DOI: 10.3897/jbcr.e184759

Authors: Yordanka Yamakova, Viktoria Ilieva

Abstract: Introduction: It is well known that sleep-related breathing disorders like obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) decrease quality of life and increase morbidity and mortality. OSA patients with good adherence to nighttime CPAP report improvement of their daily functioning, social interactions, emotional functioning, daytime sleepiness, and other symptoms. In OHS, both CPAP and non-invasive ventilation (NIV) show improvement in quality of life if prescribed accurately.Methods: We recruited 60 newly diagnosed obese patients with OSA and divided them into two groups: isolated – iOSA (n = 32) and OHS-OSA (n = 28). The health-related quality of life of all subjects was measured at baseline and after 3 months of treatment via the Interviewer Administered version of the EQ-5D-5L questionnaire.Results: The baseline EQ-5D value of the iOSA group (Median: 0.836; IQR: 0.113) was significantly higher than that of the OHS-OSA overlap syndrome (Median: 0.67; IQR: 0.209) (p < 0.001). Three months after treatment, both groups had increased their EQ-5D value significantly: The iOSA group from median: 0.836 with IQR: 0.113 to median:1 with IQR: 0 (p < 0.001), and the OHS-OSA group from median: 0.67 with IQR: 0,209 to median: 0.874 with IQR: 0.137 (p < 0.001) respectively. When we compared the EQ-5D values after treatment between the two groups, we observed the same statistically significant difference as before treatment (p < 0.001).Conclusion: NIV therapy makes a huge difference in the HRQoL of OHS-OSA patients, though it does not reach a subjective perception of full health like in subjects with iOSA.

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DOI: 10.3897/jbcr.e125939

Authors: Miroslava T. Hristova, Tsvetelina V. Miteva

Abstract: The importance of an emergency medical care system for ensuring affordable and quality healthcare in any country is indisputable. Studying and analyzing existing problems in organizing this system is the first step to solving them. The present study aimed to investigate and outline the possible scope of the problems of emergency medical care, their recurrence, and similarity in 17 European countries. Content analysis of documents was used. The most characteristic organizational problems in providing emergency medical care for each of the countries are identified and grouped into five categories: Direct patient access to hospital emergency departments; Overloading of emergency departments by non-urgent, self-referral patients; Telephone triage by dispatchers - nurses or assistants; Existing and/or impending shortage of doctors in Emergency Medical Services (EMS); Regional and social inequalities in access to emergency medical care. A quantitative measurement of the categories and their relative weight were reported. Based on the analysis, the conclusions of the study were drawn. The identified problems, grouped into categories of weaknesses of the existing emergency medical care organization in European countries, may serve as a basis for undertaking health care reforms.

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