The effect of multimorbidity on sickness absence by specific diagnoses.

BACKGROUND: As the world's population ages, the prevalence of multiple chronic and non-chronic health-related conditions is increasing. Research on multimorbidity, the co-occurrence of two or more health-related conditions, has mainly involved patient and older populations. Its effect in working populations, presumably younger and healthier, is not well known but could conceivably affect sickness absence (SA) and ability to return to work. AIMS: To examine the effect of multimorbidity on the incidence and duration of SA episodes by frequent diagnostic groups. METHODS: A prospective study (in 2006-2008) of workers in Spain. Information on health-related conditions was gathered with a standardized questionnaire and used to construct a sex-specific multidimensional multimorbidity score (MDMS). In order to estimate the effect of MDMS on incidence and duration of SA episodes due to cardiovascular diseases (CVD), musculoskeletal disorders (MSD) and mental health disorders (MHD), we fitted Cox models adjusted by age, occupational social class and number of prior SA episodes for both sexes. RESULTS: The study population was 372370. Men with high MDMS showed a trend towards higher incidence risk for SA due to CVD and MSD [adjusted hazard ratio (aHR) = 2.03; 95% confidence interval (CI) 1.48-2.78 and aHR = 1.20; 95% CI 1.01-1.43, respectively]. Women showed a similar trend for MSD, but MHD had the strongest association (aHR = 4.78; 95% CI 1.97-11.62) for high MDMS. In both sexes, the effect of MDMS was strongest among those without a prior SA. No consistent associations with SA duration were observed. CONCLUSIONS: Multimorbidity increased the risk of incident musculoskeletal, mental and cardiovascular SA episodes but not their duration.

Effect of working conditions on non-work-related sickness absence.

BACKGROUND: There is limited evidence of the role of working conditions as prognostic factors for non-work-related sickness absence (i.e. absence due to injuries or diseases of non-occupational origin). AIMS: To analyse the association between working conditions and time to return to work (RTW) in workers with long-term (>15 days) non-work-related sickness absence. METHODS: We followed up a total of 655 workers, who completed a baseline questionnaire including physical and psychosocial work factors, until their non-work-related long-term sickness absence ended. Time to RTW was determined based on the health insurance company register. Cox proportional hazard models were constructed to evaluate the associations between working conditions and time to RTW. RESULTS: A self-perceived high level of physical activity at work and work with back twisted or bent were related to longer duration of sickness absence. We did not find any strong evidence of associations between psychosocial work factors and time to RTW, although higher job insecurity and low reward showed marginal statistical significance. CONCLUSIONS: Hazardous physical working conditions are associated with longer duration of non-work-related sickness absence. Workplace ergonomic interventions could conceivably shorten the length of sickness absence that has not originated at work.

A qualitative study about immigrant workers' perceptions of their working conditions in Spain.

BACKGROUND: Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions. METHODS: Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain. RESULTS: Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions. CONCLUSIONS: The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants' work experiences should be considered and how these may influence health outcomes.

Does return to work occur earlier after work-related sick leave episodes than after non-work-related sick leave episodes? A retrospective cohort study in Spain.

OBJECTIVE: In Spain, sick pay benefits for work-related sick leave episodes are higher than for non-work-related episodes. Our aim is to assess whether time to return to work is longer for higher paid sick leave episodes than for lower paid episodes. METHODS: We used data from 62,376 work-related and 76,932 non-work-related sick leave episodes occurring among 338,226 workers from 56,099 companies in Spain in 2002. All episodes were followed for up to 18 months. Episodes were classified by a physician as being work- or non-work-related according to medico-legal judgments. The median episode duration and the 25th and 75th percentiles were calculated. The probability of remaining absent from work was estimated by a non-parametric estimator of the marginal survival function. The time ratio between both types of sick leave was estimated by a log-logistic regression model, using non-work-related episodes as the reference. RESULTS: Median episode duration (25th-75th percentiles) was 11 (6-21) days for work-related episodes and 9 (4-29) days for non-work-related episodes. Time to return to work was longer for work-related episodes than for non-work-related episodes of less than 16 days (time ratio: 1.19 in men and 1.08 in women), while the opposite was observed for episodes of more than 15 days (0.58 in men and 0.40 in women). CONCLUSIONS: Sick pay benefits have a limited effect on time to return to work after a sick leave episode.

