Prediabetes and diabetes prevalence in the Workers' Oral Health Study.

OBJECTIVE: To examine the association between periodontitis, diabetes, and prediabetes, assessed by fasting plasma glucose (FPG). MATERIALS AND METHODS: Workers' Oral Health Study is a cross-sectional survey conducted on a representative sample of the Spanish employed population including 5154 participants (59.5% men, aged 16-65). Examination of periodontal status assessed Community Periodontal Index (CPI) and clinical attachment levels (CAL). Biochemical determinations included fasting plasma glucose (FPG), triglycerides, and total cholesterol. Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and abnormal glucose regulation. RESULTS: Ninety-five participants (2.2%) of the study population had diabetes, while 373 (8.8%) presented prediabetes. Prediabetes was not associated with CPI or CAL in fully adjusted multivariate logistic regressions models. Diabetes was significantly associated with subjects having a CPI 4 after adjustment for potential confounders (odds ratio OR = 1.9, 95% confidence interval (CI) 1.1-3.1). This association was stronger in subjects < 45 years (OR = 4.0, 95% CI 1.2-12.7). CONCLUSION: Periodontitis was associated with diabetes mellitus, but not with prediabetes, in a representative sample of the Spanish employed population. The association was stronger for younger subjects, which emphasizes the need for early detection of diabetes in younger patients affected by periodontitis, particularly because periodontal therapy may help to improve glycemic control. CLINICAL RELEVANCE: Periodontitis is associated with diabetes mellitus, having at the same time a negative effect on glycemic control. It is important to develop proper early diagnosis strategies for both conditions, particularly in young male adults.

Utilidad clínica de un modelo predictivo de riesgo cardiovascular en trabajadores / Clinical usefulness of a predictive model of cardiovascular risk among workers

La identificación de sujetos con alto riesgo cardiovascular constituye un desafío en población laboral. El proyecto IberScore ha derivado una función predictiva para eventos cardiovasculares a partir de una cohorte de 774.404 trabajadores, sin enfermedad cardiovascular previa y con 10 años de seguimiento. Durante el seguimiento, se identificaron 3.762 primeros eventos cardiovasculares en la cohorte de derivación (6‰; varones 90,7%; media edad=46,9±9,19 años). En el grupo con eventos se observó una presencia importante de factores de riesgo cardiovascular en la evaluación basal (tabaquismo 63,2%; dislipemia 20,6%; hipertensión 21,8%; diabetes 7,9%). Los resultados sugieren la utilidad clínica de un sistema de predicción del riesgo cardiovascular desarrollado específicamente en población trabajadora española. En esta población se produce un número no desdeñable eventos y hay una importante presencia de factores de riesgo, que pueden pasar desapercibidos debido al peso de la edad en los sistemas predictivos desarrollados para la población general

Identification of subjects at high cardiovascular risk is a challenge among working population. The IberScore Project has calculated a predictive function for cardiovascular events from a cohort of 774,404 Spanish workers without prior cardiovascular diseases, and 10-year follow-up. At follow-up, 3,762 first cardiovascular events were identified in the cohort of derivation (6‰; 90.7% men; mean age=46.9±9.19 years-old). In the group with events, it was observed a relevant presence of cardiovascular risk factors at baseline assessment (smoking 63.2%; dyslipidaemia 20.6%; hypertension 21.8%; diabetes 7.9%). The results suggest the clinical usefulness of a system to predict cardiovascular risk among specifically developed in Spanish working population. Among such population a significant number of events take place and there is a relevant presence of risk factors, which may go unnoticed due to the weight that age has in the predictive systems developed for the general population

Prevalence of impaired fasting glucose and type 1 and 2 diabetes mellitus in a large nationwide working population in Spain / Prevalencia de la glucemia alterada en ayunas, diabetes tipo 1 (DM1) y diabetes tipo 2 (DM2) en una población trabajadora en España

