array:24 [
  "pii" => "S0213911102719675"
  "issn" => "02139111"
  "doi" => "10.1016/S0213-9111(02)71967-5"
  "estado" => "S300"
  "fechaPublicacion" => "2002-11-01"
  "aid" => "71967"
  "copyright" => "Sociedad Española de Salud Pública y Administración Sanitaria"
  "copyrightAnyo" => "2002"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Gac Sanit. 2002;16:464-79"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2690
    "formatos" => array:3 [
      "EPUB" => 131
      "HTML" => 2123
      "PDF" => 436
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0213911102719687"
    "issn" => "02139111"
    "doi" => "10.1016/S0213-9111(02)71968-7"
    "estado" => "S300"
    "fechaPublicacion" => "2002-11-01"
    "aid" => "71968"
    "copyright" => "Sociedad Española de Salud Pública y Administración Sanitaria"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Gac Sanit. 2002;16:480-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4227
      "formatos" => array:3 [
        "EPUB" => 120
        "HTML" => 3520
        "PDF" => 587
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Prevalencia del síndrome del quemado y estudio de los factores asociados en los trabajadores de un hospital comarcal"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "480"
          "paginaFinal" => "486"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "(Burnout syndrome: prevalence and associated factors among workers in a district hospital)"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "G. Pera, M. Serra-Prat"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "G."
              "apellidos" => "Pera"
            ]
            1 => array:2 [
              "nombre" => "M."
              "apellidos" => "Serra-Prat"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911102719687?idApp=WGSE"
    "url" => "/02139111/0000001600000006/v1_201310251643/S0213911102719687/v1_201310251643/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0213911102719663"
    "issn" => "02139111"
    "doi" => "10.1016/S0213-9111(02)71966-3"
    "estado" => "S300"
    "fechaPublicacion" => "2002-11-01"
    "aid" => "71966"
    "copyright" => "Sociedad Española de Salud Pública y Administración Sanitaria"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "edi"
    "cita" => "Gac Sanit. 2002;16:463"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2516
      "formatos" => array:3 [
        "EPUB" => 108
        "HTML" => 1721
        "PDF" => 687
      ]
    ]
    "es" => array:7 [
      "idiomaDefecto" => true
      "titulo" => "Evaluadores del año 2002"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "463"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "(Reviewers of 2002)"
        ]
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911102719663?idApp=WGSE"
    "url" => "/02139111/0000001600000006/v1_201310251643/S0213911102719663/v1_201310251643/es/main.assets"
  ]
  "es" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Contaminación atmosférica por partículas y salud en Valencia, 1994-1996"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "464"
        "paginaFinal" => "479"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "F. Ballester, C. Iñiguez, S. Pérez-Hoyos, J.M. Tenías"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "F."
            "apellidos" => "Ballester"
            "email" => array:1 [
              0 => "ballester_fer@gva.es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "*"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "C."
            "apellidos" => "Iñiguez"
          ]
          2 => array:2 [
            "nombre" => "S."
            "apellidos" => "Pérez-Hoyos"
          ]
          3 => array:2 [
            "nombre" => "J.M."
            "apellidos" => "Tenías"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Unitat d'Epidemiologia i Estadística. Escola Valenciana d'Estudis per a la Salut (EVES). Conselleria de Sanitat. Generalitat Valenciana"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "*"
            "correspondencia" => "Correspondencia: Ferran Ballester. Escola Valenciana d'Estudis per a la Salut (EVES). Joan de Garay, 21. 46017 Valencia"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "(Particulate air pollution and health in Valencia [Spain] 1994-1996)"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2002-03-14"
    "fechaAceptado" => "2002-09-27"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec268809"
          "palabras" => array:9 [
            0 => "Contaminación atmosférica"
            1 => "Partículas en suspensión"
            2 => "Mortalidad"
            3 => "Ingresos hospitalarios"
            4 => "Visitas a urgencias"
            5 => "Enfermedades circulatorias"
            6 => "Asma"
            7 => "EPOC"
            8 => "Series temporales"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec268808"
          "palabras" => array:9 [
            0 => "Air pollution"
            1 => "Suspended particles"
            2 => "Mortality"
            3 => "Hospital admissions"
            4 => "Emergency visits"
            5 => "Cardiovascular diseases"
            6 => "Asthma"
            7 => "COPD"
            8 => "Time series"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estimar la asociacion a corto plazo entre los valores de contaminacion atmosferica por particulas en suspension y diferentes indicadores de morbilidad y mortalidad en la ciudad de Valencia&#46;</p> <span class="elsevierStyleSectionTitle">Metodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio ecologico de series temporales en el que se relacionan las variaciones diarias en los valores de contaminacion atmosferica por humos negros e indicadores de mortalidad&#44; ingresos hospitalarios y visitas a urgencias en la ciudad de Valencia&#44; durante el periodo 1994-1996&#46; La magnitud de la asociacion se estimo mediante regresion autorregresiva de Poisson utilizando modelos aditivos generalizados&#46; Se examino la forma de la relacion&#44; el efecto retardado de la contaminacion y la posible modificacion de efecto por otros contaminantes o periodos del ano&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Existe una asociacion significativa entre los valores de particulas en suspension y varios indicadores analizados en Valencia&#46; La forma de dicha relacion es lineal&#46; Un incremento de 10 &#949;g&#47;m3 en los valores diarios de humos negros se asocio con un incremento del 1&#44;8&#37; &#40;intervalo de confianza &#91;IC&#93; del 95&#37;&#44; 0&#44;9-2&#44;7&#37;&#41; en el numero de defunciones del dia siguiente&#46; El mismo incremento en la contaminacion se asocio con un aumento del 1&#44;5&#37; &#40;0&#44;1-2&#44;8&#37;&#41; en las defunciones por causa circulatoria&#44; en un 1&#44;3&#37; &#40;0&#44;0-2&#44;6&#37;&#41; en los ingresos por causas circulatorias y en un 5&#44;4 &#40;0&#44;6-10&#44;4&#37;&#41; en el numero de visitas a urgencias por asma&#46; Esta asociacion no esta confundida por los valores de otros contaminantes&#46; No se encontro asociacion de los humos negros con la mortalidad por enfermedades respiratorias&#44; los ingresos hospitalarios por enfermedades cerebrovasculares ni las visitas a urgencias por enfermedad pulmonar obstructiva cronica &#40;EPOC&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Este estudio proporciona evidencia de que los valores de particulas en suspension en Valencia se asocian con las urgencias por asma&#44; los ingresos por enfermedades circulatorias y las defunciones diarias&#46; La asociacion encontrada es consistente con los resultados de otros estudios realizados y es coherente con conocimientos recientes sobre los mecanismos fisiopatologicos&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To estimate the short-term association between levels of air pollution due to suspended particulates and several indicators of morbidity and mortality in the city of Valencia&#44; Spain&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed an ecological time-series study&#46; Daily levels of air pollution from black smoke were related to indicators of mortality&#44; hospital admissions&#44; and visits to emergency departments in the city of Valencia between 1994 and 1996&#46; The magnitude of the association was estimated through Poisson autoregression using generalized additive models&#46; The form of the relationship&#44; the delayed effect of pollution&#44; and the possible modification of this effect by other pollutants or periods of the year were assessed&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A significant association was found between levels of suspended particulates and several of the indicators analyzed in Valencia&#46; The form of this relationship was linear&#46; An increment of 10 &#236;g&#47;m3 in the daily levels of black smoke was associated with an increase of 1&#46;8&#37; &#40;95&#37; confidence interval&#58; 0&#46;9-2&#46;7&#37;&#41; in the number of deaths on the following day&#46; The same increment in pollutant levels was associated with an increase of 1&#46;5&#37; &#40;0&#46;1-2&#46;8&#37;&#41; in deaths from all cardiovascular causes&#44; an increase of 1&#46;3&#37; &#40;0&#46;0-2&#46;6&#37;&#41; in admissions for all cardiovascular diseases and in an increase of 5&#46;4&#37; &#40;0&#46;6- 10&#46;4&#37;&#41; in the number of emergency visits for asthma&#46; This association was not confounded by levels of other pollutants&#46; Black smoke was not associated with mortality from respiratory diseases&#44; with hospital admissions for cerebrovascular diseases&#44; or with emergency visits for chronic obstructive pulmonary disease&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This study provides evidence that levels of suspended particles in Valencia are associated with emergency visits for asthma&#44; hospital admissions for cardiovascular diseases&#44; and daily deaths&#46; The association found is consistent with the results of previous studies and fits with recent knowledge of psychopathological mechanisms&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Biblograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:67 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities&#58; results from time series data from the APHEA project&#46; Air Pollution and Health&#58; a European Approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Katsouyanni"
                            1 => "G&#46; Touloumi"
                            2 => "C&#46; Spix"
                            3 => "J&#46; Schwartz"
                            4 => "F&#46; Balducci"
                            5 => "S&#46; Medina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1997"
                        "volumen" => "314"
                        "paginaInicial" => "1658"
                        "paginaFinal" => "1663"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9180068"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time-series analysis of air pollution and cause-specific mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Zmirou"
                            1 => "J&#46; Schwartz"
                            2 => "M&#46; Sa&#233;z"
                            3 => "A&#46; Zanobetti"
                            4 => "B&#46; Wojtyniak"
                            5 => "G&#46; Touloumi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "1998"
                        "volumen" => "9"
                        "paginaInicial" => "495"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9730027"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urban air pollution and emergency admissions for asthma in four European cities&#58; the APHEA Project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Sunyer"
                            1 => "C&#46; Spix"
                            2 => "P&#46; Quenel"
                            3 => "A&#46; Ponce"
                            4 => "T&#46; Barumandzadeh"
                            5 => "G&#46; Touloumi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1997"
                        "volumen" => "52"
                        "paginaInicial" => "760"
                        "paginaFinal" => "765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9371204"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674901924716"
                          "estado" => "S300"
                          "issn" => "00916749"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities&#58; results from the APHEA project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;R&#46; Anderson"
                            1 => "C&#46; Spix"
                            2 => "S&#46; Medina"
                            3 => "J&#46;P&#46; Schouten"
                            4 => "J&#46; Castellsague"
                            5 => "G&#46; Rossi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1997"
                        "volumen" => "10"
                        "paginaInicial" => "1064"
                        "paginaFinal" => "1071"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9163648"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The National Morbidity&#44; Mortality&#44; and Air Pollution Study &#40;NMMAPS&#41;&#46; Part 2&#46; Morbidity and mortality from air pollution in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Samet"
                            1 => "S&#46;L&#46; Zeger"
                            2 => "F&#46; Dominici"
                            3 => "F&#46; Curriero"
                            4 => "I&#46; Coursac"
                            5 => "D&#46;W&#46; Dockery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Health Effects Institute"
                        "fecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of air pollution on the respiratory health of asthmatic children living in Mexico City"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Romieu"
                            1 => "F&#46; Meneses"
                            2 => "S&#46; Ruiz"
                            3 => "J&#46;J&#46; Sierra Monge"
                            4 => "J&#46; Huerta"
                            5 => "M&#46;C&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.154.2.8756798"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1996"
                        "volumen" => "154"
                        "paginaInicial" => "300"
                        "paginaFinal" => "307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8756798"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air pollution and daily mortality in residential areas of Beijing&#44; China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "X&#46; Xu"
                            1 => "J&#46; Gao"
                            2 => "D&#46;W&#46; Dockery"
                            3 => "Y&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/00039896.1994.9937470"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Environ Health"
                        "fecha" => "1994"
                        "volumen" => "49"
                        "paginaInicial" => "216"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8031176"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ant&#243; JM&#46; Air pollution and emergency room admissions for chronic obstructive pulmonary disease&#58; a 5-year study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Sunyer"
                            1 => "M&#46; S&#225;ez"
                            2 => "C&#46; Murillo"
                            3 => "J&#46; Castellsague"
                            4 => "F&#46; Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "1993"
                        "volumen" => "137"
                        "paginaInicial" => "701"
                        "paginaFinal" => "705"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8484361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ant&#243; JM&#46; Short-term association between air pollution and emergency room visits for asthma in Barcelona"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Castellsague"
                            1 => "J&#46; Sunyer"
                            2 => "M&#46; S&#225;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1995"
                        "volumen" => "50"
                        "paginaInicial" => "1051"
                        "paginaFinal" => "1056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7491552"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ant&#243; JM&#46; Impacto de la contaminaci&#243;n atmosf&#233;rica sobre la mortalidad y las urgencias por enfermedad pulmonar obstructiva cr&#243;nica y asma en Barcelona"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Tob&#237;as"
                            1 => "J&#46; Sunyer"
                            2 => "J&#46; Castellsague"
                            3 => "M&#46; S&#225;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "1998"
                        "volumen" => "12"
                        "paginaInicial" => "219"
                        "paginaFinal" => "226"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mir&#243;n IJ&#46; Asociaci&#243;n entre la contaminaci&#243;n atmosf&#233;rica por di&#243;xido de azufre y part&#237;culas totales en suspensi&#243;n y la mortalidad en la ciudad de Madrid &#40;1986-1992&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; D&#237;az"
                            1 => "J&#46;C&#46; Alberdi"
                            2 => "J&#46;C&#46; Montero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "1998"
                        "volumen" => "12"
                        "paginaInicial" => "203"
                        "paginaFinal" => "211"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modeling of air pollution and its relationship with mortality and morbidity in Madrid&#44; Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; D&#237;az"
                            1 => "R&#46; Garc&#237;a"
                            2 => "P&#46; Ribera"
                            3 => "J&#46;C&#46; Alberdi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Arch Occup Environ Health"
                        "fecha" => "1999"
                        "volumen" => "72"
                        "paginaInicial" => "366"
                        "paginaFinal" => "376"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10473836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Herv&#225;s A&#46; Air pollution and mortality in Valencia&#44; Spain&#58; a study using the APHEA methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Ballester"
                            1 => "D&#46; Corella"
                            2 => "S&#46; P&#233;rez-Hoyos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "1996"
                        "volumen" => "50"
                        "paginaInicial" => "527"
                        "paginaFinal" => "533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8944859"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asssociation between hospital emergency visits for asthma and air pollution in Valencia&#44; Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Ten&#237;as"
                            1 => "F&#46; Ballester"
                            2 => "M&#46;L&#46; Rivera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Occup Environ Med"
                        "fecha" => "1998"
                        "volumen" => "55"
                        "paginaInicial" => "541"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9849541"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674900443642"
                          "estado" => "S300"
                          "issn" => "00916749"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air pollution and emergency hospital admissions for cardiovascular diseases in Valencia&#44; Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Ballester"
                            1 => "J&#46;M&#46; Ten&#237;as"
                            2 => "S&#46; P&#233;rez-Hoyos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "2001"
                        "volumen" => "55"
                        "paginaInicial" => "57"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11112952"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El proyecto EMECAM&#58; estudio multic&#233;ntrico espa&#241;ol sobre la relaci&#243;n entre la contaminaci&#243;n atmosf&#233;rica y la mortalidad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Grupo EMECAM"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Salud P&#250;blica"
                        "fecha" => "1999"
                        "volumen" => "73"
                        "paginaInicial" => "105"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10410594"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The EMECAM project&#58; a multi-center study on air pollution and mortality in Spain&#46; Combined results for particulates and for sulphur dioxide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Ballester"
                            1 => "M&#46; Saez"
