Age, Blasts, Performance Status and Lenalidomide Therapy Influence the Outcome of Myelodysplastic Syndrome With Isolated Del(5q): A Study of 58 South American Patients

BACKGROUND

Myelodysplastic Syndrome (MDS) with isolated deletion 5q is associated with a low risk to leukemic evolution and long overall survival (OS); it comprises 3%-4.5% of MDS cases in Latin America classified according to the World Health Organization 2008. This study aims to describe clinical, laboratory and the outcome of patients according to the newest World Health Organization 2016 proposal.

METHODS

We retrospectively reviewed patients from four Brazilian (BR) and four Argentinean (AR) centers diagnosed between 1999 and 2019.

RESULTS

The 58 patients (16-AR and 42-BR) presented a median age of 67 (IQR 61-75) years old, women predominance (70.7%) and transfusion dependency (62.5%) at diagnosis. Median hemoglobin level was 8.1g/dL, 27.5% and 44.4% presented thrombocytosis and neutropenia, respectively. Bone marrow (BM) was predominantly hypercellular (43.1%) with 66% showing dysplasia >1 lineage and 37.9% with >2% of blasts. Deletion 5q was mostly isolated (79.3%) and a variety of abnormalities were observed in remaining cases. Most patients were treated with erythropoietin-stimulating agents (ESA), 18 with lenalidomide and 15 with thalidomide. Median follow-up was 7.6 years, with a median OS of 3.5 years and an 8-years leukemic evolution rate of 18.4%. Multivariate analysis showed that age >75 years (HR 2.19), ECOG ≥2 (HR 5.76), BM blasts >2% (HR 2.92) and lenalidomide treatment (HR 0.25) independently influenced the OS.

CONCLUSION

Older age, worse performance status and higher percentage of blasts, that can be easily assessed, were associated to a worse prognosis. Also, our results corroborate the protective influence of lenalidomide in terms of OS in this South American series.

Life-course socioeconomic disadvantage and lung function: a multicohort study of 70 496 individuals

BACKGROUND

Lung function is an important predictor of health and a marker of physical functioning at older ages. This study aimed to quantify the years of lung function lost according to disadvantaged socioeconomic conditions across the life-course.

METHODS

This multicohort study used harmonised individual-level data from six European cohorts with information on life-course socioeconomic disadvantage and lung function assessed by forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). 70 496 participants (51% female) aged 18-93 years were included. Socioeconomic disadvantage was measured in early life (low paternal occupational position), early adulthood (low educational level) and adulthood (low occupational position). Risk factors for poor lung function (e.g. smoking, obesity, sedentary behaviour, cardiovascular and respiratory diseases) were included as potential mediators. The years of lung function lost due to socioeconomic disadvantage were computed at each life stage.

RESULTS

Socioeconomic disadvantage during the life-course was associated with a lower FEV1. By the age of 45 years, individuals experiencing disadvantaged socioeconomic conditions had lost 4-5 years of healthy lung function versus their more advantaged counterparts (low educational level -4.36 (95% CI -7.33--2.37) for males and -5.14 (-10.32--2.71) for females; low occupational position -5.62 (-7.98--4.90) for males and -4.32 (-13.31--2.27) for females), after accounting for the risk factors for lung function. By the ages of 65 years and 85 years, the years of lung function lost due to socioeconomic disadvantage decreased by 2-4 years, depending on the socioeconomic indicator. Sensitivity analysis using FVC yielded similar results to those using FEV1.

CONCLUSION

Life-course socioeconomic disadvantage is associated with lower lung function and predicts a significant number of years of lung function loss in adulthood and at older ages.

Do global ao local: desafios para redução de riscos à saúde relacionados com mudanças climáticas, desastre e Emergências em Saúde Pública

RESUMO Pela primeira vez na história, presenciam-se transformações no padrão esperado do clima com consequências ainda desconhecidas para sociedade industrial moderna. Esses riscos globais ocorrem em um mundo cada vez mais conectado, com população crescente e ambientalmente degradado, tendo como pano de fundo um cenário em que há uma relação proporcionalmente inversa entre os países, populações e grupos sociais que sofrem, de modo mais amplo e intenso, os riscos e danos provocados pelas mudanças climáticas. Um dos impactos imediatos já observados é o aumento na frequência e na magnitude de eventos extremos, gerando cenários propícios ao surgimento de emergências em saúde. Este artigo teve como objetivo apresentar os principais desafios para redução de riscos à saúde relacionados com mudanças no clima, desastre e Emergências em Saúde Pública; os principais avanços nas políticas sobre o tema; e ações de saúde dentro desse complexo cenário social, ambiental e sanitário iminente. Como resultado, apresentam-se os principais acordos globais relacionados e as necessidades de ampliação do Sistema Nacional de Redução de Riscos à Saúde visando fortalecer as ações necessárias, a fim de obter resposta adequada aos fatores de risco apresentados. Para tanto, apresentam-se seis recomendações necessária à elaboração desse sistema.

