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BACKGROUND: In 2018, Barcelona City Council implemented a pilot phase of an organisational change in the municipal home care service (HCS) system. Inspired in the Buurtzorg model, the new model promotes the creation of self-managing teams operating in a restricted community setting. OBJECTIVE: To assess the pilot phase of the new model, focusing on employees' working and employment conditions as well as on their health and well-being outcomes. METHODS: Mixed-methods impact evaluation. First, a quantitative evaluation was conducted between October 2018 and October 2020, using a pre-post study design with one pretest and two posttest measurements in an intervention and a comparison group. The intervention group was composed of the members of the work teams implemented in the pilot phase from October 2018 onwards (baseline n = 44). The comparison group consisted of workers from the same districts working under the usual HCS system (baseline n = 72). Next, a qualitative study was conducted in workers from the intervention group in winter 2021-2022 (n = 10). RESULTS: The pre-post study results yielded positive changes for the intervention group in social support and autonomy, as well as in many of the employment conditions. This group also experienced increases in psychological demands, painful positions, fatigue and psychological distress. Two main themes affecting workers' well-being emerged from the interviews: factors inherent to the self-management model and external factors. CONCLUSIONS: Health and well-being outcomes seem to depend on the balance between job demands, resources, and ways of channelling conflicts within teams.

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Objetivo: conocer las dificultades y necesidades del personal de medicina de los servicios de prevención de riesgos laborales de Cataluña para desarrollar sus funciones sanitarias descritas por la ley. Métodos: estudio Delphi en tres rondas. La selección de participantes se realizó diferenciadamente para servicios de prevención propios y ajenos. La primera ronda incluyó dos preguntas abiertas: ¿Qué dificultades tiene para realizar las funciones sanitarias de su SPRL? y ¿Qué necesidades tiene para realizar las funciones sanitarias de su SPRL? En la segunda y tercera ronda las personas participantes puntuaron las categorías identificadas en la primera ronda según su importancia y relevancia. Se calcularon un índice de acuerdo interjueces (ICC) y un “índice de preocupación (IP)”. Resultados: la gestión de las personas trabajadoras con limitaciones y la vigilancia colectiva de la salud de baja calidad son las dificultades más importantes para los Servicios de Prevención Propios. Para los Ajenos, la falta de comunicación con otros organismos, la preeminencia de los criterios económicos y de rentabilidad asociado al alto volumen de trabajo son las más relevantes. La necesidad de establecer canales de comunicación con otras instituciones u organismos como la Atención Primaria, las Mutuas, el Instituto de Evaluaciones Médicas y las Unidades de Salud Laboral es común a ambos grupos. Conclusiones: la diferente naturaleza de las actividades preventivas que realizan los servicios de prevención determina diferencias importantes en las dificultades expresadas, no así en las necesidades identificadas donde se encuentran puntos en común (AU)

Objective: to identify the difficulties and needs of medical professionals in occupational health services in Catalonia with respect to carrying out their functions, as prescribed by law. Methods: Delphi study in three rounds. The selection of participants was carried out separately for in-house versus outsourced occupational health services. The first round included two open-ended questions: What difficulties do you encounter when performing your duties in your occupational health service? And, what are your needs in terms of being able to perform your duties in your occupational health service? In the second and third rounds, participants ranked the categories identified in the first round according to their importance and relevance. We calculated an inter-rater agreement index (ICC) and an "index of concern (IP)". Results: Among in-house occupational health services, the most highly ranked difficulties were case management of workers with limitations and the low quality of medical surveillance systems. Among outsourced occupational health services, the most notable difficulties were the lack of communication with other organizations and the prioritization of economic and profitability criteria associated with the high work volume. For both types of services, there was a clear need to establish communication channels with other institutions or organizations such as primary care, mutual insurance companies, public medical evaluation units and public occupational health units. Conclusions: The different type of occupational health services reflects important differences in the types of difficulties encountered, but not in needs, where there are more points in common (AU)

