Prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros / Smoking prevalence and lung cancer morbimortality in Brazilian states / Prevalencia del tabaquismo y morbimortalidad por cáncer de pulmón en los estados brasileños

Introdução: O câncer de pulmão é uma doença grave, sendo a segunda maior causa de morte em todo o mundo, entretanto, em alguns países desenvolvidos, tornou-se já a primeira causa de morte. Cerca de 90% dos casos de neoplasia pulmonares são causados pela inalação da fumaça do cigarro. Objetivo: Correlacionar a prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros, além de demonstrar a associação destes com sexo e faixa etária. Métodos: Estudo de caráter ecológico acerca da prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros, nos períodos de 2013 e 2019, dividida por sexo e faixa etária. Foram utilizados bancos de coleta de dados como o Tabnet e Pesquisa Nacional de Saúde. Resultados: As maiores taxas de mortalidade e internações hospitalares foram do público masculino, em 2013, com taxa de 2,7 e 10, respectivamente, e em 2019 com 3,3 e 11,9, respectivamente. Ademais, a maior prevalência de tabagismo foi encontrada nos homens; entretanto seu índice tem caído, enquanto a quantidade de mulheres tabagistas tem aumentado. A Região Sul demonstrou maiores números de mortalidade em ambos os períodos estudados, com taxas de 4,9 e 5,8 por 100 mil habitantes, e morbidade hospitalar com 19,9 e 23,5 por 100 mil habitantes. Já a Região Norte se configurou com as menores prevalências: em 2013 apresentou taxa de óbito por câncer de pulmão de 1,0 e morbidade hospitalar de 3,5/100 mil habitantes, em 2019 apresentou taxa de mortalidade de 4,6 e internações de 1,6/100 mil habitantes. Os coeficientes de correlação de morbidade hospitalar e prevalência de tabagismo foram R2=0,0628, r=0,251 e p=0,042, enquanto os de mortalidade e prevalência de tabagismo foram R2=0,0337, r=0,183 e p=0,140. Conclusões: Na presente pesquisa, pode-se inferir que houve associação positiva na comparação entre taxa de morbidade hospitalar e prevalência de tabagismo; em contrapartida, não foi possível observar associação positiva na correlação da taxa de mortalidade por câncer de pulmão e prevalência de tabagismo.

Introduction: Lung cancer is a serious disease, being the second leading cause of death worldwide. Moreover, in some developed countries, it has already become the leading cause of death. About 90% of lung cancer cases are caused by cigarette smoking. Objective: To correlate the prevalence of smoking and lung cancer morbidity and mortality in Brazilian states, and to demonstrate their association with sex and age group as well. Methods: An ecological study on the prevalence of smoking and lung cancer morbidity and mortality in Brazilian states between 2013 and 2019, divided by sex and age group. The data collection databases Tabnet and National Health Survey were used. Results: The highest rates of mortality and hospital admissions were among men, in 2013 with a rate of 2.7 and 10, respectively, and in 2019 with 3.3 and 11.9, respectively. In addition, the highest prevalence of smoking was found in men, but this rate has fallen, while the number of women smokers has increased. The South region showed higher mortality rates in both periods studied, with rates of 4.9 and 5.8 per 100,000 inhabitants, and hospital morbidity with 19.9 and 23.5 per 100,000 inhabitants. The North region had the lowest prevalence, where in 2013, it had a death rate from lung cancer of 1.0 and hospital morbidity of 3.5/100 thousand inhabitants, and where in 2019, it had a mortality rate of 4.6 and hospitalizations of 1.6/100 thousand inhabitants. The correlation coefficients for hospital morbidity and smoking prevalence were R2=0.0628, r=0.251 and p=0.042, while for mortality and smoking prevalence, these were R2=0.0337, r=0.183 and p=0.140. Conclusions: In the present study, it can be inferred that there was a positive association between hospital morbidity rate and prevalence of smoking, while it was not possible to observe a correlation between lung cancer mortality rate and prevalence of smoking.

Introducción: El cáncer de pulmón es una enfermedad grave, siendo la segunda causa de muerte en todo el mundo, sin embargo, en algunos países desarrollados, ya se ha convertido en la primera causa de muerte. Alrededor del 90% de los casos de neoplasias pulmonares están causados por la inhalación del humo del cigarrillo. Objetivo: Correlacionar la prevalencia de tabaquismo y la morbimortalidad por cáncer de pulmón en los estados brasileños, además de demostrar la asociación de estos con el género y el grupo de edad. Métodos: estudio ecológico sobre la prevalencia de tabaquismo y morbimortalidad por cáncer de pulmón en los estados brasileños, dentro de los períodos 2013 y 2019, divididos por sexo y grupo de edad. Se utilizaron bancos de recogida de datos como Tabnet y la Encuesta Nacional de Salud. Resultados: las mayores tasas de mortalidad e ingresos hospitalarios se dieron en el público masculino, en 2013 con una tasa de 2,7 y 10, respectivamente, y en 2019 con 3,3 y 11,9, respectivamente. Además, la mayor prevalencia del tabaquismo se encontró en los hombres, sin embargo, su tasa ha disminuido, mientras que la cantidad de mujeres fumadoras ha aumentado. La región Sur presentó cifras más altas de mortalidad en ambos periodos estudiados, con tasas de 4,9 y 5,8 por 100.000 habitantes, y de morbilidad hospitalaria con 19,9 y 23,5 por 100.000 habitantes. Mientras que la región Norte se configuró con las prevalencias más bajas, en 2013 presentó una tasa de mortalidad por cáncer de pulmón de 1,0 y una morbilidad hospitalaria de 3,5/100.000 habitantes, en 2019 presentó una tasa de mortalidad de 4,6 y hospitalizaciones de 1,6/100.000 habitantes. Los coeficientes de correlación para la morbilidad hospitalaria y la prevalencia del tabaquismo fueron R2=0,0628, r=0,251 y p=0,042, mientras que para la mortalidad y la prevalencia del tabaquismo fueron R2=0,0337, r=0,183 y p=0,140. Conclusiones: En la presente investigación se puede inferir que existe una asociación positiva en la comparación entre la tasa de morbilidad hospitalaria y la prevalencia de tabagismo, en contrapartida, no fue posible observar una asociación positiva en la correlación de la tasa de mortalidad por cáncer de pulmón y la prevalencia de tabagismo.

