Josep M. Antó

Health Effects of Chronic High Exposure to Hexachlorobenzene in a General Population Sample

Hexachlorobenzene, an organochlorine compound that accumulates in humans, is widespread throughout the environment. In this study, we describe the health status of inhabitants of a rural village that surrounds an electrochemical factory characterized by high levels of hexachlorobenzene in the air. During 1994, we conducted a cross-sectional study of 1 800 inhabitants in the south of Catalonia, Spain, who were older than 14 y of age. We obtained information on lifestyles and occupational and medical histories via questionnaire. Self-reported health outcomes were validated against clinical records and cancer registry data. Serum levels of hexachlorobenzene were very high in males who worked in the electrochemical factory (geometric mean = 54.6 ng/ml in randomized participants). Levels were lower among subjects who had never worked in the electrochemical factory (females, 14.9 ng/ml; males, 9.0 ng/ml). Levels of other organochlorine compounds (i.e., beta-hexachlorocy-clohexane, 2,2-bis[p-chlorophenyl]-1,1-dichloroethylene) were in the same range found in other communities. Perceived health, prevalence of self-reported common chronic conditions, and porphyria cutanea tarda, thyroid pathology, Parkinsons disease, cancer, and reproductive outcomes were within the ranges observed in other studies. Employment in the plant, however, was associated with having any of the a priori selected health outcomes that were potentially related to exposure to hexachlorobenzene (odds ratio for cancer prevalence = 1.9; 95% confidence interval = 0.5, 7.6). Our population of workers and nonworkers had the highest levels of hexachlorobenzene ever described. The results suggest that exposure to hexachlorobenzene did not affect the general health status of the this population, but it was associated with specific health effects of the most highly exposed subjects.

Emergency department and hospital admissions and deaths from traffic injuries in Barcelona, Spain. a one-year population-based study

The purpose of the study was to assess the one-year incidence of traffic injuries among residents 14 years of age and older, as well as their distribution by age, gender, road-user category, place of occurrence, and severity of the injury. A one-year survey was conducted in the emergency departments in Barcelona, Spain, based on a multistage cluster sampling of 8-hour shifts stratified by time of the year, day of the week, and time of day. All death certificates (E810-829) for residents in this same age group were also included. Information was collected prospectively in EDs by specially trained nonstaff interviewers. The baseline estimate of incidence of injuries was 1,037 per 100,000 population. The highest incidence was for ages 20-24 and 15-20 years. Incidence rank-ordered road-use categories were: motorbike occupants, passenger car occupants and pedestrians, the first category accounting for almost half of all injuries. There were 108 admissions and 15 deaths per 1,000 incident cases. Case-admissions ratios increased with age and were highest for pedestrians, who also accounted for the highest case-fatality ratios and ISS mean scores. The study offers the first description of the epidemiology of traffic injuries in a large southern-European city. Although overall age and gender incidence patterns were similar to those described in other western countries, the striking contribution of motorcycle injuries has not been previously pointed out, underscoring the urgent need to implement effective strategies to reduce injury risk associated with motorcycles and mopeds.

Cohort study on cancer mortality among workers in the pulp and paper industry in Catalonia, Spain.

We examined mortality in a retrospective follow-up study of 3,241 workers employed between 1970-1992, in four pulp and paper mills in Catalonia, Spain. Vital status was determined for 95% of the cohort. Exposure was reconstructed using job histories and a company exposure questionnaire. Standardized mortality ratios (SMR) were derived using mortality rates of Spain as the reference. For all workers, mortality from all causes (SMR = 76; 95%; confidence intervals [CI] = 65-88; 189 deaths) and all malignant neoplasms (SMR = 93; CI = 72-119; 65 deaths) were less than the expected. Excess risk was observed for mortality from all neoplasms in females (SMR = 168; CI = 84-303; 11 deaths), for large intestine cancer in both sexes (SMR = 250; CI = 115-525; 8 deaths), particularly after 10 years of employment and latency (SMR = 355; CI = 154-701; 8 deaths), and for breast cancer in females (SMR = 286; CI = 77-732; 4 deaths). These findings suggest that workers employed in the pulp and paper industry may have an excess risk of specific cancers.

Using length of stay and inactive days in the hospital to assess appropriateness of utilisation in Barcelona, Spain.

STUDY OBJECTIVE: To compare the level of inappropriate utilisation of a teaching hospital in two different calendar years and to analyse the relationship between changes in appropriateness of utilisation and changes in average length of stay. DESIGN: Retrospective evaluation of the medical records of patients admitted to a hospital in two periods: 1988 and 1990. SETTING: Hospital Universitari del Mar, a teaching hospital with 440 beds located in Barcelona, Catalònia, Spain. PARTICIPANTS: Medical records were randomly selected from records of adults discharged from hospital with a principal diagnosis other than normal delivery or any psychiatric condition. Altogether 750 records with complete data were reviewed for 1988 and 633 for 1990. MEASUREMENTS AND MAIN RESULTS: The appropriateness evaluation protocol (AEP) was used to assess whether or not the admission and each day of the hospital stay were appropriate. For data analysis we used the extension of logistic regression that allows quantification of within-patient clustering of inactive days. The average length of stay (LOS) was 11.7 days in 1988 and 9.5 in 1990 (p < 0.001). In contrast, the proportion of inappropriate admissions was 12% in 1988 and 19% in 1990 (p < 0.001). Among those patients who were appropriately admitted, the average odds of a given day being inactive in 1990 was no lower (OR = 1.09) than the odds in 1988, but the clustering of inactive days was significantly (p < 0.001) lower in 1990. CONCLUSIONS: In the hospital studied, a lower average length of stay was not associated with an improved level of appropriate utilisation. Policies exclusively focused on lowering LOS may not directly lead to a reduction in inappropriate hospital utilisation.