RESUMO
PURPOSE: To evaluate the knowledge, attitudes and perceptions of epilepsy in primary care system health professionals prior to and after an educational intervention. METHODS: Educational interventions were delivered to three groups of people with an interest in epilepsy: 1. Information courses for physicians (241 subjects); 2. Social re-integration course for health professionals and community leaders (631 subjects); 3. "Training the Trainers" Course for physicians (11 subjects). The whole program is flexible and can be tailored for local or regional needs. For the evaluation of this process, health professionals completed a quantitative and qualitative questionnaire to assess their knowledge, attitudes and perception (KAP) of epilepsy prior to the training (pre-test) and 6 months after it (post-test). RESULTS: Comparison of knowledge scores prior to (mean=55.8, standard deviation=14.0) and after (mean=71.5, standard deviation=12.0) the intervention showed that physicians had improved knowledge after the training (t-test=7.8, p<0.001). The same pattern occurred with the health professionals: the knowledge score prior to (mean=22.3, standard deviation=12.5) and after (mean=36.6, standard deviation=12.5) the intervention showed that health professionals had improved knowledge after the training (t-test=12.4, p<0.001). Improvements in attitudes and perception also occurred after the courses. DISCUSSION: Training courses can promote increased knowledge, attitude and perception in a cost effective way in the primary care setting. However, a continuous education program is required to correct oversights and to improve the management of people with epilepsy.
Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Epilepsia , Pessoal de Saúde/educação , Atenção Primária à Saúde , Adulto , Brasil , Epilepsia/diagnóstico , Epilepsia/terapia , Feminino , Humanos , Capacitação em Serviço , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
PURPOSE: To validate a Stigma Scale of Epilepsy (SSE). METHODS: The SSE was completed by 40 adult with epilepsy attending an Outpatient Epilepsy Clinic at the University Hospital of UNICAMP, and by 40 people from the community. People were interviewed on an individual basis; a psychologist read the questions to the subjects who wrote the answers in a sheet. The procedure was the same for all the subjects and completion took around ten minutes. RESULTS: The SSE has 24 items. The internal consistency of the SSE showed alpha Cronbachs coefficient 0.88 for the patients with epilepsy and 0.81 for the community. The overall mean scores of the Stigma Scale of Epilepsy formula were: 46 (SD=18.22) for patients and 49 (SD=13.25) for the community where a score of 0 would suggest no stigma, and 100 maximum stigma. DISCUSSION: The SSE has satisfactory content validity and high internal consistency. It allows the quantification of the perception of stigma by patients and people from community; this can then be used for interventional studies, such as mass media campaign in minimizing the negative facets of stigma.
Assuntos
Epilepsia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Preconceito , Estereotipagem , Adulto , Feminino , Humanos , Masculino , Percepção Social , Inquéritos e QuestionáriosRESUMO
PURPOSE: To establish a social network of epilepsy lay organization in Brazil to provide advocacy for people with epilepsy and eventually form a powerful National Epilepsy movement. METHOD: We actively searched for any associations, support groups or organizations related to epilepsy in the country by personal contacts, internet search and by telephone search. Contact was then established with any entity found. RESULTS: The first meeting was held in Campinas in March 2003, and was attended by 270 people, including many people with epilepsy, members of all eleven epilepsy associations found, health professionals and representatives of the Brazilian chapters of IBE and ILAE and the Brazilian Ministry of Health. This first meeting resulted in a National Movement expressed every year through the National Week of Epilepsy and National Meeting of Lay Associations. DISCUSSION: This strategy, developed by ASPE, was simple and effective, and in a very short time a national movement was active. These actions could be reproduced in any country developing a campaign against epilepsy. It is important to consider that this is a process of empowerment, thus people with epilepsy need to take actions into their own hands and to be active participants.
Assuntos
Epilepsia , Promoção da Saúde , Programas Nacionais de Saúde , Instituições Filantrópicas de Saúde , Brasil , Epilepsia/psicologia , HumanosRESUMO
PURPOSE: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. METHODS: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. RESULTS: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001). DISCUSSION: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.
