Factors personals i laborals associats als accidents de treball mortals.

RESUMEN La investigació de les causes dels accidents de treball mortals (ATM) es justifica per limpacte des del punt de vista qualitatiu i per la necessitat de basar les estratègies preventives en levidència científica. Els objectius daquest treball són: descriure la distribució territorial i sectorial dels ATM a Espanya, avaluar-ne limpacte, analitzar el paper de determinats factors de caire individual o agregat en la producció dATM, tant personals (edat, sexe) como laborals (ocupació, tipus de contracte, grandària de lempresa, centre de treball i tasca habitual o no, hora del dia de laccident, hora de la jornada de laccident, dia de la setmana i circumstàncies de laccident), així com de determinades magnituds macroeconòmiques (PIB i PIB per càpita, creixement econòmic, Jornada efectiva, Hores treballades i Índexs de temporalitat i rotació), i elaborar una proposta estructurada de mesures preventives a través dun mètode estandarditzat. Per a assolir aquestos objectius sha fet lanàlisi dels Anys Potencials de Vida Perduts (APVP) deguts a ATM, shan calculat les incidències dATM (I) per comunitat autònoma, crues i estandarditzades per sector econòmic, sha fet una anàlisi ecològica la unitat danàlisi de la qual han estat les comunitats autònomes, sha fet un contrast estadístic de les circumstàncies dels ATM (forma de producció, agent causant, naturalesa i ubicació de les lesions) mitjançant la prova de xi quadrat, sha fet una anàlisi de casos i controls simple i multivariant mitjançant l ajust duna funció de regressió logística, i sha fet una anàlisi discriminant que incorpora totes les variables personals, laborals i de circumstàncies de laccident. Finalment, sha elaborat una proposta de mesures preventives a través del mètode de la matriu de Haddon tridimensional. Els resultats indiquen que i) shan trobat diferències sectorials i territorials estadísticament significatives en relació amb limpacte (APVP) i la freqüència dels ATM (I), sense patró aparent de distribució territorial; ii) les diferències territorials no shan trobat associades als indicadors macroeconòmics considerats; iii) els ATM difereixen de manera estadísticament significativa pel que fa als accidents de treball no mortals quant a la forma de producció, lagent causant, el tipus de lesió i la part del cos lesionada; iv) ledat avançada, el sexe masculí, el treball en els sectors dagricultura i construcció, el treball en un centre no habitual o en una tasca no habitual, les empreses de 50 treballadors o menys, lhora avançada de la jornada laboral i el treball de vesprada o nit estan associats significativament al resultat mortal dels accidents de treball. Aquests resultats poden servir com a punt de partença per al disseny de programes preventius en relació als ATM. __________________________________________________________________________________________________ Research on the causes of fatal occupational injuries (FOI) is justified by their qualitative impact and the need of basing preventive strategies on the scientific evidence. The objectives of this work were: to describe the distribution of FOI in Spain by autonomous community and economic sector, to assess their impact, to analise the role of some individual or aggregate factors in the occurrence of FOI: personal (age, sex), occupational (job, type of contract, company size, usual or unusual workplace or job, hour of the day, hour of the workshift, day of the week and circumstances of the accident), or macroeconomic (GDP and GDP per head, economic growth, overall and mean worked hours and job temporarity or rotation), and to develop a structured proposal of preventive measures through a standardised method. To achieve these aims, an analysis of the Years of Potential Life Lost (YPLL) due to FOI, a calculation of FOI incidence (I) by autonomous community -raw and standardised by economic activity-, an ecologic analysis with autonomous communities as a unit of analysis, a chi square test on FOI circumstances (way of production, causing agent, nature and part of the body injured), a case-control analysis with the adjustment of a logistic regression function, and a discriminant analysis including all variables considered, were performed. Finally, a proposal of preventive measures through the three-dimensional Haddon matrix was done. Results show that i) statistically significant differences by economic activity and autonomous community on impact (YPLL) and incidence of FOI (I) were found, without any apparent pattern of territorial distribution, ii) territorial differences were not found to be related to the macroeconomic indicators considered, iii) FOI show statistically significant differences compared to non FOI regarding way of production, causing agent, nature and part of the body injured, iv) older age, male gender, working on agriculture and construction, working in an unusual workplace or job, companies with 50 workers, later workshift hours and working on the evening or night were significantly related to a fatal result of an occupational injury. These findings can serve as a starting point to design preventive programmes on FOI

