María Manuela Morales Suárez-Varela

Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren

Background: Although several studies have investigated the influence of diet on asthma in schoolchildren, none of them has evaluated how obesity can modify this effect. A study was undertaken to evaluate the association of various foods and a Mediterranean diet with the prevalence of asthma and rhinoconjunctivitis, adjusting for obesity and exercise. Methods: A cross-sectional study was performed in 20 106 schoolchildren aged 6–7 years from eight Spanish cities. Using the ISAAC phase III questionnaire, parents reported chest and nose symptoms, food intake, weight, height and other factors, including exercise. A Mediterranean diet score was developed. A distinction was made between current occasional asthma (COA) and current severe asthma (CSA). Results: Independent of the amount of exercise, each Mediterranean score unit had a small but protective effect on CSA in girls (adjusted OR 0.90, 95% CI 0.82 to 0.98). Exercise was a protective factor for COA and rhinoconjunctivitis in girls and boys (the more exercise, the more protection). Obesity was a risk factor for CSA in girls (adjusted OR 2.35, 95% CI 1.51 to 3.64). Individually, a more frequent intake (1–2 times/week and ⩾3 times/week vs never/occasionally) of seafood (adjusted ORs 0.63 (95% CI 0.44 to 0.91) and 0.53 (95% CI 0.35 to 0.80)) and cereals (adjusted OR 0.56 (95% CI 0.30 to 1.02) and 0.39 (95% CI 0.23 to 0.68)) were protective factors for CSA, while fast food was a risk factor (adjusted ORs 1.64 (95% CI 1.28 to 2.10) and 2.26 (95% CI 1.09 to 4.68)). Seafood (adjusted ORs 0.74 (95% CI 0.60 to 0.92) and 0.67 (95% CI 0.53 to 0.85)) and fruit (adjusted ORs 0.76 (95% CI 0.60 to 0.97) and 0.71 (95% CI 0.57 to 0.88)) were protective factors for rhinoconjunctivitis. Conclusions: A Mediterranean diet has a potentially protective effect in girls aged 6–7 years with CSA. Obesity is a risk factor for this type of asthma only in girls.

A different pattern of risk factors for atopic and non-atopic wheezing in 9-12-year-old children

Few epidemiological studies have compared the risk factors of asthma or wheezing between atopic and non‐atopic children. The objective of this study was to determine if there are specific risk factors for current wheezing related to atopic status in schoolchildren. Schoolchildren 9–12 yr of age from three Spanish cities (n = 2720) were subject to a cross‐sectional study of asthma risk factors (by questionnaire) and atopy (by skin prick test) according to the ISAAC phase‐II protocol. Risk factors for current wheezing (in the last 12 months) as reported by parents were investigated among the atopic (positive prick test to at least one allergen) and the non‐atopic (negative prick test) children. The prevalence of current wheezing was 13.1% in the whole group, 22.1% in the atopic group and 7.8% in the non‐atopic group. However, only 62.4% of children with current wheezing were atopic. Male gender and asthma in the mother and/or the father were both significant and independent risk factors for current atopic wheezing, whereas maternal smoking in the first year of the childs life and mould stains on the household walls were for current non‐atopic wheezing. In summary, this study shows that atopic and current non‐atopic wheezing children in Spain do not share identical environmental and family risk factors.

Determination of pesticides and veterinary drug residues in food by liquid chromatography-mass spectrometry: A review

Monitoring of pesticides and veterinary drug residues is required to enforce legislation and guarantee food safety. Liquid chromatography-mass spectrometry (LC-MS) is the prevailing technique for assessing both types of residues because LC offers a versatile and universal separation mechanism suitable for non-gas chromatography (GC) amenable and the majority of GC-amenable compounds. This characteristic becomes more relevant when LC is coupled to MS because the high sensitivity and specificity of the detector allows to apply generic sample preparation procedures, which simultaneously extract a wide variety of residues with different physico-chemical properties. Determination of metabolites and degradation products, non-target suspected screening of an increasing number of residues, and even unknowns identification are also becoming inherent LC-MS advantages thanks to the latest advances. For routine analysis and, in particular, for official surveillance purposes in food control, analytical methods properly validated following strict guidelines are needed. After a brief introduction and an outline of the legislation applicable around the world, aspects such as improvement of specificity of high-throughput methods, resolution and mass accuracy of identification strategies and quantitative accuracy are critically reviewed in this article. In them, extraction, separation and determination are emphasized. The main objective is to offer an assessment of the state of the art and identify research needs and future trends in determining pesticide and veterinary drug residues in food by LC-MS.

