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Purpose: Until now, the Hospitalization Rate (HR) served as an indicator (among others) for the COVID-19 associated healthcare burden. To ensure that the HR accomplishes its full potential, hospitalizations caused by COVID-19 (primary cases) and hospitalizations of patients with incidental positive SARS-CoV-2 test results (incidental cases) must be differentiated. The aim of this study was to synthesize the existing evidence on differentiation criteria between hospitalizations of primary cases and incidental cases. Methods: An online survey of the members of the German Network University Medicine (NUM) was conducted. Additionally, senior clinicians with expertise in COVID-19 care were invited for qualitative, semi-structured interviews. Furthermore, a rapid literature review was undertaken on publications between 03/2020 and 12/2022. Results: In the online survey (n=30, response rate 56%), pneumonia and acute upper respiratory tract infections were the most indicative diagnoses for a primary case. In contrast, malignant neoplasms and acute myocardial infarctions were most likely to be associated with incidental cases. According to the experts (n=6), the diagnosis, ward, and type of admission (emergency or elective), low oxygen saturation, need for supplemental oxygen, and initiation of COVID-19 therapy point to a primary case. The literature review found that respiratory syndromes and symptoms, oxygen support, and elevated levels of inflammatory markers were associated with primary cases. Conclusion: There are parameters for the differentiation of primary from incidental cases to improve the objective of the HR. Ultimately, an updated HR has the potential to serve as a more accurate indicator of the COVID-19 associated healthcare burden.
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OBJECTIVES: Dizziness is one of the most common complaints amongst older persons and has relevant consequences for functioning. However, the epidemiological findings on dizziness are scarce and inconsistent and prevalence varies considerably among existing studies. Hence the objective of this study is to compare the prevalence of dizziness in persons aged 50 years or older across several European countries. The specific aim was to identify country- and person-specific determinants associated with a higher risk. STUDY DESIGN: Cross-sectional study. METHODS: Data from the Survey of Health Ageing and Retirement in Europe project, covering 20 countries were analysed. Micro-data on more than 69,000 persons aged 50+ years and additional macro-data on economic inequality, climate and urbanisation were included. We applied multilevel models to examine the impact of country-50 years or older specific determinants as well as individual characteristics on prevalence of dizziness. RESULTS: We found a total of 12.4% of the participants in our sample were troubled by dizziness in the last 6 months. Prevalence ranged from 6.5% to 23.4%. In multilevel analysis several determinants on the country (higher proportion of urban population) and on the individual level (female gender, living alone, old age, poor education, presence of comorbidities, depressive symptoms, sensory problems, lack of physical activities) were identified. CONCLUSIONS: In conclusion dizziness is a common complaint amongst older Europeans that needs more attention. Further studies should investigate the prevalence, determinants and management of defined vestibular and non-vestibular causes of dizziness across Europe.
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Mareo/epidemiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
We estimated the prevalence of sarcopenia and its impact on disability in older people. Sarcopenia was found to contribute to higher disability scores. However, our study was not able to show any influence of sarcopenia on the rate of functional decline. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not. INTRODUCTION: The objectives of this study using data from a population-based cohort were to estimate the prevalence of sarcopenia in older people in Germany and to test the hypothesis that sarcopenia is associated with disability in older adults. METHODS: Cross-sectional (n = 927) and longitudinal analyses (n = 859) of participants aged ≥65 years at baseline from southern Germany enrolled in the Cooperative Health Research in the Region Augsburg (KORA)-Age study (2009-2012). Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm which includes the presence of both low muscle mass and low muscle function (strength or performance). Disability status was measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI). The presence of disability was defined as HAQ-DI >0. Directed acyclic graphs (DAGs) were constructed to identify potential confounders. The effect of sarcopenia on disability was analyzed using linear mixed effect models with disability values as a continuous outcome. RESULTS: The overall prevalence of sarcopenia was 5.7% (men 4.0%, women 7.5%) and increased with age. The 3-year incidence of disability was 32.7%. After adjustment for potential confounders, presence of sarcopenia was significantly associated with higher disability scores (0.142 [confidence interval 0.029-0.254]). CONCLUSION: The prevalence of sarcopenia is consistent with estimates from other European studies using this algorithm. Our results suggest that sarcopenia can contribute to higher disability scores in older adults. However, our study was not able to show any influence of sarcopenia on the rate of functional decline using the EWGSOP diagnostic algorithm for sarcopenia. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not.
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Personas con Discapacidad/estadística & datos numéricos , Sarcopenia/epidemiología , Anciano , Anciano de 80 o más Años , Algoritmos , Femenino , Marcha/fisiología , Evaluación Geriátrica/métodos , Alemania/epidemiología , Fuerza de la Mano/fisiología , Encuestas Epidemiológicas , Humanos , Masculino , Fuerza Muscular/fisiología , Prevalencia , Sarcopenia/fisiopatología , Sarcopenia/rehabilitación , Sensibilidad y Especificidad , Factores SocioeconómicosRESUMEN
BACKGROUND: Joint contractures are a common problem for older, frail people, particularly in rehabilitation, nursing home and homecare settings. Joint contractures are underreported and sparsely empirically investigated despite their high prevalence. AIM: The objective of this study was to examine the prevalence of functional impairments, activity limitations and participation restrictions of patients with joint contractures using the International Classification of Functioning, Disability and Health (ICF) as a framework. We also examined contextual factors as potential mediators for functioning and disability. DESIGN: Cross-sectional study- SETTING: Three acute-geriatric hospitals in and around Munich (Germany). POPULATION: Patients aged 65 and over with confirmed joint contractures requiring rehabilitation care. METHODS: The patients were asked to answer a questionnaire that comprised 124 categories of the ICF. Patients' problems in functioning were registered separately for each category. Data were collected through face-to-face interviews with patients and health professionals and from patients' medical records. RESULTS: One hundred and fifty patients were eligible and agreed to participate. Mean age was 82.5 years (SD: 7.4), 64.8% of the patients were female. Problems in "muscle power functions" (95.9%) and "driving human-powered transportation" (89,6%) were those most frequently identified. 'Health services, systems and policies' (98,6%) was the most frequent environmental facilitator. CONCLUSION: Aged persons with joint contractures experience high levels of disability. Specifically, mobility, participation restrictions and interactions with the environment emerged as important issues of our study. CLINICAL REHABILITATION IMPACT: Mobility and support by others were frequently mentioned as aspects relevant for persons with joint contractures. These aspects have to be considered when assessing the impact of joint contractures.
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Actividades Cotidianas , Contractura/rehabilitación , Evaluación de la Discapacidad , Personas con Discapacidad/rehabilitación , Estado de Salud , Artropatías/rehabilitación , Anciano , Anciano de 80 o más Años , Contractura/epidemiología , Contractura/fisiopatología , Estudios Transversales , Femenino , Alemania/epidemiología , Humanos , Artropatías/epidemiología , Artropatías/fisiopatología , Masculino , Proyectos Piloto , Prevalencia , Encuestas y CuestionariosRESUMEN
In addition to good medical care, living environment is of central importance in encouraging social participation among older people. Therefore, municipalities should prioritise the age-appropriate design of living environments. Results of the KORA Age study were presented at the regional conference "Living environment, age and health" in the Augsburg town hall on October 1, 2013. The results on participation and living environment were discussed with local policy makers and senior citizens' representatives from Augsburg and two surrounding regions. The study examined the impact of living environment on participation using two different approaches: qualitative findings from focus group discussions and quantitative findings based on telephone interviews and the use of a geographic information system. The results were complemented by contributions from a regional and national perspective. It was stressed in the closing discussion that a senior-friendly living environment can only be created by using a broad range of different measures. On the one hand physical barriers need to be removed, while at the same time the sense of community, neighborhood cohesion and solidarity should be encouraged further.
