Medicina y Seguridad del Trabajo

Peer review in scientific journals

Determination of Contingency. Analysis of 15 Cases With Judicial Sentence Year 2015

Resumen En relación a los juicios de Determinación de contingencia (DECO) tanto en los Juzgados de lo Social (J.S) como en los Tribunales Superiores de Justicia (TSJ), teniendo como premisa que cada caso hay que analizarlo particularmente por sus múltiples circunstancias, existen diversidad de criterios para calificar: Enfermedad Común (CC): Como enfermedad preexistente no agravada por accidente de trabajo. Accidente de trabajo (AT): Como agravamiento de patología previa. Incidente en lugar y tiempo de trabajo. No parecen existir criterios concluyentes que distingan médico-legalmente Enfermedad común y Accidente de trabajo. El motivo del presente estudio es analizar 9 parámetros de 15 sentencias del año 2015 en Madrid, con el fin de llegar a razonamientos médico-jurídicos que puedan mejorar nuestro trabajo diario en los Juzgados de lo Social.

Abstract Regarding the Contingency Determination trials in both Social Courts and Superior Courts of Justice, based on the premise that each case has to be analyzed in particular for its multiple circumstances, there are several criteria to qualify: Common disease: As preexisting disease not aggravated by work accident. Work accident: As aggravation of previous pathology. Incident in place and time of work. There seems to be no conclusive criteria which distinguish between common disease and work accidents. The purpose of the present study is to analyze 9 parameters of 15 sentences of the year 2015 in Madrid, in order to arrive at medico-juridical / medico-legal reasoning reasonings that can improve our daily work in Social Courts.

Work absenteeism of patient escort staff in an acute hospital

Resumen Introducción: El absentismo es un problema importante en la actualidad. Las bajas por enfermedad común no dejan de crecer y superaron en el año 2016 los 4,5 millones, produciendo unos perjuicios laborales y económicos de gran importancia. Objetivo: Estudio del absentismo laboral por causa de enfermedad o lesiones en la categoría de Celadores de un Hospital de Agudos, con el fin de identificar factores relacionados con este absentismo. Material y métodos: Estudio descriptivo. Se registró el absentismo laboral en 177 trabajadores con categoría celadores de un hospital de agudos durante el año 2015. Las variables analizadas fueron: número de Incapacidad Transistorias (I.T), periodos de I.T, sexo, edad, IMC, estado civil, número de hijos, practicar deportes, tipo de contrato, turno de trabajo, patologías, carga de trabajo, adaptación del puesto de trabajo por las patologías que padece, fecha de la Incapacidad Transitoria y días total de absentismo. Para el análisis estadístistico univariante se aplicó una χ2 en proporciones y la t-student en variables contínuas. Posteriormente se construyó un modelo mutivariante (Regresión Logística) cuya variable dependiente fue el absentismo. Resultados: Los días totales de baja fueron de 4425 días, lo que supone 33187.5 horas perdidas. La tasa de absentismo (T.A) por cada 100 horas trabajadas fue de 11.4 horas perdidas y la tasa general de absentismo (T.G.A.) fue de 25 jornadas perdidas por cada trabajador. Un 44.6 % del total de los trabajadores tuvieron una baja médica durante el año de estudio. Las variables relacionadas en el estudio univariante fueron el sexo, tener hijos, padecer patología osteomuscular u otras patologías, tener el puesto adaptado y el sobrepeso. En el modelo multivariante las variables significativas fueron padecer patología osteomuscular con una O.R. de 1.955 (0.982-3.89) y padecer Obesidad O.R. de 3.433 (1.372 - 8.590). Discusión: Las variables patología osteomuscular y obesidad, son las que mejor predicen el absentismo laboral en nuestra muestra. Se podrían obtener mejores datos en absentismo laboral si la institución mejorara la gestión de puestos de trabajo teniendo en cuenta la gran proporción de patología osteomuscular y se realizasen planes de promoción de la salud frente a la obesidad.

