Resveratrol inhibits nicotine-induced conditioned place preference in mice

Abstract Nicotine addiction leads to in a huge burden on public health and the economy worldwide. Resveratrol (3,5,4'-tetrahydroxystilbene) is the most well-known polyphenolic stilbenoid. Resveratrol was shown to exhibit positive effects on numerous mechanisms that are important for drug and substance addiction. Thus, this study aimed to examine the effect of resveratrol on nicotine addiction. Intraperitoneal (i.p.) treatment with nicotine (0.5 mg/kg) significantly enhanced time spent in the nicotine-paired compartment. Resveratrol (50 and 75 mg/kg, i.p.) and varenicline (2 mg/kg, i.p.) co-administered with nicotine during the 3-day conditioning period effectively diminished the acquisition of nicotine-induced conditioned place preference (CPP). On the other hand, the administration of resveratrol (50 and 75 mg/kg, i.p.) and varenicline (2 mg/kg, i.p.) decreased the low dose (0.1 mg/kg, i.p.) nicotine-induced reinstatement. The results suggest that resveratrol and varenicline inhibit the acquisition and reinstatement of nicotine's reward properties. Resveratrol displayed similar results in the CPP phases as obtained with the reference drug varenicline. In conclusion, resveratrol could be beneficial as an adjuvant pharmacotherapy for nicotine addiction; however, more investigation is needed to completely explain this property.

Respiratory mechanics behavior after heart surgery: an experimental study

Changes in ventilatorymechanics and their consequent pulmonary complications are common after surgical procedures, particularly in cardiac surgery (CS), and may be associated with both preoperative history and surgical circumstances. This study aims to compare ventilatory mechanics in the moments before and after cardiac surgery (CS), describing how pulmonary complications occurred. An experimental, uncontrolled study was conducted, of the before-and-after type, and with a descriptive and analytical character. It was carried out in a private hospital in the city of Salvador, Bahia, Brazil, and involved 30 adult patients subjected to CS. In addition to clinical and epidemiological variables, minute volume (VE), respiratory rate (RR), tidal volume (VT), forced vital capacity (FVC), maximum inspiratory pressure (MIP), and peak expiratory flow (PEF) were also recorded. Data were collected in the following moments: preoperative (PRE-OP) period, immediate postoperative (IPO) period, and 1stpostoperative day (1stPOD). The sample was aged 48.1 ± 11.8 years old and had a body mass index of 25.5 ± 4.9 kg m-2; 60% of the patients remained on mechanical ventilation for less than 24 hours (17.5 [8.7-22.9] hours). There was a significant reduction in VT, FVC, MIP and PEF when PRE-OP versus IPO, and PRE-OP versus 1stPOD were compared (p < 0.05). There were no significant changes between IPO and the 1stPOD. The highest incidence of pulmonary complications involved pleural effusion (50% of the patients). This study showed that patients subjected to CS present significant damage to ventilatory parameters after the surgery, especially in the IPO period and on the 1stPOD. It is possible that the extension of this ventilatory impairment has led to the onset of postoperative pulmonary complications.

Carcinoma escamoso epicraneal metastásico con invasión parenquimatosa cerebral, a propósito de un caso / Metastatic epicranial squamous carcinoma with parenchymal brain invasion, apropos of a case

RESUMEN A nivel mundial se estiman que cada año se diagnostican aproximadamente 650 000 nuevos casos de cáncer escamoso de cabeza y cuello. Ocasionan 300 000 muertes y dos tercios de estos casos se originan en países en vías de desarrollo. Se presentó un caso de un paciente atendido en consulta a causa de crecimiento acelerado de la región frontotemporoparietal derecha, acompañado de sintomatología neurológica correspondiente a una afección funcional de los lóbulos parietal y temporal derecho. Se le realizó exámenes imagenológicos y biopsia por punción de la lesión, lo que arrojó un carcinoma escamoso como variedad histológica de la tumoración (AU).

ABSTRACT It is thought that around 650 000 new cases of head and neck squamous tumors are diagnosed in the world every year. They cause 300 000 deaths and two thirds of these cases are originated in developing countries. We presented the case of a patient who assisted the consultation due to the fast growth of the right frontotemporal parietal region, accompanied with neurological symptomatology corresponding to a functional disorder of the right parietal and temporal lobes. Imaging studies and a biopsy by lesion puncture were performed. It showed a squamous carcinoma as histological variant of the tumor (AU).

