Medications and traffic accidents involving older drivers: do Spanish primary healthcare physicians know enough?

BACKGROUND: Our aim was to evaluate Spanish family doctors' knowledge about medications that increase the risk of traffic accidents involving older drivers, and to obtain data about the involvement of family doctors in accident prevention activities and the associations between these factors and their demographic and workplace characteristics. METHODS: A cross-sectional study of 1888 family doctors throughout Spain was carried out from 2016 to 2018. Participants completed a previously validated self-administered questionnaire that explored whether family doctors distinguished between medications associated with a high or low risk of involvement in a traffic accident, investigated the appropriateness of advice given to older patients, and physicians' involvement in preventive activities. Multiple regression models were used to estimate the adjusted association of these variables with each other and with characteristics of family doctors in the sample. RESULTS: On a scale of 1 (never or hardly ever) to 4 (always), the indexes constructed to evaluate how often family doctors believed they should oversee the use of high-risk and low-risk medications yielded values of 3.38 for the former and 2.61 for the latter (p < 0.001). Only 24% responded correctly to all three items that inquired about the appropriateness of the advice they gave to older patients. On a scale of 1 to 4, the frequency at which family doctors gave older patients advice about preventive measures was 2.85, and only 43% reported allocating time during appointments to provide this advice. These latter two variables were directly associated with appropriate values for the index used to evaluate physicians' oversight of medications associated with a high risk. The perception of risk associated with medications and involvement in preventive activities were both greater among female participants. CONCLUSIONS: Family doctors correctly identified medications according to their risk of playing a role in traffic accidents, although the recommendations they gave to their patients were not always appropriate. These findings, along with physicians' infrequent involvement in preventive activities, suggest a need to improve family doctors' competencies and increase the resources available to them so that they can provide their older patients with advice on ways to prevent involvement in traffic accidents.

Hospital Environmental Disruptors and Caregiver Sleep During Hospitalization.

PURPOSE: Caregivers must cope with a poor sleep environment when caring for someone admitted to the hospital. The aim was to study the environmental factors associated with a sleep disruption pattern in caregivers during hospitalization and to test their association with caregivers' insomnia symptoms. DESIGN: This was a cross-sectional study. METHODS: One hundred twenty-three caregivers completed the study. The effect of environmental stimuli on sleep disruption was measured on a scale from 1 to 10 (1 = no disruption, 10 = significant disruption). Type of room (single vs shared), insomnia symptoms, anxiety and depression, and patients' dependence (Barthel Index) were assessed as well. Caregiver and patient characteristics as well as identified hospital disruptors were compared with Student t test, χ2 test, and Fisher exact test according to the caregivers' type of room. A linear regression model using main caregiver and patient sociodemographic variables, questionnaires, and the sum of all hospital disruptors determined the factors associated with caregivers' insomnia symptoms. RESULTS: Of the caregivers and their care recipients, 51.2% shared a room with 1 to 2 other patients. Higher self-reported levels of sleep disruption due to environmental stimuli were found in shared rooms when compared with single rooms (eg, nursing care, noise, and light) (P < .05). Hospital sleep disruptors (adjusted regression coefficient, 0.15; 95% confidence interval, 0.06-0.24) and caregiver anxiety (adjusted regression coefficient, 0.57; 95% confidence interval, 0.33-0.81) were predictors for insomnia (P < .01). However, caregivers' type of room was not associated with insomnia severity symptoms (P > .05). CONCLUSIONS: Interventions are urgent to implement, such as relieving caregivers from patient needs during the night, providing them with single rooms, and conducting multiple nursing tasks in 1 visit to minimize night hospital noise.

Attitudes, Beliefs, and Current Practices Carried Out by Family Physicians in Spain Regarding the Prevention of Road Injuries in Older Adults: A Nationwide Cross-Sectional Study.

