Estimating the impact of obesity and metabolic phenotype on sickness absence. Results from the ICARIA study.

BACKGROUND AND AIMS: To assess the impact of obesity and being overweight on sickness absence (SA) as a function of healthy/unhealthy metabolic phenotype. METHODS AND RESULTS: A total of 173 120 healthy workers who underwent a routine check-up, consisting of a structured interview, anthropometric measurements and blood pressure and fasting blood analysis, were included as the study sample (67.1% males; 49.2% manual workers; mean age 40.6 ± 21.9 years). Workers were classified according to their body mass index (BMI) and metabolic phenotype. A metabolically unhealthy phenotype was defined as the presence of three or more of the following criteria: glycaemia ≥110 mg/dL or previously diagnosed type I/II diabetes or treatment for diabetes; triglycerides ≥150 mg/dL or lipid-lowering therapy; HDL <40/50 mg/dL M/F; blood pressure ≥130/85 mmHg or previously diagnosed hypertension or antihypertensive therapy; waist circumference >102/88 cm M/F. A one-year follow-up was conducted to evaluate the incidence of work-related and non-work-related SA (WRSA/NWRSA). The association of BMI with SA was tested using Poisson regression (standard error correction), segmenting on the basis of metabolic phenotype. The overall percentages of workers who were overweight, obese and/or had a metabolically unhealthy phenotype were 37.7%, 16.3% and 8.8%, respectively. BMI was associated with increased incidence of NWRSA in both phenotypes. It was also associated with WRSA in subjects with a BMI in the range of 35-39.99 kg/m2 and in metabolically healthy individuals. WRSA was lower in subjects with a BMI ≥40 kg/m2 and among metabolically unhealthy individuals. CONCLUSION: Obesity is associated with health problems that have a significant impact on SA.

High cardiovascular risk in Spanish workers.

BACKGROUND AND AIMS: To investigate the prevalence of high cardiovascular risk in the Spanish working population, and its distribution among different occupations and gender. METHODS AND RESULTS: Cross-sectional study of 309,955 workers (72.6% males, mean age 36.5 years, range 16-74 years), who underwent a routine medical check-up. Workers were classified as high, intermediate or low cardiovascular risk, according to the SCORE system. Workers with a relative risk greater than 4 were also considered as high-risk. The prevalence of high cardiovascular risk was 7.6% (95% CI 7.5-7.7) in males and 1.7% (95% CI 1.6-1.8) in females. After adjusting for age and gender, the prevalence of high cardiovascular risk was greater in workers from the Agriculture and Construction sectors than in those from Industry and Service sectors. The prevalence of high cardiovascular risk was higher in blue-collar than in white-collar occupations. CONCLUSIONS: A sizeable proportion of workers, especially blue-collar males, are at high cardiovascular risk. Knowledge of this risk for certain workers may serve as a basis for preventive strategies.

External validation of the European and American equations for calculating cardiovascular risk in a Spanish working population.

INTRODUCTION AND OBJECTIVE: This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention. METHODS: This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until December 2017. RESULTS: A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively. CONCLUSIONS: The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations.

[Shock wave treatment in a case of complicated plantaris muscle rupture]. / Tratamiento con ondas de choque en un caso de rotura muscular del delgado plantar complicada.

Muscle injuries are frequent in the workplace. They are produced by sudden direct or indirect trauma that involves a rupture of the fibres, causing bruising. Currently, there is no single protocol-based model of treatment. We present the case of a patient diagnosed with complete muscular rupture of the plantaris muscle by an indirect traumatic mechanism (abrupt muscular elongation), with an associated large-volume hematoma. Clinical study consisted of ultrasound, magnetic resonance (MR), pain assessment (VAS) at the beginning and at the end of the treatment (3 weeks), as well as duration of occupational disability. The patient underwent extracorporeal shockwave therapy (ESWT) according to the protocol. At the end of treatment, the hematoma was resolved and there were no complications. ESWT could be a complementary therapeutic alternative to conventional treatment in this entity. However, there is a need for further, randomised controlled studies including a larger number of patients.

Prevalence of atherogenic dyslipidemia: association with risk factors and cardiovascular risk in Spanish working population. "ICARIA" study.

OBJECTIVE: The aim of this study was to assess the prevalence of atherogenic dyslipidemia (AD) and the lipid triad (LT) in the working population in Spain, their associated variables and how far they are linked to cardiovascular risk (CVR). METHODS: Observational cross-sectional study of 70,609 workers (71.5% male (M), 28.5% female (F), mean age 39.2 ± 10), who attended medical checkups and agreed to participate. Plasma samples were analysed in a central laboratory. AD definition used was: triglycerides ≥150 mg/dl and HDL cholesterol <40 mg/dl (M)/<50 mg/dl (F) and LT when LDL cholesterol > 160 mg/dl is further added. Univariate comparisons in the absence and presence of AD and LT and the probability of AD according to different parameters and their possible association with CVR were assessed. CVR was stratified following the European SCORE model for low risk-population. RESULTS: 5.7% (95% CI 4.7-6.9) of the working population have AD and 1.1% (95% CI 1.0-1.2) LT. In univariate analysis, workers with AD and LT had a higher prevalence of obesity, hypertension, smoking and diabetes than those who had not (p < 0.001). In multivariate analysis, BMI, sex, age 40-49, diabetes, tobacco, uric acid, LDL or blood pressure significantly influenced the risk of AD. AD was significantly associated with CVR after adjusting for alcohol and obesity. However, most of the AD subjects (91.8%) were classified as low risk. CONCLUSIONS: About 6% of the working population in Spain meets AD criteria. Assuming that these subjects have increased CVR, AD allows to identify additional 5% of subjects with increased CVR to that one the SCORE model detects, helping to improve cardiovascular risk stratification.