Introduction: To report the prevalence of impaired fasting glucose (IFG), undiagnosed and diagnosed diabetes, and their association to occupational categories in a representative sample of working population in Spain. Materials and methods: A cross-sectional study of workers who attended routine medical check-ups from January 2007 to December 2007. A structured questionnaire was completed, and physical examinations and routine serum biochemical tests were performed. IFG was defined as fasting glucose levels ranging from 100 to 125 mg/dl with no diagnosis of T1DM or T2DM; T1DM was defined as previous diagnosis of T1DM; and T2DM as previous diagnosis of T2DM, treatment with oral antidiabetic drugs or insulin or fasting glucose levels ≥126 mg/dl, according to ADA criteria. Results: Of the 371,997 participants (median age 35 [interquartile range 29-44] years), 72.4% were male. Raw prevalence rates (95% CI) of IFG, undiagnosed (UKDM), and previously known type 2 (KDM2) and type 1 (KDM1) diabetes were 10.4% (10.3-10.5%), 1.3% (1.2-1.3%), 1.1% (1.1-1.2%), and 0.3% (0.3–0.3%), respectively. With the exception of KDM1, prevalence of these conditions increased with age and was greater among manual/blue-collar workers (12.1%, 1.5%, 1.3% and 0.3%, respectively) as compared to non-manual/white-collar workers (7.3%, 0.8%, 0.8% and 0.3%, respectively). Age- and sex-adjusted prevalence rates of IFG, UKDM and KDM2 were 13.1%, 2.0% and 2.4%, respectively. Discussion: In this sample of Spanish working population, impaired glycemic profiles were common. Prevalence rates of IFG and T2DM were high among blue-collar workers (except for T1DM). These data emphasize the need for earlier structured preventive schemes (AU)

Objetivo: Describir la prevalencia de glucemia alterada en ayunas (GAA), diabetes no diagnosticada y diabetes, y su asociación con categorías profesionales en una muestra representativa de población trabajadora en España. Material y métodos: Estudio transversal en trabajadores que realizaron revisión médica entre enero y diciembre de 2007. Se realizó exploración física, análisis de sangre y se utilizó un cuestionario estructurado. Se definió GAA como glucosa en ayunas 100-125 mg/dl sin diagnóstico de diabetes tipo 1 (DM1) o diabetes tipo 2 (DM2); DM1 como diagnóstico previo de DM1; y DM2, según criterios ADA, como diagnóstico previo de DM2, tratamiento con antidiabéticos orales o insulina, glucosa en ayunas ≥ 126 mg/dl. Resultados: De los 371.997 participantes (mediana de edad 35 [rango intercuartílico 29-44] años), el 72,4% eran varones. La prevalencia (IC 95%) de GAA, diabetes no diagnosticada y DM2 y DM1 conocidas previamente fue del 10,4% (10,3-10,5%); 1,3% (1,2-1,3%); 1,1% (1,1-1,2%) y 0,3% (0,3-0,3%), respectivamente. Excepto para DM1, la prevalencia aumentó con la edad y fue mayor en trabajadores manuales (12,1; 1,5; 1,3; y 0,3% respectivamente) que en trabajadores no manuales (7,3; 0,8; 0,8; y 0,3% respectivamente). La prevalencia de GAA, diabetes no diagnosticada y DM2 ajustada por edad y sexo fue del 13,1, 2,0 y 2,4% respectivamente. Conclusiones: En esta muestra de población trabajadora en España, las alteraciones del perfil glucémico fueron frecuentes. En trabajadores manuales (excepto en DM1) las prevalencias de GAA y DM2 fueron mayores. Estos datos resaltan la necesidad de programas preventivos de intervención más temprana (AU)

Prevalence of impaired fasting glucose and type 1 and 2 diabetes mellitus in a large nationwide working population in Spain.

INTRODUCTION: To report the prevalence of impaired fasting glucose (IFG), undiagnosed and diagnosed diabetes, and their association to occupational categories in a representative sample of working population in Spain. MATERIALS AND METHODS: A cross-sectional study of workers who attended routine medical check-ups from January 2007 to December 2007. A structured questionnaire was completed, and physical examinations and routine serum biochemical tests were performed. IFG was defined as fasting glucose levels ranging from 100 to 125 mg/dl with no diagnosis of T1DM or T2DM; T1DM was defined as previous diagnosis of T1DM; and T2DM as previous diagnosis of T2DM, treatment with oral antidiabetic drugs or insulin or fasting glucose levels ≥126 mg/dl, according to ADA criteria. RESULTS: Of the 371,997 participants (median age 35 [interquartile range 29-44] years), 72.4% were male. Raw prevalence rates (95% CI) of IFG, undiagnosed (UKDM), and previously known type 2 (KDM2) and type 1 (KDM1) diabetes were 10.4% (10.3-10.5%), 1.3% (1.2-1.3%), 1.1% (1.1-1.2%), and 0.3% (0.3-0.3%), respectively. With the exception of KDM1, prevalence of these conditions increased with age and was greater among manual/blue-collar workers (12.1%, 1.5%, 1.3% and 0.3%, respectively) as compared to non-manual/white-collar workers (7.3%, 0.8%, 0.8% and 0.3%, respectively). Age- and sex-adjusted prevalence rates of IFG, UKDM and KDM2 were 13.1%, 2.0% and 2.4%, respectively. DISCUSSION: In this sample of Spanish working population, impaired glycemic profiles were common. Prevalence rates of IFG and T2DM were high among blue-collar workers (except for T1DM). These data emphasize the need for earlier structured preventive schemes.

