The APHEA 2 project investigated short-term health effects of particles in eight European cities. In each city associations between particles with an aerodynamic diameter of less than 10 microm (PM(10)) and black smoke and daily counts of emergency hospital admissions for asthma (0-14 and 15-64 yr), chronic obstructive pulmonary disease (COPD), and all-respiratory disease (65+ yr) controlling for environmental factors and temporal patterns were investigated. Summary PM(10) effect estimates (percentage change in mean number of daily admissions per 10 microg/m(3) increase) were asthma (0-14 yr) 1.2% (95% CI: 0.2, 2.3), asthma (15-64 yr) 1.1% (0.3, 1.8), and COPD plus asthma and all-respiratory (65+ yr) 1.0% (0.4, 1.5) and 0.9% (0.6, 1.3). The combined estimates for Black Smoke tended to be smaller and less precisely estimated than for PM(10). Variability in the sizes of the PM(10) effect estimates between cities was also investigated. In the 65+ groups PM(10) estimates were positively associated with annual mean concentrations of ozone in the cities. For asthma admissions (0-14 yr) a number of city-specific factors, including smoking prevalence, explained some of their variability. This study confirms that particle concentrations in European cities are positively associated with increased numbers of admissions for respiratory diseases and that some of the variation in PM(10) effect estimates between cities can be explained by city characteristics.
The FACET (Formoterol and Corticosteroid Establishing Therapy) study established that there is a clear clinical benefit in adding formoterol to budesonide therapy in patients who have persistent symptoms of asthma despite treatment with low to moderate doses of an inhaled corticosteroid. We combined the clinical results from the FACET study with an expert survey on average resource use in connection with mild and severe asthma exacerbations in the U.K., Sweden and Spain. The primary objective of this study was to assess the health economics of adding the inhaled long-acting beta2-agonist formoterol to the inhaled corticosteroid budesonide in the treatment of asthma. The extra costs of adding the inhaled beta2-agonist formoterol to the corticosteroid budesonide in asthmatic patients in Sweden were offset by savings from reduced use of resources for exacerbations. For Spain the picture was mixed. Adding formoterol to low dose budesonide generated savings, whereas for moderate doses of budesonide about 75% of the extra formoterol costs could be recouped. In the U.K., other savings offset about half of the extra cost of formoterol. All cost-effectiveness ratios are within accepted cost-effectiveness ranges reported from previous studies. If productivity losses were included, there were net savings in all three countries, ranging from Euro 267-1183 per patient per year. In conclusion, adding the inhaled, long-acting beta2-agonist formoterol to low-moderate doses of the inhaled corticosteroid budesonide generated significant gains in all outcome measures with partial or complete offset of costs. Adding formoterol to budesonide can thus be considered to be cost-effective.
In drug utilisation studies, the units of defined daily doses (DDD) and DDD/1000 inhabitants per day standardise for differences in dosage and population size, but not for age-related differences in drug utilisation. There is no consensus as to how age standardisation of DDD data should be carried out. Using cardiovascular drug utilisation data from Sweden and Spain, the current study compared the outcome of different methods of age standardisation. Both indirect methods (based on a comparison of observed and expected drug usage) and direct methods (using different weighting for the age categories) were used. The largest impact of standardisation was seen for diuretics. The crude rate for men and women combined was 26 DDD/1000 inhabitants per day in Costa de Ponent and 98 DDD/1000 inhabitants per day in Värmland. The corresponding figures when standardising the Costa de Ponent population were 26 and 58, respectively. Using the equivalent average rate (EAR) method, the rate for Värmland was 129 DDD/1000 inhabitants per day. Lesser but still important differences were found for beta-adrenoceptor and antihypertensives. Thus, the results of standardisation differ depending on which method is used and which drugs are evaluated. EAR is recommended for direct standardisation because of its ease of use and because it does not require the choice of a standard population.
Epidermal growth factor receptor (EGFR) is a 170-kDa transmembrane glycoprotein encoded by the HER1 protooncogene, located at 7p12. This receptor is related to the pathogenesis of breast cancer. The aim of this study was to analyze the status of HER1 using fluorescence in situ hybridization (FISH) and immunohistochemistry in a series of 48 patients with locally advanced breast cancer (LABC). Before neoadjuvant chemotherapy, core biopsies were taken from patients with LABC and were processed into paraffin blocks. Biopsies were then studied using FISH with a HER1 probe (Vysis, Downers Grove, Ill., USA). They were also analyzed immunohistochemically using two different EGFR antibodies from DakoCytomation (Denmark, A/S) and from Zymed (San Francisco, Calif., USA). HER1 amplifications were not found, although 31% of the cases presented aneusomy of chromosome 7. Only 2 cases presented EGFR expression. LABC presented a low level of EGFR expression. HER1 amplification was not present in LABC, although the polysomy of chromosome 7 was a common finding.
"Children's Dental Health in Europe" is a collaborative study of a total of 3200 children, comprising samples of 5- and 12-year-old children from eight EU-countries [Belgium, Germany, Greece, Ireland, Italy, Scotland (United Kingdom), Spain and Sweden] who have undergone clinical examination by well calibrated dentists. This study analyses the influence of a number of sociodemographic factors on the dental health of the actual children. Father's and/or mother's occupational status was used to determine the social class of the family, after construction of a family-social class variable, SocFam, and the accuracy of this variable was tested. In 15 of the 16 samples, both treatment provided and unmet treatment need were higher in children from low social class. The treatment need in children from low social class was significantly greater in the Belgium, German, Greek and Italian 5-year-old samples. The differences in both treatment need and treatment already received for children from high respectively low social class were significant in the Scottish and Spanish 12-year-old samples. Taking into account the total material of 1600 children in each age-group, risk indicators for caries, identified by logistic and multiple regression analyses, were social class of the family, the mother's smoking habits, and in the 5-year-olds the number of siblings.
Comparison of transplantation medicine in Sweden, Denmark, Germany, Spain and Portugal reveals many and important differences with respect to frequency of transplantations, frequency of life donations, legal regulations and influence of the family on organ donation. The differences observed are at least partly related to cultural and value differences between the various countries, but many questions need to be studied systematically and in more detail before useful conclusions can be drawn. One study would have to address the problem of how differences in the family influence on organ donation can be explained. Another question needing further clarification concerns the exact meaning of "medical decision" and "medical criteria" because these terms, on which access to- and selection from the waiting list largely depends, are equivocally defined and seem to differ according to different traditions. Open questions also arise with respect to the influence of "closeness or distance" on medical decision making. The findings indicate that it would be premature to propose common guidelines to be observed within Europe as long as the above mentioned and some further questions have not been systematically studied and thoroughly analyzed.
We conducted a first pilot study on healthy women living in two countries with different dietary habits, Granada in the south of Spain and Malmö in the south of Sweden, in order to compare their levels of plasma phospholipid fatty acids, and to examine the relationship between the differences in food consumption. This study is part of a pilot study which is nested in the European Prospective Investigation into Cancer and Nutrition, a multi-centre prospective cohort study on diet, plasma concentrations of antioxidants and fatty acids, and markers of oxidative stress. Thirty-nine women in Granada and thirty-eight women in Malmö, aged 45-50 years (all pre-menopausal) were selected among the female participants in the cohorts from these two countries. Individual measurements of the women's habitual diet were obtained by a food frequency questionnaire. 24-hour diet recalls were used for the standardised measurement of diet at group level. Plasma phospholipid fatty acid composition was determined by capillary gas chromatography. We found a different fatty acid profile in plasma between the two populations, with higher mean levels of palmitic acid (16:0), palmitoleic acid (16:1) (n-7), oleic acid (18:1), alpha-linolenic acid (18:3) (n-3) and eicosapentaenoic acid (20:5) (n-3), and lower mean levels of stearic acid (18:0) in Malmö compared to Granada. Women in Malmö consumed more meat, alcoholic beverages and sugar, and less fish and shellfish than women in Granada. We conclude that the fatty acid composition in plasma phospholipids is different between women from the two European centres. For polyunsaturated fatty acids, differences were observed for (n-3) fatty acids. In relation to these differences, we observed that specific food intakes, particularly meat and fish, varied between the two centres.
BACKGROUND: The little knowledge about the distribution of total cholesterol (TC) in childhood and adolescence in Spain, makes the planification of preventive measures for cardiovascular diseases difficult. The aim of this study is to determinate these values in the island of Menorca. METHODS: A sample of 1,062 boys and girls 6 to 18 years of age was studied. Blood samples were obtained by venipuncture and were analyzed by the enzymatic techniques of cholesterol-esterase, cholesterol-oxidase, and peroxidase. RESULTS: Boys showed lower mean TC values than girls in almost all age groups. In both sexes, a descending phase was observed in the TC by age curve at the beginning of the adolescence. TC values above 5.17 mmol/l (200 mg/dl) were recorded for 7% of participants, being this proportion lower than the value found in the Spanish study of Fuenlabrada (13%). CONCLUSIONS: Results obtained are compared with other national and international studies. The values of this study rank an intermediate position between the highest mean TC values registered in Norway and the lowest registered in Israel.
STUDY OBJECTIVE: To examine the relation between alcohol and main alcoholic beverage consumption and subjective health in Spain. DESIGN: Logistic regression analysis using a cross sectional survey based on self reported data on alcohol and alcoholic beverage consumption, subjective health and the principal confounding factors (age, sex, civil status, educational level, job status, social support, region of residence, size of town or city, tobacco consumption, physical activity during leisure time and work hours, and chronic disease). SETTING: The 1993 Spanish National Health Survey. PARTICIPANTS: A 19 573 person sample, representative of the non-institutionalised Spanish population aged 16 years and over. MAIN RESULTS: Among Spaniards, 31.4% reported their health as suboptimal (fair, poor or very poor) and 56.9% consumed alcohol regularly, with the majority having a preference for wine. Light (1-2 drinks per day) or moderate consumption (3-4 drinks per day) was the most frequent pattern. After adjusting for confounding factors, a negative dose-response relation was observed between consumption of total alcohol, wine and beer, and prevalence of suboptimal health (linear trend: p
This study aimed to evaluate the cost-effectiveness of formoterol (Oxis) Turbuhaler 4.5 microg and salbutamol 200 microg as reliever medications in Sweden and Spain. The study used data on effectiveness (exacerbations and symptom-free days) and resource utilisation from an open, 6-month, parallel-group, multicentre randomised trial with 18,124 asthma patients in 24 countries. Country-specific unit costs for Sweden and for Spain were used to transform resource utilisation data into costs. Total healthcare costs were not significantly different between formoterol and salbutamol dry powder inhalers in Sweden, whereas in Spain, the healthcare costs were 20% higher for formoterol vs. salbutamol pressurised metered dose inhalers. Total healthcare costs increased with disease severity, defined according to the Global Initiative for Asthma guidelines. Compared with salbutamol, formoterol produced statistically significant improvements in effectiveness, less reliever and maintenance medication usage, reduced healthcare resource utilisation, with no increase or a limited increase in healthcare cost.