Life-course socioeconomic status and lung function in adulthood: a study in the EPIPorto cohort

OBJECTIVE

This study aims to investigate the association of life-course socioeconomic status (SES) with lung function during adulthood, by exploring the influence of life-course social mobility and of cumulative exposure to low SES.

METHODS

Participants were 1458 individuals from EPIPorto study, a population-based cohort of Portuguese adults. The life-course SES was computed using participants' paternal occupation and own occupation, resulting in four patterns: stable high, upward, downward, stable low. A cumulative life-course SES index was also calculated using the participants' paternal occupation, own education and occupation. Lung function during adulthood was assessed with forced expiratory volume in first second (FEV₁) and forced vital capacity (FVC) percentages predicted (higher percentages are associated with better lung function). Linear regression models were used to estimate beta coefficients and 95% CI for the association of socioeconomic indicators and lung function.

RESULTS

Disadvantaged SES from childhood to adulthood was associated with lower lung function (FEV₁:-6.64%,-10.68;-2.60/FVC:-3.77%,-7.45;-0.08), and the greater the socioeconomic disadvantage, the lower the lung function (FEV₁:-2.56%,-3.98;-1.15/FVC:-1.54%,-2.83;-0.24) among men, independently of marital status and behavioural factors. Among women, SES effects were only observed in those experiencing a stable low life-course SES at older ages (-5.15%,-10.20;-0.09). Men experiencing a downward social mobility presented the lowest lung function, but there was attenuation to the null after accounting for marital status and behavioural factors.

CONCLUSION

A life-course disadvantaged SES is an important predictor of lower lung function during adulthood. Downward social mobility was associated with the lowest lung function among men, although this association was mostly explained by behavioural factors.

Correction: Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era

[This corrects the article DOI: 10.1371/journal.pone.0219857.].

Prevalence of Portuguese Children Exposed to Secondhand Smoke at Home and in the Car

INTRODUCTION

Children's exposure to secondhand smoke is a cause of serious health problems and infant morbidity. This is the first nationally representative study conducted in Portugal to describe the prevalence of children exposed to secondhand smoke at home and in the car.

MATERIAL AND METHODS

This is a descriptive cross-sectional study with a representative sample of 2396 Portuguese children aged 0 to 9 years old, stratified by age and administrative region NUTS II. Questionnaires were administered between January and September 2016.

RESULTS

Results showed that 6.1% of mothers and 11.2% of fathers reported smoking at home. It was found that 4.5% of mothers and 8.3% of fathers reported smoking in the car. Results also showed that 5.4% of children were double exposed to secondhand smoke at home and in the car. Children whose parents were smokers and had a lower level of education were more exposed to secondhand smoke at home.

DISCUSSION

Children's exposure to secondhand smoke has been decreasing in Portugal. Parental smoking and a low educational level were risk factors for children's exposure to secondhand smoke at home.

CONCLUSION

The main source of children's exposure to secondhand smoke is parental smoking. As such, it is crucial to implement effective measures to control parental smoking. It is necessary to promote smoking cessation among parents and to ban smoking inside the car.

Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era

BACKGROUND

The risk of recurrence of solitary plasmacytoma (SP)/progression to MM is well established, but patient, imaging and treatment factors influencing risk of progression require further evaluation.

METHODS

This is a retrospective analysis of 66 SP patients (23 UK, 43 Brazil) diagnosed 1989-2016. Patient baseline characteristics were recorded. The incidence of progression to MM was calculated, including biochemical and imaging findings and the treatment modality received. Survival estimates were determined by Kaplan-Meier analyses.

