The long road towards cancer prevention: 4 steps backward and 8 forward

At the same time andpartly as a consequence, prevalence of cancer has been risingfrom about 1.5% to 3%, especially in people of higher SES.Thus, despite better diagnoses and treatments to patients,the cancer burden is still increasing. A variety of strategieswhich integrate disease prevention policies across a widerpopulation are needed to deliver better global results: oncol-ogy might be making progress in detection and treatmentbut losing ground in prevention.This narration is not new. The ‘Europe against Cancer’ pro-gramme, which ran from 1986 to about 2002,

Association between toenail scandium levels and risk of acute myocardial infarction in European men: the EURAMIC and Heavy Metals Study

The association between scandium status and risk of acute myocardial infarction (MI) was examined in a multicentre case control study in 10 centres from Europe and Israel. Scandium in toenails was assessed in 684 cases and 724 controls less than 70 years of age. Mean concentrations of toenail scandium were 6.74 micro/kg in cases and 7.75 microg/kg in controls. Scandium among controls, adjusted for age and centre was positively associated with concentrations of lycopene and oleic acid in adipose tissue (P = 0.002 for both nutrients). Pearson correlations adjusted for age and centre were significant (P0.05) between scandium and lycopene (r = 0.08), zinc (r = 0.08), mercury (r = 0.18) and olei…

Erosion of universal health coverage in Spain

Whereas the recent UN resolution urges governments to accelerate progress towards universal access to affordable and quality health-care services, the Spanish Government, bypassing the parliamentary procedure, enacted a Royal Decree to limit access to free services at the point of delivery for all-undermining the principle of universal coverage. Spanish health and social service budgets have been subjected to large cuts (13,7% in 2012 and 16,2% in 2013) with some regions imposing additional budget cuts.

The potential link between episodes of diverticulitis or hemorrhoidal proctitis and diets with selected plant foods : a case-control study

Diverticulitis and hemorrhoidal proctitis in the population are significant public health problems. We studied the potential association between the intake of certain plant foods and diverticulitis or hemorrhoidal episodes through a case–control study including 410 cases and 401 controls. We used a semiquantitative food frequency questionnaire. The intake was additionally quantified according to a 24 h recall. The plant foods or derived food products were categorized by their main chemical components into ethanol, caffeine/theine/theobromine, capsaicin, alliin, acids, eugenol, and miscellaneous foods such as curcumin. The mean score for overall intake of plant foods under consideration was …

ASPHER Statement

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Classical cardiovascular risk factors according to fasting plasma glucose levels

To compare the prevalence of classical cardiovascular risk factors (CVRF) and metabolic syndrome (MetS) in our population according to fasting plasma glucose levels (FPG).We have studied 344 subjects between 20-70 years of age, recruited in a Primary Care Clinic. Subjects were divided into four groups according to their fasting plasma glucose (FPG) values: normal plasma glucose (NG) when FPG5.6 mmol/L; FPG between 5.6 and 6.0 mmol/L (FPG1); FPG between 6.1-6.9 mmol/L (FPG2); and diabetes (DM) FPGor = 7 mmol/L or previous diagnosis of diabetes. Cardiovascular risk factors (hypertension, TC/HDL-C index and Apo B values), presence of the MetS and indirect measure of insulin resistance (HOMA) w…

Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study

Background: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization.Methods: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008–2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care.Results: A total of 11,003 (57%) patients had uncontrolle…

Public health leadership

Background The public’s health is determined by a plethora of influences at local, national or international scale. In addition, people, services and goods have become much more mobile and the electronic revolution has fundamentally changed the range of options available to deliver public health. These changes require a reconsideration of the traditional notions of public health leadership and of approaches to develop public health …

Editorial: Why do We Choose to Address Health 2020?

Recommended Citation: Flahault A, Martin-Moreno JM. Why do we choose to address health 2020? Public Health Reviews. 2013;35: epub ahead of print.What can we predict for 2020? Solar and lunar eclipses? Without a doubt. Climate change? Most likely. Rising sea levels? Signs point to yes. Beyond that, however, in the world of human events, it is best to be cautious. In the field of health and medicine (or anywhere else, for that matter), no one predicted the most important discoveries of the twentieth century. Economists were no more successful in foreseeing financial or economic crises. The pundits did not forecast any of the recent wars, disruptions or even the recent Arab Spring movements-in…

The governments' doctors: the roles and responsibilities of chief medical officers in the European Union.

