A propósito de un caso: abordaje y manejo integral de la enfermedad de buerger en Atención Primaria / Regarding A Clinical Case: Comprehensive Approach And Management Buerger's Disease In Primary Care

Las enfermeras especialistas en atención comunitaria tenemos una misión con la salud pública para mejorar la salud de la comunidad. Desde nuestra consulta tenemos la gran responsabilidad de mejorar la salud de nuestros pacientes, desde la prevención y promoción de la salud y siempre con un enfoque centrado en la persona y su empoderamiento. A propósito de un caso clínico aborda la problemática que supone la pandemia del tabaquismo en nuestra sociedad actual y cómo desde nuestra consulta de atención primaria podemos abordar tanto la deshabituación como el seguimiento y tratamiento de las morbilidades asociadas. En este caso, la enfermedad de buerger. (AU)

Community care nurse specialists have a mission with public health to improve the health of the community. From our health center we have the great responsibility of improving the health of our patients, from the prevention and promotion of health and always with a personcentered approach and their empowerment. Regarding a clinical case, it addresses the problems that the smoking pandemic entails in our current society and from our primary care consultation we can address both cessation and follow-up and how to treat associated morbidities. In this case, Buerger's disease. (AU)

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.

Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking / Desarrollo, validación y transferencia a la práctica clínica de una aplicación móvil para el tratamiento del tabaquismo

Objective: The main objective is to transfer to clinical practice a new smoking cessation application (“Vive sin Tabaco” a) in all health centers of the public Basque Health Service. Design: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. Site: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. Intervention and main measurement: Development of “Vive sin Tabaco”; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected.ResultsThe percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. Conclusions: The conception of “Vive sin tabaco” as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.(AU)

Objetivo: El objetivo principal es transferir a la práctica clínica una herramienta corporativa para deshabituación tabáquica («Vive sin Tabaco») en la red sanitaria pública del País Vasco. Diseño: Estudio de implementación de un programa de deshabituación tabáquica previamente validado. Posteriormente se llevó a cabo un estudio retrospectivo para evaluar su efectividad en condiciones de práctica clínica. Emplazamiento: La transferencia a la práctica clínica se ha realizado en varias fases; primero se realizó un pilotaje en 4 centros de salud de Álava y, posteriormente, tras resolver todas las incidencias notificadas, se extendió al resto de centros de salud de la red sanitaria pública vasca. Intervención y principales medidas: Desarrollo de una aplicación móvil corporativa para dejar de fumar «Vive sin Tabaco», y transferencia a la práctica clínica. Todo el personal sanitario interesado recibió formación sobre el uso de la aplicación. Se elaboraron manuales de uso para pacientes y profesionales. Se recogieron las tasas de abandono del tabaco a los 12 meses. Resultados: El porcentaje de pacientes de la fase pospilotaje que dejó de fumar a los 12 meses fue del 14.1%. Conclusiones: La concepción de «Vive sin Tabaco» como herramienta corporativa para la deshabituación tabáquica, ha sido larga y ardua, y ha requerido la participación de los profesionales sanitarios y de los pacientes para conseguir una herramienta que se adapte a sus expectativas, y garantice una mayor usabilidad y satisfacción. Esta aplicación está siendo eficaz como herramienta coadyuvante del consejo sanitario.(AU)

Efecto del consumo de tabaco en la diabetes / Effect of tobacco use on diabetes

INTRODUCCIÓN: el tabaquismo es un importante factor de riesgo modificable en el desarrollo de enfermedades. En España se relaciona con más de 25 patologías y tiene una relación causal con el 30 % de los diagnósticos de cánceres, enfermedades respiratorias y cardiovasculares. En pacientes con diabetes el daño potencial del tabaco se multiplica, por lo que es necesario abordarlo en farmacia comunitaria a través del servicio de deshabituación tabáquica.OBJETIVO: el objetivo del presente estudio es analizar la importancia de la cesación tabáquica en pacientes diabéticos mediante la revisión de la relación glucemia-tabaco en fumadores, así como el efecto del humo pasivo en estos pacientes. Al mismo tiempo, se pretende observar las complicaciones de la diabetes a causa del tabaco, tratamiento en deshabituación tabáquica y las dificultades que esto conlleva centrándolo en el aumento de peso y la depresión.METODOLOGÍA: como método, se ha realizado una revisión bibliográfica utilizando principalmente Google Académico y ScienceDirect, respetando unos criterios de inclusión/ exclusión.RESULTADO: en el resultado, se demostró que los fumadores tenían mayor probabilidad de padecer diabetes que los fumadores pasivos, exfumadores y no-fumadores. Los fumadores pasivos diabéticos tenían peor control glucémico y los fumadores diabéticos aceleraban las complicaciones macro y microvasculares propias de la enfermedad. En diabetes mellitus gestacional, aumentaba el riesgo en la madre y el hijo tanto en fumadores activos como pasivos. Las complicaciones macro y microvasculares estaban asociadas a enfermedades cardiovasculares, nefropatía, neuropatía y retinopatía, mejorando estas con el cese del tabaquismo. Es recomendable que el tratamiento incluya medicación y terapia conductual. El diagnóstico precoz de psicopatologías junto con control glucémico, nutricional y medidas higiénico- dietéticas nos acercaría al éxito terapéutico. (AU)

Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking.

OBJECTIVE: The main objective is to transfer to clinical practice a new smoking cessation application ("Vive sin Tabaco" a) in all health centers of the public Basque Health Service. DESIGN: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. SITE: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. INTERVENTION AND MAIN MEASUREMENT: Development of "Vive sin Tabaco"; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected. RESULTS: The percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. CONCLUSIONS: The conception of "Vive sin tabaco" as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.

Documento de revisión y actualización de la cefalea por uso excesivo de medicación (CUEM) / Document of revision and updating of medication overuse headache (MOH)

Introducción: La cefalea con uso excesivo de medicación es una cefalea secundaria en la que el uso regular o frecuente de medicación analgésica produce un aumento de la frecuencia de una cefalea de base, pasando de episódica a crónica. La prevalencia de esta entidad está en torno al 1-2%, siendo más frecuente en mujeres entre 30 y 50 años con comorbilidades psiquiátricas como depresión o ansiedad y otros procesos de dolor crónico. Es importante conocer el manejo de esta entidad. Por este motivo, el Grupo de Estudios de Cefaleas de la Sociedad Española de Neurología ha pretendido realizar este documento de consenso sobre esta patología.DesarrolloEsta guía ha sido redactada por un grupo de expertos a partir de la revisión de la evidencia científica publicada y estableciendo recomendaciones prácticas para su adecuado manejo y tratamiento. El tratamiento de la cefalea con uso excesivo de medicación tiene varios pilares fundamentales y suele ser complejo: información y educación sobre el desarrollo de la cefalea con uso excesivo de medicación, tratamiento preventivo, suspensión del fármaco de uso frecuente y tratamiento de deshabituación. Es importante el seguimiento de pacientes con riesgo de recurrencias.ConclusionesEsperamos que este documento resulte de utilidad y permita su aplicación práctica en la consulta diaria y que sirva para actualizar y mejorar el conocimiento del manejo de esta patología. (AU)

Introduction: Medication overuse headache is a secondary headache in which the regular or frequent use of analgesics can increase the frequency of the episodes, causing the transition from episodic to chronic headache. The prevalence of medication overuse headache is approximately 1-2%, with higher rates among women aged 30-50 years and with comorbid psychiatric disorders such as depression or anxiety, or other chronic pain disorders. It is important to be familiar with the management of this disease. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a consensus document addressing this disorder.DevelopmentThese guidelines were prepared by a group of neurologists specialising in headache after a systematic literature review and provides consensus recommendations on the proper management and treatment of medication overuse headache. The treatment of medication overuse headache is often complex, and is based on 4 fundamental pillars: education and information about the condition, preventive treatment, discontinuation of the drug being overused, and treatment for withdrawal symptoms. Follow-up of patients at risk of recurrence is important.ConclusionsWe hope that this document will be useful in daily clinical practice and that it will update and improve understanding of medication overuse headache management. (AU)

Adherencia al tratamiento farmacológico del tabaquismo y factores predictores en un escenario no financiado / Adherence to pharmacological treatment of smoking and predictive factors in an unfunded scenario

