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El efecto que puedan ejercer determinadas exposiciones ocupacionales sobre el sistema respiratorio<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleHsp" style=""></span>ha sido estudiado en relaci&#243;n con determinadas enfermedades&#44; como bronquitis&#44; EPOC&#44; bronquiolitis&#44; asma o c&#225;ncer de pulm&#243;n&#46; Sin embargo&#44; no conocemos ning&#250;n trabajo que haya estudiado si la exposici&#243;n a dichas sustancias puede favorecer la aparici&#243;n de NAC&#46; El objetivo del presente estudio es conocer si determinadas profesiones o condiciones laborales son factores de riesgo de NAC en la poblaci&#243;n general adulta&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">El estudio PACAP &#40;estudio de los factores de riesgo de la neumon&#237;a adquirida en la comunidad&#41; es un estudio de casos y controles de base poblacional dise&#241;ado para estudiar factores de riesgo de NAC&#44; con una base poblacional de 859&#46;033 habitantes mayores de 14 a&#241;os&#44; adscritos a 64 centros de atenci&#243;n primaria de una extensa zona rural y urbana de la zona este de Espa&#241;a&#46; Detalles de la metodolog&#237;a de este estudio han sido previamente publicados<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se consider&#243; sospecha cl&#237;nica de NAC a toda infecci&#243;n del tracto respiratorio inferior que requer&#237;a tratamiento antibi&#243;tico y que se acompa&#241;aba de signos focales nuevos o previamente desconocidos en la exploraci&#243;n f&#237;sica y en la radiograf&#237;a de t&#243;rax<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; Todas las sospechas de NAC fueron reevaluadas peri&#243;dicamente seg&#250;n evoluci&#243;n cl&#237;nica con una radiograf&#237;a de t&#243;rax hasta la curaci&#243;n completa&#46; Se excluyeron del estudio aquellas sospechas de NAC en las que el seguimiento evolutivo confirm&#243; otra enfermedad respiratoria no infecciosa&#44; as&#237; como a los pacientes con diagn&#243;stico de tuberculosis activa&#44; sospecha de neumon&#237;a por broncoaspiraci&#243;n&#44; neumon&#237;as adquiridas en residencias asistidas y neumon&#237;as con inicio de los s&#237;ntomas antes de los 7 d&#237;as de haber sido dado de alta de un hospital&#46; Para garantizar la exhaustividad de la identificaci&#243;n de casos de NAC&#44; se estableci&#243; un sistema de vigilancia activa en los centros de atenci&#243;n primaria y hospitalaria&#44; tanto p&#250;blicos como privados&#44; del &#225;rea de estudio&#44; as&#237; como en los centros hospitalarios de referencia de fuera de dicha &#225;rea&#46; Los individuos del grupo control fueron seleccionados aleatoriamente a partir de la base de datos de los centros de atenci&#243;n primaria de donde proced&#237;an los casos y fueron apareados con estos por edad &#40;&#177; 5 a&#241;os&#41; y sexo&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se administr&#243; un cuestionario sobre factores de riesgo de NAC en el domicilio de la persona seleccionada&#46; Cuando esta no pod&#237;a contestar directamente&#44; por discapacidad mental&#44; enfermedad o muerte &#40;si era un paciente con NAC&#41;&#44; se administr&#243; al cuidador o familiar m&#225;s pr&#243;ximo&#46; Los entrevistadores eran m&#233;dicos o enfermeras formados en t&#233;cnicas de entrevista y en la administraci&#243;n del cuestionario del estudio&#46; Las preguntas se estructuraron en 3 cap&#237;tulos&#58; <span class="elsevierStyleItalic">a&#41;</span> h&#225;bitos y estilos de vida&#59; <span class="elsevierStyleItalic">b&#41;</span> enfermedades respiratorias cr&#243;nicas y otras condiciones cl&#237;nicas&#44; y <span class="elsevierStyleItalic">c&#41;</span> tratamientos habituales durante el &#250;ltimo a&#241;o&#46; Se registr&#243; informaci&#243;n sobre la profesi&#243;n actual&#44; contactos con sustancias presumiblemente t&#243;xicas &#40;en alg&#250;n momento de su vida laboral o en el &#250;ltimo mes&#41;&#44; como humos&#44; gases&#44; vapores&#44; polvo&#44; fibras org&#225;nicas o inorg&#225;nicas y contacto con animales&#46; Tambi&#233;n se registraron los cambios bruscos de temperatura relacionados con el trabajo en los &#250;ltimos 3 meses&#44; como entradas en c&#225;maras frigor&#237;ficas o trabajos en cocinas u hornos &#40;v&#233;anse las variables consideradas en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Todos los sujetos seleccionados otorgaron el consentimiento informado para participar en el estudio&#44; el cual fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n Cl&#237;nica del Consorci Sanitari del Maresme&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Se compararon la distribuci&#243;n de las profesiones y la exposici&#243;n a los distintos factores de estudio entre casos y controles mediante el test de la chi al cuadrado &#40;o el test exacto de Fisher&#44; si proced&#237;a&#41;&#46; Se compararon las medias de a&#241;os trabajados en las distintas condiciones consideradas&#44; mediante el test U de Mann-Whitney&#46; Para evaluar el efecto de los factores de estudio sobre la NAC&#44; se estim&#243; la OR mediante regresi&#243;n log&#237;stica&#46; Se realiz&#243; un an&#225;lisis bivariado y distintos modelos multivariados &#40;uno para cada una de las siguientes profesiones&#58; administrativos&#44; construcci&#243;n&#44; industriales&#44; maestros y agricultores o granjeros&#41; para ajustar el efecto de dichas profesiones por el de las condiciones de trabajo y otros factores de riesgo de NAC conocidos como asma&#44; broncopat&#237;a cr&#243;nica &#40;incluye bronquitis cr&#243;nica y EPOC&#41; y consumo de tabaco&#46; Se consider&#243; el nivel de significaci&#243;n estad&#237;stica en una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se reclut&#243; a 1&#46;336 casos confirmados de NAC y 1&#46;326 controles&#46; Un 52&#44;7&#37; de los casos de NAC fueron hombres&#44; con una edad media &#177; desviaci&#243;n est&#225;ndar&#41; de 58&#44;6 &#177; 19&#44;8 a&#241;os&#44; y un 47&#44;3&#37; eran mujeres&#44; con una edad media de 54&#44;6 &#177; 20&#44;7 a&#241;os&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se comparan las profesiones y las condiciones de trabajo entre casos y controles&#46; En ella se destaca que trabajar como administrativo es un factor protector de NAC &#40;OR &#61; 0&#44;75&#41;&#44; mientras que trabajar en la construcci&#243;n es un factor de riesgo &#40;OR &#61; 1&#44;60&#41;&#44; sin que se observe ninguna asociaci&#243;n estad&#237;sticamente significativa en ninguna de las otras profesiones consideradas&#46; En relaci&#243;n con las condiciones laborales&#44; se observa un efecto significativo del contacto con polvo en el &#250;ltimo mes &#40;OR &#61; 1&#44;66&#41;&#44; as&#237; como contacto con animales&#44; excrementos o v&#237;sceras tambi&#233;n durante el &#250;ltimo mes &#40;OR &#61; 1&#44;78&#41; o existencia de cambios bruscos de temperatura en los &#250;ltimos 3 meses &#40;OR &#61; 3&#44;28&#41;&#46; Por otro lado&#44; no se hall&#243; ninguna diferencia estad&#237;sticamente significativa al relacionar el n&#250;mero de a&#241;os trabajados en estas condiciones con la aparici&#243;n de NAC&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se presentan los resultados de los modelos multivariantes en los que se observa que el efecto de las profesiones