Eva Cirera

Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-2009

AIMS The aim of the present study was to estimate the incidence of hospital discharges for traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) in Spain by injury circumstances (traffic crashes and others), injury severity, gender and age group and to describe its trends over the period 2000-2009. METHODS It is a study of trends that includes hospital discharges with a primary diagnosis of TSCI or TBI. Crude and age-standardised rates were calculated per million inhabitants. Changes in rates between 2000 and 2009 were assessed through calculation of the relative risk adjusted for age, using Poisson regression. RESULTS Between 2000 and 2009 in Spain, 10,274 patients were admitted for traumatic TSCI, and 206,503 for TBI. The annual incidence rate for TSCI was 23.5 per million, that for TBI was 472.6 per million. The overall incidence rate for TSCI fell significantly between 2000 and 2009 by 24.2% (traffic-related 40.9%, other 12.9%), as did that for TBI (23.8% overall, 60.2% traffic-related, with no change for other circumstances). Among people aged 65 years and over, no change was observed for TSCI, incidence of TBI fell significantly when due to traffic crashes, but there was a dramatic increase of 87% in men and 89.3% in women when due to other circumstances. CONCLUSIONS Over the last decade the incidence of these types of injury has fallen significantly when the injury resulted from traffic crashes, and to a lesser extent when from other circumstances. However TBI incidence among people aged 65 and over injured in non-traffic-related circumstances has risen dramatically.

Factors associated with severity and hospital admission of motor-vehicle injury cases in a southern European urban area

Objectives: To describe the characteristics of motor-vehicle (MV) injury cases admitted to Emergency departments (ED), and to assess factors related to injury severity and hospital admission. Setting: Subjects were MV injury patients, aged 16 or more, admitted to four EDs in the city of Barcelona (Spain), from July 1995 to June 1996. Methods: Cross-sectional design. The data analyzed were obtained from the information routinely transmitted from the EDs to the Municipal Institute of Health, based on the processing of ED logs. Severity was assessed with the Abbreviated Injury Scale and the Injury Severity Score. Univariate and bivariate descriptive statistical analyses were performed, as well as multiple logistic regressions. Results: For the 3791 MV-injury cases included in the study period, a larger contribution of cases was noted for males (63.1%), for cases younger than 30 years (55.3%) and for motorcycle or moped occupants (47.1%). After adjusting for age, sex and the presence of multiple injuries, pedestrians, followed by moped and motorcycle occupants were at a higher risk of a more severe injury (OR: 1.77, 1.61 and 1.50 respectively). Correspondingly, these user groups also showed a higher likelihood of a hospital admission (OR: 2.03, 1.92 and 2.00 respectively), when attended to in an ED. Injury cases attended to in the ED during night hours (OR: 2.06) were also at a higher risk of a hospital admission. Conclusions: In Barcelona, pedestrians and two-wheel MV occupants, besides accounting for two-thirds of MV injury cases, are the user groups with a greater risk of a more severe injury, as well as a higher chance of a hospital admission, independently of demographic and health care factors.

Motor vehicle crash fatalities at 30 days in Spain

OBJECTIVES To assess level of fulfillment and utility of the hospital discharge register (HDR) as a complementary source of information for estimating the number of deaths at 30 days due to motor vehicle crashes in Spain. METHODS It is a cross-sectional study were we compared the number of people injured due to motor vehicle crashes hospitalised in a public hospital (HDR), in Spain during 2001, with the number of people severely injured or killed due to motor vehicle crashes reported by the police database (Dirección General de Tráfico, DGT) for the same year. A descriptive analysis was carried out by age, sex and region (Autonomous Community), as well as an estimation of the percentage of under-reporting of deaths by the DGT based on two assumptions. RESULTS Police reported 27,272 severe injuries and 4,811 deaths during first 24 hours after the crash and after applying a fatality adjustment factor estimated 706 more deaths up to 30 days after the crash. The HDR reported 40,174 urgent hospitalisations. Of these, 1,099 died during the day of hospitalisation or within the following 30 days. The police only notified 68% of all cases that required hospitalisation. According to the number of deaths reported by police and contrasted with hospital register, estimations of the number of deaths at 30 days made by police could represent a level of under-reporting of between 3% and 6.6%, depending on the assumption considered. CONCLUSIONS This study showed that the HDR is an information source that complements police statistics and is useful to estimate the number of deaths and non-fatal injuries due to motor vehicle crashes in Spain.

Buscando una aguja en un pajar: las técnicas de conexión de registros en los sistemas de información sanitaria

: Linking records from two or more data sets with information on an issue allows us to identify those belonging to the same individual. The linkage process can be manual, deterministic, or probabilistic. Probabilistic linkage was developed for those situations where there is no single identifier, the number of identifying variables is limited, and they have little discriminating power. Considering the possibilities for the linkage to be correct or incorrect and based on the degree of agreement among variables and their frequencies, this process weights each variable. This manuscript presents linkage techniques, describes probabilistic linkage step by step, and illustrates it with examples taken from the actual operation of our services.

Probabilistic linkage of police and emergency department sources of information on motor-vehicle injury cases: A proposal for improvement

Data on traffic injury cases that includes both the crash circumstances and the health outcome is a key tool for creating appropriate motor-vehicle injury prevention policies. The aim of this study was to explore the feasibility of the probabilistic linkage of police and emergency department data relating to motor-vehicle injury cases in Barcelona. A probabilistic linkage process was performed using local police reports (n = l2,481) and hospital emergency department data (n = 16,733) for all traffic injury cases that occurred in 1997. In almost two out of every three matched pairs for the injured person, at least five of the seven variables coincided, and in 7.3% of the cases all variables coincided. This work has allowed the empirical development of combined methods for the linkage of police and healthcare sources of information at the local level, which are the preliminary steps towards the construction of a data base that would include full information on the circumstances and the consequences of motor-vehicle crashes.

