[Labour market, occupational health and immigration]. / Mercado de trabajo, salud laboral e inmigración.

The process of economic and social change that Navarra has undergone in recent decades has been associated with the arrival of a growing flow of immigrants since the start of the new century. They have had a decisive influence as a factor of economic change in terms of production increase and internal demand. A new Navarra is being built thanks to the phenomenon of migration. In the first place, we analyse their impact on demographic growth. Their influence on the labour market, with its highlights and shadows, is evaluated. Foreigners already are about 10% of the active population and their presence in some productive sectors is decisive for their viability. The dysfunctions and problems of the labour market are reviewed, especially the question of accidents. Finally, the behaviour of the indicators of temporary disability of this collective are set out. Although this phenomenon has brought an imbalance in some spheres of social policy (education, housing, health), it can be said that the model of integration in Navarra is based on a generous welfare system, a social climate that is in general tolerant, and sustained economic growth.

Mercado de trabajo, salud laboral e inmigración / Labour market, occupational health and immigration

El proceso de cambio económico y social que está experimentando Navarra en las últimas décadas está asociado con la llegada de un flujo de inmigrantes creciente a partir del nuevo siglo. Su influencia ha sido decisiva como factor de cambio económico en términos de crecimiento de producción y demanda interna. Se está construyendo una Navarra diferente gracias al fenómeno migratorio. Analizaremos en primer lugar su impacto en el crecimiento demográfico. Se valora su influencia en el mercado de trabajo con sus luces y sus sombras. El colectivo de extranjeros supone ya el 10% de la población activa y su presencia en algunos sectores productivos es decisiva para la viabilidad de los mismos. Se revisan las disfunciones y los problemas del mercado de trabajo, especialmente el tema de la siniestralidad. Para finalizar se expone el comportamiento de los indicadores de incapacidad temporal en dicho colectivo. Aunque este fenómeno ha supuesto un desequilibrio en algunos ámbitos de la política social (educación, vivienda, sanidad) se puede afirmar que el modelo de integración en Navarra se basa en un sistema de bienestar generoso, un clima social en general tolerante y un crecimiento económico sostenido

The process of economic and social change that Navarra has undergone in recent decades has been associated with the arrival of a growing flow of immigrants since the start of the new century. They have had a decisive influence as a factor of economic change in terms of production increase and internal demand. A new Navarra is being built thanks to the phenomenon of migration. In the first place, we analyse their impact on demographic growth. Their influence on the labour market, with its highlights and shadows, is evaluated. Foreigners already are about 10% of the active population and their presence in some productive sectors is decisive for their viability. The dysfunctions and problems of the labour market are reviewed, especially the question of accidents. Finally, the behaviour of the indicators of temporary disability of this collective are set out. Although this phenomenon has brought an imbalance in some spheres of social policy (education, housing, health), it can be said that the model of integration in Navarra is based on a generous welfare system, a social climate that is in general tolerant, and sustained economic growth

[Occupational disability due to locomotor pathology in the Foral Community of Navarra. Epidemiological aspects]. / Incapacidad laboral por patología del aparato locomotor en la Comunidad Foral de Navarra. Aspectos epidemiológicos.

INTRODUCTION: Disability produced by locomotor pathology causes a loss in working hours and indirect costs that are increasing at a growing rate. The aims of this study are to estimate the costs in total working hours lost caused by this pathology in two health areas of Navarra with 441,600 inhabitants, to obtain standards for the duration and incidence of sick leave and to study the relation between the average duration of sick leave and variables such as the geographical accessibility of the rehabilitation services, residence in a rural or urban milieu, and between the different health areas. METHODS: We study all the processes of temporary disability due to pathology of the locomotor system in Health Areas I and III of Navarra in 1997 and 1998, taking different variables into account. We make a descriptive study of the pathologies, counting the working days lost. We calculate the annual incidence of sick leave because of pathologies. We compare average duration with other variables. RESULTS: These represent 221,054 lost working days per year. Low back pain and sprained ankles are the most frequent processes. We find an increase in the incidence of temporary disability due to low back pain and lumbar/sciatica in the basic rural areas of the middle region. There are no statistically significant differences with a p<0.05 in the duration of temporary disability according to Health Area, rural or urban milieu or geographical accessibility to the Rehabilitation Services. A statistically significant fall can be observed in the first year of operation of a temporary disability management program.

