Validation of the IberScore model in a primary care population.

BACKGROUND: This study aimed to validate the IberScore cardiovascular risk model in a population attended in the primary care setting. METHODS: A cohort of patients with no history of cardiovascular disease visited in a primary care center during the years 2008 and/or 2009 and followed up until 2018 was selected. Cardiovascular risk was calculated with the IberScore formula for all the subjects of the cohort and the model was calibrated, graphically represented by risk deciles the proportion of expected events and proportion of observed events at 10-year follow-up, stratified by sex. The area under the ROC curve was calculated to assess the discrimination of the model. RESULTS: A total of 10,085 patients visited during the years 2008 and/or 2009 were included in the study. Men showed a mean 10-year risk of suffering a fatal or non-fatal cardiovascular events according to IberScore of 17.07% (SD 20.13), with a mean estimated vascular age of more than 4 years higher than the biological age; while women had a mean 10-year risk of 7.91% (SD 9.03), with an estimated vascular age of more than 2 years above the biological age. The area under the ROC curve showed a discrimination index of the model of 0.86 (95% CI 0.84-0.88) in men and 0.82 (95% CI 0.79-0.85) in women. CONCLUSION: IberScore model discriminates well in the population attended in primary care but the model overestimates the risk.

Prevalence of familial hypercholesterolemia phenotype and ten-year risk of cardiovascular events in a working population in primary prevention: The ICARIA study.

BACKGROUND AND AIMS: We aimed to assess the prevalence of familial hypercholesterolaemia (FH) and to determine the incidence of cardiovascular events during a 10-year follow up in individuals with FH, compared to unaffected individuals in a working, middle-aged/young population. METHODS AND RESULTS: 576,724 active workers (36 ± 10 years-old, 70% men) without cardiovascular disease were given regular health check-ups and followed for a median of 8.5 years (i.e., 4,123,927 person-years). The FH phenotype was defined according to validated low-density lipoprotein-cholesterol thresholds, adjusted for age and sex. The primary outcome was a first cardiovascular event, whether fatal or non-fatal. We found that 707 workers (0.12% or 1 in 816 individuals) met the criteria for a heterozygous FH phenotype. During the follow-up, cardiovascular events occurred in 23 of 707 (3.25%) subjects with the FH phenotype and in 3297 of 576,017 (0.57%) subjects without the FH phenotype (p<0.001). The hazard ratio (HR, assessed with a Cox regression model) for the primary outcome was 5.7 (99% CI 3.33-9.78), before adjustments, and 4.7 (99% CI 2.62-8.58) after adjusting for sex, age, smoking, blood pressure, and diabetes. The HRs were significant for both men and women, but the magnitude of the effect was greater for men than for women. CONCLUSIONS: Our findings confirmed the high incidence of cardiovascular disease in individuals with untreated FH. We showed that regular health check-ups in an active, and mostly young, working population could contribute to the early identification of FH. Therefore, this approach may provide an opportunity for early treatment.

Prediction of fatal and non-fatal cardiovascular events in young and middle-aged healthy workers: The IberScore model.

AIMS: Our primary objective was to improve risk assessment for fatal and non-fatal cardiovascular events in a working population, mostly young and healthy. METHODS: We conducted a prospective cohort study to derive a survival model to predict fatal and non-fatal 10-year cardiovascular risk. We recruited 992,523 workers, free of diagnosed cardiovascular disease at entry, over six years, from 2004-2009. We divided the sample into two independent cohorts: a derivation one (626,515 workers; from 2004-2006) and a temporal validation one (366,008 workers; over 2007-2009). Then, we followed both cohorts over 10 years and registered all fatal and non-fatal cardiovascular events. We built a new risk calculator using an estimation of cardiovascular biological age as a predictor and named it IberScore. There were remarkable differences between this new model and Systematic Coronary Risk Evaluation (SCORE) (in both the specification and the equation). RESULTS: Over the 10-year follow-up, we found 3762 first cardiovascular events (6‰) in the derivation cohort. Most of them (80.3%) were non-fatal ischaemic events. If we had been able to use our model at the beginning of the study, we had classified in the 'high-risk' or 'very high-risk' groups 82% of those who suffered a cardiovascular event during the follow-up. All the post-estimation tests showed superior performance (true positive rate: 81.8% vs 11.8%), higher discrimination power and better clinical utility (standardised net benefit: 58% vs 13%) for IberScore when compared to SCORE. CONCLUSION: Risk assessment of fatal and non-fatal cardiovascular events in young and healthy workers was improved when compared to the previously used model (SCORE). The latter was not reliable to predict cardiovascular risk in our sample. The new model showed superior clinical utility and provided four useful measures for risk assessment. We gained valuable insight into cardiovascular ageing and its predictors.