RESULTS

With a median follow-up of 53.6 months the 5 year overall survival (OS) was 90.7% (95%CI 79-96%). The median progression free survival (PFS) from diagnosis was 61 months. Cumulative incidence of progression to MM was 49.9% at 5 years (95% CI 35.6-62.6%) and was significantly higher with bone plasmacytoma (47.2%, 95%CI 31.9-61.1%), than an extramedullary location (8.3%, 95%CI 0.4-32.3%, Gray test p = 0.0095)). The majority of patients with solitary bony plasmacytoma (SBP) received radiotherapy (RT) (51/53, 96.2%) whereas most extramedullary cases were treated with surgical resection (7/13, 53.8%). A small proportion of SBP patients received additional upfront chemotherapy, with 5/6 in remission after a median follow-up (FU) of 10 years. The diagnostic yield of surveillance functional FU imaging without other indications of relapse/progression was low. The positive predictive value of functional FU imaging was high but with a low negative predictive value, especially in cases of suspected relapse/progression.

CONCLUSION

Our data suggests functional imaging should be used if clinical suspicion of relapse/progression, rather than a routine surveillance tool, and upfront adjuvant chemotherapy is worthy of prospective evaluation.

Socioeconomic circumstances and respiratory function from childhood to early adulthood: a systematic review and meta-analysis

OBJECTIVE

Disadvantaged socioeconomic circumstances in early life have the potential to impact lung function. Thus, this study aimed to summarise evidence on the association between socioeconomic circumstances and respiratory function from childhood to young adulthood.

DESIGN

Systematic review and meta-analysis.

METHODS

Following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, Medline, ISI-Web of Science and Scopus were searched from inception up to January 2018. Original studies on the association between socioeconomic circumstances and respiratory function in early ages (ie, participants younger than 25 years of age) were investigated. Two investigators independently evaluated articles, applied the exclusion criteria, extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A meta-analysis of the standardised mean difference and 95% CI in respiratory function between participants from different socioeconomic circumstances was conducted, using a random-effects model.

RESULTS

Thirty-three papers were included in this review and 23 showed that disadvantaged socioeconomic circumstances were significantly associated with reduced respiratory function. The meta-analysis including seven papers showed a significant difference of -0.31 (95% CI -0.42 to -0.21) litres in forced expiratory volume in the first second between children, adolescents and young adults from disadvantaged versus advantaged socioeconomic circumstances. Specifically a difference of -0.31 (95% CI -0.51 to -0.10) litres in girls and -0.43 (95% CI -0.51 to -0.35) litres in boys was observed.

CONCLUSIONS

Children, adolescents and young adults from disadvantaged socioeconomic circumstances had lower respiratory function, and boys presented higher respiratory health inequalities. This information contributes to explain the social patterning of respiratory diseases, and might enable health policy makers to tackle respiratory health inequalities at early ages.

Detection of bacterial contamination in platelet concentrates from Brazilian donors by molecular amplification of the ribosomal 16S gene

OBJECTIVE

The aim of our work was to establish a semi-automated high-throughput DNA amplification method for the universal screening of bacteria in platelet concentrates (PCs).

BACKGROUND

Among cases of transfusion transmission of infectious agents, bacterial contamination ranks first in the number of events, morbidity and mortality. Transmission occurs mainly by transfused PCs. Automated culture is adopted by some blood banks for screening of bacterial contamination, but this procedure is expensive and has a relatively long turnaround time.

METHODS

PCs were spiked with suspensions of five different bacterial species in a final concentration of 1 and 10 colony-forming units (CFU) per millilitre. After incubation, the presence of bacteria was investigated by real-time polymerase chain reaction (PCR) and by the Enhanced Bacterial Detection System (eBDS, Pall) assay as a reference method. Real-time PCR amplification was performed with a set of universal primers and probes targeting the 16S rRNA gene. Co-amplification of human mitochondrial DNA served as an internal control.

RESULTS

Using the real-time PCR method, it was possible to detect the presence of all bacterial species tested with an initial concentration of 10 CFU mL^-1 24 h after contamination, except for Staphylococcus hominis. The PCR assay also detected, at 24 h, the presence of Serratia marcescens and Enterobacter cloacae with an initial concentration of 1 CFU mL^-1 .

CONCLUSIONS

The real-time PCR assay may be a reliable alternative to conventional culture methods in the screening of bacterial contamination of PCs, enabling bacterial detection even with a low initial concentration of microorganisms.