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Actividades Cotidianas , Conductas Relacionadas con la Salud , Investigación sobre Servicios de Salud/tendencias , Estado de Salud , Calidad de Vida , Características de la Residencia/estadística & datos numéricos , Condiciones Sociales/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Alemania , Humanos , MasculinoRESUMEN
Due to the increasing proportion of older people in the general population epidemiologists are interested in identifying which factors determine healthy ageing. For this reason within the German Society for Epidemiology we founded the working group 'Epidemiology of Ageing' in 2011. The working group organised a workshop to present useful datasets on ageing in Germany for epidemiological research. Those presented included: Study of Health in Pomerania (SHIP) The German Ageing Survey (DEAS) Surveys from the Robert Koch Institute: German Health Interview and Examination Survey for Adults (DEGS) and the German Health Update (GEDA) The German Socio-Economic Panel Study (SOEP) Cooperative Health Research in the Region of Augsburg (KORA-Age) Survey of Health, Ageing and Retirement in Europe (SHARE) Germany Claims data from statutory health insurance agencies Presentations contained a brief description of the datasets, methodologies, age-related themes, their strengths and limitations as well as their availability for secondary analysis. All presented datasets can be used for longitudinal analyses and are available to the scientific community.
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Envejecimiento , Congresos como Asunto , Bases de Datos Factuales , Métodos Epidemiológicos , Indicadores de Salud , Estado de Salud , Encuestas Epidemiológicas , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Antibiotics are undeniably beneficial. However, inappropriate or incorrect use puts patients at risk for avoidable adverse drug reactions, promotes emergence of resistance and potentially increases overall health-care costs. The objective of this study was to assess the impact of pharmaceutical consulting on the quality and costs of antibiotic use in surgical wards. PATIENTS AND METHODS: From February 2007 to February 2008 a total of 638 patients were enrolled in the controlled intervention study. Within the control period (n = 317) the current pattern of anti-biotic use was monitored without intervening, in the intervention period (n = 321) the pharmacist gave advice with regard to optimised antibiotic therapy. RESULTS: In 216 patients 331 antibiotic-related problems were identified; 232 interventions resulted in a modification of therapy (acceptance 70 %). The most common interventions were those regarding the duration of therapy and the choice of agent. The intervention with the greatest acceptance (91 %) was dosing recommendations. The pharmaceutical intervention resulted in a shorter duration of therapy (9.9 vs. 11.2 days, p < 0.001) and an increased adherence to the surgical department's guidelines (64 % vs. 71 %, p = 0.03). Intravenous therapy was switched to oral therapy earlier and more often (p = 0.006). As a result, the total cost for intravenous antibiotics decreased from 96 500.- to 81 600.- (p = 0.001). Dosage recommendations (e. g. in impaired organ function) or information on interaction and side effects increased drug -safety. CONCLUSION: Using the example of antibiotic therapy we showed that pharmaceutical counselling on surgical wards influences various aspects of antibiotic therapy, increases drug safety and reduces cost by having an effect on duration of therapy and timely switch from intravenous to oral preparations.
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Antibacterianos/uso terapéutico , Conducta Cooperativa , Infección Hospitalaria/tratamiento farmacológico , Comunicación Interdisciplinaria , Servicio de Farmacia en Hospital , Derivación y Consulta , Servicio de Cirugía en Hospital , Infección de la Herida Quirúrgica/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Antibacterianos/efectos adversos , Antibacterianos/economía , Ahorro de Costo/estadística & datos numéricos , Infección Hospitalaria/economía , Relación Dosis-Respuesta a Droga , Costos de los Medicamentos/estadística & datos numéricos , Farmacorresistencia Bacteriana , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Alemania , Adhesión a Directriz/economía , Humanos , Infusiones Intravenosas/economía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Garantía de la Calidad de Atención de Salud/economía , Infección de la Herida Quirúrgica/economíaRESUMEN
BACKGROUND: The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public. PATIENTS AND METHODS: In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics. RESULTS: A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%). CONCLUSION: The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.
