Trasplantes de órganos y su incidencia sobre la relación laboral. Especial referencia a la situación de Incapacidad Permanente de las personas trasplantadas / Organ transplantation and its impact on employment. Special reference to the situation of permanent disability of transplanted people

Muy pocas veces se han analizado desde un punto de vista jurídico los efectos que el trasplante de órganos puede desplegar en el ámbito del Derecho del Trabajo y de la Seguridad Social. En el presente trabajo se exponen las principales medidas de contenido socio-laboral actualmente vigentes destinadas a ofrecer una protección especial a este tipo de pacientes, a través de las que se trata de evitar que esta situación desencadene el abandono prematuro e involuntario de la vida activa (AU)

The effects of organ transplantation have been rarely addressed from a legal perspective in the Labor and Social Security Law. This paper analyzes the current, main social and labor regulations, designed to provide special protection to transplanted patients, which prevent the premature and involuntary abandonment of working life (AU)

Conflictos bioéticos en la relación sanitaria derivada de las bajas laborales / Bioethical conflicts in the healthcare relation derived from work leaves

El presente artículo realiza una reflexión sobre los conflictos bioéticos que surgen en la relación médico paciente cuando un trabajador presenta un problema de salud que deriva en una baja laboral. Se limita a aquellos casos de origen común, es decir, cuando el problema de salud no tiene una relación directa con el trabajo. Asimismo se centra específicamente en los trabajadores por cuenta ajena cuyo régimen integra la seguridad social y reciben una prestación económica mientras dura el proceso a través de la Mutua Colaboradora con la Seguridad Social (en adelante Mutua) a la que su empresa este afiliado. Aunque el trabajador acude al médico por un problema de salud, la relación no es únicamente asistencial, sino que también incluye una valoración de la capacidad laboral, ya que en caso de verse disminuida, se emitirá un certificado de incapacidad temporal. A través de dicho certificado se activan mecanismos que ponen en marcha la participación de otros sanitarios, en éste caso de la Mutua, con el objetivo de gestionar dicho proceso. Por tanto, hablamos de una relación más amplia, compleja, que va más allá de la asistencia sanitaria, y que en ocasiones puede generar conflicto de intereses (AU)

This paper reflects on the bioethical conflicts derived from the physician-patient relation when a worker presents a health condition that results in a work leave. The paper only deals with those cases that have a common origin, i.e., the health condition is not directly related to the individual’s work activity. Furthermore, it is specifically focused on employed workers whose labor regime is part of the social welfare system and receives an economic benefit for the duration of the process through a health insurance company (hereinafter, Mutua), which the worker’s firm is affiliated to. Although the worker visits the doctor due to a health condition, the relation is not limited only to receiving healthcare, but also includes an assessment of the labor capability, because, in the event that this is undermined, a temporary certificate of incapacity will be issued. This certificate will activate some mechanisms that result in the involvement of other entities related to the healthcare system, in this case the Mutua, that will manage said process. Therefore, this relation is broader and more complex and goes beyond mere healthcarerelated matters and, sometimes, may give rise to conflicts of interests (AU)

Ethical issues in decision making by hospital health committee members in Turkey.

Hospital health committees (HHC) in Turkey review medical reports from clinical practitioners and decide whether or not they are justified. As a rule, each HHC member is expected to observe and examine each patient and then evaluate the report. If the report from the patient's doctor is approved, then the Social Security Administration, a state organisation, will meet all of the patient's expenses covering treatment, medication and operations. Justification of health expenditure is crucial for the state because health resources have to be carefully allocated. Conflicts of obligation also generate ethical issues which have to be resolved as well. However, HHCs are not designed to make ethical decisions. An overall concept of organisational ethics needs to be developed.

Criterios de incapacidad laboral en cáncer de mama / Work disability criteria in breast cancer

El cáncer de mama constituye la neoplasia más frecuente en el sexo femenino, con prevalencia creciente en todos los países de nuestro entorno y también en España. Predomina en el sexo femenino, pero no son descartables los casos en los que es el hombre el afectado y en los que destacan por su importancia los riesgos inherentes al trabajo desempeñado. La importancia de los costes indirectos de esta enfermedad deriva de su elevada prevalencia en edad laboral, conllevar prolongados periodos de incapacidad temporal (IT) e incapacidades permanentes (IP), cuando las limitaciones sean incompatibles con la actividad laboral y una vez agotadas todas las opciones de readaptación/reincorporación laboral. Revisaremos los criterios existentes al respecto para poder establecer unas pautas orientativas de utilidad en la práctica diaria, en medicina del trabajo y asistencial (primaria y otras especialidades), siempre en coordinación con los equipos médicos de valoración de incapacidades del INSS(AU)

