Urinary polycyclic aromatic hydrocarbon metabolites levels in a representative sample of the Spanish adult population: The BIOAMBIENT.ES project.

In 2009, the Spanish Ministry of Agriculture, Food and Environment promoted the BIOAMBIENT.ES project, a Human Biomonitoring program on the national scale to estimate reference levels of environmental pollutants on a representative sample of the Spanish adults. The present study focuses on polycyclic aromatic hydrocarbons (PAHs). The urinary metabolites 1-hydroxypyrene, 1-,2-,3-,4- and 9-hydroxyphenanthrene and 3-hydroxybenzo[a]pyrene were selected as indicators of PAH exposure. Urine samples from 957 subjects (16-65 years old) were collected during year 2009-2010. Geometric mean and 95th percentile for 1-hydroxypyrene in µg g(-1) creatinine were 0.117 (non-smoker: 0.079, smokers: 0.184) and 0.67 µg g(-1) creatinine (non-smokers: 0.31, smokers: 0.69) respectively. GM and 95th percentile for sum of hydroxyphenanthrenes in µg g(-1) creatinine were 0.130 (non-smokers: 0.089, smokers: 0.317) and 1.29 (non-smokers: 0.71, smokers: 1.51) respectively. 3-Hydroxybenzo[a]pyrene was below the limit of quantitation (0.05 µg L(-1)) in all cases. Significant differences (p<0.05) regarding smokers and non-smokers, coal and wood heating, body mass index and second hand smoke were found, while other variables like gender, age, or diet showed no significant association. The geographical distribution of the metabolites showed higher levels in people who lived in the north and northwest of Spain. The PAH metabolites levels found were in the same range or lower than those reported from other European countries and they were higher than those found in the U.S. This study represents the first nationwide survey of exposure to PAHs in Spain and provides a background reference range for exposure to PAHs in the Spanish adult occupied population.

Factors influencing return-to-work after cerebrovascular disease: the importance of previous cardiovascular risk.

BACKGROUND: The role of prior cardiovascular risk (CVR) in the multifactorial process of returning to work after a cerebrovascular event has not been adequately investigated. Therefore, the objective of the present study was to analyse the association between previous CVR level, cardiovascular risk factors (CVRFs) and return-to-work (RTW) following cerebrovascular disease. DESIGN: This was a prospective observational study. METHODS: We analysed a cohort of 348 patients who had experienced an episode of cerebrovascular disease-related work absence. These individuals were selected from the ICARIA study (Ibermutuamur CArdiovascular RIsk Assessment). Global CVR was assessed using the SCORE system. We investigated the association between demographics, work-related variables, CVRFs and RTW following a cerebrovascular event. RESULTS: We found that a total of 254 individuals (73.0%; 95% CI: 68.3-77.7) returned to work after cerebrovascular disease. Also, we observed a median loss of 12 working years due to disability. Moreover, adjusting for potential confounders revealed that low CVR level and the absence of the following CVRFs was associated with a higher likelihood of RTW: low vs moderate-to-high CVR level (OR: 2.55; 95% CI: 1.42-4.57), no hypertension before stroke (OR: 1.95; 95% CI: 1.11-3.41), non-smoker status (OR: 2.26; 95% CI: 1.30-3.93) and no previous diabetes (OR: 2.46; 95% CI: 1.26-4.79). CONCLUSIONS: Low CVR, along with the absence of several CVRFs, can be used to predict RTW rates following cerebrovascular events. Therefore, controlling hypertension, tobacco consumption and diabetes might contribute to the effectiveness of multidisciplinary rehabilitation and/or secondary/tertiary prevention programs for cerebrovascular disease.

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.

