Ocupació i càncer de bufeta urinària al Vallès Occidental

Antecedents: El càncer de bufeta urinària és molt freqüent en els homes als països occidentals. El consum de tabac i determinades exposicions laborals són els principals factors de risc. Per a la indústria tèxtil l'evidència existent és limitada, es coneix molt poc la seva associació amb l'ocupació en dones i la relació amb el nivell socioeconòmic és controvertida. Articles: Aquesta tesi es compon de 4 articles que corresponen a dos estudis: 1) Estudi del Vallès Occidental (VO), amb l'objectiu d'avaluar el risc de càncer de bufeta a la indústria tèxtil; s'inclouen dos articles que tracten sobre aquesta associació i la classe social determinada amb l'ocupació; 2) Anàlisi combinada europea, que inclou l'estudi anterior, amb l'objectiu d'avaluar l'impacte de l'ocupació sobre el càncer de bufeta a Europa; s'inclouen dos articles, un sobre ocupació en dones i l'altre sobre tabac en homes. Mètode: 1) Estudi VO: disseny de casos i controls amb 218 casos incidents de càncer de bufeta diagnosticats entre 1993-1995 en els residents del VO, i 344 controls seleccionats dels padrons municipals; s'obtingué de tots la història laboral i de consum de tabac completes; 2) Anàlisi combinada europea: dades primàries d'onze estudis recents de casos i controls realitzats a Europa, amb informació detallada sobre ocupació i tabac. Resultats: La taxa d'incidència ajustada per als homes del VO va ser de les més altes d'Europa; per les dones va ser 10 vegades inferior i ocupà un lloc intermedi-baix. No s'observà un risc associat globalment a la indústria tèxtil ni cap dels seus sectors. S'observà un risc elevat pels filadors durant més de 20 anys (OR 3,28; IC95% 1,08-9,97) i pels ajustadors de maquinària entre 1960 i 1974 (OR 4,26; IC95% 1,09-16,7). La classe social s'associà feblement al càncer de bufeta, amb major risc per les classes socials més elevades. En l'anàlisi combinada europea, l'anàlisi de 700 casos en dones i 2.425 controls (dones) mostrà un risc elevat per a alguna ocupació prèviament identificada de risc de càncer de bufeta, així com per a certes treballadores del metall (OR 2,0; IC95% 1,1-3,6), del tabac (OR 3,1; IC95% 1,1-9,3), agricultores (OR 1,8; IC95% 1,0-3,1) i modistes (OR 1,4; IC95% 1,0-2,1). Al voltant del 8% (IC95% 3,1-19,9) dels tumors de bufeta en dones poden ser atribuïts a l'ocupació. S'analitzà el consum de cigarretes en homes europeus, per 2.600 casos i 5.524 controls, mostrant un increment lineal del risc de càncer de bufeta amb la durada del consum de cigarretes, així com una relació dosi-resposta amb el nombre de cigarretes per dia, però fins a un dintell (15-20 cigarretes/dia) després del qual el risc no augmenta. S'observà una disminució immediata del risc després d'abandonar l'hàbit, fins al 60% després de 25 anys (OR 0,37; IC95% 0,30-0,45), però el risc no s' equipara mai al dels no fumadors. La proporció de casos atribuïbles a haver fumat va ser de 0,66% (IC95% 0,66-0,79). Al estudi del VO s'obtingueren resultats similars respecte al tabac. Conclusions: La incidència del càncer de bufeta en els homes del VO es troba entre les més elevades d'Europa, està associada al tabac i determinades ocupacions i circumstàncies del tèxtil, però es desconeixen altres factors de risc. El risc associat amb ocupacions prèviament associades al càncer de bufeta és més baix que el descrit amb anterioritat. En les dones europees, el 1-2 de cada 20 casos són atribuïts a l'ocupació. En els homes europeus, el tabac explica el 65% dels casos, el risc està sobretot associat a la durada de l'hàbit i es redueix molt al deixar de fumar. Calen més estudis que utilitzin metodologies més acurades i incloguin altres possible factors de risc.Background: Urinary bladder cancer is very frequent in western countries. Its main risk factors are smoking and certain occupational exposures. The evidence of its association with the textile industry is limited, the link with occupational factors in women has received little recognition and its relationship with social class is controversial. Articles: This thesis comprises 4 articles corresponding to two studies: 1) Study of Vallès Occidental (VO), with the objective to evaluate the risk of bladder cancer in the textile industry; two articles are included, on this association and on social class on the basis of occupation; 2) European pooled analysis, including the previous study, with the objective to evaluate the impact of occupation on bladder cancer in Europe; two articles are included, one on occupation in women and the other on smoking in men. Methods: 1) Study VO: case control design, with 218 incident cases of bladder cancer diagnosed between 1993-1995 in the population living in VO, and 344 controls selected through the municipal lists; lifetime occupational and smoking history was obtained for all; 2) European pooled analysis: primary data from eleven recent case control studies conducted in Europe, with detailed information on occupation and smoking. Results: The adjusted incidence rate for men in VO was among the highest in Europe, whereas for women it was intermediate-low and 10 times lower. No overall excess risk was found associated neither with the textile industry nor for its specific sectors. An elevated risk was found for spinners for more than 20 years (OR 3.28; 95%CI 1.08-9.97) and machine setters between 1960 and 1974 (OR 4.26; 95%CI 1.09-16.7). The association with social class was weak, with the highest risk for highest social classes. Pooling the European data of 700 female cases and 2,425 female controls showed an elevated risk for a few previously identified risk occupations, and for certain for metal workers (OR=2.0, 95%CI 1.1-3.6), tobacco workers (OR=3.1, 95%CI 1.1-9.3), field crop and vegetable farm workers (OR=1.8, 95%CI 1.0-3.1) and dressmakers (OR=1.4, 95%CI 1.0-2.1). About 8% (95%CI 3.1-19.9) of all bladder cancers in women could be attributed to occupation. Cigarette smoking was analysed in European men, including 2,600 cases and 5,524 controls. There was a linear increasing risk with increasing duration of smoking, and a dose-response relationship with number of cigarettes smoked per day up to threshold limit of 15-20 cigarettes/day after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking, which was over 60% after 25 years (OR=0.37, 95%CI 0.30-0.45), but the risk did not reach the level of never-smokers. The proportion of cases attributable to ever smoking was 0,66 (95%CI 0.66-0.79). Similar results for smoking were obtained in VO study. Conclusions: The incidence of bladder cancer in men of VO is among the highest in Europe, is associated with smoking and certain occupations in the textile industry with highest exposures, but other risk factors remain unknown. The risk associated with previously identified high-risk occupations is now lower. In European women, 1-2 cases among each 20 cases can be attributed to occupation. In European men, smoking can explain a 65% of cases, the risk is mainly associated with duration and an important reduction is observed with cessation. More studies are needed using more accurate methodologies which include other potential risk factors for bladder cancer

Archivos: Success!

En tres meses Archivos de Prevención de Riesgos Laborales cumple un cuarto de siglo. En 1998, la entonces Societat Catalana de Seguretat i Medicina del Treball, hoy Associació Catalana de Salut Laboral, presidida por Jaume de Montserrat, anunciaba una nueva revista, que nacía con 35 años de historia y 120 números publicados en la extinguida Medicina de Empresa. Fernando G. Benavides asumía la tarea (1998-2005). Archivos nació con una clara voluntad de hacer realidad un instrumento “de difusión de información relevante, rigurosa y actual que necesita todo campo de conocimiento para su desarrollo y evolución” parafraseando a su segunda directora, Ana M García (2005-2015) y además de acuerdo con los criterios internacionales de calidad científica..

Lesiones por accidentes de trabajo, una prioridad en salud pública

El objetivo de esta revisión es generar nuevas ideas y acciones que nos ayuden a prevenir este importante problema de salud pública. El número total de LAT con baja en jornada, en los años 2002 y 2003, alcanzó la cifra de 971.406 y 906.638, respectivamente. Ello significa que cada día se producen en España algo más de 2.500 LAT con baja en jornada y entre 2 y 3 muertes diarias. Aunque el perfil de la población a riesgo de sufrir las LAT está cambiando profundamente en la última década, tanto cuantitativa como cualitativamente, el riesgo de sufrir una LAT se continúa concentrando en las ocupaciones que realizan trabajos de tipo manual, ya sean trabajadores cualificados o no cualificados, de los sectores primario y secundario. Los sobreesfuerzos para las lesiones no mortales y el tráfico para las mortales constituyen las principales formas en que se producen las LAT. La asociación entre temporalidad y riesgo de LAT muestra los efectos negativos sobre la salud de las nuevas formas de organización del trabajo, que enfatizan la desregulación del mercado laboral. Aunque en los últimos años se han puesto en marcha diferentes programas preventivos frente a las LAT, éstos parecen haber tenido un resultado muy limitado. Las actividades preventivas deben concentrarse, tanto en el ámbito de las condiciones de trabajo (micro), como en las políticas públicas de empleo e industriales (macro). En este segundo ámbito es imprescindible incrementar la evaluación en términos de salud de las políticas de empleo e industriales

COVID-19, es el momento de su reconocimiento pleno como enfermedad profesional

En un contexto de transición hacia el final de la pandemia, pensamos que es el momento o de reconocer como enfermedad profesional la COVID-19. Los pasos dados de reconocimiento como accidente de trabajo en sanitarios representan un avance, pero es insuficiente. Es un paso que ya ha recomendado recientemente la Comisión europea, para incluirla con el listado europeo de enfermedades profesionales, en todas aquellas actividades con un riesgo de infección demostrado. Esto supondría ventajas objetivas para las personas trabajadoras y las empresas.

