Wartezeiten von durchschnittlich mehreren Monaten sind auch nach Inkrafttreten des Psychotherapeutengesetzes in der deutschen Psychotherapieversorgung die Regel. Behandlungsbedürftige Störungen, für die ein Behandlungswunsch besteht, unversorgt zu lassen, ist weder unter ethischen, noch praktischen und therapeutischen Gesichtspunkten vertretbar. Aus diesem Grund schlagen viele Praktiker ihren wartenden Patienten niedrigschwellige Selbsthilfeangebote vor, die von psychoedukativen Informationen über Bibliotherapie bis zu Gruppenangeboten reichen. Die vorliegende Arbeit gibt einen Überblick über verschiedene Möglichkeiten, wartende Psychotherapiepatienten gut auf die bevorstehende Therapie vorzubereiten und während der Wartezeit zugleich sekundäre Prävention zu betreiben. Hierbei muss nach unserer Einschätzung vor allem die Maxime gelten, dass die vorgeschlagenen Maßnahmen mit dem Rational der darauf folgenden Therapie vereinbar sein sollten. / Even after the new psychotherapy law has been implemented, waiting times of several months remain rather common in the German mental health care system. For ethical, practical, and therapeutic reasons, however, patients who are in serious need of treatment should not be left unattended. Many practitioners therefore suggest self-help treatments such as psychoeducational information, bibliotherapy, or supportive groups to their waiting patients. The present study provides an overview on possibilities of preparing waiting psychotherapy patients for their upcoming therapy as well as implementing secondary prevention during the waiting time. As a basic, we suggest that the proposed methods should be in line with the treatment rationale of the subsequent therapy. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Bakgrund: Det finns evidens för att fysisk aktivitet har en positiv inverkan påsåväl fysisk som psykisk hälsa. Kranskärlssjukdom, som är den dominerande dödsorsaken i Sverige, karakteriseras av åderförkalkning och är direkt förenat med osunda levnadsvanor, däribland fysisk inaktivitet. En ökad fysisk aktivitet hos denna patientgrupp kan minska risken för återinsjuknande eller ytterligare eskalation i sjukdomsförloppet. Deltagande i hjärtrehabiliteringsprogram är lågt trots underlag för den fysiska aktivitetens hälsosamma fördelar. Sjuksköterskor har för uppgift att främja god hälsa och de skulle kunna bidra mer till preventionsarbetet i sitt dagliga arbete. Syfte: Studiens syfte var att undersöka erfarenheter av fysisk aktivitet ur kranskärlssjuka patienters perspektiv. Metod: En litteraturstudie med kvalitativ ansats där resultatet baserades på tio vetenskapliga studier som analyserades utefter fem steg i en analysprocess av kvalitativ forskning. Resultat: Två teman och åtta subteman identifierades. Detförsta temat var motiverande faktorer med subteman; egenansvar, socialt stöd samt individanpassat stöd. Det andra temat var hindrande faktorer med subteman; tillgänglighet, känslor samt kunskapsbrist. Slutsats: Patienter är i behov av kontinuerlig individanpassad rådgivning och vägledning för att främja åtagande av fysisk aktivitet vid kranskärlssjukdom. Sjukvårdspersonal behöver arbeta strukturerat och personcentrerat för att bidra till en trygg och säker vård. Sjuksköterskor träffar mest patienter i sitt dagliga arbete och är särskilt lämpliga att främja fysisk aktivitet som sekundärpreventiv åtgärd. / Background: There is evidence to show that physical activity has a positive effect on both physical and psychological health. Coronary heart disease, which is the dominating cause of death in Sweden, is characterized by arteriosclerosis and is directly connected to unhealthy living habits, such as physical inactivity. Increased physical activity amongst this group of patients could decrease the risk of recurrence or escalation of the disease. Participation in heart rehabilitation programs are low, despite evidence of the health benefits linked to physical activity. A nurse's task is to promote health and they could do more within the preventative workfield. Aim: The aim of this study was to explore patients with coronary heart disease and their experiences of physical activity. Method: A literature review based on ten scientific studies, analyzed according to a five step analysis process of qualitative research. Results: Two main themes and eight sub themes were identified. The first main theme was motivating factors with the sub themes; personal responsibility, social support and individually tailored support.The second theme was hindering factors with the sub themes; accessibility, emotions and lack of knowledge. Conclusion: Patients are in need of continuous and individualized counseling and guidance in order to commit to physical activity. Healthcare workers need to have a structured and person-centered approach to provide safe healthcare. Nurses encounter the most patients throughout their daily work and are particularly suitable to promote physical activity as a secondary prevention.

