Identifying the Potential Determinants of Tobacco Counseling Implementation among Oral Health Professionals of India: A Cross-Sectional Survey

ABSTRACT Objective: To identify the potential determinants of tobacco counseling implementation among oral health professionals in India. Material and Methods: A cross-sectional survey was carried out among the 298 dentists of Aligarh and Gwalior. The questionnaire used in the study had sections on dentists' sociodemographic data and a 35-item questionnaire to assess the potential determinants of tobacco cessation counseling. Descriptive statistics were carried out, and a Chi-square test was utilized to determine the association. P-value <0.05 was considered statistically significant. Results: Domains "knowledge", "Professional Responsibility and Identity", and "Remembrance, awareness, and judgment" showed a statistically significant correlation with most tobacco cessation counseling behaviors. In addition, undergraduate education received in Tobacco Cessation counseling, and Continuing education received in Tobacco Cessation counseling had significantly impacted the practice of tobacco cessation counseling (p=0.02 and 0.04, respectively). Conclusion: This study suggests that "Knowledge", "Professional Responsibility and Identity" and "Remembrance, awareness, and judgment" are the potential determinants that could be used to design effective strategies to enhance tobacco counseling among dentists in India.

Pancreatitis crónica: análisis de factores de progresión de la enfermedad / Chronic pancreatitis: analysis of disease progression factors

BACKGROUND: Alcohol and tobacco are important risk factors for chronic pancreatitis (CP). AIM: To analyze the effect of etiological factors such as tobacco and alcohol and pancreatic enzyme replacement therapy (PERT) in the progression of CP. MATERIAL AND METHODS: Patients with a diagnosis of CP were recruited and grouped according to variables such as tobacco, alcohol and PERT. They were followed for 18 months. Subsequently, different variables and analytical parameters involved in the progression of the disease were analyzed. RESULTS: A total of 50 patients diagnosed with CP were included. Of these, 28 patients underwent PERT, 39 were smokers and 33 were alcohol users. Compared with patients without PERT, those with PERT had a higher proportion of diabetes (64 and 32%, respectively), had a higher need for endoscopic treatment (25 and 0%, respectively) and a normal body mass index (71 and 27.3%, respectively. The smokers had higher calcium levels and increased lymphocytosis and leukocytosis. The alcohol consumption group had a higher mean age (p = 0.04) CONCLUSIONS: PERT may improve the nutritional status but does not reduce the need for endoscopic or surgical treatment. Smoking and alcohol consumption favored the progression of CP. Also, smoking induced a pro-inflammatory state.

Intoxicación severa por Nicotiana glauca (Palán Palán) con miocardio atontado / Severe poisoning by Nicotiana glauca (Palán Palán) with stunned myocardium

Resumen Nicotiana glauca también llamada Palán Palán, es un arbusto con hojas verdes azuladas y despulidas y una flor amarilla tubular pendulante que presenta alcaloides piridínicos, como nicotina, nornicotina, anatabina y anabastina (análogo estructural de la Nicotina). Se presenta el caso clínico de una paciente de 50 años con cuadro agudo de debilidad muscular generalizada que evoluciona con paro respiratorio, tras la ingesta accidental de una cantidad desconocida de hojas de Nicotiana glauca, cultivadas en una huerta hogareña mediante técnica de hidroponía y confundidas por su conviviente con espinaca. Presentó aumento de lactato y Troponina Ultra Sensible e Hipoquinesia Global de Ventrículo Izquierdo en el ecocardiograma, compatible con Aton tamiento Miocárdico (AM), que evolucionó favorablemente. Si bien hay pocos reportes, se han informado muertes de animales y humanos, tras la ingesta accidental de Nicotiana glauca. El inicio del cuadro es rápido, con patrón bifásico, con vómitos y estímulo simpático, seguido por bloqueo ganglionar y neuromuscular, pudiendo presentar paro respiratorio, shock, convulsiones y coma. El AM es una disfunción miocárdica prolongada con retorno gradual de la actividad contráctil, posterior a un episodio breve de isquemia grave, puede ser asintomático, pudiendo presentar alteraciones en el electrocardiograma, enzimas cardíacas o ecocardiograma. Generalmente presenta pronóstico favorable, pudiendo presentar insuficiencia cardíaca ante patologías concurrentes o aumento de requerimientos de oxígeno.

