Prevalencia y factores asociados al consumo de tabaco en alumnos de enseñanza secundaria de Cataluña / Cigarette smoking prevalence and associated factors in secondary school children in Catalunya

Objetivos: Analizar aquellos factores asociados al consumo de tabaco en adolescentes para plantear futuras intervenciones de promoción de la salud desarrolladas por las escuelas y centros de atención primaria. Diseño: Estudio transversal, muestreo por conglomerados bietápico. Emplazamiento: Se incluyeron 97 centros escolares de Cataluña, 2005-2006. Participantes: Se obtuvieron 9.340 cuestionarios completos de estudiantes entre 14-16 años. Mediciones principales: Encuesta autoadministrada que recogía variables sociodemográficas, académicas, estado de salud, familiares, relaciones sexuales, sustancias adictivas, estados de ánimo y variables de opinión sobre el consumo. Se analizó la asociación de estas variables con la variable dependiente fumador/no fumador y también fueron analizadas como factores que aumentaban la probabilidad de ser fumador mediante modelos multinivel. Resultados: Se incluyeron 4.653 chicos y 4.687 chicas, con una edad media de 15,2 años. El 71,1% de los estudiantes eran no fumadores, el 75% de los chicos y el 67,3% de las chicas. Aumentaban la probabilidad de ser fumador (OR e IC 95%): ser chica 0,60 (0,53-0,68), cursar 4.o ESO 1,27 (1,12-1,43), tener un rendimiento escolar bajo 3,38 (2,74-4,17), tener una autopercepción de salud regular/mala 2,81 (2,21-3,58), tener padres fumadores 1,68 (1,45-1,95), consumir alcohol 5,05 (4,35-5,86), tener 3 o más problemas de estado de ánimo 1,22 (1,05-1,41), vivir sin ningún progenitor 1,59 (1,07-2,38), estar de acuerdo en que exista publicidad sobre tabaco 1,64 (1,45-1,85), y opinar que el tabaco ayuda a relajarse 3,57 (3,23-4,17). Conclusiones: Aunque la mayoría de los estudiantes eran no fumadores, el consumo de tabaco era más prevalente en las chicas. Factores sociodemográficos, socioculturales, del entorno y opinión se asociaban con el consumo de tabaco entre los jóvenes (AU)

Objective: The aim of this study was to analyze those factors associated with cigarette smoking in adolescent school children, in order to plan future school interventions for promoting good health strategies developed by the schools and Primary Health Care professionals. Design: Cross-sectional study with a two-stage cluster sampling. Setting: The study included 97 schools, and was carried out in 2005-06 in Catalonia (Spain). Participants: 14-16 year-old secondary school children. Main measures: The survey was based on a self-administered paper-based questionnaire that collected sociodemographic variables, academic level, health status, family variables, sexual relations, addictive substances, mood state, and variables related to opinions on cigarette smoking The association between these variables and smoker/non-smoker variable was analyzed, as well as factors that could increase the probability of becoming a smoker using multilevel models. Results: A total of 9340 completed questionnaires, including 4653 from males, were received from the pupils, with a mean age of 15.2 years. The results showed that 71.1% of pupils were non-smokers, 75% of whom were males and 67.3% of females. The following factors increased the probability of becoming a smoker (OR and 95%CI): being a female 0.60 (0.53-0.68), being in the 4th year 1.27 (1.12-1.43), low academic performance 3.38 (2.74-4.17), self-reported regular/poor health status 2.81 (2.21-3.58), smoking parents 1.68 (1.45-1.95), alcohol consumption 5.05 (4.35-5.86), having 3 or more problems of mood state 1.22 (1.05-1.41), living without parents 1.59 (1.07-2.38), agreeing with tobacco industry advertising 1.64 (1.45-1.85) and believing that tobacco acts as a relaxant 3.57 (3.23-4.17) (AU)

Conclusions: Although the majority of pupils were non-smokers, smoking was more prevalent among females. The factors associated with cigarette smoking in the adolescents included sociodemographic, sociocultural, and personal environmental factors, as well as their opinions on the habit (AU)

Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients.

