Celina Matiko Hori Higa

Atenção aos tabagistas pela capacitação de profissionais da rede pública

The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2% quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11%); lack of medications (38%); and lack of health unit infrastructure/support (29%). The training allowed to reaching out a larger population through smoking cessation approaches at health units.

Implementation of a smoke-free psychiatric unit in a general hospital.

Dear Editor, Smoking is more prevalent among patients with severe mental disorders than in the general population. Moreover, other health threatening factors, such as obesity, sedentary lifestyle, and less attention to general health and self-care, contribute to increase the morbidity and early mortality in this population. The relationship between psychopathology and smoking (selfreported cognitive improvement, decrease in antipsychotic sideeffects, and anxiety), together with restrictions on the use of some medications and behavioral strategies, are some of the difficulties in the nicotine dependence treatment for these patients. Currently, nicotine replacement therapy (NRT) has been considered to be the most effective and safest option to aid smoking cessation in this population. The Hospital das Clínicas da Universidade Estadual de Campinas (HC-UNICAMP) has 3,100 employees and 394 beds. It is a reference institution in health care, teaching, and research, and therefore it has an exemplary role in providing high-standard care and environment. Its 12-bed Psychiatric Unit (PU) admits patients suffering from mood disorders (34%), psychotic disorders and schizophrenia (28%), personality disorders (12%), organic mental disorders (9%), and disorders related to the use of psychoactive substances (7%). In the beginning of 2008, a multisectoral committee was created in order to implement measures to make the hospital 100% free from tobacco. One of the main obstacles to achieve that goal was the fact that the fourth floor of the building, where the PU is located, used to be regarded by both patients and professionals as a smoking area. Table 1 describes the main measures taken to ban smoking in the hospital. Between June 2008 and May 2009, 196 patients were hospitalized at the PU, 26% of whom were smokers. On average, they were 37 years old and had been smoking 22 cigarettes per day for the last 19 years. Twelve months after hospital discharge, all patients were contacted by telephone and interviewed: 31% maintained the same smoking pattern, 27% reduced the number of cigarettes smoked per day, 10% had quit smoking but relapsed, and 27% had quit smoking completely since the time they were hospitalized. The two main difficulties identified in the smoke-free program were the resistance of hospital employees to acknowledge that the fourth floor was no longer a place for smoking, and the lack of NRT for all the hospital wards. Overall, the implementation of the program was smoother than initially expected. There were neither increased reports of aggressive behavior nor admission refusals. The old “negotiations” between staff and patients, who used cigarettes as an exchange currency, have been replaced by walking at the hospital yard, dominoes matches, and listening to the piano available on the fourth floor. Some hospital professionals also stopped smoking. The comment made by an interviewed patient reinforces the importance of the initiative and encourages other services to do the same: “I thought it’s all right [not being allowed to smoke in

Increased popliteal circumferential wall tension induced by orthostatic body posture is associated with local atherosclerotic plaques

OBJECTIVE Lower limb arteries are exposed to higher hemodynamic burden in erectile posture. This study evaluated the effects of body posture on popliteal, carotid and brachial circumferential wall tension (CWT) and investigated the relationship between local CWT and atherosclerotic plaques in subjects with cardiovascular risk factors. METHODS Two hundred and three subjects (118 women and 85 men) with cardiovascular risk factors (smoking, hypertension or diabetes mellitus) underwent clinical and laboratory analysis and had their blood pressure measured in the arm and calf in supine and orthostatic positions. Arteries were evaluated by ultrasound analysis, while CWT was calculated according to Laplaces law. RESULTS Among the enrolled participants, 47%, 29% and none presented popliteal, carotid and brachial plaques, respectively. Carotid CWT measurements were not associated with local plaques after adjustment for potential confounders. Conversely, general linear model and logistic regression analyses adjusted for potential confounders demonstrated that peak orthostatic CWT was the only local hemodynamic parameter showing significant relationship with popliteal plaques in the whole sample. In gender-specific analyses, although positively correlated with popliteal plaques in both genders, local peak orthostatic CWT exhibited an independent association with popliteal plaques after adjustment for potential confounders only in women. CONCLUSION Popliteal CWT measured in orthostatic posture, rather than in supine position, is associated with popliteal atherosclerotic plaques, particularly in women. These findings suggest that erectile posture might play a role in the atherogenesis of leg arteries by modifying local hemodynamic forces and that there may be gender differences in this regard.

