Search

Objective: Interventions through telerehabilitation have shown positive effects in various clinical conditions, facilitating the return to work of the working population. This study aimed to compare conventional, center-based physiotherapy versus an intervention combining home- and center-based treatment for whiplash syndrome in workers enrolled in a mutual insurance company, evaluating differences in the number of face-to-face sessions and the duration of sickness absence. The secondary aim was to assess the acceptability and usability of the telerehabilitation intervention. Methods: The study population ( n = 387) comprised workers aged 16 to 65 years who required physiotherapy due to whiplash (ICD-9 847.0). The main outcome variable was the number of face-to-face sessions. The duration of sickness absence was also calculated. A survey was also conducted to determine patient acceptance and usability of the platform. The analyses were adjusted for sex, age, occupation, and the center where the physiotherapy treatment was administered. Results: The number of face-to-face physiotherapy sessions dropped significantly, from 9 to 7, due to the implementation of telerehabilitation. This decrease was not associated with a longer duration of sickness absence. The difference in the median duration of sickness absence between patients who had not undergone telerehabilitation and those who had undergone telerehabilitation was -1 [95% CI= (-6 to 2)]. Conclusion: Telerehabilitation reduces the number of face-to-face physiotherapy sessions needed, which can reduce the care burden in physiotherapy centers and avoid the need for patients to travel (with a corresponding reduction in transportation costs), without increasing the duration of sickness absence.

To analyze compliance with dietary recommendations (DR) based on the Mediterranean Diet among natives and immigrants in Spain. A cross-sectional study was carried out using the Platform of Longitudinal Studies of Immigrant Families comparing immigrant workers from Colombia, Ecuador and Morocco with Spanish workers. Adjusted odds ratios (ORa) of sufficient compliance with DR were obtained by sociodemographic variables. We also obtained the adjusted difference in means (DMa) for foods for which there was compliance with DR. Moroccans had greater compliance for meat (ORa = 7.22), eggs (ORa = 5.03) and cured-meats (ORa = 89.78). Ecuadorians for sweets (ORa = 4.03) and Spaniards for natural-juices and dairy-products. Moroccans had the greatest compliance in terms of the number of foods (DMa = 1.53), while Colombians had the least (DMa = - 0.95). Men (DMa = - 0.98), those with primary or incomplete primary education (DMa = - 0.83) and single-parent families (DMa = - 0.58) showed lower compliance. Compliance with DR was low among both Spaniards and immigrants, despite differences in levels of compliance, especially between Moroccans and Colombians., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To characterize the diet and eating habits of adult immigrants of Chinese origin residing in Santa Coloma de Gramenet (Barcelona, Spain), and to identify the factors that influence the changes in diet and eating habits., Method: Qualitative study conducted in 2017 through a discussion group with eight adults of Chinese origin (one man and seven women). The information was complemented by five interviews with key informants (three men and two women) and non-participant observation in health promotion workshops aimed at Chinese patients of a health center in Santa Coloma de Gramenet., Results: Chinese adults made three meals a day and tended to snack between meals. Their diet was based on rice, soy and proteins of vegetable origin. Participants rarely consumed milk and milk derivatives but highlighted their consumption of snacks, sugary drinks and pastries, as well as the incorporation of foods, new dishes and cooking techniques from the host country. The Chinese immigrants tried to maintain their diet of origin, however there were various barriers to this, such as the preference of the local diet by the children, work schedules and lack of time., Conclusions: A tendency towards dietary acculturation is observed among the participants. Health promotion activities aimed at Chinese families are needed to improve aspects of their diet and eating habits, aiming to reduce the consumption of snacks and sugary products., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: We describe time trend incidence (2009-2018) of non-work related Sickness Absence(SA) segmented by duration of episodes in Spain., Methods: We used SA cases from a health insurance company ("mutua") in Spain. Overall non-work related SA incidence and incidence by duration of episodes (1-3 days, 4-15 days, 16-30 days, 31-90 days and> 90 days) were obtained. A time series ecological study was carried out with an inflection point in 2013. The annual percentage of change and 95% confidence interval were obtained. The analyses were stratified by age and sex., Results: Overall incidence went from 35.3 cases per 100 workers-years in 2009 to 25.2 in 2013. From 2014, there is a sustained rise in the incidence of ITCC, ending 2018 with 34.1 cases per 100 workers-years. The overall incidence is determined mainly by processes less than 16 days in young population. The decrease in 2009-2013 occurred in all the duration segments, especially in 4 to 15 (APC=-11,2; 95% CI=(-14,1 a -8,2)) and more than 90 days (APC =-9,4; 95% CI =(-15,5 a -2,8)), mainly in young people. The rise in 2013-2018 was observed in all the segments, with the largest significant increase in sections of 1-3 days(younger workers: APC =18,9; 95% CI =(14,8 a 23,2)) and in more than 90 days (mainly in older ones). Time trend of SA showed similar pattern in both sexes., Conclusions: Time trend analysis of SA incidence by duration segments offers a detailed information of SA. These results are useful for professionals in the prevention and management of SA.

