Antimicrobial resistance (AMR) is a global health challenge. Clinical trials are essential for evaluating novel and alternative therapeutic strategies. However, conducting randomized clinical trials (RCTs) in infectious diseases faces regulatory, logistical, and financial barriers, as well as challenges in patient recruitment. Collaborative research networks have demonstrated their effectiveness in overcoming these limitations. This study evaluates the capacity of Spanish medical centers to participate in RCTs on infectious diseases and AMR. A structured feasibility survey was developed to assess infrastructure, research experience, patient recruitment potential, and willingness to collaborate in Spanish hospitals. Responses were collected using the REDCap platform and analyzed using Microsoft Excel, with results expressed as percentages. Of 90 centers contacted, 65 centers from 17 autonomous communities responded. The majority (78.5%) had dedicated infectious disease departments or units, and 36.9% reported over 1000 annual hospital admissions for infectious diseases. Research experience was strongest in antimicrobial-resistant Gram-negative (84.6%) and Gram-positive bacteria (78.5%). Phase II-IV RCTs were the most conducted trials, predominantly funded by private sources. While 75.4% of centers reported available human resources for research, specialized roles such as project managers (18.5%) and monitors (12.3%) were less common. Notably, 90% of centers expressed willingness to participate in a collaborative network for conducting unfunded RCTs. The results highlight Spain's strong research infrastructure and expertise in infectious diseases, providing a solid foundation for establishing a national collaborative clinical trials network. However, variations in specialized research personnel and the low frequency of academic trials indicate areas for improvement.
Background Social support is an important psychosocial resource that can facilitate engaging in healthy behaviors, including oral health behaviors. Nine scales assessing Oral Health Behavior Social Support (OHBSS) for brushing, flossing and seeking dental care were developed and validated in the English and Spanish languages. The full-length scales included 37 required items to assess social support from three sources: family, health providers, and others/friends. The OHBSS-SF scales cover three oral health behaviors, use six items each to assess social support for brushing, flossing and dental care, and retain the nine-scale structure. Response options range from one (never) to four (always), with higher scores reflecting more frequent receipt of social support. This paper describes the item reduction process/outcomes and presents model fit indices and psychometric properties of the 17-item OHBSS-Short Form (OHBSS-SF) scales. Methods A large Mexican-American young adult sample completed an online survey in English or Spanish (N = 502). Participants completed the OHBSS-SF along with several other validated scales assessing general social support, dental fear, and acculturation. The survey also queried oral health behaviors of interest and socio-demographic characteristics. A subset of participants (n = 56) also completed the OHBSS-SF items a second time two to six weeks later to assess test-retest reliability. Model fit indices and psychometric properties for each of the nine OHBSS-SF scales were calculated for the full sample and subgroups stratified by the three study design characteristics of language (English/Spanish), sex (male/female), and marital status (single/married). Results The OHBSS-SF scales correlated very highly with the full-length versions (r = 0.95-0.98), and all OHBSS-SF scales exhibited acceptable model fit indices. The OHBSS-SF demonstrated stability in the full sample and in Spanish, with good to excellent intra-class correlations, supporting test-retest reliability. Patterns of moderate correlations supported convergent validity with validated general social support measures. Patterns of weak correlations suggested divergent validity between OHBSS-SF and other non-social support measures. Conclusions The OHBSS-SF demonstrated acceptable psychometric properties. A few significant differences by subgroup characteristics were identified. The OHBSS-SF scales reduce respondent burden and are a useful tool to ascertain frequency of receipt of oral health behavior social support from family, health providers, and other/friend sources.
