Combined Analysis of the Short-Term Effects of Photochemical Air Pollutants on Mortality within the EMECAM Project

In recent years, some epidemiologic studies have attributed adverse effects of air pollutants on health not only to particles and sulfur dioxide but also to photochemical air pollutants (nitrogen dioxide and ozone). The effects are usually small, leading to some inconsistencies in the results of the studies. Furthermore, the different methodologic approaches of the studies used has made it difficult to derive generic conclusions. We provide here a quantitative summary of the short-term effects of photochemical air pollutants on mortality in seven Spanish cities involved in the EMECAM project, using generalized additive models from analyses of single and multiple pollutants. Nitrogen dioxide and ozone data were provided by seven EMECAM cities (Barcelona, Gijón, Huelva, Madrid, Oviedo, Seville, and Valencia). Mortality indicators included daily total mortality from all causes excluding external causes, daily cardiovascular mortality, and daily respiratory mortality. Individual estimates, obtained from city-specific generalized additive Poisson autoregressive models, were combined by means of fixed effects models and, if significant heterogeneity among local estimates was found, also by random effects models. Significant positive associations were found between daily mortality (all causes and cardiovascular) and NO2, once the rest of air pollutants were taken into account. A 10 μg/m3 increase in the 24-hr average 1-day NO2 level was associated with an increase in the daily number of deaths of 0.43% [95% confidence interval(CI), –0.003–0.86%] for all causes excluding external. In the case of significant relationships, relative risks for cause-specific mortality were nearly twice as much as that for total mortality for all the photochemical pollutants. Ozone was independently related only to cardiovascular daily mortality. No independent statistically significant relationship between photochemical air pollutants and respiratory mortality was found. The results in this study suggest that, given the present levels of photochemical pollutants, people living in Spanish cities are exposed to health risks derived from air pollution

Métodos de estadística espacial para evaluar la influencia de factores medioambientales sobre la incidencia y mortalidad por cáncer

Los objetivos de la tesis son: 1.- Estudiar la relación entre la incidencia y mortalidad por cáncer y los factores medioambientales, en particular la contaminación atmosférica, controlando por factores socioeconómicos. 2.- Utilizar aquellos métodos de estadística espacial apropiados para cada tipo de diseño. 3.- Distinguir en los modelos las diferentes fuentes de extra-variabilidad espacial. 4.- Controlar el problema de exceso de ceros inherente a alguna de las neoplasias de interés medioambientales. Conclusiones: - Tanto la incidencia como la mortalidad de las neoplasias, presentaron dos fuentes de extravariación. La extravariaicón espacial, por la que unidades vecinas tienden a presentar razones de incidencia/mortalidad similares, y la heterogeneidad no espacial. En general la extravariabilidad espacial ha resultado ser mucho mayor que la no espacial. - Para suavizar las RIE/RME correspondientes a variables con un porcentaje de ceros superior al40-50% debe utilizarse un modelo que capture este comportamiento. - El mejor modelo en términos de ajuste para recoger el exceso de ceros en las variables de interés ha resultado ser el modelo mixto de riesgo relativo. - Las RIE/RME suavizadas presentan un patrón geográfico claro sólo en algunas neoplasias de interés medioambiental. - Parte de la variabilidad remanente en las RIE/RME suavizadas pudo ser explicada mediante la introducción de variables explicativas, en particular la contaminación atmosférica y variables socioeconómicas. -Como los contaminantes atmosféricos fueron observados en un diseño geoestadístico y las neoplasias de interés mediambiental lo fueron en un diseño en rejilla se modelizó la superficie de exposición. - El efecto del contaminante en cada municipio/sección censal se aproximó introduciendo en el modelo el valor promedio en cada área y la variabilidad intra-área. - El efecto del contaminante se consideró aleatorio, en el sentido de que podría ser diferente en cada una de las áreas. - Las condiciones socioeconómicas fueron otra de las variables que redujeron la variabilidad remanente en las RIE/RME suavizadas. -Las variables explicativas observadas con un diseño en rejilla, como el índice de privación, se introdujeron en el modelo como efectos fijos. - El efecto de la privación sobre la incidencia y/o mortalidad por cáncer de tráquea, bronquios y pulmón, controlando por contaminantes atmosféricos, fue mayor en las mujeres que en los hombres. -Altas concentraciones de contaminantes atmosféricos aumentan el riesgo de padecer neoplasias de interés medioambiental, controlando por condiciones socioeconómicas.

Effect of Community of Residence on Neurobehavioral Development in Infants and Young Children in a Flower-Growing Region of Ecuador

In this study we compared neurobehavioral development in Ecuadoran children living in two communities with high potential for exposure to organophosphate (OP) and carbamate pesticides to that of children living in a community with low potential for exposure. Residence in communities with high potential for exposure to OP and carbamate pesticides was associated with poorer neurobehavioral development of the child even after controlling for major determinants of delayed development. Malnourished populations may be particularly vulnerable to neurobehavioral effects of pesticide exposure.

Chronic pesticide poisoning from persistent low-dose exposures in Ecuadorean floriculture workers: toward validating a low-cost test battery

Chronic pesticide poisoning is difficult to detect. We sought to develop a low-cost test battery for settings such as Ecuador’s floriculture industry. First we had to develop a case definition; as with all occupational diseases a case had to have both sufficient effective dose and associated health effects. For the former, using canonical discriminant analysis, we found that adding measures of protection and overall environmental stressors to occupational category and duration of exposure was useful. For the latter, factor analysis suggested three distinct manifestations of pesticide poisoning. We then determined sensitivity and specificity of various combinations of symptoms and simple neurotoxicity tests from the Pentox questionnaire, and found that doing so increased sensitivity and specificity compared to use of acethylcholinesterase alone – the current screening standard. While sensitivity and specificity varied with different case definitions, our results support the development of a low-cost test battery for screening in such settings.