Abuso o dependencia a la cocaína y otros trastornos psiquiátricos. Estudio Madrid sobre la prevalencia de la patología dual / Cocaine abuse or dependency and other psychiatric disorders. Madrid study on dual pathology

Objetivos: El objetivo de este estudio es analizar el subgrupo de adictos (criterios de abuso o dependencia) a la cocaína procedentes del estudio Madrid sobre prevalencia de diagnóstico dual en varios dispositivos asistenciales. Material y métodos: La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 488 tenían un diagnóstico de abuso o dependencia de cocaína a lo largo de la vida y 222 tenían otros trastornos por uso de sustancias distintos de la cocaína. Se usó la entrevista Mini Internacional Neuropsychiatric Interview (MINI), para el diagnóstico de los trastornos mentales del eje i y el cuestionario Personality Disorder Questionnaire (PDQ), para la valoración de los trastornos de personalidad. Resultados: Se consideró que un 73,4% de los adictos a la cocaína tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del estado de ánimo y de ansiedad. El 49,6% de los adictos a la cocaína tenían un diagnóstico de trastorno de la personalidad. Un 94,9% de estos adictos a la cocaína tenían otros diagnósticos asociados de trastornos por uso de sustancias. El subgrupo de adictos a la cocaína no tenía mayor prevalencia de diagnóstico dual que el resto de los adictos. El subgrupo de adictos con abuso o dependencia de la cocaína tenían mayor prevalencia de trastorno antisocial de la personalidad, agorafobia y trastorno por estrés postraumático, que los adictos no consumidores de cocaína, y habían iniciado de forma más precoz el consumo de alcohol y cannabis. Conclusiones: La presencia de diagnóstico dual no es más elevada en adictos a la cocaína en tratamiento, que en otros adictos, aunque han iniciado más precozmente otros consumos y se asocia más que el resto de adictos a ciertos trastornos mentales específicos(AU)

Objectives: The main objective of this study was to analyse the cocaine addict subgroup from the Madrid study of prevalence of dual disorders in community mental health and substance misuse services. Material and methods: The sample consisted of 837 outpatients from Madrid, Spain. We compared 488 subjects who had a lifetime diagnosis of cocaine abuse or dependence, and 222 subjects who did not have a cocaine substance use disorder. We used the Mini International Neuropsychiatric Interview to evaluate axis I mental disorders, and the Personality Disorder Questionnaire to evaluate personality disorders. Results: Almost three-quarters (73.4%) of cocaine addicts had a current dual disorder. Most prevalent were mood and anxiety disorders. Almost half (49.6%) had a personality disorder. Most of them (94.9%) had other substance use disorders. Cocaine addicts did not have higher prevalence rates of dual pathology than addicts with no cocaine abuse or dependence. Cocaine addicts were associated to a diagnosis of antisocial personality disorder, agoraphobia, and posttraumatic stress disorder, and they had an early age of onset of alcohol and cannabis use. Conclusions: Dual pathology is no higher in cocaine addicts in treatment than in addicts who do not use cocaine, however cocaine addicts started other drugs earlier, and were associated with specific mental disorders(AU)

[Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services]. / Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente.

The objective was to quantify the prevalence of dual diagnosis and to evaluate the characteristics of these patients from community mental health and substance misuse services in Madrid. The sample consisted of 837 outpatients from Madrid, 208 from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate disorders from axis I and II. It was considered that 517 (61.8%) patients had dual pathology (current diagnoses of axis I or II disorders and an addictive disorder): 36,1% in mental health services and 70,3% in substance misuse services. There were fewer males amongst the dual patients and it was also found that they had a worse employment situation, along with higher figures of alcohol and cannabis dependence than addicts without dual diagnoses (n=194). When comparing them with patients with mental disorder diagnoses only, excluding substance use disorder (n=126), there were differences in all socio-demographic characteristics analyzed, and dual patients were associated with diagnoses of bipolar disorder, agoraphobia, generalized anxiety disorder, post-traumatic stress disorder, and had more suicide risk and different personality disorders. Thus, dual pathology is higher in patients who are in treatment and have differential characteristics (higher suicide risk, worse employment situation) that suggest greater severity that could be of help in the planning of care resource policies for these patients.

Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente / Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services

Se valora la prevalencia y características de los pacientes de patología dual (diagnóstico actual de un trastorno mental y de un trastorno por uso de sustancias (TUS)): en las redes asistenciales de Salud Mental y Drogodependencias de la Comunidad de Madrid. Se consigue una muestra de 837 sujetos (208 de la red de Salud Mental y 629 de la red de Drogodependencias). Se usó la entrevista MINI (Mini International Neuropsychiatric Interview) y el cuestionario PDQ4+ (Personality Disorder Questionnaire) para la valoración de los trastornos del eje I y II. Se hallaron 517 (61,8%) pacientes con patología dual (un 36,1% en la red de salud mental y un 70,3% en la red de drogas). Al compararlos con el grupo de sujetos con TUS sin patología dual (n=194), había entre los duales menos varones y peor situación laboral, siendo las drogas más consumidas el alcohol y cannabis. Al compararlos con el grupo de trastornos mentales sin uso de sustancias (n=126), encontramos diferencias en todas las características sociodemográficas analizadas y los casos de patología dual son diagnosticados más frecuentemente como trastorno bipolar, agorafobia, trastorno por ansiedad generalizada, trastorno por estrés postraumático, mayor riesgo de suicidio y distintos trastornos de personalidad. Por lo tanto, la presencia de patología dual es elevada en sujetos en tratamiento y presentan unas características diferenciales, tales como mayor riesgo de suicidio y situación laboral precaria que hacen pensar en un peor pronóstico, cuestión a considerar para el desarrollo de recursos asistenciales adecuados (AU)

The objective was to quantify the prevalence of dual diagnosis and to evaluate the characteristics of these patients from community mental health and substance misuse services in Madrid. The sample consisted of 837 outpatients from Madrid, 208 from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate disorders from axis I and II. It was considered that 517 (61.8%) patients had dual pathology (current diagnoses of axis I or II disorders and an addictive disorder): 36,1% in mental health services and 70,3% in substance misuse services. There were fewer males amongst the dual patients and it was also found that they had a worse employment situation, along with higher figures of alcohol and cannabis dependence than addicts without dual diagnoses (n=194). When comparing them with patients with mental disorder diagnoses only, excluding substance use disorder (n=126), there were differences in all socio-demographic characteristics analyzed, and dual patients were associated with diagnoses of bipolar disorder, agoraphobia, generalized anxiety disorder, post-traumatic stress disorder, and had more suicide risk and different personality disorders. Thus, dual pathology is higher in patients who are in treatment and have differential characteristics (higher suicide risk, worse employment situation) that suggest greater severity that could be of help in the planning of care resource policies for these patients (AU)

Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence.

OBJECTIVES: Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. CONCLUSIONS: Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a polysubstance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders.

Abuso o dependencia al cannabis y otros trastornos psiquiátricos. Estudio Madrid sobre prevalencia de patología dual / Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence

Objetivos. El consumo de cannabis se ha asociado con una amplia variedad de trastornos mentales, destacando el posible papel causal de dicho consumo en la etiología de trastornos mentales graves como la esquizofrenia o el trastorno bipolar. Además el sistema cannabinoide está implicado en la regulación emocional, por lo que el consumo de cannabis también puede alterar dicha regulación y asociarse con trastornos de ansiedad y depresivos. El objetivo de este estudio es analizar el subgrupo de adictos a cannabis procedentes del estudio Madrid sobre prevalencia de patología dual en varios dispositivos asistenciales. Material y métodos. La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 353 tenían un diagnóstico de abuso o dependencia de cannabis a lo largo de la vida y 357 tenían otros trastornos por uso desustancias pero no cannabis. Se uso la entrevista MINI (Mini Internacional Neuropsychiatric Interview) para el diagnóstico de los trastornos mentales del eje I y el cuestionario PDQ (Personality Disorder Questionnaire) para la valoración de los trastornos de personalidad. Resultados. Se consideró que un 76,5% de los adictos al cannabis tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del humor y de ansiedad. El 51% de los adictos a cannabis tenían un diagnóstico de trastorno de la personalidad. La mayoría tenían varios diagnósticos de trastornos por uso de sustancias. Los sujetos con abuso o dependencia de cannabis tenían un inicio más precoz en el consumo de otras drogas como el alcohol, la cocaína y el tabaco que el resto de los adictos. Igualmente este subgrupo se diferenció del resto de los adictos por su asociación con el trastorno antisocial de la personalidad, el trastorno bipolar, la psicosis y la agorafobia. La presencia de estos trastornos mentales se asoció de forma significativa con una edad de inicio más precoz en el consumo de cannabis. Conclusiones. La presencia de patología dual es muy elevada en adictos en tratamiento que tienen dependencia de cannabis y dicho consumo, posiblemente en el contexto de un patrón de poli consumo, se asocia con trastornos mentales graves como la psicosis y el trastorno bipolar. Una edad de inicio más precoz en el consumo de cannabis se asocia con más riesgo de presentar dichos trastornos mentales (AU)

Objectives. Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. Material and methods. The sample consisted of 837outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. Results. It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. Conclusions. Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a poly substance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders (AU)

Evaluación de la carga de enfermedad con medidas sintéticas de salud de la población para la Comunidad Valenciana, España: un estudio de base poblacional / Burden of disease assessment with summary measures of population health for the Region of Valencia, Spain: a population-based study

Fundamento y objetivo: La descripción consistente y comparativa del estado de salud de la población es importante para la toma de decisiones y la planificación sanitaria. El objetivo de este estudio fue describir la carga de enfermedad en la Comunidad Valenciana. Material y métodos: Se calcularon los años de vida ajustados por discapacidad (AVAD), que se dividen en años de vida perdidos (AVP) y años vividos con discapacidad (AVD). Utilizando información procedente del registro de mortalidad y de las estimaciones de la población valenciana en el año 2008, se calculó el número de muertes y AVP. Los AVD se basan en datos específicos por sexo y edad de los países de la sub-región EURO-A (que incluye a la Comunidad Valenciana) del estudio de Carga Global de Enfermedad. Los resultados fueron estratificados por grupos de edad, sexo y causa de muerte. Los valores de AVAD se utilizaron para clasificar las condiciones que producen mayor carga de enfermedad. Resultados: En 2008, se perdieron un total 551 mil AVAD (53% en hombres). Las principales categorías en AVAD perdidos fueron las enfermedades neuropsiquiátricas (167 mil [30% del total de AVAD]), los tumores malignos (85 mil [15%]), las enfermedades cardiovasculares (72 mil [13%]) y las enfermedades de los órganos de los sentidos (46 mil [8%]). La depresión (47 mil [8% de AVAD]), las demencias (42 mil [8%]), la cardiopatía isquémica (27 mil [5%]), las pérdidas de audición (22 mil [4%]), el accidente cerebrovascular (20 mil [4%]) y el cáncer de pulmón (19 mil [3%]) fueron las principales causas específicas de carga de la enfermedad. Conclusiones: Se proporciona información por primera vez sobre la carga de enfermedad en la población valenciana. A este nivel local, el uso de los AVAD puede ayudar a monitorizar el estado de salud de la población y guiar los debates sobre el establecimiento de prioridades (AU)

