Coordinated Response to Imported Vaccine-Derived Poliovirus Infection, Barcelona, Spain, 2019-2020.

In 2019, the Public Health Agency of Barcelona, Spain, was notified of a vaccine-derived poliovirus infection. The patient had an underlying common variable immunodeficiency and no signs of acute flaccid paralysis. We describe the ongoing coordinated response to contain the infection, which included compassionate-use treatment with pocapavir.

Do workers' health surveillance examinations fulfill their occupational preventive objective? Analysis of the medical practice of occupational physicians in Catalonia, Spain.

OBJECTIVES: Although routine workers' health examinations are extensively performed worldwide with important resource allocation, few studies have analyzed their quality. The objective of this study has been to analyze the medical practice of workers' health examinations in Catalonia (Spain) in terms of its occupational preventive aim. MATERIAL AND METHODS: A cross-sectional study was carried out by means of an online survey addressed to occupational physicians who were members of the Catalan Society of Safety and Occupational Medicine. The questionnaire included factual questions on how they performed health examinations in their usual practice. The bivariate analysis of the answers was performed by type of occupational health service (external/internal). RESULTS: The response rate was 57.9% (N = 168), representing 40.3% of the reference population. A high percentage of occupational physicians had important limitations in their current medical practice, including availability of clinical and exposure information, job-specificity of tests, and early detection and appropriate management of suspected occupational diseases. The situation in external occupational health services - that covered the great majority of Catalan employees - was worse remarkably in regard to knowledge of occupational and nonoccupational sickness absence data, participation in the investigation of occupational injuries and diseases, and accessibility for workers to the occupational health service. CONCLUSIONS: This study raises serious concerns about the occupational preventive usefulness of these health examinations, and subsequently about our health surveillance system, based primarily on them. Professionals alongside health and safety institutions and stakeholders should promote the rationalization of this system, following the technical criteria of need, relevance, scientific validity and effectiveness, whilst ensuring that its ultimate goal of improving the health and safety of workers in relation to work is fulfilled. Other countries with similar surveillance systems might be encouraged by our results to assess how their practices fit the intended purpose. Int J Occup Med Environ Health 2017;30(6):823-848.

Calidad y adecuación técnica a la normativa de los exámenes de vigilancia de la salud de la población trabajadora en relación con su finalidad preventiva / Quality and compliance with the regulations of workers health wcaminations in relation to their preventive purpose / Qualitat i adequació tècnica a la normativa de ls exàmens de vigilància de la salut de la població treballadora en relació amb la seva finalitat preventiva

Objetivo. Analizar si los exámenes de vigilancia de la salud en Cataluña se realizan con un grado de calidad suficiente que permitiría dar respuesta a la finalidad preventiva inherente a la normativa e identificar posibles diferencias según el tipo de servicio de prevención. Método. Análisis de contenido de la normativa relacionada con la vigilancia de la salud e identificación de conceptos preventivos. Estos conceptos se asociaron a las preguntas de un cuestionario realizado a profesionales sanitarios que realizaban exámenes de salud en su práctica habitual. Se establecieron criterios de calidad (mínimos que deben cumplirse para garantizar que la práctica profesional sea de calidad) y se calcularon indicadores de calidad (porcentaje de profesionales cuya práctica profesional cumplía los criterios de calidad) de forma global y por tipo de servicio de prevención. Se definieron estándares de calidad (mínimo exigible: cumplimiento de los criterios de calidad por parte de más del 75% de los profesionales). Resultados. Los conceptos identificados fueron: disponibilidad de información clínica y de exposición, especificidad, identificación de trabajadores especialmente sensibles, derivación a mutua, elaboración de propuestas preventivas, e independencia profesional y no perjuicio para el trabajador. Los indicadores de calidad oscilaron entre 0 y 88%, siendo en general más bajos en los servicios de prevención ajenos. Ningún concepto superó globalmente el estándar de calidad. Conclusiones. El grado de calidad con que se realizan los exámenes de vigilancia de la salud en Cataluña no parece ser suficiente para dar respuesta a la finalidad preventiva inherente a la normativa, siendo la situación peor en los servicios de prevención ajenos

Objective. To analyze whether examinations for health surveillance in Catalonia are carried out with a high enough degree of quality as to comply with the preventive aim of the regulations, and to identify potential differences by type of prevention service. Method. Qualitative and quantitative techniques. Body of data: Spanish regulations related to health surveillance, and a self-reported questionnaire answered by occupational health professionals who performed health examinations in their usual practice. Content analysis of regulations, identifying concepts, and linking them to survey questions. Quality criteria were established for each concept, referring to the minimum that must be met to ensure that the professional practice can be of quality; quality indicators (percentage of professionals whose practice met the quality criteria) were calculated globally and by type of prevention service; and quality standards (fulfilment of quality criteria by 75% or more of the professionals) were set. Results. The concepts identified were: availability of clinical and exposure information, job-specificity, identification of workers with special susceptibilities, referral to mutual insurance companies for appropriate diagnosis and treatment, development of preventive proposals, and professional independence and non detriment for workers. Quality indicators ranged between 0 and 88%. None of the concepts globally reached the quality standard. Conclusions. The quality of health examinations performed for health surveillance in Catalonia, doesn’t seem to be high enough as to comply with the preventive aim of the regulations. The situation is worse in external prevention services

Objectiu: Analitzar si els exàmens de vigilancia de la salut a Catalunya es fan amb un grau de qualitat suficient que permetria donar resposta a la finalitat preventiva inherent a la normativa i identificar possibles diferències segons el tipus de servei de prevenció. Mètode; Anàlisi de contingut de la normativa relacionada amb la vigilancia de la salut i la identificació de conceptes preventius. Aquests conceptes es van associar a les preguntes d’un qüestionari elaborat per a professionals sanitaris que feien exàmens de salut en la seva práctica habitual. Es van establir criteris de qualitat (mínims que han de complir-se per garantir que la práctica professional sigui de qualitat) i es van calcular indicadors de qualitat(percentatge de professionals la práctica professional dels quals complia els criteris de qualitat) de forma global i per tipus de servei de prevenció. Es van definir estàndards de qualitat (mínim exigible: compliment dels criteris de qualitat per part de més del 75% dels professionals). Resultats: Els concept es identificats van ser: disponibilit at d’informació clínica i d’exposició, especificitat, identificación de treballadors especialment sensibles, derivació a un a mútua , elaboració de propostes preventives, i independència professional i no- perjudici per al treballador . Els indicadors de qualitat van oscil·lar entre 0 i 88%,de manera que eren, en general, més baixos en els serveis de prevenció aliens . Cap concepte va superar globalment l’estàndard de qualitat. Conclusions: El grau de qualitat amb què es fan els exàmen s de vigilancia de la salut a Catalunya no sembla ser suficiente per donar resposta a la finalitat preventiva inherent a la normativa i ón la situació és pitjor en els serveis de prevenció aliens

[Quality and compliance with the regulations of workers'health examinations in relation to their preventive purpose]. / Calidad y adecuación técnica a la normativa de los exámenes de vigilancia de la salud de la población trabajadora en relación con su finalidad preventiva.

OBJECTIVE: To analyze whether examinations for health surveillance in Catalonia are carried out with a high enough degree of quality as to comply with the preventive aim of the regulations, and to identify potential differences by type of prevention service. METHOD: Qualitative and quantitative techniques. Body of data: Spanish regulations related to health surveillance, and a self-reported questionnaire answered by occupational health professionals who performed health examinations in their usual practice. Content analysis of regulations, identifying concepts, and linking them to survey questions. Quality criteria were established for each concept, referring to the minimum that must be met to ensure that the professional practice can be of quality; quality indicators (percentage of professionals whose practice met the quality criteria) were calculated globally and by type of prevention service; and quality standards (fulfilment of quality criteria by 75% or more of the professionals) were set. RESULTS: The concepts identified were: availability of clinical and exposure information, job-specificity, identification of workers with special susceptibilities, referral to mutual insurance companies for appropriate diagnosis and treatment, development of preventive proposals, and professional independence and non detriment for workers. Quality indicators ranged between 0 and 88%. None of the concepts globally reached the quality standard. CONCLUSIONS: The quality of health examinations performed for health surveillance in Catalonia, doesn't seem to be high enough as to comply with the preventive aim of the regulations. The situation is worse in external prevention services.

