No abstract

In Colombia, coal miner pneumoconiosis is considered a public health problem due to its irreversibility, high cost on diagnosis, and lack of data related to its prevalence in the country. Therefore, a cross-sectional study was carried out in order to determine the prevalence of pneumoconiosis in underground coal mining workers in two regions of Colombia. The results showed a 35.9% prevalence of pneumoconiosis in the study group (42.3% in region 1 and 29.9% in region 2). An association was found between a radiologic diagnosis of pneumoconiosis and a medium risk level of exposure to carbon dust (OR: 2.901, 95% CI: 0.937, 8.982), medium size companies (OR: 2.301, 95% CI: 1.260–4.201), length of mining work greater than 25 years (OR: 3.222, 95% CI: 1.806–5.748), and a history of smoking for more than one year (OR: 1.479, 95% CI: 0.938–2.334). These results establish the need to generate an intervention strategy aimed at preventing the identified factors, as well as a timely identification and effective treatment of pneumoconiosis in coal miners, in which the commitment of the General Health and Social Security System and the workers compensation system is ensured.

Resumen: Los reingresos hospitalarios son frecuentes y costosos, en Colombia existe poca información. El objetivo fue establecer la frecuencia de reingresos hospitalarios por cualquier causa a 30 días y factores asociados. Se trata de un estudio analítico con cohorte retrospectiva 64.969 hospitalizaciones entre enero de 2008 y enero de 2009 en 47 ciudades colombianas 6.573 reingresos hospitalarios, prevalencia: 10,1% (hombres 10,9%; mujeres 9,5%), 44,7% en > 65 años. Mortalidad mayor en reingresos hospitalarios (5,8% vs. 1,8%). Mayor carga de reingresos hospitalarios en grupo sistema circulatorio. Mayor probabilidad de reingresos hospitalarios en enfermedades hematológicas y neoplasias. Estancia hospitalaria promedio durante el primer ingreso: 7 días en pacientes que reingresaron y 4,5 en quienes no. Costo total mayor para reingresos hospitalarios (USD 21.998.275): 15,8% del costo total de hospitalizaciones. Mayor prevalencia en pacientes remitidos (18,8%) y de consulta externa (13,7%). Los reingresos hospitalarios son frecuentes, se asocian con mayor estancia, mortalidad y costo. Mayor riesgo de reingresos hospitalarios en sexo masculino, > 65 años, pacientes remitidos de otra institución, enfermedades hematológicas y neoplasias.

<b><i>Background:</i></b> Sepsis is a disease with a high mortality rate without prompt treatment. However, this entity is difficult to diagnose in the elderly population in the emergency room; for this reason, it is necessary to have diagnostic tools for early detection. <b><i>Objective:</i></b> The aim of the study was to determine the highest diagnostic yield of procalcitonin (PCT), Quick Sequential Organ Failure Assessment (qSOFA), and Sequential Organ Failure Assessment (SOFA) for sepsis (based on the sepsis-3 consensus), on admission at the emergency department, in those older than 65 years. <b><i>Methods:</i></b> This is a diagnostic test study of a historical cohort of 65-year-old patients with suspected sepsis. <b><i>Results:</i></b> In the sample of 179 patients, 53.6% had confirmed sepsis. Significant differences were found (<i>p</i> &#x3c; 0.0001), with a greater diagnostic and predictive capacity of PCT for the diagnosis of sepsis (receiver operating characteristics curve area [area under the curve (AUC) = 0.883, 95% CI: 0.835–0.931] than qSOFA (AUC = 0.559, 95% CI: 0.485–0.663) and SOFA (AUC = 0.662, 95% CI: 0.584–0.739); these results were similar in the cohort of patients ≥75 years. In positive PCT(≥0.5 ng/mL), the sensitivity was 71.8% (95% CI: 62.36–81.39), specificity of 89.1% (95% CI: 81.87–96.45%), V+ 88.4% (95% CI: 80.73–96.19%), V− of 73.2% (95% CI: 64.14–82.39%), positive likelihood ratio of 6.63 (95% CI: 3.53–12.44), and negative likelihood ratio of 0.32 (95% CI: 0.23–0.44); these results were similar in the cohort of patients ≥75 years. Lactate ≥2 mmol/L (RR = 1.659 [95% CI: 1.002–2.747]) and PCT ≥0.5 ng/mL (RR = 1.942 [95% CI: 1.157–3.261]) showed a significant association with in-hospital mortality. <b><i>Conclusion:</i></b> In the elderly population with suspicion of infection on admission to the emergency department, qSOFA presents a low diagnostic performance of confirmed sepsis and in-hospital mortality, for which other tools with higher diagnostic and prognostic performance should be added, such as PCT and lactate.