Assessing occupational pesticide exposure in Latin America and the Caribbean: Methods review for agricultural vulnerability reduction.

B A rapid review was conducted to describe pesticide exposure assessment methodologies in Agricultural Work Contexts (AWC)s in Latin America and the Caribbean (LAC), in order to provide elements to reduce vulnerabilities within the agricultural population. A final number of 79 articles were selected from Medline via Pubmed, LILACS, and SciELO. In the region, family agriculture is the predominant form of agricultural production (72%) in informal agricultural work contexts (AWCs), which are characterized by small-scale diversified agricultural production, lower educational attainment, limited income, and a lack of social and healthcare security for the families. Indirect exposure assessment methods were the most commonly reported (58%), and its use was associated with informal AWCs (p = 0.011). Understanding AWCs and employing appropriate assessment methods can contribute to addressing vulnerabilities in the agricultural sector.

Delphi Consensus on Diagnostic Criteria for LUMBAR Syndrome.

OBJECTIVE: To develop consensus on diagnostic criteria for LUMBAR syndrome, the association of segmental infantile hemangiomas that affect the Lower body with Urogenital anomalies, Ulceration, spinal cord Malformations, Bony defects, Anorectal malformations, Arterial anomalies and/or Renal anomalies. STUDY DESIGN: These diagnostic criteria were developed by an expert multidisciplinary and multi-institutional team based on analysis of peer-reviewed data, followed by electronic-Delphi consensus of a panel of 61 international pediatric specialists. RESULTS: After 2 Delphi rounds, a 92% or higher level of agreement was reached for each Delphi statement. 98% of panelists agreed with the diagnostic criteria, and 100% agreed the criteria would be useful in clinical practice. The diagnosis of LUMBAR requires the presence of a segmental, or patterned, infantile hemangioma of the lumbosacral, sacrococcygeal, or pelvic cutaneous regions plus one additional criterion of the urogenital, spinal, bony, anorectal, arterial, or renal organ systems. CONCLUSIONS: These diagnostic criteria will enhance clinical care by improving screening, detection, and overall awareness of this poorly understood neurocutaneous disorder. The criteria can be utilized by a wide variety of pediatric subspecialists. In addition, formal criteria will improve phenotypic uniformity among LUMBAR syndrome cohorts and a patient registry, allowing investigators to assess clinical features, long-term outcomes, and results of genetic sequencing in a standardized manner. Finally, these criteria will serve as a starting point for prospective studies to establish formal screening and management guidelines.

BRAF-Mutated Melanoma Journey in Latin America: Expert Recommendations From Diagnosis to Treatment.

OBJECTIVES: • Gather a panel of Latin American experts in testing and treating BRAF-melanoma. • Describe the current landscape of BRAF-mutated melanoma in Latin America. • Outline the current gaps in testing and recommend improvements for testing and treating BRAF-mutated melanoma in the region. INTRODUCTION: Melanoma prevalence in Latin America is lower than in high- and middle-income countries. However, recent data indicate that the region's incidence and mortality are rising, with more stage IV patients being diagnosed. According to international clinical practice guidelines, conducting BRAF-mutation testing in patients with stage III or stage IV melanoma and high-risk resected disease is imperative. Still, BRAF-mutation testing and targeted therapies are inconsistently available in the region. METHODS: Americas Health Foundation convened a meeting of Latin American experts on BRAF-mutated melanoma to develop guidelines and recommendations for diagnosis through treatment. RESULTS AND CONCLUSIONS: Some recommendations for improving diagnostics through improving access and reducing the cost of BRAF-mutation testing, enhancing efficiency in pathology laboratories, and creating country-specific local guidelines. The panel also gave treatment recommendations for neo-adjuvant therapy, adjuvant therapy, and therapy for patients with metastatic disease in Latin America.

Multicenter Study of Long-Term Outcomes and Quality of Life in PHACE Syndrome after Age 10.

