Trends in mortality from stroke in the European Union, 1996-2015.

BACKGROUND AND PURPOSE: Stroke is the second largest single cause of death in Europe, responsible for 9% and 13% of all deaths in men and women, respectively. There have been large overall declines in stroke mortality rates in the majority of European countries in recent decades. The aim of this study was to analyse trends in mortality caused by stroke in the 28 member countries of the European Union (EU) over the last two decades. METHODS: We extracted data for age-standardized stroke mortality rates per 100 000 in the EU for the period 1996-2015 from the World Health Organization database. Joinpoint regression analysis was used to analyse the trends and compute the annual percent change (APC) in the EU as a whole and by country. Analyses were conducted by gender and by European region. RESULTS: Mortality from stroke has decreased in the EU over the study period by an average APC of 4.2%. All countries showed downward trends, with the sharpest decreases in Estonia, Portugal and Austria. We recorded statistically significant decreases of 4.2% and 4.3% in mortality rates in men and women, respectively, in the whole EU. Southern and western countries showed the steepest decreases, whereas mortality has increased in northern countries in recent years. CONCLUSIONS: Stroke mortality has decreased in the EU, in both sexes, especially in southern and western European countries. Our results could be a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.

Meta-analysis of prevalence of wheezing and recurrent wheezing in infants.

BACKGROUND: Wheezing affects children's quality of life, and is related with asthma in childhood. Although prevalence of wheezing has been previously studied in several countries, there is no reference of worldwide prevalence in infants. The aim of this meta-analysis is to estimate the prevalence of wheezing and recurrent wheezing in infants aged up to two years, and compare the prevalence across world regions. METHODS: Literature search was conducted in MEDLINE and SCOPUS databases, looking for observational studies published up to June 2016, including as keywords "prevalence" or "epidemiology" combined with "wheeze", "wheezing" or "asthma symptoms" and "infant" or "preschool". Fast*Pro software and random effects Bayesian model were used. Heterogeneity was estimated using I2 statistic, and sensitivity analyses were performed. RESULTS: We identified 109 studies after duplicates were removed. After exclusions, 14 studies were included in the meta-analysis. Prevalence of wheezing and recurrent wheezing were 36.06% (95% CI 35.17-36.96), and 17.41% (95% CI 16.74-18.09), respectively. In European countries, prevalence of wheezing was 30.68% (95% CI 28.97-32.45), and 12.35% (95% CI 11.27-13.47) for recurrent wheezing. Prevalence of wheezing and recurrent wheezing in Latin America were higher, 40.55% (95% CI 39.40-41.71), and 19.27% (95% CI 18.44-20.11), respectively. In Africa, prevalence of wheezing was 15.97% (95% CI 14.05-18.00). Low or no heterogeneity was found in all cases. CONCLUSIONS: More than one third of infants suffer from wheezing and almost one fifth from recurrent wheezing, being these illnesses especially prevalent in Latin American countries, pointing out an important public health problem.

Influence of the Mediterranean diet during pregnancy in the development of wheezing and eczema in infants in Pamplona, Spain.

BACKGROUND: This study examined the relationship between different food groups and the adherence to a Mediterranean diet during pregnancy and the risk of wheezing and eczema in children aged 12-15 months. METHODS: The study involves 1087 Spanish infants from the International Study of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). The study of the association of the different food consumption and Mediterranean diet with wheezing, recurrent wheezing and eczema was performed using different models of unconditional logistic regression to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: No association was found between a good adherence to the Mediterranean diet during pregnancy and the development of wheezing (p=0.372), recurrent wheezing (p=0.118) and eczema (p=0.315). The consumption once or twice a week of white fish (OR: 1.95[1.01-3.75]), cooked potatoes (OR: 1.75[1.22-2.51]) and industrial pastry (OR: 1.59[1.13-2.24]), and the consumption more than three times a week of industrial pastry (OR: 1.47 [1.01-2.13]) during pregnancy increases the risk of "wheezing" at 12 months. Instead, high fruit consumption during the pregnancy has a protective effect against "wheezing" in 12-month-old infants (OR: 0.44 [0.20-0.99]). No statistically significant differences were observed between food intake during pregnancy and "recurrent wheezing". No statistically significant differences were observed between the consumption of any food during pregnancy and the presence of eczema at 12 months. CONCLUSIONS: The present study showed that the consumption of Mediterranean diet during pregnancy did not have a protective effect for wheezing, recurrent wheezing or eczema.

