SEA 2024 Standards for Global Control of Vascular Risk. / Estándares de la Sociedad Española de Arteriosclerosis 2024 para el control global del riesgo vascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.

Efectos de una Charla Antitabaco en Adolescentes Fumadores de Colegios Públicos y Privados en la Región Metropolitana de Santiago de Chile / Effects of an Anti-Smoking talk on Adolescent Smokers in Public and Private Schools in the Metropolitan Region of Santiago de Chile

Introducción. El tabaquismo es responsable de una gran cantidad de muertes en el mundo, la gran prevalencia del tabaquismo entre adolescentes, así como la baja edad de inicio del consumo, genera preocupación y la necesidad de implementar intervenciones específicas a esta población. Objetivo. Evaluar los efectos de una charla antitabaco en adolescentes de colegios públicos y privados en la Región Metropolitana de Santiago. Métodos. Estudio cuantitativo cuasi-experimental, se realizó una charla antitabaco en dos colegios (público y privado), se evaluó la motivación para dejar de fumar con el Test de Richmond en una muestra de 13 estudiantes pre y post charla. Resultados. hubo una mejora en los puntajes de Richmond post charla en ambos colegios, siendo mayor en el colegio público, sin embargo, la diferencia no fue estadísticamente significativa (p=0,09). Discusión. La evidencia respalda la efectividad de las charlas antitabaco. Existe una relación entre nivel socioeconómico y tabaquismo, sin embargo, no hay otros estudios que comparen la efectividad en los distintos estratos sociales. Se reconocen limitaciones del estudio como el tamaño de la muestra y el muestreo no aleatorio, se recomiendan nuevos estudios que incluyan otras variables. Conclusiones. A pesar de limitaciones del estudio, se respalda la implementación de charlas antitabaco en entornos educativos, enfatizando la necesidad de adaptar estrategias a contextos socioeconómicos específicos para mejorar la salud pública.

Background. Introduction: Smoking is responsible for a significant number of deaths worldwide, and the high prevalence of smoking among adolescents, as well as early age of onset, raises concerns, and the need of targeted interventions for this group. The aim of this study was to assess the effects of an anti-smoking talk on students from public and private schools in the Metropolitan Region of Santiago. Methods. A quasi-experimental quantitative study involving an anti-smoking talk in two schools (public and private) assessed the motivation to quit smoking using the Richmond Test in a sample of 13 students pre and post the talk. Results. There was an improvement in Richmond scores post-talk in both schools, with a greater increase observed in the public school. However, the difference was not statistically significant (p=0.09). Discussion. The evidence supports the effectiveness of anti-smoking talks. A relationship between socioeconomic status and smoking exists, yet there are no studies comparing effectiveness across different socioeconomic strata. Study limitations, such as sample size and non-random sampling, are acknowledged, and further research incorporating additional variables is recommended. Conclusions. Despite study limitations, advocating for the implementation of anti-smoking talks in educational settings is supported, emphasizing the need to adapt strategies to specific socioeconomic contexts to enhance public health.

Herramientas para el tamizaje de aneurisma de aorta abdominal / Tools for abdominal aortic aneurysm screening

Introducción. El aneurisma de la aorta abdominal (AAA) es la dilatación de la aorta abdominal mayor de 1,5 veces el diámetro esperado. Su prevalencia es variable, con tasas reportadas de hasta el 12,5 %. Se considera como causa de muerte de más de 10.000 personas al año en los Estados Unidos. El objetivo de esta revisión de la literatura fue describir los factores de riesgo y las herramientas de tamizaje de AAA. Métodos. Se realizó una búsqueda de la literatura utilizando dos ecuaciones en bases de datos electrónicas, empleando términos seleccionados de "Medical Subject Heading" (MeSH) y "Descriptores en Ciencias de la Salud" (DeCS). Se evaluó la calidad de los estudios con la herramienta STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Resultados. Se recolectaron 40 artículos y a partir de ellos se construyó el texto de revisión, identificando en estos, los factores de riesgo asociados al desarrollo de AAA, tales como sexo masculino, tabaquismo, hipertensión arterial, antecedente familiar y obesidad, entre otros. La diabetes mellitus parece actuar como factor protector. Dentro de los instrumentos de tamizaje, el ultrasonido abdominal es uno de los más usados. Conclusión. El AAA es una patología multifactorial. En la actualidad la ultrasonografía de aorta es el método de elección para el tamizaje, permitiendo la detección precoz. El tamizaje de AAA con métodos no invasivos, como el ultrasonido, es útil sobre todo en zonas con prevalencia alta de la patología y en pacientes con determinados factores de riesgo.

Introduction. Abdominal aortic aneurysm (AAA) is a dilation of the abdominal aorta greater than 1.5 times the expected diameter. Its prevalence is variable, with reported rates of up to 12.5%. It is considered the cause of death of more than 10,000 people a year in the United States. The objective of this literature review was to describe risk factors and screening tools for AAA. Methods. A literature search was conducted using two equations in electronic databases, using terms selected from "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool. Results. Forty articles were collected and from them the review text was constructed, identifying the risk factors associated with the development of AAA, such as male sex, smoking, high blood pressure, family history and obesity, among others. Diabetes mellitus seems to act as a protective factor. Among the screening instruments, abdominal ultrasound is one of the most used. Conclusion. AAA is a multifactorial pathology. Currently, aortic ultrasonography is the method of choice for screening, allowing early detection. Screening for AAA with non-invasive methods, such as ultrasound, is useful especially in areas with a high prevalence of this pathology and in patients with certain risk factors.

Evidence of validity of the Smoking Cessation Counseling scale - Brazilian version / Evidencias de validez de la escala Smoking Cessation Counseling - versión brasileña / Evidências de validade da escala Smoking Cessation Counseling - versão brasileira

Objective: to evaluate the evidence of validity of the internal structure and reliability of the Brazilian version of the Smoking Cessation Counseling instrument Method: psychometric study of confirmatory factor analysis and reliability carried out on 250 nurses in clinical practice. For the analysis of the convergent validity of the factor model, Average Variance Extracted values were calculated, and discriminant analysis was carried out using the Fornell-Larcker criterion. Reliability was examined using Cronbach's alpha coefficient and composite reliability Results: it was necessary to exclude seven items from the Advanced Counseling domain and one item from the Basic Counseling domain in order to properly obtain the Average Variance Extracted values and the Fornell-Larcker criterion. The composite reliability ranged from 0.76 to 0.86 and the overall Cronbach`s alpha coefficient was 0.86, ranging from 0.53 to 0.84 depending on the domain assessed. The final version of the instrument was made up of 16 items divided into 4 domains Conclusion: the Brazilian version of Smoking Cessation Counseling obtained adequate psychometric evidence of validity and reliability. Further studies are needed to refine the instrument.

