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A Domingo-Salvany

Publications and source records attributed to A Domingo-Salvany.

At least 19 recordsLinked to original sources
PubMed2005

Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain.

AIMS: To assess the relationship between methadone treatment (MT) and overdose and HIV/AIDS mortality among heroin users resident in Barcelona city. DESIGN: All patients who started treatment in any treatment centre between 1992 and 1997 were included in a cohort the first time they were admitted for heroin addiction treatment. Follow-up controls were carried out every 9 months, on average, until 31 December 1999. Variables, both constant and varying over time, were fitted into Cox regression models. FINDINGS: The study recruited 5049 patients, which provided 23,048.2 person-years. Fifty per cent were in MT during the study period; of the total cohort 1005 patients died: 38.4% due to AIDS, 34.7% to overdose and 27% to other causes. Overall mortality decreased from 5.9 deaths per 100 person-years in 1992 to 1.6 in 1999. Globally, life expectancy at birth was 39 years, 38 years lower than that of the general population. The main factor for overdose mortality was not being in MT at the time of death [relative ratio (RR) = 7.1]; other factors were being a current injector at baseline and being HIV positive. For AIDS mortality, the main factor was the calendar year (RR for 1996 versus 1999 = 4.6), the next major factor was more than 10 years of heroin consumption, followed by not being in MT, being unemployed, then having a prison record. CONCLUSIONS: The observed mortality decline could be linked to the effectiveness of low-threshold MT. The life expectancy of heroin users increased by 21 years during the study period.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Prevalence of problematic cocaine consumption in a city of southern Europe, using capture-recapture with a single list.

This study aims to determine the magnitude and characteristics of problematic cocaine consumption in the city of Barcelona, Spain. Capture-recapture with a single source was used to estimate prevalence. Log-linear regression models with interaction terms were fitted to the total sample and to subgroups according to other drugs consumed. Emergency room indicator data were obtained from the Barcelona Drug Information System. Drug-related emergencies of Barcelona residents for 1999 were analyzed. During 1999, a total of 4,035 drug-related emergencies were seen in Barcelona hospitals. Of these, 1,656 (41%) involved cocaine consumption; 41% of these patients had consumed cocaine with an opiate; 29% used cocaine with other substances; and 30% used cocaine alone. It was estimated that there was a total of 25,988 problematic cocaine users (95% confidence interval 11,782-58,064), yielding a rate of 31.27 per 1,000 inhabitants aged 15 to 54 years (95% confidence interval 14.2-69.9). The number of cocaine-related emergencies was high enough to allow capture-recapture to be applied, thus obtaining an estimate of the prevalence of problematic cocaine consumption, and high enough to characterize users according to different profiles. The use of capture-recapture with a single source can be interesting for problems related to the urban context.

Adult↗
PubMed2004

Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project. METHOD: ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 2001 to August 2003 using Computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained. RESULTS: Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed. CONCLUSION: The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.

Adolescent↗
PubMed2004

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. CONCLUSION: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Adolescent↗
PubMed2004

12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. RESULTS: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. CONCLUSION: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

Adolescent↗
PubMed2004

Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: This manuscript examines the impact of mental health state and specific mental and physical disorders on work role disability and quality of life in six European countries. METHOD: The ESEMeD study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an in-home computer-assisted interview. Common mental disorders, work loss days (WLD) in the past month and quality of life (QoL) were assessed, using the WMH-2000 version of the CIDI, the WHODAS-II, and the mental and physical component scores (MCS, PCS) of the 12-item short form, respectively. The presence of five chronic physical disorders: arthritis, heart disease, lung disease, diabetes and neurological disease was also assessed. Multivariate regression techniques were used to identify the independent association of mental and physical disorders while controlling for gender, age and country. RESULTS: In each country, WLD and loss of QoL increased with the number of disorders. Most mental disorders had approximately 1.0 SD-unit lower mean MCS and lost three to four times more work days, compared with people without any 12-month mental disorder. The 10 disorders with the highest independent impact on WLD were: neurological disease, panic disorder, PTSD, major depressive episode, dysthymia, specific phobia, social phobia, arthritis, agoraphobia and heart disease. The impact of mental vs. physical disorders on QoL was specific, with mental disorders impacting more on MCS and physical disorders more on PCS. Compared to physical disorders, mental disorders had generally stronger 'cross-domain' effects. CONCLUSION: The results suggest that mental disorders are important determinants of work role disability and quality of life, often outnumbering the impact of common chronic physical disorders.

