Association between occupational exposure and chronic obstructive pulmonary disease and respiratory symptoms in the Spanish population.

INTRODUCTION: The aim of this study was to analyze the impact of occupational exposure on chronic obstructive pulmonary disease (COPD) and respiratory symptoms in the general Spanish population. METHODS: This was a study nested in the Spanish EPISCAN II cross-sectional epidemiological study that included participants who had completed a structured questionnaire on their occupational history, a questionnaire on respiratory symptoms, and forced spirometry. The data were analyzed using Chi-square and Student's t tests and adjusted models of multiple linear regression and logistic regression. RESULTS: We studied 7502 subjects, 51.1% women, with a mean age of 60±11 years. Overall, 53.2% reported some respiratory symptoms, 7.9% had respiratory symptoms during their work activity, 54.2% were or had been smokers, and 11.3% (851 subjects) met COPD criteria on spirometry. A total of 3056 subjects (40.7%) reported exposure to vapors, gases, dust or fumes (VGDF); occupational exposure to VGDF was independently associated with the presence of COPD (OR 1.22, 95% CI: 1.03-1.44), respiratory symptoms (OR 1.45, 95%: CI 1.30-1.61), and respiratory symptoms at work (OR 4.69, 95% CI: 3.82-5.77), with a population attributable fraction for COPD of 8.2%. CONCLUSIONS: Occupational exposure is associated with a higher risk of COPD and respiratory symptoms in the Spanish population. These results highlight the need to follow strict prevention measures to protect the respiratory health of workers.

Association between occupational exposure and chronic obstructive pulmonary disease and respiratory symptoms in the Spanish population

Introduction: The aim of this study was to analyze the impact of occupational exposure on chronic obstructive pulmonary disease (COPD) and respiratory symptoms in the general Spanish population.MethodsThis was a study nested in the Spanish EPISCAN II cross-sectional epidemiological study that included participants who had completed a structured questionnaire on their occupational history, a questionnaire on respiratory symptoms, and forced spirometry. The data were analyzed using Chi-square and Student's t tests and adjusted models of multiple linear regression and logistic regression.ResultsWe studied 7502 subjects, 51.1% women, with a mean age of 60±11 years. Overall, 53.2% reported some respiratory symptoms, 7.9% had respiratory symptoms during their work activity, 54.2% were or had been smokers, and 11.3% (851 subjects) met COPD criteria on spirometry. A total of 3056 subjects (40.7%) reported exposure to vapors, gases, dust or fumes (VGDF); occupational exposure to VGDF was independently associated with the presence of COPD (OR 1.22, 95% CI: 1.03–1.44), respiratory symptoms (OR 1.45, 95%: CI 1.30–1.61), and respiratory symptoms at work (OR 4.69, 95% CI: 3.82–5.77), with a population attributable fraction for COPD of 8.2%.ConclusionsOccupational exposure is associated with a higher risk of COPD and respiratory symptoms in the Spanish population. These results highlight the need to follow strict prevention measures to protect the respiratory health of workers. (AU)

Enhanced fatty acid oxidation through metformin and baicalin as therapy for COVID-19 and associated inflammatory states in lung and kidney.

Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (COVID-19) pandemic. It is the final outcome of the acute respiratory distress syndrome (ARDS), characterized by an initial exacerbated inflammatory response, metabolic derangement and ultimate tissue scarring. A positive balance of cellular energy may result crucial for the recovery of clinical COVID-19. Hence, we asked if two key pathways involved in cellular energy generation, AMP-activated protein kinase (AMPK)/acetyl-CoA carboxylase (ACC) signaling and fatty acid oxidation (FAO) could be beneficial. We tested the drugs metformin (AMPK activator) and baicalin (CPT1A activator) in different experimental models mimicking COVID-19 associated inflammation in lung and kidney. We also studied two different cohorts of COVID-19 patients that had been previously treated with metformin. These drugs ameliorated lung damage in an ARDS animal model, while activation of AMPK/ACC signaling increased mitochondrial function and decreased TGF-ß-induced fibrosis, apoptosis and inflammation markers in lung epithelial cells. Similar results were observed with two indole derivatives, IND6 and IND8 with AMPK activating capacity. Consistently, a reduced time of hospitalization and need of intensive care was observed in COVID-19 patients previously exposed to metformin. Baicalin also mitigated the activation of pro-inflammatory bone marrow-derived macrophages (BMDMs) and reduced kidney fibrosis in two animal models of kidney injury, another key target of COVID-19. In human epithelial lung and kidney cells, both drugs improved mitochondrial function and prevented TGF-ß-induced renal epithelial cell dedifferentiation. Our results support that favoring cellular energy production through enhanced FAO may prove useful in the prevention of COVID-19-induced lung and renal damage.

