Adaptation and Validation of the Hooked on Nicotine Checklist (HONC) with Spanish Adolescents.

INTRODUCTION: The expansion of new tobacco consumption formats and electronic vapor products threatens to reverse the trend of declining smoking rates that had been observed among younger people in recent decades. Early detection in the health sector requires screening tools that have been adapted and validated in our context. This study aims to translate, culturally adapt, pilot and empirically validate the Hooked on Nicotine Checklist (HONC) with Spanish adolescents. METHODS: The process of translation and cultural adaptation included the following stages: direct translation, synthesis of translations, back translation, consolidation with a committee of experts and pre-test, along with a cognitive interview, which served as pilot testing. Empirical validation was conducted with a sample of 1027 adolescents aged between 12 and 18 (M=15.40; SD=1.638). RESULTS: The results obtained confirm that the HONC is a brief, clear and easy-to-understand tool, with appropriate psychometric properties. A Cronbach's alpha value of 0.90 was obtained. Sensitivity, specificity, PPV and NPV indices reached values of 0.56, 0.94, 0.79 and 0.83, respectively. Cut-off point 1 is the one reaching the best balance between the two values. CFA showed a model good overall fit. CONCLUSION: This study makes the Spanish version of the HONC available to researchers and clinicians, so that it can be used with sufficient psychometric guarantees.

Minors and drug-facilitated sexual assaults: Between submission and chemical vulnerability. / Menores y agresiones sexuales facilitadas por drogas: Entre la sumisión y la vulnerabilidad química.

Drug-facilitated sexual assault (DFSA) is a topic of growing social concern in recent years. Despite this, few empirical studies carried out in Spain have analysed the phenomenon from a preventive approach. The aim of this study, in addition to providing new evidence on DFSA, specifically in minors, was to identify possible associated variables, thus contributing to a better understanding of the problem and to the design of more effective prevention policies. To this end, a survey was carried out among minors in the autonomous community of Galicia. A total of 7,181 students aged 12 to 17 (M = 14.79; SD = 1.57) participated. Data collection was carried out by means of a self-administered questionnaire on paper. Data concerning DFSA were collected by means of specific items, piloted beforehand. Screening instruments for problem drug use (AUDIT, CAST, CRAFFT and EUPI-a) were also used. The results allow us to estimate the rate of victimisation by DFSA in Galician minors at 1.7%, of which only 11.4% would have reported it. Beyond the socio-demographic profile of the victims (females in 2 out of 3 cases), they present different patterns with regard to the pattern of problematic consumption of alcohol and other substances and the pattern of problematic use of the Internet and social networks, with a significantly higher prevalence of online risk behaviours. This suggests that this phenomenon goes far beyond sexual violence, so it is necessary to address it at a preventive level from a comprehensive perspective, including educational and public health perspectives.

Las agresiones sexuales facilitadas por drogas (DFSA) constituyen un tópico que viene suscitando una creciente preocupación social en los últimos años. Pese a ello, son pocos los trabajos empíricos llevados a cabo en España que hayan analizado el fenómeno desde un enfoque preventivo. El objetivo de este trabajo, además de aportar nueva evidencia respecto a las DFSA, concretamente en el ámbito de los menores, ha sido identificar posibles variables asociadas, contribuyendo así a comprender mejor el problema y a diseñar políticas de prevención más eficaces. Para ello se realizó una encuesta entre menores de la comunidad autónoma gallega. Participaron 7.181 estudiantes de 12 a 17 años (M= 14,79; DT=1,57). La recogida de datos se realizó mediante un cuestionario autoadministrado. Los datos referentes a las DFSA fueron recogidos mediante ítems específicos, pilotados previamente. Se utilizaron también instrumentos para el cribado de consumos problemáticos (AUDIT, CAST, CRAFFT y EUPI-a). Los resultados permiten estimar la tasa de victimización por DFSA en menores gallegos en un 1,7%, de los que únicamente habrían denunciado el 11,4%. Más allá del perfil sociodemográfico de las víctimas (mujeres en 2 de cada 3 casos), éstas presentan patrones diferenciados respecto al patrón de consumo problemático de alcohol y otras sustancias y al patrón de uso problemático de Internet y redes sociales, con una prevalencia significativamente mayor de conductas de riesgo online. Ello sugiere que este fenómeno va mucho más allá de la violencia sexual, por lo que es preciso abordarlo a nivel preventivo desde una perspectiva integral, incluyendo la perspectiva educativa y de salud pública.