Adult↗
PubMed2004

Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project. METHOD: The study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an computer-assisted interview done at home. The 21 425 participants were asked to report how frequently they consulted formal health services due to their emotions or mental health, the type of professional they consulted and the treatment they received as a result of their consultation in the previous year. RESULTS: An average of 6.4% of the total sample had consulted formal health services in the previous 12 months. Of the participants with a 12-month mental disorder, 25.7% had consulted a formal health service during that period. This proportion was higher for individuals with a mood disorder (36.5%, 95% CI 32.5-40.5) than for those with anxiety disorders (26.1%, 95% CI 23.1-29.1). Among individuals with a 12-month mental disorder who had contacted the health services 12 months previously, approximately two-thirds had contacted a mental health professional. Among those with a 12-month mental disorder consulting formal health services, 21.2% received no treatment. CONCLUSION: The ESEMeD results suggest that the use of health services is limited among individuals with mental disorders in the European countries studied. The factors associated with this limited access and their implications deserve further research.

Adult↗
PubMed2004

Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of 12-month mental disorders. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium, France, Germany, Italy, the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use. RESULTS: Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression, only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%). CONCLUSION: These data question the appropriateness of current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics.

Adolescent↗
PubMed2001

Psychosocial considerations for the prevention of HIV infection in injecting drug users.

In this article, the authors discuss a study that investigated the meaning that injecting drug users attribute to risk behaviors linked to HIV transmission, especially through the use of nonsterile syringes or the failure to use condoms. To do this, social discourses with respect to the prevention of HIV infection are evaluated. The discussion focuses on how these discourses affect the daily practices of heroin users, practices that in turn influence discourses. Ethnography was used to observe 78 heroin users and 35 people following a methadone treatment program. Observation was carried out in a central district of Barcelona, Spain, with a low socioeconomic level. The results are a useful starting point for generating strategies aimed at preventing HIV transmission among this population on personal, community, and sociostructural levels.

Adolescent↗
PubMed1999

Methadone treatment in Spain, 1994.

The objective of this study was to describe the methadone treatment (MT) network in Spain, and to evaluate compliance with criteria known to influence the spread of human immunodeficiency virus (HIV). During the last 3 months of 1994, a mailed questionnaire was sent to the coordinators of all methadone treatment centers in Spain. A total of 224 centers completed the questionnaire (90% response rate). The total number of patients receiving MT in the studied centers was 13,402. Their mean age was 29 years, 79% were male, and approximately 60% were HIV positive. The rate of patients in MT varied by Region (mean: 6.7 patients in MT per 10,000 inhabitants). Although the global mean of reported daily dose of methadone was 60 mg, in 44% of the centers it was lower than that. Despite the high number of centers involved with MT in Spain, the coverage by regions is unequal. Studied centers revealed only a moderate adherence to procedures considered to be effective in HIV prevention. Given the magnitude of HIV infection in Spain, there is a clear need for improvement.

Adolescent↗
PubMed1999

Differences in mortality between patients attending the emergency room services for asthma and chronic obstructive pulmonary disease.

Asthma has a more favourable prognosis than chronic obstructive pulmonary disease (COPD), based on studies including few asthmatics and few women with COPD. We assessed differences in mortality between people attending the emergency room for asthma and for COPD in a population-based cohort. We recruited all the men and women, who were residents of Barcelona (Spain) over 14 years of age, who attended emergency room services for an obstructive lung disease during the period 1985-1989. Vital status was followed up to the end of 1995. A total of 15,517 individuals (including 4555 asthmatics and 2194 females with COPD) were studied. Mortality was ascertained using a record linkage with the regional Mortality Registry. Overall, 43.6% people died during the follow-up period. Mortality was higher among individuals with COPD than with asthma, in males and females, for all causes of death, as well as for cancer, cardiovascular and respiratory causes. After adjusting for age, the relative risk (RR) of dying of a male attending for COPD and discharged home was 1.50 (1.29-1.74) in comparison with a male attending for asthma, and 3.06 (2.66-3.51) for a male attending for COPD and admitted into the hospital. Similar figures were found for females. The increased risk for patients with COPD was significantly higher than for asthma in all age groups. Both males and females with asthma have a more favourable prognosis than patients with COPD, for all age groups.

Adolescent↗
PubMed1999

A small area analysis estimating the prevalence of addiction to opioids in Barcelona, 1993.

STUDY OBJECTIVE: To determine the distribution of opioid use prevalence in small areas and its relation with socioeconomic indicators. DESIGN: Capture-recapture was applied using data from the Barcelona Drug Information System for 1993 (treatment demands, hospital emergency room visits, deaths from heroin acute adverse reaction and pre-trial prison admissions). To avoid dependence between sources, a log-linear regression model with interactions was fitted. For small neighbourhoods, where capture-recapture estimates were not obtainable, the Heroin Problem Index (HPI) was used to predict prevalence rates from a regression model. The correlation between estimated opioid use prevalence by neighbourhoods and their socioeconomic level was computed. MAIN RESULTS: The city's estimated prevalence was 12.9 opioid addicts per 1000 inhabitants aged 15 to 44 years (95% CI: 10.1, 17.2), which represents 9176 persons. The highest rate was found in the inner city neighbourhood. Comparing rates obtained for each neighbourhood with their unemployment rates, a high correlation coefficient was obtained (r = 0.80, p < 0.001). CONCLUSION: The main contribution of this study is that of combining capture-recapture with the HPI to produce small area prevalence estimates, which would not have been possible using only one method. Areas with higher socioeconomic status showed proportionally low addiction prevalences, but in depressed areas, prevalences varied widely.

