Diretrizes para cessação do tabagismo - 2008

Prolidase could be considered a sign of inflammation associated with cigarette smoking

Objectives

Smoking causes inflammation, thickening, and narrowing of the airways. This inflammatory process is a reaction to free radicals and oxidants. Smoking affects collagen metabolism and tissue remodeling. Prolidase enzyme hydrolyzes iminodipeptides with hydroxyproline and C terminal proline. It plays a crucial role in the metabolism of collagen and the remodeling of the matrix. The present study aims to reveal the association of prolidase with inflammation caused by smoking and to compare serum prolidase levels with oxidative-antioxidative status in healthy individuals.

Methods

A total of 76 participants (38 smokers and 38 nonsmokers) were involved in the present study. Serum cotinine levels were measured to show the exposure to nicotine in tobacco smoke by using the competitive inhibition enzyme immunoassay method. Serum prolidase, total oxidant status (TOS), and total antioxidant status (TAS) were determined by the enzyme-linked immunosorbent (ELISA) method, respectively. The correlation between smoking, serum prolidase levels, TOS, and TAS was investigated.

Results

TAS and serum prolidase levels of smokers were considerably lower than those in non-smokers (p < 0.001, p = 0.012 respectively). However, no differences were observed in TOS between the two groups. There was no statistically significant correlation between serum prolidase levels, TAS, and TOS. Moreover, no relationship was observed between respiratory function parameters and serum prolidase levels.

Conclusion

To the best of our knowledge, the present study is the first study to demonstrate the role of prolidase in smoking-related inflammation. The results achieved in the present study suggest that smoking creates an imbalance in the oxidant-antioxidant activity. Smoking decreases prolidase levels, leading to decreased collagen turnover. Chronic pulmonary disease might be related to this decrease in collagen turnover.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging

Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

Preliminary Findings on the Salivary Metabolome of Hookah and Cigarette Smokers

The aim of the study was to evaluate the salivary metabolomic profile of patients who habitually smoke hookah and cigarettes. The groups consisted of 33 regular and exclusive hookah smokers, 26 regular and exclusive cigarette smokers, and 30 nonsmokers. Unstimulated whole saliva was collected for the measurement of salivary metabolites by gas chromatography coupled with tandem mass spectrometry (GC-MS/MS). The MetaboAnalyst software was used for statistical analysis and evaluation of biomarkers. 11 smoking salivary biomarkers were identified using the area under receiving-operator curver criterion and threshold of 0.9. Xylitol and octadecanol were higher in cigarette smokers compared to controls; arabitol and maltose were higher in controls compared to cigarette smokers; octadecanol and tyramine were higher in hookah smokers compared to controls; phenylalanine was higher in controls compared to hookah smokers; and fructose, isocitric acid, glucuronic acid, tryptamine, maltose, tyramine, and 3-hydroxyisolvaleric acid were higher in hookah smokers compared to cigarettes smokers. Conclusions: The evaluation of the salivary metabolome of hookah smokers, showing separation between the groups, especially between the control versus hookah groups and cigarette versus hookah groups, and it seems to demonstrate that the use of hookah tobacco is more damaging to health.

Dual and Poly Use of Tobacco Products in a Sample of Pregnant Smokers: A Cross-sectional Study

OBJECTIVES

Our aim was to assess the use of dual/poly tobacco in a sample of pregnant women.

DESIGN

cross-sectional survey.

METHODS

Twenty prenatal care units in Botucatu, Sao Paulo, Brazil. We evaluated 127 high-risk pregnant smokers during prenatal care. Those who were 12-38 weeks pregnant and were currently smoking conventional cigarettes. The study enrollment took place between January 2015 and December 2015. The dual/poly prevalence of tobacco products during pregnancy and the characteristics related to smoking in pregnant smokers through a specific questionnaire containing questions related to sociodemographic characteristics, comorbidities, gestational history, smoking history, secondhand smoke exposure, nicotine dependence, motivation stage and use of alternative forms of tobacco.

RESULTS

Mean age was 26.9 ± 6.6 years, most had only elementary education and belonged to lower income economic groups. Twenty-five (19.7%) smoked conventional cigarettes only while 102 used conventional and alternative forms of tobacco products. Smoking pack-years was significantly lower in those only smoking conventional cigarettes than in dual/poly users. Proportion of patients with elevated degree of nicotine dependence was higher in conventional cigarettes users. On the other side, alcohol intake was higher in dual/poly smokers when compared to conventional cigarettes group. The alternative forms of smoking were associated with significantly higher occurrences of comorbidities as pulmonary, cardiovascular and cancer.

CONCLUSIONS FOR PRACTICE

The prevalence of alternative forms users of smoking products is high during pregnancy. These data reinforce the importance of a family approach towards smoking in pregnant women and education about the risks of alternative forms of tobacco.

Comparative effectiveness of two behavioral change intervention packages for tobacco cessation initiated in the tertiary care setting of North India-protocol for a two-arm randomized controlled trial

Background

To reduce the global burden of tobacco use, clinical guidelines support behavioral therapy and pharmacotherapy as preferred interventions for tobacco cessation. The evidence-based behavioral interventions has consistently shown to be impactful in community settings; however, its efficacy has not been established in hospital settings. The current study aims to investigate impact of trans-theoretical-based behavioral intervention package on tobacco users suffering from non-communicable diseases attending tertiary care settings of North India.

Methods/design

A two-arm randomized controlled trial (RCT) in a tertiary healthcare hospital will be performed. A total of 360 tobacco users attending NCD clinics in four departments, cardiology, neurology, pulmonary medicine, and ENT (otolaryngology), will be recruited over a period of 3 months. After ascertaining the eligibility criteria, they will be followed up to 6 months (1, 3, 6) for their tobacco use status, readiness to quit, nicotine dependence, stage of behavior change, and self-reported and biochemical validation (urine cotinine) for tobacco abstinence. Assignment of intervention including allocation concealment, sequence generation, and blinding will be done as per SPIRIT guidelines for RCT protocols.

Discussion

As no strong evidence exists about the effectiveness of tobacco cessation intervention in tertiary settings, the current study will build evidence about the similar interventions in such settings.

Trial registration

CTRI/2019/09/021406.

Factors Associated with Tobacco Cessation in Primary Health Care

Introduction  Cigarettes are the main cause of preventable death in the world, and primary health care services can contribute to the management of this habit.

Objective  To describe and analyze the factors associated with tobacco cessation in groups of smokers in primary health care.

Methods  The present is a cross-sectional study conducted in 12 primary health care units from July 2016 to May 2017. We investigated sociodemographic and health variables, as well as smoking characteristics and different interventions for tobacco cessation, with the outcome being studied and analyzed after the fourth group care session.