El uso de la cachimba entre los adolescentes. Posibles implicaciones y variables asociadas / Waterpipe use among adolescents. Possible implications and related variables

El consumo de sustancias en cachimba (generalmente tabaco o cannabis) constituye una práctica cada vez más popular, hasta el punto de convertirse ya en un problema de salud pública emergente, con serias consecuencias tanto a nivel pulmonar, como adictivo. A pesar de la creciente preocupación que suscita, son pocos los trabajos llevados a cabo en España que se hayan ocupado de analizar esta nueva práctica desde edades tempranas. El objetivo de este trabajo no sólo es disponer de nuevos datos acerca del uso de la cachimba entre los adolescentes, sino también analizar sus posibles implicaciones y variables asociadas. Para ello, se realizó una encuesta entre estudiantes de enseñanza secundaria de la comunidad gallega. Participaron 7.613 estudiantes de 12 a 18 años (M = 14,97; DT = 1,69). Se utilizó el CRAFFT, el AUDIT y el CAST para el cribado de consumos de riesgo. Las tasas de consumo de tabaco y de cannabis en cachimba se sitúan en niveles preocupantes (19,4% y 8,5%, respectivamente, para el último año), con tasas significativamente mayores de consumos de riesgo, de borracheras y binge drinking. Llama también la atención la baja percepción de riesgo existente. El uso de la cachimba constituye una práctica relativamente extendida en la adolescencia, que además de serias implicaciones para la salud, constituye un claro indicador de un patrón de consumo subyacente realmente problemático. La escasa percepción de riesgo, la práctica del botellón o la falta de normas familiares son elementos a tener en cuenta a nivel de prevención comunitaria. (AU)

Substance use in waterpipe (generally tobacco or cannabis) constitutes an increasingly popular practice. It has become an emerging public health problem, with serious consequences at both pulmonary and addiction levels. Despite the growing concern it raises, few studies have been carried out in Spain to analyze this new practice from an early age. The aim of this study is to have new data about waterpipe use among adolescents and to analyze its possible implications and related variables. A survey was conducted among secondary school students from the Galician community. A total of 7,613 students aged 12-18 years (M = 14.97; SD = 1.69) participated. The CRAFFT, the AUDIT and the CAST were used to screen the risky use of other substances. The rates of waterpipe tobacco and cannabis use are at worrying levels (19.4% and 8.5%, respectively, for the last year), with significantly higher rates of risky substance use, drunkenness and binge drinking. The low perception risk is striking. Waterpipe use is a widespread practice in adolescence. In addition to serious health implications, is a clear indicator of a problematic underlying consumption. The low perception of risk, the “botellón” or the lack of family control are elements to take into account in community prevention. (AU)

Waterpipe use among adolescents. Possible implications and related variables. / El uso de la cachimba entre los adolescentes. Posibles implicaciones y variables asociadas.