Estimación del riesgo cardiovascular de por vida (IBERLIFERISK): una herramienta nueva en prevención primaria de las enfermedades cardiovasculares / Estimation of lifetime risk of cardiovascular disease (IBERLIFERISK): a new tool for cardiovascular disease prevention in primary care

Introducción y objetivos: Desarrollar una función predictiva del riesgo cardiovascular de por vida de eventos cardiovasculares, mortales y no mortales en población laboral española. Métodos: Estudio de cohortes retrospectivo. Se seleccionó a trabajadores de entre 18 y 65 años sin antecedentes de enfermedad cardiovascular que realizaron un examen de salud entre los años 2004 y 2007. El 70% de la cohorte se utilizó para desarrollar la ecuación de riesgo y el 30%, para validar la ecuación. Se construyeron 4 modelos de riesgos proporcionales de Cox en los que se utilizaron como variables dependientes la aparición de eventos cardiovasculares y la aparición de eventos competitivos; se usaron los mismos modelos en varones y mujeres. Los eventos mortales y no mortales se evaluaron hasta el año 2014. Resultados: Se incluyó a 762.054 sujetos, con una media de edad de 35,48 años (el 71,14% varones). Resultaron factores significativos en el modelo la ocupación manual, el tabaquismo, la diabetes mellitus, el tratamiento antihipertensivo, la presión arterial sistólica, el colesterol total, el colesterol unido a lipoproteínas de alta densidad y el tratamiento hipolipemiante; en varones, el consumo de alcohol, el índice de masa corporal, los antecedentes de enfermedad coronaria precoz en familiares de primer grado, la enfermedad renal y la presión arterial diastólica. El área bajo la curva c fue 0,84 (IC95%, 0,82-0,85) en varones y 0,73 (IC95%, 0,66-0,80) en mujeres. La calibración mostró una subestimación en los deciles de bajo riesgo y sobrestimación en los de alto riesgo. Conclusiones: El modelo de riesgo cardiovascular de por vida tiene una discriminación y una calibración satisfactorias, con mejores resultados para varones que para mujeres

Introduction and objectives: To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain. Methods: Retrospective cohort study. We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables. The same models were replicated for men and women separately. Fatal and nonfatal events were assessed until 2014. Results: A total of 762 054 individuals were selected. The mean age was 35.48 years and 71.14% were men. Significant risk variables in the model included manual occupations, being a smoker or exsmoker, diabetes mellitus, antihypertensive treatment, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and lipid-lowering treatment; in men, the model also included alcohol consumption, body mass index, a family history of early coronary disease in first-degree relatives, renal failure, and diastolic blood pressure. The area under the curve receiver operating characteristic was 0.84 (95%CI, 0.82-0.85) in men and 0.73 (95%CI, 0.66-0.80) in women. Calibration showed underestimation in low-risk deciles and overestimation in high-risk deciles. Conclusions: The new lifetime cardiovascular risk model has satisfactory discrimination and calibration, with better results in men than in women

Estimation of Lifetime Risk of Cardiovascular Disease (IBERLIFERISK): A New Tool for Cardiovascular Disease Prevention in Primary Care.

INTRODUCTION AND OBJECTIVES: To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain. METHODS: Retrospective cohort study. We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables. The same models were replicated for men and women separately. Fatal and nonfatal events were assessed until 2014. RESULTS: A total of 762 054 individuals were selected. The mean age was 35.48 years and 71.14% were men. Significant risk variables in the model included manual occupations, being a smoker or exsmoker, diabetes mellitus, antihypertensive treatment, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and lipid-lowering treatment; in men, the model also included alcohol consumption, body mass index, a family history of early coronary disease in first-degree relatives, renal failure, and diastolic blood pressure. The area under the curve receiver operating characteristic was 0.84 (95%CI, 0.82-0.85) in men and 0.73 (95%CI, 0.66-0.80) in women. Calibration showed underestimation in low-risk deciles and overestimation in high-risk deciles. CONCLUSIONS: The new lifetime cardiovascular risk model has satisfactory discrimination and calibration, with better results in men than in women.