Antecedentes y objetivo. Las intervenciones de des habituación basadas en el asesoramiento psicológicoy tratamiento farmacológico han demostrado ser las más eficaces para abandonar el tabaco. La terapia sustitutiva con nicotina, bupropión y vareniclina son lostratamientos farmacológicos de primera elección que han demostrado una mayor seguridad y eficacia, triplicando las posibilidades de cesación tabáquica. Sinembargo, en un escenario no financiado, el grado de adherencia a estos fármacos es bajo. Por todo ello, el objetivo del estudio es analizar la adherencia a dichosfármacos y los factores predictores de ella.Pacientes y métodos. Estudio transversal de una cohorte de 660 fumadores reclutados entre 2013 y 2017en un área sanitaria de Galicia incluidos en programas de deshabituación tabáquica. Se analizan las características de los pacientes y el porcentaje de adherenciaa los fármacos de cesación tabáquica.Resultados.Un 35% de los fumadores que acuden aconsultas de deshabituación tabáquica en nuestra áreasanitaria no retiran el fármaco previamente prescrito.Son factores predictores de adherencia a fármacos dedeshabituación tabáquica: estar en fase de preparación OR: 4,06 IC95% (1,58-6,39) p=0,003; realizarintentos previos de abandono en el último año OR:5,3 IC95% (1,3-7,1) p=0,016; uso de fármacos pre-viamente OR: 4,16 IC95 (1,7-6,2) p=0,0003; o elnúmero de consultas: OR: 1,6 IC95% (1,26-2,05)p=0,000.Conclusiones.La adherencia al tratamiento del tabaquismo es mejorable en nuestra área sanitaria. Lafase de abandono del fumador, los intentos previoscon tratamientos farmacológicos y la intensidad de la intervención son factores que se asocian a su implementación. (AU)

Backgrounds and objective. The smoking cessation interventions based on psychological advice and drugtreatment have been shown to be the most effectiveto stop smoking. Nicotine replacement therapy, bu-propion and varenicline are the drug treatments of first choice that have demonstrated better safety andefficacy, tripling the possibilities of smoking cessation.However, in an unfinanced setting, the degree of ad-herence to these drugs is low. Therefore, the objectiveof the study is to analyze adherence to said drugs andthe predictive factors of it.Patients and methods.Cross-sectional study of acohort of 660 smokers recruited between 2013 and2017 in a health care area of Galicia enrolled in smo-king cessation programs. The characteristics of thepatients and percentage of adherence to the smokingcessation drugs are analyzed.Results.A total of 35% of smokers who come to thesmoking cessation consultations in our health carearea do not obtain the previously prescribed drug.Predictive factors of adherence to smoking cessationdrugs are: being in the preparation phase: OR: 4.0695% CI (1.58-6.39) p=0.003, having made previousattempts to stop smoking in the last year: OR: 5.395% CI (1.3-7.1) p=0.016, previous use of drug: OR:4.16 95% CI (1.7-6.2) p=0.0003 or number of con-sultations: OR: 1.6 95% CI (1.26-2.05) p=0.000.Conclusions.Adherence to treatment of smoking ces-sation can be improved in our health care area. Thecessation phase of the smoker, previous attempts withdrug treatments and intensity of the intervention arethe factors associated to its implementation. (AU)

Document of revision and updating of medication overuse headache (MOH). / Documento de revisión y actualización de la cefalea por uso excesivo de medicación (CUEM).

INTRODUCTION: Medication overuse headache is a secondary headache in which the regular or frequent use of analgesics can increase the frequency of the episodes, causing the transition from episodic to chronic headache. The prevalence of medication overuse headache is approximately 1-2%, with higher rates among women aged 30-50 years and with comorbid psychiatric disorders such as depression or anxiety, or other chronic pain disorders. It is important to be familiar with the management of this disease. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a consensus document addressing this disorder. DEVELOPMENT: These guidelines were prepared by a group of neurologists specialising in headache after a systematic literature review and provides consensus recommendations on the proper management and treatment of medication overuse headache. The treatment of medication overuse headache is often complex, and is based on 4 fundamental pillars: education and information about the condition, preventive treatment, discontinuation of the drug being overused, and treatment for withdrawal symptoms. Follow-up of patients at risk of recurrence is important. CONCLUSIONS: We hope that this document will be useful in daily clinical practice and that it will update and improve understanding of medication overuse headache management.