Substance use in waterpipe (generally tobacco or cannabis) constitutes an increasingly popular practice. It has become an emerging public health problem, with serious consequences at both pulmonary and addiction levels. Despite the growing concern it raises, few studies have been carried out in Spain to analyze this new practice from an early age. The aim of this study is to have new data about waterpipe use among adolescents and to analyze its possible implications and related variables. A survey was conducted among secondary school students from the Galician community. A total of 7,613 students aged 12-18 years (M = 14.97; SD = 1.69) participated. The CRAFFT, the AUDIT and the CAST were used to screen the risky use of other substances. The rates of waterpipe tobacco and cannabis use are at worrying levels (19.4% and 8.5%, respectively, for the last year), with significantly higher rates of risky substance use, drunkenness and binge drinking. The low perception risk is striking. Waterpipe use is a widespread practice in adolescence. In addition to serious health implications, is a clear indicator of a problematic underlying consumption. The low perception of risk, the "botellón" or the lack of family control are elements to take into account in community prevention.

El consumo de sustancias en cachimba (generalmente tabaco o cannabis) constituye una práctica cada vez más popular, hasta el punto de convertirse ya en un problema de salud pública emergente, con serias consecuencias tanto a nivel pulmonar, como adictivo. A pesar de la creciente preocupación que suscita, son pocos los trabajos llevados a cabo en España que se hayan ocupado de analizar esta nueva práctica desde edades tempranas. El objetivo de este trabajo no sólo es disponer de nuevos datos acerca del uso de la cachimba entre los adolescentes, sino también analizar sus posibles implicaciones y variables asociadas. Para ello, se realizó una encuesta entre estudiantes de enseñanza secundaria de la comunidad gallega. Participaron 7.613 estudiantes de 12 a 18 años (M = 14,97; DT = 1,69). Se utilizó el CRAFFT, el AUDIT y el CAST para el cribado de consumos de riesgo. Las tasas de consumo de tabaco y de cannabis en cachimba se sitúan en niveles preocupantes (19,4% y 8,5%, respectivamente, para el último año), con tasas significativamente mayores de consumos de riesgo, de borracheras y binge drinking. Llama también la atención la baja percepción de riesgo existente. El uso de la cachimba constituye una práctica relativamente extendida en la adolescencia, que además de serias implicaciones para la salud, constituye un claro indicador de un patrón de consumo subyacente realmente problemático. La escasa percepción de riesgo, la práctica del botellón o la falta de normas familiares son elementos a tener en cuenta a nivel de prevención comunitaria.

Psychometric properties of CAST for early detection of problematic cannabis use in Spanish adolescents.

The high prevalence rates of cannabis use in adolescents and its early onset constitutes a major public health problem, raising the need for its early detection. The availability of validated tools to analyze early cannabis use is essential to detect problematic use at an early age. The Cannabis Abuse Screening Test (CAST) (Legleye et al., 2007) is widely applied in Europe; however, the CAST cut-off scores vary according to the setting, the screening objective, and the correction version (CAST-f or CAST-b), creating therefore confusion in its application. Moreover, the psychometric properties of the CAST as a tool for detecting problematic cannabis use are understudied. To fill this gap, such psychometric properties have been analyzed in a sample of Spanish adolescents while using different cut-off scores for CAST-f and CAST-b. Based on our findings, the optimal cut-off scores are 2 points for CAST-b and 4 points for CAST-f. The internal reliability of CAST-f (α = 0.83) and CAST-b (KR-20 = 0.80) are satisfactory. Factorial analysis suggested the assumption of a one-dimension model. The CAST seems to be a valid and reliable tool for early screening of problematic cannabis use in Spanish adolescents.

[SBIRT model as a prevention strategy against addiction with and without substance in teenagers.] / El modelo SBIRT como estrategia de prevención de las adicciones con y sin sustancia en adolescentes.

A high prevalence of adolescent substance use, risky consumption patterns and the decrease in the age of initiation, together with the growth of non-substance addictions, represent a huge challenge for Public Health. This suggests the need for a change of focus in the work of the primary care settings, which must be more proactive in the early detection and intervention. Although there are some previous experiences in Spain, we do not have a duly standardised system, based on clinical practice and validated in consulting rooms, which could be used in a general, simple, and guaranteed manner. The SBIRT (Screening, Brief Intervention and Referral to Treatment) model, developed in the United States and conceived from a Public Health perspective, might represent such a paradigm shift. The aim of this paper was to provide researchers and professionals with a review of the available evidence in different countries, with a view to implementing it in Spain, where SBIRT remains a challenge. In addition, theoretical and technical foundations, and potential of the SBIRT are described. Not only its possible benefits and opportunities are put on the table, but also the shortcomings, limitations and needs that must be overcome for SBIRT implementation to be possible.