Abstract Nicotiana glauca is a shrub with bluish green leaves and a pendulous tubular yellow flower. It has pyridine alkaloids, such as nicotine, nornicotine, anatabine and anabastine (structural analog of Nicotine). We present the case of a 50 years old pa- tient with acute generalized muscle weakness that evolves to respiratory arrest, after accidentally ingesting an unknown quantity of Nicotiana glauca leaves, grown in a home vegetable garden, using a hydroponic technique and confused by her cohabiting with spinach. She presented increased lactate and Ultra Sensitive Troponin and Left Ventricular Global Hypokinesia in the echo- cardiogram, compatible with Myocardial Stunned, that it evolved favorably. There are few reports, animal and human deaths have been reported following accidental ingestion of Nicotiana glauca. The onset of the symptoms is early, with a biphasic pattern, with vomiting and sympathetic stimulation, followed by ganglionic and neuromuscular blockage and may present respiratory arrest, shock, seizures and coma. Myocardial Stunned is a prolonged myocardial dysfunction with gradual return of contractile activity after a brief episode of severe ischemia, it can be asymptomatic, and it can present alterations in the electrocardiogram, cardiac enzymes or echocardiogram. Generally presents a benign prognosis, being able to present heart failure with concurrent patholo- gies or increased requirements.

Socio-environmental risks associated with the green tobacco sickness in farmers: a case-control study / Riesgos socioambientales asociados a la enfermedad del tabaco verde en agricultores: un estudio caso-control / Riscos socioambientais associados à doença da folha verde do tabaco em agricultores: um estudo caso-controle

ABSTRACT Objective: to determine the presence of socio-environmental risk factors for the development of Green Tobacco Sickness in workers who grow Burley tobacco. Method: matched case-control study. The data collection took place in two moments: from December 2016 to January 2017 and December 2017, when the Burley tobacco was collected, through a household survey with interview application and urine collection for urinary cotinine. Results: the socio-environmental risk factors that remained associated with the disease were: bundling tobacco (p=0.047) and wearing socks (p=0.011); with protective effect were found sticking tobacco seeding of the day (p=0.006) and number of tobacco harvested per day (p=0.021). Conclusion: the steps in the Burley tobacco work process increase the exposure and risk of developing the disease. By identifying these factors, it is possible to address interdisciplinary control and prevention measures.

RESUMEN Objetivo: determinar la presencia de factores de riesgo socioambientales para el desarrollo de la Enfermedad del Tabaco Verde en trabajadores que cultivan el tabaco Burley. Método: estudio del tipo caso-control pareado. La recolección de datos ocurrió en dos momentos: de diciembre de 2016 a enero de 2017 y diciembre de 2017, período en que ocurrió la recolección del tabaco Burley, por medio de encuesta domiciliaria con aplicación de entrevista y recolección de orina para el examen de cotinina urinaria. Resultados: los factores de riesgo socioambientales que permanecieron asociados a la enfermedad fueron aferrar tabaco (p=0,047) y usar medias (p=0,011); con efecto protector fueron encontrados espetar los pies de tabaco del día (p=0,006) y el número de pies de tabaco cosechados por día (p=0,021). Conclusión: las etapas del proceso de trabajo con tabaco Burley aumentan la exposición y el riesgo de desarrollar la enfermedad. Al identificar estos factores, es posible dirigir, de forma interdisciplinaria, medidas de control y prevención.

RESUMO Objetivo: determinar a presença de fatores de riscos socioambientais para o desenvolvimento da Doença da Folha Verde do Tabaco em trabalhadores que cultivam o tabaco Burley. Método: estudo do tipo caso-controle pareado. A coleta de dados ocorreu em dois momentos: de dezembro de 2016 a janeiro de 2017 e dezembro de 2017, período em que ocorreu a colheita do tabaco Burley, por meio de inquérito domiciliar com aplicação de entrevista e coleta de urina para exame de cotinina urinária. Resultados: os fatores de riscos socioambientais que permaneceram associados à doença foram enfeixar tabaco (p=0,047) e usar meias (p=0,011); com efeito protetor foram encontrados espetar pés de tabaco do dia (p=0,006) e número de pés de tabaco colhido por dia (p=0,021). Conclusão: as etapas do processo de trabalho com tabaco Burley aumentam a exposição e o risco de desenvolver a doença. Ao identificar esses fatores, é possível direcionar, de forma interdisciplinar, medidas de controle e prevenção.

