Escuela Nacional de Salud Pública

Cigar and pipe smoking are considered risk factors for head and neck cancers, but the magnitude of effect estimates for these products has been imprecisely estimated. By using pooled data from the International Head and Neck Cancer Epidemiology (INHANCE) Consortium (comprising 13,935 cases and 18,691 controls in 19 studies from 1981 to 2007), we applied hierarchical logistic regression to more precisely estimate odds ratios and 95% confidence intervals for cigarette, cigar, and pipe smoking separately, compared with reference groups of those who had never smoked each single product. Odds ratios for cigar and pipe smoking were stratified by ever cigarette smoking. We also considered effect estimates of smoking a single product exclusively versus never having smoked any product (reference group). Among never cigarette smokers, the odds ratio for ever cigar smoking was 2.54 (95% confidence interval (CI): 1.93, 3.34), and the odds ratio for ever pipe smoking was 2.08 (95% CI: 1.55, 2.81). These odds ratios increased with increasing frequency and duration of smoking (Ptrend ≤ 0.0001). Odds ratios for cigar and pipe smoking were not elevated among ever cigarette smokers. Head and neck cancer risk was elevated for those who reported exclusive cigar smoking (odds ratio = 3.49, 95% CI: 2.58, 4.73) or exclusive pipe smoking (odds ratio = 3.71, 95% CI: 2.59, 5.33). These results suggest that cigar and pipe smoking are independently associated with increased risk of head and neck cancers.

BACKGROUND: Quitting tobacco or alcohol use has been reported to reduce the head and neck cancer risk in previous studies. However, it is unclear how many years must pass following cessation of these habits before the risk is reduced, and whether the risk ultimately declines to the level of never smokers or never drinkers. METHODS: We pooled individual-level data from case-control studies in the International Head and Neck Cancer Epidemiology Consortium. Data were available from 13 studies on drinking cessation (9167 cases and 12 593 controls), and from 17 studies on smoking cessation (12 040 cases and 16 884 controls). We estimated the effect of quitting smoking and drinking on the risk of head and neck cancer and its subsites, by calculating odds ratios (ORs) using logistic regression models. RESULTS: Quitting tobacco smoking for 1-4 years resulted in a head and neck cancer risk reduction [OR 0.70, confidence interval (CI) 0.61-0.81 compared with current smoking], with the risk reduction due to smoking cessation after > or =20 years (OR 0.23, CI 0.18-0.31), reaching the level of never smokers. For alcohol use, a beneficial effect on the risk of head and neck cancer was only observed after > or =20 years of quitting (OR 0.60, CI 0.40-0.89 compared with current drinking), reaching the level of never drinkers. CONCLUSIONS: Our results support that cessation of tobacco smoking and cessation of alcohol drinking protect against the development of head and neck cancer.

Introduction: The research landscape was enriched with new forms of inquiry that deviated from the positivist and neopositivist paradigms. For these idealists and subjective currents, I just think science can explain reality. Objective: To argue the use of qualitative research as scientific and complementary method of quantitative research. Methods: A review of texts in which qualitative research and its possible applications in health is defined was performed. Results: The study provides quantitative information derived from the relationships between variables, however, multivariate methods applied are insufficient to provide all the information on the phenomena being studied. Meanwhile, qualitative research allows the researcher to participate in the observation of the object of study. Both methods have their advantages and their weaknesses. Conclusions: The investigator must be careful when designing research and choose the method that provides more reliability to the study conducted. The combination of both methods seems to be the most acceptable option and reduce the possibility of bias.

