Fatores relacionados ao insucesso na cessação tabágica: um estudo de coorte prospectivo

CONTEXT AND OBJECTIVE: Considering the difficulties in stopping smoking, this article aimed to identify factors relating to failure of attempts to quit smoking among smokers who sought care at an outpatient clinic in a general university hospital. DESIGN AND SETTING: Prospective cohort study evaluating 100 smokers who sought treatment at the Psychoactive Substances Outpatient Clinic. METHODS: The variables gathered were sociodemographic factors; degree of dependence (Fagerström questionnaire); stage of motivation for change (University of Rhode Island Change Assessment Scale); and presence of depression and anxiety (Hospital Anxiety and Depression Scale). The patients were followed up after 4, 8, 12 and 24 weeks to identify factors relating to failure to quit smoking. RESULTS: The patients were mostly women (75%), between 40 and 59 years of age (67%); with incomplete elementary education (60%); with leisure activities (57%); suffering from tobacco-related disease (53%); with previous attempts to quit smoking (70%); with a medical recommendation to stop (51%); with encouragement to stop (66%); and with a high degree of dependence (78%). The main motivational stage was contemplation/action (43%); the anxiety rate was 64% and the depression rate was 39%. The quitting rate was 66% among adherents and 17% among non-adherents (P < 0.001). Lack of success was correlated with absence of leisure, higher education and absence of tobacco-related disease. CONCLUSION: The variables of lack of leisure activities, higher education and/or lack of tobacco-related disease correlated with failure to quit smoking among smokers who sought treatment at an outpatient clinic in a tertiary general hospital.CONTEXTO E OBJETIVO: Considerando as dificuldades na cessação do tabagismo, este artigo objetiva identificar fatores relacionados ao insucesso na tentativa de cessação tabágica de fumantes que procuraram atendimento em ambulatório de um hospital geral universitário. TIPO DE ESTUDO E LOCAL: Estudo de coorte prospectivo, que avaliou 100 fumantes que procuraram tratamento no Ambulatório de Substâncias Psicoativas. MÉTODOS: Avaliaram-se variáveis sociodemográficas, grau de dependência (Questionário de Fagerström), estágio de motivação para a mudança (University of Rhode Island Change Assessment), presença de depressão e ansiedade (Hospital Anxiety and Depression Scale). Os pacientes foram acompanhados em 4, 8, 12 e 24 semanas para identificar fatores relacionados ao insucesso na cessação do tabagismo. RESULTADOS: Os pacientes eram, na maioria, mulheres (75%), entre 40 e 59 anos de idade (67%), com ensino fundamental incompleto (60%), com atividades de lazer (57%), portadores de doença tabaco-relacionada (DTR) (53%), com tentativas anteriores de parar de fumar (70%), que receberam recomendação médica (51%) e incentivo para a cessação (66%) e com elevado grau de dependência (78%). O estágio de motivação principal foi contemplação/ação (43%), a taxa de ansiedade foi de 64% e de depressão, 39%. A taxa de cessação foi de 66% entre os que aderiram e de 17% entre aqueles que não aderiram (P < 0,001). O insucesso foi relacionado à ausência de lazer, maior escolaridade e ausência de DTR. CONCLUSÃO: Falta de atividades de lazer, maior nível educacional e/ou não ter DTR foram variáveis relacionadas ao insucesso na cessação tabágica para tabagistas que procuram tratamento em ambulatório inserido em hospital geral terciário.38038

Atenção aos tabagistas pela capacitação de profissionais da rede pública

The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2% quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11%); lack of medications (38%); and lack of health unit infrastructure/support (29%). The training allowed to reaching out a larger population through smoking cessation approaches at health units.O estudo avaliou desdobramentos de um treinamento para abordagem de tabagistas para 40 profissionais da rede pública, de novembro de 2004 a março de 2007. Os profissionais realizaram abordagem mínima individual (3.419 tabagistas) e grupal (982). Dos pacientes fumantes que participaram dessas atividades, 9,2% conseguiram parar de fumar. As dificuldades relatadas pelos profissionais foram baixa adesão dos pacientes (11%), falta de medicação (38%) e de apoio/estrutura da unidade (29%). O treinamento aumentou a população abordada pelas unidades de saúde nas estratégias de prevenção do tabagismo

[approach On Smoking Cessation By Training Public Health Providers].

The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2% quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11%); lack of medications (38%); and lack of health unit infrastructure/support (29%). The training allowed to reaching out a larger population through smoking cessation approaches at health units.42353-

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Factors relating to failure to quit smoking: a prospective cohort study

CONTEXT AND OBJECTIVE: Considering the difficulties in stopping smoking, this article aimed to identify factors relating to failure of attempts to quit smoking among smokers who sought care at an outpatient clinic in a general university hospital. DESIGN AND SETTING: Prospective cohort study evaluating 100 smokers who sought treatment at the Psychoactive Substances Outpatient Clinic. METHODS: The variables gathered were sociodemographic factors; degree of dependence (Fagerström questionnaire); stage of motivation for change (University of Rhode Island Change Assessment Scale); and presence of depression and anxiety (Hospital Anxiety and Depression Scale). The patients were followed up after 4, 8, 12 and 24 weeks to identify factors relating to failure to quit smoking. RESULTS: The patients were mostly women (75%), between 40 and 59 years of age (67%); with incomplete elementary education (60%); with leisure activities (57%); suffering from tobacco-related disease (53%); with previous attempts to quit smoking (70%); with a medical recommendation to stop (51%); with encouragement to stop (66%); and with a high degree of dependence (78%). The main motivational stage was contemplation/action (43%); the anxiety rate was 64% and the depression rate was 39%. The quitting rate was 66% among adherents and 17% among non-adherents (P < 0.001). Lack of success was correlated with absence of leisure, higher education and absence of tobacco-related disease. CONCLUSION: The variables of lack of leisure activities, higher education and/or lack of tobacco-related disease correlated with failure to quit smoking among smokers who sought treatment at an outpatient clinic in a tertiary general hospital