Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge.

Importance: There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective: To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants: This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures: Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures: Postdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results: A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance: In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.

International Variations in Surgical Quality of Care in Men With Prostate Cancer: Results From the TrueNTH Global Registry.

PURPOSE: Functional problems such as incontinence and sexual dysfunction after radical prostatectomy (RP) are important outcomes to evaluate surgical quality in prostate cancer (PC) care. Differences in survival after RP between countries are known, but differences in functional outcomes after RP between providers from different countries are not well described. METHODS: Data from a multinational database of patients with PC (nonmetastatic, treated by RP) who answered the EPIC-26 questionnaire at baseline (before RP, T0) and 1 year after RP (T1) were used, linking survey data to clinical information. Casemix-adjusted incontinence and sexual function scores (T1) were calculated for each country and provider on the basis of regression models and then compared using minimally important differences (MIDs). RESULTS: A total of 21,922 patients treated by 151 providers from 10 countries were included. For the EPIC-26 incontinence domain, the median adjusted T1 score of countries was 76, with one country performing more than one MID (for incontinence: 6) worse than the median. Eighteen percent of the variance (R2) of incontinence scores was explained by the country of the providers. The median adjusted T1 score of sexual function was 33 with no country performing perceivably worse than the median (more than one MID worse), and 34% (R2) of the variance of the providers' scores could be explained by country. CONCLUSION: To our knowledge, this is the first comparison of functional outcomes 1 year after surgical treatment of patients with PC between different countries. Country is a relevant predictor for providers' incontinence and sexual function scores. Although the results are limited because of small samples from some countries, they should be used to enhance cross-country initiatives on quality improvement in PC care.

Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach.

Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs. Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug-drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs. Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%. Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.

Epignatus: manejo quirúrgico y multidisciplinar. Un caso clínico / Epignathus: surgical and multidisciplinary management. A case report

El epignatus es una forma poco frecuente de teratoma que puede localizarse en cualquier punto de la cavidad oral o faringe. Son tumores con una elevada mortalidad debido a la obstrucción severa de vía aérea que producen, por lo que el diagnóstico prenatal es importante para establecer un plan terapéutico. El procedimiento ex-utero intrapartum treatment, o EXIT, es el método gold standard que permite asegurar la vía aérea de estos pacientes. La resección del tumor debe ser precoz y completa, ya que posee valor pronóstico. Existen numerosas patologías y secuelas derivadas del epignatus, la mayoría de ellas debido al efecto de masa que produce durante el desarrollo. Algunas de ellas incluyen fisura palatina, micrognatia o discrepancia anteroposterior mandibulomaxilar con mordida abierta anterior. Describimos este caso con el fin de remarcar la importancia del tratamiento quirúrgico del epignatus y mostrar el complejo manejo multidisciplinar que se realizó para esta patología tan infrecuente. Además de ello, se proponen maneras de mejorar dicha cirugía, como la implementación de modelos estereolitográficos o la reconstrucción virtual tridimensional (3D). (AU)

Epignathus are a rare presentation of congenital teratomas. As they arise from the oral cavity and pharynx they often cause severe airway obstruction leading to high mortality rates. Therefore, prenatal diagnosis is essential to establish a treatment plan. The “ex-utero intrapartum treatment” or EXIT is the gold standard procedure to ensure the upper airway flow. If feasible, early complete resection should be performed as it plays a key role in the prognosis. Several malformations are related to epignathus, most of them due to the mass effect of the epignathus growth during fetal development. Some of them include cleft palate, micrognathia or anterior-posterior maxillomandibular discrepancy with open bite. We report this case to highlight the importance of an optimal surgical treatment for epignathus, and to describe an example of the complex multidisciplinary management needed for this rare entity. Furthermore, we also propose some techniques that could be implemented to improve the surgical outcomes, like stereolithographic models or virtual three-dimensional reconstruction (3D). (AU)

