Trends in the nonmedical misuse of benzodiazepines and Z-hypnotics among school-aged adolescents (2016-2021): gender differences and related factors.

BACKGROUND: The misuse of psychotropic medication has increased during the past decade, especially among adolescents. The aim of our study was to describe the prevalence and patterns of the nonmedical use of benzodiazepines (BDZ) and Z-hypnotics among school-aged adolescents through the lens of sex. In addition, we sought to analyze the temporal evolution of the nonmedical use of these drugs during the period 2016-2021. METHODS: The temporal evolution of the nonmedical use of these drugs was analyzed based on survey data collected in 2016, 2018 and 2021, which includes the first years of the COVID-19 pandemic. To assess the possible effect of the COVID-19 pandemic, the year at survey was conducted was introduced as a categorical variable. We used data from the Spanish State Survey on Drug Use in Secondary Education, which covers drug use among students aged 14-18 years. Using multivariate logistic regression models, we estimated the independent effect of different variables (sociodemographic data, use of other psychoactive substances, risk perception and availability) on the nonmedical use of BDZ and Z-hypnotics. RESULTS: In total, survey data from 95,700 adolescents were included in our analysis. The nonmedical use of BDZ and Z-hypnotics increased among adolescents during the study period. The adjusted odds ratio (AOR) from 2016 to 2018 was 1.11 (95% CI 0.94-1.31) and from 2018 to 2021 the AOR was 1.26 (95% CI 1.08-1.46), using 2016 and 2018, respectively, as reference years. The nonmedical use of BDZ and Z-hypnotics was more likely in adolescent girls than boys (AOR = 2.11). The nonmedical use of prescription opioids (AOR = 3.44), novel psychoactive substances and other illicit psychoactive drugs (AOR = 4.10) were risk factors for the nonmedical use of BDZ and Z-hypnotics in both sexes. Use of cannabis (AOR = 1.38) was a predictor of nonmedical use in female adolescents only. CONCLUSIONS: This study shows that the trend of the nonmedical use of BDZ and Z-hypnotics among school-aged adolescents in Spain increased between 2016 and 2021. Among adolescents aged 14 to 18, the probability of nonmedical use of these psychoactive substances was twice as high for female adolescents as for male adolescents.

Gender differences in the nonmedical use of psychoactive medications in the school population- national trends and related factors.

BACKGROUND: The nonmedical use of prescribed medicines among adolescents has increased significantly in recent years. Our study was designed to describe the prevalence of the nonmedical use of tranquilizers, sedatives, and sleeping pills (TSSp) among the school-age population residing in Spain from a gender perspective, and to identify factors associated with such use. METHODS: Nationwide, epidemiological, cross-sectional study on the nonmedical use during the previous 30 days, of TSSp by the Spanish school population. We used individualized secondary data retrieved from the 2004, 2006, 2008, 2010, 2012 and 2014 Spanish state survey on Drug Use in Secondary Education and a total of 179,114 surveys from respondents aged 14 to 18 years. Using logistic multivariate regression models, we estimated the independent effect of each of these variables on the nonmedical use of medicines. Two models were generated- one for females and one for males. RESULTS: 2.86% (5116) of the Spanish school population of both sexes made nonmedical use of TSSp. Prevalence was greater among girls than among boys for all the study years. Patterns of nonmedical use among female adolescents were related to alcohol, tobacco and marijuana use. Consumption of illegal psychoactive substances, other than marijuana, was the variable showing the greatest value among male teenagers (aOR 6.21 (95% CI 4.97-7.77). CONCLUSIONS: The prevalence of the nonmedical use of TSSp is higher in girls than in boys. The influence of legal and illegal psychoactive substances leads to a higher likelihood of nonmedical use of TSSp in high-school students in Spain.

Type 2 diabetes is associated with a higher incidence of hospitalization for pulmonary embolism in Spain: Analysis of hospital discharge data during 2004-2013.

BACKGROUND AND OBJECTIVE: We compared the incidence and outcome of pulmonary embolism (PE) in individuals with and without type 2 diabetes mellitus (T2DM) in Spain during 2004-2013. METHODS: The study was based on National Hospital Discharge Data, and the study population comprised patients hospitalized for PE. Annual incidence rates were classified according to T2DM status. In-hospital mortality (IHM), length of hospital stay (LOHS), comorbidities and use of diagnosis and therapeutic procedures were analysed. RESULTS: We identified 123 872 discharges of patients (56 361 men and 67 511 women) with PE as their primary diagnosis (15.3% with T2DM). Incidence of discharge diagnoses of PE increased significantly in all groups. Crude rates were higher in diabetic patients. A positive association was identified between T2DM and PE: adjusted IRR was 2.00 (95% CI: 1.95-2.05) for men and 2.50 (95% CI: 2.45-2.57) for women. LOHS, readmissions and IHM decreased significantly for both groups. An association between IHM and risk factors (older age, Charlson comorbidity index >3, atrial fibrillation and cancer) was observed. T2DM was associated with higher IHM in men (OR: 1.22, 95% CI: 1.12-1.32) and women (OR: 1.24, 95% CI: 1.15-1.33). The use of computed tomography pulmonary angiography increased significantly overtime. CONCLUSION: We confirmed that in both men and women, diabetes was an independent risk factor for IHM. The incidence of discharge of patients with PE increased significantly during the study period. Diabetic men and women had a higher risk of hospitalization for PE than non-diabetic men and women. Diabetic women had higher IHM than diabetic men.

Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012.

BACKGROUND AND OBJECTIVE: Hospitalizations are not isolated events in COPD patients. A significant percentage of patients are readmitted during the first month after their discharge. The aim of this study was to elucidate changes in the incidence, comorbidity, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients readmitted following an initial hospitalization by acute exacerbation of COPD (AE-COPD). METHODS: We selected all patients ≥40 years, hospitalized for AE-COPD between 2006 and 2012 in Spain using the National Hospital Discharge Database. Patient readmissions were defined as inpatient re-hospitalization within 30 days of discharge for AE-COPD. RESULTS: We identified 301 794 discharges of patients having hospital admissions for AE-COPD as their primary diagnosis (82.47% first admissions, 17.53% hospital readmissions). The risk of re-hospitalization was higher in patients aged 65 to 84 years, males, with comorbidities, malnutrition, not obese, respiratory acidosis, treated with non-invasive ventilation (NIV) or discharged to a health/social institutions. Factors associated with IHM among patients readmitted were: older age, increased Charlson Index, malnutrition, not being obese, respiratory acidosis and treatment with NIV. The IHM and hospital costs were significantly higher in readmissions compared with first admissions. We observed that the incidence and mortality of readmissions had significantly decreased from 2006 to 2012. CONCLUSION: Hospital readmissions within 30 days of discharge for AE-COPD are common in Spain. They have a high impact for COPD patients and health system. However, we have found a downward trend in incidence and mortality of readmissions from 2006 to 2012.

Trends in the use of oral contraceptives among adolescents and young women in Spain.