Dans un contexte de prévention secondaire, les interventions motivationnelles brèves (IMB) effectuées par les infirmières ont le potentiel de réduire les facteurs de risque cardiovasculaires. De par sa flexibilité, la formation en ligne s’impose aujourd’hui comme une méthode pédagogique essentielle au développement des habiletés cliniques des professionnels de la santé. Le but de ce projet était d’évaluer la faisabilité, l’acceptabilité et l’effet préliminaire d’une plateforme de formation en ligne sur les IMB (MOTIV@CŒUR) sur les habiletés perçues et l’utilisation clinique des IMB chez des infirmières en soins cardiovasculaires. Pour ce faire, une étude pilote pré-post à groupe unique a été menée. MOTIV@CŒUR est composée de deux sessions d’une durée totale de 50 minutes incluant des vidéos d’interactions infirmière-patient. Dans chaque session, une introduction théorique aux IMB est suivie de situations cliniques dans lesquelles une infirmière évalue la motivation à changer et intervient selon les principes des IMB. Les situations ciblent le tabagisme, la non-adhérence au traitement médicamenteux, la sédentarité et une alimentation riche en gras et en sel. Il était suggéré aux infirmières de compléter les deux sessions de formation en ligne en moins de 20 jours. Les données sur la faisabilité, l'acceptabilité et les effets préliminaires (habiletés perçues et utilisation clinique auto-rapportée des IMB) ont été recueillies à 30 jours (± 5 jours) après la première session. Nous avons recruté 27 femmes et 4 hommes (âge moyen 37 ans ± 9) en mars 2016. Vingt-quatre des 31 participants (77%) ont terminé les deux sessions de formation en moins de 20 jours. À un mois suite à l’entrée dans l’étude, 28 des 31 participants avaient complété au moins une session. Un haut niveau d’acceptabilité a été observé vu les scores élevés quant à la qualité de l'information, la facilité d'utilisation perçue et la qualité de la plateforme MOTIV@CŒUR. Le score d'utilisation clinique auto-rapporté des interventions visant la confiance était plus élevé après les deux sessions qu’avant les sessions (P = .032). Bien que tous les scores fussent plus élevés après les deux sessions qu’au début, les autres résultats n’étaient pas statistiquement significatifs. En conclusion, l’implantation d’une plateforme de formation en ligne sur les IMB est à la fois faisable et acceptable auprès d’infirmières en soins aigus cardiovasculaires. De plus, une telle formation peut avoir un effet positif sur l'utilisation clinique d’interventions motivationnelles visant la confiance face au changement de comportement de santé. / Nursing interventions that target motivation to adopt healthy behaviors, such as brief motivational interviewing (MI), can help reduce cardiovascular risk factors. While face-to-face MI training lacks accessibility, e-learning use for MI training is promising because of the flexibility it offers. The objective was to assess the feasibility, acceptability and preliminary effect of a web-based e-learning platform for brief MI (MOTIV@CŒUR) on cardiovascular nurses’ clinical use and perceived skill in brief MI. A single group pre-post pilot study was conducted to evaluate MOTIV@CŒUR with nurses working in a coronary care unit. The web-based e-learning platform consists of two sessions with a total duration of 50 minutes based on videos of nurse-patient interactions. In each session, a theoretical introduction of brief MI is followed by role playing based on real life clinical situations in which a nurse practitioner evaluates patients’ motivation to change, and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity and diet. Nurses were asked to complete both training sessions online within 20 days. Data on feasibility, acceptability and preliminary effects (perceived skills in brief MI and self-reported clinical use of conviction and confidence interventions) were collected at 30 days (± 5 days) following the first session. We enrolled 27 women and 4 men (mean age 37 ± 9) in March 2016. Twenty-four out of 31 participants (77%) completed both sessions in less than 20 days, and at one month, 28 had completed at least one session. The training was found highly acceptable, with information quality, perceived ease of use, and system quality scoring the highest. The score of self-reported clinical use of confidence interventions was higher after the two sessions than before the sessions (P = .032). While all scores increased from baseline, other results were not statistically significant. In conclusion, the implementation of a web-based e-learning platform for brief MI is both feasible and acceptable among cardiovascular care nurses. Moreover, it can have a positive effect on self-reported clinical use of confidence interventions towards health behaviour change.