Impacto del virus papiloma humano en pacientes afectos de carcinoma escamoso de cavidad oral y orofaringe / Impact of human papilloma virus in patients with oral and oropharyngeal squamous cell carcinomas

Antecedentes y objetivos: Aunque existe evidencia científica que demuestra la relación de causalidad del virus papiloma humano (VPH) sobre el carcinoma escamoso de cabeza y cuello, su porcentaje de causalidad en las distintas regiones anatómicas permanece todavía en controversia. El presente estudio tiene como objetivos evaluar la relación del VPH con el carcinoma escamoso de cavidad oral y orofaringe (CECOO) en nuestra población de referencia, y estudiar la correlación entre diferentes pruebas de detección del VPH basadas en métodos de PCR e inmunohistoquímica. Material y método: Estudio retrospectivo en pacientes tratados de CECOO durante el año 2011, con un seguimiento de 6 años. La muestra se dividió en 2 grupos según la positividad a VPH, detectado mediante 2 técnicas: p16 por inmunohistoquímica y PCR. Se analizaron variables demográficas y clínicas mediante SPSS(R) 22.0, considerando una significación estadística con p<0,05. Resultados: Se analizaron 155 pacientes afectos de CECOO (edad media de 62,7 años y un 69% varones). Veintiséis casos resultaron p16+ (16,8%) y 19 casos PCR+ (12,3%). Los tumores VPH+ se localizaron predominantemente en orofaringe (42,1%; p=0,017) y mostraron una tendencia a ser más frecuentes en el sexo masculino, mayor incidencia en pacientes más jóvenes, menos en fumadores y bebedores, y mayor afectación ganglionar cervical en el momento diagnóstico. Los pacientes PCR+ presentaron mayor supervivencia (p=0,024), al igual que los p16+ (p=0,005). Conclusiones: La incidencia de VPH en CECOO en nuestro entorno actualmente es baja (12,3%), pero la presentación clínica y el pronóstico del paciente VPH+ difiere del clásico paciente fumador y/o bebedor, lo que implica valorar el manejo de estos pacientes de forma independiente. La tinción inmunohistoquímica para p16 tiene una gran capacidad diagnóstica para predecir el VPH (95,5%), aunque la herramienta de referencia sigue siendo la detección de secuencias del genoma del VPH

Background and objectives: Although there is scientific evidence demonstrating causation of human papilloma virus (HPV) on squamous cell carcinoma of head and neck, its percentage of causality on the anatomic region remains in dispute. This study was developed with the objectives of evaluating the relationship between HPV and oral and oropharyngeal squamous cell carcinomas (OOSCC), and of studying the correlation between HPV detection tests (PCR and p16). Material and method: Retrospective study of patients treated for OOSCC during 2011, with a follow-up of 6 years. The sample was divided into 2 groups according to HPV positivity, detected by 2 techniques: p16 by immunohistochemistry and PCR. Demographic and clinical variables were analysed using SPSS(R) 22.0, considering P<.05 to be statistically significant. Results: We analysed 155 patients affected by OOSCC (mean age of 62.7, where 69% were males). Twenty six cases were p16+ (16.8%) and 19 cases PCR+ (12.3%), The HPV+ tumours were located predominantly in the oropharynx (42.1%, P=.017) and demonstrated the tendency to be more frequent in males, with higher incidence in younger patients, lower in smokers and drinkers, and higher when patients have a greater cervical lymph node involvement at the time of diagnosis. The PCR+ patients had higher survival (P=.024), as did the p16+ (P=.005). Conclusions: The incidence of HPV in OOSCC is low (12.3%), but the clinical presentation and prognosis of the HPV+ patient differs from the classic smoker and/or drinker, which implies assessing the management of these patients independently. The p16 staining has a great diagnostic capacity to predict HPV (95.5%), although the detection of the HPV genome is still the gold standard technique

Factores asociados al estado funcional en personas de 75 o mas años de edad no dependientes / Factors associated with functional status in a population aged ≥ 75 years without total dependence

Objetivos Identificar los factores asociados al estado funcional en una poblacion de ancianos de 75 o mas años de edad sin dependencia grave. Metodos Estudio transversal de una muestra aleatoria (n = 315) de personas del Centro de Atencion Primaria El Remei (Vic, Barcelona, España). Se evaluo el estado funcional mediante el test de ejecucion de extremidades inferiores (EEII) de Guralnik, el Índice de Actividades Instrumentales de la Vida Diaria (AIVD) de Lawton y el Índice de Actividades Basicas de la Vida Diaria (ABVD) de Barthel. Se construyeron modelos de regresion lineal multiple para identificar las variables asociadas al estado funcional. Resultados La edad media fue de 81,9 años y el 60,6% eran mujeres. Casi la mitad de los ancianos de 75 o (..)

Objectives To identify the factors associated with functional status in a population aged ≥ 75 years without severe dependence. Methods A cross-sectional study of a random sample (n = 315) of elderly persons in a primary care setting (El Remei Primary Care Center, Vic, Barcelona, Spain) was carried out. Functional status was evaluated by three physical performance tests: the Guralnik chair stand test of lower limb function, Lawton-Brody's index of instrumental activities of daily living (IADL), and the Barthel index of basic activities of daily living (BADL). A backward multiple linear regression model was used to analyze the association of sociodemographic and clinical variables with functional status. Results The mean age was 81.9 years and 60.6% were female. Around 50% of elderly patients without total dependence showed disability for IADL and a third showed lower limb functional limitation. The variables associated with lower limb functional status were marital status, body mass index, number of drugs, and vision and hearing impairment (R2 = 0.208). The variables associated with IADL were age, cognitive impairment, vision and hearing impairment, and lower limb functional limitation (R2 = 0.434). The variables associated with the Barthel index were age, sex, poor self-perceived health, and lower limb functional limitation (R2 = 0.389).Conclusions The risk factors associated with functional status in our population ≥ 75 years of age without severe dependence were the number of drugs and sensory impairment (AU)

Variabilidad en la realización de la espirometría y sus consecuencias en el tratamiento de la EPOC en Atención Primaria / Variability in the Performing of Spirometry and Its Consequences in the Treatment of COPD in Primary Care

Antecedentes: Algunos estudios han abordado el uso de la espirometría en la enfermedad pulmonarobstructiva crónica (EPOC) en Atención Primaria (AP), y pocos han analizado su impacto en el tratamientodel paciente con EPOC.Objetivos: Valorar la utilización de la espirometría en el diagnóstico y seguimiento de los pacientes EPOCen AP y su impacto en el tratamiento. Analizar la variabilidad en la realización de espirometrías entre loscentros de AP.Metodología: Estudio multicéntrico, observacional y transversal en pacientes EPOC atendidos en AP deCatalunya (España) durante 2004-2005. Se usó un modelo de regresión logística multinivel para identificarfactores asociados con tener espirometría y determinar la variabilidad entre los diferentes centros.Resultados: Participaron 21 centros, que incluyeron 801 pacientes. Solo el 53,2% disponían de espirometríadiagnóstica, la media (desviación estándar) del FEV1(%) fue 54,8% (18%). Los registros del hábitotabáquico, pruebas complementarias y espirometrías de seguimiento estuvieron más presentes entre lospacientes que disponían de espirometría diagnóstica respecto a aquellos que no la disponían.Nose encontrarondiferencias estadísticamente significativas respecto a variables demográficas, clínicas, tratamientoy calidad de vida entre pacientes con o sin espirometría de seguimiento. Se observó variabilidad significativaen el porcentaje de espirometrías diagnósticas entre los diferentes centros de AP (varianza = 0,217;p < 0,001).Conclusión: La espirometría en AP está infrautilizada y su realización durante el seguimiento no se asocia aunas pautas distintas de tratamiento ni a un abordaje más completo de la enfermedad. Existe variabilidadsignificativa en la realización de espirometrías entre los centros de AP(AU)

