No effect of the Penalty Point System on road traffic accident mortality among men with a high socioeconomic status in Spain.

The purpose of this study was to assess the effect of the Penalty Point System (PPS) on road traffic accident mortality by gender and socioeconomic status. We conducted a nationwide prospective study covering adult people living in Spain on November 2001. They were followed up until 30 Nov 2007 to determine vital status and cause of death. An interrupted time-series analysis was used to assess whether PPS (explanatory variable) had both immediate and long-term effect on the rates of road traffic accident mortality (RTAMs) separately by gender. Subjects were classified by socioeconomic status (low and high) using two indicators: educational attainment (up to lower secondary education; upper secondary education or more) and occupation (manual and non-manual workers). We performed several segmented Poisson regression models, controlling for trend, seasonality, 2004 road safety measures and fuel consumption as proxy for traffic exposure. Among men, we found a decrease on the RTAMs immediately after PPS in those with low educational level (16.2 %, IC95 %: 6.1 %-25.2 %) and manual workers (16.3 %, IC95 %: 2.8 %-27.8 %), and a non-significant increase among those with high education level and non-manual workers (6.2 % and 1.8 %). Among women, there were no significant differences in the immediate effect of PPS by socioeconomic status. We did not identify significant trend changes between pre-PPS and post-PPS periods in any socioeconomic group. In a context of downward trend of traffic mortality, the PPS implementation led to an immediate reduction on death rates only among men with a low socioeconomic status.

Eficacia de las intervenciones formativas sobre médicos de atención primaria en la prevención de accidentes de tráfico en ancianos / Effectiveness of educational interventions on primary care physicians in the prevention of traffic accidents in the elderly

El objetivo del presente trabajo fue valorar el efecto de la implementación de programas formativos en médicos de atención primaria sobre la mejora de su práctica clínica en la prevención de accidentalidad por tráfico en ancianos. Para ello se llevó a cabo una revisión sistemática siguiendo la estrategia PRISMA. Se revisaron 1.677 trabajos, de los que únicamente 5 fueron incluidos por cumplir con los criterios de inclusión. Pese a que ninguno de los trabajos era de tipo experimental con grupo control, puede concluirse que existen evidencias de que una adecuada formación en esta temática por parte de los médicos mejora sus competencias en la identificación de ancianos de riesgo al volante, bien por sus patologías, bien por el consumo de fármacos, así como su nivel de confianza para comunicar a los ancianos y/o sus familiares la necesidad de la restricción o, dado el caso, el cese definitivo de la conducción

The objective of this study was to assess the effect of the implementation of training programs for Primary Care Physicians for improving their clinical practice as regards the prevention of traffic accidents in the elderly. To do this, a systematic review was carried out following the PRISMA strategy. A total of 1,677 works were reviewed, of which only 5 were included because they met the inclusion criteria. Although none of the works was of an experimental type with a control group, it can be concluded that there is evidence that an adequate training in this subject by physicians improves their skills in the identification of elderly risk drivers, due to their pathologies and/or the use of drugs, as well as their level of confidence to communicate to the elderly and/or their families the need for restriction or, if necessary, the definitive cessation of driving

[Effectiveness of educational interventions on primary care physicians in the prevention of traffic accidents in the elderly]. / Eficacia de las intervenciones formativas sobre médicos de atención primaria en la prevención de accidentes de tráfico en ancianos.

The objective of this study was to assess the effect of the implementation of training programs for Primary Care Physicians for improving their clinical practice as regards the prevention of traffic accidents in the elderly. To do this, a systematic review was carried out following the PRISMA strategy. A total of 1,677 works were reviewed, of which only 5 were included because they met the inclusion criteria. Although none of the works was of an experimental type with a control group, it can be concluded that there is evidence that an adequate training in this subject by physicians improves their skills in the identification of elderly risk drivers, due to their pathologies and/or the use of drugs, as well as their level of confidence to communicate to the elderly and/or their families the need for restriction or, if necessary, the definitive cessation of driving.

[Association of age and sex with intensity of exposure to bicycle use in Spain, 1993-2009]. / Asociación de la edad y el sexo con la intensidad de la exposición al uso de la bicicleta en España, 1993-2009.

BACKGROUND: To estimate the association of age and sex with the intensity of exposure of cyclists in Spain, between 1993 and 2009, in a global way and for subtypes of use. METHODS: From the distribution of cyclists passively involved in collisions with other vehicles included in the register of the Spanish General Traffic Directorate between 1993 and 2009, we have estimated the increase in intensity of exposure by age groups and sex, for global exposure and for subtypes of exposure (e.g. riding with or without a helmet, or riding on an open road or in urban areas), using males aged 45-49 as a reference. RESULTS: Males have a greater exposure than females and this difference increases with age, although it has tended to decrease in recent years. In both sexes the exposure is greater in young people and goes down with age, while in males the excess in young people has disappeared in recent years. Regarding subtypes of use, female underexposure riding on an open road should be highlighted, as well as overexposure in both women and extreme age groups among non-helmet users. CONCLUSION: There is a close association of age and sex with the intensity of bicycle use, which changes depending on the type of use and the time period considered. Consequently, estimations of the effect of factors affecting the accident rate and the morbidity and mortality of cyclists in Spain have to be adjusted by the age and sex of the cyclist.

Asociación de la edad y el sexo con la intensidad de la exposición al uso de la bicicleta en España, 1993-2009 / Association of age and sex with intensity of exposure to bicycle use in Spain, 1993-2009

Fundamento: Estimar la asociación de la edad y el sexo con la intensidad de exposición de los ciclistas en España, entre 1993 y 2009, globalmente y para subtipos de uso. Métodos: A partir de la distribución de los ciclistas pasivamente implicados en colisiones con otros vehículos, incluidos en el registro de la Dirección General de Tráfic oentre 1993 y 2009, se ha estimado el incremento en la intensidad de exposición por grupos de edad y sexo para la exposición global y para subtipos de exposición (conducción con o sin casco, en carretera o en zona urbana), tomando como referencia los varones de 45-49 años. Resultados. Los varones presentan una mayor exposición que las mujeres, diferencias que aumentan con la edad, aunque tienden a reducirse en años más recientes. En ambos sexos la exposición es mayor en jóvenes y desciende con la edad, si bien en los varones el exceso en los jóvenes desaparece en los últimos años. Por subtipos de uso, destaca la menor exposición de las mujeres en la conducción en carretera, así como la mayor exposición, en las mujeres y en los grupos de edad extremos, entre los no usuarios de casco. Conclusión: Existe una estrecha asociación entre el sexo y la edad con la intensidad de uso de la bicicleta, que cambia en función del tipo de uso y del período considerado. En consecuencia, las estimaciones del efecto de los factores que inciden sobre la accidentalidad y la morbi-mortalidad de los ciclistas en España deben ser ajustadas por la edad y el sexo del ciclista (AU)

Background: To estimate the association of age and sex with the intensity of exposure of cyclists in Spain, between 1993 and 2009, in a global way and for subtypes of use. Methods: From the distribution of cyclists passively involved in collisions with other vehicles included in the register of the Spanish General Traffic Directorate between 1993 and 2009, we have estimated the increase in intensity of exposure by age groups and sex, for global exposure and for subtypes of exposure (e.g. riding with or without a helmet, or riding on an open road or in urban areas), using males aged 45-49 as a reference. Results: Males have a greater exposure than females and this difference increases with age, although it has tended to decrease in recent years. In both sexes the exposure is greater in young people and goes down with age, while in males the excess in young people has disappeared in recent years. Regarding subtypes of use, female underexposure riding on an open road should be highlighted, as well as overexposure in both women and extreme age groups among non-helmet users. Conclusion: There is a close association of age and sex with the intensity of bicycle use, which changes depending on the type of use and the time period considered. Consequently, estimations of the effect of factors affecting the accident rate and the morbidity and mortality of cyclists in Spain have to be adjusted by the age and sex of the cyclist (AU)

Streptococcal vertebral osteomyelitis: multiple faces of the same disease.

