Objective: To outline the prevalence of smoking in the city of Parazinho, Brazil, with the objective of generating data on which to base a plan of action for smoking control programs in the city. Methods: A questionnaire was applied to 150 people (25.6% of whom were smokers) by community health agents during home visits. The questionnaire comprised 30 objective and subjective questions to collect social and biological information on smokers in urban and rural areas. Results: The data were analyzed using descriptive statistics, and the principal findings were as follows: the prevalence of smoking was higher among males (57.8%); most of the interviewees started smoking at an early age (45% before the age of 12); economic conditions constituted a contributing factor (66% of the smokers interviewed earned less than the minimum wage); most of the interviewees reported difficulty in kicking the habit (44.6% reported living with a smoker, and 80% had a friend who smoked); there was a high prevalence of tobacco-related diseases (56.6% had respiratory problems); and there was concomitant alcohol use in 52% of the smokers. Conclusion: This outline can be used in the generation of a local program of smoking prevention and control. Such a program is, in fact, under development. A team of professionals has received training in a 'minimal, intensive approach to the smoker', and a municipal outpatient clinic for the treatment of nicotine dependence has been inaugurated.

Keywords: Smoking/prevention & control; Questionnaires; Smoking/epidemiology.

Objective: To provide access to the results of a randomized cross-sectional study conducted by the Brazilian Center for Information on Psychotropic Drugs in 2001. Methods: This survey involved a random sample of individuals ranging from 12 to 65 years of age and residing in the 107 largest cities (over 200,000 inhabitants) in Brazil, which represented 27.7% of the Brazilian population, estimated to be 169,799,170 inhabitants at the time. A total of 8,589 interviews were conducted. The Substance Abuse and Mental Health Services Administration questionnaire, translated and adapted for use in Brazil, was used in the interviews. Results: Of the sample as a whole, 41.1% of the interviewees reported having experimented with tobacco products. The prevalence of daily smokers was 17.4% (20.3% among males and 14.8% among females). We found that 9% of the sample (10.1% of the men and 7.9% of the women) were nicotine-dependent, according to the criteria of the National Household Survey on Drug Abuse. Conclusions: The prevalence of current smoking in the 107 largest cities of Brazil is significantly lower in this decade than was the national prevalence at the end of last century.

Keywords: Smoking/epidemiology; Tobacco use disorder; Smoking cessation.

Objetive: To analyze the variables related to smoking initiation among adolescent students in two high schools (one public and one private) in the city of Belém, Brazil, in 2005. Methods: An anonymous self-report questionnaire - comprising 27 closed questions regarding smoking experimentation, smoking habit, access to buying cigarettes, reasons for smoking experimentation, self-perception regarding academic performance, conversations about smoking with the family, and socioeconomic level - was used for data collection. The study comprised 1520 students: 724 (47.6%) from the private school and 796 (52.4%) from the public school. Results: Mean age of participants was 16.5 years. Of the 1520 students evaluated, 669 (44%) reported experimenting with smoking, and 11% smoked regularly. In the public school and the private school, respectively, 51.2% and 36.7% of the participants had experimented with smoking (p = 0); 14.6% and 7%, respectively, were regular smokers (p = 0). We found that, in both schools, the following factors were associated with smoking initiation and current smoking: curiosity, presence of smokers as social contacts, not being praised for not smoking, and perceiving oneself as having poor or mediocre academic performance. Socioeconomic level was found to be associated with experimentation and current smoking only among experimenters of higher socioeconomic classes (A and B) in the private school. Conclusions: Among the students evaluated, the variable most closely associated with smoking was curiosity. Experimentation and regular tobacco use were more common in the public school than in the private school.

Keywords: Smoking; Epidemiologic factors; Students.

