SARS-CoV2 hospital surveillance and control system with contact tracing for patients and health care workers at a large reference hospital in Spain during the first wave: An observational descriptive study

Background and Aims During the first peak of the COVID-19 pandemic, the Preventive Medicine Department and the Occupational Health Department at Hospital Clinic de Barcelona (HCB), a large Spanish referral hospital, developed an innovative comprehensive SARS-CoV2 Surveillance and Control System (CoSy-19) in order to preserve patients' and health care workers' (HCWs) safety. We aim to describe the CoSy-19 and to assess the impact in the number of contacts that new cases generated along this time. Methods Observational descriptive study of the findings of the activity of contact tracing of all cases received at the HCB during the first peak of COVID-19 in Spain (February 25th-May 3rd, 2020). Results A team of 204 professionals and volunteers performed 384 in-hospital contact-tracing studies which generated contacts, detecting 298 transmission chains which suggested preventive measures, generated around 22¿000 follow-ups and more than 30¿000¿days of work leave. The number of contacts that new cases generated decreased during the study period. Conclusion Coordination between Preventive Medicine and Occupational Health departments and agile information systems were necessary to preserve non-COVID activity and workers safety.Peer ReviewedPostprint (published version

Historia natural y factores determinantes de la duración de las incapacidades temporales por contingencia común en trabajadores afiliados a la Seguridad Social

Esta tesis doctoral está basada en el estudio de los factores determinantes de la duración de la incapacidad temporal por contingencia común (ITcc). Se examina la variabilidad geográfica de la duración de la ITcc entre comarcas de Cataluña para episodios de ITcc en general y para dos patologías frecuentes, trastornos musculoesqueléticos (TME) y trastornos mentales. Se utilizan datos de cohortes de episodios de ITcc cedidos por el Institut Català d’Avaluacions Mèdiques i Sanitàries (ICAMS) de la Generalitat de Catalunya. Se analizaron todos los primeros episodios de ITcc finalizados en el año 2007 y 2010 estudiando factores individuales (sexo, edad, diagnóstico, entidad gestora del episodio, régimen de afiliación a la Seguridad Social y rama de actividad económica) y/o contextuales relacionados con recursos sanitarios (número de áreas básicas de salud) y socioeconómicos (cuota de mercado y tasa de desempleo) que podrían explicar la variabilidad observada. Se utilizaron modelos de regresión multinivel de riesgos proporcionales con episodios anidados en comarcas. También se propone un modelo de fragilidad condicional basado en un enfoque Poisson para analizar la duración de la ITcc (u otro evento de interés) en presencia de eventos repetidos para un mismo individuo, y se muestra la utilidad del modelo para analizar dicha duración en grandes bases de datos. Se utilizaron episodios de ITcc finalizados en el año 2007 por trastorno mental y por neoplasia, a partir de los cuales se comparó empíricamente el modelo de fragilidad condicional (CFM) y el enfoque propuesto basado en un modelo de fragilidad condicional Poisson (CFPM).This thesis is based on the study of the determinants of the duration of sickness absence (SA). We examined the geographic variability of the SA duration between comarcas of Catalonia for SA in general and for two common groups of disorders, musculoskeletal disorders (MSDs) and mental health disorders. Cohort data of SA episodes ceded by the Institut Català d’Avaluacions Mèdiques i Sanitàries (ICAMS) of the Generalitat of Catalunya were used. All first SA episodes ending in 2007 and 2010 were analyzed studying individual factors (sex, age, diagnosis, entity managing the sick leave, employment status, and economic activity branch) and contextual factors related to health resources (number of basic health areas) and socioeconomic indicators (market share and unemployment rate) that could explain the observed variability. Multilevel proportional hazard regression models with episodes nested in comarcas were used. This thesis also proposes using a conditional frailty model based on a Poisson approach for analyzing SA duration (or other event of interest) in the presence of repeated events in the same individual, and demonstrates the usefulness of such a model to analyze large datasets. SA episodes ending in 2007, caused by mental health disorders and neoplasms were used, from which the conditional frailty model (CFM) and a novel approach based on a conditional frailty Poisson model (CFPM) were compared empirically

Effect of economic recession on psychosocial working conditions by workers' nationality

