Josefina Jardí

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

OBJECTIVESnTo 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).nnnMETHODSnWe 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).nnnRESULTSnThe 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.nnnCONCLUSIONSnFor 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.

Heterogeneity and event dependence in the analysis of sickness absence

BackgroundSickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration.MethodsTo overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders.ResultsAs expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM.ConclusionsThe CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases.

Evaluation of the management of nonwork-related sick leave lasting more than 15 days in Catalonia (Spain)

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.

Design of an integrated management system (IMS) in a government-run medical evaluation organisation

Purpose – The authors present the application of the Lopez-Fresno approach in designing an integrated management system (IMS) for an aviation company to the development of an IMS in a government-run organization responsible for the medical evaluation of work disabilities. The purpose of this paper is to share the design process, with the intention of showing that this approach is applicable to other sectors and proposing generalization and applicability strategies to other smaller government entities. Design/methodology/approach – The study involves two phases. Phase I applies the Lopez-Fresno approach to design a basic IMS-I and ends with a European Foundation for Quality Management (EFQM) evaluation, whose suggestions were taken into consideration for the final design of IMS-II during phase II. The data were obtained from the organizations own functioning. There was a significant degree of personal involvement by the authors, external consultants and members of the management committee in areas ranging...

Distribución de la duración de la incapacidad temporal por contingencia común por diagnóstico médico (Cataluña, 2006-2008)

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.

Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors

OBJECTIVEnTo examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors.nnnMETHODSnAll first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated.nnnRESULTSnWe found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32).nnnCONCLUSIONSnCounty-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.

Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)

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.

[Non-occupational temporary sickness absence in Catalonia, 2007-2010].

OBJECTIVESnTo describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007 and 2010.nnnMETHODSnWe analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups.nnnRESULTSnThere was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to 10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20 and 30 days).nnnCONCLUSIONSnThese trends may serve as a baseline for planning and evaluating policies directed at better management of sickness absence in Spain.

Comparación entre Andalucía y Cataluña de la frecuencia de incapacidad laboral durante la gripe (H1N1) 2009

Fundamentos: La gripe estacional es una causa frecuente de episodios de incapacidad temporal por contingencia comun (ITcc). En este estudio se valora el impacto laboral de la gripe pandemica (H1N1) 2009 en Andalucia y Cataluna durante el periodo 2007-2009. Metodos: Estudio de series temporales de los casos de ITcc por gripe, segun edad y sexo. Se compararon los nuevos casos de ITcc por gripe en un primer periodo epidemico (de 01/01/2007 hasta 30/09/2009) y un segundo periodo pandemico (tres ultimos meses de 2009). Se calculo el numero semanal de nuevos casos de ITcc por gripe, representandose graficamente los valores minimo, mediano y maximo de los casos notificados durante el periodo epidemico y el pandemico. Resultados: Al contrario de lo esperado, las mujeres presentaron 52,2% en Cataluna y 49,7% en Andalucia de nuevos casos de ITcc por gripe durante el periodo pandemico. Durante ambos periodos, el grupo de edad de 25 a 34 anos presento mayor numero de casos tanto en Cataluna (37.439 en el periodo epidemico y 15.379 en el pandemico) como en Andalucia (periodo epidemico 20.465 y periodo pandemico 9.630). La llegada de la pandemia se situo alrededor del mes de noviembre (aproximadamente 10.000 casos en Cataluna y 5.000 casos en Andalucia), produciendose un importante aumento de casos respecto a la mediana del periodo epidemico. Conclusiones: La aparicion de la pandemia de gripe produjo un incremento importante de casos de ITcc, algo superior en Cataluna que en Andalucia, adelantandose su acme a noviembre, especialmente en las mujeres de las dos Comunidades Autonomas.BACKGROUNDnThis 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.nnnMETHODSnA 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.nnnRESULTSnUnexpectedly, 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.nnnCONCLUSIONSnDuring 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.

Flu and other Acute Respiratory Infections in the Working Population. The Impact of Influenza A (H1N1) Epidemic

Abstract Introduction This study aims to asses the impact of influenza and other acute respiratory infectious diseases (ARI) on the Catalan working population between January 2007 and December 2009, including the period of the influenza virus A (H1N1) pandemic in our region. Methods All certified sickness absence episodes (sick-leave) due to influenza and other ARI amongst the working population of Catalonia, Spain, were analyzed from January 2007 to December 2009. Monthly and weekly incidence was calculated, as well as an influenza sick-leave threshold, in order to identify the epidemic season in the working population. Results Registered annual sick-leave incidence for influenza-like illnesses (ILI) per 100 000 workers was 1260.6 in 2007, 915.2 in 2008 and 2377.2 in 2009. Epidemic curves show monthly peaks in January- February each year, plus a second peak in November 2009 corresponding to the influenza virus A (H1N1) pandemic in our region. In 2009 sick-leave incidence for ILI and other ARI was higher in workers from the Health-Social Services sector than in the other workers (P Conclusion This study contributes to understanding the impact of influenza and other ARI on the general workforce, during a period of time including the outbreak of influenza virus A (H1N1).