Comparing infant and toddler sleep patterns prior to and during the first wave of home confinement due to COVID-19 in Spain.

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children's functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017-2018, n = 1380) and another during COVID-19 pandemic (March-May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p < 0.001). Based on the recommended BISQ criteria, we observed an increase in poor sleepers meeting at least one criterion of inadequate patterns during confinement (p < 0.001). Parental perception of a child's sleep as problematics were 39.4% and 44.1% (adjusted p = 0.363) before and under lockdown, respectively. CONCLUSION: Home confinement generally affected infant's and toddler's sleep patterns negatively; however, parents did not report worse perception of sleep quality of their children. Follow-up studies can help understand the potential long-term effects of the COVID-19 pandemic on sleep patterns. WHAT IS KNOWN: • Adequate sleep patterns in infants and toddlers are relevant as they are linked to proper and long-term social-emotional development as well as adequate daytime functioning. • Regarding sleep patterns in paediatrics during the COVID pandemic, recent literature has described an increase in total daily sleep time as well as more exposure to screens in children and adolescents, providing evidence of immediate collateral consequences of the COVID-19 outbreak. WHAT IS NEW: • Comparing sleep patterns in two samples of infants and toddlers in Spain before and during COVID-confinement, we found later bedtimes as well as a significant increase in infants' and toddlers' sleep latency by >30 min during confinement. • Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children's sleep based on the BISQ criteria.

Correlation between tobacco control policies and mortality of haematological cancers across Europe: An ecological study.

INTRODUCTION: To determine the correlation between tobacco control policies and mortality of haematological malignancies: leukemia, lymphoma and multiple myeloma (MM). METHODS: Ecological study with the countries as the unit of analysis. Tobacco Control Scale (TCS) scores from 2010, 2013 and 2016 were used as measures for the level of tobacco control policy implementation in 27 European countries. Mortality rates for leukemia, lymphoma, and MM, were obtained from the WHO Mortality Database and the European Cancer Information System for each country for 2010, 2013, 2015 and 2018. Correlation between yearly TCS scores and mortality rates from the same and prospective years were calculated using Spearman's rank correlation coefficients (rsp) and 95% confidence intervals (95% CI) (2010 TCS scores vs 2010, 2013, 2015, 2018 mortality rates; 2013 TCS scores vs 2013, 2015, 2018 mortality rates; and 2016 TCS scores vs 2018 mortality rates). RESULTS: The 2010 TCS scores were significantly negatively associated with leukemia mortality rates in 2013 (rsp=-0.58; 95% CI: -0.79, -0.24; p=0.002), 2015 (rsp=-0.65; 95% CI: -0.85, -0.30; p=0.001) and 2018 (rsp=-0.44; 95% CI: -0.71, -0.06; p=0.021). TCS scores from 2013 and 2016 had significant negative associations with leukemia mortality in all prospective years. TCS scores did not demonstrate consistent correlations with lymphoma and MM mortality. CONCLUSIONS: The level of tobacco control policies in European countries correlates negatively with leukemia mortality at ecological level, with no correlation seen for lymphoma and MM. This study advocates that increased tobacco control implementation may improve leukemia mortality.

Mortalidad atribuible al consumo de tabaco en España 2016 / Smoking-Attributable Mortality in Spain in 2016

INTRODUCCIÓN: La mortalidad atribuible (MA) al consumo de tabaco es un indicador valioso que permite caracterizar la evolución y el impacto en la salud poblacional de la epidemia tabáquica. El objetivo de este trabajo es estimar la MA al consumo de tabaco en España en 2016 en población ≥ 35 años utilizando la mejor evidencia disponible. MÉTODOS: Se aplicó un método dependiente de las prevalencias de consumo de tabaco basado en el cálculo de fracciones atribuidas poblacionales. Las prevalencias de consumo (fumadores-exfumadores-nunca fumadores) proceden de la estimación combinada de la Encuesta Nacional de Salud-2016 y la Europea-2014; el exceso de riesgo de morir en fumadores y exfumadores del seguimiento de diferentes cohortes; y la mortalidad observada del Instituto Nacional de Estadística. Se presenta la estimación global de MA y en función del sexo, grupos de edad y grandes grupos de enfermedades (cáncer, cardiometabólicas y respiratorias), acompañadas de las fracciones atribuidas poblacionales. RESULTADOS: En 2016 se atribuyeron 56.124 muertes al consumo de tabaco, el 84% sucedieron en hombres (47.000) y el 50% en mayores de 74 años (27.795). El 50% de la MA fue por tumores (28.281), de los cuales el 65% fueron de pulmón. Una de cada cuatro muertes (13.849) ocurrió antes de los 65 años. CONCLUSIONES: Una de cada siete muertes que ocurrieron en España en 2016 se atribuyen al consumo de tabaco. Esta estimación permite objetivar el gran impacto que el consumo de tabaco tiene en la mortalidad, especialmente por cáncer de pulmón y enfermedad pulmonar obstructiva crónica

