[Contribution of the occupational health to the COVID-19 pandemic control.] / Contribución de la salud laboral al control de la pandemia por covid-19 en España.

When the World Health Organization declared Covid-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.

Cuando la Organización Mundial de la Salud declaró la Covid-19 como una emergencia de salud pública de importancia internacional, el Ministerio de Sanidad convocó a las autoridades sanitarias, laborales, de seguridad social, Inspección de Trabajo y Seguridad Social, Instituto Nacional de Seguridad y Salud en el Trabajo, empresarios, sindicatos, servicios de prevención de riesgos laborales, mutuas y sociedades científicas de la medicina y enfermería del trabajo, para colaborar en el control de la transmisión del SARS-CoV-2 en el ámbito de las empresas. La Ponencia de Salud Laboral de la Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud, elaboró el Procedimiento para los servicios de prevención de riesgos laborales frente a la exposición al SARS-CoV-2, que se ha actualizado 15 veces hasta la fecha. En él se recogen las medidas de prevención a implantar en los centros de trabajo: de carácter organizativo y de protección colectiva, de protección personal, de trabajador especialmente vulnerable y nivel de riesgo, de estudio y manejo de casos y contactos ocurridos en la empresa, de colaboración en la gestión de la incapacidad temporal y, más recientemente, de reincorporación y gestión de las y los trabajadores vacunados. Como resultado de esos marcos de cooperación y colaboración se desplegaron una serie de actividades en los lugares de trabajo que son descritas en este artículo.

Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort.

OBJECTIVE: Large-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study. METHODS: 38,379 participants (62.4% women), 30-65years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders. RESULTS: After 13.6years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1=0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend=0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1=0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality. CONCLUSIONS: HPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.

[Response bias in a population postal survey on Health-Related Quality of Life (sf-12v2)]. / Sesgo de respuesta en una encuesta postal poblacional sobre calidad de vida relacionada con la salud (SF-12v2).

BACKGROUND: the bias associated with the low response rate may limit the economic advantage of population surveys by mail. The factors associated with non-response were estimated with an emphasis on Health-Related Quality of Life (HRQoL). METHODS: people who had answered to the Health Survey Murcia-2007 2007 (≥ 18 years), realized by telephone, were sent another postal questionnaire four months later. Both evaluations included information about HRQoL: SF-12v2 (by phone) and EQ-5D (postal). A logistic regression was realized to identify baseline factors (sociodemographic factors, health-related behaviors and HRQoL-physical component summary (PCS) and mental component summary (MCS) of the SF-12v2) associated with non-response to the postal survey. RESULTS: 2,078 individuals (61.5%) did not answer. Multivariate analysis: non-response was associated with marital status, more likely not to respond if it was not married: widower OR: 2,24; IC95% 0,61/0,88; separate/divorced 1,69; 1,10/2,59-; single 1,53; 1,23/1,90 ) and inversely with age (25-34 years OR: 0,95; IC95% 0,69/1,29; 35-44 years 0,60; 0,43/0,85; 45-54 years 0,42; 0,29/0,60; 55-64 years 0,29; 0,20/0,43; 65-74 years 0,17; 0,11/0,26-;≥75 years 0,15; 0,09/0,23) and educational level (low-OR: 0,65; IC95% 0,48/0,86; intermediate 0,41; 0,30/0,57; high-0,22; 0,16/0,30). It was also associated with HRQoL, but differentially for PCS (those with intermediate scores have less probability of not answering OR: 0.73; 95% CI: 0.61/0.88) than for the MCS (the persons in the highest tertile were more likely to not answering 1.47; 1.22/1.78. CONCLUSION: the HRQoL influences the non- response to the postal surveys, leading to an overrepresentation of individuals with middle physical health and low mental health, which it adds small magnitude bias in the estimation of population HRQoL.