Manifestaciones clínicas e histopatológicas de la eritroplasia bucal en pacientes fumadores de tabaco

Fundamento la eritroplasia es la lesión precancerosa más agresiva de la cavidad oral, con un gran potencial de transformación maligna. Al momento de practicar la biopsia y analizar la muestra, puede aparecer una displasia severa o un carcinoma invasivo. Objetivo describir las manifestaciones clínicas e histopatológicas de la eritroplasia bucal en pacientes fumadores activos de tabaco. Métodos se realizó un estudio descriptivo y transversal, con 12 fumadores diagnosticados clínica e histopatológicamente con eritroplasia bucal, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Saturnino Lora Torres, de Santiago de Cuba. Para la recolección del dato primario se confeccionó una encuesta con las variables: edad, sexo, diagnóstico clínico, tiempo en el hábito de fumar, diferentes formas de consumir tabaco, localización anatómica y estudio histopatológico de la enfermedad. Resultados prevaleció el sexo masculino, el grupo etario de 60 y más años, y los fumadores convencionales de 21 y más años. El infiltrado inflamatorio crónico intenso y la displasia epitelial severa resultaron los cambios hísticos más comunes. Los signos displásicos tisulares mayormente implicados fueron la alteración de los clavos interpapilares, pérdida de la polaridad de las células basales e hiperplasia de las células del estrato basal; mientras que los displásicos citológicos más relevantes resultaron la hipercromasia de núcleos y nucleolos, el pleomorfismo nuclear y el aumento de la relación núcleo-citoplasma, siendo el paladar blando el sitio más frecuente. Conclusiones todos los pacientes fumadores mostraron lesiones eritroplásicas al examen clínico bucal, lo cual fue confirmado por estudio histopatológico.

Foundation erythroplasia is the most aggressive precancerous lesion in the oral cavity, with great potential for malignant transformation. At the time of performing the biopsy and analyzing the sample, severe dysplasia or invasive carcinoma may appear. Objective to describe the clinical and histopathological manifestations of oral erythroplasia in patients who are active tobacco smokers. Methods a descriptive and cross-sectional study was carried out, with 12 smokers clinically and histopathologically diagnosed with oral erythroplasia, attended in the Specialties Polyclinic stomatological consultation of the Saturnino Lora Torres Hospital, in Santiago de Cuba. For the collection of the primary data, a survey was made with the variables: age, sex, clinical diagnosis, time in the smoking habit, different ways of consuming tobacco, anatomical location and histopathological study of the disease. Results the male sex, the age group of 60 years old and over, and conventional smokers of 21 and over prevailed. Intense chronic inflammatory infiltrate and severe epithelial dysplasia were the most common tissue changes. The tissue dysplastic signs most involved were alteration of the interpapillary nails, loss of polarity of the basal cells, and hyperplasia of the basal layer cells; while the most relevant cytological dysplastics were hyperchromasia of nuclei and nucleoli, nuclear pleomorphism and increased nucleus-cytoplasm ratio, with the soft palate being the most frequent site. Conclusions all the smoking patients showed erythroplastic lesions on oral clinical examination, which was confirmed by histopathological study.

O impacto das diversas formas de tabagismo nos acadêmicos da área da saúde / The impact of different forms of smoking on health academics

A Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) define a Doença Pulmonar Obstrutiva Crônica (DPOC) como um distúrbio progressivo e irreversível. Nessa patologia ocorre um processo inflamatório crônico frente a exposição a gases tóxicos, principalmente advindos do tabaco. O cigarro é responsável por matar mais de 8 milhões de consumidores por ano, isso corresponde a 50% dos usuários. Objetivo: estimar a prevalência do tabagismo e possíveis doenças no sistema respiratório entre acadêmicos. Métodos: Trata-se de uma pesquisa observacional do tipo transversal em que se aplicou questionários aos alunos da área da saúde da Universidade Cesumar. Todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido e eram maiores de 18 anos. A amostra foi composta por 336 estudantes, desta foram excluídas 43 respostas preenchidas de forma incorreta, restando 293 participantes. Os dados foram submetidos à estatística analítica e teste do qui-quadrado com nível de significância de 5%. Resultados: A prevalência do tabagismo foi de 26,96%, não fumantes são 62,46% e 10,58% são fumantes passivos. O dispositivo mais utilizado foi o cigarro eletrônico com 64,55% e o narguilé com 63,29%. Com relação a tentativa de suspender o uso, 36,71% relataram apresentar ansiedade. Os fumantes informaram ter infecções respiratórias frequentes, secreção, tosse e espirros com significância estatística (p<0,05). Pneumonia apresentou tendência crescente conforme maior tempo de tabagismo. Conclusão: Observou-se que a taxa de acadêmicos tabagistas é considerável, o tempo de uso varia de 3 a 5 anos e a maioria iniciou na adolescência sob influência de amigos

The Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) defines Chronic Obstructive Pulmonary Disease (COPD) as a progressive and irreversible disorder. In this pathology, there is a chronic inflammatory process due to exposure to toxic gases, mainly from tobacco. Cigarettes are responsible for killing more than 8 million consumers a year, this corresponds to 50% of users. Objective: to estimate the prevalence of smoking and possible diseases of the respiratory system among students. Methods: This is a cross-sectional observational research in which questionnaires were applied to students in the health area of the University Cesumar. All participants signed the Informed Consent Form and were over 18 years of age. The sample consisted of 336 students, from which 43 incorrectly filled answers were excluded, leaving 293 participants. Data were submitted to analytical statistics and the chi-square test with a significance level of 5%. Results: The prevalence of smoking was 26.96%, non-smokers are 62.46% and 10.58% are passive smokers. The most used device was the electronic cigarette with 64.55% and the hookah with 63.29%. Regarding the attempt to discontinue use, 36.71% reported having anxiety. Smokers reported having frequent respiratory infections, secretion, coughing and sneezing with statistical significance (p<0.05). Pneumonia showed an increasing trend with longer smoking time. Conclusion: It was observed that the rate of academic smokers is considerable, the time of use varies from 3 to 5 years and most started in teenage years under the influence of friends

Beneficios del impuesto a los cigarros en México: análisis por sexo y quintil de ingreso / Benefits of the cigarette tax in Mexico, by sex and income quintile / Benefícios do imposto sobre cigarros no México: análise por sexo e quintil de renda

RESUMEN Objetivo. Estimar los beneficios económicos y en salud, por sexo y por quintil de ingreso, del incremento de los precios de los cigarros mediante impuestos en México. Métodos. Con un modelo de costo-efectividad extendido (ECEA, por su sigla en inglés) se estimaron los beneficios distributivos en mujeres y hombres con un escenario de incremento del precio de los cigarros de 44% (de 56,4 pesos mexicanos [MX$] a MX$81,2 por cajetilla), como resultado de triplicar el impuesto específico actual (de MX$0,49/cigarro a MX$1,49/cigarro). El modelo se calibró con fuentes oficiales de información nacional Resultados. Con el incremento del impuesto de un peso por cigarro, cerca de 1,5 millones de fumadores abandonarían el consumo (351 300 mujeres y 1,1 millón de hombres). Así, se evitarían aproximadamente 630 000 muertes prematuras atribuibles al tabaco. La reducción de la carga de enfermedad permitiría ahorros para el sector salud cercanos a MX$42 800 millones y evitaría que más de 250 000 personas (entre ellas, 50 200 mujeres fumadoras) cayeran en situación de pobreza. Además, se recaudarían MX$16 200 millones adicionales por año, de los cuales el quintil más bajo aportaría menos de 3% (1% en el caso de las mujeres de menores ingresos). Conclusiones. La epidemia de tabaquismo tiene patrones claramente diferenciados entre mujeres y hombres y reflejan un componente de género. Si bien los beneficios del impuesto al tabaco en México tendrían magnitudes relativas al estado actual de la epidemia en cada caso, estos podrían contribuir a un objetivo más amplio de justicia social mediante la reducción de las inequidades de género.

ABSTRACT Objective. Estimate economic and health benefits, by sex and income quintile, of tax-based cigarette price increases in Mexico. Methods. An extended cost-effectiveness analysis (ECEA) model was used to estimate distributional benefits for women and men in the scenario of a 44% increase in the price of cigarettes (from 56.4 Mexican pesos [MX$] to MX$81.2 per pack), as a result of tripling the current specific excise tax (from MX$0.49/cigarette to MX$1.49/cigarette). The model was calibrated with official national information sources. Results. With a tax increase of one peso per cigarette, about 1.5 million smokers would quit (351 300 women and 1.1 million men). This would prevent approximately 630 000 smoking-attributable premature deaths. Reducing the burden of disease would save the health sector close to MX$42.8 billion and prevent more than 250 000 people (including 50 200 women smokers) from falling into poverty. It would also result in an additional MX$16.2 billion in revenue per year, of which the lowest income quintile would contribute less than 3% (1% for low-income women). Conclusions. The tobacco epidemic has clearly differentiated patterns between women and men, reflecting a gender component. While the tobacco tax in Mexico would have great benefits with respect to the current state of the epidemic, this could also contribute to the broader goal of social justice by reducing gender inequities.

RESUMO Objetivo. Estimar os benefícios econômicos e de saúde, por sexo e quintil de renda, do aumento dos preços dos cigarros por meio de impostos no México. Métodos. Com um modelo de análise ampliada de custo-efetividade (ECEA, na sigla em inglês), foram estimados os benefícios distributivos em mulheres e homens com um cenário de aumento de 44% no preço dos cigarros (de 56,4 pesos mexicanos [MX$] para MX$ 81,2 por maço), como resultado da triplicação do imposto específico atual (de MX$ 0,49/cigarro para MX$ 1,49/cigarro). O modelo foi calibrado com fontes oficiais de informação nacional. Resultados. Com o aumento do imposto de um MX$ por cigarro, cerca de 1,5 milhão de fumantes abandonariam o consumo (351.300 mulheres e 1,1 milhão de homens). Assim, seriam evitadas aproximadamente 630.000 mortes prematuras atribuíveis ao tabaco. A redução da carga de doenças permitiria uma economia para o setor da saúde de cerca de MX$ 42,8 bilhões e evitaria que mais de 250.000 pessoas (incluindo 50.200 mulheres fumantes) caíssem na pobreza. Além disso, seriam arrecadados MX$ 16,2 bilhões adicionais por ano, dos quais o quintil mais baixo contribuiria com menos de 3% (1% no caso de mulheres de baixa renda). Conclusões. A epidemia de tabagismo tem padrões claramente diferenciados entre mulheres e homens e reflete um componente de gênero. Embora os benefícios do imposto sobre o tabaco no México tenham importância relativa no atual estado da epidemia em cada caso, poderiam contribuir para um objetivo mais amplo de justiça social ao reduzir as desigualdades de gênero.

