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Introduction and Objectives: Exposure to secondhand smoke (SHS) causes cardiovascular disease, respiratory disease, and cancer. The aim of this study was to estimate the mortality attributed to SHS in people aged ≥ 35 years in Spain and its autonomous communities (AC) by sex from 2016 to 2021., Methods: Estimates of SHS-attributable mortality were calculated by applying the prevalence-dependent method where SHS exposure was derived from the adjustment of small-area models and based on the calculation of population-attributed fractions. Sex, age group, AC, and cause of death (ischemic heart disease and lung cancer) were included. The estimates of attributed mortality are presented with their 95% confidence interval (95%CI). Crude and age-standardized rates were estimated for each sex and AC., Results: From 2016 to 2021, SHS exposure caused 4,970 (95%CI, 4,787-5,387) deaths, representing 1.6% of total mortality for ischemic heart disease and lung cancer. The burden of attributed mortality differed widely among the AC, with Andalusia having the highest burden of attributed mortality (crude rate: 46.6 deaths per 100 000 population in men and 17.0/100 000 in women). In all the AC, the main cause of death in both sexes was ischemic heart disease. The highest burden of mortality was observed in nonsmokers., Conclusions: The burden of SHS-attributable mortality was high and varied geographically. The results of this study should be considered to advance tobacco control legislation in Spain., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The health plan is a guiding tool for territorial health planning where the proposed objectives and measures should prioritize vulnerable groups. The aim of this study was to identify if the Regional Government health plans in Spain included measures related to frailty, dependence and unwanted loneliness aimed at elderly., Methods: Institutional websites were scanned to identify the most recent health plan of each Regional Government. Information concerning the diagnosis, objectives, specific programs and types of measures on the three domains: frailty, dependence and loneliness was extracted manually. The search was performed on 10 July 2023., Results: Sixteen health plans published between 2010 and 2023 were identified. Twelve of these had incorporated intervention measures on frailty, fourteen on dependence and eight on loneliness, with a considerable heterogeneity. Only eight Regional Governments provide for measures to detect and assess frailty. Aragón, Castilla-La Mancha, Cataluña, Extremadura, País Vasco, Principado de Asturias, Comunidad Foral de Navarra and Comunitat Valenciana were the Regional Governments that presented objectives in the three domains., Conclusions: The measures proposed by the Regional Governments on frailty, dependence and unwanted loneliness are highly heterogeneous. In the same manner that exists for frailty, it is recommended to stablish a consensus including dependency and unwanted loneliness. Surprisingly, the measures focus more on late stages (dependence) than on prevention (frailty). This study could serve the Regional Governments to in-depth review their health plans, and to examine the actions carried out in other regions to improve the quality of their proposals.

Cannabis is the most widely consumed illegal drug in Spain, with consumption concentrated mainly in adolescence and early adulthood. The objectives were to estimate the prevalence of cannabis use, cannabis use disorder (CUD) and dependent use in the Galician population aged 16 years and over, and to characterize cannabis users and cannabis dependent users. Data are from two cross-sectional studies from the Risk Behavior Information System conducted in 2017 (n = 7,841) and 2018 (n = 7,853). The Cannabis Abuse Screening Test (CAST) was used to identify users with CUD and/or dependent use. Prevalences were estimated and regression models were fitted to identify variables associated with cannabis use and dependent use. In 2017-2018, 2.7% (95% CI: 2.5-3.0) of the Galician population aged 16 years and over consumed cannabis at the time of the survey, with this prevalence being 9% in the 16-24 years age group. Prevalence decreased with age and was higher in males in all age groups. The prevalence of CUD in users was 69.5% (95% CI 61.1-78.1) and of dependent use it was 49.2% (95% CI 46.6-53.9). Tobacco use was the major determinant of being a cannabis user [OR = 19.8 (95% CI 13.8-28.4)] and daily cannabis use of being a dependent user [OR = 5.5 (95% CI 3.2-9.5)]. Cannabis use among the Galician population is high, especially among young people aged 16-24 years, who show the highest probability of dependent use. Prevention measures should be aimed especially at the younger population aged 16 years to curb its use and the development of consequences such as CUD and dependent use.

Objective: To describe the questions used to assess exposure to secondhand smoke (SHS) in Spanish health surveys., Method: Extraction and analysis of the literals of the questions on SHS in the health surveys in Spain identified on the website of the Ministry of Health, the National Plan on Drugs and Health Departments of the autonomous communities., Results: Three nationwide surveys assessed SHS exposure, with variability in questions, responses, and recall periods. Catalonia in 2022, and Galicia and the Basque Country in 2018, assessed exposure in detail., Conclusions: Questions assessing self-reported exposure to SHS are survey-dependent. There is a need for a set of questions to assess exposure in a homogeneous way in health surveys., (Copyright © 2024 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To assess the perceptions and beliefs of adolescents about cannabis consumption, studying the incentive and disincentive factors for consumption., Method: A systematic review of the literature was carried out following the PRISMA guidelines. MedLine, Embase, APA PsycInfo, Cochrane and Web of Science were searched using controlled vocabulary and free terms. We included qualitative studies published between 2000 and 2024 that assessed the perceptions of adolescents aged 10 to 19 years on the use, effects, risks of using cannabis or cannabis with other legal drugs. The quality of the studies was assessed using the CASP tool., Results: Of the 3665 articles identified in the initial search, 22 complied with elegibility criteria. Data extraction yielded a series of three lines of argument linked to cannabis use: reasons for use, reasons for not using and perceived effects. The most common discourse among adolescents was related to the feeling of social and emotional well-being, fewer adverse effects than drugs, and the influence of peers on consumption., Conclusions: The review preformed reports on the reasons that adolescents allege for cannabis use and reasons for abstention with a view of the preponderance of benefits over harms. It is considered that this information may be necessary for the development of prevention programmes with the dissemination of information on the effects of consumption., (Copyright © 2024 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The objective of this work was to assess changes during pregnancy and after childbirth in diet, consumption of tobacco, electronic cigarettes, cannabis, alcohol use and exposure to environmental tobacco smoke depending on the mother's educational level.A cross-sectional study was carried out whose target population was 18,822 Galician women aged 18-49 who gave birth between September 2015 and August 2016, and their 19,204 live-born children. A descriptive analysis was performed, and the prevalence of different behaviors was estimated at three time points - pre-pregnancy, pregnancy and after childbirth - depending on the mother's educational level. Percentages of change were calculated.Information was obtained from 6,436 women. Regardless of the educational level, during pregnancy there was an improvement in the different lifestyles. In the first months after childbirth, lifestyles worsened, except for exposure to environmental tobacco smoke and the use of electronic cigarettes. Most of the risk behaviors showed a gradient depending on the educational level; thus, the lower the educational level, the higher the prevalence of risk behaviors.In general, during pregnancy all women adopted healthier lifestyles that they abandoned in the months following childbirth. Women with a lower level of education showed a higher prevalence of risk behaviors, both in the period prior to pregnancy, as well as during pregnancy and after childbirth.

Background and Objectives: Continuous monitoring of smoking prevalence is essential to understand the evolution of the tobacco epidemic in a population. The objective of this study was to analyze the evolution of smoking prevalence in Spain and its 17 Autonomous Regions (ARs) in population ≥15 years during the period 1987-2020., Methods: Tobacco consumption data were derived from the National Health Survey of Spain and the European Health Survey in Spain. A smoker was defined as a person who smoked at the time of the survey. The trend in prevalences by sex in Spain and its ARs was analyzed by applying joinpoint models. Age-standardized prevalences were calculated for Spain by applying the direct method., Results: In Spain, the prevalence of consumption decreased 29 percentage points in men and 4.5 in women between 1987-2020. In men, the smoking prevalence decreased in all the ARs and the absolute change varied between -19.5% in the Balearic Islands and -33.9% in Andalusia. In women, the evolution of smoking prevalence differed between ARs. The absolute change varied between -15.4% in Basque Country and 0.5% in Andalusia., Conclusions: The number of men and women smokers has decreased in Spain between 1987-2020. Different patterns of evolution of the prevalence of consumption are observed among the ARs, especially among women. This reinforces the need for policies adapted to more local contexts and that take into account the gender perspective., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Sedentary behavior is a predictive factor for numerous diseases. The objective of this study was to assess the evolution of the prevalence of sedentary behavior in the Spanish adult population between 1987 and 2020., Methods: The data sources were the National and European Health Surveys. The prevalence of sedentary behavior was assessed in three scenarios (main activity, leisure time