Labour market participation after sickness absence due to cancer: a dynamic cohort study in Catalonia (Spain).

BACKGROUND: The consequences of cancer on working until retirement age remain unclear. This study aimed to analyse working life considering all possible labour market states in a sample of workers after sickness absence (SA) due to cancer and to compare their working life paths to those of a sample of workers without SA and with an SA due to other diseases. METHODS: This was a retrospective dynamic cohort study among social security affiliates in Catalonia from 2012-2018. Cases consisted of workers with an SA due to cancer between 2012-2015 (N = 516) and were individually age- and sex-matched with those of affiliates with an SA due to other diagnoses and workers without an SA. All workers (N = 1,548, 56% women) were followed up from entry into the cohort until the end of 2018 to characterise nine possible weekly labour states. Sequence analysis, optimal matching, and multinomial logistic regression were used to identify and assess the probability of future labour market participation patterns (LMPPs). All analyses were stratified by sex. RESULTS: Compared with workers with an SA due to cancer, male workers with no SA and SA due to other causes showed a lower probability of being in the LMPP of death (aRRR 0.02, 95% CI: 0.00‒0.16; aRRR 0.17, 95% CI: 0.06‒0.46, respectively) and, among women, a lower probability of permanent disability and death (aRRR 0.24, 95% CI: 0.10‒0.57; aRRR 0.39, 95% CI: 0.19‒0.83, respectively). Compared to workers with SA due to cancer, the risk of early retirement was lower among workers with no SA (women, aRRR 0.60, 95% CI: 0.22‒1.65; men, aRRR 0.64, 95% CI: 0.27‒1.52), although these results were not statistically significant. CONCLUSIONS: Workplaces, many of which have policies common to all diagnoses, should be modified to the needs of cancer survivors to prevent an increasing frequency of early retirement and permanent disability when possible. Future studies should assess the impact of cancer on premature exit from the labour market among survivors, depending on cancer localisation and type of treatment.

Waiting time from identification to recognition an occupational disease in Spain.

OBJECTIVE: To estimate the waiting time since a suspected an occupational disease (OD) is identified, notified and recognized in Spain. METHOD: A series of 34 patients attended at Occupational Diseases Unit (ODU) of Hospital del Mar in Barcelona were follow up since their identification until final resolution by the National Institute of Social Security (INSS). Median, and 25 and 75 percentiles (interquartile range [IQR]) were calculated in weeks by total time (n=27), ODU time (n=34), patient time (n=31) and INSS time (n=27). RESULTS: Total time was 51 weeks (IQR: 33.6 and 122.6), of which 42 weeks (17.6-99.5) corresponded to the waiting period at the INSS. CONCLUSIONS: The disproportionately long waiting time since INSS receives a case could impact on the under-recognition of OD. Urgent improvement of the administrative process is needed to reduce the patient waiting time for the recognition of OD.

[Ausencia por enfermedad, condiciones médicas y de trabajo durante el embarazo en una cohorte de profesionales sanitarias]. / Sickness absence, medical and workplace conditions during pregnancy in a cohort of healthcare workers.

OBJECTIVES: To assess the association between sickness absence (SA) trajectories by medical diagnoses and exposure to occupational risk factors during pregnancy.  Methods: SA trajectories were identified in a cohort of 367 pregnant workers from a healthcare institution (period 2010-2014), based on most frequent diagnosis using sequence analysis. Trajectory 1 included SA episodes due mainly to musculoskeletal disorders (58.86%), trajectory 2 included SA episodes due to pregnancy-related disorders (25.07%) and trajectory 3 included absences mainly covered by pregnancy-related occupational risk benefits (POR) and few SA episodes (16.08%). Exposure to occupational risk factors was assessed by experts and their association with trajectories was analysed using logistic regression. Relative risks (RR) and their 95% confidence intervals (95%CI) were adjusted for age, type of contract and work shift. RESULTS: Trajectory 1 was negatively associated with exposure to safety and ergonomic risks (RR=0.56, 95%CI=0.35-0.90; RR=0.50, 95%CI=0.33-0.77, respectively) and with the highest global risk index (RR=0.68, 95%CI=0.49-0.96). Trajectory 3 was associated with safety and ergonomic risks (RR=2.75, 95%CI=1.59-4.75; RR=3.64, 95%CI=2.18-6.06, respectively) and with the highest global risk index (RR=2.69, 95%CI=1.43-5.01). Nursing aides and nurses had a higher probability of belonging to trajectory 3 (RR 5.58, 95%CI=2.09-14.95 and RR 5.00, 95%CI 2.18-6.06, respectively). CONCLUSIONS: Pregnancy-related and musculoskeletal disorders are the most frequent sickness absence diagnosis during pregnancy. Low levels of occupational risk factors exposure were related to absences from work covered mainly by sickness absence. Current social benefits seem to be used as a complementary way to balance work and health during pregnancy.

OBJETIVO: Evaluar la asociación entre trayectorias de ausencia por enfermedad (SA) según diagnóstico y exposición a factores de riesgo laborales durante el embarazo. Métodos: Estudio de cohortes (367 trabajadoras sanitarias embarazadas). Se identificaron trayectorias de ausencia por enfermedad según los diagnósticos más frecuentes mediante análisis de secuencias (2010-2014). La trayectoria 1 incluía SA principalmente por trastornos musculoesqueléticos (58,86%), la 2 por trastornos relacionados con el embarazo (25,07%) y la 3 incluía ausencias por la prestación por riesgo durante el embarazo (POR) y pocas SA (16,08%). La exposición a factores de riesgo laborales fue evaluada por expertos y se analizó la asociación con las trayectorias mediante regresión logística. Los riesgos relativos (RR) y sus intervalos de confianza (IC95%) se ajustaron por edad, contrato y turno. RESULTADOS: La trayectoria 1 se asoció negativamente con la exposición a riesgos de seguridad y ergonómicos (RR=0,56, IC95%=0,35-0,90; RR=0,50, IC95%=0,33-0,77) y con índice de riesgo global más bajo (RR=0,68, IC95%=0,49-0,96). La tercera se asoció a riesgos de seguridad y ergonómicos (RR=2,75, IC 95 %=1,59-4,75; RR=3,64, IC 95 %=2,18-6,06) y con el riesgo más alto (RR=2,69, 95 % IC=1,43-5,01). El personal de enfermería tuvo mayor probabilidad de pertenecer a la trayectoria 3 (RR 5,58, IC95%=2,09-14,95 y RR 5,00, IC95% 2,18-6,06). CONCLUSIONES: Los trastornos musculoesqueléticos y por trastornos relacionados con el embarazo son los grupos diagnósticos de SA más frecuentes. Bajos niveles de exposición a riesgos laborales se relacionaron con ausencias cubiertas principalmente por SA. Las prestaciones sociales parecen utilizarse complementariamente para equilibrar el trabajo y la salud.