Comparison of application of different methods to estimate lifetime cardiovascular risk.

BACKGROUND: Recent guidelines recommend assessment of lifetime cardiovascular risk on the basis of traditional risk factors in adults who are not at high short-term risk. The aim of this study is to determine the implications of estimating the lifetime cardiovascular risk in individuals in a large occupational cohort in Spain. DESIGN: National cross-sectional study in an occupational cohort with an in-person interview including laboratory tests. METHODS: Volunteer workers who were examined between January 2011 and December 2011 were included. A total of 580,236 workers were eligible during this year and 259,834 were examined (participation rate of 44.7%). Short-term (10-year) and lifetime cardiovascular risk were estimated using the American College of Cardiology (ACC) and the American Heart Association (AHA) tool and the QRISK2 and QRISK. RESULTS: Sixty-eight per cent were male, mean age was 39 years, with an age range of 16 to 75 years. Total number of individuals included in this study was 258,676. The percentage of patients at high short-term risk was 6.85% (95% confidence interval (CI) 6.75%-6.95% and 20.83% (95% CI 20.60%-21.07%) with the QRISK2, and the ACC/AHA risk equations, respectively. Of the percentage of patients classified as not at high risk with the different tools 1.61% (95% CI 1.55%-1.66%) were high lifetime risk on QRISK, and 27.41% (95% CI 27.11%-27.70%) on ACC/AHA risk. CONCLUSIONS: Application of lifetime cardiovascular risk engages greater numbers of individuals at high risk with substantial differences between the different methods available. These differences can have important clinical implications specifically in the percentage of candidates for lifestyle changes and eventually lipid lowering drugs.

Roturas dentales debidas a accidentes de trabajo en España / Dental fractures due to occupational accidents in Spain

OBJETIVOS: El objetivo de este estudio fue caracterizar las roturas dentales debidas a accidentes de trabajo. Material y MÉTODOS: Estudio observacional retrospectivo de 1.081 sujetos con roturas dentales de origen laboral pertenecientes a la población protegida de una mutua de accidentes de trabajo y enfermedades profesionales. Se seleccionaron todos los casos del periodo 2000-2010 con un diagnóstico único de rotura dental. Se realizaron análisis descriptivos y bivariados de las principales variables demográficas, laborales y clínicas. RESULTADOS: Las roturas dentales resultaron más frecuentes entre los hombres (9:1), en trabajadores menores de 40 años (74,2%) y con ocupaciones manuales (9:1). La causa más común fueron golpes al manipular piezas o herramientas durante la realización de una tarea manual (72,8%). Muchos de tales accidentes se produjeron con herramientas poco sofisticadas (llaves 18,9%; martillos 4%). Las causas de accidente variaron en función del sexo, edad y nivel ocupacional (p < 0,001). Entre los hombres, los trabajadores más jóvenes y con ocupaciones manuales, los accidentes durante la manipulación de piezas y herramientas u operaciones de carga y descarga fueron los más frecuentes. Entre las mujeres, trabajado res de mayor edad o con ocupaciones no manuales, la variedad de causas fue mayor. CONCLUSIONES: La mejora del entrenamiento en el uso de herramientas y de los equipos de protección individual, la formación acerca de los factores de riesgo y la inspección y mantenimiento de los equipos parecen ser aspectos esenciales para la prevención de este tipo de lesiones

