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.

Norma técnica de salud para inspecciones de ambientes 100% libres de humo de tabaco / Technical health standard for inspections of 100% smoke-free environments

La norma contiene la finalidad y justificación técnica, ámbito de aplicación, base legal y disposiciones generales y específicas para inspecciones de ambientes 100% libres de humo de tabaco, a fin de contribuir a que los establecimientos dedicados a la salud o a la educación, dependencias públicas, interiores de los lugares de trabajo, espacios públicos cerrados y cualquier medio de transporte público, sean ambientes 100% libres de humo de tabaco, de acuerdo a lo dispuesto en la ley N° 28705.

Smoking cessation treatments: current psychological and pharmacological options

Abstract Background Smoking is considered an epidemic, indeed, one of the most important public health problems worldwide. It is also the most significant preventable cause of death, of a high number of premature deaths, and avoidable chronic diseases. It is considered an enormous economic burden for the world. Objective To provide an overview of smoking-cessation treatments, including pharmacological and psychological options, and to gather current scientific evidence available on them. Methods Research included reviewing publications from 2007-2018 in four databases using algorithms related to bupropion, varenicline, nicotine replacement therapy, smoking cessation, psychological treatment, motivational interview, cognitive-behavioral therapy and clinical guidelines for smoking treatment. Meta-analyses or systematic reviews and randomized or quasi-randomized trials were selected. We also included clinical guidelines for smoking treatment from Mexico and other countries. Results After refining the search, 37 articles met the criteria and were included in the review. The results were grouped by type of intervention. Conclusions It is necessary to conduct research on combinations of both kinds of treatment with an integral, multidisciplinary vision. Current standard for smoking cessation is a combined psychological and pharmacological treatment.

Prevalência de estratégias para cessação do uso do tabaco na Atenção Primária à Saúde: uma revisão integrativa / The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review

Resumo O hábito de fumar, ou tabagismo, preocupação da Atenção Primária à Saúde (APS), é um grave problema de saúde pública e a principal causa de morte evitável no mundo. A relevância de ações, cujo foco seja facilitar a cessação deste vício, motiva a discussão de estudos que apresentam diferentes abordagens para tal enfrentamento visando contribuir para a formação dos profissionais da APS. Utilizou-se as bases de dados Lilacs, Medline e Web of Science considerando as produções científicas recentes (2010 a 2015). Os descritores foram combinados a operadores boleanos e, após análise dos artigos encontrados, 75 são discutidos nesta revisão por apresentarem estratégias de maior prevalência na APS. Conclui-se que a abordagem individual breve ou intensa a partir do método dos 5A's (Modelo Transteórico) é a mais adotada, assim como os fármacos adesivos de Nicotina e Bupropiona. O uso crescente de tecnologia dura necessita de novos estudos que averiguem os seus impactos no tratamento a tabagistas. Evidenciou-se a necessidade de o profissional de saúde ser mais bem preparado para abordar o tema com os usuários, além de carecer do estímulo e das condições próprias para atuar na equipe de APS refletindo diretamente os avanços científicos em sua prática clínica.

Abstract The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.

Effect of the different smoking cessation regimens with acupuncture on smoking withdrawal and their influence factors: a multi-center randomized controlled trial / 中国针灸

