Comic book-based educational program on epilepsy for high-school students: Results from a pilot study in the Gran Chaco region, Bolivia.

INTRODUCTION: In low- and middle-income countries (LMIC), epilepsy still represents a significant health challenge. In the Bolivian Chaco, we have previously found high levels of stigma towards people with epilepsy (PWE) especially expressed by high school students. In order to increase the knowledge about epilepsy, we have tested a comic book-based intervention on a sample of high school students. METHODS: The study has been conducted in the Bolivian Chaco region where two urban and two rural classrooms have been randomly selected. Students have been administered a knowledge, attitudes, and practices (KAP) questionnaire, and then they underwent a comic book-based educational program where they were randomly assigned either to an autonomous reading or a character interpretation methodology. The same KAP questionnaire has been administered after the teaching session and at a three months follow-up. Mean KAP scores at the baseline were compared with the after teaching and the three-month assessment. RESULTS: Eighty-three students with a mean age of 15.5 ±â€¯0.9 years, of whom 38 (45.8%) males, were recruited. After the comic book session, students improved in the global score (p < 0.001) and in the knowledge (p < 0.001), attitudes (p = 0.004), and practices (p < 0.001) subscores. Both the autonomous reading and the character interpretation groups significantly improved in the global score, but only the latter improved in all the subscores. At the three months follow-up, there were no differences in the global, knowledge, and attitudes subscores, compared with scores immediately after the intervention. CONCLUSION: Using a comic book to teach about epilepsy led to a significant improvement in the knowledge, attitudes, and practices about the disease in high school students of LMIC. This teaching strategy can be easily implemented in LMIC.

Demanda asistencial neurológica ambulatoria en un centro de consulta privada en Santa Cruz de la Sierra, Bolivia / Outpatient neurological assistance demand in a private consultation center of Santa Cruz de la Sierra, Bolivia

OBJETIVO: analizar las variables demográficas y diagnósticas que condicionan la demanda asistencial ambulatoria de la consulta neurológica privada por primera vez. MÉTODOS: estudio observacional, descriptivo, retrospectivo, de la demanda de consultas ambulatorias de primera vez en un centro neurológico privado, durante 24 meses (enero-2016 hasta diciembre-2017). La información médica fue obtenida a partir de registros clínicos computarizados registrándose: edad, género y diagnóstico según la Clasificación Internacional de Enfermedades, 10 edición (CIE-10). RESULTADOS: el total de pacientes del estudio fue de 2 372, (60%) fueron mujeres. La edad media fue de 42,6 años ± 18,8 años, (42,20%) son mayores de 65 años. El diagnóstico más frecuente fue cefalea primaria (33,4%); seguido por epilepsia (14%); cervicalgia, dorsalgia y lumbalgia (13,2%), trastornos psiquiátricos (6,5%). En mayores de 65 años el deterioro cognitivo fue el diagnóstico más frecuente (14,68%), seguido de movimientos anormales. CONCLUSIÓN: los pacientes neurológicos son predominantemente menores de 65 años y de sexo femenino. La patología más frecuente fue la cefalea primaria.(AU)

OBJECTIVES: to analyze the demographic and diagnostic variables that condition the ambulatory care demand of the private neurological consultation for the first time. METHODS: observational, descriptive, retrospective study of the demand for first-time outpatient consultations in a private neurological center, for 24 months (January-2016 to December-2017). The medical information was obtained from computerized clinical records by registering: age, gender and diagnosis according to the International Classification of Diseases, 10 edition (ICD-10). RESULTS: the total number of patients in the study was 2372, (60%) were women. The mean age was 42.6 years ± 18.8 years, (42.20%) are over 65 years. The most frequent diagnosis was primary headache (33.4%); followed by epilepsy (14%); cervicalgia, dorsalgia and low back pain (13.2%), psychiatric disorders (6.5%). In older than 65 years cognitive impairment was the most frequent diagnosis (14.68%), followed by abnormal movements. CONCLUSIONS: neurological patients are predominantly under 65 years of age and female. The most frequent pathology was primary headache.(AU)

Trombolisis intravenosa en ataque cerebrovascular isquémico agudo en Santa Cruz Bolivia: análisis retrospectivo de los primeros 18 casos / Intravenous thrombolysis in acute ischemic stroke in Santa Cruz Bolivia: retrospective analysis of the first 18 cases

