Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis.

OBJECTIVES: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS: To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.

Características del consumo de tabaco, dependencia y motivación para el cambio de los especialistas internos residentes de Andalucía (España) / Characteristics of smoking, nicotine dependence and motivation for change in specialists training in health sciences (residents) in Andalusia (Spain)

Objetivo. Existen pocos trabajos sobre el consumo de tabaco entre los especialistas en formación en ciencias de la salud (residentes), por lo que se desea conocer la prevalencia del tabaquismo, la dependencia nicotínica y la motivación para el cambio, así como su relación con otras variables personales, laborales y de consumo de otras drogas. Material y métodos. Estudio multicéntrico transversal mediante cuestionario en el año 2012. Participan los residentes de todos los centros sanitarios docentes de Andalucía (España) mediante un cuestionario enviado por correo electrónico, recogiendo la edad, el sexo, la especialidad, el país de origen, el consumo cualitativo-cuantitativo de tabaco, la edad de inicio/abandono, el test de Fagerström y el estadio de cambio (Proschaka). Resultados. Dos mil seiscientos sesenta y siete residentes (63% del total). Edad media 29,1 años(± 5,2), 69% mujeres, 89% españoles, 86% médicos. El 17% fuman (patrón diario:47%, intermitente: 41%, asociado al ocio: 3%), inicio con 17,4 años(± 3,5) y media de 7,5 cigarrillos/día (± 7,1), superior en especialidades médicas (p = 0,067 ANOVA) y en hombres (p = 0,074 «t» de Student). El 82% con baja dependencia nicotínica, siendo mayor en especialidades médicas hospitalarias (p = 0,078, Chi cuadrado). El 7% son exfumadores y el 48% quieren dejar de fumar (contemplación 38%, preparación 10%). Mediante análisis multivariante se aprecia una relación entre el tabaquismo y el consumo de alcohol (OR: 2,84) y drogas ilegales (OR: 3,57), sin diferencias por edad ni país. Conclusiones. El consumo de tabaco es inferior a la población general, con una baja dependencia y buena predisposición para el cambio, por lo que sería aconsejable realizar actividades preventivas en los residentes para conseguir el cese del consumo de tabaco (AU)

Objective. As there are few studies on the smoking habits of specialists training in health sciences (residents), it is of interest to determine the prevalence of smoking, nicotine dependence and motivation for change, and their relationship with other variables (personal, work and consumption of other drugs). Material and methods. A multicentre, cross-sectional study using a questionnaire was conducted in 2012. All the residents who were studying in Teaching Health Centres in Andalusia (Spain) completed a questionnaire, which was sent by e-mail, collecting: age, sex, specialty, country of origin, qualitative-quantitative consumption of tobacco, age of onset/cessation, Fagerström test and stage of change (Proschaka). Results. A total of 2667 residents (63% of total) completed the questionnaire. The mean age was 29.1 years (± 5.2), 69% female, 89% Spanish, and 86% physicians. Of the 17% who smoked (daily pattern-47%, intermittently-41%, related to leisure-3%), starting at 17.4 years (± 3.5) and mean of 7.5 cigarettes per day (± 7.1), higher medical specialties (P = .067 ANOVA), and in men (P = .074, Student-t). More than three-quarters (82%) had a low nicotine dependence, being higher in hospital medical specialties (P = .078 χ2). Of the total, 7% were former smokers, and 48% wanted to quit smoking (contemplation 38%, preparation 10%). In the multivariate analysis there was a link between smoking and alcohol consumption (OR 2.84) and illegal drugs (OR 3.57). There were no differences by age or country. Conclusions. The consumption of tobacco in residents is less than the general population, with a low dependence and better willingness to change. The period of specialised training is a good time to offer tobacco interventions (AU)

[Characteristics of smoking, nicotine dependence and motivation for change in specialists training in health sciences (residents) in Andalusia (Spain)]. / Características del consumo de tabaco, dependencia y motivación para el cambio de los especialistas internos residentes de Andalucía (España).

OBJECTIVE: As there are few studies on the smoking habits of specialists training in health sciences (residents), it is of interest to determine the prevalence of smoking, nicotine dependence and motivation for change, and their relationship with other variables (personal, work and consumption of other drugs). MATERIAL AND METHODS: A multicentre, cross-sectional study using a questionnaire was conducted in 2012. All the residents who were studying in Teaching Health Centres in Andalusia (Spain) completed a questionnaire, which was sent by e-mail, collecting: age, sex, specialty, country of origin, qualitative-quantitative consumption of tobacco, age of onset/cessation, Fagerström test and stage of change (Proschaka). RESULTS: A total of 2667 residents (63% of total) completed the questionnaire. The mean age was 29.1 years (± 5.2), 69% female, 89% Spanish, and 86% physicians. Of the 17% who smoked (daily pattern-47%, intermittently-41%, related to leisure-3%), starting at 17.4 years (±3.5) and mean of 7.5 cigarettes per day (±7.1), higher medical specialties (P=.067 ANOVA), and in men (P=.074, Student-t). More than three-quarters (82%) had a low nicotine dependence, being higher in hospital medical specialties (P=.078 χ(2)). Of the total, 7% were former smokers, and 48% wanted to quit smoking (contemplation 38%, preparation 10%). In the multivariate analysis there was a link between smoking and alcohol consumption (OR 2.84) and illegal drugs (OR 3.57). There were no differences by age or country. CONCLUSIONS: The consumption of tobacco in residents is less than the general population, with a low dependence and better willingness to change. The period of specialised training is a good time to offer tobacco interventions.

Manejo del dolor crónico en Atención Primaria, perfil de prescripción de opiáceos mayores: indicación, coste y efectos secundarios / Managing chronic pain in Primary Care, prescription profile for strong opioids: indications, cost and adverse effects

Objetivos: el objetivo principal del estudio es conocer las características de la prescripción de opiáceos mayores en Atención Primaria. Material y métodos: se diseña un estudio retrospectivo mediante una cohorte histórica, valorando a los pacientes que hayan consumido opiáceos mayores en todos los centros de salud de Jaén capital durante 2011, mediante un muestreo sistemático, 215 pacientes, calculando el tamaño de muestra para un nivel de confianza 95 %, precisión 5 %, y pérdidas 5 % (ampliando la muestra este 5 % por sesgo de información); Se auditan las historias clínicas recogiendo: edad, sexo, antecedentes personales, nivel social, frecuentación sanitaria, características de la prescripción de opiáceos (dosis, duración, coste, efectos secundarios) y uso de otros analgésicos/coadyuvantes. Se procesan los datos para ofrecer un estudio descriptivo y una posterior comparación en función del opiáceo prescrito. Resultados: se valoran 215 pacientes (44 % del total de la población), de los que se obtienen 323 prescripciones de opiáceos en el año de estudio (23 % de la muestra con dos prescripciones de opiáceos y 13 % con tres). Los opiáceos más prescritos son fentanilo (60 %) y buprenorfina (22%), por un 3 % de morfina. La buprenorfina es el más usado en monoterapia (70 %), preferentemente en mujeres de edad avanzada y pensionistas, sobre todo para el dolor mixto por parte del médico de familia. El fentanilo se usa principalmente en parches (95 % de las prescripciones de fentanilo) y la hidromorfona se emplea en pacientes de menor edad (< 60 años), prescrito por la Unidad del Dolor y Reumatología (43 % y 20 % del total de prescripciones, respectivamente). La oxicodona se emplea más en pacientes de zonas necesitadas de transformación social (46 % del total de opioides prescritos en ZNTS) y exclusivamente para el dolor neuropático y mixto (52 % y 48 % respectivamente de las prescripciones totales de oxicodona), sobre todo por parte de Reumatología y Unidad del Dolor (25 % y 43 % del total de prescripciones respectivamente). La morfina se emplea en pacientes oncológicos por vía oral (46 % de las prescripciones de morfina), la mitad en formulación retard (45 % de las prescripciones de morfina), siendo estos pacientes quienes presentan una demanda sanitaria superior (91 % del total de pacientes con prescripción de morfina, acuden al servicio de urgencias, y un 46 % precisan ingreso hospitalario). Conclusiones: como medida de mejora, contrastando los resultados obtenidos, se debería fomentar la prescripción de morfina como analgésico de elección tanto en dolor agudo como en dolor crónico severo. Es preciso mejorar los instrumentos de medida específicos para cada tipo de dolor teniendo en cuenta la etiopatogenia de este, así como fomentar una mayor utilización de escalas de valoración, tanto al inicio del tratamiento, como durante el seguimiento de cada paciente para evaluar la evolución del dolor y la efectividad del tratamiento (AU)

Objectives: The main objective of the study was to determine the characteristics of major opioids prescribing in Primary Care. Material and methods: A retrospective study was designed through the use of a historical cohort, assessing patients who have consumed major opiates in all Jaén city health centers during 2011, by systematic sampling, 215 patients, computing the sample size for a confidence level of 95 %, accuracy 5 %, 5 % losses (expanding the 5 % sample by reporting bias). Medical records were audited to collect the following data: Age, sex, medical history, social status, number of appointments and use of hospital resources, characteristics of opioids prescription (dose, duration, cost, adverse reaction) and use of other analgesics/ adjuvants. Data were processed for a descriptive study and a subsequent comparison according to the prescribed opioid. Results: 215 patients were included (44 % of total population) those obtained 323 prescriptions for opiates in the study year (23 % of the sample with two prescriptions of opiates and 13 % with three). Most prescribed opioids were fentanyl (60 %) and buprenorphine (22 %) and the least prescribed is by 3 % morphine. Buprenorphine is the most used in monotherapy (70 %), preferably in older women and pensioners, especially for joint pain by the general practitioner. The fentanyl is mainly used in patches (95 % of prescriptions of fentanyl) and hydromorphone is used in younger patients (< 60 years), prescribed by the Pain and Rheumatology Departments (43 % and 20 % of total prescriptions, respectively). Oxycodone is used in patients from areas with social transformation needs (46 % of prescribed opioids in ZNTS) and exclusively for neuropathic and mixed pain (52 % and 48 % respectively of total prescriptions of oxycodone), especially by the Rheumatology and Pain Unit. Morphine is used orally in cancer patients (46 % of prescriptions for morphine), half in retard formulation (45 % of prescriptions for morphine), and these patients were who have a higher healthcare demands (91 % of totals patients prescribed morphine, go to the emergency department, and 46 % required hospital admission). Conclusions: As improvement measure, after contrasting the results, we should encourage the prescription of morphine as an analgesic of choice in both acute and chronic severe pain. An improvement in the measuring instruments specific to each type of pain considering its pathogenesis is required, as well as fostering a greater use of rating scales, both at the start of treatment and during the follow-up of each patient to assess the evolution of pain and treatment effectiveness (AU)

[Food consumption patterns among adolescents]. / La alimentación en el adolescente.

BACKGROUND: Adolescence is a critical time for the establishment of healthy eating habits. The objective was to analyze food consumption patterns among adolescents and their relationship with family and social factors. METHODS: Multicentre observational cross-sectional descriptive study using a food frequency questionnaire for the last week. It was answered anonymously. The adolescent's age/gender, parents' studies/occupation and school's location/type were included. The population sample was composed of 1,095 adolescents in sixth grade at primary schools from an Andalusian region. They were chosen by polietapic random sampling that distinguished between public/private and capital/provincial schools. RESULTS: 1,005 surveys were analyzed. The mean age is 11.45 (SD: 0.59). Fifty-three percent were male. The intake of dairy products (only two-thirds taken daily), pasta, fruit and vegetables (daily consumption of 30%) is deficient. Sixty-four point five percent consume legumes weekly. Fish consumption is equal to meat, with a preference for poultry. More than half consume red meat daily. Olive oil is preferred. The intake of "empty calories" (fast food, candies, soft drink) is high. Through multivariate analysis the existence of clusters of healthy and unhealthy foods, related to the social status of the parents and the type of school, is proved. CONCLUSIONS: A healthy diet based on the nutritional pyramid is not the consumption pattern in the adolescents surveyed. There is a low consumption of diary products, legumes, fruits and vegetables. There is a relationship between the social class of the family and consumption patterns (healthy and unhealthy). Health strategies are needed to modify such inappropriate consumption.

