Health-related quality of life and mortality in the 'Seguimiento Universidad de Navarra' prospective cohort study

OBJECTIVE

To study the association between health-related quality of life (HRQoL) and all-cause mortality in a healthy middle-aged Mediterranean cohort.

METHODS

We included 15,390 participants -mean age 42.8 years at first HRQoL ascertainment, all university graduates-. HRQoL was assessed with the self-administered Medical Outcomes Study Short Form-36 (SF-36) twice, with a 4-year gap. We used multivariable-adjusted Cox regression models to address the relation between self-reported health and Physical or Mental Component Summary (PCS-36 or MCS-36) and mortality, and their interaction with prior comorbidities or adherence to the Mediterranean diet (MedDiet).

RESULTS

Over 8.7 years of median follow-up time, 266 deaths were identified. Hazard ratio (HR) for the excellent vs. poor/fair category in self-reported health was 0.30 (95 % confidence interval (CI), 0.16-0.57) in the model with repeated measurements of HRQoL. Both the PCS-36 (HRquartile4(Q4)vs.Q1 0.57 [95%CI, 0.36-0.90], ptrend < 0.001; HRper+10points: 0.64 [95%CI, 0.54-0.75]) and the MCS-36 (HRQ4vs.Q1 0.67 [95%CI, 0.46-0.97], ptrend = 0.025; HRper+10points: 0.86 [95%CI, 0.74-0.99]) were inversely associated with mortality in the model with repeated measurements of HRQoL. Previous comorbidities or adherence to the MedDiet did not modify these associations.

CONCLUSIONS

Self-reported HRQoL -assessed as self-reported health, PCS-36 and MCS-36- obtained with the Spanish version of the SF-36 were inversely associated with mortality risk, regardless of the presence of previous comorbidities or adherence to the MedDiet.

Consumption of aspartame and other artificial sweeteners and risk of cancer in the Spanish multicase-control study (MCC-Spain)

Use of artificial sweeteners (AS) such as aspartame, cyclamate, saccharin and sucralose is widespread. We evaluated the association of use of aspartame and other AS with cancer. In total 1881 colorectal, 1510 breast, 972 prostate and 351 stomach cancer and 109 chronic lymphocytic leukaemia (CLL) cases and 3629 population controls from the Spanish Multicase-Control (MCC-Spain) study were recruited (2008-2013). The consumption of AS, from table-top sweeteners and artificially sweetened beverages, was assessed through a self-administered and validated food frequency questionnaire (FFQ). Sex-specific quartiles among controls were determined to compare moderate consumers (<third quartile) and high consumers (≥ third quartile) vs non consumers (reference category), distinguishing aspartame-containing products and other AS. Unconditional logistic regression models were used to estimate adjusted OR and 95%CI, and results were stratified by diabetes status. Overall, we found no associations between the consumption of aspartame or other AS and cancer. Among participants with diabetes, high consumption of other AS was associated with colorectal cancer (OR = 1.58, 95% CI 1.05-2.41, P trend = .03) and stomach cancer (OR = 2.27 [0.99-5.44], P trend = .06). High consumption of aspartame, was associated with stomach cancer (OR = 2.04 [0.7-5.4], P trend = .05), while a lower risk was observed for breast cancer (OR = 0.28 [0.08-0.83], P trend = .03). In some cancers, the number of cases in participants with diabetes were small and results should be interpreted cautiously. We did not find associations between use of AS and cancer, but found associations between high consumption of aspartame and other AS and different cancer types among participants with diabetes.

Health-related quality of life in patients newly diagnosed with prostate cancer: CAPLIFE study

PURPOSE

To analyse the Health-Related Quality of Life (HRQoL) at diagnosis of patients with prostate cancer (PCa) according to tumour extension and urinary symptomatology and to explore factors associated with HRQoL.

METHODS

408 Controls and 463 PCa cases were included. Eligibility criteria were a new diagnosis of PCa (cases), 40-80 years of age, and residence in the participating hospitals' coverage area for ≥ 6 months before recruitment. HRQoL was evaluated using the 12-Item Short-Form Health Survey, Mental (MCS) and Physical Component Summaries (PCS), and urinary symptoms with the International Prostate Symptom Score. HRQoL scores for all PCa cases, according to tumour extension and urinary symptoms, were compared with controls. In addition, information about lifestyles and comorbidities was collected and its association with low HRQoL (lower scores) were explored using logistic regression models.

