Anxiety rating scales in Parkinson's disease: Critique and recommendations

Anxiety syndromes are common in patients with Parkinson's disease (PD) with up to 30% suffering from panic disorder, and up to 11% from generalized anxiety disorder (GAD). Anxiety is associated with increased subjective motor symptoms, more severe gait problems, dyskinesias, freezing, and on/off fluctuations. Anxiety has a negative impact on health related quality of life and is strongly associated with depressive syndromes. Since a variety of anxiety scales have been used in PD patients, the Movement Disorder Society commissioned a task force to assess the clinimetric properties of these scales in PD. A systematic review was conducted to identify anxiety scales that have either been validated or used in patients with PD. Six anxiety rating scales were identified. These were the Beck anxiety inventory, the hospital anxiety and depression scale, the Zung self‐rating anxiety scale and anxiety status inventory, the Spielberger state trait anxiety inventory, and the Hamilton anxiety rating scale. In addition, Item 5 (anxiety) of the neuropsychiatric inventory was included in the review. No scales met the criteria to be “recommended,” and all scales were classified as “suggested.” Essential clinimetric information is missing for all scales. Because several scales exist and have been used in PD, the task force recommends further studies of these instruments. If these studies show that the clinimetric properties of existing scales are inadequate, development of a new scale to assess anxiety in PD should be considered. © 2008 Movement Disorder Society     

Lynch syndrome in South America: past,present and future

After decades of unawareness about Lynch syndrome, the medical community in South America is increasingly interested and informed. The visits and support of mentors like H. T. Lynch had been crucial to this awakening. Several countries have at least one registry with skilled personnel in genetic counseling and research. However, this only represents a very restricted resource for the region. According to the GETH, there are 27 hereditary cancer care centers in South America (21 in Brazil, 3 in Argentina, 1 in Uruguay, 1 in Chile and 1 in Peru). These registries differ in fundamental aspects of function, capabilities and funding, but are able to conduct high quality clinical, research and educational activities due to the dedication and personal effort of their members, and organizational support. More support from the governments as well as the participation of the community would boost the initiatives of people leading these groups. Meantime, the collaboration among the South American registries and the involvement of registries and leaders from developed countries will allow to maximize the efficiency in caring for affected patients and their families. The aim of this article is to describe how the knowledge of LS began to be spread in South America, how the first registries were organized and to summarize the current state of progress. In addition, we will provide an update of the clinical and molecular findings in the region.     

Effect of the Timing of Restoration on Implant Marginal Bone Loss: A Systematic Review

Background: The advancement in implant dentistry has allowed shortened treatment time by restoring the implants earlier. Whether the timing of restoration has an impact on implant marginal bone level has not been systematically analyzed. The aim of this study is to compare marginal bone loss (MBL) between implants that were restored with the following protocols: 1) immediate restoration/loading (IR/L); 2) early loading (EL); and 3) conventional loading (CL). Methods: An electronic literature search from three databases (until November 2011) and a hand search in implant‐related journals were conducted. Clinical human studies in English language that had reported a comparison of MBL between implants with IR/L, EL, or CL with ≥12‐month follow‐up were included. In addition, the minimal number of implants had to be 10 for each group. Implants with both immediate placement (IP) and delayed placement (DP) were included and analyzed separately. An assessment of the publication bias for the included randomized clinical trials (RCTs) was performed. Results: The initial search resulted in 1,640 articles, of which 27 articles in full text were further evaluated for eligibility. Finally, 11 studies (eight RCTs, two controlled clinical trials, and one retrospective study) were qualified and classified into four groups: 1) IR/L + DP versus CL + DP (n = 6 articles); 2) IR + DP versus EL + DP (n = 2 articles); 3) EL + DP versus CL + DP (n = 1 article); and (4) IL + IP versus CL + IP (n = 2 articles). A meta‐analysis performed for group 1 showed 0.09 mm (95% confidence interval = ?0.27 to 0.09 mm) difference in the mean MBL, favoring the IR/L protocol but without significant difference (P = 0.33). No significant difference in MBL was found for groups 2 through 4 after adjusting for the implant placement level. The eight RCTs were determined to be at moderate‐to‐high risk of publication bias. Conclusions: This meta‐analysis does not show an effect of the timing of restorations on implant MBL. The selection of restoration protocols should be based on factors other than MBL.