Effects of cigarette smoking and nicotine metabolite ratio on leukocyte telomere length

Studies of the effects of smoking on leukocyte telomere length (LTL) using cigarettes smoked per day or pack years smoked (PYS) present limitations. Reported high levels of smoking may not increase toxin exposure levels proportionally. Nicotine metabolism ratio (NMR) predicts total cigarette puff volume and overall exposure based on total N-nitrosamines, is highly reproducible and independent of time since the last cigarette. We hypothesized that smokers with higher NMRs will exhibit increased total puff volume, reflecting efforts to extract more nicotine from their cigarettes and increasing toxin exposure. In addition, higher levels of smoking could cause a gross damage in LTL. The urinary cotinine, 3-OH cotinine and nicotine levels of 147 smokers were analyzed using a LC/MS system Triple-Q6410. LTL and CYP2A6 genotype was determined by PCR in blood samples. We found a significant association between NMR and CYP2A6 genotype. Reduction in LTL was seen in relation to accumulated tobacco consumption and years smoking when we adjusted for age and gender. However, there were no significant differences between NMR values and LTL. In our study the higher exposure was associated with lower number of PYS. Smokers with reduced cigarette consumption may exhibit compensatory smoking behavior that results in no reduced tobacco toxin exposure. Our results suggest that lifetime accumulated smoking exposure could cause a gross damage in LTL rather than NMR or PYS. Nevertheless, a combination of smoking topography (NMR) and consumption (PYS) measures may provide useful information about smoking effects on health outcomes.

A Paradox: α-Klotho Levels and Smoking Intensity

Reports regarding smoking differences in α-klotho expression have provided conflicting results. In the current study we focused on the influence of smoking intensity to serum levels of the aging molecule α-klotho in healthy smokers. 40 middle aged healthy smokers without airway obstruction or restriction were selected for the analysis. Serum levels of soluble α-klotho were significantly higher in heavy smokers (P < 0.001). These results are in agreement with the possibility that α-klotho acts as anti-inflammatory molecule and strengthen the hypothesis that an increase of serum levels of α-klotho might be a compensatory response to smoking stress in healthy population.

Case-control study of semicircular lipoatrophy, a new occupational disease in office workers

OBJECTIVES

Semicircular lipoatrophy (SL) is an emerging occupational pathology. Its etiology is poorly understood. We intend to establish the probable risk factors and estimate the relative risk.

METHODS

A case-control study was performed. Our company had 55 diagnosed cases. As controls, we used the 3 closest healthy coworkers to each case. We calculated the chi square, odds ratio and logistic regression for different exposures, during the 3 years from September 2007 to August 2010.

RESULTS

There was 100% participation for the cases and 70.9% for the controls (ratio 1 : 2.1 case-control). The only risk variables found were female gender (p<0.02) and exposure to leaning on the edge of a table (p<0.01). In addition, a breakdown by sex objectifies a much stronger association with leaning on the edge of a table in women (p<0.01) than men (p 0.67).

CONCLUSIONS

Female gender and leaning on the edge of a table (repeated microtrauma), especially in women, are risk factors for development of SL. Other variables seem to be confounding factors associated with female gender. There were no SL cases showing statistically significant relations with history of cancer or autoimmune diseases. There was also no significance with regard to wearing jeans. There is therefore a new risk for office staff in addition to the more traditional disorders (musculoskeletal, ocular, and psychosocial). Further studies are necessary to evaluate what we consider an underdiagnosed condition, since there is a large percentage of people that are potentially exposed and we found very little information in the literature on the matter.

Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC

Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).

Improving cardiovascular health in Spanish seafarers

BACKGROUND AND AIM

There is a high prevalence in the Spanish general population of some cardiovascular risk factors like overweight, obesity and hypercholesterolaemia. But there is lack of research on Spanish seafarers. On the other hand, there is strong evidence of the cardiovascular risk predictive value of some biomarkers. The purpose of this work was to study the convenience of the introduction of detailed diet questionnaires and the measurement of some biomarkers in the pre-embarkation medical examination.

MATERIALS AND METHODS

Seafarers undergoing medical checkup during 2011 in Madrid, Spain (n = 334). Overweight and obese subjects received general advice on healthy diet and physical activity. Seventy-four of them were followed up in 2012 and 2013. Glycated haemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), thyrotropin (TSH) and microalbuminuria were measured in two selected groups of patients in 2011.