OBJECTIVES: The aim of this study was to characterize dental fractures due to work accidents. MATERIAL AND METHODS: Observational retrospective study of 1,081 subjects with work-related dental fractures that were selected from the insured population of a Spanish Mutual Insurance Company for Accidents at Work and Professional Illnesses. All the cases from 2000 to 2010 with the only diagnosis of traumatic dental fracture were selected. Descriptive and bivariate analysis on demographic, work related and clinical variables were performed. RESULTS: Dental fractures were more frequent among males (9:1), younger than 40 years-old (74.2%) and blue-collar vs. white-collar workers (9:1). The most common cause of dental fractures in work-related accidents were bumps when manipulating components or tools (72.8%) and many of these events involved low-sophisticated tools (wrenches 18.9%; hammers 4%). Causes of the accidents significantly differed according to sex, age and occupational level (p < 0.001). Among men, younger and blue-collar workers, work accidents involving manipulation of components and tools and loading maneuvers accounted for the majority of the injuries. On the other hand, women, older and white-collar workers showed a greater variety of causes. CONCLUSIONS: Improved training on the use of tools and individual protective equipment, education on risk factors, and inspection and maintenance practices appear to be essential for prevention

Estimating the glomerular filtration rate in the Spanish working population: chronic kidney disease prevalence and its association with risk factors.

OBJECTIVE: This study aims to investigate the influence of estimated glomerular filtration rate (eGFR) with two equations (and by one or two separate measurements), on the prevalence of chronic kidney disease (CKD) and its association with blood pressure, and cardiovascular and metabolic risk factors. METHODS: Between January 2010 and October 2011, the Ibermutuamur CArdiovascular RIsk Assessment project included 128 588 workers (77.2% men, mean age 39.3 years, range 16-75), who underwent two consecutive yearly medical check-ups and had information for eGFR according to the MDRD-IDMS and CKD-EPI equations (serum creatinine was measured by a isotope-dilution mass spectrometry traceable method in a single central laboratory). CKD was defined by an eGFR less than 60 ml/min per 1.73 m. Subclinical (occult) renal disease was defined as an eGFR less than 60 ml/min per 1.73 m in patients with serum creatinine below 1.3 mg/dl and below 1.2 mg/dl in men and women, respectively. RESULTS: In this working population, prevalence of CKD was very low, but two to six times lower when two separate eGFRs below 60 ml/min per 1.73 m were used. The prevalence of CKD was significantly lower with the CKD-EPI compared to the MDRD-IDMS equation. The same applies to occult CKD. In male workers, occult CKD was practically nonexistent.Multivariate analyses show that blood pressure, total serum cholesterol, and serum glucose (positively), and high-density lipoprotein and low-density lipoprotein (negatively) were associated with CKD, with both equations. Another metabolic factor (waist circumference) was only associated (positively) with CKD defined by the CKD-EPI equation, which appears to be associated with most components of the metabolic syndrome. CONCLUSIONS: The CKD-EPI formula, calculated on the basis of two reported blood samples, may provide the most specific definition of CKD.

Prevalencia de hígado graso no alcohólico y factores de riesgo asociados en directivos de la Comunidad de Madrid / Prevalence of non-alcoholic fatty liver disease and associated risk factors among managers from the community of madrid

Objetivo: Determinar la prevalencia de hígado graso no alcohólico (HGNA) y factores de riesgo asociados en directivos de la Comunidad de Madrid. Métodos: Estudio descriptivo de corte transversal y retrospectivo, con la participación de 1.838 trabajadores (78,5%hombres), que acudieron a reconocimiento médico como parte del Programa de Vigilancia de la Salud entre el 01/01/2010y el 31/12/2010. Se recogieron datos de la anamnesis, mediciones antropométricas, determinaciones bioquímicas y estudio ecográfico del hígado. Resultados: La prevalencia total de HGNA fue del 44,0% (54,0% en varones y 7,3% en mujeres; p<0,001). La presencia de HGNA se asocia en ambos sexos a mayor edad, peso más elevado, talla más baja, mayor índice de masa corporal perímetro abdominal y síndrome metabólico, así como a niveles más elevados de ácido úrico y glucosa en sangre. En el análisis de regresión logística multivariante se apreció riesgo elevado de HGNA para perímetro abdominal ≥102cm en varones y≥88cm mujeres (odds ratio OR=5,2; IC95% 3,8-7,1), edad ≥40 años (OR=3,0; IC95% 2,3-4,0), triglicéridos ≥150mg/dl(OR=2,1; IC95% 1,5-2,8), colesterol HDL <45mg/dl en mujeres y <40 mg/dl en hombres (OR: 1,6; IC95% 1,1-2,2) y colesterol total >200mg/dl (OR=1,4; IC95% 1,0-1,9).Conclusiones: La prevalencia de HGNA presenta diferencias muy marcadas por sexo y está asociada a hipertrigliceridemia, hipercolesterolemia, bajo colesterol HDL, obesidad abdominal y síndrome metabólico. La introducción del cribado del HGNA en la de Vigilancia de la Salud de los trabajadores podría ser una medida de interés para la Medicina del Trabajo

Objective: To determine the prevalence of non-alcoholic fatty liver disease (NAFLD) and associated risk factors in a group of managers from the Community of Madrid. Methods: Retrospective cross-sectional study of 1838 workers (78.5% male) who underwent medical examination between January 1, 2010 and December 31, 2010 as part of a worker health surveillance program. Data were collected from medical records, laboratory results, anthropometric measurements and hepatic ultrasound. Results: The prevalence of NAFLD was 44.0%: 54.0% in men and 7.3% in women (p<0.001). In both sexes, NAFLD was associated with increasing age, higher weight, shorter stature, higher body mass index, waist circumference and metabolic syndrome, as well as higher levels of uric acid and blood glucose. In the multivariate logistic regression analysis, the risk of NAFLD risk was associated with an abdominal circumference ≥ 102cm for men and ≥ 88cm in women (OR=5.2;95%CI 3.8-7.1 ), age ≥ 40 years (OR : 3.0; 95%CI 2.3-4.0), triglycerides ≥ 150mg/dl (OR=2.1; 95%CI 1.5-2.8), HDL cholesterol<45mg/dl in women and <40mg/dl in men (OR=1.6; 95%CI 1.1-2.2), and total cholesterol >200/dl mg (OR=1.4;95%CI 1.0-1.9) .Conclusions: NAFLD prevalence is notably different among sexes and is associated with hypertriglyceridemia, hypercholesterolemia, low HDL cholesterol, abdominal obesity and metabolic syndrome. Screening programs for NAFLD in worker medical surveillance programs could be of interest in occupational medicine

[Prevalence of non-alcoholic fatty liver disease and associated risk factors among managers from the community of Madrid]. / Prevalencia de hígado graso no alcohólico y factores de riesgo asociados en directivos de la Comunidad de Madrid.

OBJECTIVE: To determine the prevalence of non-alcoholic fatty liver disease (NAFLD) and associated risk factors in a group of managers from the Community of Madrid. METHODS: Retrospective cross-sectional study of 1838 workers (78.5% male) who underwent medical examination between January 1, 2010 and December 31, 2010 as part of a worker health surveillance program. Data were collected from medical records, laboratory results, anthropometric measurements and hepatic ultrasound. RESULTS: The prevalence of NAFLD was 44.0%: 54.0% in men and 7.3% in women (p<0.001). In both sexes, NAFLD was associated with increasing age, higher weight, shorter stature, higher body mass index, waist circumference and metabolic syndrome, as well as higher levels of uric acid and blood glucose. In the multivariate logistic regression analysis, the risk of NAFLD risk was associated with an abdominal circumference ≥ 102cm for men and ≥ 88cm in women (OR=5.2; 95%CI 3.8-7.1 ), age ≥ 40 years (OR : 3.0; 95%CI 2.3-4.0), triglycerides ≥ 150mg/dl (OR=2.1; 95%CI 1.5-2.8), HDL cholesterol <45mg/dl in women and <40mg/dl in men (OR=1.6; 95%CI 1.1-2.2), and total cholesterol >200/dl mg (OR=1.4; 95%CI 1.0-1.9). CONCLUSIONS: NAFLD prevalence is notably different among sexes and is associated with hypertriglyceridemia, hypercholesterolemia, low HDL cholesterol, abdominal obesity and metabolic syndrome. Screening programs for NAFLD in worker medical surveillance programs could be of interest in occupational medicine.