Background: Several publications have documented the effects of economic recessions on health. However, little is known about how economic recessions influence working conditions, especially among vulnerable workers. Objective: To explore the effects of 2008 economic crisis on the prevalence of adverse psychosocial working conditions among Spanish and foreign national workers. Methods: Data come from the 2007 and 2011 Spanish Working Conditions Surveys. Survey year, sociodemographic, and occupational information were independent variables and psychosocial factors exposures were dependent variables. Analyses were stratified by nationality (Spanish versus foreign). Prevalence and adjusted prevalence ratios (aPRs) of psychological job demands, job control, job social support, physical demands and perceived job insecurity were estimated using Poisson regression. Results: The Spanish population had higher risk of psychological and physical job demand (aPR = 1.07, 95% CI = [1.04–1.10] and aPR = 1.05, 95% CI = [1.01–1.09], respectively) in 2011 compared to 2007. Among both Spanish and foreign national workers, greater aPR were found for job loss in 2011 compared to 2007 (aPR = 2.47, 95% CI = [2.34–2.60]; aPR = 2.44, 95% CI = [2.15–2.77], respectively). Conclusion: The 2008 economic crisis was associated with a significant increase in physical demands in Spanish workers and increased job insecurity for both Spanish and foreign workers.This study was funded by the Ministerio de Ciencia e Innovación (FIS PI11/01192) and the University of Alicante (INV13-06)

Factores relacionados con la inhibición de la lactancia por medios farmacológicos al nacer en un hospital de referencia español (2011-2017)

Objective To describe the maternal, neonatal and pregnancy characteristics related to inhibition of lactation (IL) with cabergoline. Method We assessed 20,965 occasions of breastfeeding initiation, according to data collected from obstetric records at the Hospital Clinic of Barcelona (Spain) between January 2011 and December 2017. Results IL decreased over the study period from 8.78% to 6.18% (odds ratio [OR]: 0.93 per year; 95% confidence interval [95%CI]: 0.90-0.95). Women with a lower educational level (OR: 2.5; 95%CI: 2.0-3.0), mothers living in more depressed areas (OR: 1.08 per 10 extra points over 100; 95%CI: 1.04-1.12), smokers (OR: 2.2; 95%CI: 1.9-2.6), and those with more children (OR: 1.2 for each sibling; 95%CI: 1.1-1.3), preterm birth (OR: 1.8; 95%CI: 1.4-2.3), multiple births (OR: 1.6; 95%CI: 1.2-2.1) and a higher risk pregnancy (OR: 1.3 per risk point; 95%CI: 1.2-1.4) showed a higher prevalence of IL. Compared to women born in Spain, IL was less likely in all other women with the exception of Chinese women (OR: 7.0; 95%CI: 5.7-8.6). These disparities remained during the study period. Conclusions Factors related to lower socioeconomic status and poor health were more likely to be associated with IL. The overall use of cabergoline decreased during the study period while inequalities persisted. Taking these inequalities into account is the first step to addressing them.Peer ReviewedPostprint (published version

Evaluación de la gestión de los casos de incapacidad temporal por contingencia común de más de 15 días en Cataluña Evaluation of the management of nonwork-related sick leave lasting more than 15 days in Catalonia (Spain)

Objetivos: Comparar la duración de los casos de incapacidad temporal por contingencia común gestionados por las mutuas con los gestionados por el Instituto Nacional de la Seguridad Social (INSS). Métodos: Cohorte retrospectiva de 289.686 casos de incapacidad de más de 15 días de duración iniciados en 2005 tras su certificación por un médico de primaria en Cataluña (156.676 gestionados por el INSS), registrados en el Institut Català d'Avaluacions Mèdiques, y seguidos hasta su alta. La duración mediana y los percentiles fueron calculados con el estimador de Wang-Chang, que tiene en cuenta los episodios repetidos (25% aproximadamente), y se compararon mediante un modelo de regresión log-logístico con fragilidad gamma compartida, lo que permite estimar la razón de tiempo (RT) y su intervalo de confianza del 95% (IC95%). Resultados: La duración mediana fue de 43 días para los casos del INSS y de 39 para los de mutuas. Esta diferencia fue estadísticamente significativa para los hombres del régimen general (RT=0,87; IC95%: 0,85-0,88) y del régimen de autónomos (RT=0,78; IC95%: 0,75-0,80), y para las mujeres del régimen general (RT=0,85; IC95%: 0,84-0,87) y de autónomos (RT=0,84; IC95%: 0,81-0,88); diferencias que se mantienen en general después de ajustar por la edad y la región sanitaria. Conclusiones: Los resultados confirman una finalización de los episodios más rápida para los casos de más de 15 días de duración gestionados por una mutua que para los gestionados por el INSS, tanto aquellos del régimen general como de autónomos. Es necesario investigar las causas de estas diferencias.Objectives: To compare the length of nonwork-related sick leave among cases managed by an insurance company versus those managed by the National Institute of Social Security (NISS). Methods: We performed a retrospective cohort study of 289,686 cases of sick leave lasting for more than 15 days that began in 2005 after certification by a primary care physician in Catalonia, were reported to the Catalonian Institute of Medical Evaluations, and were followed to term. Of the total, 156,676 cases were managed by the NISS. To account for repeat episodes (approximately 25% of the total), the Wang-Chang estimator was used to calculate the median duration and percentiles; comparisons were made using log-logistic regression with shared gamma frailty models, with calculation of time ratios (TR) and their corresponding 95% confidence intervals (95% CI). Results: The median duration of sick leave was 43 days for cases managed by the NISS and 39 days for those managed by the insurance company. This difference was statistically significant both for men employed under contract (TR=0.87; 95% CI: 0.85-0.88) and for those who were self-employed (TR=0.78; 95% CI: 0.75-0.80) as well as for women under contract (TR=0.85; 95% CI: 0.84-0.87) and self-employed women (TR=0.84; 95% CI: 0.81-0.88). These differences persisted after adjustment was performed for age and health region. Conclusions: For sick leave lasting more than 15 days, these results confirm that cases managed by an insurance company ended earlier than for those managed by the NISS, both for contract and self-employed workers. Further research is needed to explore the reasons for these differences

