Laryngotracheal Recurrent Papillomatosis: A Case Study and Survey of Surgical and Systemic Management.

This case report presents a 72-year-old man with longstanding recurrent respiratory papillomatosis (RRP). He has undergone multiple procedures for the condition, including an apparent urgent surgical airway followed by tracheoplasty repair. Modern management of complicated RRP should include both local debulking and systemic approaches. Systemic bevacizumab (Avastin) has shown some initial success as an effective treatment option, in addition to other medications such as pembrolizumab. Other future care strategies may include an HPV vaccination and other adjuvants; vaccination has been reported to have the possibility of drastically reducing the incidence of RRP.

[Frequency of medical consultations in the adult population in Spain, before and after the restriction of access to undocumented immigrants]. / Frecuencia de consultas al médico en población adulta en España, antes y después de la restricción de acceso a los inmigrantes indocumentados.

OBJECTIVE: To study the frequency of medical consultations in autochthonous and immigrant populations in Spain, before and after a government measure of 2012 that restricted the use of public health services to undocumented immigrants. MATERIAL AND METHODS: The data were taken from the European Health Surveys in Spain in 2009 and 2014. An analysis was made of the consultations with the family doctor and the consultations with the medical specialist in autochthonous and immigrant populations from 18 to 64 years. Percentage increases were calculated in the frequency of people who consulted in 2014 with respect to 2009, and, in each year, the percentage ratio (PR) of consultation in immigrants with respect autochthonous, with 95% confidence intervals (95% CI). RESULTS: The frequency of consultations increased in 2014 compared to 2009, with the exception of family doctor's consultation with the autochthonous women. The highest increases occurred in visits to medical specialists in immigrants (39.9%), in autochthonous (21.6%), and in visits by the family doctor to immigrant women. After adjusting for age and socioeconomic variables and indicators of need for assistance, there were no significant differences in both years between immigrants and autochthonous in the 2types of consultations. CONCLUSIONS: The frequency of consultations to the family doctor or medical specialist did not decrease in Spain between 2009 and 2014 in the immigrant population.

Assessing the influence of working hours on general health by migrant status and family structure: the case of Ecuadorian-, Colombian-, and Spanish-born workers in Spain.

OBJECTIVES: The purpose of this study was to analyze the relationship between working hours (WHs) and the likelihood of poor self-reported general health (SRGH) in the first data wave from a cohort of immigrant and native workers in Spain. STUDY DESIGN: Cross-sectional analyses from a prospective cohort study. METHODS: Data were drawn from the first wave of the Platform of Longitudinal Studies on Immigrant Families. The selected sample was composed of 217 immigrant workers and 89 native-born workers. We explored differences by immigrant status and family structure, assessing prevalences and Poisson regression models; an additional analysis explored statistically optimized work hour cut points. RESULTS: Highest prevalence of poor SRGH (72.7%) was reported by immigrant, single-parent workers working >40 WH/week. Immigrant single-parent families were more likely to report poor SRGH for three WH categories: ≤20 WH/week (prevalence ratio [PR] = 3.3, 95% confidence interval [CI] 1.6-7.2), >30-≤40 WH/week (PR = 2.8, 95% CI 1.3-6.4), and >40 WH/week (PR = 4.2, 95% CI 1.8-10.1). In two-parent families, immigrants working standard hours (i.e. >30-≤40) and native-born workers in the highest and lowest categories of WHs (i.e. ≤20 and >40) had similar PRs for poor SRGH compared with native-born workers working standard hours. Findings suggested that native-born workers residing in two-parent families were able to work more than 10 h longer per week than immigrant workers before reporting equivalent prevalences of poor SRGH. CONCLUSIONS: Differences in the association of WHs and poor SRGH among immigrants in Spain seem to be explained by family structure, which suggests that the influence of WHs on health differentially affects vulnerable groups, such as immigrant workers residing in single-parent families.

Work ability, psychosocial hazards and work experience in prison environments.

