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Introduction: Estimating the prevalence of second-hand tobacco smoke exposure is a public health priority while evaluating the population-attributable disease burden and impact of smoking bans. We conducted a systematic review to analyze how secondhand tobacco smoke exposure has been assessed, and how its prevalence has been estimated among the Portuguese population since the implementation of the partial smoking ban in 2008. Methods: A literature search was conducted in the Web of Science, MEDLINE and Embase databases until November 2022, applying a pre-designed search strategy and following the PRISMA 2020 guidelines. The search was not restricted by study period, study design, sample size or language, and was complemented by a manual literature search. A modified Newcastle-Ottawa scale was used to assess the quality of the studies. Results: Thirteen cross-sectional studies were included. The prevalence of second-hand tobacco smoke exposure among the three European studies ranged from 8.2% (adult population exposed at home in 2010) to 93.3% (adolescent/adult population exposed in bar/restaurant terraces in 2016). Three nationwide studies estimated children’s exposure at home: ranging from 32.6% in 2010 - 2011 to 14.4% in 2016. According to the most recent studies, 49.8% of women living in Porto were exposed during the third trimester of pregnancy in 2010 - 2011; 32.6% and 38.4% of children were exposed at home, respectively in Lisbon and the Azores. Conclusion: A significant proportion of the Portuguese population, especially children and pregnant women, remain exposed to secondhand tobacco smoke. A comprehensive smoke-free policy is needed, not only in outdoor public places, but also in indoor private settings.

Abstract Background Despite multiple recommendations and strategies implemented at a national and international level, cigarette smoking, alcohol consumption, and cannabis use during pregnancy remains high in most countries. The objective of this study was to examine key stakeholders’ perception of the treatment interventions adopted in Spain, to identify political, organizational and personal factors associated with successful implementation, and to propose strategies for improvement. Methods A qualitative study with a phenomenological approach was conducted in 2022. The target groups were: (1) clinical decision makers in the field of addiction science, (2) health professionals who carry out treatment interventions, and (3) pregnant individuals who use tobacco, alcohol or cannabis. Two focus groups and eight in-depth interviews were conducted, recorded, and transcribed. Exploratory analysis and inductive open coding was performed, codes were merged into categories, and subcategories were identified. Results The analysis resulted in 10 subcategories which were further merged into three main categories: (1) Degree of adoption and utility of treatment interventions implemented; (2) Needs and demands with respect to the organization of treatment interventions; and, (3) Personal barriers to and facilitators for treatment. Respondents reported that despite multiple national and regional cessation initiatives, treatment interventions were rarely adopted in clinical practice. Health care administrators demanded reliable records to quantify substance use for better planning of activities. Health care professionals advocated for additional time and training and both echoed the importance of integrating cessation interventions into routine prenatal care and creating in-house specialized units. The difficulty in quitting, lack of awareness of risk for foetus and child and the controversial advice were identified as barriers by pregnant individuals. Conclusions Consistent with previous work, this study found that cessation strategies implemented by the health authorities are not effective if they are not accompanied by organizational and behavioral changes. The current study identifies a set of factors that could be pivotal in ensuring the success of treatment interventions targeting tobacco, alcohol and cannabis use among pregnant individuals.

The COVID-19 pandemic drastically transformed the integration of technology into medicine, testing the ability of health systems to make quick and effective decisions. This has been especially noticeable in emergency departments, which were overwhelmed by the massive influx of patients. In this context, this article presents the design, development, and proof of concept of a new intelligent decision support system applied to the management of patients suspected of having COVID-19 upon their arrival at an emergency department. To achieve this, starting from our proprietary database of chest X-rays (CXRs) collected at the Ribera Povisa Hospital, two modules based on the use of convolutional neural networks (CNNs) were sequentially run. The first was based on the DenseNet-121 model to identify whether a pneumonia condition was presented in the CXR, while the second was based on the COVID-Net CXR-S model and aimed to quantify the severity of airspace opacity in the CXR on a scale 0–24. Thus, based on this architecture, it will be possible to make predictions based on the CXR of new patients that, after interpretation, might allow physicians to determine whether cases are high-risk and, for example, should be admitted to the intensive care unit. Although the results we obtained were encouraging, it is important to note that this proposal is still at a conceptual stage of development and so future work will be required to validate it in real environments and develop techniques that can help explain its results.

Abstract Background Respirable crystalline silica (RCS) is associated with the development of lung cancer. However, there is uncertainty around the exposure threshold at which exposure to RCS may pose a clear risk for the development of lung cancer. The objective of this study was to review the cut-off points at which the risk of mortality or incidence of lung cancer due to occupational exposure to RCS becomes evident through a systematic review. Methods We conducted a search in PubMed, including cohort and case-control studies which assessed various categories of RCS exposure. A search was also conducted on the webpages of institutional organizations. A qualitative data synthesis was performed. Results Twenty studies were included. Studies that assessed lung cancer mortality and incidence displayed wide variability both in RCS exposure categories and related risks. Although most studies found no significant association for RCS exposure categories, it appears to be a low risk of lung cancer for mean concentrations of less than 0.07mg/m3. Regulatory agencies set annual RCS exposure limits ranging from 0.025mg/m3 through 0.1mg/m3. Conclusions There is a wide degree of heterogeneity in RCS exposure categories, with most studies observing no significant risk of lung cancer for the lowest exposure categories. Cut-off points differ between agencies but are nonetheless very similar and do not exceed 0.1mg/m3.

Introduction Small-area estimation methods are an alternative to direct surveybased estimates in cases where a survey’s sample size does not suffice to ensure representativeness. Nevertheless, the information yielded by small-area estimation methods must be validated. The objective of this study was thus to validate a small-area model. Methods The prevalence of smokers, ex-smokers, and never smokers by sex and age group (15–34, 35–54, 55–64, 65–74, ≥75 years) was calculated in two Spanish Autonomous Regions (ARs) by applying a weighted ratio estimator (direct estimator) to data from representative surveys. These estimates were compared against those obtained with a small-area model applied to another survey, specifically the Spanish National Health Survey, which did not guarantee representativeness for these two ARs by sex and age. To evaluate the concordance of the estimates, we calculated the intraclass correlation coefficient (ICC) and the 95% confidence intervals of the differences between estimates. To assess the precision of the estimates, the coefficients of variation were obtained. Results In all cases, the ICC was ≥0.87, indicating good concordance between the direct and small-area model estimates. Slightly more than eight in ten 95% confidence intervals for the differences between estimates included zero. In all cases, the coefficient of variation of the small-area model was

Resumen: Objetivo: Describir las preguntas empleadas para valorar la exposición al humo ambiental de tabaco (HAT) en las encuestas de salud en España. Método: Extracción y análisis de literales de las preguntas sobre HAT de las encuestas de salud de España identificadas en las páginas web del Ministerio de Sanidad, Plan Nacional sobre Drogas y Consejerías de Sanidad de las comunidades autónomas. Resultados: Tres encuestas de ámbito nacional valoran la exposición al HAT, con variabilidad en las preguntas, las respuestas o el periodo de recuerdo. Cataluña en 2022, Galicia en 2018 y el País Vasco en 2018 valoraron la exposición de forma detallada. Conclusiones: Las preguntas orientadas a valorar la exposición autodeclarada al HAT son dependientes de la encuesta. Es necesario disponer de un conjunto de preguntas que permitan valorar la exposición de manera homogénea en las encuestas de salud. Abstract: 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.

