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Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio
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Curso.tabagismo.sopterj.2011.leg.amb.liv.tabaco rj.w leopercio

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Aula proferida pelo Dr Waldir Leopércio durante o Curso de Atualização em Tabagismo da SOPTERJ, em 8/6/2011, no Hospital COPA D'OR.

Aula proferida pelo Dr Waldir Leopércio durante o Curso de Atualização em Tabagismo da SOPTERJ, em 8/6/2011, no Hospital COPA D'OR.

Published in: Health & Medicine
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  • 1. Leopércio Page 1SOPTERJ 2011 Dr. Waldir Leopércio E-mail: cdtorax@terra.com.br A Legislação dos Ambientes Livres de Tabaco no RJ: Resultados Observados XIII Congresso de Pneumologia e Tisiologia do Estado do RJ Hospital COPA D’OR, 8 de Junho de 2011 Curso de Atualização em Tabagismo
  • 2. Leopércio Page 2SOPTERJ 2011 Tabagismo Passivo Inalação da fumaça de derivados do tabaco, por indivíduos não- fumantes, que convivem com fumantes em ambientes fechados(OMS, 2001). Fumaça que se origina do cigarro aceso + Fumaça expirada pelo fumante
  • 3. Leopércio Page 3SOPTERJ 2011 Tabagismo Passivo  No Brasil, pelo menos 7 pessoas morrem diariamente por tabagismo passivo (INCA/UFRJ)  200 mil trabalhadores morrem por ano pelo mesmo motivo (OIT), no mundo.
  • 4. Leopércio Page 4SOPTERJ 2011  100 milhões no orçamento da saúde  439,2 milhões no orçamento do INSS Custos com tabagismo passivo Brasil 2003-2008 (INCA/UFRJ)
  • 5. Leopércio Page 5SOPTERJ 2011 “Nenhuma tecnologia de engenharia de ventilação demonstra controlar os riscos impostos pela exposição à PTA; apenas pode reduzi-los e pode controlar questões de conforto relacionadas ao odor e à irritação sensorial impostos pela exposição.”.” Sociedade Americana de Engenheiros de Aquecimento, Refrigeração e Condicionamento de Ar Evidências
  • 6. Leopércio Page 6SOPTERJ 2011  Os níveis de PTA em bares chegam a ser quase 6 vezes maior do que nos escritórios  Garçons: 4 a 10 cigarros por jornada de trabalho Fumo Passivo em Ambientes da Indústria da Hospitalidade
  • 7. Leopércio Page 7SOPTERJ 2011 CONVENÇÃO QUADRO http://www1.inca.gov.br/inca/Arquivos/convencao_quadro_texto_oficial.PDF
  • 8. Leopércio Page 8SOPTERJ 2011 Estudo requisitado pela SEDESC-RJ ao Dr. Alberto José de Araújo, MD Pneumologista, Diretor do NETT-UFRJ “Custo efetividade de intervenções de controle do tabaco no Brasil” (Baseado na Tese de Doutorado do autor) Quanto custou aos cofres públicos do Estado do RJ os cuidados com IAM, AVC e Ca de Pulmão atribuíveis ao tabagismo nos últimos 5 anos?
  • 9. Leopércio Page 9SOPTERJ 2011 Quanto custou aos cofres públicos do Estado do RJ os cuidados com IAM, AVC e Ca de Pulmão atribuíveis ao tabagismo nos últimos 5 anos? 0 20 40 60 80 2004 2005 2006 2007 2008 Ca Pulmão AVC IAM Custo Anual SUS para IAM, AVC e Ca Pulmão - RJ, 2004-2008, em R$100.000,00 R$ 52.651.505,00 / ano R$ 263.257.527,00 / 5 anos
  • 10. Leopércio Page 10SOPTERJ 2011 AÇÕES DO ESTADO PARA O CONTROLE DO TABAGISMO  Capacitação de 3 mil profissionais para implantação de PROGRAMAS DE TRATAMENTO DO TABAGISMO (INCA/MS)  Rio de Janeiro é o estado com maior cobertura para tratamento de fumantes 8 municípios 2008 81 municípios 2011
  • 11. Leopércio Page 11SOPTERJ 2011
  • 12. Leopércio Page 12SOPTERJ 2011 Lei Estadual 5517 de 17/8/2009
  • 13. Leopércio Page 13SOPTERJ 2011 www.riosemfumo.rj.gov.br
  • 14. Leopércio Page 14SOPTERJ 2011 AÇÕES DO ESTADO PARA O CONTROLE DO TABAGISMO Balanço das Ações Executadas – 18/11/2009 a 16/05/2011  21 fiscais  80 fiscalizações semanais  Bares, Restaurantes, Casas Noturnas, Similares e outros = 15.418  99 estabelecimentos foram autuados ADESÃO 99%
  • 15. Leopércio Page 15SOPTERJ 2011
  • 16. Leopércio Page 16SOPTERJ 2011 Issa JS, Abe TM, Pereira AC, Megid MC, Shimabukuro CE, Valentin LS, et al. The effect of Sao Paulo's smoke-free legislation on carbon monoxide concentration in hospitality venues and their workers. Tob Control. 2011 Mar;20(2):156-62. Victora CG, Barreto ML, do Carmo Leal M, Monteiro CA, Schmidt MI, Paim J, et al. Health conditions and health-policy innovations in Brazil: the way forward. Lancet. 2011 May 9. Colgrove J, Bayer R, Bachynski K. Nowhere Left to Hide? The Banishment of Smoking from Public Spaces. May 25, 2011 (10.1056/NEJMp1104637)
  • 17. Leopércio Page 17SOPTERJ 2011 Background: Recent studies have shown that there is no safe level of exposure to secondhand smoke (SHS). A close link between SHS and the risk of coronary heart disease and stroke is established as well as the fact that carbon monoxide (CO) is one of the most important components present in SHS. Objective: To evaluate the impact of the smoking ban law in Rio de Janeiro city, Brazil, on the CO concentration in restaurants, bars, nightclubs, and similar. Methods: The CO concentration was measured in 146 hospitality venues by using portable CO monitors to measure CO concentration in different types of establishments, and in different points inside these hospitality venues (indoor, semi-open, and open areas). These measurements were performed twice, immediately before implementation of the law and 12 weeks after it. The quality of the air was verified during the same period of time through the analysis of the databank of State Environmental Institute of Rio de Janeiro (INEA). Results: The CO concentration pre- and post-ban in hospitality venues was indoor area 2.60 (1.77) vs 1.12 (1.01) ppm (p<0.0001); semi-open 2.74 (1.21) vs 1.3 (1.22) ppm (p<0.0001); open area 2.61(1.27) vs 1.14(1.09) ppm (p<0.0001). The differences are consistent in all types of venues, except in nightclubs, where the levels of CO were similar in the pre- and post-ban measurements. It can be explained by non accomplishment of the law in these places and the small number of nightclubs visited. Conclusion: Rio de Janeiro’s smoke-free legislation significantly reduced the CO concentration in restaurants, bars, bakery and other hospitality venues. Concerning nightclubs, it is necessary more information to have a conclusive result. The effect of smoke-free legislation on carbon monoxide concentration in hospitality venues in Rio de Janeiro city. Heart institute - University of São Paulo1 Rio de Janeiro Secretary of State for Health and Civil Defense2 Jaqueline S. Issa1, Tania M. O. Abe1, Alexandre C. Pereira1, José Waldir Leopércio Jr2, Sandra Helena Costa2, Sabrina Presman2. Secondhand tobacco smoke (SHS) is one of the most important causes of death and disease worldwide. Carbon monoxide is one of the most important components of SHS. Therefore, the WHO Framework Convention on Tobacco Control (WHO FCTC) and its implementation guidelines have clearly indicated that comprehensive smoke-free legislation eliminating tobacco smoking in all indoor public places and workplaces must be implemented to protect all people from the harm effects of secondhand smoke. Based on these, Rio de Janeiro State government approved a smoke-free legislation