Trends of mortality from Alzheimer's disease in the European Union, 1994-2013.

BACKGROUND AND PURPOSE: In many countries, Alzheimer's disease (AD) has gradually become a common disease in elderly populations. The aim of this study was to analyse trends of mortality caused by AD in the 28 member countries in the European Union (EU) over the last two decades. METHODS: We extracted data for AD deaths for the period 1994-2013 in the EU from the Eurostat and World Health Organization database. Age-standardized mortality rates per 100 000 were computed. Joinpoint regression was used to analyse the trends and compute the annual percent change in the EU as a whole and by country. Analyses by gender and by European regions were conducted. RESULTS: Mortality from AD has risen in the EU throughout the study period. Most of the countries showed upward trends, with the sharpest increases in Slovakia, Lithuania and Romania. We recorded statistically significant increases of 4.7% and 6.0% in mortality rates in men and women, respectively, in the whole EU. Several countries showed changing trends during the study period. According to the regional analysis, northern and eastern countries showed the steepest increases, whereas in the latter years mortality has declined in western countries. CONCLUSIONS: Our findings provide evidence that AD mortality has increased in the EU, especially in eastern and northern European countries and in the female population. Our results could be a reference for the development of primary prevention policies.

The influence of gender and atopy in the relationship between obesity and asthma in childhood.

BACKGROUND: The objective of the study was to examine the relationship between asthma and overweight-obesity in Spanish children and adolescents and to determine whether this relationship was affected by gender and atopy. METHODS: The study involves 8607 Spanish children and adolescents from the International Study of Asthma and Allergies in Childhood phase III. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between asthma symptoms and overweight-obesity in the two groups. Afterwards, it was stratified by sex and rhinoconjunctivitis. RESULTS: The prevalence of overweight and obesity in 6-7-year-old children was 18.6% and 5.2% respectively and in 13-14 year-old teenagers was 11.4% and 1.1% respectively. Only the obese children, not the overweight children, of the 6-7 year old group had a higher risk of any asthma symptoms (wheezing ever: OR 1.68 [1.15-2.47], asthma ever: OR 2.29 [1.43-3.68], current asthma 2.56 [1.54-4.28], severe asthma 3.18 [1.50-6.73], exercise-induced asthma 2.71 [1.45-5.05]). The obese girls had an increased risk of suffering any asthma symptoms (wheezing ever: OR 1.73 [1.05-2.91], asthma ever: OR 3.12 [1.67-5.82], current asthma 3.20 [1.65-6.19], severe asthma 4.83[1.94-12.04], exercise-induced asthma 3.68 [1.67-8.08]). The obese children without rhinoconjunctivitis had a higher risk of asthma symptoms. CONCLUSIONS: Obesity and asthma symptoms were associated in 6-7 year-old children but not in 13-14 year-old teenagers. The association was stronger in non-atopic children and obese girls.

Prevalence and incidence of Alzheimer's disease in Europe: A meta-analysis. / Prevalencia e incidencia de la enfermedad de Alzheimer en Europa: metaanálisis.

BACKGROUND: A disease of unknown aetiology, Alzheimer's disease (AD) is the most common type of dementia. As the elderly population grows worldwide, the number of patients with AD also increases rapidly. The aim of this meta-analysis is to evaluate the prevalence and incidence of AD in Europe. METHODOLOGY: We conducted a literature search on Medline, Scopus, and CINAHL Complete using the keywords «Alzheimer¼, «Alzheimer's disease¼, and «AD¼ combined with «prevalence¼, «incidence¼, and «epidemiology¼. A Bayesian random effects model with 95% credible intervals was used. The I2 statistic was applied to assess heterogeneity. RESULTS: The prevalence of Alzheimer's disease in Europe was estimated at 5.05% (95% CI, 4.73-5.39). The prevalence in men was 3.31% (95% CI, 2.85-3.80) and in women, 7.13% (95% CI, 6.56-7.72), and increased with age. The incidence of Alzheimer's disease in Europe was 11.08 per 1000 person-years (95% CI, 10.30-11.89). Broken down by sex, it was 7.02 per 1000 person-years (95% CI, 6.06-8.05) in men and 13.25 per 1000 person-years (95% CI, 12.05-14.51) in women; again these rates increased with age. CONCLUSIONS: The results of our meta-analysis allow a better grasp of the impact of this disease in Europe.