Cigarro Eletrônico: Mocinho ou vilão? / Cigarrillo Electrónico: ¿Bueno o malo? / Electronic Cigarette: Good guy or bad guy?

RESUMEN Objetivo: Discutir los efectos sobre la salud causados por el uso de cigarrillos electrónicos. Material y métodos: Para ello, se realizó una búsqueda en la base de datos PubMed/Medline de artículos completos publicados en los últimos 10 años. Se utilizaron un total de 21 artículos, según los criterios de inclusión establecidos, con mayor prevalencia de estudios transversales. Resultados: Se encontró que los cigarrillos electrónicos pueden incluso ayudar en el cese del tabaquismo convencional, sin embargo, sus usuarios no están exentos de sufrir complicaciones de salud sistémicas. Estos contienen sustancias tóxicas y no deben considerarse completamente seguros e inofensivos. Conclusiones: se necesitan más estudios para determinar las implicaciones para la salud a largo plazo del uso de este deben considerarse completamente seguros e inofensivos.

SUMMARY Objective: to discuss the health effects caused by the use of electronic cigarettes. Material and Methods : A search was performed in the PubMed/Medline database of complete articles published in the last 10 years. A total of 21 articles were used, according to the established inclusion criteria, with a higher prevalence of cross-sectional studies. Results: It was verified that electronic cigarettes may even help in the cessation of conventional smoking, however, their users are not exempt from suffering systemic health complications. They present toxic substances and should not be considered totally safe and harmless. Conclusions : Further studies are still needed to determine the implications of the use of this electronic device on the health of its users in the long term.

Smoking among industrial workers in Brazil: association with sociodemographic factors, alcohol consumption, and stress levels / Tabagismo em trabalhadores da indústria no Brasil: associação com fatores sociodemográficos, consumo de bebidas alcoólicas e nível de estresse

ABSTRACT Objective: To determine the prevalence of smoking, as well as its association with sociodemographic factors, alcohol consumption, and stress levels, among industrial workers in Brazil. Methods: This was a nationwide survey, conducted in 24 capitals in Brazil through the application of a pre-tested questionnaire. The response to the question "What is your smoking status?" was the outcome variable. To determine the associations, we performed Poisson regression analyses in which the inputs were blocks of variables: block 1 (age and marital status); block 2 (level of education and gross family income); block 3 (geographic region); and block 4 (alcohol consumption and stress level). All analyses were stratified by gender. Results: The sample consisted of 47,328 workers ≥ 18 years of age, of whom 14,577 (30.8%) were women. The prevalence of smoking was 13.0% (15.2% in men and 7.9% in women). Advancing age, alcohol consumption, and a high stress level were positively associated with smoking. A lower risk of smoking was associated with being married, having a higher level of education, and living in the northeastern region of the country (versus the southern region). Conclusions: The prevalence of smoking was greater in men than in women. Alcohol consumption and high stress levels appear to promote smoking.

RESUMO Objetivo: Determinar a prevalência de tabagismo e sua associação com fatores sociodemográficos, consumo de bebidas alcoólicas e nível de estresse em trabalhadores industriários no Brasil. Métodos: Inquérito nacional realizado em 24 capitais brasileiras através da aplicação de um questionário previamente testado. A variável de desfecho foi obtida através da pergunta: "Com relação ao fumo, qual a sua situação?". Para determinar as associações, foram realizadas análises de regressão de Poisson com entrada de variáveis em blocos: nível 1 (idade e estado civil); nível 2 (escolaridade e renda familiar bruta); nível 3 (região geográfica) e nível 4 (consumo de bebidas alcoólicas e nível de estresse). Todas as análises foram estratificadas por sexo. Resultados: A amostra foi composta por 47.328 trabalhadores com 18 anos ou mais de idade, sendo 14.577 mulheres (30,8%). A prevalência de tabagismo foi de 13,0% (15,2% em homens e 7,9% em mulheres). Aumento da faixa etária, consumo de bebidas alcoólicas e nível de estresse elevado associaram-se positivamente ao tabagismo. Estar casado, ter maior nível de escolaridade e residir na região nordeste do país (quando comparada com a região sul) estiveram associados com menores probabilidades de tabagismo. Conclusões: A prevalência de tabagismo variou entre os sexos, sendo maior entre os homens. O consumo de bebidas alcoólicas e o nível de estresse elevado favoreceram o uso do tabaco.

