Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol.

Introduction: The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health.

Estimating ambient air pollution mortality and disease burden and its economic cost in Barcelona.

Background: The new WHO air quality guidelines indicate that the air pollution disease burden is greater than previously reported. We aimed to estimate the air pollution disease burden and its economic cost in Barcelona to inform local action.

Methods: We used a quantitative health impact assessment to estimate the non-accidental mortality and incidence of childhood asthma and lung cancer attributable to long-term air pollution exposure in the city of Barcelona (Spain) in 2018-2019.

[Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?].

Objective: To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence.

Design: Randomized community clinical trial with two study groups.

Location: Primary Care Centers in Central Catalonia.

Study Protocol for the Evaluation of the Health Effects of Superblocks in Barcelona: The "Salut Als Carrers" (Health in the Streets) Project.

Superblocks are currently being introduced in Barcelona to respond to the city's scarcity of green spaces and high levels of air pollution, traffic injuries, and sedentariness. The aim is to calm the streets by reducing the number of square meters dedicated to private vehicles and to reclaim part of this public space for people. Salut als Carrers (Health in the Streets) is a project to evaluate the potential environmental and health effects of the superblock model with an equity perspective in Barcelona.

Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union.

Background: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk.

Objective: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer.

Methods: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records.

Exposure to disinfection by-products in swimming pools and biomarkers of genotoxicity and respiratory damage - The PISCINA2 Study.

Background: Swimming in pools is a healthy activity that entails exposure to disinfection by-products (DBPs), some of which are irritant and genotoxic.

Objectives: We evaluated exposure to DBPs during swimming in a chlorinated pool and the association with short-term changes in genotoxicity and lung epithelium permeability biomarkers.

Methods: Non-smoker adults (N = 116) swimming 40 min in an indoor pool were included.

A multivariate approach to investigate the combined biological effects of multiple exposures.

Epidemiological studies provide evidence that environmental exposures may affect health through complex mixtures. Formal investigation of the effect of exposure mixtures is usually achieved by modelling interactions, which relies on strong assumptions relating to the identity and the number of the exposures involved in such interactions, and on the order and parametric form of these interactions. These hypotheses become difficult to formulate and justify in an exposome context, where influential exposures are numerous and heterogeneous.

Long-term exposure to trihalomethanes in drinking water and breast cancer in the Spanish multicase-control study on cancer (MCC-SPAIN).

Background: Exposure to trihalomethanes (THMs) in drinking water has consistently been associated with an increased risk of bladder cancer, but evidence on other cancers including the breast is very limited.

Objectives: We assessed long-term exposure to THMs to evaluate the association with female breast cancer (BC) risk.

Methods: A multi case-control study was conducted in Spain from 2008 to 2013.

Effects of exposure to water disinfection by-products in a swimming pool: A metabolome-wide association study.

Background: Exposure to disinfection by-products (DBPs) in drinking water and chlorinated swimming pools are associated with adverse health outcomes, but biological mechanisms remain poorly understood.

Objectives: Evaluate short-term changes in metabolic profiles in response to DBP exposure while swimming in a chlorinated pool.

Materials And Methods: The PISCINA-II study (EXPOsOMICS project) includes 60 volunteers swimming 40min in an indoor pool.

Blood transcriptional and microRNA responses to short-term exposure to disinfection by-products in a swimming pool.

Background: Swimming in a chlorinated pool results in high exposure levels to disinfection by-products (DBPs), which have been associated with an increased risk of bladder cancer.

Objectives: By studying molecular responses at the blood transcriptome level we examined the biological processes associated with exposure to these compounds.

Methods: Whole-genome gene expression and microRNA analysis was performed on blood samples collected from 43 volunteers before and 2h after 40min swimming in an indoor chlorinated pool (PISCINAII study).

Trihalomethane concentrations in tap water as determinant of bottled water use in the city of Barcelona.

Unlabelled: Bottled water consumption is increasing worldwide, despite its huge economic and environmental cost. We aim to describe personal and tap water quality determinants of bottled water use in the city of Barcelona. This cross-sectional study used data from the Health Survey of Barcelona in 2006 (N=5417 adults).

Gene expression changes in blood RNA after swimming in a chlorinated pool.

Exposure to disinfection by-products (DBP) such as trihalomethanes (THM) in swimming pools has been linked to adverse health effects in humans, but their biological mechanisms are unclear. We evaluated short-term changes in blood gene expression of adult recreational swimmers after swimming in a chlorinated pool. Volunteers swam 40min in an indoor chlorinated pool.

Acute changes in serum immune markers due to swimming in a chlorinated pool.

Background: Exposure to disinfectants and disinfection byproducts (DBPs) due to swimming in chlorinated water has been associated with allergic and respiratory health effects, including asthma.

Objectives: Biological mechanisms contributing to these associations are largely unknown. We hypothesized a potential pathway involving modulation of the immune system.

Environmental and personal determinants of the uptake of disinfection by-products during swimming.

Background: Trihalomethanes (THMs) in exhaled breath and trichloroacetic acid (TCAA) in urine are internal dose biomarkers of exposure to disinfection by-products (DBPs) in swimming pools.

Objective: We assessed how these biomarkers reflect the levels of a battery of DBPs in pool water and trichloramine in air, and evaluated personal determinants.

Methods: A total of 116 adults swam during 40min in a chlorinated indoor pool.