RESULTS

Overweight and obesity were present in 207 (62%) individuals of the studied population. Those followed up in 2012 and 2013 showed a reduction of body mass index, waist circumference and total cholesterol values. We observed risk value of HbA1c in 60 (35.5%) individuals with significant association to other cardiovascular risk factors. Microalbuminuria appeared in subjects with high blood pressure. High TSH and hs-CRP were not significantly present in our population.

CONCLUSIONS

1. Measurement of HbA1c during medical checkups improves early detection of cardiovascular risk in seafarers. 2. Individuals with overweight and obesity responded positively to medical advice and diminished their risk factors, thus it may be more effective to introduce detailed questionnaires on this issue.

The Effect of Polymorphisms in DNA Repair Genes and Carcinogen Metabolizers on Leukocyte Telomere Length: A Cohort of Healthy Spanish Smokers

INTRODUCTION

Smoking implies exposure to carcinogenic agents that causes DNA damage, which could be suspected to enhance telomere attrition. To protect and deal with DNA damage, cells possess mechanisms that repair and neutralize harmful substances. Polymorphisms altering DNA repair capacity or carcinogen metabolism may lead to synergistic effects with tobacco carcinogen-induced shorter telomere length independently of cancer interaction. The aim of this study was to explore the association between leukocyte telomere length (LTL) and several genetic polymorphisms in DNA repair genes and carcinogen metabolizers in a cohort of healthy smokers.

METHODS

We evaluated the effect of six genetic polymorphisms in cytochrome P1A1 (Ile462Val), XRCC1 (Arg399Gln), APEX1 (Asp148Glu), XRCC3 (Thr241Met), and XPD (Asp312Asn; Lys751Gln) on LTL in a cohort of 145 healthy smokers in addition to smoking habits.

RESULTS

Logistic regression analysis showed an association between XRCC1 399Gln allele and shorter telomere length (OR = 5.03, 95% CI = 1.08% to 23.36%). There were not association between the rest of polymorphisms analyzed and LTL.

CONCLUSIONS

Continuous exposure to tobacco could overwhelm the DNA repair machinery, making the effect of the polymorphisms that reduce repair capacity more pronounced. Analyzing the function of smoking-induced DNA-repair genes and LTL is an important goal in order to identify therapeutic targets to treat smoking-induced diseases.

[Occupational semicircular lipoatrophy associated with serum adipokine abnormalities]

OBJECTIVES

The aim of this study was to examine the relationship between semicircular lipoatrophy (SL), inflammation marker (high sensibility C-reactive protein [hs-CRP]), adipokines (leptine, chemerine and vaspine) and autoimmune markers (rheumatoid factor [RF], C3 and C4 complement fractions, antinuclear antibodies [ANA], HLA DR3, and DR4). Chemerine is an adipokine, but also is an immunity marker.

METHODS

A case-control study was performed in May 2013; 21 cases were included. The closest healthy coworker to each case was used as a control. We calculated Kruskal-Wallis nonparametric test.

RESULTS

We found statistical significance (P<.05) between SL and raised hs-CRP, raised leptine and low chemerine.

CONCLUSIONS

i) There seems to be an underlying inflammatory component (raised hs-CRP) in SL; ii) adipokine alteration (raised leptine and low chemerine) supports the idea that adipocytic differentiation is affected in SL, and iii) we have not found any immune marker associated with SL, except chemerine itself, which could explain a possible association between SL and immunity.

[Anorexia nervosa in a worker: a case report]

We describe the management of a case of anorexia nervosa (body mass index, -BMI-, 13,6 Kg/m2) in a bank teller. The case was detected through routine occupational health surveillance. After being evaluated by different specialists (general practitioner, psychiatrist and endocrinologist) and being closely monitored (by psychology, nursing, and occupational medicine), the worker regained weight to a near normal BMI (17 Kg/m2) in less than a year and a half. Eating disorders are a common pathology (non-occupationally related), but their high prevalence (5% of the population over a lifetime) and social and job-related impact (affecting more than 20% of cases), make them a necessary focus of attention for health promotion in the workplace. Health prevention, promotion and surveillance may be also reinforced at the workplace.