RESULTS

Overall cases had similar PCS score, but lower MCS score than controls. The lowest standardised scores for both PCS and MCS were reached by cases with severe urinary symptoms and a metastatic tumour [mean (SD); PCS: 41.9 (11.5), MCS: 42.3 (10.3)]. Having "below" PCS and MCS scores was associated with the presence of three or more comorbidities in the cases [aOR = 2.86 (1.19-6.84) for PCS and aOR = 3.58 (1.37-9.31) for MCS] and with severe urinary symptomatology [aOR = 4.71 (1.84-12.08) for PCS and aOR = 7.63 (2.70-21.58) for MCS].

CONCLUSION

The mental dimension of HRQoL at diagnosis of patients with PCa was lower than in controls, especially for cases with severe urinary symptoms and a metastatic tumour. Comorbidities and urinary symptoms were variables associated with the HRQoL of PCa cases.

Dietary inflammatory index and prostate cancer risk: MCC-Spain study

BACKGROUND

The etiology of prostate cancer (PCa) is not well-known, and the role of diet is not well established. We aimed to evaluate the role of the inflammatory power of the diet, measured by the Dietary Inflammatory Index (DII^®), on the risk of PCa.

METHODOLOGY

A population-based multicase-control (MCC-Spain) study was conducted. Information was collected on sociodemographic characteristics, personal and family antecedents, and lifestyles, including diet from a Food Frequency Questionnaire. The inflammatory potential of the diet was assessed using the energy-adjusted Dietary Inflammatory Index (E-DII) based on 30 parameters (a higher score indicates a higher inflammatory capacity of the diet). Tertiles of E-DII were created using the cut-off points from the control group. The International Society of Urology Pathology (ISUP) was grouped as ISUP 1, ISUP 2, or ISUP 3-5. Unconditional logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between E-DII score and PCa risk.

RESULTS

A total of 928 PCa cases and 1278 population controls were included. Among PCa cases, the mean value of the E-DII score was 0.18 (SD: 1.9) vs. 0.07 (SD: 1.9) in the control group (p = 0.162). Cases with a more pro-inflammatory diet (3rd tertile) had the highest risk of PCa, aOR_T3vsT1= 1.30 (95% CI 1.03-1.65) (p-trend = 0.026). When stratifying by ISUP, this risk association was observed only for ISUP 2 and ISUP 3-5, aOR_T3vsT1= 1.46 (95% CI 1.02-2.10) and 1.60 (95% CI 1.10-2.34), respectively.

CONCLUSION

A positive association was observed between consuming a pro-inflammatory diet and PCa in the MCC-Spain population, specifically for an ISUP grade greater or equal than 2.

Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized controlled trial

BACKGROUND

Previous studies in pregnancy have not focused in evaluating the effect of walking during pregnancy and prevention of insomnia. Our general objective is to determine the effect of a walking program in preventing the appearance of insomnia in the third trimester of pregnancy, increasing sleep quality and improving quality of life throughout pregnancy.

METHODS

Randomized Controlled trial in parallel in healthy sedentary pregnant women (n = 265), Walking_Preg Project (WPP), from university hospital in Granada, Spain. At 12th gestational week (GW), they will be invited to participate and randomly assigned to one of the three arms of study: the intervention group I1 (pedometer, goal of 11,000 steps/day), intervention group I2 (pedometer, no goal) and control (no pedometer). Duration of intervention: 13-32 GW. At 12th, 19th and 31st GW the average steps/day will be measured in groups I1 and I2. At 13th, 20th and 32nd GW, Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Adherence to Mediterranean Diet (AMD), physical activity (short IPAQ), quality of life (PSI), and consumption of toxic substances (caffeine, illegal drugs, alcohol and tobacco) will be collected. Student t test or Mann-Whitney U will be used to compare 19th and 31st GW mean of daily steps between I1 and I2 groups. To compare differences between groups in terms of frequency of insomnia/quality of life for each trimester of pregnancy, Pearson's Chi-square test or Fisher's exact test will be used. To determine differences in hours of sleep and quality of sleep throughout each trimester of pregnancy, analysis of variance or Friedman test will be used. McNemar-Bowker test will be used to assess differences in life quality in pre-post analyses in the 3 arms. We will use Stata 15 statistical software.

