Medical costs of cancer attributable to work in the Basque Country (Spain) in 2008

AbstractObjetivesUnderreporting of work-related cancer in the Basque Country (Spain) is massive. The aim of our study is to estimate the job-related cancer in the Basque Country in 2008 treated by the Basque Public Health System-Osakidetza, as well as the medical costs derived from its treatment in the same year.MethodsScientific evidence from industrialised countries is used to estimate the number of processes of cancer attributable to work. Medical costs for specialised care (outpatient and hospital admissions) are derived from the National Health System cost accounts. Costs due to primary health care and pharmaceutical benefits are obtained from Spanish secondary sources. Figures were computed according to disease and sex.ResultsWe estimate 1,331 work-attributable cancers hospitalizations and 229 work-attributable cancers specialized ambulatory cases. Medical costs borne by public health care system exceed 10 million euros. Specialized care accounts for 64.2% of the total cost. Bronchus and lung cancer represents the largest percentage of total expenditure (27%), followed by the bladder cancer (12.6%), mesothelioma (8.6%), the colon cancer (7.3%), and stomach (6.7%).ConclusionsThe magnitude of cancer attributable to work in the Basque Country is much higher than reflected in the official Registry of Occupational Diseases. Underreporting of work-related cancers hampers prevention and shifts funding of medical costs from social security to the tax-financed public health system

Incidence of Asbestosis and other Benign Lung Diseases. Spain, 1962-2010

Fundamentos: En España carecemos de una descripción completa de las enfermedades profesionales causadas por el amianto. El objetivo del presente trabajo esconocer la incidencia durante el período 1962-2010 de las asbestosis y otras enfermedades pulmonares benignas por amianto reconocidas como profesionales y su distribución por sectores, ocupación, sexo y ámbito geográfico. Métodos: El número de casos se obtuvo de las Memorias del INP (años 1962 a 1975), de la Estadística del Ministerio de Trabajo y las Memorias del Servicio de Higiene y Seguridad en el Trabajo (1976 a 1981) y de los Anuarios de Estadísticas Laborales a partir de 1982. Se obtuvieron tasas de incidencia específicas por actividad económica y ocupación. Se estudió la tendencia temporal del número de enfermedades a estudio, así como su distribución geográfica por Comunidad Autónoma y provincia. Resultados: Desde 1963 hasta 2010 se reconocieron 815 asbestosis y 46 afecciones fibrosantes de pleura y pericardio. La incidencia media anual de asbestosis fue 0,20 por 100.000 personas asalariadas (0,31 en el año 1990 y 0,40 en 2010). De 1990 a 2001 el sector del fibrocemento acumuló 189 casos de asbestosis, el naval 173, la construcción 49 y la metalurgia 35. Por ocupación, los operadores de maquinas fijas presentaron 114 casos, los moldeadores, soldadores, chapistas y montadores de estructuras metálicas 88 casos y los pintores, fontaneros e instaladores de tuberías 59. Las Comunidades Autónomas con más casos fueron la Valenciana (106), Galicia (86), Andalucía (82), Cataluña (75), Madrid (58) y País Vasco (41). Conclusiones: Las tasas de incidencia y la tendencia de asbestosis profesionales en España pueden estar evidenciando el infrareconocimiento del origen profesional de estas enfermedades en nuestro país. Los sectores más afectados fueron el del fibrocemento y el naval y la incidencia más alta se dió en la Comunidad Valenciana.Background: We lack in Spain of a full description of the diseases caused by asbestos since its inclusion in the list of occupational diseases 1961. The aim of this study is to know the incidence of asbestosis and other asbestos-related benign lung diseases, which were recognized as occupational diseases by the Spanish Social Security system between 1962 and 2010. Methods: Cases were obtained from Reports of the National Insurance Institute (1962 to 1975), from Employment Ministry Statistics and Reports of the Work Health and Safety Department (1976 to 1981), and from the Employment Statistics Yearbooks (from 1982). Specific rates were obtained by economic activity and occupation. We represent temporal trends in the number of the diseases under study and described their geographic distribution by provinces. Results: Between 1963 and 2010, 815 cases of asbestosis and 46 cases of fibrous pleural or pericardial disease were recognized. Since 1990 until 2001 Fiber-cement sector accumulated 189 cases of asbestosis, Shipbuilding sector 173, Construction sector 49 and Metallurgy 35. By occupation, fixed machinery operators had 114 cases; inmolders, welders, sheet metal workers and fitters 88 cases; and painters, plumbers and pipe fitters 59 cases. The autonomous communities with the highest number of cases were Valencia (106), Galicia (86), Andalusia (82), Catalonia (75), Madrid (58), and the Basque Country (41). Conclusions: Incidence rates and the time trend of professional asbestosis in Spain may be demonstrating the underreporting of the occupational origin of these diseases in our country. The most affected sectors were that of the fiber-cement and the naval one and the highest incidence was given in the Valencian Community.Trabajo realizado dentro del proyecto HAR2009-07543 del Ministerio de Ciencia e Innovación

