Gender, smoking, and tobacco cessation with pharmacological treatment in a cluster randomized clinical trial.

INTRODUCTION: Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of 'Subsidized pharmacological treatment for smoking cessation by the Spanish public health system' (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender. METHODS: A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months post-intervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed. RESULTS: A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the self-reported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0-2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7-2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3-5.8). CONCLUSIONS: The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment.

Prison officers in Latin America: quality of life, working conditions and main difficulties.

Although the number of empirical studies on prison inmates in Latin America has increased in recent years, an aspect that still remains little studied is the situation of prison workers. This article analyzes the labor situation of prison officers in Latin America, and considers their working conditions, quality of life and the problems that affect them, in a region marked by precarious, overcrowded and violent prison systems. To do so, a systematic review of articles published in Spanish or Portuguese on the Scielo platform between 2000-2021 was carried out. Our main findings show that prison officers suffer from significant levels of stress and work overload; and carry out their work in poor conditions; with long working hours; performing an invisible and socially undervalued job; with important risks of negative consequences for their physical and mental health. Finally, some implications of the findings and some lines of intervention are discussed.

Funcionarios penitenciarios en América Latina: calidad de vida, condiciones laborales y principales problemáticas / Prison officers in Latin America: quality of life, working conditions and main difficulties

Aunque los estudios empíricos sobre personas privadas de libertad en América Latina han venido creciendo en los últimosaños, un aspecto que aún permanece poco estudiado lo constituyen los trabajadores penitenciarios. El presente artículo analizala situación laboral de los funcionarios penitenciarios en Latinoamérica, ahondando en sus condiciones de trabajo, su calidad devida y las problemáticas que les afectan, dentro de una región marcada por sistemas carcelarios precarios, hacinados y violentos.Para ello, se realizó una revisión sistemática de artículos publicados en español o portugués en la plataforma Scielo, entre losaños 2000-2021.Nuestros principales hallazgos muestran una relación con funcionarios penitenciarios con importantes niveles de estrés y sobrecarga laboral, que desempeñan su trabajo en condiciones precarias, con jornadas de trabajo largas, un trabajo invisible y pocovalorado socialmente, y arrastrando importantes riesgos de consecuencias negativas en su salud física y mental. Finalmente, se discuten algunas implicaciones de los hallazgos y las líneas de intervención. (AU)

Although the number of empirical studies on prison inmates in Latin America has increased in recent years, an aspect thatstill remains little studied is the situation of prison workers. This article analyzes the labor situation of prison officers inLatin America, and considers their working conditions, quality of life and the problems that affect them, in a region markedby precarious, overcrowded and violent prison systems. To do so, a systematic review of articles published in Spanish orPortuguese on the Scielo platform between 2000-2021 was carried out.Our main findings show that prison officers suffer from significant levels of stress and work overload; and carry out theirwork in poor conditions; with long working hours; performing an invisible and socially undervalued job; with importantrisks of negative consequences for their physical and mental health. Finally, some implications of the findings and some lines of intervention are discussed. (AU)

Subsidized pharmacological treatment for smoking cessation by the Spanish public health system: A randomized, pragmatic, clinical trial by clusters.

INTRODUCTION: Research has shown that financing drug therapy increases smoking abstinence rates, although most of these studies have been carried out in the private healthcare setting. The aim of this work is to assess the effect of subsidized pharmacological treatment on smoking cessation rates by the Spanish public healthcare system. METHODS: A pragmatic, randomized, clinical trial was performed by clusters. Randomization unit was the primary healthcare center and the analysis unit was the patient. Smokers consuming ≥10 cigarettes/day were randomly assigned to an intervention group that received financed pharmacological treatment or to a control group that followed usual care. The main outcome was self-reported or CO-confirmed continuous abstinence at 12 months. The main outcome, continuous abstinence rates (%), were compared between groups at 12 months post-intervention. A model was adjusted using mixed-effect logistic regression. RESULTS: A total of 1154 patients were included from 23 healthcare centers. In the intention-to-treat analysis, self-reported abstinence after 12 months in the control and intervention groups, respectively, was 9.6% (37/387) and 15.4% (118/767) (gender-adjusted OR=1.75; 95% CI: 1.1-2.8); for CO-confirmed abstinence the corresponding values were 3.1% (12/387) and 6.4% (49/767) (gender-adjusted OR=1.72; 95% CI: 0.7-4.0). Pharmacological treatment use was 35.1% (136/387) in the control group, and 58.3% (447/767) in the intervention group (adjusted OR=4.25; 95% CI: 1.8-9.9). CONCLUSIONS: Subsidizing pharmacological treatment for smoking cessation increases self-reported or CO-confirmed abstinence rates under realistic conditions in the primary care setting of the Spanish public health system.