DISCUSSION

promoting walking in second half of pregnancy through use of pedometer and health pre-registration of a goal to be achieved -'10,000-11,000 steps a day'- should prevent appearance of insomnia in third trimester, will increase sleep quality and quality of life in pregnant women.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03735381 . Registered 8th November, 2018.

Night Shift Work, Chronotype, Sleep Duration, and Prostate Cancer Risk: CAPLIFE Study

To analyze the association between prostate cancer (PCa) risk and night shift work, chronotype, and sleep duration in the context of a population-based case-control study of incident prostate cancer in Spain, a total of 465 PCa cases and 410 controls were analyzed. Selection criteria were: (i) age 40-80 years, and (ii) residence in the coverage area of the reference hospitals for ≥6 months before recruitment. Exposure variables were: (i) night shift work (permanent or rotating); (ii) chronotype: morning, neither, or evening (Munich ChronoType Questionnaire) and (iii) sleep duration according to the recommendations of the American National Sleep Foundation. PCa aggressiveness was determined according to the International Society of Urology Pathology classification. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression models. Night shift work was associated with PCa, aOR = 1.47 (95% CI 1.02-2.11), especially for rotating night shifts, aOR = 1.73 (95% CI 1.09-2.75). The magnitude of the association between ever night work and PCa was higher in evening subjects with aOR = 3.14 (95% CI 0.91-10.76) than in morning chronotypes with an aOR = 1.25 (95% CI 0.78-2.00). Working night shifts, especially rotating night shifts, could increase PCa risk. This risk may be higher in people with an evening chronotype.

Stabilization and reversal of child obesity in Andalusia using objective anthropometric measures by socioeconomic status

BACKGROUND

Childhood obesity continues to be a significant public health issue worldwide. Recent national studies in Spain show a stable picture. However, prevalence and trends differ by socio-economic status, age, and region. We present the trend in childhood excess weight prevalence, aged 8-15 years, in Andalusia from 2011-2012 to 2015-2016 by socio-economic status.

METHODS

Using the cross-sectional Andalusian Health Surveys, objective anthropometric measures were taken for a representative sample of 8-15 year olds in Andalusia in 2011-2012 and 2015-2016. Prevalence and changes in prevalence of excess weight (overweight plus obesity) were calculated, using both the WHO and IOTF criteria, overall and for sex, age and three different indicators of SES.

RESULTS

Overall prevalence of excess weight decreased from 42.0% in 2011-2012 to 35.4% in 2015-2016. Overweight decreased from 28.2 to 24.2% and obesity from 13.8 to 11.2%. In 2011-2012 the prevalence of excess weight in boys was 46.0%and 37.9% in girls; in 2015-2016 the difference became significant with 41% of boys with excess weight compared with 30% in girls.

CONCLUSIONS

Childhood excess weight prevalence in Andalusia has decreased slightly between 2011-2012 and 2015-2016. Notably, a decrease in obesity prevalence in girls aged 8-15 years was recorded. In 2011-2012 a social gradient for excess weight prevalence across three SES indicators was observed: in 2015-2016 this gradient disappeared. Nonetheless, prevalence remains too high.

Pigmentation phototype and prostate and breast cancer in a select Spanish population-A Mendelian randomization analysis in the MCC-Spain study

INTRODUCTION

Phototype has been associated with an increased risk of prostate cancer, and it is yet unknown if it is related to other hormone-dependent cancers, such as breast cancer or whether this association could be considered causal.

METHODS

We examined the association between the phototype and breast and prostate cancers using a Mendelian randomization analysis. We studied 1,738 incident cases of breast cancer and another 817 cases of prostate cancer. To perform a Mendelian randomization analysis on the phototype-cancer relationship, a genetic pigmentation score was required that met the following criteria: (1) the genetic pigmentation score was associated with phototype in controls; (2) the genetic pigmentation score was not associated with confounders in the relationship between phototype and cancer, and (3) the genetic pigmentation score was associated with cancer only through its association with phototype. Once this genetic score is available, the association between genetic pigmentation score and cancer can be identified as the association between phototype and cancer.

