[The FECYT seal of quality, a recognition and a stimulus for Archivos]. / El sello de calidad FECYT, un reconocimiento y un estímulo para Archivos.

Un año más, mediante esta nota editorial, damos cuenta de las estadísticas y los principales avances de nuestra revista. En cuanto a las estadísticas editoriales, que se detallan en los apartados posteriores, podemos afirmar que son las de una revista consolidada: flujo nutrido y constante de trabajos recibidos/publicados, tasas de aceptación y rechazo proporcionadas, tiempos de gestión razonables y diversidad en las autorías. El logro más destacable del 2023 fue superar con éxito el proceso de evaluación de la Octava edición de Evaluación de la calidad editorial y científica de las revistas científicas españolas, comúnmente conocido como 'Sello FECYT'….

Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys.

Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers.

OBJECTIVE: This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. METHOD: The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. RESULTS: Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. CONCLUSIONS: This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers' fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.

Recognition of COVID-19 with occupational origin: a comparison between European countries.

OBJECTIVES: This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe. METHODS: A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022. RESULTS: The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries. CONCLUSIONS: COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.

Traumatic stress symptoms among Spanish healthcare workers during the COVID-19 pandemic: a prospective study.

AIM: To investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress. METHODS: This is a multicenter prospective cohort study. Spanish healthcare workers (N = 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP). RESULTS: Thirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4-95.6%) and work-related stressful experiences (PARP range 76.8-86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety. CONCLUSIONS: TSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.

[COVID-19: it's time for its full recognition as an occupational disease]. / COVID-19, es el momento de su reconocimiento pleno como enfermedad profesional.

In a context of transition towards the end of the pandemic, we think it is time to recognize COVID-19 as an occupational disease. The steps taken to recognize it as a work accident in health workers represent progress, but it is not enough. It is a step that the European Commission has recently recommended, including it on the European list of occupational diseases, in all those activities with a clear risk of contagious. This would imply objective advantages for workers and companies.

En un contexto de transición hacia el final de la pandemia, pensamos que es el momento o de reconocer como enfermedad profesional la COVID-19. Los pasos dados de reconocimiento como accidente de trabajo en sanitarios representan un avance, pero es insuficiente. Es un paso que ya ha recomendado recientemente la Comisión europea, para incluirla con el listado europeo de enfermedades profesionales, en todas aquellas actividades con un riesgo de infección demostrado. Esto supondría ventajas objetivas para las personas trabajadoras y las empresas.

Genome-wide Association Study of Bladder Cancer Reveals New Biological and Translational Insights.

BACKGROUND: Genomic regions identified by genome-wide association studies (GWAS) for bladder cancer risk provide new insights into etiology. OBJECTIVE: To identify new susceptibility variants for bladder cancer in a meta-analysis of new and existing genome-wide genotype data. DESIGN, SETTING, AND PARTICIPANTS: Data from 32 studies that includes 13,790 bladder cancer cases and 343,502 controls of European ancestry were used for meta-analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: Log-additive associations of genetic variants were assessed using logistic regression models. A fixed-effects model was used for meta-analysis of the results. Stratified analyses were conducted to evaluate effect modification by sex and smoking status. A polygenic risk score (PRS) was generated on the basis of known and novel susceptibility variants and tested for interaction with smoking. RESULTS AND LIMITATIONS: Multiple novel bladder cancer susceptibility loci (6p.22.3, 7q36.3, 8q21.13, 9p21.3, 10q22.1, 19q13.33) as well as improved signals in three known regions (4p16.3, 5p15.33, 11p15.5) were identified, bringing the number of independent markers at genome-wide significance (p < 5 × 10-8) to 24. The 4p16.3 (FGFR3/TACC3) locus was associated with a stronger risk for women than for men (p-interaction = 0.002). Bladder cancer risk was increased by interactions between smoking status and genetic variants at 8p22 (NAT2; multiplicative p value for interaction [pM-I] = 0.004), 8q21.13 (PAG1; pM-I = 0.01), and 9p21.3 (LOC107987026/MTAP/CDKN2A; pM-I = 0.02). The PRS based on the 24 independent GWAS markers (odds ratio per standard deviation increase 1.49, 95% confidence interval 1.44-1.53), which also showed comparable results in two prospective cohorts (UK Biobank, PLCO trial), revealed an approximately fourfold difference in the lifetime risk of bladder cancer according to the PRS (e.g., 1st vs 10th decile) for both smokers and nonsmokers. CONCLUSIONS: We report novel loci associated with risk of bladder cancer that provide clues to its biological underpinnings. Using 24 independent markers, we constructed a PRS to stratify lifetime risk. The PRS combined with smoking history, and other established risk factors, has the potential to inform future screening efforts for bladder cancer. PATIENT SUMMARY: We identified new genetic markers that provide biological insights into the genetic causes of bladder cancer. These genetic risk factors combined with lifestyle risk factors, such as smoking, may inform future preventive and screening strategies for bladder cancer.

