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Background: The ageing process may lead to functional limitations, musculoskeletal pain, and worsened quality of life. The aim of this paper is to evaluate two physical therapy interventions for reducing musculoskeletal pain and improving quality of life in older adults. Methods: A cohort study was carried out with older people (60–75 years old). The Geriatric Physical Therapy group (n = 70) received massage therapy, therapeutic exercise, and therapeutic education program for 5 weeks; the Standardized Therapeutic Exercise group (n = 140) received a standardized therapeutic exercise and therapeutic education program for 3 weeks. Health-related quality of life (SF-36v2) and musculoskeletal pain intensity (VAS) were collected at baseline (A0), post-intervention (A1), and 12 weeks after baseline (A2). Results: There was pain intensity reduction in both groups (p < 0.05) and health-related quality of life improvement, except for Emotional Role (p = 0.34); Physical Function (p = 0.07), Bodily Pain (p = 0.02), and General Health (p = 0.09). At A2 there was a difference (p < 0.05) for neck pain in favor of the Geriatric Physical Therapy Group. Conclusions: Within the limitations of the study, it was possible to conclude that both physical therapy interventions showed a positive effect for reducing non-specific neck pain and low back pain in older adults, which may contribute to health-related quality of life improvement.

En este ultimo ano, todos hemos sufrido las devastadoras consecuencias de la epidemia por SARS-CoV2. En unos meses, los medios de comunicacion nos han bombardeado con mensajes sobre incidencias, letalidad o incluso medidas mas tecnicas como el R0 o la tasa de ataque. Con esta actualizacion se pretende aclarar los conceptos basicos sobre la dinamica de la epidemia, asi como exponer lo que, hasta la fecha en que se escribe, se conoce de la misma. Para ello, se ha utilizado y extraido la informacion disponible en organismos internacionales como la Organizacion Mundial de la Salud, asi como en el Ministerio de Sanidad. En ningun caso se ha de entender como una situacion fija o conocida. Una situacion que, por otro lado, invariablemente ha de ser cambiante.

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

We focused on tweets containing hashtags related to ADHD pharmacotherapy between 20 September and 31 October 2019. Tweets were classified as to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. Furthermore, we classified any links included within a tweet as either scientific or non-scientific. We created a dataset of 6568 tweets: 4949 (75.4%) related to stimulants, 605 (9.2%) to non-stimulants and 1014 (15.4%) to alpha-2 agonists. Next, we manually analyzed 1810 tweets. In the end, 481 (48%) of the tweets in the stimulant group, 218 (71.9%) in the non-stimulant group and 162 (31.9%) in the alpha agonist group were considered classifiable. Stimulants accumulated the majority of tweets. Notably, the content that generated the highest frequency of tweets was that related to treatment efficacy, with alpha-2 agonist-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to alpha-2 agonists. Stimulant-related tweets obtained the highest proportion of likes and were the most disseminated within the Twitter community. Understanding the public view of these medications is necessary to design promotional strategies aimed at the appropriate population.

Background Antiobesity drugs are prescribed for the treatment of obesity in conjunction with healthy eating, physical activity, and behavior modification. However, poor adherence rates have been reported. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. The analysis of tweets has become a tool for health research. Objective The aim of this study is to investigate the content and key metrics of tweets referring to antiobesity drugs. Methods In this observational quantitative and qualitative study, we focused on tweets containing hashtags related to antiobesity drugs between September 20, 2019, and October 31, 2019. Tweets were first classified according to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. We additionally rated it as positive or negative. Furthermore, we classified any links included within a tweet as either scientific or nonscientific. Finally, the number of retweets generated as well as the dissemination and sentiment score obtained by the antiobesity drugs analyzed were also measured. Results We analyzed a total of 2045 tweets, 945 of which were excluded according to the criteria of the study. Finally, 320 out of the 1,100 remaining tweets were also excluded because their content, although related to drugs for obesity treatment, did not address the efficacy, side effects, or adherence to medication. Liraglutide and semaglutide accumulated the majority of tweets (682/780, 87.4%). Notably, the content that generated the highest frequency of tweets was related to treatment efficacy, with liraglutide-, semaglutide-, and lorcaserin-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to liraglutide and semaglutide. Semaglutide-related tweets obtained the highest probability of likes and were the most disseminated within the Twitter community. Conclusions This analysis of posted tweets related to antiobesity drugs shows that the interest, beliefs, and experiences regarding these pharmacological treatments are heterogeneous. The efficacy of the treatment accounts for the majority of interest among Twitter users.

