SARS-CoV2 hospital surveillance and control system with contact tracing for patients and health care workers at a large reference hospital in Spain during the first wave: An observational descriptive study.

BACKGROUND AND AIMS: During the first peak of the COVID-19 pandemic, the Preventive Medicine Department and the Occupational Health Department at Hospital Clinic de Barcelona (HCB), a large Spanish referral hospital, developed an innovative comprehensive SARS-CoV2 Surveillance and Control System (CoSy-19) in order to preserve patients' and health care workers' (HCWs) safety. We aim to describe the CoSy-19 and to assess the impact in the number of contacts that new cases generated along this time. METHODS: Observational descriptive study of the findings of the activity of contact tracing of all cases received at the HCB during the first peak of COVID-19 in Spain (February 25th-May 3rd, 2020). RESULTS: A team of 204 professionals and volunteers performed 384 in-hospital contact-tracing studies which generated contacts, detecting 298 transmission chains which suggested preventive measures, generated around 22 000 follow-ups and more than 30 000 days of work leave. The number of contacts that new cases generated decreased during the study period. CONCLUSION: Coordination between Preventive Medicine and Occupational Health departments and agile information systems were necessary to preserve non-COVID activity and workers safety.

Factors related to inhibition of lactation by pharmacological means at birth in a Spanish referral hospital (2011-2017) / Factores relacionados con la inhibición de la lactancia por medios farmacológicos al nacer en un hospital de referencia español (2011-2017)

Objective: To describe the maternal, neonatal and pregnancy characteristics related to inhibition of lactation (IL) with cabergoline. Method: We assessed 20,965 occasions of breastfeeding initiation, according to data collected from obstetric records at the Hospital Clinic of Barcelona (Spain) between January 2011 and December 2017. Results: IL decreased over the study period from 8.78% to 6.18% (odds ratio [OR]: 0.93 per year; 95% confidence interval [95%CI]: 0.90-0.95). Women with a lower educational level (OR: 2.5; 95%CI: 2.0-3.0), mothers living in more depressed areas (OR: 1.08 per 10 extra points over 100; 95%CI: 1.04-1.12), smokers (OR: 2.2; 95%CI: 1.9-2.6), and those with more children (OR: 1.2 for each sibling; 95%CI: 1.1-1.3), preterm birth (OR: 1.8; 95%CI: 1.4-2.3), multiple births (OR: 1.6; 95%CI: 1.2-2.1) and a higher risk pregnancy (OR: 1.3 per risk point; 95%CI: 1.2-1.4) showed a higher prevalence of IL. Compared to women born in Spain, IL was less likely in all other women with the exception of Chinese women (OR: 7.0; 95%CI: 5.7-8.6). These disparities remained during the study period. Conclusions: Factors related to lower socioeconomic status and poor health were more likely to be associated with IL. The overall use of cabergoline decreased during the study period while inequalities persisted. Taking these inequalities into account is the first step to addressing them. (AU)

Objetivo: Describir las características maternas, neonatales y del embarazo relacionadas con la inhibición de la lactancia (IL) con cabergolina. Método: Se evaluaron 20.965 ocasiones de inicio de lactancia, según los registros obstétricos del Hospital Clínic de Barcelona (2011-2017). Resultados: La IL disminuyó durante el periodo de estudio del 8,78% al 6,18% (odds ratio[OR]: 0,93 anual; intervalo de confianza del 95% [IC95%]: 0,90-0,95). Las mujeres con menor nivel educativo (OR: 2,5; IC95%: 2,0-3,0), las madres que viven en áreas más deprivadas (OR: 1,08 por 10 puntos extra sobre 100; IC95%: 1,04-1,12), las fumadoras (OR: 2,2; IC95%: 1,9-2,6), las que tienen más hijos (OR: 1,2 por cada hermano; IC95%: 1,1-1,3), los nacimientos prematuros (OR: 1,8; IC95%: 1,4-2,3), los nacimientos múltiples (OR: 1,6; IC95%: 1,2-2,1) y los embarazos de mayor riesgo (OR: 1,3 por punto de riesgo; IC95%: 1,2-1,4) tuvieron una mayor prevalencia de IL. Respecto a las mujeres nacidas en España, la IL fue menor que en las demás mujeres, con la excepción de las nacidas en China (OR: 7,0; IC95%: 5,7-8,6). Estas desigualdades se mantuvieron durante el periodo de estudio. Conclusiones: Los factores relacionados con el bajo nivel socioeconómico y la mala salud tuvieron más probabilidades de estar asociados con la IL. El uso de cabergolina disminuyó durante el periodo de estudio, mientras que las desigualdades se mantuvieron. Tener en cuenta estas desigualdades es el primer paso para abordarlas. (AU)

