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Biomedical subjects

J Sunyer

Publications and source records attributed to J Sunyer.

At least 73 records · Page 4Linked to original sources
PubMed2000

Differences in incidence of reported asthma related to age in men and women. A retrospective analysis of the data of the European Respiratory Health Survey.

Sex differences in asthma prevalence and morbidity, assessed with different methods in different populations, have raised several hypotheses about the different susceptibility to asthma in men and women. However, information on the incidence of asthma by age and sex is limited. The aim of this study was to estimate the age- and sex-specific incidence of asthma from birth to 44 yr of age in men and women across several countries, and to evaluate the main factors influencing asthma incidence in young adults. The data of the European Community Respiratory Health Survey, an international, cross-sectional, population-based survey, which were collected in 16 countries from 1991 to 1993 according to a common protocol, and which pertained to 18,659 subjects, were analyzed retrospectively, using the reported age of the first attack as the onset of asthma. During childhood, girls had a significantly lower risk of developing asthma than did boys (relative risk [RR]: 0.74 and 0.56 in the 0- to 5-yr and 5- to 10-yr age classes, respectively). Around puberty, the risk was almost equal in the two sexes (RR = 0.84; 95% confidence interval [CI]: 0.65 to 1.10 in the 10 to 15-yr age class). After puberty, the risk in women was always significantly higher than that in men (RR: 1.38 to 5.91). This pattern was consistent in all of the 16 countries studied, and was not influenced by recall or cohort effects. When the effects of airway caliber and smoking were studied with a case-control design, the results showed that women's greater susceptibility to asthma in early adulthood was at least partly, explained by their smaller airway caliber (the OR decreased from 2. 04 [95% CI: 1.32 to 3.15] to 1.47 [95% CI: 0.89 to 2.44] after controlling for height-adjusted FEV(1)); while smoking did not increase the risk. This analysis strongly confirms that the incidence of asthma shows a sex reversal during puberty, and suggests that airway caliber, in addition to hormonal factors, could play an important role in explaining the different patterns of asthma incidence in men and women.

Adolescent↗
PubMed2000

International assessment of the internal consistency of respiratory symptoms. European Community Respiratory Health Study (ECRHS).

We aimed to assess cross-cultural validity of the reporting of respiratory symptoms in the European Community Respiratory Health Study (ECRHS). A random sample of subjects from the general population (aged 20-44 yr), from 35 centers in 15 countries, answered a questionnaire and underwent allergy tests and airway challenge with methacholine. The overall response rate to the questionnaire was 60% (n = 16,635). Exploratory factor analysis was used to identify how symptoms were grouped (i.e., to specify factor structure), using data from the United Kingdom. Subsequently, a confirmatory factor analysis of the prespecified structure for the United Kingdom was assessed for each country in consecutive nested models, increasing at each step the number of parameters forced to be equal to the United Kingdom, and assessing the goodness of fit. Variables were clustered in the same four groups (factors) in all countries. The four factors, mutually adjusted, were associated with either bronchial responsiveness, atopy, or smoking, which provides coherence for the separation of the four factors. In the confirmatory factor analysis, when the load of each of the symptoms in the corresponding factor was prespecified, all countries except Spain showed an adequate fit; in Spain there were differences in answers concerning asthma treatment. We conclude that the ECRHS multilingual translated respiratory symptoms questionnaire shows high internal consistency, suggesting that international comparisons are not affected by errors due to cross-cultural variations in the reporting of symptoms.

Adult↗
PubMed2000

Comparison of asthma prevalence in the ISAAC and the ECRHS. ISAAC Steering Committee and the European Community Respiratory Health Survey. International Study of Asthma and Allergies in Childhood.