Quality of life and its relationship to oral health is an important consideration in the determinants of health of vulnerable groups. The aim of this study is to assess oral health-related quality of life (OHRQoL) and its related factors in native and immigrant population families from the Platform of Longitudinal Studies on Immigrant Families (PELFI) study in Spain. A cross-sectional study was conducted in a sample of 401 adults aged 18 years and older from Spain, Ecuador, Colombia, and Morocco. The OHIP-14 instrument was applied, and three summary variables were used (prevalence, extent, and severity). Sociodemographic and self-perceived health variables were included. Bivariate analyzes were carried out to summarize the variables of the OHIP-14 according to sociodemographic and health variables, and bivariate analyzes of the OHIP-14 dimensions was conducted by country of origin. Multivariate linear models were used to investigate predictors for the dimensions of the OHIP-14. Multivariate logistic models were used to estimate the association of OHRQoL with immigration status using crude and adjusted odds ratios with 95% confidence intervals (OR-95% CI). It was found that 14.8% of men and 23.8% of women reported negative impacts in terms of OHRQoL (statistically significant differences: p < 0.05). There were statistically significant differences according to the country of origin in the prevalence and severity outcomes of the OHIP-14 in women ( p < 0.05), and severe outcomes were observed in Moroccan women. In women, statistically significant differences ( p < 0.05) in OHRQoL were observed according to age and marital status. There were some differences between OHIP-14 summary outcomes according to the health variables. Some sociodemographic and health variables were predictors for the OHIP-14 and their dimensions with differences by sex. Multivariate analysis showed a statistically significant association between OHRQoL and immigration status for Moroccan women. Differences in OHRQoL were found according to sociodemographic and health variables. Further research could clarify the predictors of OHRQoL through epidemiological surveillance and longitudinal studies.

Diet is a principal determinant of health and is interrelated with socioeconomic factors and the acculturation of immigrants. The aim of this study was to examine the existing evidence on food, nutrition, and diet amongst immigrant populations in Spain, its relationships with their countries of origin, and to evaluate the methodological quality of these studies. A systematic review was carried out that included seventeen cross-sectional studies, 71% of them were of average quality and only one was excellent; seven dealt with adolescents and ten dealt with adults, with a total of 9,871 participants. Insights on immigrant diet and nutrition were heterogeneous because the participant groups in these studies were from several different countries, each of which has distinct cultural and geographical characteristics. Adolescent diet was of lower quality, positively correlated to socioeconomic level; acculturation and length of residence were related to both positive (such as healthier dietary patterns, better adhesion to intake recommendations) and negative aspects (higher intake of meat or bakery products, lower intake of vegetables or fish, among others). Adults show a better intake of macronutrients, but a lower intake of micronutrients and non-observance of some intake recommendations; acculturation and length of residence were related to healthier dietary patterns, significantly related to type of employment. Immigrants from Mediterranean countries show a healthier diet than other immigrants, although the quality of their diet is worse than that of their peers in their countries of origin. Finally, the quality of the diet of non-Mediterranean immigrants improves when they become resident in Spain.