Prevalence and risk factors for wheezing in infants in the region of Pamplona, Spain.

BACKGROUND: Wheezing in the first year of life affects the baby's and family's quality of life. Risk factors such as male gender, nursery attending or a family history of asthma, and protective factors such as breastfeeding more than six months have been previously described. The aim of this study is to study the prevalence and risk factors for wheezing ever and recurrent wheezing in the first year of life in infants in the region of Pamplona, Spain. MATERIAL AND METHODS: This cross-sectional study was part of the International Study of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). Between 2006 and 2008, participating families answered a standardised validated questionnaire on respiratory symptoms, environmental factors or family issues. An analysis with the chi square test (statistical significance p<0.05) identified the risk factors for wheezing ever and recurrent wheezing, which were assessed using logistic regression. RESULTS: 1065 questionnaires were answered. The prevalence of wheezing ever and recurrent wheezing were 31.2% and 12.3%, respectively. Male gender (p=<0.001), a history of pneumonia (p=<0.001) or nursery attendance (p=<0.001) were some of the risk factors found for wheezing ever. Infant eczema (p=<0.001), nursery attendance (p=<0.001) or prematurity (p=<0.001) were risk factors for recurrent wheezing. No associations with duration of breastfeeding (p=0.116 and p=0.851) or mould stains at home (p=0.153 and p=0.992) were found. CONCLUSION: The study of prevalence and risk factors for wheezing shows the importance of this public health problem, and allows the development of control and treatment strategies against preventable factors.

International study of objectively measured physical activity and sedentary time with body mass index and obesity: IPEN adult study.

BACKGROUND: Physical activity (PA) has been consistently implicated in the etiology of obesity, whereas recent evidence on the importance of sedentary time remains inconsistent. Understanding of dose-response associations of PA and sedentary time with overweight and obesity in adults can be improved with large-scale studies using objective measures of PA and sedentary time. The purpose of this study was to examine the strength, direction and shape of dose-response associations of accelerometer-based PA and sedentary time with body mass index (BMI) and weight status in 10 countries, and the moderating effects of study site and gender. METHODS: Data from the International Physical activity and the Environment Network (IPEN) Adult study were used. IPEN Adult is an observational multi-country cross-sectional study, and 12 sites in 10 countries are included. Participants wore an accelerometer for seven consecutive days, completed a socio-demographic questionnaire and reported height and weight. In total, 5712 adults (18-65 years) were included in the analyses. Generalized additive mixed models, conducted in R, were used to estimate the strength and shape of the associations. RESULTS: A curvilinear relationship of accelerometer-based moderate-to-vigorous PA and total counts per minute with BMI and the probability of being overweight/obese was identified. The associations were negative, but weakened at higher levels of moderate-to-vigorous PA (>50 min per day) and higher counts per minute. No associations between sedentary time and weight outcomes were found. Complex site- and gender-specific findings were revealed for BMI, but not for weight status. CONCLUSIONS: On the basis of these results, the current Institute of Medicine recommendation of 60 min per day of moderate-to-vigorous PA to prevent weight gain in normal-weight adults was supported. No relationship between sedentary time and the weight outcomes was present, calling for further examination. If moderator findings are confirmed, the relationship between PA and BMI may be country- and gender-dependent, which could have important implications for country-specific health guidelines.

[Prevalence and incidence of ictus in Europe: systematic review and meta-analysis].

BACKGROUND: Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe. METHOD: We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords "stroke", "cerebrovascular accident", "epidemiology", "prevalence", "incidence" and "Europe". In order to evaluate the quality and risk of bias, we used the Hoy's modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity. RESULTS: The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age. CONCLUSION: The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100,000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.

Diet and prevalence of atopic eczema in 6 to 7-year-old schoolchildren in Spain: ISAAC phase III.

