Search

Exposure to secondhand tobacco smoke (SHS) is a worldwide public health problem and children are a particularly vulnerable population due to their anatomical, physiological, and behavioral characteristics. Cotinine concentrations in saliva, blood, and hair have become the most widely used biomarkers of SHS in children. Currently, there is no consensus regarding the optimal cut-point for the classification of SHS exposure among young children. Indeed, the systematic review conducted as part of this thesis shows that serum cotinine cut-points have varied remarkably since 1985 and across the countries; the most recently used cut-point to assess SHS exposure in US children has been 0.015 ng/mL, which derives from the assay limit of detection (LOD) used by the National Health and Nutrition Examination Survey (NHANES). Considering that cotinine metabolism and clearance may vary by age, and that childrens physiology is quite different within the 0-5 years old age range, age-specific cut-points could be useful to accurately classify nonsmoking children as exposed or unexposed to SHS in a standardized manner. This thesis includes the first study estimating age-specific cut-points to classify SHS exposure among children under 5 years old. Interestingly, when applying these serum cotinine cut-points, compared to the assay LOD derived cut-point, results showed that prevalence of childrens SHS exposure declined at all ages, and that concordance between mother-reported SHS exposure and childrens serum cotinine improved considerably.

It is not known whether residential radon exposure may be linked to the development of chronic obstructive pulmonary disease (COPD) and/or have an influence on the functional characteristics or exacerbations of COPD. The aim of this study was therefore to ascertain whether there might be an association between residential radon concentrations and certain characteristics of COPD. We analyzed COPD cases drawn from a case–control study conducted in an area of high radon exposure. Data were collected on spirometric pulmonary function variables, hospital admissions, and smoking. Radon measurements were taken using alpha-track-type CR-39 detectors individually placed in patients’ homes. All statistical analyses were performed using the IBM SPSS v22 computer software program. The study included 189 COPD cases (79.4% men; median age 64 years). The median radon concentration was 157 Bq/m3. No differences were found between radon concentration and sex, age or severity of breathing obstruction as measured by FEV1%. It should be noted, however, that 48.1% of patients with FEV1% < 50 had radon concentrations below 100 Bq/m3, as compared to 35.6% with the same severity of obstruction who had over 300 Bq/m3. COPD cases with radon concentrations higher than > 600 Bq/m3 exhibited no different characteristics in lung function. Exposure to radon does not appear to have an influence on the clinical characteristics of smokers and ex-smokers with COPD. As exposure to residential radon increases, there is no trend towards a worsening of FEV1%. Further studies are thus needed to analyze this possible association in never-smokers with COPD

El consumo de tabaco es el factor de riesgo prevenible que más muertes causa en el mundo. Tiene especial relevancia su papel como principal factor de riesgo del cáncer de pulmón. El radón es el segundo factor de riesgo en el desarrollo de este cáncer después del consumo de tabaco, y el primero en personas que nunca han fumado. En América del Sur, los estudios que dan cuenta de la prevalencia de consumo de tabaco, de la exposición al radón residencial y del impacto de éstos en la mortalidad en la población son escasos. Los resultados de esta tesis permiten aproximar cuál es la carga de mortalidad asociada al consumo de tabaco en Colombia y en Brasil; aproximar cómo ha sido la evolución de la epidemia tabáquica en Colombia a partir del análisis detallado de la mortalidad por cáncer de pulmón y, disponer por primera vez de datos sobre la prevalencia de exposición a radón residencial en un municipio de Colombia.

