Obesidad infantojuvenil. Un terreno abonado para la confusión / Childhood and adolescent obesity. A matter of confusion

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Tabaco y corazón. Programas actuales del control del hábito / Smoking and the heart. Current smoking cessation programs

El consumo de tabaco es la principal causa aislada de morbilidad y de mortalidad prematuras prevenibles en países desarrollados. Este consumo se ha asociado con un importante aumento del riesgo de infarto por tres mecanismos principales: 1) la formación de carboxihemoglobina, el aumento del hematocrito y de la viscosidad sanguínea que produce el monóxido de carbono; 2) la acción de la nicotina que produce liberación de adrenalina y noradrenalina, y 3) la absorción de gran cantidad de los radicales libres, implicados en gran cantidad de mecanismos protrombóticos y aterogénicos. Por esto, la lucha agresiva contra el tabaco ha demostrado un efecto prácticamente inmediato sobre la salud de la población. Afortunadamente contamos con un amplio abanico de intervenciones eficaces para el abandono del consumo del tabaco, que puede incrementar la posibilidad de éxito hasta un 30%: el consejo mínimo o intervención breve, el tratamiento psicológico y el tratamiento farmacológico (AU)

Smoking is the main isolated cause of preventable premature morbidity and mortality in developed countries. Smoking has been associated with a substantial rise in the risk of infarction through three main mechanisms: 1) the formation of carboxyhemoglobin and increase in hematocrit and blood viscosity, which produce carbon monoxide; 2) the action of nicotine, which releases adrenaline and noradrenaline, and 3) the absorption of a large amount of free radicals, which are involved in many prothrombotic and atherogenic mechanisms. Therefore, the offensive against smoking has produced an almost immediate effect on the population's health. Fortunately, there is a wide spectrum of effective interventions for smoking cessation, which can increase the possibility of success by up to 30%: minimal advice or brief intervention, psychological treatment and drug therapy (AU)

[Consensus on health assistance for smoking control in Spain]. / Consenso sobre la atención sanitaria del tabaquismo en España.

The Consensus on Health Assistance for Smoking Cessation in Spain, is a document reviewing the treatment evidence, as well as policy needs in relation to smoking cessation in Spain. It has been developed by technical representatives of public health administrations, at a national and autonomous level, together with representatives of the scientific societies and professional bodies which are members of the Spanish coalition on smoking prevention National Committee on Tobacco Prevention (CNPT). After approval of a new national tobacco control law 28/2005, several tobacco control policies are being developed, especially by the autonomous governments, including treatment policies. Within this framework, and as part of the requirements of the law, all parties have considered the need to review effectiveness, experimentally validated tobacco dependence treatments and practices. An initial draft written by an expert committee was presented to all parties and discussed at three meetings over a period of a year and a half. The initial draft did review primary and secondary scientific literature from 1987 to 2007 on efficacy and effectiveness of different smoking cessation interventions, including: medical advice and brief smoking cessation interventions; pharmacological aids for treating nicotine dependence; behavioral interventions; specialized intensive treatment; community interventions; and treatment for groups with special needs. Considering the available evidence; current treatment needs; policy gaps; and the criteria of risk, accessibility, efficiency, sustainability and equity; the consensus document recommends the minimal requirements which should be taken into account when developing a policy on smoking cessation in Spain.

Consenso sobre la Atención Sanitaria del tabaquismo en España / Consensus on Health Assistance for Smoking Control in Spain

Tras la aprobación de la Ley 28/2005, de medidas sanitarias frente al tabaquismo y reguladora de la venta, el suministro, el consumo y la publicidad de los productos del tabaco, se están produciendo diversos desarrollos y progresos en el campo del tratamiento del tabaquismo en todas las Comunidades Autónomas. Por este motivo y por los propios requerimientos de la Ley, tanto las administraciones públicas como las sociedades científicas integradas en el Comité Nacional de Prevención del Tabaquismo CNPT, han considerado que nuestro país se halla en una posición óptima para revisar los avances conseguidos hasta el momento y señalar las bases de carácter técnico que, de acuerdo a la evidencia y los recursos disponibles, sería conveniente que pudieran orientar las actuaciones de asistencia a las personas que fuman en el Marco del Sistema Nacional de Salud. La finalidad de este documento, de carácter exclusivamente técnico y científico, ha sido consensuar una propuesta básica de calidad sobre asistencia en tabaquismo que sirva como guía orientativa en nuestro país. Los objetivos de este documento son analizar las necesidades a las que responde una estrategia asistencial en tabaquismo, revisar la eficacia de las opciones asistenciales existentes en tabaquismo, sintetizar la evidencia disponible sobre el impacto de las políticas asistenciales en la disminución del porcentaje de personas fumadoras y señalar las necesidades existentes en este sector. El documento señala los mínimos básicos para orientar las actuaciones asistenciales de calidad en España, teniendo en cuenta criterios de riesgo sanitario, accesibilidad, eficiencia, sostenibilidad y equidad (AU)

