Impacto diferencial, necesidades heterogéneas. La formación entre iguales para mejorar la salud y los hábitos de vida de los pacientes crónicos / Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors

OBJETIVO: Evaluar el impacto de la formación entre iguales de la Escuela de Pacientes sobre la salud autopercibida y los hábitos de vida de las personas con enfermedades crónicas. DISEÑO: Descriptivo, transversal de evaluación cuantitativa pretest/postest. EMPLAZAMIENTO: Andalucía. PARTICIPANTES: Novecientos sesenta y cuatro pacientes con diabetes, fibromialgia e insuficiencia cardíaca participantes en la Escuela de Pacientes entre 2013 y 2015. INTERVENCIONES: Sesión de formación para formadores en autocuidados para personas con enfermedades crónicas. Mediciones principales: Se usó un cuestionario que midió salud autopercibida, limitaciones, dieta y actividad física. El análisis estadístico fue descriptivo, bivariante, de correlaciones y de ganancias netas. RESULTADOS: Tras realizar la formación se observó una mejoría de la salud, con menos limitaciones y mejor dieta y ejercicio físico, con diferencias estadísticamente significativas en función del sexo, enfermedad, nivel de estudios y estado civil. Se plantean propuestas de mejora de la estrategia formativa, con atención a las necesidades específicas de los colectivos más vulnerables: mujeres y personas con menor nivel educativo. CONCLUSIONES: El impacto de la formación fue positivo y diferencial en función de los perfiles de participantes. Se recomienda profundizar en los resultados, a través de metodología cualitativa, realizar mediciones postest posteriores y adaptar la estrategia formativa a la heterogeneidad de las necesidades de la población formada

OBJECTIVE: To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN: Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT: Andalusia. PARTICIPANTS: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS: Peer-training intervention for self-efficacy for chronic patients. Main measurement: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations

[Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors]. / Impacto diferencial, necesidades heterogéneas. La formación entre iguales para mejorar la salud y los hábitos de vida de los pacientes crónicos.

OBJECTIVE: To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN: Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT: Andalusia. PARTICIPANTS: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS: Peer-training intervention for self-efficacy for chronic patients. MAIN MEASUREMENT: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations.

Impact, economic evaluation, and sustainability of integrated vector management in urban settings to prevent vector-borne diseases: a scoping review.

BACKGROUND: The control of vector-borne diseases (VBD) is one of the greatest challenges on the global health agenda. Rapid and uncontrolled urbanization has heightened the interest in addressing these challenges through an integrated vector management (IVM) approach. The aim was to identify components related to impacts, economic evaluation, and sustainability that might contribute to this integrated approach to VBD prevention. MAIN BODY: We conducted a scoping review of available literature (2000-2016) using PubMed, Web of Science, Cochrane, CINAHL, Econlit, LILACS, Global Health Database, Scopus, and Embase, as well as Tropical Diseases Bulletin, WHOLIS, WHO Pesticide Evaluation Scheme, and Google Scholar. MeSH terms and free-text terms were used. A data extraction form was used, including TIDieR and ASTAIRE. MMAT and CHEERS were used to evaluate quality. Of the 42 documents reviewed, 30 were focused on dengue, eight on malaria, and two on leishmaniasis. More than a half of the studies were conducted in the Americas. Half used a quantitative descriptive approach (n = 21), followed by cluster randomized controlled trials (n = 11). Regarding impacts, outcomes were: a) use of measures for vector control; b) vector control; c) health measures; and d) social measures. IVM reduced breeding sites, the entomology index, and parasite rates. Results were heterogeneous, with variable magnitudes, but in all cases were favourable to the intervention. Evidence of IVM impacts on health outcomes was very limited but showed reduced incidence. Social outcomes were improved abilities and capacities, empowerment, and community knowledge. Regarding economic evaluation, only four studies performed an economic analysis, and intervention benefits outweighed costs. Cost-effectiveness was dependent on illness incidence. The results provided key elements to analyze sustainability in terms of three dimensions (social, economic, and environmental), emphasizing the implementation of a community-focused eco-bio-social approach. CONCLUSIONS: IVM has an impact on reducing vector breeding sites and the entomology index, but evidence of impacts on health outcomes is limited. Social outcomes are improved abilities and capacities, empowerment, and community knowledge. Economic evaluations are scarce, and cost-effectiveness is dependent on illness incidence. Community capacity building is the main component of sustainability, together with collaboration, institutionalization, and routinization of activities. Findings indicate a great heterogeneity in the interventions and highlight the need for characterizing interventions rigorously to facilitate transferability.