Factores ambientales en el desarrollo y evolución de la enfermedad inflamatoria intestinal / Environmental risk factors in the development and evolution of inflammatory bowel disease

Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.

Low p27kip1 expression in head and neck squamous cell carcinoma: association with risk factors and adverse outcomes

Background: Squamous cell carcinoma (SCC) of head and neck is highly prevalent in South-asian countries, owing to high consumption of areca nut/gutka and chewing tobacco. p27kip1 is a tumor suppressor gene, thought to be downregulated in oral squamous cell carcinoma. Therefore, in the present study we used immunohistochemical analysis to investigate an association between low p27kip1 expression in SCC of the head and neck and adverse outcomes/risk factors. Methods: Total 105 cases of SCC of head and neck excision specimens were selected from records of pathology department archives that underwent surgeries at Liaquat National hospital, Karachi from January 2008 till December 2013. Clinical and pathologic characteristics of patients were evaluated and p27kip1 immunohistochemistry was applied on tumor blocks. Results: In our study, low expression of p27kip1 in SCC of head and neck was seen in 39(37.1%) cases while 66(62. 9%) of the cases showed high expression for p27kip1. Significant association of p27kip1 expression with pan/gutka usage (p = 0.004), and recurrence (p = 0.001) was noted; however, no significant association of p27kip1 expression with other clinicopathologic features was seen. Multivariate binary logistic regression showed cases with history of pan/gutka usage were more likely to show low p27kip1 expression. Similarly, we also found that recurrence was more likely to develop in patients with low expression of p27kip1 in comparison to cases showing high p27kip1 expression. Conclusion: Loss of p27kip1 expression is a significant event involved in the pathogenesis of SCC head and neck especially that of oral cavity. Significant association of gutka/areca nut with low p27kip1 expression in our study suggests that loss p27kip1 expression is a major event involved in areca nut induced SCC of head and neck in this part of the world; however, more large scale molecular based studies are required to validate this observation. Moreover, significant association of low p27kip1 expression with tumor recurrence suggests its importance as a prognostic biomarker in SCC of head and neck (AU)

Hyaluronic acid in tobacco-exposed rats. Inflammatory reaction, and duration of effect

Abstract Purpose: To evaluate the hyaluronic acid (HA) inflammatory reaction, fibroblasts, fibrosis and duration of effect in the dorsal region of tobacco-exposed rats. Methods: Ten Wistar rats were divided into two groups: tobacco-exposed-group (TEG;n=5) and air-control-group (CG;n=5). The TEG animals were tobacco-exposed twice a day, 30-minutes/session, during 60 days. After this period, all animals received 0.1 mL HA subcutaneous injection in the dorsal area. The volume of HA was measured immediately after HA injection and weekly using a hand-caliper in nine weeks. After this period, all the animals were euthanized, and a specimen of was collected to evaluate inflammatory cells, fibroblasts, and fibrosis by HE. Results: This study showed a higher inflammatory reaction in TEG than CG: inflammatory cell-count (CG: 1.07±0.9; TEG: 8.61±0.36, p<0.001); fibroblast count (CG: 2.92±0.17; TEG: 19.14±0.62, p<0.001), and fibrosis quantification (CG: 2.0; TEG: 3.75, p<0.001). The analysis of the HA volume in nine weeks in the dorsal region did not show a difference between groups (p=0.39). Conclusions: This study suggested that the HA injection in the TEG caused an increase in inflammatory cell count, fibroblast, and fibrosis quantification when compared to the CG. There was no difference in the duration of effect of HA between the groups.