The role of Streptococcus species as an aetiological microorganism of vertebral osteomyelitis (VO) is considered to be of little relevance. We aimed to describe a large number of cases of streptococcal vertebral osteomyelitis (SVO), to analyze the clinical features associated with different Streptococcus species, and to compare them with a cohort of patients with VO caused by Staphylococcus aureus. An incidence study and a retrospective, multicenter, observational clinical study of cases of SVO (1991-2011) were performed. Statistical comparison of SVO by different species and between them and staphylococcal VO was carried out. Over the whole period there was an increasing incidence in the number of VOs and SVOs per year (p <0.05). Among 58 cases of SVO, those caused by non-viridans streptococcus (Streptococcus pneumoniae, Streptococcus agalactiae and Streptococcus pyogenes; n = 26) mimicked VO by S. aureus, and presented with more fever, neurological symptoms and paravertebral abscesses in comparison with those caused by the viridans group (remaining species). In contrast, the latter have a sub-acute clinical picture and were associated with the presence of endocarditis (p <0.05). Among non-viridans SVOs, concomitant infection was specifically related to S. pneumoniae (p <0.05). In conclusion, SVO presents a wide range of clinical patterns. The relationship between VO and diagnosis of endocarditis was established with SVO caused by the viridans group. Whereas non-viridans SVO mimics acute characteristics of VO caused by S. aureus, cases of viridans SVO are significantly more likely to have a sub-acute clinical presentation. The increased incidence of SVO during the last decades could support a new epidemiological scenario.

[Evolution of the need and coverage of syringe exchange programs in Spanish prisons, 1992-2009: A revised estimation]. / Evolución de la necesidad y cobertura de los programas de intercambio de jeringuillas en las prisiones españolas, 1992-2009: Una estimación corregida.

INTRODUCTION: The objective of this paper is to amend the bias included in our previous work, presenting a corrected estimation of the need and coverage of syringes/needles in Spanish prisons between 1992 and 2009. METHODS: Data on the provision of the needles exchange programs (NEPs) in prison is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need and the difference between these magnitudes. The detected need estimate bias has been corrected. RESULTS: NEP's in prisons started in 1997. Their maximum coverage reached 36% in 2005, which is much higher than the initially estimated value. However, it decreased by half in the next four years, reaching 17.4% in 2009. CONCLUSION: The remarkable coverage reached by these programmes must be valued, but more recent evolution leads us to emphasize the need to be imaginative so that new epidemiological and economic circumstances do not lead to their disappearance.

[Evolution of the need and coverage of opioid substitution treatments and needle exchange programmes in Spanish prisons, 1992-2009]. / Evolución de la necesidad y cobertura de los programas de tratamiento con sustitutivos opioides e intercambio de jeringas en las prisiones españolas, 1992-2009.

INTRODUCTION: Spain is one of the few countries to have widely implemented opioid substitution treatments (OST) and needle exchange programmes (NEP) for drug users in prison. We analyze the evolution of the need, coverage and the timeliness of these interventions in Spain between 1992 and 2009. METHODS: Data on the provision of interventions is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need. Temporal opportunity was estimated by observing the gap between the acme of the incidence of consumption, of HIV infection or need and the curve of provision. RESULTS: OST's began to be implemented in 1992. In 2002 they reached their maximum coverage (63.8%) and subsequently stabilized. NEP's started in 1997. Their maximum coverage reached 20.7% in 2006, but halved in a period of two years. The delay between the epidemic acme and the need and maximum intervention coverage was of 8-25 years. CONCLUSIONS: OST and NEP introduction in Spanish prisons was a great advance, but the delay in their implementation and the low level of NEP coverage could have limited their potential impact on the improvement of the health of incarcerated drug users. The decline of NEP coverage in recent years is a cause of major concern for the evolution of HIV and Hepatitis C epidemics.

