Surgical site infection of 7301 traumatologic inpatients (divided in two sub-cohorts, study and validation): modifiable determinants and potential benefit.

The widespread use of peri-surgical chemoprophylaxis is decreasing the incidence of surgical site infection in Traumatology, which nevertheless remains as a problem amenable to further reduction. We have tried to identify modifiable determinants of the avoidable incidence of surgical site infection, and to estimate the potential benefit from implementing adequate measures targeting those determinants. In a firts sub-cohort of 5320 traumatologic patients with a post-surgical stay of more than 2 days, in Madrid's La Paz Hospital, between 1991 and 1996. The epidemiological surveillance was prospective during their hospital stay but also includes data on readmissions due to infection so as to analyse the actual incidence of surgical site infection, both before and after discharge. Bivariate and multivariate (multiple logistic regression model) analyses of risk factors for surgical site infections have been performed. In this sub-cohort, 212 patients (3.9%) suffered some type of nosocomial infection. The incidence of surgical site infection before discharge in cases of clean surgery was 1.6%, rising to 2% when cases readmitted for infection after discharge were considered. The multivariate analysis of risk factors for surgical site infection identified the following: contaminated ('dirty') surgery (OR: 10.5), inadequate chemoprophylaxis (OR: 1.5) and a pre-surgical stay of more than 4 days (OR: 1.6). Next, a second sub-cohort, consisting of 1981 patients, treated between 1997 and 1999, was analysed to validate the results of the first multivariate analysis. The validation model (and the global cohort with 7301 patients) corroborates the importance of the same three factors. Last, we calculated that controlling two modifiable factors, pre-surgical stay and peri-surgical chemoprophylaxis, could avoid 56% of surgical site infections.

[The obesity epidemic and related factors: the case of Spain]. / La epidemia de obesidad y sus factores relacionados: el caso de España.

The obesity epidemic is a global phenomenon that does not respect geographic or socio-demographic boundaries. Thus, research on factors related to the obesity epidemic has focused on social and economic characteristics of modern societies. This article discusses obesity in Spain and trends in several associated factors. Together with the increase in the prevalence of obesity, important changes in the population's dietary pattern have been observed, although total energy and fat intake appear to be stable. According to several indirect indicators, sedentary behavior predominates, although the percentage of the population reporting some leisure exercise is increasing. An increase in the amount of leisure time in modern societies is suggested as an explanation for this paradox. Factors related to energy expenditure could be as important as dietary factors in the genesis of the obesity epidemic.

Effectiveness and equity of serum cholesterol and blood pressure testing: a population-based study in Spain.

BACKGROUND: This study examined the effectiveness and equity of serum cholesterol and blood pressure testing in Spain. METHODS: Data were taken from a household survey of 3680 persons of the Basque Country, a region in northern Spain. Analyses were performed using logistic regression, controlling for need, equity, and predisposing factors for serum cholesterol and blood pressure testing. Proxies for need were age, subjective health and cardiovascular risk factors, such as tobacco and alcohol consumption, physical activity at work and at leisure time, and body mass index. Proxies for equity were sex, educational level, and province of residence, and predisposing factors for testing were the marital status and the number of medical visits in the preceding year. RESULTS: The percentage of subjects that had their cholesterol measured rose with age and worse subjective health, but showed no association with any cardiovascular risk factor except body mass index, for which a positive association was observed (P for linear trend, 0.0351). The percentage of subjects with serum cholesterol checked also rose with educational level (P for linear trend, 0.0024). Moreover, women were less likely to have their cholesterolemia tested than men (OR, 0.79; 95% CI, 0.67-0.94). Educational and sex differences in cholesterol testing increased after adjustment for the number of medical visits. Similar results were obtained for blood pressure testing. CONCLUSIONS: Serum cholesterol and blood pressure testing are not performed according to cardiovascular risk, which compromise its effectiveness. Moreover, there are social inequalities in testing, to which healthcare professionals could be contributing.

La epidemia de obesidad y sus factores relacionados: el caso de España / The obesity epidemic and related factors: the case of Spain

La epidemia de obesidad es un fenómeno universal que no parece reconocer límites ni geográficos ni sociodemográficos. Las investigaciones sobre los factores responsables de la epidemia se centran sobre algunas de las condiciones sociales y económicas que imperan en las sociedades actuales. El presente artículo muestra la situación de la obesidad en España y la tendencia de una serie de factores potencialmente relacionados. El incremento en la prevalencia de obesidad se acompañó de importantes cambios en el patrón de alimentación de la población a pesar de una tendencia estabilizada en la ingesta calórica total y de grasas. Diversos indicadores indirectos muestran la tendencia sedentaria de la población, a pesar de que un mayor porcentaje de la población declara realizar ejercicio físico en su tiempo libre. Los factores dependientes del gasto energético parecen tan o más importantes que los derivados del ingreso. Para explicar la situación paradójica de los distintos indicadores de sedentarismo se sugiere la hipótesis de un aumento del "stock de tiempo libre" en las sociedades actuales

Subjective health of male ex-smokers: relationship with time since smoking cessation, intensity and duration of tobacco consumption.

