conclui-se que o Programa de Controle da Hanseníase no município de São Luís não vem atuando de maneira satisfatória, visto que dois dos cinco indicadores responsáveis por avaliar a qualidade das ações e serviços prestados pelos profissionais de saúde à população foram classificados como “Precário” e um classificado como “Regular”, segundo os parâmetros estabelecidos pelo Ministério da Saúde, sugerindo uma deficiência na qualidade do acompanhamento e monitorização dos casos até a completude do tratamento. Os indicadores considerados “Precários” podem indicar que as ações não estão sendo realizados de maneira efetiva e resolutiva, contribuindo para a manutenção dos altos índices da endemia no município, até então considerado como hiperendêmico.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-07-05T21:00:44Z No. of bitstreams: 1 PedroLimaNeto.pdf: 1220345 bytes, checksum: d12eb2756ab001e68251f9f7614c3023 (MD5) / Made available in DSpace on 2017-07-05T21:00:44Z (GMT). No. of bitstreams: 1 PedroLimaNeto.pdf: 1220345 bytes, checksum: d12eb2756ab001e68251f9f7614c3023 (MD5) Previous issue date: 2017-01-27 / Introduction. Leprosy, originally known as leper, is a chronic infectious disease that has the etiological agent bacillus Mycobacterium leprae, considered to be declining, although it is prevalent in several parts of the world, including Brazil. Objective. To analyze the epidemiological and clinical characteristics and associated factors of leprosy in the city of Buriticupu, Maranhão, Brazil, from 2003 to 2015. Methodology. This is a cross-sectional, descriptive and analytical study, based on the active search and spontaneous demand of people with leprosy and evolutionary analysis of the indicators. The study considered individuals diagnosed with leprosy from January 2003 to December 2015. To verify the association between the categorical variables, the chi-square test of independence was used, considering a significance level of 5%. Prevalence ratios were calculated in case of significance, with a 95% confidence interval. Results. It was observed that most of the individuals were male (65.9%) and that the most frequent operational classification was multibacillary (55.5%), with a higher association with age equal to or greater than 60 years, the clinical form with. The greatest diagnosis was dimorphism (32.1%), being more common with advancing age. There was an important association of the male with the clinical form virchowian and multibacillary operational classification. During the historical series, there was a decrease in the detection of new cases, accompanied by high reduction rates in all age groups. Conclusion. Throughout the historical series the municipality of Buriticupu advanced a lot in the control of leprosy, presenting important reduction of the coefficient of detection and absolute number of cases in adults and children. New studies should be carried out with the objective of deepening knowledge about the endemic pattern, as well as strengthening actions based on a greater organization of the health services so that the disease ceases to be a public health problem. / Introdução. A hanseníase, originalmente conhecida como lepra, é uma doença infecciosa crônica que tem como agente etiológico o bacilo Mycobacterium leprae, considerada em declínio, embora seja prevalente em várias partes do mundo, inclusive no Brasil. Objetivo. Analisar as características epidemiológicas e clínicas e fatores associados da hanseníase no município de Buriticupu, Maranhão, Brasil no período de 2003 a 2015. Metodologia. Trata-se de um estudo transversal, descritivo e analítico, baseado em busca ativa e demanda espontânea de pessoas com hanseníase e análise evolutiva dos indicadores. O estudo considerou indivíduos com diagnóstico de hanseníase de janeiro de 2003 a dezembro de 2015. Para verificar a associação entre as variáveis categóricas, foi utilizado o teste Qui-quadrado de independência, considerando o nível de significância de 5%. Foram calculadas razões de prevalência em caso de significância, com intervalo de confiança de 95%. Resultados. Foi observado que a maioria dos indivíduos era do sexo masculino (65,9%) e que a classificação operacional mais frequente foi a multibacilar (55,5%), apresentando maior associação com idade igual ou superior a 60 anos, a forma clínica com maior diagnóstico foi a dimorfa (32,1%), sendo mais comum com o avançar da idade. Houve uma importante associação do sexo masculino com a forma clínica virchowiana e classificação operacional multibacilar. Ao longo da série histórica houve diminuição na detecção de casos novos, acompanhada de elevados índices de redução em todas as faixas etárias. Conclusão. Ao longo da série histórica o município de Buriticupu avançou muito no controle da hanseníase, apresentando importante redução do coeficiente de detecção e número absoluto de casos em adultos e crianças. Novos estudos devem ser realizados com o objetivo de aprofundar os conhecimentos sobre o padrão da endemia, além do fortalecimento das ações baseado em uma maior organização dos serviços de saúde para que a doença deixe de ser um problema de saúde pública.