RESULTS

The association between the genetic pigmentation score and phototype in controls showed that a higher genetic pigmentation score was associated with fair skin, blond hair, blue eyes and the presence of freckles. Applying the Mendelian randomization analysis, we verified that there was no association between the genetic pigmentation score and cancers of the breast and prostate.

CONCLUSIONS

Phototype is not associated with breast or prostate cancer.

Reproductive risk factors in breast cancer and genetic hormonal pathways: a gene-environment interaction in the MCC-Spain project

BACKGROUND

Reproductive factors are well known risk factors for breast cancer; however, little is known about how genetic variants in hormonal pathways interact with that relationship.

METHODS

One thousand one hundred thirty nine cases of breast cancer in women and 1322 frequency-matched controls were compared. Genetic variants in hormonal pathways (identified in the Kyoto Encyclopedia of Genes and Genomes) were screened according to their relationship with breast cancer using the Cochran-Armitage statistic. Information on reproductive factors was obtained using a face-to-face questionnaire. The interaction among the selected genetic variants and reproductive factors was tested with logistic regression.

RESULTS

Concerning C allele in rs2229712, compared to nulliparity in non-carriers the ORs for 1-2 and > 2 deliveries were 0.48 (0.28-0.81) and 0.34 (0.19-0.59), and in C carriers they were 0.92 (0.42-1.98) and 0.71 (0.31-1.61). Similar results were found in women carrying the C allele in rs1269851. Carriers of Allele T in rs35652107 and allele C in rs6018027 had the delivery number effect more pronounced.

CONCLUSIONS

The number of deliveries had a dose-response protective effect on breast cancer; women carrying C allele in rs2229712 did not benefit from this protective effect.

Factors associated with adherence to nutritional recommendations before and during pregnancy

Several epidemiologic studies and clinical trials have demonstrated the value of balanced nutrition during pregnancy. This study aimed to examine the degree of adherence to nutritional recommendations among 1,175 pregnant Spanish women and the factors associated with such adherence to pre-pregnancy and during the first half of pregnancy. Data were collected during June 2004-March 2007 and included socio-demographic and lifestyle factors. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed using logistic regression models to identify factors associated with adherence to dietary recommendations. Before pregnancy, slightly less than one quarter of the pregnant women (21 percent) did not meet the recommended intake of both vegetables and cereals, and 50 percent did not meet the recommended intake of fruits. Yet most of the participants exceeded the recommended values for proteins. During pregnancy, the adherence for all food types decreased. Factors associated with adherence to the nutritional recommendations were similar before and during pregnancy. Adherence to the Spanish Society of Community Nutrition dietary recommendations was lower among pregnant women who were younger, from a low social class, smokers, and had a low level of physical activity. These findings suggest that nutritional education should become an essential part of antenatal care.

Exploratory analysis of preventable first day mortality in Colombia

OBJECTIVE

The goal of this study was to inform public health policy which can reduce Colombia's estimated infant mortality rate (IMR), 17.78 deaths for 1000 live births (2011), by lowering preventable first day mortality (PFDM).

STUDY DESIGN

This study combined a time series analysis, using a linear regression method, for the period 2001-2012 with a cross-sectional analysis, using odds ratios and bi-variate methods, for the year 2012 to study first day mortality (FDM) and PFDM classified by biological, socio-economic, and medical correlates.

METHODS

The study examined the trends for 2001-2012 in Colombia's infant mortality rate per 1000, and in the relative significance of PFDM by cause. It established the relative odds of PFDM for 2012 by major risk categories, defined by birthweight and gestational age, and within those by biological, sociodemographic risk factors or groups and by potential access to and use of care. Then, the study established the major causes of PFDM within major risk categories and groups.

RESULTS

Between 2001 and 2012, the average annual rate of FDM declined by 6.30%, while overall infant mortality only declined by 4.20%. Yet, in 2012, 37.04% of FDM was preventable by using proper pregnancy control (7.00% of total preventable), proper care during childbirth (37.20%), and handling causes associated with late diagnosis and treatment (55.80%). PFDM is primarily a socio-economic phenomenon, even among normal weight and gestational age newborns, who account for 32.73% of PFDM due to improper management of pregnancy and delivery among lower socio-economic and outlying populations, specifically in rural areas and among members of the inferior subsidised social insurance regime.