[Approximation to the cost of occupational diseases treated in seven hospitals in Spain]. / Aproximación al coste de enfermedades profesionales atendidas en siete hospitales en España.

OBJECTIVE: To estimate the hospital cost of a sample of cases treated in seven hospitals of the National Health System in several Spanish cities. METHOD: Study based on 78 cases of occupational disease recognized by the social security, and previously treated in hospitals in Badalona, Barcelona, Ferrol, Gijón, Girona, Madrid and Vigo between 2017 and 2019. RESULTS: The healthcare activity generated by these hospitals to attend these processes involved a total cost of 282,927€. CONCLUSIONS: It is urgent to improve the coordination between the two public health systems, the social security health care system and the National Health System.

Fiber burden and asbestos-related diseases: an umbrella review.

OBJECTIVE: What are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects. METHOD: An umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument. RESULTS: We retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those > 10 µm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 µm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels <0.1 f/ml. No reviews provided information on exposure concentrations for pulmonary fibrosis. Currently, there is limited evidence in humans to establish the causal relationship between gastrointestinal cancer and asbestos exposure. CONCLUSIONS: Banning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml.

Exceso de mortalidad en población en edad de trabajar en nueve países de Latinoamérica, año 2020 / Excess mortality in 2020 in the working-age population of nine Latin American countries / Excesso de mortalidade na população em idade ativa em nove países da América Latina no ano de 2020

RESUMEN Objetivo. Estimar el impacto de la pandemia de la COVID-19 durante el año 2020, a través del exceso de mortalidad por todas las causas y los años potenciales de vida laboral perdidos en la población en edad de trabajar, de una selección de países latinoamericanos y el Caribe. Métodos. Estudio basado en datos de defunciones por todas las causas entre 15 y 69 años, procedentes principalmente de los Institutos Nacionales de Estadísticas. Se estimaron defunciones esperadas a partir de las registradas entre 2015 y 2019. El exceso de mortalidad fue estimado a través del indicador P, la razón de mortalidad estandarizada (RME) y los años potenciales de vida laboral perdidos (AVLP) hasta los 70 años. Resultados. El exceso de defunciones en Brasil, Bolivia, Chile, Colombia, Costa Rica, Cuba, México, Perú y República Dominicana sumó 426 978 (279 591 en hombres y 147 438 en mujeres), lo que representó una pérdida de 5 710 048 (3 738 775 en hombres y 1 971 273 en mujeres) de APVLP. La mortalidad observada fue significativamente superior a la esperada en todos los países, menos República Dominicana. Conclusiones. El impacto de la COVID-19 en la población en edad de trabajar tendrá un impacto profundo en la situación socioeconómica. El recuento oportuno del exceso de muertes resulta útil y puede ser usado como un sistema de alerta temprana para monitorizar la magnitud de los brotes de COVID-19. La monitorización del exceso de mortalidad en personas en edad de trabajar, realizada por el Observatorio Iberoamericano de Seguridad y Salud en el Trabajo permite evaluar con mayor exactitud la carga social y económica de la COVID-19.

ABSTRACT Objective. Estimate the impact of the COVID-19 pandemic in 2020, through excess all-cause mortality and potential years of productive life lost (YPLL) in the working-age population, in selected Latin American and Caribbean countries. Methods. Study based on data on deaths from all causes from age 15 to 69 years, mainly from national institutes of statistics. Estimates of expected deaths were based on reported deaths from 2015 to 2019. Excess mortality was estimated using the P indicator, standardized mortality ratio (SMR), and potential YPLL up to age 70 years. Results. Excess deaths in Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, the Dominican Republic, Mexico, and Peru totaled 426 978 (279 591 men and 147 438 women), representing a potential loss of 5 710 048 (3 738 775 in men and 1 971 273 in women) years of productive life. Observed mortality was significantly higher than expected in all countries except the Dominican Republic. Conclusions. COVID-19 in the working-age population will have a profound impact on socio-economic conditions. Timely counting of excess deaths is useful and can be used as an early warning system to monitor the magnitude of COVID-19 outbreaks. Monitoring of excess mortality in working-age people by the Ibero-American Observatory on Safety and Health at Work enables more accurate assessment of the social and economic burden of COVID-19.

RESUMO Objetivo. Estimar o impacto da pandemia de COVID-19 durante o ano de 2020, por meio do excesso de mortalidade por todas as causas e dos anos produtivos de vida perdidos (APrVP) na população em idade ativa, em uma seleção de países da América Latina e do Caribe. Métodos. Estudo baseado em dados de óbitos por todas as causas entre 15 e 69 anos, principalmente dos Institutos Nacionais de Estatística. Os óbitos esperados foram estimados a partir daqueles registrados entre 2015 e 2019. O excesso de mortalidade foi estimado por meio do indicador P, da razão de mortalidade padronizada (RMP) e dos APrVP até os 70 anos. Resultados. O excesso de óbitos no Brasil, na Bolívia, no Chile, na Colômbia, na Costa Rica, em Cuba, no México, no Peru e na República Dominicana totalizou 426 978 (279 591 em homens e 147 438 em mulheres), o que representou uma perda de 5 710 048 (3 738 775 em homens e 1 971 273 em mulheres) APrVP. A mortalidade observada foi significativamente maior do que o esperado em todos os países, exceto na República Dominicana. Conclusões. O impacto da COVID-19 na população em idade ativa terá um impacto profundo na situação socioeconómica. O cálculo oportuno do excesso de mortes é útil e pode ser usado como um sistema de alerta precoce para monitorar a magnitude dos surtos de COVID-19. O monitoramento do excesso de mortalidade em pessoas em idade ativa, realizado pelo Observatório Ibero-Americano de Segurança e Saúde no Trabalho, permite avaliar com mais precisão a carga social e econômica da COVID-19.