Made available in DSpace on 2016-04-26T14:55:26Z (GMT). No. of bitstreams: 1 Elizabeth Parente Costa.pdf: 1298236 bytes, checksum: e6ac5ca20eabce2d78b189b2c47824ef (MD5) Previous issue date: 2015-06-10 / The research proposes a study of the social representations of leprosy, we seek three times to understand the sense of every society and their dynamics in relation to disease. The first in the city of Sobral/CE, where we carry out research in the years 2008 and 2009; the second moment in the city of Mogi das Cruzes/SP, with a man who has gone through several periods of hospitalization and overcame the stigma through work aimed at manufacture of prosthetic patients amputees; and the third time in New Delhi in India, where we find the largest number of leprosy patients. The places chosen for the field work were selected after repeated bibliographical research, readings of scholarly articles, medical texts and physicians about the disease and mainly with the data of the World Health Organization (WHO) and of the Brazilian Institute of Geography and Statistics (IBGE). We investigate the sociocultural reality of people afflicted by illness and how these could be with the disease / A pesquisa propõe um estudo das representações sociais da hanseníase, buscamos três momentos para entendermos o senso de cada sociedade e as suas dinâmicas em relação à doença. O primeiro na cidade de Sobral/CE, onde já realizamos a pesquisa nos anos de 2008 e 2009; o segundo momento na cidade de Mogi das Cruzes/SP, com um senhor que passou por vários períodos de internação e superou o estigma, por meio do trabalho voltado à fabricação de prótese para pacientes amputados; e o terceiro momento em Nova Délhi na Índia, onde pudemos encontrar o maior número de hansenianos. Os lugares escolhidos para o trabalho de campo foram selecionados depois de reiteradas pesquisas bibliográficas, leituras de artigos acadêmicos, textos médicos e não médicos sobre a doença e principalmente com os dados da Organização Mundial de Saúde (OMS) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Buscamos investigar a realidade sociocultural de pessoas atingidas pela enfermidade e como estas percebiam estar com a doença

A hanseníase é doença crônica causada pelo Mycobaterium leprae e possui como característica a alteração de sensibilidade cutânea, causando deformidades de mãos e pés. O tratamento compreende o uso de medicamentos (PQT) e o Ministério da Saúde (MS) preconiza o uso de palmilhas tipo Plataforma para Tarso (PT) como tratamento complementar. Há na literatura muitos artigos sobre o uso de palmilhas para melhora do equilíbrio e redistribuição da pressão plantar em pacientes neuropáticos, mas não foram encontrados estudos que incluíssem as palmilhas PT. Neste estudo comparou-se o equilíbrio do paciente hanseniano com valores de normalidade pré-definidos e também comparou-se prospectivamente a influência da palmilha PT no paciente com hanseníase, por meio de testes de equilíbrio estático e dinâmico realizados com o aparelho Balance Master (NeuroCom Int. Inc.) antes e após 3 meses de uso. Foram selecionados 40 pacientes em tratamento no HCFMRP, dos quais 19 mantiveram o seguimento à pesquisa (68,4% do sexo masculino, com média etária de 51,95), e todos com mesma classificação operacional Multibacilar. Os testes delinearam o comportamento destes pacientes com relação aos controles involuntário de equilíbrio (sistemas sensoriais-teste modifCTSIB) e voluntário de excursão do Centro de Gravidade Corporal (COG; teste LOS), bem como a estabilidade da marcha (teste WA). Os resultados obtidos com o modifCTSIB mostraram que os pacientes com hanseníase, para o controle do equilíbrio (de acordo com a relação entre testes com olhos abertos e fechados, e para superfície estável e instável; valor p<0,01 para todas as correlações aplicadas), são mais dependentes do sistema visual que do somatossensorial, em relação à normalidade. As palmilhas PT não influenciaram na modulação dos sistemas sensoriais (p>0,05). No entanto o uso das palmilhas interferiu negativamente no teste LOS, para as variáveis distância final percorrida e máxima excursão do COG somente no ponto para frente e para esquerda (p<0,01), e favoreceu o controle direcional do COG no mesmo ponto (p=0,02). Na análise dos prontuários foram identificados déficits sensitivos com maior frequência nos antepés esquerdos. O teste WA revelou que os pacientes apresentaram a marcha mais lenta em relação ao padrão de normalidade, e aumentaram a velocidade de marcha (p=0,04) e o comprimento do passo (p=0,04) após o uso das palmilhas. Concluiu-se que as palmilhas tipo PT favoreceram a estabilidade para a marcha e para o controle voluntário do equilíbrio. E ainda foi observado que os pacientes tornaram-se dependentes das palmilhas, fator importante a ser considerado pelo serviço de Saúde após a alta medicamentosa / Leprosy is a chronic disease caused by the Mycobacterium leprae with sensitivity impairment as a characteristic that could lead to deformities of hands and feet. The Ministry of Health of Brazil (MS) recommends the use of platform for Tarsus (PT) insoles as a complementary treatment to the Multi-drug Therapy (MDT). Many articles in literature discussed the use of insoles for improving balance and redistribution of plantar pressure in neuropathic patients, but there are no studies that included PT insoles. This study compared the balance control values for the leprosy patient with normal standards and also prospectively compared the influence of PT insole in patients with leprosy, by means of static and dynamic tests performed with the Balance Master (NeuroCom Int. Inc.) device, before and after 3 months. 