Background and objective: An important input to decision-making and health planning is a consistent and comparative description of the population health status. The purpose of this study was to describe the burden of disease in the Region of Valencia (Spain). Material and methods: Disability-adjusted life years (DALYs) were calculated and divided into years of life lost (YLLs) and years lived with disability (YLDs). Using death registry data and Valencian population estimates in 2008, we calculated the number of deaths and YLLs. YLDs were based on age- and sex-specific data for countries of the EURO-A subregional level (which includes the Region of Valencia) from the Global Burden of Disease study. The results were stratified by age group, sex and underlying cause of death. The DALY values were used to rank the leading conditions of disease burden. Results: In 2008, the total number of DALYs lost was about 551 thousands (53% in men). The main categories of DALYs lost were neuropsychiatric conditions (30%; 167 thousands), malignant tumors (15%; 85 thousands), cardiovascular diseases (13%; 72 thousands) and sense organ diseases (8%; 46 thousands). Depression (8% of DALYs; 47 thousands), dementias (8%; 42 thousands), ischaemic heart disease (5%; 27 thousands), hearing loss (4%; 22 thousands), stroke (4%; 20 thousands) and lung cancer (3%; 19 thousands) were the leading specific causes of disease burden. Conclusions: We provide for the first time ever information on the burden of disease in the Valencian population. At this local level, the use of DALYs can help to monitor the population health status and guide the debates on rational priority-setting (AU)

Burden of disease assessment with summary measures of population health for the Region of Valencia, Spain: a population-based study.

BACKGROUND AND OBJECTIVE: An important input to decision-making and health planning is a consistent and comparative description of the population health status. The purpose of this study was to describe the burden of disease in the Region of Valencia (Spain). MATERIAL AND METHODS: Disability-adjusted life years (DALYs) were calculated and divided into years of life lost (YLLs) and years lived with disability (YLDs). Using death registry data and Valencian population estimates in 2008, we calculated the number of deaths and YLLs. YLDs were based on age- and sex-specific data for countries of the EURO-A subregional level (which includes the Region of Valencia) from the Global Burden of Disease study. The results were stratified by age group, sex and underlying cause of death. The DALY values were used to rank the leading conditions of disease burden. RESULTS: In 2008, the total number of DALYs lost was about 551 thousands (53% in men). The main categories of DALYs lost were neuropsychiatric conditions (30%; 167 thousands), malignant tumors (15%; 85 thousands), cardiovascular diseases (13%; 72 thousands) and sense organ diseases (8%; 46 thousands). Depression (8% of DALYs; 47 thousands), dementias (8%; 42 thousands), ischaemic heart disease (5%; 27 thousands), hearing loss (4%; 22 thousands), stroke (4%; 20 thousands) and lung cancer (3%; 19 thousands) were the leading specific causes of disease burden. CONCLUSIONS: We provide for the first time ever information on the burden of disease in the Valencian population. At this local level, the use of DALYs can help to monitor the population health status and guide the debates on rational priority-setting.

Cocaine abuse or dependency and other pyschiatric disorders. Madrid study on dual pathology.

OBJECTIVES: The main objective of this study was to analyse the cocaine addict subgroup from the Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients from Madrid, Spain. We compared 488 subjects who had a lifetime diagnosis of cocaine abuse or dependence, and 222 subjects who did not have a cocaine substance use disorder. We used the Mini International Neuropsychiatric Interview to evaluate axis I mental disorders, and the Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: Almost three-quarters (73.4%) of cocaine addicts had a current dual disorder. Most prevalent were mood and anxiety disorders. Almost half (49.6%) had a personality disorder. Most of them (94.9%) had other substance use disorders. Cocaine addicts did not have higher prevalence rates of dual pathology than addicts with no cocaine abuse or dependence. Cocaine addicts were associated to a diagnosis of antisocial personality disorder, agoraphobia, and post-traumatic stress disorder, and they had an early age of onset of alcohol and cannabis use. CONCLUSIONS: Dual pathology is no higher in cocaine addicts in treatment than in addicts who do not use cocaine, however cocaine addicts started other drugs earlier, and were associated with specific mental disorders.

