RESUMO
The COVID-19 pandemic led to significant delays in the diagnostic and management pathway of patients with obstructive sleep apnoea (OSA). During the first wave of COVID-19, our department adopted a fully remote diagnostic (home cardiorespiratory polygraphy) and treatment (autoset continuous positive airway pressure, CPAP) approach. As a novel mode of service delivery, our aim was to evaluate our pathway and analyse factors associated with adherence to CPAP. We analysed the first 300 patients (51 ± 13 years, 48% men) who were set up on remote CPAP between 20 May 2020 and 11 September 2020. The associations between CPAP usage at 90 days and age, gender, body mass index, disease severity, Epworth Sleepiness Scale and comorbidities were investigated with linear and logistic regression analyses. A total of 124 patients (41.3%) were fully-adherent to CPAP therapy, defined as CPAP usage ≥ 4 h on ≥ 70% of the days. Only driving status was associated with adherence to CPAP. Patients who were adherent at 28 days were more likely to stay adherent at 90 days (3.77 odd ratio /3.10-4.45/ 95% confidence interval). We have shown that a fully remote diagnostic and treatment pathway for patients with OSA can be successfully delivered, and our preliminary outcomes of adherence to CPAP are comparable with published data.
RESUMO
PURPOSE: To identify the mechanisms by which intervention-induced increases in adaptive parenting were associated with a reduction in sexual risk behavior among rural African American adolescents across a 29-month period. METHODS: African American families (N = 284) with 11-year-old children in nine rural Georgian counties participated in the 7-week Strong African American Families (SAAF) project. Counties were randomly assigned to intervention or control conditions. The program was evaluated via pretest, posttest, and long-term follow-up interview data collected in the families' homes. The current paper tests a hypothetical model of program efficacy, positing that intervention-induced changes in parenting behaviors would enhance in youth self-pride, which in turn would forecast changes in sexual behaviors measured 29 months after pretest. RESULTS: Compared with controls, parents who participated in SAAF reported increased adaptive universal and racially specific parenting. Furthermore, intervention-induced changes in these parenting behaviors were associated indirectly with sexual risk behavior through adolescent self-pride, peer orientation, and sexual intent. CONCLUSIONS: Culturally competent programs, developed through empirical and theoretical research within affected communities, can foster adaptive universal and racially specific parenting, which can have a long-term effect on adolescent sexual risk behavior. Effective strategies for designing and implementing culturally competent programs are discussed.
