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J Sunyer

Publications and source records attributed to J Sunyer.

13 recordsLinked to original sources
PubMed1992

[Sudden cardiac death in the counties of Girona].

BACKGROUND: Data on sudden cardiac death in Spain in scarce. Mortality rates from sudden cardiac death occurring in six counties of Girona (including urban, industrial, and rural areas) between October 1987 and September 1988 were assessed. METHODS: From a total of 1,573 deaths in residents of the studied area aged between 25 and 74 years, 222 cases with a suggestive diagnosis of sudden cardiac death were selected. Data that confirmed the diagnosis and the time elapsed from the initial clinical symptoms and death were obtained by inquiring physicians who signed the death certificates, relatives or witnesses and by reviewing the hospital records. RESULTS: Of a total of 137 deaths of cardiac origin, there were 107 cases of sudden cardiac death (which occurred within 24 hours after the onset of symptoms). The mortality rate of sudden death of cardiac origin was 37.5 per 100,000 inhabitants, that was significantly higher among men (67.8 in men and 15.4 in women). The mortality rate showed a statistically significant increase in the older age groups (28.4 per 100,000 inhabitants in the age group of 45-54 years, 69 in the group of 55-64 years, and 129.7 in the group of 65-74 years). Death occurred within the first hour after the onset of symptoms in 59 patients, 17 of whom were admitted to a hospital. Only 35% of the total 107 patients were treated in hospital. CONCLUSIONS: Mortality rate of sudden cardiac death in Girona is low. Few patients dying from sudden cardiac death could have medical care.

Adult↗
PubMed1992

Risk factors of soybean epidemic asthma. The role of smoking and atopy.

Epidemics of emergency room admissions for asthma occurring in Barcelona during the period 1981 to 1987 were caused by inhalation of soybean dust. To investigate the risk factors that determined why some asthma patients became reactive to soybean and were consequently affected by the asthma epidemics of Barcelona but others did not do so, a case-control study was conducted during 1989, 2 yr after the cessation of asthma epidemics. Patients with asthma admitted in emergency room services during epidemic asthma days (n = 169) were compared with asthma patients admitted in the same services during nonepidemic days and who were never admitted during the epidemics (n = 147). Risk factors other than soybean exposure, namely skin reactivity against at least one common allergen (odds ratio [OR] 3.0, 1.7 to 5.3), age over 64 yr (OR 2.8, 1.4 to 6.0), cigarette smoking at the time of the epidemics (OR 2.3, 1.2 to 2.4), past smoking (OR 1.8, 0.9 to 3.7), and total immunoglobulin E (IgE) higher than 100 IU/ml (OR 1.7, 1.0 to 3.0), were found independently related to epidemic asthma. The role of smoking was especially important for those who had a positive skin reaction and were exposed to soybean dust (OR 7.9, 1.8 to 36.0). In this group, a dose-response pattern with pack-years was observed (p less than 0.01). The present findings suggest a multifactorial process for epidemic asthma, in which atopy and cigarette smoking played an important synergistic role. This has a preventive potential for IgE-related asthma.

Asthma↗
PubMed1991

Effects of urban air pollution on emergency room admissions for chronic obstructive pulmonary disease.

The authors assessed the relation between sulfur dioxide and other air pollutants (black smoke, carbon monoxide, nitrogen dioxide, and ozone) and daily emergency room admissions for chronic obstructive pulmonary disease in Barcelona, Spain, during 1985-1986. Barcelona is a Mediterranean city of 1.7 million inhabitants that has air pollution levels lower than standard values. A weak but statistically significant association between emergency room admissions and levels of sulfur dioxide, black smoke, and carbon monoxide was observed. Daily emergency room admissions for chronic obstructive pulmonary disease increased by 0.02 and 0.01 for each microgram of sulfur dioxide and black smoke per cubic meter, respectively, and 0.11 for each milligram of carbon monoxide per cubic meter, after adjusting for meteorologic and temporal variables. Similar estimations were obtained after controlling for the autocorrelation effect by means of time series analysis. In addition, when the data were stratified by season, the effects remained in summer. This strengthened the conclusion that the relation observed in winter, spring, and throughout the study period was indeed real. After truncating the data according to sulfur dioxide or black smoke levels, the authors still found effects for these pollutants at levels below the air quality guideline of 100 micrograms/m3 established by the World Health Organization. The consistency of these results with other recent toxicologic and epidemiologic observations suggest that current air pollution standards do not totally protect public health with a margin of safety in specific places.

Air Pollutants↗
PubMed1991

Identification of soybean dust as an epidemic asthma agent in urban areas by molecular marker and RAST analysis of aerosols.

From 1981 to 1987, 26 outbreaks of asthma have occurred in the city of Barcelona, Spain, affecting a total of 687 subjects and causing 1155 emergency room admissions. Assays of urban aerosols collected with high-volume samplers between October 1986 and May 1989 have indicated that soybean dust originating from harbor activities (and not traffic or industrial pollution) is the causal agent for these epidemics. Soybean particulates in the filters have been characterized from the composition of the alcohol fraction, namely, campesterol, stigmasterol, beta-sitosterol, n-triacontan-1-ol, and n-dotriacontan-1-ol, constituting a series of aerosol components correlated with the epidemiologic data. This result has also been confirmed by immunochemical assay of specific soybean allergens. The concentration of these sterols in the air corresponds to a 24-hour average level of soybean dust in the order of 25 micrograms/m3 on epidemic days. These results suggest the advisability of monitoring soybean dust in air particulates of populated areas surrounding soybean storage or processing plants. The techniques presented here afford a simple way for the recognition of soybean dust in aerosols containing high concentrations of organic pollutants of traffic or industrial origin.

Aerosols↗
PubMed1990

Identification and partial characterization of the soybean-dust allergens involved in the Barcelona asthma epidemic.

Asthma epidemics in Barcelona, Spain, have been attributed to dust generated by the unloading of soybeans in the harbor. Sera of four different groups of 10 subjects in each group were studied: (1) patients attending an emergency room in Barcelona for an asthma attack on epidemic days, group A, (2) patients attending an emergency room for an attack on nonepidemic days, group B, (3) patients with asthma from other cities, group C, and (4) patients without asthma from Barcelona matched by age and sex with group A, group D. All subjects in group A had IgE to allergens in extracts of various soybean samples. In contrast, only one of the 10 subjects in each of groups B and C and none of those subjects in group D had IgE to uncleaned bean and hull extracts. Radioimmunoassay demonstrated that in sera from patients with asthma during an asthma outbreak reacted primarily to soybean hull and dust extracts. Sodium dodecyl sulfate-polyacrylamide and gel electrophoresis thin-layer isoelectrofocusing demonstrated protein bands of 97.4 to less than 14.4 kd and isoelectric point between 6 and 3.5. By Western blot and thin layer isoelectrofocusing/blotted radioimmunoisoelectrofocusing, IgE of patients with asthma during an asthma outbreak reacted weakly to two protein bands of molecular weight ranging from 42 to 21 kd, strongly to glycoprotein bands with molecular weight less than 14.4 kd, and isoelectric point less than 6, which appeared to be the major allergens.

Adolescent↗
PubMed1990

Characteristics of patients with soybean dust-induced acute severe asthma requiring mechanical ventilation.

