Diretrizes para cessação do tabagismo - 2008

[Nutritional status, nutritional self-perception, and use of licit drugs in adolescents]

OBJECTIVE

To associate the nutritional status and the self-perception of nutritional status with the use of licit drugs among adolescents.

METHODS

Cross-sectional study in which 210 adolescents answered a questionnaire on alcohol and tobacco experimentation and self-perceptions about their nutritional status. The correspondence between the adolescents' perception of their own nutritional status and actual nutritional status was analyzed, as well as associations between nutritional status, self-perception of nutritional status, gender, age, and presence of smokers at home with alcohol and tobacco use. The variables were analyzed separately in a bivariate analysis and, subsequently, a multivariate analysis determined the factors associated with drug use.

RESULTS

The study included 210 adolescents with a median age of 148 months; 56.6% were females. Of the total sample, 6.6% have tried cigarettes, and 20% have tried alcohol; 32.3% had BMI Z-Score≥1, 12.85% had BMI Z-Score≥2, and 50.7% had a correct perception of his/her weight. After a multivariate analysis, only the self-perception about weight statistically influenced experimentation of tobacco, and patients who identified themselves as having very high weight were more likely to experiment tobacco (odds ratio (OR) 13.57; confidence interval (95% CI) 2.05-89.8; p=0.007); regarding alcohol use, adolescents who identified themselves as having high weight were 2.4 times more likely to experiment with alcohol than adolescents that identified themselves as having normal weight (95% CI 1.08-5.32, p=0.031).

CONCLUSIONS

Adolescents with self-perception of excess weight may constitute a risk group for alcohol and tobacco use.

[Profile and motivation for smoking cessation in surgical inpatients]

The aim of this cross-sectional study was to describe the profile of smokers hospitalized for surgery, and investigate their motivation to quit. The sample consisted of 100 patients recruited from a university hospital in southern Brazil. Data were collected between February and May 2013, and analyzed using descriptive statistics. The sample was predominantly male (n=58; 58%) and had a mean age of 54.5±13.8 years. Seventy-nine (79%) of the participants were white, 38(38%) were married and 67(67%) had primary education only. Patients started smoking at a mean age of 17±6.6 years, smoked approximately 20(10 to 28.7) cigarettes/day and had been smoking for a mean of 37.4±14.4 years. Ninety-one (91%) patients wanted to stop smoking, 57(57%) were in the preparation phase, 36(36%) had low nicotine dependence and 35(35%) had been encouraged to quit. We concluded that, although hospitalization is a good moment to address smoking cessation, health care professionals do not enact effective and systematic interventions in this regard.

The electronic cigarette: the new cigarette of the 21st century?

The electronic nicotine delivery system, also known as the electronic cigarette, is generating considerable controversy, not only in the general population but also among health professionals. Smokers the world over have been increasingly using electronic cigarettes as an aid to smoking cessation and as a substitute for conventional cigarettes. There are few available data regarding the safety of electronic cigarettes. There is as yet no evidence that electronic cigarettes are effective in treating nicotine addiction. Some smokers have reported using electronic cigarettes for over a year, often combined with conventional cigarettes, thus prolonging nicotine addiction. In addition, the increasing use of electronic cigarettes by adolescents is a cause for concern. The objective of this study was to describe electronic cigarettes and their components, as well as to review the literature regarding their safety; their impact on smoking initiation and smoking cessation; and regulatory issues related to their use.

Comorbidities and cardiovascular risk factors in patients with psoriasis

BACKGROUND

Psoriasis is a chronic inflammatory disease and its pathogenesis involves an interaction between genetic, environmental, and immunological factors. Recent studies have suggested that the chronic inflammatory nature of psoriasis may predispose to an association with other inflammatory diseases, especially cardiovascular diseases and metabolic disorders.

OBJECTIVES

To describe the demographic, clinical, epidemiological, and laboratory characteristics of a sample of psoriasis patients; to assess the prevalence of cardiovascular comorbidities in this group of patients; and to identify the cardiovascular risk profile using the Framingham risk score.

METHODS

We conducted a cross-sectional study involving the assessment of 190 patients. Participants underwent history and physical examination. They also completed a specific questionnaire about epidemiological data, past medical history, and comorbidities. The cardiovascular risk profile was calculated using the Framingham risk score.

RESULTS

Patients' mean age was 51.5 ± 14 years, and the predominant clinical presentation was plaque psoriasis (78.4%). We found an increased prevalence of systemic hypertension, type 2 diabetes, metabolic syndrome, and obesity. Increased waist circumference was also found in addition to a considerable prevalence of depression, smoking, and regular alcohol intake. Patients' cardiovascular risk was high according to the Framingham risk score, and 47.2% of patients had moderate or high risk of fatal and non-fatal coronary events in 10 years.

CONCLUSIONS

Patients had high prevalence of cardiovascular comorbidities, and high cardiovascular risk according to the Framingham risk score. Further epidemiological studies are needed in Brazil for validation of our results.

