Lesley Storey

Rehabilitation for Parkinson's disease: a systematic review of available evidence

Objective: To systematically review the available evidence on the effectiveness of nonpharmacological rehabilitation interventions for people with Parkinsons disease, and identify future research needs. Design: Electronic searches of four databases (CINAHL, Cochrane Library, MEDLINE, PsychLIT) 1980-2002; examination of reference lists of relevant papers. Controlled trials and observational studies were included. Data extraction and quality assessment of papers by two independent reviewers. A narrative review. Setting: Rehabilitation interventions delivered either in subjects own homes, or in clinical settings as outpatients. Subjects: Community-living adults with Parkinsons disease. Interventions: Physiotherapy, occupational therapy, speech and language therapy, psychological counselling and support, and education. Main measures: A range of outcomes: mobility, functional status, speech, swallowing, psychological well-being, as determined by the studies included in the review. Results: Forty-four different studies (reported in 51 papers) were included (25 physiotherapy, 4 occupational therapy, 10 speech and language therapy, 3 psychological counselling, 1 educational, 1 multidisciplinary). All studies, except one, reported improvements on at least one outcome measure. Conclusions: Findings may reflect publication bias, but suggest interventions can affect patients lives for the better in a variety of ways. It is difficult to interpret the clinical importance of statistically significant improvements reported in most studies. There is a need for methodologically more robust research with meaningful follow-up periods, designed in a manner that separates specific and nonspecific effects. Cost-effectiveness evidence is required to provide clear guidance on service extensions.

Excess burden of constipation in Parkinson's disease: A pilot study

An analysis was undertaken of clinic‐based questionnaires that asked people with Parkinsons disease and a control group of older people without a known neurological condition about their experiences of constipation. People with Parkinsons disease report higher constipation on a validated objective measure, the Rome criterion (59% vs. 20.9%); a behavioral indicator, laxative‐taking (38.4% vs. 14.2%); and subjective self‐report of being always or often concerned by it (33.4% vs. 6.1%). Many people with Parkinsons disease experience constipation problems but they may not bring these to the attention of their healthcare providers. More research is required to understand the causes and management options.

Development of a food compositional database for the estimation of dietary intake of phyto-oestrogens in a group of postmenopausal women previously treated for breast cancer and validation with urinary excretion

The scientific literature contains evidence suggesting that women who have been treated for breast cancer may, as a result of their diagnosis, increase their phyto-oestrogen (PE) intake. In the present paper, we describe the creation of a dietary analysis database (based on Dietplan6) for the determination of dietary intakes of specific PE (daidzein, genistein, glycitein, formononetin, biochanin A, coumestrol, matairesinol and secoisolariciresinol), in a group of women previously diagnosed and treated for postmenopausal breast cancer. The design of the database, data evaluation criteria, literature data entry for 551 foods and primary analysis by LC–MS/MS of an additional thirty-four foods for which there were no published data are described. The dietary intake of 316 women previously treated for postmenopausal breast cancer informed the identification of potential food and beverage sources of PE and the bespoke dietary analysis database was created to, ultimately, quantify their PE intake. In order that PE exposure could be comprehensively described, fifty-four of the 316 subjects completed a 24 h urine collection, and their urinary excretion results allowed for the description of exposure to include those identified as ‘equol producers’.

A semantically enabled formalism for the knowledge management of Parkinson's disease

Bio-ontology is a formal representation of biological concepts that is used in the interchange of communication between computers and humans alike. They can then be used in the formulation and retrieval of knowledge. In developing a knowledge-based system for Parkinsons Disease, a procedure of knowledge map was used to capture and harness the intellectual resources of an organization, and new paradigms for knowledge mapping were also formulated. Knowledge bases for symptoms and drugs, physiotherapy, speech and language therapy, and dieting that affect patient care were developed. Finally, the knowledge bases were merged to form a single central repository of knowledge base.

Food choice and phytoestrogen consumption in women previously treated for postmenopausal breast cancer

Background Phytoestrogens are plant-derived, bioactive substances with a chemical structure similar to that of 17uf0e2-oestradiol. Women previously treated for breast cancer may increase their phytoestrogen intake to avoid conventional hormone replacement therapy or because of a belief that they may help avoid recurrence [1,2]. There is no recommended daily intake and there are some concerns about phytoestrogen safety in this group, although the evidence is conflicting and more research is needed [3,4]. Methods Three hundred and sixteen women each completed a 4- day food and drink diary (14 of whom also completed a 7-day weighed intake diary 6 weeks previously). The 55 most recently recruited women collected their urine for 24 hours whilst completing their diaries and were interviewed by telephone regarding their food choices since diagnosis. Results A new dietary analysis database was created using peerreviewed published data and analysing 34 additional foods and beverages for which there were no published results. The urinanalysis results contributed validation data. A summary of the dietary intake data is shown in Table 1. There was a lack of primary analytical data on the phytoestrogen profile of many foods and beverages routinely consumed by this study population. However, food frequency data from the highest quartile show the important contribution of nonsoya foods to high intakes (Table 2). Telephone interviews were completed by 39 subjects. For most women, having breast cancer had not changed their diet. Health concerns unrelated to cancer, the needs of other family members, cooking on a budget and physical appearance all seemed more important than the impact of the cancer diagnosis. Discussion Variation in phytoestrogen intakes and metabolite excretion reflect food preferences, dietary analysis database limitations and likely variations in existing knowledge combined with a lack of routine access to dietary information. In the absence of definitive advice, more immediate health and social concerns influence food choice rather than past breast cancer diagnosis. Conclusion No data previously existed on intake in this potentially vulnerable group and these data will help evaluate the health implications related to such phytoestrogen consumption patterns. Acknowledgement Funded by the Food Standards Agency, UK. References 1. Adlercreutz H: Phytoestrogens and breast cancer. J Steroid Biochem Mol Biol 2002, 83:113-118. 2. Mills E, Ernst E, et al.: Health food store recommendations:implications for breast cancer patients. Breast Cancer Res 2003, 5:170-174. 3. De Lemos M: Safety issues of soy phytoestrogens in breast cancer patients. J Clin Oncol 2002, 20:3040-3041. 4. Committee on Toxicology of Chemicals in Food, Consumer Products and the Environment. Phytoestrogens and Health. London: Food Standards Agency; 2003.