An association between sulfur dioxide levels in urban air and the daily number of emergency room admissions for chronic obstructive pulmonary disease was previously reported in Barcelona, Spain, for the period 1985-1986. The present study assesses this association over a longer period of time, 1985-1989. This made it possible to carry out separate analyses for the winter and summer seasons and thus to control more adequately for weather and influenza epidemics. An increase of 25 micrograms/m3 in sulfur dioxide (24-hour average) produced adjusted changes of 6% and 9% in emergency room admissions for chronic obstructive pulmonary disease during winter and summer, respectively. For black smoke, a similar change was found during winter, although the change was smaller in summer. The association of each pollutant with chronic obstructive pulmonary disease admissions remained significant after control for the other pollutant. The present findings support the conclusion that current levels of sulfur dioxide and black smoke may have an effect on the respiratory health of susceptible persons.

The unusual periods observed in the present study cannot be classified as heatwaves because the weather temperature never reached high values and most of them occurred during the winter. The association of unusual periods with mortality was stronger during winters than in summers, maybe because unusual winter periods showed a temperature deviation from the average twice that in summer or because humidity during unusual winter periods was higher than in summer.

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

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The cost of medication errors (MEs), and by extension their impact on the running of hospitals, is generally unknown to hospital managers. This study estimated the financial costs involved in the additional use of hospital resources as a result of MEs. For this we used a database covering 20,014 hospital admissions, with clinical and personal information about each patient, the costs related to his/her stay, and physicians' prescriptions. Analyses were carried out using cases and control techniques to calculate the additional cost of MEs. During the study period, 2001, the analysis indicated that the MEs analyzed caused an additional 303 days of hospital stay, with an overall annual cost of nearly 6,000 euros. Our study confirms that MEs are a costly reality. The presence of MEs doubled the cost per patient.