INTRODUCTION: Smoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence. METHODS: A smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, or current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiovascular diseases and respiratory diseases. RESULTS: In 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65. CONCLUSIONS: One in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease

Smoking-Attributable mortality in Spain in 2016.

INTRODUCTION: Smoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence. METHODS: A smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases. RESULTS: In 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65. CONCLUSIONS: One in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.

Communication issues in nutritional observational research.

Observational epidemiological studies involving foods and nutrients often attract great attention from both the press and the public as they involve substances that are part of the daily lives of millions of individuals. In the digital era, findings of this research can be disseminated to very large audiences almost instantaneously, informing health beliefs and potentially triggering lifestyle changes. In this context, communication of results from observational nutritional epidemiology often involves specific issues that may limit the accuracy of the information ultimately being delivered to the public. In this narrative review we discuss some of these issues, with a special attention to the selective reporting of research studies by the media, the presentation of study findings as if they were free of bias, the reporting of inconsistent study results, and the issues related to the real-life uptake of research findings presented in the press. Collaborative efforts by all stakeholders involved in the dissemination process may help ameliorate this situation, and with this purpose we discuss some innovative approaches that may help reduce these issues.

Smoking among hospitalized patients: A multi-hospital cross-sectional study of a widely neglected problem.

INTRODUCTION: A comprehensive smoking ban was recently enacted for acute-care hospital campuses in Spain. The aim of this study was to assess the prevalence and patterns of smoking among inpatients before and during hospitalization. METHODS: Multi-center cross-sectional study was conducted in 13 hospitals in the province of Barcelona, Spain from May 2014 to May 2015. Participants were adults who provided informed consent. The sample size was calculated to be representative of each hospital (prevalence 29.4%, precision ± 5%, error 5%). We approached 1228 subjects, 888 accepted to participate and 170 were replaced (were not available or declined to participate). Final sample comprised 1047 subjects. We used a computer-assisted personal interview system to collect data, including sociodemographic variables and use of tobacco before and during hospitalization. Smoking status was validated with exhaled carbon monoxide. We calculated overall tobacco prevalence and investigated associations with participant and center characteristics. We performed multiple polytomous and multilevel logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustments for potential confounders. RESULTS: In all, 20.5% (95% CI: 18.1-23.0) of hospitalized patients were smokers. Smoking was most common among men (aOR=7.47; 95% CI: 4.88-11.43), young age groups (18-64 years), and individuals with primary or less than primary education (aOR=2.76; 95% CI: 1.44-5.28). Of the smokers, 97.2% were daily consumers of whom 44.9% had medium nicotine dependence. Of all smokers, three-quarters expressed a wish to quit, and one-quarter admitted to consuming tobacco during hospitalization. CONCLUSIONS: Our findings indicate the need to offer smoking cessation interventions among hospitalized patients in all units and service areas, to avoid infringements and increase patient safety, hospital efficiency, and improve clinical outcomes. Hospitalization represents a promising window for initiating smoking interventions addressed to all patients admitted to smoke-free hospitals, specially after applying a smoke-free campus ban.

