Implementación de un programa de optimización de la farmacoterapia en pacientes institucionalizados (ÓPTIMA) / Implementation of a pharmacotherapy optimisation programme for institutionalised patients (ÓPTIMA)

Objetivo: Las personas institucionalizadas en centros sociosanitarios (CSS) tienen una mayor probabilidad de presentar más problemas relacionados con los medicamentos (PRM) que el resto de la población. El objetivo del presente trabajo ha sido describir la implementación de un proceso de mejora continua (ciclo PDCA) de la prescripción farmacológica de pacientes institucionalizados en CSS concertados/ privados orientado a reducir los PRM.Metodología: Tras una búsqueda bibliográfica, se seleccionaron varias recomendaciones sobre los PRM detectados con mayor frecuencia en los pacientes institucionalizados de nuestra área, que abarca aproximadamente 5.000 residentes en 55 CSS, y se identificaron aquellos que presentaban alguno de los PRM seleccionados. Posteriormente, se constituyó un panel de expertos multidisciplinar para definir los objetivos del proyecto, realizar un análisis de causas y determinar posibles acciones de mejora.Resultados: Tras presentarse el proyecto a los centros de salud (CS), se crearon comisiones ejecutivas entre los farmacéuticos de atención primaria, los profesionales de los CSS y de sus CS de referencia para adaptar las diferentes acciones de mejora. En el análisis intermedio se puede ver una reducción del 4,5% de los pacientes con algún PRM y del 5,2% de las prescripciones por paciente asociadas a los mismos. Debido al elevado número de pacientes institucionalizados, la revisión transversal de PRM permite disminuir la iatrogenia medicamentosa con los recursos disponibles. El ciclo de mejora continua PDCA, tras analizar la prevalencia de los PRM, nos permitirá implementar nuevas acciones o valorar iniciar el ciclo con otros PRM.  (AU)

Objective: People institutionalised in social and healthcare centres (SHCs) are more likely to present more drug related problems (DRPs) than the rest of the population. The aim of this study was to describe the implementation of a process of continuous improvement (PDCA cycle) of the pharma- cological prescription of institutionalised patients in private/contracted SHCs to reduce DRPs.Method: Following a literature search, recommendations were selected on the most frequently detected DRPs in institutionalised patients in our area (approximately 5,000 residents in 55 SHCs). Those presenting any of the selected DRPs were identified. Subsequently, a multidisciplinary panel of experts was formed to define the objectives of the project, carry out an analysis of causes and determine possible actions for improvement.Results: The project was presented to health centres (HCs) and executive committees were set up between primary care pharmacists, professionals from SHCs and their reference HCs to adapt the different improvement actions. The interim analysis shows a 4.5% reduction in the number of patients with DRPs and a 5.2% reduction in the number of prescriptions per patient associated with DRPs. Due to the high number of institutionalised patients, the cross-sectional review of DRPs allows us to reduce drug iatrogenesis. The PDCA cycle will allow us to implement new actions or consider starting the cycle with other DRPs.  (AU)

Sangre oculta en heces en pacientes sintomáticos en Atención Primaria: Un estudio retrospectivo en el área sanitaria de Toledo / Faecal occult blood test in symptomatic patients in primary care: A retrospective study in a healthcare area of Toledo

Objetivo Revisar el protocolo de solicitud de sangre oculta en heces (SOH) en pacientes sintomáticos como prueba de derivación a colonoscopia, utilizando un punto de corte de 15μg Hb/g heces en 3 muestras consecutivas y comparar su utilidad con las recomendaciones actuales de un punto de corte de 10μg Hb/g heces en una muestra. Material y métodos Estudio observacional retrospectivo centrado en las peticiones de la prueba de SOH en pacientes sintomáticos en Atención Primaria. Las muestras fueron analizadas en el servicio de laboratorio durante el año 2017. En el análisis de datos se incluyeron 715 pacientes con la prueba de SOH positiva y 925 pacientes con resultado negativo. Se realizó un análisis descriptivo de los resultados de SOH, motivo de solicitud y colonoscopia, junto con el estudio de la utilidad diagnóstica de la prueba SOH para los puntos de corte de 10 y 15μg Hb/g heces en la misma población. Resultados La tasa de positividad de la prueba fue del 22,8% y la tasa de detección de cáncer colorrectal fue del 11%. El número de muestras no modifica la precisión diagnóstica. El valor predictivo negativo es superior con el punto de corte de 10μg Hb/g heces. Conclusione La selección correcta de pacientes y del punto de corte óptimo aumentan la tasa de detección de cáncer colorrectal. El cambio de protocolo de 10μg Hb/g heces y la recogida de una muestra para pacientes sintomáticos desde Atención Primaria mejoran la utilidad de la prueba SOH (AU)