Professional Success and Gender in Family Medicine: Design of Scales and Examination of Gender Differences in Subjective and Objective Success Among Family Physicians.

Two components of professional success have been defined: objective career success (OCS) and subjective career success (SCS). Despite the increasing number of women practicing medicine, gender inequalities persist. The objectives of this descriptive, cross-sectional, and multicenter study were (a) to construct and validate OCS and SCS scales, (b) to determine the relationships between OCS and SCS and between each scale and professional/family characteristics, and (c) to compare these associations between male and female family physicians (FPs). The study sample comprised 250 female and 250 male FPs from urban health centers in Andalusia (Spain). Data were gathered over 6 months on gender, age, care load, professional/family variables, and family-work balance, using a self-administered questionnaire. OSC and SCS scales were examined by using exploratory factorial analysis and Cronbach's α, and scores were compared by gender-stratified bivariate and multiple regression analyses. Intraclass correlation coefficients were calculated using a multilevel analysis. The response rate was 73.6%. We identified three OCS factors and two SCS factors. Lower scores were obtained by female versus male FPs in the OCS dimensions, but there were no gender differences in either SCS dimension.

Understanding children: a qualitative study on health assets of the Internet in Spain.

OBJECTIVES: This research was designed to explore the opinions held by primary school pupils about the Internet as a source of assets for health and well-being. METHODS: A qualitative study was carried out based on 8 focus groups comprising 64 pupils from 8 primary schools in Spain. RESULTS: Our findings describe the Internet as a tool for learning, communication, fun and health care. In addition, they reveal how children understand influences on health and well-being in relation to their view of the Internet. The results are discussed in terms of the public-health implications of digital literacy, as well as its connection to well-being, especially in relation to health assets. CONCLUSIONS: The Internet is an important resource for children's health and well-being, which, through learning, communication, fun and health care, encourages them to make use of it. Digital and health literacy constitutes the foundation required for browsing the Internet in a positive way, as identified by the children interviewed in this study, and especially in relation to the health assets that the Internet can contain.

Las características familiares y la salud percibida en médicas y médicos de familia de Andalucía / Familial characteristics and self-perceived health among female and male primary care physicians in Andalusia (Spain)

OBJETIVO: Conocer las relaciones de un conjunto de características profesionales y familiares con los componentes de salud física y psíquica en médicas y médicos de familia que trabajan en centros de salud en Andalucía. MÉTODO: Descriptivo, transversal y multicéntrico. Población: médicas y médicos de familia de centros urbanos. Muestra: 500 profesionales, 50% por sexo. Se consideró el sexo, la edad, las características profesionales (formación posgraduada en medicina de familia, ejercer la dirección del centro de salud, ser tutor/a de formación posgraduada, y carga asistencial según tamaño del cupo y pacientes/día), las responsabilidades familiares, dos dimensiones de las relaciones familia-trabajo (sobrecarga y conflicto familia-trabajo) y la salud percibida física y psíquica. Fuente: cuestionario postal autoadministrado. Análisis: regresión múltiple para salud física y psíquica, conjunta para la muestra y por sexo. RESULTADOS: Responden 368 profesionales (73,6%). Las médicas presentan peor salud psíquica que los médicos, sin diferencias en la salud física. El conflicto familia-trabajo se asocia con salud física y psíquica en médicas y médicos. La salud física empeora al aumentar la edad en ambos sexos, mejora en médicas tutoras y disminuye en médicos al aumentar el conflicto familia-trabajo. La salud psíquica disminuye en ambos sexos al aumentar las horas dedicadas al hogar los fines de semana y el conflicto familia-trabajo. En los médicos, la salud psíquica empeora si tienen formación posgraduada y mejora si son directores de centro de salud. CONCLUSIONES: La carga de trabajo y las características profesionales tienen escasa relación con la salud de médicos y médicas de familia. Desempeñan un papel más relevante las características familiares

OBJECTIVE: To determine the relationships between a group of professional and family characteristics and the components of physical and mental health in female and male primary care physicians working in health centers in Andalusia (Spain). METHODS: A descriptive, cross-sectional, multicenter study was performed. The population consisted of urban health centers in Andalusia and their physicians. The sample comprised 88 health centers and 500 physicians. Measurements consisted of sex, age, professional characteristics (postgraduate training in family medicine, position of health center manager, accreditation as a residents" tutor, and workload based on patient quota and the mean number of patients/day); family responsibilities, defined by two dimensions of the family-work relationship (support overload-family support deficit and family-work conflict); and perceived physical and mental health. The data source was a self-administered questionnaire sent by surface mail. Multiple regression analyses were performed for physical and mental health for the whole sample and by gender. RESULTS: Responses were obtained from 368 physicians (73.6%). Mental health was worse in female physicians than in male physicians; no differences were found between genders in physical health. The family-work conflict was associated with physical and mental health in physicians of both genders. Physical health deteriorated with increasing age in both genders, improved in the female tutors of residents, and decreased with increasing family-work conflict in male physicians. Mental health decreased with increasing housework on the weekends and with family-work conflict in both genders. In male physicians, mental health deteriorated with postgraduate training in family medicine and improved if they were health center managers. CONCLUSIONS: Workload and professional characteristics have little relationship with the health of primary care physicians. Family characteristics play a greater role

[Familial characteristics and self-perceived health among female and male primary care physicians in Andalusia (Spain)]. / Las características familiares y la salud percibida en médicas y médicos de familia de Andalucía.

OBJECTIVE: To determine the relationships between a group of professional and family characteristics and the components of physical and mental health in female and male primary care physicians working in health centers in Andalusia (Spain). METHODS: A descriptive, cross-sectional, multicenter study was performed. The population consisted of urban health centers in Andalusia and their physicians. The sample comprised 88 health centers and 500 physicians. Measurements consisted of sex, age, professional characteristics (postgraduate training in family medicine, position of health center manager, accreditation as a residents' tutor, and workload based on patient quota and the mean number of patients/day); family responsibilities, defined by two dimensions of the family-work relationship (support overload-family support deficit and family-work conflict); and perceived physical and mental health. The data source was a self-administered questionnaire sent by surface mail. Multiple regression analyses were performed for physical and mental health for the whole sample and by gender. RESULTS: Responses were obtained from 368 physicians (73.6%). Mental health was worse in female physicians than in male physicians; no differences were found between genders in physical health. The family-work conflict was associated with physical and mental health in physicians of both genders. Physical health deteriorated with increasing age in both genders, improved in the female tutors of residents, and decreased with increasing family-work conflict in male physicians. Mental health decreased with increasing housework on the weekends and with family-work conflict in both genders. In male physicians, mental health deteriorated with postgraduate training in family medicine and improved if they were health center managers. CONCLUSIONS: Workload and professional characteristics have little relationship with the health of primary care physicians. Family characteristics play a greater role.

[Validation of scale to evaluate the relationship between family-work in family physicians]. / Validación de escala para evaluar la relación familia-trabajo en médicas y médicos de familia.

BACKGROUND: Studying the work-family relationships is important because it affects the personal and professional life. Women increases in medicine without redistribute domestic tasks and responsibilities. The purpose of this study was to create and validate a scale of work-family relations in women and men family physician (FP) in Andalusia. METHODS: Cross sectional and multicenter study. The study population were FP of urban primary care centres, sample=500FP (50% by sex). We studied: sex, age, postgraduate family medicine specialty, care burden (2 variables), and family burden (7 variables). We design, and included in self-administered questionnaires, a scale of 13 questions on work-family relations. Bivariate analysis, exploratory factor and multiple regressions to test the convergent validity was performed. RESULTS: The response rate was 73.6%. We identified two dimensions, Overloading and Family Support Deficit (OFSD) (5 questions), and Work-Family Conflict (WFC) (6 questions), in both, female FP score higher than their peers. There are more family variables associated with both dimensions in female FP, it expresses differences in the complexity of the causes of OFSD and WFC by sex. CONCLUSION: The scale obtained is valid, reliable and gives two empirical dimensions of family-work relationships.