Results  We evaluated 329 smokers, of which 182 quit smoking after the fourth interview. Most of the individuals who quit smoking were women ( n  = 121, 66.5%), with a monthly income of 2 to 5 minimum wages ( n  = 88, 77.9%). After the multivariable analysis, we observed that tobacco cessation was significantly associated with depression (prevalence ratio [PR] = 1.11; 95% confidence interval [95%CI] = 1.02 to 1.22), as well as with belonging to the groups which used as approaches motivational interviewing (PR = 1.21; 95%CI = 1.13 to 2.01), patches (PR = 1.36; 95%CI = 1.24 to 1.48), and bupropion (PR = 1.16; 95%CI = 1.03 to 1.31).

Conclusion  Primary health care is the ideal site for the reduction of smoking rates, given that different technologies may be applicable and useful for tobacco cessation. The comprehensiveness and longitudinal care offered in primary care may provide opportunities for health professionals to understand which is the best technology for each health system user, thus contributing to personalized care.

Tabagismo em idosos

Introdução: o tabagismo é um grave problema de saúde pública em âmbito mundial que afeta a todas as faixas etárias, causando altas taxas de morbimortalidade evitáveis.Objetivo: descrever o que vem sendo publicado sobre o tabagismo na população idosa nos últimos cinco anos na esfera internacional.Metodologia: trata-se de uma revisão integrativa da literatura, onde foram realizadas buscas de artigos nas seguintes bases de dados: PUBMED/MEDLINE, BVS/LILACS, SCOPUS e SCIELO, utilizando os seguintes Descritores em Ciências da Saúde em inglês: “Tobacco Use Cessation” OR “Tobacco Use Disorder” AND “Health of the Elderly” OR “Aged” OR “Aged, 80 and over”. O recorte temporal foi de 2016 a 2020.Resultados: dos 1.642 trabalhos recuperados das bases, houve o afunilamento para um número total de 18 artigos, com a seguinte categorização: mortalidade e outros desfechos clínicos negativos (5); o tabagismo, as síndromes geriátricas e outras patologias (4); políticas públicas para o controle do tabaco (3); qualidade de vida e tabagismo (3); e fatores preditores para cessação tabágica (3).Conclusões: apenas um estudo selecionado foi realizado no Brasil, ressaltando a necessidade de mais estudos brasileiros envolvendo o tabagismo na população idosa objetivando uma melhor compreensão dos aspectos envolvidos e futuras capacitações e otimização de políticas públicas específicas.

Effectiveness of motivational interviewing in smoking groups in primary healthcare: a community-based randomized cluster trial

Smoking is the main cause of avoidable death and a major public health problem worldwide, with primary healthcare being a strategic setting for treating this problem. Aims: to evaluate the effectiveness of motivational interviewing associated with the cognitive behavioral therapy (CBT) in smoking groups in primary healthcare. A community-based cluster randomized clinical trial was conducted in Brazil, starting in July 2016. Professionals in the test group were trained in motivational interviewing for eight hours to associate it with the CBT. The usual treatment for smoking cessation in groups consists of four structured weekly sessions of 90 minutes each using a CBT. Taylor's linearization was used to correct the p-values; the chi-square test with Pearson correlation was used for categorical variables, and analysis of variance as well as the Student t-test were used for continuous variables. In total, 44 smoking groups were conducted, totaling 329 patients (178 in the motivational interviewing group and 151 in the control group). The smoking cessation rate with motivational interviewing was 61.8%, with RR = 1.25 (95%CI: 1.01-1.54, p = 0.043), and 47.7% in the control group, in the fourth weekly group treatment session. Mean session attendance was 3.1 (95%CI: 2.9-3.3) in the motivational interviewing group and 2.9 (95%CI: 2.5-3.4) in the control group. The completion rate for the motivational interviewing group was 65.2% and for the control group, 57.6%. Motivational interviewing associated with the CBT was shown to be effective and superior to only CBT to smoking cessation in groups in the fourth weekly session and for the population profile of the study (women with an average age of 50.6 years).

Effectiveness of Aerobic Exercise on Smoking Cessation in Adults: A Systematic Review and Meta-Analysis

BACKGROUND

The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation.

METHODS

This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software.

RESULTS

The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66-0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups.

CONCLUSIONS

According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.

Smoking load reduction is insufficient to downregulate miR-301b, a lung cancer promoter

Several circulating miRNAs identified in the plasma of smokers have been implicated as promoters of nasopharyngeal and lung carcinoma. To investigate the plasma profile of miRNAs in subjects who reduces the number of smoked cigarettes and who quit after six months. We accompanied 28 individuals enrolled in a Smoking Cessation Program over 6 months. At Baseline, clinical characteristics, co-morbidities, and smoking history were similar among subjects. After 6 months, two groups were defined: who successfully quitted smoking (named "quitters", n = 18, mean age 57 years, 11 male) and who reduced the number of cigarettes smoked (20-90%) but failed to quit smoking (named "smokers", n = 10, mean age 52 years, 3 male). No significant clinical changes were observed between groups at baseline and after a 6-month period, however, quitters showed significant downregulations in seven miRNAs at baseline: miR-17 (- 2.90-fold, p = 0.029), miR-20a (- 3.80-fold, p = 0.021); miR-20b (- 4.71-fold, p = 0.027); miR-30a (- 3.95-fold, p = 0.024); miR-93 (- 3.63-fold, p = 0.022); miR-125a (- 1.70-fold, p = 0.038); and miR-195 (- 5.37-fold, p = 0.002), and after a 6-month period in 6 miRNAs: miR-17 (- 5.30-fold, p = 0.012), miR-20a (- 2.04-fold, p = 0.017), miR-20b (- 5.44-fold, p = 0.017), miR-93 (- 4.00-fold, p = 0.041), miR-101 (- 4.82-fold, p = 0.047) and miR-125b (- 3.65-fold, p = 0.025). Using time comparisons, only quitters had significant downregulation in miR-301b (- 2.29-fold, p = 0.038) after 6-month. Reductions in the number of smoked cigarettes was insufficient to change the plasma profile of miRNA after 6 months. Only quitting smoking (100% reduction) significantly downregulated miR-301b related to hypoxic conditions, promotion of cell proliferation, decreases in apoptosis, cancer development, and progression as increases in radiotherapy and chemotherapy resistance.

Prevalence of smoking and associated factors in people living with HIV undergoing treatment

OBJECTIVE

To estimate the prevalence of smoking and evaluate the factors associated with this outcome in people living with HIV (PLHIV).

METHODS

This is a cross-sectional study of a prospective concurrent cohort of 462 individuals initiating antiretroviral therapy at three HIV/AIDS specialized services in Belo Horizonte between 2015 and 2017. The following smoking status were used: current smoker (CS), former smoker (FS) and non-smoker (NS). Multinomial logistic regression was performed with NS as the reference category.

