Evaluation of mechanical closure resistance of sutureless vitrectomy sclerotomies after conjunctival cauterization with bipolar diathermy forceps.

BACKGROUND: Suturing is the most widely used technique to close leaking sclerotomies after transconjunctival sutureless vitrectomy (TSV). However, with the aim of avoiding the disadvantages caused by conjunctival stitches, there have been described other closure techniques, such as the cauterization of the conjunctiva placed over the incisions. To continue advancing knowledge of the incisional occlusion effect achieved by conjunctival diathermy, it would be also interesting to study the wound closure resistance obtained under intraocular pressure (IOP) changes, given that in the early postoperative period eyes are subjected to pressure stress. In our study, we compare the mechanical resistance observed in sclerotomies treated with bipolar diathermy after TSV compared to that found in incisions in which cauterization was not performed. METHODS: This was an experimental, randomized, and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, cauterization was performed with bipolar diathermy forceps on the conjunctiva placed over one of the superior sclerotomy sites; no maneuver was performed over the other superior incision. IOP was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape. RESULTS: In 35 % of cases (28 of 80 eyes), sclerotomies subjected to diathermy allowed intraocular fluid escape first (p = 0.01). When comparing opening pressure values, cauterized incisions leaked at significantly higher pressure levels than those in which diathermy was not applied (p < 0.001). CONCLUSIONS: Bipolar diathermy on sutureless sclerotomies has demonstrated to be, in our experimental model, an effective method for increasing the sclerotomy closure resistance. Although its use in vitrectomized eyes has previously been described, our study is the first to analyze the response of cauterized sclerotomies to IOP increases.

Assessment of Closure Competency of Sutureless Vitrectomy Sclerotomies After Scleral Hydration.

PURPOSE: To assess the influence that hydration applied on the sclerotomy edges may have on incisional closure resistance after transconjunctival sutureless vitrectomy (TSV). METHODS: Experimental, randomized and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, hydration with balanced salt solution (BSS) was applied on the sclerotomy edges of one of the superior incision sites; no maneuver was performed on the other superior sclerotomy. Intraocular pressure (IOP) was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape. RESULTS: In 45% of cases (36 of 80 eyes), sclerotomies subjected to hydration allowed intraocular fluid escape (p = 0.43). There were no differences when comparing opening pressure values of hydrated and non-hydrated sclerotomies (p = 0.19). CONCLUSIONS: Scleral hydration did not demonstrate increase in the sclerotomy closure resistance in our experimental model. Given the widespread use of sutureless TSV around the world, the results obtained in our research, in spite of being negative, may contribute to the knowledge of the behavior of sutureless sclerotomies.

Influence of the source of incisional vitreous incarceration on sclerotomy closure competency after transconjunctival sutureless vitrectomy.

PURPOSE: To evaluate the influence that the origin of incisional vitreous incarceration may have on the presence of postoperative conjunctival blebs over sclerotomies after transconjunctival sutureless vitrectomy (TSV). Blebs are formed by incisional leakage due to incompetent closure. METHODS: Twenty-three-gauge TSV was performed in 83 cadaveric pig eyes. Once each vitrectomy was finished, ultrasound biomicroscopy (UBM) was used to assess the presence of postoperative conjunctival blebs over the sclerotomy sites, as well as the existence of vitreous incarcerated in incisions. Vitreous strands may come from the perisclerotomy area, running parallel to the sclera toward the inner hole of the sclerotomies, or may radiate from the core of the vitreous cavity. RESULTS: Vitreous entrapment was found in 73.9% of the sclerotomies; 43.4% of the incisions showed vitreous strands coming parallel to the sclera (12.9% of them showed conjunctival bleb), 19.7% of the wounds presented vitreous aiming toward the core of the vitreous cavity (2% of them had conjunctival bleb) and 10.8% of the entrances presented both vitreous incarceration sources (none of them showed bleb). Incisions with vitreous entrapment parallel to the sclera were associated with a significantly greater sclerotomy leakage rate. CONCLUSIONS: Sclerotomies with vitreous incarceration coming from the core of the vitreous cavity showed a greater incisional closure competency than that observed in incisions with vitreous entrapment coming from the pericannular area; if these results were confirmed in humans, different postoperative suture rates may be expected on sclerotomies according to the vitrectomy degree performed in different areas of the vitreous cavity.

Evaluation of conjunctival bleb detection after vitrectomy by ultrasound biomicroscopy, optical coherence tomography and direct visualization.

