Actitud y conocimiento de los médicos de atención primaria, emergencias y urgencias en España sobre la donación y el trasplante de órganos y tejidos / Attitudes and knowledge on organ and tissue procurement and transplantation of emergency and primary care doctors in Spain

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Exposición al humo de tabaco y concentración de cotinina en la saliva en una muestra de escolares de Barcelona / Exposure to environmental tobacco smoke and salivary cotinine concentration in a sample of students from Barcelona, Spain

Fundamento y objetivo: El objetivo de este estudio es determinar la exposición al humo ambiental de tabaco (HAT) mediante la concentración de cotinina en saliva en una muestra de escolares y su relación con el consumo activo y pasivo de tabaco. Sujetos y método: Encuesta transversal realizada a 92 estudiantes de secundaria y bachillerato (intervalo de edad de 16 a 20 años). Se determinó la concentración de cotinina en una muestra de saliva de cada escolar, mediante cromatografía de gases con espectrometría de masas. Se calcularon las medianas y los rangos intercuartílicos (RIC) de cotinina en saliva y se aplicó el test no paramétrico de comparación de medianas. Resultados: La mediana de la concentración de cotinina en saliva en los escolares fumadores fue de 91,5ng/ml (RIC de 62,4 a 125), en los exfumadores de 7,9ng/ml (RIC de 5,1 a 15,5) y en los que nunca fumaron de 1,9ng/ml (RIC de 0 a 3,6). El valor en los fumadores de más de 10 cigarrillos diarios fue de 98,3ng/ml (RIC de 63,4 a 142,9). Para los no fumadores (los que nunca fumaron y los exfumadores), la mediana de cotinina en saliva en los que vivían con fumadores fue de 3,3ng/ml (RIC de 0 a 8,6) frente a 2,9ng/ml (RIC de 1,1 a 6,9) entre los que no vivían con fumadores. Conclusiones: La concentración de cotinina en saliva, que aumenta con el consumo de tabaco, también se relaciona con la percepción de exposición pasiva a aquel (AU)

Background and objective: The objective of this study was to assess the exposure to environmental tobacco smoke (ETS) by means of the concentration of salivary cotinine in a sample of adolescent students, and its relationship with active and passive tobacco consumption. Methods: A cross-sectional survey was conducted in 92 secondary education and high school pupils (16–20 years). Salivary samples were collected and salivary cotinine was measured by gas chromatography/mass spectrometry. Salivary cotinine medians and interquartile ranges were calculated. Significant statistical differences were detected with the non parametric test for medians. Results: The median of salivary cotinine concentration in current smokers was 91.5ng/ml (RI: 62,4–125); in former smokers 7.9ng/ml (RI: 5,1–15,5) and in never smokers 1.9ng/ml (RI: 0–3,6). In smokers of more than 10 cigarettes per day, the result was 98.3ng/ml (RI:63,4–142,9). Among non-smokers (never-smoker and ex-smokers), the median of salivary cotinine in non-smokers living with smokers was 3.3ng/ml (RI: 0–8,6) versus 2.9ng/ml (RI: 1,1–6,9) in those living with non-smokers. Conclusions: The salivary cotinine concentration increases with the intensity of tobacco consumption and the perception of passive exposure to tobacco smoke (AU)

[Exposure to environmental tobacco smoke and salivary cotinine concentration in a sample of students from Barcelona, Spain]. / Exposición al humo de tabaco y concentración de cotinina en la saliva en una muestra de escolares de Barcelona.

BACKGROUND AND OBJECTIVE: The objective of this study was to assess the exposure to environmental tobacco smoke (ETS) by means of the concentration of salivary cotinine in a sample of adolescent students, and its relationship with active and passive tobacco consumption. METHODS: A cross-sectional survey was conducted in 92 secondary education and high school pupils (16-20 years). Salivary samples were collected and salivary cotinine was measured by gas chromatography/mass spectrometry. Salivary cotinine medians and interquartile ranges were calculated. Significant statistical differences were detected with the non parametric test for medians. RESULTS: The median of salivary cotinine concentration in current smokers was 91.5 ng/ml (RI: 62.4-125); in former smokers 7.9 ng/ml (RI: 5.1-15.5) and in never smokers 1.9 ng/ml (RI: 0-3.6). In smokers of more than 10 cigarettes per day, the result was 98.3 ng/ml (RI:63.4-142.9). Among non-smokers (never-smoker and ex-smokers), the median of salivary cotinine in non-smokers living with smokers was 3.3 ng/ml (RI: 0-8.6) versus 2.9 ng/ml (RI: 1.1-6.9) in those living with non-smokers. CONCLUSIONS: The salivary cotinine concentration increases with the intensity of tobacco consumption and the perception of passive exposure to tobacco smoke.

Clinically relevant differences in the model for end-stage liver disease and model for end-stage liver disease-sodium scores determined at three university-based laboratories of the same area.

