Risk factors, early presentations, and clinical markers of Parkinson's disease in Primary Care in a diverse UK population

Importance: Predictors of future Parkinson′s disease (PD) have been suggested through population-based studies, but these studies over–represent white, affluent groups and may not be generalisable. Objective: To investigate the association between risk factors and pre–diagnostic presentations of PD in a uniquely diverse UK population, with universal access to health care. Design, Setting, and Participants: A case–control study was conducted in East London, using primary care health records. Main outcomes and Measures: Logistic regression was used to determine associations between risk factors and pre–diagnostic presentations of PD with final diagnosis. Three periods (recorded <2 years, 2–5 years, and 5–10 years prior to diagnosis) were analysed. Results: Primary care records were available for 1,055 patients with PD and 1,009,523 controls. The strongest associations were found for tremor (OR, 181.69; 95% CI, 151.91–217.31) and ′memory complaints′ (OR, 9.84; 95% CI, 7.39–13.11), <2 years before PD diagnosis. However, associations for both complaints persisted up to 10 years prior to PD diagnosis. Shoulder pain was more common in those who developed PD, emerging 5 to 10 years prior to diagnosis (OR, 2.54; 95% CI, 1.77–3.65), and may be a surrogate marker for rigidity. Epilepsy showed a strongest association with subsequent PD (OR, 5.14; 95% CI, 1.26–21.0), and associations were also found for hypertension (OR, 1.71; 95% CI, 1.34–2.17) and type 2 diabetes (OR, 1.57; 95% CI, 1.31–1.87) 5 to 10 years before diagnosis. We replicated several known associations with early non motor features including hypotension, constipation, and depression. A weak but novel association was observed with prodromal hearing loss and subsequent PD, which appeared up to 10 years prior to diagnosis. No associations with future PD diagnosis were found for ethnicity or deprivation index. Conclusions and relevance: This study provides further evidence that a range of comorbidities and pre-diagnostic presentations are encountered in primary care prior to PD diagnosis, but for the first time in such a diverse and deprived population. Convincing temporal associations were observed for epilepsy and hearing loss with subsequent PD. The predominance of ′memory symptoms′ hints at an excess of cognitive dysfunction in early PD in this population or difficulty in correctly ascertaining symptoms in traditionally under–represented groups.

Analysis of care in neurosurgery outpatient clinic in Paraíba

Background: Currently the public health system encompasses numerous demands, including in the neurology and neurosurgery sector. The wide outpatient search shows several symptoms, with pain being one of the most prominent. Objectives: To analyze the consultations performed in a neurosurgery clinic, aiming to understand the main demands found at secondary health care. Design and setting: Retrospective and descriptive study, conducted through the analysis of data from a neurosurgery outpatient clinic in the state of Paraíba Methods: Conducted through the analysis of data from 73 patients relative to a neurosurgery outpatient clinic, during the period between 11/24/2020 and 12/15/2020. The variables were: gender, age and diagnostic suspicion. Results: A predominance of females was found (65.7%) and, among all patients, the youngest patient was 8 years old and the oldest was 83 years old. Among the patients, it was possible to observe an important presence of Headache (28.7%), followed by Back Pain (17.7%) and Psychiatric disorders (6.9%), the other patients presented several diagnoses, such as Cerebellar Syndrome (1.37%) and Neoplasms (5.5%). There was found male predominance in Sequelae of Stroke, Parkinson’s Disease, Spinal Pathologies, Autism, Brachial Plexus Injury, Carpal Tunnel Syndrome and Complex Painful Syndrome. Furthermore, it was noted equivalence of occurrence in both sexes of Neuropathic Pain, Convulsion, Post- Herpetic Neuralgia and Trigeminal Neuralgia. Conclusion: The search for regional standards and their comparison to the world scenario is important to assist in clinical diagnosis, besides helping in the allocation of resources and studies.

Commentary on a “unified approach to behaviours that challenge”: my freedom – the perspective of people with learning disabilities

Purpose As self-advocate leaders, the authors aim to present the perspective of people with learning disabilities on “Behaviour that Challenges: A Unified Approach”. Building on firsthand accounts which reveal compassion and cruelty in the health-care system, the authors propose ways of working, which confirm and add to the thinking in “A Unified Approach”, especially “Capable Environments”. Design/methodology/approach To ensure integrity, the authors engaged contributors with lived experience of admission to secure care after acting in ways that put themselves or others at risk. The authors included the perspective of people whose severe learning disabilities limit them to few or no words as best they could by interviewing their parents. The authors were supported and advised in the writing of this commentary while retaining full control throughout. Findings While recognising compassionate care, the authors suggest the provider’s power over a person’s life is a central reason for the care system’s vulnerability to the cruelty evident in firsthand accounts. The authors propose practical ways to offset this power. Firsthand accounts suggest the key features of capable environments are communication, valuing families and developing a valued, caring, well-trained workforce. Lived experience in workforce training and peer-support to individuals offer great potential to transform outcomes. Originality/value The perspectives of diverse contributors with learning disabilities bring lived experience insight to the challenges of “behaviour that challenges”. The authors aim to add value by blending lived experience viewpoints with the emotion of firsthand accounts of care. The insights of lived experience – too often a marginal consideration in health-care design – are presented here as central to care that fully achieves what people want and need.

Design Thinking in Nursing Education to Improve Care for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Two-Spirit People

Design thinking methodology is a collaborative strategy with the potential to create innovations. Design thinking is being used increasingly in health care. Design jams are interdisciplinary events that bring together experts and community members to collaborate on creative solutions to health-care problems. This article describes the design thinking process and includes reflection on the authors' participation in a design jam event aimed to address the knowledge-to-action gap that exists in health care for (LGBTQI2S) people.

Sensor Fusion of Leap Motion Controller and Flex Sensors using Kalman Filter for Human Finger Tracking

<span>In our daily life, we, human beings use our hands in various ways for most of our day-to-day activities. Tracking the position, orientation and articulation of human hands has a variety of applications including gesture recognition, robotics, medicine and health care, design and manufacturing, art and entertainment across multiple domains. However, it is an equally complex and challenging task due to several factors like higher dimensional data from hand motion, higher speed of operation, self-occlusion, etc. This paper puts forth a novel method for tracking the finger tips of human hand using two distinct sensors and combining their data by sensor fusion technique.</span>