Adesao ao tratamento CPAP em pacientes com apneia obstrutiva do sono durante a pandemia COVID-19 em dois hospitais da Capital Federal

Introduction: CPAP therapy is the first line treatment for sleep apnea and its effectiveness depends on adherence. Face to face control and follow-up was limited due to the fact that our country was immersed in social isolation due to the COVID-19 pandemic as of March 2020. In order to assess whether CPAP adherence was maintained in patients with obstructive sleep apnea (OSA), in two hospitals during the COVID-19 pandemic and compare it with the pre-pandemic situation on a historical control basis in the city of Buenos Aires. Methods: Observational and retrospective study based on systematic data collection of adherence to CPAP and residual apnea-hypopnea index (AHI). For comparison, a historical control corresponding to the specular period (May to December of each year between 2016 and 2019) was used as a reference. Patients over 18 years ago with OSA on CPAP therapy more than 30 days of treatment were included. Patients with other chronic respiratory diseases requiring ventilation therapy (Bi-level, servo ventilation, volume-assured ventilation) were excluded. Results: 151 pre-pandemic patients and 127 from the pandemic period, respectively, were evaluated. Men 98 (65%) vs. 50 (60.3%) p: 0.9, age: 65.4 ± 11.9 vs. 63.6 ± 12.6 p: 0.22, body mass index 31.5 ± 5.0 vs. 31.2 ± 5.3 kg/m2 p: 0.6, respectively. In both centers, the most used treatment was fixed CPAP; 90 (59.6%) vs. 96 (75.6%) p: 0.005. There was an increase in compliance with it compared to the pre-pandemic period in minutes/night [341.4 95% CI 292.4 - 340.6 vs. 274.3 95% CI 208.5 - 267.4, p: 0.001] and residual AHI reduction [3.3 IC 95% 2.0 - 3.05 vs. 6.3 IC 95% 2.6 - 4.3 p: 0.006]. Conclusions: In the period of the COVID-19 pandemic, greater adherence to CPAP treatment was observed in patients with sleep apnea.Introducción: La terapia con CPAP es el tratamiento de primera línea para la apnea del sueño y su eficacia depende de la adherencia. El control y seguimiento de forma presencial fue limitado debido a que nuestro país se vio inmerso en aislamiento social debido a la pandemia por COVID-19 a partir de marzo del 2020. Con el objeto de evaluar si se mantuvo la adherencia de la CPAP en pacientes con apnea obstructiva del sueño (AOS), en dos hospitales durante la pandemia COVID-19 y compararlo con la situación prepandemia sobre una base de control histórico de la ciudad de Buenos Aires.  Métodos: Estudio observacional y retrospectivo basado en datos de recolección sistemática de adherencia a la CPAP e índice de apnea-hipopnea (IAH) residual. Para la comparación, se utilizó como referencia un control histórico correspondiente al periodo especular (mayo a diciembre de cada año entre el 2016 y 2019). Se incluyeron pacientes de más de 18 años de edad, con AOS con terapia con CPAP de más de 30 días de tratamiento. Se excluyeron pacientes con otras patologías respiratorias crónicas que requerían de terapias de ventilación (Bi-level, servo ventilación, ventilación con volumen asegurado). Resultados: Fueron evaluados 151 pacientes prepandemia y 127 del periodo pandemia respectivamente. Hombres 98 (65%) vs. 50 (60.3%) p: 0.9, edad de 65.4± 11.9 vs 63.6 ± 12.6 p: 0.22, índice de masa corporal 31.5 ± 5.0 vs. 31.2 ± 5.3 kg/m2 p: 0.6, respectivamente En ambos centros, el tratamiento más utilizado fue CPAP fijo; 90 (59.6%) vs. 96 (75.6%) p: 0.005. Existió un aumento en el cumplimiento del mismo en comparación al periodo prepandémico en minutos/noche [341.4 IC 95% 292.4 - 340.6 vs. 274.3 IC 95% 208.5 - 267.4, p: 0.001] y reducción del IAH residual [3.3 IC 95% 2.0 - 3.05 vs. 6.3 IC 95% 2.6 - 4.3 p: 0.006]. Conclusiones: En el periodo de pandemia COVID-19 se observó mayor adherencia al tratamiento con CPAP en pacientes con apneas del sueño.Introdução: A terapia com CPAP é o tratamento de primeira linha para a apneia do sono e a sua eficácia depende da adesão. O controle e acompanhamento presencial foi limitado devido ao fato de nosso país estar imerso em isolamento social devido à pandemia de COVID-19 a partir de março de 2020. Para avaliar se a adesão ao CPAP foi mantida em pacientes com apneia obstrutiva do sono (AOS), em dois hospitais durante a pandemia do COVID-19 e compará-lo com a situação pré-pandêmica em base de controle histórico na cidade de Buenos Aires. Métodos: Estudo observacional e retrospectivo baseado na coleta sistemática de dados de adesão ao CPAP e índice de apnéia-hipopnéia residual (IAH). Para comparação, foi utilizado como referência um controle histórico correspondente ao período especular (maio a dezembro de cada ano entre 2016 e 2019). Foram incluídos pacientes > 18 anos com AOS em terapia com CPAP por mais de 30 dias. Pacientes com outras doenças respiratórias crônicas que requerem terapia ventilatória (Bi-level, servoventilação, ventilação com volume garantido) foram excluídos. Resultados: foram avaliados 151 pacientes pré-pandêmicos e 127 do período pandêmico, respectivamente. Homens 98 (65%) vs. 50 (60.3%) p: 0.9, idade de 65.4 ± 11.9 vs. 63.6 ± 12.6 p: 0.22, índice de massa corporal 31.5 ± 5.0 vs. 31.2 ± 5.3 kg/m2 p: 0.6, respectivamente Em ambos os centros, o tratamento mais utilizado foi o CPAP fixo; 90 (59.6%) vs. 96 (75.6%) p: 0.005. Houve aumento da adesão em relação ao período pré-pandêmico em minutos/noite [341.4 IC 95% 292.4 – 340.6 vs. 274.3 IC 95% 208.5 – 267.4, p: 0.001] e redução residual do [3.3 IC 95% 2.0 - 3.05 vs. 6.3 IC 95% 2.6 - 4.3 p: 0.006]. Conclusões: No período da pandemia de COVID-19, observou-se maior adesão ao tratamento com CPAP em pacientes com apneia do sono