International and regional prevalence comparisons are required to test and generate hypotheses regarding the causes of increasing asthma prevalence in various age groups worldwide. The International Study of Asthma and Allergies in Childhood (ISAAC) is the first such study in children and the European Community Respiratory Health Survey (ECRHS) is the first such study in adults. Therefore, a comparison of the findings of these two surveys was conducted, for the 17 countries in which both surveys were undertaken. There was a strong correlation between the ISAAC and ECRHS prevalence data, with 64% of the variation at the country level, and 74% of the variation at the centre level, in the prevalence of "wheeze in the last 12 months" in the ECRHS phase I data being explained by the variation in the ISAAC phase I data. There was also generally good agreement in the international patterns observed in the two surveys for self-reported asthma (74% of country level and 36% of centre level variation explained), self-reported asthma before age 14 yrs (64 and 26%), hay fever (61 and 73%) and eczema (41 and 50%). Thus although there were differences in the absolute levels of prevalence observed in the two surveys, there is good overall agreement between the International Study of Asthma and Allergies in Childhood and European Community Respiratory Health Survey study findings with regard to international prevalence patterns. These findings, therefore, add support to the validity of the two studies, which provide a new picture of global patterns of asthma prevalence from child- to adulthood, and identify some of the key phenomena which future research must address.

Adolescent↗
PubMed2000

Cord serum cotinine as a biomarker of fetal exposure to cigarette smoke at the end of pregnancy.

This study investigated the association between biomarkers of fetal exposure to cigarette smoke at the end of pregnancy, cotinine in cord serum and in maternal and newborn urine samples, and quantitative measurement of smoking intake and exposure evaluated by maternal self-reported questionnaire. Study subjects were 429 mothers and their newborns from a hospital in Barcelona, Spain. A questionnaire including smoking habits was completed in the third trimester of pregnancy and on the day of delivery. Cotinine concentration in cord serum was associated with daily exposure to nicotine in nonsmokers and with daily nicotine intake in smokers. The geometric mean of cotinine concentration in cord serum statistically discriminated between newborns from nonexposed and exposed nonsmoking mothers, and between these two classes and smokers, and furthermore was able to differentiate levels of exposure to tobacco smoke and levels of intake stratified in tertiles. Urinary cotinine levels in newborns from nonsmoking mothers exposed to more than 4 mg nicotine daily were statistically different from levels in two other categories of exposure. Cotinine concentration in urine from newborns and from mothers did not differentiate between exposure and nonexposure to environmental tobacco smoke (ETS) in nonsmoking mothers. Cord serum cotinine appeared to be the most adequate biomarker of fetal exposure to smoking at the end of pregnancy, distinguishing not only active smoking from passive smoking, but also exposure to ETS from nonexposure.

Adult↗
PubMed2000

Excretion of hexachlorobenzene and metabolites in feces in a highly exposed human population.

A set of 53 individuals from a population highly exposed to airborne hexachlorobenzene (HCB) were selected to study the elimination kinetics of this chemical in humans. The volunteers provided blood, 24-hr urine, and feces samples for analysis of HCB and metabolites. The serum HCB concentrations ranged from 2.4 to 1,485 ng/mL (mean +/- SD, 124 +/- 278), confirming that this human population has the highest HCB blood levels ever reported. All analyzed feces samples contained unchanged HCB (range, 11-3,025 ng/g dry weight; mean +/- SD, 395 +/- 629). The HCB concentration in feces strongly correlated with HCB in serum (r = 0.85; p < 0.001), suggesting an equilibrium in feces/serum that is compatible with a main pulmonary entrance of the chemical and low intestinal excretion of nonabsorbed foodborne HCB. The equilibrium is also compatible with a nonbiliary passive transfer of the chemical to the intestinal lumen. Two HCB main metabolites, pentachlorophenol (PCP) and pentachlorobenzenethiol (PCBT), were detected in 51% and 54% of feces samples, respectively. All urine samples contained PCP and PCBT, confirming the conclusions of a previous study [Environ Health Perspect 105:78-83 (1997)]. The comparison between feces and urine showed that whereas daily urinary elimination of metabolites may account for 3% of total HCB in blood, intestinal excretion of unchanged HCB may account for about 6%, thus showing the importance of metabolism in the overall elimination of HCB. The elimination of HCB and metabolites by both routes, however, appears to be very small (< 0.05%/day) as compared to the estimated HCB adipose depots. Features of HCB kinetics that we present in this study, i.e., nonsaturated intestinal elimination of HCB and excretion in feces and urine of inert glutathione derivatives, may explain, in part, the absence of porphyria cutanea in this human population heavily exposed to HCB.

