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.

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

[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.

Incapacidad temporal por diagnósticos quirúrgicos y cirugía mayor ambulatoria / Temporary disability diagnoses and major ambulatory surgery

La incapacidad temporal implica una prestación económica para aquellos trabajadores que, como consecuencia de estar restableciéndose de una enfermedad, no pueden desempeñar su ocupación habitual. La gestión de esta prestación es el resultado de un proceso complejo sometido a la influencia de variables clínicas y cuya relación con la capacidad funcional del enfermo resulta menos clara. En un contexto social y económico en el que el mantenimiento de la viabilidad del sistema de protección social suscita un renovado interés, el rigor en la incapacidad temporal se perfila como un importante desafío. El presente artículo proporciona datos acerca de la incapacidad temporal asociada a diagnósticos quirúrgicos y discute la evidencia acerca de los potenciales beneficios y limitaciones de la cirugía mayor ambulatoria, en la reducción de los costes indirectos asociados a estas frecuentes patologías (AU)

Temporal disability refers to a social security benefit that workers receive when they are still recovering for an illness associated with work disability. The management of such benefits result in a complex process. The duration of work disability is related with a broad variety of factors and it may not always be completely explained in terms of functional impairment. In our current socioeconomic context, the cost-effectiveness of health care emerges like a essential challenge for the Social Security System and the level of rigour in the management of social security systems needs to be guaranteed. The present report provide data regarding temporary disability associated with surgical diagnoses and discuss available scientific evidence regarding major ambulatory surgery and its impact on indirect costs (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)

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.

[Prevalence of cardiovascular risk factors in the Spanish working population]. / Prevalencia de factores de riesgo vascular en la población laboral española.

INTRODUCTION AND OBJECTIVES: The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. METHODS: The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. RESULTS: Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (< or =140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index > or =30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol > or =200 mg/dL, LDL cholesterol > or =160 mg/dL, triglycerides > or =200 mg/dL, or HDL cholesterol < 40 mg/dL in males or < 50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. CONCLUSIONS: The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment.

Prevalencia de factores de riesgo vascular en la población laboral española / Prevalence of cardiovascular risk factors in the spanish working population

Introducción y objetivos. Los reconocimientos de la salud de los trabajadores constituyen una oportunidad de detección precoz de factores de riesgo vascular. El presente estudio investiga la prevalencia de factores de riesgo vascular en la población laboral española. Métodos. Se incluyó a 216.914 trabajadores (edad media, 36,4 años; intervalo, 16-74 años; el 73,1% eran varones) en los que se realizó un reconocimiento en una mutua laboral, que incluyó un cuestionario estructurado, una exploración física y determinaciones bioquímicas. Resultados. Tenían diagnóstico previo de enfermedad cardiovascular el 0,7%, de hipertensión arterial el 6,2%, de diabetes el 1,2% y de dislipidemia el 8,9%. Durante el reconocimiento se detectó la presencia de tabaquismo en el 49,3% (el 51,3% varones y el 43,8% mujeres), presión arterial elevada (≥ 140/90 mmHg) en el 22,1% (el 27,0% varones y el 8,8% mujeres), obesidad (índice de masa corporal ≥ 30) en el 15,5% (el 18,3% varones y el 13,3% mujeres), hiperglucemia (> 110 mg/dl) en el 6,2% (el 7,8% varones y el 1,9% mujeres) y alguna forma de dislipidemia (colesterol total ≥ 200 mg/dl, cLDL ≥ 160 mg/dl, triglicéridos ≥ 200 mg/dl o cHDL < 40 mg/dl en varones o < 50 mg/dl en mujeres) en el 64,2%. Con respecto al sector «servicios», y tras ajustar por factores de confusión, los trabajadores del sector industria y sobre todo de la construcción mostraron una mayor prevalencia de elevación de la presión arterial y, especialmente, de tabaquismo. Conclusiones. Hay una alta prevalencia de factores de riesgo en la población laboral española, especialmente en varones y en determinados sectores de actividad (AU)

Introduction and objectives. The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. Methods. The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. Results. Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (≥140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index ≥30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol ≥200 mg/dL, LDL cholesterol ≥160 mg/dL, triglycerides ≥200 mg/dL, or HDL cholesterol <40 mg/dL in males or <50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. Conclusions. The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment (AU)