Returning to work after a sickness absence due to cancer: a cohort study of salaried workers in Catalonia (Spain).

Cancer incidence and survival rates have increased in the last decades and as a result, the number of working age people diagnosed with cancer who return to work. In this study the probability of accumulating days of employment and employment participation trajectories (EPTs) in a sample of salaried workers in Catalonia (Spain) who had a sickness absence (SA) due to cancer were compared to salaried workers with SA due to other diagnoses or without SA. Each individual with SA due to cancer between 2012 and 2015 was matched by age, sex, and onset of time at risk to a worker with SA due to other diagnoses and another worker without SA. Accumulated days of employment were measured, and negative binomial models were applied to assess differences between comparison groups. Latent class models were applied to identify EPTs and multinomial regression models to analyse the probability of belonging to one EPT of each group. Men and women without SA or with SA due to other diagnoses had at least a 9% higher probability of continuing in employment compared to workers who had a SA due to cancer, especially among men without SA (adjusted IRR 1.27, 95% CI 1.06‒1.53). Men without SA had the highest probability of having high stable EPT compared to workers who had a SA due to cancer (adjusted RRR 3.21, 95% CI 1.87‒5.50). Even though workers with SA due to cancer continue working afterwards, they do it less often than matched controls and with a less stable employment trajectory. Health and social protection systems should guaranty cancer survivors the opportunity to continue voluntary participation in the labour market.

O futuro do trabalho após a COVID-19: o papel incerto do teletrabalho no domicílio / The future of work after the COVID-19, the uncertain role of teleworking at home / El futuro del trabajo tras la COVID-19: el papel incierto del teletrabajo en el domicilio

Resumo Introdução: o teletrabalho no domicílio, uma das medidas adotadas para controlar a pandemia de COVID-19 e, ao mesmo tempo, manter o emprego, tem aumentado em vários países. Objetivo: refletir sobre o significado, a magnitude e as tendências do teletrabalho no domicílio, antes e durante a pandemia, enfatizando seus potenciais efeitos na saúde do trabalhador. Discussão: a precedente Convenção 177/1996 da Organização Internacional do Trabalho (OIT) sobre trabalho a domicílio e o acordo sobre teletrabalho entre agentes sociais na União Europeia, em 2002, apontam a dificuldade de regulamentar essa nova forma de organização do trabalho e da prevenção de possíveis lesões e doenças associadas, especialmente transtornos mentais e distúrbios musculoesqueléticos. São necessários estudos sobre os efeitos na saude dessa modalidade de trabalho para fornecer evidências científicas que embasarão normas em nível nacional e global. A inclusão de questões específicas e bem definidas, como as que a OIT propõe, em futuros levantamentos sobre as condições de trabalho, emprego e saúde poderá auxiliar tal objetivo e proporcionar uma oportunidade para observar os efeitos do teletrabalho no domicílio na saúde do trabalhador, bem como avaliar o impacto de uma necessária e urgente regulamentação.

Abstract Introduction: teleworking at home, one of the mitigation measures adopted to control the COVID-19 pandemic, while attempting to maintain employment, has increased in many countries. Objective: to reflect on the meaning, magnitude and trends of teleworking at home, before and during the pandemic, focusing on its potential effects on the health of workers. Discussion: the precedent of Convention 177/1996 of the International Labour Organization (ILO) on home work, and the agreement on teleworking between social agents in the European Union of 2002, underscore the difficulties of regulating this new form of work organization, and the prevention of possible injuries and associated diseases, especially mental and musculoskeletal disorders. The investigation of its effects on health is a priority to base its regulation at the national and global level on scientific evidence. The incorporation of specific, well-defined questions, such as those proposed by the ILO, in questionnaires of future surveys on working conditions, employment and health may help in this objective and provide an opportunity to monitor the effects on health of teleworking at home, as well as evaluating the impact of its necessary and urgent regulation.

Resumen Introducción: el teletrabajo en el domicilio, una de las medidas adoptadas para controlar la pandemia de COVID-19, y al mismo tiempo mantener el empleo, se ha incrementado en diversos países. Objetivos: reflexionar sobre el significado, la magnitud y las tendencias del teletrabajo en el domicilio, antes y durante la pandemia, focalizando en sus potenciales efectos sobre la salud de los trabajadores. Discusión: el antecedente del Convenio 177/1996 de la Organización Internacional del Trabajo (OIT) sobre trabajo a domicilio, y el acuerdo sobre teletrabajo entre agentes sociales en la Unión Europea de 2002, muestran la dificultad de regular esta nueva forma de organización del trabajo, y de la prevención de las posibles lesiones y enfermedades asociadas, especialmente los trastornos mentales y musculoesqueléticos. La investigación de sus efectos sobre la salud es una prioridad para fundamentar en evidencias científicas su regulación a nivel nacional y global. La incorporación de preguntas específicas, bien definidas, como las que propone la OIT, en cuestionarios de futuras encuestas sobre condiciones de trabajo, empleo y salud podrán ayudar en este objetivo y propiciar una oportunidad para monitorizar los efectos del teletrabajo en el domicilio sobre la salud, así como evaluar el impacto de su necesaria y urgente regulación.

