Disability Grade Research Articles

Interaction of Socio-demographic Characteristics on Acceptance of Disability Among Individuals With Physical Disabilities.

This study aimed to investigate the interaction of sociodemographic characteristics on acceptance of disability among individuals with physical disabilities (IWPD). Data from the 8th Panel Survey of Employment for the Disabled in Korea (PSED) in the second wave were used. A sample concerning the first phase of disability was extracted using the one-step colony method to extract regions and was stratified based on the type of disability, disability grade, and age. To explore the association between acceptance of sociodemographic characteristics and of disability, we used a general linear model. A significant main effect was observed in employment, health status, degree of help, and subjective economic status. Regarding employment status, acceptance of disability in unemployment of IWPD with less than high school was lower as compared to those with more than high school. We observed that unemployed IWPD with low income or poor health status could be the group with the highest risk for acceptance of disability. Individuals in the low economic group were more religious than those in the high economic one. These findings indicate that specialized intervention programs that consider religion, economic status, employment, education, health, and their interactions would be effective for acceptance of disability. Interdisciplinary team members should consider the individual profiles of these populations and implement suitable support and rehabilitation programs.

Nationwide Trends in Body Mass Index, Underweight, Overweight and Obesity Among Korean with Disabilities from 2008 to 2017

Background: The maintenance of optimal body weight is a crucial component in health and quality of life. However, little is known about weight distribution and trends among people with disabilities. This study in South Korea examined the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities. Methods: We linked national disability registration data with national cancer screening program data. Age-standardized prevalence of underweight and obesity were analyzed for each year during the period 2008 to 2017, according to the presence, type, and severity of disabilities. Risk of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables as of 2017. Findings: People with disabilities (both male and female) had a higher risk of underweight compared to those without disability (OR 1·41, 95% CI 1·38-1·44, and OR 1·31, 95% CI 1·28-1·34, respectively), especially in those with severe disabilities (OR 2·00, 95% CI 1·94-2·06 in male, and OR 1·83, 95% CI 1·77-1·89 in female, respectively). The age-standardized prevalence of severe obesity (BMI ≥30·0 kg/m2 ) was also higher in people with disability, and the disparity relative to people without disability widened from 1·8% in 2008 to 3·7% in 2017. Women with disabilities are more likely to be obese than those without disabilities regardless of disability severity (OR 1·40, 95% CI 1·38-1·41). The risk of severe obesity was also more prominent in women with disabilities (OR 2·08, 95% CI 2·05-2·11). Interpretation: Physical, mental and developmental disabilities were significantly associated with higher prevalence of obesity as well as underweight. The intersection of female gender, severe disability, and mental/developmental disabilities was associated with risk of severe obesity. Simultaneous efforts are needed to enhance food security as well as weight control and exercise for people with disabilities. Funding Statement: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean Ministry of Science and ICT (MSIT) (No. 2019R1A2C1087507 and 2021R1C1C2008683) and the Korean Ministry of Education (No. 2019R1D1A3A03103862). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of Chungbuk National University (CBNU-201910- BMETC-946-01)

MIDAS Disability Grades are Associated with Total Health Care and Pharmaceutical Costs – A US-Based Real World Longitudinal Analysis (2416)

MIDAS Disability Grades are Associated with Total Health Care and Pharmaceutical Costs – A US-Based Real World Longitudinal Analysis (2416)

Enhanced IL-6 and IL-12B Gene Expression After SARS-CoV-2 Infection in Leprosy Patients May Increase the Risk of Neural Damage.

