Haemochromatosis patients' research priorities: Towards an improved quality of life.

BACKGROUND: Chronic diseases are associated with a range of functional and psychosocial consequences that can adversely affect patients' quality of life (QoL). Haemochromatosis (HC) is a genetically heterogeneous disorder characterized by chronic iron overload that can ultimately lead to multiple organ dysfunction. Clinical diagnosis remains challenging due to the nonspecificity of symptoms and a lack of confirmatory genotyping in a substantial proportion of patients. Illness perception among HC patients has not been extensively investigated, lacking relevant information on how to improve their QoL. METHODS: We present the results of the first worldwide survey conducted in nearly 1500 HC respondents, in which we collected essential demographic information and identified the aspects that concern HC patients the most. RESULTS: Out of all the participants, 45.3% (n = 676) voiced their concern about physical and psychological consequences such as HC-related arthropathies, which can ultimately affect their social functioning. A similar proportion of patients (n = 635, 42.5%) also consider that better-informed doctors are key for improved HC disease management. Taking a patient-centred approach, we expose differences in patients' disease perspective by social and economic influences. CONCLUSIONS: We identify potential targets to improve patients' health-related QoL and reflect on strategic measures to foster gender equity in access to health resources. Finally, we make a call for a highly coordinated effort across a range of public policy areas to empower participants in the HC research process and design. PATIENT OR PUBLIC CONTRIBUTION: Nearly 1500 patients with hereditary HC responded to an anonymized online survey in which research and clinical priorities were addressed regarding this chronic and rare disease.

Variation in Nicotine Metabolization According to Biological Factors and Type of Nicotine Consumer.

This study aims to describe the nicotine metabolite ratio among tobacco smokers and electronic cigarette (e-cigarette) users and nonusers. We analyzed pooled data from a longitudinal and a cross-sectional study of the adult population from the city of Barcelona. The final sample included information on 166 smokers, 164 e-cigarettes users with nicotine, 41 e-cigarette users without nicotine, 95 dual users (users of both products), and 508 nonusers. We used log-linear models to control for the potential confounding effect of the daily number of cigarettes smoked. Salivary nicotine metabolic rate assessment included the rate of nicotine metabolism (cotinine/nicotine) and the nicotine metabolite ratio (trans-3'-hydroxycotinine/cotinine). Exclusive users of e-cigarette without nicotine have the lowest rate of nicotine metabolism (Geometric mean: 0.08, p-values < 0.001) while cigarette smokers have the highest (Geometric mean: 2.08, p-values < 0.001). Nonusers have lower nicotine metabolic rate than cigarette smokers (Geometric means: 0.23 vs. 0.18, p-value < 0.05). Younger individuals (18−44 years) have a higher rate of nicotine metabolism than older individuals (45−64 years and 65−89) (Geometric means: 0.53 vs. 0.42 and 0.31, respectively, p-values < 0.01) and individuals with lower body mass index (21−25 kg/m2) have a higher rate of nicotine metabolism than the rest (26−30 kg/m2 and 31−60 kg/m2) (Geometric means: 0.52 vs. 0.35 and 0.36, respectively-values < 0.01). Nicotine metabolic rates are useful biomarkers when reporting smoking status and biological differences between individuals.

Specific biomarker comparison in current smokers, e-cigarette users, and non-smokers.

INTRODUCTION: This study aims to address the existing gap in the literature, while adding evidence, by comparing tobacco-specific biomarkers (cotinine and nitrosamines: NNK, NNAL, NNN), and other biomarkers of e-cigarette use (humectants: glycerol, 1,2-PD, 1,3-PD) according to five study groups. METHODS: A pooling analysis including two different studies was conducted. In both analyses, we took saliva samples from smokers (n = 409) and non-smokers (n = 154), dual tobacco and e-cig users (n = 92), exclusive e-cig user with nicotine (n = 158), and exclusive e-cig users without nicotine (n = 38). We analyzed and compared the geometric means (GM) and geometric standard deviations (GSD) of the concentration of tobacco-specific biomarkers, and e-cigarette biomarkers among groups. We used log-linear models adjusted for sex and age to model the change percentage and their 95% confidence intervals. RESULTS: Cotinine was significantly higher in nicotine consumers and in e-cigarette users without nicotine when compared to non-smokers. TSNAs were generally significantly lower in non-smokers and higher in nicotine consumers. NNN and NNAL were lower in e-cigarette users with nicotine comparted to smokers, and NNN was higher in e-cigarette users without nicotine when compared to non-smokers. No differences were found in humectant biomarkers between e-cigarette groups. CONCLUSIONS: Although there was a reduction in TSNAs in e-cigarette exclusive users compared to smokers, and a reduction of cotinine concentrations in e-cigarette exclusive users without nicotine compared to smokers, there are still high levels of these biomarkers when compared to non-smokers, which may be a clue towards the harmful effect of e-cigarettes.