Introdução: As avaliações econômicas completas do tipo custo-utilidade, suportadas por dados de efetividade do mundo real, permitem uma perspectiva diferenciada da avaliação de tecnologia em saúde. Objetivo: Realizar uma análise de custo-utilidade do uso de estatinas para a prevenção secundária de eventos cardiovasculares em portadores de doença cardiovascular isquêmica, e avaliar a variabilidade da efetividade e da razão de custo-efetividade incremental com diferentes classificações de usuários de estatina (incidentes e prevalentes). Método: Um modelo de microssimulação de Markov com 5 estados, ciclos anuais e horizonte temporal de 20 anos, com taxas de desconto de 5% foi desenvolvido. As probabilidades de transição para mortalidade por todas as causas foram extraídas após pareamento por escore de propensão dos dados e tratamento de dados ausentes de uma base secundária de registro assistencial com linkage determinístico com a base de mortalidade do Ministério da Saúde. As probabilidades dos desfechos não-fatais foram obtidas na literatura. As medidas de efetividade (QALY) foram calculadas com dados publicados dos domínios do SF-36 de um estudo realizado com a população do mesmo hospital, no mesmo período e com as mesmas condições clínicas e transformados em medidas de utilidade por modelo validado. Somente custos diretos na perspectiva do reembolso do SUS foram considerados. Resultados: 3.150 pacientes foram pareados após o escore de propensão, 1.050 não usuários de estatina, 1.050 usuários de estatinas classificados como prevalentes e 1.050 usuários de estatinas classificados como incidentes, com diagnóstico de doença cardiovascular isquêmica prévia, com seguimento médio de 5,1 anos. A efetividade das estatinas quando considerados todos os usuários em relação aos não usuários resultou em um HR para mortalidade de 0,992 (IC 95% 0,85; 0,96) e de 0,90 (IC 95% 0,85; 0,96) para os usuários incidentes. A RCEI comparando todos os usuários de estatinas versus não usuários foi de R$5.846,10/QALY e de R$7.275,61/QALY para os usuários incidentes. Conclusão: As estatinas diminuíram a mortalidade por todas as causas, e a análise incluindo usuários prevalentes diminui o tamanho do efeito. O tratamento possui custo-efetividade favorável dentro do limiar de disponibilidade a pagar definido, sendo modificado pela forma de extração do dado de efetividade / Background: The complete economic evaluations, such as cost-utility analysis, supported by real world data of effectiveness lead to a more realistic perspective of a health technology assessment. Objective: Perform a cost-utility analysis of statins for secondary prevention in ischemic cardiovascular disease patients based on effectiveness from real world data and evaluate the variability of effectiveness and incremental cost-effectiveness ratio (ICER) considering prevalent and incident users. Methods: A Markov microssimulation model with five states, annual cycle and time horizon (TH) of 20 years, with discount rate of 5% was developed. Transition probabilities for all cause mortality was derived from a secondary database of a teaching hospital after record linkage with national registry of mortality database and an analysis of propensity score matching and multiple imputation analysis for missing data. Non-fatal endpoints were derived from a published meta-analysis. Utility measures was calculated with a validated model to derive values from published domains of SF-36 QoL questionnaire, domains was measured for a published RCT in the same teaching hospital, over the same period, with similar age and diagnostic characteristics. Only direct costs were analyzed from the Brazilian public health reimbursement perspective. Results: 3150 patients were matched, 1050 non-statins users (CG), 1050 prevalent statins users (PSU) and 1050 incident statins users (ISU) with previous cardiovascular disease, with mean follow-up of 5,1 years. Treatment effects on the treatment group considering all statins users for all cause mortality had a hazard ratio of HR:0,992 (IC 95% 0,85 - 0,96) and HR: 0,90 (IC 95% 0,85 - 0,96) only for ISU. The ICER comparing all users with non-users was R$5.846,10 per QALY and for ISU was R$7.275,61 per QALY. Conclusion: Real world evidence demonstrated that statins are an effective treatment to reduce all cause mortality in secondary prevention and are a cost-effective strategy considering the willingness to pay established, but the prevalent users resulted in less effectiveness of the drug when included in the analysis and influenced the ICER

Introdução: O aumento das taxas de incidência e mortalidade por câncer colorretal (CCR) no Brasil pode ter sido consequência do processo de transição socioeconômica do país, com maior exposição aos fatores de risco. No entanto, fatores como o desconhecimento a respeito das estratégias de prevenção primária e secundária podem ter contribuído para o aumento do impacto da doença. Objetivos: Avaliar o grau de conhecimento a respeito do CCR em pacientes do Sistema Único de Saúde (SUS) e alunos da Faculdade de Medicina de Ribeirão Preto (FMRP) e caracterizar a realidade do programa de rastreamento no município de Ribeirão Preto. Métodos: Trata-se de um estudo transversal, onde se aplicou um questionário próprio, elaborado a partir de um caso clínico contendo sinais de alarme do CCR a fim de investigar o conhecimento sobre a doença. Foram entrevistados 1000 pacientes do SUS de Ribeirão Preto e 134 alunos da FMRP, no