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Enfermedad Crónica/epidemiología , Ensayos Clínicos como Asunto , Comorbilidad , Medicina Basada en la Evidencia , Investigación sobre Servicios de Salud/organización & administración , Servicios de Salud para Ancianos , Anciano , Anciano de 80 o más Años , Alemania , HumanosRESUMEN
BACKGROUND: Asthma is among the most common chronic diseases in childhood and is steadily increasing in prevalence. Better characterisation of factors that determine the risk of hospitalisation for atopic asthma in childhood may help design prevention programmes and improve our understanding of disease pathobiology. This study will focus on the altitude of residence. METHODS: This is an ongoing prospective birth-cohort study that enrolled all live-born infants in the Tyrol. Between 1994 and 1999, baseline data were collected for 33 808 infants. From 2000 to 2005, all children hospitalised for atopic asthma at the age of > or =6 years (n = 305) were identified by a careful search of hospital databases. Disease status was ascertained from the typical medical history, a thorough examination and proof of atopy. RESULTS: Living at higher altitude was associated with an enhanced risk of hospitalisation for atopic asthma (multivariate RRs (95% confidence interval 2.08 (1.45 to 2.98) and 1.49 (1.05 to 2.11) for a comparison between altitude categories > or =1200 m and 900-1199 m versus <900 m; p<0.001). This finding applied equally to hospital admissions in spring, summer, autumn and winter. When altitude of residence was analysed as a continuous variable, the risk for asthma hospitalisation increased by 7% for each 100-m increase in altitude (p = 0.013). CONCLUSIONS: This large prospective study shows a significant association between the risk of hospitalisation for atopic asthma and altitude of residence between 450 and 1800 m. The underlying mechanisms remain to be elucidated, but it is tempting to speculate about a role for altitude characteristics such as the decline in outdoor temperature and air humidity and increase in ozone levels, which may trigger airway hyper-responsiveness and attenuate lung function.
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Altitud , Asma/epidemiología , Hospitalización/estadística & datos numéricos , Asma/etiología , Austria/epidemiología , Femenino , Humanos , Recién Nacido , Masculino , Estudios Prospectivos , Factores de Riesgo , Estaciones del AñoRESUMEN
In order to resolve the spatial component of the design of a water quality monitoring network, a methodology has been developed to identify the critical sampling locations within a watershed. This methodology, called Critical Sampling Points (CSP), focuses on the contaminant total phosphorus (TP), and is applicable to small, predominantly agricultural-forested watersheds. The CSP methodology was translated into a model, called Water Quality Monitoring Station Analysis (WQMSA). It incorporates a geographic information system (GIS) for spatial analysis and data manipulation purposes, a hydrologic/water quality simulation model for estimating TP loads, and an artificial intelligence technology for improved input data representation. The model input data include a number of hydrologic, topographic, soils, vegetative, and land use factors. The model also includes an economic and logistics component. The validity of the CSP methodology was tested on a small experimental Pennsylvanian watershed, for which TP data from a number of single storm events were available for various sampling points within the watershed. A comparison of the ratios of observed to predicted TP loads between sampling points revealed that the model's results were promising.
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Monitoreo del Ambiente , Proyectos de Investigación , Contaminación del Agua , Modelos TeóricosRESUMEN
The principal instrument to temporally and spatially manage water resources is a water quality monitoring network. However, to date in most cases, there is a clear absence of a concise strategy or methodology for designing monitoring networks, especially when deciding upon the placement of sampling stations. Since water quality monitoring networks can be quite costly, it is very important to properly design the monitoring network so that maximum information extraction can be accomplished, which in turn is vital when informing decision-makers. This paper presents the development of a methodology for identifying the critical sampling locations within a watershed. Hence, it embodies the spatial component in the design of a water quality monitoring network by designating the critical stream locations that should ideally be sampled. For illustration purposes, the methodology focuses on a single contaminant, namely total phosphorus, and is applicable to small, upland, predominantly agricultural-forested watersheds. It takes a number of hydrologic, topographic, soils, vegetative, and land use factors into account. In addition, it includes an economic as well as logistical component in order to approximate the number of sampling points required for a given budget and to only consider the logistically accessible stream reaches in the analysis, respectively. The methodology utilizes a geographic information system (GIS), hydrologic simulation model, and fuzzy logic.