CONCLUSION

From efficacy and probable cost effectiveness perspectives, intervention priority should be given to handling babies with normal gestation age and birthweight, and then to babies with very low gestation age and birthweight. At the same time, more prenatal visits could lead to fewer very high-risk situations at the outset. In view of the Colombian regulation to the contrary, the use of foetal monitoring and echography methods by all general practitioners should be considered. They should be trained accordingly. Policies should focus on members of the underprovided subsidised health insurance regime, rural areas, young, low-educated and single mothers during pregnancy, mainly delivery.

The influence of body mass index on the functional prognosis of patients with hip fracture

BACKGROUNDS AND AIMS

To examine the contribution of patient body mass index to functional status, physical independence and emotional distress in various age groups (third and fourth age) of female hip-fracture patients.

METHODS

A sample of 123 older females (>65 years) admitted in a major regional hospital with a diagnosis of hip fracture participated in this cross-sectional study. The outcome measures used in this study were body mass index (BMI), the Modified Barthel Index, the Goldberg General Health Questionnaire, the Tinetti Mobility Test and a survey collecting data from participants 24-72 h after admission. For our analysis, patients were divided into two groups according to their age: <80 years (third age) and >81 years (fourth age). In addition, three groups were made according to patients' body mass index <24 h prior to surgery: a normal weight group, an overweight group and an obese group. An ANCOVA was performed with age group as a between-subjects variable (third age, fourth age) and gender, educational level, marital status, type of fracture, type of surgery, presence of other fractures and BMI as covariates.

RESULTS

Patients in the third-age group obtained significantly higher values in the Barthel Index (P = 0.040) and the Tinetti Mobility Test (P = 0.001) and lower values in the Goldberg General Health Questionnaire (P = 0.035) compared to the fourth-age group. When BMI was considered, significance was maintained only in the Tinetti Mobility Test.

CONCLUSIONS

The BMI could be a relevant mediator of the relationship between functional decline and the aging process in the transition between third to fourth age in females.

The impact of the type of hospital on survival of multiple myeloma patients: the MICORE study

OBJECTIVE

To analyze the impact of the type of hospital in overall survival of multiple myeloma patients.

PATIENTS AND METHOD

A survival analysis was performed of all patients (n=431) diagnosed in 5 public hospitals (4 community hospitals and one university hospital) during the period 1993-2006.

RESULTS

Patients attended to in community hospitals differ significantly from those seen in the university hospital in the following variables: mean age (70 years [31-92] versus 67.9 (35-91), P=.038); percentage of stage iii patients (62.6% versus 69.1%, P=.033), and percentage of patients who had autologous stem cell transplant (8.2% versus 18.2%, P=.026). The variables associated with mortality in the multivariate analysis were age (P<.001), stage (iii versus i; P=.03) and renal failure (P=.04). The type of hospital did not reach statistical significance (hazard ratio of 0.72 (95% confidence interval 0.48-1.07), P=.1].

CONCLUSIONS

The type of hospital is not significantly associated with mortality in multiple myeloma patients. These data support our current model of health care, in which the community hospitals are responsible for the primary care of these patients, in a coordinated work with the university hospital.

[Melanoma, altitude, and UV-B radiation]

BACKGROUND AND OBJECTIVES

UV radiation is the main modifiable risk factor for the development of cutaneous melanoma. Many people in the Spanish province of Granada live at high altitudes and, therefore, receive high doses of UV-B radiation. The aims of this study were to assess the possible association between melanoma and altitude and to measure the daily erythemal dose at different altitudes.

MATERIAL AND METHODS

An epidemiological study was carried out between 1982 and 2007 to assess the relationship between altitude, daily erythemal dose, and the prevalence of melanoma. We calculated the prevalence of melanoma in patients with a clinical and histological diagnosis of melanoma at Hospital Clínico Universitario San Cecilio in Granada, Spain. All individuals were required to be residents of the province of Granada in order to be included in the study. The prevalence of melanoma was calculated for altitude intervals of 100 m. Daily erythemal dose was estimated using measures of UV-B radiation obtained with pyranometers at altitudes of 0, 680, 1200, and 3398 m above sea level during the Evaluation of the Effects of Elevation and Aerosols on UV Radiation (VELETA) 2002 field campaign.

