Toxic oil syndrome mortality: the first 13 years.
BACKGROUND: The toxic oil syndrome (TOS) epidemic that occurred in Spain in the spring of 1981 caused approximately 20000 cases of a new illness. Overall mortality and mortality by cause in this cohort through 1994 are described for the first time in this report. METHODS: We contacted, via mail or telephone, almost every living member of the cohort and family members of those who were known to have died in order to identify all deaths from 1 May 1981 through 31 December 1994. Cause of death data were collected from death certificates and underlying causes of death were coded using the International Classification of Diseases, 9th Revision. RESULTS: We identified 1663 deaths between 1 May 1981 and 31 December 1994 among 19 754 TOS cohort members, for a crude mortality rate of 8.4%. Mortality was highest during 1981, with a standardized mortality ratio (SMR) of 4.92 (95% confidence interval [CI]: 4.39-5.50) compared with the Spanish population as a whole. The highest SMR, (20.41, 95% CI: 15.97-25.71) was seen among women aged 20-39 years during the period from 1 May 1981 through 31 December 1982. Women <40 years old, who were affected by TOS , were at greater risk for death in most time periods than their unaffected peers, while older women and men were not. Over the follow-up period, mortality of the cohort was less than expected when compared with mortality of the general Spanish population, or with mortality of the population of the 14 provinces where the epidemic occurred. We also found that, except for deaths attributed to external causes including TOS and deaths due to pulmonary hypertension, all causes of death were decreased in TOS patients compared to the Spanish population. The most frequent underlying causes of death were TOS, 350 (21.1%); circulatory disorders, 536 (32.3%); and malignancies, 310 (18.7%). CONCLUSIONS: We conclude that while on average people affected by toxic oil syndrome are not at greater risk for death over the 13-year study period than any of the comparison groups, women <40 years old were at greater risk of death. (+info)
Asthma visits to emergency rooms and soybean unloading in the harbors of Valencia and A Coruna, Spain.
Soybean unloading in the harbor of Barcelona, Spain, has been associated with large increases in the numbers of asthma patients treated in emergency departments between 1981 and 1987. In this study, the association between asthma and soybean unloading in two other Spanish cities, Valencia and A Coruna, was assessed. Asthma admissions were retrospectively identified for the period 1993-1995, and harbor activities were investigated in each location. Two approaches were used to assess the association between asthma and soybean unloading: One used unusual asthma days (days with an unusually high number of emergency room asthma visits) as an effect measure, and the other estimated the relative increase in the daily number of emergency room visits by autoregressive Poisson regression, adjusted for meteorologic variables, seasonality, and influenza incidence. No association between unusual asthma days and soya unloading was observed in either Valencia or A Coruna, except for one particular dock in Valencia. When the association between unloaded products and the daily number of emergency asthma visits was studied, a statistically significant association was observed for unloading of soya husk (relative risk = 1.50, 95% confidence interval 1.16-1.94) and soybeans (relative risk = 1.31, 95% confidence interval 1.08-1.59) in A Coruna. In Valencia, a statistical association was found only for the unloading of soybeans at two particular docks. Although these findings support the notion that asthma outbreaks are not a common hidden condition in most harbors where soybeans are unloaded, the weak associations reported are likely to be causal. Therefore, appropriate control measures should be implemented to avoid soybean dust emissions, particularly in harbors with populations living in the vicinity. (+info)
Cancer mortality by educational level in the city of Barcelona.
The objective of this study was to examine the relationship between educational level and mortality from cancer in the city of Barcelona. The data were derived from a record linkage between the Barcelona Mortality Registry and the Municipal Census. The relative risks (RR) of death and 95% confidence intervals (CIs) according to level of education were derived from Poisson regression models. For all malignancies, men in the lowest educational level had a RR of death of 1.21 (95% CI 1.13-1.29) compared with men with a university degree, whereas for women a significant decreasing in risk was observed (RR 0.81; 95% CI 0.74-0.90). Among men, significant negative trends of increasing risk according to level of education were present for cancer of the mouth and pharynx (RR 1.70 for lowest vs. highest level of education), oesophagus (RR 2.14), stomach (RR 1.99), larynx (RR 2.56) and lung (RR 1.35). Among women, cervical cancer was negatively related to education (RR 2.62), whereas a positive trend was present for cancers of the colon (RR 0.76), pancreas (RR 0.59), lung (RR 0.55) and breast (RR 0.65). The present study confirms for the first time, at an individual level, the existence of socioeconomic differences in mortality for several cancer sites in Barcelona, Spain. There is a need to implement health programmes and public health policies to reduce these inequities. (+info)
A comparative analysis of surveyors from six hospital accreditation programmes and a consideration of the related management issues.