                            2 => "S&#46; Perez-Hoyos"
                            3 => "C&#46; I&#241;&#237;guez"
                            4 => "A&#46; Gandarillas"
                            5 => "Tob&#237;as"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Occup Environ Med"
                        "fecha" => "2002"
                        "volumen" => "59"
                        "paginaInicial" => "300"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11983845"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Saez"
                            1 => "F&#46; Ballester"
                            2 => "S&#46; P&#233;rez-Hoyos"
                            3 => "M&#46;A&#46; Barcel&#243;"
                            4 => "J&#46; Bellido"
                            5 => "J&#46;M&#46; Ten&#237;as"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2002"
                        "volumen" => "110"
                        "paginaInicial" => "221"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11929732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of particles effects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;A&#46; Pope"
                            1 => "D&#46;W&#46; Dockery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Air pollution and health"
                        "paginaInicial" => "673"
                        "paginaFinal" => "705"
                        "serieFecha" => "1999"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health effects of outdoor air pollution &#40;Part 1&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "A Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.153.1.8542133"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1996"
                        "volumen" => "153"
                        "paginaInicial" => "3"
                        "paginaFinal" => "50"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8542133"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Council Directive 1999&#47;30&#47;EC of 22 April 1999 relating to limite values for sulphur dioxide&#44; nitrogen dioxide and oxides of nitrogen&#44; particulate matter and lead in ambient air"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Official Journal of the European Communities"
                        "fecha" => "1999"
                        "paginaInicial" => "L163"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of fine particulate air pollution and human health&#58; biologic mechanisms and who&#39;s at risk&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;A&#46; Pope"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2000"
                        "volumen" => "108"
                        "numero" => "Suppl 4"
                        "paginaInicial" => "713"
                        "paginaFinal" => "723"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10931790"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrafine particles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Donaldson"
                            1 => "V&#46; Stone"
                            2 => "A&#46; Clouter"
                            3 => "L&#46; Renwick"
                            4 => "W&#46; MacNee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Occup Environ Med"
                        "fecha" => "2001"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing confounding&#44; effect modification&#44; and thresholds in the association between ambient particles and daily deaths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2000"
                        "volumen" => "108"
                        "paginaInicial" => "563"
                        "paginaFinal" => "568"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10856032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health indices of the adverse effects of air pollution the question of coherence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;V&#46; Bates"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Res"
                        "fecha" => "1992"
                        "volumen" => "59"
                        "paginaInicial" => "336"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1464287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identificaci&#243;n de urgencias por asma y EPOC en el servicio de urgencias de un hospital&#46; Estudio de concordancia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Merelles"
                            1 => "M&#46;L&#46; Rivera"
                            2 => "F&#46; Ballester"
                            3 => "J&#46;M&#46; Ant&#243;"
                            4 => "D&#46; Oterino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "1999"
                        "volumen" => "13"
                        "paginaInicial" => "34"
                        "paginaFinal" => "41"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Schwartz"
                            1 => "C&#46; Spix"
                            2 => "G&#46; Touloumi"
                            3 => "L&#46; Bacharova"
                            4 => "T&#46; Barumandzadeh"
                            5 => "A&#46; Le Tertre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "1996"
                        "volumen" => "50"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S3"
                        "paginaFinal" => "S11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8758217"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Generalized additive models"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;J&#46; Hastie"
                            1 => "R&#46;J&#46; Tisbhirani"
                            2 => "T&#46;J&#46; Hastie"
                            3 => "R&#46;J&#46; Tisbhirani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:1 [
                        "serieFecha" => "1990"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparaci&#243;n de dos metodolog&#237;as estad&#237;sticas para el an&#225;lisis de los efectos a corto plazo de la contaminaci&#243;n en la salud &#91;resumen&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; I&#241;&#237;guez"
                            1 => "S&#46; P&#233;rez-Hoyos"
                            2 => "F&#46; Ballester"
                            3 => "M&#46; Saez"
                            4 => "F&#46; G&#243;mez"
                            5 => "J&#46;M&#46; Ten&#237;as"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2001"
                        "volumen" => "15"
                        "numero" => "Supl 2"
                        "paginaInicial" => "31"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The distributed lag between air pollution and daily deaths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "2000"
                        "volumen" => "11"
                        "paginaInicial" => "320"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10784251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis of the Italian studies on short-term effects of air pollution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Biggeri"
                            1 => "P&#46; Bellini"
                            2 => "B&#46; Terracini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Epidemiologia Prevenzione"
                        "fecha" => "2001"
                        "volumen" => "25"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air pollution and daily mortality in Rome&#44; Italy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Michelozzi"
                            1 => "F&#46; Forastiere"
                            2 => "D&#46; Fusco"
                            3 => "C&#46;A&#46; Perucci"
                            4 => "B&#46; Ostro"
                            5 => "C&#46; Ancona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Occup Environ Med"
                        "fecha" => "1998"
                        "volumen" => "55"
                        "paginaInicial" => "605"
                        "paginaFinal" => "610"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9861182"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estimating particulate matter-mortality dose-response curves and threshold levels&#58; an analysis of daily time-teries for the 20 Largest US cities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;J&#46; Daniels"
                            1 => "F&#46; Dominici"
                            2 => "J&#46;M&#46; Samet"
                            3 => "S&#46; Zeger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "2000"
                        "volumen" => "152"
                        "paginaInicial" => "397"
                        "paginaFinal" => "406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10981451"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The concentration-response relation between air pollution and daily deaths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Schwartz"
                            1 => "F&#46; Ballester"
                            2 => "M&#46; Saez"
                            3 => "J&#46; Bellido"
                            4 => "K&#46; Cambra"
                            5 => "F&#46; Arribas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2001"
                        "volumen" => "109"
                        "paginaInicial" => "1001"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11675264"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Confounding and effect modification in the short-term effects of ambient particles on total mortality&#58; results from 29 European cities within the APHEA2 Project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Katsouyanni"
                            1 => "G&#46; Touloumi"
                            2 => "E&#46; Samoli"
                            3 => "A&#46; Gryparis"
                            4 => "A&#46; Le Tertre"
                            5 => "Y&#46; Monopolis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "2001"
                        "volumen" => "12"
                        "paginaInicial" => "521"
                        "paginaFinal" => "531"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11505171"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Daily concentrations of air pollution and plasma fibrinogen in London"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Pekkanen"
                            1 => "E&#46;J&#46; Brunner"
                            2 => "H&#46;R&#46; Anderson"
                            3 => "P&#46; Tiittanen"