Quantitative hepatitis B surface antigen (qHBsAg) is increasingly recognized as a key biomarker for chronic hepatitis B (CHB) management. This study aimed to assess the adoption, practices, and barriers to qHBsAg testing in Spanish clinical microbiology laboratories. A cross-sectional survey was distributed through the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) Viral Hepatitis Study Group (GEHEP). Clinical microbiology laboratory professionals across Spain were invited to complete an anonymous online questionnaire. The survey collected information on qHBsAg implementation, technical practices, barriers, and patient-related data. Descriptive statistics were applied. Of 118 laboratories invited, 91 responded (77.1%); only 37.4% performed qHBsAg. Among non-performing centers, 86% did not refer samples, mainly due to perceived low clinical demand (57.1%), plus lack of equipment/resources. Implementation correlated with hospital size (p=0.041): 0% (<200 beds), 23.3% (200-500), 44.9% (500-1000), 62.5% (≥1000). Among performing labs, 57.6% quantified after a positive qualitative test, 27.3% on request, and 15.2% as initial screening. Proactive reporting was 69.7%, and 81.8% diluted samples above limits. In the last year, 40.7% of results were <100IU/mL and 27.1% >3000IU/mL; over five years (≈14,500 tests), 29.5% >3000IU/mL and 27.3% <100IU/mL, supporting the clinical relevance of these thresholds. qHBsAg testing is not uniformly implemented across Spanish clinical microbiology laboratories and workflows and reporting practices are heterogeneous. Given the descriptive design and potential selection bias, these results should be interpreted as a baseline assessment to inform harmonization efforts and future evaluations linking testing availability to clinical decision-making.
Prospective cohort studies analyzing the effect of plant versus animal protein intake on mortality in relatively young individuals from Mediterranean populations are limited. Moreover, a limited number of studies have performed repeated measurements of protein intake. We evaluated the relationship between plant versus animal protein intake (at baseline and at the ten-year follow-up) and mortality in the "Seguimiento Universidad de Navarra" (SUN) project. The SUN project is a prospective, multi-purpose, dynamic cohort study of Spanish university graduates. Plant and animal protein intake were assessed using a semi-quantitative food frequency questionnaire (FFQ) previously validated in Spain. Participants were divided into quartiles based on their intake of protein. Cox regression models were used, with the first quartile serving as the reference category. A total of 17,989 subjects (10,961 women and 7028 men) were included in the analysis. During 251.363 person-years of follow-up (median follow-up time: 12 years), 460 deaths were identified. The mean age at baseline was 38 years with a standard deviation of 12 years. Participants in the highest quartile of plant protein intake had a 35% lower risk of all-cause mortality compared to those in the lowest quartile after adjusting for potential confounders [hazard ratio (HR): 0.65 (95% CI: 0.45-0.93), p for trend = 0.009]. No significant association was found between animal protein intake and mortality [HR: 0.94 (95% CI: 0.70-1.26); p for trend = 0.555] nor between plant protein intake and cardiovascular or cancer mortality. Plant protein intake was inversely associated with all-cause mortality in a Mediterranean population. Animal protein intake was not associated with total mortality.
The management of children and adolescents with type 1 diabetes (T1D) in special situations requires coordinated action based on up-to-date protocols. This document presents the consensus recommendations of the Diabetes Working Group of the SEEP (Spanish Society of Pediatric Endocrinology) based on the international guidelines of the International Society for Pediatric and Adolescent Diabetes (ISPAD 2022) and the American Diabetes Association (ADA 2026). The document details specific guidelines according to treatment modality with the aim of optimizing glycemic control and preventing and/or managing diabetes decompensation and acute complications.
Genetic testing (GT) is established in ambulatory cardiomyopathy (CM), but its utility after heart transplantation (HTx) recipients remains poorly characterized. This study aimed to evaluate the clinical utility of GT in adult HTx recipients with CM, focusing on etiologic reclassification, family cascade screening, and the genetic architecture of end-stage disease. GenbaseHTx is a nationwide, multicenter retrospective study of adult HTx recipients transplanted for CM across 12 Spanish centers (2010-2023). GT results were centrally adjudicated using American College of Medical Genetics and Genomics criteria. Outcomes included prevalence of pathogenic/likely pathogenic variants, etiologic reclassification after GT, and cascade screening activation. Among 657 HTx recipients, a pathogenic/likely pathogenic variant was identified in 53% (351/657). GT led to etiologic reclassification in 35% (231/657) (42% when performed post-HTx -106/253-). Family screening (performed in 69% of families -224/328-) identified affected relatives in 22% (19/90) of genotype-negative and 42% (49/107) of genotype-positive cases. Notably, a genetic etiology was identified in 36% (15/42) of CM initially attributed to acquired or "second-hit" causes. In dilated cardiomyopathy, the genetic architecture of transplanted patients differed from ambulatory cohorts, with lower TTN variant prevalence and enrichment of arrhythmogenic genes. GT remains clinically actionable after HTx, enabling etiologic reclassification and driving cascade screening. These findings support systematic GT in HTx recipients with CM, including those with prior environmental triggers or second-hit etiologies, and regardless of time from transplantation.
