Clovis Botelho

Diretrizes para Cessação do Tabagismo

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

Psychological characteristics associated with tobacco smoking behavior

This article is a literature review of the psychological aspects of smoking behavior, highlighting personality characteristics of the smoker as an obstacle to smoking cessation. It describes the relation between smoking behavior and personality, and between smoking and the principal psychiatric disorders. Studies reveal that smokers tend to be more extroverted, anxious, tense, and impulsive, and show more traits of neuroticism and psychoticism than do ex-smokers or nonsmokers. The literature also reveals a strong association between smoking and mental disorders, such as schizophrenia and depression. Understanding the psychological factors associated with tobacco smoking and dependence can further the development and improvement of therapeutic strategies to be used in smoking-cessation programs, as well as of programs aimed at prevention and education.

Abandono do tratamento da tuberculose pulmonar em Cuiabá - MT - Brasil

OBJECTIVE: To analyze factors predictive of noncompliance with pulmonary tuberculosis treatment. METHODS: A historical cohort study involving 481 of the 529 active tuberculosis patients registered with the Tuberculosis Control Program in the city of Cuiaba, located in the state of Mato Grosso, during the 1998-2000 period. Data were obtained by analyzing medical charts and registration records. In the bivariate analysis, the chi-square test was used to calculate noncompliance rate ratios (relative risk), 95% confidence intervals were determined, and Fishers exact test was used. The choice to estimate the rate of incidence was the method of density and a multivariate logistic regression model was constructed in order to identify the variables that were most predictive of noncompliance, using a level of statistical significance of p < 0.05. RESULTS: The global rate of incidence was 27.3%, equivalent to 5.1 noncompliant patients/100 patients/month, increasing in the second and third months of treatment. In the final logistic regression model, the following were considered predictors of noncompliance: unsupervised treatment (odds ratio: 2.58; 95% confidence interval: 1.64 - 4.06; p < 0.001); having been treated during the 1998-1999 period (odds ratio: 1.43; 95% confidence interval: 1.14 - 1.80; p = 0.002); being male (odds ratio: 1.39; 95% confidence interval: 1.10 - 1.76; p = 0.005) and having been out of compliance with previous treatment regimes (odds ratio: 1.37; 95% confidence interval: 1.06 - 1.78; p < 0.017). CONCLUSION: The results indicate an elevated incidence of noncompliance and show that unsupervised treatment, year in which treatment was received, male gender and prior noncompliance were predictors of future noncompliance.

The influence of smoking on fertility, pregnancy and lactation

OBJECTIVE: To decribe the influence of smoking on different phases of the reproductive process, fecundation, pregnancy and lactation, drawing special attention to the mechanisms of action of the main toxic components found in cigarettes. To suggest prophylactic measures for environmental control and how to reduce childreńs exposure to tobacco smoke. METHODS: Nonsystematic literature review using MEDLINE database. RESULTS: Smoking has a negative effect on different phases of the reproduction process, by direct action of main toxic components, nicotine and carbon monoxide. Smoking reduces fertility, compromises the length of gestation and infant birthweight. Smoking mothers also have reduced breast milk production and shorter lactation, which affects infant weight gain through unclear mechanisms in which prolactin may probably be involved. CONCLUSIONS: Smoking compromises reproductive function quality in different phases, acting mainly on intrauterine and extrauterine development of infants. Since during pregnancy and lactation women are in closer contact with health professionals, antismoking campaigns should be especially addressed to this period.

Fatores associados à experimentação do cigarro em adolescentes

OBJECTIVE: To assess the prevalence of and factors associated with smoking experimentation among adolescents. METHODS: Cross-sectional study, using a specific questionnaire to interview 2,883 students from 7th to 10th grade in schools located in the urban area of the city of Cuiaba, in the state of Mato Grosso, Brazil. Prevalence was estimated, and the principal factors related to cigarette experimentation were analyzed. Subsequently, a hierarchical logistic model was used to describe the chances of cigarette experimentation related to the variables being investigated. RESULTS: The prevalence of cigarette experimentation was 30.2%. In the final model of the analysis, the main variables related to cigarette experimentation were low maternal level of education (OR = 2.44; 95% CI: 1.72-3.47); low socioeconomic level (OR=1.39; 95% CI: 1.01-1.93); studying in a public school (OR = 1.56; 95% CI: 1.22-2.00); being in 10th grade (OR = 3.45; 95% CI: 2.63-4.54); attending school in the evening (OR = 2.44; 95% CI: 1.85-3.22); having divorced parents (OR = 1.23; 95% CI: 1.02-1.49); having been held back for one school year (OR = 2.17; 95% CI: 1.78-2.70); having friends who smoke (OR = 3.75; 95% CI: 2.99-4.70) having a sibling who smokes (OR = 2.44; 95% CI: 1.82-3.27); and being older (age 17-19 years) (OR = 2.44; 95% CI: 1.39-4.17). CONCLUSIONS: A high proportion of adolescents have experimented with smoking. After adjusting for confounding variables, the factors most strongly associated with cigarette experimentation were maternal level of education, age of the adolescent, attending school in the evening, having been held back for one school year and having a sibling who smokes. Preventive measures must be directed at adolescents in schools in order to control smoking.