Objetivo: evaluar las evidencias de validez de la estructura interna y de la confiabilidad de la versión brasileña del instrumento Smoking Cessation Counseling. Método: estudio psicométrico de análisis factorial confirmatorio y de confiabilidad realizado en 250 enfermeras de la práctica clínica. Para el análisis de la validez convergente del modelo factorial se calcularon valores de Average Variance Extracted, el análisis discriminante se realizó mediante el criterio de Fornell-Larcker. La confiabilidad se examinó por el coeficiente de alfa de Cronbach y por la confiabilidad compuesta. Resultados: fue necesaria la exclusión de siete ítems del dominio de Asesoramiento avanzado y un ítem del dominio Asesoramiento básico para obtener adecuadamente los valores de Average Variance Extracted y del criterio de Fornell-Larcker. La confiabilidad compuesta varió de 0,76 a 0,86 y el coeficiente de alfa de Cronbach global alcanzado fue de 0,86, variando de 0,53 a 0,84 dependiendo del dominio evaluado. Se obtuvo la versión final del instrumento compuesto de 16 ítems distribuidos en 4 dominios. Conclusión: la versión brasileña de Smoking Cessation Counseling obtuvo adecuadas evidencias psicométricas de validez y confiabilidad. Estudios posteriores serán necesarios para el refinamiento del instrumento.

Objetivo: avaliar as evidências de validade da estrutura interna e da confibialidade da versão brasileira do instrumento Smoking Cessation Counseling Método: estudo psicométrico de análise fatorial confirmatória e de confiabilidade realizado em 250 enfermeiras da prática clínica. Para a análise da validade convergente do modelo fatorial foram calculados valores de Average Variance Extracted , a análise discriminante foi realizada pelo critério de Fornell-Larcker. A confiabilidade foi examinada pelo coeficiente de alfa de Cronbach e pela confiabilidade composta Resultados: foi necessária a exclusão de sete itens do domínio de Aconselhamento avançado e um item do domínio Aconselhamento básico para obtenção adequada dos valores de Average Variance Extracted e do critério de Fornell-Larcker. A confiabilidade composta variou de 0,76 a 0,86 e o coeficiente de alfa de Cronbach global alcançado foi de 0,86, variando de 0,53 a 0,84 a depender do domínio avaliado. Obteve-se a versão final do instrumento composto de 16 itens distribuídos em quatro domínios Conclusão: a versão brasileira da Smoking Cessation Counseling obteve adequadas evidências psicométricas de validade e de confiabilidade. Estudos posteriores serão necessários para o refinamento do instrumento.

Prevalência e fatores associados ao uso de cigarro eletrônico por estudantes universitários / Prevalence and factors associated with electronic cigarette use by university students / Prevalencia y factores asociados al uso de cigarrillos electrónicos por estudiantes universitarios

Este estudo objetivou estimar a prevalência do uso do cigarro eletrônico e a associação com fatores preditores. Trata-se de um estudo transversal, analítico, com amostra probabilística de universitários matriculados em um Centro Universitário de Montes Claros, Minas Gerais, Brasil no segundo semestre de 2022. A variável dependente referiu-se ao uso do cigarro eletrônico. As variáveis independentes referiram a fatores sociodemográficas, laborais e comportamentais. A associação entre as variáveis investigadas e a prevalência do uso do CE foi verificada pela análise bivariada e a regressão de Poisson. Foram entrevistados 730 universitários, com a média de idade de anos 22,56 (±6,25). Destes, 21,8 % faziam o uso cigarro eletrônico e após a análise multivariada manteve-se associado ao desfecho não ter companheiro (RP= 3,31; IC95% 1,04-10,48), morar com amigos/sozinho (RP=1,53; IC95% 1,07-2,18), ter histórico de usuários de cigarro eletrônico na residência (RP= 1,76; IC95%: 1,17- 1,89), consumir bebida alcoólica (RP= 3,07; IC95%: 1,72-5,49) e não praticar atividade física (RP= 3,37; IC95% 2,35-4,83). Conhecer sobre o cigarro eletrônico foi fator protetor (RP= 0,31 IC95% 0,20-0,46). Registrou-se elevada prevalência do uso do cigarro eletrônico, e manteve associados a fatores sociodemográficos e comportamentais. Esses achados chamam a atenção para a necessidade de novas medidas regulatórias, a fim de reduzir o uso desse dispositivo.

This study aimed to estimate the prevalence of e-cigarette use and the association with predictors. This is a cross-sectional, analytical study with a probabilistic sample of university students enrolled in a University Center of Montes Claros, Minas Gerais, Brazil in the second half of 2022. The dependent variable referred to the use of electronic cigarettes. The independent variables referred to sociodemographic, labor and behavioral factors. The association between the variables investigated and the prevalence of EC use was verified by bivariate analysis and Poisson regression. A total of 730 university students were interviewed, with a mean age of 22.56 (±6.25). Of these, 21.8% used electronic cigarettes and after multivariate analysis, it remained associated with the outcome of not having a partner (PR= 3.31; CI95% 1.04-10.48), living with friends/alone (PR=1.53; CI95% 1.07-2.18), having a history of e-cigarette users in the residence (PR= 1.76; CI95%: 1.17- 1.89), alcohol consumption (PR= 3.07; CI95%: 1.72-5.49) and not practicing physical activity (PR= 3.37; IC95% 2.35-4.83). Knowing about electronic cigarettes was a protective factor (PR= 0.31 CI95% 0.20-0.46). There was a high prevalence of e-cigarette use, and it was associated with sociodemographic and behavioral factors. These findings draw attention to the need for new regulatory measures in order to reduce the use of this device.

Este estudio tuvo como objetivo estimar la prevalencia del uso de cigarrillos electrónicos y la asociación con predictores. Se trata de un estudio analítico transversal con una muestra probabilística de estudiantes universitarios matriculados en un Centro Universitario de Montes Claros, Minas Gerais, Brasil, en el segundo semestre de 2022. La variable dependiente se refería al uso de cigarrillos electrónicos. Las variables independientes se refirieron a factores sociodemográficos, laborales y conductuales. La asociación entre las variables investigadas y la prevalencia de uso de CE fue verificada por análisis bivariado y regresión de Poisson. Fueron entrevistados 730 estudiantes universitarios, con una edad promedio de 22,56 (±6,25). De estos, 21,8% utilizaron cigarrillos electrónicos y después del análisis multivariado, se mantuvo asociado con el resultado de no tener pareja (RP= 3,31; IC95% 1,04-10,48), vivir con amigos/solo (RP=1,53; IC95% 1,07-2,18), con antecedentes de usuarios de cigarrillos electrónicos en la residencia (RP= 1,76; IC95%: 1,17- 1,89), consumo de alcohol (RP= 3,07; IC95%: 1,72-5,49) y no practicar actividad física (RP= 3,37; IC95% 2,35-4,83). El conocimiento de los cigarrillos electrónicos fue un factor protector (RP= 0,31 IC95% 0,20-0,46). Hubo una alta prevalencia de uso de cigarrillos electrónicos, y se asoció con factores sociodemográficos y de comportamiento. Estos hallazgos llaman la atención sobre la necesidad de nuevas medidas regulatorias para reducir el uso de este dispositivo.

