Categoría Top Descargas
Iniciar sesión Registrarse Subir

Tratamiento actual del tabaquismo

August 18, 2017 | Autor: A. Ramirez-Venegas | Categoría: Public health systems and services research
Share Embed
Laporkan tautan ini


Descripción

5HJDODGR3LQHGD-\FRO

!24·#5,/$%2%6)3)¼.

/À>Ì>“ˆi˜ÌœÊ>VÌÕ>Ê`iÊÌ>L>µÕˆÃ“œ *USTINO2EGALADO 0INEDA -EN#  'ABRIELA,ARA 2IVAS ,ICEN0SIC  *ENNIFER/SIO %CHÉNOVE ,ICEN0SIC  !LEJANDRA2AMÓREZ 6ENEGAS -EN# 

2EGALADO 0INEDA* ,ARA 2IVAS' /SIO %CHÉNOVE* 2AMÓREZ 6ENEGAS! 4RATAMIENTOACTUALDELTABAQUISMO 3ALUD0UBLICA-EXSUPL3 3

2ESUMEN %LTABAQUISMOESUNAAFECCIØNMÏDICADECARÉCTERCRØNICO CARACTERIZADAPORLAADICCIØNALANICOTINA%LDELOSFU MADORESDESEADEJARDEFUMAR AUNQUESØLOLOINTENTAEN UNA×O!LOSFUMADORESMOTIVADOSSELESDEBEOFRECERALGUNO DE LOS TRATAMIENTOS DISPONIBLES $ENTRO DEL TRATAMIENTO FARMACOLØGICOSEDISTINGUENLOSCOMPUESTOSSINNICOTINAY LATERAPIADEREEMPLAZOCONNICOTINA42. %NELPRIMER GRUPODESTACANELTARTRATODEVARENICLINAYLOSMEDICAMENTOS ANTIDEPRESIVOSCOMOBUPROPIØNYNORTRIPTILINA$ENTRODELA 42.SEENCUENTRANLOSPARCHES GOMADEMASCAR TABLETAS SUBLINGUALESYORALES DISPOSITIVODEINHALACIØNORALYAEROSOL NASAL %L TARTRATO DE VARENICLINA ES UN AGONISTA PARCIAL DE LOSRECEPTORESNICOTÓNICOSCEREBRALES_`QUEREDUCELOS SÓNTOMASDEABSTINENCIA ASÓCOMOELDESEOYURGENCIAPOR FUMAR ,OS ESTUDIOS MUESTRAN QUE VARENICLINA ES SUPERIOR APLACEBO2- )#  YTAMBIÏNELBUPRO PIØN2- )#  4ODASLASMODALIDADESDE 42.RESULTANEFECTIVAS2- )#  AUNQUE EN CASOS PARTICULARES ALGUNA PRESENTACIØN PUEDE RESULTAR MÉSCONVENIENTE%LPOTENCIALADICTIVODELOSSUSTITUTOSDE NICOTINA ES MENOR QUE EL DEL CIGARRILLO Y ADEMÉS CARECE DE LOS EFECTOS TØXICOS DEL HUMO %L BUPROPIØN ESTIMULA LA FUNCIØNNORADRENÏRGICAYDOPAMINÏRGICAYDUPLICALATASADE ABSTINENCIAENCOMPARACIØNCONELPARCHEDENICOTINA2-  )#  ,ANORTRIPTILINATAMBIÏNSERELACIONA CONAUMENTODELASTASASDEABSTINENCIA2- )#   /TROSTRATAMIENTOSHANMOSTRADOCIERTAElCACIA ENTRELOSCUALESDESTACANLOSBLOQUEADORESDELOSRECEPTORES ENDOCANABINOIDES COMOELRIMONABANT$ELOSTRATAMIENTOS NO FARMACOLØGICOS EL CONSEJO MÏDICO ES UNA HERRAMIENTA ÞTIL CUYOÏXITOPUEDESERDEA PEROSØLODELOS MÏDICOS LO APLICAN 2-  )#    ,A TERAPIA

2EGALADO 0INEDA* ,ARA 2IVAS' /SIO %CHÉNOVE* 2AMÓREZ 6ENEGAS! #URRENTTREATMENTFORSMOKING 3ALUD0UBLICA-EXSUPPL3 3

!BSTRACT 3MOKINGISACHRONICMEDICALCONDITIONCHARACTERIZEDBYTHE ADDICTIONTONICOTINE3EVENTYPERCENTOFSMOKERSWANTTOQUIT SMOKING ALTHOUGHONLYPERYEARMAKETHEATTEMPT3OME OFTHEAVAILABLETREATMENTSSHOULDBEOFFEREDTOSMOKERSWHO AREMOTIVATEDTOQUIT!MONGTHEPHARMACEUTICALTREATMENTS NICOTINE FREETOBACCOANDNICOTINEREPLACEMENTTHERAPY.24 STANDOUT)NTHElRSTGROUP VARENICLINETARTRATEANDANTI DEPRESSIONMEDICATIONSSUCHASBUPROPIONANDNORTRIPTYLINE ARENOTABLE.24SINCLUDEPATCHES CHEWINGGUM SUBLINGUAL ANDORALTABLETS ORALINHALATIONANDNASALAEROSOLDEVICES 6ARENICLINETARTRATEISAN_`NICOTINICRECEPTORPARTIALAGO NISTTHATREDUCESWITHDRAWALSYMPTOMSASWELLASTHEDESIRE ANDURGETOSMOKE3TUDIESSHOWTHATVARENICLINEISBETTER THANAPLACEBO2- )#  ANDBETTERTHAN BUPROPION2- )#  !LL.24MODALITIESARE EFFECTIVE2- )#  ALTHOUGHINPARTICULAR CASESONEMAYBEMOREAPPROPRIATETHANANOTHER4HEAD DICTIVEPOTENTIALOFNICOTINESUBSTITUTESISLESSTHANTHATOF CIGARETTESAND INADDITION THEYLACKTHETOXICEFFECTSOFSMOKE "UPROPIONSTIMULATESNORADRENERGICANDDOPADRENERGICFUNC TIONSANDDOUBLESTHEABSTINENCERATEASCOMPAREDWITHTHE NICOTINEPATCH2- )#  .ORTRIPTYLINEIS ALSOASSOCIATEDWITHANINCREASEINABSTINENCERATES2- )#    /THER TREATMENTS HAVE SHOWN A CERTAIN DEGREEOFEFlCACY SUCHASTHEENDOCANNABINOIDSRECEPTORS BLOCKER RIMONABANT!SFORNON PHARMACEUTICALTREATMENTS MEDICALADVICEISAUSEFULTOOLWHOSESUCCESSCANRANGEFROM TO BUTONLYOFMEDICALPROFESSIONALSPROVIDEIT2-  )#  'ROUPPSYCHOLOGICALTHERAPYHELPSTO MODIFYTHEPERCEPTIONOFCIGARETTESANDITSNOXIOUSEFFECTS 4HESUCCESSOFTHISMODALITYISBETWEENANDPER YEAR2- )#  3OMEOFTHEDISADVANTAGES

 )NSTITUTO.ACIONALDE%NFERMEDADES2ESPIRATORIAS -ÏXICO &ECHADERECIBIDODEABRILDEs&ECHADEAPROBADODEMAYODE 3OLICITUDDESOBRETIROS-EN#*USTINO2EGALADO0INEDA$EPARTAMENTODE)NVESTIGACIØNEN4ABAQUISMO )NSTITUTO.ACIONALDE%NFERMEDADES2ESPIRATORIAS #ALZADADE4LALPAN COLONIA3ECCIØN86)4LALPAN $& -ÏXICO #ORREOELECTRØNICOJREGALAD COMPUSERVECOMMX 3

VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

7UDWDPLHQWRDFWXDOGHOWDEDTXLVPR

!24·#5,/$%2%6)3)¼.

PSICOLØGICADEGRUPOPERMITEMODIlCARLAPERCEPCIØNHACIA ELCIGARRILLOYSUSEFECTOSNOCIVOS%LÏXITOCONESTAMODALI DADESDEAALA×O2-DE )#   5NADELASDESVENTAJASESELTIEMPOQUESEINVIERTEYELCOSTO DELTRATAMIENTO QUEPUEDESERCONSIDERABLE&INALMENTE LOS MATERIALESDEAUTOAYUDAPUEDENINCREMENTARELÏXITO2-  )#  %NRESUMEN ENLAACTUALIDADSEDISPONE DEMÞLTIPLESMODALIDADESQUEHANPROBADOSEREFECTIVASEN ELTRATAMIENTOPARADEJARDEFUMAR AUNQUEELTRATAMIENTOSE DEBEINDIVIDUALIZARENCADACASO

ARETHETIMEINVESTEDANDTHECOSTOFTHETREATMENT WHICH CANBECONSIDERABLE&INALLY SELF HELPMATERIALSCANINCREASE SUCCESS 2-  )#    )N SUMMARY MULTIPLE MODALITIESCURRENTLYEXISTTHATHAVEBEENPROVENEFFECTIVEIN THETREATMENTFORQUITTINGSMOKINGHOWEVER THETREATMENT SHOULDBEINDIVIDUALIZEDACCORDINGTOEACHPARTICULARCASE