N-acetylcysteine for therapy-resistant tobacco use disorder: a pilot study

INTRODUCTION

N-Acetylcysteine (NAC) may have efficacy in treating tobacco use disorder (TUD) by reducing craving and smoking reward. This study examines whether treatment with NAC may have a clinical efficacy in the treatment of TUD.

METHODS

A 12-week double blind randomized controlled trial was conducted to compare the clinical efficacy of NAC 3 g/day versus placebo. We recruited 34 outpatients with therapy resistant TUD concurrently treated with smoking-focused group behavioral therapy. Participants had assessments of daily cigarette use (primary outcome), exhaled carbon monoxide (CO(EXH)) (secondary outcome), and quit rates as defined by CO(EXH) < 6 ppm. Depression was measured with the Hamilton Depression Rating Scale (HDRS). Data were analyzed using conventional and modified intention-to-treat endpoint analyses.

RESULTS

NAC treatment significantly reduced the daily number of cigarettes used (Δ mean ± SD = -10.9 ± 7.9 in the NAC-treated versus -3.2 ± 6.1 in the placebo group) and CO(EXH) (Δ mean ± SD = -10.4 ± 8.6 ppm in the NAC-treated versus -1.5 ± 4.5 ppm in the placebo group); 47.1% of those treated with NAC versus 21.4% of placebo-treated patients were able to quit smoking as defined by CO(EXH) < 6 ppm. NAC treatment significantly reduced the HDRS score in patients with tobacco use disorder.

CONCLUSIONS

These data show that treatment with NAC may have a clinical efficacy in TUD. NAC combined with appropriate psychotherapy appears to be an efficient treatment option for TUD.

A novel dosage form for buccal administration of bupropion

Bupropion is an antidepressant used in the treatment of smoking. The purpose of this study was to prepare controlled-release hydrogel films for buccal administration of bupropion and investigate its physicochemical and cytotoxic properties. The films were prepared from ultrapure sodium carboxymethylcellulose, hydroxypropylmethylcellulose K4M, and medium-viscosity chitosan. Evaluation of film physicochemical characteristics was based on scanning electron microscopy, bupropion content, mechanical strength (burst strength, relaxation, resilience, and traction), and cytotoxicity. Bupropion content in bilayer films was 121 mg per 9 cm2. The presence of bupropion modified film mechanical strength, but did not compromise the use of this pharmaceutical form. As shown by the cytotoxicity results, films containing bupropion did not cause cellular damage. Bupropion administration in the form of hydrogel films is a potentially useful alternative in the treatment of smoking.

Preventing smoking during pregnancy: the importance of maternal knowledge of the health hazards and of the treatment options available

OBJECTIVE

To examine the pattern of tobacco use and knowledge about tobacco-related diseases, as well as to identify popular types of electronic media, in pregnant women, in order to improve strategies for the prevention or cessation of smoking among such women.

METHODS

A cross-sectional study involving 61 pregnant women, seen at primary care clinics and at a university hospital, in the city of Botucatu, Brazil. For all subjects, we applied the Hospital Anxiety and Depression Scale. For subjects with a history of smoking, we also applied the Fagerström Test for Nicotine Dependence, and we evaluated the level of motivation to quit smoking among the current smokers.

RESULTS

Of the 61 pregnant women evaluated, 25 (40.9%) were smokers (mean age, 26.4 ± 7.4 years), 24 (39.3%) were former smokers (26.4 ± 8.3 years), and 12 (19.8%) were never-smokers (25.1 ± 7.2 years). Thirty-nine women (63.9%) reported exposure to passive smoking. Of the 49 smokers/former smokers, 13 (26.5%) were aware of the pulmonary consequences of smoking; only 2 (4.1%) were aware of the cardiovascular risks; 23 (46.9%) believed that smoking does not harm the fetus or newborn infant; 21 (42.9%) drank alcohol during pregnancy; 18 (36.7%) reported increased cigarette consumption when drinking; 25 (51.0%) had smoked flavored cigarettes; and 12 (24.5%) had smoked a narghile. Among the 61 pregnant women evaluated, television was the most widely available and favorite form of electronic media (in 85.2%), as well as being the form most preferred (by 49.2%).

CONCLUSIONS

Among pregnant women, active smoking, passive smoking, and alternative forms of tobacco consumption appear to be highly prevalent, and such women seem to possess little knowledge about the consequences of tobacco use. Educational programs that include information about the consequences of all forms of tobacco use, employing new and effective formats tailored to this particular population, should be developed, in order to promote smoking prevention and cessation among pregnant women. Further samples to explore regional and cultural adaptations should be evaluated.

