[Identification and review of health promotion at work programs in Spain.] / Identificación y revisión de los programas de promoción de la salud en el trabajo en España.

OBJECTIVE: Health promotion at work (HPW) is an essential component of social and economic policies. Objectives: 1) To determine which regions in Spain have a HPW program and 2) To review these programs according to health promotion and equity models. METHODS: Regional HPW programs were identified through occupational health committee. Their webs were reviewed, and we interviewed by videoconference the persons in charge of each program. We used a data collection notebook to collect descriptive as well as quality variables, according to health promotion and equity models. RESULTS: 6 regions have a HPW program: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura and Galicia, developed by health administration or work administration, but only in 1 case by both. 4 programs have regulations and 3 have created a network. The participation of occupational risk prevention services is key, while participation of workers and management teams is variable. Only 2 regions have incorporated information and materials related to COVID-19. Measures to promote equality and work-life balance, but not to promote equity. CONCLUSIONS: HPW in Spain is a reality in 6 regions, with differences between them related to the requisites and what the administration offers to them.

OBJETIVO: La promoción de la salud en el trabajo (PSLT) es un componente esencial de la política social y económica. Los objetivos fueron: 1) Determinar en qué comunidades autónomas (CCAA) existe un programa de PSLT y 2) Revisar dichos programas de acuerdo con los modelos de promoción de la salud y equidad en salud. METODOS: Los programas se han identificado a través de la Ponencia de salud laboral. Se han revisado sus webs y se han entrevistado por videoconferencia las personas responsables de cada programa. Se ha utilizado un cuaderno de recogida de datos para recoger variables descriptivas y de calidad según los marcos de promoción de la salud y equidad. RESULTADOS: 6 CCAA tienen programa de PSLT: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura y Galicia, desarrollados por la administración sanitaria, por la de trabajo o conjuntamente. 4 CCAA han desarrollado normativa para el programa y 3 han creado una red. La participación de los servicios de prevención de riesgos laborales es clave, mientras que la de las personas trabajadoras y equipos directivos es variable. Sólo 2 CCAA han incorporado información y materiales relacionados con la COVID-19. Se observan medidas para el fomento de la igualdad y conciliación laboral, pero no para fomentar la equidad. CONCLUSIONES: La PSLT en España es una realidad en 6 CCAA, con diferencias entre los programas, tanto en relación con los requisitos, como respecto a lo que les ofrece la administración.

Anemia en paciente anciano, ¿podemos estar tranquilos? / Anaemia in an elderly patient: can we be complacent?

Presentamos el caso de un paciente de 70 años con un descenso progresivo de hemoglobina en analíticas seriadas. Tras un estudio riguroso se llega a un diagnóstico realmente poco frecuente: anemia hemolítica autoinmunitaria secundaria a carcinoma broncopulmonar (AU)

We present the case of a 70 year-old patient with a gradual decreasing haemoglobin. After a careful study, a very rare diagnosis was made: autoimmune haemolytic anaemia secondary to lung neoplasms (AU)

Brote de 400 casos de lipoatrofia semicircular en Barcelona: efectividad de las medidas de control / An Outbreak of 400 Cases of Lipoatrophia Semicircularis in Barcelona: Effectiveness of Control Measures

Objetivos. Entre febrero de 2007 y octubre de 2008 se registraron 1137 casos de lipoatrofia semicircular en distintoscentros de trabajo de Barcelona. Se diseñó un protocolo para implementar medidas de control. En este estudio se evalúa laefectividad de dichas medidas.Métodos. Se analiza la evolución del brote en relación con las medidas implementadas (control de la humedad relativapor encima del 50%, tomas de tierra para la descarga eléctrica y evitar mesas con bordes angulosos). La población de estudioconsiste en 417 trabajadores de cuatro diferentes centros diagnosticados entre febrero de 2007 y octubre de 2008.Resultados. Las incidencias acumuladas en los cuatro centros de trabajo incluidos en el estudio fueron 61,6% (centrode trabajo 1, CT1), 24,1% (CT2), 8,8% (CT4) y 5,5% (CT3). Según la información sobre altas laborales confirmadaspor los servicios médicos, la frecuencia de curación fue más elevada en el CT1 (93%), seguido por el CT2 (82%), el CT4(62%) y el CT3 (22%).Conclusiones. Cuando se aplicaron rápida y conjuntamente las tres medidas básicas de control, el 90% de los afectadosse recuperaron en un plazo de 6 meses(AU)