La alta prevalencia del consumo de sustancias entre los adolescentes, los preocupantes patrones de consumo y el descenso de las edades de inicio, junto al crecimiento de las adicciones sin sustancia, suponen uno de los grandes desafíos actuales en materia de Salud Pública. Ello sugiere la necesidad de un cambio de enfoque en la labor de los dispositivos de Atención Primaria (AP), que han de ser más proactivos en la detección e intervención precoz. Aunque en España existen algunas experiencias previas, no disponemos de una sistemática debidamente protocolizada, fundamentada clínicamente y validada en las consultas, que pueda ser utilizada de forma generalizada, sencilla y con garantías por los profesionales. El modelo SBIRT (Screening, Brief Intervention and Referral to Treatment), desarrollado en Estados Unidos y concebido desde un enfoque de Salud Púbica, representa ese cambio de paradigma. El objetivo de este trabajo, además de dar a conocer los fundamentos teóricos, técnicos y potencialidades del SBIRT, fue poner a disposición de investigadores y profesionales una revisión de la evidencia disponible en diferentes países, de cara a su posible implantación en España, donde a pesar de la existencia de experiencias precedentes puntuales, constituye todavía una cuenta pendiente. Se ponen sobre la mesa no sólo los posibles beneficios y oportunidades, sino también las carencias, limitaciones y necesidades que han de superarse para que la implementación del SBIRT sea posible.

[The botellón phenomenon. Descriptive analysis and possible implications from a sample of galician teenagers.] / El fenómeno del botellón. Análisis descriptivo y posibles implicaciones a partir de una muestra de adolescentes gallegos.

OBJECTIVE: Botellón has established itself as a recreational ritual of great importance in the leisure of young people and it has contributed to the expansion of a worrying pattern of alcohol and other substances consumption. However, there are few papers that take an integrated approach to this issue. The aim of this work was to have new data to characterize this practice, while providing evidence of its consequences and identifying relevant prognostic factors for prevention. METHODS: A cross-sectional study was carried out with a sample of 4,867 Galician adolescents between 12 and 18 years of age (Mean=14.68; SD=1.67). Data were collected in schools through an ad hoc questionnaire and they were analyzed through of a bivariate tabulation, with the application of the opportune contrasts according to the nature of the variables. RESULTS: 27.3% of the teenagers in the sample went to botellón during the last year. 96.6% admitted to drinking alcohol when they went to a botellón, 53.4% alcohol and tobacco and 30.2% three or more substances. This practice was associated with significantly higher rates of Intensive Alcohol Consumption (28% vs. 0.9%), as well as of consumption of risk of alcohol, cannabis and drugs in general. The modulating role of variables such as risk perception and beliefs and expectations associated with consumption, money available or time of arrival at home was also found. CONCLUSIONS: At least 1 in 4 teenagers continue to go to botellones. This practice associated with risky consumption. The evidence found reinforces the multidimensional nature of the problem and suggests reorienting prevention policies.