Objectives The aim of the study was to ascertain the percentage of Spanish lung cancer cases that would fulfil the lung cancer screening inclusion criteria recommended by the United States Preventive Service Task Force (USPSTF) in 2013 and 2021. Methods A cross-sectional study was carried out. All lung cancer cases registered in the Thoracic Tumor Registry with data on date of birth, date of diagnosis, smoking habit, number of pack-years and time elapsed since smoking cessation were included. Results The study included 15 006 patients diagnosed with lung cancer in Spain between 2016 and 2022. Eligibility to participate in screening increased from 53.7% to 63.5% (an increase of 9.8%) according to the 2013 and 2021 recommendations, respectively. The percentage of eligible men rose by 9.2 percentage points with the 2021 versus 2013 recommendations, whereas this rise was 11.5 percentage points in women. Under the 2021 recommendations, 36.6% of women and 5.3% of men would not have fulfilled the screening inclusion criteria due to being never-smokers; 14.9% of women and 11.0% of men would not have fulfilled the age criterion; and 27.0% of ex-smokers among women compared to 35.6% among men would not have been eligible due to >15 years having elapsed since smoking cessation. Conclusions In Spain, over one-third of lung cancer cases could not be detected through screening, by virtue of not meeting the most recent inclusion criteria stated by the USPSTF. The degree of fulfilment in a potential nationwide screening programme should be analysed, with the aim of establishing inclusion criteria in line with each country's context.

Introduction Complete and accurate data on smoking prevalence at a local level would enable health authorities to plan context-dependent smoking interventions. However, national health surveys do not generally provide direct estimates of smoking prevalence by sex and age groups at the subnational level. This study uses a small-area model-based methodology to obtain precise estimations of smoking prevalence by sex, age group and region, from a population-based survey. Methods The areas targeted for analysis consisted of 180 groups based on a combination of sex, age group (15–34, 35–54, 55–64, 65–74, and ≥75 years), and Autonomous Region. Data on tobacco use came from the 2017 Spanish National Health Survey (2017 SNHS). In each of the 180 groups, we estimated the prevalence of smokers (S), ex-smokers (ExS) and never smokers (NS), as well as their coefficients of variation (CV), using a weighted ratio estimator (direct estimator) and a multinomial logistic model with random area effects. Results When smoking prevalence was estimated using the small-area model, the precision of direct estimates improved; the CV of S and ExS decreased on average by 26%, and those of NS by 25%. The range of S prevalence was 11–46% in men and 4–37% in women, excluding the group aged ≥75 years. Conclusions This study proposes a methodology for obtaining reliable estimates of smoking prevalence in groups or areas not covered in the survey design. The model applied is a good alternative for enhancing the precision of estimates at a detailed level, at a much lower cost than that involved in conducting large-scale surveys. This method could be easily integrated into routine data processing of population health surveys. Having such estimates directly after completing a health survey would help characterize the tobacco epidemic and/or any other risk factor more precisely.

Abstract Small cell lung cancer (SCLC) comprises approximately 10% of all lung cancer cases. Tobacco is its main risk factor; however, occupation might play a role in this specific lung cancer subtype. The effect of occupation on SCLC risk has been hardly studied and therefore we aim to assess the role of occupation on the risk of SCLC. To do this, we designed a multicentric, hospital-based, case–control study. Cases consisted exclusively in SCLC patients and controls were recruited from patients having minor surgery at the participating hospitals. Face to face interviews emphasizing occupation and tobacco consumption were held and residential radon was also measured. Logistic regression models were adjusted with odds ratios with 95%CI as estimations of the effect. 423 cases and 905 controls were included. Smoking prevalence was higher in cases compared to controls. Those who worked in known-risk occupations for lung cancer showed an OR of 2.17 (95%CI 1.33; 3.52), with a similar risk when men were analysed separately. The results were adjusted by age, sex, smoking and indoor radon exposure. Those who worked in known-risk occupations and were moderate or heavy smokers had a SCLC risk of 12.19 (95%CI 5.68–26.38) compared with never or moderate smokers who had not worked in such occupations. Occupation is a relevant risk factor of SCLC, and it seems that its effect is boosted when tobacco smoking is present.

Objective: The need to generate evidence related to COVID-19, the acceleration of publication and peer-review process and the competition between journals may have influenced the quality of COVID-19 papers. Our objective was to compare the characteristics of COVID-19 papers against those of non-COVID-19 papers and identify the variables in which they differ. Method: We conducted a journal-matched case-control study. Cases were COVID-19 papers and controls were non-COVID-19 papers published between March 2020 and January 2021. Journals belonging to five different Journal Citations Reports categories were selected. Within each selected journal, a COVID-19 paper (where there was one) and another non-COVID-19 paper were selected. Conditional logistic regression models were fitted. Results: We included 81 COVID-19 and 143 non-COVID-19 papers. Descriptive observational studies and analytical observational studies had, respectively, a 55-fold (odds ratio [OR]: 55.12; 95% confidence interval [95%CI]: 7.41-409.84) and 19-fold (OR: 19.28; 95%CI: 3.09-120.31) higher likelihood of being COVID-19 papers, respectively, and also a higher probability of having a smaller sample size (OR: 7.15; 95%CI: 2.33-21.94). COVID-19 papers had a higher probability of being cited since their publication (OR: 4.97; 95%CI: 1.63-15.10). Conclusions: The characteristics of COVID-19 papers differed from those of non-COVID-19 papers published in the first months of the pandemic. In order to ensure the publication of good scientific evidence the quality of COVID-19-papers should be preserved. Resumen: Objetivo: La necesidad de generar evidencia relacionada con la COVID-19, la aceleración del proceso de revisión por pares y publicación, y la competencia entre revistas, pueden haber influido en la calidad de los artículos sobre la COVID-19. El objetivo fue comparar las características de los artículos sobre la COVID-19 con las de los artículos no COVID-19 e identificar las variables en las que difieren. Método: Se realizó un estudio de casos y controles emparejados por revista. Los casos eran artículos COVID-19 y los controles eran artículos no COVID-19 publicados en el mismo periodo. Se seleccionaron revistas pertenecientes a cinco categorías diferentes del Journal Citations Reports. Dentro de cada revista seleccionada, se escogió un artículo COVID-19 (cuando había uno) y otro artículo no COVID-19. Se ajustaron modelos de regresión logística condicional. Resultados: Se incluyeron 81 artículos COVID-19 y 143 artículos no COVID-19. Los estudios observacionales descriptivos y los estudios observacionales analíticos tenían, respectivamente, una probabilidad 55 veces mayor (odds ratio [OR]: 55,12; intervalo de confianza del 95% [IC95%]: 7,41-409,84) y 19 veces mayor (OR: 19,28; IC95%: 3,09-120,31) de ser artículos COVID-19 y de tener un tamaño de muestra menor (OR: 7,15; IC95%: 2,33-21,94). Los artículos más citados desde su publicación tenían 5 veces más probabilidades de ser artículos COVID-19 (OR: 4,97; IC95%: 1,63-15,10). Conclusiones: Los artículos COVID-19 parecen tener mayor impacto bibliométrico, a pesar de tener menor calidad metodológica. Para asegurar la publicación de buena evidencia científica se debe preservar la calidad de los artículos relacionados con la COVID-19.