Mental illness is a very common issue in the prison population. This study set out to analyse the prevalence of mental disorders among inmates at Zuera Prison (Zaragoza). A descriptive cross-sectional study was conducted in September 2023, including inmates undergoing active treatment with psychotropic drugs. The sample included 598 prisoners (560 men and 38 women), with a mean age of 39.3 years for men and 41.3 years for women. The results showed that neurotic disorders were the most prevalent in both sexes (47% men, 55.30% women), followed by disorders due to psychoactive substance use (35.40% men, 23.70% women) and, in third place, personality disorders. Significant differences were observed in the distribution of diagnoses according to gender, nationality and recidivism: repeat offenders had a higher prevalence of drug-related disorders, while first-time offenders had more neurotic disorders. The foreign population showed a lower association with drug-related pathologies than the Spanish population. The high prevalence of mental health disorders observed, and the differences found according to sociodemographic and prison-related characteristics, highlight the need to strengthen strategies for early detection, prevention and comprehensive mental health care within the prison system, particularly for individuals with a history of reoffending and substance-use disorders. La enfermedad mental constituye un problema altamente prevalente en la población privada de libertad. El objetivo de este estudio fue analizar la prevalencia de los trastornos mentales en las personas privadas de libertad del Centro Penitenciario de Zuera (CPZ) (Zaragoza). Se llevó a cabo un estudio descriptivo transversal en septiembre de 2023, incluyendo internos en tratamiento activo con psicofármacos. La muestra incluyó 598 personas privadas de libertad (560 hombres y 38 mujeres), con edad media de 39,3 años en hombres y 41,3 en mujeres. Los resultados mostraron que los trastornos neuróticos fueron los más prevalentes en ambos sexos (47% hombres, 55,30% mujeres), seguidos de los trastornos debidos al consumo de sustancias psicoactivas (35,40% hombres, 23,70% mujeres) y, en tercer lugar, de los trastornos de personalidad. Se observaron diferencias significativas en la distribución de diagnósticos en función del sexo, nacionalidad y reincidencia: los internos reincidentes presentaron mayor prevalencia de trastornos vinculados al consumo de drogas, mientras que los primarios presentaron más trastornos neuróticos. La población extranjera mostró menor asociación con patologías relacionadas con drogas que la población española. La elevada prevalencia de trastornos mentales observada y las diferencias encontradas según las características sociodemográficas y penitenciarias ponen de manifiesto la necesidad de reforzar las estrategias de detección precoz, prevención y atención integral en salud mental en el ámbito penitenciario, especialmente en personas con antecedentes de reincidencia y trastornos asociados al consumo de sustancias.
Current biosafety frameworks that directly link Risk Group (RG) to Biosafety Level (BSL) fail to capture how much exposure varies across the procedures performed in modern biomedical laboratories operating with genetically modified organisms, viral vectors, and multi-step protocols. This article presents the Procedure-Specific Risk (PSR) framework, an 8-step operational protocol for reproducible Biosafety Level assignment in which the exposure generated by the procedure-rather than agent taxonomy-serves as the primary determinant of containment. A structured comparative analysis of ten national and international biosafety reference documents was conducted (WHO Laboratory Biosafety Manual 4th ed., BMBL 6th ed., CDC Biological Risk Assessment 2024, INSST Technical Guide 2024, and relevant EU and Spanish legislation). Conceptual convergence was evaluated through qualitative thematic synthesis. The resulting 8-step protocol integrates agent Risk Group classification, procedural exposure characterization, and modulating factor evaluation into a BSL assignment matrix, and is supported by a structured assessment template and a freely accessible bilingual digital implementation tool. Framework validation rests on three complementary forms of evidence: content validity (all components derived from the ten analyzed regulatory sources), convergent validity (PSR-derived BSL assignments consistent with WHO and BMBL recommendations across all six case studies), and coverage validity (purposive case selection spanning RG1-3, Low-High PSR, escalation and reduction scenarios, and dual-technology comparison). Prospective multi-institutional inter-rater reliability assessment (target κ ≥ 0.60) constitutes the planned next validation step, supported by the digital implementation tool. The PSR framework provides a structured, reproducible, and immediately applicable protocol for proportionate containment in bioengineering and biotechnology settings. It is compatible with existing institutional biosafety programs and requires no structural regulatory modification for adoption. Implementation is supported by a freely accessible bilingual web tool, a structured assessment template, and six worked examples covering RG1-3 agents and diverse procedural risk levels.
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Analizar motivación, intentos y abandono del consumo de tabaco a partir de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025. Material y métodos. Se realizaron análisis descriptivos y siete modelos de regresión logística multivariada (RLM) para identificar los factores asociados con el abandono del consumo de tabaco. 72.17% de los fumadores (n= 2 624) presentó motivación para dejar de fumar y 47.8% reportó al menos un intento de abandono (último año). Entre los exfumadores (n= 2 668), 47.23% presentó abstinencia de 0 a 5 años y 52.7% de más de cinco años; 11.4% recibió consejo breve, 1.9% contactó la "Línea de la Vida" y 4.2% recibió tratamiento farmacológico. En los modelos de RLM, el sexo femenino y la exposición a advertencias sanitarias se asociaron con mayor motivación e intentos. Para el abandono, ser mujer, mayor edad y fumar ocasionalmente aumentaron la probabilidad de cesación, mientras que el consumo excesivo de alcohol y la exposición al humo de segunda mano (HSM) en lugares privados la redujeron. Es fundamental fortalecer intervenciones con perspectiva de género, reducir el consumo de alcohol, la exposición al HSM e incrementar la participación del personal de salud brindando consejo breve y tratamiento farmacológico.
Salt marshes support aquatic species of ecological and commercial importance, including the invasive Atlantic blue crab Callinectes sapidus and the native Atlantic ditch shrimp Palaemon varians, both of which are widely consumed in southern Europe. However, year-round comparative information on how co-occurring native and invasive decapods adjust their lipid reserves and fatty acid (FA) composition under natural estuarine conditions remains limited. Here, we compared seasonal variation in lipid classes and FA composition in adult males of both species sampled monthly from salt marsh ponds in the Bay of Cádiz (SW Spain) from February 2023 to January 2024. Environmental conditions in the water varied across seasons, and both species showed seasonal changes in lipid classes and FA composition, but with contrasting patterns. In C. sapidus, triglycerides declined during summer, whereas unsaturated fractions, particularly polyunsaturated FAs, were generally more prominent in late winter and spring. In P. varians, triglycerides increased in autumn, saturated FAs dominated from winter to spring, and monounsaturated and polyunsaturated FAs increased during autumn and early winter. The blue crab showed a more diffuse seasonal biochemical pattern, whereas the ditch shrimp showed a more structured seasonal organization, with broader statistical associations between lipid traits and environmental variables. Seasonal effects were evident in both species, but more pronounced in P. varians. Both analysed matrices contained eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) throughout the year, indicating the presence of nutritionally relevant long-chain n-3 PUFA, although these relative FA percentages should not be interpreted as direct estimates of EPA/DHA intake or food safety. This study provides a year-round biochemical baseline showing that co-occurring native and invasive decapods can display distinct matrix-specific seasonal biochemical trajectories in the Cádiz Bay salt marsh ponds.
Analizar la asociación entre consumo excesivo de alcohol (CEA) y malestar psicológico (MP) en población mexicana, y su posible modificación por experiencia migratoria (EM) en Estados Unidos. Material y métodos. Análisis transversal con datos de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025. Se realizaron análisis descriptivos según EM y se estimaron prevalencias ponderadas, así como modelos de regresión de Poisson con varianza robusta (crudo, ajustado e interacción). En el modelo crudo no se observó asociación estadísticamente significativa; tras el ajuste, el CEA se asoció con mayor prevalencia de MP (RP= 1.43; IC95%: 1.20,1.69). La asociación se mantuvo en personas sin EM (RP= 1.44; IC95%: 1.20,1.72), pero no en aquellas con EM (RP= 1.19; IC95%: 0.65,2.17), sin evidencia de interacción (p= 0.558). El CEA se asocia con el MP, independientemente de la EM. Estos hallazgos destacan la relevancia de considerar el consumo de alcohol en las estrategias de salud mental a nivel poblacional.