Objective. From February 2007 to October 2008, 1137 cases of lipoatrophia semicircularis were registered in distinctworkplaces (WPs) in Barcelona. A protocol to establish control measures was designed. This study pretends to evaluate theeffectiveness of these measures.Methods. In this case study, the outbreak course in relation to the implemented measures (relative humidity >50%,ground-mass electrical discharge, and avoidance of sharp-ended table edges) was analyzed. The study population consistedof 417 workers from four different WPs diagnosed between February 2007 and October 2008.Results. Cumulative incidences were 61.6% (WP1), 24.1% (WP2), 8.8% (WP4), and 5.5% (WP3). Based on dischargesconfirmed by medical services, healing rate was highest in WP1 (93%), followed by WP2 (82%), WP4 (62%), and WP3(22%).Conclusions. When the three basic measures were promptly and jointly applied, 90% of the cases were resolved within6 months(AU)

Reported occupational respiratory diseases in Catalonia.

OBJECTIVES: A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system. METHODS: In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia. RESULTS: Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. CONCLUSIONS: The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.

Concentration of hydroxyproline in blood: a biological marker in occupational exposure to asbestos and its relationship with Pi*Z and Pi*S polymorphism in the alpha-1 antitrypsin gene.

BACKGROUND: Hydroxyproline (OHP) is one of the most abundant amino acids in collagen and, in general, it provides a good measure of overall collagen catabolism. METHODS: Asbestos workers suffering from asbestosis (cases n = 85); asbestos exposed workers without asbestosis (exposed controls, EC, n = 86), and non-exposed population (non-exposed controls, NEC, n = 122) were studied. The concentration of free OHP in whole blood was measured following the Pico-Tag procedure. RESULTS: Concentration of OHP in blood was significantly different in the three groups studied (P < 0.001), being higher in cases (19.8 +/- 14.7 micromol/L) than in EC (16 +/- 12.4) and NEC (13.5 +/- 6.7). When all individuals were grouped and stratified by the Pi*S and Pi*Z polymorphisms in the alpha-1-antitrypsin gene, the highest OHP levels were detected in the Pi*S homozygotes, one of the asbestosis-at risk-genotypes (Pi*S homozygotes, x = 24.5 +/- 11.7; Pi*S heterozygotes, x = 16.6 +/- 10.0; wild type, wt, x = 15.9 +/- 11.8). CONCLUSIONS: Blood OHP concentration could be used for monitoring human exposure to asbestos, either as a marker for occupational monitoring or as an additional clinical parameter in diagnostic exploration of asbestosis.

Pi*S and Pi*Z alpha 1 antitrypsin polymorphism and the risk for asbestosis in occupational exposure to asbestos.

Alpha 1 antitrypsin is a highly polymorphic anti-elastase enzyme, especially active in the protection of alveoli and liver. Here we studied the distribution of two deficient alleles Pi*Z and Pi* S, in 194 asbestos workers, of whom 100 were asbestosis cases, and 94 were controls without disease (exposed controls, EC). A second group of controls without asbestos exposure (non-exposed controls, NEC; n=122) was also included. Multivariate analysis adjusted by age and smoking habit showed ninefold risk for asbestosis in Pi*Z heterozygous individuals and 5.9-fold risk for Pi*S homozygous although differences were only significant in the first case (cases vs. EC: OR 8.9; p=0.04). Considering both genotypes (Pi*Z heterozygous, Pi*S homozygous) we obtained an OR of 8 (p=0.01). Our results suggest that the alpha 1 antitrypsin polymorphisms, especially Pi*Z, could help to predict asbestosis risk and confirm the high prevalence of the Pi*S allele in Spain.

Information about occupational exposure to asbestos given to cases in an etiological study: ethical aspects.

