RESUMO
OBJECTIVE: To study the association between health-related quality of life (HRQoL) and all-cause mortality in a healthy middle-aged Mediterranean cohort. METHODS: We included 15,390 participants -mean age 42.8 years at first HRQoL ascertainment, all university graduates-. HRQoL was assessed with the self-administered Medical Outcomes Study Short Form-36 (SF-36) twice, with a 4-year gap. We used multivariable-adjusted Cox regression models to address the relation between self-reported health and Physical or Mental Component Summary (PCS-36 or MCS-36) and mortality, and their interaction with prior comorbidities or adherence to the Mediterranean diet (MedDiet). RESULTS: Over 8.7 years of median follow-up time, 266 deaths were identified. Hazard ratio (HR) for the excellent vs. poor/fair category in self-reported health was 0.30 (95 % confidence interval (CI), 0.16-0.57) in the model with repeated measurements of HRQoL. Both the PCS-36 (HRquartile4(Q4)vs.Q1 0.57 [95%CI, 0.36-0.90], ptrend < 0.001; HRper+10points: 0.64 [95%CI, 0.54-0.75]) and the MCS-36 (HRQ4vs.Q1 0.67 [95%CI, 0.46-0.97], ptrend = 0.025; HRper+10points: 0.86 [95%CI, 0.74-0.99]) were inversely associated with mortality in the model with repeated measurements of HRQoL. Previous comorbidities or adherence to the MedDiet did not modify these associations. CONCLUSIONS: Self-reported HRQoL -assessed as self-reported health, PCS-36 and MCS-36- obtained with the Spanish version of the SF-36 were inversely associated with mortality risk, regardless of the presence of previous comorbidities or adherence to the MedDiet.
Assuntos
Dieta Mediterrânea , Qualidade de Vida , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Nível de Saúde , Autorrelato , Comorbidade , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Previous studies in pregnancy have not focused in evaluating the effect of walking during pregnancy and prevention of insomnia. Our general objective is to determine the effect of a walking program in preventing the appearance of insomnia in the third trimester of pregnancy, increasing sleep quality and improving quality of life throughout pregnancy. METHODS: Randomized Controlled trial in parallel in healthy sedentary pregnant women (n = 265), Walking_Preg Project (WPP), from university hospital in Granada, Spain. At 12th gestational week (GW), they will be invited to participate and randomly assigned to one of the three arms of study: the intervention group I1 (pedometer, goal of 11,000 steps/day), intervention group I2 (pedometer, no goal) and control (no pedometer). Duration of intervention: 13-32 GW. At 12th, 19th and 31st GW the average steps/day will be measured in groups I1 and I2. At 13th, 20th and 32nd GW, Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Adherence to Mediterranean Diet (AMD), physical activity (short IPAQ), quality of life (PSI), and consumption of toxic substances (caffeine, illegal drugs, alcohol and tobacco) will be collected. Student t test or Mann-Whitney U will be used to compare 19th and 31st GW mean of daily steps between I1 and I2 groups. To compare differences between groups in terms of frequency of insomnia/quality of life for each trimester of pregnancy, Pearson's Chi-square test or Fisher's exact test will be used. To determine differences in hours of sleep and quality of sleep throughout each trimester of pregnancy, analysis of variance or Friedman test will be used. McNemar-Bowker test will be used to assess differences in life quality in pre-post analyses in the 3 arms. We will use Stata 15 statistical software. DISCUSSION: promoting walking in second half of pregnancy through use of pedometer and health pre-registration of a goal to be achieved -'10,000-11,000 steps a day'- should prevent appearance of insomnia in third trimester, will increase sleep quality and quality of life in pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03735381 . Registered 8th November, 2018.