Ingested Nitrate and Breast Cancer in the Spanish Multicase-Control Study on Cancer (MCC-Spain).

Background: Ingested nitrate leads to endogenous formation of N-nitroso compounds that are breast carcinogens in animals, but human evidence is limited.

Objective: We evaluated ingested nitrate as a risk factor for breast cancer (BC) in a multicase-control study.

Methods: Hospital-based incident BC cases and population-based controls were recruited in eight Spanish regions in 2008-2013; participants provided residential and water consumption from 18 years of age and information on known BC risk factors.

Water hardness and eczema at 1 and 4 y of age in the INMA birth cohort.

Background: Exposure to hard water has been suggested as a risk factor for eczema in childhood, based on limited evidence from two ecologic and two cross-sectional studies.

Objectives: We evaluate this hypothesis for the first time in early infancy using prospective data from a mother-child cohort study.

Methods: We used data from the INMA cohorts in Gipuzkoa, Sabadell and Valencia, Spain (N=1638).

Overview of Disinfection By-products and Associated Health Effects.

The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal absorption from drinking water and swimming pools. Epidemiological evidence has shown a consistent association between long-term exposure to trihalomethanes and the risk of bladder cancer, although the causal nature of the association is not conclusive. Evidence concerning other cancer sites is insufficient or mixed.

Influence of physical activity in the intake of trihalomethanes in indoor swimming pools.

This study describes the relationship between physical activity and intake of trihalomethanes (THMs), namely chloroform (CHCl3), bromodichloromethane (CHCl2Br), dibromochloromethane (CHClBr2) and bromoform (CHBr3), in individuals exposed in two indoor swimming pools which used different disinfection agents, chlorine (Cl-SP) and bromine (Br-SP). CHCl3 and CHBr3 were the dominant compounds in air and water of the Cl-SP and Br-SP, respectively. Physical exercise was assessed from distance swum and energy expenditure.

Risks and benefits of green spaces for children: a cross-sectional study of associations with sedentary behavior, obesity, asthma, and allergy.

Background: Green spaces have been associated with both health benefits and risks in children; however, available evidence simultaneously investigating these conflicting influences, especially in association with different types of greenness, is scarce.

Objectives: We aimed to simultaneously evaluate health benefits and risks associated with different types of greenness in children, in terms of sedentary behavior (represented by excessive screen time), obesity, current asthma, and allergic rhinoconjunctivitis.

Methods: We conducted a cross-sectional study of a population-based sample of 3,178 schoolchildren (9-12 years old) in Sabadell, Spain, in 2006.

Indoor swimming pool attendance and respiratory and dermal health in schoolchildren--HITEA Catalonia.

Background: Health benefits of swimming in pools may outweigh adverse health outcomes in children, but evidence from epidemiological studies is scarce or inconclusive for different health outcomes. We evaluated the association between indoor swimming pool attendance during childhood and respiratory and dermal conditions and symptoms in Catalan schoolchildren.

Methods: Cross-sectional study in 2758 children aged 6-12 years from 18 primary schools in Barcelona province.

[The study of social inequalities in child and adolescent health in Spain].

Objective: To identify and describe studies on social inequalities in child and adolescent health conducted in Spain with special emphasis on social determinants.

Methods: In July 2012, we conducted a systematic review in the PubMed, MEDES, SCOPUS and COCHRANE databases. We included studies on social inequalities in child and adolescent health in Spain published between 2000 and 2012.

Driving under the influence of alcohol or drugs among adolescents: the role of urban and rural environments.

This study aimed to describe driving under the influence of alcohol or drugs (DUIAD) and riding in a vehicle with a driver under the influence of alcohol or drugs (RDUIAD) and their associated factors among rural and urban adolescents in Spain. We performed a cross-sectional study including 2067 students from Barcelona and a rural area 60 km north of this city. The prevalences of ever DUIAD and RDUIAD were 17% and 41% among 17-18 year-old adolescents.

Socioeconomic inequalities in the incidence and prevalence of type 2 diabetes mellitus in Europe.

Objective: The aim of this study was to analyze socioeconomic position (SEP) inequalities in the prevalence and incidence of type 2 diabetes mellitus (T2DM) in people aged 50 years and over in Europe and to describe the contribution of body mass index (BMI) and other possible mediators.

Methods: This was a cross-sectional and longitudinal study including men and women ≥ 50 years old in 11 European countries in 2004 and 2006 (n = 21,323). The prevalence and cumulative incidence of T2DM were calculated with self-reported T2DM or when the individual took drugs for diabetes.

Swimming pool attendance, respiratory symptoms and infections in the first year of life.

Unlabelled: We evaluated the relationship between indoor and outdoor swimming pool attendance and respiratory symptoms and infections during the first year of life. A population-based mother-child cohort study was conducted in four Spanish areas (INMA project). Study subjects were recruited at pregnancy, followed to delivery and 14 months after birth.

Health impact of disinfection by-products in swimming pools.

This article is focused on the epidemiological evidence on the health impacts related to disinfection by-products (DBPs) in swimming pools, which is a chemical hazard generated as an undesired consequence to reduce the microbial pathogens. Specific DBPs are carcinogenic, fetotoxic and/or irritant to the airways according to experimental studies. Epidemiological evidence shows that swimming in pools during pregnancy is not associated with an increased risk of reproductive outcomes.