Aspectos metodológicos en la medición del consumo de alcohol: la importancia de los patrones de consumo

Measurement of alcohol consumption is essential for proper investigation of its effects on health. However, its estimation is extremely complex, because of the diversity of forms of alcohol consumption and their highly heterogeneous classification. Moreover, each form may have different effects on health; therefore, not considering the most important drinking patterns when estimating alcohol intake could mask the important role of consumption patterns in these effects. All these issues make it very difficult to compare the results of different studies and to establish consistent associations for understanding the true effects of alcohol consumption, both overall and specific to each drinking pattern. This article reviews the main methods and sources of information available in Spain for estimating the most important aspects of alcohol consumption, as well as the most frequent methodological problems encountered in the measurement and classification of drinking patterns.Medir correctamente el consumo de alcohol es fundamental para investigar de forma fiable sus efectos en salud. Sin embargo, esta estimación resulta enormemente compleja, tanto por la diversidad de formas de consumo de alcohol existente como por la gran heterogeneidad en su clasificación. Además, cada patrón de consumo de alcohol puede asociarse a efectos muy diferentes sobre la salud, por lo que no tenerlos en consideración cuando estimamos la ingesta de alcohol puede ocultar o confundir su importancia en estos efectos. Todo ello dificulta las comparaciones entre estudios y el establecimiento de asociaciones consistentes que permitan comprender los verdaderos efectos del consumo de alcohol, tanto globales como específicos de cada patrón de bebida. Este trabajo revisa los principales métodos y fuentes de información disponibles en España para estimar los aspectos más relevantes del consumo de alcohol, así como las dificultades y problemas metodológicos más frecuentes en la medición y clasificación de cada uno de estos indicadores

Patrones de consumo de alcohol en España: un país en transición

Background: Alcohol consumption in Mediterranean countries is in a transition period. The objective is to describe in the Spanish adult population the pattern of alcohol consumption by major sociodemographic variables. Methods: A cross-sectional study among 20,608 individuals aged ≥15 years who participated in the Spanish Health Interview Survey (ENS) 2011-2012. According to average intake, people were classified as heavy drinkers if they drank ≥40 g/day of alcohol (men) or ≥24 g/day (women). Binge drinking was defined as the consumption of ≥6 standard drinks (men) and ≥5 (women) at any drinking occasion (4-6 hours) in the last year. The beverage preference and the trend for 1987-2012 (ENS of these years) were estimated. The relationship of the distribution of drinking patterns with sociodemographic variables was analyzed using adjusted logistic regression models. Results: The prevalence of heavy drinkers was 1.3% (2% in men and 0.7% in women). In men, heavy drinking was more frequent among 45 to 64 year olds (odds ratio (OR)=2.92 compared to men of 15-29 years; CI 95%: 1.59-5.38) and those born in Spain (OR=3.45; CI 95%: 1.59-7.69). In women, the only differences observed were those regarding education level, with heavy drinking increasing as the level of education increases (p linear trend <0.001). The prevalence of binge drinking during the last year was 19.6% in men and 7.1% in women. In both genders, the risk of binge drinking decreased with age and increased with higher education level (p linear trend <0.001). The standardized prevalence of heavy drinkers has declined from 18.8% in 1987 to 1.3% in 2012. Conclusion: Alcohol consumption in Spain is consistent with the model for countries in transition, where binge drinking is the most common pattern of excessive use of alcohol. A strong decline in heavy drinkers was observed and wine has been displaced by beer in beverage preference.Fundamentos: El modo en el que se consume alcohol en los países mediterráneos se encuentra en proceso de transición. El objetivo de este trabajo es describir los patrones de consumo en la población adulta española según las principales características sociodemográficas. Métodos: Estudio transversal con participantes de 15 años y más utlizando como fuente de información la Encuesta Nacional de Salud (ENS) 2011-2012 (n=20.608). Según la ingesta promedio de alcohol, se clasificó como de alto riesgo el consumo ≥40 g/día de alcohol en hombres o ≥24 g/día en mujeres. Se definió binge drinking el consumo de ≥6 bebidas estándar de alcohol (hombres) y ≥5 (mujeres) en 4-6 horas durante los últimos 12 meses. Se estimó la preferencia de bebida y la tendencia 1987-2012 (ENS respectivas). Se analizó su distribución con variables sociodemográficas mediante modelos ajustados de regresión logística. Resultados: El 1,3% de los sujetos encuestados fueron bebedores promedio de alto riesgo (2% de hombres y 0,7% de mujeres). En hombres fue más frecuente entre los 45-64 años (odds ratio (OR)=2,92 respecto a 15-29 años; IC 95%:1,59-5,38) y en los sujetos nacidos en España (OR=3,45; IC 95%: 1,59-7,69). En mujeres se observaron diferencias estadísticamente significativas según el nivel educativo, incrementándose a medida que aumentaba éste (p tendencia lineal <0,001). El 19,6% de hombres y 7,1% y de mujeres realizaron binge drinking en el último año. Este patrón disminuyó con la edad y se incrementó con el nivel de estudios en ambos sexos (p tendencia lineal <0,001). La prevalencia estandarizada de bebedores promedio de alto riesgo descendió desde un 18,8% en 1987 hasta el 1,3% en 2012. Conclusiones: El consumo de alcohol en España es compatible con el modelo de países en transición, donde el binge drinking es el que más contribuye al riesgo global. Se observa un importante descenso del consumo promedio de alto riesgo. La cerveza desplaza al vino como bebida preferente

Adverse events: an expensive and avoidable hospital problem

Introduction: Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. Methods: This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. Results: A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. Conclusions: The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient’s death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messages Adverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization. Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels. Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE

Prevalence, characteristics, and impact of adverse events in 34 Madrid hospitals. The ESHMAD study

Introduction: Adverse Events (AE) are one of the main problems in healthcare. Therefore, many policies have been developed worldwide to mitigate their im pact. The Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD) measures the results of them in the region. Methods: Cross-sectional study, conducted in May 2019, in hospitalised patients in 34 public hospitals using the Harvard Medical Practice Study methodology. A logistic regression model was carried out to study the association of the variables with the presence of AE, calibrated and adjusted by patient. Results: A total of 9975 patients were included, estimating a prevalence of AE of 11.9%. A higher risk of AE was observed in patients with surgical procedures (OR[CI95%]: 2.15[1.79 to 2.57], vs. absence), in Intensive Care Units (OR[CI95%]: 1.60[1.17 to 2.17], vs. Medical) and in hospitals of medium complexity (OR[CI95%]: 1.45[1.12 to 1.87], vs. low complexity). A 62.6% of AE increased the length of the stay or it was the cause of admission, and 46.9% of AE were considered prevent able. In 11.5% of patients with AE, they had contributed to their death. Conclusions: The prevalence of AE remains similar to the previously estimated one in studies developed with the same methodology. AE keep leading to longer hospital stays, contributing to patient's death, showing that it is necessary to put focus on patient safety again. A detailed analysis of these events has enabled the detection of specific areas for improvement according to the type of care, centre and patient

causes and economic consequences in the Murcia Health System, 2002 to 2018

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Prevalence, characteristics, and impact of adverse events in 34 Madrid hospitals. The ESHMAD study

Introduction: Adverse Events (AE) are one of the main problems in healthcare. Therefore, many policies have been developed worldwide to mitigate their impact. The Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD) measures the results of them in the region. Methods: Cross-sectional study, conducted in May 2019, in hospitalised patients in 34 public hospitals using the Harvard Medical Practice Study methodology. A logistic regression model was carried out to study the association of the variables with the presence of AE, calibrated and adjusted by patient. Results: A total of 9975 patients were included, estimating a prevalence of AE of 11.9%. A higher risk of AE was observed in patients with surgical procedures (OR[CI95%]: 2.15[1.79 to 2.57], vs. absence), in Intensive Care Units (OR[CI95%]: 1.60[1.17 to 2.17], vs. Medical) and in hospitals of medium complexity (OR[CI95%]: 1.45[1.12 to 1.87], vs. low complexity). A 62.6% of AE increased the length of the stay or it was the cause of admission, and 46.9% of AE were considered preventable. In 11.5% of patients with AE, they had contributed to their death. Conclusions: The prevalence of AE remains similar to the previously estimated one in studies developed with the same methodology. AE keep leading to longer hospital stays, contributing to patient's death, showing that it is necessary to put focus on patient safety again. A detailed analysis of these events has enabled the detection of specific areas for improvement according to the type of care, centre and patient

Decontamination of filtering facepiece respirators using a low-temperature-steam–2%-formaldehyde sterilization process during a pandemic: a safe alternative for re-use

Background The coronavirus disease 2019 pandemic has caused problems with respirator supplies. Re-use may minimize the impact of the shortage, but requires the availability of an efficient and safe decontamination method. Aim To determine whether low-temperature-steam–2%-formaldehyde (LTSF) sterilization is effective, preserves the properties of filtering facepiece (FFP) respirators and allows safe re-use. Methods Fourteen unused FFP2, FFP3 and N95 respirator models were subjected to two cycles of decontamination cycles. After the second cycle, each model was inspected visually and accumulated residual formaldehyde levels were analysed according to EN 14180. After one and two decontamination cycles, the fit factor (FF) of each model was tested, and penetration tests with sodium chloride aerosols were performed on five models. Findings Decontamination physically altered three of the 14 models. All of the residual formaldehyde values were below the permissible threshold. Irregular decreases and increases in FF were observed after each decontamination cycle. In the sodium chloride aerosol penetration test, three models obtained equivalent or superior results to those of the FFP classification with which they were marketed, both at baseline and after one and two cycles of decontamination, and two models had lower filtering capacity. Conclusion One and two decontamination cycles using LTSF did not alter the structure of most (11/14) respirators tested, and did not degrade the fit or filtration capacity of any of the analysed respirators. The residual formaldehyde levels complied with EN 14180. This reprocessing method could be used in times of shortage of personal protective equipment

Risk analysis for patient safety in surgical departments: Cross-sectional design usefulness

(1) Background: Identifying and measuring adverse events (AE) is a priority for patient safety, which allows us to define and prioritise areas for improvement and evaluate and develop solutions to improve health care quality. The aim of this work was to determine the prevalence of AEs in surgical and medical-surgical departments and to know the health impact of these AEs. (2) Methods: A cross-sectional study determining the prevalence of AEs in surgical and medical-surgical departments was conducted and a comparison was made among both clinical areas. A total of 5228 patients were admitted in 58 hospitals in Argentina, Colombia, Costa Rica, Mexico, and Peru, within the Latin American Study of Adverse Events (IBEAS), led by the Spanish Ministry of Health, the Pan American Health Organization, and the WHO Patient Safety programme. (3) Results: The global prevalence of AEs was 10.7%. However, the prevalence of AEs in surgical departments was 11.9%, while in medical-surgical departments it was 8.9%. The causes of these AEs were associated with surgical procedures (38.6%) and nosocomial infections (35.4%). About 60.6% of the AEs extended hospital stays by 30.7 days on average and 25.8% led to readmission with an average hospitalisation of 15 days. About 22.4% resulted in death, disability, or surgical reintervention. (4) Conclusions: Surgical departments were associated with a higher risk of experiencing AEs

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality