Rationale: Cigarette cravings are one of the most important clinical phenomena in tobacco addiction. A wide range of studies and research designs may help to increase understanding of the relationship between physical activity (PA) and cigarette cravings. Aims: (i) To investigate the acute effects of walking and isometric exercise on cigarette cravings, withdrawal, and attentional bias among temporarily abstaining smokers. (ii) To quantify the effects of short bouts of PA on cigarette cravings among temporarily abstaining smokers. (iii) To examine who most benefits from PA, whether changes in affect mediate these effects, and whether a specific attribute of PA is associated with cravings. (iv) To investigate whether any association between habitual PA and cravings in smokers could be found. Methods: A randomised controlled crossover trial with three arms addressed aim (i). A systematic review of literature and individual participant data meta-analysis using hierarchical modelling addressed aims (ii) and (iii). Aim (iv) was achieved by using linear regression modelling of cross-sectional data from a smoking cessation study. Results: No difference in cravings, withdrawal, and attentional bias between walking and isometric exercise versus control was found. Bouts of PA decreased cigarette cravings by approximately 30%. Moderate intensity PA provided increased benefit when compared with light intensity, whereas vigorous intensity did not confer additional benefits compared with moderate intensity PA. Also bouts of medium (10 minutes) and longer duration (≥15minutes) appeared to be more effective than short duration (≤ 5 min). No moderators and mediators of this association were identified. Habitual moderate intensity PA was the strongest predictor of cigarette cravings in smokers, MPSS was an additional predictor and alcohol consumption moderated the effects of habitual PA on cravings. Conclusion: Moderate intensity PA could be recommended to smokers to help decrease cigarette cravings.

<b>Background</b>: Evidence-based policy making (EBPM) has become an article of faith. While critiques have begun to emerge, they are predominately based on theory or opinion. This thesis uses the 2008 case study of tobacco control policy making for Indigenous Australians to analyse empirically the concept of EBPM. <b>Research questions</b>: (1) How, if at all, did the Government use evidence in Indigenous tobacco control policy making? (2) What were the facilitators of and barriers to the use of evidence? (3) Does the case study augment or challenge the apparent inviolability of EBPM? <b>Methods</b>: Data were collected through: (1) a review of primary documents largely obtained under the Freedom of Information Act 1982; and (2) interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates and academics. <b>Results</b>: Historically, Indigenous smoking was not problematised because Indigenous people faced other urgent health/social problems and smoking was considered a coping mechanism. High prevalence data acquired salience in 2007/08 in the context of a campaign to reduce disparities between Indigenous and non-Indigenous health outcomes. Ensuing policy proposals were based on recommendations from literature reviews, but evidence contained in those reviews was weak; notwithstanding this, the proposals were adopted. Historical experiences led policy makers to give special weight to proposals supported by Indigenous stakeholders. Moreover, the perceived urgency of the problem was cited to justify a trial-and-evaluate approach. <b>Conclusion</b>: While the policies were not based on quality evidence, their formulation/adoption was neither irrational nor reckless. Rather, the process was a justifiable response to a pressing problem affecting a population for which barriers existed to data collection, and historical experiences meant that evidence was not the only determinant of policy success. The thesis proposes a more nuanced appraoch to conceptualising EBPM wherein evidence is neither a necessary nor a sufficient condition for policy. The approach recognises that rigorous evidence is always desirable but that, where circumstances affect the ability of such research being conducted, consideration must be given to acting on the basis of other knowledge (e.g. expert opinion, small-scale studies). Such an approach is justifiable where: (1) inaction is likely to lead to new/continued harm; and (2) there is little/no prospect of the intervention causing additional harm. Under this approach, non-evidentiary considerations (e.g. community acceptability) must be taken into account.

