Cambios en el consumo alcohólico de riesgo en población adolescente en la última década (2004-2013): una aproximación cuanti-cualitativa

Resumen: Objetivo: Conocer los cambios del consumo alcohólico de riesgo en los adolescentes en la última década, así como sus motivaciones y vivencias. Diseño: 1) descriptivo transversal: encuesta autoadministrada; 2) cualitativo explicativo: grupos de discusión videograbados, con análisis de contenido (codificación, triangulación de categorías y verificación de resultados). Emplazamiento y participantes: Alumnos de un instituto urbano de educación secundaria, administrando un cuestionario cada 3 años de 2004 a 2013. En el año 2013 se realizan las entrevistas grupales, con muestreo de conveniencia. Criterio de homogeneidad: nivel educativo; criterios de heterogeneidad: edad, sexo y consumo de drogas. Mediciones principales: Cuestionario: edad, sexo, consumo de drogas y cuestionario CAGE. Entrevistas: semiestructuradas sobre un guión previo, valorando vivencias y expectativas. Resultados: Descriptivo: 1.558 encuestas, edad 14,2 ± 0,3 años, 50% mujeres. Disminuye la prevalencia de consumo de alcohol (13%), aumentando el consumo de riesgo (11%; p  6 unidades de bebida estándar/semana; p  6 standard drink units weekly; P < .001, ANOVA), during the weekend (56%; P < .01, Ï2) and multiple drug use (P < .01, Ï2). CAGE questionnaire: 37% â¥Â 1 positive response (related to hazardous drinking, P < .05 Ï2), 18% â¥Â 2 answers. Qualitative: A total of 48 respondents, classified into 4 categories: personal factors (age, gender), social influences (family, friends), consumption standards (accessibility, nightlife), and addiction (risk, multiple drug use). Conclusion: Despite the decrease in the prevalence of alcohol drinking, the increase in the percentage of the hazardous drinking is a public health problem. It is related to being female, binge-drinking, and multiple drug use. Nightlife and social standards are the main reasons given by adolescents, who have no perception of risk. Palabras clave: Consumo de alcohol, Consumo alcohólico de riesgo, Conducta del adolescente, Consumo masivo de alcohol, Detección de abuso de sustancias, Análisis cualitativo, Keywords: Alcohol drinking, Hazardous drinking, Adolescent behaviour, Binge drinking, Substance abuse detection, Qualitative analysi

Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure. the SEMICA-2 study

Objective: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). Methods: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. Results: We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115–2.811; p = 0.016), and 1.939 (95% CI 1.114–3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. Conclusions: Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days