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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paradoxes are usually instructive&#44; and philosophers use them to reveal the complexity of reality&#46; On a global level&#44; there is a striking paradox between human health and planetary health&#46; The human animal broadly enjoys very good health&#46; There are already 7&#46;5 billion of us&#44; and numbers continue to grow&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> We are extremely long-lived&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> if not to biblical standards&#44; but it seems we are arriving at our limits in terms of age&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Extreme poverty&#44; infant and neonatal mortality&#44; and death rates from infections and chronic diseases are also falling dramatically&#46; However&#44; the ecological balance and natural systems are suffering&#46; Human health is improving at the expense of increased pollution&#44; reduced biodiversity&#44; loss of rainforests and other environmental lungs&#44; and global warming&#46; The quantity and quality of this growth of human health is neither sustainable over time&#44; nor is it compatible with the health of the planet&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Planetary health is a new concept that emerged in 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> It refers to the health of human civilization now and in the future&#44; and depends&#44; of course&#44; on the complete physical&#44; mental and social welfare of the population&#44; but also on the state of the natural systems that sustain us&#46; It implies&#44; then&#44; social&#44; economic and environmental health determinants&#46; Basically&#44; this paradigm shift reminds us that we cannot continue to exploit nature as we have been doing until now&#44; as everything is interconnected&#46; The problems of the planet directly or indirectly cause human disease&#44; and the solutions that benefit the planet must also benefit human health &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Ecosystems are currently being destroyed at a rate unprecedented in history&#46; For 12<span class="elsevierStyleHsp" style=""></span>000 years&#44; following the introduction of writing and the development of civilizations&#44; humans have been considered to live in the Holocene period&#46; Now&#44; however&#44; it has been suggested that we are already living in the Anthropocene&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> an age in which humans are changing the planet&#46; This new epoch began scarcely 200 years ago&#44; from the beginning of the 1800s&#44; when evidence already emerged of an increase in the temperature of the oceans caused by humans&#44; along with growing ocean acidification&#44; overfishing&#44; overuse of dosmesticated land&#44; requiring overuse of fertilizers&#44; increased emissions of atmospheric pollutants&#44; etc&#46; This vision of ecosystems is not catastrophic&#44; it is realistic&#59; and the solution to poor planetary health is Planetary Medicine&#44; partly based on chaos theory&#44; by which small changes can&#44; in a non-deterministic and non-linear fashion&#44; produce major worldwide upheavals&#59; and it is also based on the Gaia theory&#44; which proposes that Earth is a living&#44; self-regulating organism that balances and perpetuates life&#46; However&#44; these mechanisms have a breaking point&#44; and we can and must&#44; individually and collectively&#44; help them survive&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Nevertheless&#44; improvements in global world health do not&#44; at the moment&#44; extend to respiratory health&#46; The WHO includes 5 respiratory diseases &#40;COPD&#44; pneumonia&#44; lung cancer&#44; sleep apnea&#44; and tuberculosis&#41; in the list of the 10 top causes of global mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> There are 334 million asthmatics&#44; 323 million COPD patients&#44; and 1&#46;1 billion smokers&#44; more than at any other time in history&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> Since the mortality rates of many respiratory diseases are falling&#44; respiratory patients are living longer&#46; As a species&#44; our breathing is becoming increasingly poor&#44; and moreover&#44; we are breathing poor quality air&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Solutions to planetary respiratory diseases must begin at an individual level &#8211; not only with individualized medicine&#44; but also with more global and social medicine&#44; practiced from a population approach&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Current attitudes to healthcare &#8211; curative&#44; biomedical&#44; molecular and highly personalized &#8211; must be changed to accommodate&#44; or at least complement&#44; the root environmental and social causes of today&#39;s diseases&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We need to take a preventive approach&#58; active lifestyles with age-appropriate exercise for each individual&#44; a Mediterranean diet&#44; moderate alcohol consumption&#44; no smoking&#44; scheduled vaccination and screening programs&#44; and to encourage individuals to try to be happy and transcendent&#46; The key lies in sustainable growth&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In September 2015&#44; the United Nations identified 17 objectives for sustainable growth &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> as an extension of their Millennium health objectives&#44; adding some additional aspects associated with education&#44; individual risk factors&#44; per capita income of the country&#44; and other more environmental issues&#44; such as protection of the oceans and forests&#44; the fight against climate change&#44; and biodiversity&#46; On September 22&#44; 2016&#44; the first assessment of these objectives was conducted&#44; in which Spain was found to have made excellent progress&#46; The recent &#40;2015&#41; report on Objectives for Sustainable Development placed us in a very respectable 7th position among the 188 countries evaluated&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> However&#44; this achievement may be ephemeral if our respiratory performance does not improve on the following three levels&#46; On the healthcare level&#58; the prevalence of smoking among the population must be reduced&#44; not only by increasing the number of individuals who stop smoking&#44; but also preventing young people from taking up the habit&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> and tuberculosis&#44; AIDS&#44; and other communicable