OBJECTIVE@#To evaluate the clinical effect of acupuncture on smoking cessation and withdrawal symptoms and to explore the influence factors of acupuncture on smoking cessation.@*METHODS@#A total of 500 subjects with tobacco dependence were randomized into an acupuncture group, an auricular therapy group, an acupuncture plus auricular therapy group, a TENS group and a nicotine replacement therapy group (NRT group), 100 cases in each one. In the acupuncture group, acupuncture was applied at Baihui (GV 20), Lieque (LU 7), Hegu (LI 4) and Zusanli (ST 36). The treatment was given 5 times a week, once a day in the first 2 weeks. The treatment was given once every 2 days in the week 3 and 4, 3 times a week, and twice a week, once every 3 days in the week 5 to 8. In the auricular therapy group, the ear point pressure therapy was used at shenmen (TF), neifenmi (CO), pizhixia (AT) and jiaogan (AH), 3 times a week. In the acupuncture plus auricular therapy group, acupuncture and auricular therapy were adopted with the same points and manipulation as the previous two groups. Acupuncture was given 3 times a week and the auricular therapy was given twice a week. In the TENS group, SDZ-Ⅱ B type electric acupuncture apparatus was used to stimulate Lieque (LU 7) and Zusanli (ST 36), once a day. In the NRT group, the nicotine patch was used on the chest, back and the upper arms of the subjects, once a day. The duration of treatment was 8 weeks as one course in every group. Afterwards, the 16-week follow-up was conducted. The time-point withdrawal rate was evaluated by the level of urine cotinine in 8 weeks of treatment and in the follow-up in the subjects of 5 groups. The persistent withdrawal rate was evaluated by the self-report of the subjects in 8 weeks of treatment as well as in the follow-up in the 5 groups. The withdrawal effect, the score of the fagerstrom test for nicotine dependence (FTND) and the score of the heaviness of smoking index (HSI) were compared among the groups. Twenty indexes were selected as the potential influence factors, the 72 h withdrawal rate based on the level of urine cotinine in 8 weeks of treatment and in the follow-up was taken as the dependent variable. Using the two categories of Logistic regression analysis, the influence factors of therapeutic effect of acupuncture were screened for smoking cessation.@*RESULTS@#After 8 weeks of treatment, the time-point withdrawal rate in the subjects among the groups was NRT group > acupuncture plus auricular therapy group > auricular therapy group > acupuncture group > TENS group. In the follow-up, the time-point withdrawal rate was acupuncture plus auricular therapy group > NRT group > acupuncture group > TENS group > auricular therapy group, but without statistical significance in comparison (>0.05). After 8 weeks of treatment, the persistent withdrawal rate in the subjects among the groups was auricular therapy group > TENS group > acupuncture group > acupuncture plus auricular therapy group > NRT group. In the follow-up visit, the persistent withdrawal rate was auricular therapy group > TENS group > acupuncture plus auricular therapy group > acupuncture group > NRT group. The result in the auricular therapy group was better than all of the other 4 groups (0.05). The regression analysis showed that the factors, i.e. nationality, educational background, drinking frequency, pre-treatment FTND score, pre-treatment HSI score and smoking cessation for physical reason in family, were correlated significantly with the withdrawal result after 8-week treatment (<0.05). The factors, i.e. education background, smoking age, pre-treatment FTND score and different therapeutic methods, were correlated significantly with the withdrawal result in the follow-up (<0.05).@*CONCLUSION@#Acupuncture combined with auricular therapy effectively reduce nicotine dependence and smoking intensity and relieve withdrawal symptoms. There are many factors that affect the withdrawal effect in smoking cessation. Hence, the influence factors in smoking cessation with acupuncture should be clearly determined so as to develop the individual regimen for smoking cessation and improve the clinical therapeutic effect of acupuncture on smoking cessation.

Cigarrillo electrónico: ¿otra herramienta para ayudar a dejar de fumar o una nueva estrategia para promover la adicción a la nicotina? / Electronic cigarette: another tool to help quit smoking or a new strategy to promote nicotine addiction?