Pénfigo vulgar oral: reporte de caso

A case of a young patient who was diagnosed with pemphigus vulgaris, considered as a vesiculoampollar disease of autoimmune origin, related to genetic and environmental factors is reported. It is secondary to the production of auto IgG antibodies to the amino terminal region of the desmogleins 1 and 3 causing acantholysis and blistering. Affecting skin and mucous membranes. It is distinguished by the appearance of flaccid blisters easily hatch also crusts and erosions. The diagnosis was based on clinical and histopathologic characteristics.Se reporta el caso de un paciente jóven con diagnóstico de pénfigo vulgar, considerada como una enfermedad vesiculoampollar de origen autoinmunitario, relacionada con factores genéticos y ambientales. Es secundaria a la producción de auto anticuerpos IgG contra la región amino terminal de las desmogleínas 1 y 3 causando acantólisis y formación de ampollas. Afectando piel y mucosas.Se distingue por la aparición de ampollas flácidas que eclosionan fácilmente asi como costras y erosiones. El diagnóstico se basó en las características clínicas e histopatológicas

Differences in the recognition of occupational diseases by sex, occupation and business activity in Spain (1990-2009)

BACKGROUND: According to official statistics, men suffer more occupational diseases (OD) than women. Nevertheless, the unequal distribution and participation in the labor markets between men and women should be kept in mind. The purpose was to assess the gender impact in the recognition of OD in Spain, examining interaction and confounding factors. METHODS: An incidence study of the occupational diseases declared through the official OD reporting forms from 1999 to 2009, provided by the General Subdirectorate of Social and Labor Statistics of the Ministry of Employment and Social Security, was conducted. The variables included were: reporting year, sex, age, occupation and economic activity of the company. Rates and crude relative risks (cRR) by these variables were calculated. Adjusted RR were also computed by using multivariate Poisson regression. RESULTS: During the study period a total of 243,310 OD were reported in Spain, with a sex ratio of men to women of 1.07. Correlation existed between occupation and business activity, thus the OD rates and RR were computed by these variables separately. By occupation, men had a crude RR of 1.067 (95%CI:1.058 to 1.076) versus women, while wen the analysis was adjusted by all the variables, the RR was 0.507 (95%CI:0.502 to 0.512). By economic activity of the company, the sense of risk was reversed too in the adjusted analysis (cRR=1.065, 95%CI:1.056 to 1.074 versus 0.632, 95%CI:0.626 to 0.638). CONCLUSIONS: Although crude OD rates were lower in women than in men during the period 1999-2009 in Spain, when these rates were adjusted by company activity or worker occupation, age and year of OD declaration, RRs become almost 50% higher in women than in men for the majority of occupations and types of company activity. Fundamentos: Según las estadísticas oficiales, los hombres sufren más enfermedades profesionales (EEPP) que las mujeres. No obstante, hay que tener presente su desigual distribución y participación en el mundo laboral. El objetivo de este estudio fue valorar cómo afecta el sexo al reconocimiento de EEPP en España, identificando posibles factores de interacción/confusión.Métodos: Se estudió la incidencia de las EEPP declaradas a través del Parte Oficial durante el período de 1999 al 2009, proporcionados por la Sub-dirección General de Estadísticas Sociales y Laborales del Ministerio de Em-pleo y Seguridad Social. Las variables incluidas fueron: año de declaración, sexo, edad, ocupación y actividad económica de la empresa. Se calcularon tasas y riesgos relativos (RR) crudos de EEPP por cada variable. Se estima-ron los RR ajustados mediante análisis bivariable y multivariante de Poisson.Resultados: Durante 1999-2009 se notificaron en España 243.310 EEPP, con una razón de tasas hombres/mujeres de 1,07. Hubo correlación entre la ocupación y la actividad de la empresa, por lo que se analizaron las EEPP según estas variables por separado. Por ocupación, los hombres presenta-ron un RR crudo de 1,067 (IC95%:1,058-1,076) frente a las mujeres, mien-tras que al ajustar por todas las variables del modelo el RR fue de 0,507 (IC95%:0,502-0,512). Por actividad, el sentido del riesgo también se invirtió en el análisis ajustado para el sexo (RRc=1,065, IC95%:1,056-1,074 frente a 0,632, IC95%:0,626-0,638).Conclusiones: Aunque las tasas crudas de EEPP son inferiores en mu-jeres que en hombres durante el periodo 1999-2009 en España, al ajustar estas tasas por la actividad de la empresa o la ocupación del trabajador, la edad y el año de declaración, los RR pasan a ser casi un 50% superiores en mujeres que en hombres para la mayoría de ocupaciones y tipos de actividad de la empresa.Palabras clave: Análisis de regresión.Enfermedades profesionales. Ex-posición Profesional. Género. Incidencia.Riesgo. Ocupaciones. España.S

