Residential Radon, Smoking and Lung Cancer Risk. A Case-Control Study in a Radon Prone Area

Background. Residential radon is the second risk factor of lung cancer following tobacco consumption and the main one in never smokers, according to the WHO and USEPA statements. The joint effect of tobacco and radon exposure has been little studied and residential radon is a neglected risk factor of this disease. We aim to show lung cancer risk for different combinations of tobacco consumption and residential radon exposure on the risk of lung cancer. Method. Pooling case-control study in a radon-prone area where we have combined individual information from 5 different multicentric case-control studies. 11 Spanish hospitals from 4 different regions have taken part. All case-control studies had a similar methodology, including incident, primary, and histologically confirmed lung cancer cases and controls attending hospital for trivial surgery not related with tobacco consumption. Cases and controls were older than 30 and controls were matched with cases using a frequency-based sampling using age and gender distribution of cases. Detailed information was obtained regarding tobacco consumption, and a radon device was placed in the participants? dwelling for at least three months. We calculated lung cancer risk for each category of tobacco consumption and radon exposure taking as a reference those participants never smokers and with an indoor radon concentration below 50 Bq/m3. All Odds Ratios are accompanied by their 95% confidence intervals. Result. We included 1691 cases and 1698 controls with a similar distribution on age and gender. Heavy smokers exposed to low radon concentrations (< 50Bq/m3) posed a risk of lung cancer of 12.6, compared to 31.3 for heavy smokers exposed to indoor radon higher than 200 Bq/m3. The different odds ratios and confidence intervals for each category of exposure appear in the Table. Conclusion. There is an interaction between indoor radon and tobacco. Risk of lung cancer increases significantly when both risk factors are present

Discordance of physician clinical judgment vs. pneumonia severity index (PSI) score to admit patients with low risk community-acquired pneumonia: a prospective multicenter study.

The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP. An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain. Patients admitted with CAP and a PSI ≤2 were identified. Admitting physicians completed a patient-specific survey to identify the clinical factors influencing the decision to admit a patient. The reason for admission was categorized into 1 of 6 categories. We also assessed whether the reason for admission was associated with poorer clinical outcomes [intensive care unit (ICU) admission, 30-day mortality or readmission]. One hundred and fifty-five hospitalized patients were enrolled. Two or more reasons for admission were seen in 94 patients (60.6%), including abnormal clinical test results (60%), signs of clinical deterioration (43.2%), comorbid conditions (28.4%), psychosocial factors (28.4%), suspected H1N1 pneumonia (20.6%), and recent visit to the emergency department (ED) in the past 2 weeks (7.7%). Signs of clinical deterioration and abnormal clinical test results were associated with poorer clinical outcomes (P<0.005). Low-risk patients with CAP and a PSI ≤2 are admitted to the hospital for multiple reasons. Abnormal clinical test results and signs of clinical deterioration are two specific reasons for admission that are associated with poorer clinical outcomes in low risk CAP patients