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Hanewinckel R, van Oijen M, Taams NE, Merkies ISJ, Notermans NC, Vrancken AFJE, Ikram MA, van Doorn PA. Diagnostic value of symptoms in chronic polyneuropathy: The Erasmus Polyneuropathy Symptom Score. J Peripher Nerv Syst 2019; 24:235-241. [PMID: 31172622 DOI: 10.1111/jns.12328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
In this study, we evaluated the diagnostic value of symptoms of chronic polyneuropathy and to construct and validate a simple questionnaire that can help diagnose chronic polyneuropathy. In a multi-step procedure, we initially compiled a 12-item questionnaire concerning polyneuropathy symptoms. The questionnaire was completed by 117 polyneuropathy patients and 188 controls (headache, transient ischemic attack, multiple sclerosis). First, we calculated sensitivity, specificity and likelihood ratios of each symptom. Next, we used multi-variable logistic regression to create a model that could discriminate patients from controls, using only the most informative symptoms and their frequency of occurrence. Based on the regression coefficients, we developed a simple scoring system (Erasmus Polyneuropathy Symptom Score, E-PSS), which was externally validated in 140 cases with chronic idiopathic axonal polyneuropathy and 96 controls without polyneuropathy. We assessed performance with discrimination (area under the curve, AUC) and calibration analyses. Numb and tingling feet were most frequently reported by polyneuropathy patients and had the highest sensitivity. Walking on cotton wool and allodynia had the highest specificity. Logistic regression yielded a model that contained these four symptoms, complemented with balance problems and tingling hands. Based on this analysis, the E-PSS was created, ranging from 0 to 14. The E-PSS had a good performance (AUC = 0.92) in the derivation set and proved to be valid in the external population (AUC = 0.95). In conclusion, the Erasmus Polyneuropathy Symptom Score (E-PSS) is a simple, validated six-item score that takes the presence and frequency of six different symptoms into account and it may be a helpful tool to screen individuals for the presence of chronic polyneuropathy.
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Affiliation(s)
- Rens Hanewinckel
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marieke van Oijen
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Noor E Taams
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Nicolette C Notermans
- Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Canta A, Chiorazzi A, Carozzi VA, Meregalli C, Oggioni N, Bossi M, Rodriguez-Menendez V, Avezza F, Crippa L, Lombardi R, de Vito G, Piazza V, Cavaletti G, Marmiroli P. Age-related changes in the function and structure of the peripheral sensory pathway in mice. Neurobiol Aging 2016; 45:136-148. [DOI: 10.1016/j.neurobiolaging.2016.05.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 11/24/2022]
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3
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Hanewinckel R, Ikram MA, van Doorn PA. Assessment scales for the diagnosis of polyneuropathy. J Peripher Nerv Syst 2016; 21:61-73. [PMID: 26968746 DOI: 10.1111/jns.12170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
Abstract
Epidemiological studies that investigate the occurrence and determinants of chronic length-dependent polyneuropathy are scarce. Population-based studies on polyneuropathy require a valid and reliable screening protocol with both good sensitivity and specificity. Several questionnaires and scoring scales have been developed for the detection of polyneuropathy, grading the severity of the disease, or evaluating the clinical course during follow-up. This review summarizes the aims and content of existing diagnostic polyneuropathy screening tools in order to help future studies decide which scale to use for screening in specific situations. We searched the PubMed database and identified 27 scales, 13 are based on symptoms alone, 8 on neurological signs alone, and 6 on a combination of symptoms and signs. Scales that combine questions concerning symptoms and a neurological examination with a focus on sensory alterations seem to have the best discriminatory power. However, all scoring scales were developed for and investigated in prespecified patient populations. Therefore, the generalizability of specific findings to the general population may be limited. We also discuss other limitations of existing scales. Future studies are required to determine which clinimetrically well-developed scales are preferred for use in population-based studies.