.Experts have called attention to the possible negative impact of the coronavirus disease 2019 (COVID-19)–related cytokine storm syndrome on the progression of leprosy-related disabilities. We assessed the frequency of reactional states in patients co-infected with Mycobacterium leprae and severe acute respiratory syndrome (SARS) coronavirus (CoV) 2 (SARS-CoV-2). We consecutively included patients during the first peak of the COVID-19 epidemic in Brazil and analyzed the expressions of genes encoding interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12A, IL-12B, and tumor necrosis factor-α in peripheral blood mononuclear cells. We included 64 leprosy patients and 50 controls. Twelve of the leprosy patients and 14 of the controls had been diagnosed with COVID-19. Co-infection was associated with increased IL-6 (P = 0.043) and IL-12B (P = 0.017) expression. The median disability grades were higher for leprosy/COVID-19 patients; however, the difference was not significant (P = 0.194). Patients co-infected with M. leprae and SARS-CoV-2 may experience a higher-grade proinflammatory state.

Neurofilament light chain as a potential biomarker for monitoring neurodegeneration in X-linked adrenoleukodystrophy

X-linked adrenoleukodystrophy (X-ALD), the most frequent monogenetic disorder of brain white matter, is highly variable, ranging from slowly progressive adrenomyeloneuropathy (AMN) to life-threatening inflammatory brain demyelination (CALD). In this study involving 94 X-ALD patients and 55 controls, we tested whether plasma/serum neurofilament light chain protein (NfL) constitutes an early distinguishing biomarker. In AMN, we found moderately elevated NfL with increased levels reflecting higher grading of myelopathy-related disability. Intriguingly, NfL was a significant predictor to discriminate non-converting AMN from cohorts later developing CALD. In CALD, markedly amplified NfL levels reflected brain lesion severity. In rare cases, atypically low NfL revealed a previously unrecognized smoldering CALD disease course with slowly progressive myelin destruction. Upon halt of brain demyelination by hematopoietic stem cell transplantation, NfL gradually normalized. Together, our study reveals that blood NfL reflects inflammatory activity and progression in CALD patients, thus constituting a potential surrogate biomarker that may facilitate clinical decisions and therapeutic development.

A Feasibility Study of Kinematic Characteristics on the Upper Body According to the Shooting of Elite Disabled Archery Athletes.

The purpose of this study is to compare and analyze the kinematic characteristics of the upper limb segments during the archery shooting of Paralympic Wheelchair Class archers (ARW2—second wheelchair class—paraplegia or comparable disability) and Paralympic Standing Class archers (ARST—standing archery class—loss of 25 points in the upper limbs or lower limbs), where archers are classified according to their disability grade among elite disabled archers. The participants of this study were selected as seven elite athletes with disabilities by the ARW2 (n = 4) and ARST (n = 3). The analysis variables were (1) the time required for each phase, (2) the angle of inclination of the body center, (3) the change of trajectory of body center, and (4) the change of the movement trajectory of the bow center by phase when performing six shots in total. The ARW2 group (drawing phase; M = 2.228 s, p < 0.05, holding phase; M = 4.414 s, p < 0.05) showed a longer time than the ARST group (drawing phase; M = 0.985 s, holding phase; M = 3.042 s), and the angle of the body did not show a significant difference between the two groups. Additionally, in the direction of the anteroposterior axis in the drawing phase, the change in the movement trajectory of the body center showed a more significant amount of change in the ARW2 group than in the ARST group, and the change in the movement trajectory of the bow center did not show a significant difference between the two groups.

Effectiveness of Treatment in Children With Cerebral Palsy.

