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Introduction: Global warming is resulting in an increase in temperatures which is set to become more marked by the end of the century and depends on the accelerating pace of greenhouse gas emissions into the atmosphere. Yet even in this scenario, so-called "cold waves" will continue to be generated and have an impact on health., Objectives: This study sought to analyse the impact of cold waves on daily mortality at a provincial level in Spain over the 2021-2050 and 2051-2100 time horizons under RCP4.5 and RCP 8.5 emission scenarios, on the basis of two hypotheses: (1) that the cold-wave definition temperature (T threshold ) would not vary over time; and, (2) that there would be a variation in T threshold ., Material and Methods: The results of a retrospective study undertaken for Spain as a whole across the period 2000-2009 enabled us to ascertain the cold-wave definition temperature at a provincial level and its impact on health, measured by reference to population attributable risk (PAR). The minimum daily temperatures projected for each provincial capital considering the above time horizons and emission scenarios were provided by the State Meteorological Agency. On the basis of the T threshold definition values and minimum daily temperatures projected for each province, we calculated the expected impact of low temperatures on mortality under the above two hypotheses. Keeping the PAR values constant, it was assumed that the mortality rate would vary in accordance with the available data., Results: If T threshold remained constant over the above time horizons under both emission scenarios, there would be no cold-related mortality. If T threshold were assumed to vary over time, however, then cold-related mortality would not disappear: it would instead remain practically constant over time and give rise to an estimated overall figure of around 250 deaths per year, equivalent to close on a quarter of Spain's current annual cold-related mortality and entailing a cost of approximately €1000 million per year., Conclusion: Given that cold waves are not going to disappear and that their impact on mortality is far from negligible and is likely to remain so, public health prevention measures must be implemented to minimise these effects as far as possible., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: A number of factors contribute to attention deficit hyperactivity disorder (ADHD) and although they are not fully known, the occurrence of ADHD seems to be a consequence of an interaction between multiple genetic and environmental factors. However, apart from pesticides, the evidence is inadequate and inconsistent as it differs not only in the population and time period analysed, but also in the type of study, the control of the confounding variables and the statistical methods used. In the latter case, the studies also differ in the adjustment of spatial and temporal variability. Our objective here, is to provide evidence on an association between environmental factors and ADHD., Methods: In our study, we used a population-based retrospective cohort in which we matched cases and controls (children free of the disease) by sex and year of birth (n = 5193, 78.9% boys). The cases were children born between 1998 and 2012 and diagnosed with ADHD (n = 116). To evaluate whether there was a geographical pattern in the incidence of ADHD, we first represented the smoothed standardized incidence rates on a map of the region being studied. We then estimated the probability of being a case by using a generalized liner mixed model with a binomial link. As explanatory variables of interest, we included the following environmental variables: distance to agricultural areas, distance to roads (stratified into three categories according to traffic density and intensity), distance to petrol stations, distance to industrial estates, and land use. We control for both observed (individual and family specific variables and deprivation index) and unobserved confounders (in particular, individual and familial heterogeneity). In addition, we adjusted for spatial extra variability., Results: We found a north-south pattern containing two clusters (one in the centre of the study region and another in the south) in relation to the risk of developing ADHD. The results from the multivariate model suggest that these clusters could be related to some of the environmental variables. Specifically, living within 100 m from an agricultural area or a residential street and/or living fewer than 300 m from a motorway, dual carriageway or one of the industrial estates analysed was associated (statistically significant) with an increased risk of ADHD., Conclusion: Our results indicate that some environmental factors could be associated with ADHD occurring, particularly those associated with exposure to pesticides, organochlorine compounds and air pollutants because of traffic., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: It is believed that an interaction between genetic and non-genetic factors may be involved in the development of amyotrophic lateral sclerosis (ALS). With the exception of exposure to agricultural chemicals like pesticides, evidence of an association between environmental risk factors and ALS is inconsistent. Our objective here was to investigate the association between long-term exposure to environmental factors and the occurrence of ALS in Catalonia, Spain, and to provide evidence that spatial clusters of ALS related to these environmental factors exist., Methods: We carried out a nested case-control study constructed from a retrospective population-based cohort, covering the entire region. Environmental variables were the explanatory variables of interest. We controlled for both observed and unobserved confounders., Results: We have found some spatial clusters of ALS. The results from the multivariate model suggest that these clusters could be related to some of the environmental variables, in particular agricultural chemicals. In addition, in high-risk clusters, besides corresponding to agricultural areas, key road infrastructures with a high density of traffic are also located., Conclusion: Our results indicate that some environmental factors, in particular those associated with exposure to pesticides and air pollutants as a result of urban traffic, could be associated with the occurrence of ALS., (© 2018 S. Karger AG, Basel.)

Background: There is evidence that geographic variability of social health inequalities continues to exist even after individual risk factors have been taken into account. However, relatively few studies have examined the contribution of exposure to air pollutants to those inequalities., Objectives: To study the geographic variability of inequalities in mortality and their associations with socioeconomic and environmental inequalities in small areas of the metropolitan of Barcelona during the period 1994 to 2003., Methods: As in the MEDEA Project, the small area unit was the census tract. Study population consisted of the residents of the metropolitan area of Barcelona. Response variables were all-cause and specific-cause standardized mortality ratio (SMR). Explanatory variables were deprivation index, summarizing socioeconomic variables of the census tracts, and estimates of air pollutant exposures. Bayesian hierarchical models were used in order to reduce the extra variability when using SMR and to assess associations between mortality and deprivation and air pollution., Results: Statistically significant associations with deprivation were found for the causes of death related to consumption of tobacco and alcohol for men and, besides lung cancer, diet-related causes for women. Statistically significant pollution coefficients were only found in the metropolitan area of Barcelona and in men. A positive interaction between pollutants and the deprivation index was statistically significant for respiratory mortality and PM(10), and ischemic disease mortality and NO(2), both for men., Conclusions: We found deprivation to be associated in a statistically significant way with the geographical variation in mortality in the census tracts of the metropolitan area of Barcelona, in the period 1994 to 2003. Those air pollutants more directly related with traffic modify some of these associations.

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 NO(2), once the rest of air pollutants were taken into account. A 10 microg/m(3) increase in the 24-hr average 1-day NO(2)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.