Background Health awareness initiatives are frequent but their efficacy is a matter of controversy. We have investigated the effect of the Eating Disorder Awareness Week and Wake Up Weight Watchers campaigns on Twitter. Objective We aimed to examine whether the Eating Disorder Awareness Week and Wake Up Weight Watchers initiatives increased the volume and dissemination of Twitter conversations related to eating disorders and investigate what content generates the most interest on Twitter. Methods Over a period of 12 consecutive days in 2018, we collected tweets containing the hashtag #wakeupweightwatchers and hashtags related to Eating Disorder Awareness Week (#eatingdisorderawarenessweek, #eatingdisorderawareness, or #EDAW), with the hashtag #eatingdisorder as a control. The content of each tweet was rated as medical, testimony, help offer, awareness, pro-ana, or anti-ana. We analyzed the number of retweets and favorites generated, as well as the potential reach and impact of the hashtags and the characteristics of contributors. Results The number of #wakeupweightwatchers tweets was higher than that of Eating Disorder Awareness Week and #eatingdisorder tweets (3900, 2056, and 1057, respectively). The content of tweets was significantly different between the hashtags analyzed (P Conclusions Both awareness campaigns effectively promoted tweeting about eating disorders. The majority of tweets did not promote any specific preventive or help-seeking behaviors.

Aims The purposes of this study were: (i) to evaluate the reliability of vaginal palpation, vaginal manometry, vaginal dynamometry; and surface (transperineal) electromyography (sEMG), when evaluating pelvic floor muscle (PFM) strength and/or activation; and (ii) to determine the associations among PFM strength measured using these assessments. Methods One hundred and fifty women with pelvic floor disorders participated on one occasion, and 20 women returned for the same investigations by two different raters on 3 different days. At each session, PFM strength was assessed using palpation (both the modified Oxford Grading Scale and the Levator ani testing), manometry, and dynamometry; and PFM activation was assessed using sEMG. Results The interrater reliability of manometry, dynamometry, and sEMG (both root-mean-square [RMS] and integral average) was high (Lin's Concordance Correlation Coefficient [CCC] = 0.95, 0.93, 0.91, 0.86, respectively), whereas the interrater reliability of both palpation grading scales was low (Cohen's Kappa [k] = 0.27-0.38). The intrarater reliability of manometry (CCC = 0.96), and dynamometry (CCC = 0.96) were high, whereas intrarater reliability of both palpation scales (k = 0.78 for both), and of sEMG (CCC = 0.79 vs 0.80 for RMS vs integral average) was moderate. The Bland-Altman plot showed good inter and intrarater agreement, with little random variability for all instruments. The correlations among palpation, manometry, and dynamometry were moderate (coefficient of determination [r2] ranged from 0.52 to 0.75), however, transperineal sEMG amplitude was only weakly correlated with all measures of strength (r2 = 0.23-0.30). Conclusions Manometry and dynamometry are more reliable tools than vaginal palpation for the assessment of PFM strength in women with pelvic floor disorders, especially when different raters are involved. The different PFM strength measures used clinically are moderately correlated; whereas, PFM activation recorded using transperineal sEMG is only weakly correlated with PFM strength. Results from perineal sEMG should not be interpreted in the context of reporting PFM strength.

Background: Twitter is an indicator of real-world performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis. Objective: The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus). Methods: Each tweet’s content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness’s diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated. Results: We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3% (212/636) vs 1.15% (853/7419; P

Background: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. Objective: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. Methods: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. Results: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P

Objective To study the relationship between tension-type headaches and the oculomotor system in terms of binocular coordination, mechanosensitivity of the supraorbital nerve, and myofascial trigger points in the lateral rectus muscle, assessing the influence of visual effort caused by using a computer at work. Design Observational study with blind evaluation of the response variable. Methods Two groups were compared: 19 subjects with tension-type headaches and 16 healthy subjects, both exposed to computer use at work. A blinded assessor conducted three tests: measurement of the supraorbital nerve pressure pain threshold using a pressure algometer, evaluation of myofascial trigger points of the lateral rectus using the verbal numerical scale, and assessment of binocular coordination in smooth pursuit eye movements using an innovative video-oculography system. Tests were performed before work began and four hours later, and subjects in the headache group were examined when they presented a headache score of less than or equal to 3 on the verbal numerical scale. Results The headache group presented a greater sensitivity of the supraorbital nerve and greater local and referred pain of the lateral rectus ( P