Breast cancer is one of the most frequent neoplasia in women, with an increasing prevalence in Europe and also in Spain. Although the predominance over the male sex is clear, we should not forget the cases where men are affected, even more so when in this case the risks attached to the type of job become more important. The importance of the indirect costs of this illness arises from: the high prevalence in people of working age, long periods of work disability, and permanent disability when the limitations are incompatible with the work activity once all the options of job readjustment and return to work have been exhausted. We will review the current criteria in order to establish some orientating guidelines that can be useful in the daily practice for Occupational Medicine professionals, General Practitioners and other specialists, always in collaboration with the medical teams from the National Health Service in charge of the evaluation of disabilities(AU)

Moral hazard and supplier-induced demand: empirical evidence in general practice.

Changes in cost sharing and remuneration system in the Netherlands in 2006 led to clear changes in financial incentives faced by both consumers and general practitioner (GPs). For privately insured consumers, cost sharing was abolished, whereas those socially insured never faced cost sharing. The separate remuneration systems for socially insured consumers (capitation) and privately insured consumers (fee-for-service) changed to a combined system of capitation and fee-for-service for both groups. Our first hypothesis was that privately insured consumers had a higher increase in patient-initiated GP contact rates compared with socially insured consumers. Our second hypothesis was that socially insured consumers had a higher increase in physician-initiated contact rates. Data were used from electronic medical records from 32 GP-practices and 35336 consumers in 2005-2007. A difference-in-differences approach was applied to study the effect of changes in cost sharing and remuneration system on contact rates. Abolition of cost sharing led to a higher increase in patient-initiated utilisation for privately insured consumers in persons aged 65 and older. Introduction of fee-for-service for socially insured consumers led to a higher increase in physician-initiated utilisation. This was most apparent in persons aged 25 to 54. Differences in the trend in physician-initiated utilisation point to an effect of supplier-induced demand. Differences in patient-initiated utilisation indicate limited evidence for moral hazard.

[Incentivising personal responsibility: conceptual clarification and evidence]. / Anreize für Eigenverantwortung: Begriffsbestimmung und Evidenzlage.

Two meanings of personal responsibility are distinguished, and different policy options for promoting health and responsibility are presented. Key insights from research seeking to promote personal responsibility through health information and incentives are outlined and discussed with regard to their potential to improve health and reduce cost. Data is presented on the socioeconomic characteristics of incentive programme users. It is concluded that due to different factors the availability of data regarding the effectiveness of incentive programmes is unsatisfactory. Evaluation requirements set out in the German Social Security Code (SGB V) should focus not only on cost, but should also extend to changes in health status and the socioeconomic status of users: provisions should be revised accordingly.

[Alzheimer's disease and related disorders: specificity of young onset patients, including ethical aspects]. / Maladie d'Alzheimer et syndromes apparentés : spécificités des « malades jeunes ¼, réflexions cliniques et éthiques.

The number of patients with young onset dementia (YOD) (that is before age 65) is estimated at 32,000 in France, and 5000 with onset dementia before 60 years. These patients differ from older ones by the greater number of rares causes (29%), heterogeneity of the presentation among the usual diseases, such as non-amnestic phenotypes of Alzheimer's disease, high frequency of frontal symptoms, and possible genetic origin. These aspects must be taken into account for the diagnosis, often more difficult than in older ones because patients have a little knowledge of the YOD, excepted in the genetics forms. YOD patients can still work or drive a car, and we should choose between the respect for autonomy and the security for the patient and their carers. YOD patients can be more often included in pharmacological trials because they have lower associated disorders. Individual non-pharmacological treatment should be priviledged because they don't easily accept collective activities with other patients over 60 years of age. Excepted for the very young patients (onset before 45), the survival is longer than in late onset dementia, with sometimes severe behavioral problems related to frontal syndrome. In France, the caregiving at home has been improved since the possibility for the YOD patients to receive a financial assistance reserved for the disabled patients, but admission to a nursing home before 60 is very difficult and increases the caregiver burden and perception of unfairness. There is a discrimination between young or older demented patients related to the great difficulty to meet the needs of younger patients, due to the rigidity of the medical and social systems. The presentation of a limited offer for the YOD patients must initiate reflections on our capacities to respect the autonomy and the dignity of the Alzheimer's patients regardless of age.

Identificación y selección de enfermedad de posible origen laboral atendida por el sistema público de salud / Identification and selection of diseases of possible occupational origin managed through the National Health System

ObjetivoIdentificar y seleccionar la patología posiblemente laboral que es atendida en el sistema público de salud.DiseñoEstudio transversal.EmplazamientoCataluña (España).ParticipantesPersona mayor de 15 años que registra una primera visita en atención primaria o un ingreso en un hospital o un episodio de incapacidad por contingencia común en 2008 en Cataluña o que ha fallecido en esta misma comunidad en 2007.Mediciones principalesA partir de la conversión de la lista europea de enfermedades profesionales en 407 entidades de la CIE-10, se identificaron 34 entidades que fueron valoradas por un grupo de expertos.ResultadosEstas entidades posiblemente laborales suponían el 6,7% de las primeras visitas, el 13,8% de las incapacidades laborales, el 13,6% de los contactos con los hospitales agudos y el 15,8% de las defunciones. El asma fue una patología de posible origen laboral identificada en las 4 bases de datos. Después de la selección de los expertos, las 26 entidades representan el 3,3% de las primeras visitas, el 8,9% de las incapacidades y el 2,7% de los contactos con hospitales de agudos.ConclusionesLa implantación de un sistema de alerta en la historia clínica electrónica, cada vez que una de estas 26 enfermedades es registrada, puede ayudar a mejorar la comunicación de trastornos profesionales(AU)

ObjectiveTo identify and select common diseases of possible occupational origin, managed through the Spanish National Health System.DesignCross-sectional study.SettingCatalonia (Spain).ParticipantsData were collected on people over 15 years of age who were seen for the first time in a primary care clinic or were admitted to a hospital or had an episode of non-occupational sickness absence in catalonia in 2008 or died in this region in 2007.Main measurementsA total of 407 diagnostic codes for possible occupationally-related diseases were selected from a modified version of the european union ICD-10 list of diagnostic codes, from which 34 were selected and assessed by an expert panel.ResultsThe initial 34 diagnoses represented 6.7% of all new outpatient visits, 13.8% of the sickness absence episodes, 13.6% of acute admissions and 15.8% of all annual deaths. Asthma appeared prominently in all four databases. The list was pared down to a final list of 26 four-digit icd-10 codes, that accounted for 3.3% of the first visits, 8.9% of lost work time episodes and 2.7% of acute admissions.ConclusionsThe implementation of a “red flag” into the electronic medical record each time one of these 26 diagnostic codes is entered, could help to improve the reporting of occupational diseases(AU)

Insurance and prevention: ethical aspects.

In recent decades, prevention policies--i.e., insurance policies constructed to give incentives to investments in prevention and thereby reduce reliance on insurance--have been much discussed both with regard to different kinds of market insurance and, albeit primarily within a European context and in relation to an ongoing discussion about the need for a shift towards an "active" welfare state, with regard to social insurance. The present contribution identifies normative issues that deserve attention in relation to a general introduction of prevention policies in market insurance and social insurance. It is argued that the importance of these normative issues suggests that arguments and distinctions drawn from moral and political philosophy should play a more prominent role both in the debate on the shift towards an active welfare state and the use of prevention policies in market insurance.

Revisions to rules of conduct and standards of responsibility for representatives. Final rules.

We are revising our rules of conduct and standards of responsibility for representatives. These revisions further clarify our expectations regarding representatives' obligations to competently represent their clients and constitute official notice concerning our requirements and procedures. We are also updating other rules about the representation of parties. These changes are necessary because our current regulations are insufficient to address some representative conduct that is inappropriate, but has technically fallen outside the scope of our regulations. These changes will allow us to better protect the integrity of our administrative process, ensure that claimants receive competent and effective representation, and further clarify representatives' responsibilities in their dealings with us and with claimants.

[The wisdom of the elderly]. / Weisheit des alten Menschen.

Old age is nowadays defined as very old and people are characterized by illness, degeneration and health costs. Ethics in this case have to be healthcare ethics, which accept the challenge to lead people in old age through the healthcare point of view and demonstrate how to integrate their wisdom into culture and society.

[Clinical ethics committees in Mexico: their development in the Mexican Institute of Social Security]. / Comités de ética clínica en México: su desarrollo en el IMSS.

The Mexican Institute of Social Security (IMSS) considers the relevance of ethics in a similar context than other countries have developed. According to these considerations, IMSS implemented formally of system of local committees on clinical ethics (CLEC), not only to provide support when ethical dilemmas emerge, but to facilitate the development of an ethics culture among health professionals. The implementation of the CLEC network started in 2004, and since then, its number has increased across the country. Currently IMSS has 78 CLECs. Their number continues to grow due to the level of awareness about the importance of ethics for making medical decisions. In November 2006 the first CLEC national meeting was held and the need to redefine strategies to improve performance of CLECS emerged. This article reports the current situation of the CLECs in Mexico.