Prevalence of atherogenic dyslipidemia: association with risk factors and cardiovascular risk in Spanish working population. "ICARIA" study.

OBJECTIVE: The aim of this study was to assess the prevalence of atherogenic dyslipidemia (AD) and the lipid triad (LT) in the working population in Spain, their associated variables and how far they are linked to cardiovascular risk (CVR). METHODS: Observational cross-sectional study of 70,609 workers (71.5% male (M), 28.5% female (F), mean age 39.2 ± 10), who attended medical checkups and agreed to participate. Plasma samples were analysed in a central laboratory. AD definition used was: triglycerides ≥150 mg/dl and HDL cholesterol <40 mg/dl (M)/<50 mg/dl (F) and LT when LDL cholesterol > 160 mg/dl is further added. Univariate comparisons in the absence and presence of AD and LT and the probability of AD according to different parameters and their possible association with CVR were assessed. CVR was stratified following the European SCORE model for low risk-population. RESULTS: 5.7% (95% CI 4.7-6.9) of the working population have AD and 1.1% (95% CI 1.0-1.2) LT. In univariate analysis, workers with AD and LT had a higher prevalence of obesity, hypertension, smoking and diabetes than those who had not (p < 0.001). In multivariate analysis, BMI, sex, age 40-49, diabetes, tobacco, uric acid, LDL or blood pressure significantly influenced the risk of AD. AD was significantly associated with CVR after adjusting for alcohol and obesity. However, most of the AD subjects (91.8%) were classified as low risk. CONCLUSIONS: About 6% of the working population in Spain meets AD criteria. Assuming that these subjects have increased CVR, AD allows to identify additional 5% of subjects with increased CVR to that one the SCORE model detects, helping to improve cardiovascular risk stratification.

Características clínicas y sociolaborales de pacientes psiquiátricos al término de la incapacidad temporal por contingencia común / Clinical, social and labour features of psychiatric patients at the end of temporary nonoccupational disability

Introducción: La patología psiquiátrica es la principal causa de pérdida de calidad de vida y presenta unos altísimos costes, personales y económicos. Pese a ello, existen pocos datos sobre las características de los pacientes psiquiátricos con incapacidad laboral y sus características clínicas. Por ello nos proponemos describir estas características en los pacientes con más de 12 meses de incapacidad temporal e investigar factores que puedan estar ligados a cronicidad o disfunción. Material y métodos: Sobre el total de pacientes derivados por el INSS para evaluación psiquiátrica, se excluyeron aquellos que no se encontraran en Incapacidad Temporal o que llevaran menos de 12 meses, conformando una muestra de 97 pacientes. Se registraron las principales características sociolaborales y clínicas, diagnóstico según criterios DSM-IV-TR, se aplicaron escalas de funcionalidad e intensidad sintomatológica como EEAG, MADRS y WHODAS O. Resultados: La distribución por sexos fue homogénea, con una edad media de 47 años, vive en pareja el 51,5%, normalmente refieren una vivencia de apoyo social moderado y 1/3 no ha superado estudios primarios. El 78,4% presenta antecedentes físicos importantes, fuma 50,5%, 59% tiene antecedentes familiares psiquiátricos, que tienden a asociarse a baja funcionalidad y tratamientos más prolongados. La concordancia diagnóstica es del 71,1%, los trastornos afectivos son el grupo diagnóstico más frecuente. El trastorno adaptativo es el diagnóstico más frecuente en el grupo al que no se le encuentra limitación funcional y se asocia a menos tiempo en tratamiento y a menos intensidad sintomatológica. Las escalas utilizadas correlacionan entre sí, distinguiendo EEAG y WHODAS O a los trastornos adaptativos y a los cuadros no incapacitados, mientras que MADRS señala a los trastornos afectivos. Tras la evaluación, al 46,39% no se le propone incapacidad, al 11,34% se le solicita prórroga, al 29,90% incapacidad permanente para su trabajo, y al 12,37% incapacidad permanente para cualquier trabajo. Los pacientes a los que se les recomendó incapacidad permanente presentaban asociación a bajo apoyo social, tiempo prolongado en seguimiento psiquiátrico, antecedentes familiares psiquiátricos y diagnóstico distinto a trastorno adaptativo. Conclusiones: La evaluación funcional de pacientes psiquiátricos tras 12 meses de incapacidad temporal detecta ausencia de incapacidad en el 46,39%, generalmente ligado al trastorno adaptativo. Las escalas psicométricas son capaces de señalar discapacidad. Se han detectado marcadores de gravedad y disfunción como son la vivencia de apoyo social, la ausencia de pareja, el tiempo en seguimiento psiquiátrico, los antecedentes familiares psiquiátricos y las escalas psicométricas. Existe una alta comorbilidad física y un tabaquismo preocupante en los pacientes psiquiátricos. Son necesarios estudios similares que puedan confirmar o perfilar los datos aquí presentados (AU)

