The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms.

Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market.

The impact of harm reduction programs and police interventions on the number of syringes collected from public spaces. A time series analysis in Barcelona, 2004-2014.

BACKGROUND: To estimate the effect of opening two services for people who use drugs and three police interventions on the number of discarded syringes collected from public spaces in Barcelona between 2004 and 2014. METHODS: We conducted an interrupted time-series analysis of the monthly number of syringes collected from public spaces during this period. The dependent variable was the number of syringes collected per month. The main independent variables were month and five dummy variables (the opening of two facilities with safe consumption rooms, and three police interventions). To examine which interventions affected the number of syringes collected, we performed an interrupted time-series analysis using a quasi-Poisson regression model, obtaining relative risks (RR) and 95% confidence intervals (CIs). RESULTS: The number of syringes collected per month in Barcelona decreased from 13,800 in 2004 to 1655 in 2014 after several interventions. For example, following the closure of an open drug scene in District A of the city, we observed a decreasing trend in the number of syringes collected [RR=0.88 (95% CI: 0.82-0.95)], but an increasing trend in the remaining districts [RR=1.11 (95% CI: 1.05-1.17) and 1.08 (95% CI: 0.99-1.18) for districts B and C, respectively]. Following the opening of a harm reduction facility in District C, we observed an initial increase in the number collected in this district [RR=2.72 (95% CI: 1.57-4.71)] and stabilization of the trend thereafter [RR=0.97 (95% CI: 0.91-1.03)]. CONCLUSION: The overall number of discarded syringes collected from public spaces has decreased consistently in parallel with a combination of police interventions and the opening of harm reduction facilities.

Soy aeroallergens in thoracic fraction particles (PM10).

BACKGROUND: The aerodynamic diameter of biological particles determines their ability to penetrate the human respiratory system. OBJECTIVE: To assess the content of allergens less than 10 pm in diameter in the particle fraction of airborne dust in order to improve control of exposure to harmful soybean aeroallergens. METHODS: In this study, 98 pairs of particulate matter measuring less than 10 microm in diameter (PM10) and total suspended particulate (TSP) filters were collected in parallel and analyzed for soy aeroallergens by the inhibition enzyme-linked immunosorbent assay. RESULTS: The median levels found were 6 and 22.5 U/m3 for PM10 and TSP filters, respectively. A good correlation was found between soy aeroallergen content in PM10 and TSP filters. The median proportion of soy aeroallergen content in PM10 filters versusTSP filters was 28.6%, and varied widely across different days. CONCLUSIONS: Due to this wide variation between days, it seems that soy aeroallergen content in TSP filters is not a good surrogate of soy allergen content in PM10 filters. Further clinical studies should be conducted to assess differences in the health impact of soy allergen content in PM10 filters and TSP filters.

Surveillance of dioxins and polychlorinated biphenyls (PCBs) in food commercialized in Barcelona, Spain.

This study explored the potential use of seven congeners of polychlorinated biphenyls (PCBs-7) as indicator compounds for the presence of dioxins and PCBs in food samples, as part of the routine surveillance programme of a public health agency. Samples of 24 foodstuffs with high fat content were collected (ten fresh fish, six dairy products, five meat and three eggs). Duplicate analyses were performed. A research laboratory tested samples for seven polychlorinated dibenzo-p-dioxin (PCDDs), ten dibenzofurans (PCDFs) and twelve dioxin-like PCBs, with limits of detection in the range of ng kg(-1) (ppt). The public health services official control laboratory tested samples for PCBs-7, with a limit of quantification of 5 µg kg(-1) (ppb). The research laboratory detected the presence of dioxins and dioxin-like PCBs in all samples; fish samples had the highest levels (0.04-10.3 pg WHO-TEQ g(-1)). The public health service official control laboratory detected PCBs-7 only in five samples, which were all fish. Comparing the results in the two laboratories there seems to be an association between the detection of PCB-7 and the presence of higher levels of PCDD/Fs and dioxin-like PCBs. The use of PCB-7 as an indicator compound may be a practical surveillance strategy for those foodstuffs with higher concentrations of dioxin-like congeners.