and all scenarios). Prevalence of sedentary behavior was estimated overall, by sex and age group. In all scenarios, prevalence was also estimated by Autonomous Community. The prevalence trend was analyzed with the annual percent change (APC) obtained through joinpoint models., Results: The prevalence of sedentary in the main activity ranged from 31.2% in 1987 to 38.4% in 2020 [PCA: 0.7 (0.5-1.0)], being higher in men than in women and higher in younger and older people. The prevalence of sedentary in the leisure time varied between 55.1% in 1993 and 36.4% in 2020 [PCA: -1.4 (-1.9 to -0.9)], being always higher in women, higher in those over 64 years of age and lower in those aged 16-24 years. Cantabria and the Canary Islands were the Autonomous Communities with the lowest prevalence of sedentary behavior in all scenarios., Conclusions: The prevalence of sedentary behavior in the main activity is increasing in Spain, whereas during leisure time it is decreasing. It is important to implement prevention and health promotion measures aimed at reducing sedentary behavior in the population., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Internet use has rapidly spread around the world becoming an indispensable part of daily life. Despite its advantages, the dysfunctional use or abuse of the Internet can lead to addiction problems. The main objectives established in this study were to assess the prevalence of Internet use in the general Galician population and the prevalence of problematic internet use (PIU) and at-risk of PIU in 2017. The Surveillance Information System on Risk Behavior is based on annual cross-sectional surveys among the population aged at least 16 years residing in Galicia, Spain. A total of 7,841 participants were recruited in 2017 using a stratified random sampling. Internet users were classified into three categories: normal use, maladaptive/at-risk of PIU and PIU, based on their score in the Internet-related experiences questionnaire. A total of 74.8%, 95% CI [73.8-75.8], of the Galician population aged 16 to 74 used the Internet in the month before the survey was performed, exceeding 95% in the population aged below 45 years. Most users use chat applications and social networks. The prevalence of PIU or at-risk of PIU in the population aged 16 to 74 was 1.0% [0.8-1.3], reaching 5.2% [4.2-6.2] in the population aged between 16 and 24. The prevalence of Internet use in Galicia is slightly lower than those obtained in Spain and Europe. Moreover, PIU is an emerging problem in the population with the youngest population being the most affected.

Objective: To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy., Design: A qualitative study with phenomenological approach. SITE: The study was conducted in Spain in 2022., Participants: Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users., Methods: Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified., Results: Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register., Conclusions: The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Small cell lung cancer (SCLC) comprises 10-15% of all lung cancer cases and is the most aggressive histological type. Survival is poor and the molecular landscape of this disease is extraordinarily complex. The objective of this paper was to perform a Genome-Wide Association Study (GWAS) of this disease using a case-control study specifically designed for small cell lung cancer (SCLC)., Methods: Incident cases were consecutively recruited from 8 hospitals from different regions of Spain. Controls were recruited from the same hospitals using a frequency sampling based on age and sex distribution of cases. Biological samples were obtained along with detailed information on cases and controls lifestyle, including tobacco and radon exposure., Results: We included 271 SCLC cases and 557 controls. We found evidence (p-values<10 -5 ) of an association in the complete dataset for several loci, while MAP4 showed a significant association in the gene-based analysis. Pathway analysis suggested that ATR, ATRIP, MCM4, MCM5, ORC4, RPA3 and CDC25A genes have a role on the onset of SCLC., Conclusion: This study provides biological evidence for pathways related to SCLC, offering novel loci for further research., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Smoking-attributable mortality (SAM) is an indicator that reflects the evolution of the tobacco epidemic at the population level. The objective of this study is to identify and to describe published studies that have estimated SAM in Spain. A search in PubMed and EMBASE databases was performed, limited to studies published until April 15th, 2021. Studies that estimated SAM in Spain or its constituent regions were included. Of the 146 studies identified, 22 met eligibility criteria. The first estimate of SAM in Spain dates from 1978 and the last from 2017. Twelve of the studies found estimated SAM at national level, 8 in regions, 1 in a province and 1 in a city. Most estimates were made for adults aged over 34, categorized as smokers, ex-smokers and never smokers. Observed mortality derived, in all studies, from official records, and relative risks mostly from Cancer Prevention Study II. In the period analyzed, a decrease in the burden of SAM was observed. In Spain, different SAM estimates are available globally, but they do not have regular periodicity, and such estimates are infrequently made by region. Due to variations in methodology and data sources, it is difficult to assess changes in SAM. Having global and regional periodic estimates would be necessary to correctly monitor the tobacco epidemic in Spain.

