Demonstration project on epilepsy in Brazil - WHO/ILAE/IBE Global Campaign Against Epilepsy - A foreword

In 2002, ASPE (Assistência à Saúde de Pacientes com Epilepsia)* initiated an Epilepsy Demonstration Project (DP) in Brazil as part of the Global Campaign Against Epilepsy "Epilepsy out of the Shadows", led by the World Health Organization (WHO), the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)1-4. Demonstration Projects have been carried out in several countries and their main aim is to develop treatment models for people with epilepsy in primary health care settings, improving the quality of life of people with epilepsy and their families5-9. The project in Brazil has targeted areas in Campinas and São José do Rio Preto municipalities, both in São Paulo State, in Southeastern region8. A task force has been established to assess strategies to expand this nationwide. The DP was carried out in six phases as shown in Figure 1. The Brazilian DP was officially closed during the IV Workshop of the WHO/ILAE/IBE Global Campaign Against Epilepsy "Epilepsy out of the Shadows", held on May 4-5th 2006, in Campinas. The workshop reviewed the results of the project and discussed the establishment of a National Epilepsy Policy. This supplement presents some results from all phases of the Brazilian DP which were discussed during the Workshop. In brief, we believe that the DP had an impact in our society and brought a new perspective on epilepsy. Awareness campaigns are now carried out on September 9th (Epilepsy Awareness Day) annually in many sites around the country. Regulations and Bills related to epilepsy have been proposed in several regions. Epilepsy has been officially adopted as a theme to be considered in elementary education by the Ministry of Education. Currently, a National Epilepsy Programme, endorsed by the main Brazilian non-governmental organizations in the field of epilepsy, is under review at the Ministry of Health. We hope that this will benefit some of the many people with epilepsy in the country and will eventually bring epilepsy out of the shadows in Brazil

Rainbow Of Followers Attributes In A Leadership Process

While the breeze of leadership is swaying the continent of North America with irresistible appeal, followership is left to rest in the shade. The subject has been given a very limited attention, thus, the paper attempts to address this deficiency and propose attributes of effective followers. Statistical survey design and correlation procedures are applied to assess selected variables and their relationship when examining the results of a multicultural survey conducted among leaders and followers of six countries. The results of the sample countries Russia and Belarus are being reviewed. Findings indicate that respondents tend to have an involuntary inclination towards group work and camaraderie, and are comfortable in the atmosphere of togetherness. Results also illustrate that respondents of the sample have a different understanding of notion of tolerance than respondents in the United States. The study discusses the need to understand how individual traits are assessed and developed, and how individuals can be formed, nurtured and prepared to become effective followers. The criticality of certain attributes characteristic to followers is examined along with practical suggestions of how some attributes can be brought to a more advanced level. The significance of having a leader inside every follower is emphasized. Uncomplicated, yet effective strategies on how to unleash and sustain followership capacity in individuals are described

Demonstration project on epilepsy in Brazil - Outcome assessment

Purpose: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. Method. We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patient's and the physician's point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. Results: A total of 181 patients (93 women - 51%) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (> 10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients' and relatives' opinions were that in the majority (59%) the health status had improved a lot, some (19%) had improved a little, 20% experienced no change and in 2% the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. Discussion: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward in accordance with local health providers and managers