Dual diagnosis and suicide risk in a Spanish outpatient sample.

The present study compares dual-diagnosis patients with other groups of psychiatric patients to determine the differential characteristics in suicide risk and other clinical variables between them. During 2008 in Madrid, 837 outpatients were evaluated in addiction and mental health services. Three comparison groups were created according to current diagnosis: (i) dual patients, (ii) patients with substance use disorders but no other mental disorders, and (iii) patients with mental disorders but no substance use disorders. A multinomial logistic regression model was built to explore the risk associated with dual diagnosis. Criteria for dual diagnosis were met at the time of the study by 440 patients (52.6%). Dual patients showed several demographic and clinical differences and a higher risk for suicide than the other two comparison groups. Further research is needed to define suicide preventive strategies for dual patients.

Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid / Pilot study on the prevalence of dual pathology in community mental health and substance misuse services in Madrid

El objetivo ha sido valorar la presencia de diagnósticos comórbidos de trastornos mentales y adictivos de forma retrospectiva en la historia clínica de pacientes en tratamiento en las redes asistenciales de salud mental o de adicciones en la Comunidad de Madrid. Material y métodos: Se valoraron las historias clínicas de 400 pacientes en tratamiento en Centros de Atención al Drogodependiente (CAD), Centros de Atención Integral al Drogodependiente (CAID), Centros de Salud Mental (CSM) o servicios de psiquiatría de Hospitales de Madrid. Se recogieron de forma retrospectiva los datos de las últimas 20 historias clínicas de cada centro seleccionado. Resultados: La prevalencia de patología dual, considerando como tal la presencia de un diagnóstico actual de trastorno mental y de trastorno por uso de sustancias distinto al tabaco, fue del 34%. Había diferencias en la prevalencia entre las dos redes asistenciales, un 36.78% de los pacientes en tratamiento en la red de drogas fueron considerados duales frente a un 28.78% en la red de salud mental. Había una asociación entre el diagnóstico de patología dual y el consumo perjudicial o dependencia de alcohol o cocaína pero no con el de heroína. Los trastornos mentales más frecuentes en los pacientes duales que en los no duales fueron los trastornos del humor, los trastornos de personalidad y la esquizofrenia. Conclusión: Por lo tanto, existe una elevada prevalencia de pacientes con patología dual entre los sujetos que buscan tratamiento, siendo mayor en la red de atención al drogodependiente y mayor entre aquellos con dependencia de alcohol o cocaína. Estos datos pueden ayudar a la horade planificar los recursos asistenciales para este tipo de pacientes (AU)

Aim: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. Methods: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. Results: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patient’s records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. Conclusion: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients (AU)

[Pilot study on the prevalence of dual pathology in community mental health and substance misuse services in Madrid]. / Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid.

AIM: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. METHODS: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. RESULTS: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patient's records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. CONCLUSION: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients.

The role of suicide risk in the decision for psychiatric hospitalization after a suicide attempt.

BACKGROUND: Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. AIMS: To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. METHODS: Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). RESULTS: 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. CONCLUSIONS: Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings.

Differences between younger and older adults in the structure of suicidal intent and its correlates.