La alimentación en el adolescente / Food consumption patterns among adolescents

Fundamento: La adolescencia es un momento clave para la instauración de hábitos alimentarios saludables. El objetivo del trabajo fue conocer los hábitos alimentarios de los adolescentes y su relación con factores socio-familiares. Material y métodos: Estudio observacional descriptivo, multicéntrico, mediante cuestionario anónimo sobre consumo de alimentos en la última semana, recogiendo edad/sexo del alumnado, estudios/ocupación laboral de padres/madres y tipo/localización del colegio. La muestra comprendió 1.095 adolescentes de sexto de Educación Primaria de una provincia andaluza, elegidos mediante muestreo aleatorio polietápico diferenciando centros públicos/privados y de la provincia/capital. Resultados: Fueron recogidas 1.005 encuestas válidas (99,25% del total); media de edad 11,45 años (±0,59) y 53% varones. Consumo deficitario de lácteos (sólo dos terceras partes toman diariamente), pasta, frutas, verduras y hortalizas (consumo diario en un 30%). Las legumbres se consumen semanalmente en el 64,5%. El consumo de pescado se iguala al de carne, siendo más preferida la de ave; más de la mitad consumen embutidos diariamente. El aceite de oliva sigue siendo el más consumido. Hay un significativo consumo de alimentos con "calorías vacías" (comida rápida, dulces, refrescos). Mediante análisis multivariante (clúster) se comprueba la existencia de agrupaciones de alimentos saludables y no saludables, relacionado con el nivel social de los progenitores y el tipo de colegio. Conclusiones: La dieta basada en la pirámide nutricional no es el patrón de alimentación en los adolescentes encuestados, con escaso consumo de lácteos, legumbres y frutas/verduras. Los alimentos se agrupan en patrones saludables o no saludables relacionados con la clase social familiar. Son necesarias estrategias sanitarias para modificar este consumo inadecuado (AU)

Background: Adolescence is a critical time for the establishment of healthy eating habits. The objective was to analyze food consumption patterns among adolescents and their relationship with family and social factors. Methods: Multicentre observational cross-sectional descriptive study using a food frequency questionnaire for the last week. It was answered anonymously. The adolescent’s age/gender, parents' studies/occupation and school's location/type were included. The population sample was composed of 1,095 adolescents in sixth grade at primary schools from an Andalusian region. They were chosen by polietapic random sampling that distinguished between public/private and capital/provincial schools. Results: 1,005 surveys were analyzed. The mean age is 11.45 (SD: 0.59). Fifty-three percent were male. The intake of dairy products (only two-thirds taken daily), pasta, fruit and vegetables (daily consumption of 30%) is deficient. Sixty-four point five percent consume legumes weekly. Fish consumption is equal to meat, with a preference for poultry. More than half consume red meat daily. Olive oil is preferred. The intake of "empty calories" (fast food, candies, soft drink) is high. Through multivariate analysis the existence of clusters of healthy and unhealthy foods, related to the social status of the parents and the type of school, is proved. Conclusions: A healthy diet based on the nutritional pyramid is not the consumption pattern in the adolescents surveyed. There is a low consumption of diary products, legumes, fruits and vegetables. There is a relationship between the social class of the family and consumption patterns (healthy and unhealthy). Health strategies are needed to modify such inappropriate consumption (AU)

Disonancias cognitivas en la intervención antitabaco motivacional en adolescentes / Cognitive dissonance in the motivational smoking intervention in adolescents

