Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age

Introduction The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship. Method From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied. Results A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40–2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age. Conclusions The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.The members of the GISyC group (SCG, CFA and ESM) are funded by “Programa Operativo FEDER Extremadura (2014-2020) y Fondo Europeo Desarrollo Regional (FEDER) Grant number: GR18146. This work was supported by 4IE+ project (0499_4IE_PLUS_4_E) funded by the Interreg V-A España-Portugal (POCTEP) 2014- 2020 program

Association between the detection of alcohol, illicit drugs and/or psychotropic medications/ opioids in patients admitted due to trauma and trauma recidivism: A cohort study

To quantify the association between the presence and type of drug detected and trauma recidivism in a cohort of patients admitted due to trauma. The incidence rate of TR was 10.94 cases per 100 patient-years in the group of patients negative for substances and 27.99 per 100 patient-years in positive patients. The survival curves show very significant differences in cumulative recurrence-free survival between the groups (Log Rank: p<0.001). Both the aHRR and the aIRR estimates show an increased risk of re-injury due to alcohol consumption (aIRR: 2.33 (1.72±3.15), p<0.001), cannabis use (aIRR: 1.87 (1.09±3.20), p = 0.022) and polydrug use (aIRR: 2.34 (1.80±3.04), p<0.001). The presence of alcohol and/or illicit drugs in these patients doubles the risk of trauma recidivismThis work was supported by the Dirección General de Tráfico, Spain [grant number: 0100DGT22389

Efecto de las drogas alucinógenas, estimulantes y depresoras del sistema nervioso central sobre la gravedad de la lesión en pacientes ingresados por traumatismos

Objective: The effect of drugs other than alcohol on severity of trauma remains unclear. Pooled data analyses in previous studies that grouped substances with opposite effects on the central nervous system (CNS) may have masked the influence of substances on injury severity. The aim was to analyze the effect of stimulant, hallucinogenic and depressant drugs other than alcohol on injury severity in trauma patients. Methods: The presence of alcohol, stimulant drugs (cocaine, amphetamines and methamphetamines), depressant drugs (benzodiazepines, opiates, methadone and barbiturates) and hallucinogenic drugs (THC and PCP) was analyzed in 1187 patients between 16 and 70 years old admitted to a trauma hospital between November 2012 and June 2015. Injury severity was determined prospectively as the Injury Severity Score. A multivariate analysis was used to quantify the strength of association between exposure to substances and trauma severity, using the presence of alcohol as a stratification variable. Results: Drugs other than alcohol were found in 371 patients (31.3%): 32 (2.7%) stimulants, 186 (15.3%) depressants, 78 (6.6%) hallucinogenics and 75 (5.6%) polydrug use. The presence of CNS depressant substances was associated with increased injury severity only in patients also exposed to alcohol, with an adjusted odds ratio of 4.63 (1.37-15.60) for moderate injuries and 7.83 (2.53-24.21) for severe. Conclusion: CNS depressant drugs had a strong influence on injury severity in patients who screened positive for alcohol consumption.Objetivo: No está claro qué efecto tienen las drogas distintas del alcohol sobre la gravedad de los traumatismos. Los análisis incluidos en estudios previos, que agrupan sustancias con efectos opuestos sobre el sistema nervioso central (SNC), pueden haber enmascarado la influencia de estas sobre la gravedad. El objetivo fue analizar el efecto de las drogas alucinógenas, estimulantes y depresoras del SNC, diferentes del alcohol, sobre la gravedad de las lesiones en pacientes ingresados por traumatismos. Métodos: Se analizó la presencia de alcohol, drogas estimulantes (cocaína, anfetaminas y metanfetaminas), depresoras (benzodiacepinas, opiáceos, metadona y barbitúricos) y alucinógenas (THC y PCP) en 1187 pacientes de entre 16 y 70 años de edad ingresados por traumatismo de noviembre de 2012 a junio de 2015. La gravedad del traumatismo se determinó prospectivamente mediante la Injury Severity Score. Se cuantificó la fuerza de la asociación entre la exposición a sustancias y la gravedad del traumatismo mediante un análisis multivariante, utilizando la presencia de alcohol como variable de estratificación. Conclusión: Las drogas depresoras del SNC tuvieron una fuerte influencia en la gravedad del traumatismo en los pacientes que además presentaban resultados positivos para consumo de alcohol.This work was supported by the Dirección General de Tráfico, Spain [No. 0100DGT22389] and the Consejería de Salud, Junta de Andalucía, Spain [No. PI-0691-2013]

Effect of a brief intervention for alcohol and illicit drug use on trauma recidivism in a cohort of trauma patients

