Bakgrund: Intensivvårdspatientens sömn nattetid är fragmenterad och blir i stor utsträckning störd, vilket gör att en vila på dagen behövs; en strukturerad vilostund. För återhämtning och läkning av sjukdomstillstånd är det viktigt att patienten får den vila denne behöver. Sömnbrist och brist på vila leder till svårigheter att komma ur respirator, längre sårläkning och i slutändan längre vistelsetid på intensivvårdsavdelningen. En strukturerad vilostund är en avsatt tid på dagen där meningen är att intensivvårdspatienten ska vila, utan att bli störd mer än vad sjukdomstillståndet tillåter. Det finns främjande åtgärder som kan utföras för att ge intensivvårdspatienten en god vilostund. Syfte: Syftet är att observera den strukturerade vilostunden inom intensivvården, med hjälp av fyra frågeställningar. Metod: Studien är gjord på två olika intensivvårdsavdelningar, vilket har genererat 41 observationer. Designen är en prospektiv observationsstudie med kvantitativ ansats. Analysen tolkas med deskriptiv och analytisk statistik. Resultat: Resultatet visar att de främjande åtgärder som observerats inte görs i full utsträckning. Den strukturerade vilostunden blir störd bland annat av samtal i vårdrummet och ljud från övervakningsutrustning. Den strukturerade vilostunden störs i snitt 25 gånger och den längsta sammanhängande tid utan störningsmoment är i snitt tio minuter, dock observerades som mest 67 störningsmoment. Den längsta sammanhängande vilan uppmättes till 48 minuter och den minsta vilan till tre minuter.  Slutsats: Den strukturerade vilostunden störs frekvent, trots att riktlinjer finns för en strukturerad vilostund. Då det är frekventa störningar innebär det att möjligheten för vilan blir för kort för att gynna återhämtning och därmed risk för förlängt intensivvårdsbehov. / Background: Patients sleep in the intensive care units (ICU) is fragmented. There is a need for a daytime rest, quiet time, to help the patient heal and recover from critical illness. Sleep deprivation and lack of rest might lead to difficulties of extubation, prolonged healing of wounds and it may result in prolonged stay in the ICU. A quiet time is a period during the day, where the goal is patient rest, without any unnecessary interruptions. There are promotional actions that can be used to make the patients’ rest as good as possible. Aim: The aim of this study is to observe the structured daytime rest in ICU, with the help of four questions. Method: This study is done at two ICU’s in Sweden, which has generated 41 observations. The design is a prospective quantitative observational study with descriptive and analytic statistics. Result: The result shows that the promotional actions observed aren’t used to the full extention. The daytime rest is interrupted, amongst other things, by conversations in the IC-room and from alarms of the surveillance equipment. The daytime rest is disturbed 25 times in mean, and the longest coherent rest fort the patient is ten minutes in mean. The top number for disturbances during the daytime rest is 67 times. The longest coherent rest was 48 minutes and the shortest rest three minutes. Conclusion: The daytime rest is frequently being disturbed in spite of there being a structured daytime rest protocol. This leads to that the possibility for a rest to recover is to short to do so, which can lead to a prolonged stay at the ICU.

Made available in DSpace on 2014-12-17T15:16:05Z (GMT). No. of bitstreams: 1 MarizeJG.pdf: 1501362 bytes, checksum: 8f9c4ae91001822e07351c0f246be869 (MD5) Previous issue date: 2009-07-30 / Background: Obesity impairment to the pulmonary function related to the magnitude of adiposity and is associated with excessive daytime sleepiness (EDS) and snoring, among others symptoms of respiratory disorders related to sleep. It is possible that obese individuals with excessive daytime sleepiness may make changes in lung function on spirometry monitored during the day as a consequence of fragmented sleep or episodes of nocturnal hypoventilation that cause respiratory and changes that can persist throughout the day. The combination of these findings alone sleepiness observed by subjective scales with pulmonary function in obese patients is unknown. Objective: To assess the influence of EDS and snoring on pulmonary function in morbidly obese and distinguish between different anthropometric markers, the snoring and sleepiness which the best predictors of spirometric function and respiratory muscle strength and endurance of these patients. Methods: We evaluated 40 morbidly obese markers on the anthropometric, spirometric respiratory variables, maximal inspiratory and expiratory pressures (MIP and MEP) and maximal voluntary ventilation (MVV) and the measured excessive daytime sleepiness (the Epworth sleepiness scale) and snoring (snoring scale of Stanford). The data were treated when the differences between the groups of obese