0ALABRASCLAVETABAQUISMOCESEDELTABAQUISMO

+EYWORDSSMOKINGSMOKINGCESSATION

 (QHVWHVHQWLGRHOPRGHORWUDQVWHyULFREDVDGRHQ ODVHWDSDVGHFDPELRSUHFRQWHPSODFLyQFRQWHPSODFLyQ SUHSDUDFLyQDFFLyQ\PDQWHQLPLHQWRKDVLGRXWLOL]DGR SDUDHYDOXDUODPRWLYDFLyQGHORVIXPDGRUHVSDUDGHMDU GHIXPDU'HDFXHUGRFRQ'L&OHPHQWH\3URFKDVND HOIXPDGRUSXHGHHQFRQWUDUVHHQDOJXQDGHODVHWDSDV PHQFLRQDGDV (Q OD HWDSD GH SUHFRQWHPSODFLyQ ORV IXPDGRUHVQRGHVHDQQLSODQHDQGHMDUGHIXPDU(QOD HWDSD GH FRQWHPSODFLyQ HO IXPDGRU FRQVLGHUD GHMDU GHIXPDUHQDOJ~QPRPHQWRDXQTXHQRKDGHFLGLGR XQDIHFKDGHÀQLGD(QDPEDVHWDSDVHOFRQVHMRPpGLFR MXHJDXQSDSHOFHQWUDO(QHVWHWLSRGHSDFLHQWHVODLQ WHUYHQFLyQPiV~WLOFRQVLVWHHQSURSRUFLRQDUOHVGHPD QHUDFRQWLQXDLQIRUPDFLyQVXÀFLHQWHSDUDLQFUHPHQWDU ODPRWLYDFLyQ\SURSLFLDUTXHHPSLHFHQDFRQVLGHUDUOD SRVLELOLGDGUHDOGHGHMDUGHIXPDUHQHOIXWXURSUy[LPR GtDV $ORVIXPDGRUHVTXHWLHQHQODPRWLYDFLyQSDUD UHDOL]DUXQLQWHQWRGHGHMDUGHIXPDUHQORVVLJXLHQWHV GtDV HWDSDGHSUHSDUDFLyQ VHOHVGHEHRIUHFHUDOJXQD GHODVPRGDOLGDGHVGHWUDWDPLHQWRGLVSRQLEOHV  /DVOLPLWDFLRQHVGHOPRGHORWUDQVWHyULFRUDGLFDQHQ ODFODVLÀFDFLyQXQWDQWRDUELWUDULDGHODHWDSDHQODTXH VHSXHGHHQFRQWUDUXQSDFLHQWH$VLPLVPRVHHQIRFD GHPDQHUDFHQWUDOHQHWDSDVGHÀQLGDVHQUHODFLyQFRQHO LQWHQWRGHDEDQGRQR\GHMDGHODGRRWURVHOHPHQWRVTXH LQÁX\HQHQHOSURFHVRGHPRWLYDFLyQGHORVVHUHVKXPD QRVFRPRHOSDSHOGHODUHFRPSHQVD\HOFDVWLJRHQHO GHVDUUROORGHKiELWRVGLItFLOHVGHURPSHUODLPSRUWDQFLD GHODVDVRFLDFLRQHV\YtQFXORVGHtQGROHSVLFROyJLFDTXH ORVIXPDGRUHVYDQGHVDUUROODQGRDODUJRGHVXDGLFFLyQ \TXHSXHGHQGHVHPSHxDUVHFRPRSURPRWRUHVGHFLHUWDV FRQGXFWDVRDFFLRQHVHOLPSDFWRLQPHGLDWRGHREVWi FXORVRIDFLOLWDGRUHVSDUDHOFDPELRHQWUHRWURVPiV (VWHPRGHORVyORLQGLFDTXHODVSHUVRQDVTXHSODQHDQ UHDOL]DU XQ FDPELR HQ VXV FRQGXFWDV WLHQHQ PD\RUHV SUREDELOLGDGHV GH VHU H[LWRVDV OR FXDO UHVXOWD REYLR 'DWRVUHFLHQWHVH[KLEHQTXHH[LVWHQRWURVIDFWRUHVTXH GHVHPSHxDQXQSDSHOPX\LPSRUWDQWHFRPRGHWRQDGR UHVLQPHGLDWRVGHFDPELRVGHOFRPSRUWDPLHQWR\GHOD

OWDEDTXLVPRFRQVWLWX\HODSULQFLSDOFDXVDGHPXHU WHHYLWDEOHHQWRGRHOPXQGR(QHODxRHO WDEDFRFDXVyODPXHUWHGHFDVLPLOORQHVGHSHUVRQDV 7DQVyORHQHOFRQWLQHQWHDPHULFDQRODVHQIHUPHGDGHV DVRFLDGDVDOFRQVXPRGHWDEDFRSURGXMHURQDOUHGHGRU GHXQPLOOyQGHGHIXQFLRQHVGHHVDVPXHUWHV RFXUULHURQ HQ$PpULFD /DWLQD OR TXH UHSUHVHQWD  GHWRGDVODVPXHUWHV+R\HQGtDHOWDEDTXLVPRFDXVD PiVPXHUWHVTXHODVRFDVLRQDGDVGHPDQHUDFRQMXQWD SRU 6,'$ DEXVR GH DOFRKRO \ RWUDV GURJDV LOHJDOHV DFFLGHQWHVGHWUiQVLWR\RWUDVPXHUWHVYLROHQWDV6LODV WHQGHQFLDV DFWXDOHV QR VH UHYLHUWHQ SDUD HO DxR  FHUFD GH  PLOORQHV GH SHUVRQDV PRULUiQ HQ WRGR HO PXQGRSRUHQIHUPHGDGHVUHODFLRQDGDVFRQHOFRQVX PRGHWDEDFRORTXHLQFOX\HDORVIXPDGRUHVDFWLYRV\ SDVLYRV(OGHHVDVPXHUWHVRFXUULUiHQSDtVHVHQ GHVDUUROOR %NFOQUEINICIAL (VLPSRUWDQWHGHVWDFDUHOSDSHOGHORVSURIHVLRQDOHVGH ODVDOXGHVGHFLUPpGLFRVHQIHUPHUDVWUDEDMDGRUHVVR FLDOHVRGRQWyORJRVHWFSDUDLGHQWLÀFDUDORVSDFLHQWHV IXPDGRUHVHLQLFLDULQWHUYHQFLRQHVHVSHFtÀFDVTXHPR WLYHQDORVSDFLHQWHVDGHMDUGHIXPDU5HVXOWDUHOHYDQWH ODLQWHUYHQFLyQGHORVLQWHJUDQWHVGHOHTXLSRGHVDOXG HQODLGHQWLÀFDFLyQGHFRQGXFWDVGHULHVJRGHORVSD FLHQWHVFRPRHVHOWDEDTXLVPR/RVPpGLFRVGHOSULPHU QLYHOGHDWHQFLyQDWLHQGHQDXQQ~PHURFRQVLGHUDEOH GHSDFLHQWHVSRUORTXHVXSDUWLFLSDFLyQHQWpUPLQRV GH LGHQWLÀFDFLyQ GH ORV IXPDGRUHV SXHGH FRQWULEXLU DGLVPLQXLUODVWDVDVGHSUHYDOHQFLDGHOWDEDTXLVPR /RV SURIHVLRQDOHV GH OD VDOXG GHEHQ LQWHUURJDU VREUH WDEDTXLVPRDVXVSDFLHQWHVFRQpQIDVLVHQHOWLHPSRGH GXUDFLyQ\HQHOSURPHGLRGHFLJDUULOORVIXPDGRVDOGtD 6LHPSUHHVUHFRPHQGDEOHLQIRUPDUVREUHORVULHVJRVDOD VDOXGGHULYDGRVGHOFRQVXPRGHSURGXFWRVGHOWDEDFR DVtFRPRVREUHORVEHQHÀFLRVTXHVHREWLHQHQDOGHMDU GHIXPDU VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

3

!24·#5,/$%2%6)3)¼.

PRWLYDFLyQVLQTXHGHEDQSDVDUDIXHU]DSRUFDGDXQD GHODVHWDSDVGHFDPELRSURSXHVWDVSRU'L&OHPHQWH(Q ORVHVWXGLRVGRQGHVHFRPSDUDDOPRGHORWUDQVWHyULFR FRQFRQFHSWRVPiVWUDGLFLRQDOHVHOPRGHORGHHWDSDV GHFDPELRQRKDGHPRVWUDGRVHUPiVHIHFWLYR(QWRGR FDVRGHEHDSURYHFKDUVHODLGHQWLÀFDFLyQGHVXMHWRVVLQ PRWLYDFLyQSDUDGHMDUGHIXPDU\TXHSRUORWDQWRQR SODQHDQGHMDUGHIXPDUHQHOIXWXURSDUDLQGXFLUORVD WRPDUODGHFLVLyQ$OJXQRVHVWXGLRVPXHVWUDQTXHXQD VLPSOHJXtDGHD\XGDSDUDWRPDUODGHFLVLyQGHGHMDU GHIXPDUPHMRUDODLQIRUPDFLyQGHORVIXPDGRUHVFRQ UHVSHFWRDORVGLIHUHQWHVPpWRGRVSDUDGHMDUGHIXPDU \ORVLQGXFHDXQDDFWLWXGPiVSURDFWLYDTXHLQFOXVR IDYRUHFHHQORVSDFLHQWHVTXHODUHFLEHQHOTXHVHPDQ WHQJDQSRUPiVWLHPSRHQDEVWLQHQFLD  (VWXGLRVSREODFLRQDOHVVHxDODQTXHODPD\RUtDGH ORVIXPDGRUHV  TXLHUHGHMDUHOFLJDUULOORSHURFDUHFH GHODPRWLYDFLyQVXÀFLHQWHSODQHDGHMDUGHIXPDU HQ ORV VLJXLHQWHV  PHVHV \  GH ORV IXPDGRUHV LQWHQWDGHMDUGHIXPDUHQXQDxR(OSDSHOGHORVSUR IHVLRQDOHVGHODVDOXG\HQSDUWLFXODUHOGHORVPpGLFRV UHVXOWDGHHVSHFLDOUHOHYDQFLDHQHVWHVHQWLGRDTXHOORV IXPDGRUHV GHFLGLGRV \ PRWLYDGRV D GHMDU GH IXPDU LQFUHPHQWDQVXVSUREDELOLGDGHVGHp[LWRVLHVWDGHFLVLyQ VHHQFXHQWUDUHIRU]DGDSRUHOFRQVHMRPpGLFR )NTERVENCIONESPARADEJARDEFUMAR (OWDEDTXLVPRGHEHFRQVLGHUDUVHXQDDIHFFLyQPpGLFDGH FDUiFWHUFUyQLFRFDUDFWHUL]DGDSRUODDGLFFLyQDODQLFRWL QD(QODDFWXDOLGDGVHOHFODVLÀFDHQWUHODVHQIHUPHGDGHV SVLTXLiWULFDVFRPRRFXUUHFRQRWUDVDGLFFLRQHV  (O WUDWDPLHQWR SXHGH GLYLGLUVH HQ IDUPDFROyJLFR \ SVLFROyJLFR 'HQWUR GHO WUDWDPLHQWR IDUPDFROyJLFR VH GLVWLQJXHQ GRV JUXSRV FRPSXHVWRV VLQ QLFRWLQD \ WHUDSLDGHUHHPSOD]RFRQQLFRWLQD 751 (QHOSULPHU JUXSRGHVWDFDQHOWDUWUDWRGHYDUHQLFOLQDDVtFRPRORV PHGLFDPHQWRVDQWLGHSUHVLYRVFRPRHOEXSURSLyQ\OD QRUWULSWLOLQD'HQWURGHOD751VHHQFXHQWUDQORVSDU FKHVJRPDGHPDVFDUWDEOHWDVVXEOLQJXDOHV\RUDOHVDVt FRPRDHURVROQDVDO(Q0p[LFRVHFXHQWDFRQXQDJDPD DPSOLDGHUHFXUVRVWHUDSpXWLFRVSDUDHOWUDWDPLHQWRGH ODDGLFFLyQDODQLFRWLQD 7UDWDPLHQWRIDUPDFROyJLFRGHODDGLFFLyQDODQLFRWLQD 0HGLFDPHQWRVVLQQLFRWLQD % %

