Koldo Cambra

Short-term effects of ambient particles on cardiovascular and respiratory mortality

Background: Particulate air pollution is associated with increased mortality. There is a need for European results from multicountry databases concerning cause-specific mortality to obtain more accurate effect estimates. Methods: We report the estimated effects of ambient particle concentrations (black smoke and particulate matter less than 10 μm [PM10]) on cardiovascular and respiratory mortality, from 29 European cities, within the Air Pollution and Health: a European Approach (APHEA2) project. We applied a 2-stage hierarchical modeling approach assessing city-specific effects first and then overall effects. City characteristics were considered as potential effect modifiers. Results: An increase in PM10 by 10 μg/m3 (lag 0 + 1) was associated with increases of 0.76% (95% confidence interval = 0.47 to 1.05%) in cardiovascular deaths and 0.58% (0.21 to 0.95%) in respiratory deaths. The same increase in black smoke was associated with increases of 0.62% (0.35 to 0.90%) and 0.84% (0.11 to 1.57%), respectively. Conclusions: These effect estimates are appropriate for health impact assessment and standard-setting procedures.

Relación a corto plazo de la contaminación atmosférica y la mortalidad en 13 ciudades españolas

in the levels of the average of the concurrent and one day lag for black smoke was associated with a 0.8% (CI: 0.4-1.1) increase in mortality. The same in- crease in the concentration of SO2 was associated with a 0.5% (CI: 0.1-1.0) increase in daily deaths, and a 0.6% (CI: 0.3-0.8) increase in the case of NO2. An increase of 1 mg/m3 in the le- vels of CO was associated with an increase of 1.5% (CI: 0.5-2.6) in daily deaths. CONCLUSIONS: There is a short-term association between increases of daily levels of air pollutants and the number of daily deaths in Spanish cities.

El proyecto Emecas: protocolo del estudio multicéntrico en España de los efectos a corto plazo de la contaminación atmosférica sobre la salud

El proyecto EMECAM constato el efecto a corto plazo de la contaminacion atmosferica sobre la mortalidad en 14 ciudades espanolas entre 1990 y 1995. El Estudio Multicentrico Espanol de Contaminacion Atmosferica y Salud (EMECAS) amplia estos objetivos incorporando al analisis datos de morbilidad hospitalaria, utiliza informacion mas reciente y suma un total de 16 ciudades. Se trata de un estudio ecologico de series temporales, siendo las variables respuesta las defunciones diarias y los ingresos hospitalarios urgentes por enfermedades del aparato circulatorio y enfermedades respiratorias en los residentes de cada ciudad. Contaminantes analizados: particulas en suspension, SO2, NO2, CO y O3. Variables de control: meteorologicas, de calendario, estacionalidad y tendencia e incidencia de gripe. Analisis estadistico: estimacion de la asociacion en cada ciudad mediante la construccion de modelos de regresion de Poisson aditivos generalizados, y meta-analisis para la obtencion de estimadores conjuntos. Los niveles medios de contaminantes se situaron por debajo de los establecidos por la normativa actual para el dioxido de azufre, el monoxido de carbono y el ozono. Los valores de NO2 y PM10 se situaron alrededor de los establecidos en la normativa (40 µg/m³). Se trata del primer estudio de la relacion entre contaminacion atmosferica y morbilidad en un conjunto de ciudades espanolas. Los niveles de contaminantes estudiados son moderados para algunos contaminantes, aunque en otros, especialmente NO2 y particulas, podrian representar un problema para el cumplimiento de la normativa vigente.

Determinants of patient satisfaction with care in a Spanish oncology day hospital and its relationship with quality of life.

This study evaluates satisfaction with care (SC) in cancer patients treated at a Spanish day hospital to identify SC determinants and assess the relationship between SC and quality of life.