BACKGROUND: The prevalence of atopic dermatitis (AD), a chronic skin disease, has increased substantially in recent decades, and different factors have been implicated in its etiology. Although dietary habits are being investigated, few conclusive findings have been reported. Nevertheless, increased consumption of polyunsaturated fatty acids (PUFA) and a diet poor in antioxidants have been related to AD. OBJECTIVES: The objectives of this study were to investigate the association between AD, the intake of different foods, and the effect of a Mediterranean diet among Spanish schoolchildren aged 6 to 7. METHODS: We performed a cross-sectional study with 20 106 schoolchildren aged 6-7 years from 10 different areas of Spain. The participation rate was 76.50%. The prevalence of AD was assessed using the International Study of Asthma and Allergies in Childhood questionnaire and the criteria of the Spanish Academy of Dermatology. To calculate the Mediterranean diet score, we classified food into 2 groups: Mediterranean food, including fruit, seafood, vegetables, pulses, cereals, pasta, rice, and potatoes; and non-Mediterranean food, including meat, milk, and fast food. RESULTS: Milk was negatively associated with AD. Butter and nuts also were negatively associated, although statistical significance was only reached when these foods were consumed 3 or more times a week. CONCLUSIONS: We found no association between the Mediterranean diet score and AD and a positive association between AD and obesity.

High prevalence of asthma and allergic diseases in children aged 6 to [corrected] 7 years from the Canary Islands. [corrected].

OBJECTIVE: To investigate the prevalence of bronchial asthma and allergic diseases in schoolchildren from the Canary Islands, Spain. METHODS: Cross-sectional study following the methodology of ISAAC (International Study of Asthma and Allergies in Childhood), which uses standardized and validated questionnaires. The study participants were children aged between 6 and 7 years attending schools in Las Palmas de Gran Canaria, Canary Islands, Spain. RESULTS: Of the 3108 questionnaires distributed, 1883 were answered, and 1871 were evaluable (60.6%). Gender distribution was similar (51.8% boys vs 48.2% girls). Current prevalence of asthma was 18.4% (95% confidence interval [CI], 16.7-20.2), rhinitis 40.3% (95% CI, 38-42.3), and atopic dermatitis 35.8% (95% CI, 33.6-37.9). The highest prevalence of rhinitis was recorded during the autumn months (P<.005). Asthma was more frequent in boys than in girls (P<.05), but there were no statistical differences for the other allergic diseases. CONCLUSIONS: The prevalence of asthma and allergic diseases in children aged 6-7 years in the Canary Islands is higher than in other areas of Spain where the ISAAC study has been performed. Male gender is an important risk factor in children, especially for asthma symptoms.

How the presence of rhinoconjunctivitis and the severity of asthma modify the relationship between obesity and asthma in children 6-7 years old.

BACKGROUND: The association between asthma and obesity in children, and the effect modification of allergy on this association have not been fully established. Aims The objective of the study was to know the effect modification of the severity of asthma and of the coexistence of rhinoconjunctivitis (RC) in the relationship between obesity and asthma. METHODS: A cross-sectional study of 17 145 schoolchildren 6-7 years old from eight Spanish cities who had completed information on height and weight of the ISAAC phase III questionnaire, which also included questions about asthma and RC symptoms and on various risk factors. Body mass index (BMI) was used to define obesity according to international standards. Two different logistic regressions, using current occasional asthma (COA) and current severe asthma (CSA) as dependent variables, were made stratifying for gender and for the coexistence of RC and controlling for age, older and younger siblings, exercise, mother's education, truck traffic, cat/dog during the first year of life and smoking father or mother. RESULTS: Obesity was a risk factor of CSA without RC, both for boys (1.92, CI 95% 1.13-3.25) and for girls (2.99, CI 95% 1.68-5.32). Every BMI unit increment increased by 6.7% the risk of CSA without RC in boys and by 12.4% in girls. Obesity was not a risk factor for CSA with RC. The association between COA and obesity was weaker and the coexistence of RC did not modify it greatly. CONCLUSIONS: Obese schoolchildren are more at risk of suffering from non-allergic asthma than the non-obese subjects.

Role of the home environment in rhinoconjunctivitis and eczema in schoolchildren in Pamplona, Spain.

