[Specialised headache units, a feasible alternative in Spain]

INTRODUCTION

Visits due to headaches are the most frequent cause of demand for neurological treatment in primary care and neurology services. Headache units improve the quality of care, reduce waiting lists, facilitate access to new treatments of proven efficacy and optimise healthcare expenditure. However, these units have not been implemented on a widespread basis in Spain due to the relatively low importance attributed to the condition and also the assumption that such units have a high cost.

AIM

To define the structure and minimum requirements of a headache unit with the intention of contributing to their expansion in hospitals in Spain.

SUBJECTS AND METHODS

We conducted a consensus study among professionals after reviewing the literature on the structure, functions and resources required by a headache unit designed to serve an area with 350,000 inhabitants.

RESULTS

Eight publications were taken as a reference for identifying the minimum resources needed for a headache unit. The panel of experts was made up of 12 professionals from different specialties. The main resource required to be able to implement these units is the professional staff (both supervisory and technical), which can mean an additional cost for the first year of around 107,287.19 euros.

CONCLUSIONS

If we bear in mind the direct and indirect costs due to losses in labour productivity per patient and compare them with the estimated costs involved in implementing these units and their expected results, everything points to the need for headache units to become generalised in Spain.

Low-value care practice in headache: a Spanish mixed methods research study

BACKGROUND

Headache is one of the most prevalent diseases. The Global Burden of Disease Study ranks it as the seventh most common disease overall and the second largest neurological cause of disability in the world. The "Do Not Do" recommendations are a strategy for increasing the quality of care and reducing the cost of care for headache. This study aimed to identify specific low-value practices in headache care, determine their frequency, and estimate the cost overrun that they represent, in order to establish "Do not Do" recommendations specifically for headache by consensus and according to scientific evidence.

METHODS

This was a mixed methods research study that combined qualitative consensus-building techniques, involving a multidisciplinary panel of experts to define the "Do Not Do" recommendations in headache care, and a retrospective observational study with review of a randomized set of patient records from the past 6 months in four hospitals, to quantify the frequency of these "Do Not Do" practices. We calculated the sum of direct costs of medical consultations, medicines, and unnecessary diagnostic tests.

RESULTS

Seven "Do Not Do" recommendations were established for headache. In total, 3507 medical records were randomly reviewed. Low-value practices had a highly variable occurrence, depending on the hospital and type of headache. Overall, 34.1% of low-value practices were related to treatment, 21% were related to overuse of imaging in consultation, and 19% were related to emergency care. The estimated cost of low-value practices in the four hospitals was 203,520.47 euros per 1000 patients.

CONCLUSIONS

This study identified low-value headache practices that need to be eradicated and provided data on their frequency and cost overruns.

Experimental brain glioma: growth arrest and destruction by a blood-group-related tetrasaccharide

A synthetic tetrasaccharide (TS4), structurally related to blood groups, inhibited the proliferation of the C6 glioma cells in culture and the growth of tumors formed after intracerebral transplantation of C6 cells. TS4-treated tumors were substantially smaller than controls, as expected from TS4 cytostatic action on C6 glioma cells in culture. However, in vivo treatment also caused extensive tumor destruction. This effect appeared to be caused by indirectly, either by activation of natural killer cells, cytotoxic lymphocytes, or by inhibition of tumor vascularization. Enhanced antigenicity of TS4-treated glioma may be related to the increased expression of connexin 43 observed in glioma cell cultures treated with the oligosaccharide. Because concentrations of up to 20 mg/ml of TS4 were not toxic for normal neuronal or glial cells, specific oligosaccharides such as TS4 offer the possibility of selective tumor treatment.

Sex differences in the effect of MK-801 on normal and spinal cord injured rats

The induction of functional paraplegia in female rats by contusive spinal cord injury was not prevented by compound MK-801. However, the treatment reduced cavitation around the lesion epicenter to 14 mm3 compared to 17 mm3 in untreated controls t-test, P < 0.28) and conserved more neurons in defined regions outside the lesion epicenter (drug-treated animals vs untreated controls: 299 vs 73 neurons/mm2; t-test, P < 0.009). Thus, although MK-801 was only partially effective in preventing neuronal death secondary to contusion injury it appeared to have a definite neuroprotective effect. In view of the variety of side effects of MK-801 and the controversy on the mechanism of neuroprotection, we examined the action of the drug on non-injured animals. The effects of the drug were strongly sex-dependent. One hour after subcutaneous injection (0.5 mg/kg), female rats were hypothermic (36.8 °C treated vs 38.3 °C control) whereas male rats were hyperthermic (39.6 °C treated vs 38.4 °C control). In females, MK-801 caused cessation of cycling and appearance of numerous polymorphonuclear (PMN) phagocytes in vaginal frotis. Also, beginning 24 h after MK-801 injection, the proportion of PMN increased 400% in female blood, whereas males maintained control values. Arthritis-like joint inflammation was prominent in the toes of female rats, but males were unaffected. After continued treatment with the drug for 15 days, PMN count in female rats decreased and the animals resumed cycling. However, during this period female rats lost 20% of their weight, whereas males gained 26%. One hour after MK-801 injection large increases in blood pressure occurred in both sexes, returning to normal values 2 h later. Hypothermia does not appear to be a factor in the neuroprotective effect of MK-801, but the drug has a number of potentially dangerous side effects, particularly in female rats. Because polymorphonuclear cells are known sources of oxygen free radicals, neuroprotection by MK-801 treatment ought to be much more efficient in males than in females and the drug should be used in combination with a free-radical scavenger.

[Interactions between the immune system and the neuroendocrine system. Implications of the hypothalamo-hypophyseal-adrenal axis]

The immune and neuroendocrine systems are now recognized to be linked and involved in bidirectional communication. That interrelationship involves shared usage of common signal molecules and their receptors. The Immune System and its products can modulate neuroendocrine functions and neuroendocrine peptides and hormones can affect important immunological parameters. Specifically, this article review the evidence for immune-neuroendocrine interactions in relation to the Hypothalamic-Pituitary-Adrenocortical axis. Neuroendocrine-immune interactions appears to play an important role in psychosocial influences on immunologically resisted and mediated diseases.