M. Morales Suárez-Varela

Stabilization of asthma prevalence among adolescents and increase among schoolchildren (ISAAC phases I and III) in Spain

Background:  Most studies show a steep increase in asthma prevalence in the last decades, although few studies had applied the same methodology. Recent reports point out the possibility that the epidemic has come to an end. We have studied the prevalence of asthma in a very large sample of children, repeating the study eight years apart.

Variaciones geográficas en la prevalencia de síntomas de asma en los niños y adolescentes españoles. International Study of Asthma and Allergies in Childhood (ISAAC) fase III España

Objetivo: Analizar las variaciones geograficas en la prevalencia de sintomas relacionados con el asma en ninos y adolescentes espanoles. Poblacion y metodos: Durante los anos 2001 y 2002, el International Study of Asthma and Allergies in Childhood (ISAAC) fase III estudio a 28.445 ninos de 6-7 anos de 10 areas (A Coruna, Asturias, Barcelona, Bilbao, Cartagena, Castellon, Madrid, Pamplona, San Sebastian y Valencia) y 31.257 adolescentes de 13-14 anos de 11 areas (las anteriores mas Valladolid) espanolas. Los sintomas de asma se recogieron en un cuestionario escrito completado por los padres de los ninos o por los propios adolescentes. Las variaciones geograficas de las prevalencias de los sintomas se analizaron con un modelo de regresion logistica y su correspondencia por edad mediante correlacion lineal. Resultados: La prevalencia de sibilancias recientes (ultimos 12 meses) vario entre el 7,1 y el 12,9% a los 6-7 anos, y entre el 7,1 y el 15,3% a los 13-14 anos. El riesgo mas elevado (odds ratio [OR] respecto al area de menor prevalencia) de presentar sibilancias recientes correspondio a los ninos de A Coruna (OR = 1,96; intervalo de confianza [IC] del 95%, 1,65-2,33) y Bilbao (OR = 1,83; IC del 95%, 1,54-2,18) y los adolescentes de A Coruna (OR = 2,38; IC del 95%, 2,04-2,79) y Asturias (OR = 2,37; IC del 95%, 2,03-2,77). Se comprobo una fuerte correlacion por edad en las prevalencias de sibilancias recientes de cada area geografica (r = 0,72). Conclusiones: En Espana existen, desde edades tempranas, variaciones geograficas notables en la prevalencia de sintomas de asma. Estos son mas frecuentes en los ninos y adolescentes que habitan en la fachada atlantica del pais.

How well do questionnaires perform compared with physical examination in detecting flexural eczema? Findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two

Background  Questionnaires are widely used in epidemiological studies to measure eczema symptom prevalence, but there are concerns regarding their accuracy if used as a diagnostic tool.

Mycosis fungoides: Review of Epidemiological Observations

Background: Mycosis fungoides (MF) is a chronic cutaneous T-cell lymphoma characterized by small cells with cerebriform nuclei that usually express a mature peripheral T-helper cell (CD4+) immunophenotype. Its evolution is typically quite slow, with years between the first manifestations and development of advanced stages of disease. Objective: The purpose of the present paper is to contribute to the material about MF already present in the literature. The review articles that have appeared to date fundamentally address the morphological characteristics, diagnostic criteria and treatment of the disease; in contrast, the present study centers on the evolution of the incidence of MF and on the knowledge of the possible risk factors implicated in its development. Methods: Review of published papers about MF epidemiology. Results: The evidence suggests that the incidence is increasing, but this may be artifactual due to improved diagnostic techniques. The risk of MF is limited to gender and race, being higher in males and in blacks. Survival is highly stage dependent, but 90% of patients survive 15 years with only 10% of cutaneous involvement. Few risk factors have been identified, but several studies have found an association with industrial exposure, particularly to oils. Conclusion: MF is a rare disease and its risk factors have not been studied in any great detail. A European case-control study in progress will substantially increase the evidence available and progress towards identifying a prevention strategy.

[Geographic variation in the prevalence of asthma symptoms in Spanish children and adolescents. International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3, Spain].