Tobacco Patterns and Risk of Chronic Obstructive Pulmonary Disease: Results From a Cross-Sectional Study.

INTRODUCTION: There is still uncertainty about which aspects of cigarette smoking influence the risk of Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to estimate the COPD risk as related to duration of use, intensity of use, lifetime tobacco consumption, age of smoking initiation and years of abstinence. METHODS: We conducted an analytical cross-sectional study based on data from the EPISCAN-II study (n=9092). All participants underwent a face-to-face interview and post-bronchodilator spirometry was performed. COPD was defined as post-bronchodilator FEV1/FVC<70%. Parametric and nonparametric logistic regression models with generalized additive models were used. RESULTS: 8819 persons were included; 858 with COPD and 7961 without COPD. The COPD risk increased with smoking duration up to ≥50 years [OR 3.5 (95% CI: 2.3-5.4)], with smoking intensity up to ≥39cig/day [OR 10.1 (95% CI: 5.3-18.4)] and with lifetime tobacco consumption up to >29 pack-years [OR 3.8 (95% CI: 3.1-4.8)]. The COPD risk for those who started smoking at 22 or later was 0.9 (95% CI: 0.6-1.4). The risk of COPD decreased with increasing years of cessation. In comparison with both never smokers and current smokers, the lowest risk of COPD was found after 15-25 years of abstinence. CONCLUSION: COPD risk increases with duration, intensity, and lifetime tobacco consumption and decreases importantly with years of abstinence. Age at smoking initiation shows no effect. After 15-25 years of cessation, COPD risk could be equal to that of a never smoker. This work suggests that the time it takes to develop COPD in a smoker is about 30 years.

Impact of Early Non-Invasive Ventilation in Amyotrophic Lateral Sclerosis: A multicenter Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Forced vital capacity (FVC) less than 50% of predicted is one of the main parameters used for Non-Invasive Ventilation (NIV) initiation in Amyotrophic Lateral Sclerosis (ALS). Recent studies suggest that higher values of FVC could be considered as a threshold. The aim of this study is to evaluate whether early use of NIV improves the prognosis of ALS patients compared with standard initiation. METHODS: This is a randomized, parallel, multicenter, open-label, controlled clinical trial, with recruitment at the ALS outpatient multidisciplinary units of six Spanish hospitals. Patients were included when their FVC reached the 75% threshold and were randomized by computer, stratifying by center in an allocation ratio of 1:1 to Early NIV (FVC below 75%) or Standard NIV (FVC below 50%) initiation. The primary outcome was time to death or tracheostomy.Trial registration number ClinicalTrials.gov: NCT01641965. RESULTS: Between May 2012 and June 2014, 42 patients were randomized to two groups, 20 to Early NIV and 22 to Standard NIV initiation. We found differences in survival in favor of the intervention group: an incidence of mortality (2.68 [1.87-5.50] vs. 3.33 [1.34-4.80] person-months) and a median survival (25.2 vs. 19.4 months), although without reaching statistical significance (p = 0.267). CONCLUSIONS: This trial did not reach the primary endpoint of survival; nevertheless, it is the first Randomized Controlled Trial (RCT) to demonstrate the benefits of early NIV in slowing the decline of respiratory muscle strength and reducing adverse events. Although not all the results reached statistical significance, all the analyzed data favor early NIV. In addition, this study demonstrates good tolerance and compliance with early NIV without quality of sleep impairment. These data reinforce the early respiratory evaluation of ALS patients and NIV initiation with an FVC of around 75%.

Unravelling young COPD and pre-COPD in the general population.

