[Predictive estimation of the Visceral Adiposity Index (VAI) and Dysfunctional Adiposity Index (DAI) for metabolic syndrome in a working population]. / Estimación predictiva en población laboral del Índice de adiposidad visceral (VAI) y adiposidad disfuncional (DAI) en síndrome metabólico.

OBJECTIVE: To evaluate metabolic syndrome using three methods proposed by  recognizedinternational institutions, and the visceral adiposity (VAI) and dysfunctional adiposity (DAI) indices for prediction and prevalence estimation in working populations. METHODS: Cross-sectional study in workers from different Spanish autonomous communities who underwent a health examination between January 2019 and September 2021 at four occupational risk prevention services. Metabolic syndrome was evaluated according to criteria from the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III), the International Diabetes Federation (IDF) and  the Joint Interim Statement (JIS). VAI and DAI values were calculated using their specific formulas and their predictive capacity was measured using ROC curves. The SPSS 27.0 program was used, with statistical significance level set at p< 0.05. RESULTS: 418 343 workers were included, mostly men (58.8%), average age between 30 and 49 years (58.0%), social class III, mostly manual workers (75.9%) and nonsmokers (66.9%). The prevalence of metabolic syndrome differed  depending on the criteria used, being higher in men with IDF and JIS, and in women with ATPIII. For the three definitions of metabolic syndrome, the values of the area under the curve were > 0.8 (>80%). The highest VAI was obtained with the JIS, and the highest DAI with the ATPIII. The highest confidence index was for ATPIII and JIS. CONCLUSIONS: The VAI and ICD adiposity indices show high predictive capacity in metabolic syndrome with all three criteria used and can be useful for prevention activities in occupational health.

Introducción: Evaluar el síndrome metabólico utilizando tres métodos propuestos por instituciones internacionales de referencia, y los índices de adiposidad visceral (VAI) y adiposidad disfuncional (DAI), en la predicción y estimación de la prevalencia en población laboral. Métodos: Estudio transversal en trabajadores de distintas comunidades autónomas españolas a los que se les realizó un examen de salud entre enero 2019 y septiembre 2021. Se evaluó el síndrome metabólico con criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III), International Diabetes Federation (IDF) y Joint Interin Statement (JIS). Se calcularon los valores de VAI y DAI mediante sus fórmulas específicas y su capacidad predictiva mediante curvas ROC. Se utilizó el programa SPSS 27.0, considerando significación estadística p< 0,05. Resultados: Se incluyeron 418 343 trabajadores, la mayoría hombres (58,8%), de edad media entre 30 y 49 años (58,0%), clase social III, tipo de trabajo manual (75,9%) y no fumadores (66,9%). La prevalencia de síndrome metabólico muestra diferencias según el criterio utilizado, siendo superior en hombres con IDF y JIS, y en mujeres con ATPIII. Para las tres definiciones de síndrome metabólico, los valores del área bajo la curva fueron > 0,8 (>80%). El VAI más elevado se obtuvo con JIS, y el DAI más alto con ATPIII. El índice de mayor confianza fue para ATPIII y JIS. Conclusiones: Los índices de adiposidad VAI y DAI muestran una elevada capacidad predictiva del síndrome metabólico con los tres criterios utilizados y pueden ser de utilidad preventiva en salud laboral.

Terapias complementarias en migraña y variables relacionadas. Encuesta Europea / Complementary therapies in migraine and related variables. European Survey

Objetivo: valorar el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. La migraña afecta a una de cada diez personas en el mundo, con aumento creciente y mayor prevalencia entre mujeres de zonas urbanas. Aunque los tratamientos habituales son farmacológicos, se ha incrementado el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. Materiales y métodos: estudio observacional transversal mediante encuesta anónima vía web a 3.342 pacientes de países europeos sobre el uso de terapias alternativas para tratamiento de migraña. Variables de estudio: edad, género, país, tipo de localidad, nivel de estudios, ámbito rural o urbano y respuesta al tratamiento. Resultados: la utilización de terapias alternativas en migraña es un fenómeno creciente, con mayor uso en pacientes entre 41-60 años y estudios superiores. Conclusiones: en migraña se observan diferencias por edad, género, nivel cultural y país de procedencia. El uso de la medicina complementaria como alternativa terapéutica en la migraña es poco habitual y se debería indagar con mayor profundidad estableciendo relaciones que permitan apoyar al paciente afectado y priorizar las de mayor evidencia científica..(Au)

