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Diabetes mellitus presents high prevalence, severe complications, clinical repercussions, costs and occupational implications. Their assessment requires the use of the medical history and support questionnaires. A literature review was conducted on the topic of clinical and occupational evaluation aspects of diabetes; the database searched was Medline. The search showed numerous papers about diabetes clinical and therapeutic aspects as well as social or public health aspects but the results lacked occupational aspects. To assess the disease, the use of questionnaires is generalized and each author selects those which fit best to their purpose. It is concluded that to carry out a clinical and occupational evaluation related to diabetes, an inter-specialities cooperation, based on a complete medical history including occupational risk factors, is recommended. The questionnaires are useful, adapted to the objective, recommending those valued in Spanish as in Fear of hypoglycemia questionnaire (EsHFS) and Diabetes-related quality of life questionnaire (EsDQOL).

Resumen La diabetes mellitus presenta elevada prevalencia, complicaciones severas, repercusion clinica, costes e implicaciones laborales. Su valoracion requiere el uso de la historia clinica y cuestionarios de apoyo. Se revisa en Medline la bibliografia sobre diabetes y la experiencia de los autores en valoracion clinico-laboral, con resultados que muestran cuantiosas publicaciones en aspectos clinicos y terapeuticos relacionados con diabetes o con aspectos sociales y de salud publica, pero reducida en aspectos laborales. El uso de cuestionarios para valoracion de la enfermedad es generalizado y cada autor debe seleccionar el que mejor se adapte a sus objetivos o experiencia. Se concluye que, para la valoracion clinica y laboral en diabetes se recomienda la colaboracion interespecialidades, partiendo de una historia clinica completa que incluya los riesgos del trabajo. Son de ayuda los cuestionarios, adaptados a objetivo, recomendandose los validados en espanol como Encuesta sobre el miedo a la hipoglucemia (EsHFS) y Calidad de vida relacionada con la diabetes (EsDQOL).

Resumen Introducción: Las enfermedades reumáticas son patologías de alta prevalencia, impacto y repercusión, caracterizadas por dolor y limitación funcional. Para valorar la limitación, la historia clínica es el punto de partida, junto con las pruebas específicas necesarias, según el tipo de padecimiento. De forma complementaria, se recomienda el uso de herramientas clinimétricas. Objetivo: Comparar algunas herramientas o cuestionarios usados en las enfermedades reumáticas más prevalentes, revisando la bibliografía para destacar sus aportes y su utilidad en la labor del médico con finalidad clínica o pericial. Método: Se revisan las características básicas de los cuestionarios y herramientas más usadas en: osteoartritis, artritis reumatoide y artritis psoriásica, espondilitis anquilosante y lupus eritematoso sistémico. Se revisa en Medline la experiencia de los autores con algunos cuestionarios en función de la patología y de sus diversos usos. Resultados: Los cuestionarios se utilizan en su mayoría para la valoración de la calidad de vida, la discapacidad y la evolución clínico-terapéutica de los pacientes. No hay acuerdo entre los autores sobre si existe prioridad en el uso de algún cuestionario concreto por patología y se tiende a combinar varios. Los cuestionarios genéricos más utilizados son SF-36, NHP y EQ-5D. Por enfermedades: en artritis reumatoide, HAQy DAS28; en osteoartritis, WOMAC y Knoos; en Lupus, SLEDAI y BICLA, y en espondilitis, BASDAI y ASDAS. Conclusiones: En reumatología los cuestionarios son de uso habitual y resultan de utilidad de forma complementaria a la historia clínica y a las pruebas específicas. La elección por el profesional médico se basa en su experiencia y en la adecuación al objetivo buscado. Abstract Introduction: Rheumatic diseases are high prevalence, high impact and repercussion pathologies characterised by pain and functional limitation. To assess the limitation, the starting point is the clinical history, together with the specific tests required according to the type of condition. The use of complimentary clinometric tools is recommended. Objective: To compare some tools or questionnaires used in the most prevalent rheumatic diseases, and a review of the literature to highlight their contributions and usefulness in medical practice by the clinician or expert. Method: A review is made of the basic characteristics of the questionnaires and the most used tools in osteoarthritis, rheumatoid arthritis and psoriatic arthritis, ankylosing spondylitis and systemic lupus erythematosus. The experience of the authors is reviewed in Medline, with some questionnaires depending on the pathology and its various uses. Results: The questionnaires are used mainly to assess the quality of life, disability, and clinical-therapeutic evolution of patients. There is no agreement among the authors on whether there is a priority in the use of a specific questionnaire by pathology, and there is a tendency to combine several. The most commonly used generic questionnaires are SF-36, NHP and EQ-5D. For diseases: in rheumatoid arthritis, the HAQ and DAS28; in osteoarthritis, WOMAC and Knoos; in lupus, SLEDAI and BICLA; and in spondylitis, BASDAI and ASDAS. Conclusions: In rheumatology, questionnaires are commonly used, and are useful as a complement to the clinical history and specific tests. The choice by the medical professional is based on their experience and on the adaptation to the objective sought.