Objective: To analyze the effectiveness of the Tuberculosis Control Program, in conjunction with the recently incorporated Family Health Program, in the city of Cáceres, Brazil, between 1999 and 2004. Methods: This was a descriptive epidemiological study, based on the registry of tuberculosis cases diagnosed and treated in Cáceres, according to the characteristics of the cases diagnosed, whether or not the protocol for diagnosis, treatment, and monitoring of patients was followed, as well as the type of health care facility involved. Results: The incidence of tuberculosis was reduced from 99.4 to 49.8 (per 100,000 inhabitants) between 1999 and 2004. The patients presented characteristics similar to those of patients from other regions of Brazil, with a predominance of males during their most economically productive years. Among the patients presenting pulmonary forms and treated via the Family Health Program, there was a reduction in the number of sputum smear microscopies performed at the moment of diagnosis (OR = 0.33; 95%CI: 0.16-0.66) and prior to discharge (OR = 0.32; 95%CI: 0.18‑0.59). The patients monitored via the Family Health Program presented a 16.4% lower cure rate than did those treated at the referral center, as well as being more likely to abandon treatment (OR = 2.93; 95%CI: 1.15-7.46) and to die (OR = 5.71; 95%CI: 1.85‑18.1). Conclusion: The decentralization of the treatment services to the family health clinics did not improve the treatment or monitoring of tuberculosis cases in the city of Cáceres.

Keywords: Tuberculosis/epidemiology; Community Health Services; Health care reform/Brazil.

Objective: To evaluate the characteristics of smokers seeking treatment in a public smoking cessation program. Methods: This was a retrospective evaluation of data collected during the interview for enrollment in the smoking cessation program of the Smoking Outpatient Clinic of the Paulista State University School of Medicine in the city of Botucatu, Brazil, between April of 2003 and April of 2007. Demographic variables; previous use of the behavioral approach, medications or alternative treatments for smoking cessation; degree of nicotine dependence; and history of comorbidities were evaluated in 387 smokers. Results: In our sample, 63% of the smokers were female. The mean age of the subjects was 50 ± 25 years. More than half of the subjects (61%) had up to eight years of schooling, and 66% had a monthly income of less than twice the national minimum wage. The degree of nicotine dependence was high/very high in 59%, medium in 17% and low/very low in 24% of the subjects. Although 95% of the patients presented comorbidities, only 35% had been referred to the program by a physician. More than half of the subjects (68%) had made at least one smoking-cessation attempt, 83% of whom did so without the help of a structured program. Conclusions: Smokers seeking assistance for smoking cessation were socially disadvantaged, presented a high degree of nicotine dependence and had previously made smoking-cessation attempts without the benefit of a structured program. Therefore, in order to be effective, smoking control interventions should take into consideration the general characteristics of the smokers treated via the public health care system.

Keywords: Smoking; Tobacco use disorder; Smoking cessation.

Objective: To describe the reasons smokers give for seeking smoking cessation treatment, correlating those reasons with sociodemographic characteristics, clinical data, stage of readiness to change, and severity of nicotine dependence. Methods: Between February of 2008 and February of 2009, we evaluated 53 smokers who were naive to smoking cessation treatment and sought such treatment at the psychoactive substance abuse outpatient clinic of a university general hospital. The instruments used in the study were as follows: a form for the collection of sociodemographic and clinical data; the Fagerström Test for Nicotine Dependence; the University of Rhode Island Change Assessment scale; and a questionnaire on the smoking habit. Results: The sample comprised 34 women and 19 men, with a mean age of 48.1 years. Most of the participants had less than 8 years of schooling, had tobacco-related diseases, started smoking during adolescence, had smoked for more than 20 years, and had high nicotine dependence. The decision to quit smoking was mainly influenced by advice from family members, and the decision to seek specialized smoking cessation treatment was influenced by physicians. Most of the men were in the contemplation stage of change, whereas the women tended to have a more balanced distribution of the stages (p = 0.007). The women had attempted to quit smoking more often than had the men (p = 0.017) and also had a higher level of nicotine dependence (p = 0.053). Conclusions: The findings of this study highlight the role of health professionals in the approach to smoking cessation and suggest the importance of interventions that are more targeted, in view of the differences between men and women.

