The objective of the study was to evaluate the capacity of GERH®-derived local resistance maps (LRMs) to predict antibiotic susceptibility profiles and recommend the appropriate empirical treatment for ICU patients with nosocomial infection. Data gathered between 2007 and 2016 were retrospectively studied to compare susceptibility information from antibiograms of microorganisms isolated in blood cultures, lower respiratory tract samples, and urine samples from all ICU patients meeting clinical criteria for infection with the susceptibility mapped by LRMs for these bacterial species. Susceptibility described by LRMs was concordant with in vitro study results in 73.9% of cases. The LRM-predicted outcome agreed with the antibiogram result in >90% of cases infected with the bacteria for which GERH® offers data on susceptibility to daptomycin, vancomycin, teicoplanin, linezolid, and rifampicin. Full adherence to LRM recommendations would have improved the percentage adequacy of empirical prescriptions by 2.2% for lower respiratory tract infections (p = 0.018), 3.1% for bacteremia (p = 0.07), and 5.3% for urinary tract infections (p = 0.142). LRMs may moderately improve the adequacy of empirical antibiotic therapy, especially for lower respiratory tract infections. LRMs recommend appropriate prescriptions in approximately 50% of cases but are less useful in patients with bacteremia or urinary tract infection.
BACKGROUND: Various models have been proposed to predict mortality rates for hospital patients undergoing colorectal cancer surgery. However, none have been developed in Spain using clinical administrative databases and none are based exclusively on the variables available upon admission. Our study aim is to detect factors associated with in-hospital mortality in patients undergoing surgery for colorectal cancer and, on this basis, to generate a predictive mortality score. METHODS: A population cohort for analysis was obtained as all hospital admissions for colorectal cancer during the period 2008-2014, according to the Spanish Minimum Basic Data Set. The main measure was actual and expected mortality after the application of the considered mathematical model. A logistic regression model and a mortality score were created, and internal validation was performed. RESULTS: 115,841 hospitalization episodes were studied. Of these, 80% were included in the training set. The variables associated with in-hospital mortality were age (OR: 1.06, 95%CI: 1.05-1.06), urgent admission (OR: 4.68, 95% CI: 4.36-5.02), pulmonary disease (OR: 1.43, 95%CI: 1.28-1.60), stroke (OR: 1.87, 95%CI: 1.53-2.29) and renal insufficiency (OR: 7.26, 95%CI: 6.65-7.94). The level of discrimination (area under the curve) was 0.83. CONCLUSIONS: This mortality model is the first to be based on administrative clinical databases and hospitalization episodes. The model achieves a moderate-high level of discrimination.
Colorectal Neoplasms , Hospitalization , Aged , Aged, 80 and over , Female , Hospital Mortality , Humans , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Spain
BACKGROUND: The aim of this study is to determine values of insulinaemia, homeostasis model assessment (HOMA) index and quantitative insulin sensitivity check index (QUICKI) among a population of prepubertal Caucasian children, to analyse factors associated with insulin resistance (IR), and to study its association with cardiovascular risk factors. MATERIALS AND METHODS: Population-based study conducted on a randomly selected sample of prepubescent Caucasian subjects aged 2.00 to 9.99 years old. Anthropometric measurements, blood pressure, and fasting blood samples were obtained, including fasting glucose, triglycerides, High Density Lipoprotein (HDL)-cholesterol, and insulin. In addition, QUICKI and HOMA indices were calculated. Generalised additive models for location, scale and shape (GAMLSS) was used to calculate centiles curves and multivariate logistic regression analysis to assess factors associated with IR. RESULTS: A total of 654 subjects were included. Mean values obtained for insulinaemia, HOMA index, and QUICKI were 3.74 µIU/mL, 0.73, and 0.44, respectively, in the overall population and 3.32 µIU/mL, 0.64 and 0.46, respectively, in normal weight subjects. The main factor associated with IR was abdominal obesity (odds ratio [OR] 3.38 [95% CI 1.44-7.94] in the subgroup aged 2.00-5.99 years and OR 9.14 [3.42-24.41] for those aged 6.00-9.99 years). An increased risk of hyperglycaemia (P = 0.043), hypertriglyceridaemia (P < .001), and HDL < p10 (P = 0.021) was described among children aged 2.00 to 5.99 years with IR, and among those aged 6.00 to 9.99 years, IR was associated with an increased risk of hypertriglyceridaemia (P < .001). CONCLUSION: Abdominal obesity was the main factor associated with IR. Metabolic changes associated with IR seem to be present from early stages of life, which highlights the importance of the prevention, early diagnosis and treatment of obesity.
Insulin Resistance , Insulin/blood , Child , Child, Preschool , Female , Humans , Male , Reference Values , Risk Factors
BACKGROUND: Traffic Injuries are a major public health problem, especially among young people. However, we have not found any useful questionnaire designed in our country for the epidemiological research in this field. The objective of this study was to design and validate an easy and quickly-to-fill questionnaire aimed to collect information on how frequently university car drivers report to be involved in driving circumstances theoretically related to traffic crashes. METHODS: Between 2007 and 2010, a total of 1597 young undergraduate students at the University of Granada answered a self-administered questionnaire collecting information about exposure, accidents and involvement in 28 different driving circumstances. For designing this questionnaire, an extensive literature review was carried out and the opinions of five experts in a panel were also taken into account. By applying the tetracoric correlation coefficient, we conducted a factor analysis. Internal consistency was assessed using Cronbach's alpha coefficient. Finally, we evaluated the crude and adjusted association of each identified factor with the odds for having suffered an accident. RESULTS: After excluding 8 circumstances, the remaining ones were grouped into three factors: the first one included ten high-prevalence circumstances and explained 31.9% of the total variability. Meanwhile, the other two factors included five circumstances each one which respectively explained 15.2% and 12.5% of the variability. Cronbach's alpha coefficients ranged between 0.816 and 0.553. When adjustments according age, sex, years in possession of the driving license and intensity of exposure were made, the first factor obtained the score more strongly associated with the accident rate (OR = 1.51; CI95%: 1.25-1.85). CONCLUSIONS: The final version (20 circumstances) identified three factors related to higher accident rates among the young drivers. The first one integrated, among other circumstances, the excessive speed and driving while sleepy or tired and it was the most closely associated with the accident rate in the adjusted analysis. The second factor included, among others, the commission of driving offences, and the third one included driving under the influence of alcohol, not always wearing the seat belt and distractions.