Distribución de la duración de la incapacidad temporal por contingencia común por diagnóstico médico (Cataluña, 2006-2008) Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)

Presentamos una herramienta sencilla y práctica que permite consultar la distribución habitual de la duración de la incapacidad temporal por contingencia común, según el diagnóstico médico. Para ello se analizaron 2.646.352 episodios de incapacidad temporal ocurridos en Cataluña y seguidos hasta el alta, entre 2006 y 2008, incorporados a un aplicativo. La duración mediana, dado que sigue una distribución asimétrica, fue de 9 días. Los trastornos musculoesqueléticos fueron el grupo diagnóstico más frecuente (22,5%) y las neoplasias tuvieron la duración mediana más larga (56 días). Los diagnósticos específicos más comunes fueron la diarrea-gastroenteritis (8,2%; mediana: 3 días) y la rinofaringitis aguda (5,2%; mediana: 4 días). La distribución de la duración de la incapacidad temporal en una población varía por diagnóstico y es asimétrica; la mayoría de los episodios duran mucho menos que la media. Esta información es importante para una mejor gestión, tanto clínica como administrativa, de la incapacidad temporal.We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes

Occupational health impact of the 2009 H1N1 flu pandemic: Surveillance of sickness absence

Objectives: Workplace absences due to illness can disrupt usual operations and increase costs for businesses. This study of sickness absence due to influenza and influenza-related illness presents a unique opportunity to characterise and measure the impact of the 2009 (H1N1) pandemic, by comparing trends during the pandemic to those of previous years, and adding this information to that obtained by traditional epidemiological surveillance systems. Methods: We compared the numbers of cases of sickness absence due to illness caused by influenza and influenza-related illness in 2007-2009, and in the first 3 months of 2010 in Catalonia (n=811 940) using a time series approach. Trends were examined by economic activity, age and gender. The weekly endemic-epidemic index (EEI) was calculated and its 95% CI obtained with the delta method, with observed and expected cases considered as independent random variables. Results: Influenza activity peaked earlier in 2009 and yielded more cases than in previous years. Week 46 (in November 2009) had the highest number of new cases resulting in sickness absence (EEI 20.99; 95% CI 9.44 to 46.69). Women and the 'education, health and other social activities' sector were the most affected. Conclusions: Results indicate that the new H1N1 pandemic had a significant impact on business, with shifts in the timing of peak incidence, a doubling in the number of cases, and changes in the distribution of cases by economic activity sector and gender. Traditional epidemiological surveillance systems could benefit from the addition of information based on sickness absence data.Peer Reviewe

Evaluación de la gestión de los casos de incapacidad temporal por contingencia común de más de 15 días en Cataluña

OBJECTIVES: To compare the length of nonwork-related sick leave among cases managed by an insurance company versus those managed by the National Institute of Social Security (NISS). METHODS: We performed a retrospective cohort study of 289,686 cases of sick leave lasting for more than 15 days that began in 2005 after certification by a primary care physician in Catalonia, were reported to the Catalonian Institute of Medical Evaluations, and were followed to term. Of the total, 156,676 cases were managed by the NISS. To account for repeat episodes (approximately 25% of the total), the Wang-Chang estimator was used to calculate the median duration and percentiles; comparisons were made using log-logistic regression with shared gamma frailty models, with calculation of time ratios (TR) and their corresponding 95% confidence intervals (95% CI). RESULTS: The median duration of sick leave was 43 days for cases managed by the NISS and 39 days for those managed by the insurance company. This difference was statistically significant both for men employed under contract (TR=0.87; 95% CI: 0.85-0.88) and for those who were self-employed (TR=0.78; 95% CI: 0.75-0.80) as well as for women under contract (TR=0.85; 95% CI: 0.84-0.87) and self-employed women (TR=0.84; 95% CI: 0.81-0.88). These differences persisted after adjustment was performed for age and health region. CONCLUSIONS: For sick leave lasting more than 15 days, these results confirm that cases managed by an insurance company ended earlier than for those managed by the NISS, both for contract and self-employed workers. Further research is needed to explore the reasons for these differences.Este trabajo ha contado con la financiación de una beca (I. Torá) para la realización de un máster en Salud Laboral, concedida mediante convocatoria pública, fruto de un convenio entre la Universitat Pompeu Fabra y el Institut Català d’Avaluacions Mèdiques, con la finalidad exclusiva de financiar esta beca