Periodontal conditions among employed adults in Spain.

AIM: To assess the prevalence and severity of periodontal conditions among a representative sample of employed adults in Spain. MATERIAL AND METHODS: A national cross-sectional study was conducted during 2008-2011. Periodontal status of 5130 workers, stratified by gender, age and occupation, was assessed based on Community Periodontal Index (CPI) and Clinical Attachment Level (CAL), following the WHO criteria. RESULTS: The percentage of subjects with periodontal pockets (CPI codes 3-4) was 38.4%, [95% Confidence Interval (CI): 36.4-40.5] increasing significantly in subjects ≥45 years; 13.7% (95% CI: 12.8-14.7) of workers showed CAL 4-5 mm, while 7.7% (95% CI: 7.0-8.5) showed CAL ≥6 mm, again increasing significantly in the population ≥45 years. Prevalence of worse periodontal conditions was significantly higher in male workers, in subjects with primary school education and lower income, and in smokers and former smokers. The periodontal condition in young adults (35-44 years) was worse in comparison with those previously reported in Spanish national surveys. CONCLUSION: Prevalence of destructive periodontal diseases was age-, gender-, education-, income- and tobacco smoking-related. Young adults showed worse periodontal conditions than has been previously reported in national surveys in Spain. It is suggested to include oral evaluation and preventive strategies in work-related medical check-ups.

Impacto de las nuevas guías estadounidense y británica en el manejo y el tratamiento de las dislipemias en una población laboral española / Impact of the New American and British Guidelines on the Management and Treatment of Dyslipidemia in a Spanish Working Population

Introducción y objetivos: La guía para el manejo y el tratamiento de las dislipemias del American College of Cardiology/American Heart Association estadounidense y la del National Institute for Health and Clinical Excellence británico recomiendan cambios importantes, como la supresión de los objetivos terapéuticos o la utilización de unas tablas de riesgo nuevas. Este estudio pretende evaluar el impacto de utilizar estas nuevas guías en comparación con lo que supone la aplicación de la guía europea. Métodos Estudio de tipo observacional realizado en trabajadores españoles. Se incluyó a todos los trabajadores reconocidos por la Sociedad de Prevención de Ibermutuamur durante el año 2011 y cuyo riesgo cardiovascular era evaluable. De cada sujeto, se calculó el riesgo cardiovascular utilizando las tablas Systematic Coronary Risk Evaluation para países de bajo riesgo y las tablas recomendadas por las guías estadounidense y británica. Resultados: Se incluyó a 258.676 trabajadores (el 68,2% varones; media de edad, 39,3 años). Según las tablas Systematic Coronary Risk Evaluation, el 3,74% de la población resultó ser de alto riesgo, mientras que según las tablas británicas eran el 6,85% y según las tablas estadounidenses, el 20,83%. Se debería tratar a más de 20.558 trabajadores si se sigue la guía estadounidense, 13.322 con la británica y 2.612 siguiendo las recomendaciones de las sociedades europeas. Con la guía estadounidense, el coste diario de estatinas se multiplicaría casi por 8. Conclusiones: La nuevas recomendaciones supondrían identificar a más pacientes de alto riesgo y tratar con hipolipemiantes a más población que con las recomendaciones europeas, lo que aumentaría los costes (AU)

