Medicina y Seguridad del Trabajo

New Phase at the National School of Occupational Medicine

Performance Procedure of Occupational Risks Prevention for the Attention to Suspected Cases of Coronavirus Respiratory Disease MERS-CoV: in relation to a case

Resumen Tras el primer caso importado en España de infección humana por el coronavirus (MERS-CoV), ingresado en el Hospital Universitario Puerta de Hierro Majadahonda (HUPHM), se procede a la elaboración de un procedimiento de actuación para la atención a casos sospechosos de enfermedad respiratoria de alerta internacional. Este procedimiento se activa en el momento en el que se establece la sospecha de esta enfermedad en el hospital. Se describen las medidas de actuación ante el ingreso de un paciente con estas características, garantizando la calidad asistencial así como la protección de la salud de los trabajadores. Desde el Servicio de Prevención de Riesgos Laborales (SPPRL) se procede al registro de los trabajadores implicados, se realiza el estudio de contactos y el seguimiento de los mismos, facilitándose la información y formación a los trabajadores sobre los riesgos ante el nuevo agente causal y la utilización de los equipos de protección adecuados, y la valoración de los trabajadores especialmente sensibles, explicando la activación y puesta en marcha del protocolo en las distintas situaciones en que ha sido necesario.

Abstract After the first imported case in Spain of a human coronavirus infection (MERs- CoV) admitted to the Puerta de Hierro Universitary Hospital of Majadahonda (HUPHM, Madrid) an action procedure was developed in order to care for suspected cases of respiratory diseases that may cause an international outbreak. This procedure is activated in the hospital as soon as the suspicion of the disease arises. Action measures are described when a patient with these characteristics is admitted, ensuring both assistance quality and workers’ health protection. From the Occupational Risk Prevention Service (SPRL in Spanish) a registration of the workers involved is taken, as well as a study of contacts and their follow-up. This provides information and formation to the workers about the risks considering the new causal agent and the use of the appropriate protective equipment, the assessment of particular sensitive workers, explaining the protocol’s activation and implementation in the different situations it has been needed.

Humanizing Healthcare and Occupational Health: Implications, State of Issue and Proposal from HU-CI Project

Resumen La evolución científica y técnica de la atención sanitaria mantienen un desarrollo exponencial que permite cada vez una mejor asistencia a los pacientes, nuevas formas de tratamiento y crecientes índices de supervivencia. Sin embargo, estos importantes avances que enriquecen la atención a la salud, en muchas ocasiones, han ido invadiendo espacio al propio acto humano de la atención a la persona. Potenciar organizaciones más humanizadas implicará establecer acciones dirigidas al ambiente y lugar de trabajo, así como a todos los agentes implicados (pacientes, familiares y profesionales). Con dicha finalidad, las políticas de Humanización y su aplicación al contexto sanitario son una realidad en nuestros días y están concretándose en algunas propuestas específicas en determinadas organizaciones, con el apoyo de algunos organismos oficiales. En el presente trabajo, señalamos la interacción entre los objetivos de dichas políticas de humanización y las metas de la salud laboral en contextos asistenciales. Se exploran áreas comunes de trabajo dirigidas al bienestar del profesional sanitario, posibilidades de gestión integral de ambos conceptos, y se expone un ejemplo concreto como es el Proyecto de Humanización de las Unidades de Cuidados Intensivos (HU-CI).

Abstract The scientific and technical evolution of health care keeps growing exponentially, thus allowing a better patient care, new treatment forms and increasing survival rates. However, these important advances that improve health care have in many cases invaded the space that once belonged to the human act of caring. Promoting more humanized organizations will imply to establish actions directed to the environment and the workplace, as well as to all involved agents (patients, relatives and professionals). To that end, the humanization policies and their application to the health context are a reality in our days. These policies are being materialized in some specific proposals of certain organizations with the support of some official agencies. In this present work, we point out the interaction between the objectives of these humanization policies and the goals of occupational health in health care contexts. Common areas of work promoting the wellbeing for health professionals and the possibilities of integral management of both concepts are explored. Lastly, we provide a concrete example, like the Humanization Project of Intensive Care Units (HU-CI).

