1. Urban Ecosystems and sustainability

Photo: Ricardo Ricote Rodríguez (Flickr)

The urban fact is becoming a critical element in sustainability at local and global level. So big is the importance of the cities on the processes of sustainability that, undoubtedly, will play a more decisive role in the health of the planet.

At a general level, cities occupy 1% of the territory, but they consume 75% of energy, they generate 80% of emissions of effect Greenhouse Gases (GHG) and have 85% of the economic wealth in terms of GDP.

Worldwide more than 50% of the population is living in urban areas, figure that lays around 80% in the case of the EU. While in Spain, more than 23 million people live in urban agglomerations, defined as cities counting with more 50,000 inhabitants; this represents about 53% of the population, while citizens that live in urban areas of over 20,000 inhabitants are a total of 30 million, concentrating 67% of the total.

Health in our planet requires that cities improve their own mechanisms for sustainability and self-sufficiency, in order to be self-sufficient and do not require excessive external resources and produce impacts on other surrounding ecosystems. It is the challenge of global sustainability models for local sustainability, in synthesis “glocal” sustainability.

The most important thing is to develop sustainability as an open process in continuous change, adaptation and learning, and, above all, implementing new management systems in urban areas with a new perspective, where citizens are the protagonists of a democratic and multi-level governance, with a more direct involvement in local management and consolidating a policy change of social life while working in global management for the sake of our current generations and future.

The quality of life of citizens and urban sustainability depends in great part on the quality of the air we breathe. If we manage to reduce the air pollution of cities, the respiratory and cardiovascular health will improve both at short term and long term. So it is imperative that measures are taken to improve urban air quality, considering a set of integrated policies.

2. Quality of air, health and urban sustainability

Photo: El mundo

Air pollution is increasingly important for the quality of life of citizens and environmental sustainability of urban ecosystems, but also indoor air pollution has a growing importance. It is estimated that air pollution causes more than 2 million premature deaths per year worldwide, most of them in countries in development (WHO). Every day the inhabitants of cities give more importance to this problem and understand that it is an environmental health risk, so they require more information and political commitment to deal with this threat.

In the European Union there are more than 370,000 premature deaths, of which 16,000 correspond to Spain, with loss of lifespan between 9 months and 2 years, and annual costs exceeding 50 billion Euros in the EU. For these reasons, the improvement of sustainability, the health and quality of life are being decided, and will be decided in the future, mainly in the cities. If we fail to make our city a healthier place to live, we will not be able to turn our planet into a better place and ensure global sustainability.

“Indoor air pollution”, suffered when we breathe in an enclosed area, has health effects especially important because we move from 70 to 90% of our time in enclosed spaces. The most affected ones are children, the elderly and those ones suffering from respiratory and cardiovascular diseases. In developed countries this pollution is the cause of respiratory problems such as asthma, in addition of reducing the quality of life of its inhabitants. Some of the causes of the “indoor air pollution” are mold, spores, dust, cigarette smoke, cleaning products and pollen particles.

Globally, more than 1.5 billion people currently lack access to electricity and other 3 billion depend on biomass for their basic needs. This use of biomass generates in some cases serious health problems in their consumers in some developing regions. Poor countries also suffer from a major scourge, “indoor air pollution”, but in this case it is produced by the use in the homes of open fires with biomass fuels (wood, agricultural residues, etc.), causing smoke and gases that are harmful to the inhabitants’ health, largely affecting children and women.

Likewise, it is estimated that in industrialized countries around 20% of the total incidence of disease can be attributed to environmental factors affecting especially the most vulnerable and socially disadvantaged groups, being constraint the socio-economic conditions of risks to health throughout life with close link between poverty, health and environment.

Despite the fact that the quality of life in cities has increased, in areas such as health it has been impaired by the increase of respiratory and cardiovascular diseases. The permanent growth of transport generates air pollution and noise, and the increase in the consumption of soil has negative impacts on biodiversity and ecosystems. This makes obvious that there is a close link between environmental sustainability, quality of life and the future success of cities in social and economic terms, as well as in environmental factors.

The impact assessment of the damage caused by air pollution together with the benefits derived from its reduction has a remarkable importance in political decision-making and in promoting change towards a sustainable urban development.

3. Spain, situation and perspectives

The consequences of the economic crisis facing Spain, have contributed to a reduction in emissions. The fall of the levels of socio-economic activity, together with the plans for the improvement of the quality of the air by some regional and local administrations, has reduced emissions of acidifying substances and ozone precursors.

Trends are moderately favorable to meet the targets set out in Directive 2001/81/EC on national emission tops referred to the year 2010, something to which the measures and specific actions contained in national program of reduction of emissions and its plans of action have contributed, in certain sectors, to reduce their emissions.

Both in the EU and in Spain the biggest fall in the particulate emissions in recent years is produced, and the downward trend in particles, initiated in the year 2008, is confirmed.

Map of urban areas in Spain. Report "Sostenibilidad Local. Una aproximación urbana y rural" from OSE

This decrease was primarily due to lower energy consumption of fuels and fossil fuels in the sectors and transport, which led to the implementation of European legislation in the field of quality of the air of this pollutant (Directive 2008/50/EC) in some cities, although they still surpass other ones in a worrying way. In addition the values recommended by the World Health Organization (WHO) are still not respected and quality objectives are exceeded in mostly urban or metropolitan areas, which remain worrisome because proportionate measures do not seem to be taken yet.