desaparece cuando se ajusta por las condiciones laborales&#44; el consumo de tabaco y las enfermedades respiratorias cr&#243;nicas&#46; El contacto con polvo y los cambios bruscos de temperatura mantienen un efecto independiente en todos los modelos&#44; con una OR muy estable y cercana a 1&#44;5 en el primer caso y a 3&#44;25 en el segundo&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los resultados del presente estudio muestran que mientras la profesi&#243;n no guarda relaci&#243;n independiente con la aparici&#243;n de NAC&#44; algunas condiciones laborales recientes s&#237; lo hacen&#46; Ello sorprende en algunos casos&#44; como es el caso de los maestros&#44; ya que se ha demostrado que el contacto directo con ni&#241;os en el domicilio familiar es un factor de riesgo de NAC para los convivientes<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a>&#46; Posiblemente&#44; la relaci&#243;n no sea igual en los docentes que&#44; a pesar de estar en contacto con ellos&#44; no mantienen una relaci&#243;n de convivencia estrecha&#46; Llama la atenci&#243;n tambi&#233;n que los profesionales de la sanidad&#44; a pesar de estar mayoritariamente expuestos a posibles contactos&#44; tampoco presentan mayor riesgo de neumon&#237;a&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En cambio&#44; hemos de considerar y prevenir determinadas condiciones laborales&#44; como exposici&#243;n reciente al polvo y cambios bruscos de temperatura en el trabajo&#44; que se comportan como factores de riesgo independientes de NAC&#46; Es conocido que la exposici&#243;n a determinadas part&#237;culas&#44; como el polvo de holl&#237;n y los cristales de silicio&#44; de algod&#243;n o de cadmio&#44; entre otros&#44; pueden favorecer el desarrollo de EPOC<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; que&#44; a su vez&#44; es uno de los principales factores de riesgo conocidos de NAC&#46; A pesar de ello&#44; se desconoce si el polvo de estas y otras sustancias pueden tener un efecto directo independiente en la g&#233;nesis de la neumon&#237;a&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En este sentido&#44; Neupane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; en un estudio de base poblacional&#44; dise&#241;ado para estudiar el efecto de la poluci&#243;n ambiental&#44; observan mayor prevalencia de NAC en pacientes mayores de 65 a&#241;os que hab&#237;an estado sometidos a exposici&#243;n ocupacional de gases&#44; humos &#40;especialmente de metal&#41; o productos qu&#237;micos durante su vida laboral&#46; A pesar de ello&#44; los mismos autores reconocen<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> que la informaci&#243;n recogida por parte de los pacientes&#44; al no formar parte del objetivo principal del estudio&#44; no fueron correctamente validados y se ha de ser cauto en su interpretaci&#243;n&#46; Por otro lado&#44; Loeb et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; en un estudio de casos y controles realizado en pacientes mayores de 65 a&#241;os de edad&#44; muestran que el previo contacto laboral con gases&#44; humos o productos qu&#237;micos se comporta como factor de riesgo independiente de NAC y adem&#225;s se asocia a hospitalizaci&#243;n por NAC<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; En una revisi&#243;n sistem&#225;tica realizada por Kohlhammer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> de art&#237;culos publicados hasta el a&#241;o 2003 en relaci&#243;n con los factores de riesgo de NAC&#44; se observ&#243; que el &#250;nico factor laboral con un efecto estad&#237;sticamente significativo es el humo de metales<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> y el contacto ocupacional con polvo<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Aun as&#237;&#44; la interpretaci&#243;n de los resultados de este &#250;ltimo estudio&#44; realizado por Farr et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> conlleva algunas limitaciones&#44; dado que consideran solamente a pacientes con NAC que requer&#237;an ingreso&#46; Adem&#225;s&#44; el modelo multivariado utilizado se limita a la convivencia con animales dom&#233;sticos&#44; contacto con ni&#241;os o utilizar estufa de gas&#44; sin considerar otros factores de riesgo conocidos&#46; Los mismos autores tambi&#233;n analizan&#44; por separado&#44; a los pacientes con NAC menos graves que no necesitaban de ingreso hospitalario y en este grupo&#44; si bien el an&#225;lisis univariante muestra significaci&#243;n estad&#237;stica&#44; cuando existe exposici&#243;n al polvo ocupacional&#44; este desaparece en el an&#225;lisis multivariante&#46; En relaci&#243;n al polvo&#44; Coggon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> publicaron el resultado de un estudio observacional retrospectivo&#44; realizado en Southampton &#40;Reino Unido&#41;&#44; a partir de la identificaci&#243;n de una mayor riesgo de mortalidad atribuido a NAC&#44; en soldadores de 15-64 a&#241;os&#44; pero no en los mayores de 65 a&#241;os&#46; Se atribuy&#243; a que el humo pod&#237;a aumentar&#44; de manera reversible&#44; la susceptibilidad de desarrollar una NAC&#46; Posteriormente&#44; el mismo equipo dise&#241;&#243; un estudio multic&#233;ntrico en 11 hospitales de Inglaterra con pacientes de 20-64 a&#241;os ingresados por NAC&#44; en los que los sujetos controles eran pacientes ingresados durante el mismo tiempo por otra patolog&#237;a no neumol&#243;gica&#46; Se les administr&#243; un cuestionario sobre condiciones habituales en el trabajo y exposiciones a humos met&#225;licos&#44; as&#237; como a otros factores no ocupacionales&#44; observando como &#250;nico hallazgo significativo con OR &#61; 1&#44;6 &#40;1&#44;1-2&#44;4&#41; la exposici&#243;n reciente &#40;en los &#250;ltimos 7 d&#237;as antes del inicio de los s&#237;ntomas&#41; al humo de metal &#40;hierro&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Ello indicaba que el polvo met&#225;lico&#44; especialmente de hierro&#44; predispone a la NAC con car&#225;cter reversible y dichos resultados refuerzan el efecto observado en nuestro estudio&#44; donde aparece asociaci&#243;n entre NAC y contacto con polvo en el &#250;ltimo mes sin que este efecto se relacione con el n&#250;mero de a&#241;os trabajando en dichas condiciones&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Por otro lado&#44; se conoce menos la relaci&#243;n que pueda existir entre la NAC y los cambios bruscos de temperatura&#46; Hip&#243;crates&#44; en sus observaciones cient&#237;ficas&#44; hace 2&#46;500 a&#241;os ya describ&#237;a que los cambios clim&#225;ticos bruscos pod&#237;an afectar a la salud p&#250;blica<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Sabemos que pa&#237;ses con temperaturas ambientales m&#225;s bajas presentan mayor incidencia y gravedad de infecciones respiratorias<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; Ello se ha relacionado con una alteraci&#243;n de la inmunidad natural o adquirida<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> y localmente se ha relacionado con el efecto broncoconstrictor o da&#241;o tisular far&#237;ngeo que el aire fr&#237;o pueda ejercer en el &#225;rbol bronquial<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Las principales limitaciones del estudio incluyen posibles errores en el conocimiento de la exposici&#243;n por parte del paciente&#44; el posible