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Biomedical subjects

A Figueiras

Publications and source records attributed to A Figueiras.

At least 19 recordsLinked to original sources
PubMed2006

Factors underlying residential radon concentration: results from Galicia, Spain.

Radon causes lung cancer when inhaled for prolonged periods of time. A range of factors influence residential radon concentration and this study therefore sought to ascertain which dwelling-related factors exert an influence on radon levels. A cross-sectional study was conducted from 2001 to 2003 which analyzed 983 homes of as many subjects randomly selected from the 1991 census. Sampling was carried out by district and stratified by population density to ensure that more detectors were placed in the most heavily populated areas. Radon concentration and different dwelling characteristics were measured in each of the homes selected. Bivariate and multivariate analyses were performed to ascertain which factors influenced radon concentration. The geometric mean of radon concentration was 69.5 Bq/m3, and 21.3% of homes had concentrations above 148 Bq/m3. Factors shown to influence radon concentration in the bivariate analysis were: age of dwelling; interior building material; exterior building material; and storey on which the detector was placed. Explanatory variables in the multivariate analysis were: age of dwelling; number of storeys; distance off floor; and interior building material. The model was significant, but the variability explained was around 10%. These results highlight the fact that the study area is an area of high radon emission and that factors other than those directly related with the characteristics of the dwelling also influence radon concentration.

Air Pollution, Indoor↗
PubMed2006

Antioxidant vitamins and risk of lung cancer.

Tobacco use is the leading risk factor for lung cancer, yet in addition to smoking habit, diet may also play a role in the disease's appearance. While there are reports to indicate that antioxidant vitamins and carotenoids may decrease the risk of lung cancer, results to date have been somewhat ambiguous. This review aimed to describe the results yielded by different studies, which have addressed antioxidant vitamin intake and lung cancer, and to indicate the mechanisms whereby these nutrients might be exercising their activity. Antioxidant vitamins were observed to have no clear protective effect, though there was some evidence pointing to a protective role for vitamins C and E. Vitamin A, in contrast, evinced no clear effect. Insofar as provitamin A carotenoids were concerned, lutein/zeaxanthin, lycopene and alpha-carotene displayed a certain protective trend, yet beta-carotene exhibited no protective effect whatsoever; and indeed, there was speculation as to whether it might even be pernicious in smokers. Beta-criptoxanthin, on the other hand, showed a more consistent protective effect. The study highlighted the need to conduct further research on smokers and non-smokers alike, and in particular, to investigate the effect, if any, on lung cancer of carotenoids or vitamins when ingested in differing dosages.

Animals↗
PubMed2005

Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study.

BACKGROUND: Oral pancreatic enzyme supplements should be properly administered in order to ensure an adequate gastric mixing with the food and simultaneous gastric emptying with the chyme. AIM: To evaluate, in a prospective, randomized, open, comparative, three-way, crossover study, the effect of the administration schedule on the efficacy of oral pancreatic enzymes for the treatment of exocrine pancreatic insufficiency. METHODS: Twenty-four consecutive chronic pancreatitis patients with maldigestion secondary to exocrine pancreatic insufficiency were treated with 40 000 U lipase in the form of capsules containing enteric-coated mini-microspheres. Capsules were taken just before meals (schedule A), just after meals (schedule B) or distributed along with meals (schedule C) for three consecutive 1-week crossover periods in a randomized order. Fat digestion before and during the three treatment periods was evaluated by an optimized mixed (13)C-triglyceride breath test. RESULTS: Before therapy, the (13)CO(2) recovery in the breath test was 23.8 +/- 15.8% (normal >58.0%). During therapy, the (13)CO(2) recovery tended to be higher when capsules were taken along with meals ((13)CO(2) recovery 61.4 +/- 21.4%) or just after meals ((13)CO(2) recovery 60.6 +/- 21.8%) than when taken just before meals ((13)CO(2) recovery 53.9 +/- 20.3%). The percentage of patients who normalized fat digestion under therapy was 50, 54 and 63% with schedules A, B and C respectively. CONCLUSIONS: The efficacy of pancreatic enzyme supplements for the treatment of exocrine pancreatic insufficiency may be optimized by administration during or after meals.

Administration, Oral↗
PubMed2004

Influence of physicians' attitudes on under-notifying infectious diseases: a longitudinal study.