Objetivo. Conocer las disonancias cognitivas más frecuentes de los adolescentes entre las motivaciones para fumar y dejar de fumar. Material y métodos. Estudio descriptivo realizado en 5 institutos de secundaria tras intervención motivacional a adolescentes (< 20 años) para dejar de fumar. Se recoge por escrito una balanza de motivos para fumar/dejar de fumar, edad, sexo, tests de Fagerström/Richmond, edad de inicio y patrón del consumo. Resultados. Participan 82 adolescentes (52% hombres, edad 15,6 años±1,4). Motivos para fumar: amigos (55%), «me gusta» (44%), «estar enganchado» (28%), diversión (19%), autoafirmación (18%). Motivos para dejar de fumar: mejorar la salud (91%), «es caro» (55%), no gusta sabor/olor (23%), conflictos con padres (23%). La diversión se asocia al inicio precoz del consumo (p=0,025; Student). La dependencia aparece en adolescentes de mayor edad (p=0,075; Student). La sensación de relajación se asocia a mayor consumo (p=0,018; Student), sobre todo en mujeres (p=0,046; χ2). La autoafirmación es más frecuente en hombres (p=0,045; χ2). El test de Richmond empeora si le gusta fumar (p=0,035; Student) y mejora si tiene problemas económicos (p=0,082; Student). El rechazo al sabor/olor se relaciona con menor dependencia (Fagerström) (p=0,069; Student). Disonancias cognitivas: / (OR 4,14), / (OR 0,44), / (OR 0,38) y (OR 0,24), /< autoafirmación> (OR 0,22), / (OR 0,21). Un 54% dejan de fumar y se relaciona con el entorno, la sensación de placer y la dependencia (p<0,05 test X2). Conclusión. Las disonancias cognitivas son un elemento motivacional muy importante para conseguir el cese del consumo tabáquico entre adolescentes y deben incorporarse a la intervención antitabaco realizada por los sanitarios (AU)

Objectives. To find out the most common dissonances between smoking and giving up motivations in adolescents. Material and methods. A five Secondary Schools descriptive study after motivational interviewing of adolescents (less than 20 years) who wanted to quit smoking. A written balance sheet of reasons for smoking and quitting smoking, age, sex, Fagerström/Richmond test, beginning age, consumption pattern, was collected. Results. A total of 82 adolescents participated (52% male, age 15.6 years±1.4). Reasons for smoking: friends (55%), «I like it» (44%), «addicted» (28%), for fun (19%), and self-assertiveness (18%). Reasons for quitting smoking: better health (91%), «It's expensive» (55%), don’t like taste/smell (23%), and conflicts with parents (23%). Fun is associated with earlier onset of smoking (p=.025; Student) while dependency is recognised in older adolescents (p=.075; Student). Relaxation feeling is associated with greater cigarette consumption (p=0,018; Student) especially in women (p=.046; χ2); assertiveness is more common in men (p=.045; χ2). Richmond test results get worst if they like smoking (p=.035; Student) and get better if they have economical problems (p=.082; Student). Rejecting taste/smell is related with less dependency (Fagerström) (p=.069; Student). The most common dissonances were between / (OR 4.14), // (OR=0.38) and (OR 0.24) / (OR 0.22), / (OR 0.21). A total of 54% quit smoking and was related to the environment, the feeling of pleasure and dependency (p<.05; X2 test). Conclusions. Cognitive dissonances are a very important motivational element for the adolescent to quit smoking, and must be incorporated into anti-smoking interventions by health professionals (AU)

Atención sanitaria en medio rural: una realidad que mejora / Health care in the rural setting: a realitythat is improving

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[Tobacco dependency and adolescents: a good time to give up smoking? Relation to social and family factors]. / Tabaquismo y adolescentes: 'buen momento para dejar de fumar? Relación con factores sociofamiliares.

OBJECTIVES: To find the prevalence and dependency of adolescents on tobacco, its relation with family and social factors and the motivation for giving up smoking. DESIGN: Cross-sectional, descriptive study using questionnaires. SETTING: Secondary school, Jaén, Spain. PARTICIPANTS AND MEASUREMENTS: A total of 232 students: the questionnaire included questions on age, sex, tobacco consumption, smoking habits of family and friends, and family structure. The following tests were given: the Apgar family (AFT), Fagerström (FT), and Richmond (RT) tests. RESULTS: Mean age 14.1 years old (95% CI, 13.9-14.3; range, 5 years); 57% boys. A 22% (17.1%-24.5%) were smokers, most of whom were boys (65.2%-86.7%; P<.001, *2) and were older than non-smokers (0.7-1.5; P<.001, Student's t). Mean consumption was 9.2 cigarettes a day (7.4-11.0) over 32 months (14.6-49.5). Friends who smoked were more frequent among adolescents who smoked (80.9%-99%) than among non-smokers (57.3%-70.6%; P<.001, *2). Smoking every day increased consumption by 6 cigarettes a day (3.6-9.2; P<.001, Student's t). In 71% (65.3%-76.6%) of families, there were smokers, principally the parents (63.3%-74.6%), who, in 85% (74.2%-95.8%) of cases, disapproved of their son/daughter smoking. Family dysfunction was more frequent in smokers (30% mild [16.1%-43.9%] and 17% severe [5.4%-28.6%]; P<.001, *2). The FT was positive for 12% (2%-22%) and was associated with the consumption of cigarettes per day (r=0.78; P<.05, Pearson). The RT was positive for 22% (15.1%-28.9%): 70% in the contemplation stage (55.6%-84.3%); 17% in preparation (5.4%-28.6%); 13% in action (3%-23%). CONCLUSIONS: The consumption of tobacco among adolescents is related to family function and having friends who smoke. The low dependency and the motivation to change make this stage of life a good moment to concentrate on anti-smoking counselling.

