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This thesis deals with "Smoking of senior Citizens". Smoking of tobacco is the most significant reason of illnesses and early death in the Czech Republic. Reduction of smoking is a basic condition for decrease of deaths caused by tumour and cardiac diseases.The goal of the thesis is to monitor prevalence of smoking in senior citizens and detect their awareness of smoking. 206 respondents at the age of sixty and above paricipated in this research. 50 % of these people vrote that they had never snoked. 20 % of informants were active smokers, at the time of this survey, and 55 % of senior citizens wrote that they considered nicotine addiction to be a disease.The author tries to verify the hypothesis concerning smoking of senior citizens who suffer from chronic disease. 44 % of the respondents, who were active smokers at the time of the survey, suffered from chronic disease. The researcher uses the next hypothesis because she wants to confirm the fact that senior citizens have a positive attitude to prohibition of smoking in the restaurants and in public areas. The research verified this hypothesis - 72 % of the informants had a positive attitude to prohibition of smoking in public.

Os Transtornos por Uso de Substâncias (TUS) são propostos pela Associação Norte-Americana de Psiquiatria e englobam diversas dependências químicas, incluindo o tabagismo e a dependência de crack. O uso de crack tem aumentado consideravelmente nos últimos anos, segundo dados de levantamentos brasileiros e mundiais. Com mecanismo de ação semelhante ao da cocaína, porém com efeito mais rápido, o crack é uma droga que causa grave prejuízo a seus usuários e conduz à dependência em pouco tempo. O tabagismo também é uma condição bastante prevalente no mundo inteiro, sendo que os prejuízos relacionados a esse transtorno envolvem principalmente o desenvolvimento de doenças respiratórias e câncer. Diversos trabalhos têm buscado identificar fatores de suscetibilidade a esses transtornos, sendo que estudos de associação envolvendo genes do sistema de resposta a estresse vêm ganhando importância. O eixo Hipotálamo- Pituitária-Adrenal (HPA) é o sistema de resposta a estresse mais conhecido em humanos e alvo do presente trabalho, uma vez que o funcionamento dessa cascata de sinalização da produção de cortisol pode desempenhar um papel relevante no desenvolvimento de psicopatologias. Além disso, o eixo HPA pode ser considerado um mediador da relação entre situações adversas na infância e o surgimento de TUS. O objetivo desse trabalho, portanto, é investigar o papel de polimorfismos no gene CRHR1 (que codifica o receptor tipo 1 do hormônio liberador de corticotrofina – CRH, hormônio inicial do eixo HPA) sobre o desenvolvimento e características clínicas da dependência química. Para isso, foram realizados dois estudos, envolvendo amostras de mulheres. No primeiro artigo, a partir de três amostras – (1) 136 usuárias de crack, (2) 55 tabagistas e (3) 262 voluntárias saudáveis – foram identificadas diferenças de freqüências alélicas e genotípicas do SNP rs12944712; além disso, a análise de haplótipos envolvendo tal SNP e o rs110402 revelou maior frequência do haplótipo contendo o alelo G nos dois polimorfismos nos grupos de usuárias de crack e tabagistas. No segundo artigo, foi avaliado o efeito da interação geneambiente envolvendo os mesmos polimorfismos e situações adversas na infância – estimada pela escala Childhood Trauma Questionnaire (CTQ) –sobre características clínicas da amostra de usuárias de crack, como craving e gravidade da dependência – estimados, respectivamente, pelas escalas Cocaine Selective Severity Assessment (CSSA) e Addiction Severity Index (ASI6). A análise não revelou uma interação significativa. A presente dissertação, portanto, revela um efeito do gene CRHR1 sobre o desenvolvimento de TUS, embora esse efeito pareça não se manifestar sobre a gravidade. Mais estudos são necessários visando esclarecer o real efeito do gene e do eixo HPA como um todo sobre os fenótipos e comportamentos aditivos, bem como os mecanismos subjacentes a essa relação. / The Substance Use Disorders (SUD) are proposed by the American Psychiatric Association and comprise several addictions, including tobacco and crack cocaine smoking. The prevalence