The regular meetings of the chief medical officers (CMOs) from the European Union's (EU's) 27 Member States provide an important forum to address issues of common interest affecting Europe's populations. Yet there is no universally agreed role for a CMO. This article describes the findings of a study, based on interviews with key informants and documentary analysis that sought to describe their diverse roles. For the purpose of this article, CMOs are defined as those sent by their governments to the regular EU meetings of CMOs. Four broad categories of countries were identified: those whose CMO is the most senior doctor in the health ministry, in some cases with responsibility spanning all …

Frequency, intensity and localization of pain as risk factors for frailty in older adults

Background: the association between pain characteristics and frailty risk is uncertain. Objective: to investigate the separate impact of the frequency, intensity and location of pain on frailty risk and its possible mechanisms. Methods: prospective cohort of 1505 individuals ≥63 years followed between 2012 and 2015 in Spain. In 2012, pain was classified into: lowest pain (Score 0), middle pain (Score 1-4) and highest pain (Score 5-6). Incident frailty was assessed in 2015 as having ≥3 Fried criteria or a Frailty Index (FI) ≥0.30. Results: in multivariate analyses, the risk of frailty (measured with the Fried criteria or the FI) increased progressively with the frequency of pain, its intensi…

Making progress against cancer in Europe in 2008.

Europe is facing a cancer epidemic, with rapidly increasing incidence rates. Population growth and ageing will further increase the annual number of new patients with cancer. Cancer is a huge and growing contributor to the burden of disease and premature death within the European Union (EU). One in four of all deaths in the EU is attributable to cancer, and in the age range 45-64 years, the figure is almost one in two deaths. The 27 EU Member States differ greatly in cancer incidence, mortality and survival. Yet at least one-third of the cancer burden is preventable and a further third can be detected early and treated effectively, even on the basis of existing knowledge. "Cancer", however,…

Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study

Introduction The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with allcause mortality and hospitalization due to cardiovascular events in a high-risk population. Methods This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008-2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to corona…

Is the Physician’s Behavior in Dyslipidemia Diagnosis in Accordance with Guidelines? Cross-Sectional Escarval Study

Background: Clinical inertia has been defined as mistakes by the physician in starting or intensifying treatment when indicated. Inertia, therefore, can affect other stages in the healthcare process, like diagnosis. The diagnosis of dyslipidemia requires $ 2 high lipid values, but inappropriate behavior in the diagnosis of dyslipidemia has only previously been analyzed using just total cholesterol (TC). Objectives: To determine clinical inertia in the dyslipidemia diagnosis using both TC and high-density lipoprotein cholesterol (HDL-c) and its associated factors. Design: Cross-sectional. Setting: All health center visits in the second half of 2010 in the Valencian Community (Spain). Patient…

Goals are Not Enough: Building Public Sector Capacity for Chronic Disease Prevention

The rising burden of non-communicable diseases (NCDs) challenges the public health sector to develop, support and implement effective interventions to reduce this global epidemic. The United Nations has responded with a global action plan that includes goals and voluntary targets for the prevention and control of NCDs. However, setting goals is not enough. To achieve meaningful outcomes, governments must act and invest to improve key enabling capacities. Political and other public sector leadership at every jurisdictional level is needed to implement health-in-all-policies initiatives and to measure progress against set objectives, while technological and human resources for health should b…

Ebola: an open letter to European governments.

After months of inaction and neglect from the international community, the Ebola epidemic in west Africa has now spiralled utterly out of control. Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world. We urge our governments to mobilise all possible resources to assist west Africa in controlling this horrific epidemic. Based on our expertise in public health and emergency response, we believe the following measures would be particularly eff ective. First, with regards to human resources, given the huge need for trained health-care professionals in west Africa, we urge European governme…

Vegetable and Fruit Intakes Are Associated with hs-CRP Levels in Pre-Pubertal Girls

The influence of diet on inflammation in children remains unclear. We aimed to analyze the influence of diet on high-sensitivity C-reactive protein (hs-CRP) levels in a pre-pubertal population free of other influences that may affect hs-CRP levels. We determined hs-CRP levels in 571 six- to eight-year-old children using an hs-CRP ELISA kit. Information on food and nutrient intake was obtained through a food-frequency questionnaire. Overall dietary quality was assessed using the Healthy Eating Index (HEI). We found that girls in the highest tertile of hs-CRP levels had a higher intake of saturated fatty acid, and lower intakes of fiber and vitamin E and a lower HEI score when compared to tho…

La importancia de generar evidencia invirtiendo en investigación sobre calidad asistencial

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain

Objective: To assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI). Methods: An observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per …

Toenail cerium levels and risk of a first acute myocardial infarction: the EURAMIC and heavy metals study.

