Regression to the mean in multiple sclerosis.

In order to ensure sufficient disease activity, patients with relapsing remitting (RR) multiple sclerosis (MS) are often included in randomized placebo-controlled trials, only if they have a high baseline activity. These patients, whose evolution is unusual in the pre-study period, will tend to show a more usual behavior when followed up over a period of time. This phenomenon is known as regression to the mean. Regression to the mean should be taken into account in correctly interpreting long-term studies of cohorts treated without a placebo control group, which use the baseline period as control. The aim of this study was to evaluate the relevance of this phenomenon in a non-treated cohort of RRMS patients, selected with similar criteria to those used in randomized placebo-controlled clinical trials. Forty-four patients with definite RRMS, with two or more relapses in the previous two years, and a baseline EDSS < or = 5.5 were prospectively followed. The mean number of relapses spontaneously decreased from 1.72 (SD: 1.4) in the year prior to enrolment, to 1.0 (SD: 1.3) during the first year of follow-up (P < 0.05). Regression to the mean may explain as much as 40% of the reduction in the relapse rate from the baseline period to the period on-study.

[Evolution of the demand for ambulatory neurological care and pathologies attended in neurology clinics in the health care district of Tortosa, Tarragona]. / Evolución de la demanda de asistencia neurológica ambulatoria y patología atendida en la consulta de neurología de la región sanitaria de Tortosa, Tarragona.

AIMS: An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. PATIENTS AND METHODS: Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. RESULTS: Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0.03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). CONCLUSIONS: The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources.

Evolución de la demanda de asistencia neurológica ambulatoria y patología atendida en la consulta de neurología de la región sanitaria de Tortosa, Tarragona / Evolution of the demand for ambulatory neurological care and pathologies attended in neurology clinics in the health care district of Tortosa, Tarragona

Objetivos. Se analiza si existen cambios en la demanda de asistencia, demografía y patología atendida en las consultas externas de neurología de la región sanitaria de Tortosa entre 1997 y 2003. Pacientes y métodos. Se recogieron prospectivamente los datos de la demanda y asistencia de las primeras visitas de neurología los períodos de 1997 y marzo del 2003 a febrero de 2004. Se compararon edad, sexo, grupos de patologías, diagnósticos, índices de solicitud de primera visita, origen de la demanda y destino tras la visita. Resultados. La edad media creció de 49 a 56 años (p < 0,001). Los pacientes mayores de 70 años aumentaron del 23,7% al 35,9% (p < 0,001), mientras en la población del área sólo del 15,8 al 17,1%. La proporción de mujeres pasó del 52 al 62% (p < 0,001). La demanda (índice de solicitudes de primeras visitas/1.000 habitantes y año mayores de 15 años) creció del 8,5 al 9,3, un 9,8% (p = 0,03). La demanda desde atención primaria creció del 52 al 69% (p < 0,001). Los trastornos cognitivos (6,5% y 15,9%) crecieron un 144,6% (p < 0,001). Las cefaleas (23,9% y 24,1%), el mayor grupo diagnóstico, y los diagnósticos no neurológicos (18% y 18,5%) se mantienen (p = NS). Las altas en primera visita no cambian, 22,8% y 21,1% (p = NS). Conclusiones. Destaca el aumento de la demanda, fundamentalmente desde atención primaria, el aumento de edad de la población atendida y el marcado incremento de los trastornos cognitivos. Estos cambios cuantitativos y cualitativos de la demanda incrementan las necesidades de recursos (AU)

Aims. An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. Patients and methods. Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. Results. Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0,03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). Conclusions. The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources (AU)

[The social and work-related impact of multiple sclerosis]. / Impacto sociolaboral de la esclerosis múltiple.

OBJECTIVE: To analyse the repercussion of the disease in social and occupational status of multiple sclerosis patients. To describe the frequency with these patients are faced to architectural barriers in their own home. PATIENTS AND METHODS: We addressed a postal survey to 250 patients previously evaluated in our multiple sclerosis unit. Clinical data were recorded in the EDMUS database. RESULTS: A hundred and sixty patients answered the questionnaire. Mean age was 39.2 +/- 11.9 years. Mean duration of the disease was 10.05 +/- 8.4 years. Twenty-one per cent of patients were in progressive phase of the disease. Eighty-nine patients (55.6%) were unemployed. Unemployed patients had arrived to a moderate disability level (EIS > or = 3) before than employed patients. Only 17% of patients older than 50 years were employed vs. 63% of those among 26-35 years. Only EIS and years of school attendance were independently related to the unemployment status. Forty per cent of patients referred household income greater to $8,000/year. Thirty-six per cent of patients with severe disability (EIS > 6) was living in a floor with stairs and without lift. Forty-four per cent of patients with EIS > 6 had architectural barriers in their bathroom. CONCLUSIONS: More than half of multiple sclerosis patients were unemployed. Only the degree of disability and educational level were related in a independent way with unemployment status. Many patients unable to walking unaided had architectural barriers at home.