Los nuevos tratamientos en la deshabituación tabáquica

El propósito de este artículo es recopilar las terapias clásicas de deshabituación tabáquica más importantes, incluyendo los nuevos métodos de reciente aparición, a fin de dar una idea global de todas las herramientas que están a disposición del médico para reducir la proporción de fumadores entre sus pacientes (AU)

Epidemiología y prevención del cáncer de cuello uterino

El carcinoma de cuello de útero sigue planteando en nuestros días problemas de extraordinaria importancia en el campo de la ginecología y de la medicina social. Su larga evolución, su localización anatómica y el desarrollo de la citología exfoliativa como técnica de detección han facilitado la posibilidad de llevar a cabo su detección precoz. El cribado del cáncer de cuello de útero es, junto con el del cáncer mama, una actividad de prevención secundaria recomendada en diversos países (AU)

Dietary fat intake and prostate cancer risk: a case-control study in Spain.

OBJECTIVES: Epidemiological evidence suggests that dietary factors can play a role in the etiology of prostate cancer. Results from several case-control and cohort studies on nutrient intake and prostate cancer have been unclear. The authors examined the effect of lipid intake on the risk of prostate cancer. METHODS: In order to assess associations between lipid intake and prostate cancer risk, a case-control study was conducted between May 1994 and March 1998 in the Barcelona metropolitan area, Spain. Two hundred seventeen incident cases with histologically confirmed diagnosis of prostate cancer were matched to 434 hospital and community controls by age and residence. Information about food intake was gathered by a semiquantitative food-frequency questionnaire. Unconditional logistic regression was used for the analysis. RESULTS AND CONCLUSIONS: Animal fat intake was associated with prostate cancer with an estimated OR for highest quartile of 2.0 (95% CI 1.2-3.2). Vitamin C intake was inversely associated with prostate cancer (OR = 0.6; 95% CI 0.3-0.9). The prostate cancer risk increased in proportion to alpha-linolenic acid intake. In the analysis adjusting for energy and major covariables the estimated OR for upper quartile of alpha-linolenic acid was 3.1 (95% CI 1.1-3.8). In conclusion, the association between fat intake and prostate cancer may be correlated with alpha-linolenic acid, although the specific mechanism has to be determined.

La determinación del antígeno prostático específico en la prevención del cáncer de próstata

El desconocimiento de la historia natural del cáncer de próstata, que no permite conocer de antemano la evolución del tumor, representa un serio argumento en contra del cribado poblacional del cáncer de próstata. En cambio, el cribado oportunístico, basado en la detección del antígeno prostático específico (PSA) y la realización de un tacto rectal, junto con la biopsia dirigida si procede, es una práctica extendida y ampliamente aceptada. En este artículo se revisa el estado actual de la problemática del diagnóstico precoz del cáncer de próstata y se discuten la utilidad de varias estrategias para mejorar, en términos de sensibilidad y especificidad, el rendimiento diagnóstico de la determinación del PSA (AU)

[The process of change and sex as predictors of the quitting of tobacco consumption]. / Proceso de cambio y sexo como predictores del abandono del consumo de tabaco.

BACKGROUND: Combining drug and behavioral therapy has proved useful in helping smokers quit. One of the main predictive factors for relapse is a smoker's level of motivation. This study evaluates results in a cohort of smokers in function of motivation and sex. PATIENTS AND METHODS: This prospective study enrolled 1,045 smokers examined at a specialist unit between September 1993 and September 1997. All patients gave information about smoking history and were classified in one of three levels of motivation. Abstinence was determined by CO exhaled. Twelve months later, we compared the success rates of men and women and of subjects with different levels of motivation. Variables predicting relapse were assessed using logistical regression analysis. RESULTS: Abstinence had been achieved by 24.5% of the 1,045 patients 12 months later, the rate for men being 25% and the rate for women 23.8% (p = 0.1). No smoker in the complacent phase was abstinent at 12 months. The rates were 24.3% and 32.4%, respectively, for smokers in the contemplation and action phases (p < 0.001). Only age and degree of motivation were independently related to failure to quit. CONCLUSIONS: Strategies that combine drug treatment, behavioral therapy and follow-up achieve good rates of success among patients who are motivated to quit smoking.

Low-dose intramuscular revaccination against hepatitis B.

Little research has been conducted on low booster doses in adults and only intradermal (i.d.) inoculation has been used with high rates of adverse reactions among subjects i.d. revaccinated. The present study compare a low intramuscular dose of recombinant hepatitis B vaccine with standard 20 micrograms revaccination. We studied 122 hospital workers 5 years after vaccination with recombinant hepatitis B vaccine who were randomly allocated to either the study group or control group. The study group received revaccination with 0.1 ml (2 micrograms) of recombinant hepatitis B vaccine and the control group 1.0 ml (20 micrograms). Two micrograms of i.m. vaccine was as effective as 20 micrograms i.m. in inducing antibody response and the antibody decrease after revaccination between groups was similar (P > 0.05) and independent of the initial concentration of anti-HBs after revaccination and dose (20 micrograms vs 2 micrograms). In conclusion, in subjects who had received a standard hepatitis B vaccination and had showed anti-HBs titres higher or equal than 10 mIU ml-1 after vaccination, low i.m. booster doses of vaccine give a rapid anamestic response similar to standard revaccination with less adversal reactions than low i.d. administered dose and would be an effective and less expensive alternative to revaccination against HBV of populations at high risk.