Chlorinated organic pesticides in marketed food: Barcelona, 2001-06.

This paper reports concentration levels of 22 chlorinated organic compounds (both primary compounds and metabolites) in food marketed in the city of Barcelona (Catalonia, Spain) in 2001-06. Samples included meat products, fish and seafood, eggs, milk and dairy, vegetal oils, cereal products and derivates, vegetables, fresh fruits, dry fruits, spices, formula and baby food, tea and wine. Levels of chlorinated organic compounds were determined by gas chromatography with selective detectors: electron capture (ECD), flame photometric (FPD) and confirmation with mass-spectrometry. Chlorinated organic pesticides were detected in 7 of the 1,484 samples analyzed in the 2001-06 period (0.5%): 1 dairy product, 1 fruit, 1 olive oil and 4 vegetables. Specific pesticides detected are lindane and endosulfan alpha, beta or sulphate. A decrease in both the proportion of samples with detectable residues and in the variety of chlorinated pesticides found is visible when comparing these results with those of the previous 1989-2000 period. These results suggest the gradual disappearance of regulated chlorinated organic pesticides as a consequence of the growing worldwide implementation of current regulatory agreements.

Immunoquantitative measurement of soybean aeroallergen emissions at industrial sites.

BACKGROUND: Asthma attacks and mortality due to inhalation of soybean antigens in Barcelona, Spain have been well documented. A new control scheme was adopted in the city to avoid the emission and dispersion of soybean dust into the atmosphere during unloading. We studied soybean allergen emission during unloading and at 3 industrial sites and compared the results obtained. METHODS: Over a period of 31 months, 628 paired air samples from 3 plants (A, B, C) involved in soybean manipulation in Barcelona harbor were collected. Samples were analyzed by a radiometric competitive inhibition assay (RCIA) and the enzyme-linked immunosorbent assay (ELISA). A Bland-Altman plot was used to compare the soybean concentrations measured by each assay. RESULTS: The median values for the 628 samples were 5535 U/m3 (range, 370-18,416,751) for the RCIA and 9955 U/m3 (range, 400-22,349,059) for the ELISA. Plant A had the lowest emission levels and the lowest Spearman rank correlation coefficient (0.409). The correlation coefficients were 0.747 and 0.794 for plants B and C. Soybean aeroallergen concentrations differed by plant. The highest variability in values was seen for plant A, which had the lowest allergen concentrations. CONCLUSIONS: The competitive assays described are useful tools for the measurement of soybean allergen emission levels at industrial sites. These methods may be used to monitor unloading and the impact of environmental interventions.

Polycyclic aromatic hydrocarbons in food samples collected in Barcelona, Spain.

This study reports on the concentrations of eight polycyclic aromatic hydrocarbons (PAHs) in food samples collected in the city of Barcelona (Catalonia, Spain) from 2003 to 2004. Food samples included meat products, fish (fresh and smoked), other seafood (cephalopods, crustaceans, and bivalves), vegetable oil, and tea. Concentrations of benz[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, benzo[g,h,i]perylene, benzo[alpha]pyrene, benzo[e]pyrene, dibenz[a,h]anthracene, and indeno[1,2,3-c,d]pyrene were determined by reversed-phase high-performance liquid chromatography with fluorescence detection. PAHs were detected in most tea samples (94%), which had the highest concentration of total PAHs (mean concentration of 59 microg/kg). Other food groups with a high presence of PAHs were bivalves (present in 34% of the samples; mean value of 2.7 microg/kg) and meat products (present in 13% of the samples; mean value of 1.7 microg/kg). The PAHs detected most frequently were benzo[e]pyrene and benzo[b]fluoranthene. No sample had levels above current regulation standards. Nevertheless, the frequent presence of PAHs in bivalves, tea samples, and meat products, together with the fact that dietary sources are the main exposure to these carcinogenic compounds, suggests the need for some monitoring scheme to follow up on these trends.

[Changes in tobacco use in the general population of Barcelona, 1983-2000]. / Cambios en el consumo de tabaco en la población general en Barcelona, 1983-2000.