of crack cocaine dependence has grown considerably, according to survey data from Brazil and worldwide. With mechanism of action similar to cocaine but with faster effect, crack is a drug that causes severe impairments to its users and leads to dependence in a short time. Tobacco smoking is also a highly prevalent condition worldwide, and the impact related to this disorder includes cancer and respiratory diseases. Several studies have attempted the identification of susceptibility factors to these disorders, and association studies involving stress response system genes have been performed. The Hypothalamic-Pituitary-Adrenal (HPA) axis is the best known stress response system, and the signaling cascade production of cortisol may play a role in the development of psychopathology. In addition, HPA axis can be considered a mediator of the relationship between early life adversity and SUD. The aim of this study is to investigate the role of polymorphisms in CRHR1 gene (encoding the corticotrophin releasing factor – CRH – receptor type 1, an initial factor in HPA axis response) on the development and clinical traits of drug dependence. Two studies were conducted on women samples. In the first article, three groups were compared - (1) 136 crack smokers, (2) 55 tobacco smokers and (3) 262 healthy volunteers. Differences in allele and genotype frequencies of the SNP rs12944712 were identified; in addition, the haplotype analysis involving this SNP and rs110402 revealed a higher frequency of the haplotype containing G allele in both polymorphisms in the groups of nicotine dependents and crack smokers. In the second article, we evaluated the effect of a gene-environment interaction involving the same polymorphisms and childhood adversity - estimated by Childhood Trauma Questionnaire (CTQ) scale – on clinical characteristics of the sample of crack users, such as craving and severity of dependence - estimated respectively by the Cocaine Selective Severity Assessment (CSSA) and Addiction Severity Index (ASI6) scales. The analysis did not reveal a significant interaction. This dissertation thus shows an effect of CRHR1 genepolymorphism on the development of SUD, although this effect does not seem to impact disorder severity. More studies are needed in order to clarify the actual effect of the gene and of the HPA axis as a whole on addictive behaviors.

A tomada de decisão entre conseqüências imediatas ou de longo prazo tem sido estudada através do Modelo de Desvalorização pelo Atraso (DA). Investigou-se a DA em situações apetitivas e aversivas envolvendo valores monetários hipotéticos em fumantes, fumantes em tratamento em uma unidade de saúde e não fumantes. Participantes (20 fumantes, 20 fumantes em tratamento e 20 não fumantes), homens e mulheres, responderam a uma tarefa experimental de DA, ao questionário de tolerância de Fagerström, ao questionário sobre o comportamento de fumar e ao Teste de Triagem do Envolvimento com Álcool, Tabaco e Outras Substâncias (ASSIST). A DA em situações apetitivas (mas não em aversivas) foi maior para fumantes do que não fumantes e os fumantes em tratamento apresentaram uma DA intermediária. Os fumantes em tratamento podem ser um subgrupo menos impulsivo de fumantes ou a decisão de parar de fumar influenciou estratégias de tomada de decisão mais amplas. A DA pode ser testada como preditora do sucesso da cessação do tabagismo. / Delay Discounting Model (DD) has been used to study decision-making between immediate or delayed consequences. This research aims to study DD for hypotetical monetary gains (appetitive) and losses (aversive) in smokers, smokers who seeked out treatment to quit in a public outpatient clinic and non-smokers. Male and female participants (20 S, 20 ST and 20 NS) answer the DD task, the Fagerström Tolerance Questionnaire, a Smoking Behavior Questionnaire, and the Alcohol Smoking and Substance Involvement Screening Test (ASSIST). In the appetitive condition (but not in the aversive), smokers showed a greater DD than non-smokers and smokers on treatment showed an intermediate DD. Smokers on treatment might either be a less impulsive subgroup of smokers or the decision to quit smoking changed a broader strategy of decision making. Future studies could test DD as an outcome predictor in smoking cessation treatment.

