Determinants and Trends of the Use of Intravenous Thrombolysis for Minor Stroke: A Population-Based Study, 2016 to 2020.

BACKGROUND: We analyzed the main factors associated with intravenous thrombolysis (IVT) in patients with minor ischemic stroke. METHODS: Data were obtained from a prospective, government-mandated, population-based registry of stroke code patients in Catalonia (6 Comprehensive Stroke Centers, 8 Primary Stroke Centers, and 14 TeleStroke Centers). We selected patients diagnosed with ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) ≤5 at hospital admission from January 2016 to December 2020. We excluded patients with a baseline modified Rankin Scale score of ≥3, absolute contraindication for IVT, unknown stroke onset, or admitted to hospital beyond 4.5 after stroke onset. The main outcome was treatment with IVT. We performed univariable and binary logistic regression analyses to identify the most important factors associated with IVT. RESULTS: We included 2975 code strokes; 1433 (48.2%) received IVT of which 30 (2.1%) had a symptomatic hemorrhagic transformation. Patients treated with IVT as compared to patients who did not receive IVT were more frequently women, had higher NIHSS, arrived earlier to hospital, were admitted to a Comprehensive Stroke Centers, and had large vessel occlusion. After binary logistic regression, NIHSS score 4 to 5 (odds ratio, 40.62 [95% CI, 31.73-57.22]; P<0.001) and large vessel occlusion (odds ratio, 16.39 [95% CI, 7.25-37.04]; P<0.001) were the strongest predictors of IVT. Younger age, female sex, baseline modified Rankin Scale score of 0, earlier arrival to hospital (<120 minutes after stroke onset), and the type of stroke center were also independently associated with IVT. The weight of large vessel occlusion on IVT was higher in patients with lower NIHSS. CONCLUSIONS: Minor stroke female patients, with higher NIHSS, arriving earlier to the hospital, presenting with large vessel occlusion and admitted to a Comprehensive Stroke Centers were more likely to receive intravenous thrombolysis.

Effectiveness of a healthcare-based mobile intervention on sedentary patterns, physical activity, mental well-being and clinical and productivity outcomes in office employees with type 2 diabetes: study protocol for a randomized controlled trial.

BACKGROUND: Prolonged sedentary time is associated with an increased incidence of chronic disease including type 2 diabetes mellitus (DM2). Given that occupational sedentary time contributes significantly to the total amount of daily sedentariness, incorporating programmes to reduce occupational sedentary time in patients with chronic disease would allow for physical, mental and productivity benefits. The aim of this study is to evaluate the short-, medium- and long-term effectiveness of a mHealth programme for sitting less and moving more at work on habitual and occupational sedentary behaviour and physical activity in office staff with DM2. Secondary aims. To evaluate the effectiveness on glycaemic control and lipid profile at 6- and 12-month follow-up; anthropometric profile, blood pressure, mental well-being and work-related post-intervention outcomes at 3, 6 and 12 months. METHODS: Multicentre randomized controlled trial. A sample size of 220 patients will be randomly allocated into a control (n = 110) or intervention group (n = 110), with post-intervention follow-ups at 6 and 12 months. Health professionals from Spanish Primary Health Care units will randomly invite patients (18-65 years of age) diagnosed with DM2, who have sedentary office desk-based jobs. The control group will receive usual healthcare and information on the health benefits of sitting less and moving more. The intervention group will receive, through a smartphone app and website, strategies and real-time feedback for 13 weeks to change occupational sedentary behaviour. VARIABLES: (1) Subjective and objective habitual and occupational sedentary behaviour and physical activity (Workforce Sitting Questionnaire, Brief Physical Activity Assessment Tool, activPAL3TM); 2) Glucose, HbA1c; 3) Weight, height, waist circumference; 4) Total, HDL and LDL cholesterol, triglycerides; (5) Systolic, diastolic blood pressure; (6) Mental well-being (Warwick-Edinburgh Mental Well-being); (7) Presenteeism (Work Limitations Questionnaire); (8) Impact of work on employees´ health, sickness absence (6th European Working Conditions Survey); (9) Job-related mental strain (Job Content Questionnaire). Differences between groups pre- and post- intervention on the average value of the variables will be analysed. DISCUSSION: If the mHealth intervention is effective in reducing sedentary time and increasing physical activity in office employees with DM2, health professionals would have a low-cost tool for the control of patients with chronic disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT04092738. Registered September 17, 2019.

