Organización y actividades preventivas en el sector del transporte de mercancías por carretera

[ES] Objetivos: Identificar los recursos y actividades preventivas más prevalentes en el sector del transporte de mercancías por carretera y los hechos diferenciales con el resto de la población trabajadora española. Metodología: Estudio descriptivo de los datos de la Encuesta de Salud y Condiciones de Trabajo del sector del transporte y estudio comparativo con el resto de la población trabajadora a través de la V-Encuesta Nacional de Condiciones de Trabajo. Para el análisis estadístico se ha aplicado el ji cuadrado y la t-student. Resultados: El 77% de las empresas de este sector tienen menos de 50 trabajadores. El 41% de los conductores señala que en su empresa no existe Delegado de Prevención y un 25% no dispone de ningún Recurso Preventivo. Destaca el alto desconocimiento existente entre los conductores de los recursos preventivos en su empresa (34,3%). La modalidad preventiva más frecuentemente instaurada en el sector es la asunción de la prevención por parte del empresario (13,6%) a diferencia del resto de sectores donde predomina el SP. Ajeno (43%). Conclusiones: Predominio de la pequeña empresa en el Sector del transporte asociado a un escaso desarrollo del tejido prevenGoals: To identify the most prevalent resources and preventive activities in professional long-haul drivers and their peculiarities related to the other Spanish production branches. Methodology: We develop a descriptive analysis of data from the Survey of Health and Working Conditions in professional truck drivers and we compare these results with the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T-Student test and the Ji square. Results: In this branch 77% of companies have less than 50 employees. 41% of drivers referred that it does not exist the «Delegado de Prevención» (workers representative) in their companies and 25% that there is not any Preventive Action. It is specially relevant the unknowledge among drivers about preventive resources in their companies (34.3%). The most frequently introduced preventive modality in the sector is the employer taking prevention by himself (13.6%) whilst other sectors are mainly covered by External Preventive Services (43%). Conclusions: If Transport branch is compared with the general - reference population it shows an image in which undersized companies linked to a weak development of preventive network could be determinant to their lowest preventive activities. Also we find a better self perceived health related to a better access to preventive activities.tivo en comparación con la población de referencia. Ambas características pueden ser determinantes de la menor actividad preventiva, más baja que la observada en la población de referencia. El acceso a actividades preventivas entre los conductores se relaciona con una mejor salud percibida. Goals: To identify the most prevalent resources and preventive activities in professional long-haul drivers and their peculiarities related to the other Spanish production branches. Methodology: We develop a descriptive analysis of data from the Survey of Health and Working Conditions in professional truck drivers and we compare these results with the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T-Student test and the Ji square. Results: In this branch 77% of companies have less than 50 employees. 41% of drivers referred that it does not exist the «Delegado de Prevención» (workers representative) in their companies and 25% that there is not any Preventive Action. It is specially relevant the unknowledge among drivers about preventive resources in their companies (34.3%). The most frequently introduced preventive modality in the sector is the employer taking prevention by himself (13.6%) whilst other sectors are mainly covered by External Preventive Services (43%). Conclusions: If Transport branch is compared with the general - reference population it shows an image in which undersized companies linked to a weak development of preventive network could be determinant to their lowest preventive activities. Also we find a better self perceived health related to a better access to preventive activities.[EN] Goals: To identify the most prevalent resources and preventive activities in professional long-haul drivers andtheir peculiarities related to the other Spanish production branches.Methodology: We develop a descriptive analysis ofdata from the Survey of Health and Working Conditions inprofessional truck drivers and we compare these resultswith the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T-Student test and the Ji square. Results: In this branch 77% of companies have less than 50 employees. 41% of drivers referred that it does not exist the "Delegado de Prevención" (workers representative) in their companies and 25% that there is not any Preventive Action. It is specially relevant the unknowledge among drivers about preventive resources in their companies (34.3%). The most frequently introduced preventivemodality in the sector is the employer taking prevention by himself (13.6%) whilst other sectors are mainly covered by External Preventive Services (43%). Conclusions: If Transport branch is compared with the general - reference population it shows an image in which undersized companies linked to a weak development of preventive network could be determinant to their lowest preventive activities. Also we find a better self perceived health related to a better access to preventive activitiesS

