However, for the analysis in this study, only patients treated in German hospitals were considered. The NMTR also includes information about trauma patients who died on the scene or while being transported to the hospital . Furthermore information about the severity of the injury at the scene of a motor vehicle crash, calculated by Structural Deformity Index , is also documented in the NMTR . The use of the SDI can assist prehospital and hospital health care providers if particular serious injuries are suspected and anatomical and physiological criteria are not definitive. The main aim of the present study was to compare the Injury profile, treatment and outcome of severely injured patients in Navarra and Germany using trauma registries in the respective countries.
Brain cancer incidence in Navarre and the Basque Country is still increasing with time. The number of high risk areas within those two regions is also increasing. High risk regions were detected using upper one-sided confidence intervals.
Nowadays population based cancer registries include benign brain tumors for a better understanding of brain cancer epidemiology. However, we have not included them in this study because we did not have this information available for the whole period 1986–2008. Although these rates are high, there are other European regions with higher rates in both genders like Croatia, Norway, Serbia, Sweden and some regions of Italy and Poland. In Spain, rates ranged from 4.8 in Cuenca to 7.8 in Navarre for males, while for females the range varied between 3.0 in La Rioja and 5.7 in Navarre. In our analysis, significantly high risk areas were found in Pamplona and surrounding areas and also in municipalities close to the border between Navarre and Gipuzkoa.
If, during that year, the individual is a non-resident, the deferred compensation related to Spanish services will be taxed at a fixed general rate of 24 percent (19 percent if resident in an EU or EEA country/jurisdiction). If they are a resident, the compensation will be added to their worldwide income and taxed at progressive rates . Sampalis JS, Nathanson R, Vaillancourt J, Nikolis A, Liberman M, Angelopoulos J, et al. Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers. Study patients in Germany stayed longer in the hospital in comparison with the stay in Navarra. Some studies have examined the length of hospitalization in trauma patients, indicating that prehospital interventions such as endotracheal intubation and other procedures performed by prehospital teams at the site of the trauma can be associated with other complications such as pneumonia.
The outcome of emergency care of severely injured patients in Navarra has been compared previously. Gomez de Segura et al. compared the Navarra Emergency System and Atlantic Pyrenees using data from 2001 to 2002. The results showed that despite more aggressive approach and employment of great resources, the French comprehensive emergency system didn’t show greater survival rates among injured patients compared to Navarra . Despite the importance of injuries, there are no strict national guidelines for trauma care in Spain, nor is there a nation-wide trauma registry. It has been shown that trauma registries are valid tools to assess and improve trauma care .
Tax Treaty provisions would also have to be checked as, in certain occasions, refunds might be claimed if the Spanish withholdings applied exceeded the maximum rates foreseen in the applicable Tax Treaty. If the absences deemed temporary, the period stayed outside of Spain will be also computed as period of residence, unless the individual could prove that they have been regarded as tax resident in a third country/jurisdiction during those temporary absences. Sporadic absences are considered days of presence in Spain unless the individual can prove their tax residence status in another country/jurisdiction (if a tax haven, the individual can be requested to have spent at least 183 days during the calendar year in that country/jurisdiction).
After having identified some differences between the two trauma populations, the next step is to determine if there are regional distinctions in the treatment of trauma patients and the organization of trauma care. Most mechanisms of injury in both data registries were classified as blunt trauma, particularly in vehicle-related accidents and falls. However, more vehicle-related accidents and a high percentage of young injured patients were seen in the German data (Fig.3). Drunk driving, drowsy driving, and careless driving are several examples of the causes of motor vehicle accidents, and all of them are prominent in young men in general . The high percentage of young injured people in Germany compared to the observed in Navarra percentage may be due to the traffic culture and the relatively liberal speed limits on the German highways. In Navarra, the speed limit in highways is 100 km/h and 120 km/h in motorways.
International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high performers for insight into possible responses. In addition, by using an international perspective, comparisons can inform benchmarks and targets for national and/or provincial governments. For successful benchmarking, meaningful performance benchmarks that can guide health policy and patient care decisions must be drawn from comprehensive, systematically collected, and valid data . In Spain, data are limited at national level, and most of the well-established trauma registries are at regional or provincial level, such as the NMTR .
The first leg is to Alsasua, which is easily reached by train or bus from San Sebastian, both taking roughly 90 minutes. However, the Alsa bus stop in Alsasua is not marked but it is outside a residential home for elderly people on Calle Idertzagain. The second leg involves a 30 minute taxi ride from Alsasua, (+ , Taxi Goikoetxea – Spanish-speaking only) to Baquedano. If you have not put together a picnic, the bakeries and cafes along San Juan make for a good choice as Baquedano has no shops. Remember to arrange in good time the taxi ride back to Alsasua for the bus/train back.
Previous models analyzing brain cancer incidence data in Navarre and the Basque Country only provided geographical or temporal patterns . Due to the large number of areas involved in our analysis and the evident differences in the risk evolution in each of them, the use of spatio-temporal models including space-time interactions becomes essential. Our analysis reveals that the number of high risk municipalities is increasing with time, and that the risk evolution for particular municipalities differs from the global temporal pattern. The model used is a non-parametric CAR model where different precision matrices can be used to model the spatio-temporal interaction term .
TR-DGU® contains data from many different hospitals coded by multiple people. Although multiple plausibility controls are implemented, there is no data verification source for preventing entry errors. To minimize bias due to the previously mention limitation, definitions were carefully checked, and data were transformed into comparable variables where necessary. Some variables like ventilation days was defined again for this analysis, as the Utstein template is not clear . The different AIS versions used by both registries is a major limitation of this study and it may have affected the results of this comparison.
The Journey of Junker 035 