Validation of a Device for the Ambulatory Monitoring of Sleep Patterns: A Pilot Study on Parkinson's Disease.

The development of wearable devices has increase interest in the use of ambulatory methods to detect sleep disorders more objectively than those permitted by subjective scales evaluating sleep quality, while subjects maintain their usual lifestyle. This study aims to validate an ambulatory circadian monitoring (ACM) device for the detection of sleep and wake states and apply it to the evaluation of sleep quality in patients with Parkinson disease (PD). A polysomnographic validation study was conducted on a group of patients with different sleep disorders in a preliminary phase, followed by a pilot study to apply this methodology to PD patients. The ACM device makes it possible to estimate the main sleep parameters very accurately, as demonstrated by: (a) the lack of significant differences between the mean values detected by PSG and ACM in time in bed (TIB), total sleep time (TST), sleep efficiency (SE), and time awake after sleep onset (WASO); (b) the slope of the correlation lines between the parameters estimated by the two procedures, very close to 1, which demonstrates the linearity of the predictions; (c) the low bias value in the estimates obtained through ACM. Sleep in PD is associated with lower distal skin temperature, efficiency and overall sleep time; greater WASO, activity during sleep and duration of naps and a worse circadian function index. In summary, the ACM device has proven to be clinically useful to evaluate sleep in an objective manner, thanks to the integrated management of different complementary variables, having advantages over conventional actigraphy.

Multidimensional Circadian Monitoring by Wearable Biosensors in Parkinson's Disease.

Parkinson's disease (PD) is associated with several non-motor symptoms that may precede the diagnosis and constitute a major source of frailty in this population. The digital era in health care has open up new prospects to move forward from the qualitative and subjective scoring for PD with the use of new wearable biosensors that enable frequent quantitative, reliable, repeatable, and multidimensional measurements to be made with minimal discomfort and inconvenience for patients. A cross-sectional study was conducted to test a wrist-worn device combined with machine-learning processing to detect circadian rhythms of sleep, motor, and autonomic disruption, which can be suitable for the objective and non-invasive evaluation of PD patients. Wrist skin temperature, motor acceleration, time in movement, hand position, light exposure, and sleep rhythms were continuously measured in 12 PD patients and 12 age-matched healthy controls for seven consecutive days using an ambulatory circadian monitoring device (ACM). Our study demonstrates that a multichannel ACM device collects reliable and complementary information from motor (acceleration and time in movement) and common non-motor (sleep and skin temperature rhythms) features frequently disrupted in PD. Acceleration during the daytime (as indicative of motor impairment), time in movement during sleep (representative of fragmented sleep) and their ratio (A/T) are the best indexes to objectively characterize the most common symptoms of PD, allowing for a reliable and easy scoring method to evaluate patients. Chronodisruption score, measured by the integrative algorithm known as the circadian function index is directly linked to a low A/T score. Our work attempts to implement innovative technologies based on wearable, multisensor, objective, and easy-to-use devices, to quantify PD circadian rhythms in huge populations over extended periods of time, while controlling at the same time exposure to exogenous circadian synchronizers.

El derecho a no saber la información genética. EI caso del País Vasco de reconocimiento a favor de una pareja con antecedentes familiares de Corea de Huntington / No disponible

Una vez analizada brevemente la naturaleza jurídica del derecho a no saber, se describe a continuación un caso clínico, tramitado en 2015 ante el Departamento de Salud del Gobierno del País Vasco, que sirve de ejemplo para reflexionar acerca de la fortaleza de este derecho, singularmente cuando colisiona con los estrictos criterios de financiación de las prestaciones sanitarias (AU)

After analyzing the legal nature of the right not to know, we describe below a case which was conducted in 2015 before the Basque Country Department of Health. This case stands as an example to reflect on the strength of this right, singularly when it clashes with the strict criteria of financing of health care delivery (AU)

Alumbramiento de un código ético / No disponible

El pasado mes de abril de 2015 nuestra Sociedad, a través de su Comisión de Bioética, concluyó el Código Ético de la Farmacia Comunitaria, objetivo ambicioso que ha ocupado el quehacer de esta comisión multidisciplinar durante los últimos dos años. El hecho de que desde SEFAC se haya dado lugar a este texto es un acontecimiento de extraordinaria importancia, no solo por la circunstancia de que se trate del primer código ético específico de la farmacia comunitaria, sino por el compromiso que conlleva de que la excelencia presida la actuación profesional y la propia labor institucional de SEFAC. Se trata de una apuesta no solo por hacer las cosas bien desde el punto de vista técnico y científico, sino por hacerlas también de manera sobresaliente desde la perspectiva ética, incorporando valores y comportamientos que contribuyan a dignificar más la profesión y que redunden en mayores cotas de satisfacción de los pacientes en su relación con el farmacéutico (AU)

No disponible

[Not Available]. / El derecho a no saber la información genética. El caso del País Vasco de reconocimiento a favor de una pareja con antecedentes familiares de Corea de Huntington.

After analyzing the legal nature of the right not to know, we describe below a case which was conducted in 2015 before the Basque Country Department of Health. This case stands as an example to reflect on the strength of this right, singularly when it clashes with the strict criteria of financing of health care delivery.

Diagnóstico genético embrionario y libertad reproductiva en la procreación asistida / No disponible

En el artículo se analizan las repercusiones en el plano bioético y jurídico que presenta la técnica de Diagnóstico Genético Embrionario Preimplantatorio (DGP) en relación con la denominada “libertad reproductiva” de las parejas. Además de referir la situación legal de esta técnica en España y otros países de su entorno, se estudia la problemática particular de alguno supuestos de DGP para selección de sexo, DGP con fines terapéuticos para terceros, DGP respecto de enfermedades de posible aparición tardía, multifactoriales o de expresión fenotípica variable, y DGP para seleccionar embriones afectados por una enfermedad o discapacidad, todo ello sobre la base de casos clínicos reales

The article discusses the implications for bioethical and legal plane technique presents Embryonic Preimplantation Genetic Diagnosis (PGD) in relation to the so-called "reproductive freedom" of couples. In addition to referring the legal status of this technique in Spain and other neighboring countries, we study the particular problems of any cases of PGD for sex selection, DGP third therapeutic purposes, DGP regarding possible late-onset diseases, multifactorial or variable phenotypic expression and PGD to select embryos affected by illness or disability, all based on real clinical cases

[Embryonal genetic diagnosis and reproductive freedom in assisted procreation]. / Diagnóstico genético embrionario y libertad reproductiva en la procrea- ción asistida.

This article analyses the repercussions that the Preimplantational Genetic Diagnosis (PGD) has in the bioethical as well as legal fields in relation with the so-called "reproductive freedom" of the couple. Besides analysing the legal situation of this technique in Spain as well as other surrounding States, the article studies the problems associated with some scenarios of PGD, such as the use in the selection of sex, for therapeutic purposes for third parties, in relation with diseases of a possible late onset, multifactorial or of a variable phenotype expression and for the selection of embryos affected by a disease or disability. All are based on real clinical cases.