PHGLFDPHQWRV TXH DFW~DQ HQ ORV UHFHSWRUHV FROL QpUJLFRVQLFRWtQLFRV_`WDUWUDWRGHYDUHQLFOLQD DQWLGHSUHVLYRVEXSURSLyQ\QRUWULSWLOLQD

3

5HJDODGR3LQHGD-\FRO

 /D QLFRWLQD FRQVWLWX\H HO FRPSRQHQWH ELRDFWLYR TXHFRQWLHQHHOKXPRGHOWDEDFR\UHVXOWDODVXVWDQFLD GHWHUPLQDQWH GHO UHIRU]DPLHQWR SRVLWLYR GH OD FRQ GXFWD GH IXPDU REVHUYDGR WDQWR HQ KXPDQRV FRPR HQPRGHORVDQLPDOHV(VWHHIHFWRUHIRU]DGRUGHOD QLFRWLQDVHORJUDJUDFLDVDODHVWLPXODFLyQGHUHFHSWRUHV HVSHFtÀFRVXELFDGRVHQHOVLVWHPDPHVROtPELFRFHUHEUDO (QODDFWXDOLGDGVHKDLGHQWLÀFDGRDOUHFHSWRU_`SDUD DFHWLOFROLQDHOFXDOPXHVWUDJUDQDÀQLGDGSRUODQLFRWLQD \ SURPXHYH OD OLEHUDFLyQ GH GRSDPLQD HQ HO Q~FOHR DFFXPEHQV \ ]RQDV GHO iUHD WHJPHQWDULD YHQWUDO TXH JHQHUDQVHQVDFLRQHVSODFHQWHUDVHQORVIXPDGRUHV  (O WDUWUDWR GH YDUHQLFOLQD VH FRPSRUWD FRPR XQ DJRQLVWDSDUFLDOGHORVUHFHSWRUHVQLFRWtQLFRVFHUHEUDOHV _`(QHVWXGLRVSUHFOtQLFRVVHKDGHPRVWUDGRTXH OD YDUHQLFOLQD PXHVWUD DOUHGHGRU GH  YHFHV PD\RU DÀQLGDG SRU ORV UHFHSWRUHV FROLQpUJLFRV _` TXH OD QLFRWLQD'HODPLVPDPDQHUDVHGHVFULEHTXHXQDYH] XQLGRDVXUHFHSWRUGLFKDXQLyQSURPXHYHODOLEHUD FLyQGHGRSDPLQDHQHOVLVWHPDPHVROtPELFRFHUHEUDO HTXLYDOHQWHDGHOREVHUYDGRFRQODHVWLPXODFLyQ FRQQLFRWLQDGHOPLVPRUHFHSWRUHVGHFLUSUHVHQWDXQ HIHFWRDJRQLVWDSDUFLDO$OFRPELQDUODDGPLQLVWUDFLyQGH YDUHQLFOLQDFRQQLFRWLQDVHREVHUYDXQDUHVSXHVWDHQOD OLEHUDFLyQGHGRSDPLQDGHDGHOREVHUYDGRFRQ ODDGPLQLVWUDFLyQGHQLFRWLQDVRODHVGHFLUXQHIHFWRDQ WDJRQLVWD6HWUDWDSXHVGHXQFRPSXHVWRQRQLFRWtQLFR FDSD]GHHVWLPXODUHOiUHDGHUHFRPSHQVDGHOVLVWHPD PHVROtPELFRGHOTXHGHSHQGHHOUHIRU]DPLHQWRSRVLWLYR GHODFRQGXFWDGHIXPDU\DOPLVPRWLHPSREORTXHDU ODUHVSXHVWDGHOUHFHSWRUHQSUHVHQFLDGHQLFRWLQD  +DVWDHOPRPHQWRVHKDQSXEOLFDGRYDULRVHVWXGLRV TXHPXHVWUDQODHIHFWLYLGDGGHOWDUWUDWRGHYDUHQLFOLQD HQHOWUDWDPLHQWRSDUDGHMDUGHIXPDUGRQGHVHREVHU YDTXHHVVXSHULRUDOWUDWDPLHQWRFRQEXSURSLyQ\DO SODFHER(QJHQHUDOODUD]yQGHSUREDELOLGDG UD]yQGH PRPLRV 50  GH PDQWHQHUVH HQ DEVWLQHQFLD GHVSXpV GHPHVHVGHKDEHUVLGRWUDWDGRFRQYDUHQLFOLQDHV GH  ,&   (O SULQFLSDO HIHFWR DGYHUVR REVHUYDGRHVODSUHVHQFLDGHQiXVHDV'HDFXHUGRFRQ ODLQIRUPDFLyQGLVSRQLEOHKDVWDHVWHPRPHQWRGHVGH HOSXQWRGHYLVWDFOtQLFRXQRGHORVDVSHFWRVPiVQR WDEOHVGHOXVRGHODYDUHQLFOLQDHVODUHGXFFLyQGHORV VtQWRPDVGHDEVWLQHQFLDDVtFRPRGHOGHVHR\XUJHQFLD SRUIXPDUORTXHIDYRUHFHHODEDQGRQRGHOFRQVXPRGH FLJDUULOORV  (QXQDUHYLVLyQVLVWHPiWLFDUHFLHQWHVHHYDOXDURQORV HVWXGLRVGLVSRQLEOHVHQODOLWHUDWXUDHQGRQGHVHSUXHED HOXVRGHDJRQLVWDVSDUFLDOHVGHORVUHFHSWRUHVFROLQpUJLFRV QLFRWtQLFRV_`0HGLDQWHPHWDDQiOLVLVFRQPRGHORVGH HIHFWRVÀMRVGH0DQWHO+DHQV]HO\FRQVLGHUDQGRFLQFR

VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

7UDWDPLHQWRDFWXDOGHOWDEDTXLVPR

HQVD\RV FOtQLFRV FRQWURODGRV OD 50 DFXPXODGD SDUD DOFDQ]DU DEVWLQHQFLD FRQWLQXD GXUDQWH  PHVHV FRP SDUDQGRYDUHQLFOLQDFRQWUDSODFHERIXHGH ,&   /D 50 DFXPXODGD FRPSDUDQGR YDUHQLFOLQD FRQWUDEXSURSLyQIXHGH ,& (OHIHFWR FRODWHUDOPiVLPSRUWDQWHIXHODQiXVHDTXHHQODPD\RUtD GHORVFDVRVVHGHVFULELyFRPRPRGHUDGD ‡

$QWLGHSUHVLYRV

([LVWH HYLGHQFLD GH OD XWLOLGDG GH ORV PHGLFDPHQWRV DQWLGHSUHVLYRVFRPRDX[LOLDUHVHQHOWUDWDPLHQWRGHOD DGLFFLyQDODQLFRWLQD6HKDQLQYRFDGRSRUORPHQRV GRVUD]RQHVWHyULFDVSDUDSURSRQHUTXHHOHPSOHRGH PHGLFDPHQWRV DQWLGHSUHVLYRV SXHGH WHQHU XQ HIHFWR EHQpÀFRHQHOWUDWDPLHQWRGHOWDEDTXLVPR/DDEVWLQHQ FLDGHODQLFRWLQDSXHGHSURGXFLUVtQWRPDVGHSUHVLYRVR SUHFLSLWDUXQHSLVRGLRGHGHSUHVLyQPD\RUSRUORFXDO VHMXVWLÀFDHOXVRGHDQWLGHSUHVLYRV/DQLFRWLQDSXHGH WHQHUDOJ~QWLSRGHHIHFWRDQWLGHSUHVLYRTXHPDQWLHQH ODFRQGXFWDGHIXPDUHQWUHORVIXPDGRUHVGHPDQHUD TXHORVPHGLFDPHQWRVDQWLGHSUHVLYRVSRGUtDQVXVWLWXLU GLFKR HIHFWR 3RU RWUD SDUWH DOJXQRV PHGLFDPHQWRV DQWLGHSUHVLYRVSXHGHQDFWXDUHQIRUPDHVSHFtÀFDVREUH YtDVGHQHXURWUDQVPLVLyQTXHSDUWLFLSDQHQORVPHFD QLVPRV GH DGLFFLyQ GH OD QLFRWLQD S HM EORTXHR GH UHFHSWRUHV GHPDQHUDLQGHSHQGLHQWHDVXHIHFWRDQWLGH SUHVLYR/DGHSUHVLyQSXHGHVHUXQDPDQLIHVWDFLyQGHO VtQGURPHGHVXSUHVLyQRDEVWLQHQFLDGHODQLFRWLQD'H ODPLVPDPDQHUDVHKDREVHUYDGRTXHXQDSURSRUFLyQ GH SDFLHQWHV PDQLÀHVWD VtQWRPDV GHSUHVLYRV FXDQGR GHMDGHIXPDU'HQWURGHORVGLIHUHQWHVPHGLFDPHQWRV DQWLGHSUHVLYRVTXHVHKDQSUREDGRFRPRDG\XYDQWHV HQHOWUDWDPLHQWRGHOWDEDTXLVPRODQRUWULSWLOLQD\HOEX SURSLyQVRQORVTXHPHMRUHVUHVXOWDGRVKDQPRVWUDGR 6XXWLOL]DFLyQVHDFRPSDxDGHDXPHQWRGHODVWDVDVGH DEVWLQHQFLDDDxR 50,& WDQWRSDUD EXSURSLyQ FRPR SDUD QRUWULSWLOLQD 50  ,& ² (OEXSURSLyQHVWLPXODODIXQFLyQQRUDGUH QpUJLFD\GRSDPLQpUJLFDGXSOLFDODWDVDGHDEVWLQHQFLD DXQDODUJRSOD]R\WLHQHHIHFWRDGLWLYRFRQORVSDUFKHV GH QLFRWLQD 6H UHFRPLHQGD LQLFLDU FRQ OD PLWDG GH OD GRVLV UHFRPHQGDGD SRU OD PDxDQD SDUD LGHQWLÀFDU FRQUDSLGH]DODVSHUVRQDVLQWROHUDQWHVDOPHGLFDPHQWR $GHPiVPXHVWUDFLHUWRHIHFWRHQHYLWDUHOLQFUHPHQWRGH SHVR\SXHGHFDXVDULQVRPQLRDQVLHGDGFRQYXOVLRQHV HQHSLOpSWLFRVRDOFRKyOLFRV RVHTXHGDGGHPXFRVDV  /DVHYLGHQFLDVVXJLHUHQTXHHOPHFDQLVPRGHDFFLyQ SRU HO FXDO WDQWR HO EXSURSLyQ FRPR OD QRUWULSWLOLQD PXHVWUDQXWLOLGDGSDUDHOWUDWDPLHQWRGHODDGLFFLyQD ODQLFRWLQDHVLQGHSHQGLHQWHGHVXHIHFWRFRPRPHGLFD PHQWRVDQWLGHSUHVLYRV

VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

!24·#5,/$%2%6)3)¼.

0HGLFDPHQWRVFRQQLFRWLQD %

7HUDSLDGHUHHPSOD]RGHQLFRWLQD 751

/DUD]yQSDUDXVDUVXVWLWXWRVGHODQLFRWLQDHVWULEDHQ GLVPLQXLURHYLWDUHOVtQGURPHGHDEVWLQHQFLDGHULYDGR GHODVXSUHVLyQV~ELWDGHODVXVWDQFLD  (OSRWHQFLDODGLFWLYRGHORVVXVWLWXWRVGHQLFRWLQD HVPHQRUDOGHOFLJDUULOOR\DGHPiVFDUHFHGHORVHIHFWRV Wy[LFRVGHOKXPR/DQLFRWLQDDGPLQLVWUDGDPHGLDQWH SDUFKHV R JRPD GH PDVFDU QR DOFDQ]D FRQ OD PLVPD UDSLGH]ORVYDORUHVHQSODVPDSRUORFXDOVXSRWHQFLDO GHHVWLPXODFLyQHQHOVLVWHPDQHUYLRVRFHQWUDOHVPHQRU (OIXPDGRUGHEHFRQWURODUORVDVSHFWRVFRQGXFWXDOHVGH ODDEVWLQHQFLDSRUORTXHVHKDVHxDODGRODFRPELQDFLyQ GH OD WHUDSLD IDUPDFROyJLFD FRQ OD WHUDSLD FRJQLWLYR FRQGXFWXDOFRPRODHVWUDWHJLDPiVHIHFWLYDSDUDGHMDU GHIXPDU  ([LVWHQGLIHUHQWHVPRGDOLGDGHVGHDGPLQLVWUDFLyQ GHSURGXFWRVSDUDHOUHHPSOD]RGHQLFRWLQDJRPDGH PDVFDU GH  PJ \  PJ SDUFKHV GH OLEHUDFLyQ WUDQV GpUPLFD GH  D  KRUDV HQ GRVLV GH  PJ K  PJ K  PJ K  PJ K  PJ K \  PJK\GLVSRVLWLYRGHLQKDODFLyQGHQLFRWLQD  /DJRPDPDVWLFDEOHGHQLFRWLQDVHYHQGHHQSUHVHQ WDFLyQHQWDEOHWDVGHPJ\GHPJ8QDGHODVFDUDFWH UtVWLFDVVHFXQGDULDVGHHVWH´FKLFOHµHVTXHVXVDERUSXHGH VHUGHVDJUDGDEOH/DVGRVLVDOWDV WDEOHWDVGHPJ VRQ PiVHIHFWLYDVHQIXPDGRUHVFRQPD\RUGHSHQGHQFLDDOD QLFRWLQDTXHHQDTXpOORVFX\DGHSHQGHQFLDHVEDMD  (O LQKDODGRU RUDO HV XQD IRUPD PX\ SDUHFLGD DO FLJDUULOOR SDUD DGPLQLVWUDUVH QLFRWLQD (O FDUWXFKR GH QLFRWLQDGHOLQKDODGRUFRQWLHQHPJGHQLFRWLQD\FDGD LQKDODFLyQOLEHUD+JGHQLFRWLQDORTXHUHSUHVHQWDHQ WRWDOGHODFDQWLGDGGHQLFRWLQDOLEHUDGDHQXQD LQKDODFLyQGHXQFLJDUULOORSURPHGLR  /D751LQFUHPHQWDODVSUREDELOLGDGHVGHp[LWRD PHGLDQRSOD]RDOPLVPRWLHPSRTXHHVELHQWROH UDGDSRUORVSDFLHQWHV7RGDVODVPRGDOLGDGHVGH751 UHVXOWDQHIHFWLYDVHQHOWUDWDPLHQWRGHODDGLFFLyQDOD QLFRWLQDDXQTXHHQFDVRVSDUWLFXODUHVDOJXQDSUHVHQ WDFLyQSXHGHUHVXOWDUPiVFRQYHQLHQWH(QP~OWLSOHV HVWXGLRVTXHFRPSDUDQODHIHFWLYLGDGGHOD751FRQWUD SODFHER\FRQRWUDVPRGDOLGDGHVGHWUDWDPLHQWRVHKD FRPSUREDGRODXWLOLGDGGHHVWHWLSRGHWUDWDPLHQWR(Q XQD UHYLVLyQ VLVWHPiWLFD UHFLHQWH VH LQIRUPy XQD 50 SDUDPDQWHQHUVHHQDEVWLQHQFLDDOPHQRVPHVHVGHV SXpVGHUHFLELUHOWUDWDPLHQWRFRQFXDOTXLHUPRGDOLGDG GH751GH ,& FXDQGRVHHPSOHy JRPD GH PDVFDU GH  PJ OD 50 IXH GH  ,&   (Q SDFLHQWHV FRQ GHSHQGHQFLD HOHYDGD D ODQLFRWLQDHOHPSOHRGHJRPDGHPDVFDUGHPJHV

3

5HJDODGR3LQHGD-\FRO

!24·#5,/$%2%6)3)¼.

VXSHULRUDOXVRGHJRPDGHPDVFDUGHPJ 50 ,& &XDQGRVHXWLOL]DURQSDUFKHVOD50 IXHGH ,& (QHOFDVRGHOGLVSRVLWLYR GHLQKDODFLyQOD50GHORJUDUODDEVWLQHQFLDGXUDQWH SRUORPHQRVPHVHVIXHGH ,& \ SDUDHODHURVROQDVDOOD50IXHGH ,&  \GH ,& SDUDODQLFRWLQDHQWDEOHWDV GHDGPLQLVWUDFLyQSRUYtDRUDORVXEOLQJXDO&RPRVH SXHGH REVHUYDU WRGDV ODV SUHVHQWDFLRQHV FRPHUFLDOHV GH751UHVXOWDQHIHFWLYDVSDUDWUDWDUODDGLFFLyQDOD QLFRWLQD\DXPHQWDQODVRSRUWXQLGDGHVGHp[LWRHQWUH \YHFHV  (QWUHODVGLVWLQWDVIRUPDVGH751HOSDUFKHWUDQV GpUPLFR VH UHFRPLHQGD GH SULPHUD LQWHQFLyQ SRU VX IRUPDGHDGPLQLVWUDFLyQ$OXWLOL]DUVHXQDYH]DO GtDHODSHJRDOWUDWDPLHQWRHVPiVHIHFWLYRTXHFRQORV FKLFOHV6HUHFRPLHQGDLQLFLDUOD751FRQSDUFKHFRQ ODGRVLVPiVDOWDGXUDQWHDOPHQRVVHPDQDVODGRVLV LQWHUPHGLD\ODGRVLVPiVEDMDVHUHFRPLHQGDQGXUDQWH GRVVHPDQDVFDGDXQD  /DPDQHUDPiVHIHFWLYDGHYLJLODUODGRVLVUHTXHUL GDGHVXVWLWXWRVGHQLFRWLQDHVLQWHUURJDQGRDOSDFLHQWH VREUHVXVGHVHRVRXUJHQFLDSRUIXPDUDVtFRPRSRU ORVVtQWRPDVGHDEVWLQHQFLD(QJHQHUDOVHFRQVLGHUD TXHHVVHJXURGLVPLQXLUODGRVLVGHORVVXVWLWXWRVGH QLFRWLQDXQDYH]TXHHOSDFLHQWHQRUHÀHUHGHVHRVGH IXPDURELHQTXHKDQGLVPLQXLGRORVVtQWRPDVGHDEV WLQHQFLD(OSULQFLSDOSUREOHPDFRQHOSDUFKHVXHOHVHU ODLUULWDFLyQGHODSLHOTXHVHHOLPLQDDOURWDUHOVLWLRGH DSOLFDFLyQGHORVSDUFKHVRPHGLDQWHODDSOLFDFLyQWySL FDGHXQDFUHPDDEDVHGHHVWHURLGHV(OXVRGHOSDUFKH HVVHJXURHQSDFLHQWHVFRQHQIHUPHGDGHVFDUGLDFDV\ HQPXMHUHVHPEDUD]DGDVTXHIXPDQHQSDUWLFXODUHQ DTXHOODVTXHFRQVXPHQFLJDUULOORVRPiVSRUGtD\HQ ODVTXHODVWHUDSLDVFRQGXFWXDOHVKDQIUDFDVDGR

HQHOTXHVHUHFRJLyODLQIRUPDFLyQGHFXDWURHQVD\RV FOtQLFRVQRVHORJUyGHPRVWUDUXWLOLGDGGHHVWHPHGLFD PHQWRHQHOWUDWDPLHQWRGHOWDEDTXLVPR ‡

