[Australia's engineered stone ban. A sound decision]. / La prohibición de los aglomerados de cuarzo en Australia, una decisión modélica.

Australia se convirtió en diciembre de 2023 en el primer país en prohibir el uso de los aglomerados de cuarzo. El consumo de estos materiales sintéticos, que contienen más del 80% de sílice cristalina y que desde los años 90 se han empleado para la fabricación de encimeras de cocina y baños, ha contribuido al resurgimiento en numerosos países de formas aceleradas de silicosis y a una notable incidencia de enfermedades sistémicas. El objeto de este trabajo es analizar los fundamentos que sustentan la decisión australiana. Dichos fundamentos están principalmente recogidos en el informe elaborado en 2023 por la agencia gubernamental Safe Work Australia (SWA), que recomendó la prohibición del producto. SWA llevó a cabo una consulta pública entre todos los actores sociales y científicos interesados en el problema. El informe de SWA señaló la ausencia de evidencia científica sobre un umbral de sílice toxicológicamente seguro cuestionando la estrategia de los fabricantes del material de presentar como productos seguros a los aglomerados con menos del 40% de contenido de sílice. La recomendación de SWA tomó en consideración la evaluación del nivel de cumplimiento de las estrictas medidas de prevención implementadas entre 2019 y 2023, constatando que el incumplimiento siguió siendo generalizado en el sector. Además se realizó un análisis coste-beneficio para valorar el número de casos de silicosis que sería necesario evitar para "compensar" los costes económicos asociados a cada opción de prohibición. Para ello empleó el Valor Estadístico de la Vida (VEV) actualizado en 2023 en Australia y estimó en 4,9 millones de dólares australianos cada vida salvada y silicosis evitada. En nuestra opinión, la prohibición australiana es modélica por la forma en que se ha gestado la decisión, por su sólida fundamentación científica y socio-laboral, y por la aplicación del principio de precaución.

Análisis de los procesos asistenciales hospitalarios por silicosis en España, 1997-2020 / Analysis of Hospital Care Registers due to Silicosis in Spain, 1997-202

Fundamentos: la remergencia de la silicosis en españa desde 2007 ha sido objetivada por el incremento de partes de enfermedad profesional. El objetivo de nuestro estudio fue analizar los procesos asistenciales por silicosis atendidos por el sistema nacional De salud entre 1997 y 2020 para una mejor comprensión de la dimensión epidemiológica del problema. Métodos: se empleó el rae-cmbd, aplicando los códigos cie-9-cm 500 y 502 (1997-2016) y cie-10-cm j60, j62.0 y j62.8 (2017-2020). Se aplicaron métodos de estadística descriptiva y modelización por regresiones logísticas y metodología de regresión Joinpoint. Resultados: se obtuvieron 111.325 registros (veinte-cien años), el 4,3% por silicosis como diagnóstico principal (dp) y el 95,7% Como diagnóstico secundario (ds). El 98% eran hombres y el 2% mujeres. La edad media de los procesos por ds fue de 75,1, y de68,7 para los procesos por dp. La mediana de edad aumentó ocho años para los ds y disminuyó tres para los dp. Aunque la carga Asistencial global disminuyó, los procesos en menores de cincuenta años por dp entre 2006 y 2009 registraron una tendencia Ascendente (apc=27,01%). Los procesos por ds mostraron una tendencia ascendente no significativa (apc=1,92%) entre 2005 y 2020.Conclusiones: la tendencia al crecimiento de los procesos asistenciales por silicosis en menores de cincuenta años desde 2005 confirma el impacto asistencial de la remergencia de la silicosis en españa. La carga asistencial asociada constituye un problema de salud pública presente y futuro dada la reducción de edad de los afectados.(AU)

Background: the re-emergence of silicosis in spain since 2007 has been identified by the increase in the number of occupational disease reports. The aim of our study was to analyse the silicosis care processes attended by the national health system between 1997 and 2020 to better understand the epidemiological dimension of the problem. Methods: processes were obtained from the Registro de actividad sanitaria especializada (rae-cmbd), with icd-9-cm codes 500 and 502 (1997-2016) and icd-10-cm j60, j62.0 and j62.8 (2017-2020). Descriptive statistical methods and modelling by logistic regression and Joinpoint regression methodology were applied. Results: a total of 111,325 records were obtained (ages twenty-one hundred years), 4.3% for silicosis as the main diagnosis (pd) And 95.7% as a secondary diagnosis (sd). Men accounted for 98% and women for 2%. The mean age for sd processes was 75.1, and 68.7 for pd processes. The median age increased by eight years for sd and decreased by three years for pd. Although the overall Burden of care decreased, under-fifty pd procedures between 2006 and 2009 showed an upward trend (apc=27.01%). Sd processes Showed a non-significant upward trend (apc=1.92%) between 2005 and 2020. Conclusions: the upward trend in silicosis care processes in people under fifty years of age since 2005 confirms the healthcare Impact of the re-emergence of silicosis in spain. The associated burden of care constitutes a present and future public health problem Given the decreasing age of those affected.(AU)

[Analysis of Hospital Care Registers due to Silicosis in Spain, 1997-2020]. / Análisis de los procesos asistenciales hospitalarios por silicosis en España, 1997-2020.

OBJECTIVE: The re-emergence of silicosis in Spain since 2007 has been identified by the increase in the number of occupational disease reports. The aim of our study was to analyse the silicosis care processes attended by the National Health System between 1997 and 2020 to better understand the epidemiological dimension of the problem. METHODS: Processes were obtained from the Registro de Actividad Sanitaria Especializada (RAE-CMBD), with ICD-9-CM codes 500 and 502 (1997-2016) and ICD-10-CM J60, J62.0 and J62.8 (2017-2020). Descriptive statistical methods and modelling by logistic regression and Joinpoint regression methodology were applied. RESULTS: A total of 111,325 records were obtained (ages twenty-one hundred years), 4.3% for silicosis as the main diagnosis (PD) and 95.7% as a secondary diagnosis (SD). Men accounted for 98% and women for 2%. The mean age for SD processes was 75.1, and 68.7 for PD processes. The median age increased by eight years for SD and decreased by three years for PD. Although the overall burden of care decreased, under-fifty PD procedures between 2006 and 2009 showed an upward trend (APC=27.01%). SD processes showed a non-significant upward trend (APC=1.92%) between 2005 and 2020. CONCLUSIONS: The upward trend in silicosis care processes in people under fifty years of age since 2005 confirms the healthcare impact of the re-emergence of silicosis in Spain. The associated burden of care constitutes a present and future public health problem given the decreasing age of those affected.

OBJECTIVE: La remergencia de la silicosis en España desde 2007 ha sido objetivada por el incremento de partes de enfermedad profesional. El objetivo de nuestro estudio fue analizar los procesos asistenciales por silicosis atendidos por el Sistema Nacional de Salud entre 1997 y 2020 para una mejor comprensión de la dimensión epidemiológica del problema. METHODS: Se empleó el RAE-CMBD, aplicando los códigos CIE-9-CM 500 y 502 (1997-2016) y CIE-10-CM J60, J62.0 y J62.8 (2017-2020). Se aplicaron métodos de estadística descriptiva y modelización por regresiones logísticas y metodología de regresión Joinpoint. RESULTS: Se obtuvieron 111.325 registros (veinte-cien años), el 4,3% por silicosis como diagnóstico principal (DP) y el 95,7% como diagnóstico secundario (DS). El 98% eran hombres y el 2% mujeres. La edad media de los procesos por DS fue de 75,1, y de 68,7 para los procesos por DP. La mediana de edad aumentó ocho años para los DS y disminuyó tres para los DP. Aunque la carga asistencial global disminuyó, los procesos en menores de cincuenta años por DP entre 2006 y 2009 registraron una tendencia ascendente (APC=27,01%). Los procesos por DS mostraron una tendencia ascendente no significativa (APC=1,92%) entre 2005 y 2020. CONCLUSIONS: La tendencia al crecimiento de los procesos asistenciales por silicosis en menores de cincuenta años desde 2005 confirma el impacto asistencial de la remergencia de la silicosis en España. La carga asistencial asociada constituye un problema de Salud Pública presente y futuro dada la reducción de edad de los afectados.