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry.

BACKGROUND AND PURPOSE:  In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. METHODS:  Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). RESULTS:  Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). CONCLUSIONS:  Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

Mejoría clínica de tendinopatía de hombro tras modificaciones ergonómicas del puesto de trabajo de usuarios de ordenador / Clinical improvement of shoulder tendinopathy after ergonomic modifications of the workstation of computer users

INTRODUCCIÓN: A pesar de la baja evidencia de la relación entre la patología del hombro y el uso de ordenadores, algunos autores asocian dicha patología con el uso del ratón informático, su posición alejada del cuerpo o el espacio insuficiente en la mesa de trabajo. CASO CLÍNICO: Presentamos el caso de cuatro trabajadores que, en el transcurso del último año, se han dirigido espontáneamente al servicio médico manifestando dolor en el hombro que relacionaban con sus condiciones de trabajo y como se ha solucionado dicha clínica mediante la adaptación del puesto de trabajo, básicamente gracias a la introducción de un ratón inalámbrico que ha permitido el rediseño del puesto de trabajo. DISCUSIÓN: La imposibilidad de mover el ratón libremente debido a restricciones en el espacio de la mesa de trabajo y a la utilización de ratón más de 4 horas/día durante la jornada laboral se ha descrito como causa de patología a nivel de hombros. En otros casos también se asoció con un espacio insuficiente en la mesa de trabajo, tener el ratón alejado de la posición corporal o utilizarlo durante la mitad o más tiempo de la jornada laboral. Desde un punto de vista biomecánico el manguito de los rotadores es exigente para evitar fuerzas luxantes, lo que realiza mediante contracción excéntrica o fuerzas neutralizadoras de grupos antagonistas. El supraespinoso tiene un papel importante al inicio de la abducción con un ángulo de tracción máximo aproximadamente a 75°. Determinadas posiciones podrían influenciar su fatiga y/o proceso inflamatorio. CONCLUSIONES: Nuestra experiencia nos indica que una sencilla y asumible modificación de la posición del hombro durante la utilización del ratón ha sido útil para revertir cuadros clínicamente compatibles con tendinopatías a este nivel

INTRODUCTION: Despite the low evidence of the relationship between shoulder pathology and the use of computers, some authors associate this pathology with the use of the computer mouse, its position away from the body or insufficient space on the desk. CLINICAL CASE: We present the case of four workers who, during the last year, consulted medical services spontaneously, manifesting shoulder pain related to their working conditions and how this clinic has been solved by adapting the workplace, basically thanks to the introduction of a wireless mouse that allowed the redesign of the workplace. DISCUSSION: The inability to move the mouse freely due to restrictions in the space of the work table and the use of mice more than 4 hours / day during the workday has been described as a cause of shoulder pathology. In other cases, it was also associated with insufficient space on the work table, having the mouse away from body position or using it during half or more of the workday. From a biomechanical point of view the rotator cuff is demanding to avoid dislocating forces, which it does by means of eccentric contraction or neutralizing forces of antagonist groups. The supraspinatus plays an important role at the beginning of abduction with a maximum traction angle of approximately 75°. Certain positions may influence your fatigue and / or inflammatory process. CONCLUSIONS: Our experience indicates that a simple and acceptable modification of the position of the shoulder during the use of the mouse has been useful to improve events of clinical presentations like tendinopathies at this level

Cuestionario CVSS17 y vigilancia de la salud de trabajadores profesionalmente expuestos a pantallas de visualización / CVSS17 Questionnaire and Health Monitoring of Workers Professionally Exposed to Display Screens