Background: Chronic obstructive pulmonary disease (COPD) is commonly diagnosed when the airflow limitation is well established and symptomatic. We aimed to identify individuals at risk of developing COPD according to the concept of pre-COPD and compare their clinical characteristics with 1) those who have developed the disease at a young age, and 2) the overall population with and without COPD. Methods: The EPISCAN II study is a cross-sectional, population-based study that aims to investigate the prevalence of COPD in Spain in subjects ≥40 years of age. Pre-COPD was defined as the presence of emphysema >5% and/or bronchial thickening by computed chromatography (CT) scan and/or diffusing capacity of the lung for carbon monoxide (D LCO) <80% of predicted in subjects with respiratory symptoms and post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) >0.70. Young COPD was defined as FEV1/FVC <0.70 in a subject ≤50 years of age. Demographic and clinical characteristics were compared among pre-COPD, young COPD and the overall population with and without COPD. Results: Among the 1077 individuals with FEV1/FVC <0.70, 65 (6.0%) were ≤50 years of age. Among the 8015 individuals with FEV1/FVC >0.70, 350 underwent both D LCO testing and chest CT scanning. Of those, 78 (22.3%) subjects fulfilled the definition of pre-COPD. Subjects with pre-COPD were older, predominantly women, less frequently active or ex-smokers, with less frequent previous diagnosis of asthma but with higher symptomatic burden than those with young COPD. Conclusions: 22.3% of the studied population was at risk of developing COPD, with similar symptomatic and structural changes to those with well-established disease without airflow obstruction. This COPD at-risk population is different from those that develop COPD at a young age.

Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study.

BACKGROUND: Population distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe the prevalence of reduced DLCO in a population-based sample of current and former smoker subjects without airflow limitation and to describe its morphological, functional and clinical implications. METHODS: A sample of 405 subjects aged 40 years or older with postbronchodilator forced expiratory volume in 1 s/forced vital capacity (FVC) >0.70 was obtained from a random population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, exhaled carbon monoxide (CO) measurement, spirometry, DLCO determination, 6 min walk test, routine blood analysis and low-dose CT scan with evaluation of lung density and airway wall thickness. RESULTS: In never, former and current smokers, prevalence of reduced DLCO was 6.7%, 14.4% and 26.7%, respectively. Current and former smokers with reduced DLCO without airflow limitation were younger than the subjects with normal DLCO, and they had greater levels of dyspnoea and exhaled CO, greater pulmonary artery diameter and lower spirometric parameters, 6 min walk distance, daily physical activity and plasma albumin levels (all p<0.05), with no significant differences in other chronic respiratory symptoms or CT findings. FVC and exhaled CO were identified as independent risk factors for low DLCO. CONCLUSION: Reduced DLCO is a frequent disorder among smokers without airflow limitation, associated with decreased exercise capacity and with CT findings suggesting that it may be a marker of smoking-induced early vascular damage. TRIAL REGISTRATION NUMBER: NCT03028207.

Dissociation between physical capacity and daily physical activity in COPD patients. A population-based approach.

BADKGROUND: Physical capacity (PC) and daily physical activity (PA) are two crucial factors in the clinical course of COPD, although they do not always maintain a close relationship. The objectives were to evaluate the frequency of PC-PA dissociation in patients with COPD and subjects without airflow limitation (AL) and to identify its risk factors. METHODS: A sample of 319 COPD patients and 399 subjects without AL was consecutively obtained from a population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, lung function testing, blood analysis and low-dose computed tomography (CT) scan with evaluation of lung density and airway wall thickness. A distance walked in 6 min > 70% predicted was considered an indicator of normal PC, while a Yale Physical Activity Survey summary index score <51 was used to identify with sedentary lifestyle. RESULTS: 166 COPD patients (52.0%) reported a sedentary lifestyle with evidence of preserved PC, while this phenomenon was present in 188 (47.1%) subjects without AL. In the COPD group, symptoms of chronic bronchitis, depression and elevated hematocrit and blood eosinophil count were identified as independent risk factors for PC-PA dissociation. In turn, in the subjects without AL, the risk factors for PC-PA dissociation were low fat-free mass, obesity and anxiety, as well as reduced levels of HDL-cholesterol and the absence of osteoporosis. CONCLUSIONS: Almost half of COPD patients and subjects without airflow limitation with preserved PC maintain a sedentary lifestyle, with different risk factors for sedentarism between both groups.

Trends of COPD in Spain: Changes Between Cross Sectional Surveys 1997, 2007 and 2017.