Frecuencia de factores de riesgo coronarios en pacientes con infarto agudo de miocardio en el Servicio de Cardiología del Hospital de Clínicas

RESUMEN Introducción: el infarto agudo de miocardio es una complicación grave de la enfermedad cardiovascular y se conocen varios factores de riesgo coronarios. Objetivo: determinar la frecuencia de factores de riesgo coronarios en pacientes con infarto agudo de miocardio en el Servicio de Cardiología del Hospital de Clínicas. Material y método: diseño observacional, descriptivo, retrospectivo de corte transversal, que incluyó a pacientes adultos con diagnóstico de infarto agudo de miocardio del Servicio de Cardiología del Hospital de Clínicas desde enero de 2015 a marzo de 2018. Se determinaron las variables demográficas, motivo de consulta, antecedentes familiares de cardiopatía isquémica y la presencia de factores de riesgo coronario. Resultados: se incluyeron 231 sujetos, la edad media fue 63±1 años, 138 (60%) fueron varones. El motivo de consulta más frecuente fue el dolor precordial (71%). La mayoría presentó infarto sin elevación del segmento ST (63,6%). Los factores de riesgo coronario más frecuentes fueron la hipertensión arterial (89%), el sedentarismo (60%) y el consumo de tabaco (55,4%) sobre todo en los pacientes mayores de 65 años. Conclusión: los factores de riesgo coronario más frecuentes fueron la hipertensión arterial, el sedentarismo y el tabaquismo, predominando en mayores de 60 años.

ABSTRACT Introduction: Acute myocardial infarction is a serious complication of cardiovascular disease and several coronary risk factors are known. Objective: To determine the frequency of coronary risk factors in patients with acute myocardial infarction in the Cardiology Service of the Hospital de Clínicas. Material and method: Observational, descriptive, retrospective cross-sectional design which included adult patients diagnosed with acute myocardial infarction from the Cardiology Service of the Hospital de Clínicas from January 2015 to March 2018. Demographic variables, reason of consultation, family history of ischemic heart disease and the presence of coronary risk factors were determined. Results: Two hundred thirty-one subjects were included, the mean age was 63±1 years, and 138 (60%) were male. The most frequent reason for consultation was precordial pain (71%). The majority presented infarction without elevation of the ST segment (63.6%). The most frequent coronary risk factors were arterial hypertension (89%), sedentary lifestyle (60%) and tobacco consumption (55.4%), especially in patients older than 65 years. Conclusion: The most frequent coronary risk factors were arterial hypertension, sedentary lifestyle and smoking, predominating in people over 60 years of age.

Factores de riesgo de enfermedad cardiovascular en estudiantes universitarios / Cardiovascular Risk Factors in University Students

RESUMEN Introducción: El comienzo de los estudios universitarios está asociado a cambios en el estilo de vida que pueden predisponer a la aparición de factores de riesgo cardiovascular (FRCV). Objetivo: Determinar la prevalencia de FRCV en los estudiantes que en 2017 cursaron el primer año de la carrera de Medicina en la Universidad Nacional del Litoral. Materiales y métodos: Estudio analítico, de corte transversal. Se realizó el muestreo consecutivo de 463 estudiantes de primer año de Medicina. Los FRCV considerados fueron los siguientes: IMC (sobrepeso/obesidad), circunferencia de cintura (criterios IDF), tensión arterial (presión arterial limítrofe y HTA), actividad física (nivel bajo), consumo de tabaco (exfumador y fumador actual), consumo de alcohol (consumo excesivo ocasional) y calidad de la dieta (poco saludable y mejorable). Los resultados se expresaron en porcentajes. Se realizó una prueba de hipótesis para la diferencia de proporciones, para determinar diferencias según sexo (α = 0,05 e IC del 95%). Resultados: Se evaluaron 457 estudiantes (18-21 años), 68% eran de sexo femenino. La prevalencia de presión arterial limítrofe fue significativamente mayor en varones (28,9%). La misma tendencia se observó para HTA. El 23% presentó exceso de peso y 18% circunferencia de cintura elevada, sin diferencias entre sexos. El 17% fumaban o fumaron en el pasado. El consumo de alcohol excesivo ocasional fue mayor en los varones, mientras que un bajo nivel de actividad física fue superior en las mujeres. Conclusión: La mayoría de los estudiantes presentaba al menos un FRCV. Se destaca la elevada prevalencia de varones con tensión arterial limítrofe y con HTA, y el exceso de peso en ambos sexos. La calidad de la dieta necesita cambios en la mayoría de los estudiantes.

ABSTRACT Background: The beginning of university studies is usually associated with lifestyle changes, which can predispose to the development of cardiovascular risk factors (CVRF). Objective: The aim of this study was to determine the prevalence of CVRF in first-year medical students attending Universidad Nacional del Litoral during 2017. Methods: We conducted an analytical, cross-sectional study with consecutive sampling of 463 first-year students of the School of Medicine. The following CVRF were considered: body mass index (overweight/obesity), waist circumference (International Diabetes Federation criteria), blood pressure (bordeline blood pressure and hypertension), physical activity (low level), tobacco use (current smoker or history of former smoking), alcohol intake (binge drinking) and diet quality (unhealthy and unhealthy but manageable). The results were expressed as percentages. A hypothesis test was performed to determine a difference in proportions according to sex (α=0.05 and 95% CI. Results: A total of 457 students (18-21 years) were evaluated; 68% were women. The prevalence of borderline blood pressure and hypertension was significantly greater in men (28.9%). Overweight was present in 23% of the students and 18% had high waist circumference, without differences between sexes. The prevalence of current smoking or former smoking was present in 17% of the students. Binge drinking was more common in men, while the prevalence of physical inactivity was more frequent in women. Conclusion: Most students had at least one CVRF. The high prevalence of men with borderline blood pressure and hypertension and overweight in both sexes is emphasized. Most students have to change the diet quality.

