Vânia Rocha

The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis:

Introduction Cardiac surgery is an aggressive procedure, inducing a great level of stress and disturbance to the homeostasis of the organism and underlying several postoperative complications. Surgical prehabilitation comprises pre-operative physical conditioning designed to improve the physiological and functional capacities of the individual, prepare the organism for surgical stress and reduce the risk of postoperative morbidity. Aim This systematic review and meta-analysis is aimed at evaluating the ability of prehabilitation to prevent post-surgical complications in cardiac patients. Methods We selected studies conducted among patients who were waiting for non-urgent cardiac surgical procedures, where a comparison between prehabilitation and standard treatment was made. A total of 3650 possible studies were researched, of which eight were selected for inclusion. Results A reduction in the number of complications in the groups submitted to prehabilitation (odds ratiou2009=u20090.41; 95% confidence interval (CI): 0.28–0.62; pu2009<u20090.001; I2u2009=u20090%) was observed, as well as a significant increase in maximal inspiratory pressure (standard mean difference (SMD)u2009=u20090.66; 95% CI: 0.35–0.96; pu2009<u20090.001; I2u2009=u200958%), a non-significant decrease in the length of stay (SMDu2009=u2009–0.56; 95% CI: −1.13, 0.01; pu2009=u20090.05; I2u2009=u200993%), a non-significant increase in the distance walked by the intervention group in the six-minute walk test (SMDu2009=u20090.89; 95% CI −0.06, 1.84; pu2009=u20090.07) and a lack of effect on mechanical ventilation time (SMDu2009=u2009−0.03; 95% CI: −0.22, 0.16; pu2009=u20090.75; I2u2009=u20090%). Conclusion Prehabilitation reduces the number of post-surgical complications and increases maximal inspiratory pressure; a reduction in the length of stay and an improvement of functional capacities are also probable.

Validation of the Glover-Nilsson Smoking Behavioral Questionnaire for the Portuguese population: a psychometric process.

OBJECTIVEnTo validate the Portuguese version of the Glover-Nilsson Smoking Behavioral Questionnaire (GNSBQ).nnnMETHODSnThis manuscript represents 2 studies. In the first, the free-translated Portuguese version of GNSBQ, currently in use, was administered to 124 healthy smokers for Confirmatory Factor Analysis (CFA). In the second, a forward-backward translation was developed to achieve a proper cultural and linguistic adaptation, which allowed creating a new Portuguese version of the GNSBQ. An Exploratory Factor Analysis (EFA) was then performed, including 120 healthy smokers who completed this new version.nnnRESULTSnIn the first study, the results from performing a CFA were not acceptable, although the scale was internally consistent. The second study showed that the new Portuguese version of GNSBQ presented reliability and 2 cor-related factors retrieved from the EFA.nnnCONCLUSIONnThe new Portuguese version of the second study will contribute to an improved assessment of behavioral dependence in that population.

Motivation to Quit Smoking after Acute Coronary Syndrome

INTRODUCTIONnSelf-Determination Theory explores the process through which a person acquires motivation to initiate new behavioursxa0related to health and to maintain them over time. This study aimed to determine the overall fit of Self-Determination Theory Modelxa0for Health Behavior to the data obtained from a sample of smokers hospitalized with acute coronary syndrome, and to identify thexa0predictors of smoking status six months after clinical discharge.nnnMATERIAL AND METHODSnThe sample included 110 participants, regular smokers, hospitalized due to acute coronary syndrome.xa0Questionnaires were administered to assess autonomous self-regulation, perceived competence, family support, depressive symptomsxa0and meaning in life. Participants were asked if they were currently smokers six months after clinical discharge.nnnRESULTSnThe results showed that the process variables specified by Self-Determination Theory fit the data well. Perceived competencexa0predicted abstinence from smoking six months after clinical discharge.nnnDISCUSSIONnOur findings have similar characteristics to other international samples in which Self-Determination Theory models havebeen tested. It is important to facilitate perceived competence, as the patients who continue to smoke have shorter length of life.nnnCONCLUSIONnThis study highlights the importance of considering clinical interventions based on Self-Determination Theory to facilitatesmoking cessation.