Polimedicación y prescripción de fármacos inadecuados en pacientes ancianos inmovilizados que viven en la comunidad

Objetivos Conocer y analizar el consumo de medicamentos de la poblacion anciana inmovilizada, asi como el numero de farmacos potencialmente inapropiados (FPI). Diseno Estudio transversal. Emplazamiento Catorce centros rurales de atencion primaria. Participantes Se escogio mediante muestreo sistematico a pacientes inmovilizados, mayores de 64 anos, no institucionalizados. Mediciones principales Revision de los botiquines y anotacion de la dosis diaria y el numero de farmacos actuales del paciente, asi como el origen de la prescripcion. Identificacion de los FPI (criterios de Beers). Estadistica descriptiva e inferencial. Resultados Se visitaron 143 domicilios. La media de edad fue de 81,3 ± 7,9 anos, con un 74,8% de mujeres. Los medicamentos mas comunes fueron: analgesicos (9,2%), antiacidos (7,1%), nitritos-antagonistas del calcio (6,5%), antiinflamatorios no esteroideos (5,0%) e inhibidores de la enzima de conversion de la angiotensina (4,7%). El porcentaje de pacientes con consumo de mas de 4 farmacos fue del 76,1%. El 35% de los ancianos tomaba algun FPI. Los mas frecuentes fueron: ansioliticos de accion prolongada (41,5%), hipnoticos (13,8%), digoxina (13,8%), indometacina (7,7%) y espasmoliticos (6,1%). En la mayor parte de los casos, la prescripcion de los FPI partio del medico de familia (77,7%). Las mujeres tomaban significativamente mas farmacos inapropiados que los varones (0,50 ± 0,72 frente a 0,25 ± 0,50; p = 0,001) y los polimedicados, mas que los no polimedicados (0,50 ± 0,73 frente a 0,31 ± 0,52; p = 0,008). Conclusiones La prevalencia de inadecuacion terapeutica en los ancianos inmovilizados es alta, por lo que es necesario hacer un esfuerzo para reducirla. Actuaciones dirigidas a aumentar la calidad de las prescripciones podrian mejorar el estado de salud y la calidad de vida de estos pacientes.

La hospitalización domiciliaria: antecedentes, situación actual y perspectivas

Objetivo. Determinar las distintas variantes que ha tenido el concepto de la hospitalizacion domiciliaria a lo largo del tiempo, para asi contribuir al debate sobre las circunstancias que inciden en la gestion sanitaria frente a futuros retos. Metodos. Se revisa la literatura sobre la atencion domiciliaria como modalidad asistencial de salud mediante una exploracion de las publicaciones indizadas en MEDLINE, LILACS y el Indice Medico Espanol durante el periodo de 1995-2000. Resultados. La hospitalizacion domiciliaria ha tenido un desarrollo desigual a lo largo del tiempo en diferentes paises y son varios los modelos de este tipo de atencion, cada uno con sus respectivas ventajas y desventajas. Conclusiones. Se definen algunos criterios y propuestas que podrian enmarcar una gestion domiciliaria innovadora, efectiva y de calidad. Se concluye que la atencion domiciliaria podria contribuir a disenar y establecer un modelo consensuado y armonioso de organizacion y financiacion entre los niveles de atencion primaria y hospitalaria.

Occurrence and removal of drugs of abuse in Wastewater Treatment Plants of Valencia (Spain).

The occurrence of 8 drugs of abuse and metabolites in the influent and effluent of the 3 Wastewater Treatment Plants (WWTP) that treat wastewater from Valencia was studied in 2011, 2012 and 2013. Target drugs except 6-monoacetylmorphine (6-ACMOR) were detected in 100% of the influents. The WWTPs eliminate cocaine (COC), amphetamine (AMP), methamphetamine (MAMP) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH). Benzoylecgonine (BECG) was also efficiently eliminated (93-98%), whereas 3,4-methylenedioxymethamphetamine (MDMA) presented removal rates of 32-57% and ketamine (KET) was not eliminated. The most consumed illicit drugs, according to the estimated concentrations of each compound in the studied WWTPs, were cannabis and COC followed by KET, AMP, MAMP, MDMA and heroin. Environmental risk assessment was evaluated by calculating Risk Quotient (RQ). MDMA and KET could pose a medium risk and low risk, respectively, to the aquatic organisms. Although short-term environmental risk is not worrisome, long-term effects cannot be known exactly.