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Affiliation(s)
- Rens Hanewinckel
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
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4
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Hoffman EM, Staff NP, Robb JM, St Sauver JL, Dyck PJ, Klein CJ. Impairments and comorbidities of polyneuropathy revealed by population-based analyses. Neurology 2015; 84:1644-51. [PMID: 25832668 DOI: 10.1212/wnl.0000000000001492] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 01/06/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To quantify polyneuropathy impairments and comorbidities utilizing the Rochester Epidemiology Project (2010 census = 148,201). METHODS ICD-9-CM coding identified polyneuropathy cases (2006-2010) and their 5:1 age- and sex-matched controls. Mortality and impairments were evaluated while identifying and adjusting for Charlson Index comorbidities. RESULTS Overall prevalence of polyneuropathy was 1.66%, and markedly rose to 6.6% in persons older than 60 years. Cases (n = 2,892) had more comorbidities than controls (n = 14,435) with higher median Charlson Index (6 vs 3, p < 0.001). Diabetes with end-organ disease represented the largest increased comorbidity in cases compared with controls (46.8% vs 6.5%). Diabetic polyneuropathy was the most common specific subtype (38.2%). Miscoded idiopathic cases and false-negative controls also commonly had diabetic polyneuropathy. Median modified Rankin Scale score was considerably higher for cases than controls (4 vs 1, p < 0.001). Multiple comorbidities were found associated with polyneuropathy after adjusting for diabetes co-occurrence, including pulmonary disease, dementia, and others. Polyneuropathy was an independent contributor to multiple functional impairments including difficulty walking (odds ratio [OR] = 1.9), climbing stairs (OR = 2.0), using an assistive device (OR = 2.0), fall tendency (OR = 2.4), work disability (OR = 4.2), lower limb amputations (OR = 3.9), and opioid use (OR = 2.7). Prevalent cases had a younger median age at death than controls (80 vs 86 years, p < 0.001), and incident cases had a 6-month shorter survival. CONCLUSIONS Polyneuropathies have notable neurologic impairments beyond their identified multiple comorbidities. Life expectancy is shortened. Diabetic polyneuropathy is underidentified. The quantified extent of the disease burden and refined comorbidity associations emphasize that greater research efforts and health care initiatives are needed.
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Affiliation(s)
- E Matthew Hoffman
- From the Department of Neurology (E.M.H., N.P.S., P.J.D., C.J.K.), Divisions of Biomedical Statistics and Informatics (J.M.R.) and Epidemiology (J.L.S.), and Division of Medical Genetics and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Nathan P Staff
- From the Department of Neurology (E.M.H., N.P.S., P.J.D., C.J.K.), Divisions of Biomedical Statistics and Informatics (J.M.R.) and Epidemiology (J.L.S.), and Division of Medical Genetics and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Jared M Robb
- From the Department of Neurology (E.M.H., N.P.S., P.J.D., C.J.K.), Divisions of Biomedical Statistics and Informatics (J.M.R.) and Epidemiology (J.L.S.), and Division of Medical Genetics and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Jennifer L St Sauver
- From the Department of Neurology (E.M.H., N.P.S., P.J.D., C.J.K.), Divisions of Biomedical Statistics and Informatics (J.M.R.) and Epidemiology (J.L.S.), and Division of Medical Genetics and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Peter J Dyck
- From the Department of Neurology (E.M.H., N.P.S., P.J.D., C.J.K.), Divisions of Biomedical Statistics and Informatics (J.M.R.) and Epidemiology (J.L.S.), and Division of Medical Genetics and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- From the Department of Neurology (E.M.H., N.P.S., P.J.D., C.J.K.), Divisions of Biomedical Statistics and Informatics (J.M.R.) and Epidemiology (J.L.S.), and Division of Medical Genetics and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN.