La precariedad laboral medida de forma multidimensional: distribución social y asociación con la salud en Cataluña / Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)

Objetivo: Mostrar por vez primera la prevalencia de la precariedad laboral medida en forma multidimensional en Cataluña y su asociación con la salud mental y autopercibida. Método: Estudio transversal con datos de la II Encuesta Catalana de Condiciones de Trabajo (2010) con una submuestra de personas asalariadas con contrato. Se calculó la prevalencia de precariedad laboral usando una escala multidimensional, y su asociación con la salud mediante regresiones log-binomiales multivariadas estratificadas por sexo. Resultados: La prevalencia de la precariedad en Cataluña es alta (42,6%). Encontramos mayor precariedad en las mujeres y en los/las trabajadores/as jóvenes, inmigrantes, manuales y con menor educación. Existe un gradiente positivo en la asociación con la mala salud. Conclusiones: La precariedad laboral se asocia con peor salud en la población trabajadora. Deberían incluirse preguntas sobre precariedad e indicadores de salud en las encuestas de condiciones de trabajo para poder realizar una posterior vigilancia y un análisis de las desigualdades en salud (AU)

Objective: To show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale. Method: A cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender. Results: The prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health. Conclusions: Precarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities (AU)

How much do workers’ health examinations add to health and safety at the workplace? Occupational preventive usefulness of routine health examinations / ¿Qué aportan los exámenes de salud a la seguridad y salud en el trabajo? Utilidad preventiva ocupacional de los exámenes de salud rutinarios

Objective: Despite no evidence in favour, routine workers’ health examinations, mostly pre-employment and periodic, are extensively performed worldwide with important allocation of resources. In Spain they are performed within a theoretical job-specific health surveillance system. Our objective was to ascertain their occupational preventive usefulness from the perspective of occupational health professionals. Methods: Cross sectional study. Online survey addressed to all physicians and nurses members of the Catalan Society of Safety and Occupational Medicine (n=539) in 2011. Univariate and bivariate analyses of prevalence and prevalence differences of answers. Results: Response rate 53% (n=285). According to more than 70% of respondents the health surveillance system isn’t cost-effective, doesn’t meet the goal of early detection of health damage related to work, and doesn’t contribute to improve the occupational risk prevention system. Further deficiencies were identified regarding specificity and scientific basis for health examinations, quality of collective health surveillance and referral of suspected cases to mutual insurance companies for diagnosis and treatment. Bivariate analysis showed a significantly more negative opinion for several items amongst physicians (versus nurses) and amongst professionals working in external prevention services (versus internal services). Conclusions: This study raises serious concerns about how health examinations are performed within our workers’ health surveillance system, which should be reviewed to ensure the fulfilment of its occupational preventive objective. Our results might encourage other countries with similar practices to assess them in order to assure their fitness for purpose (AU)

Objetivo: Pese a la ausencia de evidencia a favor, la realización de exámenes de salud rutinarios a los trabajadores, sobre todo previos/iniciales y periódicos, es una práctica extendida en muchos países y conlleva una asignación importante de recursos. En España se realizan dentro de un sistema de vigilancia de la salud laboral teóricamente específico. Nuestro objetivo fue determinar su utilidad preventiva ocupacional desde la perspectiva de los profesionales sanitarios de salud laboral Métodos: Estudio transversal. Encuesta en línea dirigida a profesionales sanitarios miembros de la Sociedad Catalana de Seguridad y Medicina del Trabajo (n=539) en 2011. Análisis univariado y bivariado de prevalencia y prevalencia de diferencias de las respuestas. Resultados: Tasa de respuesta 53% (n=285). Según más del 70% de los participantes, el sistema de vigilancia de la salud no es costo-efectivo, no cumple el objetivo de detección precoz de daños a la salud relacionados con el trabajo, y no contribuye a mejorar el sistema de prevención de riesgos laborales. También se identificaron deficiencias en la especificidad y base científica de los exámenes, en la calidad de la vigilancia colectiva y en la derivación a mutua de casos sospechosos de patología laboral para diagnóstico y tratamiento. El análisis bivariado mostró una opinión significativamente más negativa para varios ítems entre los médicos (versus enfermeras) y los profesionales de servicios de prevención ajenos (versus propios). Conclusiones: Este estudio plantea serias preocupaciones acerca de cómo se realizan los exámenes de salud dentro del sistema de vigilancia de la salud de nuestros trabajadores, que debe ser revisado para asegurar el cumplimiento de su objetivo preventivo laboral. Países con prácticas preventivas similares podrían verse alentados por nuestros resultados para revisarlas (AU)

[Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)]. / La precariedad laboral medida de forma multidimensional: distribución social y asociación con la salud en Cataluña.

OBJECTIVE: To show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale. METHOD: A cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender. RESULTS: The prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health. CONCLUSIONS: Precarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities.

How much do workers' health examinations add to health and safety at the workplace? Occupational preventive usefulness of routine health examinations.

