Lung cancer mortality attributable to residential radon exposure in Spain and its regions.

Lung cancer has the highest cancer mortality rate in developed countries. The principal risk factor for lung cancer is tobacco use, with residential radon being the leading risk factor among never smokers and the second among ever smokers. We sought to estimate mortality attributable to residential radon exposure in Spain and its Autonomous Regions, with correction for dwelling height and differentiation by tobacco use. We applied a prevalence-based method for estimating attributable mortality. For estimations, we considered exposure to radon in the different Autonomous Regions corrected for dwelling height, using the National Statistics Institute Housing Census and prevalence of tobacco use (never smokers, smokers and ex-smokers). The results showed that 3.8% (838 deaths) of lung cancer mortality was attributable to radon exposure of over 100 Bq/m3, a figure that rises to 6.9% (1,533 deaths) when correction for dwelling height is not performed. By Autonomous Region, the highest population attributable fractions, corrected for dwelling height, were obtained for Galicia, Extremadura, and the Canary Islands, where 7.0, 6.9, and 5.5% of lung cancer mortality was respectively attributable to radon exposure. The greatest part of the attributable mortality occurred in men and among smokers and ex-smokers. Residential radon exposure is a major contributor to lung cancer mortality, though this contribution is highly variable among the different territories, indicating the need for targeted prevention policies. Correction of estimates for dwelling height is fundamental for providing reliable estimates of radon-attributable mortality.

[Health and well-being of healthcare workers: employment and working conditions beyond the pandemic]. / Salud y bienestar del personal sanitario: condiciones de empleo y de trabajo más allá de la pandemia. Informe SESPAS 2024.

Healthcare workers are people who work in health activities, whether or not they have direct contact with citizens. Currently, around 1.3 million people (70% women) work in healthcare activities in Spain. This represents around 10% of the active population, having increased by 33% since 2008, especially the number of women, which has doubled. Healthcare organizations, especially hospitals, are extremely complex workplaces, with precarious working and employment conditions, especially in more hierarchical occupations, exposing healthcare workers to numerous occupational hazards, mainly from ergonomic and psychosocial conditions. These causes frequent musculoskeletal and mental disorders, highlighting burnout, which is estimated at 40% in some services such as intensive care units. This high morbidity is reflected in a high frequency of absences due to illness, around 9% after the pandemic. The pandemic, and its consequences in the last three years, has put extreme pressure on the health system and has clearly shown its deficiencies in relation to working and employment conditions. The hundreds of occupational health professionals, technicians and healthcare workers, who are part of the structures of health organizations, constitute very valuable resources to increase the resilience of the NHS. We recommend the strengthening in resources and institutionally of the occupational health services of health centers and the creation of an Observatory of working, employment and health conditions in the National Health Service, as an instrument for monitoring changes and proposing solutions.

COVID-19-related temporary disability in healthcare workers in Spain during the four first pandemic waves.

Healthcare workers (HCW) have been the professional category most exposed to SARS-CoV-2. The pandemic's impact on HCW was analyzed in terms of COVID-19-related temporary disability (TD) between February 15th, 2020 and May 1st, 2021. TDs in HCW for COVID-19 infection or quarantine were described. TD quarantine/infection ratios and TDs per 100,000 affiliated HCW were compared with the cumulative incidence (CI) of COVID-19 cases notified to the National Network of Epidemiological Surveillance. TDs rates by economic activity and occupation were computed. A total of 429,127 TDs were recorded, 36,6% for infection. Three-quarters (76%) were women. The median TD quarantine/infection ratio was 2.5 (Interquartile range [IQR] 1.5-3.9). TDs rates in HCW were always above the CI except for the last two months of the fourth wave. Hospital activities accounted for 84% of TDs and showed the highest TD rate for infection (8,279/100,000). Nursing professionals and midwifery, Physicians, and Nursing assistants accounted for 26, 18 and 17 % of the conceded TD respectively, whereas the highest TDs rates were registered among Nursing assistants, Nursing professionals and Physicians: 7,426, 6,925 and 5,508/100,000, respectively. The results indicate the high impact of COVID-19 on HCW in Spain and it's inequalities. They also confirm that TDs represent a complementary source of information for epidemiological and public health surveillance and could provide an early warning of new emerging infections.

Pleural cancer mortality in Spain: time-trends and updating of predictions up to 2020.

BACKGROUND: A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011-2015 and 2016-2020 in Spain. METHODS: Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions. RESULTS: Pleural cancer deaths increased across the study period, rising from 491 in 1976-1980 to 1,249 in 2006-2010. Predictions for the five-year period 2016-2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality. CONCLUSION: The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040.

