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S Afr Med J ; 110(8): 796-801, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880309


BACKGROUND: Smoking cessation is a complex process influenced by factors such as smokers' nicotine dependence levels, socioeconomic status (SES) and other lifestyle behaviours. Little is known about these relationships in South Africa (SA). OBJECTIVES: To explore the relationship between nicotine dependence, SES, lifestyle behaviours and lifetime quit attempts among adult smokers in SA. METHODS: This study used data from 2 651 participants aged ≥16 years in the 2011 South African Social Attitudes Survey. Information on SES (measured by asset ownership), binge drinking, physical activity, fruit and vegetable intake, intention to quit smoking and lifetime quit attempts was extracted. Nicotine dependence was measured using the Heaviness of Smoking Index (HSI). All data were weighted to account for the complex survey design and to yield nationally representative estimates. Data analysis included binary logistic regression with high nicotine dependence (HND) defined as HSI ≥4 and lifetime quit attempts as separate outcomes. RESULTS: The prevalence of smoking was 20.1% (31.6% for males and 9.5% for females), and was highest in the mixed-ancestry group (37.0%). Overall, 14.5% of smokers had HND, with a higher proportion in the high-SES group. The odds of HND increased with every 10  years of smoking history (odds ratio (OR) 2.05; 95% confidence interval (CI) 1.40 - 3.00) but decreased among participants who reported frequent physical activity (OR 0.4; 95% CI 0.18 - 0.86) and those who planned to quit (OR 0.37; 95% CI 0.19 - 0.75). Quit attempts were more likely among participants who reported frequent fruit and vegetable intake (OR 1.8; 95% CI 1.07 - 2.98) and less likely among those reporting binge drinking (OR 0.31; 95% CI 0.16 - 0.59) or assessed as having HND (OR 0.32; 95% CI 0.17 - 0.58). CONCLUSIONS: Most adult smokers in SA have low nicotine dependence. However, the association of HND with high SES in this study suggests that although cessation treatment based on an integrated lifestyle behavioural intervention package may suffice for most smokers, a more intense cessation treatment package is needed for smokers of higher SES.

Abandono do Hábito de Fumar/estatística & dados numéricos , Tabagismo/epidemiologia , Adulto , Bebedeira/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Dieta , Exercício Físico , Feminino , Frutas , Humanos , Estilo de Vida , Masculino , Distribuição por Sexo , Classe Social , África do Sul/epidemiologia , Inquéritos e Questionários , Verduras
PLoS One ; 15(8): e0237723, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857771


PURPOSE: This study investigated nicotine dependence as an independent risk factor for upper aerodigestive tract (UADT) cancers, including lung and head and neck cancers (HNC). The study aimed to isolate the direct effect of nicotine dependence, independent of tobacco smoking. METHODS: A case-control study with a total of 4957 participants was conducted in Ontario, Canada, of which 2964 categorized as either current or former smokers were used in the analysis. Nicotine dependence of ever-smokers (2360 UADT cases and 604 controls) was measured using the Fagerström Test for Nicotine Dependence. Using mediation analyses and adjusted logistic regression models, we decomposed the direct effect of nicotine dependence and the mediated effect of smoking duration to quantify the risks of lung and HNC. The role of human papillomavirus (HPV) and cancer subtypes were assessed. RESULTS: Most individual nicotine dependence behaviours showed positive associations with lung cancer with approximately 1.8 to 3.5-fold risk increase, and to lesser extent with 1.4 to 2.3-fold risk for HNC. Nicotine dependence is partially accountable for increased risks of lung cancer (OR = 1.20, 95%CI = 1.13-1.28) and HNC (1.12, 95%CI = 1.04-1.19). Nicotine dependence had a greater effect on the risk of HPV-negative oropharyngeal cancer (OR = 3.06, 95%CI = 1.65-5.66) in comparison to HPV-positive oropharyngeal cancer (OR = 1.05, 95%CI = 0.67-1.65). The direct effects of nicotine dependence remained significant after accounting for cumulative tobacco exposures. CONCLUSION: Nicotine dependence increases the risks of lung and HNC cancers after accounting for tobacco smoking, suggesting potential toxic effects of nicotine. These results are informative for the safety consideration of nicotine exposures.

Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias Pulmonares/epidemiologia , Nicotina/efeitos adversos , Tabagismo/epidemiologia , Idoso , Estudos de Casos e Controles , Feminino , Neoplasias de Cabeça e Pescoço/etiologia , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tabagismo/complicações
PLoS One ; 15(5): e0233656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442211


INTRODUCTION: Depression is a global burden that is exacerbated by smoking. The association between depression and chronic smoking is well-known; however, existing findings contain possible confounding between nicotine dependence (ND), a latent construct measuring addiction, and objective smoking behavior. The current study examines the possible unique role of ND in explaining depression, independently of smoking behavior. METHODS: A nationally-representative sample of current adult daily smokers was drawn by pooling three independent, cross-sectional, biennial waves (spanning 2011-16) of the National Health and Nutrition Examination Survey (NHANES). The association between ND (operationally defined as time to first cigarette (TTFC) after waking) and the amount of depression symptoms was examined after adjusting for both current and lifetime smoking behaviors (cigarettes per day and years of smoking duration) and sociodemographic factors (gender, age, race, education and income to poverty ratio). RESULTS: Earlier TTFC was associated with more depression symptoms, such that those smoking within 5 minutes of waking had an approximately 1.6-fold higher depression score (PRR = 1.576, 95% CI = 1.324-1.687) relative to those who smoke more than 1 hour after waking. This relationship remained significant after adjusting for current and lifetime smoking behavior as well as sociodemographic factors (PRR = 1.370, 95% CI = 1.113, 1.687). CONCLUSIONS: The latent construct of ND, as assessed by TTFC, may be associated with an additional risk for depression symptoms, beyond that conveyed by smoking behavior alone. This finding can be used for more refined risk prediction for depression among smokers.

Transtorno Depressivo Maior/epidemiologia , Fumar Tabaco/epidemiologia , Tabagismo/epidemiologia , Adulto , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumantes/psicologia , Fatores Socioeconômicos , Estados Unidos
Pediatrics ; 145(Suppl 2): S175-S180, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32358208


Adolescent use of electronic cigarettes (e-cigarettes) has increased dramatically, with younger and nicotine-naive adolescents starting to use these devices and use them more frequently than combustible cigarettes. In emerging evidence, it is shown that e-cigarettes are not effective in helping adult smokers quit and that youth using e-cigarettes are at risk for becoming nicotine dependent and continuing to use as adults. Important gaps in our knowledge remain regarding the long-term health impact of e-cigarettes, effective strategies to prevent and reduce adolescent e-cigarette use, and the impact of provider screening and counseling to address this new method of nicotine use.

Sistemas Eletrônicos de Liberação de Nicotina , Avaliação do Impacto na Saúde , Saúde Pública , Tabagismo/etiologia , Vaping/efeitos adversos , Adolescente , Adulto , Criança , Aconselhamento , Estudos Transversais , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Rastreamento , Risco , Abandono do Hábito de Fumar , Tabagismo/epidemiologia , Tabagismo/prevenção & controle , Estados Unidos , Vaping/epidemiologia , Vaping/prevenção & controle , Adulto Jovem
Artigo em Inglês | MEDLINE | ID: mdl-32384614


Smoking withdrawal can be difficult due to nicotine dependence (ND). The study objective was to describe ND and to analyze the association between ND and factors related to smoking cessation among daily smoking physicians in Estonia. Data was collected in 2014, using cross-sectional postal survey sampling all practicing physicians (n = 5666) in Estonia, of whom 2939 responded (corrected response rate 53.1%). The study sample was restricted to daily smoking physicians (n = 171). Results of the Fagerström Test for Nicotine Dependence (FTND) were described and ND scores calculated. Logistic regression was used to determine the association of ND (at-least-moderate vs. low) with factors related to smoking cessation. Crude and fully adjusted ORs with 95% CIs were calculated. The mean FTND score was 2.8 ± 2.1. The odds of having at-least-moderate ND decreased significantly with each year postponing smoking initiation (OR = 0.82, 95% CI 0.72-0.94). After adjustment, ND was no longer associated with the desire to quit smoking and motives to quit. In conclusion, more than half of daily smoking physicians had low ND. Higher ND was associated with younger age of smoking initiation. Knowledge of ND and factors related to smoking cessation is useful in the prevention of smoking and in development of cessation counselling tailored for physicians.

