Do workers' health surveillance examinations fulfill their occupational preventive objective? Analysis of the medical practice of occupational physicians in Catalonia, Spain.

OBJECTIVES: Although routine workers' health examinations are extensively performed worldwide with important resource allocation, few studies have analyzed their quality. The objective of this study has been to analyze the medical practice of workers' health examinations in Catalonia (Spain) in terms of its occupational preventive aim. MATERIAL AND METHODS: A cross-sectional study was carried out by means of an online survey addressed to occupational physicians who were members of the Catalan Society of Safety and Occupational Medicine. The questionnaire included factual questions on how they performed health examinations in their usual practice. The bivariate analysis of the answers was performed by type of occupational health service (external/internal). RESULTS: The response rate was 57.9% (N = 168), representing 40.3% of the reference population. A high percentage of occupational physicians had important limitations in their current medical practice, including availability of clinical and exposure information, job-specificity of tests, and early detection and appropriate management of suspected occupational diseases. The situation in external occupational health services - that covered the great majority of Catalan employees - was worse remarkably in regard to knowledge of occupational and nonoccupational sickness absence data, participation in the investigation of occupational injuries and diseases, and accessibility for workers to the occupational health service. CONCLUSIONS: This study raises serious concerns about the occupational preventive usefulness of these health examinations, and subsequently about our health surveillance system, based primarily on them. Professionals alongside health and safety institutions and stakeholders should promote the rationalization of this system, following the technical criteria of need, relevance, scientific validity and effectiveness, whilst ensuring that its ultimate goal of improving the health and safety of workers in relation to work is fulfilled. Other countries with similar surveillance systems might be encouraged by our results to assess how their practices fit the intended purpose. Int J Occup Med Environ Health 2017;30(6):823-848.

Calidad y adecuación técnica a la normativa de los exámenes de vigilancia de la salud de la población trabajadora en relación con su finalidad preventiva / Quality and compliance with the regulations of workers health wcaminations in relation to their preventive purpose / Qualitat i adequació tècnica a la normativa de ls exàmens de vigilància de la salut de la població treballadora en relació amb la seva finalitat preventiva

Objetivo. Analizar si los exámenes de vigilancia de la salud en Cataluña se realizan con un grado de calidad suficiente que permitiría dar respuesta a la finalidad preventiva inherente a la normativa e identificar posibles diferencias según el tipo de servicio de prevención. Método. Análisis de contenido de la normativa relacionada con la vigilancia de la salud e identificación de conceptos preventivos. Estos conceptos se asociaron a las preguntas de un cuestionario realizado a profesionales sanitarios que realizaban exámenes de salud en su práctica habitual. Se establecieron criterios de calidad (mínimos que deben cumplirse para garantizar que la práctica profesional sea de calidad) y se calcularon indicadores de calidad (porcentaje de profesionales cuya práctica profesional cumplía los criterios de calidad) de forma global y por tipo de servicio de prevención. Se definieron estándares de calidad (mínimo exigible: cumplimiento de los criterios de calidad por parte de más del 75% de los profesionales). Resultados. Los conceptos identificados fueron: disponibilidad de información clínica y de exposición, especificidad, identificación de trabajadores especialmente sensibles, derivación a mutua, elaboración de propuestas preventivas, e independencia profesional y no perjuicio para el trabajador. Los indicadores de calidad oscilaron entre 0 y 88%, siendo en general más bajos en los servicios de prevención ajenos. Ningún concepto superó globalmente el estándar de calidad. Conclusiones. El grado de calidad con que se realizan los exámenes de vigilancia de la salud en Cataluña no parece ser suficiente para dar respuesta a la finalidad preventiva inherente a la normativa, siendo la situación peor en los servicios de prevención ajenos

Objective. To analyze whether examinations for health surveillance in Catalonia are carried out with a high enough degree of quality as to comply with the preventive aim of the regulations, and to identify potential differences by type of prevention service. Method. Qualitative and quantitative techniques. Body of data: Spanish regulations related to health surveillance, and a self-reported questionnaire answered by occupational health professionals who performed health examinations in their usual practice. Content analysis of regulations, identifying concepts, and linking them to survey questions. Quality criteria were established for each concept, referring to the minimum that must be met to ensure that the professional practice can be of quality; quality indicators (percentage of professionals whose practice met the quality criteria) were calculated globally and by type of prevention service; and quality standards (fulfilment of quality criteria by 75% or more of the professionals) were set. Results. The concepts identified were: availability of clinical and exposure information, job-specificity, identification of workers with special susceptibilities, referral to mutual insurance companies for appropriate diagnosis and treatment, development of preventive proposals, and professional independence and non detriment for workers. Quality indicators ranged between 0 and 88%. None of the concepts globally reached the quality standard. Conclusions. The quality of health examinations performed for health surveillance in Catalonia, doesn’t seem to be high enough as to comply with the preventive aim of the regulations. The situation is worse in external prevention services

Objectiu: Analitzar si els exàmens de vigilancia de la salut a Catalunya es fan amb un grau de qualitat suficient que permetria donar resposta a la finalitat preventiva inherent a la normativa i identificar possibles diferències segons el tipus de servei de prevenció. Mètode; Anàlisi de contingut de la normativa relacionada amb la vigilancia de la salut i la identificació de conceptes preventius. Aquests conceptes es van associar a les preguntes d’un qüestionari elaborat per a professionals sanitaris que feien exàmens de salut en la seva práctica habitual. Es van establir criteris de qualitat (mínims que han de complir-se per garantir que la práctica professional sigui de qualitat) i es van calcular indicadors de qualitat(percentatge de professionals la práctica professional dels quals complia els criteris de qualitat) de forma global i per tipus de servei de prevenció. Es van definir estàndards de qualitat (mínim exigible: compliment dels criteris de qualitat per part de més del 75% dels professionals). Resultats: Els concept es identificats van ser: disponibilit at d’informació clínica i d’exposició, especificitat, identificación de treballadors especialment sensibles, derivació a un a mútua , elaboració de propostes preventives, i independència professional i no- perjudici per al treballador . Els indicadors de qualitat van oscil·lar entre 0 i 88%,de manera que eren, en general, més baixos en els serveis de prevenció aliens . Cap concepte va superar globalment l’estàndard de qualitat. Conclusions: El grau de qualitat amb què es fan els exàmen s de vigilancia de la salut a Catalunya no sembla ser suficiente per donar resposta a la finalitat preventiva inherent a la normativa i ón la situació és pitjor en els serveis de prevenció aliens

[Quality and compliance with the regulations of workers'health examinations in relation to their preventive purpose]. / Calidad y adecuación técnica a la normativa de los exámenes de vigilancia de la salud de la población trabajadora en relación con su finalidad preventiva.

OBJECTIVE: To analyze whether examinations for health surveillance in Catalonia are carried out with a high enough degree of quality as to comply with the preventive aim of the regulations, and to identify potential differences by type of prevention service. METHOD: Qualitative and quantitative techniques. Body of data: Spanish regulations related to health surveillance, and a self-reported questionnaire answered by occupational health professionals who performed health examinations in their usual practice. Content analysis of regulations, identifying concepts, and linking them to survey questions. Quality criteria were established for each concept, referring to the minimum that must be met to ensure that the professional practice can be of quality; quality indicators (percentage of professionals whose practice met the quality criteria) were calculated globally and by type of prevention service; and quality standards (fulfilment of quality criteria by 75% or more of the professionals) were set. RESULTS: The concepts identified were: availability of clinical and exposure information, job-specificity, identification of workers with special susceptibilities, referral to mutual insurance companies for appropriate diagnosis and treatment, development of preventive proposals, and professional independence and non detriment for workers. Quality indicators ranged between 0 and 88%. None of the concepts globally reached the quality standard. CONCLUSIONS: The quality of health examinations performed for health surveillance in Catalonia, doesn't seem to be high enough as to comply with the preventive aim of the regulations. The situation is worse in external prevention services.

How much do workers’ health examinations add to health and safety at the workplace? Occupational preventive usefulness of routine health examinations / ¿Qué aportan los exámenes de salud a la seguridad y salud en el trabajo? Utilidad preventiva ocupacional de los exámenes de salud rutinarios

Objective: Despite no evidence in favour, routine workers’ health examinations, mostly pre-employment and periodic, are extensively performed worldwide with important allocation of resources. In Spain they are performed within a theoretical job-specific health surveillance system. Our objective was to ascertain their occupational preventive usefulness from the perspective of occupational health professionals. Methods: Cross sectional study. Online survey addressed to all physicians and nurses members of the Catalan Society of Safety and Occupational Medicine (n=539) in 2011. Univariate and bivariate analyses of prevalence and prevalence differences of answers. Results: Response rate 53% (n=285). According to more than 70% of respondents the health surveillance system isn’t cost-effective, doesn’t meet the goal of early detection of health damage related to work, and doesn’t contribute to improve the occupational risk prevention system. Further deficiencies were identified regarding specificity and scientific basis for health examinations, quality of collective health surveillance and referral of suspected cases to mutual insurance companies for diagnosis and treatment. Bivariate analysis showed a significantly more negative opinion for several items amongst physicians (versus nurses) and amongst professionals working in external prevention services (versus internal services). Conclusions: This study raises serious concerns about how health examinations are performed within our workers’ health surveillance system, which should be reviewed to ensure the fulfilment of its occupational preventive objective. Our results might encourage other countries with similar practices to assess them in order to assure their fitness for purpose (AU)

