Analysis of investigation reports on occupational accidents.

The investigation of accidents is an occupational safety analytical tool aimed at discovering the causes of an accident. Conducting these investigations properly is essential to obtain useful information that helps avoid these accidents in the future. To prepare this study we analysed 567 investigations, conducted by OHS technical advisors, on occupational accidents occurring in Spain from 2009 to 2012 in industries such as construction, manufacturing, agriculture and services, in order to obtain information to improve the use of this technique. In this study we analyzed how accident investigation reports are made identifying main flaws and omissions. Accident investigations lack details as they often do not consider the variables in the ESAW (European Statistics on Accidents at Work) Project. Likewise, they lack depth in determining the causes associated to active faults, preferably to latent faults, and to the company management and organisation systems. Similarly, they do not comply with the standards recommended by experts. Finally, in the conclusions we recommend two priorities: having a harmonised European model to conduct occupational accident investigations, as well as being able to access databases that collect accident investigation reports of this kind

Methodologies for investigating occupational accidents and their use in occupational health and safety research. Literature review.

El objetivo de este trabajo es revisar los principales estudios publicados sobre accidentes de trabajo para reconocer, clasificar y describir las metodologías científicas utilizadas. Para lograr el objetivo planteado utilizamos un método ya implementado y validado, consistente en una extensa revisión de la literatura científica internacional relacionada con las metodologías de investigación de accidentes en seguridad y salud laboral. A continuación, para evaluar la importancia de estas metodologías, analizamos el número de veces que se citan las publicaciones seleccionadas y el factor de impacto de la revista en la que se publicó. Los resultados de esta revisión muestran que en las últimas décadas se han desarrollado muchas metodologías de investigación diferentes. Estas metodologías cubren diferentes áreas de aplicación, cualidades y limitaciones, entendiendo que una investigación exhaustiva de un accidente requiere una combinación de diferentes actividades incluidas en estos métodos. El presente estudio describe cuáles son las metodologías más utilizadas en el ámbito de la investigación de accidentes laborales. Se identificaron un total de 35 metodologías diferentes. Este estudio revela que, incluso a día de hoy, no se dispone de muchas metodologías centradas en el ámbito de la salud y la seguridad en el trabajo. Por otro lado, para desarrollar y avanzar en la aplicación de las técnicas de investigación de accidentes de trabajo, sería recomendable promover estudios que verifiquen la correcta selección y uso de las metodologías en casos reales de accidentes de trabaj

Does Europe Need an EU Product Safety Directive for Access Scaffolding?

The main requirement established for the development of European Union product safety directives is to ensure a high level of safety for users. This research aims to analyze whether Europe needs a product safety directive for scaffolding and identify the main factors to be defined in public policies on the use of standardized scaffolding in the absence of such a directive. The principal types of scaffolding were reviewed, along with European regulations, and their risk levels. Finally, a qualitative study using a panel of experts was conducted to determine the differences between types of scaffolding and whether the enactment of such a directive would be justified. Key results were that the risk level associated with scaffolding positioned it third or fourth between material agents more hazardous in relation to falls from height. There is no existing product safety directive for scaffolding, despite the fact that there are directives for other products less dangerous than or as dangerous as scaffolding. However, there are noncompulsory standards EN 12810-1-2 and EN 12811-1-2-3-4 for scaffolding, which would form the basis of the essential requirements contained in a directive if it were created. The experts highlighted significant differences between “standardized” and “nonstandardized” scaffolding, with higher safety levels and productivity, and better maintenance, inspection, assembly, and dismantling associated with the former, and lower costs with the latter. Thus, they found that the enacting of an EU product safety directive for scaffolding would be justifiable, and in its absence supported the promotion of the use of standardized scaffolding.Ministerio de Economía, Industria y Competitividad BIA2016-79270-PMinisterio de Educación, Cultura y Deportes FPU 2016/0329

Comparative risk assessment of vehicle maintenance activities: Hybrid, battery electric, and hydrogen fuel cell cars

