[Sedentary lifestyle in pregnancy: Effects on the mother and the newborn]. / Sedentarismo en el embarazo: efectos sobre la madre y el recién nacido.

OBJECTIVE: Identify the state of sedentary lifestyle during pregnancy and the factors associated with this behavior, the possible factors of your health situation and that of the newborn. MATERIAL AND METHODS: This two-phase, cross-sectional observational study was developed at the La Fe University and Polytechnic Hospital and 228 pregnant women participated. Maternal sociodemographic characteristics were obtained using structured questionnaire and health information from the electronic medical records, as well as perinatal results of the newborn. To assess sedentary lifestyle, exercise in free time and exercise during working hours were assessed, categorizing them based on intensity (sedentary lifestyle, light activity, moderate and intense activity). RESULTS: In total, the prevalence of physical inactivity was 31.14%. The profile of this group has a lower level of education and unemployment (P<.05), presenting a higher prevalence of problems during childbirth, which required a caesarean section, as well as problems after birth in the newborn (P<.05). CONCLUSIONS: Physical inactivity is highly prevalent among pregnant women. Due to the benefits (or non-harm) attributed to exercise during pregnancy. Further efforts should be taken to overcome the barriers to promote activities among pregnant women who are younger, less well educated, and unemployed and those with multiple children and a lower income are less likely to engage in an adequate amount of physical activity, aware of the importance of doing it, resolving doubts and allaying fears that may arise from a poor understanding of the mechanism of its benefit.

Fish intake in pregnant women and its impact on maternal-fetal health status.

OBJECTIVE: The objective was to evaluate the consumption of fish in pregnant women and its association with maternal and infant outcomes. MATERIAL AND METHODS: In this observational study carried out at the La Fe University and Polytechnic Hospital in Valencia, 300 pregnant women participated. The participants were divided into 2 groups according to their fish consumption during pregnancy for comparison. The χ2 test or ANOVA test were applied for comparisons for qualitative and quantitative variables respectively. RESULTS: It was observed that 49% of women consumed adequate amounts of fish during pregnancy (2 or 3 weekly servings). Significant differences were observed for iron supplementation (higher in women with inadequate fish consumption), threatened pregnancy loss (higher in women with inadequate fish consumption), infant size (better in women with adequate fish consumption), and arterial O2 pressure (better in women with adequate fish consumption). In regard to the other components of the dietary pattern, no differences were observed but the adequacy of intake for grains and white meat was very poor (less than 5.0%). CONCLUSIONS: Half of the women met the recommendations for fish intake during pregnancy and presented an overall healthier eating pattern but without statistical significance.

Occupational exposure to pesticides and bile tract carcinoma in men: results from a European multicenter case-control study.

OBJECTIVES: To estimate the associations between occupational exposure to pesticides and extrahepatic biliary tract carcinoma in men, a population-based case-control study was carried out. METHODS: Cases (n = 104), aged 35-70, diagnosed in 1995-1997, were sampled by active reporting systems from hospitals. Controls (n = 1,401) were a random sample of the general male population. Information on occupation and confounding factors was obtained by questionnaires. Exposures were quantified with respect to time, application methods, and use of personal protective equipment. Intensity was evaluated by using a published algorithm which weighted the exposure assigned according to the use of personal protective equipment and mode of application. Logistic regression analyses were conducted adjusted for gallstones, age, and country. RESULTS: Being ever exposed to pesticides resulted in an odds ratio (OR) of 1.0 [95%-confidence interval (CI) 0.6-1.6]. A modestly elevated risk was found for backpack mounted sprayers OR = 1.4 [95% CI 0.7-2.6] and vine farmers OR = 2.5 [95% CI 0.9-7.2]. Using time periods and exposure frequency as intensity measure, no elevated risks were found. The only exception was year of maximum exposure which yielded an OR of 1.6 [95% CI 0.7-3.5]. However, no clear trend was observed in this analysis. CONCLUSIONS: This study does not rule out that pesticide exposure represents an occupational risk factor for extrahepatic biliary tract carcinoma, but no indication of a strong association was observed. Some modes of exposure were weakly, albeit not significantly associated with carcinoma risk. The observed estimates of effects may be influenced by a lack of precise exposure assessment. Different chemical compositions of pesticides were utilized during a long time span of pesticide exposure, and it should be considered that the exposure is assessed with substantial uncertainty that could non-differential and bias results toward the null.