Background: Several studies have approached the use of spirometry in the treatment of chronic obstructivepulmonary disease (COPD) in Primary Care (PC), but few have analysed its impact on the treatmentof the patient with COPD.Objectives: To evaluate the use of spirometry in the diagnosis and follow-up of COPD patients in PC, andits impact on treatment. To analyse the variation in the performing of spirometry between PC centres. Methodology: A multicentre, observational and cross-sectional study of COPD patients seen in PC inCatalonia (Spain) during 2004–2005. A multilevel logistic regression model was used to identify factorsassociated with having spirometry and to determine the variation between the different centres.Results: Twenty-one centres which included 801 patients took part. Only 53.2% of them had a diagnosticspirometer available and themean(standard deviation) FEV1(%) was 54.8% (18%). The registers of smokinghabits, complementary tests and spirometry follow-up were more common among patients who had adiagnostic spirometry available compared to those who did not. No statistically significant differenceswere found as regards demographic, clinical, treatment and quality of life variables between patientswith and without follow-up spirometry. Significant variation was observed in the percentage of diagnosticspirometries between different PC centres (variance = 0.217; p < 0.001).Conclusion: Spirometry is underused in PC and performing it during follow-up is not associated to thedifferent treatments received, or with a more complete approach to the disease. There is significantvariation in the performing of spirometry among PC centres(AU)

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Utilización de antivíricos en las pandemias gripales / No disponible

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Nuevos anticoagulantes orales en la prevención de la enfermedad tromboembólica venosa / New oral anticoagulants for the prevention of venous thromboembolism

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Desarrollo del CAT-Health, primer test adaptativo informatizado para la evaluación de la calidad de vida relacionada con la salud en España / Development of the CAT-Health, the first adaptive computerized test (CAT) for the evaluation health-related quality of life in Spain

Fundamento y objetivo: Desarrollar un test adaptativo informatizado (TAI) para la medición genérica del estado de salud percibido por el paciente. Material y método: A partir de cuestionarios de calidad de vida relacionada con la salud (CVRS) validados en España, un panel de expertos elaboró un banco de ítems con respuestas tipo Likert de 5 alternativas, que se aplicó a una muestra piloto y posteriormente a otra muestra general de pacientes en 7 centros de salud de Asturias. A la muestra general se le ofrecieron 2 modalidades de respuesta: a) en papel; b) en pantalla táctil. Se evaluó el cumplimiento de los supuestos requeridos por los modelos psicométricos de la teoría de la respuesta al ítem (TRI) (discriminación, fiabilidad y validez) mediante análisis factorial y otros métodos. Se analizó la función de información y se realizó un estudio de simulación. Resultados: Se creó un banco de 140 ítems. Comprobado el cumplimiento de los supuestos de la TRI mediante análisis factorial, se realizó una selección de ítems mediante criterio estadístico y aplicación de la TRI: se eliminaron 35, lo que dio como resultado un test de 105 ítems. Al aplicarlos a la muestra general, se estimaron nuevamente los parámetros de los ítems, se comprobó el supuesto de invariancia de los parámetros y se eliminaron 9 ítems más; esto dio como resultado una versión definitiva de 96 ítems. Conclusiones: El TAI desarrollado resulta apto para evaluar genéricamente y de forma rápida y fiable la CVRS. Este test supondrá un avance muy importante para la medición de los resultados reportados por los pacientes en la práctica clínica

Objectives: To develop a Computerized Adaptive Test to obtain a generic measure of the patients perceived health state. Methods: An experts panel created a pool of five-alternative Likert format items, chosen among Health Related Quality of Life questionnaires validated in our country. That pool was applied to a pilot sample and later to another general sample of patients belonging to 7 Primary Health Centers in Asturias. Two response options were offered to the general sample: 1) on paper 2) on a touch panel. The Item Response Theory psychometric properties (discrimination, reliability and validity) were evaluated by means of the factorial analysis and other methods. The information function was analyzed and a study of simulation was developed. Results: A pool of 140 items was created. The requirements for the application of the IRT were verified by means of the factorial analysis. A selection of items was realized following the statistical criterion and the application of the IRT. The elimination of 35 articles resulted in a test composed by 105 items. Once the questionnaire was applied to the general sample, the parameters of the items were estimated again. The parameters invariance was verified once more and other 9 items were eliminated. The result was a definitive version of 96 items. Conclusions: The Computerized Adaptive Test developed proves to be a fast and reliable tool to evaluate the Health Related Quality of Life generically. This test may imply a very important advance for the measurement of the results reported by the patients in the clinical practice

Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental / Interpretation of SF-36 and SF-12 questionnaires in Spain: physical and mental components

Fundamento y objetivo: El SF-36 es uno de los cuestionarios de calidad de vida más evaluados y utilizados. Se han desarrollado 2 componentes sumarios (físico y mental) a partir de sus 8 dimensiones originales. Nuestro objetivo ha sido obtener los pesos españoles para el cálculo de los componentes sumarios del SF-36 y el SF-12, evaluar sus características métricas y obtener las normas poblacionales de referencia. Material y método: Se han utilizado muestras representativas de la población española procedentes de 2 estudios transversales: «Encuesta domiciliaria sobre uso de drogas» (n = 9.151) e «Hipertensión arterial y otros factores de riesgo en ancianos» (n = 3.004). Los pesos españoles de los componentes sumarios del SF-36 y SF-12 se calcularon mediante análisis de componentes principales y regresión lineal múltiple, respectivamente. Para evaluar la validez de constructo se compararon grupos conocidos y la fiabilidad se evaluó con coeficientes de consistencia interna. Resultados: Los pesos españoles obtenidos fueron muy similares a los de la versión original norteamericana (correlación > 0,9). Los ítems del SF-12 explicaron el 91% de la variancia de los componentes sumarios del SF-36. Todas las puntuaciones fueron inferiores (peores) en los grupos de mayor edad y más desfavorecidos (p < 0,001). Los coeficientes de consistencia interna fueron próximos a 0,9 para el SF-36 y algo inferiores en el SF-12. Conclusiones: Los componentes sumarios físico y mental calculados con pesos españoles son fiables y válidos. Las normas de referencia para dichos sumarios facilitarán la interpretación de los resultados de calidad de vida evaluada con los cuestionarios SF en estudios realizados en España

Background and objective: The SF-36 is one of the most widely evaluated and used quality of life questionnaires. Two summary components (physical and mental) have been developed from its 8 original dimensions. The objective of this study was to obtain the Spanish weights to calculate the summary components of the SF-36 and the SF-12, to evaluate their metric characteristics, and to obtain general population based reference norms. Material and method: Representative samples of the Spanish population gathered from 2 cross-sectional studies: «Drug consumption home survey» (n = 9151) and «Arterial hypertension and other risk factors in the elderly» (n = 3,004). The Spanish weights of the summary components of SF-36 and SF-12 were calculated by principal component analysis and multiple linear regressions, respectively. Known groups were compared to evaluate construct validity and reliability was assessed with internal consistency coefficients. Results: The Spanish weights obtained were very similar to those of the original American version (correlation > 0.9). The SF-12 items explained a 91% of the variance of SF-36 summary components. All the scores were lower (worse) in the elderly and most underprivileged groups (p < 0.001). Internal consistency coefficients were close to 0.9 for the SF-36, and slightly lower for the SF-12. Conclusions: Physical and mental summary components estimated with Spanish weights are reliable and valid. The Spanish general population based norms of these summaries will facilitate the interpretation of quality of life results assessed with the SF family of questionnaires in Spanish studies

Valores de la versión española del Cuestionario del Impacto Funcional del Sueño (FOSQ) en sujetos sanos y en pacientes con apnea obstructiva del sueño / Spanish version of the functional outcomes of sleep questionnaire: scores of healthy individuals and of patients with sleep apnea-hypopnea syndrome

