Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis.

BACKGROUND: Despite the significant impact of nosocomial infections on the morbidity and mortality of patients staying in the intensive care unit (ICU), no study over the past 20 years has focused specifically on VAP following secondary peritonitis. The objective of the present study was to determine in-hospital mortality and epidemiological features attributed to ventilator-associated pneumonia (VAP) following secondary peritonitis. METHODS: Prospective observational study involved 418 consecutive patients admitted in the ICU. Univariate and multivariate analyses were performed to identify risk factors associated with mortality and development of VAP. RESULTS: The incidence of VAP following secondary peritonitis was 9.6 %. Risk factors associated with the development of VAP were hospital-acquired peritonitis, requiring >48 h of mechanical ventilation, and SOFA score. The onset of VAP was late in majority of patients. VAP was developed about 16.8 days after the initiation of the peritonitis. Etiological microorganisms responsible for the peritonitis were different than for VAP. The 90-day in-hospital mortality rate was 47.5 % of VAP patients. Independent factors associated with 30- to 90-day in-hospital mortality were VAP and SOFA. CONCLUSIONS: In light of the impact on morbidity and mortality in the ICU, more attention should be given to the concurrent features among VAP and secondary peritonitis.

Problemas laborales en pacientes dependientesdel alcohol: Evolución en un año de tratamiento / Work–related problems among alcohol–dependent patients: Development a year of alcohol treatment

Objetivo: El objetivo de este estudio es analizar la prevalencia de problemas laborales debidos al consumode alcohol en una muestra de dependientes del alcohol y su evolución durante un año de tratamiento.Material y Método: Se realizó un estudio prospectivo de una cohorte de 93 pacientes, que realizarontratamiento durante un año, diagnosticados de dependencia del alcohol según criterios DSM–IV. Se obtuvoinformación de los siguientes problemas laborales debidos al consumo de alcohol: absentismo, llamadas deatención, sanciones, accidentes laborales, despidos, desempleo o paro, ocurridos en tres momentos: durantetoda la vida, el año anterior al inicio del tratamiento y durante un año de tratamiento.Resultados: El 57% tuvieron problemas laborales a lo largo de su vida, el 35,5% el año anterior al iniciodel tratamiento, y el 23,7% durante el año de tratamiento. Los problemas mas frecuentes fueron el absentismoy el desempleo. Los problemas laborales disminuyeron (p<0,05) durante el año de tratamiento respecto alaño anterior al inicio del tratamiento.Discusión: Este estudio indica que los problemas laborales son frecuentes entre los dependientes delalcohol, y que estos disminuyen con el tratamiento de la dependencia del alcohol (AU)

Objetive: The aim of this study is to analyse the prevalence of work–related problems due to the consumptionof alcohol in a sample of alcohol–dependent patients and their evolution over twelve months of treatment.Method: A prospective study was carried out on a cohort of 93 patients diagnosed as alcohol–dependentaccording to DSM–IV criteria, who underwent treatment over a 12 month period. Information concerning thefollowing work–related problems due to the consumption of alcohol was obtained: absenteeism, warnings,sanctions, accidents at work, dismissals and unemployment, that occurred within three different time scales: thepatient’s lifetime, the 12 months prior to the start of the treatment and during the 12 months of the treatment.Results: 57% had had work–related problems during their lifetime, 35.5% in the 12 months prior tostarting treatment and 23,7% during the year of treatment. The most frequent problems during the year oftreatment were absenteeism and unemployment. Work–related problems decreased (p < 0.05) during thetreatment with respect to the year prior to the start of the treatment.Conclusion: This study indicates that work–related problems are frequent among alcohol–dependentpatients, but that such problems decrease when the dependency is treated (AU)

Alcohol y prevención de los problemas relacionados con el consumo de alcohol en el ámbito laboral / No disponible

La importancia del alcohol en el medio laboral es indiscutible ya que el alcohol es la droga más consumida entre los trabajadores. Los problemas detectados más frecuentemente en el trabajo por consumo de alcohol han sido: absentismo, incremento de las bajas laborales, mayor accidentabilidad, disminución del rendimiento, mayor conflictividad, incumplimiento de la jornada laboral, comisión de más errores, aumento de expedientes disciplinarios, aumento de despidos y como consecuencia más paro. Se ha relacionado el tener problemas con el alcohol con el tipo de de trabajo y con el incremento de la oferta/disponibilidad de bebidas alcohólicas. Los costes económicos que producen a las empresas y a los países los consumidores de alcohol son importantes, en España los costes debidos a bajas laborales por consumo de alcohol ascienden a 72.854 millones de €/año. Algunas empresas además de las normas sobre consumo proporcionan ayuda a los empleados que tienen problemas con la bebida, realizando programas de prevención primaria (información), prevención secundaria (tratamiento), prevención terciaria (reinserción laboral). Son necesarias políticas de prevención relacionadas con el consumo de alcohol en la empresa ya que se ha demostrado que los servicios de prevención producen más ahorro que coste requiere el programa y es menos costoso que el tratamiento de los trabajadores con adicción al alcohol

The importance of alcohol at work is undeniable as it is the drug most commonly consumed by workers. The most frequently detected problems in the labor field due to the consumption of alcohol are: absenteeism, an increase in absense due to illness, a greater number of accidents, lower performance levels, higher levels of conflict, not complying with the required number of work hours, a higher percentage of errors, an increase in disciplinary proceedings, an increase in the number of workers fired and consequently higher unemployment. Having problems with alcohol has been related to certain types of work and to the increase in the supply/availability of alcoholic beverages. The economic costs caused by consumers of alcohol that companies and countries have to face are sizeable. In Spain, the costs from loss of working days due to the consumption of alcohol has reached 72.854 million €/year. Apart from rules concerning consumption of alcohol, some companies provide assistance for employees who have problems with alcohol, carrying out primary prevention programs (information), secondary prevention (treatment), and tertiary prevention (work rehabilitation). Preventive policies concerning the consumption of alcohol at work are necessary as it has been proved that prevention services save more money than the cost of the programs themselves, and that it is less costly than the treatment of alcohol dependent workers