Home care is a healthcare alternative to hospitalisation. Different types of procedures are performed at home care services, such as home transfusion of blood products. However, home blood transfusion is not fully implemented and there is a great lack of knowledge about it. The aims of this study were thus to assess the safety and effectiveness of home blood transfusions and patient acceptance and satisfaction. A systematic literature review was conducted in the main biomedical databases. We included all studies that covered patients who had received a home blood transfusion, regardless of their baseline diagnosis. The literature search yielded 290 studies, 14 of which were included in this study as they met the predefined criteria. The main patient profile of a home-transfusion recipient was a person with anaemia associated with other diseases. Overall incidence of severe adverse events was 0.05%. No studies evaluated the effectiveness of home versus hospital transfusions. One study showed that 51% of patients would be willing to receive home transfusions. Home blood transfusion appears to be a feasible, safe, and well-accepted procedure. Existing studies are of low quality, however, and this is an important limitation when it comes to drawing definitive benefit–risk conclusions

Objective: The study aimed to identify periods of heightened susceptibility to the effects of pre- and postnatal secondhand tobacco smoke (SHS) exposure on body composition at age 12 years. Methods: The study used data from 217 children from the Health Outcomes and Measures of the Environment (HOME) Study, a prospective cohort in Cincinnati, Ohio. Using multiple informant models, the study estimated associations of maternal serum cotinine (16 and 26 weeks of pregnancy) and child serum cotinine concentrations (at age 12, 24, 36, and 48 months) with measures of body composition obtained with anthropometry and dual-energy x-ray absorptiometry at 12 years. We examined whether there were differences between these associations for pre- and postnatal exposure periods and potential effect measure modification by sex.Results: Postnatal cotinine concentrations were associated with higher weight, BMI, body fat and lean mass, waist circumference, and visceral, android, and gynoid fat. Each 10-fold increase in postnatal cotinine was associated with 76% increased risk of overweight or obesity (95% CI: 1.13-2.75). Associations between prenatal concentrations and measures of body composition at 12 years were generally null.Conclusions: Postnatal exposure to SHS may increase adolescent adiposity and lean mass. Future studies should determine whether early-life exposures to SHS are associated with other cardiometabolic risk markers., Objective: The study aimed to identify periods of heightened susceptibility to the effects of pre- and postnatal secondhand tobacco smoke (SHS) exposure on body composition at age 12 years. Methods: The study used data from 217 children from the Health Outcomes and Measures of the Environment (HOME) Study, a prospective cohort in Cincinnati, Ohio. Using multiple informant models, the study estimated associations of maternal serum cotinine (16 and 26 weeks of pregnancy) and child serum cotinine concentrations (at age 12, 24, 36, and 48 months) with measures of body composition obtained with anthropometry and dual-energy x-ray absorptiometry at 12 years. We examined whether there were differences between these associations for pre- and postnatal exposure periods and potential effect measure modification by sex.Results: Postnatal cotinine concentrations were associated with higher weight, BMI, body fat and lean mass, waist circumference, and visceral, android, and gynoid fat. Each 10-fold increase in postnatal cotinine was associated with 76% increased risk of overweight or obesity (95% CI: 1.13-2.75). Associations between prenatal concentrations and measures of body composition at 12 years were generally null.Conclusions: Postnatal exposure to SHS may increase adolescent adiposity and lean mass. Future studies should determine whether early-life exposures to SHS are associated with other cardiometabolic risk markers.

Background: There is evidence of strong links between exposure to different risk factors and life-threatening diseases. Assessing the burden of a risk factor on the population's mortality due to a given disease provides a clear picture of these links. The estimation of attributable mortality to a risk factor is the most widely used procedure for doing this. Although different methods are available to estimate attributable mortality, the prevalence-based methodology is the most frequent. The main objective of this study is to develop guidelines and checklists to STrengthen the design and REporting of Attributable Mortality Studies using a Prevalence-based method (STREAMS-P) and also to assess the quality of an already published study which uses this methodology. Methods: The design of the guideline and checklists has been done in two phases. A development phase, where we set recommendations based on the review of the literature, and a validation phase, where we validated our recommendations against other published studies that have estimated attributable mortality using a prevalence-based method. Results: We have developed and tested a guideline that includes the information required to perform a prevalence-based attributable mortality study to a given risk factor; a checklist of aspects that should be present when a report or a paper on attributable mortality is written or interpreted and a checklist of quality control criteria for reports or papers estimating attributable mortality. Conclusion: To our knowledge, the STREAMS-P is the first set of criteria specifically created to assess the quality of such studies and it could be valuable for authors and readers interested in performing attributable mortality studies or interpreting their reliability