Age at first full-term pregnancy, lactation and parity and risk of breast cancer: a case-control study in Spain.

A case-control study was carried out in Spain to assess associations between parity, lactation and age at first full-term pregnancy and breast cancer. From November 1989 to February 1992, 184 incident breast cancer histologically confirmed cases were interviewed and matched by age and residence to 184 hospitalized patients and 184 community controls selected by random digit dialing. Multiple logistic regression was used to assess the independent influence of each factor on the risk of breast cancer in relation to other factors included in the model. Age at first full-term pregnancy was associated with breast cancer risk with an estimated odds ratio of 3.5 (95% CI 1.41-9.83) for women with their first birth after 30 years in comparison with those whose first birth was before age 21. Breast cancer risk decreased with increasing number of full-term pregnancies, OR 0.3 (95% CI 0.16-0.78) for women who had had more than 3 full-term pregnancies in comparison with nulliparous women. Among parous women, the estimated OR for women with more than 3 children was 0.4 (95% CI 0.13-0.81) after allowance for age at first childbirth and lactation. The estimated OR was 2.6 (95% CI 1.4-4.7) for women with a positive history of breast cancer in first-degree relatives. Breast cancer was not associated with total duration of lactation. The study indicates that parity is an independent risk factor associated to breast cancer and that the women with a late age at first full-term pregnancy constitute a high-risk group.

Risk for occupational transmission of HIV infection among health care workers. Study in a Spanish hospital.

The aim of this study was to evaluate the HIV seroconversion rate associated with different types of occupational exposures in health care workers. A longitudinal study was conducted from January 1986 to October 1992 in a teaching hospital in Spain, where HIV infection is prevalent among patients. Each health care worker was asked to complete a questionnaire regarding age, sex, staff category, lace of exposure, other exposures, type of exposure, body fluid, infected material and HIV status of source patient. These health care workers were then followed up at 6 weeks, 3 months, 6 months and 12 months with repeated test for HIV antibody. Four hundred twenty three reports of occupational exposure were analysed. Nursing was the profession with more exposures (42.8%). Ninety five percent of total exposures were percutaneous, 4% mucous membrane contacts and 1% skin contacts, 88.3% were described as blood contact and 71.8% had resulted from needlestick and suture needles. Exposures from HIV-positive patients comprised 23.2% of occupational exposures. There was a significant difference in the length of follow-up in physicians (p = 0.00009) and nurses (p = 0.00001), when we compared HIV-positive patients with patients in whom the HIV status was unknown or negative. The HIV seroconversion rate was 0.00%. We consider that the risk of acquiring HIV infection via contact with a patient is low, but not zero. Well documented cases of seroconversion have been published.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutrient intake and gastric cancer risk: a case-control study in Spain.

A case-control study of dietary factors and gastric cancer was conducted between September 1986 and March 1989 in the Barcelona metropolitan area, Spain. In all 117 cases with histologically confirmed diagnosis of gastric adenocarcinoma were matched on sex, age and possession of a telephone to 234 population controls. Of the controls 188 (80.3%) were selected by random digit telephone dialing and 46 (19.7%) by neighbourhood of residence. Information about frequency and amount of consumption of 89 alimentary items was gathered by questionnaire, and cases and controls were interviewed in their homes by trained interviewers. The gastric cancer risk decreased in proportion to vitamin C intake. In multivariate analysis adjusting for major covariables, energy and vitamin A intake, the estimated odds ratio (OR) for the upper quartile of vitamin C intake was 0.3 (95% confidence interval [CI]: 0.1-0.8). After adjustment for major covariables, calories and vitamin C intake, vitamin A did not show significant association with the gastric cancer risk. Our findings are consistent with previous case-control studies and with the hypothesis that vitamin C may inhibit the intragastric nitrosation process.

Dietary factors and gastric cancer risk. A case-control study in Spain.

BACKGROUND: Evidence supports that gastric cancer has an environmental etiology, of which diet appears to be the most important component. The authors examined the effect of diet on the risk of gastric cancer. METHODS: A case-control study of dietary factors and gastric cancer was conducted between September 1986 and March 1989 in the Barcelona metropolitan area, Spain. One hundred seventeen cases with histologically confirmed diagnosis of gastric adenocarcinoma were matched by age, gender, and whether they possessed a telephone to 234 community controls. One hundred eighty-eight (80.3%) controls were selected by random-digit telephone dialing and 46 (19.7%) by neighborhood of residence. Information about frequency and amount of consumption of 89 food items in one year was gathered by using a questionnaire, and cases and controls were interviewed in their homes by trained interviewers. Unconditional logistic regression was used for the analysis. RESULTS: Gastric cancer risk rose with increasing intake of smoked and pickled foods (OR 3.67 for upper tertile) and salt (OR 2.11 for upper quartile). Intake of citrus fruits (OR 0.47 for upper tertile) and raw-green vegetables (OR 0.56 for upper quartile) appeared to be protective. Gastric cancer risk was not associated with intake of cereals, rice, total vegetables, and fruits as a whole. CONCLUSIONS: These data suggest that high intake of salt and smoked and pickled food may be associated with a high risk of gastric cancer, and this association could be due to intragastric formation of nitrosamines. The negative association with citric and green vegetables consumption to be associated with the inhibition of nitrosation process.