Introduction Rheumatic diseases are high prevalence, high impact and repercussion pathologies characterized by pain and functional limitation. To assess the limitation, the starting point is the clinical history, together with the specific tests required according to the type of condition. The use of complementary clinimetric tools is recommended. Objective To compare some tools or questionnaires used in the most prevalent rheumatic diseases, and a review of the literature to highlight their contributions and usefulness in medical practice by the clinician or expert. Method A review is made of the basic characteristics of the questionnaires and the most used tools in osteoarthritis, rheumatoid arthritis and psoriatic arthritis, ankylosing spondylitis and systemic lupus erythematosus. The experience of the authors is reviewed in Medline, with some questionnaires depending on the pathology and their various uses. Results The questionnaires are used mainly to assess the quality of life, disability, and clinical-therapeutic evolution of patients. There is no agreement among the authors on whether there is a priority in the use of a specific questionnaire by pathology, and there is a tendency to combine several. The most commonly used generic questionnaires are SF-36, NHP and EQ-5D. For diseases: in rheumatoid arthritis, the HAQ and DAS28; in osteoarthritis, WOMAC and Knoos; in lupus, SLEDAI and BICLA; and in spondylitis, BASDAI and ASDAS. Conclusions In rheumatology, questionnaires are commonly used, and are useful as a complement to the clinical history and specific tests. The choice by the medical professional is based on their experience and on the adaptation to the objective sought.

Resumen Introduccion El sindrome fibromialgico se caracteriza por dolor cronico asociado a sintomatologia somatica no especifica y con las limitaciones asociadas a su impacto personal, social, laboral y economico. Su valoracion se realiza de forma independiente, analizando sus aspectos clinicos, de severidad, los tratamientos y su efectividad, la repercusion en las actividades de la vida diaria y la repercusion o afectacion laboral. La herramienta FM-Check es una escala subjetiva que puede ser de ayuda para valorar de forma conjunta todos estos aspectos y servir de apoyo al profesional en el seguimiento del paciente y facilitar la colaboracion conjunta interprofesional. Metodo Para elaborar la FM-Check se parte de la historia clinica en la que se definen las variables que se van a utilizar agrupandolas en 4 bloques a los que se asignan porcentajes de limitacion para cada variable y cada bloque, para llegar a un porcentaje global de limitacion en los roles de las personas. Resultados La distribucion de porcentajes por cada bloque es en maximos: 10% para aspectos personales, 55% para clinico-terapeuticos, 24% para laborales y 10% para repercusion en la vida diaria. En funcion del porcentaje global obtenido tras la valoracion del paciente se asignan grados de limitacion: grado 1 hasta un porcentaje global 70%. Conclusion FM-Check pretende facilitar la labor medica en la evolucion del paciente y la toma de decisiones clinico-terapeuticas tras una valoracion global de la limitacion del paciente con fibromialgia, siguiendo una metodologia unificada que permita comparar resultados evolutivos individuales y la realizacion de estudios epidemiologicos colectivos.

Introduction Fibromyalgia syndrome is characterized by chronic pain associated with non-specific somatic symptoms, and has a personal, social, occupational, and economic impact. The assessment is performed independently, by analyzing the clinical aspects, severity, therapies, and their effectiveness, as well as the impact on daily life activities and its effect on employment. The FM-Check tool is a subjective scale that can be helpful in jointly assessing all these aspects, and provide professional support in monitoring the patient, as well as contribute to a multidisciplinary approach. Method To develop FM-Check is developed by starting with the clinical history in which the variables that are going to be used are defined, and grouped into 4 blocks to which a percentage limitation rate is assigned for each variable and each block. An overall percentage limitation is then calculated for the activities in each person. Results The distribution of assigned percentages was: a maximum of 10% for personal appearance, 55% for clinical-therapeutic aspects, 24% for work aspects, and 10% for impact on everyday life. The limitation levels were classified according to the overall percentage obtained after assessing the patient; grade 1: an overall percentage 70%. Conclusion FM-Check aims to make it easier for the clinician to monitor the patient and making medical-therapeutic decisions after an overall assessment of the limitation of the fibromyalgia patient. This achieved by following a unified methodology that can compare individual developmental outcomes, as well as for conducting joint epidemiological studies.

