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      Etiological beliefs of patients with neurological disorders attending a tertiary care center: A cross-sectional study

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          Abstract

          Background:

          The understanding and management of neurological disorders is undergoing revolutionary changes over the last three decades in the background of ever increasing advances in medical technologies, diagnostic techniques, therapeutic processes and, molecular and genetic medicine. The fruits of these advances can reach patients only if the psychosocial hurdles in their delivery are identified, acknowledged and addressed.

          Aim:

          To explore the beliefs and practices of patients with neurological disorders in a tertiary care center in the eastern Nepal.

          Materials and Methods:

          One hundred patients attending neurology/medicine outpatient for neurological disorders were interviewed about their beliefs regarding the triggering factors, causation and treatment-seeking behavior particularly from traditional healers.

          Result:

          Of the 100 patients (49 males, 51 females) recruited in the study, 51% expressed having ‘no idea’ about their illness. Only 20% patients gave medically congruent explanation for their illness. Psychological factors were attributed as triggering factors by 16% of patients, of which two-thirds were females. Chance, destiny and ‘jadu tona’ topped the list of triggering factors. Forty-four percent patients had sought help of traditional faith healers (‘Dhami Jhakri’) before seeking medical help. Traditional faith healers were approached by patients irrespective of their educational background. Fifty-nine percent of patients who first sought traditional faith healers, believed in ‘jadu-tona’. Of those interviewed, 16% were planning to go to a faith healer in near future.

          Conclusion:

          The beliefs of patients with neurological disorders frequently do not conform to current medical opinion. There is need for greater communication and education of patients by their treating physicians.

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          Most cited references9

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          Epidemiology, aetiology, and clinical management of epilepsy in Asia: a systematic review.

          Epilepsy is a significant, but often underappreciated, health problem in Asia. Here, we systematically review the literature on epidemiology, aetiology, and management of epilepsy in 23 Asian countries. Prevalence estimates are available for only 11 countries from door-to-door surveys and are generally low. Figures for annual incidence in China and India are similar to those in the USA and Europe but lower than those reported from Africa and Latin America. There is a peak in incidence and prevalence in childhood, but a second peak in elderly people, as seen in developed countries, has not been documented. The main causes are head injuries, cerebrovascular disease, CNS infections, and birth trauma. Availability of epilepsy care depends largely on economic factors. Imaging and neurophysiological facilities are available in most countries, but often only in urban centres. Costly drugs, a large treatment gap, limited epilepsy surgery, and negative public attitude to epilepsy are other notable features of management in Asia. An understanding of the psychosocial, cultural, economic, organisational, and political factors influencing epilepsy causation, management, and outcome should be of high priority for future investigations.
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            Risk awareness and knowledge of patients with stroke: results of a questionnaire survey 3 months after stroke.

            Secondary prevention of stroke has been shown to dramatically reduce recurrence and has been described as suboptimal. To analyse patients' awareness and knowledge about cerebrovascular risk factors (CVRF) and their influence on CVRF control. Patients (n = 164) who were attending a stroke outpatient clinic for the first time after hospital discharge (3 months) for a first stroke were asked to answer a short questionnaire including questions on awareness and knowledge of CVRF, visits to a CVRF specialist, number of visits to a general practitioner, adherence to drug treatments, cigarette smoking and cessation. CVRF were spontaneously mentioned as relevant for their stroke by only 13% of patients. A specialist was visited by only one-third of the patients and a general practitioner was not visited at all by 27% of the patients since their stroke. Awareness was inversely correlated with older age and good recovery. More than half of the patients had high blood pressure (> or = 140 mmHg for systolic and > or = 90 mmHg for diastolic values) at the time of follow-up. These high values were correlated with poor awareness. Appropriate secondary stroke prevention measures were not received by one-fourth of the patients; this was also correlated with poor awareness. CVRF control is not optimal and is at least partially related to patients' awareness and knowledge and suboptimal medical follow-up. Older patients and patients with excellent recovery are at particular risk for poor awareness and CVRF control.
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              Satisfaction with information and advice received by stroke patients.

              To determine levels of satisfaction with information and advice received about stroke disease and relevant issues by community-dwelling stroke survivors. An interview questionnaire survey. A family health services authority area in northern England. Stroke survivors identified by a valid screening questionnaire from a stratified random sample of 2000 subjects aged 45 years and over. Proportion of subjects interviewed responding positively to the question 'Do you think you have received enough advice and information on ...?' eighteen topics considered relevant to stroke survivors. The screening process identified 116 stroke survivors, of whom 76 agreed to be interviewed. The majority (> 80%) of patients were satisfied with information and advice received on lifestyle and health promotion issues, incontinence and their current treatment. However, satisfaction was poor for the areas of stroke disease in general, its effects, available services, and legal and financial affairs (range, 28-75% satisfied). Deficits in the provision of adequate information and advice to stroke patients on relevant issues have beer identified in this study of a representative sample of community-dwelling stroke survivors. These deficits need to be addressed by those providing care for stroke patients in order to improve patients satisfaction.
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                Author and article information

                Journal
                J Neurosci Rural Pract
                J Neurosci Rural Pract
                JNRP
                Journal of Neurosciences in Rural Practice
                Medknow Publications & Media Pvt Ltd (India )
                0976-3147
                0976-3155
                Oct-Dec 2013
                : 4
                : 4
                : 383-386
                Affiliations
                [1] Department of Neurology, PGIMER and Dr. RML Hospital, New Delhi, India
                [1 ] BPKIHS, Dharan, Nepal
                Author notes
                Address for correspondence: Dr. Bhupender K. Bajaj, Department of Neurology, PGIMER and Dr. RML Hospital, New Delhi - 110 001, India. E-mail: docbajaj@ 123456yahoo.co.in
                Article
                JNRP-4-383
                10.4103/0976-3147.120195
                3858753
                79462c89-b557-487e-a82f-abdefd278568
                Copyright: © Journal of Neurosciences in Rural Practice

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Neurosciences
                neurological disorders,practices,beliefs,attitude
                Neurosciences
                neurological disorders, practices, beliefs, attitude

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