Muerte súbita en epilepsia: casuística de una unidad médica de epilepsia española.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with epilepsy. Most studies concerning this issue have been conducted in central and northern European countries and the United States. We conducted an epidemiologic study of SUDEP at our hospital's epilepsy unit. This retrospective cohort study included all epileptic patients aged ≥14 years, regardless of epilepsy severity, who were treated at the outpatient epilepsy unit of our hospital between 2000 and 2013. The study included 2,309 patients. Deceased patients were identified using civil records. The cause of death was obtained from death certificates, autopsy reports, hospital reports, general practitioner records, and witnesses of the event. We calculated the incidence and proportional mortality of SUDEP based on our data. We identified 7 cases of definite SUDEP (2 patients with SUDEP plus), one case of probable SUDEP, and one case of possible SUDEP. Considering only cases of definite SUDEP, incidence was estimated at 0.44 cases per 1,000 patient-years and proportional mortality at 4.6%. Mean age of patients with definite SUDEP was 38.14 years; 4 were men and 3 were women. Most deaths occurred while patients were in bed and were therefore unwitnessed. Epilepsy in these patients was either remote symptomatic or cryptogenic. All patients but 2 had generalised seizures. None of the patients was in remission. SUDEP incidence and proportional mortality rates in our study are similar to those reported by population studies. This may be due to the fact that we did not select patients by severity. Risk factors for SUDEP in our sample are therefore consistent with those reported in the literature

Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer

Resumen: Introducción: La asistencia telefónica a demanda (ATAD) es una práctica habitual en las consultas de Neurología; no obstante, los estudios que valoran dicha modalidad de asistencia sanitaria son escasos. Hemos evaluado la ATAD en cuidadores de pacientes con enfermedad de Alzheimer (EA) desde el punto de vista económico y de la satisfacción percibida por el cuidador principal. Pacientes y métodos: Se seleccionó a 97 pacientes con diagnóstico de EA según criterios NINCDS-ADRDA y sus respectivos 97 cuidadores principales. Estudiamos los gastos diferenciales entre las modalidades asistenciales presencial y a demanda a lo largo de 12 meses. A los 12 meses se valoró la satisfacción de los cuidadores principales mediante un cuestionario autoadministrado. Resultados: El ahorro que supuso la ATAD frente la asistencia presencial fue de 80,05 ± 27,07 euros por usuario. Al 73,6% de los cuidadores que usaron la ATAD les parece mejor o mucho mejor esta que la asistencia presencial, mientras que al 2,6% de los cuidadores les parece peor o mucho peor. Conclusiones: La ATAD supone un servicio de salud eficiente en el seguimiento de los usuarios con EA en las consultas de Neurología y la satisfacción de los usuarios fue alta, por lo que consideramos que debería incluirse en la cartera de servicios del sistema sanitario. Abstract: Introduction: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. Patients and methods: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. Results: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. Conclusions: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services. Palabras clave: Asistencia telefónica, Cuidados, Unidad de Demencia, Enfermedad de Alzheimer, Cuidador, Satisfacción, Keywords: Telephone assistance, Healthcare, Dementia Unit, Alzheimer's disease, Caregiver, Satisfactio

An assessment of telephone assistance systems for caregivers of patients with Alzheimer disease

Introduction: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. Patients and methods: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. Results: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. Conclusions: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services. Resumen: Introducción: La asistencia telefónica a demanda (ATAD) es una práctica habitual en las consultas de Neurología; no obstante, los estudios que valoran dicha modalidad de asistencia sanitaria son escasos. Hemos evaluado la ATAD en cuidadores de pacientes con enfermedad de Alzheimer (EA) desde el punto de vista económico y de la satisfacción percibida por el cuidador principal. Pacientes y métodos: Se seleccionó a 97 pacientes con diagnóstico de EA según criterios NINCDS-ADRDA y sus respectivos 97 cuidadores principales. Estudiamos los gastos diferenciales entre las modalidades asistenciales presencial y a demanda a lo largo de 12 meses. A los 12 meses se valoró la satisfacción de los cuidadores principales mediante un cuestionario autoadministrado. Resultados: El ahorro que supuso la ATAD frente la asistencia presencial fue de 80,05 ± 27,07 euros por usuario. Al 73,6% de los cuidadores que usaron la ATAD les parece mejor o mucho mejor esta que la asistencia presencial, mientras que al 2,6% de los cuidadores les parece peor o mucho peor. Conclusiones: La ATAD supone un servicio de salud eficiente en el seguimiento de los usuarios con EA en las consultas de Neurología y la satisfacción de los usuarios fue alta, por lo que consideramos que debería incluirse en la cartera de servicios del sistema sanitario. Keywords: Telephone assistance, Healthcare, Dementia unit, Alzheimer's disease, Caregiver, Satisfaction, Palabras clave: Asistencia telefónica, Cuidados, Unidad de demencia, Enfermedad de Alzheimer, Cuidador, Satisfacció

Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer.

