A randomised controlled trial evaluating the effect of a brief motivational intervention to promote breastfeeding in postpartum depression.

Postpartum depression (PPD) is the most frequent psychiatric complication during the postnatal period. According to existing evidence, an association exists between the development of PPD and the maintenance of breastfeeding. A brief motivational intervention (bMI), based on the motivational interview, seems effective in promoting breastfeeding. The objective of this study was to analyse the impact of a bMI aiming to promote breastfeeding on the development of PPD and explore the mediating/moderating roles of breastfeeding and breastfeeding self-efficacy in the effect of the intervention on developing PPD. Eighty-eight women who gave birth by vaginal delivery and started breastfeeding during the immediate postpartum period were randomly assigned to the intervention group (bMI) or control group (breastfeeding education). Randomisation by minimisation was carried out. The breastfeeding duration was longer in the intervention group (11.06 (± 2.94) weeks vs 9.02 (± 4.44), p = 0.013). The bMI was associated with a lower score on the Edinburgh Postnatal Depression Scale, with a regression ß coefficient of - 2.12 (95% CI - 3.82; - 0.41). A part of this effect was mediated by the effect of the intervention on the duration of breastfeeding (mediation/moderation index ß = - 0.57 (95% CI - 1.30; - 0.04)). These findings suggest that a bMI aiming to promote breastfeeding has a positive impact preventing PPD mainly due to its effectiveness in increasing the duration of breastfeeding.

Factors associated with smoking susceptibility among high school students in western Spain.

The Expanded Susceptibility to Smoking Index (ESSI) is based on the combination of susceptibility to smoking and curiosity about smoking. The ESSI can identify young people who are at risk of starting to smoke cigarettes and related products. The objective of this study was to analyse the ESSI results and to examine factors associated with ESSI scores in students between 12 and 16 years of age. Sociodemographic, social/environmental and personal variables were analysed, and the ESSI value was determined for non-smoking students recruited from three schools in western Spain. Regression models were used to examine the factors associated with smoking for the entire sample and the factors associated with ESSI scores in the non-smoking population. Of the 377 participants who were analysed, 20.4% were smokers. Among the non-smokers, 53.5% and 55.3% presented medium-high ESSI scores for cigarettes and e-cigarettes, respectively, and 39.8% presented medium-high ESSI scores for hookah use. A higher ESSI score was associated with greater exposure to people smoking in the home, having more friends who smoke, alcohol consumption, and a higher impulsivity scale score. These findings reinforce the importance of reducing peer pressure and suggest the important role of resolve under conditions of positive affect on reducing impulsivity. Approaches based on self-efficacy could be addressed in preventive programmes developed in educational settings.

Paciente traumatizado recuperado: buena suerte y... hasta la próxima / Recovered trauma patient: Good luck and... until next time

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Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza» para el inicio del cambio / Admission to Intensive Care for a trauma related to alcohol or drugs, a 'teachable moment' for the beginning of a change

Objetivos: Estimar cuántos de los pacientes ingresados en la UCI por un traumatismo serían candidatos a un programa de prevención secundaria por traumatismos relacionados con el consumo de alcohol y drogas mediante intervención motivacional breve y establecer qué factores impiden la realización de esta intervención. Métodos: Se incluyeron en el estudio todos los pacientes de entre 16 a 70 años (n = 242) ingresados en la UCI por lesiones traumáticas en 32 meses no consecutivos (de noviembre de 2011 a marzo de 2015), coincidiendo con la implantación de un programa de cribado e intervención motivacional breve para traumatizados relacionados con el consumo de sustancias. El programa incluye el cribado de exposición a sustancias en el ingreso. Se recogieron prospectivamente variables sociodemográficas y clínicas. Resultados: Del total de pacientes ingresados, a 38 (15,7%) no se les realizó la determinación a sustancias. Dieron resultado negativo 101 (49,5%) de los pacientes analizados. Las variables que en mayor proporción impedían la intervención entre los positivos fueron las secuelas neurológicas debidas al traumatismo (23 pacientes; 37,1%) y el trastorno psiquiátrico previo (18 pacientes; 29%). Ambas variables aparecieron asociadas al consumo: 9,9% negativos vs 22,3% positivos (p = 0,001) y 3% negativos vs 17,5% positivos (p = 0,016), respectivamente. El número de pacientes candidatos a intervención motivacional fue de 41, el 16,9% del total de ingresados. Conclusiones: Casi 2 de cada 10 pacientes fueron potenciales candidatos a la intervención. Los factores que en mayor proporción la impedían entre los positivos fueron los que aparecieron asociados al consumo. La mortalidad en la UCI se asoció con el incumplimiento del protocolo de cribado