Sesgo de respuesta en una encuesta postal poblacional sobre calidad de vida relacionada con la salud (SF-12v2) / Response bias in population postal survey on helath-relate quality of life (sf-12v2)

Fundamentos: en las investigaciones que utilizan un cuestionario como fuente de información el sesgo asociado a la baja tasa de respuesta puede limitar la ventaja económica de las encuestas poblacionales por correo postal. El objetivo fue estimar los factores asociados a la no respuesta con énfasis en la Calidad de Vida Relacionada con la Salud (CVRS). Métodos: a las personas que respondieron a la Encuesta de Salud de Murcia-2007 (≥ 18 años), realizada vía telefónica, se les remitió cuatro meses después un segundo cuestionario por vía postal. Ambas evaluaciones incluían información sobre CVRS: SF-12v2 (telefónica) y EQ-5D (postal). Se realizó una regresión logística para identificar los factores basales (sociodemográficos, conductas relacionadas con la salud y CVRS - sumario físico (CSF) y sumario mental (CSM) del SF-12v2) asociados a la no respuesta postal. Resultados: 2.078 (61,5%) individuos no respondieron. Análisis multivariante: la no respuesta se asoció con el estado civil, mayor probabilidad de no responder si no estaba casado (viudo OR: 2,24; IC95% 0,61/0,88; separado/divorciado1,69;1,10/2,59; soltero 1,53;1,23/1,90) y de manera inversa con la edad (25-34 años OR:0,95;IC95% 0,69/1,29; 35-44 años 0,60; 0,43/0,85; 45-54 años 0,42; 0,29/0,60; 55-64 años-0,29; 0,20/0,43; 65-74 años 0,17; 0,11/0,26; ≥75 años 0,15; 0,09/0,23) y el nivel de estudios (primarios OR: 0,65; IC95% 0,48/0,86; secundarios 0,41; 0,30/0,57; superiores 0,22; 0,16/0,30). También se asoció con la CVRS pero de manera diferenciada para el CSF: las personas con puntuaciones intermedias presentaron menor probabilidad de no responder (OR: 0,73; IC95% 0,61/0,88) que para el CSM: las personas del tercil superior presentaron mayor probabilidad de no responder (OR: 1,47; 1,22/1,78). Conclusiones: la CVRS influye en la no respuesta de las encuestas postales, dando lugar a una sobrerrepresentación de los individuos con salud física media y con salud mental baja, lo que introduce sesgos de pequeña magnitud en la etimación de la CVRS poblacional (AU)

Background : the bias associated with the low response rate may limit the economic advantage of population surveys by mail. The factors asso- ciated with non-response were estimated with an emphasis on Health- Related Quality of Life (HRQoL). Methods: people who had answered to the Health Survey Murcia- 2007 2007 (≥ 18 years), realized by telephone, were sent another postal questionnaire four months later. Both evaluations included information about HRQoL: SF-12v2 (by phone) and EQ-5D (postal). A logistic regression was realized to identify baseline factors (sociodemographic factors, health-related behaviors and HRQoL-physical component summary (PCS) and mental component summary (MCS) of the SF-12v2) associated withRneosnu-rltess:po2n,0se78toitnhdeivpoidsutaallssu(r6v1ey.5. %) did not answer. Multivariate analysis: non-response was associated with marital status, more likely not to respond if it was not married: widower OR: 2,24; IC95% 0,61/0,88; separate/divorced 1,69; 1,10/2,59-; single 1,53; 1,23/1,90 ) and inversely with age (25-34 years OR: 0,95; IC95% 0,69/1,29; 35-44 years 0,60; 0,43/0,85; 45-54 years 0,42; 0,29/0,60; 55-64 years 0,29; 0,20/0,43; 65-74 years 0,17; 0,11/0,26-; ≥75 years 0,15; 0,09/0,23) and educational level (low-OR: 0,65; IC95% 0,48/0,86; intermediate 0,41; 0,30/0,57; high-0,22; 0,16/0,30). It was also associated with HRQoL, but differentially for PCS (those with intermediate scores have less probability of not answering OR: 0.73; 95% CI: 0.61/0.88) than for the MCS (the persons in the highest ter-tile were more likely to not answering 1.47; 1.22/1.78. Conclusion: the HRQoL influences the non- response to the postal surveys, leading to an overrepresentation of individuals with middle physical health and low mental health, wich it adds small magnitude bias in the estimation of population HRQoL (AU)

