Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol.

INTRODUCTION: The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health. METHODS AND ANALYSIS: DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration. ETHICS AND DISSEMINATION: The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Implantación de una prueba rápida de infección estreptocócica: ¿su uso también mejora la adherencia antibiótica? / Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?

Objetivo: Evaluar la influencia del resultado de la prueba rápida de diagnóstico para la identificación del antígeno estreptocócico en infecciones faringoamigdalares pediátricas, en términos de mejora de la adherencia a la terapia antibiótica. Diseño: Ensayo clínico comunitario de dos grupos de estudio con asignación aleatoria. Emplazamiento: Centros de atención primaria de Cataluña Central. Participantes: En el estudio se incluyeron a pacientes de tres a 15 años por muestreo consecutivo, que fueron atendidos por sospecha de infección faringoamigdalar en las consultas pediátricas entre noviembre del 2010 y febrero del 2011. De 557 pacientes que satisficieron los criterios de inclusión, se hizo seguimiento a 519. Intervención: El grupo control siguió el algoritmo diagnóstico y terapéutico habitual. Al grupo de intervención, se le realizó adicionalmente la prueba diagnóstica rápida de detección del antígeno estreptocócico y se indicó tratamiento según el resultado. Mediciones principales: Evaluación de la adherencia, los motivos de no adherencia y los factores de riesgo sociodemográficos mediante una encuesta telefónica. Resultados: Se prescribió antibiótico al 65,6% y los pediatras del grupo control fueron más propensos a recetar antibióticos que los del grupo intervención (88,5 vs. 45,5%, p< 0,001). El 64,8% de los pacientes siguió las indicaciones del tratamiento, siendo la causa principal de no adherencia no cumplir el horario (25,6%). La adherencia terapéutica fue superior en el grupo de intervención (68%) que en el de control (62,9%), no existiendo una diferencia significativa. Conclusiones: La prueba rápida del diagnóstico para la identificación de estreptococo, complementaria al uso de los criterios Centor evita la prescripción innecesaria de tratamiento antibiótico, aunque no ha demostrado mejorar la adherencia terapéutica.(AU)

Objective: To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence. Design: Randomized community clinical trial with two study groups. Location: Primary Care Centers in Central Catalonia. Participants: Patients aged from 3 to 15 years, who were attended at paediatric consultations on suspicion of pharyngotonsillitis caused by an infection between November 2010 and February 2011 (both included), were included in the study on a consecutive basis. 557 patients met the inclusion criteria and 519 were evaluated. Intervention: The control group received the usual diagnostic-therapeutic algorithm. Rapid streptococcal antigen test was additionally performed to experimental group participants and it was indicated the more convenient treatment. Main measurements: Antibiotic adherence, non-adherence causes and socio-demographic risk factors were evaluated via telephone survey. Results: Antibiotics were prescribed to 65.6% and paediatricians of the control group were more likely to prescribe antibiotic than the ones in the intervention group (88.5% vs 45.5%, p< 0.0001). 64.8% followed doctor's treatment orders, being failure following medication scheduling the main cause of non-adherence (25.6%). Medication adherence was higher in the experimental group (68%) than in the control group (62.9%) but no significant differences were found. Conclusion: Rapid strep test, complementing the use of Centor Criteria avoids unnecessary antibiotics prescriptions, but had not been proven to be effective in increasing medication adherence.(AU)

Socioeconomic inequalities in the incidence and prevalence of type 2 diabetes mellitus in Europe