Aim To review referral protocol in symptomatic patients from primary care of using 15μgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10μgHb/g faeces threshold and one sample. Material and methods A retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15μgHb/g faeces) in the same population. Results FOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10μgHb/g faeces threshold. Conclusions Correct patient selection and optimal threshold increase cancer detection rate. The protocol with 10μgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose (AU)

[Faecal occult blood test in symptomatic patients in primary care: A retrospective study in a healthcare area of Toledo]. / Sangre oculta en heces en pacientes sintomáticos en Atención Primaria: Un estudio retrospectivo en el área sanitaria de Toledo.

AIM: To review referral protocol in symptomatic patients from primary care of using 15µgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10µgHb/g faeces threshold and one sample. MATERIAL AND METHODS: A retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15µgHb/g faeces) in the same population. RESULTS: FOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10µgHb/g faeces threshold. CONCLUSIONS: Correct patient selection and optimal threshold increase cancer detection rate. The protocol with 10µgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose.

[Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections]. / Poder pronóstico de mortalidad a corto plazo del receptor soluble activador del plasminógeno tipo uroquinasa (suPAR) en los pacientes atendidos en urgencias por infección.

OBJECTIVE: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate and suPAR) in patients seen in emergency departments (ED) due to infections. Secondly, if these could improve the accuracy of systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA). METHODS: A prospective, observational and analytical study was carried out on patients who were treated in an ED of one of the eight participating hospitals. An assessment was made of 32 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. RESULTS: The study included 347 consecutive patients, 54 (15.6%) of whom died within 30 days of visiting the ED. SUPAR has got the best biomarker area under the curve (AUC)-ROC to predict mortality at 30 days of 0.836 (95% CI: 0.765-0.907; P <.001) with a cut-off > 10 ng/mL who had a sensitivity of 70% and a specificity of 86%. The score qSOFA ≥ 2 had AUC-ROC of 0.707 (95% CI: 0.621-0.793; P < .001) with sensitivity of 53% and a specificity of 89%. The mixed model (suPAR > 10 ng/mL plus qSOFA ≥ 2) has improved the AUC-ROC to 0.853 [95% CI: 0.790-0.916; P < .001] with the best prognostic performance: sensitivity of 39% and a specificity of 97% with a negative predictive value of 90%. CONCLUSIONS: suPAR showed better performance for 30-day mortality prognostic power from several biomarkers in the patients seen in ED due to infections. Score qSOFA has better performance that SRIS and the mixed model (qSOFA ≥ 2 plus suPAR > 10 ng/mL) increased the ability of qSOFA.

Saturated and unsaturated fat diets impair hippocampal glutamatergic transmission in adolescent mice.

Consumption of high-fat diets (HFD) has been associated with neuronal plasticity deficits and cognitive disorders linked to the alteration of glutamatergic disorders in the hippocampus. As young individuals are especially vulnerable to the effects of nutrients and xenobiotics on cognition, we studied the effect of chronic consumption of saturated (SOLF) and unsaturated oil-enriched foods (UOLF) on: i) spatial memory; ii) hippocampal synaptic transmission and plasticity; and iii) gene expression of glutamatergic receptors and hormone receptors in the hippocampus of adolescent and adult mice. Our results show that both SOLF and UOLF impair spatial short-term memory. Accordingly, hippocampal synaptic plasticity mechanisms underlying memory, and gene expression of NMDA receptor subunits are modulated by both diets. On the other hand, PPARγ gene expression is specifically down-regulated in adolescent SOLF individuals and up-regulated in adult UOLF mice.