Purpose: The activities related to the prevention of crash injuries in older adults (PCIOA) performed by Family Physicians (FPs) have been scarcely studied. Our aim was to estimate the frequency of PCIOA activities performed by FPs in Spain and its association with attitudes and beliefs regarding this health problem. Methods: We conducted a cross-sectional study in a nationwide sample of 1888 FPs working in Primary Health Care Services, recruited from October 2016 to October 2018. Participants completed a validated, self-administered questionnaire. Study variables included three scores related to current practices (General Practices, General Advice and Health Advice), several scores related to attitudes (General, Drawbacks and Legal), demographic and workplace characteristics. To obtain the adjusted coefficients and their 95% confidence intervals, we applied mixed effects multi-level linear regression models and the likelihood-ratio test to compare multi-level and one-level models. Results: The frequency of PCIOA activities reported by FPs in Spain was low. The General Practices Score was 0.22/1, the General Advice Score was 1.82/4, the Health Advice Score was 2.61/4, and the General Attitudes Score was 3.08/4. The importance given to road crashes in the elderly obtained 7.16/10, the role that FPs should play in the PCIOA obtained 6.73/10, and the current perceived role obtained 3.95/10. The General Attitudes Score and the importance that FPs give themselves in the PCIOA were associated with the three Current Practices Scores. Conclusion: The frequency of activities related to the PCIOA that FPs usually carry out in Spain is far below desirable standards. The average level of attitudes and beliefs about the PCIOA of the FPs working in Spain seems adequate. The variables of the most pronounced FPs associated with the prevention of traffic accidents in older drivers were age over 50 years, female sex and foreign nationality.

Insomnia Symptoms and Associated Factors in Caregivers of Adult Hospitalized Patients.

Caregivers experience high levels of emotional stress and must cope with several clinical and hospital-related environmental factors that seriously impact their night's rest. The purpose of this study was to establish the prevalence of insomnia symptoms in a sample of caregivers of adult hospitalized patients and to examine the relationships between insomnia symptoms and patient and caregiver-associated factors. A total of 152 caregivers were enrolled from the two main hospitals in Granada, Spain. Sociodemographic, economic, and care-related data were collected. Insomnia symptoms, burden, anxiety and depression, social support, and resilience were assessed. Information on patients' hospital admission, dependence, and neuropsychiatric symptoms was also obtained. Most caregivers were middle-aged women caring for their spouses. Self-reported insomnia prevalence was set at 45.4%. Comparison analyses between caregivers suffering from insomnia symptoms and non-insomniacs showed significantly higher burden, anxiety and depression and patients' neuropsychiatric symptoms (p < 0.05) and lower resilience and social support in the former (p < 0.01). A regression analysis showed that anxiety (ORa = 1.15; p < 0.05) and higher caregiver education level (ORa = 5.50; p < 0.05) were factors significantly associated with insomnia symptoms. Patients' neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; p = 0.06). There is an acute need to address, prevent and treat insomnia problems in caregivers.

Addressing the association between driving with an expired vehicle inspection certificate and injury severity after a crash.

OBJECTIVES: The aim of this study was to quantify the association between driving a vehicle with an expired vehicle inspection certificate (DEVIC) and the severity of injuries sustained by drivers involved in collisions. METHODS: A cohort study was designed to compare the incidence of minor injuries, major injuries, and deaths between DEVIC and non-DEVIC drivers involved in collisions. We selected all 51,305 non-responsible drivers (i.e., drivers who did not commit an error or infraction) involved in clean collisions (those in which only one driver in multivehicle collisions committed a traffic infraction or error) from the population of drivers of four-wheeled motor vehicles involved in crashes recorded in the National Register for Road Traffic Accident Victims in Spain from 2014 to 2017. RESULTS: DEVIC was not related with a greater severity of drivers' injuries. The adjusted estimates for the association between DEVIC and major injuries or death yielded an odds ratio of 0.91 (0.66-1.25), compared to no injuries or minor injuries, and a relative risk ratio of 0.90 (0.65-1.24) compared to no injuries. CONCLUSIONS: Although we have not found an association between DEVIC and drivers' injury severity, the study limitations does not allow us to discard the usefulness of periodic vehicle inspection in reducing the risk of more severe injury among drivers involved in road crashes.

Interventions that Improve Sleep in Caregivers of Adult Care-Recipients: A Systematic Review.

