Neuroepidemiology
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The incidence and some risk factors of Parkinson's disease were investigated in a study performed in The Netherlands. The study was based on a disease register of the Sentinel Stations, which provide a complete ascertainment of new patients with Parkinson's disease in 60 general practices in The Netherlands. ⋯ Cigarette smoking was associated with a lower risk of Parkinson's disease (relative risk 0.6, 95% confidence interval 0.3-1.0). No association was observed between Parkinson's disease and severe head trauma with loss of consciousness, or surgery with total anaesthesia.
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Injuries are the leading cause of death in the United States for those between 1 and 44 years of age and brain injuries are a major component of trauma. This report examines survival in a cohort of San Diego County, California, residents who incurred a brain injury in 1981. Cumulative risk of death over time, using the Cox Proportional Hazards Model, and predictors of death (determined by logistic regression) are used to evaluate survival. ⋯ Age as well as nature and severity of brain injury are the important predictors of in-hospital death. People who are discharged alive from the hospital have survival comparable to that of the population they came from. However, more die from trauma-related causes than would be expected.
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Case Reports
Prolonged, progressive dementia with spongiform encephalopathy: a variant of Creutzfeldt-Jakob disease?
A 46-year-old female is described with prolonged, progressive dementia and a brain biopsy consistent with Creutzfeldt-Jakob disease (CJD). She had neither myoclonic jerks nor an electroencephalogram with periodic spikes and suppression. ⋯ The nosology of CJD was discussed in the light of this case in which histopathology was characteristic of spongiform encephalopathy but the clinical features were atypical. We concluded that it would be premature to expand the traditional diagnostic criteria to include such cases as having CJD but, at the same time, it would be prudent to handle tissue, linens and surgical instruments as if they were contaminated by the resistant agent of CJD.
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Migraine trials often have to be performed at many centres, which creates a number of methodological problems. The present paper discusses single-centre versus multi-centre designs and also comments on the design of multiple-independent trials (MIT). From a methodological standpoint, the single-centre design should virtually always be preferred. ⋯ The major advantage of multi-centre trials, apart from recruitment, is that they may yield a more representative basis for conclusions regarding the whole population. Multiple-independent trials give an opportunity to summarize information from different sources. It has not the same methodological strength as the single- or multi-centre trial, but could be valuable, especially for evaluation of side effects.