Caracterización de los pacientes diabéticos tipo 2 con hipertensión arterial / Characterization of the type 2 diabetic patients with arterial hypertension

Introducción: por su elevada frecuencia y por su condición de factor de riesgo de diferentes complicaciones que constituyen la principal causa de muerte en varios países, la diabetes mellitus unido a la hipertensión arterial (HTA) ha desatado un grave problema emergente de salud pública, conocido como síndrome cardiometabólico que daña a amplios sectores poblacionales. Objetivo: caracterizar a los pacientes diabéticos tipo 2 con hipertensión arterial en las salas de Medicina Interna del "Hospital Clínico Quirúrgico Docente Amalia Simoni", de Camagüey. En el periodo enero 2016 hasta enero 2017. Materiales y métodos: se realizó una investigación descriptiva, de 96 pacientes diabéticos, ingresados en salas de Medicina, entre enero 2016 hasta enero del 2017, con vistas a caracterizarles según algunas variables clínicas, epidemiológicas y humorales. Resultados: se observó un predominio de la edad mayor de 60 años y del sexo femenino, con mayor número de negros y mestizos. Resultó interesante la prevalencia de fumadores en los no hipertensos. El mayor diámetro de la cintura abdominal lo presentaron los diabéticos-hipertensos con sobrepeso y elevado índice de masa corporal. En estos pacientes aparecieron las principales complicaciones en los primeros años del diagnóstico. Conclusiones: se identificó un grupo de factores de riesgo en hipertensos con diabetes tipo 2, útiles para una mejor evaluación de estos pacientes en la atención primaria de salud. Entre ellos se destaca la ubicación del tejido graso y el tabaquismo como los factores más importantes en la población diabética e hipertensa (AU).

Introduction: due to its high frequency and its condition as risk factor of different complications that are the main cause of death in several countries, diabetes mellitus together with arterial hypertension have triggered a serious emergent health public problem, known as cardiometabolic syndrome affecting wide population sectors. Objetive: characterize type 2 diabetic patients with arterial hypertension in the Internal Medicine rooms of the "Amalia Simoni Clinical Surgical Teaching Hospital", of Camagüey. In the period January 2016 to January 2017. Materials and methods: a descriptive research was carried out in 96 diabetic patients who entered the Medicine wards in the period January 2016-January 2017 to characterize them according to several clinical, epidemiological and humoral variables. Results: it was found the predominance of female, black or mestizo patients, aged more than 60 years. It was interesting the predominance of smokers among people that are not hypertensive. The biggest diameter of abdominal waist was found in hypertensive diabetics with overweight and increased body mass index. These patients are those who present main complications in the first years after the diagnosis. Conclusions: a group of risk factors was identified in hypertensive patients with type 2 diabetes that are useful to evaluate these patients in the primary health care. The location of fat tissues and smoking are the most important risk factors among diabetic and hypertensive population (AU).

Caracterización clínica epidemiológica de la diabetes mellitus en dos áreas de salud. Municipio Cárdenas. 2017 / Clinico-epidemiological characterization of diabetes mellitus in two health areas. Municipality of Cardenas. 2017

RESUMEN Introducción: la diabetes mellitus es un trastorno metabólico caracterizado por hiperglucemia crónica con alteraciones en los carbohidratos, grasas y proteínas. Las tasas de morbimortalidad han aumentado al igual que la obesidad, constituye un problema de salud en el mundo, Cuba y la provincia de Matanzas. Objetivo: realizar una caracterización clínica epidemiológica de la diabetes mellitus tipo 2 en dos áreas de salud, conocer las variables e identificar las barreras para una posterior intervención. Materiales y métodos: se realizó un estudio epidemiológico descriptivo- transversal a 750 diabéticos tipo 2 mayores de 18 años en dos áreas de salud. Se realizaron encuestas, procesándose en el programa Epi-Info, obteniéndose la frecuencia de las variables, y las diferencias estadísticas significativas entre variables de las dos aéreas de salud, utilizándose el valor de p < 0,05 % y el Chi2. Resultados: el promedio de edad fue de 62,2 años, predominio del sexo femenino y color de la piel blanca. La hipertensión arterial y la obesidad fueron las enfermedades más asociadas, y el tabaquismo, la ingestión de bebidas alcohólicas y azucaradas, y la no realización de ejercicios físicos fueron los factores asociados más relevantes. Los medicamentos más utilizados fueron la glibenclamida y la metformina. Conclusiones: la diabetes mellitus es la primera causa de fracaso renal en el mundo occidental, siendo la insuficiencia renal una de las complicaciones crónicas más graves de esta enfermedad. Entre las principales causas de muerte de esta enfermedad son las complicaciones macrovasculares, manifestadas clínicamente como cardiopatía isquémica, insuficiencia cardíaca, la enfermedad vascular cerebral y la insuficiencia arterial periférica.

