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tenha diminu&#237;do&#44; o n&#250;mero total de fumadores continua a aumentar&#44; condicionando um enorme desafio global para os sistemas de sa&#250;de<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Os m&#233;dicos&#44; em geral&#44; por lidarem direta e individualmente com doentes&#44; tendem a considerar sa&#250;de&#47;doen&#231;a limitada ao comprometimento org&#226;nico do utente e da sua hist&#243;ria pessoal&#44; valorizando menos as causas das causas&#44; a determinante psicossocial dos fen&#243;menos e dos comportamentos&#44; indissoci&#225;veis do contexto ecol&#243;gico e dos interesses econ&#243;micos&#46; Progressivamente tem&#8208;se valorizado a polui&#231;&#227;o ambiental &#40;que tamb&#233;m tem o contributo do tabagismo&#41; que n&#227;o tem cessado de aumentar&#44; como a mais importante causa de morbimortalidade na popula&#231;&#227;o no mundo de hoje<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a>&#44; ampliando o espetro para al&#233;m dos fatores de risco tradicionalmente valorizados&#46; Esta perspetiva &#233; muito importante para compreender a resist&#234;ncia ao controle do tabagismo e para planear estrat&#233;gias de abordagem mais efetivas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nos Pa&#237;ses de L&#237;ngua Portuguesa &#40;PLP&#41; a relev&#226;ncia do tabagismo &#233; uniformemente maior nos homens&#44; mas &#233; heterog&#233;nea entre os diferentes pa&#237;ses&#44; sendo mais prevalente nos pa&#237;ses africanos&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a> descreve as preval&#234;ncias padronizadas por sexo em 2015&#44; e a diferen&#231;a anualizada para homens e mulheres&#44; de 1990 e 2015&#44; de acordo com o &#205;ndice Sociodemogr&#225;fico &#40;SDI&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a>&#46; O n&#250;mero de fumadores di&#225;rios varia entre 19&#37;&#44; 16&#44;8&#37; e 7&#44;2&#37;&#44; nos pa&#237;ses africanos&#44; Portugal e Brasil&#44; respetivamente<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Os dados dos Inqu&#233;ritos Nacionais de Sa&#250;de &#40;INS&#41; dispon&#237;veis &#40;1987&#44; 1995&#47;96&#44; 1998&#47;99&#44; 2005&#47;06 e 2014&#41; apontaram que o consumo di&#225;rio de tabaco em Portugal Continental diminuiu nos homens de 35&#44;2&#37; &#40;IC<span class="elsevierStyleInf">95</span>&#58; 34&#44;2&#8208;36&#44;2&#41; em 1987 para 26&#44;7 &#40;IC<span class="elsevierStyleInf">95</span>&#58; 25&#44;2&#8208;28&#44;3&#41; em 2014 e aumentou progressivamente nas mulheres de 6&#44;0&#37; &#40;IC<span class="elsevierStyleInf">95</span>&#58; 5&#44;6&#8208;6&#44;4&#41; em 1987 para 14&#44;6 &#40;IC<span class="elsevierStyleInf">95</span>&#58; 13&#44;6&#8208;15&#44;8&#41; tamb&#233;m em 2014&#44; observando&#8208;se maior consumo di&#225;rio em homens de grupos socioecon&#243;micos menos desfavorecidos e o oposto nas mulheres<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A preval&#234;ncia de consumo de tabaco descrito em Mo&#231;ambique em 2003 foi de 39&#44;9&#37; em homens e 18&#37; em mulheres<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46; Em amostra de 2005&#44; observou&#8208;se diminui&#231;&#227;o das preval&#234;ncias de fumadores di&#225;rios para 33&#44;6&#37; em homens e 7&#44;4&#37; nas mulheres&#44; considerando todas as formas de consumo de tabaco&#44; nomeadamente&#44; mascar tabaco&#44; rap&#233;&#44; cigarros manufaturados e enrolados manualmente&#44; com diferentes preval&#234;ncias por sexo e regi&#227;o do pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O Brasil &#233; o pa&#237;s l&#237;der no controlo do tabagismo&#44; com o terceiro maior decl&#237;nio em preval&#234;ncia de fumadores di&#225;rios desde 1990&#44; em 57&#37; e 56&#37; para homens e mulheres respetivamente&#44; obtidos atrav&#233;s de uma robusta pol&#237;tica p&#250;blica associada a publicidade sobre os danos &#224; sa&#250;de causados pelo tabaco&#44; restri&#231;&#245;es ao seu consumo e aumento de impostos para esses produtos&#44; entre outras medidas<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Essas medidas decorreram da ades&#227;o &#224;s recomenda&#231;&#245;es prescritas pela Conven&#231;&#227;o&#8208;Quadro para Controlo do Tabaco da Organiza&#231;&#227;o Mundial da Sa&#250;de &#40;CQCT&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a>&#44; como a proibi&#231;&#227;o dos termos <span class="elsevierStyleItalic">ultralight&#44; lowtar</span>&#44; suaves&#44; fracos&#44; leves ou qualquer outro que induza a crer que esses cigarros n&#227;o sejam t&#227;o nocivos&#46; Os PLP aderiram a CQCT em diferentes &#233;pocas como pode ser verificado no cap&#237;tulo referente &#224; Legisla&#231;&#227;o&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O n&#250;mero de mortes atribu&#237;das ao consumo de tabaco aumentou de 7280 milhares &#40;7010&#8208;7560&#41; em 2007 para 8100 &#40;7790&#8208;8420&#41; em 2017&#44; com incremento de 11&#44;3&#37; &#40;9&#44;1&#8208;13&#44;4&#41; em 195 pa&#237;ses&#44; no estudo do GBD<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a>&#46; O mesmo aconteceu com os DALYs&#44; que passaram de 200 000 &#40;188 000&#8208;212 000&#41; em 2007&#44; para 213 000 &#40;201 000&#8208;227 000&#41; em 2017&#44; com incremento de 6&#44;8&#37; &#40;4&#44;6&#8208;9&#44;0&#41;&#46; Em rela&#231;&#227;o &#224;s doen&#231;as isqu&#233;micas do cora&#231;&#227;o &#40;DIC&#41;&#44; observou&#8208;se tend&#234;ncia semelhante&#44; com 1500 milhares de mortes &#40;1440&#8208;1570&#41; em 2007 e 1620 milhares de mortes &#40;1540&#8208;1690&#41; em 2017&#44; com aumento de 7&#44;8&#37; &#40;4&#44;6 &#8208;11&#44;1&#41;&#44; e para os DALY foram observados 38 400 &#40;36 800&#8208;40 200&#41; em 2007 e 40&#46;600 &#40;38 700&#8208;42 500&#41; em 2017&#44; constituindo um aumento de 5&#44;6&#37; &#40;2&#44;4&#8208;9&#44;0&#41;&#46; Incrementos similares foram notados em rela&#231;&#227;o aos acidentes vasculares cerebrais &#40;AVC&#41; isqu&#233;micos&#44; de 295 &#40;276&#8208;317&#41; em 2007&#44; para 335 &#40;313&#8208;361&#41; milhares de mortes em 2017&#44; com incremento percentual de 13&#44;4&#37; &#40;8&#44;6 &#8208;17&#44;8&#41;&#44; e nos DALYs&#44; de 7540 &#40;6910&#8208;8260&#41; em 2007 para 9000 em 2017 &#40;8170&#8208;9920&#41;&#44; com aumento percentual de 19&#44;3&#37; &#40;14&#44;7&#8208;23&#44;8&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">&#201; importante ressaltar que aproximadamente 80&#37; dos fumadores se encontram nos pa&#237;ses de rendimento baixo e m&#233;dio<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a>&#44; que representam a maior parte dos habitantes dos PLP&#44; onde n&#227;o foi observado o decl&#237;nio do consumo de tabaco relatado nos pa&#237;ses de rendimento alto<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a>&#46; J&#225; existe evid&#234;ncia robusta do custo&#8208;efetividade e das oportunidades de tratar o tabagismo nos Cuidados de Sa&#250;de Prim&#225;rios pela sua abrang&#234;ncia e pela rela&#231;&#227;o m&#233;dico&#8208;paciente pr&#243;xima e continuada<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considerando&#8208;se apenas os fatores de risco valorizados na cl&#237;nica tradicional&#44; o tabagismo &#233; o &#250;nico que poderia ser completamente abolido na preven&#231;&#227;o das doen&#231;as cardiovasculares &#40;DCV&#41;&#44; contudo&#44; ampliando o espectro e incluindo altera&#231;&#245;es ecol&#243;gicas e comportamentais introduzidas pelo pr&#243;prio homem&#44; existem muitos outros fatores pass&#237;veis de controlo&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Num ambiente social cheio de circunst&#226;ncias estressoras e frustrantes pela desigualdade&#44; conflitos de interesses&#44; alimentadas pela propaganda&#44; o sucesso da ades&#227;o &#224;s subst&#226;ncias psicoativas&#44; como o consumo de tabaco e &#225;lcool&#44; adv&#233;m do facto de atuarem no sistema l&#237;mbico&#44; no circuito de recompensa&#44; acarretando depend&#234;ncia qu&#237;mica e psicol&#243;gica&#46; Esse sistema faz parte do processo evolutivo de adapta&#231;&#227;o que promoveu a preserva&#231;&#227;o das esp&#233;cies&#44; e &#233; um dos determinantes das repetidas reca&#237;das observadas quando o paciente pretende deixar de fumar<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">&#201; sabido que parar de fumar &#233; a medida mais eficaz na preven&#231;&#227;o das doen&#231;as relacionadas ao tabaco&#46; No entanto&#44; n&#227;o recebe&#44; no decorrer das consultas m&#233;dicas em ambulat&#243;rio nem durante os epis&#243;dios de internamento&#44; a aten&#231;&#227;o necess&#225;ria para que se inicie o processo de abandono da causa evit&#225;vel mais frequente das DCV e de muitas neoplasias<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46; Desse modo&#44; o objetivo desse artigo &#233; proporcionar um instrumento que possa ser utilizado pelos profissionais de sa&#250;de na sua pr&#225;tica di&#225;ria para o combate ao tabagismo&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidemiologia e mecanismos fisiopatol&#243;gicos</span><p id="par0065" class="elsevierStylePara elsevierViewall">&#201; importante mencionar o risco atribu&#237;vel ao cigarro para algumas doen&#231;as conforme est&#225; descrito na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#44; que mostra a percentagem de mortes atribu&#237;das ao consumo de tabaco e a percentagem de risco atribu&#237;do a este fator de risco nos diversos PLP&#46; Quando se compara fumadores e indiv&#237;duos que nunca fumaram&#44; observa&#8208;se um aumento de 2 a 3 vezes no risco de acidente vascular cerebral&#44; doen&#231;a isqu&#233;mica do cora&#231;&#227;o e doen&#231;a vascular perif&#233;rica&#44; 23 vezes no risco de neoplasia em homens e 13 vezes em mulheres e de 12 a 13 vezes no risco de doen&#231;a pulmonar obstrutiva cr&#243;nica&#46; H&#225; tamb&#233;m aumento de 2&#44;87 vezes no risco de morte por enfarte em fumadores quando comparados com os n&#227;o fumadores<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">O tabagismo est&#225; ainda relacionado com aumento da press&#227;o arterial e suas complica&#231;&#245;es como morte e decl&#237;nio da fun&#231;&#227;o renal&#46; O mesmo se aplica aos aneurismas de aorta abdominal com aumento do risco atribu&#237;vel ao tabaco&#44; tal como &#224; sua superior taxa de crescimento quando comparados fumadores e n&#227;o fumadores&#46; O consumo de tabaco foi associado com dist&#250;rbios de ritmo card&#237;aco&#44; como aumento da preval&#234;ncia de fibrilha&#231;&#227;o auricular e de taquicardia ventricular&#44; e tamb&#233;m com o aumento do risco de insufici&#234;ncia card&#237;aca&#44; bem como da mortalidade e morbilidade relacionadas com essa patologia<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Salienta&#8208;se o impacto do tabagismo no aumento de probabilidade relativa das principais doen&#231;as relacionadas com o tabaco&#44; como a