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Introduction and objectives Episodes of extreme heat are associated with increased morbidity and mortality in chronically-ill patients but there is a need to clearly establish the relationship between extreme heat and myocardial infarction. The aim of this study was to analyze the relationship between the incidence of ST-segment elevation myocardial infarction (STEMI) and maximum temperature, in particular during heat wave alert periods (HWAP). Methods The population studied consisted of confirmed STEMI cases registered in the Infarction Code of the Community of Madrid between June 2013 and June 2017. Incidence rate ratios (IRR) adjusted for trend and seasonality and 95%CI were estimated using time series regression models. Results A total of 6465 cases of STEMI were included; 212 cases occurred during the 66-day period of HWAP and 1816 cases during the nonalert summer period (IRR, 1.14; 95%CI, 0.96-1.35). The minimum incidence rate was observed at the maximum temperature of 18 °C. Warmer temperatures were not associated with a higher incidence (IRR,1.03; 95%CI, 0.76-1.41), whereas colder temperatures were significantly associated with an increased risk (IRR, 1.25; 95%CI, 1.02-1.54). No effect modification was observed by age or sex. Conclusions We did not find an increased risk of STEMI during the 66 days of HWAP in the Community of Madrid between June 2013 and June 2017. However, an increased risk was found during colder temperatures. No extra health resources for STEMI management are required during periods of extreme heat, but should be considered during periods of cold weather. Resumen Introducción y objetivos Los episodios de calor extremo se asocian con una mayor morbimortalidad de los enfermos crónicos, pero su relación con el infarto de miocardio no está claramente establecida. El objetivo es analizar una posible relación entre la incidencia de infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y la temperatura máxima, especialmente durante los periodos de alerta por ola de calor (PAOC). Métodos La población estudiada son los casos de IAMCEST confirmado registrados en Código Infarto Madrid entre junio de 2013 y junio de 2017. Se estimaron las razones de tasa de incidencia (RTI) ajustadas por tendencia y estacionalidad y sus IC95% asociadas con los PAOC y con la temperatura máxima, utilizando modelos de regresión de series temporales. Resultados Se incluyó a 6.465 casos de IAMCEST. En 66 días de PAOC hubo 212 casos y 1.816 casos durante los días de verano sin alerta (RTI = 1,14; IC95%, 0,96-1,35). La tasa de incidencia mínima se observó con temperatura máxima de 18 °C. Las temperaturas más cálidas no se asociaron con mayor incidencia (RTI = 1,03; IC95%, 0,76-1,41); por el contrario, hubo un incremento significativo con las temperaturas más frías (RTI = 1,25; IC95%, 1,02-1,54). No hubo modificación por sexo o edad. Conclusiones Durante los PAOC entre junio de 2013 y junio de 2017 en la Comunidad de Madrid, no se observó un aumento de la incidencia de IAMCEST, pero sí durante periodos de bajas temperaturas. No cabe esperar un mayor uso de los recursos sanitarios para el IAMCEST en periodos de calor extremo, pero sí durante los periodos fríos., A. Tobías received support from the Japanese Society for the Promotion of the Science (JSPS) in its grant invitation program for research in Japan (S18149).

Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting., This publication was developed under Assistance Agreement No. RD83587101 awarded by the U.S. Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Research reported in this publication was also supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD012769. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Also, this work has been supported by the National Research Foundation of Korea (2021R1A6A3A03038675), Medical Research CouncilUK (MR/V034162/1 and MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/ R009384/1), Academy of Finland (Grant ID: 310372), European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655 and 874990), Czech Science Foundation (22-24920S), Emory University’s NIEHS-funded HERCULES Center (Grant ID: P30ES019776), and Grant CEX2018-000794-S funded by MCIN/AEI/ 10.13039/501100011033 The funders had no role in the design, data collection, analysis, interpretation of results, manuscript writing, or decision to publication.