The aim of this dissertation is to examine the content and communicative strategies in texts used in a project on tobacco policy delegated by the Swedish government to the National Institute of Public Health (“The National Tobacco Assignment 2008–2010”). The study uses communicative strategies as an umbrella term for the way the texts fulfil the political assignment through adaptation to suit different receivers in a discursive practice with set guidelines for communication between experts and users, and how these strategies are visible in the studied texts. The material consists of six guides for care personnel and ten brochures for smokers. The study is a text-focused critical discourse analysis combining methodological tools from different linguistic traditions. These are chiefly taken from critical text linguistics, new rhetoric, and sociosemiotics. The main question posed in the study is how the public authority’s assignment to influence people through the texts is combined with ideas about smokers’ empowerment. The investigation problematizes how the content and form of the texts relates to the authority’s assignment to exert influence, and to motivational interviewing as a discursive practice with an empowerment perspective on lifestyle changes. The analyses show that controlling ideas and notions about smokers’ empowerment exist in parallel in the government texts about smoking cessation. Controlling elements are most prominent in the sections of the guides about groups who, in the encounter with care personnel, do not show any interest or desire to quit smoking. In the studied brochures the controlling elements are most prominent in those aimed at operation ­patients, adolescents, and parents-to-be. Both groups of material – the guides and the brochures – nevertheless give the impression of being designed to be compatible with a patient-cent­red discursive practice. This is noticeable, for example, in the occurrence of associative and dissociative argumentation strategies which legitimize or tone down controlling elements.

Background: Cigarette smoking is a leading preventable factor associated with complications in pregnancy including preterm birth and low birthweight. Past interventions have raised cessation rates by approximately 6% overall (Lumley et al. 2009). Methods: A three-part literature review, two qualitative studies with a total of 36 participants, and the development of an intervention to promote smoking cessation during pregnancy were completed. Central to the design of the research was the creation of the theoretical basis which was developed in line with recommendations from the MRC Framework for Complex Interventions (Craig et al. 2008, Campbell et al. 2000). For part one of the literature review, 24 qualitative and 44 quantitative studies were re-analysed to complete a mixed-methods secondary analysis of the active ingredients in interventions to promote smoking cessation during pregnancy. Part two consisted of an exploration of psychological models and constructs which are likely to predict or influence smoking behaviour during pregnancy. The final part was a discussion regarding the modes of delivery by which an intervention could feasibly be delivered. Qualitative interviews were carried out with participants from stakeholder groups to fill in gaps in literature and determine the acceptability and feasibility of the proposed intervention. The intervention was created using the theoretical basis developed from the findings. Further qualitative interviews, a focus group, and heuristic evaluation were used to determine the acceptability and usability of the intervention for the target group of pregnant smokers. Results and Conclusions: Findings from this work are potentially relevant for a wide range of behaviours and behavioural interventions. An intervention which has a strong grounding in theory and evidence, and is acceptable and feasible for the target group and in clinical practice was developed using evidence gathered in this thesis.

Realizou-se estudo exploratório de revisão bibliográfica sistemática e metassíntese visando descrever e analisar aspectos das práticas educativas em saúde, voltados ao desenvolvimento de habilidades para a cessação do tabagismo, traduzidas na interpretação de autores de pesquisas qualitativas publicadas em periódicos entre 2000 e 2007. Concebeu-se a questão do tabagismo como um problema de enfrentamento complexo, que demanda intervenções em vários âmbitos. Destacou-se a educação em saúde, como campo estratégico e instrumental da promoção da saúde, que sob a perspectiva do \"empowerment\" e \"empowerment education\", é passível de atuação do profissional de saúde. Utilizando-se do instrumental metodológico da metassíntese qualitativa, descrito por Sandelowski e Barroso (2003), identificou-se a produção científica de pesquisas qualitativas originais sobre experiências relativas às práticas educativas na cessação do tabagismo, indexadas nas bases de dados eletrônicas MEDLINE, CINAHL e