                            4 => "R&#46;W&#46; Atkinson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Occup Environ Med"
                        "fecha" => "2000"
                        "volumen" => "57"
                        "paginaInicial" => "818"
                        "paginaFinal" => "822"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11077010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health effects of air pollution in southern Europe&#58; are there interacting factors&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Katsouyanni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "1995"
                        "volumen" => "103"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "23"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8635436"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is there harvesting in the association of airborne particles with daily deaths and hospital admissions&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "2001"
                        "volumen" => "12"
                        "paginaInicial" => "55"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11138820"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What are people dying of on high air pollution days&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1006/enrs.1994.1004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Environmental Research"
                        "fecha" => "1994"
                        "volumen" => "64"
                        "paginaInicial" => "26"
                        "paginaFinal" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8287840"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospital emergency room admissions for chronic obstructive pulmonary disease and air pollution in Valencia&#44; Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Ten&#237;as"
                            1 => "F&#46; Ballester"
                            2 => "S&#46; P&#233;rez-Hoyos"
                            3 => "M&#46;L&#46; Rivera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/00039890209602915"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Environ Health"
                        "fecha" => "2002"
                        "volumen" => "57"
                        "paginaInicial" => "41"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12071359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short term effects of particulate air pollution on cardiovascular disease in eight European cities&#58; a quantitative summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Le Tertre"
                            1 => "S&#46; Medina"
                            2 => "E&#46; Samoli"
                            3 => "B&#46; Forsberg"
                            4 => "P&#46; Michelozzi"
                            5 => "A&#46; Boumghar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "2002"
                        "volumen" => "56"
                        "paginaInicial" => "773"
                        "paginaFinal" => "779"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12239204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute effects of particulate air pollution on respiratory admissions&#46; Results from APHEA 2 project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;W&#46; Atkinson"
                            1 => "A&#46;H&#46; Ross"
                            2 => "J&#46; Sunyer"
                            3 => "J&#46; Ayres"
                            4 => "M&#46; Baccini"
                            5 => "J&#46;M&#46; Vonk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.164.10.2010138"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "164"
                        "paginaInicial" => "1860"
                        "paginaFinal" => "1866"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11734437"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peir&#243; S&#46; An&#225;lisis automatizado de la calidad del conjunto m&#237;nimo de datos b&#225;sicos&#46; Implicaciones para los sistemas de ajuste de riesgos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Librero"
                            1 => "R&#46; Ordi&#241;ana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "1998"
                        "volumen" => "12"
                        "paginaInicial" => "9"
                        "paginaFinal" => "21"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9586379"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of particulate matter components with daily mortality and morbidity in urban populations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Lippmann"
                            1 => "K&#46; Ito"
                            2 => "A&#46; Nadas"
                            3 => "R&#46;T&#46; Burnnet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Health Effects Institute"
                        "fecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing diagnostic classification in an emergency departament&#58; implications for daily time series studies of air pollution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;M&#46; Stieb"
                            1 => "R&#46;C&#46; Beveridge"
                            2 => "B&#46;H&#46; Rowe"
                            3 => "S&#46; Walter"
                            4 => "S&#46; Judek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "1998"
                        "volumen" => "148"
                        "paginaInicial" => "666"
                        "paginaFinal" => "670"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9778173"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health effects of particulate air pollution&#58; time for reassessment&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Pope"
                            1 => "D&#46;V&#46; Bates"
                            2 => "M&#46;E&#46; Raizenne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "1995"
                        "volumen" => "103"
                        "paginaInicial" => "472"
                        "paginaFinal" => "480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7656877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lines that connect&#58; assessing the causality inference in the case of particulate pollution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;V&#46; Bates"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2000"
                        "volumen" => "108"
                        "paginaInicial" => "91"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10656846"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A critical review of the evidence on particulate air pollution and mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;H&#46; Moolgavkar"
                            1 => "E&#46;G&#46; Luebeck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "1996"
                        "volumen" => "7"
                        "paginaInicial" => "420"
                        "paginaFinal" => "428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8793370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health and respirable particulate &#40;PM10&#41; air pollution&#58; a causal or statistical association&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;F&#46; Gamble"
                            1 => "R&#46;J&#46; Lewis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "1996"
                        "volumen" => "104"
                        "paginaInicial" => "838"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8875158"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oxigen saturation&#44; pulse rate&#44; and particulate air pollution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;A&#46; Pope"
                            1 => "D&#46;W&#46; Dockery"
                            2 => "R&#46;E&#46; Kanner"
                            3 => "G&#46;M&#46; Villegas"
                            4 => "J&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.159.2.9702103"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "159"
                        "paginaInicial" => "365"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9927345"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Particulate air pollution and acute health effects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Seaton"
                            1 => "W&#46; MacNee"
                            2 => "K&#46; Donaldson"
                            3 => "D&#46; Godden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1995"
                        "volumen" => "345"
                        "paginaInicial" => "176"
                        "paginaFinal" => "178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7741860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "52&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased plasma viscosity during an air pollution episode&#58; a link to mortality&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Peters"
                            1 => "A&#46; D&#246;ring"
                            2 => "H&#46;E&#46; Wichmann"
                            3 => "W&#46; Koenig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(97)01211-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1997"
                        "volumen" => "349"
                        "paginaInicial" => "1582"
                        "paginaFinal" => "1587"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9174559"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "53&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air pollution and blood markers of cardiovascular risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2001"
                        "volumen" => "109"
                        "numero" => "Suppl 3"
                        "paginaInicial" => "405"
                        "paginaFinal" => "409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11427390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib54"
              "etiqueta" => "54&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heart rate variability associated with particulate air pollution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Pope"
                            1 => "R&#46;L&#46; Verrier"
                            2 => "E&#46;G&#46; Lovett"
                            3 => "A&#46;C&#46; Larson"
                            4 => "M&#46;E&#46; Raizenne"
                            5 => "R&#46;E&#46; Kanner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "1999"