Evaluación de la dependencia física y psicológica al tabaco en fumadores mexicanos adultos, Encodat 2016 / Evaluation of physical and psychological dependence in Mexican adult smokers, Encodat 2016

Resumen: Objetivo: Evaluar la dependencia física y psicológica de los fumadores mexicanos y su asociación con factores físicos, psicológicos y sociales. Material y métodos: A partir de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016 (n=7 331), se analizó la escala de dependencia física a la nicotina de Fagerström (FTND) y la escala corta de dependencia psicológica al tabaco (TAPDSc). Se realizaron análisis bivariados y regresiones logísticas ordinales generalizadas para evaluar los factores asociados. Resultados: 82.3% de fumadores diarios y 98.8% de ocasionales reportaron dependencia física leve, mientras que 47.9 y 37.9%, respectivamente, presentaron dependencia psicológica moderada. La edad de inicio temprana de consumo de tabaco, uso de drogas, consumo alto de alcohol y malestar emocional se asociaron con niveles altos de dependencia psicológica en todos los fumadores. Conclusión: El uso exclusivo de FNTD no permite evaluar adecuadamente a los fumadores mexicanos. La dependencia física y psicológica al tabaco debe ser diagnosticada con escalas independientes y validadas en esta población.

Abstract: Objective: To evaluate the physical and psychological dependence to tobacco of Mexican smokers and its association with physical, psychological and social factors. Materials and methods: The 2016 National Alcohol and Tobacco Drug Consumption Survey (n=7 331) was analyzed using the Fagerström nicotine physical dependence scale (FTND) and the short scale of psychological dependence on tobacco (TAPDSc). Bivariate analyzes and generalized ordinal logistic regressions were performed to evaluate the associated factors. Results: 82.3% of daily smokers and 98.8% of occasional smokers reported mild physical dependence, while 47.9 and 37.9% respectively reported moderate psychological dependence. The age of initiation of tobacco use, drug use, high alcohol consumption and high emotional distress were associated with high levels of psychological dependence in all smokers. Conclusion: The exclusive use of FTND does not allow to adequately evaluate Mexican smokers. The physical and psychological dependence on tobacco should be assessed with independent and validated scales in this population.

Does everyone who quit smoking gain weight? A real-world prospective cohort study / Todos os que param de fumar ganham peso? Estudo prospectivo de coorte do mundo real

ABSTRACT Objective: To evaluate weight changes after 12 months of biochemically confirmed smoking abstinence, comparing patients who lost weight or maintained their baseline weight with those who gained weight. Methods: This was a real-world prospective cohort study conducted at the Outpatient Smoking Cessation Clinic of São Lucas Hospital, in the city of Porto Alegre, Brazil, between 2010 and 2016. The patients evaluated received intensive smoking cessation counseling, focused especially on weight issues, together with pharmacotherapy, and were followed for 12 months. The baseline and final weights were measured. Continuous abstinence was confirmed by determining the concentration of exhaled carbon monoxide (eCO). Results: Of a total of 348 patients evaluated, 161 (46.2%) achieved continuous abstinence (eCO < 10 ppm) over the 12-month follow-up period. Of those 161 patients, 104 (64.6%) maintained their initial weight or had a weight change of no more than 5% in relation to their baseline weight, whereas the remaining 57 (35.4%) had a weight gain of more than 5%, 18 of those patients showing a > 10% increase over their baseline weight. The number needed to harm (i.e., the number of patients required in order to detect one patient with a weight increase) was calculated to be 3.6 (95% CI: 2.8-5.4). Conclusions: Weight gain is not necessarily associated with smoking cessation, and smokers who are motivated to quit should be informed of that fact. This information could also be useful for addressing smokers who are still undecided because of possibility of weight gain.

RESUMO Objetivo: Avaliar as alterações de peso após 12 meses de abstinência do tabagismo confirmada bioquimicamente, comparando pacientes que perderam peso ou mantiveram o peso basal com os que ganharam peso. Métodos: Estudo prospectivo de coorte do mundo real realizado no Ambulatório de Cessação do Tabagismo do Hospital São Lucas, em Porto Alegre (RS), entre 2010 e 2016. Os pacientes avaliados receberam aconselhamento intensivo sobre cessação do tabagismo, focado especialmente em questões do peso, bem como farmacoterapia, e foram acompanhados durante 12 meses. Foram medidos os pesos basal e final. A abstinência contínua foi confirmada pela determinação da concentração de monóxido de carbono no ar exalado (COex). Resultados: Do total de 348 pacientes avaliados, 161 (46,2%) alcançaram abstinência contínua (COex < 10 ppm) durante os 12 meses de acompanhamento. Desses 161 pacientes, 104 (64,6%) mantiveram o peso inicial ou tiveram alteração de peso de não mais de 5% em relação ao peso basal, enquanto os 57 restantes (35,4%) tiveram ganho de peso de mais de 5%, com 18% deles apresentando aumento > 10% em relação ao peso basal. O número necessário para causar dano (isto é, o número de pacientes necessário para detectar um paciente com aumento de peso) foi calculado em 3,6 (IC95%: 2,8-5,4). Conclusões: O ganho de peso não está necessariamente associado à cessação do tabagismo, e os fumantes que estão motivados para parar de fumar devem ser informados desse fato. Essa informação também pode ser útil para abordar os fumantes que ainda estão indecisos em razão da possibilidade de ganho de peso.

