Escuela Nacional de Medicina del Trabajo

BACKGROUND: Incidence studies of spinal cord injury (SCI) are important for health-care planning and epidemiological research. This review gives a quantitative update on SCI epidemiology worldwide through a statistical evaluation of incidence rates. METHODS: A systematic review was conducted. For each study, the crude rate ratio was calculated and, when possible, age- and gender-adjusted incidence rate ratios with 95% CI were determined by direct adjustment or using Poisson regression. RESULTS: Thirteen studies were included. Annual crude incidence rates in traumatic SCI varied from 12.1 per million in The Netherlands to 57.8 per million in Portugal. Compared to the Portuguese reference study, incidence rates showed a 3-fold variation, with the highest rates in Canada and Portugal. Most traumatic SCI studies showed a bimodal age distribution. The first peak was found in young adults between 15 and 29 years and a second peak in older adults (mostly > or = 65 years). Motor vehicle accidents and falls were the most prevalent causes of injury accounting for nearly equal percentages. In contrast, another age pattern in non-traumatic SCI reflected steadily increasing incidence with advancing age. CONCLUSIONS: The results show significant variation in SCI incidence with changing epidemiological patterns. A trend towards increased incidence in the elderly was observed, likely due to falls and non-traumatic injury.

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic/parasympathetic neural ganglia, respectively. The heterogeneity in its etiology makes PPGL diagnosis and treatment very complex. The aim of this article was to provide practical clinical guidelines for the diagnosis and treatment of PPGLs from a multidisciplinary perspective, with the involvement of the Spanish Societies of Endocrinology and Nutrition (SEEN), Medical Oncology (SEOM), Medical Radiology (SERAM), Nuclear Medicine and Molecular Imaging (SEMNIM), Otorhinolaryngology (SEORL), Pathology (SEAP), Radiation Oncology (SEOR), Surgery (AEC) and the Spanish National Cancer Research Center (CNIO). We will review the following topics: epidemiology; anatomy, pathology and molecular pathways; clinical presentation; hereditary predisposition syndromes and genetic counseling and testing; diagnostic procedures, including biochemical testing and imaging studies; treatment including catecholamine blockade, surgery, radiotherapy and radiometabolic therapy, systemic therapy, local ablative therapy and supportive care. Finally, we will provide follow-up recommendations.

Zusammenfassung In den letzten Jahrzehnten ist ein qualitativer Wandel in der Natur von internationalen Migrationsprozessen zu registrieren, und im Zusammenhang der allgemeinen Globalisierungstendenzen ist von einem neuen „Zeitalter der Migration“ (Castles/Miller 1993) die Rede. Dieser Wandel legt auch die Veränderung des theoretischkonzeptionellen Bezugs- und Fragenrahmens nahe. Traditionell wurden internationale Migrationsprozesse in den Sozialwissenschaften überwiegend in der Perspektive unidirektionaler und einmaliger Wanderungen analysiert, wobei die Fragen nach den individuellen und strukturellen Bedingungen für Migrationsentscheidungen und die Mechanismen und Probleme der Assimilation im Mittelpunkt standen. Neuerdings gerieten die zwischen den Herkunfts- und Ankunftsregionen sich entwickelnden sozialen Vermittlungsprozesse und Netzwerkstrukturen verstärkt in das Blickfeld. Diese neue empirische Qualität gegenwärtiger internationaler Migrationsströme und die veränderten wissenschaftlichen Perspektiven hierauf legen es nahe, dem Phänomen des Entstehens neuer Transnationaler Sozialer Räume in der theoretischen Arbeit und in der praktischen Forschung besondere Aufmerksamkeit zu schenken. Hierunter werden „soziale Verflechtungszusammenhänge“ verstanden, die geographisch-räumlich diffus bzw. „de-lokalisiert“ und nicht nur transitorischer Natur sind, eine wichtige Referenzstruktur sozialer Positionen und Lebensstile darstellen und über den Sozialzusammenhang von Nationalgesellschaften hinausweisen. Am Beispiel der Arbeitswanderung zwischen Mexico und den USA werden aus einem laufenden Forschungsprojekt empirische Anhaltspunkte für das Entstehen Transnationaler Sozialer Räume und konzeptionelle Überlegungen zu deren präziserer Bestimmung vorgestellt.

Models for the development of species distribution in Europe typically invoke restriction in three temperate Mediterranean refugia during glaciations, from where recolonization of central and northern Europe occurred. The brown bear, Ursus arctos, is one of the taxa from which this model is derived. Sequence data generated from brown bear fossils show a complex phylogeographical history for western European populations. Long-term isolation in separate refugia is not required to explain our data when considering the palaeontological distribution of brown bears. We propose continuous gene flow across southern Europe, from which brown bear populations expanded after the last glaciation.

Despite the recent academic interest in the study of customer equity (CE henceforth), a comprehensive discussion of the prevailing research issues has not been provided. There is a shift in the interest of managers and researchers from a traditional focus on product management to a more recent focus on customer relationship management (CRM). We believe that research on CE could provide the necessary tools to link CRM to long-term financial performance. In this paper, we (a) discuss the academic and strategic importance of CE, (b) provide an extensive literature review, and (c) prioritize future research. We argue that there are two major agendas for future research in CE. The first is to provide better measures (e.g. the measurement of customer lifetime value), and the second is to identify the strategies that lead to CE maximization. We emphasize modeling approaches that have been used or could be used to tackle the suggested research questions. A special focus is given to statistical models that are capable of incorporating long-run dynamics.

The presence of a high prevalence of bronchial hyperresponsiveness and asthma-like symptoms in swimmers has been recently reported. Chlorine, a strong oxidizing agent, is an important toxic gas that the swimmer can breath during swimming. Measurements of the chlorine concentration at the breathing level (< 10 cm) were obtained randomly during five nonconsecutive days in four different swimming pool enclosures. The mean level in all the swimming pools was 0.42 +/- 0.24 mg.m-3, far below the threshold limited value (TLV) of 1.45 mg.m-3 for the work places for a day of work (8 h). The TLV could be reached and even exceeded if we consider the total amount of chlorine that a swimmer inhales in a daily training session of 2 h (4-6 g) compared with a worker during 8 h at the TLV (4-7 g). Low correlation was observed with the number of swimmers in the swimming pool during the measurements (0.446) and other variables as the water surface area of the pool, volume of the enclosure, and the chlorine-addition system in the swimming pool. A low turnover rate in the air with an increase of chlorine levels through the day (P < 0.05) was observed in all pools. The concentration of chlorine in the microenvironment where the swimmer is breathing is below the TLV concentration limit, but nevertheless results in a high total volume of chlorine inhaled by the swimmers in a given practice session. The possible role of chlorine in producing respiratory symptoms in swimmers needs further investigation.

OBJECTIVE: The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. METHODS: A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities. RESULTS: Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers' compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders. CONCLUSION: Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature.

Abstract Various hydration properties (solubility, water binding capacity and viscosity) of collagenous material from muscle connective tissue and skin are analysed in terms of pH and NaCl concentration in the medium. In general terms it is found that functionality is at its greatest where pH is between 2 and 4, and that the addition of NaCl reduces functionality, except in the case of viscosity. Both collagenous materials react similarly to changes deriving from pH and the addition of NaCl. The data are relevant to the possible utilisation of waste products from the fish industry as functional ingredients in other foodstuffs.

Purpose The purpose of this research is to illuminate the processes that give rise to gendered career pathways in Spanish academia, tracing how individuals might move from academic “passion” to academic “consecration” in a setting in which both visible and veiled discrimination persist. By examining academics' testimony, the paper aims to explore the production and reproduction of complex dynamics of power and gender inequalities through informal processes. Design/methodology/approach Qualitative study, drawing on semi‐structured interviews with 33 academics (16 female and 17 male) working in academic departments of psychology (17) and engineering (16) in three Madrid universities. Findings Although the percentage of professors in Spanish universities who are female is relatively high, compared to many European countries, this quantitative feminization does not appear to be associated with clear institutionalization of formal gender equality policies or the elimination of tacit discriminatory practices. Despite recent measures to reform the recruitment patterns in Spanish universities towards a more meritocratic model, the tradition of a sistema endogámico (an “inbreeding” system) persists, under which appointments are frequently made on the basis of internal (departmental) networks. This was found to operate to the disadvantage of women in both disciplines studied. Originality/value Despite the limitations inherent in a small‐scale study, this paper is likely to help not only to increase awareness of gender bias, but also to contribute to the reevaluation of the current university culture in Spain which, through its ostensibly gender‐neutral recruitment practices rooted in internal networks, constrains women's career opportunities.

