Eficácia de um protocolo hospitalar para cessação do tabagismo no pós-alta: um estudo longitudinal / Efficacy of a hospital protocol for post-discharge smoking cessation: a longitudinal study

Introdução: Na literatura nacional, são escassos os trabalhos que avaliam intervenções hospitalares para promoção da cessação do tabagismo. Objetivo: Avaliar a eficácia de um protocolo hospitalar na promoção da cessação do tabagismo segundo grau de dependência nicotínica. Método: Estudo longitudinal realizado em hospital universitário, com 146 participantes dividido em dois grupos segundo grau de dependência à nicotina. Ambos receberam abordagem motivacional, material informativo, terapia de reposição de nicotina (quando indicado) e ligações telefônicas semanais por 30 dias pós alta. Resultados: Noventa e dois participantes (63%) apresentaram maior dependência nicotínica (Fagerström ≥ 5). Os sintomas de ansiedade e depressão foram mais frequentes no grupo de maior dependência (p=0,018). A autoeficácia, foi maior no grupo com menor dependência (p=0,008). O percentual de cessação um mês após a alta foi três vezes maior nos pacientes com menor dependência (p=0,001). Conclusão: Os resultados reforçam que as estratégias devem ser aprimoradas para pacientes com maior dependência e que um protocolo estruturado favorece o alcance da cessação em pacientes hospitalizados. [au]

Introduction: In the national literature, studies which evaluates hospital interventions are still shortages to promote smoking cessation. Objective: To evaluate the effectiveness of a hospital smoking cessation program in promoting cessation, according degree of nicotine dependence. Methods: This longitudinal study evaluated 146 hospitalized smokers, divided into two groups according to their degree of nicotine dependence. During hospitalization, patients received motivational/behavioral counseling, printed educational materials, nicotine replacement for 30 days. Post-discharge, patients received weekly telephone calls for one month. Results: Ninety-two participants (63%) had an FTND score ≥ 5 indicating higher levels of nicotine dependence. Depression/anxiety was significantly more prevalent in the high-dependent group (p=0,018). The low-dependent group had higher mean self-efficacy (0-worst to 10-best) compared to the high dependence group (median of 8 and 6 respectively, p=0.008). Cessation one month after discharge was nearly three times higher in the low-dependent group, compared to the high-dependent group (p=0.001). Conclusions: In the sample studied, patients more dependent on nicotine exhibited higher depression/anxiety and lower self-efficacy­elements that negatively influence the achievement of cessation. Quit rates were much lower in the high-dependent group. Strategies that increase self-efficacy and address mental disorders could address underlying risks that hinder cessation among patients with higher nicotine dependence. A structured protocol favors the achievement of cessation in hospitalized patients. [au]

Anti-inflammatory and antinociceptive activity of Siparuna guianensis Aublet, an amazonian plant traditionally used by indigenous communities.

ETHNOPHARMACOLOGICAL RELEVANCE: Siparuna guianensis Aublet leaves, known as negramina, are used by indigenous and local communities in Brazil and other countries in the Americas to treat pain and inflammatory diseases. AIM OF THE STUDY: To characterize the chemical constituents and to evaluate the antioxidant, anti-inflammatory, antinociceptive and locomotor activities of the dichloromethane fraction (DF) of S. guianensis leaves. Also, an acute oral toxicity test was accomplished. MATERIAL AND METHODS: The chemical characterization of DF was performed by ultra-high pressure liquid chromatography (UHPLC) analyses coupled with a high-resolution mass spectrometer. The antioxidant potential of DF was investigated using nitric oxide (NO) and hydroxyl radical (OH) scavenging test. The evaluation study of the anti-inflammatory activity was carried out in vitro by NO measurement in stimulated macrophages and, in vivo, by croton oil-induced ear edema, LPS-induced peritonitis, and zymosan-induced arthritis in mice. Different mechanisms of central and peripheral nociception were stimulated by acetic acid-induced writhing, formalin, and tail-flick tests. Besides that, the open field assay was performed. RESULTS: UHPLC analyses of DF showed the presence of a mixture of glycosylated and methoxylated flavonoids. DF was able to scavenge NO and OH radicals in vitro and showed anti-inflammatory activity by inhibiting NO production in LPS-stimulated murine macrophages. Oral administration of DF considerably inhibited the ear edema after croton oil application and reduced the leukocyte infiltrated in LPS-induced peritonitis. In the inflammatory intra-articular zymosan-induced process, DF showed a significant reduction in the inflammatory area and of the cells in the synovial and connective tissues adjacent to the joint. Also, DF was able to reduce the intra-articular edema. In nociception models, the oral administration of DF considerably inhibited the acetic acid-induced writhings. The formalin test showed that DF attenuated the licking time in both phases, which suggested that DF reduce the nociception by central and peripheral mechanisms. In the tail-flick test, DF showed no activity. Besides that, DF did not affect the animal locomotion, and no acute toxicity was observed. CONCLUSIONS: For the first time, the anti-inflammatory and antinociceptive activities of S. guianensis were reported, supporting its ethnopharmacological uses for some inflammatory diseases and painful conditions.

