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

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

[Climate emergency and employment, a challenge we cannot ignore in occupational health]. / Emergencia climática y empleo, un reto que no podemos ignorar en salud laboral.

Más de 200 revistas científicas de todo el mundo han solicitado a las Naciones Unidas que declare la emergencia sanitaria global antes de la próxima Asamblea de la Organización Mundial de la Salud (OMS), prevista para mayo de 2024.

[Occupational health policies in older workers: comparative analysis between Spain and Chile]. / Políticas en salud laboral en personas trabajadoras mayores: análisis comparativo entre España y Chile.

OBJECTIVE: To analyze and compare the current Spanish and Chilean regulations regarding occupational risk prevention, regarding the existence of specific indications that protect the occupational health and safety of people over 55 years of age. METHOD: Qualitative study in which a documentary content analysis was carried out using ATLAS/ti. The sample was 88 regulatory documents on occupational risk prevention for Spain and Chile. The guidance of the European Agency for Safety at Work (EU-OSHA) regarding age-critical risks was followed. RESULTS: In global terms, 21.9% of the total Spanish documents analyzed show the explicit presence of considerations on aging, while for Chile this occurs in 9%. Both countries mention indications regarding ergonomic risks and noise. Shift work and psychosocial risks are considered only in Spain, while extreme temperatures, vibrations and geographical altitude appear exclusively in Chilean regulations. Neither country refers to issues inherent to working women (care responsibilities, menopause). CONCLUSIONS: The Spanish regulations present a greater presence of indications on aging compared to the Chilean one. However, development in this area is insufficient in both countries. Chile and Spain have guides of recommendations, which are not mandatory, and their application is voluntary. This suggests that the prevention of occupational risks has a great pending challenge with people over 55 years of age.

Downregulation of IRF8 in alveolar macrophages by G-CSF promotes metastatic tumor progression.

Tissue-resident macrophages (TRMs) are abundant immune cells within pre-metastatic sites, yet their functional contributions to metastasis remain incompletely understood. Here, we show that alveolar macrophages (AMs), the main TRMs of the lung, are susceptible to downregulation of the immune stimulatory transcription factor IRF8, impairing anti-metastatic activity in models of metastatic breast cancer. G-CSF is a key tumor-associated factor (TAF) that acts upon AMs to reduce IRF8 levels and facilitate metastasis. Translational relevance of IRF8 downregulation was observed among macrophage precursors in breast cancer and a CD68hiIRF8loG-CSFhi gene signature suggests poorer prognosis in triple-negative breast cancer (TNBC), a G-CSF-expressing subtype. Our data highlight the underappreciated, pro-metastatic roles of AMs in response to G-CSF and identify the contribution of IRF8-deficient AMs to metastatic burden. AMs are an attractive target of local neoadjuvant G-CSF blockade to recover anti-metastatic activity.

[The public health profession in Spain: an urgent challenge to strengthen its practice]. / La profesión de la salud pública en España: un reto urgente para fortalecer su práctica.

The recent health crises have highlighted the weakness of public health structures in Spain. The causes are, among others, the scarcity of economic resources and the delay in their institutional modernization. In addition, there is the weakness of the training processes and the employability. The Spanish Society of Public Health and Health Administration (SESPAS) has developed a White paper of the public health profession with the aim of contributing to strengthening professional practice. The sociodemographic characteristics of the associations federated to SESPAS have been described and the discourse of professionals has been analyzed through six focus groups and 19 interviews (72 people). To agree on the conclusions and recommendations, a meeting was organized with the participation of 29 participants. The demographic and employment data of the 3467 people belonging to seven SESPAS societies show that, overall, about 60% are women and 40% were under 50 years of age. Undergraduate degrees were medicine (35.9%), nursing (17.4%) and pharmacy and veterinary medicine (10.4%). Key aspects of the meaning of public health, training, employability and career and institutionalization of public health were collected through interviews and focus groups. The final meeting agreed on 25 conclusions and 24 recommendations that aim to contribute to strengthening professionals and the public health profession in Spain. Some of them, related to training, employability and professional career, have been shared in a workshop at the School of Public Health of Menorca with public health officials from the Ministry of Health and some autonomous communities.

USP22 overexpression fails to augment tumor formation in MMTV-ERBB2 mice but loss of function impacts MMTV promoter activity.

The Ubiquitin Specific Peptidase 22 (USP22), a component of the Spt-Ada-Gcn5 Acetyltransferase (SAGA) histone modifying complex, is overexpressed in multiple human cancers, but how USP22 impacts tumorigenesis is not clear. We reported previously that Usp22 loss in mice impacts execution of several signaling pathways driven by growth factor receptors such as erythroblastic oncogene B b2 (ERBB2). To determine whether changes in USP22 expression affects ERBB2-driven tumorigenesis, we introduced conditional overexpression or deletion alleles of Usp22 into mice bearing the Mouse mammary tumor virus-Neu-Ires-Cre (MMTV-NIC) transgene, which drives both rat ERBB2/NEU expression and Cre recombinase activity from the MMTV promoter resulting in mammary tumor formation. We found that USP22 overexpression in mammary glands did not further enhance primary tumorigenesis in MMTV-NIC female mice, but increased lung metastases were observed. However, deletion of Usp22 significantly decreased tumor burden and increased survival of MMTV-NIC mice. These effects were associated with markedly decreased levels of both Erbb2 mRNA and protein, indicating Usp22 loss impacts MMTV promoter activity. Usp22 loss had no impact on ERBB2 expression in other settings, including MCF10A cells bearing a Cytomegalovirus (CMV)-driven ERBB2 transgene or in human epidermal growth factor receptor 2 (HER2)+ human SKBR3 and HCC1953 cells. Decreased activity of the MMTV promoter in MMTV-NIC mice correlated with decreased expression of known regulatory factors, including the glucocorticoid receptor (GR), the progesterone receptor (PR), and the chromatin remodeling factor Brahma-related gene-1 (BRG1). Together our findings indicate that increased expression of USP22 does not augment the activity of an activated ERBB2/NEU transgene but impacts of Usp22 loss on tumorigenesis cannot be assessed in this model due to unexpected effects on MMTV-driven Erbb2/Neu expression.

Políticas en salud laboral en personas trabajadoras mayores: análisis comparativo entre España y Chile / Occupational health policies in older workers: comparative analysis between Spain and Chile

Objetivo Analizar y comparar la normativa vigente española y chilena en materia de prevención de riesgos laborales respecto a la existencia de indicaciones específicas que protejan la seguridad y la salud laboral de las personas trabajadoras mayores de 55 años. Método Estudio cualitativo en el que se realizó un análisis documental de contenido utilizando ATLAS/ti. La muestra fue de 88 documentos normativos en materia de prevención de riesgos laborales de España y Chile. Se siguieron las orientaciones de la Agencia Europea para la Seguridad en el Trabajo (EU-OSHA) respecto a los riesgos críticos para la edad. Resultados En términos globales, el 21,9% de los documentos españoles analizados muestran la presencia explícita de consideraciones sobre el envejecimiento, mientras que para Chile esto sucede en el 9%. Ambos países mencionan indicaciones ante riesgos ergonómicos y ruido. El trabajo en turnos y los riesgos psicosociales solo se consideran en España, mientras que las temperaturas extremas, las vibraciones y la altura geográfica solo en la normativa chilena. Ningún país hace referencia a temas inherentes a las mujeres que trabajan (responsabilidades de cuidado, menopausia). Conclusiones La normativa española presenta mayores indicaciones sobre envejecimiento que la chilena. Sin embargo, el desarrollo es insuficiente en ambos países. Chile y España cuentan con guías de recomendaciones, no obligatorias y de aplicación voluntaria. Esto sugiere que la prevención de riesgos laborales tiene un desafío pendiente con las personas mayores de 55 años. (AU)

Objective To analyze and compare the current Spanish and Chilean regulations regarding occupational risk prevention, regarding the existence of specific indications that protect the occupational health and safety of people over 55 years of age. Method Qualitative study in which a documentary content analysis was carried out using ATLAS/ti. The sample was 88 regulatory documents on occupational risk prevention for Spain and Chile. The guidance of the European Agency for Safety at Work (EU-OSHA) regarding age-critical risks was followed. Results In global terms, 21.9% of the total Spanish documents analyzed show the explicit presence of considerations on aging, while for Chile this occurs in 9%. Both countries mention indications regarding ergonomic risks and noise. Shift work and psychosocial risks are considered only in Spain, while extreme temperatures, vibrations and geographical altitude appear exclusively in Chilean regulations. Neither country refers to issues inherent to working women (care responsibilities, menopause). Conclusions The Spanish regulations present a greater presence of indications on aging compared to the Chilean one. However, development in this area is insufficient in both countries. Chile and Spain have guides of recommendations, which are not mandatory, and their application is voluntary. This suggests that the prevention of occupational risks has a great pending challenge with people over 55 years of age. (AU)

La profesión de la salud pública en España: un reto urgente para fortalecer su práctica / The public health profession in Spain: an urgent challenge to strengthen its practice

