Iñaki Galán

Short-term effects of air pollution on daily asthma emergency room admissions

Many time-series studies have shown positive associations between air pollutants and asthma morbidity. However, few studies have included pollen as a potential confounder when examining this relationship. This study analysed the short-term association between air pollutants (sulphur dioxide (SO2), particles measured with a median aerodynamic diameter of <10 µm (PM10), nitrogen dioxide (NO2) and ozone (O3)) and asthma emergency room admissions in Madrid, Spain, in 1995–1998, adjusting for four types of pollen with allergenic potential (Olea europaea, Plantago sp., Poaceae and Urticaceae). Data were analysed using autoregressive Poisson regression and generalised additive models (GAM). The strongest associations were observed at 1 day lag for O3, and 3 days lag for the remaining pollutants. Using Poisson regression, a single-pollutant model showed that a 10‐µg·m−3 rise in pollutant level led to relative risks of: 1.039 for PM10; 1.029 for SO2; 1.033 for NO2; and 1.045 for O3. Adjustment for the different types of pollen led to no substantial variation in these associations. In the multipollutant models for cold-season pollutants (including PM10, SO2 and the four types of pollen) and photochemical pollutants (including NO2, O3 and the four types of pollen) the associations for PM10, NO2 and O3 held, but no relationship with SO2 was evident. GAM analysis yielded the same results, both in terms of lags and of quantification of the effect for all pollutants. In conclusion, the usual air pollution levels in Madrid were associated with an increase in asthma emergency room admissions, and this association remained controlling for the presence of ambient pollen.

Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project

Objective: To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities Methods: The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO2, NO2, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed. Results: Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0–1), except in the case of ozone where there was a more delayed relation (lag 2–3). For combined estimates an increase of 10 μg/m3 in the PM10 levels in lag 0–1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1.6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2–3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m3 in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO2 and NO2 estimates were more sensitive in two pollutant models Conclusions: A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities.

Comparación entre encuestas telefónicas y encuestas «cara a cara» domiciliarias en la estimación de hábitos de salud y prácticas preventivas

Objetivo: En este estudio se examina la influencia del metodo de encuesta, telefonica y «cara a cara» domiciliaria, sobre la estimacion de los factores de riesgo para la salud asociados al comportamiento y la realizacion de practicas preventivas. Material y metodo: El mismo cuestionario fue administrado en 2 muestras independientes de poblacion de 18-64 anos residente en el municipio de Madrid. Una muestra (n = 1.391) realizo la entrevista telefonica y la otra (n = 739), la entrevista «cara a cara» domiciliaria. Se compararon los resultados de las 2 muestras para 28 variables relacionadas con la antropometria, la actividad fisica, el consumo de alimentos, el consumo de tabaco y alcohol, las practicas preventivas y la accidentabilidad. Resultados: La muestra telefonica obtuvo una mayor tasa de no contactos (31,8 frente a 22,2%) pero un mayor grado de cooperacion que la muestra con entrevista «cara a cara» (83 frente a 74%). En total, 19 de las 28 variables mostraron una variacion relativa entre ambas encuestas < 10%, en 8 variables las diferencias se encontraban entre el 10 y el 20%, y 1 supero el 20%. Solo en 4 variables (sedentarismo en el tiempo libre, consumo de verdura, abandono del consumo de tabaco y medicion del colesterol) las diferencias fueron estadisticamente significativas, con una variacion relativa del 6,1% (p < 0,01), 10% (p < 0,001), 36,7% (p < 0,01) y 8,6% (p < 0,01), respectivamente. El coste global de la entrevista telefonica ha sido la mitad de la domiciliaria «cara a cara». Conclusiones: Los resultados de las encuestas telefonica y «cara a cara» domiciliaria fueron muy similares. El menor coste de la encuesta telefonica la convierte en una buena alternativa para la investigacion de salud publica que requiera la recogida de datos por entrevista.

Short term effects of airborne pollen concentrations on asthma epidemic

Background: Few studies have used time series to investigate the relationship between asthma attacks and aeroallergen levels on a daily basis. Methods: This study, based on time series analysis adjusting for meteorological factors and air pollution variables, assessed the short term effects of different types of allergenic pollen on asthma hospital emergencies in the metropolitan area of Madrid (Spain) for the period 1995–8. Results: Statistically significant associations were found for Poaceae pollen (lag of 3 days) and Plantago pollen (lag of 2 days), representing an increase in the range between the 99th and 95th percentiles of 17.1% (95% confidence interval (CI) 3.2 to 32.8) and 15.9% (95% CI 6.5 to 26.2) for Poaceae and Plantago, respectively. A positive association was also observed for Urticaceae (lag of 1 day) with an 8.4% increase (95% CI 2.8 to 14.4). Conclusions: There is an association between pollen levels and asthma related emergencies, independent of the effect of air pollutants. The marked relationship observed for Poaceae and Plantago pollens suggests their implication in the epidemic distribution of asthma during the period coinciding with their abrupt release into the environment.

