Development, and Internal, and External Validation of a Scoring System to Predict 30-Day Mortality after Having a Traffic Accident Traveling by Private Car or Van: An Analysis of 164,790 Subjects and 79,664 Accidents.

Predictive factors for fatal traffic accidents have been determined, but not addressed collectively through a predictive model to help determine the probability of mortality and thereby ascertain key points for intervening and decreasing that probability. Data on all road traffic accidents with victims involving a private car or van occurring in Spain in 2015 (164,790 subjects and 79,664 accidents) were analyzed, evaluating 30-day mortality following the accident. As candidate predictors of mortality, variables associated with the accident (weekend, time, number of vehicles, road, brightness, and weather) associated with the vehicle (type and age of vehicle, and other types of vehicles in the accident) and associated with individuals (gender, age, seat belt, and position in the vehicle) were examined. The sample was divided into two groups. In one group, a logistic regression model adapted to a points system was constructed and internally validated, and in the other group the model was externally validated. The points system obtained good discrimination and calibration in both the internal and the external validation. Consequently, a simple tool is available to determine the risk of mortality following a traffic accident, which could be validated in other countries.

The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study.

AIM: Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years. METHODS: Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008-2012. We included men and women aged≥70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-cause mortality and/or hospital admission due to coronary heart disease or stroke. A standard Cox and Cox-Aalen models were adjusted. RESULTS: 5016 subjects were included whit a mean age of 75.1 years (46.7% men). During an average follow-up of 49 months (4.1 years), 807 (16.1%) MACE were recorded. The incidence of MACE was 20.6 per 1000-person-years. Variables significantly associated to the incidence of MACE were male gender (HR: 1.61), heart failure (HR: 2.26), antiplatelet therapy (HR: 1.39), oral antidiabetic treatment (HR: 0.74), antithrombotics (HR: 1.79), while age, creatinine, HbA1c and peripheral arterial disease were time-depend associated variables. CONCLUSION: These results highlights the importance of HbA1c level in the incidence of cardiovascular events in older diabetic patients.

Influencia de las medidas preventivas ergonómicas en el desarrollo de secuelas por patología no traumática del hombro / Influence of Ergonomic Preventive Resources in Development of Sequels Due to Non-Traumatic Diseases of the Shoulder

OBJETIVO: Describir las secuelas referidas en los casos atendidos por patología no traumática del hombro. Y conocer cómo se asocian con la presencia de secuelas las características sociodemográficas, disponer de conocimientos en prevención de riesgos laborales y los requerimientos ergonómicos del puesto de trabajo. MÉTODOS: Estudio observacional transversal en una población de 345 pacientes atendidos durante un año en las consultas de un centro de atención primaria de salud en Alicante. Mediante la prueba de la Ji-cuadrado se estudiaron las asociaciones entre las secuelas y el resto de variables. RESULTADOS: El 53,9% (n = 186) de los participantes refirieron presentar secuelas derivadas, sobre todo dolor ocasional asociado o no a limitación de la movilidad. Son factores de riesgo: un bajo nivel de estudios, actividades de limpieza y sector industrial, alzar los brazos por encima del hombro y la monotonía en las tareas. Sin embargo, son factores protectores: el sexo masculino, disponer de información sobre los riesgos laborales, equipos de protección individual, existencia de Servicio de Prevención de Riesgos Laborales, evaluación de riesgos, plan de prevención y los reconocimientos médicos periódicos. Conocer los riesgos del puesto se mostró como factor de protección independiente frente al desarrollo de secuelas (Ora = 0,2; IC 95% = 0,1-0,4). Sin embargo, alzar el brazo por encima del hombro, se comporta como factor de riesgo independiente para el desarrollo de secuelas por patología del hombro (Ora = 2,1; IC 95% = 1,0-4,3). CONCLUSIONES: La combinación de estrategias ergonómicas y formativas parecen útiles para la prevención del desarrollo de secuelas a nivel del hombro

