39 research outputs found
Costs of Parkinson's Disease and Antiparkinsonian Pharmacotherapy: An Italian Cohort Study
Objective: Antiparkinsonian pharmacotherapy is costly and the determinants of drug costs in Parkinson's disease (PD) have been poorly investigated. The objective of this study was to investigate the costs of PD and antiparkinsonian drugs in an Italian cohort of patients and identify cost-driving factors of drug therapy. Methods: Seventy outpatients with idiopathic PD were recruited in the Department of Neurology, Napoli University, Italy. Data on resource utilization were collected for 6 months using a bottom-up approach. Clinical status was evaluated using the Unified Parkinson's Disease Rating Scale. Direct and indirect costs were calculated from the societal perspective (figures of year 2009). Independent determinants of total costs and costs of antiparkinsonian drugs were identified using multivariate regression analysis. Results: The total costs of PD were EUR 8,640 (95% CI: EUR 6,700-11,240) per patient over a 6-month period. Direct costs accounted for 70% of the total costs. Antiparkinsonian drugs (EUR 1,450; 95% CI: EUR 1,220-1,760) were the primary component of costs paid by the health insurance (39.6%) and one of the most expensive components of the direct costs (24.0%). The highest copayments made by patients were for antiparkinsonian drugs and medical equipment (58%). Independent determinants of the increased costs of antiparkinsonian pharmacotherapy were younger age and occurrence of motor fluctuations. Conclusions: Antiparkinsonian pharmacotherapy is one of the major cost components of PD-related costs for health insurance. It imposes a considerable economic burden on patients and their families as well. Copyright (C) 2010 S. Karger AG, Base
Mapping the EQ-5D index by UPDRS and PDQ-8 in patients with Parkinsonâs disease
Background: Clinical studies employ the Unified Parkinsonâs Disease Rating Scale (UPDRS) to measure the severity of Parkinsonâs disease. Evaluations often fail to consider the health-related quality of life (HrQoL) or apply disease-specific instruments. Health-economic studies normally use estimates of utilities to calculate quality-adjusted life years. We aimed to develop an estimation algorithm for EuroQol- 5 dimensions (EQ-5D)-based utilities from the clinical UPDRS or disease-specific HrQoL data in the absence of original utilities estimates. Methods: Linear and fractional polynomial regression analyses were performed with data from a study of Parkinsonâs disease patients (n=138) to predict the EQ-5D index values from UPDRS and Parkinsonâs disease questionnaire eight dimensions (PDQ-8) data. German and European weights were used to calculate the EQ-5D index. The models were compared by R2, the root mean square error (RMS), the Bayesian information criterion, and Pregibonâs link test. Three independent data sets validated the models. Results: The regression analyses resulted in a single best prediction model (R2: 0.713 and 0.684, RMS: 0.139 and 13.78 for indices with German and European weights, respectively) consisting of UPDRS subscores II, III, IVa-c as predictors. When the PDQ-8 items were utilised as independent variables, the model resulted in an R2 of 0.60 and 0.67. The independent data confirmed the prediction models. Conclusion: The best results were obtained from a model consisting of UPDRS subscores II, III, IVa-c. Although a good model fit was observed, primary EQ-5D data are always preferable. Further validation of the prediction algorithm within large, independent studies is necessary prior to its generalised use
Altered grey matter integrity and network vulnerability relate to epilepsy occurrence in patients with multiple sclerosis
Background and purpose: The aim of this study was to investigate the relevance of compartmentalized grey matter (GM) pathology and network reorganization in multiple sclerosis (MS) patients with concomitant epilepsy.
Methods: From 3-T magnetic resonance imaging scans of 30 MS patients with epilepsy (MSE group; age 41â±â15âyears, 21 females, disease duration 8â±â6âyears, median Expanded Disability Status Scale [EDSS] score 3), 60 MS patients without epilepsy (MS group; age 41â±â12âyears, 35 females, disease duration 6â±â4âyears, EDSS score 2), and 60 healthy subjects (HS group; age 40â±â13âyears, 27 females) the regional volumes of GM lesions and of cortical, subcortical and hippocampal structures were quantified. Network topology and vulnerability were modelled within the graph theoretical framework. Receiver-operating characteristic (ROC) curve analysis was applied to assess the accuracy of GM pathology measures to discriminate between MSE and MS patients.
Results: Higher lesion volumes within the hippocampus, mesiotemporal cortex and amygdala were detected in the MSE compared to the MS group (all pâ<â0.05). The MSE group had lower cortical volumes mainly in temporal and parietal areas compared to the MS and HS groups (all pâ<â0.05). Lower hippocampal tail and presubiculum volumes were identified in both the MSE and MS groups compared to the HS group (all pâ<â0.05). Network topology in the MSE group was characterized by higher transitivity and assortativity, and higher vulnerability compared to the MS and HS groups (all pâ<â0.05). Hippocampal lesion volume yielded the highest accuracy (area under the ROC curve 0.80 [0.67â0.91]) in discriminating between MSE and MS patients.