Occupational diseases compensated in the Basque Country (Spain) from 1990 to 2008.

OBJECTIVE: Spain, and some of its regions in particular, report higher rates of occupational diseases than many other countries in Europe. We describe the distribution and temporal trend of compensated occupational diseases among the working population of the Basque Country, a heavy industrialized Spanish region, from 1990 to 2008. METHODS: Employment data and occupational disease data were obtained from the Spanish Institute of Statistics and the Basque and Spanish Social Security Departments, respectively. Annual incidence of occupational diseases and temporal trends were computed. RESULTS: Occupational diseases (33,547) were reported among workers in the Basque Country between 1990 and 2008. The occupational disease incidence increased sixfold during the study period, mainly due to less severe cases. The most frequent occupational diseases were caused by physical agents (85%), principally musculoskeletal disorders. The occupational disease incidence in Basque Country was two to six times higher than in most other regions of Spain and Europe. CONCLUSIONS: The rise in compensated occupational illnesses in the Basque Country is likely due to a mixture of better recognition of such illnesses and changes in laws, regulations, and administrative procedures. Chronic occupational diseases such as cancer and chronic respiratory diseases, however, remain under-reported, and care for people with such illnesses represents an undue financial burden on the public health care system and on their families.

[Analysis of Hospital Care Registers due to Silicosis in Spain, 1997-2020]. / Análisis de los procesos asistenciales hospitalarios por silicosis en España, 1997-2020.

OBJECTIVE: The re-emergence of silicosis in Spain since 2007 has been identified by the increase in the number of occupational disease reports. The aim of our study was to analyse the silicosis care processes attended by the National Health System between 1997 and 2020 to better understand the epidemiological dimension of the problem. METHODS: Processes were obtained from the Registro de Actividad Sanitaria Especializada (RAE-CMBD), with ICD-9-CM codes 500 and 502 (1997-2016) and ICD-10-CM J60, J62.0 and J62.8 (2017-2020). Descriptive statistical methods and modelling by logistic regression and Joinpoint regression methodology were applied. RESULTS: A total of 111,325 records were obtained (ages twenty-one hundred years), 4.3% for silicosis as the main diagnosis (PD) and 95.7% as a secondary diagnosis (SD). Men accounted for 98% and women for 2%. The mean age for SD processes was 75.1, and 68.7 for PD processes. The median age increased by eight years for SD and decreased by three years for PD. Although the overall burden of care decreased, under-fifty PD procedures between 2006 and 2009 showed an upward trend (APC=27.01%). SD processes showed a non-significant upward trend (APC=1.92%) between 2005 and 2020. CONCLUSIONS: The upward trend in silicosis care processes in people under fifty years of age since 2005 confirms the healthcare impact of the re-emergence of silicosis in Spain. The associated burden of care constitutes a present and future public health problem given the decreasing age of those affected.

OBJECTIVE: La remergencia de la silicosis en España desde 2007 ha sido objetivada por el incremento de partes de enfermedad profesional. El objetivo de nuestro estudio fue analizar los procesos asistenciales por silicosis atendidos por el Sistema Nacional de Salud entre 1997 y 2020 para una mejor comprensión de la dimensión epidemiológica del problema. METHODS: Se empleó el RAE-CMBD, aplicando los códigos CIE-9-CM 500 y 502 (1997-2016) y CIE-10-CM J60, J62.0 y J62.8 (2017-2020). Se aplicaron métodos de estadística descriptiva y modelización por regresiones logísticas y metodología de regresión Joinpoint. RESULTS: Se obtuvieron 111.325 registros (veinte-cien años), el 4,3% por silicosis como diagnóstico principal (DP) y el 95,7% como diagnóstico secundario (DS). El 98% eran hombres y el 2% mujeres. La edad media de los procesos por DS fue de 75,1, y de 68,7 para los procesos por DP. La mediana de edad aumentó ocho años para los DS y disminuyó tres para los DP. Aunque la carga asistencial global disminuyó, los procesos en menores de cincuenta años por DP entre 2006 y 2009 registraron una tendencia ascendente (APC=27,01%). Los procesos por DS mostraron una tendencia ascendente no significativa (APC=1,92%) entre 2005 y 2020. CONCLUSIONS: La tendencia al crecimiento de los procesos asistenciales por silicosis en menores de cincuenta años desde 2005 confirma el impacto asistencial de la remergencia de la silicosis en España. La carga asistencial asociada constituye un problema de Salud Pública presente y futuro dada la reducción de edad de los afectados.

[Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018.] / Recognition of pleural mesothelioma as an occupational disease in the Valencian Community from 2012 to 2018.

OBJECTIVE: Pleural mesothelioma is a neoplasm almost exclusively attributed to occupational exposure to asbestos and is legally considered an occupational disease. Nevertheless, only a few cases achieve that official recognition. The objective of this work was to describe and analyse this issue, and to identify the major obstacles to its recognition. METHODS: A descriptive and retrospective epidemiological study of data was carried out, including figures and some characteristics, of all patients with pleural mesothelioma registered in the official health and labor registries of the Valencian Community from 2012 to 2018, using frequencies, proportions, and incidence rates. RESULTS: There were large differences between the two sets of data collected in the different registries, especially regarding the number of cases. During the seven years of data examined, 590 pleural mesotheliomas were diagnosed in the Valencian public health system. Of these, the number of cases that were related to occupational exposure was at least 437. Despite the legal duty of doctors to report such cases, only 31 were reported as suspected occupational disease (7.09%), of which only 13 were ultimately officially recognized as such. It was estimated that the annual economic overcost to the public system of unrecognised patients with this occupational disease by was 2,2270,520 euros. CONCLUSIONS: Only a small proportion of occupational mesotheliomas are officially recognized as such. This has important health care and economic repercussions for the individuals involved as well as for the public health system.

OBJETIVO: El mesotelioma de pleura es un cáncer atribuido casi en exclusiva a la exposición laboral al amianto y que tiene la consideración legal de enfermedad profesional, aunque pocos casos consiguen ese reconocimiento oficial. Describir y analizar este problema y los obstáculos para su reconocimiento fue el objetivo de este trabajo. METODOS: Se realizó un estudio epidemiológico descriptivo y retrospectivo de las cifras y algunas características de todos los pacientes de mesotelioma de pleura recogidos en los principales registros oficiales, sanitarios y laborales, de la Comunidad Valenciana, desde 2012 a 2018, utilizando frecuencias, fracciones y tasas de incidencia. RESULTADOS: Hubo grandes diferencias en el número de casos recogidos en los distintos registros. En los siete años estudiados, los mesoteliomas de pleura diagnosticados en el sistema sanitario público valenciano fueron 590. De ellos, aplicando la fracción atribuible al trabajo con amianto, al menos 437 fueron atribuibles al trabajo. Los facultativos comunicaron 31 casos como sospechas de enfermedad profesional, el 7,09% del total, y, finalmente, 13 casos se reconocieron oficialmente como enfermedad profesional. El coste económico estimado de su atención sanitaria para el sistema público valenciano fue de 2.270.520 euros. CONCLUSIONES: Una mínima parte de los mesoteliomas obtienen el reconocimiento de enfermedad profesional. Este hecho conlleva importantes repercusiones asistenciales y económicas para las personas afectadas y para el sistema sanitario público.

[The impact of COVID-19 on sick leave of the persons working in nursing homes in Spain. Usefulness of sick leave for the surveillance of the pandemic evolution.] / El impacto de la Covid-19 en la incapacidad temporal de las personas que trabajan en centros socio-sanitarios en España. Utilidad de la incapacidad temporal para el seguimiento de la evolución de la pandemia.

OBJECTIVE: The nursing homes represented high-risk settings for SARS-CoV-2 infection, both for residents and for the employees. The COVID-19 impact on long-term care facilities (LTCFs) is evaluated, measured through the employees sick leave (SL). The pandemic evolution in the general population aged between 16 and 65 years was analyzed together with the sick leave to assess the latter as a complementary indicator of the SARS-CoV-2 surveillance. METHODS: A descriptive study of all sick leave processes due to COVID-19 recorded between February 15th 2020 and May 1st 2021 in nursing homes was carried out. The close contact sick leave/infection sick leave ratios, the 100,000 affiliated/occupied sick leave rates were computed and compared with the COVID-19 cases cumulative incidence notified to the National Network of epidemiological Surveillance (RENAVE). RESULTS: 261.892 SL processes were recorded. The close contact sick leave/infection sick leave median ratio in nursing homes was 1.8 (Interquartile range, ICR: 1.1-3.3), with values lower than 1 at certain periods. The infection sick leaves were higher in number and ratio and prior to the cases recorded in RENAVE. The sick leave ratio ranged between 81.679/100.000 occupied in nursing homes with medical care and 4.895/100.000 in other residential facilities. CONCLUSIONS: The results confirmed the dramatic impact of COVID-19 in nursing homes and the inequalities characterizing this impact. They also confirmed the potential use of sick leave as an alternative source for epidemiological and public health surveillance, especially now, when the transition of the COVID-19 surveillance to a system not including universal individual surveillance is being discussed.

