RESUMO
The deviations from linearity of the energy as a function of the number of electrons that arise with current approximations to the exchange-correlation (XC) energy functional have important consequences for the frontier eigenvalues of molecules and the corresponding valence-band maxima for solids. In this work, we present an analysis of the exact theory that allows one to infer the effects of such approximations on the highest occupied and lowest unoccupied molecular orbital eigenvalues. Then, we show the importance of the asymptotic behavior of the XC potential in the generalized gradient approximation (GGA) in the case of the NCAPR functional (nearly correct asymptotic potential revised) for determining the shift of the frontier orbital eigenvalues toward the exact values. Thereby we establish a procedure at the GGA level of refinement that allows one to make a single calculation to determine the ionization potential, the electron affinity, and the hardness of molecules (and its solid counterpart, the bandgap) with an accuracy equivalent to that obtained for those properties through energy differences, a procedure that requires three calculations. For solids, the accuracy achieved for the bandgap lies rather close to that which is obtained through hybrid XC energy functionals, but those also demand much greater computational effort than what is required with the simple NCAPR GGA calculation.
RESUMO
A new density functional for the total kinetic energy in the generalized gradient approximation is developed through an enhancement factor that leads to the correct behavior in the limits when the reduced density gradient tends to 0 and to infinity and by making use of the conjoint conjecture for the interpolation between these two limits, through the incorporation, in the intermediate region of constraints that are associated with the exchange energy functional. The resulting functional leads to a reasonable description of the kinetic energies of atoms and molecules when it is used in combination with Hartree-Fock densities. Additionally, in order to improve the behavior of the kinetic energy density, a new enhancement factor for the Pauli kinetic energy is proposed by incorporating the correct behavior into the limits when the reduced density gradient tends to 0 and to infinity, together with the positivity condition, and imposing through the interpolation function that the sum of its integral over the whole space and the Weiszacker energy must be equal to the value obtained with the enhancement factor developed for the total kinetic energy.
RESUMO
A new procedure, based on electronic structure calculations that only requires a dipole moment value for a given molecule as input and, from which the charges for all the atoms in it are uniquely determined, is developed and applied to the study of molecular fluids with classical dynamics. The dipole moment value considered for the isolated molecule is the one that reproduces the dielectric constant of its corresponding fluid. Following previous work, the Lennard-Jones parameters are determined to reproduce the liquid density and the surface tension at the liquid-vapor interface. The force field thus obtained leads to a reasonable description of several properties such as heats of vaporization, self-diffusion coefficients, shear viscosities, isothermal compressibilities, and volumetric expansion coefficients of pure substances.
RESUMO
Two methods to calculate negative electron affinities systematically from ground-state density functional methods are presented. One makes use of the lowest unoccupied molecular orbital energy shift provided by approximate inclusion of derivative discontinuity in the nearly correct asymptotic potential (NCAP) nonempirical, constraint-based generalized gradient approximation exchange functional. The other uses a second-order perturbation calculation of the derivative discontinuity based on the NCAP exchange-correlation potential. On a set of thirty-eight molecules, NCAP leads to a rather accurate description that is improved further through the perturbation correction. The results presented show the importance of the asymptotic behavior of the exchange-correlation potential in the calculation of negative electron affinities as well as demonstrating the versatility of the NCAP functional.
RESUMO
We develop and validate a nonempirical generalized gradient approximation (GGA) exchange (X) density functional that performs as well as the SCAN (strongly constrained and appropriately normed) meta-GGA on standard thermochemistry tests. Additionally, the new functional (NCAP, nearly correct asymptotic potential) yields Kohn-Sham eigenvalues that are useful approximations of the density functional theory (DFT) ionization potential theorem values by inclusion of a systematic derivative discontinuity shift of the X potential. NCAP also enables time-dependent DFT (TD-DFT) calculations of good-quality polarizabilities, hyper-polarizabilities, and one-Fermion excited states without modification (calculated or ad hoc) of the long-range behavior of the exchange potential or other patches. NCAP is constructed by reconsidering the imposition of the asymptotic correctness of the X potential (-1/ r) as a constraint. Inclusion of derivative discontinuity and approximate integer self-interaction correction treatments along with first-principles determination of the effective second-order gradient expansion coefficient yields a major advance over our earlier correct asymptotic potential functional [CAP; J. Chem. Phys. 2015 , 142 , 054105 ]. The new functional reduces a spurious bump in the CAP atomic exchange potential and moves it to distances irrelevantly far from the nucleus (outside the tail of essentially all practical basis functions). It therefore has nearly correct atomic exchange-potential behavior out to rather large finite distances r from the nucleus but eventually goes as - c/ r with an estimated value for the constant c of around 0.3, so as to achieve other important properties of exact DFT exchange within the restrictions of the GGA form. We illustrate the results with the Ne atom optimized effective potentials and with standard molecular benchmark test data sets for thermochemical, structural, and response properties.