[Four year follow-up of a screening program for prostate cancer in workers]

OBJECTIVES

To analyze our four-year follow-up experience (2008-2011) with a prostate cancer screening program offered to employees of a banking company.

METHODS

Data were obtained from the health examinations carried out by the bank's in-house occupational health service (with centers in Barcelona, Madrid and Valencia). PSA (prostate-specific antigen) blood levels were measured and cases with high levels (>4 ng/ml) were followed through diagnosis and treatment, including a telephone survey of confirmed cases. Personal and occupational characteristics of the participants were analyzed as well.

RESULTS

750 workers (99% with administrative and/or commercial jobs) met the inclusion criteria for the screening program. Of these, 110 had elevated PSA levels on at least one occasion. The diagnosis of prostate cancer was confirmed in 21 cases. There were no associations between a diagnosis of cancer and the remaining analyzed variables. Urology and pathology records were retrieved for 76% of the contacted cases. The most frequent histological type was adenocarcinoma (98%), the most common Gleason grade at diagnosis was 6-7% (88%), and the majority of cases were treated surgically (90%).With respect to adverse effects, 48% of cases described erectile dysfunction and 33% reported urinary incontinence.

CONCLUSIONS

In our program the observed prevalence of prostate cancer was above that expected (respectively, 21 confirmed cases vs. 12 expected). The identified cases unanimously expressed their support for the screening program.

[Work-related motor vehicle injuries among workers at a banking institution (2007-2013)]

OBJECTIVE

To study physical harm caused by road accidents (LATT in Spanish) among employees of a Spanish financial institution from 2007 to 2013. Additionally, we tried to define damage features in each sex and at different ages in hurt patients, as well as work disability caused by this type of injury.

METHODS

Cross-sectional study of labor injuries verified by the occupational medical service of the bank. Absolute (n) and relative (%) frequencies related to interesting variables were described. Chi-square test was used to assess correlation.

RESULTS

Along the mentioned period of time, 1.517 traumatic occupational injuries were recorded on a population of 14.541 workers. 27% of them were LATT. 1,3% of these were fatal or seriously harmful, significantly associated to sex and age (p < 0,05). Co-driver damage, LATT in itinere and twist or sprain were more common in women. LATT at work and closed fractures were more frequent in men.Work disability caused by LATT was higher than other traumatic occupational injuries.

CONCLUSIONS

LATT in the studied sample were almost three times higher than LATT are among general Spanish population, but serious lesions in our group were less common.We observed differences in LATT distribution by sexes and ages in workers included in this study, and also a higher incidence of work disability compared to the whole traumatic occupational injuries. Public health and occupational health authorities must find efficient strategies in order to diminish the incidence of these LATT-associated injuries.

Teleworking for Medical Reasons: Evidence From a Spanish Multinational Company

OBJECTIVES

The aim of the study is to describe the most common medical grounds for requesting or extending teleworking and to examine which requests are typically approved. This study also investigates whether there is a correlation with gender, age, or job location.

METHODS

A prevalence study of 33,190 Spanish employees found that, last year, 106 teleworking requests were addressed exclusively for medical reasons.

RESULTS

The most frequent cause was musculoskeletal issues (30%). Of all the requests, 58% were denied; 33% were temporarily approved, primarily for musculoskeletal reasons ( P < 0.05); and 8% were indefinitely approved. Requests were predominantly made by women ( P < 0.05). Indefinite approvals were more prevalent among male employees ( P < 0.05).

CONCLUSIONS

Musculoskeletal reasons were the primary cause for teleworking applications and for the temporary granting of teleworking. Teleworking appears to be associated with gender and job location.

Successful pandemic management through computer science: a case study of a financial corporation with workers on premises

Background

In November 2019, an infectious agent that caused a severe acute respiratory illness was first detected in China. Its rapid spread resulted in a global lockdown with negative economic impacts. In this regard, we expose the solutions proposed by a multinational financial institution that maintained their workers on premises, so this methodology can be applied to possible future health crisis.

Objectives

To ensure a secure workplace for the personnel on premises employing biomedical prevention measures and computational tools.

