Adult's perception of health care after myocardial infarction / Percepción del cuidado a la salud de adultos después del infarto de miocardio / Percepção do cuidado à saúde de adultos após o infarto do miocárdio

ABSTRACT Objectives: to describe the Adult's perception of healthcare after Myocardium Infarction. Methods: qualitative descriptive analysis carried out with 12 adults who had myocardial infarction and conducted from February to May 2018. The research design was based on the "Consolidated Criteria for Reporting Qualitative Research". Data collection was performed through semi-structured questionnaire, interview script and field diary. The interviews were encoded, and their content was analyzed using software support. Results: three classes were obtained: "Fear, (un) certainty and (un) awareness"; "Lifestyle and beliefs of illness" and "Health care search". Unhealthy lifestyle habits, lack of health prevention / promotion, difficulties in accessing services and lack of knowledge about the disease generated fear and uncertainty about the future. Final Considerations: the perception of acute myocardial infarction is related to the trajectory of illness, lifestyle and the belief that the infarction only affects others.

RESUMEN Objetivos: describir las percepciones del cuidado a la salud de adultos después del infarto de miocardio. Métodos: investigación cualitativa descriptiva analítica realizada de febrero a mayo de 2018 con 12 adultos que tuvieron infarto de miocardio. El dibujo ha sido basado en el "Consolidated Criteria for Reporting Qualitative Research". La recogida de datos ha sido realizada mediante cuestionario semiestructurado, guion de entrevista y diario de campo. Las entrevistas han sido codificadas, y su contenido ha sido analizado con auxilio de software. Resultados: se obtuvieron tres clases: "Medo, duda y (des)conocimiento"; "Estilo de vida y creencias de enfermedad" y "Búsqueda por el cuidado de salud". Los hábitos de vida no saludables, la falta de prevención/promoción de la salud, las dificultades de acceso a los servicios y el desconocimiento de la enfermedad generaron medo y duda cuanto al futuro. Consideraciones Finales: la percepción del infarto agudo relacionase con la trayectoria de la enfermedad, estilo de vida y creencia de que el infarto solo acomete al otro.

RESUMO Objetivos: das percepções do cuidado à saúde de adultos após o infarto do miocárdio. Métodos: pesquisa qualitativa descritiva analítica realizada com 12 adultos que tiveram infarto do miocárdio, de fevereiro a maio de 2018. O desenho baseou-se no "Consolidated Criteria for Reporting Qualitative Research". A coleta de dados foi realizada mediante questionário semiestruturado, roteiro de entrevista e diário de campo. As entrevistas foram codificadas, e seu conteúdo foi analisado com auxílio de software. Resultado: obtiveram-se três classes: "Medo, (in)certeza e (des)conhecimento"; "Estilo de vida e crenças do adoecimento" e "Busca pelo cuidado de saúde". Os hábitos de vida não saudáveis, a falta de prevenção/promoção da saúde, as dificuldades de acesso aos serviços e o desconhecimento da doença geraram medo e incerteza quanto ao futuro. Considerações Finais: a percepção do infarto agudo se relaciona com a trajetória do adoecimento, estilo de vida e crença de que o infarto só acomete o outro.

Cross-cultural adaptation of the General Comfort Questionnaire to Brazilian patients with myocardial infarction / Adaptación transcultural del General Comfort Questionnaire para brasileños con infarto de miocardio / Adaptação transcultural do General Comfort Questionnaire para brasileiros com infarto do miocárdio

ABSTRACT Objective: Describe the first stages of the cross-cultural adaptation process of the General Comfort Questionnaire for myocardial infarction patients in intensive care units. Method: This is a study of qualitative and quantitative research and analysis techniques. Conceptual, item, semantic and operational equivalence was performed. Fifteen items were added to the original instrument to better represent the comfort experienced by myocardial infarction patients in intensive care units. The content validity index was applied to analyze the answers of the experts; it was considered adequate above 0.78. Results: Some changes suggested by the experts for better understanding were adopted. All items were kept, obtaining a scale of sixty-three items. In the pre-test conducted with 30 subjects, the instrument was considered adequate to the target audience. Conclusion: The adapted version of the General Comfort Questionnaire for people with myocardial infarction is adequate to the target audience.

RESUMEN Objetivo: Describir las etapas iniciales del proceso de adaptación transcultural del General Comfort Questionnaire para personas con infarto de miocardio internadas en terapia intensiva. Método: Estudio cuyas técnicas de investigación y análisis fueron de naturaleza cualitativa y cuantitativa. Se realizó la equivalencia conceptual, de ítems, semántica y operacional. Quince elementos fueron añadidos al instrumento original para retratar mejor el confort experimentado por personas con infarto en terapia intensiva. Se aplicó el índice de validez de contenido para análisis de las respuestas de los especialistas y fue considerado adecuado por encima de 0,78. Resultados: Algunas alteraciones fueron sugeridas por los expertos para una mejor comprensión, las cuales fueron adoptadas. Todos los ítems fueron mantenidos, obteniéndose una escala con sesenta y tres ítems. En el pre-test, realizado con 30 sujetos, se constató la adecuación del instrumento al público objetivo. Conclusión: El General Comfort Questionnaire para personas con infarto de miocardio es una versión propicia para la aplicación al público objetivo.

RESUMO Objetivo: Descrever as etapas iniciais do processo de adaptação transcultural do General Comfort Questionnaire para pessoas com infarto do miocárdio internadas em terapia intensiva. Método: Estudo cujas técnicas de investigação e análise foram de natureza qualitativa e quantitativa. Realizou-se a equivalência conceitual, de itens, semântica e operacional. Quinze itens foram acrescentados ao instrumento original para retratar melhor o conforto experienciado por pessoas com infarto em terapia intensiva. Aplicou-se o índice de validade de conteúdo para análise das respostas dos especialistas, sendo considerado adequado acima de 0,78. Resultados: Algumas alterações foram sugeridas pelos especialistas para melhor compreensão, as quais foram adotadas. Todos os itens foram mantidos, obtendo-se uma escala com 63 itens. No pré-teste, realizado com 30 sujeitos, constatou-se a adequação do instrumento ao público - alvo. Conclusão: O General Comfort Questionnaire para pessoas com infarto do miocárdio configura-se como uma versão propícia a aplicação ao público alvo.

