ABSTRACT
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Subject(s)
Pulmonary Disease, Chronic Obstructive/therapy , Acute-Phase Reaction , Disease Progression , France , Humans , Language , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/pathology , Quality of Life , Severity of Illness Index , Societies, Medical/standards , Survival AnalysisABSTRACT
In order to evaluate possible correlations between blood pressure levels and sleep quality, 7,901 workers of both sexes living in Paris area have been the subject of a survey during their annual examination performed by workside physicians. The enquiry included questions related to sleep quantity and quality, sleeping pills consumption, awakenings, nightmares, snoring, way of life and working conditions. The information concerning these parameters was available for 7,542 people. Among them, 6,551 (86.9%) did not suffer from high blood pressure (HBP) (blood pressure less than 160/95 mmHg), 618 (8.2%) presented a high blood pressure but were not treated, 371 (4.9%) received a treatment against HBP. The average sleep duration is about 7.4 h (S.D. = 1.0) for men and about 7.6 h (S.D. = 1.0) for women (less than 0.001). It is significatively and negatively correlated with the systolic blood pressure level (SBP) (less than 0.001) and the diastolic blood pressure level (DBP) (less than 0.001). The frequency of patients complaining of nightly awakening and of snoring significatively increase with SBP (p less than 0.05) and DBP (p less than 0.001). The observed association between DBP (but not SBP) and sleep duration and nightly awakening remains significant in multivariate analysis including age, sex, tobacco smoking, alcohol and coffee consumption, use of sleeping pills and hypotensive treatment, as well as the negative correlation between SBP and nightmare frequency. The correlation between SBP or SBP and snoring was no more significant. In conclusion, a significant correlation has been found between the blood pressure levels and the sleep quality whose clinical consequences remain to be explored.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Hypertension/epidemiology , Sleep Wake Disorders/epidemiology , Adult , Female , France/epidemiology , Health Surveys , Humans , Hypertension/complications , Hypnotics and Sedatives/therapeutic use , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Sleep Wake Disorders/complications , Sleep Wake Disorders/drug therapy , Snoring/complications , Snoring/epidemiology , Surveys and QuestionnairesABSTRACT
Many coding systems for morbidity seen in general medicine are currently available in France. This article proposes an approach to evaluating them. Firstly, it is proposed to specify the conceptual framework within which one includes the classificatory approach to health troubles in general medicine. This assumes that the notions of primary care, pathology and diagnosis are clarified in the light of the practices of general practitioners. Secondly, it is proposed to specify the framework of analysis within which one is situated in order to reach these systems of reference that all correspond to classificatory systems. For this, one can examine several dimensions: the purpose of the system, its criteria and main lines of classification, its method of construction, its underlying conceptual model, the type of collection required and the efficiency of data used. Once the conceptual framework is fixed and the framework of analysis chosen, it is possible to evaluate these classifications without ambiguity.