Objective: The violence produced in the context of dating is known as dating violence. Currently, it is a widespread problem in adolescence and there is a great lack of knowledge about the beliefs/attitudes that help perpetuate this phenomenon. This study aimed to assess how adolescents perceive dating violence. Additionally, to estimate the observed frequency of exposure of adolescents to different dating violence items, assessing the differences according to sex and educational level., Methods: A cross-sectional study was carried out in 2022 among high school students coming from Spain (Galician Region) The data was collected by means of an anonymous online questionnaire. A descriptive analysis of the data obtained was conducted. The observed frequency of adolescents' exposure to different items of dating violence and identification of violence was estimated. Fisher's exact test was used to compare the proportions according to sex and educational level., Results: 410 students were included. 99% of the women perceived that it is not normal to control their partner's clothing compared to 88% of the men; in relation to the control of friendships these percentages were 87.6% and 73.1% and with respect to criticism of the partner 54.7% vs 67.9%, respectively in women and men. 46.8% of the students admitted knowing of cases in which they sent several messages a day to find out what their partner was doing. 21.7% referred to be aware of cases who felt fear of the partner., Conclusions: The perception of dating violence by women is higher. The largest differences between men and women are in the items of the control domain., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: To identify if the regional government health plans in Spain include specific objectives and measures related to physical activity., Method: Institutional websites were scanned to identify the most recent health plan of each regional government. The information included in the health plans on objectives and measures and the population groups targeted by these measures was extracted. The search was completed on 24 January 2022., Results: Sixteen health plans were identified of which six are in force in 2022; 15 of these have incorporated specific objectives and measures on physical activity. Most of the actions are focus on general population, children-adolescents and elderly population. The plans of Cantabria, the Comunitat Valenciana and País Vasco cover physical activity more widely, proposing measures for seven of the eight identified population groups., Conclusions: Most of the health plans include measures related to physical activity and target two or more population groups. The objectives, specific measures and population groups were highly heterogeneous. This study could serve to prompt regional governments to review their health plans, update them and improve them in terms of physical activity. It seems advisable that the different health plans should have a homogeneous framework of proposals related to the promotion of physical activity., (Copyright © 2023 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To assess changes in physical activity (PA) during pregnancy and after giving birth and to explore this according to age and educational level. To analyze whether the health professionals gave recommendations on PA., Design: Observational study. SITE: Information is derived from the Galician Risk Behavior Information System., Participants: The target population was Galician women (aged 18-49 years) who delivered between september-2015 and august-2016., Main Measurements: The prevalence of walking, physical exercise and PA recommendations were estimated for three moments (pre-pregnancy, pregnancy and after delivery)., Results: Walking during pregnancy increased by 34,0% and the performance of physical exercise decreased by 21,0%. After delivery, walking decreased by 37,0% and physical exercise decreased by 32,0% compared to pregnancy. Women of younger age and lower educational level were those who performed less PA. 72,6% and 22,1% of women declared that a healthcare professional recommended PA during pregnancy and after delivery, respectively., Conclusion: The PA performed by women during pregnancy is mainly walking, and there is a concern about the abandonment of PA practice after delivery. Healthcare professionals recommend PA mainly during pregnancy, but little is recommended after delivery. It may be desirable for the improvement of this prevalence to reinforce health action., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Exposure to environmental tobacco smoke (ETS) is associated with increased mortality and morbidity. The objective of this study was to estimate the impact of ETS exposure in Spain on mortality in 2020 in the population aged 35 years and over., Methods: A method of estimating attributable mortality (AM) based on the prevalence of ETS exposure was applied. Prevalence data were obtained from a representative study conducted in Spain and the relative risks were derived from a meta-analysis. AM point estimates are presented along with 95% confidence intervals (95% CI), calculated using a bootstrap naive procedure. AM, both overall and by smoking habit, was estimated for each combination of sex, age group, and cause of death (lung cancer and ischemic heart disease). A sensitivity analysis was performed., Results: A total of 747 (95% CI 676-825) deaths were attributable to ETS exposure, of which 279 (95% CI 256-306) were caused by lung cancer, and 468 (95% CI 417-523) by ischemic heart disease. Three-quarters (75.1%) of AM occurred in men and 60.9% in non-smokers. When chronic obstructive pulmonary disease and cerebrovascular disease are included, the burden of AM is estimated at 2242 deaths., Conclusions: ETS exposure is associated with 1.5% of all deaths from lung cancer and ischemic heart disease in the population aged 35 and over. These data underline the need for health authorities to focus on reducing exposure to ETS in all settings and environments., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To analyze the burden of tobacco consumption on mortality and years of life expectancy lost in population ≥35 years in Brazil in the period 1996-2019 and to identify trend changes in smoking-attributable mortality., Method: An independent prevalence method using