                        "volumen" => "138"
                        "paginaInicial" => "890"
                        "paginaFinal" => "899"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10539820"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib55"
              "etiqueta" => "55&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Liao"
                            1 => "J&#46; Creason"
                            2 => "C&#46; Shy"
                            3 => "R&#46; Williams"
                            4 => "R&#46; Watts"
                            5 => "R&#46; Zweidinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "1999"
                        "volumen" => "107"
                        "paginaInicial" => "521"
                        "paginaFinal" => "525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10378998"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib56"
              "etiqueta" => "56&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increases in heart rate during an air pollution episode"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Peters"
                            1 => "S&#46; Perz"
                            2 => "A&#46; Doring"
                            3 => "J&#46; Stieber"
                            4 => "W&#46; Koening"
                            5 => "H&#46;E&#46; Wichmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "1999"
                        "volumen" => "150"
                        "paginaInicial" => "1094"
                        "paginaFinal" => "1098"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10568625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib57"
              "etiqueta" => "57&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of air pollution on blood pressure&#58; a population-based approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Ibald-Mulli"
                            1 => "J&#46; Stieber"
                            2 => "H&#46;E&#46; Wichmann"
                            3 => "W&#46; Koenig"
                            4 => "A&#46; Peters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Public Health"
                        "fecha" => "2001"
                        "volumen" => "91"
                        "paginaInicial" => "571"
                        "paginaFinal" => "577"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11291368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib58"
              "etiqueta" => "58&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Salvi"
                            1 => "A&#46; Blomberg"
                            2 => "B&#46; Rudell"
                            3 => "F&#46; Kelly"
                            4 => "T&#46; Sandstrom"
                            5 => "S&#46;T&#46; Holgate"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.159.3.9709083"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "159"
                        "paginaInicial" => "702"
                        "paginaFinal" => "709"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10051240"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib59"
              "etiqueta" => "59&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Concentrated ambient air particles induce mild pulmonary inflammation in healthy human volunteers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Ghio"
                            1 => "C&#46; Kim"
                            2 => "R&#46;B&#46; Devlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.162.3.9911115"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "162"
                        "paginaInicial" => "981"
                        "paginaFinal" => "988"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10988117"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib60"
              "etiqueta" => "60&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Personal sampling of particles in adults&#58; relation among personal&#44; indoor&#44; and outdoor air concentrations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;A&#46; Janssen"
                            1 => "G&#46; Hoek"
                            2 => "B&#46; Brunekreef"
                            3 => "H&#46; Harssema"
                            4 => "I&#46; Mensink"
                            5 => "A&#46; Zuidhof"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "1998"
                        "volumen" => "147"
                        "paginaInicial" => "537"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9521180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib61"
              "etiqueta" => "61&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exposure measurement error in time-series studies of air pollution&#58; concepts and consequences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Zeger"
                            1 => "D&#46; Thomas"
                            2 => "F&#46; Dominici"
                            3 => "J&#46;M&#46; Samet"
                            4 => "J&#46; Schwartz"
                            5 => "D&#46;W&#46; Dockery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2000"
                        "volumen" => "108"
                        "paginaInicial" => "419"
                        "paginaFinal" => "426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10811568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib62"
              "etiqueta" => "62&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air pollution from truck traffic and lung function in children living near motorways"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Brunekreef"
                            1 => "N&#46;A&#46; Janssen"
                            2 => "J&#46; De Hartog"
                            3 => "H&#46; Harssema"
                            4 => "M&#46; Knape"
                            5 => "P&#46; Van Vliet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "1997"
                        "volumen" => "8"
                        "paginaInicial" => "298"
                        "paginaFinal" => "303"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9115026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib63"
              "etiqueta" => "63&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality and air pollution in London&#58; a time series analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Schwartz"
                            1 => "A&#46; Marcus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "1990"
                        "volumen" => "131"
                        "paginaInicial" => "185"
                        "paginaFinal" => "194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2403468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib64"
              "etiqueta" => "64&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differences among black smoke&#44; PM10&#44; and PM1&#46;0 levels at urban measurement sites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46; Roemer"
                            1 => "J&#46;H&#46; Van Wijnen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2001"
                        "volumen" => "109"
                        "paginaInicial" => "151"
                        "paginaFinal" => "154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11266325"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib65"
              "etiqueta" => "65&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Desarrollo de la norma europea &#40;EN&#41; para la determinaci&#243;n de las part&#237;culas PM2&#44;5 &#40;respirables&#41; en aire ambiente&#46; M&#233;todo de captaci&#243;n por un filtro y posterior an&#225;lisis gravim&#233;trico &#91;abstract&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;C&#46; Ramos"
                            1 => "L&#46; Rubio"
                            2 => "D&#46; Mart&#237;n"
                            3 => "P&#46; Hern&#225;ndez"
                            4 => "R&#46; Garc&#237;a dos Santos"
                            5 => "R&#46; Fern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Rev Salud Ambient"
                        "fecha" => "2001"
                        "volumen" => "1"
                        "paginaInicial" => "102"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib66"
              "etiqueta" => "66&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Public Health impact of outdoor and traffic-related air pollution&#58; a european assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; K&#252;nzli"
                            1 => "J&#46; Kaiser"
                            2 => "S&#46; Medina"
                            3 => "M&#46; Studnicka"
                            4 => "O&#46; Chanel"
                            5 => "P&#46; Filliger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(00)02653-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2000"
                        "volumen" => "356"
                        "paginaInicial" => "795"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11022926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib67"
              "etiqueta" => "67&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Objetivo 21&#58; mejorar la calidad del aire"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Fern&#225;ndez-Patier"
                            1 => "F&#46; Ballester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Informe SESPAS 2000"
                        "paginaInicial" => "279"
                        "paginaFinal" => "289"
                        "serieFecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/02139111/0000001600000006/v1_201310251643/S0213911102719675/v1_201310251643/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "18705"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02139111/0000001600000006/v1_201310251643/S0213911102719675/v1_201310251643/es/main.pdf?idApp=WGSE&text.app=https://gacetasanitaria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911102719675?idApp=WGSE"
]
Compartir
Publique en esta revista
Información de la revista
Vol. 16. Núm. 6.
Páginas 464-479 (noviembre - diciembre 2002)
Respuestas rápidas
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 16. Núm. 6.
Páginas 464-479 (noviembre - diciembre 2002)
Open Access
Contaminación atmosférica por partículas y salud en Valencia, 1994-1996
(Particulate air pollution and health in Valencia [Spain] 1994-1996)
Visitas
5430
F. Ballester
Autor para correspondencia
ballester_fer@gva.es