The data presented in this article is part in essence of a more extensive dataset aimed at evaluating patterns of change in the temperature-mortality relationship on population health in the city of Valencia, Spain on population health in the city of Valencia, Spain. The complete dataset was used in the framework of the European multi-city project PHASE (Public Health Adaptation Strategies to Extreme weather events) [1]. The data includes daily counts of all-cause mortality, excluding external causes and cardiovascular and respiratory diseases. All-cause mortality is also classified by gender and age groups. Besides temperature, we included other meteorological variables and air pollutants from the PHASE dataset, as well as influenza epidemics. The variable Saharan dust events was also added. All these data were collected from public Governmental data repositories accessible under request. The dataset of this article provides a basis for comparison with similar models for time-series regression, allowing researchers to integrate additional model components without duplication of effort., AT was supported by Grant CEX2018–000794-S funded by MCIN/AEI/ 10.13039/501100011033. Conflict of Interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Background: Studies have quantified the associations between ambient temperature and all-cause enteric infections. Temperature sensitivity in enteric infections, however, may be pathogen dependent. Here, we sought to identify aetiology-specific associations between ambient temperature and enteric infections. Methods: We conducted a systematic review and meta-analysis study by searching PubMed, Web of Science, and Scopus for research articles published from 2000 to 2019. We only included studies that quantified the effects of ambient temperature increases on enteric infections. Two authors screened the studies, one extracted the data from the eligible studies, and four performed data verification. The overall risks were obtained by pooling the relative risk of enteric infection by aetiology for each 1°C temperature rise using random-effects modelling and robust variance estimation for the correlated effect estimates. Findings: The 2170 screened studies generated 80 eligible for systematic review and 56 eligible for meta-analysis. The overall increased risks per 1°C temperature rise were 1·05 (95%CI 1·04–1·07; I2 :97%) for salmonellosis, 1·07 (1·04–1·10; I2 :99%) for shigellosis, 1·02 (1·01–1·04; I2 :98%) for campylobacteriosis, 1·05 (1·04–1·07; I2 :36%) for cholera, 1·04 (1·01–1·07; I2 :98%) for Escherichia coli enteritis, and 1·15 (1·07–1·24; I2 :0%) for typhoid. Reduced risks per 1°C temperature rise were found for rotaviral enteritis at 0·96 (0·90–1·02; I2 :97%), and noroviral enteritis at 0·89 (0·81–0·99; I2 :96%). Interpretation: Enteric infections have varying associations with ambient temperature depending on their aetiology. Future projections for temperature-related enteric infections should account for differing temperature sensitivity in enteric pathogens. Funding: Japan Society for the Promotion of Science (Kakenhi) Grant-in-Aid for Scientific Research. Declaration of Interest: We declare no competing interests

From the end of February, the SARS-CoV-2 epidemic in Spain has been following the footsteps of that in Italy very closely. We have analyzed the trends of incident cases, deaths, and intensive care unit admissions (ICU) in both countries before and after their respective national lockdowns using an interrupted time-series design. Data was analyzed with quasi-Poisson regression using an interaction model to estimate the change in trends. After the first lockdown, incidence trends were considerably reduced in both countries. However, although the slopes have been flattened for all outcomes, the trends kept rising. During the second lockdown, implementing more restrictive measures for mobility, it has been a change in the trend slopes for both countries in daily incident cases and ICUs. This improvement indicates that the efforts overtaken are being successful in flattening the epidemic curve, and reinforcing the belief that we must hold on.

Background: Various retrospective studies report that a higher diurnal temperature range (DTR) increases mortality risk. This study projects the impact of DTR on future mortality across 445 communities in 20 countries. Methods: We first estimated the DTR-related mortality risk based on the historical daily time-series of mortality and of weather factors from 1985 to 2015. Next, we projected the excess deaths attributable to the DTR during the current (1985–2015) and future (2020–2099) periods using daily DTR series under four climate-change scenarios. We then calculated the future excess deaths based on two assumptions: warmer temperatures affect or do not affect the DTR-mortality risk. Findings: DTR was associated with excess mortality in our time-series analyses. Under the unmitigated scenario, the future average DTR is projected to increase in most countries (-0·4–1·6 °C), and the increasing pattern was more evident in the United States, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2–7·4%. Furthermore, the DTR-related mortality risk increased with an increasing average temperature. Based on the positive interactive effect between DTR and temperature, the DTR-related excess deaths are projected to increase in all countries (1·4–10·3%) in 2090–2099. Interpretation: This study suggests that the DTR-related excess mortality may increase globally under climate change, and this increasing pattern may vary between countries. Our findings can contribute to both international and regional public health interventions to reduce the DTR impacts on health under climate change. Funding Statement: Ho Kim is supported by the Korea Ministry of Environment via the “Climate Change Correspondence Program” (2014001310007). Declaration of Interests: All authors report no financial relationships with commercial interests.

The first confirmed case of SARS-CoV-2 in the city of Barcelona, Spain, was identified on February 25th, 2020. Since then, the epidemic spread countrywide, and Spain has become the second most affected country worldwide (130,759 cases, on April 5th) after the United States, and the second in the number of deaths (12,418 deaths, on April 5th) after Italy (Our World in Data, 2020). The regions most affected are Madrid and Catalonia, where Barcelona is located (Supplementary Fig. 1).