patients with and without sleepiness, whereas the anthropometric variables, respiratory and snoring. Pearson's correlation was performed, and multiple regression analysis assessed the predictors of pulmonary function. For this we used the software SPSS 15.0 for windows and p <0.05. Results: 39 obese patients were included (28 women), age 36.92+11.97y, body mass index (BMI) 49.3+5.1kg/m?, waist-hip ratio (WHR) 0.96+0.07 and neck circumference (NC) 44.1+4.2 cm. Spirometric values and respiratory pressures were up 80% of predicted values, except for endurance (MVV <80%). Obese with EDS have lower tidal volume. Positive correlation was observed between BMI and EDS, EDS and NC and between snoring and BMI, and negative correlation between EDS and tidal volume (TV), and between snoring and snoring FVC and FEV1. In linear regression the best predictor of pulmonary function was snoring, followed by NC. NC has more obese with higher strength (MEP, p = 0.031) and endurance (MVV p = 0.018) respiratory muscle. Conclusion: Obese with EDS tend to have lower TV. In addition, snoring and NC can better predict pulmonary function in obese when compared with other anthropometric markers or EDS. Obese patients with higher NC tend to have greater capacity for overall strength of respiratory muscles, but may have low muscle endurance / Introdu??o: A obesidade acarreta preju?zo na fun??o pulmonar relacionada ? magnitude da adiposidade e se associa a sonol?ncia diurna excessiva (SDE) e ronco como sintomas de dist?rbios respirat?rios relacionados ao sono. ? poss?vel que indiv?duos obesos com sonol?ncia diurna excessiva possam apresentar altera??o na fun??o pulmonar monitorados na espirometria durante o dia como conseq??ncia da fragmenta??o do sono ou de epis?dios de hipoventila??o noturnos que ocasionam modifica??es respirat?rias e que podem persistir durante o dia. A associa??o destes achados isolados de sonol?ncia, observados atrav?s de escalas subjetivas com a fun??o pulmonar em obesos, ? desconhecida. Objetivos: Avaliar a influencia da SDE e do ronco na fun??o pulmonar em obesos m?rbidos e distinguir entre os distintos marcadores antropom?tricos, o ronco e a SDE quais os melhores preditores da fun??o espirom?trica e da for?a e resist?ncia muscular respirat?ria destes pacientes. M?todos: Foram avaliados 40 obesos m?rbidos quanto aos marcadores antropom?tricos, as vari?veis respirat?rias espirom?tricas, press?es inspirat?ria e expirat?ria m?ximas (PIM?x e PEM?x) e ventila??o volunt?ria m?xima (VVM) e mensuradas a sonol?ncia diurna excessiva (Escala de Sonol?ncia de Epworth) e ronco (Escala de Ronco de Stanford). Os dados foram tratados quando as diferen?as entre os grupos de obesos com e sem sonol?ncia, considerando as vari?veis antropom?tricas, respirat?rias e o ronco. A correla??o de Pearson foi realizada e a an?lise de Regress?o M?ltipla avaliou os preditores da fun??o pulmonar. Para tal foi utilizado o software SPSS 15.0 para windows e p<0,05. Resultados: 39 obesos foram inclu?dos (28 mulheres), idade 36,92+11,97a, ?ndice de massa corporal (IMC) 49,3+5,1kg/m?, rela??o cintura-quadril (RCQ) 0,96+0,07 e Circunfer?ncia do Pesco?o (CP) 44,1+4,2cm. Os valores espirom?tricos e de press?es respirat?rias encontravam-se acima de 80% dos valores preditos, exceto a resist?ncia (VVM<80%). Obesos com SDE apresentam menor volume corrente. Foi observada correla??o positiva entre SDE e IMC, SDE e CP e entre ronco e IMC; e correla??o negativa entre SDE e Volume Corrente, ronco e CVF e entre ronco e VEF1. Na regress?o linear o melhor preditor da fun??o pulmonar foi o ronco, seguido da CP. Obesos com maior CP tem maior for?a (PEM; p=0,031) e resist?ncia (VVM; p=0,018) muscular respirat?ria. Conclus?o: Obesos com SDE tendem a ter menor VC. Al?m disso, o ronco e a CP podem melhor predizer a fun??o pulmonar em obesos quando comparados aos demais marcadores antropom?tricos e a SDE. Obesos com maior CP tendem a ter maior capacidade de geral for?a dos m?sculos respirat?rios, entretanto podem apresentar baixa resist?ncia muscular

Made available in DSpace on 2014-12-17T15:36:59Z (GMT). No. of bitstreams: 1 JaneCS_DISSERT.pdf: 1336075 bytes, checksum: c5f6533c7142c09470c15e67f89d8cd4 (MD5) Previous issue date: 2010-05-04 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / In the school environment is fundamental the knowledge about the sleep-wake cycle (SWC), because we find children and adolescents with excessive sleepiness and learning difficulties. Furthermore, teachers with high demand and with different work schedule, which may contribute to changes in SWC. The aim of this study was to describe the SWC of high school teachers in Natal/RN. Habits and knowledge about sleep, chronotype, SWC, daytime sleepiness, sleep quality and job satisfaction were described in 98 high school teachers from public and private school. These parameters were compared according to the characteristics of work, family structure and gender. Data collection was performed with the use of questionnaires in two stages: 1) "health and sleep" (general characterization of sleep habits), Horne & Ostberg questionnaire (characterization of chronotype), Epworth Sleepiness Scale and the Index of Pittsburg Sleep Quality, 2) The sleep diary for 14 days. From the results, we observe that the teachers woke up and went to bed earlier in the week and showed a reduction of time in bed around 42min comparing to weekend. This reduction in time in bed during the week was accompanied by an increase in nap duration on weekend. In addition the teachers woke up earlier on Saturdays than on Sundays, probably due to housework and leisure. The teachers' knowledge about sleep was low in relation to individual differences and effect of alcoholic beverages on sleep, and high in the consequences of sleep deprivation. The differences found in comparisons on the characteristics of work, family structure and gender were punctual, except concerning the work schedule. The teacher who started work in the morning and finished in the night, woke up earlier, went to bed later and had less time in bed, when compared to teachers who work only in two shifts. In addition, teachers with late chronotypes who begin the work in the morning had a greater irregularity in the wake up time compared to teachers with earlier and intermediate chronotypes. Half of teachers have excessive sleepiness, which was positive correlated with work dissatisfaction. In general, teachers showed IPSQ averages equivalent to poor sleep quality and the women showed worst averages. From the results, it is suggested that the SWC of teachers varies according to work schedule, leading to irregularity and partial sleep deprivation in the week, although these responses vary according to chronotype. These changes are accompanied by excessive daytime sleepiness and poor sleep quality. However, it is necessary to expand the sample to clarify the influence of variables related to work, family structure and gender together / No ambiente escolar ? de fundamental import?ncia o conhecimento sobre o ciclo sono e vig?lia (CSV), pois encontramos crian?as e adolescentes com sonol?ncia excessiva e dificuldades de aprendizagem, al?m de professores com alta demanda e hor?rio diferenciado de trabalho, o que pode contribuir para o surgimento de altera??es no CSV. O objetivo deste estudo foi caracterizar o CSV de professores do ensino m?dio de Natal/RN. Participaram da pesquisa 98 professores de escolas p?blicas e privadas, dos quais, foram descritos os h?bitos e conhecimentos sobre o sono, cronotipo, padr?o do CSV, n?veis de sonol?ncia diurna, qualidade do sono e satisfa??o profissional, comparando estas vari?veis quanto ?s caracter?sticas de trabalho, estrutura familiar e g?nero. A coleta de dados foi realizada com a aplica??o de question?rios em duas etapas: 1) sa?de e o sono (caracteriza??o geral dos h?bitos de sono); question?rio de Horne & Ostberg (caracteriza??o do cronotipo); Escala de Sonol?ncia de Epworth e o ?ndice de Qualidade do Sono de Pittsburg; 2) O di?rio de sono durante 14 dias. A partir dos resultados, observamos que os professores levantaram e deitaram mais cedo e apresentaram uma redu??o do tempo na cama em torno de 42min na semana quando comparada ao fim de semana. Esta redu??o no tempo na cama na semana foi acompanhada por uma maior dura??o do cochilo no fim de semana. Al?m disso, os professores levantaram aos s?bados mais cedo que aos domingos, provavelmente devido aos afazeres dom?sticos e lazer. O conhecimento dos professores sobre o sono foi baixo com rela??o ?s diferen?as individuais e o efeito de bebidas alco?licas sobre o sono e alto em rela??o ?s consequ?ncias da priva??o do sono. As diferen?as encontradas nas compara??es quanto ?s caracter?sticas de trabalho, estrutura familiar e g?nero foram pontuais, exceto com rela??o ao hor?rio de trabalho. Os professores que iniciavam o trabalho pela manh? e finalizavam ? noite levantaram mais cedo, dormiram mais tarde e apresentaram menor tempo na cama, em rela??o aos que trabalhavam apenas em dois turnos. Al?m disso, entre os professores que iniciavam o trabalho pela manh? e que foram classificados como vespertinos houve uma maior irregularidade no hor?rio de levantar em rela??o aos matutinos e intermedi?rios. Metade dos professores apresentou sonol?ncia excessiva, que teve correla??o positiva com a insatisfa??o com o trabalho. Em geral, os professores apresentaram m?dias do IQSP equivalentes ? m? qualidade de sono, tendo as mulheres piores m?dias. A partir dos resultados, sugere-se que o CSV dos professores varia de acordo com o hor?rio de trabalho, acarretando em irregularidade no CSV e priva??o de sono durante a semana, embora o efeito sobre irregularidade varie em fun??o do cronotipo. Estas altera??es s?o acompanhadas de sonol?ncia excessiva diurna e m? qualidade de sono. Por?m, faz-se necess?rio ampliar a amostra para esclarecer a influ?ncia das vari?veis relacionadas ao trabalho, ? estrutura familiar e g?nero em conjunto