Médicos/psicologia , Abandono do Hábito de Fumar , Fumar/epidemiologia , Tabagismo/epidemiologia , Adulto , Idoso , Estudos Transversais , Estônia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
Medicine (Baltimore) ; 99(14): e19414, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243361


The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ±â€Š2) and moderate motivation to stop smoking (4.9 ±â€Š3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.

Fumar Cigarros/epidemiologia , Fumantes/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Fatores Etários , Estudos Transversais , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Masculino , Motivação , Portugal/epidemiologia , Prevalência , Fatores Sexuais , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Espanha/epidemiologia , Tabagismo/epidemiologia , Universidades/estatística & dados numéricos , Adulto Jovem
Womens Health Issues ; 30(3): 214-220, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32317136


BACKGROUND: Rates of smoking and related health consequences are higher for women veterans as compared with their civilian counterparts, and trauma is a known risk factor associated with smoking. Military sexual trauma is prevalent among women veterans and associated with deleterious health outcomes, including tobacco use. However, research has not examined variables that may explain this association. The purpose of the present study was to examine the association between deployment sexual trauma (DST; military sexual trauma that occurs during deployment) and nicotine dependence, and whether perceived stress is a potential explanatory variable (i.e., mediator) in this relationship. METHODS: Cross-sectional associations and Hayes mediation models were examined using baseline interview data from the Survey of Experiences of Returning Veterans sample (352 recently returned women veterans). RESULTS: DST was associated with postdeployment nicotine dependence and greater perceived stress. Further, perceived stress was a significant mediator between DST and binary nicotine dependence (indirect effect [standard error] of DST on nicotine dependence through perceived stress, 0.04 [0.01]; 95% confidence interval, 0.01-0.07; odds ratio, 1.04; p < .01) when controlling for education. CONCLUSIONS: Findings suggest that perceived stress may be a clinical target for decreasing nicotine dependence among women veterans who have experienced DST.

Militares/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Assédio Sexual/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Tabagismo/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Percepção , Prevalência , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
Artigo em Inglês | MEDLINE | ID: mdl-32233791
Compr Psychiatry ; 100: 152175, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32345436


BACKGROUND: Multiple developmental risk factors for Substance Use Disorders (SUDs) during young adulthood have been identified. In this investigation, we examined the impact of homelessness, foster care, and adverse childhood experiences (ACEs) prior to 12th grade on the development of three common SUDs during young adulthood-Alcohol Use Disorder (AUD), Tobacco Use Disorder (TUD) and Cannabis Use Disorder (CUD). Our hypothesis was that while both homelessness and ACEs are significant risk factors for young adult SUDs, foster care involvement might convey protection. METHODS: Using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health, measures of ACEs were derived from the CDC-Kaiser ACE study, and DSM-V SUD diagnoses were derived from items originally based on DSM-IV. SUD diagnoses were binned into "mild", "moderate", and "severe" groupings. Survey-based logistic models were used to estimate risks of SUDs while controlling for demographics. RESULTS: The results suggest that the experience of homelessness prior to 12th grade in addition to ACEs were significantly associated with the development in young adulthood of the most severe forms of AUD and TUD and all severity levels of CUD. Foster care was not associated with either risk or protection from SUDs. CONCLUSIONS: The experience of homelessness during development may be viewed as another detrimental ACE that is a risk factor for the most common SUDs in young adulthood. Given the magnitude of the current epidemic of homelessness in the U.S., these results should raise substantial concern.

