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Biomedical subjects

J Sunyer

Publications and source records attributed to J Sunyer.

At least 127 records · Page 7Linked to original sources
PubMed1995

Relationship between weather temperature and mortality: a time series analysis approach in Barcelona.

BACKGROUND: Many studies have reported that heatwaves increase mortality. However, it is not certain whether less pronounced rises in temperature also increase it. Such information might be important for predicting the impact of potential weather changes on mortality. We have assessed the relationship between daily mortality and moderate increases in weather temperature in Barcelona, Spain, following a time series approach. METHODS: The study included the period from 1 January 1985 to 30 December 1989. For all the population resident in Barcelona, Spain, we considered the following daily data: total mortality, mortality of those > 65 years, and cardiovascular and respiratory mortality. The meterological variables were: minimum temperature, maximum temperature, dew point temperature and relative humidity. Several transfer function (ARIMA) models were estimated for the entire period and for both winters and summers separately. RESULTS: We found that unusual periods of at least three consecutive days of increased weather temperature increased mortality, independently of the V-shaped relationship also found. The occurrence of an unusual period increased total daily mortality by 2% on average (1.7% on summers) and by 2.6% in those over 65 (2% on summers). Cardiovascular mortality rose by 4.6% (4.2% on summers) and respiratory mortality by 21.6% (13.2% on summers). However, only those unusual periods with an excess temperature and humidity were associated with mortality increases. CONCLUSIONS: The unusual periods observed in the present study cannot be classified as heatwaves because the weather temperature never reached high values and most of them occurred during the winter. The association of unusual periods with mortality was stronger during winters than in summers, maybe because unusual winter periods showed a temperature deviation from the average twice that in summer or because humidity during unusual winter periods was higher than in summer.

Aged↗
PubMed1995

Short-term association between air pollution and emergency room visits for asthma in Barcelona.

BACKGROUND: Several studies have assessed the association between urban air pollutants and hospital admissions or emergency room visits for asthma with inconsistent results. The objective of this study was to assess the relation between levels of black smoke, sulphur dioxide, nitrogen dioxide, and ozone and adult emergency room visits for asthma in Barcelona, Spain during the five year period 1985-9. METHODS: The daily number of emergency room visits for asthma was obtained from a register of respiratory emergencies designed to study the asthma outbreaks occurring in Barcelona. The association between asthma visits and levels of pollutants was assessed separately for summers and winters with Poisson regression models controlling for meteorological and time related variables. RESULTS: Black smoke was associated with asthma visits in summer but not in winter. The relative risk (RR) of asthma visits for a 25 micrograms/m3 increase of current day concentrations of black smoke was 1.082 (95% CI 1.011 to 1.157). The mean current and previous three day levels of black smoke led to a stronger association (RR = 1.114 (95% CI 1.010 to 1.160). In addition, nitrogen dioxide was associated with asthma visits in both summer (RR = 1.045, 95% CI 1.009 to 1.081) and winter (RR = 1.056, 95% CI 1.011 to 1.104). These associations were slightly higher for the previous day's level of nitrogen dioxide. No associations were found for sulphur dioxide or for ozone. CONCLUSIONS: This study provides further evidence of the effect of particulate pollution on asthma, and it suggests that nitrogen dioxide may have a role in the exacerbation of bronchial asthma in adults.

Adolescent↗
PubMed1995

Short-term effects of air pollution on health: a European approach using epidemiological time-series data. The APHEA project: background, objectives, design.

Recent studies investigating the adverse health effects of air pollution indicate that effects exist around and below the current national and international air quality guidelines and standards. However, the difficult methodological issues involved, and the diversity of analytical techniques so far applied, hinder direct between-study comparability and the drawing of clear conclusions. The APHEA (Air Pollution on Health: European Approach) project is an attempt to provide quantitative estimates of the short-term health effects of air pollution, using an extensive data base from 10 different European countries, which represent various social, environmental and air pollution situations. Within the framework of the project, the methodology of analysing epidemiological time series data, as well as that of performing meta-analysis, are further developed and standardized. Data have been collected from 15 European cities with a total population exceeding 25 million. The exposure data consist of daily measurements of black smoke, sulphur dioxide, suspended particles, nitrogen dioxide and ozone (each available in several, though not all, cities) from already existing monitoring networks. There is substantial variability in air pollution mixtures and air pollutant levels in participating cities. The mean (24 h) levels of SO2 range 27-327 micrograms.m-3 in the winter season, and those of black smoke range 15-292 micrograms.m-3. The mean (1 h) levels of ozone in the summer season range 32-166 micrograms.m-3. The outcome data are daily counts of total and cause-specific deaths and hospital emergency admissions. Data on potential confounders (mainly meteorological and chronological variables) are also used. There is large diversity in the climatic conditions in the different cities.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants↗
PubMed1994

Risk excess of soft-tissue sarcoma and thyroid cancer in a community exposed to airborne organochlorinated compound mixtures with a high hexachlorobenzene content.