In this research, vehicle maintenance activities and their safety risks were statistically analyzed. This study focused on three types of vehicle: hybrid, battery electric, and hydrogen fuel cell cars. The repair activities and the risks for each power train technology were identified by a panel of experts. Depending on its frequency and severity, risk values were calculated for each maintenance activity. The method chosen was the staticized group method, which involves collection opinions from a panel of experts. The ten experts finally chosen were asked to anonymously respond to a survey that had been especially designed to reduce bias and ensure the quality of the data. The most dangerous vehicle maintenance activities were the manipulation of asbestos, charging and discharging of high value capacitors, and welding

Economic evaluation of health services costs during pandemic influenza A (H1N1) pdm09 infection in pregnant and non-pregnant women in Spain (2009)

Background: The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old). Methods: We addressed this question with a longitudinal, observational, multicentre study. Inputs were the require-ments in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utili-sation. The mean cost per patient was calculated in this group of women. Results: We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher ( 4,689.4/non-pregnant and 2,945.07/pregnant). Conclusions: Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning

Cell free circulating tumor DNA in cerebrospinal fluid detects and monitors central nervous system involvement of B-cell lymphomas

The levels of cell free circulating tumor DNA (ctDNA) in plasma correlate with treatment response and outcome in systemic lymphomas. Notably, in brain tumors, the levels of ctDNA in the cerebrospinal fluid (CSF) are higher than in plasma. Nevertheless, their role in central nervous system (CNS) lymphomas remains elusive. We evaluated the CSF and plasma from 19 patients: 6 restricted CNS lymphomas, 1 systemic and CNS lymphoma, and 12 systemic lymphomas. We performed whole exome sequencing or targeted sequencing to identify somatic mutations of the primary tumor, then variant-specific droplet digital polymerase chain reaction was designed for each mutation. At time of enrollment, we found ctDNA in the CSF of all patients with restricted CNS lymphoma but not in patients with systemic lymphoma without CNS involvement. Conversely, plasma ctDNA was detected in only 2 out of 6 patients with restricted CNS lymphoma with lower variant allele frequencies than CSF ctDNA. Moreover, we detected CSF ctDNA in one patient with CNS lymphoma in complete remission and in one patient with systemic lymphoma, 3 and 8 months before CNS relapse was confirmed, indicating that CSF ctDNA might detect CNS relapse earlier than conventional methods. Finally, in two cases with CNS lymphoma, CSF ctDNA was still detected after treatment even though no tumoral cells were observed by flow cytometry (FC), indicating that CSF ctDNA detected residual disease better than FC. In conclusion, CSF ctDNA can detect CNS lesions better than plasma ctDNA and FC. In addition, CSF ctDNA predicted CNS relapse in CNS and systemic lymphomas

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3-15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01-1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06-1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26-2.69), asthma (OR: 1.52; 95% CI: 1.04-2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86-0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76-0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00-1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission

Feasibility and safety of treating non-unions in tibia, femur and humerus with autologous, expanded, bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials in a multicentric, non-comparative trial

Background: ORTHO-1 is a European, multicentric, first in human clinical trial to prove safety and feasibility after surgical implantation of commercially available biphasic calcium phosphate bioceramic granules associated during surgery with autologous mesenchymal stromal cells expanded from bone marrow (BM-hMSC) under good manufacturing practices, in patients with long bone pseudarthrosis. Methods: Twenty-eight patients with femur, tibia or humerus diaphyseal or metaphyso-diaphyseal non-unions were recruited and surgically treated in France, Germany, Italy and Spain with 100 or 200 million BM-hMSC/mL associated with 5–10 cc of bioceramic granules. Patients were followed up during one year. The investigational advanced therapy medicinal product (ATMP) was expanded under the same protocol in all four countries, and approved by each National Competent Authority. Findings: With safety as primary end-point, no severe adverse event was reported as related to the BM-hMSC. With feasibility as secondary end-point, the participating production centres manufactured the BM-hMSC as planned. The ATMP combined to the bioceramic was surgically delivered to the non-unions, and 26/28 treated patients were found radiologically healed at one year (3 out of 4 cortices with bone bridging). Interpretation: Safety and feasibility were clinically proven for surgical implantation of expanded autologous BM-hMSC with bioceramic. Funding: EU-FP7-HEALTH-2009, REBORNE Project (GA: 241876).The research leading to these results has received funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/FP7-HEALTH-2009); REBORNE Project (GA: 241876

Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry

(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects