Inmaculada Fierro

Prevalence of psychoactive substances, alcohol, illicit drugs, and medicines, in Spanish drivers: A roadside study

Following population, geographic, road type and time criteria, Spain has carried out random, roadside controls of 3302 representative sample of Spanish drivers, including saliva analysis for 24 psychoactive substances and alcohol breath tests. The 81.4% of the drivers were male, with an average age of 34.8±11.8 (mean±SD). The 17% of the drivers were found to be positive to any of the substances analysed. The 6.6% of the drivers found positive to alcohol (>0.05 mg/l in breath), 11% were found positive to any illicit drug, and 2% were positive to one of the medicines analysed. Some drivers were positive in more than one substance. The most common illicit drugs among Spanish drivers were cannabis (7.7%), or cocaine (3.5%), either alone or combined with other substances. The most prevalent medicines were the benzodiazepines (1.6%). As a tendency, higher figures for positive cases were observed among males than in females (being statistically significant the differences for alcohol, cannabis and cocaine). Alcohol and cocaine positive cases were more frequently found among drivers of urban roads. Alcohol positive cases (alone, >0.05 mg/l), were more likely found as age increase (OR=1.02), those driving in urban roads (OR=2.13), and driving at any period than weekdays, while alcohol+drugs cases were more likely found among males (OR=2.819), those driving on urban road (OR=2.17) and driving at night periods. Finding a medicines positive case was more likely as elder the driver was (OR=1.05). There have been differences in the prevalence of positive cases of alcohol, cannabis and cocaine, in relation to the period of the week: in three cases the highest prevalence seen in night time. This study shows the high prevalence of psychoactive substances and alcohol in Spanish drivers, mainly illicit drugs (cannabis). This question requires a response from the authorities and from society, with an integral and multi-disciplinary approach that can heighten the populations awareness of the risks of driving under the influence of certain substances.

Alcohol and drug use by Spanish drivers: Comparison of two cross-sectional road-side surveys (2008-9/2013)

BACKGROUND: Studies have shown that the use of drugs increases the risk of road traffic accidents. Law enforcement policies and roadside drug tests are considered to be important for deterring driving under the influence of substances (DUI). The aim of this study was to compare use of alcohol and drugs among Spanish drivers between 2008 and 2013. METHODS: The study aimed to compare the prevalence of positive drug and alcohol cases in two representative samples of Spanish drivers (n=2932 drivers in 2013 and n=3302 in 2008-9). RESULTS: Between 2008-9 and 2013 a decrease in the prevalence of alcohol positive (from 4.92% [4.18-5.66] to 3.41% [2.27-4.07], pCONCLUSION: The study shows a decrease in the prevalence of drivers who tested positive for alcohol and/or drugs on the road. Although these results are favourable, drug-driving remains high and requires continued intervention. The study design does not allow us to determine the factors behind the decrease in the prevalence of drug driving but the routine implementation of roadside drug tests may have been a contributing factor. Language: en

Mortalidad y mortalidad prematura relacionadas con el consumo de alcohol en España entre 1999 y 2004

Fundamento y objetivo El proposito del estudio ha sido analizar la mortalidad y la mortalidad prematura atribuibles al consumo de alcohol en Espana entre 1999 y 2004. Poblacion y metodo Se han utilizado los datos de defunciones segun causa de muerte, agrupados por edad y sexo, para 60 procesos. Para cada proceso se calcularon, por sexos y grupos quinquenales de edad, el numero de muertes atribuibles al consumo de alcohol, los porcentajes, las tasas por 100.000 habitantes ajustadas a la poblacion estandar europea y los anos potenciales de vida perdidos (APVP) hasta los 70 anos. Resultados La mortalidad, ajustada a la poblacion estandar europea, atribuible al consumo de alcohol fue del 2,1% y descendio entre 1999 y 2004. Los procesos cronicos contribuyeron al 60% de la mortalidad. Las enfermedades del aparato digestivo, y en particular «Otras cirrosis », fueron los procesos que mas contribuyeron a la mortalidad. El 9,3% de todos los APVP fue atribuible al consumo de alcohol. Los procesos agudos provocaron casi el 70% de estos APVP, y los accidentes no intencionales fueron la causa principal. Conclusiones El consumo de alcohol es una causa importante de mortalidad y mortalidad prematura en Espana.

