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      Consumo problemático de alcohol en Bucaramanga, Colombia: diseño y validación de una prueba Translated title: Test for assessing levels of alcohol consumption in Bucaramanga, Colombia: design and validation.

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          Abstract

          Introducción. Algunas consecuencias del consumo de alcohol son un problema de salud pública. El desarrollo de instrumentos para clasificar correctamente a los consumidores es la primera etapa en la investigación epidemiológica. Objetivo. Evaluar en Bucaramanga, Colombia, la validez interna y la reproducibilidad de una nueva prueba denominada consumo problemático de alcohol, durante el periodo 2005-2006. Materiales y métodos. Estudio de consistencia interna y reproducibilidad de tecnología diagnóstica. Seiscientos un sujetos entre 18 y 60 años respondieron en dos ocasiones la prueba consumo problemático de alcohol y una encuesta sobre variables biológicas, sociodemográficas y de características de la dieta. La consistencia interna de la prueba fue evaluada mediante el cálculo del coeficiente alfa de Cronbach, y la reproducibilidad con los coeficientes de Spearman y kappa. Para evaluar la asociación entre el consumo problemático, las anteriores variables y el riesgo de alcoholismo, se calcularon razones de prevalencia utilizando regresión binomial. Resultados. La prevalencia de consumo problemático para la población estudiada fue de 46,9%, intervalo de confianza del 95% de 42,9 a 50,9. Los hombres presentaron consumo problemático 1,63 veces más que las mujeres (p<0,001). El coeficiente alfa de Cronbach fue moderado para todas las preguntas de la prueba de consumo problemático de alcohol (mínimo=0,41, máximo=0,61). En la primera aplicación de la prueba se obtuvo un alfa de Cronbach de 0,63; en la segunda, de 0,49 (p=0,106). El coeficiente de correlación de Spearman fue de 0,87 (0,84 a 0,90) para la población, de 0,86 (0,82 a 0,90) para hombres y 0,86 (0,82 a 0,90) para mujeres. La reproducibilidad según el coeficiente kappa es buena, entre 0,70 y 0,89. El sexo, el gusto manifestado por las bebidas con contenido alcohólico, el riesgo de alcoholismo según la prueba Cut Down on Drinking, Annoyed by Criticism, Guilty Feeling, and Eye Opener (CAGE) y la cantidad de alcohol consumida en gramos, estuvieron asociadas al consumo problemático. Conclusión. La prueba de consumo problemático de alcohol es útil en la investigación epidemiológica aplicada.

          Translated abstract

          Introduction. Excessive alcohol intake can pose a serious problem in public health. The development of instruments to classify the consumers correctly is the first stage in the epidemiologic investigation. Objective. The internal validity and the reliability was evaluated for a test of problematic alcohol consumption (CP-alcohol) in Bucaramanga, Colombia. 2005-2006. This work provides a measure that is internally consistent and improved reliability of diagnostic technology. Materials and methods. Six hundred one subjects between 18 and 60 years participated in the test for CP-alcohol on two occasions. At the same time, a survey on biological variables (VB), socioeconomic (VSE) and dietary (D) was administered. The internal consistency of CP-alcohol was evaluated by calculating the coefficient alpha of Cronbach, and the reliability with coefficients of Spearman and Cohen’s Kappa. To evaluate the associations among problematic consumption, VB, VSE, D and the risk of alcoholism, the prevalence ratios were calculated using binomial regression. Results. The frequency of problematic alcohol consumption was of 46.9 (CI 42.9-50.9). Men presented an increased frequency of problematic alcohol use 1.6 times that of women (p<0.001). The coefficient alpha of Cronbach was moderate for all the questions of the test (minimum 0.41, maximum 0.61). In the first application of CP-alcohol, Cronbach’s alpha was 0.63, and, in the second, 0.49. Spearman’s correlation coefficient was of 0.87 (CI 0.84-0.90) for the population-for men 0.86 (CI 0.82-0.90) and for women 0.86 (CI 0.82-0.90). The Kappas obtained were very good, 0.70 to 0.89. Sex, pleasure provided by alcoholic drinks , risk of alcoholism according to Cut Down on Drinking, Annoyed by Criticism, Guilty Feeling, and Eye Opener (CAGE) and the quantity of consumed alcohol were all correlated with problematic consumption. Conclusion. CP-alcohol is a useful test for investigating the epidemiology of health problems associated with alcohol use.

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          Severe falciparum malaria.

          Falciparum malaria affect all ages with multiple-systemic complications which varies in different age group. We studied 242 children with complicated Falciparum malaria with a median age of 6.5 years to look for occurrence of different complications in younger and older age groups and overall mortality picture. Unarousable coma (40.5%), severe anemia (26.03%), repeated seizures (46.2%) and hepatopathy (32.2%) were commonest complications. Under five children had higher risk of development of cerebral malaria (P<0.01), severe anemia (P<0.05) and seizures (P<0.001); whereas above five children had higher risk of acute renal failure (P<0.05) and malarial hepatopathy (P<0.02). Over all mortality was 9.9%, cerebral malaria being the commonest cause (6.6%). Multi-system involvement was seen in 58.4% cases of death. Children having pulmonary edema, shock and cerebral malaria had high case fatality rate.
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            Context bias. A problem in diagnostic radiology.

            To determine whether radiologists' interpretations of images are biased by their context and by prevalence of disease in other recently observed cases. A test set of 24 right pulmonary arteriograms with a 33% prevalence of pulmonary emboli (PE) was assembled and embedded in 2 larger groups of films. Group A contained 16 additional arteriograms, all showing PE involving the right lung, so that total prevalence was 60%. Group B contained 16 additional arteriograms without PE so that total prevalence was 20%. Six radiologists were randomly assigned to see either group first and then "cross over" to review the other group after a hiatus of at least 8 weeks. The direction of changes in a 5-point rating scale for the 2 readings of each film in the test set was compared with the sign test; mean sensitivity, specificity, and areas under receiver operating characteristic (ROC) curves were compared with the paired t test. In the context of group A's higher disease prevalence, radiologists shifted more of their diagnoses toward higher suspicion than expected by chance (P=.03, sign test). In group A, mean sensitivity for diagnosing PE was significantly higher (75% vs 60%; P=.04), and area under the ROC curve was significantly larger (0.88 vs 0.82; P=.02). Radiologists' diagnoses are significantly influenced by the context of interpretation, even when spectrum and verification bias are avoided. This "context bias" effect is unique to the evaluation of subjectively interpreted tests, and illustrates the difficulty of obtaining unbiased estimates of diagnostic accuracy for both new and existing technologies.
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              Alcohol: Prevalencia de consumo y dependencia en Colombia

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                bio
                Biomédica
                Biomédica
                Instituto Nacional de Salud (Bogotá )
                0120-4157
                March 2008
                : 28
                : 1
                : 25-37
                Affiliations
                [1 ] Universidad Industrial de Santander Colombia
                [2 ] Universidad Industrial de Santander Colombia
                Article
                S0120-41572008000100005
                6952b718-f308-4c7c-9329-6d9b8a9f01ce

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0120-4157&lng=en
                Categories
                TROPICAL MEDICINE

                Infectious disease & Microbiology
                Alcoholism,diagnostic techniques and procedures,reproducibility of results,validity of tests,Colombia,alcoholismo,técnicas y procedimientos diagnósticos,,reproducibilidad de resultados,,validez de las pruebas

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