Opinião e conhecimento de pacientes e familiares sobre o uso da eletroconvulsoterapia: implicações para a enfermagem

The aim of this report was to verify in-patients and their relatives opinion and knowledge of the use of electroconvulsive therapy. By means of a quantitative analysis, the use of this treatment was shown to be accepted despite the individuals knew little about it. It was observed that the knowledge of this treatment had influence over individuals opinion about it. Thus nurses play an important role on the instruction of these individuals regarding this treatment.Neste trabalho verificou-se a opiniao e o conhecimento de pacientes internados em uma unidade psiquiatrica e seus familiares, sobre a aceitacao do uso da eletroconvulsoterapia. Atraves de analise quantitativa constatou-se a aprovacao da maioria ao tratamento, apesar do escasso conhecimento sobre este, apresentado pelos individuos estudados. Constatou-se tambem que o conhecimento desse tratamento e a confianca depositada no profissional medico que indica o tratamento, parece influir na opiniao dos individuos sobre seu uso. Desta forma existe a importância do papel do enfermeiro na educacao dos individuos em relacao a eletroconvulsoterapia.

Quality of life and work overload among elderly outpatient caregivers

Se evaluo la calidad de vida relacionada con la salud y la carga de trabajo de 126 cuidadores de pacientes atendidos en dos centros geriatricos de un hospital universitario, y la asociacion entre el volumen de trabajo y las variables sociodemograficas y clinicas. Es un estudio exploratorio de caracter descriptivo, transversal y cuantitativo. Se utilizo el instrumento de resultados sociodemograficos y clinicos, Zarit Burden Interview para evaluacion de la carga percibida, y el Medical Outcomes Study Short-Form Health Survey (SF-36) para la evaluacion de la calidad de vida relacionada con la salud. Se hizo el analisis descriptivo, de correlacion, de comparacion, y multivariado de los datos. Se encontro diferencia significativa entre la carga de los cuidadores de los dos ambulatorios; todos los aspectos sociodemograficos y atencion se asociaron con un empeoramiento de al menos una de las dimensiones del SF-36; y las enfermedades frecuentes en los cuidadores estaban relacionadas con un empeoramiento de su calidad de vida relacionada con la salud. Tambien se pudo constatar el desgaste experimentado por los cuidadores de ancianos en estos centros de salud.

Calidad de vida y la carga de trabajo de los cuidadores de ancianos atendidos en centros geriátricos

Se evaluo la calidad de vida relacionada con la salud y la carga de trabajo de 126 cuidadores de pacientes atendidos en dos centros geriatricos de un hospital universitario, y la asociacion entre el volumen de trabajo y las variables sociodemograficas y clinicas. Es un estudio exploratorio de caracter descriptivo, transversal y cuantitativo. Se utilizo el instrumento de resultados sociodemograficos y clinicos, Zarit Burden Interview para evaluacion de la carga percibida, y el Medical Outcomes Study Short-Form Health Survey (SF-36) para la evaluacion de la calidad de vida relacionada con la salud. Se hizo el analisis descriptivo, de correlacion, de comparacion, y multivariado de los datos. Se encontro diferencia significativa entre la carga de los cuidadores de los dos ambulatorios; todos los aspectos sociodemograficos y atencion se asociaron con un empeoramiento de al menos una de las dimensiones del SF-36; y las enfermedades frecuentes en los cuidadores estaban relacionadas con un empeoramiento de su calidad de vida relacionada con la salud. Tambien se pudo constatar el desgaste experimentado por los cuidadores de ancianos en estos centros de salud.