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OBJECTIVE: to identify the difficulties and needs of medical professionals in occupational health services in Catalonia with respect to carrying out their functions, as prescribed by law. METHODS: Delphi study in three rounds. The selection of participants was carried out sepa - rately for in-house versus outsourced occupational health services. The first round included two open-ended questions: What difficulties do you encounter when performing your duties in your occupational health service? And, what are your needs in terms of being able to per - form your duties in your occupational health service? In the second and third rounds, partic - ipants ranked the categories identified in the first round according to their importance and relevance. We calculated an inter-rater agreement index (ICC) and an "index of concern (IP)". RESULTS: Among in-house occupational health services, the most highly ranked difficulties were case management of workers with limitations and the low quality of medical sur - veillance systems. Among outsourced occupational health services, the most notable dif - ficulties were the lack of communication with other organizations and the prioritization of economic and profitability criteria associated with the high work volume. For both types of services, there was a clear need to establish communication channels with other institu - tions or organizations such as primary care, mutual insurance companies, public medical evaluation units and public occupational health units. CONCLUSIONS: The different type of occupational health services reflects important differ - ences in the types of difficulties encountered, but not in needs, where there are more points in common.

OBJETIVO: conocer las dificultades y necesidades del personal de medicina de los servicios de prevención de riesgos laborales de Cataluña para desarrollar sus funciones sanitarias descritas por la ley. MÉTODOS: estudio Delphi en tres rondas. La selección de participantes se realizó diferenciadamente para servicios de prevención propios y ajenos. La primera ronda incluyó dos preguntas abiertas: ¿Qué dificultades tiene para realizar las funciones sanitarias de su SPRL? y ¿Qué necesidades tiene para realizar las funciones sanitarias de su SPRL? En la segunda y tercera ronda las personas participantes puntuaron las categorías identificadas en la primera ronda según su importancia y relevancia. Se calcularon un índice de acuerdo interjueces (ICC) y un "índice de preocupación (IP)".  RESULTADOS: la gestión de las personas trabajadoras con limitaciones y la vigilancia colectiva de la salud de baja calidad son las dificultades más importantes para los Servicios de Prevención Propios. Para los Ajenos, la falta de comunicación con otros organismos, la preeminencia de los criterios económicos y de rentabilidad asociado al alto volumen de trabajo son las más relevantes. La necesidad de establecer canales de comunicación con otras instituciones u organismos como la Atención Primaria, las Mutuas, el Instituto de Evaluaciones Médicas y las Unidades de Salud Laboral es común a ambos grupos. CONCLUSIONES: la diferente naturaleza de las actividades preventivas que realizan los servicios de prevención determina diferencias importantes en las dificultades expresadas, no así en las necesidades identificadas donde se encuentran puntos en común.

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The growth of poor jobs related to economic crisis adds to its increase since the mid-1970s as a result of new forms of flexible employment. In Europe, there is no clear evidence on whether working in a poor-quality job is better for mental wellbeing than being unemployed. The objectives of this study were to compare mental wellbeing between the unemployed and those working in jobs with different quality levels and to examine gender and welfare state differences in Europe. We selected 8324 men and 7496 women from the European Social Survey, 2010. Hierarchical multiple logistic regression models were fitted, separated by sex and country group. No significant differences in mental wellbeing were shown between unemployed-non-active, unemployed-active, and those working in low-quality jobs in either sex. Only men from Conservative countries in low-quality jobs had better mental wellbeing than unemployed (non-active) men. Only having a good-quality job reduced the likelihood of poor mental wellbeing compared with being unemployed (non-active) among men in all countries (except Social-Democratic) and among women in Eastern and Southern European countries. No differences were observed among men or women in Social-Democratic countries, while strong gender differences were found in Conservative and Liberal countries. Our study indicates the need to take job quality into account, in addition to creating jobs during economic crises. The main mechanisms to explain the strong gender and welfare state differences identified could be social protection for unemployed, labor market regulations, and family models.

