The objective of this thesis is to define the role of employers in the prevention of chronic non-communicable diseases, more precisely to explore the existing effective opportunities for the prevention of chronic non-communicable diseases that employers can provide at workplace. Consequently, find out the attitudes of employers in the Czech Republic to these prevention interventions possibilities in comparison with the attitudes of employees. Finally, demonstrate the effectiveness of the selected prevention tool in a case study of one employer. The theoretical part of the thesis defines the main non-communicable diseases, their prevalence and incidence on a global scale and in the Czech Republic. The main risk factors of these diseases are described with an emphasis on modifiable behavioural risk factors. The review of the latest studies summarizes the evidence-based information on the impact of key behavioural lifestyle factors in the prevention of chronic non-communicable diseases. The possibilities to reduce risk factors of non-communicable diseases by employers are discussed in the analysis of available up-to-date scientific literature. The aim of the analysis was to identify and clearly define the key areas of employers' interventions and find out to what extent the employers in the Czech...

University of Macau / Faculty of Social Sciences and Humanities / Department of Government and Public Administration

S'han estudiat 1003 pacients amb el diagnòstic de Malaltia Vascular Cerebral (MVC) aguda ingressats a la unitat de neurologia de l'Hospital Josep Trueta de Girona en el període de gener de 2005 a juliol de 2007. S'ha realitzat un estudi de cohorts prospectiu d'un any en 110 pacients que eren fumadors en el moment de l'ictus. Un elevat percentatge dels pacients afectats de MVC aguda presenten factors de risc vascular que es poden evitar com el consum de tabac o d'alcohol, i factors de risc vascular que cal controlar com la hipertensió, la dislipèmia, la diabetis o la cardiopatia. Només 4 de cada 10 pacients fumadors diagnosticats d'ictus havien abandonat l'hàbit un any després de presentar la MVC aguda. Les variables que millor prediuen la cessació tabàquica en aquests pacients són la localització de la lesió a l'ínsula cerebral i la intenció de deixar de fumar prèvia a l'ictus. / Patients with a diagnosis of acute cerebrovascular disease (CVD) admitted to the Neurology Department of the Joseph Trueta Hospital of Girona between January 2005 and July 2007 were included (n: 1003). A one-year prospective cohort study of 110 patients who were smokers at the time of having the CVD was conducted. A high percentage of patients affected by acute CVD have avoidable vascular risk factors such as the use of tobacco and alcohol, and vascular risk factors which need to be controlled such as hypertension, dyslipidemia, diabetes and cardiopathy. Only 4 out of 10 patients diagnosed with stroke who were smokers had given up the habit one year after having an acute CVD. Patients who have the intention of stopping smoking before having the stroke and/or those that have a stroke lesion affecting the insular cortex are more likely to stop smoking. These factors are therefore the variables which best predict giving up smoking in these patients.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The aim of the present study was to examine smoking behaviour and motivation for smoking cessation in patients at a dental clinic. Another aim was to examine if the patients had been asked by the dental staff regarding their smoking habits. Twenty-two patients from a student clinic and twenty-one patients from a Swedish Public Dental Service Clinic in southern of Sweden participated in the study. Participants consisted of eighteen women and twenty-five men. Data collection was carried out using a questionnaire that was directed at smokers. The questionnaire was