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5
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Kruja J, Beghi E, Zerbi D, Dobi D, Kuqo A, Zekja I, Mijo S, Kapisyzi M, Messina P. High prevalence of major neurological disorders in two Albanian communities: results of a door-to-door survey. Neuroepidemiology 2012; 38:138-47. [PMID: 22433124 DOI: 10.1159/000336348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 01/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are few epidemiological studies on neurological disorders in Albania. METHODS A door-to-door survey was undertaken in two geographical areas (Tirana and Saranda) with different socioeconomic backgrounds. Two random samples of the local population underwent a structured interview to ascertain headache, epilepsy, dementia, parkinsonism, multiple sclerosis, polyneuropathy, stroke and cerebral palsy. Each diagnosis was made using standard criteria for epidemiological studies and was confirmed by history, neurological examination and, where available, the review of personal medical records. Lifetime prevalence ratios with 95% confidence intervals were calculated. RESULTS Of the 9,869 individuals screened (Tirana 4,953; Saranda 4,916), 4,867 were males aged 1-91 years (median 39 years) and 5,002 were females aged 1-96 years (median 37 years). Crude prevalence ratios (per 1,000) were: headache 241.9 (233.5-250.3), polyneuropathy 32.5 (29.0-36.0), epilepsy 14.2 (11.7-16.3), stroke 12.4 (10.2-14.6), dementia 9.6 (7.7-11.5), parkinsonism 8.0 (6.2-9.8), cerebral palsy 4.8 (3.4-6.2), and multiple sclerosis 0.3 (0.0-0.6). Prevalence varied with age and gender, with differences across diseases. Except for polyneuropathy (Tirana 39.8; Saranda 25.2), ratios were not different in the two study areas. CONCLUSIONS The prevalence of selected neurological disorders in Albania is higher than in other countries. Differences may be explained by study design, population structure and/or genetic and environmental factors.
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Affiliation(s)
- J Kruja
- University Service of Neurology, UHC 'Mother Theresa', Tirana, Albania
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6
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Kararizou E, Davaki P, Karandreas N, Davou R, Vassilopoulos D. POLYNEUROPATHIES IN THE ELDERLY: A CLINICO PATHOLOGICAL STUDY OF 74 CASES. Int J Neurosci 2009; 116:629-38. [PMID: 16644522 DOI: 10.1080/00207450600592180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In elderly patients, peripheral neuropathies are common and may lead to disability. In order to investigate the relative incidence of different polyneuropathies in the elderly focusing on the contribution of nerve biopsy to their diagnosis, the authors studied 74 patients over 65 years of age with clinical, laboratory, electrophysiological, and sural nerve biopsy findings of different types of polyneuropathy. Vasculitic polyneuropathy seemed to be the most common cause of disabling neuropathy in the elderly, followed by paraneoplasia and diabetes. The possible diagnosis of idiopathic axonal neuropathy in the nine cases with neuropathy of unknown origin is discussed.
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Affiliation(s)
- E Kararizou
- Section of Neuropathology, Neurological Clinic of University of Athens Eginition Hospital, Athens, Greece.
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8
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Benatar M. Distal symmetric polyneuropathy: Limitations of the proposed case definition. Muscle Nerve 2006; 34:131-4. [PMID: 16680711 DOI: 10.1002/mus.20573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, Cohen JA, Fisher MA, Howard JF, Kinsella LJ, Latov N, Lewis RA, Low PA, Sumner AJ. Distal symmetrical polyneuropathy: a definition for clinical research. A report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Arch Phys Med Rehabil 2005; 86:167-74. [PMID: 15641009 DOI: 10.1016/j.apmr.2004.09.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiologic studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiologic studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach to defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiologic research studies will ensure greater consistency of case selection.