Workplace aggression against healthcare workers in a Spanish healthcare institution between 2019 and 2021: The impact of the COVID-19 pandemic.

Objectives: Describe the incidence of first aggressions among healthcare workers (HCWs) before and during the COVID-19 pandemic in a Spanish healthcare institution, according to workers' socio-occupational characteristics and analyze the impact of the pandemic on it. Methods: A cohort involving HCWs who worked in the institution for at least 1 week each year from 1 January 2019 to 31 December 2021. Adjusted relative risks (aRR) were estimated using generalized estimating equations and negative binomial models to calculate the differences in WPA between the different time periods. All analyses were stratified by gender. Results: Among women, the incidence was 6.8% (6.0; 7.8) during the pre-COVID-19 period, 6.0% (5.2; 7.0) during the COVID-19 baseline and 5.1% (4.3; 5.9) during the COVID-19 endline; and 4.6% (3.4; 6.1), 5.3% (4.1; 6.8) and 4.4% (3.5; 5.8), respectively, among men. Among men, the incidence of WPA was 4.6 (3.4; 6.1), 5.3 (4.1; 6.8), and 4.4% (3.5; 5.8), respectively. These incidences were significantly higher among male nurses and aides [11.1 (8.0; 15.4), 12.3 (8.9; 16.6), and 9.3% (6.5; 13.3) during each period] and psychiatric center workers [women: 14.7 (11.2; 19.0), 15.4 (11.8; 19.8), and 12.4% (9.2; 16.6); men: 12.3 (7.2; 20.0), 17.8 (11.6; 26.2), and 14.3% (8.8; 22.4)]. Among women, the risk of WPA was 23% lower in the post-COVID-19 period compared to before the pandemic [aRR = 0.77 (0.64; 0.93)], while the risk during the COVID-19 baseline was not significantly different [aRR = 0.89 (0.74; 1.06)]. Conclusions: The COVID-19 pandemic led to an unexpected decrease in first-time WPA against HCWs. However, ~5% of HCWs experienced at least one incidence of aggression in the last follow-up year. Healthcare managers should continue to increase the prevention of aggression against HCWs, especially among vulnerable groups with a higher level of incidence.

[Archivos, positioned on the road to impact]. / Archivos, posicionada en la senda del impacto.

Con este bagaje, comenzamos 2023, un año en el que nuestra revista cumple un cuarto de siglo llevando a cabo la misión para la que fue concebida, misión que los distintos comités editoriales que hemos participado consideramos un acierto: contribuir a la transferencia de conocimiento útil para avanzar en la mejora de la salud de las personas trabajadoras.

[Economic cost estimation of a sample of occupational disease cases accepted by the National Institute of Social Security and evaluated at Parc de Salut Mar, 2014-2021]. / Estimación económica de una muestra de casos de enfermedad profesional confirmados por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar, 2014-2021.

Underreporting of occupational diseases (OD) is a social and economic problem, because it has negative consequences for both the welfare of the affected workers and its impact on budgetary planning for the management of health services. We evaluated the healthcare costs of a sample of 13 cases of OD treated at a public hospital in Barcelona between 2014 and 2021, and officially accepted by the National Institute of Social Security (INSS). The total cost of care was €474,859, with an average cost of €36,528 per patient. By diagnostic group, the highest costs were associated with cancer cases, accounting for 79% of the total (€375,068). The findings of this study reflect the economic impact of health care provided by a public hospital to patients with an OD recognized by the INSS.