Correspondencia: Ferran Ballester. Escola Valenciana d'Estudis per a la Salut (EVES). Joan de Garay, 21. 46017 Valencia
, C. Iñiguez, S. Pérez-Hoyos, J.M. Tenías
Unitat d'Epidemiologia i Estadística. Escola Valenciana d'Estudis per a la Salut (EVES). Conselleria de Sanitat. Generalitat Valenciana
Este artículo ha recibido

Under a Creative Commons license
Información del artículo
Resumen
Objetivo

Estimar la asociacion a corto plazo entre los valores de contaminacion atmosferica por particulas en suspension y diferentes indicadores de morbilidad y mortalidad en la ciudad de Valencia.

Metodos

Estudio ecologico de series temporales en el que se relacionan las variaciones diarias en los valores de contaminacion atmosferica por humos negros e indicadores de mortalidad, ingresos hospitalarios y visitas a urgencias en la ciudad de Valencia, durante el periodo 1994-1996. La magnitud de la asociacion se estimo mediante regresion autorregresiva de Poisson utilizando modelos aditivos generalizados. Se examino la forma de la relacion, el efecto retardado de la contaminacion y la posible modificacion de efecto por otros contaminantes o periodos del ano.

Resultados

Existe una asociacion significativa entre los valores de particulas en suspension y varios indicadores analizados en Valencia. La forma de dicha relacion es lineal. Un incremento de 10 εg/m3 en los valores diarios de humos negros se asocio con un incremento del 1,8% (intervalo de confianza [IC] del 95%, 0,9-2,7%) en el numero de defunciones del dia siguiente. El mismo incremento en la contaminacion se asocio con un aumento del 1,5% (0,1-2,8%) en las defunciones por causa circulatoria, en un 1,3% (0,0-2,6%) en los ingresos por causas circulatorias y en un 5,4 (0,6-10,4%) en el numero de visitas a urgencias por asma. Esta asociacion no esta confundida por los valores de otros contaminantes. No se encontro asociacion de los humos negros con la mortalidad por enfermedades respiratorias, los ingresos hospitalarios por enfermedades cerebrovasculares ni las visitas a urgencias por enfermedad pulmonar obstructiva cronica (EPOC).

Conclusiones

Este estudio proporciona evidencia de que los valores de particulas en suspension en Valencia se asocian con las urgencias por asma, los ingresos por enfermedades circulatorias y las defunciones diarias. La asociacion encontrada es consistente con los resultados de otros estudios realizados y es coherente con conocimientos recientes sobre los mecanismos fisiopatologicos.

Palabras clave:
Contaminación atmosférica
Partículas en suspensión
Mortalidad
Ingresos hospitalarios
Visitas a urgencias
Enfermedades circulatorias
Asma
EPOC
Series temporales
Summary
Objective

To estimate the short-term association between levels of air pollution due to suspended particulates and several indicators of morbidity and mortality in the city of Valencia, Spain.

Methods

We performed an ecological time-series study. Daily levels of air pollution from black smoke were related to indicators of mortality, hospital admissions, and visits to emergency departments in the city of Valencia between 1994 and 1996. The magnitude of the association was estimated through Poisson autoregression using generalized additive models. The form of the relationship, the delayed effect of pollution, and the possible modification of this effect by other pollutants or periods of the year were assessed.

Results

A significant association was found between levels of suspended particulates and several of the indicators analyzed in Valencia. The form of this relationship was linear. An increment of 10 ìg/m3 in the daily levels of black smoke was associated with an increase of 1.8% (95% confidence interval: 0.9-2.7%) in the number of deaths on the following day. The same increment in pollutant levels was associated with an increase of 1.5% (0.1-2.8%) in deaths from all cardiovascular causes, an increase of 1.3% (0.0-2.6%) in admissions for all cardiovascular diseases and in an increase of 5.4% (0.6- 10.4%) in the number of emergency visits for asthma. This association was not confounded by levels of other pollutants. Black smoke was not associated with mortality from respiratory diseases, with hospital admissions for cerebrovascular diseases, or with emergency visits for chronic obstructive pulmonary disease.

Conclusions

This study provides evidence that levels of suspended particles in Valencia are associated with emergency visits for asthma, hospital admissions for cardiovascular diseases, and daily deaths. The association found is consistent with the results of previous studies and fits with recent knowledge of psychopathological mechanisms.