Estudio comparativo sobre las causas de mortalidad entre personas con trastorno bipolar y una muestra control en Costa Rica entre 1995 y 2005 / Comparative study of mortality causes between subjects with bipolar disorder and a control sample between 1995 and 2005

Resumen Justificación: el trastorno afectivo bipolar afecta entre un 1 % y un 2 % de la población mundial. Se ha descrito que se acompaña de un aumento en la mortalidad por causas tanto violentas como no violentas. Existen pocos estudios en el país acerca de las causas de muerte en esta población. Este estudio tiene como objetivo analizar las causas de muerte de personas con trastorno afectivo bipolar y compararlas con las de controles sanos. Métodos: de los sujetos con trastorno afectivo bipolar previamente reclutados para estudios genéticos del Centro de Investigación en Biología Celular y Molecular de la UCR, se seleccionó a las 154 personas que habían fallecido entre 1993 y 2005. Se eligieron 154 controles apareados por sexo, que hubiesen nacido y fallecido en el mismo periodo que el sujeto, con una diferencia no mayor a tres meses. El análisis estadístico consistió en una prueba exacta de Fisher con 1000 simulaciones del valor de p con Monte Carlo. Resultados: de los 154 sujetos, un 50 % (n=77) fueron mujeres. No hubo diferencia en la causa de muerte entre sexos. Se encontró diferencia significativa en las principales causas de muerte entre casos y controles (p<0,05). Se observó una diferencia significativa en las categorías de "lesiones autoinflingidas" (χ2 (1)=11.0, p<0,05) y "cáncer" (χ2(1)= 4,1, p= 0,04). No se documentó diferencia en enfermedad cardiovascular (χ2(1)=0,3, p= 0,61), neumonía (χ2(1)=3,1, p= 0,07) y accidentes (χ2(1)= 2,0, p= 0,16). Conclusión: como se ha documentado en bibliografía internacional, las lesiones autoinfligidas son la causa de muerte de mayor importancia en la población afectada con trastorno afectivo bipolar.

Abstract Background: Bipolar disorder affects 1% to 2% of the world population. It has been described that it is accompanied by an increase in mortality from both violent and non-violent causes. Few studies have been published in our country about causes of death in this particular population. The objective of our study is to analyze the causes of death of subjects with bipolar disorder and compare them to healthy controls. Methods: From the pool of subjects with bipolar disorder previously recruited for genetic studies conducted at the Cellular and Molecular Biology Research Centre of the UCR, we recruited the 154 subjects who had died between 1993 and 2005. Controls of the same sex who were born and died in the same period as the subject, with a difference no greater than three months, were selected. For the statistical analysis we ran a Fisher's exact test with 1000 simulations of the p-value with Monte Carlo. Results: Of 154 subjects, 50% (n=77) were women. We found no difference in the cause of death between sexes among the cases. A significant difference in the main causes of death was found between cases and controls (p<0.05). A significant difference was observed in the categories of "self-inflicted lesions" (χ2 (1)=11.0, p<0.05) and "cancer" (χ2(1)= 4.1, p= 0.04). No difference was documented in cardiovascular disease, (χ2(1)=0.3, p= 0.61), pneumonia (χ2(1)=3.1, p= 0.07) nor accidents (χ2(1)= 2.0, p= 0.16). Conclusion: Self-inflicted lesions, as has been documented in international literature, are a cause of death of major importance in the population affected with bipolar disorder.