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The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet.

The impact of disasters on public health does not always occur immediately. In fact, medium- and long-term effects are often worse than those produced during the acute phase.On May 11th 2011, two seismic events of catastrophic consequences took place in the town Lorca; the first one happened at 5:05 pm (Spanish time) of a magnitude Mw = 4.5, and it was followed by several aftershocks. About two hours later, a stronger earthquake occurred, with a magnitude Mw = 5.1 and an intensity VII on the EMS-98 scale. The earthquakes caused nine deaths, injured about 300 people, and forced 60,000 persons to leave their homes. Three temporary camps were set up around the city, which were unified later.The public health actions and prevention and control measures were analyzed after the catastrophic earthquake. The information for this paper was obtained by interviewing individuals and groups belonging to the Lorca Public Health Service’s staff.The analysis revealed a need to improve procedures and coordination among the different groups. To conclude, the following actions, among others, are suggested: 1) to establish protocols or guidelines to allow a fast identification of risks and also a fast decision-making; 2) to carry out training exercises and drills; 3) to receive emergency and disaster training; 4) a transverse collaboration of the public health team with other Task Groups.

Fundamentos: la evaluación económica de las repercusiones sanitarias de las políticas públicas es difícil y escasa. El objetivo del presente estudio fue cuantificar monetariamente los beneficios de la reducción del plomo en la sangre de los niños de 7-8 años en la Comunidad de Madrid (España), derivada de la prohibición del plomo en las gasolinas. Métodos: se calculó la disminución de puntos de cociente intelectual (CI), utilizando dos estudios realizados en niños de 7 a 8 años según los valores de plomo en sangre que presentaban: media geométrica de 3,8 μg/dL en 1995 y 0,9 μg/dL en 2010. La mejoría neta de CI se midió en términos de capacidad de producción ganada a lo largo de la vida laboral, siguiendo los métodos de Schwartz y Salkiver. Resultados: la reducción de los niveles de plomo en sangre de estos niños evitó perder entre 135.391 y 144.153 puntos de CI. La valoración económica actual de estos puntos en términos de capacidad de producción ganada a lo largo de la vida laboral de estos sujetos se estimó en un rango entre 626,4 y 865,4 millones de euros (valor 2009). Conclusiones: las cifras de beneficios económicos encontradas derivadas de la medida de prohibición de uso de plomo en las gasolinas son importantes en términos sociales. Background: the repercussions on health of public policies are hard to assess from an economic point of view, which is why this is rarely done. The purpose of this study was to financially quantify the benefits of reducing blood lead levels in children aged 7-8 years in the Community of Madrid (Spain) as a result of the ban on the use of lead in gasoline. Methods: the decrease the intellectual quotient (IQ) points was calculated through two studies on children aged 7-8 years according to their blood lead levels. A geometric mean of 3.8 μg/dl was obtained in the 1995 study and of 0.9 μg/dl in the 2010 study. The net increase in IQ was measured in terms of productivity gained throughout the working life as per the methods of Schwartz and Salkever. Results: the decrease in blood lead levels in these children prevented a loss of between 135,391 and 144,153 IQ points; the current economic valuation of these points in terms of the productivity gained throughout the working life of this cohort of children was estimated to fall within the €626.4m- €865.4m range (2009). Conclusions: the figures of the economic benefits derived from the decision to ban leaded gasoline are very high.

In Spain, certain population-based studies have shown high blood mercury (Hg) levels due to the high consumption of fish. Some studies have stated that one of the most consumed fish in Spain is canned tuna. Different Spanish organisms consider that it is safe to consume canned tuna as it supposedly has a low mercury content, particularly in so-called light tuna. However, in Spain light tuna is mainly yellowfin and bigeye tuna, while in other countries it is mainly skipjack tuna. This study analyzed 36 cans of the most popular brands in Spain and examined the influence of the type of tuna, packaging medium (olive oil, sunflower seed oil, water or marinade), different brands, prices and expiration dates. Mercury concentrations (mg/kg) were measured by atomic absorption spectrometry and thermal decomposition amalgamation. The medians observed were (mg/kg): light tuna: 0.314; IQR: 0.205 - 0.594, white tuna: 0.338; IQR: 0.276 - 0.558, skipjack: 0.311; IQR: 0.299 - 0.322, frigate tuna: 0.219; IQR 0.182 - 0.257 and mackerel: 0.042; IQR 0.029 - 0.074. We found statistically significant differences between white tuna, light tuna and mackerel (p = 0.004); light tuna and mackerel (p = 0.002) and white tuna and mackerel (p = 0.006). However, we found no differences between white tuna and light tuna, or among packaging medium, brands, prices or expiration dates. The limit of 0.500 mg/kg of mercury in canned tuna was exceeded by the following percentages of the cans: 33.3% of light tuna, 16.7% of white tuna, and 0% of Skipjack, frigate tuna and mackerel. The mercury content of the cans of Spanish light tuna that were analyzed was variable and high. The results of this study indicate that stricter regulation of Hg in canned tuna is necessary. Until then, it is safer to recommend that vulnerable populations such as children and pregnant women consume canned mackerel, which has a markedly lower mercury content.

