Complicaciones motoras en la enfermedad de Parkinson: estudio prospectivo a 10 años

Tesis realizada en el Departamento de Neurología de la Fundación Jiménez Díaz de MadridTesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 24 de Abril de 200

The health system in the post-COVID-19 crisis era

Coronavirus SARS-CoV-2; COVID-19; 2019-nCov; Etapa postcrisi; Sistema de salutCoronavirus SARS-CoV-2; COVID-19; 2019-nCov; Etapa poscrisis; Sistema de saludCoronavirus SARS-CoV-2; COVID-19; 2019-nCov; Post-COVID-19 crisis; Health systemAquest document conté una valoració inicial realitzada pel Consell Assessor de Salut (CAS), òrgan d’assessorament del Departament de Salut, sobre com cal orientar el sistema sanitari en l’etapa postcrisi de la COVID-19. Aquesta valoració s’ha construït a partir d’una breu anàlisi crítica i de l’aprenentatge de l’experiència a fi d’aplicar-ho al futur

Strategic recommendations for the specialised healthcare model

Atenció sanitària especialitzada; Estratègia sanitària; PlanificacióAtención sanitaria especializada; Estrategia sanitaria; PlanificaciónSpecialized health care; Health strategy; PlanningL'objectiu d'aquest document és formular recomanacions estratègiques que orientin el model d’atenció especialitzada, dintre d’un model d’atenció integral i integrada de salut, que cuidi a les persones, proporcioni un entorn adient als professionals, prioritzi l’atenció de proximitat i sigui equitatiu, de qualitat i sostenible

Strategic recommendations about primary and community health care model

Enfortiment del sistema sanitari; Assessorament sobre polítiques; Atenció comunitàriaFortalecimiento del sistema de salud; Asesoramiento sobre políticas; Atención comunitariaHealth system strengthening; Policy advice; Community careL'objectiu d'aquest document és fer propostes, formulades en forma de recomanacions estratègiques, que orientin el model de l’APiC i abordin el model assistencial des de la proximitat.El objetivo de este documento es hacer propuestas, formuladas en forma de recomendaciones estratégicas, que orienten al modelo de la APC y aborden el modelo asistencial desde la proximidad.The purpose of this document is to make proposals formulated as strategic recommendations that guide the Primary and Community Care (PCC) model and address the care model from a proximity perspective

Guidance on the model of care for people with social and health care needs

Enfortiment del sistema sanitari; Assessorament sobre polítiques; Atenció integrada; Atenció social i sanitàriaFortalecimiento del sistema de salud; Asesoramiento sobre políticas; Atención integrada; Atención social y sanitariaHealth system strengthening; Policy advice; Integrated care; Social and health careL’objectiu d’aquest document és orientar en una fórmula concreta per al desenvolupament (governança i gestió) de les polítiques públiques de l’atenció a les persones amb necessitats socials i sanitàries, que garanteixi l’equitat, la qualitat i l’eficiència des d’un model assistencial de proximitat per assolir la millora de la salut i el benestar de les persones.El objetivo de este documento es orientar en una fórmula concreta para el desarrollo (gobernanza y gestión) de las políticas públicas de la atención a las personas con necesidades sociales y sanitarias, que garantice la equidad, la calidad y la eficiencia desde un modelo asistencial de proximidad para alcanzar la mejora de la salud y el bienestar de las personas.The purpose of this document is to provide guidance on a specific formula for the development (governance and management) of public policies for the care of people with health and social care needs which guarantees equity, quality and efficiency based on a local care model to improve people's health and wellbeing

Holter STAT-ON™ against other tools for detecting MF in advanced Parkinson’s disease: an observational study

BackgroundDifferent screening tools to identify advanced Parkinson’s disease (APD) have emerged in recent years. Among them, wearable medical devices, such as STAT-ON™, have been proposed to help to objectively detect APD.ObjectivesTo analyze the correlation between STAT-ON™ reports and other assessment tools to identify APD and to assess the accuracy of screening tools in APD patients, using the STAT-ON™ as the gold standard.MethodsIn this retrospective, observational study, data from the University Hospital Complex of Pontevedra database on 44 patients with potential APD who wore STAT-ON™ were extracted. Data were collected according to different sources of tools for identifying APD: (1) STAT-ON™, (2) information provided by the patient, (3) questionnaire for advanced Parkinson’s disease (CDEPA), (4) 5-2-1 Criteria, and (5) Making Informed Decisions to Aid Timely Management of Parkinson’s Disease (MANAGE-PD). Considering STAT-ON™ recordings as a reference, the sensitivity, specificity, and positive and negative predictive values for each tool were calculated. The kappa index assessed the degree of agreement between the gold standard and the other instruments.ResultsAlthough no statistically significant association was found between STAT-ON™ recordings and any screening methods evaluated, the CDEPA questionnaire demonstrated the highest sensitivity and VPN values to detect patients with APD candidates for second-line therapy (SLT). According to the correlation analyses, MANAGE-PD demonstrated the highest degree of concordance with STAT-ON™ recordings to identify the SLT indication and to predict the SLT decision.ConclusionSTAT-ON™ device may be a helpful tool to detect APD and to guide treatment decisions

Falls predict acute hospitalization in Parkinson's disease

Background: There is a need for identifying risk factors for hospitalization in Parkinson's disease (PD) and also interventions to reduce acute hospital admission. Objective: To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort. Methods: PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson's DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit. Results: Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065-5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319-6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757-8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124-4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080-8.322; p = 0.035) was an independent predictor of AH. Conclusion: Falls is an independent predictor of AH in PD patients

Predictors of clinically significant quality of life impairment in Parkinson's disease.