Plataformas digitales y empleo: necesidad de monitorización y vigilancia de salud pública / No disponible

No disponible

Attitudes of students of a health sciences university towards the extension of smoke-free policies at the university campuses of Barcelona (Spain) / Actitudes de los estudiantes de una universidad de ciencias de la salud sobre la extensión de las políticas de espacios sin humo en los campus universitarios de Barcelona (España)

Objective: To assess attitudes towards the extension of outdoor smoke-free areas on university campuses. Methods: Cross-sectional study (n=384) conducted using a questionnaire administered to medical and nursing students in Barcelona in 2014. Information was obtained pertaining to support for indoor and outdoor smoking bans on university campuses, and the importance of acting as role models. Logistic regression analyses were performed to examine agreement. Results: Most of the students agreed on the importance of health professionals and students as role models (74.9% and 64.1%, respectively) although there were statistically significant differences by smoking status and age. 90% of students reported exposure to smoke on campus. Students expressed strong support for indoor smoke-free policies (97.9%). However, only 39.3% of participants supported regulation of outdoor smoking for university campuses. Non-smokers (OR=12.315; 95% CI: 5.377-28.204) and students ≥22 years old (OR=3.001; 95% CI: 1.439-6.257) were the strongest supporters. Conclusions: The students supported indoor smoke-free policies for universities. However, support for extending smoke-free regulations to outdoor areas of university campuses was limited. It is necessary to educate students about tobacco control and emphasise their importance as role models before extending outdoor smoke-free legislation at university campuses (AU)

Objetivo: Evaluar las actitudes hacia la extensión de las políticas de campus exteriores sin humo. Métodos: Estudio transversal (n=384) mediante cuestionario administrado a estudiantes de enfermería y medicina de Barcelona en 2014. Se obtuvo información sobre el apoyo a los recintos universitarios sin tabaco (interior y exterior) y el acuerdo con el rol ejemplar. Se realizaron análisis de regresión logística para examinar el acuerdo. Resultados: La mayoría de los estudiantes están de acuerdo en la importancia del rol ejemplar de los profesionales y de los estudiantes sanitarios (74,9% y 64,1%, respectivamente), aunque hay diferencias estadísticamente significativas por edad y consumo de tabaco. El 90% afirman estar expuestos al tabaco en el campus. Existe un gran apoyo a los espacios interiores libres de humo (97,9%), pero solo el 39,3% apoya la regulación de los espacios exteriores en el campus; los no fumadores (odds ratio [OR]=12,315; intervalo de confianza del 95% [IC95%]: 5,377-28,204) y el grupo de ≥22 años de edad (OR=3,001, IC95%: 1,439- 6,257) expresaron el mayor apoyo. Conclusiones: Los estudiantes apoyan las prohibiciones de consumo de tabaco en los espacios interiores de las universidades. Existe un apoyo limitado para extender la regulación de espacios sin humo a los exteriores de los campus universitarios. Es necesario sensibilizar a los estudiantes sobre el control del tabaco y fomentar su rol ejemplar antes de extender la legislación de espacios exteriores (AU)

Attitudes of students of a health sciences university towards the extension of smoke-free policies at the university campuses of Barcelona (Spain).

OBJECTIVE: To assess attitudes towards the extension of outdoor smoke-free areas on university campuses. METHODS: Cross-sectional study (n=384) conducted using a questionnaire administered to medical and nursing students in Barcelona in 2014. Information was obtained pertaining to support for indoor and outdoor smoking bans on university campuses, and the importance of acting as role models. Logistic regression analyses were performed to examine agreement. RESULTS: Most of the students agreed on the importance of health professionals and students as role models (74.9% and 64.1%, respectively) although there were statistically significant differences by smoking status and age. 90% of students reported exposure to smoke on campus. Students expressed strong support for indoor smoke-free policies (97.9%). However, only 39.3% of participants supported regulation of outdoor smoking for university campuses. Non-smokers (OR=12.315; 95% CI: 5.377-28.204) and students ≥22 years old (OR=3.001; 95% CI: 1.439-6.257) were the strongest supporters. CONCLUSIONS: The students supported indoor smoke-free policies for universities. However, support for extending smoke-free regulations to outdoor areas of university campuses was limited. It is necessary to educate students about tobacco control and emphasise their importance as role models before extending outdoor smoke-free legislation at university campuses.

Smoking cessation after 12 months with multi-component therapy.