Abstract Introduction: Absenteeism is a currently major problem. The sick leaves due to common illness continue to grow and exceeded 4.5 million in 2016, causing important labor and economic damages. Objective: Injuries or Illness work-related absenteeism in patient escort workers of an Acute Hospital in order to identify factors related with this absenteeism. Material and methods: Descriptive study. Along 2015 work absenteeism was registered in 177 patient escort workers from an Acute Hospital. The following variables were analyzed: number of temporary work disability and periods, sex, age, BMI, marital status, number of children, exercise, type of contract, work shift, pathologies, workload, adaptation of the workplace due to the pathologies suffered, date of Temporary Disability and total days of absenteeism. For univariate statistical analysis a chi-square (χ2) was applied in proportions and t-Student in continuous variables. Subsequently, a multivariate model was constructed (Logistic Regression) whose dependent variable was absenteeism. Results: The total days of leave were 4,425 days, which means a loss of 33,187,5 hours of work. The general rate of absenteeism per 100 hours worked was 11,4 hours lost and the general absenteeism rate was 25 days lost for each worker. 44,6% of the total workers took a medical leave during the year of study. The variables related in the univariate study were sex, having children or not, musculoskeletal or other pathology, post adjustment and overweight. In the multivariate model the significant variables were musculoskeletal pathology with an OR of 1,955 (0,982-3,89) and being obese OR of 3,433 (1,372 - 8,590). Discussion: Musculoskeletal pathology and obesity variables are the best predictors of work absenteeism in our sample. Better data could be obtained in work absenteeism if the Institution improves the job management taking into account the magnitude of musculoskeletal pathology and the health promotion programs on obesity were carried out.

Quality of work life in employees of a Security and Surveillance area of a southwest colombian university

Resumen Objetivo: Evaluar la percepción de la Calidad de Vida en el Trabajo (CVT) de los funcionarios que laboran en al área de Seguridad y Vigilancia de una Universidad del suroccidente Colombiano. Métodos y Materiales: Estudio de tipo cuantitativo, descriptivo y de corte transversal. Muestra constituida por 122 personas de una población de 137. Se aplicó un cuestionario de datos socio-laborales integrado por 19 ítems y por el instrumento CVT-GOHISALO, que consta de 74 ítems y mide la CVT en siete dimensiones. Resultados: De las siete dimensiones evaluadas, los funcionarios del área de seguridad y vigilancia perciben que la dimensión seguridad en el trabajo contribuye de manera positiva a la CVT; las dimensiones: soporte institucional, satisfacción por el trabajo, bienestar logrado a través del trabajo e integración al puesto de trabajo contribuyen medianamente a una percepción positiva de la calidad de vida laboral, mientras las dimensiones: desarrollo personal del trabajador y administración del tiempo libre puntuaron bajo contribuyendo de manera negativa a dicha percepción. Finalmente se identificó relación entre la antigüedad en la empresa y la dimensión seguridad en el trabajo y las variables: sede donde labora y estado civil con las dimensiones: bienestar logrado a través del trabajo y satisfacción por el mismo. Conclusiones: Los trabajadores del área de seguridad y vigilancia evidencian sus percepciones de CVT que señalan los factores intra y extra laborales en los que se encuentran inmersos, reflejando una realidad de su medio laboral.

Abstract Objective: To evaluate the perception of the Quality of Work Life (QWL) of employees who work in the Security and Surveillance area of a Southwest Colombian University. Methods and Materials: Quantitative, descriptive and cross-sectional study. The sample consists of 122 people from a population of 137. A questionnaire of social and labor data composed of 19 items was applied and the CVT-GOHISALO instrument, which consists of 74 items and measures the QWL in seven dimensions. Results: Of the seven dimensions evaluated, security and surveillance workers perceive that the employment stability dimension contributes positively to the QWL. Institutional support, job satisfaction, well-being condition achieved through work and job integration dimensions, contribute moderately to a positive QWL perception, while worker personal development and leisure time administration dimensions scored low contributing negatively to that perception. Finally, the relationship between seniority in the company with the employment stability dimension together with workplace and marital status variables and with the dimensions well-being achieved through work and job satisfaction were identified. Conclusions: Workers in the area of security and surveillance show their perceptions of QWL that highlight the intra and extra labor factors in which they are immersed, reflecting a reality of their work environment.

