espanolIntroduccion: Se describe la utilidad de realizar un analisis de la incidencia de incapacidad temporal (IT) segmentado segun la duracion de los episodios, en comparacion con el analisis que considera la incidencia global de la IT. Metodos: Se considera un ejemplo utilizando datos de una mutua en Espana durante 2011 (230.332 episodios, 752.906 trabajadores) y la incapacidad temporal por contingencia comun (ITcc). Comparamos la incidencia de ITcc global y la segmentada por la duracion de los episodios: corta (≤ 15 dias), media (16-30 y 31-90) y larga (> 90 dias). Los analisis se realizaron tambien segun edad, como ejemplo de una de las multiples variables que afectan a la incidencia de la IT. Resultados: La incidencia global de ITcc fue del 30,6%, mostrando una disminucion con la edad (36,4% en Conclusiones: El analisis de la incidencia de IT segmentada por duracion ofrece una aproximacion mas precisa que la obtenida del analisis global. EnglishBackground: 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 ( Conclusions: Examining SA incidence by duration is more informative than relying on overall incidence of SA.

Background Sickness absence (SA) remains a significant problem globally, notably in developed countries. Early intervention to enhance return to work has been identified as a key priority in disability and SA management and these interventions implemented in the early stages of SA episodes indicate that 'early' and 'very early' intervention may result in a quicker return to work and be cost-effective. The objective of this systematic review is to investigate the effectiveness of 'very early' (under 15 days) SA workplace interventions to enhance return to work. Methods A systematic literature search was conducted in Pubmed, HMIC, Cochrane library database, CINAHL, PsychInfo and Embase. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria. Randomised controlled trials, controlled trials, cluster-randomised trials, cross-over designs, before and after studies and interrupted time-series published in English until September 2014 were included if they assessed the effectiveness of workplace interventions to reduce SA in workers who were on sick leave no longer than 15 days. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. The Cochrane Collaboration tool was used to assess the risk of bias. Results We found limited available evidence on the benefits of 'very early' workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomised controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction on the duration and recurrence of SA, and increased self-perception of health and quality of life. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders and less for workers with mental health problems. Conclusion Our review identified a lack of substantive evidence from the literature at this time point to support 'very early' intervention compared to usual care. Consensus is required on the definition of 'early' and 'very early' interventions and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.

Background Short and long term sickness absence (SA) are due to different causes, therefore require different approaches to intervention. In research on SA, incidence had usually been analysed separately from the duration of episodes. Objective Describe the usefulness of the analysis of SA incidence by segmentation of duration of episodes versus non-segmented analysis. Methods We compared overall incidence of non-work related SA and incidence of SA segmented by duration (short duration (≤ 15 days), medium (16–30, 31–90) and long (> 90)). We used data from a health insurance company (“mutua”) in Spain during 2011 (230,332 episodes, 752,906 workers). The incidence rate was calculated according to age groups (<25, 25–34, 35–44, 45–54, ≥55). We computed rate ratios, with their 95% confidence interval (95% CI), to quantify linear trend (RR-T) and association (RR) of SA between age groups. Results The overall incidence of SA showed a steady decline with age (RR-T = 0.92, 95% CI = 0.91–0.92) with an incidence of 36.4% in <25 years versus 29.3% in ≥55 years (RR = 1.24, 95% CI = 1.22–1.27). The overall excess incidence observed in young is produced by short duration (RR-T = 0.82, 95% CI = 0.82–0 82; RR = 1.98, 95% CI = 1.93–2.03). In addition, the incidence of long term SA changed this pattern (RR-T = 1.32, 95% CI = 1.30–1.33), being more frequent in ≥55 years relative to the youngest (5.5% versus 2.1%, RTI = 3.19, 95% CI = 2.97–3.43). Conclusions The analysis of indicators of SA segmented by duration of episodes provides more precise image than that obtained from global data. Information on the type of episodes of IT according to duration provides valuable information for SA intervention.

Background One way used to measure the absenteeism is the analysis of incidence of non-work related sickness absence (NWSA). Study of incidence by segments duration and its evolution allow identifying typology of incidence of NWSA, being useful in the sickness absence management. Objective Describe evolution of incidence of NWSA by segments duration between 2009 and 2015 in Spain. Methods We computed the overall incidence of NWSA and by segments duration. The data used for this study comes from a health insurance company in Spain from 2009 to 2015. The analysis was stratified by age (18–24, 25–34, 35–44, 45–54 and 55–64 years) and sex. Segments were defined by periods (days) short (≤15), medium (16–30, 31–90) and long (>90) term. The Annual Percentage Change (APC) was calculated using the Poisson Model with an inflection point in 2013. Results The overall evolution of incidence of NWSA showed a decreasing trend in 2009–2013 (APC −8%, 95% CI: −12%; − 5%), and an increasing in 2013–2015 (APC 5%, 95% CI: −3%; 13%). The drop of the APC had similar incidence of NWSA in all duration segments being the short processes the ones with a major contribution. Incidence of NWSA (overall and segments) presented an APC more pronounced in workers under 25 years. In 2009 the incidence of short processes in younger workers were 2.4 times higher than in older, while from 2013 to 2015, this difference was reduced to 1.5. In both sexes, the evolution of INWSA was similar, with higher values in women. Conclusions Changes in the evolution of incidence of NWSA occurred in all segments of duration, being the short duration segments those with more influence. The declension was more noticeable in younger workers. The ascension showed that the differences by age decreased as a result of the short duration processes.

OBJECTIVEThe aim of this review was to investigate the effectiveness of workplace return-to-work (RTW) interventions delivered at very early stages (<15 days) of sickness absence (SA).METHODSA systematic literature search was conducted in PubMed, Health Management Information Consortium (HMIC), Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo and Embase. Using pre-established criteria, independent pairs of researchers carried out the study selection, quality appraisal and data extraction. Workplace interventions before day 15 of SA, were included. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA.RESULTSWe found limited available evidence on the benefits of "very early" workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomized controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction in the duration and recurrence of SA. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders.CONCLUSIONOur review has identified a lack of evidence from the literature at this time point to support "very early" intervention compared to usual care. The methodological design of the studies, notably the extent and timing of usual care provided and variable compliance/crossover between groups could however explain the lack of demonstrated benefit. Consensus is required on the definition of "early" and "very early" interventions, and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.

Background Different countries have shown an inverse relationship between unemployment rates and indicators of sickness absence during periods of economic recession. To our knowledge there is no study which has investigated the relationship between unemployment and absenteeism in Spain. Objectives Evaluate the relationship between indicators of absenteeism and unemployment in Spain during 2009-2014. Methods We obtained incidence (IR) and absenteeism rates (AR) of non-work related sickness absence (NWSA). Data was obtained from the population protected by a health insurance company (“mutua”) collected by the Social Security. Data on unemployment rates (UR) was provided by the National Statistics Institute in Spain. The relationship between indicators of NWSA and unemployment in the period 2009 to 2014 was graphically described using time trend plots. Scatter plots of NWSA indicators were also made against unemployment. Finally, we fitted statistical regression models using absenteeism indicators as dependent variables and unemployment rates as an explanatory variable. Results Incidence and absenteeism rates of NWSA showed downward trends in 2009–2014 (IR 2009 = 28.1% and IR 2014 = 20.8%; AR 2009 = 2.5% and AR 2014 = 2.0%). On the other hand, the unemployment rate had an upward trend in the study period (UR 2009 = 17.9% and UR 2014 = 24.4%). An inverse relationship between unemployment rates and absenteeism indicators was observed (incidence rates: Beta unemployment = −0.93 (p < 0.01) and R-Squared = 95.2%; absenteeism rates: Beta unemployment = −0.08 (p < 0.01) and R-Squared = 99.0%). Conclusions As in previous international studies, an inverse relationship between unemployment and absenteeism was observed in Spain. Specific studies are needed to evaluate explanatory hypotheses such as those associated with the theory of discipline and changes in the workforce.

Resumen de la mesa redonda celebrada en la XXII Diada de la Societat Catalana de Seguretat i Medicina del Treball, 2012

BACKGROUND:There is limited evidence of the role of working conditions as prognostic factors for non-work-related sickness absence (i.e. absence due to injuries or diseases of non-occupational origin).AIMS:To analyse the association between working conditions and time to return to work (RTW) in workers with long-term (>15 days) non-work-related sickness absence.METHODS:We followed up a total of 655 workers, who completed a baseline questionnaire including physical and psychosocial work factors, until their non-work-related long-term sickness absence ended. Time to RTW was determined based on the health insurance company register. Cox proportional hazard models were constructed to evaluate the associations between working conditions and time to RTW.RESULTS:A self-perceived high level of physical activity at work and work with back twisted or bent were related to longer duration of sickness absence. We did not find any strong evidence of associations between psychosocial work factors and time to RTW, although higher job insecurity and low reward showed marginal statistical significance.CONCLUSIONS:Hazardous physical working conditions are associated with longer duration of non-work-related sickness absence. Workplace ergonomic interventions could conceivably shorten the length of sickness absence that has not originated at work.