BACKGROUND: We aimed to determine the prevalence of consumption of oral contraceptives (OCs) among adolescents and young women living in Spain and to identify the factors associated with this consumption. METHODS: We performed a cross-sectional study on the consumption of OCs by women aged 15-30 years residing in Spain. We used secondary individualized data from the 2006 (n = 2513) and 2012 (n = 1530) Spanish National Health Surveys. The dependent variable was the use of OCs in the previous 2 weeks. Independent variables included sociodemographic characteristics, comorbidity, lifestyle, and healthcare resource utilization. The prevalence of OC consumption was analysed by investigating the changes observed between 2006 and 2012. We used multivariate logistic regression to identify the independent factors associated with OC use in each year. RESULTS: In 2006, 14.42 % of women reported using OCs; this percentage dropped to 10.21 % in 2012 (p < 0.05). Multivariate analysis revealed an association between OC use and visits to the gynaecologist (AOR, 5.60 [95 % CI, 2.93-10.73] in 2006; and AOR, 3.55 [95 % CI, 1.30-9.73] in 2012), Pap smear tests (AOR, 1.8 [95 % CI, 1.23-2.87] in 2006; and AOR, 2.42 [95 % CI, 1.30-4.51] in 2012), and smoking in 2006 (AOR, 1.42 [95 % CI, 1.04-1.93]). CONCLUSIONS: There was a significant decrease in OC use from 2006 to 2012 among adolescents and young women living in Spain. In the present study, consumers of OCs were women who visited a gynaecologist more often and complied more with preventive measures such as Pap smear testing. Also, women who reported having used OCs were more likely to smoke than the rest of the study population, although the smoking habit is a risk factor for thrombotic events in women who take OCs.

Is COPD a Risk Factor for Hip Fracture?

This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without chronic obstructive pulmonary disease (COPD) in Spain (2004-2013). We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by COPD status. From 2004 to 2013, 432,760 discharges with hip fracture were identified (6.9% suffered COPD). Incidence among COPD men increased by 2.63% per year from 2004 to 2013. There were no significant changes in tendency in the incidence among women with COPD during the study period. COPD women have almost three times higher incidence than COPD men. Incidences and hospital complications were higher among patients with COPD beside sex. The proportion of patients who underwent internal fixation increased for all groups of patients and the open reduction decreased. After multivariate analysis, in-hospital mortality (IHM) has improved over the study period for all patients. Suffering COPD was associated with higher IHM in men (odds ratio 1.45; 95% confidence interval 1.33-1.58) than women. In conclusion, hip fracture incidence is higher in subjects with than without COPD and is much higher among women than men. In COPD patients, incidence rates increased significantly in men from 2004 to 2013, but not in women. For all groups, the use of internal fixation has increased overtime and open reduction, IHM, and length of hospital stay have decreased from 2004 to 2013.

Expressing sexuality in nursing homes. The experience of older women: A qualitative study.

In nursing homes, a number of barriers to the expression of sexuality exist, such as the lack of privacy, certain attitudes on behalf of the staff and the family, the lack of a sexual partner, and physical limitations. The aim of this study was to describe the lived experience of sexuality in elderly Spanish women residing in nursing homes. A qualitative phenomenological approach was followed. Data were collected over an 18-month period between 2013 and 2015. Purposeful sampling was conducted with Spanish residents in nursing homes in Madrid. Data were collected using unstructured and semi-structured interviews. The data were analyzed using thematic analysis. Twenty female residents participated. Three main themes emerged from the data: a) expressing sexuality, b) sexuality as a duty and c) respecting vows. Female residents reported key elements influencing how they manage their sexuality in Nursing Homes. These results serve to improve our understanding regarding the expression of sexuality in older female nursing home residents.

National trends in incidence and outcomes of abdominal aortic aneurysm among elderly type 2 diabetic and non-diabetic patients in Spain (2003-2012).

BACKGROUND: This study aims to describe trends in the rate of abdominal aortic aneurysm (AAA) and use of open surgery repair (OSR) and endovascular aneurysm repair (EVAR) in elderly patients with and without type 2 diabetes in Spain, 2003-2012. METHODS: We select all patients with a discharge of AAA using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. In both groups OSR and EVAR were identified. The incidence of discharges attributed to AAA were calculated overall and stratified by diabetes status and year. We calculated length of stay (LOHS) and in-hospital mortality (IHM). Use of OSR and EVAR were calculated stratified by diabetes status. Multivariate analysis was adjusted by age, sex, year, smoking habit and comorbidity. RESULTS: From 2003 to 2012, 115,020 discharges with AAA were identified. The mean age was 74.91 years and 16.7% suffered type 2 diabetes. Rates of discharges due to AAA increased significantly in diabetic patients (50.09 in 2003 to 78.23 cases per 100,000 in 2012) and non diabetic subjects (69.24 to 78.66). The incidences were higher among those without than those with diabetes in all the years studied. The proportion of patients that underwent EVAR increased for both groups of patients and the open repair decreased. After multivariate analysis we found that LOHS and IHM have improved over the study period and diabetic patients had lower IHM than those without diabetes (OR 0.81; 95%CI 0.76-0.85). CONCLUSIONS: Incidence rates were higher in non-diabetic patients. For diabetic and non diabetic patients the use of EVAR has increased and open repair seems to be decreasing. IHM and LOHS have improved from 2003 to 2012. Patients with diabetes had significantly lower mortality.