RESULTS

Most participants were men (81.4%), young (up to 34 years old; 57.2%) and non-white (75.7%). Of the total number of individuals, 27.7% were CS, 22.9% FS, and 49.4% NS. Most smokers were light smokers (65.1%), consumed up to 10 cigarettes per day and had been smoking for more than 10 years (63.3%), starting on average at 17.2 years of age (SD = 5.1). In the multivariate analysis, higher chances of being CS were associated with: being female, having up to 9 years of schooling, current or prior use of alcohol and illicit drugs (marijuana, cocaine and crack) and presenting signs and/or symptoms of anxiety or depression. Higher chances of being FS were associated with having up to 9 years of schooling and current or prior use of alcohol and illicit drugs (marijuana and crack).

CONCLUSIONS

The results show that smoking is highly prevalent among PLHIV, indicating the need for HIV specialized services to prioritize smoking cessation interventions. These interventions should consider the use of alcohol and illicit drugs and be targeted especially to young people, those with low schooling and with signs and/or symptoms of anxiety or depression.

Cardiovascular risk factors in a Brazilian rural population

Given the extensive costs due to cardiovascular diseases and the increased prevalence of these diseases in farmers, this study aims to estimate the prevalence of cardiovascular risk factors in this population and to evaluate their associated factors. A cross-sectional study was carried out involving 790 farmers from the municipality of Santa Maria de Jetibá-ES, Brazil. Six out of ten evaluated farmers had at least one cardiovascular risk factor (CRF). High blood pressure was the most prevalent risk factor in 35.8% (95%CI 32-39, n = 283) followed by dyslipidemia (34.4%, 95%CI 31-38, n = 272). Those aged more than 50 years were 5.6 times (95%CI 2.03-15.43) more likely to evidence two or more CRFs. High waist circumference or tricipital skinfold indicating overweight increased 2.35 times (95%CI 1.47-3.76) and 1.6 times (95%CI 1.05-2.44) this likelihood, respectively. These findings reveal the high prevalence of CRF in rural workers and the significant impact of age and the accumulation of body fat in the development of these factors, showing the need to intensify public health policies geared to this population.

Integrated multidisciplinary approach to hidradenitis suppurativa in clinical practice,

Background

The European hidradenitis suppurativa (HS) guidelines recommend a multidisciplinary approach for patients with HS and management of comorbidities.

Objective

We aimed to describe the organization of a multidisciplinary HS program and characterize the patient population.

Methods

We conducted a retrospective study of patients with HS undergoing prospectively defined multidisciplinary work-up including examinations by a dermatologist, plastic surgeon, smoking specialist, and nutritionist in our outpatient unit between October 2015 and January 2017.

Results

The study included 49 patients with a sex ratio of 1:1. A total of 73.4% of patients were smokers, 20.4% were overweight, 48.9% were obese, and 30.6% had symptoms of depression. The mean Sartorius score was 30.4 (±17.6). The outcome of plastic surgery consultation was as follows: 16 patients had operations, 5 were excluded based on medical history, 9 refused surgery, and 16 remained undecided. The refusal rates for consulting with the smoking cessation and nutrition specialists were 55.8% and 69.5%, respectively. Twelve patients received antibiotics, 9 received biologics, 9 underwent medico-surgical treatment, 9 underwent surgery, and 10 were lost to follow-up. The mean visual analogue scale score for satisfaction was 8.3 (±1.6; n = 28).

Conclusion

An integrated multidisciplinary care model for HS is associated with high patient satisfaction. Adherence to the proposed comorbidity management was higher in female patients and related to empathetic interactions with physicians.

Expression of DNA repair genes in oral squamous cell carcinoma using reverse transcription-quantitative polymerase chain reaction

OBJECTIVE

The aim of this study was to evaluate the expression of DNA repair genes in cases of oral squamous cell carcinoma (OSCC).

STUDY DESIGN

Expression of the MLH1, MSH2, MLH3, ATM, MRE11A, XRCC1, and PMS2 genes was evaluated by reverse transcription-quantitative polymerase chain reaction in the OSCC group (32 patients) and the control group (15 patients). The groups were compared by using the Mann-Whitney test, with Bonferroni correction. Associations between gene expression levels and clinical data were explored by using Pearson's and Spearman's correlation coefficients, with P value less than .05 indicating a significant difference.

RESULTS

The MLH1, MSH2, MLH3, ATM, MRE11A, XRCC1, and PMS2 genes were downregulated in the OSCC group compared with the control group, with significant values for MLH1 (P < .0001); MSH2 (P = .038); MLH3 (P < .0001); ATM (P < .0001); MRE11A (P < .0001); XRCC1 (P = .0004); and PMS2 (P = .008). Analysis of the correlation between gene expression and clinical data only revealed a significant negative correlation between age and expression of the PMS2 gene.

CONCLUSIONS

Expression of the DNA repair genes MLH1, MSH2, MLH3, ATM, MRE11 AMRE11A, XRCC1, and PMS2 was reduced in OSCC.

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

Background

No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs.

Aims

To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence.

Methods

This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs.

Results

A total of 296 patients were included (88.1% males, mean age: 68 ± 10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists' adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (.

Conclusion

The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients' age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.

Web-based decision-making tool for smoking cessation (Pare de fumar conosco) among patients with chronic conditions in Brazil : one-arm feasibility study

OBJECTIVE

To assess the feasibility of Pare de fumar conosco, a web-based smoking cessation decision-making tool, among patients with chronic conditions in Brazil.

METHODS

We recruited 85 Brazilian smokers in two clinical centres for chronic conditions to complete Pare de fumar conosco. Outcome measures included interest in using smoking cessation resources and self-reported 7-day point prevalence abstinence 12 weeks following the intervention.

RESULTS

The average age of participants was 54.2 years old (SD=10.5) and 77.9% had not completed high school. All participants were daily smokers and the majority smoked ≥11 cigarettes per day (63.5%). Pre-post intervention interest in using pharmacotherapy and group counselling significantly increased (82.4% vs 22.4%, p≤0.0001; and 85.9% vs 21.2%, p≤0.0001, respectively). At 12 weeks, eight participants (9.4%) reported 7-day point prevalence abstinence using intention-to-treat analysis (35.2% follow-up rate).

CONCLUSION

The Pare de fumar conosco smoking cessation web-based tool significantly increased interest in pharmacotherapy and behavioural counselling. Additional testing as a formal randomised clinical trial appears warranted.

Update on the approach to smoking in patients with respiratory diseases

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with “healthy” smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

Smoking dependence and anxio-depressive disorders in Tunisian smokers attending the smoking cessation clinic in a university hospital

Background

Smokers with comorbid anxio-depressive disorders are more prone to progress to a more severe level of dependence and to experience more severe nicotine withdrawal symptoms than smokers without anxio-depressive disorders.

