Who is legally responsible for deaths caused by air pollution?

A person's death is deemed unnatural when it is the result of an external force. This definition, however, does not apply when the cause of death is a respiratory or cardiovascular process triggered by a high concentration of an air pollutant, even if other deaths from toxicological causes (poisonings, overdoses, etc.) are. The distinction between natural and unnatural cause of death, although not internationally standardized, is critical in determining wrongfulness and liability, which in turn can have financial and/or legal repercussions. Even though the World Health Organization and other medical and scientific organizations have shown that air pollution contributes to several million deaths every year, there are currently no practical means to determine whether a person was subjected to high concentrations of atmospheric pollution before their death; indeed, the ability to find evidence of this type of exposition could prove very interesting from a forensic standpoint.

Integrating and analyzing medical and environmental data using ETL and Business Intelligence tools.

Processing data that originates from different sources (such as environmental and medical data) can prove to be a difficult task, due to the heterogeneity of variables, storage systems, and file formats that can be used. Moreover, once the amount of data reaches a certain threshold, conventional mining methods (based on spreadsheets or statistical software) become cumbersome or even impossible to apply. Data Extract, Transform, and Load (ETL) solutions provide a framework to normalize and integrate heterogeneous data into a local data store. Additionally, the application of Online Analytical Processing (OLAP), a set of Business Intelligence (BI) methodologies and practices for multidimensional data analysis, can be an invaluable tool for its examination and mining. In this article, we describe a solution based on an ETL + OLAP tandem used for the on-the-fly analysis of tens of millions of individual medical, meteorological, and air quality observations from 16 provinces in Spain provided by 20 different national and regional entities in a diverse array for file types and formats, with the intention of evaluating the effect of several environmental variables on human health in future studies. Our work shows how a sizable amount of data, spread across a wide range of file formats and structures, and originating from a number of different sources belonging to various business domains, can be integrated in a single system that researchers can use for global data analysis and mining.

Trends in motor neuron disease: association with latitude and air lead levels in Spain.

Motor neuron diseases (MND) are a group of disorders characterized by motor neuron degeneration. Among them, amyotrophic lateral sclerosis (ALS) is by far the most common in adulthood. This paper assesses the trend and geographical pattern in MND incidence in Spain and the possible air lead levels effect on this pathology. To confirm this concept, we performed a retrospective analysis of the deaths due to MND in Spain during 2000 and 2013, determined the geographical differences, and explored the relationship between MND and the air levels of lead. Overall, between 2000 and 2013, 11,355 people died in Spain because of MND. Disease mortality significantly increased in recent years (2007-2013) when compared with the first time of the period. Spearman's rank correlation coefficient also showed a statistically significant positive trend (CC = 0.824, p = 0.0002). Among people over 65 years, mortality rates were higher in Northern provinces. Moreover, we found a significant association of MND mortality with higher air lead levels (CC = 0.457, p = 0.01). Our study confirms that MND mortality is increasing in Spain, with a significant latitude gradient, which suggests an important role of environmental exposures. This ecological study suggests that air lead levels may be implicated in ALS pathogenesis.

The Influence of Nitrogen Dioxide on Arrhythmias in Spain and Its Relationship with Atmospheric Circulation.

Epidemiological studies suggest that increased ambient NO2 concentrations are associated with cardiovascular disease. However, none of them have examined the association between ambient air pollution and cardiac arrhythmias in the general population in Spain. This paper assesses the short-term association between the aforementioned air pollutant and hospital admissions for arrhythmia in nine different regions of Spain during a 6-year period (2005-2010), and the possible season-specific effects of the compound on this pathology, by performing a time-series analysis based on Poisson regression models. The results show statistically significant positive relationship increases between arrhythmia admissions and increments in NO2 concentration during the whole year, most notably in wintertime. Moreover, while trying to establish a threshold for NO2 concentration above which the incidence of arrhythmia episodes increases significantly, this study reveals that hospital admissions increased linearly in response to an increase in as we move to higher NO2 concentration levels. Finally, an analysis of NO2 concentrations and their relationship with atmospheric circulation is performed, showing higher values of NO2 under anticyclonic conditions during winter that could be used for implementing pollution level alert protocols depending on forecast circulation patterns.

[Geographical distribution of mortality by Parkinson's disease and its association with air lead levels in Spain]. / Patrón geográfico de la mortalidad por enfermedad de Parkinson en España y su asociación con los niveles de plomo en el aire.

