Factors associated with changes in inpatients' smoking pattern during hospitalization and one month after discharge: A cohort study.

INTRODUCTION: Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. OBJECTIVES: The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. METHODS: A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25-item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi-square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. RESULTS: Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical-surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). CONCLUSIONS: Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence-based tobacco cessation programs at the organizational-level, including post-discharge active quitting smoking support. CLINICAL RELEVANCE: Three-quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.

Multicentre study of pressure ulcer point prevalence in a Portuguese region.

AIM: To conduct an exploratory investigation concerning the prevalence of Pressure Ulcers in different care settings, in the Portuguese region of Cova da Beira. MATERIAL AND METHODS: Descriptive cross-sectional multicenter analysis through direct skin assessment of 473 persons with at least one wound that gave informed consent and were in the care settings of this investigation. Research was conducted during the second weeks of February and June 2018, involving 295 hospital inpatients, 993 residents from nursing homes and 85.655 persons from primary health care centers. RESULTS: A total of 115 pressure ulcers were documented, representing 18.3% of all identified wounds, most of them grade 3. Most of pressure ulcers were acquired in nursing homes, during hospital admission or at home. Pressure ulcer point prevalence rates identified corresponded to 5.76% amongst hospitalized persons, 4.03% in nursing home residents and 0.02% in community population. Within population with wounds, older age, having more wounds, more PU, being immobile and congestive heart failure were associated and had a statistically significant difference in participants with at least one pressure ulcer. CONCLUSIONS: The prevalence rates of participants with pressure ulcers of our study were similar to published international literature. We identified a higher frequency and prevalence of severe ulcers (grade 3 and 4) in hospital and nursing home populations, highlighting the need for implementing global prevention programs. Although we acknowledged many study limitations, this investigation was the first known attempt to conduct a multicenter analysis of wound epidemiology in Portugal, which included all care settings.