Risk Management in the Ambulatory Care Process in a Mutual Benefit Association Covering Work-Related Accidents and Diseases: Applying Modified Failure Mode and Effect Analysis (FMEA) Methodology.

AIM: To assess the impact of different forms of use of failure mode and effect analysis methodology for risk prioritization in the ambulatory care process in a mutual benefit association covering work-related accidents and diseases. METHODS: The study is based on a previously drafted and individually prioritized risk map by a multidisciplinary team made up of patient safety committee members from health care centers and clinics in a mutual benefit association covering work-related accidents and diseases. The professionals mainly carry out their work in the field of management (individual manager group (IMG)). A group formed by clinicians subsequently completed 2 prioritizations: one based on the individual opinions of each of the members (individual clinical group (ICG)) and another in a consensual way (consensual clinical group (CCG)) as recommended by failure mode and effect analysis methodology. The risk prioritization was compared in the 3 groups (IMG, ICG, and CCG). RESULTS: The risk prioritization by the IMG defines 7 extreme risks (risk prioritization ≥ 275). When the clinical group prioritizes them in an individual way (ICG), there is no extreme risk, whereas when it does so in a consensual way (CCG), there are 21 extreme risks. With respect to the coincidences of existing causes between the 3 groups, it is noted that the "risk of falls" is rated by both the clinical and the manager group but prioritized differently. On the other hand, the ICG and CCG coincide in that pressure on health care services can contribute to carrying out incomplete anamnesis. They also both consider that internal and external waiting lists and holiday periods can cause a delay in the starting of rehabilitation. The IMG and the CCG show similarity in the risk assessment of overprescribing medication and that multiple computer sessions are initiated. Finally, the IMG and the ICG coincide in the "lack of delivery of the medication leaflet". CONCLUSIONS: The point of view of the clinicians is important in the risk prioritization of the ambulatory health care process. The difference in the risk prioritization between the clinical group at individual level and after consensus is remarkable.

[Using Trigger Tool to detect incidents and adverse events in a mutual insurance company that collaborate with the Social Security system]. / Uso del Trigger Tool para la Detección de Incidentes y Eventos Adversos en una Mutua Colaboradora con la Seguridad Social.

OBJECTIVE: To evaluate differences between the detection of incidents or adverse events (I/AE) using a Trigger Tool (TT) and voluntary notification platform (SNEA). METHODS: The study population is the working population attended on an outpatient basis in an Insurance Company ("mutua") from January to September 2016. The cases declared as Incident or Adverse Event (I / AE) were selected through the SNEA (21 cases), according to whether the event has not affected the patient or on the contrary has affected him. On the other hand, 20 clinical histories per month were randomly selected where the TT was applied(180 cases). The 201 clinical histories were reviewed looking for the existence of triggers. The agreement between the SNEA system and the TT was evaluated using proportion of positive agreement (I/EA), proportion of negative agreement (not I/EA) and Kappa index. RESULTS: TT detected I/EA cases in 41.3% of the revisions while the SNEA was 10.3% (p<0.001). The Kappa index showed a low concordance value (Kappa = 0.12), which indicates the small coincidence of I/EA detected by both systems. The proportion of negative agreement was greater than that of positive agreement (74.5% versus 26.9%). The SNEA system detected less I/ EA and above all it deals with fewer incidents. On the contrary, the TT system detected a greater number of I EA and especially EA. CONCLUSIONS: Trigger Tool is a recommended tool for the detection of incidents or adverse events that can complement the one obtained through voluntary notification platform in the reality of a "mutua".