Diabetes mellitus presents high prevalence, severe complications, clinical repercussions, costs and occupational implications. Their assessment requires the use of the medical history and support questionnaires. A literature review was conducted on the topic of clinical and occupational evaluation aspects of diabetes; the database searched was Medline. The search showed numerous papers about diabetes clinical and therapeutic aspects as well as social or public health aspects but the results lacked occupational aspects. To assess the disease, the use of questionnaires is generalized and each author selects those which fit best to their purpose. It is concluded that to carry out a clinical and occupational evaluation related to diabetes, an inter-specialities cooperation, based on a complete medical history including occupational risk factors, is recommended. The questionnaires are useful, adapted to the objective, recommending those valued in Spanish as in Fear of hypoglycemia questionnaire (EsHFS) and Diabetes-related quality of life questionnaire (EsDQOL).

Introduction Hearing loss due to noise is considered within the prevention plans of the most common occupational diseases. In addition to evaluation of working conditions, other personal factors increasing the risk of hypoacusis, such as diabetes, should be taken into account. Objectives To explore hearing loss in the workplace and its relationship to impaired fasting baseline blood glucose levels. Methods An observational, cross-sectional study enrolling 1636 workers from service companies was conducted. Full audiometric evaluation was performed at different frequencies: high frequency (HF), early loss index (ELI), speech average loss (SAL), and monaural and binaural loss. Results were categorized by baseline blood glucose levels: G1 ( 125 mg/dl). Results Based on both HF and ELI, 11% of workers had clear indication of deafness. Women with G3 levels showed significant differences in the results of HF and ELI indexes as compared to the G1 group ( p = .038 and .046, respectively). A positive association was found between hearing loss and G3 blood glucose levels in HF (OR: .338; p = .002), ELI (OR: .407; p = .007), and the monaural test in the left ear (OR: 4.77 × 10 −5 ; p = .006). Conclusions Despite the methodological limitations of this study, there is evidence for an increased risk of high frequency hearing loss in workers with high baseline blood glucose levels.

Resumen Introduccion La hipoacusia ocupacional por ruido se considera dentro de los planes de prevencion de enfermedades profesionales mas comunes. Ademas del examen de las condiciones laborales se deben tener en cuenta otros factores personales que aumentan el riesgo de hipoacusia, como la diabetes. Objetivos Explorar la perdida de audicion en el ambito laboral y su relacion con las alteraciones de las cifras de glucemia basal en ayunas. Metodos Se realizo un estudio observacional y transversal en el que se incluyeron 1.636 trabajadores de empresas del sector servicios. Se hicieron audiometrias tonales completas midiendo: alta frecuencia (AF), indice de perdida precoz (ELI), indice promedio conversacional (SAL) y perdida perdida monoaural y binaural. Los resultados se categorizaron segun las cifras de glucemia basal: G1 ( 125 mg/dl). Resultados Segun la AF y el ELI el 11% de los trabajadores en cada caso presentaron claro indicio de sordera. Las mujeres con niveles G3 obtuvieron diferencias significativas en los resultados del indice AF y ELI respecto al grupo G1 (p = 0,038 y 0,046, respectivamente). Se encontro una asociacion positiva de hipoacusia y niveles de glucemia G3 en las pruebas de AF (OR: 0,338; p = 0,002), ELI (OR: 0,407; p = 0,007) y monoaural del oido izquierdo (OR: 4,77 × 10-5; p = 0,006). Conclusiones Pese a las limitaciones metodologicas de este estudio, existen indicios para pensar que los trabajadores con niveles elevados de glucemia basal podrian presentar un mayor riesgo de padecer hipoacusia de altas frecuencias.

Introduction and objectives To ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes. Material and method For this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated. Results In 2011, diabetes and its complications were related to 2567 TD processes, which resulted in the loss of 154,214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297,095.3 €, with an estimated cost per patient and year of 141 €. Conclusions These data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions.

