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OBJECTIVE: To perform a cost-benefit analysis of brief medical advice to quit smoking in the Region of Murcia. DESIGN: A cost-benefit analysis is performed on brief medical advice to quit smoking versus non-intervention. A Markov model is used to estimate the costs ( in 2014), under the perspective of the National Health System, and health outcomes. These are measured in quality-adjusted life years (QALY). The time horizon of the analysis is 20years, and costs and health outcomes were discounted at 3%. A univariate and multivariate deterministic sensitivity analysis is performed. LOCATION: Region of Murcia. PARTICIPANTS: Smokers in the Region of Murcia. INTERVENTIONS: Brief advice to quit smoking. KEY MEASURES: Quality Adjusted Life Years (QALYs). RESULTS: With a time horizon of 5years (2018), the incremental cost-effectiveness ratio (ICER) would be 172,400 per QALY gained; at 10years (2023) the ICER was 30,300 per QALY gained; and, for the maximum horizon considered by the model, the ICER was 7,260 per QALY gained. CONCLUSIONS: Brief advice intervention is more efficient in the long-term than in the short-term and, depending on the Spanish cost-benefit threshold, public funding for this intervention would be recommended.
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background: Smoking is the leading cause of preventable morbidity and death. It is important to know the characteristics of smoking habits among physicians and their attitude toward patients who smoke. Objective: The aim of this study is to investigate the prevalence of smoking among physicians in Argentina, the factors associated with tobacco consumption and their attitude toward their patients who smoke. Methods: An observational cross- sectional study was performed between June and December 2013 in Argentine physicians of dif-ferent specialties. Using a structured survey, the following variables were analyzed: associated cardiovascular risk factors, charac-teristics of tobacco consumption, smoking cessation training and the attitude toward the patient who smokes. results: 3,033 physicians were surveyed, ; 57% were men, and mean age was 41.3±12 years; 19.7% were current smokers and 21.7% were former smokers. The probability of being a smoker was higher among surgeons (OR 1.29) or physicians working at the emergency room (OR 1.41). Undergraduate and postgraduate tobacco cessation training was achieved by 36.6% and 40.8% of physicians, respectively. Young physicians, clinical specialties or private practice were associated with higher level of training. Tobacco cessation counseling was more frequent in physicians with higher level of training than physicians who smoked or surgeons. Former smokers presented higher prevalence of risk factors and cardiovascular events. Family history of smoking habit was more common in former smokers and current smokers. Conclusions: The prevalence of smoking among Argentine physicians is high. Different factors are involved in the probability of smoking, tobacco cessation training or the possibility of medical counseling. Higher level of training in smoking cessation must be provided.
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Introducción: El tabaquismo es una enfermedad adictiva siendo difícil para muchos fumadores la cesación. Para su prevención y control en Cuba se toman múltiples medidas que van desde el aumento del precio de los cigarrillos hasta brindar tratamientos de desestimulación.Objetivo: Caracterizar a los fumadores que solicitan ayuda para el abandono, según variables sociodemográficas, características del consumo, enfermedades asociadas y personas que influyeron en la decisión del cese.Métodos: Se realizó una investigación descriptiva transversal con los 103 pacientes que acudieron durante el 2012 al servicio de desestimulación tabáquica del Centro Comunitario de Salud Mental Plaza de la Revolución en La Habana. Se les realizó previo consentimiento informado un cuestionario y el test de Fagerström para identificar el grado de dependencia a la nicotina.Resultados: Se encontró un predominio de pacientes mayores de 45 años con un nivel educacional medio superior y vínculo laboral. La mayoría tenían familiares fumadores confirmándose la alta significación del aprendizaje por imitación. Predominó el inicio del consumo en la adolescencia y la vía patogénica sociocultural. Prevaleció un grado de tabaquismo severo siendo los trastornos respiratorios y cardiovasculares los más reportados. La familia y los amigos fueron las personas que más influyeron para el abandono. La orientación por el médico de la familia fue limitada.Conclusiones: Solicitan ayuda para la cesación tabáquica personas de edad media, dependientes a la nicotina, con un elevado consumo, iniciación temprana, con enfermedades asociadas al tabaquismo siendo necesarias estrategias psicoterapéuticas acordes a esta caracterización. Fue limitado en la atención primaria, el consejo médico(AU)
Introduction: Smoking is an addictive disease remains difficult for many smoking cessation. For prevention and control in Cuba multiple measures ranging from increasing the price of cigarettes to provide desestimulación treatments are taken.Objective: To characterize smokers seeking help to quit, according to sociodemographic variables, consumption characteristics, associates and people that influenced the decision to stop diseases.Methods: A descriptive investigation was conducted with 103 patients who came in 2012 to serve desensitization of smoking behavior the Community Mental Health Center Square of the Revolution in Havana. They conducted a questionnaire and informed the Fagerström test for identifying the degree of nicotine dependence prior consent.Results: The prevalence of patients older than 45 years with an average education level and higher employment relationship was found. Most smokers had family confirming the high significance of learning by imitation. Predominated smoking initiation in adolescence and sociocultural pathogenic pathway. Prevailed a degree of severe respiratory and smoking being the most reported cardiovascular disorders. Family and friends were the most influential people for leaving. The guidance by family doctors was limited.Conclusions: Seek help for smoking cessation middle-aged, dependent on nicotine, with high consumption, early initiation to smoking-related diseases psychotherapeutic strategies needed to be consistent with this characterization. It was limited in primary care, medical advice(AU)
Subject(s)
HumansABSTRACT
La presente investigación se basa en los análisis de el acuerdo de Corte Plena y Consejo Superior junto con el análisis de las entrevistas quienes analizan desde dos ópticas la función en alzada del Consejo Médico Forense y estas son: beneficios y perjuicios de su eliminación. Se consideran además aspectos históricos del Consejo Médico Forense y sus funciones actuales.
This investigation is based on the analyses of the agree between the Supreme Court and the Superior Council as long with the analysis of the interviews of those who study the function of the Medical Forensic Council from two points of view: benefits and damages of its elimination.
Subject(s)
Humans , Counseling , Forensic Medicine , Health Planning Councils , Costa RicaABSTRACT
El Departamento de Medicina Legal de Costa Rica está compuesto por tres secciones: Medicina Legal Clínica, Psiquiatría Forense y Patología Forense. Los dictámenes emitidos por el médico de una sección pueden ser objeto de ampliaciones en la misma sección. Posteriormente, si alguna de las partes no está conforme puede apelarse ante el Consejo Médico Forense. El Consejo Médico Forense está presidido por el Jefe del Departamento de Medicina Legal, e integrado por los jefes de sus secciones y por un quinto médico especialista que periódicamente se eligen dentro de su personal profesional. En caso de dictámenes de médicos rurales no especialistas, lo aconsejable es enviar los casos cuestinados a la respectiva sección del Departamento de Medicina Legal y sólo después de este trámite recurrir en apelación al Consejo de Médico Forense.