LILACS. Para tanto utilizou-se os descritores pesquisa qualitativa, educação em saúde e tabagismo, além de descritores de texto livre e palavras com truncamento, visando a identificação ampliada de artigos que pudessem ser relevantes. Mapeou-se os artigos selecionados para a amostra bibliográfica segundo suas características gerais, aplicando-se os critérios de qualidade, dados pelo instrumento \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002). Os resultados desta produção foram integrados através da análise de conteúdo descrita por Minayo (2004), de modo a buscar temas relacionados à educação em saúde, aos quais foram combinados atributos (ou sub-temas). A busca bibliográfica resultou na identificação de 989 citações nessa temática, das quais 634 foram consideradas relevantes. Após seleção com base na leitura do título, a seguir dos abstracts (340) e por fim dos artigos na íntegra (88), foram classificadas 14 publicações como pertinentes para este estudo. Na metassíntese os aspectos recorrentes e as diferenças entre os artigos foram agrupados em duas modalidades temáticas: contexto dos sujeitos (descrevendo os fatores facilitadores e dificultadores do processo de cessação do tabagismo) e abordagem educativa (com processos facilitadores e dificultadores dos programas de cessação do tabagismo e da relação profissional-paciente apresentados em quadro temático, com comentários). As estratégias de abordagem do processo educativo foram classificadas com base nos elementos da promoção da saúde e nos modelos educacionais. Conclui-se que a metassíntese apresenta-se como metodologia relevante no âmbito da enfermagem (que tem vasta produção de pesquisa qualitativa), pois favorece análises e interpretações com potencial de proporcionar visibilidade e impacto no processo de cuidar e ser cuidado, fornecendo elementos para tomada de decisão. A compreensão sobre temas relacionados às abordagens educativas em saúde, nos processos de cessação do tabagismo, e o seu significado para os pacientes foi ampliada / An explorative systematic bibliographic review and meta-synthesis was realized looking to describe and analyze aspects of the educational practices in health, directed to the development of abilities for the smoking cessation, translated through the interpretation of the authors of the qualitative researches published in journals from 2000 to 2007. The smoking question was identified as a complex approach problem, which requires interventions from various aspects. Health education was emphasized, which under the perspective of the empowerment and empowerment education, is liable to the performance of the health professional. Using the qualitative meta-synthesis instrumental method described by Sandelowski and Barroso (2003), it was possible to identify a scientific production of primary qualitative researches about educational practices in the smoking cessation, indexed in MEDLINE, CINAHL and LILACS databasis. For this was used qualitative research controlled vocabulary, health education and smoking, besides the free texts and words with truncation, looking to increase the identification of the studies that may be relevant. The selected studies were identified according to its general characteristics, having been applied quality criterias supplied by the \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002) instrument. The results of this production were integrated through the analysis of content described by Minayo (2004), in order to look for themes related to health education, of which had attributes (sub-themes) combined to them. The bibliographic research resulted in the identification of 989 citations about this theme, where 634 were considered relevant. After the selection based on the title of the studie, following the abstracts (340) and finally of the reading of 88 complete studies, 14 publications were classified as being pertinent to this study. In the meta-synthesis the reoccurring aspects and the differences between the studies were separated in two types of themes: context of the subjects (describing the facilitating and difficulting facts of the smoking cessation process) and education approach (with facilitating and difficulting processes of the smoking cessation programs and of the patient-professional relationship presented in a theme board, with comments). The strategies used in the educational processes were classified based on the elements of the health promotion and on educational models. We conclude that the meta-synthesis presents itself as a relevant methodology in nursing environment (which provides vast qualitative research productions), because it helps in analysis and interpretations with the potential of facilitating visibility and impact in the process of taking care and being taken care of, supplying elements for decision making. The comprehension about themes related to health educational approaches, in the smoking cessation processes, and its meaning to patients, has been increased