OBJECTIVE: To characterize long-term outcomes of PHACE syndrome. STUDY DESIGN: Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains. RESULTS: A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma (IH) residua in 94.1%. Approximately one-half had received laser treatment for residual IH, and the majority (89.5%) of participants were satisfied or very satisfied with the appearance. Neurocognitive manifestations were common including headaches/migraines (72.1%), participant-reported learning differences (45.1%), and need for individualized education plans (39.4%). Cerebrovascular arteriopathy was present in 91.3%, with progression identified in 20/68 (29.4%) of those with available follow-up imaging reports. Among these, 6/68 (8.8%) developed moyamoya vasculopathy or progressive stenoocclusion, leading to isolated circulation at or above the level of the circle of Willis. Despite the prevalence of cerebrovascular arteriopathy, the proportion of those with ischemic stroke was low (2/104; 1.9%). PROMIS global health scores were lower than population norms by at least 1 SD. CONCLUSIONS: PHACE syndrome is associated with long-term, mild to severe morbidities including IH residua, headaches, learning differences, and progressive arteriopathy. Primary and specialty follow-up care is critical for PHACE patients into adulthood.

Social determinants of blood pressure control in a middle-income country in Latin America.

Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.

Trends in Inpatient Antibiotic Use Among Adults Hospitalized During the Coronavirus Disease 2019 Pandemic in Argentina, Brazil, and Chile, 2018-2021.

BACKGROUND: High rates of antibiotic use (AU) among inpatients with coronavirus disease 2019 (COVID-19) despite low rates of bacterial coinfection and secondary infection have been reported. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in South America. METHODS: We conducted an ecologic evaluation of AU in inpatient adult acute care wards in 2 HCFs each in Argentina, Brazil, and Chile. The AU rates for intravenous antibiotics were calculated as the defined daily dose per 1000 patient-days, using pharmacy dispensing records and hospitalization data from March 2018-February 2020 (prepandemic) and March 2020-February 2021 (pandemic). Differences in median AU were compared between the prepandemic and pandemic periods, using the Wilcoxon rank sum test to determine significance. Interrupted time series analysis was used to analyze changes in AU during the COVID-19 pandemic. RESULTS: Compared with the prepandemic period, the median difference in AU rates for all antibiotics combined increased in 4 of 6 HCFs (percentage change, 6.7%-35.1%; P < .05). In the interrupted time series models, 5 of 6 HCFs had significant increases in use of all antibiotics combined immediately at the onset of the pandemic (immediate effect estimate range, 15.4-268), but only 1 of these 5 HCFs experienced a sustained increase over time (change in slope, +8.13; P < .01). The effect of the pandemic onset varied by antibiotic group and HCF. CONCLUSIONS: Substantial increases in AU were observed at the beginning of the COVID-19 pandemic, suggesting the need to maintain or strengthen antibiotic stewardship activities as part of pandemic or emergency HCF responses.

Correction: Burgos-Mansilla et al. Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis. J. Clin. Med. 2021, 10, 4696.

In the original publication [...].

Seroprevalence and risk factors associated with leukosis in cattle from Villlavicencio, Colombia / Soroprevalência e fatores de risco associados à leucose em bovinos de Villlavicencio, Colômbia

Bovine leukosis is caused by an oncogenic virus of the genus Deltaretrovirus, causing losses associated with decreased production indicators and restrictions on exports of cattle and cattle products. The disease has a prolonged incubation period of between 1-5 years and the antibodies can be detected 2-3 weeks post infection. The disease can present asymptomatically, and develop persistent lymphocytosis or lymphosarcoma. The objective of this study was to estimate the prevalence and risk factors associated with bovine leukosis in Villavicencio, Colombia. Blood samples were taken from 636 animals, and obtained randomly from 24 herds. The samples were analysed using a Competition ELISA kit for the detection of anti-gp51 antibodies. Information on possible risk factors was collected, then OR and X2 were calculated, and statistically significant with p < 0.05 variables were included in a linear regression multivariate analysis. The general seroprevalence was 24.6% and the herd seroprevalence was 83.3%. The seroprevalence was 21.3% in males and 25.0% in females. The risk factors identified were abortion, non-bearing cows, artificial insemination, and use of common needles, Creole breed and participation in cattle exhibitions. The study confirmed the presence of bovine leukosis associated with reproductive and management factors.(AU)