The association between cerium status and risk of first acute myocardial infarction (AMI) was examined in a case-control study in 10 centres from Europe and Israel. Cerium in toenails was assessed by neutron activation analysis in 684 cases and 724 controls aged 70 years or younger. Mean concentrations of cerium were 186 and 173 microg/kg in cases and controls, respectively. Cerium was positively associated with low socio-economic status, smoking, mercury, zinc and scandium (p0.001). Cases had significantly higher levels of cerium than controls after adjustment for age and centre (case-control ratio 1.074; 95% CI 1.002-1.151) and increased in further adjustment for other cardiovascular risk…

Intervenciones preventivas en el ámbito de la atención primaria. El ejemplo del PAPPS. Informe SESPAS 2012

ResumenObjetivosEl Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS), que la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) puso en marcha a finales de la década de 1980, tiene como objetivo la integración de las actividades preventivas y de promoción de la salud en el seno de las tareas desarrolladas en las consultas de atención primaria. Se pretende conocer el grado de cumplimentación del PAPPS en atención primaria.MétodosSe ha realizado una búsqueda bibliográfica de las publicaciones relacionadas con el PAPPS con el fin de evaluar su implementación y el impacto sus programas.ResultadosLas evaluaciones periódicas que se han ido realizando desde su ini…

Clinical inertia in diagnosis and treatment of hypertension in primary care: Quantification and associated factors

The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables.Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to ide…

Nosocomial rotavirus gastroenteritis in Spain: a multicenter prospective study.

BACKGROUND The objective of this study was to assess the incidence of nosocomial rotavirus gastroenteritis among children <2 years of age. METHODS We conducted a prospective active surveillance for acute gastroenteritis (AGE) in the pediatric wards of 3 representative hospitals in Valencia (Spain) from October 2006 to March 2007, among children between 1 and 23 months of age with acute diarrhea. Children were followed up for 3 days after discharge. We obtained clinical and demographic information from participants and tested their stool specimens for rotavirus. RESULTS A total of 1576 children were hospitalized at the 3 hospitals and 1300 (82.5%) were followed up as the study cohort. In 69 …

Toward ‘Vaccine Internationalism’: The Need for an Equitable and Coordinated Global Vaccination Approach to Effectively Combat COVID-19

International audience

The COVID-19 vaccines rush: participatory community engagement matters more than ever

Analyzing the risk factors influencing surgical site infections: the site of environmental factors.

Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management.We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nu…

Personalised Medicine in National Cancer Plans: How Can Innovation Be Translated Into Policy?

ABSTRACT Stratified, precision or personalised medicine (PM) is emerging as one of the most important areas of clinical innovation in cancer care. Yet, implementing policies to translate these innovations to practice entails deep changes, including in how patient information is treated, how funding is allocated, how diagnostic tests are validated and carried out, how care is organised, how clinical trials are conducted and how new drugs are approved. National Cancer Control Programmes (NCCPs), for their part, have emerged as the primary instrument to coordinate the range of cancer control policies within individual countries, and virtually all European countries have adopted one. This means…

Impact of the 2005 and 2010 Spanish smoking laws on hospital admissions for tobacco-related diseases in Valencia, Spain

OBJECTIVES: This study aimed to assess the impact of the latest smoke-free legislation on hospital admission rates due to smoking-related diseases in Spain. STUDY DESIGN: A retrospective cohort study was conducted to evaluate changes in hospital admission rates for cardiovascular, respiratory diseases, and smoking-related cancer in Valencia, Spain, during the period 1995-2013. Law 28/2005 and then law 42/2010 prohibited smoking in bars and restaurants as well as playgrounds and access points to schools and hospitals. METHODS: General population data by age and sex were obtained from the National Institute of Statistics census. Data on hospital admissions were obtained from the Minimum Basic…

Evaluación y priorización de la investigación científica en España. El punto de vista de los investigadores

