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Background: Characterizing and comparing the determinant of cotinine concentrations in different populations should facilitate a better understanding of smoking patterns and addiction. This study describes and characterizes determinants of salivary cotinine concentration in a sample of Spanish adult daily smoker men and women. Methods: A cross-sectional study was carried out between March 2004 and December 2005 in a representative sample of 1245 people from the general population of Barcelona, Spain. A standard questionnaire was used to gather information on active tobacco smoking and passive exposure, and a saliva specimen was obtained to determine salivary cotinine concentration. Two hundred and eleven adult smokers (>16 years old) with complete data were included in the analysis. Determinants of cotinine concentrations were assessed using linear regression models. Results: Salivary cotinine concentration was associated with the reported number of cigarettes smoked in the previous 24 hours (R² = 0.339; p < 0.05). The inclusion of a quadratic component for number of cigarettes smoked in the regression analyses resulted in an improvement of the fit (R² = 0.386; p < 0.05). Cotinine concentration differed significantly by sex, with men having higher levels. Conclusion: This study shows that salivary cotinine concentration is significantly associated with the number of cigarettes smoked and sex, but not with other smoking-related variables. [ABSTRACT FROM AUTHOR]

Study objective: To assess the feasibility of a colorectal cancer population-based screening programme in Catalonia (Spain). Design and setting: A pilot colorectal cancer screening programme based on faecal occult blood (FOB) test was introduced in February 2000 in Hospitalet de Llobregat (Barcelona, Spain), a city of 239,000 inhabitants. Participants: All the residents from the selected area, aged 50–69 years old, were invited by mail to participate in the screening programme. Overall, 63,880 persons were invited to the first screening round and 66,534, to the second round. Colonoscopy was the first choice of procedure for the positive FOB test. Results: The participation rate was 17.2% in the first screening round and 22.3% in the second round. The overall rate of positive FOBT was 3.4% in the first round and 0.8% in the second round. In the first round, the prevalence of screen-detected cancer was 2.1 per 1000 screened people, 7.2 for high-risk adenomas (HRA) and 11.3 for neoplasm (cancer and/or adenoma). The positive predictive value (PPV) was 6.2% for cancer, 21.2% for HRA and 33.3% for advanced neoplasm. In the second round, the prevalence of screen-detected cancer was 0.9 per 1000 people screened, 2.8 per 1000 for HRA and 4.2 per 1000 for neoplasm. The PPV was 10.6% for cancer, 34.1% for HRA and 50.4% for any neoplasm. Conclusions: Regardless of the moderate participation rate, population-based colorectal cancer screening would be feasible in Catalonia, with good results in terms of prevalence of screen-detected neoplasms. [ABSTRACT FROM AUTHOR]