Aim of the study

To determine the relationship between tobacco dependence and anxio-depressive disorders as well as assessing their impact on the withdrawal.

Methods

We conducted a cross-sectional study among attendees of the smoking cessation clinic of Sahloul University Hospital, Sousse, Tunisia, from December 2009 to May 2015. The monitoring of the attendees was performed through retrieving the records until May 2016 in order to verify their smoking cessation status at 1 year.

Results

Overall, 534 smokers were included. We identified 315 smokers (59%) presenting an anxio-depressive disorder. Based on the HAD scale, we found 231 patients (43.4%) with anxiety disorders, 200 (37.6%) patients with depressive disorders, and 116 (21.8%) patients with anxio-depressive disorder.

In multivariate analysis, only a high number of consultation was associated with a better rate of tobacco cessation at 6 months. However, no factor was found linked to the relapse at 1 year.

Conclusion

According to our results, only a high number of consultation was revealed as an independent factor of withdrawal for anxio-depressed smokers. It is necessary to simultaneously use the nicotinic substitutions and anxio-depressive treatment to ensure the tobacco cessation.

Comparison of two smoking cessation interventions for inpatients

Objective:

This study aimed to compare the effectiveness of two cognitive behavioral therapy-based smoking cessation interventions initiated during hospitalization and to evaluate the factors related to relapse after discharge.

Methods:

This was a prospective randomized study involving 90 smokers hospitalized in a university hospital. We collected data related to sociodemographic characteristics, reasons for admission, smoking-related diseases, smoking history, the degree of nicotine dependence (ND), and the level of craving. Patients were divided into two treatment groups: brief intervention (BrInter, n = 45); and intensive intervention with presentation of an educational video (InInterV, n=45). To assess relapse, all patients were assessed by telephone interview in the first, third, and sixth months after discharge. Abstinence was confirmed by measurement of exhaled carbon monoxide (eCO).

Results:

Of the 90 patients evaluated, 55 (61.1%) were male. The mean age was 51.1 ± 12.2 years. The degree of ND was elevated in 39 (43.4%), and withdrawal symptoms were present in 53 (58.9%). The mean eCO at baseline was 4.8 ± 4.5 ppm. The eCO correlated positively with the degree of ND (r = 0.244; p = 0.02) and negatively with the number of smoke-free days (r = −0.284; p = 0.006). There were no differences between the groups in terms of the variables related to socioeconomic status, smoking history, or hospitalization. Of the 81 patients evaluated at 6 months, 33 (40.7%) remained abstinent (9 and 24 BrInter and InInterV group patients, respectively; p = 0.001), and 48 (59.3%) had relapsed (31 and 17 BrInter and InInterV group patients, respectively; p= 0.001). Moderate or intense craving was a significant independent risk factor for relapse, with a relative risk of 4.0 (95% CI: 1.5-10.7; p < 0.00001).

Conclusions:

The inclusion of an educational video proved effective in reducing relapse rates. Craving is a significant risk factor for relapse.

Prevalence of latent Mycobacterium tuberculosis infection in renal transplant recipients

Objective:

To estimate the prevalence of latent Mycobacterium tuberculosis infection (LTBI) in renal transplant recipients and to assess sociodemographic, behavioral, and clinical associations with positive tuberculin skin test (TST) results.

Methods:

This was a cross-sectional study of patients aged ≥ 18 years who underwent renal transplantation at the Renal Transplant Center of the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. We included renal transplant recipients who underwent the TST between January 2011 and July 2013. If the result of the first TST was negative, a second TST was administered. Bivariate and multivariate analyses using logistic regression were used to determine factors associated with positive TST results.

Results:

The sample included 216 patients. The prevalence of LTBI was 18.5%. In the multivariate analysis, history of contact with a tuberculosis case and preserved graft function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m²) were associated with positive TST results. TST induration increased by 5.8% from the first to the second test, which was considered significant (p = 0.012).

Conclusions:

The prevalence of LTBI was low in this sample of renal transplant recipients. The TST should be administered if renal graft function is preserved. A second TST should be administered if the first TST is negative.

Evaluation of smoking cessation treatment initiated during hospitalization in patients with heart disease or respiratory disease

Objective:

To evaluate the effectiveness of a smoking cessation program, delivered by trained health care professionals, in patients hospitalized for acute respiratory disease (RD) or heart disease (HD).

Methods:

Of a total of 393 patients evaluated, we included 227 (146 and 81 active smokers hospitalized for HD and RD, respectively). All participants received smoking cessation treatment during hospitalization and were followed in a cognitive-behavioral smoking cessation program for six months after hospital discharge.

Results:

There were significant differences between the HD group and the RD group regarding participation in the cognitive-behavioral program after hospital discharge (13.0% vs. 35.8%; p = 0.003); smoking cessation at the end of follow-up (29% vs. 31%; p < 0.001); and the use of nicotine replacement therapy (3.4% vs. 33.3%; p < 0.001). No differences were found between the HD group and the RD group regarding the use of bupropion (11.0% vs. 12.3%; p = 0.92). Varenicline was used by only 0.7% of the patients in the HD group.

Conclusions:

In our sample, smoking cessation rates at six months after hospital discharge were higher among the patients with RD than among those with HD, as were treatment adherence rates. The implementation of smoking cessation programs for hospitalized patients with different diseases, delivered by the health care teams that treat these patients, is necessary for greater effectiveness in smoking cessation.

Cardiorespiratory responses in different types of squats and frequencies of whole body vibration in patients with chronic obstructive pulmonary disease

This study aims to investigate the cardiorespiratory responses to different vibration frequencies to characterize the intensity of exercise, as well as to compare the effect of two types of squatting exercises (static and dynamic) on the whole body vibration (WBV) exercise in individuals with chronic obstructive pulmonary disease (COPD). Twenty-six subjects were divided and paired into healthy and COPD groups that performed static squatting associated with WBV (frequencies: 30, 35, and 40 Hz; amplitude: 2 mm) and dynamic squatting associated with WBV (frequency: 35 Hz; amplitude 2 mm) on a vertical vibration platform. Oxygen consumption (V̇o₂), heart rate (HR), minute ventilation (V̇e), ratio of minute ventilation to oxygen production (V̇e/V̇o₂), ratio of minute ventilation to carbon dioxide production (V̇e/V̇co₂), oxygen saturation (SpO₂), and rating of perceived exertion were measured. For both groups, there was a decrease in V̇e/V̇o₂ and V̇e/V̇co₂ ratios during static and dynamic squats, as well as an increase in other cardiorespiratory parameters, and no significant difference existed between them. There was an effect of the type of squat on the HR variation; the values in the static squat were higher than those of the dynamic squat in both groups. There was a significant difference with a reduction in SpO₂ at 40 Hz frequency when compared with 30 Hz in the COPD group. The other variables behaved similarly between the frequencies. The WBV exercise, regardless of the frequencies used, represented a mild effort that promoted cardiorespiratory response in COPD, with greater responses in the static squat and no adverse effect. NEW & NOTEWORTHY This study showed that an acute session of light exercise of whole body vibration (WBV) can increase the cardiorespiratory responses in patients with chronic obstructive pulmonary disease (COPD), reaching values similar to that of the control group. The results might contribute, therefore, to the elaboration of exercise protocols with WBV for the treatment of patients with COPD during rehabilitation. Thus, future studies referring to training on the vibratory platform could use these exercise parameters and demonstrate possible long-term benefits.