OBJETIVO. Evaluar diferencias entre la detección de incidentes o eventos adversos (I/EA) en una mutua laboral, mediante una herramienta tipo Trigger Tool (TT) y una plataforma de notificación voluntaria (SNEA). MÉTODOS. La población de estudio es la población trabajadora atendida ambulatoriamente en una mutua laboral de Enero a Septiembre del 2016. Se seleccionaron los casos declarados como I/EA según si el evento no ha afectado al paciente o por el contrario le ha afectado, a través del SNEA (n=21 casos). Por otro lado, se seleccionaron aleatoriamente 20 historias clínicas por mes donde se aplicó la herramienta TT (180 casos). Se adaptaron 11 triggers para detectar I/EA. Se revisaron las 201 historias clínicas buscando la existencia de triggers. Se obtuvo la concordancia entre el sistema SNEA y el TT utilizando la proporción de concordancia positiva (I/EA), proporción de concordancia negativa (no I/EA) e índice Kappa. RESULTADOS. TT detectó casos de I/EA en el 41,3% de las revisiones mientras que el SNEA 10,3% (p<0,001). El índice Kappa ofreció un valor de concordancia baja (Kappa=0,12) lo que denota la pequeña coincidencia de sucesos adversos detectados por ambos sistemas. La proporción de concordancia negativa fue mayor que la de concordancia positiva (74,5% frente a un 26,9%). El sistema SNEA detectó menos I/EA y sobre todo se trata de menos incidentes. Por el contrario, el sistema TT detectó mayor número de I/EA y especialmente EA. CONCLUSIONES. Trigger Tool es una herramienta recomendable para la detección de incidentes o eventos adversos que puede complementar la obtenida mediante una plataforma de notificación voluntaria en la realidad de una Mutua laboral.

[The analysis of sickness absence incidence by subgroups of duration]. / Segmentación de la incidencia de la incapacidad temporal según su duración como estrategia de análisis.

BACKGROUND: We describe the usefulness of performing an analysis of sickness absence (SA) incidence, segmented by the duration of episodes, in comparison with the more common analysis that considers the overall incidence of SA without segmentation. METHODS: We used data from a health insurance company ("mutua") in Spain during 2011 (230,332 episodes, 752,906 workers) and non-work related SA as a case study. We compared the overall incidence of SA and incidence segmented by duration of episodes: short (≤ 15 days), medium (16-30 and 31-90 days) and long (> 90 days). The analyses were also performed by age, as an example of one of the multiple variables that affect SA incidence. RESULTS: The overall incidence of SA was 30.6%, and declined steadily with increasing age. When SA incidence was analyzed by duration, we observed that: 1) the incidence of the episodes of short duration is the highest; 2) the overall excess observed in younger workers (<25 years) is driven mainly by short duration and 3) the pattern for long-term SA incidence was reversed, being more frequent among those ≥55 years of age relative to the youngest. CONCLUSIONS: Examining SA incidence by duration is more informative than relying on overall incidence of SA.

INTRODUCCIÓN: Se describe la utilidad de realizar un análisis de la incidencia de incapacidad temporal (IT) segmentado según la duración de los episodios, en comparación con el análisis que considera la incidencia global de la IT. MÉTODOS: Se considera un ejemplo utilizando datos de una mutua en España durante 2011 (230.332 episodios, 752.906 trabajadores) y la incapacidad temporal por contingencia común (ITcc). Comparamos la incidencia de ITcc global y la segmentada por la duración de los episodios: corta (≤ 15 días), media (16-30 y 31-90) y larga (> 90 días). Los análisis se realizaron también según edad, como ejemplo de una de las múltiples variables que afectan a la incidencia de la IT. RESULTADOS: La incidencia global de ITcc fue del 30,6%, mostrando una disminución con la edad (36,4% en <25 años frente a 29,3% en ≥55 años (RR = 1,24, IC del 95% = 1,22 - 1,27)). El análisis de la incidencia de ITcc segmentado por la duración de los episodios, permite obtener resultados más específicos: 1) la incidencia de corta duración es la más alta respecto al resto de segmentos (20,1% en la corta frente a 2,8% en larga duración (RR = 7,29, IC 95% = 7,19 ­ 7,40); 2) el exceso global observado en jóvenes se produce mayoritariamente por los episodios cortos (RR = 1,98, IC del 95% = 1,93-2,03, en <25 años frente a ≥55 años), y 3) la incidencia de larga duración cambia este patrón, siendo más frecuente en ≥55 años (5,2%) en relación a jóvenes (1,6%)(RR = 0,31, IC 95% = 0,29-0,34). CONCLUSIONES: El análisis de la incidencia de IT segmentada por duración ofrece una aproximación más precisa que la obtenida del análisis global.