PURPOSE: To compare ultrasound biomicroscopy (UBM), anterior-segment optical coherence tomography (AS-OCT), and direct visualization for detecting conjunctival blebs in sutureless sclerotomies after vitrectomy. Conjunctival blebs are formed by sclerotomy leakage due to incompetent closure. METHODS: Experimental, randomized, and observer-masked study in which 23-gauge vitrectomies were performed in cadaveric pig eyes. Postoperative conjunctival blebs were assessed by UBM, AS-OCT, and direct visualization. No conjunctival blebs were classified as Grade 0 (G0), thin blebs (less than or equal to one-half of scleral thickness) as Grade 1 (G1) and thick blebs (greater than one-half of scleral thickness) as Grade 2 (G2). RESULTS: Fifty pig eyes were included. Conjunctival blebs were found in 13.3% (8% G1, 5.3% G2) of the incisions analyzed by UBM, in 20% (14.7% G1, 5.3% G2) of the sclerotomies studied by AS-OCT, and in 7.3% (2% G1, 5.3% G2) of the wounds evaluated by direct visualization. AS-OCT was the most sensitive method for identifying conjunctival blebs when compared with UBM and direct visualization (p<0.001). In turn, UBM was better than direct visualization for observing sclerotomy blebs (p=0.004). CONCLUSIONS: AS-OCT is the most sensitive technique for detecting subclinical blebs (G1) and thus, it may be useful in research for studying the influence that surgical factors and maneuvers may exert on sclerotomy closure capacity after vitrectomy. Direct visualization, that is used in routine clinical practice to determine which sclerotomies should be sutured, is useful only to identify thick blebs (G2) after vitrectomy.

Conocimientos y actitudes de médicos y enfermeras sobre las instrucciones previas / Knowledge and attitudes about advance directives on physicians and nurses

Objetivos: Describir y comparar los conocimientos y actitudes de médicos y enfermeras sobre las instrucciones previas. Diseño: Estudio piloto descriptivo transversal. Emplazamiento Área Asistencial Este de la Comunidad de Madrid. Participantes: Médicos y enfermeras de atención primaria y especializada. Mediciones principales: Cuestionario autocumplimentado acerca de conocimientos y actitudes sobre las instrucciones previas, compuesto por variables dicotómicas y de escala tipo Likert (0-10). Resultados: Respondieron al cuestionario un total de 192 médicos y enfermeras (tasa de respuesta = 83,4%); 72,4% eran mujeres y 27,6% hombres. La media de edad fue de 39,6 años (DE = 10,9). Para el conocimiento general sobre las instrucciones previas la mediana fue de 5 (rango intercuartílico: 3-7). El 60,1% conocía la regulación por ley, pero solo el 22,8% había leído el documento. Conclusiones: El conocimiento de médicos y enfermeras sobre las instrucciones previas es bajo, por lo que es necesario mejorar este conocimiento. Los médicos y enfermeras de ambos niveles muestran actitudes favorables hacia el uso, la utilidad y el respeto del contenido del documento de instrucciones previas. El diseño metodológico propuesto es eficaz para aplicar en un estudio más amplio, aunque se debe mejorar el sistema de distribución y recogida de cuestionarios (AU)

Objectives: To describe and compare the knowledge and attitudes of the physicians and nurses towards the advance directives. Design: A descriptive, cross-sectional pilot study. Setting: East healthcare area of the Community of Madrid (Spain)Participants: Primary care and specialized care physicians and nurses. Main measurements: Questionnaire about knowledge, use and attitudes from the healthcare professionals over the advance directives given, with dichotomous and Likert scale (0-10) variables. Results: Replies were received from a total of 192 physicians and nurses (response rate = 83,4%),72,4% were women and 27,6% were men. The mean age was 39,6 years (SD = 10,86). For general knowledge on advance directives the median was 5 (RI = 3-7). 60,1% were aware of the regulation by law, but only 22,8% had read the document. Conclusions: The knowledge of physicians and nurses on advance directives is low, so it is necessary to improve this knowledge. Physicians and nurses from both levels show positive attitude towards the use and usefulness and respect the contents of advance directive. The methodology proposed is efficient to implement in a larger study, but should improve the distribution and collection of questionnaires (AU)

Influence of sclerotomy use on vitreous incarceration in an experimental model of vitrectomized eye.

PURPOSE: To evaluate the influence of sclerotomy use during vitrectomy (vitreous cutter, illumination probe, or infusion-line entrance) on postoperative vitreous incarceration using an experimental model of vitrectomized eye. MATERIALS AND METHODS: Experimental, randomized, and observer-masked study in which 23-gauge transconjunctival sutureless vitrectomy was performed in cadaveric pig eyes. Postoperative incisional vitreous entrapment was evaluated by direct visualization. No vitreous incarceration was classified as grade 0 (G0), thin vitreous entrapment was classified as grade 1 (G1), and thick vitreous strands as grade 2 (G2). RESULTS: A total of 46 eyes were included. Vitreous incarceration was detected in 91.3% (43.5% G1, 47.8% G2) of the sclerotomies used by the vitreous cutter probe, 95.7% (45.7% G1, 50% G2) of the illumination-pipe entrances, and 93.5% (45.7% G1, 47.8% G2) of the infusion-line incisions. No statistical differences were found when comparing incisional vitreous incarceration after vitrectomy according to sclerotomy use. CONCLUSION: Different manipulation of the sclerotomies, depending on their use, does not seem to influence postvitrectomy vitreous entrapment in our experimental model.

[Knowledge and attitudes about advance directives on physicians and nurses]. / Conocimientos y actitudes de médicos y enfermeras sobre las instrucciones previas.

OBJECTIVES: To describe and compare the knowledge and attitudes of the physicians and nurses towards the advance directives. DESIGN: A descriptive, cross-sectional pilot study. SETTING: East healthcare area of the Community of Madrid (Spain) PARTICIPANTS: Primary care and specialized care physicians and nurses. MAIN MEASUREMENTS: Questionnaire about knowledge, use and attitudes from the healthcare professionals over the advance directives given, with dichotomous and Likert scale (0-10) variables. RESULTS: Replies were received from a total of 192 physicians and nurses (response rate=83,4%), 72,4% were women and 27,6% were men. The mean age was 39,6 years (SD=10,86). For general knowledge on advance directives the median was 5 (RI=3-7). 60,1% were aware of the regulation by law, but only 22,8% had read the document. CONCLUSIONS: The knowledge of physicians and nurses on advance directives is low, so it is necessary to improve this knowledge. Physicians and nurses from both levels show positive attitude towards the use and usefulness and respect the contents of advance directive. The methodology proposed is efficient to implement in a larger study, but should improve the distribution and collection of questionnaires.

Influence of incisional vitreous incarceration in sclerotomy closure competency after transconjunctival sutureless vitrectomy.

PURPOSE: To evaluate the influence that vitreous incarceration may exert on the presence of postoperative conjunctival blebs over sclerotomies after transconjunctival sutureless vitrectomy (TSV). Blebs are formed by incisional leakage due to incompetent closure. METHODS: Experimental study in which 23-gauge TSV was performed in 146 cadaveric pig eyes. Once the vitrectomy was finished, triamcinolone was injected inside the vitreous cavity for staining residual vitreous, one of the superior cannulas was extracted over the light probe, and the other cannula was removed with the plug inserted. Postoperative conjunctival blebs in superior sclerotomies were assessed by anterior-segment optical coherence tomography (AS-OCT) in a masked fashion; nondetectable blebs were classified as grade 0 (B0), thin bleb (≤half scleral thickness) as grade 1 (B1), and thick bleb (>half scleral thickness) as grade 2 (B2). Postoperative incisional vitreous entrapment was evaluated by slit-lamp photographs in a masked way; no incarceration was classified as grade 0 (V0), thin incarceration as grade 1 (V1), and thick incarceration as grade 2 (V2). RESULTS: Conjunctival blebs were found in 13.7% of the sclerotomies (11.3% bleb-B1, 2.4% bleb-B2). Vitreous incarceration was found in 96.5% of the sclerotomies without bleb (B0), 81.8% of the incisions with bleb-B1, and 14.3% of the wounds with bleb-B2. Vitreous incarceration was significantly associated with the absence of conjunctival bleb (P < 0.001). CONCLUSIONS: Vitreous incarceration in sclerotomies is related to less incisional leakage in our experimental model. Maneuvers that reduce vitreous entrapment, such as the interposition of a nonhollow probe during the cannula extraction, could decrease the sclerotomy closure competency.

Bladder autoaugmentation with protective autologous uterine flap. Experimental study in the rat.

