Análisis geográfico de nefropatía diabética e insuficiencia renal en el primer nivel de atención, IMSS 2019 / Geographic analysis of diabetic nephropathy and renal insufficiency in the primary care, IMSS 2019

Introducción: en un contexto donde la prevalencia de diabetes mellitus e hipertensión arterial ha aumentado significativamente en años recientes, las enfermedades renales adquieren importancia por la potencial demanda de atención especializada y de recursos en salud que requieren. Objetivo: analizar la distribución geográfica de la nefropatía diabética (ND) y la insuficiencia renal (IR) con base en las consultas otorgadas en unidades de primer nivel del Instituto Mexicano del Seguro Social (IMSS) durante 2019, para identificar las unidades médicas con mayor carga de atención. Material y métodos: estudio ecológico-exploratorio en el que se estimaron indicadores por cada mil derechohabientes en relación a las consultas otorgadas por ND e IR según la ocasión de servicio, la unidad médica familiar (UMF) de primer nivel y la representación. Se utilizó estadística espacial para analizar dichos indicadores. Resultados: el 45% de las consultas otorgadas fue por ND y el 52.4% por IR. La mayor carga por ND se registró en la UMF No. 50 de Cd. Juárez (Chihuahua) y en la No. 49 Gabino Barreda (Veracruz Sur), con 1.7 consultas de primera vez y 148.3 subsecuentes por mil derechohabientes, respectivamente. Mientras que en la UMF No. 40 Manlio Fabio Altamirano y No. 25 Cotaxtla, en Veracruz Norte, la mayor carga fue por IR, con 4.9 consultas de primera vez y 134.2 subsecuentes por mil derechohabientes, respectivamente. Conclusiones: los resultados podrían contribuir al fortalecimiento de las unidades médicas que así lo requieran y en la distribución eficiente de los recursos disponibles para atender la demanda de servicios de salud de ND e IR en el IMSS

Background: In a context where the prevalence of Diabetes Mellitus and Hypertension has increased significantly in recent years, kidney diseases become important for the potential demand for specialized health care and resources required. Objective: To analyze the geographical distribution of Diabetic Nephropathy (DN) and Renal Insufficiency (RI) based on the medical consultations given in first-level units of IMSS during 2019, to identify the medical units with the highest burden of care. Material and methods: Ecological-exploratory study in which indicators were estimated for every thousand persons in relation to medical consultations given by ND and RI according to service time, first-level medical unit (UMF) and representation to analyze the magnitude and geographic distribution at the national level. Results: 45% of medical consultations were by ND and 52.4% by RI. The highest burden per DN was registered in UMF No. 50 Cd. Juarez (Chihuahua) and No. 49 Gabino Barreda (Veracruz Sur), with 1.7 first-time medical consultations and 148.3 subsequent medical consultations per 1,000 persons, respectively. While in UMF No. 40 Manlio Fabio Altamirano and No. 25 Cotaxtla, in Veracruz Norte, the highest burden was for RI, with 4.9 first-time medical consultations and 134.2 subsequent medical consultations per 1000 persons, respectively. Conclusions: The results could contribute to strengthening of medical units where it is necessary and the efficient allocation of resources available to meet the demand for health services of ND and RI in IMSS.

Frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil / Incapacidade para o trabalho por doenças oculares na população segurada da Previdência Social da região metropolitana do Recife, Brasil: um estudo de frequência

ABSTRACT Purpose: To identify the frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil. Methods: A review was performed of 217,221 cases of disability benefits granted between 2010 and 2015 by the executive managerial department of the Brazilian National Institute of Social Security (Instituto Nacional do Seguro Social [INSS]) in Recife, which encompasses 14 municipalities of the metropolitan region, including the capital. The frequencies of the identified cases of ocular morbidity were then determined according to their group in the International Classification of Diseases, 10th Revision (ICD-10), their cause, the age, sex, and income of the recipient, and the type and duration of the benefit. Results: Of all disability benefits granted, 5,324 (2.5%) were due to ocular disease, the majority (91.1%) consisting of sick pay. Most of the beneficiaries (64.6%) were males, were 20 to 59 years of age, and 61.2% earned the minimum wage or less. The principal ocular diseases for which sick pay benefits were granted were cataract (24.5%), conjunctivitis (21.1%), and pterygium (8.8%). Blindness and low vision were the principal ocular diseases in cases of accident indemnity and disability retirement. Conclusions: The results highlight the magnitude of the problem of ocular diseases to the social security system, with serious economic and social losses, and emphasize the need for measures aimed at their prevention. Moreover, integration between the national departments of health and social security needs to be improved.