Physical activity and sperm quality: influence in sperm donors.

PURPOSE: To ascertain whether physical activity (PA) is associated with better sperm quality in sperm donors. METHODS: A prospective case-control study was designed in an IVF center setting. A total of 207 sperm donation candidates from a relatively small geographical area were included in the study with no intervention. Donor candidates were subjected to conventional sperm analysis according to WHO criteria. Moreover, they answered a standardized questionnaire regarding their last week PA (IPAQ), with PA expressed in metabolic equivalents (METs)-min/week. Donors were classified into 4 groups: low, moderate, high and very high PA. Specific sports were included in the questionnaire. Semen samples from 43 accepted donors were used in artificial insemination by donor (AID) and IVF. The fertilization rates (FR) and pregnancy rates (PR) were studied. RESULTS: Semen volume, sperm concentration, progressive spermatozoa, non-progressive spermatozoa, total motile progressive spermatozoa and sperm morphology were similar in the four PA groups. No correlation between various semen parameters studied and METs was found. Running or cycling > 1 h/week did not influence sperm parameters. The AID PR was similar in the different PA groups. However, in IVF the mean donor FR was significantly higher in the high PA group and in the very high PA group. CONCLUSIONS: No detrimental effect was associated with PA, or even very high PA, regarding conventional sperm parameters. Moreover, a better FR was associated with high and very high PA in IVF cycles, which merits more studies.

Perinatal outcomes in children born after fresh or frozen embryo transfer using donated oocytes.

STUDY QUESTION: Do children born after vitrified-thawed embryo transfers (ETs) using donated oocytes have worse perinatal outcomes when compared with fresh ET? SUMMARY ANSWER: No significant difference in birthweight and prematurity rates between fresh or frozen embryo transfers (FETs) in newborns after oocyte donation was found. WHAT IS KNOWN ALREADY: Autologous singletons born after fresh ET have been previously associated with higher rates of preterm birth and low birthweight, while FETs seem to confer a higher risk of hypertensive disorders during pregnancy and macrosomia. However, studies comparing these outcomes using autologous oocytes are unable to adequately disentangle the putative detrimental consequences of embryo vitrification from the possible effects that ovarian stimulation and endometrial preparation may have on endometrial receptivity prior to ET. The oocyte donation model is, for this reason, a more appropriate setting to study these hypotheses; however so far, the information available regarding neonatal outcomes in this patient population is limited to either small and/or heterogeneous studies. STUDY DESIGN, SIZE, DURATION: We performed a multicentre retrospective cohort study including 5848 singletons born between 2009 and February 2020 following oocyte donation and single blastocyst transfer, subdivided according to whether a fresh ET or FET was performed. We also performed two additional sensitivity analyses, subgrouping the sample according to the type of endometrial preparation (natural versus artificial) and whether the donated oocytes had previously been vitrified or not. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients with a first singleton livebirth after single blastocyst transfer were compared using multivariable regression analysis to account for potential confounding factors. The primary outcome was birthweight. Secondary outcomes were birthweight z-scores and percentiles, small/large for gestational age, gestational age at delivery, gender, prematurity (<37 weeks and <32 weeks), neonatal morbidity (Apgar scores and need for neonatal intensive care) and maternal morbidity (gestational hypertensive disorders, gestational diabetes and caesarean delivery). MAIN RESULTS AND THE ROLE OF CHANCE: There was no significant difference between the fresh ET and FET groups in terms of mean birthweight (3215 g versus 3200 g) and birthweight z-scores (0.03 versus 0.1), in both the unadjusted and confounder-adjusted models. However, artificial endometrial preparation was associated with a higher birthweight (3220 g versus 3105 g) and birthweight z-scores (0.06 versus -0.13) when compared with a transfer in a natural cycle. Although a 1-day statistically significant difference in gestational age at birth (275 versus 274 days) was detected, premature birth rates (<37 weeks) did not vary significantly between groups (9.9% and 11.2% for fresh ET and FET, respectively). No other statistically significant differences were found in the remaining neonatal and maternal outcomes studies between the fresh ET and FET groups. LIMITATIONS, REASONS FOR CAUTION: This study is limited by its retrospective design and lack of information regarding congenital malformations. Moreover, the sample selection criteria that were used may limit the generalizability of our results. WIDER IMPLICATIONS OF THE FINDINGS: Perinatal outcomes did not seem to be affected significantly by the embryo vitrification process in an oocyte donation model. Hence, other factors may contribute to the hindered perinatal outcomes described in ART, particularly the potential effect that ovarian stimulation and endometrial preparation may have on endometrial receptivity. STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained for this study. All authors have no conflicts to declare. TRIAL REGISTRATION NUMBER: N/A.

Current global perspectives on silicosis-Convergence of old and newly emergent hazards.

Silicosis not a disease of the past. It is an irreversible, fibrotic lung disease specifically caused by exposure to respirable crystalline silica (RCS) dust. Over 20,000 incident cases of silicosis were identified in 2017 and millions of workers continue to be exposed to RCS. Identified case numbers are however a substantial underestimation due to deficiencies in reporting systems and occupational respiratory health surveillance programmes in many countries. Insecure workers, immigrants and workers in small businesses are at particular risk of more intense RCS exposure. Much of the focus of research and prevention activities has been on the mining sector. Hazardous RCS exposure however occurs in a wide range of occupational setting which receive less attention, in particular the construction industry. Recent outbreaks of silicosis associated with the fabrication of domestic kitchen benchtops from high-silica content artificial stone have been particularly notable because of the young age of affected workers, short duration of RCS exposure and often rapid disease progression. Developments in nanotechnology and hydraulic fracking provide further examples of how rapid changes in technology and industrial processes require governments to maintain constant vigilance to identify and control potential sources of RCS exposure. Despite countries around the world dealing with similar issues related to RCS exposure, there is an absence of sustained global public health response including lack of consensus of an occupational exposure limit that would provide protection to workers. Although there are complex challenges, global elimination of silicosis must remain the goal.

[The re-emergence of silicosis as an occupational disease in Spain, 1990-2019.] / La remergencia de la silicosis como enfermedad profesional en España, 1990-2019.

OBJECTIVE: The presence of new sources of occupational exposure to crystalline silica has contributed to an increased incidence of silicosis. Spain was one of the first countries to identify new occupational risk sectors such as quartz agglomerates. The objective of this work was to describe the incidence of silicosis in Spain between 1990 and 2019 and to determine the main occupational sectors affected. METHODS: Data on occupational disease cases were obtained from the Spanish Ministry of Inclusion, Social Security and Migration. Disease rates were computed by occupational sector, and analyses were conducted of their time course and their geographical, sex and age distributions. RESULTS: Data were available on 4,418 cases (96.1% male). The mean annual number of cases was 1,223% higher between 2015 and 2019 than between 1990 and 1995. By occupational sector, 50% were in "Fabrication of other mineral non-metallic products", 18.5% in "Extraction of non-metallic non-energetic minerals", 10.2% in "Construction", 6.1% in "Metallurgy", 3.1% in "Coal mining" and 12% in other sectors. Galicia registered the greatest number of cases (32.9%), followed by Castile and León (14%), Andalusia (10%) and the Basque Country (9.1%). The greatest increase in its incidence was in coal mining, possibly due to the dismantling of this sector and drastic reduction in the workforce. CONCLUSIONS: Our results suggest the importance of the manufacturing, machining and installation of quartz agglomerates in the re-emergence of silicosis in Spain.