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BACKGROUND: A good part of the transmission of influenza occurs in the household context. The main objective of this study was to evaluate the factors associated with the index cases generating secondary cases in household. METHODS: We designed an observational, retrospective, multicenter through the implementation of a telephone survey in three regions of Spain. The study population were hospitalized and outpatient cases of confirmed H1N1 (2009) reported to the surveillance units from week 44 of 2009. We calculated the secondary attack rate within the household (TAI) and confidence interval of 95%. Factors associated with household transmission were analyzed by logistic regression, calculating odds ratios and confidence intervals at 95%. RESULTS: the secondary attack rate was 11.3% (95% CI 9.9 to 12.7) within the household. The number of household contacts was the main factor associated with the transmission (OR: 5,02 CI95% 1,78-14,13). CONCLUSION: The factor most associated with the generation of secondary cases is the family size, being greater the larger the group of cohabiting, which is consistent with the data provided by WHO.

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Fundamentos: El entorno domiciliario ofrece importantes posibilidades de estudio de la transmisibilidad de la influenza (H1N1) 2009. El objetivo principal del estudio fue valorar los factores asociados a los casos índices que generaron casos secundarios en el ámbito domiciliario. Método: Se diseñó un estudio observacional, retrospectivo, , multicéntrico mediante la aplicación de una encuesta telefónica en tres Comunidades Autónomas de España. La población de estudio fueron los casos hospitalizados y ambulatorios confirmados de gripe H1N1 (2009) declarados a las unidades de vigilancia a partir de la semana 44 de 2009. Se calculó la tasa de ataque secundaria intradomiciliaria (TAI) y su intervalo de confianza del 95% (IC95%). Los factores asociados a la transmisión domiciliaria se analizaron mediante regresión logística, calculándose las odds ratios (OR) y sus intervalos de confianza al 95%. Resultados: la tasa de ataque intradomiciliaria fue de 11,3% (IC95% 9,9 – 12,7). El número de contactos convivientes fue el factor más asociado a la transmisión (OR: 5,02 IC95% 1,78-14,13). Conclusión: El factor más asociado a la generación de casos secundarios es el tamaño del grupo familiar, siendo mayor mientras más grande es el grupo de convivientes, lo que es congruente con los datos aportados por la OMS(AU)

Bakcground: A good part of the transmission of influenza occurs in the household context. The main objective of this study was to evaluate the factors associated with the index cases generating secondary cases in household. Methods: We designed an observational, retrospective, multicenter through the implementation of a telephone survey in three regions of Spain. The study population were hospitalized and outpatient cases of confirmed H1N1 (2009) reported to the surveillance units from week 44 of 2009.We calculated the secondary attack rate within the household (TAI) and confidence interval of 95%. Factors associated with household transmission were analyzed by logistic regression, calculating odds ratios and confidence intervals at 95%. Results: the secundary attack rate was 11.3% (95% CI 9.9 to 12.7) within the household. The number of household contacts was the main factor associated with the transmission (OR: 5,02 CI95% 1,78-14,13). Conclussion: The factor most associated with the generation of secondary cases is the family size, being greater the larger the group of cohabiting, which is consistent with the data provided by WHO(AU)

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En 2008 se produjo una extensa epizootia de fiebre amarilla que afecto a zones de Brasil, Paraguay y algunas provincias del norte de Argentina. En Paraguay se presentaron28casos, de los cuales 9 se produjeron en una zona urbana de la periferia de Asunción. Estos casos constituyeron el primer brote de fiebre amarilla urbana en la región en más de 60 años. Las medidas de control del brote, basadas en el control vectorial y la vacunación a la población susceptible fueron exitosas en limitar las consecuencias del brote y evitar su expansión a otras regiones (AU)

In 2008, an extensive epizootia was produced in Brazil, Paraguay and northern provinces of Argentina. In Paraguay, 28 cases were notified, 9 of these cases were produced in a urban area of Asuncion, being the first outbreak of urban yellow fever in The Americas in more than 60 years. The control outbreak measures, based in vectorial control and vaccination of susceptible people, were effective to reduce the outbreak consequences and to avoid international spread of yellow fever (AU)