Exploring sexual health among young Black men who have sex with men in New York City.

Young Black men who have sex with men (YBMSM) account for approximately 10% of the total HIV infection in the United States but represent <1% of the population. Few interventions exist that address their unique needs, and those that do adopt a narrow, risk-based framework for prevention. Qualitative data from the Brothers Connect Study were analyzed to explore how a Sexual Health Model (SHM) developed by Robinson et al. (The sexual health model: application of a sexological approach to HIV prevention. Health Educ Res 2002; 17:43-57) could be used as a framework for HIV prevention in YBMSM. Content analysis identified five key themes within SHM: (i) race/ethnicity, including the cultural diversity and unique challenges of YBMSM; (ii) disclosure, as the ongoing process of self-identification rather than a single instance of 'coming out'; (iii) sex, in terms of practices, behaviors and health; (iv) daily challenges, microaggressions and acute instances of discrimination; and (v) the self, resilience and identity. Technology represents a new component for the SHM that may be relevant to YBMSM. YBMSM are in need of comprehensive sexual health programs that go beyond typical HIV frameworks. A tailored SHM could be used for identifying and addressing the specific sexual health needs of YBMSM in research and intervention.

Aislamiento de Clostridium difficile en niños hospitalizados con diarrea / Clostridium difficile isolation in children hospitalized with diarrhea

Introducción: Clostridium difficile es la principal causa de diarrea nosocomial en adultos, y su incidencia está aumentado en los últimos años. Es difícil determinar su impacto en niños debido a las altas tasas de colonización. Material y métodos: Estudio retrospectivo en menores de 15 años ingresados con diarrea a lo largo de un año. Se estudiaron las características epidemiológicas, clínicas, analíticas y la evolución de los niños con infección por Clostridium difficile (ICD) en comparación con otros aislamientos. Los factores predictores de ICD fueron determinados mediante análisis multivariante. Resultados: Se identificaron 250 niños con diarrea, realizándose estudio microbiológico completo en 174. En 79 (45,4%) se llegó al diagnóstico: 25,6% ICD (n=19; 13 enterotoxigénicos); 28,6% otras bacterias (n=21) y 45,8% virus (n=34; rotavirus n=31; adenovirus n=3). Un 68,4% fueron menores de 2 años, y un 15,8% fueron adquiridos en la comunidad. En comparación con otras causas de diarrea, la ICD se asoció a comorbilidad (p<0,0001), contacto reciente con el sistema sanitario (p<0,0001), estancia en UCI (p=0,003) y exposición reciente a antibióticos (p<0,0001). Los pacientes con ICD cursaron de forma oligosintomática. No hubo diferencias clínicas entre las ICD productoras o no de toxina, siendo la comorbilidad el principal asociado con la ICD (OR 40,02; IC 95% 6,84-232,32; p<0,0001). Conclusiones: El aislamiento de Clostridium difficile es frecuente en niños hospitalizados con diarrea en nuestro medio. La ICD resultó más frecuente en niños pequeños con comorbilidad y contacto reciente con el sistema sanitario, presentado, en su mayoría, un curso clínico oligosintomático. Se necesitan más estudios para conocer la epidemiología de esta infección en niños (AU)

Introduction: Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting. Material and methods: A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis. Results: Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001). Conclusions: The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of asymptomatic carriers (AU)

Importancia de la función ventricular en la elección del modo de electroestimulación cardiaca / Importance of ventricular function in the election of electro heart mode

La integración de la función ventricular en la toma de decisiones del paciente sometido a electroestimulación cardiaca resulta fundamental para comprender la estructuración de las nuevas guías sobre estimulación cardiaca y terapia de resincronización. Para argumentar la importancia de la función ventricular en la electroestimulación cardiaca es necesario conocer: a)el efecto deletéreo de la estimulación desde el ápex del ventrículo derecho; b)el efecto del bloqueo completo de rama izquierda sobre la función ventricular izquierda, y c)la disfunción ventricular izquierda como sustrato arritmogénico. Así, cuando decidimos el modo de electroestimulación cardiaca a aplicar debemos conocer el porcentaje de estimulación ventricular que precisará y su función ventricular. Si esta es normal, permitirá estimular desde el ápex del ventrículo derecho o desde sitios alternativos al ápex. Por el contrario, si es menor del 50% es recomendable la resincronización cardiaca (CRT-P) acompañada de desfibrilación (CRT-D) si la FEVI es menor del 35%

The integration of the ventricular function is essential when making decisions over a patient subjected to cardiac electrostimulation in order to understand the structure followed in the new cardiac stimulation and resynchronising therapy guides. To support the importance of ventricular function in cardiac electrostimulation it is important to know: (i)the deleterious effect of stimulation on the right ventricle apex; (ii)the effect over the left ventricular function produced by complete blockage of the left branch, and (iii)left ventricular disfunction as arrythmogenic substrate. When it comes to decide what type of cardiac electrostimualtion to apply we will know: the percentage of ventricular stimulation needed and its ventricular function. A normal ventricular function will enable electrostimulation from the right ventricle apex or alternative site. On the contrary, if this value is lower than 50% the most recommended electrostimulation is cardiac resynchronisation (CRT-P), which will be accompanied by defibrillation (CRT-D) if FEVI is lower than 35%

Importance of ventricular function in the election of electro heart mode.

The integration of the ventricular function is essential when making decisions over a patient subjected to cardiac electrostimulation in order to understand the structure followed in the new cardiac stimulation and resynchronising therapy guides. To support the importance of ventricular function in cardiac electrostimulation it is important to know: (i)the deleterious effect of stimulation on the right ventricle apex; (ii)the effect over the left ventricular function produced by complete blockage of the left branch, and (iii)left ventricular disfunction as arrythmogenic substrate. When it comes to decide what type of cardiac electrostimualtion to apply we will know: the percentage of ventricular stimulation needed and its ventricular function. A normal ventricular function will enable electrostimulation from the right ventricle apex or alternative site. On the contrary, if this value is lower than 50% the most recommended electrostimulation is cardiac resynchronisation (CRT-P), which will be accompanied by defibrillation (CRT-D) if FEVI is lower than 35%.

[Clostridium difficile isolation in children hospitalized with diarrhea]. / Aislamiento de Clostridium difficile en niños hospitalizados con diarrea.

INTRODUCTION: Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting. MATERIAL AND METHODS: A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis. RESULTS: Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001). CONCLUSIONS: The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of asymptomatic carriers.

Unknown loads affect force production capacity in early phases of bench press throws.

AIM: Explosive strength training aims to improve force generation in early phases of movement due to its importance in sport performance. The present study examined the influence of lack of knowledge about the load lifted in explosive parameters during bench press throws. METHODS: Thirteen healthy young men (22.8±2.0 years) participated in the study. Participants performed bench press throws with three different loads (30, 50 and 70% of 1 repetition maximum) in two different conditions (known and unknown loads). In unknown condition, loads were changed within sets in each repetition and participants did not know the load, whereas in known condition the load did not change within sets and participants had knowledge about the load lifted. RESULTS: Results of repeated-measures ANOVA revealed that unknown conditions involves higher power in the first 30, 50, 100 and 150 ms with the three loads, higher values of ratio of force development in those first instants, and differences in time to reach maximal rate of force development with 50 and 70% of 1 repetition maximum. CONCLUSION: This study showed that unknown conditions elicit higher values of explosive parameters in early phases of bench press throws, thereby this kind of methodology could be considered in explosive strength training.

Chemical interferences when using high gradient magnetic separation for phosphate removal: consequences for lake restoration.