Fundamento y objetivos La evaluacion y la priorizacion de la actividad investigadora resultan esenciales para el desarrollo de un sistema de ciencia, tecnologia e industria. Los datos sobre la perspectiva de los investigadores al respecto son escasos. El objetivo de este trabajo es describir el punto de vista de los cientificos espanoles sobre como perciben el actual sistema de evaluacion de la actividad investigadora en Espana y como creen que, idealmente, dicho sistema deberia estar configurado y funcionar. Sujetos y metodo A partir del universo formado por cientificos espanoles establecidos e identificados en las bases de datos del CSIC y el FIS (Instituto de Salud Carlos III), se selecc…

Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain

The aim of the present study was to assess reproducibility and relative validity of a self-administered FFQ used in the PREDIMED Study, a clinical trial for primary prevention of CVD by Mediterranean diet in a population at high cardiovascular risk. The FFQ was administered twice (FFQ1 and FFQ2) to explore reproducibility at 1 year. Four 3 d dietary records (DR) were used as reference to explore validity; participants therefore recorded their food intake over 12 d in the course of 1 year. The degree of misclassification in the FFQ was also evaluated by a contingency table of quintiles comparing the information from the FFQ2 and the DR. A total of 158 men and women (aged 55– 80 years) were a…

Tobacco use in the third trimester of pregnancy and its relationship to birth weight. A prospective study in Spain

Abstract Background Few studies have been carried out in Spain examining the use of tobacco amongst expectant mothers and its effect on birth weight. Aims To observe the proportion of expectant mothers who smoke during their pregnancy, and the impact of tobacco consumption on maternal and birth weight. We also aimed to identify the trimester of pregnancy in which tobacco use produced the greatest reduction in birth weight. Methods Prospective observational study in Spain. A random sampling strategy was used to select health centres and participant women. A total of 137 individuals were enrolled in the study. Exposure to tobacco was measured through a self-reported questionnaire. Regressions…

The need for an independent evaluation of the COVID-19 response in Spain.

Spain has been hit hard by COVID-19, with more than 300 000 cases, 28 498 confirmed deaths,1 and around 44 000 excess deaths, as of Aug 4, 2020.2 More than 50 000 health workers have been infected, and nearly 20 000 deaths were in nursing homes.3 With a population of 47 million, these data place Spain among the worst affected countries. Spain is also reported to have one of the best performing health systems in the world4 and ranks 15th in the Global Health Security index.5 So how is it possible that Spain now finds itself in this position?

Rationale and methods of the cardiometabolic valencian study (escarval-risk) for validation of risk scales in mediterranean patients with hypertension, diabetes or dyslipidemia

Abstract Background The Escarval-Risk study aims to validate cardiovascular risk scales in patients with hypertension, diabetes or dyslipidemia living in the Valencia Community, a European Mediterranean region, based on data from an electronic health recording system comparing predicted events with observed during 5 years follow-up study. Methods/Design A cohort prospective 5 years follow-up study has been designed including 25000 patients with hypertension, diabetes and/or dyslipidemia attended in usual clinical practice. All information is registered in a unique electronic health recording system (ABUCASIS) that is the usual way to register clinical practice in the Valencian Health System…

Del dicho al hecho: Calidad en la era de las tecnologías de la información durante el xxxi Congreso de la Sociedad Española de Calidad Asistencial

Valoración de la ingesta dietética a nivel poblacional mediante cuestionarios individuales: sombras y luces metodológicas

El desarrollo de la moderna metodología necesaria para caracterizar con rigor la ingesta de individuos y poblaciones data de hace sólo dos décadas, cuando germinó la epidemiología nutricional. La razón del carácter reciente de esta disciplina radica en el hecho de que la valoración de la ingesta dietética a nivel poblacional presenta retos complejos, que sólo van siendo superados a medida que investigamos y mejoramos los instrumentos metodológicos disponibles. En el presente artículo se revisan los métodos alternativos para estimar la ingesta de alimentos y nutrientes en los individuos. Tras una sucinta descripción de los métodos indirectos y directos de valoración del consumo alimentario, …

Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort

Abstract Aims To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes. Methods A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated. Results Mean follow-up was 3.2…

Policy on palliative care in the WHO European region: an overview of progress since the Council of Europe’s (2003) recommendation 24

