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Background: The burden of neurological diseases is increasing in developing countries. However, there is a prominent scarcity of literature on the incidence of neurological diseases in sub-Saharan Africa. This study was therefore undertaken to determine the prevalence and incidence of neurological diseases in this setting to serve as a baseline for planning and care for neurological disorders in Uganda. Methods: The study was conducted within rural and urban Mukono district, east of Kampala city of Uganda, central region. Over a period of six months, a cross sectional survey was conducted and screening was performed using a standardized questionnaire. All subjects with neurological symptoms and signs were reviewed by a team of neurologists and neurological diagnoses made. Results: Of the 3000 study subjects, 50.3% (1510/3000) were from the rural setting. Out of the participants screened, 67.4% were female, with a median age of 33 years. Among the 98 subjects with confirmed neurological disorders, the frequency of diseases was as follows; peripheral neuropathy (46.2%), chronic headaches (26.4%), and epilepsy (8.5%), followed by pain syndromes (7.5%), stroke (6.6%) and tremors/Parkinson disease (3.8%). The crude prevalence rates of these disorders (95% CI) were 14.3% (8.5-24.1); 13.3% (7.7-22.8); 33.7% (23.9-47.4) for stroke, epilepsy and peripheral neuropathy respectively. Peripheral neuropathy followed by chronic headaches had the highest estimated incidence/1000 years. Stroke had an estimated incidence of 3.6 new cases with 95% CI of (2.1-6.1)/1000 years. Conclusion: Peripheral neuropathy, chronic headaches and epilepsy disorders are major causes of morbidity in Sub-Saharan settings. There is an urgent need of more robust and powered studies to determine the incidence of these diseases. [ABSTRACT FROM AUTHOR]

Background The costs of serious mental illness (SMI) are $317 billion annually in the U.S. Antipsychotic medications are evidence-based treatments for SMI that improve health outcomes and reduce costs. However, rates of non-adherence can exceed 60%. Poor adherence is associated with relapse, homelessness, hospitalization, and increased costs of care. ITreatment guidelines for SMI recommend long acting injectable (LAI) medications for a wide range of patients who have trouble taking daily oral medications. However, LAI is vastly underused, with less than one in five eligible individuals receiving treatment. If adherence with antipsychotic medication in people with schizophrenia could be increased by as little as 20%, the estimated Medicaid annual savings in re-hospitalization alone would be in the order of $7,500 million. Improving adherence and the appropriate use of antipsychotic medication in people with SMI is thus a matter of critical public health importance. Methods We describe an approach to increasing the appropriate use of LAI for individuals with schizophrenia; Multi-level facilitation of long-acting AntiPsychotic use/MAP. MAP is a novel behavior change intervention drawn from evidence-based approaches and designed to improve the identification of individuals who could benefit from LAI, improve their outcomes and reduce inappropriate use of resources associated with poor adherence. MAP targets 3 stakeholder groups 1) the consumer 2) the provider and 3) the administrator and uses a variety of techniques including peer support, academic detailing, incentives and feedback to increase the appropriate use of LAI for individuals who are not receiving optimum benefit from current antipsychotic therapy. For administrators MAP focuses on getting buy-in by providing information on how appropriate use of LAI may help them maximize quality of care. Administrators nominate "key change champions" who take on the role of working with prescribers to meet clear behavioral objectives. Academic detailing for prescribers is provided by international experts and the local change champion and uses the repetition of digestible key messages to address common misconceptions about LAI and ways of making good offers of LAI which focus on the potential benefits for the consumer's recovery goals To increase the ease of identifying patients for whom a medication change to LAI may be helpful, we developed a very brief checklist to use at clinic appointments to help prescribers recognize individuals who may not be receiving optimal benefit (NOB) from antipsychotic medication. The NOB checklists asks only 5 questions (Is the person missing any doses of medication? Are they being treated with two antipsychotic medications? Are there frequent antipsychotic medication changes? Has the person been hospitalized or had an emergency/crisis visit? Is the person dissatisfied with their current treatment?) If any of the questions are answered "yes" the clinician is then asked whether they have offered and LAI. Consumers receive support from a peer specialist currently on LAI who shows them a video about Shared Decision Making prior to the visit. The video outlines the importance of telling the prescriber key information, asking questions, choosing a plan, and researching and reviewing progress. The peer provides them with a decision tool and answers any questions about his own experience with LAI. Four clinics in Texas and Ohio were randomized to use the NOB checklist only or to the entire MAP program with the NOB, academic detailing and patient peer support. Results Patients appreciate and enjoy the video which follows a patient through a visit and describes the use of shared-decision making. After viewing pros and cons of LAI versus tablets, many individuals ask their prescriber for LAI. Prescribers were initially somewhat resistant to using the NOB checklist believing that they always had LAI at the forefront of their thinking. However, they were surprised to learn the percentage of individuals on LAI versus oral. In offers of LAI they were not tying the offer to patient desired outcomes and recovery goals. Conclusions The purpose of the implementation of the MAP program is to determine whether the appropriate use of LAI can be increased by targeting all stakeholders. We will examine LAI versus oral antipsychotic prescribing at both control and MAP clinics. Results will be discussed with an eye toward barriers to implementation and dissemination. [ABSTRACT FROM AUTHOR]