Background: This study sought to analyse the trend in smoking-attributable mortality (SAM) in Spain among the population aged 35 years across the period 1990–2018. Methods: SAM was estimated by applying a prevalenceindependent method, which uses lung cancer (LC) mortality as a proxy of tobacco consumption. We sourced observed mortality from the National Institute of Statistics (Spain), LC mortality rates in smokers and never smokers from the Cancer Prevention Study I–II, and relative risks from 5 US cohorts. Estimates of annual SAM by cause of death, sex and age are shown, along with crude and annual standardised SAM rates. The trend in standardised all-cause and LC rates was analysed using a joinpoint regression model. Results: Tobacco caused 1 717 150 deaths in Spain in the period 1990–2018. Among men, cancers replaced cardiovascular diseases–diabetes mellitus (CVD–DM) as the leading group of tobacco-related cause of death in 1994. Among women, CVD–DM remained the leading cause of death throughout the period. Trend analysis of standardised SAM rates due to all causes and LC showed a decrease in men and an increase in women. Conclusions: The tobacco epidemic in Spain across the period 1990–2018 has had an important impact on mortality and has evolved differently in both genders. SAM is expected to increase dramatically in women in the coming years. SAM data highlight the importance of including a gender perspective in SAM analyses, in designing more effective and comprehensive public health interventions and in developing gender-specific tobacco control policies to curb tobacco consumption

La EPOC es una de las patologías más prevalentes en la actualidad y genera una gran morbilidad y mortalidad a nivel global, con un fuerte impacto social y sobre el sistema sanitario. La evidente escasez de estudios que analicen la mortalidad, el lugar de fallecimiento y las hospitalizaciones relacionadas con esta enfermedad justifica la elaboración de este proyecto de tesis que puede ser de utilidad para hacer estimaciones futuras y reorientar estrategias asistenciales y preventivas.

En los últimos años han salido a la luz muchos casos de mala conducta científica, algunos con importantes consecuencias, que han evidenciado las brechas que globalmente existen en cuanto a integridad científica. En España también se han dado casos notables de mala conducta científica en el ámbito de la investigación biomédica. Sin embargo, hasta el momento no se ha creado un organismo encargado de supervisar las fases de ejecución, análisis y publicación de las investigaciones biomédicas desde un punto de vista ético. Por lo tanto, en este contexto, consideramos que es necesaria la creación de una oficina que supervise la integridad científica en España y que actúe en caso de sospecha de mala conducta científica, llevando a cabo una investigación independiente y con capacidad sancionadora. La existencia de dicho organismo sería de especial importancia en el caso de las investigaciones financiadas con fondos públicos, ya que en ese caso el fraude en investigación supondría la malversación de dinero público. La creación de una oficina que realmente actúe frente a los casos detectados podría tener un efecto disuasorio sobre una potencial mala conducta de algunos investigadores, previniendo así situaciones de mala conducta científica., In recent years, many cases of scientific misconduct have come to light, some with considerable consequences, highlighting the existing breaches in the scientific integrity globally. In Spain, there have also been high-profile cases of scientific misconduct. However, so far, no organism or agency has been created to monitor the execution, analysis and publication phases of biomedical research from an ethical point of view. Therefore, in this context, we consider that there is a need for the creation of an office which supervises research integrity in Spain which would act in cases of suspected scientific misconduct, carrying out an independent investigation and proposing public sanctions. The existence of such an organism would be of particular importance in the case of publicly funded research, since in that case research fraud would involve the misappropriation of public funds. The creation of an office that would act on detected cases could have a deterrent effect on potential misconduct by some researchers, thus preventing cases of scientific misconduct.