The Joint Association of Average Volume of Alcohol and Binge Drinking with Hazardous Driving Behaviour and Traffic Crashes

BACKGROUND Previous studies on alcohol-related road safety have not assessed the joint impact of average volume of alcohol and binge drinking. AIM To examine the joint and separate association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes. METHODS Data were drawn from telephone interviews conducted in the period 2000-2005, with 12 037 individuals representative of the population aged 18-64 years in the Madrid region, Spain. The threshold between average moderate and heavy volumes was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of >or= 80 g of alcohol in men and >or= 60 g in women, during any drinking occasion in the preceding 30 days. Individuals were classified into the following categories: (i) non-drinkers; (ii) moderate drinkers with no binge drinking (MDNB); (iii) moderate drinkers with binge drinking (MDB); (iv) heavy drinkers with no binge drinking (HDNB); and (v) heavy drinkers with binge drinking (HDB). Analyses were performed using logistic regression, with adjustment for sex, age and educational level. FINDINGS Frequency of inadequate seat-belt use increased progressively across categories of alcohol consumption, with odds ratio (OR) 1 in non-drinkers, 1.19 [95% confidence interval (CI) 1.06-1.33] in MDNB, 1.69 (1.41-2.03) in MDB, 1.68 (1.24-2.29) in HDNB and 2.41 (1.83-3.18) in HDB (P for trend <0.001). Compared with MDNB, alcohol-impaired driving was also more frequent in MDB (OR 7.43; 95% CI: 5.52-10.00), HDNB (OR 7.31; 95% CI: 4.37-12.25) and in HDB (OR 15.50; 95% CI: 10.62-22.61). Lastly, compared with non-drinkers, frequency of traffic crashes increased progressively across categories of alcohol consumption (P for trend=0.028), although it only reached statistical significance in HDB (OR 2.01; 95% CI: 1.00-4.09). CONCLUSIONS Self-reported average volume of alcohol and binge drinking are both associated with self-reported hazardous driving behaviour and traffic crashes. The strength of the association is greater when average heavy consumption and binge drinking occur jointly.

[Telephone versus face-to-face household interviews in the assessment of health behaviors and preventive practices].

OBJECTIVE This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices. MATERIAL AND METHOD The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared. RESULTS The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p < 0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01), respectively. The total cost of the telephone interview was half that of the face-to-face household interview. CONCLUSIONS The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required.

Physical activity and self-reported health status among adolescents: A cross-sectional population-based study

Objectives Little is known about the dose–response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of undertaking moderate-to-vigorous physical activity (MVPA) and the self-reported health status of the adolescent population. Design Cross-sectional study. Setting All regions of Spain. Participants Students aged 11–18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected. Main outcomes The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-rated health, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose–response relationship. Results As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-rated health and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes (p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males. Conclusions A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.

Actividad física de tiempo libre en un país mediterráneo del sur de Europa: adherencia a las recomendaciones y factores asociados

Introduccion y objetivos. Examinar en adultos de la Comunidad de Madrid la adecuacion de la actividad fisica en tiempo libre (AFTL) a las recomendaciones e identificar factores asociados. Metodos. Encuesta telefonica a 12.037 personas, representativa de la poblacion de 18-64 anos de Madrid. La AFTL se calculo en MET-h/semana mediante un cuestionario de frecuencia y duracion de AFTL. Se comparo con la recomendacion de realizar actividad al menos moderada ? 150 min/semana, o vigorosa ? 60 min/semana. Los factores asociados al cumplimiento se identificaron mediante regresion logistica. Resultados. La media de AFTL fue 17,3 (intervalo de confianza [IC] del 95%, 16,9-17,7) MET-h/semana y un 28,8% (IC del 95%, 28%-29,7%) alcanzo la recomendacion. La AFTL recomendada fue mas frecuente en varones que en mujeres (odds ratio [OR] = 2,41; IC del 95%, 2,20-2,64). Comparando con los mas jovenes, la adherencia disminuyo gradualmente con la edad hasta los 60-64 anos, donde la OR fue 0,20 (IC del 95%, 0,15-0,25). Respecto a los sujetos sin estudios, los universitarios siguieron mas frecuentemente la recomendacion (OR = 2,28; IC del 95%, 1,82-2,87). Las personas obesas tuvieron menos probabilidad que los normopesos de realizar la AFTL recomendada (OR = 0,49; IC del 95%, 0,40-0,61). Las personas con actividad laboral de baja intensidad se adhirieron a la recomendacion con mas frecuencia que las de ocupacion sedentaria (OR = 1,21; IC del 95%, 1,10-1,34). Conclusiones. La mayoria de los adultos de Madrid no siguio la recomendacion de AFTL. La adherencia fue menor en mujeres, al aumentar la edad, con menor nivel de estudios y en obesos, mientras que fue mayor en personas con ocupaciones que requieren baja intensidad fisica.