Epilepsy, a complex spectrum of disorders, affects about 2.9 million people in the U.S. Similar to other chronic disorders, people with epilepsy face challenges related to management of the disorder, its treatment, co-occurring depression, disability, social disadvantages, and stigma. Two national conferences on public health and epilepsy (1997, 2003) and a 2012 IOM report on the public health dimensions of epilepsy highlighted important knowledge gaps and emphasized the need for evidence-based, scalable epilepsy self-management programs. The Centers for Disease Control and Prevention translated recommendations on self-management research and dissemination into an applied research program through the Prevention Research Centers Managing Epilepsy Well (MEW) Network. MEW Network objectives are to advance epilepsy self-management research by developing effective interventions that can be broadly disseminated for use in people's homes, healthcare providers' offices, or in community settings. The aim of this report is to provide an update on the MEW Network research pipeline, which spans efficacy, effectiveness, and dissemination. Many of the interventions use e-health strategies to eliminate barriers to care (e.g., lack of transportation, functional limitations, and stigma). Strengths of this mature research network are the culture of collaboration, community-based partnerships, e-health methods, and its portfolio of prevention activities, which range from efficacy studies engaging hard-to-reach groups, to initiatives focused on provider training and knowledge translation. The MEW Network works with organizations across the country to expand its capacity, help leverage funding and other resources, and enhance the development, dissemination, and sustainability of MEW Network programs and tools. Guided by national initiatives targeting chronic disease or epilepsy burden since 2007, the MEW Network has been responsible for more than 43 scientific journal articles, two study reports, seven book chapters, and 62 presentations and posters. To date, two programs have been adopted and disseminated by the national Epilepsy Foundation, state Epilepsy Foundation affiliates, and other stakeholders. Recent expansion of the MEW Network membership will help to extend future reach and public health impact. [ABSTRACT FROM AUTHOR]

Objective This systematic review identified papers that described epilepsy misconceptions or stigma in sub-Saharan Africa (SSA) and research interventions focused on reducing these misconceptions. Materials and methods Publications in the English language from January 2000 to October 2017 that described original research conducted in SSA on misconceptions about epilepsy were utilized. Results Twenty-three publications were identified. Studies were from Nigeria (N = 4), Cameroon (N = 4), Uganda (N = 3), Zambia (N = 2), Ethiopia (N = 2), Tanzania (N = 2), Kenya (N = 2), Ghana, Zimbabwe, Benin, and Mali (N = 1 each). The studies included assessments of misconceptions among healthcare providers and medical students (N = 3), high school students (N = 2), teachers (N = 2), the general public (N = 10), people with epilepsy (N = 7), and traditional healers (N = 1). Only two studies had stigma-focused interventions. Majority of the studies reported limitations to socialization with people with epilepsy and various beliefs associated with epilepsy. Conclusions Epilepsy misconceptions, stigmatizing cultural beliefs, and perceptions were widely prevalent in SSA, and there are a few studies targeting epilepsy stigma. Existing stigma-reduction educational approaches may be impractical for general population implementation. Scalable approaches to reduce stigma are urgently needed within SSA. [ABSTRACT FROM AUTHOR]

Introduction Stroke remains a global concern due to increasing lifespan, patterns of industrialization, adoption of harmful western diets, and an increasing prevalence of risk factors such as hypertension, obesity, and diabetes. We investigated an adopted novel self-management intervention, TargetEd mAnageMent Intervention (TEAM) to reduce modifiable stroke risk factors in Uganda. Methods A six-month, uncontrolled, prospective pilot study to establish feasibility, acceptability and preliminary efficacy of TEAM in Ugandans at high risk for stroke was conducted. The primary outcome was change in systolic BP from baseline to 24-week follow-up. Secondary outcomes included change in diastolic BP, serum cholesterol, high and low density lipoprotein (HDL, LDL) and triglycerides. Results Mean (SD) baseline systolic BP was 162.9 (± 25.6) mmHg while mean (SD) baseline diastolic BP was 99.1 (± 13.8) mmHg. There was a significant reduction in mean baseline blood pressure of 163/98.8 mmHg to blood pressure of 147.8/88.0 mmHg at 24 weeks, P = 0.023. There were also significant reductions in the serum total cholesterol levels at 24 weeks with P = 0.001. Conclusion Targeted training in self-management (TEAM) adapted to the Ugandan setting is feasible, highly acceptable to participants and appears to be associated with reduced blood pressure, improved lipid profiles and improved glucose control in diabetics. [ABSTRACT FROM AUTHOR]