[Severe burns related to steam inhalation therapy]. / Quemaduras graves relacionadas con la terapia inhalatoria con vahos.

INTRODUCTION: Despite lack of proven effectiveness and its potential to cause severe burns, steam inhalation therapy (SIT) is still used as a treatment for benign respiratory conditions. OBJECTIVE: To characterize cases of burns related to steam inhalation therapy (BRSIT) in order to formulate appropriate preventive criteria. PATIENTS AND METHODS: A review was conducted on cases of BRSIT admitted to a Burns Unit between 2006 and 2012, analysing epidemiological data, clinical aspects, severity and course. RESULTS: A total of 530 patients were admitted; 375 (70%) with scalds, and 15 with BRSIT (2.8% of burns; 4% of scalds). SIT was indicated in most cases for mild upper airway infections. The median age of patients was 7 years (2.5m-14 y). The burned area (BA) was ≥10% in 60% of cases (max. BA 22%). Injuries involved trunk, genital area, and extremities; only in one case was the face affected. The mean hospital length-of-stay was 14 days (3-30 d). Five patients (33%) were admitted to the PICU, most of them (60%) younger than 3 years. Eight patients (53%) underwent surgical treatment (skin grafting). In a 12-year-old patient whooping cough was diagnosed in the Burns Unit, and a 2.5-year-old patient developed staphylococcal toxic shock syndrome. No patient died. The final course was satisfactory in all patients. CONCLUSIONS: BRSIT can be severe and cause significant use of health resources. Professionals caring for children, particularly paediatricians, should seriously consider their prevention, avoiding treatments with SIT, and educating parents in order not to use it on their own.

Muerte por uso incorrecto del «pa˜nuelo portabebés»: necesidad de un abordaje multidisciplinar en las lesiones infantiles / Death by incorrect use of baby sling: multidisciplinary approach to infant injuries

No disponible

El juego de la asfixia: un juego potencialmente mortal / The choking game: a potentially lethal game

Los juegos asfícticos son un comportamiento conocido entre los adolescentes, pero no descrito hasta el momento en la literatura científica española. Se trata de comportamientos que buscan una breve euforia debida a la disminución del flujo de oxígeno en el cerebro. Presentamos el caso de un adolescente de 15 años que falleció en una habitación de su domicilio habitual debido a una ahorcadura accidental durante un juego asfíctico. Se analizan las características del caso y se procede a una revisión de la literatura publicada. El juego de la asfixia es una actividad peligrosa, potencialmente mortal. Casos como el descrito pueden ayudar a que los pediatras y médicos en general conozcan tanto el fenómeno como la peligrosidad del mismo. Su conocimiento es importante para la prevención y detección precoz de comportamientos de riesgo entre los adolescentes (AU)

Choking games are a known behaviour among adolescents, although they have not been reported in the Spanish scientific literature. They are games which seek a brief euphoria due to the restriction oxygen flow into the brain. The case of a 15 year-old adolescent boy who died in a room due to accidental hanging while playing the choking game is presented. Case characteristics are described and literature reviewed. The choking game is a dangerous and potentially fatal activity. Cases like the one described may be helpful for paediatricians and physicians in recognising this phenomenon and its risks. Knowledge of this activity is important for the prevention and early detection of adolescents risk behaviours (AU)

[The choking game: a potentially lethal game]. / El juego de la asfixia: un juego potencialmente mortal.

Choking games are a known behaviour among adolescents, although they have not been reported in the Spanish scientific literature. They are games which seek a brief euphoria due to the restriction oxygen flow into the brain. The case of a 15 year-old adolescent boy who died in a room due to accidental hanging while playing the choking game is presented. Case characteristics are described and literature reviewed. The choking game is a dangerous and potentially fatal activity. Cases like the one described may be helpful for paediatricians and physicians in recognising this phenomenon and its risks. Knowledge of this activity is important for the prevention and early detection of adolescents risk behaviours.

Substance use among road traffic casualties admitted to emergency departments.

OBJECTIVE: To describe the prevalence of recent psychoactive substance use and associated factors among road traffic casualties admitted to emergency departments. METHODS: A cross-sectional study was carried out, including adults injured in road traffic crashes admitted to the emergency department (ED) of eight hospitals in Catalonia (Spain), during three cross-sections, each of 4 days duration (2005-2006). Information sources were an interview, an oral fluid specimen and the patient's clinical record. Dependent variables were presence of alcohol, cannabis, cocaine, ecstasy, opiates or benzodiazepines. Independent variables were socioeconomic characteristics and circumstances of the injuries and admission. Prevalence and exact 95% confidence intervals were estimated for men and women. Bivariate analyses and multivariate binomial regression modelling were carried out to study factors associated with substance use in male drivers and pedestrians. RESULTS: The prevalence of substance use was higher in men (n = 226) than in women (n = 161) for any substance (34.4% and 16.2%), any illegal substance (19.3% and 7.6%), alcohol (18.5% and 9.2%) and cannabis (17.0% and 3.8%), respectively. In male drivers and pedestrians, alcohol use was associated with being in the 25-30-year age group, being injured at night and the weekend, and arriving at the ED by ambulance; cannabis use was only associated with being in the 18-30-year age group. CONCLUSIONS: A high prevalence of recent psychoactive substance use, especially alcohol, cannabis and cocaine, was observed in all age groups. The results indicate the need to screen for substance use and to give simple advice to casualties at EDs.