Tendencias de actividad física en tiempo libre y en el trabajo en la Comunidad de Madrid, 1995-2008

INTRODUCTION AND OBJECTIVES Information on trends in physical activity is very scarce in Mediterranean countries, which have the highest sedentariness in Europe. This study describes recent trends in leisure time physical activity (LTPA) and at work in the Madrid region. METHODS The data were taken from representative annual surveys of population aged 18-64 years, between 1995-2008, 28,084 people participated. We calculated total energy, quantified in metabolic equivalent (MET-1 h per week), spent on LTPA and on light LTPA (<3 MET), moderate LTPA (3-6 MET) and vigorous LTPA (>6 MET). The annual change in LTPA was estimated by linear regression, and occupational activity by logistic regression, adjusting for age, gender and educational level. RESULTS The total amount of LTPA in MET-1 h per week declined by 19.8% (P<.001) between 1995-2008; for both genders, all age groups and educational levels, except for those with the lowest level of education. The adjusted annual change in MET-1 h per week was: -0.21 (P<.001) for total LTPA; -0.1 (P<.001) for light; -0.08 (P<.001) for moderate; and -0.03 (P=.192) for vigorous. This decline is reflected by a shift to the left of the LTPA distribution in the population. Occupational physical inactivity has increased in the general population (odds ratio for annual change=1.01; 95% confidence interval, 1-1.02); specially in women, young and middle aged, and intermediate educational level. CONCLUSIONS There has been a decline in LTPA, mainly in light and moderate activities, accompanied by greater occupational physical inactivity. This could have contributed to the increase in obesity in the Community of Madrid between 1995-2008.

Reproducibilidad de un cuestionario telefónico sobre factores de riesgo asociados al comportamiento y las prácticas preventivas

Objetivo: Se evalua la reproducibilidad del cuestionario utilizado en un sistema de vigilancia de factores de riesgo de enfermedades no transmisibles (SIVFRENT), basado en encuestas continuas con entrevista telefonica. Metodos: El mismo cuestionario fue aplicado telefonicamente en 2 ocasiones a una muestra de 586 personas de 18-64 anos representativas de la Comunidad de Madrid, con un intervalo de 13-32 dias. Se analizan 27 variables relacionadas con la percepcion del estado de salud, antropometria, actividad fisica, consumo de tabaco y alcohol, practicas preventivas, accidentalidad y seguridad vial. Para valorar la estabilidad de las respuestas se analizo la concordancia absoluta, los valores del indice kappa sin ponderar y ponderado, y el coeficiente de correlacion intraclase (CCI), en las variables categoricas nominales, ordinales y cuantitativas, respectivamente. Resultados: La tasa de respuesta a la segunda entrevista fue del 78,7%, y participaron 461 personas. La comparacion de las prevalencias y promedios en las 2 entrevistas refleja que en 19 de los 27 indicadores analizados la desviacion relativa fue inferior al 5%, y solo 2 superaron el 20%. La concordancia absoluta excedio del 85% en 13 de las 20 variables categoricas, y los coeficientes kappa y CCI superaron el valor de 0,8 en 10 variables, en 13 oscilaron entre 0,6 y 0,8, en 3 entre 0,4 y 0,6, y solo una fue inferior a 0,4. No se observo un patron uniforme de variables sociodemograficas asociadas a la discordancia. Conclusiones: Los resultados sugieren que el cuestionario telefonico utilizado en el SIVFRENT sobre factores de riesgo asociados al comportamiento y las practicas preventivas es reproducible en una amplia muestra representativa de la poblacion adulta de la Comunidad de Madrid.