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.

Evaluating hazardous waste generation in for-profit outpatient haemodialysis centres.

BACKGROUND: "Green" haemodialysis management to reduce the environmental impact of haemodialysis is growing. OBJECTIVES: Dealing with hazardous waste production could heighten healthcare professionals' awareness of this problem, and improve their healthcare involvement in environmental sustainability and environmental-friendliness. DESIGN AND MEASUREMENTS: A list of for-profit outpatient haemodialysis centres in the Valencian Community (E Spain) was compiled. Data on their hazardous waste production from 2008 to 2012 through the annual waste reports issued by official organisations competent in environmental issues were collected. RESULTS: There are 22 for-profit dialysis centres, that managed the treatment for 69.1% of all dialysis patients in the region. Data were collected from 16 centres that collectively offer 350 dialysis places (33.8% of all the places in this region). Mean annual hazardous waste production per dialysis session increased by 14% during the study period: 0.640 kg per session in 2008 vs. 0.740 kg in 2012. DISCUSSION AND CONCLUSIONS: As hazardous waste production is high, we must examine the reasons why it is growing. Information about haemodialysis waste production and management is scarce and difficult to access. Having an evaluation of its production would motivate further research, especially as end-stage kidney disease is increasing, and whose main long-term treatment, haemodialysis, produces hazardous waste and employs substantial natural resources. Minimising its environmental impact is not mission impossible.

[Study of the obsesity and overweight as a risk factor for asthma and severity of the asthma in children of Valencia (Spain)]. / Estudio de la obesidad y del sobrepeso como factores de riesgo de la prevalencia y severidad del asma en niños de Valencia.

BACKGROUND: Obesity and overweight have been described as factors associated with asthma. Our aim was to evaluate the role obesity plays on asthma in children. SCOPE AND SUBJECTs: A study carried out on children and teenagers between 8 and 15 years of age, chosen for a cluster-type random sampling from children who studied in 80 schools, which represents 30% of the schools in the city of Valencia. MATERIAL AND METHODS: The analysed data was organized into two groups, obese (from the Body Mass Index (Kg/m2)), showing children with a percentile over 85% of the measuring reference for the Spanish population) and non obese, when they did not fulfil this condition. The prevalence of the different parameters studied was calculated by an Interval of Confidence of 95%. The risk was calculated (Relative Risk) from those symptoms compatible with asthma among obese children compared to non obese children. RESULTS: No significant relative risk (RR) was seen for obesity with regards to asthma in those percentiles of obesity over 85. Otherwise, an increase in the relative risk (RR) regarding the severity of asthma was seen in relation to obesity, mainly in the 85th percentile (RR = 1.51 of suffering between 4-12 wheezing attacks and RR = 1.86 of suffering more than 12 attacks in obese children as opposed to non obese children). CONCLUSIONS: In this study, we did not identify a higher risk of asthma among obese children than among non obese children, although we did find there was a higher risk of severity of asthmatic symptoms. As far as the severity of the asthma is concerned, we saw a higher risk of wheezing and whistling attacks among obese children with the 85th and the 95th percentiles according to the Body Mass Index.

Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case-control study.

The incidence of mycosis fungoides (MF) is low, and the aetiology of the disease is unknown. The aim of this study was to investigate whether wine consumption protects against the disease and whether smoking constitutes a risk factor. This paper is part of the European Rare Cancers Study that tries to determine the risk factors for seven selective rare cancers, including mycosis fungoides, involved in the development of cancer. A multicentre case-control study was conducted in six European countries. Only incident cases with confirmed histology were included in the analysis which include a total of 76 cases of MF and 2899 controls. Wine intake had no protective effect; on the contrary the consumption of more than 24 g of alcohol per day was associated with a high risk of MF (odds ratio (OR)=3.02, 95% confidence interval (CI), 1.34-6.79), after adjusting for centre, country, age, sex and education. There was a dose-dependent increase in the risk of MF with increased smoking habits, albeit the observed trend was not statistically significant. A combined exposure to high tobacco and alcohol use yielded a significantly increased risk factor for MF (P=0.0073). Alcohol intake was associated with MF.