OBJECTIVE: To analyze differences in the variables associated with severity of suicidal intent and in the main factors associated with intent when comparing younger and older adults. DESIGN: Observational, descriptive cross-sectional study. SETTING: Four general hospitals in Madrid, Spain. PARTICIPANTS: Eight hundred seventy suicide attempts by 793 subjects split into two groups: 18-54 year olds and subjects older than 55 years. MEASUREMENTS: The authors tested the factorial latent structure of suicidal intent through multigroup confirmatory factor analysis for categorical outcomes and performed statistical tests of invariance across age groups using the DIFFTEST procedure. Then, they tested a multiple indicators-multiple causes (MIMIC) model including different covariates regressed on the latent factor "intent" and performed two separate MIMIC models for younger and older adults to test for differential patterns. RESULTS: Older adults had higher suicidal intent than younger adults (z = 2.63, p = 0.009). The final model for the whole sample showed a relationship of intent with previous attempts, support, mood disorder, personality disorder, substance-related disorder, and schizophrenia and other psychotic disorders. The model showed an adequate fit (chi²[12] = 22.23, p = 0.035; comparative fit index = 0.986; Tucker-Lewis index = 0.980; root mean square error of approximation = 0.031; weighted root mean square residual = 0.727). All covariates had significant weights in the younger group, but in the older group, only previous attempts and mood disorders were significantly related to intent severity. CONCLUSIONS: The pattern of variables associated with suicidal intent varies with age. Recognition, and treatment of geriatric depression may be the most effective measure to prevent suicidal behavior in older adults.

Intimate partner violence: last year prevalence and association with socio-economic factors among women in Madrid, Spain.

BACKGROUND: Intimate partner violence (IPV) is a public health problem with significant consequences on women's health. This study estimates the prevalence of intimate partner violence by type among Madrid's female population and assesses the association with socio-economic variables. METHODS: We conducted a cross-sectional study in 2004, 2136 women aged 18-70 years, living in the Madrid region with a partner or who had been in contact with an ex-partner in the previous year, were interviewed by telephone. The questionnaire used to measure past-year intimate partner violence, consisted of a Spanish translation of the psychological and sexual violence module of the French National Survey on Violence against Women, and the physical violence module of the Conflict Tactics Scale-1. To assess the association with socio-economic factors, logistic regression models were fitted. RESULTS: About 10.1% [confidence interval (CI) 8.9-11.5] of the women had suffered some type of IPV in the previous year. 8.6% (CI 7.4-9.8) experienced psychological violence, 2.4% (CI 1.8-3.1) physical violence and 1.1% (CI 0.68-1.6) sexual violence; the prevalence of psychological-only violence (non-physical/non-sexual) was 6.9% (CI 5.8-8.0). Factors associated with psychological-only violence were divorced or separated status and Group III (clerical workers; supervisors of manual workers) or V (unskilled manual workers) occupation. Unemployment and divorced or separated status were associated with physical violence. CONCLUSIONS: Spanish women in our study, experienced past year partner violence at a similar level as in other industrialized countries. Unemployment and low occupational status are associated with physical and psychological-only violence, respectively.

Quality of the written information about suicide attempters.

INTRODUCTION: The aim of the study was to assess the quality of the clinical records of the patients who are seen in public hospitals in Madrid after a suicide attempt in a blind observation. METHODS: Observational, descriptive cross-sectional study conducted at four general public hospitals in Madrid (Spain). Analyses of the presence of seven indicators of information quality (previous psychiatric treatment, recent suicidal ideation, recent suicide planning behaviour, medical lethality of suicide attempt, previous suicide attempts, attitude towards the attempt, and social or family support) in 993 clinical records of 907 patients (64.5% women), ages ranging from 6 to 92 years (mean 37.1±15), admitted to hospital after a suicide attempt or who committed an attempt whilst in hospital. RESULTS: Of patients who attempted suicide, 94.9% received a psychosocial assessment. All seven indicators were documented in 22.5% of the records, whilst 23.6% recorded four or less than four indicators. Previous suicide attempts and medical lethality of current attempt were the indicators most often missed in the records. The study found no difference between the records of men and women (z=0.296; p=0.767, two tailed Mann-Whitney U test), although clinical records of patients discharged after an emergency unit intervention were more incomplete than the ones from hospitalised patients (z=2.731; p=0.006), and clinical records of repeaters were also more incomplete than the ones from non-repeaters (z=3.511; p<0.001). CONCLUSIONS: Clinical records of patients who have attempted suicide are not complete. The use of semi-structured screening instruments may improve the evaluation of patients who have self- harmed.

