Presión arterial y síndrome de apnea-hipopnea del sueño en trabajadores. Test STOP-Bang frente a la escala de Epworth / Blood pressure and sleep apnoea hypopnoea syndrome in workers. STOP-Bang test versus Epworth test

Introducción: El SAHOS está asociado con un mayor riesgo cardiovascular y cerebrovascular. La hipertensión arterial es un factor de riesgo clave a considerar por sus repercusiones en la salud. Método: Estudio transversal en trabajadores de empresas de la Administración Pública española. Se valora el riesgo de apneas nocturnas mediante los cuestionarios Epworth y STOP-Bang y su influencia en las cifras medias de presión arterial. Resultados: La detección de SAHOS con el test de Epworth y especialmente con el STOP-Bang muestra una relación significativa con las cifras medias de presión arterial con diferencias entre ambos cuestionarios. Conclusión: Tanto el Epworth como el STOP-Bang resultan de utilidad para la detección inicial de SAHOS y su relación con una mayor prevalencia de cifras elevadas de presión arterial. Ambos pueden ser utilizados en procedimientos de cribado en el mundo del trabajo (AU)

Introduction: OSAHS is associated with an increased risk of cardiovascular disease and stroke. Arterial hypertension is a key risk factor to consider due to its impact on health. Method: Cross-sectional study carried out on Spanish public service workers. The nocturnal apnoea risk using the Epworth and STOP-Bang questionnaires and their influence on the mean values of blood pressure are assessed. Results: The detection of OSAHS using the Epworth test and, particularly with the STOP-Bang shows a significant relationship with the mean values of blood pressure, with differences between both questionnaires. Conclusion: The Epworth and STOP-Bang questionnaires are useful for the initial detection of OSAHS and a higher prevalence of high blood pressure. Both can be used in screening procedures in occupational health (AU)

[Blood pressure and sleep apnoea hypopnoea syndrome in workers. STOP-Bang test versus Epworth test]. / Presión arterial y síndrome de apnea-hipopnea del sueño en trabajadores. Test STOP-Bang frente a la escala de Epworth.

INTRODUCTION: OSAHS is associated with an increased risk of cardiovascular disease and stroke. Arterial hypertension is a key risk factor to consider due to its impact on health. METHOD: Cross-sectional study carried out on Spanish public service workers. The nocturnal apnoea risk using the Epworth and STOP-Bang questionnaires and their influence on the mean values of blood pressure are assessed. RESULTS: The detection of OSAHS using the Epworth test and, particularly with the STOP-Bang shows a significant relationship with the mean values of blood pressure, with differences between both questionnaires. CONCLUSION: The Epworth and STOP-Bang questionnaires are useful for the initial detection of OSAHS and a higher prevalence of high blood pressure. Both can be used in screening procedures in occupational health.

La incapacidad laboral en epilepsia. Criterios de valoración / Occupational disability in epilepsy. The assessment criteria

La epilepsia es una enfermedad crónica, con crisis recurrentes y paroxísticas por anomalías en la actividad eléctrica cerebral, y controlable en la mayor parte de los pacientes mediante fármacos antiepilépticos, en monoterapia o politerapia. Probablemente uno de los aspectos más complejos en epilepsia es la valoración de la incapacidad laboral que produce en la persona afectada. Para realizarla deben tenerse en cuenta múltiples factores tendentes a la adopción de decisiones homogéneas, atendiendo a criterios de homologación y dentro del principio de equidad que preside la concesión de las prestaciones de la Seguridad Social por incapacidad laboral. Se requiere para ello la colaboración de todos los profesionales implicados en las distintas especialidades regidos en sus informes por criterios comunes y considerando la propia enfermedad y los efectos de los tratamientos prescritos, que pueden contribuir por sus efectos adversos a las limitaciones para el desempeño de determinadas profesiones de riesgo (AU)

Epilepsy is a chronic disease cursing with recurrent and paroxysmal crises due to anomalies in the electrical activity of brain, and is controllable in most of the patients by using antiepileptic drugs, in single or combination therapy. Probably one of the most complex aspects of epilepsy is the assessment of disability for work of the affected person. For this purpose, multiple factors need to be taken into account for homogeneous decision-making, and according to criteria of approval and within the principle of equity inherent in the granting of Social Security disability benefits. This requires the cooperation of all professionals involved in the different specialties, with reports using common criteria and taking into account the disease itself, as well as the effects of the prescribed treatments, the effects of which can contribute to the limitations in the performance of certain professions of risk (AU)

[Occupational disability in epilepsy. The assessment criteria]. / La incapacidad laboral en epilepsia. Criterios de valoración.

Epilepsy is a chronic disease cursing with recurrent and paroxysmal crises due to anomalies in the electrical activity of brain, and is controllable in most of the patients by using antiepileptic drugs, in single or combination therapy. Probably one of the most complex aspects of epilepsy is the assessment of disability for work of the affected person. For this purpose, multiple factors need to be taken into account for homogeneous decision-making, and according to criteria of approval and within the principle of equity inherent in the granting of Social Security disability benefits. This requires the cooperation of all professionals involved in the different specialties, with reports using common criteria and taking into account the disease itself, as well as the effects of the prescribed treatments, the effects of which can contribute to the limitations in the performance of certain professions of risk.

[Pain and workplace. Sociodemographic variables influence in therapeutic response and labor productivity]. / Dolor y trabajo. Influencia de variables sociodemográficas en la respuesta terapéutica y la productividad laboral.

INTRODUCTION: Pain is a major cause of medical consultation. The complexity of managing it is due to its long duration and intensity, and it sometimes requires a combination of multiple drugs. The objective of this study is to assess the use of drugs for pain in workers, the clinical response obtained, its influence on estimating work productivity, its relationship to sociodemographic variables, and the type of drug used. MATERIAL AND METHODS: A cross-sectional study on 1,080 workers, aged 18-65 years, during periodic surveys to monitor their health in companies in the service sector in Spain. Treatments used, clinical efficacy, influence on work productivity and sociodemographic variables (age, gender) are evaluated. The Brief Pain Inventory questionnaire, validated for Spain, was used to assess pain, and the SPSS(®) 20.0 package for the statistical analysis. RESULTS: NSAIDs and simple analgesics have higher percentages of improvement in pain (P=.032 and P<.0001, respectively). Men respond better to NSAIDs, and women to simple analgesics. Improved productivity is higher in men than in women (P=.042). No significant differences were observed for age, pain improvement or productivity, except in those over 55 years. CONCLUSIONS: The analgesic prescription pain conditions must consider the age and gender of the patient, as well as the type of drug. The choice of drug should be based on the aetiology and aspects unrelated to the clinical variables, such as sociodemographic, work or psychosocial.

[Chronic migraine and work: occupational risks and prevention]. / Migraña crónica y trabajo. Riesgos laborales y aspectos preventivos.

Chronic migraine is a clinically difficult to manage primary headache which affects the quality of life of the patients. This impact is important in the occupational world, where along with the clinical aspects of the disease, the therapies used for the control of the symptoms or preventive aspects, must be assessed. The side effects of the drugs and the limitations associated with their symptoms are aspects to highlight in occupational health, especially in individual workplaces, where there is a high risk of work-related injuries. The medical officer must assess the occupational risks of particular importance in the progression of this disease, as well as preventive actions, within the ambit of the current Spanish legislation, that may be favorable for both the company and the worker. The coordinated medical intervention and knowledge of these occupational aspects can provide clinically relevant tools, andoccupational and social optimization in the use of available resources.

[Colorectal cancer in Spain: Temporary disability and preventive occupational strategies]. / El cáncer colorrectal en España. Costes por incapacidad temporal y opciones preventivas desde las empresas.