Periodo prequirúrgico y duración de la incapacidad temporal por contingencias comunes en la hernia inguinal / Pre-surgical period and non-work-related sickness absence due to inguinal hernia

FUNDAMENTO Y OBJETIVO: Analizar la incapacidad temporal por contingencias comunes (ITCC) debida a hernia inguinal y los factores relacionados con su duración, prestando especial atención al periodo prequirúrgico de ITCC. MATERIAL Y MÉTODOS: Estudio de una cohorte prospectiva de 1.003 trabajadores con un episodio de ITCC por hernia inguinal, 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, laborales y clínicas potencialmente relacionadas con aquella. Se establecieron predictores de la duración de la ITCC mediante regresión de Cox. RESULTADOS: La duración media de la ITCC por hernia inguinal fue de 68,6 días. Tras el análisis multivariante, tener periodo prequirúrgico de ITCC (HR = 0,35; IC 95%: 0,28-0,43), las ocupaciones manuales (HR = 0,68; IC 95%: 0,49-0,95), pertenecer al sector Construcción (HR = 0,71; IC 95%: 0,58-0,88), la modalidad de pago directo por la mutua en trabajadores por cuenta propia (HR = 0,58; IC 95%: 0,41-0,82) o ajena (HR = 0,51; IC 95%: 0,36-0,72), la presencia de comorbilidad (HR = 0,45; IC 95%: 0,34-0,59) y la realización de la cirugía por una entidad distinta del Sistema Público de Salud o la mutua (HR = 0,76; IC 95%: 0,59-0,97) se asociaron con bajas más largas. La mutua realizó la cirugía, siempre en presencia de periodo de ITCC prequirúrgica (duración media = 47 ± 39,6 días), asociándose periodos de ITCC posquirúrgica más breves (p = 0,001). CONCLUSIONES: La ITCC por hernia inguinal es un fenómeno multifactorial en el que el periodo prequirúrgico desempeña un papel importante. La colaboración entre entidades implicadas en la gestión de la ITCC parece resultar una estrategia efectiva para reducir su duración

BACKGROUND AND OBJECTIVE: To analyze non-work-related sickness absence (NWR-SA) due to inguinal hernia and the factors related to its duration, paying particular attention to the pre-surgical period of NWR-SA. MATERIAL AND METHODS: Prospective cohort study was conducted on 1,003 workers with an episode of NWR-SA due to an inguinal hernia, belonging to the insured population of a mutual insurance company. We assessed the duration of the NWR-SA episodes and the main demographic, occupational and clinical variables potentially related to it. Cox regression analyses were conducted to establish the predictors of NWR-SA duration. RESULTS: The mean duration of NWR-SA due to inguinal hernia was 68.6 days. After multivariate analysis (Cox regression), having a pre-surgical period of NWR-SA (HR = 0.35; 95% CI: 0.28-0.43), manual occupations (HR = 0.68; 95% CI: 0.49-0.95), construction sector (HR = 0.71; 95%CI: 0.58-0.88), direct payment methods by a Mutual Insurance Company during sick leave in self-employed workers (HR = 0.58; 95% CI, 0.41-0.82), or employees (HR = 0.51; 95% CI: 0.36-0.72), comorbidity (HR = 0.45; 95% CI:0.34-0.59), and surgery performed under an entity other than the Public Health System or a mutual insurance company (HR=0,76; 95%CI: 0.59-0.97) were associated with longer NWR-SA. The Mutual Insurance Company always performed the surgery when a pre-surgery period of NWR-SA existed (mean duration = 47 ± 39.6 days); that was associated with shorter periods of post-surgical NWR-SA (P = .001). CONCLUSIONS: The NWR-SA due to inguinal hernia is a multifactorial phenomenon in which the pre-surgery period plays an important role. The collaboration between organizations involved in the management of NWR-SA seems to be an effective strategy for reducing its duration

Blood lead levels in a representative sample of the Spanish adult population: the BIOAMBIENT.ES project.

This paper provides the first baseline information on a national scale regarding lead exposure in the Spanish adult population. Blood lead levels were measured in a representative sample of the Spanish working population (1880 subjects aged 18-65 years) in order to help establish reference levels, follow temporal trends, identify high-exposure groups and to enable comparisons with other countries. All participants completed an epidemiological questionnaire including gender, age, occupational sector, geographic area, and dietary and lifestyle information. We found that the geometric mean of blood lead levels in the study population was 24.0µg/L (95% CI: 23.0-25.1µg/L), with women having significantly lower levels than men, 19.5µg/L (18.5-20.5µg/L) compared to 28.3µg/L (26.7-30.0µg/L), respectively. Mean blood lead levels were higher in elder groups in both genders. Women of a childbearing age had blood levels of 18.0µg/L (GM). Reference values (95%) for lead in blood in the studied population was 56.80µg/L, with -64.00µg/L, 44.80µg/L and 36.00µg/L for man, women and women of childbearing age, respectively. Workers from the service sector had lower blood lead levels than those from the construction, agricultural and industry sectors. Small, although significant, geographical differences had been found. In an European comparison, the Spanish population studied herein had lead levels similar to populations in countries such as France and Belgium, and slightly lower levels than Italian, Czech, German or UK populations.

[Pre-surgical period and non-work-related sickness absence due to inguinal hernia]. / Periodo prequirúrgico y duración de la incapacidad temporal por contingencias comunes en la hernia inguinal.

BACKGROUND AND OBJECTIVE: To analyze non-work-related sickness absence (NWR-SA) due to inguinal hernia and the factors related to its duration, paying particular attention to the pre-surgical period of NWR-SA. MATERIAL AND METHODS: Prospective cohort study was conducted on 1,003 workers with an episode of NWR-SA due to an inguinal hernia, belonging to the insured population of a mutual insurance company. We assessed the duration of the NWR-SA episodes and the main demographic, occupational and clinical variables potentially related to it. Cox regression analyses were conducted to establish the predictors of NWR-SA duration. RESULTS: The mean duration of NWR-SA due to inguinal hernia was 68.6 days. After multivariate analysis (Cox regression), having a pre-surgical period of NWR-SA (HR = 0.35; 95%CI: 0.28-0.43), manual occupations (HR=0.68; 95%CI: 0.49-0.95), construction sector (HR=0.71; 95%CI: 0.58-0.88), direct payment methods by a Mutual Insurance Company during sick leave in self-employed workers (HR=0.58; 95%CI, 0.41-0.82), or employees (HR=0.51; 95%CI: 0.36-0.72), comorbidity (HR=0.45; 95%CI:0.34-0.59), and surgery performed under an entity other than the Public Health System or a mutual insurance company (HR=0,76; 95%CI: 0.59-0.97) were associated with longer NWR-SA. The Mutual Insurance Company always performed the surgery when a pre-surgery period of NWR-SA existed (mean duration=47 ±39.6 days); that was associated with shorter periods of post-surgical NWR-SA (P=.001). CONCLUSIONS: The NWR-SA due to inguinal hernia is a multifactorial phenomenon in which the pre-surgery period plays an important role. The collaboration between organizations involved in the management of NWR-SA seems to be an effective strategy for reducing its duration.

Prevalence of viral hepatitis (B and C) serological markers in healthy working population.

INTRODUCTION AND OBJECTIVES: prevalence of viral hepatitis (B and C) changes geographically. Our aim was to determinate the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) serological markers in healthy working population and to describe the epidemiological characteristics associated to its presence. METHODS: blood samples and epidemiological data of 5,017 healthy workers from Murcia and Madrid were recorded prospectively. RESULTS: a total of 5,017 healthy volunteers participated. Mean age 39 ± 11 years, men predominance (73 %). Prevalence of serological markers of HCV and HBV was 0.6 % and 0.7 %. Age of patients with HCV antibody was significantly higher (43 + or - 9 years vs. 39 + or - 11 years; p = 0.03). We observed significant differences in liver test values (alanine aminotransferase [ALT] 64 ± 56 IU/L vs. 28 ± 20 IU/L; p < 0.001; aspartate aminotransferase [AST] (51 + or - 45 IU/L vs. 23 + or - 12 IU/L; p < 0.001) and in gamma-glutamyltransferase(GGT) value (104 + or - 122 IU/L vs. 37 + or - 46 IU/L; p < 0.001. The presence of HCV antibody was related significantly to previous transfusion (13 % vs. 5 %; p = 0.03), tattoos (29 % vs. 13 %; p < 0.01), intravenous drug addiction (13 % vs. 0.2 %; p < 0.001) and coexistence with people with positive HCV antibody (16 % vs. 4 %; p < 0.001). In HBV no differences in basal characteristics were observed with exception in AST values (29 + or - 15 IU/L vs. 23 + or - 12 IU/L; p < 0.01). Hepatitis B surface antigen (HBsAg) was related significantly to previous transfusion (15 % vs. 5 %; p < 0.01), tattoos (26 % vs. 14 %; p = 0.04) and coexistence with people with positive HBsAg (17 % vs. 4 %; p < 0.001). CONCLUSIONS: Prevalence of serological markers in healthy working population is low. Risk factors for infection were previous transfusion and tattoos. Intravenous drug addiction was only a risk factor in HCV.