The repercussions on health of public policies are hard to assess from an economic point of view, which is why this is rarely done. The purpose of this study was to financially quantify the benefits of reducing blood lead levels in children aged 7-8 years in the Community of Madrid (Spain) as a result of the ban on the use of lead in gasoline.The decrease the intellectual quotient (IQ) points was calculated through two studies on children aged 7-8 years according to their blood lead levels. A geometric mean of 3.8 μg/dl was obtained in the 1995 study and of 0.9 μg/dl in the 2010 study. The net increase in IQ was measured in terms of productivity gained throughout the working life as per the methods of Schwartz and Salkever.The decrease in blood lead levels in these children prevented a loss of between 135,391 and 144,153 IQ points; the current economic valuation of these points in terms of the productivity gained throughout the working life of this cohort of children was estimated to fall within the €626.4m- €865.4m range (2009).The figures of the economic benefits derived from the decision to ban leaded gasoline are very high.

The aim of this study is to describe antibiotic consumption in the Region of Murcia in 2011, within the Spanish and European context, as well as to analyze the differences within the Region, both between health areas, and between users of the regional health service and those protected by the civil servants' mutual insurance society (MUFACE).Retrospective observational study of prescriptions dispensed by the pharmacies in the Region of Murcia during 2011. Consumption rates were expressed as defined daily doses (DDD) per 1,000 inhabitants/day and standardized consumption ratios (SCR).Overall antibiotics consumption rate in the Region of Murcia in 2011 was 30.05 DDD/1000/ day (DID), which is much above the average rate for Spain (20.9 DID) and for the European Union (21.57 DID). Health areas within the Region with the highest and lowest consumption rate are, respectively, Vega Alta (SCR: 124.44; CI95% 124.26 to 124.61) and Cartagena (SCR:84.16; CI95% 84.10 to 84.22). Civil servants covered by the mutual society have higher consumption rates than users of the regional health service (SCR: 105.01; CI95% 104.86 to 105.17).There is a high level of antibiotic prescription in the Region of Murcia Region in relative terms. A great variability in antibiotics consumption was observed between the different health areas, which might be related to the higher rate of the frequency of visits. The highest amount of variability in antibiotics prescription was found in cephalosporins and macrolides.

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet.

El mercurio es un tóxico ambiental que causa numerosos efectos adversos en la salud humana y en los ecosistemas naturales. Los factores que determinan la aparición de efectos adversos y su severidad son entre otros: la forma química del mercurio (elemental, inorgánico, orgánico), la dosis, la edad, la duración de la exposición, la vía de exposición y los factores ambientales, nutricionales y genéticos. En el ciclo acuático del mercurio, una vez que se ha depositado, se transforma en metilmercurio por la acción de determinadas bacterias sulfato reductoras y se bioacumula en los organismos acuáticos incorporándose a la cadena trófica de alimentos. El contenido de metilmercurio es mayor en las especies depredadoras de mayor tamaño y que viven más años como el emperador, pez espada, tiburón, atún o marlín. El metilmercurio se halla unido a las proteínas del pescado por lo que no se elimina mediante la limpieza ni el cocinado del mismo. El feto en desarrollo y los niños pequeños son los más vulnerables a los efectos neurotóxicos del metilmercurio procedente de la ingesta de pescado contaminado. El metilmercurio se absorbe en el tracto gastrointestinal y atraviesa la barrera hematoencefálica y la placenta. Algunos componentes de la dieta como los ácidos grasos poliinsaturados, el selenio, la fibra, los compuestos tiol, algunos fitoquímicos y otros nutrientes pueden modificar la bioaccesibilidad del mercurio y su toxicidad. Además de los factores ambientales, los factores genéticos pueden influir en la toxicidad del mercurio y explicar parte de la vulnerabilidad individual. Mercury is an environmental toxicant that causes numerous adverse effects on human health and natural ecosystems. The factors that determine the existance of adverse effects, as well as their severity are, among others: the chemical form of mercury (elemental, inorganic, organic), dosis, age, period of exposure, pathways of exposure and environmental, nutritional and genetic factors. In the aquatic cycle of mercury, once it has been deposited, it is transformed into methylmercury due to the action of certain sulphate-reducing bacteria, which bioaccumulates in the aquatic organisms and moves into the food chain. The methylmercury content of large, long-lived fish such as swordfish, shark, tuna or marlin, is higher. Methylmercury binds to protein in fish and is therefore not eliminated by cleaning or cooking the fish. Fetuses and small children are more vulnerable to the neurotoxic effects of methylmercury from the consumption of contaminated fish. Methylmercury is absorbed in the gastrointestinal tract and crosses the blood-brain barrier and the placenta. The intake of certain dietary components such as polyunsaturated fatty acids, selenium, fiber, thiol compounds, certain phytochemicals and other nutrients can modify methylmercury bioaccesibility and its toxicity. Apart from environmental factors, genetic factors can influence mercury toxicity and explain part of the individual vulnerability.