[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 activities Sí

Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized.We analyzed the effect of preoperative psychologic distress on changes in pain, function, and quality of life 1 year after elective TKA.In this prospective cohort study, we assessed patients who underwent TKAs in 2009 and 2010. Before surgery, patients completed the Folstein Mini Mental Test, the Hospital Anxiety and Depression Scale (HAD), The Knee Society Score(©), the WOMAC quality-of-life questionnaire, and the VAS for pain. The patients were divided into two groups based on the degree of psychologic distress on the HAD Scale, and the groups were compared in terms of the above-listed clinical outcomes tools 1 year after surgery using multivariate linear models. Two hundred sixty-three patients met the inclusion criteria, and 202 (77%) completed the study protocol.The presence of preoperative psychologic distress did not influence 1-year postoperative pain assessment (average reduction in pain, 40.33; 95% CI, 36.9-43.8; p = 0.18). The only factor influencing change in pain experienced by patients was the preoperative pain recorded (R(2) = 0.31; β = -0.82; p0.001). The patients experiencing preoperative psychologic distress obtained poorer outcomes in function (R(2) = 0.16; β = -5.62; p = 0.001) and quality of life (R(2) = 0.09; β = -0.46; p0.001) 1 year after receiving TKA.The presence of preoperative psychologic distress is associated with worse 1-year outcomes for function and quality of life in patients undergoing TKA. Interventions designed to reduce psychologic distress may be indicated for patients to undergo this type of surgery, and incorporation of these data into discussions with patients may facilitate informed and shared decision making regarding the surgical treatment of knee osteoarthritis.Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Background Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. Methods And Findings We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Conclusions Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation.

Background The oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency. Methods/design The proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited. Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3–8,and 1 mg/month in weeks 9–52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses. Discussion The results of this study should help establish, taking quality of life into account, whether the oral administration of vitamin B12 is an effective alternative to its intramuscular administration. If this administration route is effective, it should provide a cheaper means of treating vitamin B12 deficiency while inducing fewer adverse effects. Having such an alternative would also allow patient preferences to be taken into consideration at the time of prescribing treatment. Trial registration This trial has been registered with ClinicalTrials.gov, number NCT 01476007, and under EUDRACT number 2010-024129-20.

espanolIntroduccion: El consumo excesivo de alcohol es un problema de salud publica, segun la OMS anualmente mueren 2,5 millones de personas por esta causa, el sector laboral no escapa a esta situacion, creando la necesidad detectar precozmente el consumo de alcohol en los trabajadores. Objetivos: Identificar los factores de riesgo para el consumo de alcohol en el medio laboral, y describir instrumentos utiles para el medico del trabajo, en el reconocimiento de trabajadores con problemas de abuso de alcohol. Metodo: Se consultaron distintas bases de datos PUBMED, CISDOC, SCIELO, LILACS, MEDLINE The cocrhane library. Se evaluaron resumenes y se recuperaron a texto completo aquellos relacionados con abuso de alcohol en poblacion trabajadora. Resultados: Se encontraron estudios epidemiologicos, de casos y controles, publicaciones de organismos oficiales y revistas de salud laboral. Estos evaluaron factores psicosociales y alcohol, algunos estudios usaron medidas de cribaje como cuestionarios AUDIT, CAGE y MALT para diagnosticar consumo perjudicial de alcohol. Conclusiones: Se identificaron factores de riesgo en la poblacion trabajadora, relacionados con el ambiente laboral, organizacion del trabajo, cualificacion profesional y factores individuales: edad, sexo, y nivel socio-cultural. El uso de cuestionarios para detectar consumo de alcohol fue considerado la mejor opcion, por facil aplicacion y bajo coste. Es necesario promover el uso de herramientas aplicables en el reconocimiento y prevencion del abuso de alcohol en la poblacion trabajadora. EnglishBackground: The alcohol abuse (AA) is a public health problem that causes 2.5 million deaths annually (WHO), the labor sector is not immune to this situation, creating the need for early detection of AA on workers. Objective: To identify risk factors and instruments for health surveillance of workers with AA problems. Methods: We reviewed the literature, PUBMED, CIS-DOC, SCIELO, LILACS, MEDLINE and the Cochrane Library. We included studies relating to AA in the working population, risk factors and consequences in the labor sector. They were classified according to level of evidence (Scottish Intercollegiate Guidelines Network, SIGN). Results: There were 75 articles, 31 met the criteria for inclusion: A 2+ evidence study. Fifteen evidence 3 and sixteen with evidence level 4. Alcohol was the most consumed psychoactive substance in the working population prevalence of 77.8% in men and 72.9% in women. It was considered a risk factor for the AA, nonqualified. Two studies with evidence level 4 reported the increased accident rates and absenteeism related to AA. The AA screening methods used were CAGE and AUDIT . Conclusions: The risk factors were identified in the working population, related to work organization, skill levels and individual factors. The use of CAGE and AUDIT for detection of AA was considered the best option for easy application and low cost. Insufficient documentation was found on the effects of AA, suggesting the promotion of study of these issues and assess the use of screening measures to enhance prevention.

espanolLa valoracion de la aptitud forma parte de la actividad diaria del medico del trabajo. La queja generalizada es que no hay criterios estandarizados para ello. Lo que si hay son “criterios de exclusion” utilizados en profesiones de gran responsabilidad, en las cuales un error provocaria consecuencias graves para el trabajador o para terceros. Estos criterios son requisitos minimos exigidos para la incorporacion a un puesto de trabajo pero, estan pensados desde un punto de vista de seleccion del personal mas que de salud laboral. Objetivos: Conocer la situacion actual en cuanto a la valoracion de la aptitud para trabajar y comparar criterios de aptitud con criterios de exclusion para puestos de trabajo concretos. Metodologia: La busqueda de las referencias bibliograficas se realizo mediante palabras clave y descriptores DeCS. Se recuperaron 1593 citas. Tras aplicar los criterios de exclusion y realizar un analisis de pertinencia, se pudo conseguir a texto completo23, encontrandose 7 articulos mas relacionados con el tema en la busqueda manual de la bibliografia. Resultados: Solo dos articulos tratan el tema de la aptitud a fondo. Los cuadros de exclusion medica se ocupan de practicamente todos los organos y aparatos y de la aptitud psiquica, mientras que los articulos revisados tratan unicamente de algunos de estos aspectos. Conclusiones: La tendencia de la mayoria de los autores es prescindir del examen medico pre-empleo siempre que no sea obligatorio, y mantener los examenes de salud periodicos. Las patologias hasta ahora mas estudiadas son la hipertension arterial y las deficiencias en la agudeza visual. Los profesionales en los cuales se vigila mas las capacidades psicofisicas son los conductores y los pilotos de aviacion. EnglishThe assessment of aptitude is part of the daily activity of occupational health doctors. The general complaint is that there is no standardized criteria to do so. What there exists is “exclusion criteria” used in professions of great responsibility, in which an error would cause serious consequences for the worker or others. These criteria are minimum requirements to carry out a job, but they are designed to select workers rather than for labor health purposes. Objectives: Determine the current situation regarding the assessment of aptitude for work and compare aptitude criteria with exclusion criteria for determined jobs. Methodology: The search for references was carried out using keywords and MeSH descriptors. 1593 citations were found. After applying the exclusion criteria and an analysis of relevance, we obtained23 full text citations, finding 7 more articles related to the topic in the manual search of the literature. Results: Only two articles deal with the issue of aptitude thoroughly. The tables of medical exclusion deal with every organ or system and with mental aptitude, while the articles reviewed deal with only some of these issues. Conclusions: The tendency of most authors is not to carry out pre-employment medical examinations unless it is mandatory, and maintain regular health examinations. The illnesses most studied so far are hypertension and poor visual acuity. Professionals in which psychophysical capabilities are thoroughly examined are drivers and aircraft pilots.

Artículos originales [ES ]Introducción: La lipoatrofia semicircular (LS) es un trastorno benigno del tejido subcutáneo, de causa desconocida. Se caracteriza por depresiones semicirculares en la cara anterolateral de los muslos, unilaterales o bilaterales. Se relaciona con condiciones ambientales laborales, microtraumas repetidos y factores personales. Se plateó esta revisión sistemática de la literatura científica para caracterizar el conocimiento existente. Métodos: Revisión sistemática. Bases de datos: IBECS, IBSST, LILACS, IME, OSH-UPDATE, ISI-WOK, PubMed, CIS-DOC y Cochrane. Se incluyeron los artículos sobre lipoatrofia semicircular relacionada con condiciones de trabajo y medioambientales. Se utilizaron los niveles de evidencia científica del Scottish Intercollegiate Guidelines Network. Resultados: Se recuperaron 66 artículos. Solo 22 cumplieron los criterios de inclusión: Quince con nivel de evidencia 3 y 7 con nivel 4. Siete estudios de series de casos y ocho de casos únicos, sumaron 838 casos, informados entre 1982-2010. Los principales factores de riesgo para LS son: Microtraumas repetidos, humedad relativa baja y electricidad en los edificios modernos de oficinas. Las depresiones semicirculares ocurren en la cara anterolateral de muslos, sin alteración de la piel, en mujeres (85%), sin signos inflamatorios con histopatología inespecífica. La resonancia magnética, radiología y los anticuerpos antinucleares son negativos. El diagnóstico es clínico, apoyado con ecografía. El tratamiento psicológico y fisioterapia pueden ser útiles. Las medidas preventivas de mayor impacto son controlar los factores mencionados. Conclusiones: Existe insuficiente evidencia científica sobre las causas de LS. Es un trastorno prevalente, que genera alarma, relacionado con las condiciones de trabajo. Es necesario continuar la investigación sobre agentes causales. [EN] Introduction: The semicircular lipoatrophy (LS) is a benign disorder of the subcutaneous tissue with unkvown cause. It is characterized by unilateral o bilateral semicircular depressions in the anterolateral side of the thighs. It is related to environmental labor conditions, repeated microtraumas and personal factors. We conducted this systematic review of the scientific literature to characterize the existing knowledge. Methods: Systematic Review. Databases: IBECS, IBSST, LILACS, IME, OSH-UPDATE, ISI-WOK, PubMed, CIS-DOC and Cochrane. We included articles about semicircular lipoatrophy related to working and environmental conditions. We used the levels of scientific evidence of the Scottish Intercollegiate Guidelines Network. Results: 66 articles were recovered. Only 22 fulfilled the inclusion criteria: Fifteen with evidence level 3 and 7 with evidence level 4. Seven studies were series of cases and 8 were unique case reports. All of them added 838 cases, informed between 1982-2010. The principal risk factors for LS are repetitive microtrauma, low relative humidity and electricity in modern office buildings. The semicircular depressions occur in the anterolateral side of thighs, without alteration of the skin and muscles, mostly in women (85%), without inflammatory signs and with unspecific histopathology. The magnetic resonance, x rays and the antinuclear antibodies are negative. The diagnosis is clinical, supported by ultrasonography. Psychological treatment and physical therapy can be useful. The preventive measures of greater impact are controlling risk factors. Conclusions: Insufficient scientific evidence exists about the causes of LS. It is a prevalent disorder that generates alarm, related to workplace conditions. It is necessary to continue investigating about causative agents. No