Asociación entre el tiempo de pantalla recreativo y el exceso de peso y la obesidad medidos con tres criterios diferentes entre residentes en España de 2-14 años / Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2–14 years

Introducción y objetivo: Los estudios que evalúan la relación entre la obesidad y el tiempo de pantalla en la infancia y adolescencia son heterogéneos y siguen diferentes criterios para medir la obesidad. Además, existen pocos estudios que incluyan la exposición a los teléfonos inteligentes y las tabletas. Este estudio tiene como objetivo determinar la relación entre el tiempo de pantalla de ocio diario y el exceso de peso (sobrepeso más obesidad) y obesidad, utilizando diferentes criterios en personas de 2 a 14 años residentes en España. Métodos: Estudio transversal con los datos de la Encuesta Nacional de Salud de España de menores del año 2017 (n=4.528). Se determinó el sobrepeso y la obesidad a partir de los criterios de la Organización Mundial de la Salud (OMS), International Obesity Task Force (IOTF) y Orbegozo 2011. Se categorizó el tiempo diario de pantalla para fines recreativos en minutos como: 0-59, 60-119, 120-179 y ≥180. Calculamos la razón de prevalencias cruda y ajustada (RPa) y los intervalos de confianza al 95% (IC 95%) de exceso de peso y obesidad según el tiempo de pantalla de ocio diario en minutos. Además, calculamos el cambio crudo y ajustado (Δa) y los IC 95% del número esperado de criterios de exceso de peso y obesidad cumplidos según el tiempo de pantalla recreativo en minutos. Ajustamos las asociaciones por las potenciales variables de confusión. Resultados: Utilizar las pantallas para el ocio al menos 180minutos diarios está asociado con una mayor prevalencia ajustada de tener exceso de peso (p. ej., Orbegozo 2011 RPa≥180: 1,20; IC 95%: 1,02-1,42) y obesidad (i.e. IOTF RPa≥180: 1,41; IC 95%: 1,06-1,86) y un mayor número esperado de criterios de exceso de peso cumplidos (Δa≥180: 1,18; IC 95%: 1,06-1,31). (AU)

Introduction and objective: Studies that assess the association between excess weight and screen time in childhood and adolescence are methodologically heterogeneous, and few studies have analysed the exposure to smartphones and tablets. Our study aimed to assess the association between daily recreational screen time and excess weight (overweight+obesity) and obesity in children aged 2-14 years residing in Spain using different sets of standards. Methods: We conducted a cross-sectional study using data from the 2017 Spanish National Health Survey (N=4528). We assessed the prevalence of overweight and obesity applying the criteria of the World Health Organization (WHO), International Obesity Task Force (IOTF), and Orbegozo 2011 study. We categorised daily recreational screen time in minutes as 0–59, 60–119, 120–179, and ≥180. We calculated crude and adjusted prevalence ratios (aPR) of excess weight and obesity based on the daily minutes of recreational screen time with the corresponding 95% confidence intervals (95%CI). Moreover, we calculated crude and adjusted change (aΔ) in the expected number of fulfilled excess weight/obesity criteria based on the minutes of daily recreational screen time with the corresponding 95% CI. We adjusted the association analyses for potential confounders. Results: We found that spending 180min or more a day of recreational screen time was associated with an increase in the adjusted prevalence of excess weight (e.g. Orbegozo 2011 aPR≥180, 1.20; 95% CI, 1.02–1.42) and of obesity (e.g. IOTF aPR≥180, 1.41; 95% CI, 1.06–1.86) as well as an increase in the adjusted number of fulfilled criteria for excess weight (aΔ≥180, 1.18; 95% CI, 1.06–1.31). (AU)

Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years.

INTRODUCTION AND OBJECTIVE: Studies that assess the association between excess weight and screen time in childhood and adolescence are methodologically heterogeneous, and few studies have analysed the exposure to smartphones and tablets. Our study aimed to assess the association between daily recreational screen time and excess weight (overweight+obesity) and obesity in children aged 2-14 years residing in Spain using different sets of standards. METHODS: We conducted a cross-sectional study using data from the 2017 Spanish National Health Survey (N=4528). We assessed the prevalence of overweight and obesity applying the criteria of the World Health Organization (WHO), International Obesity Task Force (IOTF), and Orbegozo 2011 study. We categorised daily recreational screen time in minutes as 0-59, 60-119, 120-179, and ≥180. We calculated crude and adjusted prevalence ratios (aPR) of excess weight and obesity based on the daily minutes of recreational screen time with the corresponding 95% confidence intervals (95%CI). Moreover, we calculated crude and adjusted change (aΔ) in the expected number of fulfilled excess weight/obesity criteria based on the minutes of daily recreational screen time with the corresponding 95% CI. We adjusted the association analyses for potential confounders. RESULTS: We found that spending 180min or more a day of recreational screen time was associated with an increase in the adjusted prevalence of excess weight (e.g. Orbegozo 2011 aPR≥180, 1.20; 95% CI, 1.02-1.42) and of obesity (e.g. IOTF aPR≥180, 1.41; 95% CI, 1.06-1.86) as well as an increase in the adjusted number of fulfilled criteria for excess weight (aΔ≥180, 1.18; 95% CI, 1.06-1.31). CONCLUSIONS: Longer periods of recreational screen time were associated with excess weight and obesity in children aged 2-14 years. Cohort studies are required to confirm these findings, as this may be a determinant of health in children.

Changes in the salivary cotinine cut-offs to discriminate smokers and non-smokers before and after Spanish smoke-free legislation.

INTRODUCTION: High levels of cotinine in non-smokers indicate passive exposure to tobacco smoke. This study aims to evaluate variations in salivary cotinine cut-offs to discriminate smokers and non-smokers before and after the implementation of smoke-free legislation (Law 28/2005 and Law 42/2010) in a sample of the adult population of Barcelona, Spain. METHODS: This longitudinal study analyzes salivary cotinine samples and self-reported information from a representative sample (n = 676) of the adult population from Barcelona before and after the approval of smoke-free legislation. We calculated the receiver operating characteristic (ROC) curves, to obtain optimal cotinine cut-off points to discriminate between smokers and non-smokers overall, by sex and age, and their corresponding sensitivity, specificity, and area under the curve. We used linear mixed-effects models, with individuals as random effects, to model the percentage change of cotinine concentration before and after the implementation of both laws. RESULTS: The mean salivary cotinine concentration was significantly lower post-2010 law (-85.8%, p < 0.001). The ROC curves determined that the optimal cotinine cut-off points for discriminating non-smokers and smokers were 10.8 ng/mL (pre-2005 law) and 5.6 ng/mL (post-2010 law), with a post-2010 law sensitivity of 92.6%, specificity of 98.4%, and an area under the curve of 97.0%. The post-2010 law cotinine cut-off points were 5.6 ng/mL for males and 1.9 ng/mL for females. CONCLUSION: The implementation of Spanish smoke-free legislation was effective in reducing secondhand smoke exposure and, therefore, also in reducing the cut-off point for salivary cotinine concentration. This value should be used to better assess tobacco smoke exposure in this population.

Knowledge and Opinions of Healthcare Professionals about Thirdhand Smoke: A Multi-National, Cross-Sectional Study.

