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

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Salud percibida y capacidad funcional de la población anciana no institucionalizada de barcelona*

ResumenCon el objetivo de conocer el nivel de salud percibida y la capacidad funcional en las personas ancianas, se realizó un estudio transversal de una muestra representativa de la población no institucionalizada de Barcelona de 65 y más años (n=1.288). incluido en la segunda Encuesta de Salud por Entrevista. Se recogió información sociodemográfica, sobre morbilidad percibida, problemas sensoriales y capacidad funcional (evaluada a través de las actividades de la vida diaria [AVD]).El 60,3% de los entrevistados manifestó tener una salud «buena» o «muy buena» y el 56% declaró ser capaz de realizar todas las AVD sin dificultad. Las mujeres expresaron peor salud general, y mayor limitación crónica en todos los grupos de edad (p < 0,001). La edad no se asoció significativamente con la salud percibida, pero sí con una mayor limitación en todas las AVD (p< 0,001). Las variables que con mayor fuerza se asociaron a una declaración de salud general «regular», «mala» o «muy mala» son: la coexistencia de trastornos crónicos (OR=3,69 IC95%=2,60–5,25), la actividad restringida (OR=3,25 IC95%=1,38–3,36). Los ancianos con incapacidad en alguna de las AVD básicas eran en su mayoría mujeres y de 75 o más años, y el 10,5% no recibía ninguna ayuda personal.El presente estudio aporta una descripción del estado de salud y funcional de los ancianos e identifica un grupo de ancianos con necesidades básicas de atención no cubiertas.SummaryIn order to explore the perceived health and functional capacity in the elderly, a cross-sectional study was undertaken in a representative sample of the non-institutionalized population aged 65 and over, resident in Barcelona (N = 1,288), and included in the 2nd Health Interview Survey Sociodemographic information was collected, as well as perceived morbidity, sensorial problems and functional capacity (measured by the activities of daily living [ADL]).Some 60,3% of the elderly reported having «good» or «very good» health, and 56% reported being able to do all ADL without difficulties. Women in general reported a worse perceived health and a higher chronic limitation in each age group (p=0,001). Age was not significnatly associated with perceived health, but was… associated with disability (ADL) (p=0.001), Variables with a stronger association with «poor», «bad» o «very bad» perceived health were: comorbidity (OR=3,69 IC 95%=2,60–5,25), restricted activity (OR=3,25 IC 95% = 1,86–5,66) and incapacity in any of the basic ADL (OR=2,15 IC 95%=1,38–3,36). The elderly who were dependent in any of the basic ADL were more frequently female, 75 or more years old, and in 10,5% of the cases did not receive any personal help.The present study gives a general description of the health status and functional capacity of the elderly and identifies a group of old people with unmet basic care reeds

Community asthma outbreaks due to soybean dust inhalation in Barcelona: time cluster study

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.Supported in part by grants (84/1851 and 86/1847) from el Fondo de Investigación de la Seguridad Social and a grant (PA85–0016) from la Comisión Interministerial de Ciencia y TecnologíaPeer reviewe

La carga de enfermedad en España: resultados del Estudio de la Carga Global de las Enfermedades 2016