INTRODUCTION: We aim to describe the changes in prevalence and risk factors associated to chronic obstructive pulmonary disease (COPD) in Spain, comparing three population-based studies conducted in three timepoints. METHODS: We compared participants from IBERPOC conducted in 1997, EPISCAN conducted in 2007 and EPISCAN II in 2017. COPD was defined as a postbronchodilator FEV1/FVC (forced expiratory volume in 1s/forced vital capacity) ratio <0.70, according to GOLD criteria; subsequently, also as the FEV1/FVC below the lower limit of normal (LLN). RESULTS: COPD prevalence in the population between 40 and 69 years decreased from 21.6% (95% CI 20.7%-23.2%) in 1997 to 8.8% (95% CI 8.2%-9.5%) in 2017, a 59.2% decline (p<0.001). In 2007, the prevalence was 7.7% (95% CI 6.8%-8.7%) with an upward trend of 1.1 percentage points in 2017 (p=0.073). Overall COPD prevalence decreased in men and women, although a significant increase was observed in the last decade in females (p<0.05). Current smokers significantly increased in the last decades (25.4% in 1997, 29.1% in 2007 and 23.4% in 2017; p<0.001). Regrettably, COPD underdiagnosis was constantly high, 77.6% in 1997, 78.4% in 2007, and to 78.2% in 2017 (p=0.95), higher in younger ages (40-49 yrs and 50-59 yrs) and also higher in women than in men in all three studies (p<0.05). CONCLUSIONS: We report a significant reduction of 59.2% in the prevalence of COPD in Spain from 1997 to 2017 in subjects aged 40-69 years. Our study highlights the significant underdiagnosis of COPD, particularly sustained in women and younger populations.

Respiratory symptoms and their determinants in the general Spanish population: changes over 20 years.

Background: Few large epidemiological studies have analysed the prevalence of respiratory symptoms and their determinants in the general adult population. We investigated the prevalence and determinants of respiratory symptoms and compared their prevalence with that of two previous studies conducted in 1999 and 2009. Method: EPISCAN II was a multicentre, cross-sectional, population-based epidemiological study in individuals older than 40 years. Results: A total of 9092 individuals were included. Up to 47.5% reported at least one respiratory symptom, being more frequent in women than in men (49.4% versus 45.5%, p=0.0002) and with wheezing being the most frequent (33.7%) followed by dyspnoea (26.8%). The presence of any symptom was associated with female sex, higher body mass index (BMI), lower forced expiratory volume in 1 s (FEV1 % pred), reduced physical activity, a higher Charlson index and the presence of anxiety and depression. Smoking was also significantly associated with having at least one respiratory symptom in a dose-response fashion (OR: 1.415, 1.916, 2.192 and 2.987 for 0-10, 10-20, 20-30 and >30 pack-years, respectively, all p<0.0001). The prevalence of symptoms remained quite similar over the last 20 years (wheezing 40%, 36% and 33.7% and dyspnoea 10.4%, 9.9% and 13.1% in 1999, 2009 and 2019, respectively). Conclusions: Approximately half of the adult Spanish population have respiratory symptoms and this prevalence has remained quite stable over the last 20 years. Smoking remains the main factor associated with respiratory symptoms, but female sex, comorbidities, high BMI and low FEV1 and low physical activity are also significantly associated with respiratory symptoms.

Stress in Emergency Healthcare Professionals: The Stress Factors and Manifestations Scale.

Background: Healthcare workers are continuously exposed to a high level of stress, especially emergency department professionals. In the present research, we aimed to determine the internal consistency and validity of the Stress Factors and Manifestations Scale for in-hospital and out-of-hospital emergency workers. Methods: A quantitative, prospective, cross-sectional, and observational study including 269 emergency service professionals. Results: The scale was composed of 21 items, with a Cronbach's α value of 0.908. The hospital workers (38.4 ± 10.8 vs. 35.1 ± 9.9, p = 0.014) and women (39.3 ± 11.4 vs. 34.2 ± 8.6, p < 0.001) had higher levels of stress. The sensitivity, specificity, and predictive values of the scale were adequate. Conclusion: In the present study, including in-hospital and out-of-hospital emergency workers, the Stress Factors and Manifestations Scale presented appropriate usefulness, internal consistency, and validity, with optimal predictive ability. Higher levels of anxiety, female gender, being less optimistic, and working in hospital emergency departments were related to increased stress levels. Further studies are warranted to validate our results and potentially extend the Stress Factors and Manifestations Scale to other contexts.

Determinants of blood eosinophil levels in the general population and patients with COPD: a population-based, epidemiological study.