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10
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Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med 2004; 21:976-82. [PMID: 15317601 DOI: 10.1111/j.1464-5491.2004.01271.x] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS A cross-sectional study has been performed in order to estimate the prevalence, severity, and current treatment of chronic painful peripheral neuropathy (CPPN) in people with diabetes in the community. METHODS Using a structured questionnaire and examination we have assessed these factors in a community sample of people with diabetes (n=350) and compared them with 344 age- and sex-matched people without diabetes from the same locality. RESULTS The prevalence of CPPN was estimated to be 16.2%[95% confidence interval (CI): 6.8-16%] in people with diabetes compared with 4.9% (95% CI: 2.6-7.2%) in the control sample (P < 0.0001). Diabetic subjects with and without CPPN did not differ in age, sex, type and duration of diabetes, body mass index, smoking status and glycaemic control. However, CPPN diabetic subjects had significantly higher Visual Analogue Scale (VAS) scores for pain over the preceding 24 h [median (interquartile range) 3.5 (1.5-6.7) cm vs. 0.7 (0-3.9) cm, P < 0.0001]. Also, the total McGill Pain Questionnaire Score (a measure of pain quality and severity) was 18 (13-31.5) vs. 10 (4-16) (P < 0.0001). Of patients with diabetes and CPPN, 12.5% (7/56) had never reported their symptoms to their treating physician and 39.3% (22/56) had never received any treatment for their painful symptoms. CONCLUSIONS CPPN is common, often severe but frequently unreported and inadequately treated.
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Affiliation(s)
- C Daousi
- Diabetes and Endocrinology Research Group, University Hospital Aintree, Liverpool, UK.
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11
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Affiliation(s)
- John D England
- Department of Neurosciences, Deaconess Billings Clinic, 2825 Eighth Avenue North, Billings, Montana 59107-7000, USA.
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12
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England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, Cohen JA, Fisher MA, Howard JF, Kinsella LJ, Latov N, Lewis RA, Low PA, Sumner AJ. Distal symmetrical polyneuropathy: Definition for clinical research. Muscle Nerve 2004; 31:113-23. [PMID: 15536624 DOI: 10.1002/mus.20233] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiological studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiological studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach for defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiological research studies will ensure greater consistency of case selection.
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Affiliation(s)
- J D England
- American Association of Electrodiagnostic Medicine, 421 First Avenue SW, Suite 300E, Rochester, MN 55902, USA
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Hughes RAC. Management of Chronic Peripheral Neuropathy. J R Coll Physicians Edinb 2000. [DOI: 10.1177/147827150003000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R. A. C. Hughes
- Guy's, Kings and St Thomas’ School of Medicine, King's College, London
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14
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Bogliun G, Di Viesti P, Monticelli ML, Beghi E, Zarrelli M, Simone P, Airoldi L, Frattola L. Anticonvulsants and Peripheral Nerve Function. Clin Drug Investig 2000. [DOI: 10.2165/00044011-200020030-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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15
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Gómez de la Cámara A, Posada de la Paz M, Abaitua Borda I, Barainca Oyagüe MT, Abraira Santos V, Ruiz-Navarro MD, Terracini B. Health status measurement in Toxic Oil Syndrome. J Clin Epidemiol 1998; 51:867-73. [PMID: 9762880 DOI: 10.1016/s0895-4356(98)00062-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Toxic Oil Syndrome (TOS) is a previously unreported condition which affected more than 20,000 people in Spain in 1981 and whose natural history is unknown. In 1993-94, a stratified random sample of 1400 survivors was drawn to measure their health status through clinical examination and their self-perception of well-being through the Nottingham Health Profile Questionnaire (NHPQ). Two-thirds of the sample population responded; indirect estimates suggest that selection bias was limited. Clear and intermediate signs of neuropathy were found in one-fifth and one-half of the patients, respectively. One-fourth and one-sixth showed some degree of scleroderma and contractures. All conditions were more frequent in women than in men and in age >50 than in younger ages. Although no concurrent control group was included in the study, prevalences of these conditions are well above expectations and are largely attributable to TOS. NHPQ scores increased with age in both sexes up to age 50, after which they reached a plateau (with values around 48 in men and 62 in women). Scores were associated to the occurrence of peripheral neurological changes, contractures, and scleroderma-like conditions. A multivariate analysis indicated age, sex, and severity of neurological conditions as major determinants of the NHPQ scores. This overall pattern of findings is peculiar to TOS and differs from the typical post-disaster nonspecific syndrome.
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Affiliation(s)
- A Gómez de la Cámara
- Centro de Investigaciones para el Síndrome del Aceite Tóxico, Subdirección General de Epidemiología e Información Sanitaria, Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo Madrid, Spain
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