Alcohol and tobacco consumption are well-recognized risk factors for head and neck cancer (HNC). Evidence suggests that genetic predisposition may also play a role. Only a few epidemiologic studies, however, have considered the relation between HNC risk and family history of HNC and other cancers. We pooled individual-level data across 12 case-control studies including 8,967 HNC cases and 13,627 controls. We obtained pooled odds ratios (OR) using fixed and random effect models and adjusting for potential confounding factors. All statistical tests were two-sided. A family history of HNC in first-degree relatives increased the risk of HNC (OR=1.7, 95% confidence interval, CI, 1.2-2.3). The risk was higher when the affected relative was a sibling (OR=2.2, 95% CI 1.6-3.1) rather than a parent (OR=1.5, 95% CI 1.1-1.8) and for more distal HNC anatomic sites (hypopharynx and larynx). The risk was also higher, or limited to, in subjects exposed to tobacco. The OR rose to 7.2 (95% CI 5.5-9.5) among subjects with family history, who were alcohol and tobacco users. A weak but significant association (OR=1.1, 95% CI 1.0-1.2) emerged for family history of other tobacco-related neoplasms, particularly with laryngeal cancer (OR=1.3, 95% CI 1.1-1.5). No association was observed for family history of nontobacco-related neoplasms and the risk of HNC (OR=1.0, 95% CI 0.9-1.1). Familial factors play a role in the etiology of HNC. In both subjects with and without family history of HNC, avoidance of tobacco and alcohol exposure may be the best way to avoid HNC.

BACKGROUND: Head and neck cancer (HNC) risk is elevated among lean people and reduced among overweight or obese people in some studies; however, it is unknown whether these associations differ for certain subgroups or are influenced by residual confounding from the effects of alcohol and tobacco use or by other sources of biases. METHODS: We pooled data from 17 case-control studies including 12 716 cases and the 17 438 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between body mass index (BMI) at different ages and HNC risk, adjusted for age, sex, centre, race, education, tobacco smoking and alcohol consumption. RESULTS: Adjusted ORs (95% CIs) were elevated for people with BMI at reference (date of diagnosis for cases and date of selection for controls) < or =18.5 kg/m(2) (2.13, 1.75-2.58) and reduced for BMI >25.0-30.0 kg/m(2) (0.52, 0.44-0.60) and BMI > or =30 kg/m(2) (0.43, 0.33-0.57), compared with BMI >18.5-25.0 kg/m(2). These associations did not differ by age, sex, tumour site or control source. Although the increased risk among people with BMI < or =18.5 kg/m(2) was not modified by tobacco smoking or alcohol drinking, the inverse association for people with BMI > 25 kg/m(2) was present only in smokers and drinkers. CONCLUSIONS: In our large pooled analysis, leanness was associated with increased HNC risk regardless of smoking and drinking status, although reverse causality cannot be excluded. The reduced risk among overweight or obese people may indicate body size is a modifier of the risk associated with smoking and drinking. Further clarification may be provided by analyses of prospective cohort and mechanistic studies.

Deleterious BRCA2 genetic variants markedly increase risk of developing breast cancer. A rare truncating BRCA2 genetic variant, rs11571833 (K3326X), has been associated with a 2.5-fold risk of lung squamous cell carcinoma but only a modest 26% increase in breast cancer risk. We analyzed the association between BRCA2 SNP rs11571833 and upper aerodigestive tract (UADT) cancer risk with multivariable unconditional logistic regression adjusted by sex and combinations of study and country for 5942 UADT squamous cell carcinoma case patients and 8086 control patients from nine different studies. All statistical tests were two-sided. rs11571833 was associated with UADT cancers (odds ratio = 2.53, 95% confidence interval = 1.89 to 3.38, P = 3x10(-10)) and was present in European, Latin American, and Indian populations but extremely rare in Japanese populations. The association appeared more apparent in smokers (current or former) compared with never smokers (P het = .026). A robust association between a truncating BRCA2 variant and UADT cancer risk suggests that treatment strategies orientated towards BRCA2 mutations may warrant further investigation in UADT tumors.