Resumen: Objetivo: En España, debido a la falta de datos, se creó un registro de cáncer de pulmón, el Registro de Tumores Torácicos (RTT), el cual debería demostrar su comparabilidad con los datos poblacionales para tener una representatividad adecuada. Con esta finalidad, se comparan las características sociodemográficas del RTT con los datos de incidencia de la Red de Registros de Cáncer (REDECAN) y de mortalidad del Instituto Nacional de Estadística (INE). Método: Se utilizaron las fuentes de datos de cáncer de pulmón disponibles hasta el momento: REDECAN e INE. De cada fuente se recogieron los casos de cáncer de pulmón globales y desagregados por sexo y por grupos de edad, y se compararon los datos para el periodo 2017-2020. Se calcularon las proporciones por sexo y grupo de edad del RTT respecto a ambas bases de datos (que recogen incidencia y mortalidad), para el periodo completo de estudio y desglosado por año. Resultados: Se incluyeron 17.109 casos incidentes de cáncer de pulmón incluidos en el RTT, 58.668 casos incidentes estimados de REDECAN y 88.083 muertes entre 2017 y 2020 del INE. En cuanto al sexo, las proporciones son muy similares entre las tres fuentes y las diferencias no superan el 4%. En cuanto a la edad, las diferencias no son elevadas, siendo mayores para los datos de mortalidad en el grupo de mayor edad del INE frente al RTT. Conclusiones: El RTT parece ser representativo de los casos de cáncer de pulmón diagnosticados en España para los años 2019 y 2020, tanto por sexo como por edad. Esto permite poder caracterizar con exactitud el estado de esta enfermedad, primera causa de muerte por cáncer en España, y que el análisis de resultados que se vayan a obtener del RTT pueda ser aplicado a los casos de cáncer de pulmón diagnosticados en nuestro país. Abstract: Objective: In Spain, due to the lack of data at national level a lung cancer registry, the Thoracic Tumour Registry (TTR), was created. Such registry should demonstrate comparability with population-based data to ensure representativeness at population level. The aim is to compare the socio-demographic characteristics of the TTR with incidence data from the Red de Registros de Cáncer (REDECAN) and mortality data from the Instituto Nacional de Estadística (INE). Method: Lung cancer data sources available to date, REDECAN and INE, were used. Lung cancer cases overall and disaggregated by sex and age groups were collected from each source of information and data were compared for the period 2017-2020. Sex and age group proportions of TTR were calculated for both databases (which collect incidence and mortality data), for the entire study period and broken down by year. Results: A total of 17,109 incident lung cancer cases from the TTR, 58,668 estimated incident cases from REDECAN and 88,083 deaths registered from INE between 2017 and 2020 were included. In terms of sex, the proportions are very similar between the three sources and the differences do not exceed 4%. In terms of age, the differences are not large, being larger for mortality data in the older age group from the INE versus the TTR. Conclusions: The TTR seems to be representative of lung cancer cases diagnosed in Spain between 2019 and 2020, both by sex and age. This allows us to accurately characterise the status of this disease, which is the leading cause of cancer death in Spain, and that the analysis of results obtained from the RTT can be applied to cases of lung cancer diagnosed in our country.

Resumen: 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. Abstract: 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.

Objetivo. Determinar la evolución de la mortalidad por cáncer de pulmón en Colombia en el período 1985-2018 en la población de 35 años y más e identificar cambios en la tendencia. Métodos. Análisis de series temporales de mortalidad. Se calcularon las tasas específicas y estandarizadas por sexo y grupos de edad. Mediante la regresión joinpoint se estimó el porcentaje de cambio anual de las tasas y se identificaron puntos de cambio. Resultados. En el período 1985-2018 se registraron 105 553 muertes por cáncer de pulmón en la población de 35 años y más. Las tasas estandarizadas muestran una tendencia decreciente en el período 1985-2005, excepto en mayores de 64 años. Conclusiones. La tendencia de las tasas de mortalidad por cáncer de pulmón es decreciente en Colombia. Es necesario potenciar medidas de prevención primaria y secundaria sobre el consumo de tabaco y vigilar otros factores de riesgo como el radón residencial o la ocupación.

Introducción: Las organizaciones internacionales recomiendan mantener la lactancia materna (LM) durante los primeros 6 meses de vida. En Europa, la prevalencia de LM a los 6 meses está por debajo de las recomendaciones. Los objetivos son estimar la prevalencia de cese de LM mes a mes y conocer los motivos asociados al abandono de la LM durante el primer año de vida en Galicia. Metodología: Los datos proceden de la encuesta del Sistema de Información sobre Conductas de Riesgo para la Salud 2016 que incluyó a mujeres que habían dado a luz en los 12 meses previos (n = 6.436) en Galicia (España). Se estimaron las prevalencias de cese de LM en función de la edad del niño. Se clasificaron las causas de abandono en cinco categorías y se estimaron las frecuencias. Resultados: Se incluyeron a 5.177 madres con niños de 3-16 meses. Al año de vida, el 33,8% de los niños mantenían LM. La razón principal del abandono fue la hipogalactia (46,5%), seguida de la vuelta al trabajo (24,1%). Hasta los 4 meses, la hipogalactia y los problemas de salud fueron los motivos principales; entre los 4-7 meses, la vuelta al trabajo y la hipogalactia; y después de los 7 meses, el rechazo del bebé y la vuelta al trabajo. Conclusión: El abandono de la LM durante el primer año de vida es preocupante. Conocer cuándo se produce el abandono y sus razones pueden ayudar a los profesionales sanitarios a prevenirlo.