Unusually high levels of hexachlorobenzene (HCB) were detected in the air and in sera of volunteers of a village located in the vicinity of an organochlorinated-compounds factory (Flix, Catalonia, Spain). A significant increase for specific causes of death was obtained only for neoplasms of unknown origin. However, an excess of incident cases was observed for thyroid neoplasms, soft-tissue sarcoma and brain neoplasms in men. These descriptive findings are in agreement with previously reported associations between soft-tissue sarcoma and human exposure to organochlorinated compounds, as well as with animal experiments relating HCB and thyroid cancer, and add new information on the possible relation between organochlorinated compounds, and particularly HCB, and cancer.

Air Pollutants↗
PubMed1994

Clinical and functional characteristics of patients two years after being affected by the soybean asthma epidemic in Barcelona.

BACKGROUND: Patients affected during the asthma outbreaks caused by soybean dust inhalation in Barcelona presented with sudden onset of severe asthma followed by the rapid relief of symptoms after treatment. Two years after the epidemics ended, a case-control study was conducted in which the clinical, functional, and immunological characteristics of these asthma patients (a randomised sample of asthmatic patients admitted as emergency cases on epidemic days, n = 213) were compared with those of a control group (a random sample of asthmatic patients admitted as emergency cases for attacks of asthma on non-epidemic days, n = 170). METHODS: The study included the administration of the ATS-DLD78 standardised respiratory questionnaire, the measurement of atopy, and performance of spirometric tests and a methacholine inhalation test. RESULTS: Patients with epidemic asthma reported fewer symptoms of asthma, had attended emergency departments less frequently during the previous year for acute attacks of asthma, were taking fewer inhaled corticosteroids at the time of the study, and attended medical follow up less frequently than did the patients with non-epidemic asthma. However, the cases and controls showed no differences in ventilatory capacity or reactivity to the methacholine bronchoprovocation test. CONCLUSIONS: Two years after the end of the soybean epidemics, people affected by epidemic asthma had a favourable prognosis. This finding contrasts with a higher risk of life threatening asthma and death during the epidemics. This paradox could be the result of a complex interaction between host and conditions of exposure.

Asthma↗
PubMed1993

Preventing asthma epidemics due to soybeans by dust-control measures.

BACKGROUND: The inhalation of soybean dust released during the unloading of soybeans into a silo caused outbreaks of asthma in Barcelona, Spain. This study was designed to determine morbidity due to asthma and serum IgE reactivity before and after the installation of filters in the silo. METHODS: We measured soybean-allergen concentrations in 136 samples of air collected for 9 months before and 24 months after the installation of filters. We compared the number of days on which there was an unexpected increase in emergency room visits for asthma, the number of days on which the number of emergency room visits for asthma in one four-hour period was so high that it was unlikely to be due to chance, and the mean daily number of emergency room and intensive care unit admissions for asthma for a total of 60 months before and after filter installation. Serum IgE antibodies against soybean allergens were measured in 38 patients before and after filter installation. RESULTS: The concentration of airborne soybean allergens on days when soybeans were unloaded decreased from 324 to 25 U per cubic meter after the installation of filters (P < 0.001). The number of days on which there was an unusually large number of visits to the hospital for asthma and the number of days on which asthma was epidemic both decreased significantly (both P < 0.001), from 29 to 6 and from 18 to 0, respectively. The mean daily number of emergency room and intensive care unit admissions for asthma on days when soybeans were unloaded decreased from 8.3 to 5.4 and from 0.26 to 0.01, respectively (both P < 0.001). The mean serum IgE antibody concentrations in the 38 patients studied decreased from 2 Pharmacia reference units per milliliter to 1 (P < 0.001). CONCLUSIONS: Installing filters on silos to prevent airborne dissemination of allergenic soybean dust eliminates outbreaks of asthma caused by inhalation of the dust, thus supporting the idea that the avoidance of allergens helps prevent asthma.