Factors associated with smoking cessation

OBJECTIVE To analyze the prevalence and factors associated with smoking abstinence among patients who were treated in a reference unit for smoking cessation. METHODS This cross-sectional study examined the medical records of 532 patients treated in a reference unit for smoking cessation in Belém, PA, Northern Brazil, between January 2010 and June 2012. Sociodemographic variables and those related to smoking history and treatment were analyzed. Statistical significance was set at p < 0.05. RESULTS The mean age of the participants was 50 years; 57.0% of the patients were women. The mean tobacco load was 30 packs/year, and the mean smoking duration was approximately 32 years. Most patients remained in treatment for four months. The rate of smoking abstinence was 75.0%. Regression analysis indicated that maintenance therapy, absence of relapse triggers, and lower chemical dependence were significantly associated with smoking cessation. CONCLUSIONS The smoking abstinence rate observed was 75.0%. The cessation process was associated with several aspects, including the degree of chemical dependence, symptoms of withdrawal, and period of patient follow-up in a multidisciplinary treatment program. Studies of this nature contribute to the collection of consistent epidemiological data and are essential for the implementation of effective smoking prevention and cessation strategies.

Association between the ankle-brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease?

Background

Patients with or at high risk of cardiovascular disease have a poor functional capacity; however, the influence of association among intermittent claudication (IC), abnormal ankle–brachial index (ABI), and physical activity level on functional capacity of these patients has not been fully studied.

Objective

The primary objective of this study was to investigate the association between the ABI, IC, and physical activity level, and the influence of these variables on the functional capacity of patients with or at high risk of cardiovascular disease seen in a reference cardiology outpatient clinic in Southern Brazil. The secondary objective was to assess the prevalence of peripheral arterial disease (PAD) in this sample of patients.

Patients and methods

This was a prospective cross-sectional study in which 162 consecutive patients were evaluated and classified into three groups according to their ABI: normal ABI (n=104, values between 1.00 and 1.40); borderline PAD (n=23, values between 0.91 and 1.00); and patients with PAD (n=35, ≤0.90). The presence of IC was assessed using the Edinburgh Claudication Questionnaire. The level of physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ) and functional capacity was assessed by the 6-minute walk distance (6MWD).

Results

The prevalence of PAD was 21.6% in the total sample. The 6MWD showed strong correlation with the absence of IC (r=0.785; P<0.001), moderate correlation with age (r=−0.347; P<0.001), and weak correlations with IPAQ scores (r=0.164; P=0.038) and ABI (r=0.216; P=0.006). Age, ABI, and absence of IC were independently associated with the outcome (P=0.001, P=0.001, and P=0.028, respectively).

Conclusion

The current study demonstrates that 6MWD is associated with IPAQ scores, ABI, and absence of IC. Age, ABI and absence of IC were independently associated with functional capacity in patients with or at high risk of cardiovascular disease.

Fatores sociodemográficos e econômicos associados ao tabagismo na população idosa

Objetivos Identificar a condição tabágica dos idosos e verificar os fatores sociodemográficos e econômicos associados ao hábito de fumar nessa população. Métodos Trata-se de um estudo quantitativo, transversal, observacional e analítico, com 980 idosos da zona urbana do município de Uberaba-MG. Utilizaram-se os instrumentos Miniexame do Estado Mental (MEEM) e Questionário Brasileiro de Avaliação Funcional e Multidimensional (BOMFAQ). Os idosos foram classificados como tabagistas, ex-tabagistas e não tabagistas de acordo com as Diretrizes para Cessação do Tabagismo. As análises procederam por meio do software SPSS-17. A condição tabágica dos idosos foi descrita por meio de frequências simples e absolutas. Aplicou-se o teste Cramer’s V (p ≤ 0,05) na análise bivariada e em seguida a Regressão Logística Multinomial Múltipla (p ≤ 0,05) ajustados para sexo e faixa etária de acordo com a classificação tabágica. Resultados Encontraram-se 122 (12,4%) idosos tabagistas, 320 (32,7%) ex-tabagistas e 538 (54,9%) não tabagistas. Os idosos tabagistas apresentaram-se com 3,57, 2,36 e 1,82 mais riscos de chances de ser do sexo masculino (p < 0,001), estar na faixa etária de 60 a 69 anos (p = 0,004) e não ter companheiro(a) (p = 0,008), respectivamente. Para os idosos ex-tabagistas, também foi encontrada maior chance de risco (5,34) para o sexo masculino (p < 0,001). Conclusão Os resultados evidenciam que o sexo, a faixa etária e a situação conjugal são fatores associados ao tabagismo na população idosa.

Activities of the healthcare team for women who smoke during pregnancy and the puerperium

OBJECTIVE

to identify activities developed by the healthcare team for pregnant and postpartum women who smoke.

METHOD

cross-sectional study with a sample of 135 healthcare team members who assist pregnant and postpartum women in a university hospital located in southern Brazil. The data was collected using questionnaires and analyzed using the Statistical Package for Social Sciences software.

RESULTS

76 (56.3%) staff members reported that they always addressed smoking cessation; however, the approach occurred in only two periods of the hospitalization and/or prenatal consultations, not including family members. In regard to the effectiveness of their actions, the health team assessed it as fair or poor, and mentioned the need for updating knowledge regarding this issue.