RESUMO Objetivo: Identificar a frequência das doenças oculares entre os segurados com benefícios por incapacidade. Métodos: Estudo retrospectivo de 217.221 benefícios por incapacidade concedidos pelo Instituto Nacional do Seguro Social (INSS) da gerência executiva de Recife, que engloba os 14 municípios da região metropolitana, incluindo a capital, no período de 2010-2015. Os casos de doenças oculares foram avaliados quanto à frequência considerando seu grupo na CID-10. Foi feita ainda uma análise do perfil dos benefícios concedidos por estas doenças com relação à causa, idade, sexo, faixa salarial, espécie e duração do benefício. Resultados Do total dos benefícios concedidos, 5.324 foram decorrentes de doenças oftalmológicas (2,5%) e entre estes, a maioria como auxíliodoença (91,1%). Houve predomínio do sexo masculino (64,6%), faixa etária dos 20 aos 59 anos e valor de até 01 salário mínimo (61,2%). Entre as concessões de auxíliodoença a principal causa foi a catarata (24,5%), seguida pela conjuntivite (21,1%) e pterígio (8,8%). A cegueira e baixa visão foi a principal causa de auxílio-acidente e aposentadoria por invalidez. Conclusões: Os resultados destacam a magnitude do problema das doenças oculares para a Previdência Social, com graves perdas econômicas e sociais, e enfatizam a necessidade de medidas que visem sua prevenção e maior integração entre os serviços de saúde e o INSS (Instituto Nacional do Seguro Social).

Public social security burden of musculoskeletal diseases in Brasil-Descriptive study

SUMMARY BACKGROUND: To present data on the social security burden of diseases of the musculoskeletal system and connective tissue (DSOTC) in Brasil in 2014, and evolution of these social security expenditures between 2009 and 2014. METHOD: Compilation and analysis of data on the granting of disability pensions and sickness benefits in the year 2014, available on the official website of Social Security, classified according to ICD 10. It was evaluated the evolution between 2009 and 2014, using the F test to compare the curves with the growth of the active age population (PIA). RESULTS: Among the 22 disease groups classified according to ICD-10, the DSOTC group led benefits grants in 2014, with 19% of the sickness benefits and 13.5% of the disability pensions. The main causes of sickness benefit and disability retirement were, respectively: dorsopathies (43.3% and 41.2%), soft tissue diseases (27.3% and 19.7%), osteoarthritis (7.6% % And 27.8%) and chronic inflammatory arthropathies (2.8% and 7.9%). In the evolution of the number of sickness benefits granted between 2009 and 2014, both INSS and DSOTC totals showed an increasing tendency (35.9 and 35.3%, respectively, with p = 0.000 for both). As for disability retirement, there was a 5.9% increase in the INSS total (p = 0.039), while for the DSOTC there was a decrease of 7.6% (p = 0.005). CONCLUSIONS: These data point to a progressive increase in the granting of sickness pensions and disability benefits in the country, superior to the growth of the PIA, as well as a high participation of DSOTC in these benefits.

RESUMO OBJETIVOS: Apresentar dados sobre o ônus previdenciário das doenças do sistema osteomuscular e tecido conjuntivo (DSOTC) no Brasil no ano de 2014, e sua evolução entre 2009 e 2014. MÉTODO: Compilação e análise de dados sobre a concessão de aposentadorias por invalidez e auxílios-doença no ano de 2014 disponíveis no portal oficial da Previdência Social, classificados segundo o CID 10. Avaliação da evolução entre 2009 e 2014, utilizando-se o teste F para comparar as curvas com o crescimento da população em idade ativa (PIA). RESULTADOS: Entre 22 grupos de doenças classificados de acordo com o CID 10, o das DSOTC liderou as concessões de benefícios em 2014, com 19% dos auxílios-doença e 13,5% das aposentadorias por invalidez. As principais causas de concessão de auxílio-doença e aposentadoria por invalidez foram, respectivamente: dorsopatias (43,3% e 41,2%), doenças de partes moles (27,3% e 19,7%), osteoartrite (7,6% e 27,8%) e artropatias inflamatórias crônicas (2,8% e 7,9%). Na evolução do número de auxílios-doença concedidos entre 2009 e 2014, tanto o total do INSS quanto o do grupo DSOTC apresentaram tendência crescente (35,9 e 35,3%, respectivamente, com p = 0,000 para ambos). Já para aposentadoria por invalidez, houve aumento de 5,9% no total do INSS (p = 0,039), enquanto que para as DSOTC houve um decréscimo de 7,6% (p = 0,005). CONCLUSÕES: Verificou-se uma elevação progressiva na concessão de auxílio-doença e aposentadoria por invalidez no País, superior ao aumento da população em idade ativa. As DSOTC foram o grupo com maior participação relativa nesses benefícios.

