Alberto José de Araújo

Diretrizes para cessação do tabagismo: 2008

These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, recommending measures and strategies for managing each case based on clinical evidence. Written in a simplified and objective manner, the text is divided into two principal sections: Evaluation and Treatment. The sections both present comments on and levels of evidence represented by the references cited, as well as some proposals for the reduction of damage and for intervening in specific and still poorly explored situations, such as relapse, passive smoking, physician smoking, and tobacco use in specific environments.

Avaliação integrada do impacto do uso de agrotóxicos sobre a saúde humana em uma comunidade agrícola de Nova Friburgo, RJ

O impacto do uso de agrotoxicos sobre a saude humana e um problema que tem merecido atencao da comunidade cientifica em todo o mundo, sobretudo nos paises em desenvolvimento. O consumo de agrotoxicos na regiao sudeste do Brasil esta estimado em 12kg de agrotoxico/trabalhador/ano. Em algumas areas agricolas do Estado do Rio de Janeiro, como na regiao da Microbacia do Corrego de Sao Lourenco, Nova Friburgo, o consumo de agrotoxico foi estimado em 56kg de agrotoxico/trabalhador/ano. Elevados niveis de contaminacao humana e ambiental foram encontrados nesta regiao, como decorrencia do uso extensivo destes agentes quimicos. A avaliacao do impacto sobre a saude humana implica o conhecimento e a visualizacao da importância/magnitude relativa de cada uma das vias de contaminacao. Inumeros fatores, que, em geral, encontram-se inter-relacionados, contribuem para a situacao encontrada na Microbacia do Corrego de Sao Lourenco e a forma mais adequada de se avaliar toda a dimensao deste problema e o uso de uma abordagem integrada.

Diretrizes para Cessação do Tabagismo

Universidade Federal do Rio de Janeiro (UFRJ) Hospital Universitario Clementino Fraga Filho

Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ

Um estudo transversal foi realizado em uma comunidade agricola localizada em Nova Friburgo, RJ, para conhecer os aspectos epidemiologicos, clinicos e laboratoriais da exposicao multipla a agrotoxicos em uma amostra representativa de 102 pequenos agricultores, de ambos os sexos. Os trabalhadores foram submetidos a um extenso protocolo que incluia aplicacao de questionario ocupacional, coleta de amostras biologicas para exame toxicologico e avaliacao clinica - geral e neurologica. Os resultados dos exames toxicologicos revelaram episodios leves a moderados de intoxicacao aguda aos organofosforados descritos pelos agricultores ou observados durante o exame clinico. Foram tambem diagnosticados 13 (12,8 %) quadros de neuropatia tardia e 29 (28,5%) quadros de sindrome neurocomportamental e disturbios neuropsiquiatricos associados ao uso cronico de agrotoxicos. Os resultados apontam para a ocorrencia de episodios recorrentes de sobre-exposicao multipla, a elevadas concentracoes de diversos produtos quimicos, com grave prejuizo para as funcoes vitais desses trabalhadores, especialmente por se encontrarem em uma faixa etaria jovem (media = 35 ± 11anos) e periodo produtivo da vida. Estes dados demonstram a importância do monitoramento da multipla exposicao a agrotoxicos, uma cadeia de eventos de grande repercussao na saude publica e para o meio ambiente.

Nicotine dependence and smoking habits in patients with head and neck cancer

Objective: To assess smoking habits and nicotine dependence (ND) in patients with head and neck cancer Methods: This study involved 71 smokers or former smokers with squamous cell carcinoma in the oral cavity, pharynx, or larynx who were treated at a university hospital in the city of São Paulo between January and May of 2010. We used the Fagerström Test for Nicotine Dependence to evaluate smoking habits and ND in the sample. Data regarding cancer treatment were collected from medical records. Depending on the variables studied, we used the chi-square test, Fishers exact test, Students t-test, or Spearmans correlation test. Results: Of the 71 patients, 47 (66.2%) presented with high or very high ND, 40 (56.3%) smoked more than 20 cigarettes/day, and 32 (45.1%) smoked their first cigarette within 5 min of awakening. Advanced disease stage correlated significantly with the number of cigarettes smoked per day (p = 0.011) and with smoking history (p = 0.047). We found that ND did not correlate significantly with gender, disease stage, smoking cessation, or number of smoking cessation attempts, nor did the number of cigarettes smoked per day correlate with smoking cessation or gender. Treatment for smoking cessation was not routinely offered. Conclusions: In most of the patients studied, the level of ND was high or very high. The prevalence of heavy smoking for long periods was high in our sample. A diagnosis of cancer is a motivating factor for smoking cessation. However, intensive smoking cessation treatment is not routinely offered to smoking patients diagnosed with cancer.