Genetic testing is increasingly applied for diagnosis and clinical treatment. In some countries, genetic counseling services are provided by professionals with specific training in this discipline, whereas other countries have no teaching programs and counseling is offered by physicians, nurses, pharmacists or biochemists. This counseling raises more and more ethical dilemmas for health professionals at their clinics. The purpose of this study was to analyze the characteristics of Spanish professionals devoted to providing genetic counseling services and to investigate the frequency of the ethical dilemmas they face. Results from 72 survey respondents revealed this counseling is provided by an almost even number of male and female professionals, mostly physicians with many years of professional experience. The overall frequency of the ethical dilemmas encountered was not high. The most frequent dilemmas corresponded to emotional responses by patients, informed consent, uncertainty about test results, and limitations on health-care resources. The frequency of dilemmas involving discrimination and provider directiveness was very low. Additional findings, practice implications, and research recommendations are presented.

Background High blood pressure (HBP) is a major risk factor for cardiovascular disease (CVD). European hypertension and cardiology societies as well as expert committees on CVD prevention recommend stratifying cardiovascular risk using the SCORE method, the modification of lifestyles to prevent CVD, and achieving good control over risk factors. The EDUCORE (Education and Coronary Risk Evaluation) project aims to determine whether the use of a cardiovascular risk visual learning method - the EDUCORE method - is more effective than normal clinical practice in improving the control of blood pressure within one year in patients with poorly controlled hypertension but no background of CVD; Methods/Design This work describes a protocol for a clinical trial, randomised by clusters and involving 22 primary healthcare clinics, to test the effectiveness of the EDUCORE method. The number of patients required was 736, all between 40 and 65 years of age (n = 368 in the EDUCORE and control groups), all of whom had been diagnosed with HBP at least one year ago, and all of whom had poorly controlled hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg). All personnel taking part were explained the trial and trained in its methodology. The EDUCORE method contemplates the visualisation of low risk SCORE scores using images embodying different stages of a high risk action, plus the receipt of a pamphlet explaining how to better maintain cardiac health. The main outcome variable was the control of blood pressure; secondary outcome variables included the SCORE score, therapeutic compliance, quality of life, and total cholesterol level. All outcome variables were measured at the beginning of the experimental period and again at 6 and 12 months. Information on sex, age, educational level, physical activity, body mass index, consumption of medications, change of treatment and blood analysis results was also recorded; Discussion The EDUCORE method could provide a simple, inexpensive means of improving blood pressure control, and perhaps other health problems, in the primary healthcare setting; Trial registration The trial was registered with ClinicalTrials.gov, number NCT01155973 [http://ClinicalTrials.gov].

Objective To describe the satisfaction and expectations of the patients with neck pain with relation to the physical therapy received and to analyse the relationship between the patient's characteristics and his degree of satisfaction and expectation. Design This study is performed in the setting of a random clinical trial. Participants Subjects between 18 and 60 years of age with subacute mechanical neck disorders. Main variables Patient's expectations and satisfaction with the received treatment (scale similar to Likert's Scale). Other variables Pain intensity, episodes of previous neck pain, depression and anxiety symptoms (Goldberg Scale), age and gender, physical disability, general state of health, duration of the present episode of neck pain, regular exercise and regular consumption of medicines. Results and conclusions A total of 90 patients were studied. The mean age was 40.1 years and 88.9% were female. Thirteen per cent of the subjects expected partial relief, 60% expected good recovery and 27% expected complete recovery. Those patients who have not suffered previous episodes of neck pain and those who have a higher score on the Goldberg Scale have a higher expectation of recovering after the treatment. About patients' satisfaction after the intervention, 2% totally unsatisfied, 1% very unsatisfied, 2% somewhat unsatisfied, 2% indifferent, 17% somewhat satisfied, 42% very satisfied and 30% totally satisfied. Those patients who experienced a greater decrease in pain were more satisfied. It would be interesting to study in depth the measurement of patients' satisfaction with the received physical therapy and to extend it to other pathologies.