Evolución de la necesidad y cobertura de los programas de tratamiento con sustitutivos opioides e intercambio de jeringas en las prisiones españolas, 1992-2009 / Evolution of the need and coverage of opioid substitution treatments and needle exchange programmes in Spanish prisons, 1992-2009

Introducción: España es de los pocos países que ha implementado generalizadamente tratamientos con sustitutivos opioides (TSO) y programas de intercambio de jeringas (PIJ) para los consumidores de drogas en prisión. Se analiza la evolución de la necesidad, cobertura y oportunidad temporal de estas intervenciones en España durante 1992-2009. Material y métodos: La provisión de intervenciones procede de publicaciones oficiales. La necesidad se estimó aplicando métodos multiplicativos a datos secundarios de varias fuentes. La cobertura se estimó mediante el cociente entre provisión y necesidad, y la diferencia entre dichas magnitudes. La oportunidad temporal se estimó observando el decalaje entre el acmé de incidencia de consumo, de infección por VIH o de necesidad y las curvas de provisión. Resultados: Los TSO comenzaron en 1992. Su máxima cobertura se alcanzó en 2002 (63.8%), y posteriormente se estabilizó. Los PIJ comenzaron en 1997. Su máxima cobertura se alcanzó en 2006 (20.7%), pero disminuyó a la mitad en dos años. El retraso entre el acmé de las epidemias o de la necesidad y la máxima cobertura de las intervenciones fue de 8-25 años. Conclusiones: La implementación de TSO y PIJ en las prisiones españolas supuso un enorme avance de salud pública, pero el retraso en su implementación y la baja cobertura de los PIJ pueden haber limitado mucho su impacto potencial en la mejora de la salud de los consumidores de drogas en prisión. El descenso de la cobertura de los PIJ a la mitad en los últimos años es especialmente preocupante para la evolución de las epidemias de VIH y hepatitis C(AU)

Introduction: Spain is one of the few countries to have widely implemented opioid substitution treatments (OST) and needle exchange programmes (NEP) for drug users in prison. We analyze the evolution of the need, coverage and the timeliness of these interventions in Spain between 1992 and 2009. Methods: Data on the provision of interventions is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need. Temporal opportunity was estimated by observing the gap between the acme of the incidence of consumption, of HIV infection or need and the curve of provision. Results: OST’s began to be implemented in 1992. In 2002 they reached their maximum coverage (63.8%) and subsequently stabilized. NEP’s started in 1997. Their maximum coverage reached 20.7% in 2006, but halved in a period of two years. The delay between the epidemic acme and the need and maximum intervention coverage was of 8-25 years. Conclusions: OST and NEP introduction in Spanish prisons was a great advance, but the delay in their implementation and the low level of NEP coverage could have limited their potential impact on the improvement of the health of incarcerated drug users. The decline of NEP coverage in recent years is a cause of major concern for the evolution of HIV and Hepatitis C epidemics(AU)

Evolución de la necesidad y cobertura de los programas de intercambio de jeringuillas en las prisiones españolas, 1992-2009. Una estimación corregida / Evolution of the need and coverage of syringe exchange programs in Spanish prisons, 1992-2009. A revised estimation

Introducción: El objetivo del presente artículo es subsanar el sesgo incluido en nuestro anterior original presentando una estimación corregida de la necesidad y cobertura de jeringuillas en las prisiones españolas en el período 1992-2009 Material y métodos: La provisión de jeringuillas procede de publicaciones oficiales. La necesidad se estimó aplicando métodos multiplicativos a datos secundarios de varias fuentes. La cobertura se estimó mediante el cociente entre provisión y necesidad, y la diferencia entre dichas magnitudes. Se corrigió el sesgo de estimación de necesidad detectado en el estudio original. Resultados: Los programas de intercambio de jeringuillas en prisión comenzaron en 1997. Su máxima cobertura se alcanzó en 2005, con un 36%, valor muy superior al estimado inicialmente, aunque disminuyó a la mitad en los cuatro años siguientes, con un 17.4% en 2009. Conclusiones: Debe valorarse la notable cobertura que se alcanzó con estos programas en España, pero su evolución más reciente nos lleva a enfatizar la necesidad de ser imaginativos para que las nuevas condiciones epidemiológicas y económicas no lleven a la desaparición de los mismos(AU)