Experiências Adversas da Infância/estatística & dados numéricos , Alcoolismo/epidemiologia , Criança Acolhida , Pessoas em Situação de Rua/estatística & dados numéricos , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tabagismo/epidemiologia , Adolescente , Adulto , Alcoolismo/psicologia , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Estudos Longitudinais , Masculino , Abuso de Maconha/psicologia , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Tabagismo/psicologia , Adulto Jovem
Rev. clín. esp. (Ed. impr.) ; 220(2): 79-85, mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186416


Objetivo: Analizar si existen factores sociales que influyan en la estancia hospitalaria prolongada (EHP) de pacientes con agudización grave de EPOC (AEPOC), además de factores clínico-demográficos. Metodología: Estudio de cohortes prospectivo. Se incluyeron pacientes consecutivos que ingresaron por AEPOC en un servicio de Neumología. Se registraron variables demográficas, clínicas (tabaquismo, exacerbaciones e infecciones, disnea, impacto según cuestionario CAT, función pulmonar, comorbilidades, oxigenoterapia y ventilación no invasiva) y sociales (situación económica, disponibilidad y sobrecarga de cuidador, dependencia en actividades básicas e instrumentales, riesgo social y uso de servicios sociales), utilizando cuestionarios e índices como Barthel, Lawton-Brody, Zarit, Barber y Gijón. Se realizó un análisis univariante y multivariante mediante un modelo de regresión logística. Resultados: Se incluyeron 253 pacientes, y la edad media fue de 68,9+/-9,8años. El 77,1% fueron varones. En el modelo de regresión logística se incluyeron tabaquismo activo, valor del FEV1, puntuación en CAT >10, disnea 3-4 de la mMRC, presencia de gérmenes en cultivos de esputo, comorbilidad cardiovascular, anemia, oxigenoterapia domiciliaria, vivir solo, residencia en zona rural, sobrecarga del cuidador y la detección de riesgo/problema sociofamiliar. Las variables que se asociaron de forma independiente con la posibilidad de una EHP fueron la puntuación en cuestionario CAT >10 (OR=8,9; p=0,04) y la detección de riesgo/problema sociofamiliar (OR=2,6; p=0,04). Fumar activamente fue predictor de estancia más breve (OR=0,15; p=0,002). Conclusiones: Variables relacionadas con la esfera social juegan un papel relevante en la estancia hospitalaria, además del impacto de la enfermedad y la persistencia del tabaquismo en pacientes con AEPOC graves

Objective: To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. Methodology: We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. Results: The study included 253 patients, with a mean age of 68.9+/-9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). Conclusions: Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Tempo de Internação/estatística & dados numéricos , Exacerbação dos Sintomas , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Testes de Função Respiratória/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Previsões , Tabagismo/epidemiologia
Rev. clín. esp. (Ed. impr.) ; 220(2): 100-108, mar. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186419


Objetivo: La hipertrofia ventricular izquierda es el marcador de daño de órgano diana más frecuente en la hipertensión arterial. Habitualmente se realiza un ECG para su identificación. El objetivo de este trabajo es analizar la utilidad pronóstica de otras alteraciones electrocardiográficas en pacientes hipertensos, más allá de la hipertrofia ventricular. Materiales y métodos: Se incluyeron 1.003 pacientes hipertensos mayores de65años. Se recogieron factores de riesgo, historia cardiovascular previa y tratamiento médico. Se analizaron diferentes alteraciones electrocardiográficas, incluyendo índice de Sokolow-Lyon, índice de Cornell, presencia de sobrecarga ventricular y bloqueos de rama, entre otros. Se llevó a cabo un seguimiento de 2años con recogida de eventos cardiovasculares mayores (mortalidad, infarto de miocardio, accidentes cerebrovascular o ingreso por insuficiencia cardiaca). Resultados: La edad media de la población era de 72,9+/-5,8años, con un 47,5% de varones. Durante el seguimiento el 13,9% sufrieron un evento cardiovascular mayor. Estos pacientes eran de mayor edad, más fumadores y practicaban menos ejercicio físico, sin presentar diferencias en el tratamiento antihipertensivo empleado ni en el control tensional. El patrón de sobrecarga ventricular (HR: 1,93; IC95%: 1,160-3,196; p=0,011) y el bloqueo completo de rama izquierda (HR: 2,27; IC95%: 1,040-4,956; p=0,040) se comportaron como factores electrocardiográficos predictores independientes de eventos cardiovasculares mayores, no así la hipertrofia ventricular izquierda por Sokolow y/o Cornell. Conclusiones: En pacientes hipertensos, la existencia en el ECG basal de un bloqueo completo de rama izquierda o un patrón de sobrecarga ventricular identifica a una población de mayor riesgo cardiovascular

