The EMECAM project: a multicentre study on air pollution and mortality in Spain: combined results for particulates and for sulfur dioxide.

OBJECTIVE: The EMECAM study is a collaborative effort to evaluate the impact of air pollution on mortality in Spain. In this paper the combined results are presented for the short term effects of particulates and sulfur dioxide on both daily mortality for all and for specific causes. METHODS: The relation between daily mortality for all causes, cardiovascular diseases, and respiratory diseases, and air pollution for particulates (daily concentrations) and SO(2) (24 and 1 hour concentrations) was assessed in 13 Spanish cities for the period 1990-6. With a standardised method, magnitude of association in each city was estimated by Poisson regression in a generalised additive model. Local estimates were obtained from both single and two pollutant analyses. Lastly, combined estimates for each cause and pollutant were obtained. RESULTS: For combined results, in single pollutant models a 10 microg/m(3) increase in the concentration of the mean of the concurrent and one day lag for black smoke was associated with a 0.8% (95% confidence interval (95% CI) 0.4 to 1.1%) increase in total mortality. The estimates for total suspended particles (TSPs) and particulate matter of aerodynamic diameter <10 microm (PM(10)) and total mortality were slightly lower. The same increase in concentrations of SO(2) was associated with a 0.5% increase in daily deaths. For groups of specific causes, higher estimations were found, specially for respiratory conditions. Peak concentrations of SO(2) showed significant associations with the three groups of mortality. When two pollutant analyses were performed, estimates for particulates, specially for black smoke, did not substantially change. The estimates for daily concentrations of SO(2) were greatly reduced, but, on the contrary, the association with peak concentrations of SO(2) did not show any change. CONCLUSIONS: There is an association between mortality and pollution through particulates among city populations in Spain. Peak rather than daily concentrations of SO(2) were related to mortality. Results suggest that populations in Spanish cities are exposed to health risks derived from air pollution.

The concentration-response relation between air pollution and daily deaths.

Studies on three continents have reported associations between various measures of airborne particles and daily deaths. Sulfur dioxide has also been associated with daily deaths, particularly in Europe. Questions remain about the shape of those associations, particularly whether there are thresholds at low levels. We examined the association of daily concentrations of black smoke and SO(2) with daily deaths in eight Spanish cities (Barcelona, Bilbao, Castellón, Gijón, Oviedo, Valencia, Vitoria, and Zaragoza) with different climates and different environmental and social characteristics. We used nonparametric smoothing to estimate the shape of the concentration-response curve in each city and combined those results using a metasmoothing technique developed by Schwartz and Zanobetti. We extended their method to incorporate random variance components. Black smoke had a nearly linear association with daily deaths, with no evidence of a threshold. A 10 microg/m(3) increase in black smoke was associated with a 0.88% increase in daily deaths (95% confidence interval, 0.56%-1.20%). SO(2) had a less plausible association: Daily deaths increased at very low concentrations, but leveled off and then decreased at higher concentrations. These findings held in both one- and two-pollutant models and held whether we optimized our weather and seasonal model in each city or used the same smoothing parameters in each city. We conclude that the association with particle levels is more convincing than for SO(2), and without a threshold. Linear models provide an adequate estimation of the effect of particulate air pollution on mortality at low to moderate concentrations.

[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.

[The short-term effects of air pollution on mortality. The results of the EMECAM project in Vitoria-Gasteiz, 1990-94. 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 Vitoria-Gasteiz, 1990-94.

BACKGROUND: The objective of this article is that of assessing the short-term relationship between the black smoke (SM) and SO2 levels and the mortality in Vitoria-Gasteiz over a five-year period by means of employing the procedure for analysis standardized in the EMECAM Project. METHODS: Ecological time series study aimed at estimating the relationship between the daily fluctuations in the mortality (total mortality of all ages and total death rate for those over age 70) and air pollution (sulfur dioxide-SO2 and black smoke), employing the Poisson regression models. The EMECAM methodology was followed. RESULTS: The median of daily deaths was three for the entire population and two for the elderly. The mean black smoke level was 51.15 micrograms/m3 and that of SO2 18.04 micrograms/m3. A statistically significant relationship was found to exist between black smoke and the mortality for the elderly through the cold half of the year, with an RR of 1.014 (CI95%: 1.002-1.026), pertinent to a 10 micrograms/m3 rise in the pollutant. A threshold at 80-90 micrograms/m3 seemed to be detected for black smoke. The relationship with SO2 was not significant. CONCLUSIONS: The black smoke levels for the period studied are related to a rise in the mortality among the elderly, tallying with the results of other studies.

[The EMECAM project: a discussion of the results in the participating cities. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / El proyecto EMECAM: discusión de los resultados en las ciudades participantes.

This article draws a comparison and provides a discussion of the findings resulting from the local analyses of the 14 cities participating in the EMECAM Project. An analysis is made of the time series related to mortality, pollutants (particles in suspension, SO2, NO2, O3 and CO), temperature and other factors taken from records of public institutions. By using Poisson autoregressive regression, an estimate has been made of the short-term relationship between the number of deaths and the air pollution indicators in each one of the following cities: Barcelona, metropolitan area of Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Seville, Oviedo, Valencia, Vigo, Vitoria and Saragossa. The findings reveal the air pollution figures in our country to be similar to those of other European cities. The levels of the different pollutants point toward road traffic as being the main source of most of this pollution. A relationship has been found between the mortality and different pollutants in most cities, although the results are not homogeneous among the cities and show variability in the different causes under study. In some cities, especially in those having smaller populations, there have been no findings providing any evidence of a relationship, or the findings themselves are not highly consistent. The meta-analysis will provide estimates for all of the cities as a whole and will allow the possibility of making a more clear-cut assessment of the time lag impact of air pollution on the mortality. Worthy of special mention is the participation in this project of public health officers as actively involved researchers.

[Acute pancreatitis and infection with the human immunodeficiency virus]. / Pancreatitis aguda e infección por el virus de la immunodeficiencia humana.

BACKGROUND: Retrospective study of the etiology and evolution of 40 episodes of acute pancreatitis in 28 patients infected with the human immunodeficiency virus (HIV). RESULTS: AIDS criteria were met by 89.3% of patients. The likely etiology was an opportunist infection in 32.5% of episodes, drug use in 22.5%, and biliary lithiasis in 5%. AP secondary to AIDS-associated cholangitis occurred in 35.7% of episodes. Sixty percent of episodes were severe in nature. The mortality rate reached 30%. CONCLUSIONS: AP in HIV infected patients: a) is more frequent in the advanced stages of disease; b) opportunistic infections and drugs are the most frequent causes in our environment; c) in a third of patients it is probably secondary to AIDS associated cholangitis; d) biliary lithiasis seems to be less common than in the general population, and e) it is associated with a high severity and mortality.

[Peritoneal pseudomyxoma secondary to mucinous cystadenoma of the ovary]. / Pseudomixoma peritoneal secundario a cistoadenoma mucinoso de ovario.

We present a new case of pseudomyxoma peritonei secondary to a mucinous cystadenoma of the ovary, whose presenting symptoms were abdominal distension and bilateral hernias. This is an uncommon entity and diagnosis tends to be casual. Each day, ultrasonography and computed tomography are more useful in suspicion. Aggressive surgical debulking followed by intraperitoneal chemotherapy seem to be the better treatment, even though controversies persist.