Cancer of the rectum in relation to components of the Spanish diet.

Cancer of the rectum is common in most industrialized countries. It is considered to be the result of a combination of environmental (diet, tobacco, alcohol, etc.) and genetic factors. We studied the evolution of morbidity and mortality due to cancer of the rectum and sigmoid in Spanish provinces and its relationship to different Spanish diet components. Our study covered the period 1977-1985. We used the indirect method to determine morbidity and mortality rates per 100,000 population, grouped according to age and sex. The consumption of different diet components was obtained from National Statistics Institute publications on the subject. These components were total lipids, animal fats, vegetable fats, butter and pork lard, margarine, fiber, and alcohol (all in g/person/day). For the study period, the mean national standardized mortality was 5.26 per 100,000 population and morbidity was 171.57 per 100,000. Provinces having rates above and below the national average were noted. The study revealed that, overall, alcohol consumption presents a 0.42 (p less than .001) positive correlation with standardized mortality, as does total lipid consumption.

Trends in malignant skin melanoma and other skin cancers in Spain, 1975-1983, and their relation to solar radiation intensity.

Epidemiological studies have shown solar exposure to play an important role in the appearance of skin cancer. We investigated the association between mortality standardized by the indirect method for malignant skin melanoma and other skin cancers and the mean intensity of solar radiation during July and August for the different provinces in Spain. A statistically significant relation was observed (p less than .05) for these two months but not upon considering mean annual solar radiation. We thus suggest that intermittent, intense exposure to sunlight constitutes an important risk factor for skin cancer. We observed an 8.5% and 15.72% increase in mortality due to malignant skin melanoma and other skin cancers, respectively, during the period 1975-1983. Mortality was slightly higher among males than females.

Atmospheric contamination in the city of Valencia: relation to noise and climate.

A qualitative and quantitative study is made of the polycyclic aromatic hydrocarbons (PAH), nitrogen oxide, and sulfur dioxide in the atmosphere of the city of Valencia for the period 1988-1989; an analysis is made of their concentrations during the year in terms of season and noise levels. Eleven sampling points in the city were used to determine PAH composition by reverse-phase, high-resolution liquid chromatography with fluorimetric detection, employing an acetonitrile-water gradient; nitrogen oxides and sulfur dioxide were determined by the Valencia city government. Environmental noise levels were determined using a BK 2221 integrated precision sonometer, and temperature values were obtained from the city Meteorological Institute. Daily PAH values varied between 0.1769 and 2.0916 micrograms/m3, whereas the figures for nitrogen oxide were between 91.5 and 100.67 micrograms/m3 during 1982-1989 (only one value, 58.01 micrograms/m3, is available for 1988-1989, corresponding to the Mercadona sampling point), and between 17.33 and 129.36 micrograms/m3 for sulfur dioxide for a total of 9 sampling points; the highest concentrations were recorded in the winter and spring months, the association between PAH and temperature being statistically significant (p less than or equal to .05). The relation to noise was also significant (p less than or equal to .005), Fluoranthene was the predominant PAH in all samples analyzed.

Variations in avoidable mortality in relation to health care resources and urbanization level.