Accidents, Traffic/psychology , Automobile Driving/psychology , Dangerous Behavior , Surveys and Questionnaires , Accidents, Traffic/statistics & numerical data , Automobile Driving/statistics & numerical data , Factor Analysis, Statistical , Female , Humans , Male , Models, Statistical , Young Adult
Fundamentos: Las Lesiones por Tráfico continúan siendo un importante problema de Salud Pública en población joven. A pesar de ello, no existen en nuestro país cuestionarios idóneos para la investigación epidemiológica de este problema. El objetivo del presente trabajo fue diseñar y validar un cuestionario orientado a explorar la frecuencia de implicación en circunstancias de conducción teóricamente asociadas con la accidentalidad por tráfico en población universitaria. Métodos: Se aplicó un cuestionario autoadministrado (MATCA: movilidad, accidentalidad por tráfico y circunstancias asociadas) a 1597 jóvenes alumnos de grado de la Universidad de Granada, entre los años 2007 y 2010, que recogía información, entre otras variables, sobre la exposición, la accidentalidad y la implicación en 28 circunstancias de conducción. Para su diseño se realizó una extensa revisión de la literatura al respecto y se contó con el juicio de un panel de cinco expertos. Aplicando el coeficiente de correlación tetracórico, se realizó un análisis factorial. La consistencia interna se valoró mediante el coeficiente alfa de Crombach. Finalmente, se valoró la asociación cruda y ajustada de cada factor identificado con la odds de haber sufrido un accidente. Resultados: Tras descartar 8 circunstancias, las restantes se agruparon en tres factores: el primero incluyó diez circunstancias de elevada prevalencia y explicó el 31,9% de la variabilidad total. Los otros dos factores, incluyeron cinco circunstancias cada uno que explicaron respectivamente, el 15,2% y el 12,5% de la variabilidad. Los coeficientes alfa de Crombach oscilaron entre 0,816 y 0,553. Cuando se ajustó por la edad, el sexo, los años de antigüedad del permiso y la intensidad de exposición, la puntuación más fuertemente asociada a la accidentalidad fue la del primer factor (OR=1,51: IC95% 1,25-1,85). Conclusiones: La versión final (20 circunstancias), identificó tres factores asociados a una mayor accidentalidad entre jóvenes conductores. El primero integró, entre otras, la velocidad excesiva y conducir con sueño o cansancio, y fue el más estrechamente asociado a la accidentalidad en el análisis ajustado. El segundo agrupó las circunstancias relacionadas con la comisión de infracciones y el tercero incluyó la conducción bajo los efectos del alcohol, el no uso siempre del cinturón y las distracciones(AU)
Background: Traffic Injuries are a major public health problem, especially among young people. However, we have not found any useful questionnaire designed in our country for the epidemiological research in this field.. The objective of this study was to design and validate an easy and quickly-to-fill questionnaire aimed to collect information on how frequently university car drivers report to be involved in driving circumstances theoretically related to traffic crashes. Methods: Between 2007 and 2010, a total of 1597 young undergraduate students at the University of Granada answered a self-administered questionnaire collecting information about exposure, accidents and involvement in 28 different driving circumstances. For designing this questionnaire, an extensive literature review was carried out and the opinions of five experts in a panel were also taken into account. By applying the tetracoric correlation coefficient, we conducted a factor analysis. Internal consistency was assessed using Cronbach's alpha coefficient. Finally, we evaluated the crude and adjusted association of each identified factor with the odds for having suffered an accident. Results: After excluding 8 circumstances, the remaining ones were grouped into three factors: the first one included ten high-prevalence circumstances and explained 31.9%of the total variability.Meanwhile, the other two factors included five circumstances each one which respectively explained 15.2% and 12.5% of the variability. Cronbach's alpha coefficients ranged between 0.816 and 0.553.When adjustments according age, sex, years in possession of the driving license and intensity of exposure were made, the first factor obtained the score more strongly associated with the accident rate (OR = 1.51; CI95%: 1.25-1.85). Conclusions: The final version (20 circumstances) identified three factors related to higher accident rates among the young drivers. The first one integrated, among other circumstances, the excessive speed and driving while sleepy or tired and it was the most closely associated with the accident rate in the adjusted analysis. The second factor included, among others, the commission of driving offences, and the third one included driving under the influence of alcohol, not always wearing the seat belt and distractions(AU)
Humans , Male , Female , Adolescent , Young Adult , Risk Management/legislation & jurisprudence , Risk Management/organization & administration , Risk-Taking , Automobile Driver Examination/legislation & jurisprudence , Automobile Driving/education , Automobile Driving/legislation & jurisprudence , Automobile Driving/standards , Accidents, Traffic/legislation & jurisprudence , Accidents, Traffic/prevention & control , Surveys and Questionnaires , Impacts of Polution on Health/legislation & jurisprudence , Impacts of Polution on Health/prevention & control , Risk Index , Accidents, Traffic/statistics & numerical data , Accidents, Traffic/trends
