2,330 research outputs found
Socioeconomic variation in incidence of epilepsy: prospective community based study in south east England
No full textObjective To determine the incidence of epilepsy in a general practice population and its variation with socioeconomic deprivation.Design Prospective surveillance for new cases over an 18 or 24 month period.Participants All patients on practice registers categorised for deprivation with the Carstairs score of their postcodc.Setting 20 general practices in London and south cast England.Main outcome measure Confirmed diagnosis of epilepsy.Results 190 new cases of epilepsy were identified during 369 283 person years of observation (crude incidence 51.5 (95% confidence interval 44.4 to 59.3) per 100 000 per year). The incidence was 190 (138 to 262) per 100 000 in children aged 0-4 years, 30.8 (21.3 to 44.6) in those aged 45-64 years, and 58.7 (42.5 to 81.0) in those aged greater than or equal to65 years. There was no apparent difference in incidence between males and females. The incidence showed a strong association with socioeconomic deprivation, the age and sex adjusted incidence in the most deprived fifth of the study population being 2.33 (1.46 to 3.72) times that in the least deprived fifth (P=0.001 for trend across fifths). Adjustment for area (London v outside London) weakened the association with deprivation (rate ratio 1.62 (0.91 to 2.88), P=0.12 for trend).Conclusions The incidence of epilepsy seems to increase with socioeconomic deprivation, though the association may be confounded by other factors
Assessing suicidal risk with antiepileptic drugs
No full textMarco Mula2, Gail S Bell1, Josemir W Sander1,31Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, United Kingdom; 2Department of Clinical and Experimental Medicine, Division of Neurology, Amedeo Avogadro University, University Hospital Maggiore della Carità, Novara, Italy; 3SEIN – Epilepsy Institute in the Netherlands Foundation, Heemstede, The NetherlandsAbstract: Recently, the US Food and Drug Administration issued an alert about an increased risk for suicidality during treatment with antiepileptic drugs (AEDs) for different indications, including epilepsy. We discuss the issue of suicide in epilepsy with special attention to AEDs and the assessment of suicide in people with epilepsy. It has been suggested that early medical treatment with AEDs might potentially reduce suicide risk of people with epilepsy, but it is of great importance that the choice of drug is tailored to the mental state of the patient. The issue of suicidality in epilepsy is likely to represent an example of how the underdiagnosis of psychiatric symptoms, the lack of input from professionals (eg, psychologists, social workers, and psychiatrists), and the delay in an optimized AED therapy may worsen the prognosis of the condition with the occurrence of severe complications such as suicide.Keywords: epilepsy, suicide, adverse effect, depressio
Vascular endothelial growth factor restores delayed tumor progression in tumors depleted of macrophages
No full textGenetic depletion of macrophages in Polyoma Middle T oncoprotein (PyMT)-induced mammary tumors in mice delayed the angiogenic switch and the progression to malignancy. To determine whether vascular endothelial growth factor A (VEGF-A) produced by tumor-associated macrophages regulated the onset of the angiogenic switch, a genetic approach was used to restore expression of VEGF-A into tumors at the benign stages. This stimulated formation of a high-density vessel network and in macrophage-depleted mice, was followed by accelerated tumor progression. The expression of VEGF-A led to a massive infiltration into the tumor of leukocytes that were mostly macrophages. This study suggests that macrophage-produced VEGF regulates malignant progression through stimulating tumor angiogenesis, leukocytic infiltration and tumor cell invasion
Demonstration project on epilepsy in Brazil - WHO/ILAE/IBE Global Campaign Against Epilepsy - A foreword
No full textIn 2002, ASPE (Assistência à Saúde de Pacientes com Epilepsia)* initiated an Epilepsy Demonstration Project (DP) in Brazil as part of the Global Campaign Against Epilepsy "Epilepsy out of the Shadows", led by the World Health Organization (WHO), the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)1-4. Demonstration Projects have been carried out in several countries and their main aim is to develop treatment models for people with epilepsy in primary health care settings, improving the quality of life of people with epilepsy and their families5-9.