BACKGROUND AND OBJECTIVE: Parkinson's disease (PD) is the second most common neurodegenerative disease, and the etiology of its sporadic form is unknown. The present study analyzes the temporal and spatial variations of mortality by PD in Spain over a period of 14 years and its relationship with lead concentration levels in the atmosphere. METHOD: An ecological study was performed, in which deaths by PD and age group in 50 Spanish provinces between 2000 and 2013 were analyzed. The annual trend of PD mortality was assessed using the non-parametric Spearman's Rho test. Finally, the relationship between lead concentration levels in the air and mortality by PD was evaluated. RESULTS: Between 2000 and 2013, 36,180 patients with PD died in Spain. There is an increasing trend in mortality through PD over the study period (P<.0001). La Rioja, Asturias, Basque Country and the Lower Ebro valley were the regions with the highest values of PD mortality. Those regions with the highest lead concentrations also showed higher mortality by this disease in people over 64 (P=.02). CONCLUSIONS: Over our period of study, there has been an increase in mortality through PD in Spain, with the northernmost half of the country registering the highest values. Mortality in men was higher than mortality in women. Moreover, a direct correlation was found between lead levels in the air and mortality through PD.

Biomarkers Associated with Vascular Calcification in Peritoneal Dialysis.

UNLABELLED: ♦ BACKGROUND: Vascular calcification is strongly associated with cardiovascular disease and mortality. However, some factors related to vascular calcification in patients with end-stage renal disease receiving peritoneal dialysis (PD) remain unknown. This study aimed to evaluate the associations of osteoprotegerin (OPG), osteopontin (OPN), osteocalcin (OCN), fibroblast growth factor 23 (FGF-23), magnesium, and phosphate clearance with vascular calcification in PD subjects, assessed by plain radiographs. ♦ METHODS: Simple vascular calcification scores (SVCS) obtained from plain X-rays of the pelvis and hands, and the Kauppila Index (KI) from lateral lumbar X-rays were assessed in 76 adults receiving PD for ≥ 6 months (43 women, median age 39 years, median time on PD 1.4 years). Levels of OPG, OPN, OCN, and FGF-23 were determined by luminometry. ♦ RESULTS: Serum OPG levels were higher in subjects with vascular calcification (n = 22 with SVCS > 3; n = 19 with KI > 7) compared with those with less calcification (p < 0.001). Spearman's correlation coefficients between OPG and SVCS and KI were r = 0.49 and r = 0.51, respectively (both p < 0.001). Subjects with vascular calcification had significantly lower renal phosphate clearance. Multiple regression analysis showed that vascular calcification assessed by SVCS was associated with age (r = 0.2, p = 0.042), diabetes mellitus (r = 2.4, p < 0.001), body mass index (BMI) (r = 0.09, p = 0.037), and OPG (r = 0.22, p = 0.001). Vascular calcification assessed by KI was associated with age (r = 0.16, p < 0.001), time on PD (r = 0.54, p = 0.001) and OPG (r = 0.08, p = 0.04). Osteocalcin, OPN, FGF-23, and magnesium were not associated with vascular calcification. ♦ CONCLUSIONS: Higher levels of OPG were consistently associated with vascular calcification in subjects on PD.

Infecciones severas de partes blandas / Soft tissue infections

Antecedentes: Las infecciones severas de partes blandas, son cuadros rápidamente progresivos. Su reconocimiento tardío conspira contra las posibilidades de curación. Objetivo: Analizar un grupo de pacientes atendidos en los últimos siete años. Evaluamos factores predisponentes y determinantes como así también el tratamiento. Método: Fueron analizados 29 pacientes que presentaron infecciones severas de partes blandas y divididos según la variedad anatomoquirúrgica de presentación. Resultados: La mortalidad global fue de 11 pacientes (37,9 por ciento). Las lesiones por clostridio presentaron 100 por ciento de mortalidad. La Cámara Hiperbárica fue utilizada en seis pacientes de los cuales cuatro fallecieron. Conclusiones: Son afecciones que deben sospecharse en forma específica, en enfermos con factores predisponentes. Los diagnósticos tempranos permiten mejor evolución. Los debridamientos deben ser amplios y reiterados

Complicaciones de los traumatismos hepáticos / Complications of the hepatic traumatisms

Antecedentes: Los traumatismos están aumentando en frecuencia en todas las sociedades y en todas las edades. El trauma hepático aunque en un 30 por ciento de los casos no requiere tratamiento específico, en las formas graves presenta alta frecuencia de complicaciones. Objetivo: Analizar las complicaciones halladas en traumatismos hepáticos. Lugar de aplicación: Servicio de Cirugía General y de Emergencia de un Hospital de Fuerzas de Seguridad. Diseño: Estudio observacional retrospectivo. Población: Se analizan las complicaciones de 153 traumatismos hepáticos. Métodos: Se analizan las complicaciones tempranas (31 casos), intermedias (30 casos) y tardías (52 casos). Se evaluaron los casos de mortalidad. Resultados: El tratamiento inicial de la acidosis, la hipotermia y las coagulopatías junto a la elección de la táctica y la ejecución de las técnicas quirúrgicas adecuadas constituyen los factores que, en conjunción con las lesiones asociadas, determinan la frecuencia y el tipo de complicaciones. La mortalidad de la serie fue de 26 casos (16,9 por ciento). Conclusiones: Las complicaciones tempranas están predeterminadas por la magnitud de lesiones (locales y asociadas) mientras que en las tardías desempeñan un papel fundamental los errores tácticos y técnicos quirúrgicos. La mortalidad global depende además del estado metabólico durante el pre, el intra y el postoperatorio