There is scarce evidence on the knowledge and opinions about third-hand smoke (THS) of health care professionals. The main aim of this study was to explore the knowledge and opinions of health care professionals about THS and, secondarily, to explore the factors that are associated with this knowledge. Cross-sectional study using a snowball sample of multi-national health care professionals (n = 233). Data were obtained from an exploratory, online questionnaire. The health care professionals' knowledge and opinions on THS were described with absolute frequency and percentage. Chi-square and Fisher-Freeman-Halton exact tests, and simple logistic regression models, were used to explore the bivariate association between the knowledge of the concept THS and sex, continent of birth, educational level, occupation, years of experience, and attitude towards smoking. Finally, a multivariable logistic regression model incorporating all the above variables was fitted. A total of 65.2% of the participants were unaware of the term THS before the study began. In the bivariate analysis, an association was found between prior knowledge of the term THS and continent of birth (p-value = 0.030) and occupation (p-value = 0.014). In the multivariable logistic regression model, a significant association was observed between prior knowledge of the concept THS and sex (p-value = 0.005), continent of birth (p-value = 0.012), and occupation (p-value = 0.001). Almost two out of three health care professionals who participated in our study did not know what THS was. Educational activities on this topic should be implemented.

Compliance Surveillance of the Tobacco Control Legislation in a Spanish Region and Characterization of Passive Exposure to Tobacco Smoke and E-Cig in Children in Outdoor Spaces.

(1) Background: Exposure to environmental tobacco smoke has decreased in recent years in Spain, due to the implementation of tobacco control policies. However, there is no regulation that protects against second-hand smoke (SHS) in outdoor environments. Our goal is to describe the smoking prohibition signage in public spaces and to characterize tobacco consumption in outdoor environments describing the SHS exposure in children. (2) Methods: A cross-sectional study using direct observation was carried out with a convenience sample (n = 179) that included hospitality venues with terraces, schools and healthcare facilities in the municipality of Sant Cugat del Vallès (Barcelona, Spain). The observations were made without notifying the owners by one single field researcher between April and June 2018. The variables were evaluated by signage and signs of tobacco consumption (ashtrays, cigarette butts and presence of smokers). (3) Results: Smoke-free zone signage outside public spaces was present in 30.7% of all venues, with only 50.9% correctness. When analysing terraces of hospitality venues, in 35.8% of them there were children present with 66.7% of tobacco consumption. (4) Conclusions: Our results show a low prevalence of antismoking signage, without an impact on tobacco consumption regardless of the presence of children.

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning.

INTRODUCTION: Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes. MATERIALS AND METHODS: A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge. RESULTS: Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women. CONCLUSION: Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Association between biomarkers of tobacco consumption and lung cancer risk among daily smokers.

BACKGROUND: Biomarkers of tobacco consumption may play a role in the lung cancer risk assessment. However, the role of salivary biomarkers has not been well studied. The aim of this study is to assess the use of salivary biomarkers of tobacco consumption as lung cancer screening criterion. RESEARCH DESIGN AND METHODS: Data came from the Determinants of cotinine phase 3 project (Barcelona, 2013-2014). We compared the concentrations of TSNAs, including NNAL, NNN and NNK, and cotinine, in saliva samples of 142 daily smokers from the general population according to their risk of lung cancer. High risk of lung cancer was defined as per the inclusion criteria in the US National Lung Screening Trial (NLST) and in the Dutch-Belgian lung cancer screening trial (NELSON). RESULTS: Among daily smokers accomplishing the age criterion for lung cancer screening, salivary concentrations of cotinine, NNAL and NNK adjusted for sex were significantly higher (p-value < 0.05) in daily smokers at high risk of lung cancer compared to smokers not at high risk according to both NELSON and NLST criteria. CONCLUSIONS: Saliva concentrations of cotinine, NNAL and NNK may be used as additional criteria for lung cancer screening. Further research on this topic is guaranteed.

Association between Leisure Screen Time and Emotional and Behavioral Problems in Spanish Children.