Medical costs of asbestos-related diseases in Spain between 2004 and 2011

The objective of this article was to estimate the medical costs derived from malignant ARD treatment in the Spanish National Health System (NHS) between 2004 and 2011. Estimation of direct healthcare costs was based on national primary data on the cost of specialized care for inpatients and outpatients treated at NHS hospitals and on national and regional secondary data on costs of primary healthcare and pharmaceutical prescriptions. A prevalence approach was used to estimate the overall burden of ARDs. Direct medical costs of 37,557 ARDs attended in Spanish NHS facilities in 2004 – 2011 were estimated at 464 million euros; specialist care accounted for 50.9% of total costs, primary healthcare 10.15%, and drug prescription 38.9%. The cost was 27.8-fold higher in males than in females. Bronchopulmonary cancers represented the greatest healthcare cost, 281 million euros. The cost of delivering healthcare to ARDs victims in Spain has a negative economic impact on the NHS due to the gross under-recognition of occupational victims under the Spanish National Insurance System

Producción de narraciones orales con una app en Educación Infantil: análisis del engagement y la competencia narrativa

The digital storytelling applications are being implemented in schools to favor the acquisition of multiple learnings. This research analyses the narrative competence of Early Childhood Education students (N=93), based on their oral stories -created with the support of a digital storytelling app- and their engagement in the narrative task. Moreover, the contribution of the application to the development of narrative competence is analyzed, considering its immersive capacity and the potential to foster self-regulation of learning. A mixed methodology is adopted: a) qualitative, focused on the content analysis of the stories, paying attention to the indicators defining the variables narrative competence and engagement and b) quantitative, centered on the statistical treatment of the data, median contrast, and correlational analysis between variables. Thus, it is verified that hardly half of the students present a medium-high narrative competence and the 73% has a medium-high engagement. There is a significant correlation between both variables, which highlights the capacity of the app to favor self-regulation and motivation towards narrative task, and to promote the skills to create a coherent, original, and well-structured story, which confirms its high educational potential.Las aplicaciones de relatos digitales se están implementando en la escuela para favorecer la adquisición de múltiples aprendizajes. Esta investigación analiza la competencia narrativa del alumnado de Educación Infantil (N=93) a partir de sus narraciones orales, elaboradas con apoyo de una aplicación de relatos digitales, y su engagement con la tarea narrativa. Además, se evalúa la contribución de la aplicación al desarrollo de su competencia narrativa, examinando su capacidad inmersiva y potencialidad para impulsar la autorregulación del aprendizaje. Se adopta una metodología mixta: a) cualitativa, focalizada en el análisis de contenido de los relatos, atendiendo a indicadores que definen las variables competencia narrativa y engagement, y b) cuantitativa, centrada en el tratamiento estadístico de los datos, contraste de medias y análisis correlacional entre variables. Así, se constata que casi la mitad del alumnado presenta una competencia narrativa medio-alta y un 73% un engagement medio-alto. Existe una correlación significativa entre ambas variables que subraya la capacidad de la app para favorecer la autorregulación y la motivación por la tarea narrativa, así como para impulsar las habilidades para crear un relato coherente, original y bien estructurado, lo que confirma su alta potencialidad didáctica