Objectives: To estimate how many of the trauma patients admitted to ICU would be candidates for a secondary prevention programme for trauma related to alcohol or drug use by brief motivational intervention and to define what factors prevent that intervention being performed. Methods: All 16-70 year old trauma patients (n = 242) admitted to ICU in 32 non-consecutive months (November 2011 to March 2015) were included in the study, coinciding with the implementation of a screening and brief motivational intervention programme for trauma patients related to substance consumption. The programme includes screening for exposure to substances at admission. Sociodemographic and clinical variables were collected prospectively. Results: The screening for substances was not performed in 38 (15.7%) of all admitted patients. Of the patients screened, 101 (49.5%) were negative. The variables that in greater proportion impeded intervention between screening positive patients were neurological damage due to the trauma with 23 patients (37.1%) and prior psychiatric disorder with 18 (29%). Both variables were associated with substance consumption: negatives 9.9% vs positive 22.3% (P = .001) and negatives 3% vs positive 17.5% (P = .016) respectively. The number of candidates for motivational intervention was 41, 16.9% of all admitted patients. Conclusions: Almost 2 out of 10 patients were potential candidates. The factors that in a greater proportion precluded the intervention were the same as those associated with consumption. Mortality in ICU was associated with non-compliance with the screening protocol

Admission to Intensive Care for a trauma related to alcohol or drugs, a 'teachable moment' for the beginning of a change. / Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza¼ para el inicio del cambio.

OBJECTIVES: To estimate how many of the trauma patients admitted to ICU would be candidates for a secondary prevention programme for trauma related to alcohol or drug use by brief motivational intervention and to define what factors prevent that intervention being performed. METHODS: All 16-70year old trauma patients (n=242) admitted to ICU in 32 non-consecutive months (November 2011 to March 2015) were included in the study, coinciding with the implementation of a screening and brief motivational intervention programme for trauma patients related to substance consumption. The programme includes screening for exposure to substances at admission. Sociodemographic and clinical variables were collected prospectively. RESULTS: The screening for substances was not performed in 38 (15.7%) of all admitted patients. Of the patients screened, 101 (49.5%) were negative. The variables that in greater proportion impeded intervention between screening positive patients were neurological damage due to the trauma with 23 patients (37.1%) and prior psychiatric disorder with 18 (29%). Both variables were associated with substance consumption: negatives 9.9% vs positive 22.3% (P=.001) and negatives 3% vs positive 17.5% (P=.016) respectively. The number of candidates for motivational intervention was 41, 16.9% of all admitted patients. CONCLUSIONS: Almost 2 out of 10 patients were potential candidates. The factors that in a greater proportion precluded the intervention were the same as those associated with consumption. Mortality in ICU was associated with non-compliance with the screening protocol.

Trauma risk perception related to alcohol, cannabis, and cocaine intake.

OBJECTIVE: A high perception of risk may exert a preventive effect against the initiation of risky activities. The aims of the present study were (1) to analyze the risk perception for traumatic incidents according to drug intake (alcohol, cannabis, cocaine, no consumption) by trauma patients admitted to our hospital, and (2) to explore the influence of drugs on trauma recidivism. METHODS: Between 1 November 2011 and 1 April 2012, 404 patients aged between 16 and 70 years were admitted to our hospital for trauma cases. In 363 (89.9 %) of the patients, data were gathered on age, the trauma mechanism, and the consumption of alcohol and other drugs. Out of these 363 patients, 286 (78.8 %) attended a motivational interview and reported their consumption habits and their perception of the risk of trauma after alcohol and/or illegal drug consumption, as well as the antecedents of previous traumatisms. RESULTS: Alcohol and/or illegal drugs were detected in 37 % of the sample, with alcohol being the most frequently detected, followed by cannabis, cocaine, and other drugs. Among the trauma patients with no consumption, a high perception of trauma risk was associated with alcohol intake by 95.9 %, with cannabis consumption by 68.4 %, and with cocaine consumption by 53.4 %, whereas these percentages were significantly lower for patients testing positive for substances (79.3, 21.1, and 8.3 % respectively). Among the patients experiencing their first trauma, the mean age was almost 15 years younger in those who were positive for these substances than in those who were negative (p < 0.001). Finally, a history of previous trauma was reported by a majority (64 %) of the trauma patients testing positive for alcohol and/or drugs, but by a minority (36 %) of those testing negative (p < 0.001). CONCLUSIONS: The low perception of risk associated with alcohol, cannabis, or cocaine consumption by trauma patients under the influence of these substances on admission may be a predisposing factor for recidivism. Recommendations for both primary and secondary prevention are presented.