Abstract Animal-assisted therapy (AAT) may affect health via an increase in perceived social support and social interaction. A meta-analysis was conducted to determine its effects on selected populations with poor social functioning. Studies involving elderly participants and those with depression and schizophrenia were searched in Medline, PsycINFO and Cochrane up to January 2009. Matched or controlled trials incorporating pre- and post-test outcome measures and with at least five participants subjected to a multiple-day AAT intervention were selected (n=21). Participants' characteristics, study design, intervention features, outcome variables, reported effects and study quality were retrieved. Design-specific effect sizes were pooled using random-effects models. Heterogeneity of effects by study characteristics, including target population and intervention features, was explored through meta-regression. Pooled effect sizes were calculated for social functioning, depression, anxiety, behavioural disturbances, loneliness, daily living skills and cognitive status. As hypothesised, AAT improved social functioning (pooled effect size = 1.06, n=275). Moderate effects were found for depression (−0.34, n=447), anxiety (−0.29, n=291) and behavioural disturbances (−0.32, n=367). Effects on social functioning and depression were larger in individuals with psychiatric conditions while behavioural disturbances were reduced in patients with dementia. The inconsistent methodological characteristics of the studies meta-analysed suggest a conservative interpretation of these findings.

OBJECTIVES: Describe the Estudio Nacional de Salud y Envejecimiento en México (ENASEM), also known by its name in English as the Mexican Health and Aging Study (MHAS). MATERIALS AND METHODS: This article summarizes the study design, its fieldwork protocol, survey contents, scope and analytical potential. It also presents descriptive results on selected topics. This is a prospective panel study on persons aged 50 or older in the year 2000. RESULTS: In the baseline survey, completed in 2001 with a national and urban-rural representation, about 15 200 interviews were completed. In the follow-up survey of the same persons in 2003, 90% of the attempted contacts resulted in successful interviews, and 546 interviews were completed about individuals who had died between the 2001 and 2003 visits. Descriptive results are presented on demographic characteristics, health, life style, institutional support, pensions, employment, family help, and two-year changes in health. CONCLUSIONS: There is evidence of large heterogeneity among older adults in Mexico, which is illustrated in a brief and precise way in the results presented. This study and its data bases have great analytical potential for exploring multiple dimensions in the health of older adults.

The growth of single crystal β‐silicon nitride fibers (see Figure) several millimeters long through the application of self‐propagating high‐temperature synthesis is demonstrated. Advantages include the igh purity of the fibers obtained, the fact that the fibers are stable up to 2000°C, and the low cost of the SHS process magnified image .

PURPOSE: Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could be applied in global health care settings. The purposes of this paper are to propose: (1) principles to transform the delivery of spine care; (2) an evidence-based model that could be applied globally; and (3) implementation suggestions. METHODS: The Global Spine Care Initiative (GSCI) meetings and literature reviews were synthesized into a seed document and distributed to spine care experts. After three rounds of a modified Delphi process, all participants reached consensus on the final model of care and implementation steps. RESULTS: Sixty-six experts representing 24 countries participated. The GSCI model of care has eight core principles: person-centered, people-centered, biopsychosocial, proactive, evidence-based, integrative, collaborative, and self-sustaining. The model of care includes a classification system and care pathway, levels of care, and a focus on the patient's journey. The six steps for implementation are initiation and preparation; assessment of the current situation; planning and designing solutions; implementation; assessment and evaluation of program; and sustain program and scale up. CONCLUSION: The GSCI proposes an evidence-based, practical, sustainable, and scalable model of care representing eight core principles with a six-step implementation plan. The aim of this model is to help transform spine care globally, especially in low- and middle-income countries and underserved communities. These slides can be retrieved under Electronic Supplementary Material.