BACKGROUND: To examine the relationship of subjective health with time since smoking cessation and amount and duration of tobacco consumption among male ex-smokers. METHODS: Pooled analysis of three household interview surveys conducted in 1993 (n = 8,494), 1995 (n = 2,556), and 1997 (n = 2,624) on samples representative of the noninstitutionalized population aged 16 and over in Spain. RESULTS: After controlling for the main confounders, ex-smokers with smoking burden < or =13 pack-years had a lower frequency of suboptimal health (fair, poor, or very poor) than current smokers (OR, 0.59; 95% Cl, 0.38-0.91) during the first year after cessation; thereafter, it reached a value similar to that of never-smokers 11 years or more after cessation. Among those with burden >13 pack-years, frequency of suboptimal health during the first year after cessation was higher than in current smokers (OR, 1.28; 95% CI, 1.00-1.63). Afterwards, it fell progressively, approaching the value of never-smokers 11 years or more after cessation. Frequency of suboptimal health in ex-smokers increased with duration (years) of smoking (P linear trend = 0.045), but did not vary with the number of cigarettes smoked. CONCLUSIONS: Suboptimal health declined with time since smoking cessation, to reach the frequency of never-smokers. Longer duration of tobacco consumption is associated with worse subjective health.

[Demography, healht-related life style and history of tobacco consumption among occasional smokers in Spain]. / Características demográficas, hábitos de vida e historia del consumo de tabaco de los fumadores ocasionales en España.

BACKGROUND: This study describes the sociodemographic characteristics, health-related lifestyle, and history of tobacco consumption of the occasional smokers in Spain, and examines whether they show differences against daily smokers. METHODS: Data were obtained from the National Health Survey of Spain, carried out in 1993 through household interviews on a sample representative of the non-institutionalised population aged 16 year and older. Analyses were performed with logistic regression and adjusted for sociodemographic, health-state and life-style variables. RESULTS: Out of the 6,668 smokers in the survey, occasional smokers were 9.2%, while daily smokers of < or = 5 cigarettes and > 5 cigarettes were 9.9% and 80.9%, respectively. As compared with daily smokers of > 5 cigarettes, occasional smokers were more frequently women (odds ratio (0R): 2.12; CI95%: 1.72-2.61), younger (OR aged 25-44 versus 16-24 years: 0.75; 0.58-0.96), with lower alcohol consumption (p for linear trend: 0.0349), and higher leisure-time physical activity (p for linear trend: < 0.0001). On the day they smoke, occasional smokers used to consume less cigarettes than daily smokers (p < 0.0001). Occasional smokers were more frequent among young smokers (aged less than 20) with relatively short history of tobacco consumption (less than 20 years), and also among older smokers (aged 65 year and older) with longer history of consumption (over 50 years). Daily smokers of < or = 5 cigarettes showed characteristics midway between those of occasional and daily smokers of > 5 cigarettes. CONCLUSIONS: Occasional smokers show sociodemographic characteristics, health-related lifestyle, and history of tobacco consumption different from daily smokers. Such differences suggest that research and intervention programs specifically tailored to occasional smokers should be developed.

[Association of cardiovascular disease with overweight and obesity in Spain]. / Asociación de la enfermedad cardiovascular con el sobrepeso y la obesidad en España.

BACKGROUND: Our purpose was to examine the relationship of overweight and obesity with cardiovascular disorders. PATIENTS AND METHOD: Data from the 1993 Spanish National Health Survey (16,692 subjects with a body mass index [BMI] >= 18.5 kg/m2). RESULTS: After adjustment for age, residence city size and tobacco consumption, we observed a positive dose-response relationship (p linear trend < 0.05) of BMI >= 18.5 kg/m2 with hypertension, hypercholesterolemia and diabetes in both sexes, as well as with heart diseases in women. These associations decreased with age. CONCLUSIONS: Overweight and obesity are associated with a greater frequency of cardiovascular disorders in Spain.

Changes in the prevalence of overweight and obesity and their risk factors in Spain, 1987-1997.

BACKGROUND: The aim of this study was to examine the relationship of the changes in the prevalence of overweight and obesity with the changes in some of their risk factors in Spain from 1987 to 1997. METHODS: Data were obtained from three interview-based health surveys, covering representative samples of the noninstitutionalized Spanish population aged 16 years and over and undertaken in 1987 (n = 17,434), 1995 (n = 4,736), and 1997 (n = 4,678). To compensate for the different sample sizes, the 1995 and 1997 surveys were combined. Risk factors for obesity and overweight considered in this study were age, educational level, physical activity at work, physical activity during leisure time, tobacco use, alcohol consumption, and civil status. Data analysis was performed with logistic regression. RESULTS: The prevalence of overweight and obesity (body mass index >or= 25 kg/m(2)) rose from 35.6% in 1987 to 40.9% in 1995/1997 among women and from 47.1 to 56.2% among men. In the period 1987-1995/1997, the proportion of persons with secondary or university education increased by 11.3% in women and 10.8% in men. Similarly, the prevalence of intense or regular leisure-time physical activity increased by 5.7 and 6.2% in women and men, respectively. The remaining risk factors for overweight and obesity registered no substantial change in prevalence over the study period. The prevalence of overweight and obesity expected in 1995/1997, had educational level and leisure-time physical activity been the same as in 1987, is higher than the observed figures; for educational level, expected figures are 7.3 and 1.4% higher than those observed among women and men, respectively, while for leisure-time physical activity corresponding values are 2.8 and 1.6%. CONCLUSIONS: The rise in the prevalence of overweight and obesity in Spain from 1987 to 1997 may have been attenuated by an increase in leisure-time physical activity and by an improvement in educational level, particularly among women. The contribution to overweight and obesity trends attributable to physical activity at work or to tobacco and alcohol consumption appears to be small or null.