Mortalidad relacionada con el consumo de alcohol en España y en las comunidades autónomas en el año 2004

Introduccion El consumo de alcohol se asocia a una gran morbimortalidad. El objetivo del estudio es analizar la mortalidad atribuible al consumo de alcohol en Espana y en las diferentes comunidades autonomas en 2004. Metodos Se utilizaron los datos de defunciones segun causa de muerte agrupados por edad, sexo y 60 categorias diagnosticas. Se calculo el numero de muertes atribuibles al consumo de alcohol por sexo y grupo de edad en 2004, para Espana y las distintas comunidades autonomas, a partir de las fracciones atribuibles propuestas por los Centers for Disease Control and Prevention para el calculo de la mortalidad en Estados Unidos en 2001. Se han calculado las tasas crudas y ajustadas de mortalidad atribuible al alcohol, por 100.000 habitantes de acuerdo a la poblacion estandar europea. Resultados La mortalidad relacionada con el alcohol en Espana en 2004 fue del 2,3%; 3,2% en hombres y 1,2% en mujeres. La comunidad autonoma de Murcia, con el 2,9% de mortalidad, junto a las de Andalucia, Canarias, Pais Vasco y Asturias, alcanzaron los mayores porcentajes de mortalidad por alcohol en 2004. Asturias, Murcia, Andalucia, Galicia y el Pais Vasco presentaron las mayores tasas ajustadas de mortalidad por alcohol. Conclusiones En las distintas comunidades autonomas espanolas, el consumo de alcohol es una causa importante de mortalidad. Esta informacion es de utilidad para la identificacion de prioridades y para la evaluacion de programas de intervencion. Las causas cronicas suponen, en general, un mayor peso en la mortalidad que las causas agudas, y son las patologias del sistema digestivo las mas contribuyentes.INTRODUCTION Alcohol consumption is associated with great morbidity-mortality rate. The aim of this study is to analyze the mortality that can be attributed to alcohol consumption in Spain and in its different Autonomous Communities during 2004. METHOD The records of deaths by cause of death were used, grouped by age, gender and 60 diagnostic categories. The number of deaths attributable to alcohol consumption according to gender and age group in 2004 for Spain and the different Autonomous Communities was calculated by means of the alcohol attributable fractions proposed by the Centers for Disease Control and Prevention for calculating the mortality rates in the U.S.A. in 2001. The raw and adjusted mortality rates attributable to alcohol per 100,000 inhabitants were calculated with respect to the European population standard. RESULTS Alcohol-related mortality in Spain was 2.3%; 3.2% for men and 1.2% for women. The Community of Murcia, with a mortality rate of 2.9%, together with those of Andalusia, the Canary Islands, the Basque Country and Asturias, had the highest rates of mortality attributable to alcohol in 2004. The highest adjusted mortality rates attributable to alcohol were found in Asturias, Murcia, Galicia and the Basque Country. CONCLUSIONS In the different Autonomous Communities of Spain, alcohol consumption is an important cause of death. This information is of use for identifying priorities and to evaluate intervention programs. Chronic causes, in general, have a greater weight in mortality rates than acute causes, disease of the digestive system having the highest rate of contribution.

