background In the United States each year nearly 570,000 people return from state prisons to the community. Prevalence data of chronic health problems for this population are lacking, impeding planning of health care programs to serve people with chronic conditions who are re-entering the community. method We used medication dispensing records as a proxy for diagnoses in assessing the prevalence of 10 major and 20 substituent health conditions among incarcerated people released from the North Carolina state prison system from July 2015 through June 2016. results Among 20,585 released people, 13% were female; 50% were black; 43% were white; and 4% were aged 55 years or older. Thirtythree percent had ≥ 1 condition and 13% had two or more. The prevalence of chronic health conditions was the following: psychiatric, 15%; cardiovascular, 15%; neurologic, 7%; pulmonary, 6%; diabetes mellitus, 3%; and infectious, 3%. Seventy-one percent of those aged 55 years or older had a chronic medical condition. Among those with a psychiatric condition, 56% had another chronic illness. limitations We could not identify unmedicated health conditions; medications prescribed across multiple disease categories were excluded from our analysis. conclusion In North Carolina, at least one in three people released from the state prison system had a chronic health condition, and among those with psychiatric conditions, most had comorbid medical disease. Coordination of health care after release from incarceration is essential to avoid preventable complications and unnecessary utilization of acute care services. Greater eligibility for Medicaid is needed to scale up transition programs for this population.
There may be some under-reporting in the earlier years, and the industry sources suggested a 3-year lower increase of nearer 80%. In addition there are likely to be errors of coding. However, there was wide variation between PCTs suggesting patchy performance. Conclusions We believe that the results show a clear improvement in the number of sleep studies and CPAP prescriptions over this period. Thus, following the NIHCE TA there has been an improvement in patient access to the diagnosis and treatment of sleep apnoea, though we are concerned that the wide variation suggests there is a substantial element of post-code lottery. CFlex (Respironics) Bi-Level device lowers expiratory PAP (EPAP) early in expiration returning EPAP to the set inspiratory PAP (IPAP) before the start of the next inspiration. Most patients with OSAS will express a preference for either CPAP or CFlex at the time of treatment initiation. We investigated the possibility that choice of CFlex was related to interaction of breathing pattern and the CFlex device in 43 newly diagnosed patients with OSAS in a single-blind study. Inspiratory and expiratory time (Ti, Te) were measured by rib-cage and abdominal inductance belts. IPAP and EPAP were measured at the mask by pressure transducer. In 23 patients we recorded simultaneous flow in the CPAP circuit and by using mask specific leak rates derived values for inspiratory tidal volume (Vt insp): (Vt insp = (Mean Inspiratory Circuit Flow x Ti) -(Mask leak x Ti)) Patients tried CPAP or CFlex in random order for periods of 10 minutes or until breathing was stable. One minute epochs of stable breathing were used to calculate mean values for Ti, Te, IPAP, EPAP and Vt insp Results 19 patients stated a preference for CFlex (CFlexpref), 20 for CPAP (CPAPpref). 4 had no preference and received CPAP . We included them in the CPAP . pref group for analysis. For the whole group (n=43) there was a small but significant fall in mean EPAP on CFlex compared with mean EPAP on CPAP (10.4 vs 11.5 cm H 2 O). PREFERENCE OF PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA SYNDROME (OSAS) FOR CONVENTIONAL CONTINUOUS POSITIVE AIRWAY PRESSURE(CPAP) OR BI-LEVEL CPAP (CFLEX) AND CHANGES IN RESISTANCE TO EXPIRATION P259(n=2) and 30 minutes of NOS inhibition [with 1 mM: L-NOrnithine, 1400W and S-Methyl-L-thiocitrulline] reduced baseline CBF by 20% to 9.6 Hz SD±0.9 (p<0.001) but the P2X 4 inhibitor [10 µM brilliant blue G] had no effect. Conclusion P2X 4 and nNOS are expressed in human airway cilia but do not co-localise. NOS inhibition reduced CBF whilst P2X 4 inhibition did not, suggesting that blocking P2X 4 activity alone is not sufficient to modify NOS activity or CBF . Neutrophils provide the body's first line of defence against invading pathogens. They respond to infection by releasing an array of chemokines, cytokines, and superoxide anions that initiate cascades of other immune mediators and cell types. Although the rapid response and flexibility of neutrophils make them an integral part of the body's immune system, human cytomegal...
Design Systematic review and meta-analysis using individual participant data. Data sources Individual patient data were obtained from eligible randomised controlled trials found by searching the electronic databases Medline, Embase and the Cochrane Central Register of Controlled Trials and reference lists of all identified articles. Eligibility criteria for selecting studies Trials were eligible if they included patients with minimally symptomatic OSA, had randomised them to receive CPAP or either sham-CPAP or no CPAP, and had measured blood pressure at baseline and at a follow-up visit. Results Five eligible trials were found (1219 patients) from which the necessary data from four studies (1206 patients) was obtained. There was some evidence that CPAP treatment was associated with a small increase in systolic blood pressure of 1mmHg (95% confidence interval -0.1 to 2.2), p = 0.079, with a larger increase in those patients using CPAP less than four hours/night ( + 2.7mmHg, 95% CI (1.1 to 4.2), p = 0.001). There was no overall effect on diastolic blood pressure (DBP), however, there was evidence of a reduction in DBP in patients using CPAP more than four hours/night (-1.2mmHg, 95% CI (-2.1 to -0.3), p = 0.013) and an increase in those using it less than four hours/night ( + 1.2, 95% CI (0.1 to 2.3), p = 0.035). CPAP treatment reduced both subjective sleepiness and OSA severity (both p<0.001), with larger reductions in patients using treatment more than four hours/night. Conclusions Although CPAP treatment reduces OSA severity and sleepiness, it seems not to have a beneficial effect on blood pressure (and possibly a detrimental effect on systolic BP) in patients with minimally symptomatic OSA,unless they use CPAP for more than four hours per night. S4 SHORT TERM USE OF CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) BY OBESE PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA SYNDROME (OSAS) DIAGNOSED DURING ASSESSMENT FOR BARIATRIC SURGERYS Thomas, HR Gribbin, G Danjoux, R Sathyamurthy.; Sleep Clinic, Division of Anaesthesia, James Cook University Hospital, Middlesbrough TS4 3BW, UK 10. 1136/thoraxjnl-2013-204457.10 Around one in three patients with OSAS is unable to continue with CPAP. The reasons for this are still poorly understood. Patients being assessed for Bariatric Surgery are informed that untreated OSAS can increase peri-operative risk. We investigated whether this information had an effect on CPAP use. Over a six month period we identified 22 obese patients (Mean BMI 49.3) with OSAS discovered during assessment for Bariatric Surgery (OSAS Bar). Over the same period we identified a group of 33 obese patients (Mean BMI 42.1) with OSAS referred through conventional pathways by General Practitioners and Hospital Doctors (OSAS Conv) not under consideration for Bariatric Surgery. OSAS was diagnosed by overnight pulse oximetry, clinical interview and Epworth Sleepiness Score (ESS) using established criteria. Results There were more women than men in the OSAS Bar group (41%) than in the OSAS Conv group (18%). Apart from this...
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