Impacto da epilepsia no trabalho: avaliação da qualidade de vida

Unemployment and early retirement among patients with epilepsy - A study on predictors, resilience factors and occupational reintegration measures

The primary aim of this study was to identify predictors and resilience factors for unemployment and early retirement in patients with epilepsy of working age based on data from a multicenter German cohort study performed in 2020 (n = 456) by using multivariate binary logistic regression analysis. A second aim was to assess the assumed working ability of patients as well as the use of occupational reintegration measures. The unemployment rate was 8.3%, and 18% of patients had retired early due to epilepsy. Multivariate binary logistic regression analysis identified the presence of a relevant disability and frequent seizures as significant predictors of unemployment and early retirement, while seizures in remission were the only resilience factor associated with job retention. Regarding occupational incapacity, at the time of the survey, most of the patients in early retirement or unemployment were fit for work in their original or extended occupational setting. The proportion of patients with recent epilepsy-related occupational retraining (0.4%) or job changes (0.9%) was low, and only 2.4% reported an epilepsy-related reduction in work time. These findings underline the persistent disadvantage of patients with epilepsy in the professional field and the urgent need for effective, comprehensive work reintegration measures that must be made accessible for all patients.

Profiles of indigenous patients with epilepsy in a Brazilian village

INTRODUCTION

Identifying epilepsy in local indigenous populations and describing its epidemiological, etiological, electroencephalographic, and therapeutic aspects can assist public health policies planning toward epilepsy in indigenous communities.

METHODS

This descriptive, cross-sectional study investigated epilepsy among indigenous people residing in Jaguapirú Village, Dourados, Mato Grosso do Sul, Brazil. Participants had their clinical histories reviewed and physical examination performed, as well as one or more electroencephalograms (EEG) registered. Other laboratory tests and neuroimaging data available were analyzed and patients with nonepileptic paroxysmal events were additionally identified.

RESULTS

Out of 2,994 respondents, 49 had a confirmed diagnosis of epilepsy (2.37%) and 22 had self-limited epileptic syndromes, a rate that exceeds the global prevalence but is close to other data reported in the Brazilian population. Focal epilepsy, predominantly from temporal lobe origin, was the most prevalent epileptic syndrome (71.4%). Febrile seizures occurred in only 0.4% of respondents, much lower rate than reported in the general population, which can be attributed to the cross-sectional study design. The etiology of epilepsy was undetermined in 82.6% of cases, with the remaining cases attributed to head trauma, hypoxic-ischemic encephalopathy, and brain malformations. A history of delayed neuropsychomotor development was significantly associated with epilepsy. Monotherapy with first-generation antiseizure medications was greatly effective in most epilepsy cases (87.7%). Electroencephalogram helped to define focal epilepsies and diagnose seizures of nonepileptic origin; the latter mostly included cases of psychogenic seizures and, less frequently, syncope.

CONCLUSION

Diagnosing epilepsy, its clinical presentation, and therapeutical response profile in traditional communities is essential for the establishment of public health policies in developing countries and may help community involvement for successful treatment.

The Perceived Social Stigma of People with Epilepsy with regard to the Question of Employability

Objective

To evaluate the perceived social stigma of people with epilepsy with regard to the question of employability.

Methods

A structured questionnaire was given to two groups of people with chronic diseases: those with epilepsy (study group) and those with heart disease (control group). The questions concerned employability.

Results

Having epilepsy was more strongly associated with higher unemployment rates (p < 0.0001); job layoffs (p = 0.001); being unfit to work (p < 0.0001); feeling shame for having the disease (p = 0.014); absence of partners (p = 0.026); and depression (p = 0.004). The tendency to hide their disease from their employers was similar for the two groups.

Conclusion

The age discrepancy between groups was an important limiting factor of this study. However, despite the limited number of participants and the age difference between the groups, there is no impediment in stating that people with epilepsy show high rates of unemployment, depression, and stigma.

Epilepsy in children and adolescents: Disease concepts, practical knowledge, and coping

PROBLEM

Children suffering from epilepsy face severe difficulties in daily life. However, data about the self-assessment of children are scarce.

METHODS

From October 2013 to February 2014, patients aged 6-18years suffering from epilepsy were consecutively invited (i) to take part in a structured interview and (ii) to draw a picture about their self-assessment of epilepsy.