A promising method for lake restoration is the treatment of lake inlets through the specific adsorption of phosphate (P) on strongly magnetizable particles (Fe) and their subsequent removal using in-flow high gradient magnetic separation (HGMS) techniques. In this work, we report an extensive investigation on the chemical interferences affecting P removal efficiencies in natural waters from 20 Mediterranean ponds and reservoirs. A set of three treatments were considered based on different Fe particles/P concentration ratios. High P removal efficiencies (>80%) were found in freshwater lakes (conductivities<600 µ S cm(-1)). However, a significant reduction in P removal was observed for extremely high mineralized waters. Correlation analysis showed that major cations (Mg(2+), Na(+) and K(+)) and anions (SO(4)(2-) and Cl(-)) played an essential role in P removal efficiency. Comparison between different treatments have shown that when increasing P and Fe concentrations at the same rate or when increasing Fe concentrations for a fixed P concentration, there exist systematic reductions in the slope of the regression lines relating P removal efficiency and the concentration of different chemical variables. These results evidence a general reduction in the chemical competition between P and other ions for adsorption sites on Fe particles. Additional analyses also revealed a reduction in water color, dissolved organic carbon (DOC) and reactive silicate (Si) concentrations with the addition of Fe microparticles.

Setting up High Gradient Magnetic Separation for combating eutrophication of inland waters.

To find new approaches to devise technologies for handling with eutrophication of inland waters is a global challenge. Separation of the P from water under conditions of continuous flow is proposed as an alternative and effective method. This work is based on using highly magnetic particles as the seeding adsorbent material and their later removal from solution by High Gradient Magnetic Separation (HGMS). Contrast to other methods based on batch conditions, large volumes of water can be easily handled by HGMS because of decreasing retention times. This study identifies the best working conditions for removing P from solution by investigating the effects of a set of four different experimental variables: sonication time, flow rate (as it determines the retention time of particles in the magnetic field), magnetic field strength and the iron (Fe) particles/P concentration ratio. Additionally, the change of P removal efficiency with time (build up effect) and the possibility of reusing magnetic particles were also studied. Our results evidenced that while flow rate does not significantly affect P removal efficiency in the range 0.08-0.36 mL s(-1), sonication time, magnetic field strength and the Fe particles/P concentration ratio are the main factors controlling magnetic separation process.

Evaluation of the Etest method for susceptibility testing of Aspergillus spp. and Fusarium spp. to three echinocandins.

We performed Etest and broth microdilution (BMD) susceptibility testing of caspofungin, micafungin and anidulafungin against 67 clinical isolates of Aspergillus spp. and 10 Fusarium spp. Minimal effective concentrations (MECs) by BMD were read after 24 h of incubation at 35 degrees C and Etest MICs were read at 24 and 48 h. MECs < or =0.25 mg/l were obtained with caspofungin for all Aspergillus spp. tested but Etest MICs were < or =1 mg/l at 24 h. The agreement between caspofungin Etest and broth microdilution was good for all Aspergillus species tested (range 82.4-100%) except for A. niger and A. glaucus at 24 h of incubation. Micafungin and anidulafungin MEC and MIC results were lower than those of caspofungin (< or =0.015 mg/l) at 24 and 48 h for all Aspergillus tested. The agreement between the methods was excellent (100%) for micafungin and anidulafungin for all Aspergillus species tested. The three echinocandins were inactive against all isolates of Fusarium spp. showing MECs and MICs >8 mg/l. The Etest method could be a suitable procedure to test the susceptibility of most Aspergillus species to caspofungin, micafungin and anidulafungin; the best agreement was at 24 h.

Substance use among road traffic casualties admitted to emergency departments.

OBJECTIVE: To describe the prevalence of recent psychoactive substance use and associated factors among road traffic casualties admitted to emergency departments. METHODS: A cross-sectional study was carried out, including adults injured in road traffic crashes admitted to the emergency department (ED) of eight hospitals in Catalonia (Spain), during three cross-sections, each of 4 days duration (2005-2006). Information sources were an interview, an oral fluid specimen and the patient's clinical record. Dependent variables were presence of alcohol, cannabis, cocaine, ecstasy, opiates or benzodiazepines. Independent variables were socioeconomic characteristics and circumstances of the injuries and admission. Prevalence and exact 95% confidence intervals were estimated for men and women. Bivariate analyses and multivariate binomial regression modelling were carried out to study factors associated with substance use in male drivers and pedestrians. RESULTS: The prevalence of substance use was higher in men (n = 226) than in women (n = 161) for any substance (34.4% and 16.2%), any illegal substance (19.3% and 7.6%), alcohol (18.5% and 9.2%) and cannabis (17.0% and 3.8%), respectively. In male drivers and pedestrians, alcohol use was associated with being in the 25-30-year age group, being injured at night and the weekend, and arriving at the ED by ambulance; cannabis use was only associated with being in the 18-30-year age group. CONCLUSIONS: A high prevalence of recent psychoactive substance use, especially alcohol, cannabis and cocaine, was observed in all age groups. The results indicate the need to screen for substance use and to give simple advice to casualties at EDs.