Biomass smoke COPD has less tomographic abnormalities but worse hypoxemia compared with tobacco COPD

Special attention has emerged towards biomass smoke-induced chronic obstructive pulmonary disease (COPD), providing new knowledge for prevention and therapeutic approach of non-smoker COPD patients. However, the understanding of biomass smoke COPD is still limited and somewhat controversial. The aim of the present study was to compare COPD exclusively caused by tobacco smoking with COPD exclusively caused by environmental or occupational exposures. For this cross-sectional study, COPD patients were recruited from outpatient clinics and formed two groups: non-smoker COPD group (n=16) with exposure to biomass smoke who did not smoke cigarette and tobacco smoker COPD group (n=15) with people who did not report biomass smoke exposure. Subjects underwent pulmonary function tests, thoracic high-resolution computed tomography, 6-min walk test, and sputum induction. The non-smoker COPD group had biomass smoke exposure of 133.3±86 hour-years. The tobacco COPD group smoked 48.5±27.4 pack-years. Women were 62.5 and 66.7%, respectively, of non-smokers and smokers. The non-smoker COPD group showed higher prevalence of dyspnea, lower arterial oxygen tension (PaO2), and lower arterial oxygen saturation (SaO2%) with similar spirometry results, lung volumes, and diffusion capacity. Regarding inflammatory biomarkers, differences were detected in sputum number of lymphomononuclear cells and in sputum concentrations of interleukin (IL)-6 and IL-8 with higher values in the smoker group. Emphysema was more prevalent in the tobacco smoker group, which also showed higher relative bronchial wall thickness and lower lung density by quantitative analysis. Biomass smoke induced more hypoxemia compared to tobacco in COPD patients with similar severity.

Study on the current status of smoking, intention of tobacco concession and related risk factors among 18-65-year olds patients with chronic diseases in Beijing / 中华流行病学杂志

Objective: To understand the status, attitude and related risk factors on smoking among 18-65 years old patients with hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD) or asthma in Beijing. Methods: Data was gathered from the 2014 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified cluster sampling method was used and 19 815 participants aged 18-65 were sampled from 16 districts in Beijing. Results: Among all the 18 405 participants, male hypertensive patients showed a higher rate on current smoking than the other groups (χ(2)=17.695, P<0.001). Male patients with dyslipidemia had higher current smoking rate than the other groups (χ(2)=39.292, P<0.001). However, female patients with COPD or with asthma showed higher rate on current smoking than the other groups (χ(2)=6.276, P=0.012), (χ(2)=8.245, P=0.004). Among the smokers, hypertensive patients presented lower rate (χ(2)=20.487, P<0.001) on intention of smoking concession, than the other groups. Patients with COPD showed greater intention in quitting smoking (χ(2)=6.085, P=0.048), than the other groups. Male patients with diabetes (χ(2)=9.219, P=0.010) or dyslipidemia (χ(2)=13.513, P=0.001) who had stopped smoking tobacco appeared having higher rates in keeping the current status. Results from logistic regression analyses showed that smoking was the risk factor for hypertension (OR=1.17), dyslipidemia (OR=1.25), COPD (OR=1.78), and asthma (OR=1.57). Conclusions: Patients with certain kinds of chronic diseases showed higher rate of current smoking and lower rate of quitting. Cigarette consumption appeared an important risk factor for patients with hypertension, dyslipidemia, COPD, or asthma in Beijing.

Tabagismo e gravidez: influência na morfologia fetal / Smoking and pregnancy: influence on fetal morphology

O hábito de fumar durante a gravidez é uma das causas evitáveis de morbidade e mortalidade infantil e materna. A nicotina tem efeitos principalmente no desenvolvimento cerebral e pulmonar fetal. Considerando que apenas uma minoria das mulheres fumantes em idade fértil consegue parar de fumar ao engravidar, o tabagismo entre mulheres jovens é o principal determinante da prevalência do tabagismo durante a gravidez. Este estudo de revisão sistemática pesquisou nas bases de dados Bireme, Scielo, PubMed, Lilacs e Site Up to Date. A seleção levou em conta seus títulos e resumos relacionados ao assunto, no período entre 2010 e 2017, utilizando os descritores tabaco/tobacco, nicotina/nicotine, hábito de fumar/smoking, gravidez/pregnancy e desenvolvimento fetal/fetal morphology. Foram encontrados 75 artigos; destes, foram selecionados 25, os mais recentes estudos randomizados, relatos de casos, estudos coortes e de alto teor teórico, necessários para a construção do texto. Através desta análise, observou-se a necessidade de uma intervenção política mais intensa para desencorajar o hábito de fumar, ocasionar maior impacto das mídias e redes sociais sobre esse assunto e maior atuação dos profissionais da saúde. Portanto, identificar os fatores associados ao tabagismo no período gestacional pode facilitar a implementação de programas que ajudem a diminuir os malefícios sobre a saúde materno-fetal.(AU)