Prospectiva ambiental al 2030 en sistemas de producción de leche de vaca en México

The objective of this study was to evaluate the environmental performance of cow milk production in small and medium scale systems in Mexico, through life cycle analysis with a cradle to farm gate approach, for the period 2021-2030. The established functional unit was 1 kg of milk corrected for fat and protein. The impact assessment was carried out with the OpenLCA 1.11.0 software, using the ReCiPe method, considering seven impact categories: agricultural land occupation (ALO), marine ecotoxicity (ME), human toxicity (HT), climate change (CC), fossil depletion (FD), soil acidification (SA), and water depletion (WD). Among the main results of the research, the production of cattle feed was identified as the chief contributor to environmental loads in most of the  categories with percentages above 71 %, while on-farm emissions contribute to the environmental loads for the CC (28 %), FD (26 %) and SA (59 %) categories. A comparison was made between pessimistic, base and optimistic scenarios for the years 2021 and 2030, which confirmed an improvement in environmental efficiency in the optimistic scenario, the increase in production volume represents a decrease of 6 % and 5 %, respectively, in the assessed impact categories.El objetivo de este estudio fue evaluar el desempeño ambiental de la producción de leche de vaca en sistema de pequeña y mediana escala en México, mediante análisis de ciclo de vida con un enfoque de la cuna a la puerta de la granja, para el periodo 2021-2030. Se estableció como unidad funcional 1 kg de leche corregida por grasa y proteína. La evaluación de impacto se realizó con el software OpenLCA 1.11.0, mediante el método ReCiPe, se consideraron siete categorías de impacto: ocupación de suelo agrícola (ALO), ecotoxicidad marina (ME), toxicidad humana (TH), cambio climático (CC), agotamiento fósil (FD), acidificación terrestre (TA) y agotamiento de agua (WD). Como principales resultados de la investigación se identificó que la producción de alimento para el ganado es el principal contribuyente a las cargas ambientales en la mayoría de las categorías con porcentajes superiores al 71 %, mientras que las emisiones generadas en la granja contribuyen a las cargas ambientales para las categorías CC (28 %), FD (26 %) y TA (59 %). Se realizó una comparación entre escenarios pesimista, base y optimista para los años 2021 y 2030, lo que confirmó una mejora en la eficiencia ambiental en el escenario optimista prospectado, el incremento en el volumen de producción representó una disminución del 6 % y 5 % respectivamente, en las categorías de impacto evaluadas

Animación sociocultural propuesta didáctica para el desarrollo del turismo sustentable en la región

La educación ambiental puede encontrar mecanismos originales para medir las repercusiones de la actividad humana sobre el medio ambiente y una de ellas puede ser mediante la animación; porque entre las dos pueden contribuir a desarrollo del conocimiento y a la adquisición de actitudes y de habilidades que se requieren para la preservación y mejoramiento de la calidad del medio ambiente. El objetivo es presentar una alternativa a la problemática ambiental que se vive actualmente a través de la animación sociocultural teniendo como herramienta básica las actividades turísticas vinculadas a la educación ambiental. Actualmente, existe un limitado conocimiento del campo de la animación lo cual no ha permitido que existan programas desarrollados acordes a las nuevas necesidades y tendencias del turismo actual. La educación ambiental forma parte fundamental de una de las nuevas tendencias del turismo de naturaleza debido a que involucra, sensibiliza y genera un cambio de actitud en las personas, puede y debe ser aprovechada como herramienta de desarrollo de nuevos productos