Promoting cessation in hospitalized smoking patients: a systematic review.

OBJECTIVES The objective of this review was to evaluate high intensity post-discharge follow-up strategies to promote smoking cessation in hospitalized patients. METHODS A systematic review was performed, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA - P) protocol. The databases used for research were: PubMed, LILACS/BIREME, Scopus, Web of Science, Cochrane and Scielo. The included articles were randomized clinical trials, published from 1990 to 2018, which evaluated in-hospital and post-discharge intervention, and provided a minimum of 30-day care post discharge. The studies aimed to evaluate tobacco cessation. RESULTS Fourteen studies were selected for analysis. Across studies, pharmacotherapy was consistently effective for smoking cessation. Communication technologies likewise were consistently effective for cessation and post-discharge access. CONCLUSION Effective strategies exist. The challenge for future trials is to determine the best approaches for different clinical contexts, to promote cessation.

Promoting cessation in hospitalized smoking patients: a systematic review

SUMMARY OBJECTIVES The objective of this review was to evaluate high intensity post-discharge follow-up strategies to promote smoking cessation in hospitalized patients. METHODS A systematic review was performed, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA - P) protocol. The databases used for research were: PubMed, LILACS/BIREME, Scopus, Web of Science, Cochrane and Scielo. The included articles were randomized clinical trials, published from 1990 to 2018, which evaluated in-hospital and post-discharge intervention, and provided a minimum of 30-day care post discharge. The studies aimed to evaluate tobacco cessation. RESULTS Fourteen studies were selected for analysis. Across studies, pharmacotherapy was consistently effective for smoking cessation. Communication technologies likewise were consistently effective for cessation and post-discharge access. CONCLUSION Effective strategies exist. The challenge for future trials is to determine the best approaches for different clinical contexts, to promote cessation.

RESUMO OBJETIVO O objetivo deste estudo foi avaliar as estratégias no acompanhamento pós-alta para a promoção da cessação no paciente tabagista hospitalizado. MÉTODOS Foi realizada uma revisão sistemática tomando-se por referência o protocolo Preferred Reporting Itens for Systematic Rewiews and Meta-Analyses (Prisma-P). Foram utilizadas as seguintes bases de dados: PubMed, Lilacs/Bireme, Scopus, Web of Science, Cochrane e SciELO. Os artigos incluídos foram ensaios clínicos randomizados, publicados entre 1990 e 2018, que promoveram intervenções durante e após a alta hospitalar, intervenções essas que se mantiveram pelo período mínimo de 30 dias após a alta. Os estudos deveriam ter como desfecho a avaliação da cessação do tabagismo. RESULTADOS Quatorze estudos foram selecionados para a análise. A revisão dos artigos destacou a farmacoterapia como elemento importante para a promoção da cessação, bem como o uso das novas tecnologias de comunicação no acesso pós-alta. CONCLUSÃO Ainda se impõe como um desafio o aprimoramento das estratégias de follow-up após a alta hospitalar para se adequarem aos contextos locais e alcançarem melhores taxas de cessação.