"Avoidable" mortality may be defined as causes of death whose occurrence is closely related to medical intervention. Areas with particular health care delivery problems can be identified through a geographical comparison of these "avoidable deaths." Mortality data for Valencia from 1982 to 1990 were examined to determine whether or not the availability of medical care resources in the area influenced the occurrence of avoidable deaths. We identified variations in mortality from avoidable causes, grouped according to the differences in levels of urbanization and health care resources, in the 537 municipalities of the Valencian community. (In Spain, the municipality is the lowest administrative division.) Linear regression analysis was performed to predict or estimate this relationship. Only in a small number of avoidable causes did the mortality trend for males differ significantly from 0 (p < 0.005) in relation to different levels of urbanization and health care resources. A direct association between these two variables was observed in males with regards to pneumonia, tuberculosis, chronic rheumatic heart disease, and bacterial infection. In females, a relationship between "avoidable" mortality rates and the differences in urbanization and health care resources was found in cervical cancer, pneumonia, abdominal hernias, and cholecystitis. Mortality from asthma and cardiovascular disease (in both males and females) declined faster in urbanized, high income areas than in rural areas. The results clearly demonstrate the considerable mortality risk associated with living in urban areas. On the contrary, we found very little correlation between health service access and mortality.

Non-melanoma skin cancer: a case-control study on risk factors and protective measures.

There is considerable evidence that exposure to ultraviolet radiation increases the risk of many dermatological conditions, such as non-melanoma skin cancer (NMSC). In order to better understand this relationship, we examined the connection between quantitative measures of individual sun exposure and the risk of NMSC, and the benefits of some protective measures against sunlight, analyzing the differences by sex. A case-control study was conducted in Valencia, Spain during 1990 to 1992 that included 276 cases of histologically confirmed NMSC and 552 control subjects matched by age, sex, and area of residence. Quantitative ultraviolet exposure, phenotypic features, and protective measures from sunlight were estimated by means of a history questionnaire administered by interview. Logistic regression analysis was carried out for each variable and level of quantitative measures. We observed a statistically significant increase in the risk of NMSC proportional to an increase in the hours of occupational exposure to the sun (OR = 1.2, 2.5, and 5.3, respectively). An increased risk of NMSC was observed in men with high nonoccupational exposure (OR = 1.7; p < 0.05 in open-air activities in the sun, OR = 2.1; p < 0.05 in the sun while on vacation). In women, we found instances of OR > 1, but without significance (p > 0.05). Wearing a hat at work appeared to be an important protective measure for men. Light phenotypic features predominated in our study, especially in women, and seems to be the major risk factor involved. It seems reasonable to presume that differences between the sexes are basically sociocultural, (i.e., different work activities and different use of leisure time.

Chlorination of drinking water and cancer incidence.

Epidemiological studies report associations between cancer mortality and type of drinking water source. Different studies appeared to lend some support to the hypothesis that surface waters contain higher levels of human carcinogens than groundwater sources. The possible contaminants that might play such a role are the halogenated organic compounds produced by the chemical reaction between organic materials in water and chlorine used for disinfection. Chlorine reacts with naturally occurring organic compounds in the water to form haloforms. Valencia Province of Spain relies almost exclusively on groundwater for its public drinking water, but the city and surrounding urban areas rely on superficial water. The chlorination used in the superficial water includes several phases: prechlorination, coagulation, filtration, and, finally, postchlorination, which shows the possible formation of organohalogenated compounds. To find an association between stomach and bladder cancer mortality with the type of water source, we studied 261 municipalities of Valencia Province. We calculated sex-specific standardized mortality ratios for deaths occurring between the 1985 to 1989 (census statistics), and we carried out a relative-risk calculation associated with the differences between superficial and groundwater supplies.

Noise in the city of Valencia: its relation to other air level contaminants.

We measured environmental noise in the Spanish Mediterranean coastal city of Valencia. Simultaneously, we made a count of the passing vehicle sat the same points. We calculated the mean of traffic intensity in the points recorded in each year of the study. The recorded noise was extrapolated to the traffic recordings of previous years to establish a relation between noise and traffic intensity. The information concerning chemical contamination was obtained from 1979 to 1989 in the same points. A statistical analysis was carried out in order to determine the evolution of various atmospheric contaminants over the last decade (SO2, smoke, NO2, lead, sedimentable material) in each point and the possible relationship between acoustic contamination and the main chemical contaminants.

Concentration of nitrates in drinking water and its relationship with bladder cancer.