ABSTRACT Introduction: diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with alterations in carbohydrates, fats and proteins. Morbi-mortality rates have increased as have done obesity, being a health problem in the world, Cuba and the province of Matanzas. Objective: to carry out clinical-epidemiological characterization of type 2 diabetes mellitus in two health areas, knowing the variables and identifying the barriers for a subsequent intervention. Materials and methods: a cross-sectional descriptive study was carried out in 750 type-2 diabetic patients over 18 years in two health areas. Surveys were made and processed in Epi-Info program, showing significant statistic differences among variables of both health areas; p < 0,05 % value and Chi2 were used. Results: the average age was 62.2 years, predominating female sex and white skin color. The most commonly associated diseases were arterial hypertension and obesity; smoking and drinking alcoholic and sugar-sweetened beverages and sedentary life were the most relevant associated factors. The most commonly used medications were glibenclamide and metformin. Conclusions: diabetes is the first cause of renal failure in the Western world, being renal insufficiency one of the most serious chronic complications of this disease. The main causes of death of this disease are macro vascular complications clinically manifested as ischemic heart disease, heart failure, cerebra-vascular disease and peripheral arterial insufficiency.

Lesiones cancerígenas y precancerosas bucales. Factores de riesgos asociados. Policlínico Bernardo Posse. Año 2017 / Cancerous and pre-cancerous buccal lesions. Associated risk factors. Policlínico Bernardo Posse Years 2017

RESUMEN Introducción: el cáncer bucal constituye uno de los mayores problemas de salud al cual se enfrenta la humanidad, no solo en el ámbito de salud pública sino también en la ciencia en general, que afecta un grupo significativo de personas en todo el mundo. Objetivo: describir el comportamiento de las lesiones precancerígenas y cancerígenas de la cavidad bucal y los factores de riesgos asociados en individuos pertenecientes al Policlínico Bernardo Posse, municipio San Miguel del Padrón, La Habana, 2017. Materiales y métodos: se realizó un estudio analítico retrospectivo en pacientes de más de 15 años de edad entre enero y noviembre del 2017 sobre los factores de riesgo asociados con la aparición de lesiones premalignas y malignas del complejo bucal con un universo de 631 pacientes. Se operacionalizaron las variables en estudio. Resultados: se mostró un predominio del sexo masculino en un 52,9 %, siendo el grupo de edad más frecuente el comprendido entre 35 a 59 años para un 53.2%. Las lesiones precancerígenas de la cavidad bucal fueron más frecuentes en los grupos etáreos mayor de 60 años para un 1,42 %. De los pacientes examinados, el 53.2% consumen bebidas alcohólicas de forma habitual. Conclusiones: en el estudio predominaron las personas del sexo masculino y los mayores de 35 años de edad. Las lesiones precancerígenas de la cavidad bucal fueron más frecuentes en los grupos etáreos de mayor de 60 años. Se constató relación entre los factores de riesgo estudiados y la presencia de lesiones malignas y premalignas.

ABSTRACT Introduction: cancer is one the major health problems in humanity, not only in the field of public health, but also in science in general.It affects a significant group of persons in the world. Objetive: to describe the behavior of the cancerous and pre-cancerous lesions in the buccal cavity and risk factors associated with patients assisted in Bernardo Posse Clinic, located in San Miguel del Padrón municipality, Havana, 2017. Materials and methods: an analytic and retrospective study about risk factors associated with cancerous and pre-cancerous lesions in the buccal cavity in patients aged 15 and over, between January and November, 2017. There is a universe of 631 patients. Some variable were analyzed in the study. Results: the male sex predominated prove a predominance of sex masculine with a 52, 9 %. The 35 and 59 age group was the most affected, with a 53,2%. The age group older than 60 was the most affected with pre-cancerous lesions in the buccal cavity, with a 1, 42 %. From the patients examined throughout the research, the 53, 2% consumed alcohol in a regular way. Conclusions: in the study predominated the persons of male sex and the older than 35 years. The pre-cancerous lesions were more frequent in the age group older than 60 years .If was proved the relation between the risk factors and the cancerous and pre-cancerous lesions.