OBJECTIVE: Despite no evidence in favour, routine workers' health examinations, mostly pre-employment and periodic, are extensively performed worldwide with important allocation of resources. In Spain they are performed within a theoretical job-specific health surveillance system. Our objective was to ascertain their occupational preventive usefulness from the perspective of occupational health professionals. METHODS: Cross sectional study. Online survey addressed to all physicians and nurses members of the Catalan Society of Safety and Occupational Medicine (n=539) in 2011. Univariate and bivariate analyses of prevalence and prevalence differences of answers. RESULTS: Response rate 53% (n=285). According to more than 70% of respondents the health surveillance system isn't cost-effective, doesn't meet the goal of early detection of health damage related to work, and doesn't contribute to improve the occupational risk prevention system. Further deficiencies were identified regarding specificity and scientific basis for health examinations, quality of collective health surveillance and referral of suspected cases to mutual insurance companies for diagnosis and treatment. Bivariate analysis showed a significantly more negative opinion for several items amongst physicians (versus nurses) and amongst professionals working in external prevention services (versus internal services). CONCLUSIONS: This study raises serious concerns about how health examinations are performed within our workers' health surveillance system, which should be reviewed to ensure the fulfilment of its occupational preventive objective. Our results might encourage other countries with similar practices to assess them in order to assure their fitness for purpose.

The changing patterns of psychosocial exposures at work in the south of Europe: Spain as a labor market laboratory.

AIMS: To examine the pattern of psychosocial risk exposures at work among wage-earners in Spain in 2005 and 2010, and to analyze changes in exposure inequalities by gender and job category. METHODS: Psychosocial exposures were compared using the COPSOQ-ISTAS21 method, based on two surveys representative of the Spanish wage-earning population (2005 and 2010). Statistical analysis was conducted using correspondence analysis. RESULTS: There was an increase in exposure to high Double Presence, low Social Support, high Work Pace, and high Insecurity about finding a job; and reduction in exposure to high Insecurity about losing a job, and to high Insecurity over worsening of employment conditions. A gender- and occupation-related gradient was maintained. CONCLUSION: Although this study analyzes wage-earner "survivors" after the outbreak of the current economic crisis, it shows a worsening of harmful exposures to some psychosocial risks. In a context of job destruction, concerns about worsening working conditions appear to be subordinate to insecurity about job loss.

The copenhagen psychosocial questionnaire II (COPSOQ II) in Spain--a tool for psychosocial risk assessment at the workplace.

AIMS: To describe the second version of the Spanish Copenhagen Psychosocial Questionnaire and to present evidence of its validity and reliability. METHODS: The original Danish long COPSOQ II questionnaire was adapted to the labor market, cultural, and linguistic setting of Spain and included in the 2010 Spanish Psychosocial Risks Survey. Analysis involved the assessment of psychometric characteristics and associations among psychosocial scales and health scales. Medium and short versions were derived from the long one. RESULTS: The long questionnaire was configured with 24 dimensions (92 items); medium-length questionnaire with 20 dimensions (69 items); and short questionnaire with 14 dimensions (28 items). All scales showed acceptable reliability and concordance between versions. Most associations among psychosocial scales and Mental Health, Stress, and Burnout scales were in the expected direction, except the scale of Influence, that showed some incongruent associations. CONCLUSION: Results support the validity and reliability of Spanish COPSOQ II questionnaires as tools for psychosocial risk assessment at the workplace, however, better scales should be developed specially for the dimension of Influence.

Conjunto mínimo básico de ítems para el diseño de cuestionarios sobre condiciones de trabajo y salud / Basic items to include when designing occupational risk and health questionnaires

Dada la utilidad de las Encuestas sobre Condiciones de Trabajo y Salud, la realización de éstas en distintos contextos es cada vez mayor. El objetivo de este trabajo fue identificar y definir los ítems básicos que deben recogerse en los cuestionarios utilizados en este tipo de encuestas mediante un proceso de consenso estructurado entre expertos y a partir del cuestionario de la VI Encuesta Nacional de Condiciones de Trabajo. Se llegó a una propuesta consensuada acerca de los contenidos mínimos de un cuestionario de estas características, incluyendo las dimensiones de condiciones de empleo (9 ítems), condiciones de trabajo (58), amenazas y violencias en el trabajo (7) y estado de salud (11). Esta propuesta pretende servir de guía para la realización de nuevas encuestas (AU)

Given their usefulness, the implementation of surveys of working conditions and health in different contexts is increasing. Using a structured consensus approach involving experts, and based on the VI Spanish Survey of Working Conditions, the aim of this research was to identify and define a minimum set of items for inclusion in questionnaires used in these types of surveys. The final consensus proposal includes dimensions on employment conditions (9 items), working conditions (58), violence and threats at work (7) and health status (11). This minimum common set of items could be useful in guiding the development of future surveys (AU)