Validación externa de las ecuaciones europea y americana para el cálculo del riesgo cardiovascular en población laboral española / Validación externa de las ecuaciones europea y americana para el cálculo del riesgo cardiovascular en población laboral española External validation of the European and American equations for calculating cardiovascular risk in a Spanish working population

Objetivo Validar externamente los modelos europeo y norteamericano de cálculo de riesgo cardiovascular en prevención primaria. Métodos Estudio transversal de una cohorte nacional de población laboralmente activa. Se incluyeron trabajadores sin antecedentes de enfermedad cardiovascular que acudieron a una revisión laboral entre los años 2004 y 2007, y se siguieron hasta 2017. Resultados Participaron 244.236 sujetos. El 24,5% eran mujeres, la edad media se situó en 48,10 años (DE 6,26). El riesgo medio según el modelo europeo SCORE fue de 1,70 (DE 1,81) para hombres y de 0,37 (DE 0,53) para mujeres. Según el modelo norteamericano PCE, el riesgo medio fue de 6,98 (DE 5,66) para hombres y de 1,97 (DE 1,96) para mujeres. Se registró un total de 1.177 eventos (0,51%) considerados en la calculadora SCORE, y un total de 2.330 eventos (1%) considerados según las PCE. El estadístico C de Harrell fue de 0,746 (SCORE) y 0,725 (PCE). La sensibilidad y especificidad para el punto de corte del 5% en SCORE fue del 17,59% (IC95% 15,52-19,87%) y 95,68% (IC95% 95,59-95,76%) y para el punto de corte del 20% de las PCE de 9,06% (IC95% 7,96-10,29%) y 97,55% (IC95% 97,48-97,61%), respectivamente. Conclusiones Las tablas europeas del SCORE y americanas de las PCE sobreestiman el riesgo en nuestra población, manteniendo una discriminación aceptable. SCORE mostró mejores índices de validez que las PCE. El perfil de riesgo de las poblaciones va cambiando, por lo que es necesario ir actualizando las ecuaciones que incluyan información de poblaciones más contemporáneas (AU)

Objective This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention. Methods This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until 2017. Results A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1,177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively. Conclusions The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations (AU)

Tratamiento con ondas de choque en un caso de rotura muscular del delgado plantar complicada / Shock wave treatment in a case of complicated plantaris muscle rupture

Las lesiones musculares son frecuentes en el ámbito laboral. Se producen por el mecanismo de traumatismos directos o indirectos bruscos, que ocasiona una rotura de sus fibras, provocando hematomas. Actualmente no existe un modelo único protocolizado de tratamiento. Presentamos el caso de un paciente diagnosticado de rotura muscular completa del delgado plantar por mecanismo traumático indirecto (elongación muscular brusca), con hematoma asociado de gran volumen. Se realizó estudio clínico mediante ecografía, resonancia magnética (RM), escala visual analógica (EVA) para valoración del dolor al inicio y al finalizar el tratamiento (3 semanas), así como la duración de su incapacidad laboral. Recibió terapia con ondas de choque electromagnéticas focales (OCEF) según protocolo. Al finalizar el tratamiento se objetivó una desaparición del hematoma y no hubo complicaciones. Las OCEF pudieran ser una alternativa terapéutica complementaria al tratamiento convencional en esta afección, no obstante, sería necesario proseguir la investigación incluyendo un mayor número de pacientes, y a través de estudios aleatorizados con grupo control

Muscle injuries are frequent in the workplace. They are produced by sudden direct or indirect trauma that involves a rupture of the fibres, causing bruising. Currently, there is no single protocol-based model of treatment. We present the case of a patient diagnosed with complete muscular rupture of the plantaris muscle by an indirect traumatic mechanism (abrupt muscular elongation), with an associated large-volume hematoma. Clinical study consisted of ultrasound, magnetic resonance (MR), pain assessment (VAS) at the beginning and at the end of the treatment (3 weeks), as well as duration of occupational disability. The patient underwent extracorporeal shockwave therapy (ESWT) according to the protocol. At the end of treatment, the hematoma was resolved and there were no complications. ESWT could be a complementary therapeutic alternative to conventional treatment in this entity. However, there is a need for further, randomised controlled studies including a larger number of patients