INTRODUÇÃO: A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) é uma doença crônica que se caracteriza por ronco e apneias que causam microdespertares e fragmentação do sono. O impacto da doença sobre o humor e a qualidade de vida não é bem conhecido. OBJETIVO: Avaliar o impacto do uso da pressão positiva contínua nas vias aéreas (CPAP) sobre sintomas depressivos e qualidade de vida em pacientes com SAHOS. MATERIAL E MÉTODOS: Pacientes com diagnóstico polissonográfico de SAHOS foram avaliados antes e seis meses após o tratamento com CPAP. Foram coletadas as seguintes medidas antropométricas: peso, altura, índice de massa corporal (IMC), circunferência do pescoço, medida da cintura e do quadril. A sonolência foi avaliada pela escala de sonolência diurna de Epworth, o sono pelo índice de qualidade do sono de Pittsburgh, a qualidade de vida através dos questionários SF-36 e FOSQ e os sintomas depressivos pelo inventário de depressão de Beck. RESULTADOS: Foram estudados 61 pacientes, sendo 42 homens e 19 mulheres, com índice de apneias e hipopneias (IAH) de 40,3 ± 27,2 eventos/hora. A média de idade foi de 53,2 ± 9,0 anos e do IMC 30,36 ± 3,93 kg/m², sendo que 96,7% dos pacientes apresentavam sobrepeso ou obesidade. Valores acima do normal para a circunferência do pescoço foram observados em 73,8% e da cintura em 72% dos indivíduos. Com o tratamento com CPAP observou-se redução da sonolência (13,2 ± 4,8 vs 7,9 ± 3,3 pontos; p=0,0001), melhora da qualidade do sono (escore 10,1 ± 4,5 vs 4,1 ± 2,5; bons dormidores pré 9 vs 36 pós; p<0, 01), melhora da qualidade de vida em todos os domínios do FS-36 (p<0,01) e do FOSQ (81,9 ± 19,5 vs 91,7 ± 14,4 pontos; p=0,00001). Os sintomas depressivos melhoraram após o uso do CPAP (12,0 ± 8,6 vs 7,5 ± 5,1; p<0,01), os quais estavam presentes em 33 pacientes antes do tratamento e em 19 após 6 meses de seguimento. Não houve associação entre sintomas depressivos e sonolência. Houve correlação fraca entre sintomas depressivos e IAH (r=0,28; p=0,02), e moderada a forte com todos os domínios do SF-36 (r entre -0,58 e - 0,72; p=0,0001). CONCLUSÕES: Nosso estudo demonstra que a terapia com CPAP tem impacto positivo sobre a sonolência, qualidade do sono e melhora a qualidade de vida e os sintomas depressivos dos portadores de SAHOS. Os sintomas depressivos não se relacionaram com a sonolência e com a gravidade da doença, mas se associaram com a qualidade de vida. / INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by snoring and apneas that cause microarrousals and sleep fragmentation. The effects of the disease on mood and health related quality of life is not well known. OBJECTIVE: To evaluate the impact of the use of continuous positive airway pressure (CPAP) on depressive symptoms and quality of life in patients with OSAS. MATERIAL AND METHODS: Patients with OSAS diagnosed by polyssomnography underwent evaluation before and after 6 months treatment with CPAP. Weight, height, body mass index (BMI), neck, waist and hip circumference were measured. Daytime sleepiness was evaluated using the Epworth scale, sleep quality using the Pittsburgh sleep quality index and quality of life using SF-36 and FOSQ. Depressive symptoms were detected through the Beck Depression Inventory. Data were analized by Student T test, McNemar test and Pearson correlation test. RESULTS: We studied 61 patients with OSAS, 42 males and 19 females, with apnea hypopnea index (AHI) of 40.3 ± 27.2 events/hour. The mean age was 53.2 ± 9.0 years, BMI was 30.4 ± 3.9 kg/m², and 90.7% of the patients were overweight or obese. Abnormal neck and waist circumference were observed in 73.8% and 72% of patients, respectively. After treatment with CPAP there was a decrease in daytime sleepiness (13.2 ± 4.8 vs 7.9 ± 3.3 points; p=0.0001), an increase in sleep quality (10.1 ± 4.5 vs 4.1 ± 2.5; the number of good sleepers 9 before vs 36 after CPAP; p<0.01), and in quality of life as shown by SF-36 (p<0.01) and FOSQ (81.9 ± 19.5 vs 91.7 ± 14.4 points; p=0.00001). Depressive symptoms improved after use of CPAP (12.0 ± 8.6 vs 7.5 ± 5.1; p<0,01), they were reported by 33 patients before treatment and by 19 after six months of follow up. There was a weak correlation between depressive symptoms and AHI (r=0.28; p=0.02) and no association between depressive symptoms and daytime sleepiness. The correlation among depressive symptoms and SF-36 domains varied from r=-0.58 and r=-0.72 (p=0.0001). CONCLUSIONS: Our study demonstrates that the CPAP therapy has a positive impact on daytime sleepiness and sleep quality and improves quality of life and depressive symptoms in patients with OSAS. Depressive symptoms were not related to daytime sleepiness or disease severity, but were associated with quality of life.