Introduction and Objectives The guidelines of the American College of Cardiology/American Heart Association and the British National Institute for Health and Clinical Excellence on the management and treatment of dyslipidemia recommend significant changes, such as the abolition of therapeutic targets and the use of new risk tables. This study aimed to evaluate the impact of the use of these new guidelines compared with the application of European guidelines. Methods Observational study conducted among Spanish workers. We included all workers registered with the Sociedad de Prevención de Ibermutuamur in 2011 whose cardiovascular risk could be evaluated. Cardiovascular risk was calculated for each worker using the Systematic Coronary Risk Evaluation cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. Results A total of 258 676 workers were included (68.2% men; mean age, 39.3 years). High risk was found in 3.74% of the population according to the Systematic Coronary Risk Evaluation tables and in 6.85% and 20.83% according to the British and American tables, respectively. Treatment would be needed in 20.558 workers according to the American guidelines and in 13.222 according to the British guidelines, but in only 2612 according to the European guidelines. By following the American guidelines, the cost of statins would increase by a factor of 8. Conclusions: The new recommendations would result in identifying more high-risk patients and in treating a larger fraction of the population with lipid-lowering drugs than with the European recommendations, which would result in increased costs (AU)

Impact of the new American and British guidelines on the management and treatment of dyslipidemia in a Spanish working population.

INTRODUCTION AND OBJECTIVES: The guidelines of the American College of Cardiology/American Heart Association and the British National Institute for Health and Clinical Excellence on the management and treatment of dyslipidemia recommend significant changes, such as the abolition of therapeutic targets and the use of new risk tables. This study aimed to evaluate the impact of the use of these new guidelines compared with the application of European guidelines. METHODS: Observational study conducted among Spanish workers. We included all workers registered with the Sociedad de Prevención de Ibermutuamur in 2011 whose cardiovascular risk could be evaluated. Cardiovascular risk was calculated for each worker using the Systematic Coronary Risk Evaluation cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. RESULTS: A total of 258,676 workers were included (68.2% men; mean age, 39.3 years). High risk was found in 3.74% of the population according to the Systematic Coronary Risk Evaluation tables and in 6.85% and 20.83% according to the British and American tables, respectively. Treatment would be needed in 20 558 workers according to the American guidelines and in 13,222 according to the British guidelines, but in only 2612 according to the European guidelines. By following the American guidelines, the cost of statins would increase by a factor of 8. CONCLUSIONS: The new recommendations would result in identifying more high-risk patients and in treating a larger fraction of the population with lipid-lowering drugs than with the European recommendations, which would result in increased costs.

Hábitos de higiene bucodental en la población trabajadora española / Oral hygiene habits in the Spanish working population

Objetivo: analizar los hábitos de higiene bucodental de la población trabajadora española. Método: estudio observacional de una muestra de 5.176 trabajadores que acudieron a realizarse un examen de Salud Laboral entre abril de 2008 y junio de 2011. Muestreo estratificado aleatorio. Los participantes completaron un Cuestionario sobre Salud Bucodental con información sobre variables demográficas, laborales y hábitos de salud bucodental. Resultados: el 63,7% de los sujetos (IC 95%: 62,4-65,0) refirieron cepillarse los dientes más de una vez al día (82,6% de las mujeres y 50,9% de los hombres), mientras que el 60,6% (IC 95%: 59,2-62,0) no usaban la seda dental y solo un 6,4% (IC 95%: 5,7-7,1) lo hacían más de una vez al día. Los hábitos de higiene más deficitarios se asociaron con ser varón, ocupaciones manuales y menores estudios e ingresos (p<0,05). Los hábitos de higiene bucodental de la población trabajadora española presentan importantes áreas de mejora (AU)

Methods: a cross sectional study of 5,176 workers, who underwent a routine work-related medical check-up from April 2008 to June 2011. Stratified random sampling. Participants fulfilled a questionnaire comprising demographic, occupational and oral hygiene habits items. Results: 63.7% (CI 95% 62.4-65.0) of workers referred to brush their teeth more than once per day (82.6% of females and 50.9% of males), while 60.6% (CI 95% 59.2-62.0) of them referred not to floss at all, and only 6.4% (CI 95% 5.7-7.1) of workers used dental floss more than once per day. Poorer oral hygiene habits were associated with male workers, blue-collar occupations, lower income and lower education level (p<0.05). Our results suggest that oral hygiene habits in the Spanish working population show important areas for improvement (AU)