Key words:
Air pollution
Suspended particles
Mortality
Hospital admissions
Emergency visits
Cardiovascular diseases
Asthma
COPD
Time series
El Texto completo está disponible en PDF
Biblografía
[1.]
K. Katsouyanni, G. Touloumi, C. Spix, J. Schwartz, F. Balducci, S. Medina, et al.
Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Air Pollution and Health: a European Approach.
BMJ, 314 (1997), pp. 1658-1663
[2.]
D. Zmirou, J. Schwartz, M. Saéz, A. Zanobetti, B. Wojtyniak, G. Touloumi, et al.
Time-series analysis of air pollution and cause-specific mortality.
Epidemiology, 9 (1998), pp. 495-503
[3.]
J. Sunyer, C. Spix, P. Quenel, A. Ponce, T. Barumandzadeh, G. Touloumi, et al.
Urban air pollution and emergency admissions for asthma in four European cities: the APHEA Project.
Thorax, 52 (1997), pp. 760-765
[4.]
H.R. Anderson, C. Spix, S. Medina, J.P. Schouten, J. Castellsague, G. Rossi, et al.
Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project.
Eur Respir J, 10 (1997), pp. 1064-1071
[5.]
J.M. Samet, S.L. Zeger, F. Dominici, F. Curriero, I. Coursac, D.W. Dockery, et al.
The National Morbidity, Mortality, and Air Pollution Study (NMMAPS). Part 2. Morbidity and mortality from air pollution in the United States.
Health Effects Institute, (2000),
[6.]
I. Romieu, F. Meneses, S. Ruiz, J.J. Sierra Monge, J. Huerta, M.C. White, et al.
Effects of air pollution on the respiratory health of asthmatic children living in Mexico City.
Am J Respir Crit Care Med, 154 (1996), pp. 300-307
[7.]
X. Xu, J. Gao, D.W. Dockery, Y. Chen.
Air pollution and daily mortality in residential areas of Beijing, China.
Arch Environ Health, 49 (1994), pp. 216-222
[8.]
J. Sunyer, M. Sáez, C. Murillo, J. Castellsague, F. Martínez.
Antó JM. Air pollution and emergency room admissions for chronic obstructive pulmonary disease: a 5-year study.
Am J Epidemiol, 137 (1993), pp. 701-705
[9.]
J. Castellsague, J. Sunyer, M. Sáez.
Antó JM. Short-term association between air pollution and emergency room visits for asthma in Barcelona.
Thorax, 50 (1995), pp. 1051-1056
[10.]
A. Tobías, J. Sunyer, J. Castellsague, M. Sáez.
Antó JM. Impacto de la contaminación atmosférica sobre la mortalidad y las urgencias por enfermedad pulmonar obstructiva crónica y asma en Barcelona.
Gac Sanit, 12 (1998), pp. 219-226
[11.]
J. Díaz, J.C. Alberdi, J.C. Montero.
Mirón IJ. Asociación entre la contaminación atmosférica por dióxido de azufre y partículas totales en suspensión y la mortalidad en la ciudad de Madrid (1986-1992).
Gac Sanit, 12 (1998), pp. 203-211
[12.]
J. Díaz, R. García, P. Ribera, J.C. Alberdi.
Modeling of air pollution and its relationship with mortality and morbidity in Madrid, Spain.
Int Arch Occup Environ Health, 72 (1999), pp. 366-376
[13.]
F. Ballester, D. Corella, S. Pérez-Hoyos.
Hervás A. Air pollution and mortality in Valencia, Spain: a study using the APHEA methodology.
J Epidemiol Community Health, 50 (1996), pp. 527-533
[14.]
J.M. Tenías, F. Ballester, M.L. Rivera.
Asssociation between hospital emergency visits for asthma and air pollution in Valencia, Spain.
Occup Environ Med, 55 (1998), pp. 541-547
[15.]
F. Ballester, J.M. Tenías, S. Pérez-Hoyos.
Air pollution and emergency hospital admissions for cardiovascular diseases in Valencia, Spain.
J Epidemiol Community Health, 55 (2001), pp. 57-65
[16.]
Grupo EMECAM.
El proyecto EMECAM: estudio multicéntrico español sobre la relación entre la contaminación atmosférica y la mortalidad.
Rev Esp Salud Pública, 73 (1999), pp. 105-314
[17.]
F. Ballester, M. Saez, S. Perez-Hoyos, C. Iñíguez, A. Gandarillas, Tobías, et al.
The EMECAM project: a multi-center study on air pollution and mortality in Spain. Combined results for particulates and for sulphur dioxide.
Occup Environ Med, 59 (2002), pp. 300-308
[18.]
M. Saez, F. Ballester, S. Pérez-Hoyos, M.A. Barceló, J. Bellido, J.M. Tenías, et al.
A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project.
Environ Health Perspect, 110 (2002), pp. 221-228
[19.]
C.A. Pope, D.W. Dockery.
Epidemiology of particles effects.
Air pollution and health, pp. 673-705
[20.]
A Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society.
Health effects of outdoor air pollution (Part 1).
Am J Respir Crit Care Med, 153 (1996), pp. 3-50
[21.]
Council Directive 1999/30/EC of 22 April 1999 relating to limite values for sulphur dioxide, nitrogen dioxide and oxides of nitrogen, particulate matter and lead in ambient air.
Official Journal of the European Communities, (1999), pp. L163
[22.]
C.A. Pope.
Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk?.
Environ Health Perspect, 108 (2000), pp. 713-723
[23.]
K. Donaldson, V. Stone, A. Clouter, L. Renwick, W. MacNee.
Ultrafine particles.
Occup Environ Med, (2001),
[24.]
J. Schwartz.
Assessing confounding, effect modification, and thresholds in the association between ambient particles and daily deaths.
Environ Health Perspect, 108 (2000), pp. 563-568
[25.]
D.V. Bates.
Health indices of the adverse effects of air pollution the question of coherence.
Environ Res, 59 (1992), pp. 336-349
[26.]
A. Merelles, M.L. Rivera, F. Ballester, J.M. Antó, D. Oterino.
Identificación de urgencias por asma y EPOC en el servicio de urgencias de un hospital. Estudio de concordancia.
Gac Sanit, 13 (1999), pp. 34-41
[27.]
J. Schwartz, C. Spix, G. Touloumi, L. Bacharova, T. Barumandzadeh, A. Le Tertre, et al.
Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions.
J Epidemiol Community Health, 50 (1996), pp. S3-S11
[28.]
T.J. Hastie, R.J. Tisbhirani, T.J. Hastie, R.J. Tisbhirani.
Generalized additive models.
[29.]
C. Iñíguez, S. Pérez-Hoyos, F. Ballester, M. Saez, F. Gómez, J.M. Tenías.
Comparación de dos metodologías estadísticas para el análisis de los efectos a corto plazo de la contaminación en la salud [resumen].
Gac Sanit, 15 (2001), pp. 31
[30.]
J. Schwartz.
The distributed lag between air pollution and daily deaths.
Epidemiology, 11 (2000), pp. 320-326
[31.]
A. Biggeri, P. Bellini, B. Terracini.
Meta-analysis of the Italian studies on short-term effects of air pollution.
Epidemiologia Prevenzione, 25 (2001),
[32.]
P. Michelozzi, F. Forastiere, D. Fusco, C.A. Perucci, B. Ostro, C. Ancona, et al.
Air pollution and daily mortality in Rome, Italy.
Occup Environ Med, 55 (1998), pp. 605-610
[33.]
M.J. Daniels, F. Dominici, J.M. Samet, S. Zeger.
Estimating particulate matter-mortality dose-response curves and threshold levels: an analysis of daily time-teries for the 20 Largest US cities.
Am J Epidemiol, 152 (2000), pp. 397-406
[34.]