período de janeiro de 2015 a março de 2016. Resultados: Comparados aos alunos, os pacientes entrevistados apresentaram menor capacidade de diagnosticar o CCR (8% x 94,8%; p< 0,001). Notou-se, ainda, diferença no número médio de fatores de risco do CCR (0,76±1,3 x 4,18±1,72; p < 0,001) e no número médio de exames complementares para o diagnóstico do CCR (0,1±0,3x 2,5±1,12; p < 0,001) citados pelos pacientes e alunos. Apenas 3,7% dos entrevistados conseguiram identificar o coloproctologista como responsável pelo tratamento do caso. A análise multivariada mostrou que, no grupo de pacientes, idade >= 50 anos, sexo feminino, história familiar prévia de CCR e nível de escolaridade mais elevado foram variáveis independentes associadas a um maior grau de conhecimento a respeito da doença. Na amostra de pacientes com idade >= 50 anos, apenas 11,1% havia realizado algum teste de rastreamento e apenas 0,2% havia recebido informações prévias sobre a doença. Conclusões: O nível de conhecimento a respeito do diagnóstico, fatores de risco e métodos complementares de prevenção do CCR foi baixo entre os pacientes e adequado no grupo de alunos. Idade maior ou igual a 50 anos, sexo feminino, história familiar prévia de CCR e nível de escolaridade elevado foram fatores associados a um maior grau de conhecimento sobre a doença. Observou-se baixa taxa de realização de exames de rastreamento para o CCR. / Introduction: The increasing burden of colorectal cancer (CRC) in Brazil may be a consequence of the socio-economic transition with higher exposure to risk factors. In addition, low levels of CRC awareness and lack of a screening program may have been responsible for the high CRC incidence and mortality rates in Ribeirão Preto. Objectives: (1) to evaluate CRC awareness among patients from the Unified Health System and medical students from Ribeirao Preto Medical School, and (2) to investigate screening practices in the city. Methods: We conducted face-to-face interviews with a questionnaire prepared by the authors, from January 2015 to March 2016. A total of 1000 users and 134 medical students were interviewed. Results: Compared to medical students, the ability to diagnose CRC was lower among patients (8% x 94.8%; p< 0.001). Patients identified lower mean number of risk factors (0.76±1.3 x 4.18±1.72; p< 0.001) and screening methods (0.1±0.3 x 2.5±1.12; p< 0.001). Thirty-seven subjects (3.7%) identified the proctologists as the most appropriate specialist to treat CCR. On a multivariate analysis, age >= 50 years old, sex (female), family history of CCR and higher education levels were significantly associated with increased CRC awareness. Four hundred and seven patients were considered eligible to CRC screening; however, only 11.1% had already performed any method. Only 0.2% of the patients had been previously exposed to any kind of information about CRC. Conclusions: CRC awareness was very low among Health System users and adequate among medical students. Age >= 50 years old, sex (female), family history of CCR and higher education levels were independent predictors of increased knowledge among patients. Low rates of screening were observed in the city.

Introdução. A doença isquêmica coronariana (DIC) ainda é a principal causa de morte no mundo. A sua prevenção secundária é essencial, uma vez que reduz novos eventos cardiovasculares e mortalidade, e pode ser influenciada por diversos fatores, incluindo sociodemográficos. Objetivo. Avaliar a prevenção secundária da doença isquêmica coronariana na linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) (2008-2010). Métodos. Os dados foram analisados pelos testes: Kolmogorov-Smirnov, qui-quadrado, análise de variância (ANOVA), Mann-Whitney e regressão logística, conforme necessário. Resultados. Dos 15.094 participantes, 2,7% reportaram diagnóstico prévio de DIC. Destes, 16,3% não utilizavam qualquer medicamento recomendado pelas diretrizes, 22,7% relataram utilizar a combinação de antiplaquetário, betabloqueador, antagonista do sistema renina-angiotensina e hipolipemiante, e 12,1% a combinação de antiplaquetário, betabloqueador e hipolipemiante. Os principais fatores associados ao uso de medicamento foram renda [Razão de Chances (RC) = 2,041 Intervalo de Confiança de 95% (IC95%)1,07 a 3,89] e sexo (RC = 0,517 IC95% 0,31 a 0,85). A frequência de uso dos medicamentos se manteve semelhante conforme o tempo desde o evento isquêmico coronariano, exceto para o uso de apenas um medicamento, que foi aumentando conforme o tempo. Conclusão. A prevenção secundária foi menor do que o recomendado pelas diretrizes, principalmente em mulheres e participantes com menor renda, indicando uma necessidade de melhores políticas públicas que visam a prevenção secundária de DIC / Introduction. Coronary heart disease (CHD) remains the main cause of mortality worldwide. Secondary prevention of CHD is necessary and avoids new cardiovascular events and mortality. Several factors, including sociodemographic characteristics, contribute positively or negatively to secondary prevention. Objective. To evaluate secondary prevention of CHD in the baseline examination of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods. Kolmogorov-Smirnov test, chi-squared test, one-way analysis of variance (ANOVA), Mann-Whitney test and logistic regression models were performed, as necessary. Results. Of the 15,094 participants included, 2.7% reported previous diagnosis of CHD. Not using any drug was reported by 16.3% of participants with CHD and the use of recommended drugs were reported by 22.7% for the combination of four classes and 12.1% for the combination of antiplatelet medication, beta-blocker and lipid lowering. The main characteristics associated with medication use was income [Odds Ratio (OR) = 2.041; 95% Confidence Interval (95%CI) 1.07 to 3.89] and sex (OR = 0.517; CI95% 0.31 to 0.85). Frequency of medication use was similar among time since CHD event, except for the use of just one drug that increased over time. Conclusion. Use of secondary prevention for CHD was below the recommended guidelines, especially in women and participants with lower income, suggesting the need of public health policies addressing secondary prevention of CHD, especially in these high-risk groups