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BACKGROUND AND OBJECTIVE: Considering recent outbreaks of rubella in immigrant population in Madrid (Spain), we investigated the proportion of rubella susceptibility in immigrant women in Catalonia, Spain. PATIENTS AND METHOD: Seroprevalence study in pregnant women of the immigrant community. Information of demographic possible risk factors associated to rubella susceptibility was collected. RESULTS: Five hundred and ninety four women were included. The global prevalence of susceptibility was 11.7% (95% confidence interval [CI], 9.2-14.5%). African women showed the highest susceptibility (17%; 95% CI, 10.5-25.2%). Age younger than 25 years was a risk factor statistically associated with rubella susceptibility (adjusted odds ratio=3.02; 95% CI, 1.09-8.35). CONCLUSIONS: Rubella susceptibility in pregnant women from low income countries is 10 times higher than that of Catalonian native women.

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Fundamento y objetivo: tras los recientes brotes de rubéola descritos en población inmigrante de Madrid, se ha querido conocer la proporción de mujeres inmigrantes susceptibles a esta enfermedad en Cataluña. Pacientes y método: se ha llevado a cabo un estudio de seroprevalencia en mujeres gestantes provenientes de países de renta baja. Se recogió información demográfica y sobre posibles factores predictivos de susceptibilidad. Resultados: se incluyó en el estudio a 594 mujeres. La proporción global de susceptibilidad a la rubéola fue del 11,7% (intervalo de confianza [IC] del 95%, 9,2–14,5%). La mayor prevalencia de susceptibles se observó en las mujeres de origen africano (17%; IC del 95%, 10,5–25,2%). La edad inferior a 25 años fue un factor de riesgo asociado a la susceptibilidad a la rubéola (odds ratio ajustada=3,02; IC del 95%, 1,09–8,35). Conclusiones: el porcentaje de susceptibilidad a la rubéola entre las gestantes provenientes de países de renta baja supera en 10 veces la susceptibilidad de las mujeres en edad fértil autóctonas de Cataluña (AU)

Background and objective: Considering recent outbreaks of rubella in immigrant population in Madrid (Spain), we investigated the proportion of rubella susceptibility in immigrant women in Catalonia, Spain. Patients and method: Seroprevalence study in pregnant women of the immigrant community. Information of demographic possible risk factors associated to rubella susceptibility was collected. Results: Five hundred and ninety four women were included. The global prevalence of susceptibility was 11.7% (95% confidence interval [CI], 9.2–14.5%). African women showed the highest susceptibility (17%; 95% CI, 10.5–25.2%). Age younger than 25 years was a risk factor statistically associated with rubella susceptibility (adjusted odds ratio=3.02; 95% CI, 1.09–8.35). Conclusions: Rubella susceptibility in pregnant women from low income countries is 10 times higher than that of Catalonian native women (AU)

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BACKGROUND AND OBJECTIVE: Epidemiologic studies of polymyositis-dermatomyositis incidence in Spain are lacking. The aim of the study was to determine the incidence rates of dermatomyositis-polymyositis and their distribution in our country. MATERIAL AND METHOD: Observational and descriptive study. Data was obtained from hospital discharge code (CMBD) during the period 1997-2004. Sex, region and age were analysed. Raw and standardized incidence rates for each region studied were calculated as new cases/million population/year with 95% confidence interval (CI). Trend odds ratio (OR) was calculated by means of a logistic regression. RESULTS: Global incidence rate in polymyositis-dermatomyositis was 8.9 new cases/million population/year (CI 95%, 8.6-9.2); 3.9 (CI 95%, 3.7-4.1) for polymyositis and 4.9 (CI 95%, 4.7-5.2) for dermatomyositis. Rate differences between both diseases reached statistical significance (p < 0.001). Annual incidence rate decreased significantly across the period studied in both diseases with a trend OR of 0.95 (CI 95%, 0.93-0.97; p < 0.001) in dermatomyositis and 0.96 (CI 95%, 0.93-0.97; p < 0.001) in polymyositis. Both diseases were significantly more frequent in females (p < 0.001). The incidence rates for each region varies between 2.2 and 10.6 cases/million population/year in polymyositis and between 2.9 and 8.6 cases/million population/year in dermatomyositis. CONCLUSIONS: Incidence of dermatomyositis-polymyositis in Spain is similar to other countries. Decreased incidence observed across the period and the higher incidence of dermatomyositis could be explained because of a better diagnosis of these entities.