Web-based screening and advice for hazardous drinkers: use of a Spanish site.

INTRODUCTION AND AIMS: A website for implementing screening and brief intervention on alcohol was launched in Barcelona, Spain, in October 2006. Its aim was to reach hazardous drinkers who probably would not ask for advice. This article describes use of the site, profiles users and discusses limitations concerning screening. DESIGN AND METHODS: The website included screening, advice and information. Demographic and self-screening data (typical weekly consumption and the Alcohol Use Disorders Identification Test, AUDIT) were examined. RESULTS: In a 12 month period, 12,138 visitors entered the website, 2574 started self-assessment, 1342 completed the table and 724 of these participants completed the AUDIT. These users had a mean age of 27.6 years, one-third of them drank above recommended weekly limits and 84.1% of those who completed the AUDIT (n = 724) scored positive (> or =5); a total of 70.3% of identified at-risk drinkers entered the advice section. Among visitors to the site, risk factors for hazardous drinking were: being male, > or =35 years of age, and drinking heavily at weekends. DISCUSSION AND CONCLUSIONS: The percentage of hazardous drinkers accessing the site was high, and visitors reported that they liked the design, that it was easy to use and that it provided relevant information. Most of those who had sought advice considered it to be helpful. The website seems to be an accessible and useful tool for young people and might be used in youth centres as well as in health-care settings, such as primary care and emergency centres, where it could contribute to health promotion and constitute an easier alternative to screening and brief intervention given by the staff.

Activity of BAL 4815 against filamentous fungi.

OBJECTIVES: BAL 4815 is a new antifungal drug and it is the active component of the antifungal triazole BAL 8557 (the water-soluble precursor). We studied the in vitro fungistatic and fungicidal activities of BAL 4815 against 103 clinical isolates of filamentous fungi, including 51 isolates of Aspergillus spp. and 52 isolates of non-Aspergillus filamentous fungi. METHODS: We evaluated the in vitro activity of BAL 4815 against 51 isolates of Aspergillus spp., 20 isolates of dematiaceous fungi, 18 isolates of hyaline Hyphomycetes and 14 isolates of Zygomycetes. MICs were determined following the CLSI M38-A broth microdilution method, using RPMI 1640 medium buffered to pH 7.0 with MOPS. Microdilution plates were incubated at 35 degrees C and read at 24 and 48 h (Mucorales were read at 24 h). Minimal fungicidal concentrations were also determined. RESULTS: For all isolates, geometric mean MICs, MIC(50)s, MIC(90)s and MIC ranges (mg/L) were: Aspergillus spp., 1.67, 2, 4 and 0.5-4; dematiaceous fungi, 1.62, 1, >8 and 0.03 to >8; hyaline Hyphomycetes, 2.41, 2, >8 and 0.03 to >8; and Zygomycetes, 6.81, 8, >8 and 0.03 to >8. Differences in susceptibility between genera were noted. Scedosporium prolificans, Fusarium spp., Mucor spp. and Rhizopus spp. (MIC(90) > 8 mg/L) were less susceptible than Aspergillus spp. (MIC(90) = 4 mg/L). CONCLUSIONS: BAL 4815 has excellent in vitro activity against Aspergillus spp. and variable activity against other filamentous fungi.

¿Por qué es tan difícil legislar sobre alcohol en España? / Why is it so difficult to legislate on alcohol in Spain?