Adolescent↗
PubMed1998

Analytical considerations in the use of capture-recapture to estimate prevalence: case studies of the estimation of opiate use in the metropolitan area of Barcelona, Spain.

Capture-recapture, an indirect method widely used to estimate undetected populations, has been criticized because it causes problems due to a lack of compliance with several important assumptions and model selection strategies. This paper expands on the problems encountered when applying this methodology to drug abuse estimations, specifically the prevalence of opiate use in the metropolitan area of Barcelona, Spain, in 1993. Three samples of opiate users (from hospital emergency rooms, treatment centers, and prisons) were available in the area studied; an additional sample (mortality data) was analyzed for the city of Barcelona. Log-linear models that provided a good fit were considered, to which further model selection strategies were applied. A total of 3,207 unique individuals aged 15-44 years were identified in the three samples from the greater Barcelona area; the mortality sample from the city of Barcelona contained an additional 83 individuals. Heterogeneity was observed in different age, sex, and residence area subgroups. Population estimates differed widely according to the log-linear model chosen. Minimum Akaike's information criterion model and saturated model estimates were used to produce population prevalence rates. The main problems the authors encountered in this study were related to population definition, source heterogeneity, and assessment of an adequate model, a problem associated with sample size.

Adolescent↗
PubMed1997

Use of the Nottingham Health Profile for measuring health status of patients in methadone maintenance treatment.

This study was conducted to assess changes in health-related quality of life over a 3-year follow-up period in a cohort of 135 opioid dependent patients using the Nottingham Health Profile (NHP) questionnaires. Data obtained at 12 months from 80 patients retained in the programme are presented. In summary, opioid addicts in a methadone maintenance programme for a 12-month period experienced an early and substantial improvement in health-related quality of life. The use of the NHP questionnaire to monitor changes in the subjective health of opioid-dependent patients over time provides new insights in the assessment of treatment effectiveness of methadone maintenance programmes.

Adult↗
PubMed1996

[Information on opiate and cocaine consumption in the emergency room clinical records: validity and reliability].

BACKGROUND: Data on drug consumption obtained from emergency room clinical records have been used for various epidemiological purposes. However the validity and reliability of these data remain unknown. This paper assesses the reliability and validity of an Emergency Room Toxicological Register (HMR) which has collected information on drug misuse from emergency room clinical records since 1979, and examines the implications for epidemiological applications. SUBJECTS AND METHODS: An Emergency Room Survey (ERS) was carried out in a Barcelona Hospital including opiate or cocaine users identified by the physician and a systematic sample of other patients age 15 to 49 years old. Data on clinical records of interviewed patients were also reviewed. Episodes from identified drug users (686) and HMR (676) for the same study period were linked and validity and reliability were analyzed. RESULTS: Sensitivity ranged between 63 and 86%, and specificity was 98%, Kappa index higher than 0.72 and intraclass correlation coefficient was 0.99. CONCLUSIONS: Information about drug users included in emergency room clinical records proved to be valid as an information system for drug use surveillance. However data about patterns of less heavy users, as cocaine use, are underreported.

Adult↗
PubMed1996

Mortality trends in a cohort of opiate addicts, Catalonia, Spain.

BACKGROUND: Opiate addiction affects young adults whose life expectancy is reduced as a consequence of their habit. In the midst of the AIDS epidemic, the present study objective was to analyse recent overall and cause-specific mortality trends among opiate addicts in Catalonia (Spain). METHODS: Mortality was assessed retrospectively in an opiate addict cohort assembled from admissions to hospital emergency wards and drug treatment centres during the period 1985-1991. The cohort included 12 711 opiate addicts (12 045 men and 3666 women) aged 15-44 years. Overall and cause-specific mortality trends were analysed using age as the time scale and Cox regression with staggered entry determined by the age at entry in the study. Annual trends were adjusted by sex and source of entry, and were stratified by length of opiate use. RESULTS: Mortality rates increased throughout the entire period from 13.8 to 34.8 deaths per 1000 person-years, with a statistically significant increase in 1987-1988 and 1988-1989. In a model including age, gender, source of entry and length of drug use, risk increased significantly in men and for longer length of use, but not with age and for source of entry into the study cohort. The causes of death associated with high mortality rates were AIDS and the causes directly related to addiction. CONCLUSIONS: A threefold increase in mortality rates was observed during the period, mainly accounted for by AIDS and direct addiction-related causes. Length of opiate use was an important determinant of mortality.

Adolescent↗