Abstract 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% 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.

Resumen: Objetivo: Conocer si en España los planes de salud autonómicos incluyen objetivos y medidas específicas relacionados con la actividad física. Método: Se realizó una búsqueda en las páginas web institucionales para identificar el plan de salud más reciente de cada comunidad autónoma. Se extrajo la información que incluían los planes de salud sobre objetivos y medidas, y grupos poblacionales a los que se dirigían dichas medidas. La búsqueda se completó el 24 de enero de 2022. Resultados: Se identificaron 16 planes de salud, de los cuales seis están vigentes en 2022; de estos, 15 incorporaban objetivos y medidas específicas sobre actividad física. La mayor parte de las acciones van destinadas a población general, población infanto-juvenil y personas mayores. Los planes de Cantabria, la Comunidad Valenciana y el País Vasco incluyen la actividad física de forma más extensa, proponiendo medidas para siete de los ocho grupos poblacionales identificados. Conclusiones: La mayor parte de los planes de salud incluyen medidas en relación con la actividad física y las dirigen a dos o más grupos poblacionales. La heterogeneidad en cuanto a objetivos, medidas específicas y grupos poblacionales es alta. Este estudio puede ayudar a las comunidades autónomas a revisar su plan de salud, actualizarlo y mejorarlo en materia de actividad física. Es conveniente que los diferentes planes de salud tengan un marco de propuestas homogéneo relacionado con la promoción de la actividad física. Abstract: 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.

Resumen: Objetivo: Analizar la carga del consumo de tabaco en la mortalidad y en los años de esperanza de vida perdidos en población ≥35 años en Brasil en el periodo 1996-2019, e identificar cambios de tendencia en la mortalidad atribuida. Método: Para estimar la mortalidad atribuida se aplicó un método independiente de prevalencia que asume la tasa de mortalidad por cáncer de pulmón como indicador indirecto del riesgo acumulado asociado al consumo de tabaco. La mortalidad atribuida se estima a partir de la tasa de mortalidad por cáncer de pulmón y aplicando riesgos relativos de cinco cohortes estadounidenses. Se presentan la mortalidad atribuida, las tasas de mortalidad atribuida brutas y estandarizadas en global, por sexo, edad y causas de muerte. Se analizó la tendencia aplicando modelos de regresión joinpoint. Se calcularon los años de esperanza de vida perdidos a causa del tabaco. Resultados: Entre 1996 y 2019 el consumo de tabaco causó 2.389.831 muertes en Brasil. Las enfermedades cardiometabólicas fueron la primera causa de muerte en mujeres en todo el periodo y en hombres hasta 2015. Desde 2006, las tasas de mortalidad atribuida en los hombres, con independencia de la edad, muestran una tendencia decreciente, mientras que en las mujeres la evolución es diferente. Los años de esperanza de vida perdidos muestran un ligero descenso desde los primeros trienios y son más en los hombres. Conclusiones: El 8,5% de la mortalidad total en Brasil durante el periodo 1996-2019 se atribuye al consumo de tabaco. Es importante monitorizar la carga del consumo de tabaco en la mortalidad para fortalecer o implantar intervenciones frente al tabaquismo en Brasil. Abstract: 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.

Resumen: El objetivo de este estudio fue proponer una versión reducida del Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) que permita estimar prevalencias de inactividad física. Se incluyó el MLTPAQ en la encuesta del Sistema de Información sobre Conductas de Riesgo de Galicia. A cada actividad se le asoció un código de intensidad, en múltiplos de 1 MET, y se definió como físicamente inactivo un gasto energético semanal

Objective: To characterize the prevalence of physical activity in the population aged ≥16 years integrating sedentarism and physical inactivity. Method: A cross-sectional study using data from the Galician Risk Behavior Data System (n = 12,928) was conducted. The population was classified into four categories: physically active (active and non-sedentary), active but sedentary (active and sedentary), lightly active (inactive and non-sedentary), and extremely sedentary (inactive and sedentary). Prevalences were calculated for each category and a multinomial logistic regression model was fitted. Results: 58.0% of the population was physically active and the remaining 42.0% presented some degree of sedentarism and/or physical inactivity. Men were more likely to be extremely sedentary. The risk of sedentarism decreased with age, and workers and/or students were prone to a higher risk of extreme sedentarism in comparison to those who reported other status. Extremely sendentary behaviors were also more common in people with higher educational levels, individuals living alone, residents of urban environments, and smokers. Conclusions: Joint evaluation of sedentarism and physical inactivity provides a more comprehensive and realistic picture of population behaviors related with physical activity. Since sedentarism is the most prevalent behavior, this study recommends that interventions be conducted at work and at academic environments. Resumen: Objetivo: Caracterizar la prevalencia de actividad física en la población ≥16 años integrando sedentarismo e inactividad física. Método: Se realizó un estudio transversal con datos del Sistema de Datos de Conductas de Riesgo de Galicia (n = 12.928). La población se clasificó en cuatro categorías: físicamente activa (activa y no sedentaria), activa pero sedentaria (activa y sedentaria), poco activa (inactiva y no sedentaria) y extremadamente sedentaria (inactiva y sedentaria). Se calcularon las prevalencias para cada categoría y se ajustó un modelo de regresión logística multinomial. Resultados: El 58,0% de la población era físicamente activa y el 42,0% restante presentaba algún grado de sedentarismo o inactividad física. Los hombres eran más propensos a ser extremadamente sedentarios. El riesgo de sedentarismo disminuía con la edad, y los trabajadores o estudiantes eran propensos a un mayor riesgo de sedentarismo extremo en comparación con los que declaraban otra condición. Los comportamientos extremadamente sedentarios también fueron más frecuentes en personas con niveles educativos más altos, personas que vivían solas, residentes en entornos urbanos y fumadores. Conclusiones: La evaluación conjunta del sedentarismo y la inactividad física proporciona una imagen más completa y realista de los comportamientos de la población relacionados con la actividad física. Dado que el sedentarismo es el comportamiento más prevalente, este estudio recomienda que se realicen intervenciones en el ámbito laboral y académico.

Abstract Foot problems are highly prevalent conditions, being a frequent reason for medical and podiatric consultation. The aim of this study was to compare the differences of quality of life (QoL) related to foot health in people with and without the presence of foot problems. A case–control study was carried out in an outpatient centre, where a clinician recorded data related to sociodemographic and clinical characteristics. In addition, self-reported data on foot health-related quality of life were recorded using the Spanish version of the Foot Health Status Questionnaire. The sample consisted of 498 participants (249 cases and 249 controls), with a median age of 30 years and an interquartile range of 23 years. The differences between the groups were statistically significant for gender, age, footwear, general health, foot health, and physical activity. Cases showed lower scores for the domain of footwear, physical activity and vitality compared to controls. Foot pathologies have a negative impact on quality of life related to foot health, and the domains of footwear, general health and physical activity seem to be the factors that are associated with the presence of alterations and foot deformities.