RESUMO
An analysis of the hardness kernel and local hardness is performed to propose new definitions for these quantities that follow a similar pattern to the one that characterizes the quantities associated with softness, that is, we have derived new definitions for which the integral of the hardness kernel over the whole space of one of the variables leads to local hardness, and the integral of local hardness over the whole space leads to global hardness. A basic aspect of the present approach is that global hardness keeps its identity as the second derivative of energy with respect to the number of electrons. Local hardness thus obtained depends on the first and second derivatives of energy and electron density with respect to the number of electrons. When these derivatives are approximated by a smooth quadratic interpolation of energy, the expression for local hardness reduces to the one intuitively proposed by Meneses, Tiznado, Contreras and Fuentealba. However, when one combines the first directional derivatives with smooth second derivatives one finds additional terms that allow one to differentiate local hardness for electrophilic attack from the one for nucleophilic attack. Numerical results related to electrophilic attacks on substituted pyridines, substituted benzenes and substituted ethenes are presented to show the overall performance of the new definition.
RESUMO
A new non-empirical exchange energy functional of the generalized gradient approximation (GGA) type, which gives an exchange potential with the correct asymptotic behavior, is developed and explored. In combination with the Perdew-Burke-Ernzerhof (PBE) correlation energy functional, the new CAP-PBE (CAP stands for correct asymptotic potential) exchange-correlation functional gives heats of formation, ionization potentials, electron affinities, proton affinities, binding energies of weakly interacting systems, barrier heights for hydrogen and non-hydrogen transfer reactions, bond distances, and harmonic frequencies on standard test sets that are fully competitive with those obtained from other GGA-type functionals that do not have the correct asymptotic exchange potential behavior. Distinct from them, the new functional provides important improvements in quantities dependent upon response functions, e.g., static and dynamic polarizabilities and hyperpolarizabilities. CAP combined with the Lee-Yang-Parr correlation functional gives roughly equivalent results. Consideration of the computed dynamical polarizabilities in the context of the broad spectrum of other properties considered tips the balance to the non-empirical CAP-PBE combination. Intriguingly, these improvements arise primarily from improvements in the highest occupied and lowest unoccupied molecular orbitals, and not from shifts in the associated eigenvalues. Those eigenvalues do not change dramatically with respect to eigenvalues from other GGA-type functionals that do not provide the correct asymptotic behavior of the potential. Unexpected behavior of the potential at intermediate distances from the nucleus explains this unexpected result and indicates a clear route for improvement.
RESUMO
The recently developed auxiliary density perturbation theory is extended to time-dependent perturbations. As its static counterpart, it is based on auxiliary density functional theory in which the Coulomb and exchange-correlation potentials are expressed through one auxiliary function density. As in the case of static perturbations a noniterative alternative to the corresponding coupled perturbed Kohn-Sham method is formulated. The new methodology is validated by local and gradient corrected dynamical polarizability calculations. Comparison with experiment indicates that for low frequencies reliable dynamical polarizabilities are obtained. Our discussion also shows that the computational performance of time-dependent auxiliary density perturbation theory is similar to the previously described static approach. In order to demonstrate the potential of this new methodology, dynamic polarizabilities of C(60), C(180), and C(240) are calculated.
RESUMO
We present a theoretical study of the polarizabilities of free and disubstituted azoarenes employing auxiliary density perturbation theory (ADPT) and the noniterative approximation to the coupled perturbed Kohn-Sham (NIA-CPKS) method. Both methods are noniterative but use different approaches to obtain the perturbed density matrix. NIA-CPKS is different from the conventional CPKS approach in that the perturbed Kohn-Sham matrix is obtained numerically, thereby yielding a single-step solution to CPKS. ADPT is an alternative approach to the analytical CPKS method in the framework of the auxiliary density functional theory. It is shown that the polarizabilities obtained using these two methods are in good agreement with each other. Comparisons are made for disubstituted azoarenes, which give support to the push-pull mechanism. Both methods reproduce the same trend for polarizabilities because of the substitution pattern of the azoarene moiety. Our results are consistent with the standard organic chemistry "activating/deactivating" sequence. We present the polarizabilities of the above molecules calculated with three different exchange-correlation functionals and two different auxiliary function sets. The computational advantages of both methods are also discussed.