INTRODUCCIÓN: Según la Encuesta Europea de Condiciones de Trabajo un 37 % de los trabajadores utiliza dispositivos con pantallas durante la práctica totalidad de su jornada de trabajo y un 20 % lo utiliza al menos durante una cuarta parte de dicha jornada. La vigilancia de la salud de dichos trabajadores sigue basándose en el protocolo específico de 1999. Desde entonces, ha habido cambios importantes en el diseño y funcionamiento de equipos de trabajo, muchos trabajadores de diferentes áreas han incorporado estas tecnologías a sus tareas comunes y actividades extralaborales, del mismo modo que las pantallas de visualización, en diferentes formatos, se han incorporado a la vida cotidiana de muchas personas. A la vista de estos cambios, es preciso actualizar el protocolo de vigilancia de la salud para optimizar la prevención de los trabajadores expuestos. OBJETIVO: El objetivo de nuestro trabajo es valorar el comportamiento del cuestionario CVSS17 cuando se evalúa el sistema óculo visual mediante una exploración física específica y determinar su utilidad como un elemento de cribado para efectuar la vigilancia de la salud de los trabajadores profesionalmente expuestos a PVD. MÉTODO: Estudio transversal efectuado en el período de septiembre de 2016 a febrero de 2017, con los resultados de los exámenes de salud efectuados a trabajadores profesionalmente expuestos a PVD en las oficinas del Institut Català de la Salut. Inicialmente los trabajadores cumplimentaron el cuestionario CVSS17, desarrollado como una escala para medir los síntomas oculares y visuales asociados al uso de PVD. Con posterioridad se efectuó el examen de salud que, desde el punto de vista de semiología óculo-visual, contempló distintas maniobras y pruebas diagnósticas. Con estos datos se construyó una variable, la alteración visual global, que se utilizó como prueba de referencia (gold standard) para calcular la validez del cuestionario y la construcción de las curvas ROC. RESULTADOS: Respondieron al cuestionario 184 individuos, de los cuáles 150 (81,52 %) se sometieron voluntariamente al examen de salud y sus datos se incluyeron en el estudio. De estos, 102 fueron mujeres (68,0 %) y 48 hombres (32,0 %), con una edad media de 49,3 a. y una desviación estándar de 8,5 a. Los resultados del cuestionario CVSS17 mostraron niveles de sintomatología (NS) del 1 al 5 respectivamente de 37 (24,7%), 42 (28,0%), 41 (27,3%), 25 (16,7 %) y 5 (3,3 %) individuos. No se obtuvieron NS de grado 6. Al efectuar la exploración ocular, 6 individuos (4,0 %) presentaron alteración de la agudeza visual cercana, 34 (22,7 %) una alteración en la posición principal de la mirada, 13 (8,7 %) una alteración del test de sobrecarga macular, 15 (10,0 %) una alteración del punto cercano de conversión, 13 (8,7 %) una alteración del test de Amsler, 50 (33,3 %) tenían alterado el test de Schirmer y 5 (3,3 %) presentaron alteración en la visión del color. Globalmente, 87 individuos (58,0 %) presentaron alteración de, al menos, una de las pruebas de exploración óculo-visuales. El ajuste de una curva ROC a partir de la variable alteración visual global no mostró diferencias significativas [Área bajo la curva de 0,47 (IC 95%: 0,37-0,57; p = 0,51)], de modo que las probabilidades de clasificar correctamente a un par de individuos como uno sano y otro patológico son mínimas. CONCLUSIONES: Mediante el uso de un cuestionario diseñado para medir los síntomas oculares y visuales asociados al uso de PVD, no se ha encontrado relación entre la intensidad de estos síntomas y la exploración clínica oftalmológica específica. La presencia de alteraciones clínicas se ha mostrado significativamente asociada a la edad de los individuos, mientras que el género femenino se ha asociado a una mayor manifestación de síntomas de síndrome óculo-visual. CVSS17 es una herramienta que permite caracterizar y monitorizar los síntomas óculo-visuales asociados a la utilización de PVD. Utilizado como herramienta de cribaje su sensibilidad es de 0,838 mientras que su especificidad seria únicamente de 0,140

INTRODUCTION: According to the European Working Conditions Survey, 37 % of workers are using devices with display screens almost the whole working day, and 20 % of workers use them for at least a quarter of its working day. The health surveillance of these workers is still based on the specific protocol of 1999. From then on, there have been remarkable changes in the design and performance of the work equipments. Many workers from different working areas have introduced these technologies to their common tasks and non-work activities. Likewise, display screens, in different sizes and formats, have also been incorporated into the daily life of many people. In view of these changes, it is necessary to update this health surveillance protocol in order to optimize the prevention of the exposed workers. AIM: The aim of our work is not only to value the behavior of the CVSS17 questionnaire assessing the visual and ocular system through a specific physical examination, but to determine its usefulness as a screening element in order to monitor the health of the workers professionally exposed to display screens. METHOD: Cross-sectional study carried out between September 2016 and February 2017, with the results of the health examinations of workers professionally exposed to display screens in the offices of the Institut Català de la Salut. Initially, the workers completed the CVSS17 questionnaire, developed as a scale to measure the computer-related ocular and visual symptoms associated with the use of PVD. Afterwards, the health surveillance took place. This involved different maneuvers and diagnostic tests in the oculo-visual sphere. A new variable was built up with these data; we called it "overall visual disturbance", used as a reference test (gold standard) to calculate the validity of the questionnaire and the construction of ROC curves. RESULTS: A total of 184 individuals answered the questionnaire. 150 (81.52%) underwent voluntarily the health examination. Their data were included in the study. 102 of them were women (68.0%) and 48 men (32.0%), with an average age of 49.3 years and a standard deviation of 8.5 years. The results of the CVSS17 questionnaire showed symptom levels (SL) from 1 to 5 respectively of 37 (24.7%), 42 (28.0%), 41 (27.3%), 25 (16.7%) and 5 (3.3%) individuals. Symptomatology Level grade 6 was not obtained. When performing the ocular exploration, 6 individuals (4.0%) showed alteration of the near visual acuity, 34 (22.7%) showed an alteration in the main gaze position, 13 (8.7%) showed an alteration of the macular overload test, 15 (10.0%) showed an alteration of the near conversion point, 13 (8.7%) an alteration of the Amsler test, 50 (33.3%) had altered the Schirmer test and 5 (3.3%) presented alteration in the color vision. Overall, 87 individuals (58.0 %) showed disturbances of at least one of the visual-eye examination tests. The ROC curve adjustment from the "overall visual disturbance" variable did not show significant differences [Area under the curve of 0.47 (95% CI: 0.37-0.57, p = 0.51)], so that the probabilities of correctly classify a pair of individuals as one healthy and another pathological are minimal. CONCLUSIONS: No relationship has been found between the intensity of these symptoms and the specific ophthalmological clinical examination by using a questionnaire designed to measure the ocular and visual symptoms associated with the use of display screens. The presence of clinical alterations has been significantly related with the age of the individuals. Female gender has been associated with a higher manifestation of the oculo-visual syndrome symptoms. CVSS17 is a tool that can be used to characterize and monitor the ocular-visual symptoms related to the use of display screens. Used as a screening tool, this tool reaches a sensitivity of 0.838 while its specificity would be only 0.140

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers.

OBJECTIVES: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. METHODS: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. RESULTS: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. CONCLUSIONS: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.

Hidrocefalia normotensiva idiopática: alta incidencia en mayores de 80 años / Idiopathic normal pressure hydrocephalus: high incidence in people over 80 years of age

Introducción. La hidrocefalia normotensiva idiopática se da habitualmente en adultos por encima de 60 años. El mayor número de casos se describen entre los 70 y 80 años, aunque pudiera haber un infradiagnóstico por encima de los 80 años. Objetivos. Se describen la incidencia global y por grupos de edad, la demora diagnóstica y el resultado de la cirugía derivativa. Pacientes y método. Se realiza estudio descriptivo de la población censada en la comarca de Osona en el periodo 2010-2015. Resultados. La incidencia global ha sido de 4,43×100.000. La incidencia aumenta con la edad: de 8,09×105 entre 60-69 años pasa a 23,61×105 entre 70-79 años y alcanza 37,02×105 entre 80-89 años. El tiempo transcurrido desde el inicio de los síntomas hasta el diagnóstico de sospecha fue de 15,01±10,35 meses. El pronóstico poscirugía fue favorable en todos los casos a los 3meses y se reducía al 73,3% al año. Conclusiones. La hidrocefalia normotensiva idiopática es una enfermedad relacionada con la edad y está probablemente infradiagnosticada en los más ancianos. Los pacientes más ancianos también se benefician de la cirugía derivativa. Se resalta la necesidad del diagnóstico precoz y de una mayor sospecha en los más ancianos (AU)

Introduction. Idiopathic normal pressure hydrocephalus is usually observed in adults over 60 years of age. The highest incidence of cases is between 70 and 80 years-old, and it could be under-diagnosed in over 80 year-olds. Objective. A description is presented on the overall incidence and age group incidence, the delay in the diagnosis, and main outcomes. Patients and methods. A descriptive study was performed on patients with idiopathic normal pressure hydrocephalus, in the population of Osona County during the years 2010-2015. Results. The annual incidence rate was 4.43 per 100,000 inhabitants. The incidence increased with age; from 8.09 per 100,000 in the 60 to 69 years age group, to 23.61 per 100,000 in the 70-79 years age group of, and to 37.02 per 100,000 in the 80-89 years age. The delay in the diagnosis was 15.01 ± 10.35 months. All the patients improved after surgery, but only 73.3% of the patients maintained the improvement after one year. Conclusions. Idiopathic normal pressure hydrocephalus is an age related disease and probably underdiagnosed in the elderly. An early diagnosis and a clinical suspicion are essential in patients over 80 years old (AU)

[Idiopathic normal pressure hydrocephalus: High incidence in people over 80 years of age]. / Hidrocefalia normotensiva idiopática: alta incidencia en mayores de 80 años.

INTRODUCTION: Idiopathic normal pressure hydrocephalus is usually observed in adults over 60 years of age. The highest incidence of cases is between 70 and 80 years-old, and it could be under-diagnosed in over 80 year-olds. OBJECTIVE: A description is presented on the overall incidence and age group incidence, the delay in the diagnosis, and main outcomes. PATIENTS AND METHODS: A descriptive study was performed on patients with idiopathic normal pressure hydrocephalus, in the population of Osona County during the years 2010-2015. RESULTS: The annual incidence rate was 4.43 per 100,000 inhabitants. The incidence increased with age; from 8.09 per 100,000 in the 60 to 69 years age group, to 23.61 per 100,000 in the 70-79 years age group of, and to 37.02 per 100,000 in the 80-89 years age. The delay in the diagnosis was 15.01 ± 10.35 months. All the patients improved after surgery, but only 73.3% of the patients maintained the improvement after one year. CONCLUSIONS: Idiopathic normal pressure hydrocephalus is an age related disease and probably underdiagnosed in the elderly. An early diagnosis and a clinical suspicion are essential in patients over 80 years old.

Miositis por cuerpos de inclusión: a propósito de un caso / Inclusion-body myositis: presentation of a case

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Revisión sistemática sobre las alteraciones óculo-visuales y músculo-esqueléticas asociadas al trabajo con pantallas de visualización de datos / Systematic review of oculo-visual and musculoskeletal alterations associated with visual display terminals work