INTRODUCTION: Enterocystoplasties are associated to complications. We developed a surgical technique for bladder autoaugmentation using autologous uterine flap in the rat, to try and improve the post-surgical evolution. METHODS: 36 female Wistar rats were randomly allocated into following groups: Group 1: Control (n = 12) for analytical parameters, Group 2: Sham-operation hysterocystorrhaphy (n = 12) and Group 3: Bladder autoaugmentation with autologous uterine flap (n = 12). Two weeks after surgery ultrasound examination of the bladder was performed. At 8 weeks and 24 weeks, blood and urine samples were taken. Post-mortem evaluation was performed and urogenital apparatus removed for gross and microscopic examination. The statistical analysis was done using the Kruskall-Wallis and the extension of the Fisher's exact test. Significance was set at 5% (p < 0.05). RESULTS: Serum chemistry, blood count and peripheral blood smears, electrolytes and urinary parameters were all within the normal range for the rat. No abnormal findings were observed during ultrasound examination. There was no mortality or other surgical complications. Post-mortem evaluation revealed no dilation of bladder, uterus or upper urinary tract. Uroliths were not observed. Histology of the augmented area demonstrated an excellent union between the bladder and the protective uterine flap. A normal urothelial layer was maintained. CONCLUSIONS: The use of autologous uterine flap to perform bladder autoaugmentation in the rat proved a safe and suitable surgical technique to augment the bladder. The major advantage is the avoidance of the complications observed in other surgical techniques for bladder augmentation, like enterocystoplasties, where gastrointestinal tract epithelium is incorporated into the urinary tract.

Influence of the interposition of a nonhollow probe during cannula extraction on sclerotomy vitreous incarceration in sutureless vitrectomy.

PURPOSE: To evaluate the effect of the cannula removal technique on postoperative vitreous incarceration using an experimental model of vitrectomized eye. METHODS: In a prospective, experimental, randomized, and observer-masked study, 118 cadaveric pig eyes were vitrectomized through 23-gauge transconjunctival sclerotomies. Once vitrectomy was finished, one of the superior cannulas was extracted with the illumination probe inserted through it, and the other cannula was removed with a cannula plug inserted. Postoperative incisional vitreous entrapment was evaluated by direct visualization. No vitreous incarceration was classified as grade 0 (G0), thin vitreous entrapment was classified as grade 1 (G1), and thick vitreous strands as grade 2 (G2). RESULTS: Considering the sclerotomies whose cannulas were extracted with the light probe inside, vitreous incarceration was detected in 93.2% (73.7% G1, 19.5% G2) of the incisions. In turn, vitreous entrapment was observed in 95.8% (43.2% G1, 52.6% G2) of the entry sites whose cannulas were extracted with the plug inserted. Statistical analysis showed significant differences when comparing postvitrectomy vitreous incarceration grades in sclerotomies according to the cannula extraction technique (P < 0.0001). CONCLUSIONS: Interposing the light probe through the cannula during its removal reduces vitreous incarceration grade in our experimental model. This simple maneuver may decrease complications related to vitreous entrapment, such as peripheral retinal tears and acute endophthalmitis.

Assessment of vitreous incarceration in sclerotomies with OCT, ultrasound biomicroscopy, and direct visualization.

BACKGROUND AND OBJECTIVE: To compare anterior-segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), and direct visualization for detecting vitreous incarceration in sutureless sclerotomies. MATERIALS AND METHODS: Prospective, randomized, and observer-masked experimental study in which 23-gauge vitrectomy was performed in pig eyes. Postoperative incisional vitreous incarceration was evaluated by AS-OCT, UBM, and direct visualization. RESULTS: One hundred eighteen pig eyes were included. Vitreous entrapment was found in 7.9% (28 of 354), 59.6% (211 of 354), and 95.5% (338 of 354) of the sclerotomies analyzed by AS-OCT, UBM, and direct visualization, respectively. Direct visualization was the most sensible method for identifying incisional vitreous when compared with UBM and AS-OCT (P < .0001). In turn, UBM was superior to AS-OCT for observing vitreous incarceration (P < .0001). CONCLUSION: Direct visualization is the most effective method for detecting vitreous entrapment. Regarding the imaging techniques, UBM was superior to AS-OCT for identifying vitreous incarceration.

Very low and low birth weight associated with maternal periodontitis.

