Enfermedad profesional en España: una realidad cambiante / The professional disease in Spain a Changing reality

El RD 1299/2006(1), por el que se establece el nuevo cuadrode EE PP, responde a la necesidad de actualizar el cuadro deEE PP existente en España(2) y de establecer nuevos criteriosde notificación y registro(3-5). Esta necesidad surge porque seconsidera un cuadro obsoleto, poco ágil en su manejo, sinun enfoque preventivo y sin criterios diagnósticos claros, loque provoca una infradeclaración, y por razones legales, yaque se trata de una disposición de aplicación y desarrollodel artículo 116 de la LGSS(6), a cuyo ámbito pertenece lanueva LPRL(7). Objetivo: Realizar una comparación descriptivaentre el antiguo cuadro de EE PP(2) y el nuevo cuadro establecido en el RD 1299/2006(1). Metodología: Estudio y análisis legislativo del RD 78/1995(2) y del RD 1299/2006(1)con revisión de la bibliografía más destacada y actualizada.Resultados y conclusiones: Tras el análisis de ambos cuadros,se observa un gran avance en cuanto a la declaración,clasificación y notificación de las EE PP en España. Queda pendiente analizar el verdadero impacto que supone este cambio legislativo en la realidad actual de las EE PP (AU)

Background: The Royal Decree 1299/2006 of November10th, which established the new legal framework for occupationaldiseases, represents an answer to the need to updatethe concept of such diseases in Spain and to establish new reportingand recording criteria. The previously existing frameworkwas considered obsolete and cumbersome and lackinga preventive approach and clear diagnostic criteria, leading tounder-reporting. Furthermore, there are also legal reasons.Objective: Descriptive comparison between the old and thenew frameworks of occupational disease. Methods: Legislativestudy and analysis of the two Royal Decrees concerned(1995/78 and 1299/2006) with a review of the pertinent andupdated bibliography. Results and conclusions: Considerableadvances are observed regarding reporting, classificationand recording of occupational diseases in Spain. The trueimpact of this legislative change on the current reality of occupationaldisease remains to be seen (AU)

Evaluación de las oportunidades de mejora de la vigilancia de la salud de los trabajadores con riesgo ergonómico en el lugar de trabajo mediante el instrumento AGREE / Evaluation of opportunities for health surveillance improvement in workers with occupational exposure to ergonomic risks through the AGREE instrument

Objetivos: Identificar las oportunidades para mejorar la vigilancia de la salud de los trabajadores expuestos a riesgo ergonómico. Material y Métodos: Se aplica el Instrumento AGREE para evaluar seis dimensiones de calidad teórica de los protocolos de vigilancia sanitaria específica de trabajadores expuestos a Manejo de cargas (MC), Posturas Forzadas (PF) y Movimientos repetidos de miembro superior (MRMS), editados por el Ministerio de Sanidad y Consumo. La evaluación se realiza por tres equipos multidisciplinares de evaluadores. Resultados: Las dimensiones mejor valoradas fueron: Claridad de la presentación, Objetivos y Alcance e Independencia editorial. Mientras que las dimensiones de Participación de los implicados, Rigor en la elaboración y Aplicabilidad recibe puntaciones inferiores. Conclusiones: Las principales oportunidades de mejora identificadas en el proceso de evaluación están relacionadas con los procedimientos de búsqueda de la evidencia, la discusión sobre barreas potenciales a la hora de aplicar las recomendaciones y una mayor implicación de los usuarios potenciales

Aim: to identify the opportunities for the improvement of health surveillance tools in workers exposed to occupational ergonomic risks. Methods: AGREE instrument has been applied by three multidisciplinary-evaluation teams for the evaluation of six quality domains in the specific health surveillance protocols edited by the Ministry of Health for monitoring workers with an occupational exposition to Handling loads, steering postures and repetitive movements. Results: Scope and purpose, Clarity and presentation and Editorial independence has been the strong points of the protocols. Stakeholder involvement, Rigor of development and Application represent the weak points of the evaluated protocols. Conclusions: The main opportunities in order to improve these guidelines are linked with the procedures for identify scientific evidence, the analysis of difficulties for the implementation of recommendations and a more involvement of potential users of the guide

