El papel de las mascarillas en el control de la epidemia COVID-19 / The role of face masks in the control of the COVID-19 epidemic

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Work demands and musculoskeletal disorders from the Spanish National Survey.

BACKGROUND: Physical demands at work remain a leading cause of work-related injuries in industrialized countries. AIMS: To use the 2003 Spanish National Survey of Work Conditions to examine prevalence of work-related musculoskeletal disorders (MSDs) and physical load at work. METHODS: Using a representative sample of 5236 persons from the Spanish workforce, the prevalence of carrying or lifting heavy loads, use of significant force and repetitive movements was examined among those with and without MSDs. RESULTS: Use of significant force and carrying heavy weights decreased inversely in relation to exposure time and was always higher among those with MSD symptoms or work-related injury. For repetitive movements, prevalence increased with longer duration of exposure and was also significantly higher in those with MSD symptoms, except in the shortest duration category. CONCLUSIONS: One-third of workers used significant force during part of their shifts, while 4% were exposed for >50% of their work shift, suggesting that 500 000 workers in Spain are at high risk of musculoskeletal injury. Moreover, repetitive movements involving >50% of the work shift affected 30% of workers. To reduce the high incidence of MSDs and work-related injury in Spain, preventive interventions should be directed at these risk factors.

Dilemas en la evaluación de riesgos psicosociales / Dilemmas in evaluating psychosocial risk

La evaluación de los riesgos psicosociales, como ordena la Ley 31/1995 constituye un reto para los servicios de prevención. En este trabajo, se trata de definir qué son y cómo se miden estos riesgos, qué relación tienen con la salud y cómo podemos intervenir para modificarlos. Los factores psicosociales se definen como características de la organización que pueden producir trastornos de la salud a través del estrés. Se discuten las diferentes acepciones de este término y la importancia que tiene la capacidad del sujeto y de los apoyos del entorno para responder a las amenazas que lo desencadenan y se hacen analogías con los modelos biológicos, epidemiológicos y las mediciones higiénicas. Se confirma que el estrés, como experiencia subjetiva, tiene su mejor forma de medición en las encuestas a pesar de las limitaciones de estos instrumentos, como son la validez, la fiabilidad y la ausencia de valores de referencia. Para minimizar estos problemas se recomienda la triangulación con información del medio y del estado de salud. También se examina la disponibilidad de marcadores biológicos de exposición o efecto. Finalmente, se observa que, aunque parece que las actuaciones que modifican aspectos de la organización suelen tener resultados positivos, las experiencias son anecdóticas y difícilmente reproducibles. A pesar de todas las dificultades reseñadas, se considera que los servicios de prevención deben acometer la evaluación de los riesgos psicosociales empleando los instrumentos disponibles con la estrategia más apropiada a su organización y que se deben recomendar intervenciones integrales que impliquen más comunicación, participación y retroalimentación (AU)

[Lung cancer and smoking in Asturias, Spain. A case-control study]. / Cáncer de pulmón y tabaco en Asturias. Un estudio de casos y controles.

OBJECTIVE: Lung cancer in Asturias is 1.4-fold greater than the Spanish average, while the proportion of smokers is similar. The objective of this study was to examine the relationship between lung cancer and smoking in Asturias. MATERIAL AND METHODS: We performed a hospital-based, incident case control study. The cases were newly diagnosed lung cancer patients and controls were patients from the surgical wards. Information was sought on smoking, occupational exposures, and demographic variables. The analysis was performed by means of odds ratios (OR). RESULTS: One hundred ninety-seven cases and 196 controls were included in the analysis. The adjusted OR of cigarette smoking was 5.77 (95% CI, 2.96-11.22). The risk increased with the number of cigarettes smoked per day (chi 2 = 56.3), the number of packs/year (chi 2 = 48.4), and the age at which smoking started (chi 2 = 76.5). The OR diminished with the number of years of cessation (chi 2 = 39.9). CONCLUSIONS: The relationship between smoking and lung cancer in Asturias is similar to that found in other studies carried out in other parts of the western world. The magnitude of the OR may explain the frequency of lung cancer in Asturias. Greater efforts should be devoted to controlling this problem.