Adaptação transcultural do Myocardial Infarction Dimensional Assessment Scale (MIDAS) para a língua portuguesa brasileira / Cross-cultural adaptation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS) to the Brazilian Portuguese language

Resumo A partir da avaliação dos fatores que incidem na qualidade de vida (QV) é possível planejar as intervenções que proporcionam melhoria do bem-estar dos pacientes. Realizar a adaptação transcultural do questionário Miocardial Infarction Dimensional Assessment Scale (MIDAS) para língua portuguesa, buscando as equivalências semântica, idiomática, conceitual e cultural. Foi utilizado o referencial teórico de Guillemin, Bombardier e Beaton, cumprindo as seguintes etapas: tradução, retrotradução, avaliação dos autores, banca de juízes e pré-teste. Após todas as avaliações, foram alcançadas as equivalências semântica, conceitual, idiomática e cultural. A escala mostrou-se de fácil aplicação e importância clínica. O MIDAS encontra-se validado no que se refere às equivalências semânticas, idiomáticas, conceituais e culturais. Posteriormente, será avaliada a equivalência de mensuração, para verificar as propriedades psicométricas.

Abstract From the evaluation of the factors that affect quality of life (QOL) it is possible to plan interventions that lead to the improved well-being of patients. The scope of this study was to conduct the cross-cultural adaptation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS) questionnaire to the Portuguese language, seeking the necessary semantic, idiomatic, conceptual and cultural equivalence. The theoretical framework of Guillemin, Bombardier and Beaton was used, fulfilling the following steps: translation, back translation, evaluation of the authors, peer review and pre-testing. After all the tests, the semantic, idiomatic, conceptual and cultural equivalence was achieved. The scale proved to be easy to use and was clinically important. MIDAS was validated in terms of its semantic, idiomatic, conceptual and cultural equivalences. Subsequently, the measurement equivalence will be evaluated to verify the psychometric properties.

Calidad de vida en adultos posinfartados de la unidad cardiovascular del hospital Dr. Hernán Henríquez aravena de temuco / Quality of life in adult postinfarction patients of the coronary unit at Dr. Hernán Henríquez aravena hospital from the city of temuco

RESUMEN Objetivo: Determinar la Calidad de Vida Relacionada con Salud (CVRS) de los pacientes infartados adultos de la Unidad Cardiovascular del Hospital Dr. Hernán Henríquez Aravena de la ciudad de Temuco, Chile. Material y método: Estudio cuantitativo exploratorio transversal retrospectivo. 105 usuarios posinfartados participaron en el estudio, correspondiendo a 72,3% varones y 27,6% mujeres; el 57,1% tenía escolaridad básica completa; el 47,6% un nivel de ingresos inferior a $200.000 y una edad media de 57,3 (DT 2,09). El instrumento utilizado fue el Cuestionario de Salud SF-36. Se aplicó Intervalo de confianza de 95% y pruebas de multicomparación con el método de Bonferroni. Para el análisis de las 8 dimensiones se utilizó la variable edad como covariable para mejorar la predictibilidad de los efectos. Resultados: Se apreció una peor percepción de CVRS en mujeres en los ítems de Función física, Dolor corporal, Salud General, Vitalidad, Función Social y Salud Mental; esto significa una peor evaluación del Dominio físico y mental en estas participantes. Las subescalas mejor evaluadas en varones corresponden a Desempeño emocional, Vitalidad, Función física y Salud mental. Sólo en las escalas Rol Físico Social y Rol Emocional, el factor sexo no generó diferencias estadísticamente significativas. Conclu sión: Al determinar la CVRS en los sujetos del estudio, se puede concluir que existe una percepción mejor en los varones que en las mujeres enroladas en este estudio, tanto en el dominio físico como mental.

ABSTRACT Objective: To determine the Quality of Life Related to Health (HRQL) of the adult infarcted patients of the Cardiovascular Unit at Dr. Hernán Henríquez Aravena Hospital in the city of Temuco, Chile. Material and method: Quantitative retrospective cross-sectional exploratory study. 105 post-infarction users participated in the study, of wich 72.3% were male and 27.6% female; 57.1% of then had completed elementary education; 47.6% had an income of less than $ 200,000 and an average age of 57.3 (DS 2.09). The instrument used was the SF-36 Health Questionnaire. 95% Confidence Interval and multicomparison tests were applied by using the Bonferroni method. For the analysis of the 8 dimensions the age variable was used as a covariate to improve the predictability of the effects. Results: A worse perception of HRQL was observed in women in the Physical Function, Body Pain, General Health, Vitality, Social Function and Mental Health items; this means a worse evaluation of the physical and mental domain in these participants. The best evaluated subscales in males correspond to Emotional Performance, Vitality, Physical Function and Mental Health. Only on the Social Physical Role and Emotional Role scales, the sex factor did not generate statistically significant differences. Conclusion: When determining the HRQL in the study subjects, it can be concluded that there is a better perception by the men than by the women enrolled in this study, both in the physical and mental domain.

Estilos de vida: representações sociais construídas por doentes com infarto do miocárdio e familiares / Estilos de vida: representaciones sociales construidas por los pacientes con infarto de miocardio y familia / Lifestyles: social representations construed by patients with myocardial infarction and family members

RESUMO Objetivo Analisar as representações sociais de estilos de vida construídas por familiares e doentes com diagnóstico de infarto do miocárdio. Método Estudo exploratório e qualitativo sustentado na teoria das representações sociais, com 70 doentes e 70 familiares, de dois hospitais portugueses, um no litoral outro no interior do país, de janeiro a junho de 2015. Foi realizada análise estrutural, com o uso de dois questionários, recorrendo à técnica de Associação Livre de Palavras. Resultados As evocações dos doentes e dos familiares indicaram fraca convergência entre os dois grupos na representação de Estilo de Vida, contudo mostraram a existência de conhecimentos potenciadores de um estilo de vida saudável. Conclusões As categorias Comer e Mudança assumiram consensualidade nos grupos. Para doentes e familiares foi consensual que uma alimentação pouco cuidada representa um estilo de vida prejudicial para a saúde. Ficou também claro que a mudança é fundamental. Tal assunção abre espaço à intervenção dos profissionais de saúde.