Anaerobic sealants are acrylates that polymerize in the absence of oxygen. They are used principally in the engineering and electronic industries. Their use can cause occupational dermatitis in the workers who handle them. In this work, we report our experience with 6 patients who presented with allergic contact dermatitis to these sealants.

The unstable and adverse working conditions Greek EFL (English as a Foreign Language) teachers are called to operate within as well as the scarcity of research on EFL teachers' job satisfaction more generally, prompted this study which aimed at identifying the job satisfaction levels and sources of motivation of Greek EFL teachers. The findings of this survey shed light on the factors/issues that affect EFL teachers' motivation and that need to be taken into account by educational policy makers and school advisors, if high quality public school foreign language education is to be achieved.

Abstract In an attempt to establish objective criteria for texture analysis as an effective substitute for organoleptic procedures, correlation between the results obtained by a panel of tasters and physical and chemical analyses of texture was determined. In addition, regression equations relating instrumental and sensory methods were applied to predict sensory data from those obtained during instru mental analysis.

Long-term incidence studies are required to identify high-risk groups, establish trends, and forecast needs, and thus contribute to health care planning in spinal cord injury (SCI). This study aimed to determine the incidence of traumatic SCI over a 36-year period in Aragón, Spain, and compare rates with other published European estimates. Hospital records from the Servet Hospital, the only specialized SCI unit in the region, of a retrospective cohort with traumatic SCI between January 1972 and December 2008 were reviewed. Specification of SCI patient demographics, injury causes, and related factors was achieved by utilizing medical records available for inpatients, hospital archives, and central databases. A total of 540 cases were reported over the 36-year study period (79% were male). The age- and sex-adjusted incidence rate was 15.5 per million population (18.8 for males and 4.9 for females). Two incidence peaks were suggested, in the 20- to 29-year and 60- to 69-year age groups. Traffic accidents and falls were the main causes of injury. The highest peak occurs in young adults, mainly caused by traffic accidents. The majority of the lesions were at cervical or thoracic level, and ASIA grade A was most frequently observed. The proportion of SCI cases in persons older than 60 years, mostly due to falls, is increasing. The age-adjusted incidence rates found for the region of Aragón in Spain fall within the range of other published European estimates. Comparative epidemiological features for 2001-2008 suggest that there is room for prevention.

Abstract This paper presents a study of the effects of frozen storage on certain functional properties, namely protein solubility, emulsifying capacity, and viscosity, both in meat and in fish. Correlations between these three functional properties were examined in an attempt to find the easiest and most sensitive method of analysis. High correlation among the different functional properties tested was found only in the case of fish. This, together with the significant variations in the viscosity values found during the storage period, suggests that the analysis of apparent viscosity is a valuable indicator method for determining alterations occurring in the functional characteristics of fish protein.

PURPOSE: The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. METHODS: The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. RESULTS: After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records. CONCLUSION: A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.

En este artículo se presenta el proceso y los resultados de una investigación de enfoque cualitativo que busca comprender las razones por las que algunas escuelas no logran que sus alumnos aprendan tanto como sería esperable teniendo en cuenta su contexto. Se trata de un estudio en profundidad en ocho escuelas "eficaces negativas" de Educación Primaria de otros tantos países iberoamericanos. Dichas escuelas fueron seleccionadas a partir de un estudio más amplio, de carácter cuantitativo y en el que se midió no solo su desempeño en áreas curriculares, como Lengua y Matemáticas, sino también diferentes variables socio-afectivas como el autoconcepto o el bienestar en la escuela bajo un planteamiento de valor agregado. Mediante la aplicación de grupos focales a docentes, estudiantes, y padres y madres, entrevistas semiestructuradas a docentes y directivos, y a través de la observación del aula y la escuela se consiguió una imagen holística. Entre los factores hallados se encuentra un clima negativo, la falta de compromiso y motivación, la sensación de desánimo, el poco trabajo en equipo del profesorado, una dirección ausente o autoritaria, la poca implicación de las familias, las bajas expectativas globales, los procesos de enseñanza reproductivos, e instalaciones inadecuadas y desatendidas.