The Consensus on Health Assistance for Smoking Cessation in Spain, is a document reviewing the treatment evidence, as well as policy needs in relation to smoking cessation in Spain. It has been developed by technical representatives of public health administrations, at a national and autonomous level, together with representatives of the scientific societies and professional bodies which are members of the Spanish coalition on smoking prevention National Committee on Tobacco Prevention (CNPT). After approval of a new national tobacco control law 28/2005, several tobacco control policies are being developed, especially by the autonomous governments, including treatment policies. Within this framework, and as part of the requirements of the law, all parties have considered the need to review effectiveness, experimentally validated tobacco dependence treatments and practices. An initial draft written by an expert committee was presented to all parties and discussed at three meetings over a period of a year and a half. The initial draft did review primary and secondary scientific literature from 1987 to 2007 on efficacy and effectiveness of different smoking cessation interventions, including: medical advice and brief smoking cessation interventions; pharmacological aids for treating nicotine dependence; behavioral interventions; specialized intensive treatment; community interventions; and treatment for groups with special needs. Considering the available evidence; current treatment needs; policy gaps; and the criteria of risk, accessibility, efficiency, sustainability and equity; the consensus document recommends the minimal requirements which should be taken into account when developing a policy on smoking cessation in Spain (AU)

Disfunción eréctil como marcador de vasculopatía en la diabetes mellitus tipo 2 en España. Estudio DIVA / Erectile dysfunction as a marker of silent cardiovascular disease in type-2 diabetic patients in Spain. The DIVA (Diabetes and Vascular disease) study

Fundamento y objetivo: la disfunción eréctil (DE) es un signo de enfermedad vascular en los sujetos con diabetes mellitus tipo 2 (DM2). El objetivo principal del estudio DIVA (por las letras iniciales de diabetes y vasculopatía) fue estimar la prevalencia de vasculopatía clínica y asintomática, así como la prevalencia de factores de riesgo en los sujetos diabéticos atendidos por especialistas en España; en él se analizó la relación de los datos citados con la prevalencia de DE. Pacientes y método: registro transversal compuesto por 2.444 sujetos consecutivos (56% varones con una edad media de 65,2 años) diagnosticados de DM2, atendidos en consulta por 387 cardiólogos y endocrinólogos. Resultados: el 37% de los sujetos presentaba cardiopatía isquémica, el 12% presentaba enfermedad cerebrovascular (ECRV) y el 13% presentaba arteriopatía periférica. El 40% de los varones tenía DE (según criterios del Índice internacional de la función eréctil), aunque en comparación con los grupos que no presentaban DE, en este grupo la enfermedad cardiovascular era significativamente más prevalente, así como los signos de vasculopatía subclínica (albuminuria e índice tobillo-brazo [ITB] anormal). El único factor predictor de DE independiente de otras variables de confusión fue la hipertrofia ventricular izquierda (riesgo relativo [RR] de 5,2; intervalo de confianza [IC] del 95%: 1,1¿24,1; p=0,03); el ITB fue menor que 0,9 de significación limítrofe (RR de 5,9; IC de 95%: 0,9¿39,9; p=0,06). El mal control glucémico y lipídico (p<0,05 en ambos casos) así como la presencia de ECRV, de enfermedad arterial periférica (p<0,01 en ambos casos) y de disfunción renal (p<0,001) eran más prevalentes en sujetos con DE grave. Conclusiones: el 40% de los varones diabéticos presenta DE. Los resultados de este estudio demuestran que la DE puede considerarse como marcador de aterosclerosis e incluirse en los algoritmos de estratificación de riesgo y detección de vasculopatía asintomática (AU)