Research question What is the association of endometrial thickness with pregnancy losses and live births in IVF treatment and the optimal threshold that optimizes the IVF outcome? Design Data were analysed from 25,767 IVF cycles from centres of the CARE Fertility Group in the UK between 2007 and 2016. Transvaginal ultrasound was conducted to measure the maximum endometrial thickness during gonadotrophin stimulation. Live birth rates were per embryo transfer. Pregnancy loss rates included the combination of biochemical and clinical pregnancy losses. Results The live birth rate was 15.6% with 5 mm or less endometrial thickness and gradually increased to 33.1% with an endometrial thickness of 10 mm. On the other hand, the pregnancy loss rate was 41.7% with 5 mm or less endometrial thickness and gradually decreased to 26.5% with an endometrial thickness of 10 mm. Statistical modelling for optimal endometrial thickness threshold found 10 mm or more maximized live births and minimized pregnancy losses. This association was independent after adjusting for confounders such as age, oocyte number, number of transferred embryos, ovarian stimulation protocol and embryo quality for live births (crude RR 1.27; 95% CI 1.21 to 1.33; Adjusted RR 1.18; 95% CI 1.12 to 1.23) and pregnancy losses (crude RR 0.83; 95% CI 0.77 to 0.89; adjusted RR 0.86; 95% CI 0.8 to 0.92). Conclusions Endometrial thickness is strongly associated with pregnancy losses and live births in IVF, and the optimal endometrial thickness threshold of 10 mm or more maximized live births and minimized pregnancy losses.

Although diurnal temperature range (DTR) is a key index of climate change, few studies have reported the health burden of DTR and its temporal changes at a multi-country scale. Therefore, we assessed the attributable risk fraction of DTR on mortality and its temporal variations in a multi-country data set. We collected time-series data covering mortality and weather variables from 308 cities in 10 countries from 1972 to 2013. The temporal change in DTR-related mortality was estimated for each city with a time-varying distributed lag model. Estimates for each city were pooled using a multivariate meta-analysis. The results showed that the attributable fraction of total mortality to DTR was 2.5% (95% eCI: 2.3–2.7%) over the entire study period. In all countries, the attributable fraction increased from 2.4% (2.1–2.7%) to 2.7% (2.4–2.9%) between the first and last study years. This study found that DTR has significantly contributed to mortality in all the countries studied, and this attributable fraction has significantly increased over time in the USA, the UK, Spain, and South Korea. Therefore, because the health burden of DTR is not likely to reduce in the near future, countermeasures are needed to alleviate its impact on human health. Keywords: Diurnal temperature range, Attributable mortality risk fraction, Time-varying effect, Climate change

Background The increased risk of mortality during periods of high and low temperatures has been well established. However, most of the studies used daily counts of deaths or hospitalisations as health outcomes, although they are the ones at the top of the health impact pyramid reflecting only a limited proportion of patients with the most severe cases. Objectives This study evaluates the relationship between short-term exposure to the daily mean temperature and medication prescribed for the respiratory system in five Spanish cities. Methods We fitted time series regression models to cause-specific medical prescriptions, including different respiratory subgroups and age groups. We included a distributed lag non-linear model with lags up to 14 days for daily mean temperature. City-specific associations were summarised as overall-cumulative exposure-response curves. Results We found a positive association between cause-specific medical prescriptions and daily mean temperature with a non-linear inverted J- or V-shaped relationship in most cities. Between 0.3% and 0.6% of all respiratory prescriptions were attributed to cold for Madrid, Zaragoza and Pamplona, while in cities with only cold effects the attributable fractions were estimated as 19.2% for Murcia and 13.5% for Santander. Heat effects in Madrid, Zaragoza and Pamplona showed higher fractions between 8.7% and 17.2%. The estimated costs are in general higher for heat effects, showing annual values ranging between €191,905 and €311,076 for heat per 100,000 persons. Conclusions This study provides novel evidence of the effects of the thermal environment on the prescription of medication for respiratory disorders in Spain, showing that low and high temperatures lead to an increase in the number of such prescriptions. The consumption of medication can reflect exposure to the environment with a lesser degree of severity in terms of morbidity., DR was supported by a postdoctoral research followship of the Xunta de Galicia (Spain). Award number: Not aplicable.