A leucose bovina é causada por um vírus oncogênico do gênero Deltaretrovirus, causando prejuízos associados à queda dos indicadores produtivos e restrições à exportação de bovinos e derivados.Adoença tem um período de incubação prolongado entre 1 e 5 anos e os anticorpos podem ser detectados 2 a 3 semanas após a infecção. A doença pode se apresentar de forma assintomática, e evoluir para linfocitose persistente ou linfossarcoma. O objetivo do estudo foi estimar a prevalência e os fatores de risco associados à leucose bovina em Villavicencio, Colômbia. Amostras de sangue foram coletadas de 636 animais, obtidos aleatoriamente de 24 rebanhos.As amostras foram analisadas com o kit Competition ELISA para detecção de anticorpos anti-gp51. Foram coletadas informações sobre possíveis fatores de risco, se realizo um analise univariado entre as variáveis e a presença da seropositividad a leukosis bovina mediante o cálculo do OR e X2, as variáveis estatisticamente significativas com p<0,05 foram incluídas em uma análise multivariada de regressão linear. A soroprevalência geral foi de 24,6% e a soroprevalência do rebanho foi de 83,3%.Asoroprevalência foi de 21,3% em machos e 25,0% em fêmeas. Os fatores de risco identificados foram: aborto, vacas não reprodutivas, inseminação artificial e uso de agulha comum, raça crioula e exposições de gado. O estudo confirmou a presença de leucose bovina associada a fatores reprodutivos e de manejo.(AU)

Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B).

Objectives: To determine the preventive effects of supervised resistance training on arms volume, quality of life, physical performance, and handgrip strength in Chilean women at high risk for breast cancer-related lymphedema (BCRL) undergoing chemotherapy. Design: Randomized control trial. Participants: One hundred and six women at high risk for breast cancer-related lymphedema aged 18 to 70 years. Interventions: Participants will be randomized into two groups: [a] intervention, who will receive 12 weeks of supervised resistance training (STRONG-B) during adjuvant chemotherapy; and [b] control, who will receive education to promote lymphatic and venous return, maintain range of motion, and promote physical activity. Main Outcome Measures: The primary outcome will be arms volume measured with an optoelectric device (perometer NT1000). Secondary outcomes will be quality of life, handgrip strength, and physical performance. Primary and secondary outcomes will be measured at baseline, just after the intervention, and 3 and 6 months after. Statistical analysis will be performed following intention-to-treat and per-protocol approaches. The treatment effect will be calculated using linear mixed models. Discussion: The STRONG-B will be a tailored supervised resistance training that attempts to prevent or mitigate BCRL in a population that, due to both intrinsic and extrinsic factors, will commonly suffer from BCRL. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT04821609], identifier NCT04821609.

Characterization of the import applications for unavailable vital medicines in 2016 and 2017 in Colombia. / Caracterización de las solicitudes de importación de medicamentos vitales no disponibles años 2016 y 2017 en Colombia.

This study analyzed the import applications for unavailable vital medicines (MVND) submitted to INVIMA and the records of MVND reimbursement requests submitted to the ADRES in the 2016-2017 period. Approximately 76% of the 2,321 MVND import applications were authorized. Eighty-eight applicants, 73 therapeutic subgroups, 195 active ingredients, and 368 diagnoses were identified. Most of the patients registered in the import applications (66%) are linked to the contributory regime, to a lesser extent to the subsidized regime and the Special or exceptional regimes. The total value of the reimbursement requests related to MVND granted by lawsuits, was USD 8,577,583, equivalent to 38,483 UPCs. The results showed that the implementation of Decree N° 481/2004 has ensured access to medicines for rare diseases. However, it is not alien to the structural inequality of access to health services and medicines of the Colombian Health System, which impacts public health and the allocated budget, either because of the high cost of importing MVND or because of the lack of MVND regulation within the national market.