PURPOSE: To gather data on how accreditors manage surveyors, to compare these data and to offer them to the accreditors for improvement and to the scientific community for knowledge of the accreditation process and reinforcement of the credibility of these processes. DATA SOURCE: The data were gathered with the aid of a questionnaire sent to all accreditors participating in the study. RESULTS: An important finding in this comparative study is the different contractual relationships that exist between the accreditors and their surveyors. CONCLUSION: Surveyors around the world share many common features in terms of careers, training, work history and expectations. These similarities probably arise from the objectives of the accreditors who try to provide a developmental process to their clients rather than an 'inspection'. (+info)
Risk factors for community-acquired pneumonia in adults: a population-based case-control study.
Although community-acquired pneumonia (CAP) remains a major cause of hospitalization and death, few studies on risk factors have been performed. A population-based case-control study of risk factors for CAP was carried out in a mixed residential-industrial urban area of 74,610 adult inhabitants in the Maresme (Barcelona, Spain) between 1993 and 1995. All patients living in the area and clinically suspected of having CAP at primary care facilities and hospitals were registered. In total, 205 patients with symptoms, signs and radiographic infiltrate compatible with acute CAP participated in the study. They were matched by municipality, sex and age with 475 controls randomly selected from the municipal census. Risk factors relating the subject's characteristics and habits, housing conditions, medical history and treatments were investigated by means of a questionnaire. In the univariate analysis, an increased risk of CAP was associated with low body mass index, smoking, respiratory infection, previous pneumonia, chronic lung disease, lung tuberculosis, asthma, treated diabetes, chronic liver disease, and treatments with aminophiline, aerosols and plastic pear-spacers. In multivariate models, the only statistically significant risk factors were current smoking of >20 cigarettes x day(-1) (odds ratio (OR)=2.77; 95% confidence interval (CI) 1.14-6.70 compared with never-smokers), previous respiratory infection (OR=2.73; 95% CI 1.75-4.26), and chronic bronchitis (OR=2.22; 95% CI 1.13-4.37). Benzodiazepines were found to be protective in univariate and multivariate analysis (OR=0.46; 95% CI 0.23-0.94). This population-based study provides new and better established evidence on the factors associated with the occurrence of pneumonia in the adult community. (+info)
Isolation and characterization of Vibrio parahaemolyticus causing infection in Iberian toothcarp Aphanius iberus.
High mortality among laboratory cultured Iberian toothcarp Aphanius iberus occurred in February 1997 in Valencia (Spain). The main signs of the disease were external haemorrhage and tail rot. Bacteria isolated from internal organs of infected fish were biochemically homogeneous and identified as Vibrio parahaemolyticus. The bacteria were haemolytic against erythrocytes from eel Anguilla anguilla, amberjack Seriola dumerili, toothcarp A. iberus and humans, and were Kanagawa-phenomenon-negative. Infectivity tests showed that the virulence for A. iberus was dependent on salinity. Finally, all strains were virulent for amberjack and eel. (+info)
Serotyping of Cryptococcus neoformans isolates from clinical and environmental sources in Spain.
We determined biovars and serotypes of 154 isolates of Cryptococcus neoformans from clinical and environmental sources from different areas of Spain. All clinical isolates belonged to C. neoformans var. neoformans. Serotypes showed an irregular distribution. C. neoformans var. gattii serotype B was isolated from necropsy specimens from goats with pulmonary disease. (+info)
Relationship of lipoprotein(a) levels to physical activity and family history of coronary heart disease.
OBJECTIVES: This study evaluated the association of physical activity with serum lipoprotein(a) [La(a)] levels in individuals according to whether they had a family history of coronary heart disease (CHD). METHODS: Lp(a) levels in 332 healthy Spanish men aged 20 to 60 years were measured. Physical activity and family history of CHD were assessed. RESULTS: For men with a family history of CHD, the odds ratio for Lp(a) levels above the median value was 0.13 (95% confidence interval = 0.03, 0.50) in very active men (energy expended in physical activity > 300 kcal/day) compared with active men (energy expended in physical activity < 300 kcal/day). CONCLUSIONS: Regular daily physical activity in individuals with a family history of CHD could be useful for controlling Lp(a) levels. (+info)