The large metropolitan areas of Madrid and Barcelona are still being affected by strong episodes of pollution exceeding the permitted levels of pollutants and the intervention measures have been inadequate. Any line of strategic guidance should focus on modifying the current mobility model, focused on the excessive use of the private car.

We even count with the National Plan of Improvement of Quality of Air. This Plan includes 90 measures to promote making cities healthier places, ensuring compliance with the values of PM₁₀ and NO₂ limit and the simultaneous reduction of ozone precursors.

All in all, the environmental costs are significant, in Spain, according to the European Union CAFE program, air pollution generates annual costs that represent at least between 1.7% and a maximum of 4.7% of the Spanish GDP, which means between 413 and 1,125 Euros per inhabitant per year. As in the rest of Europe, the greatest costs are related to chronic mortality associated with the pollution by particles.

4. Challenges for the futur

The ultimate goal is to get healthy urban centers through the pedestrianisation and promoting mobility alternatives together with the rational use of private vehicles, because it has been proved that traffic is the key element to improve the quality of the air.

The poor air quality in many of our cities reveals lacking in coherence and commitment to the principles of a healthy and sustainable urban development as well as lacking in coherence in planning and in urban management.

The most significant issue is resolutely tackling an ambitious integrated perspective of urban planning and land management, where mobility and the organization of the city have prioritary positions. Ultimately, we need to soften the current processes of unsustainability of the cities with a global approach to well-being, health and environmental quality, focusing, especially, on urban planning, rational urban planning and sustainable management of the territory.

Thereby we can favor the introduction of more sustainable ways of transport, with lower power consumption and, at the same time, avoid unnecessary occupation of land, with the ultimate goal of achieving a direct improvement of air quality which bring a higher quality of life for citizens and that contributes to sustainable urban development.

Photo: Deputado Bruno Covas (via Flickr)

In particular, the introduction of new models of transport and mobility, which go far beyond than improving the traffic and a greater energy and environmental efficiency of vehicles, is one of the main challenges of urban sustainability because of its responsibility not only on the quality of the air and climate change, but by its impact on the aspects of quality of life and physical and mental health of citizens.

People in cities share daily the pollution of the air, jams, crowds, rush, noise and many other things that generate, as a whole, the so-called ” urban stress”, as a clear exponent of the deterioration of the citizen coexistence and the “unvearability” of the cities. And in all this, the car has an unquestionable responsibility. The massive traffic of cars, occupying a large part of the public space, undermines the essence of the city complex and habitable.

As some polls reveal, the pollution of cars is perceived as a serious problem both for the environment and for the individuals’ health and their families’. Thus, almost 90% of respondents express their concern over the potential impact of the environment on their health, but 24% of the Spanish population is not ready to stop using his car to improve the quality of the air.

Urban sustainability, in general, can be propelled through the application of new technologies such as the ICT (Information and Communication Technologies), that manage in intelligent and sustainable way the metabolism of cities, including the way of life, production and consumption patterns of distribution and, most of all, the wys of transport and mobility.

Photo: Jorge Franganillo (Flickr)

For example, in the European Union, transport systems represent about 26% of final energy consumption. Systems of Intelligent Transport (STI) can introduce efficient logistics patterns with an improvement in energy efficiency, pollution reduction and rationalization of mobility.

ICT, all in all, offer environmentally more sustainable urban management models in saving energy and pollutant emissions and greenhouse gases. And this is one of the first elements to raise intelligent cities: greater energy efficiency, materials, mobility, building and land use, with a intelligent management oriented to a new urban sustainability.

The magnitude of the environmental effects in cities is too important to not dealing with the problem in depth and extension from a integral perspective and just implement the existing legislation in the area of air pollution. But we must also demand strict compliance with the legislation and redouble our efforts to facilitate the necessary information to assess the overall environmental impact on human health and on the urban environment.

Thus, systems of notice and warning to the population raising citizens’ awareness regarding the implications of their actions should be included. And, at the same time, we should increase the capacity to respond fast and in a coordinated way to different threats by promoting preventive measures and acting on the determining factors in all policies and activities.

All of this is essential to share new values of urban conviviality in terms of quality of life, and environmental and social sustainability. We must aspire to live the city as a “livable city” in a common project for the development of the personal potential of the citizens and of municipalities to develop their endogenous capacities, for the sake of a common sustainable future.

The Observatory of Sustainability in Spain (OSE) has recently released a report that gathers the situation of the climate change, the exhaustion of natural resources and the social unequalities in the planet. Its aim is to collaborate with the process of dialogue between citizens and government to define which role is Spain going to play in the next UN Conference about Sustainable Development, Rio +20.

The official Spanish position in Rio +20 Summit has to be defined through a participative process where Government and civil society shall dialogue”, Luis M. Jiménez Herrero, Director of OSE, states to SINC.

Today, this observatory has presented the monography ‘Challenges for Sustainability: Road to Rio +20’, because of the ‘Spain in the road for Rio +20. Civil Society meeting’, held by the Agriculture, Food and Environment Ministry and Biodiversity Foundation, at the Royal Botanic Garden.

The event has been inaugurated by Minister Miguel Arias Cañete with the purpose to be one of the multiple discussion spaces and a place to share information about the views of different social sectors with respect of the forth UN Conference about Sustainable Development that will be held between the 20th and 22nd of June at Rio de Janeiro, Brazil. During the session, ONG representatives have participated, together with trade union associations and some foundations, and some citizens.

To read the whole article (in spanish), click here.

Logo Radio Arenys

Last  May 9^th, the second of the fortnightly collaborations the Fundació Roger Torné carries out on Radio Arenys took place, specifically in the area of the program called “Volem pa amb oli” (“we want bread with oil” in English) called “Children and healthy habits”.

On this occasion Soledad Román, Fundació Roger Torné’s General Director, on the occasion of the celebration last May 1st of  the World Asthma Day 2012, spoke about this disease and the activities of difussion that the Foundation is developing in collaboration with other entities such as the  AEPap pediatricians (Spanish Association of primary care pediatricians).

Her speech was focused on remembering that, despite the very important prevalence of this disease among the children population in the world, there are reasons for hope, because following a series of medical advices and healthy habits, patients can have a completely normal life.

However, Mrs Roman explained the importance of keeping on working on various aspects to prevent asthma attacks and not only that, but also those diseases such as bronchitis which, in certain circumstances, become chronic and constitute what pediatricians know as “the path of asthma”. Among the actions she mentioned we can include the very important work of diffusion that is being carried out by pediatricians in schools, to raise awareness among educators  regarding asthma symptoms and how to tackle the crisis, since school is a place where children spend most of the day. She also commented the work undertaken by Fundació Roger Torné in its Respiro program, which has recently held an open day for parents with great success of participation. And, of course, she assessed very positively the work of diffusion and information that has been developed in the site of reference about asthma, To Breathe, and will continue thanks to the support that Fundació Roger Torné will provide to AEPap pediatricians for this.

In Fundació Roger Torné, we are very satisfied of this fortnightly collaboration with the programme “Volem pa amb oli”  in Radio Arenys and we also appreciate the opportunity provided by this means of communication to amplify our message and allow to share our task with other individuals and entities.

Photo: zigazou76 (Flickr)

In the Foundation we have always wanted to get the media involved in our work of dissemination, since we understand that it is the most effective way to reach families and society in general and to let them know the important impact of environmental factors on children’s health, how to protect children from this impact and how, through healthy habits, we can prevent future diseases. In order to achieve it, we have sought synergies and formulas that allow, in an informative and funny way, to bring families information about the latest scientific advances, medical recommendations and advices to parents. The radio is a close, friendly media, without stridence, allowing this message to reach the houses and spread in a natural and relaxed way, without requiring from the recipient more effort than listening and to the diffuser the speed that, at times, is required by other means, in the sense of trying to say everything in a small space of time. Therefore the radio seems an ideal way to convey this message and this is why we invite all interested parents to listen “Volem pa amb oli” in Radio Arenys, in which Soledad Román will participate every fifteen days and that can be heard on deferred through this link (in Catalan).

In future editions, Fundació Roger Torné’s General Director will speak about the importance of having meals in family with regard to children’s health and the harmful effects of tobacco (and passive smoking suffered many small children, even before their birth) on health.

Furthermore, we invite other media to join initiatives like this one and supply a space to Fundació Roger Torné, or rather, a space for the protection of children’s health. Is there any goal more important than this one?

The achievement of a sustainable development path is materialized in three pillars. Firstly, strengthen political commitments for sustainable development. Second, analyze the possibilities associated with its implementation. And thirdly, give answers to the emerging challenges of society.

The challenge of sustainable development for the 21st century takes a broad perspective. It’s a concept that does not only refer to the need to strengthen the economic behaviour of societies but it searches the access routes towards an improvement of intergenerational and intra-generational equality. Therefore, the achievement of a sustainable economy entails the achievement of social, economic and environmental agreements, both from the public and private institutions.

On the two major objectives that summarizes 20 +Rio Summit, the establishment of a green economy and an appropriate institutional framework for the achievement of sustainability and the eradication of poverty, the presentation of the monograph is articulated: “Challenges for sustainability: Path to Rio +20” (‘Retos para la Sostenibilidad: Camino a Río+20′ in spanish) published by the Observatory of Sustainability in Spain (OSE). The objective of this OSE study is to contribute and support the Spanish participation in this Conference by offering a basis for analysis, debate and the promotion of a broad social participation, as the Rio +20 Conference intends to.

However, the mistrust in front of possible arrangements which can be achieved at the of Rio +20 Confeence has led the organizers to placate our expectations. We cannot expect major agreements from Rio +20 Conference nor can we consider it the final Summit for humanity. The recent global events are backing up this strategy. The countries attending this Summit are probably not willing to compromise on their sovereignty, especially if they know that the global commitment to the issues posed by the Rio +20 Summit is not homogeneous. For this reason, the participation of a broad social base, whose interests can cushion the reluctance of their rulers, is essential for the United Nations.

The great pevious challenge in River +20 is to convince of the need to prepare this Conference, to make everybody participant of all of its objectives, giving coverage and opening the debate for a green economy in seven major problems: employment, energy, sustainable cities, food security, sustainable agriculture, water, oceans and natural disasters.

Fundació Roger Torné’s commitment in disseminating and disclosing the consequences of environmental pollution on health and particularly on children’s health; as well as the possibility of its prevention, takes the Foundation to comment this Conference that poses among its objectives, discussing the challenges of a green economy. After its conclusion, the agreements and/or commitments reached in these areas of interest will be analyzed.

Photo: ISAAC

In the “International Study Asthma and Allergy Children” (ISAAC), which is a study on allergies and asthma in children, where Spain has participated, it has been noticed that in our country between 8 and 15 pupils out of 100 are suffering from asthma. Due to this important prevalence of the disease, The Health Department has promoted the creation of communitarian programs to take care of asthma in all the Spanish communities. During the creation of the said programs, Health professionals (physicians and nurses) together with teachers have participated.