Conquistas, limites e obstáculos à redução de riscos ambientais à saúde nos 30 anos do Sistema Único de Saúde

Resumo A Constituição de 1988 representou importantes conquistas de direitos em torno de um projeto de país com um modelo de desenvolvimento socioeconômico orientado para a redução de risco de doenças e agravos e um meio ambiente ecologicamente equilibrado. Estas conquistas se manifestaram nas políticas, na institucionalização e na criação de espaços institucionais de participação da sociedade. O objetivo deste artigo é situar as conquistas e também os limites e obstáculos na agenda de saúde e ambiente expressos nestes 30 anos do Sistema Único de Saúde. As conquistas são situadas a partir da ampliação dos espaços institucionais de participação da sociedade e institucionalização no Sistema Único de Saúde dos temas relacionados aos riscos ambientais. Os limites são situados a partir da relação entre desenvolvimento e padrões de riscos ambientais presentes nos níveis global, regional, local e comunitário. Por fim são apontados os obstáculos que, a partir do golpe parlamentar de 2016, não só acentuaram os limites já existentes, como vem produzindo retrocessos em diversas áreas relacionadas à saúde ambiental.

Epidemiology, risk factors and outcomes of multi-drug-resistant bloodstream infections in haematopoietic stem cell transplant recipients: importance of previous gut colonization

BACKGROUND

Bloodstream infections (BSI) are a major complication in the early phase of a haematopoietic stem cell transplant (HSCT).

AIM

To describe the incidence and risk factors for BSI occurring in the pre-engraftment phase of HSCT, and its impact on mortality.

METHODS

Clinical variables of 232 HSCT patients were analysed retrospectively between 2014 and 2015. Univariate Cox regression analyses were performed to test the association between each covariate and the outcome. Covariates with P < 0.10 on univariate analysis were included in a multiple Cox regression analysis using a backward elimination method.

FINDINGS

The cumulative incidence of BSI was 25.4%, mainly caused by Gram-negative bacteria (GNB) (55.2%). Approximately 40.5% of the patients had gut colonization by multi-drug-resistant (MDR) bacteria (vancomycin-resistant enterococcus and carbapenem-resistant GNB). Among patients colonized by MDR GNB, 20% developed an overt BSI due to MDR bacteria with the same pattern of sensitivity. Of the 13 deaths related to infection, 10 were patients with BSI caused by MDR GNB. The independent risk factors for BSI were gut colonization by MDR bacteria including GNB (P < 0.001) and duration of neutropenia >10 days (P = 0.005), and those associated with BSI caused by MDR bacteria were age >62 years (P = 0.03), use of total parenteral nutrition (TPN) (P < 0.001) and previous gut colonization by MDR GNB (P = 0.002).

CONCLUSIONS

Previous gut colonization by MDR was an independent risk factor for BSI, together with TPN and age, and had an impact on outcome. These findings suggest that gut decolonization may be a potential strategy to prevent BSI.

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

Introduction

Cardiac surgery is an aggressive procedure, inducing a great level of stress and disturbance to the homeostasis of the organism and underlying several postoperative complications. Surgical prehabilitation comprises pre-operative physical conditioning designed to improve the physiological and functional capacities of the individual, prepare the organism for surgical stress and reduce the risk of postoperative morbidity.

Aim

This systematic review and meta-analysis is aimed at evaluating the ability of prehabilitation to prevent post-surgical complications in cardiac patients.

Methods

We selected studies conducted among patients who were waiting for non-urgent cardiac surgical procedures, where a comparison between prehabilitation and standard treatment was made. A total of 3650 possible studies were researched, of which eight were selected for inclusion.

Results

A reduction in the number of complications in the groups submitted to prehabilitation (odds ratio = 0.41; 95% confidence interval (CI): 0.28–0.62; p < 0.001; I2 = 0%) was observed, as well as a significant increase in maximal inspiratory pressure (standard mean difference (SMD) = 0.66; 95% CI: 0.35–0.96; p < 0.001; I2 = 58%), a non-significant decrease in the length of stay (SMD = –0.56; 95% CI: −1.13, 0.01; p = 0.05; I2 = 93%), a non-significant increase in the distance walked by the intervention group in the six-minute walk test (SMD = 0.89; 95% CI −0.06, 1.84; p = 0.07) and a lack of effect on mechanical ventilation time (SMD = −0.03; 95% CI: −0.22, 0.16; p = 0.75; I2 = 0%).

Conclusion

Prehabilitation reduces the number of post-surgical complications and increases maximal inspiratory pressure; a reduction in the length of stay and an improvement of functional capacities are also probable.

Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis

Objective

To assess the relationship between socioeconomic deprivation and health-related quality of life in urban neighbourhoods, using a multilevel approach.

Methods

Of the population-based cohort EPIPorto, 1154 georeferenced participants completed the 36-Item Short-Form Health Survey. Neighbourhood socioeconomic deprivation classes were estimated using latent-class analysis. Multilevel models measured clustering and contextual effects of neighbourhood deprivation on physical and mental HRQoL.

Results

Residents from the least deprived neighbourhoods had higher physical HRQoL. Neighbourhood socioeconomic deprivation together with individual-level variables (age, gender and education) and health-related factors (smoking, alcohol consumption, sedentariness and chronic diseases) explained 98% of the total between-neighbourhood variance. Neighbourhood socioeconomic deprivation was significantly associated with physical health when comparing least and most deprived neighbourhoods (class 2—beta coefficient: -0.60; 95% confidence interval:-1.76;-0.56; class 3 –beta coefficient: -2.28; 95% confidence interval:-3.96;-0.60), and as neighbourhood deprivation increases, a decrease in all values of physical health dimensions (physical functioning, role physical, bodily pain and general health) was also observed. Regarding the mental health dimension, no neighbourhood clustering or contextual effects were found. However, as neighbourhood deprivation increases, the values of vitality and role emotional dimensions significantly decreased.

Conclusion

Neighbourhood socioeconomic deprivation is associated with HRQoL, affecting particularly physical health. This study suggests that to improve HRQoL, people and places should be targeted simultaneously.

-318C/T polymorphism of the CTLA-4 gene is an independent risk factor for RBC alloimmunization among sickle cell disease patients

Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) molecule is expressed on T-lymphocyte membrane and negatively influences the antigen-presenting process. Reduced expression of CTLA-4 due to gene polymorphisms is associated with increased risk of autoimmune disorders, whose physiopathology is similar to that of post-transfusion red blood cell (RBC) alloimmunization. Our goal was to evaluate if polymorphisms of CTLA-4 gene that affect protein expression are associated with RBC alloimmunization. This was a case-control study in which 134 sickle cell disease (SCD) patients and 253 non-SCD patients were included. All patients were genotyped for the polymorphisms 49A/G and -318C/T of CTLA-4 gene. The genotype frequency of -318C/T differed significantly between alloimmunized and nonalloimmunized SCD patients, irrespective of clinical confounders (p = .016). SCD patients heterozygous for -318T allele presented higher risk of alloantibody development (OR: 5.4, CI: 1.15-25.6). In conclusion, the polymorphism -318C/T of CTLA-4 gene is associated with RBC alloimmunization among SCD patients. This highlights the role played by CTLA-4 on post-transfusion alloantibody development.

Clinical Utility of Frailty Scales for the Prediction of Postoperative Complications: Systematic Review and Meta-Analysis

INTRODUCTION

Frailty can be defined as a biological syndrome of reduced reserve and resistance to stressful events. Evidence suggests that this syndrome is linked to adverse outcomes in various surgical populations. Several instruments have been developed to measure frailty, however there is no consensus about which one is the most useful in the surgical population. Therefore, this study aims to evaluate the utility of different frailty scales in the prediction of postoperative complications in older surgical population.

METHODS

This review and meta-analysis assembles prospective cohort studies reporting frailty and postoperative outcomes. Searches were performed in PubMed/Medline, Scielo, Cochrane Library and ScienceDirect databases. Statistical analyses was performed using Review Manager software and the pooled Odds Rattios was calculated.

RESULTS

A total of 15 articles were included in the present review. Frailty was significantly associated with postoperative complications (OR=2.53, 95% CI: 2.07-3.10; p<0.00001), mortality until 30 days (OR=3.49, 95% CI: 2.40-5.09, p<0.00001) and higher 1-year mortality (OR= 2.90, 95% CI: 1.99-4.24, p<0.00001), and with hospital length of stay >5days or >14days (OR=2.78, 95% CI: 1.45-5.30, p=0.002 and OR=2.40 (95% CI: 1.08-5.36, p= 0.03, respectively). In addition, our meta-analysis showed that frailty is a significant predictor of renal failure (OR=5.03, 95% CI: 1.74-14.54, p=0.003), neurological complications (OR= 3.41, 95% CI: 1.08-10.73, p=0.04), respiratory complications (OR=9.21 (95% CI: 2.35- 36.02, p=0.001), wound infection (OR=2.85 (95% CI: 1.65-4.94, p=0.0002) and sepsis (OR=3.84 (95% CI: 1.37-10.71, p=0.01).