Alcohol drinking, smoking, and cutaneous melanoma risk: Mendelian randomization analysis.

OBJECTIVE: To investigate the causal relationship between poor lifestyle habits, such as smoking and drinking, and cutaneous malignant melanoma. METHOD: In the present study, alcohol consumption and smoking were used as exposure factors, and single nucleotide polymorphisms closely associated with alcohol consumption and smoking were used as instrumental variables, while cutaneous melanoma was set as an outcome variable. Two-sample Mendelian randomization analyses were run between alcohol consumption and melanoma and smoking and melanoma to investigate their causal associations, respectively. RESULTS: We found a positive and statistically significant causal effect of alcohol intake on the risk of cutaneous malignant melanoma (OR: 2.23; 95%CI: 1.11-4.47; p=0.02). The present study showed no significant causal relationship between cigarettes per day and cutaneous melanoma (OR: 0.85; 95%CI: 0.54-1.35; p=0.50) or smoking initiation and cutaneous melanoma (OR: 1.02; 95%CI: 0.74-1.39; p=0.88). CONCLUSIONS: This study provides Mendelian randomization evidence supporting alcohol consumption as a risk factor for cutaneous malignant melanoma. And the causal relationship between smoking and cutaneous malignant melanoma still needs to be further investigated.

Relationship between Smoking and Vocal Self-perception of Trans Women

Objective: To verify the relationship between smoking, age, schooling, and the vocal self-perception of trans women. Methods: Cross-sectional observational quantitative study conducted with 24 trans women over 18 years old, living in their affirmed gender for a minimum of 6 months. Data collection involved selected questions from the translated and authorized Portuguese version of the Trans Woman Voice Questionnaire (TWVQ) and information regarding age, education, occupation, and smoking status. All variables were analyzed descriptively, and the association with smoking was assessed using Pearson's Chi-square, Fisher's Exact, Student's T, and Mann-Whitney tests, with a significance level of 5%. Results: The mean age of trans women was 28.2 +/- 6.5 years (range: 21 - 48). Most participants (41.6%) had completed their high school education and pursued diverse careers. Regarding smoking habits, 58.3% of women were either current smokers or had smoked at least 100 cigarettes in their lifetime. A statistically significant association was found between smoking and age (p = 0.001), with smokers having a lower average age (24.9 years) compared to nonsmokers (32.9 years). However, no statistical significance was observed between smoking, education, and self-perception of vocal femininity. Only 9 (37.5%) trans women perceived their voices as feminine, while 17 (70.7%) desired a more feminine-sounding voice. Limitation: The limited sample size in this study may have constrained the ability to detect significant differences between the analyzed groups using statistical tests. Conclusion: The smoking prevalence was notably high among younger trans women. However, there was no statistically significant difference in vocal self-perception between those who smoked and those who did not. The majority of trans women expressed a desire for their voices to sound more feminine, particularly among smokers.

Objetivo: Verificar la relación entre el tabaquismo, edad, escolaridad y la autopercepción vocal de mujeres trans. Métodos: Estudio observacional transversal cuantitativo realizado con 24 mujeres trans mayores de 18 años, que viven en su género afirmado durante 6 meses. Para la recolección de datos se utilizaron preguntas seleccionadas de la versión portuguesa traducida y autorizada del Trans Woman Voice Questionnaire (TWVQ) y datos sobre edad, educación, ocupación y tabaquismo. Todas las variables se analizaron descriptivamente y la asociación con el tabaquismo se realizó mediante las pruebas Chi-cuadrado de Pearson, Exacta de Fisher, T de Student y Mann Whitney, con un nivel de significación del 5%. Resultados: La edad promedio de las mujeres trans fue de 28,2 +/- 6,5 (rango 21 - 48). La mayoría de las participantes (41,6%) había terminado la escuela secundaria con carreras muy diversas. Respecto al tabaquismo, el 58,3% de las mujeres fuman actualmente o han fumado al menos 100 cigarrillos en su vida. Hubo una asociación estadísticamente significativa entre el tabaquismo y la edad (p = 0,001), en la que la edad promedio entre los fumadores (24,9 años) fue menor que la de los no fumadores (32,9 años). No hubo significación estadística entre el tabaquismo, la educación y la autopercepción vocal. Solo 9 (37,5%) mujeres trans actualmente consideran su voz femenina y 17 (70,7%) dijeron que la voz ideal podría sonar más femenina. Limitación: La pequeña casuística puede haber limitado la identificación de diferencias entre los grupos analizados a través de pruebas estadísticas. Conclusión: El tabaquismo fue alto entre las mujeres trans, especialmente las más jóvenes. La autopercepción vocal no fue estadísticamente diferente entre los grupos de fumadores y no fumadores. La mayoría de las mujeres trans dijeron que sus voces podrían sonar más femeninas, especialmente las fumadoras.

Arterial hypertension and smoking in pregnant women in the Valencian Community: maternal and neonatal outcomes.

OBJECTIVE: Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn. MATERIALS AND METHODS: An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case-control nested in a retrospective cohort corresponding to pregnancy. RESULTS: A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a "U" shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed. CONCLUSIONS: Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension.

Prevalencia y evaluación diagnóstica inicial del hábito tabáquico en adolescentes de Moa, Holguín

Fundamento el tabaquismo en la adolescencia constituye un problema de salud pública mundial, al punto de ser considerado la principal causa prevenible de enfermedad y muerte prematura. Objetivo describir el comportamiento del tabaquismo en adolescentes. Métodos estudio de corte transversal, realizado en el periodo septiembre-diciembre de 2022. De un universo de 1561 adolescente de 15-19 años de edad, se seleccionó una muestra de 1444 (92,50 %) mediante muestreo deliberado. Las variables del estudio: edad, sexo, fumador, exfumador, edad de inicio, años fumando, número de cigarrillos consumidos por día, carga tabáquica, dependencia y motivación. Resultados la prevalencia de tabaquismo resultó de 17,94 %. El 0,83 % de los adolescentes expresó haber abandonado el hábito (exfumadores). El 55,98 % tenía entre 17-18 años de edad, y el 77,61 % perteneció al sexo masculino. El 64,86 % comenzó a fumar entre los 12 y 14 años, el 52,51 % fumaba desde hacía 1-2 años; mientras un 59,85 % consumía entre 6-10 cigarrillos diarios. La carga tabáquica recibida por el 44,34 % resultó 0,25-0,50. El 57,08 % declaró dependencia física baja, y el 81,13 % motivación baja. Conclusiones la prevalencia del tabaquismo en los adolescentes de Moa fue similar a la reportada por otras investigaciones. Resulta preocupante que más de la mitad de la población estudiada consuma cigarros desde los 12-14 años, y que, a pesar de mostrar bajos niveles de dependencia, no sientan motivación por abandonar este mal hábito.

Foundation smoking in adolescence constitutes a global public health problem, is being considered the main preventable cause of illness and premature death. Objective to describe smoking behavior in adolescents. Methods cross-sectional study, carried out from September to December 2022. From a universe of 1,561 adolescents aged 15-19, a sample of 1,444 (92.50%) was selected through deliberate sampling. The study variables: age, sex, smoker, ex-smoker, age of initiation, years of smoking, number of cigarettes consumed per day, smoking load, dependence and motivation. Results the prevalence of smoking was 17.94%. 0.83% of adolescents expressed having quit the habit (ex-smokers). 55.98% were between 17-18 years of age, and 77.61% were male. 64.86% started smoking between 12 and 14 years old, 52.51% had been smoking for 1-2 years; while 59.85% consumed between 6-10 cigarettes a day. The smoking burden received by 44.34% was 0.25-0.50. 57.08% declared low physical dependence, and 81.13% reported low motivation. Conclusions the prevalence of smoking in Moa adolescents was similar to that reported by other investigations. It is worrying that more than half of the population studied consumes cigarettes from the age of 12-14, and that, despite showing low levels of dependence; they do not feel motivated to abandon this bad habit.

Tabaco y tabaquismo en Cuba: de la economía agrícola a la economía de la salud

El consumo de cigarrillos y tabacos crea una externalidad que tiene mayor relevancia en el detrimento de la calidad de vida y de la expectativa de vida que experimenta el individuo fumador con relación a los que no consumen cigarrillos o tabacos. el costo psicosocial no cuantificado de forma financiera supera con creces cualquier expectativa de beneficio económico. El presente artículo versa en torno al impacto socioeconómico del tabaquismo en Cuba. La distribución económica inducida por el tabaquismo conlleva a la persistencia de una inequidad socioeconómica tal, que se agudiza con el número de fumadores y la intensidad del consumo de cigarrillos y tabáquico. Este fenómeno contradice el principio socialista de distribución con arreglo al trabajo, donde los no fumadores no deberían cargar con las consecuencias del tabaquismo y los propios fumadores no deberían ser inducidos a persistir en el consumo tabáquico. La sutileza de los costos sociales atribuibles al tabaquismo y el impacto de los beneficios del comercio interior y exterior, no permiten valorar en su completa dimensión los principales efectos del tabaquismo desde el aspecto socioeconómico.

The cigarettes and tobacco consumption creates an externality that is more relevant in the detriment of the life quality and life expectancy experienced by the individual smoker, in relation to those who do not consume cigarettes or tobacco. The psychosocial cost not financially quantified far exceeds any expectation of economic benefit. This article deals with the socioeconomic impact of smoking in Cuba. The economic distribution induced by smoking leads to the persistence of such socioeconomic inequity, which worsens with the number of smokers and the intensity of cigarette and tobacco consumption. This phenomenon contradicts the socialist principle of distribution according to work, where non-smokers should not bear the consequences of smoking and smokers themselves should not be induced to persist in smoking. The subtlety of the social costs attributable to smoking and the impact of the benefits of domestic and foreign trade do not allow a full assessment of the main effects of smoking from the socioeconomic aspect.

Factores predisponentes a enfermedades no transmisibles en un área de salud del municipio de Santiago de Cuba / Predisposing factors to non-communicable diseases in a health area from Santiago de Cuba municipality i: en

Introducción: Hoy en día las enfermedades no transmisibles constituyen un grave problema que afecta el estado de salud de la población, con una tendencia ascendente preocupante. Objetivo: Identificar los factores predisponentes a las enfermedades no transmisibles en pacientes de un área de salud. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 286 individuos, escogidos a través de un muestreo aleatorio bietápico en el área de salud Josué País García del municipio de Santiago de Cuba, durante el 2021. Las variables analizadas fueron antecedentes patológicos personales, consumo de productos del tabaco y alcohol, hábitos dietéticos y evaluación nutricional. Se utilizaron como medidas de resumen las frecuencias absolutas, el porcentaje y la tasa de prevalencia para variables cualitativas; la media aritmética y el mínimo e intervalo de confianza para variables cuantitativas. Resultados: El mayor riesgo de presentar hipertensión arterial figuró en las féminas (35,6 %) y existió alta prevalencia de fumadores en hombres (30,5 %) y mujeres (27,7 %). Asimismo, predominaron la exposición al humo de tabaco (fumadores pasivos) y el consumo de alcohol en edades tempranas (25-34 años). De los encuestados, 33,3 % resultó estar sobrepeso u obeso. Conclusiones: Los factores predisponentes a las enfermedades no transmisibles pudieran estar asociados con estilos de vida no saludables como el consumo de productos del tabaco y el alcohol, los hábitos dietéticos inadecuados y el sobrepeso.

Introduction: Nowadays non-communicable diseases are a serious problem that affects the health of the population, with a worrying upward tendency. Objective: To identify the predisposing factors to non-communicable diseases in patients from a health area. Methods: An observational, descriptive and cross-sectional study of 286 individuals, chosen by a two-stage random sampling in Josué País García health area from Santiago de Cuba municipality, was carried out during 2021. The analyzed variables were personal pathological history, consumption of tobacco and alcohol products, dietary habits and nutritional evaluation. The absolute frequencies, percentage and prevalence rate were used as summary measures for qualitative variables; the arithmetic mean and the minimum and interval of confidence were used for quantitative variables. Results: The highest risk of presenting hypertension was in females (35.6%) and there was a high prevalence of smokers in men (30.5%) and women (27.7%). Also, the exposure to tobacco smoke (passive smokers) and alcohol consumption at an early age (25-34 years) prevailed. Of those interviewed, 33.3% was overweight and obese. Conclusions: The predisposing factors to non-communicable diseases could be associated with the non healthy lifestyle as the consumption of tobacco and alcohol products, inadequate dietary habits and overweight.