Assuntos
Educação de Graduação em Medicina , Epilepsia , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina , Adulto , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
PURPOSE: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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.
Assuntos
Epilepsia/psicologia , Docentes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
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% CI 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 Informação da Atenção Básica - 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.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Pessoal de Saúde , Atenção Primária à Saúde/normas , Avaliação de Processos em Cuidados de Saúde , Brasil/epidemiologia , Epilepsia/epidemiologia , Humanos , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
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 patients and the physicians 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.
Assuntos
Epilepsia/terapia , Avaliação de Resultados em Cuidados de Saúde , Atenção Primária à Saúde/normas , Absenteísmo , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Pré-Escolar , Epilepsia/psicologia , Feminino , Seguimentos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Ajustamento Social , Resultado do TratamentoRESUMO
OBJECTIVE: To estimate the perception of stigma attached to epilepsy in an urban society of a limited-resource country, Brazil. METHODS: We applied a validated Stigma Scale of Epilepsy (SSE) cross-sectionally to 1850 people from all regions within the metropolitan area of Campinas, following a sampling selection methodology (95% confidence interval and error of 2.3). RESULTS: The overall score for epilepsy stigma perception was 42 (range, 3-98; SD, 14). The SSE score for women was higher (43) than that for men (40). With respect to religion, Spiritism had the lowest SSE score (35) compared with Catholic, Evangelical, other, and no religion. Level of education was inversely related to SSE scores; illiterate people had higher SSE scores (45) than people with higher education (37). CONCLUSION: This is one of the first systematic assessments of epilepsy stigma perception in an urban area of a limited-resource country. It was found that the magnitude of stigma is different within segments of the local society, highlighting that sociocultural factors such as gender, religion, and level of education may be important predictors of stigma.
Assuntos
Atitude Frente a Saúde , Epilepsia/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Preconceito , Percepção Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Conformidade Social , População UrbanaRESUMO
PURPOSE: The worldwide prevalence of epilepsy is variable, estimated at 10//1,000 people, and access to treatment is also variable. Many people go untreated, particularly in resource-poor countries. OBJECTIVE: To estimate the prevalence of epilepsy and the proportion of people not receiving adequate treatment in different socioeconomic classes in Brazil, a resource-poor country. METHODS: A door-to-door survey was conducted to assess the prevalence and treatment gap of epilepsy in three areas of two towns in Southeast Brazil with a total population of 96,300 people. A validated screening questionnaire for epilepsy (sensitivity 95.8%, specificity 97.8%) was used. A neurologist further ascertained positive cases. A validated instrument for socioeconomic classification was used. RESULTS: Lifetime prevalence was 9.2/1,000 people [95% CI 8.4-10.0] and the prevalence of active epilepsy was 5.4/1,000 people. This was higher in the more deprived social classes (7.5/1,000 compared with 1.6/1,000 in the less deprived). Prevalence was also higher in elderly people (8.5/1,000). Thirty-eight percent of patients with active epilepsy had inadequate treatment (19% on no medication); the figures were similar in the different socioeconomic groups. CONCLUSION: The prevalence of epilepsy in Brazil is similar to other resource-poor countries, and the treatment gap is high. Epilepsy is more prevalent among less wealthy people and in elderly people. There is an urgent need for education in Brazil to inform people that epilepsy is a treatable, as well as preventable, condition.