respiratory diseases must be controlled&#46; On the infrastructure level&#58; free&#44; universal access to healthcare and education must be maintained&#46; And on the environmental level&#58; pollution&#44; both in the environment and indoor&#44; must be reduced&#44; and actions must be taken to combat climate change and its impact &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; These indicators underline the importance of committing to and working toward changes promoting healthy lifestyles&#44; improving infrastructures&#44; reducing pollution&#44; and enhancing the quality of life and respiratory health of our society&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">13&#44;14</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Examples of success include the Montreal protocol of 1987&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> the aim of which was to reduce&#47;eliminate the greenhouse gases damaging the ozone layer and led to the replacement of CFC propellants by HFA in the majority of metered dose inhalers for respiratory diseases&#46; The objective was achieved before the planned date&#46; We have to seek out and identify more examples of good practice in Respiratory Planetary Medicine&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Respiratory medicine specialists and translational respiratory clinical scientists have and will continue to have ample opportunities&#44; in both national and international research programs&#46; But such translation cannot only be from the test-tube or the animal to the patient&#44; nor can it be limited to Public Health&#58; definitive translational medicine must have an impact on Respiratory Planetary Health&#46; Planetary pulmonologists are needed&#44; experts who care as much for their patients&#8217; lungs as for the welfare of natural systems and their impact on future generations&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs1">Horizon 2020 HCO 2015</span> Grant Agreement Number <span class="elsevierStyleGrantNumber" refid="gs1">681040</span> TackSHS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests directly or indirectly related with the contents of this manuscript&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Soriano JB&#44; Soriano C&#44; Fern&#225;ndez E&#46; Medicina planetaria respiratoria&#46; Arch Bronconeumol&#46; 2017&#59;53&#58;297&#8211;299&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sustainable Development Goals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Directly or Indirectly Related Objectives <span class="elsevierStyleItalic">&#91;and Selected Respiratory Indicators&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; End poverty in all its forms everywhere&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; End hunger&#44; achieve food security and improved nutrition and promote sustainable agriculture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Goal 2&#46;2&#58; End all forms of malnutrition&#44; including achieving&#44; by 2025&#44; the internationally agreed targets on stunting and wasting in children under 5 years of age&#44; and address the nutritional needs of adolescent girls&#44; pregnant and lactating women and older persons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; Ensure healthy lives and promote well-being for all at all ages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Goal 3&#46;3&#58; By 2030&#44; end the epidemics of AIDS&#44; tuberculosis <span class="elsevierStyleItalic">&#91;standardized rate of new and relapsed tuberculosis cases per 1000 inhabitants&#93;</span>&#44; malaria and neglected tropical diseases and combat hepatitis&#44; water-borne diseases and other communicable diseases<br>Objective 3&#46;9&#58; Substantially reduce the number of deaths and illnesses fromhazardous chemicals and air <span class="elsevierStyleItalic">&#91;Age-standardised death rate attributable to household air pollution and ambient air pollution&#44; per 100</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">000 population&#93;</span> water and soil pollution and contamination<br>Objective 3&#46;A&#58; Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries&#44; as appropriate <span class="elsevierStyleItalic">&#91;Age-standardised prevalence of daily smoking in populations aged 10 years and older&#44; &#37; population aged 10 years and older&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; Achieve gender equality and empower all women and girls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; Ensure availability and sustainable management of water and sanitation for all&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; Ensure access to affordable&#44; reliable&#44; sustainable and modern energy for all&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Objective 7&#46;1&#58; Ensure universal access to affordable&#44; reliable and modern energy services <span class="elsevierStyleItalic">&#91;Risk-weighted prevalence of household air pollution&#44; as measured by the SEV for household air pollution&#44; &#37;&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; Promote sustained&#44; inclusive and sustainable economic growth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; Build resilient infrastructure&#44; promote inclusive and sustainable industrialization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Reduce inequality within and among countries&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; Make cities and human settlements inclusive&#44; safe&#44; resilient and sustainable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Objective 11&#46;6&#58; Reduce the adverse per capita environmental impact of cities&#44; including by paying special attention to air quality &#91;mean levels of PM2&#46;5 in <span class="elsevierStyleItalic">&#956;g&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span><span class="elsevierStyleItalic">&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; Ensure sustainable consumption and production patterns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; Take urgent action to combat climate change and its impacts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; Conserve and sustainably use the oceans&#44; seas and marine resources for sustainable development&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; Protect&#44; restore and promote sustainable use of terrestrial ecosystems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#46; Promote peaceful and inclusive societies for sustainable development&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46; Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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