Prevención de Trastornos Musculoesqueléticos mediante la mejora de Hábitos Posturales: experiencia en el colectivo de limpieza / Prevention of Musculoskeletal Disorders by improving Postural Habits: experience with cleaning personnel

OBJETIVO: El objetivo es valorar la efectividad de una intervención de mejora de hábitos posturales para prevenir los trastornos musculoesqueléticos en el sector limpieza. MÉTODO: Se diseñó una intervención específica para el colectivo de limpieza, mediante una serie de acciones continuadas en el tiempo dirigidas a fomentar una buena higiene postural y el ejercicio físico. Se aplicó la intervención en dos años distintos (estudio original y estudio de replicación), a una muestra de trabajadores del subsector Limpieza general de edificios, pertenecientes a distintos centros de trabajo de una misma empresa. Se incorporaron herramientas de valoración de las intervenciones basadas en la autopercepción y el registro de los hábitos por un observador externo. RESULTADOS: En el primer estudio se obtuvo un aumento del 92% de las personas que manifestaban adoptar siempre o casi siempre buenos hábitos posturales durante las tareas de limpieza. En el estudio de replicación esta mejora fue del 67%. Las principales mejoras se observaron en: flexionar las piernas, mantener la espalda recta, alternancia de brazos y buscar puntos de apoyo. En la valoración observacional de los hábitos posturales se constató la mejoría autopercibida. CONCLUSIONES: El modelo de intervención fundamentado en una serie de acciones continuadas en el tiempo, favoreciendo el empoderamiento de los trabajadores puede ser efectivo para mejorar, a corto plazo, los hábitos posturales del colectivo de limpieza. Se precisa de más estudios para valorar si el cambio de hábitos se mantiene a largo plazo y su efecto sobre la disminución de los trastornos musculoesqueléticos

INTRODUCTION: The aim of this study was to assess the effectiveness of an intervention for improving postural habits among cleaning personnel, to prevent musculoskeletal disorders. METHODS: We designed a specific intervention for cleaning personnel, consisting of a set of continuous actions focused on promoting good postural habits and physical activity. The intervention was implemented over two different years (initial implementation and replication phases) in a sample of workers in the general building cleaning subsector who belonged to different work centers of the same company. The evaluation of the intervention consisted of self-reported worker feedback and recording of habits by an external observer. RESULTS: In the initial implementation phase, we observed a 92% increase in participants who reported they always or almost always adopt good postural habits during cleaning tasks. In the replication phase, this improvement was sustained by about 67% of participants. The main improvements were observed in: bending knees and hips, keeping the back straight, alternating use of arms and using support while bending forward. The external observation of postural habits corroborated the improvement reported by the workers. CONCLUSIONS: This intervention approach, consisting of different actions, could be continued over time, facilitating worker empowerment, and may be effective in improving the postural habits of cleaning workers in the short term. More research is needed to assess whether the change in habits is maintained over the long term and what its effect would be on the reduction of musculoskeletal disorder

[Prevention of Musculoskeletal Disorders by improving Postural Habits: experience with cleaning personnel]. / Prevención de Trastornos Musculoesqueléticos mediante la mejora de Hábitos Posturales: experiencia en el colectivo de limpieza.

INTRODUCTION: The aim of this study was to assess the effectiveness of an intervention for improving postural habits among cleaning personnel, to prevent musculoskeletal disorders. METHODS: We designed a specific intervention for cleaning personnel, consisting of a set of continuous actions focused on promoting good postural habits and physical activity. The intervention was implemented over two different years (initial implementation and replication phases) in a sample of workers in the general building cleaning subsector who belonged to different work centers of the same company. The evaluation of the intervention consisted of self-reported worker feedback and recording of habits by an external observer. RESULTS: In the initial implementation phase, we observed a 92% increase in participants who reported they always or almost always adopt good postural habits during cleaning tasks. In the replication phase, this improvement was sustained by about 67% of participants. The main improvements were observed in: bending knees and hips, keeping the back straight, alternating use of arms and using support while bending forward. The external observation of postural habits corroborated the improvement reported by the workers. CONCLUSIONS: This intervention approach, consisting of different actions, could be continued over time, facilitating worker empowerment, and may be effective in improving the postural habits of cleaning workers in the short term. More research is needed to assess whether the change in habits is maintained over the long term and what its effect would be on the reduction of musculoskeletal disorders.