Resumen: Objetivo: Evaluar la asociación entre la exposición al radón y el cáncer genitourinario en población minera a través de una revisión sistemática de la literatura científica. Método: Se realizó una revisión sistemática de la literatura científica en MEDLINE (PubMed) combinando términos MeSH (Medical Subject Heading) y términos libres. Se realizó una escala específica de valoración de la calidad de los estudios incluidos. Resultados: Se incluyeron 17 estudios. Todos fueron estudios de cohortes, excepto uno que fue un pool de datos. Todos los estudios incluían análisis de la relación entre la exposición al radón y el cáncer genitourinario. Los resultados son ambiguos: unos estudios apuntan hacia una asociación entre la exposición y el cáncer genitourinario, especialmente de riñón, y otros no encuentran asociación. Conclusión: Los estudios incluidos presentan una gran heterogeneidad metodológica. No puede concluirse que exista una asociación entre la exposición al radón y el cáncer genitourinario. Es necesaria más investigación sobre el tema, con estudios que tengan más potencia estadística y mejor control de las variables confusoras, y preferentemente que sean prospectivos. Abstract: Objective: To assess the association between exposure to radon and genitourinary cancer in a mining population through a systematic review of the scientific literature. Method: A systematic review of the scientific literature was carried out in MEDLINE (PubMed), combining MeSH (Medical Subject Heading) terms and free terms. We applied a specific scale to assess the quality of the included studies. Results: We included 17 studies; all were cohort studies with the exception of one which was a pooling of data. All studies included analysed the relationship between exposure to radon and genitourinary cancer. While some studies point towards an association between radon exposure and genitourinary cancer, especially kidney cancer, others do not find such association. Conclusions: The included studies showed great heterogeneity. It cannot be concluded that there is an association between exposure to radon and genitourinary cancer. More research is needed on this topic, designing studies with higher statistical power, better control of confounders, and preferably prospective.

BackgroundEurope has had a large variability in COVID-19 incidence between and within countries, particularly after June 2020. We aim to assess the variability between European countries and regions located in a given country.MethodsWe used ECDC information including countries having 7 regions or more. The metric used to assess the regional variability within a country was the intercuartilic range in a weekly basis for 32 weeks between June 29th 2020 and February 1st 2021. We also calculated each country's overall variability across the 32 weeks using the distances from the regional curves of the 14-day incidence rates to the corresponding national curve, using the L2 metric for functional data. We afterwards standardised this metric to a scale from 0 to 100 points. We repeated the calculations excluding island regions.ResultsThe variability between and within countries was large. Slovenia, Spain and Portugal have the greatest variability. Spain and Slovenia held also the top three places for the greatest number of weeks (Spain for 19 weeks and Slovenia for 10) with the highest variability. For variability among the incidence curves across the 32-week period, Slovenia, Portugal and Spain ranked first in functional variability, when all the regions were analysed but also when the island regions were excluded.ConclusionsThese differences might be due to how countries tackled the epidemiological situation. The persistent variability in COVID-19 incidence between regions of a given country suggests that governmental action may have an important role in applying epidemiological control measures.

Objective: To explore whether there is a possible problem regarding indoor radon concentration surpassing the new European Directive 2013/59/Euratom threshold in Spanish workplaces. We also aim to find out whether radon concentration might be associated with certain characteristics of workplaces. Method: We performed a cross-sectional study to measure indoor radon concentrations in Spanish workplaces including five different sectors (education, public administration, the health sector, the tourist sector and the private sector). To be measured, the workplace should be occupied permanently by at least one worker. Alpha-track type radon detectors were placed for at least three months and read at the Galician Radon Laboratory at the University of Santiago de Compostela. A descriptive analysis was performed on radon distribution by sector, building characteristics and number of workers affected. Results: We faced enormous difficulties in finding volunteers for this study. Galicia and Madrid had the highest number of measurements. Of a total of 248 measurements, 27% had concentrations above 300 Bq/m3. Median radon concentration was 251 Bq/m3 in Galicia, followed by Madrid, with 61.5 Bq/m3. Forty-six percent of the workplaces measured in Galicia had radon concentrations higher than 300 Bq/m3 followed by 10.6% in Madrid. Nineteen percent of all workers were exposed to more than 300 Bq/m3 and 6.3% were exposed to radon concentrations higher than 500 Bq/m3. Conclusion: Indoor radon exposure might be a relevant problem in Spanish workplaces and the number of affected workers could be high. The prevalence of workers exposed to high radon concentrations probably depends on the geographical area. Resumen: Objetivo: Explorar si podría existir un problema en cuanto a la concentración de radón en los puestos de trabajo en España por superación del umbral propuesto por la nueva Directiva Europea 2013/59/Euratom. También se pretende conocer si la concentración de radón puede estar asociada a las características de los puestos de trabajo. Método: Estudio transversal en seis regiones y diferentes sectores (educación, administración pública, sanitario, turístico y privado). El puesto de trabajo medido debía ser ocupado de manera permanente por al menos un trabajador. Los detectores de radón de tipo alfa-track estuvieron colocados al menos 3 meses y fueron revelados en el Laboratorio de Radón de Galicia, de la Universidad de Santiago de Compostela. Se realizó un análisis descriptivo de la concentración de radón por sector, por características de los edificios y por número de trabajadores afectados. Resultados: Hubo dificultades para encontrar voluntarios para este estudio. Galicia y Madrid tuvieron el mayor número de mediciones. Se midieron 248 lugares de trabajo, con el 27% por encima de los 300 Bq/m3. La concentración mediana fue de 251 Bq/m3 en Galicia, seguida de Madrid con 61,5 Bq/m3. El 46% de los puestos de trabajo en Galicia tenían concentraciones mayores de 300 Bq/m3, y el 10,6% en Madrid. El 19% de los trabajadores estuvieron expuestos a más de 300 Bq/m3 y el 6,3% a más de 500 Bq/m3. Conclusión: La exposición a radón podría ser un problema de salud relevante en los lugares de trabajo en España. El número de trabajadores expuestos parece elevado. La prevalencia de trabajadores afectados depende del área geográfica. Keywords: Radon, Lung cancer, Cross-sectional studies, Workplace, Spain, Palabras clave: Radón, Cáncer de pulmón, Estudio transversal, Lugar de trabajo, España