Association of proximity to polluting industries, deprivation and mortality in small areas of the Basque Country (Spain)

BACKGROUND The study is aimed at assessing social inequities in the location of polluting industries in the Basque Country, and at exploring if the effect on mortality of living near air polluting industries is modified by economic deprivation. METHODS This is a cross-sectional ecological study that uses the census sections as analysis units. Mortality from all causes, lung cancer, respiratory diseases and ischaemic heart disease were studied. Ordinal logistic regression models were fitted to assess if proximity of census sections to polluting industries is associated with deprivation. Bayesian Poisson regression models were used to explore if the association between proximity to polluting industries and mortality is modified by socio-economic deprivation. RESULTS Proximity to a polluting industry and deprivation are positively associated, showing a clear gradient across deprivation quintiles. In women, the risk associated with proximity to metal-processing industries grows as the deprivation of the area increases in the case of total and lung cancer mortality. In men, the interaction terms between proximity and deprivation are positive for total, ischaemic heart disease mortality, with a credibility level approaching 90%. High levels of deprivation are associated with greater risk of mortality, excepting lung cancer in women. CONCLUSION There is a higher proportion of more deprived census sections around polluting industries in the Basque Country. Risks of mortality associated with proximity to polluting industries tend to be higher in more deprived areas.

Influence of Age at Diagnosis and Time-Dependent Risk Factors on the Development of Diabetic Retinopathy in Patients with Type 1 Diabetes

Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset. Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables. Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10–14, 15–29, 30–44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure. Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.

The EORTC QLQ-C15-PAL questionnaire: validation study for Spanish bone metastases patients

PurposeQuality of life (QL) is a key outcome for advanced disease cancer patients. The European Organization for Research and Treatment of Cancer (EORTC) has developed the QLQ-C15-PAL questionnaire, a short version of the QLQ-C30 for palliative care. The aim of the present study is to validate the QLQ-C15-PAL for use with Spanish patients with bone metastasis.MethodsFor this study, we used a consecutive sample of stage IV cancer patients with bone metastases who started radiotherapy with palliative intention. Two assessments were proposed for each patient: one on the first day of treatment and one a month after the end of the radiotherapy sessions. Psychometric evaluation of the structure, reliability, and validity was undertaken.ResultsOne hundred and sixteen patients completed the first questionnaire and seventy five completed the second. Multitrait scaling analysis showed that all items met the standards for convergent validity, and all except the fatigue scale met the standards for divergent validity. Cronbach’s coefficient met the 0.7 alpha criterion on all scales except pain (second assessment). Most QLQ-C15-PAL areas had low-to-moderate correlations with the other areas. Significant differences appeared in the comparisons between groups with regard to: patients who died before the second assessment (six areas); patients receiving chemotherapy before starting radiotherapy in the two assessments (three and four areas, respectively); the performance status in the two assessments (nine and eight areas); and the number of RT sessions received (four). Quality of life was better in the second assessment in nine areas.ConclusionThe QLQ-C15-PAL is a reliable and valid instrument when applied to a sample of Spanish patients. These results are in line with those of other validation studies.

Changes of age at onset in patients with type 1 diabetes during the last two decades.

la interrupción voluntaria del embarazo era de origen sudamericano. Nuestros datos completan el perfil de las mujeres: edad de la primera relación entre los 15 y los 19 años, con un porcentaje preocupantemente alto de menores de 15 años (14%). Un 48,6% de las encuestadas aseguraban usar siempre métodos anticonceptivos (diferencias estadísticamente significativas entre españolas y extranjeras: 60% frente a 38,6%, p = 0,02), con el preservativo, seguido de los anticonceptivos hormonales, como los métodos más utilizados, lo que coincide con los datos de un estudio multicéntrico publicados por Serrano et al.3 Consideramos importante, de cara a la posible implantación de programas preventivos, informar del alto porcentaje de mujeres (23,3%) que no hacían uso de métodos anticonceptivos o empleaban alguno con tasas de fallo muy altas (coitus interruptus), dato ya publicado por Dueñas et al.4 en un estudio sobre los métodos anticonceptivos y la interrupción voluntaria del embarazo. Del 43,9% de las mujeres que reconocían no haber usado método anticonceptivo en el embarazo actual, el 38,3% justificaba haberlo acordado con su pareja. Es alarmante que un 12,8% admitió desconocer los métodos anticonceptivos a los cuales podían acceder, mientras que un 14,8% no hacía uso de ellos por temor a sus efectos secundarios. Los problemas económicos fueron el principal motivo de demanda de interrupción voluntaria del embarazo. Finalmente, encontramos un alto porcentaje de mujeres con alguna interrupción voluntaria del embarazo previa (37,4%), mayor en las extranjeras. Como conclusión, a pesar de los datos aportados serán necesarios estudios prospectivos de análisis sociodemográficos más detallados, y que incluyan un mayor número de mujeres, para establecer programas de información, prevención y asistencia más efectivos.