sesgo de memoria en la recolecci&#243;n de los datos referentes a las condiciones y exposiciones laborales a lo largo de la vida&#44; y la dificultad de agrupar las profesiones en un n&#250;mero razonable de categor&#237;as&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En resumen&#44; si bien la profesi&#243;n como tal no se ha relacionado con mayor riesgo de NAC&#44; algunas condiciones laborales&#44; como el contacto con polvo y los cambios bruscos de temperatura recientes&#44; son factores de riesgo reversibles y modificables y&#44; por lo tanto&#44; de inter&#233;s en la prevenci&#243;n de las NAC en el &#225;mbito laboral&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Beca 08&#47;PI 090448 del Fondo de Investigaciones Sanitarias &#40;FIS&#41; y CIBER de Respiratorio &#40;06&#47;06&#47;0028&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Autor&#237;a</span><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dise&#241;o metodol&#243;gico&#58;</span> Mateu Serra-Prat&#44; Ignasi Bol&#237;bar&#44; Jordi Almirall&#46; <span class="elsevierStyleItalic">Trabajo de campo&#58;</span> Jordi Almirall&#44; Ramon Boixeda&#44; Maria Bartolom&#233;&#44; Jordi Roig&#44; Mari C&#46; de la Torre&#44; Olga Parra&#46; <span class="elsevierStyleItalic">An&#225;lisis e interpretaci&#243;n de datos&#58;</span> Elisabet Palomera&#44; Mateu Serra-Prat&#44; Ignasi Bol&#237;bar&#44; Jordi Roig&#44; Jordi Almirall&#46; <span class="elsevierStyleItalic">Manuscrito&#58;</span> Jordi Almirall&#44; Mateu Serra-Prat&#44; Mari C&#46; de la Torre&#44; Olga Parra&#44; Ramon Boixeda&#44; Maria Bartolom&#233;&#44; Antoni Torres&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0085" class="elsevierStylePara elsevierViewall">No existen&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La neumon&#237;a adquirida en la comunidad &#40;NAC&#41; no se considera una enfermedad profesional&#44; por lo que se desconoce la influencia que puedan tener las distintas profesiones y condiciones laborales sobre el riesgo de desarrollar una NAC&#46; El objetivo del estudio es conocer si las profesiones y determinadas condiciones laborales se pueden comportar como factores de riesgo de NAC&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Metodolog&#237;a</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de casos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;336&#41; y controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;326&#41; de base poblacional&#46; Se estudiaron todos los casos de NAC con confirmaci&#243;n radiol&#243;gica&#44; diagnosticados en una base poblacional&#44; durante un a&#241;o&#46; Los factores de riesgo de NAC&#44; incluyendo las profesiones y las condiciones laborales actuales&#44; fueron estudiados mediante entrevista individual&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis bivariado mostr&#243; que trabajar como administrativo es un factor protector de NAC&#44; mientras que trabajar en la construcci&#243;n&#44; estar expuesto al polvo y sufrir cambios bruscos de temperatura en el trabajo son factores de riesgo de NAC&#46; El efecto de las profesiones desaparece cuando se ajusta por las condiciones laborales en el an&#225;lisis multivariado&#46; El contacto con polvo &#40;&#250;ltimo mes&#41; y cambios bruscos de temperatura recientes &#40;&#250;ltimos 3 meses&#41; son factores de riesgo de NAC sin que ello guarde relaci&#243;n con el n&#250;mero de a&#241;os trabajados en estas condiciones&#44; lo que sugiere un car&#225;cter reversible&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Algunas condiciones laborales recientes&#44; como el contacto con polvo y cambios bruscos de temperatura&#44; son factores de riesgo de NAC reversibles y potencialmente prevenibles&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Metodolog&#237;a"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusi&#243;n"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Community-acquired pneumonia &#40;CAP&#41; is not considered a professional disease&#44; and the effect of different occupations and working conditions on susceptibility to CAP is unknown&#46; The aim of this study is to determine whether different jobs and certain working conditions are risk factors for CAP&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methodology</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Over a 1-year period&#44; all radiologically confirmed cases of CAP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;336&#41; and age- and sex-matched controls &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;326&#41; were enrolled in a population-based case-control study&#46; A questionnaire on CAP risk factors&#44; including work-related questions&#44; was administered to all participants during an in-person interview&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The bivariate analysis showed that office work is a protective factor against CAP&#44; while building work&#44; contact with dust and sudden changes of temperature in the workplace were risk factors for CAP&#46; The occupational factor disappeared when the multivariate analysis was adjusted for working conditions&#46; Contact with dust &#40;previous month&#41; and sudden changes of temperature &#40;previous 3 months&#41; were risk factors for CAP&#44; irrespective of the number of years spent working in these conditions&#44; suggesting reversibility&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Some recent working conditions such as exposure to dust and sudden changes of temperature in the workplace are risk factors for CAP&#46; Both factors are reversible and preventable&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Methodology"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controles &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;326&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Profesiones</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Maestro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;402&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;75 &#40;0&#44;60-0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;431&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;20 &#40;0&#44;76-1&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sanitario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;879&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Camarero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;256&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cocinero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;914&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;03 &#40;0&#44;60-1&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Agricultor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;5&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;6&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;16 &#40;0&#44;80-1&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ganadero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;0&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;572&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;39 &#40;0&#44;44-4&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Agricultor o ganadero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;6&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89 &#40;6&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transportista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;4&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gasolinera&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;60 &#40;1&#44;13-2&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;4&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;35 &#40;0&#44;93-1&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ama de casa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">115 &#40;8&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;615&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;07 &#40;0&#44;82-1&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Limpieza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;4&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;959&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;01 &#40;0&#44;70-1&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Militar&#44; municipal&#44; bombero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;340&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;70 &#40;0&#44;33-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Jubilado&#44; paro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">217 &#40;16&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">211 &#40;15&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;96 &#40;0&#44;78-1&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Comercio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111 &#40;8&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">109 &#40;8&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97 &#40;0&#44;74-1&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Industrias&#44; f&#225;bricas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;5&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;296&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;84 &#40;0&#44;61-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Textil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 &#40;6&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;76 &#40;0&#44;54-1&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deportista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99 &#40;0&#44;20-4&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Condiciones laborales&#44; exposici&#243;n durante el &#250;ltimo mes</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Humos&#44; gases y&#47;o vapores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;4&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;3&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;597&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;90 &#40;0&#44;61-1&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gasolina&#44; petr&#243;leo o hidrocarburos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;675&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;10 &#40;0&#44;71-1&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polvo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 &#40;7&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;66 &#40;1&#44;18-2&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fibras org&#225;nicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;1&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;1&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;979&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99 &#40;0&#44;55-1&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fibras inorg&#225;nicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;887&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;05 &#40;0&#44;55-2&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Radiaciones ionizantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;0&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;49 &#40;0&#44;53-4&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Radiaciones no ionizantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;0&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;24 &#40;0&#44;33-4&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Animales&#44; excrementos y&#47;o v&#237;sceras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;78 &#40;1&#44;00-3&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cambio brusco de temperatura &#40;en los &#250;ltimos 3 meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;2&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;8&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;28 &#40;2&#44;24-4&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IC del 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Administrativos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Administrativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;66-1&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;56-2&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Broncopat&#237;a cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;88-3&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fumador &#40;actual o exfumador&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;01-1&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Contacto con polvo &#40;&#250;ltimo mes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;05-2&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cambio brusco de temperatura &#40;&#250;ltimos 3 meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;19-4&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;78-1&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;489&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;57-2&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Broncopat&#237;a cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;89-3&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fumador &#40;actual o exfumador&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00-1&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Contacto con polvo &#40;&#250;ltimo mes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00-2&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cambio brusco de temperatura &#40;&#250;ltimos 3 meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;21-4&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Industriales</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Industriales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;291&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;055&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;25&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "The burden of hospitalisations for community-acquired pneumonia &#40;CAP&#41; and pneumococcal pneumonia in adults in Spain &#40;2003-2007&#41;"
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                            3 => "C&#46; M&#233;ndez"
                            4 => "A&#46; Garc&#237;a"
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                    0 => array:2 [
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                      "doi" => "10.1056/NEJM200002103420607"
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                        "link" => array:1 [
                          0 => array:2 [
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Original
Relación de las profesiones y las condiciones laborales con la neumonía adquirida en la comunidad
Professions and Working Conditions Associated With Community-Acquired Pneumonia
Jordi Almiralla,
Corresponding author
jalmirall@csdm.cat

Autor para correspondencia.