Resumen Introduccion y Objetivos Para conocer el impacto socioeconomico de la diabetes es indispensable realizar el calculo de los costes globales, de modo que se incluyan los gastos directos, pero tambien los indirectos (jubilaciones prematuras por enfermedad, perdida de horas de trabajo o bajas laborales). El presente trabajo estudio los costes indirectos por incapacidad temporal (IT) derivados de la diabetes y sus complicaciones en Espana en el ano 2011 mediante la evaluacion de los codigos CIE-9 MC relacionados con esta patologia. Material y metodo Para ello, se registraron el numero de procesos de IT y su duracion media. Ademas, se estimo el coste asociado a la perdida de dias laborales. Resultados La diabetes y sus complicaciones se relacionaron con 2.567 procesos de IT en 2011 que dieron lugar a una perdida de 154.214 dias. Traducido en costes, esta enfermedad supuso para las administraciones publicas de salud en Espana un gasto de 3.297.095,3 €, siendo el coste por IT estimado por paciente y ano de 141€. Conclusiones Estos datos hacen pensar en la necesidad urgente de planes de prevencion y diagnostico temprano de la diabetes y sus complicaciones, asi como programas de optimizacion de los recursos sanitarios existentes, mediante la formacion de equipos multidisciplinares en los que los servicios de medicina del trabajo cobran un papel importante. La disminucion del absentismo laboral redundaria en un beneficio para los pacientes diabeticos, la sociedad en general y las empresas e instituciones publicas.

Resumen Objetivo Valorar la legislacion espanola vigente y los criterios aplicables en discapacidad referentes a los procesos neoplasicos en general y al cancer de mama en particular, y revisar la conflictividad juridica que las reclamaciones por discapacidad, incapacidad o minusvalia generan en el cancer de mama. Metodos Se realizo una revision de la normativa espanola en discapacidad para el cancer en general y, de forma concreta, para el cancer de mama, y junto con ello se llevo a cabo una busqueda jurisprudencial mediante la base de datos juridica (Westlaw Insignis) en relacion con la conflictividad que generan estas materias, las areas de derecho involucradas y su evolucion por anos (1999-2012). Resultados La valoracion de la discapacidad asociada a cancer de mama ha de ajustarse de forma estricta a criterios legales y depende del estadio en que se encuentre, la respuesta a las terapias, las secuelas residuales y la adaptacion de la paciente a las limitaciones. En la jurisprudencia espanola, la conflictividad por estas materias es escasa, centrada en el ambito de lo social y con un incremento lento y paulatino en los ultimos anos. Conclusiones Es necesario que todos los sanitarios implicados en el tratamiento y seguimiento de los enfermos con cancer de mama posean un conocimiento basico de la normativa vigente y criterios de baremacion de la discapacidad por esta enfermedad, y se requiere de un trabajo coordinado entre todos los profesionales afectados por este tema para optimizar los medios y resultados finales.

Hearing loss due to noise is considered within the prevention plans of the most common occupational diseases. In addition to evaluation of working conditions, other personal factors increasing the risk of hypoacusis, such as diabetes, should be taken into account.To explore hearing loss in the workplace and its relationship to impaired fasting baseline blood glucose levels.An observational, cross-sectional study enrolling 1636 workers from service companies was conducted. Full audiometric evaluation was performed at different frequencies: high frequency (HF), early loss index (ELI), speech average loss (SAL), and monaural and binaural loss. Results were categorized by baseline blood glucose levels: G1 (100mg/dl), G2 (100-125mg/dl), and G3 (125mg/dl).Based on both HF and ELI, 11% of workers had clear indication of deafness. Women with G3 levels showed significant differences in the results of HF and ELI indexes as compared to the G1 group (P=.038 and .046, respectively). A positive association was found between hearing loss and G3 blood glucose levels in HF (OR: .338; p=.002), ELI (OR: .407; p=.007), and the monaural test in the left ear (OR: 4.77×10-5; p=.006).Despite the methodological limitations of this study, there is evidence for an increased risk of high frequency hearing loss in workers with high baseline blood glucose levels.

To ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes.For this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated.In 2011, diabetes and its complications were related to 2.567 TD processes, which resulted in the loss of 154.214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297.095.3 €, with an estimated cost per patient and year of 141 €.These data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions.