ABSTRACT
Background: To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse). Methods: A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each "do not do" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist. Results: In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care. Conclusion: Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.
Subject(s)
Medical Overuse , Pulmonary Disease, Chronic Obstructive/therapy , Self Care/adverse effects , Clinical Decision-Making , Consensus , Cost-Benefit Analysis , Disease Progression , Health Care Costs , Humans , Medical Overuse/economics , Patient Safety , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/economics , Risk Assessment , Risk Factors , Self Care/economics , Unnecessary Procedures/adverse effectsABSTRACT
No disponible
Subject(s)
Humans , Asthma/epidemiology , Anti-Asthmatic Agents/therapeutic use , Patient Education as Topic , Primary Health Care/trends , Patient ComplianceABSTRACT
OBJECTIVE: Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD). It is not clear whether the high cardiovascular comorbidity is due to an increase in traditional risk factors or whether, in contrast, COPD can be considered an independent risk factor. The aim of this study was to analyze the prevalence of risk factors and cardiovascular comorbidity in a community-based population treated for COPD. PATIENTS AND METHODS: This was a concurrent multicenter, cross-sectional study that included 572 patients with confirmed diagnosis of COPD. Information on cardiovascular risk factors and comorbidity was collected by extracting data from the medical records of the participating center. RESULTS: The mean (SD) forced expiratory volume in 1 second (FEV1) was 53.7% (16.85%) of predicted and the ratio of FEV1 to forced vital capacity was 57.9% (10.9%). Hypertension was reported in 53%, obesity in 27%, dyslipidemia in 26%, and diabetes in 23% of the patients. The prevalence of risk factors was not related to disease severity, but there was a trend towards an association with age. In the study group, 16.4% had ischemic heart disease, 7% cerebrovascular disease, and 17% peripheral vascular disease. Cardiovascular disease was not associated with COPD severity, but such an association was reported for age and traditional risk factors. CONCLUSIONS: Cardiovascular risk factors are highly prevalent in patients with COPD. The prevalence of cardiovascular and cerebrovascular disease exceeds that reported in the general population. No relationship was found between the severity of airflow obstruction and the presence of cardiovascular comorbidity.
Subject(s)
Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Adult , Aged , Comorbidity , Cross-Sectional Studies , Demography , Diabetes Complications/epidemiology , Female , Humans , Hyperlipidemias/epidemiology , Male , Middle Aged , Prevalence , Risk FactorsABSTRACT
Objetivo: La enfermedad cardiovascular es una causa de muerte frecuente en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). No está claro si el exceso de comorbilidad cardiovascular se relaciona con un incremento de factores de riesgo clásicos o si, por el contrario, la EPOC puede considerarse un factor de riesgo independiente. El objetivo de este estudio ha sido analizar la prevalencia de factores de riesgo y comorbilidad cardiovascular en una población atendida en la comunidad por presentar EPOC. Pacientes y métodos: Se ha realizado un estudio multicéntrico, concurrente y transversal, en el que se incluyó a 572 pacientes con diagnóstico confirmado de EPOC. Se recogieron datos de factores de riesgo y comorbilidad cardiovascular extraídos de la historia clínica del centro. Resultados: El valor medio ± desviación estándar del volumen espiratorio forzado en el primer segundo era del 53,7 ± 16,85% y la relación volumen espiratorio forzado en el primer segundo/capacidad vital forzada del 57,9 ± 10,9%. La prevalencia de hipertensión arterial era del 53%, la de obesidad del 27%, la de dislipemia del 26% y la de diabetes del 23%. La prevalencia de factores de riesgo no se relacionó con la gravedad de la enfermedad, pero sí había una tendencia de asociación con la edad. La prevalencia de cardiopatía isquémica fue del 16,4%, la de enfermedad cerebrovascular del 7% y la de enfermedad vascular periférica del 17%. La prevalencia de comorbilidad vascular no se relacionó con la gravedad de la enfermedad, pero sí con la edad y los factores de riesgo clásicos. Conclusiones: Los pacientes con EPOC muestran una elevada prevalencia de factores de riesgo cardiovascular. La prevalencia de enfermedad cardiovascular y cerebrovascular excede la comunicada en población general. No se ha observado relación entre la gravedad de la obstrucción al flujo aéreo y la presencia de comorbilidad cardiovascular