BACKGROUND: Blood eosinophils are considered a biomarker for the treatment of chronic obstructive pulmonary disease (COPD). Population-based studies are needed to better understand the determinants of the blood eosinophil count (BEC) in individuals with and without COPD. METHODS: EPISCAN II is a multicentre, cross-sectional, population-based epidemiological study aimed at investigating the prevalence and determinants of COPD in Spain. Study subjects were randomly selected from the general population, and COPD was defined by a post-bronchodilator FEV1/FVC < 0.7. For the pre-specified outcomes related to BEC, the first 35 COPD and 35 non-COPD subjects were consecutively recruited in 12 of the participating centres with the objective of analysing 400 individuals in each group. Baseline BEC and its association with demographic, clinical and functional variables were analysed. RESULTS: A total of 326 COPD and 399 non-COPD subjects were included in the analysis. The mean age (standard deviation [SD]) was 63.2 years (11.0), 46.3% were male, and 27.6% were active smokers. BEC was significantly higher in individuals with COPD [192 cells/µL (SD: 125) vs. 160 cells/µL (SD: 114); p = 0.0003]. In a stepwise multivariate model, being male, active smoker and having a previous diagnosis of asthma were independently associated with having a higher BEC. CONCLUSIONS: This population-based study estimated the distribution of eosinophils in the healthy adult population and concluded that COPD patients have a significantly higher BEC. Male sex, active smoking and concomitant asthma were significantly associated with a higher BEC.

Decalogue for the selection of oral antibiotics for lower respiratory tract infections / Decálogo para la selección del antibiótico oral en las infecciones respiratorias de vías bajas

Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options betalactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected (AU)

Las infecciones del tracto respiratorio inferior, incluyendo las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) y la neumonía adquirida en la comunidad (NAC), son uno de los motivos de consulta más frecuentes en atención primaria y los servicios de urgencias hospitalarios, y son la causa de una elevada prescripción de antimicrobianos. La selección del tratamiento oral más adecuado con antibióticos se basa en diferentes aspectos e incluye considerar en primer lugar una etiología bacteriana y no una infección vírica, conocer los patógenos bacterianos que más frecuentemente causa estas infecciones y la frecuencia local de su resistencia antimicrobiana. Además, el tratamiento debe prescribirse rápidamente y los antibióticos deben seleccionarse entre los que tienen un modo de acción más rápido, logrando el mayor efecto en el menor tiempo y con el menor número de efectos adversos (toxicidad, interacciones, resistencia y/o impacto ecológico). Siempre que sea posible, hay que rotar y diversificar los antimicrobianos y pasar a la vía oral lo antes posible. Con estas premisas, las guías de tratamiento oral de la exacerbación leve o moderada de la EPOC y NAC en España incluyen como primera opción los antibióticos betalactámicos (amoxicilina y amoxicilina-clavulánico y cefditoreno), en determinadas situaciones asociados a un macrólido, y relegando las fluoroquinolonas como alternativa, salvo en los casos en que se sospeche la presencia de Pseudomonas aeruginosa (AU)

Relationship between sleep habits and academic performance in university Nursing students.

BACKGROUND: Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students. METHODS: This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the 'Morningness and Eveningness scale', an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the 'sleep habits questionnaire' was assessed with the Cronbach's alpha test. RESULTS: Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the 'sleep habits questionnaire' was appropriate (Cronbach's alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01-2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11-2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30-3.98) were independently associated with a higher probability of poor academic performance. CONCLUSIONS: Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.

Prevalence and Determinants of COPD in Spain: EPISCAN II / Prevalencia y determinantes de la EPOC en España: EPISCAN II

BACKGROUND: Two previous national epidemiological studies, IBERPOC in 1997 and EPISCAN in 2007, determined the COPD burden in Spain. Changes in demographics and exposure to risk factors demand the periodic update of COPD prevalence and its determinants. METHODS: EPISCAN II aimed to estimate the prevalence of COPD in the general population aged 40 years or older in all 17 regions of Spain. A random population screening sample, requiring 600 participants per region performed a questionnaire plus post-bronchodilator (post-BD) spirometry. RESULTS: A total of 12,825 subjects were initially contacted, and 9433 (73.6%) agreed to participate, of whom 9092 performed a valid spirometry. Baseline characteristics were: 52.6% women, mean ± SD age 60 ± 11 years, 19.8% current- and 34.2% former-smokers. The prevalence of COPD measured by post-BD fixed ratio FEV1/FVC < 0.7 was 11.8% (95% C.I. 11.2-12.5) with a high variability by region (2.4-fold). Prevalence was 14.6% (95% C.I. 13.5-15.7) in males and 9.4% (95% C.I. 8.6-10.2) in females; according to the lower limit of normal (LLN) was 6.0% (95% C.I. 5.5-6.5) overall, by sex being 7.1% (95% C.I. 6.4-8.0) in males and 4.9% (95% C.I. 4.3-5.6) in females. Underdiagnosis of COPD was 74.7%. Cases with COPD were a mean of seven years older, more frequently male, of lower attained education, and with more smokers than the non-COPD population (p < 0.001). However, the number of cigarettes and pack-years in non-COPD participants was substantial, as it was the reported use of e-cigarettes (7.0% vs. 5.5%) (p = 0.045). There were also significant social and clinical differences including living alone, previous respiratory diagnoses, more comorbidities measured with the Charlson index, greater BODE and COTE scores, cognitive impairment, and depression (all p < 0.001). CONCLUSIONS: COPD remains prevalent in Spain and frequently underdiagnosed

