A Smoking Prevention Program Delivered by Medical Students to Secondary Schools in Brazil Called "Education Against Tobacco": Randomized Controlled Trial.

BACKGROUND: Smoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years. OBJECTIVE: The aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil. METHODS: A randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up. RESULTS: From baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant (P<.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance. CONCLUSIONS: To our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background. TRIAL REGISTRATION: ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.7134.

A Medical Student-Delivered Smoking Prevention Program, Education Against Tobacco, for Secondary Schools in Brazil: Study Protocol for a Randomized Trial.

BACKGROUND: Smoking is the largest preventable cause of morbidity and mortality in Brazil. Education Against Tobacco (EAT) is a large network of medical students in 13 countries who volunteer for school-based prevention in the classroom setting. A recent quasi-experimental EAT study conducted in Germany showed significant short-term smoking cessation effects on 11- to 15-year-old adolescents. OBJECTIVE: The aim of this study is both to describe and to provide the first randomized long-term evaluation of the EAT intervention involving a photoaging app for its effectiveness to reduce the smoking prevalence among 12- to 17-year-old pupils in Brazilian public schools. METHODS: A randomized controlled trial will be conducted among approximately 1500 adolescents aged 12 to 17 years in grades 7-11 of public secondary schools in Brazil. The prospective experimental study design includes measurements at baseline and at 6 and 12 months postintervention. The study groups will consist of randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes within the same schools (no intervention). The questionnaire measures smoking status, gender, social, and cultural aspects as well as predictors of smoking. Biochemical validation of smoking status is conducted via random carbon monoxide measurements. The primary end point is the difference of the change in smoking prevalence in the intervention group versus the difference in the control group at 12 months of follow-up. The differences in smoking behavior (smoking onset, quitting) between the 2 groups as well as effects on the different genders will be studied as secondary outcomes. RESULTS: The recruitment of schools, participating adolescents, and medical students was conducted from August 2016 until January 2017. The planned period of data collection is February 2017 until June 2018. Data analysis will follow in July 2018 and data presentation/publication will follow shortly thereafter. CONCLUSIONS: This is the first evaluative study of a medical student-delivered tobacco prevention program in Brazil and the first randomized trial on the long-term effectiveness of a school-based medical student-delivered tobacco prevention program in general. CLINICALTRIAL: ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021 (archived by WebCite at http://www.webcitation.org/6njy3nNml).

Estudo de série histórica de casos de tuberculose entre 1999 e 2015, em Ouro Preto, Minas Gerais, Brasil / Study of historical series of tuberculosis cases between 1999 and 2015, in Ouro Preto, Minas Gerais, Brazil

Resumo Introdução A tuberculose, caracterizada pela Organização Mundial de Saúde (OMS) como emergência sanitária mundial, é uma doença de impacto global. Objetivo Realizar série histórica de casos de tuberculose em um período de 17 anos em Ouro Preto, Minas Gerais, considerando a histórica relação da doença com a mineração. Método Dados foram obtidos em sistema próprio de registros do município, por busca ativa em prontuários médicos e comparados à quantidade de casos notificados no Sistema de Informação de Agravos de Notificação (SINAN). Para análises de tendência, foram utilizados modelos de regressão polinomial para séries históricas. Resultados Idade média dos casos foi 40,3 ± 16,4 anos. Homens apresentaram 2,23 vezes mais casos e chance 2,07 vezes maior para desfechos negativos. A forma mais observada foi pulmonar (84%), e sorologia para HIV foi realizada em apenas 16,3% dos registros. Principal desfecho observado foi cura (70%), e desfechos negativos totalizaram 20,2% dos registros. Taxa de incidência média foi 29,76 e 16,23 casos/100 mil habitantes na área municipal e distrital, respectivamente. Conclusão Apesar da relação histórica entre mineração e tuberculose no município, observa-se que este ainda apresenta preocupantes vulnerabilidades em relação à vigilância da doença. Análise de série temporal sugeriu declínio na proporção de casos curados entre 2009 e 2015.