O câncer de boca e faringe é um importante problema de saúde pública, apresentando cerca de 400 mil novos casos ao ano no mundo. O presente estudo objetiva estudar o papel da alimentação no acomentimento por câncer de boca e orofaringe. Foi realizado estudo caso-controle de base hospitalar pareado por sexo e idade (com tolerância de cinco anos para mais ou para menos de diferença entre casos e controles). A amostra foi composta por 296 casos com diagnóstico de câncer de boca ou orofaringe e 296 controles sem câncer atendidos, entre os anos de 2006 e 2008, em quatro hospitais na cidade de São Paulo: Instituto do Câncer Arnaldo Vieira de Carvalho da Santa Casa de Misericórdia de São Paulo, Hospital A. C. Camargo, Hospital Heliópolis da Secretaria de Estado da Saúde de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os dados foram coletados por meio de entrevista e a dieta foi avaliada utilizando-se um questionário de frequência alimentar. Após análise de regressão logística condicional ajustada por sexo, idade, renda, hábito de fumar e ingestão de bebidas alcoólicas, verificou-se associação inversa entre a chance de câncer de boca e orofaringe e a ingestão total de vegetais crús (Odds Ratio=0,19; p tendência<0,001) e frutas (OR=0,15; p tend<0,001) e associação direta da doença com a ingestão de alimentos de origem animal ou fritos, como o bacon (OR=26,38; p tend<0,001), a carne boniva (OR= 3,77; p tend=0,004), os ovos (OR=22,23; p tend<0,001) e frituras em geral (OR= 5,53; p tend<0,001). A avaliação do efeito dos alimentos estratificada pelo hábito de fumar apontou para uma possível relação entre o tabaco e a ingestão de frutas e vegetais. Os resultados do presente estudo são compativeis com a hipótese de que a alimentação rica em alimentos fritos e de origem animal poderia aumentar a chance de câncer de boca e orofaringe, enquanto a ingestão frequente de frutas e verduras poderia ser protetora contra a doença. Essa informação é relevante para a tomada de medidas de prevenção contra o câncer de boca e orofaringe. / Oral and oropharyngeal cancer is an important public health problem, which involves near 400 thousand new cases each year worldwide. This study aimed at assessing the association between dietary habits and the incidence of oral and oropharyngeal cancer. We performed a hospital-based case-control study with concurrent pairing by gender and age (±5 years). The sample comprised 296 cases diagnosed with oral or oropharyngeal cancer and 296 controles without cancer Who were assisted in four hospitals in the city of São Paulo, Brazil, from 2006 to 2008: do Cancer Institute Arnaldo Vieira de Carvalho, A. C. Camargo Hospital, Heliópolis Hospital (São Paulo State Health Department) and Clinics Hospital (School of Medicine, University of São Paulo). Information on diet was gathered during an interview, and used a food frequency questionnaire. Conditional logistic regression adjusted for gender, age, income, tobacco smoking and alcohol drinking allowed the identification of an inverse association between oral and oropharyngeal cancer and the intake of raw vegetables (Odds Ratio=0.19; p for trend<0.001) and fruits (OR=0.15; p trend<0.001) and a direct association between the disease and fat foods, as bacon (OR=26.38; p trend<0.001), meat (OR= 3.77; p trend=0.004), eggs (OR=22.23; p trend<0.001) and deep fried foods (OR= 5.53; p trend<0.001). The stratification of subjects according to smoking habits allowed the identification of a likely higher protective effect of fruits and raw vegetables among smokers. These results are consistent with the hypothesis that food rich in animal and saturated fat would increase the risk of oral and oropharyngeal cancer, whereas the frequent intake of fruits and raw vegetables would be protective against the disease. This information is relevant for the instruction of preventive interventions against oral and oropharyngeal cancer.