Tratamiento del tabaquismo guiado por marcadores genéticos

Introducción: Entre las adicciones por drogas, el tabaquismo ocupa el primer lugar como causa de morbimortalidad y es factor de riesgo para seis de las ocho principales causas de muerte en el mundo. La nicotina es el principal componente adictivo del tabaco. En la terapia de reemplazo con nicotina (TRN), la vareniclina y el bupropion son los medicamentos aprobados para tratamiento del tabaquismo, pero los resultados de las clínicas de dejación del tabaquismo sugieren que aún se desconoce muchas variables influyentes en la respuesta al tratamiento. Objetivo: Determinar la adherencia, la tolerabilidad y la efectividad de un programa de dejación de tabaquismo basado en nicotina o bupropion, en pacientes con dependencia al tabaco, seleccionados según los genotipos de las enzimas que metabolizan los dos fármacos. Hallazgos clínicos: Se incluyeron en esta serie 21 fumadores, 67% hombres, con edad promedio de 46,2±11,7 años. Su tabaquismo comenzó a los 17,8±6 años y llevaban fumando 28±13 años. Al inicio del estudio fumaban 17±12 cigarrillos por día (CPD), habían hecho 3,7±2 intentos de dejar de fumar y el puntaje NDSS (escala breve de evaluación de dependencia de la nicotina, por sus siglas en inglés) fue de 22±5 (punto de corte para dependencia a nicotina: 11 o más puntos). Tratamiento: Los pacientes tenían libre acceso telefónico al médico tratante y, cada semana, una consulta consistente en consejería y control del tratamiento farmacológico prescrito según los genotipos CYP2A6 (que codifica la enzima que metaboliza la nicotina) y CYP2B6 (que codifica la enzima que metaboliza el bupropion). Se empleó nicotina en parches transdérmicos de 14 mg el primer mes y luego de 7 mg el segundo mes, complementados con chicles para manejo del síndrome de abstinencia y bupropion en forma de liberación regulada por 300 mg, 1-2 veces al día. Resultados: Después de 8 semanas de tratamiento y 4 de observación, 15 sujetos (71,4%) respondieron en forma parcial/total. El consumo de CPD bajó de 17±12 al inicio del estudio, a 2,2±3,5 al final del estudio, que corresponde a una reducción de 195 cigarrillos/día. Siete de ocho pacientes tratados con bupropion (87,5%) y siete de trece tratados con nicotina (54%) tuvieron respuesta parcial/total. Solo un paciente formulado con nicotina suspendió el medicamento por intolerancia gastrointestinal (náusea y vómito). La tasa de recaídas, evaluada un mes después del tratamiento farmacológico, fue de cero. Se encontró buena correlación genotipo-fenotipo en los individuos tratados con bupropion, pero no en los tratados con nicotina. Relevancia clínica: La inclusión de marcadores farmacogenéticos para la elección de nicotina o bupropion en un programa de dejación de tabaquismo puede mejorar la adherencia, la tolerabilidad al fármaco y la efectividad del tratamiento.

Introduction: Among drug addictions, smoking ranks first as a cause of morbidity and mortality and is a risk factor for six of the eight leading causes of death in the world. Nicotine is the main addictive component of tobacco. In nicotine replacement therapy (NRT), varenicline and bupropion are the approved medications for smoking cessation, but results from smoking cessation clinics suggest that many variables influencing response to treatment remain unknown. Objective: To determine the adherence, tolerability and effectiveness of a smoking cessation program based on nicotine or bupropion, in patients with tobacco dependence, selected according to the genotypes of the enzymes that metabolize the two drugs. Clinical findings: Twenty-one smokers were included in this series, 67% men, with a mean age of 46.2 ± 11.7 years. Their smoking began at 17.8±6 years and they had been smoking for 28±13 years. At baseline, they smoked 17±12 cigarettes per day (CPD), had made 3.7±2 quit attempts, and the NDSS score it was 22±5 (cut-off point for nicotine dependence: 11 or more points). Treatment: The patients had free telephone access to the treating physician and, every week, a consultation consisting of counseling and control of the pharmacological treatment prescribed according to the CYP2A6 genotypes (encoding the enzyme that metabolizes nicotine) and CYP2B6 (coding for the enzyme that metabolizes bupropion). Nicotine was used in transdermal patches of 14 mg the first month and then 7 mg the second month, supplemented with gum to manage the withdrawal syndrome and bupropion in the form of controlled release 300 mg, 1-2 times a day. Results: After 8 weeks of treatment and 4 weeks of observation, 15 subjects (71.4%) responded partially/totally. CPD consumption dropped from 17±12 at the beginning of the study to 2.2±3.5 at the end of the study, which corresponds to a reduction of 195 cigarettes/day. Seven of eight patients treated with bupropion (87.5%) and seven of thirteen treated with nicotine (54%) had a partial/total response. Only one patient receiving nicotine discontinued the medication due to gastrointestinal intolerance (nausea and vomiting). The relapse rate, assessed one month after drug treatment, was zero. Good genotype-phenotype correlation was found in individuals treated with bupropion, but not in those treated with nicotine. Clinical relevance: The inclusion of pharmacogenetic markers for the choice of nicotine or bupropion in a smoking cessation program may improve adherence, drug tolerability, and treatment effectiveness.

Hyperthyroidism and cardiovascular risk factors: A nationwide study.

BACKGROUND: Thyroid hormones (THs) have important effects on cardiovascular (CV) physiology. Thyroid disorders are accompanied by serious effects on the CV system. OBJECTIVE: To study the association between hyperthyroidism and the main CV risk factors (CVRFs), such as hypertension, dyslipidemia, diabetes and smoking in the Spanish population. MATERIAL AND METHODS: An observational, retrospective, non-interventional study was performed using the statistical portal of the Spanish Ministry of Health associated with the Base de Datos Clínicos de Atención Primaria (BDCA) database. RESULTS: In 2019, 384,182 people [300,243 women (78.1%)] were diagnosed with hyperthyroidism, which represents 1.0% of the population with health problems registered in the BDCAP database (38,365,258 people). The prevalence of hyperthyroidism was more frequent in women (2.48 times) than in men and increased with age. When the whole population was considered, the prevalence of hypertension (34.90% vs. 19.90%; odds ratio, OR 2.16, 95% CI 2.14-2.17), dyslipidemia (34.47% vs. 21.57%; OR 1.90, 95% CI 1.88-1.91), diabetes (12.88% vs. 8.12%; OR 1.66, 95% CI 1.65-1.68) and smoking (10.89% vs. 7.61%; OR 1.48, 95% CI 1.46-1.49) was significantly (p<0.0001) higher in the population diagnosed with hyperthyroidism compared to those without this diagnosis. These significant differences were maintained in both women and men. A separate analysis of the age group 65 years or older showed statistically significant (p<0.0001) differences in the prevalence of hypertension (66.26% vs. 59.43%; OR 1.34, 95% CI 1.33-1.36), dyslipidemia (52.61% vs. 49.05%; OR 1.15, 95% CI 1.14-1.17) and smoking (6.29% vs. 5.93%; OR 1.06, 95% CI 1.04-1.09) between patients with and without a diagnosis of hyperthyroidism, but not in the prevalence of diabetes, which was similar (24.63% vs. 24.63%; OR 1.00, 95% CI 0.99-1.01; p=0.89). CONCLUSION: Our study shows that the diagnosis of hyperthyroidism is significantly associated with the main CVRFs in Spanish population attended by primary care regardless of the gender of the patients. This association disappears in those patients aged 65 years or older diagnosed with diabetes.

[Study of correlation between different scales that measure smoking dependence]. / Estudio de correlación entre diferentes escalas que miden la dependencia al tabaquismo.

OBJECTIVE: To analyze the correlation between the degrees of smoking dependence, measured with the Fagerström Test Nicotine Dependence (FTND), Glover-Nilsson Smoking Behavioral Dependence (GN-SBQ) and a measure of self-perceived-dependence (SPD). DESIGN: Cross-sectional descriptive observational study. SITE: Urban primary health-care center. PARTICIPANTS: Men and women between 18 and 65 years old, daily smokers, selected by non-random consecutive sampling. INTERVENTIONS: Self-administration of various questionnaires though an electronic device. MAIN MEASUREMENTS: Age, sex and nicotine dependence assessed by: FTND, GN-SBQ and SPD. Statistical analysis, with SPSS 15.0: descriptive statistics, Pearson correlation analysis and conformity analysis. RESULTS: Two hundred fourteen smokers were included, 54.7% were women. Median age 52 years (range: 27-65). Depending on the test used, different results of the high/very high degree of dependence were found: FTND 17.3%, GN-SBQ 15.4% and SPD 69.6%. A moderate magnitude (r≈0.5) correlation between the 3 test was found. When assessing concordance, comparing the FTND with SPD, 70.6% of smokers didn't coincide in the severity of dependence, reporting a milder degree of dependence with the FTND than with SPD. Comparing GN-SBQ versus FTND, showed conformity in 44.4% of patients while in 40.7%, the FTND underestimated the severity of dependence. Likewise, when comparing SPD with the GN-SBQ, in the 64% GN-SBQ underestimates, while in 34.1% smokers conformity was demonstrated. CONCLUSIONS: The number of patients who consider their SPD to be high/very high was four times higher compared to the GN-SBQ or the FNTD; the latter, being the most demanding, categorizing patients with very high dependence. Requiring a FTND score greater than 7 to prescribe drugs for smoking cessation may exclude subsidiary patients from receiving treatment.

Adherence to the Mediterranean diet in first-year university students and its association with lifestyle-related factors: A cross-sectional study.

INTRODUCTION: Students' dietary habits are moving from Mediterranean diet guidelines towards unhealthy eating patterns. The aim of this study was to determine adherence to the Mediterranean diet in a sample of Spanish university students and its association with lifestyle factors. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted with 685 university students who completed a self-report questionnaire. The data collected included demographic characteristics, dietary habits, smoking habits, alcohol consumption and physical activity. Mediterranean diet adherence was assessed by measuring the consumption of the foods that compose this type of diet through a score (range 0-10). Adherence to the Mediterranean diet was considered poor, average, or good. RESULTS: The mean adherence score for the Mediterranean diet was 4.9 (1.2) points out of 10. A higher degree of adherence to the Mediterranean diet was observed in physically active students (OR=2.31, 95% CI: 1.05-5.10; p=0.038). Students who performed ≥150min/week of physical activity (OR=0.45, 95% CI: 0.33-0.62; p<0.001) and those over 25 years old (OR=0.44, 95% CI: 0.26-0.73; p=0.002) were less prone to low adherence to the Mediterranean diet than sedentary and younger students. CONCLUSION: The university students have poor adherence to the Mediterranean diet. The results of the current study indicate that age and physical activity are associated with Mediterranean diet adherence. It is urgent to raise awareness among university students and implement intervention programmes promoting a healthy lifestyle.

[Changes in smoking cessation in Spain, 1987-2020]. / Cambios en el abandono del consumo de tabaco en España, 1987-2020.

INTRODUCTION: The goal of this study was to estimate and to describe the smoking cessation changes in Spain from 1987 to 2020, according to the main sociodemographic characteristics. MATERIAL AND METHOD: Analysis of the historical series of the Spanish National Health Survey and the European Health Survey in Spain. Quit rate (QR) was defined as the number of former smokers among the total number of people who are smokers or have smoked at some time in their life. Other included variables were year of survey, age, gender and educational level. Poisson regression models were simultaneously adjusted for sociodemographic characteristics, estimating QR and its 95% confidence intervals (CIs) for each year. RESULTS: The absolute difference in standardized QR increased from 1987 to 2017 by 18.6% (95%CI: 16.8-20.4), being moderately higher in men (19.2%; 95%CI: 17.1-21.4) than in women (16.5%; 95%CI: 13.3-19.7). An increase in QR was observed in all age groups, but its magnitude increased with age, estimating a difference in QR between 1987 and 2017 of 22.4% (95%CI: 17.7-27.1) in those aged over 64. People having university studies showed a higher QR during the period, 32.7% (95%CI: 27.5-38.0), especially when compared to those with a lower level of education (9.0%; 95%CI: 4.8-13.2). CONCLUSION: QR has increased sharply and steadily since 1987, however important differences were detected according to age and educational level, highlighting the large increase in inequity observed in these 33years of evolution.

Avaliação da adesão ao tratamento de cessação tabágica em um município do interior do Ceará / Assessment of adherence to smoking cessation treatment in a city in the interior of Ceará / Evaluación de la adherencia al tratamiento para dejar de fumar en una ciudad del interior de Ceará

Introdução: O tabagismo é capaz de causar intoxicação química desencadeando efeitos deletérios de natureza aguda ou crônica em diversas estruturas do corpo, afetando significativamente a saúde. É considerada uma epidemia que mais ameaça à saúde pública em todo o mundo. Objetivo: Para tanto, esse estudo objetiva-se analisar o grau de dependência, a história tabágica, a caracterização sociodemográfica a adesão terapêutica dos usuários em tratamento de cessação do tabagismo atendidos pela rede CAPS-AD em um município do interior do Ceará. Métodos: Trata-se de um estudo quantitativo e descritivo. Foi desenvolvido por meio de reuniões coletivas com o grupo de cessação tabágica, os usuários foram convidados a participar da pesquisa, respeitando o princípio da autonomia, após apresentação dos objetivos e esclarecimentos a cerda do estudo. Resultados: Foram recrutados 19 usuários em tratamento de cessação tabágica. Desses, 10 participantes eram do sexo masculino e 9 ao sexo feminino. Com relação a faixa etária, 42,11% estavam entre as idades de 46 a 55 anos e a maioria dos participantes não tinha o ensino fundamental completo e eram civilmente casados. Analisando o IMC, 57,9% estavam com peso normal e 21,05% com sobrepeso. Mais de 80% iniciaram o vício na adolescência e68% relataram não conviver com fumantes em casa. Em relação à adesão terapêutica, cerca de 52% foram satisfatórias. Conclusão: De um modo geral observa-se que a população do estudo, tem um elevado índice de dependência à nicotina em decorrência do prolongado tempo de uso, do início precoce e de uma procura de tratamento tardia.

Introduction: Smoking is able to cause chemical intoxication triggering deleterious effects of acute or chronic nature in several structures of the body, significantly affecting health. It is considered an epidemic that most threatens public health worldwide. Objective: Therefore, this study aimed to analyze the degree of dependence, smoking history, sociodemographic characterization, and therapeutic adherence of users in smoking cessation treatment assisted by the CAPS-AD network in a city in the interior of Ceará. Methods: This is a quantitative and descriptive study. It was developed through collective meetings with the smoking cessation group, users were invited to participate in the research, respecting the principle of autonomy, after presentation of the objectives and clarifications about the study. Results: Nineteen users in smoking cessation treatment were recruited. Of these, 10 participants were male and 9 were female. Regarding the age range, 42.11% were between 46 and 55 years old, and most participants did not have complete elementary school education and were civilly married. Analyzing the BMI, 57.9% were normal weight and 21.05% were overweight. More than 80% started smoking during adolescence and 68% reported not living with smokers at home. In relation to therapeutic adherence, about 52% were satisfactory. Conclusion: In general, it is observed that the study population has a high rate of nicotine dependence due to the prolonged time of use, the early onset and a late search for treatment.