The Model for End-Stage Liver Disease (MELD) score is considered an objective and reliable measure of liver disease severity. However, the use of specific laboratory methodologies may introduce significant and clinically relevant variations into the score. It has been suggested that the incorporation of sodium into MELD (MELD-Na) can provide a more accurate survival prediction than MELD alone. Before implementing organ allocation based on the MELD score in an area with 3 transplant centers, we studied whether there were significant variations in MELD and MELD-Na scores determined at each center. Seventy patients on the waiting list were studied simultaneously. Blood samples for each patient were divided into 3 aliquots and were processed in the 3 laboratories in order to calculate MELD and MELD-Na scores. There were statistical differences between the 3 laboratories in the MELD and MELD-Na scores and their parameters. The MELD score was identical in the 3 laboratories for only 6 of the 70 patients, and the MELD-Na score was identical for only 9. MELD and MELD-Na scores from 2 laboratories differed by 1 point or more in 54% and 47% of cases, respectively. Our study confirms that there is major variability in the MELD score, serum sodium, and MELD-Na score. These differences are clinically relevant, and in order to guarantee equitable organ allocation based on the MELD score, similar laboratory methodologies should be implemented at all centers in the same organ procurement area. Alternatively, the possibility of setting up a central laboratory in each organ procurement area should be considered.

[Secondhand smoke exposure in Spanish adult non-smokers following the introduction of an anti-smoking law]. / Exposición al humo ambiental de tabaco en población adulta no fumadora en España tras la Ley de medidas sanitarias frente al tabaquismo.

INTRODUCTION AND OBJECTIVES: The aim was to investigate the prevalence of secondhand smoke exposure and active smoking in the Spanish population following the introduction of an anti-smoking law. METHODS: This cross-sectional study involved a telephone survey (in June and July 2006) of a representative sample of the Spanish population aged at least 18 years-old (1221 men and 1301 women). The prevalence of secondhand smoke exposure among non-smokers was determined in terms of the context of exposure (i.e., at home, in the place of work or study, during leisure activities, or in transportation) and in general (i.e., in any context). In addition, the prevalence of active smoking in the general population was also determined. RESULTS: Overall, 74,3% of non-smoking men and 70.1% of non-smoking women had been exposed to secondhand smoke in one of the four defined contexts. In men, the age-standardized prevalence of exposure was 26.4% at home, 39.8% at the place of work or study, 61.1% during leisure activities, and 37.2% in transportation. In women, the prevalence of secondhand smoke exposure was 31.4% at home, 30.7% at the place of work or study, 51.9% during leisure activities, and 45.5% in transportation. Prevalence of active smoking was 26.7% of men and 21.1% of women. CONCLUSIONS: One-third of the Spanish non-smoking population are still exposed to second hand smoke in their work place or study center despite the ban introduced by the new law.

Exposición al humo ambiental de tabaco en población adulta no fumadora en España tras la Ley de medidas sanitarias frente al tabaquismo / Secondhand Smoke Exposure in Spanish Adult Non-Smokers Following the Introduction of an Anti-Smoking Law

Introducción y objetivos. Analizar las prevalencias deexposición al humo ambiental de tabaco y de consumode tabaco de la población española tras la entrada en vigor de la Ley de medidas sanitarias frente el tabaquismo.Métodos. Estudio transversal mediante encuesta telefónica(junio-julio de 2006) a una muestra representativade la población española de 18 o más años (1.221 varonesy 1.301 mujeres). Se ha calculado la prevalencia deexposición al humo ambiental de tabaco de los no fumadores según ámbito de exposición (domicilio, trabajo/centro de estudios, tiempo libre y transporte) y en general (en cualquiera de ellos). Se ha calculado la prevalencia del consumo de tabaco en la población general.Resultados. El 74,3% de los varones y el 70,1% de lasmujeres no fumadoras están expuestos al humo ambientalde tabaco en alguno de los cuatro ámbitos estudiados. Entre los varones, la prevalencia de exposición estandarizada por edad fue del 26,4% en el domicilio, el 39,8% en el trabajo/ centro de estudios, el 61,1% durante el tiempo libre y el 37,2% en los medios de transporte. Entre las mujeres, laexposición al humo ambiental de tabaco fue del 31,4% enel domicilio, el 30,7% en el trabajo/centro de estudios, el 51,9% durante el tiempo libre y el 45,5% en los medios de transporte. La prevalencia de consumo de tabaco fue del 26,7% de los varones y del 21,1% de las mujeres.Conclusiones. Una tercera parte de la población nofumadora sigue expuesta en el lugar de trabajo o centrode estudios pese a la prohibición introducida por la nueva Ley

