Prevención de los accidentes de trabajo mortales basada en la evidencia: una aproximación sistemática / Evidence-based prevention of work-related fatalities: A systematic approach

Objetivos: Elaborar una propuesta sistematizada de medidas preventivas dirigida a factores personales y laborales asociados a la ocurrencia de accidentes de trabajo mortales (ATM) de naturaleza traumática, y valorar la utilidad de dicho procedimiento. Métodos: El proceso se basa en la adaptación de la matriz de Haddon (dimensiones temporal, nivel de acción y colectivos específicos), determinando sus componentes a partir de los resultados de una investigación etiológica previa sobre factores asociados a los ATM. Los contenidos de las celdas de la matriz se completan mediante la identificación de las correspondientes medidas preventivas en la literatura científica. Resultados: La matriz consta de las filas pre-lesión, lesión y post-lesión (dimensión temporal); las columnas trabajador, agente, centro de trabajo y entorno social (nivel de acción); y los colectivos específicos, definidos por actividad económica, género, edad, temporalidad y trabajo o centro no habituales. Las medidas propuestas incluyen la formación y el diseño de procedimientos seguros de trabajo en el nivel del trabajador, los elementos de protección pasiva en el nivel del agente productor de la lesión, la organización del espacio y las condiciones ambientales en el centro de trabajo, y la efectividad de los sistemas de prevención y atención de urgencia en el entorno social. Conclusiones: La utilización y adaptación de la matriz de Haddon, a partir de resultados previos en la investigación etiológica de los ATM permite identificar de manera sistemática medidas preventivas dirigidas a los correspondientes factores de riesgo identificados, lo que puede ayudar a priorizar y seleccionar las acciones preventivas más adecuadas(AU)

Objectives: To produce a systematic proposal of preventive measures directed at individual and occupational risk factors for work-related traumatic fatalities, and to assess the usefulness of such a process. Methods: The process is based on the adaptation of the Haddon matrix (dimensions of time, action level and specific groups of workers), establishing their components from the results of a previous etiological investigation on factors related to fatal occupational injuries. The content of each cell of the matrix is completed by the identification of specific preventive measures through a review of the scientific literature. Results: The matrix is formed by the rows pre-injury, injury and post-injury (time dimension); columns are worker, agent, workplace and social environment (action level); and specific groups of workers, defined by economic activity, gender, age, type of employment contract, and non-routine tasks or workplaces. Measures proposed include training and design of safe working procedures at a worker’s action level, passive protective elements at the injurious agent level, organisation and environmental conditions at the workplace level and effectiveness of prevention and emergency care systems at the social environment level. Conclusions: Use and adaptation of Haddon matrix based on prior results derived from etiologic investigations of fatal occupational injuries, helps to systematically identify preventive measures aimed at hazard identification. This approach can help prioritise and select the most appropriate preventive actions(AU)

Evaluation of the national health surveillance program of workers previously exposed to asbestos in Spain (2008)

Objectives: Although asbestos was banned in Spain in 2001, monitoring the health of previously-exposed workers is required. In 2002 the Ministry of Health and the autonomous regions of Spain planned a health surveillance program for workers exposed to asbestos (Programa de Vigilancia de la Salud de los Trabajadores Expuestos al Amianto [PIVISTEA]) with employers’ organizations, trade unions and scientific societies. The aim of this study was to evaluate the PIVISTEA to improve its effectiveness. Methods: A questionnaire with indicators for the year 2008 was sent to Spain's 17 autonomous regions, as well as to the autonomous cities of Ceuta and Melilla. The results were analyzed by evaluating the compliance of each program with the activities established by the PIVISTEA. Results: In December 2008, a total of 22,158 workers from 14 autonomous regions and 306 companies were included in the program. The program had been started in 88% of the regions but surveillance activities remained scarce in 24%. Fifty-seven percent of the autonomous regions (69% of the total number of workers) provided the information requested. Seven autonomous regions provided data on the relationship between the diseases found and asbestos exposure. Only 5% of these diseases entitled affected individuals to receive compensation for occupational diseases. Conclusions: The health surveillance of workers previously exposed to asbestos in Spain, as well as medical-legal recognition of diseases caused by exposure at work, remain in adequate. Although the trend is positive, the effectiveness of many regional programs is limited, and inter-regional inequalities among affected workers have been detected (AU)