OBJETIVO: El botellón se ha consolidado como un ritual recreativo de gran importancia en el ocio de los jóvenes y ha contribuido a la expansión de un patrón preocupante de consumo de alcohol y otras sustancias. Pese a ello, son escasos los trabajos que lo aborden de manera integral. Este trabajo se planteó con el objetivo disponer de nuevos datos que permitan caracterizar dicha práctica, al tiempo que aportar evidencias sobre sus consecuencias e identificar factores de pronóstico relevantes para la prevención. METODOS: Se llevó a cabo un estudio transversal con una muestra de 4.867 adolescentes gallegos de entre 12 y 18 años (Media=14,68; DT=1,67). Los datos se recogieron en centros escolares mediante un cuestionario elaborado ad hoc y fueron analizados mediante una tabulación bivariada, con la aplicación de los contrastes oportunos en función de la naturaleza de las variables. RESULTADOS: El 27,3% de los adolescentes de la muestra hicieron botellón en el transcurso del último año. El 96,6% reconoció beber alcohol cuando acude a un botellón, el 53,4% alcohol y tabaco y un 30,2% tres o más sustancias. Esta práctica se asoció con tasas significativamente mayores de consumo intensivo de alcohol (28% vs. 0,9%), así como de consumo de riesgo de alcohol, cannabis y drogas en general. Se constató también el papel modulador de variables como la percepción de riesgo y las creencias y expectativas asociadas al consumo, el dinero disponible o la hora de llegada a casa. CONCLUSIONES: Al menos 1 de cada 4 adolescentes sigue haciendo botellón, asociándose este a un consumo de riesgo. Las evidencias encontradas refuerzan el carácter multidimensional del problema y sugieren reorientar las políticas de prevención.

El fenómeno del botellón. Análisis descriptivo y posibles implicaciones a partir de una muestra de adolescentes gallegos / The botellón phenomenon. Descriptive analysis and possible implications from a sample of galician teenagers

OBJETIVO: El botellón se ha consolidado como un ritual recreativo de gran importancia en el ocio de los jóvenes y ha contribuido a la expansión de un patrón preocupante de consumo de alcohol y otras sustancias. Pese a ello, son escasos los trabajos que lo aborden de manera integral. Este trabajo se planteó con el objetivo disponer de nuevos datos que permitan caracterizar dicha práctica, al tiempo que aportar evidencias sobre sus consecuencias e identificar factores de pronóstico relevantes para la prevención. MÉTODOS: Se llevó a cabo un estudio transversal con una muestra de 4.867 adolescentes gallegos de entre 12 y 18 años (Media=14,68; DT=1,67). Los datos se recogieron en centros escolares mediante un cuestionario elaborado ad hoc y fueron analizados mediante una tabulación bivariada, con la aplicación de los contrastes oportunos en función de la naturaleza de las variables. RESULTADOS: El 27,3% de los adolescentes de la muestra hicieron botellón en el transcurso del último año. El 96,6% reconoció beber alcohol cuando acude a un botellón, el 53,4% alcohol y tabaco y un 30,2% tres o más sustancias. Esta práctica se asoció con tasas significativamente mayores de consumo intensivo de alcohol (28% vs. 0,9%), así como de consumo de riesgo de alcohol, cannabis y drogas en general. Se constató también el papel modulador de variables como la percepción de riesgo y las creencias y expectativas asociadas al consumo, el dinero disponible o la hora de llegada a casa. CONCLUSIONES: Al menos 1 de cada 4 adolescentes sigue haciendo botellón, asociándose este a un consumo de riesgo. Las evidencias encontradas refuerzan el carácter multidimensional del problema y sugieren reorientar las políticas de prevención

OBJECTIVE: Botellón has established itself as a recreational ritual of great importance in the leisure of young people and it has contributed to the expansion of a worrying pattern of alcohol and other substances consumption. However, there are few papers that take an integrated approach to this issue. The aim of this work was to have new data to characterize this practice, while providing evidence of its consequences and identifying relevant prognostic factors for prevention. METHODS: A cross-sectional study was carried out with a sample of 4,867 Galician adolescents between 12 and 18 years of age (Mean=14.68; SD=1.67). Data were collected in schools through an ad hoc questionnaire and they were analyzed through of a bivariate tabulation, with the application of the opportune contrasts according to the nature of the variables. RESULTS: 27.3% of the teenagers in the sample went to botellón during the last year. 96.6% admitted to drinking alcohol when they went to a botellón, 53.4% alcohol and tobacco and 30.2% three or more substances. This practice was associated with significantly higher rates of Intensive Alcohol Consumption (28% vs. 0.9%), as well as of consumption of risk of alcohol, cannabis and drugs in general. The modulating role of variables such as risk perception and beliefs and expectations associated with consumption, money available or time of arrival at home was also found. CONCLUSIONS: At least 1 in 4 teenagers continue to go to botellones. This practice associated with risky consumption. The evidence found reinforces the multidimensional nature of the problem and suggests reorienting prevention policies