[PELFI Project: Recruitment and Sociodemographic Characteristics of Immigrant and Autochthonous Families from Alicante and Barcelona City Subcohorts]. / Proyecto PELFI: reclutamiento y características sociodemográficas de las familias inmigradas y autóctonas de las sub-cohortes de Alicante y Barcelona.

This study is a part of the multi-centre project "Platform of Longitudinal Studies of Immigrant Families (PELFI)" of the Immigration and Health Subprogram of the CIBER-ESP. It describes the field work and data collection of two sub-cohorts of immigrant and native families, and their main socio-demographic characteristics. Prospective observational cohort study in carried out in Barcelona and Alicante, Spain. The study population is a a non-probabilistic sample of 180 families of Colombian, Ecuadorian and Moroccan origin and 50 families of Spanish origin. We interviewed adults aged 18-65 years and adolescents aged 12-17 years in each family, through two questionnaires (adolescent/adult). The cooperation rate was 82.0% with an average recruitment rate of 1.3 families per day. In total, 250 families have been recruited, 82 from Ecuador, 82 from Colombia, 29 from Morocco and 57 from Spain. A total of 473 adults (59.8% women and 68.5% employed) were surveyed. Immigrant adults have an average of 13 years living in Spain. A total of 304 adolescents (53.9% female, 27.1% born in Spain but with immigrant parents) were surveyed. The combination of non-probabilistic techniques promoted access and improved recruitment speed. This study provides key information for the design and improvement of cohort studies with immigrant families.

Este artículo corresponde al "Proyecto de Estudios Longitudinales de Familias Inmigradas (PELFI)" del Subprograma de Inmigración y Salud del CIBERESP y describe el trabajo de campo basal y principales características socio-demográficas de dos sub-cohortes de familias inmigrantes y autóctonas. El diseño es observacional prospectivo. La población de estudio se definió como una muestra no probabilística de 180 familias de origen colombiano, ecuatoriano y marroquí y 50 españolas. Se entrevistó a a 473 personas adultas entre 18 y 65 años (59,8% mujeres, 68,5% ocupados/as) y a 304 adolescentes entre 12 y17 años (53,9% mujeres, 27,1% nacidos en España pero de padres inmigrados) de cada familia, mediante dos cuestionarios diseñados ad hoc. La tasa de cooperación fue del 82,0% con una velocidad media de reclutamiento de 1,3 familias diarias. En total, se reclutó a 250 familias, 82 procedentes de Ecuador, 82 de Colombia, 29 de Marruecos y 57 españolas. Los adultos inmigrados llevaban una media de 13 años en España. Las combinación de técnicas no probabilísticas permitió el acceso y velocidad de reclutamiento. Este estudio aporta información clave para el diseño y mejora de este tipo de cohortes en familias inmigradas.

Incidence of sickness absence by type of employment contract: one year follow-up study in Spanish salaried workers.

BACKGROUND: To examine the differences in the incidence of registered sickness absence by type of employment contract in a large representative sample of salaried workers in Spain in 2009. METHOD: A study of 653,264 salaried workers covered by the Social Security system who had 133,724 sickness absence episodes in 2009. Crude and adjusted rate ratios and their corresponding 95 % confidence intervals (CIs) were calculated with Poisson regression models. RESULTS: The incidence rate per 100 workers-year of sickness absence for temporary workers (IR = 32.2) was slightly higher than that of permanent workers (IR = 28.9). This pattern was observed in both men (RR = 1.12; 95 % CI 1.10-1.14) and women (RR 1.11; 95 % CI 1.09-1.12). However, after adjusting for age, company size, and occupational category, the differences disappeared in men (aRR = 1.01; 95 % CI 0.99-1.02) and decreased in women (aRR = 1.06; 95 % CI 1.04-1.07). CONCLUSION: Our findings provide evidence on the independence of sickness absence benefits from the type of employment contract as well as on the nonexistence of incentives for taking sickness absence in workers with a permanent employment contract. In the context of increasing market flexibility, these results show a positive functioning of the Social Security system.