Validación de escala para evaluar la relación familia-trabajo en médicas y médicos de familia / Validation of scale to evaluate the relationship between family- work in family physicians

Fundamentos: Estudiar las relaciones familia-trabajo es relevante porque afectan a la vida personal y profesional. Elnúmero de mujeres aumenta en medicina sin que se redistribuyan las tareas y responsabilidades domésticas. El objetivo fueelaborar y validar una escala sobre las relaciones familia-trabajo en médicas y médicos de familia (MF) de Andalucía. Métodos: Estudio transversal y multicéntrico. La población de estudio fueron MF de los centros de salud urbanos de Andalucía, muestra=500 MF, 50% por sexo. Estudiamos: sexo,edad, formación postgraduada en medicina de familia, carga asistencial (2 variables) y carga familiar (7 variables). Diseñamos un cuestionario postal para ser autoadministrado con una escala de 13 preguntas sobre las relaciones familia-trabajo. serealizó análisis bivariante, factorial exploratorio y regresión múltiple para probar la validez convergente. Resultados: La tasa de respuesta fue del 73,6%. Se identificaron dos dimensiones: Sobrecarga y Déficit de Apoyo Familiar (SDAF) (5 preguntas) y Conflicto Familia-Trabajo (CFT)(6 preguntas). En ambas las médicas puntúan más alto que sus compañeros. Hay más variables familiares asociadas a ambasdimensiones en las médicas que en los médicos, lo que expresa diferencias en la complejidad de las causas de SDAF y CFT por sexo. Conclusiones: La escala obtenida es válida, fiable y recoge dos dimensiones empíricas de las relaciones familia-trabajo(AU)

Bakcground: Studying the work-family relationships is important because it affects the personal and professional life.Women increases in medicine without redistribute domestic tasks and responsibilities. The purpose of this study was to create and validate a scale of work-family relations in women and men family physician (FP) in Andalusia. Methods: Cross sectional and multicenter study. The studypopulation were FP of urban primary care centres, sample= 500FP (50% by sex). We studied: sex, age, postgraduatefamily medicine specialty, care burden (2 variables), and family burden (7 variables). We design, and included in self-administered questionnaires, a scale of 13 questions on work-family relations. Bivariate analysis, exploratory factor and multiple regressions to test the convergent validity was performed. Results: The response rate was 73.6%. We identified two dimensions, Overloading and Family Support Deficit (OFSD)(5 questions), and Work-Family Conflict (WFC) (6 questions),in both, female FP score higher than their peers. There are more family variables associated with both dimensions in female FP,it expresses differences in the complexity of the causes of OFSD and WFC by sex. Conclusion: The scale obtained is valid, reliable and givestwo empirical dimensions of family-work relationships(AU)

Uncontrolled migrations as a cause of inequality in health and mortality in small-area studies.

Mortality is one of the most widely used indicators in small-area ecologic studies. Both accessibility to mortality data and advances in the development of new disease mapping techniques have contributed to an abundance of mortality maps and atlases over the last decade. Results may be biased in this kind of study if there has been unmeasured geographic mobility of the population. Most published papers tend to neglect this possibility. We use the theory of dynamics systems to demonstrate that migratory flows unmonitored by official population registers may lead to major errors in mortality rates and relative risks. Simulations in 4 scenarios showed more than 8% underestimation of the mortality rate and more than 11% underestimation of relative risk in areas with high uncontrolled emigration, and above 19% overestimation of mortality rate and above 15% overestimation of relative risk in areas with high uncontrolled immigration.Researchers conducting small-area epidemiologic studies should explore the reliability of population information in geographic areas before drawing hypothesis or conclusions on other possible causes of mortality differences.

Patterns of smoking according to individual social position, and to socio-economic environment in municipal areas, Spain 1987-2001.

We analyzed the impact of municipal areas socio-economic environment and trends in inequalities in smoking in Spain, 1987-2001. Inequalities in smoking have increased in both sexes. In males are the result of a higher decrease in the prevalence of smoking among the most advantaged groups, and in women, it is due to a higher increase among the less advantaged groups. Males residing in more deprived areas have a higher likelihood of smoking. For women, the likelihood of smoking is higher when residing in less deprived municipal areas up to 1995/1997. Individual and environmental social factors are relevant for smoking in Spain.

[Interactive mortality atlas in Andalusia, Spain (AIMA)]. / Atlas interactivo de mortalidad en Andalucía (AIMA).

Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in www.demap.es. AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia.