Chronic Kidney Disease Disability Insurance in Baja California Delegation from Mexican Social Security Institute

Resumen Introducción: La Insuficiencia Renal Crónica (IRC) es un problema de salud pública discapacitante que limita las capacidades funcionales y la calidad de vida de los pacientes, genera la pérdida de años de vida productiva, siendo factible obtener un dictamen de invalidez si no pueden desempeñar su actividad laboral, esto conlleva a incrementar costes por esta enfermedad en las instituciones de salud. Objetivo: Evaluar los costes de invalidez por Insuficiencia Renal Crónica en el Instituto Mexicano del Seguro Social (IMSS) durante el año 2015 en la delegación Baja California (BC). Material y métodos: Estudio descriptivo y retrospectivo. Se realizó en la Delegación de BC del IMSS, se analizaron los expedientes de los asegurados con dictamen de invalidez por IRC en 2015, previa autorización por el Comité de Investigación, donde se evaluaron las variables de sexo, edad, años laborales perdidos, días de incapacidad temporal y costes por invalidez. Se realizó estadística descriptiva. Resultados: El total de pacientes estudiados fue de 81, donde el 83% fueron hombres y 17% mujeres, la edad promedio al momento del estado de invalidez fue de 46 años, con un promedio de años laborales perdidos de 19, se subsidiaron 7.842 días de Incapacidad Temporal para el Trabajo (ITT) representando $1.125.759 millones de pesos con un coste de subsidio por invalidez de $3.008.104 millones de pesos, cantidades que sumadas representan el 3,37% del Producto Interno Bruto (PIB) de Baja California. Conclusión: La enfermedad renal crónica produce altos costes monetarios y en especie en las instituciones de salud, por lo que prevenir enfermedades causantes y atención temprana, podrá mejorar la calidad de vida y disminuir el número de años laborales perdidos en esta enfermedad.

Abstract Introduction: Chronic Kidney Disease (CKD) is a disabling public health problem which affects functional capacity, health-related quality of life and generates loss of productive life years. Since sick persons cannot perform their work activity -representing incremental costs in health institutions for the disease- it would be feasible to obtain a disability report. Methods and materials: Descriptive and retrospective study. It was carried out in the BC Delegation of the Mexican Social Security Institute. In 2015 and after the Research Committee approval, the insured patients’ records with CKD invalidity report were analyzed and the variables of gender, age, lost of working years, temporary disability days and disability costs were evaluated. Descriptive statistics were performed. Results: The total number of patients was 81: 83% were men, 17% women. The average disability age was 46 years, with an average of working years loss of 19, subsidized 7,842 thousand days of Temporary Incapacity for Work (TIW) meaning $1,125,759 million pesos, with a disability subsidy cost of $3,008,104 million pesos, totaling 3,37% of BC’s Gross Domestic Product (GDP). Conclusion: Chronic Kidney Disease causes high financial and in-kind costs in health institutions. The quality of life care will be improved and the number of working years lost for this disease will decrease preventing those disease-causing agents and going through an early care attention.