OBJETIVO: Los centros sociosanitarios representaron entornos de alto riesgo de contagio por SARS-CoV-2, tanto para los residentes como para las personas trabajadoras. Se evaluó el impacto en términos de incapacidad temporal (IT) por COVID-19 en las personas que trabajan en centros sociosanitarios y se comparó con la evolución de la pandemia en la población general de 16 a 65 años, para valorar la utilidad de la IT como indicador complementario de la epidemia por SARS-CoV-2. METODOS: Se realizó un estudio descriptivo de todos los procesos de incapacidad temporal por COVID-19 registrados entre el 15 de febrero de 2020 y el 1 de mayo de 2021 en establecimientos residenciales. Se obtuvieron las ratios de incapacidad temporal por contacto estrecho /incapacidad temporal por infección, las tasas de incapacidad temporal por 100.000 afiliados/ocupados y se compararon con la incidencia acumulada de casos COVID-19 notificados a la Red Nacional de Vigilancia Epidemiológica (RENAVE). RESULTADOS: Se registraron 261.892 procesos de incapacidad temporal. La mediana de la ratio de incapacidad temporal por contacto estrecho /incapacidad temporal por infección en residencias fue de 1,8 (Rango intercuartílico, RIC: 1,1-3,3), con valores menores a 1 en periodos. Las IT por infección fueron superiores en número, tasa y anteriores en el tiempo a los casos registrados en RENAVE. Por tipo de residencia, la tasa de incapacidad temporal osciló entre 81.679/100.000 ocupados en asistencia en establecimientos residenciales con cuidados sanitaros y 4.895/100.000 en otros establecimientos residenciales. CONCLUSIONES: Los resultados confirmaron el enorme impacto que tuvo la COVID-19 en los centros sociosanitarios y la desigualdad que ha caracterizado este impacto. Apoyan también la posible utilización de la incapacidad temporal como fuente de información alternativa para la vigilancia epidemiológica y de salud pública, lo cual resulta de especial interés en este momento en el que se está planteando una transición en la vigilancia del COVID-19 hacia un sistema que ya no incluya una vigilancia individualizada universal.

[Vaccination against COVID-19 in working groups.] / La vacunación frente a la COVID-19 en colectivos laborales.

The Spanish Vaccination Strategy against COVID-19 has been prepared by a multidisciplinary Technical Working Group. It has considered the situation of the different socio-occupational groups against COVID-19, having assessed the criteria of risk of exposure, transmission, serious illness and death, negative social and economic impact, feasibility and acceptability of vaccination, in addition to taking into consideration the ethical pillars that govern the Strategy. In the working population, priority has been given to first-line health and social-healthcare personnel in the first stage and, later, to the rest of healthcare and social-healthcare personnel (Groups 1, 2 and 3 of the Strategy). Group 6 included emergency personnel, security and army forces, and early childhood, special, primary and secondary education teaching personnel, due to the role that they played during the state of alarm, the significant risk of exposure, and the essential role they play in maintaining the proper functioning of society. This paper describes the stages of vaccination and their prioritization by groups in the labour context, and shows the strategy by age groups, together with the prioritization of Group 6, has been shown to be efficient and to reach workers with high risk of COVID-19 early.

La Estrategia de Vacunación frente a COVID-19 en España ha sido elaborada por un Grupo de Trabajo Técnico multidisciplinar, que ha tenido en cuenta la situación de los diferentes grupos sociolaborales frente a COVID-19, habiendo valorado los criterios de riesgo de exposición, transmisión, enfermedad grave y muerte, impacto social y económico nega-tivo, factibilidad y aceptabilidad de la vacunación, además de tener en consideración los pilares éticos que rigen la Estrategia. Por lo que se refiere a la población trabajadora, se priorizó al personal sanitario y sociosanitario de primera línea en una primera etapa y, posteriormente, al resto de personal sanitario y sociosanitario (Grupos 1, 2 y 3 de la Estrategia). En el Grupo 6 se incluyó al personal de urgencias y emergencias, Fuerzas y Cuerpos de Seguridad del Estado y personal docente de educación infantil, especial, primaria y secundaria, por el papel desempeñado durante el estado de alarma, el importante riesgo de exposición, y la función esencial que desempeñan en el mantenimiento del adecuado funcionamiento de la sociedad. En este artículo se describen las etapas de la vacunación y su priorización por grupos en el contexto laboral, y se muestra que la estrategia por grupos de edad, junto con la priorización del Grupo 6, ha demostrado ser eficiente y alcanzar de forma precoz a los trabajadores con mayor riesgo de COVID-19.