Comportamiento antisocial y uso de drogas: implicaciones para la prevención / No disponible

El comportamiento antisocial se asocia frecuentementeal consumo de drogas. En la práctica clínica, elabuso y dependencia de las drogas suele asociarse altrastorno antisocial de la personalidad y a una historiapositiva de trastorno disocial. Los trastornos relacionadoscon el uso de drogas y con el comportamiento antisocialpueden tener mecanismos etiopatogénicos comunes,entre los que los factores de riesgo y de protecciónde naturaleza familiar jugarían un papel central.Los adolescentes que muestran un comportamientoantisocial pueden precisar intervenciones específicaspara prevenir posteriores trastornos relacionados con eluso de drogas. A pesar de la amplia literatura que muestrala eficacia del entrenamiento familiar como unaestrategia adecuada para prevenir el abuso de sustanciasentre los adolescentes con comportamiento antisocial,los programas de prevención familiar son escasos tantoen España como en América Latina, una situación quecomienza a cambiar con el desarrollo de nuevos programasde prevención selectiva

Antisocial behaviour is frequently related to substanceuse. In clinical practice, substance abuse anddependence are commonly associated to antisocial personalitydisorders and a positive history of conduct disorder.Both substance use and antisocial behaviour disordersmay share common etiopathogenic factors, withfamily-related risk and protective factors playing animportant causative role.Adolescents showing behaviour problems mayrequire specific interventions to prevent subsequentsubstance use disorders. In spite of the extensive literatureshowing the efficacy of parental training as anappropriate strategy to prevent substance abuse amongantisocial adolescents, family prevention programmesare scarce in Spain and Latin America, a situation that isbeginning to change due to the development of newselective prevention programmes

[Change in health-related problems of cocaine consumption in Catalonia, Spain]. / Cambio de los problemas de salud provocados por la cocaína en Cataluña.

BACKGROUND: Our aim was to study the evolution of cocaine-related health problems in Catalonia, Spain. METHODS: Analysis of first treatment admissions, emergency-room episodes, and mortality recorded by information systems on drug abuse in Catalonia and the city of Barcelona (Spain) in 1999. RESULTS: In 1999, cocaine was the illegal drug most frequently reported among drug-related emergency-room episodes (1,093 episodes in the city of Barcelona). In addition, cocaine was the illegal drug most frequently found among fatal drug overdoses (80% of all deaths in the last quarter of 1999) and the one that caused the highest number of treatment admissions (1,547 cases in Catalonia). CONCLUSIONS: There is an increase in cocaine-related health problems which means that it is needed health to improve the diagnosis, health education, treatment and prevention of complications associated with the use of this substance.

Prevención del abuso de drogas en la escuela secundaria tras la reforma educativa. Implantación de diversos programas en la ciudad de Barcelona / Prevention of drug abuse in the secondary school after the reform of the Spanish educational system. Implementation of several programmes in the city of Barcelona, Spain

Objetivos: Evaluar la adopción de tres programas escolares diferentes de prevención del abuso de drogas en centros de educación secundaria, analizando algunas características de su implantación, así como la relación entre el porcentaje de escuelas que han adoptado cada intervención y la prevalencia de la adicción a los opiáceos en diferentes distritos. Métodos: Encuesta por correo con seguimiento telefónico a los 235 centros de educación secundaria de Barcelona realizada al finalizar el curso escolar 1997-1998. Se practicó un análisis de correlación bivariada (Spearman) para evaluar la asociación entre el porcentaje de escuelas que habían adoptado cada uno de los tres programas en cada distrito y las estimaciones de la tasa de prevalencia de la adicción a los opiáceos publicadas anteriormente. Resultados: un 44,7 por ciento de las escuelas completaron la encuesta, 38 de ellas (16,2 por ciento de las respondientes) ofrecieron uno de los programas durante el curso, 20 escuelas (19,0 por ciento) ofrecieron dos programas, y cuatro escuelas (3,0 por ciento) los tres programas. Se observaron correlaciones estadísticamente significativas entre distritos en la adopción de diferentes programas, pero no entre los porcentajes de escuelas que ofrecían programas de prevención y la prevalencia de adicción a los opiáceos. Conclusiones: Las necesidades sociales y sanitarias, indicadas por la prevalencia de la adicción a los opiáceos, no explican la desigualdad territorial en la adopción de programas de prevención escolar. Se discute la necesidad de desarrollar programas de prevención destinados a grupos en riesgo (AU)

Monitoring treatment demand for drug abuse in Spain: perspective over a decade.