Adolescent↗
PubMed1993

Air pollution and emergency room admissions for chronic obstructive pulmonary disease: a 5-year study.

An association between sulfur dioxide levels in urban air and the daily number of emergency room admissions for chronic obstructive pulmonary disease was previously reported in Barcelona, Spain, for the period 1985-1986. The present study assesses this association over a longer period of time, 1985-1989. This made it possible to carry out separate analyses for the winter and summer seasons and thus to control more adequately for weather and influenza epidemics. An increase of 25 micrograms/m3 in sulfur dioxide (24-hour average) produced adjusted changes of 6% and 9% in emergency room admissions for chronic obstructive pulmonary disease during winter and summer, respectively. For black smoke, a similar change was found during winter, although the change was smaller in summer. The association of each pollutant with chronic obstructive pulmonary disease admissions remained significant after control for the other pollutant. The present findings support the conclusion that current levels of sulfur dioxide and black smoke may have an effect on the respiratory health of susceptible persons.

Adolescent↗
PubMed1993

Reliability of a monitoring system for respiratory emergency room admissions.

A respiratory emergency room admissions monitoring system (RERAMS) was set up in Barcelona between 1985-1989, in order to investigate asthma epidemics in the city. Information on emergency room admissions for asthma and chronic obstructive pulmonary disease (COPD) was recorded daily from the four main hospitals of the city. The present study aims at assessing the reliability and coverage of this monitoring system. Identification of asthma and COPD emergencies was repeated by a reference observer, following the same protocol to extract data as that used by the register. To assess the coverage of the monitoring system, information was collected over 28 randomly selected days, from the emergency room clinical records for the seven additional hospitals in the city with five or more daily emergencies. Identification of asthma emergencies was highly reliable (kappa value, kappa = 0.81) as was the discrimination between asthma and COPD diagnoses (kappa = 0.91). Reliability for emergencies classified as COPD was lower, but still good (kappa = 0.65). The monitoring system covered 76 and 78% of all Barcelona asthma and COPD emergency room admissions, respectively. Emergency room admissions from our monitoring system did not differ in terms of social and demographic characteristics from emergencies recorded at the other hospitals. We conclude that the monitoring system for the Barcelona respiratory emergency room admissions was highly reliable, which suggests that, when adequately collected, information from clinical records of respiratory emergencies could be used for environmental epidemiological purposes.

Asthma↗
PubMed1992

[Sudden cardiac death in the counties of Girona].

BACKGROUND: Data on sudden cardiac death in Spain in scarce. Mortality rates from sudden cardiac death occurring in six counties of Girona (including urban, industrial, and rural areas) between October 1987 and September 1988 were assessed. METHODS: From a total of 1,573 deaths in residents of the studied area aged between 25 and 74 years, 222 cases with a suggestive diagnosis of sudden cardiac death were selected. Data that confirmed the diagnosis and the time elapsed from the initial clinical symptoms and death were obtained by inquiring physicians who signed the death certificates, relatives or witnesses and by reviewing the hospital records. RESULTS: Of a total of 137 deaths of cardiac origin, there were 107 cases of sudden cardiac death (which occurred within 24 hours after the onset of symptoms). The mortality rate of sudden death of cardiac origin was 37.5 per 100,000 inhabitants, that was significantly higher among men (67.8 in men and 15.4 in women). The mortality rate showed a statistically significant increase in the older age groups (28.4 per 100,000 inhabitants in the age group of 45-54 years, 69 in the group of 55-64 years, and 129.7 in the group of 65-74 years). Death occurred within the first hour after the onset of symptoms in 59 patients, 17 of whom were admitted to a hospital. Only 35% of the total 107 patients were treated in hospital. CONCLUSIONS: Mortality rate of sudden cardiac death in Girona is low. Few patients dying from sudden cardiac death could have medical care.

Adult↗
PubMed1992

Risk factors of soybean epidemic asthma. The role of smoking and atopy.

Epidemics of emergency room admissions for asthma occurring in Barcelona during the period 1981 to 1987 were caused by inhalation of soybean dust. To investigate the risk factors that determined why some asthma patients became reactive to soybean and were consequently affected by the asthma epidemics of Barcelona but others did not do so, a case-control study was conducted during 1989, 2 yr after the cessation of asthma epidemics. Patients with asthma admitted in emergency room services during epidemic asthma days (n = 169) were compared with asthma patients admitted in the same services during nonepidemic days and who were never admitted during the epidemics (n = 147). Risk factors other than soybean exposure, namely skin reactivity against at least one common allergen (odds ratio [OR] 3.0, 1.7 to 5.3), age over 64 yr (OR 2.8, 1.4 to 6.0), cigarette smoking at the time of the epidemics (OR 2.3, 1.2 to 2.4), past smoking (OR 1.8, 0.9 to 3.7), and total immunoglobulin E (IgE) higher than 100 IU/ml (OR 1.7, 1.0 to 3.0), were found independently related to epidemic asthma. The role of smoking was especially important for those who had a positive skin reaction and were exposed to soybean dust (OR 7.9, 1.8 to 36.0). In this group, a dose-response pattern with pack-years was observed (p less than 0.01). The present findings suggest a multifactorial process for epidemic asthma, in which atopy and cigarette smoking played an important synergistic role. This has a preventive potential for IgE-related asthma.

Asthma↗
PubMed1991

Effects of urban air pollution on emergency room admissions for chronic obstructive pulmonary disease.

The authors assessed the relation between sulfur dioxide and other air pollutants (black smoke, carbon monoxide, nitrogen dioxide, and ozone) and daily emergency room admissions for chronic obstructive pulmonary disease in Barcelona, Spain, during 1985-1986. Barcelona is a Mediterranean city of 1.7 million inhabitants that has air pollution levels lower than standard values. A weak but statistically significant association between emergency room admissions and levels of sulfur dioxide, black smoke, and carbon monoxide was observed. Daily emergency room admissions for chronic obstructive pulmonary disease increased by 0.02 and 0.01 for each microgram of sulfur dioxide and black smoke per cubic meter, respectively, and 0.11 for each milligram of carbon monoxide per cubic meter, after adjusting for meteorologic and temporal variables. Similar estimations were obtained after controlling for the autocorrelation effect by means of time series analysis. In addition, when the data were stratified by season, the effects remained in summer. This strengthened the conclusion that the relation observed in winter, spring, and throughout the study period was indeed real. After truncating the data according to sulfur dioxide or black smoke levels, the authors still found effects for these pollutants at levels below the air quality guideline of 100 micrograms/m3 established by the World Health Organization. The consistency of these results with other recent toxicologic and epidemiologic observations suggest that current air pollution standards do not totally protect public health with a margin of safety in specific places.

Air Pollutants↗
PubMed1991

Identification of soybean dust as an epidemic asthma agent in urban areas by molecular marker and RAST analysis of aerosols.

From 1981 to 1987, 26 outbreaks of asthma have occurred in the city of Barcelona, Spain, affecting a total of 687 subjects and causing 1155 emergency room admissions. Assays of urban aerosols collected with high-volume samplers between October 1986 and May 1989 have indicated that soybean dust originating from harbor activities (and not traffic or industrial pollution) is the causal agent for these epidemics. Soybean particulates in the filters have been characterized from the composition of the alcohol fraction, namely, campesterol, stigmasterol, beta-sitosterol, n-triacontan-1-ol, and n-dotriacontan-1-ol, constituting a series of aerosol components correlated with the epidemiologic data. This result has also been confirmed by immunochemical assay of specific soybean allergens. The concentration of these sterols in the air corresponds to a 24-hour average level of soybean dust in the order of 25 micrograms/m3 on epidemic days. These results suggest the advisability of monitoring soybean dust in air particulates of populated areas surrounding soybean storage or processing plants. The techniques presented here afford a simple way for the recognition of soybean dust in aerosols containing high concentrations of organic pollutants of traffic or industrial origin.

Aerosols↗
PubMed1990

Identification and partial characterization of the soybean-dust allergens involved in the Barcelona asthma epidemic.

Asthma epidemics in Barcelona, Spain, have been attributed to dust generated by the unloading of soybeans in the harbor. Sera of four different groups of 10 subjects in each group were studied: (1) patients attending an emergency room in Barcelona for an asthma attack on epidemic days, group A, (2) patients attending an emergency room for an attack on nonepidemic days, group B, (3) patients with asthma from other cities, group C, and (4) patients without asthma from Barcelona matched by age and sex with group A, group D. All subjects in group A had IgE to allergens in extracts of various soybean samples. In contrast, only one of the 10 subjects in each of groups B and C and none of those subjects in group D had IgE to uncleaned bean and hull extracts. Radioimmunoassay demonstrated that in sera from patients with asthma during an asthma outbreak reacted primarily to soybean hull and dust extracts. Sodium dodecyl sulfate-polyacrylamide and gel electrophoresis thin-layer isoelectrofocusing demonstrated protein bands of 97.4 to less than 14.4 kd and isoelectric point between 6 and 3.5. By Western blot and thin layer isoelectrofocusing/blotted radioimmunoisoelectrofocusing, IgE of patients with asthma during an asthma outbreak reacted weakly to two protein bands of molecular weight ranging from 42 to 21 kd, strongly to glycoprotein bands with molecular weight less than 14.4 kd, and isoelectric point less than 6, which appeared to be the major allergens.