Orientadores: Enilson Antonio Sallum, Francisco Humberto Nociti Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T03:11:36Z (GMT). No. of bitstreams: 1 Carvalho_MarceloDiniz_M.pdf: 838460 bytes, checksum: d0aff5d2298e732ab336cd58428d002a (MD5) Previous issue date: 2005 / Resumo: O objetivo do presente estudo foi avaliar a influência da fumaça de cigarro na presença da deficiência de estrógeno sobre o reparo ósseo ao redor de implantes de titânio. Foram utilizadas 45 ratas (Wistar) divididas em 3 grupos: ovariectomia simulada (SHAM, n=15), ovariectomia (OVX, n=15) e exposição a fumaça de cigarro (EFM) associada a OVX (EFM+OVX, n=15). No grupo EFM+OVX, a EFM iniciou-se 60 dias antes da colocação dos implantes e manteve-se até o fim do período experimental. Todos animais receberam um implante em uma das tíbias e no mesmo período cirúrgico foram realizadas as OVX e SHAM. Sessenta dias após as cirurgias, os animais foram mortos e secções não descalcificadas obtidas para avaliação dos seguintes parâmetros: porcentagem de osso na região adjacente ao implante (500 µm) (OA), porcentagem de preenchimento ósseo dentro dos limites das roscas de cada implante (PR) e porcentagem de contato ósseo direto com a superfície do implante (CD). As medidas foram obtidas separadamente para região A (cortical) e B (medular). Os resultados deste estudo mostraram que, na região A, o grupo EFM+OVX apresentou uma menor OA e um menor CD quando comparado aos outros grupos (p<0,05). Na região B, menores valores de CD e OA foram observados no grupo EFM+OVX, seguidos dos grupos OVX e SHAM, respectivamente (p<0,05). Já para PR, os grupos EFM+OVX e OVX se comportaram de maneira semelhante diferindo do grupo SHAM (p<0,05). Conclui-se que, dentro dos limites deste estudo, a exposição à fumaça de cigarro amplificou os efeitos da deficiência de estrógeno, prejudicando a qualidade e o reparo ósseo ao redor de implantes de titânio inseridos em tíbias de ratas ovariectomizadas / Abstract: Background: Smoking has been considered one of the main risk factors for osteoporosis. Cigarette smoke inhalation and estrogen deficiency have been proving to negatively affect bone healing around titanium implants. Thus, the purpose of this study was to investigate the effect of cigarette smoking inhalation on bone around titanium implants in estrogen deficiency rats. Methods: Fourth-five female wistar rats had the tibia surface exposed for the placement of a screw-shaped titanium implant (4.0mm in length; 2.2mm in diameter). The animals were randomly assigned to group SHAM (sham operated rats / n=15), group OVX (ovarectomized rats / n=15) and group CSI+OVX (2 months of intermittent cigarette smoke inhalation (CSI) prior and 2 months after implant placement in ovariectomized rats/ n=15). The implants were placed at the same time of OVX or Sham surgery. After 60 days the animals were sacrificed and undecalcified sections obtained. Percentage of bone in a 500mm-wide zone lateral to the implant (BO), bone filling within the limits of the threads (BF) and bone-to-implant contact (BC) was measured in cortical (zone A) and cancellous (zone B) bone separately. Results: Data analysis showed that, in zone A, a decreased BO and BC was observed for CSI+OVX (p <0.05). In zone B, the CSI+OVX group showed the lowest values for BO and BC, followed by groups OVX and SHAM, respectively (p<0.05). Similar values of BF were observed for CSI+OVX and OVX groups, that were lower than the ones obtained by SHAM group (p <0.05). Conclusion: Within the limits of the present investigation, cigarette smoke inhalation amplified the effects of estrogen deficiency on bone around titanium implants inserted in ovariectomized rats / Mestrado / Periodontia / Mestre em Clínica Odontológica

Orientador: Francisco Humberto Nociti Jr / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T08:26:01Z (GMT). No. of bitstreams: 1 CesarNeto_JoaoBatista_D.pdf: 2722134 bytes, checksum: 2ee28fef6f22a3857a1bc4db6f34ca19 (MD5) Previous issue date: 2005 / Resumo: O consumo de cigarros tem demonstrado um impacto negativo na taxa de sucesso de implantes osseointegráveis e é considerado um fator de risco verdadeiro para doença periodontal. Alguns estudos têm relatado que ex-fumantes apresentam taxas de sucesso de implantes osseointegráveis semelhantes a indivíduos que nunca fumaram e que o risco de perda de inserção periodontal também diminui após a interrupção do consumo de cigarros. Em vista disso, o objetivo do presente estudo é avaliar histologicamente, em modelo animal (ratos), a influência da inalação da fumaça de cigarro (IFC) sobre o tecido ósseo ao redor de implantes de titânio inseridos na tíbia dos animais, sobre o osso alveolar de suporte, sobre a evolução da periodontite induzida e a expressão de MMP-2 no tecido gengival. Além disso, numa segunda fase, investigou-se o efeito da interrupção da IFC nas situações descritas acima. Os resultados deste estudo mostram que a IFC influencia negativamente a densidade do osso preexistente e a qualidade do osso neoformado ao redor de implantes de titânio (menor contato osso-implante e preenchimento das roscas). Tanto a interrupção temporária quanto a definitiva promoveram um efeito positivo no osso ao redor dos implantes de titânio. Resultados semelhantes foram observados nas avaliações do osso alveolar de suporte. A IFC promoveu uma diminuição da densidade óssea alveolar e esse efeito foi revertido após a interrupção da IFC. Quanto à doença periodontal induzida, a IFC potencializou a perda óssea na região avaliada (furca) e maiores níveis de MMP-2 foram encontrados no tecido gengival adjacente a essa área. Além disso, os animais do grupo submetido à interrupção da IFC apresentaram níveis de perda óssea semelhantes ao grupo controle, demonstrando um impacto positivo da interrupção do consumo de cigarros sobre a progressão da periodontite induzida. Dentro dos limites do presente estudo conclui-se que: 1- a IFC exerce um efeito negativo tanto no osso preexistente (região medular) quanto no novo osso ao redor de implantes de titânio; 2- confirmou-se histologicamente que a IFC potencializa a perda óssea durante a periodontite e que a MMP-2 pode ser uma das moléculas envolvidas nesse processo; 3- os efeitos negativos da IFC, no tecido ósseo e periodontal, podem ser revertidos após a interrupção da IFC / Abstract: Smoking has been reported to negatively impact on titanium implants success rates and has been considered a true risk factor for periodontal disease. Some studies have shown that former-smokers present a implant success rate similar to the one of never-smokers, and that the risk of clinical attachment loss decreases after smoking cessation. Thus, the aim of the present investigation was to histologically evaluate, in an animal model (rats), the influence of cigarette smoke inhalation (CSI) on 1- bone tissue around titanium implants inserted in tibiae, 2- the tooth-supporting alveolar bone, and 3- bone loss resulting from ligature-induced periodontitis and MMP-2 expression in gingival tissue. Additionally, it was investigated the influence of CSI cessation on the conditions described above, e.g. bone healing around titanium implants and bone loss resulting from ligature-induced periodontitis. The results of the present study demonstrated that CSI exerted a negative influence on the preexisting and newly-formed bone around titanium implants and, both temporary and complete CSI cessation were able to revert its harmful effect. Similar findings were observed for the tooth-supporting alveolar bone, where CSI negatively affected bone density and such an effect was reverted after CSI cessation. With respect to the ligature-induced periodontitis, CSI enhanced bone loss in the furcation area and produced higher levels of MMP-2 in gingival tissue adjacent to periodontitis sites. In addition, CSI cessation exerted a positive impact on bone loss, with the cessation group showing a bone loss rate similar to the one of control group. Within the limits of the present study, it can be concluded that: 1- CSI exerted a negative effect on both preexisting and newly-formed bone around titanium implants; 2- CSI may enhance periodontal breakdown, and MMP-2 may take part of this process; 3- the negative effects of CSI, on bone around implants and periodontal tissues, may be reverted after smoking cessation / Doutorado / Periodontia / Doutor em Clínica Odontológica

Background: Throughout industrialized countries, tobacco consumption is seen as the predominant driver of both the trend and the extent of gender differences in life expectancy. However, several factors raise doubts to this generalization. We hypothesize that the impact of smoking on the gender gap is context-specific and differs between populations. Methods: We decompose the gender differences in life expectancy into fractions caused by smoking and other non-biological factors for 53 industrialized countries and the period 1955-2009 to assess the significance of smoking among the causes that can be influenced by direct or indirect interference. Results: The trend of the gender gap can indeed be attributed to smoking in most populations of the western world. However, with regard to the overall extent of male excess mortality, smoking is the main driver only in the minority of the studied populations. While the impact of smoking to gender differences in life expectancy declines in all populations, the contribution of other non-biological factors is in most cases higher at the end than at the beginning of the observation period. Conclusions: Over-generalized statements suggesting that smoking is the main driver of the gender gap in all populations can be misleading. The results of this study demonstrate that - regardless of the prevailing effect of smoking - many populations have still remarkable potentials to further narrow their gender gaps in life expectancy. Although measures to further reduce the prevalence of tobacco consumption must be continued, more attention should be directed to the growing importance of other non-biological factors.