OBJETIVO: El objetivo es valorar la efectividad de una intervención de mejora de hábitos posturales para prevenir los trastornos musculoesqueléticos en el sector limpieza. MÉTODO: Se diseñó una intervención específica para el colectivo de limpieza, mediante una serie de acciones continuadas en el tiempo dirigidas a fomentar una buena higiene postural y el ejercicio físico. Se aplicó la intervención en dos años distintos (estudio original y estudio de replicación), a una muestra de trabajadores del subsector Limpieza general de edificios, pertenecientes a distintos centros de trabajo de una misma empresa. Se incorporaron herramientas de valoración de las intervenciones basadas en la autopercepción y el registro de los hábitos por un observador externo. RESULTADOS: En el primer estudio se obtuvo un aumento del 92% de las personas que manifestaban adoptar siempre o casi siempre buenos hábitos posturales durante las tareas de limpieza. En el estudio de replicación esta mejora fue del 67%. Las principales mejoras se observaron en: flexionar las piernas, mantener la espalda recta, alternancia de brazos y buscar puntos de apoyo. En la valoración observacional de los hábitos posturales se constató la mejoría autopercibida. CONCLUSIONES: El modelo de intervención fundamentado en una serie de acciones continuadas en el tiempo, favoreciendo el empoderamiento de los trabajadores puede ser efectivo para mejorar, a corto plazo, los hábitos posturales del colectivo de limpieza. Se precisa de más estudios para valorar si el cambio de hábitos se mantiene a largo plazo y su efectosobre la disminución de los trastornos musculoesqueléticos.

Occupation and mammographic density: A population-based study (DDM-Occup).

INTRODUCTION: High mammographic density is one of the main risk factors for breast cancer. Although several occupations have been associated with breast cancer, there are no previous occupational studies exploring the association with mammographic density. Our objective was to identify occupations associated with high mammographic density in Spanish female workers. METHODS: We conducted a population-based cross-sectional study of occupational determinants of high mammographic density in Spain, based on 1476 women, aged 45-68 years, recruited from seven screening centers within the Spanish Breast Cancer Screening Program network. Reproductive, family, personal, and occupational history data were collected. The latest occupation of each woman was collected and coded according to the 1994 National Classification of Occupations. Mammographic density was assessed from the cranio-caudal mammogram of the left breast using a semi-automated computer-assisted tool. Association between mammographic density and occupation was evaluated by using mixed linear regression models, using log-transformed percentage of mammographic density as dependent variable. Models were adjusted for age, body mass index, menopausal status, parity, smoking, alcohol intake, educational level, type of mammography, first-degree relative with breast cancer, and hormonal replacement therapy use. Screening center and professional reader were included as random effects terms. RESULTS: Mammographic density was higher, although non-statistically significant, among secondary school teachers (eß = 1.41; 95%CI = 0.98-2.03) and nurses (eß = 1.23; 95%CI = 0.96-1.59), whereas workers engaged in the care of people (eß = 0.81; 95%CI = 0.66-1.00) and housewives (eß = 0.87; 95%CI = 0.79-0.95) showed an inverse association with mammographic density. A positive trend for every 5 years working as secondary school teachers was also detected (p-value = 0.035). CONCLUSIONS: Nurses and secondary school teachers were the occupations with the highest mammographic density in our study, showing the latter a positive trend with duration of employment. Future studies are necessary to confirm if these results are due to chance or are the result of a true association whose causal hypothesis is, for the moment, unknown.

Association Between Western and Mediterranean Dietary Patterns and Mammographic Density.