Doenças e agravos do trabalho em Minas Gerais de 2008 a 2012 / Work diseases and injuries in Minas Gerais from 2008 to 2012

A notificação dos acidentes de trabalho é de fundamental importância na gestão da saúde pública, tendo grande impacto no atendimento dos serviços de emergência e nos benefícios acidentários da Previdência Social. O objetivo deste estudo foi realizar uma análise descritiva dos dados de doenças ou agravos relacionados ao trabalho notificados em Minas Gerais, Brasil por meio de sistemas de informação do SUS, disponíveis no DATASUS. Tratou-se de estudo ecológico, exploratório descritivo, quantitativo, retrospectivo, apoiado em análise de base de dados secundários, no período de janeiro de 2008 a dezembro de 2012. Os resultados apontaram um aumento de 101,1% na proporção de municípios com casos de doenças ou agravos notificados relacionados ao trabalho e de 39,1% na taxa de acidentes de trabalho em Minas Gerais por 100 mil habitantes, taxa não proporcional ao crescimento populacional do estado no mesmo período. Concluiu-se que havia ainda um grande sub-registro nos sistemas de informação, principalmente no Sistema de Informação de Agravos de Notificação, apesar do crescimento das variáveis analisadas

The notification of occupational accidents has fundamental importance to the management of public health, with great impact on the attendance of emergency services and accidental benefits of Social Security. The objective of this study was to conduct a descriptive analysis of work diseases and injuries data reported in Minas Gerais, Brazil by means of SUS information systems available in DATASUS. This was an ecological, exploratory, descriptive, quantitative, retrospective study, based on secondary data analysis, from january 2008 to december 2012. The results indicated a 101.1% increase to the proportion of municipalities with reported cases of work related diseases or injuries and 39.1% to the rate of work accidents in Minas Gerais per 100,000 habitants, a not proportional rate to the state's population growth in the same period. In conclusion, there was still a great underreporting to the information systems, especially in the Notification of Injury Information System, despite the growth of the analyzed variables

Notificación de accidentes de trabajo y posibles enfermedades profesionales en Ecuador, 2010-2015 / Notification of occupational accidents and possible occupational diseases in Ecuador, 2010-2015

OBJETIVO: Describir la evolución de notificaciones por accidentes de trabajo y posibles enfermedades profesionales en Ecuador para el período desde 2010 a 2015. MATERIALES Y MÉTODOS: Estudio descriptivo a partir de fuentes secundarias reportadas al Seguro General de Riesgos de Trabajo del Instituto Ecuatoriano de Seguridad Social; se emplean frecuencias absolutas (n) y relativas (%), así como el cálculo de la tasa de incidencia en relación con las variables de interés. RESULTADOS: Se evidencia un incremento considerable del número de casos notificados por accidentes de trabajo y posibles enfermedades profesionales; la tasa de incidencia por accidentes aumentó de 381,2 en 2010 a 775,0 en 2015; asimismo, para los casos de enfermedades de 6,0 en 2010 a 28,4 en 2015. CONCLUSIONES: El aumento de registros de accidentes de trabajo y posibles enfermedades profesionales al Seguro General de Riesgos de Trabajo podría deberse a la entrada en vigor de normativas sobre la obligatoriedad de notificación en 2010 y 2011. No obstante, se evidencia la falta de implantación de medidas preventivas en los centros de trabajo, lo que supone plantearse una nueva reformulación de las políticas nacionales en seguridad y salud en el trabajo.

OBJECTIVE: To describe the evolution of reports of occupational accidents and possible occupational diseases in Ecuador for the period from 2010 to 2015. MATERIALS AND METHODS: Descriptive study from secondary sources reported to the General Occupational Risk Insurance of the Ecuadorian Social Security Institute; Absolute (n) and relative frequencies (%) are used, as well as the calculation of the incidence rate in relation to the variables of interest. RESULTS: There is a considerable increase in the number of cases reported due to occupational accidents and possible occupational diseases; The incidence rate for accidents increased from 381.2 in 2010 to 775.0 in 2015; Likewise, for cases of diseases from 6.0 in 2010 to 28.4 in 2015. CONCLUSIONS: The increase of records of occupational accidents and possible occupational diseases to the General Insurance of Occupational Risks could be due to the regulations on the obligation of notification that became effective in 2010 and 2011. However, it is evident the lack of implantation Of preventive measures in the work centers, what supposes to consider a new reformulation of the national policies in security and health in the work.

Cancer incidence and mortality in children in the Mexican Social Security Institute (1996-2013) / Incidencia y mortalidad por cáncer en niños atendidos en el Instituto Mexicano del Seguro Social (1996-2013)

Abstract Objective: To identify the cancer incidence and mortality in Mexican Social Security Institute beneficiary (MSSI-B) children during 1996-2013. Materials and methods: Both cancer cases (n=4 728) and deaths (n=2 378) were analyzed in MSSI-B children who were registered in five states of the Mexican Republic. The incidence and mortality trends and the incidences (rate x 1 000 000 children / year) of the type of cancer, age, sex, and place of residence were obtained. Results: For both indicators (incidence and mortality), there was a downward trend for the period of 1996-2001 and a stable trend for 2002-2013. This occurred in the overall mortality and incidence trends of the Estado de México and Chiapas and in the leukemia and the acute lymphoid subgroups. The annual overall incidence was 128 cases per 1 000 000 children. Leukemia, lymphomas, and central nervous system tumors were the principal cancer groups. Conclusions: Cancer mortality for the period of 2002-2013 did not diminish. Interinstitutional and/or international research should be designed to improve the care of these children.