Procalcitonin cannot be used as a biomarker of infection in heart surgery patients with acute kidney injury

PURPOSE We intended to assess how acute kidney injuy impacts on procalcitonin levels in cardiac surgery patients, with or without infection, and whether procalcitonin might be used as a biomarker of infection in acute kidney injuy. MATERIAL AND METHODS A case-control study was designed which included patients that had had cardiac surgery between January 2011 and January 2015. Every patient developing severe sepsis or septic shock (n = 122; 5.5%) was enrolled. In addition, consecutive cardiac surgery patients during 2013 developing systemic inflammatory response syndrome (n = 318) were enrolled. Those recruited 440 patients were divided into 2 groups, according to renal function. RESULTS Median procalcitonin levels were significantly higher during the 10 postoperative days in the acute kidney injury patients. Regression analysis showed that postoperatory day, creatinine, white blood cells and infection were significantly (P < .0001) associated to serum procalcitonin level. In patients with creatinine ≥2, median procalcitonin levels were similar in infected and non-infected patients. Only when creatinine was less than 2 mg/L, the median procalcitonin levels were significantly higher in patients with infection, as compared to those with no infection. CONCLUSIONS In acute kidney injuy patients, high procalcitonin levels are a marker of acute kidney injuy but will not be able to differentiate infected from non-infected patients.

Predicting cardiac surgery-associated acute kidney injury: The CRATE score

PURPOSE Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with increased mortality. The aim was to design a nondialytic AKI score in patients with previously normal renal function undergoing cardiac surgery. METHODS Data were collected on 909 patients who underwent cardiac surgery with cardiopulmonary bypass between 2012 and 2014. A total of 810 patients fulfilled the inclusion criteria. Patients were classified as having AKI based on the RIFLE criteria. Postoperative AKI occurred in 137 patients (16.9%). Several parameters were recorded preoperatively, intraoperatively, and at intensive care unit admission, looking for a univariate and multivariate association with AKI risk. A second data set of 741 patients, from 2 different hospitals, was recorded as a validation cohort. RESULTS Four independent risk factors were included in the CRATE score: creatinine (odds ratio [OR], 9.66; 95% confidence interval [CI], 4.77-19.56; P < .001), EuroSCORE (OR, 1.40; CI, 1.29-1.52; P < .001), lactate (OR, 1.03; CI, 1.01-1.04; P < .001), and cardiopulmonary bypass time (OR, 1.01; CI, 1.01-1.02; P < .001). The accuracy of the model was good, with an area under the curve of 0.89 (CI, 0.85-0.92). The CRATE score retained good discrimination in validation cohort, with an area under the curve of 0.81 (95% CI, 0.78-0.85). CONCLUSIONS CRATE score is an accurate and easy to calculate risk score that uses affordable and widely available variables in the routine care surgical patients.

Roadside opioid testing of drivers using oral fluid: the case of a country with a zero tolerance law, Spain

BackgroundOpioids can impair psychomotor performance, and driving under the influence of opioids is associated with an increased risk of accidents. The goals of this study were i) to determine the prevalence of opioids (heroin, morphine, codeine, methadone and tramadol) in Spanish drivers and ii) to explore the presence of opioids, more specifically whether they are used alone or in combination with other drugs.MethodsThe 2008/9 DRUID database regarding Spain was used, which provided information on 3302 drivers. All drivers included in the study provided a saliva sample and mass-chromatographic analyses were carried out in all cases. To determine the prevalence, the sample was weighted according to traffic intensity. In the case of opioid use combinations, the sample was not weighted. The detection limit for each substance was considered a positive result.ResultsThe prevalence of opioids in Spanish drivers was 1.8% (95% CI, 1.4–2.3). Polydrug detection was common (56.2%): of these, in two out of three cases, two opioids were detected and cocaine was also detected in 86% of the cases. The concentration (median [Q1-Q3] ng/ml) of the substances was low: methadone 1.71 [0.10–15.30], codeine 40.55 [2.10–120.77], 6-acetylmorphine 5.71 [1.53–84.05], and morphine 37.40 [2.84–200.00]. Morphine was always detected with 6-acetylmorphine (heroin use).ConclusionsDriving under the influence of opioids is relatively infrequent, but polydrug use is common. Our study shows that 6 out of 10 drivers with methadone in their OF (likely in methadone maintenance programs) are using other substances. This should be taken into account by health professionals in order to properly inform patients about the added risks of mixing substances when driving.