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Monitoreo del Ambiente/normas , Modelos Teóricos , Fósforo/análisis , Control de Calidad , Abastecimiento de Agua/normas , Monitoreo del Ambiente/métodos , Lógica Difusa , Sistemas de Información Geográfica , Movimientos del Agua , Abastecimiento de Agua/análisisRESUMEN
OBJECTIVE: Schizophrenia is a relatively common, often chronic and debilitating mental illness. Evidence from various studies has clearly demonstrated that genetic factors contribute substantially to the etiology. The goal of this study was to identify chromosomal regions likely to contain schizophrenia susceptibility genes. METHODS: A genome-wide map of 388 microsatellite DNA markers was genotyped in 5 schizophrenia families. Nonparametric linkage analysis (Genehunter) was used to assess the pattern of allele sharing at each marker locus relative to the presence of disease. RESULTS: Nonparametric linkage scores did not reach a genome-wide level of statistical significance (p < 0.00002) or a p value suggestive of linkage (p < 0.007) for any marker; however, one p value suggested replicated linkage (p < 0.01) at chromosome 6p24 in region D6S309 (p = 0.0047). Furthermore, 11 markers resulted in p < 0.05 at chromosomes 6p, 6q, 10q, 12q and 14q. CONCLUSIONS: Despite the differences in diagnostic schemes, in markers used and methods of analyses between studies published so far, we think that our result supports the notion that there is possibly some consistent evidence for replicated linkage of a schizophrenia susceptibility locus around the region of D6S309 at chromosome 6p24.
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Esquizofrenia/genética , Adulto , Cromosomas/genética , Femenino , Ligamiento Genético/genética , Marcadores Genéticos , Genoma Humano , Humanos , Masculino , Repeticiones de Microsatélite , Linaje , Esquizofrenia/clasificación , Esquizofrenia/diagnósticoRESUMEN
With schizophrenics negative delusional identities constitute one way of psychotic alteration of self-identification. The main notion is of being a personification of evil. In a cross-cultural comparison study we found in the Austrian sample 13 patients with negative delusional identities. Our present study is based on detailed interviews and evaluations of medical records of this sample. Our aim was to draft a typology of delusional identities as a basic requirement for a phenomenology of the negative manifestations. Further investigative goals were the efforts of self-explanation undertaken by the patients with regard to their altered condition, the search for a pathogenetic transitional series and the functional value of the new identities. According to our estimation the basic mood on which negative delusional identities are founded is timid and dejected. Further basic requirements are a disturbed conscience of the ego and the concurrence of grandeur and guilt ideas. Half of our patients imagined to be reincarnations of negative biblical figures, three regarded themselves as possessed, two attributed their identities to heredity. Despite of diverse situative points of departure a common pathogenetic transitional series emerged for all patients. From a functional point of view a negative delusional identity seems to offer some kind of protection from further structural disintegration as well as relief from feelings of guilt--all that however at the price of structural deformations with dynamic depletion.
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Deluciones/psicología , Psicología del Esquizofrénico , Adulto , Afecto , Austria , Femenino , Humanos , MasculinoRESUMEN
The clinical phenomenon called anticipation is usually defined as a decrease in age at onset and/or an increase in disease severity in successive generations of afflicted families. The purpose of this study was to examine variables that might influence anticipation in schizophrenia. A total of 380 Austrian patients, born between 1935 and 1964, met criteria for schizophrenia with ICD-8 or ICD-9, SADS-L and DSM-III-R criteria. The inclusion criteria also required medical records of patients to contain information about the year of birth, season of birth, age at onset, accidents or meningoencephalitic diseases during childhood, first- and second-degree relatives afflicted with schizophrenia, sibship size, sib order, education of patient, age of parents, occupation of parents, loss of parents, and place of residence. A Cox multiple-regression analysis showed three factors as having a significant influence on the age of disease onset, including year of birth (which had the largest influence), family history (sporadic cases showed an onset 2 years later than familial cases) and residence (urban dwellers showed psychotic symptoms approximately 1 year sooner than rural ones). A Kaplan-Meier Survival Analysis showed that younger cohorts had onset approximately 10 years earlier in sporadic and familial cases. This cohort effect might be a major source of bias in studies of anticipation.