OBJETIVO: Determinar la prevalencia de hígado graso no alcohólico (HGNA) y factores de riesgo asociados en directivos de la Comunidad de Madrid. MÉTODOS: Estudio descriptivo de corte transversal y retrospectivo, con la participación de 1.838 trabajadores (78,5% hombres), que acudieron a reconocimiento médico como parte del Programa de Vigilancia de la Salud entre el 01/01/2010 y el 31/12/2010. Se recogieron datos de la anamnesis, mediciones antropométricas, determinaciones bioquímicas y estudio ecográfico del hígado. RESULTADOS: La prevalencia total de HGNA fue del 44,0% (54,0% en varones y 7,3% en mujeres; p<0,001). La presencia de HGNA se asocia en ambos sexos a mayor edad, peso más elevado, talla más baja, mayor índice de masa corporal perímetro abdominal y síndrome metabólico, así como a niveles más elevados de ácido úrico y glucosa en sangre. En el análisis de regresión logística multivariante se apreció riesgo elevado de HGNA para perímetro abdominal ≥102cm en varones y ≥88cm mujeres (odds ratio OR=5,2; IC95% 3,8-7,1), edad ≥40 años (OR=3,0; IC95% 2,3-4,0), triglicéridos ≥150mg/dl (OR=2,1; IC95% 1,5-2,8), colesterol HDL <45mg/dl en mujeres y <40 mg/dl en hombres (OR: 1,6; IC95% 1,1-2,2) y colesterol total >200mg/dl (OR=1,4; IC95% 1,0-1,9). CONCLUSIONES: La prevalencia de HGNA presenta diferencias muy marcadas por sexo y está asociada a hipertrigliceridemia, hipercolesterolemia, bajo colesterol HDL, obesidad abdominal y síndrome metabólico. La introducción del cribado del HGNA en la de Vigilancia de la Salud de los trabajadores podría ser una medida de interés para la Medicina del Trabajo.

Predictores de la duración de la incapacidad temporal por contingenciascomunes en los trastornos de ansiedad / Predictors of the duration of non-work-related sick leave due to anxiety disorders

Objetivos: Analizar la duración de la incapacidad temporal por contingencias comunes (ITCC) en lostrastornos de ansiedad e identificar variables demográficas, laborales y clínicas que puedan contribuir asu predicción.Métodos: Estudio de una cohorte prospectiva de 1161 trabajadores con un episodio de ITCC por trastornode ansiedad, pertenecientes a la población protegida de una mutua de accidentes de trabajo y enfermedades profesionales. Se evaluaron la duración de la ITCC y las principales variables demográficas, laboralesy clínicas potencialmente relacionadas con ésta. Se realizó un seguimiento de todos los procesos hasta elalta. Se establecieron predictores de la duración de la ITCC mediante regresión de Cox.Resultados: La duración mediana de la ITCC en los trastornos de ansiedad fue de 83 días. Tras el análisismultivariado, tener más de 35 anos, un menor nivel de estudios (primarios, secundarios o titulación ˜media frente a titulación superior), la existencia de comorbilidad y las situaciones de desempleo quesobrevienen durante la baja, se asociaron de forma significativa con incrementos en la duración de laITCC (p <0,05). Por el contrario, encontrarse separado o divorciado se relacionó con una reincorporaciónlaboral más precoz (p <0,05).Conclusiones: Los trastornos de ansiedad se asocian con periodos de ITCC largos respecto a otras enfermedades y a los tiempos estándar de duración. Variables demográficas, laborales y clínicas presentes en laevaluación inicial del proceso permiten identificar grupos con mayor riesgo de que la ITCC se prolongue,y que requerirán estrategias orientadas a facilitar la reincorporación laboral (AU)

Objectives: To analyze the duration of non-work-related sick leave due to anxiety disorders and to identifydemographic, occupational and clinical variables that may contribute to its prediction.Methods: We performed a prospective cohort study of 1,161 workers with an episode of non-workrelated sick leave due to an anxiety disorder, belonging to the insured population of a mutual insurancecompany. We assessed the duration of non-work-related sick leave episodes and the main potentiallyrelated demographic, occupational and clinical variables. All non-work-related sick leave processes werefollowed-up until discharge. Cox regression analyses were conducted to establish the predictors of nonwork-related sick leave duration.Results: The median duration of non-work-related sick leave due to anxiety disorders was 83 days. In amultivariate analysis, the following factors were identified as being significantly associated with increasesin the duration of sick leave (p <0.05): age of over 35 years, lower educational level (primary schoolstudies, secondary school studies or high-school diploma vs. university degree), and the existence ofcomorbidity and unemployment occurring during the sick leave. In contrast, being separated or divorcedwas associated with an earlier return to work (p <0.05).Conclusions: Anxiety disorders are associated with long periods of non-work-related sick leave comparedwith other disorders and standard time duration. Demographic, occupational and clinical variables collected at the initial assessment of the sick leave episode would help to identify groups with an increasedrisk of prolonged sick leave, requiring strategies to facilitate return to work (AU)

