Hip fractures in Spain: are we on the right track? Statistically significant differences in hip fracture management between Autonomous Communities in Spain.

Although medicine is currently protocol-based, there are still differences in the management of the hip fracture in Spain, especially regarding surgical delay, type of anesthesia, early mobilization, and discharge destinations. This data will be of great value to assist stakeholders in formulating health policies. PURPOSE: Analysis of demographic, clinical, surgical, and functional data of the Spanish National Hip Fracture National Registry (RNFC), during admission and at 1-month follow-up, by Autonomous Communities (ACs). METHODS: Cross-sectional analysis in the framework of a RNFC cohort, from January 2017 to May 2018, including 15 ACs from Spain, with 1 month of follow-up. Sociodemographic, clinical, surgical, and outcome variables were analyzed. RESULTS: In total, 13,839 patients were analyzed. There were significant differences (p <0.001) in median surgical delay and percentage of patients operated in less than 48 h. Mean surgical delay was 70.75 h, with a 12-h difference between the Communities of Madrid (71.22) and Catalonia (59.65). Only 43% of patients had less than 48-h delay. Overall, most patients received regional anesthesia (91.9%); however, there was a significant difference between ACs (p = 0.0001). There were also differences in inpatient stay, early mobilization, discharge destination, and mortality (p <0.001). Mortality 30 days after surgery was 7.8%, and highest in the Basque Country (12.5%). CONCLUSIONS: The registry showed homogeneity among ACs regarding sociodemographic variables, fracture type, surgical treatment, ASA risk, and co-management with a geriatrician or an integrated internist. There were significant differences in hip fracture management between ACs in Spain, especially regarding surgical delay, type of anesthesia, early mobilization, and discharge destinations.

Densidad de los puntos de venta de alcohol y su consumo en jóvenes de Galicia / Alcohol outlet density and alcohol consumption in Galician youth

OBJETIVO: Valorar la influencia que la densidad de los puntos de venta y los de venta y consumo de alcohol ejercen sobre los patrones de consumo de los/las jóvenes preuniversitarios/as de Galicia. MÉTODOS: Se ha llevado a cabo un análisis transversal de la cohorte de estudiantes de la Universidad de Santiago de Compostela (Cohorte Compostela 2016). Se calcularon las prevalencias de consumo para cada uno de los municipios de procedencia de los/las estudiantes de primer ciclo durante el año anterior al ingreso. Se valoró la asociación del consumo de riesgo de alcohol (CRA) y consumo intensivo de alcohol (CIA) con un modelo logístico, considerando como variables independientes la población del municipio, la densidad de locales de venta, la densidad de locales de venta y consumo de alcohol, y la densidad de ambos tipos de locales en el municipio. RESULTADOS: La prevalencia de CRA fue del 60,5% (interval de confianza del 95% [IC95%]: 58,4-62,5) y la de CIA de 28,5% (IC95%: 26,7-30,2). Se observó una gran variabilidad según el municipio de procedencia. El modelo logístico multivariante mostró que los municipios con una densidad de 8,42-9,34 de ambos tipos de locales por mil habitantes presentaban mayor riesgo de CRA (odds ratio [OR]:1.39; IC95%: 1,09-1,78) y de CIA (OR= 1,29; IC95%: 1,01-1,66). CONCLUSIÓN: Estos datos sugieren la importancia de incluir la información del entorno al estudiar el consumo de alcohol. Conocer mejor el entorno podría ayudar a plantear políticas que fomenten en la población conductas más saludables

OBJECTIVE: To assess the influence that alcohol outlet density, off- and on-alcohol premises, and alcohol consumption wield on the consumption patterns of young pre-university students in Galicia (Spain). METHOD: A cross-sectional analysis of a cohort of students of the University of Santiago de Compostela (Compostela Cohort 2016) was carried out. Consumption prevalence were calculated for each of the municipalities from the first-cycle students' home residence during the year prior to admission. The association with risky alcohol consumption (RC) and binge-drinking (BD) was assessed with a logistic model considering as independent variables the municipality population, alcohol outlet density of off- premises, density of off- and on- premises and total density of both types of premises in the municipality. RESULTS: The prevalence of RC was 60.5% (95% confidence interval [95%CI]: 58.4-62.5) and the BD was 28.5% (95%CI: 26.7-30.2). A great variability was observed according to the municipality of provenance. The multivariate logistic model showed municipalities with a density of 8.42-9.34 of both types of premises per thousand inhabitants presented a higher risk of RC (odds ratio [OR]: 1,39; 95%CI: 1.09-1.78) and BD (OR: 1.29; 95%CI: 1.01-1.66). CONCLUSIONS: These data suggest the importance of including environmental information when studying alcohol consumption. Knowing our environment better could help plan policies that encourage healthier behaviour in the population

[Alcohol outlet density and alcohol consumption in Galician youth]. / Densidad de los puntos de venta de alcohol y su consumo en jóvenes de Galicia.

OBJECTIVE: To assess the influence that alcohol outlet density, off- and on-alcohol premises, and alcohol consumption wield on the consumption patterns of young pre-university students in Galicia (Spain). METHOD: A cross-sectional analysis of a cohort of students of the University of Santiago de Compostela (Compostela Cohort 2016) was carried out. Consumption prevalence were calculated for each of the municipalities from the first-cycle students' home residence during the year prior to admission. The association with risky alcohol consumption (RC) and binge-drinking (BD) was assessed with a logistic model considering as independent variables the municipality population, alcohol outlet density of off- premises, density of off- and on- premises and total density of both types of premises in the municipality. RESULTS: The prevalence of RC was 60.5% (95% confidence interval [95%CI]: 58.4-62.5) and the BD was 28.5% (95%CI: 26.7-30.2). A great variability was observed according to the municipality of provenance. The multivariate logistic model showed municipalities with a density of 8.42-9.34 of both types of premises per thousand inhabitants presented a higher risk of RC (odds ratio [OR]: 1,39; 95%CI: 1.09-1.78) and BD (OR: 1.29; 95%CI: 1.01-1.66). CONCLUSION: These data suggest the importance of including environmental information when studying alcohol consumption. Knowing our environment better could help plan policies that encourage healthier behaviour in the population.

Perceptions and attitudes of patients and health care workers toward patient empowerment in promoting hand hygiene.

BACKGROUND: Patient empowerment is a component of the World Health Organization's multimodal strategy to improve hand hygiene (HH). Its successful implementation requires knowledge of the perceptions and attitudes of patients and health care workers (HCWs) toward patient empowerment in HH. METHODS: A cross-sectional study, through a self-administered questionnaire of patients and their families and HCWs, was conducted in a 433-bed block of an 850-bed university hospital in Galicia, Spain. RESULTS: A total of 337 patients and their families and 196 HCWs completed the questionnaire. Among patients and their families, 49.9% were willing to remind HCWs about HH. However, only 31.6% of HCWs (41.8% of physicians and 24.8% of nurses) supported patient participation. The most common reason for patients and their families not being willing to ask caregivers to perform HH was fear of causing annoyance or receiving worse treatment as a consequence (76%). The main reasons that physicians disagreed with patient participation was patients' lack of knowledge (40%) and possible negative effects on the HCW/patient relationship (40%). Nurses considered this participation unnecessary (58%). CONCLUSIONS: There were significant differences between patients and their families and HCWs regarding support for patient empowerment in promoting HH. In our setting, a cultural change is needed in the HCW/patient relationship to create a facilitating environment.