INTRODUÇÃO: A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) é uma doença crônica que se caracteriza por ronco e apneias que causam microdespertares e fragmentação do sono. O impacto da doença sobre o humor e a qualidade de vida não é bem conhecido. OBJETIVO: Avaliar o impacto do uso da pressão positiva contínua nas vias aéreas (CPAP) sobre sintomas depressivos e qualidade de vida em pacientes com SAHOS. MATERIAL E MÉTODOS: Pacientes com diagnóstico polissonográfico de SAHOS foram avaliados antes e seis meses após o tratamento com CPAP. Foram coletadas as seguintes medidas antropométricas: peso, altura, índice de massa corporal (IMC), circunferência do pescoço, medida da cintura e do quadril. A sonolência foi avaliada pela escala de sonolência diurna de Epworth, o sono pelo índice de qualidade do sono de Pittsburgh, a qualidade de vida através dos questionários SF-36 e FOSQ e os sintomas depressivos pelo inventário de depressão de Beck. RESULTADOS: Foram estudados 61 pacientes, sendo 42 homens e 19 mulheres, com índice de apneias e hipopneias (IAH) de 40,3 ± 27,2 eventos/hora. A média de idade foi de 53,2 ± 9,0 anos e do IMC 30,36 ± 3,93 kg/m², sendo que 96,7% dos pacientes apresentavam sobrepeso ou obesidade. Valores acima do normal para a circunferência do pescoço foram observados em 73,8% e da cintura em 72% dos indivíduos. Com o tratamento com CPAP observou-se redução da sonolência (13,2 ± 4,8 vs 7,9 ± 3,3 pontos; p=0,0001), melhora da qualidade do sono (escore 10,1 ± 4,5 vs 4,1 ± 2,5; bons dormidores pré 9 vs 36 pós; p<0, 01), melhora da qualidade de vida em todos os domínios do FS-36 (p<0,01) e do FOSQ (81,9 ± 19,5 vs 91,7 ± 14,4 pontos; p=0,00001). Os sintomas depressivos melhoraram após o uso do CPAP (12,0 ± 8,6 vs 7,5 ± 5,1; p<0,01), os quais estavam presentes em 33 pacientes antes do tratamento e em 19 após 6 meses de seguimento. Não houve associação entre sintomas depressivos e sonolência. Houve correlação fraca entre sintomas depressivos e IAH (r=0,28; p=0,02), e moderada a forte com todos os domínios do SF-36 (r entre -0,58 e - 0,72; p=0,0001). CONCLUSÕES: Nosso estudo demonstra que a terapia com CPAP tem impacto positivo sobre a sonolência, qualidade do sono e melhora a qualidade de vida e os sintomas depressivos dos portadores de SAHOS. Os sintomas depressivos não se relacionaram com a sonolência e com a gravidade da doença, mas se associaram com a qualidade de vida. / INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by snoring and apneas that cause microarrousals and sleep fragmentation. The effects of the disease on mood and health related quality of life is not well known. OBJECTIVE: To evaluate the impact of the use of continuous positive airway pressure (CPAP) on depressive symptoms and quality of life in patients with OSAS. MATERIAL AND METHODS: Patients with OSAS diagnosed by polyssomnography underwent evaluation before and after 6 months treatment with CPAP. Weight, height, body mass index (BMI), neck, waist and hip circumference were measured. Daytime sleepiness was evaluated using the Epworth scale, sleep quality using the Pittsburgh sleep quality index and quality of life using SF-36 and FOSQ. Depressive symptoms were detected through the Beck Depression Inventory. Data were analized by Student T test, McNemar test and Pearson correlation test. RESULTS: We studied 61 patients with OSAS, 42 males and 19 females, with apnea hypopnea index (AHI) of 40.3 ± 27.2 events/hour. The mean age was 53.2 ± 9.0 years, BMI was 30.4 ± 3.9 kg/m², and 90.7% of the patients were overweight or obese. Abnormal neck and waist circumference were observed in 73.8% and 72% of patients, respectively. After treatment with CPAP there was a decrease in daytime sleepiness (13.2 ± 4.8 vs 7.9 ± 3.3 points; p=0.0001), an increase in sleep quality (10.1 ± 4.5 vs 4.1 ± 2.5; the number of good sleepers 9 before vs 36 after CPAP; p<0.01), and in quality of life as shown by SF-36 (p<0.01) and FOSQ (81.9 ± 19.5 vs 91.7 ± 14.4 points; p=0.00001). Depressive symptoms improved after use of CPAP (12.0 ± 8.6 vs 7.5 ± 5.1; p<0,01), they were reported by 33 patients before treatment and by 19 after six months of follow up. There was a weak correlation between depressive symptoms and AHI (r=0.28; p=0.02) and no association between depressive symptoms and daytime sleepiness. The correlation among depressive symptoms and SF-36 domains varied from r=-0.58 and r=-0.72 (p=0.0001). CONCLUSIONS: Our study demonstrates that the CPAP therapy has a positive impact on daytime sleepiness and sleep quality and improves quality of life and depressive symptoms in patients with OSAS. Depressive symptoms were not related to daytime sleepiness or disease severity, but were associated with quality of life.