The purpose of the present review was to compile and analyze all interventions aimed at improving the sleep-rest pattern of adult caregivers. A database search was performed in PubMed, Embase, Scopus, CINAHL and PsycINFO. Twenty-four papers published between 1998 and 2020 met the inclusion criteria. Informal caregivers can benefit from various types of sleep interventions, including (a) cognitive-behavioral sleep interventions (CBIs), (b) caregiver health interventions (CHIs), and (c) exercise programs. Other types of interventions such as acupressure, back massage, reflexology, music, and heart rate variability biofeedback sessions may have beneficial effects on the sleep of caregivers. Yet, studies on this topic are heterogeneous and often have considerable methodological shortcomings. Few clinical trials have explored sleep problems as a dyadic caregiver-patient relationship. It is necessary to conduct new clinical trials to determine the viability and level of evidence of the various strategies aimed at improving sleep of informal caregivers.

Development and validation of a questionnaire measuring knowledge, attitudes, and current practices of primary healthcare physicians regarding road injury prevention in older adults.

BACKGROUND: Older adults present high risk of involvement in road crashes. Preventive interventions conducted by their primary healthcare physicians (PHPC) could reduce this public health issue. OBJECTIVE: The objective of this study was to design and validate a self-administered questionnaire that measures the knowledge, attitudes, and current practices (CP) of PHCP in Spain regarding the prevention of road injuries in older adults. METHODS: One thousand eight hundred and ninety-seven PHCP completed a questionnaire piloted previously in an expert panel and two convenience samples of physicians. It comprised 78 items grouped in five sections and was mainly focused on exploring three constructs: knowledge, attitudes, and CP. Exploratory factor analysis was used to obtain evidence of internal structure validity. Reliability was assessed through Cronbach's α coefficient. Correlation coefficients for the scores constructed for each of the extracted factors were calculated to assess convergent and discriminant validity. RESULTS: Factor analysis extracted four factors each for the knowledge and attitudes constructs, and three factors for the CP construct, which explained more than 55% of the variance in each construct. Except for two factors of the knowledge construct regarding existing health problems associated to the risk of involvement in road crashes, the clustering pattern of all other items across the remaining nine factors was consistent and in agreement with previous knowledge. Cronbach's α values were greater than 0.7 for all constructs. CONCLUSIONS: Our questionnaire appears to be valid enough to assess the attitudes, CP, and medication-related knowledge of PHCP in Spain regarding the prevention of road injuries in older adults.

Sex Differences in the Amount and Patterns of Car-Driving Exposure in Spain, 2014 to 2017: An Application of a Quasi-Induced Exposure Approach.

We designed a cross-sectional study in Spain, from 2014 to 2017. Our objective was to assess sex-related differences in the amount of driving exposure of car drivers, overall and stratified by the main environment-related driving conditions. We compared the sex distribution across three populations: (1) total number of person-years aged > 18 years; (2) total number of person-years aged > 18 years holding a valid car-driving license; and (3) total number of non-responsible car drivers involved in crashes with another offending driver, stratified by different environmental variables. The quasi-induced exposure approach was applied: the non-responsible drivers were considered as representative of the entire population of drivers on the road at the place and time at which the crash occurred. We calculated the female-to-male odds ratio (OR) by comparing population 2 versus 1, and population 3 versus 2. Finally, we performed separate regression models in population 3 for each environment-related variable as the dependent variable and driver's age and sex as the independent variables. The female-to-male OR for the first comparison was 1.12, but values below 1 were found for extreme age groups. In the second comparison, an OR of 0.50 (0.49-0.51) was found, with progressively lower OR values as age increased. In population 3, women were found to drive less than men in environments known to be high risk (i.e., open roads, night-time, poor light conditions, and weekends). A significant gender gap exists in the amount and type of driving exposure. Although women obtain a driving license more frequently than men, they drive much less and tend to avoid high-risk environments. These results emphasize the need to incorporate a gender perspective in the development and implementation of road safety interventions.

Prevention of road crashes in older adults: perspectives on facilitators, barriers and the role of the family doctor.