Intervenção nutricional educativa em pacientes submetidos à angioplastia transluminal coronária: ensaio clínico randomizado [Tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2016. INTRODUÇÃO: Mudanças no estilo de vida são estimuladas na prevenção primária e secundária da doença arterial coronária. A educação para promoção de saúde requer uma atividade capaz de problematizar a realidade do indivíduo e capacitá-lo para escolhas conscientes. Considerando os aspectos pluridimensionais da alimentação e a dificuldade de mudanças no comportamento alimentar, o objetivo deste estudo foi analisar a efetividade de uma intervenção nutricional educativa em pacientes submetidos à angioplastia transluminal coronária (ATC) quanto à mortalidade e recorrência de eventos como infarto agudo do miocárdio (IAM), revascularização cirúrgica do miocárdio (RM) ou nova ATC em até um ano de acompanhamento. Os objetivos secundários incluíram consumo alimentar; medidas antropométricas e bioquímicas; estágios de mudança do comportamento alimentar e a ocorrência de eventos cardiovasculares em até quatro anos de seguimento, além de uma análise qualitativa dos fatores socioculturais e atitudinais que influenciaram as práticas alimentares dessa população. MÉTODOS: Foi realizado um ensaio clínico controlado, randomizado e pragmático, com duração de um ano, relativo aos cuidados clínico-nutricionais nos grupos controle e intervenção, sendo neste adicionadas oficinas educativas de nutrição com abordagem construtivista. O ensaio foi complementado com um estudo de coorte para observar eventos cardiovasculares em até quatro anos. Foram alocados 200 pacientes, sendo 101 no grupo intervenção. Ao final do primeiro ano e depois de quatro anos, foram calculadas a redução do risco absoluto e o risco relativo como medidas de incidência cumulativa, respectivamente. RESULTADOS: Ao final de um ano de seguimento, nos grupos intervenção e controle, respectivamente, houve cinco e sete óbitos (p = 0,53); cinco e seis IAM (p = 0,73); quatro e seis re-ATC (p = 0,50); e quatro e quatro RMs (p = 0,98). Após quatro anos, os RR entre os grupos de intervenção e controle foram 0,75 (IC95% 0,35-1,58) para óbito; 0,89 (IC95% 0,34-2,28) para IAM; 0,86 (IC95% 0,40-1,84) para re-ATC e 1,14 (IC95% 0,38-3,40) para RM. Quanto à ingestão alimentar, observou-se redução de gordura saturada (p=0,04) e aumento de fibras (p=0,03) e potássio (p=0,01) no grupo intervenção comparado ao controle. As medidas antropométricas e bioquímicas não apresentaram diferença entre os grupos. A análise estratificada mostrou um efeito protetor para a circunferência da cintura nos subgrupos de idosos [-2.6 cm (IC95% -4,7; -0.6)] e até quatro anos de estudo [-2.5 cm (IC95% -4,9; -0,1)], com interação entre eles (p=0,02). Quanto à mudança de comportamento, houve um aumento no número de indivíduos nos estágios de ação/manutenção de 2,2 vezes (IC95%1,0;5,2) no grupo intervenção, porém sem diferença entre os grupos. Foram identificados fatores socioculturais relacionados ao prazer, hábito, cultura e medo, bem como fatores atitudinais como mudanças declaradas, ambivalência e resistência que permearam as práticas alimentares independente do estágio de mudança, além do conhecimento adquirido, explícito ou ausente. CONCLUSÕES: A intervenção educativa pareceu vantajosa, embora a amostra não tenha sido suficiente para ser conclusiva quanto à ocorrência de eventos cardiovasculares. Houve redução de gordura saturada e aumento no consumo de fibras e potássio, porém sem melhora nas medidas antropométricas e bioquímicas, exceto um menor acúmulo de gordura abdominal em idosos e sujeitos com baixa escolaridade. Há de se fortalecer o debate dos aspectos culturais que constituem o espaço social alimentar e repensar a orientação valorizando as mudanças positivas e escolhas alimentares dentro de um contexto de padrão alimentar saudável / INTRODUCTION: Changes in lifestyle are encouraged in primary and secondary prevention of coronary artery disease. The education for health promotion requires an activity capable of problematizing the individual\'s reality and enabling him to make conscious choices. Considering the multidimensional aspects of feeding and the difficulty of changes in eating behavior, the objective of this study was to analyze the effectiveness of a nutrition education intervention program on mortality and recurrence of events as acute myocardial infarction (AMI), revascularization with re-percutaneous coronary intervention (re-PCI), or coronary artery bypass graft (CABG) surgery after one year of follow-up in patients who previously underwent elective PCI. The secondary objectives included food consumption, anthropometric