Prolonged stay predictors in patients admitted with chronic obstructive pulmonary disease acute exacerbation.

OBJECTIVES: The study aimed to identify the factors related to prolonged stay in those patients admitted with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) to our hospital. METHODS: We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD to the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with length of stay, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis. RESULTS: Six hundred and sixty-one patients were assessed; 76.6% were male and the mean age was 74.5 years (standard deviation [SD]: 11.48). The mean stay was 11.9 days (SD: 8) and 24% of all patients required prolonged stay. Factors associated with prolonged mean stay in multivariate analysis were admission to the Intensive Care Unit (odds ratio [OR], 14.7), hospitalization by internal medicine (OR, 2.1), and use of noninvasive mechanical ventilation (OR, 1.75). CONCLUSIONS: Prolonged stay in AECOPD is primarily related to the unit patients are admitted to, and to the need for more intensive care.

Asthma exacerbations: factors related to longer hospital stay.

BACKGROUND: Hospital admissions account for a significant part of asthma cost, but with significant differences between geographic areas. AIMS: The aim of our study is to analyse hospital admissions due to asthma, as well as the factors associated with longer hospital stays. METHODS: A review was retrospectively carried out on all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. The personal characteristics of each patient, the asthma personal history, characteristics of every exacerbation, as well as the treatment before admission and after hospital discharge were recorded. RESULTS: During the study period, there were 2163 hospital admissions in 1316 patients (mean age 62.6 years; mean hospital stay 11.6 days). The admissions mainly occur in winter, in the 56-75-year age group, and in patients with severe asthma. Female sex, higher comorbidity, a greater number of emergencies due to asthma in the previous year, and baseline treatment with theophylline were independently associated to longer hospital stay. CONCLUSIONS: The management of asthma in our population seems improvable. There appears to be a need to optimise both the diagnosis and treatment of the disease, and to identify risk factors as important as tobacco habits. As regards exacerbations, the hospital stay and mortality must be significantly reduced.

Educación en asma / Education in asthma

No disponible

Characteristics and prognosis of near-fatal asthma exacerbations.

BACKGROUND: Asthma remains a major public health concern because of its high prevalence and the costs it generates. Near-fatal asthma (NFA) episodes represent the most severe forms of the disease after fatal asthma with significant variations in their incidence between different populations. OBJECTIVE: To analyze the episodes of NFA over a period of 11 years in the hospital. METHODS: The authors retrospectively reviewed all admissions due to asthma exacerbation in our hospital between 2000 and 2010 for patients over 18 years of age. RESULTS: The study included 400 NFA episodes of 285 patients (74% women; mean age 66 years). Of these patients, 228 (80%) had a single episode of NFA and 57 had more than 1 episode during the study period. The authors observed no clear upward or downward trend during the study period. Readmitted patients had more comorbidities, poorer lung function, more severe forms of asthma and more admissions in the year before the index admission. There was a mortality rate of 3.1%. More than 20% of patients were not given controller treatment and more than 40% of patients were not treated with inhaled corticosteroids (ICS). CONCLUSIONS: NFA episodes are still prevalent in the population of patients with asthma. Reasons for this could be related to improper management in the stable phase, as suggested by the low rate of patients treated with ICS. It also seems necessary to optimize patient management during hospitalization because stays appear prolonged in comparison with studies in other countries.