Prevalência simultânea de hipertensão e diabetes em idosos brasileiros: desigualdades individuais e contextuais

Resumo A prevalência da simultaneidade de doenças específicas nos idosos ainda é pouco descrita na literatura. O objetivo do estudo foi estimar a prevalência simultânea de hipertensão arterial e diabetes mellitus em idosos brasileiros, e os fatores contextuais e individuais a ela associados. Estudo transversal de base populacional com idosos (≥ 60 anos) entrevistados pelo Vigitel em 2012 (n = 10.991). As análises foram realizadas por meio de regressão de Poisson multinível no Stata 12. A média de idade dos idosos foi de 69,4 anos e a prevalência simultânea das doenças foi de 16,2% com variação nas capitais brasileiras. Em São Paulo e Curitiba as prevalências foram mais elevadas do que em Boa Vista e Manaus. Maiores prevalências foram observadas nas capitais das regiões Sul/Sudeste/Centro-Oeste, nos idosos de cor preta e parda, naqueles com escolaridade ≤ 8 anos de estudo, nos não fumantes e ex-fumantes, e com excesso de peso. Verificou-se o efeito da região geográfica na prevalência simultânea pela elevação de 23,5% na magnitude da razão de prevalencia, após ajuste para todas as variáveis individuais. Por meio do estudo, foi possível dimensionar o efeito do contexto onde estão inseridos os idosos (região de residência) sobre a prevalência das principais doenças que acometem e relacionam-se à mortalidade na população idosa na atualidade.

Tobacco influence in heavy metals levels in head and neck cancer cases

Heavy metals intoxication is known to be risk factors for various diseases, including cancer. These metals may be presented in food and soil as well as in leaf and tobacco smoke. The aim of this study was to correlate the exposure to heavy metals stemming from tobacco and head and neck squamous cell carcinoma carcinogenesis. Analysis of lead, copper, manganese, arsenic, chromium, and cadmium by atomic absorption spectrophotometry was performed in whole blood samples from 91 patients: 68 smokers with oral cavity, pharynx, or laryngeal cancer; 8 non-smokers with oral or larynx cancer; and 15 non-cancer smokers with tobacco-related diseases (control group). No differences were found in metals quantifications, except a significant difference was observed (p = 0.0223) with higher mean in copper levels for non-smokers with cancer. The present study concluded, for the groups evaluated, it was not possible to prove the relationship between the studied metals in the development of the neoplasm. On the other hand, the results of copper demonstrated a correlation with smokers with cancer and lower levels of circulating copper.

Whole body vibration training increases physical measures and quality of life without altering inflammatory-oxidative biomarkers in patients with moderate COPD

Whole body vibration training (WBVT) has been identified as an alternative intervention to improve exercise capacity and quality of life of patients with chronic obstructive pulmonary disease (COPD). However, the effect of WBVT on inflammatory-oxidative biomarkers remains unknown. The aim of this trial was to investigate the effects of WBVT on quality of life and physical and inflammatory-oxidative parameters in patients with COPD. Twenty patients were equally divided into 1) an intervention group (IG) that performed the WBVT, and 2) a control group (CG) that did not receive any intervention. Intervention consisted in performing static squatting on a vibrating platform, in six series of 30 s, 3 days/wk, for 12 wk. Patients were evaluated for plasma levels of IL-6, IL-8, IFN-γ, soluble receptors of TNF-α; white cell count; plasma levels of oxidant and antioxidant markers; 6-min walking distance (6MWD); peak oxygen uptake (V̇o2peak); handgrip strength; quality of life; timed 5-chair sit-to-stand (5STS); and timed get-up and go test (TUG). After WBVT, patients from IG showed a significant increase in the 6MWD, V̇o2peak, and handgrip strength ( P < 0.05). Furthermore, patients from the IG reached minimal clinically important difference regarding quality of life. No significant differences were found in 5STS, TUG, inflammatory-oxidative biomarkers, and white cell count in the IG. The CG did not show significant improvement in all assessments ( P > 0.05). Taken together, our results demonstrated that the WBVT induced clinically significant benefits regarding exercise capacity, muscle strength, and quality of life in patients with COPD that were not related to inflammatory-oxidative biomarker changes.

NEW & NOTEWORTHY Whole body vibration training is a new option for nonpharmacological treatment of chronic obstructive pulmonary disease (COPD). This study showed the potential of this training to improve exercise capacity, quality of life, and muscle strength in patients with COPD. Furthermore, to our knowledge this was the first study showing that vibration exercise does not modify the plasma levels of inflammatory-oxidative biomarkers, suggesting that the beneficial effects on physical measures and quality of life are independent of changes in biomarkers.

Acute Effects of Whole-Body Vibration on Inflammatory Markers in People with Chronic Obstructive Pulmonary Disease: A Pilot Study

Whole-body vibration (WBV) has gained prominence in the rehabilitation of individuals with chronic obstructive pulmonary disease (COPD) because it is a safe and low intensity exercise that promises beneficial effects on physical performance and quality of life. However, its effects on plasma cytokine levels in COPD are still unclear. The aim of the current study was to investigate the acute effects of WBV on inflammatory biomarkers in people with COPD. Twenty-six participants, COPD people (n=13) and healthy controls (n=13), were included. Both groups performed WBV at amplitude of 2 mm and frequency of vibration of 35 Hz, during six series of 30 seconds. They were assessed for lung function, body composition, 6-minute walking test (6MWT), handgrip strength test, plasma concentrations of interleukin (IL), IL-6, IL-8, and IL-10, and soluble tumor necrosis factor alpha (TNF-α) receptors (sTNFR-1 and sTNFR-2). People with COPD had moderate disease [forced expiratory volume in the first second (FEV1) = 58.1%], as well as a worse performance in the 6MWT. The plasma cytokine profile at rest showed that participants with COPD had higher levels of IL-8 and lower levels of IL-10. After one session of WBV, we found an increased plasma IL-10 level in the COPD group, with similar levels for healthy controls. One session of WBV modified the plasma IL-10 level. No effects were found on the other investigated cytokines.

Evaluation of Patients in a Smoking Cessation Support Group Using the Nursing Outcomes Classification

PURPOSE

To evaluate patients in a smoking cessation support group using the Nursing Outcomes Classification (NOC).

METHODS

Prospective observational cohort study conducted with 21 patients participating in a smoking cessation support group. Data were collected using an instrument consisting of 2 NOC outcomes and 20 indicators, applied during each of the six support group meetings.

FINDINGS

The two NOC outcomes, Smoking Cessation Behavior (1625) and Substance Withdrawal Severity (2108), showed statistically significant differences over time in many of their indicators.

CONCLUSIONS

The NOC outcomes demonstrated the clinical evolution and behavioral improvement of patients during the smoking cessation process.

IMPLICATIONS FOR NURSING PRACTICE

The findings highlight important elements of the evaluation of behavioral change and severity of withdrawal symptoms.

Longitudinal Study on the Lifestyle and Health of University Students (ELESEU): design, methodological procedures, and preliminary results

Admission to a university may cause significant changes in the pattern of exposure to health risks. The aim of this paper is to describe the study design and methodological procedures adopted in the Longitudinal Study on the Lifestyle and Health of University Students (ELESEU). This study examines a dynamic cohort of full-time students at a public university in the State of Mato Grosso, Brazil. This research, which started in 2015, will have four years of follow-up and is scheduled to end in 2018. A self-administered questionnaire is applied, containing questions regarding demographic and socioeconomic characteristics, and information on health conditions and risk factors such as lifestyle, perceived stress, symptoms of depression, body image, risk behaviors for eating disorders, self-assessment of health and diet quality, and other issues related to nutrition and health. Anthropometric and blood pressure measurements are also recorded. Two 24-hour dietary recalls and cholesterol, triglycerides, and glucose capillary measurements are collected in 50% of the students. In 2015, 495 participants (82.6% of the eligible students) were assessed in the baseline study. Of these, 348 (70.3%) were followed up in 2016. In 2016, 566 participants were included in the cohort (81% of the eligible students). This study will help to identify the factors that might influence changes in the nutritional, health, and metabolic status of young adults during college life.

Smoking during pregnancy and harm reduction in birth weight: a cross-sectional study

Background

Different studies have shown the advantages of abstinence from cigarette smoking during pregnancy to promote full fetal development. Given that pregnant women do not always abstain from smoking, this study aimed to analyze the effect of different intensities of smoking on birth weight of the newborn.

Methods

A cross-sectional study was adopted to explore smoking in a population of pregnant women from a medium-sized city in São Paulo state, Brazil, who gave birth between January and June of 2012. Data were collected from maternal and pediatric medical files and, where data were absent, they were collected by interview during hospitalization for delivery. For data analysis, the effect of potential confounding variables on newborn birth weight was estimated using a gamma response model. The effect of the identified confounding variables was also estimated by means of a gamma response regression model.

Results

The prevalence of smoking during pregnancy was 13.4% in the study population. In full-term infants, birth weight decreased as the category of cigarette number per day increased, with a significant weight reduction as of the category 6 to 10 cigarettes per day. Compared with infants born to non smoking mothers, mean birth weight was 320 g lower in infants whose mothers smoked 6 to 10 cigarettes per day and 435 g lower in infants whose mothers smoked 11 to 40 cigarettes per day during pregnancy.

Conclusions

Based on the study results and the principle of harm reduction, if a pregnant woman is unable to quit smoking, she should be encouraged to reduce consumption to less than six cigarettes per day.

Different levels of brain-derived neurotrophic factor and cortisol in healthy heavy smokers

Studies suggest that brain-derived neurotrophic factor (BDNF) and the hypothalamic-pituitary-adrenal (HPA) axis modulate dopaminergic activity in response to nicotine and that the concentrations of BDNF and cortisol seem to be dependent on the amount and duration of smoking. Therefore, we investigated BDNF and cortisol levels in smokers ranked by daily cigarette consumption. Twenty-seven adult males (13 non-smokers and 14 smokers) participated in the study. The smokers were divided in two groups: light (n=7) and heavy smokers (n=7). Anthropometric parameters and age were paired between the groups, and plasma BDNF and salivary cortisol levels were measured. Saliva samples were collected on awakening, 30 min after awakening, at 10:00 and 12:00 am, 5:00 and 10:00 pm. Additionally, cotinine serum levels were measured in smokers. Heavy smokers had higher mean values of BDNF compared to the control group (P=0.01), whereas no difference was observed in light smokers. Moreover, heavy smokers presented lower cortisol levels in the last collection (10:00 pm) than the control group (P=0.02) and presented statically higher values of cotinine than the light smokers (P=0.002). In conclusion, changes in BDNF and cortisol levels (10:00 pm) appear to be dependent on heavy cigarette smoking and can be involved in activation and in the relationship between the mesolimbic system and the HPA axis.

Effective tobacco control measures: agreement among medical students

Objective:

To determine the level of agreement with effective tobacco control measures recommended by the World Health Organization and to assess the attitudes toward, knowledge of, and beliefs regarding smoking among third-year medical students at University of São Paulo School of Medicine, located in the city of São Paulo, Brazil.

Methods:

Between 2008 and 2012, all third-year medical students were invited to complete a self-administered questionnaire based on the Global Health Professionals Student Survey and its additional modules.

Results:

The study sample comprised 556 students. The level of agreement with the World Health Organization recommendations was high, except for the components "received smoking cessation training" and "raising taxes is effective to reduce the prevalence of smoking". Most of the students reported that they agree with banning tobacco product sales to minors (95%), believe that physicians are role models to their patients (84%), and believe that they should advise their patients to quit cigarette smoking (96%) and using other tobacco products (94%). Regarding smoking cessation methods, most of the students were found to know more about nicotine replacement therapy than about non-nicotine therapies (93% vs. 53%). Only 37% of the respondents were aware of the importance of educational antismoking materials, and only 31% reported that they believe in the effectiveness of encouraging their patients, during medical visits. In our sample, the prevalence of current cigarette smoking was 5.23%; however, 43.82% of the respondents reported having experimented with water-pipe tobacco smoking.

Conclusions:

Our results revealed the need to emphasize to third-year medical students the importance of raising the prices of and taxes on tobacco products. We also need to make students aware of the dangers of experimenting with tobacco products other than cigarettes, particularly water-pipe tobacco smoking.

Objetivo:

Determinar o grau de concordância com medidas eficazes de controle do tabaco recomendadas pela Organização Mundial da Saúde e avaliar as atitudes, o conhecimento e as crenças a respeito do tabagismo em alunos do terceiro ano de medicina da Faculdade de Medicina da Universidade de São Paulo, em São Paulo (SP).