OBJETIVO: La existencia de nuevas fuentes de exposición laboral a sílice cristalina ha contribuido al aumento de la incidencia de silicosis. España es uno de los países pioneros en la identificación de nuevos sectores de riesgo como los aglomerados de cuarzo. El objetivo de este trabajo fue conocer la evolución de la silicosis en España entre 1990 y 2019 e identificar los principales sectores de exposición responsables. METODOS: Los partes de enfermedad profesional se obtuvieron de la Secretaría General de Planificación del Ministerio de Inclusión, Seguridad Social y Migraciones. Se calcularon tasas por actividad económica y se analizó la tendencia temporal de los partes, su distribución por sexo, edad y sector económico, así como su distribución territorial. RESULTADOS: Se recuperaron 4.418 partes (96,1% hombres, 3,9% mujeres). La media anual de partes del quinquenio 2015-2019 (404,2) creció un 1.223,2% respecto al primer quinquenio de la serie. Por sectores de actividad, la distribución fue: 50% "Fabricación de otros productos minerales no metálicos"; 18,5% "Extracción de minerales no metálicos ni energéticos"; 10,2% "Construcción"; 6,1% "Metalurgia"; 3,1% "Minería del carbón"; 12% demás sectores. Galicia concentró el 32,9% de los partes, seguida de Castilla y León (14%), Andalucía (10,3%) y País Vasco (9,1%). La "Minería del carbón" registró el mayor incremento de tasa en el intervalo estudiado, reflejo del desmantelamiento del sector. CONCLUSIONES: Los resultados de nuestro estudio señalan la centralidad del sector de los aglomerados de cuarzo en la remergencia de la silicosis en España, tanto en su fabricación como en su mecanizado e instalación.

A Natural Xenogeneic Endometrial Extracellular Matrix Hydrogel Toward Improving Current Human in vitro Models and Future in vivo Applications.

Decellularization techniques support the creation of biocompatible extracellular matrix hydrogels, providing tissue-specific environments for both in vitro cell culture and in vivo tissue regeneration. We obtained endometrium derived from porcine decellularized uteri to create endometrial extracellular matrix (EndoECM) hydrogels. After decellularization and detergent removal, we investigated the physicochemical features of the EndoECM, including gelation kinetics, ultrastructure, and proteomic profile. The matrisome showed conservation of structural and tissue-specific components with low amounts of immunoreactive molecules. EndoECM supported in vitro culture of human endometrial cells in two- and three-dimensional conditions and improved proliferation of endometrial stem cells with respect to collagen and Matrigel. Further, we developed a three-dimensional endometrium-like co-culture system of epithelial and stromal cells from different origins. Endometrial co-cultures remained viable and showed significant remodeling. Finally, EndoECM was injected subcutaneously in immunocompetent mice in a preliminary study to test a possible hypoimmunogenic reaction. Biomimetic endometrial milieus offer new strategies in reproductive techniques and endometrial repair and our findings demonstrate that EndoECM has potential for in vitro endometrial culture and as treatment for endometrial pathologies.

The influence of oxygen concentration during embryo culture on obstetric and neonatal outcomes: a secondary analysis of a randomized controlled trial.