ANTECEDENTES: Dos estudios epidemiológicos nacionales anteriores, IBERPOC en 1997 y EPISCAN en 2007, determinaron la carga de EPOC en España. Los cambios en la demografía y la exposición a factores de riesgo exigen una actualización periódica de la prevalencia de EPOC y sus determinantes. MÉTODOS: EPISCAN II tuvo como objetivo estimar la prevalencia de EPOC en la población general de 40 años o más en las 17 Comunidades Autónomas de España. Una muestra aleatoria de población para cribado, que requirió 600 participantes por región, realizó un cuestionario y una espirometría tras la administración de un broncodilatador (post-BD). RESULTADOS: Un total de 12.825 sujetos fueron contactados inicialmente, y 9.433 (73,6%) aceptaron participar, de los cuales 9.092 realizaron una espirometría válida. Las características sociodemográficas basales fueron: un 52,6% eran mujeres, la edad media ± DE era de 60 ± 11 años, un 19,8% eran fumadores activos y un 34,2% eran exfumadores. La prevalencia de EPOC medida por el criterio de cociente fijo post-BD FEV1/FVC < 0,7 fue del 11,8% (IC 95%: 11,2-12,5) con una alta variabilidad por región (2,4 veces). La prevalencia fue del 14,6% (IC 95%: 13,5-15,7) en varones y del 9,4% (IC 95%: 8,6-10,2) en mujeres; considerando el límite inferior de la normalidad (LIN), fue del 6,0% (IC 95%: 5,5-6,5) en la muestra global y, por sexos, del 7,1% (IC 95%: 6,4-8,0) en varones y del 4,9% (IC 95%: 4,3-5,6) en mujeres. El infradiagnóstico de la EPOC fue del 74,7%. Los casos con EPOC tenían de media 7 años más, eran con mayor frecuencia varones, tenían menor nivel educativo y había más fumadores que en la población sin EPOC (p < 0,001). Sin embargo, el número de cigarrillos y paquetes/año en los participantes que no tenían EPOC fue sustancial, como también fue elevado el uso de cigarrillos electrónicos (7,0 vs. 5,5%) (p = 0,045). También hubo diferencias sociales y clínicas significativas que incluyeron: vivir solo, diagnósticos previos de enfermedad respiratoria, más comorbilidades medidas con el índice de Charlson, puntuaciones más altas en el índice BODE y la escala COTE, deterioro cognitivo y depresión (todos p < 0,001). CONCLUSIONES: La EPOC sigue siendo prevalente en España y con frecuencia está infradiagnosticada

Prevalence and Determinants of COPD in Spain: EPISCAN II.

