Gonzalo López-Abente

Association between health information, use of protective devices and occurrence of acute health problems in the Prestige oil spill clean-up in Asturias and Cantabria (Spain): a cross-sectional study

BackgroundThis paper examines the association between use of protective devices, frequency of acute health problems and health-protection information received by participants engaged in the Prestige oil spill clean-up in Asturias and Cantabria, Spain.MethodsWe studied 133 seamen, 135 bird cleaners, 266 volunteers and 265 paid workers selected by random sampling, stratified by type of worker and number of working days. Information was collected by telephone interview conducted in June 2003. The association of interest was summarized, using odds ratios (OR) obtained from logistic regression.ResultsHealth-protection briefing was associated with use of protective devices and clothing. Uninformed subjects registered a significant excess risk of itchy eyes (OR:2.89; 95%CI:1.21–6.90), nausea/vomiting/dizziness (OR:2.25; 95%CI:1.17–4.32) and throat and respiratory problems (OR:2.30; 95%CI:1.15–4.61). There was a noteworthy significant excess risk of headaches (OR:3.86: 95%CI:1.74–8.54) and respiratory problems (OR:2.43; 95%CI:1.02–5.79) among uninformed paid workers. Seamen, the group most exposed to the fuel-oil, were the worst informed and registered the highest frequency of toxicological problems.ConclusionProper health-protection briefing was associated with greater use of protective devices and lower frequency of health problems. Among seamen, however, the results indicate poorer dissemination of information and the need of specific guidelines for removing fuel-oil at sea.

Cigarette smoking and bladder cancer in men : A pooled analysis of 11 case-control studies

The primary risk factor for bladder cancer is cigarette smoking. Using a combined analysis of 11 case‐control studies, we have accurately measured the relationship between cigarette smoking and bladder cancer in men. Available smoking information on 2,600 male bladder cancer cases and 5,524 male controls included duration of smoking habit, number of cigarettes smoked per day and time since cessation of smoking habit for ex‐smokers. There was a linear increasing risk of bladder cancer with increasing duration of smoking, ranging from an odds ratio (OR) of 1.96 after 20 years of smoking (95% confidence interval [CI] 1.48–2.61) to 5.57 after 60 years (CI 4.18–7.44). A dose relationship was observed between number of cigarettes smoked per day and bladder cancer up to a threshold limit of 15–20 cigarettes per day, OR = 4.50 (CI 3.81–5.33), after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking. This decrease was over 30% after 1–4 years, OR = 0.65 (0.53–0.79), and was over 60% after 25 years of cessation, OR = 0.37 (0.30–0.45). However, even after 25 years, the decrease in risk did not reach the level of the never‐smokers, OR = 0.20. (0.17–0.24). The proportion of bladder cancer cases attributable to ever‐smoking was 0.66 (0.61–0.70) for all men and 0.73 (0.66–0.79) for men younger than 60. These estimates are higher than previously calculated. Int. J. Cancer 86:289–294, 2000.

Validation of the geographic position of EPER-Spain industries

BackgroundThe European Pollutant Emission Register in Spain (EPER-Spain) is a public inventory of pollutant industries created by decision of the European Union. The location of these industries is geocoded and the first published data correspond to 2001. Publication of these data will allow for quantification of the effect of proximity to one or more such plant on cancer and all-cause mortality observed in nearby towns. However, as errors have been detected in the geocoding of many of the pollutant foci shown in the EPER, it was decided that a validation study should be conducted into the accuracy of these co-ordinates. EPER-Spain geographic co-ordinates were drawn from the European Environment Agency (EEA) server and the Spanish Ministry of the Environment (MOE). The Farm Plot Geographic Information System (Sistema de Información Geográfica de Parcelas Agrícolas) (SIGPAC) enables orthophotos (digitalized aerial images) of any territorial point across Spain to be obtained. Through a search of co-ordinates in the SIGPAC, all the industrial foci (except farms) were located. The quality criteria used to ascertain possible errors in industrial location were high, medium and low quality, where industries were situated at a distance of less than 500 metres, more than 500 metres but less than 1 kilometre, and more than 1 kilometre from their real locations, respectively.ResultsInsofar as initial registry quality was concerned, 84% of industrial complexes were inaccurately positioned (low quality) according to EEA data versus 60% for Spanish MOE data. The distribution of the distances between the original and corrected co-ordinates for each of the industries on the registry revealed that the median error was 2.55 kilometres for Spain overall (according to EEA data). The Autonomous Regions that displayed most errors in industrial geocoding were Murcia, Canary Islands, Andalusia and Madrid. Correct co-ordinates were successfully allocated to 100% of EPER-Spain industries.ConclusionKnowing the exact location of pollutant foci is vital to obtain reliable and valid conclusions in any study where distance to the focus is a decisive factor, as in the case of the consequences of industrial pollution on the health of neighbouring populations.

Recent Changes in Breast Cancer Incidence in Spain, 1980–2004

Background Since the 1980s, Spain experienced two decades of sharply increasing breast cancer incidence. Declines in breast cancer incidence have recently been reported in many developed countries. We examined whether a similar downturn might have taken place in Spain in recent years. Methods Cases of invasive female breast cancer were drawn from all population-based Spanish cancer registries that had at least 10 years of uninterrupted registration over the period 1980–2004. Overall and age-specific changes in incidence rates were evaluated using change-point Poisson models, which allow for accurate detection and estimation of trend changes. All statistical tests were two-sided. Results A total of 80 453 incident cases of invasive breast cancer were identified. Overall age- and registry-adjusted incidence rates rose by 2.9% (95% confidence interval [CI] = 2.7% to 3.1%) annually during the 1980s and 1990s; there was a statistically significant change in this trend in 2001 (95% CI = 1998 to 2004; P value for the existence of a change point <.001), after which incidence declined annually by 3.0% (95% CI = 1.8% to 4.1%). This trend differed by age group: There was a steady increase in incidence for women younger than 45 years, an abrupt downturn in 2001 for women aged 45–64 years, and a gradual leveling off in 1995 for women aged 65 years or older. Separate analyses for registries that had at least 15 years of uninterrupted registration detected a statistically significant interruption of the previous upward trend in breast cancer incidence in provinces that had aggressive breast cancer screening programs and high screening participation rates, including Navarra (change point = 1991, P < .001), Granada (change point = 2002, P = .003), Bizkaia (change point = 1998, P < .001), Gipuzkoa (change point = 1998, P = .001), and Araba (change point = 1997, P = .002). Conclusions The recent downturn in breast cancer incidence among Spanish women older than 45 years is best explained by a period effect linked to screening saturation.

The contribution of cigarette smoking to bladder cancer in women (pooled European data).

AbstractBackground: Using a combined analysis of 11 case–control studies from Europe, we have investigated the relationship between cigarette smoking and bladder cancer in women. Methods: Available smoking information on 685 female bladder cancer cases and 2416 female controls included duration of smoking habit, number of cigarettes smoked per day, and time since cessation of smoking habit for ex-smokers. Results: There was an increasing risk of bladder cancer with increasing duration of smoking, ranging from approximately a two-fold increased risk for a duration of less than 10 years (odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.1–3.1) to over a four-fold increased risk for a duration of greater than 40 years (OR = 4.1, 95% CI 3.0–5.5). A dose–response relationship was observed between number of cigarettes smoked per day and bladder cancer up to a threshold limit of 15–20 cigarettes per day, OR = 3.8 (95% CI 2.7–5.4), after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking. This decrease was over 30% in the immediate 1–4 years after cessation, OR = 0.68 (95% CI 0.38–1.2). However, even after 25 years the decrease in risk did not reach the level of the never-smokers, OR = 0.27 (95% CI 0.21–0.35). Conclusion: The proportion of bladder cancer cases among women attributable to ever smoking was 0.30, (0.25–0.35) and to current smoking was 0.18 (0.14–0.22). These attributable proportions are less than those observed among men, although they are likely to increase in the future as the smoking-related disease epidemic among women matures.

Situación del cáncer en España: incidencia

It is estimated that at present in Spain around 162,000 cases of cancer are diagnosed each year (without including non-melanoma skin cancer), of which 25,600 correspond to colorectal carcinomas, which is the most frequent of all tumours in absolute terms. The next tumour in terms of frequency is lung cancer with 18,800 new cases, followed by breast cancer in women with 15,979 cases. When the incidence of cancer is compared with that in neighbouring countries, Spain shows adjusted rates in men higher than those of the average for the EU, occupying the 5th place. However, in women, Spain shows the lowest rates together with Greece. Spain occupies the first place for cancer of the bladder in men, with rates that are considerably higher than those of the rest of the countries. It is important to verify the increase underway in the incidence of cancer in Spain and the contrast that this represents facing the evolution of mortality. For many important tumoral localisations (lung, stomach, bladder), the population registers do not cover the provinces where there is a greater mortality.

Accuracy of cancer death certificates in Spain: a summary of available information

OBJECTIVES Differences in mortality rates within Europe might be partly due to the quality of mortality statistics. The present article summarizes the available data on the quality of cancer death certification in Spain. A short description of the temporal distribution of the proportion of deaths due to ill-defined tumors in Spain -an indirect indicator of the quality of cancer death certification- is also provided. METHODS Relevant studies were identified from electronic databases (MEDLINE, EMBASE, IME and IBECS) and from manual searches of the references contained in the articles retrieved. Quality data on death certificates for all tumors and for each specific cancer location were summarized, and all main cancer sites were classified according to their pooled accuracy indicators. Trends for the percentage of deaths due to ill-defined tumors and conditions were studied for the period from 1980 to 2002. RESULTS In Spain, deaths from cancer as a whole and leading cancer sites (lung, colon-rectum, prostate, stomach, pancreas, female breast, uterus, brain, leukemia, lymphomas and myeloma) were well-certified. However, other frequent locations, such as the larynx, esophagus and liver were overcertified, while deaths from bladder, kidney and ovarian cancer were undercertified. The percentage of deaths due to ill-defined tumors and causes was regularly higher in females and decreased in both sexes during the study period. However, the recent introduction of the International Classification of Diseases (ICD)-10 has reversed this trend. CONCLUSIONS Spanish death certificates can be considered as accurate and useful to estimate the burden of cancer, though certification of some frequent sites should be improved. The possible effect of the introduction of the ICD-10 requires careful surveillance.