Efecto de Petiveria alliacea y drogas colinérgicas sobre la habituación / Effects of Petiveria alliacea and cholinergic drugs on the habituation cognitive behavior

Petiveria alliacea (PA) have anxiolytic, antidepressant and cognitive effects. In the present paper the effect of PA water infusion and cholinergic drugs on cognitive behavior were studied. For that, 40 male NMRI mice were divided in 4 groups: Control (n=10), Drug Control (n=10), PA (n=10) and PA plus Drug (n=10). PA 1% was administered orally (7.59±1.39 ml/day); while scopolamine (2 mg/Kg), galantamine (1 mg/Kg) and nicotine (0.1 mg/Kg) were administered intraperitoneally. Behavioral tests included: anxiety maze (AM), open field (OF) and marble burying (MB). Habituation cognitive behavior was evaluated in 4 sessions, one week each session. PA had anxiolytic and antidepressant effect effect in AM, combined with nicotine potentiated an anxiogenic effect in AM, galantamine favored habituation in OF. Scopolamine potentiated the habituation in LA and decreased the obsessive-compulsive behavior in OF. In conclusion; PA had an anxiolytic effect and favored deshabituation, combined with nicotine induced an anxiogenic effect, galantamine favored habituation and scopolamine decreased obsessive-compulsive behavior and favored motor habituation indicated a possible anxiolytic effect.

La Petiveria alliacea (PA) está relacionada con efectos ansiolíticos, antidepresivos y cognitivos. El presente trabajo estudió el efecto de la infusión de PA y drogas colinérgicas sobre la habituación. 40 ratones NMRI machos fueron divididos en 4 grupos: Control (n=10), Control Drogas (n=10), PA (n=10) y PA plus Drogas (n=10). La PA (1%) fue administrada vía oral (7.59±1.39 ml/día); escopolamina (2 mg/Kg), galantamina (1 mg/Kg) y nicotina (0.1 mg/Kg) fueron administrados vía intraperitoneal. Los ensayos conductuales incluyeron: laberinto de ansiedad (LA), campo abierto (CA) y enterramiento aversivo (EA). La habituación fue evaluada en 4 sesiones con duración de una semana cada una. PA mostró un efecto ansiolítico en el LA, combinada con nicotina potenció un efecto ansiogénico en el LA. Galantamina favoreció la habituación en CA, y escopolamina potenció el fenómeno de habituación en LA y disminuyó la conducta obsesivo-compulsiva en CA. En conclusión, la PA mostró un efecto ansiolítico y antidepresivo que potencia la deshabituación, combinada con nicotina indujo un efecto ansiogénico, galantamina favoreció la habituación y escopolamina disminuyó la conducta obsesivo­ compulsiva y favoreció la habituación motora indicando un posible efecto ansiolítico.

[Comparative analysis: Effectiveness of nicotine addiction treatment in people with psychiatric comorbidity]. / Análisis comparativo: Efectividad del tratamiento antitabáquico en la población con comorbilidad psiquiátrica.

OBJECTIVE: To determine whether or not nicotine addiction treatment was less effective in psychiatric than in the healthy population. MATERIAL AND METHODS: A retrospective, descriptive and comparative cohort study was conducted in Albacete University Hospital during years 2008-2012 on all patients that attended the Tobacco Cessation Unit. The statistical tests used were Chi-squared, likelihood ratio, and the Student t test. Statistical significance P≤.05. RESULTS: The study included a total of 1,484 patients, of which 48.6% were female. The mean age was 46.8 years, and the mean age of starting smoking was 17.6 years. The mean number of previous attempts to quit was 1.48, and mean number of cigarettes smoked was 25.39. They had a mean Fagerström score of 6.04, a Richmond score of 8.13, and a mean carbon monoxide level of 16.65ppm. Most patients were referred from Primary Care (38.7%) and Chest Diseases department (33%), and the type of tobacco smoked was "light" in 75.8%. There was 15% with chronic obstructive pulmonary disease, 8% with asthma, and 9.4% with obstructive sleep apnoea syndrome. Furthermore, there was respiratory disease in 28.7%, cardiovascular disease in 4.6%, and both in 3.5%. Hiatus hernia was present in 7.2%, thyroid disease in 3.8%, hypertension in 19%, diabetes in 10.7%, and dyslipidaemia in 29.4%, Drugs were used by 7.1%, and 12.6% consumed alcohol. There was 39.3% psychiatric comorbidity (PC), and were comparable except in gender, age of onset, Fagerström, Richmond, source of referral, asthma, hiatus hernia, thyroid disease, hypertension, as well as drugs and treatment. Drug treatment was completed by 22.3% in the PC group, with no significant difference. There were differences in success (P=.008), but not in failure and relapse rates. CONCLUSION: Anti-smoking treatment in psychiatric patients is effective. An increase in the probability of treatment success is observed in patients without psychiatric comorbidity.

Repercusión de alcoholismo en familiares de pacientes con esta enfermedad / Impact of alcoholism on relatives of patients with this disease

Se realizó un estudio descriptivo sobre la repercusión del alcoholismo en familiares de pacientes alcohólicos que han ingresado en Servicio de deshabituación del Hospital Psiquiátrico de Guantánamo, durante 2015 y 2016. Se evaluó el estado actual de los familiares de los pacientes al ingreso y en el momento del estudio. Predominó el sexo masculino, se registró el 38.2 por ciento de casados, y el 32.2 por ciento divorciados, el tiempo de ingestión del tóxico está entre 5 a 10 años seguidos por 11 a 20 años. Entre los diagnósticos nosológicos de dependencia alcohólica se reporta en un 76.7 por ciento. Las afectaciones psíquicas predominantes en los familiares son la violencia familiar y el insomnio. Los trastornos en la adolescencia influyen, generando fobia, trastorno en el aprendizaje y por último los trastornos en la conducta, en los testimonios los familiares reconocen el sufrimiento al vivir esta amarga experiencia en el hogar con un enfermo alcohólico, concluyendo con las graves afectaciones provocadas por la repercusión de la enfermedad en los familiares de estos pacientes(AU)

A descriptive study was carried out on the impact of alcoholism on relatives of alcoholic patients admitted to the Psychiatric Hospital of Guantanamo, during 2015 - 2016. The current status of the relatives of the patients was evaluated at the time of admission and at the time of the study. Men predominated, 38.2 percent were married, and 32.2 percent were divorced; the time of ingestion of the drug was between 5 and 10 years followed by 11 to 20 years. Among the nosologic diagnoses of alcohol dependence, 76.7 percent were reported. The predominant psychic affections in relatives were: family violence and insomnia. The disorders in adolescence influence, generating phobia, learning disorder and finally behavioral disorder, in the testimonies relatives recognize the suffering when living this bitter experience at home with an alcoholic patient, concluding with the serious affectations provoked by the repercussion of the disease in the relatives of these patients(AU)

[Use of COPD-6 Vitalograph in Primary Care as tool for smoking cessation]. / Uso del Vitalograph COPD-6 en atención primaria como herramienta para la deshabituación tabáquica.

PRIMARY OBJECTIVE: To assess the evolution of smoking cessation process after using a COPD-6 Vitalograph in smokers that came to a primary care practice (PCP) during a three year period (March 2011- February 2013). SECONDARY OBJECTIVES: To assess if there are any new COPD diagnoses and to compare the smoking cessation outcomes to those of a specific smoking cessation practice (SSCP) from another healthcare centre. METHODOLOGY: Two devices were used: Vitalograph (electronic device measuring the lung function) and the CO-oximeter, in 176 patients (active search of smokers). VARIABLES: tobacco pack-years, tobacco dependence (shortened Fagerström test), CO in exhaled breath (in parts per million-ppm), personal history of COPD or cardiovascular disease (CVD). The patients performed three forced exhalations and the Vitalograph registered the lung function (FEV1, FEV6, FEV1/FEV6) and the estimated lung age (ELA). Patient attitude was assessed (phases: pre-contemplation, contemplation, preparation) before and after the test, informing them of the outcomes. Patient progress in the smoking cessation process was also recorded. RESULTS: A total of 176 smokers were studied in PCP and 33 in SSCP. PCP/SSCP: age: 45.9/51.6 years old (p=042); pack-years 25.5/39.3 (p=0001); patients who quit smoking and used medicines for it 2/9. In PCP: age-ELA 45.9/57.4 (p=0.000). In SSCP: age-ELA 51.6/74.3 (p=000). Smoking habit evolution PCP/SSCP: cessation 24.5%/48.5% (p=004). Difference 24%. CI difference (6.4-42.8%). In PCP new COPD diagnosis in 6 smokers. CONCLUSIONS: COPD-6 Vitalograph is a fast and easy to use tool in day-to-day practice. The percentage of smoking cessation is better in SSCP, although a high smoking cessation rate was obtained in PCP (active search).

Proyectos futuros de un grupo de jóvenes alcohólicos / Future projects of a group of young alcoholics

Introducción: el trabajo con los proyectos futuros de cada uno de los jóvenes alcohólicos, después de insertados y dados de alta de un proceso de deshabituación, constituye un pilar esencial con vistas a la reinserción social y en la prevención de recaídas.Objetivo: caracterizar los proyectos futuros de jóvenes alcohólicos de La Habana que asistieron a terapia de rehabilitación. Métodos: estudio observacional y descriptivo de corte vertical. Se aplicaron cuestionarios abiertos y cerrados sobre proyectos de vida a 20 jóvenes que asistieron a terapia de rehabilitación en enero de 2013. Los resultados se expresaron en frecuencias absolutas y relativas. Resultados: los jóvenes expresan en su mayoría más de siete proyectos futuros, los que se orientan a la salud y a la familia. Las estrategias se encuentran parcialmente estructuradas, la temporalidad de los proyectos se concibe a corto plazo y los obstáculos se prevén como mixtos. Conclusiones: no existen diferencias entre los jóvenes estudiados con respecto a investigaciones anteriores realizadas en muestras con características afines, las esferas a la que hacen referencia los proyectos y cada uno de los indicadores se manifiesta de modo similar(AU)

Introduction: working with future projects of each alcoholic young person, after being inserted and discharged from a detoxification process, is an essential pillar in order to aftercare and relapse prevention.Objective: to characterize the future projects of alcoholic young persons in Havana attending rehabilitation therapy. Methods: an observational and descriptive study of vertical cut was conducted. Open and closed questionnaires on life projects were applied to 20 young persons who attended rehabilitation therapy in January 2013. The questionnaires results were expressed in absolute and relative frequencies. Results: these subjects mostly stated more than seven future projects, aiming health and family. The partially structured strategies were found, the timing of projects was conceived in the short term and obstacles were foreseen as mixed. Conclusions: there are no differences between young persons studied with respect to previous research conducted on samples with similar characteristics; referring spheres to project and each of the indicators are similarly expressed(AU)

Proyectos futuros de un grupo de jóvenes alcohólicos / Future projects of a group of young alcoholics

INTRODUCCIÓN: el trabajo con los proyectos futuros de cada uno de los jóvenes alcohólicos, después de insertados y dados de alta de un proceso de deshabituación, constituye un pilar esencial con vistas a la reinserción social y en la prevención de recaídas. OBJETIVO: caracterizar los proyectos futuros de jóvenes alcohólicos de La Habana que asistieron a terapia de rehabilitación. MÉTODOS: estudio observacional y descriptivo de corte vertical. Se aplicaron cuestionarios abiertos y cerrados sobre proyectos de vida a 20 jóvenes que asistieron a terapia de rehabilitación en enero de 2013. Los resultados se expresaron en frecuencias absolutas y relativas. RESULTADOS: los jóvenes expresan en su mayoría más de siete proyectos futuros, los que se orientan a la salud y a la familia. Las estrategias se encuentran parcialmente estructuradas, la temporalidad de los proyectos se concibe a corto plazo y los obstáculos se prevén como mixtos. CONCLUSIONES: no existen diferencias entre los jóvenes estudiados con respecto a investigaciones anteriores realizadas en muestras con características afines, las esferas a la que hacen referencia los proyectos y cada uno de los indicadores se manifiesta de modo similar.

INTRODUCTION: working with future projects of each alcoholic young person, after being inserted and discharged from a detoxification process, is an essential pillar in order to aftercare and relapse prevention. OBJECTIVE: to characterize the future projects of alcoholic young persons in Havana attending rehabilitation therapy. METHODS: an observational and descriptive study of vertical cut was conducted. Open and closed questionnaires on life projects were applied to 20 young persons who attended rehabilitation therapy in January 2013. The questionnaires results were expressed in absolute and relative frequencies. RESULTS: these subjects mostly stated more than seven future projects, aiming health and family. The partially structured strategies were found, the timing of projects was conceived in the short term and obstacles were foreseen as mixed. CONCLUSIONS: there are no differences between young persons studied with respect to previous research conducted on samples with similar characteristics; referring spheres to project and each of the indicators are similarly expressed.

[Previous abstinence time as a predictive factor at 12 months follow-up in a multi-component smoking cessation program]. / El tiempo previo de abstinencia como factor predictor a los 12 meses en un programa multicomponente para dejar de fumar.

INTRODUCTION: The objective of this study is to analyze the length of the longest period of previous abstinence time as a predictor of the results of a smoking cessation program at 12 months follow-up. MATERIAL AND METHODS: A cross-sectional study was conducted on a sample of 475 smokers who had participated in a multi-component smoking cessation group therapy program. The independent variable is the longest abstinence time passed, measured in weeks, before the current treatment. Success was defined as self-reported abstinence. Bivariate analyses were applied to the independent variable and to other variables in order to determine the factors that would be part of a logistic regression model using contrasts Student t or χ(2) comparisons, as appropriate. Those that showed statistical significance were entered into a multivariate logistic regression model. RESULTS: Within the studied variables, previous abstinence time and sex were the only predictive variables of success at 12 month follow-up. CONCLUSIONS: The probability of being abstinent at 12 months follow-up was significantly associated with the length of the previous longest period of abstinence, and this is the best of the predictors considered. Successful cessation programs depend more on the relationship with the consumer biographical aspects than with biological factors. The history of previous attempts is a more valuable source of information for designing treatments than others traditionally considered.