Background and objectives: Erectile dysfunction(ED) is a sign of vascular disease in type 2 diabetic patients. The presents ubanalys is of the DIVA Registry, whos emain objective wast o estimate the prevalence of clinical vascular disorder and silent vascular disorder, as well as risk factors in type2diabetic patients treated in Spain, aims to analyze the relationship between those data and the prevalence of ED in these patients. Patients and Methods: A total of 2444 type 2 diabetic patients (56%male; meanage 65.2 years) attended by 387 cardiologists and endocrinologists at ambulatory care were included. Results: Coronary heart disease was present in 37%of the patients, cerebrovascular disease in12%,and peripheral arterial disease in 13%. Forty percent of male patients had ED (according to the IIEF criteria),although in this group, as compared to those patients without ED, the prevalence of cardiovascular disease and signs of subclinical vascular disorder (microalbuminuria and abnormalankle/brachialindex (ABI)) was higher. The only independent predictor of ED was left ventricular hypertrophy (OR5.2;95%CI: 1.1–24.1; P ¼ .03), with the ABI o0,9 being of border line significance (OR5.9;95%CI:0.9–39.9;P ¼ .06).Poor glycemic and lipemic control (Po.05 in both cases)as well as cerebrovascular and peripheral arterial disease (Po.01inbothcases) and renaldys function (Po.001)were all more frequent among patients with severe ED. Conclusions: Forty percent of diabetic patients suffer from ED. The results of this study suggest that EDmay be considered as an at hero sclerosis marker and could be included in algorithms for risk stratification and subclinical vascular disorder detection (AU)

Lentos avances en el control del tabaquismo involuntario / No disponible

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[Spain's process of passing effective smoking prevention legislation]. / El proceso en españa de la adopción de una legislación eficaz para la prevención del tabaquismo.

The prevention movement has been the key agent involved in smoking control policies. This study describes the context and the process in which Law 28/2005 was passed in Spain with a synthesis of its substance. It provides the background of the events leading up to Spain's current smoking control law in addition to an analysis of the role played by the different social actors in the process and the arguments and strategies employed in opposition by the tobacco industry. A review is also provided of the political agents, highlighting that decentralized countries have further problems in enforcing regulations. This case offers lessons for the future.

El proceso en España de la adopción de una legislación eficaz para la prevención del tabaquismo / Spain's process of passing effective smoking prevention legislation

El movimiento de prevención ha sido el agente clave para laadopción de políticas de prevención y control del tabaquismo y parapromover una legislación eficaz. En este trabajo se describen el contextoy el proceso en el que se ha desarrollado en España la aprobaciónde la Ley 28/2005 y se sintetizan sus contenidos. Se resumen losantecedentes de la política española de control del tabaquismo, seanaliza el papel que han jugado los distintos actores sociales en elproceso de aprobación de la Ley, así como los argumentos y estrategiasutilizados en contra por la industria tabacalera. Se revisan losobstáculos políticos y se señala que los países descentralizados presentanproblemas añadidos para el cumplimiento de las regulaciones.Este caso permite extraer algunas lecciones para el futuro(AU)

The prevention movement has been the key agent involved insmoking control policies. This study describes the context and theprocess in which Law 28/2005 was passed in Spain with a synthesisof its substance. It provides the background of the events leading upto Spain's current smoking control law in addition to an analysis ofthe role played by the different social actors in the process and thearguments and strategies employed in opposition by the tobaccoindustry. A review is also provided of the political agents, highlightingthat decentralized countries have further problems in enforcingregulations. This case offers lessons for the future(AU)

[Diabetes mellitus in cardiology practice in Spain. Survey by the Working Group on Heart and Diabetes regarding the importance of diabetes mellitus in relation with other cardiovascular diseases]. / La diabetes mellitus en la práctica de la cardiología en España. Encuesta del Groupo de Trabajo de Corazón y Diabetes sobre la importancia de la diabetes mellitus en relación con las enfermedades cardiovasculares.

INTRODUCTION AND OBJECTIVES: Diabetes mellitus has been defined as a cardiovascular disease of metabolic origin. This article reports the results of a survey of cardiologists regarding their knowledge about this disease and their management of patients with diabetes in daily practice. METHODS: A survey was mailed to all 1840 cardiologists who were members of the Spanish Society of Cardiology, and responses were returned by 348 (18.9%). The survey consisted of 16 questions dealing with organizational and practical aspects of cardiological management for patients with diabetes. RESULTS: The creation of a Working Group on the Heart and Diabetes was judged necessary by 90.2% of the responders. Almost two thirds of the members felt their knowledge of diabetes and its treatment was inadequate, and 82.5% declared that cardiologists should be better able to treat patients with diabetes, since between 15% and 30% of the patients they see have this disease. With respect to secondary prevention, 65.8% of the cardiologists felt that medical care is much better for coronary patients than for patients with diabetes. Among the latter, angiotensin-inhibiting drugs, statins and aspirin are used for secondary prevention. CONCLUSIONS: Because of gaps in the cardiologist's knowledge of how to manage diabetes, the high prevalence of diabetes and its unquestionable impact on the cardiovascular system additional clinical training and educational efforts are needed. One potentially useful measure is the creation of a specific Working Group on the Heart and Diabetes.