Informal employment and health status in Central America.

BACKGROUND: Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low- and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60% of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment. METHODS: Employment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract--only for employees--(written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables. RESULTS: Poor self-perceived health was reported by 34% of women and 27% of men, and 30% of women and 26% of men reported poor mental health. Lack of social security coverage was associated with poor self-perceived health (women, aOR: 1.38, 95% CI: 1.13-1.67; men, aOR: 1.36, 95% CI: 1.13-1.63). Almost all employment profiles with no social security coverage were significantly associated with poor self-perceived and poor mental health in both sexes. CONCLUSIONS: Our results show that informal employment is a significant factor in social health inequalities among Central American workers, which could be diminished by policies aimed at increasing social security coverage.

Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors.

OBJECTIVE: To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. METHODS: All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. RESULTS: We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). CONCLUSIONS: County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.

Effect of economic recession on psychosocial working conditions by workers' nationality.

BACKGROUND: Several publications have documented the effects of economic recessions on health. However, little is known about how economic recessions influence working conditions, especially among vulnerable workers. OBJECTIVE: To explore the effects of 2008 economic crisis on the prevalence of adverse psychosocial working conditions among Spanish and foreign national workers. METHODS: Data come from the 2007 and 2011 Spanish Working Conditions Surveys. Survey year, sociodemographic, and occupational information were independent variables and psychosocial factors exposures were dependent variables. Analyses were stratified by nationality (Spanish versus foreign). Prevalence and adjusted prevalence ratios (aPRs) of psychological job demands, job control, job social support, physical demands and perceived job insecurity were estimated using Poisson regression. RESULTS: The Spanish population had higher risk of psychological and physical job demand (aPR = 1.07, 95% CI = [1.04-1.10] and aPR = 1.05, 95% CI = [1.01-1.09], respectively) in 2011 compared to 2007. Among both Spanish and foreign national workers, greater aPR were found for job loss in 2011 compared to 2007 (aPR = 2.47, 95% CI = [2.34-2.60]; aPR = 2.44, 95% CI = [2.15-2.77], respectively). CONCLUSION: The 2008 economic crisis was associated with a significant increase in physical demands in Spanish workers and increased job insecurity for both Spanish and foreign workers.

Labour market trajectories and early retirement due to permanent disability: a study based on 14 972 new cases in Spain.

BACKGROUND: To analyse the impact of labour market trajectory indicators on early retirement, measured by age at onset of permanent disability (PD). METHODS: Four labour market trajectory indicators were reconstructed in 14 972 new cases of PD recognized between 2004 and 2010: (1) number of employment contracts, (2) number of unemployment periods, (3) number of periods without social security affiliation and (4) percentage of time spent in inactivity. The outcome was measured as the age at onset of PD. Median differences and 95% confidence intervals (95%CI) were compared using a median regression. Analyses were stratified by sex and adjusted for occupational category and total time elapsed between the beginning of working life and the age at onset of PD: separately for each labour market indicator, and adjusted for each other. RESULTS: In men, the age at the onset of PD for workers with 15 or more employment contracts decreased by 4.8 years; and for workers with five or more periods without affiliation it decreased by 4.6 years. In women, the corresponding decreases were 5.8 years for 15 or more contracts and 7.2 years for five or more unaffiliated periods. The results for four indicators slightly changed when they were mutually adjusted. CONCLUSIONS: Poor employment conditions, such as having a high number of periods without affiliation, a high number of contracts (in men) and a higher percentage of inactive time (in women) are associated with early retirement due to PD.

[Estimating the burden of disease due to permanent disability in Spain during the period 2009-2012]. / Estimación de la carga de enfermedad por incapacidad laboral permanente en España durante el período 2009-2012.

BACKGROUND: Permanent disability (PD) is a major social and economic burden. The aim of this study was to determine the burden of disease due to PD. METHODS: Using data from the Continuous Working Life Sample (CWLS) -a random sample consisting of 4% of the active members affiliated to the Social Security (SS) System in Spain (1.1 million members) which data come from administrative registries from the SS- the diagnosis of PD (2009-2012) was established from the information on the temporary sickness absence (TSA) episodes from 2009. The diagnoses were imputed if two criteria were fulfilled: long duration of TSA and short period of time between the TSA episode and PD. The burden of disease was estimated for cases with an established diagnosis of PD by using the potential years of working life lost (PYWLL), estimated as the difference between the legal retirement age (65 years) and the age at the start of a PD. RESULTS: In the CWLS, 163,135 (13.6%9 individuals suffered a TSA episode in 2009, out of which 4,738 were granted a PD pension in the period of 2009-2012. The diagnosis was established for 3,073 (64.9%) cases. A large percentage of PD was produced by musculoskeletal (27.4%) and mental disorders (11.6%), likewise these diagnoses produced more PYWLL due to a PD: 11,086 (26.5%) and 7,052 (16.9%), respectively. Mental disorders produced PD at younger ages (median= 49 years of age). CONCLUSION: Mental and musculoskeletal disorders represent a major burden of disease produced by PD and measured by PYWLL. The diagnoses of PD should become available in order to estimate with more accuracy the PYWLL produced by PD and specific diagnoses.

[The value of using administrative data in public health research: the Continuous Working Life Sample]. / La utilidad del uso de datos administrativos en la investigación de salud pública: la Muestra continua de vidas laborales.

The use of administrative data is common practice in public health research. The present field note describes the Continuous Working Life Sample (CWLS) and its use in health research. The CWLS is built on records generated by all contacts with the social security system (work contracts, disability, etc.), plus tax data (monetary gains, income, etc.) and census data (level of education, country of birth, etc.), but does not allow individuals to be identified. The CWLS was started in 2004 with 4% (1.1 million persons) of the total population who were either contributors to or beneficiaries of the social security system. The information on the individuals in the CWLS is updated annually and lost individuals are replaced. This continuous design allows the construction of a cohort with information on working life and financial status and evaluation of their relationship with work disability. Future connection with clinical records would enable analysis of other health-related outcomes.

From the boom to the crisis: changes in employment conditions of immigrants in Spain and their effects on mental health.

BACKGROUND: Migrant workers have been one of the groups most affected by the economic crisis. This study evaluates the influence of changes in employment conditions on the incidence of poor mental health of immigrant workers in Spain, after a period of 3 years, in context of economic crisis. METHODS: Follow-up survey was conducted at two time points, 2008 and 2011, with a reference population of 318 workers from Colombia, Ecuador, Morocco and Romania residing in Spain. Individuals from this population who reported good mental health in the 2008 survey (n = 214) were interviewed again in 2011 to evaluate their mental health status and the effects of their different employment situations since 2008 by calculating crude and adjusted odds ratios (aORs) for sociodemographic and employment characteristics. FINDINGS: There was an increased risk of poor mental health in workers who lost their jobs (aOR = 3.62, 95%CI: 1.64-7.96), whose number of working hours increased (aOR = 2.35, 95%CI: 1.02-5.44), whose monthly income decreased (aOR = 2.75, 95%CI: 1.08-7.00) or who remained within the low-income bracket. This was also the case for people whose legal status (permission for working and residing in Spain) was temporary or permanent compared with those with Spanish nationality (aOR = 3.32, 95%CI: 1.15-9.58) or illegal (aOR = 17.34, 95%CI: 1.96-153.23). In contrast, a decreased risk was observed among those who attained their registration under Spanish Social Security system (aOR = 0.10, 95%CI: 0.02-0.48). CONCLUSION: There was an increase in poor mental health among immigrant workers who experienced deterioration in their employment conditions, probably influenced by the economic crisis.

Measuring employment precariousness in the European Working Conditions Survey: the social distribution in Europe.

