[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

La vigilancia de la salud de los trabajadores expuestos al amianto: ejemplo de colaboración entre el sistema de prevención de riesgos laborales y el sistema nacional de salud / Health surveillance of workers exposed to asbestos: an example of co-operation between the occupational prevention system and the national health system

El Ministerio de Sanidad y Consumo y las Comunidades Autónomashan diseñado y consensuado con los profesionales sanitariosy las organizaciones empresariales y sindicales representativas unPlan Integral de Vigilancia de la Salud de los Trabajadores que hanestado expuestos a Amianto, con el objetivo de garantizar una intervenciónadecuada, uniforme y armonizada de estos trabajadores entodo el territorio nacional. La elaboración del Programa partió delGrupo de Trabajo de Salud Laboral del Consejo Interterritorial, seenriqueció con las aportaciones del Grupo de Trabajo Amianto de laComisión Nacional de Seguridad y Salud en el Trabajo, fue consensuadocon los profesionales de la medicina y enfermería del trabajo,y fue aprobado por las autoridades sanitarias y laborales. El Programaconsta de siete grandes bloques de actividades. Dos años despuésde aprobado el Programa, el estado de implantación en las ComunidadesAutónomas es desigual. Las principales dificultades para supuesta en marcha se encuentran en la elaboración del Registro deexpuestos. Un total de 5.778 trabajadores están incluidos en el Registro.208 trabajadores tienen EPOC, 198 alteraciones pleurales benignas,8 cáncer de pulmón, 10 mesotelioma y 7 presentan otros cáncerescon posible relación con el amianto (gástrico, de laringe y colon). El consenso y la participación alcanzados alrededor de este Programaestán permitiendo lograr coberturas de las políticas de prevenciónde riesgos laborales muy superiores a las que se consiguen conla mera actuación institucional y elaboración de normativa, ya que ensólo los dos primeros años de implantación del Programa se ha duplicadoel número de trabajadores atendidos

The Ministry of Health and Consumer Affairs and the AutonomousGovernments of Spain have designed and agreed by consensuswith the sanitary professionals and major employer's organizationsand Unions a Integral Health Surveillance Programme ofasbestos-exposed workers, in order to assure appropriate, uniformand harmonized action throughout the national territory with relationto these workers. Program description: this initiative startedfrom the Occupational Health Working group of the InterterritorialCouncil, with inputs from the Asbestos Working Group of theNational Occupational Safety and Health Commission. It was agreedwith occupational medicine and infirmary professionals and wasapproved by the Health and Labour authorities. The program isorganised in seven main activities. Current Program status: twoyears after the Programme approval a total of 5,778 workers areincluded in the Registry of asbestos-exposed workers. 208 workershave COPD, 198 benign pleural disease, 8 lung cancer, 10 mesotheliomaand 7 workers have other cancers possibly related toasbestos (gastric, larynx and colon cancer). Remarks: the agreementand participation reached in this Programme allow achievingmuch higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see duringthe second year of implementation of the Programme in which thenumber of attended workers has doubled

[Role of specialized care services of the national health service in the framework for the prevention of occupational risks (II)]. / Papel de los servicios de Atención Especializada del Sistema Nacional de Salud en el nuevo marco de la prevencion de riesgos laborales (y II).

INTRODUCTION: Since 1986, the Government of Navarra has taken over the functions of security and health as part of the health 'area', with a broad conception of health, avoiding separating the citizen from the worker. In 1993, the Instituto Navarro de Salud Laboral created, under the direction of the departments of Health and Labor, combined diverse functions and resources, integrating preexisting structures into a technical department to be responsible for the overall health care of workers. DEVELOPMENT: The structure is based on two coordinated pillars, security and hygiene at work and occupational health. As more specifically to do with health, we describe the systems of epidemiological information and vigilance and programs for occupational disabilities, health activities in industry and investigation of diseases. The Unidades de Salud Laboral link the workplace with the public health service. The occupational health plan of Navarra will set out future strategies. CONCLUSIONS: It is necessary to involve neurologists in occupational health. Occupational risks and injury are everyone's problem. The neurologist's role in accidents is usually of health care; detection of illness is more difficult when an occupational relationship is not considered. Data from work should be included in the clinical history. The official figures for occupational neurological diseases are ridiculous and more cases should be detected. There should be a fluid relationship between neurologists, occupational doctors and experts in prevention.

Papel de los servicios de Atención Especializadadel Sistema Nacional de Salud en el nuevo marcode la prevencion de riesgos laborales (y II) / The role of specialist medical services in the National Health Service in the new framework for the prevention of industrial accidents (& II)

Introducción. Desde 1986, el Gobierno de Navarra adscribió las funciones de seguridad e higiene al área sanitaria, con una concepción amplia de salud, evitando la separación ciudadano-trabajador. En 1993, creó el Instituto Navarro de Salud Laboral, co-tutelado por los departamentos de Salud y Trabajo, el cual aunaba funciones y recursos dispersos, integrando en un órgano técnico las estructuras existentes, para contemplar de forma globalizada la salud de todos los trabajadores. Desarrollo.Su estructura se fundamenta en dos pilares coordinados, la seguridad e higiene en el trabajo y la salud laboral. Como más específicamente sanitarios, se señalan los sistemas de información y vigilancia epidemiológica y los programas sobre incapacidades laborales, actividades sanitarias en las empresas e investigación de patologías. Las Unidades de Salud Laboral enlazan el mundo del trabajo y el sistema público de salud. El plan de salud laboral de Navarra fija las estrategias futuras. Conclusiones. Es necesaria la incorporación de los neurólogos a la salud laboral. Los riesgos y daños laborales son cuestión de todos. La función del neurólogo en los accidentes suele ser asistencial; es más difícil la detección de enfermedades, al no pensarse en una relación laboral. Los datos del trabajo deben incluirse en la historia clínica.Las cifras oficiales de enfermedades neurológicas laborales son ridículas y deberían detectarse un mayor número de casos. Debería existir una relación fluida entre neurólogos, médicos del trabajo y técnicos de prevención (AU)

[The Instituto Navarro de Salud Laboral: an experience in collaboration between health and occupational jurisdictions]. / El Instituto Navarro de Salud Laboral: una experiencia de colaboración entre competencias sanitarias y laborales.

BACKGROUND: Ever since 1986, when the first jurisdictional transfers took place from the State to Navarre in matters concerning occupational health and hygiene, the allocation of the different functions and means related to occupational health and the health structure has been an ongoing process. These activities were carried out from an overall health perspective, in the spirit of the General Health Act and the Local (Navarre) Health Act. Workers were viewed in a global way, no distinction being made between their work situation and the rest of their lives. That is why the Provincial Technical Bureau for Occupational Health and Hygiene was set up in 1986, followed by the Occupational Health Bureau, in 1988, as part of the Public Health Institute. THE NAVARRE OCCUPATIONAL HEALTH INSTITUTE: This was set up in 1993, under the responsibility of the Health Department. It incorporated the occupational health means which already existed in the Navarre Government. It was restructured in November 1995. The Departments of Health and Employment jointly control it, and collaboration between the two departments and other units, is the key factor. CONCLUSIONS: Experiences of over nine years, and especially the last three, have made it possible to guarantee that activities concerning occupational safety, hygiene and health do not depend to a greater or a lesser extent upon the spheres of either employment or health, but upon Public Administration in general, and the civil servants involved. Administrative coordination in such matters is of paramount importance.