Caracterización Sociodemográfica y Biológica de pacientes ingresados en el Centro de Deshabituación del Adolescente. Periodo 2006-2007 / Sociodemographic and biological characterization of patients admitted to the Detoxification Center Adolescent. Period 2006-2007

Se realizó un estudio descriptivo, transversal con 31 pacientes con antecedentes de drogodependencias, ingresados en el Centro de Deshabituación de Adolescentes en Ciudad de La Habana (CDA), en el período comprendido entre mayo 2006 a mayo 2007 realizándose una caracterización desde el punto de vista sociodemográfico y biológico para analizar mediante diferentes variables, cómo las adicciones a sustancias y las adicciones comportamentales, tuvieron repercusión integralmente sobre los mismos. Los datos se introdujeron en Excel y exportado al paquete de programa estadístico en su versión SPSS 11.5, con el que se procesó la información. Se calcularon frecuencias absolutas y relativas. Prevaleció el sexo masculino; la marihuana fue la sustancia que inició el consumo en los pacientes en las edades 10 a 19 años. El policonsumo se destacó como forma de consumo en el momento del ingreso, Desde el punto de vista biológico observamos alteraciones a nivel neurológico, hepático, oftalmológico y en menor medida cardiovasculares(AU)

A descriptive, cross-sectional study of 31 patients with a history of drug addiction, admitted to the Detoxification Center Adolescent Havana (CDA) in the period from May 2006 to May 2007 performed a characterization from the point of view was performed sociodemographic and biological variables by analyzing how substance addictions and behavioral addictions, had fully impact on them. Data were entered in Excel and exported to statistical software package SPSS 11.5 in its version with which information is processed. Absolute and relative frequencies were calculated. Males prevailed; marijuana was the substance began drinking in patients ages 10-19 years. Polydrug excelled as a form of consumption at the time of admission, from a biological point of view we look at the neurological level disturbance, liver, eye and cardiovascular lesser extent(AU)

Aplicabilidad del yoga como recurso terapéutico, junto a las mujeres en el proceso de deshabituación del diazepam / Applicability that yoga how therapeutic use, with women on the process of reducing the doses of diazepam medication

El presente artículo analiza las contribuciones que el yoga puede traer a las mujeres que se encuentran en proceso de deshabituación de Diazepam. Fueron descritas las vivencias de esas mujeres y más específicamente se evalúa el modo como ellas confrontan las situaciones de su estar cotidiano, tanto sobre el efecto de los medicamentos, como también sobre los efectos de la práctica continuada de técnicas de yoga. La investigación fue desarrollada en el Centro de Atención Psicosocial (CAPS) de Maracanaú en el Estado de Ceará - Brasil. Los sujetos de la investigación fueron dos mujeres que estaban en proceso de deshabituación de Diazepam. Se utilizó como método de recolección de datos, al inicio, una anamnesis, y entrevistas semiestructuradas, al medio y al final de la investigación. Los datos fueron analizados a través de la técnica de análisis del discurso. Los resultados obtenidos con la investigación consideraron los beneficios de la práctica del yoga en la vida de las participantes y la posibilidad de la disminución de la ansiedad y el aumento del equilibrio emocional. Fue constatado que las prácticas de yoga condujeron a las participantes a una mejor autopercepción y a la concientización de la dependencia al medicamento. Hubo una reducción significativa en el uso del tranquilizante y hasta la interrupción total por parte de las participantes del estudio en cuestión. Además, se valida la necesidad de una transformación en la conducta de los profesionales de salud, que tratan no solamente las mujeres usuarias del Diazepam, sino también a las mujeres en general.

