Noise Disturbance and Well-Being in the North of Spain.

Environmental noise is considered one of the main risks for physical and mental health and well-being, with a significant associated burden of disease in Europe. This work aims to explore the main sources of noise exposure at home and its effect on well-being in northern Spain. A transversal opinion study has been performed through a closed questionnaire. The questionnaire included three different parts: sociodemographic data, noise disturbance, and the 5-item World Health Organization Well-Being Index (WHO-5). A Binary Logistics Regression model was performed to analyze the relationship between noise exposure and well-being. Overall, 16.6% of the participants consider that the noise isolation of their homes is bad or very bad. The noise generated by the neighbors (air and impact noise) is considered the most disturbing indoor noise source, while street works are the most disturbing outdoor noise source in urban areas and road traffic is the most disturbing in rural areas. People who indicate that noise interferes with their life at home have a worse score on the WHO-5 (decreased perception of well-being). The exposure to outdoor noise (specifically the noise coming from the street and trains), internal impact noise produced by neighbors, and in general, the noise that wakes you up, is related to receiving a worse score in the WHO-5 (p < 0.05). Administrative bodies must ensure that laws regulating at-home noise levels, which are continually being updated with stricter restrictions, are enforced.

Pain and health-related quality of life in patients with hypophosphatasemia with and without ALPL gene mutations.

Background: Low serum alkaline phosphatase levels are the hallmark of hypophosphatasia, a disorder due to pathogenic variants of the ALPL gene. However, some patients do not carry ALPL variants and the cause of low alkaline phosphatase remains unknown. We aimed to determine health-related quality of life in adults with low alkaline phosphatase and explore the differences between patients with and without ALPL mutations. Methods: We studied 35 adult patients with persistently low alkaline phosphatase unrelated to secondary acquired causes who had ALPL sequenced, and 35 controls of similar age. Three questionnaires about body pain (Brief Pain Inventory, BPI), physical disability (Health Assessment Questionnaire Disability Index, HAQ-DI), and health-related quality of life (36-item Short-Form Health Survey, SF-36) were delivered by telephone interviews. Results: The mean BPI intensity and interference scores were higher in the patient group (p=0.04 and 0.004, respectively). All domains of the HAQ instrument tended to score better in the control group, with significant differences in the "reach" score (p=0.037) and the overall mean score (0.23 vs 0.09; p=0.029). Patients scored worse than controls in several SF-36 dimensions (Role physical, p=0.039; Bodily pain p=0.046; Role emotional, p=0.025). Patients with and without pathogenic variants scored similarly across all tests, without between-group significant differences. Conclusions: Patients with persistently low levels of alkaline phosphatase have significantly worse scores in body pain and other health-related quality of life dimensions, without differences between patients with and without pathogenic variants identified in ALPL gene. This is consistent with the latter ones carrying mutations in regulatory regions.

¿Son concluyentes los estudios epidemiológicos de suicidio en España? / Are the epidemiological studies of suicide in Spain conclusive?

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Suicide and apparent temperature in the two capitals cities in the iberian peninsula.

Different authors have identified geographic variations in the rates of suicide. This study aims to discuss the limitations of the officially recorded suicide data and to evaluate the statistical relationship between a biometeorological index, Apparent Temperature (AT), and suicide in Madrid and Lisbon. We performed a time-series study. The association was analyzed using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of AT on suicides, a lag non-linear model was fitted in a generalized additive model. There was an average rate of 3.30 suicides/100,000 inhabitants in Madrid and of 7.92 suicides/100,000 inhabitants in Lisbon, and a downward trend was found throughout the period. In Madrid, there is no statistically significant association between AT and suicide. However, in Lisbon, under higher AT, there was a higher risk of suicide. The highest accumulated statistically significant Relative Risk (RR) of suicide was detected at 7 days after the exposure, when at 38 °C, the risk of suicide is 2.7 times that existing at the median AT, 20.62°. The average mortality rate recorded in Lisbon was 41.6% higher than that registered in Madrid. However, the limitations of suicide record databases in Spain and Portugal have to be taken into account when analyzing incidence and especially when comparing data from different countries. It is necessary to improve the filing systems of violent deaths in order to perform reliable epidemiological studies.

Cocaine in Hospital Admissions for Diseases of the Circulatory System and as the Underlying Cause of Death: Analysis and Discussion.

Cocaine is a cardiotoxic drug which has been associated with morbi-mortality due to cardiovascular diseases (CVD). This study aims to: (1) analyze the hospitalizations due to cardiovascular processes and the presence of cocaine among the toxic habits of patients; and (2) discuss the forensic difficulties in sudden cardiac death (SCD) in the presence of cocaine. Hospital discharges due to CVD reporting cocaine consumption as a secondary diagnosis between 2003 and 2013 in Spain were analyzed. Subsequently, a review of judicial autopsies (SCD in cocaine users) was carried out to illustrate the forensic difficulties in the determination of the manner and underlying cause of death when cocaine use is involved. The average CVD morbidity rate was 1104.4 per 100,000 population. The most common main diagnoses of which cocaine use was recorded as a secondary diagnosis were rheumatic fever, ischemic heart disease and cerebrovascular disease in male patients between 15 and 44 years. The cardiovascular findings in the autopsies of cocaine users vary, and determining the mechanism that triggered the death in forensic practice is a challenge. The presence of cocaine among the toxic habits of young patients admitted for CVD in Spain is increasing. In our opinion, criteria must be unified to establish the manner and underlying cause of death in SCD and toxicological analysis can be a key part in the process.