Objective: The objective of this study was to assess the effectiveness of conservative and surgical treatment in cerebral palsy children by evaluating the Medical Research Council (MRC) grading system, modified Ashworth scale, and Barthel Activities of Daily Life (ADL) scale.Method: This prospective case series was performed using a non-probability consecutive sampling technique at the Department of Orthopedic Surgery and Traumatology, King Edward Medical University/Mayo Hospital, Lahore from October 2011 to November 2013. Two hundred children of all ages, having cerebral palsy diagnosed on history and clinical examination were enrolled in the study. Children were treated with conservative and surgical treatment. Pre- and post-treatment, all children were classified based on movement disorder (spastic, athetoid, ataxic, and mixed), parts of the body involved (paraplegic, tetraplegic, diplegic, hemiplegic, monoplegic, double hemiplegic, and triplegic), and gross motor function (GMFCS level I-IV). Their muscle power and tone were assessed using the MRC grading system and modified Ashworth scale, respectively. Assessment of disability and daily function was done by ranking disability grading and Barthel ADL, respectively. The range of motion (ROM) of each joint was assessed clinically. Children were divided based on the treatment method as non-surgical versus surgical treatment.Results: Out of a total of 200 children, the mean age of the children was 7.86±4.17year. There were 134 (67.0%) males and 66 (33.0%) female children. Classification on basis of movement disorder, body part involved, and gross motor function at three-month intervals till twelve months was performed. From the first presentation of children till the last follow-up time period, i.e., 12th month there was no change in the movement disorder (a type of CP, body parts involved, and GMFCS). The final rating of overall treatment results shows that there were 84 (42%) patients who had a poor outcome, and only 35 (17.50%) patients had a fair treatment outcome and 81 (40.50%) patients had good treatment outcomes. Conclusion: The conservative and surgical management showed no effect on movement disorder of the child although, on the final rating scale fair to good treatment outcome was observed in all children. There was an improvement in muscle power grading on the ADL, but no significant improvement was seen on the improvement of type, parts of the body involved, gross motor function classification, modified Ashworth, and ranking disability grading of the children.

Revised estimates of leprosy disability weights for assessing the global burden of disease: A systematic review and individual patient data meta-analysis.

Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination. The chronicity of the disease and disabilities are the prime contributors to the disease burden of leprosy. The current figures of the disease burden in the 2017 global burden of disease study, however, are considered to be under-estimated. In this study, we aimed to systematically review the literature and perform individual patient data meta-analysis to estimate new disability weights for leprosy, using Health-Related Quality of Life (HRQOL) data. The search strategy included all major databases with no restriction on language, setting, study design, or year of publication. Studies on human populations that have been affected by leprosy and recorded the HRQOL with the Short form tool, were included. A consortium was formed with authors who could share the anonymous individual-level data of their study. Mean disability weight estimates, sorted by the grade of leprosy disability as defined by WHO, were estimated for individual participant data and pooled using multivariate random-effects meta-analysis. Eight out of 14 studies from the review were included in the meta-analysis due to the availability of individual-level data (667 individuals). The overall estimated disability weight for grade 2 disability was 0.26 (95%CI: 0.18-0.34). For grade 1 disability the estimated weight was 0.19 (95%CI: 0.13-0.26) and for grade 0 disability it was 0.13 (95%CI: 0.06-0.19). The revised disability weight for grade 2 leprosy disability is four times higher than the published GBD 2017 weights for leprosy and the grade 1 disability weight is nearly twenty times higher. The global burden of leprosy is grossly underestimated. Revision of the current disability weights and inclusion of disability caused in individuals with grade 0 leprosy disability will contribute towards a more precise estimation of the global burden of leprosy.

Validation of the Brazilian version of the WHODAS 2.0 for people affected by leprosy

The International Classification of Functioning has an impact on the way clinical information related to functioning are thought and worked on. The use of instruments such as WHODAS 2.0 allows the practical and routine incorporation of an instrument based on the ICF in the health care of people affected by leprosy. For clinical and research purposes, measurement instruments need to be validated based on their psychometric properties. This study aimed to validate the WHODAS 2.0 for use in people affected by leprosy. The instruments used were WHODAS 2.0 version of 36 questions, World Health Organization Quality of Life (WHOQOL-bref) and Screening of Activity Limitation and Safety Awareness (SALSA). Data were also collected on disability grade and eye–hand–foot score. The psychometric properties evaluated were internal consistency, convergent and divergent construct and criterion validity. Cronbach’s α coefficient ranged from 0.76 to 0.91, revealing good internal consistency. The convergent validity showed a moderate correlation between the total score of WHODAS 2.0 and WHOQOL-bref (rho = −0.67; p &lt; 0.05) and strong correlation between WHODAS 2.0 and SALSA (rho = 0.72; p &lt; 0.05). For related domains, the correlation was moderate to strong. An exception was the weak correlation with the Interpersonal Relations domain. The divergent validity showed weak correlations. The criterion validity showed a significant result between WHODAS 2.0 and disability grade (p = 0.01). The correlation between WHODAS 2.0 and eye–hand–foot score showed a weak but significant correlation (rho = 0.23 p = 0.003). WHODAS 2.0 has valid and reliable psychometric characteristics for use in people affected by leprosy.