Prevalence of secondhand smoke exposure in asthmatic children at home and in the car: A cross-sectional study.

OBJECTIVEnTo compare secondhand smoke exposure (SHSe) prevalence at home and inside the car between asthmatic and non-asthmatic Portuguese children.nnnMATERIALS AND METHODSnThis is a cross-sectional study that assessed childrens SHSe in a representative sample of nine Portuguese cities. A validated self-reported questionnaire was administered to a random sample of 4th grade students during the school year of 2010/2011. The asthma prevalence was defined by the answers to three questions regarding asthma symptoms, medication and inhaler use. We performed chi-square tests and analysed frequencies, contingency tables, confidence intervals, and odd-ratios.nnnRESULTSnThe self-reported questionnaire was administered to 3187 students. Asthma prevalence was 14.8% (472 students). Results showed that 32.3% of non-asthmatic children and 32.4% of asthmatic children were exposed to secondhand smoke as at least one of their household members smoked at home. The prevalence of parental smoking, smoking among fathers and smoking among mothers at home was also similar in both groups (asthmatic and non-asthmatic children). SHSe inside the car was 18.6% among non-asthmatic children and 17.9% among asthmatic children.nnnCONCLUSIONSnAsthmatic and non-asthmatic children were equally exposed to secondhand smoke, because no significant differences were found between the two groups concerning the prevalence of SHSe at home and inside the car. These findings highlight the need to include SHSe brief advice in paediatric asthma management.

Dependência tabágica, assertividade e alexitimia em doentes cardíacos

Smoking is a major cause of preventable death, which greatly increases the risk of suffering a myocardial infarction. This cardiac event is associated with certain psychosocial variables which have been related to smoking, such as alexithymia and non assertiveness. The general purpose of this study is to evaluate both types of tobacco dependence (physiological and behavioural), assertiveness and alexithymia, as well as the relation established between them in 30 male patients hospitalized with myocardial infarction. The Fagerstrom Test, the Glover-Nilsson Questionnaire, the Rathus Assertiveness Schedule and TAS-20 were used. The results point out that alexithymia is related with behavioural dependence and assertiveness, which suggest that cigarette smoking is used by the subjects as a coping mechanism, due to their difficulties in expressing emotions assertively, regulating negative affects and dealing properly with stressful events. Social skills and emotional regulation should be emphasized in psychological interventions for smoking cessation with cardiac patientsO tabagismo e uma das principais causas evitaveis de morte, aumentando acentuadamente o risco de infarto do miocardio. Este ultimo esta associado a certas variaveis psicossociais relacionadas com o tabagismo, nomeadamente a alexitimia e a falta de assertividade. O objetivo do presente artigo foi caracterizar os dois tipos de dependencia tabagica (fisiologica e comportamental), a assertividade e a alexitimia, e avaliar a relacao das variaveis entre si, em 30 doentes homens internados com infarto. Foram aplicados o Teste de Fagerstrom, o Questionario de Glover-Nilsson, a Escala de Rathus e a TAS-20. Os resultados indicam que a alexitimia encontra-se relacionada com a dependencia comportamental e com a assertividade, sugerindo que os sujeitos menos assertivos e com dificuldade em gerir afetos negativos e situacoes de estresse, podem recorrer ao tabagismo como mecanismo de enfrentamento. Nas intervencoes voltadas a interrupcao do habito de fumar em doentes infartados deve-se enfatizar as competencias sociais e de regulacao emocional.