El delito contra la libertad sexual en el anciano: una realidad escondida difícil de detectar / Sexual abuse of the elderly: A hidden, difficult to detect, reality

El maltrato a personas mayores es un problema de salud pública; existen diversos tipos de maltrato; el abuso sexual en el anciano es uno de los menos estudiados y comúnmente no se detecta. Este trabajo presenta el caso de una paciente que fue llevada al hospital por la sospecha de que pudiera haber sido víctima de un delito contra la libertad sexual. La paciente se encontraba ingresada en una residencia geriátrica y presentaba una demencia de 10 años de evolución. En el artículo se expone la vulnerabilidad de este tipo de pacientes y las dificultades encontradas para el diagnóstico, y se reflexiona sobre la necesidad de trabajar en la prevención e intervención efectiva desde el ámbito sanitario

Abuse of the elderly is an important public health problem. There are different types of abuse, with sexual abuse being one of the least studied, and usually underdiagnosed. A forensic case-study is presented on a female patient who was taken to the hospital under the suspicion that she had have been a victim of sexual assault. The patient was admitted to a geriatric centre and had been diagnosed with senile dementia type I of 10 years onset. In this article, an analysis is carried out on the vulnerability of this kind of patient, the difficulties in diagnosis, and on the need to work on prevention and effective intervention from a health care perspective

¿Afecta el medio a los suicidios que se cometen en España? Análisis descriptivo del patrón temporoespacial / Does the environment affect suicide rates in Spain? A spatiotemporal analysis

Introducción: El suicidio es un problema de salud pública, ya que representa una de las principales causas de muerte no natural. Hay múltiples factores que influyen en el riesgo de la conducta suicida. Este trabajo analiza la distribución geográfica del suicidio en España, el patrón temporal y la relación entre la tasa de suicidios y el producto interior bruto (PIB) per cápita en el país. Material y métodos: Se ha realizado un estudio retrospectivo en el que se han analizado las muertes por suicidio, por sexo y por grupos de edad, en las 50 provincias españolas entre 2000 y 2012. La tendencia anual de los suicidios se calculó mediante el coeficiente de correlación Tau b de Kendall, y se empleó el análisis de varianza (ANOVA) y el test de Bonferroni para evaluar las diferencias en la mortalidad a escala estacional, mensual y semanal. Finalmente, se evaluó la asociación entre el PIB per cápita y las muertes autoinflingidas en las provincias. Resultados: Entre 2000 y 2012 fallecieron 42.905individuos de 15años de edad en adelante por suicidio en España. La tasa media anual de incidencia durante el periodo de estudio fue de 95suicidios/millón de habitantes. El sur y el noroeste de España acumularon las mayores tasas de mortalidad por esta causa. A escala global, en el país existió una tendencia descendente en las muertes por suicidio en personas de más de 64años (CC=-0,744; p=0,0004), y los suicidios siguieron un patrón estacional con máximos en verano y mínimos en otoño (f=0,504; p<0,0001); asimismo, se encontró una relación inversa entre el PIB per cápita y la tasa de suicidios de cada provincia (r=-0,645; p<0,0001), que se intensificó en los grupos poblacionales de mayor edad. Conclusiones: Los suicidios no siguen una distribución geográfica homogénea en el país y la tasa de suicidios en varones es muy superior a la tasa en mujeres. Existió un descenso en la tasa de suicidios en las personas de más de 64años, por lo que parece que las medidas de actuación tomadas en España estuvieran siendo efectivas. El patrón espacio-temporal encontrado, así como la relación con el PIB, sirven de base para en futuros estudios poder profundizar en los factores de riesgo asociados