Made available in DSpace on 2015-09-25T12:19:58Z (GMT). No. of bitstreams: 1 Johnnatas Mikael Lopes.pdf: 1466778 bytes, checksum: 5046b57d301d6c9c6f495adbb993d925 (MD5) Previous issue date: 2012-09-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objective: To determine the prevalence of Excessive Daytime Sleepiness (EDS) in the elderly and its relationship with socio-demographic characteristics of sleep, depression, nutritional status and cardiovascular risk (CR). Materials and Methods: This crosssectional elderly population study conducted in 2010-2011 in the city of Campina Grande-PB. It was estimated sample of 205 seniors, selected randomly in the health districts. The EDS was diagnostic by Epworth Sleepiness Scale. Also investigated were: anthropometric measurements, depression, nutritional status, quality of sleep, snoring, insomnia and physical activity. Results: They were 168 elderly participants, age 72.34±7.8 years, 122 (72.6%) of women. The EDS was diagnostic in 53 (31.5%) participants (95%CI: 27.94%-35.06%). Men (43.5%) were the most affected (p<0.04). The snoring was associated with SED (x2=8.49, p=0.04). Seniors aged over 80 are three times more likely to have SED than the elderly aged 60-69 years (95% CI: 1.08 to 9.24, p=0.03). Elderly obese (42.6%) and high waist circumference (88.5%) had more EDS (p=0.04). Depression (78.6%, p=0.0005) and high waist circumference is associated with EDS in men (57.1%, p=0.02). Only in women, obesity was related to the SED (42.1%, p=0.01). Conclusion: There is high prevalence of SED among the elderly population studied. The high age, men and snoring predict the SED. Obesity, depression and RC s factors present association with SED. The male is a key variable in this relationship. / Objetivo: Determinar a prevalência de Sonolência Excessiva Diurna (SED) em idosos e sua relação com fatores sócio-demográficos, características do sono, depressão, estado nutricional e risco cardiovascular (RC). Materiais e Métodos: Pesquisa transversal de base populacional realizada de 2010-2011 com idosos da cidade de Campina GrandePB. Foi estimada amostra de 205 idosos, selecionada aleatoriamente nos distritos sanitários. A SED foi diagnóstica através da Escala de Sonolência de Epworth. Foram também investigados: medidas antropométricas, depressão, estado nutricional, qualidade do sono, ronco, insônia e atividade física. Resultados: Participaram da pesquisa 168 idosos, idade de 72,34 ±7,8 anos, 122 (72,6%) de mulheres. A SED foi diagnóstica em 53 (31,5%) participantes (IC95%: 27,94%-35,06%). Os homens (43,5%) foram os mais acometidos (p<0,04). O ronco foi associado à SED (x2=8,49; p=0,04). Idosos com idade igual ou superior a 80 anos têm três vezes mais probabilidade de apresentar SED do que os idosos com idade entre 60-69 anos (IC95%: 1,08-9,24; p=0,03). Idosos obesos (42,6%) e com elevada circunferência abdominal (88,5%) apresentaram mais SED (p=0,04). Depressão (78,6%; p=0,0005) e circunferência abdominal elevada está associada à SED nos homens (57,1%; p=0,02). Apenas nas mulheres a obesidade mostrou-se relacionada com a SED (42,1%; p=0,01). Conclusão: Existe alta prevalência de SED na população idosa estudada. A idade elevada, homens e roncar predizem a SED. A obesidade, depressão e fatores que favorecem RC apresentam associação com a SED. O sexo masculino é uma variável determinante desta relação.