The involvement of health professionals is perfectly understood, but what about teachers?  What do they do giving their opinions in health forums about medical problems instead of educational ones? The reality is that almost a third of the life of the child or teenager takes place at the school or Institute, where they receive training and they socialize with their mates; this is why it is so important that the school is involved in caring for the students suffering from asthma, who attend it.

According to the figures provided by the ISACC study, at a school with 1,000 students at least 100 will suffer from asthma and their symptoms may occur while they are at school. But being such a prevalent disease currently, there are a great ignorance about it in schools, despite this can have an influence on school absenteeism and on the quality of life.

Photo: "Para padres y madres" website

We have recently published a research work in which 3.827 students have participated, of which 279 suffered from asthma, and the school teachers¹. Throughout this study we noticed that only 4.7% of asthmatic students identified the 3 main symptoms of asthma, with no difference in comparison with their mates who did not suffer the disease. More than 97% of teachers and pupils did not answer correctly when they were asked about the most important asthma triggers, and up to 95% were unable to name 2 treatments to prevent it. This ignorance distorts, or it even harms the situation of pupils who suffer from asthma at schools.

Another aspect we studied was the quality of life for students with asthma and we could see that it was affected to a degree from mild to moderate, which highlights the importance of dealing the problem through different strategies to improve this situation. In this same study it was revealed that the responsibility that teachers considered they had on the problem was lower than the students considered. This difference was also very significant in relation to the responsibility assigned by students to teachers regarding the help they should provide their students who suffer from asthma. In another recent study, up to 60% of the teaching staff of secondary believed that, in case of severe symptoms, their way of performing would be calling the parents or sending the student to the director of the High School, compared to 30% which would intervene in the pupil’s help². This attitude of teachers represents an obstacle for their participation in the care of their asmathic students, perhaps due to the ignorance they have regarding the disease or the legal implications of their performance, or because specific rules for asthma in schools in our country have not been defined.

Physical education activities may be the scenario where a pupil or student with asthma has a crisis of suffocation. At this moment the pupil may need the help of classmates and teachers, something for which they are not prepared according to our findings and other studies carried out in Spain during the last 5 years.

Asthma, Sport and Physical Education

Photo: AEPap

Asthma is a disease that, well controlled, does not prevent from practising physical exercise or from participating on sports activities, even in those ones of high level. There are examples of elite athletes who have asthma and have take part in the Olympics Games. In the Olympic Games of Barcelona, for example, up to 8% of the athletes had asthma and their illness wasn’t a problem to reach the highest levels of sporting success, as representing their country during an Olympic Games is. Therefore, any effort to improve asthma control will have a positive impact on the ability to practice exercise, and school is a good place to cope with this problem.

To breathe ®, Spanish website of high quality regarding asthma with international diffusion, presents a Decalogue of healthy schools for students suffering from asthma; it focuses on the ideal conditions that a school that cares for a safe and healthy environment for their students with asthma must have. We must thank Foundation Roger Torné their help for the revival of this prestigious website which from now on will be updated by the Spanish Association of Pediatrics primary care (AEPap), taking the baton of its founder, Carlos Díaz Vázquez. Among other questions, in point 8 of this Decalogue calls for that physical education teachers:

• They must know well what the asmathic illness is.
• They must control that those children-teenagers suffering from asthma due to practising sport, take their medicines and carry out the sportive hygiene measures (previous preheating)
  • Help avoid sudden cahnges of temperature.
  • Prevent the pupil from practising sport during one crisis.
  • Allow children to have a shower and change their clothes alter practising sport; likewise they should offer alternative activities when necessary.

Logically this should be accompanied by the support from the direction of the school or High School, together with other measures to help achieve a secure environment, as recommended by the Spanish society of Pediatric² Pneumology.

Education, Health and Asthma (GESA) group

Our group Education, Health and Asthma (GESA) was created with the intention of achieving a healthy school and it has developed an educational program named after the suggestive name  of asthma sport and health ®, to involve teachers in the acquisition of sufficient knowledge about asthma and to teach their pupils. This program includes a series of recreational activities along three classes that make up the asthmatic students with their mates who do not suffer from asthma. In addition, it seeks the participation of parents and pupils with asthma physicians and makes it possible the learning of teachers so that they can attend their students in case they submit an asthmatic crisis at school, thanks to a few simple instructions for action in the event of symptoms.  Thus, and thanks to the agreement between parents and physicians, who signing a document, teachers are less reluctant to supply first aid for asthma treatment. If this is important, not less important advantages are derived; teachers recognize the symptoms of asthma in their students during their early stages, as a simple repetitive cough with exertion, for example, and they also can work with the family to report on how the student is or the need to visit a doctor to adjust treatment.

26 secondary schools in Seville and province participated in the first phase of the study of the GESA and managed to improve the knowledge of the students who participated in the experience. We are currently in a second phase that takes place in primary schools in which we have extended the experience throughout Andalusia, with the participation of 95 schools and more than 5,000 children coordinated by school physicians who have joined in this initiative.