Background Globally, radon is the leading risk factor for lung cancer in never-smokers (LCINS). In this study, we systematically reviewed and meta-analysed the evidence of the risk of LCINS associated with residential radon exposure. Methods Medline and Embase databases were searched using predefined inclusion and exclusion criteria to identify relevant studies published from 1 January 1990 to 5 March 2020 focused on never-smokers. We identified four pooled collaborative studies (incorporating data from 24 case–control studies), one case–control study and one cohort study for systematic review. Meta-analysis was performed on the results of the four pooled studies due to different measures of effect and outcome reported in the cohort study and insufficient information reported for the case–control study. In a post hoc analysis, the corresponding risk for ever-smokers was also examined. Results Risk estimates of lung cancer from residential radon exposure were pooled in the meta-analysis for 2341 never-smoker cases, 8967 never-smoker controls, 9937 ever-smoker cases and 12 463 ever-smoker controls. Adjusted excess relative risks (aERRs) per 100 Bq·m−3 of radon level were 0.15 (95% CI 0.06–0.25) for never-smokers and 0.09 (95% CI 0.03–0.16) for ever-smokers, and the difference between them was statistically insignificant (p=0.32). The aERR per 100 Bq·m−3was higher for men (0.46; 95% CI 0.15–0.76) than for women (0.09; 95% CI −0.02–0.20) among never-smokers (p=0.027). Conclusion This study provided quantified risk estimates for lung cancer from residential radon exposure among both never-smokers and ever-smokers. Among never-smokers in radon-prone areas, men were at higher risk of lung cancer than women.

The coronavirus disease caused by SARS-Cov-2 is a pandemic with millions of confirmed cases around the world and a high death toll. Currently, the real-time polymerase chain reaction (RT-PCR) is the standard diagnostic method for determining COVID-19 infection. Various failures in the detection of the disease by means of laboratory samples have raised certain doubts about the characterisation of the infection and the spread of contacts.In clinical practice, chest radiography (RT) and chest computed tomography (CT) are extremely helpful and have been widely used in the detection and diagnosis of COVID-19. RT is the most common and widely available diagnostic imaging technique, however, its reading by less qualified personnel, in many cases with work overload, causes a high number of errors to be committed. Chest CT can be used for triage, diagnosis, assessment of severity, progression, and response to treatment. Currently, artificial intelligence (AI) algorithms have shown promise in image classification, showing that they can reduce diagnostic errors by at least matching the diagnostic performance of radiologists.This review shows how AI applied to thoracic radiology speeds up and improves diagnosis, allowing to optimise the workflow of radiologists. It can provide an objective evaluation and achieve a reduction in subjectivity and variability. AI can also help to optimise the resources and increase the efficiency in the management of COVID-19 infection. Resumen: La enfermedad causada por el coronavirus SARS-CoV-2 es una pandemia con millones de casos confirmados en todo el mundo, y un alto número de fallecimientos. Actualmente, la reacción en cadena de la polimerasa en tiempo real (RT-PCR) es el método de diagnóstico estándar para determinar la infección por COVID-19. Diversos fracasos en la detección de la enfermedad por medio de muestras de laboratorio han planteado ciertas dudas sobre la caracterización de la infección y la propagación a los contactos.En la práctica clínica, la radiografía de tórax (RT) y la tomografía computarizada (TC) de tórax son extremadamente útiles y se han utilizado extensamente en la detección y el diagnóstico de la COVID-19. La RT es la técnica de diagnóstico por imagen más común, y la que está más ampliamente disponible, sin embargo, su lectura por personal menos cualificado, en muchos casos con sobrecarga de trabajo, hace que se cometa un gran número de errores. La TC de tórax se puede utilizar para el triaje, el diagnóstico, la evaluación de la gravedad, la progresión y la respuesta al tratamiento. Actualmente, los algoritmos de inteligencia artificial (IA) han resultado prometedores en la clasificación de imágenes, mostrando que pueden reducir los errores de diagnóstico, como mínimo igualando el rendimiento diagnóstico de los radiólogos.Esta revisión muestra cómo la IA aplicada a la RT acelera y mejora el diagnóstico, lo que permite optimizar el flujo de trabajo de los radiólogos. Puede proporcionar una evaluación objetiva y lograr una reducción de la subjetividad y la variabilidad. La IA también puede ayudar a optimizar los recursos y aumentar la eficiencia en la gestión de la infección por COVID-19.

RESUMEN: Objetivo: Actualizar la estimación de la mortalidad atribuida al consumo de tabaco en Brasil en población de 35 y más años. Métodos: Se aplicó un método dependiente de prevalencia, basado en la fracción atribuida poblacional. Este método estima la mortalidad atribuida a partir de la mortalidad observada en Brasil (fuente: Sistema de Información de Mortalidad del Sistema Único de Salud de Brasil-2016); de las prevalencias de fumadores, exfumadores y nunca fumadores (Encuesta Nacional de Salud de Brasil-2013) y del exceso de riesgo de morir (riesgo relativo) que tienen los fumadores y exfumadores en comparación con los nunca fumadores (5 estudios de cohortes norteamericanos). Se presentan estimaciones de mortalidad atribuida globales, por sexo, grupo de edad (35-54; 55-64; 65-74 y 75 años en adelante) y 3 grupos de enfermedades: tumores malignos, enfermedades cardiometabólicas y respiratorias. Resultados: En 2016, el consumo de tabaco causó con 163.831 muertes en Brasil, el 67% (109.369) fue en hombres y cuatro de cada diez (62.791) sucedieron antes de los 65 años. El 42% de la mortalidad atribuida se asocia a enfermedades cardiometabólicas, seguidas de respiratorias (34%) y tumorales (24%), sin diferencias por sexo. Conclusión: El 14% de las muertes que sucedieron en Brasil durante 2016 en población de 35 y más años se atribuye al consumo de tabaco. Realizar de forma periódica estimaciones de MA es necesario para valorar y fortalecer las leyes de control de tabaquismo implantadas.