Introduction: The objective of this paper is to amend the bias included in our previous work, presenting a corrected estimation of the need and coverage of syringes/needles in Spanish prisons between 1992 and 2009. Methods: Data on the provision of the needles exchange programs (NEPs) in prison is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need and the difference between these magnitudes. The detected need estimate bias has been corrected. Results: NEP’s in prisons started in 1997. Their maximum coverage reached 36% in 2005, which is much higher than the initially estimated value. However, it decreased by half in the next four years, reaching 17.4% in 2009. Conclusion: The remarkable coverage reached by these programmes must be valued, but more recent evolution leads us to emphasize the need to be imaginative so that new epidemiological and economic circumstances do not lead to their disappearance(AU)

Cuestionarios sobre factores de riesgo de la exposición y la accidentalidad por tráfico en conductores. Una revisión / A review of questionnaires exploring driver’s exposure and risk factors in road crashes

Dada la diversidad de cuestionarios empleados en el estudio de la epidemiología analítica de las lesiones por tráfico, realizamos una revisión de los estudios publicados al respecto entre 1989 a 2011, con objeto de identificar sus fortalezas y debilidades. Dicha revisión puso de relieve que la mayor parte de los cuestionarios se centran en el factor humano sobre el riesgo de accidente, pero son muy pocos los que incluyen la intensidad de exposición y la asociación de ésta con otros factores de riesgo de la accidentalidad. Muchos cuestionarios poseen un elevado número de ítems y complejas escalas de valoración. Además, en España son escasos los cuestionarios validados sobre la exposición y la accidentalidad por tráfico. Por todo ello, es necesario trabajar en el diseño y la validación de cuestionarios que recojan de forma sencilla información integral sobre la epidemiología de las lesiones por tráfico de cara a su mayor conocimiento y prevención (AU)

Given the diversity of questionnaires currently being used in the study of the analytic epidemiology of traffic injuries, we made a review of studies on this question published between 1989 and 2011 in order toidentify their advantages and disadvantages. We wereable to observe that most of the questionnaires were focused on the human factor regarding the risk of road crashes, but very few of them included intensity of exposure and its association with other risk factors in road crashes. Many questionnaires have a high number of items and complex rating scales. Further more, in Spain there are few validated questionnaires which contain complete information about exposure and road crashes. In Spain we should work on the design and validation of questionnaires containing questions aimedat obtaining complete and easy information about the epidemiology of traffic injuries. In this way we would be able to increase our awareness of traffic injuries and how to prevent them (AU)

Cerebrospinal fluid tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-8 as diagnostic markers of cerebrospinal fluid infection in neurosurgical patients.

OBJECTIVE: To evaluate whether cerebrospinal fluid concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, or IL-8 may be used as diagnostic markers for the differential diagnosis of aseptic vs. bacterial meningitis and/or ventriculitis in neurosurgical patients. DESIGN: Prospective, observational study. SETTING: University teaching hospital. SUBJECTS: A total of 112 cerebrospinal fluid samples from 14 asymptomatic patients with normal cerebrospinal fluid after neurosurgery, 27 asymptomatic and 19 symptomatic patients with postneurosurgical aseptic meningitis, 32 patients with postneurosurgical cerebrospinal fluid infection, and 20 with severe subarachnoid and/or cerebral hemorrhage. MEASUREMENTS AND MAIN RESULTS: Specific ELISA kits were used to analyze TNF-alpha, IL-1beta, IL-6, and IL-8 concentrations on cerebrospinal fluid samples. Elevations in cerebrospinal fluid concentrations of TNF-alpha, IL-1beta, IL-6, and IL-8 were induced by different diseases or neurosurgical procedures, but cerebrospinal fluid bacterial infection induced the highest concentrations. To discriminate between aseptic cerebrospinal fluid pleocytosis and cerebrospinal fluid infection with a specificity of 95%, cerebrospinal fluid leukocyte count >1700/mL, TNF-alpha >150 pg/mL, and IL-1beta >90 pg/mL showed sensitivities of 51%, 74%, and 90%, respectively. Sufficiently sensitive and specific cutoff points could not be found for cerebrospinal fluid IL-6 or IL-8. CONCLUSION: Cerebrospinal fluid IL-1beta appears to be the best biochemical marker of cerebrospinal fluid infection in neurosurgical patients.