BACKGROUND: Two previous national epidemiological studies, IBERPOC in 1997 and EPISCAN in 2007, determined the COPD burden in Spain. Changes in demographics and exposure to risk factors demand the periodic update of COPD prevalence and its determinants. METHODS: EPISCAN II aimed to estimate the prevalence of COPD in the general population aged 40 years or older in all 17 regions of Spain. A random population screening sample, requiring 600 participants per region performed a questionnaire plus post-bronchodilator (post-BD) spirometry. RESULTS: A total of 12,825 subjects were initially contacted, and 9433 (73.6%) agreed to participate, of whom 9092 performed a valid spirometry. Baseline characteristics were: 52.6% women, mean±SD age 60±11 years, 19.8% current- and 34.2% former-smokers. The prevalence of COPD measured by post-BD fixed ratio FEV1/FVC<0.7 was 11.8% (95% C.I. 11.2-12.5) with a high variability by region (2.4-fold). Prevalence was 14.6% (95% C.I. 13.5-15.7) in males and 9.4% (95% C.I. 8.6-10.2) in females; according to the lower limit of normal (LLN) was 6.0% (95% C.I. 5.5-6.5) overall, by sex being 7.1% (95% C.I. 6.4-8.0) in males and 4.9% (95% C.I. 4.3-5.6) in females. Underdiagnosis of COPD was 74.7%. Cases with COPD were a mean of seven years older, more frequently male, of lower attained education, and with more smokers than the non-COPD population (p<0.001). However, the number of cigarettes and pack-years in non-COPD participants was substantial, as it was the reported use of e-cigarettes (7.0% vs. 5.5%) (p=0.045). There were also significant social and clinical differences including living alone, previous respiratory diagnoses, more comorbidities measured with the Charlson index, greater BODE and COTE scores, cognitive impairment, and depression (all p<0.001). CONCLUSIONS: COPD remains prevalent in Spain and frequently underdiagnosed.

Scientific evidence on heated-tobacco products. A narrative review / Evidencia científica sobre productos de tabaco calentado. Una revisión narrativa

Given the impact of smoking on individuals and National Healthcare Systems, it has become necessary for the continuous evaluation of tobacco products, especially when they are claimed or perceived as being less harmful than conventional cigarettes (CCs), and coexisting conflict of interests. The objective of the present manuscript was to perform a complete and updated narrative review of scientific literature on the assessment of harmful and potentially harmful constituents (HPHCs) and the biological and clinical impact from the newest available heated tobacco products (HTPs), in comparison with CCs. A total of 52 studies (46 from the review and 6 manually found) were finally analyzed. Despite some existing differences among the studies, most of them point to a reduction of the emissions of HPHCs as well as exposure to toxicants, and thus in the biological and clinical impact with HTPs when compared with CCs. In the scenario where individuals decide to continue smoking, HTPs seem to be a better option than CCs. Further prospective, independent studies should replicate the existing experiments in order to corroborate the conclusions raised in the original studies. Moreover, long-term investigations (decades) are also needed to obtain more compelling safety information of HTPs. (AU)

Dado el impacto del tabaquismo en las personas y en los Sistemas Nacionales de Salud, se ha vuelto una necesidad la evaluación continua de los nuevos productos de tabaco, especialmente cuando se afirma o se percibe que son menos dañinos que los cigarrillos convencionales (CC). El objetivo del presente manuscrito es presentar una revisión narrativa completa y actualizada de la literatura científica sobre la evaluación de los componentes dañinos y potencialmente dañinos (HPHC) y el impacto biológico y clínico de los productos de tabaco calentado (PTC), más novedosos, en comparación con los CC. Se analizaron un total de 52 estudios (46 de la revisión y 6 encontrados manualmente). A pesar de algunas diferencias existentes entre los estudios, la mayoría de ellos apuntan a una reducción de las emisiones de HPHC, así como a la exposición a sustancias tóxicas y, por lo tanto, en el impacto biológico y clínico con los PTC en comparación con los CC. En un posible escenario de personas que deciden seguir fumando, los PTC parecen ser una mejor opción que los CC. Estudios independientes prospectivos deberían replicar los experimentos existentes para corroborar las conclusiones planteadas en los estudios originales aquí presentados. De la misma manera, investigaciones a largo plazo (décadas) son necesarias para obtener información más completa sobre la seguridad de los PTC. (AU)

Evidencia científica sobre productos de tabaco calentado. Una revisión narrativa / Scientific evidence on heated-tobacco products. A narrative review

Dado el impacto del tabaquismo en las personas y en los Sistemas Nacionales de Salud, se ha vuelto una necesidad la evaluación continua de los nuevos productos de tabaco, especialmente cuando se afirma o se percibe que son menos dañinos que los cigarrillos convencionales (CC). El objetivo del presente manuscrito es presentar una revisión narrativa completa y actualizada de la literatura científica sobre la evaluación de los componentes dañinos y potencialmente dañinos (HPHC) y el impacto biológico y clínico de los productos de tabaco calentado (PTC), más novedosos, en comparación con los CC. Se analizaron un total de 52 estudios (46 de la revisión y 6 encontrados manualmente). A pesar de algunas diferencias existentes entre los estudios, la mayoría de ellos apuntan a una reducción de las emisiones de HPHC, así como a la exposición a sustancias tóxicas y, por lo tanto, en el impacto biológico y clínico con los PTC en comparación con los CC. En un posible escenario de personas que deciden seguir fumando, los PTC parecen ser una mejor opción que los CC. Estudios independientes prospectivos deberían replicar los experimentos existentes para corroborar las conclusiones planteadas en los estudios originales aquí presentados. De la misma manera, investigaciones a largo plazo (décadas) son necesarias para obtener información más completa sobre la seguridad de los PTC. (AU)