RESULTS

The highest prevalence of melanoma was found between 1400 and 1499 m above sea level (the interval at which the highest settlements are found), with a rate of 2.36 cases per 1000 inhabitants (95% confidence interval, 0.64-6.03). Above 700 m, the daily erythemal dose increased exponentially with increasing altitude.

CONCLUSIONS

We observed a tendency toward increased prevalence of melanoma at higher altitude, with higher prevalences observed beyond 700 m above sea level.

Driver dependent factors and the risk of causing a collision for two wheeled motor vehicles

OBJECTIVE

To assess the effect of driver dependent factors on the risk of causing a collision for two wheeled motor vehicles (TWMVs).

DESIGN

Case control study.

SETTING

Spain, from 1993 to 2002.

SUBJECTS

All drivers of TWMVs involved in the 181 551 collisions between two vehicles recorded in the Spanish registry which did not involve pedestrians, and in which at least one of the vehicles was a TWMV and only one driver had committed a driving infraction. The infractor and non-infractor drivers constituted the case and control groups, respectively.

MAIN OUTCOME MEASURES

Logistic regression analyses were used to obtain crude and adjusted odds ratio estimates for each of the driver related factors recorded in the registry (age, sex, nationality, psychophysical factors, and speeding infractions, among others).

RESULTS

Inappropriate speed was the variable with the greatest influence on the risk of causing a collision, followed by excessive speed and driving under the influence of alcohol. Younger and older drivers, foreign drivers, and driving without a valid license were also associated with a higher risk of causing a collision. In contrast, helmet use, female sex, and longer time in possession of a driving license were associated with a lower risk.

CONCLUSIONS

Although the main driver dependent factors related to the risk of causing a collision for a TWMV were similar to those documented for four wheeled vehicles, several differences in the pattern of associations support the need to study moped and motorcycle crashes separately from crashes involving other types of vehicles.

Risk compensation theory and voluntary helmet use by cyclists in Spain

OBJECTIVE

To obtain empirical data that might support or refute the existence of a risk compensation mechanism in connection with voluntary helmet use by Spanish cyclists.

DESIGN

A retrospective case series.

SETTING

Spain, from 1990 to 1999.

SUBJECTS

All 22 814 cyclists involved in traffic crashes with victims, recorded in the Spanish Register of Traffic Crashes with Victims, for whom information regarding helmet use was available.

MAIN OUTCOME MEASURES

Crude and adjusted odds ratios for the relation between committing a traffic violation and using a helmet.

RESULTS

Fifty four percent of the cyclists committed a traffic violation other than a speeding infraction. Committing a traffic violation was associated with a lower frequency of helmet use (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.58 to 0.69). Cycling at excessive or dangerous speed, a violation observed in 4.5% of the sample, was not significantly associated with helmet use either alone (aOR 0.95, 95% CI 0.56 to 1.61) or in combination with any other violation (aOR 0.97, 95% CI 0.79 to 1.20).

CONCLUSIONS

The results suggest that the subgroup of cyclists with a higher risk of suffering a traffic crash are also those in which the health consequences of the crash will probably be higher. Although the findings do not support the existence of a strong risk compensation mechanism among helmeted cyclists, this possibility cannot be ruled out.

Proportion of hospital deaths potentially attributable to nosocomial infection

OBJECTIVE

To determine the fraction of hospital deaths potentially associated with nosocomial infection (NI).

DESIGN

A matched (1:1) case-control study.

SETTING

An 800-bed, tertiary-care, teaching hospital.

PATIENTS

All patients older than 14 years who were admitted to the hospital between January 1, 1990, and January 1, 1991, were eligible. All 524 consecutive deaths that occurred in the hospital comprised the case group. For each case, a control patient was matched for primary admission diagnosis and admission date.

OUTCOME MEASURES

The proportion of hospital deaths potentially associated with NI was estimated from the population attributable risk (PAR) adjusted for age, gender, service, severity of illness, length of stay, and quality of the medical record.