Background and objectives: The global burden of disease (GBD) project measures the health of populations worldwide on an annual basis, and results are available by country. We used the estimates of the GBD to summarise the state of health in Spain in 2016 and report trends in mortality and morbidity from 1990 to 2016. Material and methods: GBD 2016 estimated disease burden due to 333 diseases and injuries, and 84 risk factors. The GBD list of causes is hierarchical and includes 3 top level categories, namely: (1) communicable, maternal, neonatal, and nutritional diseases;(2) non-communicable diseases (NCDs), and (3)injuries. Mortality and disability-adjusted life-years (DALYs), risk factors, and progress towards the sustainable development goals (SDGs) are presented based on the GBD 2016 data in Spain. Results: There were 418,516 deaths in Spain in 2016, from a total population of 46.5 million, and 80.5% of them occurred in those aged 70 years and older. Overall, NCDs were the main cause of death: 388,617 (95% uncertainty interval 374,959–402,486), corresponding to 92.8% of all deaths. They were followed by 3.6% due to injuries with 15,052 (13,902–17,107) deaths, and 3.5% communicable diseases with 14,847 (13,208–16,482) deaths. The 5 leading specific causes of death were ischaemic heart disease (IHD, 14.6% of all deaths), Alzheimer disease and other dementias (13.6%), stroke (7.1%), chronic obstructive pulmonary disease (6.9%), and lung cancer (5.0%). Remarkable increases in mortality from 1990 to 2016 were observed in other cancers, lower respiratory infections, chronic kidney disease, and other cardiovascular disease, among others. On the contrary, road injuries moved down from 8th to 32nd position, and diabetes from 6th to 10th. Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position. The greatest changes in DALYs were observed for road injuries dropping from 4th to 16th position, and congenital disorders from 17th to 35th; conversely, oral disorders rose from 25th to 17th. Overall, smoking is by far the most relevant risk factor in Spain, followed by high blood pressure, high body mass index, alcohol use, and high fasting plasma glucose. Finally, Spain scored 74.3 of 100 points in the SDG index classification in 2016, and the main national drivers of detrimental health in SDGs were alcohol consumption, smoking and child obesity. An increase to 80.3 points is projected in 2030. Conclusion: Low back and neck pain was the most important contributor of disability in Spain in 2016. There has seen a remarkable increase in the burden due to Alzheimer disease and other dementias. Tobacco remains the most important health issue to address in Spain.Antecedentes y objetivo: El estudio de la carga global de las enfermedades, conocido como GBD por sus siglas en inglés (global burden of disease), mide la salud poblacional en todo el mundo de forma anual y sus resultados están disponibles por país. Utilizamos las estimaciones GBD para resumir el estado de salud poblacional en España en 2016 y describir las tendencias en morbimortalidad de 1990 a 2016. Material y métodos: GBD 2016 estima la carga debida a 333 enfermedades y lesiones, y a 84 factores de riesgo. La lista de causas de GBD es jerárquica e incluye 3 categorías de nivel superior: 1) enfermedades transmisibles, maternas, neonatales y nutricionales; 2) enfermedades no transmisibles (ENT), y 3) accidentes. Se presentan la mortalidad, los años de vida ajustados por discapacidad (AVAD), los factores de riesgo y el progreso hacia los objetivos de desarrollo sostenible (ODS) a partir de los datos de GBD 2016 en España. Resultados: En 2016 en España hubo 418.516 muertes, de una población total de 46,5 millones, y el 80,5% de ellas ocurrieron en personas de 70 años o más. Las ENT fueron la principal causa de muerte (92,8%), con 388.617 (intervalo de incertidumbre del 95% 374.959–402.486), seguidas de los accidentes (3,6%), con 15.052 (13.902–17.107), y de las enfermedades transmisibles (3,5%), con 14.847 (13.208–16.482) muertes. Las 5 principales causas específicas de muerte fueron la cardiopatía isquémica (CI), con el 14,6% de todas las muertes, la enfermedad de Alzheimer y otras demencias (13,6%), el accidente cerebrovascular (7,1%), la enfermedad pulmonar obstructiva crónica (6,9%) y el cáncer de pulmón (5,0%). Se observaron incrementos notables en la mortalidad de 1990 a 2016 en otros cánceres, infecciones respiratorias del tracto inferior, enfermedad renal crónica y otras enfermedades cardiovasculares, entre otros. Por el contrario, los accidentes de tráfico bajaron del puesto 8 al 32 y la diabetes del 6 al 10. Los dolores de espalda y cervicales se convirtieron en la causa principal de AVAD en España en 2016, superando a la CI, mientras que la enfermedad de Alzheimer pasó del puesto 9 al 3. Los mayores cambios en AVAD se observaron para accidentes de tráfico, que cayeron de la posición 4 a la posición 16, y los trastornos congénitos, de la 17 a la 35; por el contrario, los trastornos orales aumentaron, pasando del puesto 25 al 17. En general, fumar es, con mucho, el factor de riesgo más relevante en España, seguido de presión arterial alta, índice de masa corporal alto, consumo de alcohol y glucemia alta en ayunas. Finalmente, España obtuvo 74,3 sobre 100 puntos en la clasificación del índice ODS en 2016, y los principales determinantes de salud nacionales relacionados con los ODS fueron el consumo de alcohol, el tabaquismo y la obesidad infantil. Se proyecta un aumento a 80,3 puntos en 2030. Conclusión: Los dolores de espalda y cervical fueron el contribuyente más importante de discapacidad en España en 2016. Hubo un aumento notable de la carga poblacional debida a la enfermedad de Alzheimer y otras demencias. El tabaco sigue siendo el riesgo para la salud más importante que debe abordarse en España

Environmental and nutritional impacts of dietary changes in Spain during the COVID-19 lockdown

The COVID lockdown has affected food purchases and eating habits. In this regard, this short communication assesses the nutritional and environmental impacts of these changes during the COVID lockdown in Spain, by applying Life Cycle Assessment and an energy- and nutrient-corrected functional unit. Three environmental impacts were studied (Global Warming Potential, Blue Water Footprint and Land Use) and a total of seven weekly diet scenarios were designed: two pre-COVID diets for March and April in 2019 (MAR19, APR19), one COVID diet (COVID) and two alternative diets, one based on the National Dietary Guidelines (NDG) and another one on the Planetary Health Diet (PHD). Results show that the COVID diet had larger energy intake and lower nutritional quality, as well as higher environmental impacts (between 30 and 36%) than the pre-COVID eating patterns. Further research is needed to account for food affordability within this assessment, as well as to analyze how eating patterns will evolve after the COVID lockdown. Finally, the definition of short guidelines for sustainable food behaviors for future possible lockdowns is suggested, as well as the introduction of sustainable indicators within NDGs.The authors are grateful for the funding of the Spanish Ministry of Science and Competitiveness through the CERES-PROCON Project CTM2016-76176 (AEI/FEDER, UE) and the KAIROS-BIOCIR Project PID2019-104925RB (AEO/FEDER, UE)

MASK (Mobile Airways Sentinel Network), una app móvil con la solución integral de ARIA en países de habla hispana

Aunque existen guías clínicas de alta calidad sobre rinitis alérgica, numerosos pacientes reciben tratamiento deficiente, en parte debido al alto grado de automedicación. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS; en ella, los pacientes indican diariamente cuánto les molestan los síntomas a través de cinco pantallas con una escala visual análoga; recientemente se agregaron dos pantallas más (afectación del sueño). La aplicación también permite descargar los datos del “Diario de alergias” en la computadora del médico en el momento de la consulta a través de un código QR. En este artículo reseñamos el primer año de experiencia en España, México y Argentina, que utilizan la versión española.Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the "Allergy Diary" on the physician's computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used