[Design and validation of a questionnaire exploring risky-driving patterns in young drivers]

BACKGROUND

Traffic Injuries are a major public health problem, especially among young people. However, we have not found any useful questionnaire designed in our country for the epidemiological research in this field. The objective of this study was to design and validate an easy and quickly-to-fill questionnaire aimed to collect information on how frequently university car drivers report to be involved in driving circumstances theoretically related to traffic crashes.

METHODS

Between 2007 and 2010, a total of 1597 young undergraduate students at the University of Granada answered a self-administered questionnaire collecting information about exposure, accidents and involvement in 28 different driving circumstances. For designing this questionnaire, an extensive literature review was carried out and the opinions of five experts in a panel were also taken into account. By applying the tetracoric correlation coefficient, we conducted a factor analysis. Internal consistency was assessed using Cronbach's alpha coefficient. Finally, we evaluated the crude and adjusted association of each identified factor with the odds for having suffered an accident.

RESULTS

After excluding 8 circumstances, the remaining ones were grouped into three factors: the first one included ten high-prevalence circumstances and explained 31.9% of the total variability. Meanwhile, the other two factors included five circumstances each one which respectively explained 15.2% and 12.5% of the variability. Cronbach's alpha coefficients ranged between 0.816 and 0.553. When adjustments according age, sex, years in possession of the driving license and intensity of exposure were made, the first factor obtained the score more strongly associated with the accident rate (OR = 1.51; CI95%: 1.25-1.85).

CONCLUSIONS

The final version (20 circumstances) identified three factors related to higher accident rates among the young drivers. The first one integrated, among other circumstances, the excessive speed and driving while sleepy or tired and it was the most closely associated with the accident rate in the adjusted analysis. The second factor included, among others, the commission of driving offences, and the third one included driving under the influence of alcohol, not always wearing the seat belt and distractions.

Randomized clinical trial on antimicrobial prophylaxis for flexible urethrocystoscopy

OBJECTIVES

One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection (UTI). In order to reduce this risk, antimicrobial prophylaxis has been considered, however there is not a unanimous view regarding indications, dosage, type of antibiotic, and so on. To clarify this uncertainty, we practiced a pilot and experimental study aimed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy.

METHODS

Sixty patients were entered into a pilot randomized clinical trial between March and August 2011. Thirty patients were assigned to a control group without receiving any antibiotic dose, and the intervention group (30 patients) received 3 g fosfomycin trometamol. Ten days later urine culture and sediment analysis were performed in all patients. Significant bacteriuria was considered from > 105 CFU /ml. One month later a telephone survey was developed to assess urinary symptoms, and assistance to the family doctor. We estimated the cumulative incidence of bacteriuria, pyuria and microhematuria in both groups, and we compared the results using a strategy of analysis per protocol and intention to treat.

RESULTS

The incidence of bacteriuria, pyuria and microhematuria in the control group was 10%, 23.3% and 26.7% respectively and in the intervention groups the values differed depending on the type of analysis. Considering only the 27 patients (per protocol analysis), the incidence would be 11.1%, 37.0% and 29.6% respectively. If we include the three patients who did not completed the study (per intention to treat analysis) and considering their results as negative, the results were 10%, 33.3% and 26.7% respectively. Finally, in the case the three cultures not performed in this group had produced a positive result, the impact would have been 20.0%, 43.3% and 36.7%. In any of the three cases, the differences with the control group were not statistically significant.

CONCLUSIONS

In a selected population and with appropriate aseptic measures, antibiotic chemoprophylaxis does not appear to show a clinically relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy.

[The dimensions of the organisational climate as seen by general practitioners]

OBJECTIVE

To create and validate a tool to assess the organizational climate (OC) perceived by general practitioners (GP).

DESIGN

Descriptive, cross-sectional, and multi-site, study.

SETTING

Health centres (HC) in Jaén and Málaga province Spain.

PARTICIPANTS

Random sample of 38 HCs and 387 GPs.