Mental wellbeing among people affected by leprosy in the Terai region, Nepal

Objectives: The relationship between leprosy, stigma and poor mental health is well recognized. The overall objective of this study was to help improve mental wellbeing in people affected by leprosy by gaining more insight into what factors related to cultural, social and personal life influence mental wellbeing amongst people affected by leprosy in the Terai region, Nepal. Methods: We adopted a qualitative approach with purposive sampling to include people affected by leprosy in the Terai region of Nepal. Fourteen people with various leprosy disability grades and two healthcare workers were recruited for in-depth interviews. We used a framework analysis method with characteristics of the Grounded Theory Approach. Predetermined themes were explored, and new themes brought up during the interviews were also analysed. Results: Leprosy-related stigma still persists in the Terai region, negatively influencing mental wellbeing. A higher disability grade can result in a poorer mental wellbeing. Additional key factors influencing mental wellbeing include: people’s feelings and experiences regarding leprosy, family and community, work and culture. Conclusions: The mental wellbeing of the respondents was negatively influenced by direct and indirect consequences of being affected by leprosy. Stigma, disability grade, family, community, work and culture are very important factors that influence mental wellbeing in the Terai region, Nepal. We recommend that interventions should include a combination of strategies, including lay and peer counselling, socio-economic rehabilitation and involvement of community and family to improve the mental wellbeing of those affected. We also recommend using a holistic and gender-specific approach when developing these interventions.

Characterization of Respiratory Disability in the Adult Population of the Rostov Region

Introduction: Disability resulting from diseases of the respiratory system is a complex problem for the health care and social security systems. The prevalence of chronic lung diseases keeps growing. Our objective was to analyze the rates of initial and recurrent respiratory disability in the adult population of the Rostov Region in 2014–2018 and to compare them with those registered in the Southern Federal District and the Russian Federation. Material and methods: We used information about initial and recurrent respiratory disability in adults from the electronic database of the unified information and analytical system of medical and social expertise of the Rostov Region and digests of the Federal Bureau of Medical and Social Expert Examination of the Ministry of Labor and Social Protection of the Russian Federation for 2014–2018. We applied methods of data copying, descriptive statistics (estimation of extensive and intensive indicators, significance tests (p)), analytical and comparative analysis. Results: The analysis of adult respiratory disability in the Rostov Region in 2014–2018 showed a decrease in the number of adults with initial and recurrent disability. The proportion of initial cases tended to decrease and was similar to the Russian average rate but exceeded that in the Southern Federal District while the proportion of recurrent disability cases increased. The rates of initial respiratory disability in the adult population of the Rostov Region and the Russian Federation were comparable. The regional proportion of young people with respiratory disability was 42.2 % in contrast to the Southern Federal District and the Russian Federation where elderly cases prevailed (42.0 % and 48.7 %, respectively). In terms of severity of disability, grade II disability cases prevailed (50.4 %) in the Rostov Region as opposed to the Southern Federal District and the Russian Federation with higher proportions of persons with disability grade III (62.3 % and 72.0 %, respectively). The recurrent disability rate showed a rising trend and was higher than the intensive indicator in the Southern Federal District but lower than that in the Russian Federation. The majority of regional cases with recurrent respiratory disability were young and middle-aged (40.5 % and 40.2 %, respectively); the proportion of young cases tended to increase while that of the middle-aged showed a downward trend. In the Southern Federal District and the Russian Federation, most recurrent cases were middle-aged or elderly (37.8 % and 35.3 %) and elderly or middle-aged (39.0 % and 35.1 %), respectively. The rate of recurrent respiratory disability among young people in the Rostov Region was twice as high as in the Southern Federal District and the Russian Federation. In terms of severity of recurrent respiratory disability, grade III disability was most prevalent in all territories but in the Rostov Region its proportion was lower than in the areas of comparison. The proportion of people with grade II disability tended to decrease but was still higher than in the Southern Federal District and the Russian Federation. Conclusions: Our findings will allow a more accurate assessment of severity of impairments and vital activity limitations in adults with respiratory disability and help plan appropriate age and sex-specific rehabilitation measures contributing to effective rehabilitation and habilitation actions and successful social integration of a disabled person.

Diabetic Status of People Affected by Leprosy in Donorojo Leprosy Recovered Village: A Cross Sectional Study

Background: Just like diabetes, leprosy also cause painless neuropathic ulcers which process is mediated by Schwann-cell. Biochemical changes on leprosy patients presumed to have role on pathogenesis of diabetes mellitus. Methods: This study is cross-sectional study aimed to know further about diabetic status on population of people affected by leprosy, as the preliminary study to prove the association between diabetes mellitus and leprosy. Data, such as diabetic status, type of leprosy, grade of disability, and other variables are collected from 127 people affected by leprosy in Donorojo leprosy recovered village.Result: Result showed that 19.7% are having diabetes mellitus, and other 23.6% are in pre-diabetic condition. This number is higher than prevalence of diabetes mellitus in Central Java (2.09%) and Indonesia (2%).Conclusion : Further research is needed to prove the association between leprosy and diabetic status. All leprosy patients should be recommended to be routinely screened for diabetes mellitus.

Editorial: Disseminating Knowledge About Orofacial Pain— A Huge and Important Challenge

Editorial: Disseminating Knowledge About Orofacial Pain— A Huge and Important Challenge

Effect of professional certification on employees\u2019 return-to-work rate after occupational injuries in Korea: focusing on vulnerable groups

BackgroundOne effective way to improve return-to-work (RTW) performance may be to convince the employer that the worker has the necessary skills. The aim of this paper is to investigate the effect of having a professional certification among workers injured in occupational injuries on their return to work.MethodsThe Panel Study of Workers’ Compensation Insurance (PSWCI) targets workers who completed medical care in 2012 after an occupational injury. The study population (n = 2000) was stratified by gender, age, region, disability grade, and rehabilitation service use. A total of 1458 workers were finally selected for this study.The effect of having a certification on RTW status was calculated with an odds ratio and 95% confidence intervals using binomial and multinomial logistic regression analyses. In the binomial logistic regression analysis, the RTW group was made up as a combination of the return to original work and the reemployment groups.ResultsThe ORs of RTW among those with a certification compared to those without certification were 1.38 (1.16–1.65) in Model 1, 1.25 (1.05–1.50) in Model 2, and 1.22 (1.01–1.47) in Model 3. Among female workers with a certification, the OR of RTW was 4.60 (2.68–7.91), that of return to original work was 3.21 (1.74–5.91), and that of reemployment was 5.85 (3.34–10.27). Among daily workers with a certification, the OR of RTW was 1.32 (1.03–1.69) and that of reemployment was 1.37 (1.07–1.76).ConclusionIn conclusion, injured workers with a certification generally had a higher RTW rate. In particular, the RTW rate was higher among female workers and daily workers with a certification than among those without.

Adverse outcomes after major surgery in children with intellectual disability.