Sintomatología depresiva asociada al trabajo como causa de incapacidad temporal en la Comunidad de Madrid / Work related depression syntoms as short-term disability cause in Madrid Comunity

Objetivos: Calcular la prevalencia de los trastornos mentales como causa deincapacidad temporal (IT) en la Comunidad de Madrid y describir que trastornosmentales asociados al trabajo son más prevalentes por profesión, edad y sexo.Métodos: Estudio observacional descriptivo, cuyo ámbito es la población dela Comunidad de Madrid. Se han estudiado los pacientes en situación de IT con pagodirecto por el Instituto Nacional de la Seguridad Social (INSS): desempleados,trabajadores del régimen de autónomos, empleadas de hogar y régimen agrario. Elperiodo estudiado incluye desde enero de 2002 a septiembre de 2003. Se han registradolas siguientes variables: edad, sexo, régimen de la Seguridad Social, diagnóstico(CIE-10), ocupación, duración de la baja, desempleo y si alegan relación de susituación de incapacidad con el trabajo. Se ha calculado la prevalencia de trastornosmentales entre los pacientes en IT y la prevalencia de aquellos que relacionabansu patología con el trabajo. Se han utilizado técnicas estadísticas descriptivas,para sintetizar los resultados.Resultados: Un total de 1.628 trabajadores en IT (11,2%) presentaban comodiagnóstico principal algún trastorno mental, de los cuales el 17,8% (289) relacionansu patología con el trabajo. La edad media fue de 43,5 años (DE = 11,5). Lasmujeres presentan con mayor frecuencia T. mental como causa de IT, sin embargoel porcentaje de hombres que lo asocian al trabajo es significativamente mayor. Delos 289 trabajadores que relacionan su patología con el trabajo un 39,4% presentancomo diagnóstico un T. Adaptación, un 27,7% un T. mixto ansioso-depresivo yun 20,8% un episodio depresivo. Los trabajadores cualificados: directivos (41%),técnicos científico-intelectuales (30%) y empleados administrativos (27%) son losque presentan mayor prevalencia de sintomatología depresiva asociada al trabajo.Conclusiones: Los trastornos mentales son la segunda causa de IT de largaduración. Uno de cada cinco pacientes relaciona su patología con el trabajo, siendolos diagnósticos más prevalentes los trastornos de adaptación, trastornos mixtos ansioso-depresivos y los episodios depresivos. En tres de cada cuatro casos la duraciónmedia de la IT supera los seis meses. Los trabajadores cualificados: directivos,técnicos científico-intelectuales y empleados administrativos son los que presentanmayor prevalencia de sintomatología depresiva asociada al trabajo

Objectives: To calculate the prevalence of mental disorders as cause ofshort-term disability in Madrid Community and to describe work-related depressionsymptoms by occupation, age and sex.Method: We conducted a descriptive observational study in MadridCommunity. Patients in Short-term Disability (STD) paid by The National Instituteof Social Security (NISS) have been studied. It have been used the databaseof the NISS in Madrid as a source of information. The recorder variableswas: age, sex, social security status, diagnosis (ICD-10), occupation, unemployed,and work related depression symptoms. Assessment was made by calculatingthe mental disorders prevalence in patients with short-term disabilityand work related depressive symptoms. Descriptive statistic techniques hasbeen used.Results: In total 1628 workers in short-term disability (11,2%) were diagnosisfor mental disorders, 17,8% (289) of them were work related pathology.The mean age of patients was 43,5 (SD = 11,5). The prevalence of mentaldisorders as cause of short-term disability is higher in females, but males presentsmore work-related depression symptoms. The 39,4% presents adaptationdisorder diagnosis, 27% mixed anxious-depressive disorders and 20,8% depressiveepisode. Women between 30 and 40 years old, and men of more tan 50years were more frequently work related pathology. In 75% of the cases themedium time of STD was six months. Qualified workers: directors (41%), scientificintellectual technicians (30%) and administrative workers (27%) werethe ones who presents more prevalence of work-related depressive symptoms.Conclusions: Mental disorders were the second cause of short term disabilityin Madrid. One of each five patients present work-related depressivesymptoms. The more prevalence diagnosis were adaptation disorders mixedanxious-depressive disorders and depressive episodes. In three of each fourcases, the medium last of STD was six months. Qualified workers: directorsscientific intellectual technicians and administrative workers, were the oneswho presents more prevalence of work-related depressive symptoms

[Variability in resource utilization in primary care]. / Variabilidad en la utilización de recursos en atención primaria.