AEPap and Fundació Roger Torné join together their efforts due to the World Asthma Day

World Asthma Day 2012 Logo

This article is published in the fringes of the World Asthma Day, held always the first Tuesday of May (this year it took place on May 1st) and ending clear messages to the society on the importance of having controlled the disease is desired. Foundation Roger Torné and AEPap, to which I belong as coordinator of the Group of Respiratory Tracks, have joined their efforts to disseminate the Global Initiative for asthma (GINA) messages to people suffering from asthma; we summarize them below:

 “In order to be able to control asthma you must”:

• Receive treatment customized treatment in written for your asthma.

• Take medicines prescribed by your doctor.

• Know and avoid the factors that can trigger a crisis of asthma.

• Learn to recognize the symptoms of a crisis of asthma.

• Know what you should do before a crisis of asthma.

Activities at the school in Asthma, Sport and Health ® program are intended to achieve these same objectives, making students with asthma responsible for their self-care, which is the basis for a healthy life without limitations and with high level of satisfaction and personal fulfillment.

Networking of all institutions and persons connected with asthma is essential to reach the maximum number of people who can benefit and the publication of this article in the Inspira magazine issued by Foundation Roger Torn ® is an opportunity to achieve this. We want to thank Foundation Roger Torné for his kind invitation and for hosting our writing.

Bibliography:

1. Praena Crespo M, Fernández Truan JC, Aquino Llinares N  et al. Situación de los conocimientos, las actitudes y la calidad de vida en asma de adolescentes y profesorado. Necesidad de educar en los centros de enseñanza. An Pediatr (Barc). 2012 Mar 30. [Epub ahead of print] .
2. López-Silvarrey Varela A. coordinator. Estudio sobre el asma en los centros escolares españoles (EACEE). 2009-2010. A Coruña. Fundación María José Jove; 2011.

◊ Manuel Praena Crespo is Doctor on Medicine, pediatrician, AEPAP Grupo de Vías Respiratorias coordinator and Grupo Educación Salud y Asma (GESA) coordinator and Professor of Pediatrics in the University of Seville. In Barcelona, he gave the lecture “Can we spare our children the respiratory diseases?” organized by Fundació Roger Torné in collaboration with Fundació “la Caixa” and he took part in the talk-colloquium “children’s health and environment: do we know the keys of this relationship?” that was issued to present “Salud infantil y medio ambiente. Una relación de por vida” guide, where he has also participated.

The web ‘To Breathe’ was founded more than ten years ago by Dr Carlos Díaz Vázquez, and their rigour has made it become the most important one on the subject in Spanish language, with a high international recognition and hundreds of thousands of visitors from around the world. It even counts with the accreditation of medical websites of quality draft WMC. In recent months, however, it had become outdated due to a lack of funding. Now this agreement allow pediatricians themselves to take care of the contents, both the maintenance of the existing ones as well as  adding new ones.

To Breathe website

Among other things, more content on the relationship between the environment and children’s health will be added, as Dr Manuel Praena explains; he is Coordinator of the Group of Respiratory Tracts of AEPap. Thus, efforts are joined to publicize the maximum information on children’s respiratory health: the medical part and the part related with environmental factors that have an influence on them and that is what Fundació Roger Torné is devoted to. Soledad Roman, Fundació Roger Torné’s general director, points out the importance of creating alliances with professionals in children’s health and much more at a time as sensitive as the one faced now by the public sector. “We must help professionals in their task and, at the same time, this collaboration will allow us raising this group aware on environmental aspects to take into account when making diagnoses.”

To Breathe website is addressed to two very different audiences: the health professionals and families. The more technical part includes educational resources for paediatricians, the results of the latest researches on asthma and other affections and it is a meeting point for the specialists in the field. The part devoted to the general public exhibits, with a perfectly understandable terminology for patients and their families, information on what asthma is like and the way to coexist with it: from a dictionary of terminology related with the problem to a description of the various types of inhalers, how to recognize triggers. All for free and with the maximum scientific rigour. “All the contents are contrasted, based on researches, opinions are not included,” Dr Praena specified. And this is what has given him fame throughout the world.

This information, moreover, is shown in a completely educational way and with an optimistic approach: “the goal is to make people who suffer from asthma have control of their lives and that there is a range of behaviours and healthy habits that can help them improve their quality of life. For example, the importance of sport must be explained and even high competitive sport  can be practiced, as it is shown in the case of Miguel Indurain, or 8% of athletes who suffered from asthma and participated in the Olympic Games of Barcelona”, the doctor states.

This is also Fundació Roger Torné’s approach. “We do not focus on the point of view of the disease, but in health’s”, Soledad Román said. “People must be aware that our behaviour affects our health and our sons’ and daughters’ and that 30% of diseases are preventable. This is why information of quality must be provided, we all must talk about prevention and about how to maintain a good level of health, this is our objective”.

"Asthma and childhood" guide, edited by Donostia Hospital that you can download in 'To Breathe' website

On the other hand, To Breathe web’s approach complements perfectly the other online project that Fundació Roger Torné, Para padres y madres (For Parents), devotes to families, parents and mothers, that despite it has initially focused on children’s respiratory health, it now extends to all children’s health and their relationship with environment and it counts with a medical staff that answers queries or doubts that families still have after the visit to the doctor. Breathing, on the other hand, collects a lot of information, but it is basically focused on asthma.

