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Objective: This study aims to employ machine learning (ML) tools to cluster patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) based on their diverse social and clinical characteristics. This clustering is intended to facilitate the subsequent analysis of differences in clinical outcomes., Methods: We analysed a cohort of patients with severe COPD from two Pulmonary Departments in north-western Spain using the k-prototypes algorithm, incorporating demographic, clinical, and social data. The resulting clusters were correlated with metrics such as readmissions, mortality, and place of death. Additionally, we developed an intelligent clinical decision support system (ICDSS) using a supervised ML model (Random Forest) to assign new patients to these clusters based on a reduced set of variables., Results: The cohort consisted of 524 patients, with an average age of 70.30±9.35 years, 77.67% male, and an average FEV 1 of 44.43±15.4. Four distinct clusters (A-D) were identified with varying clinical-demographic and social profiles. Cluster D showed the highest levels of dependency, social isolation, and increased rates of readmissions and mortality. Cluster B was characterized by prevalent cardiovascular comorbidities. Cluster C included a younger demographic, with a higher proportion of women and significant psychosocial challenges. The ICDSS, using five key variables, achieved areas under the ROC curve of at least 0.91., Conclusions: ML tools effectively facilitate the social and clinical clustering of patients with severe COPD, closely related to resource utilization and prognostic profiles. The ICDSS enhances the ability to characterize new patients in clinical settings., (Copyright © 2024 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To describe the biomedical journal characteristics that are associated with the retraction of papers., Method: A descriptive cross-sectional study was conducted. All papers retracted and indexed in PubMed from January 1 st 2013 to December 31 st , 2016 were included. We used nine main categories to classify retractions: aspects related with data, authors issues, plagiarism, unethical research, journal issues, review process, conflict of interest, other, and unknown. These categories were further classified as: misconduct, suspicion of misconduct, or no misconduct., Results: The proportion of retraction was 2.5 per 10,000 publications. Retractions appeared in 611 journals. During the study period, retraction due to misconduct was more frequent among journals with low-impact factor. Within these retracted publications, among low-impact journals the presence of misconduct was higher with a 73% compared to 61% for the high-impact journals (p=0.001). There were differences in the percentage of retractions due to misconduct regarding the journal classification category (p<0.001)., Conclusions: Retraction of publications is present in both high- and low-impact factor biomedical journals, but misconduct is more frequent among the papers retracted from lower impact journals. Measures before and after publication should be taken to limit misconduct., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Scant evidence is available on whether dependency for basic (BADL) or instrumental (IADL) activities of daily living can be predictors of mortality after severe COPD exacerbation (COPDE). In addition, it is as yet unclear whether the inclusion of this parameter in a multidimensional score can improve the prediction of mortality., Methodology: Prospective cohort study, with follow-up of patients discharged after COPDE and multivariate analysis of clinical-demographic and dependency variables (Barthel and Lawton and Brody indices) as predictors of mortality. Three scores were generated (including or not including dependency for BADL and IADL) that were compared with each other and with other commonly used multidimensional indices (BODEx, ADO, DOSE, CODEx)., Results: In total, 247 patients were included, 112 (45%, 3); and 195 (72.4%) had some dependency for BADL and IADL. Survival was 631.7 (258.8) days, 95% confidence interval (95% CI), 60-912 days. Fifty-four (21.9%, 95% CI 17-27) patients died. Age> 60 years, FEV1 <50% and Charlson score ≥ 3 were independent predictors in the 3 models generated. Dependency for BADL and IADL were predictors in each of the models in which they were included. The score that included the dependency for BADL presented the best predictive capacity (area under the curve 0.818, 95% CI 0.757-0.879). Stratification into tertiles differentiated groups with a higher risk of death from the beginning of the follow-up (P<.01)., Conclusions: Dependence for activities of daily living, especially the most elementary ones, is an independent predictor of mortality after a severe COPDE that is comparable to clinical variables. Its inclusion in multidimensional scores clearly improves predictive capacity., (Copyright © 2019 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To describe and compare from a gender perspective the social profile of patients admitted to a respiratory unit for COPD exacerbations (COPDE)., Methodology: A cross-sectional study in patients with serious COPDE in which