Las últimas crisis sanitarias han puesto de manifiesto la debilidad de las estructuras de salud pública en España. Las causas son, entre otras, la escasez de recursos económicos y el retraso en su modernización institucional, junto a la debilidad de los procesos formativos y de la empleabilidad. La Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) ha impulsado la elaboración del Libro blanco de la profesión de salud pública con el objetivo de contribuir a fortalecer el ejercicio profesional. Para ello se han descrito las características sociodemográficas de las asociaciones federadas a SESPAS y se ha analizado el discurso de los profesionales a través de seis grupos focales y 19 entrevistas en profundidad (72 personas). Con este material se realizó una reunión (29 personas) para consensuar conclusiones y recomendaciones. De las 3467 personas pertenecientes a las siete sociedades de SESPAS que proporcionaron datos, alrededor del 60% son mujeres y el 40% tienen menos de 50 años, siendo los estudios de grado de medicina (35,9%), enfermería (17,4%), farmacia y veterinaria (10,4%) los más frecuentes. En las entrevistas y grupos focales se identificaron como temas centrales la formación, la empleabilidad y la carrera profesional. En la reunión final se acordaron 25 conclusiones y 24 recomendaciones que pretenden contribuir a fortalecer a los/las profesionales y la profesión de la salud pública en España. Las relacionadas con la formación, la empleabilidad y la carrera profesional fueron compartidas en un Encuentro en la Escuela de Salud Pública de Menorca con responsables de salud pública del Ministerio de Sanidad y de algunas comunidades autónomas.(AU)

The recent health crises have highlighted the weakness of public health structures in Spain. The causes are, among others, the scarcity of economic resources and the delay in their institutional modernization. In addition, there is the weakness of the training processes and the employability. The Spanish Society of Public Health and Health Administration (SESPAS) has developed a White paper of the public health profession with the aim of contributing to strengthening professional practice. The sociodemographic characteristics of the associations federated to SESPAS have been described and the discourse of professionals has been analyzed through six focus groups and 19 interviews (72 people). To agree on the conclusions and recommendations, a meeting was organized with the participation of 29 participants. The demographic and employment data of the 3467 people belonging to seven SESPAS societies show that, overall, about 60% are women and 40% were under 50 years of age. Undergraduate degrees were medicine (35.9%), nursing (17.4%) and pharmacy and veterinary medicine (10.4%). Key aspects of the meaning of public health, training, employability and career and institutionalization of public health were collected through interviews and focus groups. The final meeting agreed on 25 conclusions and 24 recommendations that aim to contribute to strengthening professionals and the public health profession in Spain. Some of them, related to training, employability and professional career, have been shared in a workshop at the School of Public Health of Menorca with public health officials from the Ministry of Health and some autonomous communities.(AU)

Labour market participation after sickness absence due to cancer: a dynamic cohort study in Catalonia (Spain).

BACKGROUND: The consequences of cancer on working until retirement age remain unclear. This study aimed to analyse working life considering all possible labour market states in a sample of workers after sickness absence (SA) due to cancer and to compare their working life paths to those of a sample of workers without SA and with an SA due to other diseases. METHODS: This was a retrospective dynamic cohort study among social security affiliates in Catalonia from 2012-2018. Cases consisted of workers with an SA due to cancer between 2012-2015 (N = 516) and were individually age- and sex-matched with those of affiliates with an SA due to other diagnoses and workers without an SA. All workers (N = 1,548, 56% women) were followed up from entry into the cohort until the end of 2018 to characterise nine possible weekly labour states. Sequence analysis, optimal matching, and multinomial logistic regression were used to identify and assess the probability of future labour market participation patterns (LMPPs). All analyses were stratified by sex. RESULTS: Compared with workers with an SA due to cancer, male workers with no SA and SA due to other causes showed a lower probability of being in the LMPP of death (aRRR 0.02, 95% CI: 0.00‒0.16; aRRR 0.17, 95% CI: 0.06‒0.46, respectively) and, among women, a lower probability of permanent disability and death (aRRR 0.24, 95% CI: 0.10‒0.57; aRRR 0.39, 95% CI: 0.19‒0.83, respectively). Compared to workers with SA due to cancer, the risk of early retirement was lower among workers with no SA (women, aRRR 0.60, 95% CI: 0.22‒1.65; men, aRRR 0.64, 95% CI: 0.27‒1.52), although these results were not statistically significant. CONCLUSIONS: Workplaces, many of which have policies common to all diagnoses, should be modified to the needs of cancer survivors to prevent an increasing frequency of early retirement and permanent disability when possible. Future studies should assess the impact of cancer on premature exit from the labour market among survivors, depending on cancer localisation and type of treatment.

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.

Consensus on post COVID in the Spanish national health system: Results of the CIBERPOSTCOVID eDelphi study.