Objective: Psychiatric Pathology is a major problem because it is the main cause of loss of quality of life while it generates large individual, social and economic costs. Despite the mentioned above, few data are available on the clinical features of psychiatric work disabled patients. We aim to describe the mentioned features in patients with temporary disability for more than 12 months and to investigate the factors associated with chronicity or disability. Methods: A total of 97 patients with temporary disability for more than 12 months were selected from all of the patients referred to our office by the INSS for psychiatric evaluation. Main clinical, social and labour features were recorded in addition to the diagnosis, according to DSM-IV-TR criteria. Global Assessment of Functioning (GAF) and Symptom Intensity scales (MADRS and WHODAS O) were used. Results: Our sample had a balanced sex ratio and an average age of 47 years. Patients usually described an experience of moderate social support and 51.5% of them were living as a couple. A third of the patients had primary education at most. A noteworthy physical illness background was found in 78.4% of them, 50.5% had smoking habits and 59% had family history of psychiatric disorders. All of these conditions tend to be associated with low functionality and longer treatments. We have found a 71.1% diagnostic agreement and the most frequent diagnosis-related group were affective disorders. In the group of patients without functional limitation, adjustment disorder was the most frequent diagnosis. It was associated to shorter treatments and lower levels of Symptom Intensity. The scales that we used correlated with each other. GAF and WHODAS O distinguish adjustment disorders in non-disabled patients while MADRS points out affective disorders. Decisions made after assessment were: no disability in 46.39% of the patients, grant an extension of paid sick leave days in 11.34%, permanent occupational disability to work in their previous job in 29.90% and permanent occupational disability to work in any job in 12.37%. Patients with permanent occupational disability were associated with low social support, prolonged psychiatric follow-up, family history of psychiatric disorders and diagnosis other than adjustment disorder. Conclusions: The functional assessment of psychiatric patients after a 12-month period of temporary disability showed no disability in 46.39% of the patients and it is usually bound to adjustment disorder. Psychometric scales may mark occupational disability. Markers of severity and dysfunction have been identified like social support experience, absence of a partner, psychiatric follow-up span, family history of psychiatric disorders and psychometric scales. Physical comorbidity is highly frequent and smoking habits are disturbing among psychiatric patients. Similar studies are needed to confirm our results and increase knowledge on this subject (AU)

Long-term sickness absence due to adjustment disorder.

BACKGROUND: Although adjustment disorder is frequently reported in clinical settings, scientific evidence is scarce regarding its impact on sickness absence and the variables associated with sickness absence duration. AIMS: To report sickness absence duration and to identify predictors of long-term sickness absence in patients with adjustment disorder. METHODS: This observational, prospective study included subjects with non-work-related sickness absence (>15 days) after a diagnosis of adjustment disorder. A stepwise logistic regression analysis was conducted to identify the best predictors of long-term sickness absence (≥ 6 months). RESULTS: There were 1182 subjects in the final analysis. The median duration of sickness absence due to adjustment disorder was 91 days. Twenty-two per cent of the subjects reported long-term sickness absence. After multivariate analysis, comorbidity (OR = 2.23, 95% CI 1.43-3.49), age (25-34 years old versus <25 years old: OR = 2.78, 95% CI 1.27-6.07; 35-44 years old versus <25 years old: OR = 3.70, 95% CI 1.71-7.99; 45-54 years old versus <25 years old: OR = 3.58, 95% CI 1.60-8.02; ≥ 55 years old versus <25 years old: OR = 6.35, 95% CI 2.64-15.31) and occupational level (blue collar versus white collar: OR = 1.52, 95% CI 1.10-2.09) remained significantly associated with long-term sickness absence. Comorbidity was the strongest predictor. CONCLUSIONS: It is possible to predict long-term sickness absence due to adjustment disorder on the basis of demographic, work-related and clinical information available during the basic assessment of the patient.