Objetivos: Después de la prohibición del amianto en España en 2001, resulta necesario vigilar la salud de los trabajadores expuestos en el pasado. En 2002, el Ministerio de Sanidad y las Comunidades Autónomas consensuaron un Programa de Vigilancia de la Salud de los Trabajadores Expuestos al Amianto (PIVISTEA) con las organizaciones empresariales y sindicales, y con las sociedades profesionales del sector. El objetivo de este estudio es evaluar el programa con el fin de tratar de mejorar su eficacia. Métodos: Se enviaron cuestionarios con indicadores referentes al año 2008 a las 17 comunidades autónomas y a las ciudades autónomas de Ceuta y Melilla. Los resultados se analizaron evaluando el cumplimiento de cada programa en relación con las actividades establecidas en PIVISTEA. Resultados: En diciembre de 2008, un total de 22.158 trabajadores, de 14 comunidades autónomas y 306 empresas, estaban incluidos en el programa. El 88% de las comunidades autónomas han iniciado el programa, aunque en el 24% las actividades siguen siendo escasas. El 57% (69% del total de los trabajadores) de las comunidades autónomas han proporcionado la información solicitada. Siete han comunicado datos sobre la relación entre la patología que encuentran y la exposición al amianto. Sólo el 5% de esas enfermedades son compensadas como profesionales. Conclusiones: La situación en España respecto a la vigilancia de la salud de los trabajadores previamente expuestos al amianto, y el reconocimiento médico-legal de las enfermedades derivadas de esa exposición, aún no es adecuada. Aunque la tendencia es positiva, muchos de los programas autonómicos tienen todavía una eficacia limitada y se detectan desigualdades interterritoriales (AU)

Evaluation of the national health surveillance program of workers previously exposed to asbestos in Spain (2008).

OBJECTIVES: Although asbestos was banned in Spain in 2001, monitoring the health of previously-exposed workers is required. In 2002 the Ministry of Health and the autonomous regions of Spain planned a health surveillance program for workers exposed to asbestos (Programa de Vigilancia de la Salud de los Trabajadores Expuestos al Amianto [PIVISTEA]) with employers' organizations, trade unions and scientific societies. The aim of this study was to evaluate the PIVISTEA to improve its effectiveness. METHODS: A questionnaire with indicators for the year 2008 was sent to Spain's 17 autonomous regions, as well as to the autonomous cities of Ceuta and Melilla. The results were analyzed by evaluating the compliance of each program with the activities established by the PIVISTEA. RESULTS: In December 2008, a total of 22,158 workers from 14 autonomous regions and 306 companies were included in the program. The program had been started in 88% of the regions but surveillance activities remained scarce in 24%. Fifty-seven percent of the autonomous regions (69% of the total number of workers) provided the information requested. Seven autonomous regions provided data on the relationship between the diseases found and asbestos exposure. Only 5% of these diseases entitled affected individuals to receive compensation for occupational diseases. CONCLUSIONS: The health surveillance of workers previously exposed to asbestos in Spain, as well as medical-legal recognition of diseases caused by exposure at work, remain in adequate. Although the trend is positive, the effectiveness of many regional programs is limited, and inter-regional inequalities among affected workers have been detected.

[Evidence-based prevention of work-related fatalities: a systematic approach]. / Prevención de los accidentes de trabajo mortales basada en la evidencia: una aproximación sistemática.

OBJECTIVES: To produce a systematic proposal of preventive measures directed at individual and occupational risk factors for work-related traumatic fatalities, and to assess the usefulness of such a process. METHODS: The process is based on the adaptation of the Haddon matrix (dimensions of time, action level and specific groups of workers), establishing their components from the results of a previous etiological investigation on factors related to fatal occupational injuries. The content of each cell of the matrix is completed by the identification of specific preventive measures through a review of the scientific literature. RESULTS: The matrix is formed by the rows pre-injury, injury and post-injury (time dimension); columns are worker, agent, workplace and social environment (action level); and specific groups of workers, defined by economic activity, gender, age, type of employment contract, and non-routine tasks or workplaces. Measures proposed include training and design of safe working procedures at a worker's action level, passive protective elements at the injurious agent level, organisation and environmental conditions at the workplace level and effectiveness of prevention and emergency care systems at the social environment level. CONCLUSIONS: Use and adaptation of Haddon matrix based on prior results derived from etiologic investigations of fatal occupational injuries, helps to systematically identify preventive measures aimed at hazard identification. This approach can help prioritise and select the most appropriate preventive actions.