OBJECTIVE: To describe the sequelae referred to the cases attended by non-traumatic diseases of the shoulder. To know how sociodemographic characteristics, preventive knowl-edge about the workplace and ergonomic requirements are associated with the presence of sequelae. METHODS: Cross-sectional observational study in a population of 345 patients attended for a year in the consultations of a primary health care center in Alicante. Through the Chi-square test, the associations between the sequels and the rest of the variables were studied. RESULTS: 53.9% (n = 186) of the participants reported having sequelae derived, especially occasional pain associated or not with limitation of joint mobility. They are risk factors: a low level of studies, cleaning activities and industrial sector, raising the arm over the shoulder and the monotony in the workplace. However, they are protective factors: male sex, having information on occupational risks, Personal Protective Equipment, the existence of a Labor Risk Prevention Service, Risk Assessment, Prevention Plan and periodic medical examinations. Knowing the risks of the position was shown as an independent protection factor against the development of secondary sequelae in the shoulder (ORa = 0,2; IC 95% = 0,1-0,4). However, to raise the arm above the shoulder, behaving as an independent risk factor for the development of sequelae due to shoulder pathology (ORa = 2,1; IC95% = 1,0-4,3)

[Influence of Ergonomic Preventive Resources in Development of Sequels Due to Non-Traumatic Diseases of the Shoulder]. / Influencia de las medidas preventivas ergonómicas en el desarrollo de secuelas por patología no traumática del hombro.

OBJECTIVE: To describe the sequelae referred to the cases attended by non-traumatic diseases of the shoulder. To know how sociodemographic characteristics, preventive knowledge about the workplace and ergonomic requirements are associated with the presence of sequelae. METHODS: Cross-sectional observational study in a population of 345 patients attended for a year in the consultations of a primary health care center in Alicante. Through the Chi-square test, the associations between the sequels and the rest of the variables were studied. RESULSTS: 53.9% (n=186) of the participants reported having sequelae derived, especially occasional pain associated or not with limitation of joint mobility. They are risk factors: a low level of studies, cleaning activities and industrial sector, raising the arm over the shoulder and the monotony in the workplace. However, they are protective factors: male sex, having information on occupational risks, Personal Protective Equipment, the existence of a Labor Risk Prevention Service, Risk Assessment, Prevention Plan and periodic medical examinations. Knowing the risks of the position was shown as an independent protection factor against the development of secondary sequelae in the shoulder (ORa=0,2; IC95%=0,1-0,4). However, to raise the arm above the shoulder, behaving as an independent risk factor for the development of sequelae due to shoulder pathology (ORa=2,1; IC95%=1,0-4,3). CONCLUSIONS: The combination of ergonomic and training strategies seems useful in the prevention of the development of shoulder-level sequelae.

OBJETIVO: Describir las secuelas referidas en los casos atendidos por patología no traumática del hombro. Y conocer cómo se asocian con la presencia de secuelas las características sociodemográficas, disponer de conocimientos en prevención de riesgos laborales y los requerimientos ergonómicos del puesto de trabajo. MÉTODOS: Estudio observacional transversal en una población de 345 pacientes atendidos durante un año en las consultas de un centro de atención primaria de salud en Alicante. Mediante la prueba de la Ji-cuadrado se estudiaron las asociaciones entre las secuelas y el resto de variables. RESULTADOS: El 53,9% (n=186) de los participantes refirieron presentar secuelas derivadas, sobre todo dolor ocasional asociado o no a limitación de la movilidad. Son factores de riesgo: un bajo nivel de estudios, actividades de limpieza y sector industrial, alzar los brazos por encima del hombro y la monotonía en las tareas. Sin embargo, son factores protectores: el sexo masculino, disponer de información sobre los riesgos laborales, equipos de protección individual, existencia de Servicio de Prevención de Riesgos Laborales, evaluación de riesgos, plan de prevención y los reconocimientos médicos periódicos. Conocer los riesgos del puesto se mostró como factor de protección independiente frente al desarrollo de secuelas (ORa=0,2; IC95%=0,1-0,4). Sin embargo, alzar el brazo por encima del hombro, se comporta como factor de riesgo independiente para el desarrollo de secuelas por patología del hombro (ORa=2,1; IC95%=1,0-4,3). CONCLUSIONES: La combinación de estrategias ergonómicas y formativas parecen útiles para la prevención del desarrollo de secuelas a nivel del hombro.

A new risk score to assess atrial fibrillation risk in hypertensive patients (ESCARVAL-RISK Project.

This study aimed to assess atrial fibrillation (AF) incidence and predictive factors in hypertensive patients and to formulate an AF risk assessment score that can be used to identify the patients most likely to develop AF. This was a cohort study of patients recruited in primary healthcare centers. Patients aged 40 years or older with hypertension, free of AF and with no previous cardiovascular events were included. Patients attended annual visits according to clinical practice until the end of study or onset of AF. The association between AF incidence and explanatory variables (age, sex, body mass index, medical history and other) was analyzed. Finally, 12,206 patients were included (52.6% men, and mean age was 64.9 years); the mean follow-up was 36.7 months, and 394 (3.2%) patients were diagnosed with AF. The incidence of AF was 10.5/1000 person-years. Age (hazard ratio [HR] 1.06 per year; 95% confidence interval [CI] 1.05-1.08), male sex (HR 1.88; 95% CI 1.53-2.31), obesity (HR 2.57; 95% CI 1.70-3.90), and heart failure (HR 2.44; 95% CI 1.45-4.11) were independent predictors (p < 0.001). We propose a risk score based on significant predictors, which enables the identification of people with hypertension who are at the greatest risk of AF.

The influence of information on the prevention of occupational risks and ergonomic requirements in the development of non-traumatic osteomuscular diseases of the shoulder - a pilot study.

OBJECTIVES: Shoulder pain associated with upper limb musculoskeletal disorders is an important health problem in clinical practice due to its high prevalence, frequent consultations in primary healthcare and occupational health. Preventive strategies, including information disseminated among workers, can be useful. The aim of this study is to analyze the associations between non-traumatic osteomuscular diseases of the shoulder and the workers' knowledge of the risks at the workplace and preventive measures developed there, as well as the association with ergonomic requirements. MATERIAL AND METHODS: An observational case-control study was carried out on an occupationally active population assisted during 1 year in 1 healthcare center, involving 690 participants. Data were collected through a questionnaire including sociodemographic variables, the workplace, the knowledge of prevention and ergonomic requirements. The independent effect of the variables associated with non-traumatic shoulder pathology was explored through logistic regression. RESULTS: In total, 66.7% of the participants stated that they had been informed of the occupational hazards related to their jobs. The following variables were associated with a lower probability of shoulder injuries: male gender, working hours > 9 h/day or > 40 h/week, as well as having information on the risks associated with the workplace, using personal protective equipment, the existence of an occupational risks prevention service and/or risk assessment, the knowledge of the prevention plan, periodic medical examinations, and using one arm or physical force at work. A multivariate analysis revealed that the risk increased with age and lower educational levels, forced postures, repeated gestures, monotony and temporary absences from work. Furthermore, being informed of workplace risks, and using a single arm as well as physical force were shown as independent protective factors. CONCLUSIONS: Information on both the ergonomic requirements and how to prevent occupational risks is a useful tool for the prevention of non-traumatic shoulder diseases. Preventive policies including health education interventions in the workplace could benefit other developed preventive activities. Int J Occup Med Environ Health. 2019;32(6):825-40.

Influencia de los requerimientos ergonómicos y recursos preventivos percibidos en el desarrollo de bajas laborales por patología no traumática del hombro / Influence of ergonomic requirements and perceived preventive work resources on sickness absence due to non-traumatic shoulder disorders

INTRODUCCIÓN: El hombro doloroso es un problema médico común en Atención Primaria de salud y en el ámbito laboral. Puede producir una discapacidad funcional considerable y requerir de periodos de incapacidad temporal. OBJETIVOS: Describir las características de pacientes atendidos por patología no traumática del hombro, así como estudiar la asociación entre requerimientos ergonómicos y conocimientos preventivos del puesto de trabajo y el desarrollo de bajas laborales. MATERIAL Y MÉTODO: Estudio observacional transversal en una población de 345 pacientes en edad laboral que consultaron al médico de familia por dolor en el hombro en un año, pertenecientes a un centro de salud del Departamento de Salud de Alicante-Hospital General. Se utilizó un cuestionario con preguntas sobre conocimientos en prevención de riesgos laborales, requerimientos del puesto de trabajo y haber requerido o no periodos de incapacidad temporal derivada. Se realizó un análisis descriptivo y analítico. RESULTADOS: El 39,1% de los entrevistados refirieron periodos de baja laboral, calificándose el 87% como enfermedad común. El 51% refirió no tener información sobre los riesgos asociados a sus puestos de trabajo. Los requerimientos ergonómicos más frecuentes referidos por los encuestados fueron: posturas forzadas, alzar el brazo por encima del hombro, girar cuello-columna, y movimientos repetidos. Presentaron mayor probabilidad de baja las actividades relacionadas con construcción, agricultura, ganadería y pesca, conocer la existencia de evaluación de riesgos y/o plan de prevención y los requerimientos de alzar los brazos, golpear superficies, manejar cargas pesadas, y usar fuerza física. Conocer la existencia de un plan de prevención se mostró como factor de riesgo independiente (OR 4,2 [1,1-15,9]). CONCLUSIONES: Es importante abordar preventivamente los requerimientos ergonómicos del puesto así como conseguir mayores conocimientos de las estructuras preventivas para evitar el desarrollo de bajas laborales por hombro doloroso