Mesothelioma mortality in men: trends during 1977-2001 and projections for 2002-2016 in Spain.

OBJECTIVES: To evaluate mesothelioma death trends in Spain and to predict the number of future cases of mesothelioma. METHODS: After descriptive analysis of mesothelioma mortality data, an age-period-cohort model was applied to estimate future mesothelioma deaths. RESULTS: From 1977 to 2001, 1928 men over 35 years of age died of mesothelioma in Spain. Projections indicate that 1321 men are expected to die from mesothelioma between 2007 and 2016. CONCLUSION: It is expected that mesothelioma deaths will increase at least until 2016. Available data do not allow prediction of the year when mortality will start to decrease.

Work in the textile industry in Spain and bladder cancer.

BACKGROUND/OBJECTIVE: Textile manufacturing is a complex industry that has frequently been associated with bladder cancer. However, results have not been consistent. This study investigated the risk of bladder cancer in Spanish textile workers. METHODS: We analysed data from a multicentre hospital-based case-control study carried out in Spain (1998-2001) including 1219 cases of bladder cancer and 1271 controls. Of those, 126 cases and 122 controls reported a history of employment in the textile industry. Lifetime occupational history was obtained using a computer-assisted personal interview. Occupations, locations and materials used in the textile industry were assessed using a detailed questionnaire and expert assessment. RESULTS: Overall, no increased risk of bladder cancer was found for textile workers, including duration of employment analysis. Increased risks were observed for weavers (OR = 1.82, 95% CI 0.95 to 3.47), for workers in winding/warping/sizing (OR 4.11, 95% CI 1.58 to 10.71) and for those exposed to synthetic materials (OR 1.89, 95% CI 1.00 to 3.56). Working for more than 10 years appeared to be associated with an increased risk for weavers (OR 2.27, 95% CI 0.97 to 5.34), for those who had ever worked in winding/warping/sizing (OR 11.03, 95% CI 1.37, 88.89), for workers in the weaving room (OR 2.94, 95% CI 1.24 to 7.01) and for those exposed to synthetic (OR 2.62, 95% CI 1.14 to 6.01) or cotton (OR 2.00, 95% CI 1.04 to 3.87) materials. Statistically significant higher risks were also found for specific combinations of occupations or locations with exposure to synthetics and cotton. CONCLUSIONS: There was no overall increased risk for textile workers, but increased risks were found for specific groups of workers. Our findings indicate that observed risks in previous studies may be better evaluated by analysis of materials used or section worked within the industry and occupation.

Evaluación de los planes de actuación preferente sobre las empresas de mayor siniestralidad en las comunidades autónomas / Evaluation of strategic action plans for the prevention of occupational injuries carried out by regional governments in Spain

Objetivo. Los planes de actuación preferente (PAP) son planes de prevención frente a los accidentes de trabajo. En este trabajo se describen los PAP desarrollados por las comunidades autónomas (CCAA) entre 1999 y 2006 y se evalúa la calidad formal de los mismos. Métodos. Mediante contacto postal y telefónico se solicitó a los responsables en cada CCAA (n=17) toda la documentación disponible sobre los PAP. Se buscó también información al respecto en las páginas de Internet de cada gobierno autónomo. Se definieron mediante consenso doce criterios con distinto peso según su relevancia como indicadores de calidad de los planes (1=baja; 2=moderada; 3=alta). Se calcularon puntuaciones totales para cada plan autonómico según el cumplimiento de dichos criterios. Resultados. No se obtuvo ninguna documentación sobre PAP en Madrid y Galicia. La mayoría de los planes revisados desarrollan protocolos de visita (n=14) y de actuación (n=13) en las empresas, además de mecanismos de coordinación con la Inspección de Trabajo (n=13). La definición de objetivos sobre los procesos a desarrollar, la evaluación de estos procesos o la coordinación con las mutuas de accidentes de trabajo y enfermedades profesionales son criterios presentes con baja frecuencia en los planes revisados (n<=4). Los planes con mayores puntuaciones y mayor cumplimiento de criterios son los de Comunidad Valenciana, Andalucía y Aragón, mientras que los planes con puntuaciones más bajas son los de Castilla-La Mancha y Extremadura. Conclusiones. La mayoría de CCAA han desarrollado planes de actuación preferente, aunque con diferentes niveles de calidad formal según los criterios aplicados. La evaluación de los resultados de estos planes en términos de incidencia de accidentes de trabajo permitirá valorar en último término la efectividad de este tipo de intervenciones