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.

[ES] Trabajo de revisión que tienen como objetivo conocer el nivel de evidencia existente sobre los efectos extra-auditivos de la exposición profesional al ruido relacionados con: alteraciones bioquímicas, efectos neuro-piscológicos, salud reproductiva y accidentes de trabajo mediante el análisis sistemático de la producción científica publicada entre 1995 y 2008. La búsqueda de las referencias bibliográficas se realizó mediante términos "Major Topic"y "MeSH" para MEDLINE y términos "Decriptors" para OSH update. Se recuperaron un total de 370 referencias y se incluyeron en la revisión todos los estudios experimentales, estudios de cohortes y estudios casos control y aquellos estudios trasversales que cumplieron al menos con cinco de los nueve criterios que la declaración STROBE establece para los estudios observacionales. Fueron seleccionados para su revisión a texto completo un total de 35 artículos: 14 estudios experimentales, 2 estudios de cohortes, 6 estudios casos control, 12 estudios transversales y 1 estudio de validación. La asignación del nivel de evidencia se realizó de acuerdo a los criterios SIGN. La selección y revisión de los artículos se realizó mediante revisión por pares, los casos de discrepancia entre pares se resolvió mediante consenso. Encontramos un alto nivel de evidencia (1+) para influencia de la exposición profesional al ruido sobre el incremento de la secreción de cortisol y noradrenalina, fatiga y disminución del rendimiento, funciones cognitivas y memoria, disminución en la calidad del sueño, estrés e irritabilidad y percepción de malestar. Con un nivel de evidencia 2++ se relacionó la exposición profesional al ruido con la accidentalidad laboral. No encontramos unos resultados concluyentes para la determinación de la relación entre exposición profesional al ruido sobre la salud reproductiva. Existe una diversidad en los métodos utilizados para la evaluación de la exposición profesional al ruido, empleándose tanto métodos de medición cuantitativos y métodos cualitativos de percepción subjetiva. Nuestros resultados son coincidentes con las revisiones realizadas anteriormente por Smith AP y cols (1991) y Butler MP y cols (1999). Review aimed at ascertaining the level of evidence on non-auditory effects related with occupational exposure to noise concerning: biochemical, neuro- psychology effects, reproductive health and accidents at work through a systematic analysis of the scientific literature published between 1995 and 2008. The search for references was conducted using terms "Major Topic" and "MeSH" terms for MEDLINE and "Decriptors" for OSH update. We retrieved a total of 370 references, were included in the review all experimental studies, cohort studies and case control studies and those cross-sectional studies that had at least five of the nine criteria that the STROBE Statement provides for observational studies. Were selected for full text review a total of 35 studies: 14 experimental studies, 2 cohort studies, 6 case control studies, 12 cross-sectional studies and 1 validation study. The assignment of the level of evidence was performed according to SIGN criteria. The selection and review of articles was done by peer review, cases of disagreement between pairs was resolved by consensus. We found a high level of evidence (1+) about the influence of occupational noise exposure and the increased secretion of cortisol and norepinephrine, fatigue and decreased performance, cognitive function and memory, decreased quality of sleep, stress and irritability annoyance. A level of evidence 2++ was identify for occupational noise exposure and work accidents. We found no conclusive results in determine the relationship between occupational exposure to noise on reproductive health. There is diversity in the methods used for assessing occupational exposure to noise, using both quantitative measurement methods and qualitative methods of subjective perception. Our results are consistent with those previously reported by Smith AP et alt (1991) and Butler MP et al (1999). [EN] Review aimed at ascertaining the level of evidence on non-auditory effects related with occupational exposure to noise concerning: biochemical, neuro- psychology effects, reproductive health and accidents at work through a systematic analysis of the scientific literature published between 1995 and 2008. The search for references was conducted using terms “Major Topic” and “MeSH” terms for MEDLINE and “Decriptors” for OSH update. We retrieved a total of 370 references, were included in the review all experimental studies, cohort studies and case control studies and those cross-sectional studies that had at least five of the nine criteria that the STROBE Statement provides for observational studies. Were selected for full text review a total of 35 studies: 14 experimental studies, 2 cohort studies, 6 case control studies, 12 cross-sectional studies and 1 validation study. The assignment of the level of evidence was performed according to SIGN criteria. The selection and review of articles was done by peer review, cases of disagreement between pairs was resolved by consensus. We found a high level of evidence (1+) about the influence of occupational noise exposure and the increased secretion of cortisol and norepinephrine, fatigue and decreased performance, cognitive function memory, decreased quality of sleep, stress and irritability annoyance. A level of evidence 2++ was identify for occupational noise exposure and work accidents. We found no conclusive results in determine the relationship between occupational exposure to noise on reproductive health. There is diversity in the methods used for assessing occupational exposure to noise, using both quantitative measurement methods and qualitative methods of subjective perception. Our results are consistent with those previously reported by Smith AP et alt (1991) and Butler MP et al (1999). Sí