Introducción: El tabaquismo es capaz de causar intoxicación química desencadenando efectos deletéreos de naturaleza aguda o crónica en diversas estructuras del organismo, afectando significativamente la salud. É considerada uma das epidemias que mais ameaça a saúde pública em todo o mundo. Objetivo: Para tanto, este estudo objetiva-se analisar o grau de dependência, a história tabágica, a caracterização sociodemográfica e a adesão terapêutica dos usuários em tratamento de cessação do tabagismo atendidos pela rede CAPS-AD em um município do interior do Ceará. Método: Se trata de un estudio cuantitativo y descriptivo. Fue desarrollado a través de reuniones colectivas con el grupo de cesación de fumar, los usuarios fueron invitados a participar en la investigación, respetando el principio de autonomía, después de la presentación de los objetivos y aclaraciones sobre el estudio. Resultados: Diecinueve usuarios en tratamiento para dejar de fumar fueron reclutados. De ellos, 10 participantes eran hombres y 9 mujeres. En cuanto al rango de edad, el 42,11% tenía entre 46 y 55 años y la mayoría de los participantes no había completado los estudios primarios y estaban casados por lo civil. Analizando el IMC, el 57,9% tenían un peso normal y el 21,05% tenían sobrepeso. Más del 80% iniciaron la adicción en la adolescencia y el68% declararon no convivir con fumadores en casa. En cuanto a la adherencia terapéutica, cerca del 52% fue satisfactoria. Conclusión: En general se observa que la población de estudio, presenta una alta tasa de dependencia nicotínica debido al tiempo prolongado de consumo, inicio precoz y demanda tardía de tratamiento.

Associação da percepção do nível de estresse com marcadores de obesidade e funcionalidade em idosos / Association of perceived stress level with obesity and functionality markers in elderly / Asociación del nivel de estrés percibido con marcadores de obesidad y funcionalidad en ancianos

O estresse é um grave problema de saúde pública e sua gravidade e suscetibilidade se relacionam com uma série de fatores como a idade, a obesidade e a funcionalidade. As mudanças na saúde física, na saúde mental, na vida social e na capacidade cognitiva no envelhecimento predispõem o estresse. Assim, saber manejar o estresse do cotidiano é necessário, principalmente durante a velhice. O presente estudo teve como objetivo avaliar a percepção de estresse, presença de obesidade, funcionalidade e histórico de tabagismo em idosos de uma Universidade Aberta a Pessoa Idosa (UniAPI). Trata-se de um transversal. Foram coletados dados sociodemográficos, aplicado o questionário de percepção de estresse (EPS-10), medidas antropométricas (índice de massa corporal e circunferência de cintura), Escala de Brody e Lawton e histórico de tabagismo de 63 idosos. A comparação entre dois grupos foi realizada com o teste t- Student ou o Teste de Mann-Whitney. Para variáveis categóricas, o teste Qui-quadrado de Pearson e também, regressão linear múltipla ajustados por sexo e idade. A maioria dos idosos eram do sexo feminino (85,7%). Em relação ao estresse, 34% dos idosos apresentaram maior percepção de estresse. O IMC (∆= 3,57 kg/m²) foi maior no grupo com maior percepção de estresse, enquanto o score da escala de Lawton e Brody (∆= 0,47) foi maior no grupo sem percepção. Houve associação entre a presença de percepção de estresse com o IMC (p= 0,031). 100% dos idosos com baixa funcionalidade apresentaram maior percepção de estresse. O IMC (ß= 0,28; p=0,038) e a circunferência de cintura (ß=0,13; p=0,028) tiveram relação direta com o escore de percepção subjetiva de estresse. Em conclusão, a presença de estresse está associada a altos valores de IMC e CC e menor funcionalidade em idosos.

Stress is a serious public health problem and its severity and susceptibility are related to a number of factors such as age, obesity and functionality. Changes in physical health, mental health, social life, and cognitive ability in aging predispose to stress. Thus, knowing how to manage everyday stress is necessary, especially during old age. The present study aimed to evaluate the perception of stress, presence of obesity, functionality and smoking history in elderly people from an Open University for the Elderly (UniAPI). This is a cross-sectional study. We collected sociodemographic data, applied the questionnaire of perceived stress (EPS-10), anthropometric measurements (body mass index and waist circumference), Brody and Lawton Scale and smoking history of 63 elderly. Comparison between two groups was performed with the t-Student test or the Mann-Whitney test. For categorical variables, Pearson's chi-square test and also, multiple linear regression adjusted for gender and age. Most of the elderly were female (85.7%). Regarding stress, 34% of the elderly showed higher perception of stress. The BMI (∆= 3.57 kg/m²) was higher in the group with higher perception of stress, while the Lawton and Brody scale score (∆= 0.47) was higher in the group with no perception. There was an association between the presence of perceived stress and BMI (p= 0.031). 100% of the elderly with low functionality had higher perceived stress. BMI (ß= 0.28; p=0.038) and waist circumference (ß=0.13; p=0.028) had a direct relationship with the score of subjective perception of stress. In conclusion, the presence of stress is associated with high BMI and WC values and lower functionality in the elderly.

El estrés es un grave problema de salud pública y su gravedad y susceptibilidad están relacionadas con una serie de factores como la edad, la obesidad y la funcionalidad. Los cambios en la salud física, la salud mental, la vida social y la capacidad cognitiva en el envejecimiento predisponen al estrés. Por ello, es necesario saber cómo gestionar el estrés cotidiano, especialmente durante la vejez. El presente estudio tuvo como objetivo evaluar la percepción del estrés, la presencia de obesidad, la funcionalidad y los antecedentes de tabaquismo en ancianos de una Universidad Abierta para Ancianos (UniAPI). Se trata de un estudio transversal. Se recogieron datos sociodemográficos, se aplicó el cuestionario de estrés percibido (EPS-10), medidas antropométricas (índice de masa corporal y perímetro de cintura), Escala de Brody y Lawton e historia de tabaquismo a 63 ancianos. La comparación entre dos grupos se realizó con la prueba t-Student o la prueba de Mann-Whitney. Para las variables categóricas, se utilizó la prueba de chi-cuadrado de Pearson y también la regresión lineal múltiple ajustada por sexo y edad. La mayoría de los ancianos eran mujeres (85,7%). En cuanto al estrés, el 34% de los ancianos mostró una mayor percepción de estrés. El IMC (∆= 3,57 kg/m²) fue mayor en el grupo con mayor percepción de estrés, mientras que la puntuación de la escala de Lawton y Brody (∆= 0,47) fue mayor en el grupo sin percepción. Hubo asociación entre la presencia de estrés percibido y el IMC (p= 0,031). El 100% de los ancianos con baja funcionalidad tenían mayor estrés percibido. El IMC (ß= 0,28; p=0,038) y el perímetro de cintura (ß=0,13; p=0,028) tuvieron una relación directa con la puntuación de percepción subjetiva de estrés. En conclusión, la presencia de estrés se asocia a valores elevados de IMC y CC y a una menor funcionalidad en los ancianos.