Objective: The aim of this study was to analyze socioeconomic position (SEP) inequalities in the prevalence and incidence of type 2 diabetes mellitus (T2DM) in people aged 50 years and over in Europe and to describe the contribution of body mass index (BMI) and other possible mediators. Methods: This was a cross-sectional and longitudinal study including men and women >50 years old in 11 European countries in 2004 and 2006 (n = 21,323). The prevalence and cumulative incidence of T2DM were calculated with self-reported T2DM or when the individual took drugs for diabetes. Prevalence ratio (PR) and relative risk (RR) of prevalent and incident T2DM were calculated according to educational level and adjusted by BMI and other possible mediators. Results: The age-adjusted and country-adjusted prevalence of T2DM in 2004 was 10.2% in men and 8.5% in women. Compared to those with higher education, men and women with lower education had a PR [95% CI] of T2DM of 1.29 [1.12-1.50] and 1.61 [1.39-1.86], respectively. SEP-related inequalities in incidence (RR [95%CI]) were 1.88 [1.35-2.62] in women and 1.04 [0.78-1.40] in men. Adjusting for potential mediators reduced inequalities in the prevalence and incidence of T2DM among women by 26.2% and 21.6%, respectively, and inequalities in prevalence among men by 44.8%. Conclusions: We observed significant inequalities in the prevalence and incidence (women only) of T2DM as a function of socioeconomic position. These inequalities were mediated by BMI (AU)

Objetivo: Analizar las desigualdades por posición socioeconómica en la prevalencia y la incidencia de diabetes mellitus de tipo 2 (DM2) en las personas de 50 o más años de edad en Europa, y describir la contribución del índice de masa corporal (IMC) y la de otros posibles mediadores. Métodos: Estudio de diseño transversal y longitudinal que incluye personas de 50 o más años de edad de 11 países de Europa, entre 2004 y 2006 (n = 21.323). Se calculó la prevalencia y la incidencia acumulada de DM2 a partir del autorreporte de DM2 o de si la persona consumía fármacos para la diabetes. Se estimaron riesgos relativos (RR) de incidencia y razones de prevalencia (RP) de DM2 según el nivel educativo, y se ajustaron por el IMC y otros posibles mediadores. Resultados: La prevalencia de DM2 ajustada por edad y país en 2004 era del 10,2% en los hombres y del 8,5% en las mujeres. Comparado con las personas con un nivel de estudios más alto, los hombres y las mujeres con menor nivel de estudios tenían una RP (IC95%) de DM2 de 1,29 (1,12-1,50) y 1,61 (1,39-1,86), respectivamente. Las desigualdades por posición socioeconómica en la incidencia (RR [IC95%]) eran de 1,88 (1,35-2,62) en las mujeres y de 1,04 (0,78-1,40) en los hombres. Ajustando por los potenciales mediadores, las desigualdades en la prevalencia y la incidencia de DM2 se redujeron en las mujeres un 26,2% y un 21,6%, respectivamente, y las desigualdades en la prevalencia en los hombres un 44,8%. Conclusiones: Se observan desigualdades en la prevalencia y la incidencia (sólo en las mujeres) de DM2 en función de la posición socioeconómica. Estas desigualdades estaban mediadas por el IMC (AU)

Trihalometanos en el agua de piscinas en cuatro zonas de España participantes en el proyecto INMA / Trihalomethanes in swimming pool water in four areas of Spain participating in the INMA project

Objetivo La natación es uno de los deportes más practicados en España, por personas de todas las edades y condiciones físicas. También es una vía de exposición a subproductos de la desinfección, compuestos potencialmente tóxicos. Su concentración en el agua de las piscinas no está legislada y es poco conocida. El objetivo de este trabajo es describir la concentración de trihalometanos en el agua de piscinas de los municipios de cuatro cohortes del estudio INMA. Métodos En julio de 2009 se analizaron los trihalometanos en el agua de piscinas (n=27) de Asturias, Granada, Valencia y Sabadell. Resultados La concentración media de trihalometanos totales fue de 42,7μg/l (desviación estándar [DE]=19,1) en las piscinas interiores y de 151,2μg/l (DE=80,7) en las exteriores, predominando siempre el cloroformo. Granada tuvo los valores más bajos. Conclusión La concentración de trihalometanos en el agua de piscinas presenta una gran variabilidad. Las piscinas exteriores tienen valores más altos, superando mayoritariamente los límites legales establecidos para el agua de consumo (AU)