La infranotificación de enfermedades profesionales (EEPP) es un problema social y económico, pues repercute en el bienestar del trabajador afectado, y en las estimaciones presupuestarias que se planifican anualmente para la gestión de los servicios sanitarios. Los costes asistenciales fueron evaluados en una muestra de 13 casos de EEPP con resolución positiva por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar (Barcelona) entre 2014 y 2021. El coste de la asistencia generada del total de casos fue de 474.859 €, con un coste medio de 36.528 € por paciente. Por grupo diagnóstico, el coste más alto lo originaron los casos de cánceres que supusieron el 79% del gasto total (375.068 €). Los hallazgos del estudio reflejan el impacto económico que supone la asistencia sanitaria prestada por un hospital público a pacientes con una EEPP reconocida en el INSS.

Study of Excipients in Delayed Skin Reactions to mRNA Vaccines: Positive Delayed Intradermal Reactions to Polyethylene Glycol Provide New Insights for COVID-19 Arm.

BACKGROUND: Skin local reactions to mRNA COVID-19 vaccines have been linked to the use of vaccine excipients. The aim of the study is to evaluate the role of skin testing excipients in delayed skin reactions due to mRNA COVID-19 vaccines. METHODS: Skin testing among a group of healthcare workers with skin reactions due to mRNA vaccines was performed. Patch testing and intradermal testing (IDT) with polyethylene glycol (PEG)-400, PEG-2000, trometamol, and 1,2-dimyristoyl-sn-glycero-3-phosphocholine were performed. Healthcare workers without skin reactions to vaccines were used for skin testing as controls. RESULTS: Thirty-one healthcare workers (from a total of 4315 vaccinated healthcare workers) experienced cutaneous adverse vaccine reactions. Skin testing was performed in sixteen of the healthcare workers (11 delayed large local reactions (DLLR) and 5 widespread reactions). Positive IDT for PEG-2000 1% in DLLR was seen in 10 (90.9%) patients, in comparison with one (16.6%) individual with a delayed widespread reaction. Delayed positive IDT reactions for PEG-2000 1% on day 2 were observed in three (27.3%) patients with DLLR. Patch testing of the excipients was negative. Among 10 controls, only one exhibited a transient positive IDT reaction to PEG-2000 1%. CONCLUSIONS: Immediate and delayed reactions to IDT are frequently detected in patients with DLLR. The observation of positive delayed intradermal reactions to PEG disclosed only in patients with DLLR reinforces a possible role of PEG in the development of these reactions. Skin testing of other excipients is of little importance in clinical practice.

[Proposal for a summary index of the non-pharmacological preventive measures adopted against SARS-CoV-2 in companies, the case of Parc de Salut Mar (Barcelona).] / Propuesta de un índice que resume las medidas preventivas no farmacológicas adoptadas frente al SARS-CoV-2 en las empresas, el caso del Parc de Salut Mar (Barcelona).

INTRODUCTION: Construct a numerical index of non-pharmacological preventive measures against Sars-CoV-2 based on the experience of Parc de Salut Mar (PSMar), a healthcare institution in Barcelona. METHOD: The construction of the index was carried out in three phases. The identification and selection of the variables to be included based on semi-structured interviews with key informants and documental revision. The definition of the dimensions (consisting of one or more variables) and, finally, the operationalisation of the index on the basis of these dimensions. The index was estimated in the PSMar, and in its two main centres, the Hospital del Mar and the Hospital de la Esperanza. RESULTS: Twenty-one variables were identified and categorised into six dimensions: personal protective equipment, individual organisational measures, collective organisational measures, epidemiological surveillance measures, training activities and protocol development. During the first wave, the Hospital del Mar index remained above the value obtained at the Hospital de la Esperanza, while in the second wave both indexes showed similar values until week 36, when the Hospital del Mar index began to show higher values. These oscillations were mainly due to the dimensions of personal protective equipment and training activities. CONCLUSIONS: The proposed index shows the difficulties in implementing the various non-pharmacological preventive measures in the first weeks of the pandemic. This tool can be useful for evaluating the activities carried out by the Occupational Risk Prevention Services in the face of the pandemic, with the appropriate adaptations to the reality of each individual company.