ДОСЛІДЖЕННЯ РАДІОЗАХИСНИХ ТА АНТИМІКРОБНИХ ВЛАСТИВОСТЕЙ КИСЛОМОЛОЧНОГО ПРОДУКТУ ДЛЯ ОЗДОРОВЧОГО ХАРЧУВАННЯ

There are given the results of experimental and clinical investigations of sour–milk bacterial product of «Narine». The sour–milk product «Narine» and bacterial preparation «Narine» show the antioxidant, membrane stabilizing and adaptogenic properties revealed in conditions of the everyday application in organisms of animals of isotope of 137Cs during 30 days. The products of «Narine» eliminate occurrence of inflammatory processes, normalizes conditions of mucous membranes and improves the state of organisms of women suffered of gardnerellezus. It is recommended to consume the products of «Narine» by men who live in regions contaminated by radionuclides. The product may be consumed also as the dietetic, prophylactic, and be used for curing of ill men.Представлены результаты экспериментальных и клинических исследований кисломолочного продукта и бактериального препарата «Наринэ». Выявлены антиоксидантные, мембраностабилизирующие и адаптогенные свойства кисломолочного продукта и бактериального препарата «Наринэ» на фоне ежедневного введения в организм животным 137Cs в течение 30 суток. Кисломолочный продукт и бактериальный препарат «Наринэ» устраняют воспалительные процессы, нормализуют слизистые оболочки и улучшают общее состояние организма у женщин с гарднереллезом. Рекомендовано употреблять «Наринэ» населению, которое проживает на радиоактивно загрязненных терриротиях, а также в качестве диетического продукта для профилактики и лечения.Представлені результати експериментальних і клінічних досліджень кисломолочного продукту і бактеріального препарату «Наріне». Виявлені антиоксидантні, мембрано стабілізуючі і адаптогенні властивості кисломолочного продукту і бактеріального препарату «Наріне» на фоні щоденного введення в організм тварин на протязі 30 діб. Кисломолочний продукт і бактеріальний препарат «Наріне» запобігає запальним процесам , нормалізує слизневі оболонкиі покращує загальний стан організму у жінок з гарднереллезом. Рекомендовано вживати «Наріне» населенню, яке проживає на радіоактивно забруднених територіях, а також в якості дієтичного продукту для профілактики та лікування. &nbsp

РОЗЛАДИ СИСТЕМИ МІКРОЕЛЕМЕНТІВ У ХВОРИХ НА ХРОНІЧНИЙ ПАНКРЕАТИТ У ПОЄДНАННІ З ГІПЕРТОНІЧНОЮ ХВОРОБОЮ

Equilibrium in the system of microelements is an important element of the normal functioning of all organs and systems. Of course, the presence of certain pathological changes contributes to the emergence or progression of disorders in this well-established system. Chronic pancreatitis (CP) and hypertonic disease (HD) are not exception. The aim of the study – to determine the changes in the microelement composition of blood of patients with CP in conjunction with HD. Material and Methods. To achieve this goal, we examined 102 patients with CP and HD (main group) and 23 practically healthy patients (control group). In addition to the general clinical trial, the concentration of natrium, calcium, kalium, chlorine, selenium and zincum in blood plasma was determined and the exocrine function of the pancreas (P) was measured for fecal elastase-1 (FE-1) levels. Results. The patients of the main group had decreased calcium concentration to (2.16±0.26) mmol/l against (2.47±0.18) mmol/l in the group of practically healthy persons, p<0.01), selenium – up to (63.68±18.47) mcg/l, as opposed to (88.16±15.71) mcg/l in group II (p=0.61) zincum – up to (741.05±202.47) mcg/l versus (956.24±172.31) mcg/l in the examined control group (p=0.20). The levels of other microelements studied by us did not go beyond the reference values. In the study of functional capacity, external-secretion insufficiency of the pancreas at the border of the lung and moderate degree was diagnosed ((157.82±17.28) mcg/g faeces). Conclusions. Diagnosed changes in the composition of microelements require correction in order to achieve homeostasis in the body and prevent the progression and development of complications of CP and HD.Равновесие в системе микроэлементов является важным элементом нормального функционирования всех органов и систем. Наличие тех или иных патологических изменений способствуєт появлению или прогрессированию расстройств в этой отлаженной системе. Не являются исключением хронический панкреатит (ХП) и гипертоническая болезнь (ГБ). Цель исследования – определить изменения микроэлементного состава крови у больных ХП в сочетании с ГБ. Материал и методы. Для достижения поставленной цели мы обследовали 102 больных ХП и ГБ II стадии (основная группа) и 23 практически здоровых лиц (контрольная группа). Кроме общеклинического обследования, определяли концентрацию натрия, кальция, калия, хлора, селена и цинка в плазме крови и исследовали экзокринную функцию поджелудочной железы (ПЖ) по уровню фекальной еластазы-1 (ФЕ-1). Результаты. У пациентов основной группы было выявлено снижение концентрации кальция (до (2,16± 0,26) ммоль/л против (2,47±0,18) ммоль/л в группе практически здоровых лиц, р<0,01), селена (до (63,68± 18,47) мкг/л в противовес (88,16±15,71) мкг/л у лиц II группы (р=0,61) и цинка (до (741,05±202,47) мкг/л против (956,24±172,31) мкг/л у обследованных контрольной группы (р=0,20). Уровни других исследуемых нами микро­элементов не выходили за пределы референтных величин. При исследовании функциональной способности ПЖ была диагностирована ее внешнесекреторная недостаточность на грани легкой и умеренной степени ((157,82±17,28) мкг/г кала). Выводы. Диагностированные изменения в составе микроэлементов требуют коррекции с целью достижения гомеостаза в организме и предупреждения прогрессирования и развития осложнений ХП и ГБ.Рівновага у системі мікроелементів є важливою для нормального функціонування усіх органів та систем. Наявність тих чи інших патологічних змін сприяє появі або ж прогресуванню розладів у цій налагодженій системі. Не є винятком і хронічний панкреатит (ХП) та гіпертонічна хвороба (ГХ). Мета дослідження – визначити зміни мікроелементного складу крові у хворих на ХП у поєднанні з ГХ. Матеріал і методи. Для досягнення поставленої мети ми обстежили 102 хворих на ХП та ГХ ІІ стадії (основна група) та 23 практично здорових осіб (контрольна група). Крім загальноклінічного обстеження визначали концентрацію натрію, кальцію, калію, хлору, селену та цинку у плазмі крові та досліджували екзокринну функцію підшлункової залози (ПЗ) за рівнем фекальної еластази-1 (ФЕ-1). Результати. У пацієнтів основної групи було виявлено зниження концентрації кальцію (до (2,16±0,26) ммоль/л проти (2,47±0,18) ммоль/л у групі практично здорових осіб, р<0,01), селену (до (63,68±18,47) мкг/л на противагу (88,16±15,71) мкг/л у осіб ІІ групи (р=0,61) ти цинку (до (741,05±202,47) мкг/л проти (956,24±172,31) мкг/л у обстежених контрольної групи) (р=0,20). Рівні інших досліджуваних нами мікроелементів не виходили за межі референтних величин. При вивченні функціональної спроможності було діагностовано зовнішньосекреторну недостатність ПЗ на межі легкого та помірного ступеня ((157,82±17,28) мкг/г калу). Висновки. Діагностовані зміни у складі мікроелементів потребують корекції з метою досягнення гомеостазу в організмі і запобігання прогресуванню та розвитку ускладнень ХП та ГХ

Teachers Perception About Epilepsy.

To identify in a town of Brazil the knowledge, attitude and perception of epilepsy in teachers of elementary schools and to compare these before and after a training exercise. Teachers of nine public schools of Barão Geraldo, Campinas, Brazil completed a questionnaire. Two researchers had meetings with teachers, presenting the Global Campaign Epilepsy out of the shadows, when the questionnaire was first completed by all attendees. Twenty teachers of these schools were motivated to attend a training course entitled Epilepsy and Health as part of their continuous education programme. Two years later the same questionnaire was again completed (post-test) by these 20 teachers. 100 teachers originally completed the questionnaire (97 women, mean age 42 years, 64 married). Forty-three percent of teachers said that they had enough knowledge regarding epilepsy and 20% said that they had poor knowledge about the condition. Regarding the IQ of children with epilepsy, 45% of teachers believed that they had average IQ, 18% above average, six percent under average and 29% did not know. Teachers believed that children with epilepsy have a higher possibility of acquiring mental disease in the future (51%); that epilepsy is a disease (68%); that epilepsy is contagious (1%); epilepsy is treatable (90%). After the course, the teachers beliefs seem to have improved. This work with elementary school teachers identified difficulties related to epilepsy which, if addressed, may help promote better quality of life of people with epilepsy in the community and help to decrease stigma attached to the condition. Better informed teachers are likely to have a more positive attitude and this will be passed to others. Educational campaigns about epilepsy amongst teachers should be encouraged as this may improve the management of epilepsy, by helping to develop a well informed and tolerant community.65 Suppl 128-3

Meanings of epilepsy in its sociocultural context and implications for stigma: Findings from ethnographic studies in local communities in China and Vietnam

We investigated beliefs about the causes, course, and treatment of epilepsy and its impact on quality of life (QOL) in key target groups, using “mini-ethnographies” involving 141 in-depth interviews and 12 focus groups in China, and 84 in-depth interviews and 16 focus groups in Vietnam. Data were analyzed thematically, using a qualitative data analysis package. In both countries, beliefs about causes and triggers of epilepsy and seizures were a complex interweaving of Western, traditional, and folk medicine concepts. Epilepsy was understood to be chronic, not curable, but controllable, and was seen as enormously socially disruptive, with wide-ranging impact on QOL. Our findings suggest a more “embodied” and benign set of theories about epilepsy than in some other cultural contexts; nonetheless, people with epilepsy are still seen as having low social value and face social rejection. By exploring meanings attached to epilepsy in these two cultural contexts, we have clarified reasons behind previously documented negative attitudes and foci for future intervention studies

