Presbylarynx: Is it Possible to Predict Glottal Gap by Cut-Off Points in Auto-Assessment Questionnaires?

PURPOSE: To determine cut-off points in auto-assessment questionnaires to predict the presence and extent of presbylarynx signs. METHOD: This case control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by Otorhinolaryngology, in a tertiary center, in 2020. Each subject underwent fiberoptic videolaryngoscopy with stroboscopy, and presbylarynx was considered when it was identified two or more of the following endoscopic findings: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed three questionnaires: the Voice Handicap Index (VHI), with 30 and 10 questions, and the "Screening for voice disorders in older adults questionnaire" (RAVI). RESULTS: The studied population included 174 Caucasian subjects (60 males; 114 females), with a mean age of 73.99 years (standard deviation = 6.37; range 65-95 years). Presbylarynx was identified in 71 patients (41%). Among patients with presbylarynx, a glottal gap was identified in 22 patients (31%). The mean score of VHI-30 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. The presence of glottal gap was associated to a higher mean score of VHI-30 (41.64 ± 11.87) (P < 0.001). The mean score of VHI-10 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to higher mean score of VHI-10 (14.04 ± 3.91) (P < 0.001). There was a strong positive correlation between VHI-30 and VHI-10 (rs = 0.969; P < 0.001). The mean score of RAVI between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to a higher mean score of RAVI (11.68 ± 1.61) (P < 0.001). There was a strong positive correlation not only between RAVI and VHI-30 (rs = 0.922; P < 0.001), but also between RAVI and VHI-10 (rs = 0.906; P < 0.001). The optimal cut-off points to discriminate "no presbylarynx" from "presbylarynx", obtained by the Youden' index, were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity. The optimal cut-off points to predict glottal gap, obtained by the Youden' index, were 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10. CONCLUSION: The optimal cut-off points do discriminate "no presbylarynx" from "presbylarynx" were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity, probably because it was designed specifically for vocal complaints of the elderly. Among patients with presbylarynx, cut-off points of 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10 were determined to predict patients with and without glottal gap. It was found a strong positive correlation between RAVI, VHI-30 and VHI-10. Thus, VHI-10 can be preferred to VHI-30 to assess voice impairment in clinical practice, because for elderly patients it is easier to answer. However, to predict endoscopic signs of presbylarynx, RAVI should be preferred.

Correction: Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885.

The authors wish to make the following corrections to this paper [...].

Economic costs of dementia in 11 countries in Europe: Estimates from nationally representative cohorts of a panel study.

Background: With population aging, the economic burden of dementia is growing in Europe. Understanding the economic costs of dementia provides an important basis for prioritization in public health policy and resource allocation. Methods: We calculate the economic costs of dementia, including both direct medical and social care costs and indirect costs of informal care, for 11 countries in Europe. Costs are estimated using population-representative data from the Survey of Health, Ageing, and Retirement in Europe from 2004 to 2017, supplemented with external information about wages of care workers, dementia prevalence, and fraction of direct costs paid by other sources. We report overall costs for persons, both living and deceased with dementia and also isolate the costs attributable to dementia by estimating regression models that relate a given cost component to dementia while controlling for coexisting conditions and demographics. We make the monetary data comparable by adjusting for inflation and Purchasing Power Parity to 2018 euros. Findings: Average annual direct out of pocket costs that can be attributed to dementia vary between EUR 253(95% CI: -17 to 522) and EUR 859 (95% CI: -587 to 2306) across countries, but are not statistically significant after adjustment for multiple testing. Average annual hours of informal care that can be attributed to dementia vary between 163 (95% CI: 27-299) and 1051 (95% CI: 15-2086) annual hours across countries, and are statistically significant in all countries before adjustment for multiple testing, and in seven out of 11 countries after this adjustment. Combining these estimates with external wage information in each country implies a burden between EUR 2687.4 (95% CI: 704.5 to 4670.3) and EUR 15,468 (95% CI: 8088.1 to 22,847.9) per individual with dementia per year depending on the country. When combined with external estimates of the fraction of direct costs covered by other payment sources (insurance, government) and numbers of individuals with dementia, estimates of the total costs of dementia at the country level vary from EUR 162.9 million (95% CI: 56.3 to 269.5) in Estonia to EUR 32,606.9 (95% CI: 13,893.9 to 51,319.9) in Germany. Informal care costs account for the largest proportion of costs attributable to dementia in all European countries, varying between about 50% and about 90%. Interpretation: The economic burden of dementia on families in terms of direct out-of-pocket and informal care costs varies greatly by country, depending on the health and social care systems. Informal care costs accounts for the largest proportion of costs, requiring policy attention to dementia care provision and costs. Funding: This project is funded by the National Institute on Aging, National Institutes of Health, USA (R01 AG030153).