Incidence and Risk Factors Involved in the Development of Nephropathy in Patients with Type 1 Diabetes Mellitus: Follow Up Since Onset

OBJECTIVES Estimation of the incidence of nephropathy as well as potential risk factors involved in its onset in a cohort of patients with type 1 diabetes who were followed from diagnosis. METHODS We studied 716 patients, who were followed for a mean (standard deviation [SD]) of 10.1 (SD: 5.3) years. We analyzed the influence of demographic characteristics and levels of glycated hemoglobin (A1C), lipids and blood pressure during the course of the disease by univariate and multivariate survival methods. RESULTS The cumulative incidence of nephropathy was 2.6%, 6.3% and 11.9% at 5, 10 and 15 years of evolution, respectively. The factors associated with increased risk for nephropathy were systolic blood pressure and A1C levels. An increment of 10 mm Hg in systolic blood pressure increases the risk by 36%, and an increment of 1% in A1C levels raises the risk by 13% at 5 years since onset and 68% at 10 years, and it doubles the risk at 15 years. Women have higher risk than men (hazard ratio 1.79; p=0.024). CONCLUSIONS Our study suggests that female gender and high levels of A1C and systolic blood pressure throughout the course of the disease are the main factors associated with an increased risk for development of nephropathy in patients with type 1 diabetes mellitus.

Changes of age at onset in patients with type 1 diabetes during the last two decades

la interrupción voluntaria del embarazo era de origen sudamericano. Nuestros datos completan el perfil de las mujeres: edad de la primera relación entre los 15 y los 19 años, con un porcentaje preocupantemente alto de menores de 15 años (14%). Un 48,6% de las encuestadas aseguraban usar siempre métodos anticonceptivos (diferencias estadísticamente significativas entre españolas y extranjeras: 60% frente a 38,6%, p = 0,02), con el preservativo, seguido de los anticonceptivos hormonales, como los métodos más utilizados, lo que coincide con los datos de un estudio multicéntrico publicados por Serrano et al.3 Consideramos importante, de cara a la posible implantación de programas preventivos, informar del alto porcentaje de mujeres (23,3%) que no hacían uso de métodos anticonceptivos o empleaban alguno con tasas de fallo muy altas (coitus interruptus), dato ya publicado por Dueñas et al.4 en un estudio sobre los métodos anticonceptivos y la interrupción voluntaria del embarazo. Del 43,9% de las mujeres que reconocían no haber usado método anticonceptivo en el embarazo actual, el 38,3% justificaba haberlo acordado con su pareja. Es alarmante que un 12,8% admitió desconocer los métodos anticonceptivos a los cuales podían acceder, mientras que un 14,8% no hacía uso de ellos por temor a sus efectos secundarios. Los problemas económicos fueron el principal motivo de demanda de interrupción voluntaria del embarazo. Finalmente, encontramos un alto porcentaje de mujeres con alguna interrupción voluntaria del embarazo previa (37,4%), mayor en las extranjeras. Como conclusión, a pesar de los datos aportados serán necesarios estudios prospectivos de análisis sociodemográficos más detallados, y que incluyan un mayor número de mujeres, para establecer programas de información, prevención y asistencia más efectivos.