A network perspective on the ecology of gut microbiota and progression of type 2 diabetes: Linkages to keystone taxa in a Mexican cohort

IntroductionThe human gut microbiota (GM) is a dynamic system which ecological interactions among the community members affect the host metabolism. Understanding the principles that rule the bidirectional communication between GM and its host, is one of the most valuable enterprise for uncovering how bacterial ecology influences the clinical variables in the host.MethodsHere, we used SparCC to infer association networks in 16S rRNA gene amplicon data from the GM of a cohort of Mexican patients with type 2 diabetes (T2D) in different stages: NG (normoglycemic), IFG (impaired fasting glucose), IGT (impaired glucose tolerance), IFG + IGT (impaired fasting glucose plus impaired glucose tolerance), T2D and T2D treated (T2D with a 5-year ongoing treatment).ResultsBy exploring the network topology from the different stages of T2D, we observed that, as the disease progress, the networks lose the association between bacteria. It suggests that the microbial community becomes highly sensitive to perturbations in individuals with T2D. With the purpose to identify those genera that guide this transition, we computationally found keystone taxa (driver nodes) and core genera for a Mexican T2D cohort. Altogether, we suggest a set of genera driving the progress of the T2D in a Mexican cohort, among them Ruminococcaceae NK4A214 group, Ruminococcaceae UCG-010, Ruminococcaceae UCG-002, Ruminococcaceae UCG-005, Alistipes, Anaerostipes, and Terrisporobacter.DiscussionBased on a network approach, this study suggests a set of genera that can serve as a potential biomarker to distinguish the distinct degree of advances in T2D for a Mexican cohort of patients. Beyond limiting our conclusion to one population, we present a computational pipeline to link ecological networks and clinical stages in T2D, and desirable aim to advance in the field of precision medicine

HLA-B*08 identified as the most associated MHC locus for anti-carbamylated protein antibody-positive/anti-CCP-negative rheumatoid arthritis

Objective: Previously, only the HLA-DRB1 alleles have been assessed in rheumatoid arthritis (RA). The aim of the present study was to identify the key major histocompatibility complex (MHC) susceptibility factors showing a significant association with anti-carbamylated protein antibody-positive (anti-CarP+) RA. Methods: Analyses were restricted to RA patients who were anti-cyclic citrullinated peptide antibody negative (anti-CCP-), because the anti-CCP status dominated the results otherwise. Therefore, we studied samples from 1,821 anti-CCP- RA patients and 6,821 population controls from Spain, Sweden, and the Netherlands. The genotypes for ~8,000 MHC biallelic variants were assessed by dense genotyping and imputation. Their association with the anti-CarP status in RA patients was tested with logistic regression and combined with inverse-variance meta-analysis. Significance of the associations was assessed according to a study-specific threshold of P < 2.0 × 10-5 . Results: The HLA-B*08 allele and its correlated amino acid variant Asp-9 showed a significant association with anti-CarP+/anti-CCP- RA (P < 3.78 × 10-7 ; I2 = 0). This association was specific when assessed relative to 3 comparator groups: population controls, anti-CarP-/anti-CCP- RA patients, and anti-CCP- RA patients who were positive for other anti-citrullinated protein antibodies. Based on these findings, anti-CarP+/anti-CCP- RA patients could be separated from other antibody-defined subsets of RA patients in whom an association with the HLA-B*08 allele has been previously demonstrated. No other MHC variant remained associated with anti-CarP+/anti-CCP- RA after accounting for the presence of the HLA-B*08 allele. Specifically, the reported association of HLA-DRB1*03 was observed at a level comparable to that reported previously, but it was attributable to linkage disequilibrium. Conclusion: These results identify HLA-B*08 carrying Asp-9 as the MHC locus showing the strongest association with anti-CarP+/anti-CCP- RA. This knowledge may help clarify the role of the HLA in susceptibility to specific subsets of RA, by shaping the spectrum of RA autoantibodies. © 2020, American College of Rheumatology