[Participation to improve working conditions: evidence and experience]. / Participación para mejorar las condiciones de trabajo: evidencias y experiencias.

Participation of stakeholders is a key requirement for the success of public health programmes. Working and employment conditions are major determinants for people's health and wellbeing, and workplaces are ideal environments to implement programmes with a very direct level of participation. In Spain, the main regulatory framework for occupational health and safety, Law 31/1995, establishes the principles of "efficiency, coordination and participation" as a necessary basis for workers' health protection. This same Law establishes the role of the health and safety workers' representative, responsible for occupational risk prevention, and the occupational health and safety committee, a body with equal representation and the same objectives at the heart of the company. Among recent experiences of participation in occupational health, participatory ergonomics programmes have stood out. The aim of these programmes is to improve working conditions with a view to reducing musculoskeletal disorders, which is a very common and highly prevalent work-related injury in Spain. This study describes the characteristics and results of some experiences of participatory ergonomics carried out recently in Spain, from which relevant learning can be extrapolated about processes, facilitators and barriers in order to extend such programmes to other areas of occupational and public health.

Gestión del retorno al trabajo versus control del absentismo / No disponible

No disponible

Experiencia de transferencia de conocimiento en el proyecto de investigación ITSAL (Inmigración, Trabajo y SALud) con representantes de la población diana / Experience of knowledge translation in the ITSAL (immigration, work and health) research project with representatives of the target population

Se describe una experiencia de transferencia de conocimiento entre investigadores del proyecto ITSAL (Inmigración, Trabajo y SALud) y representantes de asociaciones que trabajan con población inmigrante para discutir los resultados obtenidos en esta investigación y las líneas de futuro. Para ello se llevó a cabo una reunión en la que participaron tres investigadoras y 18 representantes de 11 instituciones. Tras una exposición de la metodología y los resultados del proyecto ITSAL, todos los asistentes comentaron los resultados presentados y líneas de investigación de interés. Se pusieron de manifiesto coincidencias entre ambas partes y también se obtuvieron propuestas de interés para el proyecto ITSAL. Entendemos el proceso descrito como una aproximación a la validación social de algunos resultados principales del proyecto. Esta experiencia nos ha permitido abrir un canal de comunicación con la población diana del estudio, en línea con la necesaria interacción de investigadores y población (AU)

This article describes the experience of knowledge translation between researchers of the ITSAL (immigration, work and health) project and representatives of organizations working with immigrants to discuss the results obtained in the project and future research lines. A meeting was held, attended by three researchers and 18 representatives from 11 institutions. Following a presentation of the methodology and results of the project, the participants discussed the results presented and research areas of interest, thus confirming matches between the two sides and obtaining proposals of interest for the ITSAL project. We understand the process described as an approach to social validation of some of the main results of this project. This experience has allowed us to open a channel of communication with the target population of the study, in line with the necessary two-way interaction between researchers and users (AU)

[Experience of knowledge translation in the ITSAL (immigration, work and health) research project with representatives of the target population]. / Experiencia de transferencia de conocimiento en el proyecto de investigación ITSAL (Inmigración, Trabajo y SALud) con representantes de la población diana.

This article describes the experience of knowledge translation between researchers of the ITSAL (immigration, work and health) project and representatives of organizations working with immigrants to discuss the results obtained in the project and future research lines. A meeting was held, attended by three researchers and 18 representatives from 11 institutions. Following a presentation of the methodology and results of the project, the participants discussed the results presented and research areas of interest, thus confirming matches between the two sides and obtaining proposals of interest for the ITSAL project. We understand the process described as an approach to social validation of some of the main results of this project. This experience has allowed us to open a channel of communication with the target population of the study, in line with the necessary two-way interaction between researchers and users.

Salud laboral en España: balance de una década / No disponible

No disponible

Tratamiento regional del sarcoma y melanoma localmente avanzado de la extremidad mediante la perfusión aislada con tumor necrosis factor α y melfalan asociada a hipertermia / Tumor necrosis factor α and melfalan-based hyperthermic isolated limb perfusion in locally advanced extremity soft tissue sarcomas and melanomas

