Manual Cervical Traction and Trunk Stabilization Cause Significant Changes in Upper and Lower Esophageal Sphincter: A Randomized Trial.

OBJECTIVES: Dysfunctions in the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) levels can occur owing to poor muscle coordination, contraction, or relaxation. Such condition can possibly be addressed by functional rehabilitation. The aim of this study was to measure pressure changes in the UES and LES at rest and during routine rehabilitation techniques, that is, cervical manual traction and trunk stabilization maneuver. METHODS: This study was conducted in a University Hospital Gastrointestinal Endoscopy Center. Cervical manual traction and a trunk stabilization maneuver were performed in a convenient group of 54 adult patients with gastroesophageal reflux disease. High-resolution manometry was used to measure pressure changes in the LES and UES at rest and during manual cervical traction and trunk stabilization maneuver. RESULTS: Average initial resting UES pressure was 90.91 mmHg. A significant decrease was identified during both cervical traction (average UES pressure = 42.13 mmHg, P < .001) and trunk stabilization maneuver (average UES pressure = 62.74 mmHg, P = .002). The average initial resting LES pressure was 14.31 mmHg. A significant increase in LES pressure was identified both during cervical traction (average LES pressure = 21.39 mmHg, P < .001) and during the trunk stabilization maneuver, (average pressure = 24.09 mmHg, P < .001). CONCLUSION: Cervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.

Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers.

BACKGROUND: Facing an increasing prevalence of dementia, the Czech Republic is developing a new nationwide strategy for the management and prevention of dementia. Lack of evidence about characteristics of individuals with dementia in the country is a major obstacle. OBJECTIVE: The study aimed to 1) characterize individuals with dementia, 2) compare their mortality with the general population, and 3) analyze differences in survival between different dementia disorders. METHODS: The study capitalizes on two nationwide registers in the Czech Republic, from which information about individuals who were hospitalized with dementia or died from it between 1994 and 2014 was retrieved. Standardized intensity of hospitalizations was calculated for each year, mortality was studied using standardized mortality ratio, life-tables, Kaplan-Mayer curves, and Cox proportional hazard models. RESULTS: Standardized intensity of hospitalizations for dementia increased more than 3 times from 1994 to 2014. Standardized mortality ratio was 3.03 (95% confidence interval 2.97-3.08). One-year survival rate was 45% and five-year survival rate 16%. Vascular dementia was the most common type of dementia disorders and was associated with higher hazard of death than Alzheimer's disease, even after adjusting for sociodemographic and clinical covariates (hazard ratio 1.04; 95% confidence interval 1.02-1.05). CONCLUSION: The study provides estimates on demographic characteristics and mortality of the Czech hospitalized dementia population, which have not been so far available and which are unique also in the context of the entire region of Central and Eastern Europe.

The Potential Impact of Alzheimer's Disease Early Treatment on Societal Costs of Care in Czechia: A Simulation Approach.

BACKGROUND: In Czechia, only about a quarter of people suffering from the Alzheimer's disease (AD) receive (usually belated) treatment. Because of their more rapid cognitive decline, untreated patients require extensive assistance with basic daily activities earlier than those receiving treatment. This assistance provided at home and nursing homes represents a substantial economic burden. AIMS OF THE STUDY: To calculate lifetime costs of care per AD patient and to evaluate potential care savings from early treatment. METHODS: We use Monte Carlo simulation to model lifetime societal costs of care per patient under two different scenarios. In the first one, a cohort of 100,000 homogeneous patients receives usual care under which the majority of patients are undiagnosed or diagnosed late. The second scenario models a hypothetical situation in which an identical cohort of patients starts receiving treatment early after the disease onset. Data on the rates of cognitive decline for treated and untreated patients, and survival probability for AD patients are derived from foreign clinical studies. Information on costs and population characteristics is compiled on the basis of published Czech research and databases. RESULTS: Early treatment of AD decreases social lifetime costs of care. This result holds true regardless of gender, age at which the disease is contracted, or whether the patient lives at home or uses a social residential service. The potential savings amount up to Euro 26,800 (23,500) per woman (man), being negatively correlated with the age at which the disease onsets as well as the delay between the onset and treatment initiation DISCUSSION: The results suggest that early treatment of AD would decrease costs of care in Czechia. The main limitation of the simulation arises from the fact that missing domestic information was substituted by input from foreign clinical trials or simplifying assumptions. Because of insufficient data, we do not model hospitalization risk; on the other hand, introduction of this risk into our model would likely increase the savings from early treatment. IMPLICATIONS FOR HEALTH POLICIES: Makers of AD policies ought to appreciate the trade-off between costs of daily assistance in untreated patients and health care costs in treated patients, notwithstanding that the costs of assistance are largely born by households rather than public budgets. Our results show that the savings on costs of assistance brought about by early treatment would exceed the additional costs of treatment. IMPLICATIONS FOR FURTHER RESEARCH: A number of missing or insufficient data about the Czech Alzheimer's population were identified. In addition, to determine the total societal cost-effect of early treatment, further research ought to evaluate the related increase in detection costs. Finally, it should also assess cost-effectiveness of early treatment by considering its impact on patients' utility.