Conclusions: High lesion load, altered integrity of mesiotemporal GM structures, and network reorganization are associated with a greater propensity for epilepsy occurrence in people with MS
Order-Based Inference in Natural Logic
This paper develops a version of Natural Logic -- an inference system that works directly on natural language syntactic representations, with no intermediate translation to logical formulae. Following work by S'anchez, we develop a small fragment that computes semantic order relations between derivation trees in Categorial Grammar. The proposed system has the following new characteristics: (i) It uses orderings between derivation trees as purely syntactic units, derivable by a formal calculus. (ii) The system is extended for conjunctive phenomena like coordination and relative clauses. This allows a simple account of non-monotonic expressions that are reducible to conjunctions of monotonic ones. (iii) A decision procedure for provability is developed for a fragment of Natural Logic
Die Vorhersage gesundheitsbezogener LebensqualitÀt durch Selbstwirksamkeitserwartung und kardiovaskulÀre Risikofaktoren bei Patienten mit ischÀmischem Schlaganfall
Die Inzidenz von SchlaganfĂ€llen in Deutschland ist ĂŒber die letzten Jahre hinweg gestiegen; als einer der hĂ€ufigsten GrĂŒnde fĂŒr körperliche Behinderung ist damit die LebensqualitĂ€t der beÂtroffenen Patienten zusehends beeintrĂ€chtigt (Centers for Disease Control and Prevention (CDC) 2009).
Bislang wurde eine Reihe kardiovaskulĂ€rer Risikofaktoren identifiziert, die das Auftreten von SchlaganfĂ€llen begĂŒnstigen. Hierzu zĂ€hlen unter anderem arterielle Hypertonie, Diabetes melliÂtus, DyslipoproteinĂ€mie und Ăbergewicht (As et al. 2013; Kirtania et al. 2013; O'Donnell et al. 2010; Zhao et al. 2009). In verschiedenen Studien konnte ein Zusammenhang der RisikofaktoÂren mit gesundheitsbezogener LebensqualitĂ€t (HRQoL) dargestellt werden (Larsson et al. 2002; Poljicanin et al. 2010; Sullivan et al. 2007). DarĂŒber hinaus hĂ€ngt HRQoL mit SelbstwirksamÂkeitserwartung zusammen (AndenĂŠs et al. 2014; Bentsen et al. 2010; Phillips und McAuley 2014; Weng et al. 2010; Yeung, N C Y und Lu 2014). Dieses Konstrukt geht auf die SozialkognitiÂve Theorie von Albert Bandura zurĂŒck (Bandura 1977) und beschreibt die Ăberzeugung, durch die eigenen FĂ€higkeiten Einfluss auf das eigene Leben zu haben. In der Vergangenheit konnte gezeigt werden, dass Selbstwirksamkeit mit unterschiedlichem Gesundheitsverhalten zusamÂmenhĂ€ngt (Bandura 2004), so auch mit Verhaltensweisen, die das kardiovaskulĂ€re Risiko senÂken (Aljasem et al. 2001; Ogedegbe et al. 2003; Richman et al. 2001; Sarkar et al. 2006; Steele et al. 2011).
Ziel dieser Studie war es, mithilfe einer multiplen Mediationsanalyse in einem lĂ€ngsschnittliÂchen Design die gesundheitsbezogene LebensqualitĂ€t 24 Monate nach einem Schlaganfall durch die direkt nach dem cerebrovaskulĂ€ren Ereignis erfasste Selbstwirksamkeit vorherzusaÂgen, wobei die Beziehung vermittelt wird ĂŒber die kardiovaskulĂ€ren Risikofaktoren Blutdruck, HbA1c, LDL und BMI.
Die Datenerhebung fand wĂ€hrend des initialen Krankenhausaufenthaltes in dem UniversitĂ€tsÂklinikum GieĂen und Marburg, Standort Marburg, sowie sechs, 12 und 24 Monate nach dem Schlaganfall statt. Hierzu wurden Messinstrumente eingesetzt, deren GĂŒtekriterien in verschieÂdenen vorherigen Studien getestet wurden (Post et al. 2011; Rabin und Charro 2001; RamachÂaudran 1994).
