Chagas disease screening among HIV-positive Latin American immigrants: an emerging problem.

Chagas disease (CD) is an emergent disease in Europe that can behave as an opportunistic infection in HIV positive patients. The objective of this study was to evaluate the implementation of a CD screening programme in an HIV unit. An immunochromatography (ICT) of Trypanosoma cruzi was performed as a screening tool in HIV-positive patients born in CD endemic countries. ELISA and IFAT were used to confirm the diagnosis. A total of 155 patients, 116 males and 38 females, were included. Mean age was 36.9 years (± 8.4) and mean length of stay in Spain at the screening was 7.1 years (± 4.7). T. cruzi ICT was positive in four cases (2.6%), being confirmed (by ELISA and IFAT) in three of those (1.9%). Factors associated with confirmed positive T.cruzi serology were: Bolivia origin (p=0.016), Bolivia or Argentina origin (p=0.002), Southern Cone origin (p=0.015), rural origin (p=0.023), previously living in an adobe-made (p=0.001) or thatch-roofed house (p<0.0001), having a previous CD test (p=0.015), previous knowledge about CD (p=0.019), about vector (p=0.009) or recorded seeing vectors at home (p=0.012). Units dealing with HIV patients from endemic areas of American trypanosomiasis should implement CD screening protocols. Interviews of patients coming from endemic areas should include CD epidemiological questions.

Guía SEPAR para el tratamiento del tabaquismo en la empresa / SEPAR guide for treatment of smoking habit in the work sites

No disponible

Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: a multinational comparison.

OBJECTIVE: To estimate the incremental cost-effectiveness of the first-line pharmacotherapies (nicotine gum, patch, spray, inhaler, and bupropion) for smoking cessation across six Western countries-Canada, France, Spain, Switzerland, the United States, and the United Kingdom. DESIGN AND STUDY POPULATION: A Markov-chain cohort model to simulate two cohorts of smokers: (1) a reference cohort given brief cessation counselling by a general practitioner (GP); (2) a treatment cohort given counselling plus pharmacotherapy. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications. INTERVENTIONS: Addition of each first-line pharmacotherapy to GP cessation counselling. MAIN OUTCOME MEASURES: Cost per life-year saved associated with pharmacotherapies. RESULTS: The cost per life-year saved for counselling only ranged from US190 dollars in Spain to 773 dollars in the UK for men, and from 288 dollars in Spain to 1168 dollars in the UK for women. The incremental cost per life-year saved for gum ranged from 2230 dollars for men in Spain to 7643 dollars for women in the US; for patch from 1758 dollars for men in Spain to 5131 dollars for women in the UK; for spray from 1935 dollars for men in Spain to 7969 dollars for women in the US; for inhaler from 3480 dollars for men in Switzerland to 8700 dollars for women in France; and for bupropion from 792 dollars for men in Canada to 2922 dollars for women in the US. In sensitivity analysis, changes in discount rate, treatment effectiveness, and natural quit rate had the strongest influences on cost-effectiveness. CONCLUSIONS: The cost-effectiveness of the pharmacotherapies varied significantly across the six study countries, however, in each case, the results would be considered favourable as compared to other common preventive pharmacotherapies.

Amebic liver abscess with bacterial superinfection in a patient with no epidemiologic risk factors.

The amebic liver abscess is uncommon in developed countries like Spain, but the incidence is increasing probably due to the migratory movements of the population. We report a case of an amebic abscess, initially unsuspected due to the absence of epidemiologic risk factors and the negative serology for amebiasis, in the early stages of the disease.

[Smoking cessation in a population-based cohort study]. / Abandono del consumo de tabaco en una cohorte de base poblacional.

OBJECTIVE: To study the incidence rates and the determinants of smoking cessation in a population-based cohort. MATERIAL AND METHODS: We used data from the Cornellà Health Interview Survey Follow-up Study. Subjects who declared they were daily smokers at baseline (1994) and had complete follow-up, with information on smoking status in 2002, entered into analysis. We calculated incidence rates and the relative risks of cessation (with 95% confidence intervals) using the Cox model. RESULTS: Out of 353 daily smokers, 100 quit smoking during the follow-up period (cumulative incidence of 28.3%). The incidence rate of cessation was higher among men (42.34 per 1000 person-years) than among women (24.97 per 1000 person-years), with a relative risk of cessation of 1.69 (95% confidence interval, 1.02-2.79) for men. Age and level of education were associated with a higher relative risk of quitting in men. CONCLUSIONS: The main determinants for smoking cessation are sociodemographic (sex, age, and level of education).