Evolución del uso de la ventilación mecánica no invasiva en enfermedad pulmonar obstructiva crónica en una región española, 1997-2010 / Evolution of the Use of Noninvasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease in a Spanish Region, 1997-2010

Introducción: La ventilación mecánica no invasiva (VMNI) aparece, en los 80, como alternativa a la ventilación mecánica invasiva (VMI) en pacientes con fracaso respiratorio agudo. Se pretende valorar la introducción de la VMNI y los resultados sobre los pacientes hospitalizados por agudización de enfermedad pulmonar obstructiva crónica en la Región de Murcia. Sujetos y métodos: Estudio observacional retrospectivo basado en el conjunto mínimo básico de datos al alta hospitalaria de todos los pacientes hospitalizados en todos los hospitales públicos de la región entre 1997-2010. Se realizó análisis de tendencias temporales en la frecuentación hospitalaria, el uso de cada intervención ventilatoria y la mortalidad hospitalaria mediante regresión joinpoint. Resultados: En los 14 años estudiados se identificaron 30.027 casos. Análisis joinpoint: tendencia descendente de la frecuentación (porcentaje de cambio anual [PCA] = −3,4; IC95%: 4,8; -2,0; p < 0,05) y en el grupo sin intervención ventilatoria (PCA = −4,2; −5,6;−2,8; p < 0,05), ascendente en el uso de VMNI (PCA = 16,4; 12,0;20,9; p < 0,05); el uso de la VMI presenta una tendencia descendente sin significación estadística (PCA = −4,5; −10,3;1,7). Se aprecia una tendencia ascendente sin significación estadística en la mortalidad global (PCA = 0,5; −1,3;2,4) y en el grupo sin intervención (PCA = 0,1; −1,6;1,9); decreciente con significación estadística en el grupo VMNI (PCA = −7,1; −11,7;−2,2; p < 0,05) y sin significación estadística en el grupo VMI (PCA = −0,8; −6,1;4,8). La estancia media no varía sustancialmente. Conclusiones: La introducción de la VMNI ha hecho disminuir el grupo de pacientes que no reciben ventilación asistida. No se aprecia mejora de los resultados en términos de mortalidad o estancia media global (AU)

Introduction: Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain). Subjects and methods: A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through JoinPoint regression. Results: We identified 30 027 hospital discharges. JoinPoint analysis: downward trend in attendance (annual percentage change [APC]=−3.4, 95% CI : −4.8 to −2.0, P<0.05) and in the group without ventilatory intervention (APC=−4.2%, −5.6 to −2.8, P<0.05); upward trend in the use of NIV (APC=16.4, 12.0–20.9, P<0.05), and downward trend that was not statistically significant in IMV (APC=−4.5%, −10.3 to 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, −1.3 to 2.4) and in the group without intervention (APC=0.1, −1.6 to 1.9); downward trend with statistical significance in the NIV group (APC=−7.1, −11.7 to −2.2, P<0.05) and not statistically significant in the IMV group (APC=−0.8, −6, 1–4.8). The mean stay did not change substantially. Conclusions: The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay (AU)

Evolution of the use of noninvasive mechanical ventilation in chronic obstructive pulmonary disease in a Spanish region, 1997-2010.

INTRODUCTION: Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain). SUBJECTS AND METHODS: A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression. RESULTS: We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC]=-3.4, 95% CI: - 4.8; -2.0, P <.05) and in the group without ventilatory intervention (APC=-4.2%, -5.6; -2.8, P <.05); upward trend in the use of NIV (APC=16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC=-4.5%, -10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, -1.3; 2.4) and in the group without intervention (APC=0.1, -1.6; 1.9); downward trend with statistical significance in the NIV group (APC=-7.1, -11.7; -2.2, P <.05) and not statistically significant in the IMV group (APC=-0,8, -6, 1; 4.8). The mean stay did not change substantially. CONCLUSIONS: The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.