OBJECTIVE: To examine the association between two dietary patterns (Western and Mediterranean), previously linked to breast cancer risk, and mammographic density. METHODS: This cross-sectional study included 3,584 women attending population-based breast cancer screening programs and recruited between October 7, 2007, and July 14, 2008 (participation rate 74.5%). Collected data included anthropometric measurements; demographic, obstetric, and gynecologic characteristics; family and personal health history; and diet in the preceding year. Mammographic density was blindly assessed by a single radiologist and classified into four categories: less than 10%, 10-25%, 25-50%, and greater than 50%. The association between adherence to either a Western or a Mediterranean dietary pattern and mammographic density was explored using multivariable ordinal logistic regression models with random center-specific intercepts. Models were adjusted for age, body mass index, parity, menopause, smoking, family history, hormonal treatment, and calorie and alcohol intake. Differences according to women's characteristics were tested including interaction terms. RESULTS: Women with a higher adherence to the Western dietary pattern were more likely to have high mammographic density (n=242 [27%]) than women with low adherence (n=169 [19%]) with a fully adjusted odds ratio (ORQ4vsQ1) of 1.25 (95% confidence interval [CI] 1.03-1.52). This association was confined to overweight-obese women (adjusted ORQ4vsQ1 [95% CI] 1.41 [1.13-1.76]). No association between Mediterranean dietary pattern and mammographic density was observed. CONCLUSION: The Western dietary pattern was associated with increased mammographic density among overweight-obese women. Our results might inform specific dietary recommendations for women with high mammographic density.

Association analysis between breast cancer genetic variants and mammographic density in a large population-based study (Determinants of Density in Mammographies in Spain) identifies susceptibility loci in TOX3 gene.

BACKGROUND: Mammographic density (MD) is regarded as an intermediate phenotype in breast cancer development. This association study investigated the influence of 14 breast cancer susceptibility loci identified through previous genome-wide association studies on MD among the participants in the "Determinants of Density in Mammographies in Spain" (DDM-Spain) study. METHODS: Our study covered a total of 3348 Caucasian women aged 45-68years, recruited from seven Spanish breast cancer screening centres having DNA available. Mammographic density was blindly assessed by a single reader using a semiquantitative scale. Ordinal logistic models, adjusted for age, body mass index and menopausal status, were used to estimate the association between each genotype and MD. RESULTS: Evidence of association with MD was found for variant rs3803662 (TOX3) (Odds Ratio (OR)=1.13, 95% Confidence Interval (CI)=1.03-1.25), and marginal evidence of association for susceptibility loci rs3817198 (LSP1) (OR=1.09, 95% CI=1.00-1.20) and rs2981582 (FGFR2) (OR=0.92, 95% CI=0.84-1.01). Two other loci were associated with MD solely among pre-menopausal women, namely, rs4973768 (SLC4A7) (OR=0.83, 95% CI=0.70-1.00) and rs4415084 (MEPS30) (OR=1.22, 95% CI=1.00-1.49). CONCLUSIONS: Our findings lend some support to the hypothesis which links these susceptibility loci to MD.

Diet quality and related factors among Spanish female participants in breast cancer screening programs.

OBJECTIVE: A healthy diet is particularly important during menopause, a period in which the risk of a number of health problems increases. This study analyzed diet quality as measured by two indices, namely, the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet (aMED) index, which measures adherence to a Mediterranean diet, and examined the factors associated with lower diet quality. METHODS: This was a cross-sectional study covering 3,564 women aged 45 to 68 years who underwent breast cancer screening at 7 centers (Corunna, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia, and Zaragoza). Data on diet were collected using a food frequency questionnaire validated for the Spanish population. We calculated the AHEI out of a total of 80 points and the aMED out of a total of 9 points. Ordinal logistic regression models were fitted, taking diet quality (tertiles of the AHEI and the aMED) as dependent variables. The following were included in the final multivariate models as explanatory variables: sociodemographic characteristics, chronic diseases, and lifestyles that were associated with diet quality, with a P value <0.100 in an initial simple model (adjusted solely for calorie intake and screening center). Interaction between menopause status and the other explanatory variables was checked. RESULTS: The median score for AHEI was 40 of a maximum of 80 points. Lower diet quality was registered by the youngest women (P for trend < 0.001), premenopausal and perimenopausal women (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; and OR, 1.48; CI, 1.20-1.83, respectively), obese women (OR, 1.18; CI, 0.99-1.41), those with a diagnosis of diabetes (OR, 1.35; CI, 1.01-1.79), smokers (OR, 1.41; CI, 1.21-1.66), and women reporting lower daily physical activity (OR, 1.31; CI, 1.12-1.53). Better diet quality was shown by women with higher education (OR, 0.74; CI, 0.62-0.88) and ex-smokers (OR, 0.82; CI, 0.69-0.98). Nulliparity was associated with higher AHEI scores, but only among premenopausal women (OR, 0.50; CI, 0.32-0.78). aMED index varied between 0 and 9 (median 5). Lower scores were associated with younger age (P for trend < 0.001), low socioeconomic level (OR, 1.13; CI, 0.96-1.33), lower educational level (P for trend = 0.008), and low level of daily physical activity (OR, 1.27, CI, 1.08-1.50). CONCLUSIONS: The youngest women, the most sedentary women, and those who had a lower educational level and socioeconomic status registered worse diet quality. Ex-smokers and postmenopausal women obtained better scores, probably reflecting a keener concern about leading a healthy life.

Adult weight gain, fat distribution and mammographic density in Spanish pre- and post-menopausal women (DDM-Spain).

High mammographic density (MD) is a phenotype risk marker for breast cancer. Body mass index (BMI) is inversely associated with MD, with the breast being a fat storage site. We investigated the influence of abdominal fat distribution and adult weight gain on MD, taking age, BMI and other confounders into account. Because visceral adiposity and BMI are associated with breast cancer only after menopause, differences in pre- and post-menopausal women were also explored. We recruited 3,584 women aged 45-68 years within the Spanish breast cancer screening network. Demographic, reproductive, family and personal history data were collected by purpose-trained staff, who measured current weight, height, waist and hip circumferences under the same protocol and with the same tools. MD was assessed in the left craniocaudal view using Boyd's Semiquantitative Scale. Association between waist-to-hip ratio, adult weight gain (difference between current weight and self-reported weight at 18 years) and MD was quantified by ordinal logistic regression, with random center-specific intercepts. Models were adjusted for age, BMI, breast size, time since menopause, parity, family history of breast cancer and hormonal replacement therapy use. Natural splines were used to describe the shape of the relationship between these two variables and MD. Waist-to-hip ratio was inversely associated with MD, and the effect was more pronounced in pre-menopausal (OR = 0.53 per 0.1 units; 95 % CI = 0.42-0.66) than in post-menopausal women (OR = 0.73; 95 % CI = 0.65-0.82) (P of heterogeneity = 0.010). In contrast, adult weight gain displayed a positive association with MD, which was similar in both groups (OR = 1.17 per 6 kg; 95 % CI = 1.11-1.23). Women who had gained more than 24 kg displayed higher MD (OR = 2.05; 95 % CI = 1.53-2.73). MD was also evaluated using Wolfe's and Tabár's classifications, with similar results being obtained. Once BMI, fat distribution and other confounders were considered, our results showed a clear dose-response gradient between the number of kg gained during adulthood and the proportion of dense tissue in the breast.

Obstetric history and mammographic density: a population-based cross-sectional study in Spain (DDM-Spain).