CONCLUSION

Overall, frailty significantly increases the risk for developing adverse outcomes after surgery, so early detection of frailty may be a window of opportunity for intervention and a key factor for improving clinical outcomes. Moreover, future studies are required for the standardization of the frailty scales used.

Clinical impact of NK-cell reconstitution after reduced intensity conditioned unrelated cord blood transplantation in patients with acute myeloid leukemia: analysis of a prospective phase II multicenter trial on behalf of the Société Française de Greffe de Moelle Osseuse et Thérapie Cellulaire and Eurocord

Unrelated cord blood transplantation (UCBT) after a reduced intensity conditioning regimen (RIC) has extended the use of UCB in elderly patients and those with co-morbidities without an HLA-identical donor, although post-transplant relapse remains a concern in high-risk acute myeloid leukemia (AML) patients. HLA incompatibilities between donor and recipient might enhance the alloreactivity of natural killer (NK) cells after allogeneic hematopoietic stem-cell transplantation (HSCT). We studied the reconstitution of NK cells and KIR-L mismatch in 54 patients who underwent a RIC-UCBT for AML in CR in a prospective phase II clinical trial. After RIC-UCBT, NK cells displayed phenotypic features of both activation and immaturity. Restoration of their polyfunctional capacities depended on the timing of their acquisition of phenotypic markers of maturity. The incidence of treatment-related mortality (TRM) was correlated with low CD16 expression (P=0.043) and high HLA-DR expression (P=0.0008), whereas overall survival was associated with increased frequency of NK-cell degranulation (P=0.001). These features reflect a general impairment of the NK licensing process in HLA-mismatched HSCT and may aid the development of future strategies for selecting optimal UCB units and enhancing immune recovery.

In vitro cytotoxicity evaluation of resveratrol-loaded nanoparticles: Focus on the challenges of in vitro methodologies

Assessment of toxic effects is mandatory before market placement of pharmaceutical and cosmetic products. Nanotoxicology is an emerging regulatory concern and still a challenging field. Topical application of resveratrol (RSV) has been extensively studied owing to its multi-mechanistic skin anti-aging effects. Nanoencapsulation has been suggested as a promising solution to overcome RSV stability issues. In this work RSV-loaded solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC) were prepared using a homogenization/sonication technique. Cytotoxicity assays were conducted with an immortalized cell line of human keratinocytes (HaCaT). For a comprehensive cytotoxicity characterization MTT and Alamar Blue^® reduction assays (assessment of metabolic activity), Neutral red uptake (evaluation of lysosomal integrity), and Trypan blue (assessment of membrane integrity) were used. The results obtained with the different assays were not always concordant, as put in evidence by an adequate statistical analysis. Experimental parameters such as washing steps were found to be critical. The study is of interest because it draws attention to the importance of careful selected experimental conditions of in vitro nanotoxicological tests. Experimental protocols should be adapted taking into account nano-related features such as interference with the dyes and light dispersion/absorption properties.

Motivation to Quit Smoking after Acute Coronary Syndrome

INTRODUCTION

Self-Determination Theory explores the process through which a person acquires motivation to initiate new behaviours related to health and to maintain them over time. This study aimed to determine the overall fit of Self-Determination Theory Model for Health Behavior to the data obtained from a sample of smokers hospitalized with acute coronary syndrome, and to identify the predictors of smoking status six months after clinical discharge.

MATERIAL AND METHODS

The sample included 110 participants, regular smokers, hospitalized due to acute coronary syndrome. Questionnaires were administered to assess autonomous self-regulation, perceived competence, family support, depressive symptoms and meaning in life. Participants were asked if they were currently smokers six months after clinical discharge.

RESULTS

The results showed that the process variables specified by Self-Determination Theory fit the data well. Perceived competence predicted abstinence from smoking six months after clinical discharge.

DISCUSSION

Our findings have similar characteristics to other international samples in which Self-Determination Theory models havebeen tested. It is important to facilitate perceived competence, as the patients who continue to smoke have shorter length of life.

CONCLUSION

This study highlights the importance of considering clinical interventions based on Self-Determination Theory to facilitatesmoking cessation.