BACKGROUND AND OBJECTIVE: Indoor air quality has become an important factor for sensitization and development of allergic diseases because of increased time spent in homes. We aimed to analyze the possible home-condition risk factors for allergic rhinoconjunctivitis, atopic eczema, and severe disease in schoolchildren aged 5 through 8 years. MATERIAL AND METHODS: The parents of 3360 school children in Pamplona, Spain in the 5-8-year-old age bracket answered questions about rhinitis and eczema symptoms from the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). The instrument contained additional questions about current home conditions related to mold and dust exposure and about conditions in the first year of life. Associations between the allergic diseases and early and current exposure were studied with chi(2) tests and bivariate and multivariate logistic regression. RESULTS: Exposure to certain home conditions related to molds and dust in the first year of life increased the risk of allergic disease, but having good isolating windows in the first year of life protected against allergic rhinoconjunctivitis and severe atopic eczema. Some current home conditions were also related to an increased risk of current allergic disease; severe atopic eczema was more common among children with single glazing over the bedroom window. CONCLUSION: Current and first-year-of-life home conditions related to dust and mold exposure should be controlled because they influence the prevalence of allergic rhinoconjunctivitis and atopic eczema diseases. Moreover, having a double-glazed window currently and in the first year of life seems to protect against these diseases.

Prevalencia e incidencia de ictus en Europa: revisión sistemática y metaanálisis / Prevalence and incidence of ictus in Europe: systematic review and meta-analysis

Fundamento. El ictus es la segunda causa de muerte y la primera causa de discapacidad en Europa. El número de pacientes con ictus muestra una tendencia de crecimiento rápido debido al aumento de la población anciana. El objetivo de este metaanálisis es estimar la prevalencia e incidencia de ictus en Europa. Método. Se buscaron artículos en las bases de datos MEDLINE, SCOPUS, CINAHL Complete y EMBASE con los términos “stroke”, “cerebrovascular accident” combinadas con “epidemiology”, “prevalence”, “incidence” y “Europe”. La calidad y el riesgo de sesgo se analizó con las escalas Hoy modificada y Newcastle Ottawa para los artículos de prevalencia e incidencia, respectivamente. El metaanálisis utilizó un modelo de efectos aleatorios con intervalos de confianza del 95% (IC95%) y el estadístico I2 para estimar la heterogeneidad. Resultados. La prevalencia de ictus en Europa ajustada por sexo fue 9,2% (IC95%: 4,4-14,0); en hombres fue 9,1% (IC95%: 4,7-16,6) y en mujeres 9,2% (IC95%: 4,1-14,4); se encontró una tendencia creciente con el aumento de la edad. La incidencia de ictus ajustada por sexo fue 191,9 por 100.000 personas-año (IC95%: 156,4-227,3); en hombres fue de 195,7 por 100.000 personas-año (IC95%: 142,4-249,0) y en mujeres 188,1 por 100.000 personas-año (IC95%: 138,6-237,7), con igual tendencia creciente con el aumento de la edad. Conclusiones. La prevalencia de ictus en Europa alcanza un 9,2%. La incidencia se sitúa en 191,9 por 100.000 personas-año. La prevalencia de ictus ha aumentado mientras que la incidencia se mantiene estable en comparación con estudios realizados a comienzos del siglo XXI.(AU)

Background. Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe. Method. We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords “stroke”, “cerebrovascular accident”, “epidemiology”, “prevalence”, “incidence” and “Europe”. In order to evaluate the quality and risk of bias, we used the Hoy’s modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity. Results. The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age. Conclusion. The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.(AU)

[Validation of Antonovsky Orientation to Life Questionnaire (OLQ-13) in a sample of university students in Navarre]. / Validación del Cuestionario de Orientación a la Vida (OLQ-13) de Antonovsky en una muestra de estudiantes universitarios en Navarra.