Tabaquismo pasivo y su efecto en la salud infantil: ¿Qué cambió en 11 años?: Hospital Zubizarreta / Passive smoking and its effect on children's health: What changes in 11 years?: Zubizarreta Hospital

Investigación que sigue los hallazgos de un estudio previo realizado entre junio de 2005 y junio de 2006, sobre el humo ambiental de tabaco y sus efectos en las madres y sus hijos, donde se encuestaron 100 madres de niños que se atendieron en el Hospital Zubizarreta. de la Ciudad de Buenos Aires. La presente investigación tuvo como objetivo determinar cuál es la situación actual de las familias que asisten al mismo hospital, en relación a la exposición al tabaco y si hay algún cambio en la distribución de fumadores en los hogares de los pacientes, o si se expone menos a los niños fumando fuera de las viviendas en las familias de fumadores. Se realizó un estudio epidemiológico descriptivo transversal para el que se confeccionó una encuesta semiestructurada anónima que se les realizó a las madres de niños/as entre 4 meses y 12 años de edad que concurrieron al hospital. La misma fue administrada por médicos del Consultorio Externo de Pediatría y una voluntaria que concurrió por 1 mes para efectuarla. El estudio se llevó a cabo entre julio de 2016 y julio de 2017, y se trabajó sobre las variables socio demográficas incluidas en el Índice de Graffar modificado, como tipo de vivienda, trabajo, escolaridad entre otros. A su vez se incluyen datos de salud, sobre antecedentes obstétricos de la madre y de procesos de enfermedad de los/as hijos/as y del consumo o no de tabaco, entre otras variables

Tratamento do tabagismo em pacientes com DPOC / Smoking Cessation in patients with COPD

DPOC é uma das doenças pulmonares mais prevalentes no mundo. No Brasil, as prevalências de DPOC e de tabagismo são 15,8% e e 10,4%, respectivamente. Entre 30 e 70% dos pacientes com DPOC permanecem tabagistas. O tratamento destes pacientes é um desafio. Frequentemente apresentam baixa motivação e auto eficácia para a interrupção do tabagismo (IT), elevada dependência de nitcotina e associação com depressão. A investigação destes elementos deve preceder o início do tratamento farmacológico, que deve sempre estar associado a terapia cognitivo comportamental (TCC) e ao tratamento da depressão. O paciente com DPOC deve ser informado sobre a relação do tabagismo com sua doença e a importância da interrupção para o controle dos sintomas e mudança do prognóstico. A TCC inclui e sugere a escolha da data de IT, a identificação de situações de alto risco, o desenvolvimento de comportamentos alternativos e o manejo dos sintomas de abstinência, além de proporcionar apoio e incrementar motivação. Todos os fármacos de primeira linha no tratamento do tabagismo podem ser utilizados no tratamento deste grupo, com as doses e períodos clássicos, mas para os mais dependentes, é frequente a necessidade de se estender o período de tratamento, aumentar doses e associar fármacos.

COPD is one of the most prevalent pulmonary diseases in the world. In Brazil, the prevalence of COPD and smoking is 15.8% and 10.4%, respectively. Between 30 and 70% of COPD patients are smokers. The treatment of these patients is a challenge. Frequently they present low motivation and self-efficacy for smoking cessation (SC), high level of nicotine dependence and association with depression. The investigation of these elements should precede the beginning of pharmacological treatment, which should always be associated with cognitive behavioral therapy (CBT) and with the treatment of depression. The patient with COPD should be informed about relationship of smoking with their disease and the importance of discontinuation for symptom control and change of prognosis. CBT includes and suggests the choice of SC date, the identification of high-risk situations, the development of alternative behaviors and the management of withdrawal symptoms, as well as providing support and increasing motivation. All first-line drugs in the smoking treatment can be used in the treatment of this group, with the classic doses and periods, but for the most dependent, it is often necessary to extend the period of treatment, increase doses and associate drugs.

