Background: Hypokinetic dysarthria -with hypophonia as its main symptom-is a common feature of Parkinson's disease, affecting approximately 90% of patients. Hypophonia, characterized by reduced speech volume, leads to difficulties in communication with others due to decreased speech intelligibility. Current treatments involve intensive and cognitively demanding behavioral therapies such as the Lee Silverman Voice Treatment (LSVT). The SpeechVive is a wearable device that produces noise to elicit increased vocal intensity utilizing a natural reflex through the Lombard effect. Methods: We propose a multicenter, phase III, two-armed, parallel, open-label, randomized controlled trial comparing the effectiveness of LSVT with SpeechVive. We seek to assign 238 patients to either LSVT or SpeechVive device in a 1:1 ratio through a stratified permuted block randomization. Patients ages 50 to 80 years, diagnosed with idiopathic Parkinson's Disease based on MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) criteria, a Hoehn and Yahr stage 2 and 3, on stable dopaminergic doses for the past 3 months, with perceived communication difficulties will be included in the trial. Patients will be excluded if they present additional neurodegenerative diseases, prior stroke, laryngeal pathologies, hearing or a severe visual impairment, or who underwent speech therapy or have a deep brain stimulation electrode implanted. The primary outcome is speech intelligibility measured through the Speech Intelligibility Test (SIT) for windows. Secondary outcomes include adherence, the vocal intensity measured with Sound Pressure Level (SPL), Vocal Handicap Index (VIH), and Parkinson's Disease Questionary-39. We will measure each outcome at baseline and after eight weeks of treatment. Our principal statistical analysis is multiple linear regression analysis, with age, gender, site, and PD severity as covariates. Discussion: We present a protocol for a randomized controlled trial addressing an important issue that hampers the ability of Parkinson's Disease patients to communicate effectively. We aim at exploring SpeechVive as an alternative, more accessible treatment for hypophonia in patients with Parkinson's Disease.
Análisis de sobrevida en pacientes incidentes de hemodiálisis en Chile, 2013-2019 rodrigo a. sepúlveda 1 , andrés pavloviC 2 , osCar Corsi 3 , aquiles Jara 1 Survival analysis of patients starting hemodialysis in Chile between 2013 and 2019Background: Renal replacement therapies, especially hemodialysis (HD) in end-stage kidney disease, avoid an inevitable death caused by the disease. However, in elderly patients with multiple comorbidities, this therapy could derive in a comparable survival than conservative management. Considering that HD represents a high cost for the health system, it is worth analyzing the effects of HD on survival. Aim: To analyze the survival and mortality of all national health security system´s patients (FONASA) admitted to HD in Chile from 2013 to 2019. Material and Methods: We requested to the Ministry of Health information about all patients affiliated to the public health insurance system that started dialysis between 2013 and 2019. We evaluated the influence of age when starting HD, sex, presence of hypertension, presence of diabetes mellitus (DM), the region of residence, and year of admission on mortality. Results: A total of 24,113 patients aged 61 ± 15 years (45% women) were analyzed. Forty five percent of patients were aged > 65 years. After 5 years of follow-up, the median survival in this age group was 36.1 months. Among patients who started HD at age > 85 years, the median survival was 14.8 months. Diabetic patients had a median survival of 52.3 months. Advanced age and DM were associated with higher annual mortality. Also, the region of residence and year of admission were associated with higher mortality at 3 and 12 months. Conclusions: The median survival of patients on HD is dependent on age and the presence of comorbidities, among other factors. We performed an analysis to determine if starting HD in older patients with comorbidities has a real benefit over conservative management in terms of survival.
Background: With the aim to inform end of life public policies, the place of death in Chile, its trends and associated factors were analysed. Materials and Methods: A cross sectional using publically available death database from 1990 to 2014 was conducted. The proportion of hospital deaths was selected as the main outcome. A logistic regression was used to assess the association between place of death, age, and main diagnosis at death. Also, a Prais-Winsten regression and a Chi 2 test were used to assess a time series and regional analysis, respectively. Results: 2,063,615 deaths were analysed. Overall, deaths 898,871 (43.6%) occurred at hospital. Those who died over 85 years (OR 2,52 IC95% 2.49-2.55) and those who died from cancer (OR 2.43 IC95% 2.42-2.45) had higher risk for dying outside de hospital. For the general population and those who die form cancer, there is no evidence for an increase or decrease trend in the proportion of hospital deaths over time (p = 0,75 and p = 0.68, respectively). However, there is an increase of the proportion of hospital deaths in those who died over 85 years (p < 0.001, 27% in 1990 to 32% in 2014). Also, there are geographic differences between country regions (p < 0.001) (Eg. Magallanes 52.9%). Conclusions: The proportion of hospital deaths has been stable over time in the general population and has increased in those over 85 years.
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