Resumen Objetivo: Mostrar la incidencia y mortalidad por cáncer en niños derechohabientes del Instituto Mexicano del Seguro Social (DH-IMSS) (periodo 1996-2013). Material y métodos: Se analizaron los casos (n=4 728) y las muertes (n=2 378) por cáncer en niños DH-IMSS registrados en cinco estados de la República mexicana. Se obtuvo la tendencia de la incidencia y mortalidad y la incidencia por tipo de cáncer, edad, sexo y lugar de residencia. Resultados: Para ambos indicadores (incidencia y mortalidad) hubo tendencia a la disminución para el periodo 1996-2001 y estabilidad para 2002-2013; esto sucedió para la tendencia global, para el Estado de México y Chiapas, para las leucemias y para el subgrupo de las linfoide agudas. La incidencia global fue de 128 x 1 000 000 niños/año; las leucemias, tumores del sistema nervioso central y linfomas fueron los principales grupos de cáncer. Conclusiones: La mortalidad por cáncer para el periodo 2002-2013 no ha disminuido; deben diseñarse investigaciones interinstitucionales e internacionales para mejorar la atención médica de estos niños.

Cancer mortality in the Mexican Social Security Institute, 1989-2013 / Mortalidad por cáncer en el Instituto Mexicano del Seguro Social, 1989-2013

Abstract Objetive: To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social - IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. Materials and Methods: A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age- and sex-adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. Results: The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. Conclusion: The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment.

Resumen Objetivo: Analizar la frecuencia de las defunciones por cáncer en la población derechohabiente (DH) del Instituto Mexicano del Seguro Social, así como la tendencia temporal en el riesgo de muerte por esta causa de 1989 a 2013. Material y métodos: Se realizó análisis descriptivo del comportamiento de la mortalidad por cáncer en población derechohabiente del IMSS. Las tasas de mortalidad ajustadas por edad y sexo se obtuvieron con el método directo utilizando la población mundial estándar de la OMS. Los cambios en el riesgo de morir por cáncer a través del tiempo se evaluaron mediante regresión de Poisson. Resultados: El número absoluto de defunciones por cáncer se duplicó de1989 a 2013 debido a un aumento y al envejecimiento de la población derechohabiente. El riesgo de muerte en los DH disminuyó para la mayoría de los diferentes tipos de cáncer, excepto para el cáncer de colon y recto. Conclusión: El riesgo de morir por cáncer en DH del IMSS muestra una discreta disminución, posiblemente debido a la mejora en la detección y tratamiento oportuno.

The burden of disease of cancer in the Mexican Social Security Institute / La carga de la enfermedad debida al cáncer en el Instituto Mexicano del Seguro Social

Abstract: Objective: To estimate the disease burden of cancer in the affiliate population of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in 2010 by delegation. Materials and methods: The Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability/Disease (YLD) for 21 specific cancers and a subgroup of other malignant neoplasms were calculated based on the methodology of the Global Burden of Disease Study (GBD) for each of the 35 delegations of the IMSS. Results: In 2010, cancer represented the fifth overall leading cause of disease burden in IMSS affiliates (16.72 DALYs/1000 affiliates). A total of 75% of the cancer disease burden in each delegation is due to ten specific cancers, particularly breast cancer, which ranks first in 82% of the delegations. Prostate cancer; tracheal, bronchial, and lung cancers; leukemia, and colorectal and stomach cancers occupy the second to fourth positions in each delegation. With the exception of breast and prostate cancer, for which the contribution of YLD to the DALYs was higher than 50%, the greatest contribution to the DALYs of the other cancers was premature mortality, which accounted for more than 90% of the DALYs in some cases. Conclusion: The results obtained in this study allow for the identification of intervention priorities with regard to cancer at the institutional level and also for the focus at the delegation level to be placed on cancers ranking in the top positions for disease burden.