BACKGROUND: People over 64 years have a high fatality rate when they are involved in traffic accidents. Besides, older victims of road crashes are expected to rise in the future due to population aging. The purpose of the study was to document their perception on the role of the family doctor, the main facilitating factors, and the perceived barriers to the temporary or permanent restriction of their driving. METHODS: This qualitative study used focus group methodology. A sample of 16 people over 65 years old was obtained through a series of segmentation criteria at an active participation centre for older adults in a small town in Jaén province (Spain). All were invited to participate in a discussion during which they were asked to express their opinions and subjective experiences concerning the role of their family doctor. The group conversation was taped, fully transcribed and analysed, and codes were generated with both deductive and inductive methods. RESULTS: After merging the codes to generate themes, we identified 9 relevant categories: perception of age-related risk, road safety, role of public authorities, driver assessment centre, role of the family doctor, role of the family, proposals for addressing traffic accidents in older adults, consequences of the driving prohibition, and public transport. All categories help to explain the subjective driving and traffic safety experiences of older road users. CONCLUSIONS: Although family doctors do not usually ask their older patients about road driving, they are highly valued by these patients. Thus, family doctors have a great potential to act, along with the family members, for the benefit of older patients' traffic safety, in ways that can prevent their involvement in road crashes and reduce the negative consequences of having to stop driving if necessary.

Erythema Increase Predicts Psoriasis Improvement after Phototherapy.

Psoriasis is a major global health problem. There is a need to develop techniques to help physicians select the most appropriate cost-effective therapy for each patient. The main objectives of this study are (1) to evaluate changes in epidermal barrier function and skin homeostasis after phototherapy and (2) to explore potentially predictive values in epidermal barrier function and skin homeostasis to assess clinical improvement after fifteen sessions of phototherapy. A total of 76 subjects, 38 patients with plaque-type psoriasis and 38 gender- and age-matched healthy volunteers, were included in the study. Erythema, transepidermal water loss (TEWL), temperature, stratum corneum hydration (SCH), pH, sebum, and antioxidant capacity were measured before and after the first and fifteenth phototherapy session. Erythema (401.09 vs. 291.12 vs. 284.52 AU, p < 0.001) and TEWL (18.23 vs. 11.44 vs. 11.41 g·m-2·h-1, p < 0.001) were significantly higher at psoriatic plaques than in uninvolved psoriatic skin and healthy volunteers, respectively, while SCH was lower (9.71 vs. 44.64 vs. 40.00 AU, p < 0.001). After fifteen phototherapy sessions, TEWL (-5.19 g·m-2·h-1, p = 0.016) decreased while SCH (+7.01 AU, p = 0.013) and erythema (+30.82 AU, p = 0.083) increased at psoriatic plaques. An erythema increase exceeding 53.23 AU after the first phototherapy session, with a sensitivity of 71.4% and specificity of 84.2%, indicates that a patient may improve Psoriasis Area and Severity Index (PASI) by ≥3 points after fifteen phototherapy sessions. In conclusion, phototherapy improves epidermal barrier function in psoriatic patients and the erythema increase after one phototherapy session could help doctors select psoriasis patients who are more likely to respond to phototherapy.

Effect of Periodic Vehicle Inspection on Road Crashes and Injuries: A Systematic Review.

This systematic review was conducted to determine the effect of periodic motor vehicle inspections on road crashes and injuries, compared to less exposure to periodic inspections or no inspections. The Medline, Web of Science, and Scopus databases were used to search the literature. Ecological studies were specifically excluded. A reverse search of the results with these databases and of other identified narrative reviews was also performed. Of the 5065 unique references initially extracted, only six of them met the inclusion criteria and were selected for review: one experimental study, two cohort studies with an internal comparison group, two cohort studies without a comparison group, and one case-control study. Two authors independently extracted the information and assessed the quality of each study. Due to the heterogeneity of the designs and the intervention or comparison groups used, quantitative synthesis of the results was not attempted. Except for the case-control study, which showed a significant association between road crashes and the absence of a valid vehicle inspection certificate, the other studies showed either a small reduction in crash rates (around 9%), no association, or a higher crash rate in vehicles with more inspections. In all observational studies, the risk of residual confounding bias was significant and could have explained the results. Therefore, although the research reviewed here suggests that periodic inspection may be associated with a slight reduction in road crashes, the marked heterogeneity along with probable residual confounding in most reports prevented us from establishing causality for this association.

