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1±14%, 77.8±12%, 66.5±16% and 67±16%, respectively. Age, duration of exposure, comorbidities, moderate to severe ventilatory defects, and significant to severe impairment were correlated with altered QoL. Improvement of QoL requires comprehensive care with the management of complications, co-morbidities, better patient awareness, and better consideration of the feelings of patients. Improvement of QoL requires comprehensive care with the management of complications, co-morbidities, better patient awareness, and better consideration of the feelings of patients. Investigation for obstructive sleep apnea syndrome (OSAS) is mandatory before bariatric surgery. selleck chemicals Data regarding chronic insomnia and chronic sleep deprivation are scarce in this population. A cross-sectional study assessing the prevalence of chronic insomnia, OSAS and chronic sleep privation in an obese population referred for bariatric surgery. In all, 88 patients (74% women, median age 41 [33.5-50] years and median body mass index 42 [39.2-45.7] kg/m ) were included. The prevalence of chronic insomnia was 31% in the 87% suffering from OSAS that required continuous positive airway pressure therapy. Comorbid insomnia and sleep apnoea (COMISA) were found in 27% of our population. Chronic insomnia was associated with a lower quality of life (median EQ5D analogue visual scale 60 [50-70] P=0.04) and a poor sleep quality (median Pittsburgh sleep quality index (PSQI) 8 (6-11 P<0.01) The deleterious combination of sleep privation and insomnia had a higher impact in terms of impairment of quality of life anl scale 50 [40-65] P=0.02 et median PSQI 11 [9-14, P less then 0.01) CONCLUSION Chronic insomnia and sleep privation have synergistic deleterious effects in candidates for bariatric surgery. Further studies need to be conducted to evaluate the evolution after surgery.The Written Action Plan is a tool designed to help people with asthma to manage their condition when they experience an exacerbation. Asthma guidelines are consistent in their recommendation that action plans are useful for all people with asthma, but implementation is not systematic. The evidence base for such plans is limited because of methodological biases, but does support their effectiveness. The recommended action plan involves different color-coded zones which advise patients to adjust their management, such as increasing the level of daily treatment, or introducing oral corticosteroids based on symptoms and peak expiratory flow measurements. Recommendations are much less clear as to how to encourage patients to adopt and take ownership of their plan, although they all recommend that written action plans be incorporated into therapeutic education programs. The published literature shows that those caring for people with asthma may not support action plans because they are uncomfortable with the necessary educational posture and as a consequence of this they are under-utilized by patients. Patient-centered therapeutic education principles help us understand both how to encourage the patient want to have a written action plan and how to co-create it with them so that it is useful and meaningful in their life in order to make it more than just a disconnected tool.Although breast conserving surgery is the standard of care for patients with localized breast cancer in high-income countries, little is known about its use in developing countries, where disparities in access to treatment may lead to an increased use of mastectomy. We examined the use of breast conserving surgery at a Mexican cancer center after the implementation of a public insurance program aimed at providing coverage for previously uninsured patients. Between 2006 and 2016, 4519 women received surgical treatment for breast cancer, of which 39% had early-stage disease. The proportion of patients treated with breast conserving surgery increased from 10% in the 2006-2009