Introducción: Los cambios en el mundo del trabajo y la introducción de nuevas tecnologías en los últimos años han propiciado el aumento del uso de pantallas de visualización de datos (PVD) en multitud de puestos de trabajo. El malestar y los síntomas que se experimentan durante el uso de PVD pueden tener un impacto importante en términos de calidad, —derivado del aumento en el número de errores que se producen durante el trabajo—, como económicos —si se tienen en cuenta los costes derivados de incapacidad temporal, pérdida en horas de trabajo o por disminución de productividad—. La constante evolución en este ámbito implica que la vigilancia de la salud de los trabajadores expuestos a este riesgo debe adaptarse al conocimiento y la evidencia más actual. Objetivo: El objetivo de nuestra revisión es estructurar y analizar la literatura más reciente sobre el tema para determinar qué efectos sobre la salud se asocian al uso habitual de las pantallas de visualización de datos. Método: Durante los meses de noviembre 2015 a enero de 2016 se efectuó una búsqueda bibliográfica utilizando combinaciones de las palabras clave «eyestrain», «occupational diseases», «video display terminals», «musculoskeletal diseases», «occupational diseases», «computer», «work» y «population surveillance» en las bases de datos electrónicas PubMed y la Cochrane Library, limitada a los últimos diez años. La población objeto del estudio en nuestra revisión son los individuos expuestos a PVD y los resultados, en términos de salud, los síntomas o patologías que se relacionan con el uso de estas tecnologías. Se han excluido de la búsqueda de síntomas, enfermedades o trastornos relacionados con los riesgos psicosociales. Los criterios para la selección de los artículos se basaron en que la población de estudio debía ser trabajadora, total o parcialmente, que utilizara ordenadores o pantallas de visualización de datos y que los efectos para la salud debían ser en la esfera óculo-visual o musculo-esquelética, relacionada con las condiciones de trabajo o factores de riesgo asociados. No se excluyeron inicialmente artículos por motivo de idioma o tipo de estudio. Para clasificar la evidencia científica y determinar el grado de las recomendaciones se utilizaron los criterios del SIGN (Scottish Intercollegiate Guidelines Network). Resultados: Resultado de la búsqueda inicial se localizaron 1711 referencias, de las cuáles, una vez leídos los títulos y excluidos los duplicados, se redujeron a 496. Una vez leído los resúmenes se excluyeron otras 424 referencias al considerar que el contenido no era relevante y por motivos idiomáticos. De los restantes 72 artículos, se excluyeron otros 10 bien porque el contenido no se consideró relevante o no respondía a los criterios de inclusión, de modo que finalmente se incluyeron 62 artículos en la revisión final. Los trabajadores usuarios de PVD habitualmente presentan síntomas de malestar y dolor relacionados con el trabajo. Actualmente existen datos que sugieren relación entre el uso de estos equipos y problemas a nivel de la zona cervical. En menor medida, también se asocia con sintomatología de muñeca-mano y con la vergencia y el astigmatismo a nivel óculo-visual. Conclusiones: La inclusión de sintomatología en la mayor parte de estudios (recogida a través de cuestionarios), hace más complicada la valoración de patología asociada al uso de PVD. En general es factible identificar molestias o síntomas subjetivos, pero es difícil traducirlo en patologías concretas si no son debidamente contrastadas con pruebas objetivas y bien definidas. Aunque no existen recomendaciones sólidas para efectuar intervenciones específicas en el lugar de trabajo, una estrategia de intervenciones múltiples se apunta como el enfoque más razonable, priorizando actividades de prevención primaria y secundaria, promoviendo el correcto diseño de los lugares de trabajo y actuando sobre la capacitación de los trabajadores para que ellos mismos se conviertan en sujetos activos de la prevención. Son precisos más estudios, con diseños longitudinales y con carácter multicéntrico para poder generar mayor evidencia entre la asociación de problemas osteomusculares y óculo-visuales con la exposición laboral a PVD (AU)

Introduction: The changes in the world of work and the introduction of new technologies in recent years have led to an increasing use of visual display terminals (VDT) in many jobs. The discomfort and symptoms experienced during the use of VDT can have a significant impact in terms of quality, —as a result of the increase in the number of mistakes at work—, as well as the economic ones —taking into account the costs derived from temporary incapacity, the loss in working hours or the decrease of productivity—. The constant evolution in this area implies that the workers' health surveillance exposed to this risk must be adapted to the knowledge and the most current evidence. Objective: The objective of our review is to structure and analyze the most recent literature on the subject to determine which health effects are associated with the usual use of visual display terminals. Method: Among November 2015 and January 2016 a bibliographic search was carried out using the keywords combinations «eyestrain», «occupational diseases», «video display terminals», «musculoskeletal diseases», «occupational diseases», «computer» «work» and population surveillance «in the electronic databases PubMed and the Cochrane Library limited to the last ten years. The studied population are individuals exposed to DDS and the results, in terms of health, symptoms or pathologies associated with the use of these technologies. Symptoms, diseases or disorders related to psychosocial risks were excluded of the search. The criteria for the selection of the articles were based on whether the study population had to be fully or partially employed and used computers or data visualization screens and that the health effects had to be in the visual or musculoskeletal sphere, related to working conditions or associated risk factors. Articles were not initially excluded because of language or type of study. The SIGN criteria (Scottish Intercollegiate Guidelines Network) were used to classify the scientific evidence and to determine the degree of the recommendations. Results: Results of the initial search were 1711 references, of which, once read the titles and excluded duplicates were reduced to 496. Once read the summaries, 424 other references were excluded considering that the content was not relevant and also for language reasons. Of the remaining 72 articles, 10 were excluded either because the content was irrelevant or did not meet the inclusion criteria, so that finally 62 items were included in the final review. Workers who usually use DSS regularly have symptoms of work-related discomfort and pain. Currently there are data that suggest the relationship between the use of these equipment and problems at the level of the cervical area. To a lesser extent, it is also associated with symptomatology of the wrist-hand and with vergence and astigmatism at the eye-visual level. Conclusions: The inclusion of symptomatology in most studies (collected through questionnaires), makes the pathology assessment associated with the use of VDT more complicated. In general it is possible to identify subjective discomfort or symptoms, but it is difficult to translate it into specific pathologies if they are not properly contrasted with objective and well-defined tests.Although there are no strong recommendations for specific interventions in the workplace, a multiple intervention strategy is seen as the most reasonable approach, prioritizing primary and secondary prevention activities, promoting the correct design of workplaces, and acting on training of workers so that they themselves become active subjects of prevention. More studies are required, with longitudinal designs and with a multicentric character to generate more evidence between the association of osteomuscular and oculomotor problems with the labor exposure to VDT (AU)

