Estrategias de reducción de riesgos en tabaquismo: ¿oportunidad o amenaza?

The smoking control policies recommended by the World Health Organisation have achieved a slight decrease in smoking prevalence in the developed countries, although associated mortality is still very high. The use of tobacco products other than cigarettes and even medicinal nicotine (known as nicotine replacement therapy (NRT)) has been proposed as a risk reduction strategy. Among the tobacco products with less individual risk than cigarettes would be any type of tobacco without smoke (smokeless) with a low content in nitrosamines and modified cigarettes; both forms included under the PREP (Potentially Reduced Exposure Products) concept. The idea would be to promote these products among those who cannot quit smoking or wish to reduce their risk without giving up nicotine intake. The possible effects of risk reduction strategies, including PREP, on the decreased prevalence and morbidity and mortality are reviewed, and the possible implications that this measure could have in our country are analysed. Tobacco control measures in Spain are recent and still insufficient. Therefore, the current priority in Spain is the development of policies of control that have shown to more than effective. The marketing and advertising of new tobacco products, even with reduced potential risk, seems more a serious threat than an opportunity for the development of smoking control policies.     

Gran altitud y prevalencia de la enfermedad pulmonar obstructiva crónica: ¿relación casual o causal?

Introduction

Studies on the relationship of chronic obstructive pulmonary disease (COPD) prevalence and altitude have reported contrasting results. The aim of this COPD case-finding study was to include a larger number of geographical sites to determine if there is an association between altitude and COPD prevalence.

Patients and methods

Individuals aged 40 or older with known COPD risk factors, whether symptomatic or not, were referred by primary-care physicians. After obtaining written informed consent, they were invited to answer a questionnaire and undergo pre- and post-bronchodilator spirometry.

Results

Subjects were recruited in 27 Mexican cities, within an altitude range from 1 to 2,680 m above sea level. We found a weak (–0.31; P < .0001) although significant negative correlation between altitude and COPD prevalence. The COPD rate for cities located ≤1,000 m was 32.7% vs 16.4% for cities located >1,000 m (P < .0001); the rate for cities located at ≤2,000 m was 22.7% vs 15.6% for those >2,000 m; in the multiple logistic regression analysis, older age, male sex, tobacco habit, pack-years of smoking, years of exposure to biomass smoke and city altitude over sea level were significantly associated with COPD prevalence.

Conclusions

Our data shows a significant inverse correlation between prevalence/severity of COPD and altitude.     

Colonoscopia con insuflación de dióxido de carbono: ¿lujo o necesidad?

Colonoscopy is an essential diagnostic and therapeutic tool for many gastrointestinal diseases and is also a key element in the prevention and early diagnosis of colon cancer. Despite numerous technical advances, colonoscopy continues to be uncomfortable for patients, both during and after the procedure. To a large extent, the discomfort of colonoscopy depends on the need to distend the colon, which usually produces abdominal pain. Although ambient air is usually employed to expand and inflate the colon, in the last few years devices that allow carbon dioxide (CO₂) insufflation in colonoscopy have been developed. This gas is a highly attractive option for pain-free colonoscopy.