Doctor Praena is particularly pleased to have been able to get Fundació Roger Torné’s support, not only because they have common interests, but by the fact that it is a non-profit entity. “From a strategic point of view, the two entities seek to improve children’s respiratory health. And the fact that it is an independent entity, without any relationship with the pharmaceutical industry, guarantees full freedom to make the contents of the web. Fundació Roger Torné, also extends its range of collaboration to the health professionals through this agreement, since so far it supported several researches and the celebration of an annual Conference on children’s health and environment. “With all these actions we want to also help generate networking among the professionals who are devoted to this subject”, Mrs Román says, “it is very important to create these links, because we all have a common goal, but we cannot deal with it alone by ourselves”.

Logo "Para padres y madres" (For Parents)

It is two years ago that Fundació Roger Torné launched, on the occasion of World Asthma Day 2010, Para padres y madres (For parents), website on children’s respiratory health.

The project was started approximately one year earlier, when our Foundation was aware of the lack of information and of the need for quality contents that families had regarding respiratory diseases suffered by their sons and daughters, together with treatments, diagnosis, etc.

First of all, Fundació Roger Torné’s staff started a search on the different options offered by internet and it was then when we found out that there was no web for specific consulting regarding children’s respiratory health all over Europe, despite the alarming growth of asthma prevalence and respiratory diseases among children all over the world. This data convinced our foundation that it was necessary to put at families’ disposal qualified information on these subjects, offered by professionals on health; the information should be expressed through an informative and accessible language that could be understood by everybody.  The next step was to involve an excellent team of medical professionals, all of them working in public health, who elaborated the content “ad hoc”.

“All the members of “Para padres y madres (For parents) medical team who initially drawn up the “ad hoc” contents, are working in public health”

Dr Herminia Villena

Two years later, on the occasion of the World Asthma Day 2012, we wanted to meet some members of the medical staff in order to question ourselves again whether a web like Para padres y madres (For parents) makes sense today, if it is worth to continue supplying it with information or whether, on the contrary, there is an excess of rigorous and reliable information available to interested users as it seems to be said some times from the media when they speak about the “information age”.

Lack of information or excess of it?

For Dr Herminia Villena the answer is clear: “Yes, there is an excess of information. The problem is that it is not always rigorous and proved and, what is worse, it is difficult for people in general to know what source is reliable”. For this reason, on her point of view, Para padres y madres (For parents) is useful, because it is an accessible, reliable and rigorous information, apart from being expressed in an understandable and informative language. Doctors Sandra Gonzalez and Esther Martín add that Para padres y madres (For parents) can provide updated information and that it conforms to the latest scientific advances, because the medicine is not an unchangeable science. The three doctors agree that, often, quality scientifically backed information often is supplied in a language or format too technical to be understood by the public in general and it can be very oriented to health professionals, so an informative approach can be very useful for families.

“I also think it is important to emphasize that behind this project there is no financing that can generate a bias in the information provided,” Dr González notes. We must remember that Para padres y madres (For parents) is entirely funded by Fundació Roger Torné in order to complement its work of diffusion with regard to the importance of children’s respiratory health and its impact on the environmental factors.

Should we protect ourselves from non qualified or not scientific information?

Dr Sandra González

“It is very easy to fall into panic when it comes to health problems suffered by our children.” In fact, professionals ourselves we try it when we play the role of fathers or mothers. Searching for information is not bad, on the contrary. The risk is searching what we want to be told. “And this is where many opportunists take advantage,” Dr. Sandra Gonzalez says. “Indeed,” Dr Villena adds, “we find cases in which people obtain wrong or even dangerous information for their health, cases of ‘miracle’ products or people who apply alternative therapies or ancient remedies without having a formation.” In such cases it is very important that the pediatrician would supply parents with rely and understanding, in order to transmit them that he or she understands their situation and who can even recommend sites where information of quality is provided, such as Para padres y madres (For parents). For Dr. Martín, “it is vital that the information provided to families is based on studies of quality”.

The task undertaken by a medical staff and the sense of the consultant office

“This is why it is essential that families can rely on sources – Internet or of any other nature-where it is easily identifiable that information is supported by professional and reliable sources,” Dr. González says. Esther Martín does agree with that and she says that “a recognizable medical staff supplies the project with great prestige by enabling continuous update of the contents and ensures the scientific seriousness of the contents”.

“Para padres y madres (For parents) is backed by two ethical codes of conduct internationally known, the HON Code and that one provided by the College of Physicians of Barcelona, which become again in force each year, something that ensures quality, reliability and timeliness of its content.”

But also Para padres y madres (For parents) is backed by two ethical codes of conduct that are internationally known, the HON Code and that of the College of Physicians of Barcelona, which become again in force each year, something that ensures quality, reliability and timeliness in its content.

Para padres y madres (For parents) is not an individualized clinic, it does not replace the visit to the doctor, so parents may not clarify specific questions of the treatment and/or diagnosis of their children, but they can learn about generic knowledge about children’s health. “There are a series of consultations that are repeated frequently and whose answer can be “generalized” somehow, because they are not so much depending on individual factors or specific situations. Therefore, the answer to a particular problem can help others to solve similar problems in different contexts”, Dr Martín explains. Dr. Villena adds that “even when the consultation with the pediatrician has taken place in a quiet manner and in sufficient time, which today can be considered an utopia, some doubts always arise during the course of the treatment of a disease, or questions about its evolution…And also, we often think that our case is unique and seeing it reflected comforts us or clarify our questions”.

The easy access to information is linked with a correctly informed society?

Dr Esther Martín

The three doctors belonging to Para padres y madres (For parents) medical staff believe that health is a shared responsibility and they point out that health professional’s role is to safeguard and help maintain health, but ultimately it is a partly controllable responsibility by us, through our habits and behaviors and, in addition, using Dr Villena words, “treatments should be proposed by the health care professional, but they must be accepted by patients”.