Objetivo: Pese a la ausencia de evidencia a favor, la realización de exámenes de salud rutinarios a los trabajadores, sobre todo previos/iniciales y periódicos, es una práctica extendida en muchos países y conlleva una asignación importante de recursos. En España se realizan dentro de un sistema de vigilancia de la salud laboral teóricamente específico. Nuestro objetivo fue determinar su utilidad preventiva ocupacional desde la perspectiva de los profesionales sanitarios de salud laboral Métodos: Estudio transversal. Encuesta en línea dirigida a profesionales sanitarios miembros de la Sociedad Catalana de Seguridad y Medicina del Trabajo (n=539) en 2011. Análisis univariado y bivariado de prevalencia y prevalencia de diferencias de las respuestas. Resultados: Tasa de respuesta 53% (n=285). Según más del 70% de los participantes, el sistema de vigilancia de la salud no es costo-efectivo, no cumple el objetivo de detección precoz de daños a la salud relacionados con el trabajo, y no contribuye a mejorar el sistema de prevención de riesgos laborales. También se identificaron deficiencias en la especificidad y base científica de los exámenes, en la calidad de la vigilancia colectiva y en la derivación a mutua de casos sospechosos de patología laboral para diagnóstico y tratamiento. El análisis bivariado mostró una opinión significativamente más negativa para varios ítems entre los médicos (versus enfermeras) y los profesionales de servicios de prevención ajenos (versus propios). Conclusiones: Este estudio plantea serias preocupaciones acerca de cómo se realizan los exámenes de salud dentro del sistema de vigilancia de la salud de nuestros trabajadores, que debe ser revisado para asegurar el cumplimiento de su objetivo preventivo laboral. Países con prácticas preventivas similares podrían verse alentados por nuestros resultados para revisarlas (AU)

How much do workers' health examinations add to health and safety at the workplace? Occupational preventive usefulness of routine health examinations.

OBJECTIVE: Despite no evidence in favour, routine workers' health examinations, mostly pre-employment and periodic, are extensively performed worldwide with important allocation of resources. In Spain they are performed within a theoretical job-specific health surveillance system. Our objective was to ascertain their occupational preventive usefulness from the perspective of occupational health professionals. METHODS: Cross sectional study. Online survey addressed to all physicians and nurses members of the Catalan Society of Safety and Occupational Medicine (n=539) in 2011. Univariate and bivariate analyses of prevalence and prevalence differences of answers. RESULTS: Response rate 53% (n=285). According to more than 70% of respondents the health surveillance system isn't cost-effective, doesn't meet the goal of early detection of health damage related to work, and doesn't contribute to improve the occupational risk prevention system. Further deficiencies were identified regarding specificity and scientific basis for health examinations, quality of collective health surveillance and referral of suspected cases to mutual insurance companies for diagnosis and treatment. Bivariate analysis showed a significantly more negative opinion for several items amongst physicians (versus nurses) and amongst professionals working in external prevention services (versus internal services). CONCLUSIONS: This study raises serious concerns about how health examinations are performed within our workers' health surveillance system, which should be reviewed to ensure the fulfilment of its occupational preventive objective. Our results might encourage other countries with similar practices to assess them in order to assure their fitness for purpose.

Prevalence and severity of categorical and dimensional personality disorders in adolescents with eating disorders.

OBJECTIVE: The objective of this study is to explore and compare the prevalence of categorical and dimensional personality disorders (PDs) and their severity in Spanish adolescents with Eating Disorders (EDs). METHOD: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and International Classification of Diseases, Tenth Revision-10 modules of the International Personality Disorder Examination were administered to a sample of 100 female adolescents with EDs (mean age=15.8 years, SD=0.9). RESULTS: 'Thirty-three per cent of the sample had at least one PD, in most cases a simple PD. The rate of PDs was 64-76% in bulimia patients, 22-28% in anorexia and 25% in EDs not otherwise specified. The highest dimensional scores were observed in bulimia, [corrected] mainly in borderline and histrionic PDs, and higher scores for anankastic PD in anorexia than in the other ED diagnoses. Overall, purging type EDs had higher cluster B personality pathology scores than restrictive type.' [corrected] The Publisher would like to apologize for this error and any confusion it may have caused. [corrected]. DISCUSSION: Adolescent female patients with ED have a risk of presenting a comorbid PD, especially patients with bulimia and purging type EDs.

Eating disorders and body image in Spanish and Mexican female adolescents.

OBJECTIVE: To compare the prevalence of eating disorders (ED), socio-cultural risk factors, and body image characteristics in two populations of female adolescents, one Mexican and one Spanish, from similar socio-economic backgrounds. METHOD: A total of 467 Spanish and 329 Mexican girls aged from 11-12 to 17-18 years were assessed using the Eating Attitude Test-26 (EAT-26), the CETCA (Eating Disorders Assessment Questionnaire), the CIMEC (Questionnaire on Influences on Body Shape Model), and a survey of socio-demographic and risk factors produced for this study. RESULTS: One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase. CONCLUSIONS: Risk behaviors and the ideal body models of these Spanish and Mexican adolescent girls varied significantly, indicating major socio-cultural differences. However, the prevalence of ED was similar. Further research should aim to clarify whether the similarities found between this Spanish sample and a Mexican sample taken from an upper-middle class urban environment, a minority that is unrepresentative of the general population, are also observed in samples from other sectors of Mexican society.

Psychological Variables for Identifying Susceptibility to Mental Disorders in Medical Students at the University of Barcelona.

INTRODUCTION: This study analyses some psychological variables related to susceptibility to mental disorders in medical students. METHODS: A sample of 209 first- and second-year medical students was evaluated using the State and Trait Anxiety Inventory (STAI), and three questionnaires: Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), General Health Questionnaire (GHQ-28) and UNCAHS scale of STRAIN. RESULTS: Thirty percent of the students suffered from emotional distress as measured by de GHQ-28, and showed significantly higher scores on trait anxiety, sensitivity to punishment and reward scales, and had higher levels of strain both in the academic environment and their personal life. Women scored significantly higher than men on trait anxiety and sensitivity to reward. Logistical regression found that trait anxiety and strain in non-academic life were the best predictors of the development of a mental disorder. CONCLUSIONS: The study confirms the usefulness of the STAI for detecting psychological distress and the validity of the SPSRQ for identifying subjects likely to present emotional distress when facing high environmental demands. Subjects most likely to present with mental illness are those who evaluate their personal (non-academic) lives as more stressful.

Habilidades y procedimientos clínicos básicos a adquirir por los estudiantes de la Facultad de Medicina de la Universidad de Barcelona / Basic clinical skills and procedures to be acquired by the students of the Faculty of Medicine of the University of Barcelona

Las facultades de medicina deben definir las competencias que sus estudiantes han de adquirir a lo largo de su formación de pregrado, poner los medios necesarios para asegurar su adquisición y proceder a su evaluación. Esto ha de permitir que los estudiantes sepan lo que se espera de ellos al licenciarse, que los profesores puedan enmarcar su actividad docente y definir los criterios de evaluación de la adquisición de los objetivos. Este trabajo describe el proceso de definición de las habilidades correspondientes al nivel técnico de competencias y en especial las referidas a la anamnesis y exploración física y a los procedimientos clínicos básicos en la Facultad de Medicina de la Universidad de Barcelona. Se han definido 93 habilidades de exploración física y 47 procedimientos clínicos. Asimismo, se presentan los resultados de una encuesta realizada a los estudiantes del sexto año de la primera promoción de plan nuevo, para valorar su opinión sobre el grado de adquisición de las diferentes habilidades. El estudio pone de manifiesto las áreas deficitarias y facilita la elección de la estrategia más adecuada para mejorar su adquisición. La definición de las habilidades y los procedimientos clínicos básicos ha de permitir hacer más efectiva la enseñanza clínica y que su evaluación sea más objetiva (AU)

El Programa de Atención Psicológica de la Facultad de Medicina de la Universidad de Barcelona / The UB Medicine School's Psychological Care Program

Se analizan las particularidades de un programa de atención psicológica diseñado para los estudiantes de la Facultad de Medicina de la Universidad de Barcelona al cabo de un año de su puesta en marcha. Se especifican las características de esta población universitaria y se relacionan con la demanda académica a que está sometida. La dotación disponible es de dos coordinadores, ambos profesores de la unidad de psiquiatría, que prestan su servicio a cambio de actividad docente y una psicóloga clínica, alumna de tercer ciclo. El espacio físico comprende un despacho y una sala para intervención en grupo. Las prestaciones se vertebran en tres conceptos: a) asistencia psicológico-psiquiátrica individual; b) estudios epidemiológicos sobre factores de riesgo psicosocial, y c) generación de recursos vinculados a aspectos académicos y profesionales. El interés del Programa de Atención Psicológica no reside en replicar una oferta asistencial con una dotación precaria, sino en recoger información del alumnado que pueda orientar los recursos, tanto en el campo de la problemática psicológica individual como de grupo, y vincularlos, en la medida de lo posible, a la docencia y a la futura práctica médica (AU)