Association between obstructive sleep apnea and alcohol, caffeine and tobacco: A meta-analysis.

The aim of this systematic review was to answer the focused question, "Is there an association between obstructive sleep apnea (OSA) and alcohol, caffeine or tobacco use?" Five electronic databases (Cinahl, Literatura Latth American and Caribbean, PubMed, Scopus, Web of Science) and 3 grey literature (Google Acadêmico, ProQuest, OpenGrey) were searched, as well as search on reference list of included papers and contacts with study authors. Observational studies were included. The Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool assessed the potential risk of bias (RoB) among the studies, while the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach determined the level of evidence. Meta-Analysis was performed with RevMan 5.3 software. Among 3,442 identified studies, 14 were included. Eleven studies were classified as moderate RoB and 3 as high RoB. Meta-analysis showed OSA has no association with tobacco and presented a positive association with alcohol. The odds ratio for OSA increased almost 1.33 times (95% confidence interval [CI]; 1.10-1.62) for alcohol users. There was insufficient published data to evaluate whether OSA is associated with caffeine. The overall quality of evidence ranged from low to very low. OSA was associated with the use of alcohol, however there is not enough evidence to confirm the association with tobacco or caffeine. Due to the very low GRADE level of evidence, caution should be applied when considering these findings.

Compreensão, pelos acompanhantes, do conteúdo da receita médica nos atendimentos pediátricos em postos de saúde pública em Tubarão, SC / Comprehension level of the medical prescription s by the companions of children attended in public health ambulatories located in Tubarão, SC

Objetivo: Conhecer a compreensão que os acompanhantes de pacientes, atendidos por pediatras, têm doconteúdo da receita médica. Método: Qualitativo. A coleta de dados deu-se através da observação participante e de entrevista semi-estruturada, realizada logo após a consulta médica, com20 acompanhantes de crianças atendidas por pediatras em duas unidades públicas de saúde do município de Tubarão-SC. Resultados: A compreensão da receita médica, emalgumas situações, foi satisfatória, com bom entendimento do conteúdo da receita, que era adequadamente legível.Em outras situações houve dificuldade de compreender a letra do profissional, bem como de algumas abreviaturasutilizadas por ele, ocasionando falha na comunicação. Criamos três categorias para mostrar a realidade observada: compreensão adequada da receita médica; dificuldade de compreensão da receita médica; e, compreensão equivocada da receita médica. A categoria “dificuldade de compreensão da receita médica” foi dividida em três sub-categorias: caligrafia inadequada,utilização de abreviaturas e analfabetismo. Conclusões: A comunicação adequada mostrou-seum meio necessário para que ocorresse interação entre médico e aaciente/ acompanhante, influindo diretamente na qualidade do atendimento. A análise dos dados mostrou que há necessidade de melhor treinamento do médico na arte da comunicação, em especial para aqueles que prestam atendimento no setor público. Sugere-se que se façam outras pesquisas abordando temas relacionados à comunicação médica e à relação médico-paciente, propicie-se melhor capacitação dos médicos queatuam nas comunidades, e que se ensine, nos cursos de medicina, a utilização de ferramentas para uma adequada comunicação.

Objective: To verify the comprehension level that those accompanying patients attended by pediatricians have of the content of medical prescriptions.Method: Qualitative. Data were collected through participant observation and semi-structured interviews. Twenty companions of children attended by pediatriciansin two public health units located in Tubarão, Santa Catarina, were interviewed just after the doctor’s appointment. Results: The comprehension level of the medicalprescriptions was satisfactory, with individuals showing a good understanding of the content of the prescriptions which were written in a readable way. In some situations,the doctors’ handwriting, as well as the abbreviations they used, caused communication problems. To show the observed reality three categories were created: (a) adequate comprehension of the medical prescription; (b) difficulty in understanding the medical prescription; and (c) medical prescription misunderstanding. Category (b)was divided into three subcategories: (i) inadequate handwriting;(ii) use of abbreviations; and (iii) companions’ illiteracy. Conclusions: Adequate communication betweenphysicians and patient companions has a direct impact on the quality of attendance. Data analysis revealed thatphysicians, specially those involved in the public sector attendance, should be trained to develop communicationsskills. Suggestions include further research on communication techniques between physicians and patients,better training programs for physicians who work within the community, and better teaching in medical schoolson how to use communication tools.