La publicidad del tabaco, ¿incrementa el hábito de fumar entre los adolescentes? Datos desde California / Tobacco advertising, does it increase smoking among teenagers? Data from California

La industria tabacalera ha estado dirigiendo campañas masivas y efectivas para aumentar las ventas de tabaco y asegurar la aparición de nuevos fumadores, principalmente adolescentes. En este artículo se describe cómo esas actividades publicitarias han cambiado en EE.UU. en los últimos años y la evidencia de su impacto especialmente en los adolescentes. En la última década, en dicho país se ha popularizado un programa de alcance nacional sobre control del tabaco. Estos programas financian con fondos públicos campañas de publicidad para promover una sociedad libre de humo y para movilizar a la población a tomar medidas preventivas ante las influencias que incitan al consumo de tabaco en los jóvenes. Los programas cuya meta sea prevenir el inicio del hábito tabáquico necesitan conocer el proceso temporal en el cual los adolescentes se convierten en adictos. El proceso de convertirse en fumador comienza antes de que el individuo experimente con cigarrillos, con el desarrollo de una predisposición cognitiva para fumar a menudo en la prepubertad. Existe evidencia de que las actividades promocionales de la industria desempeñan un papel importante incitando a los adolescentes no fumadores a estar en riesgo de experimentar y desarrollar de forma temprana signos de dependencia antes de llegar a la edad adulta. Los programas efectivos de control del tabaco pretenden contrarrestar la influencia de la industria tabacalera en los adolescentes y desalentar la demanda mediante el incremento de los precios y las barreras en la accesibilidad a los cigarrillos. Estos programas de salud pública han empezado a ofrecer resultados importantes reduciendo la mayor causa prevenible de muerte en los países desarrollados (AU)

The tobacco industry has continued to conduct large and effective promotional campaigns to increase tobacco sales and to ensure that there is a continuing pool of new smokers who are now mainly adolescents. This paper describes how these activities have changed in the United States in recent years and the evidence of their impact particularly on adolescents. Over the past decade, Statewide tobacco control programs have become increasingly popular in the United States. These programs use public monies to conduct mass media campaigns, to restructure the environment to emphasize a smoke free society and to mobilize the population to take action to prevent young people from being influenced to start to smoke. Programs that aim to prevent initiation need to be grounded in a knowledge of the time-related process by which adolescents become addicted. The smoking uptake process begins before experimenting with cigarettes with the development of a cognitive predisposition to smoke often in the pre-teen years. We present evidence that tobacco promotional activities play a major role in encouraging non-smoking adolescents to become at risk to experiment and to develop early signs of dependence prior to becoming adults. Effective tobacco control programs focus on countering the influence of the tobacco industry on adolescents, dampening demand with higher prices and barriers to easy access to cigarettes. These public health programs have started to show major results in reducing the most preventable cause of death in developed countries (AU)

East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme.

BACKGROUND: Differences have been reported in life expectancy and mortality between Eastern and Western European countries. Also, disparities have been found among different European countries or populations concerning the implementation of preventive practices by health professionals. This study analysed the patterns of reported preventive practices in three Eastern European areas and three Western ones. METHODS: Health surveys were carried out in particular geographical area of six countries participating in the project (three Eastern European countries; Russia, Poland and Hungary and three Western European countries; Finland, Germany and Spain). All of them are partners in the WHO-CINDI (Countrywide Integration Non-communicable Diseases Intervention) Programme. Three preventive practices are analysed: reported blood pressure and blood cholesterol measurements and reported antismoking counseling during the last year. Data are presented separately for the general population and for people reporting specific chronic conditions (cardiovascular disease, respiratory disease and/or diabetes mellitus). RESULTS: Blood pressure measurement and antismoking counseling are more frequently reported to be carried out by primary health care physicians in the Eastern European areas while blood cholesterol measurement is more frequently reported in Western European countries. All these preventive activities are more frequently reported to be done among people with chronic conditions than in the population as a whole. CONCLUSIONS: Major differences have been found in reported preventive practices between Eastern and Western European countries. Great potential exists for chronic disease prevention among them.