Prevalencia de marcadores serológicos de virus hepatotropos (B y C) en población trabajadora sana / Prevalence of viral hepatitis (B and C) serological markers in healthy working population

Introducción y objetivos: la prevalencia de las hepatitis víricas (B y C) varía geográficamente. Nuestro objetivo fue determinar la prevalencia de los marcadores serológicos de los virus de la hepatitis B (VHB) y de la hepatitis C (VHC) en población trabajadora sana describiendo las características epidemiológicas asociadas. Métodos: se recogieron prospectivamente muestras de sangre y datos epidemiológicos de 5.017 trabajadores sanos de Murcia y Madrid. Resultados: se incluyeron en el estudio 5.017 voluntarios sanos. Edad media 39 ± 11, 73 % varones. La prevalencia de los marcadores serológicos del VHC y el VHB fue de 0,6 % y 0,7 %, respectivamente. La edad de los pacientes con presencia de anti-VHC fue significativamente mayor (43 ± 9 años frente a 39 ± 11 años; p = 0,03). Se objetivaron diferencias significativas en los valores de transaminasas (alanina-aminotransferasa [ALT] 64 ± 56 UI/l frente a 28 ± 20 UI/l; p < 0,001; aspartato-aminotransferasa [AST] 51 ± 45 UI/l frente a 23 ± 12 UI/l; p < 0,001) y en los valores de gamma-glutamiltransferasa (GGT) (104 ± 122 UI/l frente a 37 ± 46 UI/l; p < 0,001). La presencia de anti-VHC se relacionó significativamente con transfusión previa (13 % frente a 5 %; p = 0,03), tatuajes (29 % frente a 13 %; p < 0,01), adicción a drogas por vía parenteral (ADPV) (13 % frente a 0,2 %; p < 0,001) y convivencia con personas con anti-VHC positivo (16 % frente a 4 %; p < 0,001). Respecto al VHB, no se evidenciaron diferencias en las características basales, a excepción de los valores de AST (29 ± 15 UI/l frente a 23 ± 12 UI/l; p < 0,01) El antígeno de superficie del VHB (AgHBs) se relacionó significativamente con transfusión previa (15 % frente a 5 %; p < 0,01), tatuajes (26 % frente a 14 %; p = 0,04) y convivencia con personas con AgHBs + (17 % frente a 4 %; p < 0,001). Conclusiones: la prevalencia de los marcadores serológicos del VHC y del VHB en población trabajadora sana es baja. Los factores de riesgo asociados a su presencia fueron la transfusión previa y la presencia de tatuajes. La ADVP se demostró como factor de riesgo solo en el caso del VHC (AU)

Introduction and objectives: prevalence of viral hepatitis (B and C) changes geographically. Our aim was to determinate the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) serological markers in healthy working population and to describe the epidemiological characteristics associated to its presence. Methods: blood samples and epidemiological data of 5,017 healthy workers from Murcia and Madrid were recorded prospectively. Results: a total of 5,017 healthy volunteers participated. Mean age 39 ± 11 years, men predominance (73 %). Prevalence of serological markers of HCV and HBV was 0.6 % and 0.7 %. Age of patients with HCV antibody was significantly higher (43 ± 9 years vs. 39 ± 11 years; p = 0.03). We observed significant differences in liver test values (alanine aminotransferase [ALT] 64 ± 56 IU/L vs. 28 ± 20 IU/L; p < 0.001; aspartate aminotransferase [AST] (51 ± 45 IU/L vs. 23 ± 12 IU/L; p < 0.001) and in gamma-glutamyltransferase (GGT) value (104 ± 122 IU/L vs. 37 ± 46 IU/L; p < 0.001. The presence of HCV antibody was related significantly to previous transfusion (13 % vs. 5 %; p = 0.03), tattoos (29 % vs. 13 %; p < 0.01), intravenous drug addiction (13 % vs. 0.2 %; p < 0.001) and coexistence with people with positive HCV antibody (16 % vs. 4 %; p < 0.001). In HBV no differences in basal characteristics were observed with exception in AST values (29 ± 15 IU/L vs. 23 ± 12 IU/L; p < 0.01). Hepatitis B surface antigen (HBsAg) was related significantly to previous transfusion (15 % vs. 5 %; p < 0.01), tattoos (26 % vs. 14 %; p = 0.04) and coexistence with people with positive HBsAg (17 % vs. 4 %; p < 0.001). Conclusions: prevalence of serological markers in healthy working population is low. Risk factors for infection were previous transfusion and tattoos. Intravenous drug addiction was only a risk factor in HCV (AU)

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)

[Practical features of the pre-analytical phase of the BIOAMBIENT.ES biomonitoring study]. / Aspectos prácticos de la fase preanalítica del estudio de biovigilancia BIOAMBIENT.ES.

The fieldwork of BIOAMBIENT.ES was developed from March 2009 to July 2010. BIOAMBIENT.ES is a human biomonitoring study of environmental pollutants performed in Spain at the national level. This article aims to show the tasks performed before starting the fieldwork to ensure the quality of the samples and consequently the quality of the results. A total of 1,936 whole blood, serum and first-morning urine samples and 604 hair samples were collected from workers who attended the annual occupational health examination in 38 centers in the Peninsula, Ceuta and the Canary Islands. Before the fieldwork was started, the optimal sampling material and sample shipment was identified and fieldworkers were trained in their tasks. Due to the planning and organization of the pre-analytical phase, only 1% of the collected samples had to be rejected due to problem with spills, conservation, etc. In addition, the analyses conducted showed no pre-analytical interferences.

BIOAMBIENT.ES study protocol: rationale and design of a cross-sectional human biomonitoring survey in Spain.

Human biomonitoring (HBM), defined as the measurement of concentrations of chemicals or of their metabolites in human biological matrices, is considered the method of choice for determining internal exposures in individuals. HBM is part of environmental exposure surveillance systems in several countries. In 2007, the Ministry of Agriculture, Food and Environment promoted BIOAMBIENT.ES project, a national-level HBM study on environmental pollutants carried out in Spain to estimate levels of heavy metals, persistent organic pollutants, and other substances on the Spanish active workforce. BIOAMBIENT.ES is a nationwide cross-sectional study, with a stratified cluster sampling designed to cover all geographical areas, sex and occupational sectors, and aimed to obtain a representative sample of the Spanish workforce. Participants were recruited among people residing in Spain for 5 years or more, which underwent their annual occupational medical check-up in the health facilities of the Societies for Prevention of IBERMUTUAMUR, MUTUALIA, MC-PREVENCIÓN, MUGATRA, UNIMAT PREVENCIÓN, and PREVIMAC (March 2009-July 2010). A total of 1,892 subjects fulfilled the criteria for inclusion, donated biological samples (1,880 blood, 1,770 urine, and 577 hair) and completed a short self-administrated epidemiological questionnaire on environmental and lifestyle-related exposures. Additionally, clinical information from participant's health exams was obtained. This project will provide a first overview of the body burden of selected pollutants in a representative sample of the Spanish-occupied population. This information will be useful to establish reference values of the studied population and, eventually, to evaluate temporal trends and the effectiveness of environmental and health policies.

[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.