Made available in DSpace on 2016-08-10T10:29:46Z (GMT). No. of bitstreams: 1 VALQUIRIA LUZIA DE CASTRO.pdf: 16657284 bytes, checksum: 1a01a269f0ffa3172c86e8ea2baba363 (MD5) Previous issue date: 2010-06-30 / The bupropion hydrochloride is an antidepressant pharmacological used in treatment of smoking cessation; the drug increases the interstitial concentrations of dopamine, reducing the smoking habit. The objective was the achievement of physical and chemical tests of the tablets of bupropion hydrochloride, of a laboratory acquired in similar ethical and commercial pharmacies in Imperatriz city, the drug being used in the Smoking Cessation Program of the Ministry of Health, Brazil. Were evaluated twelve lots of tablets of bupropion hydrochloride and observed the conditions of air conditioning in commercial pharmacies using a digital thermometer of Sper Scient brand. The raw materials of bupropion hydrochloride was used as a reference standard, purchased at a masterful pharmacy and subjected to laboratory tests in Quality Control of Faculdade de Imperatriz. The temperature verification at pharmacies where the tablets were purchased ranged from 37 ° C to 40 ° C, which is above the specification of boxes of medicine, whose guidelines: keep the temperature between 15°C to 30°C, which can cause instability pharmaceuticals. When weighing values were observed within the variation limits allowed. The friability showed no variations. The disintegration occurred at the scheduled time of 45 minutes. The twelve lots subject to durometer to resistance verification were higher than 3 Kgf, it is possible to change the nature of the excipients. There was no significant dissolution of the samples showing a concentration of 0.95 &#956;g / ml, less than 80% of predicted value. The content of the active principle, analyzed by non aqueous titration, samples were taken by present concentration of between 90% and 110% as stated in the American Pharmacopoeia. Pharmaceutical equivalence between the similar medicine and the ethical medicine becomes related that both possess the same fármaco, and similar results evaluated in vitro. One concludes that the process of dissolution and hardness can have been affected significantly for the peculiar characteristics to the proper fármaco, as well as for the presence of excipientes that had made it difficult the same dissolution or for the employed techniques of manufacture. Also suggesting an analysis in the process of production inside of the quality control in the Pharmaceutical Industry verifying the processes of validation for attainment of planned results. / O Cloridrato de bupropiona é um fármaco antidepressivo utilizado no tratamento na cessação do tabagismo, o fármaco aumenta as concentrações intersticiais de dopamina, diminuindo a saciedade do fumo. O objetivo deste trabalho foi a realização dos ensaios físicos e químicos dos comprimidos do Cloridrato de Bupropiona, de um laboratório ético e similar adquiridos nas farmácias comerciais na cidade de Imperatriz, sendo o fármaco empregado no Programa da Cessação do Tabagismo pelo Ministério da Saúde, Brasil. Foram avaliados doze lotes dos comprimidos do Cloridrato de Bupropiona e observadas as condições de climatização nas farmácias comerciais utilizando um termômetro digital da marca Sper Scient. Utilizou-se como padrão de referência a matéria prima, adquirida em uma farmácia magistral e submetida aos testes realizados no laboratório de Controle de Qualidade da Faculdade de Imperatriz. A verificação da temperatura nas farmácias onde os comprimidos foram adquiridos variava de 37°C a 40°C, estando acima das especificações das caixas do medicamento, cujas orientações: manter a temperatura entre 15°C a 30°C, o que pode causar instabilidade nos fármacos. Na pesagem foram observados valores dentro dos limites de variações permitidos. A friabilidade não apresentou variações. A desintegração ocorreu no tempo previsto de 45 minutos. Os doze lotes submetidos ao durômetro para verificação da resistência foram superiores a 3 Kgf, sendo possível a variação pela natureza dos excipientes. Não houve dissolução significativa das amostras analisadas apresentando uma concentração de 0,95 &#956;g/ml, inferior a 80% do valor previsto. O teor do princípio ativo, analisado por titulação em meio não aquoso, as amostras foram aprovadas por apresentarem concentração situada entre 90% e 110% como consta a Farmacopéia Americana. A equivalência farmacêutica entre o medicamento similar e o medicamento ético relaciona-se que ambos possuem o mesmo fármaco, e resultados semelhantes avaliados in vitro. Conclui-se que o processo de dissolução e dureza pode ter sido afetado significativamente pelas características peculiares ao próprio fármaco, bem como pela presença de excipientes que dificultaram a dissolução ou mesmo pelas técnicas de fabricação empregadas. Sugerindo também uma análise no processo de produção dentro do controle de qualidade na Indústria Farmacêutica verificando os processos de validação para obtenção de resultados planejados.

Introdução: O tabagismo é um problema crônico e de enfrentamento complexo. A ampliação da legislação, a conscientização da sociedade e a menor aceitação social do tabagismo, aumentaram a procura por serviços de cessação do tabagismo. A avaliação de programas desse tipo é tarefa complexa, considerando os diferentes níveis de intervenção, a diversidade de cenários e atores envolvidos. A avaliação de programas de cessação do tabagismo necessita incorporar ferramentas participativas, capazes de apontar a eficiência do programa, além de fomentar ações de transformação das práticas. Esta pesquisa buscou configurar uma matriz avaliativa capaz de contribuir na organização e autoaprendizagem de serviços dirigidos aos sujeitos em suas tentativas de parar de fumar, captando os diferentes contextos presentes na intervenção, nos cenários e nos atores. As questões da pesquisa foram: Quais são os indicadores que podem apontar o quanto um serviço se aproxima ou se distancia das práticas baseadas em evidências e dos modelos e diretrizes da promoção da saúde? Quais são os elementos que indicam ou não a qualidade de um serviço de tratamento do tabagismo? Objetivos: Desenvolver a matriz de indicadores de um serviço de tratamento do tabagismo. Para tanto buscou-se a) Identificar a percepção de experts, usuários e profissionais sobre serviços de tratamento do tabagismo; b) Caracterizar as práticas e bases de um serviço de cessação do tabagismo; c) Construir o modelo lógico avaliativo desse serviço; c) Formular as bases teóricas e práticas para a construção de matriz avaliativa de indicadores para um serviço de tratamento do tabagismo. Método: Situado no desenho orientado por modelo teórico (theory-driven evaluation) na perspectiva da Promoção da Saúde preconizada por Hartz, o percurso metodológico foi apoiado nas abordagens qualitativas e participativas e na estratégia da pesquisa-ação. O cenário de estudo foi o serviço de cessação do tabagismo de um hospital universitário, no município de São Paulo. Foram sujeitos dessa pesquisa profissionais de referência para o PNCT (experts), profissionais que atuam diretamente no serviço (implicados) e usuários do serviço. A análise e discussão dos achados apoiaram-se na triangulação de dados, correlacionada com a literatura. Resultados: O desfecho desta pesquisa foi o desenvolvimento da matriz avaliativa. Utilizou-se as percepções dos experts, implicados e usuários sobre as dimensões de estrutura, processo e resultado. A legislação, o financiamento, extensão e cobertura, a acessibilidade, as instalações, os recursos humanos, os equipamentos e insumos foram apontados como categorias para estrutura. Na dimensão processo as categorias foram: divulgação e captação, acolhimento e busca ativa, o perfil sócio psicológico dos usuários, a rede de referência e contra referência, o diagnóstico, acompanhamento e as estratégias educativas com base no autocuidado e na redução de danos. No âmbito de resultados os sujeitos pontuaram: a taxa de sucesso na cessação do tabagismo, a regularidade do serviço, a adesão, o respeito à autonomia, a melhora na qualidade de vida e a satisfação do usuário. Conclusão: Conclui-se que a matriz avaliativa construída possui potencial para avaliar a qualidade do serviço e promover o aprendizado institucional e o desenvolvimento pessoal/profissional. Contribui para o movimento de reflexão-ação-reorientação das práticas de cuidado. Ao ampliar a análise para além dos importantes indicadores solicitados pelo Programa Nacional do Controle do Tabagismo, a matriz elaborada dirige-se ao fortalecimento (empowerment) dos envolvidos (profissionais e usuários). Ajuda a estabelecer papéis e responsabilidades na reorientação de aspectos que possam influenciar o desempenho no acesso, acolhida, diagnóstico, tratamento e acompanhamento dos que desejam parar de fumar. / Introduction: Tobacco smoking is a chronic problem and very difficult to face. The improvements in the legislation, the awakening of the society and the smaller social acceptance to tobacco smoking have increased the number of people looking for smoking cessation services. The evaluation of such programs is a complex task, considering the different levels of intervention and the diversity of sceneries and actors involved. The evaluation of smoking cessation programs needs to incorporate participatory tools in order to indicate the program efficiency, and foster transformation actions of the practices. This study sought to configure an evaluation framework capable of contributing to the organization and self-learning of the services addressed to individuals in their attempts to quit smoking by capturing the different contexts present in the intervention sceneries and actors. The research questions were: Which are the indicators that may point out how much a service comes close or is distant from evidence-based practices, guidelines and models of health promotion? Which are the elements that indicate or not the quality of a smoking cessation treatment service? Objective: Developing the indicators framework of a smoking cessation service. For this it was sought to a) identify the experts, users and professionals perceptions about smoking cessation services, b) Characterize the practices and basis for a smoking cessation service c) Build the evaluative logical model of such service c) Formulate the theoretical and practical basis for the construction of an evaluative framework of indicators for a smoking