Factors related to inhibition of lactation by pharmacological means at birth in a Spanish referral hospital (2011-2017).

OBJECTIVE: To describe the maternal, neonatal and pregnancy characteristics related to inhibition of lactation (IL) with cabergoline. METHOD: We assessed 20,965 occasions of breastfeeding initiation, according to data collected from obstetric records at the Hospital Clinic of Barcelona (Spain) between January 2011 and December 2017. RESULTS: IL decreased over the study period from 8.78% to 6.18% (odds ratio [OR]: 0.93 per year; 95% confidence interval [95%CI]: 0.90-0.95). Women with a lower educational level (OR: 2.5; 95%CI: 2.0-3.0), mothers living in more depressed areas (OR: 1.08 per 10 extra points over 100; 95%CI: 1.04-1.12), smokers (OR: 2.2; 95%CI: 1.9-2.6), and those with more children (OR: 1.2 for each sibling; 95%CI: 1.1-1.3), preterm birth (OR: 1.8; 95%CI: 1.4-2.3), multiple births (OR: 1.6; 95%CI: 1.2-2.1) and a higher risk pregnancy (OR: 1.3 per risk point; 95%CI: 1.2-1.4) showed a higher prevalence of IL. Compared to women born in Spain, IL was less likely in all other women with the exception of Chinese women (OR: 7.0; 95%CI: 5.7-8.6). These disparities remained during the study period. CONCLUSIONS: Factors related to lower socioeconomic status and poor health were more likely to be associated with IL. The overall use of cabergoline decreased during the study period while inequalities persisted. Taking these inequalities into account is the first step to addressing them.

Prevalence of adenomatous polyposis in a fecal immunochemical test-based colorectal cancer screening program and risk of advanced neoplasia during follow-up.

BACKGROUND : Current guidelines recommend genetic counseling and intensive colonoscopy surveillance for patients with ≥ 10 colorectal adenomas based on scarce data. We investigated the prevalence of this condition in a fecal immunochemical test (FIT)-based colorectal (CRC) screening program, and the incidence of metachronous lesions during follow-up. METHODS: We retrospectively included all FIT-positive participants with ≥ 10 adenomas at index colonoscopy between 2010 and 2018. Surveillance colonoscopies were collected until 2019. Patients with inherited syndromes, serrated polyposis syndrome, total colectomy, or lacking surveillance data were excluded. The cumulative incidence of CRC and advanced neoplasia were analyzed by Kaplan-Meier analysis. Risk factors for metachronous advanced neoplasia were investigated by multivariable logistic regression analysis. RESULTS: 215 of 9582 participants (2.2 %) had ≥ 10 adenomas. Germline genetic testing was performed in 92 % of patients with ≥ 20 adenomas, identifying two inherited syndromes (3.3 %). The 3-year cumulative incidence of CRC and advanced neoplasia were 1 % and 16 %, respectively. In 39 patients (24.2 %), no polyps were found on first surveillance colonoscopy. The presence of an advanced adenoma was independently associated with a higher risk of advanced neoplasia at first surveillance colonoscopy (odds ratio 3.91, 95 %CI 1.12-13.62; P = 0.03). Beyond the first surveillance colonoscopy, the risk of metachronous advanced neoplasia was lower. CONCLUSIONS: The prevalence of ≥ 10 adenomas in a FIT-based CRC screening program was 2.2 %; a small proportion of inherited syndromes were detected, even amongst those with ≥ 20 adenomas. A low rate of post-colonoscopy CRC was observed and the risk of advanced neoplasia beyond the first surveillance colonoscopy tended to progressively decrease throughout successive follow-ups.

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

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

Distribución de la duración de la incapacidad temporal por contingencia comúnpor diagnóstico médico (Cataluna, 2006-2008) / Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)

Presentamos una herramienta sencilla y práctica que permite consultar la distribución habitual de laduración de la incapacidad temporal por contingencia común, según el diagnóstico médico. Para ello seanalizaron 2.646.352 episodios de incapacidad temporal ocurridos en Cataluna y seguidos hasta el alta, ˜entre 2006 y 2008, incorporados a un aplicativo. La duración mediana, dado que sigue una distribuciónasimétrica, fue de 9 días. Los trastornos musculoesqueléticos fueron el grupo diagnóstico más frecuente(22,5%) y las neoplasias tuvieron la duración mediana más larga (56 días). Los diagnósticos específicos máscomunes fueron la diarrea-gastroenteritis (8,2%;mediana: 3 días) y la rinofaringitis aguda (5,2%;mediana:4 días). La distribución de la duración de la incapacidad temporal en una población varía por diagnósticoy es asimétrica; la mayoría de los episodios duran mucho menos que la media. Esta información esimportante para una mejor gestión, tanto clínica como administrativa, de la incapacidad temporal (AU)

We present a simple and practical tool that allows the usual distribution of the duration of nonoccupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medicallycertified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008,were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, themedian duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnosticgroup (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%;median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and isasymmetric, with most episodes being much shorter than the mean duration. This finding is importantfor better clinical and administrative management of sick leave episodes (AU)

[Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)]. / Distribución de la duración de la incapacidad temporal por contingencia común por diagnóstico médico (Cataluña, 2006-2008).

We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes.

Incapacidad temporal por enfermedad común y accidente no laboral en Cataluña, 2007-2010 / Nonoccupational temporary sickness absence in Catalonia, 2007-2010

Objetivos: Describir los episodios de incapacidad temporal por enfermedad común y accidente no laboral (ITcc) registrados en Cataluña entre 2007 y 2010. Métodos: Se analizaron 4.273.601 procesos de ITcc certificados en los Centros de Atención Primaria de Cataluña con alta entre 2007 y 2010. Se estimó para cada año la incidencia de episodios de ITcc por cada 100 afiliados en la Seguridad Social, la duración mediana y la duración media de días de baja por afiliado según el sexo, la edad, la provincia, el régimen de la seguridad social y la familia diagnóstica de la CIE-10.Resultados: Se observa una tendencia consistente en descenso de la duración media de días de baja por afiliado (de12,2 días en 2007 a 10,8 en 2010) y de la incidencia (de 34,4 a 30,4 casos por 100 afiliados). Este patrón se observa tanto en hombres como en mujeres, aunque los hombres presentan una incidencia, duración mediana y días de baja por afiliado menor que las mujeres. La mayoría de los diagnósticos fueron por enfermedades respiratorias (alrededor de 7 episodios porcada 100 afiliados), osteomusculares (que desciende de 6,9 a 3,2 en el periodo de estudio) e infeccionas (alrededor de 4). En cuanto a la duración mediana de los episodios destacan las enfermedades tumorales (sobre 50 días), mentales (sobre 30 días)y cardiovasculares (entre 20 y 30 días). Conclusiones: Las tendencias mostradas pueden servir como valores de referencia para la planificación y evaluación delas políticas de gestión de la ITcc(AU)

Objectives: To describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007and 2010.Methods: We analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups. Results: There was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20and 30 days)(AU)

[Non-occupational temporary sickness absence in Catalonia, 2007-2010]. / Incapacidad temporal por enfermedad común y accidente no laboral en Cataluña, 2007-2010.