Influence of pesticide use in fruit orchards during blooming on honeybee mortality in 4 experimental apiaries.

Samples of dead honey bees (Apis mellifera L.) were collected periodically from 4 different locations during citrus and stone fruit trees blooming season to evaluate the potential impact of agrochemicals on honey bee death rate. For the determination of mortality, dead honey bee traps were placed in front of the experimental hives entrance located in areas of intensive agriculture in Valencian Community (Spain). A total of 34 bee samples, obtained along the monitoring period, were analyzed by means of QuEChERS extraction method and screened for 58 pesticides or their degradation products by LC-MS/MS. An average of four pesticides per honey bee sample was detected. Coumaphos, an organophosphate acaricide used against varroosis in the experimental hives, was detected in 94% of the samples. However, this acaricide was unlikely to be responsible for honey bee mortality because its constantly low concentration during all the monitoring period, even before and after acute mortality episodes. The organophosphates chlorpyrifos and dimethoate, as well as the neonicotinoid imidacloprid, were the most frequently detected agrochemicals. Almost 80% of the samples had chlorpyrifos, 68% dimethoate, and 32% imidacloprid. Maximum concentrations for these three compounds were 751, 403, 223 ng/g respectively. Influence of these pesticides on acute honey bee mortality was demonstrated by comparing coincidence between death rate and concentrations of chlorpyrifos, dimethoate and imidacloprid.

Air Pollution and Recent Symptoms of Asthma, Allergic Rhinitis, and Atopic Eczema in Schoolchildren Aged Between 6 and 7 Years

Abstract Objective The objective of the study was to analyze the relationship between air pollutants and the prevalence of recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years. Patients and Methods The prevalence of recent (previous 12 months) symptoms of allergic diseases was obtained by means of the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), Spain, with the participation of 7 centers (Asturias, Barcelona, Bilbao, Cartagena, La Coruna, Madrid, and Valencia) and 20 455 schoolchildren aged between 6 and 7 years, from 2002 to 2003. The pollutant detection systems of the aforementioned centers provided the mean annual concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and total suspended particulate matter. Results The annual average concentration of SO2 showed a significant association with a higher prevalence of recent severe asthma (adjusted odds ratio [aOR] between level-1 and level-3 pollution, 1.32; 95% confidence interval [CI], 1.01–1.73), rhinitis (aOR, 1.56; 95% CI, 1.39–1.75), and rhinoconjunctivitis (aOR, 1.70; 95% CI, 1.45–2.00). The annual average concentration of CO was associated with a higher prevalence of rhinitis (aOR, 1.65; 95% CI, 1.34-2.04), rhinoconjunctivitis (aOR, 1.76; 95% CI, 1.31–2.37), and eczema (aOR, 1.55; 95% CI, 1.17–2.04). The annual average concentration for NO2 and total suspended particulate matter showed inverse associations with the prevalence of nocturnal dry cough. Conclusions Findings suggest that air pollutants such as SO2 and CO increase the risk of recent symptoms of asthma and allergic rhinitis in schoolchildren aged between 6 and 7 years in Spain.

Quality of life in patients with non-muscle-invasive bladder cancer: One-year results of a multicentre prospective cohort study