Methods

Professionals were subjected to recurrent COVID-19 diagnostic tests during the pandemic. The sanitary team implemented an individual following to all personnel and introduced the information in databases. The data collected were used for clustering algorithms, decision trees, and networking diagrams to predict outbreaks in the workplace. Individualized control panels assisted the decision-making process to increase, maintain, or relax restrictive measures.

Results

55,789 diagnostic tests were performed. A positive correlation was observed between the cumulative incidence reported by Madrid's Ministry of Health and the headcount. No correlation was observed for occupational infections, representing 1.9% of the total positives. An overall 1.7% of the cases continued testing positive for COVID-19 after 14 days of quarantine.

Conclusion

Based on a combined approach of medical and computational science tools, we propose a management model that can be extended to other industries that can be applied to possible future health crises. This work shows that this model resulted in a safe workplace with a low probability of infection among workers during the pandemic.

Occupational injuries in workers of a Spanish bank

BACKGROUND

In 2017, 69 108 work-related traffic injuries with medical leave were documented, constituting 12% of all occupational injuries (OI) in Spain.

AIMS

The aim of this study was to describe OI within a Spanish bank company during 2017.

METHODS

A cross-sectional analysis was conducted using the company's mandatory OI records, presenting data in both absolute (n) and relative (%) frequencies. The chi-square test was employed for comparisons.

RESULTS

Among the company's 10 399 employees, 176 OI cases were recorded. Most were minor musculoskeletal incidents, with one severe myocardial infarction and one mild anxiety episode. Lower limb injuries were the most prevalent. Injuries of the trunk (P < 0.001), neck (P < 0.05), and upper limbs (P < 0.001) were linked to workplace factors. Approximately 62% of OI occurred outside the workplace and resulted in more extended medical leave (P < 0.01). Traffic-related injuries accounted for 39% of OI cases and caused 49% of days lost due to OI (P < 0.001).Female gender (P < 0.001) and age over 40 years (P < 0.05) were significantly associated with OI.

CONCLUSIONS

In our study, musculoskeletal injuries were the most common, with a single cardiovascular event being the most severe. OI occurring outside the workplace was more frequent and led to longer medical leaves. Notably, traffic-related injuries were especially significant, exceeding official statistics 4-fold.

Effectiveness of a workplace health promotion program in reducing obesity: A retrospective study

OBJECTIVE

This retrospective study aimed to evaluate the effectiveness of a workplace health promotion program targeting obesity.

METHODS

Weight loss, body mass index (BMI), and abdominal circumference were measured before and after the program during medical check-ups at a single workplace.36 employees (BMI ≥30 kg/m2) received six months of free telemedicine endocrinology consultations. This metrics were compared with 164 workers (BMI ≥ 30 kg/m2) using the t-Student test and Odds Ratio.

RESULTS

Participants lost more weight (1.98 kg on average vs. 0.11 kg), OR: 1.5 (0.72-3.12), BMI (0.84 kg/m2 vs. 0.03 kg/m2), OR: 2.16 (0.99-4.68), and abdominal circumference (1.06 cm vs. 0.55 cm), OR: 1.07 (0.51-2.25) than non-participants.

CONCLUSIONS

The program was slightly more effective than standard verbal and written medical advice given during check-ups. Studies with bigger sample sizes are needed to support these findings.

Association Between the "COVID-19 Occupational Vulnerability Index" and COVID-19 Severity and Sequelae Among Hospital Employees

OBJECTIVES

In addition to personal and health related factors, healthcare workers have an increased risk due to their work. We assessed the association of the score of the Occupational Vulnerability Index with the risk of suffering a severe COVID-19 and sequelae.

METHODS

Retrospective observational study carried out in healthcare workers. Among 119 employees infected, the COVID-19 Occupational Vulnerability Index (composed of 29 items regarding personal health, working conditions, and ability to comply with preventive measures) was calculated and correlated with COVID-19 severity/sequelae.

RESULTS

Workers with higher scores (six to seven points) had a significantly increased risk of developing severe disease (OR = 9.73; 95% CI, 1.53 to 35.56) and clinical sequelae (OR = 5.22; 95% CI, 1.80 to 15.16) than those with lower scores (0 to 3).

CONCLUSION

The "COVID-19 Occupational Vulnerability Index" may predict the risk of severe COVID-19 disease and clinical sequelae among healthcare workers.