Envellir «activament». Mapa d’actius per a un envelliment saludable

[cat] La Conselleria de Salut i l’Ajuntament de Palma han iniciat una línia conjunta de treball per a implicar la ciutadania en la presa de decisions mitjançant l’elaboració de mapes d’actius. Un actiu en salut es defineix com «qualsevol recurs que millora la capacitat de les persones, les comunitats, els sistemes socials i/o les institucions per a mantenir i conservar la salut i el benestar, contribuint a reduir les desigualtats». D’altra banda, l’Observatori de Persones Majors del Consell de Mallorca va elaborar un catàleg de recursos per a la promoció de l’envelliment actiu i saludable i va veure la possibilitat d’integrar aquesta informació al mapa d’actius. Aquesta informació pot ser molt útil tant per a les entitats i els professionals que treballen per un envelliment saludable com per al col·lectiu de gent gran. De cada actiu es recull diversa informació: la població a la qual va dirigit, la localització, la temàtica, etc. Una vegada validats, s’inclouen en el mapa «LOCALIZAsalud» del Ministeri de Sanitat, una aplicació web que permet visualitzar tots els recursos disponibles per a una població determinada, sobre una temàtica (envelliment saludable, alimentació, benestar emocional, etc.) i en un territori determinat (carrer, codi postal, municipi, illa).[spa] La Consejería de Salud y el Ayuntamiento de Palma han iniciado una línea conjunta de trabajo para implicar a la ciudadanía en la toma de decisiones mediante la elaboración de mapas de activos. Un activo en salud se define como «cualquier recurso que mejora la capacidad de las personas, las comunidades, sistemas sociales y/o las instituciones para mantener y conservar la salud y el bienestar, contribuyendo a reducir las desigualdades». Por otra parte, el Observatorio de Personas Mayores del Consell de Mallorca elaboró un catálogo de recursos para la promoción del envejecimiento activo y saludable y vio la posibilidad de integrar esta información en el mapa de activos. Esta información puede ser muy útil tanto para las entidades y profesionales que trabajan para un envejecimiento saludable como para el colectivo de personas mayores. De cada activo se recoge diversa información: la población a la que va dirigido, la localización, la temática, etc. Una vez validados, se incluyen en el mapa «LOCALIZAsalud» del Ministerio de Sanidad, una aplicación web que permite visualizar todos los recursos disponibles para una población determinada, sobre una temática (envejecimiento saludable, alimentación, bienestar emocional, etc.) y en un territorio determinado (calle, código postal, municipio, isla)

Efectos extra-auditivos del ruido, salud, calidad de vida y rendimiento en el trabajo; actuación en vigilancia de la salud

Este documento se ha realizado en el marco del proyecto de investigación “Estudio de prevalencia de los efectos extra-auditivos del ruido y su relación en la calidad de vida y rendimientos en la población trabajadora española”. Financiado por el FIS (PI07/90034)Esta publicación tiene como objetivo difundir los resultados del proyecto de investigación “ESTUDIO DE PREVALENCIA DE LOS EFECTOS EXTRA-AUDITIVOS DEL RUIDO Y SU RELACIÓN EN LA CALIDAD DE VIDA Y RENDIMIENTO EN LA POBLACIÓN TRABAJADORA ESPAÑOLA” realizado por un equipo de investigación formado por investigadores de la Escuela Nacional de Medicina del Trabajo del Instituto de Salud Carlos III y de la Universidad de Alcalá de Henares

Inconsistencies in Guidelines for Visual Health Surveillance of VDT Workers

Objectives: In Europe, 25% of workers use video display terminals (VDTs). Occupational health surveillance has been considered a key element in the protection of these workers. Nevertheless, it is unclear if guidelines available for this purpose, based on EU standards and available evidence, meet currently accepted quality criteria. The aim of this study was to appraise three sets of European VDT guidelines (UK, France, Spain) in which regulatory and evidence-based approaches for visual health have been formulated and recommendations for practice made. Methods: Three independent appraisers used an adapted AGREE instrument with seven domains to appraise the guidelines. A modified nominal group technique approach was used in two consecutive phases: first, individual evaluation of the three guidelines simultaneously, and second, a face-to-face meeting of appraisers to discuss scoring. Analysis of ratings obtained in each domain and variability among appraisers was undertaken (correlation and kappa coefficients). Results: All guidelines had low domain scores. The domain evaluated most highly was Scope and purpose, while Applicability was scored minimally. The UK guidelines had the highest overall score, and the Spanish ones had the lowest. The analysis of reliability and differences between scores in each domain showed a high level of agreement. Conclusions: These results suggest current guidelines used in these countries need an update. The formulation of evidence-base European guidelines on VDT could help to reduce the significant variation of national guidelines, which may have an impact on practical application.This study was supported by the National Institute for Occupational Safety and Health at Work of the Spanish Work and Immigration Ministry (INSHT). Project reference: 606/UAL/PVDVIS