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Edad de Inicio , Anticipación Genética , Esquizofrenia/epidemiología , Esquizofrenia/genética , Adulto , Austria/epidemiología , Sesgo , Estudios de Cohortes , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Análisis de Supervivencia , Población Urbana/estadística & datos numéricosRESUMEN
One of the central purposes of cross-cultural psychiatry is to scrutinize the sociocultural influences on the phenomenology of psychiatric diseases. On the other hand it is possible to lay bare a nucleus of symptoms, common to all cultures, which, independently of all influences, occupies a central position for an understanding of the disease considered. In this study an attempt was made to approach this problem by means of investigating the contents of delusion of schizophrenic patients in Austria and Pakistan. The contents of delusion among 126 Austrian and 108 Pakistani patients diagnosed as having schizophrenia according to DSM-III-R (art. 295) were compared following the classification of Huber and Gross. Additionally the kind of persecution and the type of the persecutor were registered. However it appeared that only a few contents of delusion are frequent in both countries. In both countries persecution was the most frequently mentioned content of delusion. The comparison of the contents of delusion revealed significantly higher frequencies of delusions of grandeur, guilt and religious delusions in Austrian patients. Significant differences could also be found with the kind of persecution and the persecutor's type. Cultural factors seem to have a decisive influence on shaping the contents of delusion.
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Comparación Transcultural , Deluciones/etnología , Esquizofrenia/etnología , Psicología del Esquizofrénico , Adulto , Austria , Características Culturales , Deluciones/psicología , Femenino , Humanos , Masculino , Pakistán , Escalas de Valoración Psiquiátrica , Esquizofrenia/diagnósticoRESUMEN
Functional psychosis has only rarely been described in context with extreme stressors, most studies focusing singularly on posttraumatic stress disorder symptoms. We report for the first time the case histories of 2 patients suffering from Capgras syndrome along with schizoaffective disorder and posttraumatic stress disorder after prior experience of prolonged torture. Interaction of personal life experience and psychiatric disorder are proposed as factors resulting in persistent changes in perception and affect.
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Síndrome de Capgras/psicología , Trastornos Psicóticos/psicología , Trastornos por Estrés Postraumático/psicología , Tortura/psicología , Adulto , Afecto , Síndrome de Capgras/etiología , Humanos , Masculino , AutoimagenRESUMEN
Sleep apnea is the most common sleep-related breathing disorder characterized by repetitive episodes of hypoxemia. Therapies include behavioral, surgical, orthodontic, pneumological, and pharmacological interventions. The aim of the present study was to compare the efficiency of pneumological therapy by nasal continuous positive airway pressure (CPAP) versus a pharmacological approach with theophylline (Respicur retard(R) 400 mg) on respiratory variables as well as objective and subjective sleep and awakening quality in patients with moderate sleep apnea measured by polysomnography and psychometry. Under CPAP therapy all respiratory variables improved and normalized, while under theophylline only the apnea-hypopnea index and the desaturation index improved but still did not return to normal values. Regarding sleep initiation and maintenance, CPAP therapy prolonged sleep latency and reduced movement time, while patients treated with theophylline showed reduced total sleep period, total sleep time and sleep efficiency. Sleep architecture demonstrated an increase in deep sleep and REM stages under CPAP therapy, and remained unchanged under theophylline. Concerning subjective sleep and awakening quality, both treatments improved well-being in the morning. Regarding objective awakening quality, reaction time performance was improved in both groups. In conclusion, CPAP treatment is more effective than theophylline regarding respiratory variables as well as the normalization of sleep maintenance and sleep architecture in sleep apnea patients.
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Broncodilatadores/uso terapéutico , Respiración con Presión Positiva , Síndromes de la Apnea del Sueño/terapia , Sueño/fisiología , Teofilina/uso terapéutico , Vigilia/fisiología , Estudios Cruzados , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Mecánica Respiratoria/efectos de los fármacos , Mecánica Respiratoria/fisiología , Sueño/efectos de los fármacos , Síndromes de la Apnea del Sueño/tratamiento farmacológico , Síndromes de la Apnea del Sueño/psicología , Vigilia/efectos de los fármacosRESUMEN
This report describes the application of a unified biosocial model of personality developed by C.R. Cloninger to a sample of families identified through a proband with schizophrenia and a sample of controls. Families of schizophrenic patients were ascertained in USA and Austria. We could detect differences between females and males in their response to positive reinforcement (Reward Dependence) and differences between young and old people with respect to the response to new and/or exciting situations (Novelty Seeking). In general, results obtained for individuals from schizophrenia families and controls were similar. These results are not substantially influenced by psychiatric disorders in individuals. Psychiatric diagnosis may have an influence on the third dimension of Cloninger's model, designated Harm Avoidance. Analysis showed that patients with a diagnosis of schizophrenia or from the schizophrenia spectrum try harder to avoid punishment or aversive stimuli than family members with another psychiatric disorder or without a psychiatric diagnosis as well as controls. The results are promising and further research is needed to evaluate the structure of the proposed personality model in families and the relationship of personality to psychiatric status.