RESULTS

For stays longer than 48 hours, the PAR for all NIs was estimated to be 21.3% (95% confidence interval [CI95], 16.8%-30.5%). The greatest proportion of deaths potentially associated with NIs was observed in patients with only one infection (PAR, 15.0%; CI95, 10.9%-22.6%) and bacteremia or sepsis (PAR, 7.7%; CI95, 4.6%-11.6%).

CONCLUSIONS

NIs are associated with a large proportion of intrahospital deaths. This information may help clinicians and healthcare managers to assess the impact of programs for the prevention and control of NIs on intrahospital death.

Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes

The aim of this prospective cohort study was to identify the risk factors involved in falls in 190 elderly residents of two geriatric centres in Granada (Andalusia, Spain). Because different types of falls may be associated with different factors, falls were classified according to the precipitating cause, either extrinsic or intrinsic. The incidence density and the ratios for crude and adjusted density were calculated. Cox proportional risk analysis was used to calculate adjusted incidence density ratios. Of the 121 falls identified, 63 (52.1%) had a extrinsic precipitating cause, 43 (35.5%) had an intrinsic precipitating cause, and no precipitating cause was determined in 15 falls. The rate of falls with an extrinsic precipitating cause was 0.39 per person per year, while falls with an intrinsic precipitating cause showed a frequency of 0.27 per person per year. For falls with an extrinsic precipitating cause, the most significant risk factors were: age, diabetes mellitus, a history of falling, and treatment with neuroleptics or oral bronchodilators. The number of illnesses acted as a protective factor. For falls with an intrinsic precipitating cause, the independent risk factors were: age, diabetes, dementia, alterations of gait and balance, previous falls, and treatment with digitalins, neuroleptics or antidepressants. These results suggest that the susceptibility to a fall with an intrinsic precipitating cause is easier to identify and has a greater potential for being controlled.

Application of the induced exposure method to compare risks of traffic crashes among different types of drivers under different environmental conditions

The authors used the induced exposure method to compare risks of traffic crashes among different types of Spanish drivers under different environmental conditions. The authors analyzed traffic crashes recorded by the Spanish Dirección General de Tráfico for the years 1991 and 1992 to compare proportions of drivers in different age/sex categories who were involved in single-vehicle and multivehicle crashes under different psychological and physical conditions. Crash risk was 1.42- to 2.35-fold greater in men than in women, depending on driver category and environmental factors. Risk was also significantly higher in the 18- to 24-year-old age group (1.75- to 2.87-fold greater than in drivers aged 25-49 years) and under abnormal psychological-physical conditions (1.69- to 4.10-fold greater among drivers under the influence of alcohol). Twilight and night driving, driving in urban areas, and driving on weekends and legal holidays were also associated, though nonsignificantly, with a slightly higher traffic crash risk. These findings are consistent with earlier reports, and they support the usefulness of the induced exposure method as an easy and economical tool with which to analyze data contained in traffic crash records.

Predictive value of a screen for gestational diabetes mellitus: influence of associated risk factors

BACKGROUND

There is a need for solid evidence of the relative advantages of universal vs. selective screening for gestational diabetes mellitus. Our study of a broad obstetric population determines the positive predictive value of the 50-g oral glucose challenge test for screening in the presence and absence of classical gestational diabetes risk factors.

METHODS

A retrospective cohort study was carried out with a total of 2,574 pregnant women. Clinical information was obtained from hospital records and each patient's medical history, and gestational diabetes risk factors were quantified for each pregnant woman. The positive predictive value of a screen was determined with respect to the number of risk factors.

RESULTS

Age 30 or over, family history of diabetes, obesity (BMI > or =27) and previous fetal macrosomia were established as the most frequent risk factors. Just over half (54.2%) of our population presented one or more risk factors. Screening covered 75% of the population, and was positive in 15% of the cases. Diagnosis was confirmed in 64 cases, 57 of them at risk, and seven with no risk factors. We obtained an overall positive predictive value of 21.8% (CI 17.3-27.0). This figure increases with the number of risk factors, from 12% for the women with no risk factors, to 40% for those presenting three or more risk factors.

CONCLUSIONS

A selective screening program that takes into account the clinical background and characteristics of each pregnant woman allows a high yield of true positives while reducing the possible undesirable effects associated with false positives.