Objective. Plans of preferential action (PPA) are strategic plans for the prevention of occupational injuries. In this paper, PPAs developed by the autonomous community governments in Spain are described and their formal quality evaluated (1999-2006). Methods. Persons responsible for PPAs were contacted via mail and phone in order to obtain all available documentation about the plans in each autonomous government (n=17). Available online information was also reviewed. For evaluation of the PPA, twelve explicit criteria were agreed on and weighted according to their value as quality indicators (1=low; 2=moderate; 3=high). Global scores were generated for plans in each autonomous government according to the level of fulfilment of these criteria. Results. It was not possible to obtain written information about PPA from the autonomous governments of Madrid and Galicia. Most of the reviewed plans included protocols for site visits (n=14) of companies and protocols for actions (n=13) , as well as mechanisms for coordination with the labour inspectorate (n=13). Defined objectives and evaluation processes, as well as mechanisms for coordination with insurance companies, were rarely described in the plans (n<=4). The PPAs with the highest global scores corresponded to the autonomous communities of Valencia, Andalusia and Aragon, whereas the plans with the lowest accomplishment of criteria were found in Castilla-La Mancha and Extremadura. Conclusions. Most autonomous governments in Spain have strategic plans for the prevention of occupational injuries but the formal quality of these plans varies among them. Assessment of the results of these plans for preventive interventions, in terms of incidence of occupational injuries, will ultimately allow an evaluation of their effectiveness

Vigilancia epidemiológica de las posibles enfermedades laborales atendidas en la Atención Primaria de Salud. Casos notificados a la Unidad de Salud Laboral de Sabadell, 2001-2005 / Epidemiological surveillance of suspected occupational diseases in primary health care. Cases notified to the Occupational Health Unit in Sabadell (Spain), 2001-2005

Se describen las características de una serie de casos de posibles enfermedades laborales atendidos en el sistema público de salud en el sector de Sabadell (Barcelona) y notificados al sistema de vigilancia epidemiológica de la Unidad de Salud Laboral de Sabadell por los médicos de atención primaria de la zona (2001- 2005). La posible relación con las condiciones de trabajo se valoró mediante historia clínico-laboral. Se recibieron y estudiaron 641 notificaciones de enfermedades posiblemente relacionadas con el trabajo. Se descartaron 56 casos (8,7%) como no laborales. De los 585 (91,3%) casos valorados como relacionados con el trabajo, 422 fueron seguidos telefónicamente por un periodo máximo de doce meses; 109 casos pidieron el reconocimiento de la contingencia laboral y 9 casos fueron reconocidos como laborales por el Instituto Nacional de la Seguridad Social

We describe the features of a series of cases of suspected occupational disease presenting to the the primary health care system in the area of Sabadell (Barcelona, Spain) and reported by general physicians to the Sabadell Epidemiological Surveillance System of the Occupational Health Unit, between 2001 and 2005. The possible work-relatedness was studied by clinical and occupational history. A total of 641 cases of suspected occupational disease were reported. After evaluation, 56 cases (8,7%) were excluded as not being work-related. Of the remaining 585 cases (91,3%), 422 were followed by telephone contact for a maximum period of twelve months; 109 cases applied for official recognition as a work-related disease and 9 cases were officially recognised as such by the National Social Security Institute

Reconocimiento de las enfermedades profesionales en España, una ya larga historia / Tittle

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La nueva lista de enfermedades profesionales, ¿qué novedades aporta respecto a la situación vigente hasta ahora? / No disponible

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Opinión de los diplomados en enfermería de empresa sobre el contenido formativo de su especialización. De la enfermería de empresa a la enfermería del trabajo / The opinion of occupational nurses on the content of their specialit y training. From compan y to occupational health nursing