CONCLUSIONS

the health team did not perform the approach as recommended by the tobacco control guidelines, requiring training to offer a qualified and efficient intervention.

Ansiedade e baixo nível motivacional associados ao fracasso na cessação do tabagismo

Objetivo Analisar a associação entre as características sociodemográficas, status do tabagismo, grau de motivação, nível de ansiedade, depressão e de estresse com o fracasso em pacientes de um programa de cessação de tabagismo. Métodos Estudo de corte transversal realizado com pacientes que procuraram os programas de cessação do tabagismo de Cuiabá/MT, Brasil. Todos os fumantes matriculados no início desses programas, durante o período de maio a agosto de 2012, foram convidados a participar deste estudo, totalizando 216 pacientes. Os instrumentos utilizados foram o questionário Perfil Sociodemográfico, Teste de Fagerström (FTND), URICA, Inventário de Ansiedade de Beck (BAI), Inventário de Depressão de Beck (BDI) e Inventário de Sintomas de Stress de Lipp (ISSL). Os dados foram digitados duplamente em programa Epidata versão 3.1, e para análise dos dados foi utilizado um modelo de regressão de Poisson. Resultados Foram encontradas associações do fracasso terapêutico com as seguintes variáveis: faixa etária jovem (RP = 1,68; IC 95% 1,11-2,56); menor tempo de tabagismo (RP = 1,32; IC 95% 1,09-1,61); maior consumo de cigarros/dia (RP = 1,24; IC 95% 1,01-1,52) e menor grau de motivação (RP = 1,55; IC 95% 1,04-2,30). No modelo final (RPa), ficaram associadas ao fracasso as variáveis: menor tempo de tabagismo (RPa 1,53; IC 95% 1,07-2,32), maior carga tabágica (RPa 1,48; IC 95% 1,12-1,95), baixo nível de motivação (RPa 1,58; IC 95% 1,07-2,32) e alto nível de ansiedade (RPa 1,22; IC 95% 1,01-1,48). Conclusão Baixo nível motivacional (Contemplação e Pré-contemplação), alto nível de ansiedade (moderado/grave), menor tempo de tabagismo e alta carga tabágica estão associados ao fracasso terapêutico.

SLC6A4 STin2 VNTR genetic polymorphism is associated with tobacco use disorder, but not with successful smoking cessation or smoking characteristics: a case control study

Background

The aim of this study was to determine if variable number of tandem repeats (VNTR) in the second intron (STin2) of the serotonin transporter (SLC6A4) gene was associated with tobacco use disorder, successful smoking cessation, or smoking characteristics. In this case–control study, patients with current tobacco use disorder, diagnosed according to DSM IV criteria (n = 185), and never-smokers, diagnosed according to CDC criteria (n = 175), were recruited and received 52 weeks of combined pharmacotherapy and cognitive therapy. Successful smoking cessation was defined as exhaled carbon monoxide < 6 ppm. SLC6A4 gene STin2 VNTR polymorphism was assessed using a Multiplex-PCR-based method. At baseline, participants were evaluated using the Fagerström Test for Nicotine Dependence (FTND) and the ASSIST scale.

Results

The STin2.12 allele (OR = 2.45; 95% CI = 1.44-4.15, p < 0.001) was associated with an increased risk for tobacco use disorder, while the STin2.10/10 genotype (OR = 0.42; 95% CI 0.25-0.71, p < 0.001) decreased risk. There were no significant associations between tobacco use disorder and the STin2.10 or STin2.9 alleles or the other genotypes (STin2.12/12, 12/10, 12/9, 10/9 or 9/9). There were no significant associations between the STin2 genotypes and alleles and successful smoking cessation, smoking characteristics and increased alcohol or sedative use risk.

Conclusions

Our results suggest that the STin2.10/10 genotype and STin2.12 allele are associated with tobacco use disorder or nicotine dependence, but not with treatment response or severity of dependence. It is hypothesized that the ST2in.12 allele by modulating the metabolism of serotonin may participate in the pathophysiology of tobacco use disorder or nicotine dependence.

Nasal and systemic inflammatory profile after short term smoking cessation

INTRODUCTION

Smoking cessation promotes health benefits and, despite cigarette smoking be an important pro inflammatory stimulus, there are few studies concerning the nasal and systemic inflammation; as well as the mucociliary clearance behavior in smokers after short period of smoking cessation.

AIM

To evaluate the nasal and systemic inflammatory markers and mucociliary clearance behavior after 30 days of cigarette smoking abstinence.

METHODS

Twenty-five smokers were included and divided into two groups: abstinent smokers (n = 14) and current smokers (n = 11). Tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-8 and IL-10 were measured on nasal lavage and blood serum samples by ELISA at baseline and after 30 days. The mucociliary clearance, exhaled carbon monoxide (exCO) and carboxyhemoglobin (HbCO) were also measured at the same moments.