and biochemical parameters, stages of dietary change, and recurrence of cardiovascular events after four years of follow-up, besides a qualitative analysis of the cultural and attitudinal factors that influenced the dietary practices of this population. METHODS: A controlled, randomized, and pragmatic clinical trial was performed during one-year, related to the clinical and nutritional care in the control and intervention groups, and nutrition education workshops that adopted a constructivist approach were additionally applied to the intervention group. The trial was complemented with a cohort study to observe cardiovascular events up to four years of follow-up. Two hundred patients were allocated, 101 in the intervention group. The absolute risk reduction and the risk ratio were calculated as measures of the cumulative incidence after one and four years, respectively. RESULTS: After one year of follow-up, in the intervention and control groups, respectively, there were five and seven deaths (p=0,53); five and six AMIs (p=0,73); four and six re-PCIs (p=0,50); and four and four CABGs (p=0,98). After four years, the risk ratios between intervention and control groups were 0,75 (95%CI 0,35-1,58) for death, 0.89 (95%CI 0,34-2,28) for AMI, 0,86 (95%CI 0,40-1,84) for re-PCI, and 1,14 (95%CI 0,38-3,40) for CABG. Regarding food consumption, a decrease in saturated fat (p = 0.04) and increase in fiber (p = 0.03) and potassium (p = 0.01) intakes were observed in the intervention group compared to the control group. Anthropometric and biochemical measurements did not show any difference between groups. The stratified analysis showed a protective effect for waist circumference in the elderly [-2.6 cm (95%CI-4,7; -0,6)] and individuals up to four years of study [-2.5 cm (95%CI -4,9 ;-0,1)] subgroups, with interaction between them (p = 0,02). Regarding the change in dietary behaviour, there was an increase in the number of individuals in the action/maintenance stages of 2.2 times (95%CI 1,0; 5,2) in the intervention group, but with no difference between the groups. Factors related to pleasure, habit, culture and fear were identified, as well as attitudinal factors such as stated changes, ambivalence and resistance that permeated eating practices regardless of the stage of change, as well as acquired, explicit or absent knowledge. CONCLUSION: The educational intervention seemed advantageous, although the sample was not enough to be conclusive about the occurrence of cardiovascular events. There was a reduction in saturated fat and an increase in fiber and potassium consumption, but there was no improvement in anthropometric and biochemical measurements, except for a lower accumulation of abdominal fat in the elderly and subjects with low schooling. There is a need to strengthen the debate on the cultural aspects that constitute the food social space and rethink the orientation by valuing positive changes and food choices within a healthy eating pattern

Submitted by William Justo Figueiro (williamjf) on 2015-07-06T22:12:30Z No. of bitstreams: 1 02a.pdf: 469334 bytes, checksum: d1ee27d63e3def5d073e04e680f2b027 (MD5) / Made available in DSpace on 2015-07-06T22:12:30Z (GMT). No. of bitstreams: 1 02a.pdf: 469334 bytes, checksum: d1ee27d63e3def5d073e04e680f2b027 (MD5) Previous issue date: 2013 / Nenhuma / Verificou-se a prevalência do uso de medicamentos recomendados na prevenção secundária da síndrome coronariana aguda na alta hospitalar e seguimentos de seis meses e de um ano. Utilizaram-se dados de estudo de coorte no qual se incluíram pacientes de 30 anos ou mais, de ambos os sexos, egressos de hospital da região sul do Brasil. Os desfechos foram o uso dos medicamentos recomendados para prevenção secundária: antiagregante plaquetário, betabloqueador, estatina e inibidor da enzima conversora de angiotensina ou bloqueador do receptor de angiotensina; e uso de bloqueio antiplaquetário duplo. Entre as 138 pessoas incluídas, 36,2% receberam os quatro medicamentos na alta, e 64,5% usaram bloqueio antiplaquetário. Na análise não se verificou associação entre exposições e o uso dos quatro medicamentos. Quanto ao uso de bloqueio antiplaquetário verificou-se diminuição nos seguimentos, porém ele foi mais frequente nos indivíduos que realizaram intervenção coronária percutânea. A prevalência de uso dos medicamentos na alta e nos seguimentos mostrou subutilização desta terapêutica na prática clínica. / We verify the prevalence of medication recommended in secondary prevention of Acute Coronary Syndrome in patient discharge and follow-up of a six months and one year period. We used data from a cohort study which included patients 30 years old or older, of both genders, discharged of hospital in southern Brazil. The outcome was the simultaneous use of drugs recommended by scientific evidence for secondary prevention: antiplatelet agents, beta-blocker, statin and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; and use of dual antiplatelet blockage. Among the 138 people included, 36.2% were prescribed the four drugs at discharge, and 64,5% and dual blockage. In the analysis there was no association between exposure and the use of the four drugs. Regarding the use of antiplatelet blockage there was a decrease in the follow-up, but he was more frequent in subjects who underwent percutaneous coronary intervention. The prevalence of drug use at discharge and follow-up showed underutilization of this therapy in clinical practice.