[ES] Trabajo de revisión que tiene como objetivo conocer el nivel de evidencia existente sobre los efectos cardiovasculares debidos a la exposición profesional al ruido, mediante el análisis sistemático de la producción científica publicada entre 1995 y 2008. La búsqueda de las referencias bibliográficas se realizó mediante términos "Major Topic" y "MeSH" para MEDLINE y términos "Decriptors" para OSH update. Se recuperaron un total de 236 referencias y se incluyeron en la revisión todos los estudios experimentales, estudios de cohortes y estudios casos control y aquellos estudios trasversales que cumplieron, al menos, con cinco de los nueve criterios que la declaración STROBE establece para los estudios observacionales. Fueron seleccionados para su revisión a texto completo un total de 23 artículos: 12 estudios transversales, 7 estudios de cohortes, dos estudios casos control, 1 meta-análisis y 1 estudio experimental. La asignación del nivel de evidencia se realizó de acuerdo a los criterios SIGN. La selección y revisión de los artículos se realizó mediante revisión por pares, los casos de discrepancia entre pares se resolvió mediante consenso. En relación con los efectos cardiovasculares de la exposición laboral a ruido, nuestra revisión encuentra un mayor nivel de evidencia (1++) para el incremento de la tensión arterial e incremento de la frecuencia cardiaca. Estudios con nivel de evidencia 2++ muestran resultados en esa misma dirección. La enfermedad isquémica, infarto agudo de miocardio y coronariopatía muestran un nivel de evidencia 2++. La alteraciones metabólicas de lípidos y alteraciones de parámetros vasculares disponen de un nivel bajo de evidencia3. El control del ruido en entornos laborales es un factor de prevención del riesgo cardio-vascular. HTA, riesgo coronario y otras enfermedades cardiovasculares deben considerarse en los protocolos de vigilancia médica específica de los trabajadores expuestos a ruido. Review aimed to identify the level of scientific evidence about the relationship between cardiovascular diseases and occupational noise exposure, by a systematic analysis of the scientific literature published between 1995 and 2008. "Major Topic" and "MeSH" terms for MEDLINE and "Decriptors" for OSH update was used for the search of references. We retrieved a total of 236 references. Experimental studies, cohort studies and case control studies were all included in the review and those cross-sectional studies with at least five of the nine criteria from the STROBE declaration provides for observational studies. 23 articles were selected for full text review: 12 cross-sectional studies, 7 cohort studies, two case control studies, 1 meta-analysis and 1 experimental study. The evidence level was performed according to SIGN criteria. The selection and review of articles was done by peer review, cases of disagreement between pairs was resolved by consensus. Our review found a higher level of evidence (1++) for increasing blood pressure and increased heart rate and occupational noise exposure. Studies with a level of evidence 2++ show results in the same direction. Ischemic heart disease, myocardial infarction and coronary diseases show a level of evidence 2++. Metabolic changes of lipid parameters and vascular abnormalities have a low level of evidence3. Noise control in working environments is a measure for cardiovascular risk prevention. Hypertension, coronary risk and other cardiovascular diseases should be considered in medical surveillance practice of workers exposed to noise.[EN] Review aimed to identify the level of scientific evidence about the relationship between cardiovascular diseases and occupational noise exposure, by a systematic analysis of the scientific literature published between 1995 and 2008. “Major Topic” and “MeSH” terms for MEDLINE and “Decriptors” for OSH update was used for the search of references. We retrieved a total of 236 references. Experimental studies, cohort studies and case control studies were all included in the review and those cross-sectional studies with at least five of the nine criteria from the STROBE declaration provides for observational studies. 23 articles were selected for full text review: 12 cross-sectional studies, 7 cohort studies, two case control studies, 1 meta-analysis and 1 experimental study. The evidence level was performed according to SIGN criteria. The selection and review of articles was done by peer review, cases of disagreement between pairs was resolved by consensus. Our review found a higher level of evidence (1++) for increasing blood pressure and increased heart rate and occupational noise exposure. Studies with a level of evidence 2++ show results in the same direction. Ischemic heart disease, myocardial infarction and coronary diseases show a level of evidence 2++. Metabolic changes of lipid parameters and vascular abnormalities have a low level of evidence 3. Noise control in working environments is a measure for cardiovascular risk prevention. Hypertension, coronary risk and other cardiovascular diseases should be considered in medical surveillance practice of workers exposed to noise. Sí

ObjetivoComparar la efectividad de la terapia manual frente a electroestimulación nerviosa transcutánea en la disminución de la intensidad del dolor en pacientes con cervicalgia mecánica subaguda o crónica atendidos en unidades de fisioterapia de atención primaria (UFAP).DiseñoEnsayo clínico aleatorio.EmplazamientoSe incluyeron 13 UFAP de 4 áreas de salud de la Comunidad de Madrid.ParticipantesFormaron parte del estudio 90 pacientes atendidos con cervicalgia mecánica subaguda o crónica. Se produjeron 3 pérdidas tras la intervención.IntervencionesSe asignaron aleatoriamente 47 pacientes al tratamiento con terapia manual y 43 a recibir electroestimulación nerviosa transcutánea.Mediciones principalesSe midieron las características sociodemográficas y las variables pronóstico por grupo de intervención, así como la intensidad del dolor antes y después de la intervención con la media de los valores de la escala analógica visual (momento presente, promedio y peor dolor de las últimas 2 semanas) y los efectos adversos.ResultadosLa diferencia en la intensidad del dolor antes-después fue de 21,83 mm (intervalo de confianza [IC] del 95%, 13,71-29,95) para el grupo tratado con electroestimulación nerviosa transcutánea y de 22,87 mm (IC del 95%, 17,11-28,64) para la terapia manual. La diferencia de medias comparando la mejoría obtenida con uno y otro procedimiento fue de 1,04 (IC del 95%, de −8,66 a 10,75).ConclusionesSe ha observado una reducción en la intensidad del dolor percibida por los pacientes, si bien no se encontraron diferencias entre ambos tratamientos (electroestimulación nerviosa transcutánea y terapia manual). Este estudio no permite establecer la alternativa de tratamientos fisioterapéuticos en la cervicalgia mecánica atendida en atención primaria.ObjectiveTo compare the effectiveness of manual therapy (MT) versus transcutaneous electrical nervous stimulation (TENS) in reducing the intensity of pain in patients with subacute or chronic neck pain (NP) attended at primary care physiotherapy units (PCPU).DesignRandomised clinical trial.SettingThirteen PCPU in 4 health districts of the Community of Madrid, Spain.ParticipantsNinety patients with subacute or chronic NP attended. Lost after intervention:3.InterventionsAt random, 47 patients were allocated to MT treatment and 43 to TENS.Main measurementsSocial and demographic characteristics and prognosis variables in the intervention groups were measured. Intensity of pain before and after intervention was calculated by mean values on the analogue visual scale (present moment, average and worst pain of the last 2 weeks). Side-effects were also measured.ResultsDifference between before-and-after pain was 21.83 mm (95% CI, 13.71-29.95) for the group treated with Transcutaneous electrical nervous stimulation and 22.87 mm (95% CI, 17.11-28.64) for manual therapy. The difference in averages on comparing the 2 procedures for improvement was 1.04 (95% CI,−8.66% to 10.75%).ConclusionsTENS and MT significantly reduce patients’ perceived intensity of pain, although there were no differences between the 2 groups. There are no conclusive results for the alternative physiotherapy treatments that determine a clear strategy of intervention.

El Objetivo principal de la "Encuesta de Salud y Condiciones de Trabajo en el Transporte de Mercancías por Carretera" es obtener información sobre las condiciones de trabajo, problemática, riesgos y daños para la salud de los trabajadores del sector de transporte de mercancías por carretera con el objeto de identificar las oportunidades de mejora y progreso del sector en materia de salud y condiciones de trabajo.

Background The aim of this work was to analyze the number and distribution of circulating monocytes, and of their CD14+highCD16−, CD14+highCD16+ and CD14+lowCD16+ subset cells, in treatment-naive patients with rheumatoid arthritis (RA), and to determine their value in predicting the clinical response to methotrexate (MTX) treatment. Methods This prospective work investigated the number of circulating monocytes, and the numbers of CD14+highCD16−, CD14+highCD16+ and CD14+lowCD16+ subset cells, in 52 untreated patients with RA before MTX treatment, and at 3 and 6 months into treatment, using flow cytometry. Results The absolute number of circulating monocytes, and the numbers of CD14+highCD16−, CD14+highCD16+ and CD14+lowCD16+ subset cells, were significantly higher in MTX non-responders than in responders and healthy controls before starting and throughout treatment. Responders showed normal numbers of monocytes, and of their subset cells, over the study period. The pre-treatment absolute number of circulating monocytes, and the numbers of CD14+highCD16− and CD14+highCD16+ subset cells, were found to be predictive of the clinical response to MTX, with a sensitivity and specificity of >70% and >88%, respectively. Conclusions Treatment-naive patients with RA showed an anomalous distribution of circulating monocyte subsets, and an anomalous number of cells in each subset. A higher pre-treatment number of circulating monocytes, and higher numbers of CD14+highCD16− and CD14+highCD16+ subset cells, predict a reduced clinical response to MTX in untreated patients with RA. Electronic supplementary material The online version of this article (doi:10.1186/s12967-014-0375-y) contains supplementary material, which is available to authorized users.