El objetivo de este estudio ha sido evaluar el programa formativo de enfermería de empresa a través de la opinión de una muestra de enfermeros (n=381), una vez finalizado dicho programa entre 1998 y el 2003. Un total de 153 enfermeros (tasa de respuesta del 40%) respondieron a la encuesta sobre el programa; de éstos sólo 23 (15%) consideraron que el programa de postgrado presentaba limitaciones en los contenidos formativos y 10 (6,5%) que había contenidos prescindibles. De un 13,1% que trabajaban exclusivamente en enfermería de empresa antes de iniciar la formación, se pasó al 54,3% después de finalizada. La utilidad del programa para su desarrollo profesional se valoró con una puntuación media de 7,8 sobre 10. Estos resultados muestran que el programa formativo evaluado puede constituir una experiencia positiva a tener en cuenta al definir el programa de la futura especialidad

A survey on training program content was conducted in a sample of occupational health nurses (n=381) who completed their training between 1998 and 2003. One hundred fifty-three nurses responded (response rate, 40%). Among these, 23 (15%) considered that the programme was lacking some related training content, and 10 (6.5%) thought that some training content could have been missing. The proportion of respondents working only in occupational health nursing was 13.1% prior to starting their training; this increased to 54.3% after program completion. The usefulness of the training programme for their professional development was rated as high, with a mean score of 7.8 on a scale of 10. These results suggest that the training programme had had a positive impact, and that this should be taken into account in future revisions of the specialty training curriculum

Decálogo de la valoración de la aptitud para trabajar Diez principios básicos para su realización en el ámbito de la medicina del trabajo / Ten commandments on assessment of fitness for duty. Basic principles for its practice in Occupational Medicine

La valoración de la aptitud para trabajar es la evaluación de la capacidad psicofísica del individuo para realizar su trabajo sin riesgo para su propia salud o la de otros. A pesar de ser una actividad relevante de la medicina del trabajo, no existen en España criterios claros o recomendaciones para su realización. Se organizó un taller de expertos con el fin de analizar los criterios y métodos utilizados al valorar la aptitud e iniciar una reflexión científico-técnica sobre este tema en nuestro país. Fruto de ello, y sobre la base de las evidencias científicas existentes y las buenas prácticas profesionales en el ámbito internacional, se ha elaborado un decálogo que pretende aportar criterios técnicos para una mejor ordenación de la práctica profesional en este campo. Se trata de diez principios básicos para la realización de la valoración de la aptitud para trabajar en el ámbito de la medicina del trabajo

The assessment of fitness for duty, or work fitness, is the evaluation of a person’s psychophysical capacity to perform his/ her job without risk to self or others. Despite being a relevant activity in occupational medicine, there are no clear criteria or recommendations on how to assess fitness for work in Spain. An experts workshop was organised to analyse criteria and methods to assess fitness for work, as well as to initiate a scientific and technical debate on this subject in our country. As a consequence, and based on the available scientific evidence and international standards of good professional practice, ten commandments were developed, centered around technical criteria, to achieve a more systematic approach to professional practice in this field. Ten basic principles are listed for the assessment of fitness for duty in occupational medicine

[Quality of medical diagnosis in sick leave certificates for non-occupational diseases and injuries]. / Calidad del diagnóstico médico en la certificación de la incapacidad temporal por enfermedad común y accidente no laboral.

OBJECTIVE: To evaluate the quality of medical diagnosis in the sick leave certificate. DESIGN: Retrospective, observational study. SETTING: Castelldefels Primary Care Centre, Barcelona, Spain. MEASUREMENTS AND INTERVENTIONS: 205 sick leave episodes of patients reported as non-occupational diseases and injuries were analyzed. The diagnosis of the sick leave certificate was checked against the clinical report carried out by the same physician who made out the sick leave certificate. To assess the quality of medical diagnosis, sensitivity, positive predictive value and the percentage of positive agreement were calculated. The variability of these indicators was also assessed according to the duration of the sick leave episode. RESULTS: Simple agreement between the diagnoses of the sick leave certificate and the clinical report was 92%. The sensitivity of the sick leave certificate in relation to the clinical report by diagnostic group ranged from 75% to 97%; positive predictive value, from 81% to 100%; and the percentage of positive agreement, from 86% to 97%. Short-term sick leave episodes (< or =15 days) had lower values than long-term sick leave (>15 days). CONCLUSIONS: Our findings confirm that the quality of diagnosis on the sick leave certificate is high. The availability of more medical information about the reasons for the sick leave episode does not modify the quality of the diagnosis substantially.

Associations between temporary employment and occupational injury: what are the mechanisms?