BACKGROUND: The sense of coherence (SOC), the central concept of the salutogenesis model described by Aaron Antonovsky, has been employed as a predictor of measures of perceived and objective health. It is strongly and positively related to healthy behaviour and is mainly developed while young and studying. University students are a target youth group for applying measures promoting health according to their SOC level; it is therefore necessary to check the quality of the scale's measurement. The goal is to validate and study the psychometric properties of the SOC scale in students at the University of Navarre and determine their temporal evolution. METHODS: Newly enrolled students at the University of Navarre were analysed. Cohort study with a 3 year follow-up. The instruments used were the Orientation to Life Questionnaire (OLQ-13), Perceived Stress Scale (PSS) and the Discomfort Index. The following were studied: the quality and viability of the data, scale assumptions, temporal stability, reliability, concurrent and clinical validity, as well as factorial structure and confirmatory analysis of the data obtained. SPSS v. 19 and Amos v.7 statistical software were used. RESULTS: The study sample consisted of 508 students, 33.5% male and 65.9% female. High reliability (Cronbach Alpha 0.814). Adequate validity converging with the PSS. Inadequate clinical validity. Analysis of main components with three factors that explain 50.73% of the variation. CONCLUSIONS: A valid instrument that makes it possible to propose it as a tool for applying measures promoting health in young people.

[Cost-effectiveness study of prevaccination screening tests in vaccination against hepatitis B in hospital health professionals]. / Estudio coste-efectividad de las pruebas de detección prevacunal en la vacunación contra la hepatitis B en profesionales sanitarios hospitalarios.

BACKGROUND: The aim of this study was to know the cost-effectiveness of a vaccination program of hospital personnel against hepatitis B as compared to vaccination strategy with previous screening tests versus vaccination without screening. METHODS: The costs of the process of vaccination with and without previous screening tests for hospital personnel (first year residents = MIR R1 and staff doctors) was calculated taking, not only the cost of the vaccinations, but also the costs of withdrawal, injection, antibody determination and the displacement costs of the subject into account. RESULTS: In the case of a MIR-R1, the cost of vaccination without previous screening is 12,492 pesetas, with the cost for a staff doctor being 15,092 pesetas. The vaccination strategy with previous antibody screening tests is only profitable with prevalences of 28.77% of positivity in the case of MIR-R1 and 29.55% in staff doctors. CONCLUSIONS: This study defends the elimination of previous antibody screening tests in vaccination against hepatitis B since the legal obligation of previous screening tests is no longer applicable. Moreover, vaccination is practically innocuous and prevaccination screening tests are only profitable with prevalences os seropositivity higher than 28% in the case of MIR-R1 and 29.55% in the case of staff doctors which are ciphers much higher than those of the prevalence of seropositivity normally found among Spanish hospital personnel.

[The prevalence of asthma-related symptoms in 13-14-year-old children from 9 Spanish populations. The Spanish Group of the ISAAC Study (International Study of Asthma and Allergies in Childhood)]. / Prevalencia de síntomas relacionados con el asma en niños de 13-14 años de 9 poblaciones españolas. Grupo Español del Estudio ISAAC (International Study of Asthma and Allergies in Childhood).

BACKGROUND: Asthma is one of the more prevalent diseases in childhood. Geographical differences have been found but it is unknown if they are true or are a consequence of the different methods used in the study of asthma. POPULATION AND METHODS: In 9 Spanish populations: Almería, Barcelona, Bilbao, Bahía de Cádiz, Cartagena, Castellón, Pamplona, Valencia and Valladolid, 27,407 children aged 13-14 years were interviewed using the asthma written and video questionnaires of the ISAAC protocol. Comparisons among geographical areas were performed using a cluster analysis and a Poisson regression model adjusting by gender. RESULTS: The prevalence of resting wheezing using the video questionnaire was higher in males than in females (15.4% versus 12.6%) for wheezing ever. In the last year the prevalence of wheezing was 7.8% in males versus 7.0% in females. The analysis shows a group of centers with low prevalence of asthma symptoms: Valladolid, Almería, Castellón and Pamplona. Nevertheless there are also centers with higher prevalences as Bilbao, Barcelona and Bahía de Cádiz. CONCLUSIONS: Prevalence of asthma and asthmatic symptoms is high in Spanish children aged 13-14 years. There are true geographical differences in Spain, being Valladolid, Almería, Castellón and Pamplona the areas with lowest prevalence.

[Unusual attendance at Hospital Emergency Services for asthma and chronic obstructive pulmonary disease and SO2 air pollution in Cartagena (Spain)]. / Afluencia inusual por asma y enfermedad pulmonar obstructiva crónica en urgencias hospitalarias y contaminación por SO2 en Cartagena.