Objective: to evaluate the use of alternative non-pharmacological therapies in migraine and related variables. Migraine affects one in ten people worldwide, with a growing increase and a higher prevalence among women in urban areas. Although the usual treatments are pharmacological, the use of alternative techniques is increasing. Materials and methods: cross-sectional observational study by anonymous web survey of 3,342 patients from European countries on the use of alternative therapies. Study variables: age, gender, country, type of locality, educational level, rural or urban setting and treatment response. Results: the use of alternative therapies in migraine treatment is a growing phenomenon, with greater use in patients between 41-60 years of age and higher education. Conclusions: in Migraine, differences are observed by age, gender, cultural level and country of origin. The use of complementary medicine as an therapeutic alternative in migraine is uncommon and should be investigated in greater depth, establishing relationships that allow supporting the affected patient and prioritizing, if possible, some over others with scientific evidence..(Au)

[Preventive Aspects for Migraine and the Workplace: A European Survey]. / Aspectos preventivos en migraña y trabajo. Encuesta europea.

INTRODUCTION: Workplace health promotion integrates initiatives in health and safety in the occupational field, with personal improvements, increased productivity and lower risks and social cost, especially with respect to migraine headaches, a neurological disorder affecting approximately 11% of the population. The objective of this study was to know the preventive resources available to workers with migraine headaches and the preventive management options in their companies. METHOD: Cross-sectional observational study of 3,342 patients from Spain, Italy, France, Portugal, Ireland, United Kingdom, Germany and other European Union countries, conducted through an anonymous survey on the web of the European Migraine & Headache Alliance (EMHA-web), from September 2018 to January 2019. RESULTS: Occupational stress (77.65%) and use of computer monitors (63.87%) are the most common risks described by workers with migraine. About. 43.71% of workers are not familiar with the type of occupational health service present in their company, 49.06% do not have a medical service; 67.67% reported no work-related limitations due to migraine, neither dismissal nor non-renewal of their contract (88.29%), but 42.14% had experienced some conflict due to decreased productivity; 26.54% were unaware of the concept of vulnerable workers or had not requested this status because of their migraine (63.8%), nor had.

INTRODUCCIÓN: La promoción de la salud en el trabajo integra las iniciativas en salud y seguridad en ámbito ocupacional, con mejoras personales, incremento de productividad y menores riesgos y gastos sociales, especialmente en migraña, como enfermedad neurológica con prevalencia estimada en el 11% de la población. El objetivo de este trabajo fue conocer las condiciones preventivas de los trabajadores con migraña y las opciones de gestión preventiva en sus empresas. MÉTODO: Estudio observacional transversal realizado en 3.342 pacientes de España, Italia, Francia, Portugal, Irlanda, Reino Unido, Alemania y otros países de la UE mediante encuesta anónima en la web de la European Migraine & Headache Alliance(EMHA-web), entre septiembre de 2018 y enero de 2019.RESULTADOS: Estrés laboral (77.65%) y uso de PVD (63.87%) son los riesgos más referidos por los trabajadores con migraña. El 43.71% de trabajadores desconoce el tipo de Servicio de Prevención de su empresa, 49.06% no dispone de servicio médico; el 67.67% no ha tenido impedimentos de acceso laboral por migraña, ni despido o no renovación del contrato (88,29%), pero el 42,14% tuvo algún conflicto por pérdida de productividad; el 26,54% desconoce el concepto de especial sensibilidad o no lo ha solicitado por migraña (63,8%), ni ha demandado modificaciones laborales (67,64%) o cambio de puesto de trabajo (80,89%); un 55,42% no se ha sentido comprendido ni apoyado por su empresa en sus limitaciones por migraña, pero sí por los compañeros (63,07%). CONCLUSIÓN:Se observa una deficiente información preventiva y escaso uso de las opciones de gestión adaptativa en las empresas para personas con migraña.

Cuestionarios de valoración funcional en traumatología / Trauma functional assessment questionnaires

RESUMEN Introducción: Las enfermedades musculoesqueléticas son dolencias de alta prevalencia, impacto y repercusión. La historia clínica y las pruebas complementarias son las primeras pautas para diagnosticarlas. Se recomienda el uso de cuestionarios para la valoración de las limitaciones e impacto en la calidad de vida de los pacientes. Objetivo: Valorar el uso y eficacia de los cuestionarios en traumatología. Métodos: Se revisaron las bases de datos Medline, Pubmed. Se obtuvieron 32 publicaciones, fundamentalmente, en inglés, aunque también en español y otros idiomas, realizadas entre 2001-2018, que recogen la experiencia de los investigadores con el uso de los cuestionarios. Los términos de búsqueda empleados fueron: Musculoskeletal Disorders, Musculoskeletal pain; and Foot and Ankle, hip and knee, Upper Extremity, low back pain; and disability, quality of life questionnaires and assessment tool. Resultados: Se han revisado 46 cuestionarios: 4 de calidad de vida, 16 de miembro superior (1 general y 15 por localización de la lesión), 19 de miembro inferior (4 generales y 15 por localización de la lesión) y 7 para raquis. Conclusiones: No hay acuerdo en los autores sobre cuál es el mejor cuestionario para la valoración de impacto y repercusión, y se combinan varios de ellos. La elección del cuestionario y el que sea genérico (de calidad de vida) o específico (de miembro superior, inferior o raquis), está en consonancia con el objetivo buscado en la investigación, la experiencia del investigador, su uso clínico y tiempo necesario para cumplimentarlo(AU)