[The re-emergence of silicosis as an occupational disease in Spain, 1990-2019.] / La remergencia de la silicosis como enfermedad profesional en España, 1990-2019.

OBJECTIVE: The presence of new sources of occupational exposure to crystalline silica has contributed to an increased incidence of silicosis. Spain was one of the first countries to identify new occupational risk sectors such as quartz agglomerates. The objective of this work was to describe the incidence of silicosis in Spain between 1990 and 2019 and to determine the main occupational sectors affected. METHODS: Data on occupational disease cases were obtained from the Spanish Ministry of Inclusion, Social Security and Migration. Disease rates were computed by occupational sector, and analyses were conducted of their time course and their geographical, sex and age distributions. RESULTS: Data were available on 4,418 cases (96.1% male). The mean annual number of cases was 1,223% higher between 2015 and 2019 than between 1990 and 1995. By occupational sector, 50% were in "Fabrication of other mineral non-metallic products", 18.5% in "Extraction of non-metallic non-energetic minerals", 10.2% in "Construction", 6.1% in "Metallurgy", 3.1% in "Coal mining" and 12% in other sectors. Galicia registered the greatest number of cases (32.9%), followed by Castile and León (14%), Andalusia (10%) and the Basque Country (9.1%). The greatest increase in its incidence was in coal mining, possibly due to the dismantling of this sector and drastic reduction in the workforce. CONCLUSIONS: Our results suggest the importance of the manufacturing, machining and installation of quartz agglomerates in the re-emergence of silicosis in Spain.

OBJETIVO: La existencia de nuevas fuentes de exposición laboral a sílice cristalina ha contribuido al aumento de la incidencia de silicosis. España es uno de los países pioneros en la identificación de nuevos sectores de riesgo como los aglomerados de cuarzo. El objetivo de este trabajo fue conocer la evolución de la silicosis en España entre 1990 y 2019 e identificar los principales sectores de exposición responsables. METODOS: Los partes de enfermedad profesional se obtuvieron de la Secretaría General de Planificación del Ministerio de Inclusión, Seguridad Social y Migraciones. Se calcularon tasas por actividad económica y se analizó la tendencia temporal de los partes, su distribución por sexo, edad y sector económico, así como su distribución territorial. RESULTADOS: Se recuperaron 4.418 partes (96,1% hombres, 3,9% mujeres). La media anual de partes del quinquenio 2015-2019 (404,2) creció un 1.223,2% respecto al primer quinquenio de la serie. Por sectores de actividad, la distribución fue: 50% "Fabricación de otros productos minerales no metálicos"; 18,5% "Extracción de minerales no metálicos ni energéticos"; 10,2% "Construcción"; 6,1% "Metalurgia"; 3,1% "Minería del carbón"; 12% demás sectores. Galicia concentró el 32,9% de los partes, seguida de Castilla y León (14%), Andalucía (10,3%) y País Vasco (9,1%). La "Minería del carbón" registró el mayor incremento de tasa en el intervalo estudiado, reflejo del desmantelamiento del sector. CONCLUSIONES: Los resultados de nuestro estudio señalan la centralidad del sector de los aglomerados de cuarzo en la remergencia de la silicosis en España, tanto en su fabricación como en su mecanizado e instalación.

Scabies in Spain? A comprehensive epidemiological picture.

INTRODUCTION: Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997-2019 as well as to describe the main environments of transmission using different data sources. METHODS: We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes. RESULTS: The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored. DISCUSSION: An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.

[COVID-19 outbreaks in occupational settings in Spain, one year of follow-up (June 2020-June 2021).] / Brotes de COVID-19 en el ámbito laboral en España, un año de seguimiento (junio 2020-junio 2021).

COVID-19 outbreak surveillance in Spain was established with the main objective of characterizing outbreaks and the settings in which they occurred, in order to identify those population groups at highest risk to support them with the implementation of preventive and control measures. Between June 2020 and June 2021, 55,824 outbreaks were reported, with 414,882 cases in all settings. About 12.5% were reported in an occupational setting and within this, most of them were identified in the industry and building sectors. The outbreaks that had a greater impact were those that took place both in agriculture and in the meat industry, where there is a higher risk of exposure due to living and working conditions. Outbreaks in the catering and home care sectors were also frequent. Since the beginning, there was coordination between all stakeholders involved in the management of the pandemic, in order to implement prevention and control measures, as well as social protection measures. In addition, special actions were implemented in the most vulnerable sectors. Despite the work carried out, the presence of outbreaks in these sectors continues, although they are smaller than the previous pandemic phase. Due to this, there is needed to continue strengthening the inter-sectoral coordination structures and mechanisms to ensure the implementation of those measures that contribute to the containment of the pandemic.