OBJECTIVE: To measure variability in the use of primary care resources and identify factors that explain the differences. DESIGN: An ecological observation study. SETTING: Primary care. PARTICIPANTS: The 1996 index of frequency of attendance was chosen as the indicator of primary care resource use throughout the territory managed by INSALUD. INTERVENTIONS: The analysis was conducted on a provincial basis, using the statistical technique of multiple linear regression. The index of frequency of attendance was chosen as dependent variable; and demographic, social and economic, mortality, organisation, and offer and accessibility indicators were chosen as explanatory or independent variables. MEASUREMENTS AND RESULTS: There was wide variability in frequency of attendance in the areas managed by INSALUD during 1996, with a variation coefficient of 20.5%. The simple linear regression analysis showed that the population's income explained 55% of variability. Income, the number of doctors per 1,000 inhabitants and the percentage of children under 3 explained 70% of the variability of frequency of attendance at primary care. CONCLUSIONS: There are differences between provinces in primary care health resource use. Attendance for primary care consultation in INSALUD is more frequent in provinces with a low social and economic level, more doctors per 1000 inhabitants and more children under 3.

[Validity of the attendance pressure indicator in a primary care area]. / Validez del indicador presión asistencial en un área de atención primaria.

OBJECTIVE: To measure the validity of the attendance pressure indicator in the Primary Care clinics at a Health Centre. DESIGN: An observational, crossover study. SETTING: Primary Care Area 3, Madrid. PATIENTS AND OTHER PARTICIPANTS: Stratified sampling by professional group and systematic sampling out of a total of 296 Primary Care team professionals in the area were performed. The size of the sample was 100: 40 general practitioners, 15 paediatricians and 45 nurses. Information on the attendance pressure indicator was gathered directly from the Health Centres and compared with that sent to Area 3's Information System (3-IS) by the professionals themselves. MEASUREMENTS AND MAIN RESULTS: The attendance pressure indicator showed the following ICC for Area 3: 0.86 (LL > or = 0.79) in general medicine, 0.79 (LL > or = 0.69) in paediatrics and 0.95 (LL > or = 0.93) in nursing. The over-notification found was: 1.35 users per day (p < 0.05) in general medicine, 1.47 (p < 0.05) in paediatrics and 0.47 in nursing. CONCLUSIONS: The measurement method of the attendance pressure indicator in Madrid's Primary Care Area 3 is valid for general medicine, paediatrics and nursing. A light, but statistically significant, over-notification to 3-IS was observed in general medicine and paediatrics, but this does not affect the validity of the indicator.

[Quality of the certification of death due to acute reaction to opiates and cocaine among inhabitants of the City of Madrid]. / Calidad de la certificación de la muerte por reacción aguda a opiáceos y cocaína entre residentes del municipio de Madrid.

BACKGROUND: Deaths by acute reaction from drugs consumption (RAD) particularly heroine or cocaine, collected in routine morality statistics, have not changed substantially during the last ten years, whereas an specific collection system (State Information System on Drug-Abuse SISD) presented a great increase. For this reason, we try to measure the validity of drug-related deaths certificate. METHODS: The cause of death, corresponding to the persons, from 15 to 39 years of age, decreased in 1988 and residing in the Municipality of Madrid, registered in the Civil Register Decease Book and in the death Statistics Bulletins (DSB) was compared with the cause present in the autopsy report. RESULTS: A detection rate of 2.45% for the CR and 3.27% for the DSB were obtained. With the consequent correction, the RAD for this age group would be the second cause of mortality in the Municipality of Madrid and deaths related to circulatory and respiratory system would decrease in a great measure. CONCLUSIONS: It is necessary to improve substantially the collection of this cause of death in mortality statistics if we want a correct measurement of drug abuse lethal effects and the effectiveness of control programmes on this health problem.