[Predictors of the duration of non-work-related sick leave due to anxiety disorders]. / Predictores de la duración de la incapacidad temporal por contingencias comunes en los trastornos de ansiedad.

OBJECTIVES: To analyze the duration of non-work-related sick leave due to anxiety disorders and to identify demographic, occupational and clinical variables that may contribute to its prediction. METHODS: We performed a prospective cohort study of 1,161 workers with an episode of non-work-related sick leave due to an anxiety disorder, belonging to the insured population of a mutual insurance company. We assessed the duration of non-work-related sick leave episodes and the main potentially related demographic, occupational and clinical variables. All non-work-related sick leave processes were followed-up until discharge. Cox regression analyses were conducted to establish the predictors of non-work-related sick leave duration. RESULTS: The median duration of non-work-related sick leave due to anxiety disorders was 83 days. In a multivariate analysis, the following factors were identified as being significantly associated with increases in the duration of sick leave (p <0.05): age of over 35 years, lower educational level (primary school studies, secondary school studies or high-school diploma vs. university degree), and the existence of comorbidity and unemployment occurring during the sick leave. In contrast, being separated or divorced was associated with an earlier return to work (p <0.05). CONCLUSIONS: Anxiety disorders are associated with long periods of non-work-related sick leave compared with other disorders and standard time duration. Demographic, occupational and clinical variables collected at the initial assessment of the sick leave episode would help to identify groups with an increased risk of prolonged sick leave, requiring strategies to facilitate return to work.

[Prevalence of tobacco consumption among working population after the law 42/2010, Spain]. / Prevalencia de consumo de tabaco en población trabajadora tras la entrada en vigor de la Ley 42/2010.

BACKGROUND: The aim of this study was to analyze the impact on tobacco consumption among working population of the Law 42/2010, which amends smoking regulations in Spain. METHODS: Data were obtained from 413,473 Occupational Health check-ups, conducted between July of 2009 and June of 2011, in the Society for Prevention of a Mutual Insurance Company. We analyzed changes in the biannual percentage of smokers and the magnitude of tobacco consumption among smokers in the overall set of medical check-ups, by gender, age, occupational level (manual vs. non-manual workers), and in the specific occupational subgroup of waiters, barmen and similar workers (chi-square test). RESULTS: In the overall set of medical check-ups, the percentage of smokers decreased by 5% (from 40.3% to 35.3%) over the period of study (p <0.001) and the group of smokers with lower daily consumption (< 10 cigarettes) became the most frequent (p <0.001). In the group of waiters, barmen and similar workers the differences in the biannual percentage of smokers did not reach statistical significance (p =0.07). In this group, smokers of < 10 cigarretes/ day also became the most common consumption group (increasing from 40.5% to 48.8%) and the percentage of 21-40 cigarretes/day decreased from 10.6% to 4% (p =0.008). CONCLUSIONS: These results suggest that the new regulation has been accompanied by a significant reduction in smoking among Spanish workers and strongly support population-level measures against tobacco consumption.

Prevalencia de consumo de tabaco en población trabajadora tras la entrada en vigor de la Ley 42/2010 / Prevalence of tobacco consumption among working population after the Law 42/2010, Spain