Abandono del hábito tabáquico tras un primer ingreso en el Servicio de Neumología / Smoking cessation after first admission in a respiratory unit

Some authors suggest that hospitalization is an ideal moment to stop smoking. It is unknown the outcome of smokers admitted for the first time in the pulmonology department, which interventions are carried out to achieve smoking cessation and which are the dropout rates once they are discharged. The purpose of this study is to analyze the impact of a first hospital admission in a service of Pneumology on smokers. Epidemiological variables, smoking habit, specialized interventions carried out on these subjects and rate of withdrawal after discharge were studied. It is necessary to train specialists to diagnose and treat the patient in the process, so that on every hospitalized smoker a cessation intervention should be carried out.

Algunos autores defienden que el ingreso hospitalario constituye un marco ideal para dejar de fumar. Se desconoce lo que sucede con los fumadores que ingresan por primera vez en el Servicio de Neumología, sobre las intervenciones que en ellos se lleva a cabo, así como sus tasas de abandono una vez que son dados de alta. El objetivo de este estudio es analizar el impacto que tiene un primer ingreso hospitalario en el Servicio de Neumología en sujetos fumadores. Conocer sus variables epidemiológicas, el hábito de tabáquico, las intervenciones que el personal médico especializado realiza sobre estos sujetos y las tasas de abstinencia posteriores al alta. Es necesario formar a los especialistas para diagnosticar y tratar al paciente en dicho proceso, de tal forma que sobre todo sujeto fumador hospitalizado se realice alguna intervención.

Instrumentos para avaliação do tabagismo: uma revisão sistemática / Instruments used to evaluate smoking habits: a systematic review

O tabagismo é um dos principais responsáveis pela carga de doenças no mundo, causando uma a cada oito mortes. Conhecer os instrumentos que caracterizam o uso do tabaco é o primeiro passo para desenvolver pesquisas qualificadas e comparativas para enfrentar esse desafio. O objetivo foi identificar instrumentos e comparar domínios temáticos utilizados em pesquisas populacionais para avaliação do tabagismo nos últimos 5 anos. Foi realizada revisão sistemática em publicações de setembro de 2002 a setembro de 2007. Os termos utilizados foram: (Smok* or tobacco) AND (Questionnaire or scale or score or instrument or assessment or form) AND (*cultural* or translat* or valid* or reproduc* or psychomet*). Foram selecionados 186 artigos do total de 2236. Em apenas 91 havia citação dos instrumentos utilizados. Os principais temas foram perfil e prevalência (38 por cento), dependência (24 por cento) e motivação (10,8 por cento). Questionários definidos foram empregados em 96 por cento dos estudos de dependência. Já nas pesquisas de perfil e prevalência 79 por cento utilizaram questionários próprios. A transparência e a padronização dos instrumentos e a preferência pelo uso de questionários validados são quesitos essenciais para a qualidade e reprodutibilidade das pesquisas sobre o tabagismo.

Smoking is one of the most important causes of illness in the world, responsible for one out of every eight deaths. To know the instruments that characterize the use of tobacco is the first step to develop reliable and comparable research to tackle this challenge. The objective was to identify and compare instruments and domains used in population-based studies over the past five years aiming to determine smoking patterns. A systematic review was conducted on articles published from September 2002 to September 2007. The terms used were: (*Smok or tobacco) AND (Questionnaire or scale or score or instrument or assessment or form) AND (*cultural* or translat* or valid* or reproduc* or psychomet*). Out of 2,236 references, 186 articles were selected, of which only 91 informed the instruments used. From the 91 manuscripts, 49 distinct instruments were identified. The main topics were profile and prevalence (38 percent), dependence (24 percent) and motivation (10.8 percent). The researchers used standard instruments in 96 percent of studies of addiction. The majority of articles about profile and prevalence (79 percent) used self-developed questionnaires. The transparency and standardization of instruments and the preference for the use of validated questionnaires are crucial areas for quality and reproducibility of research on smoking.