doen&#231;a coron&#225;ria e enfarte do mioc&#225;rdio &#40;25&#37;&#41;&#44; doen&#231;as pulmonares obstrutivas cr&#243;nicas &#40;85&#37;&#41;&#44; neoplasias pulmonares &#40;90&#37;&#41;&#44; neoplasias de boca&#44; faringe&#44; laringe&#44; es&#243;fago&#44; est&#244;mago&#44; p&#226;ncreas&#44; rim&#44; bexiga&#44; colo de &#250;tero&#44; mama &#40;30&#37;&#41;&#44; e doen&#231;as cerebrovasculares &#40;25&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;15</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O risco de doen&#231;a isqu&#233;mica do cora&#231;&#227;o e sua mortalidade aumentam com os anos de tabagismo e com o n&#250;mero de cigarros fumados por dia&#44; existindo risco de doen&#231;a em todos os n&#237;veis de consumo de cigarro&#44; mesmo nos que consomem menos de cinco cigarros por dia e nos fumadores passivos&#46; Acresce que o doente que abandona o tabagismo ap&#243;s cirurgia de revasculariza&#231;&#227;o coron&#225;ria reduz o risco de hospitaliza&#231;&#227;o por doen&#231;a card&#237;aca&#46; Parar de fumar &#233; o &#250;nico tratamento eficaz para evitar a progress&#227;o da tromboange&#237;te obliterante&#44; melhorando os sintomas e reduzindo o risco de amputa&#231;&#227;o ao longo da vida<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Os benef&#237;cios ap&#243;s a cessa&#231;&#227;o do tabagismo s&#227;o muitos e devem ser mencionados nas consultas de fumadores &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; Os cigarros cont&#234;m mais de 7000 subst&#226;ncias t&#243;xicas&#44; que contribuem de formas diversas para as DCV&#44; destacando&#8208;se efeitos hemodin&#226;micos adversos&#44; como aumento da press&#227;o arterial e da frequ&#234;ncia card&#237;aca&#44; desequil&#237;brio entre a oferta e consumo de oxig&#233;nio&#44; altera&#231;&#227;o do fluxo sangu&#237;neo coron&#225;rio&#44; disfun&#231;&#227;o e les&#227;o endotelial&#44; hipercoagulabilidade e trombose&#44; inflama&#231;&#227;o cr&#243;nica e altera&#231;&#245;es dos lip&#237;dos&#44; al&#233;m do substrato para a ocorr&#234;ncia de arritmias e eventos cardiovasculares&#46; Esses efeitos tamb&#233;m podem ser observados nos fumadores passivos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#44;17</span></a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fatores associados com o consumo de tabaco</span><p id="par0090" class="elsevierStylePara elsevierViewall">O consumo de tabaco deve ser considerado uma doen&#231;a cr&#243;nica que se pode iniciar na inf&#226;ncia e adolesc&#234;ncia&#46; Cerca de 80&#37; dos indiv&#237;duos que experimentaram o tabaco fizeram&#8208;no com idade inferior a 18 anos&#44; existindo uma rela&#231;&#227;o direta entre o in&#237;cio do tabagismo e a manuten&#231;&#227;o do h&#225;bito na vida adulta<span class="elsevierStyleItalic">&#46;</span> Desse modo&#44; a preven&#231;&#227;o primordial torna&#8208;se fundamental no controlo do tabagismo&#46; Entende&#8208;se por preven&#231;&#227;o primordial do tabagismo a preven&#231;&#227;o do in&#237;cio do h&#225;bito de fumar entre crian&#231;as e adolescentes&#46; Crian&#231;as que usam tabaco durante 12 meses inalam a mesma quantidade de nicotina por cigarro que os adultos e experimentam os mesmos sintomas da depend&#234;ncia e da abstin&#234;ncia&#44; que habitualmente se desenvolvem muito rapidamente nas crian&#231;as&#46; Uma maneira de abordar a preven&#231;&#227;o primordial &#233; por grupos et&#225;rios observando&#8208;se em cada grupo os cinco principais itens da metodologia 5 As&#58; <span class="elsevierStyleBold">auscultar</span> no sentido de inquirir&#44; perguntar&#59; <span class="elsevierStyleBold">aconselhar</span> a parar de fumar&#59; <span class="elsevierStyleBold">avaliar</span> a motiva&#231;&#227;o e os sintomas da depend&#234;ncia do tabaco&#59; <span class="elsevierStyleBold">ajudar</span> na tentativa de parar de fumar&#59; e <span class="elsevierStyleBold">agendar</span> visitas peri&#243;dicas <a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A Organiza&#231;&#227;o Mundial da Sa&#250;de &#40;OMS&#41; lan&#231;ou o pacote chamado <span class="elsevierStyleBold">MPOWER</span>&#44; de impacto comprovado para a redu&#231;&#227;o dos produtos do tabaco<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">M</span>onitoring</span>&#58; monitorizando a epidemia&#59;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">P</span>rotecting</span>&#58; protegendo a popula&#231;&#227;o contra o fumo do tabaco&#59;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">O</span>ffering</span>&#58; oferecendo ajuda para parar de fumar&#59;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">W</span>arning</span>&#58; advertindo sobre os perigos do tabaco&#59;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">E</span>nforcing</span>&#58; fazendo cumprir a proibi&#231;&#227;o da publicidade&#44; promo&#231;&#227;o e patroc&#237;nio&#59;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">R</span>aising</span>&#58; aumentando impostos dos produtos do tabaco&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Essas medidas ter&#227;o algum impacto na interrup&#231;&#227;o do tabagismo ao n&#237;vel populacional&#44; mas a grande maioria dos fumadores necessitar&#225; de tratamento individualizado prestado por profissionais de sa&#250;de&#44; combinando muitas vezes abordagem comportamental e f&#225;rmacos&#44; para abandonar o fumo em definitivo&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Novas formas de tabagismo</span><p id="par0135" class="elsevierStylePara elsevierViewall">Na &#250;ltima d&#233;cada temos verificado o aparecimento de novas formas de tabagismo&#44; publicitadas como tendo risco ausente ou risco reduzido&#44; como os cigarros eletr&#243;nicos&#44; populares entre os jovens e os adultos&#44; denominados de JUUL&#44; que funcionam como vaporizadores de nicotina encapsulada&#44; flavorizantes e outros conte&#250;dos em pequenos cartuchos substitu&#237;veis denominados <span class="elsevierStyleItalic">pod&#8208;mods</span>&#46; Estes dispositivos&#44; que j&#225; est&#227;o na sua terceira gera&#231;&#227;o&#44; associam nicotina a outras subst&#226;ncias vaporizantes ou fornecedoras de sabores&#44; com efeitos mal conhecidos&#44; mas potencialmente indutores de risco para a sa&#250;de<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Fruto de bem elaboradas campanhas de <span class="elsevierStyleItalic">marketing</span>&#44; promotoras da introdu&#231;&#227;o das novas formas de uso do tabaco&#44; existe atualmente uma discuss&#227;o intensa entre a sociedade leiga e a comunidade cient&#237;fica sobre o risco inerente ao uso de cigarros eletr&#243;nicos como causa de doen&#231;as cardiovasculares e de neoplasias&#46; Apesar da evid&#234;ncia epidemiol&#243;gica atual n&#227;o ser extensa e de estas novas formas parecerem ter um risco inferior &#224; forma cl&#225;ssica&#44; j&#225; dispomos atualmente de evid&#234;ncia suficiente para afirmar que o seu consumo agudo causa disfun&#231;&#227;o endotelial&#44; les&#227;o do DNA&#44; estresse oxidativo e aumento tempor&#225;rio da frequ&#234;ncia card&#237;aca&#46; Quanto ao seu uso cr&#243;nico parece aumentar o risco de enfarte do mioc&#225;rdio&#44; acidente vascular cerebral e de neoplasias da cavidade oral e do es&#243;fago<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#44;13</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Baseado no aparente risco inferior das novas formas&#44; tem sido advogado que os cigarros eletr&#243;nicos podem ser utilizados como m&#233;todo de cessa&#231;&#227;o do tabagismo&#44; o que carece de comprova&#231;&#227;o&#46; Em 60&#37; dos casos&#44; os fumantes usam a forma cl&#225;ssica em simult&#226;neo com os cigarros eletr&#243;nicos&#44; mantendo o elevado risco pr&#233;vio&#46; Em muitos casos&#44; estas novas formas ser&#227;o adotadas por um curto espa&#231;o de tempo&#44; findo o qual o fumador retomar&#225; na totalidade o seu h&#225;bito anterior<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Por outro lado&#44; os cigarros eletr&#243;nicos s&#227;o considerados preocupantes pela comunidade cient&#237;fica por propiciarem a depend&#234;ncia &#224; nicotina nos jovens&#44; tornando&#8208;se uma porta de entrada para o tabagismo cl&#225;ssico&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">No momento atual&#44; mesmo reconhecendo que as evid&#234;ncias cient&#237;ficas dispon&#237;veis n&#227;o s&#227;o robustas&#44; recomendamos que sejam interrompidas e n&#227;o seja iniciada qualquer forma de tabagismo&#44; nomeadamente o uso de tabaco oral &#40;mastigar tabaco&#44; <span class="elsevierStyleItalic">snus&#44;</span> rap&#233;&#44; tabaco sol&#250;vel&#44; <span class="elsevierStyleItalic">vaping</span>&#8208;JUUL&#41; e cigarros&#44; charutos&#44; cigarrilhas&#44; cachimbos&#44; canos de narguil&#233;&#46; Tamb&#233;m &#233; de fundamental import&#226;ncia combater o tabagismo passivo&#44; que exp&#245;e os n&#227;o fumadores aos riscos de fumar e os agrava em 20&#8208;30&#37;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#44;14</span></a>&#44; relativamente &#224; popula&#231;&#227;o saud&#225;vel&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Abordagem do fumador</span><p id="par0160" class="elsevierStylePara elsevierViewall">A maioria dos fumadores tem a perce&#231;&#227;o e reconhece que o tabaco &#233; nocivo para a sua sa&#250;de&#46; No entanto&#44; isso n&#227;o basta para abandonar o h&#225;bito de fumar&#46; Da mesma forma&#44; os m&#233;dicos reconhecem os malef&#237;cios do tabagismo&#44; mas na pr&#225;tica di&#225;ria h&#225; uma tend&#234;ncia para dar prioridade ao tratamento da doen&#231;a e n&#227;o &#224; sua preven&#231;&#227;o&#46; A abordagem inicial do fumador visa encoraj&#225;&#8208;lo a iniciar o tratamento&#44; independentemente do tipo de condi&#231;&#227;o cl&#237;nica e do estadio em que se encontra a sua doen&#231;a&#46; &#201; importante salientar os benef&#237;cios de parar de fumar&#44; em cada consulta dos diferentes profissionais de sa&#250;de e em todos os doentes&#46; Como muitos pa&#237;ses t&#234;m restri&#231;&#245;es ao consumo de tabaco em ambientes p&#250;blicos&#44; salienta&#8208;se a relev&#226;ncia de perguntar de forma sistem&#225;tica sobre a exposi&#231;&#227;o ao tabaco dos n&#227;o fumadores que residem ou convivem com fumadores&#44; nomeadamente as crian&#231;as e jovens&#44; que al&#233;m de poderem considerar o h&#225;bito de fumar como algo normal e n&#227;o prejudicial &#224; sua sa&#250;de&#44; tamb&#233;m podem v&#234;&#8208;la piorar de forma aguda como no caso dos asm&#225;ticos&#46; &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">Tabela 4&#44; 5 e 6</a>&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a> descreve as medidas habituais para o acompanhamento da interrup&#231;&#227;o do tabagismo&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Anamnese</span><p id="par0165" class="elsevierStylePara elsevierViewall">Escalas&#58; Fagerstr&#246;m &#40;para depend&#234;ncia&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> &#8211; <a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Prochaska e DiClementi &#40;para motiva&#231;&#227;o&#41; <a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> &#8211; verificar as t&#233;cnicas de aconselhamento por paciente &#8211; <a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Comorbilidades cl&#237;nicas e&#47;ou psiqui&#225;tricas &#40;diabetes&#44; HAS&#44; depress&#227;o&#44; alcoolismo&#44; AVC&#44; convuls&#245;es&#44; cancro&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Medica&#231;&#245;es de uso cont&#237;nuo&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Fatores de risco para DCV &#40;dislipidemia&#44; uso de contraceptivos orais ou estrog&#233;nios&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Gesta&#231;&#227;o ou amamenta&#231;&#227;o&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Quest&#245;es relacionadas com o h&#225;bito de fumar&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0200" class="elsevierStylePara elsevierViewall">h&#225; quanto tempo fuma&#63;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0205" class="elsevierStylePara elsevierViewall">quantos cigarros fuma por dia&#63;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0210" class="elsevierStylePara elsevierViewall">j&#225; tentou parar de fumar e qual foi o resultado&#63;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0215" class="elsevierStylePara elsevierViewall">est&#225; interessado &#40;ou pensa&#41; em parar de fumar&#63;</p></li></ul></p><p id="par0220" class="elsevierStylePara elsevierViewall">Quest&#245;es relacionadas com a interrup&#231;&#227;o do tabagismo&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0225" class="elsevierStylePara elsevierViewall">pensa marcar uma data para deixar de fumar e gostaria de obter ajuda&#63;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0230" class="elsevierStylePara elsevierViewall">j&#225; tentou parar de fumar alguma vez&#44; se conseguiu&#44; se fez uso de alguma medica&#231;&#227;o e por quanto tempo ficou sem fumar&#63;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Exame f&#237;sico</span><p id="par0235" class="elsevierStylePara elsevierViewall">Monitorizar a PA&#44; especialmente se for utilizada a bupropiona&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Monitorizar o peso corporal&#58; o aumento ponderal pode ser uma barreira para iniciar o abandono do tabaco e um fator preditivo da reca&#237;da&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Exames complementares</span><p id="par0245" class="elsevierStylePara elsevierViewall">Hemograma&#44; provas de fun&#231;&#227;o hep&#225;tica&#44; glicemia&#44; lipidograma e bioqu&#237;mica s&#233;rica&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Radiografia do t&#243;rax&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Eletrocardiograma&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Espirometria &#40;nem sempre dispon&#237;vel&#41;&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Aferi&#231;&#227;o do mon&#243;xido de carbono no ar expirado &#40;COex&#41;&#44; se poss&#237;vel&#46; Essa medida tem rela&#231;&#227;o direta com a carboxihemoglobina e com o n&#250;mero de cigarros fumados por dia&#46; O ponto de corte &#233; de 6<span class="elsevierStyleHsp" style=""></span>ppm&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Tratamento</span><p id="par0270" class="elsevierStylePara elsevierViewall">A maioria dos pacientes necessitar&#225; de implementa&#231;&#227;o de terapia cognitivo&#8208;comportamental &#40;TCC&#41; como demonstrado na <a class="elsevierStyleCrossRef" href="#tbl0040">Tabela 8</a>&#44; apoiada por suporte farmacol&#243;gico para enfrentar o per&#237;odo da s&#237;ndrome de abstin&#234;ncia&#44; que normalmente dura entre duas e quatro semanas&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><p id="par0275" class="elsevierStylePara elsevierViewall">Explicar os mecanismos de depend&#234;ncia e ambival&#234;ncia&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Discutir as vantagens de parar de fumar e as desvantagens de continuar&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Aumentar a motiva&#231;&#227;o do fumador antes de iniciar o programa de cessa&#231;&#227;o&#44; saindo da postura contemplativa para um estadio de a&#231;&#227;o&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Sess&#245;es estruturadas com apoio de folhetos&#44; onde os principais aspetos da depend&#234;ncia&#44; os sintomas da abstin&#234;ncia e os obst&#225;culos a superar ser&#227;o discutidos&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Sess&#245;es com 90 minutos&#44; de quatro a seis com periodicidade semanal &#40;sess&#245;es de cessa&#231;&#227;o&#41; e de tr&#234;s a quatro com intervalo quinzenal &#40;sess&#245;es de manuten&#231;&#227;o&#41; nos primeiros tr&#234;s meses de tratamento&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Orientar os pacientes para marcar uma data para deixar de fumar entre a segunda e a terceira sess&#227;o terap&#234;utica&#44; independente do protocolo terap&#234;utico escolhido&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">A <span class="elsevierStyleItalic">fase de manuten&#231;&#227;o</span> &#233; voltada para a preven&#231;&#227;o de epis&#243;dios de reca&#237;da&#46; Esta fase dura 12 meses&#44; com seguimento mensal &#40;presencial ou por telefone&#41;&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Os seis primeiros meses ap&#243;s a cessa&#231;&#227;o s&#227;o considerados o per&#237;odo mais cr&#237;tico para a ocorr&#234;ncia de reca&#237;das&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">S&#237;ndrome de abstin&#234;ncia &#224; nicotina</span><p id="par0315" class="elsevierStylePara elsevierViewall">Os principais sinais e sintomas da s&#237;ndrome de abstin&#234;ncia est&#227;o expressos na <a class="elsevierStyleCrossRef" href="#tbl0045">Tabela 9</a>&#46;</p><elsevierMultimedia ident="tbl0045"></elsevierMultimedia><p id="par0320" class="elsevierStylePara elsevierViewall">A nicotina inalada liga&#8208;se a recetores neuronais espec&#237;ficos que produzem excessiva liberta&#231;&#227;o de dopamina e endorfinas&#44; cujos efeitos s&#227;o percecionados pelo fumador como estimulantes e associados a sensa&#231;&#227;o de prazer&#46; Quando esses efeitos se dissipam &#8211; com a recapta&#231;&#227;o da dopamina &#8211; os recetores enviam um sinal de que precisam de novo est&#237;mulo&#44; isto &#233;&#44; exigem mais nicotina&#44; o que &#233; apercebido como uma sensa&#231;&#227;o desagrad&#225;vel &#40;sistema l&#237;mbico&#44; no circuito de recompensa&#41;&#46; O fumador regular convive com abstin&#234;ncia todos os dias&#44; sempre que fica impedido de fumar por um curto per&#237;odo<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">A fissura &#40;<span class="elsevierStyleItalic">craving</span>&#41; &#233; um sintoma t&#237;pico da depend&#234;ncia f&#237;sica da nicotina&#44; sendo definida como um forte desejo ou urg&#234;ncia de fumar&#46; A priva&#231;&#227;o da nicotina produz efeitos f&#237;sicos vari&#225;veis que duram entre sete e trinta dias&#44; sendo mais intensos nos tr&#234;s primeiros dias ap&#243;s parar de fumar&#46; Contudo&#44; a fissura pode persistir por muitos meses porque continuam presentes os est&#237;mulos ambientais que se associaram ao tabagismo ao longo da vida&#44; sendo dif&#237;cil desconectar essas associa&#231;&#245;es&#46; Para enfrentar estas situa&#231;&#245;es&#44; o ex&#8208;fumador precisa adquirir capacidades e tra&#231;ar estrat&#233;gias para evitar os gatilhos que levam ao lapso e deste &#224; reca&#237;da<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">A farmacoterapia deve ser utilizada com o objetivo de complementar a terapia cognitivo&#8208;comportamental e aliviar os sintomas de abstin&#234;ncia&#46; Recomenda&#8208;se o uso dos medicamentos durante tr&#234;s meses por rotina&#44; estendendo para seis meses nos casos com maior dificuldade de cessa&#231;&#227;o do tabagismo<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a>&#46; Estima&#8208;se que com o uso de terapia farmacol&#243;gica uma pessoa deixa de fumar com sucesso &#40;abstin&#234;ncia de 6 meses&#41; em cada 6 a 23 pessoas tratadas<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0050">Tabela 10</a> resume os crit&#233;rios para o in&#237;cio da terapia farmacol&#243;gica&#44; para a qual devem ser considerados sempre o conforto&#44; a seguran&#231;a e a prefer&#234;ncia do paciente&#44; bem como o facto de n&#227;o haver contraindica&#231;&#245;es para a utiliza&#231;&#227;o de determinado medicamento&#46;</p><elsevierMultimedia ident="tbl0050"></elsevierMultimedia><p id="par0340" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Terapia com reposi&#231;&#227;o de nicotina&#46;</span> A terapia com reposi&#231;&#227;o de nicotina &#40;TRN&#41; &#233; considerada medica&#231;&#227;o de primeira linha na abordagem do fumador&#46; A TRN &#233; indicada nos doentes com graus moderado e elevado de depend&#234;ncia&#44; segundo o teste de Fagerstr&#246;m&#44; e n&#227;o deve ser combinada com o consumo de tabaco&#46; Os doentes devem ser orientados para interromper o consumo de tabaco ap&#243;s iniciar o uso da TRN&#46; O NNT para a cessa&#231;&#227;o definitiva &#233; de 23 e de 46 para morte prematura<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46; As formas dispon&#237;veis s&#227;o o adesivo com liberta&#231;&#227;o durante 24 horas&#44; as pastilhas de mascar gomas &#40;2<span class="elsevierStyleHsp" style=""></span>mg e 4<span class="elsevierStyleHsp" style=""></span>mg&#41; e a pastilha de nicotina &#40;2<span class="elsevierStyleHsp" style=""></span>mg e 4<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0055">Tabela 11</a> descreve a abordagem com a terapia de reposi&#231;&#227;o de nicotina para interrup&#231;&#227;o do tabagismo<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;15</span></a>&#46;</p><elsevierMultimedia ident="tbl0055"></elsevierMultimedia><p id="par0345" class="elsevierStylePara elsevierViewall">Para a abordagem farmacol&#243;gica com terapia n&#227;o nicot&#237;nica &#40;TNN&#41; est&#227;o dispon&#237;veis a bupropiona e a vareniclina &#40;f&#225;rmacos de primeira linha&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0060">Tabela 12</a>&#41; <a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;15</span></a>&#46; A clonidina e a nortriptilina s&#227;o op&#231;&#245;es de segunda linha no tratamento&#44; em fun&#231;&#227;o dos seus efeitos colaterais&#46; Os NNTs para bupropiona e vareniclina s&#227;o 18 e 10 para o sucesso no tratamento e 36 e 20 para evitar morte permanente&#44; respetivamente<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46; A <a class="elsevierStyleCrossRef" href="#tbl0065">Tabela 13</a> representa uma s&#250;mula do tratamento farmacol&#243;gico habitual para o tabagismo<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;15</span></a>&#46;</p><elsevierMultimedia ident="tbl0060"></elsevierMultimedia><elsevierMultimedia ident="tbl0065"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Cloridrato de bupropiona</span><p id="par0350" class="elsevierStylePara elsevierViewall">Simula alguns dos efeitos da nicotina no c&#233;rebro&#44; bloqueando a capta&#231;&#227;o neuronal de dopamina e norepinefrina&#46; Pode ser usado em associa&#231;&#227;o com a terapia de reposi&#231;&#227;o de nicotina com adesivo&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">Excelente op&#231;&#227;o para subgrupos de fumadores mais propensos a reca&#237;das&#44; com depress&#227;o ap&#243;s deixar de fumar&#44; para mulheres e para aqueles que possuem alto grau de depend&#234;ncia&#46; As taxas de sucesso na cessa&#231;&#227;o s&#227;o de 30&#37; a 36&#37;&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">Esquema terap&#234;utico&#58; Iniciar tratamento oito dias antes da paragem&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">150<span class="elsevierStyleHsp" style=""></span>mg&#47;tr&#234;s dias &#8211; toma &#250;nica de manh&#227;&#44; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;3 meses &#8211; toma de manh&#227; e &#224; tarde com intervalo de 8 horas&#44; podendo prolongar&#8208;se durante seis meses&#46; Controlar a press&#227;o arterial e se houver eleva&#231;&#227;o pode&#8208;se reduzir a dose para 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#44; antes da suspens&#227;o em casos refrat&#225;rios&#46; Reduzir as doses na insufici&#234;ncia renal e hep&#225;tica para 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#46; Inibidores da enzima MAO devem ser suspensos nos 15 dias anteriores ao in&#237;cio da bupropiona&#46; Usar com cautela ou evitar nos pacientes sob antipsic&#243;ticos teofilina e esteroides sist&#233;micos&#44; por favorecer o aparecimento de crises convulsivas&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">Contraindica&#231;&#245;es&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8211;</span><p id="par0375" class="elsevierStylePara elsevierViewall">Absolutas&#58; hist&#243;ria de convuls&#227;o &#40;mesmo febril&#41;&#44; epilepsia&#44; traumatismo cranioencef&#225;lico&#44; anormalidades no eletroencefalograma&#44; tumor cerebral&#44; alcoolismo grave&#44; anorexia nervosa e bul&#237;mia&#44; gravidez e lacta&#231;&#227;o&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8211;</span><p id="par0380" class="elsevierStylePara elsevierViewall">Relativas&#58; uso associado de barbit&#250;ricos&#44; benzodiazepinas&#44; cimetidina&#44; pseudoefedrina&#44; fenito&#237;na&#44; hipoglicemiantes orais&#44; insulina&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Tartarato de vareniclina</span><p id="par0385" class="elsevierStylePara elsevierViewall">Agonista parcial do recetor colin&#233;rgico de nicotina &#945;4&#946;2 que media a liberta&#231;&#227;o de dopamina no c&#233;rebro&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">Apresenta duplo&#8208;efeito&#58; reduz os sintomas da abstin&#234;ncia e o desejo de fumar&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">Esquema terap&#234;utico&#58; iniciar uma semana antes da data de interrup&#231;&#227;o&#44; com 0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;3 dias &#8211; manh&#227;&#59; 0&#44;5<span class="elsevierStyleHsp" style=""></span>mg do 4&#176; ao 7&#176; dia &#8211; manh&#227; &#40;7<span class="elsevierStyleHsp" style=""></span>h&#41; e tarde &#40;19<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; 1<span class="elsevierStyleHsp" style=""></span>mg&#47;dia durante 3 meses &#8211; manh&#227; &#40;7<span class="elsevierStyleHsp" style=""></span>h&#41; e tarde &#40;19<span class="elsevierStyleHsp" style=""></span>h&#41; podendo ser estendida at&#233; os seis meses&#44; nos casos em que a cessa&#231;&#227;o plena n&#227;o seja obtida ou haja risco de reca&#237;da&#46; A administra&#231;&#227;o &#233; por via oral&#44; n&#227;o sofre metaboliza&#231;&#227;o hep&#225;tica&#44; sendo a excre&#231;&#227;o renal praticamente <span class="elsevierStyleItalic">in natura</span>&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">Efeitos adversos&#58; n&#225;useas &#40;20&#37;&#41;&#44; cefaleias&#44; sonhos v&#237;vidos e ganho ponderal&#46; Raramente mudan&#231;as do humor&#44; agita&#231;&#227;o e agressividade&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">Por n&#227;o sofrer metaboliza&#231;&#227;o hep&#225;tica&#44; a vareniclina n&#227;o interfere com o uso concomitante de digoxina&#44; metformina&#44; varfarina&#46; A cimetidina pode causar aumento na biodisponibilidade&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">Deve ser usada com cautela em pacientes com insufici&#234;ncia renal&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">Contraindica&#231;&#227;o&#58; gravidez&#44; lacta&#231;&#227;o&#44; doentes com menos de 18 anos&#44; pacientes com dist&#250;rbio bipolar&#44; esquizofrenia ou epilepsia&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Legisla&#231;&#227;o</span><p id="par0420" class="elsevierStylePara elsevierViewall">Considerando que o tabagismo &#233; um fen&#243;meno populacional&#44; que imp&#245;e riscos tamb&#233;m aos n&#227;o fumadores &#40;quer se trate de gr&#225;vidas&#44; fetos e crian&#231;as ou de outros&#41;&#44; respons&#225;vel por desperd&#237;cio de grande volume de recursos p&#250;blicos &#40;financeiros e organizacionais&#41;&#44; ocasionando depend&#234;ncia &#40;o que coloca as pessoas numa situa&#231;&#227;o de vulnerabilidade semelhante &#224;s dependentes de outras drogas&#41;&#44; n&#227;o s&#227;o suficientes a assist&#234;ncia m&#233;dica e a educa&#231;&#227;o para a sa&#250;de&#46; A legisla&#231;&#227;o precisa contemplar o controlo do uso do tabaco em todas as suas formas e a sua explora&#231;&#227;o&#44; de forma semelhante ao controlo de outras drogas causadoras de depend&#234;ncia&#46;</p><p id="par0425" class="elsevierStylePara elsevierViewall">Os interesses econ&#243;micos envolvidos na planta&#231;&#227;o do tabaco&#44; na produ&#231;&#227;o das diferentes formas de consumo de tabaco&#44; a sua industrializa&#231;&#227;o&#44; comercializa&#231;&#227;o e propaganda s&#227;o muito elevados e transnacionais&#44; tornando insuficiente a sua categoriza&#231;&#227;o e abordagem exclusiva no &#226;mbito dos m&#233;dicos ou dos servi&#231;os de sa&#250;de&#46; Por esse motivo a Organiza&#231;&#227;o Mundial da Sa&#250;de promoveu a Conven&#231;&#227;o&#8208;Quadro ratificada por 168 pa&#237;ses em 2003<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a>&#44; na qual os pa&#237;ses se comprometeram na observ&#226;ncia de alguns princ&#237;pios que devem ser incorporados progressivamente no conjunto das leis nacionais&#46; Cabe ao setor de sa&#250;de de cada pa&#237;s permanecer vigilante&#44; promover esses princ&#237;pios junto da popula&#231;&#227;o e da classe pol&#237;tica&#46;</p><p id="par0430" class="elsevierStylePara elsevierViewall">As datas da assinatura do tratado e de ratifica&#231;&#227;o da Conven&#231;&#227;o&#8208;Quadro nos pa&#237;ses Lus&#243;fonos foram as seguintes&#58; Angola &#40;29&#47;06&#47;2004 e 20&#47;09&#47;2007&#41;&#44; Brasil &#40;16&#47;06&#47;2003 e 03&#47;11&#47;05&#41;&#44; Cabo Verde &#40;17&#47;02&#47;2004 e 04&#47;10&#47;2005&#41;&#44; Guin&#233; Equatorial &#40;01&#47;04&#47;2004 e 07&#47;11&#47;2007&#41;&#44; Guin&#233; Bissau &#40;07&#47;11&#47;2008&#41;&#44; Mo&#231;ambique &#40;18&#47;06&#47;03 e 14&#47;07&#47;17&#41;&#44; Portugal &#40;09&#47;01&#47;2004 e 08&#47;11&#47;2005&#41;&#44; S&#227;o Tom&#233; e Pr&#237;ncipe &#40;18&#47;06&#47;2004 e 12&#47;04&#47;2006&#41;&#44; Timor Leste &#40;25&#47;05&#47;2004 e 22&#47;12&#47;2004&#41; <a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">23&#44;24</span></a>&#46;</p><p id="par0435" class="elsevierStylePara elsevierViewall">Em muitos pa&#237;ses t&#234;m surgido organiza&#231;&#245;es especificamente voltadas para a vigil&#226;ncia das atividades pol&#237;ticas e da observ&#226;ncia do tratado&#46; Como no Brasil&#44; para al&#233;m da ACT &#40;Alian&#231;a de Controlo do Tabagismo &#8211; Promo&#231;&#227;o da Sa&#250;de &#8211; <a href="http://actbr.org.br/"><span class="elsevierStyleUnderline">http&#58;&#47;&#47;actbr&#46;org&#46;br&#47;</span></a>&#41; existem organiza&#231;&#245;es n&#227;o governamentais e associa&#231;&#245;es nacionais ou comit&#233;s dentro de entidades m&#233;dicas ou de outros segmentos da &#225;rea da sa&#250;de&#44; interessados na necessidade de mobiliza&#231;&#227;o social&#44; coordena&#231;&#227;o e atualiza&#231;&#227;o permanente das a&#231;&#245;es de controlo<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">23&#44;24</span></a>&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclus&#245;es</span><p id="par0440" class="elsevierStylePara elsevierViewall">Todas as formas de tabagismo representam um grave problema de sa&#250;de p&#250;blica para a preven&#231;&#227;o e tratamento das doen&#231;as cr&#243;nicas n&#227;o transmiss&#237;veis&#46; Compete aos m&#233;dicos dos cuidados prim&#225;rios&#44; internistas&#44; cardiologistas ou especialistas de outras &#225;reas rastrear os fumadores&#44; conhecer e utilizar todas as ferramentas dispon&#237;veis para encorajar o fumador a procurar ajuda profissional para cessar o h&#225;bito&#44; n&#227;o desperdi&#231;ar momentos&#8208;chave como os do diagn&#243;stico de doen&#231;a &#40;doen&#231;a das art&#233;rias coron&#225;rias&#44; arterial perif&#233;rica ou cerebral ou neoplasias relacionadas com o tabaco&#41; no doente&#44; em familiares ou membros&#8208;chave da sociedade&#46; O aumento da consci&#234;ncia da popula&#231;&#227;o quanto aos riscos do tabagismo torna o momento atual muito favor&#225;vel para a abordagem dos doentes fumadores&#46; O tratamento est&#225; mais acess&#237;vel &#40;a terapia de reposi&#231;&#227;o nicot&#237;nica e a bupropiona est&#227;o dispon&#237;veis nos PLP&#41;&#44; podendo ser realizado em qualquer local e em qualquer n&#237;vel dos cuidados de sa&#250;de&#46;</p><p id="par0445" class="elsevierStylePara elsevierViewall">A associa&#231;&#227;o da TCC com o suporte farmacol&#243;gico para enfrentar o per&#237;odo da abstin&#234;ncia aumenta a efic&#225;cia das interven&#231;&#245;es&#46; As reca&#237;das fazem parte do ciclo da depend&#234;ncia tab&#225;gica e devem servir como aprendizagem para uma tentativa subsequente&#46; Finalmente&#44; a cessa&#231;&#227;o do tabagismo em qualquer idade trar&#225; benef&#237;cios para a sa&#250;de do pr&#243;prio e dos seus pr&#243;ximos e o m&#233;dico deve estar sempre dispon&#237;vel para oferecer os seus cuidados&#44; qualquer que seja a fase em que se encontre a pessoa dependente da nicotina&#46;</p><p id="par0450" class="elsevierStylePara elsevierViewall">As novas formas de tabagismo&#44; designadamente com recurso de sistemas eletr&#243;nicos&#44; est&#227;o longe de provar a sua