Not Fit but Not Disabled. To Be or Not to Be

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Abstract Abstract: the declaration of «non-incapacity and the unfit one» or that of «unfit and not incapacity» implies a controversy in the decision since it supposes to have taken two opposite qualifications on a worker: the health status and the work. The non-incapacity signifies the assessment of ability to work and that of not, fit exact the opposite, considering that he/she cannot work. Beyond the different application rule, different entities, professionals and purposes of qualification, what is certain is that the worker affected by this controversy is left without public administrative resources to solve such a controversial classification, which can finally lead to the loss of jobs. The causes of such controversy can be found in the specific regulations (which do not establish synergies or convergences in the decision), the lack of completed and shared information among the scope of work, the health area and the area of disability management; the lack of an arbitration body, and the non-definition and confusion of the terms and concepts valued are the causes of such controversy. Occupational health is a continuum care and therefore the administrations and entities involved must collaborate, share information, act synergistically and converge in their decisions. The public authorities must make the normative updates to try to avoid the ambiguity or the fragmentation decision that leaves the worker helpless. The medical discharge assessment is a medical procedure, which goes beyond its immediate consequence of ending the economic benefit that was being perceived and forces the employee to return to work. As soon as the discharge is extended, the ability to work is valued not only with occupational medical criteria but with a medical performance, through a medical examination. The EVIs Disability Assessment Teams of the NSSI (Spain’s Social Security National Institute) must know in a certain, detailed and exhaustive manner the work for which the incapacity for work is considered. It cannot be and not be at the same time, it cannot be NOT SUITABLE because work entails serious problems for your health or because the psychophysical capacities prevent you from working and, at the same time, being NO DISABILITY i.e. not being impeded for work, not having a decrease or a cancellation of work capacity. Conclusions: To improve the communication among the work environment, the healthcare area and the area of management and control of the disability, with shared information on the health of the worker and work, for a precise and joint clinical assessment of the worker and avoid controversy. Modification in its composition and functions of the EVI SSNI (assessment body team assessment disability), including new members of the board who can provide greater scientific content and technical medical evaluator labor (doctors of occupational health units, prevention service, primary care doctors and labor technicians) and adding to its functions the resolution of the dispute. Refer to the discharge report as medical report of labor capacity. The EVI should consider non-incapacity status as a full capacity to develop their work and to know what it is about and also must understand that working routine should not involve a deterioration of the workers’ health or a risk of their safety and that of others. To modify the regulations regarding the assessment of disability; to regulate the incapacity (regulation of the work capacity?); to change in the consideration of the habitual profession like reference obliged to evaluate the incapacity, with concrete valuation of the work demands; to reformulate the total permanent disability, assessing whether in concrete circumstances it could not be a long transitory compensation to facilitate the labor incursion in another job. Adoption of joint action protocols for labor, health and disability management. Update of regulations on prevention of occupational risks and social security and disability. Change of the paradigm of competence separation in the qualification of the non-apt and the non-incapacity, when the latter is declared. To consider the preventive nature of the performance actions assess the work capacity. Integrate the assistance healthcare areas, preventive labor and management-inspection of the work incapacity in means not only of collaboration and information interchange but of preventive or prestational integral decisive consideration. To positive value the work capacity in comparison with that of the incapacity value. Material and method: The following bibliographic databases have been reviewed up to May 2016: SciELO, PUBMED and the bibliography and medical consultation documentation named in it.

Systematic Review of Oculo-Visual and Musculoskeletal Alterations Associated with Visual Display Terminals Work

