Métodos indirectos para la estimación de poblaciones ocultas.

En determinadas situaciones podemos encontrar dificultades a la hora de calcular prevalencias en algunas poblaciones. Es el caso de personas que tienen comportamientos que son difíciles de identificar debido a que pueden estar sancionados socialmente o ser ilegales. Es lo que llamamos poblaciones ocultas. Este artículo proporciona una revisión crítica de los métodos más utilizados para calcular el tamaño de una población de difícil acceso. Se trata de métodos indirectos, que estiman la prevalencia de una población oculta basándose en fuentes de datos incompletas. Se exponen diferentes métodos, cada uno de ellos tiene diferentes indicaciones para ser utilizado, dependiendo de los datos de los que dispongamos. Además, precisan de una serie de requisitos para poder ser aplicados y cada uno está expuesto a diferentes tipos de sesgos. Por estos motivos, hay que valorar correctamente los datos disponibles para aplicar el método más preciso, y si fuese posible, utilizar simultáneamente varios métodos para poder comparar los resultados obtenidos, además de valorar críticamente los resultados y comprobar si se ajustan a la realidad.Estimating the prevalence of the so-called “hidden populations” can be challenging, because the identification of its members is difficult due to their socially sanctionable or illegal behaviors. This article provides a critical review of the most widely used methods for estimating the size of a hard-to-reach population. All are indirect methods, based on incomplete data sources. Depending on the available data, one method can be more appropriate than another. Besides, each method must fulfill a number of requirements, and each one may be subject to specific risk of bias. To choose the most suitable method, an accurate evaluation of the available data is necessary, and. if possible several methods should be used simultaneously to be able to compare the results and to critically evaluate if these results fit with the reality.Parcialmente financiado por “Ministerio de Economía y Competitividad, Actuación de Formación Posdoctoral” (FPDI-2013-15827)

Psychological Distress, Family Support and Employment Status in First-Year University Students in Spain

Mental disorders are consistently and closely related to psychological distress. At the start of the university period, the relationship between a student’s psychological distress, family support, and employment status is not well-known. The aims of this study were: To determine the prevalence of psychological distress in first-year university students and to analyze its relationship with family support and the student’s employment status. Data from 4166 first-year university students from nine universities across Spain were considered. The prevalence of psychological distress was obtained using the GHQ-12, a valid and reliable screening tool to detect poor mental health. To analyze the relationship between psychological distress, family support, and employment status, logistic regression models were fitted. Regarding the prevalence found, 46.9% of men and 54.2% of women had psychological distress. In both genders, psychological distress levels increased as family support decreased. Among women, psychological distress was associated with their employment status. The prevalence of psychological distress among first-year university students in Spain is high. In addition, family support, and employment status for women, could be factors to take into account when developing psychological distress prevention strategies at the beginning of the university period.This study was funded by the National Drug Plan from the Ministry of Health, Social Services and Equality of Spain (Codes: 2010|145 and 2013|034)

Consumo de alimentos y calidad de la dieta en estudiantes universitarios: Proyecto uniHcos

Antecedentes/Objetivos: La etapa universitaria se caracteriza por cambios en estilos de vida y, la alimentación es uno de los de mayor variación, especialmente en los primeros cursos. El objetivo de este estudio es describir la frecuencia de consumo de alimentos y la calidad de la dieta de los universitarios españoles. Métodos: Estudio observacional, descriptivo, transversal, multicéntrico de estudiantes universitarios de primer año participantes en el proyecto uniHcos. Población de 1363 estudiantes, 72,6% mujeres y 27,4% hombres de 6 universidades españolas. Los participantes respondieron un cuestionario online de frecuencia de consumo de alimentos: A diario; 3-4 veces/semana pero no diario; 1-2 veces/semana; < 1 vez/semana; Nunca/casi-nunca. Para interpretar los resultados los alimentos se categorizaron según guías-dietéticas SENC-2004 en consumo: diario (pasta, pan-cereales, fruta, verduras, lácteos); semanal (carnes, huevos, pescado, legumbres) y ocasional (embutidos, dulces, refrescos con azúcar. A partir de estos datos se calculó el Índice de Alimentación Saludable (IASE) para determinar la calidad de la dieta. Se clasificó en saludable, necesita cambios y poco saludable. Se realizaron estadísticos descriptivos mediante el software estadístico SPSS 20.0. Resultados: El 38,1% de los universitarios consumen frutas a diario, 21,4% verduras, 74,5% lácteos, 60% pan-cereales y 15% pasta. Semanalmente, el 55,3% consumen carne 3-4 veces/semana, 20,7% huevos, 22,2% pescado y 25,5% legumbres. Además, el 13,3%, 22,2% y 10,2% de los universitarios declaran consumir a diario embutido, dulces y refrescos con azúcar respectivamente. Estos resultados van en concomitancia con los del IASE estadísticamente significativos (p-valor < 0,001), donde se muestra que 6,5% de los universitarios se alimentan saludablemente (mujer: 6,9%; hombre: 5,3%), frente a 78% que necesitan cambios (mujer: 76,7%; hombre: 81,3%) y 15,6% que presentan una alimentación poco saludable, siendo mayor en mujeres (16,4%) que en hombres (13,4%). Conclusiones: La alimentación de los universitarios españoles sigue siendo poco saludable y necesitando cambios, como muestran otros estudios en población universitaria. Los patrones alimentarios de consumo semanal de embutidos, dulces, como el de frutas, verduras y pasta, muestra una inversión de la alimentación saludable y, por tanto un problema de salud pública que requiere de atención por ser población que inicia su camino universitario.Plan Nacional Sobre Drogas (2010I145)