Keywords: Smoking; Smoking cessation; Motivation; Tobacco use disorder.

Objective: To evaluate the prevalence of asthma attacks treated in public health facilities in the city of Juiz de Fora, Brazil from February 1, 2002 to January 31, 2003. Methods: This was a cross-sectional study involving monthly analyses performed in order to evaluate the asthma attacks treated. The variables analyzed were patient gender, age, and place of residence, as well as the profile of the visits by age bracket and by the site of the visit. In addition, we attempted to determine whether asthma attacks correlated with temperature or relative humidity. Results: A total of 25,243 patients were treated for asthma attacks, accounting for 11.1% of the total number of visits to pediatric clinics and 2.7% of the total number visits to medical clinics. The mean age of the patients was 11.6 years (median, 4 years), and 52.9% of the patients were male. The analysis of the annual distribution revealed an increase in the number of asthma attacks treated in the months of May (11.5%), June (10.8%), and July (10.9%). Asthma attack presented a strong inverse correlation with temperature (-0.86) and a weak inverse correlation with relative humidity (-0.27). Statistically significant differences, in terms of mean age and gender, were found between patients with asthma attacks treated in emergency rooms and those treated in basic health clinics. The evaluation by age bracket revealed a predominance of males among patients younger than 12 years of age and a predominance of females among those aged 12 or older. Conclusion: We found that asthma represents a significant public health problem in this city. Local strategies are urgently needed in order to increase in the availability of prophylactic treatment.

Keywords: Asthma/epidemiology; Prevalence; Public Hospitals; Brazil

Objective: To evaluate the level of access to health care clinics of a population of patients hospitalized for tuberculosis (TB) at two hospitals in the city of São Paulo, Brazil, comparing them with a population of TB patients under outpatient treatment only. Methods: We compiled sociodemographic, clinical and epidemiological data related to patients hospitalized for TB at two hospitals in the city of São Paulo, Brazil, between January and December of 2007, using a structured questionnaire. We also identified the outpatient clinics to which the patients were referred at discharge. The same variables were evaluated for TB outpatients during the same period, using a database. Results: The study sample consisted of 474 patients (166 inpatients and 308 outpatients: mean age, 41.0 and 39.1 years, respectively). The univariate analysis showed positive associations between hospitalization due to TB and the following variables: 30-39 year age bracket (OR = 2.17); 50-59 year age bracket (OR = 2.17); combination of pulmonary and extrapulmonary forms of TB (OR = 5.31); TB re-treatment (OR = 2.66); seeking treatment at other health care facilities prior to the diagnosis of TB (OR = 2.05); symptom duration of more than 12 weeks (OR = 2.23); and TB diagnosed at hospitals or in emergency rooms (OR = 4.68). The proportion of inpatients who resided in the same regional health district area as that in which the respective hospital was located was 77.6% and 36.8%. The proportion of discharged patients who were referred to outpatient clinics in the same areas was 67.1% and 39.7%, respectively. Conclusions: Patients hospitalized for TB should be monitored from discharge until their admission to the outpatient clinic.

Keywords: Tuberculosis; Health services accessibility; Inpatients; Outpatients.

Objective: To determine the prevalence of smoking, as well as its association with sociodemographic factors, alcohol consumption, and stress levels, among industrial workers in Brazil. Methods: This was a nationwide survey, conducted in 24 capitals in Brazil through the application of a pre-tested questionnaire. The response to the question "What is your smoking status?" was the outcome variable. To determine the associations, we performed Poisson regression analyses in which the inputs were blocks of variables: block 1 (age and marital status); block 2 (level of education and gross family income); block 3 (geographic region); and block 4 (alcohol consumption and stress level). All analyses were stratified by gender. Results: The sample consisted of 47,328 workers ≥ 18 years of age, of whom 14,577 (30.8%) were women. The prevalence of smoking was 13.0% (15.2% in men and 7.9% in women). Advancing age, alcohol consumption, and a high stress level were positively associated with smoking. A lower risk of smoking was associated with being married, having a higher level of education, and living in the northeastern region of the country (versus the southern region). Conclusions: The prevalence of smoking was greater in men than in women. Alcohol consumption and high stress levels appear to promote smoking.

