that has been made in this area, even in a short period of time. Tobacco dependence is increasingly acknowledged as a chronic condition that can require multiple interventions. In addition, recent evidence supports the critical role of counseling, in individual and group interventions, as well as in conjunction with pharmacological treatment.The evidence-based selection method was applied in order to identify appropriate references in the specialized litera- IntroductionThis update represents the strong commitment of the Brazilian Thoracic Association to smoking cessation. It provides health professionals with a comprehensive instrument to deal with the principal aspects of tobacco dependence. It includes new and effective clinical treatments and highlights changes in procedures in certain situations.The comparison between this content and that of the previous guidelines shows the significant scientific progress The use of the strength of recommendation associated with the bibliographic citations in the text has as the following principal objectives: to clarify the information source; to stimulate the search for stronger scientific evidence; and to introduce a didactic and simple way to aid in the critical evaluation on the part of the reader, who is the one responsible for making the decisions concerning the patient being treated. Diagnostic approach Clinical evaluationThe smoker should be submitted to clinical evaluation upon admission to the smoking cessation program. The objective is to identify functional alterations in the lungs, the existence of smoking related diseases (SRDs), possible contraindications and drug interactions during the pharmacological treatment of the dependence. The profile of the smoker, the level of nicotine dependence and the motivation to stop smoking are also evaluated at this time.This evaluation (Chart 1) should include accurate clinical history, complete physical examination, and some complementary tests, depending on local diagnostic resources.Chest X-ray is an essential tool during the treatment. A good physician-patient relationship, together with professional sensitivity and observation skills, will indicate the most appropriate time. Some people are afraid of what they might find, avoiding treatment so that they do not have to face the situation. ture. This was followed by critical review by pairs, who ultimately presented their recommendations.The decision to adopt any of these guidelines should be made by the professional, taking into consideration the resources available in the locale and the specific circumstances of the patient. Although this document describes the principal recommendations in each situation, there is limited space for publishing. Therefore, additional references are provided to those interested in broadening their scientific knowledge on this subject.These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, in public or private health care clinics. This is the role of the government and the public poli...

O impacto do uso de agrotóxicos sobre a saúde humana é um problema que tem merecido atenção da comunidade científica em todo o mundo, sobretudo nos países em desenvolvimento. O consumo de agrotóxicos na região sudeste do Brasil está estimado em 12kg de agrotóxico/trabalhador/ano. Em algumas áreas agrícolas do Estado do Rio de Janeiro, como na região da Microbacia do Córrego de São Lourenço, Nova Friburgo, o consumo de agrotóxico foi estimado em 56kg de agrotóxico/trabalhador/ano. Elevados níveis de contaminação humana e ambiental foram encontrados nesta região, como decorrência do uso extensivo destes agentes químicos. A avaliação do impacto sobre a saúde humana implica o conhecimento e a visualização da importância/magnitude relativa de cada uma das vias de contaminação. Inúmeros fatores, que, em geral, encontram-se inter-relacionados, contribuem para a situação encontrada na Microbacia do Córrego de São Lourenço e a forma mais adequada de se avaliar toda a dimensão deste problema é o uso de uma abordagem integrada.

A cross section study was carried out in a farming community from Nova Friburgo, Rio de Janeiro state, Brazil, to examine epidemiological, clinical and laboratory aspects of multiple exposure to pesticides in a representative sample of 102 small farmers. Both males and females were submitted to an extensive protocol which included an occupation questionnaire, biological sample collection for toxicology analysis and clinical - general and neurological - evaluation. The toxicology test results showed light to moderate episodes of acute intoxication by organophosphorates either described by the farmers or observed during clinical examination. Thirteen cases of delayed neuropathies (12,8%) as well as 29 cases of neural behavioral syndromes and psychiatric disorders associated to the continued use of pesticides were diagnosed. These results indicate recurrent multiple overexposures to high concentrations of different chemicals, with serious damage to vital functions, especially considering their young age (average 35 +/- 11 years old) and the productive period in their lifetime. These results show how important it is to monitor multiple exposure to pesticides - a chain of events that may have major impacts on public health and the environment.

Autores e colaboradores Diretrizes para Cessação do Tabagismo Número de substâncias identificadas em 15 funções químicas existentes no fumo Funções Número de químicas substâncias Amidas, imidas 237 Ácidos carboxílicos 227 Lactonas 150 Ésteres 474 Aldeídos 108 Cetonas 521 Álcoois 379 Fenóis 282 Aminas 196 N-eterocíclicos 921 Hidrocarbonetos 755 Nitrilas 106 Éteres 311 Carboidratos 42 Anidridos 11 Total 4.720

BackgroundSilicosis is an occupational disease for which no effective treatment is currently known. Systemic administration of bone marrow-derived mononuclear cells (BMDMCs) has shown to be safe in lung diseases. However, so far, no studies have analyzed whether bronchoscopic instillation of autologous BMDMCs is a safe route of administration in patients with silicosis.MethodsWe conducted a prospective, non-randomized, single-center longitudinal study in five patients. Inclusion criteria were age 18–50 years, chronic and accelerated silicosis, forced expiratory volume in 1 s <60 % and >40 %, forced vital capacity ≥60 % and arterial oxygen saturation >90 %. The exclusion criteria were smoking, active tuberculosis, neoplasms, autoimmune disorders, heart, liver or renal diseases, or inability to undergo bronchoscopy. BMDMCs were administered through bronchoscopy (2 × 107 cells) into both lungs. Physical examination, laboratory evaluations, quality of life questionnaires, computed tomography of the chest, lung function tests, and perfusion scans were performed before the start of treatment and up to 360 days after BMDMC therapy. Additionally, whole-body and planar scans were evaluated 2 and 24 h after instillation.ResultsNo adverse events were observed during and after BMDMC administration. Lung function, quality of life and radiologic features remained stable throughout follow-up. Furthermore, an early increase of perfusion in the base of both lungs was observed and sustained after BMDMC administration.ConclusionAdministration of BMDMCs through bronchoscopy appears to be feasible and safe in accelerated and chronic silicosis. This pilot study provides a basis for prospective randomized trials to assess the efficacy of this treatment approach.Clinical trials.gov identifierNCT01239862 Date of Registration: November 10, 2010

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, Fisher's exact test, Student's t-test, or Spearman's 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.

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.

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