Assuntos
Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Acessibilidade aos Serviços de Saúde , Classe Social , Adolescente , Adulto , Fatores Etários , Anticonvulsivantes/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Pesquisas sobre Atenção à Saúde , Educação em Saúde , Acessibilidade aos Serviços de Saúde/normas , Humanos , Masculino , Indigência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Prevalência , Inquéritos e QuestionáriosRESUMO
PURPOSE: To evaluate the knowledge, attitudes and perceptions of epilepsy in primary care system health professionals prior to and after an educational intervention. METHODS: Educational interventions were delivered to three groups of people with an interest in epilepsy: 1. Information courses for physicians (241 subjects); 2. Social re-integration course for health professionals and community leaders (631 subjects); 3. "Training the Trainers" Course for physicians (11 subjects). The whole program is flexible and can be tailored for local or regional needs. For the evaluation of this process, health professionals completed a quantitative and qualitative questionnaire to assess their knowledge, attitudes and perception (KAP) of epilepsy prior to the training (pre-test) and 6 months after it (post-test). RESULTS: Comparison of knowledge scores prior to (mean=55.8, standard deviation=14.0) and after (mean=71.5, standard deviation=12.0) the intervention showed that physicians had improved knowledge after the training (t-test=7.8, p<0.001). The same pattern occurred with the health professionals: the knowledge score prior to (mean=22.3, standard deviation=12.5) and after (mean=36.6, standard deviation=12.5) the intervention showed that health professionals had improved knowledge after the training (t-test=12.4, p<0.001). Improvements in attitudes and perception also occurred after the courses. DISCUSSION: Training courses can promote increased knowledge, attitude and perception in a cost effective way in the primary care setting. However, a continuous education program is required to correct oversights and to improve the management of people with epilepsy.
OBJETIVO: Avaliar conhecimentos, atitudes e percepção sobre epilepsia de profissionais da saúde do sistema de atenção básica antes e depois de curso de capacitação. MÉTODO: Cursos de capacitação foram realizados em três grupos de profissionais de saúde: 1. cursos de capacitação para médicos (241 sujeitos); 2. cursos de inserção social para agentes comunitários de saúde (631 sujeitos); 3. cursos de replicadores para médicos (11 sujeitos). O programa de capacitação foi adaptado para as condições de cada local. Para avaliar o processo, foram aplicados questionários a respeito do seu conhecimento, sua atitude e percepção perante à epilepsia (KAP) antes dos cursos (pré-teste) e após a intervenção (pós-teste). RESULTADOS: A comparação feita a respeito do conhecimento com médicos mostrou que os mesmos melhoram seu conhecimento com os cursos (pré-teste: nota média=55.8; DP=14,0) vs. pós-teste: nota média=71,5; DP=12,0; t-test=7,8; p<0,001). O mesmo padrão ocorreu com os agentes comunitários de saúde: pré-teste: nota média=22.3; DP=12,5) vs. pós-teste: nota média=36,6; DP=12,5; t-test=12,4; p<0,001. Com relação a atitudes e percepção, foram observadas melhoras significativas depois da realização dos cursos. DISCUSSÃO: Os cursos de capacitação promovem melhoras no conhecimento, atitude e percepção, com baixo custo e de maneira efetiva, no sistema básico de saúde. Entretanto, um programa de educação continuada deve existir para que consiga corrigir os erros e melhorar o tratamento das pessoas com epilepsia.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Competência Clínica , Epilepsia , Pessoal de Saúde/educação , Capacitação em Serviço , Atenção Primária à Saúde , Brasil , Inquéritos e QuestionáriosRESUMO
PURPOSE: To establish a social network of epilepsy lay organization in Brazil to provide advocacy for people with epilepsy and eventually form a powerful National Epilepsy movement. METHOD: We actively searched for any associations, support groups or organizations related to epilepsy in the country by personal contacts, internet search and by telephone search. Contact was then established with any entity found. RESULTS: The first meeting was held in Campinas in March 2003, and was attended by 270 people, including many people with epilepsy, members of all eleven epilepsy associations found, health professionals and representatives of the Brazilian chapters of IBE and ILAE and the Brazilian Ministry of Health. This first meeting resulted in a National Movement expressed every year through the National Week of Epilepsy and National Meeting of Lay Associations. DISCUSSION: This strategy, developed by ASPE, was simple and effective, and in a very short time a national movement was active. These actions could be reproduced in any country developing a campaign against epilepsy. It is important to consider that this is a process of empowerment, thus people with epilepsy need to take actions into their own hands and to be active participants.
OBJETIVO: Estabelecer uma rede social na epilepsia, através de encontros de associações de pacientes para promover um melhor atendimento bio-psico-social aos pacientes e com isso, formar um Movimento Nacional de Epilepsia. MÉTODO: Foram pesquisadas as associações de epilepsia e grupos de apoio existentes em nosso país através de contatos pessoais ou telefônicos e pesquisas pela internet. RESULTADOS: O primeiro encontro aconteceu em Campinas em março de 2003 e contou com a participação de 270 pessoas, incluindo pessoas com epilepsia, membros de 11 associações de epilepsia, profissionais da saúde, representantes dos capítulos brasileiros da ILAE e da IBE e o Ministro da Saúde. Este primeiro encontro resultou em um Movimento Nacional, expresso anualmente através da Semana Nacional de Epilepsia e do Encontro Nacional de Associações e Grupos de Pacientes com Epilepsia. DISCUSSÃO: Esta estratégia, desenvolvida pela ASPE, é simples e efetiva, mostrando que em um curto período de tempo, o movimento nacional ficou ativo. Estas ações podem ser reproduzidas em qualquer lugar, dentro da campanha "Epilepsia fora das sombras". É importante enfatizar que isso é um processo de fortalecimento, de modo que as pessoas com epilepsia precisam tomar suas próprias decisões, tendo o controle da situação para enfim, serem participantes ativos de todo o processo.
Assuntos
Humanos , Epilepsia , Promoção da Saúde , Programas Nacionais de Saúde , Instituições Filantrópicas de Saúde , Brasil , Epilepsia/psicologiaRESUMO
PURPOSE: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. METHODS: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. RESULTS: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001). DISCUSSION: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.
OBJETIVO: Avaliar conhecimentos, atitudes e percepção sobre epilepsia em estudantes de medicina antes e depois de curso de capacitação. MÉTODO: Foi utilizado o questionário KAP da Campanha Global "Epilepsia fora das sombras", liderada pela OMS, ILAE e IBE. Este questionário avalia conhecimento, atitude e percepção sobre epilepsia em 61 questões. Foi aplicado este questionário em 185 estudantes de medicina, antes e depois de cursos de capacitação sobre epilepsia. As questões foram comparadas para analisar as mudanças obtidas com o treinamento. RESULTADOS: Cento e seis estudantes de medicina responderam ao questionário antes do curso de capacitação e 79 estudantes responderam após um ano do curso. A comparação feita a respeito do conhecimento com estes estudantes mostrou que os mesmos melhoram seu conhecimento com os cursos (pré-teste: nota média=53,9; DP=11,4 vs. pós-teste: nota média=63,8; DP=11,9; t-test=5,6; p<0,001). DISCUSSÃO: O curso de capacitação promove melhoras no conhecimento, atitude e percepção sobre epilepsia, mesmo após um ano. Estes resultados salientam a importância de programas de educação continuada dentro do currículo médico.
Assuntos
Humanos , Masculino , Feminino , Adulto , Educação de Graduação em Medicina , Epilepsia , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina , Inquéritos e QuestionáriosRESUMO
PURPOSE: To validate a Stigma Scale of Epilepsy (SSE). METHODS: The SSE was completed by 40 adult with epilepsy attending an Outpatient Epilepsy Clinic at the University Hospital of UNICAMP, and by 40 people from the community. People were interviewed on an individual basis; a psychologist read the questions to the subjects who wrote the answers in a sheet. The procedure was the same for all the subjects and completion took around ten minutes. RESULTS: The SSE has 24 items. The internal consistency of the SSE showed alpha CronbachÆs coefficient 0.88 for the patients with epilepsy and 0.81 for the community. The overall mean scores of the Stigma Scale of Epilepsy formula were: 46 (SD=18.22) for patients and 49 (SD=13.25) for the community where a score of 0 would suggest no stigma, and 100 maximum stigma. DISCUSSION: The SSE has satisfactory content validity and high internal consistency. It allows the quantification of the perception of stigma by patients and people from community; this can then be used for interventional studies, such as mass media campaign in minimizing the negative facets of stigma.