MAIN MEASUREMENTS

A self-administered questionnaire in March 2001, with the personal variables of sex, age, graduation date, specialty, kind of contract, time worked in primary care teams, time in current job, list size, case load, tutor of residents and academic qualification. HC variables: urban/rural, team structure, accreditation for teaching residents, service portfolio, out-patient care, and an OC scale of 40 Likert-like questions. We analysed the content validity of the scale by factorial analysis; and its reliability, by Cronbach's alpha and corrected scale-item correlation coefficients.

RESULTS

Reply rate was 89.8%, 71% of the GPs were male, mean age was 44, 76% had tenure, and 37% were specialists in family medicine and 28% tutors, 17% with 3rd-year residents, 9% with doctors; 50% of HCs were rural and the mean team structure had 13 GPs and 4 paediatricians. We obtained 12 factors that explained 60% of variance, and 7 factors with reliability coefficients >0.50. We made an OC-positive scale (alpha=.82) with the dimensions for team-work, cohesion and social life; and another OC-negative scale (alpha=.78) composed of team conflict, perceived team failure, excess autonomy, authoritarian management, and GP-nurse tension.

CONCLUSIONS

We found a questionnaire with good validity and reliability, which was useful for evaluating the OC perceived by GPs.

Age and sex differences in the risk of causing vehicle collisions in Spain, 1990 to 1999

This retrospective, paired case-control study was designed to estimate crude and adjusted effects of age and sex on the risk of causing collisions between vehicles with four or more wheels in Spain during the period from 1990 to 1999. We selected all 220284 collisions registered from 1990 to 1999 in the Spanish Dirección General de Tráfico (DGT) traffic crash database in which only one driver committed any infraction. Information was collected about age, sex and several confounding factors for both the responsible and paired-by-collision nonresponsible drivers. Crude and adjusted odds ratios (aORs) were calculated for each age and sex category. For men, the lowest risk was seen for drivers aged 25-49 years. Below the age of 35 years the crude odds ratio (cOR) was highest in the 18-24-year-old group (1.61; CI: 1.57-1.65). The risk increased significantly and exponentially after the age of 50 years, to a maximum odds ratio of 3.71 (3.43-4.00) for drivers aged >74 years. In women, the lowest risk values were found for the 25-44-year-old age group. In older women the risk increased significantly with age to a maximum odds ratio of 3.02 (2.31-3.97) in the oldest age group. aOR estimates tended to be lower than crude estimates for drivers younger than 40 years of age, but the opposite was seen for drivers 40 years old and older. Regarding sex differences, among younger drivers crude and aORs for men were higher than for women. Our results suggest that the risk of causing a collision between vehicles with four or more wheels is directly dependent on the driver's age.

[An assessment of the effect of helmet use among cyclists and the risk of head injury and death in Spain, 1990 to 1999]

BACKGROUND AND OBJECTIVE

This study aimed to assess the protective effect of helmet use by cyclists on risk of suffering head injury or dying as a consequence of a traffic crash.

SUBJECTS AND METHOD

26,832 cyclists involved in traffic crashes with victims registered in the Dirección General de Tráfico database from 1990 to 1999 in Spain were studied. From this database, variables relating to each cyclist (i.e., age, sex, presence of head trauma, severity of lesions) and those related with the crash (i.e., place, date, type of crash), were collected. The odds ratio and the proportion of the population attributable risk for non-use of a helmet by cyclist were estimated.

RESULTS

An adjusted odds ratio of 2.45 (2.19-2.73) for the association between non-use of a helmet and the risk of head injury was obtained. As death of the cyclist as the outcome, the corresponding odds ratio was 1.35 (1.09-1.67). The values of proportion of the population attributable risk were 0.51 (0.47-0.55) and 0.22 (0.07-0.36), for head injury and death, respectively.

CONCLUSIONS

This study confirms that helmet use among cyclists significantly decreased the risk of head injury and, to a lesser extent, death. These results constitute a strong argument for increasing in the frequency of helmet use among cyclists in Spain.