Objective: To determine the health economic burden on patients with Parkinson’s disease (PD) in Germany over a 12‐month observation period and provide a comprehensive analysis of cost‐driving ...factors.
Methods and patients: Patients with PD (n = 145) were recruited from two clinical departments, two office‐based neurologists and 12 GPs. Clinical evaluations were performed at baseline, 3, 6 and 12 months. Disease severity was measured using the Unified Parkinson’s Disease Rating Scale (UPDRS). Cost data were assessed based on a patient diary and via personal structured interviews at the respective time‐points. Costs were calculated from the societal perspective (2009 €). Cost‐driving factors were identified by multivariate regression analysis.
Results: Mean annual costs totalled €20 095 per patient. Amongst direct costs, the highest expenditures (€13 158) were for drugs (€3526) and inpatient care including nursing homes (€3789). Indirect costs accounted for 34.5% (€6937) of total costs. Costs of home care provided by family accounted for 20% of direct costs. Cost‐driving factors were identified for total costs (UPDRS, fluctuations, dyskinesia and younger age), direct costs (UPDRS, fluctuations), patient expenditures (UPDRS, depression) and drug costs (younger age).
Conclusion: Parkinson’s disease has a chronic course with growing disability and considerable socioeconomic burden. Disease progression leads to an increasing number of patients who require costly institutionalized care. Home care is a major factor influencing patients’ families. Healthcare programmes aimed at reducing the burden of PD on society and individuals should consider cost‐driving factors of PD.
The advent of therapeutic strategies designed to modify the disease course in Parkinson's disease has raised great expectations in the currently conducted clinical trials. However, we see ethical ...challenges in the cooperation of industry and clinical partners, specifically evident in the way recruitment is performed.We here discuss the different positions and challenges of all involved to set the stage for a study and recruitment culture taking into account the expectations of all: (i) patients and their caregivers, ready to take the considerable burden of clinical trials in hope for the development of disease-modifying treatments; (ii) physicians and study nurses, obligated to the patients' well-being and benefit who accompany and supervise patients closely as basis for the performance of elaborate clinical trials (iii) industrial partners, investing years of efforts and finances to develop new treatments.
We conclude that the current competitive race for enrollment in clinical studies in PD is challenging the primary goal to ensure patients' benefit and formulate requests to the industrial partners to encounter these concerns.
This article is devoted to an analysis of plant remains from the Early Iron Age site of Boso-Njafo on the Lulonga River (Democratic Republic of the Congo). They were excavated in the context of ...archaeological research in 1985 but—due to unfavorable circumstances— could not be analyzed at that time. The site belongs to the Imbonga group, the earliest ceramic style group to date in the Inner Congo Basin. The archaeological context of the botanical remains is dated to the first millennium cal (Pennisetum glaucum). A correlation between cultivation of this crop, that is primarily adapted to semi-arid environments, with the climatic changes taking place in the second and first millennium cal is discussed. However, regional palaeoecological proxy data for the Inner Congo Basin are still missing. Further plant species present in Boso-Njafo include trees with edible fruits like Musanga cecropioides, Raphia, and Elaeis guineensis, Afromomum sp., and some grasses and herbs exploitable as leafy vegetables. They indicate a forest environment including swamps and secondary Guineo-Congolian forests as well as disturbed ruderal vegetation. Cet article porte sur l'analyse des restes de plantes du site de l'Âge du Fer ancien de Boso-Njafo sur la rivière Lulonga (RDC). Ces restes ont été mis au jour au cours de recherches archéologiques en 1985, mais ils n'ont pu être étudiés que très récemment. Ce matériel botanique est associé au groupe Imbonga qui actuellement représente le plus ancien style céramique du bassin intérieur du Congo. Le contexte archéologique des plantes de Boso-Njafo est daté du courant du premier millénaire cal Le fait le plus frappant concernant ces plantes est la mise en évidence du mil (millet perlé, Pennisetum glaucum). Une corrélation de la culture de cette plante, principalement adaptée aux environnements semi-arides, avec les changements climatiques qui ont eu lieu dans le 2éme et 1er millénaire cal est discutée. BC est discutée Toutefois, des données paléoécologiques régionales manquent pour l'intérieur du bassin du Congo. D'autres espèces végétales présentes à Boso-Njafo comprennent des arbres à fruits comestibles comme Musanga cecropioides, les palmiers Raphia et Elaeis guineensis, Afromomum sp. et des graminées et des herbes utilisables comme herbes potagères. Ils indiquent un environnement de forêts, y compris de marécages et de forêts guinéo-congolaises secondaires ainsi qu'une végétation ruderale perturbée.