RESULTS

Eighty-four children and their parents agreed to participate: (i) 63/84 (75%) of the children named their disease correctly; contagiousness was assumed by 8/84 (10%); 81/84 (96%) knew whether they have to take medication; 36/69 (52%) of the children taking long-term medication reported the name(s) of their medication; 8/69 (12%) believed that their medication will cure their disease; 45/84 (54%) named specific precautions to prevent harm from seizures; 6/84 (7%) believed that nonadherence to safety precautions would cause new seizures; and 23/84 (27%) believed that they are worse off than healthy children. (ii) 67/84 (80%) drew a picture titled "This is how I feel when I have a seizure". Specific symptoms [17/67 (25%)] and the interaction between child and environment [12/67 (18%)] were the most common subjects.

CONCLUSION

Most children with epilepsy had rather good knowledge about medication; half of the children knew specific safety precautions. The children were often able to describe their seizures well. Pictures drawn by patients can give an insight into their experiences. Teaching programs should, among others, address the fear of contagiousness of epilepsy in some children and the fact that children with epilepsy might feel disadvantaged.

Quality of life in epilepsy: a study of Brazilian adolescents

Objective

Our objectives were: to assess the QOL of Brazilian adolescents with epilepsy with a specific QOL assessment tool; to compare the adolescents with epilepsy and healthy adolescents using a generic QOL assessment tool; to correlate the 2 different QOL assessment tools (the generic and the epilepsy-specific); and to correlate QOL scores of the adolescents with epilepsy obtained by both tools with physical, psychological and social variables of the disease.

Methods

Fifty subjects (case group) attending the outpatient clinic of epilepsy of the Clinics Hospital of UNICAMP, Campinas-SP, answered the Brazilian version of the QOL inventory for adolescents with epilepsy - QOLIE-AD-48 and the QOL Questionnaire - WHOQOL – BREF – Portuguese version. Fifty-one subjects (control group) from public schools in Campinas-SP answered only the WHOQOL-BREF.

Results

The results showed that adolescents with epilepsy presented a good score of QOL in both tools; overall scores for both groups with WHOQOL-BREF were good, but a statistically significant difference was seen with regards to the Psychological domain of the WHOQOL-BREF favoring the control group. Significant correlations between QOLIE-AD-48 Total and WHOQOL domains were found. Adolescents that were considered seizure-free (P = 0.001), had good perception of seizure control (P = 0.012) and had not had occurrence of seizures in public places (P = 0.001) presented better QOL scores.

Conclusions

Brazilian adolescents with epilepsy may present good QOL scores when they themselves consider the disease as under control; physical, social and especially psychological variables associated to the disease may play an important role in these results. As a generic QOL tool, WHOQOL-BREF was sufficient to allow for a comparison between chronic disease bearers and healthy adolescents and showed that the gap in QOL between both populations is not as extensive as once was thought, probably due to better support and adaptation to the disease.

Epilepsia e Previdência Social: a decisão médico-pericial

A maior dificuldade encontrada no manejo de pacientes com epilepsia frente aos seguros saúde é que, apesar de todo o aparato tecnológico de que se dispõe atualmente, o diagnóstico continua sendo predominantemente clínico, não havendo critérios objetivos na definição da incapacidade laborativa. Este ensaio tem como propósito discutir necessidades e parâmetros e apresentar uma proposta de aperfeiçoamento de relatório a ser preenchido pelo médico assistente a fim de traçar estratégias para que o perito médico defina, com maior segurança, a incapacidade laborativa em segurados portadores de epilepsia. A proposta discute aspectos relacionados a diagnóstico, tratamento e prognóstico, assim como fatores que interferem na capacidade de trabalho, visando auxiliar a decisão médico-pericial acerca da concessão ou não de benefícios.

Validation of the Subjective Handicap of Epilepsy (SHE) in Brazilian patients with epilepsy

The objectives of the study were to translate and adapt the Subjective Handicap of Epilepsy (SHE) instrument to Brazilian Portuguese and to determine its psychometric properties for the evaluation of quality of life in patients with epilepsy. A sample of 448 adult patients with epilepsy with different clinical profiles (investigation, preoperative period, postoperative period, and drug treatment follow-up) was evaluated with the SHE and the Epilepsy Surgery Inventory (ESI-55). Exploratory factorial analysis demonstrated that four factors explained 60.47% of the variance and were sensitive to discriminate the different clinical groups, with the preoperative group having the poorest quality of life. Internal consistency ranged from 0.92 to 0.96, and concurrent validity with the ESI-55 was moderate/strong (0.32-0.70). Test-retest reliability was confirmed, with an ICC value of 0.54 (2 days), 0.91 (7 days), and 0.97 (30 days). The SHE had satisfactory psychometric qualities for use in the Brazilian population, similar to those of the original version. The instrument seems to be more adequate in psychometric terms for the postoperative and drug treatment follow-up groups, and its use should be encouraged.