How many collateral casualties are associated with road users responsible for road crashes? / ¿Cuántas víctimas colaterales se asocian con los usuarios de la carretera responsables de los accidentes de tráfico?

Objective: To estimate the number of collateral casualties associated with road users considered responsible for a road crash. Method: We analyzed the case series comprising all 790,435 road users involved in road crashes with victims in Spain from 2009 to 2013, recorded in a nationwide police-based registry. For each road user assumed to be responsible for a crash, we collected information relative to health outcomes in other people involved in it, and obtained the total number of collateral casualties per 100 road users considered responsible for the crash. We then estimated the strength of associations between sex, age and the number of collateral casualties generated by car drivers considered responsible for the crash, and calculated rate ratios and corresponding 95% confidence intervals. Results: Pedestrians responsible for crashes were associated with the lowest number of collateral casualties (13.1/100), whereas the highest number (153/100) was observed for bus drivers responsible for crashes. Car drivers were associated with 104.4/100 collateral casualties. The youngest and the oldest car drivers responsible for crashes were associated with 33% and 41% more deaths, respectively, than the 25-34 year old group. Male drivers were associated with 22% more collateral casualties than female drivers. Conclusions: Regardless of the type of road user who was responsible for a road crash, their active contribution to the crash led to an additional number of collateral casualties in other, non-responsible users. The number and severity of collateral casualties were related to the type of vehicle and the number of people involved. These results are potentially useful to support the need to promote safer driver practices among subgroups of high-risk drivers. (AU)

Objetivo: Estimar el número de víctimas colaterales asociadas a los usuarios de las vías de tráfico responsables de una colisión. Método: Se estudió la serie de casos formada por los 790.435 usuarios de la vía implicados en accidentes de tráfico con víctimas en España, entre 2009 y 2013, recogidos en el Registro de Accidentes de Tráfico con Víctimas de la Dirección General de Tráfico. Para cada uno de los usuarios considerado responsable se recogió información sobre las consecuencias sanitarias para las otras personas implicadas en el mismo accidente, y se calculó el número total de víctimas colaterales por cada 100 usuarios responsables. A continuación se estimó la fuerza de asociación de la edad y el sexo de los conductores de turismo con el número de víctimas colaterales generadas por ellos, y se obtuvieron las correspondientes razones de tasas y sus intervalos de confianza del 95%. Resultados: Los peatones responsables de atropellos se asociaron al menor número de víctimas colaterales (13,1/100), mientras que la cifra más alta de estas (153/100) se asoció a los conductores de autobús responsables del accidente. Los de turismo implicaron a 104,4/100. Los conductores de turismo más jóvenes (<25 años) y los de mayor edad (>64 años) implicaron respectivamente un 33% y un 41% más de víctimas colaterales que el grupo de 25-34 años. Los varones se asociaron a un 22% más de víctimas colaterales que las mujeres. Conclusiones: Independientemente del tipo de usuario responsable del accidente, su contribución activa se asoció a un número adicional de víctimas colaterales, cuyas magnitud y gravedad dependieron sobre todo del tipo de vehículo conducido. Este trabajo puede ser útil para reforzar las actuaciones destinadas a prevenir la accidentalidad en los usuarios de alto riesgo. (AU)

Sequelae, persistent symptomatology and outcomes after COVID-19 hospitalization: the ANCOHVID multicentre 6-month follow-up study.

