Conceptualizing a Rehabilitation 'Model of Care' for Improving the Quality of Life of People with Parkinson's in India.

Given the rise in the elderly population and predicted increase in age-related diseases like Parkinson's disease, as well as the treatment gaps in Low-and-Middle-Income Countries (LMICs), there is an urgent need to develop a culturally and socioeconomically viable Parkinson's model of care that would be multidisciplinary, replicable, affordable, and accessible to those who need it the most. We present here an outline of a rehabilitation model of care, which incorporates a standardized group therapy format, community-based Parkinson's Support Centers, collaboration with local stakeholders to ensure sustainability, and active engagement of People with Parkinson's (PwPs) and caregivers (CGs) in rehabilitation programs. This model of care incorporates a unique 16-session multi-disciplinary community rehabilitation module for PwPs and CGs which is evidence-based, easily deliverable by non-medical facilitators, relevant to PwPs and CGs, adaptable to different groups, practical and beneficial, and effective in a group - format. This rehabilitation model of care, encompassing the multidisciplinary rehabilitation module, holds promise for implementation in LMICs due to its dynamic nature, cost-effectiveness, community-based approach and easy adaptability to telehealth platforms. We share our experience of developing the model and outline implications for practice and insights about community rehabilitation work in LMICs.

Six Action Steps to Address Global Disparities in Parkinson Disease: A World Health Organization Priority.

Importance: The Global Burden of Disease study conducted between 1990 and 2016, based on a global study of 195 countries and territories, identified Parkinson disease (PD) as the fastest growing neurological disorder when measured using death and disability. Most people affected by PD live in low- and middle-income countries (LMICs) and experience large inequalities in access to neurological care and essential medicines. This Special Communication describes 6 actions steps that are urgently needed to address global disparities in PD. Observations: The adoption by the 73rd World Health Assembly (WHA) of resolution 73.10 to develop an intersectoral global action plan on epilepsy and other neurological disorders in consultation with member states was the stimulus to coordinate efforts and leverage momentum to advance the agenda of neurological conditions, such as PD. In April 2021, the Brain Health Unit at the World Health Organization convened a multidisciplinary, sex-balanced, international consultation workshop, which identified 6 workable avenues for action within the domains of disease burden; advocacy and awareness; prevention and risk reduction; diagnosis, treatment, and care; caregiver support; and research. Conclusions and Relevance: The dramatic increase of PD cases in many world regions and the potential costs of PD-associated treatment will need to be addressed to prevent possible health service strain. Across the board, governments, multilateral agencies, donors, public health organizations, and health care professionals constitute potential stakeholders who are urged to make this a priority.

Epidemiological Survey of Neurological Diseases in a Tribal Population Cluster in Gujarat.

BACKGROUND: There are few community-based neuroepidemiological studies based in tribal communities. This cross-sectional community-based study explored the prevalence rates of neurological disorders in the tribal region of Kaparada in Gujarat. METHODOLOGY: A two-stage methodology was used. Door-to-door surveys were conducted in the villages of Moti Vahiyal, Arnai, and Chavshala in Kaparada taluka in the Valsad district. Trained volunteers administered a questionnaire that assessed demographic details and common neurological symptoms in children and adults. Data were obtained from 8217 individuals from 1464 households using the questionnaire in stage 1. A number of 615 individuals reported at least one symptom. In stage 2, a team of neurologists conducted a medical camp to assess those "screened in" for neurological disorders. RESULTS: The crude prevalence rate for neurological disorders in general was found to be 2592.19/100,000. The prevalence rates for lower motor neuron diseases were highest (1010.1), and the rates of epilepsy, movement disorders, stroke, vertigo, headaches, upper motor neuron diseases, and mental and behavioral disorders were found to be 255.6, 133.9, 109.53, 170.38, 511.4, 109.53, and 292.08/100,000, respectively. Age- and sex-specific rates and patterns varied for different disorders. CONCLUSION: The prevalence rates of most disorders were found to be lower than those reported elsewhere, but age and sex prevalence patterns were similar to existing research. Challenges in conducting such a study in a remote population are discussed.