Assuntos
Complicações na Gravidez/prevenção & controle , Distúrbios do Início e da Manutenção do Sono/prevenção & controle , Caminhada , Actigrafia , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto/métodosRESUMO
PURPOSE: Breast cancer (BC) incidence is increasing worldwide. Higher insulin resistance may potentially lead to an increased risk of BC. Sugar-sweetened beverages (SSB) are an acknowledged dietary factor that increases insulin resistance. However, the association between SSB and BC has not been widely explored. We evaluated the association between baseline consumption of SSB and the incidence of BC among relatively young women in a cohort of Spanish university graduates. METHODS: We evaluated 10,713 middle-aged, Spanish female university graduates (median age 33) from the Seguimiento Universidad de Navarra (SUN) cohort, initially free of BC. SSB consumption was collected at baseline using a validated 136-item semi-quantitative food-frequency questionnaire. Incidence of BC was confirmed by a trained oncologist using medical records. We fitted Cox regression models to assess the relationship between baseline categories of SSB consumption and the incidence of BC during follow-up. We stratified the analyses by menopausal status. RESULTS: During 106,189 person-years follow-up, 100 incident cases of BC were confirmed. Among postmenopausal women, regular consumption of SSB was associated with a significantly higher incidence of BC (HR 2.12; 95% CI 1.02, 4.41) in the fully adjusted model, compared to women who never or seldom consumed SSB. No association was found among premenopausal women (HR 1.16; 95% CI 0.66, 2.07). CONCLUSIONS: Even though the number of cases was small, in this Mediterranean cohort, we observed a direct association between SSB consumption and BC risk among postmenopausal women. Nonetheless further larger longitudinal studies are needed to support this association.
Assuntos
Neoplasias da Mama/epidemiologia , Bebidas Adoçadas com Açúcar/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Fatores de Risco , Espanha/epidemiologia , Bebidas Adoçadas com Açúcar/efeitos adversos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Childhood obesity continues to be a significant public health issue worldwide. Recent national studies in Spain show a stable picture. However, prevalence and trends differ by socio-economic status, age, and region. We present the trend in childhood excess weight prevalence, aged 8-15 years, in Andalusia from 2011-2012 to 2015-2016 by socio-economic status. METHODS: Using the cross-sectional Andalusian Health Surveys, objective anthropometric measures were taken for a representative sample of 8-15 year olds in Andalusia in 2011-2012 and 2015-2016. Prevalence and changes in prevalence of excess weight (overweight plus obesity) were calculated, using both the WHO and IOTF criteria, overall and for sex, age and three different indicators of SES. RESULTS: Overall prevalence of excess weight decreased from 42.0% in 2011-2012 to 35.4% in 2015-2016. Overweight decreased from 28.2 to 24.2% and obesity from 13.8 to 11.2%. In 2011-2012 the prevalence of excess weight in boys was 46.0%and 37.9% in girls; in 2015-2016 the difference became significant with 41% of boys with excess weight compared with 30% in girls. CONCLUSIONS: Childhood excess weight prevalence in Andalusia has decreased slightly between 2011-2012 and 2015-2016. Notably, a decrease in obesity prevalence in girls aged 8-15 years was recorded. In 2011-2012 a social gradient for excess weight prevalence across three SES indicators was observed: in 2015-2016 this gradient disappeared. Nonetheless, prevalence remains too high.
Assuntos
Obesidade Infantil/epidemiologia , Classe Social , Adolescente , Distribuição por Idade , Antropometria , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Sobrepeso/epidemiologia , Prevalência , Distribuição por Sexo , Espanha/epidemiologiaRESUMO
OBJECTIVE: The goal of this study was to inform public health policy which can reduce Colombia's estimated infant mortality rate (IMR), 17.78 deaths for 1000 live births (2011), by lowering preventable first day mortality (PFDM). STUDY DESIGN: This study combined a time series analysis, using a linear regression method, for the period 2001-2012 with a cross-sectional analysis, using odds ratios and bi-variate methods, for the year 2012 to study first day mortality (FDM) and PFDM classified by biological, socio-economic, and medical correlates. METHODS: The study examined the trends for 2001-2012 in Colombia's infant mortality rate per 1000, and in the relative significance of PFDM by cause. It established the relative odds of PFDM for 2012 by major risk categories, defined by birthweight and gestational age, and within those by biological, sociodemographic risk factors or groups and by potential access to and use of care. Then, the study established the major causes of PFDM within major risk categories and groups. RESULTS: Between 2001 and 2012, the average annual rate of FDM declined by 6.30%, while overall infant mortality only declined by 4.20%. Yet, in 2012, 37.04% of FDM was preventable by using proper pregnancy control (7.00% of total preventable), proper care during childbirth (37.20%), and handling causes associated with late diagnosis and treatment (55.80%). PFDM is primarily a socio-economic phenomenon, even among normal weight and gestational age newborns, who account for 32.73% of PFDM due to improper management of pregnancy and delivery among lower socio-economic and outlying populations, specifically in rural areas and among members of the inferior subsidised social insurance regime. CONCLUSION: From efficacy and probable cost effectiveness perspectives, intervention priority should be given to handling babies with normal gestation age and birthweight, and then to babies with very low gestation age and birthweight. At the same time, more prenatal visits could lead to fewer very high-risk situations at the outset. In view of the Colombian regulation to the contrary, the use of foetal monitoring and echography methods by all general practitioners should be considered. They should be trained accordingly. Policies should focus on members of the underprovided subsidised health insurance regime, rural areas, young, low-educated and single mothers during pregnancy, mainly delivery.