BACKGROUND: Precarious employment is becoming an increasingly important social determinant of health inequalities among workers. The way in which contemporary employment arrangements and their health consequences are addressed in empirical research is mostly based on the contract-related or employment instability dimension. A broader conceptual approach including various important characteristics of the degrading of employment conditions and relations is needed. OBJECTIVE: The general objective of this paper is to empirically test a new multidimensional construct for measuring precarious employment in an existing database. Special focus is on the social distribution of precarious employment. METHODS: A subsample of 21,415 participants in the EU-27 from the Fourth European Working Conditions Survey-2005 was analysed. A cross-sectional study of the social distribution of precarious employment was conducted through the analysis of proportional differences according to gender, social class and credentials for the European Union as a whole and within each country. The 8 dimensions of the employment precariousness construct were represented by 11 indicators. RESULTS: In general, women, workers without supervisory authority, those with fewer credentials, and those living in Eastern and Southern European countries suffer the highest levels of precarious employment. Exceptionally, men, workers with supervisory authority and those with the highest credentials suffer the highest levels of long working hours, schedule unpredictability and uncompensated flexible working times. CONCLUSIONS: This article offers the first validation for an innovative multidimensional conceptualisation of employment precariousness applied to the analysis of existing survey data, showing the unequal distribution of precarious employment across the European labour force. This set of indicators can be useful for monitoring precarious employment.

Impact of economic crisis on mental health of migrant workers: what happened with migrants who came to Spain to work?

OBJECTIVES: To assess changes in mental health in a sample of migrant workers after the eruption of the economic crisis in Spain. METHODS: 318 migrant workers were interviewed. Mental health, sociodemographic, and economic crisis related variables were obtained through face-to-face (2008) and phone (2011) interviews. Prevalence of poor mental health (PMH) was compared (2011-2008) and multivariate logistic regression models were fitted. RESULTS: Change in prevalence of PMH was higher in men (aOR 4.63; 95 % CI 2.11-10.16). Subgroups of men showing the largest detrimental mental health effects were: unemployed, with low salaries (≤1,200 euros) and those reporting family burden. An increase of PMH was found in women, without significant associations. CONCLUSIONS: Mental health of migrant workers in Spain has worsened during the economic crisis.

A new typology of policies to tackle health inequalities and scenarios of impact based on Rose's population approach.

The last decade has witnessed a surge in interest for policies to tackle health inequalities. Adequate theoretical development of policy models is needed to understand how to design and evaluate equity-oriented health policies. In this paper we review Graham's typology of policies (focused on the worst-off, on the gap, or on the gradient) and propose an adaptation (targeted, universal with additional targeting, redistributive, and proportionate universalism). For each type, potential scenarios of impact on population health and health inequalities are depicted following the idea of Geoffrey Rose's population curves and strategies, policy examples are given and a simulation with survey data is shown. The proposed typology of scenarios of health inequality reduction can serve as an effective tool to interpret the differential impact of interventions and to reflect on how to adequately design or re-orient a policy and which measures to use to evaluate it.

Occupational factors associated with the potential years of working life lost due to a non-work related permanent disability.

OBJECTIVE: To analyze the association between occupational factors (number of contracts and occupational category) and potential years of working life lost (PYWLL) due to non-work related permanent disability (PD). PARTICIPANTS: The study design was a retrospective cohort of 11,812 workers affiliated with the Social Security System in Spain that began a non-work related PD between 2004 and 2009. METHODS: The PYWLL was defined as the time in years between the age at which a worker initiates a PD and age 65 or the age of reinstatement to a job. The PYWLL was analyzed by calculating the quartiles and using an approach based on a median regression. RESULTS: The difference in medians of PYWLL between men and women was 2.49 years (95% CI: 2.01-2.97); between skilled non-manual and unskilled manual workers was 1.88 years (95% CI: 1.08-2.69); between workers with three or more contracts and workers with a single contract in the period was 3.78 years (95% CI: 3.28-4.29). CONCLUSION: Women, non-skilled workers and employees that have had more contracts within the period of study are those with greatest loss of PYWLL. This suggests that individuals with poorer working and employment conditions could have more PYWLL.