Although active tobacco smoking has been identified as a major risk factor for head and neck cancer, involuntary smoking has not been adequately evaluated because of the relatively low statistical power in previous studies. We took advantage of data pooled in the International Head and Neck Cancer Epidemiology Consortium to evaluate the role of involuntary smoking in head and neck carcinogenesis. Involuntary smoking exposure data were pooled across six case-control studies in Central Europe, Latin America, and the United States. Adjusted odds ratios (OR) and 95% confidence interval (95% CI) were estimated for 542 cases and 2,197 controls who reported never using tobacco, and the heterogeneity among the study-specific ORs was assessed. In addition, stratified analyses were done by subsite. No effect of ever involuntary smoking exposure either at home or at work was observed for head and neck cancer overall. However, long duration of involuntary smoking exposure at home and at work was associated with an increased risk (OR for >15 years at home, 1.60; 95% CI, 1.12-2.28; P(trend) < 0.01; OR for >15 years at work, 1.55; 95% CI, 1.04-2.30; P(trend) = 0.13). The effect of duration of involuntary smoking exposure at home was stronger for pharyngeal and laryngeal cancers than for other subsites. An association between involuntary smoking exposure and the risk of head and neck cancer, particularly pharyngeal and laryngeal cancers, was observed for long duration of exposure. These results are consistent with those for active smoking and suggest that elimination of involuntary smoking exposure might reduce head and neck cancer risk among never smokers.

Odds ratios for head and neck cancer increase with greater cigarette and alcohol use and lower body mass index (BMI; weight (kg)/height(2) (m(2))). Using data from the International Head and Neck Cancer Epidemiology Consortium, the authors conducted a formal analysis of BMI as a modifier of smoking- and alcohol-related effects. Analysis of never and current smokers included 6,333 cases, while analysis of never drinkers and consumers of < or =10 drinks/day included 8,452 cases. There were 8,000 or more controls, depending on the analysis. Odds ratios for all sites increased with lower BMI, greater smoking, and greater drinking. In polytomous regression, odds ratios for BMI (P = 0.65), smoking (P = 0.52), and drinking (P = 0.73) were homogeneous for oral cavity and pharyngeal cancers. Odds ratios for BMI and drinking were greater for oral cavity/pharyngeal cancer (P < 0.01), while smoking odds ratios were greater for laryngeal cancer (P < 0.01). Lower BMI enhanced smoking- and drinking-related odds ratios for oral cavity/pharyngeal cancer (P < 0.01), while BMI did not modify smoking and drinking odds ratios for laryngeal cancer. The increased odds ratios for all sites with low BMI may suggest related carcinogenic mechanisms; however, BMI modification of smoking and drinking odds ratios for cancer of the oral cavity/pharynx but not larynx cancer suggests additional factors specific to oral cavity/pharynx cancer.

BACKGROUND: This is an updated version of the original review published in Issue 2, 2003. Some studies have suggested a protective effect of antioxidant nutrients on lung cancer. Observational epidemiological studies suggest an association between higher dietary levels of fruits and vegetables containing beta-carotene and a lower risk of lung cancer. OBJECTIVES: To determine whether vitamins, minerals and other potential agents, alone or in combination, reduce incidence and mortality from lung cancer in healthy people. SEARCH METHODS: For this update we have used a search strategy adapted from the design in the original review. The following electronic databases have been searched up to December 2011: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). References included in published studies and reviews were also screened. SELECTION CRITERIA: Included studies were randomised controlled clinical trials comparing different vitamins, mineral supplements or supplements with placebo, administered to healthy people with the aim of preventing lung cancer. DATA COLLECTION AND ANALYSIS: Two authors independently selected the trials to be included in the review, assessed the methodological quality of each trial and extracted data using a standardised form. For each study, relative risk and 95% confidence limits were calculated for dichotomous outcomes and pooled results were calculated using the random-effect model. MAIN RESULTS: In the first version of this review four studies were included; in this review update, an additional five studies have been included. Four studies included only males and two only females; two studies included only participants considered at high risk, namely smokers or exposed to asbestos, and one study included people deficient in many micronutrients. Six studies analysed vitamin A, three vitamin C, four vitamin E, one selenium supplements, and six studied combinations of two or more products. All the RCTs included in this review were classified as being of low risk of bias.For people not at high risk of lung cancer and compared to placebo, none of the supplements of vitamins or minerals or their combinations resulted in a statistically significant difference in lung cancer incidence or mortality, except for a single study that included 7627 women and found a higher risk of lung cancer incidence for those taking vitamin C but not for total cancer incidence, but that effect was not seen in males or when the results for males and females were pooled.For people at high risk of lung cancer, such as smokers and those exposed to asbestos and compared to placebo, beta-carotene intake showed a small but statistically significant higher risk of lung cancer incidence, lung cancer mortality and for all-causes mortality. AUTHORS' CONCLUSIONS: There is no evidence for recommending supplements of vitamins A, C, E, selenium, either alone or in different combinations, for the prevention of lung cancer and lung cancer mortality in healthy people. There is some evidence that the use of beta-carotene supplements could be associated with a small increase in lung cancer incidence and mortality in smokers or persons exposed to asbestos.