RESULTS

There was a decrease of TNF-α level only in blood serum at 30 days of abstinence compared to current smokers. The mucociliary clearance improved and there was a reduction in exCO and HbCO (p < 0.05 for all) after 30 days of smoking cessation.

CONCLUSION

The short term smoking abstinence decreased systemic inflammation and improved nasal mucociliary clearance, despite not having changed the nasal inflammation.

Psychological morbidity as a moderator of intention to quit smoking: a study of smokers and former smokers

OBJECTIVE:

To analyze psychological morbidity as a moderator of the relationship between smoking representations and quality of life in smokers and former smokers, as well as to determine which psychological variables discriminate between smokers with and without the intention to quit smoking.

METHODS:

This was a quantitative, correlational cross-sectional study involving a convenience sample of 224 smokers and 169 former smokers.

RESULTS:

In smokers and former smokers, psychological morbidity had a moderating effect on the relationship between mental/physical quality of life and smoking representations (cognitive representations, emotional representations, and comprehensibility). Smokers with the intention to quit smoking more often presented with low comprehensibility, threatening emotional representations, behavioral beliefs, and perceived behavioral control, as well as with normative/control beliefs, than did those without the intention to quit.

CONCLUSIONS:

The results of this study underscore the importance of the moderating effect exerted by psychological morbidity, as well as that of sociocognitive variables, among smokers who have the intention to quit smoking.

Nicotine dependence and smoking habits in patients with head and neck cancer

OBJECTIVE

To assess smoking habits and nicotine dependence (ND) in patients with head and neck cancer Methods: This study involved 71 smokers or former smokers with squamous cell carcinoma in the oral cavity, pharynx, or larynx who were treated at a university hospital in the city of São Paulo between January and May of 2010. We used the Fagerström Test for Nicotine Dependence to evaluate smoking habits and ND in the sample. Data regarding cancer treatment were collected from medical records. Depending on the variables studied, we used the chi-square test, Fisher's exact test, Student's t-test, or Spearman's correlation test.

RESULTS

Of the 71 patients, 47 (66.2%) presented with high or very high ND, 40 (56.3%) smoked more than 20 cigarettes/day, and 32 (45.1%) smoked their first cigarette within 5 min of awakening. Advanced disease stage correlated significantly with the number of cigarettes smoked per day (p = 0.011) and with smoking history (p = 0.047). We found that ND did not correlate significantly with gender, disease stage, smoking cessation, or number of smoking cessation attempts, nor did the number of cigarettes smoked per day correlate with smoking cessation or gender. Treatment for smoking cessation was not routinely offered.

CONCLUSIONS

In most of the patients studied, the level of ND was high or very high. The prevalence of heavy smoking for long periods was high in our sample. A diagnosis of cancer is a motivating factor for smoking cessation. However, intensive smoking cessation treatment is not routinely offered to smoking patients diagnosed with cancer.

Fatores associados ao uso regular de cigarros por adolescentes estudantes de escolas públicas de Londrina, Paraná, Brasil

Estudo epidemiológico transversal com objetivo de identificar fatores associados ao uso regular de cigarros por adolescentes. A amostra foi constituída por 517 alunos do 9o ano do Ensino Fundamental de escolas públicas de Londrina, Paraná, Brasil. O instrumento de coleta de dados incluiu características sociodemográficas, relações sociais e comportamentos de risco. Na análise estatística, foi utilizado o modelo de regressão logística com nível de significância em 5%. Relataram uso de cigarros, pelo menos, um dia nos últimos trinta dias 8,9% dos alunos. Os fatores idade ≥ 15 anos (OR = 2,28; IC95%: 1,21-4,32; p = 0,011) e possuir amigos fumantes (OR = 12,62; IC95%: 4,44-35,89; p < 0,0001) associaram-se ao uso regular de cigarros, tanto na análise univariada como na multivariada. Por outro lado, sexo, raça, classe social, morar com pai e mãe, religião, escolaridade materna, experimentação de álcool, atividade física e atividade remunerada não se associaram a essa prática. Esses achados podem subsidiar a elaboração de estratégias antitabágicas direcionadas à comunidade, tendo o adolescente como alvo.

Proposta interdisciplinar de apoio à cessação do tabagismo em uma unidade de saúde da Estratégia Saúde da Família: relato de experiência

Este artigo descreve a proposta interdisciplinar utilizada atualmente no Centro Municipal de Saúde Manguinhos (CMSM), Rio de Janeiro, para condução longitudinal do tratamento antitabagismo em pacientes residentes em comunidades de baixa renda da região, sob a ótica de um estudante de medicina em seu período de internato rotatório. A abordagem antitabágica consiste em terapia longitudinal dividida em duas etapas: (i) assistência a grupo de pacientes com abordagem interdisciplinar ao longo de quatro sessões distribuídas semanalmente que inclui tratamento psicoterápico e recursos farmacológicos; seguida de (ii) duas sessões quinzenais de terapia de manutenção, caracterizadas por atenção individualizada e desmame farmacológico, complementadas por um seguimento mensal de até um ano. Os protocolos atuais, as atividades dos profissionais e a condução da proposta são descritos. Este relato sugere que o aprimoramento da formação em medicina pode ocorrer por meio da participação dos estudantes em ações de educação em saúde, tais como o grupo antitabagismo.

3D Echo pilot study of geometric left ventricular changes after acute myocardial infarction

BACKGROUND

Left ventricular remodeling (LVR) after AMI characterizes a factor of poor prognosis. There is little information in the literature on the LVR analyzed with three-dimensional echocardiography (3D ECHO).

OBJECTIVE

To analyze, with 3D ECHO, the geometric and volumetric modifications of the left ventricle (VE) six months after AMI in patients subjected to percutaneous primary treatment.

METHODS

Prospective study with 3D ECHO of 21 subjects (16 men, 56 ± 12 years-old), affected by AMI with ST segment elevation. The morphological and functional analysis (LV) with 3D ECHO (volumes, LVEF, 3D sphericity index) was carried out up to seven days and six months after the AMI. The LVR was considered for increase > 15% of the end diastolic volume of the LV (LVEDV) six months after the AMI, compared to the LVEDV up to seven days from the event.

RESULTS

Eight (38%) patients have presented LVR. Echocardiographic measurements (n = 21 patients): I- up to seven days after the AMI: 1- LVEDV: 92.3 ± 22.3 mL; 2- LVEF: 0.51 ± 0.01; 3- sphericity index: 0.38 ± 0.05; II- after six months: 1- LVEDV: 107.3 ± 26.8 mL; 2- LVEF: 0.59 ± 0.01; 3- sphericity index: 0.31 ± 0.05. Correlation coefficient (r) between the sphericity index up to seven days after the AMI and the LVEDV at six months (n = 8) after the AMI: r: 0.74, p = 0.0007; (r) between the sphericity index six months after the AMI and the LVEDV at six months after the AMI: r: 0.85, p < 0.0001.

CONCLUSION

In this series, LVR has been observed in 38% of the patients six months after the AMI. The three-dimensional sphericity index has been associated to the occurrence of LVR.

[Campaign against smoking in a home for the elderly: the report of an experiment]

Studies on institutionalized elderly smokers are important for developing appropriate preventive measures. This was a cross-sectional population-based study of individuals over 60 admitted to a Home for the Elderly in the Federal District. The following aspects were investigated: smoking prevalence, socio-demographic and clinical profile, gender, education, probable depression, degree of motivation to stop smoking, prior use of medication to stop smoking and perception of the harm of smoking to health. Spirometry, the measurement of exhaled carbon monoxide and classification according to severity of nicotine dependence were conducted. The program followed guidelines for stopping smoking, and was evaluated one year later. Results revealed that 25.7% were smokers, 22.8% men and 2.9% women, mean age 68.3 ± 8.5 years. A significant decrease in smoking among the more elderly was detected. Significant associations emerged between the degree of nicotine dependence and education, probable depression, degree of motivation for stopping smoking and perception of the harm of smoking to health. Higher indices of carbon monoxide were identified in individuals with severe obstruction. Initially, 37.9% of smokers agreed to participate in the campaign, and after a year 9% of them succeeded in stopping smoking.

Can an index of smokers' emotional status predict the chances of success in attempts to quit smoking?

Smoking cessation still is a great challenge for smokers and health care professionals. Most subjects try cigarettes in adolescence under predominant environmental influences, and some psychological features are clearly associated with the establishment of continuous cigarette use. As a result, it is acceptable to assume that the risk of becoming regular smokers should be higher for subjects exhibiting imperfect psychological well-being. Since nicotine exhibits recognized psychopharmacological actions, an important reason for smoking would be the comfort of smokers' emotional afflictions. In this scenario, cigarettes might be seen as effective coping instruments for smokers. We hypothesize that a simple measure covering major emotional features of smokers might become a useful instrument for predicting the chances of success in attempts to quit smoking. The development of this new test aimed to measure the degree of smokers' emotional imbalance has the potential to predict the chances of success in response to standard therapy, as well as the need for introduction of intensive individualized psychological or psychiatric interventions. Preliminary analyses of a new test called Smokers' Emotional Index (SEI) support such a hypothesis. The SEI scores showed significant correlations with the values of the Fagerström test of nicotine dependence (FTND) for adult smokers. More numerous and better correlation coefficients were also observed between aspects of smoking history with SEI punctuations than with FTND scores. A clinical trial is proposed to test this hypothesis that could help to improve the results of current approaches to smoking cessation.