OBJECTIVE: To assess the relation between leisure screen time and emotional and behavioral problems in Spanish children aged 4-14 years. STUDY DESIGN: This cross-sectional study used a representative sample of children aged 4-14 years included in the 2017 Spanish National Health Survey (n = 4073). Emotional and behavioral problems of children were assessed through the parent-report Strengths and Difficulties Questionnaire. Daily leisure screen time in minutes was categorized as 0-59, 60-119, 120-179, and ≥180. We calculated adjusted prevalence ratios (aPR) and their 95% CIs of being at risk of developing emotional and behavioral problems. Associations were adjusted for potential confounding variables. RESULTS: Children spending 180 minutes or more of daily leisure screen time compared with children spending less than 1 hour were more likely to be at risk of developing emotional and behavioral problems: aPR≥180: 2.19 (95% CI 1.53-3.14), emotional symptomology: aPR≥180: 2.09 (95% CI 1.37-3.18), conduct problems aPR≥180: 1.85 (95% CI 1.34-2.54), peer problems aPR≥180: 1.78 (95% CI 1.15-2.75), and to behave less prosocially: aPR≥180: 2.20 (95% CI 1.43-3.37). CONCLUSIONS: We have found significant associations between daily leisure screen time and emotional and behavioral problems in Spanish children between 6 and 14 years of age. However, these findings should be confirmed in cohort studies, so institutions might consider including screen time as a new risk factor for children.

Differences in sleep duration in a territory with the same time zone according to the geographic longitude: the Spanish case.

OBJECTIVE/BACKGROUND: In some territories, such as Spain, daytime starts with around 1 h of difference between the easternmost and westernmost areas, but the time zone is the same in these areas. This difference might have an effect on children's sleep. The aim of this study is to assess if there are differences in the prevalence of short sleep duration between children under 15 years from easternmost (Catalonia) and westernmost (Galicia) continental territory areas in Spain. METHODS: Cross-sectional study using data from the 2017 Spanish National Health Survey (n = 6106). The final sample includes 1004 children under 15 years living in Catalonia and Galicia. We categorized sleep duration according to the National Sleep Foundation recommendations with respect to age in (1) not short sleep duration and (2) short sleep duration. We calculated overall percentages of short sleep duration, and unadjusted and adjusted Prevalence Ratios (PR) with 95% Confidence Intervals (95% CI), according to area and stratified by confounders and covariates. Unadjusted and adjusted PR were obtained through generalized linear models with Poisson family and robust variance. We adjusted the associations for confounders. RESULTS: Children from Galicia were less likely to have short sleep duration than children from Catalonia, aPRGalicia = 0.61 (95% CI: 0.45,0.83). CONCLUSIONS: Children living in the same country, potentially with a similar timetable, could be having shorter sleep durations according to their longitude position. Further studies are needed in order to consider promoting policies to apply timetables based on the sun position instead of on the national time zone.

Association between Leisure Screen Time and Junk Food Intake in a Nationwide Representative Sample of Spanish Children (1-14 Years): A Cross-Sectional Study.

Evidence on the association between new patterns of leisure screen time and junk food consumption in Spanish children at the national level is scarce. The aim of this study is to assess the relation between daily leisure screen time and the frequency of sweet, soft drink, fast food, and snack intake in a representative sample of Spanish children and adolescents aged from 1 to 14 years. We conducted a cross-sectional study using a representative sample of the Spanish population under 15 years recruited for the 2017 Spanish National Health Survey (n = 5480). We dichotomized sweet, soft drink, fast food, and snack intake (high/low) and categorized daily leisure screen time (0-59, 60-119, 120-179, and ≥180 min). We calculated crude prevalence ratios and adjusted prevalence ratios, and their 95% confidence intervals (95% CI), of high frequency of sweet, soft drink, fast food, and snack intake. Children spending at least one hour of daily leisure screen time had higher prevalence of high frequency of sweet and snack intake than children being exposed less than one hour. For soft drinks and fast food, prevalence of high frequency intake was significantly higher from two and three hours of exposure, respectively. Longer periods of screen exposure in Spanish children during their leisure time may be associated with poorer dietary behaviors. The negative effects of excessive screen time in pediatrics population should be further studied.

Smartphone and Tablet Usage during COVID-19 Pandemic Confinement in Children under 48 Months in Barcelona (Spain).