Abstract Numerous adverse effects and health problems are associated with smoking, but the mechanisms of the adverse effects of smoking on skin are not well documented. The aim of the present study was to elucidate the effects of smoking on the structure, metabolism and appearance of skin. The study population consisted of 98 Finnish males, of whom 47 were current smokers and 51 non-smokers. The main parameters under evaluation were the appearance and physical qualities of skin, including skin wrinkling, thickness and elasticity. Biochemical analyses were performed to assess the rate of type I and III collagen biosynthesis as well as the degradation of the extracellular matrix (ECM) of skin in terms of matrix metalloproteinase levels (MMPs). To compare the morphology of skin between the groups, histological and immunohistological studies were performed, including assessments of the proportional area and width of dermal elastic fibres. The results revealed decreased synthesis of type I and III collagens in smokers as well as changes in the regulatory mechanisms which control the turnover of these and other extracellular matrix proteins. The level of matrix metalloproteinase -8 (collagenase-2), a protease degrading both type I and type III collagen, in suction blister fluid was significantly higher in smokers, indicating enhanced degradation of these collagens. In skin tissue samples, the levels of the active forms of MMP-8 and MMP-9 were significantly lower in smokers compared to non-smokers. Serum levels of MMP-8 were slightly but not significantly higher in smokers, whereas the levels of the matrix metalloproteinases MMP-2 and MMP-9 (72-kDa and 92-kDa gelatinase, respectively) were significantly higher in smokers compared to non-smokers. Salivary MMP-8 and MMP-9 were lower in smokers compared to non-smokers, but only the latter showed a statistically significant difference. The levels of the tissue inhibitor of matrix metalloproteinases (TIMP-1) were significantly lower in the suction blister fluid of smokers compared to non-smokers. In general, there were no significant differences in skin thickness and elasticity or regeneration of barrier function, nor in the amount or width of elastic fibres between the groups. We did not observe significant differences in skin wrinkling between smokers and non-smokers, but smokers looked older than their age compared to non-smokers. It can be concluded that the rate of type I and III collagen synthesis in skin is decreased and the regulation of ECM turnover is altered in smokers, which may lead to deterioration of the tensile strength and resiliency of skin in the long term, even though no morphological changes were detected in the present study.

Smoking remains the single most preventable cause of death worldwide and primary cause of several types of cancer, cardiovascular disease, and respiratory illness (USDHHS, 2014). Although the prevalence of smoking among the general population continues to decline, the prevalence of smoking among the veteran population remains high. In addition, the prevalence of smoking among veterans with substance and alcohol use disorders is 2 to 3 times higher than in the general population. Over the years, the VA has implemented empirically-based treatments for smoking cessation to address the cigarette smoking epidemic. These services, however, are greatly underutilized. Motivational interviewing (MI) has traditionally been used to treat alcohol dependence; however, its efficacy for smoking cessation has been mixed. There is some evidence, however, suggesting that MI could be used to motivate smokers to seek treatment. The purpose of this study was to use a brief MI intervention to motivate veteran smokers undergoing treatment for substance use to seek smoking cessation services at the VA. We recruited 60 veterans undergoing substance and alcohol use treatment at the Substance Use Disorders/Intensive Outpatient Program (SUDs/IOP) at the James A. Haley VA. Participants were randomized to one of two groups: MI vs. active control. We hypothesized that veterans in the MI condition would be more likely to seek services for smoking cessation compared to those in the control condition. Our findings supported our hypothesis: 40% of participants in the MI condition sought treatment to quit smoking after the intervention compared to 23% of participants in the control condition (p = .03, controlling for baseline differences in cessation motivation). In addition, we found that the MI intervention was most beneficial for individuals with lower baseline motivation to quit smoking. Although we did not find significant mediators of the effect of the intervention on our primary outcome, this study showed that a brief MI intervention can promote seeking of smoking cessation resources.