RESUMEN Objetivo analizar las representaciones sociales de los estilos de vida construidos por la familia y los pacientes con diagnóstico de infarto agudo de miocardio. Método Estudio cualitativo exploratorio, apoyado en teoría de las representaciones sociales, con 70 pacientes y 70 familiares, de hospitales portugueses, uno en la costa y el otro en el interior del país, de enero a junio el año 2015. Se llevó a cabo el análisis estructural, para eso se utilizaron dos cuestionarios y la técnica de asociación libre de palabras. Resultados Evocaciones de los pacientes y familiares indican débil convergencia entre los dos grupos en representación de Estilos de vida, sin embargo, muestran la existencia de mejorar el conocimiento de un estilo de vida saludable. Conclusión Las categorías de la Alimentación y del Cambio tienen una clara consensualidad en ambos grupos. Para los pacientes y sus familiares existe un consenso de que una dieta poco cuidadosa es un estilo de vida perjudicial para la salud. También está claro que el cambio es fundamental. Esta premisa deja espacio para la intervención de profesionales de la salud.

ABSTRACT Objective The social representations of lifestyles construed by family members and patients diagnosed with myocardial infarction. Method Exploratory qualitative study supported by the theory of social representations, with 70 patients and 70 family members of two Portuguese hospitals, one on the coast and one inland from January to June 2015. Structural analysis was performed using two questionnaires relying on the technique called Free Association of Words. Results The evocations of patients and family members indicated weak convergence between the two groups in representing Lifestyle, yet showed the existence of knowledge that enhances a healthy lifestyle. Conclusions The categories Eat and Change were a consensus among the groups. For patients and family members, it was consensual that a poor diet is a harmful lifestyle for health. It was also clear that change is fundamental. Such an assumption makes room for the intervention of health professionals.

Psychological distress related to smoking cessation in patients with acute myocardial infarction / Sofrimento psicológico relacionado à cessação do tabagismo em pacientes com infarto agudo do miocárdio

Among all causes of preventable deaths, smoking is responsible for the greatest number of deaths worldwide and predisposes to fatal, noncommunicable diseases, especially cardiovascular diseases. Lifestyle changes are effective in the treatment of patients with smoking-related diseases and assist in the prevention of premature mortality. Our objective was to investigate the available scientific evidence regarding the psychological distress related to smoking cessation in patients who have had acute myocardial infarction. To that end, we conducted an integrative review of the literature in order to summarize relevant studies on this topic. The selected databases were Scopus, PubMed Central, Institute for Scientific Information Web of Science (Core Collection), ScienceDirect, EMBASE, SciELO, LILACS e PsycINFO. On the basis of the inclusion and exclusion criteria adopted for this study, 14 articles were selected for analysis. Those studies showed that the prevalence of psychological distress is higher among smokers than among nonsmokers, and distress-related symptoms are much more common in smokers with acute myocardial infarction than in those without. Smoking cessation depends on the active participation of the smoker, whose major motivation is the underlying disease. Most studies have shown that there is a need to create treatment subgroups as a means of improving the treatment provided. This review article expands the knowledge regarding smoking cessation and shows the need to invest in future research that investigates subgroups of smokers diagnosed with the major smoking-related comorbidities, such as acute myocardial infarction, in order to develop specific interventions and psychological support strategies.

O uso de tabaco é responsável pelo maior número de mortes evitáveis no mundo e predispõe seus usuários a doenças não transmissíveis e fatais, especialmente as doenças cardiovasculares. Mudanças no estilo de vida são eficazes no tratamento de pacientes com comorbidades relacionadas ao uso do tabaco e auxilia na prevenção de mortalidade prematura. Nosso objetivo foi analisar as evidências científicas acerca do sofrimento psicológico na cessação do tabagismo envolvendo pacientes que tiveram infarto agudo do miocárdio. Para tanto, realizamos uma revisão integrativa como forma de sumarizar os estudos relevantes sobre esse tema. As bases de dados selecionadas foram Scopus, PubMed Central, Institute for Scientific Information Web of Science (Coleção Principal), ScienceDirect, EMBASE, SciELO, LILACS e PsycINFO. Com base nos critérios de inclusão e exclusão adotados para o estudo, 14 artigos foram selecionados para análise. Esses estudos demonstraram que fumantes têm uma maior prevalência de sofrimento psicológico quando comparado a não fumantes, e os sintomas relacionados são muito frequentes nos fumantes com infarto agudo do miocárdio do que naqueles sem. A cessação do tabagismo depende da participação ativa do fumante, cuja motivação principal é a doença de base. A maioria dos artigos aponta para a necessidade da criação de subgrupos de tratamento como forma de melhorar a assistência prestada. Este estudo de revisão amplia o conhecimento sobre o tema abordado e mostra a necessidade de se investir em pesquisas futuras que analisem subgrupos de fumantes com as principais comorbidades relacionadas ao uso do tabaco, como o infarto agudo do miocárdio, desenvolvendo-se intervenções especificas e estratégias de apoio psicológico.

Facilitators and barriers to the adoption of healthy lifestyles after first myocardial infarction in Chile: a qualitative study / Facilitadores y barreras para la adopción de estilos de vida saludable después de un primer infarto del miocardio en Chile: estudio cualitativo

Factors associated with therapeutic lifestyle change (TLC) after myocardial infarction (MI) have not been fully investigated in Chile. This study aimed to provide a descriptive examination of facilitators and barriers to TLC after first MI. Methods: Qualitative study based on in-depth interviews and focus groups with cardiologists and patients who had first MI one-year±2 months before the begin-ning of the study. Grounded theory research methods were used to guide sampling and coding of data. Results: Twenty-one patients who had first myocardial infarction and 14 cardiologists participated in in-depth interviews and focus groups until the point of theoretical saturation. Facilitators for TLC included optimism, self-efficacy, faith-based life purpose, positive attitudes by family and friends, social participation, good patient-physician relationship, and positive medical advice. Barriers were: individual (older age, female sex, lower educational level, limiting beliefs, ambi val ence, depressive mood, lack of knowledge on strategies to achieve TLC, financial constraints), family (family crisis, overprotection, im-posing attitudes, unhealthy habits at home), work (work overload and competition between work recovery and TLC), socio-environmental (neighborhood unsafety), and health provider-related (poor patient-physician re-lationship, limiting beliefs among physicians, medical advice centered on restrictions or imprecise, medical training focused on pharmacological therapies and in-terventional procedures over preventive care, and orga-nizational issues). Conclusions: Reported facilitators and barriers enhance understanding of the process of lifestyle change after first myocardial infarction, and might be targets for optimization of secondary preventive strategies among Chilean patients.