Cáncer de pulmón y tabaco en Asturias.Un estudio de casos y controles / Lung cancer and smoking in Asturias, Spain. A case-control study

Objetivo: Examinar la relación entre el consumo de tabaco y cáncer de pulmón en Asturias. Material y métodos: Se realizó un estudio de casos y controles de base hospitalaria. Los casos fueron pacientes con diagnóstico nuevo de cáncer de pulmón (casos incidentes) y los controles procedían de los servicios quirúrgicos. La información obtenida incluyó el consumo de tabaco, las exposiciones ocupacionales y las variables demográficas. Resultados: Se incluyeron en el análisis 197 casos y 196 controles. La odds ratio (OR) ajustada de cáncer de pulmón fue de 5,77 (intervalo de confianza [IC] del 95 por ciento, 2,96-11,22) para el consumo de cigarrillos. El riesgo aumentaba con la cantidad de cigarrillos fumados por día, el número de paquetes/día, la edad de inicio del hábito, y disminuía con el número de años desde el abandono. Conclusiones: La relación entre el tabaco y el cáncer de pulmón en Asturias es similar a la encontrada en otros estudios llevados a cabo en el mundo occidental. La magnitud de la asociación puede explicar la frecuencia de cáncer de pulmón en Asturias (AU)

Fish consumption and stroke: a community case-control study in Asturias, Spain.

BACKGROUND: The relationship between fish consumption and stroke is controversial. Actually, a low fish consumption may protect against ischemic stroke, while a fish diet is ecologically associated with an increased risk of hemorrhagic stroke. OBJECTIVE: This study seeks to examine the relationship between fish consumption and stroke in a population with a high fish consumption and stroke incidence. METHODS: A population-based case-control study was performed, lasting from September 1990 to December 1991. The study comprised 440 incident cases of stroke and 473 controls between the ages of 40 and 85. Cases were defined following WHO criteria, and controls were randomly selected from the study base population. Information on fish consumption was obtained with a food frequency questionnaire. RESULTS: After controlling for age, energy intake and several stroke risk factors, the risk of stroke increased with the consumption of fish, chi(2) 4.12, p = 0.04. Those in the highest quintile of consumption (46 g of fish/day) had a multivariate adjusted odds ratio (OR) of 1.95 (95% CI: 1.14-3.33) as compared to those in the lowest quintile of fish consumption (11 g/ day). The risk of cerebral infarction also increased with the consumption of fish, showing an OR of 1.98 (95% CI: 1.08-3.47). Those in the highest quintile of n-3 fatty acid consumption (660 mg/day) were at borderline higher risk of stroke, with an OR of 1.76 (95% CI: 0.95-3.26), and also of cerebral infarction (OR: 1.89, 95% CI: 0.95-3.75), as compared to those in the lower quintile of n-3 fatty acids consumption (115 mg/day). CONCLUSION: Although misclassification of exposure and residual confounding by unmeasured factors cannot be ruled out, a high fish consumption was associated with an increased risk of stroke and cerebral infarction in this study. More studies should be done to clarify the effect of fish consumption on stroke and stroke subtype in order to issue recommendations regarding the consumption of fish and the risk of stroke.

La variabilidad de la práctica médica. A propósito de la utilización de TAC y RNM en el territorio Insalud / Variations in medical practice. A propos of use of computerized axial tomography and nuclear magnetic resonance in the Spanish National Health System

Objetivo: Determinar la variabilidad de la utilización de tomografía axial computarizada (TAC) y resonancia nuclear magnética (RNM) entre hospitales y provincias en 1996 en el ámbito INSALUD, y evaluar la contribución de la disponibilidad de recursos, tanto humanos como materiales, a la variabilidad observada. Métodos: Los recursos, la utilización y la población asignada se obtuvieron del Sistema de Información de Atención Especializada (SIAE) del INSALUD. Las unidades de análisis fueron los hospitales y las provincias del territorio gestionado por el INSALUD. Las variables independientes analizadas fueron el número de equipos de TAC y RNM, el número de médicos de diversas especialidades, la lista de espera para estas tecnologías, y el nivel económico de la provincia. Para el análisis estadístico se utilizó la razón de variación entre las tasas de utilización y la regresión múltiple. Resultados: La relación de la mayor a la menor tasa de utilización de TAC y RNM es de 15 y 27 entre hospitales, y de 3 y 4 entre provincias, respectivamente. El número de neurocirujanos, el número de equipos TAC, la lista de espera para TAC y la tasa de utilización de RNM, todo ello por habitante, explican el 61 por ciento de la variabilidad para TAC por hospitales. Por provincias, el número de equipos TAC explica el 31 por ciento de esta variabilidad. Para la utilización de RNM por hospitales, el número de neurocirujanos, de traumatólogos y la tasa de utilización de TAC, todo ello por habitante, explica el 42 por ciento de la variabilidad. Los recursos disponibles no están asociados a la variabilidad en la utilización de RNM, por provincias. Conclusiones: La variabilidad encontrada en el territorio INSALUD para el uso de RNM y TAC por hospitales es alta y está ecológicamente asociada a la disponibilidad de recursos. Convendría confirmar estos hallazgos con estudios observacionales en los que también se evalúe la posible aportación del uso inadecuado a esta variabilidad (AU)

Screening de cáncer colorrectal / Screening for colo-rectal cancer

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[Variation in medical practice. Apropos of the use of CAT and NMR in INSALUD]. / La variabilidad de la práctica médica. A propósito de la utilización de TAC y RNM en el territorio INSALUD.