[Alcohol consumption prevalence in civil servants]. / Prevalencia de consumo de alcohol en trabajadores de la función pública.

Temporomandibular dysfunction syndrome (TMDS) includes a number of clinical conditions involving the temporomandibular joint (TMJ), the muscles involved in mastication, or both. The symptoms of TMDS include decreased mobility, masticatory muscle pain, TMJ pain, functional alteration accompanied by articular noises, myofascial pain or deviation of the mouth opening. Work with visual display terminals (VDTs) has become widespread in the past several years and the conditions associated with this type of work have been associated with the appearance of certain musculoskeletal pathologies. Our objective was to conduct a review of the scientific literature onthe possible association between TMDS and work with VDTs. METHOD: A search of the literature in MEDLINE (PubMed), Cochrane Plus Library, CINHAL, Scielo and Google Academic was performed.We included those studies involving workers using VDTs and the outcome measures had to include references to TMDS symptoms. RESULTS AND DISCUSSION: A total of 112 articles were identified, of which finally 11 were selected for in-depth review. Given the heterogeneity of the results and the nature of the studies, we conclude that currently there is insufficient evidence to support a consistent relationship between TMDS pathology and work with VDTs. There is insufficient evidence linking the presence of TMDS with ergonomic and postural aspects, an association that should not be totally ruled out from a pathophysiological point of view and biological plausibility. Further studies are needed to better assess this relationship.

El síndrome de disfunción temporomandibular (DTM) incluye una serie de condiciones clínicas que involucran la articulación temporo-mandibular (ATM), la musculatura masticatoria o ambas. Los síntomas de DTM incluyen disminución de movilidad, dolor en la musculatura masticatoria, dolor de ATM, alteración funcional acompañada de ruidos articulares, dolor miofascial y desviación de la obertura mandibular. El trabajo con pantallas de visualización de datos (PVD) se ha generalizado en los últimos años las y condiciones de trabajo asociadas a este tipo de actividad se han relacionado con la aparición de determinadas patologías musculo-esqueléticas. El objetivo de este trabajo es revisar la literatura científica sobre la asociación entre el síndrome deDTMy el trabajo con PVD. MÉTODO: Se efectuó una búsqueda bibliográfica en las bases de datos de MEDINE (PubMed), Biblioteca Cochrane Plus, CINHAL, Scielo y Google Academic. Se incluyeron aquellos estudios en los que participaran trabajadores usuarios de PVD y la medida del efecto debía incorporar referencias a la sintomatología de ATM. RESULTADOS Y DISCUSIÓN: Se identificaron un total de 112 artículos, de los que se incluyeron 11 en la revisión final. Dada la heterogeneidad de los resultados observado y el diseño de los estudios no existe suficiente evidencia sobre la relación entre la patología de ATMy el trabajo con PVD. Tampoco existe suficiente evidencia para asociar la presencia de DTMcon aspectos ergonómicos y posturales, una asociación que no debería descartarse desde un punto de vista fisiopatológico y de plausibilidad biológica. Son precisos nuevos estudios para evaluarla con mayor precisión.