Los factores asociados con el cambio terapéutico de estilos de vida (TLC) después de un infarto agudo al miocardio (IAM) no han sido suficientemente investigados en Chile. El objetivo de este estudio fue explorar y describir los facilitadores y barreras para la adopción de TLC en pacientes que han sufrido un primer IAM. Métodos: Estudio cualitativo basado en entrevistas en profundidad y grupos focales con cardiólogos y pacientes que tuvieron un primer IAM un año ± 2 meses antes del inicio del estudio. Se usó metodología de Teoría Fundada para guiar el muestreo y la codificación de los datos. Resultados: Veintiún pacientes con un primer IAM y 14 cardiólogos participaron en las entrevistas en profundidad y grupos focales, hasta el punto de saturación teórica. Facilitadores para TLC incluyeron optimismo, autoeficacia, propósito de vida basado en la fe, actitudes positivas por familiares y amigos, participación social, buena relación médico-paciente, y un consejo médico positivo. Las barreras fueron: individuales (edad avanzada, sexo femenino, bajo nivel educacional, creencias limitantes entre los pacientes, ambivalencia, estado de ánimo depresivo, falta de conocimiento sobre estrategias para lograr TLC, limitaciones financieras), a nivel familiar (crisis de la familia, sobreprotección, imposición de actitudes, hábitos no saludables en el hogar), a nivel laboral (sobrecarga de trabajo y competencia entre la recuperación del trabajo y la adopción de TLC), a nivel socio-ambiental (inseguridad del barrio), y a nivel del proveedor de salud (mala relación médico-paciente, creencias limitantes entre los médicos, consejo médico impreciso o basado en restricciones, formación médica centrada en aspectos farmacológicos e intervencionales por sobre lo preventivo, y problemas de organización). Conclusiones: Los facilitadores y barreras reportados mejoran la comprensión del proceso de cambio de estilos de vida después del primer infarto agudo al miocardio, y pueden contribuir a la optimización de estrategias de prevención cardiovascular secundaria en pacientes chilenos.

Pre-hospital delay in acute myocardial infarction: judgement of symptoms and resistance to pain / Retardo pré-hospitalar no infarto do miocárdio: julgamento dos sintomas e resistência à dor

Objective To estimate the time of decision (TD) to look for medical care and the time of arrival (TA) at the health service for men (M) and women (W) suffering from acute myocardial infarction and to analyze the influence of the interpretation of pain and pain resistance behaviors during these times. Methods This is an exploratory research, performed at the university hospital in Salvador/Bahia. 43 W and 54 M were interviewed. To study the dependence among sociodemographic and gender variables, the Fisher Exact Test was used. To analyze times, a geometric mean (GM) was used. In order to verify the association between the GM of TD and TA and the judgment of pain, and between the GM of TD and TA and the behavior of resistance to pain, as well as to test the time of interaction between the gender variable and other variables of interest, the robust regression model was used. The statistical significance adopted was 5%. Results The GM of the TD for M was 1.13 h; for W, 0.74 h. The GM of the TA was 1.74 h for M and 1.47 h for W. Those who did not recognize the symptoms of AMI and presented behavior of resistance to pain had higher TD and TA, being the associations significant. Gender did not change the associations of interest. Conclusion The findings demonstrate the importance of health education aiming at the benefits of early treatment. .

Objetivo estimar o tempo de decisão (TD) para a procura de atendimento medico e o tempo de chegada a um serviço de saúde (TC) para homens (H) e mulheres (M) que sofreram infarto do miocárdio e analisar a influência da interpretação da dor e de comportamentos de resistência à dor nesse tempo. Métodos trata-se de pesquisa exploratória, realizada em hospital universitário de Salvador/BA. Foram entrevistados 43 M e 54 H. Para estudar a dependência entre as variáveis sociodemográficas e os sexos, empregou-se o Teste Exato de Fisher. Para analisar os tempos, utilizou-se a média geométrica (MG). Para verificar a associação entre a MG dos TD e TC e o julgamento da dor e entre a MG dos TD e TC e os comportamentos de resistência à dor, bem como para testar o termo de interação entre a variável sexo e as variáveis de interesses, utilizou-se o modelo de regressão robusto. A significância estatística adotada foi de 5%. Resultados a MG do TD para H foi de 1,13 h; para M, de 0,74 h. A MG do TC foi de 1,74 h para H e de 1,47 h para M. Aqueles que não reconheceram os sintomas do IAM e apresentaram comportamentos de resistência à dor apresentaram maior TD e TC, sendo as associações significantes. Os sexos não modificaram as associações de interesse. Conclusão os achados assinalam a importância da educação em saúde visando aos benefícios do tratamento precoce. .

Vivências da família após infarto agudo do miocárdio / Experiencias de la familia después de infarto agudo del miocario / Family experiences post-acute myocardial infarction

Objetivou-se descrever as vivências da família no pós-infarto. Pesquisa qualitativa, descritiva e exploratória, realizada com seis famílias de pacientes pós-infarto. A coleta de dados ocorreu no domicílio das famílias, no período de fevereiro a maio de 2012, por meio de observação e entrevista com a família. Foi utilizado o software Atlas Ti 6.2 na codificação das entrevistas e os dados foram explorados com a análise temática. Surgiram duas categorias: "Tempos difíceis": consequência imediata do infarto agudo do miocárdio para as famílias; e "Nos reeducamos - a gente se adapta", vivência atual das famílias. A vivência imediata pós-infarto é permeada por variados sentimentos, necessitando adaptação das famílias para adequação às necessidades. A vivência atual demonstra modificações nas famílias devido à enfermidade. A família é a principal responsável pelas práticas de cuidado, porém a Enfermagem deve atuar na troca e no compartilhamento de saberes.

Se objetivó describir las experiencias de la familia en el postinfarto. Estudio cualitativo, descriptivo y exploratorio, realizado con seis familias de pacientes postinfarto. La recolección de datos se la realizó en los hogares de las familias, de febrero a mayo de 2012 a través de observación y entrevista con la familia. Se utilizó el software Atlas Ti 6.2 en la codificación de las entrevistas y los datos fueron explorados con el análisis temático. Emergieron dos categorías: "Tiempos difíciles": consecuencia inmediata del infarto agudo del miocardio para las familias y "Hacemos una reeducación - Nosotros nos adaptamos": experiencia actual de las familias. La experiencia inmediata postinfarto es permeada por diversos sentimientos que requiere adaptación para adecuación a las necesidades. La experiencia actual muestra los cambios en las familias debido a la enfermedad. La familia es la principal responsable por las prácticas de cuidado, pero la Enfermería debe actuar en el cambio y compartimiento de conocimientos.

This study aimed to describe the family experiences post-infarction. Qualitative, descriptive and exploratory research, carried out with six families of post-infarction patients. Data collection was conducted in families' homes, in the period of February to May of 2012, through observation and interviews with the family. The software Atlas Ti 6.2 was used to code the interviews and the data were explored with thematic analysis. Two categories emerged "Difficult times": immediate consequence of acute myocardial infarction for the families; and "We reeducate ourselves - we can adapt ourselves": current experience of families. The immediate post-infarction experience is permeated by several feelings, with the need for families to adapt to fit into the needs. The current experience shows changes in families due to the disease. The family is the main responsible for the care giving, although Nursing should exchange and share knowledge.

Effects of a Smoking Cessation Program including Telephone Counseling and Text Messaging using Stages of Change for Outpatients after a Myocardial Infarction

PURPOSE: This study was done to identify effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients who have had a myocardial infarction (MI). METHODS: This research was a quasi-experimental design with a nonequivalent control group pretest-posttest. The participants were 48 outpatients (experimental group=24, control group=24) recruited from one university hospital. They were randomly assigned to one of two groups: (a) an experimental group with telephone counseling (once a week) and text messaging (five times a week) using stages of change, and (b) a control group with traditional telephone counseling (once a month). Efficacy of the intervention was measured by comparing the two groups on smoking-related variables at 3 weeks and 12 weeks. RESULTS: At the 3-week and 12-week measurements, there were significant differences between the experimental and control groups on smoking cessation self-efficacy (p<.001), nicotine dependence (p<.001), CO levels (p<.001), and smoking cessation rates (p<.001). CONCLUSION: The results indicate that the smoking cessation program including telephone counseling and text messaging using stages of change is effective for outpatients after a MI. Further attention should be paid to the intensity of the smoking cessation program and periods for long-term follow-up.

[ effect of eye movement desensitization and reprocessing on anxiety in patients with myocardial infarction]

Coronary heart disease is the main cause of death and inability in all communities. Anxiety is the most common psychological response to myocardial infarction. Present study was conducted to indentify efficacy of eye movement desensitization and reprocessing on the anxiety of patients with myocardial infarction. This study is a clinical trial. Sixty patients with myocardial infarction hospitalized at the cardiac ward of a hospital in Qazvin between 2011-2012 were selected using sampling and were divided by random assignment into experimental and control groups. In order to collect data, demographic and anxiety questionnaires were used. Interventions were subsequently performed in two sessions every other day for 45 to 90 mi and anxiety level of the patients was measured before and after intervention. Data were analyzed using descriptive statistics, paired - t-test, t-test, Willcoxon and Chi square. Mean anxiety levels in experimental group were [48.87 +/- 4.28] and [7.37 +/- 2.42] before and after intervention, respectively; therefore it statistically showed a significant difference [P<0.001]. Mean anxiety level in control group was [49.10 +/- 5.13] before intervention and it was [48.40 +/- 5.31] after intervention, so it statistically showed a significant difference [P<0.001]. The eye movement desensitization and reprocessing is a newly effective, useful, efficient and non-invasive method for treatment and reducing anxiety in patients with myocardial infarction. Nurses, particularly those who are working in Critical Care Units can use this new and effective method for treatment of anxiety in patients

Fatores associados à decisão para procura de serviço de saúde no infarto do miocárdio: diferenças entre gêneros / Factors associated with the decision to seek health care in myocardial infarction: gender differences / Factores asociados a la decisión de búsqueda de servicio de salud ante infarto de miocardio: diferencias entre géneros

O objetivo deste estudo foi analisar, entre gêneros, a influência de variáveis cognitivas e emocionais no tempo de decisão (TD) para procura de atendimento face ao infarto do miocárdio. Cem adultos foram entrevistados em dois hospitais de Salvador-BA. Na análise empregaram-se médias percentuais, teste Q-quadrado e modelo de regressão linear robusto. Houve a predominância de homens, com idade média de 58,78 anos e baixa condição socioeconômica. A média geométrica da amostra foi 1,1h - 0,9h para homens; 1,4h para mulheres. Constatou-se menor tempo de decisão para quem considerou grave os sintomas, e maior para quem esperou melhora e tomou algo para recuperar-se, tais associações são estatisticamente significantes. Houve interação entre gênero e variáveis: esperar a melhora dos sintomas (p=0,014), ocultá-los (p=0,016) e pedir ajuda (p=0,050), quando verificou-se a associação das variáveis de interesse e TD. Os tempos de decisão foram elevados e sofreram influência de variáveis cognitivas, emocionais e de gênero. Cuidados de enfermagem podem promover o atendimento precoce.

Analyze cognitive and emotional variables between genders in terms of the decision time (DT) to seek care when experiencing symptoms of myocardial infarction. One hundred adults were interviewed at two hospitals in Salvador-BA. The analysis used percentage means, the chi-square test, and a robust linear regression model. Most participants were male, with a mean age of 58.78 years and a low socioeconomic status. The geometrical mean of the sample was 1.1h (0.9h for men, and 1.4h for women). A shorter decision time was found for those who considered their symptoms to be severe, and a longer decision time for those who expected symptoms to improve and took something to feel better, with statistically significant associations. An interaction was observed between gender and the following variables: waiting for symptoms to improve (p=0.014), concealing symptoms (p=0.016) and asking for help (p=0.050), thus an association was observed between the variables of interest and DT. The decision times were long and were affected by cognitive, emotional and gender variables. Nursing care may promote early assistance.