inoc&#234;ncia&#44; mesmo que contribuam para a redu&#231;&#227;o global do tabagismo e dos respetivos malef&#237;cios&#44; pelo que o seu uso deve ser desaconselhado&#46;</p><p id="par0455" class="elsevierStylePara elsevierViewall">O tabagismo precisa ser considerado como um problema que transcende os danos causados nos &#243;rg&#227;os afetados pelo fumo e produtos derivados do tabaco e relaciona&#8208;se com um conjunto de problemas produzidos pelo pr&#243;prio homem envolvendo aspetos econ&#243;micos&#44; sociais&#44; culturais e ecol&#243;gicos&#44; comprometendo a qualidade de vida e a pr&#243;pria sobreviv&#234;ncia&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflitos de interesse</span><p id="par0460" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ap&#243;s v&#225;rias d&#233;cadas de iniciativas orientadas pela Organiza&#231;&#227;o Mundial de Sa&#250;de com express&#227;o a n&#237;vel global e nos diferentes pa&#237;ses&#44; o consumo de tabaco continua a ser a segunda causa de mortalidade no mundo e a primeira causa de morte prematura e de incapacidade em consequ&#234;ncia de v&#225;rias neoplasias&#44; doen&#231;as pulmonares e c&#233;rebro&#8208;cardiovasculares&#44; com ele relacionadas&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O consumo de tabaco nos pa&#237;ses de l&#237;ngua portuguesa continua a ser tamb&#233;m um problema importante de sa&#250;de p&#250;blica&#44; o que justifica plenamente o lan&#231;amento e a implementa&#231;&#227;o destas &#171;Recomenda&#231;&#245;es de 2019 para a Redu&#231;&#227;o do Consumo de Tabaco nos Pa&#237;ses de L&#237;ngua Portuguesa&#187; pela Federa&#231;&#227;o das Sociedades de Cardiologia de L&#237;ngua Portuguesa&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Neste artigo de tomada de posi&#231;&#227;o s&#227;o revistas as &#250;ltimas altera&#231;&#245;es recentes e a epidemiologia atual referente ao consumo de tabaco nos diferentes pa&#237;ses de l&#237;ngua portuguesa&#44; &#233; salientado o impacto negativo para a sa&#250;de das novas formas de consumo de tabaco e s&#227;o abordadas as estrat&#233;gias de preven&#231;&#227;o e as terap&#234;uticas dispon&#237;veis&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Banir o tabagismo exige um esfor&#231;o concertado de v&#225;rias entidades a n&#237;vel nacional e internacional&#44; incluindo uma abordagem pol&#237;tica a n&#237;vel de cada pa&#237;s baseada em leis espec&#237;ficas&#44; em campanhas de educa&#231;&#227;o orientadas para o p&#250;blico em geral&#44; dirigidas nomeadamente para as novas gera&#231;&#245;es com o objetivo de n&#227;o iniciarem o consumo de tabaco&#44; associada a uma resposta do sistema de sa&#250;de com o objetivo de apoiar os fumadores a cessarem e a manterem&#8208;se livres do h&#225;bito de fumar no longo prazo&#44; com recurso a uma associa&#231;&#227;o de terap&#234;utica farmacol&#243;gica e de uma abordagem cognitivo&#8208;comportamental&#44; com o intuito de obter o controlo do &#250;nico fator de risco que pode ser totalmente abolido&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Esta tomada de posi&#231;&#227;o da FSCLP chama a aten&#231;&#227;o para a necessidade de os profissionais de sa&#250;de abordarem a problem&#225;tica da cessa&#231;&#227;o tab&#225;gica&#44; junto dos doentes e dos seus familiares durante momentos&#8208;chave como os epis&#243;dios de internamento hospitalar ou de consulta externa&#44; e capacita&#8208;os com o conhecimento cient&#237;fico hoje existente para cessar o h&#225;bito e manter o controlo deste fator de risco a longo prazo&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">After several decades of initiatives at international and national level inspired by the World Health Organization&#44; tobacco consumption is still the second leading cause of death in the world and the leading cause of premature death and disability&#44; as a result of various types of cancer and pulmonary&#44; cerebrovascular and cardiovascular disease&#46;</p><p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Tobacco consumption is also an important public health issue in Portuguese&#8208;speaking countries&#44; which fully justifies the launch and implementation of these 2019 recommendations for reducing tobacco consumption in Portuguese&#8208;speaking countries by the Federation of Portuguese Language Cardiology Societies&#46;</p><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">This position statement reviews recent changes in and the present epidemiology of tobacco consumption in the Portuguese&#8208;speaking countries&#44; discusses the negative health impact of new forms of tobacco consumption&#44; and addresses available prevention and drug treatment strategies&#46;</p><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Eliminating smoking requires a coordinated effort between various national and international bodies&#44; with a policy approach in each country focusing on laws&#44; education campaigns for primary prevention aimed at to the general public&#44; particularly to encourage young people not to start smoking&#44; and a health system approach to help smokers quit smoking permanently by a combination of drug treatment and cognitive behavioral therapy&#46; The aim is to control the only cardiovascular risk factor that can be completely eliminated&#46;</p><p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">This position statement aims to alert health professionals to the need to approach the subject of smoking cessation with patients and their families during hospitalizations and outpatient consultations&#44; and to provide them with up&#8208;to&#8208;date knowledge on how to quit smoking and maintain control of this risk factor in the long term&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#44;0 &#40;24&#44;2&#8208;25&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;1&#44;7 &#40;&#8211;2&#44;0&#47; &#8211;1&#183;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8211;1&#44;3 &#40;&#8211;1&#44;5&#47; &#8211;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Baixo&#8208;Intermedi&#225;rio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;6 &#40;0&#44;9&#8208;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8211;3&#44;3 &#40;&#8211;3&#44;8&#47;&#8211;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;5 &#40;1&#44;7&#8208;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;8 &#40;8&#44;0 &#8208;11&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;0&#44;9 &#40;&#8211;3&#44;1&#47;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncias padronizadas por sexo em 2015 e diferen&#231;a anualizada por sexo&#44; de 1990 e 2015&#44; de acordo com o &#205;ndice Sociodemogr&#225;fico &#40;SDI&#41;</p>"
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                  \t\t\t\t" scope="col">Doen&#231;aisqu&#233;micacard&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Acidentevascularcerebral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Cancro do pulm&#227;otraqueia&#44; br&#244;nquio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Doen&#231;aobstrutivacr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Alzheimer&#46;outras dem&#234;ncias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortes risco atribu&#237;do tabagismo &#37; &#40;IC<span class="elsevierStyleInf">95&#37;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortes risco atribu&#237;do tabagismo &#37; &#40;IC<span class="elsevierStyleInf">95&#37;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortes risco atribu&#237;dotabagismo &#37; &#40;IC<span class="elsevierStyleInf">95&#37;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortes risco atribu&#237;dotabagismo &#37; &#40;IC<span class="elsevierStyleInf">95&#37;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortes risco atribu&#237;do tabagismo&#37; &#40;IC<span class="elsevierStyleInf">95&#37;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angola&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;79 &#40;4&#44;06 &#8208;5&#44;60&#41;22&#44;51 &#40;19&#44;74&#8208;25&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;99 &#40;3&#44;43&#8208;4&#44;59&#41;42&#44;00 &#40;13&#44;13&#8208;17&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;62 &#40;0&#44;50&#8208;0&#44;74&#41;56&#44;32 &#40;51&#44;09 &#8208;61&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;24 &#40;1&#44;01&#8208;1&#44;67&#41;32&#44;93 &#40;26&#44;55&#8208;38&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;90 &#40;0&#44;78&#8208;1&#44;03&#41;13&#46;26 &#40;8&#44;21&#8208;18&#44;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brasil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;03 &#40;12&#44;7&#8208;13&#44;27&#41;24&#44;41 &#40;22&#44;31&#8208;26&#44;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;10 &#40;8&#44;88 &#8208;9&#44;29&#41;16&#44;60 &#40;14&#44;77&#8208;18&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;40 &#40;2&#44;35&#8208;2&#44;46&#41;64&#44;01 &#40;61&#44;19&#8208;66&#44;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;83 &#40;4&#44;71&#8208;4&#44;96&#41;46&#44;63 &#40;41&#44;89&#8208;51&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;44 &#40;5&#44;37&#8208;5&#44;50&#41;13&#44;29 &#40;7&#44;94&#8208;19&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabo Verde&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;39 &#40;14&#44;47&#8208;16&#44;41&#41;8&#44;78 &#40;7&#44;34&#8208;10&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;28 &#40;6&#44;43&#8208;8&#44;07&#41;7&#44;35 &#40;5&#44;99&#8208;8&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;65 &#40;1&#44;51&#8208;1&#44;79&#41;32&#44;99 &#40;28&#44;26&#8208;37&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;11 &#40;1&#44;85&#8208;2&#44;63&#41;19&#44;03 &#40;14&#44;88&#8208;22&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;49 &#40;5&#44;16&#8208;5&#44;81&#41;2&#44;93 &#40;1&#44;37&#8208;4&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guin&#233; Equatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;80 &#40;3&#44;24&#8208;4&#44;40&#41;11&#44;38 &#40;9&#44;12&#8208;13&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;95 &#40;2&#44;52&#8208;3&#44;40&#41;7&#44;65 &#40;6&#44;09&#8208;9&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;65 &#40;0&#44;46&#8208;0&#44;84&#41;36&#44;74 &#40;28&#44;63&#8208;45&#44;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;30 &#40;0&#44;96&#8208;1&#44;89&#41;19&#44;91 &#40;15&#44;15&#8208;24&#44;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;1&#44;12 &#8208;1&#44;60&#41;6&#44;77 &#40;3&#44;43&#8208; 10&#44;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guin&#233;&#8208;Bissau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;22 &#40;5&#44;36&#8208;7&#44;04&#41;11&#44;6 &#40;9&#44;60&#8208;13&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;59 &#40;4&#44;87&#8208;6&#44;31&#41;8&#44;16 &#40;6&#44;45&#8208;10&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;44 &#40;0&#44;33&#8208;0&#44;55&#41;32&#44;58 &#40;26&#44;63&#8208;38&#44;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;30 &#40;1&#44;07&#8208;1&#44;53&#41;19&#44;19 &#40;14&#44;65&#8208;23&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;90 &#40;0&#44;75&#8208;1&#44;14&#41;2&#44;99 &#40;1&#44;43&#8208;5&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mo&#231;ambique&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;77 &#40;3&#44;31&#8208;4&#44;26&#41;18&#44;74 &#40;15&#44;5&#8208;22&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;58 &#40;4&#44;86&#8208;6&#44;35&#41;14&#44;00 &#40;11&#44;2616&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;39 &#40;0&#44;33&#8208;0&#44;45&#41;48&#44;74 &#40;43&#44;34&#8208;54&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;91 &#40;0&#44;77&#8208;1&#44;08&#41;32&#44;06 &#40;26&#44;60&#8208;37&#44;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;88 &#40;0&#44;71&#8208;1&#44;01&#41;8&#44;56 &#40;4&#44;20&#8208;13&#44;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Portugal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;1 &#40;11&#44;53&#8208;12&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;91 &#40;13&#44;31&#8208;14&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;87 &#40;3&#44;61&#8208;4&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;11 &#40;4&#44;81&#8208;5&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;49 &#40;9&#44;07&#8208;9&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;69 &#40;11&#44;61&#8208;13&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;72 &#40;6&#44;92&#8208;8&#44;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;32 &#40;61&#44;42&#8208;66&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;71 &#40;27&#44;32&#8208;36&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;29 &#40;4&#44;37&#8208;10&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#227;o Tom&#233; e Pr&#237;ncipe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;77 &#40;8&#44;63&#8208;10&#44;92&#41;8&#44;59 &#40;6&#44;9&#8208;10&#44;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;61 &#40;7&#44;60&#8208;9&#44;93&#41;5&#44;51 &#40;4&#44;36&#8208;6&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;39 &#40;1&#44;06&#8208;1&#44;73&#41;33&#44;33 &#40;26&#44;09&#8208;40&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;19 &#40;4&#44;23&#8208;6&#44;07&#41;18&#44;26 &#40;14&#44;46&#8208;22&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;28 &#40;2&#44;07&#8208;2&#44;48&#41;3&#44;26 &#40;1&#46;62&#61;5&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Timor&#8208;Leste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;00 &#40;10&#44;30&#8208;15&#44;20&#41;24&#44;67 &#40;20&#44;66&#8208;28&#44;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;26 &#40;13&#44;18&#8208;17&#44;24&#41;17&#44;21 &#40;14&#44;23&#8208;20&#44;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;03 &#40;1&#44;65&#8208;2&#44;68&#41;59&#44;83 &#40;53&#44;01&#8208;66&#44;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;34 &#40;3&#44;59&#8208;5&#44;08&#41;47&#44;43 &#40;38&#44;34&#8208;54&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;66 &#40;2&#44;22&#8208;3&#44;07&#41;12&#44;18 &#40;6&#44;20&#8208;18&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Percentagem de mortes atribu&#237;das ao consumo de tabaco e percentagem de risco atribu&#237;do a este fator de risco&#44; nos diferentes Pa&#237;ses de L&#237;ngua Portuguesa<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a></p>"
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          0 => array:3 [
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          "leyenda" => "<p id="spar0170" class="elsevierStyleSimplePara elsevierViewall">AVC&#58; acidente vascular cerebral&#59; EAM&#58; enfarte agudo do mioc&#225;rdio&#59; FC&#58; frequ&#234;ncia card&#237;aca&#59; PA&#58; press&#227;o arterial&#46; Adaptado de<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a></p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">ap&#243;s 2 minutos&#58; PA e FC voltam ao normal&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">ap&#243;s 3 semanas&#58; respira&#231;&#227;o mais f&#225;cil e melhoria da circula&#231;&#227;o&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">ap&#243;s 1 ano&#58; o risco de morte por EAM reduz&#8208;se para metade&#44; igualando o dos n&#227;o fumadores ap&#243;s 15 anos&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">em 2&#8208;5 anos&#58; risco de AVC cai em mais de 90&#37; ficando pr&#243;ximo do risco de quem nunca fumou&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ap&#243;s 10 anos de abstin&#234;ncia&#58; risco de cancro baixa para cerca de metade do risco de um fumador&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">entre 5&#8208;10 anos o risco de EAM fica igual ao dos n&#227;o fumadores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ap&#243;s 20 anos&#58; risco de cancro de pulm&#227;o &#233; igual ao dos n&#227;o fumadores&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Benef&#237;cios da cessa&#231;&#227;o do tabagismo a curto&#44; m&#233;dio e longo prazo</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">AVC&#58; acidente vascular cerebral&#59; DCV&#58; doen&#231;a cardiovascular&#59; HAS&#58; hipertens&#227;o arterial sist&#233;mica&#59; PA&#58; press&#227;o arterial&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#8226; ANAMNESE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Escalas&#58; Fagerstr&#246;m &#40;para depend&#234;ncia&#41; 21 &#8211; Tabela 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Prochaska e DiClementi &#40;para motiva&#231;&#227;o&#41; 22 &#8211; verificar as t&#233;cnicas de aconselhamento por paciente &#8211; Tabela 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Comorbilidades cl&#237;nicas e&#47;ou psiqui&#225;tricas &#40;diabetes&#44; HAS&#44; depress&#227;o&#44; alcoolismo&#44; AVC&#44; convuls&#245;es&#44; cancro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Medica&#231;&#245;es de uso cont&#237;nuo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Fatores de risco para DCV &#40;dislipidemia&#44; uso de contracetivos orais ou estrog&#233;nios&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Gesta&#231;&#227;o ou amamenta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Quest&#245;es relacionadas com o h&#225;bito de fumar&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; h&#225; quanto tempo fuma&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; quantos cigarros fuma por dia&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; j&#225; tentou parar de fumar e qual foi o resultado&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; est&#225; interessado &#40;ou pensa&#41; em parar de fumar&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quest&#245;es relacionadas com a interrup&#231;&#227;o do tabagismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; pensa marcar uma data para deixar de fumar e gostaria de obter ajuda&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; j&#225; tentou parar de fumar alguma vez&#44; se conseguiu&#44; se fez uso de alguma medica&#231;&#227;o e por quanto tempo ficou sem fumar&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; EXAME F&#205;SICO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Monitorizar a PA&#44; especialmente se for utilizada a bupropiona&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Monitorizar o peso corporal&#58; o aumento ponderal pode ser uma barreira para iniciar o abandono do tabaco e um fator preditivo da reca&#237;da&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; EXAMES COMPLEMENTARES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Hemograma&#44; provas de fun&#231;&#227;o hep&#225;tica&#44; glicemia&#44; lipidograma e bioqu&#237;mica s&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Radiografia do t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Eletrocardiograma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Espirometria &#40;nem sempre dispon&#237;vel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Aferi&#231;&#227;o do mon&#243;xido de carbono no ar expirado &#40;COex&#41;&#44; se poss&#237;vel&#46; Essa medida tem rela&#231;&#227;o direta com a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; carboxihemoglobina e com o n&#250;mero de cigarros fumados por dia&#46; O ponto de corte &#233; de 6<span class="elsevierStyleHsp" style=""></span>ppm&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o inicial para abordagem do tabagismo</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabela 5"
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          0 => array:3 [
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Durante quanto tempo&#44; logo ap&#243;s acordar&#44; fuma o primeiro cigarro&#63;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;3&#41; Dentro de 5<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#41; Entre 6&#8208;30 min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#41; Entre 31&#8208;60 min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#41; Ap&#243;s 60 min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46; &#201;&#8208;lhe dif&#237;cil n&#227;o fumar em lugares proibidos&#63;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#41; Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#41; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46; Qual dos cigarros que fuma durante o dia lhe d&#225; mais satisfa&#231;&#227;o&#63;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#41; O primeiro da manh&#227;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#41; os outros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46; Quantos cigarros fuma por dia&#63;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#41; Menos de 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#41; de 11&#8208;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#41; de 21&#8208;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;3&#41; Mais de 31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46; Fuma mais frequentemente pela manh&#227;&#63;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#41; Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#41; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46; Fuma mesmo quando est&#225; doente&#44; quando precisa ficar acamado na maior parte do tempo&#63;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#41; Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#41; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Total&#58; &#91;0&#8208;2&#93; Muito baixa &#91;3&#8208;4&#93; Baixa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;5&#93; Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;6&#8208;7&#93; Elevada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;8&#8208;10&#93; Muito elevada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Escala de nicotina&#8208;depend&#234;ncia de Fagerstr&#246;m<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a></p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabela 6"