The relationship between observed signs of impairment and THC concentration in oral fluid

BACKGROUND Studies have shown that cannabis intake increases the risk of traffic accidents. Controlled experiments support these findings and have shown a positive dose-effect relationship. METHODS In this retrospective cross-sectional study of data from a roadside survey, we investigated whether a police officers judgment regarding signs of impairment is related to the concentration of delta-9-tetrahydrocannabinol (THC) in the oral fluid (OF). We investigated 2,632 cases from a representative sample of 3,302 Spanish drivers: 253 drivers positive for THC only, 32 positive for THC and ethanol, 201 with only ethanol detected in their breath, and 2,146 drivers who tested negative for ethanol in breath and drugs in OF. Recorded data comprised breath alcohol concentrations, THC concentrations in the OF, and the 31 observed signs of impairment. Subject groups were compared using the chi-square test, and logistic regression was used to examine the risk of being categorized as exhibiting signs of impairment. RESULTS A relationship was found between the OF THC concentration and some observed signs of impairment. Eye signs were noticeable from a THC concentration >3.0 ng/ml in OF, and >25 ng/ml was related to behavior, facial expression, and speech signs. Alcohol and THC contribute to impairment independently and, when taken simultaneously, the effects are comparable to the sum of the effects when consumed separately. CONCLUSIONS The observation of signs of impairment due to cannabis occurs in an OF concentration-related manner but, as a clinical test, OF has low sensitivity and specificity in a random roadside survey.

Analysis of heavy metals in ecstasy tablets by electrochemical methods

Trace amounts of heavy metals have been analysed by electrochemical techniques in ecstasy tablets obtained from different police seizures in Spain. Lead, cadmium, copper and zinc were determined by differential-pulse anodic stripping voltammetry at a hanging mercury drop electrode, whereas nickel and cobalt were determined by adsorptive differential-pulse cathodic stripping voltammetry from their dimethylglyoxime complexes, M(DMG)2. The performance of the procedure was compared with electrothermal atomic absorption spectrometry. The procedure was applied to the determination of these elements in nine ecstasy samples, finding that Zn is the element present in the highest concentration, ranging from 0.3 to 200 mg kg−1, Ni, Cu appear below 15 mg kg−1 and Pb below 8 mg kg−1, while Cd and Co levels were always lower than 0.51 mg kg−1.

Carpal Tunnel Syndrome Associated with Oral Bisphosphonates. A Population-Based Cohort Study.

Background Bisphosphonates are widely used to prevent osteoporotic fractures. Some severe musculoskeletal reactions have been described with this medication; among them, some cases of carpal tunnel syndrome. Thus, the aim of this study was to explore whether bisphosphonates may be associated with this syndrome. Methods A cohort study was conducted to compare exposed to unexposed women; the exposed group was that composed of women having received at least one prescription of an oral bisphosphonate. For the purpose, we used information from The Health Improvement Network (THIN) database. The outcome of interest was defined as those women diagnosed with carpal tunnel syndrome. A survival analysis was performed; the Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals, and to adjust for identified confounding variables. Results Out of a sample of 59,475 women older than 51 years, 19,825 were treated with bisphosphonates during the period studied. No differences in age distribution or mean follow-up time were observed between the two groups in comparison. Overall, there were 572 women diagnosed with carpal tunnel syndrome, 242 (1.2%) in the group exposed to bisphosphonates, and 330 (0.8%) in the unexposed. An adjusted hazard ratio of developing carpal tunnel syndrome of 1.38 (95%CI, 1.15–1.64) was found for women exposed to bisphosphonates; no significant changes in the hazard ratios were found when considering different levels of bisphosphonate exposure. Conclusions An increased risk of carpal tunnel syndrome is associated with the use of bisphosphonates in postmenopausal women.