Objective: Left ventricular hypertrophy is the most common marker of target organ damage in arterial hypertension. Electrocardiograms are typically performed to identify left ventricular hypertrophy. The aim of this study was to analyse the prognostic utility of other electrocardiographic abnormalities in patients with arterial hypertension, beyond ventricular hypertrophy. Materials and methods: The study included 1003 patients older than 65years with arterial hypertension. We recorded risk factors, previous cardiovascular history and medical treatment and analysed various electrocardiographic abnormalities including the Sokolow-Lyon index, the Cornell index, ventricular overload and branch blocks. The study conducted a 2-year follow-up, recording the major cardiovascular events (mortality, myocardial infarction, stroke and hospitalisation for heart failure). Results: The study population's mean age was 72.9+/-5.8years, 47.5% of whom were men. During the follow-up, 13.9% of the patients experienced a major cardiovascular event. These patients were older, more often smokers and engaged in less physical exercise, without presenting differences in the antihypertensive therapy or blood pressure control. The ventricular overload pattern (HR: 1.93; 95%CI: 1.160-3.196; P=.011) and the complete left bundle branch block (HR: 2.27; 95%CI: 1.040-4.956; P=.040) behaved as independent electrocardiographic predictors of major cardiovascular events; however, left ventricular hypertrophy using the Sokolow and/or Cornell index did not behave as such. Conclusions: For patients with hypertension, the presence in the baseline electrocardiogram of complete left bundle branch block or a pattern of ventricular overload identifies a population at increased cardiovascular risk

Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Hipertensão/fisiopatologia , Eletrocardiografia/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Valor Preditivo dos Testes , Fatores de Risco , Seguimentos , Comportamento Sedentário , Tabagismo/epidemiologia , Fatores Etários , Bloqueio de Ramo/epidemiologia
Rev. esp. drogodepend ; 45(1): 101-110, ene.-mar. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-192293


Se presenta un análisis sobre los posibles motivos que han causado un aumento de los índices de prevalencia e incidencia en el consumo de tabaco en España en los últimos años y que inevitablemente lleva a un aumento del tabaquismo pasivo infantil. Se analizan pormenorizadamente tres estrategias novedosas que están utilizando la industria del tabaco en la actualidad: los influencers, el producto placement de películas y series de TV y la aparición de las think tanks. Se proponen medidas a implantar para reducir esta "in-cultura" del tabaquismo, principal causa de muerte evitable en España

An analysis is presented on the possible reasons that have caused an increase in the prevalence and incidence rates in tobacco consumption in Spain in recent years and that inevitably leads to an increase in passive infant smoking. We analyze in detail three novel strategies that the tobacco industry is currently using: influencers, the product placement of films and TV series and the emergence of think tanks. We propose measures to be implemented to reduce this "in-culture" of smoking, the main cause of avoidable death in Spain

Humanos , Mídias Sociais , Meios de Comunicação de Massa , Indústria do Tabaco , Tabagismo/epidemiologia , Comercialização de Produtos Derivados do Tabaco , Fumantes/estatística & dados numéricos , Tabagismo/mortalidade , Tabagismo/prevenção & controle , Prevalência , Incidência
Rev. clín. med. fam ; 13(1): 22-31, feb. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193915