Trends in self-rated health status and health services use in COPD patients (2006-2012). A Spanish population-based survey.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients often have a significant impairment in their health status, which is an independent predictor of health services use. OBJECTIVES: To describe the self-rated health status and the prevalence of health services use among COPD Spanish patients; to identify which factors are independently associated with a worse health status and a higher use of health services; and to study the time trends in the health status and prevalence of use of health services (2006-2012). METHODS: Observational study: We analyzed data from the Spanish National Health Surveys conducted in 2006 and 2012. We included responses from adults aged 40 years or over. Subjects described their health status as very good, good, fair, poor, or very poor, which was dichotomized into very good/good or fair/poor/very poor self-perceived health status. RESULTS: We identified 2,321 COPD patients. The percentage of patients with health status fair, poor, or very poor was 76.8 % in 2006 and 74.8 % in 2012 (p > 0.05). Regarding the health resources use, we observed a significant decrease in the number of visits to primary care over time in women (67.8 vs. 57.2 %, p < 0.05) and men (62.2 vs. 54.0 %, p < 0.05). However, we did not find improvement in the prevalence of emergency department visits or hospitalizations. Associated factors with a worse self-rated health status and a higher use of health services in women and men included: having three or more chronic diseases, presence of mental disorders, and absence of leisure time physical activity. CONCLUSIONS: The current study revealed a decrease in the general practitioner visits, without changes in use of other health care services in the COPD Spanish population from 2006 to 2012. The self-rated health status did not changed significantly during this period.

Obstructive sleep apnea among hospitalized patients in Spain, analysis of hospital discharge data 2008-2012.

BACKGROUND: The aim of this study is to describe clinical characteristics, diagnostic and therapeutic procedure (polysomnography and continuous positive airway pressure (CPAP)/bi-level positive airway pressure (BPAP)), comorbidity, length of hospital stay (LOHS), discharge destination, and in-hospital mortality (IHM) of patients hospitalized for obstructive sleep apnea (OSA) in Spain over a 5-year study period. METHODS: We included all patients who were hospitalized for OSA (ICD9-CM code 327.23) as primary or secondary diagnosis between 2008 and 2012. Data were collected from the National Hospital Discharge Database, covering the entire Spanish population. RESULTS: We identified 196,769 discharges of patients admitted for OSA. The number of patients with OSA as primary or secondary diagnosis increased from 2008 to 2012 from 5358 to 7992 and 14,916 to 51,135 respectively. The mean age was 50.7 ± 20.3 years in patients admitted for OSA as primary diagnosis (n = 32,010) and 63.7 ± 17.6 years in patients admitted for OSA as secondary diagnosis (n = 164,759). The most common secondary diagnoses for patients discharged with a primary diagnosis of OSA was arterial hypertension (19.0%), obesity (16.9%), disorders of lipid metabolism (8.01%) and diabetes mellitus (6.48%). The most common primary diagnoses for patients discharged with a secondary diagnosis of OSA were obesity (12.5%), heart failure (9.6%), and chronic bronchitis (4.5%). The percentage of patients that received continuous positive airway pressure (CPAP)/bi-level positive airway pressure (BPAP) therapy was 11.3%. Patients who received this therapy had a higher length of stay compared with those who did not (10.4 ± 14.1 versus 7.3 ± 9.5 days, respectively, p < 0.05) and were less likely to be discharged to home (87.2 versus 91.1%, p < 0.05). The mortality was higher in the first group of patients (9 versus 5.6%, p < 0.05). Multivariate analysis showed that each year from 2008 to 2012, the mean probability of having OSA as primary diagnosis increased an average of 8%, and 33% as secondary diagnosis, after adjusting for other variables. CONCLUSIONS: The results of this study reveal a national perspective on the characteristics and management of OSA in hospitalized patients in Spain during the period of 2008-2012. The burden of the disease seems to be increasing in Spain. Clinical studies are needed to provide a better knowledge of OSA in this subgroup of patients.