ABSTRACT Introduction: Musculoskeletal diseases are ailments of high prevalence, impact and impact. The medical record and the complementary tests are the first guidelines to diagnose them. The use of questionnaires is recommended to assess the limitations and impact on the quality of life of patients. Objective: To assess the use and effectiveness of traumatology questionnaires. Methods: Medline, Pubmed databases were reviewed. We recovered 32 publications mainly in English, but also in Spanish and other languages, made from 2001 to 2018. These publications collect the experience of researchers with the use of questionnaires. The search terms used were Musculoskeletal Disorders, Musculoskeletal pain; and Foot and Ankle, hip and knee, Upper Extremity, low back pain; and disability, quality of life questionnaires and assessment tool. Results: Forty six questionnaires were reviewed. Four on quality of life, 16 on the upper limbs (one general and 15 by location of the lesion), 19 on the lower limbs (four general and 15 by location of the lesion) and 7 on spine. Conclusions: There is no consensus among the authors on which is the best questionnaire for assessing of the impact and repercussion. Several of them are combined. The choice of the questionnaire and the one that is generic (on quality of life) or specific (on upper, lower limbs or spinal) is in line with the objective sought in this research, the researcher´s experience, clinical use and the time needed to fill it out(AU)

RÉSUMÉ Introduction: Les troubles musculo-squelettiques sont des affections dont la prévalence, l'impact et le retentissement sont élevés. Le dossier médical et les examens complémentaires sont les premières orientations pour les diagnostiquer. L'emploi des questionnaires pour évaluer les limitations et l'impact sur la qualité de vie des patients est recommandé. Objectif: Évaluer l'emploi et l'efficacité des questionnaires en traumatologie. Méthodes: On a consulté les bases de données Medline et PubMed. On a obtenu 32 publications notamment en anglais, mais aussi en espagnol et d'autres langues, parues entre 2001-2018, recueillant toute l'expérience des chercheurs dans l'usage des questionnaires. Les termes de recherche utilisés ont été: Musculoskeletal Disorders, Musculoskeletal pain ; and Foot and Ankle, hip and knee, Upper Extremity, low back pain ; and disability, quality of life questionnaires and assessment tool. Résultats: Sur 46 questionnaires, on a révisé 4 concernant la qualité de vie, 16 concernant les membres supérieurs (1 de sujet général et 15 de localisation de la lésion), 19 concernant les membres inférieurs (4 de sujet général et 15 de localisation de la lésion), et 7 concernant le rachis. Conclusions: Les auteurs ne sont pas arrivés à un consensus sur le meilleur questionnaire pour évaluer l'impact et le retentissement; on a fait une combinaison de plusieurs d'entre eux. La sélection d'un questionnaire et le fait qu'il soit générique (qualité de vie) ou spécifique (membre supérieur, inférieur ou rachis) ont été en concordance avec l'objectif de la recherche, l'expérience du chercheur, l'usage clinique et le temps nécessaire pour le compléter(AU)

Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study.

BACKGROUND: Early appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of a multifaceted educational intervention to improve antibiotic treatment. We hypothesized that the intervention would hasten and improve the appropriateness of empirical antibiotic administration, favor de-escalation, and decrease mortality. METHODS: We prospectively studied all consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). We compared process-of-care variables (resuscitation bundle and time-to-initiation, appropriateness, and de-escalation of empirical antibiotic treatment) and outcome variables between the two cohorts. The primary outcome was hospital mortality. We analyzed the intervention's long-term impact in a subset of 50 ICUs. RESULTS: We included 2628 patients (age 64.1 ± 15.2 years; men 64.0%; Acute Physiology and Chronic Health Evaluation (APACHE) II, 22.0 ± 8.1): 1352 in the preintervention cohort and 1276 in the postintervention cohort. In the postintervention cohort, the mean (SD) time from sepsis onset to empirical antibiotic therapy was lower (2.0 (2.7) vs. 2.5 (3.6) h; p = 0.002), the proportion of inappropriate empirical treatments was lower (6.5% vs. 8.9%; p = 0.024), and the proportion of patients in whom antibiotic treatment was de-escalated was higher (20.1% vs. 16.3%; p = 0.004); the expected reduction in mortality did not reach statistical significance (29.4% in the postintervention cohort vs. 30.5% in the preintervention cohort; p = 0.544). Gains observed after the intervention were maintained in the long-term follow-up period. CONCLUSIONS: Despite advances in sepsis treatment, educational interventions can still improve the delivery of care; further improvements might also improve outcomes.

Apnea obstructiva del sueño valorada con los cuestionarios Epworth y Stop-Bang y su relación con síndrome metabólico / Obstructive sleep apnea assessed with Epworth and Stop-Bang questionnaires and its relationship with metabolic syndrome

Resumen: ANTECEDENTES El síndrome metabólico se define como un grupo de afecciones que implican incremento de riesgo de enfermedad cardiovascular y diabetes tipo 2. Su prevalencia va en aumento y es una prioridad preventiva en la comunidad científica. OBJETIVO cuantificar las horas de sueño y conocer el riesgo de síndrome de apnea-hipopnea obstructiva del sueño y su relación con síndrome metabólico en trabajadores. MATERIAL Y MÉTODO Estudio epidemiológico transversal, efectuado en trabajadores de la Administración Pública española durante los reconocimientos de vigilancia periódica de la salud de enero a diciembre de 2015. Se valoró el riesgo de síndrome de apnea-hipopnea obstructiva del sueño mediante los cuestionarios Epworth y Stop-Bang y su influencia en el síndrome metabólico con criterios de la Federación Internacional de Diabetes (IDF) y Adult Treatment Panel III (ATP III). RESULTADOS Se incluyeron 1110 pacientes; se encontró que el número de horas de sueño no guarda relación con la existencia mayor de síndrome metabólico en población trabajadora. La detección de síndrome de apnea-hipopnea obstructiva del sueño con la prueba Epworth y con Stop-Bang mostró relación significativa con la existencia de síndrome metabólico con ambos criterios (IDF y ATP III). CONCLUSIONES El mayor riesgo de síndrome de apnea-hipopnea obstructiva del sueño muestra relación estadística con mayor prevalencia de síndrome metabólico.

Abstract: BACKGROUND Metabolic syndrome includes a group of conditions involving an increased risk of developing cardiovascular disease and type 2 diabetes. Its growing prevalence makes it a preventive priority in the scientific community. OBJECTIVE To quantify sleep hours and to know the risk of sleep apnoea detected and the relationship with the metabolic syndrome in workers. MATERIAL AND METHOD An epidemiological cross-sectional study was done in 1110 workers in the Spanish Public Administration during periodic health surveillance from January to December 2015. The risk of presenting nocturnal apnoea was assessed using Epworth and Stop-Bang questionnaires, and their influence on metabolic syndrome with International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. RESULTS The number of hours of sleep is not related to the greater presence of metabolic syndrome in the working population. The detection of obstructive sleep apnoea-hypopnea syndrome with Epworth and Stop-Bang questionnaires showed significant relationship with metabolic syndrome with IDF and ATP III criteria. CONCLUSIONS The highest risk of obstructive sleep apnoea-hypopnea syndrome assessed shows statistic relation to a higher prevalence of metabolic syndrome.

[Disability leave and sick leave in Spain. 2016 legislative update]. / Discapacidad e incapacidad laboral en España. Actualización legislativa 2016.

In Spanish, the concepts of discapacidad (disability leave) and incapacidad (sick leave) jointly refer to the impairment of a person due to injuries, diseases or deficiencies that limit their activity in a social, personal or occupational field. However, this common link does not imply that both concepts are the same. Statistical data from INE (Instituto Nacional de Estadística: Statistic National Institute) show that Spain had in 2015 3.85 million persons with a disability (59.8% were women). Statistical data from 2015 from INSS (Instituto Nacional de Seguridad Social: Social Security National Institute) show high levels in the number of processes and in workers affected by temporary sick leave, with social costs to the social security system. Both concepts have been updated: about disability leave, Law 39/2006 adjusted terminology by avoiding the use of concepts with discriminating or pejorative connotation. Regarding sick leave, the Ley General de Seguridad Social (General Social Security Law)has been amended and came into effect in January, 2016. It is necessary to know and distinguish these aspects for a better administrative management, and a more oriented information to the affected patient.

Los conceptos de discapacidad e incapacidad hacen referencia conjuntamente al menoscabo de una persona por lesiones, enfermedades o deficiencias que limitan su actividad en el ámbito social, personal o laboral. Pero este nexo común no implica equiparación entre ambos. Datos estadísticos del 2015 del Instituto Nacional de Estadística (INE) muestran en España 3.85 millones de personas con alguna discapacidad, el 59.8% mujeres. Datos estadísticos del 2015 del Instituto Nacional de la Seguridad Social (INSS), tanto en número de procesos, como de trabajadores afectados por incapacidad muestran cifras elevadas, con costos sociales en prestaciones a cargo de la seguridad social. Ambos conceptos han sido objeto de actualización legislativa: en discapacidad, la Ley 39/2006 ajusta la terminología y evita el uso de conceptos con connotación peyorativa o discriminativa. En incapacidad, la Ley General de la Seguridad Social ha sido modificada y ha entrado en vigor en enero de 2016. Es necesario conocer y diferenciar estos aspectos para una mejor gestión administrativa, e información más orientada al paciente afectado.

Cardiovascular risk and obesity in sleep apnea syndrome assessed with the Stop-Bang questionnaire. / Riesgo cardiovascular y obesidad en el síndrome de apnea del sueño valorado con el cuestionario Stop-Bang.

INTRODUCTION: Sleep disorders include a number of different processes, of which the most prevalent is the sleep apnea-hypopnea syndrome (SAHS). Prevalence of SAHS has increased worldwide, and has a significant social and health impact because of the increased cardiometabolic risk attributed to obesity and the associated metabolic syndrome. MATERIAL AND METHODS: A cross-sectional epidemiological study of 1110 workers from public service companies in the Spanish Mediterranean area (Balearic Islands and Valencian Community) was conducted between January and December 2015. Cardiovascular risk was calculated using the Castelli, Kannel and TG/HDL indices, and prevalence of obesity using body mass index, waist circumference, waist-height ratio, and visceral fat. SAHS risk was assessed using the Stop-Bang questionnaire. RESULTS: Risk of SAHS was low in 77% of patients and intermediate-high in 23% of patients. All obesity parameters showed a statistically significant association (p value <.001) with intermediate/high risk of SAHS. Obesity prevalence is higher the worse the quality of sleep. There was a statistically significant relationship between risk of SAHS and cardiovascular risk with the atherogenic indexes found. CONCLUSIONS: Twenty-three percent of workers had intermediate/high SAHS risk. The results of this study support the relationship of SAHS with an increased CVR and with obesity parameters. Further prospective studies in different productive sectors may be useful to confirm the results of this research.

[Cardiovascular risk parameters, metabolic syndrome and alcohol consumption by workers]. / Parámetros de riesgo cardiovascular, síndrome metabólico y consumo de alcohol en poblacion laboral.

INTRODUCTION: Prevalence of alcohol consumption is high in the general population and generates specific problems at the workplace. OBJECTIVE: To establish benchmarks between levels of alcohol consumption and cardiovascular risk variables and metabolic syndrome. METHODS: A cross-sectional study of 7,644 workers of Spanish companies (2,828 females and 4,816 males). Alcohol consumption and its relation to cardiovascular risk was assessed using Framingham calibrated for the Spanish population (REGICOR) and SCORE, and metabolic syndrome was assessed using modified ATPIII and IDF criteria and Castelli and atherogenic index and triglycerides/HDL ratio. A multivariate analysis was performed using logistic regression and odds ratios were estimated. RESULTS: Statistically significant differences were seen in the mean values of the different parameters studied in prevalence of metabolic syndrome, for both sexes and with modified ATPIII, IDF and REGICOR and SCORE. The sex, age, alcohol, and smoking variables were associated to cardiovascular risk parameters and metabolic syndrome. Physical exercise and stress are only associated to with some of them. CONCLUSIONS: The alcohol consumption affects all cardiovascular risk parameters and metabolic syndrome, being more negative the result in high level drinkers.

Síndrome del ojo seco y trabajo: revisión preventiva desde la legislación española / Dry eye syndrome and work: A preventive review around the Spanish legislation

El síndrome de ojo seco tiene una prevalencia en la población española de aproximadamente el 11 % y su impacto en el mundo laboral se asocia a formas de trabajo con uso creciente de pantallas y dispositivos electrónicos, condiciones medioambientales de modernos diseños de oficinas y despachos y exposición laboral a radiaciones ionizantes, productos químicos o polvo ambiental. Revisamos los factores de riesgo asociados con este síndrome en el mundo del trabajo y en torno a la legislación preventiva española, en la que las actuaciones en salud laboral se desarrollan en los servicios de prevención de riesgos, y se destacó la aptitud laboral del trabajador afectado y su posible consideración como trabajador especialmente sensible a determinados riesgos laborales. Las actuaciones consensuadas, precoces y coordinadas entre médicos del trabajo, técnicos y especialidades clínicas implicadas, especialmente la Oftalmología, permitirá prevenir y controlar más eficazmente esta patología de forma más eficaz, cuanto más precoz.

Dry eye syndrome is a condition whose prevalence in Spanish population is around 11 % and with an impact on the labor world associated with new ways of working, with increasing use of screens and electronic devices, environmental conditions encountered in modern designs in offices, with changes in air exchange and variations in ambiental humidity and occupational exposure to ionizing radiation, environmental chemicals or dust. We review the risk factors associated with the syndrome of dry eye in the labor world around Spanish preventive legislation. The occupational health actions must be carried out within the preventive service, with special relevance in Occupational Health assessment of fitness of the worker concerned and possible consideration as a worker especially sensitive to certain occupational hazards. The implementation of actions agreed, coordinated early and occupational physicians, safety technicians and clinical specialties involved, among which ophthalmology, will prevent and control this disease more effectively.

Epidemiology, antibiotic therapy and clinical outcomes of healthcare-associated pneumonia in critically ill patients: a Spanish cohort study.

PURPOSE: Information about healthcare-associated pneumonia (HCAP) in critically ill patients is scarce. METHODS: This prospective study compared clinical presentation, outcomes, microbial etiology, and treatment of HCAP, community-acquired pneumonia (CAP), and immunocompromised patients (ICP) with severe pneumonia admitted to 34 Spanish ICUs. RESULTS: A total of 726 patients with pneumonia (449 CAP, 133 HCAP, and 144 ICP) were recruited during 1 year from April 2011. HCAP patients had more comorbidities and worse clinical status (Barthel score). HCAP and ICP patients needed mechanical ventilation and tracheotomy more frequently than CAP patients. Streptococcus pneumoniae was the most frequent pathogen in all three groups (CAP, 34.2 %; HCAP, 19.5 %; ICP, 23.4 %; p = 0.001). The overall incidence of Gram-negative pathogens, methicillin-resistant Staphylococcus aureus (MRSA), and Pseudomonas aeruginosa was low, but higher in HCAP and ICP patients than CAP. Empirical treatment was in line with CAP guidelines in 73.5 % of patients with CAP, in 45.5 % of those with HCAP, and in 40 % of those with ICP. The incidence of inappropriate empirical antibiotic therapy was 6.5 % in CAP, 14.4 % in HCAP, and 21.8 % in ICP (p < 0.001). Mortality was highest in ICP (38.6 %) and did not differ between CAP (18.4 %) and HCAP (21.2 %). CONCLUSIONS: HCAP accounts for one-fifth of cases of severe pneumonia in patients admitted to Spanish ICUs. The empirical antibiotic therapy recommended for CAP would be appropriate for 90 % of patients with HCAP in our population, and consequently the decision to include coverage of multidrug-resistant pathogens for HCAP should be cautiously judged in order to prevent the overuse of antimicrobials.

Determinación del riesgo de fracturaosteoporótica en población laboralespañola mediante la herramientaFRAX / Osteoporotic risk of hip fracture calculated using the FRAX toolfor the Spanish population

Introducción: las fracturas osteoporóticas constituyen una problemática de creciente trascendenciaen salud pública, por lo que la utilización de herramientas que permitan una valoraciónprecoz y adecuada del riesgo de fractura y el establecimiento de políticas preventivas deberíanser prioritarios. En este trabajo se valora el riesgo de sufrir diferentes tipos Materiales y métodos: se realizó un estudio descriptivotransversal en población general trabajadora delsector socio-sanitario español con edades comprendidasentre 40 y 65 años. El riesgo de fractura de cadera ymayor osteoporótica se calculó mediante la herramientaFRAX para población española. Se incluyeron en elestudio 749 trabajadores seleccionados aleatoriamente:251 varones, 251 mujeres no menopáusicas y 247 mujeresmenopáusicas.Resultados: las edades medias fueron de 46,8 años envarones, 43,9 años en mujeres no menopáusicas y 52,3años en las menopáusicas. El riesgo medio de fracturade cadera y mayor osteoporótica fue de 2,1±1,33 y de0,22±0,36 en varones, 2,65±2,16 y 0,27±0,94 enmujeres no menopáusicas y 3,1±2,93 y 0,44±0,88en mujeres menopáusicas. Presentaron criterios positivosde tratamiento según la National Osteoporosis Foundationel 0,8 % de las mujeres no menopáusicas, un 2 %de las menopáusicas y ninguno de los hombres.Conclusiones: el riesgo de sufrir fracturas osteoporóticasen este colectivo es muy bajo, sin embargo, el uso dela herramienta FRAX puede ser muy útil para detectarel riesgo en sus estadios iniciales y establecer políticas deprevención y actuación precoz que permitan un ahorroen costes y mejorar la salud de nuestra población generalmediante captación en su etapa laboral.