Depression among smokers of a web-based intervention to quit smoking: a cross-sectional study / Depresión entre fumadores de una intervención en línea para dejar el tabaco: un estudio transversal

Abstract: Introduction: Web-based interventions for smoking cessation are an innovative strategy to reduce the burden of smoking. Although many web-based interventions are freely available in many languages and have proven to be effective, so far no study has covered in detail the association between depression and smoking. Objective: The aim of this study was to evaluate the prevalence of depression among users of the Viva sem Tabaco, a web-based intervention for smoking cessation. Method: This was a retrospective cross-sectional study. In the internet-based intervention participated 1 433. Inclusion criteria were: being 18 years or older and a smoker; exclusion criteria were: omitting to fill out two questions of the screening depression questionnaire PHQ-2 and having made multiple accesses within a limited time span, characterizing invalid access. At the end, the sample had 461 participants. Participants answered questions related to sociodemographic characteristics, tobacco history, depression (PHQ-2 and PHQ-9), alcohol use, and intervention use. Results: Participants average age was 42.3 years (SD = 12.1). Most participants were female (67%), and 70% were employed during the time of the study. From the total sample, 36.4% of the participants presented depression according to PHQ-2. Being screened with depression was associated with tobacco dependence (OR = 1.10; 95% CI = 1.00, 1.20), and associated with not having a job (OR = .53; 95% CI = .29, .97). Discussion and conclusion: Depression may be a factor to be considered in programs that offer support to quit smoking through the internet for Portuguese Speakers.

Resumen: Introducción: Las intervenciones en línea para la interrupción del tabaquismo son una estrategia innovadora para reducir el nivel de consumo de tabaco. Aunque hay muchas intervenciones en línea gratuitas en varios idiomas que han demostrado ser eficaces, ningún estudio ha abarcado detalladamente la asociación entre depresión y tabaquismo. Objetivo: El objetivo de este estudio fue evaluar la prevalencia de depresión entre usuarios de una intervención en línea para dejar de fumar. Método: Se trata de un estudio transversal retrospectivo. 1 433 participantes fueron invitados para participar de la intervención mediada por internet. Los criterios de inclusión fueron tener 18 años o más y ser fumador; los criterios de exclusión fueron no haber marcado dos preguntas del cuestionario de detección de depresión PHQ-2 y haber realizado múltiples accesos dentro de un lapso de tiempo limitado, lo que se caracterizó como un acceso no válido. Los participantes (N = 461) respondieron a preguntas relacionadas con características sociodemográficas, historia del tabaco, depresión (PHQ-2 y PHQ-9), uso de alcohol y uso de la intervención. Resultados: De la muestra total, el 36.4% de los participantes presentaron depresión de acuerdo con el PHQ-2. La depresión se asoció con la dependencia del tabaco (OR = 1.10; 95% IC = 1.00, 1.20) y asociada con no tener un empleo (OR = .53; 95% IC = .29, .97). Discusión y conclusión: La depresión es un factor que se debe considerar en los programas que ofrecen apoyo para dejar de fumar a través de Internet para hablantes de portugués.

Cotinina urinaria en embarazadas expuestas al humo ambiental del tabaco que concurren a controles prenatales en la ciudad de Gualeguaychú / Urinary cotinine values and exposure to environmental snuff in pregnant women who attend prenatal examinations in the city of Gualeguaychú

El tabaco es uno de los factores de riesgo prevenibles más importante de las enfermedades crónicas no trasmisibles (ECNT). Los efectos de fumar no están limitados a los fumadores activos, involucran además a los individuos que sufren los efectos de los tóxicos del humo del tabaco ambiental (HTA): los fumadores pasivos. Las mujeres embarazadas fumadoras activas o expuestas al HTA son una población muy sensible a los efectos tóxicos del tabaco, ya que los mismos repercuten también sobre el feto en formación. La cotinina es en la actualidad el marcador biológico más adecuado para medir exposición al HTA tanto activa como pasiva. Objetivo: determinar el nivel de cotinina en mujeres embarazadas que manifestaron ser fumadoras pasivas, relacionando los valores obtenidos con los días de exposición manifestados. Materiales y métodos: se trabajó con 443 embarazadas que concurrieron a centros de salud públicos y a un centro privado de Gualeguaychú para su control prenatal, solicitándoles a las que manifestaron estar expuestas al HTA una muestra de orina para el dosaje de cotinina. Se aplicó un diseño de tipo no experimental, retrospectivo y de corte transversal. El dosaje de cotinina se realizó en orina, empleando una metodología quimioluminiscente. Previamente se obtuvo un valor referencial de cotinina urinaria inferior a los 15,2 ng/ml para el 98 % de sujetos no fumadores no expuestos al HTA. Resultados: los análisis de los niveles de cotinina en las embarazadas fumadoras pasivas revelaron que, el 82 % en los centros públicos y el 42 % en el centro privado, presentaron un nivel de cotinina superior a 15,2 ng/ml. Teniendo en cuenta los días de exposición, el registro promedio de cotinina para las que manifestaron estar expuestas los últimos siete días fue de 52,3 ng/ml en el sector público y 64,1 ng/ml en el privado. Discusión y conclusiones: la medición de cotinina resulta de utilidad para tener datos fidedignos de la exposición pasiva al HTA. En los centros públicos el 82 % de las embarazadas que manifestaron estar expuestas tenían valores de cotinina urinaria que coincidían con lo expresado, mientras que en el centro privado el 42 % de las que manifestaron la misma situación presentaba valores del indicador que denotaban exposición al tabaco. Se observó un aumento progresivo del promedio del indicador biológico de acuerdo a los días de exposición en ambos sectores, superando los 50ng/ml cuando la exposición declarada fue durante los últimos 7 días, lo que es indicativo de una exposición al HTA severa. El interés y preocupación manifestados por las embarazadas que participaron en este estudio indica que la implementación de este tipo de diagnóstico puede contribuir a las campañas de prevención contra el consumo de tabaco y promover el derecho de quienes no fuman a vivir en ambientes saludables libres de los compuestos tóxicos del mismo.