Preclinical studies of toxicity and safety of the AS-48 bacteriocin

The in vitro antimicrobial potency of the bacteriocin AS-48 is well documented, but its clinical application requires investigation, as its toxicity could be different in in vitro (haemolytic and antibacterial activity in blood and cytotoxicity towards normal human cell lines) and in vivo (e.g. mice and zebrafish embryos) models. Overall, the results obtained are promising. They reveal the negligible propensity of AS-48 to cause cell death or impede cell growth at therapeutic concentrations and support the suitability of this peptide as a potential therapeutic agent against several microbial infections, due to its selectivity and potency at low concentrations. In addition, AS-48 exhibits low haemolytic activity in whole blood and does not induce nitrite accumulation in non-stimulated RAW macrophages, indicating a lack of pro-inflammatory effects. The unexpected heightened sensitivity of zebrafish embryos to AS-48 could be due to the low differentiation state of these cells. The low cytotoxicity of AS-48, the absence of lymphocyte proliferation in vivo after skin sensitization in mice, and the lack of toxicity in a murine model support the consideration of the broad spectrum antimicrobial peptideThis research was funded by the Spanish Ministry of Economy and Competitiveness (SAF2013-48971-C2-1-R, CSD2010-00065, and AGL2015-67995-C3-3-R, all including funds from the European Regional Development Funding, ERDF) and by the Research Groups (BIO160, CTS 944 and CTS 164, UGR) from Junta de Andalucía (Spain). The CIBER-EHD is funded by the Instituto de Salud Carlos III. RM-E is grateful for an FPU Grant (FPU14/01537) from the Ministry of Education, (Spain)

Antihyperthermic treatment decreases perihematomal hypodensity

OBJECTIVE: To investigate the effect on perihematomal hypodensity and outcome of a decrease in body temperature in the first 24 hours in patients with intracerebral hemorrhage (ICH). METHODS: In this retrospective study on a prospectively registered database, among the 1,100 patients, 795 met all the inclusion criteria. Temperature variations in the first 24 hours and perihematomal hypodensity (PHHD) were recorded. Patients >/=37.5 degrees C were treated with antihyperthermic drugs for at least 48 hours. The main objective was to determine the association among temperature variation, PHHD, and outcome at 3 months. RESULTS: The decrease in temperature in the first 24 hours increased the possibility of good outcome 11-fold. Temperature decrease, lower PHHD volume, and a good outcome were observed in 31.8% of the patients who received antihyperthermic treatment. CONCLUSION: The administration of early antihyperthermic treatment in patients with spontaneous ICH with a basal axillary temperature >/=37.5 degrees C resulted in good outcome in a third of the treated patients

Intra- and extra-hospital improvement in ischemic stroke patients: influence of reperfusion therapy and molecular mechanisms

Neuroprotective treatments in ischemic stroke are focused to reduce the pernicious effect of excitotoxicity, oxidative stress and inflammation. However, those cellular and molecular mechanisms may also have beneficial effects, especially during the late stages of the ischemic stroke. The objective of this study was to investigate the relationship between the clinical improvement of ischemic stroke patients and the time-dependent excitotoxicity and inflammation. We included 4295 ischemic stroke patients in a retrospective study. The main outcomes were intra and extra-hospital improvement. High glutamate and IL-6 levels at 24 hours were associated with a worse intra-hospital improvement (OR:0.993, 95%CI: 0.990-0.996 and OR:0.990, 95%CI: 0.985-0.995). High glutamate and IL-6 levels at 24 hours were associated with better extra-hospital improvement (OR:1.13 95%CI, 1.07-1.12 and OR:1.14, 95%CI, 1.09-1.18). Effective reperfusion after recanalization showed the best clinical outcome. However, the long term recovery is less marked in patients with an effective reperfusion. The variations of glutamate and IL6 levels in the first 24 hours clearly showed a relationship between the molecular components of the ischemic cascade and the clinical outcome of patients. Our findings suggest that the rapid reperfusion after recanalization treatment blocks the molecular response to ischemia that is associated with restorative processes

Analysis of mutant allele fractions in driver genes in colorectal cancer - biological and clinical insights