Introducción El objetivo del estudio fue evaluar el número de amputaciones evitables en pacientes con sarcomas y melanomas localmente avanzados de las extremidades mediante la perfusión aislada de la extremidad (PAE) con melfalán y tumor necrosis factor α (PAE-MT) en condiciones de hipertermia. Material y métodos Se revisó a todos los pacientes con sarcoma y melanoma localmente avanzados de la extremidad que fueron tratados en nuestro centro con PAE-MT durante el periodo comprendido entre noviembre de 2001 y febrero de 2010. Se evaluó el porcentaje de respuestas, las amputaciones evitadas, la toxicidad del tratamiento, las complicaciones, el intervalo libre de enfermedad y la supervivencia global. Resultados Treinta pacientes (19 mujeres y 11 varones), con una mediana de edad de 60 años (14-82), fueron tratados con esta técnica. Tras un seguimiento medio de 23 meses, el porcentaje de respuestas globales fue del 93,4% (completas, 46,7%; parciales 46,7%). La mediana de duración de la respuesta fue de 5 meses (0-62) y la mediana de supervivencia global de 13,5 meses (rango 1-62). Se evitó la amputación en el 86,7% de los casos. En la actualidad, once pacientes (5 sin enfermedad, 2 con enfermedad residual en tratamiento, 2 con progresión local y 2 con progresión sistémica) están vivos. Conclusión Mediante la PAE hemos logrado evitar la amputación de 26 miembros afectos de melanoma y sarcoma localmente avanzados. La PAE es factible y segura en un entorno multidisciplinar (AU)

Introduction The aim of the study is to evaluate the limb salvage rate achieved by treating locally advanced extremity sarcoma and melanoma by hyperthermic isolated limb perfusion with melphalan and (..) (AU)

[Tumor necrosis factor α and melfalan-based hyperthermic isolated limb perfusion in locally advanced extremity soft tissue sarcomas and melanomas]. / Tratamiento regional del sarcoma y melanoma localmente avanzado de la extremidad mediante la perfusión aislada con tumor necrosis factor α y melfalan asociada a hipertermia.

INTRODUCTION: The aim of the study is to evaluate the limb salvage rate achieved by treating locally advanced extremity sarcoma and melanoma by hyperthermic isolated limb perfusion with melphalan and TNF-α (ILP-MT). MATERIAL AND METHODS: A retrospective study was conducted on patients suffering from locally advanced soft tissue sarcoma and melanoma of the limb and treated by means of ILP-MT between November 2001 and February 2010. The response rate, toxicity, complications, disease free intervals, overall survival and limb salvage rate were evaluated. RESULTS: A total of 30 patients (19 females and 11 males) with a median age of 60 years (14-82) were treated by this technique. The overall response rate was 93.4% (complete, 46.7%; partial 46.7%); the mean follow-up was 23 months. The median duration of response was 5 months (0-62), The median overall survival was 13.5 months (range 1 - 62). Limb salvage rate was 86.7%. Eleven patients are currently alive (5 without disease, 2 with residual disease on treatment, 2 with local progression and 2 with systemic progression). CONCLUSION: With the use of ILP-MT we have avoided the amputation of 26 limbs affected by locally advanced sarcoma or melanoma. ILP-MT is feasible and safe in a multidisciplinary environment.

Pharmacokinetic and pharmacodynamic analysis of hyperthermic intraperitoneal oxaliplatin-induced neutropenia in subjects with peritoneal carcinomatosis.

The objective of this study was to characterize the pharmacokinetics and the time course of the neutropenia-induced by hyperthermic intraperitoneal oxaliplatin (HIO) after cytoreductive surgery in cancer patients with peritoneal carcinomatosis. Data from 30 patients who received 360 mg/m(2) of HIO following cytoreductive surgery were used for pharmacokinetic-pharmacodynamic (PK/PD) analysis. The oxaliplatin plasma concentrations were characterized by an open two-compartment pharmacokinetic model after first-order absorption from peritoneum to plasma. An oxaliplatin-sensitive progenitor cell compartment was used to describe the absolute neutrophil counts in blood. The reduction of the proliferation rate of the progenitor cells was modeled by a linear function of the oxaliplatin plasma concentrations. The typical values of oxaliplatin absorption and terminal half-lives were estimated to be 2.2 and 40 h, with moderate interindividual variability. Oxaliplatin reduced the proliferation rate of the progenitor cells by 18.2% per mg/L. No patient's covariates were related to oxaliplatin PK/PD parameters. Bootstrap and visual predictive check evidenced the model was deemed appropriate to describe oxaliplatin pharmacokinetics and the incidence and severity of neutropenia. A peritoneum oxaliplatin exposure of 65 and 120 mg·L/h was associated with a 20% and 33% incidence of neutropenia grade 4. The time course of neutropenia following HIO administration was well described by the semiphysiological PK/PD model. The maximum tolerated peritoneum oxaliplatin exposure is 120 mg L/h and higher exposures should be avoided in future studies. We suggest the prophylactic use of granulocyte colony stimulating factor for patients treated with HIO exposure higher than 65 mg L/h.

