Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial / Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension

Introducción y objetivos: La hipertensión arterial es el factor de riesgo más prevalente a nivel global. Se recomienda el cálculo del riesgo cardiovascular en pacientes hipertensos antes del inicio del tratamiento. Este estudio tuvo como objetivo evaluar el valor predictivo y la utilidad clínica de la escala SCORE para prevenir eventos cardiovasculares y mortalidad por todas las causas en los pacientes con hipertensión arterial. Métodos: Se incluyeron los pacientes con hipertensión arterial de la cohorte ESCARVAL-RISK. El riesgo cardiovascular se calculó mediante la escala SCORE. Todas las muertes y eventos cardiovasculares se registraron durante un periodo de 5 años de seguimiento. Se calculó la sensibilidad, la especificidad y los valores predictivos para diferentes puntos de corte, y se evaluó el efecto de diferentes factores de riesgo sobre la exactitud diagnóstica de las gráficas SCORE. Resultados: En una cohorte final de 9.834 pacientes, hubo 555 eventos cardiovasculares y 69 muertes. El valor de riesgo recomendado para iniciar tratamiento farmacológico (5%) presentó una especificidad del 92% para la muerte y del 91% para los eventos cardiovasculares, y una sensibilidad del 20% para la muerte y del 22% para los eventos cardiovasculares. Además, la escala clasificó al 80,4% de los pacientes que sufrieron un evento cardiovascular, y al 78,3% de los que murieron, como de bajo riesgo. La edad, el índice de masa corporal, la retinopatía y el tratamiento anticoagulante se asociaron con una reducción en la capacidad predictiva de la escala SCORE, mientras que ser mujer se asoció con mejor predicción de riesgo. Conclusiones: La capacidad predictiva de la escala SCORE para la enfermedad cardiovascular y la mortalidad total en los pacientes con hipertensión arterial es limitada.(AU)

Introduction and objectives: Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. Methods: Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. Results: In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. Conclusions: The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.(AU)

[Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]. / Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial.

INTRODUCTION AND OBJECTIVES: Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. METHODS: Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. RESULTS: In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. CONCLUSIONS: The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.

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.

Sexual behaviour and risk of sexually transmitted infections in young female healthcare students in Spain.

UNLABELLED: Background. Several authors have examined the risk for sexually transmitted infections (STI), but no study has yet analyzed it solely in relation with sexual behaviour in women. We analyzed the association of sexual behaviour with STI risk in female university students of healthcare sciences. Methods. We designed a cross-sectional study assessing over three months vaginal intercourse with a man. The study involved 175 female university students, without a stable partner, studying healthcare sciences in Spain. MAIN OUTCOME VARIABLE: STI risk (not always using male condoms). Secondary variables: sexual behaviour, method of orgasm, desire to increase the frequency of sexual relations, desire to have more variety in sexual relations, frequency of sexual intercourse with the partner, and age. The information was collected with an original questionnaire. A logistic regression model was used to estimate the adjusted odds ratios (ORs) in order to analyze the association between the STI risk and the study variables. Results. Of the 175 women, 52 were positive for STI risk (29.7%, 95% CI [22.9-36.5%]). Factors significantly associated with STI risk (p < 0.05) included: orgasm (not having orgasms →OR = 7.01, 95% CI [1.49-33.00]; several methods →OR = 0.77, 95% CI [0.31-1.90]; one single method →OR = 1; p = 0.008) and desiring an increased frequency of sexual activities (OR = 0.27, 95% CI [0.13-0.59], p < 0.001). Conclusions. Women's desire for sexual activities and their sexual function were significant predictors of their risk for STI. Information about sexual function is an intrinsic aspect of sexual behaviour and should be taken into consideration when seeking approaches to reduce risks for STI.

Fear of becoming pregnant among female healthcare students in Spain.

