La Enfermería Escolar y la necesidad de su inserción en la comunidad educativa de la Cuenca Carbonífera

School Nursing as a specialisation with a more solid background in the European countries than in the rest of the world. In Argentina, the school nursing figure is not included in interdisciplinary teams to assist teachers in primary schools. Although there are many requests for legislation to consolidate the school nursing figure, it has not been consolidated yet. We put emphasis on the knowledge society has regarding the figure of School Nurses and on its possible incorporation in the schools of the Cuenca Carbonífera as a means of prevention and promotion of the health of students. In order to achieve this aim, a field research was mainly carried out together with a comprehensive bibliography research. This research was qualitative. Primary teachers took part in this study through a convenience sample to carry out a comprehensive and comparative analysis, answering an online survey clearly defined which was spread through the Internet. Previously, using the same tool, a pilot project was used to have a better approach. The first results found in this research gave information about teacher´s recognition of the importance of the School Nurses´ work, the discernment of the different pathologies that current students have and that must be treated by interdisciplinary teams with the intervention of full-time Nurses and the validity and continuation of current health programmes and thepossible decrease of the current absenteeism rate. The implementation of the figure of the School Nurses in primary schools is necessary based on the primary teachers´ appreciations, student´s needs and the great variety of advantages offered through their preventive and innovative work. Different possible studies can be designed, especially as regards regulations, protocol and interdisciplinary work. La Enfermería Escolar como especialización con una trayectoria más sólida en los países europeos y mucho menor en el resto del mundo. En Argentina no existe como una figura que es componente de los equipos interdisciplinarios que asisten a los docentes en las escuelas primarias. Si bien hay varios pedidos legislativos para su formalización, aún no se han concretado. Nuestra pretensión se enfocó en conocer el estado de conocimiento y posible inserción de la Enfermera Escolar en las escuelas de la Cuenca Carbonífera, como un factor de prevención y promoción de la salud en los escolares. Para ello se realizó una investigación de campo principalmente complementada con una recopilación bibliográfica. El tipo de diseño fue de tipo cualitativo. Se abordó la población compuesta por docentes en actividad a través de una muestra de conveniencia para un análisis integral y comparativo con una encuesta definida y que se difundió por internet. Se utilizó también una prueba piloto previa para el mejor abordaje con el instrumento citado. Los resultados principales brindaron información sobre la importancia con que los docentes particularizan el trabajo de la Enfermería Escolar, el discernimiento de las diversas patologías que tienen los escolares actuales y que debe atenderse en forma adecuada por equipos interdisciplinarios con la actuación de la Enfermera a tiempo completo, la validez y prosecución de los programas de salud vigentes y la posible disminución de la actual tasa de ausentismo. Es necesaria la implementación de esta figura entre nuestras escuelas, fundado en las expresiones de los docentes, las necesidades de los alumnos y las diversas consecuencias de su trabajo preventivo e innovador. Se abren muchas líneas de investigación especialmente en la parte normativa, protocolar y de trabajo interdisciplinar

Treating People With Epilepsy in Rural Low-Income Countries Is Feasible. Observations and Reflections From a “Real Life Experience” After a Long Lasting Intervention in the Rural Chaco

Introduction: Epilepsy represents an important public health issue, in particular in low and middle-income countries where significant disparities are present in the care available for patients with epilepsy. Treatment cost and unavailability of drugs represent important barriers in treating people with epilepsy especially in rural setting. Aim of the study was to evaluate, by means of routine data, the current real-life clinical practice in epilepsy in the rural communities of the Plurinational State of Bolivia. Treatment activity followed educational campaigns and an anthropological fieldwork over more than 20 years.Material and Methods: Medical records of people with epilepsy (PWE) living in the rural communities of the Bolivian Chaco who received antiepileptic drugs (AEDs), from 2012 to 2016, and were followed-up for at least 1 year were analyzed. Treatment delivery and follow up visits were managed by a neurologist with the support of rural health care workers.Results: From 2012 to 2016, 157 PWE (76 men with a mean age of 24.2 ± 15.7) have been included in the study. Structural epilepsy was the most common type, recorded in 54 cases (34.4%) and the most common reported causes were perinatal factors, present in 11 subjects (20.0%). Almost all patients presented epilepsy with generalized tonic-clonic seizures (91.4%). The most common AED prescribed was phenobarbital followed by carbamazepine. During the follow-up, a dramatic seizures reduction was observed, with 31 subjects (19.7%) being seizures-free at the last follow-up. However, 48 subjects (30.6%) did not assume the medication regularly and 10 interrupted the drug intake. More than 20% of PWE did not receive any financial supports for AEDs. During the follow-up period 10 patients died but only in one case the death was probably caused by epilepsy.Conclusion: Our study demonstrated that PWE in rural areas of the Bolivian Chaco are willing to seek medical attention and to receive antiepileptic treatment. However, improvement in care is needed to assure compliance to AED treatment, including activity to increase awareness toward epilepsy among community members and health staff of the rural communities and to guarantee the coverage of treatment costs and drug supply

Epilepsy and neurocysticercosis in rural areas of the Bolivian Chaco: What has changed during the last 30 years?

Abstract Objective Neurocysticercosis (NCC) is considered the major cause of epilepsy in endemic regions. In the rural areas of the Bolivian Chaco prevalence of NCC among people with epilepsy (PWE) was 27.4%, according to a population‐based survey carried out in 1994. The aim of the study was to estimate the prevalence of Epilepsy Associated with Tonic–Clonic Seizures (EATCS) and to evaluate the prevalence of NCC among PWE in the rural communities of the Bolivian Chaco after 30 years. Methods Twenty‐two rural communities (total population 12 852) were involved in the study. PWE in the study area were ascertained by multiple sources and the diagnosis was confirmed by a neurologist. All PWE identified were invited to undergo brain CT scan examination and diagnosis of NCC was sought according to the revised Del Brutto criteria. Results Seventy‐eight PWE (30 men, 38.4%; mean age at onset was 12.7 ± 13.2 years) with EATCS were identified giving a crude prevalence of 6.1/1000 (95% CI: 4.7–7.3). Due to the COVID‐19 lockdown, the study was interrupted in 2020 and only 36 PWE (46%) of the whole sample underwent CT scan examination. Of these, 8 (22.2%) fulfilled the criteria for NCC of whom 6 (75%) presented only single or multiple calcifications. Significance This is the first study reassessing the prevalence of NCC among PWE after 30 years, in the same rural area and using a population‐based design. T. solium is still endemic in the Bolivian Chaco where more than 20% of EATCS may be attributable to NCC. Our findings show a substantially unchanged prevalence of NCC over the past 30 years despite improved knowledge, underlining the need for active intervention programs to control T. solium transmission in this area. Plain Language Summary Neurocysticercosis is still endemic in the Bolivian Chaco. The proportion of epilepsy attributable to neurocysticercosis is about 22%. Systematic efforts towards elimination of neurocysticercosis in these areas should be implemented