Métodos:

Entre 2008 e 2012, todos os alunos do terceiro ano de medicina foram convidados a preencher um questionário autoaplicável baseado na Global Health Professions Student Survey e em seus módulos adicionais.

Resultados:

A amostra consistiu em 556 estudantes. O grau de concordância com as recomendações da Organização Mundial da Saúde foi alto, à exceção de "receberam treinamento a respeito de cessação do tabagismo" e "aumentar os impostos é uma medida eficaz para reduzir a prevalência do tabagismo". A maioria dos estudantes relatou que concorda com a proibição da venda de produtos do tabaco a menores de idade (95%), acredita que os médicos são modelos de comportamento para seus pacientes (84%) e acredita que deveriam aconselhar seus pacientes a parar de fumar cigarros (96%) e de usar outros produtos do tabaco (94%). No tocante aos métodos de cessação do tabagismo, observamos que a maioria dos estudantes sabe mais sobre terapia de reposição da nicotina do que sobre terapias não nicotínicas (93% vs. 53%). Apenas 37% dos participantes estavam cientes da importância de material educacional antitabagismo, e apenas 31% relataram que acreditam na eficácia de incentivar seus pacientes, durante as consultas médicas, a parar de fumar. Em nossa amostra, a prevalência de tabagismo atual foi de 5,23%; entretanto, 43,82% dos participantes relataram ter experimentado fumar tabaco com um narguilé.

Conclusões:

Nossos resultados revelaram a necessidade de deixar claro para os alunos do terceiro ano de medicina o quão importante é aumentar os preços e impostos dos produtos do tabaco. É também preciso conscientizar os alunos dos perigos de experimentar outros produtos do tabaco que não os cigarros, particularmente o narguilé.

Tumor necrosis factor receptor 2 as a possible marker of COPD in smokers and ex-smokers

Introduction

Oxidative stress and systemic inflammation are higher in smokers and patients with COPD; however, markers that may help differentiate between smokers and patients with COPD have not yet been identified. We hypothesized that tumor necrosis factor-alpha receptor (TNFR) and soluble form of the receptor for advanced glycation end products (sRAGE) can be indicators of COPD in asymptomatic patients.

Patients and methods

We evaluated 32 smokers (smoking history >10 pack-years), 32 patients with mild/moderate COPD (smokers and ex-smokers), and 32 never smokers. Concentrations of C-reactive protein (CRP), interleukin (IL)-6, TNFR1 and TNFR2, advanced glycation end products (AGEs), and the sRAGE were measured in serum.

Results

There were higher CRP and AGEs concentrations in smokers and in patients with COPD (P<0.001 and P=0.01, respectively) compared to controls, without statistical difference between smokers and patients with COPD. Concentrations of sRAGE, IL-6, and TNFR1 did not differ between study groups. TNFR2 was significantly higher in patients with COPD than in smokers (P=0.004) and controls (P=0.004), and the presence of COPD (P=0.02) and CRP (P=0.001) showed a positive association with TNFR2. Positive associations for smoking (P=0.04), CRP (P=0.03), and IL-6 (P=0.03) with AGEs were also found. The interaction variable (smoking × COPD) showed a positive association with IL-6.

Conclusion

Our data suggest that TNFR2 may be a possible marker of COPD in asymptomatic smokers and ex-smokers. Although smokers and patients with early COPD presented other increased systemic inflammation markers (eg, CRP) and oxidative stress (measured by AGEs), they did not differentiate smokers from COPD.

Recommendations for the pharmacological treatment of COPD: questions and answers

The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.

Smoking control: challenges and achievements

Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

Nasal mucociliary transportability of male and female smokers

Introduction

Female smoker's present increased susceptibility to several diseases when compared to the opposite gender. However, there are no studies showing differences in nasal mucociliary transport behavior between male and female smokers.

Objective

To compare the nasal mucociliary transportability in male and female smokers and non-smokers, taking into consideration age, anthropometric data, smoking load and pulmonary function.

Methods

The analysis included 139 individuals (33 men and 37 women smokers and 32 men and 37 women non-smokers). All participants answered an initial interview to obtain personal data and smoking load. Anthropometric data and carbon monoxide in the exhaled air were assessed. Individuals also performed pulmonary function test and Saccharin Transit Time test. To compare saccharin transit time values between men and women, smokers and non-smokers, stratification of all independent variables was performed (sociodemographic, smoking and respiratory variables) into two categories: below and above the median values.

Results

There was no difference between men and women, smokers and non-smokers, regarding nasal mucociliary transportability. Significant differences were only observed between non-smokers. Among those with less forced vital capacity values (<97.37% of predicted), women presented mucociliary transport faster than men. Moreover, it was observed influence of BMI and COex (women smokers), FCV and FEV1 (men non-smokers) and FEF_25–75% (women non-smokers) on saccharin transit time values.

Conclusion

Based on the findings of this study, nasal mucociliary transport in male and female adult smokers, apparently healthy, are similar.

Smoking in adults in the municipality of Rio Branco, Acre, Brazil: a population-based study

OBJECTIVE

To analyze the associations between smoking and socioeconomic status, and to analyze the profile of smokers in the city of Rio Branco, Acre.

METHODS

A population-based cross-sectional study conducted with 1,512 adults living in urban and rural areas. Information about demographic aspects, socioeconomic status and smoking habits were collected through home interviews. Crude and adjusted prevalence ratios with their respective 95% confidence intervals were calculated by Poisson regression.

RESULTS

The overall prevalence of smoking was of 19.9%. Males had a higher prevalence (22.7%) in contrast to females (17.6%). By age, a higher prevalence was observed at 50 - 59 years in males (30.9%) and at 40 - 49 years in females (23.8%). A linear trend was observed between the higher prevalence of smoking and the lower amount of years of education and income (p < 0.05). The profile of smokers indicated that the majority, in both genders, began smoking at age 15, smoked between 1 and 10 cigarettes per day, lit the first cigarette of the day 60 minutes after waking up and had tried to quit smoking at least twice.

CONCLUSION

The high prevalence of smoking is a relevant public health problem in Rio Branco. Community actions must be implemented for the prevention and control of tobacco use.