PURPOSE: To analyze the impact of primary and catheterrelated bloodstream infections (PBSI/CRBSI) on morbidity and mortality. METHODS: A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed. RESULTS: Out of the 74,585 registered patients, those with at least one episode of monomicrobial PBSI/CRBSI were selected and paired with patients without PBSI/CRBSI for demographic and diagnostic criteria and seriousness of their condition on admission to the Intensive Care Unit (ICU). for mortality analysis, 1,879 patients with PBSI/CRBSI were paired with 7,516 controls. The crude death rate in the ICU was 28.1% among the cases and 18.7% among the controls. Attributable mortality 9.4% (HR:1.20; 95% confidence interval: 1.07-1.34; p<0.001). Risk of death varied according to the source of infection, aetiology, moment of onset of bloodstream infection and severity on admission to the ICU. The median stay in the ICU of patients who survived PBSI/CRBSI was 13 days longer than the controls, also varying according to aetiology, moment of onset of bloodstream infection and severity on admission. CONCLUSIONS: Acquisition of PBSI/CRBSI in critically ill patients significantly increases mortality and length of ICU stay, which justifies prevention efforts.

Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients

Objetivos. El propósito de este estudio es analizar el impacto de la bacteriemia primaria y relacionada con catéter (BP/ BRC) en la morbilidad y mortalidad. Métodos. Con datos pertenecientes a la base de datos epidemiológica de pacientes críticos en España ENVIN-HELICS, se realiza un estudio casos controles (1:4). Para analizar el riesgo de muerte en pacientes con BP/BRC se realiza un estudio emparejado de riesgos proporcionales de Cox. Resultados. De 74.585 pacientes registrados, se buscó pacientes con al menos un episodio de BP/BRC monomicrobiana y fueron emparejados con pacientes sin BP/BRC por criterios demográficos, diagnósticos y de gravedad al ingreso en la Unidad de Cuidados Intensivos (UCI). Para el análisis de mortalidad 1.879 pacientes con BP/BRC fueron emparejados con 7.516 controles. La mortalidad cruda en UCI fue del 28,1 % en los casos y 18,7 % en los controles. Mortalidad atribuida 9,4 %. (HR:1,20; intervalo confianza 95 %: 1,07 - 1,34; p<0,001). El riesgo de muerte varía de acuerdo a la fuente de la infección, la etiología, el momento de aparición de la bacteriemia y la gravedad al ingreso en UCI. Los pacientes que sobreviven y sufren una BP/BRC tienen una estancia en UCI 13 días de mediana más prolongada que los controles, variando también según la etiología, el momento de aparición de la bacteriemia y la gravedad al ingreso en UCI. Conclusiones. En pacientes críticos, la adquisición de una BP/BRC produce un significativo incremento de la mortalidad y la estancia, lo que justifica los esfuerzos de prevención(AU)

Purpose. To analyze the impact of primary and catheterrelated bloodstream infections (PBSI/CRBSI) on morbidity and mortality. Methods. A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed. Results. Out of the 74,585 registered patients, those with at least one episode of monomicrobial PBSI/CRBSI were selected and paired with patients without PBSI/CRBSI for demographic and diagnostic criteria and seriousness of their condition on admission to the Intensive Care Unit (ICU). For mortality analysis, 1,879 patients with PBSI/CRBSI were paired with 7,516 controls. The crude death rate in the ICU was 28.1% among the cases and 18.7% among the controls. Attributable mortality 9.4% (HR:1.20; 95% confidence interval: 1.07-1.34; p<0.001). Risk of death varied according to the source of infection, aetiology, moment of onset of bloodstream infection and severity on admission to the ICU. The median stay in the ICU of patients who survived PBSI/CRBSI was 13 days longer than the controls, also varying according to aetiology, moment of onset of bloodstream infection and severity on admission. Conclusions. Acquisition of PBSI/CRBSI in critically ill patients significantly increases mortality and length of ICU stay, which justifies prevention efforts(AU)

[Cigarette smoking prevalence and associated factors in secondary school children in Catalunya]. / Prevalencia y factores asociados al consumo de tabaco en alumnos de enseñanza secundaria de Cataluña.

OBJECTIVE: The aim of this study was to analyze those factors associated with cigarette smoking in adolescent school children, in order to plan future school interventions for promoting good health strategies developed by the schools and Primary Health Care professionals. DESIGN: Cross-sectional study with a two-stage cluster sampling. SETTING: The study included 97 schools, and was carried out in 2005-06 in Catalonia (Spain). PARTICIPANTS: 14-16 year-old secondary school children. MAIN MEASURES: The survey was based on a self-administered paper-based questionnaire that collected sociodemographic variables, academic level, health status, family variables, sexual relations, addictive substances, mood state, and variables related to opinions on cigarette smoking The association between these variables and smoker/non-smoker variable was analyzed, as well as factors that could increase the probability of becoming a smoker using multilevel models. RESULTS: A total of 9340 completed questionnaires, including 4653 from males, were received from the pupils, with a mean age of 15.2 years. The results showed that 71.1% of pupils were non-smokers, 75% of whom were males and 67.3% of females. The following factors increased the probability of becoming a smoker (OR and 95%CI): being a female 0.60 (0.53-0.68), being in the 4(th) year 1.27 (1.12-1.43), low academic performance 3.38 (2.74-4.17), self-reported regular/poor health status 2.81 (2.21-3.58), smoking parents 1.68 (1.45-1.95), alcohol consumption 5.05 (4.35-5.86), having 3 or more problems of mood state 1.22 (1.05-1.41), living without parents 1.59 (1.07-2.38), agreeing with tobacco industry advertising 1.64 (1.45-1.85) and believing that tobacco acts as a relaxant 3.57 (3.23-4.17). CONCLUSIONS: Although the majority of pupils were non-smokers, smoking was more prevalent among females. The factors associated with cigarette smoking in the adolescents included sociodemographic, sociocultural, and personal environmental factors, as well as their opinions on the habit.

Gender differences in negative mood states in secondary school students: health survey in Catalonia (Spain)

Objective: To determine the prevalence of negative mood states in adolescents according to gender, toanalyze variability among schools, and to evaluate the associated factors.Methods: A cross-sectional study with a cluster design was carried out. We administered the High-schoolstudents health survey to a sample of 9,340 students (aged 14-16 years) in the third and fourth year ofCompulsory Secondary Education in Catalonia, Spain, during the 2005-6 academic year. The main outcome measure was evidence of a negative mood state. A multilevel logistic regression model stratified bygender was used to identify the factors associated with negative mood states and to determine variabilityamong distinct schools.Results: Approximately 19% of adolescents reported evidence of a negative mood state, with a higherprevalence in girls (25%). The most significant factors associated with negative mood states were “useof tranquilizers” and “having eating disorders” in girls and “not exercising” and “poor self-perception ofhealth status” in boys. In both genders, variability was found among schools in the prevalence of negativemood states (girls: variance = 0.078; p <0.001; boys: variance = 0.079; p = 0.012).Conclusions: The prevalence of negative mood states in adolescent boys and girls was high. Differenceswere observed between genders in the factors related to these health states. The variability observedin the prevalence of negative mood states among distinct schools could not be explained by the studyvariables. Our results emphasize the association between the use of tranquilizers and negative moodstates (AU)

Objetivos: Determinar la prevalencia del estado de ánimo negativo entre alumnos adolescentes segúnsexo, analizar la variabilidad entre escuelas y evaluar los factores asociados.Métodos: Estudio transversal basado en un muestreo por conglomerados bietápico. Administramos unaencuesta de salud a 9340 estudiantes de tercero y cuarto curso de Educación Secundaria Obligatoriade 14 a 16 anos de edad, en Catalu ˜ na, durante el curso escolar 2005-06. La variable principal fue el ˜estado de ánimo negativo. Se usó un modelo de regresión logística multinivel estratificado por sexopara identificar los factores asociados al estado de ánimo negativo y determinar la variabilidad entre lasdiferentes escuelas.Resultados: Aproximadamente el 19% de los adolescentes refirieron un estado de ánimo negativo, siendomás prevalente entre las chicas (25%). En ellas, los factores asociados significativamente con estadosde ánimo negativo fueron «tomar tranquilizantes» y tener trastornos alimentarios, mientras que en loschicos fueron no realizar deporte y tener una mala percepción de su estado de salud. Hay variabilidad enla prevalencia del estado de ánimo negativo según las escuelas en ambos sexos (chicas: varianza = 0,078,p <0,001; chicos: varianza = 0,079, p = 0,012).Conclusiones: La prevalencia del estado de ánimo negativo entre los adolescentes fue alta. Se observarondiferencias entre sexos respecto a los factores relacionados con este estado de salud. Destacó la asociacióndel uso de tranquilizantes con el estado de ánimo negativo. Se observó una variabilidad de la prevalenciadel estado de ánimo negativo entre las diferentes escuelas no explicada por las variables de estudio (AU)

Evolución del consumo de antifúngicos en pacientes críticos. Estudio multicéntrico observacional, 2006-2010 / Trends in systemic antifungal use in critically ill patients. Multicenter observational study, 2006-2010

Hay poca información sobre el consumo de antifúngicos (AF) en pacientes críticos y las variaciones temporales desde la introducción de nuevos AF. Este consumo puede tener influencia en la aparición de resistencias. Métodos Estudio observacional prospectivo del consumo de AF sistémicos en pacientes ingresados en unidades de cuidados intensivos (UCI) españolas del registro ENVIN-HELICS durante los años 2006 a 2010. Se compara la utilización anual, el consumo según prescripciones y para infecciones intra-UCI, el calculado por tamaño de hospital y por 1.000 días de estancia. Resultados De 8.240 prescripciones de AF registradas, los AF más frecuentemente empleados fueron el fluconazol y la caspofungina (55 y 19,5%, respectivamente). Existió un incremento del consumo hasta el año 2008 y una estabilización posterior. Anualmente, se comprobó la disminución del uso de fluconazol y el crecimiento del consumo de equinocandinas. Predominó la utilización de fluconazol en hospitales de tamaño mediano con respecto a hospitales grandes (60,4% versus 53,3%; p=0,036), y lo contrario con respecto a la utilización de caspofungina (15,8% versus 21,8%; p<0,001). El fluconazol se empleó más precozmente (mediana desde el ingreso en UCI: 12 días) y durante un tiempo similar a otros AF (mediana: 8 días). El total de días de tratamiento fue de 39,51 días por 1.000 estancias, con predominio de fluconazol (21,48 días por 1.000 estancias).Conclusiones El fluconazol es el AF más utilizado en pacientes críticos en cualquiera de las indicaciones, aunque se constata un progresivo descenso en su consumo y un incremento proporcional del empleo de equinocandinas (AU)

Introduction: There are limited data about the use of antifungal agents (AF) in critically ill patients and treatment trends since the inclusion of the new generation AF. The use of these agents may have a significant influence on the development of new resistances. Methods: Observational prospective study of the systemic use of AF in patients admitted to Spanish intensive care units (ICU) participating in the ENVIN-HELICS register, from 2006 to 2010. The annual use, the indications that led to that use and, the intra-ICU infections, the AF employment related to the hospital size, and per 1000 patients/day, were compared. Results: Of the 8240 prescriptions for AF, fluconazole and caspofungin were the most often employed (55%and 19.5%, respectively). An increase in use was observed to the year 2008, with subsequent stabilisation. A decrease in the use of fluconazole and an increase in echinocandins consumption was observed overtime. As regards the intra-ICU infections, the AF were ordered empirically in 47.9% of the indications. Fluconazole was more frequently used in medium size hospitals than in the large ones (60.4% versus 53.3%;P = .036) and the opposite occurred in the case of caspofungin (15.8% versus 21.8%; P < .001). Fluconazole was more prematurely employed (median 12 days since ICU admission) and the duration of the therapy was similar to the other AF (median 8 days). The total therapy days were 39.51 per 1000 patient/day, with predominance in fluconazole use (21.48 per 1000 patients/day).Conclusions: Fluconazole is the most used antifungal agent in critically ill patients in any of the indications, although a progressive decrease in its use is observed, with a proportional increase in the use of echinocandins (AU)

[Trends in systemic antifungal use in critically ill patients. Multicenter observational study, 2006-2010]. / Evolución del consumo de antifúngicos en pacientes críticos. Estudio multicéntrico observacional, 2006-2010.

INTRODUCTION: There are limited data about the use of antifungal agents (AF) in critically ill patients and treatment trends since the inclusion of the new generation AF. The use of these agents may have a significant influence on the development of new resistances. METHODS: Observational prospective study of the systemic use of AF in patients admitted to Spanish intensive care units (ICU) participating in the ENVIN-HELICS register, from 2006 to 2010. The annual use, the indications that led to that use and, the intra-ICU infections, the AF employment related to the hospital size, and per 1000 patients/day, were compared. RESULTS: Of the 8240 prescriptions for AF, fluconazole and caspofungin were the most often employed (55% and 19.5%, respectively). An increase in use was observed to the year 2008, with subsequent stabilisation. A decrease in the use of fluconazole and an increase in echinocandins consumption was observed over time. As regards the intra-ICU infections, the AF were ordered empirically in 47.9% of the indications. Fluconazole was more frequently used in medium size hospitals than in the large ones (60.4% versus 53.3%; P=.036) and the opposite occurred in the case of caspofungin (15.8% versus 21.8%; P<.001). Fluconazole was more prematurely employed (median 12 days since ICU admission) and the duration of the therapy was similar to the other AF (median 8 days). The total therapy days were 39.51 per 1000 patient/day, with predominance in fluconazole use (21.48 per 1000 patients/day). CONCLUSIONS: Fluconazole is the most used antifungal agent in critically ill patients in any of the indications, although a progressive decrease in its use is observed, with a proportional increase in the use of echinocandins.