Organización de la asistencia rehabilitadora extrahospitalaria en unidades de aparato locomotor en la Comunidad Foral de Navarra / Organization of outpatient rehabilitation care in locomotor disorder units in the Foral Community of Navarre

La asistencia rehabilitadora extrahospitalaria en la Comunidad Foral de Navarra se crea bajo el concepto de que la mayoría de los procesos del aparato locomotor pueden ser atendidos por la especialidad de rehabilitación a nivel extrahospitalario sin merma en la calidad asistencial. El principal objetivo es dar a conocer el modelo organizativo rehabilitador extrahospitalario existente en Navarra. Los objetivos secundarios son presentar la organización y funcionamiento de las unidades periféricas de rehabilitación desde la perspectiva de nuestra actividad clínica, prestando asistencia en diferentes unidades periféricas de rehabilitación. Revisamos planes de actuación de servicios de rehabilitación relacionados con este tema. Realizamos una búsqueda en PubMed, revisamos la normativa existente, comunicaciones en libros de abstracts de congresos de SERMEF, memorias de actividad anual de hospitales de la comunidad y programas asistenciales relacionados con rehabilitación extrahospitalaria. El modelo basa la asistencia extrahospitalaria en las zonas con mayor densidad de población en unidades periféricas de rehabilitación en el centro de especialidades. Para las regiones menos pobladas, alejadas del nivel hospitalario, se opta por unidades periféricas de rehabilitación en el centro de salud, ubicadas estratégicamente para garantizar una buena accesibilidad geográfi ca. Son objetivos prioritarios del modelo la equidad y la calidad científico-técnica. En el año 2000 se implementa el Plan de Coordinación Primaria-Especializada y en el año 2009 la unidad de raquis. En la Comunidad Foral de Navarra existe un modelo organizativo de rehabilitación extrahospitalaria coordinado con atención primaria, orientado fundamentalmente a la atención a procesos del aparato locomotor (AU)

Outpatient rehabilitation care in the Foral Community of Navarre arose from the belief that most locomotor system processes can be managed by the speciality of rehabilitation on an outpatient basis without compromising quality. This article aims primarily to describe the organizational model of outpatient rehabilitation in Navarre. Secondary aims are to present the organization and functioning of peripheral rehabilitation units through a description of their clinical activity, carried out in several units. We review the standards of rehabilitation care related to this topic. A literature search was performed in PubMed, and current regulations, communications in books of abstracts of the congresses of the Spanish Society of Rehabilitation and Physical Medicine, reports of annual activity of hospitals in Navarre, and welfare programs related to outpatient rehabilitation were reviewed. In areas with the highest population density, this model places peripheral rehabilitation units in the outpatient hospital setting or in specialized centers. In the least populated regions, geographically remote from the nearest hospital, these units are situated in health centers, and are strategically located to guarantee good geographical accessibility. The main priorities are equity and high scientific-technical quality. The Plan for Primary-Specialized Care Coordination was implemented in 2000 and the spinal unit in 2009. The organizational model of outpatient rehabilitation in Navarre is coordinated with primary care and is aimed mainly at the care of locomotor processes (AU)

[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

Calidad de vida en pacientes con y sin linfedema después del tratamiento del cáncer de mama. Implicaciones en la rehabilitación / Quality of life in patients with and without lymphoedema after breast cancer treatment. Implications in rehabilitation

Introducción: Para determinar el impacto que tiene el linfedema sobre la calidad de vida se ha evaluado ésta en dos grupos de pacientes intervenidas de cáncer de mama, unas afectas de linfedema y otras no, en dos controles con seis meses de intervalo.Pacientes y método: Se ha realizado un estudio prospectivo con 60 pacientes afectas de cáncer de mama, 20 con linfedema, con una edad media de 64 años (DE 12,4) y 40 sin linfedema, con una edad media de 59 años (DE 12,6). Se utilizaron dos cuestionarios de calidad de vida, el EORTC QLQ-C30 versión 2.0, que es un cuestionario general para el cáncer, y el EORTC Q1Q-BR23, que es específico para el cáncer de mama, ambos validados al castellano.Resultados: En las pacientes con linfedema se observan diferencias significativas (p<0,05) en la actividad física, imagen corporal, sexualidad, perspectivas de futuro y estado global de salud, pero no en la funcionalidad de la extremidad superior, mientras que las pacientes sin linfedema, muestran sólo diferencias significativas en las perspectivas de futuro (p<0,05). Al comparar en el control inicial ambos grupos se observan diferencias significativas en la actividad física (p<0,05), funcionalidad de la extremidad superior (p<0,05) y estado global de salud (p<0,05). A los seis meses las diferencias significativas (p<0,05) aparecen en todos los ítems evaluados. El linfedema es, pues, una condición que añade déficit en la calidad de vida en las pacientes, tratadas de cáncer de mama. Este déficit es mayor con el paso del tiempo, aunque hay un estado de convivencia con él (AU)

[Outpatient rehabilitation in the Foral community of Navarra: 1972-1997]. / Rehabilitación extrahospitalaria en la Comunidad Foral de Navarra: 1972-1997.