BACKGROUND: Colorectal cancer is one of the most frequent cancers in both sexes and the most frequent in the developed countries, if men and women are considered together as a group. It has an important associated morbidity and mortality in all countries and constitutes a public health problem with a high direct and indirect economic cost. The number of workdays lost due to temporary disability (TD) is one of the quantifiable references of these indirect costs. AIMS: To determine the indirect cost associated with TD due to colorectal cancer in Spain during the year 2011, a cost that aids in the prevention cost/benefit estimation. METHODS: The number of TD processes, the number of workdays lost due to TD, and the mean duration of those processes, based on the CIE 9-MC codes related to this pathology, as well as the calculated cost, using the Spanish minimum wage as a reference, during the period of January to December 2011, were all reviewed. RESULTS: Colorectal cancer in Spain during 2011 represented 1,046 TD processes, 202,784 workdays lost, and a mean process duration of 194 days/year. The resulting cost of the pathology due to TD was 4,335,521.92 euros. CONCLUSIONS: These results are beneficial for evaluating the usefulness of implementing public health support strategies for a greater reduction in colorectal cancer prevalence and mortality, and an improvement in quality of life of the affected individuals and their families, together with an economic savings resulting from a reduction in TD as a consequence of this disease.

[Work disability criteria in breast cancer]. / Criterios de incapacidad laboral en cáncer de mama.

Breast cancer is one of the most frequent neoplasia in women, with an increasing prevalence in Europe and also in Spain. Although the predominance over the male sex is clear, we should not forget the cases where men are affected, even more so when in this case the risks attached to the type of job become more important. The importance of the indirect costs of this illness arises from: the high prevalence in people of working age, long periods of work disability, and permanent disability when the limitations are incompatible with the work activity once all the options of job readjustment and return to work have been exhausted. We will review the current criteria in order to establish some orientating guidelines that can be useful in the daily practice for Occupational Medicine professionals, General Practitioners and other specialists, always in collaboration with the medical teams from the National Health Service in charge of the evaluation of disabilities.

[Allergies in occupational health. Prevention aspects]. / Las alergias en salud laboral. Aspectos preventivos.

The concern in all countries of occupational health has led to the study of occupational risk factors and their impact on health. But maintaining the health of workers is increasingly complex, especially in occupational allergic diseases, which have increased in parallel with the increased use in industries of potentially irritating chemicals or allergens, leading to skin or respiratory sensitization. Diseases arising from these immunological substances are classified by Spanish Legislation as occupational diseases, as set out in Royal Decree 1299/2006, of November 10, 2006 (Group 1, Group 4 and Group 5). The most important ones in occupational medicine are allergic respiratory diseases and dermatological allergic diseases, although there are other allergies of interest, such as those involving mucous membranes (allergic eye diseases). A joint collaboration between the different medical disciplines involved to improve prevention at work is highly desirable.

Minusvalía e incapacidad en la diabetes y sus complicaciones. Una revisión desde la legislación española / Handicap and disability in diabetes and its complications. A review of the Spanish laws

Los conceptos de discapacidad, minusvalía e incapacidad hacen referencia,en su conjunto, a consecuencias de las patologías y/o malformaciones y a susrepercusiones en la vida de las personas. Lo que varía en cada caso es elámbito de repercusión personal, socioambiental o laboral, y con ello las implicacionesque suponen y sus prestaciones. Estos temas, que forman parte delas tareas habituales del médico del trabajo, resultan menos conocidos y utilizadosen el ámbito asistencial, tanto para el médico de atención primaria comopara otros especialistas. Este artículo pretende aproximar a los profesionalessanitarios, partiendo de la legislación vigente en España, la definición deestos conceptos, su manejo y el procedimiento de valoración de la diabetes,entidad patológica que por sí misma, y sobre todo cuando se le añaden complicacionesevolutivas, genera en el paciente una compleja problemática asociadaa sus limitaciones personales, familiares, sociales y laborales, de grantrascendencia en los sistemas públicos sanitarios y de la Seguridad Social,con costes económicos difíciles de cuantificar(AU)

The concepts of disability, handicap and impairment refer, as a whole, to consequencesof diseases and/or malformations and their impact on the lives ofpeople. What varies in each case is scope of the personal, social and environmentalor labour, and thus the implications posed and the benefits that couldresult in. These issues, as part of normal duties of occupational doctors, areless known and used in the level of medical care, either by GPs as well byother specialists. This article aims to bring practitioners health, based on currentlegislation in Spain, the definition of these concepts, their managementand the valuation process of diabetes, pathological entity in itself, especiallywhen other complications evolutionary generated are added in the complexproblems of patients due to due to personal, familiar, social and labour limitations.These limitations have a great repercussion in public health systems andsocial security, which economic costs are very difficult to evaluate(AU)