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Familia/psicología , Trastornos de la Personalidad/complicaciones , Esquizofrenia/complicaciones , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/psicología , Escalas de Valoración Psiquiátrica , Esquizofrenia/diagnóstico , Psicología del EsquizofrénicoRESUMEN
OBJECTIVE: Pre- and postnatal pyelectasis detected by sonographic screening is of questionable pathologic importance. Therefore, we defined the natural course and diagnostic value of renal pelvis diameter (RPD) during fetal life and the neonatal period as such dilatation was revealed on routine sonography. MATERIALS AND METHODS: Routine sonography in pregnant women was obtained between gestational weeks 22 and 30. Sonograms were obtained for 1021 fetuses, of which 15 could not be followed up as neonates. The remaining 1006 fetuses also underwent neonatal sonography. All neonates with an RPD larger than 5 mm were followed up sonographically. Neonates with an RPD larger than 9 mm or persistent widening (> 5-9 mm) were examined by voiding cystourethrogram, radionuclide renogram, or both. RESULTS: Thirty fetuses (3%) had an RPD larger than 5 mm. Nine of these fetuses also had an RPD larger than 5 mm as neonates. Of these nine neonates, one had bilateral grade II vesicoureteric reflux (VUR) and two had urinary tract obstructions (one posterior urethral valve and one ureteropelvic junction obstruction). Forty-nine neonates whose results on fetal sonograms had been normal showed an RPD larger than 5 mm on neonatal sonograms. Grade III VUR was found in one boy, and ureteropelvic junction obstruction was found in two boys. The kidneys of 54 neonates who showed an RPD larger than 5 mm without urinary tract obstruction were followed up until an RPD of 0-5 mm was evident. RPD normalized within 1 year of birth, whether VUR was present or not. Symptomatic urinary tract infection was diagnosed in 17 infants who had no renal pelvis dilatation seen on pre-or postnatal screening during the observation period. Seven of the 17 neonates had VUR. Conversely, none of the infants with pre- postnatal dilatation presented with symptomatic urinary tract infection. However, in one neonate an asymptomatic urinary tract infection without VUR was diagnosed by routine urinalysis. CONCLUSION: In our study, we linked renal pelvis dilatation on pre- and postnatal sonograms to obstructive uropathies rather than to vesicoureteric reflux. Prenatal sonography proved less sensitive than postnatal sonography in revealing obstructive uropathies. An RPD smaller than 10 mm on neonatal sonography was of no pathologic significance because renal collecting systems normalized spontaneously in all infants within 1 year of birth. These neonates and infants had no significant risk for urinary tract infection and did not need further evaluation.
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Pelvis Renal/diagnóstico por imagen , Ultrasonografía Prenatal , Dilatación Patológica/diagnóstico por imagen , Femenino , Enfermedades Fetales/diagnóstico por imagen , Humanos , Recién Nacido , Pelvis Renal/embriología , Pelvis Renal/patología , Masculino , Embarazo , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/diagnóstico por imagen , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico por imagen , Reflujo Vesicoureteral/complicaciones , Reflujo Vesicoureteral/diagnóstico por imagenRESUMEN
We analysed gender-concordance rates among 29 prospectively sampled schizophrenic probands and their 39 affected and 71 unaffected siblings. We did not find any unusual concordance rates. We found no same-gender concordance particularly in siblings affected by schizophrenia and related disorders. We considered unaffected siblings in an additional attempt to make valid and unbiased comparisons between genders, but this reduced the number of informative sibships to 20. We stratified the siblings of probands by sibship and by the proband's gender in order to check gender distribution within families. The data do not support hypotheses that schizophrenia is pseudo-autosomal or male-female chromosomally transmitted.