Demonstration project on epilepsy in Brazil - Situation assessment

Purpose: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. Methods: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. Results: The lifetime prevalence of epilepsy was 9.2/1,000 people [95% Cl 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure-free. They estimated that 55% of patients were on monotherapy and that 59% had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. Discussion: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de lnformacao da Atencao Basica - SIAB) and iv) continuous education of health professionals. The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy

The headache under-response to treatment (HURT) questionnaire, an outcome measure to guide follow-up in primary care: development, psychometric evaluation and assessment of utility

Background: Headache disorders are both common and burdensome but, given the many people affected, provision of health care to all is challenging. Structured headache services based in primary care are the most efficient, equitable and cost-effective solution but place responsibility for managing most patients on health-care providers with limited training in headache care. The development of practical management aids for primary care is therefore a purpose of the Global Campaign against Headache. This manuscript presents an outcome measure, the Headache Under-Response to Treatment (HURT) questionnaire, describing its purpose, development, psychometric evaluation and assessment for clinical utility. The objective was a simple-to-use instrument that would both assess outcome and provide guidance to improving outcome, having utility across the range of headache disorders, across clinical settings and across countries and cultures. Methods: After literature review, an expert consensus group drawn from all six world regions formulated HURT through item development and item reduction using item-response theory. Using the American Migraine Prevalence and Prevention Study’s general-population respondent panel, two mailed surveys assessed the psychometric properties of HURT, comparing it with other instruments as external validators. Reliability was assessed in patients in two culturally-contrasting clinical settings: headache specialist centres in Europe (n = 159) and primary-care centres in Saudi Arabia (n = 40). Clinical utility was assessed in similar settings (Europe n = 201; Saudi Arabia n = 342). Results: The final instrument, an 8-item self-administered questionnaire, addressed headache frequency, disability, medication use and effect, patients’ perceptions of headache “control” and their understanding of their diagnoses. Psychometric evaluation revealed a two-factor model (headache frequency, disability and medication use; and medication efficacy and headache control), with scale properties apparently stable across disorders and correlating well and in the expected directions with external validators. The literature review found few instruments linking assessment to clinical advice or suggested actions: HURT appeared to fill this gap. In European specialist care, it showed utility as an outcome measure across headache disorders. In Saudi Arabian primary care, HURT (translated into Arabic) was reliable and responsive to clinical change. Conclusions: With demonstrated validity and clinical utility across disorders, cultures and settings, HURT is available for clinical and research purposes

The role of sociopolitical newspapers in shaping public opinion on drug falsification

По результатам анализа информации 432 номеров 15 социально-политических газет национального уровня выявлено наличие двух упоминаний об изъятии фальсифицированных лекарств в августе 2010 г. (Васильков) и восьми сообщений об аналогичной ситуации в ноябре 2012 г. (Львов). Установлено, что первые две публикации не содержат информацию о количестве фальсификата. В остальных восьми сообщениях выявлены расхождения в количестве изъятых лекарств и их названиях. При этом объем фальсификата указывали по стоимости, количеству названий и упаковок, в ящиках и тоннах. В публикациях приводился различный перечень изъятых лекарств. Указанное объясняется использованием отдельными журналистами манипулятивной, а не гуманистической программы воздействия на аудиторию через эксплуатацию ее потребности в безопасности и сохранении здоровья, а также через закрепление в массовом сознании читателей газет негативного образа аптечной службы.The media actively shape public confidence in the pharmacies and pharmacists. This is one of the determining factors of patient compliance, significantly affects the overall effectiveness of pharmacotherapy. This applies particularly to media reports about drugs falsification. The aim of the work was to analyze reports of socio-political newspapers of national level with respect to identifying the most resonant cases of counterfeit drugs. The study used methods are qualitative and contextual analysis. Results. The analysis of information 432 issues of 15 sociopolitical newspapers revealed the presence of two references of counterfeit drugs withdrawal in Vasilkiv in August 2010 and eight reports of the similar situation in Lviv in November 2012. It has been found that the first two publications do not contain information about the number of counterfeit drugs. In the other eight reports there were revealed differences regarding the number of seized drugs and their names. The volume of counterfeit drugs were determined value, number of items, packages, boxes and tone. In the article there were submitted different names of seized drugs. Conclusions. Different content of posts on falsification of drugs in the two analyzed periods was established. This is due to the use of the individual journalist manipulative rather than humanistic program impact on the audience. For this purpose journalists are turning to the needs of the audience for security and preservation of health and to consolidate in the mass consciousness of newspaper readers a negative image of pharmacy services