Análisis de la influencia de polimorfismos en APOE, APOA5, LPL, LIPC y CETP sobre los niveles de triglicéridos en población laboral malagueña / Analysis of the influence of polymorphisms in the APOE, APOA5, LPL, LIPC and CETP (Spain)

Introducción: Los triglicéridos se consideran un factor independiente de riesgo vascular. La influencia, por separado, de polimorfismos en genes como APOE, APOA5, LPL, LIPC y CETP sobre dichos niveles está descrita, por lo que resulta de interés su análisis conjunto y el estudio de interacciones con factores ambientales. Métodos: Se han genotipado en 1.825 sujetos (80% varones, edad media 36 años) procedentes del estudio ICARIA, el polimorfismo de APOE, 2 variantes de APOA5 (S19W y -1131 T/C), 5 deLPL (D9N, N291S, PvuII, HindIII y S447X), 1 de LIPC (-250G/A) y 1 de CETP (TaqI ) mediante PCR-restricción y ensayos TaqMan. El efecto conjunto de las variantes se ha analizado mediante regresión lineal con la variable triglicéridos transformada logarítmicamente y corrigiendo porcovariables. Las interacciones se han explorado mediante contrastes múltiples. Resultados: El alelo 4 de APOE, los polimorfismos de APOA5 S19W y -1131T/C y las variantes de LPL, D9N y N291S mostraron un efecto elevador de triglicéridos significativo e independiente. Los polimorfismos HindIII y S447X de LPL se asociaron significativamente con una reducción de los niveles de TG. Las variantes PvuII (LPL), -250G/A (LIPC) y TaqI (CETP) no mostraron asociaciones significativas. Se encontró una tendencia estadística (p=0,048) para la interacción entre obesidad abdominal (perímetro de cintura >102 cm en hombres; >88 cm en mujeres) y elalelo APOE- 4 (AU)

Introduction: Triglyceride levels are considered to be an independent vascular risk factor. The influence of polymorphisms in genes such as APOE, APOA5, LPL, LIPC and CETP on these levels has been separately described. The aim of the present study was to analyze the combined effects of these polymorphisms and their interaction with environmental factors. Methods: We genotyped the APOE polymorphism, two variants of APOA5 (S19W and -1131 T/C),five of LPL (D9N, N291S, PvuII, HindIII and S447X), one of LIPC (-250G/A) and one of CETP (TaqI )by polymerase chain reaction-restriction and TaqMan assays in 1825 subjects (80% male, meanage 36 years) from the ICARIA study. The combined effect of the variants was analyzed by linear regression with the log-transformed triglyceride variable and adjustment for covariates. The interactions were explored by multiple comparisons. Results: The 4 allele of APOE, the APOA5 polymorphisms S19W and -1131T/C and the LPL variants D9N and N291S independently and significantly increased triglyceride levels. The HindIII and S447X LPL polymorphisms were significantly associated with lower triglyceride levels. The PvuII (LPL), -250G/A (LIPC) and TaqI (CETP) variants showed no significant associations. There was a statistical trend (p = 0.048) for an interaction between abdominal obesity (waist circumference >102 cm in men and >88 cm in women) and the APOE- 4 allele. Conclusions: Our study shows the influence of the APOE- 4 allele, the S19W and -1131T/Cpolymorphisms of APOA5 and the LPL-D9N, N291S, HindIII and S447X variants on triglyceride levels and suggests that the effect of the 4 allele could by modulated by interaction with abdominal obesity (AU)

Efectividad de una estrategia de intervención preventiva, basada en entrevistas telefónicas estructuradas, en una población laboral con riesgo cardiovascular moderado/alto / Effectiveness of a preventive intervention strategy based on structured telephone interviews in a working population with a moderate to high cardiovascular risk

ObjetivoEvaluar la efectividad de una estrategia de intervención preventiva sobre el estilo de vida, basada en entrevistas telefónicas.DiseñoEstudio de intervención cuasiexperimental.EmplazamientoServicio de Prevención de Ibermutuamur (Mutua de Accidentes de Trabajo y Enfermedades Profesionales de la Seguridad Social).Participantes4.792 trabajadores con nivel de riesgo cardiovascular (RCV) moderado/alto en el reconocimiento médico laboral (RML) que otorgaron su consentimiento. Se excluyeron los sujetos con antecedentes de enfermedad cardiovascular o que recibían tratamiento antihipertensivo, hipolipemiante o antidiabético.IntervenciónSe pudo contactar telefónicamente con 3.085 trabajadores, a los que se realizó seguimiento en los meses primero, cuarto y octavo tras el RML, enfatizando recomendaciones cardiosaludables. Al resto de trabajadores (n=1.707), solo se les realizó el RML inicial y final.Mediciones principalesEl RCV se estimó según el modelo SCORE europeo. Todos los sujetos recibieron un informe, una carta dirigida a su médico de atención primaria con los factores de RCV detectados, su nivel de riesgo y recomendaciones sobre modificación del estilo de vida(AU)