OBJETIVO: Conocer los cambios producidos en un período de cuatro y nueve años en el control de los pacientes diabéticos y en el uso de la medicación en la práctica habitual. DISEÑO: Estudio descriptivo observacional transversal. EMPLAZAMIENTO: Zona de Salud de Manzanares II. PARTICIPANTES: Pacientes diabéticos de ambos sexos de la Zona de Salud. MEDICIONES PRINCIPALES: Se recogieron datos sociodemográficos, factores de riesgo cardiovascular, repercusión macro y microvascular de la diabetes, valores analíticos (glucídicos, lipídicos) y tensionales, así como los fármacos empleados en el tratamiento de diabetes, dislipemia y con efecto antiagregante/anticoagulante. Los datos fueron comparados con los de los estudios observacionales realizados en 2010 y 2014. RESULTADOS: El control metabólico (HbA1c) ha mejorado en 2019 (6,87 ± 0,99) respecto a 2014: 7,09 % (± 1,17) y 2010: 7,22 % (±1,21), siendo significativo el descenso en el porcentaje de HbA1c (≥ 8 % y ≥ 10 %). El porcentaje de HbA1c ≤ 7 % ha pasado del 50,5 % (2010) y 53,7 % (2014) al 61,3 % (2019), (p<0,05). Los mayores descensos se han producido en los parámetros lipídicos: colesterol total (p < 0,001), LDL-colesterol (p < 0,001). El porcentaje de HbA1c ≤ 7 % y LDL-colesterol ≤ 100 mg/dl ha pasado del 13,1 % (2010) y 21,7 % (2014) al 36,5 % (2019) (p < 0,001). Ha disminuido el uso de sulfonilureas y glinidas (p<0,01) y ha aumentado uso de iSGLT2 y ar-GLP1 (p < 0,001), estatinas (p<0,01), ácido acetilsalicílico (p<0,01) y nuevos anticoagulantes orales (NACOs) (p<0,01). CONCLUSIONES: En el periodo de nueve años ha mejorado significativamente el control metabólico glucídico, siendo mayor en el patrón lipídico. Ha disminuido el uso de sulfonilureas y glinidas y ha aumentado el uso de iSGLT2, arGLP1, estatinas y ácido acetilsalicílico y NACOs

OBJECTIVE: To determine the changes produced during a period of four years and a period of nine years in the control of diabetic patients and in drug use in usual practice. DESIGN: Observational, descriptive, cross-sectional study. LOCATION: Manzanares II Healthcare Area. PARTICIPANTS: Diabetic patients of either sex from the Health Area. MAIN MEASURES: We collected sociodemographic data, cardiovascular risk factors, macro and microvascular complications of diabetes, analytical test findings (carbohydrates, lipids), and blood pressure, as well as drugs used for the treatment of diabetes, dyslipidemia, and antiplatelets/anticoagulants. The data were compared with the findings of the observational studies conducted in 2010 and 2014. RESULTS: Metabolic control (HbA1c) has improved in 2019 (6.87 ± 0.99) in comparison with 2014: 7.09 % (± 1.17) and 2010: 7.22 % (±1.21), with a significant decrease in the percentage of HbA1c (≥ 8 % y ≥ 10 %). The percentage of HbA1c ≤ 7% has grown from 50.5 % (2010) and 53.7% (2014) to 61.3 % (2019), (p<0.05). The highest decreases have taken place in lipid levels: total cholesterol (p < 0.001), LDL-cholesterol (p < 0.001). The percentage of HbA1c ≤ 7% and LDL-cholesterol ≤ 100mg/dl has increased from 13.1 % (2010) and 21.7% (2014) to 36.5 % (2019) (p < 0.001). There has been a decrease in the use of sulfonylureas and glinides (p<0.01) and an increase in the use of SGLT2 inhibitors and GLP-1 receptor antagonists (p < 0.001), statins (p<0.01), acetylsalicylic acid (p<0.01), and novel oral anticoagulants (NOACs) (p<0.01). CONCLUSIONS: Carbohydrate metabolic control has significantly improved during the nine-year period, with greatest improvement in lipid profiles. The use of sulfonylureas and glinides has decreased, whereas the use of SGLT2 inhibitors, CLP-1 receptor antagonists, statins, acetylsalicylic acid, and NOACs has increased

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hemoglobina A Glicada/análise , Hipoglicemiantes/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Estudos Transversais , Hiperglicemia/metabolismo , Hiperlipidemias/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Obesidade/epidemiologia , Tabagismo/epidemiologia
JAMA Netw Open ; 3(2): e1921513, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32074292


