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Resumen: En España, el modelo retributivo para el personal estatutario es complejo, heterogéneo y orientado más a compensar funciones y actividades complementarias que a recompensar el buen desempeño mostrado en las tareas específicas del puesto de trabajo. Las diversas tentativas de incorporar complementos incentivadores han sido desnaturalizadas ante una cultura igualitarista de la función pública y una débil gobernanza sistémica. Los atractores externos (v.g. actividad privada) para los profesionales sanitarios están siendo importantes y neutralizan muchos incentivos intramurales. Hay pocas expectativas de cambios relevantes o estructurales, ya que los principales agentes implicados no apuestan por trasformaciones; sin embargo, algunos factores del entorno pueden propiciar mejoras incrementales en los sistemas de contratación, en la información disponible para mejorar la fijación comparativa de objetivos y en la creación de espacios de buena gobernanza y gestión clínica. El escenario económico, crecientemente preocupado por las tendencias inflacionarias y los riesgos de sostenibilidad, así como la trasformación digital, pueden tener un efecto dinamizador de algunas reformas en la gobernanza y la gestión. Abstract: In Spain, the compensation model for statutory health personnel is complex, heterogeneous, and more oriented to rewarding complementary functions and activities, than to paying for the actual performance in the position of employee. The various attempts to incorporate incentives have been distorted by a civil service egalitarianist culture, and weak systemic governance. External attractors (private practice, etc.) for healthcare professionals are becoming more important and neutralize many intramural incentives. There are few prospects of relevant or general changes, since the main actors involved are reforms-averse; but some environmental factors can lead to incremental improvements in employment contracts, in the information available to improve benchmarking, and in the creation of islands of good clinical governance and management. The economic scenario, increasingly concerned about inflationary trends and sustainability risks, may have a revitalizing effect of some governance and management reforms.

Resumen: La dificultad para evaluar y compensar el rendimiento en las organizaciones profesionales se extrema en entornos de gestión pública directa de servicios sanitarios. La evaluación del rendimiento es compleja por razones técnicas y por la existencia de múltiples principales en las relaciones de agencia, que influyen en la fijación de objetivos. Los incentivos son una palanca para generar direccionalidad y motivación, tanto los estructurales (que atraen y retienen trabajadores) como los específicos (que retribuyen el desempeño y orientan el comportamiento hacia metas institucionales). Los incentivos influyen de forma diversa en el comportamiento de los trabajadores, y su efectividad parece débil y controvertida en entornos públicos sanitarios. Abordar con éxito los problemas de determinación y evaluación del desempeño requiere tanto instrumentos de buen gobierno como la revitalización de la gestión contractual. Para mejorar la efectividad de los modelos de incentivos es conveniente: 1) ampliar el marco conceptual de los incentivos, para incorporar los aspectos estructurales del empleo y la remuneración; 2) mejorar los diseños a partir de una mayor comprensión de los determinantes de la motivación; y 3) contemplar los factores extramurales que alteran el comportamiento de los trabajadores y tratar de contrarrestarlos. Abstract: Assessing and compensating performance in professional organizations is extremely difficult in direct public management settings of health services. Performance assessment is technically complex and, more so, with multiplicity of principals influencing goal setting. Incentives are a lever to generate directionality and motivation, both structural (for attracting and retaining workers) and specific ones (rewarding performance and directing behavior towards institutional goals). Incentives influence the behavior of workers in various ways, and their effectiveness seams weak and controversial in publicly run health services. To overcome the problems of deciding and evaluating performance, both good governance models and the revitalization of contractual management are required. To improve the effectiveness of incentive models, it is convenient to: 1) widen the conceptual framework of incentives, to incorporate the structural aspects of employment contract and payment; 2) improve the designs from a greater understanding of the determinants of motivation; and 3) broaden the lens to survey the extra-mural factors that alter the behavior of workers, trying to counter them.

Dos recientes pronunciamientos de la Sala 4 ª de lo Social del Tribunal Supremo han puesto fin a la doctrina jurisprudencial por la que, para evitar el "enriquecimiento injusto" del trabajador accidentado, se exoneraba al empresario del deber de reparar los perjuicios causados en un accidente de trabajo o enfermedad profesional, por el incumplimientos de sus obligaciones en materia de seguridad. Este cambio jurisprudencial obliga a abordar la cuantificación económica de los distintos componentes indemnizatorios. En este trabajo ofrecemos un novedoso método para la evaluación económica directa del daño moral basado los años de vida ajustados por calidad perdidos por los trabajadores que sufren un accidente de trabajo. El método propuesto se ofrece como una alternativa ventajosa frente a la utilización del baremo de tráfico.Two recent Social Supreme Court rulings have put an end to the jurisprudential doctrine that prevented the "unfair enrichment" of an injured worker. This doctrine exempted the employer from the obligation of repairing the damage caused by work accidents or occupational diseases, stemming from breaches of the employer’s security obligations. The jurisprudential change requires addressing the economic quantification of the various components of workers’ compensation. Our study offers a novel method for assessing the economic value of moral damage based on Quality Adjusted Life Years lost by workers who suffer a work accident. The proposed method is presented as an alternative that is more appropriate than the use of the traffic scale.

Abstract Objective: to analyze the Brazilian labor reform repercussions and its implications for nursing work. Method: this is an exploratory-descriptive case study. Data were collected on the website of four Regional Labor Courts (in Brazil), taking into account the cases judged in first and second instance, involving nurses and aspects of labor rights that were linked to labor reform. Results: two cases were captured that dealt with: 1) lack of prior inspection for unhealthy work; 2) expansion of nurses’ working hours without overtime pay. These two situations were based on the labor reform, which confirms the process of loss of rights for nurses. Conclusion: implementing the new labor rules brought harm and had negative repercussions for nursing work, as it resulted in professionals’ loss of rights. In this treadmill, it is believed that the dissatisfaction of these workers will increase and may result in professional evasion.

Introduction and Objectives: Medical-legal implications of dizziness and imbalance in work-related patients are important. In these cases, computerized dynamic posturography (CDP) adds information to standard vestibular tests and aphysiologic patterns have been described. The objective is to assess the prevalence of aphysiologic performance on CDP in work-related patients complaining of dizziness/imbalance., Material and Methods: Retrospective review of patients referred by the workers' compensation board for assessment of dizziness, imbalance or both. Standard vestibular assessment including CDP was carried out in all patients. The sensory organization test (SOT) summaries were scored as normal, aphysiologic or vestibular using the scoring method published by Cevette et al. in 1995., Results: Aphysiologic performance in SOT, evaluated with the Cevette formula, was found in 31 out of 100 cases. Low composite score results and aphysiologic SOT results had a statistically-significant association (P=.01). Videonystagmography (VNG) was altered in 14 out of 31 cases with aphysiologic SOT., Conclusion: The 31% prevalence of aphysiologic results on CDP among work-related patients complaining of dizziness/imbalance is relatively high in comparison with the 25% published by Longridge and Mallinson in 2005. However, aphysiologic performance should not necessarily be related to malingering or exaggeration and altered vestibular tests are found in some of these cases., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

The present paper was aimed at promoting countermeasures based on scientific evidence and international cooperation for evaluating the impact on health caused by exposure to asbestos fibres in the workplace and the environment. Scientific evidence regarding asbestos made available by the international scientific community, decades of experience gained in Italy on this issue and being aware that adopting measures to combat the health effects caused by asbestos exposure should be verified considering the specificity of various national and local contexts in Latin-America form the basis for identifying four main areas for intervention which may be developed in the field of technical and scientific cooperation between Italy and Latin-America countries: promoting access to information about asbestos, interventions for reducing exposure to asbestos, health surveillance of exposed subjects and mesothelioma detection. Integrating Colombian and Italian researchers' abilities may lead to such results being achieved, thereby contributing to banning asbestos, which is already underway in Latin-America.

Objective: To assess the potential under-registration of work-related accidents in the Mexican Institute of Social Security., Material and Methods: A countrywide cross-sectional study was carried out with information collected from 27 district offices of the Mexican Institute of Social Security (MISS), on workers seen at MISS emergency rooms during November 2001 because of a probable accident at work. We compared these reports to official records of work-related accidents to estimate the proportion of incomplete reports. Data analysis consisted of descriptive statistics for each variable; the annual estimation of incomplete reporting proportions was made by multiplying by twelve months; 95% confidence intervals were estimated using Poisson's exact method for a proportion., Results: Data from 27 out of 37 MISS district offices revealed that 7211 cases were not recognized as work accidents, accounting for an underestimation of 26.3%, ranging between 0 and 68% among the different district offices. The accidents that were most frequently left unregistered were mild and blunt injuries., Conclusions: Under-registration can affect worker compensation plans and the financial balance of the institution's occupational risk insurance. Research is needed to investigate and eliminate the causes of under-registration. Employers, the industry, and health institutions should be involved in this effort. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Audiometric tests at noisy workplaces serve as a means for the early detection of noise-induced hearing loss. As such a tool for secondary prevention, the conditions under which they are to be made and the factors which may influence their effectiveness: sources of error, hearing loss due to old age, testing intervals, significant hearing loss readings and criteria for referral to ear specialists are analyzed. These aspects are also compared with that which has been set forth is the Decree recently published regarding the medical checkups of workers exposed to noise, in which these criteria are not taken into account. Some norms to complement this Decree, in which, in addition to describing the conditions for carrying out audiometric tests, proposals regarding methods for interpreting the results thereof, measures for following up on said results and proposals for an epidemiological analysis of the data must be made. Advantage must also be taken of this occasion to define new norms for qualification as a professional and the medical-legal compensation for on-the-job noise-induced hearing loss.