Our objective was to assess the ability of a smartphone-based electroencephalography (EEG) application, the Smartphone Brain Scanner-2 (SBS2), to detect epileptiform abnormalities compared to standard clinical EEG. The SBS2 system consists of an Android tablet wirelessly connected to a 14-electrode EasyCap headset (cost ~ 300 USD). SBS2 and standard EEG were performed in people with suspected epilepsy in Bhutan (2014–2015), and recordings were interpreted by neurologists. Among 205 participants (54% female, median age 24 years), epileptiform discharges were detected on 14% of SBS2 and 25% of standard EEGs. The SBS2 had 39.2% sensitivity (95% confidence interval (CI) 25.8%, 53.9%) and 94.8% specificity (95% CI 90.0%, 97.7%) for epileptiform discharges with positive and negative predictive values of 0.71 (95% CI 0.51, 0.87) and 0.82 (95% CI 0.76, 0.89) respectively. 31% of focal and 82% of generalized abnormalities were identified on SBS2 recordings. Cohen’s kappa (κ) for the SBS2 EEG and standard EEG for the epileptiform versus non-epileptiform outcome was κ = 0.40 (95% CI 0.25, 0.55). No safety or tolerability concerns were reported. Despite limitations in sensitivity, the SBS2 may become a viable supportive test for the capture of epileptiform abnormalities, and extend EEG access to new, especially resource-limited, populations at a reduced cost.
There are potentially modifiable associations with low QOLIE. Addressing the educational level and self-perceived stigma of PWE may have an especial impact. The low QOLIE in Bhutan may reflect cultural approaches to epilepsy, health services, or other factors including those outside of the health sector.
Subsistence Bhutanese farmers spread across different agro-ecological zones maintain large species and varietal diversity of different crops in their farm. However, no studies have been undertaken yet to assess why farmers conserve and maintain large agro-biodiversity, the extent of agro-ecological richness, species richness, estimated loss of traditional varieties and threats to the loss of on-farm agro-biodiversity. Information on the number of varieties cultivated by the farmers for six important staple crops were collected from nine districts and twenty sub-districts spread across six different agro-ecological zones of the country to understand farmers reasons for maintaining on-farm crop diversity, estimate OPEN ACCESSAgriculture 2015, 5 3 agro-ecological richness, species richness and the overall loss of traditional varieties, to know the famers' level of awareness on climate change and the different threats to crop diversity. The results from this study indicated that an overwhelming 93% of the respondents manage and use agro-biodiversity for household food security and livelihood. The average agro-ecological richness ranged from 1.17 to 2.26 while the average species richness ranged from 0.50 to 2.66. The average agro-ecological richness indicates a large agro-ecological heterogeneity in terms of the different species of staple crops cultivated. The average species richness on the other hand shows that agro-ecological heterogeneity determines the type and extent of the cultivation of the six different staple cereals under consideration. The overall loss of traditional varieties in a time period of 20 years stands at 28.57%. On climate change, 94% of the farmers recognize that local climate is changing while 86% responded that they are aware of the potential impacts of climate change on their livelihoods. Climate change and associated factors was considered the most imminent threat to the management and loss of on-farm agro-biodiversity. The results from this study indicate that on-farm agro-biodiversity conservation, development and utilization programs have to be more specific to the different agro-ecological zones considering the agro-ecological heterogeneity. Attention has to be given to individual crops that have low average species richness and high percentage of loss of traditional varieties. The impact of climate change could offset the traditional seed system which primarily supports the persistence of on-farm agro-biodiversity in several ways.
Summary Objective: To assess the economic impact of epilepsy in Bhutan, a lower-middle-income country with a universal health care system, but with limited access to neurological care. Methods: A cross-sectional survey was conducted of patients with epilepsy receiving care at Jigme Dorji Wangchuk National Referral Hospital from January to August, 2016. Data were collected on clinical features of epilepsy, cost of care, impact of epilepsy on school or work, and household economic status of participants and matched comparisons (a sibling or neighbor from a separate household without epilepsy). Results: A total of 172 individuals were included in the study (130 adults and 42 children). One-third of adults and 20 (48%) children had seizures at least once per month. Mean annual direct out-of-pocket costs for epilepsy care was 6,054 BTN (91 USD), of which transportation formed the greatest portion (53%). Direct costs of epilepsy were an average of 3.2% of annual household income. Adults missed 6.8 ± 9.0 days of work or school per year on average, and children missed 18.6 ± 34.7 days of school. Of adult participants, 23 (18%) abandoned employment or school because of epilepsy; among school-age children, seven (18%) stopped school because of epilepsy. Households with a person with epilepsy had lower monthly per-person income (6,434 BTN) than comparison households without epilepsy (8,892 BTN; p = 0.027). Significance: In this lower-middle-income country, despite universal health care services, households of people with epilepsy face a significant economic burden. Cost of transportation for epilepsy care contributes a major proportion of the direct cost burden. Indirect costs, including negative effects on school achievement and employment, disrupt the economic potential of people with epilepsy in Bhutan. Household economic well-being is impacted by the direct and indirect costs of epilepsy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.