Abstract Background Tuberculosis, characterized by the World Health Organization as a global health emergency, is a disease of global impact. Objective To investigate a series of tuberculosis cases during 17 years in Ouro Preto, Minas Gerais, Brazil, considering the historic relationship between mining and the disease. Method Data was obtained through the city's system of tuberculosis notifications, plus active search through medical records, and compared to the amount of notified cases present in the System of Information of Notifications Complications. For trend analysis, polynomial regression models were used for the historic series. Results The average age was 40.3 ± 16.4 years old. Men showed 2.23 times more cases and chances (odds ratio) of 2.07 times higher for negative outcomes. The most observed form was lung (85%) and HIV serology was performed in only 16.3% of the logs. The main observed outcome was a cure (70%) and negative outcomes accounted for 20.2% of the logs. The average incidence rate was 29.76 and 16.23 cases/100 thousand inhabitants in the city and district zones, respectively. Conclusion Despite the historical relationship between mining and tuberculosis in the municipality, it is observed that the same still presents worrying vulnerabilities about disease surveillance, temporal series analysis suggested a decline in the proportion of cases cured between 2009 and 2015.

Cuidados paliativos no manejo da insuficiência cardíaca / Palliative care in the management of heart failure

Introdução: a insuficiência cardíaca (IC) é uma condição que determina grande sofrimento aos pacientes. Entretanto, a prática de cuidados paliativos (CP) no seu manejo ainda é bastante incipiente. Objetivos: analisar a distribuição territorial dos serviços de CP no Brasil e discutir o papel destes no manejo de pacientes com IC. Metodologia: estudo exploratório documental, com informações demográficas e epidemiológicasobtidas do DATASUS e do IBGE. A relação dos serviços de CP foi obtida da Associação Brasileira de Cuidados Paliativos (ABCP), da Academia Nacional de Cuidados Paliativos (ANCP) e do Ministério da Saúde (MS). A revisão bibliográfica foi realizada nas bases PubMed, LILACS e Scielo, usando os descritores insuficiência cardíaca, cuidados paliativos,qualidade de vida e assistência terminal. Resultados: entre 1996 e 2013 houve mais de 500 mil óbitos por IC no país. Em 2014, os custos hospitalares para tratamento de IC foram superiores a R$ 315 milhões. Embora os CP sejam eficazes no manejo da IC, há baixa disponibilidade desses serviços, que se concentram principalmente no Sudeste, vinculados a instituições oncológicas. Conclusão: a IC é uma síndrome clínica complexa que exige abordagem interdisciplinar. A atenção holística provida pelos CPs mostra-se eficaz na redução de internações por doença descompensada, na incidência de depressão e na melhoria da qualidade de vida do paciente.

Introduction: Heart failure (HF) is a condition that results in great suffering to patients. However, the practice of palliative care in their management is still incipient. Objective: The aim of this study was to analyze the territorial distribution of palliative care services in Brazil and discuss their role in the treatment of patients with HF. Methods: This is a documental exploratory study, with information obtained from DATASUS, IBGE, the Brazilian Association of Palliative Care (ABCP) and the National Palliative Care Academy (ANCP). A literature review was conducted on PubMed, LILACS and Scielo, using the descriptors Heart Failure, Palliative Care, Quality of Life and Terminal Care. Results: Between 1996 and 2013 there were over than 500.000 deaths due to HF in Brazil. In 2014, hospital costs for treating HF were higher than R$ 315 million. Despite the evidence of the effectiveness of palliative care in heart failure?s management, there is low availability of these services, which is mainly concentrated in the southeast of the country, linked to oncological institutions. Conclusion: The HF is a clinical syndrome that requires an interdisciplinary approach. The holistic care provided by palliative care is effective in reducinghospitalizations for complications of the HF, the incidence of depression and in improving the patient?s quality of life.