OBJECTIVE: To determine whether observed higher risks of occupational injury among temporary workers are due to exposure to hazardous working conditions and/or to lack of job experience level. METHODS: Data systematically recorded for 2000 and 2001 by the Spanish Ministry of Labour and Social Affairs on fatal and non-fatal traumatic occupational injuries were examined by type of employment and type of accident, while adjusting for gender, age, occupation, and length of employment in the company. In the study period there were 1500 fatal and 1 806 532 non-fatal traumatic occupational injuries that occurred at the workplace. Incidence rates and rate ratios (RR) were estimated using Poisson regression models. RESULTS: Temporary workers showed a rate ratio of 2.94 for non-fatal occupational injuries (95% CI 2.40 to 3.61) and 2.54 for fatal occupational injuries (95% CI 1.88 to 3.42). When these associations were adjusted by gender, age, occupation, and especially length of employment, they loose statistic significance: 1.05 (95% CI 0.97 to 1.12) for non-fatal and 1.07 (95% CI 0.91 to 1.26) for fatal. CONCLUSIONS: Lower job experience and knowledge of workplace hazards, measured by length of employment, is a possible mechanism to explain the consistent association between temporary workers and occupational injury. The role of working conditions associated with temporary jobs should be assessed more specifically.

Validation of an asthma questionnaire for use in healthcare workers.

BACKGROUND: Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. AIMS: To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. METHODS: An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk-through surveys and review of material safety data sheets. A cross-sectional validation study was conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. RESULTS: The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test-retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach's alpha > or = 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. CONCLUSIONS: Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross-validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self-report is underscored.

Calidad del diagnóstico médico en la certificación de la incapacidad temporal por enfermedad común / Quality of medical diagnosis in sick leave certificates for non-occupational diseases and injuries

Objetivo. Evaluar la calidad del diagnóstico que consta en el parte de alta de la incapacidad temporal (IT). Diseño. Estudio observacional, retrospectivo. Emplazamiento. Centro de atención primaria de Castelldefels (Barcelona). Participantes. Un total de 205 episodios de IT por enfermedad común o accidente no laboral entre los pacientes atendidos. Mediciones principales. El diagnóstico del parte de alta se comprobó con el informe clínico que cumplimentaba el mismo médico que prescribió el alta. Para valorar la calidad del diagnóstico se calcularon la sensibilidad, el valor predictivo positivo y el porcentaje de concordancia positiva. También se valoró la variabilidad de estos índices según la duración del episodio de baja. Resultados. La concordancia simple entre el diagnóstico del parte de alta y el del informe clínico para toda la muestra fue del 92%. La sensibilidad del parte respecto al informe por grupo diagnóstico variaba entre un 75-97%, el valor predictivo positivo en el 81-100% y el porcentaje de concordancia positiva oscilaba en el 86-97%. Los episodios de corta duración (¾ 15 días) tuvieron valores menores que los episodios de larga duración (> 15 días). Conclusiones. Los resultados corroboran que la calidad del diagnóstico del parte de alta es elevada, sin que la disponibilidad de mayor información sobre los motivos de baja modifique sustancialmente la calidad del diagnóstico

Objective. To evaluate the quality of medical diagnosis in the sick leave certificate. Design. Retrospective, observational study. Setting. Castelldefels Primary Care Centre, Barcelona, Spain. Measurements and interventions. 205 sick leave episodes of patients reported as non-occupational diseases and injuries were analyzed. The diagnosis of the sick leave certificate was checked against the clinical report carried out by the same physician who made out the sick leave certificate. To assess the quality of medical diagnosis, sensitivity, positive predictive value and the percentage of positive agreement were calculated. The variability of these indicators was also assessed according to the duration of the sick leave episode. Results. Simple agreement between the diagnoses of the sick leave certificate and the clinical report was 92%. The sensitivity of the sick leave certificate in relation to the clinical report by diagnostic group ranged from 75% to 97%; positive predictive value, from 81% to 100%; and the percentage of positive agreement, from 86% to 97%. Short-term sick leave episodes (¾15 days) had lower values than long-term sick leave (>15 days). Conclusions. Our findings confirm that the quality of diagnosis on the sick leave certificate is high. The availability of more medical information about the reasons for the sick leave episode does not modify the quality of the diagnosis substantially