OBJETIVO: Validar a Escala de Estigma na Epilepsia (EEE). MÉTODO: A EEE foi aplicada em 40 pacientes adultos com o diagnóstico de Epilepsia do Ambulatório de Epilepsia do HC/Unicamp e em 40 pessoas da comunidade em geral. Os sujeitos foram entrevistados individualmente pelas psicólogas, que foram lendo as questões e anotando as respostas na escala. As condições de aplicação foram as mesmas e a aplicação durou cerca de 10 minutos. RESULTADOS: A EEE possui 24 itens. A consistência interna da EEE mostrou alfa de Cronbach, de 0,88 para os pacientes com epilepsia e 0,81 para a comunidade. As médias do valor geral de estigma obtido com a fórmula da EEE foram: 46 (DP=18,22) para os pacientes e 49 (DP=13,25) para a comunidade. DISCUSSÃO: A EEE possui uma satisfatória validade e alta consistência interna. Isso permite uma quantificação da percepção de estigma da epilepsia na comunidade em geral, que pode ser utilizada para estudos interventivos, como campanhas na mídia, para minimizar as facetas negativas do estigma na sociedade.
Assuntos
Humanos , Masculino , Feminino , Adulto , Epilepsia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Preconceito , Estereotipagem , Percepção Social , Inquéritos e QuestionáriosRESUMO
PURPOSE: 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. METHODS: 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. RESULTS: 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 percent said that they had poor knowledge about the condition. Regarding the IQ of children with epilepsy, 45 percent of teachers believed that they had average IQ, 18 percent above average, six percent under average and 29 percent did not know. Teachers believed that children with epilepsy have a higher possibility of acquiring mental disease in the future (51 percent); that epilepsy is a disease (68 percent); that epilepsy is contagious (1 percent); epilepsy is treatable (90 percent). After the course, the teachersÆ beliefs seem to have improved. DISCUSSION: 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...
OBJETIVO: Identificar atitudes e percepção dos professores do ensino fundamental a respeito da epilepsia, antes e depois de um curso específico sobre o tema. MÉTODO: Participaram da pesquisa professores de nove escolas da rede pública do ensino fundamental de Barão Geraldo, distrito de Campinas, SP. Dois pesquisadores reuniram-se com os professores e apresentaram a Campanha Global "Epilepsia fora das sombras", momento também em que os questionários foram aplicados. Vinte professores ficaram motivados para fazer o curso de extensão "Temas transversais: epilepsia e saúde". Após este curso, os questionários foram re-aplicados. RESULTADOS: Foram aplicados 100 questionários em professores das nove escolas, sendo que: noventa e sete professores eram do sexo feminino, idade média de 42 (D.P. 22 a 63) e 64 estavam casados. Quarenta e três professores declararam possuir conhecimento sobre epilepsia abaixo da média e 20, disseram possuir um pobre conhecimento sobre a condição. No que diz respeito à idéias sobre epilepsia, os professores acham que: as crianças com epilepsia tem QI igual (45 por cento), na média (18 por cento), abaixo da média (6 por cento) e não sabem opinar (29 por cento); crianças com epilepsia têm maior chance de terem doença mental no futuro (51 por cento); a epilepsia é uma doença (68 por cento); a epilepsia é contagiosa (1 por cento); a epilepsia é tratável (90 por cento). Após o curso, crenças e mitos sobre epilepsia dos professores mostraram diferenças significativas. DISCUSSÃO: Idéias errôneas sobre epilepsia podem ser mudadas através de cursos educacionais sobre epilepsia. Este trabalho, realizado com professores do ensino fundamental, visou a identificação das dificuldades relacionadas à epilepsia para promover a redução do estigma. É importante que professores sejam melhor instruídos sobre a epilepsia para consequentemente, ter atitudes mais positivas em relação às crianças com epilepsia. Acreditamos que professores...
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Epilepsia , Docentes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e QuestionáriosRESUMO
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 percent CI 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 percent who were taking no medication. The survey of health workers showed that they estimated that 60 percent of patients under their care were seizure-free. They estimated that 55 percent of patients were on monotherapy and that 59 percent had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56 percent. Most of the physicians (73 percent) 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 Informação da Atenção Básica - SIAB) and iv)...