Incidencia de incapacidad permanente en una cohorte de trabajadores afiliados a la Seguridad Social, 2004–2007 / Incidence of permanent disability in a cohort of social security-affiliated workers (2004–2007)

Objetivo Describir la incidencia de incapacidad permanente, común y laboral, según variables sociolaborales y territoriales.Métodos Cohorte retrospectiva de 768.454 afiliados al régimen general de la Seguridad Social, seguidos entre 2004 y 2007, basándose en la Muestra Continua de Vidas Laborales de la Seguridad Social. En los 4 años de seguimiento se identificaron 7.749 casos con un tiempo total de exposición de 1.937.921 trabajadores-año. Se calcularon las tasas de incidencia y las razones de tasas crudas y ajustadas mediante regresión Poisson.Resultados La incidencia de incapacidad permanente de origen común fue 10 veces superior a la de origen laboral (36,3 frente a 3,7 por 10.000 trabajadores-año). La incidencia de ambos orígenes fue más alta en los hombres, aumenta con la edad y disminuye a medida que aumenta el nivel de estudios. Por comunidades autónomas y para incapacidad permanente común, Asturias presentó la mayor incidencia y Madrid la menor (56,7 frente a 23,3). Para incapacidad permanente laboral, Asturias sigue teniendo la mayor incidencia, mientras que Navarra tiene la menor (7,8 frente a 1,4). Estas diferencias se mantuvieron, respectivamente, para incapacidad común y laboral para Asturias, después de ajustar por sexo, edad, nivel educativo, tamaño de la empresa y actividad económica. Conclusiones En este estudio sobre la incapacidad permanente observamos que su incidencia presenta importantes diferencias demográficas, sociales y territoriales, que deben estudiarse con más detalle, en especial las observadas por comunidades autónomas (AU)

Objective To describe the incidence of permanent disability, both work-related and non-work-related, by several socioeconomic and geographical variables.Methods We performed a retrospective study of a cohort of 768,454 workers covered by the General Social Security Regimen, followed-up from 2004 to 2007. This study was based on the Continuous Working Life Survey. In the 4 years of follow-up, 7,749 cases in 1,937,921 workers-years were identified. Incidence rates and crude and adjusted rate ratios were estimated by Poisson regression models.Results The incidence of non-work-related permanent disability was 10 times greater than that of work-related disability (36.3 versus 3.7 per 10,000 workers-years). The incidences for both non-work-related and work-related disability were higher in men and increased with age and lower education level. For non-work-related permanent disability, the region with the highest incidence was Asturias and that with the lowest was Madrid (56.7 vs. 23.3). For work-related permanent disability, the highest incidence was found in Asturias and the lowest in Navarre (7.8 vs. 1.4). This differential was maintained for work-related and non-work-related permanent disability for Asturias, after adjustment was made by sex, age, educational level, company size and economic activity.Conclusions In this study, we observed substantial differences in the incidences of permanent disability by demographic, social and geographical characteristics, which should be analyzed in greater depth, especially the differences observed by regions (AU)

[Incidence of permanent disability in a cohort of social security-affiliated workers (2004-2007)]. / Incidencia de incapacidad permanente en una cohorte de trabajadores afiliados a la Seguridad Social, 2004-2007.

OBJECTIVE: To describe the incidence of permanent disability, both work-related and non-work-related, by several socioeconomic and geographical variables. METHODS: We performed a retrospective study of a cohort of 768,454 workers covered by the General Social Security Regimen, followed-up from 2004 to 2007. This study was based on the Continuous Working Life Survey. In the 4 years of follow-up, 7,749 cases in 1,937,921 workers-years were identified. Incidence rates and crude and adjusted rate ratios were estimated by Poisson regression models. RESULTS: The incidence of non-work-related permanent disability was 10 times greater than that of work-related disability (36.3 versus 3.7 per 10,000 workers-years). The incidences for both non-work-related and work-related disability were higher in men and increased with age and lower education level. For non-work-related permanent disability, the region with the highest incidence was Asturias and that with the lowest was Madrid (56.7 vs. 23.3). For work-related permanent disability, the highest incidence was found in Asturias and the lowest in Navarre (7.8 vs. 1.4). This differential was maintained for work-related and non-work-related permanent disability for Asturias, after adjustment was made by sex, age, educational level, company size and economic activity. CONCLUSIONS: In this study, we observed substantial differences in the incidences of permanent disability by demographic, social and geographical characteristics, which should be analyzed in greater depth, especially the differences observed by regions.

Effectiveness of occupational injury prevention policies in Spain.