Adolescent↗
PubMed2000

Serum concentrations of hexachlorobenzene in family members of workers in an electrochemical factory.

OBJECTIVES: This study analyzed the effect of living in the same household with a worker employed in an electrochemical factory on the hexachlorobenzene (HCB) concentrations of serum in the general population of Flix, Spain. METHODS: A total of 608 subjects from the general population (response rate 42%) completed a questionnaire about residence, occupation, life-styles, and medical history and provided blood samples. Among them, 412 had never worked in the electrochemical factory. Information about the occupation of the family members was completed, and the subjects were classified with the degree of relationship with the worker having been taken into account. A multiple linear regression analysis was conducted to model HCB serum for nonfactory workers. RESULTS: Having a spouse who worked in the factory was associated with elevated HCB concentrations in serum. The adjusted relative increases were 1.28 (P=0.0004) and 1.23 (P=0.0022) times the corresponding value of people not living with workers of the factory, respectively for spouses of current and past workers. Relatives other than spouses did not show any increase. CONCLUSIONS: The results of this study suggest that, among nonworkers, living with a worker of the electrochemical factory in Flix is associated with an increase in concentrations of HCB in blood. These findings may suggest a source of exposure to HCB that has thus far not been studied and that could be important in populations not occupationally exposed to organochlorines.

Adult↗
PubMed2000

Bladder cancer in the textile industry.

OBJECTIVES: This study examined the occupations and industries at high risk for bladder cancer in an area where the textile industry is plentiful and the incidence of the disease is very high. METHODS: A case-referent study concerning 218 incident bladder cancer cases diagnosed during 1993-1995 in the county of Vallès Occidental, Barcelona, was carried out. A reference group (N=344) was selected from municipal lists matched to the cases by age, gender, and area of residence. All the subjects were personally interviewed, and a complete occupational history was abstracted together with other sociodemographic and life-style factors. All odds ratios (OR) and 95% confidence intervals (95% CI) were adjusted for age, gender, and smoking. RESULTS: No overall excess risk was found forever having worked in the textile industry (OR 1.13, 95% CI 0.79-1.63) nor for specific sectors of this industry (ie cotton, wool, silk). An excess risk was observed for spinners and winders employed for more than 20 years (OR 3.28, 95% CI 1.08-9.97) and for machine setters employed between 1960 and 1974 (OR 4.26, 95% CI 1.09-16.7). CONCLUSIONS: The results of this study do not support the findings of some earlier studies for an increased bladder cancer risk in the textile industry. However, some elevated risks were observed among the workers with the highest exposures.

Adult↗
PubMed1999

Occupational asthma in Europe and other industrialised areas: a population-based study. European Community Respiratory Health Survey Study Group.

BACKGROUND: There are no large population-based studies on occupational asthma, and few estimates of the proportion of asthma attributed to occupation, even though asthma is the most common occupational respiratory disorder in industrialised countries. METHODS: We assessed data on 15,637 people aged 20-44, randomly selected from the general population of 26 areas in 12 industrialised countries. Asthma was assessed by methacholine challenge test and by questionnaire data on respiratory symptoms and use of medication. Occupation was defined by job-titles and a job exposure matrix was constructed. FINDINGS: Highest risk of asthma, defined as bronchial hyperresponsiveness and reported asthma symptoms or medication, was shown for farmers (odds ratio 2.62 [95% CI 1.29-5.35]), painters (2.34 [1.04-5.28]), plastic workers (2.20 [0.59-8.29]), cleaners (1.97 [1.33-2.92]), spray painters (1.96 [0.72-5.34]), and agricultural workers (1.79 [1.02-3.16]). Similar risks were shown for asthma defined as reported asthma symptoms or medication. The most consistent results across countries were shown for farmers and cleaners. Excess asthma risk was associated with high exposure to biological dusts, mineral dusts, and gases and fumes. The proportion of asthma among young adults attributed to occupation was 5%-10%. INTERPRETATION: The prevalence of occupational asthma in women and in specific occupations has been underestimated. Given a mean prevalence of asthma of about 5%, about 0.2%-0.5% of young adults become asthmatics or have their asthma exacerbated because of their occupations.