%ORTXHDGRUHVGHUHFHSWRUHVHQGRFDQDELQRLGHV

2WUDVPRGDOLGDGHVWHUDSpXWLFDV

(OVLVWHPDHQGRFDQDELQRLGHPRGXODODQHXURWUDQVPL VLyQVLQiSWLFDFHQWUDO\SHULIpULFD\IRUPDSDUWHGHYtDV FHUHEUDOHVUHODFLRQDGDVFRQHOGHVDUUROORGHFRQGXFWDV DGLFWLYDVUHJXODFLyQFHQWUDOGHOSHVRFRUSRUDO\IXQFLyQ GHOWHMLGRDGLSRVRGHOFXHUSR/DDGPLQLVWUDFLyQVLPXO WiQHDGHFDQWLGDGHVSRUGHEDMRGHOXPEUDOGHDJRQLVWDV FDQDELQRLGHVHQFRQMXQWRFRQQLFRWLQDSURGXFHHIHFWRV VLPLODUHV D OD UHFRPSHQVD \ SODFHU REVHUYDGRV HQ HO UHIRU]DPLHQWR SRVLWLYR GH OD FRQGXFWD GH IXPDU (Q DSR\RDORDQWHULRUVHKDREVHUYDGRTXHHOXVRFUyQLFR GHQLFRWLQDDXPHQWDORVYDORUHVGHHQGRFDQDELQRLGHVHQ ODUHJLyQPHVROtPELFDGHOFHUHEUR\VHKDFRPSUREDGR TXHHOVLVWHPDHQGRFDQDELQRLGHVHHQFXHQWUDDFWLYDGR H LQFUHPHQWDGR HQ PRGHORV DQLPDOHV GH REHVLGDG \ DEXVRGHQLFRWLQD(OULPRQDEDQWRFRQVWLWX\HXQHMHPSOR GHHVWHJUXSRGHVXVWDQFLDVVHWUDWDGHXQEORTXHDGRU GHO UHFHSWRU  GHO VLVWHPD HQGRFDQDELQRLGH &%  /RVUHVXOWDGRVGHHVWXGLRVGHIDVHGHPRVWUDURQTXH HOULPRQDEDQWPXHVWUDHÀFDFLDHQHOWUDWDPLHQWRGHOD REHVLGDGGLVOLSLGHPLD\GLDEHWHVDVRFLDGDFRQREHVLGDG SUHYLHQH HO DXPHQWR GH SHVR TXH VLJXH DO DEDQGRQR GHOWDEDFR\VHVXJLHUHTXHSRGUtDVHUGHXWLOLGDGFRPR XQPHGLFDPHQWRGHSUHVFULSFLyQSDUDGHMDUGHIXPDU (QHVWXGLRVSUHFOtQLFRVVHVXJLHUHTXHHOULPRQDEDQWR UHGXFHODDXWRDGPLQLVWUDFLyQGHQLFRWLQDHOUHFDPELRGH GRSDPLQDHQHOQ~FOHRDFFXPEHQV\DWHQ~DODFRQGXFWD GHE~VTXHGDGHQLFRWLQDHQPRGHORVDQLPDOHV+DVWD HOPRPHQWRORVUHVXOWDGRVQRKDQVLGRFRQFOX\HQWHV 6XHPSOHRFRPRPHGLFDPHQWRSDUDHOWUDWDPLHQWRGHO WDEDTXLVPR D~Q FDUHFH GH DXWRUL]DFLyQ HQ WRGRV ORV SDtVHV

‡

‡

$QWDJRQLVWDVRSLRLGHV

(OUHIRU]DPLHQWRSRVLWLYRTXHVHREVHUYDHQORVIXPD GRUHVSXHGHHVWDUPHGLDGRSRUP~OWLSOHVPHFDQLVPRV DWUDYpVGHODOLEHUDFLyQGHGLYHUVRVQHXURWUDQVPLVRUHV WDQWRGHPDQHUDFHQWUDOFRPRSHULIpULFD/RVIXPDGRUHV UHÀHUHQXQDVHULHGHHIHFWRVSRVLWLYRVFRPRSODFHUDX PHQWRGHOHVWDGRGHDOHUWD\UHODMDFLyQDVtFRPRHIHFWRV QHJDWLYRVFRPRGLVPLQXFLyQGHODIHFWRWHQVLyQ\DQVLH GDG/RVDQWDJRQLVWDVGHDJHQWHVRSLRLGHVRQDUFyWLFRV UHVXOWDQGHHVSHFLDOLQWHUpVGHELGRDVXSRWHQFLDOSDUD DWHQXDUHOUHIRU]DPLHQWRSRVLWLYRTXHVHREVHUYDHQORV IXPDGRUHV6HKDHVWXGLDGRODQDOWUH[RQDFRQWUDSODFHER SDUDHYDOXDUVXSRWHQFLDOXWLOLGDGHQHOWUDWDPLHQWRGHO WDEDTXLVPR6LQHPEDUJRHQXQPHWDDQiOLVLVUHFLHQWH 3

9DFXQDVHLQPXQRPRGXODGRUHV

(OHPSOHRGHYDFXQDVRPHMRUGLFKRGHPROpFXODVLQPX QRPRGXODGRUDVSURPHWHVHUXQiUHDGHGHVDUUROORIXWXUR HQHOFDPSRGHODVDGLFFLRQHV(VWRVPHGLFDPHQWRVUHGX FHQHOUHFDPELRGHGRSDPLQDGHOVLVWHPDPHVROtPELFR FHUHEUDOHVSHFtÀFDPHQWHHQHOQ~FOHRDFFXPEHQVSRU ORTXHVHVXSRQHTXHSRGUtDQUHGXFLUODFRQGXFWDGH E~VTXHGDGHQLFRWLQDGHVSXpVGHODDGPLQLVWUDFLyQGH QLFRWLQDHQVXMHWRVDGLFWRV(OPHFDQLVPRSRUHOFXDO VHORJUDHOHIHFWRHVHVWLPXODQGRODSURGXFFLyQGHDQ WLFXHUSRVFRQWUDXQFRQMXJDGRSURWHtQLFRTXHFRQWLHQH QLFRWLQDODSUHVHQFLDGHORVDQWLFXHUSRVOLPLWDODFDQ WLGDGGHQLFRWLQDTXHSHQHWUDHQHOFHUHEURFRQORFXDO VHUHGXFHODUHVSXHVWDSVLFRIDUPDFROyJLFDDODQLFRWLQD VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

7UDWDPLHQWRDFWXDOGHOWDEDTXLVPR

/RVFRPSXHVWRVHVWXGLDGRVKDVWDHOPRPHQWRPXHVWUDQ DGHFXDGDWROHUDQFLD\HÀFDFLDSHURHODXPHQWRGHORV WtWXORV GH DQWLFXHUSRV SURYRFDGR SRU HO WUDWDPLHQWR PXHVWUDYDULDFLRQHVHQWUHORVLQGLYLGXRVPX\DPSOLDV \VHFRQVLGHUDQGHFRUWDGXUDFLyQ$XQTXHHOHPSOHR GH VXVWDQFLDV LQPXQRPRGXODGRUDV TXH UHJXODUDQ OD DFFLyQSVLFRIDUPDFROyJLFDGHODQLFRWLQDUHVXOWDIDFWLEOH SDUHFHSRFRSUREDEOHTXHSXHGDQVHUXWLOL]DGDVFRPR HVWUDWHJLDWHUDSpXWLFDGHSULPHUDOtQHD ‡

&ORQLGLQD

/DFORQLGLQDXQDJHQWHDJRQLVWDGHORVUHFHSWRUHVDGUH QpUJLFRVDOIDHVFRQRFLGDGHWLHPSRDWUiVSRUTXHVH HPSOHDSDUDHOWUDWDPLHQWRGHODKLSHUWHQVLyQDUWHULDO VLVWpPLFD7DPELpQVHKDREVHUYDGRTXHDFW~DHQHO 61& \ SXHGH UHGXFLU ORV VtQWRPDV GH DEVWLQHQFLD GH YDULDVFRQGXFWDVDGLFWLYDVHQWUHODVTXHVHLQFOX\HDOD QLFRWLQD(OHPSOHRGHFORQLGLQDSXHGHLQFUHPHQWDUODV SUREDELOLGDGHVGHDEVWLQHQFLDDPHGLDQR\ODUJRSOD]R FRQXQD50GH ,& $SHVDUGHVHUXQ PHGLFDPHQWR~WLOSDUDHOWUDWDPLHQWRGHOWDEDTXLVPR ODFORQLGLQDVHDFRPSDxDGHXQDSUHYDOHQFLDHOHYDGD GHHIHFWRVDGYHUVRVUHODFLRQDGRVFRQODGRVLVGHOPHGL FDPHQWRHQHVSHFLDOERFDVHFD\VHGDFLyQ ‡

'HVDUUROORGHQXHYDVPROpFXODV

(QHVWRVPRPHQWRVVHHQFXHQWUDQHQGHVDUUROORGLYHUVDV PROpFXODVTXHWUDWDQGHFRQWUDUUHVWDUORVHIHFWRVSHUQL FLRVRVGHOFRQVXPRFUyQLFRGHWDEDFR'HQWURGHWDOHV VXVWDQFLDVVHHQFXHQWUDQLQKLELGRUHVGHODPRQRDPLQR R[LGDVDPHGLFDPHQWRVTXHLQWHUÀHUHQVHOHFWLYDPHQWH FRQ ORV UHFHSWRUHV FROLQpUJLFRV QLFRWtQLFRV GLIHUHQWHV GH OD YDUHQLFOLQD PHGLFDPHQWRV TXH LQWHUÀHUHQ FRQ UHFHSWRUHVGHGRSDPLQDJOXWDPDWR\iFLGRJDPPDD PLQREXWtULFR'HELGRDTXHVHWUDWDGHPROpFXODVHQ GHVDUUROORSRUHOPRPHQWRUHVXOWDSUHPDWXURDYHQWXUDU FXiOVHUiVXGHVHPSHxRHQPDWHULDGHHÀFDFLDHIHFWLYL GDG\VHJXULGDG 7UDWDPLHQWRSVLFROyJLFRGHODDGLFFLyQDODQLFRWLQD (VWUDWHJLDVFRQGXFWXDOHV ‡

&RQVHMRPpGLFR

(OFRQVHMRPpGLFRHVODKHUUDPLHQWDGLVSRQLEOHPiVVLP SOHFRQODTXHHOPpGLFRFXHQWDSDUDLQÁXLUGHPDQHUD GHFLVLYDHQXQIXPDGRUSDUDTXHGHMHGHIXPDU6LQ HPEDUJRVyORGHORVPpGLFRVVHRFXSDHQSURSRU FLRQDUFRQVHMRDODPD\RUtDGHORVSDFLHQWHVIXPDGRUHV TXHKDFHFXDQGRPHQRVXQDYLVLWDDQXDODXQPpGLFR VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

!24·#5,/$%2%6)3)¼.

