[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

La vigilancia de la salud de los trabajadores expuestos al amianto: ejemplo de colaboración entre el sistema de prevención de riesgos laborales y el sistema nacional de salud / Health surveillance of workers exposed to asbestos: an example of co-operation between the occupational prevention system and the national health system

El Ministerio de Sanidad y Consumo y las Comunidades Autónomashan diseñado y consensuado con los profesionales sanitariosy las organizaciones empresariales y sindicales representativas unPlan Integral de Vigilancia de la Salud de los Trabajadores que hanestado expuestos a Amianto, con el objetivo de garantizar una intervenciónadecuada, uniforme y armonizada de estos trabajadores entodo el territorio nacional. La elaboración del Programa partió delGrupo de Trabajo de Salud Laboral del Consejo Interterritorial, seenriqueció con las aportaciones del Grupo de Trabajo Amianto de laComisión Nacional de Seguridad y Salud en el Trabajo, fue consensuadocon los profesionales de la medicina y enfermería del trabajo,y fue aprobado por las autoridades sanitarias y laborales. El Programaconsta de siete grandes bloques de actividades. Dos años despuésde aprobado el Programa, el estado de implantación en las ComunidadesAutónomas es desigual. Las principales dificultades para supuesta en marcha se encuentran en la elaboración del Registro deexpuestos. Un total de 5.778 trabajadores están incluidos en el Registro.208 trabajadores tienen EPOC, 198 alteraciones pleurales benignas,8 cáncer de pulmón, 10 mesotelioma y 7 presentan otros cáncerescon posible relación con el amianto (gástrico, de laringe y colon). El consenso y la participación alcanzados alrededor de este Programaestán permitiendo lograr coberturas de las políticas de prevenciónde riesgos laborales muy superiores a las que se consiguen conla mera actuación institucional y elaboración de normativa, ya que ensólo los dos primeros años de implantación del Programa se ha duplicadoel número de trabajadores atendidos

The Ministry of Health and Consumer Affairs and the AutonomousGovernments of Spain have designed and agreed by consensuswith the sanitary professionals and major employer's organizationsand Unions a Integral Health Surveillance Programme ofasbestos-exposed workers, in order to assure appropriate, uniformand harmonized action throughout the national territory with relationto these workers. Program description: this initiative startedfrom the Occupational Health Working group of the InterterritorialCouncil, with inputs from the Asbestos Working Group of theNational Occupational Safety and Health Commission. It was agreedwith occupational medicine and infirmary professionals and wasapproved by the Health and Labour authorities. The program isorganised in seven main activities. Current Program status: twoyears after the Programme approval a total of 5,778 workers areincluded in the Registry of asbestos-exposed workers. 208 workershave COPD, 198 benign pleural disease, 8 lung cancer, 10 mesotheliomaand 7 workers have other cancers possibly related toasbestos (gastric, larynx and colon cancer). Remarks: the agreementand participation reached in this Programme allow achievingmuch higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see duringthe second year of implementation of the Programme in which thenumber of attended workers has doubled

El uso del miedo en los mensajes de salud / Use of fear in health messages

Gran parte de las intervenciones en promoción de salud y prevención de la enfermedad incluyen mensajes, dirigidos a la población, que se basan en las consecuencias negativas para la salud que acarrea una determinada conducta. De esta forma se pretende conseguir la adherencia del público a las recomendaciones que, habitualmente, son transmitidas en el mismo mensaje. Estas comunicaciones que utilizan la amenaza como elemento persuasivo fundamental han sido llamadas «mensajes de miedo» y, a pesar de la frecuencia con que se utilizan, su eficacia para promover las conductas que recomiendan está sujeta a controversia. Distintos autores han llegado a la conclusión de que el uso de la amenaza en los mensajes de salud parece influir en el desarrollo posterior de actitudes y conductas preventivas. Esto, no significa, sin embargo, que los mensajes amenazadores tengan necesariamente consecuencias positivas. Para ello deben cumplir dos condiciones básicas: provocar la atención del sujeto en lugar de miedo e incluir una recomendación para eliminar la amenaza del mensaje, que sea percibida por el sujeto como eficaz y fácil de realizar. De estas condiciones se derivan una serie de recomendaciones prácticas para el desarrollo de mensajes de promoción de salud (AU)

Many activities in health promotion and disease prevention address to the target group messages which are based in the negative consequences for health linked to a certain behavior. This infomation is supposed to promote adherence to the recommendations that are usually included in the same message. These kind of communications, which use threat as the basic persuasive strategy, are defined as «fear appeals» and, in spite of being a frequent resource for practicioners their effectiveness to promote the recommended behaviors have caused much controversy. In trying to answer this question several authors have concluded that the use of threat in health messages can influence the subsequent development of preventive attitudes and behaviors. However, this does not mean that fear appeals necessarily have positive consequences. To achieve its objective threat messages must meet two basic conditions: they must induce attention, instead of fear, in the subject; and be accompanied by a recommendation percibed as effective to avoid the threat and easily carried out by the subject. Some practical advices for the developmente of health promotion messages are derived from these two conditions (AU)

¿Son la ocupación y la educación intercambiables como indicadores sociales en salud comunitaria? Un estudio en población ocupada / ¿Are education and occupation interchangeable as social indicators in community health? a study on employed people