Analizar, entre géneros, la influencia de variables cognitivas y emocionales en Tiempo de Decisión (TD) para búsqueda de atención ante infarto de miocardio. Cien adultos fueron entrevistados en dos hospitales de Salvador-BA. Para análisis, se emplearon promedios porcentuales, test Chi-cuadrado y modelo de regresión lineal robusto. Predominaron hombres, edad promedio 58,78 años y baja condición socioeconómica. La media geométrica de la muestra fue 1,1h, para hombres 0,9h, para mujeres 1,4h. Se constató menor TD para quien consideró graves los síntomas y mayor para quien esperó evolución y tomó algo para mejorar, tales asociaciones estadísticamente significativas. Existió interacción entre género y variables: esperar la mejoría sintomática (p=0,014), ocultarlo (p=0,016) y pedir ayuda (p=0,050), cuando se verificó la asociación de variables de interés y TD. Los tiempos de decisión fueron elevados, e influidos por variables cognitivas, emocionales y de género. Los cuidados de enfermería pueden promover la atención precoz.

Influencia de la rehabilitación cardíaca sobre la tasa de re-hospitalización en pacientes con infarto agudo de miocardio, Santander, Colombia / The influence of cardiac rehabilitation on acute myocardial infarction patients' readmission rate in Santander, Colombia

Objetivo Estimar el efecto de la rehabilitación cardiaca (RC) pos-infarto, según sus niveles de intervención, sobre las tasas de re-hospitalización. Métodos Estudio de cohorte prospectiva de pacientes con diagnóstico de IAM. Se obtuvieron datos sobre gravedad del infarto, antecedentes, historia médica, evolución intrahospitalaria, clasificación Killip, estancia y condición de egreso. A través de la historia clínica electrónica y mediante contacto telefónico se constató si el paciente recibió RC y cuáles fueron sus componentes; el seguimiento se extendió hasta por un año. Resultados Se incluyeron 96 pacientes de ambos sexos con IAM. En 72 se contó con información sobre RC; 5 de los cuales recibieron RC basada únicamente en actividad física; 49 pacientes recibieron una RC más completa que integró actividad física, educación, psicología y nutrición; 18 pacientes no recibieron RC. Durante el seguimiento, se registraron 10 nuevas hospitalizaciones y una muerte. En un modelo de Poisson, los pacientes cuya RC se basó sólo en la actividad física presentaron una tasa de re-hospitalizaciones significativamente mayor que la de los pacientes que recibieron un esquema completo de RC (Razón de tasas: 5,89; IC 95 %:1,14-30,49; ρ=0,04). Conclusiones La RC debe tener un enfoque multidisciplinario, que además del componente físico, incluya el psicológico, nutricional y educativo.

Objective Estimating the effect of post-infarction cardiac rehabilitation (CR) on readmission/re-hospitalization rates according to intervention level. Method This was a prospective cohort study of patients diagnosed as suffering acute myocardial infarction (AMI). Data concerning infarction severity, previous illness, medical history, hospital course, Killip classification, length of hospital stay and condition on discharge. Medical records and telephone contact were used to confirm whether a patient had received CR and ascertain pertinent components. Follow-up was extended to one year. Results 96 AMI patients of both genders were included; information about CR was available for 72 of them,5 of whom had received CR based only on physical activity. 49 patients received complete CR based on education, physical activity, psychological and nutritional assessment. 18 patients had not received CR. One death and 10 new admissions/hospitalizations were recorded during follow-up. A Poisson regression model showed that patients who had received CR based only on physical activity presented significantly higher re-hospitalization rates than patients who had received a complete CR scheme (rate ratio 5.89:1.14-30.4995 % CI; p=0.04). Conclusions A multidisciplinary approach must bead opted to CR involving physical activity, education and psychological and nutritional assessment.

Pre-hospital attitudes adopted by patients faced with the symptoms of acute myocardial infarction / Atitudes pré-hospitalares adotadas por pacientes frente aos sintomas de infarto agudo do miocárdio / Actitudes prehospitalarias adoptadas por pacientes frente a los síntomas de infarto agudo del miocardio

This case series aimed to evaluate the behavior adopted by patients during the pre-hospital phase of acute myocardial infarction (AMI). A total of 115 AMI sufferers with ST-segment elevation were evaluated. The chi-square and Fisher's exact tests were applied. The individuals that did not associate the symptoms with cardiovascular disease most often attributed them to the following sources: gastrointestinal (38 percent), musculoskeletal (29.7 percent), food and/or medication poisoning (8.5 percent) and arising from the respiratory apparatus (6.3 percent). The proportion of major outcomes and of patients that arrived in the emergency department after 12 hours was higher among women, individuals with monthly income of up to one minimum wage, those who used analgesics and did not associate the symptoms with cardiovascular disease. It was found that individuals in unfavorable socioeconomic conditions, who interpreted the symptoms incorrectly, arrived later at the emergency department and had worse intra-hospital outcomes.

Esta série de casos teve o objetivo de avaliar as condutas adotadas pelos pacientes, durante a fase pré-hospitalar do infarto agudo do miocárdio (IAM). Avaliaram-se 115 indivíduos portadores de IAM, com supradesnivelamento do segmento ST. Foi aplicado o teste qui-quadrado e o teste exato de Fisher. Os indivíduos que não associaram os sintomas à doença cardiovascular atribuíram, mais frequentemente, às seguintes origens: gastrointestinal (38 por cento), osteomuscular (29,7 por cento), intoxicação alimentar e/ou medicamentosa (8,5 por cento) e decorrentes do aparelho respiratório (6,3 por cento). A proporção de desfechos maiores e de pacientes que chegaram à emergência após 12 horas foi mais elevada entre mulheres, indivíduos com renda mensal de até um salário mínimo, que usaram analgésicos e não associaram os sintomas à doença cardiovascular. Constatou-se que indivíduos em condições socio-conômicas desfavoráveis, que interpretaram os sintomas de forma incorreta, chegaram mais tardiamente à emergência e apresentaram piores desfechos intra-hospitalares.