The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults

Background To examine combined associations between self-reported context-specific sitting time (ST) and physical activity (PA) with working memory capacity (WMC) and academic achievement in a sample of Spanish adults. Design Undergraduate students (n = 371; 21 years ± 3 years, 44% female) were recruited from University of Vic-Central University of Catalonia. Methods Participants completed a 54-item survey that assessed socio-demographic variables (e.g. age, gender, academic year), min/week of light (LPA), moderate (MPA) and vigorous (VPA) intensity PA (International Physical Activity Questionnaire), min/day of domain-specific ST (Last 7 days sedentary behavior questionnaire) and academic performance (grade point average). WMC was assessed through a multiple complex span task that included: Operation Span, Symmetry Span and Rotation Span. These tasks interleave a processing task with a short list of to-be-remembered items. General linear models-adjusted by PA, ST and gender-assessed combined associations between ST and PA with WMC and academic achievement. Results Performing more than 3 h/week of MPA was related to increases in WMC (P < 0.001). However, PA was not associated with academic performance. More than 3 h seated on a weekend day while performing non-screen leisure activities were related to reduced WMC after adjusting for PA (P = 0.012). Similarly, >3 h/weekday spent seated in these sedentary activities or in leisure-forms of screen time were inversely associated with academic performance regardless of PA (P = 0.033; P = 0.048). Conclusions MPA may benefit working memory; however, specific domains of leisure-time sedentary behavior may have an unfavorable influence on working memory and academic performance regardless of time spent in PA.

Fallecidos a 30 días por lesiones producidas en accidente de tráfico en España

Resumen Objetivos: Valorar el grado de cumplimiento y la utilidad del conjunto mínimo y básico de las altas hospitalarias (CMBDAH) para estimar el número de fallecidos a 30 días por accidente de tráfico (AT). Método: Las poblaciones del estudio fueron los heridos graves y fallecidos por AT registrados en la base de accidentes de la Dirección General de Tráfico (DGT) y los lesionados por AT ingresados en un hospital público. Se ha llevado a cabo un análisis descriptivo por edad, sexo y comunidad autónoma y una estimación del porcentaje de subnotificación de muertes de la DGT según dos asunciones. Resultados: Según la DGT, se registraron 27.272 heridos graves y 4.811 fallecidos en las primeras 24 h y se estimaron 706 fallecidos con la aplicación del factor de corrección a los 30 días. Según el CMBDAH, se produjeron 40.174 ingresos hospitalarios urgentes, en los que en 1.099 casos se produjo el fallecimiento el mismo día del ingreso o en los 30 días posteriores. Así pues, por la información obtenida por la policía, se detectó el 68% de los casos que requirieron ingreso hospitalario. Tomando como referencia el número de fallecidos según la DGT, completado por las muertes según el CMBDAH, las estimaciones de fallecidos a 30 días realizadas por la DGT fueron entre un 3 y un 6,6% inferiores según la asunción considerada. Conclusiones: Este estudio pone de manifiesto la utilidad de la información suministrada por el CMBDAH para la obtención de información sobre el número de fallecidos y heridos graves complementaria a las estadísticas policiales. Palabras clave: Lesión. Accidente de tráfico. Datos policiales. Infranotificación. Víctimas mortales. Abstract Objectives: To assess level of fulfilment and utility of the hospital discharge register (HDR) as a complementary source of information for estimating the number of deaths at 30 days due to motor vehicle crashes in Spain. Methods: It is a crossectional study were we compared the number of people injured due to motor vehicle crashes hospitalised in a public hospital (HDR), in Spain during 2001, with the number of people severely injured or killed due to motor vehicle crashes reported by the police database (Dirección General de Tráfico, DGT) for the same year. A descriptive analysis was carried out by age, sex and region (Autonomous Community), as well as an estimation of the percentage of underreporting of deaths by the DGT based on two assumptions. Results: Police reported 27,272 severe injuries and 4,811 deaths during first 24 hours after the crash and after applying a fatality adjustment factor estimated 706 more deaths up to 30 days after the crash. The HDR reported 40,174 urgent hospitalisations. Of these, 1,099 died during the day of hospitalisation or within the following 30 days. The police only notified 68% of all cases that required hospitalisation. According to the number of deaths reported by police and contrasted with hospital register, estimations of the number of deaths at 30 days made by police could represent a level of under-reporting of between 3% and 6.6%, depending on the assumption considered. Conclusions: This study showed that the HDR is an information source that complements police statistics and is useful to estimate the number of deaths and non-fatal injuries due to motor vehicle crashes in Spain.

ActivPAL™ determined sedentary behaviour, physical activity and academic achievement in college students

ABSTRACT The aim of this study was to examine relationships between activPAL™-determined sedentary behavior (SB) and physical activity (PA) with academic achievement. A total of 120 undergraduates (N = 57 female; 20.6 ± 2.3 years) participated in the study. Academic achievement was measured as the grade point average obtained from all completed courses. Participants wore on the right tight an activPAL™ for 7 days to determine total sedentary time, total number of sedentary breaks, sedentary bouts, standing time, light and moderate-to-vigorous physical activity (MVPA). Separate multiple linear regression models were performed to examine associations between SB variables and academic achievement. Light PA, MVPA, total sedentary time, total standing time, or total number of sedentary breaks were not related to academic achievement. Independently of PA, the amount of time spent in sedentary bouts of 10-20min during weekdays was positively related to academic achievement. Given that college students spend the majority of their workday in environments that encourage prolonged sitting, these data suggest that interruptions in prolonged periods of sitting time every 10-20min via short breaks may optimize cognitive operations associated with academic performance.