Environmental contamination is a characteristic of industrialized nations. The quality of public drinking water, particularly from underground reserves, has increasingly deteriorated. The fundamental cause of the contamination of underground water layers has been the growing worldwide use of nitrogen fertilizers and pesticides since the 1960s. The Valencian Community comprises three provinces on the East Mediterranean coast of Spain. Public drinking water in this community is obtained chiefly from underground sources. As a result, this area suffers the highest nitrates contamination of public drinking water recorded not only in Spain but in all of Europe. The aim of the present study was to investigate the existence of differences in the occurrence of bladder cancer between the population of Valencia province and the rest of the country. We studied the differences in bladder cancer incidence among populations exposed to different levels of nitrates in drinking water in the province of Valencia, as expressed in terms of relative risk. We found a statistically significant difference (p < 0.0001) between the occurrence of bladder cancer in the Valencia province and the rest of Spain, as reflected by the analysis of the corresponding regression curve slopes. Our analytical study revealed relative risks of over 1 in Valencia province in men and women, associated with the consumption of water containing a mean concentration of > 50 mg/L.

Subjective annoyance caused by environmental noise.

We developed an acoustic study implemented throughout a neighborhood of Valencia (Spain). Acoustic recordings were made during the months of November and December 1989, on workdays between 9 a.m. and 1 p.m., and between 5 p.m. and 8 p.m. We also directly interviewed individuals living in this city area to determine their perception of noise and to evaluate the discomfort caused by it in daily life. A personal interview in the form of a questionnaire was employed to poll the neighborhood inhabitants on the magnitude of environmental noise and the distress it caused. The results showed that 40% of those interviewed considered environmental noise to cause considerable distress. On a 1 to 10 scale, over half of those interviewed rated noise in the neighborhood of 5 or higher. Traffic was considered the major source of noise, followed by noise from neighbors and factories. Of those interviewed, 9% changed the location of their bedroom as a result of noise, whereas 11% were forced to sleep with the windows closed for the same reason.

[Prevalence and depression degree in patients with rheumatoid arthritis]. / Prevalencia y grado de depresión en los pacientes con artritis reumatoide.

BACKGROUND: Study goals were: a) to know the existence and depressive level among a series of rheumatoid arthritis (RA) patients; b) to assess differences in depression levels of individuals with and without RA, and c) to identify the association of depression level with socioepidemiological, clinical, and prognostic characteristics in these patients. MATERIAL AND METHODS: Cross-sectional study that undertakes a 3 years period (July 1992-March 1995) and includes 221 patients diagnosed of RA according to the 1988 criteria of the American College of Rheumatology (ACR). Association of depression levels, assessed with the Self-Rating Depression Scale of Zung-Conde, with each one of the variables was evaluated using chi 2 tests (p < 0.05). A multivariate analysis type Automatic Interaction Detection (AID), based on the statistic r2, was applied to determine patient's profile with RA and depression. RESULTS: Depressive level was identified in 33.48% of patients. Odds ratio (OR) between "not depressive" and "depressive" levels was from 20.35 with 95% CI: 8.87-47.88 (p < 0.00001). Association was found with the variables sex (p < 0.0001), profession (p = 0.02), weight and height (p < 0.0001 in both variables), Ritchie index (p < 0.004), number of painful joints (p = 0.002), morning stiffness (p = 0.049) and secondary effects of the treatment (p = 0.034). Sex was the variable that most influenced in depressive level (p < 0.00001). In females group, the factor mainly related with depression was the number of painful joints (p < 0.0002) while in males, it was the self-rating pain valuation with a Likert scale (p < 0.0001). CONCLUSIONS: RA could causes depression in the patients. The factor with highest influence in the depression of these patients was the sex. The most influential factor in the females was the number of painful joints, while in the males was the self-rating of pain.

[Effect of the ingestion of food and gynecologic risk factors on breast cancer risk in Valencia]. / Influencia de la ingesta de alimentos y factores de riesgo ginecológicos en el riesgo de cáncer de mama en Valencia.