Los autores de este artículo describen las principales características del cigarrillo electrónico y sus componentes, anali-zan la controversia sobre su potencial uso como terapia de sustitución del tabaco y describen las experiencias regulato-rias de Argentina y de otros países. (AU)

The authors of this article describe the main features of electronic cigarettes and its components, analyze the controversy about its potential use as tobacco substitution therapy, and summarize the regulatory experiences in Argentina and other countries. (AU)

National Trends in Smoking Cessation Medication Prescriptions for Smokers With Chronic Obstructive Pulmonary Disease in the United States, 2007-2012 / 예방의학회지

OBJECTIVES: Smoking cessation decreases morbidity and mortality due to chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation is highly effective. However, the optimal prescription rate of smoking cessation medications among smokers with COPD has not been systemically studied. The purpose of this study was to estimate the national prescription rates of smoking cessation medications among smokers with COPD and to examine any disparities therein. METHODS: We conducted a retrospective study using National Ambulatory Medical Care Survey data from 2007 to 2012. We estimated the national prescription rate for any smoking cessation medication (varenicline, bupropion, and nicotine replacement therapy) each year. Multiple survey logistic regression was performed to characterize the effects of demographic variables and comorbidities on prescriptions. RESULTS: The average prescription rate of any smoking cessation medication over 5 years was 3.64%. The prescription rate declined each year, except for a slight increase in 2012: 9.91% in 2007, 4.47% in 2008, 2.42% in 2009, 1.88% in 2010, 1.46% in 2011, and 3.67% in 2012. Hispanic race and depression were associated with higher prescription rates (odds ratio [OR], 5.15; 95% confidence interval [CI], 1.59 to 16.67 and OR, 2.64; 95% CI, 1.26 to 5.51, respectively). There were no significant differences according to insurance, location of the physician, or other comorbidities. The high OR among Hispanic population and those with depression was driven by the high prescription rate of bupropion. CONCLUSIONS: The prescription rate of smoking cessation medications among smokers with COPD remained low throughout the study period. Further studies are necessary to identify barriers and to develop strategies to overcome them.

Various Forms of Fatal Nicotine Intoxications: Three Cases Report / 대한법의학회지

Recently, fatal nicotine intoxications with electronic cigarette liquid have increased in Korea, but various kinds of cigarettes and smoking cessation aids may also cause fatal poisoning. We report cases of fatal nicotine intoxications involving causes other than the use of liquid nicotine. A 29-year-old woman (case 1) found dead in a hotel room with about 70 patches (21 mg dose) of nicotine on her body. Blood nicotine levels were 7.68 mg/L (heart) and 3.25 mg/L (femoral). A toxic level of zolpidem was also detected. A 28-year-old Uzbekistan man (case 2) was found dead in his uncle's room with his face covered with chewing tobacco. Blood nicotine levels were 7.3 mg/L (heart) and 4.6 mg/L (femoral). Blood alcohol level was 0.139%. A 55-year-old man (case 3) bit his tongue. As he was taken to the hospital, his wife put tobacco powders in his mouth for hemostasis, and he died of cardiac arrest. Blood nicotine levels were 2.01 mg/L (heart) and 0.96 mg/L (femoral). Nicotine-related deaths can be caused by various types of administration including transdermal and transmucosal routes, and relatively small doses may cause death, so meticulous investigation should be taken when such deaths are suspected.

Evaluation of nicotine patch in pain control of patients undergoing laparoscopic cholecystectomy / Avaliação do adesivo de nicotina no controle da dor em pacientes submetidos à colecistectomia videolaparoscópica

ABSTRACT Objective: to analyze the effects of nicotine patch on pain control, occurrence of nausea and its hemodynamic repercussions in laparoscopic cholecystectomy procedures. Methods: we conducted an analytical, prospective, randomized, triple-blinded, clinical study between January and July 2017. The sample consisted of 17 patients who underwent laparoscopic cholecystectomy for the treatment of cholelithiasis. Nine patients used nicotine patch, and eight, placebo patch. The studied variables were pain, nausea, patient satisfaction, blood pressure, heart rate, oximetry and morphine rescue. Results: taking into account the pain and nausea parameters, there was no statistically significant difference between the groups (p>0.05). Also, the evaluation of rescue medication, both opioids and prokinetics, did not show any significant statistical difference between the groups. Among the hemodynamic parameters, there was only one statistically significant difference in the analysis of oxygen saturation and systolic blood pressure (SBP) six hours after surgery: the mean oxygen saturation was higher in the Test group (97.89 x 95.88) and the mean SBP was higher in the Control group (123.89 x 110.0). Conclusion: although pain levels were lower for nicotine within 24 hours, the action of nicotine and the need for rescue opioids in pain control were not statistically significant between the groups and at the time intervals studied. There was no clinical repercussion in the hemodynamic parameters.