The project in Brazil has targeted areas in Campinas and São José do Rio Preto municipalities, both in São Paulo State, in Southeastern region8. A task force has been established to assess strategies to expand this nationwide. The DP was carried out in six phases as shown in Figure 1.
The Brazilian DP was officially closed during the IV Workshop of the WHO/ILAE/IBE Global Campaign Against Epilepsy "Epilepsy out of the Shadows", held on May 4-5th 2006, in Campinas. The workshop reviewed the results of the project and discussed the establishment of a National Epilepsy Policy. This supplement presents some results from all phases of the Brazilian DP which were discussed during the Workshop. In brief, we believe that the DP had an impact in our society and brought a new perspective on epilepsy. Awareness campaigns are now carried out on September 9th (Epilepsy Awareness Day) annually in many sites around the country. Regulations and Bills related to epilepsy have been proposed in several regions. Epilepsy has been officially adopted as a theme to be considered in elementary education by the Ministry of Education. Currently, a National Epilepsy Programme, endorsed by the main Brazilian non-governmental organizations in the field of epilepsy, is under review at the Ministry of Health. We hope that this will benefit some of the many people with epilepsy in the country and will eventually bring epilepsy out of the shadows in Brazil
Fidelidad del cliente del Hotel JW Marriott el Convento Cusco -2020
No full textEl presente trabajo de investigación se titula “La fidelidad del cliente del hotel JW Marriott El
Convento Cusco-2020”. Teniendo en cuenta que la fidelidad del cliente es un tema que en la
hotelería es uno de los principales intereses y lo vienen desarrollando la mayoría de las cadenas
hoteleras más renombradas, como es Marriott Hotels y específicamente el hotel JW Marriott El
Convento Cusco. En el cual encontramos un problema del cual tratamos en la presente
investigación, la cual se basa en que: si el cliente no pasa satisfactoriamente las fases de
fidelización, no llega a fidelizarse completamente, ello se debe a que existen ciertos aspectos que
impiden una fidelización, es decir que pueden resquebrajar la fidelidad del cliente, por ejemplo los
inconvenientes que puede tener el cliente, ya sea previo al servicio (desde la reserva del servicio
por medio de Online Travel Agency o por otro medio), la entrega o disfrute del servicio (la estadía)
y el post servicio (después del check out del hotel). Por ello, la presente investigación tiene como
objetivo principal describir la fidelidad del cliente del hotel JW Marriott El Convento Cusco-2020.
Como también, los objetivos específicos que describen la fidelidad del cliente en cada una de las
fases de fidelización. La metodología manejada para la elaboración de la presente tesis fue de tipo
cuantitativo, el nivel es descriptivo no experimental.
Se obtuvo datos del autor (Oliver R. , 1999) sobre las fases de la fidelidad del cliente, que son
fidelidad cognitiva, fidelidad afectiva, fidelidad conativa y fidelidad de acción; las cuales se
utilizaron como dimensiones de la variable, describiendo cada una de ellas. Para describir la
fidelidad del cliente del hotel JW Marriott El Convento Cusco-2020 se realizó encuestas vía web
dada la coyuntura actual, con una muestra no probabilística de 102 personas que fueron los clientes
que voluntariamente respondieron el cuestionario.
Según los resultados obtenidos de las encuestas realizadas, se determinó que la fidelidad del cliente
del hotel JW Marriott El Convento Cusco-2020 es muy buena, al igual que sus cuatro fases de
fidelidad del cliente. Debido a que el hotel cumple con todas las expectativas que tiene el cliente y
al final genera una recompra por parte del cliente hacia el hotel JW Marriott El Convento Cusco,
dado por el cumplimiento de las cuatro fases de fidelización del cliente por lo siguiente: El cliente
es inicialmente fiel en un sentido cognitivo basado en la información y creencia que tiene el cliente,
después de las experiencias satisfactorias se genera un sentimiento de compromiso hacia el hotel
siendo fiel afectivamente, para así por medio de intenciones de comportamientos positivos por parte de asociados del hotel siendo fiel conativa, y finalmente el hotel al cumplir con todas las
expectativas del cliente y superar todos los obstáculos posibles se produce un control de la acción
que viene a ser la fidelidad de acción donde se produce la recompra del servicio del hotel JW
Marriott El Convento Cusco y retener al cliente.
Se pudo concluir que, el hotel JW Marriott El Convento Cusco es muy bueno fidelizando a sus
clientes y puede ser mejor incluso, si se siguen las propuestas planteadas. En la investigación, se
ha logrado describir cómo retener a los clientes y generar un compromiso profundo de recompra
del servicio JW Marriott El Convento Cusco por medio de las fases de fidelización.This research is titled “The costumer loyalty of the JW Marriott El Convento Cusco hotel-2020”.
We know that the loyalty in costumers is one of the most important issues for the hospitality
industry and it is been developed by most of the renowned hotel chains in the World, such as
Marriott Hotels and specifically the JW Marriott El Convento Cusco hotel. We found a problem
wich is based on the fact that: if the costumer doesn´t satisfactorily obtain the four loyalty phases,
the client will not become completely loyal to the hotel. This because there are some aspects that
don´t allow the loyalty, for example the pre service (from the reservation of the service through the
Online Travel agency or other method of reservation), the service (the stay) and the post service
(after the check out of the hotel). The main objective of this research is to describe the customer
loyalty of the JW Marriott El Convento Cusco hotel-2020. As well as, the especific objectives, that
describes the customer loyalty in each of the loyalty phases. The methodology used to prepare this
research was quantitative, and the level is descriptive, not experimental.
The data was obtained from the author (Oliver R. , 1999) that explained about the phases of
customer loyalty, which are Cognitive Loyalty, Afective loyalty, Conative loyalty and Action
loyalty; which were used as dimensions, describing each one of them. In order to describe the
costumer loyalty of the JW Marriott El Convento Cusco hotel-2020, we make the surveys via web
because of the current situation, with a non probability sample of 102 people who were the
costumers who voluntarily answered the questionnaire.
The costumer loyalty of the JW Marriott El Convento Cusco hotel -2020 was determined to be very
good, and also the phases of the customer loyalty as well. All that because the hotel meets all the
expectations that the customer has and in the end generates a repurchase by the customer from the
JW Marriott El Convento Cusco hotel, all that with the four phases of the loyalty of the client, and
we can detail that: The cliente initially gets the cognitive loyalty based in the information and
believes that the client has; after the satisfactory experiences, a feeling of commitment to the hotel
is generated, that is the afective loyalty; and for this reason through the intentions of positive
behaviors of the associates of the hotel, that is the conative loyalty; and finally when the hotel
meets all the expectations of the clients and overcoming all the possible obstacles, there is a control
of the action that comes to be the action loyalty, and the repurchase of the service of the JW Marriott
El Convento Cusco hotel occurs and retain more clients. In conclusion, the hotel JW Marriott El Convento Cusco is very good building customers loyalty
and can be better if the proposals proposed are followed. In the research, it has been possible to
describe how to retain customers and generate a deep commitment to repurchase the service of the
JW Marriott El Convento Cusco hotel through the loyalty phases
Dynamics of brain states and cortical excitability in paroxysmal neurological conditions
No full textEpilepsy and migraine are neurological conditions that are characterised by periods of disruption of normal neuronal functioning. Aside from this paroxysmal feature, both conditions share genetic mutations and altered cortical excitability. People with epilepsy appear to be diagnosed with migraine more often than people without epilepsy and, likewise, people with migraine seem to be diagnosed with epilepsy more often than people without migraine. Changes in cortical excitability may help explain the pathophysiological link between both conditions, and could be a biomarker to monitor disease activity. In this thesis, the association between migraine and epilepsy and their relation to cortical excitability is further explored. A meta-analysis of previous population based studies provides epidemiological evidence for the co-occurrence of migraine and epilepsy. The combination of computer modelling with human electroencephalographic recordings offers insight into multi-stability of brain states in epilepsy. Results described in this thesis show that Transcranial Magnetic Stimulation can be used to measure cortical excitability, but that its use as a biomarker of disease activity in epilepsy is limited due to large interindividual variability. By combining Transcranial Magnetic Stimulation with electroencephalography, two novel variables that may contribute to cortical excitability are investigated: phase clustering, which possibly reflecting functional neuronal connectivity, and the non-linear residual of a stimulus-response curve, which may reflect brain state multi-stability. The results presented in this thesis suggest that the higher propensity to global synchronisation is not shared between epilepsy and migraine. These new variables have potential value to differentiate people with epilepsy, but not people with migraine, from normal controls
Ictal ECG changes in temporal lobe epilepsy.
No full textChanges in cardiac rhythm may occur during epileptic seizures and this has been suggested as a possible mechanism for sudden unexpected death amongst patients with chronic epilepsy (SUDEP). We have studied ECG changes during 61 complex partial seizures of temporal lobe origin in 20 patients. Tachycardia was observed in 24/61 (39%) and bradycardia in 3/61 (5%). The mean and median tachycardia rate was 139 and 140 beats/min (range 120-180). The longest R-R interval observed was 9 seconds. No difference was found in regard to the lateralisation of seizures and cardiac arrhytmia. One of the patients with bradycardia was fitted with a demand cardiac pacemaker, which appeared to decrease the number of his falls. In conclusion, ictal cardiac changes which may be seen in temporal lobe epilepsy (TLE) are sinus tachycardia and occasionally sinus bradycardia. Patients presenting vague complains suggestive of either TLE or cardiac dysrhythmia, simultaneous monitoring with EEG/ECG is required, and if the episodes are frequent, video-EEG should be considered. Further studies on this subject are warranted as this may shed some light on possible mechanisms for SUDEP
Optical coherence tomography in people with epilepsy: symmetry and clinical correlations
No full textOptical Coherence Tomography (OCT) provides detailed images by assessing the scattering properties of a tissue (1). OCT is precise and easily repeatable. It is quick to obtain and does not cause any significant discomfort to patients. For these reasons, it is a useful clinical tool to diagnose and monitor many conditions. Peripapillary retinal nerve fibre layer (pRNFL) thickness measured by OCT was recently confirmed as a biomarker of white matter (WM) integrity in various neurological conditions (2). In epilepsy, retinal thinning is found in people exposed to vigabatrin (3) but also in people not exposed to this antiepileptic drug (AED), particularly in cases where drug-resistance or intellectual disability are present (4). I have reviewed and expanded these analyses. I tested the hypothesis that OCT is useful in identifying changes associated with different epilepsy syndromes by identifying changes in specific retinal segments related to retrograde trans-synaptic degeneration of areas in the brain. Though thinning was present, it did not reach statistical significance when I analysed the different cerebral lobes of onset. The rate of pRNFL thinning in people with epilepsy is yet unknown. I have identified a strong effect of age in this cohort and hypothesise that this might be related to disease progression. Longitudinal studies starting at the time of diagnosis are necessary to confirm this hypothesis. I assessed if pRNFL thickness asymmetry could correlate to seizure focus and widespread neuronal damage. This complex analysis seems to show that people with epilepsy present with asymmetry in inferior segments of the optic nerve head (ONH). It is possible that this finding could become useful to help phenotype epilepsy syndromes. I analysed the correlation between brain volume and retinal thickness and identified a statistically significant association with thalamic volume. This result needs to be further explored. I also analysed the effect of AED exposure to assess whether, as seen with vigabatrin, this correlates with changes in retinal thickness. The analysis failed to identify any relation between drug exposure and pRNFL thickness, but the insufficient number of people exposed to certain AEDs limited the analysis. Keywords: retinal thickness, retinal asymmetry, MRI, OC
Stigma scale of epilepsy - Validation process
No full textPurpose: 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. Cronbach's 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
Training medical students to improve the management of people with epilepsy
No full textPurpose: 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
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