OBJECTIVES: The present case-control study was undertaken to elucidate the role of recent diet, specially in the influence of food groups, in the development of cancer of the breast. MATERIAL AND METHODS: A case-control study of breast cancer (BC) was conducted between April to November 1997 in Valencia (Spain). Cases were 65 women aged 35-78 years. Controls included 78 women aged 34-82. Dietary habits were investigated through a validated food frequency consumption questionnaire (FFQ) included 100 foods. One summary questions were included, concerning all food items of a certain type or food frequently consumption. The difference between variables was tested by the chi-square method. For each food item, quintiles of consumption were calculated by dividing the frequency distribution of the entire study group into 20th, 40th, 60th and 80th percentiles and multiple linear regression analysis were fitted to the data. To assess the independent associations between selected BC risk factors and BC stage. RESULTS: A significant trend of increasing risk with increasing intake emerged for the following food groups: Cereal dish (rice) (OR = 1.1; 95% CI: 0.1-10.0), poultry (OR = 6.0; 95% CI: 0.9-43.9), beef meat (OR = 1.3: 95% CI: 0.5-3.6) and high intake of some food groups exerted a significant protection against development of BC: eggs (OR = 0.6; 95% CI: 0.2-1.9), olive oil (OR = 0.5; 95% CI: 0.1-2.0), tomatoes (OR = 0.5; 95% CI: 0.1-1.8). When linear regression analyses was performed, consumption of tomatoes and parity showed an inverse association statistically significant with the stage of BC. CONCLUSIONS: Consumption of tomatoes, mainly, consumption of eggs and olive oil, and parity exhibited a statistically significant relationship (p < 0.05) with BC stage in Valencia (Spain).

[Sleep changes produced by environmental noise]. / Alteraciones del sueño producidas por el ruido ambiental.

This article reports the results of a survey trying to evaluate different aspects related with ambient noise and its effects on selected urban communities. A total of 263 residents in 5 different neighbourhoods of the city of Valencia were interviewed. For each one of the neighbourhoods, level of ambient noise were independently registered during 24 hours during some days of a week. 40% of the interviewees reported having some difficulty for getting to sleep and 59% of these with difficulties identified the traffic noise as the causation. Also, 49% reported to awake sometime during the night (24% of them pointed to the traffic noise as the major cause). All these problems were reported more frequently in the neighbourhoods with a greater level of ambient noise. The probably high number of people affected by sleep disturbances related with ambient noise during the night makes necessary to adopt adequate correcting actions.

[The clinical history and physical examination in patients with chronic lumbar pain. Patient classification by a decision tree]. / Historia clínica y exploración física en pacientes con dolor lumbar crónico. Clasificación de pacientes con un árbol de decisión.

AIM: To analyze the correlation between clinical symptoms and physical examination signs in diagnostic groups of low back pain patients; making a spanning tree. MATERIAL AND METHOD: A prospective longitudinal study of 485 low back pain patients was carried. We assess the type of pain and its irradiation, evolution in time, duration of the episodes, timetable, intensity and morning stiffness. A complete physical examination with specific tests for sacroiliac joints and neurologic examination was carried. We carried out a study of absolute and relative frequencies; calculating the rates with the chi 2 Pearson test and having a confidence of 95%. RESULTS: We found a significant relation (p < 0.0001) between the type of pain and the diagnosis groups. Proximal irradiation with functional disorders (p < 0.01) and metabolic bone diseases (p < 0.0001); the radicular irradiation and the disorders by physical agents (p < 0.001). The flare-up back pain with disorders by physical agents and metabolic bone diseases (p < 0.001). The morning stiffness was exclusive in the inflammatory diseases. In the physical examination, was found a significant relation (p < 0.0001) between the different tests with the diagnostic groups. CONCLUSION: The history and the physical examination provide us symptoms and signs which let us direct towards the above diagnostic. The type of pain with its characteristics and the referred pain as a main symptoms, give us some information, which complemented with the physical examination tests, providing the base on which we support our diagnostic hypothesis, allow us the first classification of the patients; at the same time we understand as a low back pain patients suffer its problem.