cessation service. Method: Situated in the theoretical model oriented design (theory-driven evaluation) from the perspective of health promotion proposed by Hartz, the methodological trajectory was based on the qualitative and participative approaches as well as in the strategy of the action research. The study setting was the smoking cessation service at a university hospital in São Paulo. The subjects of this study were reference for the NTCP professionals (experts), the professionals who work directly in the service (stakeholders) and service users. The analysis and discussion of the findings were based upon the triangulation of data, correlated with the literature. Results: The outcome of this research was the development of the evaluation framework. It was used the perceptions of experts, and users concerned about the dimensions of structure, process and outcome. The legislation, funding, the extension and coverage, accessibility, facilities, human resources, equipment and supplies were identified for \"structure\". In the dimension \"process\" the categories were: dissemination and uptake, host and active search, the social psychological profile of the users, the network of reference and cross reference, diagnosis, monitoring and educational strategies based on self-care and harm reduction. Within the scope of \"outcomes\" the subjects pointed: the success rate of stop smoking, the regularity of service, treatment adherence, the autonomy, the improvement in quality of life and user satisfaction. Conclusions: We conclude that the evaluative framework constructed has the potential for assessing the service quality and to promote institutional learning and personal / professional development. It contributes to the movement of the reflection-action-reorientation of care practices. By broadening the analysis beyond the important indicators requested by the National Tobacco Control Program, the elaborate framework is targeted to the empowerment of those involved (professionals and patients). It helps to set roles and responsibilities in reorienting the aspects that may influence the access, reception, diagnosis, treatment and monitoring performance of those who want to quit smoking.

Realizou-se estudo exploratório de revisão bibliográfica sistemática e metassíntese visando descrever e analisar aspectos das práticas educativas em saúde, voltados ao desenvolvimento de habilidades para a cessação do tabagismo, traduzidas na interpretação de autores de pesquisas qualitativas publicadas em periódicos entre 2000 e 2007. Concebeu-se a questão do tabagismo como um problema de enfrentamento complexo, que demanda intervenções em vários âmbitos. Destacou-se a educação em saúde, como campo estratégico e instrumental da promoção da saúde, que sob a perspectiva do \"empowerment\" e \"empowerment education\", é passível de atuação do profissional de saúde. Utilizando-se do instrumental metodológico da metassíntese qualitativa, descrito por Sandelowski e Barroso (2003), identificou-se a produção científica de pesquisas qualitativas originais sobre experiências relativas às práticas educativas na cessação do tabagismo, indexadas nas bases de dados eletrônicas MEDLINE, CINAHL e LILACS. Para tanto utilizou-se os descritores pesquisa qualitativa, educação em saúde e tabagismo, além de descritores de texto livre e palavras com truncamento, visando a identificação ampliada de artigos que pudessem ser relevantes. Mapeou-se os artigos selecionados para a amostra bibliográfica segundo suas características gerais, aplicando-se os critérios de qualidade, dados pelo instrumento \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002). Os resultados desta produção foram integrados através da análise de conteúdo descrita por Minayo (2004), de modo a buscar temas relacionados à educação em saúde, aos quais foram combinados atributos (ou sub-temas). A busca bibliográfica resultou na identificação de 989 citações nessa temática, das quais 634 foram consideradas relevantes. Após seleção com base na leitura do título, a seguir dos abstracts (340) e por fim dos artigos na íntegra (88), foram classificadas 14 publicações como pertinentes para este estudo. Na metassíntese os aspectos recorrentes e as diferenças entre os artigos foram agrupados em duas modalidades temáticas: contexto dos sujeitos (descrevendo os fatores facilitadores e dificultadores do processo de cessação do tabagismo) e abordagem educativa (com processos facilitadores e dificultadores dos programas de cessação do tabagismo e da relação profissional-paciente apresentados em quadro temático, com comentários). As estratégias de abordagem do processo educativo foram classificadas com base nos elementos da promoção da saúde e nos modelos educacionais. Conclui-se que a metassíntese apresenta-se como metodologia relevante no âmbito da enfermagem (que tem vasta produção de pesquisa qualitativa), pois favorece análises e interpretações com potencial de proporcionar visibilidade e impacto no processo de cuidar e ser cuidado, fornecendo elementos para tomada de decisão. A compreensão sobre temas relacionados às abordagens educativas em saúde, nos processos de cessação do tabagismo, e o seu significado para os pacientes foi ampliada / An explorative systematic bibliographic review and meta-synthesis was realized looking to describe and analyze aspects of the educational practices in health, directed to the development of abilities for the smoking cessation, translated