Os riscos do uso do cigarro eletrônico entre os jovens

Initially conceived as a substitute for the traditional cigarette, with the aim of reducing the risks and damages caused by smoking, electronic cigarettes were introduced in society as a proposal of relevance for health and society in general. However, they began to be consumed by smokers along with traditional cigarettes and, even more seriously, began to represent a gateway to smoking for young people seduced by its modernity and particularities. smoking in some cases, e-cigarettes have their effectiveness questioned, in addition to the risk of leading to traditional smoking and not having safety parameters attested. The study addresses this issue of the efficacy and safety of electronic cigarettes, especially among adolescents and young adults, through a qualitative and descriptive literature review.Inicialmente idealizado como substituto do cigarro tradicional, com o intuito de reduzir os riscos e danos provocados pelo tabagismo, os cigarros eletrônicos foram introduzidos na sociedade como uma proposta de relevância para a saúde e para a sociedade em geral. No entanto, passaram a ser consumidos por fumantes junto com os cigarros tradicionais e, de forma ainda mais grave, passaram a representar uma porta de entrada para o tabagismo para jovens seduzidos por sua modernidade e particularidades. Dessa forma, apesar de representar a queda do tabagismo em alguns casos, os cigarros eletrônicos têm sua eficácia questionada, além do risco de levar ao fumo tradicional e não terem parâmetros de segurança atestados. O estudo aborda essa problemática da eficácia e segurança dos cigarros eletrônicos, especialmente junto a adolescentes e jovens adultos, por meio de uma revisão bibliográfica qualitativa e descritiva

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)