Smoking during pregnancy is one of the preventable causes of infant and maternal morbidity and mortality. Nicotine has effects primarily on fetal brain and lung development. Considering that only a minority of women of childbearing age can quit when they become pregnant, smoking among young women is the main determinant of the prevalence of smoking during pregnancy. This systematic review study searched the Bireme, Scielo, PubMed, Lilacs and Site Up to Date databases. The selection took into account the titles and summaries related to the subject, from 2010 to 2017, using the descriptors tabaco / tobacco, nicotine / nicotine, smoking tuxedo, pregnancy / fetal development and fetal morphology. We found 75 articles, of which 25 were selected, the most recent randomized studies, case reports, cohort studies, and high theoretical content required for the construction of the text. Through this analysis we observed the need for a more intense political intervention that discourages smoking, greater impact of the media and social networks on this subject and greater performance of health professionals. Therefore, identifying the factors associated with smoking in the gestational period may facilitate the implementation of programs that help reduce the harm to maternal-fetal health.(AU)

Costo por años de vida perdidos: una propuesta para estimar el impuesto al tabaco / Cost per year of potential life lost: a proposal to estimate tobacco taxation

RESUMEN Objetivos Determinar y justificar la carga impositiva de los cigarrillos, con base en los años de vida que se pierden por su consumo. Métodos Mediante revisión de literatura se estimó la reducción promedio de la expectativa de vida de un fumador. Se aplicó a cada año perdido el valor empleado en estudios de costo-efectividad, de tres veces el PIB per cápita (COP 16 613.951 de 2015, equivalentes a USD 6 056, aplicando tasa de 1 USD=2 743 COP). A partir de los años de consumo promedio, y de los paquetes que consume en ese lapso, se estimó el impuesto que debería tener cada paquete para que, con un interés de 3 % anual, el fumador al fallecer reuniera el valor correspondiente a los años que pierde. Resultados Dada una reducción promedio de esperanza de vida de seis años, cada fumador debería contribuirle al sistema de salud COP 299 051 115 (USD 109 008). Si en promedio consume 166 paquetes de cigarrillos anuales, durante 50 años, debería reunir COP 2.659 648 (USD 969) cada año, y cada paquete debería tener un impuesto de COP 16 022 (USD 5,84). Conclusiones Si se acepta que el sistema de salud pague hasta tres PIB per cápita por cada año de vida por intervenciones en salud que aporten años, es razonable que aquellas intervenciones que quitan años de vida hagan también un aporte equivalente.(AU)

ABSTRACT Objectives Taxes are the most effective measure to reduce tobacco consumption, although this remains a controversial matter. This study presents a method to determine and justify taxation based on the monetary value of the years of potential life lost due to tobacco consumption. Methods A literature review allowed estimating the average reduction of life expectancy in smokers. The value used in cost-effectiveness studies -three times the GDP per capita (COP 16 613 951 for 2015, equivalent to USD 6 056, applying an exchange rate of USD 1=COP 2743) - was applied to each year lost. Considering the average years of tobacco consumption and the number of packs consumed during that period, the tax that each pack should have was estimated in such a way that, by the time the smoker dies, he or she will have paid for the years lost with an annual interest rate of 3 %. Results Given an average reduction of life expectancy of 6 years, each smoker should contribute to the health system with COP 299 051 115 (USD 109 008). With an annual average consumption of 166 cigarette packs for 50 years, a smoker should pay each year COP 2 659 648 (USD 969), which means that each cigarette pack should have a tax of COP 16 022 (USD 5.84). Conclusions If it is accepted that the health system has to pay up to three times the GDP per capita for each year of life in health interventions that add years, it is reasonable to think that those interventions that take away years of life should also make an equivalent contribution.(AU)

