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Benavides" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Consol" "apellidos" => "Serra" "email" => array:1 [ 0 => "cserrapujadas@parcdesalutmar.cat" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José María" "apellidos" => "Ramada" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "Jordi" "apellidos" => "Delclòs" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 3 => array:3 [ "nombre" => "Fernando G." "apellidos" => "Benavides" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:2 [ "colaborador" => "on behalf of the Monitoring Group UPL-PSMar/CiSAL" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Salud Laboral, Parc de Salut Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Investigación en Salud Laboral (CiSAL), Universidad de Pompeu Fabra, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER de Epidemiología y Salud Pública (CIBERESP), Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, United States" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedades profesionales atendidas en el Parc de Salut Mar (Barcelona, España), 2010–2014" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1839 "Ancho" => 2508 "Tamanyo" => 200824 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Occupational disease (OD) recognition circuit flowchart of patients with confirmed OD suspicion by the Occupational Pathology Unit of the Parc de Salut Mar 2010–2014.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">For specialists in occupational medicine, identifying a disease as occupational is not an easy task, being even more difficult for professionals in other specialties. Three centuries after Ramazzini wrote his seminal treatise <span class="elsevierStyleItalic">De morbis artificum diatribas</span>, and after further adjustments<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1,2</span></a> carried out in Spain since 1936 in order to facilitate the task, we still find ourselves without an adequate solution to this problem.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Different studies assessing reporting and recognition of occupational diseases (OD) show that this problem is not just ours,<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3,4</span></a> although it is especially serious in Spain, because only about a quarter of potentially work-related illnesses are recognized each year (29,000 instead of 93,000 new cases each year),<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> reaching reporting levels as low as 0.04% for cancer (one case per year against an estimated minimum of 2000).<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> And although these estimates include all possible illnesses, the differences when compared to other countries are so large (7 times less than in Finland or 6 times less than in Belgium) that they leave no doubt about the low number of recognized OD in Spain.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The reasons for underdiagnosing are manifold, and have been analyzed in detail.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> Among them, the limited competence of physicians in occupational health should be noted, having more to do with attitude than with aptitude, which is clearly reflected in how rarely the occupation variable is filled in medical records, both in primary care (8%)<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> as well as in specialized care (27%).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> Also the lack of information regarding patients seeking quality care to their problems. Similarly, the interests of companies, that look at the problem from a guilt perspective, thinking of a possible work inspection, rather than from a social responsibility viewpoint. And finally, the Social Security System, from which the Mutual Insurance Companies for Occupational Accidents and Diseases (hereinafter mutual insurance companies) depend, whose approach is similar to that of an insurance company rather than a social protection system.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Indeed, it is not enough for an OD to be identified and reported by a physician of the National Health System, but it must also be recognized by the Social Security. That is, an OD is such only if it is legally recognized.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> Those other diseases for which there is strong evidence of a possible occupational origin, but are not on the official list of OD,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> cannot be recognized by the Social Security, and are called work-related diseases.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the most widespread initiatives in recent years to help solve the problem has been to create primary care units specialized in occupational health, which have been implemented in several autonomous regions (Valencia, Navarra, Catalonia, Andalusia, etc.), with the aim to support primary care physicians to report these suspected cases as occupational. Although it has not been evaluated, the results do not seem to be those expected, because even the number of OD recognized by the Social Security system has decreased.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Among the possible explanations for not achieving this goal, we find the limited resources of primary care, especially in connection with the time needed to do an adequate occupational clinical history to substantiate the suspicion of the etiologic relationship between the clinical signs and symptoms and the patient's occupation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In order to overcome some of these limitations, the Parc de Salut Mar (PSMAR) health centre began in 2010 a pioneer experience in Spain, creating the first occupational pathology unit (OPU), whose objective is the identification and confirmation of suspected OD among the cases treated in this hospital and subsequent notification to the OPU. The aim of this paper is to present the results obtained until 2014.