OBJECTIVES: To identify practitioners' demographic and professional characteristics associated with reporting of mandatory-reporting diseases (MRDs), and to identify attitudes associated with MRD reporting. DESIGN: Longitudinal study. SETTING: Regional Health Service of Galicia (North-western Spain). SUBJECTS: Random sample of 600 physicians. MAIN OUTCOME MEASURES: A postal questionnaire was used to measure the physicians' beliefs, knowledge and attitudes regarding MRDs. Associations between the independent variables and outcomes (notification or non-notification of MRDs every week during 1998) were modelled using the Andersen-Gill proportional hazards model. RESULTS: The response rate was 60.1%. The following beliefs, knowledge and attitudes were statistically associated with a smaller probability of reporting any given MRD: (1) I would only notify an MRD after confirming diagnosis; (2) the MRD reporting system interferes with my daily clinical practice; (3) besides the legal requirements, I would have to report MRDs as a medical professional; and (4) only the reporting of relevant or severe MRDs is necessary. Under-reporting was not associated with specialization (general or paediatric) or the type of contract (fixed or temporary), but was associated with gender. CONCLUSIONS: Some physicians' beliefs, knowledge and attitudes regarding MRDs are associated with under-reporting. This suggests that modification of certain attitudes and knowledge in physicians could greatly reduce the under-reporting of MRDs.

Attitude of Health Personnel↗
PubMed2004

Type of wine and risk of lung cancer: a case-control study in Spain.

BACKGROUND: Few epidemiological studies have examined the effect of wine on the risk of lung cancer. A study was therefore undertaken to estimate the effect of wine consumption, both overall and by type of wine, on the risk of developing lung cancer. METHODS: A hospital based case-control study was conducted on 319 subjects (132 cases, 187 controls) in 1999-2000. All subjects were interviewed about their lifestyles with particular reference to alcohol consumption and tobacco use. The results were analysed using non-parametric logistic regression. The main outcome measure was the risk of lung cancer associated with consumption of wine and its individual types. RESULTS: A very slight but significant association was observed between the risk of lung cancer and white wine consumption (odds ratio (OR) 1.20 for each daily glass). Red wine consumption, on the other hand, had an OR of 0.43 (95% CI 0.19 to 0.96), with each daily glass of red wine having an inverse association with the development of lung cancer (OR 0.87 (95% CI 0.77 to 0.99)). There was no apparent association between lung cancer and consumption of beer or spirits. CONCLUSIONS: These results suggest that the consumption of red wine is negatively associated with the development of lung cancer. Further studies are needed to test this finding in cancer induced laboratory animals.

Alcohol Drinking↗
PubMed2003

Lung cancer and related risk factors: an update of the literature.

At the present time, lung cancer is the leading cause of cancer-related death in males. Diagnostic difficulty makes detection complicated and this, in conjunction with the low survival rate, renders the disease a serious health problem. In-depth knowledge of associated risk factors is therefore called for, in order to prevent or at least reduce the appearance of lung cancer and to open new avenues of research. Although the disease has a multicausal aetiology, tobacco accounts for 85-90% of all cases. This paper reviews the current situation, dividing the risk factors, for study purposes, into two groups; intrinsic (non-modifiable) and extrinsic (modifiable).

Female↗
PubMed2003

Dose-response relationship between tobacco and lung cancer: new findings.

The purpose of this work is to model the relationship between smoking-related variables and the risk of lung cancer by using parametric and non-parametric models. A hospital-based case-control study was conducted to ascertain the influence of smoking on risk of lung cancer. We used parametric logistic regression with a series of categorized independent variables and non-parametric logistic regression models. Such models allow for variables to be treated as continuous, since they avoid arbitrariness in the selection of cut-offs and furnish information on the dose-risk relationship. The results point to the possible existence of a saturation effect for a lifetime tobacco consumption of around 25 000-30 000 packets. Duration of habit and years of abstinence show a linear relationship marked by opposite, though similar, slopes, which would seem to indicate that for every year of smoking, risk rises by an amount (8.00%, 95% confidence interval (CI) 5.94-10.06) equal to the decline in risk for every year of abstinence (6.98%, 95% CI 2.53-11.84). Lastly, a lower age of smoking initiation appears to have an influence, although non-significant, on the appearance of the disease. The risk of lung cancer due to duration of the habit would seem to be proportional to years of abstinence, and there could be a saturation effect with respect to lifetime tobacco consumption.