OBJETIVO Estime la efectividad de las intervenciones breves para reducir la reincidencia de traumas en pacientes hospitalizados que tuvieron resultados positivos en la prueba de alcohol y / o uso de drogas ilícitas. Metodos Estudio de cohorte dinámico basado en datos de registro de 1818 pacientes incluidos en un programa de detección e intervención breve para el uso de alcohol y drogas ilícitas para pacientes hospitalizados con traumatismos. Del análisis de los datos surgieron tres subcohortes: los pacientes que obtuvieron un resultado negativo, los que obtuvieron un resultado positivo y se les ofreció una intervención breve, y los que obtuvieron un resultado positivo y no se les ofreció una intervención breve. El seguimiento duró de 10 a 52 meses. Se calcularon la supervivencia libre de traumatismo, los índices de tasa de riesgo ajustados (aHRR) y los índices de tasa de incidencia ajustados (aIRR), y se utilizó un análisis de efecto causal promedio más completo (CACE). RESULTADOS Encontramos un mayor riesgo acumulativo de reincidencia de trauma en el subcohort que dio positivo. En esta subcohorte, se obtuvo un aHRR de 0,63 (IC del 95%: 0,41-0,95) para el grupo que ofreció una intervención breve en comparación con el grupo que no recibió intervención. El análisis CACE produjo una reducción estimada del 52% en la reincidencia del trauma asociada con la intervención breve. CONCLUSIÓN La breve intervención ofrecida durante la hospitalización en pacientes con trauma positivos por el uso de alcohol y / o drogas ilícitas puede reducir a la mitad la incidencia de reincidencia del trauma.OBJECTIVE Estimate the effectiveness of brief interventions in reducing trauma recidivism in hospitalized trauma patients who screened positive for alcohol and/or illicit drug use. METHODS Dynamic cohort study based on registry data from 1818 patients included in a screening and brief intervention program for alcohol and illicit drug use for hospitalized trauma patients. Three subcohorts emerged from the data analysis: patients who screened negative, those who screened positive and were offered brief intervention, and those who screened positive and were not offered brief intervention. Follow-up lasted from 10 to 52 months. Trauma-free survival, adjusted hazard rate ratios (aHRR) and adjusted incidence rate ratios (aIRR) were calculated, and complier average causal effect (CACE) analysis was used. RESULTS We found a higher cumulative risk of trauma recidivism in the subcohort who screened positive. In this subcohort, an aHRR of 0.63 (95% CI: 0.41–0.95) was obtained for the group offered brief intervention compared to the group not offered intervention. CACE analysis yielded an estimated 52% reduction in trauma recidivism associated with the brief intervention. CONCLUSION The brief intervention offered during hospitalization in trauma patients positive for alcohol and/or illicit drug use can halve the incidence of trauma recidivism.• Dirección General de Tráfico. Beca 0100DGT22389, para Enrique Fernández Mondéjar • Junta de Andalucía. Beca PI-0691-2013, para Raquel Vilar López • Ministerio de Educación, Cultura y Deportes. Beca FPU13/00669, para Juan Francisco Navas PérezpeerReviewe

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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El efecto del consumo del alcohol, las drogas ilícitas y los psicofármacos sobre la reincidencia y la gravedad de los traumatismos: Propuesta de una estrategia de prevención

En 2011 se llevó a cabo en el Hospital de Traumatología de Granada la implantación de un proyecto de prevención, mediante el cribado sistemático de sustancias, en pacientes ingresados por traumatismos, para la realización de una intervención motivacional breve. Mediante el registro de pacientes creado por el proyecto se llevó a cabo esta Tesis Doctoral con los objetivos de: 1) describir a los pacientes del registro; 2) cuantificar la fuerza de asociación entre el tipo de sustancias detectadas y su historial de traumatismos previos; 3) analizar la asociación de las drogas según su efecto en el sistema nervioso central sobre la gravedad; 4) estimar y comparar la reincidencia de nuevos traumatismos en los pacientes positivos y negativos a sustancias; 5) y estimar la efectividad de la intervención motivacional breve en la reducción de la reincidencia de traumatismos.Tesis Univ. Granada.m Programa de doctorado en Medicina Clínica y Salud PúblicaLa realización de esta Tesis Doctoral ha sido en parte posible gracias a la financiación obtenida por la Dirección General de Tráfico (Proyecto: “Asistencia técnica para la implementación de una intervención Motivacional en accidentes asociados con el alcohol y las drogas. Ref.0100DGT22389”) y por la Consejería de Salud de la Junta de Andalucía (Proyecto: “Efectividad de una Intervención Breve en el tratamiento de pacientes admitidos por un accidente de tráfico relacionado con el consumo de drogas. Ref. PI-0691-2013”)

Influence of Breastfeeding in the Adaptation of and Absenteeism of Infants in Early Childhood Centers: A Preliminary Study