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Fundamento y objetivo: No existen estudios epidemiológicos sobre la incidencia de miopatía inflamatoria en España. El objetivo de este estudio fue determinar las tasas de incidencia de dermatomiositis y polimiositis y su distribución en el territorio español. Material y método: Estudio descriptivo observacional a partir de los datos del Conjunto Mínimo Básico de Datos de Altas Hospitalarias en el período 1997-2004. Se analizaron las variables sexo, comunidad autónoma y edad. Se calcularon las tasas de incidencia de hospitalización en casos por millón de habitantes y año brutas y estandarizadas y su intervalo de confianza (IC) del 95%, en total y por comunidad autónoma. Para el análisis de tendencia del período estudiado, se calculó la odds ratio (OR) de tendencia mediante regresión logística. Resultados: La tasa de incidencia total del conjunto de dermatomiositis y polimiositis fue de 8,9 (IC del 95%, 8,6-9,2) nuevos casos por millón de habitantes y año; la de polimiositis, 3,9 (IC del 95%, 3,7-4,1), y la dermatomiositis, 4,9 (IC del 95%, 4,7-5,2). La diferencia entre las tasas de ambas enfermedades fue estadísticamente significativa (p < 0,001). La tasa de incidencia anual de ambas enfermedades disminuyó de forma significativa durante el período (dermatomiositis, OR de tendencia = 0,95; IC del 95%, 0,93-0,97; p < 0,001; polimiositis, OR = 0,96; IC del 95%, 0,93-0,97; p < 0,001). La incidencia de ambas enfermedades fue significativamente superior en mujeres. Las tasas de incidencia de polimiositis oscilaban en las diferentes comunidades autónomas entre 2,2 y 10,6 casos por millón de habitantes y año y las de la dermatomiositis, entre 2,9 y 8,6 casos por habitantes y año. Conclusiones: La incidencia de dermatomiositis y polimiositis en España es similar a la observada en otras zonas del mundo. La disminución de la incidencia mantenida a lo largo del período y la incidencia más alta de dermatomiositis podrían explicarse por una mejor categorización de estas enfermedades

Background and objective: Epidemiologic studies of polymyositis-dermatomyositis incidence in Spain are lacking. The aim of the study was to determine the incidence rates of dermatomyositis-polymyositis and their distribution in our country. Material and method: Observational and descriptive study. Data was obtained from hospital discharge code (CMBD) during the period 1997-2004. Sex, region and age were analysed. Raw and standardized incidence rates for each region studied were calculated as new cases/million population/year with 95% confidence interval (CI). Trend odds ratio (OR) was calculated by means of a logistic regression. Results: Global incidence rate in polymyositis-dermatomyositis was 8.9 new cases/million population/year (CI 95%, 8.6-9.2); 3.9 (CI 95%, 3.7-4.1) for polymyositis and 4.9 (CI 95%, 4.7-5.2) for dermatomyositis. Rate differences between both diseases reached statistical significance (p < 0.001). Annual incidence rate decreased significantly across the period studied in both diseases with a trend OR of 0.95 (CI 95%, 0.93-0.97; p < 0.001) in dermatomyositis and 0.96 (CI 95%, 0.93-0.97; p < 0.001) in polymyositis. Both diseases were significantly more frequent in females (p < 0.001). The incidence rates for each region varies between 2.2 and 10.6 cases/million population/year in polymyositis and between 2.9 and 8.6 cases/million population/year in dermatomyositis. Conclusions: Incidence of dermatomyositis-polymyositis in Spain is similar to other countries. Decreased incidence observed across the period and the higher incidence of dermatomyositis could be explained because of a better diagnosis of these entities

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