Modelling asthma epidemics on the relationship between air pollution and asthma emergency visits in Barcelona, Spain

We have investigated different methods of controlling for asthma epidemics in the time series regression of the relationship between air pollution and asthma emergency visits in Barcelona, Spain. The relationship between air pollution and asthma emergency room visits was modelled using autoregressive Poisson models. We examined the effect of using no control by epidemics, and modelling asthma epidemics with a single dummy variable, six dummy variables, and a dummy variable for each epidemic day. Air pollution coefficients increased when controlling asthma epidemics with six dummy variables instead of a single variable. They further increased when autocorrelation was allowed for. Standard errors were relatively unaffected when either the epidemics or the autocorrelation were included in the model. Black smoke, nitrogen dioxide and ozone were statistically significant associated to asthma emergency visits after using six dummy variables to control for asthma epidemics. We have shown that different models, including different confounding variables, give markedly different estimates of the effect of a pollutant on health. Care is needed in the interpretation of such models, and careful reporting so it is clear how the confounding variables have been modelled.     

The social cost of depression in the city of Sabadell (Barcelona, Spain) (2007-2008)

Objective

To determine the social cost and burden of depression in the city of Sabadell (Barcelona, Spain) in 2007 and 2008.

Method

The social cost of depression was calculated using the prevalence approach, based on information obtained in the development of the European Project Against Depression (EAAD). The results referred to the cost of public resources used, and the sources came from the appropriate official registers.

Results

The direct public cost of depression in the city of Sabadell was € 9,155,620 in 2007 and € 9,304,706 in 2008. The relative weight of primary care visits and the use of drugs accounted for more than 85% of direct costs. In the section of indirect costs, the cost of permanent work disability could not be obtained. Indirect costs amounted to € 9,720,225 in 2007 and € 9,763,541 in 2008. In both years, the highest weight corresponded to temporary work disability reaching € 8,561,962 and € 7,333,181, respectively.

Conclusions

Depression has a substantial economic impact on the health system because it is associated with high direct public costs. However, the lack of knowledge of the cost associated with permanent work disability is a major limitation, as this cost category represents the highest percentage for this disorder.     

Trends in the use of emergency contraception: an epidemiological study in Barcelona, Spain (1994-2002)

We conducted a retrospective review of the medical records of women requesting emergency contraception (EC) at our emergency department over a 9-year period (1994-2002). EC accounted for 5.9% of all visits (n = 95,288) and increased from 1.26% in 1994 to 9.82% in 2002 (p < 0.001). Reasons for EC were condom problems in 79.5% of cases. EC was used only once by 93% of women. The mean daily number of visits was significantly higher in August (2.46), July (2.01) and September (2.02) than in other months (p < 0.05), and was more frequent on Sunday (3.26), Saturday (2.92) and Monday (2.05) compared to other week days (p < 0.001). New Year's Day and the St. John's Night registered the highest number of visits (mean of 17.2 and 11.7, respectively), with significant differences compared to the remaining days of the year (p < 0.001).     

Safety belt and mobile phone usage in vehicles in Barcelona (Spain)

Objectives

To describe the prevalence and correlates of safety belt and mobile phone usage in vehicles in the city of Barcelona (Spain).

Methods

We performed a study using direct observation with a cross-sectional design. We selected 2,442 private cars, commercial vehicles, and taxis from all districts of Barcelona.

Results

The prevalence of people not wearing safety belt was 10.5% among drivers, 4.6% among front seat passengers, and 32.2% among some of the rear passengers. It was higher among the passengers than among the drivers, regardless of the type of the vehicle. The prevalence of mobile phone usage while driving during a moment of the trip was 3.8%.

Conclusion

Our study shows noticeably high prevalence of people not wearing safety belt in the rear seats. Moreover, four out of one hundred drivers still use the mobile phone while driving during a moment of the trip.     

Blood lead concentrations of an adult population of Barcelona (Spain)

Lead concentrations were determined in blood samples of 339 men and 190 women from ages 16–65 years who were residents in the city of Barcelona, Spain. The samples were subjected to lead analyses by atomic absorption spectrophotometry. Blood lead levels were related to some biological and habitual factors. The concentrations of lead in blood distributed log‐normally with a geometric mean of 10.7 μg dl^‐1 for men and 7.9 μg dl^‐1 for women, which are within the normal values (NLV) as defined by the WHO. The mean atmospheric levels determined in Barcelona did not exceed the EEC directive: 2 μg m^‐3. The results of this study indicate that in relation to environmental health there is not a serious problem from lead contamination in Barcelona.     

A serological survey of toxocariasis in patients and healthy donors in Barcelona (Spain)

The ELISA test, using excretory-secretory antigen from larvae II of Toxocara canis, was applied on 1018 sera (793 from adults and 225 from pediatrics) distributed in: A) patients with an hypereosinophilia where the ethiological agent was undetermined (99); B) patients with ocular complaints compatible with an ocular toxocariasis (116); C) patients with hidatidosis (97); D) patient with other non-toxocaral helminthiasis (34); E) patients with other clinical features (468) and F) healthy donors (204).Over 3,6 % of sera showed elevated levels of antibodies reacting with T. canis antigen. The prevalence of seropositivity was statistically higher in patients with eosinophilia (14,1%) ( < 0,001) and ocular complaints (6%) (0,025 > > 0,01) than in the control group (1%). In the overall seropositivity from pediatrics did not differ from that of the adults.     