Objetivo. Los estudios epidemiológicos y las intervenciones para reducir las desigualdades en salud en la comunidad requieren la asignación de indicadores socioeconómicos exhaustivos y fáciles de obtener. Dos de los más utilizados son la ocupación y la educación. En este estudio pretendemos evaluar la asociación entre educación y ocupación en población adulta ocupada, por si, en ausencia de una variable, fuera posible utilizar la otra con la menor pérdida posible de información sobre nivel socioeconómico. Diseño. A partir de una muestra representativa (n = 3.091) de población general (18-65 años), tomada de una encuesta de prevalencia sobre factores de riesgo de enfermedades crónicas realizada en la Región de Murcia, se ha realizado un análisis (log)lineal entre educación y ocupación en la población ocupada (65,8 por ciento varones y 34,2 por ciento mujeres de la muestra total). Resultados. Los varones presentan una asociación significativa entre las posiciones directivas y la educación universitaria. La asociación se reduce entre la ocupación en tareas administrativas y la categoría de estudios secundarios, para incrementarse en los trabajadores manuales con estudios primarios o sin estudios. En las mujeres, con un menor número de efectivos, la asociación educación-ocupación describe el mismo patrón, incluso con mayor magnitud en las asociaciones entre las clases directivas y el nivel educativo universitario. En varones y mujeres las mayores asociaciones se encuentran en ambas diagonales de las tablas de educación por ocupación, indicando: a mejor ocupación, mayor educación, y lo contrario. Conclusión. La clasificación de la gente con trabajo de acuerdo con la educación y la ocupación presenta: asociación, consistencia interna y gradiente. En ausencia de información exhaustiva sobre ocupación, la educación puede ser una alternativa como indicador de nivel socioeconómico (AU)

[Are occupation and education interchangeable as social indicators in community health? A study in an employed population]. / Son la ocupación y la educación intercambiables como indicadores sociales en salud comunitaria? Un estudio en población ocupada.

OBJECTIVE: Epidemiological studies and interventions to reduce inequalities in community health require the assignation of exhaustive and easy-to-obtain social indicators. Occupation and education are two of the most often used. In this study we attempt to evaluate the association between education and occupation among adult working population because if, in the absence of one of these two variables, it will be feasible to use the remaining with the lesser lost of socio-economic information. DESIGN: From a representative sample (n = 3091) of general population (18-65 years old) drawn out from a prevalence survey on chronic disease risk factors performed in the Region of Murcia, a log-lineal analysis has been made between education and occupation among working people (65.8% of males and 34.2% of females from the original sample). RESULTS: Men present significant association between managerial positions and university education. The association drops between clerks and high school graduates to increase among all manual workers with or without primary schooling education. Among women--with a lesser number of participants--the education/occupation association describes the same pattern but with higher magnitudes in the positive associations between managerial positions and university education. For both genders, the greatest associations are found in both diagonals of the education by occupation tables indicating: better occupation, more education, and the opposite. CONCLUSIONS: The classification of working people according to education and occupation presents association, internal consistency and gradient. In absence of comprehensive information regarding occupation, education could be an alternative as socio-economic indicator.

[Factors related with compliance with tuberculosis chemoprophylaxis]. / Factores relacionados con el cumplimiento de la quimioprofilaxis contra la tuberculosis.

OBJECTIVES: To determine therapeutic tolerance and compliance level with antituberculous chemoprophylaxis. PATIENTS AND METHODS: 587 patients were proposed for antituberculous chemoprophylaxis with isoniazid from January 1995 to June 1996 in Murcia (Spain). RESULTS: 3.6% of the patients gave up treatment because of hepatic intolerance and 73% completed the prophylaxis. Non-compliance related factors were: social risk factors (odds ratio [OR] = 9.31), previous history of allergies (OR = 2.87), previous personal history of tuberculosis-related events (OR = 0.49) and interaction between sex and age. CONCLUSIONS: Support and intervention measures directed to risk groups of a social origin deem to be needed. Control measures and information provided to middle-aged males, with particular emphasis to the first weeks of prophylaxis, should also be implemented.

[Tuberculous infection in schoolchildren in the 1st year of basic general education in the Murcia region (1985-1992)]. / Infección tuberculosa en escolares de 1st de EGB de la región de Murcia (1985-1992).

OBJECTIVE: To find the evolution of the prevalence of tubercular infection. DESIGN: Study of the tendency of the findings from crossover surveys carried out during the last 7 years. SETTING: First-year EGB students from public and private schools in the Autonomous Community of Murcia. INTERVENTION: Performing the Mantoux intradermoreaction test with 2 UT of PPDRT23/TWEEN80 for the first 5 years and 5 UT of PPDCT68/TWEEN80 the last 2, with any induration over 5 mm. being considered positive. A clinical study of school students found positive and of their family contacts. RESULTS: Coverage was established at about 80% (71,520 tests studied), with prevalence diminishing from 0.97% to 0.44%, this establishing a downward tendency (p < 0.001). 6.5% of the tuberculin-test positive students (21) and 2.8% of the family contacts (34) were diagnosed with tuberculosis. CONCLUSIONS: At the moment we lack data to suggest an increase in endemic tuberculosis among the school population. The results mentioned justify tuberculosis surveys of school students, although low prevalence suggests that the age at which it is performed should be raised.