Objective Swimming is one of the most widely practiced sports in Spain among people of all ages and physical conditions. This activity is also a source of exposure to disinfection by-products (DBP), which are potentially toxic. The DBP concentration in swimming pool water is not regulated and is poorly known. The aim of this study was to describe trihalomethane concentrations in swimming pool water in the municipalities of four cohorts of the INMA project. Methods In July 2009, trihalomethanes were analyzed in water from 27 swimming pools in Asturias, Granada, Valencia and Sabadell. Results The mean total trihalomethane concentration was 42.7μg/L (standard deviation [SD]=19.1) in indoor pools and 151.2μg/L (SD=80.7) in outdoor pools. In all pools, the most abundant trihalomethane was always chloroform. The lowest levels were found in Granada. Conclusion Trihalomethane concentrations in swimming pool water were highly variable. Outdoor swimming pools showed the highest levels, which were usually above the legal limit for drinking water (AU)

Determinantes del retraso de la interrupción voluntaria del embarazo / Determinants of induced abortion delay

AntecedentesEl momento de la gestaci¨®n en que se induce una interrupci¨®n voluntaria del embarazo (IVE) determina el m¨¦todo, el riesgo de complicaciones y el coste econ¨®mico de la intervenci¨®n. El objetivo de nuestro estudio fue describir los determinantes del retraso de la IVE hasta el segundo trimestre de gestaci¨®n en Barcelona.M¨¦todosEstudio transversal de las IVE por motivos de salud f¨ªsica o mental de la mujer (Barcelona, 2004¨C2005; N=9.175). El registro de IVE de la ciudad proporcion¨® el tiempo de gestaci¨®n (variable dependiente), el nivel de estudios, la edad, la convivencia en pareja, el n¨²mero de hijos, IVE anteriores y tipo de centro. Se calcularon razones de prevalencia ajustadas (RPa) mediante modelos de regresi¨®n log-binomial.ResultadosEl 7,7% de las IVE fueron de segundo trimestre y el 99,3% se realizaron en centros privados. En comparaci¨®n con las mujeres con estudios universitarios, las que tienen educaci¨®n primaria o menos tienen una RPa de 1,8 (intervalo de confianza del 95% [IC95%]: 1,4¨C2,2) de IVE de segundo trimestre. Tambi¨¦n se registran m¨¢s IVE de segundo trimestre en las menores de 18 años (RPa=2,6; IC95%: 2,0¨C3,4), las que no conviven en pareja (RPa=1,4; IC95%: 1,2¨C1,6) y en los centros p¨²blicos (RPa=2,8; IC95%: 2,2¨C3,7). No hay diferencias en el retraso de la IVE entre las mujeres que han tenido IVE anteriores y las que no.Conclusi¨®nEl retraso de la IVE hasta el segundo trimestre se asoci¨® a niveles educativos m¨¢s bajos, edades j¨®venes, no convivencia en pareja y centros p¨²blicos, y se demuestra la existencia de desigualdades socioecon¨®micas en las condiciones de acceso a la IVE(AU)

BackgroundIn induced abortion, the method, the risk of complications and the economic cost of the abortion are determined by gestational age. The aim of this study was to describe the determinants of induced abortion delay until the second trimester of pregnancy in Barcelona.MethodsWe performed a cross-sectional study of induced abortions due to the physical or mental health of the woman (Barcelona, 2004¨C2005; N=9,175). The city¡äs induced abortion register provided data on gestational age at abortion (dependent variable), educational level, age, cohabitation with the partner, number of children previous abortions, and type of center. Adjusted prevalence ratios (aPR) were calculated with log-binomial regression models.ResultsA total of 7.7% of induced abortions were second-trimester abortions and 99.3% were performed in private centers. Compared with women with a university education, those with primary education or less had an aPR of 1.8 (95% confidence interval [95%CI]: 1.4¨C2.2) of delaying the abortion until the second trimester. A higher proportion of second-trimester abortions were also recorded in women aged less than 18 years old (aPR=2.6; 95%CI: 2.0¨C3.4), women not cohabiting with their partners (aRP=1.4; 95% CI: 1.2¨C1.6) and in public centers (aPR=2.8; 95% CI: 2.2¨C3.7). No differences were found in induced abortion delay among women with previous abortions and those without.ConclusionInduced abortion delay until the second trimester of pregnancy was associated with low educational level, young ages, not cohabiting with a partner, and public centers. This study demonstrates the existence of socioeconomic inequalities in access conditions to abortion services(AU)