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study.

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.

Gender Differences in Cognitive Function among Older Mexican Immigrants.

This paper uses data from the Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) to study the cognitive function of Mexican-born older adults residing in the United States (Mexican immigrants). We find that, once differences in socioeconomic factors are accounted for, the cognitive function of male Mexican immigrants is statistically indistinguishable from that of male non-Hispanic (NH) whites, but the cognitive scores of female Mexican immigrants remain significantly below those of their NH white counterparts. We explore four potential hypotheses that may explain the cognition gap for female Mexican immigrants. Namely, we investigate whether the relative incidence of risk factors for dementia, when compared to NH whites, is higher for female than for male Mexican immigrants (the "risk factor hypothesis"); whether the mortality rate of male Mexican immigrants with low cognition is higher, relative to their white counterparts, than that of female Mexican immigrants (the "survival bias hypothesis"); whether female Mexican immigrants are less positively selected than their male counterparts in terms of predisposition to cognitive decline when compared with either the non-migrant Mexican population or the population of return migrants (the "differential selection hypothesis"); and whether male immigrants are better acculturated to life in the United States than female immigrants (the "acculturation hypothesis). We find no support for the risk-factor, survival, or acculturation hypotheses but we find evidence suggesting that the differential selection hypothesis may explain part of the female cognitive gap. Our results imply that older Mexican females currently residing in the U.S. may be at elevated risk for dementia and should be targeted by campaigns aimed at preventing or diagnosing the condition.

Flow cytometry for fast screening and automated risk assessment in systemic light-chain amyloidosis.

Early diagnosis and risk stratification are key to improve outcomes in light-chain (AL) amyloidosis. Here we used multidimensional-flow-cytometry (MFC) to characterize bone marrow (BM) plasma cells (PCs) from a series of 166 patients including newly-diagnosed AL amyloidosis (N = 94), MGUS (N = 20) and multiple myeloma (MM, N = 52) vs. healthy adults (N = 30). MFC detected clonality in virtually all AL amyloidosis (99%) patients. Furthermore, we developed an automated risk-stratification system based on BMPCs features, with independent prognostic impact on progression-free and overall survival of AL amyloidosis patients (hazard ratio: ≥ 2.9;P ≤ .03). Simultaneous assessment of the clonal PCs immunophenotypic protein expression profile and the BM cellular composition, mapped AL amyloidosis in the crossroad between MGUS and MM; however, lack of homogenously-positive CD56 expression, reduction of B-cell precursors and a predominantly-clonal PC compartment in the absence of an MM-like tumor PC expansion, emerged as hallmarks of AL amyloidosis (ROC-AUC = 0.74;P < .001), and might potentially be used as biomarkers for the identification of MGUS and MM patients, who are candidates for monitoring pre-symptomatic organ damage related to AL amyloidosis. Altogether, this study addressed the need for consensus on how to use flow cytometry in AL amyloidosis, and proposes a standardized MFC-based automated risk classification ready for implementation in clinical practice.