Comparisson in Andalusia and Catalonia of sickness absence because of influenza (H1N1) 2009 | Comparación entre Andalucía y Cataluña de la frecuencia de incapacidad laboral durante la gripe (H1N1) 2009

Background: This study compared surveillance of cases of sickness absence due to illness caused by influenza and reported in Andalusia and Catalonia in the period 2007-2009. Methods:Atime series of incident cases of sickness absence due to influenza, by sex and age, in which episodes in Andalusia and Catalonia in a previous epidemic period (from 01/01/2007 through 30/09/2009) were compared to the pandemic period (last three months of 2009). The weekly number of new cases of sickness absence due to influenza was calculated, and the minimum, median and maximum values were plotted for each of these two periods. Results: Unexpectedly, women had a higher proportion of new cases of sickness absence due to influenza during the pandemic period (52.2% in Catalonia and 49.7% in Andalusia). During both periods the 25 to 34 year old age group had a higher number of new cases of sickness absence both in Catalonia (37.439 in the epidemic period and 15.379 in the pandemic) and Andalusia (20.465 epidemic period and 9.630 pandemic period).The arrival of the pandemic was around November (approximately 10.000 cases in Catalonia and 5.000 cases in Andalusia), resulting in a significant increase of cases in contrast to the median of the epidemic period. Conclusions: During the 2009 pandemic, there was an increase in new cases of sickness absence due to influenza, somewhat greater in Catalonia than Andalusia, with an earlier peak in November, especially among women in these two autonomous communities.Background: This study compared surveillance of cases of sickness absence due to illness caused by influenza and reported in Andalusia and Catalonia in the period 2007-2009. Methods: A time series of incident cases of sickness absence due to influenza, by sex and age, in which episodes in Andalusia and Catalonia in a previous epidemic period (from 01/01/2007 through 30/09/2009) were compared to the pandemic period (last three months of 2009). The weekly number of new cases of sickness absence due to influenza was calculated, and the minimum, median and maximum values were plotted for each of these two periods. Results: Unexpectedly, women had a higher proportion of new cases of sickness absence due to influenza during the pandemic period (52.2% in Catalonia and 49.7% in Andalusia). During both periods the 25 to 34 year old age group had a higher number of new cases of sickness absence both in Catalonia (37.439 in the epidemic period and 15.379 in the pandemic) and Andalusia (20.465 epidemic period and 9.630 pandemic period). The arrival of the pandemic was around November (approximately 10.000 cases in Catalonia and 5.000 cases in Andalusia), resulting in a significant increase of cases in contrast to the median of the epidemic period. Conclusions: During the 2009 pandemic, there was an increase in new cases of sickness absence due to influenza, somewhat greater in Catalonia than Andalusia, with an earlier peak in November, especially among women in these two autonomous communities.Peer reviewe

Duración de los episodios de incapacidad temporal por contingencia común según regiones sanitarias en Cataluña

Fundamentos: En este estudio se analizó la duración de los episodios de incapacidad temporal por contingencia común en Cataluña según regiones sanitarias. Partiendo de la hipótesis de una distribución homogénea de las duraciones entre las regiones sanitarias. Métodos: Estudio de cohorte retrospectiva de 811.790 episodios obtenidos del Institut Català d�Avaluacions Mèdiques iniciados el año 2005 y seguidos hasta su finalización, cómo máximo julio de 2007, donde se describió la mediana de la duración en días de los episodios para cada una de las siete regiones sanitarias de Cataluña. La probabilidad de volver al trabajo se representó según las curvas de supervivencia de Wang_Chang y se comparó la duración mediana (DM) tomando como referencia la Región Sanitaria Barcelona, estratificando por sexo. Resultados: La región de Camp de Tarragona registra la menor duración de 5 días. Por contra, los episodios ocurridos en el Alt Pirineu i Aran presentaron una mayor duración de 13 días. Para la región de Barcelona la duración fue 7 días, al igual que para Cataluña Central. En Girona fue de 8 días, y en Lleida y Terres de l�Ebre de 9 días. Conclusiones: Existen diferencias significativas en las duraciones de los episodios entre las regiones sanitarias de Cataluña, que se mantienen después de ajustar por la edad, la gestión del episodio y el régimen de Seguridad Social, tanto para hombres como para mujere