BACKGROUND: Work ability is predicted by age- and work-related psychosocial hazards; however, its association with work experience has not been studied. Work ability has not been studied in prison environments as well. AIMS: To describe work ability and its associates among prison workers. METHODS: A cross-sectional study was carried out in two prisons in Spain, one large and one medium prison, randomly selected from 17 in total. Prison workers were randomly administered a voluntary anonymous questionnaire to measure work ability [Work Ability Index (WAI)], work-related psychosocial hazards (Spanish version of COPSOQ), sociodemographic, lifestyle and work-related variables. RESULTS: Four hundred and forty-one workers (54%) participated. Results confirmed that older and more experienced workers (analysis of variance analysis) and workers in large prisons (t-student) presented significantly lower WAI scores. Quantitative and emotional demands, family work conflict, low work control, low autonomy, low social support from colleagues and stress had negative significant associations with WAI. Age, which highly correlated with work experience (Spearman's r = 0.85), had significant association with WAI (beta = -0.62). In the stepwise linear regression, the association between age and WAI lost statistical significance after controlling for work experience, which maintained significant correlation with WAI (beta = -0.37). CONCLUSIONS: The apparent association between age and WAI was confounded by work experience. Interventions to improve work ability among prison workers may benefit from results of this study to focus their efforts on the risk groups in such a psychologically demanding work environment rarely examined in previous research.

Heterogeneous trend in smoking prevalence by sex and age group following the implementation of a national smoke-free law.

OBJECTIVE: Given the limited evidence available about the effects of clean indoor air laws on smoking behaviour in the general population, the impact of national smoke-free workplace, bar and restaurant legislation, implemented on 1 January 2006, on smoking prevalence in Spain was assessed in this study. METHODS: Population-based trend analysis using estimates for 27 periods from the beginning of 2000 to the end of 2008-three periods per year. To calculate the period per cent change in smoking prevalence, the permutation test for joinpoint regression to detect significant changes was used. RESULTS: In men and women aged 15-24 years, the prevalence of smoking declined between the first period in 2000 and the third period in 2008, whereas in women aged 45-64 years, it increased by 1.7% per period. A declining trend was detected up to the first period in 2006 in men and women aged 25-44 years and in men aged 45-64 years, but between the beginning of 2006 and the end of 2008 the prevalence of smoking increased by 1.2%, 0.7% and 2.0% per period in men aged 25-44 years, in women aged 25-44 years and in men aged 45-64 years, respectively. CONCLUSIONS: 3 years after a national smoke-free law was implemented, the trend in smoking prevalence in some population groups was unchanged; however, in others, the declining trend of previous years was reversed. The similarity of these findings to those observed in other countries suggests that clean indoor air laws, although effective in reducing exposure to second-hand smoke, may not achieve the secondary objective of reducing the prevalence of smoking in the population.

Segmental hemangiomas of the upper airway.

OBJECTIVES/HYPOTHESIS: To characterize the anatomic distribution of segmental hemangiomas of the larynx and to describe indications for treatment modalities. STUDY DESIGN: Retrospective chart review. METHODS: We performed a retrospective chart review of patients with cutaneous hemangiomas at a tertiary care center over a 4-year period. Only patients with upper airway hemangiomas were studied. We reviewed the anatomic distribution of hemangiomas within the upper airway and the treatment course of each patient. RESULTS: Of 1,226 patients with cutaneous hemangiomas, 108 (9%) were segmental in distribution. There were 56 patients (52%) who had a V3 distribution pattern, and 16 patients (29%) with upper airway involvement. All of these patients had associated V3 or mandibular segmental hemangiomas. As with the cutaneous manifestation, the distribution of hemangioma within the upper airway was segmental. This included the following anatomic sites: oral cavity, oropharynx, hypopharynx, intrinsic structures of the larynx, and subglottis. Many of these patients had diffuse mucosal involvement, including tracheal involvement. A total of 13 out of 16 patients underwent medical intervention, and seven also required surgical intervention. Medical management included systemic (12 patients) and intralesional (two patients) steroids. One patient received chemotherapy prior to referral. Surgical treatment included tracheostomy (four patients prior to referral) and laser ablation of subglottic involvement (total of four patients). CONCLUSIONS: A high percentage of patients with V3 cutaneous hemangiomas (29%) will manifest with upper airway involvement, the distribution of which is segmental. Treatment should take this diffuse pattern of involvement into consideration.

Staged surgical management of hypopharyngeal traction diverticulum.