the lung cancer mortality rate as a proxy for cumulative smoking risk was used to estimate smoking-attributable mortality. Smoking-attributable mortality is estimated from the lung cancer mortality rate and applying relative risks from 5 US cohorts. Smoking-attributable mortality, crude and standardized attributed mortality rates are presented overall, by sex, age and causes of death. Trend analysis was performed by applying joinpoint regression models. Years of life expectancy lost due to tobacco were calculated., Results: Tobacco consumption caused 2,389,831 deaths in Brazil between 1996-2019. Cardiometabolic diseases were the leading cause of death in women throughout the period and in men until 2015. Since 2006, smoking-attributable mortality rates in men, regardless of age, show a decreasing trend while in females the evolution is different. The years of life expectancy lost show a slight decrease since the first triennia and are higher in men., Conclusions: In Brazil, the 8.5% of total mortality between 1996-2019 is attributed to tobacco consumption. It is important to monitor the burden of the tobacco consumption on mortality in order to strengthen or implement interventions against smoking in Brazil., (Copyright © 2023 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Residential radon is considered the second cause of lung cancer and the first in never smokers. Nevertheless, there is little information regarding the association between elevated radon levels and small cell lung cancer (SCLC). We aimed to assess the effect of residential radon exposure on the risk of SCLC in general population through a multicentric case-control study., Methods: A multicentric hospital-based case-control study was designed including 9 hospitals from Spain and Portugal, mostly including radon-prone areas. Indoor radon was measured using Solid State Nuclear Track Detectors at the Galician Radon Laboratory., Results: A total of 375 cases and 902 controls were included, with 24.5% of cases being women. The median number of years living in the measured dwelling was higher than 25 years for both cases and controls. There was a statistically significant association for those exposed to concentrations higher than the EPA action level of 148Bq/m 3 , with an Odds Ratio of 2.08 (95%CI: 1.03-4.39) compared to those exposed to concentrations lower than 50Bq/m 3 . When using a dose-response model with 100Bq/m 3 as a reference, it can be observed a linear effect for small cell lung cancer risk. Smokers exposed to higher radon concentrations pose a much higher risk of SCLC compared to smokers exposed to lower indoor radon concentrations., Conclusions: Radon exposure seems to increase the risk of small cell lung cancer with a linear dose-response pattern. Tobacco consumption may also produce an important effect modification for radon exposure., (Copyright © 2021 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Tobacco consumption and radon exposure are considered the first and second most common causes of lung cancer, respectively. The aim of this study was to analyze both whether selected genetic polymorphisms in loci that are in DNA repair pathways, are related to non-small-cell lung cancer (NSCLC) and whether they may modulate the association between residential radon exposure and lung cancer in both smokers and never smokers., Methods: A multicentre, hospital-based, case-control study with 826 cases and 1201 controls was designed in a radon-prone area. Genotyping was determined in whole blood and residential radon exposure was measured in participants' dwellings., Results: Attending to tobacco exposure, the variant in the gene NBN (rs1805794) was associated with lung cancer in never smokers (OR 2.72; 95%1.44-5.2) and heavy smokers (OR 3.04; 95%CI 1.21-7.69). The polymorphism with the highest lung cancer association was OGG1 (rs125701), showing an OR of 8.04 (95%CI 1.64-58.29) for its homozygous variant genotype in heavy smokers. Attending to indoor radon exposure (>200Bq/m 3 ), rs1452584, for its homozygous variant genotype, showed the highest association (OR 3.04 (95%CI 1.15-8.48)., Conclusion: The genes analyzed seem to have no association with the fully adjusted model, but they might modulate lung cancer association when different categories of tobacco consumption are considered (i.e. heavy smokers). This association may similarly be elevated for those individuals having high indoor radon exposures, though at a minor extent., (Copyright © 2021 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: To estimate smoking-attributable mortality (SAM) in the regions of Spain among people aged ≥ 35 years in 2017., Methods: SAM was estimated using a prevalence dependent method based calculating the population attributable fraction. Observed mortality was derived from the National Statistics Institute. The prevalence of smoking by age and sex was based on the Spanish National Health Survey for 2011 and 2017 and the European Survey for 2014. Relative risks were reported from the follow-up of 5 North American cohorts. SAM and population attributable fraction were estimated for each region by age group, sex, and causes of death. Cause-specific and adjusted SAM rates were estimated., Results: Smoking caused 53 825 deaths in the population aged ≥ 35 years (12.9% of all-cause mortality). SAM ranged from 10.8% of observed mortality in La Rioja to 15.3% in the Canary Islands. The differences remained after rates were adjusted by age. The highest adjusted SAM rates were observed in Extremadura in men and in the Canary Islands in women. Adjusted SAM rates in men were inversely correlated with those in women. The percentage of total SAM represented by cardiovascular diseases in each region ranged from 21.8% in Castile-La Mancha to 30.3% in Andalusia., Conclusions: The distribution of SAM differed among regions. Conducting a detailed region-by-region analysis provides relevant information for health policies aiming to curb the impact of smoking., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Residential radon is considered the second cause of lung cancer and the first in never smokers. Nevertheless, there is little information regarding the association between elevated radon levels and small cell lung cancer (SCLC). We aimed to assess the effect of residential radon exposure on the risk of