La vigilancia de brotes COVID-19 en España se estableció con el objetivo de caracterizar los brotes y los ámbitos en los que ocurrían, con el propósito de identificar aquellos grupos de población con mayor riesgo para apoyar la toma de medidas de prevención y control. Entre junio de 2020 y junio de 2021 se comunicaron 55.824 brotes con 414.882 casos en todos los ámbitos. Alrededor del 12,5% de brotes y casos asociados fueron comunicados en el ámbito laboral y dentro de éste, la mayoría se identificó en los sectores de la industria y construcción, si bien, entre los brotes que han tenido un mayor impacto se encuentran aquellos producidos en el sector agrícola y en la industria de la carne, donde existe un mayor riesgo de exposición debido a las condiciones de vida y trabajo. También destacaron los brotes en el sector de la restauración y hostelería, y cuidados a domicilio. Desde el inicio hubo una coordinación entre las administraciones implicadas en la gestión de la pandemia para poner en marcha las medidas de prevención y control, así como las de protección social. Además, se llevaron a cabo medidas especiales en sectores de mayor vulnerabilidad. A pesar del trabajo realizado, los brotes en estos sectores continúan ocurriendo, si bien son de menor tamaño, por lo que se deben continuar fortaleciendo las estructuras y mecanismos de coordinación intersectoriales para la aplicación de las medidas que contribuyen además de la contención de la pandemia, a mantener activo el tejido productivo.

[Contribution of the occupational health to the COVID-19 pandemic control.] / Contribución de la salud laboral al control de la pandemia por covid-19 en España.

When the World Health Organization declared Covid-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.

Cuando la Organización Mundial de la Salud declaró la Covid-19 como una emergencia de salud pública de importancia internacional, el Ministerio de Sanidad convocó a las autoridades sanitarias, laborales, de seguridad social, Inspección de Trabajo y Seguridad Social, Instituto Nacional de Seguridad y Salud en el Trabajo, empresarios, sindicatos, servicios de prevención de riesgos laborales, mutuas y sociedades científicas de la medicina y enfermería del trabajo, para colaborar en el control de la transmisión del SARS-CoV-2 en el ámbito de las empresas. La Ponencia de Salud Laboral de la Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud, elaboró el Procedimiento para los servicios de prevención de riesgos laborales frente a la exposición al SARS-CoV-2, que se ha actualizado 15 veces hasta la fecha. En él se recogen las medidas de prevención a implantar en los centros de trabajo: de carácter organizativo y de protección colectiva, de protección personal, de trabajador especialmente vulnerable y nivel de riesgo, de estudio y manejo de casos y contactos ocurridos en la empresa, de colaboración en la gestión de la incapacidad temporal y, más recientemente, de reincorporación y gestión de las y los trabajadores vacunados. Como resultado de esos marcos de cooperación y colaboración se desplegaron una serie de actividades en los lugares de trabajo que son descritas en este artículo.

[Interterritorial inequalities in compensation for occupational diseases in Spain from 1990-2007]. / Desigualdades interterritoriales en la compensación de las enfermedades profesionales en España de 1990 a 2007.

OBJECTIVES: To determine the reporting pattern and trends for occupational diseases by autonomous communities in Spain between 1990 and 2007. METHODS: Cases were obtained from the Ministry of Labor and Social Affairs, and the number of workers was obtained from the National Institute of Statistics. A principal components analysis was used to explain the data structure. Adjusted annual incidence rates were computed and relative risk is shown in maps. RESULTS: The number of reported occupational diseases remained constant from 1990 to 2005 in all the autonomous communities, except for minor occupational diseases not leading to sick leave (accounting for 99% of the total), which increased. From 2006-07, reported rates decreased to almost half: 17,061 cases in 2007 versus 30,030 in 2005. Both the increase and the decrease in incidence were observed in all autonomous communities, but with distinct values and slopes. As revealed by the principal components analysis, all the autonomous communities showed the same time pattern, except Asturias. Northern Spain showed the highest rates, which cannot be explained by factors such as age, sex, economic activity or occupation. CONCLUSIONS: The social security system is not compensating the complex and chronic diseases that are prevalent today. Despite improvements in disease reporting from 1990-2005, the decrease observed from 2006-07 and, above all, the gap among autonomous communities show that provision is not working with equity, generating inequality and lack of cohesion and posing a challenge for the definition of efficient prevention policies.