Schooling of children between 0 and 3 years old involves a process of adaptation and increases their exposure to infectious diseases, which leads to school absenteeism. Breastfeeding facilitates the development of secure attachment and protects the infant against infections. This study aimed to determine whether breastfeeding facilitates the adaptation of infants between 0 and 3 years old to early childhood center and decreases school absenteeism. A cross-sectional study was carried out by collecting data through a questionnaire, which was filled out by the parents and the childcare professionals. 160 infants participated. 40% of the infants who received infant formula from birth showed dependency behaviors (inconsolable crying or do not leave the caregiver for a long time) at the time of pick-up from the center, compared with 10%, 2.7%, and 2.6% of children breastfed between 0 and 6 months, and more than 6 and 12 months, respectively (p = 0.001). The interquartile range of absenteeism days per episode was 2&ndash;3 days for infants fed infant formula versus 1&ndash;2 days for those who were breastfed for more than 12 months (p = 0.041). Breastfeeding seems to be associated with fewer dependency behaviors at the time of collection and with fewer days of absence

Gender differences in susceptibility to smoking among high school students

Objetivos: Analizar el grado de susceptibilidad al tabaquismo según el género en estudiantes de 12 a 16 años y estudiar el papel de los factores asociados al género y al índice ampliado de susceptibilidad al tabaquismo. Diseño: Estudio transversal. Métodos: Entre noviembre de 2019 y marzo de 2020 se reclutaron estudiantes de 12 a 16 años de tres centros educativos del oeste de España. Se analizaron variables sociodemográficas, ambientales, sociales y personales. Se calculó el valor del índice ampliado de susceptibilidad al tabaquismo y se estudiaron las asociaciones entre el género de los estudiantes y la susceptibilidad al tabaquismo. Se utilizó la regresión logística multinomial para estudiar las asociaciones entre las variables independientes y los resultados del índice ampliado de susceptibilidad (ESSI). El papel de los factores en esta asociación se exploró mediante un análisis de mediación. Resultados: Un total de 364 estudiantes participaron en el estudio (53% mujeres). El 79,3% de las mujeres y el 61,4% de los hombres presentaron un nivel medio-alto del índice ampliado de susceptibilidad. Las mujeres declararon un mayor consumo de cigarrillos (28% frente a 12,3%), narguile (19,9% frente a 9,9%) y alcohol (20,7% de consumo de alcohol de riesgo). Obtuvieron puntuaciones más altas en la escala de impulsividad en el dominio de urgencia y en la escala de afecto negativo. Independientemente de otros factores, las mujeres mostraron más del doble de propensión a fumar (aOR: 2,05; IC 95%: 1,03-4,07; p = 0,041). El análisis de mediación mostró que el sexo tenía un efecto total sobre el índice de susceptibilidad ampliado β = 0,023 (IC 95%: 0,07-0,38; p = 0,01). El efecto parecía estar mediado sólo por tener amigos fumadores (0,08; IC 95%: 0,03-0,15; p = 0,001). Conclusiones: La mayor susceptibilidad al tabaquismo encontrada en las mujeres puede estar relacionada con una mayor influencia del tabaquismo entre los amigos. Repercusiones: Estos resultados muestran que los amigos fumadores tienen una fuerte influencia entre las adolescentes, por lo que sería interesante desarrollar programas preventivos con enfoque de género dirigidos a reducir la influencia de estos factores ambientales.Aims: To analyse the degree of susceptibility to smoking according to gender in students between 12 and 16 years of age and study the role of factors associated with gender and the extended index of susceptibility to smoking. Design: Cross-sectional study. Methods: Between November 2019 and March 2020, 12-to 16-year-old students were recruited from three educational centres in western Spain. Sociodemographic, environmental, social and personal variables were analysed. The value of the extended index of susceptibility to smoking was calculated, and the associations between the students' genders and smoking susceptibility were studied. Multinomial logistic regression was used to study associations between the independent variables and Expanded Susceptibility Index (ESSI) results. The roles of factors in this association were explored through mediation analysis. Results: A total of 364 students participated in the study (53% females). A total of 79.3% of females and 61.4% of males presented a medium-high level of the extended index of susceptibility. Females reported greater cigarette use (28% vs. 12.3%), hookah (19.9% vs 9.9%) and alcohol consumption (20.7% risk alcohol consumption). They obtained higher scores on the impulsivity scale in the urgency domain and the negative affect scale. Regardless of other factors, females showed more than double the smoking susceptibility (aOR: 2.05, 95% CI: 1.03–4.07, p = .041). Mediation analysis showed that gender had a total effect on the extended susceptibility index β = .023 (95% CI: 0.07–0.38, p = .01). The effect appeared to be mediated only by having smoking friends (0.08; 95% CI: 0.03–0.15, p = .001). Conclusions: The greater susceptibility to smoking found in females may be related to a greater influence of smoking among friends. Impact: These results show that smoking friends have a strong influence among adolescent females; therefore, developing preventive programmes with gender approaches aimed at reducing the influence of these environmental factors would be of interest.• Programa operativo FEDER Extremadura (2014–2020) y Fondo Europeo de Desarrollo General (FEDER). Subvención GR21010peerReviewe