Frequency of use and preferences for information and communication technologies in patients with sleep apnea: A multicenter, multinational, observational cross-sectional survey study

Background: Obstructive sleep apnea (OSA) is a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep. An accessible method to facilitate self-management education is through information and communication technologies (ICTs). Purpose: To assess the frequency of and preferences for ICT use in patients with sleep apnea. Methods: A multicenter, multinational, observational cross-sectional survey study was conducted between 2018 and 2019 in sleep units in different countries of Latin America, including patients of both genders older than 18 years with a diagnosis of sleep apnea. Participants were asked to complete 20 questions in a self-administered survey about the frequency of use of ICTs and their preferences for receiving disease-related information. Results: A total of 435 patients participated in the study, with a mean age of 59.1 ± 14.0; 62.5% (n = 272) were males. Most patients had access to cellphones (92.4%, n = 402), smartphone (83.0%, n = 361) and an internet connection (82.3%, n = 358). One-to-one ICTs were regarded as the most frequently used ICT type, as 75.4% (n = 328) of participants reported using them daily (χ2(4) = 848.207, p =.000). With respect to categories of interest, one-to-one ICTs were also the best rated ICT type to receive (59.1%, n = 257; χ2(2) = 137.710, p =.000) and ask physicians (57.0%, n = 248; χ2(2) = 129.145, p =.000) information about OSA. Finally, older adults and those with lower educational levels were found to be less likely to use and be interested in ICTs. Conclusion: Most patients have access to different ICTs and often use them to seek and receive medical information. The preferred ICTs include those in the one-to-one category (WhatsApp, email) and the one-to-many category (web browsers) for general health and OSA-related informatio

AUDIT OPERASIONAL TERHADAP TATA KELOLA KREDIT BERMASALAH PADA PT BANK TABUNGAN PENSIUNAN NASIONAL, TBK KCP LEUWILIANG BOGOR

AUDIT OPERASIONAL TERHADAP TATA KELOLA KREDIT BERMASALAH PADA PT BANK TABUNGAN PENSIUNAN NASIONAL, TBK KCP LEUWILIANG BOGOR

Data in a concurrent environment

none3E. Astesiano;A. Giovini;G. ReggioAstesiano, Egidio; A., Giovini; Reggio, Giann

Observational Structures and Their Logics

A poweful paradigm is presented for defining semantics of data types which can assign sensible semantics also to data representing processes. Processes are abstractly viewed as elements of observable sort in an algebraic structure, independently of the language used for their description. In order to define process semantics depending on the observations we introduce observational structures, essentially first-order structures where we specify how processes are observed. Processes are observationally related by means of experiments considered similar depending on a similarity law and relations over processes are propagated to relations over elements of non-observable sort by a propagation law. Thus an observational equivalence is defined, as union of all observational relations, which can be seen as a very abstract generalization of bisimulation equivalences introduced by David Park. Though being general and abstract our construction allows to extend and improve interesting classical results. For example it is shown that for finitely observable structures the observational equivalence is obtainable as a limit of a denumerable chain of iterations; our conditions, which apply to algebraic structures in general, when instantiated in the case of labelled transition systems, are more liberal than the finitely branching condition. More importantly, we show how to associate with an observational structure various modal observational logics, related to sets of experiment schemas, that we call pattern sets. The main result of the paper proves that for any family of pattern sets representing the simulation law the corresponding modal observational logic is a Hennessy\u2014Milner logic: two observable objects are observationally equivalent if and only if they satisfy the same set of modal observational formulas. Indeed observational logics generalize to first-order structures various modal logics for labelled transition systems. Applications are shown to multilevel parallelism, higher-order concurrent calculi, distributed and branching bisimulation. The theory presented in the paper is not at all confined to give semantics of processes. Indeed it provides a general semantic paradigm for abstract data type specifications, where some data are processes. In order to support this claim, in the final section we briefly consider algebraic specifications and give small examples of specifications integrating processes, data types and functions