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          0 => array:3 [
            "identificador" => "at6"
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Pr&#233;&#8208;contemplativo</span>&#58; ainda n&#227;o se preocupa&#59; n&#227;o est&#225; pronto para a mudan&#231;a de comportamento&#59; informar brevemente sobre os riscos de continuar fumando e encorajar o paciente a pensar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Contemplativo&#58;</span> reconhece que precisa e quer mudar&#44; por&#233;m ainda deseja fumar &#40;ambival&#234;ncia&#41;&#59; ponderar sobre os pr&#243;s e contras da cessa&#231;&#227;o e manter&#8208;se dispon&#237;vel para conversar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Determinado&#58;</span> quer parar de fumar e est&#225; pronto para tomar as medidas necess&#225;rias&#59; escolher uma data para parar de fumar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">A&#231;&#227;o&#58;</span> empenhar&#8208;se em atitudes com a inten&#231;&#227;o de promover mudan&#231;as e entrar em abstin&#234;ncia&#59; seguimento para prevenir a reca&#237;da e aliviar os sintomas de abstin&#234;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Manuten&#231;&#227;o&#58;</span> mant&#233;m a mudan&#231;a de comportamento conquistada e permanece em abstin&#234;ncia&#59; refor&#231;ar os benef&#237;cios obtidos ao deixar de fumar&#44; identificar as situa&#231;&#245;es de risco para reca&#237;da e as habilidades para enfrent&#225;&#8208;los&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Reca&#237;da&#58;</span> n&#227;o consegue manter a abstin&#234;ncia conquistada e retorna ao comportamento de fumante&#59; oferecer apoio&#44; rever e retomar todo o processo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Est&#225;gios de motiva&#231;&#227;o e t&#233;cnicas de aconselhamento<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a></p>"
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        "etiqueta" => "Tabela 7"
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        "mostrarFloat" => true
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marcar a data para parar de fumar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conhecer o ambiente social do fumador&#44; de forma que os seus familiares&#44; amigos e colegas de trabalho possam ajud&#225;&#8208;lo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso haja familiares fumadores&#44; ser&#225; importante encoraj&#225;&#8208;los a parar de fumar ou fumar fora do domic&#237;lio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elaborar o plano de a&#231;&#227;o com estrat&#233;gias n&#227;o farmacol&#243;gicas e farmacol&#243;gicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acompanhamento das tentativas de cessa&#231;&#227;o do tabagismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Informar sobre a poss&#237;vel s&#237;ndrome de abstin&#234;ncia e fissura para interromper o tabagismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O doente&#44; com o m&#233;dico&#44; deve escolher o m&#233;todo de cessa&#231;&#227;o a ser utilizado&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cessa&#231;&#227;o abrupta&#58; &#233; geralmente o m&#233;todo de escolha entre os fumadores&#44; sendo a s&#237;ndrome de abstin&#234;ncia o seu maior obst&#225;culo&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cessa&#231;&#227;o gradual&#44; o fumador pode ficar a fumar uma pequena quantidade de cigarros indefinidamente e acaba por retornar ao padr&#227;o anterior de consumo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Acompanhamento para interrup&#231;&#227;o do tabagismo</p>"
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        "identificador" => "tbl0040"
        "etiqueta" => "Tabela 8"
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          0 => array:3 [
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            "detalle" => "Tabela "
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        "tabla" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Explicar os mecanismos de depend&#234;ncia e ambival&#234;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Discutir as vantagens de parar de fumar e as desvantagens de continuar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Aumentar a motiva&#231;&#227;o do fumador antes de iniciar o programa de cessa&#231;&#227;o&#44; saindo da postura contemplativa para um estadio de a&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Sess&#245;es estruturadas com apoio de folhetos&#44; onde os principais aspetos da depend&#234;ncia&#44; os sintomas da abstin&#234;ncia e os obst&#225;culos a superar ser&#227;o discutidos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Sess&#245;es com 90 minutos&#44; de quatro a seis com periodicidade semanal &#40;sess&#245;es de cessa&#231;&#227;o&#41; e de tr&#234;s a quatro com intervalo quinzenal &#40;sess&#245;es de manuten&#231;&#227;o&#41; nos primeiros tr&#234;s meses de tratamento&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Orientar os pacientes para marcar uma data para deixar de fumar entre a segunda e a terceira sess&#227;o terap&#234;utica&#44; independente do protocolo terap&#234;utico escolhido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; A fase de manuten&#231;&#227;o &#233; voltada para a preven&#231;&#227;o de epis&#243;dios de reca&#237;da&#46; Esta fase dura 12 meses&#44; com seguimento mensal &#40;presencial ou por telefone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Os seis primeiros meses ap&#243;s a cessa&#231;&#227;o s&#227;o considerados o per&#237;odo mais cr&#237;tico para a ocorr&#234;ncia de reca&#237;das&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2171128.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Terapia cognitivo&#8208;comportamental</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0045"
        "etiqueta" => "Tabela 9"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at9"
            "detalle" => "Tabela "
            "rol" => "short"
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        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sintomas neurocomportamentais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sintomas f&#237;sicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ansiedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Redu&#231;&#227;o da press&#227;o arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cefaleias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Redu&#231;&#227;o da frequ&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dificuldade de concentra&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sudorese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dificuldade de mem&#243;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tontura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inquieta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fissura &#40;urg&#234;ncia para fumar&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Irritabilidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tremores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sentimento de frustra&#231;&#227;o ou de raiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento do apetite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Humor deprimido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganho de peso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ins&#243;nia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descoordena&#231;&#227;o motora&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Sintomas da s&#237;ndrome de abstin&#234;ncia &#224; nicotina</p>"
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          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Os f&#225;rmacos pertencem a duas categorias b&#225;sicas&#58;</p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">terapias com reposi&#231;&#227;o de nicotina &#40;TRN&#41;</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">terapias n&#227;o nicot&#237;nicas &#40;TNN&#41;&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fuma 20 ou mais cigarros por dia <span class="elsevierStyleItalic">OU</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fuma o primeiro cigarro do dia at&#233; 30<span class="elsevierStyleHsp" style=""></span>min ap&#243;s acordar e fuma&#44; pelo menos&#44; 10 cigarros&#47;dia <span class="elsevierStyleItalic">OU</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tentativa pr&#233;via&#44; somente com a TCC&#44; n&#227;o eficaz devido &#224; s&#237;ndrome de abstin&#234;ncia&#46;&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Determinantes do in&#237;cio da terapia farmacol&#243;gica</p>"
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      10 => array:8 [
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        "etiqueta" => "Tabela 11"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reposi&#231;&#227;o r&#225;pida de nicotina&#58; goma de mascar e pastilha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#8226; Empregada quando h&#225; fissura &#40;necessidade imperiosa de fumar&#41; ou em intervalos de 1&#8208;2 horas&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Promove liberta&#231;&#227;o mais r&#225;pida da nicotina&#46; Pode ser combinada com o adesivo de nicotina ou associada &#224; bupropiona e &#224; vareniclina&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; O tempo aproximado de liberta&#231;&#227;o da nicotina &#233; de 5 minutos com a pastilha e 10 minutos com a goma&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; A dose m&#225;xima tolerada &#233; cerca de 10 gomas&#47;pastilhas por dia&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; O paciente deve mascar a goma&#47;pastilha at&#233; sentir um sabor picante&#46; Nesse momento&#44; deve parar de mascar por 2 minutos &#40;tempo para absorver a nicotina&#41; at&#233; que desapare&#231;a o sabor&#59; depois voltar a mascar repetindo o ciclo at&#233; 20 minutos para uma segunda liberta&#231;&#227;o de nicotina&#46; Ingerir um copo de &#225;gua antes do uso para neutralizar o pH bucal&#44; que se altera com o consumo de alimentos&#44; e para remo&#231;&#227;o de res&#237;duos alimentares&#44; que podem diminuir a absor&#231;&#227;o pela mucosa oral&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Efeitos colaterais&#58; hipersaliva&#231;&#227;o&#44; n&#225;useas&#44; solu&#231;os&#44; ulcera&#231;&#227;o gengival &#40;podendo levar a amolecimento de dentes&#41; e dor na articula&#231;&#227;o t&#234;mporo&#8208;mandibular &#40;ATM&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Contraindica&#231;&#227;o&#58; incapacidade de mascar&#44; les&#245;es na mucosa oral&#44; &#250;lcera p&#233;ptica&#44; subluxa&#231;&#227;o na ATM e uso de pr&#243;teses dent&#225;rias m&#243;veis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reposi&#231;&#227;o lenta&#58; adesivo de nicotina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Os