Background: With the goal of achieving greater unity and coherence, the Council of Europe developed a national palliative care (PC) policy framework—Recommendation (2003) 24. Although directed at member states, the policy spread to the wider World Health Organisation (WHO) European Region. This article aims to present the current situation relating to national PC health policies in European countries. Methods: A cross-sectional survey was conducted in 53 European countries of the WHO European Region. Relevant data reported (i) the existence of official documents concerning the provision of PC; (ii) the role of health departments and policymakers in the evaluation of PC provision and (iii) t…

Gender Inequalities in Diagnostic Inertia around the Three Most Prevalent Cardiovascular Risk Studies: Protocol for a Population-Based Cohort Study

Evidence shows that objectives for detecting and controlling cardiovascular risk factors are not being effectively met, and moreover, outcomes differ between men and women. This study will assess the gender-related differences in diagnostic inertia around the three most prevalent cardiovascular risk factors: dyslipidemia, arterial hypertension, and diabetes mellitus, and to evaluate the consequences on cardiovascular disease incidence. This is an epidemiological and cohort study. Eligible patients will be adults who presented to public primary health care centers in a Spanish region from 2008 to 2011, with hypertension, dyslipidemia, or/and diabetes and without cardiovascular disease. Parti…

Quo vadis SANEPID? A cross-country analysis of public health reforms in 10 post-Soviet states

Abstract Background The public health systems of the post-Soviet states have evolved from the san-epid system, which dominated public health practice throughout the former Soviet Union. Since independence, reforms have taken different directions. This article provides a cross-country comparison of public health reform processes and contents in 10 post-Soviet states. Methods The study is descriptive and comparative, based on a literature review of the major health databases, the Health Systems in Transition (HiT) volumes and grey literature. Search terms included terms on public health, the san-epid services and organizational reforms in one or several post-Soviet states. Results Public heal…

Body shape trajectories and risk of breast cancer: results from the SUN ('Seguimiento Universidad De Navarra') Project.

AbstractObjective:The aim of this study was to assess body shape trajectories in childhood and midlife in relation to subsequent risk of breast cancer (BC) in a Mediterranean cohort.Design:The ‘Seguimiento Universidad de Navarra’ (SUN) Project is a dynamic prospective cohort study of university graduates initiated in 1999. With a group-based modelling approach, we assessed body shape trajectories from age 5 to 40 years. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for BC after the age of 40 years according to the body shape trajectory.Setting:City of Pamplona, in the North of Spain.Participants:6498 women with a mean age of 40 years (sd9).Results:We identi…

Need for global action for cancer control.

Inefficient arterial hypertension control in patients with metabolic syndrome and its link to renin-angiotensin-aldosterone system polymorphisms.

There is evidence that uncontrolled arterial hypertension (AHT) in patients with metabolic syndrome (MS) increases cardiovascular risks. The renin-angiotensin-aldosterone system (RAAS) and its polymorphisms apparently confer a genetic risk for uncontrolled AHT. This study aims to investigate the influence of RAAS polymorphisms on AHT control in patients diagnosed with MS. This is a two-stage population-based nested case-control pilot study (n=1514). We differentiated between MS-diagnosed patients and non-MS patients (ATP-III criteria) and selected those individuals diagnosed with AHT from each group (n=161 and n=156, respectively). Those who successfully controlled their AHT (controls) and …

The Porto European Cancer Research Summit 2021.

Key stakeholders from the cancer research continuum met in May 2021 at the European Cancer Research Summit in Porto to discuss priorities and specific action points required for the successful implementation of the European Cancer Mission and Europe's Beating Cancer Plan (EBCP). Speakers presented a unified view about the need to establish high‐quality, networked infrastructures to decrease cancer incidence, increase the cure rate, improve patient's survival and quality of life, and deal with research and care inequalities across the European Union (EU). These infrastructures, featuring Comprehensive Cancer Centres (CCCs) as key components, will integrate care, prevention and research acros…

Dairy Consumption and Incidence of Breast Cancer in the 'Seguimiento Universidad de Navarra' (SUN) Project.

Dairy products might influence breast cancer (BC) risk. However, evidence is inconsistent. We sought to examine the association between dairy product consumption—and their subtypes—and incident BC in a Mediterranean cohort. The SUN (“Seguimiento Universidad de Navarra”) Project is a Spanish dynamic ongoing cohort of university graduates. Dairy product consumption was estimated through a previously validated 136-item food frequency questionnaire (FFQ). Incident BC was reported in biennial follow-up questionnaires and confirmed with revision of medical records and consultation of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression …

Ranking of Palliative Care Development in the Countries of the European Union.