OBJETIVOS: describir la experiencia en la implementación del protocolo de trombolisis i.v. en 18 pacientes con Accidente Cerebrovascular (ACV) isquémico en la Unidad de ACV de la Clínica Foianini, concretamente, entre septiembre de 2013 y julio de 2017. MÉTODOS: el estudio tiene un enfoque cuantitativo, tipo descriptivo y retrospectivo. Se revisó las historias clínicas de los pacientes con diagnóstico de ACV isquémico agudo, que fueron tratados con trombolitico intravenoso (Alteplasa) en el servicio UTAC, entre septiembre de 2013 y julio 2017 en Santa Cruz, Bolivia. RESULTADOS: el Tiempo Síntoma-Puerta alcanzo a 62,7 +/- 38 min, mientras que el Tiempo Puerta-Aguja fue de 53,6 +/- 15 min. y Tiempo Síntoma-Aguja 114,6 +/- 43 min. Se registraron complicaciones en 6 (33,3%). promedio de 4,6 +/- 3 días de internación en la clínica, pasando un promedio de 2,8 +/- 2 días en la Unidad de ACV. La tasa de mortalidad fue de 16,6%. Según la Escala Modficada de Rankin, tuvieron un puntaje de 0-1 mRS. CONCLUSIONES: el tiempo Puerta-Aguja en nuestro establecimiento fue de un promedio de 57 minutos, cumpliendo de esta forma la recomendación de la American Heart Association Guidelines 2013, la cual recalca que éste debe ser <60 min13.

OBJECTIVE: describe the experience in the implementation of the thrombolysis intravenous protocol in eighteen patients with acute ischemic stroke in the Stroke unit from the Foianini Clinic specifically, between September of 2013 and July of 2017. METHODS: the study has a quantitative, descriptive and retrospective approach. The medical record of the patients with the acute ischemic stroke diagnosis treated with intravenous thrombolytic (Alteplasa) in the UTAC service between September of 2013 and July 2017 in Santa Cruz Bolivia was revised. RESULTS: symptoms-Door time reached to 62.7 +/- 38 minutes. While the time Door- needle time was 53.6 +/- 15 minutes and the time symptoms- needle 114.6 +/- 3 days of internment in the clinic, passing out an average of 2.8 +/- 2 days in the stroke unit. The mortality tax was 16.6%. According to the modified Rankin Scale, it had a 0-1 mRS score. CONCLUSIONS: the time Door-needle in our establishment was an average of 57 minutes, fulfilling in this way the recommendation of the American Heart Association Guidelines 2013, which emphasize that it has to be < 60 minutes.

Knowledge, stigma, and quality of life in epilepsy: Results before and after a community-based epilepsy awareness program in rural Bolivia.

INTRODUCTION: Epilepsy represents around 0.7% of the overall global burden of diseases and is particularly prevalent and associated with significant disability in low- and middle-income countries (LMIC) in Latin American Countries (LAC). A community-based epilepsy awareness program was carried out by our group in the rural areas of the Chaco region, Plurinational state of Bolivia, to improve the knowledge about epilepsy, with a first part directed toward general practitioners and a second part toward nurses and community health workers (CHWs) of the rural communities with a positive outcome. The objective of the study was to assess the level of knowledge, attitudes, and practices toward epilepsy, the stigma related to epilepsy and the quality of life in people with epilepsy (PWE) before and after the interventional campaign directed toward representative members of the rural communities in the Chaco region in Bolivia. METHODS: The study was conducted in three areas of Bolivia. Key subjects from each community were randomly selected. Before and after the courses they answered a questionnaire to assess their knowledge, attitudes, beliefs, and practices about epilepsy, a validated Stigma Scale of Epilepsy (SSE) and Quality of Life in Epilepsy Inventory-10 (QOLIE-10). RESULTS: Two hundred sixteen subjects were involved in the program. Only 133 (61.6%) subjects completed the questionnaires a month after the educational program. A significant improvement was recorded in knowledge, attitudes, and practices toward epilepsy, and a significant reduction was found in the mean SSE total score (38.3 ±â€¯14.7 vs. 28.5 ±â€¯12.3; p < 0.01), reflecting a reduction of stigma levels. Regarding the quality of life, after the training, PWE stated to experience less depression, memory difficulties, work or social issues, and seizure worry. CONCLUSION: Our study confirms that continuous educational campaigns can lead to a significant change in the social perception and attitudes toward epilepsy.