OBJECTIVES: To analyze the prevalence trends for smoking and its determinants in the general population of Barcelona from 1983 to 2000. DESIGN: Time series study. SETTING: Health survey based on home interviews of a representative sample of the general population of Barcelona. PARTICIPANTS: In the years 1983, 1992, and 2000 we interviewed 3134, 5004, and 10,000 persons, respectively. MAIN OUTCOME MEASURES AND RESULTS: Between 1983 and 2000 daily tobacco use showed a steady tendency to decrease among men, with a prevalence that decreased from 54.6% to 38.3%, while in women, smoking increased between 1983 and 1992 (from 20.9% to 25.4%) but remained stable in 2000 (24.5%). The proportion of smokers who said they wanted to quit increased in both sexes from 1992 (54.2%) to 2000 (65.7%). During this period the proportion of smokers who said their doctor had advised them to quit increased from 36.1% to 48.1%. The trends for both sexes showed that consumption of tobacco products was greater among less privileged socioeconomic groups. CONCLUSIONS: The results of this study confirm the decrease in the prevalence of daily consumption of tobacco products and the increase in smokers who would like to quit, in parallel with the increase in advice from physicians to quit. However, the trends among younger groups remained stable, a finding that makes it necessary to intensify efforts aimed at this population group.

[Changing epidemiology of smoking: Barcelona, 2000-2001]. / La cambiante epidemiología del tabaquismo: Barcelona, 2000-2001.

CONTEXT: In recent years various initiatives of prevention and social changes have been carried out that should have an effect on epidemiology of smoking in our area. Their real effect is little known, however, because of methodological changes in the existing population surveys. In this work the data on smoking in the last city of Barcelona health survey (ESBA 2000-01) are analyzed, with reference to the cumulative information obtained along 18 years from the first survey in 1983. METHOD: ESBA 2000-01 is an interview health survey carried out on a weighted sample with 10,030 people. Data relative to tobacco use are showed for people 15-year-old or older included in the survey, stratified by age, sex, and class. Consumption context variables are also showed, and the tobacco consumption quitting among people who have smoked is analyzed. RESULTS: The proportion of daily smokers in the population over 14 years of age is 29 %, while that of former smokers is 21 % and 2.2 % in this population are occasional smokers. The prevalence is maximum in the 35-44 year-old group, and the prevalence is reduced drastically after this age. Stratified analysis by age, sex, and occupational category shows interesting differences among daily smokers. A strong gradient is observed according to occupational category in males. The situation is more complex in women. The typical smoker began when 17-year-old, and now consumes 16 cigarettes a day. Consumption is somewhat higher in males and is maximum in the 35-44 year-old group. Two-third of the smokers (65.7 %) want to quit smoking and more than one third (36 %) has attempted it along the last year. Almost half of smokers (48.1 %) have received advice to quit smoking from their physician. One of every four (24.9 %) smokers has been warned for smoking in some places. Almost half smokers are the only smoker in their home, and barely a third are the only smokers at work. The proportion of quitting increases with age in both sexes, and nowadays the differences in the probability of quitting smoking are few when the data are stratified by age groups. CONCLUSIONS: These results show the changing pattern of tobacco epidemiology in Barcelona: smoking is no longer the main behavior in no age and sex group, and the only social group in which more than half of its members smoke are 25-44 year-old not qualified worker males. This situation has occurred because of two processes: an important proportion of early quitting (demonstrated even in young adults) and a decrease in the beginning of the habit. Real differences are not observed between males and females with regard to the probability of quitting smoking. These data correct recent estimates that could be influenced by methodological changes in the instruments used.

Epidemic soybean asthma and public health: new control systems and initial evaluation in Barcelona, 1996-98.