Esta serie de casos tuvo el objetivo de evaluar las conductas adoptadas por los pacientes durante la fase prehospitalaria del infarto agudo del miocardio (IAM). Se evaluaron 115 individuos portadores de IAM con el segmento ST supradesnivelado. Fue aplicada la prueba Chi-cuadrado y la prueba exacta de Fisher. Los individuos que no asociaron los síntomas a la enfermedad cardiovascular la atribuyeron más frecuentemente a los siguientes orígenes: gastrointestinal (38 por ciento), osteomuscular (29,7 por ciento), intoxicación alimentar y/o medicamentosa (8,5 por ciento) y provenientes del aparato respiratorio (6,3 por ciento). La proporción de resultados más graves y de pacientes que llegaron a la emergencia después de 12 horas fue más elevada entre mujeres, individuos con renta mensual de hasta un salario mínimo, que usaron analgésicos y no asociaron los síntomas a la enfermedad cardiovascular. Se constató que individuos en condiciones socioeconómicas desfavorables, que interpretaron los síntomas de forma incorrecta, llegaron más tarde a la emergencia y presentaron peores resultados intrahospitalarios.

Type-D personality: a predictor of quality of life and coronary heart disease

The present study examined the association of type - D personality [and its components] with quality of life in cardiac patients compared with healthy people. A sample of 80 patients with myocardial infarction [Ml] and 70 healthy people aged 45-60 years completed the WHO quality of life brief questionnaire and the 14-item type-D personality scale. A significantly higher percentage of the Ml group scored positive for type-D personality compared with healthy individuals [71% versus 33%]. Significantly more Ml patients had low quality of life scores than did healthy individuals [64% versus 20%]. Regression analysis showed that higher scores on type-D personality had a negative impact on quality of life in Ml patients and that the social inhibition component had a greater impact than negative affectivity. Psychological assessment for type-D personality may be helpful in developing health care plans

Prevalencia y evolución de síntomas depresivos en pacientes hospitalizados por infarto agudo al miocardio y su relación con procedimientos de revascularización / Depressive symptoms among patients with acute myocardial infarction. Relationship with revascularization therapy

Background: Persistence of depressive symptoms after myocardial infarction (MI) is associated with an adverse outcome. The relationship between depression and Invasive Revascularization Therapy (IRT) is not yet fully understood. Aim: To compare the frequency of depressive symptoms and other psychosocial variables among patients with MI, undergoing or not undergoing IRT. Material and Methods: Prospective evaluation of 45 patients aged 58 ± 11 years (87 percent males) with a diagnosis of MI (Killip I and II). On admission to hospital and at follow up 3 months after discharge, all patients completed the Beck Depression Inventory (BDI), the Zung Anxiety Inventory (ASI), and the Medical Outcomes Study (MOS) social support survey. Depressive symptoms were considered to be present if the BDI score was over 10. Results: Thirty seven percent were hypertensive, 15 percent diabetic and 44 percent smokers. Sixty four percent of patients underwent IRT (11.1 percent revascularization surgery and 53.3 percent coronary angioplasty). Forty four percent of patients scored over 10 in the BDI at baseline assessment and 26.5 percent at 3 months follow-up (p < 0.01). At baseline BDI score was 10.2 ± 5.1 and 9.1 ± 4.4 among patients subjected or not subjected to IRT, respectively (NS). The fgures at 3 months of follow up were 9.9 ± 5.6 and 4.1 ± 2.5, respectively (p < 0,01). At baseline and three months BDI, anxiety and perceived social support were significantly correlated. Conclusions: Depressive symptoms were frequent after MI in this group of patients, and decreased at follow up only among patients not subjected to IRT.

Doença arterial coronariana e vivência de perdas / Coronary artery disease and experiences of losses

FUNDAMENTO: Na literatura, a depressão aparece associada a doenças cardiovasculares. A partir da experiência clínica, observou-se a categoria vivência de perdas associada à instalação e ao desenvolvimento da coronariopatia. A vivência de perdas, desencadeada por evento(s) significativo(s) apontado(s) pelo paciente, implica em processo de luto, remetendo-o aos fatores psicossociais predisponentes ao adoecer. OBJETIVO: Investigar vivência de perdas por meio da avaliação do estado de luto e de depressão, e verificar a relação entre ambos, em pacientes internados com doença arterial coronariana. MÉTODOS: Avaliaram-se 44 pacientes internados, com os diagnósticos de infarto agudo do miocárdio ou angina, de 33 a 65 anos, 50 por cento homens e 50 por cento mulheres. Foram utilizados dois instrumentos: entrevista semi-estruturada para investigação de vivência de perdas e avaliação do estado de luto, e inventário de depressão de Beck para avaliação de depressão. Os resultados foram relacionados pelo programa Statistical Package for Social Sciences, versão 11.0. RESULTADOS: O estado de luto pode ser identificado em 66 por cento dos casos, com significativa relação entre luto e depressão (p < 0,05). Observou-se ainda que 100 por cento das pessoas com depressão grave apresentam luto. O evento significativo referido com mais frequência foi morte de familiares (47 por cento) e de pessoa próxima (13 por cento), totalizando 60 por cento dos eventos relatados por 84 por cento dos participantes. De acordo com os resultados obtidos pelo inventário de depressão de Beck, 48 por cento encontram-se em estado de depressão. CONCLUSÃO: Este estudo sugere que a categoria vivência de perdas deve ser utilizada como indicativo de fator psicológico predisponente às manifestações da doença arterial coronariana (DAC), apontando para a relação entre luto e depressão.

BACKGROUND: In literature, depression is associated with cardiovascular diseases. From clinical experience, we observed that the psychological category "experience of loss" was associated with the onset and development of coronary heart disease. The experience of loss caused by self-reported significant event(s) leads to grief and the psychosocial factors which predispose the patient to diseases. OBJECTIVE: To study the impact of the experience of loss by investigating the relationship between mourning and depression, in hospitalized patients with coronary heart disease. METHODS: 44 inpatients (50 percent men and 50 percent women, aged 33 to 65 years), with a diagnosis of acute myocardial infarction or angina, were evaluated. Two instruments were used: a semi-structured interview, for investigating the experience of loss and evaluating the state of grief; and the Beck Depression Inventory, for measuring the severity of depression. The results were expressed using the computer program Statistical Package for Social Sciences version 11.0. RESULTS: 66 percent of the patients were in mourning, the relationship between mourning and depression was significant (p<0,05), and we verified that 100 percent of the patients who had serious depression were in mourning. The most frequent self-reported significant event was death of a family member (47 percent) and death of a close person (13 percent), totaling 60 percent of the events, reported by 84 percent of the participants. According to the results of Beck Depression Inventory, 48 percent of them had depression. CONCLUSION: This study suggests that the psychological category "experience of loss" should be used as an indicator of the existence of psychological factors that could predispose the patient to CAD, and also confirms the relationship between a state of mourning and depression.

