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Because of the epidemiological transition, the global burden of illness has changed. Several factors have contributed to this change, including improvements in maternal and child health, increasing age of populations, and newly recognized disorders of the nervous system. It is now evident that neurologic disorders have emerged as priority health problems worldwide. This is reflected in the Global Burden of Disease Study, jointly published by the World Health Organization and other groups. The proportionate share of the total global burden of disease resulting from neuropsychiatric disorders is projected to rise to 14.7% by 2020. Although neurologic and psychiatric disorders comprise only 1.4% of all deaths, they account for a remarkable 28% of all years of life lived with a disability. This study provides compelling evidence that one cannot assess the neurologic health status of a population by examining mortality statistics alone. Health ministries worldwide must prioritize neurologic disorders, and neurologists must be prepared to provide care for increased numbers of people individually and in population groups.

This study sought to reveal the patterns of medical care given to patients with neurologic diseases in Colombia. To that end, it tracked the daily activities of 30 neurologists chosen from a representative sample of 119 neurologists registered in Colombia in 1993. The information was requested by means of a previously standardized questionnaire and was complemented by demographic and epidemiologic data. The results showed that demand for specialized neurologic care depended more on cultural perceptions than on objective measures of prevalence. Moreover, it was found that education in neurology should place greater emphasis on ambulatory treatment as an alternative to hospital treatment. The survey also offered preliminary information on the prevalence and incidence of the primary neurologic diseases in the country. The prevalence of these diseases far exceeds the supply of specialized neurologic care. Finally, the results point out the advantages and deficiencies of this type of care, findings that might guide future efforts in this field in other countries and under different circumstances.

There is a consensus that technology is not always used appropriately in many medical care situations. In this article, a social and epidemiologic approach looks beyond biomedical issues to examine short- and long-term social consequences of using newer technology, particularly as related to neurologic disease. The prevailing belief that noninvasive neurodiagnostic testing is harmless for the patient often overlooks important physical and behavioral effects. High-technology subspecialization within neurology affects the matrix of patient care as well as the character of the specialty. The principles of clinical epidemiology and social medicine can help practitioners use neurotechnology more rationally.

Thirteen consultant neurologists working in ten different towns or cities in the United Kingdom were asked to log all their encounters with patients in 1 week. The median number of encounters was 79 (range 33-144). Forty-one per cent were new patients; 85% of all new patient encounters were with National Health Service patients. In more than four-fifths of all encounters, the neurologist felt that the consultation was a justified use of his experience. Consultations for headache/migraine and epilepsy together accounted for over a quarter of all encounters.

Most of the clinical instruction in the medical specialties, for medical students as well as residents in the primary care specialties, occurs in the hospital environment. To improve the relevance of the teaching experience in this milieu, a study is presented in which the faculty conducts the teaching exercises on the primary care service. Emphasis is given to those disorders that constitute the secondary diagnosis, rather than the disorder that is responsible for hospitalization in most cases. It is suggested that this approach is appropriate for primary care, due to the case mix encountered and the exposure of trainees to the specialist faculty within a primary care environment.