BACKGROUND: Long-term effects of COVID-19, also called Long COVID, affect more than 10% of patients. The most severe cases (i.e. those requiring hospitalization) present a higher frequency of sequelae, but detailed information on these effects is still lacking. The objective of this study is to identify and quantify the frequency and outcomes associated with the presence of sequelae or persistent symptomatology (SPS) during the 6 months after discharge for COVID-19. METHODS: Retrospective observational 6-month follow-up study conducted in four hospitals of Spain. A cohort of all 969 patients who were hospitalized with PCR-confirmed SARS-CoV-2 from March 1 to April 15, 2020, was included. We collected all the SPS during the 6 months after discharge reported by patients during follow-up from primary care records. Cluster analyses were performed to validate the measures. The main outcome measures were return to the Emergency Services, hospital readmission and post-discharge death. Surviving patients' outcomes were collected through clinical histories and primary care reports. Multiple logistic regression models were applied. RESULTS: The 797 (82.2%) patients who survived constituted the sample followed, while the rest died from COVID-19. The mean age was 63.0 years, 53.7% of them were men and 509 (63.9%) reported some sequelae during the first 6 months after discharge. These sequelae were very diverse, but the most frequent were respiratory (42.0%), systemic (36.1%), neurological (20.8%), mental health (12.2%) and infectious (7.9%) SPS, with some differences by sex. Women presented higher frequencies of headache and mental health SPS, among others. A total of 160 (20.1%) patients returned to the Emergency Services, 35 (4.4%) required hospital readmission and 8 (1.0%) died during follow-up. The main factors independently associated with the return to Emergency Services were persistent fever, dermatological SPS, arrythmia or palpitations, thoracic pain and pneumonia. CONCLUSIONS: COVID-19 cases requiring hospitalization during the first wave of the pandemic developed a significant range of mid- to long-term SPS. A detailed list of symptoms and outcomes is provided in this multicentre study. Identification of possible factors associated with these SPS could be useful to optimize preventive follow-up strategies in primary care for the coming months of the pandemic.

OXA-48 Carbapenemase-Producing Enterobacterales in Spanish Hospitals: An Updated Comprehensive Review on a Rising Antimicrobial Resistance.

Carbapenemase-producing Enterobacterales (CPE) are significant contributors to the global public health threat of antimicrobial resistance. OXA-48-like enzymes and their variants are unique carbapenemases with low or null hydrolytic activity toward carbapenems but no intrinsic activity against expanded-spectrum cephalosporins. CPEs have been classified by the WHO as high-priority pathogens given their association with morbidity and mortality and the scarce number of effective antibiotic treatments. In Spain, the frequency of OXA-48 CPE outbreaks is higher than in other European countries, representing the major resistance mechanism of CPEs. Horizontal transfer of plasmids and poor effective antibiotic treatment are additional threats to the correct prevention and control of these hospital outbreaks. One of the most important risk factors is antibiotic pressure, specifically carbapenem overuse. We explored the use of these antibiotics in Spain and analyzed the frequency, characteristics and prevention of CPE outbreaks. Future antibiotic stewardship programs along with specific preventive measures in hospitalized patients must be reinforced and updated in Spain.

Prevalence of and Factors Associated with Driving a Vehicle with Timed-Out Inspection Certificate in Spain.

This study aimed to estimate the prevalence of vehicles on the road with a timed-out vehicle inspection certificate (TOVIC) and the associations of driver, vehicle, and environmental factors with this infraction. A quasi-induced exposure approach was used in this cross-sectional study to analyze a case series comprising 51,305 drivers passively involved in clean collisions (only one infractor driver involved) between two or more vehicles registered in the Spanish National Register of Road Crashes with Victims from 2014 to 2017. The prevalence of TOVIC was estimated in the whole sample and in subgroups defined by the variables considered. Multivariate logistic regression modeling was used to obtain adjusted odds ratios for the association between TOVIC and each category of the variables. The prevalence of TOVIC was low, although significant differences were found for certain subcategories of drivers, vehicles, and environmental factors. Significant positive adjusted associations were found between TOVIC and license-related infractions, vans (compared to cars), vehicle age, and vehicle defects. Several vehicle-related factors potentially associated with a high risk of involvement in a crash were clearly related with TOVIC, which suggests the need for measures to control this non-negligible number of high-risk vehicles on the road.

How many collateral casualties are associated with road users responsible for road crashes?

