Over 200,000 new cases of leprosy are detected each year, of which approximately 7% are associated with grade-2 disabilities (G2Ds). For achieving leprosy elimination, one of the main challenges will be targeting higher risk groups within endemic communities. Nevertheless, the socioeconomic risk markers of leprosy remain poorly understood. To address this gap we systematically reviewed MEDLINE/PubMed, Embase, LILACS and Web of Science for original articles investigating the social determinants of leprosy in countries with > 1000 cases/year in at least five years between 2006 and 2016. Cohort, case-control, cross-sectional, and ecological studies were eligible for inclusion; qualitative studies, case reports, and reviews were excluded. Out of 1,534 non-duplicate records, 96 full-text articles were reviewed, and 39 met inclusion criteria. 17 were included in random-effects meta-analyses for sex, occupation, food shortage, household contact, crowding, and lack of clean (i.e., treated) water. The majority of studies were conducted in Brazil, India, or Bangladesh while none were undertaken in low-income countries. Descriptive synthesis indicated that increased age, poor sanitary and socioeconomic conditions, lower level of education, and food-insecurity are risk markers for leprosy. Additionally, in pooled estimates, leprosy was associated with being male (RR = 1.33, 95% CI = 1.06–1.67), performing manual labor (RR = 2.15, 95% CI = 0.97–4.74), suffering from food shortage in the past (RR = 1.39, 95% CI = 1.05–1.85), being a household contact of a leprosy patient (RR = 3.40, 95% CI = 2.24–5.18), and living in a crowded household (≥5 per household) (RR = 1.38, 95% CI = 1.14–1.67). Lack of clean water did not appear to be a risk marker of leprosy (RR = 0.94, 95% CI = 0.65–1.35). Additionally, ecological studies provided evidence that lower inequality, better human development, increased healthcare coverage, and cash transfer programs are linked with lower leprosy risks. These findings point to a consistent relationship between leprosy and unfavorable economic circumstances and, thereby, underscore the pressing need of leprosy control policies to target socially vulnerable groups in high-burden countries. Many cases of leprosy still occur in low and middle-income countries, with a considerable proportion of them leading to permanent nerve damage and visible physical deformities. Disease elimination can be achieved with a better understanding of the sociodemographic characteristics of those most affected by the disease and by targeting those with greater risk within endemic countries. To address this question, we reviewed all published studies evaluating the social determinants of leprosy in countries endemic for leprosy. We found 39 studies, most of them conducted in Brazil (i.e., an upper-middle-income country), India or Bangladesh (i.e., lower-middle income countries), and none in low-income countries. Our review found strong evidence that males, household contacts of leprosy patients, individuals living in crowded households, and individuals who suffered food shortage in the past are more affected by leprosy. Evidence also exists that increasing age, poor sanitary and socioeconomic conditions, lower levels of education, and food insecurity are associated with a greater risk of leprosy. Our review underscores the importance of improving living conditions and decreasing inequality in low and middle-income countries to achieve leprosy elimination.

This study emphasizes the importance of analyzing factors that contribute to student well-being, as a result of the multiplicity of factors that can affect their quality of life (QoL). The literature indicates that, among these factors, emotional intelligence and self-regulation play a central role in influencing adolescents’ psychological and scholastic well-being. Technology is a fundamental aspect of adolescent life but addiction to the use of smartphones is increasing, which can affect both emotional intelligence and self-regulation, and in turn individual well-being and QoL. Therefore, this study explores the role of smartphone use with respect to these aspects. Participants were 215 Italian students attending middle school. By applying partial least squares structural equation modeling (PLS-SEM), the results confirm that self-regulation affects the QoL of students, but its role varies according to the degree of smartphone addiction. In conclusion, we confirm the relevance of the relationship between self-regulation and smartphone addiction in teaching students to be aware of their time spent using smartphones. Emotional intelligence and, in general, self-regulation should be encouraged to support the well-being and QoL of students in their adolescence at school.

This study aimed to evaluate the risk factors associated with developing leprosy among the contacts of newly-diagnosed leprosy patients. A total of 6,158 contacts and 1,201 leprosy patients of the cohort who were diagnosed and treated at the Leprosy Laboratory of Fiocruz from 1987 to 2007 were included. The contact variables analyzed were sex; age; educational and income levels; blood relationship, if any, to the index case; household or non-household relationship; length of time of close association with the index case; receipt of bacillus Calmette-Guérin (BGG) vaccine and presence of BCG scar. Index cases variables included sex, age, educational level, family size, bacillary load, and disability grade. Multilevel logistic regression with random intercept was applied. Among the co-prevalent cases, the leprosy-related variables that remained associated with leprosy included type of household contact, [odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.02, 1.73] and consanguinity with the index case, (OR = 1.89, 95% CI: 1.42–2.51). With respect to the index case variables, the factors associated with leprosy among contacts included up to 4 years of schooling and 4 to 10 years of schooling (OR = 2.72, 95% CI: 1.54–4.79 and 2.40, 95% CI: 1.30–4.42, respectively) and bacillary load, which increased the chance of leprosy among multibacillary contacts for those with a bacillary index of one to three and greater than three (OR = 1.79, 95% CI: 1.19–2.17 and OR: 4.07–95% CI: 2.73, 6.09), respectively. Among incident cases, household exposure was associated with leprosy (OR = 1.96, 95% CI: 1.29–2.98), compared with non-household exposure. Among the index case risk factors, an elevated bacillary load was the only variable associated with leprosy in the contacts. Biological and social factors appear to be associated with leprosy among co-prevalent cases, whereas the factors related to the infectious load and proximity with the index case were associated with leprosy that appeared in the incident cases during follow-up. Leprosy is an infectious disease that can lead to physical disabilities, social stigma, and great hardship. Transmitted from person to person, it is still endemic in developing countries, like Brazil and India. Effective treatment has been available since 1960, but early diagnosis of the disease remains the most effective way to stop the transmission chain and avoid late diagnoses and subsequent disabilities. Knowledge of the risk factors for leprosy can facilitate early detection; therefore, our study aimed to investigate the factors presented by leprosy patients and their contacts, who are considered at highest risk of contracting the disease. We studied 6,158 contacts of 1,201 patients under surveillance from 1987 to 2007 in a Public Health Care Center in the City of Rio de Janeiro, Brazil. We evaluated the ways patient and contact demographics and epidemiological characteristics were associated with the detection of leprosy. Statistical analyses took into account both individual and group characteristics and their interrelationships. The main characteristics facilitating the contraction of leprosy among contacts were shown to be consanguinity and household association. Conversely, the bacillary load index of leprosy patients was the principle factor leading to disease among their contacts.