Made available in DSpace on 2017-07-10T19:23:55Z (GMT). No. of bitstreams: 1 Jiam Pires_ Frigo.pdf: 2243207 bytes, checksum: 76a818d3ba4a98ecda459c13486050ca (MD5) Previous issue date: 2014-06-02 / The sprinkler irrigation system is widely used because of the possibility of high uniform distribution and to adapt itself to different crops and soils. On the other hand, the water uniform application in irrigation is affected by meteorological factors that decrease the system efficiency. There has always been some concern about the quality of products and services in human history, since all products should have desirable characteristics to be accepted by consumers. Currently, development, improvement and monitoring of new management models quality during the production process have become essential for many organizations. Thus, inspection control has enhanced by statistical techniques, losses have been decreased and it was possible to stimulate some trading competition. In this context, this study aimed at evaluating the irrigation system in a conventional sprinkler using the Christiansen Uniformity Coefficient (CUC) and the index Process Capability (CP) to correlate techniques with the system efficiency as well as verify the wind influence on irrigation by Shewhart control chart and compare the results of Shewhart control charts use with the EWMA and tabular CUSUM control charts, applied in quality control of the conventional sprinkler irrigation. In this study, 60 essays were carried out on a four irrigation sprinklers system, Xcel-Wobbler model, 1.0 m height above soil and 6.0 x 6.0 m spaced. The collectors were 1.0 m spaced apart with 0.5 m height from soil. The service pressure was monitored and appropriate to the sprinklers specifications, while wind was monitored in situ by a 2.0 m high digital anemometer. In order to evaluate the system, Christiansen Uniformity Coefficient (CUC), the index Process Capability (CP), Shewhart charts (Xbarra) and the charts of exponentially weighted moving average (EWMA) and cumulative sum (CUSUM) were used. The irrigation sprinkler system showed the best performance and was under control when the average wind speed was less than 1.0 m s-1. The use of individual Shewhart control charts visually allowed affirming that wind has a direct influence on CUC. Night irrigation showed less variability on the studied data, when compared to daytime ones and this has resulted in greater efficiency in irrigation. The CPi index showed great similarity with the Christiansen Uniformity Coefficient (CUC). It proved to be very sensitive to efficiency sprinkler (Ea) variation and able to indicate the quality of sprinkler irrigation. The EWMA chart, when compared to the control charts, was susceptible when used in autocorrelated data, according to the occurrence of false alarms. But, to the residue data without autocorrelation (the ARIMA model), the CUSUM tabular chart was more sensitive to detect variations in irrigation due to wind speed, when compared to EWMA and Shewhart charts for the same data. In sprinkler irrigation, when there is a relation between CUC and wind speed, the Shewhart chart was more indicated by simplicity, reliability and ease of interpretation, even in the presence of autocorrelated data. / O sistema de irrigação por aspersão é muito utilizado, devido à possibilidade de elevada uniformidade de distribuição e por adaptar-se às diversas culturas e solos. Porém, a uniformidade de aplicação de água nas irrigações é afetada por fatores meteorológicos que diminuem a eficiência do sistema. A preocupação com a qualidade de produtos e serviços oferecidos sempre esteve presente na história da humanidade, pois para que os produtos fossem aceitos, deveriam possuir características desejáveis pelos consumidores. Atualmente, com o surgimento de novos modelos gerenciais, a melhoria e o monitoramento da qualidade durante o processo de produção tornaram-se uma necessidade para muitas organizações. Assim, aprimorou-se o controle da inspeção por meio de técnicas estatísticas, reduziram-se perdas e foi possível competir no mercado. Neste contexto, o objetivo deste estudo foi avaliar a irrigação em um sistema por aspersão convencional, utilizando o Coeficiente de Uniformidade de Christiansen (CUC), o índice de Capacidade do Processo (CP) para correlacionar as técnicas com a eficiência do sistema, verificar a influência do vento na irrigação pelo gráfico de controle de Shewhart e confrontar os resultados da utilização dos gráficos de controle de Shewhart, com os gráficos de controle MMEP e CUSUM tabular, aplicados no controle de qualidade da irrigação por aspersão convencional. Neste estudo, foram realizados 60 ensaios em um sistema de irrigação por aspersão convencional. O sistema era constituído de quatro aspersores, modelo Xcel-wobbler, altura de 1,0 m em relação ao solo e espaçamento de 6,0 x 6,0 m. Os coletores foram espaçados em 1,0 m entre si com altura de 0,5 m do solo. A pressão de serviço foi monitorada e adequada às especificações dos aspersores, e o vento monitorado in loco, por um anemômetro digital com 2,0 m de altura. Para a avaliação do sistema, foram utilizados o Coeficiente de Uniformidade de Christiansen (CUC), o índice de Capacidade do Processo (CP), gráficos de Shewhart (Xbarra) e os gráficos de média móvel exponencialmente ponderada (MMEP) e de soma cumulativa (CUSUM). O sistema de irrigação por aspersão convencional teve melhor desempenho e esteve sob controle, quando a velocidade média do vento esteve menor que 1,0 m s-1. O uso dos gráficos individuais de controle de Shewhart possibilitou afirmar visualmente que o vento tem influência direta sobre o CUC. A irrigação noturna apresentou menor variabilidade nos dados, quando comparados aos dados do período diurno e isso resultou em maior eficiência na irrigação. O índice CPi teve grande similaridade com o Coeficiente de Uniformidade de Christiansen (CUC); mostrou-se bastante sensível à variação da eficiência de aspersão (Ea) e capaz de indicar a qualidade da irrigação por aspersão. Em comparação aos gráficos de controle, o gráfico MMEP mostrou-se suscetível quando utilizado em dados autocorrelacionados, pelas ocorrências de alarmes falsos. Para dados de resíduos, sem autocorrelação (pelo modelo ARIMA), o gráfico CUSUM tabular foi mais sensível ao detectar as variações ocorridas na irrigação devido à velocidade do vento, quando comparado aos gráficos MMEP e Shewhart para os mesmos dados. Na irrigação por aspersão, relacionando CUC com velocidade do vento, o gráfico de Shewhart foi mais indicado pela simplicidade, confiabilidade e facilidade de interpretação, mesmo na presença de dados autocorrelacionados entre si.