Smoking is one of the most important causes of morbidity and mortality in developed countries. One of the priorities of public health programmes is the reduction of its prevalence, which would involve millions of people quitting smoking, but cessation programs often have modest results, especially within certain population groups. The aim of this study was to analyze the variables determining the success of a multicomponent therapy programme for smoking cessation. We conducted the study in the Smoking Addiction Unit at the Hospital of Manresa, with 314 patients (91.4% of whom had medium or high-level dependency). We observed that higher educational level, not living with a smoker, following a multimodal programme or smoking cessation with psychological therapy, and pharmacological treatment are relevant factors for quitting smoking. Abstinence rates are not associated with other factors, such as sex, age, smoking behaviour characteristics or psychiatric history. The combination of pharmacological and psychological treatment increased success rates in multicomponent therapy. Psychological therapy only also obtained positive results, though somewhat more modest.

Abstinencia a los 12 meses de un programa multicomponente para dejar de fumar / Smoking cessation after 12 months with multi-component therapy

El tabaquismo es una de las causas de morbimortalidad más importantes en los países desarrollados. Uno de los objetivos prioritarios de los programas de salud pública es la disminución de su prevalencia lo que implica que millones de personas dejen de fumar, sin embargo los programas de cesación a menudo tienen resultados discretos, especialmente con algunos grupos de población. El objetivo de este estudio fue analizar la eficacia de un tratamiento de cesación tabáquica multicomponente realizado en una unidad de tabaquismo hospitalaria. Fue realizado en la Unidad de Tabaquismo del Hospital de Manresa, e incluyó 314 pacientes (91,4% presentaban un nivel de dependencia medio o alto). Se observó que el nivel de estudios, no convivir con fumadores, seguir la terapia multicomponente y utilizar tratamiento farmacológico son factores relevantes en el éxito al dejar de fumar. La tasa de abstinencia no se asocia con otras características como el sexo, la edad, las características del hábito tabáquico o el presentar antecedentes psiquiátricos. La combinación del tratamiento farmacológico y psicológico aumentó las tasas de éxito en la terapia multicomponente. La terapia psicológica única también obtuvo resultados positivos aunque más modestos

Smoking is one of the most important causes of morbidity and mortality in developed countries. One of the priorities of public health programs is the reduction of its prevalence, which means millions of people quit smoking, but cessation programs often have modest results, especially within some population groups. The aim of this study was to analyze the variables determining the success of a multicomponent therapy program for smoking cessation. We conducted the study in the Tobacco Unit of the Hospital of Manresa, with 314 patients (91.4% have a medium or high level dependency). We observed that education and not living with a smoker, following a multimodal program for smoking cessation with psychological therapy and pharmacological treatment are relevant factors to quit. The abstinence rate is not associated with other factors such as sex, age, and the characteristics of the smoking behavior or psychiatric history. The combination of pharmacological and psychological treatment increased success rates in multicomponent therapy. Psychological therapy only also obtained positive, through more modest results

Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys.

BACKGROUND: Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws. METHODS: Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law). RESULTS: Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project. CONCLUSIONS: A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.

Assessment of the smoke-free outdoor regulation in the WHO European Region.

OBJECTIVE: The aim of this study is to assess the level of protection of secondhand smoke in outdoor locations among countries belonging to the WHO European Region. METHOD: This cross-sectional study measures the level of protection provided by laws in outdoor locations. A protocol to evaluate the outdoor smoke-free legislation was developed according to the recommendations provided by the WHO Guidelines for implementing smoke-free outdoor places. For each law 6 main sectors and 28 outdoor locations were evaluated. RESULTS: 68 laws from 48 countries were reviewed, totally assessing 1758 locations. Overall 3.1% of the locations specified 100% smoke-free outdoor regulation without exceptions, 2.5% permitted smoking in designated outdoor areas, 37.5% allowed smoking everywhere, and 56.9% did not provide information about how to deal with smoking in outdoor places. In the Education sector 17.8% of the laws specified smoke-free outdoor regulation, mainly in the primary and secondary schools. Three pioneering laws from recreational locations and two from general health facilities specified 100% outdoor smoke-free regulation. CONCLUSION: Outdoor smoke-free policies among countries belonging to the WHO European Region are limited and mainly have been passed in the primary and secondary schools, which protect minors from the hazards of secondhand smoke in educational settings.