OBJECTIVE: To evaluate the new measures adopted to control the risks from soybean unloading operations in the Port of Barcelona, after an episode of epidemic asthma in June 1996. METHODS: After an initial cautionary suspension of all soybean unloading operations, they were subsequently resumed under restrictive criteria for time, flux, simultaneity, and meteorological conditions. Emission filtration systems based on either micro pore size filters or polytetrafluoroethylene membranes on tetratex filters showed promising results. RESULTS: Allergen emission underwent a very important decrease to levels 95% to 98% lower. Emissions from the two plants with unloading operations are in the same order of magnitude as the processing plant that does not unload soybean. Allergen concentration levels presented fluctuations initially, but the new filters decreased mean values; despite increased unloading, allergen levels did not increase-mean allergen levels on unloading days (67 U/m(3)) and on days without unloading operations (63 U/m(3)) are similar. A panel of patients detected a cluster of increased symptoms during unloading operations on a day with suboptimal meteorological conditions and comparatively low allergen levels (225-415 U/m(3)). Since the June 1996 episode, no further asthma outbreak has been detected. CONCLUSIONS: The evaluation shows the effectiveness of the new filters in the control of soybean dust emission. With a systematic control programme, industrial soybean operations may function near urban centres without public health risks. These data may be useful in the development of future standards for allergenic agents.

[Exposure to smoking during pregnancy: Barcelona (Spain) 1994-2001]. / Tendencias en la exposición al tabaquismo durante la gestación: Barcelona, 1994-2001.

BACKGROUND: Exposure to smoking during pregnancy is an important risk factor for child health. In the last few decades, the prevalence of smoking among fertile women has increased in Spain. OBJECTIVES: To assess fetal exposure to smoking in a representative sample of pregnant women and its trends. METHODS: The prevalence of smoking and smoking cessation were analyzed in a representative sample of women who gave birth in the city of Barcelona, extracted from a population-based registry of birth defects. The sample consisted of 1,801 women and covered the period 1994 to 2001. RESULTS: Among pregnant women, 43.4 % smoked before pregnancy, and 42.2 % of these quit. At the time of giving birth, 25.2 % of the women were smokers. Over the period studied the prevalence of smoking among pregnant women clearly decreased. Although the proportion of cessations showed no significant changes, fetal exposure to tobacco decreased. CONCLUSIONS: The prevalence of smoking among pregnant women was high, although many quit during pregnancy. Over the period studied, fetal exposure to smoking decreased. There is a need for more systematic interventions.

[From the municipal dog pound to the pet shelter in Barcelona, Spain]. / De la perrera municipal al centro de acogida de animales de compañía de Barcelona.

This article aims to present changes in public health policy and services related to pet dogs and cats in the city of Barcelona from 1983 to 2001. Initially the center's activity was limited to the custody and euthanasia of stray animals, serving not only the city but also the rest of the province. With the formulation of a city Plan for Pet Animals, the activities were redirected, concentrating on services within the city limits and stimulating adoption. Participation of both professional and humane organizations was sought, premises were renovated, responsible ownership of animals was promoted, controlled urban colonies of cats were established, and adoptions become the cornerstone of policy, centering the activity of the shelter toward its clients. Changes in the shelter's activity since 1998 reflects a clear decrease in the number of animals retained, as well as in the proportion subjected to euthanasia. This decrease may reflect an improvement in the problem of stray animals. These developments have also resulted in a positive change in the relationship with the media and animal welfare organizations.

[Trends in tobacco, alcohol and cannabis consumption among secondary school pupils in Barcelona, Spain (1987-1999)]. / Tendencias en el consumo de tabaco, alcohol y cannabis de los escolares de Barcelona (1987-1999).

OBJECTIVE: To describe trends in tobacco, alcohol, and cannabis consumption among secondary school pupils in Barcelona between 1987 and 1999. METHODS: Cross-sectional surveys administered to representative samples of pupils in the second year of secondary school between 1987 and 1999. The questionnaires were anonymous and self-completed. We present data from 5013 secondary school pupils from Barcelona who participated in one of the five surveys. RESULTS: Regular smoking (daily and weekly) showed a uniform decrease between 1987 and 1996. The results of the last survey (1999) showed an increase over those the 1996 survey, ranging from 13.4% for regular smoking to 38.7% for experimental smoking. Between 1987 and 1999, the percentage of schoolchildren who reported drinking at least half a glass of alcohol at some time showed an overall decrease of 14.0%. No differences in sex were found in problematic alcohol consumption, while a higher proportion of girls (14.0%) than boys (10.5%) reported getting drunk at some time. Whereas in 1996, 6.9% of the population studied had smoked cannabis at some time, in 1999 this proportion was 7.3%, with no differences between sexes. CONCLUSIONS: During the study period regular smoking increased, alcohol consumption decreased and cannabis consumption tended to level-off. Differences between boys and girls tended to disappear.