Assuntos
Mortalidade Infantil/tendências , Colômbia/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fatores de RiscoRESUMO
BACKGROUND: Psoriasis may imply a remarkable psychological impairment, which can influence patient's personality. The Type D personality is defined by the combination of social inhibition and negative affectivity. Furthermore, Type D personality has been associated with impaired health-related quality of life (HRQOL) and increased cardiovascular risk, both facts being associated with moderate to severe psoriasis. OBJECTIVES: To explore the prevalence of Type D personality in moderate to severe psoriasis patients; To analyse the relationship between Type D personality and the most common physical and psychological comorbidities in moderate to severe psoriasis and To explore the impact of Type D personality on HRQOL. METHODS: A prospective comparative study matched to age and sex. Eighty patients with moderate to severe psoriasis and 80 healthy volunteers were included in the study. The participants completed the DS14 test, the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, the SF-36 and the Psoriasis Disability Index. RESULTS: The prevalence of Type D personality was higher in patients with moderate to severe psoriasis as compared to healthy volunteers: 38.7% vs. 23.7%, P < 0.001. Psoriasis patients with Type D personality had a 3.2-fold risk of anxiety when compared to patients without Type D personality; odds ratio 3.2 (1.3-8.83 P = 0.01). Type D personality was significantly associated with an impaired general, sexual and psoriasis-related HRQOL (P < 0.01). CONCLUSION: Because Type D personality could represent a frequent type of personality among individuals with moderate to severe psoriasis, it could serve as a 'marker' of more psychologically vulnerable patients, probably related to dysfunctional coping strategies. The Type D personality could represent a profile more frequently encountered among patients with psoriasis, and might therefore help identify subjects physiologically more vulnerable to disease, most likely due to inadequate adaptation mechanisms.
Assuntos
Afeto , Nível de Saúde , Transtornos Mentais/epidemiologia , Personalidade , Psoríase/epidemiologia , Qualidade de Vida/psicologia , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Projetos Piloto , Prevalência , Estudos Prospectivos , Psoríase/complicações , Psoríase/psicologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Psoriasis has been associated with numerous psychological disorders such as low self-esteem, depression, anxiety, sexual dysfunction or suicidal ideation. Recently, there has been a progressive increase in studies examining the impact of psoriasis on sexual function. This alteration seems to be considerable and can cause significant changes in quality of life. OBJECTIVE: The aim of this study was to elaborate recommendations for psoriasis and sexual function supported by a systematic review, to facilitate the application of new scientific findings into clinical practice and to serve as a basis for conducting future research. METHODS: We performed a systematic review of the available studies on psoriasis and sexual dysfunction. RESULTS: Scientific evidence shows that psoriasis patients have a higher risk of sexual dysfunction as compared to the general population. The risk of erectile dysfunction is also higher in psoriasis patients. The risk factors associated with sexual dysfunction in psoriasis patients are disease severity, female gender, psoriatic arthritis and age.