El ABCD de la cesación de fumar: de la evidencia a la práctica clínica en medicina preventiva / The ABCD of smoking cessation: from evidence to clinical practice in preventive medicine

En el presente artículo se revisan aspectos epidemiológicos sobre el tabaquismo, mostrándolo como la enfermedad o causa de muerte más evitable en el mundo al día de hoy. Dada esta situación se plantea la importancia de la intervención médica en medicina preventiva, mostrando su efectividad por sobre otras aproximaciones alternativas. Se analizan las razones y limitaciones por las que los médicos no aplican estrategias de intervención antitabaco, incluyendo el hecho de que un porcentaje importante de los médicos fuma. Asimismo, se muestran las dificultades que pueden enfrentar los médicos al hacer una intervención, a la vez que se explican en detalle las intervenciones de las 5 A´s y el ABCD de dejar de fumar, resaltando que todo fumador es un paciente objetivo y que todo médico puede tratar fumadores. Un punto importante que destaca este artículo es la comorbilidad psiquiátrica de los fumadores particularmente con depresión; y entrega herramientas como la entrevista de Goldberg 12 (GHQ) para ser utilizado como screening o tamizage y así mejorar el sistema de triage y derivación cuando corresponde. Un último punto no menos importante es tocar el tema del fumar pasivo por el humo de terceras personas, se entregan datos acerca de su importancia y cómo intervenir con los pacientes

In the present article epidemiological aspects of Tobacco are being reviewed, showing it as a disease or the most avoidable cause of death in the world today. Under this predicament the importance of a medical intervention in preventive medicine is emphasized, showing its effectiveness upon other alternatives nonmedical approaches. We analyze the reasons and limitations why physicians do not apply such strategies of antitobacco interventions, including the fact that an important percentage of the physicians themselves smoke. We show the difficulties that doctors may find in facing smokers, and correspondingly explain in details interventions like the 5 A´s or the Latin-American ABCD for stopping smoking, reinforcing the fact that every smoker is a target patient and that every doctor can treat smokers. An important point highlighted in this article i psychiatric comorbidity between smokers particularly with depression, and we share some tools like GHQ 12 Goldberg test in order to be used as a screening tools for an adequate triage of the patientsor referral when necessary. A last but not least issue is the importance of discussing the problem of passive smoking both for the patient and the family, data is share don its relevance and a few tools in how to intervene with the patients

As propriedades psicométricas do Teste de Fagerström para Dependência de Nicotina / Psychometric properties of the Fagerström Test for Nicotine Dependence

OBJETIVO: O Fagerström Test for Nicotine Dependence (FTND, Teste de Fagerström para Dependência de Nicotina) é um instrumento de rastreamento para dependência física de tabaco, amplamente utilizado em diversos países. Objetivou-se realizar uma revisão de artigos relacionados às propriedades psicométricas do FTND. MÉTODOS: Uma busca sistemática foi realizada usando-se vários indexadores eletrônicos até dezembro de 2007, com os seguintes descritores: "Fagerström Test for Nicotine Dependence"; "FTND"; "psychometric"; "validity"; "reliability"; "feasibility"; e "factors". Foram incluídos os artigos relacionados à avaliação das propriedades psicométricas do FTND publicados em inglês, espanhol e português. RESULTADOS: Vinte e seis estudos relativos às propriedades psicométricas do FTND foram identificados na literatura indexada. A análise dos estudos confirmou a confiabilidade do FTND na avaliação da dependência de tabaco em diferentes contextos e populações. CONCLUSÕES: Futuros estudos de validação, utilizando como medida comparativa instrumentos aferidos, de modo a referendar o seu extenso uso pelas suas qualidades psicométricas ainda são necessários.

OBJECTIVE: The Fagerström Test for Nicotine Dependence (FTND) is a screening instrument for physical nicotine dependence and is extensively used in various countries. The objective of the present report was to review articles related to the psychometric properties of the FTND. METHODS: A systematic search for articles published up through December of 2007 was carried out in various electronic databases. The following search terms were used: "Fagerström Test for Nicotine Dependence"; "FTND"; "psychometric"; "validity"; "reliability"; "feasibility"; and "factors". We included articles published in English, Spanish or Portuguese and in which the psychometric properties of the FTND were evaluated. RESULTS: Twenty-six studies related to the psychometric properties of the FTND were identified in the indexed literature. Analysis of the studies confirmed the reliability of the FTND for the assessment of nicotine dependence in different settings and populations. CONCLUSIONS: Further validation studies using previously validated instruments as a comparative measure are needed before the extensive use of the FTND can be justified on the basis of its psychometric qualities.

Diagnóstico y tratamiento psicosocial del tabaquismo / Smoking cessation: Diagnosis and psychosocial intervention

Tobacco dependence is an addictive chronic disease, characterized by its trend to the recurrence, in which the relapses are part of the process of smoking cessation. It is recommended a complete clinical evaluation, including the application of certain tests that can allow level of dependence, motivation and psychiatric comorbidities evaluation. The current treatment of smoking has two pillars: psycho-social intervention and pharmacological therapy. The current interventions are based on two theoretical models that try to understand changes of smoking behavior: The Stages of Change and PRIME Theory. Brief intervention is a strategy internationally approved because of its population impact on smoking cessation. The methodology used is named "5A's": Ask, Advise, Asses, Assist and Arrange follow-up. For not motivated patients at the intervention time it can be used the "5R 's" methodology: Relevance, Risks, Rewards, Roadblocks and Repetition. The actual approach used in smokers management, is Motivational Interview, which tries to produce the behavioral change from inside and not imposing it. Its four tools are: express empathy, develop discrepancy, roll with resistance and support self efficacy. The useful psychosocial strategies, in which exists consensus, are: 1) Give practical counseling of problem solving and skills training to face risky situations; 2) Intra-treatment support, encouraging attempts of smoking cessation and communicate caring and concern.

El tabaquismo es una enfermedad crónica adictiva, caracterizada por su tendencia a la recurrencia, en que las recaídas son parte del proceso de dejar de fumar. Se recomienda una evaluación clínica completa de los fumadores, incluyendo la aplicación de algunos tests que permitan evaluar nivel de adicción, motivación y comorbilidad psiquiátrica. El tratamiento actual del tabaquismo tiene dos pilares: intervención psicosocial y terapia farmacológica. las intervenciones actuales, se basan en dos modelos teóricos que intentan comprender los cambios de la conducta de fumar de las personas: las Etapas de Cambio y la Teoría PRIME. la Consejería Breve es una estrategia aprobada internacionalmente por su impacto poblacional en dejar de fumar. la metodología que utiliza se denomina las 5 A: Averiguar, Aconsejar, Acordar, Ayudar y Acompañar. Para los pacientes no motivados al momento de la intervención se utiliza la metodología de las 5 R: Relevancia, Riesgos, Recompensas, Resistencias y Repetición. El enfoque actualmente utilizado en el manejo de los fumadores, es la Entrevista Motivacional, que intenta producir el cambio conductual desde dentro y no imponiéndolo. Sus cuatro herramientas son: expresar empatia, desarrollar las discrepancias, lidiar con las resistencias y mejorar la autoeficacia. Hay consenso en que las estrategias psicosociales útiles son: 1) la entrega de consejos prácticos para resolución de problemas y desarrollo de habilidades para enfrentar situaciones de riesgo; 2) el apoyo intratratamiento, incentivando los intentos por dejar de fumar y trasmitiendo preocupación y apoyo.

Tobacco use amongst children in Karnataka.

OBJECTIVE: To estimate the prevalence, pattern and correlates of tobacco use amongst the 13-15 year olds in schools of Karnataka. METHODS: A three stage (area, school level and class level) cluster sample design was adopted and 80 schools from 12 districts of the state were selected. A total of 4,110 students participated in the study with an overall response rate of 87%. RESULTS: Point prevalence of tobacco use amongst 13-15 year old was 4.9%. Current tobacco use was predominantly a male feature and use of smokeless variety predominated (transitional Karnataka (8.2%); metropolis (6.8%); rural (3.4%). One third of current tobacco users (30.8%) purchased tobacco product in a store and one-fifth used it at home. Nearly half of the never smokers (43% to 56.7%) were exposed to tobacco smoke outside home and 83% favored a ban on smoking in public places. A male tobacco user was perceived to have more friends and was reported to make them look attractive. Print media was a predominant source of message, more so in the metropolitan region. Only one-third (31.6%) reported that the reasons of tobacco usage amongst youth was discussed in formal school settings. CONCLUSION: GYTS Karnataka has provided reliable estimates and shown the feasibility of implementing a surveillance programme. Specific challenges for Public health that emerge from the study are increasing number of users in transitional areas, continued media exposure, tobacco users being perceived to be popular and attractive, easy and relatively unrestricted access, lack of systematic support within schools and social acceptance of tobacco use at home. The need of the hour is to target and focus interventions through comprehensive programmes aimed at children, school authorities, parents and policy makers.