Análisis bibliométrico de temas económicos en artritis reumatoide / Literature analysis of economic aspects of rheumatoid arthritis

RESUMEN Introducción: La artritis reumatoide es una enfermedad inflamatoria con una prevalencia de hasta el 5% y con un impacto significativo sobre la calidad de vida. La artritis reumatoide representa una condición médica de alto costo; para el año 2010 se estimó un gasto anual de 4,8 millones de dólares, según un estudio realizado en Estados Unidos. Objetivos: Realizar el análisis descriptivo de la literatura biomédica indexada en Medline entre 1996 y 2016 sobre temas relacionados con aspectos económicos de la artritis reumatoide. Materiales y métodos: El diseño es un análisis bibliométrico retrospectivo, de tipo descriptivo. Se realizó una búsqueda bibliográfica en Medline utilizando GoPubMed y Fabumed, y la siguiente estrategia de búsqueda: («Arthritis, Rheumatoid¼ [Majr]) AND («Costs and Cost Analysis¼ [Majr]) AND (1996:2016 [dp]). Resultados: Se obtuvieron un total de 350 referencias indexadas en 80 revistas diferentes. Rheumatology con 6 (1,71%) referencias fue la revista con mayor número de publicaciones, seguida por Clinical and Experimental Rheumatology con 5 (1,42%). Estados Unidos fue el país más productivo con 30 (8,57%) publicaciones. En Latinoamérica, Brasil aporta 3 publicaciones (0,85%), al igual que Colombia con 3 publicaciones (0,85%). A lo largo del periodo estudiado se observó una tasa de crecimiento de 41,4%. Conclusiones: Colombia ha aportado menos del 1% de la producción científica a escala mundial; teniendo en cuenta que los análisis económicos no son extrapolables, consideramos necesario el desarrollo de nuevas propuestas y contribuciones en esta área de investigación en nuestro país.

ABSTRACT Introduction: Rheumatoid arthritis is an inflammatory disorder with a prevalence of up to 5%, and with a significant impact on the quality of life quality. Rheumatoid arthritis is a high cost medical condition. According to a study carried out in the United States by 2010 an annual expenditure of 4.8 million dollars was estimated. Objective: To perform a descriptive analysis of the Medline-indexed biomedical literature on economic aspects of rheumatoid arthritis published between 1996 and 2016. Materials and methods: The design is retrospective descriptive literature analysis, with a search performed in Medline using GoPubMed and Fabumed, with the following search strategy: ("Arthritis, Rheumatoid" [Majr]) AND ("Costs and Cost Analysis" [Majr]) AND (1996:2016 [dp]). Results: A total of 350 references were obtained on economic aspects of rheumatoid arthritis indexed in 80 different journals. Rheumatology, with 6 (1.71%) references was the top journal, followed by Clinical and Experimental Rheumatology with 5 (1.42%). The United States was the most productive country with 30 (8.57%) publications. In Latin America, Brazil and Colombia each contributed with 3 (0.85%) references. During the period studied, there was a growth rate of 41.4% Conclusions: Colombia has contributed with less than 1% of scientific production worldwide, and taking into account that the economic analysis cannot be decontextualized, the development of new proposals and contributions in this research area in our country is considered necessary.

La evaluación de la actividad de ciencia y tecnología en la Atención Primaria de Salud: una aproximación al tema / The Assessment of Science and Technology Activity in Primary Health Care: an Approach to the Subject

La Atención Primaria de Salud es la estrategia para organizar la gestión del sistema de salud, que garantiza el acceso universal a servicios sanitarios mínimos mediante una distribución equitativa de los recursos, la participación comunitaria y la implicación de las políticas de otros sectores; por tanto, el desarrollo del Sistema de Ciencia y Tecnología a este nivel reviste una vital importancia. La política y la gestión de la ciencia y la tecnología son decisivas en el desarrollo estratégico de cada país. Por eso, tener en cuenta la convergencia de la actividad de la ciencia y la tecnología con el desarrollo social se convierte en una necesidad particularmente importante para los países en desarrollo. El propósito de esta revisión bibliográfica es realizar una reseña del desarrollo de esta modalidad en Cuba y el mundo, de manera que sirva de ayuda las personas que necesiten información sobre el tema.

Primary Health Care is the strategy to organize the management of health system that ensures universal access to minimum health services through equitable distribution of resources, community participation and implication of policies from other sectors. Therefore, the development of assessment in Science and Technology System at this level becomes of vital importance. The policy and management of science and technology are crucial in the strategic development of each country. In this sense, considering the convergence of the activity of science and technology with social development becomes a necessity particularly important for developing countries. The purpose of this literature review is to summarize the development of this modality in Cuba and the world, in such a way that it will serve to help people who need information on the subject.