RESUMO Objetivo: analisar os efeitos do adesivo de nicotina sobre o controle da dor, ocorrência de náuseas e suas repercussões hemodinâmicas em cirurgias de colecistectomia videolaparoscópica. Métodos: estudo analítico, do tipo ensaio clínico, prospectivo, randomizado e triplo-cego realizado entre janeiro e julho de 2017. A amostra foi composta de 17 pacientes em pós-operatório de colecistectomia videolaparoscópica para tratamento de colelitíase. Nove pacientes fizeram uso do adesivo com nicotina e oito de adesivo placebo. As variáveis estudadas foram: dor, náusea, satisfação do paciente, pressão arterial, frequência cardíaca, oximetria e resgate de morfina. Resultados: levando em consideração os parâmetros dor e náuseas, não houve diferença estatisticamente significativa entre os grupos (p>0,05). Ainda, a avaliação da medicação de resgate, tanto opioide como procinéticos, também não evidenciou diferença estatística relevante entre os grupos. Dentre os parâmetros hemodinâmicos, só houve diferença estatística nas análises da saturação de oxigênio e da pressão arterial sistólica (PAS) seis horas após a cirurgia: a média da saturação de oxigênio foi maior no grupo Teste (97,89 x 95,88) e a média da PAS foi maior no grupo Controle (123,89 x 110,0). Conclusão: apesar dos níveis de dor terem sido menores para nicotina no intervalo de 24 horas, a ação da nicotina e a necessidade de opioide de resgate no controle da dor não foram estatisticamente significantes entre os grupos e intervalos de tempo estudados. Não houve repercussão clínica nos parâmetros hemodinâmicos.

Terapia de reemplazo de nicotina / Nicotine replacement therapy

Resumen Todas las formas comercialmente disponibles de terapia de reemplazo de nicotina (TRN) (chicles, parche transdérmico, aerosol nasal, inhalador y tabletas sublinguales / lozenges) pueden ayudar a de dejar de fumar con éxito. TRN aumenta la tasa cesación en un 50 a 70%. La combinación de un parche de nicotina con una forma de administración rápida de TRN es más eficaz que un solo tipo de NRT. No hay diferencia en la eficacia entre TRN y bupropión, la combinación de NRT y bupropión es más efectiva que bupropión solamente. Los efectos de TRN son en gran parte independientes de la duración de la terapia, la intensidad del apoyo prestado o lugar en el que se ofreció. Según expertos chilenos, se puede usar TRN en adolescentes, en forma de chicles de 2 mg asociado a terapia conductual. Si una embarazada expresa un claro deseo de recibir TRN, se sugiere (i) discutir con ella los riesgos y beneficios asociados, (ii) utilizarla sólo si falla la cesación con medidas no farmacológicas y (iii) utilizar el criterio profesional al decidir si ofrecer la prescripción de TRN, tomando en cuenta el nivel de adicción de la embarazada y la presencia de comorbilidades. Estos fármacos existen en Chile, pero no están hasta el momento disponibles en el sistema público de salud.

