The BlandAltman analysis demonstrates that the dispersion of the mean error is not very wide, between 4.
From a clinical point of view this means that for the low and central values perimeters between 73 and cm the overlapping of the results of the two techniques is almost perfect, with no clinical differences. Differences may only occur with very large abdominal perimeters.
The radiological estimation of the abdominal perimeter by a circumferential line or by using the ellipse perimeter formula also seems to function as an equivalent of the standing waist circumference. Both methods yielded similar results. The measurement performed by using a circumferential line that approximates the use of a Gulick tape seems more logical to use in this case.
Furthermore, the results were practically identical to those obtained by direct measurement of the abdominal perimeter in supine position. Nonetheless, this feature was only available in a program, OsiriX, which we do not use on regular bases.
Our workstations are still based on Windows and the RAIM Alma program does not allow a direct estimation of any kind of perimeter.. For that purpose we introduced the idea of approximating the abdominal circumference by using a formula proposed for the estimation of the perimeter of an ellipse. As expected, we found a good correlation between the measurements, and the BlandAltman analysis returned a mean error of just 1. As in the case of the supine abdominal perimeter, the differences appeared with very high values, more than The central and low values of the waist circumference overlapped almost perfectly Figure 2.
The sub-analysis of values between 73 and cm showed a mean error of 0. Our study showed that for abdominal perimeters of less than cm the supine and standing position measurements are equivalent. The estimation of the abdominal perimeter using either a circumferential line or the formula for the perimeter of an ellipse is also equivalent to the real abdominal perimeter measured in standing position..
All authors declare that there is no duality of interest associated with the manuscript..
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Please cite this article as: Artigo anterior Artigo seguinte. Measurement of waist circumference for retrospective studies — Prospective validation of use of CT images to assess abdominal circumference. Alexandru Ciudin a , b ,?? Mostrar mais Mostrar menos. Introduction To validate the use of supine position and CT images for assessing abdominal circumference AC. Method A prospective study in consecutive patients undergoing scheduled abdominal CT at our center between 17 and 25 September While lying on the CT table.
On CT images with a skin contour line, using OsiriX software. Student's t tests and Q-Q and BlandAltman plots were used for statistical analysis. Results A total of patients were recruited. Resultados Se incluyeron pacientes. Moreover, as the waist circumference changes with time, it cannot be evaluated retrospectively.
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Method We performed a prospective study with three independent observers in consecutive out-patients who underwent a programmed abdominal CT in our center between the 17th and the 25th of September In supine position on the CT table. On CT images with a free-hand elliptical line following skin contour. On CT images using an ellipse perimeter formula, imputing anterior-posterior and transverse abdominal diameters. After the patients took 2 or 3 normal breaths the abdominal circumference was measured at the end of a normal expiration.
The waist circumference was measured in the vertical plane cranial from the iliac crest, similar to the standing measurement. The study adheres to local regulations and standards and was approved by the Institutional Review Board. Detailed CT acquisition parameters for a standard non-enhanced abdominal scan. Evaluation of the waist circumference on a CT image, using both a line to approximate the skin contour and calculating the anteriorposterior and transverse abdominal diameters.
Results of the comparison of standing abdominal perimeter versus supine, circumferential and ellipse perimeter abdominal perimeter.
Q-Q plot of standing versus ellipse formula abdominal perimeters. BlandAltman plot of the differences between the standing and the ellipse formula abdominal perimeters. Diabet Med, 23 , pp. Body mass index, waist circumference, and health risk: Many of the prevalence studies completed in Spain have clear methodological limitations, but they provide the only information available on PD in our setting.
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Furthermore, we should be mindful that these studies are very costly in terms of both time and money, and they are often underrated.. Spanish studies show a marked increase in prevalence after age 70, with decreasing prevalence in older cohorts that is probably due to patient mortality. Only the study by Errea et al. In addition to those described above, we find a cross-sectional retrospective multi-centre study showing that PD onset before the age of 40 was predominant in men in urban settings. According to Errea et al. While this tendency seems to arise in Spanish studies, data from other European countries do not support it..
The aetiology of sporadic PD remains unknown. Environmental and genetic factors contribute to its physiopathogenesis. It accounts for 0. The frequency of the mutation in sporadic PD cases in Seville 29 was determined to be 1. These data are similar to those from other regions of Europe. The RG mutation that is so common in the Basque population figures only as a rare cause of PD in the Catalan study; it was present in 0. Morbidity is defined as the percentage of individuals who contract an illness in a specific time and place, but from an epidemiological standpoint, the concept can be applied to the study and measurement of the presence of a specific disease and its effects on a population.