answered in connection with the visit to the dental hygienist. The patients smoked between eight and twelve cigarettes per day and had on average smoked between 5 -15 years. More than half of the patients started smoking because of pressure from friends. In the future the patients would consider quitting smoking to avoid oral health diseases. Most of the patients wanted to try without external aid. The general health and oral health was perceived as good, or very good by 43 respondents. The most common oral health problems were dry mouth, dark brown coating on the teeth and gingivitis. This survey shows that many of those who currently smoke started smoking because of their surroundings. Giving up smoking to avoid oral health diseases was very important / important to the respondents. The motivation for smoking cessation was different among the patients. It was difficult for many patients to stop smoking. The survey also showed that more dental hygienists than dentists asked their patients about smoking habits and informing them about smoking cessation. / Syftet med denna studie var att undersöka rökvanor och motivation till rökavvänjning hos patienter vid tandvårdsklinik. Ytterligare ett syfte var att undersöka om patienterna blivit tillfrågade av tandvårdspersonalen om sina rökvanor. Tjugutvå patienter från en studentklinik och tjuguen patienter från en folktandvårdsklinik i södra Sverige deltog i studien. Deltagarna bestod av 58 % män och 42 % kvinnor. Datainsamlingen genomfördes med användning av en enkät som var riktad till rökare. Enkäten besvarades i samband med ett tandhygienistbesök. Patienterna uppgav att de rökte mellan åtta och tolv cigaretter per dag och hade rökt mellan  5-15 år. Mer än hälften av patienterna började röka på grund av grupptryck eller kompisar. Patienterna kunde tänka sig att sluta röka i framtiden, för att undvika munhälsoskador och dem flesta av rökarna vill försöka sluta röka utan hjälp. Den allmänna hälsan respektive munhälsan upplevdes som bra eller mycket bra av samtliga 43 respondenter. De vanligaste problemen med munhälsan var muntorrhet, svarta bruna beläggningar på tänderna samt gingivit. Denna enkätstudie visar att många av dem som rökte började röka på grund av att personer i deras omgivning rökte. Att sluta röka för att undvika munhälsoskador var mycket viktigt/viktigt för patienterna. Motivationen till rökstopp varierade bland patienterna. Det var svårt för många av de att hålla sig rökfria. Studien visar även att det var fler tandhygienister än tandläkare som frågade patienterna om deras rökvanor och informerade om rökavvänjning.

Hintergrund: Das Thema Rauchen und Tabakentwöhnung ist in der medizinischen Lehre vieler Universitäten unterrepräsentiert. Ziel der Untersuchung war es, den Wissensstand der Grazer und Bratislavaer Medizinstudierenden diesbezüglich zu untersuchen. Methode: Im Zeitraum vom WS 2007/2008 bis WS 2008/2009 wurden Medizinstudierende beider Universitäten mittels eines standardisierten dreiseitigen Fragebogens befragt. Ergebnisse: 1356 Probanden nahmen an der Befragung teil. Die Raucherquoten der befragten Medizinstudierenden lagen bei 21,6% für Graz und 24,9% für Bratislava. Eine adäquate Repräsentation des Themas in der Lehre beider Universitäten konnte nicht nachgewiesen werden. Die Mehrheit der Befragten beider Universitäten kannte die durch das Rauchen bedingte Mortalität nicht; Nikotin wurde als Hauptrisikoinhaltsstoff beim Rauchen betrachtet. Die Mehrheit der Studierenden beider Universitäten schätzte die Willenskraft des Patienten für einen erfolgreichen Rauchstopp als entscheidender als Entwöhnungsprogramme in Kombination mit einer Nikotinersatztherapie ein. Schlussfolgerung: Der Wissensstand der befragten Medizinstudierenden in Bezug auf das Thema Rauchen und Tabakentwöhnung war unzureichend. Die Lehre an den Universitäten bezüglich dieses Themas muss verbessert werden.

Objetivo: Avaliar a influência de mudanças no hábito de fumar sobre o ganho de peso gravídico materno. Métodos: Foram entrevistadas 5.564 gestantes com 20 anos ou mais, sem diabetes mellitus prévio em serviços de pré-natal geral de seis capitais brasileiras, entre 1991 e 1995, e acompanhamos, através de revisão de prontuários, as gestações até o parto, identificando 4.000 gestantes com peso pré-gravídico relatado, peso medido no terceiro trimestre, hábito de fumar e época de sua eventual modificação, quando disponíveis. Resultados: Entre as gestantes ex-fumantes (915, 23% do total), 240 (26%) pararam de fumar durante a gravidez. A mediana de cigarros/dia das que continuaram fumantes (717, 18%) foi reduzida de 10 para 5 após o início da gravidez. Após ajustar para idade, escolaridade, cor da pele, IMC pré-gravídico, paridade e centro clínico, as ex-fumantes ganharam 1.030 g (IC95% 590 a 1.460) a mais que as nunca fumantes, sendo maior a diferença (1.540, IC95% 780 a 2.300 g) nas que pararam após a concepção. O ganho do peso na gravidez se correlacionou, tanto em fumantes quanto em ex-fumantes, com o número de cigarros diminuídos na gravidez. Conclusão: Diminuir ou parar de fumar na gravidez, embora importante para uma gestação saudável, é fator de risco para ganho de peso materno. / Objective: Evaluate the association of changes in smoking habit with maternal weight gain. Methods: We interviewed 5564 pregnant women > 20 years, without prior diabetes mellitus, during a second trimester pre-natal visit in general prenatal care clinics in 6 Brazilian cities, from 1991 to 1995, and followed them, through chart review, to term. We now report associations in the 4000 women who had complete information concerning pre-pregnancy and 3rd trimester weight, smoking status and its eventual changes during pregnancy. Results: Of women who stopped smoking (915, 23% do total), 240 (26,2%) stopped during pregnancy. The median number of cigarettes smoked/day among those who continued (717, 18%) decreased from 10 to 5 with pregnancy. In linear regression models adjusting for age, educational level, ethnicity, pre-pregnancy body mass index, parity and clinical center, exsmokers gained 1030 (95%CI 590 – 1460) grams more than never smokers, this difference being greater – 1540 (95%CI 780 – 2300) grams – in those who quit while pregnant. The size of weight gain in both smokers and ex-smokers was proportional to the quantitative reduction in daily number of cigarettes smoked during pregnancy (p=0.007). Conclusion: Stopping to smoke or decreasing the quantity of cigarettes smoked in pregnancy, although important for maternal and child health, is a risk factor for maternal weight gain.

Objetivo: Avaliar a influência de mudanças no hábito de fumar sobre o ganho de peso gravídico materno. Métodos: Foram entrevistadas 5.564 gestantes com 20 anos ou mais, sem diabetes mellitus prévio em serviços de pré-natal geral de seis capitais brasileiras, entre 1991 e 1995, e acompanhamos, através de revisão de prontuários, as gestações até o parto, identificando 4.000 gestantes com peso pré-gravídico relatado, peso medido no terceiro trimestre, hábito de fumar e época de sua eventual modificação, quando disponíveis. Resultados: Entre as gestantes ex-fumantes (915, 23% do total), 240 (26%) pararam de fumar durante a gravidez. A mediana de cigarros/dia das que continuaram fumantes (717, 18%) foi reduzida de 10 para 5 após o início da gravidez. Após ajustar para idade, escolaridade, cor da pele, IMC pré-gravídico, paridade e centro clínico, as ex-fumantes ganharam 1.030 g (IC95% 590 a 1.460) a mais que as nunca fumantes, sendo maior a diferença (1.540, IC95% 780 a 2.300 g) nas que pararam após a concepção. O ganho do peso na gravidez se correlacionou, tanto em fumantes quanto em ex-fumantes, com o número de cigarros diminuídos na gravidez. Conclusão: Diminuir ou parar de fumar na gravidez, embora importante para uma gestação saudável, é fator de risco para ganho de peso materno. / Objective: Evaluate the association of changes in smoking habit with maternal weight gain. Methods: We interviewed 5564 pregnant women > 20 years, without prior diabetes mellitus, during a second trimester pre-natal visit in general prenatal care clinics in 6 Brazilian cities, from 1991 to 1995, and followed them, through chart review, to term. We now report associations in the 4000 women who had complete information concerning pre-pregnancy and 3rd trimester weight, smoking status and its eventual changes during pregnancy. Results: Of women who stopped smoking (915, 23% do total), 240 (26,2%) stopped during pregnancy. The median number of cigarettes smoked/day among those who continued (717, 18%) decreased from 10 to 5 with pregnancy. In linear regression models adjusting for age, educational level, ethnicity, pre-pregnancy body mass index, parity and clinical center, exsmokers gained 1030 (95%CI 590 – 1460) grams more than never smokers, this difference being greater – 1540 (95%CI 780 – 2300) grams – in those who quit while pregnant. The size of weight gain in both smokers and ex-smokers was proportional to the quantitative reduction in daily number of cigarettes smoked during pregnancy (p=0.007). Conclusion: Stopping to smoke or decreasing the quantity of cigarettes smoked in pregnancy, although important for maternal and child health, is a risk factor for maternal weight gain.