OBJECTIVES: To describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007 and 2010. METHODS: We analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups. RESULTS: There was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to 10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20 and 30 days). CONCLUSIONS: These trends may serve as a baseline for planning and evaluating policies directed at better management of sickness absence in Spain.

OBJETIVOS: Describir los episodios de incapacidad temporal por enfermedad común y accidente no laboral (ITcc) registrados en Cataluña entre 2007 y 2010. MÉTODOS: Se analizaron 4.273.601 procesos de ITcc certificados en los Centros de Atención Primaria de Cataluña con alta entre 2007 y 2010. Se estimó para cada año la incidencia de episodios de ITcc por cada 100 afiliados en la Seguridad Social, la duración mediana y la duración media de días de baja por afiliado según el sexo, la edad, la provincia, el régimen de la seguridad social y la familia diagnóstica de la CIE-10. RESULTADOS: Se observa una tendencia consistente en descenso de la duración media de días de baja por afiliado (de 12,2 días en 2007 a 10,8 en 2010) y de la incidencia (de 34,4 a 30,4 casos por 100 afiliados). Este patrón se observa tanto en hombres como en mujeres, aunque los hombres presentan una incidencia, duración mediana y días de baja por afiliado menor que las mujeres. La mayoría de los diagnósticos fueron por enfermedades respiratorias (alrededor de 7 episodios por cada 100 afiliados), osteomusculares (que desciende de 6,9 a 3,2 en el periodo de estudio) e infeccionas (alrededor de 4). En cuanto a la duración mediana de los episodios destacan las enfermedades tumorales (sobre 50 días), mentales (sobre 30 días) y cardiovasculares (entre 20 y 30 días). CONCLUSIONES: Las tendencias mostradas pueden servir como valores de referencia para la planificación y evaluación de las políticas de gestión de la ITcc.

[Comparison in Andalusia and Catalonia of sickness absence for influenza (H1N1) 2009]. / Comparación entre Andalucía y Cataluña de la frecuencia de incapacidad laboral durante la gripe (H1N1) 2009.

BACKGROUND: This study compared surveillance of cases of sickness absence due to illness caused by influenza and reported in Andalusia and Catalonia in the period 2007-2009. METHODS: A time series of incident cases of sickness absence due to influenza, by sex and age, in which episodes in Andalusia and Catalonia in a previous epidemic period (from 01/01/2007 through 30/09/2009) were compared to the pandemic period (last three months of 2009). The weekly number of new cases of sickness absence due to influenza was calculated, and the minimum, median and maximum values were plotted for each of these two periods. RESULTS: Unexpectedly, women had a higher proportion of new cases of sickness absence due to influenza during the pandemic period (52.2% in Catalonia and 49.7% in Andalusia). During both periods the 25 to 34 year old age group had a higher number of new cases of sickness absence both in Catalonia (37.439 in the epidemic period and 15.379 in the pandemic) and Andalusia (20.465 epidemic period and 9.630 pandemic period). The arrival of the pandemic was around November (approximately 10.000 cases in Catalonia and 5.000 cases in Andalusia), resulting in a significant increase of cases in contrast to the median of the epidemic period. CONCLUSIONS: During the 2009 pandemic, there was an increase in new cases of sickness absence due to influenza, somewhat greater in Catalonia than Andalusia, with an earlier peak in November, especially among women in these two autonomous communities.