Prevalência do tabagismo na adolescência: uma revisão integrativa de literatura / Prevalence of smoking in adolescence: an integrative literature review

O uso do tabaco é a principal causa evitável de morte em todo o mundo, além de ser referenciada como uma das principais causas de doenças evitáveis. Aproximada- mente 80% dos fumantes no mundo vivem em países de baixa e/ou média renda, onde o ônus das doenças relacionadas ao tabaco tem grande impacto. Contudo, mesmo com esses dados, há aumento constante na prevalência do tabagismo durante a adolescência. Obje- tivo: objetivo analisar dados nacionais retirados da literatura científica sobre a prevalência do tabagismo na adolescência entre os anos 2018 a 2021. Métodos: Trata-se de uma revi- são integrativa da literatura. Resultados e discussão: Para a seleção, 15 artigos científicos foram inclusos na revisão. As análises em nível de grupo mostraram um aumento signi- ficativo no tabagismo da adolescência até a idade adulta e um declínio não significativo após os 20 anos. O status de tabagismo adolescente e adulto jovem foi um poderoso pre- ditor de tabagismo adulto. Além disso, houve mais prevalência entre os indivíduos menos escolarizados e aqueles com pais e colegas fumantes. Considerações finais: A prevalência do uso do tabaco na adolescência é alta no Brasil, sendo ainda um problema de saúde pública relevante, com consequências negativas para a saúde física e mental dos jovens. Portanto, é necessário estabelecer um sistema eficiente e mecanismos de vigilância temá- tica para monitorar as tendências de uso do tabaco e seus derivados, a fim de diminuir esses índices.

Tobacco use is the main preventable cause of death worldwide, in addition to being referred to as one of the main causes of preventable diseases. Approximately 80% of the world's smokers live in low- and/or middle-income countries, where the bur- den of tobacco-related disease has a high impact. However, even with these data, there is a constant increase in the prevalence of smoking during adolescence. Objective: to ana- lyze national data taken from the scientific literature on the prevalence of smoking in adolescence between the years 2018 to 2021. Methods: This is an integrative literature review. Results and discussion: For the selection, 15 scientific articles were included in the review. Group-level analyzes showed a significant increase in smoking from adoles- cence to adulthood and a non-significant decline after age 20. Adolescent and young adult smoking status was a powerful predictor of adult smoking. In addition, there was more prevalence among less educated individuals and those with parents and peers who smoked. Final considerations: The prevalence of tobacco use in adolescence is high in Brazil, and it is still a relevant public health problem, with negative consequences for the physical and mental health of young people. Therefore, it is necessary to establish an efficient system and thematic surveillance mechanisms to monitor trends in the use of tobacco and its derivatives, in order to reduce these rates.

El consumo de tabaco es la principal causa evitable de muerte en todo el mundo, además de estar considerado como una de las principales causas de enfermedades prevenibles. Aproximadamente el 80% de los fumadores del mundo viven en países de renta baja y/o media, donde la carga de enfermedades relacionadas con el tabaco tiene un gran impacto. Sin embargo, incluso con estos datos, se observa un aumento constante de la prevalencia del tabaquismo durante la adolescencia. Objetivo: analizar datos nacionales extraídos de la literatura científica sobre la prevalencia de tabaquismo en la adolescencia entre los años 2018 a 2021. Métodos: Se trata de una revisión bibliográfica integradora. Resultados y discusión: Para la selección se incluyeron 15 artículos científicos en la revisión. Los análisis a nivel de grupo mostraron un aumento significativo del tabaquismo desde la adolescencia hasta la edad adulta y un descenso no significativo después de los 20 años. El hábito de fumar en adolescentes y adultos jóvenes fue un potente factor predictivo del hábito de fumar en la edad adulta. Además, se observó una mayor prevalencia entre las personas con menor nivel educativo y entre las que tenían padres y compañeros fumadores. Consideraciones finales: La prevalencia del consumo de tabaco en la adolescencia es alta en Brasil, y sigue siendo un problema relevante de salud pública, con consecuencias negativas para la salud física y mental de los jóvenes. Por lo tanto, es necesario establecer un sistema eficiente y mecanismos de vigilancia temática para monitorear las tendencias en el uso del tabaco y sus derivados, con el fin de reducir estas tasas.

Enfermedad de Buerger o el endotelio como laberinto: a propósito de un caso clínico / Buerger's disease or the endothelium as a labyrinth: case report

La enfermedad de Buerger, también llamada tromboangeítis obliterante, es una enfermedad vascular inflamatoria transmural no aterosclerótica, segmentaria, que afecta pequeños y medianos vasos de las extremidades, de especial asociación etiopatogénica con el tabaquismo. Ocurre comúnmente en hombres menores de 50 años, siendo un diagnóstico diferencial en el escenario de pacientes con isquemia crónica. Se presenta el caso de un hombre de 43 años, con antecedente de tabaquismo pesado, quien cursaba con claudicación intermitente llegando hasta el dolor en reposo, asociado a úlceras de aspecto vasculopático en miembros inferiores, en ausencia de pulsos distales (pedio, tibial posterior); la pletismografía reportó mayor compromiso infrapoplíteo, con circulación colateral segmentaria por arteriografía, sin posibilidad de revascularización endovascular. Se consideró un caso compatible con enfermedad de Buerger, planteándose un manejo híbrido: médico (con agentes antiagregantes) y quirúrgico (con puente femoropoplíteo directo). Se realiza una breve revisión de tema de esta enfermedad de rara aparición

Abstract. Buerger's disease, also called thromboangiitis obliterans, is a non-atherosclerotic, segmental, transmural inflammatory vascular disease affecting small and medium-sized vessels of the extremities with a special etiopathogenic association with smoking; it commonly occurs in men under 50 years of age, and is a differential diagnosis in the setting of patients with chronic ischemia. We describe the case of a 43-year-old man, with a history of heavy smoking, who presented with intermittent claudication reaching pain at rest, associated with ulcers of vasculopathic appearance in the lower limbs, in the absence of distal pulses (pedius, posterior tibial); plethysmography reported greater infrapopliteal involvement, with segmental collateral circulation by arteriography, without the possibility of endovascular revascularization. The case was considered compatible with Buerger's disease, and hybrid management was weighed: medical (with antiplatelet agents) and surgical (with direct femoropopliteal bridging). A brief review of this rare disease is presented