Introducción En la Escuela Nacional de Salud Pública de Cuba se desarrolla un proyecto de investigación que pretende evaluar los niveles de adherencia al tratamiento en personas hipertensas, en este marco fue necesaria la construcción y validación de un cuestionario que permitiera realizar su medición. Objetivos Presentar el proceso de construcción del cuestionario asi como la validación de contenido, de construcción lógica y la evaluación de su consistencia interna. Métodos La validación de contenido se realizó a través de la metodología propuesta por Moriyama. La muestra utilizada para la evaluación de la confiabilidad interna y validez de construcción lógica del MBG estuvo compuesta por pacientes con hipertensión arterial esencial, bajo tratamiento médico, mayores de 20 años, pertenecientes al área de salud del Policlínico Van-Troi (n: 114) del Municipio Centro Habana. La consistencia interna se determinó a través del cálculo del coeficiente Alfa de Cronbach y la validez de construcción del MBG fue evaluada a través de un análisis factorial por componentes principales. Resultados El índice de consistencia interna Alfa de Cronbach obtenido para la muestra fue de ,889. Los resultados de la validación de contenido permitieron considerar que la formulación de los ítems, es razonable, se encuentran claramente definidos y se justifica su presencia en el cuestionario; aportó que las categorías propuestas para ser incluidas en la construcción del instrumento son adecuadas. Los resultados sugirieron la presencia de tres factores denominados: Cumplimiento activo, Autonomía ante el tratamiento y Complejidad de la adhesión, que explicaron el 68,72 % de la varianza acumulada. Conclusiones Los resultados obtenidos por estas alternativas de validez fueron favorables. Está disponible un instrumento con condiciones adecuadas y criterios válidos que justifican su uso y aplicación en el terreno investigativo y la práctica médica.

BACKGROUND: Some studies have suggested a protective effect of antioxidant nutrients on lung cancer. Observational epidemiological studies suggest an association between higher dietary levels of fruits and vegetables containing beta carotene and a lower risk of lung cancer. OBJECTIVES: To determine whether vitamins, minerals and other potential agents, alone or in combination, reduce incidence and mortality from lung cancer in healthy people. SEARCH STRATEGY: The electronic databases MEDLINE (1966-july 2001), EMBASE (1974-july 2001) and the Cochrane Controlled Trial Register (CENTRAL, Issue 3/2001) and bibliographies were searched. In addition authors of included studies were contacted to identify potentially eligible published and unpublished trials. SELECTION CRITERIA: Included studies were randomised controlled clinical trials comparing different supplements or comparing supplements with placebo, administered to healthy people with the aim of preventing lung cancer. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included in the review and assessed the methodological quality of each trial, and two extracted data using a standardised form. For each study, relative risk and 95% confidence limits were calculated for dichotomous outcomes. MAIN RESULTS: Four studies were eligible for inclusion. All were population based trials, including a total of 109,394 participants. Two studies included smokers, one included workers exposed to asbestos and two studies were carried out in health professionals. A group of participants with no known risk factors for lung cancer was included in the study sample of two trials. Beta-carotene was evaluated in all trials, alone or combination with alpha-tocopherol or retinol, and one study tested alpha-tocopherol alone. Duration of treatment varied from 2 to 12 years and follow-up was from two to five years. All trials had a placebo group. For people with risk factors for lung cancer no reduction in lung cancer incidence or mortality was found in those taking vitamins alone compared with placebo (incidence of lung cancer: RR 0.98, 95% CI 0.81-1.19; lung cancer mortality: RR 0.93, 95% CI 0.73-1.19). For people with no known risk factors of lung cancer, none of the vitamins or their combinations appeared to have any effect. Combined data from three studies showed a non-statistically significant increased risk of lung cancer incidence (RR 1.11, 95% CI 0.94-1.33) and mortality (RR 1.05, 95% CI 0.87-1.28) for beta-carotene alone at pharmacological doses in groups with risk factors for lung cancer. When beta-carotene was combined with retinol, data from a single study showed that there was a statistically significant, increased risk of lung cancer incidence (RR 1.42, 95% CI 1.13-1.80) and mortality (RR 1.75, 95% CI 1.29-2.38) in people with risk factors for lung cancer who took both vitamins compared with those who took placebo. Data from also from one study showed that the combination of beta-carotene with alpha-tocopherol in people with risk factors for lung cancer was associated with a non-statistically significant increased risk of lung cancer incidence (RR 1.16, 95% CI 0.96-1.39) and mortality (RR 1.15, 95% CI 0.91-1.45). No effect was observed for total cancer incidence, mortality or all-cause mortality. REVIEWER'S CONCLUSIONS: There is currently no evidence to support recommending vitamins such as alpha-tocopherol, beta-carotene or retinol, alone or in combination, to prevent lung cancer. A harmful effect was found for beta-carotene with retinol at pharmacological doses in people with risk factors for lung cancer (smoking and/or occupational exposure to asbestos). More research from larger trials and with longer follow-up is needed to analyse the effectiveness of other supplements.

