Search

Nodding syndrome as a distinctive entity was reported from southern Sudan in the 1990s and investigated by local authorities and the World Health Organization (WHO) during 2001-2002 (1,2). In retrospect, [...]

Objective To describe the magnitude and variation of the epilepsy treatment gap worldwide. Methods We conducted a systematic review of the peer-reviewed literature published from 1 January 1987 to 1 September 2007 in all languages using PubMed and EMBASE. The purpose was to identify population-based studies of epilepsy prevalence that reported the epilepsy treatment gap, defined as the proportion of people with epilepsy who require but do not receive treatment. Negative binomial regression models were used to assess trends and associations. Findings The treatment gap was over 75% in low-income countries and over 50% in most lower middle- and upper middle- income countries, while many high-income countries had gaps of less than 10%. However, treatment gaps varied widely both between and within countries. They were significantly higher in rural areas (rate ratio, RR: 2.01; 95% confidence interval, Cl: 1.40-2.89) and countries with lower World Bank income classification (RR: 1.55; 95% Cl: 1.32-1.82). There was no significant trend in treatment gap over time (RR: 0.92; 95% Cl: 0.79-1.07). Conclusion There is dramatic global disparity in the care for epilepsy between high- and low- income countries, and between rural and urban settings. Our understanding of the factors affecting the treatment gap is limited; future investigations should explore other potential explanations of the gap. Objectif Decrire I'ampleur et les variations de I'insuffisance du traitement de I'epilepsie dans le monde. Methodes A I'aide de PubMed et d'EMBASE, nous avons realise une revue systematique de la litterature examinee par des pairs et publiee entre le 1 er janvier 1987 et le 1 er septembre 2007 dans toutes les langues. L'objectif etait d'identifier des etudes en population de la prevalence de I'epilepsie indiquant l'insuffisance du traitement de cette maladie, definie comme la proportion des personnes epileptiques ayant besoin d'etre traitees, mais ne recevant pas de traitement. Des modeles par regression binomiale negative ont ete utilises pour evaluer les tendances et les associations. Resultats L'insuffisance du traitement de I'epilepsie depassait 75% dans les pays a faible revenu et 50% dans la plupart des pays a revenu moyen inferieur et moyen superieur, alors que dans de nombreux pays a revenu eleve, cette insuffisance etait inferieure a 10%. Neanmoins, l'insuffisance du traitement variait fortement d'un pays a I'autre et au sein d'un meme pays. Elle etait significativement plus importante dans les zones rurales (risque relatif, RR : 2,01 ; intervalle de confiance a 95%, IC : 1,40-2,89) et dans les pays appartenant a la classe de revenu inferieure de la Banque mondiale (RR : 1,55 ; IC a 95 % : 1,32-1,82). On n'a releve aucune tendance significative de l'insuffisance du traitement de I'epilepsie au cours du temps (RR : 0,92 ; IC a 95 % : 0,79-1,07). Conclusion II existe a travers le monde des disparites considerables dans les soins dispenses aux epileptiques, et notamment entre les pays a revenu faible et eleve et entre les environnements ruraux et urbains. Notre comprehension des facteurs influant sur I'insuffisance du traitement est limitee : dans le cadre d'investigations futures, li conviendrait d'etudier d'autres explications possibles de cette insuffisance. Objetivo Describir la magnitud y las diferencias de la brecha de tratamiento de la epilepsia a nivel mundial. Metodos Atraves de PubMed y EMBASE, se hizo una revision sistematica de los articulos revisados por homologos publicados entre el 1 de enero de 1987 y el 1 de septiembre de 2007. La finalidad era encontrar estudios poblacionales sobre la prevalencia de la epilepsia que informaran acerca de la brecha de tratamiento de esa enfermedad, definida como la proporcion de personas afectadas que necesitan pero no reciben tratamiento. Las tendencias y relaciones se evaluaron mediante modelos de regresion binomial negativa. Resultados La brecha terapeutica era superior al 75% en los paises de ingresos bajos, y superior al 50% en la mayoria de los paises de ingresos medios bajos y medios altos, mientras que muchos paises de ingresos altos presentaban brechas inferiores al 10%. Sin embargo, la magnitud de la brecha terapeutica diferia ampliamente tanto entre los paises como en cada pais. Era significativamente mayor en las zonas rurales (razon de tasas, RT: 2,01, intervalo de confianza del 95%: 1,40-2,89) y en los paises incluidos en la categoria de ingresos bajos dei Banco Mundial (RT: 1,55, IC95%: 1,32-1,82). No se observo ninguna tendencia significativa de la brecha a lo largo dei tiempo (RT: 0,92, IC95%: 0,79-1,07). Conclusion En lo referente ai tratamiento de la epilepsia, existe una enorme disparidad mundial entre los paises de altos y de bajos ingresos, y entre las zonas rurales y las urbanas. Nuestros conocimientos sobre los factores que determinan esa brecha terapeutica son limitados, y en las investigaciones futuras se deberian estudiar otras posibles explicaciones de la misma., Introduction Epilepsy affects 50 million people worldwide, and 80% of them live in the developing world. (1) An individual with epilepsy suffers recurrent seizures unprovoked by acute brain insults or [...]