Problems and psychological factors in the return to work process after prolonged temporary disability due to breast cancer

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Abstract Abstract: Breast cancer is the most common cancer in women, mostly affects women in the working age, between 45-65 years. The therapeutic advances have achieved a very high prevalence (survivors) of about 86%, but are the leading cause of death in women between 35-55 years. It has a great economic impact for health expenses, expenses in incapacity benefits, loss of wages, loss of productivity of the economic system and losses due to absenteeism to companies. Its treatment is in general intense, prolonged, and causes strong emotional distress and poor quality of life damaging the personal, family and social environment. It especially affects negatively the body image and the female self-esteem. This may be a frequent cause of long casualties (prolonged absence of work) and difficult return to work process due both to the effects of the tumor and secondary effects of the treatment, as well as to the appearance of «minor» psychiatric disorders: stress, anxiety, depression and adaptive disorders. The return to work is more difficult when psychological processes appear and sometimes causes more disability than the cancer itself and its sequels. 36% of women with breast cancer suffer from depression and need psychiatric support, and 55% have some type of anxiety disorder or adaptive disorder that requires at least psychological support and anxiolytic prescription in any of the stages of cancer treatment. The psychological factors are directly related to the attitude and this is determinant regarding the return to work. On the other hand, the presence of anxiety and/or depression diminishes the capacity of the woman with cancer to tolerate the treatment and its side effects or to face the problems in the personal environment that a generally so long and sometimes so aggressive process supposes. Conclusions: The emergence of psychological processes in breast cancer occurs frequently in the final phase of the process and hinders the return of labor. The appearance of psychological disorders in the initial stage of diagnosis and treatment is not very frequent and against what it might seems, the greater severity of the process or the aggressiveness of the treatments does not parallel imply a greater emotional affection, it is more in these severe processes where anxiety or depression if appear revert or lessen at one year of diagnosis and are more related to structural characteristics of the patient’s personality and other factors in the social and work environment than to the severity of the process. However, it is in the final stage of the treatment, in a percentage close to 35% of the patients with breast cancer, that they develop «minor» psychiatric pathologies causing severe difficulties in the labor return, when they do not condition the no-return or the permanent disability. These mental disorders that occur at the end of the treatment appear more frequently when support is lacking in the social or family environment if the disability (incapacity) is prolonged beyond the year of diagnosis, as well as in cases of uninspiring work, intense physical load or lack of labor support or labor conflict, and as much less influential factors if the patient has a history of previous pathologies or psychological alterations, or older than 55 years. For this reason it is necessary to identify and prevent these psychological processes for a complete socio-health and labor approach and to obtain a greater reincorporation of the surviving patients to work, as well as to improve the patients’ quality of life, and to seek their reintegration into a standardized life. Support should be given to the environment, including support in the work environment to facilitate return to work, including measures for partial and gradual return to work and/or job adaptation. It is also necessary to be aware that the woman who survives breast cancer often needs psychological reconstruction and this also means the therapeutic «rest» of the clinical world that attended her in the phase of active disease and reinforced with a period of adaptation and coping of the vital realities. Material and method: the following bibliographic databases were reviewed until May 2017: SciELO, PUBMED, BMC cancer, in relation to breast cancer survivors, onset of mental processes, and return to work, including several systematic reviews. As well as a study of the processes of breast cancer that reached 12 months of temporary incapacity and those assessed as permanent disability in the disability assessment teams of the National Institute of Social Security of Gipuzkoa and Murcia in three annual periods 2006, 2013, and 2015, as well as the Bibliography and reference documents cited in the bibliography.

Behavioral Analysis in Disability Assessment Medicine: An Interdisciplinary Proposal

Resumen Se propone un nuevo marco teórico, el Análisis de Conducta en Medicina, para abordar los desafíos que la evaluación de la incapacidad y la medicina pericial afrontan en su práctica clínica diaria. Mediante un enfoque con base científica interdisciplinar y flexible pero sistemático en su aplicación, el Sistema de Análisis de Validez en la Evaluación (SAVE) está diseñado para incorporar una amplia gama de métodos, técnicas y habilidades útiles, tomadas de diferentes fuentes (psicología forense, criminología, derecho sanitario, detección del engaño y el fraude, etc.). Se estructura en tres fases sucesivas, Verosimilitud (V1), que corresponde al análisis del contenido verbal de la declaración; Veracidad (V2) como congruencia entre lo verbal y lo no verbal, y Verificación (V3), el proceso de comprobación de la información previamente obtenida. Estos conocimientos y habilidades se pueden aprender y entrenar, todos ellos han sido probados científicamente y cuentan con un amplio número de referencias publicadas para profundizar en cada tema. Además, este proceso permite una fácil adaptación a cada caso y contexto, evitando molestar a los informados genuinamente impedidos al pasar desapercibido excepto cuando la probabilidad de fraude es elevada. Por lo tanto, creemos que cualquier profesional de la salud y especialmente los peritos médicos, sean funcionarios o independientes, se beneficiarán de este modo de realizar la consulta médica, mejorando la relación médico-paciente y la necesaria gestión del engaño cuando sea preciso.