OBJECTIVE: We examined the effectiveness of preventive interventions against occupational injuries (preferential action plans [PAPs]) developed by Spanish regional governments starting in 2000. METHODS: We included 3,252,028 occupational injuries with sick leave due to mechanical causes occurring between 1994 and 2004 in manufacturing and private service companies. Time trends for occupational injury rates were estimated before and after implementation of PAPs in each region, with a control group defined for those regions in which no PAPs were implemented (e.g., Galicia, Madrid, and Cataluña). We determined annual change percentages and their 95% confidence intervals (CIs) through a negative binomial regression model. Regions were grouped into three categories according to formal quality of their PAPs. RESULTS: The regions with the best PAPs (Andalucia, Aragon, Valencia, and Murcia) showed annually increasing occupational injury rates (2.3%, 95% CI -2.5, 7.4) before implementation of PAPs. After PAPs were implemented, occupational injury rates decreased significantly to -7.4% (95% CI -10.2, -4.5). Similar results were also found for regions with PAPs of lower quality and even for regions that didn't implement a PAP (control group). These results did not vary substantially in stratified analysis by gender, age, type of contract, or length of sick leave. CONCLUSION: PAPs are not related to a general decline in occupational injury rates in Spain starting in 2000. Reinforcement of Spanish health and safety regulations and labor inspection activities since 2000, resulting from a social agreement between central government and social agents, remains an alternative hypothesis requiring additional research.

Evaluación de la efectividad de las actividades preventivas (planes de actuación preferente) sobre la incidencia de las lesiones traumáticas no mortales con incapacidad laboral por accidentes de trabajo en jornada en España (1994-2004) / Evaluation of the effectiveness of preventive activities (strategic action plans) on the incidence of non-fatal traumatic occupational injuries leading to disabilities in Spain (1994-2004)

Fundamento. Los planes de actuación preferente (PAP) han sido lasprincipales actividades preventivas desarrolladas por las comunidadesautónomas (CCAA) frente a las lesiones por accidentes de trabajo (LAT)en España desde 1999. El objetivo de este trabajo es evaluar la efectividadde los planes.Métodos. Fueron seleccionados 4.714.080 casos incidentes de LATno mortales con incapacidad laboral, ocurridos entre 1994 y 2004 durantela jornada laboral producidos por causas mecánicas y por sobreesfuerzoen empresas manufactureras y de servicios no públicos. A partir de lasincidencias anuales se estimó en cada CCAA el porcentaje de cambioanual y su intervalo de confianza al 95% (IC95%) para el periodo anteriory posterior del inicio del PAP mediante una regresión binomial negativa.Resultados. El patrón observado siguió una tendencia ascendente en losperiodos previos al inicio del PAP y descendente a continuación de la puestaen marcha de estos planes. Por ejemplo, en Aragón, donde el PAP se inicióen 1999, observamos un incremento de +5,3% entre 1994-1999 frente a undescenso de -4,9% entre 2000-2004. En Baleares, que inició su PAP en 2002,la tendencia correspondiente fue de +5,4% entre 1994-2001 frente a -14%entre 2002-2004. Sin embargo, se observaron tendencias similares en Madrid(-3,9% entre 2000 y 2004) o en Galicia (-4,8% entre 2000 y 2004), donde noconsta que se pusieran en marcha un PAP específico en el periodo de estudio.Conclusiones. Estos resultados no permiten atribuir a los PAP el descensogeneralizado en la incidencia de las LAT no mortales a partir del 2000en España. Posiblemente, otras acciones de carácter general, que habríanafectado a todas las CCAA por igual (incluyendo a aquéllas que no han desarrolladosus propios PAP), explicarían este descenso en la incidencia de laslesiones por accidente de trabajo seleccionadas en el presente análisis(AU)

Backgound: The strategic action plans have been the mainpreventive activities carried out by the Autonomous CommunityGovernments in relation to occupational injuries in Spain since 1999.This study is aimed at evaluating the effectiveness of these plans.Methods.A total of 4,714,080 cases of non-fatal traumatic occupationalinjuries leading to disability having occurred within the 1994-2004 perioddue to mechanical causes and over-exertion at non-publicly owned serviceand manufacturing companies were included. Based on the annual incidencerates, the percentage of annual change and the 95% confidence interval (95%CI) were estimated for the periods prior to and following the start-up of theStrategic Action Plans by means of negative binomial regression.Results. The pattern found followed an upward trend during theperiods prior to the start-up of the Strategic Actions Plans, followed by adownward trend as of the start-up of these plans. For example, in Aragon,where the Strategic Action Plan was started up in 999, a +5.3% rise wasfound within the 1994-1999 period, as compared to a –4.9% decreaseduring the 2000-2004 period. On the Balearic Islands, which started uptheir Strategic Action Plan in 2002, the corresponding trend was +5.4%for 1994-2001, as compared to –14% for 2002-2004. However, similartrends were found in Madrid (-3.9% for 2000-2004) or in Galicia (-4.8%for 2000-2004), where there is no record of any specific Strategic ActionPlan having been gotten under way during the period under study...(AU)