Incapacidad laboral por patología del aparato locomotor en la Comunidad Foral de Navarra. Aspectos epidemiológicos / Occupational disability due to locomotor pathology in the Foral Community of Navarra. Epidemiological aspects

Introducción. La discapacidad producida por la patologíadel aparato locomotor ocasiona una pérdida de horas de trabajoy unos costes indirectos que están aumentando a un ritmocreciente. Los objetivos de este estudio son estimar los costesen horas de trabajo totales perdidas ocasionadas por la patologíadel aparato locomotor en 2 áreas sanitarias de Navarra con 441.600 habitantes, obtener estándares de duración e incidenciade bajas y estudiar la relación entre duración media de las bajasy variables como la accesibilidad geográfica a los servicios derehabilitación, vivir en entorno rural o urbano y entre diferentesáreas sanitarias.Material y métodos. Se han estudiado todos los procesosde incapacidad temporal por patología del aparato locomotoren las Áreas Sanitarias I y III de Navarra en 1997 y 1998, recogiendodiferentes variables. Se ha realizado un estudio descriptivode las patologías, contabilizando las jornadas laborales perdidas.Calculamos la incidencia anual de bajas por patologías.Comparamos duración media con otras variables.Resultados. La discapacidad producida por la patología delaparato locomotor supone pérdidas de 221.054 jornadas de trabajo/año. La lumbalgia, el esguince de tobillo son los procesosmás frecuentes. Encontramos un aumento en la incidencia deincapacidad temporal por lumbalgia y lumbociatalgia en laszonas básicas rurales de la zona media. No existen diferenciasestadísticamente significativas con una p<0,05 en la duración dela incapacidad temporal según área sanitaria, entorno rural ourbano ni accesibilidad geográfica a los servicios de rehabilitación.Se observa un descenso significativo estadísticamente elprimer año de funcionamiento de un programa de gestión deincapacidad temporal

pahtology causes a loss in working hours and indirect coststhat are increasing at a growing rate. The aims of this studyare to estimate the costs in total working hours lost caused bythis pathology in two health areas of Navarra with 441,600inhabitants, to obtain standards for the duration andincidence of sick leave and to study the relation between theaverage duration of sick leave and variables such as thegeographical accessibility of the rehabilitation services,residence in a rural or urban milieu, and between the differenthealth areas.Methods. We study all the processes of temporarydisability due to pathology of the locomotor system in HealthAreas I and III of Navarra in 1997 and 1998, taking differentvariables into account. We make a descriptive study of thepathologies, counting the working days lost. We calculate theannual incidence of sick leave because of pathologies. Wecompare average duration with other variables.Results. These represent 221,054 lost working days peryear. Low back pain and sprained ankles are the most frequentprocesses. We find an increase in the incidence of temporarydisability due to low back pain and lumbar/sciatica in the basicrural areas of the middle region. There are no statisticallysignificant differences with a p<0.05 in the duration oftemporary disability according to Health Area, rural or urbanmilieu or geographical accessibility to the RehabilitationServices. A statistically significant fall can be observed in thefirst year of operation of a temporary disability managementprogram

International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-associated Pneumonia.

Ventilator-associated pneumonia (VAP) is an important health problem that still generates great controversy. A consensus conference attended by 12 researchers from Europe and Latin America was held to discuss strategies for the diagnosis and treatment of VAP. Commonly asked questions concerning VAP management were selected for discussion by the participating researchers. Possible answers to the questions were presented to the researchers, who then recorded their preferences anonymously. This was followed by open discussion when the results were known. In general, peers thought that early microbiological examinations are warranted and contribute to improving the use of antibiotherapy. Nevertheless, no consensus was reached regarding choices of antimicrobial agents or the optimal duration of therapy. Piperacillin/tazobactam was the preferred choice for empiric therapy, followed by a cephalosporin with antipseudomonal activity and a carbapenem. All the peers agreed that the pathogens causing VAP and multiresistance patterns in their ICUs were substantially different from those reported in studies in the United States. Pathogens and multiresistance patterns also varied from researcher to researcher inside the group. Consensus was reached on the importance of local epidemiology surveillance programs and on the need for customized empiric antimicrobial choices to respond to local patterns of pathogens and susceptibilities.

Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices.

This retrospective multicenter study compared microorganisms documented by quantitative cultures from bronchoscopic samples in episodes of ventilator-associated pneumonia (VAP) from three different institutions in Barcelona (B), Montevideo (M), and Seville (S). The observations were compared with the findings reported by Trouillet and coworkers (AJRCCM 1998;157:531-539) in Paris (P). The objective was to evaluate whether a classification of etiologies of VAP in four groups, based on the number of ventilation days and previous antimicrobial use, might contribute to establishing generalized guidelines for empirical therapy. Significant variations in etiologies (p < 0.05) were found in all of the microorganisms isolated from VAP episodes across three treatment sites when compared with the reference site (P). In Group 1 (< 7 d and absence of antibiotics), Pseudomonas aeruginosa remained extremely infrequent (3 of 89, 3.3%) in the joint category, whereas the incidence of Acinetobacter baumannii was significantly higher, owing to M findings. On the other hand, one site (B) had a significantly lower incidence of multiresistant pathogens (Methicillin-resistant Staphylococcus aureus [MRSA] and nonfermenters other than P. aeruginosa), even in Group 2 (< 7 d and antibiotics), Group 3 (>/= 7 d and absence of antibiotics), and Group 4 (antibiotics and >/= 7 days). Similar findings were documented when episodes were grouped according to Groups 1 and 3 of the ATS guidelines. We conclude that causes of VAP varied markedly across four treatment sites, resulting in the need for large-scale variations in antimicrobial prescribing practices. Instead of following general recommendations, antimicrobial prescribing practices for VAP should be based on up-to-date information of the pattern of multiresistant isolates from each institution.

Use of vasopressors to raise cerebral perfusion pressure in head injured patients.

Cerebral ischemia due to low cerebral perfusion pressure (CPP) is the most important secondary effect of severe head injury. There is consensus regarding the maintenance of this pressure at levels above 70 mm Hg. One way to elevate CPP is by increasing mean arterial pressure (MAP). In this study, the authors attain this target by using adrenergic vasopressors investigating the effectiveness of dopamine, noradrenaline and methoxamine in 16 severe head injured patients. The results were: a) the increase of MAP effectively increased CPP without changes in intracranial pressure (ICP) and cerebral extraction of oxygen (CEO2); b) noradrenaline at a dose of 0.5 mg to 5 mg/h was effective and safe and might be considered the drug of choice; c) dopamine was not as effective at a high dose of 10 to 42.5 micrograms/kg/min; d) methoxamine given as a bolus was an effective way to control sudden decreases in MAP. It made the patients more responsive to dopamine. No important undesirable reactions occurred during the study.

Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia.

STUDY OBJECTIVE: To investigate the epidemiology of infection by Acinetobacter baumannii in patients with ventilator-associated pneumonia (VAP). DESIGN: Prospective clinical study. SETTING: Three medical-surgical ICUs in teaching hospitals. PATIENTS: We followed up 707 mechanically ventilated patients and 148 episodes of VAP with etiologic diagnosis. RESULTS: A baumannii was isolated in 12 (8.1%) episodes in 148 patients. Five of these episodes were directly responsible for death. Using logistic regression analysis, the risk of VAP due to A baumannii was found to be high in patients with neurosurgery (odds ratio [OR]=10.03; 95% confidence interval [CI]=1.55 to 64.90), ARDS (OR=9.73; 95% CI=1.60 to 59.24), head trauma (OR=5.17; 95% CI=0.88 to 30.34), and large-volume pulmonary aspiration (OR=2.90; 95% CI=0.80 to 10.53). CONCLUSIONS: Intubated patients who develop pneumonia and have any of the above factors are at an increased risk of Acinetobacter infection.