Condiciones de trabajo, seguridad y salud en la población económicamente activa y ocupada en áreas urbanas del Perú / Working, safety and health conditions in the economically active and employed population in urban areas of Peru

RESUMEN Objetivos: La presente investigación tiene como objetivo conocer las condiciones de trabajo, seguridad y sa lud en el trabajo de la población urbana económicamente activa ocupada del Perú. Materiales y métodos: Se realizó un estudio transversal basado en una muestra probabilística de áreas y multietápica en la que partici paron 3122 personas mayores de 14 años distribuidas en todo el país. Resultados : La mayoría fueron hombres (53,6%) entre 30 y 59 años (50%). En cuanto a las condiciones de trabajo, la mayoría labora más de 48 horas semanales (39,8%) y de lunes a sábado (44,7%). Respecto a las condiciones de seguridad, higiene, ergonómicas y psicosociales, los resultados mostraron una menor exposición de riesgo. Sobre las condiciones de salud, la mayoría refiere que no se identifican ni se evalúan los riesgos laborales en su puesto de trabajo (35,9%); que no tienen servicios de salud ocupacional (40,7%) ni un delegado o un comité de seguridad y salud (39,4%); y que no se le realizan evaluaciones médico ocupacionales (39,3%). Conclusiones: La población económica mente activa urbana ocupada del Perú se expone con más frecuencia al ruido, la radiación solar, las posturas incómodas y los movimientos repetitivos; trabaja rápido con poco control y esconde sus emociones; además, en los lugares de trabajo no se gestiona la salud ocupacional. Estas condiciones pueden afectar la salud de los trabajadores y la calidad del trabajo.

ABSTRACT Objetives: The present study aims to know the work, safety and health conditions at the jobs of the economically active urban population in Peru. Materials and Methods: A cross-sectional study was carried out based on a probabilistic sample of multistage areas in which 3122 people over 14 years of age distributed nationwide partici pated. Results: The majority were men (53.6%) between 30 and 59 years (50%). As for working conditions, most people work more than 48 hours per week (39.8%), and Monday through Saturday (44.7%). Regarding the safety, hygiene, ergonomic and psychosocial conditions, the results showed a lower risk exposure. Regarding health conditions, the majority report that the identification and evaluation of occupational hazards is not carried out in their workplace (35.9%), they do not have occupational health services (40.7%) or a delegate or a Health and sa fety committee (39.4%) and no occupational medical evaluations (39.3%). Conclusions: The economically active urban population of Peru is more frequently exposed to noise, solar radiation, awkward postures and repetitive movements, work at a fast pace with little control and hide their emotions; In addition, occupational health is not managed adequately in workplaces. These conditions may affect the health of workers and the quality of work.

Saúde do trabalhador no Equador: uma comparação com inquéritos sobre condições de trabalho na América Latina / Occupational health in Ecuador: a comparison with Latin-American surveys on working conditions / La salud ocupacional en Ecuador: una comparación con las encuestas sobre condiciones de trabajo en América Latina

Resumo Introdução: o Equador realizou recentemente seu primeiro inquérito sobre condições de trabalho. Objetivo: descrever as condições de trabalho e emprego e o estado de saúde dos trabalhadores equatorianos em uma amostra que permita comparação com inquéritos latino-americanos anteriores. Métodos: uma amostra de 1.713 trabalhadores foi selecionada do primeiro inquérito sobre condições de trabalho no Equador. Prevalências e intervalos de confiança de 95% (IC95%) foram calculados e comparados com inquéritos anteriores na Colômbia, Argentina, Chile, América Central e Uruguai. Resultados: homens foram frequentemente mais expostos a trabalho em condições perigosas, sendo as mais relatadas trabalho com ruído (81% dos homens e 69% das mulheres) e com movimentos repetitivos (56% dos homens e 48% das mulheres). Cerca de 31% dos homens e 19% das mulheres trabalhavam mais de 40 horas por semana. Quase 11% das mulheres e dos homens relataram uma autopercepção de saúde ruim. A prevalência de agravos ocupacionais foi a mais alta da região: 15% para homens e 8,4% para mulheres. Conclusão: este é um primeiro levantamento das condições de trabalho e emprego e do estado de saúde de trabalhadores no Equador. Harmonizar e aperfeiçoar os Inquéritos sobre Condições de Trabalho na América Latina deve ser uma meta prioritária para melhorar a vigilância em saúde do trabalhador na região.

Abstract Introduction: Ecuador has recently implemented its First Working Conditions Survey. Objective: to describe working and employment conditions and workers' health status in Ecuador in a sample that allows comparison with previous Latin American surveys. Methods: a sample of 1,713 workers was drawn from the First Working Conditions Survey in Ecuador. Prevalence and a 95% confidence Interval (95%CI) were calculated and compared with previous Latin American surveys in Colombia, Argentina, Chile, Central America, and Uruguay. Results: men were more often exposed to hazardous working conditions, with noise (81% of men and 69% of women), and repetitive movements (56% and 48%, respectively) being the most frequently reported. About 31% of men and 19% of women worked more than 40 hours per week. Almost 11% of both women and men reported poor self-perceived health status. The prevalence of occupational injury was the highest in the region: 15% for men and 8.4% for women. Conclusions: this is a first approach to the working and employment conditions and workers' health status in Ecuador. To harmonize and improve Working Conditions Surveys in Latin America should be a priority goal for enhancing regional occupational health surveillance.

Resumen Introducción: Ecuador ha realizado recientemente su primera encuesta sobre las condiciones de trabajo. Objetivo: describir las condiciones de trabajo y empleo y el estado de salud de los trabajadores en Ecuador en una muestra que permita la comparación con encuestas anteriores en América Latina. Métodos: se seleccionó una muestra de 1.713 trabajadores de la Primera Encuesta de Condiciones de Trabajo en el Ecuador. Se calculó la prevalencia y el intervalo de confianza del 95% (IC95%) y se comparó con las encuestas anteriores realizadas en América Latina - Colombia, Argentina, Chile, América Central y Uruguay. Resultados: hombres se exponen con mayor frecuencia a condiciones de trabajo peligrosas, siendo las más frecuentes el ruido (81% de los hombres y 69% de las mujeres) y los movimientos repetitivos (56% y 48%, respectivamente). Alrededor del 31% de los hombres y el 19% de las mujeres trabajan más de 40 horas por semana. Casi el 11% de las mujeres y de los hombres reportaron mala salud autopercibida. La prevalencia de lesiones ocupacionales fue la más alta de la región: el 15% para los hombres y el 8,4% para las mujeres. Conclusiones: este es un primer acercamiento a las condiciones de trabajo y empleo y al estado de salud de los trabajadores en el Ecuador. Armonizar y mejorar las Encuestas de Condiciones de Trabajo en América Latina debería ser un objetivo prioritario para mejorar la vigilancia de la salud ocupacional en esta región.