The Spanish Information System on Drug Abuse (SEIT) was established in 1987 by the National Plan on Drugs, based on three indirect indicators that reflect the health effects of drug use: treatment, emergency and mortality. The treatment indicator is the core of the system, the one with the best consolidation, higher coverage and greater quantity of reliable data accumulated. The configuration of the system has a regional basis (Autonomous Communities), which strongly influences its potentialities, operation, results, strengths and limitations. Only outpatient treatment admissions, reported by ambulatory treatment centres and prison units, are recorded. Double counting is eliminated at the regional level. Over a decade of existence, the SEIT, and mainly its treatment indicator, has proven to be an excellent tool for public health action, planning and decision making, as well as for research and co-operation between regions.

Analytical considerations in the use of capture-recapture to estimate prevalence: case studies of the estimation of opiate use in the metropolitan area of Barcelona, Spain.

Capture-recapture, an indirect method widely used to estimate undetected populations, has been criticized because it causes problems due to a lack of compliance with several important assumptions and model selection strategies. This paper expands on the problems encountered when applying this methodology to drug abuse estimations, specifically the prevalence of opiate use in the metropolitan area of Barcelona, Spain, in 1993. Three samples of opiate users (from hospital emergency rooms, treatment centers, and prisons) were available in the area studied; an additional sample (mortality data) was analyzed for the city of Barcelona. Log-linear models that provided a good fit were considered, to which further model selection strategies were applied. A total of 3,207 unique individuals aged 15-44 years were identified in the three samples from the greater Barcelona area; the mortality sample from the city of Barcelona contained an additional 83 individuals. Heterogeneity was observed in different age, sex, and residence area subgroups. Population estimates differed widely according to the log-linear model chosen. Minimum Akaike's information criterion model and saturated model estimates were used to produce population prevalence rates. The main problems the authors encountered in this study were related to population definition, source heterogeneity, and assessment of an adequate model, a problem associated with sample size.

Mortality trends in a cohort of opiate addicts, Catalonia, Spain.

BACKGROUND: Opiate addiction affects young adults whose life expectancy is reduced as a consequence of their habit. In the midst of the AIDS epidemic, the present study objective was to analyse recent overall and cause-specific mortality trends among opiate addicts in Catalonia (Spain). METHODS: Mortality was assessed retrospectively in an opiate addict cohort assembled from admissions to hospital emergency wards and drug treatment centres during the period 1985-1991. The cohort included 12 711 opiate addicts (12 045 men and 3666 women) aged 15-44 years. Overall and cause-specific mortality trends were analysed using age as the time scale and Cox regression with staggered entry determined by the age at entry in the study. Annual trends were adjusted by sex and source of entry, and were stratified by length of opiate use. RESULTS: Mortality rates increased throughout the entire period from 13.8 to 34.8 deaths per 1000 person-years, with a statistically significant increase in 1987-1988 and 1988-1989. In a model including age, gender, source of entry and length of drug use, risk increased significantly in men and for longer length of use, but not with age and for source of entry into the study cohort. The causes of death associated with high mortality rates were AIDS and the causes directly related to addiction. CONCLUSIONS: A threefold increase in mortality rates was observed during the period, mainly accounted for by AIDS and direct addiction-related causes. Length of opiate use was an important determinant of mortality.

Use of capture-recapture to estimate the prevalence of opiate addiction in Barcelona, Spain, 1989.

It is difficult to obtain accurate prevalence estimates of opiate addiction with direct methods. The capture-recapture method has been used to estimate the prevalence of hidden populations, including opiate addicts. In this study, we applied capture-recapture, including log-linear modeling, to estimate the prevalence of opiate addicts in Barcelona, Spain. Anonymous identification data from three 1989 sources (hospital emergency rooms, treatment admissions, and heroin overdose deaths) in Barcelona were used to obtain population samples. For prevalence estimation, two strategies were followed: 1) emergency room data only, divided into trimesters; and 2) all three sources used simultaneously. Estimates based only on emergency room data were lower than estimates obtained by the simultaneous analysis of all three data sources; the latter estimates gave narrower confidence intervals (6,324-7,414 addicts), giving a prevalence for Barcelona in 1989 of between 8.5 and 9.9 opiate addicts per 1,000 residents aged 15-44 years. The estimated prevalence varied by sex and age group and was highest in males aged 15-29 years (between 17.1 and 21.2). At least 42% had contacted one or more of the services studied, although only one in seven had been admitted for treatment during 1989. Capture-recapture is the election method for prevalence estimation when direct methods are not feasible.