[Evaluation of the effectiveness of preventive activities (Strategic Action Plans) on the incidence of non-fatal traumatic occupational injuries leading to disabilities in Spain (1994-2004)]. / Evaluación de la efectividad de las actividades preventivas (Planes de Actuación Preferente) sobre la incidencia de las lesiones traumáticas no mortales con incapacidad laboral por accidentes de trabajo en jornada en España (1994-2004).

BACKGROUND: [corrected] The strategic action plans have been the main preventive activities carried out by the Autonomous Community Governments in relation to occupational injuries in Spain since 1999. This study is aimed at evaluating the effectiveness of these plans. METHODS: A total of 4,714,080 cases of non-fatal traumatic occupational injuries leading to disability having occured within the 1994-2004 period due to mechanical causes and over-exertion at non-publicly owned service and manufacturing companies were included. Based on the annual incidence rates, the percentage of annual change and the 95% confidence interval (95% CI) were estimated for the periods prior to and following the start-up of the Strategic Action Plans by means of negative binomial regression. RESULTS: The pattern found followed an upward trend during the periods prior to the start-up of the Strategic Actions Plans, followed by a downward trend as of the start-up of these plans. For example, in Aragon, where the Strategic Action Plan was started up in 999, a +5.3% rise was found within the 1994-1999 period, as compared to a -4.9% decrease during the 2000-2004 period. On the Balearic Islands, which started up their Strategic Action Plan in 2002, the corresponding trend was +5.4% for 1994-2001, as compared to -14% for 2002-2004. However, similar trends were found in Madrid (-3.9% for 2000-2004) or in Galicia (-4.8% for 2000-2004), where there is no record of any specific Strategic Action Plan having been gotten under way during the period under study. CONCLUSIONS: These results do not make it possible to attribute the widespread drop in the non-fatal traumatic occupational injury incidence as of 2000 in Spain to the Strategic Action Plans. Possibly other actions of a general nature which may have had a bearing on all of the Autonomous Communities in the same manner (including those which have not developed their own Strategic Action Plans) might explain this drop in the incidence of the occupational injuries selected in this analysis.

Laparoscopia y cirugía hepática: técnica e indicaciones / Laparoscopic liver surgery: technique and indications

Introducción. La cirugía laparoscópica de los órganos sólidos ha ido ganando aceptación durante los últimos años. Sin embargo, la utilización del abordaje laparoscópico en las resecciones hepáticas ha sido muy limitado. En este artículo presentamos nuestra experiencia en la cirugía hepática laparoscópica, y establecemos sus indicaciones y las limitaciones técnicas que ésta conlleva. Pacientes y método. Estudio prospectivo y descriptivo de 14 pacientes con lesiones hepáticas quísticas y sólidas tratadas por vía laparoscópica desde febrero de 2000 a marzo de 2003. La mayoría de las lesiones se localizaban en los segmentos hepáticos izquierdos o periféricos derechos (segmentos II-VI). La técnica quirúrgica incluyó neumoperitoneo con CO2, resección hepática con bisturí armónico con o sin control vascular de la tríada portal. Las piezas de resección se extrajeron de la cavidad abdominal mediante una bolsa a través de una incisión accesoria. Resultados. Ocho pacientes presentaban lesiones quísticas y 6 lesiones sólidas (un hepatocarcinoma, una metástasis hepática de neoplasia de pulmón, una metástasis hepática de melanoma maligno, un adenoma y 2 lesiones de etiología desconocida tras el estudio diagnóstico). El tiempo quirúrgico medio fue de 149 min, el índice de conversión del 14,3 por ciento (2 pacientes), la estancia hospitalaria de 4 días; sólo se observaron complicaciones postoperatorias en un paciente con cefalea y fiebre, y en otro que presentó náuseas en el postoperatorio inmediato. La mortalidad de la serie fue del 0 por ciento. Conclusiones. La resección hepática laparoscópica es factible y segura en casos seleccionados; sin embargo, las indicaciones quirúrgicas no deben modificarse por la introducción de esta técnica. Las lesiones más favorables son las benignas o nódulos de pequeño tamaño localizados en los segmentos II, III, IVb,V y VI (AU)