Tabaco y enfermedad cardiovascular / Smoking and cardiovascular disease

El tabaco es actualmente el responsable de cerca de 5 millones de muertes cada año en el mundo, y una parte importante de esta mortandad es debida al incremento en las enfermedades cardiovasculares. Actúa de forma sinérgica con otros factores de riesgo, de forma que los fumadores con hipertensión e hipercolesteremia pueden multiplicar su mortalidad cardiovascular por 20. Los fumadores que dejan el tabaco disminuyen rápidamente su riesgo cardiovascular, de forma que a los 2-3 años tienen un riesgo superponible al de los no fumadores. El mecanismo de acción del tabaco sobre el sistema cardiovascular es complejo, alterando las condiciones hemodinámicas, y produciendo disfunción endotelial, alteraciones protrombóticas y aterogénicas, empeoramiento del perfil lipídico y del metabolismo hidrocarbonado, y circulación de numerosos factores proinflamatorios. No hay ninguna forma segura de consumir tabaco, especialmente en las formas inhaladas. La actual lucha de las administraciones de los países desarrollados está desplazando el consumo de tabaco a los países en vías de desarrollo y a los segmentos de población más vulnerables, como los jóvenes o las personas de clase social baja (AU)

Tobacco is currently responsible for the death of about 5 million people worldwide each year, being the increase in cardiovascular diseases a substantial part of these deaths. It acts synergistically with other risk factors, so that smokers with hypertension and hypercholesterolemia can have a 20-fold increase in their cardiovascular mortality. Smokers that quit tobacco have a quick decrease in their cardiovascular risk quickly, so that by 2-3 years they have a risk similar to that of the non smokers. The mechanism of action of tobacco on the cardiovascular system is complex, producing hemodynamic changes, endothelial dysfunction, thrombogenic and atherogenic alterations, worsening of the lipid profile and of the glucose metabolism, and increasing many circulating pro-inflammatory factors. There is no way of consuming tobacco without risk, especially in the inhaled forms. The current fight of the administrations of developed countries is displacing the consumption of tobacco to the developing countries and to the most vulnerable population segments, as young people or low social class (AU)

[Inflammation markers and risk stratification in patients with acute coronary syndromes: design of the SIESTA Study (Systemic Inflammation Evaluation in Patients with non-ST segment elevation Acute coronary syndromes)]. / Marcadores de inflamación y estratificación de riesgo en pacientes con síndorome coronario agudo: diseño del estudio SIESTA (Systemic Inflammation Evaluation in patients with non-ST segment elevaton Acute coronary syndromes).

BACKGROUND AND OBJECTIVE: Evidence is growing regarding the prognostic value of markers of inflammation in unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). However, the independent value of these variables has not been systematically investigated in prospective studies. The main objective of the SIESTA study is to assess the relative prognostic roles of C-reactive protein, fibrinogen, neopterin, interleukins 6, 8, 10 and 18, tumor necrosis factor, e-selectin, endothelin 1, tissue factor, VCAM-1, ICAM-1, pregnancy-associated plasma protein-A, B-type natriuretic peptide, leukocytes, troponin I or T and serum creatine kinase-MB (CKMB) in UA/NSTEMI patients. PATIENTS AND METHOD: SIESTA is a prospective, multicenter trial involving patients with chest pain suggestive of acute coronary syndrome (ACS) within 48 hours of enrolment and at least one of the following: abnormal troponin levels, electrocardiographic signs of ischaemia or previously documented vascular disease. Clinical outcome data and serial biochemical determinations will be assessed during hospital admission and at 30, 180 and 365 days of follow-up. The TIMI (Thrombolysis In Myocardial Infarction) and PEPA (Proyecto de Estudio del Pronóstico de la Angina) risk scores will be also validated. Study variables will include death due to any cause, cardiac death, non-fatal myocardial infarction, unstable angina requiring re-admission, emergency revascularization and a composite of death, myocardial infarction and need for emergency hospitalization or myocardial revascularization. Each of these conditions will be treated as secondary end-points when assessed individually. This study will provide valuable prospective information about the prognostic value of inflammatory markers in real life ACS patients of Mediterranean origin.

Tabaquismo: tiempo de actuar / Smoking: Time to Work

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