Association between hospital emergency visits for asthma and air pollution in Valencia,Spain

OBJECTIVE: To assess the short term effect of concentrations of black smoke, sulphur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) in ambient air on emergency room visits for asthma in the city of Valencia, Spain during the period 1994-5. METHODS: Ecological study with time series data and application of Poisson regression. Associations between number of daily emergency visits in a city''s hospital and concentrations of air pollutants were analysed taking into account potential confounding factors by the standardised protocol of the air pollution and health: a European approach (APHEA) project. RESULTS: Mean (range) daily number of emergency room visits for asthma was 1 (0-5). Concentrations of all pollutants studied remained within current air quality standards. The association between an increase of 10 micrograms/m3 in ambient air pollution and asthma, measured as a relative risk (RR) of emergency visits, was significant for NO2 24 hour mean (lag 0, RR 1.076, 95% confidence interval (95% CI) 1.020 to 1.134), NO2 hour maximum (lag 0, RR 1.037, 95% CI 1.008 to 1.066), and O3 hour maximum (lag 1, RR 1.063, CI 95% 1.014 to 1.114). The association was not significant for SO2 or for black smoke during the period analysed. The effects were not significantly different for the time of year, cold months (November to April), or warm months (May to October). CONCLUSIONS: Current concentrations of ambient air pollution in Valencia are significantly associated with emergency room visits for asthma. This association is high and more consistent for NO2 and O3 than for particulate matter and SO2 (classic pollutants).       

Prevalence of sarcopenia in healthy community-dwelling elderly in an urban area of Barcelona (Spain)

Introduction  

The purpose of this study was to evaluate the prevalence of sarcopenia in a cohort of healthy community-dwelling elderly in an urban area in Barcelona (Spain) for native benchmarks and compare them with those published in other geographical areas.     

The impact of immigration and vaccination in reducing the incidence of hepatitis B in Catalonia (Spain)

ABSTRACT: * Background The Hepatitis B virus (HBV) infection is a major cause of liver disease and liver cancer worldwide according to the World Health Organization. Following acute HBV infection, 1-5% of infected healthy adults and up to 90% of infected infants become chronic carriers and have an increased risk of cirrhosis and primary hepatocellular carcinoma. The aim of this study was to estimate the reduction in hepatitis B incidence due to universal vaccination programmes in Catalonia (Spain), taking population changes into account, and to construct a model to forecast the future incidence of cases that allows the best preventive strategy to be adopted. * Methods Reported acute hepatitis B incidence in Catalonia according to age, gender, vaccination coverage, percentage of immigrants and the year of report of cases was analysed. A statistical analysis was made using three models: generalized linear models (GLM) with Poisson or negative binomial distribution and a generalized additive model (GAM). * Results The higher the vaccination coverage, the lower the reported incidence of hepatitis B (p <0.01). In groups with a vaccination coverage > 70%, the reduction in incidence was 2-fold higher than in vaccinated groups with a coverage <70% (p <0.01). The increase in incidence was significantly higher in groups with a high percentage of immigrants and more than 15% (p <0.01) in immigrant males of working age (19-49 years * Conclusions The results of the adjusted models in this study confirm that the global incidence of hepatitis B has declined in Catalonia after the introduction of the universal preadolescent vaccination programme, but the incidence increased in male immigrants of working age. Given the potential severity of hepatitis B for the health of individuals and for the community, universal vaccination programmes should continue and programmes in risk groups, especially immigrants, should be strengthened.     

Health care utilisation and immigration in Spain

The aim of this work was to analyse the use of health care services by immigrants in Spain. Using a nationally representative health survey from 2006–2007 and negative binomial and hurdle models, it was found that there is no statistically significant difference in the patterns of visits to general practitioners and hospital stays between migrants and natives in Spain. However, immigrants have a lower access to specialists and visit emergency rooms with a higher frequency than nationals.     

Review of the utilisation of a university hospital in Barcelona (Spain): evolution 1992-1996

Background: To test the applicability of the appropriateness evaluation protocol (AEP) as a tool for reviewing hospital utilisation. To quantify and to compare the rate of inappropriate admissions and amount of in-hospital days, emphasising the main causes and factors in the hospital associated with inappropriateness during the studied periods of time. Patients and methods: Two retrospective studies were carried out, the first one in 1992, when 2048 clinical histories were analysed, and the second in 1996, with 1099 reviewed histories. The tool used for the evaluation of the level of hospital utilisation is the AEP. Results: The proportion of admissions considered to be inappropriate was 25% (95% CI: 20.8–24.5) in 1992, and 16% (95% CI: 13.8–18.2) in 1996. Premature admission was the most frequent cause of inappropriateness in both periods. The logistic regression model built for the dependent variable admission showed the following variables to be associated to inappropriateness: scheduled admission (OR: 15; 95% CI: 10.8–20.7) and (OR: 10; 95% CI: 6–16.5), weekend admission (OR: 2; 95% CI: 1.3–1.2) and (OR: 2; 95% CI: 1.2–2.3), for 1992 and 1996, respectively. The rate of inappropriate in-hospital stays in 1992 was 29% (95% CI: 28.3–29.6), and 13.5% (95% CI: 12.7–14.3) in 1996. Hospital organisational problems were the main cause of inappropriate in-hospital days in 1992, and diagnostic/therapeutical tests that could be performed ambulatorily ranked first in 1996. The logistic regression model built for the dependent variable in-hospital days had the following independent variables associated to its inappropriateness: discharge on week-days (OR: 1.4; 95% CI: 1.2–1.8) and (OR: 0.6; 95% CI: 0.5–0.8) and length of stay (OR: 2; 95% CI: 1.8–2.4) and (OR: 2.4; 95% CI: 2.3–2.5), for 1992 and 1996 respectively, among other variables. Conclusion: Periodic checking of the utilisation levels with the application of methods such as the AEP will contribute towards adapting hospital management in the more competitive current setting.