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Descriptive study of a series of 46 patients admitted and treated at the PSMAR, which included the identification and confirmed suspicion of OD by the OPU between June 2010 and December 2014, from a total of 115 patients derived by referral to the OPU by doctors of the hospital in the same period. The process of reporting the suspicion to the OPU by a hospital doctor attending the inpatient, as long as this one gives his consent, and the subsequent study by the OPU to confirm or not the suspicion, has already been described.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> Briefly, when a health professional of a hospital service identifies a case of suspected OD arranges a referral to the OPU, where the case is evaluated by a face to face medical visit by occupational physicians who review his/her medical history to evaluate such suspicion. The evaluation consists of obtaining the medical-occupational history, documenting the occupational risk exposure whenever possible and reviewing the available scientific evidence, after which a detailed contingency report is given to the patient, explaining the findings, as well as forwarding copies to the hospital referral doctor, the family doctor and the patient's company prevention department (in case of active workers). The socio-demographic data (sex and age), diagnosis according to ICD-9-MC12, the referral origin and the final conclusion of the assessment are recorded in each case: OD suspected or confirmed occupational disease. If suspected OD is confirmed, the patient is also informed verbally of his/her rights in connection with the administrative channels related to the application for OD recognition by the Social Security.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In order to achieve the official recognition of an OD, an administrative procedure must be initiated first. Usually, (but not always) the patient will be referred to the mutual insurance company concerted by the patient's employer to cover occupational contingencies. If the mutual insurance company accepts the occupational origin and the OD recognition of the illness in question, the OD recognition process is finalized. Otherwise, the patient may exhaust the administrative remedies by requesting from the National Institute of Social Security (INSS) the evaluation of the case and OD recognition. Patients cannot always be seen right away by a mutual insurance company in order to request that the occupational origin of their illness is recognized, for example, when confirmation of suspected OD occurs at the time when the worker is retired (very common situation in cases of diseases with long latency periods such as cancer), unemployed, with a permanent disability for any other cause or inactive or working without social security coverage. In these cases, the patient will necessarily have to go directly to the INSS (Social Security), whose resolution (recognizing or not the OD) exhausts the administrative remedies. In the event that the INSS (Social Security) resolves recognizing the OD, the procedure is finalized. Otherwise (when the INSS decides not to recognize the OD) the administrative remedies are exhausted and the patient may appeal the decision of the INSS before the Labour Court, with as many court ruling appeal possibilities as permitted by law for each judicial instance.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding follow-up, the patient was contacted by telephone as many times as needed in order to find out if the administrative procedure related to his/her OD recognition had been initiated, the protocol followed and what was the result. In all cases they were asked to send a copy of the resolution and/or ruling to the OPU. Telephone interviews were conducted by RG and MU, closing follow-up on this first assessment in May 2015. The following information was collected about each patient: sex, age, diagnosis and employment status at the time of confirmation of the suspicion. The study protocol was approved by the Clinical Research Ethics Committee of the PSMAR.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 46 patients with suspected OD confirmed, 37 were male (80%), the median age of all was 58 years (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The most common disorder was hypoacusis (20 patients), followed by musculoskeletal disorders (11) and cancer (10). At the end of follow-up, in May 2015, 31 (67.4%) patients had initiated the procedure for recognition, 10 (21.7%) had ruled it out and 5 (10.9%) were not contactable.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 31 patients who started the recognition process by the Social Security (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), 13 (41.9%) obtained OD recognition, 14 (45.2%) were denied recognition and 4 (12.9%) cases are still pending. By diagnostic group, stands out the proportion of recognition of cancer cases: 5 out of 8 (62.5%), although one is still in process, and dermatosis: 3 out of 4 (75%). The lower proportion of recognition was related to musculoskeletal disorders (2 out of 9, 33%) and hypoacusis (3 out of 10, 60.0%).