Tabaquismo y adolescentes: ¿buen momento para dejar de fumar? Relación con factores sociofamiliares / Tobacco dependency and adolescents: a good time to give up smoking? Relation to social and family factors

Objetivo. Conocer la prevalencia y la dependencia del tabaquismo entre adolescentes, la relación con factores sociofamiliares y la motivación para abandonar el consumo. Diseño. Estudio descriptivo transversal mediante encuesta. Emplazamiento. Instituto de educación secundaria de Jaén. Sujetos y mediciones. Se estudió a 232 alumnos; se recogen la edad, el sexo, el hábito tabáquico, la estructura familiar y el consumo de la familia y los amigos. Se entregan los tests de Apgar familiar, Fagerström y Richmond. Resultados. Edad media 14,1 años; 57% varones y 43% mujeres. Un 22% (intervalo de confianza [IC] del 95%, 17,1-26,9%) fuma, la mayoría son varones (IC del 95%, 65,2-86,7; p < 0,001, test de la *2) y con mayor edad que los no fumadores (diferencia de 1 año; IC del 95%, 0,7-1,5; p < 0,001 test de la t de Student), consumo medio de 9,2 cigarrillos/día (IC del 95%, 7,4-11,0) y duración de 32 meses (IC del 95%, 14,6-49,5). Los amigos que fuman son más frecuentes entre adolescentes fumadores (IC del 95%, 80,9-99,0) que entre no fumadores (IC del 95%, 57,3-70,6; p < 0,001, test de la *2). Fumar diariamente incrementa el consumo en 6 cigarrillos/día (IC del 95%, 3,6-9,2; p < 0,001, test de la t de Student). Se fuma en un 71% (IC del 95%, 65,3-76,6) de las familias, sobre todo los padres (IC del 95%, 63,3-74,6), la mayoría de los cuales reprueba el tabaquismo de su hijo/a (IC del 95%, 74,2-95,8). La disfunción familiar es más frecuente en fumadores (un 30% disfunción leve [IC del 95%, 16,1-43,9] y un 17% con disfunción grave [IC del 95%, 5,4-28,6]; p < 0,001, test de la *2). Un 12% (IC del 95%, 2-22) da positivo en el test de Fagerström y se asocia con el consumo de cigarrillos/día (r = 0,78; p < 0,05, Pearson). Un 22% tiene un test de Richmond positivo (IC del 95%, 15,1-28,9): el 70% se encuentra en fase de contemplación (IC del 95%, 55,6-84,3), el 17% en fase de preparación (IC del 95%, 5,4-28,6) y el 13% en fase de acción (IC del 95%, 3-23). Conclusiones. El consumo de tabaco entre adolescentes se relaciona con la función familiar y el tabaquismo de los amigos. La baja dependencia y el porcentaje de motivación para el cambio hacen de esta etapa vital un buen momento para incidir en el consejo antitabaco

