Nonoperative management of pectus carinatum with orthotic bracing

En portada aparecen los logos de la Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del SNS y del Ministerio de Sanidad, Servicios Sociales e Igualda

Irreversible electroporation for the treatment of liver and pancreatic cancer

A electroporación irreversible (IRE) preséntase como unha técnica ablativa non térmica que podería destruír, a través de pulsos eléctricos, células canceríxenas e evitar o dano en estruturas próximas, como vasos, nervios ou os condutos biliares. Proponse como unha alternativa para pacientes con tumores sólidos avanzados de páncreas ou fígado que non son candidatos para cirurxía ou outras técnicas ablativas. Os resultados do informe poñen de manifesto que a evidencia actual é inadecuada para establecer se a IRE é máis efectiva que a terapia de referencia convencional. Ademais, non se pode descartar a aparición de complicacións graves relacionadas co quecemento, o que non permite desestimar totalmente o efecto térmico durante o seu uso.La electroporación irreversible (IRE) se presenta como una técnica ablativa no térmica que podría destruir, a través de pulsos eléctricos, células cancerígenas y evitar el daño en estructuras próximas, como vasos, nervios o los conductos biliares. Se propone cómo una alternativa para pacientes con tumores sólidos avanzados de páncreas o hígado que no son candidatos para cirugía u otras técnicas ablativas. Los resultados del informe ponen de manifiesto que la evidencia actual es inadecuada para establecer si la IRE es más efectiva que la terapia de referencia convencional. Además, no se puede descartar la aparición de complicaciones graves relacionadas con el calentamiento, lo que no permite desestimar totalmente el efecto térmico durante su uso

Residential Radon in Manizales, Colombia: Results of a Pilot Study

Radon is a colorless, odorless, and tasteless noble gas, causally related with the onset of lung cancer. We aimed to describe the distribution of radon exposure in the municipality of Manizales, Colombia, in order to estimate the population’s exposure and establish the percentage of dwellings that surpass reference levels. A cross-sectional study representing all geographical areas was carried out by measuring indoor radon concentrations. Participants answered a short questionnaire. Alpha-track type radon detectors were installed in all residences for six months. The detectors were subsequently processed at the Galician Radon Laboratory, an accredited laboratory at the University of Santiago de Compostela. A total of 202 homes were measured. Seventy-seven percent of the sampled houses were three stories high, their median age was 30 years, and half were inhabited by three people or fewer. For most dwellings, the building materials of walls and flooring were brick and covered cement, respectively. Results showed a geometric mean of radon concentration of 8.5 Bq/m3 and a maximum value of 50 Bq/m3. No statistically significant differences were found either between the geometric mean of the dwelling’s site, the height at which detectors were placed inside the home, or the wall and flooring materials, or between mean 222Rn concentrations in rural and urban areas. No dwelling surpassed the 222Rn reference level established by the WHO. This study shows that residential radon levels in Manizales, Colombia, seem to be low, though a more in-depth approach should be carried out. Despite these results, it is essential to create a national radon program and establish a radon concentration reference level for Colombia in line with international recommendationsThis study was funded by the Galician Radon Laboratory from the University of Santiago de Compostela (School of Medicine) and by the Institute of Health Research and Vicerrectorate of Research and post-graduate studies REF 0340220) of the University of Caldas (Manizales, Colombia)S

Serum cotinine cut-points for secondhand smoke exposure assessment in children under 5 years: A systemic review

