Cristina Martínez

An international systematic review of smoking prevalence in addiction treatment.

AIMS Smoking prevalence is higher among people enrolled in addiction treatment compared with the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally. METHODS PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation and substance use disorders using and/or Boolean connectors. For 4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies, collectively comprising 37,364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated and smoking prevalence. RESULTS The random-effect pooled estimate of smoking across people in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%). The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates were higher in programs treating opiate use compared with alcohol use [odds ratio (OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs (OR = 1.42, CI = 1.19, 1.68). CONCLUSIONS Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder.

Lung cancer in never-smokers: a case–control study in a radon-prone area (Galicia, Spain)

The aim of the study was to assess the effect of residential radon exposure on the risk of lung cancer in never-smokers and to ascertain if environmental tobacco smoke modifies the effect of residential radon. We designed a multicentre hospital-based case–control study in a radon-prone area (Galicia, Spain). All participants were never-smokers. Cases had an anatomopathologically confirmed primary lung cancer and controls were recruited from individuals undergoing minor, non-oncological surgery. Residential radon was measured using alpha track detectors. We included 521 individuals, 192 cases and 329 controls, 21% were males. We observed an odds ratio of 2.42 (95% CI 1.45–4.06) for individuals exposed to ≥200 Bq·m−3 compared with those exposed to <100 Bq·m−3. Environmental tobacco smoke exposure at home increased lung cancer risk in individuals with radon exposure >200 Bq·m−3. Individuals exposed to environmental tobacco smoke and to radon concentrations >200 Bq·m−3 had higher lung cancer risk than those exposed to lower radon concentrations and exposed to environmental tobacco smoke. Residential radon increases lung cancer risk in never-smokers. An association between residential radon exposure and environmental tobacco smoke on the risk of lung cancer might exist. Residential radon exposure increases risk of lung cancer in never-smokers, ETS exposure may raise radon effect http://ow.ly/xRVte For editorial comments see page 850.

Second-hand smoke exposure in a sample of European hospitals

Smoking in hospitals is banned in many European countries; nevertheless, the level of compliance is diverse, and, in some cases, smoking areas remain. The present study describes the levels of second-hand smoke, as derived from respirable suspended particle measurements, in a sample of European hospitals during the year 2007. The present study was a multicentric descriptive cross-sectional study carried out in 30 hospitals in seven European countries (Austria, Belgium, France, Germany, Greece, Romania and Spain). Particulate matter with a 50% cut-off aerodynamic diameter of 2.5 μm (PM2.5) concentration was measured by means of a hand-held laser-operated monitor of particle size and mass concentration in six selected indoor locations. Medians and interquartile ranges of PM2.5 concentration were computed in order to describe the data by country and location of measurement. The median PM2.5 concentration in all countries and locations was 3.0 μg·m−3, with half of the measurements ranging 2.0–7.0 μg·m−3. PM2.5 levels were similar across countries. Eleven (5.5%) measurements were >25.0 μg·m−3, which is the 24-h mean limit recommended by the World Health Organization outdoor air quality guideline. The present results show that exposure to second-hand smoke in this sample of European hospitals is very low, and can be easily monitored in order to ensure smoke-free legislation compliance.

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.

Residential radon, EGFR mutations and ALK alterations in never-smoking lung cancer cases

The aim of this study was to assess if residential radon exposure might cause EGFR mutations or ALK rearrangements in never-smokers. We designed a multicentre case–control study in a radon-prone area (Galicia, Spain); only lung cancer cases were included in the study. We obtained residential radon measurements and clinical information for all the participants. We compared the median values of residential radon between patients with EGFR mutations or ALK rearrangements versus those without them. 323 patients were included. Median age was 70 years and 19.5% were males. 42 and 15% of patients were EGFR- and ALK-positive, respectively. The most frequent EGFR alterations were exon 19 deletions and exon 21 (L858R) single-point substitution mutations. ALK-positive patients were 10 years younger than ALK-negative patients. Residential radon levels were two-fold higher in patients with exon 19 deletions compared with patients with exon 21 (L858R) single-point substitution mutations (216 versus 118 Bq·m−3; p=0.057). There were no differences in residential radon levels by EGFR mutation status. ALK-positive patients (n=12) essentially had two-fold residential radon levels compared with ALK-negative patients (290 versus 164 Bq·m−3, respectively). Residential radon may have a role in the molecular signature of lung cancer in never-smokers, although more studies with larger sample sizes are needed to support this hypothesis. Residential radon might cause genetic alterations in driver genes for lung cancer in never-smokers http://ow.ly/1u4P302JdBs

Secondhand smoke in outdoor settings: smokers’ consumption, non-smokers’ perceptions, and attitudes towards smoke-free legislation in Spain

Objective To describe where smokers smoke outdoors, where non-smokers are exposed outdoors to secondhand smoke (SHS), and attitudes towards smoke-free outdoor areas after the implementation of national smoke-free legislation. Design This cross-sectional study was conducted between June 2011 and March 2012 (n=1307 participants). Setting Barcelona, Spain. Participants Representative, random sample of the adult (≥16 years) population. Primary and secondary outcomes Proportion of smoking and prevalence of exposure to SHS in the various settings according to type of enclosure. Percentages of support for outdoor smoke-free policies according to smoking status. Results Smokers reported smoking outdoors most in bars and restaurants (54.8%), followed by outdoor places at work (46.8%). According to non-smokers, outdoor SHS exposure was highest at home (42.5%) and in bars and restaurants (33.5%). Among non-smoking adult students, 90% claimed exposure to SHS on university campuses. There was great support for banning smoking in the majority of outdoor areas, which was stronger among non-smokers than smokers. Over 70% of participants supported smoke-free playgrounds, school and high school courtyards, and the grounds of healthcare centres. Conclusions Extending smoking bans to selected outdoor settings should be considered in further tobacco control interventions to protect non-smokers from SHS exposure and to establish a positive model for youth. The majority of public support for some outdoor smoke-free areas suggests that it is feasible to extend smoking bans to additional outdoor settings.

Predictors of quit attempts among smokers enrolled in substance abuse treatment

INTRODUCTION This study investigates factors predicting past year quit attempts among smokers enrolled in substance abuse treatment in New York State. METHODS Data were drawn from two prior cross-sectional surveys conducted among clients treated in 10 randomly selected substance abuse treatment programs. Among 820 clients recruited, 542 self-identified as current smokers, and 485 provided information about their quit attempts. The main outcome was reporting a quit smoking attempt in the past year, dichotomized as quit attempters or non-quit attempters. Univariate and multivariate logistic regression analyses were performed to explore predictors of attempting to quit. RESULTS Half of substance abuse clients in treatment programs reported a past year quit attempt. Quit attempters were more likely to be in a preparation and contemplation stage of change (preparation: OR=2.68, 95% CI: 1.51-4.77; contemplation: OR=2.96 95% CI: 1.61-5.42), reported more positive attitudes toward quitting (OR=1.49; 95% CI: 1.11-1.99) and received more cessation services than non-quit attempters (OR=1.21; 95% CI: 1.11-1.99). CONCLUSIONS Addressing patient attitudes about quitting smoking, having clinicians address smoking in the course of addiction treatment, and offering interventions to increase readiness to quit may contribute to increased quit attempts in smokers enrolled in addiction treatment programs.

Residential radon and lung cancer characteristics in never smokers

Abstract Purpose: The aim of this study is to assess if there is a relationship between residential radon and lung cancer histological types and patients’ age at diagnosis. Materials and methods: We conducted a multicenter hospital-based case-control study with eight participating hospitals. We included 216 never-smoking cases with primary lung cancer and 329 never-smoking controls. Controls were frequency matched with cases on age and sex distribution. Of them, 198 cases (91.7%) and 275 controls (83.5%) had residential radon measurements. Results: Lung cancer risk reached statistical significance only for adenocarcinoma (Odds ratio [OR] 2.19; 95% Confidence interval [CI] 1.44–3.33), for other histologies the results were marginally significant. Residential radon level was higher for patients diagnosed before 50 and 60 years old than for older lung cancer cases. Conclusions: Residential radon in never smokers seems to be a risk factor for all lung cancer histologies. Individuals diagnosed at a younger age have a higher residential radon concentration, suggesting an accumulative effect on lung cancer appearance.

Leisure time activities related to carcinogen exposure and lung cancer risk in never smokers. A case-control study

We aim to assess the relationship between leisure time activities related to exposure to carcinogenic substances and lung cancer risk in a hospital-based case-control study performed in never smokers. We included never smoking cases with anatomopathologically confirmed lung cancer and never smoking controls undergoing trivial surgery, at 8 Spanish hospitals. The study was conducted between January 2011 and June 2013. Participants were older than 30 and had no previous neoplasms. All were personally interviewed focusing on lifestyle, environmental tobacco smoke exposure, occupational history and leisure time activities (including duration of such activities). Results were analyzed through logistic regression and adjusted also by residential radon and education level. We included 513 never smokers, 191 cases and 322 controls. The OR for those performing the studied leisure time activities was 1.43 (95%CI 0.78-2.61). When we restricted the analysis to those performing do-it-yourself activities for more than 10 years the OR was 2.21 (95%CI 0.93-5.27). Environmental tobacco smoke exposure did not modify this association. The effect for the different lung cancer histological types was very close to significance for adenocarcinoma but only when these activities were performed for more than 10 years. We encourage health professionals to recommend protective measures for those individuals while performing these hobbies to reduce the risk of lung cancer.

Dificultades en la valoración enfermera

Resumen La valoracion es la primera etapa del proceso de atencion de enfermeria (PAE). En ella se realiza la valoracion del estado de salud de la persona, familia o comunidad y tiene como proposito recoger y organizar informacion. Cuando la recogida de datos se organiza de forma exhaustiva, se facilita la evaluacion de la salud y el diagnostico enfermero En este articulo presentamos nuestro trabajo de investigacion, cuyo principal objetivo es conocer las dificultades mas habituales de las enfermeras de nuestro centro durante la etapa de valoracion El metodo para recoger los datos ha consistido en una encuesta realizada a una muestra a 34 enfermeras, que previamente habian realizado una valoracion enfermera siguiendo el modelo conceptual de Virginia Henderson. El diseno utilizado es descriptivo transversal retrospectivo. Las variables analizadas han sido los conocimientos, habilidades, estrategias, la motivacion y el tiempo para realizar la valoracion enfermera Los principales problemas que se identifican son el tiempo necesario, con una media de 71,25 min, y la dificultad para valorar determinadas necesidades, como la necesidad de creencias y valores, la necesidad de ocuparse y la necesidad de evitar peligros Tras analizar los resultados obtenidos decidimos reforzar las estrategias de trabajo y profundizar en algunos aspectos de la valoracion enfermera que nos ayuden en la busqueda del diagnostico enfermero mas adecuado a cada situacion de vida. Por ello, creemos conveniente aumentar nuestros conocimientos en determinadas areas deficitarias e incrementar la experiencia en la elaboracion de planes de cuidados