in 2009, forbidding the consumption of all tobacco products in enclosed and partly closed collective sites. Introduction Disclosure form: JS Issa has consulted for Pfizer and has been the site principal investigator for clinical trials of smoking cessation medications funded by Pfizer. The other authors reported no conflict. Objective The main goal of this study was to compare levels of secondhand smoke exposure, measured through carbon monoxide concentrations in hospitality venues in Rio de Janeiro City before and after the implementation of the law. Material and Methods A total of 146 hospitality venues in Rio de Janeiro city were visited before and after the tobacco-free policy was implemented. The sites were a sample of convenience. The first phase included the period prior to the implementation of the tobacco-free policy and the second phase was performed approximately 12 weeks after the banning law was introduced. Bars, restaurants, nightclubs, and similar venues were visited by agents from Rio de Janeiro Secretary of State for Health and Civil Defense (Figures 1A and 1B). A specific type of portable CO monitor - ToxCo (Bedfont Scientific; Rochester, England) was utilized. Data collected from venues were compared with data obtained by the State Environmental Institute of Rio de Janeiro (INEA) in 4 automatic stations, covering the same region of our collected data. These data were used to test whether possible reductions in CO could be influenced by other conditions, such as meteorological elements. Results In the pos-ban period, significant reductions in almost all the studied environments were observed (Table 1). Moreover, the difference between indoor area and open area disappeared in all venue types (restaurants, bars and others), thus suggesting equalization with outdoor levels. The only exception was observed in the night clubs, where no significant reduction in the CO concentration was observed in the pre- and pos-ban measurements (Figures 2 and 3). It can be explained by violation of the law in these places, resulting in penalties application, and also because of the small number of nightclubs visited. The quality of the air in the city during the same period of our study measured by INEA was less than 1 in the pre- and pos-ban periods. Conclusion The smoking ban law significantly reduced the CO concentration in hospitality venues. Hence, one can speculate that the significant reduction obtained in CO concentrations after the adoption of tobacco smoke free legislation could be related to the reduction in cardiovascular events incidence observed in many places where similar law has already been adopted. Closed pre-ban Closed pos-ban Semi-opened pre- ban Semi-opened pos-ban Open pre-ban Open pos-ban Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD Bar 3.2 2.3 1.0 1.0 2.9 0.9 1.0 1.0 3.0 1.2 0.9 1.0 Night Club 2.6 0.5 2.5 0.6 3.2 0.8 3.0 1.4 3.7 1.5 3.5 2.1 Restaurant 2.3 1.4 1.2 1.0 2.2 1.2 1.2 1.2 2.2 1.3 1.1 1.0 Similar 2.6 1.6 1.0 0.6 3.5 1.8 1.6 0.7 3.1 1.0 1.7 1.3 Pre- and pos-ban CO measurement 0,00 0,50 1,00 1,50 2,00 2,50 3,00 3,50 4,00 Bar Night Club Restaurant Similar Comeasurement Closed pre-ban Closed pos-ban Semi-opened pre-ban Semi-opened pos-ban Open pre-ban Open pos-ban Restaurant Night ClubBar 2011 SRNT 17TH ANNUAL MEETING Toronto, Canada Figure 1A – Team of agents from Rio de Janeiro Secretary of State for Health and Civil Defense (SESDEC). Figure 1B – Agent from SESDEC during fiscalization. Figure 1C – Advertisement about smoke-free law Table 1 – Pre- and pos-ban mean CO level according to venue type and sampled environment. P value was <0,01 for all places, comparing pre- and pos-ban periods, except for night clubs (p value NS). Figure 2 – Mean CO concentrations in pre- and pos-ban periods according to location within the venue and venue type. Figure 3 – Mean CO concentration in bars, restaurants and night clubs in pre- (1) and pos-ban (2) periods. Blue line – open environments; green line – semi open environments; yellow line – closed environments.
  • 18. Leopércio Page 18SOPTERJ 2011
  • 19. Leopércio Page 19SOPTERJ 2011
  • 20. Leopércio Page 20SOPTERJ 2011 AÇÕES DO ESTADO PARA O CONTROLE DO TABAGISMO 2.60 ppm 1.12 ppm 12 semanas 56.9% co
  • 21. Leopércio Page 21SOPTERJ 2011 SAÚDE: Direito de todos e Dever do Estado cdtorax@terra.com.br

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