Importance: Understanding the prevalence and symptoms of electronic cigarette (e-cigarette) dependence and its association with future e-cigarette use among youth may help to guide pediatric clinical services and health policy. Objectives: To examine the cross-sectional prevalence and symptom presentation of e-cigarette dependence and to determine whether e-cigarette dependence is associated with subsequent e-cigarette use patterns 6 months later among youth with baseline past-year e-cigarette use. Design, Setting, and Participants: This prospective cohort study used baseline and 6-month follow-up surveys among students in the 12th grade during the 2016 to 2017 school year who reported any past-year e-cigarette use. Surveys were conducted on site in 10 high schools in Los Angeles, California. Data were analyzed from March 2019 to December 2019. Main Outcomes and Measures: Self-reported checklist of 10 tobacco product dependence symptoms reflecting loss of control over use, craving or urge, or withdrawal symptoms while abstinent, completed at baseline and administered separately for e-cigarettes and combustible cigarettes. Reporting 1 or more symptoms indicated a positive screen for dependence. Vaping continuation, defined as any past 6-month vaping, and past 30-day nicotine vaping days (range, 0-30), sessions per vaping day (range, 0-20), and puffs per session (range, 0-20) at 6-month follow-up were assessed. Results: Among 3168 twelfth-grade students who completed the baseline survey, 444 youths (mean [SD] age, 17.48 [0.39] years; 217 [48.9%] female) reported past-year e-cigarette use. Among these, 52 youths (11.7%) reported at least 1 e-cigarette dependence symptom. Among youth who reported past-year dual e-cigarette and combustible cigarette use, combustible cigarette dependence, reported by 43 youths (29.7%), was more prevalent than e-cigarette dependence, which was reported by 24 youths (16.4%). The most common symptoms, craving, urge, and need to use, and least common symptoms, abstinence-related concentration and emotional problems, were similar in both combustible and e-cigarette dependence. The prevalence of e-cigarette dependence was higher among youth who reported vaping in the past month than among those who did not (41 youths [17.6%] vs 11 youths [5.2%]; P < .001) and among youth who used e-cigarettes with nicotine than among those who used e-cigarettes without nicotine (42 youths [15.2%] vs 10 youths [6.0%]; P = .004). After adjusting for baseline vaping and e-cigarette dependence risk propensity scores, baseline e-cigarette dependence symptom status was associated with vaping continuation (adjusted odds ratio, 2.30 [95% CI, 1.07-4.94]; P = .02) and past 30-day number of nicotine vaping days (adjusted rate ratio, 2.17 [95% CI, 1.44-3.28]; P < .001), vaping sessions per day (adjusted rate ratio, 2.41 [95% CI, 1.52-3.83]; P < .001), and puffs per session (adjusted rate ratio, 1.70 [95% CI, 1.09-2.66]; P = .02) at 6-month follow-up. Conclusions and Relevance: These findings suggest that e-cigarette dependence may be an expression of tobacco use disorder associated with future use persistence and escalation among youth. Electronic cigarette dependence may be a behavioral health consequence of adolescent vaping that warrants consideration in pediatric patient care and public health policy.

Tabagismo/epidemiologia , Vaping/epidemiologia , Adolescente , Estudos Transversais , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Prevalência , Estudos Prospectivos , Autorrelato , Inquéritos e Questionários
Aten. prim. (Barc., Ed. impr.) ; 52(1): 47-53, ene. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185983


El Proyecto ÉVICT (, a raíz del aumento de consumo de cannabis en población juvenil española, ha estudiado su asociación con el tabaco, concluyendo que el consumo conjunto de tabaco y cannabis: tiene una influencia en el proceso de aprender a fumar, pues el inicio puede ser conjunto y con influencia bidireccional; tiene una influencia en el desarrollo de dependencia pues su interacción es relevante para el desarrollo de este trastorno, y tiene una influencia en la toxicidad, pues probablemente, el fumar tabaco y cannabis genera mayores problemas que fumar solo una de las 2. Y, por tanto, el equipo EVICT emite unas consideraciones en prevención: diferenciar uso medicinal y recreativo; comunicar que fumar cannabis no es terapéutico ni inocuo, y puede ayudar a generar dependencia de nicotina o, menos frecuentemente, al propio cannabis. Consideraciones en abordaje y tratamiento: en personas que consumen tabaco/cannabis debemos plantear como primera opción el cese de las 2 sustancias. Consideraciones en reducción de daños: a quienes solo consumen productos de tabaco/cannabis, los programas serían más aplicables a aquella cuyo consumo se considere más problemático

EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence. Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic

Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Fumar/epidemiologia , Fumantes , Tabagismo/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Abuso de Maconha/epidemiologia , Codependência Psicológica , Tabagismo/prevenção & controle , Prevenção do Hábito de Fumar/legislação & jurisprudência
Artigo em Inglês | MEDLINE | ID: mdl-31936477