To evaluate outcomes after major surgery in children and adolescents with intellectual disability. We used 2004 to 2013 claims data from Taiwan's National Health Insurance programme to conduct a nested cohort study, which included 220292 surgical patients aged 6 to 17years. A propensity score matching procedure was used to select 2173 children with intellectual disability and 21730 children without intellectual disability for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the postoperative complications and 30-day mortality associated with intellectual disability. Children with intellectual disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI 1.48-3.15; p<0.001), sepsis (OR 1.67, 95% CI 1.28-2.18; p<0.001), and 30-day mortality (OR 2.04, 95% CI 1.05-3.93; p=0.013) compared with children without intellectual disability. Children with intellectual disability also had longer lengths of hospital stay (p<0.001) and higher medical expenditure (p<0.001) when compared with children with no intellectual disability. Children with intellectual disability experienced more complications and higher 30-day mortality after surgery when compared with children without intellectual disability. There is an urgent need to revise the protocols for the perioperative care of this specific population. Surgical patients with intellectual disability are at increased risk of postoperative pneumonia, sepsis, and 30-day mortality. Intellectual disability is associated with higher medical expenditure and increased length of stay in hospital after surgical procedures. The influence of intellectual disability on postoperative outcomes is consistent in both sexes and those aged 10 to 17 years. Low income and a history of fractures significantly impacts postoperative adverse events for patients with intellectual disability.

Lower Back Complaints in Adolescent Competitive Alpine Skiers: A Cross-Sectional Study

Background: Little is known about lower back complaints in adolescent competitive alpine skiers. This study assessed their prevalence and severity (i.e., intensity and disability) with respect to sex, category, discipline preference, and training attributes. Methods: 188 competitive skiers aged 15 to 18 years volunteered in this study. Data collection included (i) questions on participants’ demographics, sports exposure, discipline preferences, and other sports-related practices; (ii) the Nordic Musculoskeletal Questionnaire on lower back complaints; and (iii) the Graded Chronic Pain Scale. Results: As many as 80.3% and 50.0% of all skiers suffered from lower back complaints during the last 12 months and 7 days, respectively. A total of 50.7% reported their complaints to be attributable to slalom skiing, and 26% to giant slalom. The majority of complaints were classified as low intensity/low disability (Grade I, 57.4%) and high intensity/low disability complaints (Grade II, 21.8%). The Characteristic Pain Intensity was found to be significantly related to the skiers’ years of sports participation, number of competitions/season, and number of skiing days/season. Conclusion: This study further supports the relatively high magnitudes of lower back-related pain in adolescent competitive alpine skiers, with a considerable amount of high intensity (but low disability) complaints, and training attributes being a key driver.

The relationship between disability and clinical outcomes in maintenance dialysis patients.

BackgroundDialysis patients are prone to having disabilities. We aimed to evaluate the association between disability and various clinical outcomes in Korean dialysis patients.MethodsThis study consisted of 1,615 dialysis patients from 27 centers. We evaluated disability by using four questions on the activities of daily living (ADLs) concerning whether help was needed for feeding, dressing/undressing, getting in/out of bed, or taking a bath/shower. We divided the patients into three groups: no disability (Non-D, none of the four ADL domains required help; n=1,312), mild disability (Mild-D, one ADL domain required some/full help; n=163), or moderate to severe disability (MS-D, two or more ADL domains required some/full help; n=140). We evaluated falls, frailty, health-related quality of life (HRQoL), mortality, and hospitalization.ResultsThe numbers of participants with a fall during the last 1 year were 199 (15.2%), 42 (25.8%), and 44 (31.4%) in the Non-D, Mild-D, and MS-D groups, respectively (p<0.001). The numbers of participants with frailty in the Non-D, Mild-D, and MS-D groups were 381 (29.0%), 84 (51.5%), and 93 (66.4%), respectively (p<0.001). In both univariate and multivariate analyses, the physical component scale and mental component scale scores decreased as the grade of disability increased (p<0.001 for both scores). Hospitalization-free survival rate at 500 days was 64.2%, 56.7%, and 51.1% in the Non-D, Mild-D, and MS-D, respectively (p=0.001 for trend). Patient survival rate at 500 days was 95.3%, 89.5%, and 92.3% in the Non-D, Mild-D, and MS-D, respectively (p=0.005 for trend).ConclusionDisability was associated with falls, frailty, HRQoL scales, and survival trends in Korean dialysis patients.