[Determinants of quitting smoking in Catalonia, Spain]. / El abandono del hábito tabáquico en Cataluña.

OBJECTIVE: While trends in the prevalence of smoking and ex-smoking in Catalonia, Spain have been monitored, the characteristics of those smokers who quit have not been investigated. The aim of this investigation was to analyze the prevalence of cessation, or quit ratio, in Catalonia and to study its sociodemographic, life-style, and smoking correlates. SUBJECTS AND METHODS: We analyzed data collected in the Catalan Health Interview Survey conducted in 1994. This is a cross-sectional study based on a representative sample of the non-institutionalized population of Catalonia. We included for analysis a total of 5,424 subjects (3,649 males and 1,775 females) who declared to be current smokers (2,335 males and 1,331 females) or past smokers (1,314 males and 444 females). We computed the crude and age-standardized quit ratios (QR) or prevalence of cessation, as well as the odds ratio (OR) of quitting smoking, according to gender and the variables studied. RESULTS: The age-standardized QR was 31. 8% for males and 30.9% for females and increased with age. The QR was, both in males and females, greater among married subjects, with higher socioeconomic status, and with healthy life-styles (moderate and heavy leisure physical activity and moderate alcohol consumption). The OR of quitting smoking was higher in heavy smokers (OR = 2.9; 95% CI: 2.2-3.8; smokers of > 30 cigarettes/day vs. 1-10 cigarettes/day) in males, while it was < 1 for females of medium intensity, conforming a shaped curve rather than a linear trend (OR = 1.7; 95% CI: 1.0-2.9, in heavy smokers). CONCLUSIONS: This study confirms a positive association in males and females between quitting smoking and increasing age, a higher socioeconomic level, heavy smoking, and healthy life-styles. The identification of these groups should facilitate the planning of successful interventions. Further effort is also necessary to target groups with low cessation rates, such as individuals in disadvantaged social classes and light smokers.

Age at starting smoking and number of cigarettes smoked in Catalonia, Spain.

BACKGROUND: Few studies have investigated the association between age at starting smoking and the average number of cigarettes smoked per day in adulthood. To provide further evidence on this issue, we analyzed data from the Catalan Health Interview Survey (CHIS). METHODS: The CHIS was conducted in 1994 on a randomly selected sample (N = 15,000) of the population of Catalonia, Spain. A total of 4,897 current or exsmokers (3,276 males and 1,621 females) were included for analysis. Age-standardized proportions of subjects smoking <15, 15-24, and >/=25 cigarettes/day, age-standardized mean number of cigarettes smoked per day, and multivariate odds ratios (OR) of being a heavy smoker (>/=25 cigarettes/day) according to age at starting smoking (<15, 15-17, 18-19, >/=20 years) were computed. RESULTS: Men who started smoking before the age of 15 smoked on average 5.5 cigarettes more than those who started at age 19 or over. Women who started smoking early in life smoked, on average, 6.8 cigarettes/day more than women who started later. The proportion of smokers of <15 cigarettes/day was higher among subjects who started smoking later. Both for males and for females, the OR of being a heavy smoker significantly increased with decreasing age at starting smoking (OR = 2.4 for males and 4.5 for females who started at age <15 versus >/=20 years). The level of education did not modify the relationship in males, whereas the association with age at starting was only apparent for more educated women. CONCLUSIONS: This study confirms that age at starting smoking is inversely and strongly associated to the number of cigarettes smoked per day. Thus, actions aimed at the prevention or delay of smoking onset among adolescents would have an important beneficial effect.

[Evaluation of a community intervention program ("Quit and Win") for smoking cessation]. / Evaluación de una intervención comunitaria (programa "Quit and Win") para dejar de fumar.