RDXQRGRQWyORJR6HVDEHTXHODUHFRPHQGDFLyQGHO PpGLFRLQFUHPHQWDHOQ~PHURGHIXPDGRUHVTXHGHMDQ GH IXPDU GH  D  50  ,&   \ WDPELpQ VH VDEH TXH HO FRQVHMR PpGLFR LQWHQVLYR HV PHMRUTXHHOFRQVHMRPpGLFRPtQLPR 50,&   6H KD REVHUYDGR TXH OD SDUWLFLSDFLyQ GHO PpGLFRXRWURVSURIHVLRQDOHVGHODVDOXGLQFUHPHQWDODV SUREDELOLGDGHVGHp[LWRKDVWDYHFHVPiVHQFRPSD UDFLyQFRQQRKDFHUQDGDFXDQGRVHDWLHQGHDSDFLHQWHV IXPDGRUHV  3DUDORVSDFLHQWHVIXPDGRUHVTXHGHÀQLWLYDPHQWH QRHVWiQLQWHUHVDGRVHQGHMDUGHIXPDUODSDUWLFLSDFLyQ GHOPpGLFRFRPRSURPRWRUGHODVDOXGQRTXHGDFDQFH ODGDGHOWRGR(QSULQFLSLRHQHVWHJUXSRQRVHREWLHQH p[LWRDPHQRVTXHVHPRGLÀTXHODDFWLWXG ‡

7HUDSLDSVLFROyJLFDGHJUXSR

&RQVWLWX\HXQPpWRGRGHSVLFRWHUDSLDFX\RREMHWLYRHV HQVHxDUDORVSDFLHQWHVDSHQVDUGHPDQHUDUDFLRQDO /DWHUDSLDGHJUXSRVHEDVDHQODXWLOL]DFLyQGHKHUUD PLHQWDVGHDSR\RFRJQLWLYRFRQGXFWXDOHQFDPLQDGDV DPRGLÀFDUODSHUFHSFLyQ\ODVDFWLWXGHVGHOSDFLHQWH KDFLDHOFLJDUULOOR\VXVHIHFWRVQRFLYRV+DELWXDOPHQWH ODWHUDSLDVHSURSRUFLRQDHQJUXSRVGHDSR\RTXHVH UH~QHQHQIRUPDSHULyGLFDSRUHVSDFLRGHFXDWURDVHLV VHPDQDV HQ FRPELQDFLyQ FRQ WUDWDPLHQWR IDUPDFROy JLFRFRQVXVWLWXWRVGHQLFRWLQD&RQHVWDPRGDOLGDG GHWUDWDPLHQWRVHORJUDXQDDEVWLQHQFLDDQXDOGHD /DWHUDSLDSVLFROyJLFDLQGLYLGXDOKDPRVWUDGRVHU XQDKHUUDPLHQWDHÀFD]SDUDORJUDUODDEVWLQHQFLDGHOD QLFRWLQDDPHGLDQRSOD]RFRPSDUDGRFRQODDWHQFLyQ HVWiQGDU HQ FRQVXOWD DPEXODWRULD OD WHUDSLD LQGLYL GXDOPRVWUyXQD50GH ,& 1RVH REVHUYDQGLIHUHQFLDVHQWUHHOFRQVHMRLQGLYLGXDOEUHYH HLQWHUYHQFLRQHVLQGLYLGXDOHVPiVLQWHQVLYDV(QXQD UHYLVLyQVLVWHPiWLFDVHREVHUYyTXHODWHUDSLDJUXSDO VHDVRFLDFRQXQDXPHQWRHQODWDVDGHDEDQGRQRGHO WDEDTXLVPRFRQXQD50GH ,& 'H ODPLVPDPDQHUDVHREVHUYDTXHODWHUDSLDSVLFROyJLFD HQJUXSRHVPiVHIHFWLYDFRPSDUDGDFRQJUXSRVTXH QRUHFLEHQQLQJ~QWLSRGHLQWHUYHQFLyQFRQXQD50GH  ,& (QHVWDUHYLVLyQVLVWHPiWLFDQR VHGHPRVWUyTXHODWHUDSLDGHJUXSRIXHUDPiVHIHFWLYD RGHPHQRUFRVWRTXHODVLQWHUYHQFLRQHVLQGLYLGXDOHV GH VLPLODU LQWHQVLGDG 8QD GH ODV GHVYHQWDMDV HV HO WLHPSRTXHVHLQYLHUWH\HOFRVWRGHOWUDWDPLHQWRTXH SXHGHVHUFRQVLGHUDEOHH[LVWHYDULDELOLGDGHQHOJUDGR GHDFHSWDFLyQSRUSDUWHGHORVSDFLHQWHVKDFLDHVWHWLSR GHWUDWDPLHQWR'HDFXHUGRFRQ6WHDG\/DQFDVWHUOD WHUDSLDSVLFROyJLFDGHJUXSRHVVXSHULRUDODVHVWUDWHJLDV GHDXWRD\XGD\DLQWHUYHQFLRQHVGHPHQRULQWHQVLGDG (Q0p[LFRVHKDHYDOXDGRHOp[LWRDFRUWR\PHGLDQR 3

5HJDODGR3LQHGD-\FRO

!24·#5,/$%2%6)3)¼.

SOD]RGHODWHUDSLDSVLFROyJLFDSDUDGHMDUGHIXPDU\VH REVHUYDURQEXHQRVUHVXOWDGRV$OÀQDOGHODVVHVLRQHV GHWHUDSLDGHJUXSRGHORVSDFLHQWHVVHPDQWLHQH HQDEVWLQHQFLDHQWDQWRTXHHOVHJXLPLHQWRDPHVHV PRVWUy TXH OD WDVD GH DEVWLQHQFLD VH XELFD HQ  SRU FLHQWR ‡

0DWHULDOGHDXWRD\XGD

0XFKRV IXPDGRUHV GHMDQ GH IXPDU VLQ QHFHVLGDG GH UHFXUULUDQLQJ~QWLSRGHD\XGDSURIHVLRQDO/DLQFRU SRUDFLyQGHPDWHULDOHVTXHSURYHDQLQIRUPDFLyQSXHGH VHUGHXWLOLGDGSDUDORJUDULQWHQWRVH[LWRVRVSDUDGHMDU GHIXPDU([LVWHQGLYHUVRVHVWXGLRVHQODOLWHUDWXUDTXH VHxDODQODXWLOLGDGGHHVWHWLSRGHPDWHULDOHVGHDXWRD\X GD6LVHFRPSDUDQPDWHULDOHVGHDXWRD\XGDJHQpULFRV FRQWUDQLQJ~QWLSRGHLQWHUYHQFLyQVHREVHUYDXQD50 SDUDORJUDUDEVWLQHQFLDGH ,& /RV PDWHULDOHVGLVHxDGRVHVSHFtÀFDPHQWHSDUDHOSHUÀOGHO IXPDGRUTXHWRPDQHQFXHQWDODVFDUDFWHUtVWLFDVLQGL YLGXDOHVGHORVIXPDGRUHVPXHVWUDQVXSHULRULGDGVLVH ORVFRPSDUDFRQORVPDWHULDOHVJHQpULFRVFRQXQD50 GH  ,&   3DUWH GHO HIHFWR REVHUYDGR SXHGHGHEHUVHDOFRQWDFWRDGLFLRQDOHQWUHHOSDFLHQWH\ HOHTXLSRGHVDOXG ‡

7HUDSLDDYHUVLYD

(OUD]RQDPLHQWRSDUDXWLOL]DUODWHUDSLDDYHUVLYDFRPR UHFXUVRSDUDHOWUDWDPLHQWRGHOWDEDTXLVPRUDGLFDHQ DFRSODUORVHVWtPXORVSODFHQWHURVGHODQLFRWLQDHQHO 61&FRQORVHIHFWRVQHJDWLYRVSRUVDWXUDFLyQGHORVUH FHSWRUHVFRQODÀQDOLGDGGHDEROLUORVGHVHRVGHIXPDU 'H PDQHUD LQPHGLDWD D ODV VHVLRQHV GH WUDWDPLHQWR VHREVHUYDTXHHOXVRGHODWHUDSLDDYHUVLYDDXPHQWD ODVSUREDELOLGDGHVGHDEVWLQHQFLDFRQXQD50GH ,& 6LQHPEDUJRYDOHODSHQDDFODUDUTXH ODPD\RUtDGHORVHVWXGLRVUHDOL]DGRVKDVWDHOPRPHQWR DGROHFHQGHGHÀFLHQFLDVPHWRGROyJLFDVSRUORTXHOD LQIRUPDFLyQGHEHWRPDUVHFRQFDXWHOD  2WUDVPRGDOLGDGHVGHWUDWDPLHQWRFRPRODDFXSXQ WXUDWHUDSLDOiVHUKLSQRVLVDFXSUHVLyQRHOHFWURHVWLPX ODFLyQKDQPRVWUDGRUHVXOWDGRVLQFRQVLVWHQWHVSRUOR TXHVXXVRQRVHUHFRPLHQGDSDUDHOWUDWDPLHQWRGHOD DGLFFLyQDODQLFRWLQD

#UADRO)

54),)$!$$%$)&%2%.4%3-³4/$/30!2!$%*!2$%&5-!2 -ÏTODO

2-)#

6ARENICLINAVSPLACEBO 6ARENICLINAVSBUPROPIØN #ITISINA "UPROPIØNp .ORTRIPTILINAp 42.ENGENERALe !EROSOLNASAL #HICLEDENICOTINADEMGe )NHALADORDENICOTINA 4ABLETASVÓAORALOSUBLINGUAL 0ARCHESDENICOTINAe #LONIDINA

                     

!CETATODEPLATA #ONSEJOMÏDICO

  .OSEENCONTRØBENElCIO n

!UTOAYUDASIMPLE VSNINGUNAINTERVENCIØN VSAUTOAYUDAPERSONALIZADA VSMANUALESTÉNDAR’

   

4ERAPIAAVERSIVA

 

 

!POYODEPAREJA ESPOSA PAREJA AMIGO SOCIO ETC    4ERAPIAGRUPALENGENERAL   VSNOINTERVENCIØN¡   #ONSEJOINDIVIDUAL¹ !CUPUNTURA (IPNOSIS -EDIOSMASIVOS %JERCICIO

  .OSEENCONTRØBENElCIO .OSEENCONTRØBENElCIO ,ASEVIDENCIASNOSONCONCLUYENTES 3EREQUIEREMÉSINVESTIGACIØN

4OMADODELAREFERENCIA 4OMADODELAREFERENCIA e 4OMADODELAREFERENCIA  4OMADODELAREFERENCIA  4OMADODELAREFERENCIA  4OMADODELA2EFERENCIA ’ 4OMADODELAREFERENCIA ¡ 4OMADODELAREFERENCIA ¹ 4OMADODELAREFERENCIA p

&RPSDUDFLyQGHORVGLIHUHQWHVPpWRGRVSDUDGHMDU GHIXPDU (QHOFXDGUR,\HQODÀJXUDVHPXHVWUDXQDFRPSD UDFLyQGHODVGLIHUHQWHVPRGDOLGDGHVGHWUDWDPLHQWRHQ WpUPLQRVGH50SDUDPDQWHQHUDEVWLQHQFLDDPHGLDQR \ODUJRSOD]R&RPRVHSXHGHREVHUYDUSUiFWLFDPHQWH 3

WRGRVORVPpWRGRVGHWUDWDPLHQWRFRQORVTXHVHFXHQWD HQHOSUHVHQWHPXHVWUDQHÀFDFLDSDUDORJUDUODDEVWLQHQ FLDDPHGLDQR\ODUJRSOD]RHQHVSHFLDOFXDQGRVHOHV FRPSDUDFRQSODFHER'HVWDFDQODYDUHQLFOLQDEXSUR SLyQQRUWULSWLOLQDDVtFRPRODVGLIHUHQWHVPRGDOLGDGHV VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

7UDWDPLHQWRDFWXDOGHOWDEDTXLVPR

!24·#5,/$%2%6)3)¼.