Background Serum cotinine has become the most widely used biomarker of secondhand smoke exposure (SHS) over time in all ages. The aim of this study was to review the serum cotinine cutpoints used to classify children under 5 years as exposed to SHS. Methods A systematic review performed in the Pubmed (MEDLINE) and EMBASE databases up to April 2021 was conducted using as key words serum cotinine, tobacco smoke pollution (MeSH), secondhand smoke, environmental tobacco smoke and tobacco smoke exposure. Papers which assessed SHS exposure among children younger than 5 years old were included. The PRISMA 2020 guidelines were followed. Analysis was pre-registered in PROSPERO (registration number: CRD42021251263). Results 247 articles were identified and 51 fulfilled inclusion criteria. The selected studies were published between 1985-2020. Most of them included adolescents and adults. Only three assessed postnatal exposure exclusively among children under 5 years. None of the selected studies proposed age-specific cut-points for children < 5 years old. Cut-point values to assess SHS exposure ranged from 0.015 to 100 ng/ml. The most commonly used cut-point was 0.05 ng/ml, derived from the assay limit of detection used by the National Health and Nutrition Examination Survey (NHANES). Conclusions No studies have calculated serum cotinine age-specific cut-points to ascertained SHS exposure among children under 5 years old. Children's age-specific cut-points are warranted for health research and public health purposes aimed at accurately estimating the prevalence of SHS exposure and attributable burden of disease to such exposure, and at reinforcing 100% smoke-free policies worldwide, both in homes, private vehicles and public places

Quantifying indoor radon levels and determinants in schools: a case study in the radon-prone area Galicia–Norte de Portugal Euroregion

Radon is a carcinogenic compound, and is particularly concerning in the education sector, where children and teachers may be exposed even longer than at home. Thus, this study intended to characterise radon in the indoor air of scholar environments in different provinces/districts of the Euroregion Galicia–Norte de Portugal. With a pioneering approach, this study evaluated the influence of specific factors/characteristics (location, type of management, construction material, season and floor within the building) and quantified their relative contribution to indoor radon levels. Radon was continuously monitored in 416 classrooms from school buildings located in urban and rural sites from different provinces/districts both in the regions of Galicia (A Coruña and Lugo provinces) and Portugal (Porto and Bragança districts), considering rooms for different age groups (from nursery schools to universities). Single and multivariate linear regression models were built considering the radon concentrations as the outcome variable and different room/building characteristics as predictor variables. Mean and median radon concentrations were 332 Bq·m−3 and 181 Bq·m−3, respectively. The radon concentrations observed are a public health concern, as almost 1/3 of the places monitored exceeded the reference limit value of the European legislation (300 Bq·m−3). Moreover, around 50 % of the indoor levels measured could be attributed to room/building characteristics: the building's location and the main construction material, as well as the occupants' age group, the floor within the building and the school's type of management (public/private). This study concluded that radon testing is needed in all school buildings and classrooms without exceptions. Thus, public administrations are urged to dedicate funds for testing, mitigation and public dissemination initiatives in schools. A special protocol for radon sampling in school buildings should also be developedThis work was financially supported by: LA/P/0045/2020 (ALiCE) and –(LEPABE) funded by national funds through FCT/MCTES (PIDDAC); competitive scholarship from Fundación Prevent (Beca I + D en PRL). PTBS Branco thanks the Portuguese Foundation for Science and Technology (FCT) for the financial support of his work contract through the Scientific Employment Stimulus – Individual Call – 2022.05461.CEECIND. The funding sources did not have any involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; nor in the decision to submit the article for publicationS

Estimations of smoking-attributable mortality in Spain at a regional level: comparison of two methods

Purpose: To estimate and discuss smoking-attributable mortality (SAM) for the 17 regions in Spain among the population aged ≥35 years in 2017, using two methods. Methods: A descriptive analysis of SAM was conducted using two methods, the prevalence-independent method (PIM) and the prevalence-dependent method (PDM). Observed mortality was obtained from the National Institute of Statistics; smoking prevalence from three National Health Surveys; lung cancer mortality rates from the Cancer Prevention Study-II; and relative risks from five US cohorts. SAM and percentages of change were estimated for each region overall, by sex, age and cause of death. Results: In 2017, tobacco caused 56,203 deaths in Spain applying the PIM. Using the PDM the number of deaths was 4.4% (95% CI: 3.4-5.5) lower (53,825 deaths). Except in four regions, the PIM estimated a higher overall SAM and the maximum percentage of change was 18.6%. Overall percentages of change were higher for women (15.7% 95% CI: 12.6-19.0) and for cardiovascular diseases-diabetes mellitus (13.8%; 95% CI: 11.5-16.2). Conclusions: At the national level, both methods estimate similar figures for SAM. However, the difference in estimates appears at the subnational level. Differences were higher in subgroups with lower smoking prevalence and for causes of death with periods of induction shorter than those for lung cancer.This paper forms part of the research conducting to the PhD degree of Julia Rey-Brandariz, who has received a FPU fellowship (reference number FPU20/00926), from the Ministry of Universities of Spain. This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project “PI19/00288″ and co-funded by the European Union.S

Lung cancer mortality attributable to residential radon exposure in Spain and its regions

Lung cancer has the highest cancer mortality rate in developed countries. The principal risk factor for lung cancer is tobacco use, with residential radon being the leading risk factor among never smokers and the second among ever smokers. We sought to estimate mortality attributable to residential radon exposure in Spain and its Autonomous Regions, with correction for dwelling height and differentiation by tobacco use. We applied a prevalence-based method for estimating attributable mortality. For estimations, we considered exposure to radon in the different Autonomous Regions corrected for dwelling height, using the National Statistics Institute Housing Census and prevalence of tobacco use (never smokers, smokers and ex-smokers). The results showed that 3.8% (838 deaths) of lung cancer mortality was attributable to radon exposure of over 100 Bq/m3, a figure that rises to 6.9% (1,533 deaths) when correction for dwelling height is not performed. By Autonomous Region, the highest population attributable fractions, corrected for dwelling height, were obtained for Galicia, Extremadura, and the Canary Islands, where 7.0, 6.9, and 5.5% of lung cancer mortality was respectively attributable to radon exposure. The greatest part of the attributable mortality occurred in men and among smokers and ex-smokers. Residential radon exposure is a major contributor to lung cancer mortality, though this contribution is highly variable among the different territories, indicating the need for targeted prevention policies. Correction of estimates for dwelling height is fundamental for providing reliable estimates of radon-attributable mortalityCarlos III Institute of Health (Instituto de Salud Carlos III) Project FIS PI19/00288S

Trends in smoking-attributable mortality in Spain: 1990-2018

Background: This study sought to analyse the trend in smoking-attributable mortality (SAM) in Spain among the population aged ≥35 years across the period 1990-2018. Methods: SAM was estimated by applying a prevalence-independent method, which uses lung cancer (LC) mortality as a proxy of tobacco consumption. We sourced observed mortality from the National Institute of Statistics (Spain), LC mortality rates in smokers and never smokers from the Cancer Prevention Study I-II, and relative risks from 5 US cohorts. Estimates of annual SAM by cause of death, sex and age are shown, along with crude and annual standardised SAM rates. The trend in standardised all-cause and LC rates was analysed using a joinpoint regression model. Results: Tobacco caused 1 717 150 deaths in Spain in the period 1990-2018. Among men, cancers replaced cardiovascular diseases-diabetes mellitus (CVD-DM) as the leading group of tobacco-related cause of death in 1994. Among women, CVD-DM remained the leading cause of death throughout the period. Trend analysis of standardised SAM rates due to all causes and LC showed a decrease in men and an increase in women. Conclusions: The tobacco epidemic in Spain across the period 1990-2018 has had an important impact on mortality and has evolved differently in both genders. SAM is expected to increase dramatically in women in the coming years. SAM data highlight the importance of including a gender perspective in SAM analyses, in designing more effective and comprehensive public health interventions and in developing gender-specific tobacco control policies to curb tobacco consumption.This article forms part of the research conducting to the PhD degree of Julia Rey-Brandariz, who has received a FPU fellowship (reference number FPU20/00926), from the Ministry of Universities of Spain.S

Residential radon and characteristics of chronic obstructive pulmonary disease

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 COPDSpanish Society of Pneumology & Thoracic Surgery (Sociedad Española de Neumología y Cirugía Torácica—SEPAR), competitive Project Number 439, call 2018S