Comparación entre Andalucía y Cataluña de la frecuencia de incapacidad laboral durante la gripe (H1N1) 2009 / Comparisson in andalusia and Catalonia of sickness absence because of influenza (H1N1) 2009

Fundamentos: La gripe estacional es una causa frecuente de episodios de incapacidad temporal por contingencia común (ITcc). En este estudio se valora el impacto laboral de la gripe pandémica (H1N1) 2009 en Andalucía y Cataluña durante el periodo 2007- 2009. Métodos: Estudio de series temporales de los casos de ITcc por gripe, según edad y sexo. Se compararon los nuevos casos de ITcc por gripe en un primer periodo epidémico (de 01/01/2007 hasta 30/09/2009) y un segundo periodo pandémico (tres últimos meses de 2009). Se calculó el número semanal de nuevos casos de ITcc por gripe, representándose gráficamente los valores mínimo, mediano y máximo de los casos notificados durante el periodo epidémico y el pandémico. Resultados:Al contrario de lo esperado, las mujeres presentaron 52,2% en Cataluña y 49,7% en Andalucía de nuevos casos de ITcc por gripe durante el periodo pandémico. Durante ambos periodos, el grupo de edad de 25 a 34 años presentó mayor número de casos tanto en Cataluña (37.439 en el periodo epidémico y 15.379 en el pandémico) como en Andalucía (periodo epidémico 20.465 y periodo pandémico 9.630). La llegada de la pandemia se situó alrededor del mes de noviembre (aproximadamente 10.000 casos en Cataluña y 5.000 casos en Andalucía), produciéndose un importante aumento de casos respecto a la mediana del periodo epidémico. Conclusiones: La aparición de la pandemia de gripe produjo un incremento importante de casos de ITcc, algo superior en Cataluña que en Andalucía, adelantándose su acmé a noviembre, especialmente en las mujeres de las dos Comunidades Autónomas(AU)

Background: This study compared surveillance of cases of sickness absence due to illness caused by influenza and reported in Andalusia and Catalonia in the period 2007-2009. Methods:Atime series of incident cases of sickness absence due to influenza, by sex and age, in which episodes in Andalusia and Catalonia in a previous epidemic period (from 01/01/2007 through 30/09/2009) were compared to the pandemic period (last three months of 2009). The weekly number of new cases of sickness absence due to influenza was calculated, and the minimum, median and maximum values were plotted for each of these two periods. Results: Unexpectedly, women had a higher proportion of new cases of sickness absence due to influenza during the pandemic period (52.2% in Catalonia and 49.7% in Andalusia). During both periods the 25 to 34 year old age group had a higher number of new cases of sickness absence both in Catalonia (37.439 in the epidemic period and 15.379 in the pandemic) and Andalusia (20.465 epidemic period and 9.630 pandemic period).The arrival of the pandemic was around November (approximately 10.000 cases in Catalonia and 5.000 cases in Andalusia), resulting in a significant increase of cases in contrast to the median of the epidemic period. Conclusions: During the 2009 pandemic, there was an increase in new cases of sickness absence due to influenza, somewhat greater in Catalonia than Andalusia, with an earlier peak in November, especially among women in these two autonomous communities(AU)

Evaluación de la gestión de los casos de incapacidad temporal por contingencia común de más de 15 días en Cataluña / Evaluation of the management of nonwork-related sick leave lasting more than 15 days in Catalonia (Spain)