  



     

"

" 

!!

! 

 



 

 

 

 



$







&)'52!2!:¼.$%02/"!"),)$!$2-0!2!,/'2!2,!!"34).%.#)!!-%$)!./9,!2'/0,!:/ 3%'Â.$)&%2%.4%3-/$!,) $!$%3$%42!4!-)%.4/0!2!4!"!15)3-/

GH751\ODWHUDSLDSVLFROyJLFDHQSDUWLFXODUFXDQGRVH FRPELQDFRQHOWUDWDPLHQWRIDUPDFROyJLFR  'HVSXpVGHXQLQWHQWRH[LWRVRSDUDGHMDUGHIXPDU VHREVHUYDTXHXQEXHQQ~PHURGHVXMHWRVUHFDHHQORV VLJXLHQWHV  PHVHV /D WDVD GH DEVWLQHQFLD HV DOWD DO SULQFLSLRSHURGHFOLQDFRQHOWLHPSRKDVWDOOHJDUD HQDxRHQFXDOTXLHUDGHORVPHMRUHVSURJUDPDV DQWLWDEDFRTXHVHTXLHUDDQDOL]DU(QHOPRPHQWRDFWXDO QR H[LVWHQ PRGDOLGDGHV GH WUDWDPLHQWR TXH SXHGDQ JDUDQWL]DUHOp[LWRDODUJRSOD]R\PDVDOOiGHORTXHVH KDSUHVHQWDGRHQHOSUHVHQWHGRFXPHQWRODPD\RUtDGH ORVSURJUDPDVLQFOX\HHOGHVDUUROORGHKDELOLGDGHVSRU SDUWHGHORVSDFLHQWHVSDUDLGHQWLÀFDU\UHVROYHUVLWXD FLRQHVTXHSRWHQFLDOPHQWHSRQJDQDOSDFLHQWHHQULHVJR GHXQDUHFDtGDVLQHPEDUJRFDEHUHFRQRFHUTXHGLFKDV HVWUDWHJLDVQRKDQPRVWUDGRXWLOLGDG8QDUHFDtGDVLQ HPEDUJRQRGHEHFRQVLGHUDUVHXQDIDOODGHÀQLWLYD\D TXHODPD\RUtDGHORVTXHGHMDURQGHIXPDUSDUDVLHPSUH ORFRQVLJXLyGHVSXpVGHYDULRVLQWHQWRV

2EFERENCIAS 53$EPARTMENTOF(EALTH %DUCATION AND7ELFARE3MOKINGAND(EALTH !2EPORTOFTHE!DVISORY#OMMITTEETOTHE3URGEON'ENERALOFTHE 0UBLIC(EALTH3ERVICE53$EPARTMENTOF(EALTH %DUCATION AND7ELFARE 0UBLIC(EALTH3ERVICE0(30UBLICATION.O  'UINDON'% "OISCLAIR$4ENDENCIASPASADAS PRESENTESYFUTURASDEL CONSUMODETABACO/RGANIZACIØN0ANAMERICANADELA3ALUD$OCUMENTO VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

.O3ERIE!SPECTOS%CONØMICOSDEL#ONTROLDEL4ABACO7ASHINGTON $#/03  7ILKINGS. 9àREKLI! (U 4E(!NÉLISIS%CONØMICODELADEMANDA DE4ABACO/RGANIZACIØN0ANAMERICANADELA3ALUD"ANCO-UNDIAL 7ASHINGTON$#/03  /KUYEMI+3 .OLLEN., !HLUWALIA*3)NTERVENTIONSTOFACILITATESMOKING CESSATION!M&AM0HYSICIAN   -C%WEN! (AJEK0 -C2OBBIE( 7EST2-ANUALOFSMOKINGCESSATION !GUIDEFORCOUNSELORSANDPRACTITIONERS"LACWELL0UBLISHING 0ROCHASKA*/ $I#LEMENTE##*#ONSULT#LIN0SYCHOL  $I#LEMENTE## 0ROCHASKA*/ &AIRHURST3+ 6ELICER7& 6ELASQUEZ -- 2OSSI*34HEPROCESSOFSMOKINGCESSATIONANANALYSISOF PRECONTEMPLATION CONTEMPLATIONANDPREPARATIONSTAGESOFCHANGE* #ONSULT#LIN0SYCHOL  !CLINICALPRACTICEGUIDELINEFORTREATINGTOBACCOUSEANDDEPENDENCE !530UBLIC(EALTH3ERVICEREPORT4HE4OBACCO5SEAND$EPENDENCE #LINICAL0RACTICE'UIDELINE0ANEL 3TAFF AND#ONSORTIUM2EPRESENTATIVES *!-! 7EST24IMEFORCHANGEPUTTINGTHETRANSTHEORETICALSTAGESOFCHANGE MODELTOREST!DDICTION  7ILLEMSEN-# 7IEBING- VAN%MST! :EEMAN'(ELPINGSMOKERSTO DECIDEONTHEUSEOFEFlCACIOUSSMOKINGCESSATIONMETHODSARANDOMIZED CONTROLLEDTRIALOFADECISIONAID!DDICTION   7EST2!SSESSMENTOFDEPENDENCEANDMOTIVATIONTOSTOPSMOKING "-*  !MERICAN0SYCHIATRIC!SSOCIATION$IAGNOSTICAND3TATISTICAL-ANUALOF -ENTAL$ISORDERS THEDITION$3- )6 !MERICAN0SYCHIATRIC!SSOCIATION  (UGHES*2 &IESTER3 'OLDSTEIN-'ETAL!MERICAN0SYCHIATRIC !SSOCIATIONPRACTICEGUIDELINEFORTREATMENTOFPATIENTWITHNICOTINE DEPENDENCY!M*0SYCHIATRY3UPPL 3 3ANSORES2( 2AMÓREZ 6ENGAS! %SPINOSA -ARTÓNEZ- 3ANDOVAL2! 4RATAMIENTOSPARADEJARDEFUMARDISPONIBLESEN-ÏXICO3ALUD0UBLICA -EXSUPL3 3 3

!24·#5,/$%2%6)3)¼.

2EGALADO 0INEDA* 3ANSORES -ARTÓNEZ2 "UITRAGO' EDS'UÓAS -EXICANASPARAEL4RATAMIENTODEL4ABAQUISMO2EV3OC-EX.EUMOL#IR 4OR3UPL 3HOAIB- 3CHINDLER#7 'OLDBERG32.ICOTINESELF ADMINISTRATION INRATSSTRAINANDNICOTINEPRE EXPOSUREEFFECTSONACQUISITION 0SYCHOPHARMACOLOGY  (ENNINGlELD$ 'OLDBERG32.ICOTINEASREINFORCERINHUMANSUBJECTS ANDLABORATORYANIMALS0HARMACOL"IOCHEM"EHAV  #ORRIGAL7! #OHEN+- !DAMSON+,3ELF ADMINISTEREDNICOTINE ACTIVATESTHEMESOLIMBICDOPAMINESYSTEMTROUGHTHEVENTRALTEGMENTAL AREA"RAIN2ES  4APPER!2 -C+INNEY3, .ASHIMI2ETAL.ICOTINEACTIVATIONOFALPHA  RECEPTORSSUFlCIENTFORREWARD TOLERANCE ANDSENSITIZATION3CIENCE   /NCKEN# 'ONZÉLEZ$ .IDES- 2ENNARD3 7ATSKY% ETAL%FlCACY ANDSAFETYOFTHENOVELSELECTIVENICOTINICACETYLCHOLINERECEPTOR PARTIALAGONISTVARENICLINE FORSMOKINGCESSATION!RCH)NTERN-ED   2OLLEMA( #HAMBERS,+ #OE*7 'LOWA* (URST23 ETAL 0HARMACOLOGICALPROlLEOFTHE_`NICOTINICACETYLCHOLINERECEPTOR PARTIALAGONISTVARENICLINE ANEFFECTIVESMOKINGCESSATIONAID .EUROPHARMACOLOGY  'ONZALES$ 2ENNARD3* .IDES- /NCKEN# !ZOULAY3 ETAL 6ARENICLINE AN_`.ICOTINIC!CETYLCHOLINE2ECEPTORPARTIALAGONIST VSSUSTAINEDRELEASE"UPROPIONAND0LACEBOFOR3MOKINGCESSATION! RANDOMIZEDCONTROLLEDTRIAL*!-!  *ORENBY$% (AYS*4 2IGOTTI.! 7ILLIAMS+% "ILLING#" ETAL%FlCACY OF6ARENICLINE AN_`.ICOTINICACETYLCHOLINERECEPTORPARTIALAGONIST VS0LACEBOOSSUSTAINED RELEASE"UPROPIONFORSMOKINGCESSATION! 2ANDOMIZED#ONTROLLED4RAIL*!-!  4ONSTAND3 4ONESSEN0 (AYEK0 7ILLIAMS+% "ILLING#" ETAL%FFECT OFMAINTENANCETHERAPYWITH6ARENICLINEON3MOKING#ESSATION*!-!   7ILLIAMS+% 2EEVES+ "ILLING#" 0ENNINGTON!- 'ONG*!DOUBLE BLINDSTUDYEVALUATINGTHELONG TERMSAFETYOF6ARENICLINEFORSMOKING CESSATION#URR-ED2ES/P  .IDES- /NCKEN# 'ONZÉLEZ$ 2ENNARD3 7ATSKY%* !NZIANO2 ET AL3MOKINGCESSATIONWITHVARENICLINE ASELECTIVEABNICOTINICRECEPTOR PARTIALAGONIST!RCH)NTERN-ED  #AHILL+ 3TEAD*& ,ANCASTER4.ICOTINERECEPTORPARTIALAGONISTFOR SMOKINGCESSATION2EVIEW #OCHRANE$ATABASE3YST2EV  (UGHES*2 3TEAD,& ,ANCASTER4!NTIDEPRESSANTSFORSMOKING CESSATION#OCHRANE$ATABASE3YST2EV #$ (AYS*4 (URT2$ 2IGOTTI.! ETAL3USTAINED RELEASEBUPROPIONFOR PHARMACOLOGICRELAPSEPREVENTIONAFTERSMOKINGCESSATION!RANDOMIZED CONTROLLEDTRIAL!NN)NTERN-ED (URT2$ 3ACHS$0, 'LOVER%$ /FFORD+0 $ALE,#ETAL! COMPARISONOFSUSTAINED RELEASEBUPROPIONANDPLACEBOFORSMOKING CESSATION.%NGL*-ED *ORENBY$% ,EISCHOW33* .IDES-! 2ENNARD3) *ONSON*!! (UGHES !2ETAL!CONTROLLEDTRIALOFSUSTAINED RELEASEBUPROPION ANICOTINE PATCH ORBOTHFORSMOKINGCESSATION.%NGL*-ED  3IMON*! $UNCAN# #ARMODY40 (UDES%3"UPROPIONFORSMOKING CESSATION!RCH)NTERN-ED  3HIFFMAN3 7EST2 'ILBERT$2ECOMMENDATIONFORTHEASSESSMENTOF TOBACCOCRAVINGANDWITHDRAWALINSMOKINGCESSATIONTRIALS.ICOTINE4OB 2ES   3TAPLETON*! 2USSELL-!( &EYERABEN# 7ISEMAN3- 'USTAVSSON ' ETAL$OSEEFFECTSANDPREDICTORSOFOUTCOMEINARANDOMIZEDTRIALOF TRANSDERMANNICOTINEPATCHESINGENERALPRACTICE!DDICTION  'LOVER%$ 3ACHS$0, 3TITZER-, ETAL3MOKINGCESSATIONINHIGHLY DEPENDENTSMOKERSWITHMGNICOTINEPOLACRILEX!M*(EALTH"EHAVIOR 