Asthma, bronchitis, respiratory diseases and allergies in general are increasingly widespread, and there is much research focused on them. However, the doctors belonging to Para padres y madres (For parents) medical staff point out that such a situation does not correspond with a well-informed society. In Dr Villena’s opinion, the information spreads based on the news and announcements that appear in the media. “There is much interest”, she says, “but in general people are not well informed, especially in what is referred to prevention”. For example, it is usual to speak about asthma and allergies when spring arrives and it is already late to prevent them. Dr. Martín said that there was an absence of health strategies appropriate to spread the information properly; besides there is a significant mismatch between the research related with chronic respiratory diseases and the knowledge of them that the population has.

"Para padres y madres" website

At Fundació Roger Torné we think that Para padres y madres (For parents) is a useful and necessary project for society. Proof of this are the increasingly more frequent consultations carried out by parents and mothers interested on expanding the information obtained in the pediatrician’s consultancy, regarding how to protect their children’s health. However, we wanted to contact the staff of medical professionals to ensure the quality and thoroughness of the content, as well as the necessary experience to understand the concern and the problems faced by parents ,  so that they can give us their opinion as professionals who also care for patients in health centers, on the usefulness and validity of this project. After listening to the doctors, we have no doubt that society has this need and this week in which the World Asthma Day is celebrated, we adopt in a stronger way if possible, the commitment to give to Para padres y madres (For parents) increasingly more visibility through the means we have at our disposal, in this shared task which is to protect children’s health. Would you like to join us?

This is exactly what is being investigated in the new phase of the INMA project (Children and the Environment) which has just been launched with the cohort of Valencia. INMA is a research project that examines the role of environmental contaminants during pregnancy and during the first years of life; it takes place on several points of the Spanish state. In Valencia it is composed by around 500 children in 32 municipalities starting during the first medical visit made by the pregnant mother. Today this group of volunteer participants are already 7 years old children (they were also considered when they were 1 year, 4 and 5 and a half years of age), and on this occasion they are looking for triggers causing the respiratory diseases and possible allergies which may develop.

“With the statistics in hand, we know that at least 150 of the 500 members of this cohort study will suffer some kind of allergy and we want to have all the possible data to try to detect the causes. Mainly we focus on the environmental exposure, food and air pollution,” explains Dr. Mazon.

Ferran Ballester, one of the coordinators of the cohort of INMA project in Valencia, explains to us what the visit consists in. It starts with questionnaires to assess the overall state of health of each participant, the environmental exposure (where he/she lives, presence of smokers around, etc. ) and the child’s diet. Tests are also performed anthropometric (height, weight), a test of bioimpedance (to measure the fat and detect childhood obesity), a visual examination of the skin and specific evidence of the respiratory system: Spirometry, oscillometric (a vest captures the movements of the chest during inspiration and expiration) as well as a collection of bronchial condensate (blowing continuously to capture samples of fluid from the inside of the lungs, which provides markers of oxidation and enables to detect possible problems of lung development). The visit is completed with the collection of biological samples and neuropsychological tests by computer to measure the working memory and the attention ability.

With all of this, and thanks to the continuous supervising that is made from the stage of embryo, one can get to know the evolution of the presence of toxic compounds in the body, such as mercury and pesticides, the emergence of other environmental factors and the possible connection with conditions the person can suffer. Detecting any small alteration can be a symptom of asthma or allergy in the future and the supervising that makes the INMA project will allow volunteers to check if they will later develop these affections or not and will attempt to find the cause.

Data are crossed, in addition, with the internal and external environmental factors. Among the internal ones, special attention is paid to the mother’s smoking or other persons of the usual environment, something which is known to cause breathing problems, bronchial affections, asthma, and the persistence and evolution more complicated for the disease. It is also important to know the quality of the domestic air, because the current of air conditioning systems make many houses not to let air run enough and this creates a microenvironment that can accumulate allergens such as dust mites and pets dander.

External pollutants are substances present in the air pollution that are recorded through environmental sensors located in the areas where these children have their home. Likewise, we must bear in mind that there is a relationship between air pollution and pollen, one of the most common causes of allergy. “The trees of the city, being immersed in a polluted air, create a pollen more chemically aggressive than that one coming from the natural environments and, therefore, with a greater capacity to induce allergy,” says Àngel Mazon.

“All of this information,” says Ballester, “will allow us to see which factors increase the risk, the probability of suffering from respiratory diseases or allergies. ”

The INMA project, which is the first study of these features that is carried out from pregnancy, has already begun to offer results. For example, it has been noticed that children whose mothers have high levels of chlorinated pesticides suffer more risk to suffer from respiratory diseases and the times which are most determinants regarding exposure during the child’s development are being studied. “We are already noticing that the intrauterine exposure, prenatal, has a great significance“, according to Ferrán Ballester statement. It has also been proved that breastfeeding protects of pneumologic and respiratory problems. Another outcome of the study says that women who eat more than 200 grams of vegetables per day during pregnancy reduce the risk of having babies with low birth weight than expected by gestational age.

To draw conclusions about the causes of allergy we will still have to wait. This new phase of the INMA project in Valencia has just started and will last almost one year. Later, the project will focus on childhood obesity, because the figures that have been detected so far make it possible to anticipate that it will be an important subject: in the control children had to pass when they were 4 years old, 14% of them had overweight and 6% suffered from obesity. And in addition to the direct challenge that this represents, it is known that obesity is associated with asthma.