AIM: The aim of this study was to evaluate the association of very low and low birth weight (VLBW and LBW) with maternal periodontitis. MATERIAL AND METHODS: Overall, 1206 women were examined at post-partum and two alternative criteria for periodontitis definition were used: (1) four or more teeth with at least one site with probing depth (PD) ≥ 4 mm and clinical attachment loss (CAL) ≥ 3 mm; and (2) at least one site with PD and CAL ≥ 4 mm. For each definition, two multivariate analyses were performed: (1) linear regression for birth weight; (2) ordinal logistic regression for birth weight, categorized as adequate (n = 1046), LBW (n = 145) and VLBW (n = 15). RESULTS: Linear regression showed that maternal periodontitis was associated with a decrease in mean birth weight (periodontitis definition 1: p = 0.027; periodontitis definition 2: p = 0.003). Ordinal logistic regression showed that maternal periodontitis was associated with LBW and VLBW [odds ratio (OR) = 2.0; 95% confidence interval (CI) 1.39-2.90, when considering periodontitis definition 2]; and with LBW (OR = 1.65; 95% CI 1.15-2.36, when considering periodontitis definition 1). CONCLUSION: Maternal periodontitis was associated with a decrease in mean birth weight, as well as with LBW and VLBW.

Effect of interposition maneuver during cannula removal on vitreous incarceration rate in vitrectomized eyes measured by ultrasound biomicroscopy.

PURPOSE: To evaluate the influence of the cannula removal maneuver on the postoperative incisional vitreous incarceration using an experimental model of vitrectomized eye. METHODS: Prospective, experimental, randomized and observer-masked experimental study in which 23-gauge transconjunctival sutureless vitrectomy was performed through oblique sclerotomies in cadaveric pig eyes. Once the vitrectomy was finished, one of the superior cannulas was removed with the light probe introduced through it, and the other cannula was extracted with the cannula plug inserted. Postoperative incisional vitreous incarceration was evaluated by ultrasound biomicroscopy (UBM). RESULTS: 60 eyes included. Considering the 60 superior sclerotomies whose cannulas were extracted with the light pipe inserted, vitreous incarceration was observed in 35% of them. On the other hand, 71.6% of the incisions whose cannulas were removed with the cannula plug inserted showed vitreous incarceration (p = 0.00013). CONCLUSIONS: Interposing the light probe through the cannula when it is removed seems to reduce the postoperative wound vitreous incarceration rate in our experimental model.

Influence of the sclerotomy use on mechanical incision competency in experimental model of vitrectomized eyes.

PURPOSE: To evaluate the influence of superior sclerotomy use (vitreous cutter or illumination probe entrance) on the postoperative sclerotomy closure competency using an experimental model of vitrectomized eye. METHODS: Prospective, experimental, randomized and observer-masked experimental study in which 23 and 25-gauge transconjunctival sutureless vitrectomy was performed through oblique sclerotomies in the same cadaveric pig eye. Closure competency was determined by the resistance to intraocular fluid leak through the superior incisions in face of a progressive intraocular pressure (IOP) rise. RESULTS: 120 eyes included. In 52.5% of cases, the vitreous cutter probe sclerotomy showed intraocular fluid leakage first (p = 0.65). When comparing opening pressure values, there were no significant differences (p = 0.77) between the leakage pressure level of both sclerotomies depending on their use. CONCLUSIONS: Different uses of superior sutureless oblique sclerotomies do not seem to influence on TSV incision mechanical resistance to IOP rise in our experimental model.

A survey of ethical and professional challenges experienced by Spanish health-care professionals that provide genetic counseling services.

Genetic testing is increasingly applied for diagnosis and clinical treatment. In some countries, genetic counseling services are provided by professionals with specific training in this discipline, whereas other countries have no teaching programs and counseling is offered by physicians, nurses, pharmacists or biochemists. This counseling raises more and more ethical dilemmas for health professionals at their clinics. The purpose of this study was to analyze the characteristics of Spanish professionals devoted to providing genetic counseling services and to investigate the frequency of the ethical dilemmas they face. Results from 72 survey respondents revealed this counseling is provided by an almost even number of male and female professionals, mostly physicians with many years of professional experience. The overall frequency of the ethical dilemmas encountered was not high. The most frequent dilemmas corresponded to emotional responses by patients, informed consent, uncertainty about test results, and limitations on health-care resources. The frequency of dilemmas involving discrimination and provider directiveness was very low. Additional findings, practice implications, and research recommendations are presented.

Experimental model to evaluate mechanical closure resistance of sutureless vitrectomy sclerotomies using pig eyes.