Introduction: Suicide is an important public health problem, it represents one of the major causes of unnatural death, and there are many factors that affect the risk of suicidal behaviour. The present study analyzes the temporal and spatial variations of mortality by suicide in Spain and its relationship with gross domestic product (GDP) per capita. Material and methods: A retrospective study was performed, in which deaths by suicide, sex and age group in 50 Spanish provinces between 2000 and 2012 were analyzed. The annual trend of suicide mortality was assessed using Kendall's tau-b correlation coefficient. Seasonality and monthly and weekly behaviour were evaluated by performing the ANOVA test and the Bonferroni adjustment. Finally, the relationship between GDP per capita and suicide was studied. Results: Between 2000 and 2012, 42,905adult people died by suicide in Spain. The annual average incidence rate was 95 suicides per million population. The regions located in the south and in the northwest of the country registered the highest per capita mortality rates. There is a decreasing trend in mortality by suicide over the period studied (CC=-.744; P=.0004) in adults over the age of 64, and a seasonal behaviour was identified with summer maximum and autumn minimum values (f=.504; P<.0001). The regions with the highest GDP per capita showed the lowest mortality by suicide (r=-.645; P<.0001) and the relationship is stronger among older age groups. Conclusions: Mortality by suicide does not follow a homogenous geographical distribution in Spain. Mortality in men was higher than in women. Over the period of study, there has been a decrease in mortality by suicide in Spain in adults over the age of 64. The seasonal cycle of suicides and the inverse relationship with GDP per capita found in this study, provide information which may be used as a tool for developing prevention and intervention strategies

Riesgos y conflictos ante la clasificación de las personas transexuales como pacientes de salud mental / Risks and conflicts regarding the classificacion of transexual individuals as mental health patients

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Association Between Suicide and Environmental Variables in the North of Spain: A 14-Year Analysis.

Suicide is a serious public health problem around the world. Since the nineteenth century, the impact of socio-environmental factors on suicide has attracted much public attention, especially in the context of global climate change. We have performed a retrospective correlation study that analyzes the demographic pattern of suicide in Cantabria, a northern coastland region of Spain. Moreover, we have created a multivariable binomial regression model to study the relationship between suicide and environmental factors (atmospheric pollutants and meteorological variables) among January 1, 2000, and December 31, 2013 in the province. During the 14-year study period, there was a suicide annual incidence of 4.9 cases per 100,000 population in Cantabria. The incidence was highest in adults aged 70-74 years old (11.8 per 100,000 population). The most common method group of suicide was hanging, strangulation and suffocation, accounting for 49.3% of all suicide deaths. When correlating suicide and meteorological variables, a statistically significant association was found with the level of cloudiness (p = 0.007). According to our results, an increase of one eighth of sky cloud-cover correlated to a 7% increase in total deaths by suicide and the association was especially strong during spring.

Does the environment affect suicide rates in Spain? A spatiotemporal analysis. / ¿Afecta el medio a los suicidios que se cometen en España? Análisis descriptivo del patrón temporoespacial.

INTRODUCTION: Suicide is an important public health problem, it represents one of the major causes of unnatural death, and there are many factors that affect the risk of suicidal behaviour. The present study analyzes the temporal and spatial variations of mortality by suicide in Spain and its relationship with gross domestic product (GDP) per capita. MATERIAL AND METHODS: A retrospective study was performed, in which deaths by suicide, sex and age group in 50 Spanish provinces between 2000 and 2012 were analyzed. The annual trend of suicide mortality was assessed using Kendall's tau-b correlation coefficient. Seasonality and monthly and weekly behaviour were evaluated by performing the ANOVA test and the Bonferroni adjustment. Finally, the relationship between GDP per capita and suicide was studied. RESULTS: Between 2000 and 2012, 42,905adult people died by suicide in Spain. The annual average incidence rate was 95 suicides per million population. The regions located in the south and in the northwest of the country registered the highest per capita mortality rates. There is a decreasing trend in mortality by suicide over the period studied (CC=-.744; P=.0004) in adults over the age of 64, and a seasonal behaviour was identified with summer maximum and autumn minimum values (f=.504; P<.0001). The regions with the highest GDP per capita showed the lowest mortality by suicide (r=-.645; P<.0001) and the relationship is stronger among older age groups. CONCLUSIONS: Mortality by suicide does not follow a homogenous geographical distribution in Spain. Mortality in men was higher than in women. Over the period of study, there has been a decrease in mortality by suicide in Spain in adults over the age of 64. The seasonal cycle of suicides and the inverse relationship with GDP per capita found in this study, provide information which may be used as a tool for developing prevention and intervention strategies.

Genetic DNA profile in urine and hair follicles from patients who have undergone allogeneic hematopoietic stem cell transplantation.

Biological samples from patients who have undergone allogeneic hematopoietic stem cell transplantation (HSCT) constitute a challenge for individual identification. In this study we analyzed the genetic profiles (by the amplification of 15 autosomic STRs) of HSCT patients found in different types of samples (blood, hair and urine) that may be the source of DNA in civil or criminal forensic cases. Our results show that while in hair follicles the donor component was not detected in any patient, thus being a reliable source of biological material for forensic identification, mixed chimerism was detected in urine samples from all patient, and no correlation was found between the time elapsed from the transplant and the percentage of chimerism. These results certainly have practical implications if the urine is being considered as a source of DNA for identification purposes in HSTC patients. Moreover, taking into consideration that chimerism was found not only in patients with leukocyturia (given the hematopoietic origin of leukocytes, this was expected), but also in those without observable leukocytes in the sediment, we conclude that an alternative source or sources of donor DNA must be implicated.