The relationship between headache-attributed disability and lost productivity: 3 Attack frequency is the dominating variable.

BACKGROUND: In an earlier paper, we examined the relationship between headache-attributed disability, measured as proportion of time in ictal state, and lost productivity. In a linear model, we found positive and significant associations with lost paid worktime, lost household worktime and total lost productivity (paid + household), but with high variance, which was increased when headache intensity was introduced as a factor. We speculated that analyses based on headache frequency alone as the independent variable, eliminating both the subjectivity of intensity estimates and the uncertainties of duration, might show stronger associations. METHODS: Focusing on migraine, we used individual participant data from 16 countries surveyed either in population-based studies or in the Eurolight project. These data included frequency (headache days/month), usual attack duration (hours), usual headache intensity ("not bad", "quite bad", "very bad") and lost productivity from paid and household work according to enquiries using the Headache-Attributed Lost Time (HALT) questionnaire. We used multiple linear regressions, calculating regression equations along with unstandardized and standardized regression coefficients. We made line and bar charts to visualize relationships. RESULTS: Both frequency and intensity were significant predictors of lost productivity in all multiple linear regressions, but duration was a non-significant predictor in several of the regressions. Predicted productivity in paid work decreased among males by 0.75-0.85 days/3 months for each increase of 1 headache day/month, and among females by 0.34-0.53 days/3 months. In household chores, decreases in productivity for each added day/month of headache were more similar (0.67-0.87 days/3 months among males, 0.83-0.89 days/3 months among females). Visualizations showed that the impact of duration varied little across the range of 2-24 h. The standardized regression coefficients demonstrated that frequency was a much better predictor of lost productivity than intensity or duration. CONCLUSION: In the relationship between migraine-attributed impairment (symptom burden) and lost productivity, frequency (migraine days/month) is the dominating variable - more important than headache intensity and far more important than episode duration. This has major implications for current practice in headache care and for health policy and health-resource investment. Preventative drugs, grossly underutilized in current practice, offer a high prospect of economic benefit (cost-saving), but new preventative drugs are needed with better efficacy and/or tolerability

Structured education can improve primary-care management of headache: the first empirical evidence, from a controlled interventional study

Headache disorders are under-recognized and under-diagnosed. A principal factor in their suboptimal management is lack of headache-related training among health-care providers, especially in primary care. In Estonia, general practitioners (GPs) refer many headache patients to neurological specialist services, mostly unnecessarily. GPs request diagnostic investigations, which are usually unhelpful and therefore wasteful. GP-made headache diagnoses are often arcane and non-specific, and treatments based on these are inappropriate. The aim of this study was to develop, implement and test an educational model intended to improve headache-related primary health care in Estonia.This was a controlled study consisting of baseline observation, intervention and follow-up observation using the same measures of effect. It involved six GPs in Põlva and the surrounding region in Southern Estonia, together with their future patients presenting consecutively with headache as their main complaint, all with their consent. The primary outcome measure was referral rate (RR) to neurological specialist services. Secondary measures included number of GP-requested investigations, GP-made headache diagnoses and how these conformed to standard terminology (ICD-10), and GP-recommended or initiated treatments.RR at baseline (n = 490) was 39.5 %, falling to 34.7 % in the post-intervention group (n = 295) (overall reduction 4.8 %; p = 0.21). In the large subgroup of patients (88 %) for whom GPs made clearly headache-related ICD-10 diagnoses, RR fell by one fifth (from 40 to 32 %; p = 0.08), but the only diagnosis-related RR that showed a statistically significant reduction was (pericranial) myalgia (19 to 3 %; p = 0.03). There was a significant increase towards use of more specific diagnoses. Use of investigations in diagnosing headache reduced from 26 to 4 % (p < 0.0001). Initiation of treatment by GPs increased from 58 to 81 % (p < 0.0001).These were modest changes in GPs entrenched behaviour. Nevertheless they were empirical evidence that GPs practice in the field of headache could be improved by structured education. Furthermore, the changes were likely to be cost-saving. To our knowledge this study is the first to produce such evidence

Guidelines for telematic second opinion consultation in headaches in Europe: on behalf of the European Headache Federation

