ABSTRACT
Objetivo: Validar el cuestionario STOP-Bang para la apnea moderada frente al método de referencia (polisomnografía de tipo I) en atención primaria. Método: Estudio de utilidad diagnóstica en atención primaria con una muestra estimada de 85 casos y 85 controles sanos. Con muestreo por conveniencia, 203 pacientes fueron reclutados por sus médicos en seis centros de salud. Se excluyeron 25 y se analizaron 57 mujeres y 121 hombres, de los cuales 74 tenían un índice de hipopnea-apnea (IHA) ≥15. Se evaluaron el STOP-Bang y el IHA observado en la polisomnografía en cada paciente. El tamaño de la muestra, el análisis de la curva ROC y los puntos de corte óptimos se identificaron con los paquetes easyROC, pROC y OptimalCutpoints del software libre R. Resultados: El área bajo la curva en la apnea moderada (IHA ≥15) del STOP-Bang fue 0,737 (0,667-0,808), con puntos de corte óptimos diferentes por sexo (4 en mujeres y 6 en hombres). En la validación cruzada con k=10, el área bajo la curva para el STOP-Bang fue 0,678. Conclusiones: El STOP-Bang tiene una utilidad diagnóstica moderada para un IHA ≥15, pero superior a la de otras escalas, en una población comunitaria. Su desempeño es más adecuado en las mujeres
Objective: We aimed to compare the diagnostic utility of the STOP-Bang questionnaire for moderate apnoea against the gold standard (type I polysomnography) in a primary care setting. Method: Study of diagnostic utility in primary care. Estimated sample: 85 cases and 85 healthy controls. In convenience sampling, 203 patients were recruited by their physicians at six health centres. Twenty-five were excluded, and 57 women and 121 men, of whom 74 had apnoea-hypopnoea index (AHI) ≥15, were analyzed. STOP-Bang was validated by comparing scores in the same patient with the apnoea-hypopnoea index observed in polysomnography, as a gold standard. Sample size, ROC curve analysis and optimal cut-off points were identified with the easyROC, pROC, and OptimalCutpoints packages. Results: The area under the curve in moderate apnoea (AHI ≥15) of the STOP-Bang was 0.777 (0.667-0.808), with optimal cut-off points different by sex (4 in women and 6 in men). In the cross-validation with k=10, the area under the curve for the STOP-Bang was 0.678. Conclusions: The STOP-Bang presents a diagnostic moderate utility for AHI≥15, but superior to other scales, in a community population. Its performance is more appropriate in women
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Sleep Apnea Syndromes/diagnosis , Psychometrics/instrumentation , Polysomnography/methods , Primary Health Care/statistics & numerical data , Sensitivity and Specificity , Sex Distribution , Sleep Apnea Syndromes/epidemiology , Cross-Sectional StudiesABSTRACT
OBJECTIVE: We aimed to compare the diagnostic utility of the STOP-Bang questionnaire for moderate apnoea against the gold standard (type I polysomnography) in a primary care setting. METHOD: Study of diagnostic utility in primary care. Estimated sample: 85 cases and 85 healthy controls. In convenience sampling, 203 patients were recruited by their physicians at six health centres. Twenty-five were excluded, and 57 women and 121 men, of whom 74 had apnoea-hypopnoea index (AHI) ≥15, were analyzed. STOP-Bang was validated by comparing scores in the same patient with the apnoea-hypopnoea index observed in polysomnography, as a gold standard. Sample size, ROC curve analysis and optimal cut-off points were identified with the easyROC, pROC, and OptimalCutpoints packages. RESULTS: The area under the curve in moderate apnoea (AHI ≥15) of the STOP-Bang was 0.777 (0.667-0.808), with optimal cut-off points different by sex (4 in women and 6 in men). In the cross-validation with k=10, the area under the curve for the STOP-Bang was 0.678. CONCLUSIONS: The STOP-Bang presents a diagnostic moderate utility for AHI≥15, but superior to other scales, in a community population. Its performance is more appropriate in women.