OBJECTIVE:To analyze the association between organizational support and time to return to work (RTW) in workers with long-term non-work-related sick leave. METHODS:Cohort participants were 571 workers, with a non-work-related sick leave episode of more than 15 days, recruited during the first visit in a health insurance company (mutua). Workers completed a baseline questionnaire regarding organizational RTW support measures and were followed until the end of the episodes. Return to work and time to RTW were established on the basis of the mutua's register. Multivariate Cox regression models were used. RESULTS:Workers in companies with an overall high organizational RTW support returned to work earlier. This effect was mainly due to workers in companies that provided specific RTW programs. CONCLUSIONS:Our findings suggest that companies play an important role in facilitating RTW for workers with long-term non-work-related sick leave episodes.

INTRODUCTION:Despite suggestions that worker perception might be the best predictor of return to work (RTW), there still is limited research on time to RTW in workers with lengthy non-work-related sick leave.METHODS:Prospective cohort study of 663 workers with a current long-term non-work-related sick leave episode recruited during the first medical visit in a mutua (Spanish health insurance company) and followed until their sick leave episode ended. Workers completed a baseline questionnaire regarding their perceptions of sick leave episode and expectations of RTW (i.e., health status, work ability, expectations and time required to RTW, self-efficacy and self-perceived connection between health and job). Time to RTW was established based on the mutua's register. Cox regression models were used to examine the associations of worker perception and expectation of RTW with time to RTW within the study population as a whole as well as in three diagnostic subgroups (i.e., musculoskeletal disorders, mental disorders and other physical conditions).RESULTS:As a whole, time to RTW was longer for workers reporting poor health [hazard ratio (HR) = 0.71, 95%CI 0.59-0.85], extremely reduced work ability (HR = 0.69, 95%CI 0.53-0.88), a longer period of time required to RTW (HR = 0.36, 95%CI 0.25-0.52) and lack of expectation of returning to the same job (HR = 0.13, 95%CI 0.06-0.31). Workers with musculoskeletal and other physical conditions showed a similar pattern to whole study population, while workers with mental disorders did not.CONCLUSION:Self-required time and RTW expectations are important prognostic factors in sick listed workers by all types of health conditions certified as non-work-related. Questioning the workers on their perceptions and expectations of RTW during medical visits could help health care professionals to identify individuals at risk of long-term sickness absence and facilitate triage and management of the patient.

espanolOBJETIVOS. Describir la duracion de los episodios de incapacidad temporal por contingencia comun (ITcc) por grupos diagnosticos. METODOS. Cohorte retrospectiva de 258.751 episodios de ITcc de duracion prolongada (>15 dias en trabajadores del regimen general, >3 dias en trabajadores autonomos) iniciados entre 2002 y 2006, gestionados por una mutua de ambito estatal en Espana, y seguidos hasta su alta. Se examino la distribucion de los episodios por el diagnostico medico al alta, segun la duracion mediana (DM), los percentiles 25 y 75, la media y desviacion estandar. RESULTADOS. La DM fue de 73 dias para aquellos casos en los que constaba un diagnostico clinico (n=148.588, 57,4%); los percentiles 25 y 75 fueron de 41 y 143 dias, respectivamente. Las patologias mas frecuentes fueron las osteoarticulares (22,2%), seguidas por las traumatologicas (16,7%) y psiquiatricas (12,3%). Las neoplasias presentaron la mayor DM (201 dias), seguidas por los trastornos psiquiatricos (117 dias), reumatologicos (103 dias) y neurologicos (102 dias), aumentando esta con el sexo femenino, una mayor edad y ser trabajador autonomo. CONCLUSIONES. En las ITcc de duracion prolongada hay importantes diferencias en la duracion de los procesos segun la patologia. Duracion que se ve modulada por el sexo, la edad y el regimen de la seguridad social. Estos datos pueden servir de guia para mejorara la gestion clinica de los procesos que conllevan una incapacidad temporal por contingencia comun. EnglishOBJECTIVES. To describe the typical duration of episodes of nonoccupational temporary sickness absence (SA) by diagnostic groups. METHODS. Retrospective cohort study of 258,751 episodes of temporary SA (lapsing >15 days in employed, >3 days in selfemployed workers) initiated between 2002 and 2006, managed by a Spanish national insurance company and followed until case closure. Distribution of the duration of SA episodes by medical diagnosis at the time of case closure, by median, 25th and 75th percentiles, mean and standard deviation were obtained. RESULTS. Median duration of SA was 73 days for cases where there was a medical diagnosis (n=148,588, 57.4%); the 25th and 75th percentiles were 41 and 143 days, respectively. The most frequent pathologies were musculoskeletal (22.2%), followed by trauma (16.7 %) and psychiatric disorders (12.3%). Neoplasms had the longest median duration (201 days), followed by psychiatric (117 days), rheumatologic (103 days) and neurological disorders (102 days). Duration was greater among women, older age groups and self-employed workers. CONCLUSIONS. In prolonged SA, there are significant differences in duration by clinical diagnosis. This duration is further affected by sex, age and social security scheme. These results, despite their limitations, could be useful to improve the clinical management of the process of sickness absence.

