O impacto de variáveis familiares e socioculturais no declínio da natalidade : um estudo exploratório

Tese de mestrado, Psicologia (Secção de Psicologia Clínica e da Saúde, Núcleo de Psicologia Sistémica), Universidade de Lisboa, Faculdade de Psicologia, 2014O presente estudo, misto, descritivo e exploratório, pretende analisar a relação entre variáveis socioculturais e familiares e o seu impacto no declínio da natalidade. Numa primeira etapa, quantitativa, recolheu-se uma amostra de 345 participantes portugueses, casados ou em união de facto, com filhos biológicos. Tendo como objetivo caraterizar a amostra, analisar a relação entre variáveis socioculturais (crença religiosa e nível socioeconómico) e familiares (idade em que se tem o primeiro filho, número de filhos, estilos parentais, satisfação conjugal e coesão familiar), bem como o papel mediador da satisfação conjugal na relação entre os estilos parentais e a coesão familiar, foram utilizados: um Questionário Sociodemográfico, a Escala de Avaliação da Satisfação em Áreas da Vida Conjugal (Narciso & Costa, 1996), a Family Adaptability and Cohesion Scales II (Olson & Bell, 1982) e o Questionário de Dimensões de Estilos Parentais, (Robinson, Mandleco, Olsen & Heart, 2001). Os resultados foram analisados com análise descritiva, estudo de correlação e regressão linear, tendo-se verificado que as variáveis contextuais e familiares se relacionam (e.g., o nível socioeconómico está positivamente correlacionado com o estilo parental autoritativo), e que a satisfação conjugal tem um papel mediador na relação entre os estilos parentais e a coesão familiar. A segunda etapa, de cariz qualitativo, teve como objetivo estudar a perceção das pessoas quanto à relação entre variáveis socioculturais (crença religiosa, valores, rede familiar, rede social e nível socioeconómico) e variáveis familiares (idade em que se tem o primeiro filho, número de filhos, estilos parentais, satisfação conjugal e coesão familiar), bem como explorar o impacto das mesmas sobre a natalidade. Assim, foram elaboradas entrevistas a 12 participantes, com e sem filhos, e sujeitas a análise temática. Diversas variáveis contextuais e familiares parecem estar relacionadas e contribuir para a natalidade, abrindo novos temas para debate ou investigação, bem como as suas implicações clínicas.This exploratory and descriptive, mixed-methods study aims to examine the relationship between sociocultural and family variables and their impact on the fertility decline. Firstly, and regarding the quantitative study, it was collected a sample of 345 Portuguese participants, married or unmarried, with biological children. In order to characterize the sample, to analyze the relationship between sociocultural (religious beliefs and socioeconomic status) and family variables (age at which they had their first child, number of children, parenting styles, marital satisfaction and family cohesion), as well as the mediator role of marital satisfaction in the relationship between parenting styles and family cohesion, it was used: a Sociodemographic Questionnaire, the Evaluation of Satisfaction in Areas of Marital Life Scale (Narciso and Costa, 1996), the Family Adaptability and Cohesion Scales II (Olson & Bell, 1982) and the Parenting Styles and Dimensions Questionnaire (Robinson, Mandleco, Heart and Olsen, 2001). Data were studied with descriptive, correlation and linear regression analysis, and it was observed that contextual and family variables are related (e.g., socioeconomic status is positively correlated with authoritative parenting style), and that marital satisfaction has a mediating role in the relationship between parenting styles and family cohesion. Secondly, it has been elaborated a qualitative study and it intended studying the perception of people, regarding the relationship between sociocultural (religious beliefs, values, family network, social network and socioeconomic status) and family variables (age at which they had their first child, number of children, parenting styles, marital satisfaction and family cohesion), as well as to explore their impact on the birth rate. To accomplish that, interviews to 12 participants, with and without children, were performed and then they were subjected to thematic analysis. Several contextual and family variables seem to be related and contribute to the birth rate, opening new themes for discussion or research, as well as their clinical implications

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status