OBJECTIVE: In this study the variability on the utilization of nuclear magnetic resonance (NMR) and computerized tomography (CT) scan among hospitals and provinces in the INSALUD (Spanish National Health System) is evaluated as well as the role of the availability of resources in the variability. METHOD: Data on availability of resources, its use and the reference population for each hospital were obtained from the Specialized Care Information System (SIAE) for the years 1996-1997. The units of analysis were the hospitals and the provinces in the INSALUD territory. The independent variables were the ratio of technologies and professional per inhabitant. Also the waiting list and the economical level of the province were used. Data analysis included the extremal quotient and multiple linear regression. RESULTS: The ratio of the highest to lowest rate of CT and NMR use is 15 and 27 among hospitals and 3 and 4 among provinces, respectively. The number of neurosurgeons, number of CT apparatus, waiting list for CT and rate of NMR use, all standardized per population, explains 61% of CT variability among hospitals. Among provinces, the number of CT apparatus explains 31% of all variability. For NMR use among hospitals, the number of neurosurgeons, number of orthopedic surgeons and CT use, all variables standardized per population, explains 42% of variability. The amount of equipment is not associated with NMR rate among provinces. CONCLUSIONS: The variation found in the INSALUD territory for the two procedures is high and ecologically associated to the availability of resources. It would be convenient to perform an observational study to confirm the findings and evaluate the possible contribution of inappropriate use to the variation.

Epidemiological study of Streptococcus pneumoniae carriers in healthy primary-school children.

To obtain information on the Streptococcus pneumoniae carrier state in Spanish children, 332 healthy 6-year-old children from nine primary schools in northern Spain were screened. Thirty-six percent of the children had positive cultures yielding 128 strains. Seventy-one strains belonged to 14 serogroup/serotypes, the most frequent being 19, 23, 3, 24 and 11. Fifty-seven strains were nontypeable. The identification of strains with equivocal results was confirmed at species level by means of hybridisation with a specific probe, pneumolysin-mediated agglutination and a pathogenicity test in mice. Sixty-four percent of strains showed resistance to penicillin, 22% of these also being resistant to cefotaxime. More than 40% of the strains were resistant to trimethoprim-sulfamethoxazole, tetracycline and erythromycin. Twenty percent of the erythromycin-resistant strains were susceptible to clindamycin. Two strains were resistant to rifampicin and one strain was resistant to ofloxacin. All strains were susceptible to vancomycin. Previous antibiotic administration and having siblings under the age of 2 years correlated with the carriage of pneumococcus. There was no correlation with the carriage of antibiotic-resistant strains, or a record of previous infections, previous hospital admissions or having relatives with chronic respiratory disease.

Alcohol and stroke: a community case-control study in Asturias, Spain.

The relationship between alcohol consumption and stroke is uncertain. Heavy alcohol consumption has been associated with an increased risk of stroke, while light drinking appears to be protective. However, the evidence is not uniform. We sought to examine the relationship between alcohol consumption and stroke, according to stroke type. We performed a population-based case-control study from September 1990 to December 1991. The study comprised 467 incident cases of stroke and 477 controls aged between 40 and 85. Case was defined following WHO criteria and control was randomly selected from the study base population. Alcohol exposure was obtained by medical interview. We found that consumption of less than 30 g/day of alcohol was protective against all stroke types combined, the multivariated adjusted odds ratio (OR) was 0.58 (95% confidence interval [CI], 0.41-0.83). Moderate alcohol drinking is also protective against all cerebral infarction combined (OR = 0.53; 95% CI, 0.35-0.80) and cortical infarction (OR = 0.40; 95% CI, 0.18-0.86). Drinking up to 30 g/day of alcohol has a borderline protective effect on deep cerebral infarction (OR = 0.40; 95% CI, 0.16-1.02) and has no effect on intracerebral hemorrhage (OR = 0.88; 95% CI, 0.44-1.74). Heavy alcohol drinking, over 140 g/day, is a risk factor for all stroke types combined (OR = 3.2; 95% CI, 1.1-9.7), all cerebral infarction combined (OR = 5.0; 95% CI, 1.5-16.3), small deep cerebral infarction (OR = 9.7; 95% CI, 2.6-36.7), intracerebral hemorrhage (OR = 6.2; 95% CI, 1.3-24.0), and is marginally associated with superficial cerebral infarction (OR = 4.6; 95% CI, 1.0-20.6). The relationship between alcohol and stroke depends on the alcohol dose and the pathology of the disease. Atherosclerosis of the large and medium cerebral arteries is found mainly in superficial cerebral infarction, and this type of stroke shows a J-shaped relationship with alcohol similar to that found in coronary heart disease, suggesting that they are similar diseases. On the other hand, arteriosclerosis of the penetrating arteries has been found in deep cerebral infarction and intracerebral hemorrhage, while atherosclerosis is not prominent. This may explain why alcohol does not have a protective effect on cerebral hemorrhage whereas heavy drinking is a strong risk factor in these two types of stroke.