Night shift work and stomach cancer risk in the MCC-Spain study

OBJECTIVES: Night shift work has been classified as a probable human carcinogen by the International Agency for Research on Cancer, based on experimental studies and limited evidence on human breast cancer risk. Evidence at other cancer sites is scarce. We evaluated the association between night shift work and stomach cancer risk in a population-based case-control study. METHODS: A total of 374 incident stomach adenocarcinoma cases and 2481 population controls were included from the MCC-Spain study. Detailed data on lifetime night shift work were collected including permanent and rotating shifts, and their cumulative duration (years). Adjusted unconditional logistic regression models were used in analysis. RESULTS: A total of 25.7% of cases and 22.5% of controls reported ever being a night shift worker. There was a weak positive, non-significant association between ever having had worked for at least 1?year in permanent night shifts and stomach cancer risk compared to never having worked night shifts (OR=1.2, 95% CI 0.9 to 1.8). However, there was an inverse 'U' shaped relationship with cumulative duration of permanent night shifts, with the highest risk observed in the intermediate duration category (OR 10-20?years=2.0, 95% CI 1.1 to 3.6) (p for trend=0.19). There was no association with ever having had worked in rotating night shifts (OR=0.9, 95% CI 0.6 to 1.2) and no trend according to cumulative duration (p for trend=0.68). CONCLUSION: We found no clear evidence concerning an association between night shift work and stomach cancer ris

Night shift work and stomach cancer risk in the MCC-Spain study

OBJECTIVES: Night shift work has been classified as a probable human carcinogen by the International Agency for Research on Cancer, based on experimental studies and limited evidence on human breast cancer risk. Evidence at other cancer sites is scarce. We evaluated the association between night shift work and stomach cancer risk in a population-based case-control study. METHODS: A total of 374 incident stomach adenocarcinoma cases and 2481 population controls were included from the MCC-Spain study. Detailed data on lifetime night shift work were collected including permanent and rotating shifts, and their cumulative duration (years). Adjusted unconditional logistic regression models were used in analysis. RESULTS: A total of 25.7% of cases and 22.5% of controls reported ever being a night shift worker. There was a weak positive, non-significant association between ever having had worked for at least 1 year in permanent night shifts and stomach cancer risk compared to never having worked night shifts (OR=1.2, 95% CI 0.9 to 1.8). However, there was an inverse 'U' shaped relationship with cumulative duration of permanent night shifts, with the highest risk observed in the intermediate duration category (OR 10-20 years=2.0, 95% CI 1.1 to 3.6) (p for trend=0.19). There was no association with ever having had worked in rotating night shifts (OR=0.9, 95% CI 0.6 to 1.2) and no trend according to cumulative duration (p for trend=0.68). CONCLUSION: We found no clear evidence concerning an association between night shift work and stomach cancer risk

Night shift work and stomach cancer risk in the MCC-Spain study

OBJECTIVES: Night shift work has been classified as a probable human carcinogen by the International Agency for Research on Cancer, based on experimental studies and limited evidence on human breast cancer risk. Evidence at other cancer sites is scarce. We evaluated the association between night shift work and stomach cancer risk in a population-based case-control study. METHODS: A total of 374 incident stomach adenocarcinoma cases and 2481 population controls were included from the MCC-Spain study. Detailed data on lifetime night shift work were collected including permanent and rotating shifts, and their cumulative duration (years). Adjusted unconditional logistic regression models were used in analysis. RESULTS: A total of 25.7% of cases and 22.5% of controls reported ever being a night shift worker. There was a weak positive, non-significant association between ever having had worked for at least 1 year in permanent night shifts and stomach cancer risk compared to never having worked night shifts (OR=1.2, 95% CI 0.9 to 1.8). However, there was an inverse 'U' shaped relationship with cumulative duration of permanent night shifts, with the highest risk observed in the intermediate duration category (OR 10-20 years=2.0, 95% CI 1.1 to 3.6) (p for trend=0.19). There was no association with ever having had worked in rotating night shifts (OR=0.9, 95% CI 0.6 to 1.2) and no trend according to cumulative duration (p for trend=0.68). CONCLUSION: We found no clear evidence concerning an association between night shift work and stomach cancer risk

Night shift work and stomach cancer risk in the MCC-Spain study

OBJECTIVES: Night shift work has been classified as a probable human carcinogen by the International Agency for Research on Cancer, based on experimental studies and limited evidence on human breast cancer risk. Evidence at other cancer sites is scarce. We evaluated the association between night shift work and stomach cancer risk in a population-based case-control study. METHODS: A total of 374 incident stomach adenocarcinoma cases and 2481 population controls were included from the MCC-Spain study. Detailed data on lifetime night shift work were collected including permanent and rotating shifts, and their cumulative duration (years). Adjusted unconditional logistic regression models were used in analysis. RESULTS: A total of 25.7% of cases and 22.5% of controls reported ever being a night shift worker. There was a weak positive, non-significant association between ever having had worked for at least 1 year in permanent night shifts and stomach cancer risk compared to never having worked night shifts (OR=1.2, 95% CI 0.9 to 1.8). However, there was an inverse 'U' shaped relationship with cumulative duration of permanent night shifts, with the highest risk observed in the intermediate duration category (OR 10-20 years=2.0, 95% CI 1.1 to 3.6) (p for trend=0.19). There was no association with ever having had worked in rotating night shifts (OR=0.9, 95% CI 0.6 to 1.2) and no trend according to cumulative duration (p for trend=0.68). CONCLUSION: We found no clear evidence concerning an association between night shift work and stomach cancer risk

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)