The aim of the study is to consider some ethical aspects of the provision of information, to the cases or their families, about the assessment of occupational asbestos exposure obtained in a case-control study of malignant mesothelioma of the pleura. An informative letter with the result of the evaluation of their occupational exposure to asbestos was sent to the participating cases (and/or their family). Those whose exposure was classified as certain/probable were also informed of the legislation regarding occupational diseases. Of the 132 cases, 32.6% of subjects and/or their families made telephone calls expressing interest in the content of the informative letter. Among the 63 cases classified as certain/probable exposure, this proportion was 47.6%. Out of 43 cases in which the age at diagnosis was < or = 65 years and the exposure to asbestos was certain/probable, only two (4.6%) were signed off work owing to occupational disease. Only one of the mesothelioma cases was recognized by the Spanish National Institute for Social Security (INSS) as having an occupational disease. The process of communication of the results of an epidemiological research should include the provision of information on the exposure data to each one of the subjects, and/or their families. There is a great disparity between the number of cases of certain/probable exposure to asbestos identified in our study, and the number registered as an occupational disease by the INSS.

¿Es útil que el médico de atención pimaria pregunte al paciente por su trabajo?: a propósito de un caso / Is it useful that general practitioners ask patient about their jobs

Interrogar al paciente sobre el puesto de trabajo es una condición imprescindible para llegar a identificar la etiología laboral de sus trastornos. Cuando este interrogatorio es realizado adecuadamente desde la atención primaria, la intervención permite colaborar con el servicio de prevención de la empresa en la vigilancia de la salud del trabajador. Para que esta colaboración resulte efectiva es necesaria, sin embargo, la comunicación entre ambos grupos profesionales. Cuando ésta no existe o bien no se produce de forma adecuada, aparecen consecuencias negativas que afectan a ambas partes. En primer lugar, se pone en peligro la salud y en algunos casos también la vida de un paciente sobre el que tienen responsabilidad ambos profesionales. Pero no deberíamos olvidar que, incluso ante situaciones de menor gravedad, siempre puede resultar perjudicada la calidad de vida del trabajador expuesto así como la calidad de funcionamiento de las organizaciones implicadas. Por un lado, es frecuente que se produzcan bajas laborales de causa no identificada que provoquen, por tanto, episodios repetidos por una misma causa. Por otro lado, es igualmente frecuente la realización de pruebas complementarias y de prescripción farmacéutica que intentan, en vano, controlar unos daños para la salud que en la mayoría de casos pueden desaparecer o como mínimo atenuarse considerablemente con sólo ejercer un adecuado control sobre la exposición causal (AU)

Asking patients about their jobs is an essential condition to get identification of occupational disorders. When questions are co­ rrectly made from primary care, the col.laboration with the prevention services in enterprises, for workers health surveillance, is possible from this level. However, to be efective, this collaboration needs a good comunication between both professional group. When the comunication is not present or it is inadequate, negatives cosequences for both apear. First, health and in sorne cases life of patient, who is responsability of both professionals, is threatened. E ven in cases of lower severity, no only quality of patients life is damaged but quality of implicated organitations too. Therefore, frequently, absentism for non­identificated cause is produced, so that recurrent episodes for a same rcason apear. Frequently too, complementary proves and diferent drugs are prescribed in an use­ less attempt to avoid health damages which frequently can desapear or improve, at least, through and adequate control on causal exposition (AU)

Occupation and risk of malignant pleural mesothelioma: A case-control study in Spain.

BACKGROUND: The association of mesothelioma and asbestos exposure is well known, but some data suggest that probably many people are still being exposed to asbestos without knowing it. METHODS: Between 1993 and 1996, 132 cases (77% males) of histologically confirmed malignant pleural mesothelioma and 257 controls, residents in two provinces of Spain (Barcelona and C¿adiz), were interviewed. They were classified according to their probability and intensity of occupational asbestos exposure by a panel of industrial hygienists, based on a detailed occupational history. RESULTS: Age and sex-adjusted odds ratio (OR) for the highest probability of exposure to asbestos was 13.2 (95% confidence interval 6.4-27.3), and 27.1 (9. 28-79.3) for high intensity. A dose-response trend was observed for both, probability and intensity. Overall, 61% of cases and 42% of controls had ever worked in an occupation with risk of asbestos exposure, with an OR of 2.59 (1.60-4.22). In our population 62% of cases could be attributed to occupational asbestos exposure. CONCLUSIONS: A high risk of pleural mesothelioma due to occupational asbestos exposure is confirmed, but there is still a sizeable proportion for which no evidence of occupational exposure was found. Most of these cases could be due to other sources of asbestos exposure, mainly domestic or environmental.