We would like to express our concern about the limited capacity of actions taken by the Spanish Government to successfully control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak and end the exponential growth phase of new cases. The measures taken so far, consisting primarily of partial restriction mobility, are in the right direction, although some researchers have warned about the pressure placed on the building blocks of the health system.1 Given that the actual extent of an epidemic can only be assessed retrospectively, governments and policy makers are forced to make decisions on the basis of mathematical models of other diseases and previous experiences by other countries taking different actions.2 In Spain, various models simulating the spread of infection and using different assumptions converge in a landscape of a high number of new cases within the next few weeks. Simulations have been done using the URV and UNIZAR models to predict the progression of the number of patients who will require admission into hospital intensive care units because of coronavirus disease 2019 (COVID-19) in three scenarios (appendix): scenario 1, no mobility restrictions; scenario 2, partial restriction of mobility (ie, movement to the workplace allowed for 30% of people); and scenario 3, complete restriction of mobility (ie, no workplace mobility allowed except for essential services).

Background The use of obstetric early warning systems (OEWS) are recommended as an adjunct to reduce maternal morbidity and mortality. The aim of this review was to document the variation in OEWS trigger thresholds and the quality of information included within accompanying escalation protocols. Methods A review of OEWS charts and escalation policies across consultant-led maternity units in the UK (n = 147) was conducted. OEWS charts were analysed for variation in the values of physiological parameters triggering different levels of clinical escalation. Relevant data within the escalation protocols were also searched for: urgency of clinical response; seniority of responder; frequency of on-going clinical monitoring; and clinical setting recommended for on-going care. Results The values of physiological parameters triggering specific clinical responses varied significantly between OEWS. Only 99 OEWS charts (67.3%) had an escalation protocol as part of the chart. For 29 charts (19.7%), the only escalation information included was generic, for example to “contact a doctor if triggers”. Only 76 (51.7%) charts detailed the required seniority of responder, 37 (25.2%) the frequency for on-going clinical monitoring, eight (5.4%) the urgency of clinical response and two (1.4%) the recommended clinical setting for on-going care. Conclusion The observed variations in the trigger thresholds used in OEWS charts and the quality of information included within the accompanying escalation protocols is likely to lead to suboptimal detection and response to clinical deterioration during pregnancy and the post-partum period. The development of a national OEWS and escalation protocol would help to standardise care across obstetric units.

Numerous studies showing statistically significant associations between environmental noise and adverse health effects already exist for short-term (over one day at most) and long-term (over a year or more) noise exposure, both for morbidity and (albeit to a lesser extent) mortality. Recently, several studies have shown this association to be independent from confounders, mainly those of air pollutants. However, what has not been addressed is the problem of misalignment (i.e. the exposure data locations and health outcomes have different spatial locations). Without any explicit control of such misalignment inference is seriously compromised. Our objective is to assess the long-term effects of traffic noise on mortality in the city of Barcelona (Spain) during 2004-2007. We take into account the control of confounding, for both air pollution and socioeconomic factors at a contextual level and, in particular, we explicitly address the problem of misalignment. We employed a case-control design with individual data. We used deaths resulting from myocardial infarction, hypertension, or Type II diabetes mellitus in Barcelona between 2004 and 2007 as cases for the study, while for controls we used deaths (likewise in Barcelona and over the same period of time) resulting from AIDS or external causes (e.g. accidental falls, accidental poisoning by psychotropic drugs, drugs of abuse, suicide and self-harm, or injuries resulting from motor vehicle accidents). The controls were matched with the cases by sex and age. We used the annual average equivalent A-weighted sound pressure levels for daytime (7-21h), evening-time (21-23h) and night-time (23-7h), and controlled for the following confounders: i) air pollutants (NO2, PM10 and benzene), ii) material deprivation (at a census tract level) and iii) land use and other spatial variables. We explicitly controlled for heterogeneity (uneven distribution of both response and environmental exposures within an area), spatial dependency (of the observations of the response variables), temporal trends (long-term behaviour of the response variables) and spatial misalignment (between response and environmental exposure locations). We used a fully Bayesian method, through the Integrated Nested Laplace Approximation (INLA). Specifically, we plugged the whole model for the exposure into the health model and obtained a linear predictor defined on the entire spatial domain. Separate analyses were carried out for men and for women. After adjusting for confounders, we found that traffic noise was associated with myocardial infarction mortality along with Type II diabetes mellitus in men (in both cases, odds ratios (OR) were around 1.02) and mortality from hypertension in women (ORs around 1.01). Nevertheless, only in the case of hypertension in women, does the association remain statistically significant for all age groups considered (all ages, ≥65 years and ≥75 years).

Lockdown measures came into force in Spain from March 14th, two weeks after the start of the SARS-CoV-2 epidemic, to reduce the epidemic curve. Our study aims to describe changes in air pollution levels during the lockdown measures in the city of Barcelona (NE Spain), by studying the time evolution of atmospheric pollutants recorded at the urban background and traffic air quality monitoring stations. After two weeks of lockdown, urban air pollution markedly decreased but with substantial differences among pollutants. The most significant reduction was estimated for BC and NO2 (−45 to −51%), pollutants mainly related to traffic emissions. A lower reduction was observed for PM10 (−28 to −31.0%). By contrast, O3 levels increased (+33 to +57% of the 8 h daily maxima), probably due to lower titration of O3 by NO and the decrease of NOx in a VOC-limited environment. Relevant differences in the meteorology of these two periods were also evidenced. The low reduction for PM10 is probably related to a significant regional contribution and the prevailing secondary origin of fine aerosols, but an in-depth evaluation has to be carried out to interpret this lower decrease. There is no defined trend for the low SO2 levels, probably due to the preferential reduction in emissions from the least polluting ships. A reduction of most pollutants to minimal concentrations are expected for the forthcoming weeks because of the more restrictive actions implemented for a total lockdown, which entered into force on March 30th. There are still open questions on why PM10 levels were much less reduced than BC and NO2 and on what is the proportion of the abatement of pollution directly related to the lockdown, without meteorological interferences., The present work was supported by the Spanish Ministry of Agriculture, Fishing, Food and Environment, Madrid City Council and Madrid Regional Government, by the Ministry of Economy, Industry and Competitiveness and FEDER funds under the project HOUSE (CGL2016-78594-R), and by the Generalitat de Catalunya (AGAUR 2015 SGR33), and by the Spanish Ministry of Sciences, Innovation and Universities (EQC2018-004598-P).

Specific IgE performed better than SPT to predict reactivity to milk and egg during challenges with 50% positive predictive value cut-offs being useful to support the decision of whether to challenge to baked milk and egg to assess for tolerance.

Background: Increased atmospheric particulate matter (PM) concentrations are commonly observed during desert dust days in Iran, but there is still no evidence of their effects on human health. We aimed to evaluate the association between daily mortality and exposure to PM10 and PM2.5 during dust and non-dust days in Tehran and Ahvaz, two major Middle Eastern cities with different sources, intensity, and frequency of desert dust days. Methods: We identified desert dust days based on exceeding a daily PM10 concentration threshold of 150 µg/m3 between 2014 and 2017, checking for low PM2.5/PM10 ratio typical of dust days. We used a time-stratified case-crossover design to estimate the short-term effects of PM10 and PM2.5 concentrations on daily mortality during dust and non-dust days. Data was analyzed using conditional Poisson regression models. Results: Higher concentrations of PM and frequency of desert dust days were observed in Ahvaz rather than Tehran. In Ahvaz, the effect of PM10 at lag 0 was much higher during dust days, an increment of 10 μg/m3 was associated with 3.28% (95%CI = [2.42, 4.15]) increase of daily mortality, than non-dust days, 1.03% (95%CI = [−0.02, 2.08]), while in Tehran, was slightly higher during non-dust days, 0.72% (95%CI = [0.23, 1.23]), than in dust days, 0.49% (95%CI = [−0.22, 1.20]). No statistically significant associations were observed between PM2.5 and daily mortality in Ahvaz, while in Teheran the effect of PM2.5 increased significantly during non-dust days at lag 2, 1.89% (95%CI = [0.83, 1.2.95] and lag 3, 1.88% (95%CI = [0.83, 1.2.95]). Conclusion: The study provides evidence that exposure to PM during Middle East dust days is an important risk factor to human health in arid regions and areas affected by desert dust events. © 2019 The Authors, Funding text #1 Daily counts of all-natural cause mortality (ICD 10th revision: A00-R99) were collected for the cities of Ahvaz, from 21st March 2015 to 22nd September 2017, and Tehran, from 21st March 2014 to 20th March 2017. Mortality data were provided by the Iran Ministry of Health and Medical Education and the database of Tehran Municipality. 2.2.2 Funding text #2 This study was funded by Shahid Beheshti University of Medical Sciences (grant number #6649 ), the Environmental and Occupational Health Center of Ministry of Health and Medical Education , and the Generalitat de Catalunya ( AGAUR 2017 SGR41 ), Spain.

Objectives: To evaluate the impact of road safety interventions, including the penalty point system (PPS) and the reformed Spanish penal code (RPC), on traffic-related occupational injuries in Spain. Methods: The study design was an interrupted time-series with a comparison group. The study group had traffic-related, occupational injuries incurred during working and commuting hours; the comparison group had non-traffic-related injuries incurred at the work site. A negative binomial regression model was used to determine the relative risk (RR) of sustaining occupational injuries for the post-intervention periods compared to the non-intervention period. Results: Non-fatal, traffic-related injuries did not significantly change after the PPS and RPC implementations, except for those occurred in commuting hours, which increased significantly after the PPS. On the other hand, after the RPC, fatal, traffic-related injuries decreased significantly during working hours (0.79; 95%CI 0.65 to 0.97) and commuting hours (RR: 0.63; 95%CI:0,56 to 0.72), although fatal, non-traffic-related injuries also decreased at the work site. Conclusions: Road safety interventions did not clearly affect traffic-related occupational injuries in Spain. Specific occupational risk factors could influence the occurrence of those injuries. (C) 2014 Elsevier Ltd. All rights reserved.