Validation study of a scale of life quality evaluation in a group of pediatric patients infected by HIV

With the advent of potent antiretroviral therapy and the increase in life expectancy of pediatric patients infected with HIV, the quest for the promotion of enhanced quality of life should currently be the main focus in care of children with HIV/Aids. The scope of this study was to validate the Scale of Children's Quality of Life in a group of children infected with HIV receiving clinical care in Aids Service Units in Rio de Janeiro, Brazil. This scale consists of 26 questions and was tested on 100 children, with ages varying between 4 and 12, and their respective parents or guardians. Statistical analysis was conducted using canonical correlation and confidence interval analysis and the X² test. The results showed that the cut-off point obtained was 49; the internal consistency with Cronbach's alpha was 0.73 for the children and 0.67 for parents or guardians. The response profile revealed marked satisfaction with aspects such as vacations and birthdays, though less satisfaction with items including hospitalization and playing alone. The conclusion was that the scale revealed satisfactory psychometric measurements, proving to be a reliable, consistent, valid and recommended instrument for measuring the quality of life of children infected with HIV.

Epilepsy and occupational accidents in Brazil: a national statistics study

Epilepsy may restrict the patient's daily life. It causes lower quality of life and increased risk for work-related accidents (WRA). The aim of this study is to analyze the implantation of the Epidemiologic and Technical Security System Nexus (ETSSN) and WRA patterns among patients with epilepsy. Data regarding WRA, between 1999 and 2008, on the historical database of WRA Infolog Statistical Yearbook from Brazilian Ministry of Social Security were reviewed. There was a significant increase of reported cases during the ten year period, mainly after the establishment of the ETSSN. The increased granted benefits evidenced the epidemiologic association between epilepsy and WRA. ETSSN possibly raised the registration of occupational accidents and granted benefits. However, the real number of WRA may remain underestimated due to informal economy and house workers' accidents which are usually not included in the official statistics in Brazil.

Factors associated with the employment situation and driving license of patients with epilepsy

INTRODUCTION: It is estimated that approximately 50% of patients with epilepsy have difficulty finding employment. OBJECTIVE: Evaluate the employment situation and driving license of patients with symptomatic or probably symptomatic focal epilepsy and correlate it with clinical and socio-demographic aspects. METHODS: Ninety-two patients were classified into 3 groups: "employed", "unemployed" and "retired/on leave". The relationship between employment and socio-demographic aspects and those of epilepsy was studied, and also whether the patients were holders of national driving licenses. RESULTS: Thirty-one (33.7%) of the patients were employed, 19 (20.7%) unemployed and 33 (35.9%) retired/on leave. Patients with formal education of less than 9 years predominated (p<0.05) in the "retired/on leave" group and non-white patients were more frequently unemployed. Of 58 patients who lost their jobs, 27 (46.6%) reported that epilepsy was the main reason (p<0.05). There was a significant relationship between the occurrence of ES at work and unemployment and "leave/retirement" (p<0.05). There was no relationship between clinical aspects and the employment situation. Nineteen (33.9%) of the 56 surveyed reported being holders of driving licenses. DISCUSSION: There was a high index of unemployment and retired/on leave individuals. There was a relationship between unemployment and the occurrence of ES at work and with a low scholastic level. CONCLUSION: The low scholastic level/professional qualifications and the stigma aggravated the employment perspectives of these individuals, contributing to their social exclusion.

Qualidade de vida e saúde: aspectos conceituais e metodológicos

O conceito qualidade de vida tem suscitado pesquisas e cresce a sua utilização nas práticas desenvolvidas nos serviços de saúde, por equipes profissionais que atuam junto a usuários acometidos por enfermidades diversas. O presente artigo tem como objetivo descrever a evolução histórica e tecer algumas considerações sobre aspectos conceituais e metodológicos do conceito qualidade de vida (QV) no campo da saúde. Baseando-se na revisão da literatura, dois aspectos do termo são destacados no plano conceitual: subjetividade e multidimensionalidade. Quanto aos aspectos metodológicos, uma tendência significativa tem sido a construção e/ou adaptação de instrumentos de medida e de avaliação da QV. Conclui-se que os esforços teórico-metodológicos têm contribuído para a clarificação e relativa maturidade do conceito. Trata-se de um construto eminentemente interdisciplinar, o que implica a contribuição de diferentes áreas do conhecimento para o seu aprimoramento conceitual e metodológico. Sua utilização, portanto, pode contribuir para a melhoria da qualidade e da integralidade da assistência na perspectiva da saúde como direito de cidadania.