Adipose tissue concentrations of non-persistent environmental phenols and local redox balance in adults from Southern Spain.

The aim was to evaluate the associations of environmental phenol and paraben concentrations with the oxidative microenvironment in adipose tissue. This study was conducted in a subsample (n = 144) of the GraMo cohort (Southern Spain). Concentrations of 9 phenols and 7 parabens, and levels of oxidative stress biomarkers were quantified in adipose tissue. Associations were estimated using multivariable linear regression analyses adjusted for potential confounders. Benzophenone-3 (BP-3) concentration was borderline associated with enhanced glutathione peroxidase (GPx) activity [exp(ß) = 1.20, p = 0.060] and decreased levels of reduced glutathione (GSH) [exp(ß) = 0.55, p = 0.070]. Concentrations of bisphenol A (BPA) and methylparaben (MeP) were associated to lower glutathione reductase (GRd) activity [exp(ß) = 0.83, exp(ß) = 0.72, respectively], and BPA was borderline associated to increased levels of oxidized glutathione (GSSG) [exp(ß) = 1.73, p-value = 0.062]. MeP was inversely associated to both hemeoxygenase-1 (HO-1) and superoxide dismustase (SOD) activity, as well as to the levels of thiobarbituric acid reactive substances (TBARS) [0.75 < exp(ß) < 0.79]. Our results suggest that some specific non-persistent pollutants may be associated with a disruption of the activity of relevant antioxidant enzymes, in addition to the depletion of the glutathione stock. They might act as a tissue-specific source of free radicals, contributing to the oxidative microenvironment in the adipose tissue.

Environmental phenols and parabens in adipose tissue from hospitalized adults in Southern Spain.

Urinary concentrations of non-persistent environmental pollutants (npEPs) are widely assessed in biomonitoring studies under the assumption that they are metabolised and eliminated in urine. However, some of these chemicals are moderately lipophilic, and their presence in other biological matrices should also be evaluated to estimate mid/long-term exposure to npEPs and its impact on human health. The present study aims to explore concentrations and potential determinants of npEPs in adipose tissue from a hospital-based adult cohort (GraMo cohort, Southern Spain). Concentrations of bisphenol-A (BPA), benzophenone-3 (BP-3), triclosan (TCS), three chlorophenols (2,4-DCP, 2,5-DCP and 2,4,5-TCP) and two phenylphenols (2-PP and 4-PP), triclocarban (TCCB) and parabens [methyl- (MeP), ethyl- (EtP), propyl- (n-PrP and i-PrP), butyl- (n-BuP and i-BuP) and benzyl-paraben (BzP)] were analysed in adipose tissue samples from a subcohort of 144 participants. Spearman correlation tests were performed, followed by stepwise multivariable linear regression analyses to assess determinants of the exposure. Detection frequencies and median concentrations were: BPA (86.8%, 0.54 ng/g tissue), BP-3 (79.2%, 0.60 ng/g tissue), TCS (45.8%,

Assessing the public health impacts of urban air pollution in 25 European cities: results of the Aphekom project.

INTRODUCTION: The Aphekom project aimed to provide new, clear, and meaningful information on the health effects of air pollution in Europe. Among others, it assessed the health and monetary benefits of reducing short and long-term exposure to particulate matter (PM) and ozone in 25 European cities. METHOD: Health impact assessments were performed using routine health and air quality data, and a common methodology. Two scenarios were considered: a decrease of the air pollutant levels by a fixed amount and a decrease to the World Health Organization (WHO) air quality guidelines. Results were economically valued by using a willingness to pay approach for mortality and a cost of illness approach for morbidity. RESULTS: In the 25 cities, the largest health burden was attributable to the impacts of chronic exposure to PM2.5. Complying with the WHO guideline of 10 µg/m(3) in annual mean would add up to 22 months of life expectancy at age 30, depending on the city, corresponding to a total of 19,000 deaths delayed. The associated monetary gain would total some €31 billion annually, including savings on health expenditures, absenteeism and intangible costs such as well-being, life expectancy and quality of life. CONCLUSION: European citizens are still exposed to concentrations exceeding the WHO recommendations. Aphekom provided robust estimates confirming that reducing urban air pollution would result in significant health and monetary gains in Europe. This work is particularly relevant now when the current EU legislation is being revised for an update in 2013.

Predictors of the total effective xenoestrogen burden (TEXB) in human adipose tissue. A pilot study.

The estrogenicity of biological extracts tested by appropriate bioassay is a standard method to evaluate the total effective xenoestrogen burden (TEXB). Information has been published on the combined effect of xenoestrogens after removing endogenous hormones. The main goal of the present study was to investigate the combined estrogenicity of endogenous and xenoestrogens in human adipose tissue samples with and without HPLC fractionation. The results suggest that both approaches may be useful to study interaction between xenoestrogens and endogenous hormones. TEXB of the whole extract provides information about the overall estrogenicity to which humans are exposed, useful to assess the potential contribution to health outcomes. Additionally, it is possible to identify the source and potency of the estrogenicity by using the method with fractionation, distinguishing the effect of organohalogenated chemicals (alpha-fraction) from that of endogenous hormones and more polar xenoestrogens (beta-fraction). Both methods are an integrative measure of internal estrogen load.

Predictors of concentrations of hexachlorobenzene in human adipose tissue: a multivariate analysis by gender in Southern Spain.

Hexachlorobenzene (HCB) was measured in adipose tissue intraoperatively collected from 387 subjects over 16 years old undergoing surgery in two hospitals in Granada (Southern Spain). HCB was quantified in 90.7% of subjects. The concentrations and frequencies of HCB were similar to those reported in adipose tissue samples in other recent European studies. Exposure patterns differed between females and males: higher HCB concentrations were found in females than in males (geometric mean 18.3 vs. 6.8 ng/g, p<0.001). The relationship between HCB concentrations and exposure risk factors was assessed by multivariate analysis stratifying by gender. In men, HCB concentrations were predicted (r(2)=0.45) by age, body mass index (BMI), place of residence, smoking, consumption of fish, chicken and cheese, occupation related to agriculture, and family involvement in construction activities. In women, HCB concentrations were predicted (r(2)=0.50) by age, BMI, consumption of milk and cheese, and occupation related to industry. The finding that women had three-fold higher levels of HCB than the men deserves further investigation.

[Comparison of two models of education for asthmatic patients]. / Comparación de dos modelos de educación para pacientes asmáticos.

BACKGROUND: The education programs have demonstrated to be an important point in the management of asthmatic patients. The aim of the present study was to assess if an intensive group asthma education program was able to improve a simplified and individual asthma education program, both with a self-management plan included. PATIENTS AND METHOD: A prospective randomised controlled trial was conducted over 12 months and 73 moderate-severe asthmatic patients were included. Patients were randomly assigned to control or study group. Patients in control group received individual and simplified education with a self-management plan and patients in study group attended an <> in small groups where they received a three hours education program in three weeks.The outcome measures were: number of hospital admissions, observation unit admissions, emergency visits and unscheduled general practice consultations. Knowledge, adherence to treatment, ability with inhaler devices, airway function, environmental control measures and quality of life. They were assessed at the beginning and the end of the study. RESULTS: At the end of the study period the outcome of morbidity had improved in both groups but the number of observation unit admissions (p = 0.028) and unscheduled general practice consultations (p = 0.022) was substantially lower in study group. This group also demonstrated improvement in environmental control measures and better inhaler technique and knowledge (p = 0.007). In adherence, lung function or quality of life there were no differences between groups. CONCLUSIONS: In patients with asthma better results can be obtained with an intensive group asthma education program than with the individual and simplified program.

[Evaluation of theory-practice knowledge on inhalation systems in primary care physicians, post-graduates in training and undergraduates]. / Evaluación del conocimiento teórico-práctico de los sistemas de inhalación en médicos de atención primaria, posgrados en formación y pregrado.

OBJECTIVE: To find the theoretical and practical knowledge concerning inhalation systems of primary care doctors, postgraduates in training--family & community medicine (FCM) residents--and undergraduates who had passed their course in pneumology. DESIGN: Crossover, descriptive study. SETTING: FCM teaching unit of the Puerta del Mar Hospital (Cadiz), the Cadiz Faculty of Medicine and seven primary care centres on the Bay of Cadiz. PARTICIPANTS: 31 practising primary care doctors, 25 third-year FCM residents and 31 medical students were evaluated. MEASUREMENTS AND MAIN RESULTS: A thirteen-point questionnaire was used to evaluate the subjects theoretical knowledge of inhalation systems. The percentage of correct replies was used to establish reply levels. Their techniques of handling different systems of inhalation (pressurised cartridge, pressurised cartridge with spacing chamber, Turbuhaler and Accuhaler) were assessed according to the guidelines of the SEPAR (Spanish Society of Pneumology and Thoracic Surgery). 26% of the practising doctors and residents answered over 75% of the questionnaire correctly, with no significant differences between the two groups (p > 0.66). No undergraduate reached 75% of correct answers. After exclusion of asthmatic participants, three of the practising doctors (9.7%) and one of the residents (4.8%) performed the technique correctly with the four systems: there were no differences between the two groups (p > 0.87). No undergraduate performed them satisfactorily. CONCLUSIONS: Specific training for primary care doctors in handling inhalation therapy is recommended.

Evaluación del conocimiento teórico-práctico de los sistemas de inhalación en médicos de atención primaria, posgrados en formación y pregrado / Evaluation of the theoretical and practical knowledge concerning inhalation systems of primary care doctors, postgraduates in training and undergraduates

Objetivo. Conocer el nivel de conocimientos teórico-prácticos sobre sistemas de inhalación en médicos de atención primaria, posgrado en formación (residentes de medicina familiar y comunitaria) y pregrado con la asignatura de neumología aprobada. Diseño. Estudio descriptivo transversal. Emplazamiento. Unidad docente de MFyC del Hospital Puerta del Mar (Cádiz), Facultad de Medicina de Cádiz y 7 centros de atención primaria de la bahía de Cádiz. Participantes. Fueron evaluados 31 médicos en ejercicio en atención primaria, 25 residentes de tercer año de MFyC y 31 estudiantes de medicina. Mediciones y resultados principales. Se valoró el conocimiento teórico de los sistemas de inhalación mediante cuestionario de 13 preguntas. Se establecieron niveles de respuesta en función del porcentaje de respuestas correctas. La técnica inhalatoria en el manejo de los distintos sistemas (cartucho presurizado, cartucho presurizado con cámara espaciadora, Turbuhaler® y Accuhaler®) fue evaluada según normativa de la SEPAR (Sociedad Española de Neumología y Cirugía Torácica). Un 26 por ciento de los médicos en ejercicio y residentes respondió correctamente a más del 75 por ciento del cuestionario, sin diferencias significativas entre ambos (p > 0,66). Ningún pregrado alcanzó un 75 por ciento de respuestas correctas. Excluyendo a los participantes asmáticos, realizaron correctamente la técnica con los 4 sistemas evaluados tres de los médicos en ejercicio (9,7 por ciento) y uno de los residentes (4,8 por ciento), sin que hubiera diferencias entre ambos colectivos (p > 0,87). Ningún pregrado las realizó satisfactoriamente. Conclusiones. Es recomendable formación específica a los profesionales de atención primaria en el manejo de la terapia inhalada (AU)