Resumen: Objetivo: Estimar, por delegación, la carga de enfermedad debida al cáncer en la población derechohabiente del Instituto Mexicano del Seguro Social (IMSS) para el año 2010. Material y métodos: Se calcularon los años de vida perdidos ajustados por discapacidad (AVISA), los años perdidos por muerte prematura (APMP) y los años vividos con discapacidad (AVD) para 21 cánceres específicos y un subgrupo de otras neoplasias malignas, con base en la metodología del Global Burden of Disease Study (GBD) para cada una de las 35 delegaciones en las que se divide el IMSS al interior del país. Resultados: En el año 2010, el cáncer representó la quinta causa de carga de enfermedad en derechohabientes del IMSS (16.72 AVISA/1000 derechohabientes). El 75% de la carga de enfermedad por cáncer en cada delegación se debe a diez cánceres específicos entre los que destaca el cáncer de mama, que ocupa el primer lugar de importancia en 82% de las delegaciones. Los cánceres de próstata, tráquea, bronquios y pulmón, leucemias, de colon y recto, así como el de estómago, se ubican entre las segundas y cuartas posiciones en cada delegación. Con excepción del cáncer de mama y de próstata, cuya contribución de los AVD a los AVISA fue superior a 50%, en los demás cánceres la mayor contribución fue debida a la mortalidad prematura, en algunos superior a 90% de los AVISA. Conclusión: Los resultados obtenidos en este estudio permiten identificar las prioridades de intervención en materia de cáncer a nivel institucional y focalizarlas a nivel delegacional para los cánceres que ocupan los primeros lugares de carga de enfermedad.

Hospitalization and mortality in Mexico due to breast cancer since its inclusion in the catastrophic expenditures scheme / Hospitalización y mortalidad en México por cáncer de mama a partir de su inclusión en el esquema de gastos catastróficos

Abstract Objective: To compare trends in hospital discharges and mortality due to breast cancer (BC) in Mexico from 2004 to 2012 by insurance condition before and after incorporating BC comprehensive treatment into the System of Social Protection in Health (Sistema de Protrección Social en Salud, SPSS) in 2007. Materials and methods: Data on BC hospital discharges and mortality reported in women aged 25 years and over were obtained from the National Health Information System. Mortality rates were adjusted by age and state. Results: At the national level, a growing tendency in hospital discharges was observed, mainly for women without social security, while mortality rate remained constant. Mortality rates by state show that lower marginalization index corresponded to higher mortality. Conclusions: A differential behavior was observed among women according to insurance condition, partly due to the inclusion of BC treatment in the SPSS.

Resumen Objetivo: Comparar las tendencias de egresos hospitalarios y mortalidad por cáncer de mama (CaMa) en México de 2004 a 2012, según esquema de aseguramiento, antes y después de la incorporación del tratamiento integral del CaMa al Sistema de Protección Social en Salud (SPSS) en 2007. Material y métodos: Los egresos hospitalarios y de mortalidad por CaMa en mujeres de 25 años o más se obtuvieron del Sistema Nacional de Información en Salud. Las tasas de mortalidad se ajustaron por edad y entidad federativa. Resultados: A nivel nacional, hubo una tendencia creciente de los egresos hospitalarios, principalmente para mujeres sin seguridad social, mientras que la tasa de mortalidad se mantuvo constante. Las tasas de mortalidad fueron mayores en estados con menor índice de marginación. Conclusiones: Se observó un comportamiento diferencial entre las mujeres según esquema de aseguramiento en salud debido, en parte, a la inclusión del tratamiento de CaMa al SPSS.

Sociodemographic status of severely disabled and visually impaired elderly people in Turkey / Estado sociodemográfico de pacientes idosos com incapacidades graves e deficiência visual na Turquia

ABSTRACT Purpose: To identify the prevalence of ophthalmologic diseases in elderly patients who had been classified as severely disabled and to identify the ophthalmologic conditions leading to visual impairment and blindness. Methods: The medical records of 2806 patients who had applied to the Health Board of the Erzurum Region Training and Research Hospital between January 2011 and December 2012 were reviewed. One hundred ninety-nine patients aged >64 years who were classified as severely disabled with disability rates of over 50%, and who were unable to care for themselves or to move and/or communicate without help were included in the study. Results: The most frequently seen disabilities were neurological (47.2%) and those resulting from eye diseases (17.1%). The most common ophthalmologic diseases were cataract, glaucoma, and age-related macular degeneration. The mean right and left eye visual acuities were 1.17 ± 1.10 logMAR and 1.13 ± 1.0 logMAR, respectively. Of the 60 patients with ophthalmologic diseases or conditions, 33 were blind (visual acuity worse than 20/400) and 10 were visually impaired (visual acuity worse than 20/70 but better than 20/400). Cataracts were the main cause of blindness. The mean age of the patients who were still being followed up at the time of application to the disability board was significantly lower than that of the others (p =0.015). Seventy-nine percent of the blind patients were from rural areas, and 88% of these had no regular follow-up. Among the blind and visually impaired, significantly more patients from urban areas had social security insurance (SSI) than those from rural areas (p =0.043). Nearly 64% of the blind patients were women. The follow-up rate was significantly lower in women (p =0.025). According to multinomial logistic regression analysis, the visually impaired and blind patients were more likely to have lower follow-up rates than the other types of severely disabled patients (OR: 0.231, 95% Cl: 0.077-0.688, p=0.009). Conclusions: Blindness gives rise to severe disability, and the most common ophthalmologic diseases that cause severe disabilities in elderly patients are cataract, glaucoma, and age-related macular degeneration. Sociodemographic factors that may affect the accessibility of visually impaired and blind people to health services include their place of residence and gender.