Family history and stroke: a community case-control study in Asturias, Spain.

BACKGROUND: Family history of stroke has been considered as a risk factor for stroke, but this relationship is controversial. Some, but not all, studies have found an independent association between family history of stroke and stroke. This study examines the relationship between family history of stroke and all stroke types combined, cerebral infarction and intraparenchymatous haemorrhage. METHODS: This is an incidence type, population-based case-control study. Cases were defined following WHO criteria and controls were randomly selected from the study-base population. Family history of stroke was obtained by medical interview. A total of 470 cases and 477 controls, aged 40-85 years, form the subjects of the study. RESULTS: Family history of stroke in a first-degree relative is an independent risk factor for all stroke types combined, multivariate adjusted odds ratio (OR) 1.74, 95% confidence interval (CI) 1.24-2.44, for cerebral infarction, OR = 1.79 (95% CI 1.25-2.56), but not for intraparenchymatous haemorrhage, OR = 1.71 (95% CI 0.91-3.17). Risk of all stroke types combined was independently associated with a positive history of father with stroke OR = 1.93 (1.19-3.54) with a positive history of sibling with stroke, OR = 1.67 (95% CI 1.03-2.71) and a borderline significant association with a positive history of mother with stroke OR = 1.45 (95% CI 0.92-2.29). Cerebral infarction was independently associated with a positive history of father with stroke OR = 2.05 (95% CI 1.17-3.59), a positive history of sibling, OR = 1.69 (95% CI 1.01-2.84) and a borderline significant association with a positive history of mother with stroke OR = 1.58 (95% CI 0.97-2.56). Intracerebral haemorrhage was not significantly associated with a positive history of father with stroke OR = 1.39 (0.55-3.58) with a positive history of sibling, OR = 1.83 (95% CI 0.77-4.40), or with a positive history of mother with stroke OR = 1.36 (95% CI 0.59-3.09). CONCLUSIONS: Family history of stroke is found in this study to be an independent risk factor for all stroke types combined and for cerebral infarction. Genetic factors may be involved, but it cannot be ruled out that the observed relationship is confounded by other risk factors, especially family aggregation of life-styles.

[Stroke incidence in Asturias, 1990-1991]. / Incidencia del accidente cerebrovascular en Asturias: 1990-1991.

BACKGROUND: Stroke, with a rate of 121/100,000 was the second cause of death in Asturias, Spain. Here we communicate the results of a population based stroke register in the oriental health districts of Asturias. METHOD: The study took place between October 1, 1990 and May 30, 1991, covering a population of 652,549. Surveillance was both active and passive and included the public and private hospitals, and the primary health care. Death certificates could not be checked due to legal reasons. We defined case following the WHO criteria. RESULTS: During the eight months of study 708 case occurred. The crude incidence rate of first stroke was 132.4/100,000 and that of any stroke, 162.7/100,000. The age adjusted incidence to the world population was, respectively, 61.3/100,000 and 73.6/100,000. There were no differences in the incidence across sexes. Age showed a strong effect in cerebral infarctation and less marked in intracerebral hemorrhage Infarcts are very rare in women before 50. Distribution of stroke type was: infarct: 77%; intracerebral hemorrhages: 14%: subarachnoid hemorrhage: 4% and unspecified stroke: 4%. Almost 50% of the strokes occurred in the morning hours, from 6:00 am to 12:00 am also during the cold season, winter and fall, the proportion of stroke was higher than during the warm season. CONCLUSION: Stroke is an important cause of morbi-mortality in Asturias. The magnitude of mortality is larger than the expected from the incidence. It maybe explained by a high case/fatality ratio in Asturias due to proportion of hemorrhagic stroke, the ageing of the population and the distribution of competing causes of death. However, we cannot rule out a small incomplete registration of cases, mostly in patients over 85. We estimated the incidence of any stroke, given underegistration, to be 176/100,000 for any stroke.