39 Escritores y medio (Las Tres Edades) (Spanish Edition)

Unfortunately, data about kidney graft donor biopsies were not available and a better correlation with histology could not be performed. Final evidence will come from prospective studies.. Development of predictive scores by regions may better help in the organ acceptance decision.. The authors have no conflicts of interest to declare.. DR-P and AB contributed in data analyses.

Under a Creative Commons license. Introduction Kidney donor shortage requires expanding donor selection criteria, as well as use of objective tools to minimize the percentage of discarded organs. We aimed to establish the accuracy of the three models to determine the prognostic value of kidney transplantation KT major outcomes.

Material and methods We performed a retrospective study in deceased donor KTs at our institution. Results KTs were included. More studies are needed before using KDPI as a tool to discard or accept kidneys for transplantation. Resultados Se incluyeron TR. Introduction The gap between organ supply and the number of patients requiring kidney transplantation KT becomes larger along the time. Material and methods Study design and data collection This was a retrospective patient cohort based study.

Finally, DDKT in patients were analyzed. The study was undertaken following the principles in the World Medical Association Declaration of Helsinki, only relying in the official center database. Variables Donor variables included in ECD and KDPI definitions were considered, as well as recipient variables, such as age, sex, ethnicity, hypertension, diabetes, hepatitis C virus, hepatitis B virus, cardiac disease, peripheral vascular disease, underlying kidney disease, maximum cytotoxic panel reactive antibody PRA prior to transplant and time on dialysis before transplant.

Statistical analysis Quantitative variables with a normal distribution are expressed as mean and standard deviation SD and the remaining as median and interquartile range [IQR]. The variable acute rejection proven by biopsy was included as time-dependent covariate in both graft and death-censored graft survival analyses. The baseline characteristics of recipients, donors, and kidney transplants are shown in Table 1. Baseline characteristics of recipients, donors and kidney transplants. Cox univariate analysis with variables related to patient death, graft failure and death-censored graft failure.

Different models were calculated including donor age as a continuous variable, donor age above 60 years, expanded criteria donor definition, KDPI continuous variable or different cut-off levels for KDPI. Am J Transpl, 15 , pp. Catalan Transplant Organization, Health Department, N Engl J Med, , pp. Outcomes of kidney transplantation from older living donors to older recipients. Am J Kidney Dis, 52 , pp. Renal transplantation in recipients over the age of Transplantation, 67 , pp.

Pascual, Catalan Renal Registry Committee. Survival benefit from kidney transplantation using kidneys from deceased donors over 75 years — a time dependent analysis. Am J Transpl, 16 , pp. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol, 12 , pp. Survival of recipients of cadaveric kidney transplants compared with those receiving dialysis treatment in Australia and New Zealand, — Nephrol Dial Transpl, 17 , pp.

Donor characteristics associated with reduced graft survival: Transplantation, 74 , pp. A systematic review of kidney transplantation from expanded criteria donors. Strategies for an expanded use of kidneys from elderly donors. Transplantation, , pp. A paired survival analysis comparing hemodialysis and kidney transplantation from deceased elderly donor older than 65 years.

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Transplantation, 99 , pp. Comparison of survival outcomes between expanded criteria donor and standard criteria donor kidney transplant recipients: Transpl Int, 29 , pp. A comprehensive risk quantification score for deceased donor kidneys: Transplantation, 88 , pp. The meaning and use of the area under a receiver operating characteristic ROC curve. Radiology, , pp. Is the Kidney Donor Risk Index a step forward in the assessment of deceased donor kidney quality?.

Nephrol Dial Transpl, 30 , pp. Kidney Donor Profile Index: Nefrologia, 36 , pp. Am J Transpl, 14 , pp. Transplantation, 63 , pp. The influence of age on outcome after renal transplantation. Geriatr Nephrol Urol, 7 , pp. The impact of donor age on the results of renal transplantation. Nephrol Dial Transpl, 19 , pp.