Quality of life (QOL) plays an important role in independent living in Parkinson?s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson?s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ? 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829?0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422?12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053?1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027?1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer?Lemeshow test, p = 0.665; R2 = 0.655). An increase in ?5 and ?10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663?17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975?22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patient

Diplopia Is Frequent and Associated with Motor and Non-Motor Severity in Parkinson’s Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up

[Background and objective] Diplopia is relatively common in Parkinson’s disease (PD) but is still understudied. Our aim was to analyze the frequency of diplopia in PD patients from a multicenter Spanish cohort, to compare the frequency with a control group, and to identify factors associated with it.[Patients and Methods] PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort were included in this longitudinal prospective study. The patients and controls were classified as “with diplopia” or “without diplopia” according to item 15 of the Non-Motor Symptoms Scale (NMSS) at V0, V1 (1-year ± 15 days), and V2 for the patients and at V0 and V2 for the controls.[Results] The frequency of diplopia in the PD patients was 13.6% (94/691) at V0 (1.9% in controls [4/206]; p < 0.0001), 14.2% (86/604) at V1, and 17.1% (86/502) at V2 (0.8% in controls [1/124]; p < 0.0001), with a period prevalence of 24.9% (120/481). Visual hallucinations at any visit from V0 to V2 (OR = 2.264; 95%CI, 1.269–4.039; p = 0.006), a higher score on the NMSS at V0 (OR = 1.009; 95%CI, 1.012–1.024; p = 0.015), and a greater increase from V0 to V2 on the Unified Parkinson’s Disease Rating Scale–III (OR = 1.039; 95%CI, 1.023–1.083; p < 0.0001) and Neuropsychiatric Inventory (OR = 1.028; 95%CI, 1.001–1.057; p = 0.049) scores were independent factors associated with diplopia (R2 = 0.25; Hosmer and Lemeshow test, p = 0.716).[Conclusions] Diplopia represents a frequent symptom in PD patients and is associated with motor and non-motor severity.Martínez-Martin P. has received honoraria from National School of Public Health (ISCIII), Editori-al Viguera and Takeda Pharmaceuticals for lecturing in courses, and from the International Parkinson and Movement Disorder Society (MDS) for management of the Program on Rating Scales. Mir P. has received honoraria from AbbVie, Abbott, Allergan, Bial, Merz, UCB, and Zambon and have received grants from the Spanish Ministry of Economy and Competitiveness [PI16/01575], co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación) and by Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], the Consejería de Salud y Bienestar Social de la Junta de Andalucía [ PI-0437-2012, PI-0471-2013], the Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña.Peer reviewe

Staging Parkinson’s disease according to the MNCD classification correlates with caregiver burden

Malaltia de Parkinson; Cuidador; Símptomes no motorsParkinson's disease; Caregiver; Non-motor symptomsEnfermedad de Parkinson; Cuidador; Síntomas no motoresBackground and objective: Recently, we demonstrated that staging Parkinson's disease (PD) with a novel simple classification called MNCD, based on four axes (motor, non-motor, cognition, and dependency) and five stages, correlated with disease severity and patients’ quality of life. Here, we analyzed the correlation of MNCD staging with PD caregiver's status. Patients and methods: Data from the baseline visit of PD patients and their principal caregiver recruited from 35 centers in Spain from the COPPADIS cohort from January 2016 to November 2017 were used to apply the MNCD total score (from 0 to 12) and MNCD stages (from 1 to 5) in this cross-sectional analysis. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory-II (BDI-II), PQ-10, and EUROHIS-QOL 8-item index (EUROHIS-QOL8). Results: Two hundred and twenty-four PD patients (63 ± 9.6 years old; 61.2% males) and their caregivers (58.5 ± 12.1 years old; 67.9% females) were included. The frequency of MNCD stages was 1, 7.6%; 2, 58.9%; 3, 31.3%; and 4–5, 2.2%. A more advanced MNCD stage was associated with a higher score on the ZCBI (p < .0001) and CSI (p < .0001), and a lower score on the PQ-10 (p = .001), but no significant differences were observed in the BDI-II (p = .310) and EUROHIS-QOL8 (p = .133). Moderate correlations were observed between the MNCD total score and the ZCBI (r = .496; p < .0001), CSI (r = .433; p < .0001), and BDI-II (r = .306; p < .0001) in caregivers.Conclusion: Staging PD according to the MNCD classification is correlated with caregivers’ strain and burden.Fundación Española de Ayuda a la Investigación en Enfermedades Neurodegenerativas y/o de Origen Genético; Alpha Bioresearch; Spanish Ministry of Economy and Competitiveness, Grant/Award Number: PI16/0157