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 13 patients whose OD was recognized (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) 11 were recognized through an administrative procedure, 3 being through a mutual insurance company and 8 through the INSS (Social Security) (2 after being denied by a mutual insurance company); and 2 had to resort to the courts. Of the 7 cases that initially went to the INSS (Social Security), 6 were recognized as OD and one subsequently appealed to the courts. In contrast, of the 6 that initially went to a mutual insurance company, only 3 were recognized as OD by it, 2 were subsequently recognized by the INSS (Social Security) and one through the courts. The average time for recognition was 295 days, with an interval of 20–679 days, with dermatosis cases showing the shortest times (20 to 199 days), and cancer cases, in contrast, showing the longest times (from 370 to 699 days) (data not shown). Of the 14 patients whose OD was not recognized by the INSS (Social Security), the procedure involved in all cases was the administrative one (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and none have so far resorted to a court appeal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study shows for the first time a burden estimate of OD treated at a tertiary care hospital of the National Health System in our country. Otolaryngology, orthopaedics/rehabilitation and oncology seem to be the departments where the burden is greater, not forgetting the dermatology department. The training of doctors within these specialties and their close collaboration with specialists in occupational medicine are significant details to bear in mind. In fact, these results have been possible thanks to the fact that this collaboration has worked in the PSMAR through different clinical services referrals to the OPU, so that occupational doctors can resolve any doubts about the possible occupational aetiology of their patient's disease. A pioneer initiative in our country, but not in the international arena, where, for years, there have been clinical units within the specialized and hospital healthcare settings, whose aims have been, as in our case, to improve the detection of OD.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">16–19</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Obviously, these results have also been made possible thanks to the willingness of patients and their families, who initiated the process to recognize their OD through the Social Security. A process that can last between 9 and 10 months, and in some cases up to 2 years, which usually requires the help of lawyers and even court proceedings. In fact, of the 14 cases that were refused, they all followed the administrative channels (12 through the INSS (Social Security) and 2 through mutual insurance companies) and none of them had initiated court proceedings, possibly because of doubts and costs related to pursuing this channel. In this regard, a case of cancer stands out. It was a malignant pleural mesothelioma with well documented exposure to asbestos, which was initially rejected through the administrative channel, but finally recognized by the courts. The complexity of the process can explain why 10 (21.7%) patients decided not to start the process.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The implication of all this effort, both for the patient who initiates the procedure and for the hospital who has created the OPU, is clear. The patient, or their descendants if the patient has died, can see the economic subsidy increased, which goes from about 60% of the income-based wage premiums if the disease is common (non-professional) to nearly 80% if it is recognized as an OD, and the possible recognition of the right to additional benefits are approved. Regarding the hospital, it will have the possibility to balance the cost of healthcare in these cases between the National Health System and the Social Security, because when an OD is treated by the National Health System, the costs generated must be financed by the Social Security. In this sense, it is often forgotten that there are two healthcare systems in Spain. One tax-financed and managed by the autonomous communities, which is the National Health System dealing with “common” (non-occupational) diseases, and another funded through contributions to the Social Security and mostly managed by mutual insurance companies, which deals with conditions recognized as occupational, both accidents as well as OD. One of the consequences of OD underdiagnose is that the National Health System is bearing the cost of healthcare for a significant number of OD when this should be assumed by the Social Security. All this points to the need for close cooperation between these two health systems. Initial studies have estimated that approximately 16% of disabilities which were classified as common had a possible occupational origin.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> This estimate has been recently confirmed.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> To our knowledge, no studies have evaluated the costs that these possible occupational diseases represent for the National Health System. This is especially relevant in cases of cancer, which are hardly recognized by the Social Security (49 in 2014 in the whole of Spain, with only 4 of them in Catalonia<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a>), and whose healthcare has an average cost of about 15,000<span class="elsevierStyleHsp" style=""></span>€, taking lung cancer as an example.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">But besides these two implications, the existence of an OPU in a hospital can contribute to the epidemiological surveillance of OD,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> as suspected cases of OD which are then confirmed can serve as sentinel cases to suspect others, especially when it comes to acute illnesses, and thus take preventive measures via the Occupational Health & Safety Inspectorate and Social Security, and prevent the emergence of new cases. An example of such utility is related to what happened in Spain with the Ardystil “epidemic”.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In our series, 43% of cases (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20) where the suspicion was confirmed had to do with hypoacusis, which in most cases were not recognized by the Social Security as OD (60%), giving as reason the lack of economic consequences for patients, as they are not incapacitated for work as a result of the hypoacusis. This lack of recognition hinders epidemiological surveillance and prevention of occupational hypoacusis, as they are rarely a cause of work disability, and therefore are under-recognized as an official OD.