Age Factors↗
PubMed2001

Application of nonparametric models for calculating odds ratios and their confidence intervals for continuous exposures.

Calculating odds ratios and corresponding confidence intervals for exposures that have been measured using a continuous scale presents important limitations in the traditional practice of analytical epidemiology. Approximations based on linear models require making arbitrary assumptions about the shape of the relation curve or about its breakpoints. Categorical analyses generally have low statistical efficiency, and cutpoints for the categories are in most cases arbitrary and/or opportunistic. The use of logistic generalized additive models to calculate odds ratios does not require these assumptions and allows great flexibility and adequate statistical efficiency. Based on the asymptotic normality of the logarithm of the odds ratio, the authors propose the use of an approximate analytical expression for the corresponding covariance matrix, which will allow the construction of confidence intervals for odds ratios that can be interpreted as in the classical parametric context. The authors illustrate this procedure by examining the relation between glycemia and risk of postoperative infection, using data obtained from a cohort study of patients undergoing surgery in Santiago, Spain (January 1996--March 1997). The authors found that glycemia values below 75 mg/dl and above 130 mg/dl were associated with increased risk of postoperative infection.

Blood Glucose↗
PubMed2001

Prevalence of and risk factors for IgE sensitization to Anisakis simplex in a Spanish population.

BACKGROUND: The number of allergic reactions to A. simplex reported in Spain has increased dramatically in the last decade. Nevertheless, there have been no studies of the prevalence of and possible risk factors for IgE sensitization to this parasite, possibly because suitably specific diagnostic methods have only recently become available. The objective was to investigate the prevalence of and risk factors for IgE sensitization to A. simplex in Galicia, a region of northwestern Spain with a population of about 3 million and high average fish consumption (78.5 g/person per day). METHODS: The study was performed with a random sample of 2801 healthy blood donors distributed in 53 geographic areas, proportional to the density of donors. IgE sensitization to A. simplex was tested by a capture ELISA method that has proved to be the most specific method currently available. RESULTS: The results showed a total of only 12 positive subjects, of whom five also showed IgG1 sensitization. All positive subjects and 101 randomly selected seronegative subjects were then included in a case-control study of risk factors for sensitization to A. simplex, based on a telephone interview about fish consumption (especially raw and undercooked fish). All seropositive subjects (but only 25% of seronegative subjects) reported consumption of undercooked fish or homemade raw-fish products. CONCLUSIONS: Our results strongly suggest that sensitization to A. simplex is caused only by live larvae, and not by allergens contained in fish tissues, and that ingestion of homemade boquerones (anchovies [Engraulis encrasicholus] in vinegar), and to a much lesser extent of undercooked fish, are the main risk factors for IgE sensitization to Anisakis in this region.

Adolescent↗
PubMed2001

Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review.

This paper is a critical review of studies of educational programmes designed to improve prescription practices in ambulatory care. Scientific articles were selected from the following bibliographical indices: MEDLINE, IME, ICYT and ERIC. The searches covered the time period between 1988 and 1997. The search criteria included: primary-care, educat*, prescription* and other related keywords. The inclusion criteria were studies describing educational strategies aimed at general practitioners working in ambulatory settings. The study outcome was change in prescribing behaviour of physicians through prescribing indicators. The following data were extracted: study design, target drugs, type of intervention, follow-up period of the prescription trends, type of data analysis, type of statistical analysis and reported results. We found 3233 articles that met the search criteria. Of these, 51 met the inclusion criteria and 43 studied the efficacy/effectiveness of one or various interventions as compared to no intervention. Among seven studies evaluating active strategies, four reported positive results (57%), as opposed to three of the eight studies assessing passive strategies (38%). Among the 28 studies that tested reinforced active strategies, 16 reported positive results for all variables (57%). Eight studies were classified as a high degree of evidence (16%). We concluded that the results of our review suggest that the more personalized, the more effective the strategies are. We observe that combining active and passive strategies results in a decrease of the failure rate. Finally, better studies are still needed to enhance the efficacy and efficiency of prescribing practices.

Ambulatory Care↗
PubMed2001

Physicians' attitudes towards voluntary reporting of adverse drug events.