Prevalence of neck and low back pain in community-dwelling adults in Spain: an updated population-based national study (2009/10-2011/12).

PURPOSE: To estimate time trends in the prevalence of neck (NP) and low back pain (LBP) from 2009 to 2012; and to determine the socio-demographic features, self-rated health status, co-morbidity, lifestyle-related habits, and health care service associated with NP and LBP in Spanish adults. OUTCOME MEASURES: The European Health Interview Survey for Spain (2009) and the Spanish National Health Survey (2011). METHODS: A total of 43,072 subjects were included. We analyzed data collected from the European Health Interview Survey for Spain conducted in 2009 (n = 22,188), and the Spanish National Health Survey in 2011 (n = 20,884). We considered the presence of isolated NP, LBP and both (NP&LBP). We analyzed socio-demographic features; self-perceived health status; lifestyle habits; comorbid diseases, and professional treatment using logistic regression models. RESULTS: The prevalence of isolated NP, LBP and NP&LBP increased from 2008/9 to 2011/12 (7.86 vs. 8.56 %; 5.18 vs.5.44 %; 10.61 vs.11.12 %, respectively). Being female, increased the probability of isolated NP and NP&LBP, but decreased the probability of LBP. The prevalence of all pain localizations increased with older age, lower education level, poor self-rated health, smoker, comorbidities, psychological distress (anxiety or depression), hospital and physiotherapist visits and consumed drugs for pain, in 2008/9 as compared to 2011/12. Moreover, LBP, and NP&LBP were associated with obesity, whereas NP&LBP was associated with being married. CONCLUSIONS: The prevalence of LBP, NP and NP&LBP had increased in the last 3 years in Spain.

[Physical activity in adult working population: results from the European National Health Survey for Spain (2009)]. / Actividad física en población adulta trabajadora española: resultados de la Encuesta Europea de Salud en España (2009).

OBJECTIVES: 1) To describe physical activity in the Spanish adult working population aged 16-70 years in 2009, and 2) to describe the prevalence of physical activity according to socio-demographic features, self-perceived health status, co-morbidity, and lifestyle habits. DESIGN: An epidemiological population based descriptive study was conducted using individual data taken from the European Health Survey for Spain. SETTING: Community. PARTICIPANTS: The number of subjects aged 16-70 years included in the study was 10,928 (5,628 women and 5,300 men). INTERVENTIONS: None. MAIN VARIABLES: Physical activity and intensity were assessed from questions included in the interview-survey. An analysis was performed on the socio-demographic characteristics and self-rated physical and mental health, using multivariate logistic regression models. RESULTS: Not having a partner (OR 1.44; P<.001), have university studies (OR 1.62; P<.001), non-smoker (OR 1.50; P<.001), and taking medications (OR 1.22; P<.5) were a predictor of intense physical activity in men. The first 3 factors are equal for intense activity in women. In contrast, obesity (OR 0.58; P<.001), and 36-50 years (OR 0.68; P<.001) were factors related to low activity in men. Aged between 36-50 years (OR 1.26; P<.01), suffering≥2 co-morbid conditions (OR 1.30; P<.001), and non-smoker (OR 1.17; P<.5) were also associated with higher probability of reporting moderate physical activity in women. The positive mental health was significant for physical activity in both sexes (OR 1.01; P<.5). CONCLUSIONS: This study identified several factors that appear to influence physical activity in the Spanish adult working population, with potential implications for healthcare providers.