Keywords: Tobacco use disorder/epidemiology; Tobacco smoking; Occupational health; Industry; Brazil.

Objective: To evaluate the association between adherence to treatment and mortality among Chronic Obstructive Pulmonary Disease (COPD) patients treated in the Brazilian public health system. Methods: This is cohort study of moderate-to-severe COPD patients monitored in a public pharmaceutical care-based Disease Management Program (DMP). All subjects who died one year after the beginning of the cohort were age-matched with those who remained alive at the end of the cohort period. Treatment adherence was measured through pharmacy records. Patients who received at least 90% of the prescribed doses were considered adherent to treatment. Results: Of the 333 patients (52.8% age = 65 years, 67.9% male), 67.3% were adherent to treatment (adherence rate, 87.2%). Mortality was associated with lack of adherence (p = 0.04), presence of symptoms (mMRC = 2) and COPD treatment use. The death was associated with non-adherence, presence of symptoms and previous hospitalization. After adjustment, non-adherent patients to treatment were almost twice times likely to die compared to those adherents (Hazard Ratio (HR) 1.86; CI 1.16-2.98, p = 0.01). Conclusion: Non-adherence to treatment was associated with higher mortality among moderate-to-severe COPD patients treated in the Brazilian public health system. Strategies to monitor and optimize adherence should be strengthened to reduce COPD-related mortality.

Keywords: COPD; Treatment adherence; Mortality; Pharmaceutical care.

Background: Tuberculosis cure is dependent upon treatment adherence. Objective: To analyze the results of tuberculosis treatment in public health clinics in the city of Campinas, in the state of São Paulo, Brazil, during 2002. Method: From a cohort of 484 patients diagnosed with tuberculosis, we evaluated 436. Treatment outcomes were described for all patients, whether new patients or patients in retreatment, including those presenting the pulmonary form, with or without acquired immunodeficiency syndrome (AIDS) comorbidity. Results: The success rate was 68.6% (72.3% among non-AIDS patients and 57.6% among AIDS patients). Among new cases, the non-AIDS group presented a 2.2-times greater chance of presenting favorable results. In the AIDS group, no differences were observed between new patients and those in retreatment. Among the unfavorable outcomes, only lethality presented a difference (18.9% among AIDS patients and 8.0% among non-AIDS patients). In patients presenting the pulmonary form, the success rate was similar between those who were initially acid-fast bacilli positive and those who were not. Conclusion: The tuberculosis control program in Campinas presented low effectiveness. In comparison to the 2001 national cohort, success rates were higher for non-AIDS patients but lower for AIDS patients. The higher success rate among cases of tuberculosis without AIDS was primarily derived from the treatment of new cases. The unfavorable profile of tuberculosis patients co-infected with AIDS, characterized by the (18.9%) lethality and the (15.3%) noncompliance, were partially responsible for the lower success rate seen among such patients. It is notable that such high proportions of noncompliant patients were seen in a city providing easy access to treatment. In order to improve the program, medical teams should receive further training in supervised treatment, health education and techniques for interacting with patients, all of which will require considerable investment.

Keywords: Key words: Tuberculosis. Treatment Refusal. Retreatment. Acquired Immunodeficiency Syndrome. Comorbidity

Objective: To quantify the use of health care resources among patients enrolled in the Bahia State Asthma and Allergic Rhinitis Control Program. Methods: As of January of 2006, 1405 patients had enrolled in the program, which is carried out in four referral centers in the city of Salvador. These patients formed the basis of this retrospective/prospective, observational cohort study. The preliminary analysis involved 269 consecutive patients, all above the age of 12 and diagnosed with severe asthma. After being seen by pulmonologists, nurses, pharmacologists and psychologists, the patients received inhaled asthma medications. Based on patient interviews and charts, the year preceding enrollment in the program was compared with the first year enrolled in the program in terms of the following quantifiable parameters: hospital admissions; emergency room visits; courses of oral corticosteroids; and days of school/work missed due to asthma attacks. Results: In this sample of patients with severe asthma, enrollment in the program resulted in significant reductions in the number of emergency room visits and hospital admissions (of 85% and 90%, respectively). There were also reductions in the number of school/work days missed due to asthma attacks and in the number of courses of oral corticosteroids (of 86% and 67%, respectively). Conclusion: A program designed to control severe asthma in referral outpatient clinics and including pharmacological services at no charge can lead to a pronounced reduction in the demand for Unified Health Care System resources.