OBJECTIVE To analyze geographic variations in the prevalence of symptoms related to asthma in Spanish children and adolescents. POPULATION AND METHODS In 2001 and 2002, the Spanish arm of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3 collected information on 28 445 children in the age bracket of 6-7 years in 10 metropolitan areas (A Coruña, Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona, San Sebastián, and Valencia) and on 31 257 adolescents in the bracket 13-14 years in 11 areas (the previously named areas plus Valladolid). An asthma symptom questionnaire was filled in by parents or the adolescents themselves. Differences in symptoms between geographic areas were analyzed by fitting a logistic regression model. The relationship between symptoms and age was analyzed by linear correlation. RESULTS The prevalence of recent wheezing (last 12 months) ranged from 7.1% to 12.9% among 6-7-year-olds and from 7.1% to 15.3% among the 13-14-year-olds. The greatest risk of recent wheezing was observed for children in A Coruña (odds ratio [OR] =1.96 in comparison with the area of lowest prevalence; 95% confidence interval [CI], 1.65-2.33) and Bilbao (OR=1.83; 95% CI, 1.54-2.18) and for adolescents in A Coruña (OR=2.38; 95% CI, 2.04-2.79) and Asturias (OR=2.37; 95% CI, 2.03-2.77). A strong correlation (r=0.72) was observed between the prevalence of recent wheezing and age in each of the geographic areas. CONCLUSIONS Considerable geographic variation in the prevalence of asthma symptoms can be seen in Spain even among young children. Symptoms are more frequent in children and adolescents who live on the Spain s northern Atlantic coast.

BCG Immunization at Birth and Atopic Diseases in a Homogeneous Population of Spanish Schoolchildren

Background: The role of immunization with bacillus Calmette-Guérin (BCG) in the prevalence of asthma, hay fever and atopic dermatitis is not definitely established and seems to be influenced by ethnic background. The aim of this study was to analyze the relationship between this immunization and the prevalence of those diseases in a homogeneous population of Spanish schoolchildren. Methods: The International Study of Asthma and Allergies in Childhood (ISAAC) core and environmental questionnaires were used in four different centers of the Spanish North Atlantic coast. Bilbao, San Sebastián and Asturias have a universal BCG immunization policy during the first days of life, whereas La Coruña discontinued this practice in 1989. Except for this center, immunization coverage was above 90%. A random sample of schools of Asturias or all schools in the city district (rest of centers) with children 6 and 7 years old was surveyed. Results: The participation rate was above 70%. After excluding those children born outside Spain, the numbers were 6,762 immunized and 2,828 nonimmunized. After adjusting for gender, age, smoking habits of the father and mother, truck traffic near the household, older and younger siblings and having a cat or a dog during the first year of the child’s life, the adjusted ORs of the BCG-immunized children suffering from asthma, hay fever and atopic dermatitis were respectively 0.87 (95% CI 0.76–1.00), 0.87 (0.75–1.01) and 0.89 (0.76–1.05). Conclusions: BCG immunization offers a weak but significant protection against asthma and hay fever in Spanish schoolchildren.

Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case-control study

The incidence of mycosis fungoides (MF) is low, and the aetiology of the disease is unknown. The aim of this study was to investigate whether wine consumption protects against the disease and whether smoking constitutes a risk factor. This paper is part of the European Rare Cancers Study that tries to determine the risk factors for seven selective rare cancers, including mycosis fungoides, involved in the development of cancer. A multicentre case-control study was conducted in six European countries. Only incident cases with confirmed histology were included in the analysis which include a total of 76 cases of MF and 2899 controls. Wine intake had no protective effect; on the contrary the consumption of more than 24 g of alcohol per day was associated with a high risk of MF (odds ratio (OR)=3.02, 95% confidence interval (CI), 1.34-6.79), after adjusting for centre, country, age, sex and education. There was a dose-dependent increase in the risk of MF with increased smoking habits, albeit the observed trend was not statistically significant. A combined exposure to high tobacco and alcohol use yielded a significantly increased risk factor for MF (P=0.0073). Alcohol intake was associated with MF.