The objective of this article is to analyze the influence of employment conditions on adherence to dietary recommendations among those born in Spain and immigrants by their time of residence. Data were used from the Platform of Longitudinal Studies of Immigrant Families (PELFI) cohort ( n = 215) to compare Spaniards and immigrants with <14 and >14 years of residence. The questionnaire on frequency of food consumption (15 items) was used to measure adherence to dietary recommendations. Logistic regression models were used, adjusting for sociodemographic characteristics and employment conditions. Adherence to dietary recommendations was greater among Spaniards, followed by immigrants with >14 years of residence and <14 years of residence. The greatest adherence among Spaniards was for eggs (immigrants ≥ 14 years: 1/ORa = 2.89, <14 years: 1/ORa = 3.92), fish (immigrants ≥ 14 immigrants: 1/ORa = 2.33, <14 years: 1/ORa = 4.72), vegetables (immigrants ≥ 14 years: 1/ORa = 3.26, <14 years: 1/ORa = 4.87), dairy products (immigrants ≥ 14 years: 1/ORa = 14.34, <14 years: 1/ORa = 26.78), and sugary drinks (immigrants ≥14 years: 1/ORa = 2.12, <14 years: 1/ORa = 3.48), and the lowest adherence was for the consumption of sausages and cold cuts (immigrants ≥ 14 years: Ora = 7.62, <14 years: ORa = 24.65). Adjusting for sociodemographic and employment conditions variables did not result in variation in the observed differences between Spaniards, immigrants with <14 years of residence, and immigrants with >14 years of residence.

Background: We describe the usefulness of performing an analysis of sickness absence (SA) incidence, segmented by the duration of episodes, in comparison with the more common analysis that considers the overall incidence of SA without segmentation., Methods: We used data from a health insurance company ("mutua") in Spain during 2011 (230,332 episodes, 752,906 workers) and non-work related SA as a case study. We compared the overall incidence of SA and incidence segmented by duration of episodes: short (≤ 15 days), medium (16-30 and 31-90 days) and long (> 90 days). The analyses were also performed by age, as an example of one of the multiple variables that affect SA incidence., Results: The overall incidence of SA was 30.6%, and declined steadily with increasing age. When SA incidence was analyzed by duration, we observed that: 1) the incidence of the episodes of short duration is the highest; 2) the overall excess observed in younger workers (<25 years) is driven mainly by short duration and 3) the pattern for long-term SA incidence was reversed, being more frequent among those ≥55 years of age relative to the youngest., Conclusions: Examining SA incidence by duration is more informative than relying on overall incidence of SA., (Copyright belongs to the Associació Catalana de Salut Laboral.)

Introduction: Different countries have shown an inverse relationship between unemployment rates (UR) and indicators of sickness absence during periods of economic recession., Objective: To evaluate the relationship between indicators of sickness absence and unemployment in Spain during 2009-2015., Methods: We obtained incidence and absenteeism rates of non-work related sickness absence (NWSA) from Social Security data, and UR from the National Institute of Statistics. The relationship between indicators of NWSA and UR in the period 2009 to 2015 was graphically described using time trend plots. Scatter plots of NWSA indicators were also made against UR. Finally, we fitted linear regression models., Results: Incidence (IR) and absenteeism rates (AR) of NWSA showed downward trends in 2009-2013 (IR 2009=28.07%, IR 2013=20.41%; AR 2009=2.53% and AR 2013=1.86%), changing to an upward trend up to 2015 (IR 2015=22.52%, AR 2015=2.12%). Unemployment rates trended upward in 2009-2013 (UR 2009=17.86%, UR 2013=26.10%), and then changed to a downward trend through 2015 (UR 2015=22.06%). There was an inverse relationship between UR and NWSA indicators., Conclusions: As in previous international studies, we found an inverse relationship between unemployment rates and indicators of sickness absence in Spain. More detailed studies are needed to evaluate explanatory hypotheses, such as those associated with the effects of discipline, selection and/or changes in the workforce., (Copyright belongs to the Societat Catalana de Salut Laboral.)

This study is a part of the multi-centre project "Platform of Longitudinal Studies of Immigrant Families (PELFI)" of the Immigration and Health Subprogram of the CIBER-ESP. It describes the field work and data collection of two sub-cohorts of immigrant and native families, and their main socio-demographic characteristics. Prospective observational cohort study in carried out in Barcelona and Alicante, Spain. The study population is a a non-probabilistic sample of 180 families of Colombian, Ecuadorian and Moroccan origin and 50 families of Spanish origin. We interviewed adults aged 18-65 years and adolescents aged 12-17 years in each family, through two questionnaires (adolescent/adult). The cooperation rate was 82.0% with an average recruitment rate of 1.3 families per day. In total, 250 families have been recruited, 82 from Ecuador, 82 from Colombia, 29 from Morocco and 57 from Spain. A total of 473 adults (59.8% women and 68.5% employed) were surveyed. Immigrant adults have an average of 13 years living in Spain. A total of 304 adolescents (53.9% female, 27.1% born in Spain but with immigrant parents) were surveyed. The combination of non-probabilistic techniques promoted access and improved recruitment speed. This study provides key information for the design and improvement of cohort studies with immigrant families.