Amyotrophic lateral sclerosis: A higher than expected incidence in people over 80 years of age.

Our objective was to determine the age-specific incidence and clinical-epidemiological characteristics of an amyotrophic lateral sclerosis (ALS) cohort of patients in Catalonia (Spain). New cases diagnosed between 1 January 2004 and 31 December 2013 were 41 (20 males and 21 females), with an annual crude incidence rate of 2.7 per 100,000 person-years (95% CI 1.90-3.59). The incidence rate increased with age reaching a peak in the age group of 70-79 years. There was a non-significant decrease in the incidence rate in the group of patients over 80 years (p-value = 0.75) at 17.99 per 100,000 person years (95% CI 7.81-28.17). The percentage of patients over 80 years of age was 29.3% and over age 85 years was 9.8%. The prevalence rate at the end of the study period was 8.38/100,000 of the total population. Mean age at symptom onset was 76.0 years. Onset of symptoms was bulbar or generalized in 36.6% of cases. In conclusion, ALS incidence in Osona is within the range of other countries across Europe. Our results suggest that the age-specific incidence rate of ALS increases with age through the oldest age groups suggesting an age-risk effect to develop the disease.

[Benign intracranial hypertension secondary to hypoparathyroidism]. / Hipertension intracraneal benigna secundaria a hipoparatiroidismo.

TITLE: Hipertension intracraneal benigna secundaria a hipoparatiroidismo.

Hipertensión intracraneal benigna secundaria a hipoparatiroidismo / Benign intracranial hypertension secondary to hypoparathyroidism

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Riesgo cardiovascular, ocupación y riesgos laborales en una población laboral de Catalunya / No disponible

Objetivo: Determinar la prevalencia de factores de riesgo cardiovascular en población trabajadora de Catalunya, analizar su relación con la actividad laboral y los riesgos laborales asociados a esta. Material y métodos: Se analizaron datos de factores de riesgo cardiovascular (tabaquismo, hipertensión, dislipemia y diabetes) durante el periodo de Enero a Junio de 2.006 en el ámbito territorial de Catalunya, y de los riesgos laborales obtenidos a partir de las evaluaciones de riesgos y de la actividad profesional y empresarial de los trabajadores incluidos en el estudio. Resultados: Se obtuvieron datos de 2.573 trabajadores, 1.766 (68,7%) hombres y 806 (31,3 %) mujeres. 2.233 (86,9 %) presentaron un riesgo cardiovascular bajo, 304 (11,8%) un riesgo cardiovascular ligero y 34 (1,3%) un riesgo cardiovascular moderado-alto. Se evidenciaron diferencias significativas en el comportamiento del riesgo cardiovascular en función de dicha actividad laboral (p < 0,00). Conclusiones: La distribución de los factores de riesgo cardiovascular no fue homogénea en las diferentes actividades laborales. Distintos sectores de actividad llevan implícitos hábitos y conductas, que son las que definitivamente influyen en el riesgo cardiovascular. Este se encuentra asociado a factores de tipo individual y no tanto a las condiciones laborales. El abordaje preventivo deberá elaborarse en función de los diferentes sectores de actividad

Objective: Determining the prevalence of cardiovascular risk factors in Catalan workers; analysing their relationships with labour activity and the labour risks associated with this. Materials and Methods: Cardiovascular risk factors data (nicotine poisoning, hypertension, dyslipemia, and diabetes) from January to June of 2006 in Catalonia, and labour risks data obtained from evaluations of professional and business activity of workers object of this study were analysed. Results: Data from 2.573 workers (1.766 (68,7 %) men and 806 (31,3 %) women) were obtained. 2.233 (86,9 %) present a low cardiovascular risk, 304 (11,8) present a light cardiovascular risk, and 34 (1,3 %) a high-medium cardiovascular risk. Significant differences in the cardiovascular risk behaviour according to this labour activity were shown (p<0,00). Conclusions: The distribution of cardiovascular risk factors was not homogeneous in the different labour activities. Different activity sectors involve habits and behaviours which definitively influence cardiovascular risk. You can find this risk associated to factors of individual type and not to labour conditions. The preventive treatment must be prepared according to different activity sectors

Parálisis facial posparto / No disponible

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