Fundamentos: El objetivo del presente trabajo consistió en analizar el impacto sobre el consumo de tabaco en población trabajadora de la Ley 42/2010 que modifica la normativa antitabaco en España. Métodos: Se obtuvieron datos de 413.473 reconocimientos médicos de Salud Laboral, realizados entre julio de 2009 y junio de 2011, en la Sociedad de Prevención de una Mutua de Accidentes de Trabajo y Enfermedades Profesionales de la Seguridad Social. Se analizó la evolución semestral del porcentaje de fumadores y la magnitud del consumo de tabaco en el total de reconocimientos, segmentando por sexo, edad, nivel ocupacional (trabajos manuales vs. no manuales) y en el subgrupo específico de camareros, bármanes y asimilados (test de chi2). Resultados: En el total de reconocimientos, el porcentaje de fumadores descendió un 5% (del 40,3% al 35,3%) a lo largo del periodo de estudio (p<0,001) y el grupo de fumadores con menor consumo diario (≤10 cigarrillos) se convirtió en el más frecuente (p<0,001). En el grupo de camareros, bármanes y asimilados las diferencias en el porcentaje semestral de fumadores no alcanzaron significación estadística (p=0,07). En este grupo, los fumadores de ≤10 cigarrillos/día también se convirtieron en el grupo de consumo más frecuente (pasando del 40,5% al 48,8%) y el porcentaje de fumadores de 21-40 cigarrillos/día disminuyó del 10,6% al 4% (p=0,008). Conclusiones: Los resultados sugieren que la nueva normativa se ha acompañado de una importante reducción del tabaquismo entre la población trabajadora española y respaldan fuertemente las medidas de lucha contra el tabaco de alcance poblacional(AU)

Background: The aim of this study was to analyze the impact on tobacco consumption among working population of the Law 42/2010, which amends smoking regulations in Spain. Methods: Data were obtained from 413,473 Occupational Health check-ups, conducted between July of 2009 and June of 2011, in the Society for Prevention of a Mutual Insurance Company. We analyzed changes in the biannual percentage of smokers and the magnitude of tobacco consumption among smokers in the overall set of medical check-ups, by gender, age, occupational level (manual vs. non-manual workers), and in the specific occupational subgroup of waiters, barmen and similar workers (chi-square test). Results: In the overall set of medical check-ups, the percentage of smokers decreased by 5% (from 40.3% to 35.3%) over the period of study (p <0.001) and the group of smokers with lower daily consumption (≤ 10 cigarettes) became the most frequent (p <0.001). In the group of waiters, barmen and similar workers the differences in the biannual percentage of smokers did not reach statistical significance (p =0.07). In this group, smokers of ≤ 10 cigarretes/ day also became the most common consumption group (increasing from 40.5% to 48.8%) and the percentage of 21-40 cigarretes/day decreased from 10.6% to 4% (p =0.008). Conclusions: These results suggest that the new regulation has been accompanied by a significant reduction in smoking among Spanish workers and strongly support population-level measures against tobacco consumption(AU)

Association of moderate and severe hypertriglyceridemia with obesity, diabetes mellitus and vascular disease in the Spanish working population: results of the ICARIA study.

AIM: To study the prevalence, risk factors, and vascular disease associated with moderate and severe hypertriglyceridemia in an active working population. DESIGN AND METHODS: Cross-sectional study of 594,701 workers from all Spanish geographical areas, occupation sectors, ages, and sexes who underwent a yearly routine checkup. Data collected from participants included age, sex, anthropometric measurements, vascular risk factors, lipidic profile and basic biochemical analysis, from a fasting blood sample. A cardiovascular risk assessment was performed. RESULTS: The study population included 428,334 males and 166,367 females, mean age 36+/-10 years. A total of 95,673 (16%) workers had mild hypertriglyceridemia (HTg) (Tg 150-399mg/dL), 7,081 (1.1%) had moderate HTg (400-999mg/dL), and 224 (0.03%) had severe HTg (>or=1000mg/dL). Of workers with hypertriglyceridemia, 90% were male. Age, obesity, type 1 and 2 diabetes, alcohol consumption, and vascular disease were associated with hypertriglyceridemia. Cardiovascular risk gradually increased for each HTg category. Amongst risk factors, the major independent predictor of mild-HTg was obesity (OR 2.42, CI 95% 2.37-2.48), whereas diabetes was a predictor of moderate HTg (OR 3.64, CI 95% 3.17-4.18) and severe HTg (OR 7.35, CI 95% 4.27-12.66). In multivariate analyses, HTg was gradually associated with vascular disease, even after adjusting for other risk factors. CONCLUSION: In this working population, preventive programs for HTg and associated vascular disease should consider obesity-diabetes control as its first objective.