OBJECTIVE: To estimate the number of collateral casualties associated with road users considered responsible for a road crash. METHOD: We analyzed the case series comprising all 790,435 road users involved in road crashes with victims in Spain from 2009 to 2013, recorded in a nationwide police-based registry. For each road user assumed to be responsible for a crash, we collected information relative to health outcomes in other people involved in it, and obtained the total number of collateral casualties per 100 road users considered responsible for the crash. We then estimated the strength of associations between sex, age and the number of collateral casualties generated by car drivers considered responsible for the crash, and calculated rate ratios and corresponding 95% confidence intervals. RESULTS: Pedestrians responsible for crashes were associated with the lowest number of collateral casualties (13.1/100), whereas the highest number (153/100) was observed for bus drivers responsible for crashes. Car drivers were associated with 104.4/100 collateral casualties. The youngest and the oldest car drivers responsible for crashes were associated with 33% and 41% more deaths, respectively, than the 25-34 year old group. Male drivers were associated with 22% more collateral casualties than female drivers. CONCLUSIONS: Regardless of the type of road user who was responsible for a road crash, their active contribution to the crash led to an additional number of collateral casualties in other, non-responsible users. The number and severity of collateral casualties were related to the type of vehicle and the number of people involved. These results are potentially useful to support the need to promote safer driver practices among subgroups of high-risk drivers.

Adherence to recommended intake of pulses and related factors in university students in the UniHcos project.

Pulses such as peas, beans or lentils are one of the most complete foods at the nutritional level; however, they are one of the most often neglected foods in the diets of university students. Entrance to university translates into a major lifestyle change for many young people, and the habits acquired or cemented at this time will remain into adulthood. The objective of this study is to analyse the association between personal/sociodemographic factors, dietary intake of other food groups and the consumption of pulses in first-year university students. This cross-sectional study is part of the UniHcos project, a multicentre study of multipurpose prospective cohorts in eleven Spanish universities. Data from 9862 university students were collected through an online self-questionnaire completed by all students who met the selection criteria and agreed to participate in the project during the 2011-2018 academic years. Of students, 75·8 % presented an inadequate (≤2 times/week) consumption of pulses. Living outside the family home in either a student residence (OR 0·76; 95 % CI 0·69, 0·84) or rental (OR 0·81; 95 % CI 0·70, 0·95) decreased the compliance with recommendations on the consumption of pulses. Low consumption of pulses is seemingly not restricted to a specific profile or dietary pattern among university students, and no specific focus group for intervention can be identified. Policies promoting the consumption of pulses among the university population as a whole are necessary to increase compliance rates with the dietary recommendations.

Is driving without a valid license associated with an increased risk of causing a road crash?

The aim of this study was to estimate the association between each cause of driving without a valid license (DWVL) and the risk of causing a road crash, considering driver, vehicle and environmental factors. A case-control study based on data from the Spanish Register of Road Accidents with Victims was carried out between 2014 and 2017. Cases included 28,620 drivers of moving private cars, vans and off-road vehicles involved in single crashes plus 50,100 drivers deemed responsible for clean collisions (i.e. those in which only one driver was labeled as responsible). In accordance with the quasi-induce exposure approach, drivers not responsible for clean collisions comprised the control group (N = 51,656). Logistic and multinomial regression models were used to estimate crude and adjusted Odds Ratios or Relative Risk Ratios between each reason for DWVL and the risk of being a case of all, single and multi-vehicle collisions. A significant association was found between all reasons for DWVL and the risk of causing a road crash. This association was particularly high for drivers with a suspended license and drivers who had never obtained a license. In these subgroups of drivers, the proportion of the relationship explained by high-risk driving behaviors is high. Our results support the need for applying continued strategies to identify and control these subgroups of drivers.

Explaining the Association between Driver's Age and the Risk of Causing a Road Crash through Mediation Analysis.

It has been widely reported that younger and older drivers have an excess risk of causing a road crash. Two casual hypotheses may coexist: the riskier driving behaviors and age-related mechanisms in extreme age groups (direct path) and the different environmental and vehicle circumstances (indirect path). Our aim was to quantify, through a mediation analysis, the percentage contribution of both paths. A case-control study was designed from the Spanish Register of Road Crashes with victims from 2014 to 2017. Assuming a quasi-induced exposure approach, controls were non-responsible drivers involved in clean collisions between two or more vehicles (n = 52,131). Responsible drivers for these collisions plus drivers involved in single crashes constituted the case group (n = 82,071). A logit model in which the outcome was the log (odds) of causing a road crash and the exposure was age groups was adjusted for driver, vehicle and environmental factors. The highest crash risk was observed in extreme age groups, compared to the 35-44 year old age group: the youngest (18-24 years old, odds ratio = 2.14, 95% confidence interval: 2.06-2.24) and the oldest drivers (>74 years old, odds ratio = 3.30, 95% confidence interval: 3.04-2.58). The mediation analysis identified the direct path as the main explanatory mechanism for these increases: 89% in the youngest and 93% in the oldest drivers. These data support the hypothesis that the excess crash risk observed for younger and older drivers is mainly related to their higher frequency of risky driving behaviors and age-related loss of capabilities. Preventive strategies in extreme-aged drivers should focus on decreasing these behaviors.

