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Questionnaires assessing symptoms, disability and handicap, predisposition to anxiety, and current anxiety and depression were completed by 127 people attending neuro-otology clinics with a major complaint of vertigo or dysequilibrium. Definite signs of vestibular dysfunction (spontaneous or positional nystagmus, or canal paresis) were found in 56% of the sample, but the presence or absence of abnormal vestibular test results was unrelated to diagnosis, reported symptoms, handicap and psychological status. Two-thirds of employed respondents admitted to occupational difficulties, and more than one in seven had left work because of vertigo. Although the number of people in the sample with a predisposition to anxiety was not unusually high, over a third of the sample had abnormally elevated levels of current anxiety. Multiple regression analyses indicated that disability was determined mainly by physical factors (vertigo severity and duration, age and sex). Handicap was influenced by a mixture of somatic and psychological variables, including the severity of autonomic symptoms. Anxiety and depression were only indirectly related to the severity and duration of the vertigo, insofar as this contributed to handicap. The partial dissociation between these different aspects of patient well-being suggests a need for separate evaluation and differing management of problems at each level of functioning.

Determinantes dos níveis de cotinina salivar: um estudo de base populacional no Brasil ABSTRACT OBJECTIVE: A cross-sectional population-based study was conducted to assess, in active smokers, the relationship of number of cigarettes smoked and other characteristics to salivary cotinine concentrations. METHODS:A random sample of active smokers aged 15 years or older was selected using a stepwise cluster sample strategy, in the year 2000 in Rio de Janeiro, Brazil. The study included 401 subjects. Salivary cotinine concentration was determined using gas chromatography with nitrogen-phosphorus detection. A standard questionnaire was used to collect demographic and smoking behavioral data. The relation between the number of cigarettes smoked in the last 24h and cotinine level was examined by means of a nonparametric fi tting technique of robust locally weighted regression. RESULTS:Signifi cantly (p<0.05) higher adjusted mean cotinine levels were found in subjects smoking their fi rst cigarette within fi ve minutes after waking up, and in those smoking 1-20 cigarettes in the last 24h who reported inhaling more than ½ the time. In those smoking 1-20 cigarettes, the slope was signifi cantly higher for those subjects waiting for more than fi ve minutes before smoking their fi rst cigarette after waking up, and those smoking "light" cigarettes when compared with their counterparts. These heterogeneities became negligible and non-signifi cant when subjects with cotinine >40 ng/mL per cigarette were excluded. CONCLUSIONS:There was found a positive association between selfreporting smoking fi ve minutes after waking up, and inhaling more than ½ the time are consistent and higher cotinine levels. These can be markers of dependence and higher nicotine intake. Salivary cotinine proved to be a useful biomarker of recent smoking and can be used in epidemiological studies and smoking cessation programs.KEY WORDS: Smoking. Cotinine, pharmacokinetics. Cross-sectional studies.955 Rev Saúde Pública 2007;41(6):954-62 Nicotine has a short half-life and its major metabolite is cotinine. Cotinine has a half-life of 16-20 hours and is a useful indicator of nicotine intake from recent smoking. About 70% to 80% of nicotine absorbed into the blood stream is converted into cotinine. 5 Thus, measurement of cotinine in biological samples provides is an objective approach to identify recent smoking exposure. 5

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years-from the statutory health insurance (SHI), family and societal perspectives-the number of AD cases, the direct medical, non-medical, and productivity loss costs, and quality adjusted life-year (QALY) in infant receiving each formula type for 4 months. The model included the following health states: disease free, mild, moderate, and severe AD, and death. Efficacy estimates were based on the German Infant Nutritional Intervention trial. Outcomes were discounted at 3% and reported as cost per QALY gained and per avoided cases of AD. Extensive deterministic and probabilistic sensitivity analyses (SA) were performed. RESULTS: In the base case, pHF-W resulted in 0.016 (95% CI: 0.0066; 0.0249) QALY gained and 0.14 AD cases avoided per patients relative to SF, with corresponding estimated incremental saving (SHI perspective) of €70.14 (95%CI: €16.26; €145.94;) per patient. pHF-W resulted in 0.006 (95% CI: 0.0004; 0.0149) QALY gained and 0.04 AD cases avoided per patients relative to eHF-W, with corresponding estimated incremental saving (SHI perspective) of €424 (95%CI: €106.94; €848.26) per patient.