OBJETIVO: Avaliar a situação da assistência à epilepsia no contexto da atenção primária sob o Projeto Demonstrativo em epilepsia no Brasil, parte da Campanha Global Epilepsia Fora das Sombras da WHO/ILAE/IBE. MÉTODO: Fizemos um levantamento epidemiológico para definir a prevalência e lacuna de tratamento em epilepsia. Avaliamos a percepção de 598 profissionais de saúde da atenção básica de diferentes regiões do Brasil sobre epilepsia e seu manejo na rede básica de saúde. RESULTADOS: A prevalência acumulada de epilepsia foi de 9,2/1000 pessoas (95 por centoIC= 8,4-10) e a prevalência estimada de epilepsia ativa foi de 5,4/1000 pessoas. Trinta e oito porcento dos pacientes com epilepsia ativa estavam sendo tratados inadequadamente, incluindo 19 por cento que estavam sem medicação. A enquete com os profissionais de saúde mostrou que a média estimada de pacientes livre de crises sob os cuidados dos mesmos era de 60 por cento. A média estimada de porcentagem em monoterapia era de 55 por cento. A média estimada de porcentagem de referência para neurologistas era de 59 por cento. A média estimada de porcentagem de pacientes que estavam trabalhando ou estudando era de 56 por cento. A maioria dos médicos não se sente confiante em atender uma pessoa com epilepsia. DISCUSSÃO: A análise situacional da Fase I - estudo epidemiológico nas áreas de interesse do PD mostrou que a prevalência da epilepsia é similar a outros países em desenvolvimento e a lacuna de tratamento é grande. Um dos fatores importantes para a lacuna de tratamento é a falta de adequação à assistência na atenção básica. Essa situação pode ser revertida no Brasil, pois os elementos chaves existem na rede básica para o manejo de pessoas com epilepsia. Entretanto, para torna efetivo e eficiente é preciso i) estabelecimento de um sistema de referência e contra-referência, ii) fornecimento contínuo de medicação anti-epiléptica, iii) monitorização de manejo de pessoas com epilepsia através...
Assuntos
Humanos , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Pessoal de Saúde , Avaliação de Processos em Cuidados de Saúde , Atenção Primária à Saúde/normas , Brasil/epidemiologia , Epilepsia/epidemiologia , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
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 patients and the physicians 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 percent) 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 percent) the health status had improved a lot, some (19 percent) had improved a little, 20 percent experienced no change and in 2 percent 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...
OBJETIVO: Avaliar o resultado do tratamento de pacientes com epilepsia na atenção básica sob o modelo proposto pelo Projeto Demonstrativo no Brasil, como parte da Campanha Global Contra a Epilepsia da WHO/ILAE/IBE. MÉTODO: Avaliamos o resultado do tratamento nos pacientes acompanhados em quatro unidades básicas de saúde. As equipes de saúde fizeram um treinamento padrão. O resultado do tratamento foi baseado em cinco aspectos: 1) redução da freqüência das crises, 2) percepção subjetiva dos pacientes e dos médicos, 3) redução de absenteísmo, 4) integração social (escola, trabalho), e 5) senso de independência. RESULTADOS: Um total de 181 pacientes (93 mulheres - 51 por cento), com uma média de 38 anos (variando de 2 a 86 anos) entraram nesta análise. O tempo médio de seguimento foi de 26 meses (variou de 1 a 38 meses, 11 pacientes tinham seguimento menos de 12 meses). A freqüência das crises foi categorizada variando de 0 (sem nenhuma crise nos últimos 24 meses) a 7 (>10 crises/dia). O escore mediano da freqüência de crises no começo era de 3 (uma a três crises por mês). O escore mediano da freqüência de crises no final era de 1 (uma a três crises por ano). A opinião dos pacientes e familiares é que a maioria (106 casos) houve uma melhora importante na saúde, 34 tiveram pouca melhora, 37 não tiveram mudanças e em quatro houve piora. Em relação ao absenteísmo, integração social e senso de independência houve pouca melhora. DISCUSSÃO: O modelo desenvolvido de tratamento de epilepsia na atenção primária com base na estrutura de saúde existente, com estratégias centradas nos profissionais de saúde e na comunidade, provou ser efetivo com redução importante na freqüência das crises bem como na melhora em geral da saúde. Esse modelo pode ser aplicado em âmbito nacional, pois os elementos chaves já existem, desde que essas estratégias sejam pactuadas com os organismos locais de saúde.