ResultadosEl 71,5% de los trabajadores eran mayores de 45 años, el 95,0% varones, el 76,6% trabajadores manuales y el 69,7% fumadores. Ambos grupos mostraron mejoría en los parámetros lipídicos, presión arterial, abandono del hábito tabáquico y RCV global en el segundo RML. El grupo A presentó una mayor mejoría en la presión arterial, lípidos (excepto colesterol-HDL), índice de masa corporal, glucemia, abandono del hábito tabáquico (23,5% vs 19,4%, p=0,001) y en el estrato de riesgo (46,6% vs 37,7%, p=0,0001). Un 52,9% de los trabajadores declaró haber llevado la carta informativa a su médico de Atención Primaria, que aconsejó modificar la dieta (47%), o añadir tratamiento antihipertensivo (19,5%), hipolipemiante (16,7%), antidiabético (4,4%) y antitabaco (2,9%).ConclusionesLa estrategia de intervención sobre el estilo de vida, basada en entrevistas telefónicas, en trabajadores de RCV moderado-alto, puede ser efectiva. El envío de información preventiva y la participación de Atención Primaria pueden contribuir, per se, a los cambios positivos observados(AU)

ObjectiveThis study assesses the effectiveness of a structured telephone survey on cardiovascular prevention, in modifying lifestyle, on cardiovascular risk parameters, percentage of smoking cessation and overall cardiovascular risk (CVR).DesignQuasi-experimental study of preventive intervention.SettingIbermutuamur (Spanish Accident and Health Insurance Company). Centres established throughout Spain.ParticipantsA total of 4,792 workers with moderate/high cardiovascular risk who had agreed to be contacted by phone. Subjects with a previous diagnosis of cardiovascular disease and those receiving treatment for hypertension, hypercholesterolemia or diabetes were excluded.InterventionA final total of 3,085 workers were contacted and were followed up by telephone surveys on the first, fourth and eighth month after the initial check up (CU) in order to emphasise cardiovascular health advice (Group A); we failed to contact 1,707 workers, who only attended the baseline and one year CUs (Group B).Principal outcomesCUs included medical records and physical examination, with two blood pressure measurements, Body Mass Index (BMI), and biochemical parameters.Principal outcomesCardiovascular risk was stratified following the European cardiovascular SCORE. Individuals with a relative risk higher than 4 were also considered as high-risk. All workers were informed about their cardiovascular risk profile (CVRF) and healthy cardiovascular lifestyle measures. They were also given a letter for their General Practitioner (GP) to inform them on the worker's cardiovascular risk level(AU)

ResultsA total of 71.5% of the workers were over 45 years, 95.0% males, 76.6% manual workers (“Blue Collar”) and 69.7% smokers. Both groups showed improvement in lipid parameters, blood pressure, smoking cessation and overall cardiovascular risk in the second CU. There were significant differences in favour of Group A as regards blood pressure, lipids (except HDL cholesterol), BMI, glycaemia, smoking cessation (A: 23.5%/B: 19.44%, P=0.001) and CVR stratum improvement (A: 46.6%/B: 37.7%, P=0.0001). The large majority (85%) of workers read preventive recommendations; 33% knew their risk level and 73% knew their CVRF. 52.9% gave the letter to the GP, which led them to start therapies on diet (47%), hypertension (19.5%), dyslipidaemia (16.7%), diabetes (4.4%) and smoking (2.9%) and no changes were made in 36.5% of cases.ConclusionsThe results of this study suggests that cardiovascular prevention strategy based on structured telephone surveys on high/moderate CVR subjects to promote lifestyle changes could be effective at reducing CVR. A clinical trial is required for confirmation. Sending information on CVRF following routine medial CUs and Primary Care involvement, could contribute to the positive changes observed(AU)