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Montero J.C.,Health Science Institute | Miron I.J.,Torrijos Health District | Criado-Alvarez J.J.,University of Castilla - La Mancha | Linares C.,Carlos III Institute of Health | Diaz J.,Carlos III Institute of Health
Science of the Total Environment | Year: 2010

Introduction: As is known, the effects of extreme temperatures on mortality are characterised by an annual periodicity, with a rise centred in the winter months. The most recent epidemiological studies show that mortality caused by cold waves is, in many cases, comparable to that caused by the severest heat waves. This study sought to quantify the rise in mortality due to extreme cold and the factors that determine the relationship between these variables in Castile-La Mancha (Spain). Methods: We examined the effect of extreme winter temperature on daily non accidental cause mortality in Castile - La Mancha from 1975 to 2003, for all ages. Quantitative analyses were performed using ARIMA models, with other covariates, such as influenza, pressure trends, relative humidity, and cold wave duration and chronological number. Results: There were two mortality peaks: a short-term peak (with a lag of 3 to 7 days); and a longer term peak (of under two weeks). Excess mortality during cold waves was around 10% per degree centigrade below the threshold temperature for all the provinces except Guadalajara, where an increase of only 4.61% was detected.Mortality increased in response to rises in cold-wave duration and relative humidity. Cold waves occurring at the end of the "winter" season caused the greatest mortality. Conclusions: This study confirms that daily mortality in Castile - La Mancha increases during cold waves. Efficient cold-wave prevention plans must therefore be implemented. Such plans should be based on in-depth knowledge of the causes that underlie and modulate the relationship between low temperatures and health effects. © 2010 Elsevier B.V. Source


Objective: To evaluate the construct validity of the Turkish version of the EQ-5D in patients with acute coronary syndrome. Methods: The study was conducted as a cross-sectional study at the Trakya University Hospital between February and May 2008. All patients completed the Turkish version of the EQ-5D and MacNew heart-related quality of life scale. Construct validity of the EQ-5D was assessed according to relationships with MacNew subscales by using Spearman rank correlation and multiple linear regression analyses. Results: One hundred and twenty-two patients responded to the instruments. Mean age was 62.9±9.3 years and male gender (88 or 72.1%) was dominant. Mean score of the EQ-5D index was 0.79±0.32, while the global score of MacNew was 5.01±1.16. The correlation coefficients of the EQ-5D index score with the MacNew subscales ranged from 0.557 to 0.721, with EQ-5D VAS score ranging from 0.297 to 0.484 (p<0.001 for all of them). According to the stepwise regression model MacNew global score was found to be significantly effective factor on EQ-5D index score (β=0.188; 95% CI: 0.152-0.224; p<0.001). Conclusion: The Turkish version of the EQ-5D-based utility score seems to be a valid instrument in the assessment of quality of life studies in patients with acute coronary syndrome. © 2011 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd. Source


Miron I.J.,Torrijos Public Health District | Linares C.,Carlos III Institute of Health | Montero J.C.,Health Science Institute | Criado-Alvarez J.J.,Castile La Mancha Health Service Servicio de Salud de Castilla La Mancha SESCAM | Diaz J.,Carlos III Institute of Health
International Journal of Biometeorology | Year: 2015

The relationship between heat waves and mortality has been widely described, but there are few studies using long daily data on specific-cause mortality. This study is undertaken in central Spain and analysing natural causes, circulatory and respiratory causes of mortality from 1975 to 2008. Time-series analysis was performed using ARIMA models, including data on specific-cause mortality and maximum and mean daily temperature and mean daily air pressure. The length of heat waves and their chronological number were analysed. Data were stratified in three decadal stages: 1975–1985, 1986–1996 and 1997–2008. Heat-related mortality was triggered by a threshold temperature of 37 °C. For each degree that the daily maximum temperature exceeded 37 °C, the percentage increase in mortality due to circulatory causes was 19.3 % (17.3–21.3) in 1975–1985, 30.3 % (28.3–32.3) in 1986–1996 and 7.3 % (6.2–8.4) in 1997–2008. The increase in respiratory cause ranged from 12.4 % (7.8–17.0) in the first period, to 16.3 % (14.1–18.4) in the second and 13.7 % (11.5–15.9) in the last. Each day of heat-wave duration explained 5.3 % (2.6–8.0) increase in respiratory mortality in the first period and 2.3 % (1.6–3.0) in the last. Decadal scale differences exist for specific-causes mortality induced by extreme heat. The impact on heat-related mortality by natural and circulatory causes increases between the first and the second period and falls significantly in the last. For respiratory causes, the increase is no reduced in the last period. These results are of particular importance for the estimation of future impacts of climate change on health. © 2014, ISB. Source


Montero J.C.,Health Science Institute | Miron I.J.,Torrijos Health District | Criado J.J.,Castile La Mancha Health Service | Linares C.,Carlos III Institute of Health | Diaz J.,Carlos III Institute of Health
Science of the Total Environment | Year: 2010

Introduction: Following the 2003 heat wave, many European countries implemented heat-wave prevention plans. A number of aspects can prove fundamental in determining the effectiveness of such plans, and of these we sought to analyse the criteria used to define threshold temperatures and trigger a higher level of intervention. Method: Retrospective study of the days on which heat-wave thresholds were exceeded during the period 1974-2003 was conducted. We compared when and at what level the heat-wave prevention plan would have been activated using a statistical-meteorological criterion (as applied by the Spanish Ministry of Health & Consumer Affairs) versus a temperature-mortality criterion. Results: The number of days on which the threshold was exceeded was far higher when the temperature-mortality criterion was applied. The temperature percentile at which a heat wave occurred was different for each province analysed and was inversely proportional to its respective ageing index. Using both criteria, there was an increase in heat-wave days per decade. Conclusion: The establishment of a heat-wave threshold temperature must be based on knowledge of the cause-effect relationship between temperature and the health of a given population. Mortality is an appropriate indicator of population health. The future effects of climate change render it essential for this relationship to be studied on a local scale, so as to enable truly efficient prevention plans to be drawn up. © 2010 Elsevier B.V. Source


Gonzalez Alonso S.,Rey Juan Carlos University | Valcarcel Y.,Rey Juan Carlos University | Montero J.C.,Health Science Institute | Catala M.,Rey Juan Carlos University
Science of the Total Environment | Year: 2012

The presence of pharmaceuticals in surface and drinking water has been evidenced in numerous studies. Despite representing one of the most common consumption sources, to the best of our knowledge, this is the first report on the presence of pharmaceutical compounds in bottled mineral water. Pollution of these sources not only could pose a serious human health risk, but would also warn about the quality of the water in our aquifers, a vital and vulnerable source of water, essential for the future water supply. Fifty eight pharmaceutically active compounds (PhACs) belonging to the 12 main therapeutic groups were analyzed in 10 bottled mineral water brands produced in Spain. Nicotine was detected in concentrations ranging from 7ngL -1 to 15ngL -1 in 5 of 10 bottled mineral waters. Despite the low nicotine concentration measured, the presence of this compound in bottled water still raises concern. Health risk assessment researchers have postulated that the risk to adult healthy humans from oral intake of nicotine at low levels is negligible. However, no studies have been conducted to assess the human health risk of vulnerable populations such as pregnant women and newborns. This population is the target of advertising on the purity and quality characteristics of bottled mineral water. © 2011 Elsevier B.V. Source

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