OBJETIVOS: Elaborar una propuesta sistematizada de medidas preventivas dirigida a factores personales y laborales asociados a la ocurrencia de accidentes de trabajo mortales (ATM) de naturaleza traumática, y valorar la utilidad de dicho procedimiento. MÉTODOS: El proceso se basa en la adaptación de la matriz de Haddon (dimensiones temporal, nivel de acción y colectivos específicos), determinando sus componentes a partir de los resultados de una investigación etiológica previa sobre factores asociados a los ATM. Los contenidos de las celdas de la matriz se completan mediante la identificación de las correspondientes medidas preventivas en la literatura científica. RESULTADOS: La matriz consta de las filas pre-lesión, lesión y post-lesión (dimensión temporal); las columnas trabajador, agente, centro de trabajo y entorno social (nivel de acción); y los colectivos específicos, definidos por actividad económica, género, edad, temporalidad y trabajo o centro no habituales. Las medidas propuestas incluyen la formación y el diseño de procedimientos seguros de trabajo en el nivel del trabajador, los elementos de protección pasiva en el nivel del agente productor de la lesión, la organización del espacio y las condiciones ambientales en el centro de trabajo, y la efectividad de los sistemas de prevención y atención de urgencia en el entorno social. CONCLUSIONES: La utilización y adaptación de la matriz de Haddon, a partir de resultados previos en la investigación etiológica de los ATM permite identificar de manera sistemática medidas preventivas dirigidas a los correspondientes factores de riesgo identificados, lo que puede ayudar a priorizar y seleccionar las acciones preventivas más adecuadas.

Individual and occupational factors related to fatal occupational injuries: a case-control study.

This study has been designed in order to identify factors increasing the risk of a fatal outcome when occupational accidents occur. The aim is to provide further evidence for the design and implementation of preventive measures in occupational settings. The Spanish Ministry of Labour registry of occupational injuries causing absence from work includes information on individual and occupational characteristics of injured workers and events. Registered fatal occupational injuries in 2001 (n=539) were compared to a sample of non-fatal injuries in the same year (n=3493). Risks for a fatal result of occupational injuries, adjusted by individual and occupational factors significantly associated, were obtained through logistic regression models. Compared to non-fatal injuries, fatal occupational injuries were mostly produced by trapping or by natural causes, mostly related to elevation and transport devices and power generators, and injured parts of body more frequently affected were head, multiple parts or internal organs. Adjusted analyses showed increased risk of fatality after an occupational injury for males (adjusted odds ratio aOR=10.92; 95%CI 4.80-24.84) and temporary workers (aOR=5.18; 95%CI 2.63-10.18), and the risk increased with age and with advancing hour of the work shift (p for trends <0.01). Injuries taking place out of the usual occupational setting (aOR=2.85, 95%CI 2.27-3.59), or carrying out atypical tasks (aOR=2.08; 95%CI 1.27-3.39) showed increased risks of a fatal result too, as occupational accidents in agricultural or construction companies. These data can help to select and define priorities for programmes aimed to prevent fatal consequences of occupational injuries.

Validity and reliability of surrogate information for controls in a case-control study on Alzheimer's disease.

This study is aimed to investigate proxy respondent's information usefulness in retrospective studies by comparing information obtained with a questionnaire (with a total of 171 items) from controls and their proxy respondents in a case-control study on Alzheimer's disease. Kappa indices and intraclass correlation coefficients were calculated to assess reliability, and bias factor and mean differences were calculated to assess validity. Proxy respondent's personal features (gender, age and relationship with the index subject) were also studied. Kappa indices and intraclass correlation coefficients were in general good or very good (>0.6), specially regarding control's personal and family data (ranges 0.45-1 for Kappa and 0.86-0.99 for intraclass correlation coefficient) and occupational exposures (range for Kappa 0.48-1). No systematic biases were found (range for bias factor 0.65-4.12 and range for mean differences -1.81-1.30, none of them statistically significant). Proxy respondent's individual features were not found to systematically affect reliability. The use of surrogate information for controls in etiologic case-control studies of Alzheimer's disease may be useful without unacceptable loss of information or systematic biases.