RESUMO Objetivo: Identificar a prevalência de doenças oftalmológicas em pacientes idosos que tinham sido considerados como incapacitados graves, e para identificar as condições oftalmológicas que levam à deficiência visual e cegueira. Métodos: Prontuários de 2806 pacientes que tinham solicitado ao conselho de saúde do hospital de treinamento e pesquisa da região de Erzurum entre janeiro de 2011 e dezembro de 2012, foram revistos. Cento e noventa e nove idosos com mais de 64 anos, que foram considerados como incapacitados graves nos quais as taxas de incapacidade são mais de 50% e não são capazes de cuidado próprio e não são capazes de mover-se e/ou comunicar-se sem ajuda, foram incluídos no estudo. Resultados: As deficiências mais frequentemente observados são neurológicas (47,2%) e doenças oculares (17,1%). As doenças oftalmológicas mais frequentemente observadas foram catarata, glaucoma e degeneração macular relacionada à idade. Média de acuidade visual em olho direito e esquerdo foram 1,17 ± 1,10 e 1,13 ± 1,0 logMAR, respectivamente. Dos 60 pacientes, 33 apresentaram cegueira (acuidade visual pior que 20/400), 10 tinham deficiência visual (acuidade visual pior do que 20/70, melhor do que 20/400). A catarata foi a principal causa de cegueira. A idade média dos pacientes com acompanhamento no momento da solicitação ao conselho foi significativamente menor do que os demais (p=0,015). Setenta e nove por cento dos pacientes cegos eram da área rural e 88% deles não tinham acompanhamento regular. Entre cegos e deficientes visuais, a taxa de posse do seguro de segurança social (SSI) foi significativamente maior em pacientes de área urbana (p=0,043). Quase 64% dos pacientes cegos eram mulheres. A taxa de acompanhamento foi significativamente menor nas mulheres (p=0,025). De acordo com a análise de regressão logística multinominal, os pacientes com deficiência e cegos visuais eram mais propensos a ter menor taxa de acompanhamento do que os outros pacientes com deficiência grave (OR: 0,231, 95% Cl: 0,077-0,688, e p=0,009). Conclusões: A cegueira gera incapacitação grave. As doenças oftalmológicas mais frequentemente observadas que causam deficiência grave em pacientes idosos são a catarata, glaucoma e degeneração macular relacionada à idade. O local de residência e o gênero são fatores sociodemográficos que podem ter impacto sobre o acesso à saúde de pessoas com deficiência visual e cegos.

Efecto de la seguridad social en la duración del ausentismo laboral en el Servicio de Salud de Ñuble: un análisis de supervivencia / Social security and labor absenteeism in a regional health service

Background: Absenteism can generate important economic costs. Aim: To analyze the determinants of the time off work for sick leaves granted to workers of a regional health service. Material and Methods: Information about 2033 individuals, working at a health service, that were granted at least one sick leave during 2012, was analyzed. Personal identification was censored. Special emphasis was given to the type of health insurance system of the workers (public or private). Results: Workers ascribed to the Chilean public health insurance system (FONASA) had 11 days more off work than their counterparts ascribed to private health insurance systems. A higher amount of time off work was observed among older subjects and women. Conclusions: Age, gender and the type of health insurance system influence the number of day off work due to sick leaves.

Psychiatric legal investigation for sickness benefits due to disability at the Brazilian Federal Social Security Special Court in Florianópolis, capital city of the State of Santa Catarina, southern Brazil / Perícias judiciais psiquiátricas em benefícios por incapacidade no Juizado Especial Federal Previdenciário de Florianópolis, capital do estado de Santa Catarina, sul do Brasil

Objective: To describe the profile of insured individuals that filed claims for sickness benefits and compare the results of the administrative and legal investigations. Method: This case series included 114 insured persons that filed lawsuits against the Brazilian National Institute of Social Security (Instituto Nacional de Seguridade Social, INSS). They underwent psychiatric examinations required by the Brazilian Federal Social Security Special Court in Florianópolis from August to December 2010. Results: Mean age was 47 years, and participant age ranged from 24 to 64 years. Most insured individuals were women (79%), and most were employed (67.5%) and self-employed (26.5%) workers. Mean contribution time was 99.9 months, ranging from 8 to 352 months. Mean benefit duration was 20.4 months, ranging from 2 to 97 months. The most prevalent category of workers was service workers, store and supermarket salespeople (54.4%), followed by administrative workers (19.3%). Conclusions: Only 17 participants were found to be unable to work after benefit cessation, a 14.9% mismatch between administrative and legal investigations. The most frequent diagnoses were mood disorders (59.6%) and anxiety disorders (17.5%). .