Purpose: Osteoporotic fractures are a significantgrowing problem of public health, so theuse of tools that allow a proper risk assessmentand establishing preventive policies should be apriority. This paper assesses the risk of differenttypes of fractures as much in men as in menopausaland non menopausal women.Patients and methods: A descriptive crosssectionalstudy in working population from theSpanish health system aged between 40 and65. The risk of increased osteoporotic hip fractureis calculated using the FRAX tool for the Spanishpopulation. 749 randomly selected workerswere included in the study, 251 men, 251 nonmenopausal women and 247 post-menopausalwomen.Results: Mean ages were 46.8 years in men, 43.9years in non-menopausal women and 52.3 yearsin the menopausal. The average risk of hip fractureand major osteoporotic was 2.1 ± 1.33 and0.22 ± 0.36 in males, 2.65 ± 2.16 and 0.27 ±0.94 in non-menopausal women 3.1 ± 2.93 and0.44 ± 0.88 in menopausal women. No men, 0.8% of menopausal women and 2 % of menopausaltreatment had positive criteria for treatmentaccording to the National OsteoporosisFoundation.Conclusion: The risk of osteoporotic fracturesin this group is very low, however the use of theFRAX tool can be very useful to detect the riskin its early stages and establishing preventionpolicies that allow cost savings and improve thehealth of our workforce.

Efficacy and safety of caspofungin in critically ill patients. ProCAS Study.

INTRODUCTION: Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). ProCAS is a study sponsored by the Working Group of the Infectious Diseases of the Spanish Society of Intensive Care Medicine, which analyzes the effectiveness and safety of caspofungin in routine clinical practice conditions in the critically ill. METHODS: A prospective, multicenter, observational study designed to estimate the clinical effectiveness and safety of caspofungin acetate in the treatment of IC and IA in patients refractory to or intolerant of conventional antifungal therapy. The assessment of effectiveness both clinic and the microbiological was carried out at the end of the treatment with caspofungin. RESULTS: We included 98 patients, 62 IC proven, 25 probable and 11 IA probable, from 24 centers during 2005 and 2006. Treatment with caspofungin monotherapy was performed in 89.8% of cases and as first line therapy in 54.1%. The favorable clinical response obtained for IC, probable IC, and probable IA was 91.9, 84, and 81.8%, respectively. The microbiological response was favorable in 74.6, 68, and 54.6% for proven cases of IC, probable IC, and probable IA, respectively. No serious adverse effects were observed. CONCLUSIONS: In routine clinical practice conditions, caspofungin is effective and safe for the treatment of invasive fungal infections (IC/IA). The efficacy and safety profile was similar to that observed in published clinical trials.

[Fibromyalgia and laboral activities on the Spain legislation]. / Fibromialgia y trabajo. Valoración en la legislación española.

Fibromyalgia is a pain disorder listed in the International Classification of Diseases (ICD) of the World Health Organization under the code 729.1. It is a controversial disease that affects young people in many cases during their working years, posing a social and labour problem, in addition to the complexity of its diagnosis, which is based almost exclusively on clinical criteria as few objective data can be obtained from physical examination or additional tests. Nowadays, the criteria for clinical diagnosis of fibromyalgia are established and periodically revised by an Expert Consensus Panel; the most recent document is dated May, 2010. The occupational status of these patients attains an important significance due to the labour costs resulting from this disease and the difficulty in establishing clear and concise parameters for assessing the personal disability of the patients by the legally authorized organizations.

El paciente diabético como trabajador especialmente sensible en medicina del trabajo: [revisión] / The diabetic patient as a restricted Worker in occupational medicine: [review]

El concepto de Trabajador especialmente Sensible, recogido en lanormativa Española de Prevención de Riesgos Laborales, es uno de los campos más atractivos para el Médico del Trabajo y, de forma especial, en aquellas patologías que, como la diabetes, cursan de forma crónica y generan complicaciones evolutivas limitantes en las personas que la sufren. Conviene por ello revisar la legislaciónactual y contrapesarla con los puestos de trabajo y tareas en las que el trabajador diabético puede tener una especial peligrosidad para sí mismo o para su entorno o bien generar un mayor número de complicaciones evolutivas en su proceso, con repercusión laboral, personal y social y jurídica.

The "Restricted Worker" concept, enclosed in the Spanish norm of Occupational Risk Prevention, is one of the most attractive fields for the Occupational Medicine Doctor and specially, in pathologies, like diabetes, that has chronic progress and evolutive causes, limiting complications in those patients. For that reason, it could be good, to review the current legislation and link it with the jobs and tasks that the diabetic worker has a special danger for itself or its surroundings or generate a greater number of evolutive limiting complications in his disease with work, personal and social repercussion.

[Staphylococcus aureus nosocomial infections in critically ill patients admitted in intensive care units]. / Infecciones nosocomiales por Staphylococcus aureus en pacientes críticos en unidades de cuidados intensivos.

BACKGROUND AND OBJECTIVE: To investigate the frequency of nosocomial infections caused by Staphylococcus aureus in critically ill patients admitted to Spanish intensive care units (ICUs) and to describe the characteristics and outcome of patients in whom this pathogen was isolated. PATIENTS AND METHOD: Prospective, observational, and multicenter study. All patients admitted during one or 2 months to the participating ICUs in the National Nosocomial Infection Surveillance Study (ENVIN) between 1997 and 2003 were included. Patients were classified as infected by S. aureus, infected by other microorganisms, and without nosocomial infection. RESULTS: A total of 34,914 patients were controlled of whom 3,450 (9.9%) had acquired a nosocomial infection during his/her ICU stay (16.0 infections per 100 patients). In 682 (19.8%) patients, a total of 775 infectious episodes in which one of the microorganisms isolated was S. aureus were documented (cumulative incidence 2.2 episodes of S. aureus infection per 100 patients). There was a predominance of S. aureus infection in patients with pneumonia associated with mechanical ventilation (21.4%) and in patients with catheter-related bacteremia (13%). Independent variables associated with S. aureus infection were male sex (odds ratio [OR] = 1.25; 95% confidence interval [CI], 1.03-1.52) and underlying trauma pathology (OR = 1.72, 95%; 95%CI, 1.26-2.35), whereas an older age has been a protective factor (OR = 0.90; 95%CI, 0.84-0.96). Mortality in patients with S. aureus infection was significantly higher than in infections caused by other microorganisms, and in both cases higher than in patients without infection (34.5%, 30.3%, and 10.7%, respectively). In 208 (30.5%) patients, infections due to methicillin-resistant S. aureus were diagnosed, which in turn had increased significantly over the years (p = 0.001). Mortality in patients with methicillin-resistant S. aureus infection was 35.1% compared with 34.2% in patients with methicillin sensitive S. aureus infections (p = NS). CONCLUSIONS: S. aureus was isolated in 19.8% of patients with ICU-acquired infection, particularly in relation to pneumonia in mechanically ventilated patients. Mortality in patients with S. aureus infection was higher than that in patients with infections due to other microorganisms and patients without infection. In contrast, differences in the outcome of patients with infections caused by methicillin-sensitive or methicillin-resistant S. aureus were not found.

Antiseptic chamber-containing hub reduces central venous catheter-related infection: a prospective, randomized study.

OBJECTIVE: The hub connecting the catheter and the infusion equipment is a common portal of entry for bacteria causing catheter-related sepsis. We assessed the efficacy of a new hub model (Segur-Lock) that incorporates an antiseptic chamber filled with 3% iodinated alcohol in preventing endoluminal catheter contamination and catheter-related bloodstream infection arising at the hub. DESIGN: Prospective, randomized, multicenter study. SETTING: Seven medical and surgical adult intensive care units in Spain. PATIENTS: A total of 230 patients aged 18 yrs or older requiring the insertion of a nontunneled central venous catheter for >or=6 days from January 1, 1998, to April 30, 1999. INTERVENTIONS: Patients were randomized at the time of catheter insertion to receive catheters with standard Luer-lock connector (control group, n = 114) or catheters with the new hub model (n = 116). MEASUREMENTS AND MAIN RESULTS: Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or due to suspicion of sepsis, in which case peripheral blood and infusate cultures were simultaneously taken. Catheter-related bloodstream infection was diagnosed in 19 (8.3%) patients. Catheters were more often withdrawn because of suspicion of infection in the control group (43.8%) than in the new hub model group (30.1%, p <.035). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (14.4% vs. 4.3%, p <.001). Catheter-related bloodstream infection from the catheter hub also occurred more frequently in controls than in patients assigned to the new hub model (7% vs. 1.7%; p <.049; relative risk, 4.14; 95% confidence interval, 0.8-19). CONCLUSIONS: This new antiseptic chamber-containing hub has proved to be effective in preventing endoluminal bacterial colonization and catheter-related bloodstream infection from hub contamination in intensive care unit patients with central venous catheters inserted for >or=6 days.