Pasaulio sveikatos organizacijos duomenimis, širdies ir kraujagyslių ligos yra dažniausia neįgalumo ir ankstyvos mirties priežastis pasaulyje. Modifikuojant rizikos faktorius galima sumažinti klinikinių atvejų bei ankstyvų mirčių skaičių. Prevenciją būtina taikyti žmonėms, kuriems jau diagnozuota koronarinė širdies liga, ir žmonėms, kuriems nustatyta širdies ir kraujagyslių ligų rizika. Darbo tikslas: Koronarine širdies liga persirgusių pacientų sveikatos priežiūros ir slaugos poreikių tyrimas. Darbo uždaviniai: Įvertinti rizikos veiksnius, veikiančius koronarine širdies liga sergančius pacientus, ir nustatyti pacientų žinias apie rizikos veiksnių modifikavimo būtinumą; Ištirti koronarine širdies liga sergančių pacientų biopsichoemocinę būklę; Išanalizuoti koronarine širdies liga sergančių pacientų fizinį aktyvumą; Ištirti pacientų gyvenimo kokybę, susijusią su sveikatos būkle; Pasiūlyti galimus slaugytojo darbo su pacientais metodus, siekiant įgyvendinti širdies ir kraujagyslių ligų susirgimų prevenciją. Medžiaga ir metodika: Tyrimo objektas – koronarine širdies liga sergančių pacientų žinios, sveikatos priežiūros ir slaugos poreikiai. Tyrimo populiacija - 100 pacientų, sergančių koronarine širdies liga. Tyrimo metodas – koronarine širdies liga sergančių pacientų apklausa (interviu) panaudojant standartizuotus klausimynus, ligos istorijų analizė, fizinių paciento duomenų matavimai. Panaudoti klausimynai: Klausimynas, parengtas Europos kardiologų draugijos, skirtas ES šalių... [toliau žr. visą tekstą] / Following the information by the World Health Organization (WHO) CHD is the leading cause of disability and early death all over the world. Modification of risk factors may reduce the number of clinical records and early deaths. Prevention measures need to be taken for individuals with already diagnosed CHD as well as those with risk factors for CHD. Thesis objective: Investigation of healthcare and nursing needs of patients after CHD. Thesis tasks: Assessment of risk factors affecting patients suffering from CHD and knowledge possessed by patients suffering from CHD about the need for modification of the risk factors; Examination of biopsychoemotional condition of patients suffering from CHD; Analysis of physical activity of patients suffering from CHD; Examination of health condition–related quality of life of patients suffering from CHD; Suggesting possible methods of nursing staff working with the patients aiming at CHD prevention. Material and methodology: Investigation target: Knowledge possessed by patients suffering from CHD; healthcare and nursing needs. Investigation method: interviewed patients suffering from CHD through applying standardized questionnaires; analysis of case records, measurements of physical data of patients. Questionnaires used: Questionnaire developed by the European Society of Cardiology, aimed to assess the level of knowledge on prophylaxis of CHD EU-wide; HADS Questionnaire – Hospital Anxiety and Depression scale; EUROQOL 5D Questionnaire... [to full text]

Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the industrialised world, and places a heavy burden on society in terms of personal disability and health care costs. The first signs of CHD often present acutely as a myocardial infarction (AMI), commonly known as a heart attack. Survivors of a heart attack remain vulnerable to poor health-related quality of life (HRQOL), further cardiac events, and increased morbidity due to a progression of CHD. Thus, the implementation of interventions to reduce these risks is an important public health strategy. To date, secondary prevention and rehabilitation efforts post-AMI focus primarily on the patient. However, it is argued that recovery from AMI occurs within a social context, and that risk reduction strategies are likely to be enhanced if interventions take into account the impact of the event on the quality of life of patients and their partners. Evidence from a review of couple relationship literature indicates that a significant proportion of couples experiences poor HRQOL (i.e., physical and emotional wellbeing) when coping with stressful life events, and that interactive aspects of a couple relationship (i.e., dyadic functioning and behaviour) are associated with individual well-being at such a time. Information from studies of couples dealing with recovery from heart attack is sparse, but tends to reflect the findings from the broader literature. Further research is required with post-AMI couples, though, as there are a number of shortcomings associated with the existing evidence. For instance, it is derived from studies conducted with, mostly small, samples of convenience; many different instruments are used to collect the data; and no studies specifically measure HRQOL. Analytically, most evidence is obtained with univariate and bivariate statistics, and data are analysed as groups of patients or partners, as opposed to dyads. Where multivariable analyses are undertaken a number of bivariate relationships are no longer significant after accounting for covariates such as age and gender; and few researchers investigate predictive associations between dyadic functioning/behaviour and HRQOL outcomes. Finally, there is a paucity of information from comparative analyses. Thus, it is not known whether the well-being of post-AMI couples over time is better than, similar to, or worse than, for example, that in the general population. The research program underpinning this thesis, the QUT-AMI Project, comprised two studies designed to address these methodological issues. The first was an