Assuntos
Disfunção Erétil/epidemiologia , Psoríase/epidemiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Fatores Etários , Artrite Psoriásica/epidemiologia , Feminino , Humanos , Masculino , Psoríase/psicologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
BACKGROUND: To estimate the association of age and sex with the intensity of exposure of cyclists in Spain, between 1993 and 2009, in a global way and for subtypes of use. METHODS: From the distribution of cyclists passively involved in collisions with other vehicles included in the register of the Spanish General Traffic Directorate between 1993 and 2009, we have estimated the increase in intensity of exposure by age groups and sex, for global exposure and for subtypes of exposure (e.g. riding with or without a helmet, or riding on an open road or in urban areas), using males aged 45-49 as a reference. RESULTS: Males have a greater exposure than females and this difference increases with age, although it has tended to decrease in recent years. In both sexes the exposure is greater in young people and goes down with age, while in males the excess in young people has disappeared in recent years. Regarding subtypes of use, female underexposure riding on an open road should be highlighted, as well as overexposure in both women and extreme age groups among non-helmet users. CONCLUSION: There is a close association of age and sex with the intensity of bicycle use, which changes depending on the type of use and the time period considered. Consequently, estimations of the effect of factors affecting the accident rate and the morbidity and mortality of cyclists in Spain have to be adjusted by the age and sex of the cyclist.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/estatística & dados numéricos , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Acidentes de Trânsito/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Espanha , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUNDS AND AIMS: To examine the contribution of patient body mass index to functional status, physical independence and emotional distress in various age groups (third and fourth age) of female hip-fracture patients. METHODS: A sample of 123 older females (>65 years) admitted in a major regional hospital with a diagnosis of hip fracture participated in this cross-sectional study. The outcome measures used in this study were body mass index (BMI), the Modified Barthel Index, the Goldberg General Health Questionnaire, the Tinetti Mobility Test and a survey collecting data from participants 24-72 h after admission. For our analysis, patients were divided into two groups according to their age: <80 years (third age) and >81 years (fourth age). In addition, three groups were made according to patients' body mass index <24 h prior to surgery: a normal weight group, an overweight group and an obese group. An ANCOVA was performed with age group as a between-subjects variable (third age, fourth age) and gender, educational level, marital status, type of fracture, type of surgery, presence of other fractures and BMI as covariates. RESULTS: Patients in the third-age group obtained significantly higher values in the Barthel Index (P = 0.040) and the Tinetti Mobility Test (P = 0.001) and lower values in the Goldberg General Health Questionnaire (P = 0.035) compared to the fourth-age group. When BMI was considered, significance was maintained only in the Tinetti Mobility Test. CONCLUSIONS: The BMI could be a relevant mediator of the relationship between functional decline and the aging process in the transition between third to fourth age in females.
Assuntos
Índice de Massa Corporal , Fraturas do Quadril/fisiopatologia , Fatores Etários , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , PrognósticoRESUMO
OBJECTIVE: To analyze the impact of the type of hospital in overall survival of multiple myeloma patients. PATIENTS AND METHOD: A survival analysis was performed of all patients (n=431) diagnosed in 5 public hospitals (4 community hospitals and one university hospital) during the period 1993-2006. RESULTS: Patients attended to in community hospitals differ significantly from those seen in the university hospital in the following variables: mean age (70 years [31-92] versus 67.9 (35-91), P=.038); percentage of stage iii patients (62.6% versus 69.1%, P=.033), and percentage of patients who had autologous stem cell transplant (8.2% versus 18.2%, P=.026). The variables associated with mortality in the multivariate analysis were age (P<.001), stage (iii versus i; P=.03) and renal failure (P=.04). The type of hospital did not reach statistical significance (hazard ratio of 0.72 (95% confidence interval 0.48-1.07), P=.1]. CONCLUSIONS: The type of hospital is not significantly associated with mortality in multiple myeloma patients. These data support our current model of health care, in which the community hospitals are responsible for the primary care of these patients, in a coordinated work with the university hospital.
Assuntos
Hospitais Públicos , Mieloma Múltiplo/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Taxa de SobrevidaRESUMO
AIMS: To analyze the relationship between serum levels of osteocalcin and parameters of atherosclerosis in patients with type 2 diabetes mellitus (T2DM). METHODS: This cross-sectional study of 78 patients with T2DM evaluated intima-media thickness, and the prevalence of coronary heart disease, atherosclerotic plaques and aortic calcifications. Serum osteocalcin levels were also determined by radioimmunoassay. RESULTS: The patients' mean age was 57.8±6.4 years (duration of diabetes: 13.4 years; mean HbA(1c) level: 8.01%), and 37.2% had coronary heart disease, 56% had an abnormal intima-media thickness, 26.9% had carotid plaques and 32.1% had aortic calcifications. Coronary heart disease was associated with higher levels of osteocalcin in male vs female patients (1.95±1.36 vs 0.93±0.86 ng/mL, respectively; P=0.006). Also, higher concentrations of osteocalcin were found in female patients with vs without abnormal intima-media thicknesses (2.17±1.84 vs 1.25±0.67 ng/mL, respectively; P=0.042), carotid plaques (2.86±2.10 vs 1.43±1.09 ng/mL, respectively; P=0.03) and aortic calcifications (2.85±1.97 vs 1.26±0.83 ng/mL, respectively; P=0.002). Serum osteocalcin levels were associated with coronary heart disease on multivariate logistic regression (odds ratio: 2.27, 95% confidence interval: 1.21-4.25; P=0.01). CONCLUSION: In T2DM patients, serum osteocalcin levels were associated with parameters of atherosclerosis, suggesting that osteocalcin is involved not only in bone metabolism, but also in atherosclerotic disease.