[Health care costs of occupational disease: analysis of a patient series at a public hospital]. / Costes sanitarios de las enfermedades profesionales: análisis de una serie de pacientes de un hospital público.

The consistent under-recognition of occupational diseases (OD) in Spain leads to an exchange of patients and resources between the country's National Health System and the Social Security System. We examined the direct healthcare costs of a series of patients diagnosed with OD by the Clinical Occupational Diseases Unit in a Barcelona hospital. Information on all care associated with the diagnosis of PD was systematically reviewed. The economic value of each episode of care was obtained from the hospital cost accounting and billing system. Overall, we computed costs for 524 episodes in 33 patients. The average cost was 345.5€, being highest for hospital admissions (4,032.5€). The average cost per patient was € 5,486.2, and for cancer € 15,223.3. These results highlight the need for coordination between the National Health System and the Social Security System so that OD can be appropriately recognized.

El infra-reconocimiento secular de las enfermedades profesionales (EP) en España provoca un intercambio de pacientes y recursos entre el Sistema Nacional de Salud y el de Seguridad Social. Se estimaron los costes asistenciales directos de una serie de pacientes de un hospital de Barcelona diagnosticados de EP por su Unidad de Patología Laboral. La información sobre todas las asistencias asociadas al diagnóstico de EP fue revisada sistemáticamente. El valor económico de cada asistencia se obtuvo de la contabilidad de costes y sistema de facturación del hospital. En total, se computaron 524 asistencias de 33 pacientes, con un coste medio de 345,5€, siendo el más alto para las hospitalizaciones (4.032,5€). El coste medio por paciente fue de 5.486,2€, y para el cáncer de 15.223,3€. Estos resultados ponen de manifiesto la necesidad de coordinación entre el Sistema Nacional de Salud y el de Seguridad Social para un adecuado reconocimiento de EP.

A hospital occupational diseases unit: an experience to increase the recognition of occupational disease.

BACKGROUND: Under-reporting and recognition of occupational diseases is a problem in countries with workers' compensation schemes. OBJECTIVE: To describe the role of a public hospital Occupational Disease Unit (ODU) in Barcelona that resulted in improved reporting and official recognition of occupational diseases from 2010 to 2017. METHODS: Hospital physicians referred possible cases of work-related disease to the ODU, where in-depth medical evaluations were then performed, and a detailed report addressing causation was generated. Patients with confirmed cases of occupational disease were counselled and followed while pursuing official recognition and benefits claims by the Spanish Social Security System. RESULTS: Between 2010 and 2017, 149 cases were referred to the ODU for evaluation. Of these, 80 (53.7%) were confirmed to have an occupational disease, 54 (67.5%) patients pursued official recognition, and to date 26 (48.1%) have been recognized by the Social Security System. The recognition rate varied by diagnosis group (p=0.003), and was highest for skin diseases (71.4%) and cancer (66.7%), and lowest for hearing loss (29.4%) and musculoskeletal disorders (16.7%). CONCLUSIONS: A hospital ODU can improve reporting and official recognition of occupational diseases that otherwise might not have been recognized. Expanding this experience to other Spanish and European hospitals could improve the efficiency of workers' compensation schemes and better support preventive policies.

[Sociodemographic and occupational factors related to exposure to psychosocial risk factors by occupation in Spain. The MatEmESp Project.] / Factores sociodemográficos y laborales relacionados con la exposición laboral a riesgos psicosociales por ocupación en España. Proyecto MatEmESp.

OBJECTIVE: The objective of the study is to describe the level of exposure to psychosocial risk factors by occupation in the Spanish working population and analyze their relationship with sociodemographic characteristics and employment conditions. METHODS: The Spanish Job-Exposure Matrix (MatEmESp) is used to describe the levels of exposure to psychosocial risk factors in 2005. We identified occupations with higher levels of exposure and analysed their relationship with employment conditions and sociodemographic characteristics. RESULTS: Levels of exposure to work influence were below the midpoint (50, on a scale from 0 to 100); for work pace, they were slightly above ( =46.8 and =50.8, respectively). The highest levels of exposure were found in manual occupations; some skilled occupations were also associated with high insecurity (economists) and work pace (managers). As social class and education decreased, insecurity increased (rho = 0.45 and 0.38 respectively), and both co-worker support (rho=-0.46 y -0.48, respectively) and influence (rho=-0.73 y -0.63, respectively) decreased. As the proportion of foreigners increased, support and influence decreased (rho =-0.44 and -0.43, respectively). As the number of employees increased, work influence decreased (rho =-0.38). Increases in temporary contracts were associated with a decrease in co-worker support (rho =-0.34) and influence (rho =-0.53) and, as overtime increased, work influence increased (rho = 0.49). CONCLUSION: This study confirms the presence of inequalities in exposure to psychosocial risk factors at work, depending on the occupation and the sociodemographic characteristics and employment conditions of the occupation performed.

OBJETIVO: El objetivo del estudio es describir el nivel de exposición a riesgos psicosociales por ocupación en población laboral española y analizar su relación con condiciones de empleo y características sociodemográficas. MÉTODOS: La Matriz Empleo Exposición Española (MatEmESp) es la fuente de información para la descripción de los niveles de exposición a riesgos psicosociales en 2005. Se identifican las ocupaciones con mayores niveles de exposición y se analiza su relación con condiciones de empleo y características sociodemográficas por ocupación. RESULTADOS: Se encontraron niveles de exposición a influencia en el trabajo inferiores al punto medio de la escala (50, escala de 0 a 100) y a ritmo en el trabajo ligeramente por encima ( =46,8 y =50,8). Los niveles más elevados de exposición estaban en ocupaciones manuales, algunas cualificadas presentaban también alta inseguridad (Economistas) y ritmo de trabajo (Directores/as). Conforme disminuía el nivel de clase social y de estudios, aumentaba la inseguridad (rho=0,45 y 0,38 respectivamente), y disminuía el apoyo de los compañeros (rho=-0,46 y -0,48) y la influencia en el trabajo (rho=-0,73 y -0,63). Conforme aumentaba la proporción de extranjeros, disminuía el apoyo e influencia (rho=-0,44 y -0,43); conforme aumentaba el número de asalariados, disminuía la influencia (rho=-0,38); el aumento en contratos temporales, disminuía el apoyo de los compañeros (rho=-0,34) e influencia (rho=-0,53); y conforme aumentaba el número de horas extraordinarias, aumentaba la influencia (rho=0,49). CONCLUSIONES: Este estudio confirma la existencia de desigualdades en la exposición a riesgos psicosociales en el trabajo en función de la ocupación y las características sociodemográficas y condiciones de empleo de la ocupación desempeñada.

[TRENDS IN OCCUPATIONAL INJURY AND DISEASE IN ARGENTINA, 1997-2015]. / Evolución de las lesiones por accidentes de trabajo y enfermedades profesionales en la República Argentina, 1997-2015.

OBJECTIVES: To describe temporal trends in occupational injuries (OI) and occupational diseases (OD) in Argentina, by severity of the injury, place of occurrence, economic activity and selected provinces, in the period 1997 to 2015. METHODS: The study population consists of the working population covered by the Argentine Law of Occupational Risks system, roughly 4 million people in 1997 and 9.5 million in 2015. The annual incidence rate of the OI and OD was calculated by using the number of reported cases divided by the mean number of employees covered by the system each year. To measure change in incidence over time, we calculated the overall percentage change (OPC), by dividing the difference between the incidence rate of the first minus the last year by the incidence rate of the last year. RESULTS: The overall incidence of OI and OD showed a greater decline for fatal (OPC=-65%) versus nonfatal injuries (OPC-23,3%). By place of occurrence, we observed a decrease in the incidence of nonfatal occupational injuries at the workplace (OPC =-47,7%), but an increase in occupational commuting OI (OPC =+123,4%). For OD, there was an increase in the incidence of nonfatal OD (OPC =393%), although the tendency showed both increases and declines among fatal occupational diseases. This pattern was consistent among different economic activities as well as in selected provinces. CONCLUSIONS: Observed trends are in line with other high-income countries, with decreasing nonfatal workplace OI, and increasing commuting OI and nonfatal OD. Further in-depth research is warranted on temporal trends in non-fatal OD.

OBJETIVO: Describir la tendencia temporal de las lesiones por accidentes de trabajo (LAT) y las enfermedades profesionales (EP) en Argentina, entre 1997 y 2015, según gravedad del daño, lugar de ocurrencia, actividad económica y provincia. MÉTODOS: La población de estudio está formada por la población trabajadora asalariada cubierta por el sistema de Riesgos del Trabajo de Argentina, que era de aproximadamente 4 millones en 1997 y de 9.6 millones en 2015. La tasa anual de incidencia de las LAT y EP se calculó según el número de casos notificados dividido por el promedio de trabajadores cubiertos por el sistema en cada año. Para medir el cambio temporal en la incidencia se calculó el porcentaje de cambio general (PCG), como el cociente de la diferencia entre tasa del primer año menos la del último año, dividido por la tasa del último año. RESULTADOS: La incidencia global de LAT y EP disminuyó de manera más pronunciada entre los mortales (PCG = -65,0%) que en los no mortales (PCG = -23,3%). Según el lugar de ocurrencia, se observó un descenso en la incidencia de las LAT no mortales en jornada (PCG = -47,7%) y un incremento de las in itinere (PCG = 123,4%). En relación a las EP, se apreció un aumento en la incidencia de las EP no mortales (PCG=393,0%). Las EP mortales mostraron una tendencia más oscilante. Estas tendencias se reproducen de manera similar tanto para las actividades económicas como para las provincias seleccionadas. CONCLUSIONES: Las tendencias observadas, especialmente en los últimos años, en las LAT y las EP en Argentina muestran un patrón similar al de países europeos, con un descenso de las LAT en jornada, mortales y no mortales, excepto para las LAT in itinere. Sin embargo, en el estudio de las EP no mortales se debe profundizar en el conocimiento más detallado y completo de su tendencia temporal.

Joint effect of paid working hours and multiple job holding on work absence due to health problems among basic education teachers in Brazil: the Educatel Study / Efecto conjunto de las horas de trabajo remunerado y el pluriempleo sobre la ausencia al trabajo por problemas de salud en profesores de educacuión básica en Brasil: el Estudio Educatel / Efeito conjunto das horas de trabalho remunerado e de múltiplos empregos sobre o absenteísmo por motivo de saúde entre professores de ensino básico no Brasil: Estudo Educatel

Abstract: The objectives were to assess the joint effect of working hours paid per week and multiple job holding on sickness absence, by sex, among basic education teachers in Brazil. This study is based on a survey carried out over a representative sample of 5,116 active basic education teachers in Brazil between 2015 and 2016 (Educatel Study). We created a dummy variable to assess the joint effect of weekly paid working hours [standard (35-40 hours); part-time (< 35 hours); moderately long (41-50 hours); and very long (> 50 hours)] and multiple job holding (working in several schools - no/yes). Working 35-40 hours in one school was the reference category. We conducted Poisson regression models with robust variance to obtain prevalence ratios (PR) and 95% confidence intervals (95%CI) of the association with self-certified sickness absence and medically certified sickness absence. Models were adjusted for age, type of contract and salary, and stratified by sex. Significant associations with sickness absence were only found among teachers working in more than one school. Associations with self-certified sickness absence were found among women with standard and men with moderately long working hours, and for both women and men working > 50 hours (PR: 1.21, 95%CI: 1.09-1.35; PR: 1.40, 95%CI: 1.18-1.66; respectively). Associations with medically certified sickness absence were found among teachers working > 50 hours, among women (PR: 1.30, 95%CI: 1.03-1.63) and men (PR: 1.41, 95%CI: 1.04-1.92). Teachers working longer hours in several schools could be suffering health problems, deriving in work absence.