Background: Despite the risks associated with the use of new forms of tobacco consumption, such as electronic cigarettes or heated tobacco products such as IQOS (I Quit Ordinary Smoking), few studies have estimated the prevalence of use at the population level. The aims of this study were to describe, in Galicia, the evolution of the prevalence of the use of electronic cigarettes and the reasons for its use in the period 2014-2018, and, the use and knowledge of IQOS in 2018. Methods: The information analyzed comes from 4 cross-sectional surveys conducted in 2014 (n=7,874), 2015 (n=7,908), 2017 (n=7,841) and 2018 (n=7,853) within the framework of the Information System on Risk Behaviors (SICRI), being the target population Galicians aged 16 and over. Estimates of prevalence of consumption, the devices knowledge and reasons for use are shown accompanied with 95% confidence intervals (95% CI), globally, by gender, age group and tobacco consumption. Results: In the period under study, the prevalence of electronic cigarette use remained stable. In 2018 it was estimated at 0.7% (0.5-0.9). In 2017, the only year in which changes were observed, it fell to 0.3% (0.2-0.4). Prevalence of electronic cigarette use among the population aged 16 to 24 increased from 0.8% in 2014 to 2.1% in 2018. The main reason for using electronic cigarettes was to quit smoking. The prevalence of the IQOS use at the time study (2018) was 0.1% (0.01-0.15) and 4.2% (3.7-4.7) of the Galicians knew what the IQOS was. Conclusions: In Galicia, the prevalence of electronic cigarette and IQOS use is low, although an increase was observed among the population aged 16- 24 between 2014 and 2018. Surveillance of use at the population level should not be neglected., Fundamentos: A pesar de los riesgos asociados al uso de nuevas formas de consumo de tabaco, como los cigarrillos electrónicos o los productos de tabaco calentado como los IQOS (I Quit Ordinary Smoking), son pocos los estudios que han estimado su prevalencia de uso a nivel poblacional. Los objetivos de este trabajo fueron describir, en Galicia, la evolución de la prevalencia y las razones de uso de cigarrillos electrónicos en el periodo 2014-2018; y el uso y conocimiento del IQOS en 2018. Métodos: La información analizada procede de 4 estudios transversales que se realizaron en 2014 (n=7.874), 2015 (n=7.908), 2017 (n=7.841) y 2018 (n=7.853) en el marco del Sistema de Información sobre Conductas de Riesgo (SICRI), siendo la población objetivo la población gallega de 16 años y más. Se presentan estimaciones puntuales de prevalencia de consumo y de conocimiento de los dispositivos y razones de uso acompañadas de intervalos de confianza al 95% (IC95%), en global, en función del sexo, el grupo de edad y el consumo de tabaco. Resultados: En el periodo a estudio la prevalencia de uso de cigarrillos electrónicos se mantuvo estable. En 2018 se estimó en el 0,7% (0,5-0,9). En 2017, único año en el que se observaron cambios, se redujo al 0,3% (0,2-0,4). La prevalencia de uso de cigarrillos electrónicos entre la población de 16 a 24 años pasó del 0,8% en 2014 al 2,1% en 2018. El principal motivo de su uso de cigarrillos electrónicos fue dejar de fumar. La prevalencia de uso de IQOS en el momento del estudio (2018) fue del 0,1% (0,01-0,15) y el 4,2% (3,7-4,7) de los gallegos sabían lo que era el IQOS. Conclusiones: En Galicia, la prevalencia de uso de cigarrillos electrónicos e IQOS es baja, aunque se observó un aumento entre la población de 16 a 24 años entre 2014 y 2018. No se debe descuidar la vigilancia del uso a nivel poblacional.