Treinta años de diabetes en la jurisprudencia española (revisión 1979-2009) / Thirty years of diabetes in spanish law (1979-2009 Review)

La medicina y el derecho son ramas del conocimiento que, lejos de caminar de una forma independiente, están cada vez más interconectadas. Este hecho, que en medicina afecta a todas las especialidades médicas, es de especial trascendencia en patologías crónicas como la diabetes, con un curso evolutivo tendente al desarrollo de múltiples complicaciones que generan conflictos médicos y derivan con frecuencia en procedimientos administrativos que, si no son correctamente gestionados, desembocan en la vía judicial. Conviene, pues, familiarizarse con la búsqueda jurídica y jurisprudencial en medicina, como ya se hace de forma habitual y sistematizada con la búsqueda bibliométrica y bibliográfica a través de los portales de prestigio al uso, entre los que sin duda PubMed es el referente para la profesión sanitaria. La revisión jurisprudencial de la diabetes y sus complicaciones en los cuatro órdenes jurisdiccionales: penal, social, contencioso-administrativo y civil, permite valorar todos los matices derivados de la conflictividad de la patología y actuar con un conocimiento básico jurídico y preventivo ante posteriores consecuencias, tanto para el propio profesional sanitario implicado como para la empresa y la sociedad en la que finalmente recaen los costes económicos de este tipo de procedimientos (AU)

The Medicine and Law are branches of the knowledge that far from walking of an independent way, at every time are more interconnected. This fact, that in Medicine affects to anyone of the medical disciplines, has great importance in chronic pathologies like diabetes with a progression that has the development of multiple complications of medical conflict and administrative procedures of them derived that are not correctly managed, end at legal channels. It would be better to become familiarize with legal and jurisprudential search in Medicine, and as it has become a common situation and systematized form with the bibliometrical and bibliographical search through the internet portal of prestige, that the Pub-Med is the reference one, without a doubt, for the sanitary profession. The jurisprudential revision of the diabetes and its complications in the four jurisdictional orders: penal, social, Administrative contentious and civil, allows to approach all the shades derived from the confliction of the pathology and can act with a basic legal and preventive knowledge before consequences within the complex management of the diabetic patient, who has repercussions, for the own involved sanitary professional, like company and society which finally fall the economic costs of this type of procedures (AU)

El hombro y sus patologías en medicina del trabajo / Shoulder and their pathologies in occupational medicine

Las patologías del hombro son de las más frecuentes tanto en medicina del trabajo como en Atención Primaria, traumatología, reumatología y rehabilitación. Nos interesa estudiar con detalle los factores laborales y las actividades de riesgo dentro del mundo del trabajo que pudieran provocar o favorecer su aparición o bien agravar su evolución, haciendo especial hincapié en la legislación de aplicación en salud laboral y en las actividades preventivas relacionadas con la vigilancia periódica de la salud y en los protocolos que se aplican, así como en el Real Decreto de enfermedades profesionales en el que se encuentran incluidas las enfermedades del hombro, para los casos en los que pudiera establecerse un origen laboral. Se trata, en conclusión, de buscar una actuación profesional coordinada entre los médicos del trabajo, los de Atención Primaria y atención especializada en el manejo y control evolutivo de estas patologías (AU)

Shoulder pathologies are among the most common in both in occupational health and in primary care, traumatology, rheumatology and rehabilitation. In this paper, we examine in detail the risk factors and activities in the workplace that could provoke, aggravate or favor the appearance of shoulder pathologies. We emphasize the application of the laws on occupational health, preventive activities related to periodic vigilance and check-ups and the current protocols in effect as well as the Royal Decree on illnesses (including shoulder illnesses) which originate in the workplace. Our objective is to improve professional coordination among occupational, primary care and specialized health professionals in the management and care of these pathologies (AU)