BACKGROUND: Total lockdown due to COVID-19 pandemic might have potentially increased screen time in children. This study aims to describe the smartphone and tablets usage in children under 48 months living in Barcelona during the COVID-19 confinement. METHODS: Cross-sectional study using a non-probabilistic sample of parents with children under 48 months living in Barcelona (Spain) during COVID-19 confinement (n = 313). We calculated percentages of exposure to smartphones and tablets. Moreover, for those children were exposed, we calculated unadjusted and adjusted Geometric Mean Ratios (GMR) of daily smartphones and tablets usage and their 95% confidence intervals (95% CI) trough Generalized Linear Models with Gamma family and link log. Associations were adjusted for potential confounders. RESULTS: During COVID-19 confinement, 67.5% of children under 48 months were daily exposed to smartphones and tablets. Further, those children who were exposed during meals, as well as before going to bed, spend longer durations using them, aGMR = 2.38 (95% CI 1.73, 3.34) and aGMR = 1.95 (95% CI 1.34, 2.91) respectively. CONCLUSION: Two out of three children under 48 months living in Barcelona were daily exposed to smartphones and tablets during total lockdown due to COVID-19. Taking this findings into account cohort studies are needed to assess any change in the screen time patterns due to total confinement in order to allow the Government help families, particularly those more vulnerable, in a possible pandemic resurgence.

Association of screen time and sleep duration among Spanish 1-14 years old children.

BACKGROUND: Due to the change in screen time usage in the last decade, there is needed to add more evidence about the relationship of screen time and sleep duration. OBJECTIVE: To assess the association between screen time and sleep duration among Spanish children between 1 and 14 years old. METHODS: We used data from the 2017 Spanish National Health survey, conducted on a representative sample of the Spanish population. We categorised daily leisure screen time as 0-59, 60-119, 120-179, and ≥180 minutes. We classified sleep duration, depending on the age, as proper sleep duration and short sleep duration. We calculated unadjusted, and adjusted prevalence ratio (PR) and 95% confidence interval (CI) of short sleep duration according to daily leisure screen time after adjusting for potential confounders. PR's were derived from fitting generalised linear models with Poisson distribution and robust variance. RESULTS: Of the 5517 Spanish children aged 1-14 years, 44.3% spent 120 minutes or more of daily leisure screen time and 23.6% had short sleep duration. 24.5% and 28.2% of children spending between 120 and 179 minutes and exceeding 180 minutes of daily leisure screen time suffered short sleep duration, respectively. In the adjusted model, higher patterns of daily leisure screen time were associated with short sleep duration: adjusted PR120-179  = 1.34 (95% CI 1.18, 1.54) and adjusted PR≥180  = 1.48 (95% CI 1.27, 1.73). CONCLUSIONS: Around one out of four Spanish children between 1 and 14 years old, exceeding 120 minutes of daily leisure screen time, had short sleep duration. More scientific research is needed for institutions to work on providing novel healthcare programmes that consider these new determinants of child health.

Third-hand exposure at homes: Assessment using salivary cotinine.

BACKGROUND/OBJECTIVES: While exposure to secondhand smoke (SHS) is a well-established problem, exposure to third-hand smoke (THS) is scanty known and needs to be studied. The objective of this work is to characterize salivary cotinine concentrations among people who self-reported exposure to SHS and THS at home. METHODS: Cross-sectional study of a representative sample (n = 736) of the adult population (≥16 years) from the city of Barcelona carried out in 2013-2014. A questionnaire on tobacco use and passive exposure was administered, and a saliva sample was collected for cotinine determination. For this study, the information of the non-smoker participants who provided saliva sample (n = 519) was used. The geometric means (GM) and geometric standard deviations (GSD) of the cotinine concentration were compared according to the type of self-reported exposure at home: (1) Not exposed to SHS or THS; (2) Exposed to SHS and THS; and (3) Only exposed to THS. We used log-linear models to compare the cotinine concentration of each exposed group with respect to the unexposed group, adjusting for sex, age, educational level, and tobacco exposure in other settings. RESULTS: The GM of the salivary cotinine concentration was 0.34 ng/ml (GSD = 0.16) among individuals reporting SHS and THS exposure, 0.22 ng/ml (GSD = 0.15) among those reporting only THS exposure and 0.11 ng/ml (GSD = 0.04) among those who declared not to be exposed to SHS nor THS (p-value for trend <0.001). The regression model showed a statistically significant increase in cotinine concentration among those exposed to SHS and THS (188% higher, 95% CI: 153%; 223%), and only exposed to THS (106% higher, IC95. %: 74.5%; 137.0%) when comparing with the unexposed group. No statistically significant differences in cotinine concentration were observed between those exposed to SHS and THS compared to the THS group (-25.8%, 95% CI: -69.5%; 17.9%). CONCLUSIONS/RECOMMENDATIONS: People exposed to third-hand smoke at home had quantifiable cotinine levels in saliva. No differences in cotinine levels were found between those exposed to second-hand and third-hand smoke at home. The reduction of exposure to third-hand smoke at home should be put into the agenda of tobacco control.