Resumen: El objetivo de este estudio fue evaluar el efecto conjunto de las horas laborales pagadas semanalmente y pluriempleo, en relación con las ausencias por enfermedad, según el por sexo, entre profesores de educación básica en Brasil. Este estudio se llevó a acabo sobre una encuesta de una muestra representativa de 5.116 profesores activos de educación básica en Brasil, entre 2015 y 2016 (Estudio Educatel). Creamos una variable dummy para evaluar el efecto conjunto de las horas laborales pagadas semanalmente [estándar (35-40 horas); a tiempo parcial (< 35 horas); moderadamente largas (41-50 horas); y muy largas (> 50 horas)] y el pluriempleo (trabajando en varias escuelas no/sí). Estar trabajando 35-40h en una escuela fue la categoría de referencia. Se realizaron modelos de regresión de Poisson con varianza robusta para obtener la razón de prevalencia (RP) e intervalos de 95% de confianza (IC95%) de la asociación con las ausencias por enfermedad justificadas personalmente y las ausencias por enfermedad con certificado médico. Los modelos fueron ajustados por edad, tipo de contrato y salario, y estratificados por sexo. Las asociaciones significativas con ausencias por enfermedad se encontraron sólo entre profesores que trabajaban en más de una escuela. Las asociaciones con las ausencias por enfermedad justificadas personalmente se hallaron entre mujeres con horas de trabajo estándar y hombres con horas de trabajo moderadamente largas, y para ambos, mujeres y hombres trabajando > 50 horas (RP: 1,21, IC95%: 1,09-1,35; RP: 1,40, IC95%: 1,18-1,66; respectivamente). Las asociaciones con las ausencias por enfermedad con certificado médico se hallaron entre profesores trabajando > 50 horas, entre mujeres (RP: 1,30, IC95%: 1,03-1,63) y hombres (RP: 1,41, IC95%: 1,04-1,92). Los profesores que trabajan más horas en varias escuelas podrían estar sufriendo problemas de salud, ocasionando ausencias laborales.

Resumo: O estudo teve como objetivos avaliar o efeito conjunto das horas semanais de trabalho remunerado e do fato de ter vários empregos sobre o absenteísmo por motivo de doença entre professores de ensino básico, desagregado por sexo, no Brasil. Este estudo teve como base um inquérito realizado em uma amostra representativa de 5.116 professores de ensino básico em atividade no Brasil entre 2015 e 2016 (Estudo Educatel). Criamos uma variável dummy para avaliar o efeito conjunto das horas semanais de trabalho remunerado [padrão (35-40 horas); tempo parcial (< 35 horas); semana de trabalho moderadamente longa (41-50 horas) e muito longa (> 50 horas)] e múltiplos empregos (trabalho em mais de uma escola - não/sim). A categoria de referência foi o trabalho em uma única escola durante 35-40 horas semanais. Realizamos modelos de regressão de Poisson com variância robusta para obter razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) para a associação com ausência no trabalho por motivo de saúde alegado pelo próprio indivíduo, e com atestado médico. Os modelos foram ajustados para idade, tipo de vínculo de trabalho e salário, e estratificados por sexo. Os resultados só mostraram associações significativas com absenteísmo por motivo de saúde em professores que trabalhavam em mais de uma escola. Foram observadas associações com ausência por motivo de saúde alegado pelo próprio indivíduo em mulheres com semana de trabalho padrão e em homens com semana moderadamente longa, e em mulheres e homens que trabalhavam mais de 50 horas por semana (RP: 1,21, IC95%: 1,09-1,35; RP: 1,40, IC95%: 1,18-1,66; respectivamente). Foram encontradas associações com ausência com atestado médico entre professores que trabalhavam mais de 50 horas por semana, em mulheres (RP: 1,30, IC95%: 1,03-1,63) e homens (RP: 1,41, IC95%: 1,04-1,92). Professores brasileiros que trabalham horas longas em várias escolas podem sofrer problemas de saúde, levando ao absenteísmo.

The burden of disease in Spain: Results from the Global Burden of Disease 2016. / La carga de enfermedad en España: resultados del Estudio de la Carga Global de las Enfermedades 2016.

BACKGROUND AND OBJECTIVES: The global burden of disease (GBD) project measures the health of populations worldwide on an annual basis, and results are available by country. We used the estimates of the GBD to summarise the state of health in Spain in 2016 and report trends in mortality and morbidity from 1990 to 2016. MATERIAL AND METHODS: GBD 2016 estimated disease burden due to 333 diseases and injuries, and 84 risk factors. The GBD list of causes is hierarchical and includes 3 top level categories, namely: 1) communicable, maternal, neonatal, and nutritional diseases; 2) non-communicable diseases (NCDs), and 3) injuries. Mortality and disability-adjusted life-years (DALYs), risk factors, and progress towards the sustainable development goals (SDGs) are presented based on the GBD 2016 data in Spain. RESULTS: There were 418,516 deaths in Spain in 2016, from a total population of 46.5 million, and 80.5% of them occurred in those aged 70 years and older. Overall, NCDs were the main cause of death: 388,617 (95% uncertainty interval 374,959-402,486), corresponding to 92.8% of all deaths. They were followed by 3.6% due to injuries with 15,052 (13,902-17,107) deaths, and 3.5% communicable diseases with 14,847 (13,208-16,482) deaths. The 5 leading specific causes of death were ischaemic heart disease (IHD, 14.6% of all deaths), Alzheimer disease and other dementias (13.6%), stroke (7.1%), chronic obstructive pulmonary disease (6.9%), and lung cancer (5.0%). Remarkable increases in mortality from 1990 to 2016 were observed in other cancers, lower respiratory infections, chronic kidney disease, and other cardiovascular disease, among others. On the contrary, road injuries moved down from 8th to 32nd position, and diabetes from 6th to 10th. Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position. The greatest changes in DALYs were observed for road injuries dropping from 4th to 16th position, and congenital disorders from 17th to 35th; conversely, oral disorders rose from 25th to 17th. Overall, smoking is by far the most relevant risk factor in Spain, followed by high blood pressure, high body mass index, alcohol use, and high fasting plasma glucose. Finally, Spain scored 74.3 of 100 points in the SDG index classification in 2016, and the main national drivers of detrimental health in SDGs were alcohol consumption, smoking and child obesity. An increase to 80.3 points is projected in 2030. CONCLUSION: Low back and neck pain was the most important contributor of disability in Spain in 2016. There has seen a remarkable increase in the burden due to Alzheimer disease and other dementias. Tobacco remains the most important health issue to address in Spain.