The level of psychological and docial adjustment among a sample of persons with learning disabilities in Asir Region in light of some variables

&lt;p&gt;This study aimed at investigating the level of psychological and social adjustment in relation to the grade and type of learning disability among persons with learning disabilities in the Asir region. The study was applied to a sample of (350) students studying in schools in the Department of Education in Asir. The sample responded to the psychological and social adjustment scale developed as a tool of the study. The results showed that the level of psychological and social adjustment came with a medium degree, as well as the absence of statistically significant differences in the level of psychological and social adjustment students in the basic stage. In light of the results, the researcher recommended preparing awareness programs for teachers of learning disabilities to identify the various indicators that accompany the phenomenon of psychological and social adjustment for persons with learning disabilities. The study also recommends conducting more studies on psychological and social adjustment and its relationship to other variables, such as emotional intelligence.&lt;/p&gt;

Depression and mental wellbeing in people affected by leprosy in southern Nepal

ABSTRACT Background Leprosy, a leading cause of disability, remains endemic in southern Nepal. Alongside physical impairment and stigmatization, many people affected by leprosy suffer from mental health problems. Objectives This study had two objectives: (a) Establishing a baseline level of mental wellbeing and depression among people affected by leprosy in southern Nepal, and (b) Examining factors that influence mental wellbeing and depression in this target group. Methods A cross-sectional survey was conducted using three interview-administered questionnaires measuring level of depression (PHQ-9), mental wellbeing status (WEMWBS) and level of stigma (5-QSI-AP). Random clustering sampling was used to include leprosy-affected people from Self Help Groups (SHGs) and the reference group was matched based on socio-demographic characteristics. All participants were adults with no additional major morbidities. A sample of 142 persons affected by leprosy and 54 community controls were included. Results People affected by leprosy participating in SHGs had a significantly lower level of mental wellbeing and higher level of depression than the general population. Both mental wellbeing and depression were influenced by gender and the level of stigma. In addition, the level of depression was associated with the disability grade of leprosy-affected people. Conclusion Leprosy-affected people need mental health-care interventions at different organizational levels, with attention to identifying individuals at increased risk for mental health problems or with additional needs. These findings highlight the demand for further research on specific interventions to improve the mental health of leprosy-affected people.

Contexto clínico-epidemiológico dos casos de hanseníase notificados em Governador Valadares, Minas Gerais - Brasil, entre 2015 e 2019

Objetiva-se caracterizar o contexto clínico-epidemiológico dos casos de hanseníase notificados no município de Governador Valadares (GV) entre 2015 e 2019. Metodologia: Trata-se de um estudo ecológico no qual foram analisadas variáveis sociodemográficas (sexo, faixa etária e escolaridade) e variáveis clínicas (forma clínica, classificação operacional, número de lesões, presença de incapacidade e tipo de saída). Resultados: Entre os 387 casos notificados, 52,1% eram do sexo masculino, 26,6% apresentavam idade ≥65 anos e 22,9% possuíam da 1ª a 4ª série do ensino fundamental incompleta. Com relação às variáveis clínicas, 42,8% foram classificados como dimorfos e 56,3% como multibacilares. Além disso, foi possível identificar que a maior parte apresentava 5 ou mais lesões (43,4%) e grau de incapacidade zero (71,3%). Observou-se ainda correlação entre ser do sexo masculino e apresentar forma virchowiana (*p=0,0001), multibacilar (*p=0,0004), possuir 5 ou mais lesões (*p=0,0008) e desenvolver incapacidade de grau 2 (*p=0,002). Por outro lado, houve correlação entre ser do sexo feminino e forma tuberculóide (*p=0,001) e o surgimento de somente 1 lesão (*p=0,002). Torna-se importante ressaltar que os percentuais de cura permaneceram acima de 90%. Considerações finais: A hanseníase é uma doença de impacto em GV, fato que torna imprescindível o diagnóstico precoce e a prevenção por meio de medidas de educação em saúde.