Interleukin 6 in cerebrospinal fluid of patients with meningitis is not a useful diagnostic marker in the differential diagnosis of meningitis.

We assayed interleukin 6 (IL-6) concentrations in cerebrospinal fluid (CSF) from patients affected by meningitis of different aetiologies, and verified whether IL-6 can be used as a diagnostic marker in the differential diagnosis of meningitis. We used a monoclonal antibody enzyme immunoassay to test 98 CSF samples classified as pyogenic (15), viral (15), self-resolving aseptic meningitis (20), other infectious meningitis (9), neoplastic (4) and normal CSF from patients with (20) and without (15) non-infectious neurological diseases. CSF IL-6 concentrations were increased in pyogenic meningitis (100%) and in more than 50% of viral and other subarachnoid space infections, and rarely in patients without central nervous system infections. Though patients affected by pyogenic meningitis showed the highest levels of CSF IL-6, only a cut-off point > or = 10000 pg/mL was able to discriminate pyogenic meningitis from those of other aetiologies with a specificity > or = 94% and a positive predictive value of > or = 0.75 but the sensitivity was < or = 60%. Therefore, CSF IL-6 concentration is not a good diagnostic marker in the differential diagnosis of meningitis.

Adenosine deaminase activity in the CSF of patients with aseptic meningitis: utility in the diagnosis of tuberculous meningitis or neurobrucellosis.

We assayed 229 CSF samples from 180 adults with meningitis of different etiologies for adenosine deaminase activity (ADA) and evaluated the usefulness of this assay in the differential diagnosis of aseptic meningitis. Cases of meningitis were classified as tuberculous meningitis (TBM), pyogenic meningitis, viral meningitis, self-resolving aseptic meningitis without a specific diagnosis, meningitis associated with other infections, and neoplastic meningitis. We also tested 117 CSF specimens for which parameters were normal. We chose a cutoff point of 10 IU/L on the basis of our results and found elevated ADA levels in 50% of the patients with TBM (no differences between patients with AIDS and those who did not have AIDS were observed). Among samples from patients with aseptic meningitis, we observed high ADA levels in only two of five of the patients with neurobrucellosis. Therefore, we concluded that in cases of aseptic meningitis, a CSF ADA level of > or = 10 IU/L has a sensitivity of 48%, a specificity of 100%, a positive predictive value of 1, and a negative predictive value of 0.91 as a diagnostic criterion for TBM or neurobrucellosis. ADA levels were also > 10 IU/L in 30% of the patients with pyogenic meningitis, but this diagnosis was easily excluded on other grounds.

Antibodies to antigen A60 in cerebrospinal fluid from patients with tuberculous meningitis.

Cerebrospinal fluid (CSF) anti-mycobacterial antigen 60 (A60) IgM, IgG and IgA in patients affected by meningitis of different etiologies were assayed as a rapid diagnostic test in cases of tuberculous meningitis. A commercial EIA was used to test 127 CSF samples classified as follows: tuberculous meningitis (n = 27 CSF samples from 16 patients, 6 of them with AIDS), pyogenic meningitis (n = 13), non-tuberculous aseptic meningitis (n = 43) and 44 normal CSF samples (16 of them from HIV-positive patients, 8 of whom had extraneurological tuberculosis). Anti-A60 IgM was positive only in two cases (1 tuberculous meningitis and 1 self-resolving aseptic meningitis). Positive CSF anti-A60 IgG and IgA were observed in eight and nine out of 16 patients with tuberculous meningitis, but only in four and five out of 13 samples studied prior to or in the first ten days of treatment, respectively. Most of the patients with false-positive IgG and IgA (16%) had pyogenic meningitis, but without intrathecal synthesis of antibodies. In patients with aseptic meningitis, the finding of CSF anti-A60 IgG plus IgA, initially or during follow-up, can be used as a diagnostic criterion for tuberculous meningitis, with a specificity of 100%, a positive predictive value of 1, and a negative predictive value of 0.81. However, its sensitivity is only 50% in immunocompetent patients and 16% in patients with AIDS.