All commercially available forms of nicotine replacement therapy (NRT) (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/pills) can help to quit smoking successfully. NRT increases the cessation rate by 50 to 70%. The combination of a nicotine patch with a rapid dosage form of NRT is more effective than a single type of NRT. There is no difference in efficacy between NRT and bupropion, the combination of NRT and bupropion is more effective than bupropion alone. The effects are largely independent of the duration of therapy, the intensity of the support provided or the setting in which the NRT was offered. According to Chilean experts, NRT can be used in adolescents, as chewing gum 2 mg adding behavioral therapy. If a pregnant woman expresses a clear desire to use NRT, it is suggested (i) discuss the associated risks and benefits with her, (ii) use it only if the cessation fails with non-pharmacological measures and iii) use the professional approach when deciding whether to offer the prescription of NRT, considering the level of addiction of the pregnant woman and the presence of comorbidities. TRN exists in Chile, but is not currently available in the public health system.

Terapia combinada para el control de la dependencia a nicotina / Combination therapy for nicotine dependence control

Resumen La terapia combinada es la de mezcla de farmacos para al cesación del tabaquismo, tal como terapias de reemplazo nicotínico (TRN) en modalidad prolongada como es el parche junto a una modalidad de acción corta como puede ser chicle, goma, lozenge, pastillas o inhalador nasal), es decir dos o más fármacos aprobados y demostrados útlies para el cese del tabaco con o sin el apoyo de TRN. Es muy importante considerar la comorbilidad médica y psiquiatrica porque la población que persiste adicta es cada vez más compleja en términos de comorbilidades y elevado nivel adictivo. La mayor parte de las terapias combinadas usan TRN asociadas a bupropión o vareniclina. Existe evidencia sobre efectividad y seguridad de las TRN utilizadas entre ellas o en asociación a vareniclina o bupropión, sin embargo, la evidencia sobre seguridad en la modalidad combinada no es tan robusta como la que existe para cada fármaco en monoterapia, ya que los efectos adversos se suman de manera que se sugiere reservar las combinaciones para personas con alto nivel de adicción y/o con historia de fracaso en intentos previos con monoterapia. En suma, los fármacos de demostrada efectividad y seguridad como TRN, bupropión y vareniclina pueden usarse en combinación doble o triple, preferenciando el uso de TRN de corta acción cuando se adiciona a alguno de los fármacos orales para aliviar la ansiedad por fumar.

This therapy is a combination of medicines consisting of nicotine replacement therapy (NRT) using a prolonged modality such as the patch, along with a short-acting medicine such as chewing gum, lozenge, gum, or nasal inhaler). This means two or more drugs approved and demonstrated useful for cessation of smoking with or without the support of NRT. It is very important to consider medical and psychiatric comorbidity because the population that persists addicted is increasingly complex in terms of comorbidities and high addictive level. Most of the combination therapies use NRT associated with bupropion or varenicline. There is evidence on the effectiveness and safety of TRN used in both modalitres (long and short acting) in combination with varenicline or bupropion. However, safety evidence is not robust for the combination modality as it is for, each drug as monotherapy, since adverse effects are added so it is suggested to reserve the combinations for people with high level of addiction and / or history of failure in previous attempts with monotherapy. In summary, therapy with demonstrated effectiveness as NRT, bupropion and varenicline can be used in double or triple combination, prefering the use of short acting NRT added to one of the oral drugs to alleviate smoking anxiety.

Transdermal Nicotine Patch Effects on EEG Power Spectra and Heart Rate Variability During Sleep of Healthy Male Adults

OBJECTIVE: The effect of transdermal nicotine patch on sleep physiology is not well established. The current study aimed to examine the influence of nicotine patch on homeostatic sleep propensity and autonomic nervous system. METHODS: We studied 16 non-smoking young healthy volunteers with nocturnal polysomnography in a double blind crossover design between sleep with and without nicotine patch. We compared the sleep variables, sleep EEG power spectra, and heart rate variability. RESULTS: The night with nicotine patch showed significant increase in sleep latency, wake after sleep onset, and stage 1 sleep; and decrease in total sleep time, sleep efficiency, and percentage of REM sleep. Also, spectral analysis of the sleep EEG in the night with nicotine patch revealed decreased slow wave activity in stage 2 and REM sleep and increased alpha activity in the first NREM-REM sleep cycle. Heart rate variability showed no differences between the 2 nights, but the low to high ratio (a parameter indicative of sympathetic nervous system activity) positively correlated with wake after sleep onset in night with nicotine patch. CONCLUSION: Transdermal nicotine patch significantly disrupts sleep continuity, sleep architecture, and homeostatic sleep propensity. The overactivation of the sympathetic nervous system may be responsible for these changes.