Monitoring the cluster of high-risk mortality areas in the southwest of Spain.

Inspired by a previous study showing a striking geographical mortality clustering, not attributable to chance, in the south-western region of Spain in 1987-1995, the authors have conducted an ecological study of time trends in all-cause mortality risk between 1987-1995 and 1996-2004 in 2,218 small areas of Spain. To identify high-risk areas, age-adjusted relative risks for each area, stratified by sex and time period, were computed using a Bayesian approach. Areas of high-risk in both periods, or in the second period only, were identified. Annual excess mortality and percentage of people living in these high-risk areas, again stratified by sex and time period, were estimated. The cluster of high mortality risk areas identified in the southwest of Spain during 1987-1995 persisted in the period 1996-2004 with an increase in the number of high-risk areas and in annual excess of mortality. These increases showed a gender difference, being more pronounced in women.

[Time series of permanent disability in Spain (1992-2010)]. / Tendencia temporal de la incapacidad laboral permanente en España (1992-2010).

BACKGROUND: Permanent disability (PD) is an occupational health problem that involves occupational, healthcare and legal factors that have changed in Spain over recent years. The aim of this study was to describe the trend of the incidence of PD in Spain. METHODS: Based on Social Security System data on enrolment and PD in Spain, we graphically described the time trend of the annual incidence of PD in the period between 1992 and 2010. In order to assess the trends, the Annual Percent Change (APC) and its confidence interval (CI 95%) was estimated through a binomial negative regression model. RESULTS: The incidence trend of PD was divided into three periods. The initial period (1992 to 1997) showed a constant incidence of approximately 75 cases per 10,000 workers (ACP= -0.1; IC 95%:-1.6, 1.4). This period was followed by a 3 year period reaching approximately 50 new cases per 10,000 workers in the year 2000 (ACP:-12.1%; CI 95%:-13.9; -10.4). Lastly, there was a 10 year period until the year 2010 in which the incidence was stable (ACP= 0.4; IC 95%:-0.2; 1.0). CONCLUSIONS: Despite the increase in social security affiliates in the studied period, the incidence of PD was fairly stable during this period, with a decline between 1997 and 2000, which could be attributed to measures of evaluation and monitoring of IP adopted in 1995.

Beyond Rose's strategies: a typology of scenarios of policy impact on population health and health inequalities.

There is growing interest and debate in the area of policy strategies to tackle health inequalities, as well as the impact of health policies and non-health-sector policies on the health of populations. Geoffrey Rose's milestone idea of a population strategy to "shift the curve" has provided key insights for both research and policy on social determinants of health. However, changes that occur both in the overall shift and in the shape of the curve (i.e., in inequality) should also be considered. This article presents a classification of policies and interventions based on all possible outcome scenarios of changes in population health and health inequalities, with examples of real policies.

Methods for the study of employment relations and health inequalities in a global context.

The authors describe the major methods and sources of information used in the EMCONET study for researching global, employment-related health inequalities. A systematic review of the literature provides valuable knowledge for research in this area. However, the limited number of studies, the poor quality of methods used, and a lack of theories or concepts have produced inconsistent results. To minimize bias from these limitations and to reach a comprehensive understanding of the complexity and health effects of global employment conditions, this article outlines key strategies for a synthetic, comprehensive, participatory approach: adapting transdisciplinary knowledge acquisition, building a theoretical model, employing multiple sources for data collection, and using a variety of methods (qualitative/ quantitative studies and narrative knowledge). This approach provides solutions to important research and policy needs regarding the global context of key employment relations, social mechanisms, and health inequalities. The strategies are adapted to synthesize input from several disciplines (epidemiology, sociology, and political science), social actors, and institutions. The study's main sources of information are a variety of digital, bibliographic databases; the authors reviewed the scientific literature from 1985 to 2008 and books, reports, and other documents from 2000 to 2008.