Difference between the prevalence of symptoms of depression and anxiety in non-diabetic smokers and in patients with type 2 diabetes with and without nicotine dependence

BACKGROUND

Individuals with diabetes who are smokers have higher risks of cardiovascular disease, premature death, and microvascular complications. The present study aims to determine the prevalence of symptoms of depression and anxiety in smokers with type 2 diabetes mellitus (T2D) and to evaluate if the prevalence of symptoms of depression and anxiety differ between the three groups studied (patients with T2D who smoke; patients with T2D who do not smoke; smokers without T2D), and finally determine if the degree of nicotine dependence is related to symptoms of anxiety and depression in smokers (with or without T2D).

METHODS

Three study groups were formed: 46 T2D smokers (DS), 46 T2D non-smokers (D), and 46 smokers without diabetes (S), totaling 138 participants. Hospital Anxiety and Depression (HAD) scale and Fagerström Test were applied.

RESULTS

The prevalence of symptoms of depression and anxiety in smokers with T2D was 30.4% and 50%, respectively. There was no significant difference in the proportion of individuals with symptoms of anxiety (p = 0.072) or depression (p = 0.657) in the DS group compared to group D or S. Among male patients with T2D, the smokers had a higher prevalence of anxiety symptoms (19.6%) than non-smokers (4,3%) (p = 0,025). The prevalence of high nicotine dependence among smokers with and without T2D was 39.1% and 37.1%, respectively (p = 0.999). Fagerström scores showed no significant correlation with the scores obtained on the subscale of anxiety (p = 0,735) or depression (p = 0,364).

CONCLUSIONS

The prevalence of depression and anxiety among smokers with and without diabetes and non-smokers T2D is similar. Among male individuals with T2D, the smokers have more symptoms of anxiety than the non-smokers. There is no difference in the prevalence of nicotine dependence among smokers with and without diabetes. The presence of symptoms of anxiety or depression is similar between patients who are dependent and not dependent on nicotine.

[Reasons that make individuals in a higher education institution to become or not to become smokers]

This is a cross-sectional study that aims to identify reasons that make individuals in a higher education institution to become or not to become smokers. The data were collected in 2009, with specific questionnaires analyzed statistically. The sample was of 426 subjects, of which 21 (5%) smokers, 26 (6.1%) ex-smokers and 376 (88.9%) non-smokers. The main reasons for smokers to quit smoking are the health problems that arise from it. Nicotine addiction is among the factors that make this process difficult. Ex-smokers say that emotional issues and the pleasure of smoking can make them smoke again, but they remain abstinent because they are determined not to smoke. Non-smokers report they don't like the cigarette, its smell and its smoke. The reasons to be a smoker or a non-smoker can help implementing health education actions that prevent people from starting to smoke and that help them stop.

Assessing evidence of interaction between smoking and warfarin: a systematic review and meta-analysis

BACKGROUND

Chronic smoking, theoretically, can interfere with warfarin metabolism through enzyme-inducing effects of polycyclic aromatic hydrocarbons. However, clinical evidence of interactions between warfarin and smoking are inconclusive. This study aimed to systematically review all relevant clinical evidence of this interaction.

METHODS

We performed a systematic search using computerized databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine, PsycINFO, International Pharmaceutical Abstracts, and ClinicalTrials.gov from 1966 to December 2008. Keywords included "warfarin" with "smoking," "tobacco," "cigarette," and "polycyclic aromatic hydrocarbons." Original articles reporting interaction between warfarin and smoking were included. All articles were reviewed independently by two investigators for study design, population, outcomes, and quality of evidence.

RESULTS

Of the 1,240 studies retrieved, one experimental pharmacokinetic study and 12 cross-sectional studies were included. The pooled analyses of multivariate studies suggested that smoking was associated with a 12.13% (95% CI, 6.999-17.265; P < .001) increase in warfarin dosage requirement and an additional 2.26 mg (95% CI, 2.529-7.042; P = .355) per week compared with nonsmoking. Additional sensitivity analysis of four multivariate studies with adjustment for pharmacogenomic factors suggested that smoking was associated with a 13.21% (95% CI, 8.59%-17.83%; P < .001) increase in warfarin dosage requirement compared with nonsmokers. Results of an experimental pharmacokinetic study lend theoretical support to the findings.

CONCLUSIONS

Evidence suggests that smoking may potentially cause significant interaction with warfarin by increasing warfarin clearance, which leads to reduced warfarin effects. Close monitoring of warfarin therapy should be instituted when there is a change in smoking status of patients requiring warfarin therapy.

Prevalence and factors associated with difficulty and intention to quit smoking in Switzerland

BACKGROUND

Recent data indicate a slight decrease in the prevalence of smoking in Switzerland, but little is known regarding the intention and difficulty to quit smoking among current smokers. Hence, we aimed to quantify the difficulty and intention to quit smoking among current smokers in Switzerland.

METHODS

Cross-sectional study including 607 female and 658 male smokers. Difficulty, intention and motivation to quit smoking were assessed by questionnaire.

