Emergency contraception and risk habits in a university population

OBJECTIVE

The aim of our study was to determine the self-reported prevalence of use of emergency contraception (EC), identify factors associated with EC use, and measure the prevalence in university students of pregnancy and abortion among users and non-users of EC.

METHODS

A cross-sectional descriptive study of university students using a self-administered questionnaire was carried out in 2016. The main dependent variable was EC use at any time. Independent variables included sociodemographic factors and factors related to harmful habits and sexual behaviour.

RESULTS

The study sample consisted of 1309 students (median age 20 years). Forty per cent of participants reported using EC; condom failure was given as the main reason. Variables associated with EC use in both men and women were illegal drug consumption and having had more than 10 sexual partners. In women, other factors associated with EC use were age at first coitus and non-centrist political views. The prevalence of pregnancy was 6.5% and the prevalence of voluntary abortion was 2.9%. This prevalence was similar for men and women and for EC users and non-users.

CONCLUSION

EC use in university students was more likely in those who experienced contraceptive failure or used no contraception. There were differences between men and women. Those at higher risk of unplanned pregnancy were more likely to report EC use, which may explain why there was no difference in the rates of unwanted pregnancies between EC users and non-users.

Models for the propensity score that contemplate the positivity assumption and their application to missing data and causality

Generalized linear models are often assumed to fit propensity scores, which are used to compute inverse probability weighted (IPW) estimators. To derive the asymptotic properties of IPW estimators, the propensity score is supposed to be bounded away from zero. This condition is known in the literature as strict positivity (or positivity assumption), and, in practice, when it does not hold, IPW estimators are very unstable and have a large variability. Although strict positivity is often assumed, it is not upheld when some of the covariates are unbounded. In real data sets, a data-generating process that violates the positivity assumption may lead to wrong inference because of the inaccuracy in the estimations. In this work, we attempt to conciliate between the strict positivity condition and the theory of generalized linear models by incorporating an extra parameter, which results in an explicit lower bound for the propensity score. An additional parameter is added to fulfil the overlap assumption in the causal framework.

[Adult community acquired pneumonia vaccination: 2018 Update of the positioning of the Pneumonia Prevention Expert Group]

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

[Identification of gaps in the clinical patient care of asthma in Spain. Results of the OPTIMA-GEMA survey]

BACKGROUND

Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement.

METHODS

The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II).

RESULTS

In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups.

CONCLUSIONS

The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma.

Multiple robustness in factorized likelihood models

We consider inference under a nonparametric or semiparametric model with likelihood that factorizes as the product of two or more variation-independent factors. We are interested in a finite-dimensional parameter that depends on only one of the likelihood factors and whose estimation requires the auxiliary estimation of one or several nuisance functions. We investigate general structures conducive to the construction of so-called multiply robust estimating functions, whose computation requires postulating several dimension-reducing models but which have mean zero at the true parameter value provided one of these models is correct.

On the behavior of reduced graphene oxide based electrodes coated with dispersed platinum by alternate current methods in the electrochemical degradation of reactive dyes

The electrochemical behavior of different carbon-based electrodes with and without nanoparticles of platinum electrochemically dispersed on their surface has been studied. Among others, reduced graphene oxide based electrodes was used to determine the best conditions for the decolorization/degradation of the reactive dye C.I. Reactive Orange 4 in sulfuric medium. Firstly, the electrochemical behavior was evaluated by cyclic voltammetry. Secondly, different electrolyses were performed using two cell configurations: cell with anodic and cathodic compartments separated (divided configuration) and without any separation (undivided configuration). The best results were obtained when reduced graphene oxide based anodes were used. The degree of decolorization was monitored by spectroscopic methods and high performance liquid chromatography. It was found that all of them followed pseudo-first order kinetics. When reduced graphene oxide-based electrodes coated with dispersed platinum by alternate current methods electrodes were used, the lowest energy consumption and the higher decolorization kinetics rate were obtained. Scanning Electronic Microscopy was used to observe the morphological surface differences.

First Direct-Detection Constraints on eV-Scale Hidden-Photon Dark Matter with DAMIC at SNOLAB

We present direct detection constraints on the absorption of hidden-photon dark matter with particle masses in the range 1.2-30  eV c^{-2} with the DAMIC experiment at SNOLAB. Under the assumption that the local dark matter is entirely constituted of hidden photons, the sensitivity to the kinetic mixing parameter κ is competitive with constraints from solar emission, reaching a minimum value of 2.2×10^{-14} at 17  eV c^{-2}. These results are the most stringent direct detection constraints on hidden-photon dark matter in the galactic halo with masses 3-12  eV c^{-2} and the first demonstration of direct experimental sensitivity to ionization signals <12  eV from dark matter interactions.

Incidence and risk factor prevalence of community-acquired pneumonia in adults in primary care in Spain (NEUMO-ES-RISK project)

Background

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in adults even in developed countries. Several lifestyle factors and comorbidities have been linked to an increased risk, although their prevalence has not been well documented in the primary care setting. The aim of this study is to assess the incidence, risk factor and comorbid conditions distribution of CAP in adults in primary care in Spain.

Methods

Retrospective observational study in adults (>18 years-old) with CAP diagnosed and attended at primary care in Spain between 2009 and 2013, using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP).

Results

Twenty-eight thousand four hundred thirteen patient records were retrieved and analyzed. Mean age (standard deviation): 60.5 (20.3) years, 51.7 % males. Global incidence of CAP in adults was estimated at 4.63 per 1000 persons/year. CAP incidence increased progressively with age, ranging from a 1.98 at 18–20 years of age to 23.74 in patients over 90 years of age. According to sex, global CAP incidence was slightly higher in males (5.04) than females (4.26); CAP incidence from 18 to 65 year-olds up was comparable between males (range: 2.18–5.75) and females (range: 1.47–5.21), whereas from 65 years of age, CAP incidence was noticeable higher in males (range: 7.06–36.93) than in females (range: 5.43–19.62). Average prevalence of risk factors was 71.3 %, which increased with age, doubling the risk in males by the age of 75 (females 20 % vs males 40 %). From 55 years of age, at least one risk factor was identified in 85.7 % of cases: one risk factor (23.8 %), two risk factors (23.4 %), three or more risk factors (38.5 %). Major risk factors were: metabolic disease (27.4 %), cardiovascular disease (17.8 %) and diabetes (15.5 %).

Conclusions

The annual incidence of CAP in primary care adults in Spain is high, comparable between males and females up to 65 years of age, but clearly increasing in males from that age. CAP risk increases with age and doubles in males older than 75 years. The majority of CAP cases in patients over 55 years of age is associated to at least one risk factor. The main risk factors associated were metabolic disease, cardiovascular disease, and diabetes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1974-4) contains supplementary material, which is available to authorized users.