Protection from secondhand smoke in countries belonging to the WHO European Region: an assessment of legislation.

OBJECTIVES: Comprehensive smokefree laws, as recommended by the WHO Framework Convention of Tobacco Control (WHO FCTC), are the most effective tool to protect the population from secondhand smoke (SHS) and to ensure healthy environments. Studies evaluating how laws govern SHS protection are scarce. This study assessed the level of protection from SHS of laws from countries belonging to the WHO European Region. METHODS: A new methodology system was developed to evaluate the smokefree legislation according to the principles provided by the WHO guidelines for the correct implementation of Article 8 of the FCTC. For each law, six main sectors and 28 facilities were evaluated. RESULTS: Overall 68 laws from 48 countries from the WHO European Region were reviewed. 'Education' and 'Public transport' were the most protected sectors from SHS. Many WHO European laws do not provide protection from SHS across all public sectors. For example, 48.5% of general health facilities and 71.2% of restaurants are unprotected from SHS. The level of protection provided in the 28 facilities studied was low; many WHO European laws still allow smoking under certain conditions, permitting smoking in designated and/or ventilated areas. CONCLUSIONS: Nine years after the adoption of the WHO FCTC there are still legal formulas in which smoking is allowed in several facilities, through the inclusion of separated areas, ventilated areas and other conditions. Tobacco control efforts still face the challenge of eradicating the legal clauses that prevent 100% smokefree environments.

Questionnaire-based second-hand smoke assessment in adults.

BACKGROUND: Numerous studies have assessed second-hand smoke (SHS) exposure but a gold standard remains to be established. This study aimed to review how SHS exposure has been assessed in adults in questionnaire-based epidemiological studies. METHODS: A literature search of original papers in English, French, Italian or Spanish published from January 2000 to May 2011 was performed using PubMed. The variables recorded for each study included target population, sample size, validation of the SHS questions, study design and phrasing of every question used to assess SHS exposure. For each item, information such as the setting where exposure was assessed or the indicator used to ascertain SHS exposure was extracted. RESULTS: We retrieved 977 articles, of which 335 matched the inclusion criteria. The main objective of 75.8% of the studies was to assess SHS exposure.The proportion of validated questions aiming to ascertain SHS exposure was 17.9%. Most studies collected data only for one (40.3%) or two settings (33.4%), most frequently the home (83.9%) and workplace (57%). The most commonly used indicator to ascertain exposure was the presence of smokers and 68.9% of the studies included an item to assess the intensity of SHS exposure. CONCLUSIONS: The variability in the indicators and items used to ascertain SHS exposure is very high, whereas the use of items derived from validated studies remains low. Identifying the diverse settings where SHS exposure may occur is essential to accurately assess exposure over time. A standard set of items to identify SHS exposure in distinct settings is needed.

[Mortality and hospital utilization due to breast cancer in Extremadura, Spain (2002-2004)]. / Mortalidad y frecuencia hospitalaria de tumor maligno de mama en Extremadura (2002-2004).

OBJECTIVE: To provide an update on breast cancer mortality and hospital utilization in the autonomous region of Extremadura (Spain). METHOD: We performed a retrospective, cross-sectional study of breast cancer in Extremadura, using the minimum data set and the death register as data sources. The means and standard deviation (SD) are presented. Crude, age-specific, and standardized mortality rates were calculated and expressed as rates per 100,000 women. The potential years of life lost were also calculated. RESULTS: In the period studied, there were 413 deaths, 1,233 hospital admissions, and 1,809 discharges due to malignant breast disease. The mean age at the time of death and hospital discharge was 70.0 years (SD 14.9) and 59.9 years (SD 14.3), respectively. The mean length of hospital stay was 8.9 days (SD 6.3). A total of 3,423 potential years of life were lost. The highest mortality rates of breast cancer were observed in the health area of Llerena and the lowest in the health area of Coria. CONCLUSIONS: The pattern of breast cancer mortality in Extremadura is typical of developed countries with higher mortality among older age groups. The aged-adjusted rate in Extremadura is lower than that in Spain for the period 1996-2000.