Prevalence of sleepiness in a group of Brazilian lorry drivers.

OBJECTIVE: To determine the prevalence of sleepiness in a group of Brazilian lorry drivers. STUDY DESIGN: Cross-sectional study. METHODS: This study used a self-administrated questionnaire and the Epworth Sleepiness Scale (ESS). The questionnaire included questions regarding demographic features, professional data, sleep habits, night-time symptoms, excessive daytime sleepiness and history of previous automobile accidents. RESULTS: Four hundred and thirty-eight male drivers, aged 34.2+/-9.5 years (mean+/-SD), were included in the study. The mean number of hours spent driving each day was 9.2+/-2.6h, compared with 4.5+/-2.3h for the night shift. The median distance covered weekly was 1,200 km (range 70-6,000 km). The most common sleep complaints were insomnia (26.6%), loud snoring (45%) and witnessed apnoea (7.6%). Eighty-six of 392 (22%) drivers reported falling asleep while driving, and 11 (2.8%) subjects indicated falling asleep daily or almost daily. One hundred and seventy-one drivers (39%) had been involved in a traffic accident, and 21 of 128 drivers (16.4%) indicated sleepiness as a possible contributing factor. The ESS was higher than 10 points in 120 (28%) of the interviewees. CONCLUSIONS: Sleepiness is a prevailing symptom in lorry drivers and is probably related to accidents.

Early prediction of poor outcome in patients with acute asthma in the emergency room

Early identification of patients who need hospitalization or patients who should be discharged would be helpful for the management of acute asthma in the emergency room. The objective of the present study was to examine the clinical and pulmonary functional measures used during the first hour of assessment of acute asthma in the emergency room in order to predict the outcome. We evaluated 88 patients. The inclusion criteria were age between 12 and 55 years, forced expiratory volume in the first second below 50 percent of predicted value, and no history of chronic disease or pregnancy. After baseline evaluation, all patients were treated with 2.5 mg albuterol delivered by nebulization every 20 min in the first hour and 60 mg of intravenous methylprednisolone. Patients were reevaluated after 60 min of treatment. Sixty-five patients (73.9 percent) were successfully treated and discharged from the emergency room (good responders), and 23 (26.1 percent) were hospitalized or were treated and discharged with relapse within 10 days (poor responders). A predictive index was developed: peak expiratory flow rates after 1 h <=0 percent of predicted values and accessory muscle use after 1 h. The index ranged from 0 to 2. An index of 1 or higher presented a sensitivity of 74.0, a specificity of 69.0, a positive predictive value of 46.0, and a negative predictive value of 88.0. It was possible to predict outcome in the first hour of management of acute asthma in the emergency room when the index score was 0 or 2

Early prediction of poor outcome in patients with acute asthma in the emergency room.

Early identification of patients who need hospitalization or patients who should be discharged would be helpful for the management of acute asthma in the emergency room. The objective of the present study was to examine the clinical and pulmonary functional measures used during the first hour of assessment of acute asthma in the emergency room in order to predict the outcome. We evaluated 88 patients. The inclusion criteria were age between 12 and 55 years, forced expiratory volume in the first second below 50% of predicted value, and no history of chronic disease or pregnancy. After baseline evaluation, all patients were treated with 2.5 mg albuterol delivered by nebulization every 20 min in the first hour and 60 mg of intravenous methylprednisolone. Patients were reevaluated after 60 min of treatment. Sixty-five patients (73.9%) were successfully treated and discharged from the emergency room (good responders), and 23 (26.1%) were hospitalized or were treated and discharged with relapse within 10 days (poor responders). A predictive index was developed: peak expiratory flow rates after 1 h < or =0% of predicted values and accessory muscle use after 1 h. The index ranged from 0 to 2. An index of 1 or higher presented a sensitivity of 74.0, a specificity of 69.0, a positive predictive value of 46.0, and a negative predictive value of 88.0. It was possible to predict outcome in the first hour of management of acute asthma in the emergency room when the index score was 0 or 2.