40 patients following treatment in HCFMRP were selected, of which 19 completed the follow-up to the survey (68.4% male, mean age 51.95), all classified operationally as Multibacillary. The tests outlined the behavior of these patients with regard to involuntary balance control (modifCTSIB sensory test) and voluntary excursion of the Body Center of Gravity (COG; LOS test) as well as the gait stability (WA test). The results obtained with the modifCTSIB showed that patients with leprosy are more dependent on the visual system than the somatosensation for balance controlwhen compared to normal values (according to the relationship between tests with open and closed eyes, and stable and unstable surface; p <0.01 for all applied correlations). The insoles PT did not influence the modulation of the sensory systems (p> 0.05). However the use of insoles interfered negatively in the LOS test for the variables end point and maximum excursion of the COG only on the forward to left position (p <0.01), and favored the directional control of COG at the same position (p= 0.02). The analysis of the patients file revealed that sensitivity deficits were identified more frequently in the left forefeet, which might explain the observed differences for the excursion of the COG only in this region. The WA test showed that patients have slower walking patters compared to normal values but had their walking speed (p = 0.04) and the length of their step increased (p = 0.04) after the use of the insoles. It was concluded that the PT insoles favored gait stability and voluntary control of body balance. It was also observed that patients become dependent on the insoles, an important factor to be considered by the Health service after the PQT discharge

This study was sponsored by the Swedish International Development Cooperation Agency (SIDA) as a Minor Field Study. Background: The treatment of leprosy patients in endemic countries is free of charge. Despite that, leprosy is still a disease that is spreading and can lead to severe consequences such as disability. With leprosy comes also social stigma, discrimination and poverty which often affect the decision of seeking treatment at an early stage, or even treatment at all until the resulting disability forces the patient to seek help. With this study I wish to increase the knowledge of the importance of compliance and education in health care system with patients with leprosy, and to enlightening how nurses can promote this in their daily work. Problem rationale: Even though the importance of seeking early treatment is known, people tend not to seek treatment because of reasons such as stigma. As a nurse, one has responsibilities to care for the whole patient and to give the right information to handle the situation, but because of factors, such as stigma, it constitutes a challenge for nurses within the care of leprosy. Aim: To investigate nurses’ experiences of educating patients with leprosy, with emphasis on aspects of how to handle compliance problems in the treatment and how to support a patient with leprosy. Method: A qualitative study based on interviews held according to an interview guide with semi-structured questions. Result: The findings in this study emphasize the significance of education in order to gain and maintain compliance of treatment with the patients with leprosy even though nurses had many different ways of supporting by education. The findings were divided in to four main categories with in total eleven subcategories to present the techniques and methods of supporting the patients. Discussion: The importance of supporting the patients with leprosy in different ways by education has showed very clearly in the study. Though, at the same time nurses educate with medical knowledge, the patients are the experts in this case of the lived knowledge and this could be a problem to satisfy both aspects unless they complement each other. To do so, a dialog and a relationship of trust must be present between thepatient and the nurse, and this could be done through giving the patients time to express themselves and ask their questions of concern. When the questions and thoughts have been heard, the nurse can satisfy the patient’s need in a more accurate way and continue to support the patient with education and encouragement.