Introducción: Construir un índice numérico con las medidas preventivas no farmacológicas frente a Sars-CoV-2 a partir de la experiencia del Parc de Salut Mar (PSMar), una institución sanitaria en Barcelona. Método: La construcción del índice se ha realizado en tres fases. La identificación y selección de las variables incluidas a partir de entrevistas semiestructuradas a informantes clave y la revisión documental. La definición de las dimensiones (con una o más variables) y la operacionalización del índice (a partir de las dimensiones). Se ha estimado el índice en el PSMar, y en sus dos principales centros, el Hospital del Mar y el Hospital de la Esperanza. Resultados: Se identificaron 21 variables, clasificadas en 6 dimensiones: equipos de protección individual, medidas organizativas individuales, medidas organizativas colectivas, medidas de vigilancia epidemiológica, actividades formativas, y elaboración de protocolos. Durante la primera ola, el índice en el Hospital del Mar se mantuvo por encima del valor obtenido en el Hospital de la Esperanza; en la segunda ola ambos índices presentaron valores similares hasta la semana 36, cuando el hospital del Mar comenzó a presentar valores superiores. Estas oscilaciones se debieron principalmente a los equipos de protección individual y actividades formativas. Conclusiones: El índice propuesto muestra las dificultades para aplicar las medidas preventivas no farmacológicas en las primeras semanas de la pandemia. Esta herramienta puede ser útil para evaluar las actividades desarrolladas frente a la pandemia por parte de los Servicios de Prevención de Riesgos Laborales, con las oportunas adaptaciones a la realidad de cada empresa.

Disinfection By-Products in Drinking Water and Bladder Cancer: Evaluation of Risk Modification by Common Genetic Polymorphisms in Two Case-Control Studies.

BACKGROUND: By-products are formed when disinfectants react with organic matter in source water. The most common class of disinfection by-products, trihalomethanes (THMs), have been linked to bladder cancer. Several studies have shown exposure-response associations with THMs in drinking water and bladder cancer risk. Few epidemiologic studies have evaluated gene-environment interactions for total THMs (TTHMs) with known bladder cancer susceptibility variants. OBJECTIVES: In this study, we investigated the combined effect on bladder cancer risk contributed by TTHMs, bladder cancer susceptibility variants identified through genome-wide association studies, and variants in several candidate genes. METHODS: We analyzed data from two large case-control studies-the New England Bladder Cancer Study (n/n=989 cases/1,162 controls), a population-based study, and the Spanish Bladder Cancer Study (n/n=706 cases/772 controls), a hospital-based study. Because of differences in exposure distributions and metrics, we estimated effects of THMs and genetic variants within each study separately using adjusted logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CI) with and without interaction terms, and then combined the results using meta-analysis. RESULTS: Of the 16 loci showing strong evidence of association with bladder cancer, rs907611 at 11p15.5 [leukocyte-specific protein 1 (LSP1 region)] showed the strongest associations in the highest exposure category in each study, with evidence of interaction in both studies and in meta-analysis. In the highest exposure category, we observed OR=1.66 (95% CI: 1.17, 2.34, p-trend=0.005) for those with the rs907611-GG genotype and p-interaction=0.02. No other genetic variants tested showed consistent evidence of interaction. DISCUSSION: We found novel suggestive evidence for a multiplicative interaction between a putative bladder carcinogen, TTHMs, and genotypes of rs907611. Given the ubiquitous exposure to THMs, further work is needed to replicate and extend this finding and to understand potential molecular mechanisms. https://doi.org/10.1289/EHP9895.

Patterns of change of multisite pain over 1 year of follow-up and related risk factors.