Sant Jordi's Stand of the Roger Torné Foundation

It is hard for those who haven’t been to Barcelona on St. George’s Day to have an idea about what this festivity means for the city. And I said festivity, which is not an exact term, because Sant Jordi is no official holiday in Catalonia, but it instead is a business day with an intensity that I would say that surpasses that one felt in other official celebrations in the community. Thousands of students (from all ages), couples and families go out and come to the city centre to get a rose and a book that after will be given to that chosen person. And on Monday, Barcelona was again a party of the majority, undeniably popular, so much that the cutbacks with all their bad auguries couldn’t drown it.

Fundació Roger Torné, for its first time, took part in Saint George’s festivity, joining the hundreds of stands that flooded the centre of Barcelona. Our white, red, blue and multi-coloured roses sold out in the beginning of the afternoon and although we could present the third tale of the Mapendo Collection, ‘Me llamo Agua’, Mabel Piérola (inexhaustible and generous, Mabel), greeted everybody and signed copies of her other books of tales. When, in the end of the day, we arrived home, we were exhausted but also satisfied for having handed information to dozens of families who, in some cases, expressed their worries to us.
To all of them, to the ones that came to visit us, to the ones that accepted our information gladly, to the ones that took photos to our witches, to those that bought roses and books, to the ones that made possible that Fundació Roger Torné participated in the joy that for one day was lived in the street, thank you. We keep an unforgettable memory.

And now, without stopping, we are getting prepared to flood the network with information about asthma. May’s Inspira will include numerous guest firms that, from different perspectives and angles (school, pollution, sustainability and tobacco) will deal with factors that have influence in a disease that nowadays affects between 8 and 15 out of 100 scholars in our country. It is not a minor issue. For the 2012 awareness campaign , we have the privilege to cooperate with AEPap (Asociación Española de Pediatría de Atención Primaria), an entity which is engaged with children’s health and that works with Fundació Roger Torné to offer serious and rigorous information to the families , with no unnecessary alarmism, about how to prevent and control asthma.

I am convinced that the thoughts and information that you will find in our virtual pages will not disappoint you. We wait for you.

Growing obesity in Spain. It is estimated that more than one out of 10 Spanish children between 6 and 7 years are obese, and of them about 12% are asthmatic. Obesity figures are among the highest in the world and make obesity becomes a factor of additional risk of childhood asthma. Recent studies published in Australia and United Kingdom confirm that obese children are more likely to have asthma of allergic origin. In addition, the result of its pharmacological treatment is less effective. A study by the Institute for medical research John Hunter (Australia) has proven the effectiveness of inhaled steroids reduced in obese children with asthma and also its function ventilatory and bronchial activity are affected in a negative way. Another study at the University of Dundee (Scotland) has shown as (BMI) body mass index is related to the effect of medications for asthma in children with normal weight and overweight children. According to Dr. Luis García-Marcos of the Spanish society of Clinical Immunology and allergy Pediatric (SEICAP) “the paediatric Allergists have seen obese teenage girls are more likely to have asthma and also all of them are more likely to develop another type of allergies due to the inflammatory process underlying obesity.”

Risk factors and defense of childhood asthma

Obesity affects the respiratory system of children in two way: alters its respiratory mechanics and makes the body is in a proinflamatorio State, which affects the own lung inflammation.But obesity is not the only risk factor for childhood asthma, although if it is the most important. A review carried out by the Centre for research in environmental epidemiology in Barcelona draws others:

Tobacco (especially if the mother smokes during pregnancy).Pollution.Exposure to fungi in houses with damp patches. Have parents or relatives with asthma.

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Obese children are more likely to have allergic asthma

Growing obesity in Spain. It is estimated that more than one out of 10 Spanish children between 6 and 7 years are obese, and of them about 12% are asthmatic. Obesity figures are among the highest in the world and make obesity becomes a factor of additional risk of childhood asthma. Recent studies published in Australia and United Kingdom confirm that obese children are more likely to have asthma of allergic origin. In addition, the result of its pharmacological treatment is less effective. A study by the Institute for medical research John Hunter (Australia) has proven the effectiveness of inhaled steroids reduced in obese children with asthma and also its function ventilatory and bronchial activity are affected in a negative way. Another study at the University of Dundee (Scotland) has shown as (BMI) body mass index is related to the effect of medications for asthma in children with normal weight and overweight children. According to Dr. Luis García-Marcos of the Spanish society of Clinical Immunology and allergy Pediatric (SEICAP) “the paediatric Allergists have seen obese teenage girls are more likely to have asthma and also all of them are more likely to develop another type of allergies due to the inflammatory process underlying obesity.”

Risk factors and defense of childhood asthma

Obesity affects the respiratory system of children in two way: alters its respiratory mechanics and makes the body is in a proinflamatorio State, which affects the own lung inflammation.But obesity is not the only risk factor for childhood asthma, although if it is the most important. A review carried out by the Centre for research in environmental epidemiology in Barcelona draws others:

Tobacco (especially if the mother smokes during pregnancy).Pollution.Exposure to fungi in houses with damp patches.Have parents or relatives with asthma.

There are also factors of protection against childhood asthma. One of them is breastfeeding. Children breast-fed at the chest for 3 or more months have less risk of asthma, at least in the first years of life. The Mediterranean diet rich in fruits, vegetables, proteins, cereals and olive oil also decreases the risk.