Abstract A new theoretical framework, the Behavioral Analysis in Medicine is proposed to address the challenges that disability assessment and clinical forensic medicine face in everyday practice. Through an interdisciplinary approach, scientifically based and flexible yet systematically applied, the System of Validity Analysis in Assessment (referred to by its Spanish acronym SAVE) is designed to incorporate a wide array of useful methods, techniques and skills from different sources (forensic psychology, criminology, health law science, deception and fraud detection, etc.). It is structured in three successive phases, Verisimilitude (V1), as verbal content analysis of the statement; Veracity (V2) as congruence between verbal and non-verbal communication, and Verification (V3), the checking process of previously obtained information. These knowledge and abilities are affordable to learn and train. All of them have been scientifically tested and have an extensive number of published references to delve deeper in each subject. Additionally, this process allows an easy adaptation to each case and context, avoiding disturbing those genuinely disabled examinees by going unnoticed unless there is a high probability of fraud. Hence, we believe that every health practitioner, especially the medical examiners, public servants or independent ones will benefit from this way to accomplish every medical consultation, improving the patient-physician relationship and the necessary fraud management whenever necessary.

Active and healthy aging. How to promote it at work?

Resumen Introducción: Actualmente se está produciendo un acusado cambio demográfico en el que se observa un envejecimiento en la población activa, debido principalmente al aumento de la esperanza de vida y la disminución en las tasas de fecundidad. Resulta un desafío para nuestra sociedad el tratar de mejorar la calidad de vida del trabajador mayor. Objetivo: Identificar y evaluar las intervenciones más actuales en la promoción de la salud del trabajador mayor, fomentando el envejecimiento activo y saludable en su entorno laboral. Metodología: Se ha realizado una revisión bibliográfica basada en la literatura publicada durante el periodo de 2006-2016 en varias bases de datos científicas: MEDLINE, SCOPUS, IBECS, LILACS, y WOK. Resultados: La búsqueda produjo un total de 63 registros y tras la aplicación de filtros y criterios de exclusión e inclusión, se seleccionaron un total de 8 artículos (3 estudios transversales, 3 ensayos clínicos controlados aleatorizados y 2 ensayos clínicos cuasi-experimentales). Se evidenciaron resultados estadísticamente significativos en distintas estrategias de promoción de la salud en el trabajador mayor, repercutiendo positivamente en su desempeño laboral. Conclusiones: Se obtuvieron hallazgos positivos en determinados parámetros de salud (actividad física diaria, hábitos alimenticios, peso, BMI, etc.) en los programas cuyo objetivo era mantener la salud y bienestar del trabajador mayor. Además se ha constatado la falta de estudios longitudinales de calidad, existiendo la necesidad de generar evidencia para el ajuste de los actuales programas en función de la franja de edad, patología predominante en cada sector laboral y su correspondiente análisis coste-efectividad.

Abstract Introduction: The aging of the active workforce explains the strong demographic change which is nowadays taking place mainly due to both increasing longevity and decreasing fertility rates. It seems to be a challenge to improve the life quality of the older worker. Objective: To identify and evaluate the modern interventions in the health promotion of the older worker by encouraging an active and healthy aging at the workplace. Methods: A systematic review based on the literature published between 2006-2016 in different scientific databases has been carried out: MEDLINE, SCOPUS, IBECS, LILACS and WOK. Results: The search produced a total of 63 registers. After applying filters and inclusion and exclusion criteria a total of 8 original articles were selected: 3 cross-sectional studies, 3 randomised controlled studies and 2 non randomised control trials. Statistically significant results were observed in different health promotion strategies of the older worker improving the workplace activities. Conclusions: The articles aiming for the maintenance of health, well-being in active aging obtained positive results regarding several health indicators (daily physical activity, food habits, body weight, BMI, etc.). Still, quality longitudinal studies are scarce. There is a clear necessity to generate evidence adjusting the existing programmes according to the age, the predominant pathology in each labour sector and the corresponding cost-effectiveness analysis.