through the interpretation of the authors of the qualitative researches published in journals from 2000 to 2007. The smoking question was identified as a complex approach problem, which requires interventions from various aspects. Health education was emphasized, which under the perspective of the empowerment and empowerment education, is liable to the performance of the health professional. Using the qualitative meta-synthesis instrumental method described by Sandelowski and Barroso (2003), it was possible to identify a scientific production of primary qualitative researches about educational practices in the smoking cessation, indexed in MEDLINE, CINAHL and LILACS databasis. For this was used qualitative research controlled vocabulary, health education and smoking, besides the free texts and words with truncation, looking to increase the identification of the studies that may be relevant. The selected studies were identified according to its general characteristics, having been applied quality criterias supplied by the \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002) instrument. The results of this production were integrated through the analysis of content described by Minayo (2004), in order to look for themes related to health education, of which had attributes (sub-themes) combined to them. The bibliographic research resulted in the identification of 989 citations about this theme, where 634 were considered relevant. After the selection based on the title of the studie, following the abstracts (340) and finally of the reading of 88 complete studies, 14 publications were classified as being pertinent to this study. In the meta-synthesis the reoccurring aspects and the differences between the studies were separated in two types of themes: context of the subjects (describing the facilitating and difficulting facts of the smoking cessation process) and education approach (with facilitating and difficulting processes of the smoking cessation programs and of the patient-professional relationship presented in a theme board, with comments). The strategies used in the educational processes were classified based on the elements of the health promotion and on educational models. We conclude that the meta-synthesis presents itself as a relevant methodology in nursing environment (which provides vast qualitative research productions), because it helps in analysis and interpretations with the potential of facilitating visibility and impact in the process of taking care and being taken care of, supplying elements for decision making. The comprehension about themes related to health educational approaches, in the smoking cessation processes, and its meaning to patients, has been increased

Objective. Coronary heart disease has been on the rise in poorer countries and decreasing in developed countries over the last twenty years. However, the cardiac-related health-related quality of life (HRQOL) in poorer countries has not been studied. This study aimed to compare HRQOL following heart attack in a developing country in the East with that of a developed country in the West. Using the self-regulation of health and illness behaviour, the relationships between illness beliefs, coping cognitions and HRQOL are studied. Design. This study was a cross-sectional correlational survey and data were collected shortly before myocardial infarction patients were discharged from hospital. Methods. A sample of 243 individuals from the UK and Indonesia were recruited. Illness beliefs were assessed with the B-IPQ, along with coping cognitions (Brief-COPE) and health-related quality of life (MacNew questionnaire). Results. Illness beliefs and coping cognitions predicted HRQOL in the combined sample. Some aspects of socio-demographic and clinical variables were concurrently associated with HRQOL. Conclusion. The results demonstrate that people in the East have low illness beliefs and these are associated with worse HRQOL compared with those in the West. The findings suggest that there is an urgent need for smoking cessation campaigns in the East, while the West could benefit more from tailored-cardiac rehabilitation programme.

Both smoking addiction and illicit substance abuse are prevalent issues in the United States today. Furthermore, these are issues that have significant impact on women’s health and mental state. Despite research that shows that smoking cessation coupled with substance abuse recovery can decrease likelihood of relapse post-recovery, few substance abuse recovery facilities today offer smoking cessation programming options. To address the issue of smoking addiction on top of substance abuse recovery, formative research was conducted through this study to determine the underlying causes of smoking habits coupled with recovery efforts and the attitudes. Through focus group sessions with women in a residential treatment facility in the southeastern US, a determination of the specific audience’s motivations to smoke and perceived self-efficacy to quit smoking was made. Based on the findings of this formative research, a full social marketing plan was then developed to offer an intervention program option for smoking cessation among a target audience of women undergoing residential treatment for substance abuse. The study conducted and the social marketing developed from it proposes a pilot program that may be implemented in other similar settings with similar populations in the future.