In the case of PD, we can define 2 perspectives on quantifying these effects. Secondly, specific effects on a given patient. Since PD is studied within the biopsychosocial model, analysing how all medical and social interventions directed at patients affects their quality of life has become increasingly important.. There are many reasons for diminished quality of life in patients with PD, including reduced mobility, falls, motor complications, affective disorders, and sleep disorders. Since many of these aspects go unnoticed in routine clinical assessments, doctors require instruments specifically intended to measure quality of life that can be applied systematically.
With this end in mind, a pilot study and a multi-centre study concluded that the Spanish version of the PDQ was valid and consistent as an instrument for the assessment of physical, emotional, and psychosocial aspects of quality of life in patients with PD.. Numerous publications have also studied the impact of surgical treatment for PD on health-related quality of life.
A study of 11 patients undergoing pallidotomy 36 and in which quality of life was measured with the PDQ found a statistically significant improvement in the global index as well as in 4 of its aspects of well-being: Another study in 17 patients who underwent bilateral stimulation of the subthalamic nucleus 37 analysed the impact of this treatment on quality of life using the Spanish-language version of the PDQ It found statistically significant improvement on its summary index and on the dimensions for mobility and activities of daily living.
Benefits were less marked for other dimensions, such as bodily discomfort, emotional well-being, and stigma; none were detected for the rest.
A third study 38 examined the changes in the PDQ score in 14 patients a year after they underwent subthalamic stimulation, as well as 2 years after the procedure in 11 of those patients. In light of these results, these authors highlight the importance of evaluating quality of life as part of the pre- and post-surgical assessment for patients with PD..
Using a sample of patients with PD referred to a specialised unit, Cubo et al. Specifically, low educational level, memory complaints, and psychotic symptoms are associated with poorer quality of life; along with depression, parts I and II of the Unified Parkinson's Disease Rating Scale UPDRS and educational level are the most important predictors of variation in scores on quality of life questionnaires.. Regarding symptoms of the disease and their impact on quality of life, one study in patients 46 analysed the correlation between years living with the disease and PDQ with the UPDRS score.
In another study, 47 an isokinetic dynamometer was used to assess axial rigidity in 36 patients and correlated findings with PD severity, number of years since diagnosis, functioning, and health-related quality of life. The authors concluded that axial rigidity affected quality of life because increased rigidity was associated with greater disability for trunk movements, an increase in perceived stigma, and poorer cognitive function..
A presentation published in addressed non-motor symptoms, 48 focusing on their prevalence, rate of underdiagnosis, and impact on quality of life. These symptoms are the leading cause of morbidity and the main reason for institutionalisation and hospitalisation of patients with PD.
The authors also stressed that numerous scales had been developed to detect and measure these symptoms, including quality of life scales. A prospective study focusing on non-motor symptoms such as pain, and including PD patients assessed in a movement disorders unit, 49 found a very high prevalence of pain in the sample They also determined that this symptom behaved as an independent predictor of poorer quality of life measured with the PDQ, and of reduced autonomy on the Schwab and England scale; it was also associated with depression and increased stress and burden on the part of the carer..
ELEP is a national multi-centre longitudinal and observational follow-up study over the long term 6 years. It includes patients who undergo cross-sectional evaluations every year during the study period. ELEP is also part of the Spanish Consortium on PD, together with the VIP project, 51 which is a multi-purpose patient cohort focusing on the collection of biological samples and the development of genetic and neuroimaging research.
This project has 2 angles: Using these assessment systems to obtain data that increase knowledge about PD evolution in the long term. Until now, this knowledge has been limited by a lack of protocolised, systematic studies using the right instruments.. The ELEP group has already presented numerous publications on the validation of PD scales and how they relate to quality of life, 52—56 and others on the diverse clinical features of PD. In , Hoehn and Yahr published the first study to examine mortality in a population with parkinsonism.
Since then, the international literature has featured multiple studies generating a wealth of statistics on mortality in PD; in general, these articles point to higher mortality.. Obtaining mortality data for study purposes is possible in Spain by accessing the National Statistics Institute data 61 on deaths broken down by cause of death and coded according to the ICD classification system. In any case, finding this information is only possible if the death certificate states the diagnosis of PD, and this is not the case for a variable percentage of certificates which may be quite high according to different international studies.