Cigarrillo y cáncer de cuello uterino / Cigarette and cervical cancer

El cáncer es un problema de salud pública mundial y su incidencia sigue elevándose. El 90 a 95% de las causas se deben a factores externos, de esos factores externos, el cigarrillo representa el 20 a 25%. La Agencia Internacional para la Investigación del Cáncer (IARC) han evaluado 62 de los 5.000 compuestos químicos del tabaco o cigarrillo, siendo considerados con suficientes evidencias como carcinogénicos tanto para humanos como para animales. Entre los canceres que han sido asociados con el consumo del cigarrillo, se encuentra el Cáncer del Cuello Uterino (CaCU). El CaCu está asociado a la infección del Virus del Papiloma Humano, sin embargo, hay fuerte evidencias que el cigarrillo es un factor de riesgo independiente en la origen y evolución del CaCU.

Cancer is a worldwide public health problem and its incidence is increasing. External factors are the 90-95% of the causes, cigarette represents the 20-25%. International Agency for Cancer Research has evaluated 62 of the 5.000 cigarette or tobacco chemical compounds; they have been considered with enough evidences as carcinogenic. Among the cancers that have been associated to the cigarette or tobacco, the Cancer of the Cervix (CaC) is one of them. The CaC is associated to the infection of the Human Papillomavirus, however, there are strong evidences that support the cigarette as an independent risk factor in the origin and evolution of the CaC.

Tabaquismo crónico y cirugía plástica / Chronic smoking and plastic surgery

Se describe la repercusión del tabaquismo crónico en el proceso de cicatrización de las heridas, en la actividad del sistema inmunitario y en el proceso de envejecimiento cutáneo. Esto condiciona diversas complicaciones en cirugía plástica de estos pacientes fumadores.

The impact of chronic smoking in the process of wound healing, in the activity of the immune system and in the process of skin aging is described. This conditions various complications in plastic surgery of these smokers.

Tabaquismo y glomeruloesclerosis / Smoking and glomerulosclerosis

El tabaquismo es un factor de riesgo para el desarrollo de lesiones vasculares y glomeruloesclerosis. La glomerulopatía nodular relacionada con el tabaquismo es una entidad bien reconocida que simula clínica y patológicamente a la nefropatía nodular diabética. El humo del tabaco altera la hemodinamia intrarrenal por activación simpática y contiene radicales libres que inducen estrés oxidativo, incrementando la matriz extracelular glomerular. Presentamos un caso de esclerosis glomerular focal y segmentaria e hialinosis arteriolar severa en un hombre de 63 años, con proteinuria en rango nefrótico, hipertensión leve y función renal normal, con una historia de tabaquismo de larga data. La ausencia de otros factores de riesgo y los hallazgos clinicopatológicos sugieren en este caso, el posible rol del tabaquismo en la patogenia de la esclerosis glomerular focal y segmentaria

Smoking is a risk factor for the development of vascular lesions and glomerulosclerosis. Nodular glomerulopathy associated with this habit is well known and resembles diabetes nephropathy clinically and pathologically. Tobacco smoke affects intrarenal hemodynamics through sympathetic activation and contains free radicals inducting oxidative stress, which increases glomerular extracellular matrix. We report the case of a 63-year-old man with focal segmental glomerulosclerosis, severe arteriolar hyalinosis, nephrotic-range proteinuria, mild hypertension, normal renal function and a long-term smoking history. The absence of other risk factors and the clinicopathologic findings suggest that in this case smoking may play a role in the pathogenesis of focal segmental glomerulosclerosis

Measures of association in epidemiological studies: smoking mothers and low birth weight children in the city of Campina Grande ­ PB / Medidas de associação em estudos epidemiológicos: mães fumantes e crianças de baixo peso na cidade de Campina Grande ­PB

The aim of this study was to present and describe the essential aspects, and to discuss the use of measures of association, relative risk and odds ratio, including formulas for calculating confidence intervals of obtained data from a cohort study of underweight live births of mothers who smoked during pregnancy, whose deliveries were performed in hospitals and maternity wards located in Campina Grande, state Pernambuco. Smoking during pregnancy was analyzed as a potential risk factor for low birth weight among 3612 newborns. In assessing the association of outcome, there were no large numeric differences between the estimates of the relative risk, odds ratios and confidence intervals obtained. It is an acceptable approximation to the relative risk and the odds ratio. It is up to the researcher to choose the most appropriate technique to its subject matter and should be determined according to the surveyed data.