Objective To study primary-level management for people with epilepsy in rural Gambia by means of community surveys. Methods After population screening was carried out, visits were made by a physician who described the epidemiology of epilepsy and its management. Gaps between required management and applied management were investigated by conducting interviews and discussions with people with epilepsy and their communities. Findings The lifetime prevalence of epilepsy was 4.9/1000 and the continuous treatment rate was less than 10%. The choice of treatment was shaped by beliefs in an external spiritual cause of epilepsy and was commonly expected to be curative but not preventive. Treatment rarely led to the control of seizures, although when control was achieved, the level of community acceptance of people with epilepsy increased. Every person with epilepsy had sought traditional treatment. Of the 69 people with active epilepsy, 42 (61%) said they would like to receive preventive biomedical treatment if it were available in their local community. Key programme factors included the local provision of effective treatment and community information with, in parallel, clarification of the use of preventive treatment and genuine integration with current traditional sources of treatment and advice. Conclusion Primary-level management of epilepsy could be integrated into a chronic disease programme covering hypertension, diabetes, asthma and mental health. Initial diagnosis and prescribing could take place away from the periphery but recurrent dispensing would be conducted locally. Probable epilepsy etiologies suggest that there is scope for primary prevention through the strengthening of maternal and child health services. Keywords Epilepsy/epidemiology/therapy; Seizures/therapy; Patient acceptance of health care/ethnology; Attitude/ethnology; Choice behavior; Primary health care; Medicine, Traditional; Gambia (source: MESH, NLM). Mots cles Epilepsie/epidemiologie/therapeutique; Crise/therapeutique; Acceptation des soins/ethnologie; Attitude/ethnologie; Comportement choix; Programme soins courants; Medecine traditionnelle; Gambie (source: MESH, NLM). Palabras clave Epilepsia/epidemiologia/terapia; Ataques/terapia; Aceptacion de la atencion de salud/etnologia; Actitud/etnologia; Conducta de eleccion; Atencion primaria de salud; Medicina tradicional; Gambia (fuente: DeCS, BIREME)., Resume Insuffisance du traitement et soins de sante primaires pour les personnes atteintes d'epilepsie dans des zones rurales de Gambie Objectif Etudier, au moyen d'enquetes en communaute, la prise en [...]