Agentes terapéuticos utilizados en 238 pacientes hospitalizados por COVID-19 y su relación con la mortalidad / Therapeutic agents tested in 238 COVID-19 hospitalized patients and their relationship with mortality

ANTECEDENTES Y OBJETIVO: En los últimos meses se han realizado grandes esfuerzos para evaluar las terapias más eficaces en el manejo de pacientes con COVID-19. Actualmente ninguna combinación ha demostrado de manera consistente una relación clara con la mortalidad. Nuestro objetivo fue valorar el patrón de asociaciones observado entre los distintos tratamientos intrahospitalarios administrados a 238 pacientes ingresados por COVID-19 y la mortalidad. MATERIALES Y MÉTODOS: Se analizaron las historias clínicas electrónicas de aquellos pacientes dados de alta o que fallecieron por COVID-19 entre el 16 de marzo y el 10 de abril de 2020 en el Hospital Universitario San Cecilio (Granada, España). Se obtuvo información sobre sexo, edad, comorbilidades al ingreso, parámetros clínicos, analíticos, pruebas de imagen y tratamientos empíricos empleados. La variable de desenlace fue la mortalidad intrahospitalaria. Para estimar las asociaciones entre los diferentes tratamientos y el riesgo de mortalidad se estimaron, mediante modelos de regresión de Cox, hazard ratio ajustadas por edad, sexo, patologías previas y gravedad al ingreso. RESULTADOS: La combinación de fármacos más frecuentemente empleada fue la formada por heparina de bajo peso molecular (HBPM), hidroxicloroquina y ritonavir/lopinavir. Ninguno de los tratamientos utilizados mostró una asociación independiente con la mortalidad. Los fármacos que mostraron una asociación inversa de mayor magnitud fueron el tocilizumab y los corticoides. CONCLUSIONES: El patrón se asociaciones obtenido es consistente con lo reportado en la bibliografía. Parece oportuno diseñar ensayos aleatorizados que valoren el posible efecto protector de los corticoides y el tocilizumab sobre el riesgo de muerte en algunos subgrupos de pacientes hospitalizados por COVID-19

BACKGROUND AND OBJECTIVES: In the last months great efforts have been developed to evaluate the more efficient therapeutic agents in the management of patients with COVID-19. Currently, no specific drug combination has consistently demonstrated an association with mortality. The aim of this study was to assess the pattern of associations observed between the different in-hospital treatments administered to a series of 238 patients admitted for COVID-19 and their relationship with mortality. METHODS: The electronic medical records of patients that discharged or died from COVID-19 in the Hospital Universitario San Cecilio (Granada, Spain) between March 16 and April 10, 2020 were analysed. From these records, information was obtained on sex, age, comorbidities at admission, clinical information, analytical parameters, imaging tests and empirical treatments used. The outcome variable was the in-hospital mortality. To estimate the associations between the different therapeutic alternatives and the risk of mortality, hazard ratios adjusted for age, sex, previous pathologies and severity at discharge were estimated using Cox regression models. RESULTS: The most frequently used combination of drugs was low molecular weight heparins, hydroxychloroquine, and ritonavir/lopinavir. None of the analysed treatments showed independent association with mortality. The drugs that showed a greater inverse association with mortality were tocilizumab and corticoids. CONCLUSIONS: The observed association patterns are consistent with previous literature. It seems necessary to design randomized controlled clinical trials that evaluate the possible protector effect of tocilizumab and corticoids in the risk of mortality for some subgroups of COVID-19 hospitalized patients