Objetivo: Descrever o perfil dos segurados que requerem benefícios por incapacidade e comparar os resultados das perícias administrativas e judiciais. Método: Esta série de casos incluiu 114 segurados que buscaram a justiça contra o Instituto Nacional de Seguridade Social (INSS). Os participantes foram submetidos a perícia psiquiátrica exigida pelo Juizado Especial Federal em Florianópolis, entre agosto e dezembro de 2010. Resultados: A idade média dos participantes foi de 47 anos, variando de 24 a 64 anos. A maioria dos segurados era do sexo feminino (79%) e era empregada (67,5%) ou autônoma (26,5%). O tempo médio de contribuição foi de 99,9 meses, variando de 8 até 352 meses. A duração média dos benefícios foi de 20,4 meses, com mínimo de 2 e máximo de 97 meses. A categoria mais prevalente foi de trabalhadores no setor de serviços e vendedores de lojas e supermercados (54,4%), seguida por trabalhadores em atividades administrativas (19,3%). Conclusão: Apenas 17 participantes foram considerados incapazes de trabalhar após o término do benefício, uma diferença de 14,9% entre as perícias administrativa e judicial. Os diagnósticos mais frequentes foram transtornos de humor (59,6%) e transtornos de ansiedade (17,5%). .

Benefícios auxílio-doença concedidos aos trabalhadores empregados no ramo de carne e pescado no Brasil em 2008 / Sick leave benefits for workers in the Brazilian meat and fish industries in 2008 / Prestaciones sociales por enfermedad, concedidas por el Seguro Social, a los empleados en el sector de la carne y pescado en Brasil durante el año 2008

Este estudo objetivou identificar fatores associados à incidência de concessão de benefícios entre trabalhadores na atividade de carne e pescado no Brasil. Foram estudados os benefícios auxílio-doença concedidos pela Previdência Social aos empregados em carne e pescado no Brasil em 2008. As incidências por 10 mil vínculos empregatícios foram estratificadas por sexo, idade, diagnóstico, atividade econômica, unidade federada, espécie e duração dos benefícios auxílio-doença. Foram concedidos 31.913 benefícios auxílio-doença, com incidência de 788,7. O ramo abate de bovinos, equinos, ovinos e caprinos apresentou a maior incidência (1.223,2); o pescado, a maior duração (61 dias) de benefícios auxílio-doença. As mulheres apresentaram maior incidência, enquanto os homens, maior duração de benefícios auxílio-doença. Os grupos Lesões, doenças osteomusculares e transtornos mentais representaram 67,2% dos benefícios auxílio-doença. Os diagnósticos mais incidentes foram as dorsopatias, hemorragia no início da gravidez e episódios depressivos. O ramo de atividade, sexo, e a idade representaram importantes fatores associados à incidência de benefícios auxílio-doença, sugerindo uma precarização das condições/relações de trabalho.

This study aims to analyze factors associated with sick leave rates among workers in the meat, fish, and seafood industries in Brazil. The study analyzed all sick leave benefits granted by the country's social security system to workers in these industries in 2008. Incidence of sick leave per 10 thousand jobs was stratified by sex, age, diagnosis, job position, State, and nature and length of benefits. The study analyzed 31,913 sick leaves, with an annual incidence of 788.7. Meat processing and packaging showed the highest incidence, and fish and seafood processing and packaging showed the longest mean length of sick leave. Women showed a higher sick leave incidence, while men received longer average sick leaves. Injuries, musculoskeletal disorders, and mental disorders accounted for 67.2% of sick leaves. The most common diagnoses were lower back pain, first-trimester bleeding in pregnancy, and depression. The data suggest poor job protection and adverse working conditions in these industries.

El objetivo del presente estudio fue identificar factores asociados a la incidencia de concesión prestaciones sociales por enfermedad a los trabajadores del sector cárnico y pesquero en Brasil. Se estudiaron las prestaciones sociales por enfermedad, concedidas por el Seguro Social, a los empleados de los sectores anteriormente mencionados durante el año 2008. Las incidencias por cada 10 mil empleados fueron estratificadas por sexo, edad, diagnóstico, actividad económica, departamento, tipo y duración de las prestaciones por enfermedad. Se concedieron 31.913 prestaciones sociales por enfermedad, con una incidencia de 788,7. El colectivo perteneciente a mataderos de ganado vacuno, equino, bovino y caprino presentó la mayor incidencia (1.223,2) y el de pesca la mayor duración (61 días de prestaciones sociales por enfermedad). Las mujeres presentaron una mayor incidencia, mientras los hombres una mayor duración de las prestaciones por enfermedad. Los grupos de lesiones, enfermedades osteomusculares y trastornos mentales representaron un 67,2% de los beneficios de auxilio por enfermedad. Los diagnósticos más incidentes fueron las dorsopatías, hemorragias en el principio de la gestación y episodios depresivos, según las ramas de la actividad ejercida, el sexo y la edad son importantes factores, sugiriendo precariedad en las condiciones de trabajo.