STUDY QUESTION: Does oxygen concentration during 3-day embryo culture affect obstetric and neonatal outcomes? SUMMARY ANSWER: Oxygen concentration during 3-day embryo culture does not seem to affect the obstetric and neonatal outcomes measured. WHAT IS KNOWN ALREADY: Atmospheric oxygen appears to be harmful during extended embryo culture. Embryo culture conditions might therefore be a potential risk factor for subsequent fetal development and the health of future children. No data are available concerning the obstetrics and neonatal outcomes after Day 3 transfer of embryos cultured under reduced and atmospheric oxygen tensions. STUDY DESIGN, SIZE, DURATION: A secondary analysis of a previous randomized controlled trial assessing clinical pregnancy outcomes was carried out. This analysis included 1125 consecutive oocyte donation cycles utilizing ICSI or IVF and Day 3 embryo transfers between November 2009 and April 2012. The whole cohort of donated oocytes from patients who agreed to participate in the study were randomly allocated (1:1 ratio) to a reduced O2 tension group (6% O2) or an air-exposed group (20% O2) based on a computer-generated randomization list. Fresh and vitrified oocytes were used for oocyte donation. Only those pregnancies with a live birth at or beyond 24 weeks of gestation were included. PARTICIPANTS/MATERIALS, SETTING, METHODS: Day 3 embryos were cultured in an atmosphere of 5.5% CO2, 6% O2, 88.5% N2 versus a dual gas system in air. MAIN RESULTS AND THE ROLE OF CHANCE: From the eligible 1125 cycles, 564 were allocated to the 6% O2 group and 561 cycles to the 20% O2 group. However, 50 and 62 cycles did not reach embryo transfer in the 6% and 20% O2 groups, respectively. No differences were found between 6% O2 and atmospheric O2 tension in the number of livebirths per embryo transfer (mean ± SD, 0.5 ± 0.7 versus 0.5 ± 0.7), pregnancy complications or neonatal outcomes. Both groups (6% and atmospheric O2) had similar single and twin delivery rates (40.8% versus 38.1% and 10.7% versus 12.3%, respectively). Preterm delivery rates and very preterm delivery rates (10.80% versus 13.24% and 1.25% versus 2.94%, respectively), birthweight (3229 ± 561 g versus 3154 ± 731 g), low birthweight (2.92% versus 2.45%), birth height (50.18 ± 2.41 cm versus 49.7 ± 3.59 cm), head circumference (34.16 ± 1.87 cm versus 33.09 ± 1.85 cm) and 1 min Apgar scores (8.96 ± 0.87 versus 8.89 ± 0.96) were also similar between 6% and atmospheric O2 groups, respectively. LIMITATIONS, REASONS FOR CAUTION: The number of liveborns finally analyzed is still small and not all obstetric and neonatal variables could be evaluated. Furthermore, a small proportion of the obstetric and neonatal data was obtained through a questionnaire filled out by the patients themselves. One reason for the lack of effect of oxygen concentration on pregnancy outcome could be the absence of trophectoderm cells at cleavage stage, which may make Day 3 embryos less susceptible to hypoxic conditions. WIDER IMPLICATIONS OF THE FINDINGS: Nowadays many IVF laboratories use a more physiological oxygen concentration for embryo culture. However, the benefits of using low oxygen concentration on both laboratory and clinical outcomes during embryo culture are still under debate. Furthermore, long-term studies investigating the effect of using atmospheric O2 are also needed. Gathering these type of clinical data is indeed, quite relevant from the safety perspective. The present data show that, at least in egg donation cycles undergoing Day 3 embryo transfers, culturing embryos under atmospheric oxygen concentration seems not to affect perinatal outcomes. STUDY FUNDING/COMPETING INTEREST(S): The present project was supported by the R + D program of the Regional Valencian Government, Spain (IMPIVA IMDTF/2011/214). The authors declare that they have no conflict of interest with respect to the content of this manuscript. TRIAL REGISTRATION NUMBER: NCT01532193.

Anti-Müllerian hormone is an independent marker for oocyte survival after vitrification.

RESEARCH QUESTION: This study explored the relationship between anti-Müllerian hormone (AMH) and oocyte survival after vitrification. The association between AMH and blastocyst formation after oocyte vitrification was also assessed. DESIGN: A retrospective observational analysis was performed in a private IVF centre. A total of 4507 metaphase-II warmed oocytes were included from 450 couples, predominantly of Arab ethnicity. Between August 2015 and August 2018, couples underwent 484 intracytoplasmic sperm injection (ICSI) treatments using vitrified-warmed oocytes. RESULTS: Patients' median age ± SD was 36.2 ± 6.1 years, AMH concentration 2.6 ± 3.4 ng/ml and body mass index (BMI) 26.5 ± 4.6 kg/m2. The oocyte survival rate after vitrification was 87.37 ± 20.42%. AMH concentration showed a significant correlation (Kendall's tau 0.087, P = 0.0079) with oocyte survival rate independent of oocyte yield. Correlation was significant (odds ratio 1.041, 95% confidence interval 1.007-1.077, P = 0.018) when a multivariant model was applied that included AMH, age and BMI. The receiver operating characteristic curve showed an AMH cut-off value of 1.09 ng/ml that could obtain at least a 70% survival rate, with an area under the curve of 0.669. Regarding embryo development in ICSI cycles including fresh and warmed oocytes for the same patient, blastocyst formation rate was higher in fresh compared with warmed oocytes (P < 0.001). In this subgroup no significant correlation was seen between fertilization or blastocyst rate and AMH concentration. CONCLUSIONS: AMH concentration showed a significant correlation with oocyte survival. Blastocyst formation was significantly lower after oocyte vitrification, but no correlation was found with AMH. Clinicians should carefully evaluate oocyte vitrification for patients with AMH below 1.09 ng/ml and consider embryo accumulation for these patients in preference to oocyte accumulation.