SCLC in general population through a multicentric case-control study., Methods: A multicentric hospital-based case-control study was designed including 9 hospitals from Spain and Portugal, mostly including radon-prone areas. Indoor radon was measured using Solid State Nuclear Track Detectors at the Galician Radon Laboratory., Results: A total of 375 cases and 902 controls were included, with 24.5% of cases being women. The median number of years living in the measured dwelling was higher than 25 years for both cases and controls. There was a statistically significant association for those exposed to concentrations higher than the EPA action level of 148Bq/m 3 , with an Odds Ratio of 2.08 (95%CI: 1.03-4.39) compared to those exposed to concentrations lower than 50Bq/m 3 . When using a dose-response model with 100Bq/m 3 as a reference, it can be observed a linear effect for small cell lung cancer risk. Smokers exposed to higher radon concentrations pose a much higher risk of SCLC compared to smokers exposed to lower indoor radon concentrations., Conclusions: Radon exposure seems to increase the risk of small cell lung cancer with a linear dose-response pattern. Tobacco consumption may also produce an important effect modification for radon exposure., (Copyright © 2021 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Pulmonary arterial hypertension (PAH) requires structured processes of diagnosis and risk stratification, being the function of the right ventricle (RV) a hallmark prognosis determinant. The main therapeutic goals in PAH are to improve and try to revert RV dysfunction and maintaining a low risk. Currently, there are multiple treatments with different mechanisms of action, the combination of which in double or triple therapy has shown improved results compared to monotherapy. Recent clinical evidence shows the importance of early incorporation of parenteral prostanoids to the scheme, improving RV function and survival. In this review, we discuss the role of the RV function in the diagnosis, prognosis, and follow-up of PAH. We recommend the systematic and standardised evaluation of the RV as well as the early initiation of combined treatment in cases of intermediatehigh risk to try to reach and keep the patient with PAH at a low risk and / or avoid the progression of PAH.

Background: COPD is a multifactorial disease which causes considerable mortality and morbidity worldwide. Previous studies assessing the possible relationship between indoor radon exposure and COPD have shown inconclusive results., Methods: A multicentric, hospital-based, case-control study was conducted in a Spanish radon-prone area. COPD cases were confirmed by spirometry and controls were selected due to trivial surgery or procedures not related to tobacco consumption. All participants had to have lived for at least 15 years in the same dwelling. Radon measurements were conducted individually in dwellings using alpha-track detectors. Results were obtained using multivariate logistic regression., Results: 189 cases and 747 controls took part. There was no significant association between residential radon concentrations and COPD onset with a OR of 1.12 (95%CI 0.41-3.06) for individuals exposed to more than 200Bq/m 3 compared to those exposed to less than 50Bq/m 3 . Heavy smokers seem to increase their COPD risk if exposed to higher radon concentrations vs those exposed to lower concentrations. There was a statistically significant synergy index between radon exposure and tobacco consumption, S-index 11.60 (95%CI 3.71-36.26). Indoor radon concentration was higher in never/light smokers with COPD compared to controls., Conclusions: No association between indoor radon and COPD has been observed. However, there might be some effect modification on the COPD risk in heavy smokers when high radon exposure is present. This is supported by the additive synergy observed. Also, a possible association between indoor radon and COPD onset in never and light smokers needs to be further studied., (Copyright © 2020 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: This study was carried out to develop an explicit health priority setting methodology to support decision-making regarding the technologies to be assessed for inclusion in the National Health Service service portfolio. The primary objective is to identify and analyse the criteria, approaches and conceptual frameworks used for national/international priority setting., Method: An exhaustive review of the literature was carried out. For this purpose, a search of the main biomedical databases was performed and assessment agency websites were reviewed, among other sources., Results: In general terms, it was found that there are no standardised criteria for priority setting, although some consensus and common trends have been identified regarding key elements (criteria, models and strategies, key actors, etc.). Globally, 8 key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality of and uncertainties regarding the evidence; 6) implementation and complexity of the intervention/feasibility; 7) priority, justice and ethics; and 8) overall context., Conclusions: The review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritisation framework. Findings are envisioned to be useful for different public organisations that are aiming to establish healthcare priorities., (Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Sutureless aortic valve replacement is perceived to be an alternative treatment for high surgical risk patients with severe aortic stenosis. This work presents the results of a systematic review undertaken to assess the effectiveness and safety of this procedure. Eight low quality case series were identified. Six focused on prosthesis ATS 3f Enable(®) and 2 on Perceval S. Results show good haemodynamic and clinical results for both prosthesis. Implantation of ATS 3f Enable(®) valves was successful in more than 85% of the patients and the mean cardiopulmonary bypass (BCP) time ranged from 58 to 85 minutes. For Perceval S, implantation was successful in all patients and the mean BCP time was less than 30 minutes. Since there are no long term follow-up studies, the durability of the prosthesis and the appearance of late complications is uncertain., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

The objectives of this study were to compare the frequency of dyslipidemia (DLP) and the elevated cardiovascular risk between rheumatoid arthritis (RA) patients and a control group, to identify disease-related factors associated with the presence of DLP and to estimate the frequency of RA patients receiving treatment for DLP. This is a cross sectional study that included 409 RA patients and 624 controls. Cardiovascular (CV) risk was determined using the Framingham score, National Cholesterol Education Program (NCEP) and the Systematic Coronary Risk Evaluation (SCORE) adapted versions according to the European League Against Rheumatism (EULAR) guidelines. DLP was defined according to the Adult Treatment Panel III (ATPIII). The frequency of CV risk was similar in RA patients and controls, except when NCEP-EULAR adapted version for RA was applied (7% vs. 2%; p = 0.00002). A 43% of patients and 47% of controls had DLP (p = 0.15). RA patients with DLP tended to have extra-articular manifestations more frequently (36% vs. 24%; p = 0.01) and higher erythrocyte sedimentation rate (ESR) (21 [13-35] vs. 18 [10-30] mm; p = 0.003). RA patients treated for DLP varied between 11% and 32% according to the definition used. Patients with RA showed an elevated CV risk only when the NCEP-EULAR definition was used. Among RA patients, those with higher ESR and the presence of extra-articular manifestations were more likely to show DLP. The vast majority of patients were not receiving treatment for DLP.

Objective: To explore perceptions of the use of health technology assessment (HTA) in the Galician public health system, identify opinions on the usefulness of the products and services developed by the Galician Health Technology Assessment Agency (avalia-t), and determine the barriers and facilitators to the transfer of results to clinical practice., Method: We performed a qualitative study based on in-depth semi-structured interviews of 20 intentionally selected experts (10 health care professionals and 10 hospital decision makers). The interviews were tape recorded and transcribed for inductive thematic analysis., Results: Interest in HTA activities was high, but most informants considered these activities to be underused as a tool to aid decision making in clinical practice. A series of key factors was identified to guarantee HTA use: greater dissemination of HTA activities and availability of the results, increased involvement and communication among health care professionals in the selection and prioritization of relevant research, contextualization and adaptation of results to the local context, increased organizational support and greater financial resources., Conclusions: The present study allows end-userś opinions on the utility of the various products/services offered by HTA agencies to be contrasted in order to adapt HTA activity to their needs and requirements. The involvement of health care professionals in all HTA fields is perceived as one of the main lines of action for HTA agencies. Such involvement could be achieved by reinforcing personal contact and increasing feedback to collaborators., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: Oral and pharyngeal cancers represent the fifth most common cancer type and the seventh cause of deaths by cancer worldwide. Few studies have assessed the risks associated with occupational exposure and in many cases the results are contradictory. The objective of this study is to determine the association between occupational exposure to carcinogenic substances and risk of oral and pharyngeal cancer (including nasopharynx and hypopharynx) through a systematic review., Material and Methods: A literature search was carried out in MEDLINE (PubMed) and EMBASE. The articles were selected by two independent investigators on the basis of inclusion and exclusion criteria (sample size, publication type, etc.)., Results: 10 original articles were included, all with a case-control design. The results showed that a prolonged exposure to formaldehyde may increase the risk of nasopharyngeal and hypopharyngeal cancer, whilst other chemical products were not associated with these tumours. The exposure to different types of particles (such as wood dust in nasopharyngeal cancer) and smoke of various origins has also been associated with several oral and pharyngeal tumours., Conclusions: The literature reviewed shows that occupational exposure to formaldehyde may be associated with an increased risk of nasopharyngeal and hypopharyngeal cancer. The results regarding other occupational exposures are not consistent, therefore additional studies with more statistical power and better design are needed to ascertain if occupation is really a relevant risk factor for these types of cancer., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Introduction: (18)F-fluorodopa ((18)F-DOPA) is a functional tracer of presynaptic dopaminergic neuron terminations in the nigrostriatal system. This review is aimed to assess the efficacy of (18)F-DOPA-PET in the diagnosis and evaluation of the progression of Parkinson's Disease (PD) and in the differential diagnosis with other Parkinsonism Syndromes., Methods: A review was made of the literature by searching six databases and selecting the most relevant articles according to strict inclusion and exclusion criteria. The study data were systematically extracted and included in evidence tables., Results: Of the 1478 registries recovered through the search of the literature, 48 studies were extracted. Of these, only 13 were included in the systematic review. It was observed in all of them that PD is manifested by a lower striatal uptake of (18)F-DOPA, especially in the putamen with posterior predominance. Prospective studies have shown that there is loss of uptake with disease progression. One article described regional differences in (18)F-DOPA striatal pattern between PD, multisystem atrophy (MSA) and progressive supranuclear palsy (PSP). Cognitive impairment in PD seems to be related with (18)F-DOPA abnormal uptake in some regions of frontal cortex and caudate nucleus., Conclusion: (18)F-DOPA-PET seems to be useful for the diagnosis and evaluation of PD progression. However, the evidence is not conclusive regarding its utility in the differential diagnosis with other Parkinsonism Syndromes and in the differentiation between ex novo and advanced PD.