[Occupational diseases of musicians: the price of perfection]. / Las enfermedades profesionales de los músicos, el precio de la perfección.

BACKGROUND: Musicians suffer from a wide range of health problems related to their profession. The aim of this paper was to assess whether work-related musician diseases are included into the Official Spanish List of Occupational Diseases and, if so, to describe and quantify those recognized in recent years. METHODS: The Official Spanish List of Occupational Diseases was searched to identify occupational diseases affecting musicians. We then conducted an incidence study of those occupational diseases recognized under code 29.32 Composers, musicians and singers (CNO-2011) for the period 2007 to 2014. Cases and rates were described and represented by disease type, gender and year of recognition. RESULTS: Ten entries were identified as musician diseases in the official occupational disease list; mostly involved musculoskeletal disorders (MSD) and hearing loss. Mental health disorders and focal dystonia are not included in the list. In the period 2007-2014, 213 cases were identified, 120 for men and 93 for women. Of these, 81% were MSD, 11% hearing loss and 7% vocal cord nodules. The average incidence rate per 100,000 was 18.3 (19.1 in men and 17.3 in women). CONCLUSIONS: The official Spanish List of Occupational Diseases allows the recognition of most occupational diseases affecting musicians with the exception of focal dystonia and mental health disorders. Their inclusion should be evaluated. The highest incidence corresponds to musculoskeletal disorders.

OBJETIVO: En el ejercicio de su profesión los músicos pueden sufrir diferentes problemas de salud. El objetivo de este trabajo es analizar si éstos están incluidos en el cuadro de enfermedades profesionales y, de ser así, cuantificar y describir las que hayan sido reconocidas en los últimos años. MÉTODOS: Se realizó una búsqueda de todas las enfermedades que podrían ser incluidas como enfermedades profesionales en la legislación vigente. Se realizó un estudio de incidencia de las enfermedades profesionales reconocidas bajo el código 29.32 Compositores, músicos y cantantes (CNO-2011) en los años 2007 a 2014. Se describieron y representaron los casos y tasas obtenidas por tipo de enfermedad, sexo y año de reconocimiento. RESULTADOS: Se identificaron 10 entradas en el cuadro de enfermedades profesionales para las enfermedades de los músicos, principalmente trastornos músculo-esqueléticos (TME) e hipoacusia. Los trastornos mentales y la distonía focal no están incluidos. Se localizaron 213 enfermedades profesionales en 2007-2014, 120 en hombres y 93 en mujeres. El 81% fueron TME, el 11% hipoacusias y el 7% nódulos de las cuerdas vocales. La tasa de incidencia media para el periodo fue de 18,3 por cien mil, 19,1 en hombres y 17,3 en mujeres. CONCLUSIONES: El Cuadro de enfermedades profesionales contiene epígrafes que permiten la declaración de diferentes problemas de salud que padecen los músicos, a excepción de la distonía focal y de los trastornos mentales. La mayor incidencia corresponde a los trastornos músculo-esqueléticos.

[Occupational health administrative coordination a propos of a case: brake linings with asbestos in a company]. / La coordinación administrativa en salud laboral a propósito de un caso: Zapatas de freno con amianto en una empresa.

The current structure of the Spanish State of Autonomies is characterized by institutional pluralism and the autonomy of the different public administrations. In this context, the principle of coordination is fundamental for the cohesion of the system, but experience shows that its implementation is difficult. This paper examines the set of actions carried out by the administrations in relation to an occupational and public health problem raised in March 2016. The Public Health General Direction of Aragon's Government was informed of a possible use of brake linings with asbestos to manufacture axles for agricultural machinery by a Company from Zaragoza; the collaboration from Aragon's Institute of Occupational Safety and Health, the Industry Department and the Labour and Social Security Inspectorate were asked; the joint action of these administrations detected the use of several models of brake linings with a content of 2-5% of Chrysotile. The brake linings came from a Chinese company. The axles nated are sold in several Spanish Autonomous Communities. A national alert was activated by the SIRIPQ (System of Rapid Exchange of Information on Chemical Products) which is coordinated by the Ministry of Health, Social Services and Equality. Several measures were taken including: ceasing the work with the brake linings, the replacement of brake linings with asbestos, the immobilization of brake linings in the company by application of the REACH Reglament, etc. This case shows that the cooperation and co-responsibility of public administrations from different territorial, sectoral and competence areas allows improving the occupational risks prevention and the public health.