BACKGROUND: Multisite musculoskeletal pain is common and disabling. This study aimed to prospectively investigate the distribution of musculoskeletal pain anatomically, and explore risk factors for increases/reductions in the number of painful sites. METHODS: Using data from participants working in 45 occupational groups in 18 countries, we explored changes in reporting pain at 10 anatomical sites on two occasions 14 months apart. We used descriptive statistics to explore consistency over time in the number of painful sites, and their anatomical distribution. Baseline risk factors for increases/reductions by ≥3 painful sites were explored by random intercept logistic regression that adjusted for baseline number of painful sites. RESULTS: Among 8927 workers, only 20% reported no pain at either time point, and 16% reported ≥3 painful sites both times. After 14 months, the anatomical distribution of pain often changed but there was only an average increase of 0.17 painful sites. Some 14% workers reported a change in painful sites by ≥3. Risk factors for an increase of ≥3 painful sites included female sex, lower educational attainment, having a physically demanding job and adverse beliefs about the work-relatedness of musculoskeletal pain. Also predictives were as follows: older age, somatizing tendency and poorer mental health (each of which was also associated with lower odds of reductions of ≥3 painful sites). CONCLUSIONS: Longitudinally, the number of reported painful sites was relatively stable but the anatomical distribution varied considerably. These findings suggest an important role for central pain sensitization mechanisms, rather than localized risk factors, among working adults. SIGNIFICANCE: Our findings indicate that within individuals, the number of painful sites is fairly constant over time, but the anatomical distribution varies, supporting the theory that among people at work, musculoskeletal pain is driven more by factors that predispose to experiencing or reporting pain rather than by localized stressors specific to only one or two anatomical sites.

[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.

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.

Non-Pharmacological Preventive Measures Had an Impact on COVID-19 in Healthcare Workers before the Vaccination Effect: A Cohort Study.

Healthcare workers have been and still are at the forefront of COVID-19 patient care. Their infection had direct implications and caused important challenges for healthcare performance. The aim of this study is to assess the impact of non-pharmacological preventive measures against COVID-19 among healthcare workers. This study is based on a dynamic cohort of healthcare workers (n = 5543) who had been hired by a Spanish hospital for at least one week during 2020. Negative binomial regression models were used to estimate the incidence rate and the rate ratio (RR) between the two waves (defined from 15 March to 21 June and from 22 June to 31 December), considering natural immunity during the first wave and contextual variables. All models were stratified by socio-occupational variables. The average COVID-19 incidence rate per 1000 worker-days showed a significant reduction between the two waves, dropping from 0.82 (CI95%: 0.73-0.91) to 0.39 (0.35-0.44). The adjusted RR was 0.54 (0.48-0.87) when natural immunity was acquired during the first wave, and contextual variables were considered. The significant reduction of the COVID-19 incidence rate could be explained mainly by improvement in the non-pharmacological preventive interventions. It is needed to identify which measures were more effective. Young workers and those with a replacement contract were identified as vulnerable groups that need greater preventive efforts. Future preparedness plans would benefit from these results.

[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.

What is meant by case management for the return-to-work of workers with musculoskeletal disorders? A scoping review.

BACKGROUND: Case management interventions have shown to be effective to prevent musculoskeletal pain and disability, but a single definition has not been achieved, nor an agreed profile for case managers. OBJECTIVE: To describe the elements that define case management and case managers tasks for return-to-work of workers with musculoskeletal disorders (MSDs). METHODS: A comprehensive computerized search of articles published in English until February 16, 2021 was carried out in several bibliographic databases. Grey literature was obtained through a search of 13 key websites. A peer-review screening of titles and abstracts was carried out. Full text in-depth analysis of the selected articles was performed for data extraction and synthesis of results. RESULTS: We identified 2,422 documents. After full-text screening 31 documents were included for analysis. These were mostly European and North American and had an experimental design. Fifteen documents were published between 2010 to 2021 and of these 7 studies were published from 2015. Fifteen elements were identified being the commonest "return-to-work programme" (44.4%) and "multidisciplinary assessment/interdisciplinary intervention" (44.4%). Of 18 tasks found, the most frequent was "establishing goals and planning return-to-work rehabilitation" (57.7%). Eighteen referral services were identified. CONCLUSIONS: Despite there were several elements frequently reported, some elements with scientific evidence of their importance to deal with MSDs (e.g. early return-to-work) were almost not mentioned. This study proposes key points for the description of case management and case managers tasks.

Process evaluation of a complex workplace intervention to prevent musculoskeletal pain in nursing staff: results from INTEVAL_Spain.

BACKGROUND: INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation. OBJECTIVES: This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers. METHODS: The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan's framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically. RESULTS: The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers. CONCLUSIONS: This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed. TRIAL REGISTRATION: ISRCTN15780649 .