Complicaciones de los traumatismos duodenopancreáticos / Duodenal-pancreatic trauma complications

Antecedentes: El aumento de la incidencia de traumatismos en general y de los abdomen en particular es una constante en todas la sociedades y en todas las edades. Los traumatismos duodenopancreáticos son poco frecuentes. Sin embargo, son considerados de resolución compleja por presentar alto indice de complicaciones, independiente del tipo de reparación duodenal o pancreática, como así también, por la frecuente posibilidad de lesiones que pasan inadvertidas. Objetivos: Exponer la experiencia de un Servicio de Cirugía General en el manejo de las complicaciones del traumatismo duodenopancreático. Lugar de aplicación: Hospital de Comunidad cerrada. Diseño: Estudio retrospectivo. Población: Se analizaron 60 lesiones duodenopancreáticas: a- heridas de bala: 51 casos; b- heridas por arma blanca: 2 casos; c- traumatismos cerrados: 7. Métodos: Las lesiones fueron clasificadas siguiendo a Moore y col. en: Lesiones duodenales: se comprobaron dos casos de lesión grado I (sin mortalidad), trece casps de lesión grado II (3 fallecidos), siete casos de lesión grado III (con 2 fallecidos), 2 casos grado IV (sin fallecidos) y no hubo casos grado V. Lesiones pancreáticas: Se comprobaron tres casos de lesiones grado I (sin mortalidad), cuatro grado II (sin mortalidad), diez grado III (con 2 fallecidos), ocho casos grado IV (con 2 fallecidos) y no hubo leciones grado V. Resultados: Lesiones duodenales: Hubo veinticuatro con cinco fallecidos (20,8 por ciento de mortalidad). Dos pacientes presentaron sepsis, dos falla multisistémica y uno paro cardiorrespiratorio. Lesiones pancreáticas: Hubo veinticinco, con 4 fallecidos (16 por ciento de mortalidad). Dos por coagulación intravascular diseminada, uno por sepsis y uno por falla multisistémica. Lesiones combinadas: Hubo once, con 2 fallecidos (18 por ciento de mortalidad). Uno por sepsis y uno por falla multisistémica. La mortalidad global fue de once enfermos (18,3 por ciento)...

"Packing abdominal: un recurso práctico en hemorragias incontrolables / Abdominal packing: a practical tool on bleeding

Antecedentes: El taponamiento o "packing" es una técnica antigua que cayó en desuso después de la segunda guerra mundial. Las causas del abandono fueron el aumento de la incidencia de abscesos, sepsis y fístulas digestivas, como así también el resangrado cuando se los retiraba en las primeras horas de colocado. Objetivos: Evaluar las indicaciones actuales de este procedimiento de excepción y analizar los resultados obtenidos con su utilización. Diseño: Estudio retrospectivo. Población: Grupo etario predominantemente masculino y joven. Método: Los pacientes fueron divididos en dos grupos: A) Traumatismos hepáticos (10). B) Lesiones no hepáticas (12). Las lesiones hepáticas (según Moore) pertenecen: seis al tipo III, tres al IV y uno al V. Cuando las lesiones eran extrahepáticas correspondieron en cinco oportunidades a fracturas pelvianas, en dos oportunidades a lesiones de varicoceles pelvianos por percretismo placentario, en otras dos, a necrosis pancreática infectada con complicación hemorrágica, una a nefrectomía izquierda con esplenopancratectomía corporocaudal y estallido del ángulo esplénico del colon por una herida de bala y en dos oportunidades, a un hematoma retroperitoneal en crecimiento debido a lesión venosa en pelvis menor secundarias a una histerectomía por vía vaginal. Se realizaron seis taponamientos intraviscerales (2 vitales y 4 con bolsa de gasas) y dieciséis taponamientos perilesionales. No se realizó taponamiento con redecillas de contención o con sonda balón. Resultados: Fallecieron 5 pacientes (22,72 por ciento). La mortalidad en el grupo de lesiones hepáticas fue de dos casos (20 por ciento), mientras que las extrahepáticas fue de tres (25 por ciento). Recibieron más transfuciones las lesiones extrahepáticas que las hepáticas. De la misma manera tanto el tiempo de protrombina como el parcial de tromboplatina fueron más bajos en las lesiones del hígado que en las extrahepáticas. En tres oportunidades, al retirarse a las 72 horas el "pack", ocurrió un resangrado importante que obligó a recolocarlo (1 hepático y 2 extrahepáticos). Conclusiones: El "packing" es un procedimiento de excepción, indicado en la persistencia del sangrado en enfermos hemodinámicamente inestables, en los cuales se han solucionado tanto las lesiones vasculares como la contaminación intestinal...