Rehabilitation care for persons with disabilities who live in zones distant from the hospital of reference represents a challenge even for the Health Services of the most advanced countries. The requirements of the principles of "Health for All in the Year 2000" of the 1981 WHO Assembly, fully assumed by Foral Law 10/1990 (integral conception of health, efficiency, equity, decentralisation, quality and humanisation in the service) have stimulated the initiatives proceeding from the Rehabilitation Service of the "Virgen del Camino" Hospital orientated towards the pragmatic application of those principles to the reality our Community. The result has been the creation of an outpatient care network with units in both the Specialties Units and the Health Centres. As in other neighbouring Communities, we are witnessing a growing increase in the demand for rehabilitation treatment; to a great extent this is due to the increasing age of the population. This must be regulated in order to guarantee access to quality rehabilitation for every person who requires it. In order to achieve the complete fulfillment of the objectives of the WHO we propose the co-ordination between levels of attention (Primary care and Specialised care), consolidation of the figure of the rehabilitation doctor as a specialised individual providing support to Primary care in the whole community, and the realisation of certain protocols for rehabilitation referral agreed upon with the Primary care doctors

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. II. Tobacco smoking.

This paper describes the smoking habits of six populations in France, Switzerland, Italy and Spain. A total of 2,965 men and 2,369 women have been interviewed. The proportion of ever smoking men is almost the same (75 to 80%) everywhere but in Geneva and Calvados a higher proportion of smokers quitted the habit (over 30%). In females, on the contrary, the prevalences of ever smokers is higher in Torino (42%) and Geneva (36%) than in Spain (25%) and Calvados (19%). Young females, however, tend to smoke more and intercountry differences tend to disappear. In both sexes successive generations begin to smoke earlier. Exclusive use of black tobacco is still very high in Calvados (90%) and Navarra (80%) whilst it tends to disappear in Italy (30%). Plain cigarettes decrease everywhere, especially in Spain and Varese, but they are still smoked by the majority of men in Calvados. The results suggest that the tobacco epidemic is still increasing in those areas where it began more recently.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. I. Study design and dietary habits.

Diet, tobacco and alcohol consumption, and occupational histories have been investigated in stratified random samples of the adult population in 6 areas in France (departement of Calvados), Italy (province of Varese and city of Torino), Spain (provinces of Navarra and Zaragoza) and Switzerland (canton of Geneva), to be used as a reference group in a case-control study on cancer of the larynx and hypopharynx. Out of a total of 8,074 sampled subjects, 5,564 could be interviewed. Sampling procedures are described, and reasons for non-response are analysed. Everywhere the intake of the 4 energy providing nutrients (particularly alcohol) was much greater in men than in women. In both sexes, total caloric intake was higher in Calvados and in Italy than elsewhere. There were wide inter-area variations in the consumption of butter + milk products and oils, resulting in a polyunsaturated/saturated fatty acid ratio ranging from 0.27 in Calvados to 0.54-0.65 in Spain. Among nutrients suggested to be involved in cancer aetiology, inter-area differences in daily intake were up to 3-fold for carotene and smaller for vitamin C and fibre. The proportion of lipids, fibres, vitamin C and carotene provided by different foods varied widely between areas, thus suggesting that in etiological cancer studies consideration should be given not only to nutrients but also to foods providing them.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. III. Consumption of alcohol.

Individual present and life time intake of aethanol has been studied in population samples of six areas of Italy (Torino, Varese), Spain (Navarra, Zaragoza), Switzerland (Geneva) and France (Calvados); 2,965 men and 2,369 women were interviewed. Abstinent men were no more than 4% except in Zaragoza (11.5%); 49 to 61% drank between 20 and 80 g. aethanol a day and 21 to 26% more than 80 g. (36% in Navarra). Women drank much less and were more often abstinent: 50 to 94% of them did not drink or drank less than 20 g. a day. Wine was the most commonly consumed beverage (over 60% of total alcohol intake), except in Calvados where cider was still largely consumed (over 30%). Such differences in drinking habits by sex and region are of major public health importance. They do not appear in national sales statistics which must be complemented by surveys on individuals.

[Statistical research and epidemiology in oncology]. / La investigación estadística y epidemiológia en oncología.

The author indicates briefly the results from the statistical and epidemiological studies of cancer in Spain. Between 1903 and 1978 cancer mortality passed from 39.00 per 100.000 to 152.4 per 100.000, and sex distribution from 43% men and 56% women to 57% men and 42% women. Cancer represented 1.52% of the total mortality in 1903 and 18.95% in 1978. The largest incidence of cancer diseases is observed for ages between 45 and 75 years in men, with a maximum at 60, and between 40 and 71 years in women, with a maximum at 55. In all Spanish regions the most frequent mortal localizations are lung cancer among men and mammary cancer among women. The second place corresponds to stomach cancer in both sexes. Other important causes of death are the tumors of the prostate, liver, urinary bladder, larynx, colon and rectum, hematopoietic system, and esophagus in man, and the neoplasms of liver, lung, body of the uterus, colon and rectum, hematopoietic system and gallbladder and bile ducts in women. It is surprising the high frequency of primitive liver cancer in some regions, reaching an incidence of 4.39% in Tarragona and 6.07% in Zaragoza.

[Geographic distribution in some latin countries of cancers of the alimentary tract (author's transl)]. / Distribution géographique des cancers digestifs dans quelques régions de pays latins.

Geographic distribution in some latin countries of cancers of the alimentary tract. A comparison of alimentary tract cancer incidence rates has been undertaken from the results of 5 latin cancer registries. The most striking features are the high incidence rates for gastric cancers in the provinces of Zaragoza and Piemont, for colorectal cancers in the canton of Geneva, and in the countries of Côte-d'Or and Bas-Rhin. Tumour localization in the large bowel differs significantly between Geneva and the French counties. The canton of Geneva has the highest rate for cancer of the pancreas, French countries for cancer of the oesophagus in males. Sex ratio for primary cancer of the liver differs considerably from one region to another.