J. Schwartz, F. Ballester, M. Saez, J. Bellido, K. Cambra, F. Arribas, et al.
The concentration-response relation between air pollution and daily deaths.
Environ Health Perspect, 109 (2001), pp. 1001-1006
[35.]
K. Katsouyanni, G. Touloumi, E. Samoli, A. Gryparis, A. Le Tertre, Y. Monopolis, et al.
Confounding and effect modification in the short-term effects of ambient particles on total mortality: results from 29 European cities within the APHEA2 Project.
Epidemiology, 12 (2001), pp. 521-531
[36.]
J. Pekkanen, E.J. Brunner, H.R. Anderson, P. Tiittanen, R.W. Atkinson.
Daily concentrations of air pollution and plasma fibrinogen in London.
Occup Environ Med, 57 (2000), pp. 818-822
[37.]
K. Katsouyanni.
Health effects of air pollution in southern Europe: are there interacting factors?.
Environ Health Perspect, 103 (1995), pp. 23-27
[38.]
J. Schwartz.
Is there harvesting in the association of airborne particles with daily deaths and hospital admissions?.
Epidemiology, 12 (2001), pp. 55-61
[39.]
J. Schwartz.
What are people dying of on high air pollution days?.
Environmental Research, 64 (1994), pp. 26-35
[40.]
J.M. Tenías, F. Ballester, S. Pérez-Hoyos, M.L. Rivera.
Hospital emergency room admissions for chronic obstructive pulmonary disease and air pollution in Valencia, Spain.
Arch Environ Health, 57 (2002), pp. 41-47
[41.]
A. Le Tertre, S. Medina, E. Samoli, B. Forsberg, P. Michelozzi, A. Boumghar, et al.
Short term effects of particulate air pollution on cardiovascular disease in eight European cities: a quantitative summary.
J Epidemiol Community Health, 56 (2002), pp. 773-779
[42.]
R.W. Atkinson, A.H. Ross, J. Sunyer, J. Ayres, M. Baccini, J.M. Vonk, et al.
Acute effects of particulate air pollution on respiratory admissions. Results from APHEA 2 project.
Am J Respir Crit Care Med, 164 (2001), pp. 1860-1866
[43.]
J. Librero, R. Ordiñana.
Peiró S. Análisis automatizado de la calidad del conjunto mínimo de datos básicos. Implicaciones para los sistemas de ajuste de riesgos.
Gac Sanit, 12 (1998), pp. 9-21
[44.]
M. Lippmann, K. Ito, A. Nadas, R.T. Burnnet.
Association of particulate matter components with daily mortality and morbidity in urban populations.
Health Effects Institute, (2000),
[45.]
D.M. Stieb, R.C. Beveridge, B.H. Rowe, S. Walter, S. Judek.
Assessing diagnostic classification in an emergency departament: implications for daily time series studies of air pollution.
Am J Epidemiol, 148 (1998), pp. 666-670
[46.]
C.A. Pope, D.V. Bates, M.E. Raizenne.
Health effects of particulate air pollution: time for reassessment?.
Environ Health Perspect, 103 (1995), pp. 472-480
[47.]
D.V. Bates.
Lines that connect: assessing the causality inference in the case of particulate pollution.
Environ Health Perspect, 108 (2000), pp. 91-92
[48.]
S.H. Moolgavkar, E.G. Luebeck.
A critical review of the evidence on particulate air pollution and mortality.
Epidemiology, 7 (1996), pp. 420-428
[49.]
J.F. Gamble, R.J. Lewis.
Health and respirable particulate (PM10) air pollution: a causal or statistical association?.
Environ Health Perspect, 104 (1996), pp. 838-850
[50.]
C.A. Pope, D.W. Dockery, R.E. Kanner, G.M. Villegas, J. Schwartz.
Oxigen saturation, pulse rate, and particulate air pollution.
Am J Respir Crit Care Med, 159 (1999), pp. 365-372
[51.]
A. Seaton, W. MacNee, K. Donaldson, D. Godden.
Particulate air pollution and acute health effects.
Lancet, 345 (1995), pp. 176-178
[52.]
A. Peters, A. Döring, H.E. Wichmann, W. Koenig.
Increased plasma viscosity during an air pollution episode: a link to mortality?.
Lancet, 349 (1997), pp. 1582-1587
[53.]
J. Schwartz.
Air pollution and blood markers of cardiovascular risk.
Environ Health Perspect, 109 (2001), pp. 405-409
[54.]
C.A. Pope, R.L. Verrier, E.G. Lovett, A.C. Larson, M.E. Raizenne, R.E. Kanner, et al.
Heart rate variability associated with particulate air pollution.
Am Heart J, 138 (1999), pp. 890-899
[55.]
D. Liao, J. Creason, C. Shy, R. Williams, R. Watts, R. Zweidinger.
Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly.
Environ Health Perspect, 107 (1999), pp. 521-525
[56.]
A. Peters, S. Perz, A. Doring, J. Stieber, W. Koening, H.E. Wichmann.
Increases in heart rate during an air pollution episode.
Am J Epidemiol, 150 (1999), pp. 1094-1098
[57.]
A. Ibald-Mulli, J. Stieber, H.E. Wichmann, W. Koenig, A. Peters.
Effects of air pollution on blood pressure: a population-based approach.
Am J Public Health, 91 (2001), pp. 571-577
[58.]
S. Salvi, A. Blomberg, B. Rudell, F. Kelly, T. Sandstrom, S.T. Holgate, et al.
Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers.
Am J Respir Crit Care Med, 159 (1999), pp. 702-709
[59.]
A.J. Ghio, C. Kim, R.B. Devlin.
Concentrated ambient air particles induce mild pulmonary inflammation in healthy human volunteers.
Am J Respir Crit Care Med, 162 (2000), pp. 981-988
[60.]
N.A. Janssen, G. Hoek, B. Brunekreef, H. Harssema, I. Mensink, A. Zuidhof.
Personal sampling of particles in adults: relation among personal, indoor, and outdoor air concentrations.
Am J Epidemiol, 147 (1998), pp. 537-547
[61.]
S. Zeger, D. Thomas, F. Dominici, J.M. Samet, J. Schwartz, D.W. Dockery, et al.
Exposure measurement error in time-series studies of air pollution: concepts and consequences.
Environ Health Perspect, 108 (2000), pp. 419-426
[62.]
B. Brunekreef, N.A. Janssen, J. De Hartog, H. Harssema, M. Knape, P. Van Vliet.
Air pollution from truck traffic and lung function in children living near motorways.
Epidemiology, 8 (1997), pp. 298-303
[63.]
J. Schwartz, A. Marcus.
Mortality and air pollution in London: a time series analysis.
Am J Epidemiol, 131 (1990), pp. 185-194
[64.]
W. Roemer, J.H. Van Wijnen.
Differences among black smoke, PM10, and PM1.0 levels at urban measurement sites.
Environ Health Perspect, 109 (2001), pp. 151-154
[65.]
M.C. Ramos, L. Rubio, D. Martín, P. Hernández, R. García dos Santos, R. Fernández.
Desarrollo de la norma europea (EN) para la determinación de las partículas PM2,5 (respirables) en aire ambiente. Método de captación por un filtro y posterior análisis gravimétrico [abstract].
Rev Salud Ambient, 1 (2001), pp. 102
[66.]
N. Künzli, J. Kaiser, S. Medina, M. Studnicka, O. Chanel, P. Filliger, et al.
Public Health impact of outdoor and traffic-related air pollution: a european assessment.
[67.]
R. Fernández-Patier, F. Ballester.
Objetivo 21: mejorar la calidad del aire.
Informe SESPAS 2000, pp. 279-289
Copyright © 2002. Sociedad Española de Salud Pública y Administración Sanitaria
Descargar PDF
Idiomas
Gaceta Sanitaria
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?