OBJECTIVES: In recent years community intervention plans for motivating smokers to stop smoking have been developed. One of these programs is the <> initiative of the World Health Organization. Our study evaluated the impact of this intervention in a sample of persons who participated in the 1996 edition of the program in Barcelona, Spain. METHODS: One year after the contest, a telephone follow-up survey was carried out in one-third of the participants. Subjects were questioned about their current smoking status and their participation in the contest, including motivation and whether they had remained abstinent throughout the contest. RESULTS: A total of 941 valid cards were received from Barcelona residents, equivalent of 0.23% of all smokers. A selection was made of 307 persons for follow-up, 18 of which were excluded because they were former smokers. From the remaining 289 participants, we obtained valid responses from 196, 82 (41.8%) of which were abstinent when the survey was made. Participating in the contest with the intention to stop smoking permanently and continued abstinence throughout the contest period (one month) were significantly associated with abstention one year later. The overall agreement between participants' statements and the statements of a subsample (n=18) was 81.3%. CONCLUSIONS: One year after the intervention the proportion of abstinent smokers was higher than in earlier studies. However, self-selection by the participation who responded to the follow-up questionnaire could have contributed to the final result. Overall, such initiatives could be useful in motivating predisposed persons to stop smoking.

[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.

Management of the hypertensive patient who smokes.

Smoking and arterial hypertension are highly prevalent at the community level. While the coexistence of both risk factors is less frequent, the potentiation of cardiovascular risk when both are present makes the association highly relevant in terms of a preventive approach. There are many interrelationships between smoking and high blood pressure at the clinical, epidemiological and pathophysiological levels. Those demonstrable links compel us to review the usual explanation of the influence of smoking on blood pressure. Pharmacological treatment of the hypertensive patient who smokes must be adapted to the patient's risk profile, using the most efficacious antihypertensive agents. With the exception of nonselective beta-blockers, all the available antihypertensive drugs can be prescribed. Minimal intervention and nicotine replacement constitute the most well tested interventions in helping smokers to quit their habit. Nicotine replacement is currently a well tolerated intervention, even in patients with cardiovascular disease.

[Smoking prevalence trends in Catalonia, Spain, 1982-1994]. / La evolución del hábito tabáquico en Cataluña, 1982-1994.

BACKGROUND: Smoking prevalence trends from 1982 to 1994 of adult population in Catalonia (Spain) are described. SUBJECTS AND METHODS: Four population surveys have been carried out periodically using the same questionnaires and definitions for smoking status. Surveys in 1982, 1986 and 1990 have been implemented taking samples of Catalonia population through a multistage sampling with random stratified selection by province and habitat. Individuals were chosen through a random route process. In 1994, a survey with a complex probabilistic sample design with 8 geographical areas (health regions) and 2 basic units (towns and individuals) was implemented. RESULTS: Among the 15-64 years old adults, a decrease of 6.9% in smoking prevalence has been observed. The initial prevalence in 1982 was 37.9% (CI 95%: 35.4; 40.3); in 1994 this prevalence was 35.3% (CI 95%: 34.4; 36.2). In 1994, the prevalence of current smokers in population over 14 years old was 30.6% (CI 95%: 29.8; 31.4). We have observed a significant decrease in smoking prevalence in all age groups among male population (-20.6% for the 12-year period) whereas prevalence has increased among female (+28.0%) mainly among those between 25 and 54 years old. The main percentual decrease in smoking prevalence has been observed among young people aged 15-24 years old for both genders. The proportion of former smokers has remained stable (11.4% in 1982, 12.9% in 1994) during the period studied. The proportion of former smokers increases with age among man over 25 years. CONCLUSIONS: Smoking habit is still very prevalent in Catalonia, even higher than in other Western European countries. In spite of the increase among women, the significant dectines of smoking prevalence among men and youngsters (of both genders) could represent encouraging findings in order to pursue the efforts aimed at reducing the morbi-mortality burden of smoking in our society.

Passive smoking and risk of pulmonary tuberculosis in children immediately following infection. A case-control study.

