Inês Rosendo

Caracterização dos fumadores e factores que influenciam a motivação para a cessação tabágica

Resumo Introducao: O tabaco e actualmente um dos maiores problemas de saude publica. Desta forma, o conheci-mento do perfil do fumador e essencial para poder adequar estrategias de intervencao, sendo fundamental avaliar a sua motivacao. Objectivos: Calcular a prevalencia de fumadores de quatro ficheiros de tres centros de saude do distrito de Coimbra e caracteriza-los em termos demograficos, padrao de consumo, motivacao para a cessacao tabagica e comorbilidades. Determinar a relacao entre motivacao para deixar de fumar e idade, sexo, idade de inicio e quantidade do consumo, comorbilidades cardiovasculares, respiratorias e psiquiatricas associadas. Metodologia: Estudo descritivo com componente analitico. Populacao acessivel: utentes entre 15 e 65 anos, utilizadores da consulta de quatro ficheiros de tres centros de saude do distrito de Coimbra entre Ju-nho e Agosto de 2007. Tratamento de dados: SPSS17. Resultados: Duzentos e vinte e quatro entrevistados aleatoriamente, 64,3% mulheres, com idade media de 44,9 anos. A prevalencia de fumadores foi de 17% (52,63% mulheres). A idade media dos fumadores foi de 39,4 anos. A idade media de inicio de consumo ta-bagico foi de 17,2 anos. A quantidade media de cigarros consumidos foi de 17,5/dia. Dos fumadores, 50% eram portadores de comorbilidades. Nao foi encontra-da associacao estatisticamente significativa de nenhum destes factores com a motivacao para deixar de fumar. Discussao/conclusao: Os resultados obtidos sao so-breponiveis a outros estudos nacionais. Entre os jovens, ha mais mulheres fumadoras, e as mulheres fumam menos cigarros/dia. Das comorbilidades estudadas, as mais frequentes foram as cardiovasculares e as psiquiatricas. Apenas metade dos fumadores estavam motiva-dos para a cessacao tabagica. Rev Port Pneumol 2009; XV (5): 783-802

Pressão arterial periférica por Dinamap e pressão arterial central por tonometria planar de absorção no ambulatório de Medicina Geral e Familiar

INTRODUCTION Central blood pressure (CBP) is the pressure exerted by the blood column at any given moment on the aortic and carotid artery walls, which is a close proxy for the blood pressure inside the brain and the heart, and is thus a better marker of cardiovascular morbidity and mortality than peripheral blood pressure (PBP). OBJECTIVE To assess how the augmentation index (AI), peripheral pulse pressure (pPP), central pulse pressure (cPP) and subendocardial viability ratio (SEVR) vary in hypertensive patients according to level of control of CBP and PBP. METHODS We performed an observational, cross-sectional study in a convenience sample from a general practice in Central Portugal over a period of four days in May 2010. Measurements were taken after a four-minute resting period. The following values were considered to reflect controlled pressures: PBP <140/90 mmHg, CBP <130/80 mmHg, pPP <55 mmHg and cPP <45 mmHg. RESULTS The sample included 92 patients, 38 male (41.3%), mean age 62.3±11.1 years, with no significant difference in gender distribution. PBP was controlled in 55 (59.8%), and CBP in 53 (57.6%). Both PBP and CBP were controlled in 50 patients (54.3%) and neither was controlled in 34 (37.9%). pPP and cPP were significantly lower in those with controlled PBP (p<0.001) and CBP (p<0.001). AI was non-significantly lower in those with controlled PBP (78±9 vs. 80.7) and those with controlled CBP (78±9 vs.81±7) (p=0.02). SEVR was within the desirable range in 92 patients (92.2%). 78.4% of individuals were taking drugs acting on the renin angiotensin aldosterone system (RAAS). CONCLUSIONS In a convenience sample of 92 patients, PBP and CBP were controlled in 59.8% and 57.6%, respectively. Those with controlled PBP had significantly better peripheral systolic and diastolic blood pressure, CBP, pPP and cPP; the same was true of those with controlled CBP, who also had a significantly better AI. The percentage of the cardiac cycle in diastole had a desirable value for 92,2% of the subjects.

Characteristics Associated with Uncontrolled Blood Pressure Among Portuguese Primary Care Patients with Type 2 Diabetes

INTRODUCTION Determine whether socio-demographic, habits and risk factors are associated with a better tensional control in type 2 diabetes in primary care patients in order to identify a specific target population for compensatory interventions improving diabetes control and reducing its morbi-mortality. MATERIAL AND METHODS Cross-sectional study in primary care. Randomized type 2 diabetes patient data collection by their volunteer family doctors, proportionally stratified from the 5 Portuguese continental regions. VARIABLES blood pressure, age, gender, education, diabetes duration, HbA1c, smoking habits, weight, waist circumference, physical activity and adherence to medication. Bivariate and logistic regression analysis to evaluate each measured variables independent association with uncontrolled blood pressure (≥ 140/90). RESULTS 709 patients were included in the study, 60.2% men, mean age 66.12 ± 10.47 years. In logistic regression analysis, the factors independently associated to uncontrolled BP were lower education (p = 0.014), shorter diabetes duration (p = 0.002), higher waist circumference (p < 0.001), higher pulse pressure (p < 0.001), higher physical activity level (p = 0.043) and being a smoker (p < 0.001). DISCUSSION The main limitations are the fact that the sample was not totaly random and included only primary care patients, a possible inter-observer bias and being a cross-sectional study, thus not providing information on temporal relation or causality. CONCLUSION The sub-group of people with diabetes identified to have worse tensional control should have a different and more intensive approach in primary care. We recommend further longitudinal and population based confirmatory research.