Adult↗
PubMed1999

Asthma visits to emergency rooms and soybean unloading in the harbors of Valencia and A Coruña, Spain.

Soybean unloading in the harbor of Barcelona, Spain, has been associated with large increases in the numbers of asthma patients treated in emergency departments between 1981 and 1987. In this study, the association between asthma and soybean unloading in two other Spanish cities, Valencia and A Coruña, was assessed. Asthma admissions were retrospectively identified for the period 1993-1995, and harbor activities were investigated in each location. Two approaches were used to assess the association between asthma and soybean unloading: One used unusual asthma days (days with an unusually high number of emergency room asthma visits) as an effect measure, and the other estimated the relative increase in the daily number of emergency room visits by autoregressive Poisson regression, adjusted for meteorologic variables, seasonality, and influenza incidence. No association between unusual asthma days and soya unloading was observed in either Valencia or A Coruña, except for one particular dock in Valencia. When the association between unloaded products and the daily number of emergency asthma visits was studied, a statistically significant association was observed for unloading of soya husk (relative risk = 1.50, 95% confidence interval 1.16-1.94) and soybeans (relative risk = 1.31, 95% confidence interval 1.08-1.59) in A Coruña. In Valencia, a statistical association was found only for the unloading of soybeans at two particular docks. Although these findings support the notion that asthma outbreaks are not a common hidden condition in most harbors where soybeans are unloaded, the weak associations reported are likely to be causal. Therefore, appropriate control measures should be implemented to avoid soybean dust emissions, particularly in harbors with populations living in the vicinity.

Air Pollutants↗
PubMed1999

Urinary porphyrin excretion in a human population highly exposed to hexachlorobenzene.

BACKGROUND: Data from an epidemic reported in Turkey (1955-1959) is the only information about the relationship between hexachlorobenzene (HCB) intake and porphyria cutanea tarda in humans. No information is available on the HCB threshold exposure level to induce porphyria cutanea tarda. OBJECTIVES: To study HCB serum levels and urinary porphyrin excretion in the inhabitants of a village located near an organochlorine compound factory with high HCB concentrations in the air and to detect possible alterations in urinary porphyrin excretion and examine their relationship with HCB serum levels. DESIGN: Cross-sectional study. SETTING: Unit of Porphyrias of a tertiary care facility in Barcelona, Spain. PARTICIPANTS: Six hundred four inhabitants of the village who were older than 14 years provided serum and urine samples (185 participants were factory workers). MAIN OUTCOME MEASURES: Serum HCB was analyzed by gas chromatography coupled to electron capture detection. Quantification of urinary total porphyrins was performed by spectrofluorimetry. Porphyrin profile was determined by high-pressure liquid chromatography. RESULTS: Hexachlorobenzene was detected in all serum samples (mean, 39.8 ng/mL; range, 1.1-1616.0 ng/mL), and levels were higher in factory workers. Mean +/- SD level urinary total porphyrin average concentration was 98 +/- 69 nmol/L (range, 9-1009 nmol/L). Only the urine sample with the highest porphyrin concentration showed an increase of highly carboxylated porphyrins, with a typical profile of porphyria cutanea tarda. In the remaining 603 urine samples, coproporphyrin was the predominant fraction. CONCLUSION: The airborne exposure to and increased body burden of HCB in the Flix village population are not enough to trigger a significant alteration of the heme biosynthesis pathway.

Adolescent↗
PubMed1999

Missense mutations in the cystic fibrosis gene in adult patients with asthma.

Asthma is a complex genetic disorder that affects 5% of adults and 10% of children worldwide. The complete characterization of the cystic fibrosis transmembrane conductance regulator (CFTR) gene identified missense mutations in 15% of 144 unrelated adult patients with asthma, but in none of 41 subjects from the general population. The four more common mutations were analyzed in an extended sample consisting of 184 individuals from the general population and did not show a significant difference in frequency. The hyperfunctional CFTR M470 allele was detected in 90% of patients with CFTR missense mutations, but in 63% of subjects from the general population and 63% of asthma patients without CFTR mutations. None of the patients with missense mutations had the 5T allele of intron 8 of CFTR, responsible for low CFTR levels, while it was detected in 8% of asthma patients without CFTR mutations and in 9% of subjects from the general population. These findings suggest a putative role for a combination of CFTR missense mutations, including the M470 allele, in the genetic variability of asthma.

Adult↗
PubMed1999

[European Asthma Study. Identifying and treating young adults with epidemiological criteria for asthma in five areas of Spain. Spanish Group of the European Asthma Study].

BACKGROUND AND OBJECTIVES: Asthma's great impact on public health stems from its chronicity and to high prevalence among all age groups and both sexes. To estimate the appropriateness of treatment and management of asthma in Spain during the period of 1991 and 1992, we analyzed data from the European Community Respiratory Health Survey (ECRHS). METHOD: The ECRHS was undertaken with a random sample of 20-to-44-year-olds in Albacete, Barcelona, Galdakao, Huelva and Oviedo. In total, 181 individuals with asthma were identified. Current asthma was defined as the presence of respiratory symptoms associated with asthma within the past 12 months and a positive methacholine challenge test. RESULTS: Subjects who were unaware of having asthma made up 57.5% (CI: 49.9-64.8%), and 35.9% (CI: 27.9-42.3%) were not following any specific treatment. Among asthmatics who reported having continuous or frequent respiratory symptoms, 25.9% (CI: 15.3-39.0%) were not following any treatment. CONCLUSION: Over half the individuals with asthma in 1991 to 1993 were unaware of having the disease at the time of the study or of ever having had it, and approximately one third were not in treatment. The delivery of appropriate treatment in asthma generally, and in asthma with continuous or frequent respiratory symptoms, was markedly inadequate during the period studied.

Adult↗
PubMed1999

Differences in mortality between patients attending the emergency room services for asthma and chronic obstructive pulmonary disease.

Asthma has a more favourable prognosis than chronic obstructive pulmonary disease (COPD), based on studies including few asthmatics and few women with COPD. We assessed differences in mortality between people attending the emergency room for asthma and for COPD in a population-based cohort. We recruited all the men and women, who were residents of Barcelona (Spain) over 14 years of age, who attended emergency room services for an obstructive lung disease during the period 1985-1989. Vital status was followed up to the end of 1995. A total of 15,517 individuals (including 4555 asthmatics and 2194 females with COPD) were studied. Mortality was ascertained using a record linkage with the regional Mortality Registry. Overall, 43.6% people died during the follow-up period. Mortality was higher among individuals with COPD than with asthma, in males and females, for all causes of death, as well as for cancer, cardiovascular and respiratory causes. After adjusting for age, the relative risk (RR) of dying of a male attending for COPD and discharged home was 1.50 (1.29-1.74) in comparison with a male attending for asthma, and 3.06 (2.66-3.51) for a male attending for COPD and admitted into the hospital. Similar figures were found for females. The increased risk for patients with COPD was significantly higher than for asthma in all age groups. Both males and females with asthma have a more favourable prognosis than patients with COPD, for all age groups.

Adolescent↗
PubMed1999

Sensitization to individual allergens and bronchial responsiveness in the ECRHS. European Community Respiratory Health Survey.

Little is known about the relation of bronchial responsiveness (BHR) to sensitization to individual allergens, or its variation between countries. Data were obtained for BHR, specific immunoglobulin E and confounding variables from 11,215 subjects, aged 20-44 yrs at the start of the European Community Respiratory Health Survey, in 34 centres in 15 countries. The relation of BHR to sensitization to cat, house dust mite, timothy grass and Cladosporium was estimated by means of multiple regression for each centre, and combined across centres by random effects meta-analysis, controlling for baseline lung function, height, sex, season of testing, age, smoking and age/sex and age/smoking interactions. BHR was greater, on average, in those sensitized to cat (p=0.023), house dust mite (p<0.001) and timothy grass (p=0.018), but not to Cladosporium (p=0.60), and increased with degree of sensitization (p<0.001). All relations showed heterogeneity between centres, although to a lesser extent in the relation to sensitization to house dust mite. More variation in bronchial responsiveness was explained by sensitization and degree of sensitization to the individual allergens than by atopy defined as any positive test in each centre, but the relative importance of each allergen varied. The use of atopy as a single variable in relation to bronchial hyperresponsiveness may be misleading.

Adult↗