This study describes the prevalence and correlates of adult smokers' discussions about electronic cigarettes (e-cigarettes) with health professionals (HPs), including whether these discussions may lead smokers and vapers to use e-cigarettes for smoking cessation. METHODS: We analyzed data from an online survey of Mexican smokers recruited from a consumer panel for marketing research. Participants who had visited an HP in the prior four months (n = 1073) were asked about discussions of e-cigarettes during that visit and whether this led them to try to quit. Logistic models regressed these variables on socio-demographics and tobacco use-related variables. RESULTS: Smokers who also used e-cigarettes (i.e., dual users) were more likely than exclusive smokers to have discussed e-cigarettes with their HP (adjusted odds ratio (AOR) = 3.96; 95% C.I. 2.73, 5.74), as were those who had recently attempted to quit smoking (AOR = 1.89; 95% C.I. 1.33, 2.7). Of smokers who had discussed e-cigarettes, 53.3% reported that the discussion led them to use e-cigarettes in their quit attempt. Also, dual users (AOR = 2.6; 95% C.I. 1.5, 4.5) and daily smokers (>5 cigarettes per day) (AOR = 3.62; 95% C.I. 1.9, 6.8) were more likely to report being led by their HP to use e-cigarettes in the quit attempt compared to exclusive smokers and non-daily smokers, respectively. CONCLUSIONS: Discussions between HP and smokers about e-cigarettes were relatively common in Mexico, where e-cigarettes are banned. These discussions appear driven by the use of e-cigarettes, as well as by greater smoking frequency and intentions to quit smoking.

Aconselhamento/métodos , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Pessoal de Saúde , Marketing/legislação & jurisprudência , Abandono do Hábito de Fumar/psicologia , Fumar/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumantes , Inquéritos e Questionários , Produtos do Tabaco , Fumar Tabaco , Uso de Tabaco , Tabagismo/epidemiologia , Adulto Jovem
PLoS One ; 15(1): e0227405, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945093


BACKGROUND: Khat abuse and psychopathy are both strongly related to criminal activity. Higher rates of substance use in people with psychopathy are hypothesized to be related to psychopathic personality traits, which include high sensation seeking, low conscientiousness and neuroticism, impulsivity, and irresponsibility. Little is known, however, about the association between psychopathy and khat abuse among prisoners in Ethiopia. Therefore, we evaluated the presence of these two factors in prisoners in the correctional institution in Jimma, Southwest Ethiopia. MATERIALS AND METHODS: We used a cross-sectional study design to collect data from 336 prisoners from June 5 to July 5, 2017. Study participants were selected by a systematic random sampling technique. Khat abuse was assessed with the Drug Abuse Screening Tool and psychopathy with the Psychopathy Checklist: Screening Version. We also assessed nicotine dependence with the Fagerstrom Test for Nicotine Dependence; alcohol use disorder, with the alcohol use disorder identification test; adverse traumatic life events, with the Life Events Checklist; and social support, with the Oslo 3-Item Social Support Scale. Data were entered into EpiData version 3.1 and analyzed in bivariate and multivariable logistic regression models. Variables with a P value < 0.05 in the final fitted model were declared to be significantly associated with the outcome variable. RESULTS: The overall prevalence of lifetime khat use was 59.9%, and the prevalence of khat abuse in prisoners with psychopathy was 78.0%. Prisoners with psychopathy had a three times higher odds ratio of abusing khat than those without psychopathy (AOR = 3.00 [1.17-7.67]). Among the confounders, a family history of substance use (AOR = 2.50 [1.45-4.31]), poor support (AOR = 2.28 [1.11-4.67]), alcohol use disorder (AOR = 7.78 [4.16-14.53]), and suicidal ideation and suicide attempts (AOR = 2.26 [1.45-4.31]) were also positively associated with khat abuse. CONCLUSIONS: The prevalence of khat abuse was higher in prisoners with possible or probable psychopathy.

Transtorno da Personalidade Antissocial/epidemiologia , Catha , Prisioneiros/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Alcoolismo/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Tabagismo/epidemiologia