O objetivo deste estudo foi apresentar e descrever os aspectos essenciais, bem como discutir a utilização das medidas de associação, risco relativo e razão de chances, incluindo fórmulas para o cálculo de intervalos de confiança de dados obtidos por meio de um estudo de coorte realizado com nascidos vivos de baixo peso de mães que fumaram durante a gravidez, cujos partos foram realizados em hospitais e maternidades localizados em Campina Grande, Pernambuco. O hábito de fumar durante a gravidez foi analisado como um potencial fator de risco para o baixo peso ao nascer entre 3612 recém nascidos. Na avaliação do desfecho de associação, não se observaram grandes diferenças numéricas entre as estimativas do risco relativo, da razão de chances e do intervalo de confiança obtidos. É uma aproximação aceitável para o risco relativo e para a razão de chances. Cabe ao pesquisador a escolha da técnica mais adequada ao seu objeto de estudo, devendo ser determinada de acordo com os dados pesquisados.

Tobacco chewing and risk of gastric cancer: a case–control study in Yemen

This study aimed to assess the risk factors for gastric cancer in Yemen. A hospital-based case-control study of 70 cases and 140 controls was carried out in Sana'a city between May and October 2014. A structured questionnaire was used to collect information through direct interview. Living in rural areas, tobacco chewing and drinking untreated water were significant risk factors for gastric cancer. Frequent consumption of chicken, cheese, milk, starchy vegetables, cucumber, carrots, leeks, sweet pepper, fruit drinks, legumes and olive oil were associated significantly with decreased risk of gastric cancer. Multiple logistic regression analysis showed that chewing tobacco and frequent consumption of white bread were associated with increased risk of gastric cancer, whereas frequent consumption of chicken, cooked potatoes and fruit drinks had an inverse association. Risk of gastric cancer can be prevented by health education and increasing community awareness

Fatores associados ao sucesso do tratamento cirúrgico das recessões gengivais: revisão da literatura / Factors associated with success of surgical treatment of gingival recessions: literature review

Introdução: A recessão gengival é uma condição de alta prevalência que leva a exposição radicular causando queixas estéticas e sintomáticas e cujo tratamento pode ser de difícil execução caso fatores complicadores estejam associados. Objetivo: Realizar uma revisão da literatura para discutir a influência de determinados fatores sobre os resultados dos procedimentos para recobrimento radicular. Métodos: Artigos foram selecionados nas bases de dados Pubmed, Scopus, Web of Science, Scielo e LILACS. Os critérios de escolha dos artigos foram: escritos em Inglês, Espanhol, Francês ou Português e que fossem classificados como ensaios clínicos. Resultados: A busca resultou em 20 artigos selecionados que avaliaram e discutiram sobre os possíveis fatores influenciadores como fumo (11), lesão cervical não cariosa (5), biótipo periodontal (4) e anatomia local (1). Discussão: O fumo foi o fator mais discutido na literatura cujos resultados mostram que pode interferir negativamente no tratamento cirúrgico da recessão gengival, embora pacientes fumantes possam apresentar bons resultados desde que façam um bom controle do biofilme dentário. Os artigos sobre lesão cervical não cariosa mostram que os resultados do recobrimento radicular são iguais, em curto e em longo prazo, independente da lesão cervical não cariosa estar restaurada ou não ou com qual material restaurador. Indivíduos que apresentam biótipo periodontal espesso apresentaram melhor prognóstico quanto ao recobrimento radicular. Conclusão: O tratamento da recessão gengival é complexo devido estar ligado a vários fatores relacionados ao indivíduo, desde fatores anatômicos a hábitos que o mesmo apresente. A literatura demonstra que o fumo é um dos fatores que limitam a previsibilidade do tratamento das recessões gengivais (AU).