Atlas interactivo de mortalidad en Andalucía (AIMA) / Interactive mortality atlas in Andalusia, Spain (AIMA)

Los atlas de mortalidad publicados hasta la fecha son estáticos. La mayoría describen la distribución geográfica de la mortalidad agrupando datos de varios años y usando razones de mortalidad estandarizadas que resumen la mortalidad de todos los grupos de edad. Sin embargo, esta metodología presenta limitaciones para estudiar cambios temporales en la distribución geográfica de la mortalidad o diferencias entre grupos etarios. Aplicando una metodología alternativa surge el Atlas Interactivo de Mortalidad en Andalucía (AIMA), un Sistema de Información Geográfica dinámico que permite visualizar en web-site más de 12.000 mapas y 338.000 gráficos de tendencias correspondientes a la distribución espacio-temporal de las principales causas de muerte en Andalucía por grupos de edad y sexo desde 1981. El objetivo de este trabajo es describir la metodología utilizada para el desarrollo de AIMA, dar a conocer sus características y especificaciones técnicas y mostrar las posibilidades interactivas que ofrece. El sistema está disponible en el hipervínculo productos de www.demap.es. AIMA es el primer SIG interactivo de estas características implementado en España. Para el análisis de datos se han utilizado modelos jerárquicos bayesianos espacio-temporales, integrando posteriormente los resultados en web-site utilizando entorno PHP y cartografía dinámica en formato Flash. La selección de mapas temáticos muestra el carácter dinámico de la distribución geográfica de la mortalidad, con un patrón diferente para cada año, grupo de edad y sexo. La información contenida actualmente en este sistema y las futuras actualizaciones contribuirán a la reflexión sobre el pasado, presente y futuro de la salud en Andalucía (AU)

Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in www.demap.es. AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia (AU)

Area deprivation and trends in inequalities in self-rated health in Spain, 1987--2001.

AIMS: This study examined the impact that individual social position and municipal area deprivation levels had on trends in inequalities in self-rated health in Spain, between 1987 and 2001. METHODS: The study was based on cross-sectional data of the National Health Surveys of Spain for the years 1987, 1993, 1995, 1997, and 2001 (n=84,567). The indicators used were educational level and occupational class, and deprivation level as the indicator of municipal areas. Multilevel logistic regression models were made, with individuals nested into municipal areas. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. To evaluate trends, the relative index of inequality was calculated. RESULTS: At the individual level, the likelihood of less-than-good health between those with no formal education as compared to those with graduate-level education increased from OR=2.66 (95% CI: 2.06-3.38) in 1987 to OR=3.62 (95% CI: 2.95-4.63) in 2001 among women. The values for men were OR=2.27 (95% CI: 1.89-2.72) and OR=2.94 (95% CI: 2.36-3.68) respectively. Living in areas with the highest deprivation levels as compared to the lowest systematically increased the likelihood of less-than-good health. The likelihood of reporting less-than-good health among women with no formal education as compared to women with graduate-level education in municipal areas with the highest deprivation levels increased from OR=3.61 (95% CI: 2.39-5.45) in 1987 to 4.85 (95% CI: 3.06-7.69) in 2001. Among men, the corresponding magnitudes were OR=2.07 (95% CI: 1.39-3.08) and OR=4.16 (95% CI: 2.52-6.89). CONCLUSIONS: Inequalities in self-rated health increased in Spain in this period. These inequalities may be explained by the social conditions existing throughout the period of reference, and the pattern varies according to gender, municipal area deprivation levels, and the individual indicator of social position used.

[Health impact evaluation of particle air pollution in five Spanish cities. European APHEIS project]. / Evaluación en cinco ciudades españolas del impacto en salud de la contaminación atmosférica por partículas. Proyecto europeo APHEIS.