Informal caregivers of patients with Alzheimer's disease (AD) have a poor health-related quality of life (HRQOL). HRQOL is an increasingly common user-focused outcome measure. We have evaluated HRQOL longitudinally in caregivers of AD patients at baseline and at 12 months. Ninety-seven patients diagnosed with AD according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer's Disease and Related Disorders Association) and their 97 respective primary caregivers were included in the study. We analysed the following data at the baseline visit: sociodemographic data of both patients and carers, patients' clinical variables, and data related to the healthcare provided to patients by carers. HRQOL of caregivers was measured with the SF-36 questionnaire at baseline and 12 months later. At 12 months, primary caregivers scored lower in the 8 subscales of the SF-36 questionnaire; differences were statistically significant in all dimensions except for 'physical function' and 'social function'. Baseline scores in our sample were lower than those of the general population. 'Vitality' is the dimension that presented the lowest scores. HRQOL in caregivers of patients with Alzheimer's disease deteriorates over time and is poorer than that of the age- and sex-matched general population

Health-related quality of life in caregivers of patients with Alzheimer disease

Introduction: Informal caregivers of patients with Alzheimer disease (AD) have a poor health-related quality of life (HRQOL). HRQOL is an increasingly common user-focused outcome measure. We have evaluated HRQOL longitudinally in caregivers of AD patients at baseline and at 12 months. Methods: Ninety-seven patients diagnosed with AD according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer's Disease and Related Disorders Association) and their 97 respective primary caregivers were included in the study. We analysed the following data at the baseline visit: sociodemographic data of both patients and carers, patients’ clinical variables, and data related to the healthcare provided to patients by carers. HRQOL of caregivers was measured with the SF-36 questionnaire at baseline and 12 months later. Results: At 12 months, primary caregivers scored lower in the 8 subscales of the SF-36 questionnaire; differences were statistically significant in all dimensions except for ‘physical function’ and ‘social function’. Baseline scores in our sample were lower than those of the general population. ‘Vitality’ is the dimension that presented the lowest scores. Conclusion: HRQOL in caregivers of patients with AD deteriorates over time and is poorer than that of the age- and sex-matched general population. Resumen: Introducción: Los cuidadores de pacientes con enfermedad de Alzheimer (EA) tienen un deterioro de su calidad de vida relacionada con la salud (CVRS). La CVRS es una medida de resultado centrada en el usuario cada vez más usada. Evaluamos de forma longitudinal la CVRS en cuidadores de pacientes con EA, antes y después, durante un periodo de 12 meses. Métodos: Se incluyó en el estudio a 97 pacientes diagnosticados de EA según criterios NINCDS-ADRDA (Instituto Nacional de Trastornos Neurológicos y de la Comunicación y Accidente Cerebrovascular y Asociación de Enfermedad de Alzheimer y Trastornos relacionados) y sus respectivos 97 cuidadores principales. Se analizaron datos sociodemográficas de ambos, clínicos de los pacientes, y datos en relación con el cuidado en la visita basal. La CVRS se midió con el cuestionario SF-36 en la visita basal y a los 12 meses. Resultados: Las 8 dimensiones de la escala SF-36 en los cuidadores principales empeoraron de forma significativa a los 12 meses, salvo las dimensiones «Función física» y «Función social», que lo hicieron de forma no significativa. Las puntuaciones en la visita basal fueron menores que las correspondientes a la población general. La dimensión que presentó peor puntuación fue «Vitalidad». Conclusiones: La CVRS en cuidadores de pacientes con EA empeora a lo largo de la evolución de esta y es peor que la de la población general, para su edad y género. Keywords: Health-related quality of life, Questionnaire, Informal caregiver, Alzheimer disease, SF-36, Dementia Unit, Palabras clave: Calidad de vida relacionada con la salud, Cuestionario, Cuidador informal, Enfermedad de Alzheimer, SF-36, Unidad de Demencia

Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer

Resumen: Introducción: Los cuidadores de pacientes con enfermedad de Alzheimer (EA) tienen un deterioro de su calidad de vida relacionada con la salud (CVRS). La CVRS es una medida de resultado centrada en el usuario cada vez más usada. Evaluamos de forma longitudinal la CVRS en cuidadores de pacientes con EA, antes y después, durante un periodo de 12 meses. Métodos: Se incluyó en el estudio a 97 pacientes diagnosticados de EA según criterios NINCDS-ADRDA (Instituto Nacional de Trastornos Neurológicos y de la Comunicación y Accidente Cerebrovascular y Asociación de Enfermedad de Alzheimer y Trastornos relacionados) y sus respectivos 97 cuidadores principales. Se analizaron datos sociodemográficas de ambos, clínicos de los pacientes, y datos en relación con el cuidado en la visita basal. La CVRS se midió con el cuestionario SF-36 en la visita basal y a los 12 meses. Resultados: Las 8 dimensiones de la escala SF-36 en los cuidadores principales empeoraron de forma significativa a los 12 meses, salvo las dimensiones «Función física» y «Función social», que lo hicieron de forma no significativa. Las puntuaciones en la visita basal fueron menores que las correspondientes a la población general. La dimensión que presentó peor puntuación fue «Vitalidad». Conclusiones: La CVRS en cuidadores de pacientes con EA empeora a lo largo de la evolución de esta y es peor que la de la población general, para su edad y género. Abstract: Introduction: Informal caregivers of patients with Alzheimer's disease (AD) have a poor health-related quality of life (HRQOL). HRQOL is an increasingly common user-focused outcome measure. We have evaluated HRQOL longitudinally in caregivers of AD patients at baseline and at 12 months. Methods: Ninety-seven patients diagnosed with AD according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer's Disease and Related Disorders Association) and their 97 respective primary caregivers were included in the study. We analysed the following data at the baseline visit: sociodemographic data of both patients and carers, patients’ clinical variables, and data related to the healthcare provided to patients by carers. HRQOL of caregivers was measured with the SF-36 questionnaire at baseline and 12 months later. Results: At 12 months, primary caregivers scored lower in the 8 subscales of the SF-36 questionnaire; differences were statistically significant in all dimensions except for ‘physical function’ and ‘social function’. Baseline scores in our sample were lower than those of the general population. ‘Vitality’ is the dimension that presented the lowest scores. Conclusion: HRQOL in caregivers of patients with Alzheimer's disease deteriorates over time and is poorer than that of the age- and sex-matched general population. Palabras clave: Calidad de vida relacionada con la salud, Cuestionario, Cuidador informal, Enfermedad de Alzheimer, SF-36, Unidad de Demencias, Keywords: Health-related quality of life, Questionnaire, Informal caregiver, Alzheimer's disease, SF-36, Dementia Uni

Association between toenail scandium levels and risk of acute myocardial infarction in European men: The EURAMIC and Heavy Metals Study

The association between scandium status and risk of acute myocardial infarction (MI) was examined in a multicentre case control study in 10 centres from Europe and Israel. Scandium in toenails was assessed in 684 cases and 724 controls less than 70 years of age. Mean concentrations of toenail scandium were 6.74 μg/kg in cases and 7.75 μg/kg in controls. Scandium among controls, adjusted for age and centre was positively associated with concentrations of lycopene and oleic acid in adipose tissue (P = 0.002 for both nutrients). Pearson correlations adjusted for age and centre were significant (P < 0.05) between scandium and lycopene (r = 0.08), zinc (r = 0.08), mercury (r = 0.18) and oleic acid (r = 0.21). Overall, cases had lower levels of scandium than controls after adjustment for age and centre (case control ratio, 0.87; 95% CI 0.79-0.96). This association persisted after adjustment for other cardiovascular risk factors (case-control ratio 0.88; 95% CI, 0.79-0.98). The risk of MI at high scandium levels was reduced after adjustment for age and centre (P-trend = 0.04). Further adjustments for BMI, history of hypertension, smoking, alcohol intake, diabetes, family history of CHD, alpha-tocopherol, beta-carotene, lycopene, selenium and mercury slightly attenuated this trend (P = 0.055). Our results suggest that toenail scandium level is associated with a reduced risk of acute MI, but we are uncertain whether this element can really play a protective role in the development of CHD. Without an identified plausible mechanism, these results should be regarded as preliminary and should be tested in future studies

Dietary total antioxidant capacity and mortality in the PREDIMED study.

The aim of the present study was to assess the association between the dietary total antioxidant capacity, the dietary intake of different antioxidants and mortality in a Mediterranean population at high cardiovascular disease risk. A total of 7,447 subjects from the PREDIMED study (multicenter, parallel group, randomized controlled clinical trial), were analyzed treating data as an observational cohort. Different antioxidant vitamin intake and total dietary antioxidant capacity were calculated from a validated 137-item food frequency questionnaire at baseline and updated yearly. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were fitted to assess the relationship between dietary total antioxidant capacity and mortality. Dietary total antioxidant capacity was estimated using ferric-reducing antioxidant power assays. A total of 319 deaths were recorded after a median follow-up of 4.3 years. Subjects belonging to the upper quintile of antioxidant capacity were younger, ex-smokers, with high educational level, and more active and had higher alcohol intake. Multivariable-adjusted models revealed no statistically significant difference between total dietary antioxidant capacity and mortality (Q5 vs. Q1 ref HR 0.85; 95% CI 0.60-1.20) neither for the intake of all the vitamins studied. No statistically significant association was found between antioxidant capacity and total mortality in elderly subjects at high cardiovascular risk