PURPOSE: The purpose of this study was to report a novel model for comparing mechanical resistance to intraocular pressure (IOP) increases with 23-gauge (23G) and 25G transconjunctival sutureless vitrectomy (TSV) sclerotomies in the immediate postoperative period using an experimental model of a vitrectomized eye. METHODS: This was a prospective, experimental, randomized, and observer-masked experimental study in which TSV 23G and 25G oblique sclerotomies, performed in same cadaveric pig eye, were subject to an increase in IOP. Mechanical resistance was determined by the resistance to intraocular fluid leak through the sclerotomy. The simultaneous use of the different sclerotomy diameters in the same eye avoided interindividual scleral resistance differences. RESULTS: This animal model allowed comparison of the effect of different sclerotomy diameters (23G and 25G) on incisional mechanical resistance. One hundred twenty eyes were included. In 60.7% of cases, the 23G sclerotomy first allowed intraocular fluid escape (leaked; P = 0.02). When comparing opening pressure values, 23G sclerotomies leaked at significantly lower pressure levels than 25G sclerotomies (P < 0.0001); 53% of the 25G incisions but only 16% of 23G incisions opened at pressure levels greater than 120 mm Hg. CONCLUSIONS: Oblique 23G sutureless sclerotomies offer less mechanical resistance to increases in IOP than do 25G sclerotomies. This animal model may become the basis for future studies to evaluate the advantages of using other types of incision or other surgical tools on sclerotomy closure capacity.

Maternal periodontal disease and preterm or extreme preterm birth: an ordinal logistic regression analysis.

BACKGROUND: Despite previous studies addressing the link between preterm or low birth weight infants and maternal periodontitis, extreme preterm births have received far less attention. This study is designed to address the possible association between maternal periodontal disease and preterm or extreme preterm birth. METHODS: Immediately after childbirth, 1,207 women underwent an examination in which periodontal disease was assessed according to two alternative definitions: 1) four or more teeth with at least one site showing probing depth (PD) >or=4 mm and clinical attachment loss (AL) >or=3 mm, and 2) at least one site showing PD and clinical AL >or=4 mm. For each of these definitions, two types of multivariate analysis were conducted: a linear regression analysis for the number of gestation weeks, and a more specific ordinal logistic regression analysis for the ordinal variable gestation time categorized as normal (term) (n = 1,046 women) or mild-moderate (n = 146 women) or extreme preterm (n = 15 women). RESULTS: Periodontal disease was associated with fewer weeks of gestation by linear regression (definition 1: P = 0.012; definition 2: P <0.001) and with preterm (n = 161; mild-moderate and extreme) or extreme preterm births (n = 15) by ordinal logistic regression (definition 1: odds ratio [OR] = 1.83, 95% confidence interval [CI]: 1.28 to 2.62; definition 2: OR = 2.37, 95% CI: 1.62 to 3.46). CONCLUSION: Our findings suggest that periodontal disease is associated with a premature or extremely premature birth.

Revisión sobre la evidencia de la relación entre exposición profesional al ruido y efectos extrauditivos no cardio-vasculares / Systematic review and evidence on occupational Noise exposure and extra-auditory effects of no cardiovascular nature

Trabajo de revisión que tienen como objetivo conocer el nivel de evidencia existente sobre los efectos extra-auditivos de la exposición profesional al ruido relacionados con: alteraciones bioquímicas, efectos neuro-piscológicos, salud reproductiva y accidentes de trabajo mediante el análisis sistemático de la producción científica publicada entre 1995 y 2008. La búsqueda de las referencias bibliográficas se realizó mediante términos "Major Topic"y "MeSH" para MEDLINE y términos "Decriptors" para OSH update. Se recuperaron un total de 370 referencias y se incluyeron en la revisión todos los estudios experimentales, estudios de cohortes y estudios casos control y aquellos estudios trasversales que cumplieron al menos con cinco de los nueve criterios que la declaración STROBE establece para los estudios observacionales. Fueron seleccionados para su revisión a texto completo un total de 35 artículos: 14 estudios experimentales, 2 estudios de cohortes, 6 estudios casos control, 12 estudios transversales y 1 estudio de validación. La asignación del nivel de evidencia se realizó de acuerdo a los criterios SIGN. La selección y revisión de los artículos se realizó mediante revisión por pares, los casos de discrepancia entre pares se resolvió mediante consenso. Encontramos un alto nivel de evidencia (1+) para influencia de la exposición profesional al ruido sobre el incremento de la secreción de cortisol y noradrenalina, fatiga y disminución del rendimiento, funciones cognitivas y memoria, disminución en la calidad del sueño, estrés e irritabilidad y percepción de malestar. Con un nivel de evidencia 2++ se relacionó la exposición profesional al ruido con la accidentalidad laboral. No encontramos unos resultados concluyentes para la determinación de la relación entre exposición profesional al ruido sobre la salud reproductiva. Existe una diversidad en los métodos utilizados para la evaluación de la exposición profesional al ruido, empleándose tanto métodos de medición cuantitativos y métodos cualitativos de percepción subjetiva. Nuestros resultados son coincidentes con las revisiones realizadas anteriormente por Smith AP y cols (1991) y Butler MP y cols (1999) (AU)