This thesis discusses the possibilities of additional equipment on vehicle body. The content of the theoretical and practical part. The theoretical part is focused on clarifying the fundamental concepts, including the issue of legislative regulations and laws. The practical part deals with specific examples of changes in the body, which are then examined in terms of legislation and clarify their possible assembly and conditions of use.

The daytime serial drama, commercially known as the soap opera, has for a long time been diminished as an inferior artform, which previous research has connected to bias towards its historically predominantly female audience as well as its close relation to advertising. This thesis examines Guiding Light (original title The Guiding Light, CBS, 1937-1956, 1952-2009) and its transition from radio to television in the 1950s by using a historiographical approach through analysis of archive artefacts that cover the decade. The archive material, consisting of newspapers and magazines, have two parts to play: the first regarding the influence of the sponsor Procter &amp; Gamble considering the soap opera’s status as a thriving advertisement vehicle of the time, and the second in the relationship between soap opera and its listeners/viewers throughout the era of transition. Throughout the years that it existed as a combination serial; both factors were seen to play a vital role in shaping the serial, both from an industry point-of-view, and as evident in its text. The two perspectives are often contradictory to one another but the co-existence of them is essential to the shaping of the soap opera’s history writing. Gender ties into both angles as the transition added to a growing social panic surrounding the housewife as a pillar for postwar US-American values.

本研究主要目的在探討高中生的睡眠型態與學業表現的關係，試圖分析睡眠時間量及睡眠的規律性與其課業表現以及睡眠相關現象(白天嗜睡程度及睡眠品質)的關係，並探討白天嗜睡及睡眠品質之中介效果及以日夜節律型態之調節效果。本研究以自填「青少年睡眠習慣問卷」，對台灣北區普通高中及綜合高中中學術學程的高中生進行調查，採群集抽樣的方式進行，共進行42個班級施測，發出1,650份問卷，取得有效問卷1,308份樣本分別以日夜節律型態類型及高低成就動機兩種分類方式進行分析，主要研究結果如下： 1.夜貓型高中生之週間週末規律性變項對於學業表現具有影響力。 2.白日型高中生之週間規律性變項對於學業表現具影響力。 3.以高低成就動機分組，兩組之睡眠型態變項對於學業影響力皆未達顯著性。 4.白天嗜睡及睡眠品質在兩種分類分析下，皆無中介效果。 本研究初步結果支持夜貓型高中生在維持週間週末某種程度睡眠規律性對於學業表現具有相當的影響性，而早晨型在週間內維持其規律性也是對於其學業表現是具有顯著影響性，也就是依其日夜節律型態在其睡眠型態維持自己生活作息的規律性，而不在時間點或睡眠量的多寡來作要求，也許對於正值課業壓力或生心理高度變化的青少年時期會是更合適的睡眠作息。 / The purposes of this study are to explore the relationship of the sleep pattern with academic performance, day time sleepiness and sleep quality in senior high school students. Data were collected by sleep pattern questionnaire of the adolescent. The participants included 1650 students form the 10th grade to 12th grade, recruited form senior high schools in Taipei. Using stratified cluster sampling method. There were 1308 of valid questionnaires obtained. The major results are as follow: (1) The variablity of the sleep-wake pattern between weekdays and weekends has significant influences on academic performace in the evening type students. (2) The variablity of the sleep-wake pattern during weekdays showed significant influences on academic performace in the morening type students. (3) In both the high and low achievement motivation groups, sleep pattern showed no significant associations with academic performance. (4) The mediation effect of daytime sleepiness and sleep quality were not proven in all the data analyses. In coclusion, the results indicate that in evening type students, maintaining regularity of sleep pattern between weekdays and weekends would be beneficial to their academic performance; and in the morning type students, keeping regular weekday sleep-wake schedules seem to be more important for better academic performance. Therefore, when considering the influences on academic performance, regularity of sleep seem to be more important than quantity of sleep in high schoolers.