Manutenção da abstinência do tabaco por ex-fumantes: estudo fenomenológico / Mantenimiento de la abstinencia del tabaco por los exfumadores: estudio fenomenológico / Maintenance of tobacco withdrawal by former smokers: a phenomenological study

Resumo OBJETIVO Compreender a vivência de ex-fumantes acerca da manutenção da abstinência do tabaco. MÉTODOS Pesquisa qualitativa que utilizou o referencial teórico-metodológico da Fenomenologia Social de Alfred Schütz. Realizou-se a entrevista fenomenológica em 2016 com 12 ex-fumantes de um município de Minas Gerais, Brasil. Os depoimentos foram organizados em categorias e discutidos com base na literatura. RESULTADOS A manutenção da abstinência do tabaco foi revelada nas categorias: "Ganhos na saúde, sociabilidade e finanças"; "Convívio com a vontade de fumar e com o aumento do peso corpóreo"; "Autodeterminação e utilização de estratégias substitutivas" e "Manter-se longe do cigarro". CONCLUSÕES Estes resultados alertam os profissionais de saúde para a necessidade de apoiar ex-fumantes a manter-se nesta condição. Isso implica considerar não só os efeitos negativos da abstinência tabágica, como também o contexto social em que o ex-fumante está inserido, que poderá influenciar na manutenção ou não da abstinência do cigarro.

Resumen OBJETIVOS Comprender la experiencia de ex-fumadores con respecto a mantener la abstinencia al tabaco. MÉTODOS Investigación cualitativa que utilizó la Fenomenología Social de Alfred Schütz. Se llevó a cabo la entrevista fenomenológica en 2016 con 12 ex-fumadores de una ciudad de Minas Gerais, Brasil. Los testimonios fueron organizados en categorías y discutidos con base en la literatura. RESULTADOS Se revelaron las categorías: "Las ganancias em la salud, la sociabilidad y la financiación"; "La convivencia com el deseo de fumar y aumento del peso corporal"; "La autodeterminación y el uso de estrategias sustitutivas" y "Para permanecer fuera de los cigarrillos". CONCLUSIONES Estos resultados llaman la atención de los profesionales de la salud hacia la necesidad de apoyar a los ex-fumadores parapermanecer libres de tabaco. Esto implica considerar no sólo los efectos negativos de la abstinencia de fumar sino el contexto social en el que se inserta el ex-fumador, el cualpuede influir en el mantenimiento o no de la abstinencia al cigarrillo.

Abstract OBJECTIVE To understand the experience of former smokers maintaining tobacco abstinence. METHODS Qualitative research using the theoretical-methodological reference of the Social Phenomenology, as defined by Alfred Schütz. The phenomenological interview was carried out in 2016 with 12 former smokers from a city in the state of Minas Gerais, Brazil. The statements were organized into categories and discussed based on the literature. RESULTS The maintenance of tobacco abstinence was revealed in the categories: "Health, sociability, and financial gains"; "Living with the urge to smoke and with the increase of body weight"; "Self-determination and use of replacement strategies"; and "Staying away from cigarettes." CONCLUSIONS These results alert health professionals to the need to provide support to former smokers so they can remain smoke-free. This implies considering not only the negative effects of the tobacco abstinence, but also the social context in which former smokers are inserted that might have an impact on the maintenance or not of the cigarette withdrawal.