At the time a new drug is placed on the market, information on its therapeutic effect and toxicity is limited. Because of its simplicity and widespread use, the voluntary reporting by clinical physicians is the main method for detecting rare or unexpected adverse drug events (ADEs). However, the usefulness of this method may be compromised if the reporting rate is low. We present the results of a questionnaire-based case-control study carried out among 692 physicians from Galicia (north-west region of Spain), in which we assessed their attitudes and opinions towards ADEs. In general, the Galician physicians think it is difficult to link a given ADE with a drug (P < 0.05) and have very heterogeneous opinions on the fact that very severe ADEs are known before the drug is commercialized. They globally disagree with the proposal that ADE reporting should be renumerated and the fact that ADE reporting can be risky for the physician. Some of the beliefs concerning ADEs are incorrect. It is crucial to improve the training of the physicians through active educational strategies based on personal contact.

Adult↗
PubMed2001

One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.

OBJECTIVES: The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. METHODS: A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. RESULTS: One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. CONCLUSIONS: A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Comparing meta-analysis and ecological-longitudinal analysis in time-series studies. A case study of the effects of air pollution on mortality in three Spanish cities.

STUDY OBJECTIVE: The objective of this paper is to introduce a different approach, called the ecological-longitudinal, to carrying out pooled analysis in time series ecological studies. Because it gives a larger number of data points and, hence, increases the statistical power of the analysis, this approach, unlike conventional ones, allows the complementation of aspects such as accommodation of random effect models, of lags, of interaction between pollutants and between pollutants and meteorological variables, that are hardly implemented in conventional approaches. DESIGN: The approach is illustrated by providing quantitative estimates of the short-term effects of air pollution on mortality in three Spanish cities, Barcelona, Valencia and Vigo, for the period 1992-1994. Because the dependent variable was a count, a Poisson generalised linear model was first specified. Several modelling issues are worth mentioning. Firstly, because the relations between mortality and explanatory variables were non-linear, cubic splines were used for covariate control, leading to a generalised additive model, GAM. Secondly, the effects of the predictors on the response were allowed to occur with some lag. Thirdly, the residual autocorrelation, because of imperfect control, was controlled for by means of an autoregressive Poisson GAM. Finally, the longitudinal design demanded the consideration of the existence of individual heterogeneity, requiring the consideration of mixed models. MAIN RESULTS: The estimates of the relative risks obtained from the individual analyses varied across cities, particularly those associated with sulphur dioxide. The highest relative risks corresponded to black smoke in Valencia. These estimates were higher than those obtained from the ecological-longitudinal analysis. Relative risks estimated from this latter analysis were practically identical across cities, 1.00638 (95% confidence intervals 1.0002, 1.0011) for a black smoke increase of 10 microg/m(3) and 1.00415 (95% CI 1.0001, 1.0007) for a increase of 10 microg/m(3) of sulphur dioxide. Because the statistical power is higher than in the individual analysis more interactions were statistically significant, especially those among air pollutants and meteorological variables. CONCLUSIONS: Air pollutant levels were related to mortality in the three cities of the study, Barcelona, Valencia and Vigo. These results were consistent with similar studies in other cities, with other multicentric studies and coherent with both, previous individual, for each city, and multicentric studies for all three cities.

Air Pollutants↗
PubMed2000

Influence of physician's education, drug information and medical-care settings on the quality of drugs prescribed.

OBJECTIVE: To identify factors associated with low prescription quality in primary care. METHODS: We carried out a cross-sectional study on a sample of 405 primary care physicians in Galicia (Northwest Spain). The following independent variables were collected through a mail questionnaire survey: physician's education and speciality, physician's perception of the quality of available drug information sources, type of practice and number of patients. We constructed multiple regression models using as dependent variables four indicators of the quality of drugs prescribed. RESULTS: The response rate was 75.2%. The quality of drugs prescribed was found to be associated with regulated physician training (P = 0.001), perceived credibility of information sources (P = 0.013) and environmental characteristics of the practice (reform model and number of patients' cards). CONCLUSION: Study results suggest that in order to improve the quality of drugs prescribed, physician education and training must be improved and the role of pharmaceutical companies in physician training should be limited, emphasising more objective sources of information, such as therapeutic guidelines. Our results also underline the need to complete the reform of our primary care system and promote better relationships among physicians and between physicians and patients.

Cross-Sectional Studies↗