Six to think about, represents an interesting and creative proposal for the management of collective thinking, which, applied to specific meetings or moments where a group of people discuss a particular topic, could mean the key to success. The use of the six hats in contexts such as the one described above, makes it possible to effectively conduct the analysis in a group discussion, make decisions based on the construction of collective thinking, while minimizing the negative and destructive effect of confrontation and disagreement. Of criteria. The author proposes a method for the use of hats, with which he describes the order, the situation and its effect. Red, blue, green, yellow, black and white are the colors of these and each one represents a way of thinking and expressing what the moment demands, but with future projection.

En el estudio se brindan algunos conceptos sobre el análisis de información. También se ofrecen algunas características de los especialistas que laboran en esta área. Se abordan los métodos de investigación cuantitativa y cualitativa, como aristas de la Metodología de la Investigación y se exponen los conceptos y componentes de ambos métodos. Por otro lado, se hace una valoración de las ventajas y desventajas de cada uno de estos métodos para su utilización en el análisis de información.

El género surge a través de un proceso de construcción social que define lo masculino y lo femenino a partir de los sexos biológicos, hasta establecer las posiciones de poder entre los mismos. Agendas políticas nacionales y organismos internacionales han tratado la situación de desventaja de las mujeres, en relación con las desigualdades a las que han sido sometidas a lo largo de la historia, respecto a los hombres. En la Tercera Conferencia de la Mujer celebrada en Nairobi en 1985 se reconoció la discriminación de este sexo en la vida económica, política y social, lo que se considera como un hecho natural. La Cuarta Conferencia de la Mujer celebrada en Beijing en 1995 discutió acerca de la equidad de género y el empoderamiento de la mujer, aceptados como piedra angular para la planificación de políticas de salud y programas de población. En este artículo se realiza una reflexión sobre el enfoque de género en el campo de la salud pública que se sustenta en el sistema teórico sexo-género.

Resumen es: La salud de la familia constituye uno de los objetivos de la estrategia de la Atencion Primaria en Cuba. Es un interes del sistema de salud cubano el des...

En la actualidad el clima organizacional es un tema de gran importancia para las organizaciones que encaminan su gestion en el continuo mejoramiento del ambiente de trabajo, por ello se considera que es un factor clave en el desarrollo de las instituciones y su estudio en profundidad, diagnostico y mejoramiento incide de manera directa en el denominado espiritu de la organizacion. Por lo anterior, en el presente trabajo se realiza una aproximacion conceptual al tema, que permite demostrar la importancia del clima en la gestion del cambio en los sistemas organizacionales. De igual forma, se exponen las diferentes dimensiones y categorias a tener en cuenta para su medicion las cuales giran en torno a los valores de la organizacion, las creencias, costumbres y practicas institucionales, que permiten esclarecer las causas de la satisfaccion e insatisfaccion en el trabajo y su incidencia en los cambios organizacionales.

Objetivo: mostrar el diseno y resultados de la implantacion de una estrategia educativa extracurricular, de tipo participativa, dirigida a mejorar la salud sexual y reproductiva de adolescentes y jovenes en instituciones universitarias cubanas. Metodos: se realizo un estudio de desarrollo con la aplicacion de tecnicas cuantitativas y cualitativas. Se identificaron las necesidades de aprendizaje sobre el tema mediante el modelo de Leiva Gonzalez. Se aplico un cuestionario estructurado en 592 estudiantes de dos instituciones universitarias en La Habana, se realizaron ademas, grupos focales y entrevistas en profundidad a expertos. Resultados: se diseno una estrategia educativa extracurricular conformada por el componente capacitacion y comunicacion articulados entre si y que se desagregan en un conjunto de acciones. Se encontraron deficiencias en la educacion sexual, baja percepcion del riesgo de un embarazo o de contraer alguna infeccion de trasmision sexual, practicas de cambio frecuente de parejas, tanto en sexo masculino, como el femenino; comienzo temprano de las relaciones sexuales y bajo uso del condon, unido a poca comunicacion entre padres e hijos. Conclusiones: el diseno de la estrategia educativa conduce a fomentar un pensamiento responsable sobre salud sexual y reproductiva en los estudiantes. Su implantacion ha sido factible y ha brindado buenos resultados en los adolescentes y jovenes y ademas, hace que los mismos una vez egresados de sus respectivos perfiles de formacion puedan realizar correctamente actividades de promocion, prevencion y educacion para la salud en la poblacion donde trabajen.

Resumen es: El presenta trabajo pretende fundamentar la importancia del problema de la deficiente adherencia a los tratamientos medicos de larga duracion y como esto...

Resumen es: La poblacion, principal fuerza productiva de la sociedad y al propio tiempo, consumidora por excelencia de los medios y servicios producidos, exige la ...

La sociedad moderna está obligada a competir dentro de un mercado cuya dinámica está pautada fundamentalmente por el desarrollo vertiginoso de la ciencia y la técnica. La clave de una gestión acertada en las organizaciones educacionales, fundamentalmente en los sistemas de salud, está en las personas que participan en ella; en la actualidad, los altos niveles de competitividad exigen nuevas formas de compromiso, de ver los hechos, de decidir y dirigir, de pensar y sentir, así como de gestionar las relaciones humanas en las organizaciones de una forma más efectiva. Los estudios del capital humano en la gestión académica cada vez cobran mayor importancia y están encaminados a hacer más eficientes los sistemas y procesos de gestión, ya que de esta forma se impulsa el rendimiento y desarrollo de la organización educacional. Por lo antes expuesto, es que este trabajo tiene el objetivo de reflexionar sobre el desarrollo organizacional dando una mirada desde el ámbito académico y destacando el papel que desempeña el capital humano en las organizaciones. Se concluye que la gestión del capital humano para el desarrollo organizacional en educación médica es necesario en busca del logro de una mayor calidad y pertinencia de los procesos que lleva a cabo la institución, lo que se convierte en condición indispensable en el mundo actual. En estos tiempos cambiantes en que los valores evolucionan rápidamente y los recursos se vuelven escasos, cada vez es más necesario comprender aquello que influye sobre el rendimiento de las personas en el trabajo. Modern society is forced to compete in a market in which the dynamics are mainly driven by the rapid development of science and technology. The key to successful management in educational organisations, primarily in the health system, is in the people who participate in it. At present, high levels of competitiveness require new forms of commitment; to see the facts, to decide and direct, of thinking and feeling, and for managing human relations in organisations more effectively. Studies of human capital in academic management are becoming increasingly important and are directed at streamlining the management systems and processes, and as such boost the performance and development of the educational organisation. Taking into account the above, this work aims to reflect on the role of human capital in the academic management for the development of the organization. Concluding that the human capital management for organisational development in medical education is necessary in pursuit of achieving greater quality and relevance of the processes carried out by the institution, which are indispensable in the modern world. In these changing times in which values are evolving rapidly and resources become scarce, it is increasingly necessary to understand what influences the performance of people at work.