Introduction: Gingival recession is a high prevalence condition that leads to root exposure causing aesthetic and symptomatic complaints and whose treatment can be difficult to perform when factors are associated with. Objective: To perform a literature review to discuss the influence of some factors on the results of root coverage procedures. Methods: Articles were selected in data basis Pubmed, Scopus, Web of Science, Scielo, and LILACS. The inclusion criteria were the language in English, Spanish, French, and Portuguese as well as classified as clinical trials. Results: The search resulted in twenty articles selected which was evaluated and discussed about possible influencing factors such as smoking (11), non-carious cervical lesion (5), periodontal biotype (4), and local anatomy (1). Discussion: Smoking was the most discussed factor whose results demonstrate that it can adversely affect the result of surgical treatment for gingival recession, although smokers can present good results as long as they present a good control of the biofilm. Non-carious cervical lesion articles showed that the results of root coverage are the same, in short and long follow-up, regardless of whether the noncarious cervical lesion was restored or not as well as which restorative material was used. Individuals with thick periodontal biotype have a better prognosis regarding root coverage. Conclusions: The treatment of gingival recession is complex because it is linked to several factors related to the individual, anatomical factors and patients' habits. The literature demonstrates that smoking is one of the factors that limit the predictability of treatment of gingival recessions (AU).

Effects of tobacco control policies on smoking prevalence and tobacco-attributable deaths in Mexico: the SimSmoke model / Efectos de las políticas de control del tabaco sobre la prevalencia del tabaquismo y las defunciones atribuibles al tabaco en México: el modelo SimSmoke

OBJECTIVE: To examine how policies adopted in Mexico in response to the Framework Convention on Tobacco Control affected smoking prevalence and smoking-attributable deaths. METHODS: The SimSmoke simulation model of tobacco control policy is applied to Mexico. This discrete time, first-order Markov model uses data on population size, smoking rates and tobacco control policy for Mexico. It assesses, individually and jointly, the effects of seven types of policies: cigarette taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth tobacco access policies. RESULTS: The Mexico SimSmoke model estimates that smoking rates have been reduced by about 30% as a result of policies implemented since 2002, and that the number of smoking-attributable deaths will have been reduced by about 826 000 by 2053. Increases in cigarette prices are responsible for over 60% of the reductions, but health warnings, smoke-free air laws, marketing restrictions and cessation treatments also play important roles. CONCLUSIONS: Mexico has shown steady progress towards reducing smoking prevalence in a short period of time, as have other Latin American countries, such as Brazil, Panama and Uruguay. Tobacco control policies play an important role in continued efforts to reduce tobacco use and associated deaths in Mexico.

OBJETIVO: Analizar cómo las políticas adoptadas en México en respuesta al Convenio Marco para el Control del Tabaco han tenido efecto en la prevalencia de tabaquismo y en la mortalidad atribuible al tabaco. MÉTODOS: Se aplicó en México el modelo de simulación SimSmoke de la política de control del tabaco. Este modelo de Markov de tiempo discreto y de primer orden utiliza datos sobre el tamaño de la población, las tasas de tabaquismo y la política de control del tabaco en México. También evalúa individual y conjuntamente los efectos de siete tipos de políticas: impuestos sobre el tabaco, legislaciones de ambientes libres de humo de tabaco, campañas en medios de comunicación, prohibiciones de publicidad, etiquetas de advertencias sanitarias, tratamientos de cesación y regulaciones del acceso al tabaco por parte de los jóvenes. RESULTADOS: Mediante el modelo SimSmoke aplicado en México, se calculó que las tasas de tabaquismo se han reducido aproximadamente en un 30% como resultado de las políticas implantadas desde el 2002, y que el número de defunciones atribuibles al tabaquismo podrían reducirse aproximadamente en 826 000 para el 2053. Los aumentos de precios de los cigarros son responsables de más del 60% de las reducciones, pero las advertencias sanitarias, las leyes de ambientes libres de humo de tabaco, las restricciones a la mercadotecnia y los tratamientos de cesación también desempeñan una función importante. CONCLUSIONES: En México, análogamente a lo ocurrido en otros países latinoamericanos, como Brasil, Panamá y Uruguay, se ha observado un constante progreso en la reducción de la prevalencia del tabaquismo en poco tiempo. Las políticas de control del tabaco desempeñan una importante función en las iniciativas continuadas para reducir el consumo de tabaco y las defunciones asociadas a este en México.