Objective: To review the published evidence of links between radon exposure and central nervous system tumors through a systematic review of the scientific literature. Methods: We performed a thorough bibliographic search in Medline (PubMed) and EMBASE. We combined MeSH (Medical Subject Heading) terms and free text. We developed a purpose-designed scale to assess the quality of the included manuscripts. Results: We have included 18 studies, 8 performed on miners, 3 on the general population and 7 on children, and the results have been structured using this classification. The results are inconclusive. An association between radon exposure and central nervous system tumors has been observed in some studies on miners, but not in others. The results observed in the general adult population and in children are also mixed, with some research evincing a statistically significant association and others showing no effect. Conclusions: We cannot conclude that there is a relationship between radon exposure and central nervous system tumors. The available studies are extremely heterogeneous in terms of design and populations studied. Further research is needed in this topic, particularly in the general population residing in areas with high levels of radon. Resumen: Objetivo: Revisar la evidencia publicada entre la exposición al radón y los tumores del sistema nervioso central a través de una revisión sistemática de la literatura científica. Método: Se realiza una revisión sistemática exhaustiva de la literatura científica en Medline (PubMed) y EMBASE, combinando términos MeSH (Medical Subject Heading) y texto libre. Se desarrolla una escala específica para valorar la calidad de los estudios incluidos. Resultados: Se incluyeron 18 estudios (8 realizados en mineros, 3 en población general y 7 en niños) y los resultados se estructuraron siguiendo esa clasificación. Los resultados son inciertos. Algunos estudios en mineros han observado una asociación entre la exposición a radón y tumores del sistema nervioso central, pero otros no. Los resultados en población general adulta y en niños también son diversos, con algunas investigaciones que encuentran una asociación estadísticamente significativa y otras que no encuentran ningún efecto. Conclusiones: No puede concluirse que exista una asociación entre la exposición al radón y los tumores del sistema nervioso central. Los estudios disponibles son muy heterogéneos en cuanto al diseño y los sujetos incluidos. Es necesaria más investigación sobre este tema, en particular en población general residente en áreas con elevados niveles de radón. Keywords: Central nervous system neoplasms, Radon, Systematic review, Palabras clave: Sistema nervioso central, Radón, Revisión sistemática

Abstract We aimed to know if radon concentration is associated with municipal mortality due to brain cancer in Galicia, Spain. We designed an ecological study taking as study unit Galician municipalities. To be included, municipalities had to have at least three radon measurements. We correlated radon concentrations with municipal mortality due to these malignant tumors during the period 1999–2008. We calculated the relative risk of dying of brain cancers for each municipality and correlated this value with municipal radon concentration using Spearman’s Rho. 251 municipalities were included, with close to 3,500 radon measurements and an average of 14 radon measurements at each municipality. We observed a significant correlation between residential radon with brain cancer mortality for males and females and the intensity of the correlation was higher for females. These results were reinforced when the analysis was restricted to municipalities with more than 5 radon measurements: Spearman’s Rho 0.286 (p-value

Background: Radon (and its decay products) is a known human carcinogen and the leading cause of lung cancer in never-smokers and the second in ever-smokers. The carcinogenic mechanism from radiation is a combination of genetic and epigenetic processes, but compared to the genetic mechanisms, epigenetic processes remain understudied in humans. This study aimed to explore associations between residential radon exposure and DNA methylation in the general population. Methods: Potential residential radon exposure for 75-metre area buffers was linked to genome-wide DNA methylation measured in peripheral blood from children and mothers of the Accessible Resource for Integrated Epigenomic Studies subsample of the ALSPAC birth cohort. Associations with DNA methylation were tested at over 450,000 CpG sites at ages 0, 7 and 17 years (children) and antenatally and during middle-age (mothers). Analyses were adjusted for potential residential and lifestyle confounding factors and were determined for participants with complete data (n = 786 to 980). Results: Average potential exposure to radon was associated in an exposure-dependent manner with methylation at cg25422346 in mothers during pregnancy, with no associations at middle age. For children, radon potential exposure was associated in an exposure-dependent manner with methylation of cg16451995 at birth, cg01864468 at age 7, and cg04912984, cg16105117, cg23988964, cg04945076, cg08601898, cg16260355 and cg26056703 in adolescence. Conclusions: Residential radon exposure was associated with DNA methylation in an exposure-dependent manner. Although chance and residual confounding cannot be excluded, the identified associations may show biological mechanisms involved in early biological effects from radon exposure.

Objective: The main objective of this study is to analyse the role of alcohol consumption on lung cancer risk in people who have never smoked. Methods: We conducted a systematic review of the scientific literature following the PRISMA statement. We searched Medline, EMBASE and CINAHL using different combinations of MeSH terms and free text. We included cohort studies, pooled cohort studies and case-control studies comprising at least 25 anatomopathologically-confirmed diagnoses of lung cancer cases, a sample size larger than 100 individuals and more than five years of follow-up for cohort studies. We excluded studies that did not specifically report results for never smokers. We developed a quality score to assess the quality of the included papers and we ultimately included 14 investigations with a heterogeneous design and methodology. Results: Results for alcohol consumption and lung cancer risk in never smokers are inconclusive; however, several studies showed a dose-response pattern for total alcohol consumption and for spirits. Heterogeneous results were found for wine and beer. Conclusion: No clear effect is observed for alcohol consumption. Due to the limited evidence, no conclusion can be drawn for beer or wine consumption. There is little research available on the effect of alcohol on lung cancer risk for people who have never smoked, and more studies are urgently needed on this topic.

Background: Radon (and its decay products) is a known human carcinogen and the leading cause of lung cancer in never-smokers and the second in ever-smokers. The carcinogenic mechanism from radiation is a combination of genetic and epigenetic processes, but compared to the genetic mechanisms, epigenetic processes remain understudied in humans. This study aimed to explore associations between residential radon exposure and DNA methylation in the general population. Methods: Potential residential radon exposure for 75-metre area buffers was linked to genome-wide DNA methylation measured in peripheral blood from children and mothers of the Accessible Resource for Integrated Epigenomic Studies subsample of the ALSPAC birth cohort. Associations with DNA methylation were tested at over 450,000 CpG sites at ages 0, 7 and 17 years (children) and antenatally and during middle-age (mothers). Analyses were adjusted for potential residential and lifestyle confounding factors and were determined for participants with complete data (n = 786-980). Results: Average potential exposure to radon was associated in an exposure-dependent manner with methylation at cg25422346 in mothers during pregnancy, with no associations at middle age. For children, radon potential exposure was associated in an exposure-dependent manner with methylation of cg16451995 at birth, cg01864468 at age 7, and cg04912984, cg16105117, cg23988964, cg04945076, cg08601898, cg16260355 and cg26056703 in adolescence. Conclusions: Residential radon exposure was associated with DNA methylation in an exposure-dependent manner. Although residual confounding cannot be excluded, the identified associations may show biological mechanisms involved in early biological effects from radon exposure.

Introduction. Influenza A H1N1 community-acquired pneumonia (CAP) is a quite frequent respiratory disease. Despite being considered more serious than other CAPs, there are very few studies comparing its characteristics with noninfluenza CAP. We aim to establish the differences between pneumonia due to H1N1 virus and pneumonia not caused by H1N1 influenza virus and to determine the probability that a pneumonia is due to an H1N1 virus infection based on the most relevant variables. Methods. We used a case-control study where cases were H1N1 CAP patients with confirmed microbiological diagnosis and controls were patients with CAP admitted to hospital. H1N1 and other influenza types were discarded among controls. We calculated the probability of being a case or control using multivariate logistic regression. Results. We included 99 cases and 270 controls. Cases were younger than controls (53 vs 71 years, respectively). Mortality was much higher for H1N1 patients (13% vs 0.3%), and admission to intensive care unit was more frequent for H1N1 cases. The variables most associated with presenting H1N1 CAP were bilateral affectation on chest X-rays (OR: 5.70; 95% CI 2.69–10.40), followed by presence of arthromyalgias, with cases presenting close to three times more arthromyalgias compared to controls. Low leukocytes count and high AST values were also significantly associated with H1N1 CAP. H1N1 CAPs are characterized by bilateral affectation, low leukocyte count, presence of arthromyalgias, and high AST. Conclusions. A few and easy to obtain clinical parameters might be extremely useful to distinguish H1N1 CAP from CAPs of other origin.