Revisión sistemática de estudios de costo-efectividad y análisis de transferibilidad de intervenciones sanitarias para la cesación del hábito tabáquico / Systematic review of cost-effectiveness studies and transferability analysis of health interventions for cessation of smoking

Objetivo: El objetivo de este estudio fue conocer la eficiencia de las estrategias de consejería breve (CB), terapia de reemplazo de la nicotina (TRN) y el uso de medicamentos como el bupropión y la vareniclina. Para \r\nlo cual se plantearon las siguientes preguntas de investigación: Son la consejería breve, la terapia de reemplazo de nicotina en combinación con CB y/o las terapias farmacológicas con vareniclina o bupropión asociadas a CB, intervenciones costo-efectivas en la cesación del hábito tabáquico? Son transferibles los resultados de los estudios que evalúan la costo-efectividad de la consejería breve, terapia de reemplazo de nicotina y/o terapias farmacológicas con vareniclina o bupropión al contexto chileno? Metodología: Se realizó una búsqueda sistemática de la literatura en MEDLINE y CRD (Centre for Reviews and Dissemination) de estudios publicados entre los años 2004 y 2014, que evaluaran la costo-efectividad de la consejería breve, terapia de reemplazo de la nicotina y terapias farmacológicas con bupropión o vareniclina como estrategias para el cese del hábito tabáquico en población general. Conclusiones: Todas las intervenciones evaluadas fueron costo-efectivas al compararlas con CSA. Las terapias farmacológicas asociadas a CB demostraron ser más costo-efectivas que la CB por sí sola. Vareniclina +CB resultó ser una intervención dominante en relación a sus comparadores.Vareniclina domina todas las otras terapias, por lo que debiera ser considerada como la terapia de elección en fumadores en su primer intento para dejar de fumar. La inclusión de vareniclina asociada a consejería breve en el Sistema Nacional de Salud, reduciría la morbilidad y la mortalidad relacionada con el tabaquismo en Chile, resultando en importantes ahorros económicos en salud.

Effects of tobacco control policies on smoking prevalence and tobacco-attributable deaths in Mexico: the SimSmoke model / Efectos de las políticas de control del tabaco sobre la prevalencia del tabaquismo y las defunciones atribuibles al tabaco en México: el modelo SimSmoke

OBJECTIVE: To examine how policies adopted in Mexico in response to the Framework Convention on Tobacco Control affected smoking prevalence and smoking-attributable deaths. METHODS: The SimSmoke simulation model of tobacco control policy is applied to Mexico. This discrete time, first-order Markov model uses data on population size, smoking rates and tobacco control policy for Mexico. It assesses, individually and jointly, the effects of seven types of policies: cigarette taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth tobacco access policies. RESULTS: The Mexico SimSmoke model estimates that smoking rates have been reduced by about 30% as a result of policies implemented since 2002, and that the number of smoking-attributable deaths will have been reduced by about 826 000 by 2053. Increases in cigarette prices are responsible for over 60% of the reductions, but health warnings, smoke-free air laws, marketing restrictions and cessation treatments also play important roles. CONCLUSIONS: Mexico has shown steady progress towards reducing smoking prevalence in a short period of time, as have other Latin American countries, such as Brazil, Panama and Uruguay. Tobacco control policies play an important role in continued efforts to reduce tobacco use and associated deaths in Mexico.