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, the existence of a OPU in a hospital can offer advantages for patients and their families, for the hospital that has treated these patients with OD and for the general population through prevention. This makes its generalization to other National Health System hospitals advisable, as well as the development of guidelines so that patients and their advisers can start the process of recognition with the best possible information.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">Consol Serra and Jose Maria Ramada are professionals working at Parc de Salut Mar.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 5 => array:2 [ "identificador" => "xack244041" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-18" "fechaAceptado" => "2015-12-04" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Serra C, Ramada JM, Delclòs J, Benavides FG, en nombre del Grupo Seguimiento UPL-PSMar/CiSAL. Enfermedades profesionales atendidas en el Parc de Salut Mar (Barcelona, España), 2010–2014. Med Clin (Barc). 2016;146:506–510.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Members of the UPL-PSMar/CISAL Monitoring Group are listed in <a class="elsevierStyleCrossRef" href="#sec0030">Appendix A</a>.</p>" "identificador" => "fn1" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0110" class="elsevierStylePara elsevierViewall">The UPL-PSMar/CISAL Monitoring Group is composed of the following members: Consol Serra, José María Ramada, Jordi Delclòs, Fernando G. Benavides, Rosabel Garrido y Mònica Ubalde.</p>" "etiqueta" => "Appendix A" "titulo" => "UPL-PSMar/CISAL Monitoring Group" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1839 "Ancho" => 2508 "Tamanyo" => 200824 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Occupational disease (OD) recognition circuit flowchart of patients with confirmed OD suspicion by the Occupational Pathology Unit of the Parc de Salut Mar 2010–2014.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">(%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age (years)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(12.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(80.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(19.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Diagnostic group</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Musculoskeletal disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(23.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(21.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypoacusis/deafness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(43.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skin disorder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(10.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Situation of OD recognition process</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Initiated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(67.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not started \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(21.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Untraceable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(10.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(100.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1211109.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics of confirmed cases of suspected occupational disease (OD) by the Occupational Pathology Unit of the Parc de Salut Mar, Barcelona, 2010–2014.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Diagnostic group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">OD recognized \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">OD unrecognized \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">OD in progress \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Musculoskeletal disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (77.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (62.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (22.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypoacusis/deafness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (30.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (60.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (10.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Skin disorder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (41.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (45.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (12.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1211108.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Situation after follow-up of patients with confirmed suspicion of occupational disease (OD) who initiated the recognition process (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>31), by diagnostic groups. 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Adolf Rodés for his participation at the start of the process. Patients assessed at the Pathology Unit of the Parc de Salut Mar, and their families, for their cooperation during the diagnostic process and recognition of their occupational disease suspicion, as well as taking part in the process which eventually led to Social Security recognition.</p> <p id="par0105" class="elsevierStylePara elsevierViewall">The Occupational Medicine specialty resident doctors (Mateu Orfila-UPF Occupational Medicine Teaching Unit) who have contributed to the OPU assessing cases of suspected OD: Anna Martí, Beatriz Calvo, Nilo Ditolvi, María Gómez de Carvallo, Aniela Diaconu, Cristina Barrera, Anastasiya Maltseva, Alexis Roncal, Felipe Martínez, Jeni Miu, Daniel Soria, Adrián Aguilar y Dalia Mora.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014600000011/v1_201609250103/S2387020616303771/v1_201609250103/en/main.assets" "Apartado" => array:4 [ "identificador" => "44145" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014600000011/v1_201609250103/S2387020616303771/v1_201609250103/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616303771?idApp=UINPBA00004N" ]