Background: Parkinson disease (PD) is the second most frequent neurodegenerative disease, affecting the 1-2 % of the population over 65. Around 20-24 % of diagnosed patients are estimated to be misdiagnosed. The aim of this paper is to assess the efficacy of DaTSCAN in the diagnosis of early PD and to determine the efficacy of 123I-FP in the differential diagnosis of vascular parkinsonism, drug-induced parkinsonism, essential tremor, Lewy body dementia (LBD) and Alzheimer disease (AD)., Methods: Systematic review. Two independent investigators reviewed and selected the papers according to predefined selection criteria. The quality of the original studies was assessed using one specifically designed scale., Results: Eleven original articles were included. No randomized clinical trials were found. Three papers assessed the effect of DaTSCAN in medication of patients and found that 17 to 69 % of the patients treatment changed after SPECT. Six studies assessed the change in the diagnosis for patients with parkinsonian syndromes after SPECT. Four of them showed that 123I-FP could be useful for the differential diagnosis between PD and non-degenerative disorders. One observed that ioflupane could help differentiate between PD and AD and between this last disease and LBD. The other investigation group showed that DaTSCAN could help in the differential diagnosis between PD and parkinsonian syndromes such as multisystem atrophy (MSA) and progressive supranuclear palsy (PSP)., Conclusions: The scientific evidence available indicates that 123I-FP can be useful to differentiate PD from essential tremor and vascular and drug-induced parkinsonism, and also to differentiate AD from LBD.

There are currently many hemodialysis modalities that are believed to be superior to conventional hemodialysis. In order to compare the effectiveness and security of the different hemodialysis techniques a systematic review was carried out. Faced with the fact that the scales available mainly focus on study design and tend to ignore external validity, a quality scale was specifically developed to assess the quality of the studies included in the review. The objective of this article is to introduce the quality assessment scale developed and present the results of its usability and applicability. The following databases were searched in order to identify the studies: MEDLINE, EMBASE, Cochrane, HTA, CRD and others. The articles obtained were selected based on previously established inclusion/exclusion criteria. The scale covers three issues: general aspects of the studies, specific aspects of the studies and patient characteristics. This scale allowed for a more accurate classification of the global quality of the studies and was reproducible. In general, those studies classified as high quality studies received the highest score and those studies classified as low quality studies received the lowest scores. The median value was 5,35 (53,5%). The intraclass correlation coefficient was 0,96. As a conclusion of this work it can be stated that currently available scales have serious limitations for the use in studies that compare different hemodialysis modalities and that the use of a scale specifically constructed for this purpose provides more accurate information on the quality of the evidence which is fundamental to interpret results and generate inferences.

Objectives: To report one case of unilateral acute orchiepididymitis due to Brucella and to review its diagnosis and treatment in the related literature., Method: We report the case of a 37-year-old-male with undulant fever, scrotal pain and swelling and osteoarticular involvement. Diagnosis was obtained by anamnesis, blood cultures and specific serologic tests for Brucella., Results: Antibiotic therapy with orally administered Doxycycline (6 weeks) and im-administered Streptomycin (3 weeks). Complete clinical resolution was achieved., Conclusions: We must perform an exhaustive anamnesis looking for a history of contact with animals or ingestion of contaminated dairy products in endemic areas of Brucella when facing the case of orchiepididymitis resistant to usual antibiotic therapy. The diagnosis is based on Brucella spp. isolation in blood cultures and on positive serologic tests (Rose Bengal test, standard seroagglutination test, anti-Brucella Coombs test, Brucellacapt test). Doxycycline with Streptomycin or Rifampin for 6 weeks seems to be the most adequate combinations of antibiotics. Surgical treatment only in exceptional cases.