Anti-müllerian Hormone During Natural Cycle Presents Significant Intra and Intercycle Variations When Measured With Fully Automated Assay.

Anti-Müllerian hormone (AMH) is an important ovarian reserve marker for baseline assessment and therapeutic strategy in fertility treatments, which is considered reliable when measured on any day of the cycle. Recent data have pointed toward significant fluctuations of AMH and questioned whether a single measurement is reliable for clinical decision-making. The aim of this study was to evaluate whether the AMH does have significant variations during a natural cycle when a fully automated assay is used for the sample analysis. We performed a prospective study including healthy volunteers with regular cycles, from April to December 2017. Blood samples for AMH, FSH, LH, estradiol, and progesterone were obtained on day 2/3, day 10, day of LH surge, luteal phase and day 2/3 of subsequent menses. AMH analysis was performed with Elecsys® AMH automated assay. Trial was registered with clinical.trials.gov: NCT03106272. One hundred samples from 22 women with a mean age of 30.74 ± 0.11 years and a BMI of 23.23 ± 0.63 kg/m2 were analyzed. There was a substantial longitudinal fluctuation in AMH levels, indicated by the coefficient of variation (CV) intra-cycle of 0.2070 ± 0.143. A positive correlation between LH and AMH concentrations was found at the moment of LH rise (p < 0.0001). Absolute intra-individual inter-cyclic variability was 0.75 ng/mL (range: 0.03-2.81 ng/mL) and inter-cycle CV was 0.28 (Confidence interval: 0.16-0.39; p < 0.0001). According to our results, with the use of a fully automated assay in natural cycle, AMH shows significant intra- and inter-cycle variations, which are not caused by analytical variability. Future investigations, evaluating AMH dynamics and the best time for AMH assessment should be conducted.

Medical costs of asbestos-related diseases in Spain between 2004 and 2011.

The objective of this article was to estimate the medical costs derived from malignant ARD treatment in the Spanish National Health System (NHS) between 2004 and 2011. Estimation of direct healthcare costs was based on national primary data on the cost of specialized care for inpatients and outpatients treated at NHS hospitals and on national and regional secondary data on costs of primary healthcare and pharmaceutical prescriptions. A prevalence approach was used to estimate the overall burden of ARDs. Direct medical costs of 37,557 ARDs attended in Spanish NHS facilities in 2004-2011 were estimated at 464 million euros; specialist care accounted for 50.9% of total costs, primary healthcare 10.15%, and drug prescription 38.9%. The cost was 27.8-fold higher in males than in females. Bronchopulmonary cancers represented the greatest healthcare cost, 281 million euros. The cost of delivering healthcare to ARDs victims in Spain has a negative economic impact on the NHS due to the gross under-recognition of occupational victims under the Spanish National Insurance System.

Asbestos-related occupational cancers compensated under the Spanish National Insurance System, 1978-2011.