Conjunto mínimo básico de ítems para el diseño de cuestionarios sobre condiciones de trabajo y salud / Basic items to include when designing occupational risk and health questionnaires

Dada la utilidad de las Encuestas sobre Condiciones de Trabajo y Salud, la realización de éstas en distintos contextos es cada vez mayor. El objetivo de este trabajo fue identificar y definir los ítems básicos que deben recogerse en los cuestionarios utilizados en este tipo de encuestas mediante un proceso de consenso estructurado entre expertos y a partir del cuestionario de la VI Encuesta Nacional de Condiciones de Trabajo. Se llegó a una propuesta consensuada acerca de los contenidos mínimos de un cuestionario de estas características, incluyendo las dimensiones de condiciones de empleo (9 ítems), condiciones de trabajo (58), amenazas y violencias en el trabajo (7) y estado de salud (11). Esta propuesta pretende servir de guía para la realización de nuevas encuestas(AU)

Given their usefulness, the implementation of surveys of working conditions and health in different contexts is increasing. Using a structured consensus approach involving experts, and based on the VI Spanish Survey of Working Conditions, the aim of this research was to identify and define a minimum set of items for inclusion in questionnaires used in these types of surveys. The final consensus proposal includes dimensions on employment conditions (9 items), working conditions (58), violence and threats at work (7) and health status (11). This minimum common set of items could be useful in guiding the development of future surveys(AU)

Social inequalities in mortality in a retrospective cohort of civil servants in Barcelona.

BACKGROUND: The objective of this study is to describe the inequalities in mortality by occupational category and sex in a retrospective cohort of civil servants working in the city council of Barcelona (Spain). METHODS: The cohort was followed for the period 1984-1993. There were 11 647 men and 9001 women. Age-adjusted hazard ratios (HR) of death for occupational categories and manual versus non-manual groups and 95% CI were derived from Cox proportional hazards models. RESULTS: For total deaths in males, compared with high-level professionals, auxiliary workers (HR = 1.30, 95% CI: 0.96-1.77), skilled manual workers (HR = 1.29, 95% CI: 0.95-1.77), unskilled manual workers (HR = 1.46, 95% CI: 1.07-1.98) and police and fire manual workers (HR = 1.42, 95% CI: 1.08-1.87) had higher risk of death. Among women, for all causes of mortality, only police manual workers had higher mortality (HR = 5.63, 95% CI: 1.89-16.7) whereas auxiliary workers had the lowest HR (HR = 0.51, 95% CI: 0.25-1.05). The HR comparing manual and non-manual categories for all causes of death was 1.29 for males (95% CI: 1.09-1.52) and 1.07 for females (95% CI: 0.77-1.49). Among males, whereas manual workers had lower cardiovascular mortality (HR = 0.85, 95% CI: 0.63-1.15), cancer mortality was higher in the manual category. No association between manual category and mortality was found among women. CONCLUSIONS: This study provides an analysis of social inequalities in mortality in a cohort from a Southern European urban area.

Sickness leave, administrative category and gender: results from the "Casa Gran" project.

OBJECTIVE: The aim of this study was to analyse the variations of sickness leave rates among the Barcelona city council civil servants by administrative category and gender. METHODS: The study was a retrospective cohort including all people who worked for more than six months for the City Council of Barcelona from 1 January 1984 to 31 December 1993. The cohort was composed of 11,647 men and 9,001 women who contribute to a total of 134,928.7 person/years of follow-up. The study population was classified into administrative categories. Sickness leaves were classified into short episodes (less than 11 days) and long episodes (more than 10 days). Age-specific rates of long and short episodes of sickness leave were computed in a gender-specific analysis. RESULTS: Among men, rate ratios of long spells increased constantly from the middle technician category to the unskilled worker category for the three oldest age groups. This social pattern was not as clear for younger workers. Among women, rate ratios of long spells showed far fewer differences than among men. The social gradient was evident for the three youngest age groups, with the exception of the unskilled workers. The oldest age group showed similar differences between all categories. Short spells followed a different pattern for men and women. CONCLUSIONS: Women had generally higher rates than men did, and manual categories had higher rates than non-manual ones, which was more evident for men and long episodes. The relationship between incidence rates and gender could be due to the different contents of the jobs performed by men and women, the influence of gender-based work segregation, and the unequal share of the reproductive workload between men and women, information which was not available for this study.