RESUMEN
OBJECTIVES: There are limited data on treatment effect in early and drug-naïve Parkinson's disease (PD) outside of clinical trials. We sought to review the treatment effects on motor symptoms in early, unselected PD patients. METHODS: We included 183 drug-naïve patients from a longitudinal cohort (The Norwegian ParkWest study). At the time of diagnosis, motor symptoms were assessed and rated. Treatment was unrestricted, aimed at treating each patient optimally. Patients were reassessed after 12 months, and then grouped according to treatment: No dopaminergic treatment (NDT), dopamine agonists (DA) or levodopa. All strategies could be combined with monoamine oxidase B inhibitors. RESULTS: In general, the chosen treatment was coherent with current practice. During follow-up, patients given NDT (n = 40) had unaltered clinical motor symptoms, as opposed to improvement in the DA- and levodopa-treated patients (n = 140). The overall improvement in these two groups was fairly similar, but axial symptoms did not improve in levodopa-treated patients as opposed to the younger DA-treated patients. CONCLUSIONS: Twelve months after the diagnosis, motor symptoms in approximately one-fifth of PD patients remained clinically stable. Tremor, bradykinesia and rigidity improved in the dopaminergic-treated patients. Axial symptoms were more treatment resistant, and the different symptomatic effects found between treatment strategies may be age related.
Asunto(s)
Antiparkinsonianos/uso terapéutico , Enfermedad de Parkinson/terapia , Actividades Cotidianas , Anciano , Estudios de Cohortes , Dopaminérgicos/uso terapéutico , Femenino , Humanos , Levodopa/uso terapéutico , Masculino , Persona de Mediana Edad , Examen Neurológico , Noruega , Enfermedad de Parkinson/epidemiología , Enfermedad de Parkinson/psicología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Between 16 September and 5 October 2011 rabies was diagnosed in two arctic foxes and eight reindeer in the Svalbard archipelago, in Norway. This outbreak occurs at the end of the reindeer hunting season and poses an increased risk to many people that were involved in the hunt. As of 28 September 2011, 280 people had received post-exposure prophylaxis. No human cases of rabies have occurred.
Asunto(s)
Brotes de Enfermedades/veterinaria , Zorros/virología , Profilaxis Posexposición , Salud Pública , Rabia/veterinaria , Reno/virología , Animales , Mordeduras y Picaduras , Sistema Nervioso Central/virología , Perros , Enfermedades Endémicas , Femenino , Contaminación de Alimentos , Humanos , Programas de Inmunización , Inmunización Pasiva , Carne , Noruega/epidemiología , Rabia/diagnóstico , Rabia/epidemiología , Rabia/prevención & control , Rabia/transmisión , Vacunas Antirrábicas , Virus de la Rabia/aislamiento & purificación , Saliva/virologíaRESUMEN
Research has shown great variety in the clinical practice of consultation-liaison psychiatry in and between different countries. This paper presents the Norwegian experiences from a European collaborative study of quality management in consultation-liaison psychiatry. We describe a dynamic model for total quality management based on regular registration of some clinical data and the subsequent feed-back on changes of these. We discuss our experiences with this model and obstacles met in everyday work. Finally we point to different ways of implementing this method on a broader base in consultation-liaison psychiatry.
