RESUMO
Excessive daytime sleepiness (EDS) can be caused by insufficient sleep but is also a manifestation of medical or sleep disorders and a side effect of medications. It impacts quality of life and creates safety concerns in the home, at work, and on the roads. Screening questionnaires can be used to estimate EDS, but further evaluation is necessary. EDS is a common symptom of both narcolepsy and obstructive sleep apnea (OSA). Polysomnography and multiple sleep latency testing are used to diagnose these disorders. However, isolating the primary etiology of EDS can be challenging and may be multifactorial. Untreated OSA can show polysomnographic findings that are similar to narcolepsy. The effects of sleep deprivation and certain medications can also affect the polysomnographic results. These challenges can lead to misdiagnosis. In addition, narcolepsy and OSA can occur as comorbid disorders. If EDS persists despite adequate treatment for either disorder, a comorbid diagnosis should be sought. Thus, despite advances in clinical practice, appropriate management of these patients can be challenging. This review is focused on EDS due to OSA and narcolepsy and addresses some of the challenges with managing this patient population.
RESUMO
A comparative study of the attitudes and performances of graduates from an innovative medical school and a conventional one in relation to primary health care [PHC] was conducted. The aim was to identify the impact of a community-oriented medical education. The results showed that both groups were aware of PHC but those of the innovative school had received practical training in PHC centres, had skills to approach solving community problems, and gave due emphasis to promotional and preventive aspects of patient management. The study concludes that a community-oriented medical education is more appropriate to community needs