High mammographic density (MD) is used as a phenotype risk marker for developing breast cancer. During pregnancy and lactation the breast attains full development, with a cellular-proliferation followed by a lobular-differentiation stage. This study investigates the influence of obstetric factors on MD among pre- and post-menopausal women. We enrolled 3,574 women aged 45-68 years who were participating in breast cancer screening programmes in seven screening centers. To measure MD, blind anonymous readings were taken by an experienced radiologist, using craniocaudal mammography and Boyd's semiquantitative scale. Demographic and reproductive data were directly surveyed by purpose-trained staff at the date of screening. The association between MD and obstetric variables was quantified by ordinal logistic regression, with screening centre introduced as a random effect term. We adjusted for age, number of children and body mass index, and stratified by menopausal status. Parity was inversely associated with density, the probability of having high MD decreased by 16% for each new birth (P value < 0.001). Among parous women, a positive association was detected with duration of lactation [>9 months: odds ratio (OR) = 1.33; 95% confidence interval (CI) = 1.02-1.72] and weight of first child (>3,500 g: OR = 1.32; 95% CI = 1.12-1.54). Age at first birth showed a different effect in pre- and post-menopausal women (P value for interaction = 0.030). No association was found among pre-menopausal women. However, in post-menopausal women the probability of having high MD increased in women who had their first child after the age of 30 (OR = 1.53; 95% CI = 1.17-2.00). A higher risk associated with birth of twins was also mainly observed in post-menopausal women (OR = 2.02; 95% CI = 1.18-3.46). Our study shows a greater prevalence of high MD in mothers of advanced age at first birth, those who had twins, those who have breastfed for longer periods, and mothers whose first child had an elevated birth weight. These results suggest the influence of hormones and growth factors over the proliferative activity of the mammary gland.

Childhood factors associated with mammographic density in adult women.

Growth and development factors could contribute to the development of breast cancer associated with an increase in mammographic density. This study examines the influence of certain childhood-related, socio-demographic and anthropometric variables on mammographic density in adult woman. The study covered 3574 women aged 45-68 years, participating in breast cancer-screening programmes in seven Spanish cities. Based on a craniocaudal mammogram, blind, anonymous measurement of mammographic density was made by a single radiologist, using Boyd's semiquantitative scale. Data associated with the early stages of life were obtained from a direct survey. Ordinal logistic regression and generalised linear models were employed to estimate the association between mammographic density and the variables covered by the questionnaire. Screening programme was introduced as a random effects term. Age, number of children, body mass index (BMI) and other childhood-related variables were used as adjustment variables, and stratified by menopausal status. A total of 811 women (23%) presented mammographic density of over 50%, and 5% of densities exceeded 75%. Our results show a greater prevalence of high mammographic density in women with low prepubertal weight (OR: 1.18; 95% CI: 1.02-1.36); marked prepubertal height (OR: 1.25; 95% CI: 0.97-1.60) and advanced age of their mothers at their birth (>39 years: OR: 1.28; 95% CI: 1.03-1.60); and a lower prevalence of high mammographic density in women with higher prepubertal weight, low birth weight and earlier menarche. The influence of these early-life factors may be explained by greater exposure to hormones and growth factors during the development of the breast gland, when breast tissue would be particularly susceptible to proliferative and carcinogenic stimulus.

Alcohol, tobacco, and mammographic density: a population-based study.

Mammographic density (MD), or the proportion of the breast with respect to its overall area that is composed of dense tissue, is a strong risk factor for breast cancer. Studies support a positive association of mammographic density and alcohol drinking. This was a cross-sectional multicenter study based on 3584 women, aged 45-68 years, recruited from seven screening centers within the Spanish breast cancer screening program network. The association between MD, alcohol consumption and tobacco use was evaluated by using ordinal logistic models with random center-specific intercepts. We found a weak positive association between current alcohol intake and higher MD, with current alcohol consumption increasing the odds of high MD by 13% (OR = 1.13; 95% CI 0.99-1.28) and high daily grams of alcohol being positively associated with increased MD (P for trend = 0.045). There were no statistically significant differences in MD between smokers and non-smokers. Nevertheless, increased number of daily cigarettes and increased number of accumulated lifetime cigarettes were negatively associated with high MD (P for trend 0.017 and 0.021). The effect of alcohol on MD was modified by menopausal status and tobacco smoking: whereas, alcohol consumption and daily grams of alcohol were positively associated with higher MD in postmenopausal women and in women who were not currently smoking, alcohol consumption had no effect on MD in premenopausal women and current smokers. Our results support an association between recent alcohol consumption and high MD, characterized by a modest increase in risk at low levels of current consumption and a decrease in risk among heavier drinkers. Our study also shows how the effects of alcohol in the breast can be modified by other factors, such as smoking.