Indirect methods to estimate hidden population

Estimating the prevalence of the so-called "hidden populations" can be challenging, because the identification of its members is difficult due to their socially sanctionable or illegal behaviors. This article provides a critical review of the most widely used methods for estimating the size of a hard-to-reach population. All are indirect methods, based on incomplete data sources. Depending on the available data, one method can be more appropriate than another. Besides, each method must fulfill a number of requirements, and each one may be subject to specific risk of bias. To choose the most suitable method, an accurate evaluation of the available data is necessary, and. if possible several methods should be used simultaneously to be able to compare the results and to critically evaluate if these results fit with the reality. En determinadas situaciones podemos encontrar dificultades a la hora de calcular prevalencias en algunas poblaciones. Es el caso de personas que tienen comportamientos que son difíciles de identificar debido a que pueden estar sancionados socialmente o ser ilegales. Es lo que llamamos poblacio-nes ocultas. Este artículo proporciona una revisión crítica de los métodos más utilizados para calcular el tamaño de una población de difícil acceso. Se trata de métodos indirectos, que estiman la prevalencia de una población oculta basándose en fuentes de datos incompletas. Se exponen diferentes métodos, cada uno de ellos tiene diferentes indicaciones para ser utilizado, dependiendo de los datos de los que dispongamos. Además, precisan de una serie de requisitos para poder ser aplicados y cada uno está expuesto a di-ferentes tipos de sesgos. Por estos motivos, hay que valorar correctamente los datos disponibles para aplicar el método más preciso, y si fuese posible, utilizar simultáneamente varios métodos para poder comparar los resultados obtenidos, además de valorar críticamente los resultados y comprobar si se ajustan a la realidad.Palabras clave: Poblaciones Vulnerables, Métodos Epidemiológicos, Vigilancia Epidemiológica, Recogida de Datos.Financiación: parcialmente financiado por “Ministerio de Economía y Competitividad, Actuación de Formación Posdoctoral” (FPDI-2013-15827).S

Erythema Increase Predicts Psoriasis Improvement after Phototherapy

Psoriasis is a major global health problem. There is a need to develop techniques to help physicians select the most appropriate cost-effective therapy for each patient. The main objectives of this study are (1) to evaluate changes in epidermal barrier function and skin homeostasis after phototherapy and (2) to explore potentially predictive values in epidermal barrier function and skin homeostasis to assess clinical improvement after fifteen sessions of phototherapy. A total of 76 subjects, 38 patients with plaque-type psoriasis and 38 gender- and age-matched healthy volunteers, were included in the study. Erythema, transepidermal water loss (TEWL), temperature, stratum corneum hydration (SCH), pH, sebum, and antioxidant capacity were measured before and after the first and fifteenth phototherapy session. Erythema (401.09 vs. 291.12 vs. 284.52 AU, p < 0.001) and TEWL (18.23 vs. 11.44 vs. 11.41 g·m−2 ·h −1 , p < 0.001) were significantly higher at psoriatic plaques than in uninvolved psoriatic skin and healthy volunteers, respectively, while SCH was lower (9.71 vs. 44.64 vs. 40.00 AU, p < 0.001). After fifteen phototherapy sessions, TEWL (–5.19 g·m−2 ·h −1 , p = 0.016) decreased while SCH (+7.01 AU, p = 0.013) and erythema (+30.82 AU, p = 0.083) increased at psoriatic plaques. An erythema increase exceeding 53.23 AU after the first phototherapy session, with a sensitivity of 71.4% and specificity of 84.2%, indicates that a patient may improve Psoriasis Area and Severity Index (PASI) by ≥3 points after fifteen phototherapy sessions. In conclusion, phototherapy improves epidermal barrier function in psoriatic patients and the erythema increase after one phototherapy session could help doctors select psoriasis patients who are more likely to respond to phototherapy

Differences in mobility, driving styles and road crashes among drivers, according to their status of user and non-user of bicycle

Introducción: Se conoce la tendencia al menor respeto de las normas de seguridad vial por parte de los usuarios de bicicleta. Los objetivos de este estudio fueron identificar las diferencias en la movilidad, estilos de conducción y accidentalidad entre conductores de turismo, en función de su condición o no de usuarios de bicicleta y valorar el efecto de montar en bicicleta sobre cada una de estas variables. Material y Métodos: Se realizó un estudio transversal sobre una muestra de 1114 conductores de turismo (34,4% de ellos usuarios de bicicleta) empleando un cuestionario autoadministrado que valoró: su movilidad, uso de dispositivos de seguridad, estilos de conducción y accidentalidad. Resultados: Los conductores usuarios de bicicleta presentaron mayores exposiciones, manifestaron conducir más deprisa, se percibieron como mejores al volante y se implicaron más frecuentemente en estilos de conducción de riesgo. Conclusión: En nuestra población, ser usuario de bicicleta se asoció positivamente con todos los factores relacionados con una mayor morbi-mortalidad por tráfico.Introduction: It is well known the lower respect to the road safety rules by the bicycle users. The objectives of this study were to identify differences in mobility, driving styles and road crashes among car drivers, according to their condition or not as bicycle users and to assess the effect of being bicycle users on each of these variables. Material and Methods: A cross sectional study was conducted on a sample of 1114 car drivers (34.4% of them cyclists) using a self-administered questionnaire which assessed: mobility, use of safety devices, driving styles and road crashes. Results: The drivers who were also bicycle users had: higher level of exposure, they drove faster, they perceived themselves as better car drivers and they had been more frequently involved in risky-driving styles than car drivers not bicycle users. Conclusion: In our population, the bicycle user condition was positively associated with all factors that increase morbidity and mortality due to traffic accident

Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study

Objective To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash. Results Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists (‘over 74’ category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling. There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41). Conclusions We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.This work was partially supported by the National Council of Science and Technology of Mexico [doctorate grant number 410668]

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.Catedra de Docencia e Investigacion SEMERGEN-Medicina de Familia, University of Granada, Spai

Prevention of road crashes in older adults: perspectives on facilitators, barriers and the role of the family doctor

This work was supported by the SEMERGEN-UGR Chair of Teaching and Research in Family Medicine (Catedra de Docencia e Investigacion en Medicina de Familia SEMERGEN-UGR), University of Granada, Spain.Background: People over 64 years have a high fatality rate when they are involved in traffic accidents. Besides, older victims of road crashes are expected to rise in the future due to population aging. The purpose of the study was to document their perception on the role of the family doctor, the main facilitating factors, and the perceived barriers to the temporary or permanent restriction of their driving. Methods: This qualitative study used focus group methodology. A sample of 16 people over 65 years old was obtained through a series of segmentation criteria at an active participation centre for older adults in a small town in Jaén province (Spain). All were invited to participate in a discussion during which they were asked to express their opinions and subjective experiences concerning the role of their family doctor. The group conversation was taped, fully transcribed and analysed, and codes were generated with both deductive and inductive methods. Results: After merging the codes to generate themes, we identified 9 relevant categories: perception of age-related risk, road safety, role of public authorities, driver assessment centre, role of the family doctor, role of the family, proposals for addressing traffic accidents in older adults, consequences of the driving prohibition, and public transport. All categories help to explain the subjective driving and traffic safety experiences of older road users. Conclusions: Although family doctors do not usually ask their older patients about road driving, they are highly valued by these patients. Thus, family doctors have a great potential to act, along with the family members, for the benefit of older patients’ traffic safety, in ways that can prevent their involvement in road crashes and reduce the negative consequences of having to stop driving if necessary.SEMERGEN-UGR Chair of Teaching and Research in Family Medicine (Catedra de Docencia e Investigacion en Medicina de Familia SEMERGEN-UGR), University of Granada, Spai