Ferran Catala-Lopez * y Aurelio Tobias d Division de Farmacoepidemiologia y Farmacovigilancia, Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Espana b Fundacion Instituto de Investigacion en Servicios de Salud, Valencia, Espana Centro Superior de Investigacion en Salud Publica (CSISP), Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Valencia, Espana d Instituto de Diagnostico Ambiental y Estudios del Agua (IDAEA), Centro Superior de Investigaciones Cientificas (CSIC), Barcelona, Espana

This study focuses on the synthesis of merlinoite from Chinese coal fly ashes by KOH direct conversion method, with special emphasis on the application of synthetic merlinoite as fertilizer. These fly ashes were collected from two pulverized-coal combustion (PCC) power plants in Xinjiang, Northwest China. The synthesis results are influenced by fly ash characteristics and different synthesis conditions (KOH solution concentrations, activation temperature, time, and KOH/fly ash ratios). A high quality merlinoite-rich product was synthesized under optimal activation conditions (KOH concentration of 5 M, activation temperature of 150 °C, activation time of 8 h and KOH/fly ash ratio of 2 l/kg), with a cation exchange capacity (CEC) of 160 cmol kg−1. The synthetic merlinoite is proved to be an efficient slow release K-fertilizer for plant growth, indicating that it can be widely used for high-nutrient demanding crops growing in nutrient-limited soils and for large-area poor soil amendment in opencast coal mine areas around the power plants that will substantially grow with the increasing coal combustion in Xinjiang in the near future.

The enrichment of inorganic trace pollutants in re-circulated water streams was studied at two power plants equipped with wet limestone Flue Gas Desulphurisation (FGD) system from the first re-circulation cycle of water up to the start of sampling campaigns. To elucidate the enrichment of inorganic trace pollutants as result of water re-circulation, a partial and total mass balances were undertaken. A t-Student analysis was performed to ascertain whether the mean contribution of filtered water affected the balance of elements and the enrichment of this water stream. The t-Student revealed the mean contribution of filtered water to total mass balance was statistically significant (p < 0.05) for Na, Mg, Cl, B, Mn, Se, Cd, Mo, and U at first plant, and Na, Cl, K, Mg, Hg, Li, B, F, Ni, Zn, Mn, Co Sc, Ge, Se, at the second one. High levels of inorganic trace pollutants in filtered water could be affected by limestone purity, electrostatic precipitator gas temperature, use of additives, fluoride and/or sulphate complexes, and the S/F and S/Cl ratios in the scrubber, which may reduce the gaseous retention efficiencies in FGD and increase the emission of metals by entraining and/or evaporation of droplets as particulate matter from gypsum slurry. © 2011 Elsevier B.V., This work was carried out with a grant from the Research Fund for Coal and Steel (Contract Number: RFCR-CT-2006-00006). The authors would like to thank the staff of the Spanish power plants for their support, help and assistance during and after the sampling campaigns. The corresponding author gratefully acknowledges the Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC) for awarding, a JAE-pre-doctoral fellowship to Ms. Patricia Córdoba.

Mercury exposure of the local population was assessed in two areas of the Almadén mercury mining district, Spain, which has been the world's largest producer of this element. Two groups, who are exposed to different sources of mercury, from a point source in Almadén and a diffuse source hundreds of kilometres away in the same region, were studied. Total mercury (THg) in human hair ranged from 0.20 to 9.35mgkg-1 and the mean value was 2.64mgkg-1. About 87% of subjects had THg levels in excess of the EPA reference dose (RfD=1.0mgkg-1), while a high percentage (68%) of them live in Almadén. There was a clear increase in hair Hg with reported fish consumption and the highest mean hair mercury level was 4 times the RfD in a group who had reported the highest consumption of fish. For the whole group, there was a significant effect of age, gender and fish consumption in relation to Hg concentration in the hair. Nevertheless, when both groups were tested separately by means of a multivariate regression model, there was significant exposure in those living near the mine area. Several factors such as age, gender and fish consumption remained statistically significant and were associated with THg. The main conclusion is that people living close to the hot spot are more impacted by mercury than people living further away. The intake of Hg through consumption of fish is an important parameter for Hg exposure; however, in the case of people living close to the hot spot, their levels are related to the highly Hg-impacted living environment. © 2011 Elsevier Ltd., Funding from Spanish Ministry of Science and Innovation (Grants CTM2006-13091 and CGL2009-13171) and from Castilla-La Mancha regional government – Viceconsejería de Universidades e Investigación (Grant PII1I09-0142-4389) is acknowledged. Luis Mansilla Plaza (EUP Almadén) collaborated in the sampling process. Núria Ribas collaborated in the early data treatment.