Oxidative stress and skeletal muscle dysfunction are present in healthy smokers

Chronic exposure to cigarette smoke seems to be related to an increase of pro-inflammatory cytokines, oxidative stress and changes in muscular and physical performances of healthy smokers. However, these parameters have not yet been evaluated simultaneously in previous studies. The participants of this study were healthy males divided into two groups: smokers (n=20) and non-smokers (n=20). Inflammation was evaluated by measuring plasma levels of the cytokines IL-10, IL-6 e TNF-α, and of the soluble receptors sTNFR1 and sTNFR2. Oxidative stress was evaluated by determination of thiobarbituric acid reactive substances (TBARS) plasma levels, total antioxidant capacity of plasma and erythrocytes activity of the antioxidant enzymes superoxide dismutase (SOD) and catalase. Muscular performance was evaluated by measuring the peak torque of knee flexors and extensors, and by determining the total work of the knee extensors. Physical performance was assessed by measuring the peak oxygen uptake (VO2 peak), the maximum heart rate (HRmax) and the walking distance in the shuttle walking test. Smokers showed an increase in the levels of the sTNFR1 and TBARS and a decrease in the total antioxidant capacity of plasma, in the catalase activity and in the total work (P<0.05). IL-6, IL-10, sTNFR2, SOD, peak torque, VO2 peak, HRmax and walking distance were similar between groups. Smokers presented increased oxidative stress and skeletal muscle dysfunction, demonstrating that the changes in molecular and muscular parameters occur simultaneously in healthy smokers.

Smoking and Early COPD as Independent Predictors of Body Composition, Exercise Capacity, and Health Status

The effects of tobacco smoke, mild/moderate COPD disease and their combined effect on health status (HS), body composition (BC), and exercise capacity (EC) impairment are still unclear. We hypothesized that smoking and early COPD have a joint negative influence on these outcomes. We evaluated 32 smokers (smoking history >10 pack/years), 32 mild/moderate COPD (current smokers or former smokers), and 32 never smokers. All individuals underwent medical and smoking status evaluations, pre and post-bronchodilator spirometry, BC [fat-free mass (FFM) and FFM index (FFMI)], EC [six-minute walk distance (6MWD)] and HS [Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)]. FFM (p = 0.02) and FFMI (p = 0.008) were lower in COPD than never smokers. 6MWT, as a percentage of reference values for the Brazilian population, was lower in COPD and smokers than never smokers (p = 0.01). Smokers showed worse SF-36 score for functional capacity than never smokers (p<0.001). SF-36 score for physical functioning (p<0.001) and role-emotional (p<0.001) were impaired in COPD patients than smokers. SF-36 scores for physical functioning (p<0.001), role-physical (p = 0.01), bodily pain (p = 0.01), vitality (p = 0.04) and role-emotional (p<0.001) were lower in COPD than never smokers. Multiple linear regression analysis showed that both COPD diagnosis and smoking were inversely associated with FFMI, 6MWD and HS. Smoking and early COPD have a joint negative influence on body composition, exercise capacity and health status.

Intention to Quit Smoking among Intermediate and Secondary School Students in Saudi Arabia

BACKGROUND

Smoking is one of the most preventable causes of disease and death, including cancer, and quitting at an early age can reduce smoking-related morbidity and mortality. This study aimed to estimate the prevalence and to identify factors affecting the "intention to quit" among intermediate and secondary school current cigarette smoker students in Al Madinah city, Saudi Arabia.

MATERIALS AND METHODS

This study cohort included 307 current smoker students in a school-based survey. The intention to quit and its related determinants were assessed using a self-administered questionnaire.

RESULTS

More than half of the participants were ≥17 years, and of male gender (54.7%, 77.9% respectively). An intention to quit smoking was reported in 71.7% of participants, and was been significantly associated with: male gender (OR=3.25, 95% CI=1.65-6.41): age at 1st trial of smoking. 10-15 years (OR=2.11, 95% CI=1.03-4.32) along with age of ≥15 years (OR=3.10, 95% CI=1.20-7.88); days of smoking in the past 30 days (days<10 (OR=2.31, 95% CI=1.23-4.35) along with days ranging from 10-19 days (OR= 3.42, 95% CI=1.18-9.91); knowing that smoking is hazardous to health (OR=3.04, 95% CI=1.42-6.47); and finally, supporting smoking bans in public places (OR=1.89, 95% CI=1.11-3.25).

CONCLUSIONS

A substantial number of participants were willing to quit smoking. Effective interventions focusing on providing information about the hazards of smoking and prohibiting smoking in public places could help initiate the intention to quit among youth smokers.

Depression, anxiety, stress, and motivation over the course of smoking cessation treatment

OBJECTIVE

To evaluate changes in the levels of patient anxiety, depression, motivation, and stress over the course of smoking cessation treatment.

METHODS

This cohort study involved patients enrolled in a smoking cessation program in Cuiabá, Brazil. We selected patients who completed the program in six months or less (n = 142). Patient evaluations were conducted at enrollment (evaluation 1 [E1]); after 45 days of treatment with medication and cognitive-behavioral therapy (E2); and at the end of the six-month study period (E3). Patients were evaluated with a standardized questionnaire (to collect sociodemographic data and determine smoking status), as well as with the University of Rhode Island Change Assessment scale, Beck Anxiety Inventory, Beck Depression Inventory, and Lipp Inventory of Stress Symptoms for Adults. The data were analyzed with the nonparametric Wilcoxon test for paired comparisons. To compare treatment success (smoking cessation) with treatment failure, the test for two proportions was used.

RESULTS

Among the 142 patients evaluated, there were improvements, in terms of the levels of anxiety, depression, motivation, and stress, between E1 and E2, as well as between E1 and E3. In addition, treatment success correlated significantly with the levels of motivation and anxiety throughout the study period, whereas it correlated significantly with the level of depression only at E2 and E3.

CONCLUSIONS

We conclude that there are in fact changes in the levels of patient anxiety, depression, motivation, and stress over the course of smoking cessation treatment. Those changes appear to be more pronounced in patients in whom the treatment succeeded.

Psychological distress related to smoking cessation in patients with acute myocardial infarction

Among all causes of preventable deaths, smoking is responsible for the greatest number of deaths worldwide and predisposes to fatal, noncommunicable diseases, especially cardiovascular diseases. Lifestyle changes are effective in the treatment of patients with smoking-related diseases and assist in the prevention of premature mortality. Our objective was to investigate the available scientific evidence regarding the psychological distress related to smoking cessation in patients who have had acute myocardial infarction. To that end, we conducted an integrative review of the literature in order to summarize relevant studies on this topic. The selected databases were Scopus, PubMed Central, Institute for Scientific Information Web of Science (Core Collection), ScienceDirect, EMBASE, SciELO, LILACS e PsycINFO. On the basis of the inclusion and exclusion criteria adopted for this study, 14 articles were selected for analysis. Those studies showed that the prevalence of psychological distress is higher among smokers than among nonsmokers, and distress-related symptoms are much more common in smokers with acute myocardial infarction than in those without. Smoking cessation depends on the active participation of the smoker, whose major motivation is the underlying disease. Most studies have shown that there is a need to create treatment subgroups as a means of improving the treatment provided. This review article expands the knowledge regarding smoking cessation and shows the need to invest in future research that investigates subgroups of smokers diagnosed with the major smoking-related comorbidities, such as acute myocardial infarction, in order to develop specific interventions and psychological support strategies.