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Sleep Med ; 84: 352-355, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242925


OBJECTIVES: Adherence to Continuous Positive Airway Pressure (CPAP) in children can be challenging. Advancements in CPAP technology have potential to influence adherence. The aim of this study was to compare adherence rates of children with obstructive sleep apnoea (OSA) initiated on autotitrating CPAP (APAP) with remote modem monitoring compared to a cohort started on fixed pressure CPAP alone. METHODS: Children aged over 3 years starting APAP at our centre between February 2017 and February 2020 were included. Therapy data was obtained for the initial 90 days. Data was compared to a cohort of children started on CPAP between July 2004 and September 2008. RESULTS: A total of 61 patients with a median age of 14.3 years formed the APAP group, and were significantly older than the CPAP group who had a median age of 8.6 years (p = 0.02). Co-morbid conditions were present in 51% compared with 69% in the earlier cohort (p = 0.11). No significant difference was found in any adherence parameters between the groups. The value closest to achieving a significant difference was hours used per day used, with an median of 5.2 h in the CPAP group compared with 7.0 h in the APAP group (p = 0.07). Two-way ANOVA including age group (above or below 13 years) showed that both age group and treatment group (CPAP vs APAP) were significantly associated with a difference in adherence (F = 4.41, p = 0.006), with mean hours used on days used being highest in the APAP group aged under 13 years. However no significant interaction was found between age and treatment group. CONCLUSION: Despite the convenience for patients with outpatient initiation and ability to achieve optimal pressures quickly and remotely, our results show no improvement in adherence using APAP with remote monitoring, with the possible exception of children aged under 13 years. A large randomized controlled trial would be required to confirm these findings.

Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Cooperação do Paciente , Polissonografia , Apneia Obstrutiva do Sono/terapia
IEEE Comput Graph Appl ; 41(2): 8-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729921


We argue that visualization research has overwhelmingly focused on users from the economically developed world. However, billions of people around the world are rapidly emerging as new users of information technology. Most of the next billion users of visualization technologies will come from parts of the world that are extremely populous but historically ignored by the visualization research community. Their needs may be different to the types of users that researchers have targeted in the past, but, at the same time, they may have even more to gain in terms of access to data potentially affecting their quality of life. We propose a call to action for the visualization community to identify opportunities and use cases where users can benefit from visualization; develop universal design principles; extend evaluations by including the general population; and engage with a wider global population.

J Paediatr Child Health ; 56(10): 1659-1660, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33099815
J Clin Sleep Med ; 16(10): 1655-1661, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32515344


STUDY OBJECTIVES: An increasing number of children with obstructive sleep apnea (OSA) require treatment with continuous positive airway pressure (CPAP). This study aimed to determine whether automatic respiratory indices from a CPAP device accurately predict manually determined respiratory indices derived from overnight polysomnography (PSG) in children. METHODS: Consecutive children undergoing manual CPAP titration PSG using a ResMed VPAP ST-A (S9) were included. The apnea-hypopnea index (AHI), apnea index (AI), and hypopnea index (HI) from automatic analysis of the CPAP device for that night (AHICPAP, AICPAP, and HICPAP) were compared with manually derived respiratory indices (RDIPSG, OAHIPSG, AIPSG, and HIPSG) using the Wilcoxon matched-pairs signed-ranks test. RESULTS: Forty-six children (32 boys; median age, 13.5 years; range, 4.6-20.0 years) were included. There was no difference between RDIPSG and AHICPAP (P = .6) nor between HIPSG and HICPAP (P = .2). AIPSG was significantly lower than AICPAP (mean difference -1.3 events/hr, P < .001). AIPSG and AICPAP were strongly correlated (r² = .72, P < .01), but the CPAP machine overestimated the number of apneas at higher AIs. OAHIPSG was significantly lower than AHICPAP (P = .003) but strongly correlated (r² = .87, P < .01). The CPAP device significantly underestimated the number of hypopneas at higher indices. Using the manually scored OAHIPSG of ≥5 events/hr to define significant residual OSA, the AHICPAP had a high specificity (0.95) but low sensitivity (0.20). CONCLUSIONS: The ResMed S9 respiratory indices are not accurate enough to guide treatment decisions in children; in particular, they do not rule out the presence of residual OSA in children that remain symptomatic on CPAP. A low AHICPAP is reassuring in the context of a stable patient but may miss ongoing hypopneas.

Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia
Am J Intellect Dev Disabil ; 122(2): 97-117, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28257246


Children with intellectual and developmental disabilities (IDD) experience significant difficulties in attention, learning, executive functions, and behavioral regulation. Emerging evidence suggests that computerized cognitive training may remediate these impairments. In a double blind controlled trial, 76 children with IDD (4-11 years) were randomized to either an attention training (n = 38) or control program (n = 38). Both programs were completed at home over a 5-week period. Outcome measures assessed literacy, numeracy, executive functioning, and behavioral/emotional problems, and were conducted at baseline, post-training, and 3-month follow-up. No training effects were observed at post-training; however, children in the training group showed greater improvements in numeracy skills at the 3-month follow-up. These results suggest that attention training may be beneficial for children with IDD; however, the modest nature of the intervention effects indicate that caution should be taken when interpreting clinical significance.

Logro , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Atenção , Instrução por Computador , Deficiências do Desenvolvimento/terapia , Crianças com Deficiência/educação , Educação Especial/métodos , Função Executiva , Deficiência Intelectual/terapia , Transtornos do Comportamento Social/terapia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Austrália , Criança , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/psicologia , Crianças com Deficiência/psicologia , Método Duplo-Cego , Inteligência Emocional , Feminino , Seguimentos , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/psicologia , Masculino , Testes Neuropsicológicos/estatística & dados numéricos , Nova Zelândia , Psicometria , Transtornos do Comportamento Social/diagnóstico , Transtornos do Comportamento Social/psicologia
J Child Psychol Psychiatry ; 57(12): 1380-1389, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27550746


BACKGROUND: Children with intellectual and developmental disabilities (IDD) experience heightened attention difficulties which have been linked to poorer cognitive, academic and social outcomes. Although, increasing research has focused on the potential of computerised cognitive training in reducing attention problems, limited studies have assessed whether this intervention could be utilised for those with IDD. This study aimed to assess the efficacy of a computerised attention training programme in children with IDD. METHODS: In a double-blind randomised controlled trial, children (n = 76; IQ < 75) aged 4-11 years were assigned to an adaptive attention training condition or a nonadaptive control condition. Both conditions were completed at home over a 5-week period and consisted of 25 sessions, each of 20-min duration. Outcome measures (baseline, posttraining and 3-month follow-up) assessed core attention skills (selective attention, sustained attention and attentional control) and inattentive/hyperactive behaviour. RESULTS: Children in the attention training condition showed greater improvement in selective attention performance compared to children in the control condition (SMD = 0.24, 95% CI 0.02, 0.45). These improvements were maintained 3 months after training had ceased (SMD = 0.26, 95% CI 0.04, 0.48). The attention training programme was not effective in promoting improvements in sustained attention, attentional control or inattentive/hyperactive behaviours. CONCLUSIONS: The findings suggest that attention training may enhance some aspects of attention (selective attention) in children with IDD, but the small to medium effect sizes indicate that further refinement of the training programme is needed to promote larger, more global improvements.

Atenção/fisiologia , Remediação Cognitiva/métodos , Deficiências do Desenvolvimento/reabilitação , Deficiência Intelectual/reabilitação , Avaliação de Resultados em Cuidados de Saúde , Terapia Assistida por Computador/métodos , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino
MedEdPORTAL ; 12: 10448, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31008226


Introduction: End-of-life (EOL) care delivery to Latinos is a well-documented challenge. The majority of caregivers for Latino patients are family relatives, but because Latino caregivers may spend more hours in the caregiving role than other ethnic groups and are less likely to use additional available health care, caregivers can experience an increased burden. This can result in Latino elders being more vulnerable to receiving aggressive care. "Caregivers Like Me" was created as a source for nonprofessional caregivers to improve their knowledge about Latino caregiving of elders at end-of-life (EOL). This resource aims to educate about caregiver stress and to improve attitudes towards the utilization of EOL services. Methods: "Caregivers Like Me" is a bilingual education intervention that includes a video soap opera, or telenovela. The video is followed by discussion of hospice, palliative care, and caregiver stress definitions and ends with an explanation of services available for caregivers (i.e., social services, support groups, adult day care, chore workers, home care with or without palliative care, and respite care under hospice). Results: "Caregivers Like Me" has been demonstrated to improve Latino family caregivers' openness to receiving professional help while caring for their loved ones. Participants in a multisite cross-sectional pilot study among nonprofessional Latino caregivers (N = 145) reported active learning from the intervention and high satisfaction with the overall educational experience. Discussion: This tool provides an education format that is culturally and literacy-sensitive to Latino caregivers and effective in changing their attitude toward EOL care. It may be used by professional caregivers to educate Latino caregivers about EOL care.