[Portfolio of services in a public health organization]. / La cartera de servicios en una organización de salud pública.

Health services in Spain are currently being improved. Definition of the services portfolio has been one of the elements in this process, from which public health services have been largely left out. In the present article public health services are examined from the perspective of the Public Health Agency of Barcelona. We propose a scheme to classify services into productive public health services, health care services, services that are intermediate products, support services, and liaison or coordinating services. Indicators of productivity, result, impact, and cost are explored, and a catalogue of services for a public health organization with a well defined population and area is proposed.

Prevalence of cigarette smoking by birth cohort among males and females in Spain, 1910-1990.

We analysed the prevalence of cigarette smoking among subsequent birth cohorts of Spanish males and females. Data were drawn from the Spanish NHIS conducted in 1993 ( = 26 400), 1995 ( = 8300) and 1997 ( = 8300). From the original computer files, the three surveys were pooled to obtain a single sample. A total of 33 223 subjects (16 036 men and 17 187 women) born between 1900 and 1979, >/= 16 years old, were directly interviewed and with complete information on the history of smoking included for analysis. Based on each respondent's sex and calendar year of birth, the person was classified into a particular sex-birth cohort in the decades from 1900-09 to 1970-79. For each year from date of birth to date of survey, respondents were further classified as either cigarette smoker or nonsmoker. The prevalence of cigarette smoking among successive cohorts of Spanish men and women was estimated, with correction for excess mortality of smokers. In men, the peak in smoking was reached in the 1950-59 birth cohort (prevalence rate of 68% at ages 20-29), after increases during the previous calendar years. Smoking among women was rare until 1960. Female smoking prevalence rates increased progressively among subsequent cohorts until 1980. The age distribution of smoking prevalence in women in 1990 mimics that observed in men 40 years earlier. A substantial delay in the spread of the tobacco epidemic among men is apparent. In women, the delay in the initiation of the smoking epidemic ended with a quick diffusion of the habit.

[The tobacco industry's internal documents and smoking prevention in Spain]. / Los documentos internos de la industria tabaquera y la prevención del tabaquismo en España.

A 1998 agreement between several states in the USA and the tobacco industry made millions of pages of internal documents available to the public. Many of these documents contain information that the industry would have preferred to keep confidential. Systematic review of these internal documents constitutes a valuable resource for international tobacco control, since they are available on the Internet and can be accessed from anywhere in the world. These documents provide relevant and useful information to antismoking activists and researchers. To facilitate their use, the present article presents the electronic archives of the tobacco industry's documents, describes methods for conducting searches, and identifies the documents with information on the industry's tactics for manipulating Spanish politics and society for its own commercial interests during the 1970s, 1980s, and 1990s.

[Smoking initiation: epidemiology, research, and behavioral sciences]. / La iniciación al tabaquismo: aportaciones de la epidemiología, el laboratorio y las ciencias del comportamiento.

Becoming a regular smoker is a process that begins even before the first cigarette, and ends in lifelong physical and psychological dependence. Various psychological and behavioral factors contribute to this process. This article discusses smoking initiation from a comprehensive perspective, including the physiological and addictive effects of nicotine, and the personal and environmental factors that lead to smoking. Because smoking usually begins in adolescence, special emphasis is placed on this developmental stage and on the situations that encourage teenagers to smoke the first cigarette. Finally, this article analyzes the importance of the initiation process in the epidemiology and prevention of smoking. This approach may prove to be particularly useful to clinicians interested in interventions aimed to curb smoking.