Especially noteworthy are the publications on PD mortality in Spain; an example would be the study by Burguera et al. Data on annual deaths and their distribution by sex, age group, and Spanish province were provided by the National Statistics Institute. The overall mortality rate was 2. These observations call for further studies to clarify whether place of residence may have an effect on the development of PD..
The mortality gradient we describe was analysed in great detail by De Pedro-Cuesta et al. The study addressed the geographical distribution of PD mortality in Spain by city between and in order to detect any non-coincidental distribution tendencies and examine their causes. These data were also obtained from the National Statistics Institute.
This distribution can be superimposed on that reported by the earlier study 65 ; furthermore, a previous study 67 of levodopa consumption in Spain between and reported high sales in the north and low consumption in the south. As such, the pattern seems to correspond to selective areas in which PD is underdiagnosed, rather than to aetiological factors having to do with the presence of the disease itself.
The situation calls for measures to improve diagnosis the authors mention a lack of neurologists in smaller Andalusian hospitals. The authors suggest conducting specific aetiological studies in these populations.. Mortality in Parkinson's disease. De Pedro-Cuesta et al. Of this total, 81 patients had PD at baseline, and there were 66 deaths during follow-up.
Risk of mortality for patients with PD 2. Risk of mortality was higher among patients with dementia. For that reason, this study concluded that PD is an independent predictor of mortality in elderly patients, and that risk is especially high among those with dementia. It should be said that PD is mentioned on death certificates in only Another longitudinal study 70 with 20 years of follow-up included patients in the province of Segovia. It found a standardised mortality rate of 1. In recent years, disability and dependency have become 2 extremely relevant concepts in politics and social health.
Spain's National Statistics Institute has completed 3 major surveys on disability and dependency , , 71—73 which present their importance in quantitative terms. Similarly, a featured article in Gaceta Sanitaria 74 analyses the evolution of our understanding of these concepts. The initial concept of disability was the array of deficiencies and illnesses suffered by an individual and which were addressed with medical treatment, rehabilitation and care; at present, we stress the primordial importance of the resulting disability, understood as a need for personal care.. Data from the last 2 surveys can be accessed from the National Statistics Institute's webpage 72,73 and they include data related to PD.
For example, in the group of patients of both sexes aged 65 to 79, we find 38 patients with disability and a diagnosis of PD at this time; in the group of patients of both sexes aged 65 to 69 years, the proportion of patients with disability and diagnosed with PD was 6. These authors have shown keen interest in the relationship of these social concepts with health-related quality of life in both patients and carers. One study on the burden of PD-related disease in Spain in the year presents comparisons with data from similar countries in Europe and around the world. Although the authors interpret this data cautiously, they stress the need for a better understanding of the burden of PD in Spain.
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They feel that disability in this context may arise due to multiple factors; although PD is a motor disorder, depression, dementia, and psychosis are manifestations of advanced stages of the disease that increase burden.. Additional publications 76—79 have also addressed carer burden in PD and its impact on quality of life. A study 76 analysed the impact of PD on those caring for patients and aimed to identify the main factors associated with carer stress.
Another cross-sectional multicentre study 77 evaluated 80 patients and their carers and delivered the following findings: In summary, the psychological well-being of carers, clinical aspects of the disease, the patient's mental state, and the quality of life related to patient and carer health are predictors of the burden of the disease..
The ELEP group 78 has also presented an article on these topics in which it studied patients and their carers to reach the following conclusions: Lastly, the carer's emotional state is the factor with the greatest influence on the carer's burden and self-perceived state of health; as such, ameliorating this aspect may lessen the burden and prevent a decrease in health-related quality of life. This will have positive repercussions on both care for the patient and use of healthcare resources.. They also highlight the importance of applying effective interventions to promote carer well-being, which will result in the patient being able to remain at home and still receive appropriate care..
Different studies have illustrated the social health repercussions of PD, both in terms of the medical expenses it generates and in terms of decreased productivity and lower quality of life related to the disease. 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.
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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. 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. Este aspecto puede relacionarse con los comentarios que los estudiantes realizan, en las preguntas abiertas, al identificar una fortaleza y una debilidad de las redes sociales.
The link that bind: Uncovering novel motivations for linking on Facebook. Computers in Human Behavior , v. Profile and motivations of Turkish social network sites users. Convergencia Revista de Ciencias Sociales , n. Interactive Advertising Bureau - Spain; Elogia. Estudio Anual de Redes Sociales We are Social, News and social networks: Pew Research Center, Toward a new er sociability: Uses, gratifications and social capital on Facebook.
Media perspectives for the 21st century. Ideas para aprender a aprender.