The tutor‐web is an open‐source learning environment designed to be used for teaching mathematics and statistics. The system offers thousands of exercises at high school and university level, and has ...been used for a decade to teach introductory statistics courses with good results. A new component has recently been added to the tutor‐web so that students can enter their own data or get real data from several data sources for practicing and learning new concepts.
Background
Chronic spontaneous pain is a clinically relevant non‐motor symptom in multiple system atrophy (MSA) and Parkinson's disease (PD). Experimental pain sensitivity, reflecting the mechanisms ...of nociception and pain perception leading to clinical pain, is known to be enhanced in both diseases at advanced stages. Also, this study aimed at investigating experimental pain sensitivity already at an early stage (i.e. symptom duration ≤5 years).
Methods
Experimental pain sensitivity was assessed by investigating the nociceptive flexion reflex (NFR, reflecting spinal nociception) and heat and electrical pain thresholds. ‘Off‐drug’ MSA (n = 11) and PD (n = 14) patients selected at an early stage of the disease were compared to healthy controls (HC, n = 27). MSA patients had either parkinsonian (MSA‐P, n = 5) or cerebellar (MSA‐C, n = 6) subtypes.
Results
Compared to HC, MSA patients had lower heat pain sensitivity, whereas PD patients had reduced NFR threshold. MSA and PD patients did not differ from HC regarding other variables. MSA‐P and MSA‐C patients did not differ, either.
Conclusions
Impaired sensory discrimination and attention deficits could contribute to the reduced perception of heat pain in MSA, whereas in PD, local changes in spinal excitability or a diminished dopaminergic descending inhibition might impact on the motor efference of the NFR to reduce its threshold to nociceptive afferent information.
What does this study add?
This study investigated experimental pain sensitivity at an early stage in MSA and PD.
Transdermal patches are used for the treatment of various diseases including neurologic and psychiatric disorders such as Parkinson disease (PD), major depression, and attention deficit hyperactivity ...disorder. They are believed to offer many advantages over conventional oral therapies. By providing smoother, continuous drug delivery and steadier plasma levels, patches may reduce the incidence of side effects, thus making optimal therapeutic doses easier to attain and potentially improving treatment efficacy and compliance. Drug delivery systems such as patches that are more patient- and caregiver-friendly may enable patients to continue treatment for longer periods and to attain greater, more sustained treatment benefits. To date, approved therapies for Alzheimer disease (AD), including cholinesterase inhibitors and memantine, are orally administered. Potential advantages associated with patches provide a therapeutic rationale to offer additional benefits in AD patients. Rivastigmine is well suited to patch administration because it is a small, potent molecule that is both lipophilic and hydrophilic. A rivastigmine patch has been developed and may provide a promising new approach to dementia therapy.
The fungal infection of emmer grain (Triticum dicoccum) with Fusarium graminearum and Fusarium culmorum was investigated at the level of the proteome. High‐resolution two‐dimensional gel ...electrophoresis and mass spectrometry were used to identify proteins that were differentially expressed in response to fungal infection of emmer. Moreover, the effects of natural field conditions at two locations on the carbon and nitrogen contents and the mycotoxin concentration of emmer grains were evaluated. Inoculation of emmer with a mixture of the two Fusarium species led to infection of the ears, with deoxynivalenol concentrations up to 10 mg kg−1 in the grain. Carbon concentration and crude protein content were not significantly changed, but 10 distinct proteins changed in abundance. Stress‐related proteins, such as a serine protease inhibitor, a thaumatin‐like protein that reduced fungal growth and the starch hydrolysis β‐amylase increased upon infection, whereas the stress‐related proteins peroxidase, peroxiredoxin, a starch‐synthesis protein (a glycosyltransferase) and a fungal cell wall degrading protein (a chitinase) decreased. Furthermore, levels of three storage proteins in emmer grains were affected by Fusarium infection: α‐gliadin decreased and two globulins increased upon infection.
Clist et al comment on Garcin et al's study which assumed that a sharp increase in settlement activities in the Central African rainforest during the first millennium BC caused widespread ...deforestation between 2,600 and 2,020 cal y BP (the late Holocene rainforest crisis or LHRC). They conclude that currently available archaeological evidence does not point toward a major anthropogenic impact on the Western Central African rainforest between 2,600 and 2,000 cal y BP. In other words, it is very unlikely that human activity triggered the LHRC.
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