RESULTS

90% of women and 85% of men reported being "very difficult" or "difficult" to quit smoking. Almost three quarters of smokers (73% of women and 71% of men) intended to quit; however, less than 20% of them were in the preparation stage and 40% were in the precontemplation stage. On multivariate analysis, difficulty to quit was lower among men (Odds ratio and 95% [confidence interval]: 0.51 [0.35-0.74]) and increased with nicotine dependence and number of previous quitting attempts (OR=3.14 [1.75-5.63] for 6+ attempts compared to none). Intention to quit decreased with increasing age (OR=0.48 [0.30-0.75] for ≥65 years compared to <45 years) and increased with nicotine dependence, the number of previous quitting attempts (OR=4.35 [2.76-6.83] for 6+ attempts compared to none) and among non-cigarette smokers (OR=0.51 [0.28-0.92]). Motivation to quit was inversely associated with nicotine dependence and positively associated with the number of previous quitting attempts and personal history of lung disease.

CONCLUSION

Over two thirds of Swiss smokers want to quit. However, only a small fraction wishes to do so in the short term. Nicotine dependence, previous attempts to quit or previous history of lung disease are independently associated with difficulty and intention to quit.

Tabagismo em idosos internados em instituições de longa permanência

OBJETIVO: Determinar a prevalência de tabagismo entre idosos internados em instituições de longa permanência para idosos (ILPIs) e verificar a associação do grau de dependência nicotínica com variáveis sociodemográficas, vínculo afetivo, motivação para cessação e depressão. MÉTODOS: Estudo transversal de base populacional, incluindo 573 idosos com idade > 60 anos, internados em 13 ILPIs no Distrito Federal. Foram analisadas as seguintes variáveis: tipo de ILPI, gênero, idade, escolaridade, renda mensal, estado civil, condição previdenciária, vínculo afetivo, motivação para a cessação, depressão provável e o grau de dependência nicotínica. Para a obtenção dos dados, foram utilizados os seguintes instrumentos: questionário sociodemográfico, Escala de Qualidade de Vida de Flanagan, Miniexame do Estado Mental, Escala de Depressão Geriátrica, teste de Richmond e Teste de Fagerström para Dependência de Nicotina. RESULTADOS: A prevalência geral de fumantes na amostra (573 indivíduos) foi de 23,0%. Dos 132 fumantes, havia 81 homens (24,9%) e 35 mulheres (20,1%). Foram incluídos no estudo 116 fumantes, dos quais 70 (60,3%) apresentavam depressão provável. Houve significativas associações entre o grau de dependência nicotínica e as seguintes variáveis: escolaridade, renda mensal, vínculo afetivo, motivação para a cessação e depressão provável. Não houve associações significativas entre a dependência de nicotina e as seguintes variáveis: tipo de ILPI, gênero, idade, condição previdenciária e estado civil. CONCLUSÕES: Nos idosos institucionalizados em ILPIs no Distrito Federal, constatamos uma elevada prevalência de tabagismo, havendo entre eles baixa motivação para a cessação tabágica.

Características clínicas e qualidade de vida de fumantes em um centro de referência de abordagem e tratamento do tabagismo

OBJETIVO: Comparar, entre fumantes e nunca fumantes, os seguintes aspectos: qualidade de vida, IMC, hospitalizações, incapacidades, história familiar de transtorno mental, doenças relacionadas ao uso de tabaco, depressão e uso de substâncias psicoativas. MÉTODOS: Um total de 167 fumantes inscritos em um programa de cessação do tabagismo no Centro de Referência de Abordagem e Tratamento do Tabagismo da Universidade Estadual de Londrina e 272 nunca fumantes doadores de sangue foram incluídos no estudo. Foram utilizados um questionário estruturado para a coleta de dados sociodemográficos, Alcohol, Smoking and Substance Involvement Screening Test, World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF) e Fagerström Test for Nicotine Dependence, todos validados para uso no Brasil, assim como critérios diagnósticos para a pesquisa de transtornos depressivos. RESULTADOS: A média de idade para fumantes e nunca fumantes foi, respectivamente, de 45 e 44 anos. As mulheres predominaram nos dois grupos. Fumantes mais frequentemente apresentaram incapacidades laborais e domésticas, presença de fumantes em casa, hospitalizações, transtorno depressivo, uso de sedativos, história de transtorno mental na família e piores escores em todos os domínios do WHOQoL-BREF. A média de idade do início do tabagismo em fumantes com depressão ou em uso de substâncias psicoativas foi mais baixa do que os sem essas comorbidades. Fumantes apresentaram mais frequentemente diabetes, hipertensão arterial, doenças cardíacas, doenças respiratórias e úlcera péptica do que os que nunca fumaram. O IMC médio foi menor entre fumantes do que nos que nunca fumaram. CONCLUSÕES: Este estudo sugere que, no tratamento do tabagismo, deveriam ser identificados subgrupos de fumantes com características específicas: início precoce do tabagismo, doenças que sofrem agravos pelo tabaco, depressão e uso de substâncias psicoativas.