Trends in hospital admissions for pulmonary embolism in Spain from 2002 to 2011.

The aim of our study was to analyse changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay, costs and in-hospital mortality of patients hospitalised for pulmonary embolism in Spain over a 10-year period. We included all patients who were hospitalised for pulmonary embolism (ICD-9-CM codes 415.11 and 415.19) as the primary diagnosis between 2002 and 2011. Data were collected from the National Hospital Discharge Database, covering the entire Spanish population. 115 671 patients were admitted. The overall crude incidence increased from 20.44 per 100 000 inhabitants in 2002 to 32.69 in 2011 (p<0.05). In 2002, 13.3% of patients had a Charlson comorbidity index>2, and in 2011 the prevalence increased to 20.8% (p<0.05). Mean length of hospital stay was 12.7 days in 2002 and decreased to 9.99 in 2011 (p<0.05). During the study period, mean cost per patient increased from €3915 to €4372 (p<0.05). In-hospital mortality decreased from 12.9% in 2002 to 8.32% in 2011 (p<0.05). The increase in the use of computed tomographic pulmonary angiography over time was associated with increased incidence and lower mortality. Our results revealed an increase in the incidence of hospitalised pulmonary embolism patients from 2002 to 2011 with concomitant increase in comorbidities and cost. However, length of hospital stay and in-hospital mortality decreased.

National trends in utilization and outcomes of coronary revascularization procedures among people with and without type 2 diabetes in Spain (2001-2011).

BACKGROUND: Diabetes is associated with a high risk of death due to coronary artery disease (CAD). People with diabetes suffering from CAD are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of coronary revascularization procedures in diabetic and non-diabetic patients in Spain between 2001 and 2011. METHODS: We identified all patients who had undergone coronary revascularization procedures, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. The incidence of discharges attributed to coronary revascularization procedures were calculated stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We apply joinpoint log-linear regression to identify the years in which changes in tendency occurred in the use of PCI and CABG in diabetic and non-diabetic patients. Multivariate analysis was adjusted by age, sex, year and comorbidity (Charlson comorbidity index). RESULTS: From 2001 to 2011, 434,108 PCIs and 79,986 CABGs were performed. According to the results of the joinpoint analysis, we found that sex and age-adjusted use of PCI increased by 31.4% per year from 2001 to 2003, by 15.9% per year from 2003 to 2006 and by 3.8% per year from 2006 to 2011 in patients with diabetes. IHM among patients with diabetes who underwent a PCI did not change significantly over the entire study period (OR 0.99; 95% CI 0.97-1.00).Among patients with diabetes who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 10.4% per year from 2001 to 2003, and then decreased by 1.1% through 2011. Diabetic patients who underwent a CABG had a 0.67 (95% CI 0.63-0.71) times lower probability of dying during hospitalization than those without diabetes. CONCLUSIONS: The annual percent change in PCI procedures increased in diabetic and non-diabetic patients. Higher comorbidity and the female gender are associated with a higher IHM in PCI procedures. In diabetic and non-diabetic patients, we found a decrease in the use of CABG procedures. IHM was higher in patients without diabetes than in those with diabetes.

Awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests in Spain.

BACKGROUND: We aim to describe levels of awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests and to analyze the association to socio-demographic and health-related variables. METHODS: Population-based cross-sectional study conducted using a home-based personal interview survey on a nationwide representative sample (n = 7938) of population aged ≥18 years (Oncobarometro Survey). Awareness was assessed by asking participants: Now I am going to mention several medical tests for cancer detection, please tell me if you already know about them or if this is the first time you have heard of them? The tests mentioned were faecal occult blood test (FOBT), mammography, Pap smear and prostate-specific antigen (PSA). Cancer screening uptake was assessed by asking participants whether they had received tests within the previous 2 years. RESULTS: Awareness rates of 38.55% for FOBT, 95.03% for mammography, 70.84% for Pap smears and 54.72% for PSA were found. Uptake mammography was 74.46%, Pap smears 65.57%, PSA 35.19% and FOBT 9.40%. Factors such as immigration status, lower educational level or income and not suffering from chronic conditions are negative predictors for uptake. CONCLUSIONS: Awareness and uptake results showed acceptable figures for mammography, moderate for Pap smears and unacceptably low for FOBT. Inequalities exist in uptake of cancer screening. It is necessary to develop public health educational programmes, especially for the vulnerable populations, aiming to inform and motivate them to use screening services on a regular basis. Our data suggest that although PSA is not recommended, this opportunistic screening is frequently used in Spain.

Clustering of unhealthy lifestyle behaviors is associated with a low adherence to recommended preventive practices among COPD patients in Spain.

AIMS: To analyze clustering of unhealthy lifestyle behavior and its relationship with non-adherence to recommended clinical preventive care services among Spanish COPD patients. METHODS: Cross-sectional study including 2,575 COPD subjects from the 2006 Spanish National Health Survey (NHS) and 2009 European Health Survey for Spain (EHISS). Subjects were asked about the following recommended preventive practices: uptake of blood pressure (BP) measurement, lipid profile, influenza vaccination and dental examination. Lifestyle behaviors included: smoking status, physical activity, alcohol consumption and obesity. Logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of preventive activities. RESULTS: Blood pressure measurement in the previous 6 months and a blood lipid test in the last year had not been taken by 11.74% and 23.26% of the subjects, respectively, in 2006 NHS and by 11.16% and 16.33% of the subjects, respectively, in EHISS 2009. Then, 36.36% percent had not been vaccinated and 70.61% had not received dental examination in 2006 NHS and these percentages decreased to 27.33% and 66.22%, respectively, in 2009 EHISS. A higher number of unhealthy lifestyle behaviors increased the probability of not being vaccinated and not having a dental examination. Clustering of unhealthy lifestyle behaviors is linearly associated with a greater number of preventive measures unfulfilled. CONCLUSIONS: Compliance with healthy lifestyles and adherence to recommended clinical preventive services is under desirable levels among Spanish COPD patients. Patients with lifestyles considered as "worse" are those who also have lower uptake of recommended preventive activities.

Gender Differences in the Co-Use of Tranquilizers, Sedatives, Sleeping Pills and Alcohol among Spanish Adolescents: A Nationwide Population-Based Study.

Adolescence is a critical developmental stage for the initiation of substance use worldwide, which is one of the main risk-taking behaviors that may impact adolescents' physical and mental well-being. The aims of this study were to (1) assess the prevalence of the co-use of tranquilizers, sedatives, and sleeping pills with alcohol (TSSp&AC) by gender in the Spanish adolescent population in 2018 and (2) identify the variables associated with TSSp&AC. An observational cross-sectional study following STROBE guidelines was conducted. We analyzed data from 38,010 adolescents aged 14 to 18 years old (18,579 males and 19,431 females) who participated in ESTUDES (Survey on Drug Use in Secondary Education in Spain) 2018. Female adolescents reported a higher prevalence of TSSp&AC than males (p < 0.001). The factors associated with female co-use were being 16-18 years of age (OR 1.65); the consumption of tobacco (OR 1.73), cocaine (OR 1.84), other illicit psychoactive drugs (OR 1.89); and novel illicit psychoactive drugs (OR 1.74); no perceived health risk from the consumption of TSSps (OR 2.45); and the perceived availability of TSSps (OR 2.23) and alcohol (OR 2.09). There are several factors associated with TSSp&AC in Spanish female adolescents with potential implications for healthcare providers.

Trends in hospitalizations among children with type 1 diabetes in Spain, 2001-2009.