Insgesamt wurden die Daten von 374 Patienten ausgewertet, deren demographische Daten - abgesehen vom Bildungsniveau - sowohl vergleichbar mit denen der BundesbĂŒrger als auch mit denen der Stichproben anderer groĂer Schlaganfallstudien sind (Kelly-Hayes et al. 2003; Kolominsky-Rabas et al. 1998; Palm et al. 2010). Ein GroĂteil der Patienten litt an arterieller HyÂpertonie, HyperlipoproteinĂ€mie und Ăbergewicht, ein Drittel war an Diabetes mellitus erÂkrankt. FĂŒr die multiple Mediationsanalyse konnten die Daten von 111 (Berechnung mit dem EQ-5D) resp. 80 (Berechnung mit dem SSQoL-12) Patienten genutzt werden, wodurch die TestÂstĂ€rke deutlich reduziert wurde. Keine der im Modell angenommenen Korrelationen erreichte statistische Signifikanz. Neben der eingeschrĂ€nkten Power können die Ergebnisse dadurch erÂklĂ€rt werden, dass die SpezifitĂ€t der erhobenen Daten zu ungenau gewĂ€hlt wurde; so wurden in den bisherigen Studien primĂ€r fĂŒr das jeweilige Krankheitsbild spezifische SelbstwirksamÂkeitserwartungen (Bentsen et al. 2010; Motl et al. 2013; Richman et al. 2001; Steele et al. 2011) zur Vorhersage von HRQoL genutzt. BezĂŒglich der Risikofaktoren indes wurden in frĂŒheÂren Erhebungen Verhaltensweisen wie Medikamentencompliance oder das Einhalten einer DiĂ€t erfasst anstelle der in der aktuellen Studie erhobenen, sehr spezifischen und möglicherÂweise von Drittvariablen abhĂ€ngigen Parameter wie dem HbA1c oder dem LDL (Aljasem et al. 2001; Sarkar et al. 2006).
DarĂŒber hinaus bezogen sich die in der Vergangenheit durchgefĂŒhrten Studien zur LebensquaÂlitĂ€t meist auf eine Gesamtpopulation, in der die AusprĂ€gung der LebensqualitĂ€t deutlich höÂher war als im aktuellen Studienkollektiv. Es ist möglich, dass ein Zusammenhang zwischen karÂdiovaskulĂ€ren Risikofaktoren und HRQoL nur bei einem vergleichsweise höheren Niveau der LebensqualitĂ€t aufzuzeigen ist. Die Risikofaktoren selbst sowie deren Standardabweichungen waren in der Stichprobe mit Ausnahme des BMI relativ niedrig ausgeprĂ€gt, so dass hier wiederÂum nur ein geringer Anteil an Varianz durch Selbstwirksamkeit aufzuklĂ€ren war.
In zukĂŒnftigen Studien gilt es, den Anreiz fĂŒr die Studienteilnahme zu erhöhen, so dass die DroÂpout-Rate möglichst gering gehalten und die TeststĂ€rke optimiert werden. Des Weiteren wĂ€ren Selbstwirksamkeit so spezifisch wie möglich und die kardiovaskulĂ€ren Risikofaktoren im Sinne gesundheitsförderlicher Verhaltensweisen zu erfassen. Die Datenerhebung sollte im Rahmen einer prospektiven Kohortenstudie statt finden, so dass die Daten um Aussagen bezĂŒglich der basalen AusprĂ€gung der einzelnen Variablen erweitert werden können
Depression in elderly patients with Alzheimer dementia or vascular dementia and its infl uence on their quality of life
Background: Alzheimer dementia (AD) and vascular dementia (VD) are the most common causes of dementia in the elderly. Depression is an important co-morbid disorder in these diseases, which is often challenging to recognize. We investigated the prevalence of depression in patients with AD and VD and estimated the influence of depression on the health-related quality of life (HrQoL) in these patients. Materials and Methods: We evaluated prevalence of depression in consecutively recruited patients with AD or VD (n= 98). Depression was diagnosed according to criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and scored using the Geriatric Depression Scale. The EuroQol (EQ-5D and visual analogue scale) was applied to evaluate HrQoL. The severity of cognitive impairment was measured by the Mini-Mental State Examination (MMSE). Multiple regression analysis was used to identify factors predicting severity of depression. Results: The prevalence of depression in AD/VD was 87%. In comparison to the general population, HrQoL measured on the visual analogue scale was reduced by 54% in patients with AD/VD. In the dimension âanxiety/depressionâ of the EQ-5D, 81% of patients with AD/VD had moderate or severe problems. Depression showed significant association with reduced HrQoL (P < 0.01). Independent predictors of more severe depression were older age, male gender, better MMSE scores and being not married. Conclusions: Depression is a prevalent psychiatric co-morbidity in patients with AD/VD, which is often under-diagnosed being masked by cognitive impairment. Depression is a predictor of reduced HrQoL in elder people with AD/VD. Therefore, they should be screened for presence of depressive symptoms and receive adequate antidepressant treatment