Background: The high relapse and mortality rate of small-cell lung cancer (SCLC) fuels the need for epidemiologic study to aid in its prevention. Methods: We included 24 studies from the ILCCO collaboration. Random-effects panel logistic regression and cubic spline regression were used to estimate the effects of smoking behaviors on SCLC risk and explore their non-linearity. Further, we explored whether the risk of smoking on SCLC was mediated through COPD. Findings: Significant dose–response relationships of SCLC risk were observed for all quantitative smoking variables. Smoking pack-years were associated with a sharper increase of SCLC risk for pack-years ranged 0 to approximately 50. The former smokers with longer cessation showed a 43%quit_for_5–9 years to 89%quit_for_≥20 years declined SCLC risk vs. subjects who had quit smoking

Chronic obstructive pulmonary disease (COPD) is a significant health problem in developed countries. We aimed to estimate the prevalence of COPD in a single Spanish healthcare area. We also aimed to assess if there are any differences in prevalence and spirometry use among primary care services by utilizing already registered information. We designed a cross-sectional study to determine the prevalence of COPD and the performance of spirometries in each primary care service. A total of 8,444 patients were diagnosed with COPD, with a prevalence of 2.6% for individuals older than 39 years. The prevalence increased with age and was much higher in men. Significant heterogeneity was found in the prevalence of COPD and spirometry use among primary care services. COPD was underdiagnosed and there was wide variability in spirometry use in our area. Greater efforts are needed to diagnose COPD in order to improve its clinical outcomes and to refine registries so that they can be used as reliable sources of information

Objective: To compare whether there are differences among hospital and population controls. Methods: Two case-control studies were conducted on lung cancer risk factors in the Santiago de Compostela Public Health District. Whereas one used randomly chosen census-based population controls, the other used consecutive hospital controls that went to the reference hospital for non-smoking-related trivial interventions. The differences were analyzed using logistic regression. The dependent variable was type of control (hospital or population). Results: Hospital controls had a similar tobacco habit than population controls, but consumed more alcohol. For those consuming more than 50 ml daily, the risk of being a hospital control was 4.83 (95%CI: 2.55-9.14). Conclusions: There may be some differences between hospital and population-based controls, which must be taken into account in the design of case-control studies. It is necessary to ascertain whether such differences are reproduced at other geographic locations and whether they can affect estimation of exposure-disease.Objetivo: Comparar si hay diferencias entre los controles poblacionales y los hospitalarios. Métodos: Se llevaron a cabo dos estudios de casos y controles sobre factores de riesgo de cáncer de pulmón en el Área Sanitaria de Santiago de Compostela. En uno de los estudios los controles fueron seleccionados aleatoriamente entre la población general, y en el otro los controles hospitalarios fueron incluidos de manera consecutiva entre los individuos que acudían al hospital por intervenciones quirúrgicas banales no relacionadas con el consumo de tabaco. Las diferencias fueron analizadas mediante regresión logística. La variable dependiente fue el tipo de control (hospitalario o poblacional). Resultados: Los controles hospitalarios y los poblacionales tenían un hábito tabáquico similar, pero los controles hospitalarios consumían más alcohol. Para los que consumían más de 50 ml al día, el riesgo de ser un control hospitalario fue de 4,83 (intervalo de confianza del 95%: 2,55-9,14). Conclusiones: Podría haber algunas diferencias entre los controles poblacionales y los hospitalarios que deberían tenerse en cuenta cuando se diseñe un estudio de casos y controles. Es necesario saber si esas diferencias son similares en otras áreas geográficas y si podrían afectar a la estimación de las medidas de efecto entre exposición y enfermedad.

Fundamento y objetivo: Las infecciones asociadas a la asistencia sanitaria suponen una parte sustancial de los efectos adversos que los pacientes sufren durante la atención médica. Las bacteremias asociadas a catéter vascular central (CVC) suponen una causa importante de estas infecciones. Los objetivos fueron determinar la tasa de incidencia de bacteremia asociada a CVC en unidades de cuidados intensivos y la identificación de los principales factores de riesgo involucrados en el desarrollo de bacteremia asociada a CVC. Sujetos y métodos: El estudio se llevó a cabo en 2 hospitales de Galicia (España) y se realizó un estudio de cohorte o incidencia y posteriormente, anidado en este, un subestudio de casos y controles. Se incluyeron a pacientes atendidos en unidades de cuidados intensivos de 2 hospitales (hospital A y hospital B) durante un período de 2 meses, de los años 2009, 2010 y 2011. Se calcularon las tasas de incidencia y los factores de riesgo asociados al desarrollo de bacteremia asociada a CVC. Resultados: Las tasas de incidencia encontradas fueron 3,21; 2,91 y 5,76 bacteremias por 1.000 días en riesgo para el hospital A para los años 2009, 2010 y 2011 respectivamente. Estas tasas fueron de 2,10; 0 y 4,74 bacteremias por 1.000 días en riesgo para el hospital B para los mismos años. Se identificaron como factores de riesgo, el estado de coma (OR = 3,72; IC95% 1,06-13,02) y el número de catéteres (OR = 1,90; IC95% 1,21-2,97). Conclusiones: Se observan tasas superiores al estándar recomendado en la mayoría de los períodos de estudio. Se debe prestar especial atención a los pacientes en coma y con varios catéteres, al presentar estos un riesgo mayor de desarrollo de bacteremias asociadas a CVC.

Case-control studies show an association between residential radon and lung cancer. The aim of this paper is to investigate this association through a cohort study. We designed an ambispective cohort study using the Galician radon map, Spain, with controls drawn from a previous case-control study. Subjects were recruited between 2002 and 2009. The data were cross-checked to ascertain lung cancer incidence and then analysed using a Cox regression model. A total of 2,127 subjects participated; 24 lung cancer cases were identified; 76.6% of subjects were drawn from the radon map. The adjusted hazard ratio was 1.2 (95%CI: 0.5-2.8) for the category of subjects exposed to 50Bq/m3 or more. This risk rose when subjects from the case-control study were analyzed separately. In conclusion, we did not observe any statistically significant association between residential radon exposure and lung cancer; however, it appears that with a sample of greater median age (such as participants from the case-control study), the risk of lung cancer would have been higher.