A Rare Case of Ascites due to Peritoneal Amyloidosis.

BACKGROUND: The clinical manifestations of amyloidosis depend on the type of insoluble protein as well as the location of amyloid deposits in tissues or organs. In the gastrointestinal tract, the small intestine is the most common site of amyloid deposits, whereas peritoneal involvement and ascites are rare. CASE REPORT: We report on a case of ascites due to peritoneal amyloidosis. A 65-year-old patient was admitted to our institution due to anasarca and pulmonary congestion, mimicking heart failure. We started the patient on diuretics and vasodilators. Despite improvement in pulmonary congestion and peripheral edema, his ascites was not reduced. Echocardiogram revealed restrictive cardiomyopathy and a speckle-tracking pattern suggestive of cardiac amyloidosis. Subcutaneous and peritoneal biopsies revealed amyloidosis. CONCLUSIONS: Amyloidosis is rare in the peritoneum and is usually asymptomatic. Ascites occurs in only 20% of patients with peritoneal amyloidosis. We searched PubMed using "ascites" and "amyloidosis" and identified only eight case reports of amyloidosis with ascites. Physicians should be particularly careful in heart failure and anasarca cases when ascites is disproportional or not responsive to diuretic treatment. To date, there is no specific treatment for peritoneal amyloidosis.

Avaliação de alunos de graduação em Medicina após treinamento / Evaluation of the effect of IMCI training on medical students

A Estratégia de Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) foi adotada pelo Ministério da Saúde do Brasil em 1996, sendo adaptada de acordo com as características epidemiológicas às normas nacionais de atenção à criança. Desde 1997, a AIDPI vem progressivamente sendo implantada em diversos estados brasileiros. Algumas Universidades já incluem a AIDPI no curso médico. Em dezembro de 2002, foi iniciado treinamento na estratégia AIDPI para alunos de graduação em Medicina da UFBA. O presente estudo teve como objetivo avaliar o grau de mudança no conhecimento e nas atitudes de estudantes de Medicina após treinamento na estratégia AIDPI. Foi realizado um estudo longitudinal prospectivo no período de dezembro de 2002 a junho de 2003. Catorze alunos constituíram 2 coortes que receberam treinamento na estratégia AIDPI entre dezembro de 2002 e junho de 2003. No ponto zero do acompanhamento de cada coorte, foi realizado um teste com questões referentes a temas de conhecimentos básicos em pediatria, que também fazem parte do programa do curso de treinamento m AIDPI. O teste foi repetido nos desfechos das coortes. Foram utilizados a Prova dos Sinais e o teste de Mcnemar para análise estatística das variáveis estudadas, utilizando-se o software SPSS. Após o treinamento, houve mudanças estatisticamente significativas no conhecimento dosestudantes sobre os principais sinais de doença grave, de pneumonia, de pneumonia grave, de desnutrição grave, dedesidratação e do uso apropriado de vacinas. O conhecimento dos estudantes sobre a taxa de mortalidade infantil e causas de óbitos em crianças também se modificou de forma estatisticamente significativa. Houve significativa melhoria nas habilidades de orientação das técnicas adequadas para amamentação exclusiva e para introdução de outros alimentos no desmame. Os resultados demonstraram que o treinamento na estratégia AIDPI gerou modificações estatisticamente significativas nos conhecimentos e atitudes dos alunos...

Determinantes do exito do aleitamento natural / Determinants of the sucess of the breast feeding

Foram entrevistadas 88 maes, num hospital pediatrico doInamps-UFBA, visando a identificar fatores determinantes de sucesso no aleitamento natural. o grupo bem sucedido constituiu-se de 18 maes que mantiveram aleita-mento natural exclusivo por 6 meses ou mais. Entre as variaveis estudadas, a du-racao do sono do recem-nascido foi a unica que pareceu ter influido no exito dessas 18 maes, mostrando correlacao positiva com o tempo de aleitamento natural exclusivo. Discute-se o tipo de orientacao que deve ser proporcionado as maes, pa-ra melhorar o seu desempenho no aleitamento natural .