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Abstract Introduction: The changes in the world of work and the introduction of new technologies in recent years have led to an increasing use of visual display terminals (VDT) in many jobs. The discomfort and symptoms experienced during the use of VDT can have a significant impact in terms of quality, -as a result of the increase in the number of mistakes at work-, as well as the economic ones -taking into account the costs derived from temporary incapacity, the loss in working hours or the decrease of productivity-. The constant evolution in this area implies that the workers’ health surveillance exposed to this risk must be adapted to the knowledge and the most current evidence. Objective: The objective of our review is to structure and analyze the most recent literature on the subject to determine which health effects are associated with the usual use of visual display terminals. Method: Among November 2015 and January 2016 a bibliographic search was carried out using the keywords combinations «eyestrain», «occupational diseases», «video display terminals», «musculoskeletal diseases», «occupational diseases», «computer» «work» and population surveillance «in the electronic databases PubMed and the Cochrane Library limited to the last ten years. The studied population are individuals exposed to DDS and the results, in terms of health, symptoms or pathologies associated with the use of these technologies. Symptoms, diseases or disorders related to psychosocial risks were excluded of the search. The criteria for the selection of the articles were based on whether the study population had to be fully or partially employed and used computers or data visualization screens and that the health effects had to be in the visual or musculoskeletal sphere, related to working conditions or associated risk factors. Articles were not initially excluded because of language or type of study. The SIGN criteria (Scottish Intercollegiate Guidelines Network) were used to classify the scientific evidence and to determine the degree of the recommendations. Results: Results of the initial search were 1711 references, of which, once read the titles and excluded duplicates were reduced to 496. Once read the summaries, 424 other references were excluded considering that the content was not relevant and also for language reasons. Of the remaining 72 articles, 10 were excluded either because the content was irrelevant or did not meet the inclusion criteria, so that finally 62 items were included in the final review. Workers who usually use DSS regularly have symptoms of work-related discomfort and pain. Currently there are data that suggest the relationship between the use of these equipment and problems at the level of the cervical area. To a lesser extent, it is also associated with symptomatology of the wrist-hand and with vergence and astigmatism at the eye-visual level. Conclusions: The inclusion of symptomatology in most studies (collected through questionnaires), makes the pathology assessment associated with the use of VDT more complicated. In general it is possible to identify subjective discomfort or symptoms, but it is difficult to translate it into specific pathologies if they are not properly contrasted with objective and well-defined tests. Although there are no strong recommendations for specific interventions in the workplace, a multiple intervention strategy is seen as the most reasonable approach, prioritizing primary and secondary prevention activities, promoting the correct design of workplaces, and acting on training of workers so that they themselves become active subjects of prevention. More studies are required, with longitudinal designs and with a multicentric character to generate more evidence between the association of osteomuscular and oculomotor problems with the labor exposure to VDT.

Experiences of a large copper mining worker with silicosis

Resumen Se realizó un estudio de caso para conocer las vivencias de un trabajador minero con silicosis a través del método fenomenológico, en el último trimestre del año 2016. El criterio de inclusión más importante fue el diagnóstico de silicosis categoría 1. Se aplicó entrevista en profundidad basada en una guía de entrevista. El análisis se enfocó en los cuatro existenciales fenomenológicos. En los resultados se encontró que el trabajador describió de forma profunda sus relaciones familiares, sociales y laborales («de mi familia recibí todo el apoyo en cuanto se supo de mi enfermedad»). Percibió el apoyo de su jefatura y de sus compañeros de trabajo. Sobre la reubicación laboral manifestó: «no es solo que te cambien de lugar para trabajar, sino donde tú puedas aportar para el desarrollo de la empresa y donde tú puedas desarrollarte profesionalmente». El trabajador mostró conciencia de su enfermedad, refiriéndose a una buena cobertura de salud otorgada por la Unidad de Salud Ocupacional de la Clínica Río Blanco de la ciudad de Los Andes - Chile. Es importante continuar explorando otros casos de reubicación laboral por silicosis para comprender el fenómeno con mayor profundidad.

Abstract In the last quarter of 2016 a case study was conducted to learn the experience of a mining worker with silicosis through the phenomenological method. The most important criterion for inclusion was the silicosis diagnosis of category 1. A deep interview was carried out based on an interview guide. The analysis was focused on the four phenomenological existentialisms. The results showed that the worker described in a profound way his family, social and work relations (“from my family I received all the support as soon as my illness was known”). He sensed the support of his employers and co-workers. About the job relocation he said: “it is not just about changing the working place, but as well the place where you can contribute to the company´s development and improve professionally.” The worker was aware of his illness, referring to a good health coverage granted by the Occupational Health Unit of the Río Blanco Clinic in the city of Los Andes - Chile. In order to gain a deeper understanding of this phenomenon it is important to continue exploring other silicosis labor relocation cases.