3

5HJDODGR3LQHGD-\FRO

3ILAGY# ,ANCASTER4 3TEAD, -ANT$ &OWLER'.ICOTINEREPLACEMENT THERAPYFORSMOKINGCESSATION#OCHRANRE2EVIEW )N4HE#OCHRANE ,IBRARY )SSUE 4ONNESEN0 .ORREGAARD* -IKKELSEN+ *ORGENSEN3 .ILSSON&! DOUBLE BLINDTRIALOFANICOTINEINHALERFORSMOKINGCESSATION*!-!   (AJEK0 7EST2 &OULDS* ETAL2ANDOMIZEDCOMPARATIVETRIALOF NICOTINEPOLACRILEX ATRANSDERMALPATCH NASALSPRAY ANDANINHALER!RCH )NTERN-ED 7U0 7ILSON+ $IMOULAS0 -ILLS%*%FFECTIVENESSOFSMOKINGCESSATION THERAPIESASYSTEMATICREVIEWANDMETA ANALYSIS"-#0UBLIC(EALTH   (ENNINGlELD*%.ICOTINEMEDICATIONFORSMOKINGCESSATION.%NGL* -ED  $AUGHTON$- &ORTMANN30 'LOVER%$ ETAL4HESMOKINGCESSATION EFlCACYOFVARYINGDOSESOFNICOTINEPATCHDELIVERYSYSTEMSTOYEARS POST QUITDAY0REV-ED 7ORKINGGROUPFORTHESTUDYOFTRANSDERMALNICOTINEINPATIENTSWITH CORONARYARTERYDISEASE.ICOTINEREPLACEMENTFORPATIENTSWITHCORONARY ARTERYDISEASE!RCH)NTERN-ED  "ENOWITZ., 'OURLAY3'#ARDIOVASCULARTOXICITYOFNICOTINE IMPLICATIONSFORNICOTINEREPLACEMENTTHERAPY*!M#OLL#ARDIOL   -AHMARIAN** -OYE,! .ASSER'! ETAL.ICOTINEPATCHTHERAPYIN SMOKINGCESSATIONREDUCESTHEEXTENTOFEXERCISE INDUCEDMYOCARDIAL ISCHEMIA*!M#OLL#ARDIOL "ENOWITZ.,.ICOTINEREPLACEMENTTHERAPYDURINGPREGNANCY*!-!   $AVID3 ,ANCASTER4 3TEAD,& %VINS!%/PIOIDANTAGONISTSFORSMOKING CESSATION#OCHRANE$ATABASE3YST2EV #$ #OHEN# +ODAS% 'RIEBEL'#"RECEPTORANTAGONISTSFOR THETREATMENTOFNICOTINEADDICTION0HARMACOL"IOCHEM"EHAV    4ONSTAND32IMONABANTACANNABINOIDRECEPTORBLOCKERFORTHE TREATMENTOFMETABOLICANDCARDIOVASCULARRISKFACTORS.UTR-ETAB #ARDIOVASC$IS   &AGERSTROM+ "ALFOUR$*.EUROPHARMACOLOGYANDPOTENTIALEFlCACY OFNEWTREATMENTSFORTOBACCODEPENDENCE%XPERT/PIN)NVESTIG$RUGS    (ATSUKAMI$+ 2ENNARD3 *ORENBY$ &IORE- +OOPMEINERS* DE6OS! ETAL3AFETYANDIMMUNOGENICITYOFANICOTINECONJUGATEVACCINEINCURRENT SMOKERS#LIN0HARMACOL4HER   (ASMAN! (OLM3.ICOTINECONJUGATEVACCINEISTHEREARIGHTTOA SMOKINGFUTURE*-ED%THICS   "UNCE#* ,OUDON04 !KERS# $OBSON* 7OOD$-$EVELOPMENT OFVACCINESTOHELPTREATDRUGDEPENDENCE#URR/PIN-OL4HER    #RASSOUS0! $ENIS# 0ARIS( 3ENARD*-)NTERESTOFALPHA ADRENERGICAGONISTSANDANTAGONISTSINCLINICALPRACTICEBACKGROUND FACTS ANDPERSPECTIVES#URR4OP-ED#HEM   +ARACHALIOS'. #HARALABOPOULOS! 0APALIMNEOU6 +IORTSIS$ $IMICCO0 +OSTOULA/+ ETAL7ITHDRAWALSYNDROMEFOLLOWINGCESSATION OFANTIHYPERTENSIVEDRUGTHERAPY)NT*#LIN0RACT   'OURLAY3' 3TEAD,& "ENOWITZ.,#LONIDINEFORSMOKINGCESSATION #OCHRANE$ATABASE3YST2EV #$ (ARRIS$3 !NTHENELLI2-%XPANDINGTREATMENTOFTOBACCO DEPENDENCE#URR0SYCHIATRY2EP   'RAUL!) 0ROUS*2%XECUTIVESUMMARYNICOTINEADDICTION$RUGS4ODAY "ARC    3MOKINGANDHEALTHAPHYSICIANSRESPONSIBILITY!STATEMENTOFTHE JOINTCOMMITTEEONSMOKINGANDHEALTH!MERICAN#OLLEGEOF#HEST 0HYSICIANS !MERICAN4HORACIC3OCIETY !SIA0ACIlC3OCIETYOF2ESPIROLOGY

VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

7UDWDPLHQWRDFWXDOGHOWDEDTXLVPR

#ANADIAN4HORACIC3OCIETY %UROPEAN2ESPIRATORY3OCIETY )NTERNATIONAL 5NION!GAINST4UBERCULOSISAND,UNG$ISEASE%UR2ESPIR* 3ILAGY# 3TEADD,&0HYSICIANADVICEFORSMOKINGCESSATION#OCHRANE $ATABASE3YST2EV#$ 7ILLEMSEN-# 7IEBING- VAN%MST! :EEMAN'(ELPINGSMOKERSTO DECIDEONTHEUSEOFEFlCACIOUSSMOKINGCESSATIONMETHODSARANDOMIZED CONTROLLEDTRIALOFADECISIONAID!DDICTION   %LLIS! !BRAHAMS%4ERAPIA2ACIONAL%MOTIVA42% -ÏXICO0AX  ,ANCASTER4)NDIVIDUALBEHAVIOURALCOUNSELLINGFORSMOKINGCESSATION #OCHRANE$ATABASE3YST2EV #$ 3TEAD,& ,ANCASTER4'ROUPBEHAVIORTHERAPYPROGRAMMESFOR SMOKINGCESSATION#OCHRANE$ATABASE3YST2EV #$ 3ANSORES -ARTÓNEZ2( #ØRDOBA 0ONCE-0 %SPINOSA -ARTÓNEZ- (ERRERA +IENGERHER, 2AMÓREZ 6ENEGAS! ETAL%VALUACIØNDELPROGRAMA COGNITIVO CONDUCTUALPARADEJARDEFUMARDEL)NSTITUTO.ACIONALDE %NFERMEDADES2ESPIRATORIAS2EV)NST.AL%NF2ESP 

VDOXGS~EOLFDGHPp[LFRYROVXSOHPHQWRGH

!24·#5,/$%2%6)3)¼.

,ANCASTER4 3TEAD,&3ELF HELPINTERVENTIONSFORSMOKINGCESSATION 3ELF HELPINTERVENTIONSFORSMOKINGCESSATION *ULIANO,- (OUTSMULLER%* 3TITZER-,!PRELIMINARYINVESTIGATIONOF RAPIDSMOKINGASALAPSE RESPONSIVETREATMENTFORTOBACCODEPENDENCE %XP#LIN0SYCHOPHARMACOL   (AJEK0 3TEAD,&!VERSIVESMOKINGFORSMOKINGCESSATION#OCHRANE $ATABASE3YST2EV #$ 7HITE!2 2AMPES( #AMPBELL*,!CUPUNCTUREANDRELATED INTERVENTIONSFORSMOKINGCESSATION#OCHRANE$ATABASE3YST2EV  #$ ,ANCASTER4 (AJEK0 3TEAD,& 7EST2 *ARVIS-*0REVENTIONOFRELAPSE AFTERQUITTINGSMOKINGASYSTEMATICREVIEWOFTRIALS!RCH)NTERN-ED   

3

Lihat lebih banyak...

Comentarios

Copyright © 2017 DATOSPDF Inc.