Assuntos
Compostos Azo/química , Calixarenos/química , Simulação por Computador , Modelos Químicos , Teoria QuânticaRESUMO
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
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.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Epilepsia/terapia , Avaliação de Resultados em Cuidados de Saúde , Atenção Primária à Saúde/normas , Absenteísmo , Adaptação Psicológica , Brasil , Epilepsia/psicologia , Seguimentos , Entrevistas como Assunto , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Ajustamento Social , Resultado do TratamentoRESUMO
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
OBJECTIVE: To assess attitudes and beliefs concerning epilepsy held by physicians and allied health professionals who work in the primary care network in Brazil. METHODS: The data were collected during a national family and community medicine conference held in Rio de Janeiro in 2004, which was attended by 1,200 health professionals from throughout the country. Two questionnaires were used, one for physicians and another for nonphysician health workers. RESULTS: A total of 598 conference participants (345 physicians and 253 nonphysician health professionals) completed a questionnaire. Both the physicians and the nonphysician health professionals had acceptable personal attitudes towards persons with epilepsy. According to data from 286 physicians who provided information, the estimated mean percentage of individuals with epilepsy in the populations cared for by the physicians' health care systems in the preceding year was 0.78% (range, 0 to 8%; median = 0.37%). The estimated mean percentage of seizure-free patients was 60%. The estimated mean percentage of persons on monotherapy was 55%. The estimated mean percentage of referrals to a neurologist was 59%. The estimated mean percentage of patients who were working or studying was 56%. Of the 345 physicians, 252 of them (73%) reported not feeling confident about managing individuals with epilepsy, whereas 84 (24%) felt confident, and 9 (3%) were not sure. Of the 252 physicians who did not feel confident, 226 (90%) said that they would participate in a training program to improve the quality of the care provided to individuals with epilepsy. CONCLUSIONS: The professionals participating in the study indicated that the primary care system has the essential elements needed to provide comprehensive epilepsy care, including professional personnel who want to improve their skills. However, establishing an efficient, effective program of epilepsy management in the primary care network will require an effective referral network, regular distribution of antiepileptic drugs, the close monitoring of epilepsy management by using the federal primary health information system, and the ongoing education of health professionals, with emphasis on psychological support and the inclusion in society of individuals with epilepsy.
Assuntos
Competência Clínica , Epilepsia/terapia , Atenção Primária à Saúde/normas , Adolescente , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
OBJETIVO: Identificar a percepção quanto à epilepsia dos profissionais médicos e não-médicos que atuam na rede básica de saúde no Brasil. MÉTODO: Os dados foram coletados durante o VI Congresso Brasileiro de Medicina de Família e Comunidade e VI Congresso de Medicina Familiar, realizados em 2004 no Rio de Janeiro, com 1 200 participantes de todo o Brasil. Foram aplicados dois questionários, um para os médicos e outro para profissionais não-médicos da área da saúde. RESULTADOS: Quinhentas e noventa e oito pessoas responderam aos questionários. Tanto os 345 médicos como os 253 não-médicos mostraram uma percepção adequada sobre a epilepsia. A porcentagem média estimada (auto-informada) de pessoas com epilepsia na população atendida pelos profissionais que participaram do estudo foi de 0,78 por cento (286 respostas; 0 a 8 por cento; mediana = 0,37 por cento); de pacientes com crises controladas, 60 por cento; de pacientes em monoterapia, 55 por cento; de médicos que encaminhavam seus pacientes para o neurologista, 59 por cento; e de pacientes que estavam trabalhando ou estudando, 56 por cento. Do total de médicos, 252 (73 por cento) informaram não se sentir seguros no manejo de pessoas com epilepsia, enquanto 84 (24 por cento) sentiam-se seguros e nove (3 por cento) não sabiam; dos 252 médicos que se sentiam inseguros, 226 (90 por cento) disseram que participariam de um treinamento para melhorar a qualidade do atendimento médico na epilepsia. CONCLUSÃO: Os profissionais que participaram do estudo, atuantes no sistema básico de saúde, indicaram que o sistema tem os elementos fundamentais para o tratamento integral da epilepsia. Contudo, para garantir o estabelecimento de um programa efetivo e eficiente de manejo da epilepsia na rede básica, são necessárias: uma rede de referência e contra-referência, a distribuição contínua de drogas anti-epilépticas, a monitorização do manejo da epilepsia pelo Sistema de Informação da Atenção Básica do governo federal e a educação continuada de profissionais de saúde, com ênfase inclusive no apoio psicológico e inserção social dos pacientes portadores de epilepsia.