OBJETIVO: Analizar cómo las políticas adoptadas en México en respuesta al Convenio Marco para el Control del Tabaco han tenido efecto en la prevalencia de tabaquismo y en la mortalidad atribuible al tabaco. MÉTODOS: Se aplicó en México el modelo de simulación SimSmoke de la política de control del tabaco. Este modelo de Markov de tiempo discreto y de primer orden utiliza datos sobre el tamaño de la población, las tasas de tabaquismo y la política de control del tabaco en México. También evalúa individual y conjuntamente los efectos de siete tipos de políticas: impuestos sobre el tabaco, legislaciones de ambientes libres de humo de tabaco, campañas en medios de comunicación, prohibiciones de publicidad, etiquetas de advertencias sanitarias, tratamientos de cesación y regulaciones del acceso al tabaco por parte de los jóvenes. RESULTADOS: Mediante el modelo SimSmoke aplicado en México, se calculó que las tasas de tabaquismo se han reducido aproximadamente en un 30% como resultado de las políticas implantadas desde el 2002, y que el número de defunciones atribuibles al tabaquismo podrían reducirse aproximadamente en 826 000 para el 2053. Los aumentos de precios de los cigarros son responsables de más del 60% de las reducciones, pero las advertencias sanitarias, las leyes de ambientes libres de humo de tabaco, las restricciones a la mercadotecnia y los tratamientos de cesación también desempeñan una función importante. CONCLUSIONES: En México, análogamente a lo ocurrido en otros países latinoamericanos, como Brasil, Panamá y Uruguay, se ha observado un constante progreso en la reducción de la prevalencia del tabaquismo en poco tiempo. Las políticas de control del tabaco desempeñan una importante función en las iniciativas continuadas para reducir el consumo de tabaco y las defunciones asociadas a este en México.

Intervenções de cessação de tabagismo em fumantes leves: uma revisão sistemática / Smoking cessation interventions in light smokers: a systematic review

Apesar da diminuição da prevalência de fumantes, o número de tabagistas de baixo consumo de cigarro tem aumentado, comumente denominados de fumantes leves ou intermitentes. É sabido que qualquer quantidade de consumo de tabaco pode trazer danos à saúde. A pesquisa sobre essa população é escassa e pouco se sabe sobre intervenções de cessação de tabagismo direcionadas a esses grupos. Dessa forma, o objetivo do presente estudo foi realizar uma revisão sistemática a fim de descrever estudos que apresentam intervenções para fumantes leves e intermitentes. As pesquisas foram conduzidas nas bases de dados PubMed, PsycInfo, SciELO e Pepsic. Palavras-chave incluíram: [light smoker, non-daily smoker, intermittent smoker; social smoking, occasional smoking, low-level smoking] AND [intervention studies, clinical trial and evaluation studies] AND [tobacco use cessation, tobacco use disorder]. Nove artigos preencheram os critérios de inclusão e foram analisados. Os resultados apontaram que intervenções bem-sucedidas incluíram aconselhamento e uso de medicamentos, tais como intervenção breve, tratamento de reposição de nicotina, Vareniclina, educação em saúde, entre outros. No entanto, intervenções ainda estão em estágio inicial. Destaca-se a necessidade de mais investigações sobre intervenções específicas para fumantes de baixo consumo, desenvolvimento de escalas de dependência exclusivas para esse grupo e estudos epidemiológicos para compreender quem são os fumantes leves e intermitentes, especialmente no Brasil

Despite decreases in the prevalence of smoking, the number of low-rate smokers – commonly called light or intermittent smokers – is increasing. Any dose of tobacco can be hazardous to health. Research about this population is scarce and little is known about tobacco cessation interventions that focus on these groups. The aim of the present paper is to conduct a systematic review to describe research on interventions for light and intermittent smokers. Searches were conducted in PubMed, PsycInfo, SciELO and Pepsic. Search terms included: [light smoker, non-daily smoker, intermittent smoker; social smoking, occasional smoking, low-level smoking] AND [intervention studies, clinical trial and evaluation studies] AND [tobacco use cessation, tobacco use disorder]. Nine studies met the inclusion criteria. Successful interventions included counseling and pharmacotherapy such as brief intervention, health education, nicotine replacement, and varenicline. Interventions for light smokers are in the early stages of development. Future studies should test interventions specifically designed for low-rate smokers, develop dependence scales designed for low-rate smokers, and pursue epidemiologic studies to better profile light and intermittent smokers, especially in Brazil.