El diseño de casos cruzados es un diseño epidemiológico observacional propuesto por Maclure en 1991 para valorar si alguna exposición intermitente o inusual ha desencadenado un evento agudo a muy corto plazo. En este trabajo se presentan los fundamentos de los diseños de casos cruzados, con sus aplicaciones y limitaciones. El diseño de casos cruzados se basa en seleccionar sólo sujetos caso. Para calcular el riesgo relativo se compara la exposición durante el periodo de tiempo previo al evento (periodo caso) con la exposición del mismo sujeto en uno o varios periodos control. Este método únicamente es adecuado cuando las exposiciones son cambiantes en el tiempo, con efectos a corto plazo, y el efecto es agudo. Para exposiciones en que no existe tendencia, el planteamiento unidireccional es el más frecuente, y consiste en seleccionar uno o varios periodos control previos al momento caso. Cuando la exposición tiene una tendencia temporal (por ejemplo las de contaminación atmosférica), el planteamiento unidireccional proporciona estimaciones sesgadas, por lo que se utilizan diseños de casos cruzados bidireccionales, que seleccionan periodos de tiempo control anteriores y posteriores al del evento. Es un método que cuenta con una creciente utilización en amplios campos: desencadenantes de accidentes de tráfico, laborales y domésticos, o de infarto agudo de miocardio, contaminación atmosférica y salud, farmacoepidemiología, etc. Para el análisis de datos, generalmente se pueden considerar los diseños de casos cruzados como estudios de casos y controles emparejados, por lo que se aplica regresión logística condicional. Finalmente, en este trabajo se analizan ejemplos prácticos de diferentes aplicaciones del diseño de casos cruzados Case-crossover analysis is an observational epidemiological design that was proposed by Maclure in 1991 to assess whether a given intermittent or unusual exposure may have triggered an immediate short-term, acute event. The present article outlines the basics of case-crossover designs, as well as their applications and limitations. The case-crossover design is based on exclusively selecting case subjects. To calculate relative risk, exposure during the period of time prior to the event (case period) is compared against the same subject's exposure during one or more control periods. This method is only appropriate when the exposures are transient in time and have acute short-term effects. For exposures in which there is no trend, a unidirectional approach is the most frequent and consists of selecting one or more control periods prior to the case period. When the exposure displays a time trend (e.g., air pollution), a unidirectional approach will yield biased estimates, and therefore bidirectional case-crossover designs are used, which select control time intervals preceding and subsequent to that of the event. The case-crossover design is being increasingly used across a wide range of fields, including factors triggering traffic, occupational and domestic accidents and acute myocardial infarction, and those involved in air pollution and health and pharmacoepidemiology, among others. Insofar as data-analysis is concerned, case-crossover designs can generally be regarded as matched case-control studies and consequently conditional logistic regression can be applied. Lastly, this study analyzes practical examples of distinct applications of the case-crossover design Este trabajo se ha financiado por una acción específica del CIBERESP (CIBERESP-MET-007) y por el proyecto intramural del ISCIII: SEPY1106/07 SI

In this study we have explored the nature and range of sleep dysfunction that occurs in untreated Parkinson's disease (PD) comparing data obtained from the use of the Parkinson's disease sleep scale (PDSS) in an untreated PD patient group compared to advanced PD and healthy controls. 25 untreated (drug-naive, DNPD) PD patients (mean age 66.9 years, range 53-80, 18 males) completed the validated Parkinson's disease sleep scale (PDSS), mean duration of PD was 2.1 years (1-10, up to 4 years in all except one patient with tremulous PD reporting tremor duration of 10 years) and mean Hoehn and Yahr score 1.9 (1-3). Data were compared to 34 advanced PD (mean age 70.2 years, range 51-88, 23 male), mean duration of PD 11 years (range 4-22), mean Hoehn and Yahr score 3.4 (3-5) and PDSS data obtained from 131 healthy controls (mean age 66.6 years, range 50-93, 56 males). Total PDSS scores and PDSS sub-items, except PDSS item 2, were highly significantly different (p