Tobacco is one of the preventable risk factors, which is most important in the chronic non-communicable diseases (NCDs). The effects of smoking are not limited to active smokers; it also involves individuals who suffer the effects of environmental tobacco smoke (ETS): passive smokers. Pregnant women who are active smokers or exposed to ETS are a very sensitive population to the toxic effects of snuff, since they also affect the developing fetus. Cotinine is currently the most suitable biomarker for measuring ETS exposure both active and passive. Objective: To determine the level of cotinine in pregnant women who reported being passive smokers, relating the values obtained with the indicated days of exposure. Materials and methods: We worked with 443 pregnant women attending public health centers and a private centre in Gualeguaychú for prenatal care, asking to be exposed to ETS showed a urine sample for cotinine dosage. We performed a non-experimental, retrospective and cross-sectional design. The dosage of cotinine in urine was performed using a chemiluminescent method. Previously we obtained a reference value of urinary cotinine less than 15,2ng/ml for 98% of non smokers unexposed to ETS. Results: The analysis of cotinine levels in passive smoking pregnant women show tHTA in public centers, 82% has a cotinine level greater than 15,2ng/embaml, whereas in the private centre, 42% have the same range values. Considering the days of exposure, the average cotinine log for those who said were exposed for the past seven days, was 52.32 ng/ml in the public sector and 64.17 ng/ml in the private one. Discussion and conclusion: The measurement of cotinine is useful to have reliable data from passive exposure to ETS. In public centers, 82% of pregnant women who said were exposed had urinary cotinine levels consistent with the statement, while in the private centre the 42% who said had the same situation had indicator values denoting exposure to snuff. There was a progressive increase in average biological indicator according to the days of exposure in both sectors, exceeding 50ng/ml when the declared exposure was during the last 7 days, which is indicative of a severe ETS exposure. The interest and concern expressed by the pregnant women who participated in this study indicates HTA the implementation of this kind of diagnosis may contribute to prevention campaigns against snuff consumption and promote the right of nonsmokers to live in healthy environments free of the toxic compounds thereof.

Eficacia y seguridad del uso de medicamentos para la cesación de la adicción al tabaco: revisión de guías de práctica clínica / Efficacy and safety of medication use for the cessation of tobacco addiction: Are view of Clinical Practice Guidelines

Objetivo Revisar la eficacia y seguridad de medicamentos para cesación del tabaquismo en el contexto de construcción de guías de práctica clínica (GPC). Métodos Revisión sistemática de GPC para adaptación mediante ADAPTE. Los desenlaces fueron cesación ≥6 meses y seguridad de las intervenciones. Las GPC se calificaron por pares con DELBI. Se extrajeron resultados de estudios agregativos incluidos en las guías seleccionadas. Resultados Los fármacos duplican la cesación comparados con placebo (tasas de 25,0 % hasta 27,0 % al combinarse con consejería). Los mayores incrementos en cesación se obtienen con ansiolíticos y antidepresivos (8,7% a 19,4%), y los menores con terapia de reemplazo nicotínico -TRN- (5,2% a 12,9%). La nortriptilina tiene eficacia similar al bupropion (aproximadamente 10,0 %). Con limitadas excepciones (parche e inhalador, tabletas y bupropion), las combinaciones de medicamentos no incrementan la abstinencia. Conclusiones TRN, vareniclina, bupropion y nortriptilina son eficaces para dejar de fumar. Las combinaciones de medicamentos requieren más evidencia y deberían restringirse a personas con alta dependencia o con falla terapéutica inicial. Serían deseables análisis de costo-efectividad para valorar implementación de programas en países en desarrollo.

Objective To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG). Methods A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained. Results Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates. Conclusions NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.

Predictores del consumo de tabaco en jóvenes chilenos: inicio y mantenimiento / Predictors of consumption in Chilean adolescents tobacco: initiation and maintenance

El consumo de cigarrillos en adolescentes es un importante problema de salud en Chile, sin embargo poco se sabe sobre los determinantes en esta población. En este estudio se examinaron los predictores de diferentes niveles de consumo de cigarrillos en adolescentes chilenos usando la base de datos de la Encuesta Mundial de Tabaquismo Juvenil que incluyó a 8.258 adolescentes. Los resultados muestran que las creencias sobre el atractivo físico de los fumadores, la influencia de los amigos y la facilidad de acceso a los cigarrillos, predicen todos los niveles de consumo. Se encontraron diferencias en la influencia de las creencias sobre los efectos de los cigarrillos en la salud, la influencia de amistades que fuman y de la familia dependiendo de cómo se evalúa consumo de cigarrillos. Estos resultados sugieren que los predictores de consumo en adolescentes difieren dependiendo del nivel de consumo y por lo tanto para comprender en cabalidad este problema es necesario evaluar los distintos niveles de consumo.

Cigarette use is a major health problem among adolescents in Chile, but little is known about the determinants of use in this population. In this study, the predictors of different levels of cigarette smoking in Chilean adolescents were, examined using data from the Global Youth Tobacco Survey which included 8.258 adolescents. The findings suggest that beliefs about physical attractiveness of smokers, the influence of friends and the easy access to cigarettes, predict all levels of consumption. Differences were found differences in the influence of beliefs about health effects, friends who smoke and family influences depending on how smoking is assessed. These results suggest that predictors of cigarette use among adolescents differ depending on the level of use and therefore to further understanding of this problem, it is necessary to examine the different levels of use.