This paper analyses the contributions that yoga can bring to women who are in the process of Diazepam cessation. Were described the experiences of these women and more specifically it is evaluated the way they confront everyday situations, both on the effects of medicines as well as on the effects of yoga techniques. Research was carried out at the Psicosocial Care Center, in Maracanaú, Ceará -CAPS- Brazil. Subjects in this study were two women in the process of Diazepam cessation. Data collection methods were, anamnesis at the beginning, and the semi-structured interviews in the middle and at the end. Data analysis was carried out through Discourse Analysis technique, Results obtained with the study considered the benefits of yoga practice in participant’s life, such as decrease of anxiety and increase of emotional balance. It was found that yoga practices led participants to a better self-perception and awareness that they were dependant of medicines. There was a significant reduction on the use of Diazepam and also a total cessation by some participants in the study. Furthermore, the need for a transformation in health professional’s behavior is validated, by treating not only women who use diazepam, but also women in general.

La deshabituación tabáquica con técnicas de medicina tradicional y natural / Smoking cessation with natural and tradictional technniques

Se realizó un estudio longitudinal en la Clínica de Medicina Tradicional Natural Boyeros, en los años 2004 al 2006, con los objetivos de evaluar la efectividad de las técnicas auriculoterapia, terapia floral y la terapia grupal en la deshabituación tabáquica; describir síntomas más frecuentes que aparecen en la abstinencia según tratamiento e identificar posibles causas de recaída. Se incorporaron 1 080 pacientes de ambos sexos y se dividieron en tres grupos de tratamientos al azar: Auriculoterapia, Terapia Floral y Terapia Grupal. Las Terapias constaron de 12 sesiones. Los puntos que se utilizaron en la auriculoterapia fueron el Shen Men, hígado, pulmón y punto hambre, la esencia floral fue el Rescue Remedy. El 65.0 por ciento de los pacientes tuvieron una evolución satisfactoria. La terapia floral fue la técnica más eficaz. Las situaciones estresantes fueron motivos de recaídas. Los síntomas presentes en la abstinencia fueron la ansiedad, irritabilidad y la sensación de hambre.

A longitudinal study was carried out in the Clinic of Medicine Traditional Natural Cowherds, City of the Havana, from year 2004 to 2006, with the objectives of evaluating the effectiveness of the technical auriculoterapia, floral therapy and the group therapy in the Smoking cessation, to describe more frequent symptoms that appear in the abstinence according to treatment and Identifying its possible relapse causes. 1080 patients of both sexes incorporated, and they were divided at random in three groups of treatments: Auriculotherapy, Floral Therapy and Group Therapy. The Therapies consisted of 12 sessions. 65.0 percent of the patients had a satisfactory evolution. The floral therapy was the most effective technique. The stress situations were reasons of relapses. The symptoms of the abstinence were: anxiety, irritability and the sensation of hunger.

La deshabituación tabáquica con técnicas de medicina tradicional y natural / Smoking cessation with natural and tradictional technniques

Se realizó un estudio longitudinal en la Clínica de Medicina Tradicional Natural Boyeros, en los años 2004 al 2006, con los objetivos de evaluar la efectividad de las técnicas auriculoterapia, terapia floral y la terapia grupal en la deshabituación tabáquica; describir síntomas más frecuentes que aparecen en la abstinencia según tratamiento e identificar posibles causas de recaída. Se incorporaron 1 080 pacientes de ambos sexos y se dividieron en tres grupos de tratamientos al azar: Auriculoterapia, Terapia Floral y Terapia Grupal. Las Terapias constaron de 12 sesiones. Los puntos que se utilizaron en la auriculoterapia fueron el Shen Men, hígado, pulmón y punto hambre, la esencia floral fue el Rescue Remedy. El 65.0 por ciento de los pacientes tuvieron una evolución satisfactoria. La terapia floral fue la técnica más eficaz. Las situaciones estresantes fueron motivos de recaídas. Los síntomas presentes en la abstinencia fueron la ansiedad, irritabilidad y la sensación de hambre(AU)

A longitudinal study was carried out in the Clinic of Medicine Traditional Natural Cowherds, City of the Havana, from year 2004 to 2006, with the objectives of evaluating the effectiveness of the technical auriculoterapia, floral therapy and the group therapy in the Smoking cessation, to describe more frequent symptoms that appear in the abstinence according to treatment and Identifying its possible relapse causes. 1080 patients of both sexes incorporated, and they were divided at random in three groups of treatments: Auriculotherapy, Floral Therapy and Group Therapy. The Therapies consisted of 12 sessions. 65.0 percent of the patients had a satisfactory evolution. The floral therapy was the most effective technique. The stress situations were reasons of relapses. The symptoms of the abstinence were: anxiety, irritability and the sensation of hunger(AU)