Kidney transplantation in the elderly — the Norwegian experience. Nephrol Dial Transpl, 23 , pp. Renal transplants using expanded cadaver donor criteria. Ann Transpl, 9 , pp. Utilization of kidneys with similar Kidney Donor Risk Index values from standard versus expanded criteria donors. Am J Transpl, 12 , pp. The combination of donor and recipient age is critical in determining host immunoresponsiveness and renal transplant outcome.

Ann Surg, , pp. The combined risk of donor quality and recipient age: Transplantation, 98 , pp. Kidney donor risk index is a good prognostic tool for graft outcomes in deceased donor kidney transplantation with short, cold ischemic time. Clin Transpl, 28 , pp. Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: Transpl Int, 30 , pp. These authors contributed equally. Si continua navegando, consideramos que acepta su uso.

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Are you a health professional able to prescribe or dispense drugs? The costs generated by PD were estimated by including both direct and indirect costs. Direct costs were those generated directly by primary care, other levels of medical care, and treatments. Indirect costs were those generated by the decrease in productivity due to the patient's early retirement or decreased participation in the workforce on the part of the carer.

We also find intangible costs that gauge the patient's degree of suffering due to the decrease in quality of life.. In addition to evaluating the motor symptoms that characterise PD, it is important to assess non-motor symptoms, especially psychiatric symptoms, which contribute greatly to the decision to institutionalise patients. Multiple studies evaluate the direct and indirect costs of PD associated with both motor and non-motor symptoms. Furthermore, monetary expenses rise as the disease progresses, such that a higher score on the UPDRS signifies higher direct costs generated by the disease.

In the Spanish population, the economic impact of PD was measured in a cross-sectional multicentre study in a cohort of 82 patients in Using this approach, it analysed the association between clinical variants and their direct and indirect costs. The indirect costs, whether medical or non-medical, included specialist and primary care visits, diagnostic tests, prescribed orthotics, transport, homecare services, home adaptations, etc. Indirect costs generated by the disease were linked to a decrease in workplace productivity as well as to early retirement.

As has been shown on multiple occasions, drug costs place the highest burden on the healthcare system. The lower costs linked to surgical treatment was the result of the reduced drug consumption in patients treated with DBS rather than the other techniques requiring continuous administration of dopaminergic drugs. Data support using advanced PD therapies rather than conventional drug treatment in patients referred to more specialised hospitals.

Generally speaking, evidence shows that costs incurred by patients undergoing DBS may be as much as The appearance of motor complications worsens quality of life in addition to increasing costs. As the second most common neurodegenerative disease, PD incurs major healthcare expenses in our population. The severity of this disease, and the extent of the disability caused by motor and non-motor symptoms, contribute greatly to increases in both direct and indirect costs. Evaluating use of advanced treatments for these cases of PD is therefore of the utmost importance.

Projections for the future, taking into account the tendency of life expectancy to increase, indicate that there will be rising demand for social and healthcare resources having to do with PD. Developing and optimising not only treatments but also health protocols able to reduce the social and economic impact of PD on the population is therefore a crucial undertaking.. Since no data on this type of neurological care are available in Spain, the present report includes a study whose main objective is to define the public and private resources offered to patients with PD in our country..

We received answers from a total of 40 neurologists from 40 different hospitals throughout Spain. Respondents included neurologists from all of Spain's autonomous communities. Although data do not reflect the entire panorama of PD care in Spain, since we do not have data from every health district, it does map out an approximate idea of how neurological care is provided to PD patients at this time.. Secondly, we consulted data from the Imserso publication 89 on the situation, needs, and priorities of patients with PD.. According to the analysis of data provided by the surveys, all of Spain's autonomous communities have at least one specialised PD unit.

Health districts with fewer than inhabitants also have specialist clinics. The Region of Madrid has specialised units in all of its major hospitals, with specialist consults in smaller hospitals. Catalonia is another example of an autonomous community with specialised units in all major hospitals, most of which are in Barcelona. The types of patients cared for by these units will vary from place to place. Half of the units provide care to all patients diagnosed with PD who are referred to the neurology department.

The patient referred by a general practitioner as a suspected PD case will be seen by a general neurologist.

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This doctor in turn will assign the case to the specialised unit, and all follow-up work will be performed by that unit. This is the dominant model in Madrid and Barcelona. Other units, such as those in Seville and in most hospitals in the Valencian Community and Castile-Leon, only follow up on complicated patients, young patients, or those undergoing advanced therapy with perfusion or deep stimulation techniques..

PD units include one to 5 neurologists, who are not solely dedicated to that unit in most cases. They will also be active in other areas of neurology. Patients in the early stages of PD are examined in the specialised unit once or twice yearly, whereas patients in later stages are seen every 3 months on average. However, respondents from most hospitals stated that the patients had a direct line of contact in case they needed to move up their appointment.. We note that only 10 of the 40 units on which we have data are supported by a specialised nursing consult.

This consult is usually offered once a week. Another 10 hospitals have general nursing staff assisting neurologists specialised in PD in their consults. Telephone consults are not a common practice.. What we have discovered is that although PD units should be multidisciplinary, the vast majority of them consist solely of neurologists. Neurologists work with neurosurgeons and neurophysiologists in those units performing DBS.. There are no specific rehabilitation programmes in any of these units, or in any rehabilitation departments in public hospitals.

This coincides with the Spanish National Health System's list of common services approved by Royal Decree in ; according to this document, rehabilitation, including physical, occupational, and speech therapy, is currently considered only for those patients with a reversible functional loss. This being the case, most patients with PD do not have continued access to these therapies in hospitals forming part of the Spanish National Health System.

Rather, this role is filled by patient associations, which will be described in a later section.. According to the data obtained, advanced therapies are covered sufficiently in most of Spain's autonomous communities. All 40 hospitals from which we received a response indicated that they can perform apomorphine and duodopa pump therapy. While DBS is performed in 15 of the 40 hospitals, it is available for patients in all autonomous communities.

Nevertheless, waiting periods are long at 6 months to a year at most hospitals.. Our data are limited, but they do show that once patients have been referred to extremely specialised units, which is an option in most provinces, their neurological care is well covered. Units with neurologists able to dedicate at least part of their time to specialised care are available in all provinces in Spain. Intervals between follow-up visits are reasonable, and patients experiencing emergencies can contact their doctors directly.

However, there are drawbacks including a marked lack of the other treatments that are fundamental to the complex task of managing PD: The waiting lists for surgical treatment are also very long.. According to data from Imserso, 90 the main problem seems to stem from the preceding level, primary care. Long periods of time may pass before some patients are suspected of having Parkinson's disease and referred to a neurologist. One possible explanation is that this disease has numerous manifestations and may therefore be difficult for a general practitioner to recognise.

Furthermore, PD has a low prevalence in the primary care setting compared to other diseases, so general practitioners may be less familiar with its signs.. As mentioned before, the Spanish public health system does not contemplate part of the integral treatment that patients with PD need, and which includes physical, speech, and occupational therapy, and psychological support. This gap is currently filled by patient associations.

Part of the problem arises from their neurologists not providing this information. Patients are more commonly informed of these options in specialised units, where neurologists have a deeper understanding of integral treatment of the disease and tend to work with associations in their area.. However, these treatments are essential at all stages of the disease. As we have seen, patients in the early stages of Parkinson's disease are not seen in specialised units. Rather, they are assessed by general neurologists who do not provide information about patient associations and other treatment options available because they are not aware of them.

Doctors at the primary care level are also unlikely to know of any patient associations.. Associations also provide material to patients and their family members that healthcare professionals may not explain fully. Among other activities, associations organise training courses, sessions, and workshops on the disease which are aimed at both patients and their carers. This being the case, good care will require raising awareness of the role played by associations and better coordination between them and healthcare professionals at all levels..

In addition to its effects on patients, PD has an impact on those living with them. Patients with PD present an array of motor symptoms that will give rise to various difficulties and disabilities over the course of the disease. As the disease progresses, the patient will experience decreased autonomy, obliging the family to gradually take responsibility for his or her daily activities.

