Prevalence of ictal injuries in functional (psychogenic nonepileptic) seizures: A systematic review and meta-analysis.

OBJECTIVE: Ictal injuries have long been considered typical signs of epileptic seizures. However, studies have shown that patients with functional seizures (FS)-also named psychogenic nonepileptic seizures-can also present these signs, misleading physicians and delaying a correct diagnosis. This systematic review aimed to assess the prevalence of injuries from FS. METHODS: A literature search was performed in PubMed, Embase, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Web of Science, PsycINFO, Google Scholar, OpenGrey, and ProQuest. Observational studies were included. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for studies reporting prevalence data. RStudio was used for meta-analyses. Cumulative evidence was evaluated according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS: From the 2607 identified records, 41 studies were included in the qualitative synthesis, and 28 were included in meta-analyses. A meta-analysis of 13 studies, including 1673 individuals, resulted in an overall lifetime prevalence of injuries due to FS per person of 25% (95% confidence interval [CI] = 19%-32%, I2 = 88%). Considering a limited period (video-electroencephalographic [VEEG] monitoring days), a meta-analysis of 13 studies, including 848 individuals, resulted in an injury prevalence due to FS per person of .7% (95% CI = 0%-3%, I2 = 73%). Also, a meta-analysis of eight studies, including 1000 individuals, resulted in a prevalence of injuries per FS of .1% (95% CI = 0%-.98%, I2 = 49%). The certainty in cumulative evidence assessed by GRADE was rated "very low" for lifetime prevalence of injuries per person, "low" for prevalence per person during VEEG monitoring, and "moderate" for prevalence per number of FS. SIGNIFICANCE: Overall pooled lifetime prevalence of injuries due to FS per person was 25%. In comparison, the prevalence of injuries per person during VEEG monitoring and per functional seizure was .7% and .1%, respectively. [Correction added on 07 October 2023, after first online publication: In the preceding sentence, 'consecutively' was corrected to 'respectively'.] The evidence of the occurrence of injuries due to FS breaks the paradigm that epileptic seizures can cause injuries but FS cannot.

Efeitos de sinalização por meio de legendas sobre o comportamento de separar lixo em restaurante de uma universidade pública / Effects of signaling through the legends about the behavior of separating waste at a restaurant in a public university / Efectos deseñalización por medio de legendas sobre el comportamiento de separar basura en restaurante de una universidade pública

O objetivo deste estudo foi verificar se a sinalização (legenda) e a organização espacial das lixeiras influenciam o modo de utilizá-las pelos usuários de um restaurante universitário. Participaram 600 usuários, de ambos os sexos, que frequentavam o restaurante, cuja idade variava entre 16 e 25 anos. Foram realizadas três sessões de observação direta. Na primeira sessão estabeleceu-se uma linha de base, na segunda interviu-se na configuração das lixeiras com a colocação de legendas para indicar o tipo de lixo a ser depositado e, na terceira, as condições foram iguais às da linha de base. Os resultados mostram que as legendas colocadas nas lixeiras influenciaram o comportamento de separar lixo, ou seja, as porcentagens de comportamentos apropriados aumentaram consideravelmente no período de intervenção e os inapropriados diminuíram. A intervenção aponta para a necessidade de mudar o ambiente de maneira que facilite o comportamento desejado. Mostra-se também a necessidade de construir programas de educação ambiental que gerem mudanças efetivas e duradouras nos comportamentos pró-ambientais.

This study shows the influence of signaling through captions behavior separate waste at a restaurant in a public university. Attended by 600 users of both sexes, who frequented the restaurant, whose age ranged between 16 and 25 years. Were three sessions of direct observation. In the first session established a baseline, in the latter intervened in the configuration of the dumps with the placement of captions to indicate the type of waste to be deposited, and the third, the conditions were the same as the baseline. The results show that the key is placed in landfills influenced the behavior of separating garbage, ie, the percentage of appropriate behaviors increased significantly during the intervention and decreased inappropriate. The intervention points to the need to change the environment so as to facilitate the desired behavior. We also show the need to build environmental education programs that manage effective and lasting changes in pro-environmental behaviors.

El objetivo de este estúdio fue verificar si la señalización (legenda) y la organización espacial de los basureros influencian el modo de utilizarlos por los usuarios de un restaurante universitario. Participaron 600 usuarios de los dos sexos que frequentabam el restaurante, cuya edad variaba entre 16 y 25 años. Fueron realizadas tres sesiones de observación directa. En la primera sesión se estableció una línea de base, en la segunda se intervino en la configuración de los basureros con la colocación de legendas para indicar el tipode basura a ser depositado y en la tercera, las condiciones fueron iguales a las de la línea de base. Los resultados muestran que las legendas colocadas en los basureros influenciaron el comportamiento de separar la basura, es decir, los porcientos de comportamientos apropiados aumentaron considerablemente en el período de intervención y los inapropiados disminuyeron. La intervención apunta para la necesidad de cambiar el ambiente de manera a facilitar el comportamiento deseado. Se muestra tambiém la necesidad de construir programas de educación ambiental que generem câmbios efectivos y duradoros en los comportamientos pró-ambientales.