The inconsistent use of hormonal contraceptive methods can result, during the first year of use, in one in twelve women still having an undesired pregnancy. This may lead to women experiencing fear of becoming pregnant (FBP). We have only found one study examining the proportion of FBP among women who used hormonal contraceptives. To gather further scientific evidence we undertook an observational, cross-sectional study involving 472 women at a Spanish university in 2005-2009. The inclusion criteria were having had vaginal intercourse with a man in the previous three months and usual use for contraception of a male condom or hormonal contraceptives, or no method of contraception. The outcome was FBP. The secondary variables were contraceptive method used (oral contraceptives; condom; none), desire to increase the frequency of sexual relations, frequency of sexual intercourse with the partner, the sexual partner not always able to ejaculate, desire to increase the partner's time before orgasm, age and being in a stable relationship. A multivariate logistic regression model was used to determine the associated factors. Of the 472 women, 171 experienced FBP (36.2%). Factors significantly associated (p < 0.05) with this FBP were method of contraception (condom and none), desire to increase the partner's ability to delay orgasm and higher frequency of sexual intercourse with the partner. There was a high proportion of FBP, depending on the use of efficient contraceptive methods. A possible solution to this problem may reside in educational programmes. Qualitative studies would be useful to design these programmes.

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)

Calzado de seguridad y el papel del podólogo en la salud laboral / No disponible

Según datos del Ministerio de Trabajo y AsuntosSociales, en 2006 se produjeron en España 253.362accidentes con baja laboral, esto supone un elevadocoste económico y personal. Alguno de estos accidentespodría evitarse con la utilización de un calzadolaboral adecuado. El presente estudio se centra enel calzado de seguridad por ser uno de los más utilizados.Para realizar el estudio se ha realizado unarevisión de los estudios publicados sobre calzado deseguridad, utilizando como palabras clave: “safetyshoes” o “safety footwear”; se revisó en las bases dedatos: Pubmed, Medline, Embase y Scopus recogiendoun total de 79 referencias bibliográficas.Los objetivos del presente trabajo son: describir loscampos de estudio en el ámbito del calzado de seguridady señalar las funciones del podólogo dentrode un equipo de salud laboral.Resultados: se observó un evidente crecimiento en elinterés por el estudio del calzado dentro del ámbitolaboral, con un incremento en el número de artículospublicados. Se detectaron dos líneas básicas deestudio: la medición de coeficientes de rozamientoen la interfase suelo/piso para evitar caídas; y otravertiente dedicada a la valoración del confort delcalzado (reparto de presiones plantares, aislamientotérmico, etc.).Las lesiones podológicas asociadas a la utilizacióndel calzado laboral y los problemas de ajuste adicho calzado según las características personalesdel trabajador, ponen de manifiesto la importanciadel asesoramiento por parte de un podólogo en laselección del calzado laboral, la colaboración delpodólogo en el diseño del calzado y las revisionespodológicas como parte del chequeo médico de lostrabajadores...(AU)

According to data of the Ministry of Work and SocialSubjects, in 2006 253,362 accidents with labour losstook place in Spain, this supposes a high economicand personal cost. Some of these accidents could beavoided with the use of suitable labour footwear.The present study concentrates in the securityfootwear for being one of the most used. In order torealise the study a revision of the studies publishedon security footwear has been realised, using likekey words: “safety shoes” or “safety to footwear”; itwas reviewed in the data bases: Pubmed, Medline,Embase and Scopus gathering a total of 79 bibliographicalreferences.The objectives of the present work are: to describethe fields of study in the scope of the security footwearand to indicate the functions of the podiatristswithin an equipment of labour health. Results: anevident growth in the interest by the study of thefootwear within the labour scope was observed, withan increase in the number of published articles. Twobasic lines of study were detected: the measurementof coefficients of friction in the interphase ground/floor to avoid falls; and another slope dedicated tothe valuation of the comfort of the footwear (distributionof plantar pressures, heat insulation, etc.).The podiatry injuries associated to the use of the labourfootwear and the problems of adjustment to thisfootwear according to the personal characteristics ofthe worker, show the importance of the advising onthe part of a podiatrist in the selection of the labourfootwear, the collaboration of the podiatrist in thedesign of the footwear and revisions as it leaves fromthe medical control of the workers...(AU)