Objetivo: El síntoma principal del síndrome de apneas-hipopneas durante el sueño (SAHS) es la excesiva somnolencia diurna. El Functional Outcomes of Sleep Questionnaire (FOSQ) es un cuestionario autoadministrado que se concibió para evaluar la repercusión de la somnolencia en la vida diaria del paciente. El objetivo de este estudio es conocer los valores de la versión española del FOSQ y su utilidad para evaluar el impacto de la hipersomnolencia en personas con sospecha de SAHS. Población y métodos: Se incluyó en el estudio a 31 pacientes con SAHS diagnosticado mediante polisomnografía convencional y a 31 personas sanas. Se recogieron las siguientes variables: medidas antropométricas, hábitos tóxicos, presión arterial, fármacos y cuestionario sobre horarios de sueño. La somnolencia se estudió mediante la Escala de Somnolencia de Epworth y el impacto de la somnolencia en las actividades de la vida diaria mediante el FOSQ. Resultados: El valor medio del FOSQ total en los pacientes con SAHS (índice de apneas-hipopneas: 57) fue de 88,7 y en sanos, de 110,9 (p < 0,001). Se encontraron diferencias significativas entre ambos grupos en todas las subescalas del FOSQ, excepto en la que mide las relaciones sociales. Se obtuvo una correlación moderada entre ambos cuestionarios (r = ­-0,54; p = 0,01) y entre el FOSQ y el índice de apneas-hipopneas (r = ­-0,39; p = 0,05). Aunque la capacidad de predicción de presentar SAHS, calculada mediante curvas de eficacia diagnóstica, fue mayor para la Escala de Somnolencia de Epworth que para el FOSQ (área bajo la curva = 0,91 y 0,77, respectivamente), el rendimiento diagnóstico aumentaba al considerar conjuntamente ambos cuestionarios (área bajo la curva = 0,96). Conclusiones: Se han obtenido valores de referencia del FOSQ en pacientes con SAHS y en sujetos sanos de nuestro medio. Con este estudio se demuestra que la versión española del FOSQ es un buen instrumento de evaluación del impacto de la somnolencia en las actividades de la vida diaria en personas con sospecha de SAHS

Objective: The main symptom of sleep apnea-hypopnea syndrome (SAHS) is excessive daytime sleepiness. The self-administered Functional Outcomes of Sleep Questionnaire (FOSQ) was designed to evaluate the impact of sleepiness on a patient's daily life. The aim of this study was to determine the scores of patients with SAHS and of healthy individuals on the Spanish version of the FOSQ and to assess its usefulness for evaluating the impact of excessive sleepiness in patients with suspected SAHS. Population and methods: Thirty-one patients with SAHS diagnosed by conventional polysomnography and 31 healthy individuals were included in the study. The following data were collected: patient information; use of tobacco, alcohol, or street drugs; blood pressure; and sleep schedule. Sleepiness was assessed on the Epworth Sleepiness Scale and the impact of sleepiness on activities of daily living by the FOSQ. Results: Patients with SAHS (apnea­hypopnea index, 57) had a mean FOSQ total score of 88.7; healthy individuals had a mean score of 110.9 (P<.001) Significant differences were found between the 2 groups on all the FOSQ subscales, except for the one that measured social outcome. There was a moderate correlation between the 2 questionnaires (r=-­0.54; P=.01) and between FOSQ and the AHI (r=-­0.39; P=.05). While the capacity to predict SAHS, based on receiver operating characteristic curves was greater for the Epworth Sleepiness Scale than for the FOSQ (area under the curve, 0.91 and 0.77, respectively), the diagnostic yield increased when both questionnaires were considered together. Conclusions: We obtained FOSQ reference scores for Spanish patients with SAHS and for healthy individuals. The study showed that the Spanish version of the FOSQ is a good instrument for assessing the impact of excessive sleepiness on activities of daily living in patients with suspected SAHS

Noticias sobre medicamentos en los suplementos de salud de la prensa española / Drugs coverage in the health supplement of Spanish newspapers

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