Patients presenting with acute severe asthma during the Barcelona's outbreaks caused by soybean dust inhalation from August, 1981, through September, 1987, characteristically showed an abrupt severe onset of each attack followed by a rapid relief of symptoms after treatment. To throw further light on clinical findings, pathophysiology and outcome in the most life-threatening episodes, we reviewed records of acute severe asthma patients treated by mechanical ventilation in one of the four main hospitals of the city. Twelve such patients (15 episodes) were compared to 24 non-epidemic asthmatic patients (25 episodes) also treated by mechanical ventilation in the same institution during the same period of time. There was a male predominance during outbreaks (p less than 0.03) and epidemic patients were ventilated fewer hours (12 +/- 8 h) (mean +/- SD), admitted fewer days to intensive care (1.6 +/- 0.7 days), and hospitalized fewer days (7.1 +/- 4.4 days) than non-epidemic patients (65 +/- 84 h, 4.6 +/- 3.8 days (p less than 0.001, each), and 16.0 +/- 13.2 days (p less than 0.004), respectively). These differences together with both the fulminant presentation of the episodes of epidemic asthma and the point-source origin of the asthma outbreaks previously shown are consistent with the unusual nature of the aetiologic agent, soybean dust.

Acute Disease↗
PubMed1989

Community outbreaks of asthma associated with inhalation of soybean dust. Toxicoepidemiological Committee.

Since 1981, 26 outbreaks of asthma have been detected in the city of Barcelona. The geographic clustering of cases close to the harbor led us to consider the harbor as the probable source of the outbreaks. We therefore studied the association between the unloading of 26 products from ships in the harbor and outbreaks of asthma in 1985 and 1986. All 13 asthma-epidemic days in these two years coincided with the unloading of soybeans (lower 95 percent confidence limit of the risk ratio, 7.2). Of the remaining 25 products, only the unloading of wheat was related to the epidemics of asthma, although when adjusted for the unloading of soybeans the relation was not statistically significant. High-pressure areas and mild southeasterly to southwesterly winds, which favored the movement of air from the harbor to the city, were registered on all epidemic days. Particles of starch and episperm cells that were recovered from air samplers placed in the city had morphologic characteristics identical to those of soybean particles. Furthermore, the lack of bag filters at the top of one of the harbor silos into which soybeans were unloaded allowed the release of soybean dust into the air. We conclude that these outbreaks of asthma in Barcelona were caused by the inhalation of soybean dust released during the unloading of soybeans at the city harbor.

Asthma↗
PubMed1989

Case-control study of serum immunoglobulin-E antibodies reactive with soybean in epidemic asthma.

Since 1981, twenty-six asthma outbreaks have been identified in Barcelona, all coinciding with the unloading of soybean in the harbour. Serum from patients with epidemic asthma and individually matched controls with non-epidemic asthma was assayed for immunoglobulin-E (IgE) antibodies against soybean antigens by means of a radioallergosorbent test. In 64 of 86 cases (74.4%) there was a reaction with commercial soybean antigen extracts, compared with only 4 of the 86 controls (4.6%) (odds ratio = 61; lower 95% confidence limit = 8.1). The statistical significance was greater for reactions with extracts of soybean dust taken from Barcelona harbour (odds ratio, unquantifiably high; lower 95% confidence limit = 11.7). No other serological covariate (total serum IgE levels or specific IgE levels against the commonest airborne allergens or legumes) confounded the association between serum anti-soybean IgE antibodies and epidemic asthma. These results support a causal relation between the release of dust during unloading of soybean at the harbour and the occurrence of asthma outbreaks, suggesting an underlying allergic mechanism.

Antibodies↗
PubMed1986

A point-source asthma outbreak.

Epidemiological data for the eighth asthma epidemic in Barcelona were available from the whole city. They reveal a striking space clustering, an hour-time clustering, and simultaneous time and space clustering, which indicate that the outbreak was a point-source epidemic. Air pollution by smoke and oxides of sulphur and nitrogen was unlikely to have been the cause of the epidemic, as was an unusual level of pollen or fungal spores. The industrial area adjacent to the neighbourhood in which the epidemic occurred was a probable source of the cause of the outbreak.

Acute Disease↗
PubMedDate not supplied

[Features and functions of environmental epidemiology].

The interest of epidemiology in the environmental effects has grown up in recent years. The present paper discusses the role of environmental epidemiology based on a revision of the medical literature appeared in 1989, and on a review of the strategy in setting up standards. Different aspects of the exposure measure, the main characteristic of environmental epidemiology are presented.

Environmental Exposure↗