Montse Bartroli

Impacto del trastorno por consumo de alcohol en la mortalidad: ¿hay diferencias según la edad y el sexo?

OBJECTIVES To estimate excess mortality in patients with an alcohol use disorder and to calculate the population-based impact attributable to this disorder, with emphasis on differences according to gender and age. METHODS We carried out a longitudinal study of a dynamic retrospective cohort in which 7,109 patients (76.5% men) aged 18-64 years who started medical day treatment between 1997 and 2006 were recruited. Deaths were monitored until the end of 2006 using a national mortality register. Standardized mortality ratios (SMR) by age and gender and population attributable risks (PAR) by age group were estimated. RESULTS There were 557 deaths (83% were men). The total excess mortality was 8 times higher than in the general population aged 18-64 years, especially in the group aged 25-34 years old (SMR: 11.2 [95% CI: 7.8-16.0] in men and 24 [IC95%: 11.5-50.4] in women). Significant differences by gender were found in all the variables analyzed. In Barcelona, alcohol use disorder was estimated to cause 73 deaths per year, representing 3.3% of the total annual deaths in this city in persons aged 18-64 years. This percentage was substantially higher in the groups aged 25-34 years (PAR: 19.4% [95% CI: 19.2-19.6]) and 18-24 years (PAR: 11.1% [95% CI: 10.7-11.4]). CONCLUSIONS Women and young men with an alcohol use disorder have a higher risk of early mortality. Early detection of problematic alcohol consumption and selective and well-indicated prevention programs should be improved.

Gender differences in hazardous drinking among middle-aged in Europe: the role of social context and women's empowerment.

BACKGROUND The aim of this study was to estimate the magnitude of gender differences in hazardous drinking among middle-aged people and to analyse whether these differences are associated with contextual factors, such as public policies or socioeconomic factors. METHODS Cross-sectional design. The study population included 50- to 64-year-old residents of 16 European countries who participated in the Survey of Health, Ageing and Retirement in Europe project conducted in 2010-12 (n = 26 017). We estimated gender differences in hazardous drinking in each country. To determine whether different social context or womens empowerment variables were associated with gender differences in hazardous drinking, we fitted multilevel Poisson regression models adjusted for various individual and country-level variables, which yielded prevalence ratios and their 95% confidence intervals (95% CI). RESULTS Prevalence of hazardous drinking was significantly higher in men than women [30.2% (95% CI: 29.1-31.4%) and 18.6% (95% CI: 17.7-19.4%), respectively] in most countries, although the extent of these differences varied between countries. Among individuals aged 50-64 years in Europe, risk of becoming a hazardous drinker was 1.69 times higher (95% CI: 1.45-1.97) in men, after controlling for individual and country-level variables. We also found that lower values of the gender empowerment measure and higher unemployment rates were associated with higher gender differences in hazardous drinking. CONCLUSION Countries with the greatest gender differences in hazardous drinking were those with the most restrictions on womens behaviour, and the greatest gender inequalities in daily life. Lower gender differences in hazardous drinking seem to be related to higher consumption among women.

Hazardous drinking in people aged 50 years or older: a cross-sectional picture of Europe, 2011-2013

To assess gender and age differences in hazardous drinking and to analyse and compare the factors associated with it in men versus women, and in 50 to 64‐year‐old versus ≥65‐year‐old people in Europe.

Prevención indicada del consumo problemático de drogas en adolescentes de Barcelona

Fundamentos: El Servicio de Orientacion sobre Drogas (SOD) de Barcelona ofrece un programa de Informacion y Orientacion (PIO) para adolescentes y un Programa de Medidas Alternativas (PMA) a menores sancionados por consumo/tenencia de drogas en la via publica. El objetivo de este trabajo es describirlos y comparar los perfiles de los usuarios en cada uno de ellos. Metodos: Estudio transversal descriptivo de 1.010 personas atendidas en ambos programas durante el periodo 2008-2010, con cribado de patologia psiquiatrica y adiccion e intervencion breve extendida en consumidores sin indicios de patologia. Se compararon los perfiles de los usuarios y se calcularon las tasas de uso del PMA por edad. Resultados: El cannabis motivo el 89,9% de entradas en el Servicio. Entre los usuarios del PIO el consumo de alto riesgo de cannabis fue del 13,1% y el consumo de riesgo de alcohol del 11,3%. Entre los usuarios del PMA los consumos fueron del 8,9 y 4% respectivamente. El 38% de los usuarios del PIO y el 6% de los del PMA se derivaron a atencion especializada por presentar criterios de abuso o dependencia a alguna sustancia psicoactiva u otro trastorno psiquiatrico. Conclusiones: Los adolescentes atendidos en PMA hacen un consumo de cannabis (y en muchos casos de alcohol) de riesgo bajo o moderado comparados con los del PIO. Ademas del valor de la intervencion preventiva indicada, los programas facilitan la deteccion precoz de consumos problematicos o trastornos mentales incipientes y su derivacion.

Cancer and Alcohol Consumption in People Aged 50 Years or More in Europe

Aims To estimate the prevalence of hazardous drinking in individuals aged 50 and older who had or had had cancer in 17 European countries and Israel and to analyze the factors associated with their consumption. Methods Cross-sectional study based on data from 2011 to 2013 SHARE surveys. A total of 69,509 individuals aged 50 or more from 17 European countries and Israel participated in the study. Prevalence of hazardous drinking in people with cancer was estimated (adapting the SHARE questionnaire to the AUDIT-C). To ascertain whether type of cancer or time since diagnosis were associated with hazardous drinking, Poisson regression models with robust variance were estimated, obtaining prevalence ratios (PR). Results Overall, 5.4% of participants reported having been diagnosed with cancer. Prevalence of hazardous drinking in people with cancer was 18% in women and 23% in men. After adjusting for various socioeconomic and health variables, no significant differences were observed between hazardous drinking and type of cancer [PR = 0.99 (95% confidence interval (95% CI) = 0.83-1.17) in people with alcohol-related cancers compared to non-alcohol related cancers] and time since diagnosis [PR = 1.01 (95% CI = 0.82-1.25) in people with a cancer diagnosed >5 years ago compared to those diagnosed ≤5 years ago]. Significant differences were found between hazardous drinking and smoking status and self-perceived health. Conclusion In total, 20% of people diagnosed with cancer were hazardous drinkers, despite the known relationship between alcohol use and a worse prognosis of the disease and an increased likelihood of recurrence. Short Summary Overall, 20% of people diagnosed with cancer were hazardous drinkers. There were no significant differences in the prevalence of hazardous drinking depending on the type of cancer (alcohol-related versus non-alcohol related cancers). Highest prevalence of hazardous drinking in people with cancer is found in smokers and people with good self-perceived health.

A population based perspective of twenty years of specialized ambulatory treatment for alcohol use disorders in publicly financed clinics. Barcelona 1996–2015

OBJECTIVE To provide information on persons treated for alcohol use disorders (AUD) over 20 years in a large city in a Southern European country and its trends, adding knowledge on the frequency of treatment from a population perspective. METHODS This is a study of the number of annual admissions to ambulatory addiction treatment centers funded by the public sector in Barcelona (Catalonia, Spain) for the years 1996-2015. Descriptive analyses of AUD admissions were conducted, comparing changes in the number of patients entering treatment by different independent variables across periods. For city residents, sex and age-specific population annual treatment initiation rates were estimated. RESULTS The number of ambulatory admissions to AUD treatment increased over the study period. There were about 2100 treatment admissions per year in 2011-2015, of which one fourth were women. About half of these patients had never been treated before for any substance use disorder. Annual rates of treatment initiation among city residents were 208 and 68 per 100,000 people aged 15 and older for men and women respectively, almost the double among 45-54 years old citizens. Rates of total AUD treatment admission increased moderately, but declined among younger adult men. CONCLUSIONS These figures provide a basic population-based estimation for formal AUD treatment use in a Southern European urban setting with services available free of charge. The development of ambulatory publicly funded addiction centers may have improved access to treatment for people with AUD. age-related changes in treatment admissions may either be related to trends in the population pattern of drinking or to changes in the city demographics.

The Role of Individual and Social Mediators in the Association Between Drug Consumption and Mental Health Among Adolescents in Barcelona

This study aims to analyze whether there is an association between poor mental health and high-risk cannabis and alcohol use in adolescents attending secondary schools in the city of Barcelona, and to analyze which individual and/or contextual variables mediate this association. Prevalence of risk of poor mental health, binge drinking, high-risk cannabis use, and comorbidity were stratified by sex. To analyze the association between poor mental health and high-risk cannabis and alcohol use, multilevel linear regression models were constructed, obtaining regression coefficients and confidence intervals at 95%. Poor mental health among adolescents is associated with high-risk cannabis use, and association remains after adjusting for individual and contextual variables. Binge drinking shows a weak association with poor mental health that is only significant in girls. This study emphasizes the relevance of focusing on the context in which students live, specifically the school environment, in order to prevent high-risk drug use and poor mental health.

Patterns of physical activity and associated factors among teenagers from Barcelona (Spain) in 2012

OBJECTIVE To estimate the prevalence of moderate and vigorous physical activity (MVPA), as defined by the World Health Organisation (WHO), and associated factors among teenagers from Barcelona in 2012. METHODS Cross-sectional survey to assess risk factors in a representative sample of secondary school students (aged 13-16 years, International Standard Classification of Education [ISCED] 2, n=2,162; and 17-18 years, ISCED 3, n=1016) in Barcelona. We estimated MVPA prevalence overall, and for each independent variable and each gender. Poisson regression models with robust variance were fit to examine the factors associated with high-level MVPA, and obtained prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS Only 13% of ISCED 2 and 10% of ISCED 3 students met the WHO physical activity recommendations. This percentage was lower among girls at both academic levels. MVPA was lower among ISCED 3 compared to ISCED 2 students, and among students with a lower socioeconomic status. Physical activity was associated with positive self-perception of the health status (e.g., positive self-perception of health status among ISCED 2 compared to ISCED 3 students: PR=1.31 [95%CI: 1.22-1.41] and 1.61 [95%CI: 1.44-1.81] for boys and girls, respectively]. CONCLUSIONS The percentage of teenagers who met WHO MVPA recommendations was low. Strategies are needed to increase MVPA levels, particularly in older girls, and students from low socioeconomic backgrounds.