Given the impact of smoking on individuals and National Healthcare Systems, it has become necessary for the continuous evaluation of tobacco products, especially when they are claimed or perceived as being less harmful than conventional cigarettes (CCs), and coexisting conflict of interests. The objective of the present manuscript was to perform a complete and updated narrative review of scientific literature on the assessment of harmful and potentially harmful constituents (HPHCs) and the biological and clinical impact from the newest available heated tobacco products (HTPs), in comparison with CCs. A total of 52 studies (46 from the review and 6 manually found) were finally analyzed. Despite some existing differences among the studies, most of them point to a reduction of the emissions of HPHCs as well as exposure to toxicants, and thus in the biological and clinical impact with HTPs when compared with CCs. In the scenario where individuals decide to continue smoking, HTPs seem to be a better option than CCs. Further prospective, independent studies should replicate the existing experiments in order to corroborate the conclusions raised in the original studies. Moreover, long-term investigations (decades) are also needed to obtain more compelling safety information of HTPs. (AU)

Reliability and Validity of a Stress Scale in Public Employees from Murcia (Spain).

Stress is common in all work environments. Technostress and the difficulty of separating the family arena from the work environment are some of the new and emerging risks faced by companies, employees and society in general. Most of the available instruments for measuring stress in workers have been focused on education professionals and healthcare workers. Therefore, it is necessary to validate simple and friendly-use tools to detect stress levels in public workers. The aim of this study was to determine the internal consistency of an adapted version of the Student Stress Inventory-Stress Manifestations (SSI-SM) for public employees and to determine if high-stress levels are related to personal and work-related factors. A cross-sectional and descriptive study was conducted from October 2016 to February 2019 including 468 Spanish public workers based in Murcia. An adapted version of the SSI-SM was administered and data on personal and work-related factors were collected. Results showed that all of the factors had Cronbach's α over 0.700, and no items need to be deleted due to correlations with the factor exceeding 0.300. Factor 1, "Self-concept", has a Cronbach's α of 0.868, with values of 15.62 ± 4.99; factor 2, "Sociability", Cronbach's α: 0.853, with mean values of 13.33 ± 4.17; factor 3, "Somatization", Cronbach's α: 0.704, mean value of 5.35 ± 1.90 and: factor 4, "Uncertainty", Cronbach's α: 0.746, with a mean value of 8.19 ± 2.51. In conclusion, the internal consistency of the adapted SSI-SM for public employees with different work positions and shifts has been validated and determined. This study provides a useful tool for the early detection of stress in public employees and may be potentially useful for preventing the harmful consequences of stress.

Work Shift and Circadian Rhythm as Risk Factors for Poor Sleep Quality in Public Workers from Murcia (Spain).

The purpose of this study was to determine the prevalence of sleep quality and to investigate variables predicting the risk of poor sleep quality in public workers from Murcia (Spain). A cross-sectional and prospective study was conducted from October 2013 to February 2016 in 476 public workers. The Pittsburgh Sleep Quality Index was used to measure the quality of sleep, and the reduced scale of the Horne and Österberg Morningness-Eveningness Questionnaire was applied to analyze the circadian typology. The predictive variables of self-reported poor sleep quality were identified by multivariate logistic regression. No significant differences were found according to sex in the overall sleep quality scores (5 ± 2.9 versus 5.1 ± 3, p = 0.650), but there were in the duration of sleep. Three percent of females slept <5 hours compared to 2% of men (p = 0.034). Fixed morning shifts (OR = 1.9, 95% CI 1.3-3.1; p = 0.007) and evening chronotypes (OR = 1.6, 95% CI 1.0-2.3; p = 0.017) were independent predictors of suffering from poor sleep quality. In conclusion, the frequency of self-reported poor sleep quality among public workers from Murcia was 37.4%. Being a public worker with a fixed morning shift and having an evening chronotype demonstrated to be associated with the quality of sleep.