A 50-year-old woman who had undergone cervical spine fixation 6 years earlier presented with dysphagia, regurgitation of undigested food, halitosis, and weight loss. Operative examination demonstrated a hypopharyngeal diverticulum with spinal hardware visible in a defect in the mucosa. She underwent an open cervical approach to removal of the hardware. Endoscopic staple diverticulotomy as described by Scher and Richtsmeier was performed 8 weeks later in the ambulatory surgical setting. After a period of enteral feeding via a nasogastric tube in the initial postoperative period, she was able to resume oral nutrition in the interim between the surgical procedures. After the second procedure, she was able to resume a normal diet immediately and she experienced minimal symptoms. It is established that traction diverticulum is appropriately treated by removing the inciting anatomic factor(s). We propose that staged surgical management begin with the removal of the nidus followed by marsupialization of the diverticulum pouch. Standard staple diverticulotomy is a viable option for the second stage. This technique allows the patient to minimize the length of, or avoid, the second hospitalization for diverticulum management.

Impact of cumulative area-based adverse socioeconomic environment on body mass index and overweight.

OBJECTIVE: Although the relationship between area socioeconomic environment and obesity is known, previous research has measured area socioeconomic environment at only one point in time. This study evaluates the relationship of cumulative area-based adverse socioeconomic environment with body mass index (BMI) and overweight. DESIGN: Cross-sectional study. SETTING: Spain. PARTICIPANTS: 17 917 subjects in 2001. MAIN OUTCOME MEASURE: Information from 1980, 1990 and 2000 was used for the percentage of the population with low educational achievement, gross domestic product per capita (GDPpc), and Gini coefficient to estimate BMI and prevalence of overweight by the number of times each province had an adverse exposure to each of these measures of socioeconomic environment. RESULTS: After adjusting for individual variables and sports facilities in the area, the difference in BMI in residents of provinces with the highest percentage of population with low educational achievement in 1980, 1990 and 2000, compared with residents of provinces with no history of adverse socioeconomic environment based on this indicator, was 0.61 kg/m(2), whereas the prevalence of overweight was 1.46 times higher. Similar results were obtained for residents of provinces with cumulative low GDPpc versus residents of provinces that had never had low GDPpc. Neither BMI nor overweight were associated with cumulative income inequality based on the Gini coefficient. CONCLUSION: Cumulative adverse socioeconomic environment based on indicators of educational level or wealth, but not of income inequality, is positively associated with BMI and overweight. This association is not explained by individual characteristics or by the availability of sports facilities.

Multipotential differentiation of adipose tissue-derived stem cells.

Tissue engineering offers considerable promise in the repair or replacement of diseased and/or damaged tissues. The cellular component of this regenerative approach will play a key role in bringing these tissue engineered constructs from the laboratory bench to the clinical bedside. However, the ideal source of cells still remains unclear and may differ depending upon the application. Current research for many applications is focused on the use of adult stem cells. The properties of adult stem cells that make them well-suited for regenerative medicine are (1) ease of harvest for autologous transplantation, (2) high proliferation rates for ex vivo expansion and (3) multilineage differentiation capacity. This review will highlight the use of adipose tissue as a reservoir of adult stem cells and draw conclusions based upon comparisons with bone marrow stromal cells.

Adult stem cell therapy for the heart.

The purpose of this review is to summarize current data leading to and arising from recent clinical application of cellular therapy for acute myocardial infarct (heart attack) and congestive heart failure. We specifically focus on use of adult stem cells and compare and contrast bone marrow and adipose tissue; two different sources from which stem cells can be harvested in substantial numbers with limited morbidity. Cellular therapy is the latest in a series of strategies applied in an effort to prevent or mitigate the progressive and otherwise irreversible loss of cardiac function that frequently follows a heart attack. Unlike surgical, pharmacologic, and gene transfer approaches, cellular therapy has the potential to restore cardiac function by providing cells capable of regenerating damaged myocardium and/or myocardial function. Skeletal muscle myoblast expansion and transfer allows delivery of cells with contractile function, albeit without any evidence of cardiomyogenesis or electrical coupling to remaining healthy myocardium. Delivery of endothelial progenitor cells (EPCs) which drive reperfusion of infarct zone tissues is also promising, although this mechanism is directed at halting ongoing degeneration rather than initiating a regenerative process. By contrast, demonstration of the ability of adult stem cells to undergo cardiomyocyte differentiation both in vitro and in vivo suggests a potential for regenerative medicine. This potential is being examined in early clinical studies.