BACKGROUND: In 1978, asbestos-related occupational cancers were added to the Spanish list of occupational diseases. However, there are no full accounts of compensated cases since their inclusion. OBJECTIVE: To analyze the cases of asbestos-related cancer recognized as occupational in Spain between 1978 and 2011. METHODS: Cases were obtained from the Spanish Employment Ministry. Specific incidence rates by year, economic activity, and occupation were obtained. We compared mortality rates of mesothelioma and bronchus and lung cancer mortality in Spain and the European Union. RESULTS: Between 1978 and 2011, 164 asbestos-related occupational cancers were recognized in Spain, with a mean annual rate of 0·08 per 10(5) employees (0·13 in males, 0·002 in females). Under-recognition rates were an estimated 93·6% (males) and 99·7% (females) for pleural mesothelioma and 98·8% (males) and 100% (females) for bronchus and lung cancer. In Europe for the year 2000, asbestos-related occupational cancer rates ranged from 0·04 per 10(5) employees in Spain to 7·32 per 10(5) employees in Norway. CONCLUSIONS: These findings provide evidence of gross under-recognition of asbestos-related occupational cancers in Spain. Future work should investigate cases treated in the National Healthcare System to better establish the impact of asbestos on health in Spain.

En el principio fue Almadén: los orígenes de la Medicina del Trabajo en España / In the Beginning was Almadén: the Origins of Occupational Medicine in Spain

El objeto de este trabajo es mostrar el papel clave que las minas de mercurio de Almadén jugaron durante el siglo XVIII para que cristalizara en nuestro país un conjunto de saberes y prácticas médicas centradas en la gestión de los problemas de enfermedad generados por la actividad productiva. Ello fue posible gracias a la confluencia del auge de las teorías mercantilistas, que otorgaron valor económico a la salud de los trabajadores, a la naturaleza nociva del proceso de obtención del mercurio y a sus implicaciones para la economía colonial española. En Almadén se produjo el nacimiento de la corriente empírica más rica y original en el estudio de la patología laboral en el mundo hispánico. Además, se posibilitó la conversión del medio laboral en un espacio de legitimación de saberes y prácticas sanitarias, dotando a los profesionales de nuevas competencias en el control de la salud de los trabajadores. Así mismo, la medicina desempeñó un papel normativo y regulador de los hábitos de vida de los trabajadores destinado a modelar valores y comportamientos acordes a los requerimientos del orden productivo. Este estudio se basa en el análisis de los principales escritos médicos españoles y en la reconstrucción de las prácticas asistenciales y preventivas desarrolladas en las minas de mercurio de Almadén (AU)

This paper explores the case of the 18th-century state-owned Almadén mercury mines as main precursor of the emergence of medical concerns with workers' health and the establishment of a systematic medical approach to work-related diseases in our country. This was largely a product of the growing influence of mercantilist theories, which assigned an increasingly important economic value to health, the unhealthy nature of mercury mining work and the extraordinarily important role played by Almadén in the overall Spanish economy. Almadén became the source of the most original empirical medical research on dangerous trades carried out in the Hispanic World. It also provided a propitious space for the legitimisation of new knowledge and practices related to the health and illness of workers, reserving new competencies for healthcare professionals. Likewise, medicine began to fulfil a normative function in the work setting, modelling the values of the workers and regulating their behaviour patterns in accordance with the requirements of the productive order. The study is based on an analysis of the main Spanish medical literature on this issue and on a reconstruction of the care and preventive practices developed in Almadén mercury mines (AU)

Pleural cancer mortality in Spain: time-trends and updating of predictions up to 2020.

BACKGROUND: A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011-2015 and 2016-2020 in Spain. METHODS: Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions. RESULTS: Pleural cancer deaths increased across the study period, rising from 491 in 1976-1980 to 1,249 in 2006-2010. Predictions for the five-year period 2016-2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality. CONCLUSION: The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040.

Radiological protection in the Spanish nuclear industry under Franco, 1939-1975. / La protección radiológica en la industria nuclear española durante el franquismo, 1939-1975.

In debates about nuclear controversy, the issue of occupational safety in radioactive facilities is rarely foregrounded; it has historically been relegated to second place compared to the attention given to potential harm to the general population. Aiming for, at least, partially filling this historiographical gap, this article deals with the development of occupational radiological protection in Spain under the dictatorship of General Franco (1939-1975). It covers the rise of radiological protection measures on an international level and the subsequent development of legislation in the case of Spain, a process that paralleled the growth of the nation's nuclear program. Finally, it explores the main evidence of the impact of ionizing radiation on Spain's working population.