, Mateu Serra-Pratb, Ignasi Bolíbarc, Elisabet Palomerab, Jordi Roigd, Ramon Boixedae, Maria Bartoloméf, Mari de la Torrea, Olga Parrag, Antoni Torresh
a Unidad de Cuidados Intensivos, Hospital de Mataró, Mataró, Universitat Autònoma de Barcelona, Barcelona, CIBERES, España
b Unidad de Investigación, Consorci Sanitari del Maresme, CIBEREHD, Mataró, Barcelona, España
c Departamento de Epidemiologia Clínica y Salud Pública, Institut de Recerca Biomédica (IIB Sant Pau), Barcelona, Universitat Autònoma de Barcelona, Barcelona, Ciber de Epidemiología y Salud Pública (CIBERESP), España
d Servei de Pneumologia, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Principat d’Andorra
e Servei de Medicina Interna, Hospital de Mataró, Mataró, Barcelona, España
f ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró, Barcelona, España
g Servei de Pneumologia, Hospital Universitari Sagrat Cor, Universitat de Barcelona, CIBERES, Barcelona, España
h Institut Clínic del Tórax, Servei de Pneumologia, IDIBAPS, Hospital Clínic de Barcelona, CIBERES, Universitat de Barcelona, Barcelona, España
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El efecto que puedan ejercer determinadas exposiciones ocupacionales sobre el sistema respiratorio<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleHsp" style=""></span>ha sido estudiado en relaci&#243;n con determinadas enfermedades&#44; como bronquitis&#44; EPOC&#44; bronquiolitis&#44; asma o c&#225;ncer de pulm&#243;n&#46; Sin embargo&#44; no conocemos ning&#250;n trabajo que haya estudiado si la exposici&#243;n a dichas sustancias puede favorecer la aparici&#243;n de NAC&#46; El objetivo del presente estudio es conocer si determinadas profesiones o condiciones laborales son factores de riesgo de NAC en la poblaci&#243;n general adulta&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">El estudio PACAP &#40;estudio de los factores de riesgo de la neumon&#237;a adquirida en la comunidad&#41; es un estudio de casos y controles de base poblacional dise&#241;ado para estudiar factores de riesgo de NAC&#44; con una base poblacional de 859&#46;033 habitantes mayores de 14 a&#241;os&#44; adscritos a 64 centros de atenci&#243;n primaria de una extensa zona rural y urbana de la zona este de Espa&#241;a&#46; Detalles de la metodolog&#237;a de este estudio han sido previamente publicados<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se consider&#243; sospecha cl&#237;nica de NAC a toda infecci&#243;n del tracto respiratorio inferior que requer&#237;a tratamiento antibi&#243;tico y que se acompa&#241;aba de signos focales nuevos o previamente desconocidos en la exploraci&#243;n f&#237;sica y en la radiograf&#237;a de t&#243;rax<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; Todas las sospechas de NAC fueron reevaluadas peri&#243;dicamente seg&#250;n evoluci&#243;n cl&#237;nica con una radiograf&#237;a de t&#243;rax hasta la curaci&#243;n completa&#46; Se excluyeron del estudio aquellas sospechas de NAC en las que el seguimiento evolutivo confirm&#243; otra enfermedad respiratoria no infecciosa&#44; as&#237; como a los pacientes con diagn&#243;stico de tuberculosis activa&#44; sospecha de neumon&#237;a por broncoaspiraci&#243;n&#44; neumon&#237;as adquiridas en residencias asistidas y neumon&#237;as con inicio de los s&#237;ntomas antes de los 7 d&#237;as de haber sido dado de alta de un hospital&#46; Para garantizar la exhaustividad de la identificaci&#243;n de casos de NAC&#44; se estableci&#243; un sistema de vigilancia activa en los centros de atenci&#243;n primaria y hospitalaria&#44; tanto p&#250;blicos como privados&#44; del &#225;rea de estudio&#44; as&#237; como en los centros hospitalarios de referencia de fuera de dicha &#225;rea&#46; Los individuos del grupo control fueron seleccionados aleatoriamente a partir de la base de datos de los centros de atenci&#243;n primaria de donde proced&#237;an los casos y fueron apareados con estos por edad &#40;&#177; 5 a&#241;os&#41; y sexo&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se administr&#243; un cuestionario sobre factores de riesgo de NAC en el domicilio de la persona seleccionada&#46; Cuando esta no pod&#237;a contestar directamente&#44; por discapacidad mental&#44; enfermedad o muerte &#40;si era un paciente con NAC&#41;&#44; se administr&#243; al cuidador o familiar m&#225;s pr&#243;ximo&#46; Los entrevistadores eran m&#233;dicos o enfermeras formados en t&#233;cnicas de entrevista y en la administraci&#243;n del cuestionario del estudio&#46; Las preguntas se estructuraron en 3 cap&#237;tulos&#58; <span class="elsevierStyleItalic">a&#41;</span> h&#225;bitos y estilos de vida&#59; <span class="elsevierStyleItalic">b&#41;</span> enfermedades respiratorias cr&#243;nicas y otras condiciones cl&#237;nicas&#44; y <span class="elsevierStyleItalic">c&#41;</span> tratamientos habituales durante el &#250;ltimo a&#241;o&#46; Se registr&#243; informaci&#243;n sobre la profesi&#243;n actual&#44; contactos con sustancias presumiblemente t&#243;xicas &#40;en alg&#250;n momento de su vida laboral o en el &#250;ltimo mes&#41;&#44; como humos&#44; gases&#44; vapores&#44; polvo&#44; fibras org&#225;nicas o inorg&#225;nicas y contacto con animales&#46; Tambi&#233;n se registraron los cambios bruscos de temperatura relacionados con el trabajo en los &#250;ltimos 3 meses&#44; como entradas en c&#225;maras frigor&#237;ficas o trabajos en cocinas u hornos &#40;v&#233;anse las variables consideradas en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Todos los sujetos seleccionados otorgaron el consentimiento informado para participar en el estudio&#44; el cual fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n Cl&#237;nica del Consorci Sanitari del Maresme&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Se compararon la distribuci&#243;n de las profesiones y la exposici&#243;n a los distintos factores de estudio entre casos y controles mediante el test de la chi al cuadrado &#40;o el test exacto de Fisher&#44; si proced&#237;a&#41;&#46; Se compararon las medias de a&#241;os trabajados en las distintas condiciones consideradas&#44; mediante el test U de Mann-Whitney&#46; Para evaluar el efecto de los factores de estudio sobre la NAC&#44; se estim&#243; la OR mediante regresi&#243;n log&#237;stica&#46; Se realiz&#243; un an&#225;lisis bivariado y distintos modelos multivariados &#40;uno para cada una de las siguientes profesiones&#58; administrativos&#44; construcci&#243;n&#44; industriales&#44; maestros y agricultores o granjeros&#41; para ajustar el efecto de dichas profesiones por el de las condiciones de trabajo y otros factores de riesgo de NAC conocidos como asma&#44; broncopat&#237;a cr&#243;nica &#40;incluye bronquitis cr&#243;nica y EPOC&#41; y consumo de tabaco&#46; Se consider&#243; el nivel de significaci&#243;n estad&#237;stica en una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se reclut&#243; a 1&#46;336 casos confirmados de NAC y 1&#46;326 controles&#46; Un 52&#44;7&#37; de los casos de NAC fueron hombres&#44; con una edad media &#177; desviaci&#243;n est&#225;ndar&#41; de 58&#44;6 &#177; 19&#44;8 a&#241;os&#44; y un 47&#44;3&#37; eran mujeres&#44; con una edad media de 54&#44;6 &#177; 20&#44;7 a&#241;os&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se comparan las profesiones y las condiciones de trabajo entre casos y controles&#46; En ella se destaca que trabajar como administrativo es un factor protector de NAC &#40;OR &#61; 0&#44;75&#41;&#44; mientras que trabajar en la construcci&#243;n es un factor de riesgo &#40;OR &#61; 1&#44;60&#41;&#44; sin que se observe ninguna asociaci&#243;n estad&#237;sticamente significativa en ninguna de las otras profesiones consideradas&#46; En relaci&#243;n con las condiciones laborales&#44; se observa un efecto significativo del contacto