Smoking Abstinence Twelve Months after an Acute Coronary Syndrome

Studies on the cognitive working mechanism of smoking cessation in high-risk populations are few and much needed, and identifying long-term psychosocial factors to smoking cessation are relevant to improve intervention for cardiac patient groups. This longitudinal study followed patients who smoked and suffered an acute coronary syndrome from hospitalization to 12 months after clinical discharge. Questionnaires were administered to assess nicotine dependence, behavioral dependence, autonomous self-regulation, perceived competence, social support, anxiety, depressive symptoms and meaning in life at baseline, six months and twelve months after clinical discharge. The results showed that anxiety (F(2, 62) = 28.10, p < .001, η p 2 = .48) and depressive symptoms (F(2, 62) = 10.42, p < .001, η p 2 = .25) decreased over time, whereas meaning in life (F(2, 61) = 44.77, p < .001, η p 2 = .59) and social support increased (t(63) = -4.54, p < .001, 95% IC[-11.05, 4.29], η2 =.25). Smoking dependence was negatively predicted by change in perceived competence (B = -2.25, p = .011, 95% IC[.02, .60]) and positively by change in depressive symptoms (B =.37, p = .042, 95% IC[1.01, 2.05]) 12 months after clinical discharge. Nicotine dependence (t(17) = 2.76, p = .014, 95% IC[.39, 2.94], η2 =.31) and the number of cigarettes smoked per day (t(17) = 4.48, p < .001, 95% IC[5.49, 15.29], η2 =.54) decreased over time, whereas behavioral dependence increased among smokers (t(17) = -2.37, p = .030, 95% IC[-4.30, 2.54], η2 =.25). This study suggests that long term abstinence in cardiac patients may be enhanced by psychological interventions addressing perceived competence, depressive symptoms and behavioral dependence.

Traffic risk behaviour: an observational study of drivers’ behaviour in Braga (Portugal)

Traffic accidents are a serious public health problem which causes a high number of deaths and injuries. In Portugal, 32,299 traffic accidents involving victims (accidents involving at least one injured person), 554 accidents involving deaths and 2148 accidents involving severe injuries occurred in 2016.1 The use of cell phones and tobacco consumption cause traffic accidents, whose consequences are aggravated if passengers fail to use seat belts.2 Using a cell phone while driving (whether it is used with or without a hands-free system) causes visual, auditive, physical and cognitive distraction. Tobacco consumption negatively affects the health of the driver and the other passengers in the vehicle (particularly children) by the high concentrations of tobacco smoke inside the car, and it is also a distracting factor that compromises driving.3 Several studies have shown that using a seat belt is associated to a drastic reduction on the number of accidents and injuries. Many traffic accidents could be avoided by modifying these behaviors. The present study aimed to describe drivers’ risk behaviors in the city of Braga (Portugal), namely the use of cell phone, tobacco consumption and failure to use seat belts while driving. This is an observational study conducted between December 2016 and January 2017 which followed the validated methodology of Martínez-Sánchez et al.4 The observers registered the behavior of the first five drivers who stopped at a red light traffic in Avenida João XXI, Avenida 31 de Janeiro, Rua da Estrada Nova, and EN 103 (Braga, Portugal). Motorcycles, mopeds and non-motor vehicles were excluded from the study. The observation focused on the use of cell phones, tobacco consumption (lit cigarettes), and failure to use seat belts by the driver of the vehicle. Descriptive analysis was performed. Among the 705 conductors observed, 70 (9.8%) used a cell phone, 50 (7.1%) did not use a seat belt, and 39 (5.5%) smoked while driving. There is still a significant percentage of drivers who adopt risk behaviors while driving. Greater police attention is needed to prevent non-compliance with the law regarding the use of cell phones and driving without seat belts. However, it still does not exist a ban on smoking inside the cars in Portugal. Car smoking bans should be similar to other restrictions on drivers’ behavior that are critical for public health and safety, such as the driving ban under the influence of alcohol or other drugs. Studies show that over 90% of respondents agree with a car smoking ban, especially with children on board.5 Creating campaigns to highlight the importance of banning tobacco consumption inside the car would be useful, not only to increase awareness about the negative effects of smoking on the driver’s health and on the road traffic safety, but also as a way to collect signatures to present this ban at the Portuguese Parliament.