Abstract Context There is growing interest in monitoring palliative care (PC) development internationally. One aspect of this is the ranking of such development for comparative purposes. Objectives To generate a ranking classification and to compare scores for PC development in the countries of the European Union, 2007 and 2013. PC "development" in this study is understood as a combination of the existence of relevant services in a country ("resources") plus the capacity to develop further resources in the future ("vitality"). Methods "Resources" comprise indicators of three types of PC services per population (inpatient palliative care units and inpatient hospices, hospital support teams, …

Are we really seeing the total costs of surgical site infections? A Spanish study.

To identify overall costs generated by surgical site infections (SSI) patients, including indirect costs. A prospective study of case series of patients who have undergone major surgical treatment was undertaken. Patients who suffered SSI were compared with controls (nested case-control design). Centers for Disease Control and Prevention definitions were followed and SSI established. Overall costs and indirect related morbidity/mortality costs were estimated. The study was performed in a general, tertiary hospital (Valencia, Spain) for 4.5 years. Surgical site infections patients were 9.02% of the total people who underwent surgery. Their stays were prolonging by 14 days, and resources were…

Defining and Assessing Public Health Functions: A Global Analysis.

Given the broad scope and intersectoral nature of public health structures and practices, there are inherent difficulties in defining which services fall under the public health remit and in assessing their capacity and performance. The aim of this study is to analyze how public health functions and practice have been defined and operationalized in different countries and regions around the world, with a specific focus on assessment tools that have been developed to evaluate the performance of essential public health functions, services, and operations. Our review has identified nearly 100 countries that have carried out assessments, using diverse analytical and methodological approaches. …

Association between dietary and beverage consumption patterns in the SUN (Seguimiento Universidad de Navarra) cohort study.

Objective: The objective of the present study was to determine the dietary patterns of a Mediterranean cohort and relate them to the observed patterns of beverage consumption. Design: Prospective cohort study. Dietary habits were assessed with a semiquantitative FFQ validated in Spain. A principal components factor analysis was used to identify dietary patterns and to classify subjects according to their adherence to these patterns. The association between adherence to each dietary pattern and beverage consumption was assessed cross-sectionally. In a longitudinal analysis (2-year follow-up), the relationship between adherence to the baseline dietary patterns and the likelihood of changing a…

Cancer screening and health system resilience: Keys to protecting and bolstering preventive services during a financial crisis

The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for e…

SARS: Solución mediante Acciones y Respuestas Sensatas

The Social Nature of Chronic Noncommunicable Diseases and How to Tackle Them Through Communication Technology, Training, and Outreach

As world leaders prepare for the United Nations High Level Meeting on Noncommunicable Diseases, to take place in September 2011, international organizations, nongovernmental organizations, and economic and business fora have created new alliances and initiatives to accelerate research, advocacy, and political commitment. This article argues that the time is propitious to reflect on the social nature of the most common behavioral noncommunicable disease determinants, including tobacco and alcohol use, physical inactivity, and unhealthy diet. Evidence is presented related to the fact that these diseases are profoundly rooted in social and community ties and points to the need for a modern com…

Leptin concentration and risk of impaired physical function in older adults: the Seniors-ENRICA cohort

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Age and Ageing following peer review. The version of record Alberto Lana, Ellen Struijk, Pilar Guallar-Castillón, Jose María Martín-Moreno, Fernando Rodríguez Artalejo, Esther Lopez-Garcia; Leptin concentration and risk of impaired physical function in older adults: the Seniors-ENRICA cohort. Age Ageing 45.6 (2016): 819-826 is available online at: http://dx.doi.org/ 10.1093/ageing/afw142

Foreword: Implementing cancer prevention in Europe

The understanding of risk factors underpinning the aetiology of many common cancers is well established, yet the conversion of this knowledge into prevention lags considerably behind. The title of this Special Issue - Implementing cancer prevention in Europe - captures the central theme within; namely, the translation of cancer epidemiology into public health policy. The Special Issue is supported by focused evidence-based case studies of how these processes might be best taken forward. (C) 2010 Published by Elsevier Ltd.

[Insight on how to assess and improve the response to the COVID-19 pandemic].