The D'Arcy Island leprosarium, located in Haro Strait off the east coast of southern Vancouver Island, B.C., was first established in 1891. During its thirty-four years of operation it was administered by three governments: the Victoria municipal government from 1891 to 1904, the B.C. provincial government during the year 1905, while the federal government was in charge until closure of the institution in 1924. The colony now comprises three archaeological sites, the earliest phase DdRt 29 on Little D'Arcy Island, where predominantly Chinese males were incarcerated, DdRt 28 the remains of the caretakers' facilities built in 1907 on D'Arcy Island, and the latest phase of the colony DdRt 31, located to the south of the caretakers. The purpose of this research is to examine why and how social inequality is created and how it is maintained. Specifically, it will evaluate the historical sociopolitical circumstances surrounding the establishment of the colony, explain why it was created, and why and how the form of the institution changed over its thirty-four years of existence. Archaeological investigations are employed to illuminate the ongoing material and social conditions of the unfortunate lepers, in contrast to those of the colony caretakers. Historical research is used to provide a meaningful context to understand colony developments. Historical data are also used to complement the gaps in the archaeological record. In my research, I combine aspects of two theoretical approaches employed in contemporary archaeological theory. Processual archaeology is used to provide a framework for evaluating the relationship between racist ideology and the material manifestations of the D'Arcy Island leper colony. Changes in both the location and the architectural form and function are linked to changes in government policy and legislation to exclude Chinese immigrants. Apparently deliberate actions of the medical community to ignore available knowledge about leprosy are also associated with changes in the colony. Symbolic archaeology is employed to illustrate how portable material culture, cultural landscape and architectural form are utilized to symbolically reinforce the ideology of White dominant society. Inferior status based on perceived racial and social difference are reinforced by the cultural manifestations of the facilities. It is my contention that racist ideology is the prime mover in the creation and evolution of the D'Arcy Island leprosarium. It was fueled by stereotypical views of the Chinese immigrants held by White dominant society of the late 19th and early 20th century. The unwarranted fear of leprosy was seized upon by those in power to further incite racism in the general public. It was also used to support the belief that Chinese should further be excluded from mainstream Canadian society. The timing of the establishment of the colony followed a decade of strong anti-Oriental agitation. Other developments in the colony may be directly linked to federal and provincial actions or changes in immigration legislation. Further proof that racism was involved is that there were alternate means available to deal with the issue of the Chinese lepers: care in the Victoria Chinese Hospital, deportation, or transfer to the leprosarium at Tracadie, New Brunswick. Differential care of non-Chinese lepers also indicates that the provision of appropriate medical care was not a consideration in the maintenance of the colony. The D'Arcy Island leper colony was part of an historic process which contributed to racist ideology. The location, landscape, and architectural design all reflected the perceived inferior and outcast status of the Chinese lepers. They also reinforced the power and dominance of Euro-Canadians, maintaining social distance and creating social inequality.