This will involve a loss of free time, working time, or leisure activities on the part of the patient's main carer. However, patients will present other types of symptoms that are equally important and which limit quality of life and social relationships: All of these manifestations mean that family relationships will be affected at all stages of the disease..

The extent to which all of these considerations will affect the family is fundamentally determined by the patient's age.

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Older patients tend to be more accepting of their condition, whereas the workplace and economic problems that PD poses for younger patients make their experience more traumatic. Behaviour disorders in younger patients, especially compulsive behaviours, are common and they can result in serious difficulties in the home, including divorce and family rupture.. The consequences of these disruptions are extremely negative for families in some cases.

Carers may experience depression, apathy, exhaustion, and social isolation. They will require substantial psychological support, in addition to social assistance and information. These aspects of the disease are normally covered by associations.. This report allows us to conclude that PD incidence and prevalence in Spain are similar to rates in the rest of Europe.

Given the current population estimates, we calculate that there are at least patients with PD in Spain. The disease has a major impact on the patient's quality of life and mortality rates are nearly twice that in non-patients. Healthcare professionals and government bodies are making a concerted effort to provide patients with quality care. Nevertheless, much remains to be done to ensure high-quality, effective multidisciplinary care for all patients with PD in Spain..

The authors have no conflicts of interest to declare.. Please cite this article as: Report by the Spanish Fou Previous article Next article. July - August Pages The social impact of Parkinson's disease in Spain: Report by the Spanish Foundation for the Brain. This item has received. Introduction Understanding the social and economic impact of Parkinson's disease is essential for resource planning and raising social awareness. Development Researchers reviewed the data published to date on epidemiology, morbidity and mortality, dependency, and economic impact of Parkinson's disease in Spain.

In addition, a study has been carried out in order to define the public and private health care resources of Spanish patients affected by Parkinson's disease by means of an e-mail survey of all neurologists specialising in this disease and belonging to the Spanish Society of Neurology's study group for movement disorders.

Conclusions The incidence and prevalence rates of Parkinson's disease in Spain are similar to those in the rest of Europe. Despite the above, we still have a long way to go in order to provide quality, efficient, multidisciplinary, and universal healthcare. A pesar de ello es mucho el camino que nos queda por recorrer para que una asistencia de calidad, eficaz y multidisciplinar sea universal para todos los pacientes con esta enfermedad. Introduction The Spanish Foundation for the Brain was created to raise social awareness of neurological diseases and present the most accurate information to patients, family members, and non-neurological healthcare workers.

In compliance with some of these objectives, the Foundation of the Brain prepares reports on the societal impact of different neurological diseases in Spain. Society and health authorities alike are becoming increasingly aware of the need for quality specialist care for these patients, since patient management in such cases is complex and the treatment provided is crucial and may even change the prognosis over the long term. With this in mind, the Foundation of the Brain has completed a report on the social implications of PD in which it presents what we know about the disease's epidemiology, morbidity and mortality, and economic impact, as well as care for these patients in Spain.

Development Epidemiology of Parkinson's disease in Spain Estimates of the incidence and prevalence of degenerative diseases, such as PD, are important not only as epidemiological information, but also in resource planning. From a methodological viewpoint, the main differences are due to differing diagnostic criteria, the age of the study population, and the case selection methods. The most important epidemiological data are generated by door-to-door studies, which include such large longitudinal epidemiological studies as the Framingham study, the East Boston study, and EURODEM.

Sex-based or age-based variations in disease incidence in a certain place also let us study the environmental or other factors that may affect that disease. They also believe these studies underestimate the real numbers since many are based on diagnostic records and overlook patients who do not see a doctor. Prevalence studies of Parkinson's disease in Spain. Epidemiology and etiology of Parkinson's disease: Eur J Epidemiol, 26 , pp. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry, 51 , pp.