Resumen: La pandemia de COVID-19 ha afectado de manera particularmente intensa a España, pese a su nivel de desarrollo y la elogiada solidez de su Sistema Nacional de Salud. Para comprender qué ha pasado e identificar cómo mejorar la respuesta creemos imprescindible una evaluación independiente multidisciplinaria de la esfera sanitaria, política y socioeconómica. En este trabajo proponemos objetivos, principios, metodología y dimensiones a evaluar, además de esbozar el tipo de resultados y conclusiones esperadas. Nos inspiramos en los requerimientos formulados por el panel independiente de la Organización Mundial de la Salud y en las experiencias evaluativas en otros países, y detallamos la…

Response to “MacIntyre et al., 2014: Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations?”

Strengthening global health security by embedding the International Health Regulations requirements into national health systems

The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote th…

The role of lifestyle behaviour on the risk of hypertension in the SUN cohort: The hypertension preventive score

Lifestyles may influence the risk of hypertension. Our objective was to assess the association between a healthy-lifestyle score and the incidence of hypertension. The SUN Project is a dynamic, prospective cohort of Spanish university graduates (1999-2014). Among 14,057 participants initially free of hypertension, we assessed the influence of lifestyle-related factors based on a 10-item score that we previously reported to be associated with lower risk of major cardiovascular events. However, we focused on factors related to hypertension risk according to previous scientific evidence and international clinical guidelines and constructed a 6-item score including: no smoking, moderate-to-high…

Five years of the South Eastern European Journal of Public Health (SEEJPH): Focusing on health systems in transition and global health

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European code against cancer 4th edition: 12 ways to reduce your cancer risk

AbstractThis overview describes the principles of the 4th edition of the European Code against Cancer and provides an introduction to the 12 recommendations to reduce cancer risk. Among the 504.6 million inhabitants of the member states of the European Union (EU28), there are annually 2.64 million new cancer cases and 1.28 million deaths from cancer. It is estimated that this cancer burden could be reduced by up to one half if scientific knowledge on causes of cancer could be translated into successful prevention. The Code is a preventive tool aimed to reduce the cancer burden by informing people how to avoid or reduce carcinogenic exposures, adopt behaviours to reduce the cancer risk, or t…

The UK needs a sustainable strategy for COVID-19

The UK is well into the second wave of COVID-19, with 60 051 lives lost to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to date, according to provisional data from the Office for National Statistics. Official UK Government data show that cases have been rising exponentially since late August, 2020, with increases across all regions in England in recent weeks.As of Nov 4, 2020, the UK had 25 177 confirmed daily cases. These are almost certainly underestimates as between Oct 17 and Oct 23, 2020, England alone had 52 000 estimated daily cases.Estimates of the effective reproduction number in England vary between 1.1 and 1.6.Daily deaths have doubled every fortnight si…

Mortalidad atribuible al consumo de tabaco en España en 2006

Resumen Fundamento y objetivo Estimar la mortalidad atribuible al consumo de tabaco en Espana en 2006, y compararla con las estimaciones de anos anteriores. Poblacion y metodo A partir de la prevalencia de tabaquismo y la mortalidad correspondientes a Espana, y los riesgos relativos de muerte por enfermedades causadas por el tabaquismo, procedentes del Cancer Prevention Study II, se ha calculado la mortalidad atribuible al tabaquismo en los individuos de edad ≥ 35 anos. Resultados En el ano 2006 se produjeron 53.155 muertes atribuibles al tabaquismo en individuos ≥ 35 anos, lo que supone el 14,7% (25,1% en varones y 3,4% en mujeres) de todas las muertes ocurridas en los mismos. El 88,7% (47…

Enhanced labelling on alcoholic drinks: reviewing the evidence to guide alcohol policy

Background: Consumer and public health organizations have called for better labelling on alcoholic drinks. However, there is a lack of consensus about the best elements to include. This review summarizes alcohol labelling policy worldwide and examines available evidence to support enhanced labelling. Methods: A literature review was carried out in June-July 2012 on Scopus using the key word 'alcohol' combined with 'allergens', 'labels', 'nutrition information', 'ingredients', 'consumer information' and/or 'warning'. Articles discussing advertising and promotion of alcohol were excluded. A search through Google and the System for Grey Literature in Europe (SIGLE) identified additional source…

Is respiratory protection appropriate in the Ebola response?