Propuesta de indicadores para la vigilancia de la salud ocupacional en América Latina y el Caribe / Proposed indicators for occupational health surveillance in Latin America and the Caribbean / Proposta de indicadores para vigilância em saúde ocupacional na América Latina e Caribe

RESUMEN Este artículo propone un conjunto básico y común de indicadores para la vigilancia en salud ocupacional en América Latina y el Caribe e identifica las fuentes de datos disponibles para su medición. Para ello, se llevó a cabo un proceso de consenso de la Red Experta en Encuestas sobre Condiciones de Trabajo, Empleo y Salud (RED ECoTES) en dos etapas. En la primera etapa, se consensuó un primer listado de indicadores, y en la segunda etapa, se identificaron las fuentes de datos y sus características, con el fin de facilitar la comprobación de la factibilidad del cálculo real de cada indicador en 20 países de la Región. La propuesta del conjunto básico de indicadores, y sus definiciones, está conformado por 13 indicadores distribuidos en cuatro dimensiones: condiciones de empleo (tres indicadores), condiciones de trabajo (cuatro indicadores), recursos y actividades preventivas (dos indicadores) y salud (cuatro indicadores). Las principales fuentes disponibles para calcular estos indicadores en la Región fueron las encuestas permanentes de hogares, las encuestas de condiciones de trabajo, empleo y salud, las estadísticas vitales, y los sistemas de notificación de lesiones por accidentes de trabajo. En la Región existen datos para un número relevante de los indicadores propuestos. Sin embargo, un número importante de aquellos orientados a las condiciones de trabajo y actividades preventivas están ausentes en la mayoría de países. La vigilancia efectiva de la salud ocupacional en la Región exige impulsar decididamente las encuestas sobre condiciones de empleo, trabajo y salud en cada uno de los países que la conforman.

ABSTRACT This article proposes a set of common basic indicators for occupational health surveillance in the region of Latin America and the Caribbean and identifies the sources of data that are available for their measurement. To this end, consensus was built among members of the Expert Network on Working, Employment, and Health Conditions Surveys (RED ECoTES) in two stages. In the first stage, a preliminary list of indicators was agreed upon; in the second stage, data sources and their characteristics were identified to help determine the feasibility of measuring the actual value of each indicator in 20 countries of the region. The proposed set of basic indicators, together with their definitions, is composed of 13 indicators in four areas: employment conditions (three indicators), working conditions (four indicators), resources and preventive activities (two indicators), and health (four indicators). The primary sources of data available in the region for calculating these indicators were: permanent household surveys; surveys on conditions of work, employment, and health; vital statistics; and reporting systems for occupational injuries. Data are available in the region for many of the proposed indicators, but a sizable number of those having to do with working conditions and preventive activities are not available in most countries. For effective occupational health surveillance in the region, surveys on conditions of work, employment, and health must be vigorously promoted in each country.

RESUMO Neste artigo é proposto um conjunto básico de indicadores comuns para vigilância em saúde ocupacional na América Latina e Caribe, com a identificação das fontes de dados disponíveis para mensuração destes indicadores. A Rede Latino-Americana de Especialistas em Inquéritos sobre Condições de Trabalho, Emprego e Saúde (REDE ECoTES) conduziu um processo de decisão por consenso em duas etapas. A primeira etapa consistiu da seleção inicial dos indicadores e a segunda etapa compreendeu a identificação das fontes de dados e suas características, com o propósito de facilitar comprovar a viabilidade do cálculo efetivo de cada indicador em 20 países da Região. É proposto um conjunto básico de indicadores e respectivas definições contendo 13 indicadores distribuídos em quatro dimensões: condições de emprego (três indicadores), condições de trabalho (quatro indicadores) e recursos e atividades de prevenção (dois indicadores) e saúde (quatro indicadores). As principais fontes disponíveis na Região para determinar os indicadores são: as pesquisas permanentes de domicílios, as pesquisas sobre as condições de trabalho, emprego e saúde, as estatísticas vitais e os sistemas de notificação de acidentes de trabalho. Existem dados disponíveis para o cálculo de um número relevante dos indicadores propostos. Porém, a maioria dos países não dispõe de dados para calcular um número importante dos indicadores relacionados às condições de trabalho e atividades de prevenção. A vigilância efetiva em saúde ocupacional requer um firme incentivo às pesquisas sobre as condições de emprego, trabalho e saúde em cada país da Região.

Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Exposure to Psychosocial Risk Factors at Work and the Incidence of Occupational Injuries: A Cohort Study in Spain.

OBJECTIVES: The aim of this study is to analyze the association between the exposure to psychosocial risk factors at work and the incidence of occupational injuries (OIs). METHODS: A prospective dynamic cohort study (n = 16,693) of 1-year follow-up. Psychosocial risk factors at work were assessed with the Spanish version of Copenhagen Psychosocial Questionnaire. Incidence rates of OI per 1000 workers-year were calculated and associations between psychosocial risk factors and OI were estimated by Poisson regression models. RESULTS: Unfavorable levels of esteem in men [rate ratio (RR) = 1.28], and unfavorable levels of social support and quality of leadership (RR = 1.87), psychological demands (RR = 2.20), and active work and possibilities for development (RR = 1.83) among women, were associated with OI incidence. CONCLUSIONS: Poor quality of psychosocial work environment increases the incidence of OI. Psychosocial intervention programs could be helpful in order to reduce OI incidence rates and their associated costs.