OBJECTIVE Few studies describe the effect of non-muscle-invasive bladder cancer (NMIBC) on health-related quality of life (HRQL), although patients are mostly diagnosed at this stage of the disease. Taking into account this current evidence gap and the high incidence rates in Spain, we aimed to describe the evolution over time of HRQL in Spanish patients with NMIBC and to examine the clinical and treatment-related factors associated with HRQL change during the first year of management. METHODS AND MATERIALS Observational multicenter prospective inception cohort study conducted in urology departments of 7 Spanish hospitals. A consecutive sample of 244 patients with anatomopathologically confirmed NMIBC, recruited from October 2010 to September 2011, was followed during the diagnostic process, and 6 and 12 months later. HRQL was assessed by generic and disease-specific instruments: the Short Form-36 (covering physical and mental health) and the Bladder Cancer Index, measuring urinary, bowel, and sexual domains (summary scores: 0-100). Bivariate analysis was performed and generalized estimating equation models were constructed to assess HRQL score change. RESULTS Almost 52% of the patients were diagnosed at stage I, and 84% were men. The number of patients treated only with transurethral resection (TUR) was 144, and 82 also received intravesical therapy with bacillus Calmette-Guérin (BCG) or mitomycin C. Mental health was significantly worse than Short Form-36 reference norms at diagnosis (mean of 49.7 vs. 53.3, 95% CI: 52.5-54.2). Urinary domain improved significantly from diagnosis (85.2, 95% CI: 82.9-87.4) to 12-month evaluation (90.2, 95% CI: 87.7-92.8), whereas sexual domain showed deterioration from 56.4 (95% CI: 52.8-59.9) to 53.7 (95% CI: 50.0-57.4). Adjusted HRQL score changes from baseline to 12-month follow-up estimated with generalized estimating equation models showed improvement on the following parameters: urinary domain after TUR with or without intravesical therapy (+3.9, 95% CI: 0.1-7.7), bowel domain among patients treated with TUR and BCG (+7.0, 95% CI: 2.4-11.5), and sexual domain among those treated with TUR and mitomycin C (+13.1, 95% CI: 5.9-20.2). CONCLUSIONS For the first time, a distinctive HRQL pattern of bladder cancer treatment benefits emerges for TUR alone, and in combination with BCG or mitomycin C, which deserves further research. Treatment differences cannot be interpreted in terms of efficacy but can be useful to generate hypotheses to test in future studies.

La hospitalización domiciliaria ante los cambios demográficos y nuevos retos de salud

Objetivos. En la actualidad, el fenomeno demografico mas importante es el rapido envejecimiento de la poblacion, que tiene un creciente y profundo impacto en todos los ambitos de la sociedad, aunque su mayor trascendencia es en la sanidad, tanto por su repercusion en todos los niveles asistenciales como por la necesidad de nuevos recursos y estructuras. De ahi que se hayan desarrollado en muchos paises diferentes alternativas y programas institucionales, ambulatorios y domiciliarios, encaminados a mejorar la situacion sanitaria y a auxiliar en el proceso de establecer prioridades. La hospitalizacion domiciliaria (HD) es una de ellas. El objetivo de este estudio consistio en describir y analizar las caracteristicas de la poblacion asistida en HD, y en comentar el papel de la HD como mecanismo de integracion y coordinacion entre niveles, frente al reto de la reorganizacion de politicas y proyectos de atencion sanitaria, especialmente los dirigidos a la poblacion anciana. Metodos. Se realizo un estudio descriptivo, retrospectivo, de una serie de pacientes asistidos en HD en el area sanitaria numero 9 de la Comunidad Valenciana, Espana, con una poblacion de referencia de 321 361 habitantes, de los cuales 60 079 (18,7%) son personas de 60 anos o mas, y 43 044 (13,4%), de 65 anos o mas. Se realizo un estudio descriptivo de las variables analizadas, calculandose la media y la desviacion estandar para las variables cuantitativas, y las frecuencias absoluta y relativa (porcentaje) para las variables cualitativas. Resultados. El perfil de los pacientes estudiados corresponde a ancianos (el 78% con 65 anos o mas; media de 73 anos), predominantemente del sexo femenino, con enfermedades cronicas (72%) y multiples enfermedades asociadas (el 67% tenia al menos un diagnostico secundario asociado). Se constato la existencia de un importante problema de comunicacion entre los dos principales niveles de atencion (primaria y hospitalaria), que obviamente repercute en los pacientes y en la calidad y eficacia de la asistencia sanitaria. Asimismo, se verifico que la HD encuentra todo su significado en la poblacion adulta o anciana con multiples enfermedades cronicas degenerativas o terminales, en la que ha demostrado ser una herramienta eficiente. Conclusiones. Se destaca la necesidad de crear o potenciar los canales y mecanismos de comunicacion interinstitucional que garanticen la continuidad del proceso asistencial. La asistencia continua y eficaz de la salud y bienestar del anciano requiere diferentes niveles de intervencion sanitaria y debe estar basada en lo que hoy es un objetivo inaplazable: la atencion integral, adecuada, de calidad, humanizada, oportuna y basada en una asistencia integrada y coordinada entre los dos principales niveles de atencion sanitaria. Son estos factores los que, en ultima instancia, determinan la calidad de la asistencia y la capacidad resolutiva de los problemas asistenciales planteados en la atencion al paciente geriatrico.