Objective: This article describes the self-reported use of substances, participation in unprotected intercourse and differences in sexual risk-taking behavior with state of inebriation among a group of aboriginal (First Nations) people in Ontario. And, in so doing, attempts to answer some of the questions about the association between the use of alcohol and sexual risk taking in this population. Method: The project was developed in a partnership between an aboriginal steering committee and university researchers. Data were collected via interview from 658 randomly selected status First Nations people living within 11 reserve communities in the province. Results: Of the 426 individuals included in the within subject analysis 9.6% reported variation in their participation in sex, 13.8% variation in their participation in intercourse and 10.3% variation in their participation in unprotected intercourse with inebriation. An examination of individual behavior across 'sober' and 'drunk or high' states showed that there were almost equal proportions of respondents who only participated in unsafe sex when sober and respondents who only participated in unsafe sex when drunk or high. Where significant differences occurred, individuals were more likely to report a shift towards no sex or no intercourse with inebriation, not towards unprotected intercourse. Conclusions: Since a large proportion of individuals in this study engage in unprotected intercourse, the small proportion of individuals reporting different sexual behavior were more likely to report participation in a safe activity rather than an unsafe activity while 'drunk or high.' Stereotypes and assumptions may lead educators and researchers to feel the need to focus their messages on the relationship between drug and alcohol consumption and unsafe sex; however, the amount of unsafe sexual intercourse that occurs only while individuals are inebriated suggests that this focus is not of principal concern. (J. Stud. Alcohol 58: 312-322, 1997), Interviews with 426 Native American men and women reveal that their level of inebriation from alcohol has no significant effect upon their willingness to engage in unprotected sexual intercourse. The data gathered shows that more than 66% of the subject population either never uses condoms during sexual intercourse or uses them inconsistently. This indicates a very high level of risky sexual behavior existing in this population regardless of sobriety level. Those who varied their sexual behavior when inebriated were actually more likely to avoid sex at that time than attempt it., SLIGHTLY MORE than 1 million of Canada's 27 million people identified themselves as aboriginal (First Nations) people in the 1991 national census and 24% of these individuals live within the [...]

Epidemiological surveys indicate that the prevalence of epilepsy is higher in developing countries than in industrialized countries. Except for neurocystocercosis due to Taenia solium, little is known about possible underlying causes. This article reports the relationship between epilepsy and onchocerciasis in an Onchocerca volvulus endemic area in West Uganda. Individuals complaining of seizures were identified by means of a population census in 12 villages. Active epilepsy was confirmed in 61 of 4743 inhabitants (crude prevalence rate = 1.3%; age-standardized rate = 1.1%). Distribution of epilepsy in the study area was clustered, ranging from a prevalence of 0.2% to 3.4% in different villages. Age-specific prevalence was highest between 10 and 19 years, with a rate of 3.6% for the study area as a whole, and up to 10.0% in villages of high epilepsy prevalence. The prevalence of onchocerciasis in the 10-19-year-old age group was assessed by skin-snip biopsy and ranged from 15% to 85% in different villages. Epilepsy was significantly more frequent in the three villages with the highest levels of O. volvulus endemicity than in other villages (P < 0.0001). Serological testing for T. solium infection was positive in one and borderline in three of 53 epilepsy patients tested. The significant correlation between epilepsy and onchocerciasis did not change when these four patients were excluded from the analysis. These findings suggest a strong association between epilepsy and onchocerciasis in this area. This could have significant implications for the concept of morbidity due to O. volvulus., Introduction In comparison with figures from industrialized countries, higher prevalences of epilepsy have been reported in studies from developing countries (1). Apart from neurocystocercosis due to Taenia solium, which is [...]

Epilepsy is an important health problem in developing countries, where its prevalence can be up to 57 per 1000 population. This article reviews the epidemiology of epilepsy in developing countries in terms of its incidence, prevalence, seizure type, mortality data, and etiological factors. The prevalence of epilepsy is particularly high in Latin America and in several African countries, notably Liberia, Nigeria, and the United Republic of Tanzania. Parasitic infections, particularly neurocysticercosis, are important etiological factors for epilepsy in many of these countries. Other reasons for the high prevalence include intracranial infections of bacterial or viral origin, perinatal brain damage, head injuries, toxic agents, and hereditary factors. Many of these factors are, however, preventable or modifiable, and the introduction of appropriate measures to achieve this could lead to a substantial decrease in the incidence of epilepsy in developing countries., Introduction In 1978 a WHO Study Group identified epilepsy to be a disorder whose control should receive top priority, in view of its high prevalence in developing countries and potentially [...]

The professional literature dealing with multicultural concerns suggests that effective service delivery and outcomes in health and human services depend upon cultural relevance and on the degree to which specific [...]

Byline: Chamroeun. Hun, Tola. Hok, Sina. Ros, Samleng. Chan, Devender. Bhalla Epilepsy-related health outcomes remain unacceptably low in much of the developing world. According to us, it is because of [...]

THE PSYCHOLOGY OF PENISSHRINKING MASS HYSTERIAS IT SOUNDS LIKE SOMETHING from a poor B movie. It might even make the 1978 cult film Attack of the Killer Tomatoes seem plausible. [...]