This article draws a comparison and provides a discussion of the findings resulting from the local analyses of the 14 cities participating in the EMECAM Project. An analysis is made of the time series related to mortality, pollutants (particles in suspension, SO2, NO2, O3 and CO), temperature and other factors taken from records of public institutions. By using Poisson autoregressive regression, an estimate has been made of the short-term relationship between the number of deaths and the air pollution indicators in each one of the following cities: Barcelona, metropolitan area of Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Seville, Oviedo, Valencia, Vigo, Vitoria and Saragossa. The findings reveal the air pollution figures in our country to be similar to those of other European cities. The levels of the different pollutants point toward road traffic as being the main source of most of this pollution. A relationship has been found between the mortality and different pollutants in most cities, although the results are not homogeneous among the cities and show variability in the different causes under study. In some cities, especially in those having smaller populations, there have been no findings providing any evidence of a relationship, or the findings themselves are not highly consistent. The meta-analysis will provide estimates for all of the cities as a whole and will allow the possibility of making a more clear-cut assessment of the time lag impact of air pollution on the mortality. Worthy of special mention is the participation in this project of public health officers as actively involved researchers.

Introduction: Lead is a toxic element for humans, with children being the most vulnerable population.Objective: To find out the risk factors associated to the existing blood lead levels (BLLs) of children in the Community of Madrid, after 9 years of lead being banned in gasoline.Methods: A cross-sectional study was carried out in 2010 with a sample of 85 children, less than 15 years of age, recruited via the outpatients’ service of the Pediatrics Department of the Hospital Clínico San Carlos in Madrid. Routine blood tests provided the opportunity for determining other blood parameters. Lead levels were measured using electrothermal-atomization atomic absorption spectrometry with the Zeeman-effect background correction. In addition, a survey was undertaken directed to the parents for gathering information about a series of socioeconomic and environmental variables.Results: The arithmetic mean of the BLLs in the children was 1.1 μg/dL (SD=0.7 μg/dL) with a range from 0.1 μg/dL to 3.4 μg/dL. The geometric mean was 0.9 μg/dL (SD= 1.1 μg/dL). The risk factors associated to these BLLs are the following: playing in the street; low educational level of the parents; leisure activities of one of the parents linked to lead; tobacco smoking of the father; and drinking tap water.Conclusions: The BLLs of the children in the Community of Madrid have decreased, but there are still sociodemographic and environmental risk factors associated to the present levels. Introducción: El plomo es un elemento tóxico para el hombre, siendo los niños la población más vulnerable.Objetivo: Conocer los factores de riesgo asociados a los niveles de plomo en sangre existente en niños de la Comunidad de Madrid tras 9 años de prohibición del plomo en las gasolinas. Métodos: Estudio transversal realizado en el año 2010 en el que se incluyeron 85 niños de ambos sexos, menores de 15 años reclutados en consulta ambulatoria del Servicio de Pediatría del Hospital Clínico San Carlos de Madrid. Se aprovechó la extracción de sangre para la determinación de otros parámetros sanguíneos. El plomo se midió por espectrometría de absorción atómica con atomización electrotérmica y corrección de fondo por efecto Zeeman. Además se pasó una encuesta a los padres recogiéndose toda una serie de variables socioeconómicas y ambientales.Resultados: La media aritmética de plomo en sangre encontrada en los niños ha sido de 1,1 μg/dL (DE=0,7 μg/dL) con un rango desde 0,1 μg/dL hasta 3,4 μg/dL. La media geométrica es de 0,9 μg/dL (DE= 1,1 μg/dL). Los factores de riesgo asociados a estos niveles son: jugar en la calle, bajo nivel de estudios del padre como de la madre, las aficiones ligadas al plomo de alguno de los padres, el consumo de tabaco del padre y beber agua del grifo.Conclusiones: Los niveles de plomo en la sangre de los niños de la Comunidad de Madrid se han reducido pero siguen existiendo factores de riesgo sociodemográficos ya ambientales asociados a estos niveles. Introdução: O chumbo é um elemento tóxico para os seres humanos, sendo as crianças as mais vulneráveis.Objetivo: Conhecer os fatores de risco associados aos níveis de chumbo existentes no sangue das crianças da comunidade de Madrid, após 9 anos de proibição de chumbo na gasolina.Métodos: Estudo transversal realizado em 2010 que incluiu 85 crianças de ambos os sexos, com menos de 15 anos, selecionadas na consulta externa do Serviço de Pediatria do Hospital Clínico San Carlos em Madrid. Para a deteção dos níveis de chumbo foram aproveitadas amostras de sangue destinadas à determinação de outros parâmetros. O chumbo foi medido por espectrometria de absorção atómica com atomização eletrotérmica e correção de fundo por efeito Zeeman. Conjuntamente, realizou-se um questionário aos pais para recolher uma série de variáveis socioeconómicas e ambientais.Resultados: A média aritmética de chumbo no sangue encontrado nas crianças foi de 1,1 μg/dl (SD=0,7 μg/dl), com um intervalo de 0,1 μg/dl a 3,4 μg/dl. A média geométrica é de 0,9 μg/dl (SD=1,1 μg/dl). Os fatores de risco associados aos níveis apresentados são: o brincar na rua, o baixo nível de escolaridade dos pais, as atividades de lazer de um dos pais relacionadas com o chumbo, os hábitos tabágicos do pai e o consumo de água da rede pública.Conclusões: Os níveis de chumbo no sangue das crianças da Comunidade de Madrid reduziram, contudo subsistem fatores de risco sociodemográficos e ambientais associados a estes níveis.