Keywords: Asthma/therapy; Asthma/prevention  control; Hospitalization; National Health System (BR)

Objective: To determine the prevalence of and factors associated with smoking among medical students, as well as to evaluate the profile of this group. Methods: A total of 316 medical students (98.7% of the total) at the University of Passo Fundo, in the city of Passo Fundo, Brazil, completed a self-report questionnaire with questions on tobacco intake and on attitudes related to smoking. In accordance with the World Health Organization guidelines, the students were classified as daily smokers, occasional smokers, former smokers or nonsmokers, those in the two first categories being considered active smokers. Results: We found that 16.5% of the students were active smokers (daily smokers, 5.4%; occasional smokers, 11.1%) and that 3.5% were former smokers. The mean age was 22.2 ± 2.4 years. Factors significantly associated with the smoking habit (p < 0.05) were male gender, paternal smoking, regular alcohol consumption and use of antidepressants or anxiolytics. For the majority (69.2%) of the smokers, the age at smoking onset was 15-19 years of age, and the main motivations to start smoking were self-initiative and influence of friends. The conceptualization of smoking as an illness was significantly higher among the nonsmokers. In 70.6% of the smokers, tobacco intake was 1-10 cigarettes a day. Among the smokers, 92.3% agreed that smoking is harmful to health, 67.3% had tried to quit smoking, 96.0% believed themselves able to do so, and 87.2% intended to quit smoking. Conclusions: The prevalence of smoking remains significant among medical students. Therefore, it is fundamental that we develop more effective strategies for smoking prevention and cessation in order to reduce the number of smokers among future doctors.

Keywords: Smoking; Prevalence; Students, medical; Behavior.

The direct costs incurred in managing patients with poorly controlled asthma are high and educational programs could decrease these costs. Aim: The objectives of this study were to compare the direct cost of the implementation of an educational program for adult asthmatic patients with the cost of the usual care delivered to asthmatics by specialists. Methods: Five years ago, a six-month study demonstrated that an educational program improved clinical outcomes (22 in educational program-E and 20 patients in control group-C). Throughout the educational intervention period all cases of hospitalization, emergency and regular calls involving patients from both groups were recorded. The basis for the values utilized in the calculation of costs was the healthcare database of the Brazilian government (DATASUS). The overall medication cost/patient in both groups was based on the amount of medication taken during the month preceding the last call. The final values were converted into US dollars. Results: The mean direct cost/patient in the educational (E) and control (C) groups and the difference (Δ) between groups were: hospitalizations (C = US$ 183, E = 0, Δ = US$ 183); emergency calls (C = US$ 14, E = US$ 5, Δ = US$ 9); regular calls (C = US$ 10, E = US$ 24, Δ = -US$ 14); medication (C = US$ 124,3, E = US$ 195,6, Δ = -US$ 71,3). The total cost was US$ 33/patient in group C and US$ 224/patient in group E with an average cost saving of US$ 107/patient. Conclusion: The expenses with medication is higher in E group because the regular use of maintenance drugs, however the study suggested that the application of the asthma education program reduced the total direct costs of asthma.

Keywords: Asthma. Cost-benefit. Patient education.

Objective: To describe the sociodemographic and clinical characteristics of individuals exposed to smoking or biomass smoke and followed at primary health care (PHC) centers across three states in Brazil. Methods: This was a cross-sectional multicenter study including patients followed at any of four PHC centers in Brazil. Patients = 35 years of age who were smokers or former smokers, or were exposed to biomass smoke were included, the exception being those with physical/mental disabilities and those who were pregnant. Face-to-face assessments included a questionnaire assessing clinical and sociodemographic characteristics, as well as the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnea scale. Results: Of a total of 737 patients, 56.3% were female and 64.2% were White, with a mean age of 57.7 ± 11.8 years. Most (54.4%) had < 9 years of schooling, 50.2% had low socioeconomic status, and 71.5% were overweight/obese. Smokers accounted for 43.4% of the study sample, whereas 15.0% had no direct exposure to cigarette smoke. Common symptoms included cough, in 37.3%; wheezing, in 33.8%; and phlegm, in 27.4%. Most (75.1%) of the study participants had mMRC dyspnea scale scores of 0 or 1. CAT scores were 0-10, in 40.2%; 11-20, in 44.6%; 21-30, in 14.1%; and 31-40, in 1.1%. Binary logistic regression showed that sex and age significantly impacted mMRC dyspnea scale predictions, whereas BMI and socioeconomic status influenced CAT predictions. Common comorbidities included hypertension, in 51.3%; depression, in 27.4%; and diabetes, in 24.3%. No association was found between hypertension and obesity or smoking, or between diabetes and obesity or smoking. Conclusions: PHC patients with risk factors such as smoking and exposure to biomass smoke have a high comorbidity burden, with over half experiencing mild to moderate quality-of-life impacts. This study emphasizes the need for targeted preventive measures in PHC settings.

Keywords: Smoking; Risk factors; Biomass; Primary health care.

Objective: To evaluate the effect that the distribution of food baskets to tuberculosis (TB) patients has on treatment outcomes at a primary health care clinic. Methods: Retrospective comparative study of the medical and social aspects of 142 patients at a primary health care clinic in the city of Duque de Caxias, Brazil. The patients were divided into two groups: the first group included 68 patients treated with standard regimens (between September of 2001 and December of 2003); and the second group included 74 patients treated with the same regimens but also receiving food baskets on a monthly basis (between January of 2004 and July of 2006). Results: The statistical comparison between the two groups revealed that the cure rate was higher in the group receiving the food baskets (87.1% vs. 69.7%), whereas the rate of noncompliance was markedly lower (12.9% vs. 30.3%). Conclusions: The results indicate that the distribution of food baskets can be a useful strategy to improve compliance with TB treatment at primary health care clinics.

Keywords: Tuberculosis; Nutritional support; Treatment outcome; Ambulatory health services.

Objective: To assess the influence of the COVID-19 pandemic on hospital admissions (HA), intra-hospital deaths (HD), and intra-hospital lethality rates (HL) related to respiratory diseases (RD) other than COVID-19 in Brazil. Methods: This observational time-series study was conducted through comparative analyses of the HA, HD, and HL related to non-COVID-19 RD registered between March and December 2020 by the Brazilian Unified Public Health System on the DataSUS Tabnet platform, using as reference the values recorded in the same period of 2019 and those projected by linear regression methods for 2020, considering the period from 2015 to 2019. The adopted statistical significance level was 5% (p < 0.05). Results: Compared to 2019, in 2020, there was a 42% decrease in HA and a 7.4% decrease in total HD related to non-COVID-19 RD, followed by a 60% increase in HL associated with this group of diseases. The HA and HL registered in 2020 differed significantly from the projected trend for that year by linear regression (p < 0.05). Of note, a significant reduction in hospitalizations due to asthma (-46%), chronic obstructive pulmonary disease (-45%), bronchiectasis (-54%), pneumonia (-46%), and acute bronchitis (-73%) was observed. Conclusions: During the first 8 months of the pandemic, there was a decline in HA and an increase in HL related to non-COVID-19 RD in Brazil, which can hypothetically reflect logistical challenges and delays in the management of this group of diseases.

Keywords: Pulmonary disease, COVID-19, non-COVID-19, Hospitalization, Mortality.