Chronic Kidney Disease (CKD) anemia is one of the main common comorbidities in patients undergoing End Stage Renal Disease (ESRD). Iron supplement and especially Erythropoiesis Stimulating Agents (ESA) have become the treatment of choice for that anemia. However, it is very complicated to find an adequate treatment for every patient in each particular situation since dosage guidelines are based on average behaviors, and thus, they do not take into account the particular response to those drugs by different patients, although that response may vary enormously from one patient to another and even for the same patient in different stages of the anemia. This work proposes an advance with respect to previous works that have faced this problem using different methodologies (Machine Learning (ML), among others), since the diversity of the CKD population has been explicitly taken into account in order to produce a general and reliable model for the prediction of ESA/Iron therapy response. Furthermore, the ML model makes use of both human physiology and drug pharmacology to produce a model that outperforms previous approaches, yielding Mean Absolute Errors (MAE) of the Hemoglobin (Hb) prediction around or lower than 0.6 g/dl in the three countries analyzed in the study, namely, Spain, Italy and Portugal., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Patients who suffer from chronic renal failure (CRF) tend to suffer from an associated anemia as well. Therefore, it is essential to know the hemoglobin (Hb) levels in these patients. The aim of this paper is to predict the hemoglobin (Hb) value using a database of European hemodialysis patients provided by Fresenius Medical Care (FMC) for improving the treatment of this kind of patients. For the prediction of Hb, both analytical measurements and medication dosage of patients suffering from chronic renal failure (CRF) are used. Two kinds of models were trained, global and local models. In the case of local models, clustering techniques based on hierarchical approaches and the adaptive resonance theory (ART) were used as a first step, and then, a different predictor was used for each obtained cluster. Different global models have been applied to the dataset such as Linear Models, Artificial Neural Networks (ANNs), Support Vector Machines (SVM) and Regression Trees among others. Also a relevance analysis has been carried out for each predictor model, thus finding those features that are most relevant for the given prediction., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Anemia is a frequent comorbidity in hemodialysis patients that can be successfully treated by administering erythropoiesis-stimulating agents (ESAs). ESAs dosing is currently based on clinical protocols that often do not account for the high inter- and intra-individual variability in the patient's response. As a result, the hemoglobin level of some patients oscillates around the target range, which is associated with multiple risks and side-effects. This work proposes a methodology based on reinforcement learning (RL) to optimize ESA therapy., Methods: RL is a data-driven approach for solving sequential decision-making problems that are formulated as Markov decision processes (MDPs). Computing optimal drug administration strategies for chronic diseases is a sequential decision-making problem in which the goal is to find the best sequence of drug doses. MDPs are particularly suitable for modeling these problems due to their ability to capture the uncertainty associated with the outcome of the treatment and the stochastic nature of the underlying process. The RL algorithm employed in the proposed methodology is fitted Q iteration, which stands out for its ability to make an efficient use of data., Results: The experiments reported here are based on a computational model that describes the effect of ESAs on the hemoglobin level. The performance of the proposed method is evaluated and compared with the well-known Q-learning algorithm and with a standard protocol. Simulation results show that the performance of Q-learning is substantially lower than FQI and the protocol. When comparing FQI and the protocol, FQI achieves an increment of 27.6% in the proportion of patients that are within the targeted range of hemoglobin during the period of treatment. In addition, the quantity of drug needed is reduced by 5.13%, which indicates a more efficient use of ESAs., Conclusion: Although prospective validation is required, promising results demonstrate the potential of RL to become an alternative to current protocols., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Ergonomic hazards exposure is the main cause of occupational pain. The aim of this paper is to describe the prevalence of exposure to occupational physical load by occupation, in Spanish working population, and its relationship to employment conditions and sociodemographic characteristics of workers., Methods: We used the information contained in the Spanish Job-Exposure Matrix (MatEmESp), with data between 1997 and 2005. We describe the prevalence of exposure to ergonomic hazards, we identify the occupations with the highest prevalence of exposure and we analyze its relationship to employment conditions and sociodemographic characteristics by occupation, using Spearman correlation coefficients and Scatter plots., Results: Repetitive movements are ergonomic hazard most frequently reported (prevalence around 60%). The greater prevalence of exposure to awkward postures are given in "Bricklayers" (96%), to handling loads in "construction labourers" (89%), to repetitive movements in "graphic arts workers" (95%) and sedentary work in "administrative assistants" (98%). We found a strong relationship (p<0,001) between the prevalence of exposure to the four hazards considered, and the proportion of people with primary education by occupation (correlation coefficients -0,62 in sedentary work and between 0,59 and 0,66 in the other). Occupations with a high proportion of women and with a university studies levels ("nurses"), also has frequent exposure to handling loads (>50%)., Conclusions: In general, the prevalence of exposure to ergonomic hazards remains high in the period analyzed. Less qualified occupations usually have a higher prevalence of exposure.