Adolescent↗
PubMed1990

Characteristics of patients with soybean dust-induced acute severe asthma requiring mechanical ventilation.

Patients presenting with acute severe asthma during the Barcelona's outbreaks caused by soybean dust inhalation from August, 1981, through September, 1987, characteristically showed an abrupt severe onset of each attack followed by a rapid relief of symptoms after treatment. To throw further light on clinical findings, pathophysiology and outcome in the most life-threatening episodes, we reviewed records of acute severe asthma patients treated by mechanical ventilation in one of the four main hospitals of the city. Twelve such patients (15 episodes) were compared to 24 non-epidemic asthmatic patients (25 episodes) also treated by mechanical ventilation in the same institution during the same period of time. There was a male predominance during outbreaks (p less than 0.03) and epidemic patients were ventilated fewer hours (12 +/- 8 h) (mean +/- SD), admitted fewer days to intensive care (1.6 +/- 0.7 days), and hospitalized fewer days (7.1 +/- 4.4 days) than non-epidemic patients (65 +/- 84 h, 4.6 +/- 3.8 days (p less than 0.001, each), and 16.0 +/- 13.2 days (p less than 0.004), respectively). These differences together with both the fulminant presentation of the episodes of epidemic asthma and the point-source origin of the asthma outbreaks previously shown are consistent with the unusual nature of the aetiologic agent, soybean dust.

Acute Disease↗
PubMed1989

Community outbreaks of asthma associated with inhalation of soybean dust. Toxicoepidemiological Committee.

Since 1981, 26 outbreaks of asthma have been detected in the city of Barcelona. The geographic clustering of cases close to the harbor led us to consider the harbor as the probable source of the outbreaks. We therefore studied the association between the unloading of 26 products from ships in the harbor and outbreaks of asthma in 1985 and 1986. All 13 asthma-epidemic days in these two years coincided with the unloading of soybeans (lower 95 percent confidence limit of the risk ratio, 7.2). Of the remaining 25 products, only the unloading of wheat was related to the epidemics of asthma, although when adjusted for the unloading of soybeans the relation was not statistically significant. High-pressure areas and mild southeasterly to southwesterly winds, which favored the movement of air from the harbor to the city, were registered on all epidemic days. Particles of starch and episperm cells that were recovered from air samplers placed in the city had morphologic characteristics identical to those of soybean particles. Furthermore, the lack of bag filters at the top of one of the harbor silos into which soybeans were unloaded allowed the release of soybean dust into the air. We conclude that these outbreaks of asthma in Barcelona were caused by the inhalation of soybean dust released during the unloading of soybeans at the city harbor.

Asthma↗
PubMed1989

Case-control study of serum immunoglobulin-E antibodies reactive with soybean in epidemic asthma.

Since 1981, twenty-six asthma outbreaks have been identified in Barcelona, all coinciding with the unloading of soybean in the harbour. Serum from patients with epidemic asthma and individually matched controls with non-epidemic asthma was assayed for immunoglobulin-E (IgE) antibodies against soybean antigens by means of a radioallergosorbent test. In 64 of 86 cases (74.4%) there was a reaction with commercial soybean antigen extracts, compared with only 4 of the 86 controls (4.6%) (odds ratio = 61; lower 95% confidence limit = 8.1). The statistical significance was greater for reactions with extracts of soybean dust taken from Barcelona harbour (odds ratio, unquantifiably high; lower 95% confidence limit = 11.7). No other serological covariate (total serum IgE levels or specific IgE levels against the commonest airborne allergens or legumes) confounded the association between serum anti-soybean IgE antibodies and epidemic asthma. These results support a causal relation between the release of dust during unloading of soybean at the harbour and the occurrence of asthma outbreaks, suggesting an underlying allergic mechanism.

Antibodies↗