The Prevalence of Parkinson's Disease in Poland: Regional and Sex-Related Differences

Background

Given the growing evidence for an environmental contribution to the etiology of Parkinson's disease (PD), searching for local and regional differences in PD prevalence in multiple areas across the world may further clarify the role of environmental toxins.

Objective

To provide local and regional prevalence estimates of PD in Poland.

Methods

We analyzed the prevalence of PD and its trend over the last decade (2010 to 2019) based on data from the National Health Fund in Poland. We specifically examined sex differences in PD prevalence, as well as differences across Polish regions.

Results

During the above period, the prevalence of PD in Poland increased from 226 per 100,000 to 269 per 100,000 inhabitants. Unexpectedly, we found that PD was 1.2-times more common in women than men. The increase in prevalence over the past decade was different between both sexes: an increase from 250 to 283 per 100,000 for women (13.3% increase), and from 200 to 254 per 100,000 for men (27.1% increase). In addition, we observed differences in prevalence across different Polish regions, with some regions having up to 51% lower prevalence rates than others.

Conclusions

The prevalence of PD in Poland is in line with previously reported prevalence rates across Europe. However, unlike the situation in most of the world, PD was more prevalent in women than men. We discuss several possible explanations as well as potential measures that might help to reduce the growth of PD.

Accessibility of device-aided therapies for persons with Parkinson's disease in Poland

Background

Access to care for people with Parkinson's disease (PD), in particular to device-aided therapies (DAT), is not equally distributed.

Objectives

To analyse accessibility to DAT (deep brain stimulation; intraduodenal levodopa pump therapy; or apomorphine pump therapy) in Poland.

Methods

We analysed the distribution of DAT use in Poland by determining the number of persons with PD receiving one of the three DATs during 2015-2021.

Results

In 2021 the number of persons receiving DAT in Poland was 0.56% of the total PD population, having increased from 0.21% in 2015. Overall, deep brain stimulation was the preferred DAT in Poland, but strong regional differences in the use of the other DAT were present. Accessibility to DAT was negatively associated with average annual income (p<0.001).

Conclusions

Access to DAT for PD in Poland is still limited and accessibility showed strong regional differences, although its general increase over the last decade is encouraging.

Kinds of Harm: Animal Law Language from a Scientific Perspective

Simple Summary

Clarity and consistency of legal language are essential qualities of the law. Without a sufficient level of those, legal acts are often hardly capable of determining legal duties appropriately. The review of rules governing the protection of animals reveals that the current language remains far from satisfactory. Therefore, the paper discusses the most sensitive notions relevant for defining animal harm and argues for action to make the legal language of respective legal regulations more scientifically accurate and adequate to the actual needs of animal protection.

Abstract

The current language of animal welfare laws is inconsistent and unclear in the basic terms pertaining to animal sensations and potential harms. In the case of law, the exact language often plays an essential role in determining legal duties and establishing their scope. Thus, for further progress in animal law, a coherent and unified basic conceptual framework is needed. To establish such a framework, the relevant legal terminology should be discussed in a prescriptive rather than interpretive manner while drawing on the medical sciences. Here, we propose a way to clarify the relevant terms to prevent misconceptions and improve the consistency of animal law.

Ethical Review of Animal Research and the Standards of Procedural Justice: A European Perspective

Committees established for the ethical review of research involving animals have become a widespread legal standard around the world. Despite many differences in their composition, powers, and institutional settings, they share many common problems related to the well-established standards of procedural justice in administrative practice. The paper adapts the general theory of procedural justice to the specific context of ethical review committees. From this perspective, the main concerns over the procedural aspects of the ethical evaluation of research projects are identified and examined. They include in particular the standards of the committees' composition, impartiality, fair hearing, appeal, transparency, and benevolence. Their proper reflection in the regulatory regimes of animal ethics committees is necessary to secure the standards of fairness of the ethical review itself. This, in turn, is a condition of the moral and social legitimacy of all administrative and quasi-administrative procedures, including the committees' operations (irrespective of whether they are legally entrusted with the task of authorizing or only evaluating research projects).

Cost-Effectiveness of Device-Aided Therapies in Parkinson's Disease: A Structured Review

Background:

Despite optimal dopaminergic treatment most patients in moderate to advanced stages of Parkinson’s disease (PD) experience progressively increasing disabilities, necessitating a shift from oral medication to device-aided therapies, including deep brain stimulation (DBS), intrajejunal levodopa-carbidopa infusion (IJLI), and continuous subcutaneous apomorphine infusion (CSAI). However, these therapies are costly, limiting their implementation.