Detection of ventricular fibrillation (VF) at an early stage is being deeply studied in order to lower the risk of sudden death and allows the specialist to have greater reaction time to give the patient a good recovering therapy. Some works are focusing on detecting VF based on numerical analysis of time-frequency distributions, but in general the methods used do not provide insight into the problem. However, this study proposes a new methodology in order to obtain information about this problem. This work uses a supervised self-organising map (SOM) to obtain visually information among four important groups of patients: VF (ventricular fibrillation), VT (ventricular tachycardia), HP (healthy patients) and AHR (other anomalous heart rates and noise). A total number of 27 variables were obtained from continuous surface ECG recordings in standard databases (MIT and AHA), providing information in the time, frequency, and time-frequency domains. self-organising maps (SOMs), trained with 11 of the 27 variables, were used to extract knowledge about the variable values for each group of patients. Results show that the SOM technique allows to determine the profile of each group of patients, assisting in gaining a deeper understanding of this clinical problem. Additionally, information about the most relevant variables is given by the SOM analysis., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

This paper tackles the design of a graphical user interface (GUI) based on Matlab (MathWorks Inc., MA), a worldwide standard in the processing of biosignals, which allows the acquisition of muscular force signals and images from a ultrasound scanner simultaneously. Thus, it is possible to unify two key magnitudes for analyzing the evolution of muscular injuries: the force exerted by the muscle and section/length of the muscle when such force is exerted. This paper describes the modules developed to finally show its applicability with a case study to analyze the functioning capacity of the shoulder rotator cuff., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background and Objective: The progressive increase in cases of multiple chemical sensitivity (MCS) syndrome and the lack of studies which associate the syndrome with possible occupational origins means that further research in this field is required. The objective of this study was to compare the epidemiological, clinical and prognostic aspects of cases of MCS of occupational and non-occupational origin., Patients and Method: Observational study of patients diagnosed with MCS by the toxicology outpatients clinic of the Hospital Clinic of Barcelona between 2002 and 2007. The occupational and non-occupational origin of MCS was considered as an independent variable. The dependant variables were occupational activity, triggering agents of MCS, chemical agents associated with the development of clinical manifestations, severity of the symptoms, comorbidities and work disability. Percentages were compared between groups., Results: A total of 165 patients were included: The mean age was 47.7 years and 90.9% were women. There were significant differences between patients of occupational and non-occupational origin with respect to comorbidities such as chronic fatigue syndrome (68.1% versus 88.5%; p=0.002) and fibromyalgia (49.3% versus 73.9%; p=0.002), temporary disability (60.9% versus 39.6%; p=0.006) and permanent disability (8.7% versus 22.9%; p=0.006)., Conclusions: Cases of MCS attributed to an occupational origin had fewer comorbidities and less permanent disability than those of non-occupational origin., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Background: This study analyze the duration of episodes of work absence due to non work-related diseases in Catalonia by health regions, assuming a homogeneous distribution of durations between health regions., Methods: A retrospective cohort study of 811.790 episodes in 2005 and followed to episode closure through July 2007 provided by the Institut Català d'Avaluacions Mèdiques, describing their median duration (MD) in days for each of the seven health regions of Catalonia. The probability of returning to work was plotted according to Wang&#95;Chang survival curves and median durations were then compared using the Barcelona health region as the referent group. Results were extended through stratification by sex., Results: The Camp de Tarragona health region had the shortest MD (5 days), while the episodes in the Alt Pirineu i Aran region had the longest (MD, 13 days). The Barcelona health region had a MD of 7 days as was the case for Cataluña Central. MD in Girona was 8 days, and in Lleida and Terres de l'Ebre it was 9 days. This latter region also had the highest median duration 13 days., Conclusions: The are significant differences in the duration of work absence between the health regions of Catalonia. These differences persisted after adjusting for age, management of episodes and social security system status, in both men and women.