Review aimed at as certaining the level of evidence on non-auditory effects related with occupational exposure to noise concerning: biochemical, neuro- psychology effects, reproductive health and accidents atwork through a systematic analysis of the scientific literature published between 1995 and 2008. The search for references was conducted using terms “Major Topic” and “MeSH” terms for MEDLINE and “Decriptors”for OSH update. We retrieved a total of 370 references, were included in the review all experimental studies,cohort studies and case control studies and those cross-sectional studies that had at least five of the nine criteria that the STROBE Statement provides for observational studies. Were selected for full text review a total of 35 studies: 14 experimental studies, 2 cohort studies, 6 case control studies, 12 cross-sectional studies and 1 validation study.The assignment of the level of evidence was performed according to SIGN criteria. The selection and review of articles was done by peer review, cases of disagreement between pairs was resolved by consensus.We found a high level of evidence (1+) about the influence of occupational noise exposure and the increased secretion of cortisol and no repinephrine, fatigue and decreased performance, cognitive function and memory, decreased quality of sleep, stress and irritability annoyance. A level of evidence 2++ was identify for occupational noise exposure and work accidents. We found no conclusive results in determine the relationship between occupational exposure to noise on reproductive health.There is diversity in the methods used for assessing occupational exposure to noise, using both quantitative measurement methods and qualitative methods of subjective perception. Our results are consistent with those previously reported by Smith AP et alt (1991) and Butler MP et al (1999) (AU)

Efecto de la exposición a ruido en entornos laboralessobre la calidad de vida y rendimiento / Effects of noise exposure in working places on quality of life and performance

Objetivos: La exposición laboral a ruido origina efectos sobre la salud de carácter no auditivo. El objetivo de este estudio es estimar la asociación entre exposición a ruido en entornos laborales y la aparición de alteraciones en la conducta, rendimiento y síntomas psicosomáticos. Metodología: Estudio de prevalencia a partir de datos de la VI Encuesta Nacional de Condiciones de Trabajo analizando como variable independiente la exposición a ruido y como variables dependientes los "síntomas que manifiesta el trabajador" tratados de forma individual o por grupo de síntomas según su naturaleza: conductual, psicosomáticos y rendimiento. La asociación entre exposición y efecto se analizó mediante la prueba de X2 y se calculó el OR de prevalencias ajustado por ritmo de trabajo (IC95%) para medir la asociación entre "exposición a ruido" y grupos de síntomas de forma cruda en el conjunto de la población y de forma estratificada por ramas de actividad. Resultados: El 36,5% de la población trabajadora está expuesta a ruido en su puesto de trabajo. Se observa una mayor prevalencia de los grupos de síntomas conductuales, psicosomáticos y de rendimiento (p<0,001) entre los trabajadores expuestos a ruido frente a no expuestos. La rama de Actividades Sanitarias presenta los mayores valores de OR para el grupo de síntomas conductuales (OR=2,53 [1,71-3,75]) y de rendimiento (OR=2,26, [1,43-3,56]) y la Industria Química presenta el mayor grado de asociación entre exposición a ruido y síntomas psicosomáticos (OR=5,37, [1,13-25,55]). Conclusiones: Se observa una asociación estadísticamente significativa entre exposición a ruido y alteraciones de conducta, rendimiento y síntomas psicosomáticos en la población trabajadora española (AU)

Aims: Occupational noise exposure could produce extra-auditory effects. The purpose of this study was to investigate whether occupational noise exposure can influence human behaviour, performance and development of psychosomatic symptoms. Methodology: Cross-sectional study, from the Data-base of Spanish VI National Survey on Working Conditions, "noise exposure" has been analyzed as independent variable and: "symptoms self-reportered by workers" as effect variable, considering them independently or grouped variables in behavioural, psychosomatic and performance symptoms. The relationship between exposure and effect was analyzed by X2 test. Prevalence adjusted Odds Ratio by work rhythm (95% CI), were estimated to measure the association between perceived noise annoyance and grouped symptoms in the population and in the different branches of activity. Results: 36.5% of the working population is exposed to noise in their workplace. There is a higher prevalence of behavioural symptoms group, psychosomatic and performance (p <0.001) among workers exposed to noise compared to unexposed. Health Care Sector reported the highest risk for behavioural (OR=2,53 [1,71-3,75]) and performance symptoms(OR=2,26, [1,43-3,56]) . Chemical Industry had a prevalence ratio between noise and psychosomatic symptoms of (OR=5,37 [1,13-25,55]). Conclusions: Our results found and statistic significant association between noise annoyance exposure and behavioural, performance and development of psychosomatic symptoms in the Spanish working population (AU)

Revisión sistemática y evidencia sobre exposición profesional a ruido y efectos extra-auditivos de naturaleza cardiovascular / Systematic review and evidence on occupational noise exposure and extra-auditory effects of cardiovascular nature

Trabajo de revisión que tiene como objetivo conocer el nivel de evidencia existente sobre los efectos cardiovasculares debidos a la exposición profesional al ruido, mediante el análisis sistemático de la producción científica publicada entre 1995 y 2008. La búsqueda de las referencias bibliográficas se realizó mediante términos “Major Topic” y “MeSH” para MEDLINE y términos “Decriptors” para OSH update. Se recuperaron un total de 236 referencias y se incluyeron en la revisión todos los estudios experimentales, estudios de cohortes y estudios casos control y aquellos estudios trasversales que cumplieron, al menos, con cinco de los nueve criterios que la declaración STROBE establece para los estudios observacionales. Fueron seleccionados para su revisión a texto completo un total de 23 artículos: 12 estudios transversales, 7 estudios de cohortes, dos estudios casos control, 1 meta-análisis y 1 estudio experimental.La asignación del nivel de evidencia se realizó de acuerdo a los criterios SIGN. La selección y revisión de los artículos se realizó mediante revisión por pares, los casos de discrepancia entre pares se resolvió mediante consenso. En relación con los efectos cardiovasculares de la exposición laboral a ruido, nuestra revisión encuentra un mayor nivel de evidencia (1++) para el incremento de la tensión arterial e incremento de la frecuencia cardiaca. Estudios con nivel de evidencia 2++ muestran resultados en esa misma dirección.La enfermedad isquémica, infarto agudo de miocardio y coronariopatía muestran un nivel de evidencia 2++.La alteraciones metabólicas de lípidos y alteraciones de parámetros vasculares disponen de un nivel bajo de evidencia 3.El control del ruido en entornos laborales es un factor de prevención del riesgo cardio-vascular. HTA, riesgo coronario y otras enfermedades cardiovasculares deben considerarse en los protocolos de vigilancia médica específica de los trabajadores expuestos a ruido (AU)

Review aimed to identify the level of scientific evidence about the relationship between cardiovascular diseases and occupational noise exposure, by a systematic analysis of the scientific literature published between 1995 and 2008. “Major Topic” and “MeSH” terms for MEDLINE and “Decriptors” for OSH update was used for the search of references. We retrieved a total of 236 references. Experimental studies, cohort studies and case control studies were all included in the review and those cross-sectional studies with at least five of the nine criteria from the STROBE declaration provides for observational studies. 23 articles were selected for full text review: 12 cross-sectional studies, 7 cohort studies, two case control studies, 1 meta-analysis and 1 experimental study.The evidence level was performed according to SIGN criteria. The selection and review of articles was done by peer review, cases of disagreement between pairs was resolved by consensus.Our review found a higher level of evidence (1++) for increasing blood pressure and increased heart rate and occupational noise exposure. Studies with a level of evidence 2++ show results in the same direction.Ischemic heart disease, myocardial infarction and coronary diseases show a level of evidence 2++.Metabolic changes of lipid parameters and vascular abnormalities have a low level of evidence 3.Noise control in working environments is a measure for cardiovascular risk prevention. Hypertension, coronary risk and other cardiovascular diseases should be considered in medical surveillance practice of workers exposed to noise (AU)