ObjetivosComparar la duración de los casos de incapacidad temporal por contingencia común gestionados por las mutuas con los gestionados por el Instituto Nacional de la Seguridad Social (INSS).MétodosCohorte retrospectiva de 289.686 casos de incapacidad de más de 15 días de duración iniciados en 2005 tras su certificación por un médico de primaria en Cataluña (156.676 gestionados por el INSS), registrados en el Institut Català d’Avaluacions Mèdiques, y seguidos hasta su alta. La duración mediana y los percentiles fueron calculados con el estimador de Wang-Chang, que tiene en cuenta los episodios repetidos (25% aproximadamente), y se compararon mediante un modelo de regresión log-logístico con fragilidad gamma compartida, lo que permite estimar la razón de tiempo (RT) y su intervalo de confianza del 95% (IC95%).ResultadosLa duración mediana fue de 43 días para los casos del INSS y de 39 para los de mutuas. Esta diferencia fue estadísticamente significativa para los hombres del régimen general (RT=0,87; IC95%: 0,85–0,88) y del régimen de autónomos (RT=0,78; IC95%: 0,75–0,80), y para las mujeres del régimen general (RT=0,85; IC95%: 0,84–0,87) y de autónomos (RT=0,84; IC95%: 0,81–0,88); diferencias que se mantienen en general después de ajustar por la edad y la región sanitaria.ConclusionesLos resultados confirman una finalización de los episodios más rápida para los casos de más de 15 días de duración gestionados por una mutua que para los gestionados por el INSS, tanto aquellos del régimen general como de autónomos. Es necesario investigar las causas de estas diferencias(AU)

ObjectivesTo compare the length of nonwork-related sick leave among cases managed by an insurance company versus those managed by the National Institute of Social Security (NISS).MethodsWe performed a retrospective cohort study of 289,686 cases of sick leave lasting for more than 15 days that began in 2005 after certification by a primary care physician in Catalonia, were reported to the Catalonian Institute of Medical Evaluations, and were followed to term. Of the total, 156,676 cases were managed by the NISS. To account for repeat episodes (approximately 25% of the total), the Wang-Chang estimator was used to calculate the median duration and percentiles; comparisons were made using log-logistic regression with shared gamma frailty models, with calculation of time ratios (TR) and their corresponding 95% confidence intervals (95% CI).ResultsThe median duration of sick leave was 43 days for cases managed by the NISS and 39 days for those managed by the insurance company. This difference was statistically significant both for men employed under contract (TR=0.87; 95% CI: 0.85–0.88) and for those who were self-employed (TR=0.78; 95% CI: 0.75–0.80) as well as for women under contract (TR=0.85; 95% CI: 0.84–0.87) and self-employed women (TR=0.84; 95% CI: 0.81–0.88). These differences persisted after adjustment was performed for age and health region.ConclusionsFor sick leave lasting more than 15 days, these results confirm that cases managed by an insurance company ended earlier than for those managed by the NISS, both for contract and self-employed workers. Further research is needed to explore the reasons for these differences(AU)

[Evaluation of the management of nonwork-related sick leave lasting more than 15 days in Catalonia (Spain)]. / Evaluación de la gestión de los casos de incapacidad temporal por contingencia común de más de 15 días en Cataluña.

OBJECTIVES: To compare the length of nonwork-related sick leave among cases managed by an insurance company versus those managed by the National Institute of Social Security (NISS). METHODS: We performed a retrospective cohort study of 289,686 cases of sick leave lasting for more than 15 days that began in 2005 after certification by a primary care physician in Catalonia, were reported to the Catalonian Institute of Medical Evaluations, and were followed to term. Of the total, 156,676 cases were managed by the NISS. To account for repeat episodes (approximately 25% of the total), the Wang-Chang estimator was used to calculate the median duration and percentiles; comparisons were made using log-logistic regression with shared gamma frailty models, with calculation of time ratios (TR) and their corresponding 95% confidence intervals (95% CI). RESULTS: The median duration of sick leave was 43 days for cases managed by the NISS and 39 days for those managed by the insurance company. This difference was statistically significant both for men employed under contract (TR=0.87; 95% CI: 0.85-0.88) and for those who were self-employed (TR=0.78; 95% CI: 0.75-0.80) as well as for women under contract (TR=0.85; 95% CI: 0.84-0.87) and self-employed women (TR=0.84; 95% CI: 0.81-0.88). These differences persisted after adjustment was performed for age and health region. CONCLUSIONS: For sick leave lasting more than 15 days, these results confirm that cases managed by an insurance company ended earlier than for those managed by the NISS, both for contract and self-employed workers. Further research is needed to explore the reasons for these differences.