BACKGROUND: In 2021, the Spanish Ministry of Health launched the CIBERPOSTCOVID project to establish what post COVID was. The present study reports the level of agreement among stakeholders on post COVID and its clinical and diagnostic characteristics in the Spanish health system. METHODS: The agreement on post COVID among clinicians, public health managers, researchers and patients' representatives was explored in a real-time, asynchronous online Delphi. In a two-wave consensus, respondents rated from 1 (total disagreement) to 6 (total agreement) 67 statements related to terminology, duration, etiology, symptoms, impact on quality of life, severity, elements to facilitate diagnosis, applicability in the pediatric population, and risk factors. Consensus was reached when 70 % of ratings for a statement were 5 or 6, with an interquartile range equal or less than 1. FINDINGS: A total of 333 professionals and patients participated in this eDelphi study. There was agreement that post COVID was "a set of multi-organic symptoms that persist or fluctuate after acute COVID-19 infection and are not attributable to other causes" with a minimum duration of 3 months. The highest levels of agreement were found in the most frequent symptoms and its impacts on everyday activities. Aspects related to the diagnostic process and the measurement of its severity reached a lower level of consensus. There was agreement on the need to rule out previous health problems and assess severity using validated functional scales. However, no agreement was reached on the risk factors or specific features in the pediatric population. INTERPRETATION: This policy-based consensus study has allowed the characterization of post COVID generating collective intelligence and has contributed to an operational definition applicable in clinical practice, health services management and useful for research purposes in Spain and abroad. Agreements are consistent with existing evidence and reference institutions at European and international level.

A single dominant locus restricts retrovirus replication in YBR/Ei mice.

Differential responses to viral infections are influenced by the genetic makeup of the host. Studies of resistance to retroviruses in human populations are complicated due to the inability to conduct proof-of-principle studies. Inbred mouse lines, which have a range of susceptible phenotypes to retroviruses, are an ideal tool to identify and characterize mechanisms of resistance and define their genetic underpinnings. YBR/Ei mice become infected with Mouse Mammary Tumor Virus, a mucosally transmitted murine retrovirus, but eliminate the virus from their pedigrees. Virus elimination correlates with a lack of virus-specific neonatal oral tolerance, which is a major mechanism for blocking the anti-virus response in susceptible mice. Virus control is unrelated to virus-neutralizing antibodies, cytotoxic CD8+ T cells, NK cells, and NK T cells, which are the best characterized mechanisms of resistance to retroviruses. We identified a single, dominant locus that controls the resistance mechanism, which we provisionally named attenuation of virus titers (Avt) and mapped to the distal region of chromosome 18. IMPORTANCE Elucidation of the mechanism that mediates resistance to retroviruses is of fundamental importance to human health, as it will ultimately lead to knowledge of the genetic differences among individuals in susceptibility to microbial infections.

[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.

[The need for university links for public health professionals]. / La necesaria vinculación universitaria de los profesionales de salud pública.

There needs to be a bidirectional relationship between the public health profession and academia. This will enhance their professional practice and the academy will be able to carry out practice-based teaching and research. This field note explains a legislative advance in this direction. So that professionals from public health institutions can access permanent positions as university professors, as well as the professionals in the clinical field, we ask several deputies from some parliamentary groups of the Universities Commission to include a reform that modifies article 70 of the project of Organic Law of the University System (LOSU in Spanish acronym) with this possibility. Ultimately, LOSU was approved in March 2023 with the requested amendment, providing a great opportunity for both public health institutions and academia to advance a bidirectional relationship.

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.

Extreme temperatures and sickness absence in the Mediterranean province of Barcelona: An occupational health issue.

Objectives: This study aims to assess the association between daily temperature and sickness absence episodes in the Mediterranean province of Barcelona between 2012 and 2015, according to sociodemographic and occupational characteristics. Methods: Ecological study of a sample of salaried workers affiliated to the Spanish social security, resident in Barcelona province between 2012 and 2015. The association between daily mean temperature and risk of new sickness absence episodes was estimated with distributed lag non-linear models. The lag effect up to 1 week was considered. Analyses were repeated separately by sex, age groups, occupational category, economic sector and medical diagnosis groups of sickness absence. Results: The study included 42,744 salaried workers and 97,166 episodes of sickness absence. The risk of sickness absence increased significantly between 2 and 6 days after the cold day. For hot days there was no association with risk of sickness absence. Women, young, non-manual and workers in the service sector had a higher risk of sickness absence on cold days. The effect of cold on sickness absence was significant for respiratory system diseases (RR: 2.16; 95%CI: 1.68-2.79) and infectious diseases (RR: 1.31; 95%CI: 1.04-1.66). Conclusion: Low temperatures increase the risk of having a new episode of sickness absence, especially due to respiratory and infectious diseases. Vulnerable groups were identified. These results suggest the importance of working in indoor and possibly poorly ventilated spaces in the spread of diseases that eventually lead to an episode of sickness absence. It is necessary to develop specific prevention plans for cold situations.