INTRODUCTION: Painful shoulder is a common medical problem in Primary Health Care and at the workplace. It can cause a considerable functional disability and can require periods of sick leave. OBJECTIVES: To describe the characteristics of patients treated for non-traumatic diseases of the shoulder, as well as to know the association between ergonomic requirements and preventive knowledge about the workplace in the development of sickness absence. METHODS: Cross-sectional observational study in working age population of 345 patients who consulted their general practitioner throughout the year for shoulder pain, belonging to a health center from the Health Department of the Hospital General de Alicante. A questionnaire was used with questions about knowledge in occupational risk prevention, work requirements and whether or not temporary disability periods were required. A descriptive and analytical analysis was carried out. RESULTS: 39.1% of the interviewees reported periods of sick leave, qualified in 87% as a common disorder. 51% of them reported having no information about risks associated with their jobs. The most frequent ergonomic requirements referred by the respondents were: unnatural body posture, to raise the arm over the shoulder, to turn the neck-column, and to repeat movements. The probability of temporal disability was higher in those activities related to construction, agriculture, livestock and fisheries, people with knowledge of the existence of risk assessment and / or prevention plan, and the requirements of raising the arms, hitting surfaces, handling heavy loads, and using physical strength. To have knowledge about the existence of a prevention plan was shown as an independent risk factor (OR 4.2 [1.1-15.9]). CONCLUSIONS: It is important to preventively address the ergonomic requirements of the position as well as to gain greater knowledge of preventive structures in order to prevent the development of sick leave due to shoulder pain

Utilización de marcadores genéticos de la CYP2E1 en la valoración de riesgos de exposición laboral a estireno mediante control biológico / Use of genetic markers for CYPE1 in the assessment of risks through occupational exposure to styrene using biologic controls

Hemos estudiado la utilidad del genotipado y fenotipado de la enzima CYP2E1 para la evaluación del riesgo de exposición laboral a estireno, correlacionando los datos obtenidos con los indicadores biológicos habituales en programas de Salud Laboral (ácidos mandélico y fenilglioxílico, principales metabolitos urinarios del estireno). Se examinaron 49 trabajadores con exposición conocida a estireno y un grupo control, determinándose mARN de CYP2E1 en sangre y polimorfismos de la enzima en muestras de mucosa oral. Nuestros resultados muestran que el efecto combinado del fenotipo de CYP2E1 y del genotipo de los alelos CYP2E1*5B y CYP2E1*6 puede explicar en parte la variabilidad en la excreción urinaria de metabolitos del estireno. La técnica de obtención de material biológico a partir de la mucosa oral puede ser de interés en el ámbito laboral (AU)

We have studied the usefulness of geno and phenotyping of the enzyme CYP2E1 for the assessment of risk through occupational exposure to styrene and correlated the results achieved with the habitual biologic markers in Occupational Health programmes (mandelic and phenylglyoxylic acids, the main urinary metabolites of styrene). The study group comprised 49 workers with known exposure to styrene and a control group; CYP2E1 mRNA in blood and enzyme polymorphisms in samples of the oral mucosa were assessed. Our results show that the combined affects of CYP2E1 phenotype and of the CYP2E1*5B and CYP2E1*6 allele genotype may in part explain the variability in the urinary excretion of styrene metabolites. The sampling technique for biologic material from the oral mucosa may be useful in the occupational environment (AU)