Hepatitis C and hepatitis B-related mortality in Spain.

BACKGROUND: Although hepatitis C and hepatitis B virus (HCV/HBV) infections are an important health problem worldwide, their burden of disease (BoD) taking into account their chronic consequences, cirrhosis, and hepatocellular carcinoma (HCC), is still unknown. Our aim was to assess the total number of deaths attributable to these viruses in Spain and the years of life lost, first component of the disability adjusted life years, a comparative index of BoD. METHODS: We selected the International Classification of Diseases-Tenth Revision specific codes related to HCV/HBV. For unspecified cirrhosis and HCC, the attributable fraction of mortality was assessed in two steps: literature review and expert panel. Deaths in Spain in 2000 were obtained from the National Statistics Institute. Years of life lost were calculated using the estimated mortality and life expectancies (Princeton Model Life Table). RESULTS: HCV could have caused around 70% of HCC deaths and 50% of cirrhosis mortality in Spain in 2000 (60% HCC, 40% cirrhosis with HCV lower estimate). For HBV these proportions are 10 and 13%, respectively. We estimated 4342 HCV-related deaths and 877 HBV-related deaths in Spain in 2000, globally 1.5% of total deaths in Spain that year. Mortality by cirrhosis and HCC represented most of these viral-related deaths. Attributable mortality in AIDS patients was also estimated. CONCLUSION: HCV leads the list of infectious disease-related mortality in Spain in 2000, doubling the AIDS mortality even if lower HCV attributable fractions are considered. Exclusion of cirrhosis and HCC-related mortality severely underestimates the BoD attributable to HCV/HBV. Improving early diagnosis and access to treatment could have an important impact on mortality because of hepatitis virus in the next decades.

Estimating the burden of scleroderma disease in Spain.

OBJECTIVE: Scleroderma (systemic sclerosis) is a rare disease that results in great suffering. We estimated the burden of disease posed by scleroderma and its relative importance in the health of the Spanish population. METHODS: We estimated scleroderma-based burden of disease following procedures developed for the Global Burden of Disease study to ensure comparability. RESULTS: Despite its low prevalence, scleroderma generated 1732 disability-adjusted life-years (DALY) in Spain in 2001, comprising 562 (32%) years of life lost and 1170 (68%) years lived with disability. Most scleroderma-related DALY (73%) occurred in the population aged 15-54 years. Estimated DALY accounted for 0.59% of other musculoskeletal disorder-related DALY in the European A subregion (countries with low mortality rate in both adults and children in the World Health Organization classification), a significant value in the overall burden of disease. CONCLUSION: The burden of scleroderma in Spain was high, with disability being the major contributing factor. Burden of disease is an important measure in rare diseases, and may be an important indicator to be considered as a health unit in developed countries.

Burden of disease related to Parkinson's disease in Spain in the year 2000.

We measured the burden caused by Parkinson's disease (PD) in Spain during the year 2000 and compared it against PD burden worldwide and in the European A subregion. Burden of disease (BoD) is an important factor in health policy. Disability-adjusted life years (DALY) as a measure of BoD is the result of adding years of life lost (YLL) and years lived with disability (YLD). The burden of PD (BPD) has not been studied in Spain. YLL were obtained from the Spanish death certificates and YLD from the estimated number of incident PD cases and the average PD duration. PD disability was calculated, using the Disability Weights for Diseases in the Netherlands. Prior PD DALY data for Europe and the world were obtained from the 2001 World Health Organization World Health Report. A discount rate of 3% and age-weighting modulation factor with K = 1 were used. In Spain, PD generated 67,582 DALY, comprising 6,351 (9.4%) YLL and 61,231 (90.6%) YLD. Most PD DALY (57.5%) occurred in the population 60 to 74 years of age. When PD DALY estimates were adjusted using the world population in 2000, Spain registered a PD DALY rate of 84 per 100,000 population, higher than both the world and European A subregion rates (24 and 35 per 100,000 population, respectively). PD burden in Spain in 2000 was high, with disability being the major contributing factor. Although BPD in Spain was greater than both world and European A subregion BPD, these differences should nevertheless be interpreted with caution.