El consumo de alcohol y/o drogas favorece la reincidencia en el traumatismo y reduce el período sin traumatismos / Alcohol and/or drug abuse favors trauma recurrence and reduces the trauma-free period

Objetivo Nuestro objetivo ha sido determinar la influencia del consumo de alcohol y/o drogas en la reincidencia de pacientes traumatizados y, en pacientes no reincidentes, analizar el papel de estas sustancias en el tiempo de aparición del primer episodio de traumatismo. Diseño Estudio observacional prospectivo. Ámbito Unidad de cuidados intensivos (UCI) de un hospital terciario. Pacientes traumatizados ingresados en UCI. Intervención Ninguna. Variables principales La reincidencia en el traumatismo se definió por antecedentes de traumatismo previo que requiriera atención médica. Se ha determinado la presencia de alcohol y otras drogas de abuso al ingreso tras un traumatismo grave. Resultados De los 166 pacientes con traumatismo ingresados en la UCI durante el período de estudio, se incluyeron 102 (87 hombres). Se detectó alguna sustancia en 51 pacientes (50%), alcohol (39%), cannabis (12%) y cocaína (7%). De los 102 pacientes, 42 eran reincidentes, de los cuales 32 (76%) dieron positivo a alguna sustancia y solo en 10 se obtuvieron resultados negativos (p<0,001). De los 60 pacientes no reincidentes, 19 (32%) dieron resultados positivos a alguna sustancia, estos últimos eran significativamente más jóvenes (34,3±9 años) que los 41 con resultados negativos (48±23 años) (p<0,001).Conclusión El consumo de alcohol y/o drogas aumenta la probabilidad de reincidencia en el traumatismo y adelanta en casi 15 años la presentación del primer traumatismo (AU)

Aim A study is made of the influence of alcohol and/or drug abuse upon traumatism o recurrence, with an analysis of the influence of such abuse upon the time to appearance of first injury in patients without antecedents of trauma. Design A prospective observational study was made. Setting Trauma patients admitted to the Intensive care Unit (ICU) of a University Hospital. Patients Trauma patients admitted to the ICU. Intervention None. Main measurements Trauma recurrence was defined by a history of previous trauma requiring medical care. The presence of alcohol and other drugs of abuse were determined upon admission after severe trauma. Results Out of the 166 trauma patients admitted to the ICU during the study period, 102 (87 males) were included in the study. Some substance was detected in 51 patients (50%), most frequently in the males (48/87, p<0.02). The most frequently detected substance was alcohol (39%), followed by cannabis (12%) and cocaine (7%), while more than one substance was found in 10 patients (9.8%). Of the 102 patients, 42 were recurrent trauma cases, and 32 (76%) of them were substance-positive, while only 10 were substance-negative (p<0.001). Of the 60 patients without antecedents of trauma, 19 (32%) were substance-positive, and these were significantly younger (34.3±9 years) than the 41 subjects who were substance-negative (48±23 years) (p<0.001).Conclusion Alcohol and/or drug abuse increases the likelihood of recurrent trauma and may shorten the mean trauma-free period among patients without a history of trauma by almost 15 years (AU)

Alcohol and/or drug abuse favors trauma recurrence and reduces the trauma-free period.

AIM: A study is made of the influence of alcohol and/or drug abuse upon traumatismo recurrence, with an analysis of the influence of such abuse upon the time to appearance of first injury in patients without antecedents of trauma. DESIGN: A prospective observational study was made. SETTING: Trauma patients admitted to the Intensive care Unit (ICU) of a University Hospital. PATIENTS: Trauma patients admitted to the ICU. INTERVENTION: None. MAIN MEASUREMENTS: Trauma recurrence was defined by a history of previous trauma requiring medical care. The presence of alcohol and other drugs of abuse were determined upon admission after severe trauma. RESULTS: Out of the 166 trauma patients admitted to the ICU during the study period, 102 (87 males) were included in the study. Some substance was detected in 51 patients (50%), most frequently in the males (48/87, p<0.02). The most frequently detected substance was alcohol (39%), followed by cannabis (12%) and cocaine (7%), while more than one substance was found in 10 patients (9.8%). Of the 102 patients, 42 were recurrent trauma cases, and 32 (76%) of them were substance-positive, while only 10 were substance-negative (p<0.001). Of the 60 patients without antecedents of trauma, 19 (32%) were substance-positive, and these were significantly younger (34.3±9 years) than the 41 subjects who were substance-negative (48±23 years) (p<0.001). CONCLUSION: Alcohol and/or drug abuse increases the likelihood of recurrent trauma and may shorten the mean trauma-free period among patients without a history of trauma by almost 15 years.