Estimación del riesgo de cáncer de pulmón en mujeres que participan en un programa de cribado poblacional de cáncer de mama / Estimation of the Risk of Lung Cancer in Women Participating in a Population-Based Breast Cancer Screening Program

INTRODUCCIÓN: La mortalidad por cáncer de pulmón está aumentando en mujeres. Se ha proyectado que en España pueda superar a la mortalidad por cáncer de mama, la principal causa de mortalidad por cáncer en mujeres, en pocos años. El objetivo de este estudio es estimar la proporción de mujeres que presentan alto riesgo de desarrollar cáncer de pulmón en un grupo de participantes en un cribado poblacional de cáncer de mama. MÉTODOS: Estudio transversal de una muestra de mujeres que participaron en un cribado poblacional de cáncer de mama en el año 2016 en Hospitalet de Llobregat (n = 1.601). El riesgo elevado de cáncer de pulmón se definió según los criterios del National Lung Screening Trial (NLST) y del Dutch-Belgian randomised lung cancer screening trial (NELSON). RESULTADOS: Alrededor de un 20% y un 40% de fumadoras según los criterios NLST y NELSON, respectivamente, y alrededor de un 20% de exfumadoras según ambos criterios, presentan un alto riesgo de desarrollar cáncer de pulmón. Se observa una tendencia positiva, estadísticamente significativa, entre la proporción de mujeres que presentan alto riesgo y la dependencia a la nicotina medida por el test de Fagerström breve. CONCLUSIÓN: Una alta proporción de participantes en este cribado de cáncer de mama presenta un riesgo elevado de desarrollar cáncer de pulmón y sería elegible para participar en un programa de cribado de cáncer de pulmón. Los cribados poblacionales de cáncer de mama pueden ser útiles para implementar estrategias de prevención primaria de cáncer de pulmón

INTRODUCTION: Lung cancer mortality is increasing in women. In Spain, estimates suggest that lung cancer mortality may soon surpass breast cancer mortality, the main cause of cancer mortality among women. The aim of this study was to estimate the proportion of women at high risk of developing lung cancer in a group of participants in a population-based breast cancer screening program. METHODS: Cross-sectional study in a sample of women who participated in a population-based breast cancer screening program in 2016 in Hospitalet de Llobregat (n=1,601). High risk of lung cancer was defined according to the criteria of the National Lung Screening Trial (NLST) and the Dutch-Belgian randomized lung cancer screening trial (NELSON). RESULTS: Around 20% of smokers according to NLST criteria and 40% of smokers according to NELSON criteria, and around 20% of former smokers according to both criteria, are at high risk of developing lung cancer. A positive and statistically significant trend is observed between the proportion of women at high risk and nicotine dependence measured with the brief Fagerström test. CONCLUSIONS: A high proportion of participants in this breast cancer screening program have a high risk of developing lung cancer and would be eligible to participate in a lung cancer screening program. Population-based breast cancer screening programs may be useful to implement lung cancer primary prevention activities

Estrategias de prevención primaria y secundaria para reducir el impacto del cáncer de pulmón en las mujeres: ¿dónde nos encontramos y hacia dónde vamos? / Primary and Secondary Prevention Strategies to Reduce the Impact of Lung Cancer in Women: Where Are We Now and Where Are We Going?

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