Subject(s)
Primary Health Care/methods , Sleep Apnea Syndromes/diagnosis , Surveys and Questionnaires , Adult , Aged , Area Under Curve , Confidence Intervals , Cross-Sectional Studies , False Negative Reactions , False Positive Reactions , Female , Humans , Hypertension/complications , Male , Middle Aged , Polysomnography , ROC Curve , Self Report , Sleep Apnea Syndromes/complicationsABSTRACT
Objetivo: El objetivo de este trabajo es realizar una evaluación económica de las intervenciones sobre tabaquismo en atención primaria. Diseño: Análisis de coste-efectividad (ACE) comparando 2 estrategias de intervención: intensiva y breve. Emplazamiento: Pacientes de una consulta de medicina de familia en un centro de salud (CS) periurbano. Participantes: Todas las historias con etiqueta de fumadores; 235 y 37 en el grupo de intervención breve e intensiva, respectivamente. Intervenciones: La intervención breve (IB) se realizó en el contexto de otro motivo de consulta (1-5 min). La intervención intensiva (II) fue exclusivamente para tabaquismo (10-15 min). Mediciones principales: Los datos de efectividad son obtenidos de la evaluación de la intervención sobre los fumadores de dicha consulta después de 6 años. Empleamos costes sanitarios directos. Excluimos fármacos, costes no sanitarios e indirectos. Aplicamos la tasa de coste-efectividad incremental (ICER) de las intervenciones breve, intensiva y total (breve + intensiva), comparando no intervenir con cada tipo de intervención e II respecto a la IB y análisis probabilístico para tratar la incertidumbre. Resultados: El coste por paciente abstinente, globalmente, fue 406,74 €. Para la IB fue de 129,83 € y para la II, 1.034,99 €. ICER intervención total=498,87 €/paciente que deja de fumar. ICER IB=235,32 €/paciente que deja de fumar. ICER II=1.232,85 €/paciente que deja de fumar. ICER II/IB=7.772,25 €/paciente que deja de fumar. Conclusiones: Las intervenciones sobre tabaquismo en AP son eficientes. Una propuesta para el abordaje del tabaquismo en AP, desde una perspectiva coste-efectiva, podría ser la IB sobre todos los fumadores e II sobre aquellos con más dificultad para abandonar(AU)
Objective: The aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC). Design: Cost-Effectiveness Analysis comparing two intervention strategies; intensive and brief. Setting: Patients in a general practitioner's list in a peri-urban Health Centre. Participants: All the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively. Interventions: The brief intervention (BI) was made in the context of consultation for another purpose (1-5minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15minutes).Main measurements The effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief + intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty. Results: The total cost per abstinent patient was 406,74 €: 129,83 € for BI and 1.034,99 € for I.I.ICER Total intervention = €498, 87/patient who stops smoking. ICER BI = €235, 32/patient who stops smoking. ICER II=€1.232, 85/patient who stops smoking. ICER II/BI= €7.772,25/patient who stops smoking. Conclusions: Smoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit(AU)
Subject(s)
Humans , Male , Female , Primary Health Care/methods , Primary Health Care/trends , Cost Efficiency Analysis , Tobacco Smoke Pollution/economics , Smoking/economics , Primary Health Care , Cost-Benefit Analysis , 50303 , Cross-Sectional Studies/methods , Cross-Sectional Studies/trends , Cross-Sectional StudiesABSTRACT
OBJECTIVE: The aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC). DESIGN: Cost-Effectiveness Analysis comparing two intervention strategies; intensive and brief. SETTING: Patients in a general practitioner's list in a peri-urban Health Centre. PARTICIPANTS: All the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively. INTERVENTIONS: The brief intervention (BI) was made in the context of consultation for another purpose (1-5 minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15 minutes). MAIN MEASUREMENTS: The effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief + intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty. RESULTS: The total cost per abstinent patient was 406,74 : 129,83 for BI and 1.034,99 for I.I. ICER Total intervention = 498, 87/patient who stops smoking. ICER BI = 235, 32/patient who stops smoking. ICER II = 1.232, 85/patient who stops smoking. ICER II/BI = 7.772,25/patient who stops smoking. CONCLUSIONS: Smoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit.