English Abstract; Journal Article; Research Support, Non-U.S. Gov't; In recent years, a growing number of studies suggests that increases in air pollution levels may have short-term impact on human health, even at pollution levels similar to or lower than those which have been considered to be safe to date. The different methodological approaches and the varying analysis techniques employed have made it difficult to make a direct comparison among all of the findings, preventing any clear conclusions from being drawn. This has led to multicenter projects such as the APHEA (Short-Term Impact of Air Pollution on Health. A European Approach) within a European Scope. The EMECAM Project falls within the context of the aforesaid multicenter studies and has a wide-ranging projection nationwide within Spain. Fourteen (14) cities throughout Spain were included in this Project (Barcelona, Metropolitan Area of Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Seville, Oviedo, Valencia, Vigo, Vitoria and Saragossa) representing different sociodemographic, climate and environmental situations, adding up to a total of nearly nine million inhabitants. The objective of the EMECAM project is that to asses the short-term impact of air pollution throughout all of the participating cities on the mortality for all causes, on the population and on individuals over age 70, for respiratory and cardiovascular design causes. For this purpose, with an ecological, the time series data analyzed taking the daily deaths, pollutants, temperature data and other factors taken from records kept by public institutions. The period of time throughout which this study was conducted, although not exactly the same for all of the cities involved, runs in all cases from 1990 to 1996. The degree of relationship measured by means of an autoregressive Poisson regression. In the future, the results of each city will be combined by means of a meta-analysis. Yes En los últimos años, un número creciente de estudios sugiere que los incrementos en los niveles de contaminación atmosférica pueden causar efectos a corto plazo sobre la salud, incluso con niveles de contaminación cercanos o inferiores a los considerados hasta ahora como seguros. Los distintos enfoques metodológicos y la diversidad de técnicas de análisis utilizadas han dificultado la comparabilidad directa entre los resultados obtenidos, impidiendo llegar a conclusiones claras. Ello ha estimulado la puesta en marcha de proyectos multicéntricos, como el proyecto APHEA (short-term effects of Air Pollution on Health: a European Approach), dentro del ámbito europeo. El proyecto EMECAM se enmarca en el contexto de los estudios multicéntricos citados y tiene una proyección amplia en el ámbito nacional español. En él se incluyen 14 ciudades españolas (Barcelona, Gran Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Sevilla, Oviedo, Valencia, Vigo, Vitoria y Zaragoza) que representan diferentes situaciones sociodemográficas, climáticas y ambientales, sumando un total cercano a nueve millones de habitantes. El objetivo del proyecto EMECAM es evaluar el impacto a corto plazo de la contaminación atmosférica, en el conjunto de las ciudades participantes, sobre la mortalidad por todas las causas, en toda la población y en personas de 70 y más años, y por causas respiratorias y del aparato circulatorio. Para ello, con un diseño ecológico, se analizan los datos de las series temporales tomando como unidad los datos diarios de mortalidad, contaminantes, temperatura y otros factores, obtenidos de registros de instituciones públicas. El periodo de estudio, aunque no es exactamente el mismo para todas las ciudades, está comprendido en todos los casos entre los años 1990 y 1996. El cálculo de las medidas de asociación se realiza mediante regresión autorregresiva de Poisson. En una fase posterior los resultados de cada ciudad se combinarán mediante la realización de un meta-análisis.