Tobacco dependence, assertiveness and alexithymia in cardiac patients

Smoking is a major cause of preventable death, which greatly increases the risk of suffering a myocardial infarction. This cardiac event is associated with certain psychosocial variables which have been related to smoking, such as alexithymia and non assertiveness. The general purpose of this study is to evaluate both types of tobacco dependence (physiological and behavioural), assertiveness and alexithymia, as well as the relation established between them in 30 male patients hospitalized with myocardial infarction. The Fagerstrom Test, the Glover-Nilsson Questionnaire, the Rathus Assertiveness Schedule and TAS-20 were used. The results point out that alexithymia is related with behavioural dependence and assertiveness, which suggest that cigarette smoking is used by the subjects as a coping mechanism, due to their difficulties in expressing emotions assertively, regulating negative affects and dealing properly with stressful events. Social skills and emotional regulation should be emphasized in psychological interventions for smoking cessation with cardiac patientsO tabagismo e uma das principais causas evitaveis de morte, aumentando acentuadamente o risco de infarto do miocardio. Este ultimo esta associado a certas variaveis psicossociais relacionadas com o tabagismo, nomeadamente a alexitimia e a falta de assertividade. O objetivo do presente artigo foi caracterizar os dois tipos de dependencia tabagica (fisiologica e comportamental), a assertividade e a alexitimia, e avaliar a relacao das variaveis entre si, em 30 doentes homens internados com infarto. Foram aplicados o Teste de Fagerstrom, o Questionario de Glover-Nilsson, a Escala de Rathus e a TAS-20. Os resultados indicam que a alexitimia encontra-se relacionada com a dependencia comportamental e com a assertividade, sugerindo que os sujeitos menos assertivos e com dificuldade em gerir afetos negativos e situacoes de estresse, podem recorrer ao tabagismo como mecanismo de enfrentamento. Nas intervencoes voltadas a interrupcao do habito de fumar em doentes infartados deve-se enfatizar as competencias sociais e de regulacao emocional.

Tabaquismo, asertividad y alexitimia en pacientes cardíacos

Smoking is a major cause of preventable death, which greatly increases the risk of suffering a myocardial infarction. This cardiac event is associated with certain psychosocial variables which have been related to smoking, such as alexithymia and non assertiveness. The general purpose of this study is to evaluate both types of tobacco dependence (physiological and behavioural), assertiveness and alexithymia, as well as the relation established between them in 30 male patients hospitalized with myocardial infarction. The Fagerstrom Test, the Glover-Nilsson Questionnaire, the Rathus Assertiveness Schedule and TAS-20 were used. The results point out that alexithymia is related with behavioural dependence and assertiveness, which suggest that cigarette smoking is used by the subjects as a coping mechanism, due to their difficulties in expressing emotions assertively, regulating negative affects and dealing properly with stressful events. Social skills and emotional regulation should be emphasized in psychological interventions for smoking cessation with cardiac patientsO tabagismo e uma das principais causas evitaveis de morte, aumentando acentuadamente o risco de infarto do miocardio. Este ultimo esta associado a certas variaveis psicossociais relacionadas com o tabagismo, nomeadamente a alexitimia e a falta de assertividade. O objetivo do presente artigo foi caracterizar os dois tipos de dependencia tabagica (fisiologica e comportamental), a assertividade e a alexitimia, e avaliar a relacao das variaveis entre si, em 30 doentes homens internados com infarto. Foram aplicados o Teste de Fagerstrom, o Questionario de Glover-Nilsson, a Escala de Rathus e a TAS-20. Os resultados indicam que a alexitimia encontra-se relacionada com a dependencia comportamental e com a assertividade, sugerindo que os sujeitos menos assertivos e com dificuldade em gerir afetos negativos e situacoes de estresse, podem recorrer ao tabagismo como mecanismo de enfrentamento. Nas intervencoes voltadas a interrupcao do habito de fumar em doentes infartados deve-se enfatizar as competencias sociais e de regulacao emocional.