Assuntos
Aterosclerose/sangue , Calcinose/sangue , Diabetes Mellitus Tipo 2/sangue , Angiopatias Diabéticas/sangue , Osteocalcina/sangue , Aterosclerose/mortalidade , Aterosclerose/fisiopatologia , Biomarcadores/sangue , Calcinose/mortalidade , Calcinose/fisiopatologia , Artérias Carótidas/fisiopatologia , Estudos Transversais , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Feminino , Hemoglobinas Glicadas , Humanos , Masculino , Pessoa de Meia-Idade , Túnica Íntima/fisiopatologiaRESUMO
BACKGROUND AND OBJECTIVES: UV radiation is the main modifiable risk factor for the development of cutaneous melanoma. Many people in the Spanish province of Granada live at high altitudes and, therefore, receive high doses of UV-B radiation. The aims of this study were to assess the possible association between melanoma and altitude and to measure the daily erythemal dose at different altitudes. MATERIAL AND METHODS: An epidemiological study was carried out between 1982 and 2007 to assess the relationship between altitude, daily erythemal dose, and the prevalence of melanoma. We calculated the prevalence of melanoma in patients with a clinical and histological diagnosis of melanoma at Hospital Clínico Universitario San Cecilio in Granada, Spain. All individuals were required to be residents of the province of Granada in order to be included in the study. The prevalence of melanoma was calculated for altitude intervals of 100 m. Daily erythemal dose was estimated using measures of UV-B radiation obtained with pyranometers at altitudes of 0, 680, 1200, and 3398 m above sea level during the Evaluation of the Effects of Elevation and Aerosols on UV Radiation (VELETA) 2002 field campaign. RESULTS: The highest prevalence of melanoma was found between 1400 and 1499 m above sea level (the interval at which the highest settlements are found), with a rate of 2.36 cases per 1000 inhabitants (95% confidence interval, 0.64-6.03). Above 700 m, the daily erythemal dose increased exponentially with increasing altitude. CONCLUSIONS: We observed a tendency toward increased prevalence of melanoma at higher altitude, with higher prevalences observed beyond 700 m above sea level.
Assuntos
Altitude , Melanoma/etiologia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Cutâneas/etiologia , Luz Solar/efeitos adversos , Raios Ultravioleta/efeitos adversos , Atmosfera , Estudos de Coortes , Exposição Ambiental , Humanos , Melanoma/epidemiologia , Neoplasias Induzidas por Radiação/epidemiologia , Prevalência , Doses de Radiação , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia , Espanha , Queimadura Solar/etiologiaRESUMO
OBJECTIVE: To assess the effect of driver dependent factors on the risk of causing a collision for two wheeled motor vehicles (TWMVs). DESIGN: Case control study. SETTING: Spain, from 1993 to 2002. SUBJECTS: All drivers of TWMVs involved in the 181 551 collisions between two vehicles recorded in the Spanish registry which did not involve pedestrians, and in which at least one of the vehicles was a TWMV and only one driver had committed a driving infraction. The infractor and non-infractor drivers constituted the case and control groups, respectively. MAIN OUTCOME MEASURES: Logistic regression analyses were used to obtain crude and adjusted odds ratio estimates for each of the driver related factors recorded in the registry (age, sex, nationality, psychophysical factors, and speeding infractions, among others). RESULTS: Inappropriate speed was the variable with the greatest influence on the risk of causing a collision, followed by excessive speed and driving under the influence of alcohol. Younger and older drivers, foreign drivers, and driving without a valid license were also associated with a higher risk of causing a collision. In contrast, helmet use, female sex, and longer time in possession of a driving license were associated with a lower risk. CONCLUSIONS: Although the main driver dependent factors related to the risk of causing a collision for a TWMV were similar to those documented for four wheeled vehicles, several differences in the pattern of associations support the need to study moped and motorcycle crashes separately from crashes involving other types of vehicles.
