RESUMEN
Obstructive sleep apnea (OSA) is a frequent and underdiagnosed disease in hypertensive individuals who experience cardiovascular events. The aim of this study was to define the best model that combined the ambulatory blood pressure (BP) monitoring (ABPM), anthropometric, sociodemographic, and biological variables to identify moderate to severe OSA. A total of 105 ABPM-confirmed hypertensive patients were evaluated using their clinical histories, blood analyses, ABPM, and home respiratory polygraphic results. A multivariate logistic regression analysis was performed to identify the significant variables. The best model included sex, presence of obesity (body mass index ≥30 kg/m(2) and abdominal obesity), mean daytime BP, mean nocturnal heart rate, and minimal diastolic nighttime BP to achieve an area under the curve of 0.804. Based on this model, a validated scoring system was developed to identify the patients with an apnea-hypopnea index ≥15. Therefore, in untreated hypertensive patients who snored, ABPM variables might be used to identify patients at risk for OSA.
Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial/métodos , Hipertensión/diagnóstico , Apnea Obstructiva del Sueño/diagnóstico , Adulto , Antropometría , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/fisiopatología , Ronquido/diagnóstico , Ronquido/fisiopatología , España/epidemiologíaRESUMEN
OBJECTIVES: The main objective was to analyse the Zarit scale's (ZS) ability to identify signs of caregiver collapse amongst people looking after patients suffering from dementia. We also evaluated the dimensions most affected by the ZS and risk factors associated with caregiver burden and collapse. METHODS: We administered the ZS and semi-structured interviews to identify signs of caregiver collapse amongst 66 people looking after patients suffering from dementia. We evaluated the risk factors associated with the patient: age, sex, type of dementia, place of residence, length of illness, behavioural disorders, incontinence, the Barthel index (IB), the Global Deterioration Scale (GDS), Folstein's Mini-Mental State Examination (MMSE) and the use of day-care centres and also risk factors associated with the caregiver: age, sex, relationship with the patient, help received with caring, the patient's illness, other family responsibilities and other work outside the home. RESULTS: There was a large degree of agreement between the findings from the interview and the ZS (Kappa = 0.545; p < 0.001). With regard to the risk factors evaluated in this study, there was a statistically significant relationship between behavioural disorders and both burden (p < 0.27) and collapse (p < 0.17) and between caregiver collapse and the caregiver and patient not living at the same home (p < 0.27). CONCLUSION: The ZS is not only useful for identifying caregiver burden, but also for predicting main caregiver collapse. Behavioural disorders and not living with the patient are the main causes of caregiver burden and collapse.
Asunto(s)
Cuidadores/psicología , Costo de Enfermedad , Demencia/psicología , Atención Domiciliaria de Salud/psicología , Escalas de Valoración Psiquiátrica/normas , Adulto , Anciano , Anciano de 80 o más Años , Demencia/enfermería , Dependencia Psicológica , Métodos Epidemiológicos , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estrés PsicológicoRESUMEN
BACKGROUND: Our purpose was to assess the usefulness of a strategy based on the clinical presentation in order to choose antibiotics in patients with non-severe community-acquired pneumonia (CAP). PATIENTS AND METHOD: During one year, all patients admitted to the emergency department with a diagnosis of non-severe (Fine risk-classes I, II and III) CAP, were randomized and assigned into the following groups: GROUP 1: the clinical presentation was not taken into account and all patients were treated with levofloxacin; GROUP 2: patients with typical presentation were treated with amoxicillin and patients with atypical presentation were treated with clarithromycin. The following aspects were evaluated during the follow-up: presence of fever after 72 h of treatment, days of hospitalization and complications. RESULTS: The eventual population analyzed included 125 patients: 59 (47%) were assigned to Group 1 and 66 (53%) to Group 2. Patients assigned to Group 1 had a lower rate of fever after 72 h of treatment (7% vs 27%, p = 0.005); they were hospitalized for fewer days (4.8 vs 8.1 days, p = 0.01), and had less complications: changes in antibiotic treatment (10% vs 23% p = NS), admissions in ICU (0% vs 5%, p = NS), re-admissions in hospital (0% vs 5%, p = 0.05) and mortality (0% vs 2%, p = NS). CONCLUSIONS: A strategy of empiric treatment of non-severe CAP with levofloxacin as the antibiotic of choice is more useful than that of a treatment based on the clinical presentation.
Asunto(s)
Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Levofloxacino , Ofloxacino/uso terapéutico , Neumonía Bacteriana/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos/uso terapéutico , Infecciones Comunitarias Adquiridas/diagnóstico , Femenino , Hospitalización , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Penicilinas/uso terapéutico , Neumonía Bacteriana/diagnóstico , Resultado del TratamientoRESUMEN
FUNDAMENTO: Evaluar la utilidad de la estrategia basada en tener en cuenta la presentación clínica para la elección del tratamiento antibiótico en enfermos con neumonía adquirida en la comunidad (NAC) no grave. PACIENTES Y MÉTODO: Durante un año, todos los enfermos con diagnóstico de NAC no grave (clases I, II y III del índice de gravedad de Fine) fueron aleatorizados a los siguientes grupos de tratamiento: grupo 1, en el que no se tuvo en cuenta la presentación clínica y todos los enfermos fueron tratados con levofloxacino, y grupo 2, en el que a los pacientes con presentación clínica típica se les administró amoxicilina y a los enfermos con presentación atípica se les administró claritromicina. Durante el seguimiento se evaluaron los siguientes aspectos: persistencia de fiebre tras 72 h de tratamiento, estancia media hospitalaria y complicaciones. RESULTADOS: La población final analizada fue de 125 enfermos, 59 (47 per cent) fueron asignados al grupo 1 y 66 (53 per cent) al grupo 2. Los asignados al grupo 1 tuvieron menor porcentaje de fiebre tras 72 h de tratamiento (el 7 frente al 27 per cent; p = 0,005); su estancia media hospitalaria resultó inferior (4,8 frente 8,1 días; p = 0,01) y tuvieron un menor número de complicaciones: cambios de tratamiento (el 10 frente al 23 per cent; p = NS), necesidad de control en UCI (el 0 frente al 5 per cent, p = NS), reingresos en el hospital (0 frente al 5 per cent; p = 0,05) y mortalidad (0 frente al 2 per cent; p = NS). CONCLUSIONES: Una estrategia de tratamiento empírico de la NAC no grave independientemente de la presentación clínica y que utilice levofloxacino como antibiótico de elección es más útil que un tratamiento empírico basado en la presentación clínica (AU)