El vino forma parte de la cultura mediterránea. Beber alcohol es parte de nuestra vida social y sus consecuencias adversas a menudo se han minimizado, culpando más bien al individuo, que no sabe beber, que al agente causante del daño. En los últimos años, los accidentes de tráfico y el consumo ‘en atracones’ de los jóvenes han logrado poner el alcohol en la agenda política. En efecto, los adolescentes han incrementado su consumo de alcohol y desarrollado una pauta de episodios de consumo intensivo, insertado en el ocio nocturno en espacios abiertos, donde masas de jóvenes beben al aire libre botellas grandes (‘botellón’). Se han generado campañas y materiales educativos, pero dos sucesivos anteproyectos de ley sobre medidas de control para prevenir el daño relacionado con el alcohol han fracasado en su intento de ser aprobadas, al chocar dos veces con los mismos intereses creados. El primer anteproyecto (2002) se orientaba a la prevención de problemas de alcohol en la población general. El segundo (2006), se limitaba a la prevención en menores. Nadie, ni siquiera la industria, podía estar en contra. Pero un sesgado interés puso el acento en el vino – que, presuntamente, no debería ser considerado alcohol, sino alimento y, en consecuencia, debía eliminarse de la ley – de modo que el anteproyecto se convirtió en la ‘guerra del vino’, con sus predecibles consecuencias. De nuevo, un anteproyecto de ley sobre alcohol se guardaba sine die en el ‘baúl de los recuerdos’. Dentro de este panorama pesimista, todavía existe algún indicio positivo. Ninguna razón económica ni política debería obstaculizar siquiera la protección de los menores

Wine belongs to the Mediterranean culture. Drinking alcohol is part of our social life, and its negative consequences have often been minimised, blame being apportioned rather to the individual, who doesn’t know how to drink, than to the agent causing the harm. In recent years, road accidents and binge-drinking among young people have put alcohol on the political agenda. Adolescents and young adults have increased their consumption, and a pattern of binge-drinking has developed based on the open-air ‘fiesta’ nightlife, where groups of young people drink large bottles in the streets and squares (botellón). Educational campaigns and material have been mounted and produced, but two consecutive draft laws on measures for the prevention of alcohol-related harm have failed to be approved, coming up on both occasions against the same vested interests. This editorial reviews the ambivalence of society towards regulations on alcohol and the current state of the art. The first draft law (2002) was about preventing alcohol problems in the general population; the second (2006) was limited to the question of prevention among minors. Nobody could oppose it, not even the industry. However, an interested bias put the accent on wine – which allegedly should be considered not as alcohol but rather as food, and consequently removed from the law – so that discussion of the draft law became a ‘wine war’, with predictable consequences. Once again, a draft law on alcohol was shelved sine die and tossed into a corner to gather dust. Within this pessimistic scene, though, there are still some positive signs. No economic or political motives should constitute an obstacle to the protection of minors, at the very least

Recurrent tuberculosis from 1992 to 2004 in a metropolitan area.

The proportion of recurrent tuberculosis (TB) cases caused by re-infection has varied widely in previous studies. The aim of the present study was to determine the relative frequency of relapse and exogenous re-infection in patients with second episodes of TB, using DNA fingerprinting. A population-based retrospective longitudinal descriptive study was conducted in Madrid (Spain) during 1992-2004. The study consisted of 645 patients with culture-confirmed TB. Of these, 20 (3.1%) were retained because they presented with a second isolate of Mycobacterium tuberculosis. Finally, 12 of these cases were excluded because they did not complete the full treatment prescribed. All strains were typed by restriction fragment length polymorphism analysis and some by mycobacterial interspersed repetitive unit-variable number of tandem repeats analysis. The patients with recurrent TB were compared with those without recurrent TB. For seven out of the eight patients, the restriction fragment length polymorphism patterns of the Mycobacterium tuberculosis strains from the episodes of recurrent disease showed identical initial and final genotypes, indicating relapse; the remaining recurrent case showed different genotypes, suggesting exogenous re-infection. Re-infection is possible among people in developed countries, but the rates are lower than those occurring in high-risk areas. The risk factors for recurrent tuberculosis should be taken into account in the follow-up of treatment and tuberculosis control strategies.