One of the consequences of diagnostic and therapeutic progress in cancer is the increased survival observed in the last few decades in Spain and elsewhere in Europe. New cancer cases are increasing steadily due to population aging, among other factors. Consequently, the number of long-term survivors can be expected to increase in the years to come. This increase will tax healthcare systems, which are already showing the limitations of the present model of follow-up. New scenarios should be assessed and proposed from both the management and clinical perspectives. Although there is insufficient scientific evidence to indicate the most effective way to organize the follow-up of these patients, several approaches are being proposed in other countries to improve the fit between health services provision and the specific needs of these patients. In Spain, these experiences are scarce. However, given the situation, which could be described as a snowball effect, the current model should be reviewed and new approaches discussed in order to provide a more effective response to this situation. This article aims to identify the priorities for cancer survivors from the healthcare point of view, to review organizational approaches in other countries, and to propose a framework, based on the integration of the different levels of health care, including primary care - the Cinderella of this situation - in order to assess various healthcare options for these patients in the Spanish healthcare context., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objectives: To analyze the prioritization process for chemotherapy drugs in the Drug-Therapeutic Committees (DTCs) in Catalan hospitals and assess their impact on patients' access to these drugs., Methods: A case qualitative study of the DTCs of tertiary hospitals in Catalonia was performed, based on semi-structured interviews and a review of the scientific literature. Key professionals were interviewed with technical and institutional involvement in the DTCs assessment process, including pharmacists, oncologists, clinical pharmacologists and other physicians with different medical specialties. The conceptual framework "accountability for reasonableness", by Daniels and Sabin, which analyzes prioritization processes from a "fair and legitimate decision-making" perspective, was used., Results: The current regulatory framework for the introduction of drugs is characterized by a fragmented hospital system and lacks coordination strategies. These weaknesses fail to allow the prioritization and optimization of resources in the Catalan health service., Conclusion: We propose the implementation of a decision-making coordination strategy for all public sector hospitals. This strategy would allow an increasingly innovative environment to be exploited, in which inequalities in access to drugs at the hospital level should be avoided., (Copyright © 2009 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To assess the optimal cut-point for salivary cotinine concentration to identify smoking status in the adult population of Barcelona., Methods: We performed a cross-sectional study of a representative sample (n=1,117) of the adult population (>16 years) in Barcelona (2004-2005). This study gathered information on active and passive smoking by means of a questionnaire and a saliva sample for cotinine determination. We analyzed sensitivity and specificity according to sex, age, smoking status (daily and occasional), and exposure to second-hand smoke at home. ROC curves and the area under the curve were calculated., Results: The prevalence of smokers (daily and occasional) was 27.8% (95% CI: 25.2-30.4%). The optimal cut-point to discriminate smoking status was 9.2 ng/ml (sensitivity=88.7% and specificity=89.0%). The area under the ROC curve was 0.952. The optimal cut-point was 12.2 ng/ml in men and 7.6 ng/ml in women. The optimal cut-point was higher at ages with a greater prevalence of smoking. Daily smokers had a higher cut-point than occasional smokers., Conclusions: The optimal cut-point to discriminate smoking status in the adult population is 9.2 ng/ml, with sensitivities and specificities around 90%. The cut-point was higher in men and in younger people. The cut-point increases with higher prevalence of daily smokers.

Background: Characterizing and comparing the determinant of cotinine concentrations in different populations should facilitate a better understanding of smoking patterns and addiction. This study describes and characterizes determinants of salivary cotinine concentration in a sample of Spanish adult daily smoker men and women., Methods: A cross-sectional study was carried out between March 2004 and December 2005 in a representative sample of 1245 people from the general population of Barcelona, Spain. A standard questionnaire was used to gather information on active tobacco smoking and passive exposure, and a saliva specimen was obtained to determine salivary cotinine concentration. Two hundred and eleven adult smokers (>16 years old) with complete data were included in the analysis. Determinants of cotinine concentrations were assessed using linear regression models., Results: Salivary cotinine concentration was associated with the reported number of cigarettes smoked in the previous 24 hours (R2 = 0.339; p < 0.05). The inclusion of a quadratic component for number of cigarettes smoked in the regression analyses resulted in an improvement of the fit (R2 = 0.386; p < 0.05). Cotinine concentration differed significantly by sex, with men having higher levels., Conclusion: This study shows that salivary cotinine concentration is significantly associated with the number of cigarettes smoked and sex, but not with other smoking-related variables.

Relative survival is the most commonly used method to determine survival in patients diagnosed with cancer. This method takes into account estimation of expected survival in cancer patients based on the observed mortality in the geographical area to which they belong. The most frequently used methods for estimation of expected survival are the Ederer (I and II) and Hakulinen methods. Survival tables for the geographical areas stratified by age and calendar year are required for these calculations. The present article presents an example of how to perform these estimations and how to choose the most appropriate method for the type of analysis to be performed. This article shows that if the follow-up of the cohort is less than 10 years, any of these methods should give similar results. However, the Hakulinen method is preferred, since it accounts for heterogeneity due to potential withdrawals.