Tendencia temporal y variaciones geográficas de la prevalencia de síntomas de rinitis alérgica en escolares de 6-7 años de ocho áreas españolas, según el ISAAC☆

Antecedentes Se presenta la fase III del estudio ISAAC (International Study of Asthma and other Allergies in Childhood) en escolares de 6-7 anos de ocho areas espanolas para estimar la tendencia temporal y variaciones geograficas de los sintomas de rinitis alergica. Material y metodo Se comparan las prevalencias de sintomas de rinitis alergica entre la fase I y fase III, efectuadas entre los anos 1993-1994 y 2001-2002, mediante un cuestionario estandarizado y validado segun metodologia ISAAC, cumplimentado por los padres de los escolares. Participaron ocho centros de Asturias, Barcelona, Bilbao, Cartagena, Castellon, Madrid, Pamplona y Valencia. Se empleo la regresion de Poisson en el analisis. Resultados La poblacion estudiada fue de 25.113 escolares con una mediana de participacion del 81,7 %. En todos los centros se observo una tendencia creciente en sintomas de rinitis alergica, destacando la razon de prevalencia de rinoconjuntivitis en los ultimos 12 meses de 1,61 (intervalos de confianza del 95 %: 1,48-1,76) al comparar ambas fases, y despues de ajustar por sexo, centro y variacion estacional. La prevalencia de sintomas de rinitis alergica fue mayor en los ninos que en las ninas. Se apreciaron amplias variaciones entre centros con elevadas prevalencias en Asturias, Madrid, Cartagena y Bilbao. Las menores prevalencias se produjeron en Barcelona, Castellon y Pamplona. Conclusiones El incremento de los sintomas de rinitis alergica parece ser general y existen amplias variaciones entre centros que sugieren la diferente magnitud de factores de riesgo a escala local y cuya investigacion mas exhaustiva potenciaria actuaciones preventivas mas adecuadas.

International variations in associations of allergic markers and diseases in children: ISAAC Phase Two.

To cite this article: Weinmayr G, Genuneit J, Nagel G, Björkstén B, van Hage M, Priftanji A, Cooper P, Rijkjärv M‐A, von Mutius E, Tsanakas J, Forastiere F, Doekes G, Garrido JB, Suarez‐Varela MM, Bråbäck L, Strachan DP, the ISAAC Phase Two Study Group. International variations in associations of allergic markers and diseases in children: ISAAC Phase Two. Allergy 2010; 65: 766–775.

Spontaneous pneumothorax related with climatic characteristics in the Valencia area (Spain).

Spontaneous pneumothorax (SP) is a common respiratory condition that is easily recognized and treated, though the etiology remains largely unknown. Apart from individual factors, it has been suggested that changes in atmospheric pressure may trigger the onset of SP. Our aim was to examine the association between the onset of episodes of SP with atmospheric pressure changes in the general population of an area with a Mediterranean climate. A prospective survey was conducted to detect all episodes of SP in a region of Valencia (Spain) from January 1994 to January 1996. A total of 69 cases were identified; of these, 62 episodes of SP met the inclusion criteria for this survey. Climatic measurements during the two years studied were obtained from the Spanish National Meteorological Institute, including 6-hour readings of temperature, relative humidity, clear sunlight, atmospheric pressure, visibility, wind speed and rainfall. Associations were evaluated between the daily number of hospital admissions for SP and diurnal changes in atmospheric pressure involving rises and falls of as much as 7 and 10 mbar. In addition, the association of atmospheric pressure changes to time periods of 1 a.m., 7 a.m., 1 p.m. and 7 p.m. was assessed. Drops in atmospheric pressure below the fifth percentile and elevations above the ninety-fifth percentile were regarded as ‘unusual’. There was no association between the development of SP and changes in atmospheric pressure, and no correlation was found with repeated exposure to unusual changes of atmospheric pressure. Further research is needed using similar methods to establish comparisons between countries with different climates.