BACKGROUND: The health effects of air pollution have been analyzed in numerous studies over recent years, thus having made it possible to quantify the relationship between the two. This study is aimed at analyzing the theoretical benefits which would be achieved by meeting the air quality objectives set forth under EC Directive 1999/30/EC with regard to suspended particles. METHODS: The exposure measurement was taken for Black Smoke (Barcelona, Bilbao, Valencia) and suspended particles under 10 microm (PM10) (Bilbao, Madrid y Sevilla). The health indicators calculated were the mortality due to all causes and respiratory and cardiovascular causes, and emergency hospital admissions and mortality due to respiratory and cardiovascular causes. In the case of PM10 the impact has been calculated because its effects to short-term, within a period of up to 40 days following exposure, and to long-term. For Black Smoke the effects only has been calculated to short-term. RESULTS: The daily levels of PM10 from exceeding 50 microg/m3 in Bilbao, Madrid and Sevilla cause the earlier death of 1.4/100,000 individuals per year because its effects. The effect within a period of up to 40 days following exposure is of 2.8 deaths/100,000. The total number of deaths per year which may be later due to long-term exposure if the yearly average is lowered to 20 microg/m3 is 68/100,000. CONCLUSIONS: The health impact of the current air pollution levels is quantifiable and is not insignificant. APHEIS and the impact evaluations may be of aid in healthcare planning and environmental policies.

Evaluación en cinco ciudades españolas del impacto en salud de la contaminación atmosférica por partículas. Proyecto europeo APHEIS / Health impact evaluation of particle air pollution in five spanish cities. European APHEIS project

Fundamento: Los efectos de la contaminación atmosféricasobre la salud han sido objeto en los últimos años de numerosos estudiosque han permitido cuantificar la asociación entre ambas El objetivode este trabajo es llevar a cabo la Evaluación del Impacto enSalud (EIS) calculando los beneficios que se obtendrían al cumplirlos objetivos establecidos por la Directiva 1999/30/CE en relacióncon las partículas en suspensión.Métodos: Se ha valorado el impacto en salud de la contaminación atmosférica por partículas en suspensión, para lo que se han utilizadodos indicadores distintos: Humos Negros (HN) (Barcelona,Bilbao, Valencia) y partículas en suspensión menores de 10 mm(PM10) (Bilbao, Madrid y Sevilla). Los indicadores de salud fueronla mortalidad por todas las causas, por causa respiratoria y por causacardiovascular, e ingresos hospitalarios urgentes por causa respiratoriay cardiovascular. El EIS se ha realizado mediante el cálculo de lafracción atribuible a la contaminación por partículas. En el caso dePM10 se ha calculado el impacto debido a efectos de la contaminación a corto plazo, los acumulados hasta 40 días después, y a largoplazo. Para HN únicamente se han calculado efectos a corto plazo.Resultados: Los niveles diarios de PM10 por encima de 50µg/m3 en Bilbao, Madrid y Sevilla son responsables de 1,4 muertesprematuras por 100.000 habitantes y año debido a sus efectos a cortoplazo y de 2,8 muertes/100.000 en un periodo de hasta 40 días trasla exposición. A largo plazo, el número de muertes prematuras atribuiblesa la contaminación media anual de PM10 por encima de 20µg/m3 es 68/100.000.Conclusiones: El impacto en salud de los niveles actuales decontaminación atmosférica es cuantificable y no despreciable.APHEIS y las evaluaciones de impacto pueden ayudar a la planificación sanitaria y a las políticas medioambientales

Background: The health effects of air pollution have beenanalyzed in numerous studies over recent years, thus having madeit possible to quantify the relationship between the two. This studyis aimed at analyzing the theoretical benefits which would be achievedby meeting the air quality objectives set forth under EC Directive1999/30/EC with regard to suspended particles.Methods: The exposure measurement was taken for Black Smoke(Barcelona, Bilbao, Valencia) and suspended particles under 10mm (PM10) (Bilbao, Madrid y Sevilla). The health indicators calculatedwere the mortality due to all causes and respiratory and cardiovascularcauses, and emergency hospital admissions and mortalitydue to respiratory and cardiovascular causes. In the case of PM10 theimpact has been calculated because its effects to short-term, within aperiod of up to 40 days following exposure, and to long-term. ForBlack Smoke the effects only has been calculated to short-term.Results: The daily levels of PM10 from exceeding 50 µg/m3 inBilbao, Madrid and Sevilla cause the earlier death of 1.4/100,000individuals per year because its effects. The effect within a period ofup to 40 days following exposure is of 2.8 deaths/100,000. The totalnumber of deaths per year which may be later due to long-term exposureif the yearly average is lowered to 20 µg/m3 is 68/100,000.Conclusions: The health impact of the current air pollutionlevels is quantifiable and is not insignificant. APHEIS and theimpact evaluations may be of aid in healthcare planning and environmentalpolicies