Objectives. To find the prevalence and dependency of adolescents on tobacco, its relation with family and social factors and the motivation for giving up smoking. Design. Cross-sectional, descriptive study using questionnaires. Setting. Secondary school, Jaén, Spain. Participants and measurements. A total of 232 students: the questionnaire included questions on age, sex, tobacco consumption, smoking habits of family and friends, and family structure. The following tests were given: the Apgar family (AFT), Fagerström (FT), and Richmond (RT) tests. Results. Mean age 14.1 years old (95% CI, 13.9-14.3; range, 5 years); 57% boys. A 22% (17.1%-24.5%) were smokers, most of whom were boys (65.2%-86.7%; P<.001, *2) and were older than non-smokers (0.7-1.5; P<.001, Student's t). Mean consumption was 9.2 cigarettes a day (7.4-11.0) over 32 months (14.6-49.5). Friends who smoked were more frequent among adolescents who smoked (80.9%-99%) than among non-smokers (57.3%-70.6%; P<.001, *2). Smoking every day increased consumption by 6 cigarettes a day (3.6-9.2; P<.001, Student's t). In 71% (65.3%-76.6%) of families, there were smokers, principally the parents (63.3%-74.6%), who, in 85% (74.2%-95.8%) of cases, disapproved of their son/daughter smoking. Family dysfunction was more frequent in smokers (30% mild [16.1%-43.9%] and 17% severe [5.4%-28.6%]; P<.001, *2). The FT was positive for 12% (2%-22%) and was associated with the consumption of cigarettes per day (r=0.78; P<.05, Pearson). The RT was positive for 22% (15.1%-28.9%): 70% in the contemplation stage (55.6%-84.3%); 17% in preparation (5.4%-28.6%); 13% in action (3%-23%). Conclusions. The consumption of tobacco among adolescents is related to family function and having friends who smoke. The low dependency and the motivation to change make this stage of life a good moment to concentrate on anti-smoking counselling

Liver fibrosis assessment with semiquantitative indexes and image analysis quantification in sustained-responder and non-responder interferon-treated patients with chronic hepatitis C.

BACKGROUND/AIMS: The effect of interferon on the reduction of liver fibrosis is controversial. We aimed to compare semiquantitative methods with a quantitative digital image analysis system to assess liver fibrosis in biopsies from patients with chronic hepatitis and different responses to interferon. METHODS: We studied 98 liver biopsies with chronic hepatitis C before and after recombinant interferon alfa-2 treatment, using conventional histological assessment, grading of histological activity, scoring/staging of fibrosis (Knodell and Scheuer), and quantification of fibrosis with image analysis (FibroQuant). RESULTS: Sustained-responders to interferon showed a significant reduction in histological lesions and in their Knodell and Scheuer activity indexes. The semiquantitative systems showed no reduction in fibrosis. The FibroQuant application showed a significant reduction in porto-periportal and septal areas among sustained-responders (P < 0.001) and non-responders (P < 0.05), and in porto-periportal and septal fibrosis areas only in sustained-responders (P < 0.001), whereas the percentage of fibrosis increased in non-responders (P < 0.001). CONCLUSIONS: The Scheuer system is useful for the daily evaluation of fibrosis, but the FibroQuant application provides more objective data on the anti-fibrogenic effects of interferon, which include a reduction in the porto-periportal area in sustained-responders and non-responders, accompanied by a reduction in the area of fibrosis only when the viral replication has ceased.

Automatic quantification of liver fibrosis: design and validation of a new image analysis method: comparison with semi-quantitative indexes of fibrosis.

BACKGROUND/AIMS: Liver fibrosis is one of the most important and characteristic histologic alterations in progressive and chronic liver diseases. Thus, in both clinical and experimental practice, it is fundamental to have a reliable and objective method for its precise quantification. Several semi-quantitative scoring systems have been described. All are time-consuming and produce partially subjective fibrosis evaluations that are not very precise. This paper describes the design and validation of an original image analysis-based application, FibroQuant, for automatically and rapidly quantifying perisinusoidal, perivenular and portal-periportal and septal fibrosis and portal-periportal and septal morphology in liver histologic specimens. METHODS: The implemented image-processing algorithms automatically segment interstitial fibrosis areas, while extraction of portal-periportal and septal region is carried out with an automatic algorithm and a simple interactive step. For validation, all automatically extracted areas were also manually segmented and quantified. RESULTS: Statistical analysis showed significant intra- and interoperator variability in manual segmentation of all areas. Automatic quantifications did not significantly differ from mean manual evaluations of the same areas. Comparison of our image analysis quantifications with staging histologic evaluations of liver fibrosis showed significant correlations (Spearman's, 0.72