BACKGROUND: The objective of this investigation is to determine the influence of air pollution (SO2 and particulate matter) on the existence of days of unusual attendance at emergency services for asthma and chronic obstructive pulmonary lung disease (COPD). A registry of attendances for these diseases and the daily mean concentrations of SO2 and particles were used (1989-1991). RESULTS: Unusual attendance days are establish by the fortnightly movable mean of the period that has that day as central one, under the hypothesis of a Poisson distribution with equal mean as the calculated one. In the logistic regression model, Odds Ratio (OR) between an excess of attendance of cases for asthma and SO2 levels greater than 80.60 m/m3 was 3.6 (CI95%: 1.1-11.7). For COPD, SO levels ten days before were introduced, and OR for SO2 levels more than 56.5m/m was 4.7 (CI95%: 1.5-15.1). CONCLUSIONS: High SO2 levels are related with the appearances of days with an excessive use of emergencies for Asma and EPOC.

[The short-term effects of air pollution on mortality: the results of the EMECAM project in the city of Pamplona, 1991-95. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en la ciudad de Pamplona, 1991-95.

BACKGROUND: To assess the short-term impact of air pollution on the daily death rate in the city of Pamplona. METHOD: Ecological study with a population of 212,000 inhabitants. A time series data analysis is conducted by means of multiple linear regression and Poisson regression, with the daily death rate data, air pollution levels for Particles and SO2, weather parameters of average relative humidity and temperature daily and number of cases weekly of flu for the 1991-1995 period. RESULTS: The average number of deaths daily for non-external causes is that of 4.15 deaths, with a range from zero to 13 deaths. The city of Pamplona has a mean annual temperature of 12.7 degrees C (-2.3 degrees C to 31.6 degrees C) and a relative humidity of 68.5%. In the model, the temperature (with a one-day time lag and a six-day time lag temperature squared) and the humidity (with a one-day time lag) is related to the death rate for all causes. But the death rate for non-external causes is only related in the model with the temperature (one-day time lag, P: 0.035) and five-day time lag with temperature squared (p: 0.028). The timely estimates of the relative particle-related risk show that the highest risk of dying stems from respiratory causes with a relative risk of 1.13. However, none of these relationships is statistically significant. In the case of Sulfur Dioxide, the estimates closely near the zero figure, and none of them is significant. CONCLUSIONS: The Temperature has an impact of the death rate for all causes, both external and non-external, and the relative humidity solely has an impact on the death rate for non-external causes. It has not been possible to prove any influence of the daily environmental pollution levels on the daily death rate.

[The EMECAM project: the Spanish Multicenter Study on the Relationship between Air Pollution and Mortality. The background, participants, objectives and methodology]. / El proyecto EMECAM: Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad. Antecedentes, participantes, objetivos y métodología.

In recent years, a growing number of studies suggests that increases in air pollution levels may have short-term impact on human health, even at pollution levels similar to or lower than those which have been considered to be safe to date. The different methodological approaches and the varying analysis techniques employed have made it difficult to make a direct comparison among all of the findings, preventing any clear conclusions from being drawn. This has led to multicenter projects such as the APHEA (Short-Term Impact of Air Pollution on Health. A European Approach) within a European Scope. The EMECAM Project falls within the context of the aforesaid multicenter studies and has a wide-ranging projection nationwide within Spain. Fourteen (14) cities throughout Spain were included in this Project (Barcelona, Metropolitan Area of Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Seville, Oviedo, Valencia, Vigo, Vitoria and Saragossa) representing different sociodemographic, climate and environmental situations, adding up to a total of nearly nine million inhabitants. The objective of the EMECAM project is that to asses the short-term impact of air pollution throughout all of the participating cities on the mortality for all causes, on the population and on individuals over age 70, for respiratory and cardiovascular design causes. For this purpose, with an ecological, the time series data analyzed taking the daily deaths, pollutants, temperature data and other factors taken from records kept by public institutions. The period of time throughout which this study was conducted, although not exactly the same for all of the cities involved, runs in all cases from 1990 to 1996. The degree of relationship measured by means of an autoregressive Poisson regression. In the future, the results of each city will be combined by means of a meta-analysis.