Depressão e infarto agudo do miocárdio: [revisão] / Depression and myocardial infarction: [review]

A associação entre transtorno depressivo maior e doenças cardiovasculares, em particular infarto agudo do miocárdio, é frequente, levando a pior prognóstico tanto da depressão como da doença cardiovascular, com maiores taxas de reinfarto e maior morbidade e mortalidade. Os autores discutem as evidências na literatura que demonstram essa associação entre infarto agudo do miocárdio e quadros depressivos, com enfoque nos avanços em fisiopatologia e terapêutica psiquiátrica. Vários estudos têm mostrado que o tratamento da depressão associada a quadros cardíacos é eficaz, melhora a qualidade de vida e pode ser feito com segurança. Embora o tratamento da depressão tenha sido associado à melhora de alguns parâmetros cardiovasculares, ainda não existem, entretanto, evidências de associação entre tratamento da depressão e melhora da morbidade e mortalidade cardiovascular.

The association between major depressive disorder and cardiovascular diseases, particularly myocardial infarction, is frequently observed, leading to worse prognosis both on the depressive disorder as well as cardiovascular disease, with increased rates of re-infarction and both morbidity and mortality. The authors review and discuss the evidence in the literature that supports the relationship between depressive disorder and cardiovascular disease, with focus on the advances on the physiopathology and the psychiatric management. Various studies have shown that treatment of depression is efficacious, improves quality of life and can be safely conducted. Although, treatment of depression has been associated with improvement on some cardiovascular parameters, there is no evidence so far that treatment of depression is associated with decrease of cardiovascular morbidity and mortality.

Atividade sexual pós-infarto do miocárdio: tabu ou desinformação? / Sexual activity after myocardial infarction: taboo or lack of knowledge?

FUNDAMENTO: O retorno à atividade sexual após síndrome coronária aguda (SCA), apesar da importância clínica e social, é assunto pouco abordado pela equipe de saúde, e que tem recebido pouca ênfase durante a internação. A disfunção erétil tem sido uma queixa freqüente entre pacientes cardiopatas, aliada a dúvidas sobre a segurança no retorno à atividade sexual após evento cardiovascular. OBJETIVO: Descrever o conhecimento dos pacientes quanto ao infarto agudo do miocárdio (IAM) e às orientações recebidas para o retorno à atividade sexual. MÉTODOS: Estudo transversal realizado entre junho e julho de 2005. Foram incluídos pacientes que se encontravam no sexto dia pós-IAM. Foi aplicado um instrumento relacionado ao conhecimento sobre o IAM, à freqüência e às expectativas de retorno à atividade sexual no período pós-alta hospitalar. RESULTADOS: Foram incluídos 96 pacientes, dos quais 70 por cento eram do sexo masculino, com média de idade de 59 ± 12 anos, e 80 por cento eram vítimas de primeiro infarto agudo do miocárdio. Desses pacientes, 96 por cento desconheciam as manifestações clínicas e as possíveis limitações provocadas pelo IAM, 63 por cento relataram ter vida sexual ativa antes do evento, 60 por cento tinham dúvidas quanto ao retorno à atividade sexual após a alta, e apenas 4 por cento dos pacientes receberam orientações pelos profissionais de saúde durante o período de internação. CONCLUSÃO: Nossos achados indicam que as orientações dispensadas pela equipe aos pacientes durante a internação são subótimas, no que tange tanto ao IAM quanto ao retorno à atividade sexual. A atualização da equipe de saúde, principalmente dos enfermeiros que despendem mais tempo com os pacientes, são estratégias que podem melhorar esses resultados.

BACKGROUND: Despite its clinical and social relevance, resumption of sexual activity after an acute coronary syndrome (ACS) is a subject that is poorly addressed by healthcare providers and one that is given scant emphasis during hospitalization. Erectile dysfunction is a common complaint among cardiac patients, and these patients are in doubt regarding the safety of resuming sexual activity after a cardiovascular event. OBJECTIVE: To describe how well informed patients are in regard to acute an myocardial infarction (AMI) and what sort of guidance they receive regarding resumption of sexual activity. METHODS: A cross-sectional study was performed from June to July 2005 with patients on the sixth day of AMI. A questionnaire was applied to assess not only patients' knowledge of AMI, but also their expectations regarding their resumption of sexual activity - and frequency of same - following hospital discharge. RESULTS: Ninety-six patients were included in the study (mean age 59 ± 12); 70 percent of them were male and 80 percent had experienced their first AMI. Of these, 96 percent lacked any knowledge of AMI clinical manifestations and possible limitations, 63 percent reported an active sex life before the event, 60 percent were in doubt regarding their sex life following hospital discharge, and only 4 percent received sexual guidance from healthcare providers during their hospital stay. CONCLUSION: According to our findings, the recommendations patients receive during hospitalization are suboptimal in regard to both AMI and resumption of sexual activity. The updating of healthcare providers may change this situation. This is especially true for the nursing staff, since they spend more time with patients.

Acute myocardial infarction and depression

Depression found to be common after acute myocardial infarction AMI, its recognition and treatment may be important to reduce its consequences. To clarify the effect of depression following AMI. Prospective study was conducted at the coronary care unit [CCU] at Ibn-Sena, Mosul teaching hospital. Two hundred cases with AMI ages 25 years up to 75 years were included. Depression was prevalent after AMI, with a higher incidence in females, 57% vs 43% for males. P value < 0.05 and odds ratio: 2.85, this study found that higher percentage of depression was among those with low educational and socioeconomic state and discovered that patients with depression following AMI developed more cardiac complications such as recurrent angina, recurrent AMI, arrhythmia, congestive cardiac failure [CCF] and death more than non depressed patients, 38% of the depressed group needed coronary angiogram vs 23% of non depressed. Patients who developed depression following [AMI] are more prone to complications