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]

Desigualdades en Salud: La Mortalidad Perinatal e Infantil en España

ResumenSe ha considerado al coeficiente de variación interprovincial (CV) como un indicador objetivo de la dispersión de los valores provinciales de las tasas de mortalidad infantil, neonatal, postneonatal y perinatal. Así, se ha estudiado la evolución de los CV anuales, para las cuatro tasas, desde 1940 hasta 1986, con objeto de identificar la evolución temporal de las diferencias interprovinciales con respecto a dichas tasas de mortalidad. Se observa que en ningún caso los CV muestran una tendencia decreciente en el tiempo, lo que parece indicar que las desigualdades interregionales permanecen inalteradas. La tasa de mortalidad postneonatal es la que mayor dispersión presenta en sus valores provinciales durante el período estudiado (CV entre 23 y 40%), y su evolución es independiente de la de la tasa de mortalidad neonatal, lo que parece indicar que los factores que influyen en ambas son diferentes.SummaryThe interregional variation coefficient (VC)) has been considered as an accurate measure of the dispersion of regional infant, neonatal, postneonatal and perinatal mortality rates. Thus, trends of annual VC have been analyzed, for each rate, from 1940 to 1986, to identify the evolution in time of the regional differences with respect to these mortality rates. None of the four mortality rates showed a decreasing trend in their respective VCs. This may indicate that interregional differences do not change along time. The postneonatal mortality rate has been shown to have the highest VCs during the study period (ranging from 23 to 40%), with an independent evolution with respect to neonatal mortality rate, probably because the factors that influence both rates are clearly different

Cycling area can be a confounder and effect modifier of the association between helmet use and cyclists’ risk of death after a crash

The effect of helmet use on reducing the risk of death in cyclists appears to be distorted by some variables (potential confounders, effect modifiers, or both). Our aim was to provide evidence for or against the hypothesis that cycling area may act as a confounder and effect modifier of the association between helmet use and risk of death of cyclists involved in road crashes. Data were analysed for 24,605 cyclists involved in road crashes in Spain. A multiple imputation procedure was used to mitigate the effect of missing values. We used multilevel Poisson regression with province as the group level to estimate the crude association between helmet use and risk of death, and also three adjusted analyses: (1) for cycling area only, (2) for the remaining variables which may act as confounders, and (3) for all variables. Incidence–density ratios (IDR) and their 95% confidence intervals were calculated. Crude IDR was 1.10, but stratifying by cycling area disclosed a protective, differential effect of helmet use: IDR = 0.67 in urban areas, IDR = 0.34 on open roads. Adjusting for all variables except cycling area yielded similar results in both strata, albeit with a smaller difference between them. Adjusting for cycling area only yielded a strong association (IDR = 0.42), which was slightly lower in the adjusted analysis for all variables (IDR = 0.45). Cycling area can act as a confounder and also appears to act as an effect modifier (albeit to a lesser extent) of the risk of cyclists’ death after a crash

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

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

Exposure to pesticides and cryptorchidism: geographical evidence of a possible association

Synthetic hormone-disrupting chemicals may play a role in the increased frequency of cryptorchidism observed in some studies. We used a spatial ecological design to search for variations in orchidopexy rates in the province of Granada in Spain and to search for relationships between these differences and geographical variations in exposure to pesticides. Orchidopexy rates were estimated for the period from 1980 to 1991 in all municipalities and health care districts served by the University of Granada Hospital. A random sample of males of the same age (1-16 years) admitted for any reason during the same period was used to estimate inpatient control rates. Each municipality was assigned to one of four levels of pesticide use. We used Poisson homogeneity tests to detect significant differences in rates of orchidopexy between districts and between levels of pesticide use. Poisson and logistic regression models were also used to estimate the strength of association between orchidopexy and level of pesticide use. Orchidopexy rates tended to be higher in districts near the Mediterranean coast where intensive farming is widespread. The city of Granada, where the reference hospital is located, also had higher figures both for orchidopexy and inpatient control rates. Regression models showed that the strength of association between orchidopexy and level of pesticide use tended to increase with higher levels of use, with the exception of level 0 (mainly in the city of Granada). Our results are compatible with a hypothetical association between exposure to hormone-disruptive chemicals and the induction of cryptorchidism. Several methodological limitations in the design make it necessary to evaluate the results with caution.This work was partially supported by the Health Council, Andalusian Regional Government through grant no. 94/556-140

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