Introducción: Las actuales estrategias de cronicidad no incluyen la competencia digital como característica propia del paciente crónico. Con la irrupción de las nuevas tecnologías de información y comunicación (TIC), es cada vez más frecuente encontrar e-chronics: pacientes con enfermedad crónica y competencias digitales. Detectar a estos pacientes puede ayudar a estratificar según su predisposición al uso de TICs para conseguir una forma de atención sanitaria diferente. De esta forma, se podrán adecuar los recursos sanitarios digitales para aquellos pacientes que realmente sean capaces de darles uso. Objetivos: El objetivo del presente estudio es analizar la prescripción de una herramienta digital usando el Cuestionario Cambados, midiendo su adherencia y la predisposición del paciente a usar otras soluciones de Salud Digital prescritas por su médico. Material y métodos: Se realizó una recogida de datos en el servicio de Endocrinología del Hospital de Montecelo con la aplicación del Cuestionario Cambados, asociando la prescripción de una herramienta digital. Tras 15 días se valoró el uso de la herramienta y la predisposición al uso de otras. Resultados y conclusión: Los datos de las variables descriptivas como el sexo, la edad, el lugar de residencia y el nivel de estudios son descritos en la tabla 1. Tanto la adherencia a la herramienta digital prescrita como su predisposición a usar otras soluciones de Salud Digital prescritas por su médico fueron evaluadas en relación con la puntuación obtenida en el cuestionario. Con los resultados obtenidos, podemos concluir que el Cuestionario Cambados selecciona adecuadamente a pacientes crónicos digitales, con el fin de dirigirles a ellos la prescripción de recursos digitales y hacer más eficiente su proceso asistencial, Introduction: Current chronicity strategies do not include digital competence as a characteristic of the chronic patient. With the emergence of new information and communication technologies (ICT), it is increasingly common to find e-chronics: patients with chronic disease and digital skills. Detecting these patients can help to stratify according to their predisposition to the use of ICTs to achieve a different form of healthcare. In this way, digital healthcare resources can be adapted for those patients who are really capable of using them. Objectives: The objective of this study is to analyze the prescription of a digital tool using the Cambados Questionnaire, measuring its adherence and the predisposition of the patient to use other Digital Health solutions prescribed by their doctor. Material and methods: Data was collected in the Endocrinology service of the Montecelo´s Hospital with the application of the Cambados Questionnaire associating the prescription of a digital tool. After 15 days, the use of the tool and the predisposition to the use of others were assessed. Results and conclusión: The data of the descriptive variables such as sex, age, place of residence and educational level are described in Table 1. Both adherence to the prescribed digital tool and their predisposition to use other Digital Health solutions prescribed by their doctor, were evaluated in relation to the score obtained in the questionnaire. With the results obtained, we can conclude that the Cambados Questionnaire adequately selects chronic digital patients, in order to direct the prescription of digital resources to them and make their care process more efficient

Lung cancer has the highest cancer mortality rate in developed countries. The principal risk factor for lung cancer is tobacco use, with residential radon being the leading risk factor among never smokers and the second among ever smokers. We sought to estimate mortality attributable to residential radon exposure in Spain and its Autonomous Regions, with correction for dwelling height and differentiation by tobacco use. We applied a prevalence-based method for estimating attributable mortality. For estimations, we considered exposure to radon in the different Autonomous Regions corrected for dwelling height, using the National Statistics Institute Housing Census and prevalence of tobacco use (never smokers, smokers and ex-smokers). The results showed that 3.8% (838 deaths) of lung cancer mortality was attributable to radon exposure of over 100 Bq/m3, a figure that rises to 6.9% (1,533 deaths) when correction for dwelling height is not performed. By Autonomous Region, the highest population attributable fractions, corrected for dwelling height, were obtained for Galicia, Extremadura, and the Canary Islands, where 7.0, 6.9, and 5.5% of lung cancer mortality was respectively attributable to radon exposure. The greatest part of the attributable mortality occurred in men and among smokers and ex-smokers. Residential radon exposure is a major contributor to lung cancer mortality, though this contribution is highly variable among the different territories, indicating the need for targeted prevention policies. Correction of estimates for dwelling height is fundamental for providing reliable estimates of radon-attributable mortality