Low back pain among office workers in three Spanish-speaking countries: Findings from the CUPID study

Artículo científicoObjectives—To assess differences in the prevalence and incidence of low back pain (LBP) and associated disability among office workers in Costa Rica, Nicaragua and Spain. Methods—Data were collected at baseline (n=947, 93% response) in November 2007 and at follow-up after 12 months (n=853, 90% response). Six outcome measures were examined: baseline prevalence of (1) LBP in past 12 months, (2) LBP in past month, and (3) disabling LBP in past month; and at follow-up: (4) incidence of new LBP in the past month, (5) new disabling LBP, and (6) persistent LBP. Differences in prevalence by country were characterized by odd ratios (ORs) with 95% confidence intervals (95%CIs), before and after adjustment for covariates. Results—Prevalence of LBP in the past month among office employees in Costa Rica (46.0%) and Nicaragua (44.2%) was higher than in Spain (33.6%). Incidence of new LBP was 37.0% in Nicaragua (OR=2.49; 95% CI: 1.57-3.95), 14.9% in Costa Rica (OR=0.74; 95% CI: 0.41-1.34), and 19.0% in Spain (reference). Incidence of new disabling LBP was higher in Nicaragua, 17.2%(OR=2.49; 95% CI: 1.43-4.34) and Costa Rica, 13.6% (OR=1.89; 95% CI: 1.03-3.48) than Spain (7.7%), while persistence of LBP was higher only in Nicaragua. Conclusions—Prevalence of LBP and disabling LBP was higher in Costa Rican and Nicaraguan office workers than in Spain, but incidence was higher mainly in Nicaragua. Measured sociodemographic, job-related and health-related variables only partly explained the differences between countries, and further research is needed to explore reasons for the remaining differences

Estimación económica de una muestra de casos de enfermedad profesional confirmados por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar, 2014-2021

La infranotificación de enfermedades profesionales (EEPP) es un problema social y económico, pues repercute en el bienestar del trabajador afectado, y en las estimaciones presupuestarias que se planifican anualmente para la gestión de los servicios sanitarios. Los costes asistenciales fueron evaluados en una muestra de 13 casos de EEPP con resolución positiva por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar (Barcelona) entre 2014 y 2021. El coste de la asistencia generada del total de casos fue de 474.859 €, con un coste medio de 36.528 € por paciente. Por grupo diagnóstico, el coste más alto lo originaron los casos de cánceres que supusieron el 79% del gasto total (375.068 €). Los hallazgos del estudio reflejan el impacto económico que supone la asistencia sanitaria prestada por un hospital público a pacientes con una EEPP reconocida en el INSS

Process evaluation of a complex workplace intervention to prevent musculoskeletal pain in nursing staff: results from INTEVAL_Spain.

Background INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation. Objectives This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers. Methods The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan's framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically. Results The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers. Conclusions This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed

Archivos, posicionada en la senda del impacto

Con este bagaje, comenzamos 2023, un año en el que nuestra revista cumple un cuarto de siglo llevando a cabo la misión para la que fue concebida, misión que los distintos comités editoriales que hemos participado consideramos un acierto: contribuir a la transferencia de conocimiento útil para avanzar en la mejora de la salud de las personas trabajadora

Large-Scale Evaluation of Candidate Genes Identifies Associations between VEGF Polymorphisms and Bladder Cancer Risk

Common genetic variation could alter the risk for developing bladder cancer. We conducted a large-scale evaluation of single nucleotide polymorphisms (SNPs) in candidate genes for cancer to identify common variants that influence bladder cancer risk. An Illumina GoldenGate assay was used to genotype 1,433 SNPs within or near 386 genes in 1,086 cases and 1,033 controls in Spain. The most significant finding was in the 5′ UTR of VEGF (rs25648, p for likelihood ratio test, 2 degrees of freedom = 1 × 10(−5)). To further investigate the region, we analyzed 29 additional SNPs in VEGF, selected to saturate the promoter and 5′ UTR and to tag common genetic variation in this gene. Three additional SNPs in the promoter region (rs833052, rs1109324, and rs1547651) were associated with increased risk for bladder cancer: odds ratio (95% confidence interval): 2.52 (1.06–5.97), 2.74 (1.26–5.98), and 3.02 (1.36–6.63), respectively; and a polymorphism in intron 2 (rs3024994) was associated with reduced risk: 0.65 (0.46–0.91). Two of the promoter SNPs and the intron 2 SNP showed linkage disequilibrium with rs25648. Haplotype analyses revealed three blocks of linkage disequilibrium with significant associations for two blocks including the promoter and 5′ UTR (global p = 0.02 and 0.009, respectively). These findings are biologically plausible since VEGF is critical in angiogenesis, which is important for tumor growth, its elevated expression in bladder tumors correlates with tumor progression, and specific 5′ UTR haplotypes have been shown to influence promoter activity. Associations between bladder cancer risk and other genes in this report were not robust based on false discovery rate calculations. In conclusion, this large-scale evaluation of candidate cancer genes has identified common genetic variants in the regulatory regions of VEGF that could be associated with bladder cancer risk