Sequencing of tumors is now routine and guides personalized cancer therapy. Mutant allele fractions (s, or the 'mutation dose') of a driver gene may reveal the genomic structure of tumors and influence response to targeted therapies. We performed a comprehensive analysis of s of driver alterations in unpaired primary and metastatic colorectal cancer () at our institution from 2010 to 2015 and studied their potential clinical relevance. Of 763 samples, 622 had detailed annotation on overall survival in the metastatic setting (met) and 89 received targeted agents matched to ( inhibitors), ( inhibitors), or 3 mutations (3K pathway inhibitors). s of each variant were normalized for tumor purity in the sample (adjs). We found lower adjs for 600E and 3 than for , , and non-V600 variants. 53 and 600E adjs were higher in metastases as compared to primary tumors, and high adjs were found in metastases of patients with wild-type primary tumors previously exposed to antibodies. Patients with - or 600E -mutated tumors, irrespective of adjs, had worse met. There was no significant association between adjs and time to progression on targeted therapies matched to , , or 3 mutations, potentially related to the limited antitumor activity of the employed drugs (overall response rate of 4.5%). In conclusion, the lower 600E and 3 adjs in subsets of primary tumors indicate subclonality of these driver genes. Differences in adjs between metastases and primary tumors suggest that approved therapies may result in selection of 600E - and -resistant clones and an increase in genomic heterogeneity with acquired 53 alterations. Despite significant differences in prognosis according to mutations in driver oncogenes, adjs levels did not impact on survival and did not help predict benefit with matched targeted agents in the metastatic setting

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Working conditions in the public road transport

Caracterizar las condiciones de trabajo de los conductores de transporte de viajeros por carretera estableciendo un perfil diferencial con el resto de la población trabajadora. Encuesta dirigida a conductores de transporte de viajeros por carretera para determinar la morbilidad percibida y los factores relacionados con el trabajo que incrementan el riesgo de estos profesionales. En total se entrevistaron 1428 conductores seleccionados por muestreo aleatorio. Se eligió como población de referencia la VI Encuesta Nacional de Condiciones de Trabajo (VI-ENCT/INSHT). Para garantizar la comparabilidad entre nuestro estudio y la VIENCT, se seleccionaron en ambas encuestas varones en edades comprendidas entre los 25 y 65 años. Los cálculos estadísticos se han basado en el X2 para diferencia de proporciones, t-test de diferencia de medias entre variables categóricas y numéricas y estimación del riesgo mediante el OR ajustado por edad. La media de edad de los conductores fue, estadísticamente superior a la población de referencia (diferencia de medias=3,598 [3,05-4,15]). Los conductores perciben con más riesgo que la población de referencia que el trabajo afecta a su salud (ORaj=1,574([1,38-1,79]). En general, soportan unas cargas globales físicas y mentales más altas que el resto de trabajadores (p=0,000) y presentan una mayor prevalencia de amenazas de violencia física. Los detalles ergonómicos del puesto de trabajo (espacio, confort del asiento e iluminación) también resultaron estadísticamente peor valorados entre los conductores. Se trata por tanto, de un colectivo de trabajadores de más edad que desarrolla sus tareas en un puesto ergonómicamente inadecuado y que soportan una importante carga física y mental, indicadores indispensables a la hora de establecer programas de prevención de accidentes en carretera. Characterize the working conditions in public road transport bus drivers and compare them with a control group obtained from the national work force. survey of intercity bus drivers to determine the perceived morbidity and work-related factors that increase the risk of these professionals. A randomized sample of 1428 bus drivers was interviewed by means of a questionnaire (personal interview). Our control group was obtained from the VI National Survey of Working Conditions (VI-ENCT/INSHT). The surveys were done in males aged between 25 and 65 to ensure the comparability between our study and VIENCT. Appropriate statistical calculations included: X2 for difference of proportions, t-test of mean difference between categorical and numerical variables and risk estimation using the OR adjusted for age. The mean age in bus drivers was statistically higher than the reference population. Bus drivers perceived more frequently than the control group that work conditions affects their health (ORaj = 1,54 ([1,36-1,76]). Likewise, they have higher physical and mental loads than the control group (p = 0.000) and a higher prevalence of threats of physical violence. Ergonomic job details (space, seating comfort and lighting) were also statistically worst rated among drivers. These results evidence that intercity bus drivers are older than the control group and they have worst ergonomic, physical and mental work-conditions, all of them are essential indicators to establish prevention road accidents programs.S