There is little information on chronic obstructive pulmonary disease (COPD) mortality trends, age of death, or male:female ratio. This study therefore sought to analyze time trends in mortality with COPD recorded as the underlying cause of death from 1980 through 2017, and with COPD recorded other than as the underlying cause of death. We conducted an analysis of COPD deaths in Galicia (Spain) from 1980 through 2017, including those in which COPD was recorded other than as the underlying cause of death from 2015 through 2017. We calculated the crude and standardized rates, and analyzed mortality trends using joinpoint regression models. There were 43,234 COPD deaths, with a male:female ratio of 2.4. Median age of death was 82 years. A change point in the mortality trend was detected in 1996 with a significant decrease across the sexes, reflected by an annual percentage change of −3.8%. Taking deaths into account in which COPD participated or contributed without being the underlying cause led to an overall 42% increase in the mortality burden. The most frequent causes of death when COPD was not considered to be the underlying cause were bronchopulmonary neoplasms and cardiovascular diseases. COPD mortality has decreased steadily across the sexes in Galicia since 1996, and age of death has also gradually increased. Multiple-cause death analysis may help prevent the underestimation of COPD mortality

1.1. ANTECEDENTES: Se realizó una revisión bibliográfica de la literatura científica para comparar las características epidemiológicas del SARS-CoV, MERS-CoV y SARS-CoV-2. Es relevante hacer un análisis comparativo de las tres epidemias de coronavirus descritas hasta la fecha para entender cómo abordar la pandemia de COVID-19. Las similitudes y las diferencias entre el ellos pueden servir como guía para mejorar las medidas de prevención y para llegar a una mejor comprensión de la propagación de futuras epidemias. Los coronavirus humanos se consideraban patógenos respiratorios relativamente inofensivos hasta la aparición del brote de SARS-CoV en 2002. Desde entonces, han recibido atención como patógenos importantes en las infecciones respiratorias. Posteriormente, con la aparición del MERS en 2012 y del COVID-19 en 2019, han acaparado aún más la atención internacional. Hay que señalar que todos los datos de la pandemia de COVID-19 están en constante revisión y sujetos a posibles variaciones por la publicación de nuevos estudios. 1.2. MÉTODOS: Las búsquedas se realizaron en las bases de datos de MEDLINE (Pubmed) y Cochrane Library utilizando términos específicos. Con el objetivo de obtener la información epidemiológica más actualizada respecto a los patógenos analizados, se visitaron las páginas web de los organismos oficiales de distintos países. También se realizaron búsquedas de información en la página web de la OMS (Organización Mundial de la Salud) y de la Universidad Johns Hopkins. La última fecha en que se realizaron dichas búsquedas fue el 17 de abril de 2021. 1.3. OBJETIVOS: Llevar a cabo una revisión de las diferencias en la epidemiología que permita valorar el diferente impacto que ha tenido cada coronavirus a nivel mundial y los motivos de dicho impacto. 1.4. RESULTADOS: El virus que ha presentado un mayor número de casos es el SARS-CoV-2 registrando 139.501.934 (17/04/2021) con una tasa de letalidad del 2,15%. El virus que presenta una mayor tasa de leta

Radon is a colorless, odorless, and tasteless noble gas, causally related with the onset of lung cancer. We aimed to describe the distribution of radon exposure in the municipality of Manizales, Colombia, in order to estimate the population’s exposure and establish the percentage of dwellings that surpass reference levels. A cross-sectional study representing all geographical areas was carried out by measuring indoor radon concentrations. Participants answered a short questionnaire. Alpha-track type radon detectors were installed in all residences for six months. The detectors were subsequently processed at the Galician Radon Laboratory, an accredited laboratory at the University of Santiago de Compostela. A total of 202 homes were measured. Seventy-seven percent of the sampled houses were three stories high, their median age was 30 years, and half were inhabited by three people or fewer. For most dwellings, the building materials of walls and flooring were brick and covered cement, respectively. Results showed a geometric mean of radon concentration of 8.5 Bq/m3 and a maximum value of 50 Bq/m3. No statistically significant differences were found either between the geometric mean of the dwelling’s site, the height at which detectors were placed inside the home, or the wall and flooring materials, or between mean 222Rn concentrations in rural and urban areas. No dwelling surpassed the 222Rn reference level established by the WHO. This study shows that residential radon levels in Manizales, Colombia, seem to be low, though a more in-depth approach should be carried out. Despite these results, it is essential to create a national radon program and establish a radon concentration reference level for Colombia in line with international recommendations