Research diagnostic criteria for Parkinson's disease. Adv Neurol, 53 , pp. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: J Neurol Neurosurg Psychiatry, 55 , pp. Improved accuracy of clinical diagnosis of Lewy body Parkinson's disease. Neurology, 57 , pp. Accuracy of the clinical diagnoses of Lewy body disease, Parkinson disease, and dementia with Lewy bodies: Arch Neurol, 55 , pp. Systematic review of incidence studies of Parkinson's disease. Mov Disord, 18 , pp. Acta Neurol Scand, 84 , pp. Prevalence and incidence of Parkinson's disease in Europe.

Eur Neuropsychopharmacol, 15 , pp. Incidence of idiopathic and secondary Parkinson disease in Navarre. Neurologia, 14 , pp. Incidence of Parkinson disease and parkinsonism in three elderly populations of central Spain. Neurology, 62 , pp. Neurol Clin, 10 , pp. Projected number of people with Parkinson disease in the most populous nations, through Neurology, 68 , pp.

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Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Prevalence of Parkinson's disease in Cantalejo, Spain: Mov Disord, 17 , pp. Prevalence of Parkinson's disease and other types of Parkinsonism. A door-to-door survey in Bidasoa, Spain. J Neurol, , pp. Prevalence of Parkinson's disease in lower Aragon, Spain. Mov Disord, 14 , pp. Estimation of the prevalence of Parkinson's disease in Asturia, Spain. A pharmacoepidemiological study of the consumption of antiparkinson drugs.

Rev Neurol, 31 , pp. Use of antiparkinsonian agents in Castilla-La Mancha. Estimate of prevalence of Parkinson disease. Rev Neurol, 27 , pp. The estimation of prevalence of Parkinson disease in Navarra. An epidemiological study of the consumption of anti-parkinsonian drugs. Prevalence of parkinsonism and Parkinson's disease in Europe: J Neurol Neurosurg Psychiatry, 62 , pp.

A report on a Spanish series. Rev Neurol, 45 , pp. Parkinsonism Relat Disord, 16 , pp. Parkinson's disease due to the RG mutation in Dardarin: Mov Disord, 21 , pp. Lopez de Munain, A. Neurogenetics, 10 , pp. Mov Disord, 25 , pp.

Mov Disord, 26 , pp. Rev Neurol, 50 , pp. Eur J Neurol, 16 , pp. Arch Neurol, 63 , pp. Instrumentos, estudios comparativos y tratamientos. Rev Neurol, 49 , pp. Determinantes y factores asociados. Assesing quality of life in Parkinson's disease using the PDQ Neurologia, 12 , pp.

Quality of life in Parkinson's disease: An introduction to the concept of quality of life in Parkinson's disease. Pallidotomy and quality of life in patients with Parkinson's disease: Mov Disord, 15 , pp. Bilateral subthalamic nucleus stimulation and quality of life in advanced Parkinson's disease. Improvement in quality of life of life in patients with advanced Parkinson's disease following bilateral deep-brain stimulation in subthalamic nucleus.

Eur J Neurol, 11 , pp. The importance of educational and psychological factors in Parkinson's disease quality of life. Eur J Neurol, 9 , pp. Repercusiones sobre la calidad de vida del deterioro cognitivo en la enfermedad de Parkinson. Rev Neurol, 43 , pp. Behav Neurol, 8 , pp. Assesment of cognition in Parkinson's disease. Neurology, 61 , pp. Measurement of health-related quality of life for people with dementia: Health Technol Assess, 9 , pp. Health Qual Life Outcomes, 1 , pp. A review of quality of life instruments used in dementia.

Qual Life Res, 14 , pp. Influence of motor symptoms upon the quality of life of patients with Parkinson's disease. Eur Neurol, 57 , pp. Cano de la Cuerda, L. Rev Neurol, 51 , pp. Trastornos no motores de la enfermedad de Parkinson: Pain in Parkinson's disease: Rev Neurol, 52 , pp. Rev Neurol, 42 , pp. A pilot study on a specific measure for sleep disorders in Parkinson's disease: Mov Disord, 24 , pp.

Eur J Neurol, 17 , pp. Frades, miembros del grupo ELEP. Impact of motor and non-motor symptoms on the direct costs of Parkinson's disease. Neurologia, 24 , pp. What contributes to driving ability in Parkinson's disease.