Estimar las prevalencias de consumo de drogas ilegales, describir las características del uso de cannabis y cocaína, y analizar su asociación con variables sociodemográficas y de salud mental en población de 15 a 24 años. Material y métodos. Análisis secundario de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025 en población de 15 a 24 años (n= 3 982; N= 21 696 193). La prevalencia de consumo de cualquier droga ilegal alguna vez en la vida fue de 15.2% (IC95%: 13.3,17.4) y de 5.6% (IC95%: 4.5,6.9) en el último año. Cannabis y cocaína fueron las sustancias de mayor consumo; los estimulantes tipo anfetamínico ocuparon el tercer lugar en consumo reciente. El consumo de cannabis se asoció significativamente con ser hombre, trabajar, exposición a drogas y consumo excesivo de alcohol. El consumo de cocaína se asoció significativamente con ser hombre, escolaridad básica, exposición a drogas y consumo excesivo de alcohol. Los resultados respaldan políticas integrales que combinen prevención, tratamiento especializado, reducción de riesgos y daños, vigilancia epidemiológica y acciones intersectoriales.
Brown adipose tissue (BAT) activity in humans is linked to better glucose metabolism and cardiometabolic health. In mice, cold exposure increases circulating succinate and enhances BAT thermogenesis, but whether similar succinate responses occur in humans remains undetermined. We analysed data from 33 young (18-25 years), sedentary adults (20 women) from the ACTIBATE cohort (NCT02365129). Plasma succinate was measured enzymatically at baseline and 60 and 120 min during a personalized cooling protocol. BAT volume, activity, and radiodensity were assessed via static 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) at the end of the cold exposure. Circulating succinate changed over time during cold exposure, with no significant change at 60 min and a significant increase at 120 min versus baseline (+ 23.8%, P = 0.017), with substantial interindividual variability. Exploratory stratification by median baseline succinate revealed divergent temporal patterns: the low-baseline group showed increases at 60 min (+ 46%) and 120 min (+ 80.5%; both P ≤ 0.021), while the high-baseline group showed reductions at both timepoints (-31.4% and - 2.4%; both P ≤ 0.003). These profiles were not explained by phenotypic or BAT-related parameters. In the full cohort, changes in circulating succinate were not associated with BAT outcomes. Overall, our findings indicate that circulating succinate responses during acute cold exposure are highly heterogeneous and no associated with BAT PET/CT-derived parameters in humans.
Analizar la asociación entre experiencia migratoria en Estados Unidos y consumo de alcohol y drogas en población mexicana residente en México. Material y métodos. Estudio transversal con datos de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025. El análisis incluyó descripción de características sociodemográficas y prevalencias de consumo según experiencia migratoria (Sí/No); comparación bivariada con pruebas χ² de Rao-Scott y t ajustadas por diseño; estimación de razones de prevalencia (RP) ajustadas mediante modelos de regresión de Poisson con varianza robusta y exploración de interacción entre experiencia migratoria y sexo. La población con experiencia migratoria presentó mayores prevalencias de consumo de alcohol y consumo excesivo en el último año (57.7 vs 45.5%) y (40.6 vs 28.6%), respectivamente, consumo de drogas ilícitas alguna vez en la vida (24.8 vs 12.5%). En los modelos ajustados la asociación entre experiencia migratoria y consumo de alcohol ([RP= 1.18; IC95%: 1.08,1.27], y consumo excesivo [RP= 1.22; IC95%: 1.09,1.37]) se mantuvo. La interacción con sexo fue significativa para consumo de drogas ilícitas. Los resultados sugieren que la experiencia migratoria puede influir en los patrones de consumo de alcohol. Las trayectorias migratorias deben considerarse como un determinante social relevante en el análisis y prevención del consumo de sustancias.