Possible addiction transference from cocaine insufflation to oral bupropion in bipolar patient.

Objective:Alert for the risk of oral bupropion addiction in patients with cocaine dependence. Methods:Single-case study. Results:After a period of cocaine and alcohol abstinence, a 42-year-old patient started taking oral bupropion to relieve the symptoms of cocaine craving. He increased the bupropion dose up to 2250 mg/d without seizures. Conclusion:This case highlights the possibility of oral bupropion addiction after cocaine dependence. To our knowledge, it is the first case in the literature and emphasizes the risk of bupropions misuse. Therefore, physicians should carefully examine the patients profile before prescribing it, as well as follow appropriate measures.

Tabagismo na adolescência: por que os jovens ainda fumam?

The hallmarks of adolescence are the search for knowledge, learning by experimentation, a taste for adventure, critical judgment through questioning, and rebellion against the values imposed by adults. In this unforgettable period of life, myths, beliefs, and attitudes are revisited or reinvented. The demands of contemporary society have conditioned people to a high tech way of life, with a strong consumer appeal for brands and products and the globalization of customs and tendencies. Youths, at increasingly early ages, are enchanted with this magical world of novelties and amenities, such as social networks. This virtual world has increasingly mimicked the real world, unveiling new possibilities that can lead youths either to develop their creative potential or to seek compensatory mechanisms for dramas that are typical of their age. Children are the perfect targets for the first addictions, such as excessive consumption of foods/beverages with low nutritional value, the so-called fast-food, being encouraged by their own parents. The same is true for drugs, especially tobacco and alcohol, which are introduced to children at the very heart of the family, when parents—the behavioral role models—use these substances.

Controle do tabagismo: desafios e conquistas

O tabagismo e o fator de risco mais prevenivel e controlavel em saude e, por isso, precisa ter a maxima atencao e ser muito mais enfocado por todos os profissionais da saude. O tabaco e um produto de alta rentabilidade pela sua grande producao e pelo elevado numero de consumidores. As politicas de controle e os recursos terapeuticos para o tabagismo avancaram muito nos ultimos anos e tem mostrado resultados altamente satisfatorios, particularmente no Brasil. Entretanto, ainda resta um longo caminho a ser percorrido para que se possa considerar o tabagismo como uma doenca controlada sob o ponto de vista da saude publica. Ja se observam modificacoes do comportamento da sociedade com relacao ao tabagismo, mas ainda em escala muito lenta, de modo que os pneumologistas tem nesse setor um campo muito promissor para atuar junto a seus pacientes e a populacao em geral. E preciso atuar com maior impeto em prol das politicas de saude e das normas de convivio social que contribuem diretamente para melhorar a saude e a vida. Nesse aspecto, os pneumologistas podem ter um papel de maior destaque na medida em que se envolvam com o tratamento dos fumantes, a aplicacao da lei antifumo e as politicas de saude relacionadas as doencas respiratorias.

Smoking control: challenges and achievements.

ABSTRACT Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

Cessação tabágica em paciente com tremor essencial

There are patients that are resistant to reducing tobacco use, despite the effort of the professionals helping them to quit. Among the most cited motives, there are alcohol abuse, anxiety and depression. Furthermore, frequently neglected by patients and doctors, essential tremor has direct and indirect clinical implications for those who want to stop smoking. Once known as a benign condition, essential tremor has strong association with psychiatric disorders and can get worse because of nicotine abstinence and certain medications used in smoking cessation. We report a case of essential tremor and psychiatric comorbidities on the path towards tobacco abstinence. Regarding the link between nicotine and the course of essential tremor, further studies are necessary. However, diagnosing its presence is clinically relevant and should be considered a marker of worse prognosis in smoking cessation.