The oral histories utilized by this research reveal the experiences of those who suffered leprosy in five South Pacific nations, Fiji, New Caledonia, Samoa, Tonga and Vanuatu. This thesis explores how leprosy and its stigma impacted on the lives of these people, some of whom suffered decades of isolation at various leprosaria including the case of one New Caledonian resident for nearly seventy years. The testimonies of their experiences of diagnosis, removal into isolation, medical treatment and eventual discharge back to their homes implicitly contain descriptions of attitudes of stigma in their communities. This research reveals that where there is openness and knowledge about the minimal risk of leprosy contagion, as occurred in Fiji and Vanuatu from the 1950s, less stigma is attached to the disease. Nevertheless even in these countries, prior to the 1950s and availability of any effective medication, the fear and horror of the physical effects of leprosy was such that the victims were either cast out or chose to move away from their homes. This segregation led to groups of leprosy sufferers banding together to help care for each other. Once the policy of isolation in leprosaria was implemented, advanced cases of leprosy benefited from the better medical facilities and found opportunities for friendships and camaraderie. However, where the conditions at leprosaria were miserable and movements of the residents visibly restricted by fences, as occurred in Samoa and Tonga, there was heightened leprosy stigma. Perceptions of stigma varied from person to person and region to region. Higher levels of stigma were evident in New Caledonia, where leprosaria had been situated at former prison sites and strict isolation enforced, and in Tonga, where the removal of all leprosy sufferers had from the earliest days been associated with biblical strictures asserting that leprosy was a curse and the sufferers unclean. Following the availability of sulphone treatment in the South Pacific in the1950s and the improved medication in the 1980s, leprosy need no longer be physically disfiguring or disabling. Assisted by the generous donations gathered by the Pacific Leprosy Foundation in New Zealand to the medical services at the central leprosy hospital in Fiji, and by direct assistance to leprosy sufferers in the Pacific, the disadvantages that were imposed by leprosy in the past are disappearing and as one contributor to the project said ‘the time of darkness’ is ending.

Thesis (Ph.D.)--University of Hawaii, 1996. / Includes bibliographical references (p. 369-392).

Hanseníase é uma das mais antigas e instigantes doenças que acometem o ser humano. Ferramentas moleculares e imunológicas são avaliadas em diversos estudos epidemiológicos, porém com resultados controversos devido à alta complexidade da doença e metodologias utilizadas. Este estudo descreve o uso da sorologia anti PGL-I e da detecção de DNA em swab nasal para caracterizar a epidemiologia molecular do Mycobacterium leprae em pacientes e contatos domiciliares de pacientes com hanseníase. Em pacientes com hanseníase a positividade nos testes ELISA anti PGL-I e PCR para a detecção do DNA de M. leprae em swab nasal são inversamente associadas ao teste de Mitsuda e são diretamente associadas com o índice baciloscópico e as formas clínicas no espectro da doença, aumentando em direção às formas bacilíferas. As porcentagens gerais de positividade em pacientes foram 63,3% para o ELISA anti PGL-I e 34,2% para a PCR para detecção do DNA de M. leprae em swab nasal. Nos contatos domiciliares de pacientes com hanseníase as porcentagens gerais para o ELISA anti PGL-I e para a PCR para detecção do DNA de M. leprae em swab nasal foram 13,3% e 4,7% respectivamente. Os contatos com resultados positivos nestas metodologias representam portadores sadios ou com infecção subclínica e podem participar na transmissão e manutenção do M. leprae na comunidade, mesmo que os mesmos não venham a adoecer. É imperativo para o controle da hanseníase o monitoramento de contatos domiciliares em regiões endêmicas para detecção precoce de novos casos e a quimioprofilaxia deve ser utilizada como prevenção para o desenvolvimento da doença e interrupção da transmissão. / Leprosy is one of the oldest and most instigating diseases to affect humans. Molecular and immunological tools are evaluated in epidemiological studies; however, the results present controversies mainly due to disease complexity and methodologies. This study describes the application of anti PGL-I serology and nasal swab DNA detection to characterize Mycobacterium leprae molecular epidemiology in patients and household contacts of leprosy patients. Among leprosy patients the positivity to the anti PGL-I ELISA and the PCR for the detection of M. leprae DNA in nasal swabs are inversely associated to the lepromin test and arte directly associated to the bacillary index and the clinical forms in the disease spectrum, increasing towards baciliferous forms. The overall positivity percentages were 63.3% for the anti PGL-I ELISA and 34.2% for the PCR for the detection ofM. leprae DNA in nasal swabs. Among household contacts of leprosy patients the overall percentages for the anti PGL-I ELISA and for the PCR for the detection of M. leprae DNA in nasal swabs were 13.3% e 4.7% respectively. Among leprosy patients, assays positivity is associated with the clinical presentation of the disease, increasing towards bacilliferous subtypes. Positive results in contacts represent healthy carriers and subclinical infection and these individuals can participate in transmission and spread of M. leprae in the community, even though they may not develop the disease. In endemic regions, contact monitoring is imperative in leprosy control for early case detection and chemoprophylaxis must be applied as prevention to disease development and disruption of transmission. / Dissertação (Mestrado)