Neurology. Charles H. Clarke

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Название Neurology
Автор произведения Charles H. Clarke
Жанр Медицина
Серия
Издательство Медицина
Год выпуска 0
isbn 9781119235705



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href="#ulink_9d2fb532-c5c0-519f-b743-0202f3ad7750">Figure 1.3);

       Infant mortality rate: number of infant (<1 year) deaths/number of live births;

       Stillbirth rate: number of intrauterine deaths after 28 weeks/total births;

       Perinatal mortality rate: number of stillbirths + deaths in first week of life/total number of births.

Schematic illustration of comparison of age-specific fertility rates in women with treated epilepsy and general UK population of women in 1993.

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      Cost of Illness Studies

      The principal duty of a clinician is to provide individual care. However, doctors are now rightly involved in economic considerations. In any study of cost, analysis is of signal importance. Who was the study for, and who did it? The cost and burden for an individual have different parameters when compared with the effect on families, on health services and on society. Many studies are carried out from the point of view of society, with costs estimated in terms of lost employment, lost productivity and premature death, rather from the perspective of a patient, or their family.

       Direct costs mean any resource used – medical costs of primary care, out‐patient and in‐patient investigation, drugs, residential and community care, training and rehabilitation.

       Indirect costs are from lost economic production. They include premature mortality, dependency, unemployment and underemployment. The ‘human capital’ approach ascribes a monetary value to a person in terms of their potential productivity.

      Source: Modified from Olesen and Leonardi 2003.

Condition DALYs × 10
Europe Wealthy countries a India Sub‐Saharan Africa World
Neurological and psychiatric conditions (all)b 53 009 24 682 23 949 15 788 165 082
Cerebrovascular disease 10 316 5166 5223 5487 45 770
Unipolar depression 4091 6721 10 064 6193 60 166
Bipolar disease 1541 1673 2867 1,785 16 722
Schizophrenia 1609 2151 2041 611 14 614
Epilepsy 633 427 848 526 4712
Alcoholism 4435 4611 1113 2387 18,973
Dementia 4531 3286 1192 453 10 135
Parkinson’s disease 428 523 167 63 1278
Multiple sclerosis 303 222 253 140 1569

      a Established market economies.

      b This category excludes cerebrovascular disease.

      Disability‐adjusted life year is an indicator of the time lived with a disability and the time lost due to premature mortality. Reproduced with permission from the World Health Organization 1996b. The figures for Europe were separately calculated (Olesen and Leonardi 2003).

      Social policy can greatly lessen the individual burden, for example by financial benefits and social support. It must be stressed that in the majority of countries, even those who pride themselves on wealth and power, there is either no or minimal support for those who are ill, either acutely or chronically.

      Stigma

      Disease burden includes psychological, social, employment and legislative aspects. Some are rational, for example driving restrictions in epilepsy or stroke.

      Stigma and discrimination deserve mention:

       enacted stigma – discrimination experience for example ‘does he (the man in the wheelchair) take sugar?’

       felt stigma – discrimination fear

       self‐stigma – shame/withdrawal – response to discrimination perceived.

      Complex interactions construct a stigma theory – to explain potential dangers people represent, either to others or to themselves. Whilst many no longer believe in witchcraft, in life after death, in the power of prayer or of the devil, some still do, and there remains a view that someone with a condition such as epilepsy, mental sub‐normality or schizophrenia is in some way to blame.

      Epilepsy is one example. To be regarded as epileptic