demographic, clinical, and social data (economic situation, care, dependency for basic and instrumental activities, social risk, caregiver overload, use of social services) were collected using questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber, and Gijón. A descriptive analysis was made of patients' social and healthcare situation, compared on the basis of gender., Results: We included 253 patients, aged 68.9±9.8years, 58 (23%) women, FEV1 42.1±14.2%, and Charlson index 1.8±0.9; 37.9% were active smokers. In total, 55.2% had an income of less than €800/month, 46.2% had some dependency for basic activities, and 89.3% for instrumental activities, 89% presented social fragility, while 64% were in a situation of social problem/risk; 49% had a caregiver, 83% in a non-formal arrangement, 90.9% of whom were women, with some overload reported by 69.2%. A total of 21.4% lived alone, and 22.9% had contacted social services. Women with COPDE are younger, smoke more actively, and have fewer comorbidities. They have more scant economic resources and assistance and are in a poorer socio-familiar situation, but they are less dependent for some activities., Conclusions: The social profile of patients with serious COPDE admitted to respiratory units is very unfavorable, especially among women. These inequalities appear to go beyond differences in the expression of COPD, and are associated with gender., (Copyright © 2019 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Silicosis is a chronic progressive disease caused by inhalation of crystalline silica. Most cases develop in underground mine workers and in subjects involved in the extraction of natural stone (slate and granite). In view of the progressive emergence of new cases of silicosis in artificial quartz conglomerate workers, we performed a study to analyze the characteristics of silicosis produced by this new agent in Spain., Methods: The study consisted of a series of 96 cases of silicosis diagnosed according to international criteria during the period 2010-2017. We analyzed clinical, radiological, pathological and functional characteristics., Results: Mean age of participants was 45 years; 55% had simple silicosis and 45% had complicated silicosis. Ten patients were diagnosed with accelerated silicosis, with a mean age of 33 years. Mean time of exposure to conglomerates was 15 years, and 77% had not used appropriate protection measures. Half of the patients were asymptomatic and presented different classic forms on chest X-ray and chest high-resolution computed tomography, along with ground-glass images. No lung function changes were recorded., Conclusions: Silicosis in artificial quartz conglomerate workers occurs in a young, actively employed population, a considerable percentage of whom present an accelerated form. They have few symptoms and no functional limitations. Protection measures are scarce. It is important to characterize these features to provide early diagnosis and implement the necessary preventive measures., (Copyright © 2019 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyze the causes of retracted publications and the main characteristics of their authors., Method: A descriptive cross-sectional study was designed including all retracted publications from January 1st, 2013-December 31st, 2016 indexed in PubMed. The causes of retraction were classified as: data management, authorship issues, plagiarism, unethical research, journal issues, review process, conflict of interest, other causes, and unknown reasons. Then, misbehaviour was classified as misconduct, suspicion of misconduct or no misconduct suspicion., Results: 1,082 retracted publications were identified. The retraction rate for the period was 2.5 per 10,000 publications. The main cause of retraction was misconduct (65.3%), and the leading reasons were plagiarism, data management and compromise of the review process. The highest proportion of retracted publications corresponded to Iran (15.52 per 10,000), followed by Egypt and China (11.75 and 8.26 per 10,000)., Conclusions: Currently, misconduct is the main cause of retraction. Specific strategies to limit this phenomenon must be implemented. It would be useful to standardize reasons and procedures for retraction. The development of a standard retraction form to be permanently indexed in a database might be relevant., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The aim of this study was to identify factors influencing hospital stay due to pulmonary embolism., Methods: We performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19)., Results: We included 965 patients with a median stay of 8 days (IQR 6-13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42-13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07-2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07-2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85-3.48) when oral anticoagulation (OAC) was initiated 2-3 days after admission, and 2.43 (95% CI: 1.16-5.07) when initiated at 4-5 days, compared to OAC initiation at 0-1 days., Conclusions: sPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay., (Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. 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.)