Incidencia de Cáncer de Páncreas en la provincia de Albacete / Incidence of Pancreatic Cancer in the province of Albacete

Objetivos. Determinar la incidencia de cáncer de páncreas en la provincia de Albacete, la presenciade diferentes factores de riesgo, síntomas y estadios más frecuentes en el momento del diagnóstico,pruebas realizadas y tratamientos recibidos.Diseño. Estudio epidemiológico descriptivo.Ámbito. Atención especializada.Participantes. Pacientes diagnosticados de cáncer de páncreas entre 2003-2006 en el ComplejoHospitalario Universitario de Albacete.Mediciones Principales. Se recogieron datos sobre sexo, edad, factores de riesgo asociados, síntomasde debut, pruebas complementarias realizadas, estadio diagnóstico, supervivencia y tratamientosrecibidos.Resultados. La incidencia de cáncer de páncreas en Albacete durante los 4 años fue 9 casos/100.000habitantes. Los factores de riesgo más frecuentes: antecedente de Diabetes Mellitus (32,8%), tabaco(32,1%) y patología biliar (15,3%). Los síntomas de debut más frecuentes: dolor abdominal (59,1%),pérdida de peso (54,7%) e ictericia (50,5%). Las pruebas complementarias realizadas: analítica(96,4%) y TAC (94,2%). El estadio más frecuente al diagnóstico fue el 4 (49%) y el tratamiento elpaliativo (73%). La supervivencia media fue de 150 días.Conclusiones. La incidencia del cáncer de páncreas en Albacete se ha incrementado en los últimosaños. Los factores de riesgo más frecuentes fueron la diabetes y el tabaquismo. El síntoma de debutmás frecuente fue el dolor abdominal. Los síntomas de colestasis fueron menos frecuentes en losestadios avanzados y la anorexia más frecuente a mayor edad. Los estadios diagnósticos más frecuentesfueron los más avanzados y el tratamiento el paliativo. La supervivencia media fue menor de 6 meses y ésta fue mayor en edades superiores

Objectives. To determine the incidence of pancreatic cancer in the province of Albacete, the presenceof risk factors, the onset symptoms and most frequent disease stage at the time of diagnosis,tests performed and treatments received.Design. Descriptive, epidemiological studySetting. Specialised healthcareParticipants. Patients diagnosed with pancreatic cancer between 2003 and 2006 at the HospitalComplex of the University of Albacete.Main measurements. Data on gender, age, associated risk factors, onset symptoms, complementarytests performed, disease stage at diagnosis, survival time and treatment received.Results. The incidence of pancreatic cancer in Albacete during the four year study period was 9cases/100,000 inhabitants. The most frequent risk factors were: history of Diabetes Mellitus (32.8%),tobacco smoking (32.1%) and biliary disease (15.3%). The most frequent onset symptoms were:abdominal pain (59.1%), weight loss (54.7%) and jaundice (50.5%). Complementary tests performedwere: analytical (96,4%) and CAT scan (94,2%). The most frequent disease stage at diagnosis was 4(49%) and treatment was palliative (73%). The mean survival time was 150 days.Conclusions. Over the last few years there has been an increase in pancreatic cancer in Albacete.The most frequent risk factors were diabetes and tobacco smoking. The most frequent onsetsymptom was abdominal pain. Symptoms of cholestasis were less frequent in the advanced stages band weight loss was more frequent with older age. At diagnosis, the advanced stages of the disease were more frequent and the treatment was palliative. The mean survival time was less than 6 months but was longer in older patientsl