adesivos s&#227;o apresentados em caixas com sete unidades cada&#44; em dosagens que variam entre 7 e 25<span class="elsevierStyleHsp" style=""></span>mg&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; &#201; indicada para manter um n&#237;vel cont&#237;nuo de nicotina circulante durante 24 horas&#44; em processo de desabitua&#231;&#227;o gradual do tabagismo&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Pode estar indicada como terapia pr&#233;&#8208;cessa&#231;&#227;o durante 2 a 4 semanas em fumadores que apresentem muita dificuldade em reduzir o n&#250;mero de cigarros e em marcar uma data para interromper o h&#225;bito&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Os adesivos devem ser aplicados pela manh&#227;&#44; em &#225;reas cobertas&#44; na parte superior do t&#243;rax ou regi&#245;es anteriores&#44; posteriores e superiores laterais do bra&#231;o&#44; com rota&#231;&#227;o entre estes locais e troca na mesma hora do dia&#46; Deve evitar&#8208;se exposi&#231;&#227;o solar no local&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Pode ser usado em associa&#231;&#227;o com a bupropiona ou com a vareniclina&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Esquema terap&#234;utico&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211; Fumador de 20 cigarros&#47;dia e&#47;ou com <span class="elsevierStyleItalic">score</span> de Fagerstr&#246;m entre 8&#8208;10 pontos&#58; Adesivo de 21 a 25 mg&#47;dia da 1<span class="elsevierStyleHsp" style=""></span>&#170; &#224; 4<span class="elsevierStyleHsp" style=""></span>&#170; semana&#59; 14 a 15 mg&#47;dia da 5<span class="elsevierStyleHsp" style=""></span>&#170; &#224; 8<span class="elsevierStyleHsp" style=""></span>&#170; semana&#59; 7 mg&#47;dia da 9<span class="elsevierStyleHsp" style=""></span>&#170; &#224; 10&#170; semana&#46; Sugere&#8208;se colocar o adesivo pela manh&#227; logo ap&#243;s o despertar&#46; Em casos de ins&#243;nia&#44; deve&#8208;se retirar ap&#243;s 16 horas de uso&#46; Em casos especiais de grande depend&#234;ncia e na aus&#234;ncia de contraindica&#231;&#227;o&#44; pode&#8208;se empregar at&#233; dois adesivos de 21<span class="elsevierStyleHsp" style=""></span>mg&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211; Fumador de 10&#8208;20 cigarros&#47;dia e&#47;ou com <span class="elsevierStyleItalic">score</span> de Fagerstr&#246;m entre 5&#8208;7 pontos&#58; Adesivo de 14&#8208;15 mg&#47;dia nas primeiras 4 semanas seguido de 7 mg&#47;dia da quinta &#224; oitava semana&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Efeitos colaterais&#58; prurido&#44; exantema&#44; eritema&#44; cefaleia&#44; n&#225;usea&#44; dispepsia&#44; mialgia e taquicardia&#44; quando em dose excessiva&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Contraindica&#231;&#245;es&#58; hist&#243;ria de enfarte do mioc&#225;rdio recente &#40;nos &#250;ltimos 15 dias&#41;&#44; arritmias card&#237;acas graves&#44; angina pectoris inst&#225;vel&#44; doen&#231;a vascular perif&#233;rica&#44; &#250;lcera p&#233;ptica&#44; doen&#231;as cut&#226;neas&#44; gravidez e lacta&#231;&#227;o&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2171134.png"
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Terapia de reposi&#231;&#227;o de nicotina &#40;TRN&#41;</p>"
        ]
      ]
      11 => array:8 [
        "identificador" => "tbl0060"
        "etiqueta" => "Tabela 12"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at12"
            "detalle" => "Tabela 1"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cloridrato de bupropiona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Simula alguns dos efeitos da nicotina no c&#233;rebro&#44; bloqueando a capta&#231;&#227;o neuronal de dopamina e&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">norepinefrina&#46; Pode ser usado em associa&#231;&#227;o com a terapia de reposi&#231;&#227;o de nicotina com adesivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excelente op&#231;&#227;o para subgrupos de fumadores mais propensos a reca&#237;das&#44; com depress&#227;o ap&#243;s deixar de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">fumar&#44; para mulheres e para aqueles que possuem alto grau de depend&#234;ncia&#46; As taxas de sucesso na cessa&#231;&#227;o s&#227;o de 30&#37; a 36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esquema terap&#234;utico&#58; Iniciar tratamento oito dias antes da paragem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211; 150 mg&#47; tr&#234;s dias &#8211; toma &#250;nica de manh&#227;&#44; 150 mg&#47; 3 meses &#8211; toma de manh&#227; e &#224; tarde com intervalo de 8 horas&#44; podendo prolongar&#8208;se durante seis meses&#46; Controlar a press&#227;o arterial&#44; e se houver eleva&#231;&#227;o pode&#8208;se&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">reduzir a dose para 150 mg&#47;dia&#44; antes da suspens&#227;o em casos refrat&#225;rios&#46; Reduzir as doses na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">insufici&#234;ncia renal e hep&#225;tica para 150mg&#47;dia&#46; Inibidores da enzima MAO devem ser suspensos nos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 dias anteriores ao in&#237;cio da bupropiona&#46; Usar com cautela ou evitar nos pacientes sob antipsic&#243;ticos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">teofilina e esteroides sist&#233;micos&#44; por favorecer o aparecimento de crises convulsivas&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contraindica&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211; Absolutas&#58; hist&#243;ria de convuls&#227;o &#40;mesmo febril&#41;&#44; epilepsia&#44; traumatismo cranioencef&#225;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">anormalidades no eletroencefalograma&#44; tumor cerebral&#44; alcoolismo grave&#44; anorexia nervosa e&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">bul&#237;mia&#44; gravidez e lacta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211; Relativas&#58; uso associado de barbit&#250;ricos&#44; benzodiazepinas&#44; cimetidina&#44; pseudoefedrina&#44;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">fenito&#237;na&#44; hipoglicemiantes orais&#44; insulina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tartarato de vareniclina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Agonista parcial do recetor colin&#233;rgico de nicotina &#945;4&#946;2 que media a liberta&#231;&#227;o de dopamina no c&#233;rebro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Apresenta duplo&#8208;efeito&#58; reduz os sintomas da abstin&#234;ncia e o desejo de fumar&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esquema terap&#234;utico&#58; iniciar uma semana antes da data de interrup&#231;&#227;o&#44; com 0&#44;5 mg&#47;3 dias &#8211; manh&#227;&#59; 0&#44;5<span class="elsevierStyleHsp" style=""></span>mg do 4<span class="elsevierStyleHsp" style=""></span>&#176; ao 7<span class="elsevierStyleHsp" style=""></span>&#176; dia &#8211; manh&#227; &#40;7<span class="elsevierStyleHsp" style=""></span>h&#41; e tarde &#40;19h&#41;&#44; 1 mg&#47;dia durante 3 meses &#8211; manh&#227; &#40;7<span class="elsevierStyleHsp" style=""></span>h&#41; e tarde &#40;19h&#41; podendo ser estendida at&#233; os seis meses&#44; nos casos em que a cessa&#231;&#227;o plena n&#227;o seja obtida ou haja risco de reca&#237;da&#46; A administra&#231;&#227;o &#233; por via oral&#44; n&#227;o sofre metaboliza&#231;&#227;o hep&#225;tica&#44; sendo a excre&#231;&#227;o renal praticamente <span class="elsevierStyleItalic">in natura</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Efeitos adversos&#58; n&#225;useas &#40;20&#37;&#41;&#44; cefaleias&#44; sonhos v&#237;vidos e ganho ponderal&#46; Raramente mudan&#231;as do humor&#44; agita&#231;&#227;o e agressividade&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Por n&#227;o sofrer metaboliza&#231;&#227;o hep&#225;tica&#44; a vareniclina n&#227;o interfere com o uso concomitante de digoxina&#44; metformina&#44; varfarina&#46; A cimetidina pode causar aumento na biodisponibilidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deve ser usada com cautela em pacientes com insufici&#234;ncia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contraindica&#231;&#227;o&#58; gravidez&#44; lacta&#231;&#227;o&#44; doentes com menos de 18 anos&#44; pacientes com dist&#250;rbio bipolar&#44; esquizofrenia ou epilepsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Terapia n&#227;o nicot&#237;nica &#40;TNN&#41;</p>"
        ]
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      12 => array:8 [
        "identificador" => "tbl0065"
        "etiqueta" => "Tabela 13"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at13"
            "detalle" => "Tabela 1"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medicamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">In&#237;cio do tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Esquema terap&#234;utico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dura&#231;&#227;o &#40;semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TRN&#58; adesivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na data escolhida para deixar de fumar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#8208;25 mg&#47; dia &#8208; 4 semanas14&#8208;15mg&#47;dia &#8208; 4 semanas7 mg&#47;dia &#8208; 2 semanasSe fumador com grau de depend&#234;ncia elevada&#44; podem ser necess&#225;rias doses superiores a 21 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 a 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TRN&#58; goma ou pastilha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Na data escolhida para deixar de fumar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>mg ou 4 mg&#58; 1 a 4&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 a 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bupropiona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uma semana antes da data escolhida para deixar de fumar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primeiro ao terceiro dia &#8208; 150<span class="elsevierStyleHsp" style=""></span>mg&#44; 1 x diaQuarto dia at&#233; o final &#8208; 150<span class="elsevierStyleHsp" style=""></span>mg&#44; 2 x ao dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vareniclina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uma semana antes da data escolhida para deixar de fumar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primeiro ao terceiro dia &#8208; 0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#44; 1 x diaQuarto ao s&#233;timo dia &#8208; 0&#44;5<span class="elsevierStyleHsp" style=""></span>mg de 12&#47;12 horasOitavo dia at&#233; o final &#8208; 1<span class="elsevierStyleHsp" style=""></span>mg 12&#47;12 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">Tratamento farmacol&#243;gico habitual para o tabagismo</p>"
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                            0 => "A&#46;F&#46; Sim&#227;o"
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