Objective: In Spain, sick pay benefits for work-related sick leave episodes are higher than for non-work-related episodes. Our aim is to assess whether time to return to work is longer for higher paid sick leave episodes than for lower paid episodes.Methods: We used data from 62 376 work-related and 76 932 non-work-related sick leave episodes occurring among 338 226 workers from 56 099 companies in Spain in 2002. All episodes were followed for up to 18 months. Episodes were classified by a physician as being work-or non-work-related according to medico-legal judgments. The median episode duration and the 25th and 75th percentiles were calculated. The probability of remaining absent from work was estimated by a non-parametric estimator of the marginal survival function. The time ratio between both types of sick leave was estimated by a log-logistic regression model, using non-work-related episodes as the reference.Results: Median episode duration (25th-75th percentiles) was 11 (6-21) days for work-related episodes and 9 (4-29) days for non-work-related episodes. Time to return to work was longer for work-related episodes than for non-work-related episodes of less than 16 days (time ratio: 1.19 in men and 1.08 in women), while the opposite was observed for episodes of more than 15 days (0.58 in men and 0.40 in women).Conclusions: Sick pay benefits have a limited effect on time to return to work after a sick leave episode.

BACKGROUND:To describe the duration of non-work related sickness absences incidents according to age, sex, economic activity and Autonomous Community.METHODS:The sample of non-work related sick spells included 76,598 incident cases started in 2002 among workers cover by the general regime of the Social Security system, and managed by an insurance company. The median and intercuartils range were estimated by sex, age, economic activities and Autonomous Comunnity. Probability ratio of continuing out of work (PRCOW) were compared among Autonomous Comunities, after adjusting by sexo, age and economic activities, taking Navarra as reference, using a log-logistic regression model with a gamma distribution.RESULTS:The 25% of cases there were returned to work at 40 day, the 50% at 90 day; and the 75% at 26 degrees day. Extremadura (PCOW=2,7; IC95%: 2,4-3,1) and Galicia (2,6; 2,4-2,9) showed the highest differences with Navarra. There were also statistically significant differences among economic activities after adjusting by age and sex.CONCLUSIONS:Return to work after a non-work related sick spell is a complex process, which is influenced by age, sex, economic activities and autonomous community.

Background: To, describe the duration of non-work related sickness absences incidents according to age, sex, economic activity and Autonomous Community.,Methods: The sample of non-work related sick spells included 76,598 incident cases started in 2002 among workers cover by the general regime of the Social Security system, and,managed by an insurance company. The median and intercuartils range were estimated by sex, age, economic activities and Autonomous Community. Probability ratio of continuing out of work (PRCOW) were compared among Autonomous Comunities, after adjusting by sexo, age and economic activities, taking Navarra as reference, using a log-logistic regression model with a gamma distribution.Results: The 25% of cases there were returned to work at 4 degrees day, the 50% at 90 day; and the 75% at 26 degrees day. Extremadura (PCOW=2,7; IC95%: 2,4-3, 1) and Galicia (2,6; 2,4-2,9) showed the highest differences with Navarra. There were also statistically significant differences among economic activities after adjusting by age and sex.Conclusions: Return to work after a non-work related sick spell is a complex process, which is influenced by age, sex, economic activities and autonomous community.