Paternal exposure to agricultural pesticides and cause specific fetal death.

AIMS: To study the association between fetal death and paternal agricultural occupation in areas and time periods with different levels of use of agricultural pesticides. METHODS: A total of 1 473 146 stillbirths and births occurring in Spain between 1995 and 1999 were analysed. RESULTS: The offspring of agricultural workers had the highest risk of fetal death from congenital anomalies in the southern and eastern area (where pesticide use is greatest) and the lowest risk in the rest of Spain. In both areas the offspring of agricultural workers had a similar excess risk of fetal death from the remaining causes of death. The relative risk of fetal death from congenital anomalies in infants conceived between April and September (the months of greater use of pesticides) in the southern and eastern area was 0.90 in manual workers and 1.62 in agricultural workers, compared to non-manual workers; in individuals who were conceived during the rest of the year, the relative risk was 0.87 and 0.85, respectively. In both periods the offspring of agricultural workers had an excess risk of fetal death from the remaining causes of death. CONCLUSIONS: Paternal agricultural work in the areas where pesticides are massively used increases the risk of fetal death from congenital anomalies. The risk is also increased for fetuses conceived during the time periods of maximum use of pesticides The higher risk of fetal death from the remaining causes of death in the offspring of agricultural workers seems unrelated to pesticide exposure.

[Care according to patient gender in emergency services: different or unequal?]. / Atención según el género del paciente en los servicios de urgencias: diferente o desigual?

It has been recently published different studies that support the idea that the health services make variability according to the patient's gender. In this sense, the aim of this study is to find out if there are gender differences in diagnostic and therapeutic care in health problems attended in emergency services. With the purpose of assessing this problem in a public hospital in Spain we have make a secondary analysis of the patient's findings got in the Emergency Service of Elche Hospital during four weeks in 1985.3, 709 patients were attended during this period. The results show a greater utilization of this service by men ORmale/female = 1.37 (1.29-1.47). The waiting time was higher for women (35 minutes) than men (29 minutes) (p = 0.0001), and also the time of getting a diagnostic (86 minutes vs 76) (p = 0.003). Diagnostic test were more frequent perform to women than men ORmale/female = 0.75 (0.64-0.85) meanwhile men receive treatment more often, ORmale/female = 1.34 (1.09-1.47). The associations are adjusted for age, diagnostic groups and patient's destination. Taking into account the possibility of more severity diseases among men that could explain the shorter waiting time and the therapeutic effort, the results show the possibility of an inequality attitude in the emergency services that would need further investigations. The more frequent use of diagnostic tests among women and consequently the longer diagnostic time, could be explain by the fact of the higher rates of nonspecific pathology.

Occupational accidents and alcohol consumption in Spain.

The real impact that alcohol consumption has on occupational accidents is unknown. We estimate the percentage of occupational accidents related to the regular consumption of alcohol in the population through the population attributable proportion (PAP). Spanish National Health Survey data were used to calculate the odds ratio (OR) and prevalence of alcohol consumption. The study restricted the selection of individuals by age and sex, using only interviews of men aged between 16 and 64 years. The results obtained show that approximately 17% of all occupational accidents can be attributable to alcohol consumption; 19% aged 16-24 years, 21% in those aged 25-44, and 9% in those aged 45-64. Although this methodology has some limitations, the advantages of this kind of study are important in public health because the magnitude of the problem, the potential impact of different strategies and the population groups most susceptible to intervention are addressed.

Physical dependence to morphine diminishes the interferon response in mice.

Morphine pellet implantation in mice was demonstrated to diminish resistance to encephalomyocarditis virus infections. The variations in the response to three different interferon (IFN) inducers--Newcastle disease virus, Escherichia coli lipopolysaccharide and a tilorone analogue--were evaluated. A close relationship between morphine dependence and IFN response was detected. A clear inhibition in IFN induction appeared as a concomitant phenomenon with the syndrome of morphine dependence. In the response intensity, the mice strain tested was more important than the total drug dose in the pellet. This effect of morphine on IFN responses presented a characteristic age-related pattern and, perhaps, may also be influenced by the H-2 murine phenotype.