SETTING: Passive smoking-related respiratory disorders in children. OBJECTIVES: To assess the effect of passive smoking on the development of active pulmonary tuberculosis (PTB) in children immediately following infection by Mycobacterium tuberculosis within the family. DESIGN: An unmatched case-control study in which 93 contacts who became cases (active PTB diagnosed) and 95 contacts who did not became cases (tuberculin-positive children without evidence of active disease) were included. All were household contacts of a new case of pulmonary bacillary tuberculosis. Smoking habits were investigated by a questionnaire. Urinary cotinine was analysed. Odds Ratio (OR) was adjusted for age and socio-economic status using multiple logistic regression analysis. RESULTS: Passive smoking was a risk factor for PTB (OR: 5.29; 95% confidence interval (CI): 2.33-12.82; P < 0.00005). The adjusted OR was 5.39 (95% CI: 2.44-11.91; P < 0.00001). The risk increased when contacts were passive smokers both at home and outside the home within the family (OR: 6.35; 95% CI: 3.20, 12.72; P < 0.00001). Contacts 0-4 and 5-9 years old showed a significantly higher risk than those aged > or = 10. There was a dose-response relationship between the risk of developing active PTB immediately following infection and the number of cigarettes smoked daily by the household adults (P < 0.001). Mean (SD) urinary continine detectable concentrations (ng/ml) were different between disease contacts (119.46 [68.61]) and non diseased contacts (91.87 [73.10]). The difference was statistically significant (P < 0.001). CONCLUSIONS: Passive exposure to tobacco smoke in children was associated with an increased risk of developing pulmonary tuberculosis immediately following infection. This is an association of great concern requiring health education programmes and antitobacco medical advice.

Cigarette smoking as a risk factor for tuberculosis in young adults: a case-control study.

SETTING: The association between smoking and pulmonary tuberculosis has not often been studied. OBJECTIVE: To assess the influence of cigarette smoking on the development of active pulmonary tuberculosis in young people who were close contacts of new cases of smear-positive pulmonary tuberculosis. DESIGN: A case-control study in which 46 'cases' (patients with active pulmonary tuberculosis: isolation of Mycobacterium tuberculosis or clinical and/or radiographic evidence of current pulmonary tuberculosis, with a positive tuberculin skin test) and 46 'controls' (persons with positive tuberculin reaction, negative bacteriological test and without clinical and/or radiological evidence of pulmonary tuberculosis) were included. Smoking habits were investigated by questionnaire. Univariate and multivariate analysis was performed, and odds ratio (OR) was adjusted for age, gender and socio-economic status. RESULTS: Statistically significant differences were found in active smokers (occasional and daily smokers) (OR: 3.65; 95% CI, 1.46 and 9.21; P < 0.01), daily smokers (OR: 3.53; 95% CI, 1.34 and 9.26; P < 0.05), and individuals who were both passive and active smokers (OR: 5.10; 95% CI, 1.97 and 13.22; P < 0.01) and passive and daily smokers (OR: 5.59; 95% CI, 2.07 and 15.10; P < 0.001). There was a dose-response relationship between the number of cigarettes smoked daily and the risk of active pulmonary tuberculosis. CONCLUSIONS: The data studied show that cigarette smoking is a risk factor for pulmonary tuberculosis in young people, with a dose-response relationship with the number of cigarettes consumed daily.

[Smoking cessation program using nicotine patch among physicians and pharmacists of Catalonia: results after 3-12 months]. / Programa de cesación tabáquica con parche de nicotina en médicos y farmacéuticos de Cataluña: resultados a 3 y 12 meses.

Smoking abstinence rates of a group of 300 physicians and pharmacists of Catalonia (Spain) who participated in an open non-controlled follow-up design study with nicotine patch, are presented. Were eligible all the individuals who regularly smoke more than 15 cigarettes/day and get Fagerström Test score of 5 or more. Those who smoke more than 20 cig/day were offered a 3-month 24-hour transdermal nicotine treatment (30-20-10 schedule) and those smoking between 15 and 20 cig/day, received the 20-20-10 schedule. A follow up of participants was carried out at 3, 6, 9 and 12 months. After one year, 12 participants (4%) were dropped out. The overall abstinence rates at 3, 6, 9 and 12 months were respectively 55.9% (IC95%: 50.2-61.6), 42.7% (IC95%: 37.0-48.4), 35.4% (IC95% 29.9-40.9), 33.7% (IC95%: 28.2-39.2). Among predictive cessation variables, only those who had mad 1 to 3 previous attempts and those with only "cold turkey" (or slow reduction) quit experience, obtained statistically better results at 3 months. These results seem to be as good as or even better than those obtained in other similar studies with nicotine patch.