A relação entre a previdência social rural e a permanência dos idosos no campo em municípios do extremo sul catarinense / The relation beteen the rural social security and the permanence of the elderly in the field in the municipalities of the far south catarinense

O presente trabalho tem por finalidade analisar a relação entre a Previdência Social Rural (PSR) e a permanência no campo dos idosos residentes nos municípios integrantes da Associação dos Municípios da Região Carbonífera – AMREC (localizada no sul do estado de Santa Catarina). A metodologia utilizada foi um estudo de caso em que foram entrevistados 22 aposentados; a abordagem de análise foi qualitativa. A presente pesquisa evidenciou que a PSR é uma política pública fundamental para manutenção e melhoria das condições de vida dos idosos residentes no campo, bem como de seus familiares, uma vez que o valor recebido se traduz na principal fonte de subsistência para as famílias, quer seja na manutenção da atividade produtiva, na aquisição de medicamentos, ou na melhoria do padrão de vida. Este trabalho permite concluir que, apesar de alguns idosos terem saído do meio rural, a PSR ainda está relacionada com o fenômeno do “envelhecimento do campo”, tendo em vista os benefícios que a aposentadoria traz, a segurança que fornece aos idosos ao darem continuidade ao trabalho agrícola, e a forma como estes empregam esta renda, em alguns casos auxiliando os próprios familiares a também permanecerem no campo.

This work was developed in order to analyze the relation between the Rural Social Security (PSR) and the permanence of the elderly in the field, in municipalities of AMREC – Association of Municipalities of Carboniferous Area. The methodology used was a case study in which were interviewed 22 retired, the approach was qualitative. This research showed that the PSR is a fundamental public policy for maintenance and improvement of living conditions of elderly residents in the field, as well as their families, once the amount received translates into main source of livelihood for families, in maintenance of productive activity, in purchase of medicines, or the improvement of living standards. This allows to conclude that, although some elders have left the rural areas, the PSR is still related to the phenomenon of “aging field”, in view of the benefits that retirement behind, that provides security for the elderly when give continuity to agricultural work, and how they employ this income, in some cases helping their own families also remain in the field.

Análisis de la mortalidad por tuberculosis en Medellín, 2012 / Analysis of mortality caused by tuberculosis in Medellín, Colombia, 2012

Introducción. La tuberculosis es uno de los principales problemas globales de salud pública. Aunque los reportes de la Organización Mundial de la Salud muestran un descenso en las tasas de mortalidad global, Colombia y la ciudad de Medellín no muestran reducciones significativas. Objetivo. Describir las características sociodemográficas, clínicas y de diagnóstico y tratamiento, de los pacientes fallecidos por tuberculosis en Medellín en el 2012. Materiales y métodos. Es un estudio descriptivo de las muertes por tuberculosis reportadas en Medellín durante el 2012. Resultados. El número de muertes fue de 93, de las cuales, 32 (34,4 %) se confirmaron como muertes directas por tuberculosis y 23 (24,7 %) como asociadas a esta enfermedad. En 34 (61,7 %) de los pacientes hubo alguna enfermedad concomitante, siendo el sida la más importante (18, 32,7 %). Se detectaron factores de riesgo social como ser habitante de la calle, farmacodependencia o carencia de domicilio fijo, en 32 casos (58,1 %), y aspectos que afectaron el proceso de atención de los servicios de salud, en 26 (47,2 %). Hubo un retraso de 40 días (rango intercuartílico: 19 a 84) entre el inicio de los síntomas y el diagnóstico. No se encontró retraso significativo en el inicio del tratamiento antituberculoso después del diagnóstico microbiológico; sin embargo, el porcentaje de incumplimiento del tratamiento fue de 64%. Conclusión. La mortalidad por tuberculosis en Medellín es un problema relevante que está relacionado con retrasos en el diagnóstico de los casos y con el cumplimiento del tratamiento.

Introduction: Tuberculosis is a relevant global public health problem. Although reports of the World Health Organization show decrease in overall mortality rates, Colombia and Medellin show no significant decline. Objective: To describe the sociodemographic, clinical, diagnosis, and treatment characteristics of patients who died due to tuberculosis in Medellin, Colombia, during 2012. Materials and methods: A descriptive study of tuberculosis deaths reported in the city. Results: 93 deaths were identified, of which 32 were confirmed as directly caused by tuberculosis (34.4%); in 23 deaths (24.7%) tuberculosis was an associated cause. Co-morbidities were found in 34 patients (61.7%), HIV being the most common with 18 cases important(32.7%). Social risk factors such as being homeless, drug addiction or having no fixed address were found in 32 cases (58.1%); and there were deficiencies in the healthcare system in 26 cases (47.2%). No meaningful delay in the onset of anti-tuberculosis treatment was found after the microbiological diagnosis; however, 64% of patients did not adhere to treatment. Conclusion: Mortality caused by tuberculosis in Medellin is a relevant problem associated with delays in diagnosis of the disease and lack of adherence to treatment.