Assuntos
Acidentes de Trânsito , Condução de Veículo , Motocicletas , Adolescente , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Licenciamento/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Assunção de RiscosRESUMO
OBJECTIVE: To obtain empirical data that might support or refute the existence of a risk compensation mechanism in connection with voluntary helmet use by Spanish cyclists. DESIGN: A retrospective case series. SETTING: Spain, from 1990 to 1999. SUBJECTS: All 22 814 cyclists involved in traffic crashes with victims, recorded in the Spanish Register of Traffic Crashes with Victims, for whom information regarding helmet use was available. MAIN OUTCOME MEASURES: Crude and adjusted odds ratios for the relation between committing a traffic violation and using a helmet. RESULTS: Fifty four percent of the cyclists committed a traffic violation other than a speeding infraction. Committing a traffic violation was associated with a lower frequency of helmet use (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.58 to 0.69). Cycling at excessive or dangerous speed, a violation observed in 4.5% of the sample, was not significantly associated with helmet use either alone (aOR 0.95, 95% CI 0.56 to 1.61) or in combination with any other violation (aOR 0.97, 95% CI 0.79 to 1.20). CONCLUSIONS: The results suggest that the subgroup of cyclists with a higher risk of suffering a traffic crash are also those in which the health consequences of the crash will probably be higher. Although the findings do not support the existence of a strong risk compensation mechanism among helmeted cyclists, this possibility cannot be ruled out.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Assunção de Riscos , Estudos Transversais , Feminino , Humanos , Masculino , Razão de Chances , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologiaRESUMO
STUDY OBJECTIVE: To estimate the association between driver nationality and the risk of causing a collision between vehicles in motion. DESIGN: Retrospective, matched by collision, case-control study. SETTING: Collisions that occurred in Spain during the period from 1990 to 1999 were studied. PARTICIPANTS: Responsible (case) and non-responsible (control) drivers identified in the databases of the Dirección General de Tráfico (General Traffic Directorate) who were involved in a collisions between two or more four wheeled vehicles in motion, in which only one of the drivers had committed a traffic violation. MAIN RESULTS: Crude odds ratios (ORs) for the effect of driver nationality on the risk of causing a collision were significantly higher for foreign drivers than for Spanish drivers, and ranged from a minimum of 1.19 (95% CI 1.09 to 1.29) for Portuguese drivers to a maximum of 2.06 (1.88 to 2.27) for British drivers. Corresponding adjusted ORs were slightly lower, but were still significantly higher than 1 for all nationalities except Italian, Belgian, and American (USA). Adjusted ORs were usually higher for collisions that occurred in urban areas than on open roads. CONCLUSIONS: Authorities responsible for traffic safety, and drivers in general, should consider foreign drivers in Spain at particularly high risk for causing collisions, especially in urban areas.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Estudos de Casos e Controles , Humanos , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologiaRESUMO
The authors used the induced exposure method to compare risks of traffic crashes among different types of Spanish drivers under different environmental conditions. The authors analyzed traffic crashes recorded by the Spanish Dirección General de Tráfico for the years 1991 and 1992 to compare proportions of drivers in different age/sex categories who were involved in single-vehicle and multivehicle crashes under different psychological and physical conditions. Crash risk was 1.42- to 2.35-fold greater in men than in women, depending on driver category and environmental factors. Risk was also significantly higher in the 18- to 24-year-old age group (1.75- to 2.87-fold greater than in drivers aged 25-49 years) and under abnormal psychological-physical conditions (1.69- to 4.10-fold greater among drivers under the influence of alcohol). Twilight and night driving, driving in urban areas, and driving on weekends and legal holidays were also associated, though nonsignificantly, with a slightly higher traffic crash risk. These findings are consistent with earlier reports, and they support the usefulness of the induced exposure method as an easy and economical tool with which to analyze data contained in traffic crash records.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Meio Ambiente , Modelos Estatísticos , Acidentes de Trânsito/psicologia , Acidentes de Trânsito/tendências , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Consumo de Bebidas Alcoólicas , Condução de Veículo/psicologia , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Distribuição por Sexo , Fatores Sexuais , EspanhaRESUMO
OBJECTIVE: To determine the fraction of hospital deaths potentially associated with nosocomial infection (NI). DESIGN: A matched (1:1) case-control study. SETTING: An 800-bed, tertiary-care, teaching hospital. PATIENTS: All patients older than 14 years who were admitted to the hospital between January 1, 1990, and January 1, 1991, were eligible. All 524 consecutive deaths that occurred in the hospital comprised the case group. For each case, a control patient was matched for primary admission diagnosis and admission date. OUTCOME MEASURES: The proportion of hospital deaths potentially associated with NI was estimated from the population attributable risk (PAR) adjusted for age, gender, service, severity of illness, length of stay, and quality of the medical record. RESULTS: For stays longer than 48 hours, the PAR for all NIs was estimated to be 21.3% (95% confidence interval [CI95], 16.8%-30.5%). The greatest proportion of deaths potentially associated with NIs was observed in patients with only one infection (PAR, 15.0%; CI95, 10.9%-22.6%) and bacteremia or sepsis (PAR, 7.7%; CI95, 4.6%-11.6%). CONCLUSIONS: NIs are associated with a large proportion of intrahospital deaths. This information may help clinicians and healthcare managers to assess the impact of programs for the prevention and control of NIs on intrahospital death.