abstract: Cigarette smoking remains a major global public health issue. This is partially due to the chronic and relapsing nature of tobacco use, which contributes to the approximately 90% quit attempt failure rate. The recent rise in mobile technologies has led to an increased ability to frequently measure smoking behaviors and related constructs over time, i.e., obtain intensive longitudinal data (ILD). Dynamical systems modeling and system identification methods from engineering offer a means to leverage ILD in order to better model dynamic smoking behaviors. In this dissertation, two sets of dynamical systems models are estimated using ILD from a smoking cessation clinical trial: one set describes cessation as a craving-mediated process; a second set was reverse-engineered and describes a psychological self-regulation process in which smoking activity regulates craving levels. The estimated expressions suggest that self-regulation more accurately describes cessation behavior change, and that the psychological self-regulator resembles a proportional-with-filter controller. In contrast to current clinical practice, adaptive smoking cessation interventions seek to personalize cessation treatment over time. An intervention of this nature generally reflects a control system with feedback and feedforward components, suggesting its design could benefit from a control systems engineering perspective. An adaptive intervention is designed in this dissertation in the form of a Hybrid Model Predictive Control (HMPC) decision algorithm. This algorithm assigns counseling, bupropion, and nicotine lozenges each day to promote tracking of target smoking and craving levels. Demonstrated through a diverse series of simulations, this HMPC-based intervention can aid a successful cessation attempt. Objective function weights and three-degree-of-freedom tuning parameters can be sensibly selected to achieve intervention performance goals despite strict clinical and operational constraints. Such tuning largely affects the rate at which peak bupropion and lozenge dosages are assigned; total post-quit smoking levels, craving offset, and other performance metrics are consequently affected. Overall, the interconnected nature of the smoking and craving controlled variables facilitate the controller's robust decision-making capabilities, even despite the presence of noise or plant-model mismatch. Altogether, this dissertation lays the conceptual and computational groundwork for future efforts to utilize engineering concepts to further study smoking behaviors and to optimize smoking cessation interventions. / Dissertation/Thesis / Doctoral Dissertation Bioengineering 2014

Submitted by Lígia Ângelo Tavares (ligia.atavares@gmail.com) on 2018-05-25T15:51:29Z No. of bitstreams: 1 DISSERAÇÃO - LIGIA SCHWARZMEIER - MESTRADO.pdf: 3091413 bytes, checksum: 654a7ae7d828dff5e2f782ebb4eb3c96 (MD5) / Approved for entry into archive by Silvana Alvarez null (silvana@ict.unesp.br) on 2018-05-25T19:44:25Z (GMT) No. of bitstreams: 1 schwarzmeier_la_me_sjc.pdf: 3091413 bytes, checksum: 654a7ae7d828dff5e2f782ebb4eb3c96 (MD5) / Made available in DSpace on 2018-05-25T19:44:25Z (GMT). No. of bitstreams: 1 schwarzmeier_la_me_sjc.pdf: 3091413 bytes, checksum: 654a7ae7d828dff5e2f782ebb4eb3c96 (MD5) Previous issue date: 2018-03-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo desta pesquisa foi investigar a frequência de micronúcleos e anomalias metanucleares na mucosa bucal de vaporizadores de cigarro eletrônico e de fumantes de cigarro industrializado, e comparar com ex-fumantes e não fumantes para determinar se existe diferença no dano citogenético e citotóxico, bem como se o dano diminui após a cessação tabágica. Os pacientes foram divididos em 4 grupos: Controle; E-cig; Fumante e Ex-fumante. Os critérios de inclusão adotados foram: ausência de histórico de neoplasia maligna bucal e ausência de quaisquer sinais clínicos visíveis de alteração no local avaliado. Foi realizada avaliação quanto ao grau de dependência nicotínica, por meio do Teste de Fagerström para Dependênca à Cigarro e Escore de Consumo Situacional Issa, e quanto ao perfil tabágico dos pacientes. A mensuração de CO expirado foi utilizada como critério objetivo de avaliação de consumo de tabaco, bem como a concentração de cotinina no sangue capilar dos pacientes avaliados. As amostras foram coletadas por meio de citologia esfoliativa da região de bordo lateral de língua e soalho bucal. Os esfregaços obtidos foram fixados com spray alcoólico e as lâminas coradas pelo método de Feulgen. Posteriormente, foi realizada a investigação dos micronúcleos e das anomalias metanucleares. Para a comparação dos dados não paramétricos foram utilizados os testes Kruskal-Wallis e Mann-Whitney. Já para as correlações e associações entre os dados, foram utilizados o teste da correlação de Spearman e o Teste Exato de Fisher, respectivamente. Foi adotado um nível de significância de 5% para todos os testes. A partir dos resultados, observou-se diferença significante entre os grupos E-cig e Controle (p=0,0072), e também entre os grupos Fumante e Controle (p=0,0004), no total de MN. Em contrapartida os grupos E-cig e Ex-fumante foram semelhantes, enquanto que o grupo Fumante foi significativamente maior que o grupo Ex-fumante (p=0,0370) também no total de MN. Também foi possível observar diferença significante entre os grupos E-cig e Ex-fumante, bem como entre os grupos E-cig e Controle em todas as anomalias metanucleares, exceto cariorrexe. Os grupos Fumante e Ex-fumante foram diferentes em cariorrexe (p=0,0517), e nuclear bud (p=0,0470) apenas, e o grupo Fumante foi significativamente maior que o grupo Controle em todas as anomalias metanucleares. A comparação entre os grupos E-cig e Fumante não foi realizada, devido à ingestão de altas doses de bebidas alcoólicas no grupo E-cig. O tabagismo promove danos citotóxicos e citogenéticos e o uso de E-cig associado ao álcool parece causar genotoxicidade e citotoxicidade. A cessação tabágica promove reversibilidade dos danos causados anteriormente. / The objective of this research was to investigate the frequency of micronuclei and metanuclear anomalies in the oral mucosa of electronic cigarette vaporizers and smokers of industrialized cigarettes and to compare with former smokers and nonsmokers to determine if there is a difference in cytogenetic and cytotoxic damage, as well as if it decreases after smoking cessation. The patients were divided into 4 groups: Control; E-cig; Smoker; and Former smoker. The inclusion criteria adopted were: absence of a history of oral malignancy and absence of any visible clinical signs of alteration at the evaluated site. An assessment was made of the degree of nicotinic dependence, using the Fagerström Test for Cigarette Dependence and the Issa Situational Consumption Score, and of the smoking profile of the patients. Measurement of expired CO was used as the objective criterion for the evaluation of tobacco consumption as well as the concentration of cotinine in the capillary blood of the evaluated patients. The samples were collected from the tongue lateral region and floor of the mouth by means of exfoliative cytology. The smears obtained were fixed with alcoholic spray and the slides were stained by the Feulgen method. Subsequently, the investigation of the micronuclei (MN) and metanuclear anomalies was carried out. For the non-parametric data, the Kruskal-Wallis and Mann-Whitney tests were performed. For the correlations and associations between the data, the Spearman correlation test and the Fisher Exact Test were respectively used. A significance level of 5% was adopted for all tests. From the results, we observed a significant difference between groups E-cig and Control (p = 0.0072), and also between groups Smoker and Control (p = 0.0004), in the total of MN. In contrast, groups E-cig and Former smoker were similar, whereas the group of Smoker was significantly higher than Former smoker (p = 0.0370) also in the total of MN. It was also possible to observe a significant difference between E-cig and Former smoker, as well as between E-cig and Control in all metanuclear anomalies, except for karyorrhexis. Already Smoker and Former smoker, they were different in karyorrhexis (p = 0.0517), and nuclear bud (p = 0.0470) only, and Smoker was significantly higher than Control in all metanuclear abnormalities. The comparison between groups E-cig and Smoker could not be performed due to the ingestion of high doses of alcoholic beverages in E-cig group. Smoking promotes cytotoxic and cytogenetic damage and the use of alcohol-associated electronic cigarettes appears to cause genotoxicity and cytotoxicity. Smoking cessation promotes reversibility of previously caused harm.