La actual estructura del Estado de las Autonomías se caracteriza por el pluralismo institucional y la autonomía de las diferentes administraciones públicas. En este contexto el principio de coordinación es fundamental para la cohesión del Estado, pero la experiencia muestra que es difícil su puesta en práctica. En este trabajo se examinó el conjunto de actuaciones realizado por las administraciones en relación a un problema de salud laboral y de salud pública planteado en marzo de 2016. La Dirección General de Salud Pública del Gobierno de Aragón tuvo conocimiento de la posible utilización por una empresa de Zaragoza de zapatas de freno con amianto para fabricar ejes de maquinaria agrícola. Se recabó la colaboración del Instituto Aragonés de Seguridad y Salud Laboral (ISSLA), del Departamento de Industria y de la Inspección de Trabajo y Seguridad Social, dichas administraciones detectaron la utilización de varios modelos de zapatas con un contenido de crisotilo del 2-5%. Las zapatas procedían de una empresa china. Los ejes eran comercializados en varias Comunidades Autónomas. Se activó una alerta nacional a través del SIRIPQ (Sistema de Intercambio Rápido de Información de Productos Químicos) coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad. Se tomaron medidas tales como el cese del trabajo con las zapatas, la sustitución de las ya instaladas mediante la aplicación de un Plan Único de Trabajo, la inmovilización de las zapatas presentes en la empresa, etc. Este caso muestra que la cooperación y la corresponsabilidad de administraciones públicas de diferentes ámbitos territoriales, sectoriales y competenciales permite mejorar la prevención de riesgos laborales.

Exposure to mercury in the mine of Almaden.

OBJECTIVES: To describe the process for obtaining mercury and the historical exposure of Almadén miners to mercury. METHODS: Information on every workplace and historical data on production, technological changes in the productive process and biological and environmental values of mercury was collected. A job-exposure matrix was built with these values and the exposure to inorganic mercury was estimated quantitatively as mug/l of urine mercury. A cumulative exposure index was calculated for every worker by adding the estimates for every year in the different workplaces. RESULTS: In the mine, the highest exposures occurred during drilling, with values up to 2.26 mg/m3 in air, 2194 microg/l in urine and 374 microg/l in blood. Furnace operation and cleaning were the tasks with the highest values in metallurgy, peaking up to 3.37 mg/m3. The filling of bottles with mercury by free fall gave values within a range of 1.13-2.43 mg/m3 in air; these values dropped to 0.32-0.83 mg/m3 after introducing a new ventilation system. The toxicity effects of high doses of inorganic mercury on the central nervous and urinary systems have been known for decades. CONCLUSIONS: The exposure of the workers in Almadén mines to mercury has been very high. The extremely high content cinnabar ore of the mine explains the increased concentrations of mercury in air at the work places. This, together with inadequate working conditions, explains the high mercury levels found in blood and urine during the study period.

[Cardiovascular mortality in mercury miners]. / Mortalidad por enfermedades cardiovasculares en los mineros de mercurio.

BACKGROUND AND OBJECTIVES: To study the mortality from cardiovascular diseases after long-term exposure to inorganic mercury. POPULATION AND METHOD: 3,998 workers exposed to mercury in Minas de Almadén y Arrayanes S.A. were studied. The follow-up period was a century, since 1895 to 1994. The study was completed assessing the vital status and the basic cause of death, in case of fatalities. Standardized mortality ratios (SMR) by age, sex and calendar period were calculated. Expected deaths were obtained from age, sex and calendar period specific from rates for the Spanish and regional populations. RESULTS: A significant increase in mortality due to circulatory diseases was found (SMR 1.11, 95% confidence interval [CI], 1.02-1.20), especially for hypertension (SMR 2.78, 95% CI, 1.89-3.95), cerebrovascular diseases (SMR 1.17, 95% CI, 1.01-1.35), and other diseases of the heart (SMR 1.51, 95% CI, 1.29-1.76). Ischemic heart disease showed a significant decrease in these workers, with an SMR 0.69, and a CI between 0.57 and 0.84. Cerebrovascular diseases showed a trend over the time since first exposure, duration of exposure and with the accumulated expected exposure, while none of the exposure variables was linearly associated with mortality due to ischemic heart diseases. There was also a trend over the time since first exposure for mortality due to hypertension and other heart diseases. CONCLUSIONS: This study suggests an association between long-term exposure to inorganic mercury in workers of mercury mines and an increased risk of circulatory mortality, especially mortality due to hypertension and cerebrovascular diseases.