Describir los factores sociodemográficos, de salud mental y relacionados con el consumo de drogas en el último año en personas con y sin dependencia. Material y métodos. Participaron 692 personas mexicanas entre 12-65 años con uso de sustancias en los 12 meses previos a la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025. El 17% presentó dependencia a drogas. Los factores más asociados con dependencia fueron uso de drogas por vías de administración de alto riesgo (PRa= 5.13, IC95%: 1.65,15.94), uso de tres o más drogas (PRa= 6.73, IC95%: 4.15,10.93), y presentar dos o más problemas de salud mental (PRa= 3.69, IC95%: 1.93,7.06). Conclusión. Estos resultados subrayan la necesidad de acciones y programas de prevención encaminados a retrasar la edad de inicio, fortalecer la implementación de intervenciones tempranas y de reducción de riesgos, y daños dirigidos a poblaciones con consumo actual y modelos de tratamiento que incluyan abordajes integrales de los TUS y la salud mental.
To assess socioeconomic and medical factors associated with prenatal confirmatory diagnostic testing after positive prenatal cell-free (cfDNA) screening for sex chromosome aneuploidies (SCA) in a diverse contemporary patient cohort. We conducted a retrospective cohort study of patients who had abnormal prenatal cfDNA screening results indicative of SCA and were seen for genetic counseling between 2014 and 2024 at two tertiary academic medical centers. We used logistic regression analysis to evaluate the association of demographic and clinical factors with confirmatory testing. Of the 692 patients with abnormal cfDNA results, 26% (n = 180) underwent diagnostic testing. These patients were older, resided in more affluent areas, presented earlier for genetic counseling, were more likely to have commercial insurance, and were less likely to prefer Spanish or use an interpreter. Compared to Non-Hispanic (NH) Whites, diagnostic testing rates were higher for NH Asians but were lower for NH Blacks and Hispanics or when results indicated XYY or XXX. In logistic modeling, lower deprivation scores and commercial insurance were independently associated with higher testing rates. Only 1 in 4 patients pursued prenatal diagnostic testing following positive cfDNA screening for SCAs. Race, ethnicity, socioeconomic status and preferred language were the primary determinants of testing.
Analizar la prevalencia y covariables de la motivación dejar de fumar y evitar fumar a causa de las advertencias sanitarias con pictogramas (ASP) en cajetillas de tabaco en personas fumadoras adultas en México. Material y métodos. Estudio transversal con datos de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco (Encodat) 2025. Se incluyeron 2 477 personas fumadoras adultas (población ponderada: 13.4 millones). Se estimaron prevalencias e intervalos de confianza al 95%, así como modelos de regresión de Poisson con enlace log para calcular razones de prevalencia crudas y ajustadas, considerando el diseño complejo de la encuesta. El 39.3% reportó que las ASP motivaron a dejar de fumar, mientras que 26.9% señaló que evitó fumar cuando estaba a punto de encender un cigarro. El consumo ocasional, la menor dependencia a la nicotina, los intentos recientes de cesación y el interés en dejar de fumar se asociaron con una mayor probabilidad de reportar ambas respuestas a la ASP. Las ASP continúan asociándose con conductas relacionadas con la cesación del tabaco en personas fumadoras adultas en México. Su actualización periódica y medidas complementarias podrían fortalecer su efectividad.
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Describir la aceptabilidad de modificaciones a políticas públicas para reducir el consumo de alcohol en población adolescente y adulta mexicana, en total y por variables sociodemográficas. Material y métodos. Se utilizó la sección "Políticas de alcohol" de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025. Se estimó el porcentaje de población de acuerdo con ocho modificaciones a políticas públicas para reducir el consumo de alcohol recomendadas por la Organización Mundial de la Salud. La aprobación general de las políticas para reducir el consumo de alcohol fue mayoritaria, en un rango de 67% para impuestos al alcohol a 95.7% para el derecho al diagnóstico y tratamiento. Las mayores diferencias en la aceptabilidad de las políticas se observaron por estatus de consumo de alcohol. La amplia aceptabilidad de las políticas públicas para reducir el consumo de alcohol sugiere la viabilidad de acciones legislativas que protejan la salud de las personas frente a los riesgos del alcohol.