To examine the relationship between the clustering of behavioural risk factors and compliance with clinical preventive practices.Cross-sectional study using a telephone interview of a sample of 16043 persons, representative of the population aged 18-64 years in the Madrid Region (Spain). The criteria for providing clinical preventive services were based on recommendations issued by the Spanish Society for Family and Community Medicine. Analyses were performed using logistic regression with adjustment for age, education, social class and year of interview.A positive dose-response association was observed between the number of behavioural risk factors (tobacco smoking, hazardous alcohol drinking, leisure-time sedentariness and unbalanced diet) and non-compliance of recommendations for blood-pressure and cholesterol testing, and for cytology and mammography screening (P0.001). Compared to subjects with no behavioural risk factors, those with all four risk factors showed a higher frequency of non-compliance of blood pressure assessment: OR = 2.5 (95% CI: 1.6, 3.8) in men and 2.7 (1.5, 4.8) in women, and cholesterolaemia testing: OR = 2.6 (1.8, 3.9) in men and 2.7 (1.5, 5.1) in women. Furthermore, among women, the presence of these four risk factors was also associated with a higher frequency of non-performance of cytology: OR = 6.4 (2.8, 14.8) and mammography screening: OR = 10.2 (2.1, 49.8). However, as it is a cross-sectional study, we do not know the direction of this relationship, therefore, any causal inference should be made with caution.Clustering of behavioural risk factors is associated with greater non-compliance with recommendations for both blood pressure and cholesterolaemia testing, and for cytology and mammography screening.

Objetivos: Describir la agregacion de factores de riesgo relacionados con el comportamiento en la poblacion adulta de la Comunidad de Madrid y evaluar la asociacion del grado de agregacion de dichos factores con la salud subjetiva suboptima. Metodos: Los datos proceden del Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles (SIVFRENT). Las relaciones entre el consumo de tabaco, el consumo de alcohol de riesgo, el sedentarismo en tiempo libre y la dieta desequilibrada fueron estudiadas en 16.043 personas de 18 a 64 anos, y se compararon las proporciones observadas respecto a las esperadas. Mediante un analisis de regresion logistica se estimo la asociacion entre la agregacion de factores de riesgo y la salud percibida suboptima (regular, mala y muy mala). Resultados: Cerca del 20% de los sujetos presentan 3 o 4 factores de riesgo simultaneamente. La mayoria de combinaciones de 3 factores de riesgo son superiores a las esperadas, destacando la agregacion de los 4 factores con un cociente observado/esperado de 2,15 (IC del 95%, 1,93-2,38) en varones y de 2,96 (IC del 95%, 2,46-3,46) en mujeres. En ambos sexos, el factor individual que mas se asocia al resto de factores de riesgo es el tabaco. La agregacion de factores de riesgo es mas frecuente en varones, en edades jovenes y en el nivel educativo bajo. En comparacion con los que carecen de los 4 factores de riesgo, los que presentan simultaneamente 3 o 4 de ellos tienen con mayor frecuencia una salud percibida suboptima (OR = 2,49; IC del 95%, 1,59-3,90 en varones y OR = 1,96; IC del 95%, 1,29-2,97 en mujeres). Conclusiones: Los factores de riesgo ligados al comportamiento se agregan, y esta acumulacion es superior en varones, en personas jovenes y con bajo nivel de estudios. Un mayor grado de agregacion se asocia a mayor frecuencia de salud percibida suboptima.

Objective: Controlled studies have shown deliberate self-harm to be more common in abused populations, but no controlled studies have shown abuse to be more common in self-harming populations. This is the first controlled study to determine whether abuse experiences (sexual, physical, and psychological) occurred more commonly in women who take overdoses than in controls. Method: The design was a matched (1:1) case-control study set in a district general hospital in England. The subjects were 36 women admitted following deliberate self-poisoning. They were matched with the next non-overdose admission to the same hospital on six variables (sex, age, ethnicity, social class, marital status, and geographical locality). The main outcome measures used were modified versions of standardized self-report questionnaires of sexual, physical, and psychological abuse, together with measures of parenting style and general psychopathology. Results: Women who had taken an overdose were more likely (odds ratio 15.0, 95% confidence interval 2.0 to 113.6) to have been sexually abused, and somewhat more likely to have been psychologically (1.02, 1.00 to 1.05) but not physically abused. They also had higher measures of psychopathology (GHQ-30: 1.19, 1.07 to 1.31), were more likely to have been abused at a younger age, exposed to the “affectionless control” style of parenting by their mothers, and to have harmed themselves in other ways. Conclusions: The management of women presenting to hospital after self-poisoning should include assessment of abuse experiences, and instigation of appropriate treatment in those with significant sequelae of abuse.