Introduction and objectives. The aim was toinvestigate the prevalence of secondhand smokeexposure and active smoking in the Spanish populationfollowing the introduction of an anti-smoking law.Methods. This cross-sectional study involved atelephone survey (in June and July 2006) of a representative sample of the Spanish population aged atleast 18 years-old (1221 men and 1301 women). Theprevalence of secondhand smoke exposure among nonsmokerswas determined in terms of the context ofexposure (i.e., at home, in the place of work or study,during leisure activities, or in transportation) and ingeneral (i.e., in any context). In addition, the prevalence of active smoking in the general population was also determined.Results. Overall, 74,3% of non-smoking men and70.1% of non-smoking women had been exposed tosecondhand smoke in one of the four defined contexts. Inmen, the age-standardized prevalence of exposure was26.4% at home, 39.8% at the place of work or study,61.1% during leisure activities, and 37.2% intransportation. In women, the prevalence of secondhandsmoke exposure was 31.4% at home, 30.7% at the placeof work or study, 51.9% during leisure activities, and45.5% in transportation. Prevalence of active smokingwas 26.7% of men and 21.1% of women.Conclusions. One-third of the Spanish non-smokingpopulation are still exposed to second hand smoke intheir work place or study center despite the banintroduced by the new law

Correlates of exposure to second-hand smoke in an urban Mediterranean population.

BACKGROUND: To describe the socio-demographic factors associated with exposure to second-hand smoke (SHS) in different settings (home, leisure, and workplace). METHODS: We analysed cross-sectional data on self-reported SHS exposure in 1059 non-daily smokers interviewed in the Cornellà Health Interview Survey Follow-up Study in 2002. We calculated age-adjusted prevalence rates and prevalence rate ratios of SHS exposure at home, at the workplace, during leisure time, and in any of these settings. RESULTS: The age-standardized prevalence rate of SHS exposure in any setting was 69.5% in men and 62.9% in women. Among men, 25.9% reported passive smoking at home, 55.1% during leisure time, and 34.0% at the workplace. Among women, prevalence rates in these settings were 34.1%, 44.3% and 30.1%, respectively. Overall exposure to SHS decreased with age in both men and women. In men, SHS exposure was related to marital status, physical activity, smoking, and alcohol intake. In women, SHS exposure was related to educational level, marital status, occupational status, self-perceived health, smoking-related illness, and alcohol intake. CONCLUSION: The prevalence of SHS exposure in this population was high. The strongest association with exposure were found for age and occupational status in men, and age and educational level in women.

Social class, education, and smoking cessation: Long-term follow-up of patients treated at a smoking cessation unit.

Our objective was to examine social class and educational differences in long-term smoking cessation success among a cohort of smokers attending a specialized smoking clinic. We studied sustained abstinence after cessation among 1,516 smokers (895 men and 621 women) treated for smoking cessation between 1995 and 2001 at a university teaching hospital in the metropolitan area of Barcelona, Spain. We calculated 1-year and long-term (up to 8-year) abstinence probabilities by means of Kaplan-Meier curves and the hazard ratio of relapse by means of Cox regression, after adjusting for other predictors of relapse. Overall abstinence probability was .277 (95% CI = .254-.301). Men and women in social classes IV-V had significant hazard ratios of relapse after long-term follow-up (men: 1.36, 95% CI = 1.07-1.72; women: 1.60, 95% CI = 1.24-2.06), as compared with patients in social classes I-II. The same independent effect was observed for education: Men and women with primary or less than primary studies had higher hazard ratios of relapse (men: 1.75, 95% CI = 1.35-2.25; women: 1.92, 95% CI = 1.51-2.46), as compared with patients with a university degree. Similar estimates were obtained after adjustment for stage of change, Fagerström score for nicotine dependence, and type of treatment. Patients of lower socioeconomic status are at higher risk of relapse, and this association is independent of other well-known predictors of relapse. Social differences have to be taken into account in the clinical setting when tailoring specific actions to treat smoking dependence.

[Prevalence of exposure to environmental tobacco smoke in a urban population]. / Prevalencia de la exposición al humo ambiental del tabaco en un área urbana.

BACKGROUND AND OBJECTIVE: We decided to assess the overall prevalence of exposure to environmental tobacco smoke (ETS) both in general and according to the settings of exposure (home, workplace and leisure time). SUBJECTS AND METHOD: We analyzed cross-sectional data of ETS exposure in 1,059 non-smokers included in the Cornellà Health Interview Survey Follow-up (CHIS-FU) study. We calculated the crude and age-standardized prevalence of ETS exposure in general and in the different settings. RESULTS: 69.5% (confidence interval [CI] 95%, 64.5%-74.4%) of men and 62.9% (CI 95%, 58.1%-67.6%) of women of the sample studied were exposed to ETS. We observed a decreasing trend of ETS exposure by age in both sexes. The age-standardized prevalence rates of ETS exposure according to the environment and sex were: 25.9% (95% CI, 21.8%-30.1%) at home, 55.1% (95% CI, 50.8%-59.4%) during leisure time and 34.0% (95% CI, 23.5%-45.6%) in the workplace in men, and 34.1% (95% CI, 29.8%-38.5%), 44.3% (95% CI, 40.5%-48.2%) and 30.1% (95% CI, 18.9%-41.3%), respectively, in women. CONCLUSION: In this study, more than half of non-smokers were exposed to ETS.