Desarrollo e implantación de una vía clínica para la cirugía bariátrica / Development and implementation of a clinical pathway for bariatric surgery

Objetivo: Elaboración e implantación de una vía clínica para la cirugía de la obesidad en el Hospital Universitario La Paz. Material y métodos: Coordinación por parte de la unidad de calidad del equipo de trabajo; revisión bibliográfica en busca de la mejor evidencia científica publicada; diseño de los documentos de la vía clínica mediante el consenso entre todos los profesionales implicados en el proceso. La implantación de la vía clínica se realizó en mayo de 2003. Resultados: Se obtienen los siguientes resultados: algoritmo de actuación en el paciente obeso; secuencia de evaluaciones prequirúrgicas; hoja de información preoperatoria para el paciente; matriz temporal para los profesionales con evaluaciones, determinaciones, tratamiento y cuidados de enfermería, actividad, dieta, objetivos y criterios; hoja de información iconográfica para el paciente durante su estancia hospitalaria; hoja de información al paciente sobre el postoperatorio inmediato; hoja de tratamientos y cuidados de enfermería en planta (preoperatorio), quirófano, reanimación y planta (postintervención); hoja de variaciones de la vía clínica; encuesta de satisfacción e indicadores para la evaluación. Conclusiones: La vía clínica facilita el consenso de este proceso multidisciplinario, y mejora el trabajo en equipo, los tiempos de espera y la implicación de los profesionales. Asimismo, mejora la información proporcionada a los pacientes y aumenta la implicación de éstos en sus cuidados (AU)

Mortalidad por suicidio en Castilla-La Mancha (1991-1998) / Death by suicide in Castilla-La Mancha, Spain (1991-1998)

INTRODUCCIÓN: El suicidio es un problema de salud pública, de importancia creciente en los países desarrollados. Nuestro objetivo es calcular las tasas de mortalidad por suicidio en Castilla-La Mancha en el período 1991-1998 y valorar su tendencia temporal. MATERIAL Y MÉTODOS: Cálculo de las tasas de mortalidad crudas y estandarizadas y su incremento porcentual medio anual, a partir de los datos del Registro de Mortalidad de Castilla-La Mancha, codificados según la CIE-9 (Códigos 950-959).RESULTADOS: Se han producido 1.096 suicidios en el período estudiado: 874 (79,7 por ciento) en varones y 222 (20,3 por ciento) en mujeres con una razón varón/mujer de 3,94 para todo el período. Las tasas crudas de mortalidad fueron de 9,75 y 8,13 por 100.000 habitantes en 1991 y 1998, respectivamente; el incremento porcentual es de -1,89 por ciento medio anual. Las tasas específicas por grupo de edad son más altas en edades más avanzadas, llegando a quintuplicar las de los más jóvenes. En su evolución temporal se ha producido un incremento en los grupos de edad más avanzada (65-80 años en varones y mayores de 80 años en mujeres). En los otros grupos de edad se produce, en general, un descenso con algunas variaciones por edad y sexo. CONCLUSIONES: Los datos sitúan a nuestra comunidad ligeramente por encima de las cifras nacionales pero por debajo de algunas comunidades como Andalucía. La distribución por edad y sexo concuerda con la bibliografía. Hallamos una tendencia descendente en la tasa global con diferencias entre edades y sexo. Asimismo, cabe destacar el aumento de las tasas en los ancianos, en el período estudiado. Estos datos son útiles para la planificación de los servicios sanitarios castellano-manchegos (AU)