engleski

Activities of the World Federation of Neurology Research Group on Organization and Delivery of Neurological Services in the Prevention of Cerebrovascular Diseases

The present trend of improving delivery of neurologi-cal services, as collaboration between the World Federa-tion of Neurology (WF N) and World Health Organization (WHO), shown in the recent World Congress of Neurology in Buenos Aires ( I997), originated from Croatia on the expe-rience of neurologists in this country. In the period after the Second World War, a new organization of public heal-th was accepted in Croatia, based on the premises which were mostly put down by Andrija Štampar, chairman of the Founding Conference of the WHO in 1948, professor -at the School of Medicine and founder of the School of Public Health in Zagreb. His ideas of the importance of prevention and of primary health care were incorporated into the model of Croatian Public Health Service. Conse-cutively, a system of "public health homes" was dissemi-nated throughout the country, and some medical discipli-nes were organized according to this system. The recent advances in neurological science were re-latively early introduced in the practice in Croatia, stimu-lating the rapid growth of neurology. Whereas in the early '60ies there were no more than 10 neuropsychiatrists acti-ve in neurology in Croatia, this number grew up very fast. So, at the end of the '80ies, there were around 150 neurolo-gists in Croatia, covering a population of about 4,500,000. Since 1974, a separate speciality of neurology has developed, with activities in subspecialized fields, among others intensive neurology and cerebrovascular diseases (C.VD). The State of Croatia, constituting one of the 6 republics of the former Yugoslav Federation, consisted of regions of various socio-economic power and development. In Za-greb, a strong industrial and university center of the Repu-blic, subspecialized neurological activities developed early in parallel with necessary ancillary services and strong ncurosurgery. Various uninstitutionalizcd forms of colla-boration of the centers of strong neurology with the others was established, functioning as reference centers, their specialists serving as consultants for the less developed parts of the country In the mid-'80ies. a system of three ,general levels of neurology was proposed, which could co-ver the basic needs of neurology in the country' On the ground of this experience, in 1987 we proposed an interna-tional symposium on neurology in developing countries to be organized during the 14' World Congress of Neurology (New Delhi, 1989), the first international meeting dedica-ted to the problems of delivery of neurological services on the international scale. Many arguments led to a conclu-sion that the problems which neurologists meet in various less developed parts and regions of the world, were diffe-rent from those encountered in industrialized countries. CVDs, for example, occur frequently at a much younger age, often caused by malaria or other infectious diseases. The deliberations and discussions on the Symposium as well as on the following Symposia in Vienna' and Mar-rakech,~ and at the subsequent two Conferences (New Delhi, 199, and Athens,1996) evolved the ideas of levels of neurology services, leading to the present concepts of comprehensive neurology services. Some of the objectives and programs of activities of RG ODNS should be accentuated: exchange of informa-tion on the present status of neurology among various com-munities of different social and cultural background in order to contribute to the improvement of health and gene-ral well-being throughout the world; comparison of expe-rience of existing neurology services in two specific areas, i.c. organization of the diagnosis and treatment of (a) com-mon neurologic diseases (CVDs, epilepsies, dementias, craniocerebral and spinal trauma, etc.), and (b) typical rare neurologic diseases with great impact on the indivi-dual (hereditary degenerative diseases, CNS tumors, algic syndromes, etc.); making conclusions in order to establish the most rational organization of neurological services ac-cording to the locally available personnel, existing cultu-ral and medical tradition and available financial resour-ces as well as to the WHO general policies. 'This program of activities should be achieved by the membership of RG ODNS, in cooperation with other WFN research groups, and all the interested neurologists and other medical or non-medical professionals from all over the world. As a consequence of the advances in neurology, new concepts nave been developed and some classical fields of neurology have completely changed their scope of prac-tical activities and organization. CVDs, once regarded as a fate on the ground of vast neuroepidemiological and ba-sic research, have been recognized as a complex process resulting from many risk factors, some of which can be successfully controlled and prevented, and, especially in countries with modern medicine, in their early pl~ascs very successfully treated and rehabilitated. Evolution of the ideas cn the possibilities of the management of CVI~s in Croatia demonstrates how modern advances of basic research in CVDs, contemporary clinical concepts and te-chnological improvements, arc reflected in a small coun-try with European cultural and medical tradition.

Prevention of stroke; organisation of neurological services

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