Fatores ambientais e hospitalizações em crianças menores de cinco anos com infecção respiratória aguda

Considering hospitalization as an indicator of seriousness of acute respiratory infection (ARI), this study focuses on the association between some environmental factors with the need for hospitalization of children with a diagnosis of ARI. The study analyzed all the medical records (at the Municipal Emergency Ward in Cuiabá, Mato Grosso State) of children under five years of age (both sexes), collected by month of attendance. Two weather seasons were considered: dry (May-October) and rainy (November-April). Variables included: temperature, relative humidity, and number of fires (due to extensive slashing and burning for agriculture in the region). Prevalence of ARI was 49.8%, and hospitalization was required in 7.6% of cases, with a higher percentage during the dry season. The dry season and lower relative humidity were associated with increased pediatric hospitalization rate due to ARI.

Relação entre tabagismo e transtornos psiquiátricos

Este artigo apresenta uma revisao nao sistematica da literatura sobre a relacao entre tabagismo e doencas mentais, destacando algumas perspectivas recentes sobre o assunto. Buscou-se identificar e descrever as hipoteses levantadas por estudiosos nas ultimas decadas acerca da natureza da associacao entre o tabagismo e as perturbacoes psiquiatricas como depressao maior, esquizofrenia e transtornos de ansiedade. Discutem-se, tambem, as reflexoes sobre as abordagens utilizadas nas pesquisas, bem como as possiveis contribuicoes desse conhecimento para os programas de intervencao e assistencia a pacientes psiquiatricos fumantes.

Respiratory disease and climatic seasonality in children under 15 years old in a town in the Brazilian Amazon

OBJECTIVE To analyze the climatic seasonality of primary care visits for respiratory disease (RD) in children less than 15 years old. METHODS This was a descriptive, epidemiological study based on data from the municipal records of primary care events from basic healthcare centers for the period 2004-2005, for the municipality of Tangará da Serra (MT), Brazil. Population estimates were obtained from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IGBE), and data on temperature and relative humidity of the air, from the National Meteorology Institute (Instituto Nacional de Meteorologia, INMET). Mean rates of primary care visits for RD were calculated according to sex, age group and anatomic location of complaint. The ratio of dry season to rainy season visits was calculated according to anatomic location of the RD. Data were analyzed using Epi-Info 3.2, testing differences between proportions using the chi-square test to a significance level of 5%. RESULTS Male children had an almost 50% greater (37.3/25.0) rate of primary care visits for diseases of the lower respiratory tract than did females. The rates of primary care visits due to RD in children under 15 years of age varied as age increased, varying from 457.7 per thousand of children less than 1 year of age to 133.5 per thousand in the 10 to 14 years-of-age group. During the dry season there were an average of 21% (4,148/5,231) fewer visits for RD (p = 0.000). Peaks in numbers of visits were observed during the months of March and August, being more accentuated in March, which is the wet season in the region. CONCLUSION Primary care visits for RD, especially those due to upper airway diseases, are related to the rainy season in this municipality.

Variações climáticas e uso de serviços de saúde em crianças asmáticas menores de cinco anos de idade: um estudo ecológico

OBJECTIVE: To study variations in climate (dry or rainy periods) and health services use for the treatment of asthma in children under five years of age. METHODS: An ecological study was conducted and involved analysis of the medical charts of all children under the age of five that were diagnosed with asthma and treated in the Municipal Emergency Room of the city of Cuiaba, located in the state of Mato Grosso, Brazil. In accordance with the geographic location of Cuiaba, two climatic periods were identified: a dry season (from May to October) and a rainy season (from November to April). RESULTS: The percentage of children treated that were diagnosed with asthma was 12.2% (3140/25,802), with no gender-based difference. Children from 3 to 5 years of age were most often affected. The overall asthma hospitalization rate was 1.3% (336/25,802), rising to 10.7% (336/3140) among the asthmatic children treated in the emergency room. In the rainy season, the percentage of outpatients seeking treatment for asthma was higher than in the dry season: 39.1% (1228/3140) versus 60.9% (1912/3140). However, during the dry season, a greater proportion of such patients were hospitalized: 52.3% (176/336) versus 47.7% (160/336). These differences were statistically significant (p < 0.05). CONCLUSIONS: The dry season, which was correlated with higher asthma hospitalization rates, seems to be related to more severe cases of asthma in children under five years of age.

Factors associated with hookah use initiation among adolescents

OBJECTIVE to determine the prevalence and to analyze factors associated with hookah use initiation among adolescents. METHODS This was a cross-sectional study, in which questionnaires were collected from 495 students attending public and private schools of the urban area of the city of Várzea Grande, in the state of Mato Grosso, Brazil. Data were analyzed through descriptive, bivariate, and multiple Poisson regression analyses. RESULTS A total of 19.7% students had tried a hookah. The use of hookah was associated with the final period of adolescence [PR=6.54 (2.79, 15.32)]; enrollment in private schools [PR=2.23 (1.73, 2.88)]; and presence of work activities [PR=1.80 (1.17, 2.78)]. CONCLUSION The proportion of adolescents that had tried a hookah was high. The influence of age, work activities, and class period on smoking initiation using the hookah was observed. Preventive measures encompassing all forms of tobacco smoking should be targeted at adolescents in the school environment, aiming at tobacco use control.