con polvo en el &#250;ltimo mes &#40;OR &#61; 1&#44;66&#41;&#44; as&#237; como contacto con animales&#44; excrementos o v&#237;sceras tambi&#233;n durante el &#250;ltimo mes &#40;OR &#61; 1&#44;78&#41; o existencia de cambios bruscos de temperatura en los &#250;ltimos 3 meses &#40;OR &#61; 3&#44;28&#41;&#46; Por otro lado&#44; no se hall&#243; ninguna diferencia estad&#237;sticamente significativa al relacionar el n&#250;mero de a&#241;os trabajados en estas condiciones con la aparici&#243;n de NAC&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se presentan los resultados de los modelos multivariantes en los que se observa que el efecto de las profesiones desaparece cuando se ajusta por las condiciones laborales&#44; el consumo de tabaco y las enfermedades respiratorias cr&#243;nicas&#46; El contacto con polvo y los cambios bruscos de temperatura mantienen un efecto independiente en todos los modelos&#44; con una OR muy estable y cercana a 1&#44;5 en el primer caso y a 3&#44;25 en el segundo&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los resultados del presente estudio muestran que mientras la profesi&#243;n no guarda relaci&#243;n independiente con la aparici&#243;n de NAC&#44; algunas condiciones laborales recientes s&#237; lo hacen&#46; Ello sorprende en algunos casos&#44; como es el caso de los maestros&#44; ya que se ha demostrado que el contacto directo con ni&#241;os en el domicilio familiar es un factor de riesgo de NAC para los convivientes<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a>&#46; Posiblemente&#44; la relaci&#243;n no sea igual en los docentes que&#44; a pesar de estar en contacto con ellos&#44; no mantienen una relaci&#243;n de convivencia estrecha&#46; Llama la atenci&#243;n tambi&#233;n que los profesionales de la sanidad&#44; a pesar de estar mayoritariamente expuestos a posibles contactos&#44; tampoco presentan mayor riesgo de neumon&#237;a&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En cambio&#44; hemos de considerar y prevenir determinadas condiciones laborales&#44; como exposici&#243;n reciente al polvo y cambios bruscos de temperatura en el trabajo&#44; que se comportan como factores de riesgo independientes de NAC&#46; Es conocido que la exposici&#243;n a determinadas part&#237;culas&#44; como el polvo de holl&#237;n y los cristales de silicio&#44; de algod&#243;n o de cadmio&#44; entre otros&#44; pueden favorecer el desarrollo de EPOC<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; que&#44; a su vez&#44; es uno de los principales factores de riesgo conocidos de NAC&#46; A pesar de ello&#44; se desconoce si el polvo de estas y otras sustancias pueden tener un efecto directo independiente en la g&#233;nesis de la neumon&#237;a&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En este sentido&#44; Neupane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; en un estudio de base poblacional&#44; dise&#241;ado para estudiar el efecto de la poluci&#243;n ambiental&#44; observan mayor prevalencia de NAC en pacientes mayores de 65 a&#241;os que hab&#237;an estado sometidos a exposici&#243;n ocupacional de gases&#44; humos &#40;especialmente de metal&#41; o productos qu&#237;micos durante su vida laboral&#46; A pesar de ello&#44; los mismos autores reconocen<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> que la informaci&#243;n recogida por parte de los pacientes&#44; al no formar parte del objetivo principal del estudio&#44; no fueron correctamente validados y se ha de ser cauto en su interpretaci&#243;n&#46; Por otro lado&#44; Loeb et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; en un estudio de casos y controles realizado en pacientes mayores de 65 a&#241;os de edad&#44; muestran que el previo contacto laboral con gases&#44; humos o productos qu&#237;micos se comporta como factor de riesgo independiente de NAC y adem&#225;s se asocia a hospitalizaci&#243;n por NAC<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; En una revisi&#243;n sistem&#225;tica realizada por Kohlhammer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> de art&#237;culos publicados hasta el a&#241;o 2003 en relaci&#243;n con los factores de riesgo de NAC&#44; se observ&#243; que el &#250;nico factor laboral con un efecto estad&#237;sticamente significativo es el humo de metales<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> y el contacto ocupacional con polvo<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Aun as&#237;&#44; la interpretaci&#243;n de los resultados de este &#250;ltimo estudio&#44; realizado por Farr et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> conlleva algunas limitaciones&#44; dado que consideran solamente a pacientes con NAC que requer&#237;an ingreso&#46; Adem&#225;s&#44; el modelo multivariado utilizado se limita a la convivencia con animales dom&#233;sticos&#44; contacto con ni&#241;os o utilizar estufa de gas&#44; sin considerar otros factores de riesgo conocidos&#46; Los mismos autores tambi&#233;n analizan&#44; por separado&#44; a los pacientes con NAC menos graves que no necesitaban de ingreso hospitalario y en este grupo&#44; si bien el an&#225;lisis univariante muestra significaci&#243;n estad&#237;stica&#44; cuando existe exposici&#243;n al polvo ocupacional&#44; este desaparece en el an&#225;lisis multivariante&#46; En relaci&#243;n al polvo&#44; Coggon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> publicaron el resultado de un estudio observacional retrospectivo&#44; realizado en Southampton &#40;Reino Unido&#41;&#44; a partir de la identificaci&#243;n de una mayor riesgo de mortalidad atribuido a NAC&#44; en soldadores de 15-64 a&#241;os&#44; pero no en los mayores de 65 a&#241;os&#46; Se atribuy&#243; a que el humo pod&#237;a aumentar&#44; de manera reversible&#44; la susceptibilidad de desarrollar una NAC&#46; Posteriormente&#44; el mismo equipo dise&#241;&#243; un estudio multic&#233;ntrico en 11 hospitales de Inglaterra con pacientes de 20-64 a&#241;os ingresados por NAC&#44; en los que los sujetos controles eran pacientes ingresados durante el mismo tiempo por otra patolog&#237;a no neumol&#243;gica&#46; Se les administr&#243; un cuestionario sobre condiciones habituales en el trabajo y exposiciones a humos met&#225;licos&#44; as&#237; como a otros factores no ocupacionales&#44; observando como &#250;nico hallazgo significativo con OR &#61; 1&#44;6 &#40;1&#44;1-2&#44;4&#41; la exposici&#243;n reciente &#40;en los &#250;ltimos 7 d&#237;as antes del inicio de los s&#237;ntomas&#41; al humo de metal &#40;hierro&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Ello indicaba que el polvo met&#225;lico&#44; especialmente de hierro&#44; predispone a la NAC con car&#225;cter reversible y dichos resultados refuerzan el efecto observado en nuestro estudio&#44; donde aparece asociaci&#243;n entre NAC y contacto con polvo en el &#250;ltimo mes sin que este efecto se relacione con el n&#250;mero de a&#241;os trabajando en dichas condiciones&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Por otro lado&#44; se conoce menos la relaci&#243;n que pueda existir entre la NAC y los cambios bruscos de temperatura&#46; Hip&#243;crates&#44; en sus observaciones cient&#237;ficas&#44; hace 2&#46;500 a&#241;os ya describ&#237;a que los cambios clim&#225;ticos bruscos pod&#237;an afectar a la salud p&#250;blica<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Sabemos que pa&#237;ses con temperaturas ambientales m&#225;s bajas presentan mayor incidencia y gravedad de infecciones respiratorias<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; Ello se ha relacionado con una alteraci&#243;n de la inmunidad natural o adquirida<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> y localmente se ha relacionado con el efecto broncoconstrictor o da&#241;o tisular far&#237;ngeo