The seeking of a second opinion is the long-established process whereby a physician or expert from the same or a similar specialty is invited to assess a clinical case in order to confirm or reject a diagnosis or treatment plan. Seeking a second opinion has become more common in recent years, and the trend is associated with significant changes in the patient-doctor relationship. Telemedicine is attractive because it is not only fast but also affordable and thus makes it possible to reach highly qualified centres and experts that would otherwise be inaccessible, being impossible, or too expensive, to reach by any surface transport. In Europe, the European Headache Federation (EHF), being able to draw on a group of headache experts covering all the European languages, is the organisation best placed to provide qualified second-opinion consultation on difficult headache cases and to develop a Headache Medical Opinion Service Centre. The provision of good quality clinical information is crucial to the formulation of a valid, expert second opinion. This preliminary step can be properly accomplished only by the primary health care provider through the furnishing of an appropriate clinical report, together with the results of all available tests, including original films of all imaging studies already performed. On receiving the EHF's proposed standardised data collection form, properly filled in, we may be sure that we have all the relevant data necessary to formulate a valid expert second opinion. This form can be accessed electronically and downloaded from the EHF website. Once finalised, the EHF second opinion project should be treated as a pilot strategy that requires careful monitoring (for the first year at least), so that appropriate changes, as suggested by the retrospective analysis and its quality control, can be implemented

Framing education on headache disorders into the Global Burden of Disease Study 2010 : the European Headache Federation stands ready

Framing education on headache disorders into the Global Burden of Disease Study 2010. The European Headache Federation stands ready

Headache disorders are third cause of disability worldwide

Commentar

A Study on Headache Disorder in Kingdom Of Saudi Arabia Review (October 2013)

Headache is the most common central nervous systemdisorders &amp; one of commonest health problem (1).It has psychological, social &amp; economic effect on the patients &amp;their surrounding populations. Although many epidemiologicalstudies about headache disorders are performed yearly; they areonly partially documented. Those studies are performed mainlyin the developed countries &amp; only few numbers of studies wasperformed in the developing countries because of the limitedresources &amp; funding and the present of difficult to be reachedcites or villages.ObjectivesThe aim of our study is to define the problem of headacheworldwide &amp; to compare the world wide studies &amp; experienceswith studies published in Arabian Gulf countries &amp; Kingdom ofSaudi Arabia (KSA); to gain better understanding of the burdenof headache &amp; situation of headache care in our country; if it issatisfying the patient and if the health resources are well utilizedto decrease their suffering. Worldwide experience should be usedto put helpful solutions &amp; to make the management of headachedisorders in our country more effective &amp; efficient.MethodsReview of most relevant worldwide studies related tointernational headache epidemiology including Arabian Gulfcountries &amp; burden of headache worldwide. We searched studiespublished on PubMed &amp; Google scholar for the most relevant &amp;updated studies.An electronic survey that was performed will be discussed to,those surveys were spread through social websites to get someideas about general populations &amp; physicians opinions on recentstatus of headache care provided to headache patients &amp; the ideaof initiating a specialized headache clinic in Kingdom of SaudiArabia.ResultsIn KSA; prevalence of headache was measured throughsmall number of studies; 1-year prevalence of all headache was63% &amp; it is accounted for 13% of all neurological outpatients.More than one-third of school students were absent from schooldue to headache. Mean headache-attributed lost work-days perperson/year was 24.0 days for migraine, 6.6 days for Tension typeheadache (TTH ) &amp; 53.4 days for medication overuse headache .The results of our 3 questionnaires show that; almost half ofour samples have monthly attacks of headache &amp; around 10-15%have daily headache attacks. More than one third of theresponders mentioned that headache prevent them fromperforming their daily activity , it causes social isolation in morethan 20 % of them , in almost equal percentage it is affect theirrelations &amp; it is affect the school or work attendance in 8.33-9.3% of them.Almost all of our responders agree that there is a need formore organization in management of headache cases &amp; moreeducation for headache patients in KSA.ConclusionEpidemiological studies worldwide show that headache has ahigh prevalence &amp; burden; most of the developed country initiateheadache organizations, programs that is aiming for physicianeducations &amp; specialized headache clinic. Studies in KSA showthat headache is affecting people life &amp; most of the patients donot know where to go to manage their headaches. Moreorganized headache care is needed &amp; a Saudi headache societyshould be built to perform more studies &amp; provide optimal carefor headache patients

Electrospun biodegradable polymers loaded with bactericide agents

Development of materials with an antimicrobial activity is fundamental for different sectors, including medicine and health care, water and air treatment, and food packaging. Electrospinning is a versatile and economic technique that allows the incorporation of different natural, industrial, and clinical agents into a wide variety of polymers and blends in the form of micro/nanofibers. Furthermore, the technique is versatile since different constructs (e.g. those derived from single electrospinning, co-electrospinning, coaxial electrospinning, and miniemulsion electrospinning) can be obtained to influence the ability to load agents with different characteristics and stability and to modify the release behaviour. Furthermore, antimicrobial agents can be loaded during the electrospinning process or by a subsequent coating process. In order to the mitigate burst release effect, it is possible to encapsulate the selected drug into inorganic nanotubes and nanoparticles, as well as in organic cyclodextrine polysaccharides. In the same way, processes that involve covalent linkage of bactericide agents during surface treatment of electrospun samples may also be considered.; The present review is focused on more recent works concerning the electrospinning of antimicrobial polymers. These include chitosan and common biodegradable polymers with activity caused by the specific load of agents such as metal and metal oxide particles, quaternary ammonium compounds, hydantoin compounds, antibiotics, common organic bactericides, and bacteriophages.Peer ReviewedPostprint (published version

Evaluation of headache service quality indicators: pilot implementation in two specialist-care centres

Background Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so that deficiencies in headache care worldwide might be recognized and rectified. These indicators themselves require evaluation and proof of fitness for purpose. This pilot study begins this process. Methods We tested the quality indicators in the tertiary headache centres of the University of Duisburg-Essen in Essen, Germany, and the Hospital da Luz in Lisbon, Portugal. Using seven previously-developed enquiry instruments, we interrogated health-care providers (HCPs), including doctors, nurses, psychologists and physiotherapists, as well as consecutive patients and their medical records. Results The questionnaires were easily understood by both HCPs and patients and were not unduly time-consuming. The results from the two headache centres were comparable despite their differences in structure, staffing and language. These findings met the purpose of the study. Diagnoses were made according to ICHD criteria and critically evaluated during follow-up. However, diagnostic diaries and instruments assessing burden and response to treatment were not always in place or routinely utilised. Triage systems adjusted waiting times to urgency of need. Treatment plans included pathways to other specialities. Patients felt welcomed, reassured and educated, and were mostly satisfied. Discussion points arose over inclusion of psychological therapies in treatment plans; over recording of outcomes; over indicators of efficiency and equitability (protocols to limit wastage of resources, systems to measure input costs and means of ensuring equal access to the services); and over protocols for reporting serious adverse events. Conclusion This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next stages

New poly(ester urea) derived from L-leucine: Electrospun scaffolds loaded with antibacterial drugs and enzymes

Electrospun scaffolds from an amino acid containing poly(ester urea) (PEU) were developed as promising materials in the biomedical field and specifically in tissue engineering applications. The selected poly(ester urea) was obtained with a high yield and molecular weight by reaction of phosgene with a bis(alpha-aminoacy1)-alpha,omega-dioldiester monomer. The polymer having L-Ieucine, 1,6-hexanediol and carbonic acid units had a semicrystalline character and relatively high glass transition and melting temperatures. Furthermore it was highly soluble in most organic solvents, an interesting feature that facilitated the electrospinning process and the effective incorporation of drugs with bactericidal activity (e.g. biguanide derivatives such as clorhexidine and polyhexamethylenebiguanide) and enzymes (e.g. alpha-chymotrypsin) that accelerated the degradation process. Continuous micro/nanofibers were obtained under a wide range of processing conditions, being diameters of electrospun fibers dependent on the drug and solvent used.; Poly(ester urea) samples were degradable in media containing lipases and proteinases but the degradation rate was highly dependent on the surface area, being specifically greater for scaffolds with respect to films. The high hydrophobicity of new scaffolds had repercussions on enzymatic degradability since different weight loss rates were found depending on how samples were exposed to the medium (e.g. forced or non-forced immersion). New scaffolds were biocompatible, as demonstrated by adhesion and proliferation assays performed with fibroblast and epithelial cells. (C) 2014 Elsevier B.V. All rights reserved.Peer ReviewedPostprint (published version

Migraine-attributed burden, impact and disability, and migraine-impacted quality of life: Expert consensus on definitions from a Delphi process

Delphi; Migraine; DisabilityDelphi; Migraña; DiscapacidadDelphi; Migranya; DiscapacitatBackground Migraine-attributed burden, impact, disability and migraine-impacted quality of life are important concepts in clinical management, clinical and epidemiological research, and health policy, requiring clear and agreed definitions. We aimed to formulate concise and precise definitions of these concepts by expert consensus. Methods We searched the terms migraine-attributed burden, impact, disability and migraine-impacted quality of life in Embase and Medline from 1974 and 1946 respectively. We followed a Delphi process to reach consensus on definitions. Results We found widespread conflation of concepts and inconsistent terminology within publications. Following three Delphi rounds, we defined migraine-attributed burden as “the summation of all negative consequences of the disease or its diagnosis”; migraine-attributed impact as “the effect of the disease, or its diagnosis, on a specified aspect of life, health or wellbeing”; migraine-attributed disability as “physical, cognitive and mental incapacities imposed by the disease”; and migraine-impacted quality of life as “the subjective assessment by a person with the disease of their general wellbeing, position and prospects in life”. We complemented each definition with a detailed description. Conclusion These definitions and descriptions should foster consistency and encourage more appropriate use of currently available quantifying instruments and aid the future development of others.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by Eli Lilly and Company