Assuntos
Infecção Hospitalar/mortalidade , Mortalidade Hospitalar , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Hospitais de Ensino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Prontuários Médicos/normas , Pessoa de Meia-Idade , Projetos de Pesquisa , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Espanha/epidemiologiaRESUMO
BACKGROUND: There is a need for solid evidence of the relative advantages of universal vs. selective screening for gestational diabetes mellitus. Our study of a broad obstetric population determines the positive predictive value of the 50-g oral glucose challenge test for screening in the presence and absence of classical gestational diabetes risk factors. METHODS: A retrospective cohort study was carried out with a total of 2,574 pregnant women. Clinical information was obtained from hospital records and each patient's medical history, and gestational diabetes risk factors were quantified for each pregnant woman. The positive predictive value of a screen was determined with respect to the number of risk factors. RESULTS: Age 30 or over, family history of diabetes, obesity (BMI > or =27) and previous fetal macrosomia were established as the most frequent risk factors. Just over half (54.2%) of our population presented one or more risk factors. Screening covered 75% of the population, and was positive in 15% of the cases. Diagnosis was confirmed in 64 cases, 57 of them at risk, and seven with no risk factors. We obtained an overall positive predictive value of 21.8% (CI 17.3-27.0). This figure increases with the number of risk factors, from 12% for the women with no risk factors, to 40% for those presenting three or more risk factors. CONCLUSIONS: A selective screening program that takes into account the clinical background and characteristics of each pregnant woman allows a high yield of true positives while reducing the possible undesirable effects associated with false positives.
Assuntos
Diabetes Gestacional/diagnóstico , Programas de Rastreamento , Adulto , Estudos de Coortes , Reações Falso-Positivas , Feminino , Teste de Tolerância a Glucose , Humanos , Valor Preditivo dos Testes , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To assess the evolution of the traffic accident mortality rate in Spain from 1962 to 1994, and the role played by its four theoretical components: motorization index (vehicles/population), accidentability index (accidents/vehicles), harmfulness index (victims/accidents) and fatality index (deaths/victims). METHODS: Data from the National Population Census and the Bulletin of the Dirección General de Tráfico were collected to estimate the above mentioned indicators for all accidents and accidents in road and urban zones. Simple and multiple partial correlation coefficients among variables were calculated. Poisson regression models were also obtained. RESULTS: An increasing trend during the whole period was observed for the national traffic accident mortality rate, especially from 1982 to 1989 in the younger age groups, followed by a decrease since 1990. The aforementioned four components were significatively associated with the mortality rate. The strength of this association was especially high for the motorization index and for the harmfulness index when all accidents and road accidents were considered. For urban accidents, the fatality index rate is the component most strongly associated with mortality rate. The role played by the accidentability index in the magnitude of the mortality rate seems less important. CONCLUSIONS: The growing exposure rate to traffic accidents observed in Spain (measured by the motorization index) is not directly influenced by public heath strategies. Therefore, it seems advisable to emphasize the development of measures focused to control the other three components of traffic accident mortality rate, especially those related with harmfulness and fatality.