Predictions of cancer mortality in Europe in 2021: room for hope in the shadow of COVID-19?

Barriers in access to cancer treatment in Europe: a systematic review of the European Literature

Abstract Background Within NCD`s, Cancer accounts for the 2nd most frequent cause after Cardiovascular diseases and in some European countries it´s the leading cause of premature deaths. One of the challenges within cancer therapy can be found in inequity in access to cancer treatment, because this causes worse health outcomes, which are attributable to the accessibility of health care and thus avoidable. The objective of the systematic review was to identify barriers in access to cancer treatment in Europe (inter-country) and within 6 European countries (intra-country): Spain, Germany, Switzerland, Finland, Bulgaria, UK. Methods To obtain data scientific (PubMed, CINAHL, Embase) and grey l…

Total polyphenol intake, polyphenol subtypes and incidence of cardiovascular disease: The SUN cohort study.

Abstract Background and aims Polyphenol-rich diets have been associated with reduced risk of cardiovascular disease (CVD). However, few prospective epidemiological studies have examined the relationship between classes of ingested polyphenols and risk of CVD. Our aim was to evaluate the association between polyphenol intake and risk of major cardiovascular events in a prospective Spanish cohort. Methods and results We included 17,065 university graduates (60.7% women, mean age: 37.2 years, age range: 20–89) followed-up for a mean of 10.1 years. Polyphenol intake was assessed at baseline using a validated semi-quantitative 136-item food frequency questionnaire and matching food consumption d…

Association between AT C573T polymorphism and cardiovascular risk factors in myocardial infarction.

Abstract Background Polymorphisms in the AT1 gene have been associated with various parameters related to the pathogenesis of cardiovascular diseases and to myocardial infarction. This study analyzed the relationship between two polymorphisms of the angiotensin II AT-1 receptor gene (AT1_1166 and AT1_573) and the risk of ischemic heart disease by studying their association with several cardiovascular risk factors. Methods The sample population comprised 356 subjects: 174 patients who had survived myocardial infarction (61.01±8.15 years), and 182 age- and gender-matched controls (mean age of 60.25±9.43). The polymorphisms of the angiotensin II AT1-receptor gene (C573T and A1166C) were studie…

Will austerity cuts dismantle the Spanish healthcare system?

In the face of austerity, a series of disconnected “reforms” could, without corrective measures, lead to the effective dismantling of large parts of the Spanish healthcare system, with potentially detrimental effects on health. Helena Legido-Quigley and colleagues explain.

The effects of the financial crisis on primary prevention of cancer

The present financial crisis will affect primary cancer prevention through several avenues: personal lifestyle choices, exposure to environmental risk factors, decisions made in the private sector and public policy on cancer prevention. Whilst it is clearly problematic to reach solid conclusions on a direct connection between economic crises and cancer mortality, we can identify trends that provide guidance for further action. For some lifestyle choices such as smoking or diet, we argue that public policy may channel existing tendencies during times of crisis for clear added value. In other areas, including research and health system investments, we will make the case that the resources not…

The international Ebola response: heroes and bystanders in the chronicle of an epidemic foretold.

Characterizing Diagnostic Inertia in Arterial Hypertension With a Gender Perspective in Primary Care

Background and ObjectivesSubstantial evidence shows that diagnostic inertia leads to failure to achieve screening and diagnosis objectives for arterial hypertension (AHT). In addition, different studies suggest that the results may differ between men and women. This study aimed to evaluate the differences in diagnostic inertia in women and men attending public primary care centers, to identify potential gender biases in the clinical management of AHT.Study Design/Materials and MethodsCross-sectional descriptive and analytical estimates were obtained nested on an epidemiological ambispective cohort study of patients aged ≥30 years who attended public primary care centers in a Spanish region …

Chronic Disease Prevention and the New Public Health

Chronic diseases are the major causes of morbidity and mortality across the globe in developed and developing countries, and in countries transitioning from former socialist status. Chronic diseases — including heart disease, cancer, stroke, diabetes, and respiratory diseases — share major risk factors beyond genetics and social inequalities including tobacco use, unhealthy diet, physical inactivity, and lack of access to preventive care. There are evidence-based interventions that are effective in modifying these risks and subsequently preventing disease. Evidence for prevention is strongest for measures aimed at reducing tobacco use and increasing physical activity, while large gaps remai…

Long-term care of AIDS and non-communicable diseases.