Objectives:

To perform a systematic review on cost-effectiveness analyses for device-aided therapies in PD.

Methods:

References were identified by performing a systematic search in the PubMed and Web of Science databases in accordance with the PRISMA statement. In the absence of universal cost-effectiveness definitions, the gross domestic product per capita (GDP) in the country where a study was performed was used as a cut-off for cost-effectiveness based on cost per quality adjusted life year (QALY) gained.

Results:

In total 30 studies were retrieved. All device-aided therapies improved quality of life compared to best medical treatment, with improvements in QALYs between 0.88 and 1.26 in the studies with long temporal horizons. For DBS, nearly all studies showed that cost per QALY was below the GDP threshold. For infusion therapies only three studies showed a cost per QALY below this threshold, with several studies with long temporal horizons showing costs below or near the GDP threshold.

Conclusion:

Of the device-aided therapies, DBS can be considered cost-effective, but the majority of infusion therapy studies showed that these were less cost-effective. However, long-term use of the infusion therapies appears to improve their cost-effectiveness and in addition, several strategies are underway to reduce these high costs.

The reality of informed consent: empirical studies on patient comprehension-systematic review

Background

Informed consent is a basic concept of contemporary, autonomy-based medical practice and facilitates a shared decision-making model for relations between physicians and patients. Thus, the extent to which patients can comprehend the consent they grant is essential to the ethical viability of medicine as it is pursued today. However, research on patients’ comprehension of an informed consent’s basic components shows that their level of understanding is limited.

Methods

Systemic searches of the PubMed and Web of Science databases were performed to identify the literature on informed consent, specifically patients’ comprehension of specific informed consent components.

Results

In total, 14 relevant articles were retrieved. In most studies, few clinical trial participants correctly responded to items that examined their awareness of what they consented to. Participants demonstrated the highest level of understanding (over 50%) regarding voluntary participation, blinding (excluding knowledge about investigators’ blinding), and freedom to withdraw at any time. Only a small minority of patients demonstrated comprehension of placebo concepts, randomisation, safety issues, risks, and side effects.

Conclusions

We found that participants’ comprehension of fundamental informed consent components was low, which is worrisome because this lack of understanding undermines an ethical pillar of contemporary clinical trial practice and questions the viability of patients’ full and genuine involvement in a shared medical decision-making process.

Intelligent backtracking in plan-based deduction

This paper develops a method of mechanical deduction based on a graphical representation of the structure of proofs. Attempts to find a refutation(s) are recorded in the form of plans, corresponding to portions of an AND/OR graph search space and representing a purely deductive structure of derivation. This method can be applied to any initial base (set of nonnecessarily Horn clauses). Unlike the exhaustive (blind) backtracking which treats all the goals deduced in the course of a proof as equally probable sources of failure, his approach detects the exact source of failure. Only a small fragment of the solution space is kept on disk as a collection of pairs, each of which consists of a plan and a graph of constraints. The search strategy and the method of nonredundant processing of individual pairs which leads to a solution (if it exists) is presented. This approach is compared¿on a special case¿with a blind backtracking algorithm for which an exponential improvement is demonstrated. Some important implementation problems are discussed, and toplevel design of a mechanical deduction system implementing our algorithm is presented. It is proven that the algorithm is complete in the following sense: if for a given base a resolution refutation exists, then this refutation is found by the algorithm.

Deduction plans: a basis for intelligent backtracking

A proof procedure is described that relies on the construction of certain directed graphs called ``deduction plans.'' Plans represent the structure of proofs in such a way that problem reduction may be used without imposing any ordering on the solution of subproblems, as required by other systems. The structure also allows access to all clauses deduced in the course of a proof, which may then be used as lemmas. Economy of representation is the maximum attainable, consistent with this unrestricted availability of lemmas. Restricted versions of this deduction system correspond to existing linear deduction procedures, but do not suffer from some of their shortcomings, such as redundant representation, strict ordering of subproblems, and explicit substitution. One of the rules for constructing plans, however, allows a subproblem to be factored to a previously solved one: this has no equivalent in existing system. A further economy is obtained by making it unnecessary to perform substitutions and calculate most general unifiers. The source of unification failure can be located when a subproblem is found to be unsolvable, so that exact backtracking can be performed rather than the blind backtracking performed by existing systems. Therefore, a deduction system based on the construction of plans can avoid the wasteful search of irrelevant areas of the search space that results from the usual backtracking methods.