que el aire fr&#237;o pueda ejercer en el &#225;rbol bronquial<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Las principales limitaciones del estudio incluyen posibles errores en el conocimiento de la exposici&#243;n por parte del paciente&#44; el posible sesgo de memoria en la recolecci&#243;n de los datos referentes a las condiciones y exposiciones laborales a lo largo de la vida&#44; y la dificultad de agrupar las profesiones en un n&#250;mero razonable de categor&#237;as&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En resumen&#44; si bien la profesi&#243;n como tal no se ha relacionado con mayor riesgo de NAC&#44; algunas condiciones laborales&#44; como el contacto con polvo y los cambios bruscos de temperatura recientes&#44; son factores de riesgo reversibles y modificables y&#44; por lo tanto&#44; de inter&#233;s en la prevenci&#243;n de las NAC en el &#225;mbito laboral&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Beca 08&#47;PI 090448 del Fondo de Investigaciones Sanitarias &#40;FIS&#41; y CIBER de Respiratorio &#40;06&#47;06&#47;0028&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Autor&#237;a</span><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dise&#241;o metodol&#243;gico&#58;</span> Mateu Serra-Prat&#44; Ignasi Bol&#237;bar&#44; Jordi Almirall&#46; <span class="elsevierStyleItalic">Trabajo de campo&#58;</span> Jordi Almirall&#44; Ramon Boixeda&#44; Maria Bartolom&#233;&#44; Jordi Roig&#44; Mari C&#46; de la Torre&#44; Olga Parra&#46; <span class="elsevierStyleItalic">An&#225;lisis e interpretaci&#243;n de datos&#58;</span> Elisabet Palomera&#44; Mateu Serra-Prat&#44; Ignasi Bol&#237;bar&#44; Jordi Roig&#44; Jordi Almirall&#46; <span class="elsevierStyleItalic">Manuscrito&#58;</span> Jordi Almirall&#44; Mateu Serra-Prat&#44; Mari C&#46; de la Torre&#44; Olga Parra&#44; Ramon Boixeda&#44; Maria Bartolom&#233;&#44; Antoni Torres&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0085" class="elsevierStylePara elsevierViewall">No existen&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La neumon&#237;a adquirida en la comunidad &#40;NAC&#41; no se considera una enfermedad profesional&#44; por lo que se desconoce la influencia que puedan tener las distintas profesiones y condiciones laborales sobre el riesgo de desarrollar una NAC&#46; El objetivo del estudio es conocer si las profesiones y determinadas condiciones laborales se pueden comportar como factores de riesgo de NAC&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Metodolog&#237;a</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de casos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;336&#41; y controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;326&#41; de base poblacional&#46; Se estudiaron todos los casos de NAC con confirmaci&#243;n radiol&#243;gica&#44; diagnosticados en una base poblacional&#44; durante un a&#241;o&#46; Los factores de riesgo de NAC&#44; incluyendo las profesiones y las condiciones laborales actuales&#44; fueron estudiados mediante entrevista individual&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis bivariado mostr&#243; que trabajar como administrativo es un factor protector de NAC&#44; mientras que trabajar en la construcci&#243;n&#44; estar expuesto al polvo y sufrir cambios bruscos de temperatura en el trabajo son factores de riesgo de NAC&#46; El efecto de las profesiones desaparece cuando se ajusta por las condiciones laborales en el an&#225;lisis multivariado&#46; El contacto con polvo &#40;&#250;ltimo mes&#41; y cambios bruscos de temperatura recientes &#40;&#250;ltimos 3 meses&#41; son factores de riesgo de NAC sin que ello guarde relaci&#243;n con el n&#250;mero de a&#241;os trabajados en estas condiciones&#44; lo que sugiere un car&#225;cter reversible&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Algunas condiciones laborales recientes&#44; como el contacto con polvo y cambios bruscos de temperatura&#44; son factores de riesgo de NAC reversibles y potencialmente prevenibles&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Metodolog&#237;a"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusi&#243;n"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Community-acquired pneumonia &#40;CAP&#41; is not considered a professional disease&#44; and the effect of different occupations and working conditions on susceptibility to CAP is unknown&#46; The aim of this study is to determine whether different jobs and certain working conditions are risk factors for CAP&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methodology</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Over a 1-year period&#44; all radiologically confirmed cases of CAP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;336&#41; and age- and sex-matched controls &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;326&#41; were enrolled in a population-based case-control study&#46; A questionnaire on CAP risk factors&#44; including work-related questions&#44; was administered to all participants during an in-person interview&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The bivariate analysis showed that office work is a protective factor against CAP&#44; while building work&#44; contact with dust and sudden changes of temperature in the workplace were risk factors for CAP&#46; The occupational factor disappeared when the multivariate analysis was adjusted for working conditions&#46; Contact with dust &#40;previous month&#41; and sudden changes of temperature &#40;previous 3 months&#41; were risk factors for CAP&#44; irrespective of the number of years spent working in these conditions&#44; suggesting reversibility&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Some recent working conditions such as exposure to dust and sudden changes of temperature in the workplace are risk factors for CAP&#46; Both factors are reversible and preventable&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Methodology"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controles &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;326&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Profesiones</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Maestro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;402&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;75 &#40;0&#44;60-0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;431&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;20 &#40;0&#44;76-1&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sanitario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;879&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Camarero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;256&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cocinero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;914&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;03 &#40;0&#44;60-1&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Agricultor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;5&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;6&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;16 &#40;0&#44;80-1&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ganadero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;0&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;572&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;39 &#40;0&#44;44-4&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Agricultor o ganadero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;6&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89 &#40;6&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transportista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;4&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gasolinera&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;60 &#40;1&#44;13-2&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;4&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;35 &#40;0&#44;93-1&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ama de casa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">115 &#40;8&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;615&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;07 &#40;0&#44;82-1&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Limpieza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;4&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;959&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;01 &#40;0&#44;70-1&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Militar&#44; municipal&#44; bombero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;340&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;70 &#40;0&#44;33-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Jubilado&#44; paro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">217 &#40;16&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">211 &#40;15&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;96 &#40;0&#44;78-1&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Comercio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111 &#40;8&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">109 &#40;8&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97 &#40;0&#44;74-1&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Industrias&#44; f&#225;bricas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;5&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;296&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;84 &#40;0&#44;61-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Textil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 &#40;6&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;76 &#40;0&#44;54-1&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deportista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99 &#40;0&#44;20-4&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Condiciones laborales&#44; exposici&#243;n durante el &#250;ltimo mes</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Humos&#44; gases y&#47;o vapores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;4&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;3&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;597&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;90 &#40;0&#44;61-1&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gasolina&#44; petr&#243;leo o hidrocarburos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;3&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;675&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;10 &#40;0&#44;71-1&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polvo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 &#40;7&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;66 &#40;1&#44;18-2&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fibras org&#225;nicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;1&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;1&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;979&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99 &#40;0&#44;55-1&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fibras inorg&#225;nicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;887&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;05 &#40;0&#44;55-2&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Radiaciones ionizantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;0&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;49 &#40;0&#44;53-4&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Radiaciones no ionizantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;0&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;24 &#40;0&#44;33-4&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Animales&#44; excrementos y&#47;o v&#237;sceras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;78 &#40;1&#44;00-3&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cambio brusco de temperatura &#40;en los &#250;ltimos 3 meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;2&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;8&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;28 &#40;2&#44;24-4&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IC del 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Administrativos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Administrativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;66-1&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;56-2&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Broncopat&#237;a cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;88-3&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fumador &#40;actual o exfumador&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;01-1&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Contacto con polvo &#40;&#250;ltimo mes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;05-2&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cambio brusco de temperatura &#40;&#250;ltimos 3 meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;19-4&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;78-1&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;489&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;57-2&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Broncopat&#237;a cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;89-3&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fumador &#40;actual o exfumador&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00-1&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Contacto con polvo &#40;&#250;ltimo mes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00-2&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cambio brusco de temperatura &#40;&#250;ltimos 3 meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;21-4&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Industriales</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Industriales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;291&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;055&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;25&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "The burden of hospitalisations for community-acquired pneumonia &#40;CAP&#41; and pneumococcal pneumonia in adults in Spain &#40;2003-2007&#41;"
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                            3 => "C&#46; M&#233;ndez"
                            4 => "A&#46; Garc&#237;a"
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                    0 => array:2 [
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                      "doi" => "10.1056/NEJM200002103420607"
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                        "link" => array:1 [
                          0 => array:2 [
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Article information
ISSN: 03002896
Original language: Spanish
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2018 February 41 16 57
2018 January 18 13 31
2017 December 47 27 74
2017 November 84 23 107
2017 October 60 27 87
2017 September 37 19 56
2017 August 41 31 72
2017 July 33 13 46
2017 June 50 38 88
2017 May 53 36 89
2017 April 37 28 65
2017 March 48 37 85
2017 February 60 15 75
2017 January 49 5 54
2016 December 45 17 62
2016 November 90 35 125
2016 October 105 34 139
2016 September 160 33 193
2016 August 96 21 117
2016 July 81 13 94
2016 June 103 25 128
2016 May 87 28 115
2016 April 53 2 55
2016 March 71 2 73
2016 February 1 2 3
2016 January 4 3 7
2015 December 38 10 48
2015 November 17 2 19
2015 October 3 0 3
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