AIM: To examine the trends in the incidence of hospital discharges among children between 0 and 14 years with type 1 diabetes in Spain (2001-2009). METHODS: We identified all hospital discharges with a diagnosis of type 1 diabetes, using national hospital discharge data. RESULTS: A total of 22,955 type 1 diabetes discharges to Spanish hospitals were recorded. The discharge incidence per year increased from 39.6 in 2001 to 40.02 per 100,000 inhabitants in 2009. There was no significant change in hospital discharge rates for children 0-14 years old. In the 0-4 years group, the incidence increased significantly over the study period (incidence rate ratio, 1.031; 95% confidence interval, 1.017-1.045). CONCLUSION: Hospitalization trends in children 0-4 years old with type 1 diabetes has increased over the study period, consistent with an increase in the incidence of diabetes in Spain. The stable rate for those aged 10-14 years may indicate that the control of these patients in specialized outpatient settings is preventing the expected increase in hospitalizations.

Prevalence of physical disability in patients with chronic obstructive pulmonary disease and associated risk factors.

INTRODUCTION: To analyze the prevalence of disability among patients with COPD as compared to people without this lung disease and to identify sociodemographic and health factors associated with these physical limitations. METHODS: We performed a cross-sectional study based on data taken from the European Health Interview Survey for Spain (EHISS) 2009. The survey included adults aged 40 to 79 years (n = 13624). We identified patients with COPD using a direct question from the survey. The main study variable was disability, including basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility disability (MD). Independent variables analyzed included socio-demographic characteristics, self-perceived health status, presence of mental disease and co-morbid chronic conditions and lifestyles. RESULTS: The overall prevalence of self-reported COPD was 7.2%. The total prevalence of ADL, IADL and MD was higher among men suffering COPD than among the population without this disease (16.39% vs. 4.91%; 27.70% vs. 12.45%; 48.94% vs. 17.46% respectively). These significant differences were also observed among women with equivalent figures of: 23.25% vs. 8.71%; 31.03% vs. 10.53%; 64.83% vs. 34.08%. Being older, having a self-perceived health status of "fair/poor/very poor" and suffering from mental disease (anxiety and/or depression) were factors associated with a higher probability of reporting any disability in both men and women suffering from COPD. CONCLUSIONS: Higher rates of disability were seen among COPD patients compared to the general population. Among COPD patients older age, depression, anxiety and worse self-rated health were associated with higher disability.

Trends 2001 to 2008 in incidence and immediate postoperative outcomes for major joint replacement among Spanish adults suffering diabetes.

OBJECTIVES: To analyze the trend of incidence rates of primary total knee (TKA) and primary total hip arthroplasty (THA) due to osteoarthritis among Spanish adults suffering diabetes (type-1 and 2) from 2001 to 2008 and analyze in-hospital mortality (IHM), length of stay (LOS) and hospital charges compared with non-diabetic patients. METHODS: From the Spanish National Hospital Database, we selected 250,205 patients with TKA and 122,926 patients with THA; 12 and 9% of patients undergoing TKA and THA, respectively, were diabetes sufferers, of them, 1.6% was classified as type 1 in each procedure. RESULTS: Incidence of both procedures increased over the period, but diabetic patients had a larger increment compared with non-diabetic patients. The ratio of diabetes versus non-diabetes sufferers undergoing TKA increased from 0.10 in 2001 to 0.16 in 2008 and from 0.08 to 0.11 for THA. Unadjusted IHM was higher among type-2 diabetic adults in both procedures. IHM rate did not show a secular time trend among diabetic patients. LOS was significantly longer among patients with diabetes type-1 and 2 undergoing THP when compared with non-diabetic patients. Hospital charges were higher among diabetic versus non-diabetic patients for both procedures showing a significant increase over the period. CONCLUSIONS: Immediate postoperative outcomes for major joint replacement are worse among persons with than without diabetes, and prevalence of diabetes is increasing in patients undergoing these surgeries.