Mercury, Cadmium, and Lead Levels in Human Placenta: A Systematic Review

Background: Placental tissue may furnish information on the exposure of both mother and fetus. Mercury (Hg), cadmium (Cd), and lead (Pb) are toxicants of interest in pregnancy because they are associated with alterations in child development. Objectives: The aim of this study was to summarize the available information regarding total Hg, Cd, and Pb levels in human placenta and possible related factors. Methods: We performed a systematic search of PubMed/MEDLINE, EMBASE, Lilacs, OSH, and Web of Science for original papers on total Hg, Cd, or Pb levels in human placenta that were published in English or Spanish (1976–2011). Data on study design, population characteristics, collection and analysis of placenta specimens, and main results were extracted using a standardized form. Results: We found a total of 79 papers (73 different studies). Hg, Cd, and Pb levels were reported in 24, 46, and 46 studies, respectively. Most studies included small convenience samples of healthy pregnant women. Studies were heterogeneous regarding populations selected, processing of specimens, and presentation of results. Hg concentrations > 50 ng/g were found in China (Shanghai), Japan, and the Faroe Islands. Cd levels ranged from 1.2 ng/g to 53 ng/g and were highest in the United States, Japan, and Eastern Europe. Pb showed the greatest variability, with levels ranging from 1.18 ng/g in China (Shanghai) to 500 ng/g in a polluted area of Poland. Conclusion: The use of the placenta as a biomarker to assess heavy metals exposure is not properly developed because of heterogeneity among the studies. International standardized protocols are needed to enhance comparability and increase the usefulness of this promising tissue in biomonitoring studies.

Health impact assessment of a reduction in ambient PM2.5 levels in Spain

BACKGROUND Health effects linked to exposure to high air pollutant levels have been described in depth, and many recent epidemiologic studies have also consistently reported positive associations between exposure to air pollutants at low concentrations (particularly PM(2.5)) and adverse health outcomes. OBJECTIVE To estimate the number of avoidable deaths associated with reducing PM(2.5) levels in Spain. MATERIALS AND METHODS For exposure assessment, we used the US Environmental Protection Agencys Community Multiscale Air Quality model to simulate air pollution levels with a spatial resolution of 18×18 km(2). Two different scenarios were compared, namely, a baseline 2004 scenario based on Spains National Emissions Inventory and a projected 2011 scenario in which a reduction in PM(2.5) was estimated on the basis of the benefits that might be attained if specific air quality policies were implemented. Using an 18×18 km(2) grid, air pollution data were estimated for the entire Iberian Peninsula, the Balearic Islands, Ceuta and Melilla. For these strata, crude all-cause mortality rates (ICD-10: A00-Y98) were then calculated for the over-30 and 25-74 age groups, taking into account the 2004 population figures corresponding to these same age groups, selected in accordance with the concentration-response functions (Pope CA 3rd, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 2002; 287:1132-41; Laden F, Schwartz J, Speizer FE, Dockery DW. Reduction in fine particulate air pollution and mortality: extended follow-up of the Harvard Six Cities study. Am J Respir Crit Care Med 2006; 173:667-72.). Health impacts were assessed using the Environmental Benefits Mapping and Analysis Program (BenMAP). RESULTS Air quality improvement was defined as an average annual reduction of 0.7 μg/m(3) in PM(2.5) levels. Using long-term health impact assessment analysis, we estimated that 1720 (673-2760) all-cause deaths (6 per 100,000 population) in the over-30 age group and 1450 (780-2108) all-cause deaths (5 per 100,000 population) in the 25-74 age group could be prevented annually. CONCLUSIONS The results showed the potential benefits in general mortality which could be expected if pollution control policies were successfully implemented by 2011. A specifically adapted BenMAP could be used as a tool for estimating health impacts associated with changes in air pollution in Spain.

Cattle, pets, and Paget's disease of bone.

To identify animal‐related factors associated with Pagets disease of bone (osteitis deformans), we conducted a case‐control study in two geographical areas of Spain characterized by different socioeconomic profiles. The analysis presented here is based on 149 cases and 150 controls, frequency matched by sex, age, study area, and place of residence in youth (urban/rural). From a logistic regression analysis, we found that contact with bovine cattle [odds ratio (OR) = 2.14; 95% confidence interval (CI) = 1.16–3.94], consumption of meat traceable to sick livestock (OR = 2.70; 95% CI = 0.98–7.43), and frequent consumption during youth of brains (OR = 1.77; 95% CI = 1.05–2.98) and other viscera increased the risk for Pagets disease of bone. Contact with bovine cattle and consumption during youth of bovid viscera exhibited a dose‐response effect as regards length of exposure and frequency of consumption, respectively. A life‐style shared with dogs showed itself to be differentially linked to the disease in one study area. Overall, our results support the hypothesis that various animal species are carriers of etiologic agents of Pagets disease of bone.