Objective: Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD). It is not clear whether the high cardiovascular comorbidity is due to an increase in traditional risk factors or whether, in contrast, COPD can be considered an independent risk factor. The aim of this study was to analyze the prevalence of risk factors and cardiovascular comorbidity in a community-based population treated for COPD. Patients and methods: This was a concurrent multicenter, cross-sectional study that included 572 patients with confirmed diagnosis of COPD. Information on cardiovascular risk factors and comorbidity was collected by extracting data from the medical records of the participating center. Results: The mean (SD) forced expiratory volume in 1 second (FEV1) was 53.7% (16.85%) of predicted and the ratio of FEV1 to forced vital capacity was 57.9% (10.9%). Hypertension was reported in 53%, obesity in 27%, dyslipidemia in 26%, and diabetes in 23% of the patients. The prevalence of risk factors was not related to disease severity, but there was a trend towards an association with age. In the study group, 16.4% had ischemic heart disease, 7% cerebrovascular disease, and 17% peripheral vascular disease. Cardiovascular disease was not associated with COPD severity, but such an association was reported for age and traditional risk factors. Conclusions: Cardiovascular risk factors are highly prevalent in patients with COPD. The prevalence of cardiovascular and cerebrovascular disease exceeds that reported in the general population. No relationship was found between the severity of airflow obstruction and the presence of cardiovascular comorbidity
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Cardiovascular Diseases/complications , Comorbidity/trends , Hypertension/complications , Surveys and Questionnaires , Risk Factors , Anthropometry/methods , Analysis of Variance , Myocardial Ischemia/complications , Cross-Sectional Studies , Obesity/epidemiology , Hyperlipidemias/epidemiology , Informed Consent/statistics & numerical data , Oxidative Stress/physiologyABSTRACT
Mortality of honeybees is a serious problem that beekeepers have to face periodically in Uruguay and worldwide. The presence of RNA viruses, in addition to other pathogens may be one of its possible causes. In this work, we detected Chronic bee paralysis virus, Acute bee paralysis virus, Black queen cell virus, Sacbrood virus and Deformed wing virus in samples of Uruguayan honeybees with or without Varroa destructor and Nosema apis. The detection of viruses in different provinces, simultaneous co-infection of colonies by several viruses and the fact that 96% of the samples were infected with one or more virus, indicates they are widely spread in the region.
Subject(s)
Bees/virology , Insect Viruses/isolation & purification , RNA Viruses/isolation & purification , Virus Diseases/diagnosis , Animals , Insect Viruses/genetics , Insect Viruses/pathogenicity , RNA Viruses/genetics , RNA Viruses/pathogenicity , RNA, Viral/analysis , Virus Diseases/virologyABSTRACT
Chronic bee paralysis virus (CBPV) causes a disease characterized by trembling, flightless, and crawling bees, while Acute bee paralysis virus (ABPV) is commonly detected in apparently healthy colonies, usually associated to Varroa destructor. Both viruses had been detected in most regions of the world, except in South America. In this work, we detected CBPV and ABPV in samples of Uruguayan honeybees by RT-PCR. The detection of both viruses in different provinces and the fact that most of the analyzed samples were infected, suggest that, they are widely spread in the region. This is the first record of the presence of CBPV and ABPV in Uruguay and South America.
Subject(s)
Bees/virology , Insect Viruses/isolation & purification , Paralysis/veterinary , Acute Disease , Animal Diseases/virology , Animals , Chronic Disease , Paralysis/virology , UruguayABSTRACT
American foulbrood is a severe bacterial disease affecting larvae of the honeybee Apis mellifera and it is caused by Paenibacillus larvae larvae. The disease is present worldwide and cases have been reported in almost all the beekeeping regions of the five continents. During 2001 and 2002 we carried out a nationwide study to assess the presence and amount of P. l. larvae spores in honey samples from Uruguay, combining classic bacteriological, and molecular approaches. The distribution of P. l. larvae spores in honey of the whole country showed a clear pattern and may provide useful data for a control and prevention strategy of American foulbrood.
Subject(s)
Bees/parasitology , Gram-Positive Bacteria/physiology , Gram-Positive Bacterial Infections/epidemiology , Honey/microbiology , Animals , Polymerase Chain Reaction , Spores, Bacterial , UruguayABSTRACT
En las abejas melíferas el comportamiento higiénico (desoperculado de las celdas y posterior remoción de las pupas muertas) se estudia extensamente como un mecanismo de resistencia de las abejas adultas a las enfermedades de la cría. Utilizando una colmena de observación y abejas marcadas, se encontró que la edad media de las abejas que realizan las actividades de desoperculado y remoción es de 11,7 y 11,4 días respectivamente, sugiriendo que ambas actividades son desarrolladas por las mismas abejas como parte de un único comportamiento. También se determinó la edad de las abejas que alimentan a las larvas (7,5 días), retiran residuos hacia afuera de la colmena (16,1 días), colectan néctar y polen (23,1 y 23,0 días respectivamente). Se discute la ubicación del comportamiento higiénico en el marco del programa de actividades de la casta obrera y la posibilidad de que el desarrollo de las pupas esté controlado por las abejas adultas [AU]