observational, cross-sectional, pilot study conducted in 1998 with 26 post-AMI couples. The main investigation was a prospective cohort study of 93 post-AMI couples undertaken in 1999-2000. In both studies the samples comprised a consecutive series of adult males younger than 75 years who had experienced a first AMI, and their female partners. The average couple in both studies was middle-aged, had been married for many years, and both members of the dyad were working at the time of the heart attack. Prospective participants were identified in major clinical centres that admit cardiac patients, and couples were recruited to the project soon after the patient's heart attack. Clinical data were collected in hospital. Further data were collected with self-administered questionnaires during a home visit at 1 month (pilot and main study), and by mailed questionnaire or during a home visit at 6 months(main study) after the heart attack. The pilot study was undertaken to test recruitment and data collection procedures in preparation for the second (main) study, measure couples' HRQOL at 1 month after the event using the SF-36, and qualitatively investigate life issues for couples coping with recovery from AMI. In the main study couples' HRQOL outcomes were measured at 1 and 6 months post-AMI using the SF-36, and examined for changes over that time. The outcomes were also compared with those from matched population norms to estimate the impact of a heart attack on couples' HRQOL during the early and later recovery period. Additionally, the following relationships were investigated to determine the extent to which:* patients' dyadic functioning (e.g. happiness/satisfaction with relationship, measured with the Marital Adjustment Scale) and use of dyadic behaviour (e.g., hiding concerns and negative feelings from the other member of the dyad, measured with the Protective Buffering Scale) at 1 month predicted patients' emotional well-being at 6 months post-AMI;* partners' dyadic functioning and behaviour at 1 month predicted partners' emotional well-being at 6 months post-AMI;* patients' and partners' dyadic functioning at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI; and* patients' and partners' dyadic behaviour at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI. Exploratory analyses were also undertaken to determine the effect of dyadic discrepancies in functioning and behaviour, at 1 month after the heart attack, on patients' and partners' emotional well-being at 6 months after the event. Important findings were as follows:* At 1 month after an AMI the HRQOL of couples is impaired. The major impact is on physical well-being for patients, and emotional well-being for their partners.* In general, couples' HRQOL improves between 1 and 6 months after an AMI.* At 6 months after an AMI, the HRQOL of average couples is similar to that of their peers in the normal population.* There are subgroup variations in the quality of life of post-AMI couples, and these are associated with age, clinically poor physical health, and depression.* The combination of patients' and partners' use of dyadic behaviour at 1 month after an AMI explains 7% of the variation in patients' emotional well-being at 6months after the event, after adjustment for patients' concurrent physical wellbeing and prior levels of emotional well-being, as well as duration of couple relationships.* The combination of partners' perceptions of dyadic functioning and use of dyadic behaviour at 1 month after an AMI explains 5% of the variation in partners' emotional well-being at 6 months after the event, after adjustment for partners' concurrent physical well-being and prior levels of emotional well-being, as well as duration of couples' relationships.* Patients have poorer emotional well-being at 6 months after an AMI if partners use dyadic behaviour infrequently at 1 month after the event.* Partners have poorer emotional well-being at 6 months after an AMI if they are not satisfied/unhappy with the functioning of their relationships at 1 month after the event. Adjusted exploratory analyses, undertaken to determine the extent to which dyadic discrepancies in perceptions of functioning or use of protective buffering behaviour, predict emotional well-being, show that patients who are less satisfied/unhappier with functioning than their partners at 1 month after an AMI have poor emotional wellbeing at 6 months after the event; patients who use the behaviour more frequently than their partners at 1 month after an AMI have poor emotional well-being at 6months after the event; and partners who are less satisfied/unhappier with functioning than their patients at 1 month after an AMI have poor emotional well-being at 6months after the event. The evidence from the QUT-AMI Project supports the proposition that the interaction that occurs within a couple relationship, combined with individual characteristics of members of a dyad, influences the extent to which a heart attack impacts on couples' HRQOL. It is argued that it is not enough to merely focus on implementing secondary prevention strategies with post-AMI patients. Given that poor emotional well-being is known to predict adverse cardiac events, and premature mortality due to cardiac disease, it is recommended that a couple-focused intervention designed to meet specific needs should be implemented with at-risk couples as a public health strategy to improve not only the patients' quality of life but also that of his partner. Further research is recommended to determine the extent to which such an intervention improves post-AMI couples' quality of life.