En este estudio se analizaron las solicitudes de importación de Medicamentos vitales no disponibles (MVND) presentadas al INVIMA y los registros de solicitudes de recobros presentados en la ADRES por MVND, en el periodo 2016-2017. De las 2321 solicitudes de importación de MVND, el 76% fueron autorizadas. Se identificaron 88 solicitantes, 73 subgrupos terapéuticos y 195 principios activos, así como 368 diagnósticos. El 66% de los pacientes registrados en las solicitudes de importación se encuentran vinculados al régimen contributivo, en menor proporción al régimen subsidiado y al régimen especial o excepcional. En solicitudes de recobros asociados a MVND por vía judicial, se observó que, el monto solicitado por recobro fue de USD 8.577.583, equivalentes a 38483 UPCs. Los resultados mostraron que la implementación del decreto 481 de 2004 ha sido útil para garantizar el acceso a medicamentos para enfermedades raras, aunque no es ajena a la inequidad estructural de acceso a servicios de salud y medicamentos del SGSSS y que generan impacto, no solo en la salud pública, si no en el presupuesto asignado, bien sea por el alto costo que implica su importación o por la falta de regulación de estos dentro del mercado nacional.

Caracterización de las solicitudes de importación de medicamentos vitales no disponibles años 2016 y 2017 en Colombia / Characterization of the import applications for unavailable vital medicines in 2016 and 2017 in Colombia

Resumen En este estudio se analizaron las solicitudes de importación de Medicamentos vitales no disponibles (MVND) presentadas al INVIMA y los registros de solicitudes de recobros presentados en la ADRES por MVND, en el periodo 2016-2017. De las 2321 solicitudes de importación de MVND, el 76% fueron autorizadas. Se identificaron 88 solicitantes, 73 subgrupos terapéuticos y 195 principios activos, así como 368 diagnósticos. El 66% de los pacientes registrados en las solicitudes de importación se encuentran vinculados al régimen contributivo, en menor proporción al régimen subsidiado y al régimen especial o excepcional. En solicitudes de recobros asociados a MVND por vía judicial, se observó que, el monto solicitado por recobro fue de USD 8.577.583, equivalentes a 38483 UPCs. Los resultados mostraron que la implementación del decreto 481 de 2004 ha sido útil para garantizar el acceso a medicamentos para enfermedades raras, aunque no es ajena a la inequidad estructural de acceso a servicios de salud y medicamentos del SGSSS y que generan impacto, no solo en la salud pública, si no en el presupuesto asignado, bien sea por el alto costo que implica su importación o por la falta de regulación de estos dentro del mercado nacional.

Abstract This study analyzed the import applications for unavailable vital medicines (MVND) submitted to INVIMA and the records of MVND reimbursement requests submitted to the ADRES in the 2016-2017 period. Approximately 76% of the 2,321 MVND import applications were authorized. Eighty-eight applicants, 73 therapeutic subgroups, 195 active ingredients, and 368 diagnoses were identified. Most of the patients registered in the import applications (66%) are linked to the contributory regime, to a lesser extent to the subsidized regime and the Special or exceptional regimes. The total value of the reimbursement requests related to MVND granted by lawsuits, was USD 8,577,583, equivalent to 38,483 UPCs. The results showed that the implementation of Decree N° 481/2004 has ensured access to medicines for rare diseases. However, it is not alien to the structural inequality of access to health services and medicines of the Colombian Health System, which impacts public health and the allocated budget, either because of the high cost of importing MVND or because of the lack of MVND regulation within the national market.

Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis.

The objective was to describe the effectiveness of different physical therapy modalities to improve Quality of Life (QoL) in Head and Neck Cancer (HNC) survivors. PubMed, Scopus, Web of Science, CINAHL and Cochrane Library were searched for randomized clinical controlled trials published until 30 April 2020. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 251 records were retrieved, and 10 met the inclusion criteria. Interventions whose parameters focus on a 12-week exercise programs of aerobic activity (walking) or Progressive Resistance Training (PRT) for the whole body are effective and safe modalities improving QoL in HNC survivors. Electrophysical agents did not show significant results between groups. As for the assessment of methodological quality, 4 of the 10 articles included had a high risk of overall bias. Only five articles provided sufficient information to conduct a meta-analysis for exercise program intervention on QoL, showing a tendency in favor of intervention group, even when the global results did not show statistically significant improvements (pooled Cohen's d 0.15; 95% CI: -0.25 to 0.54; I2 45.87%; p heterogeneity = 0.10). The present review and meta-analysis identified meaningful benefits of exercise on QoL of HNC survivors; this has been confirmed in a meta-analysis. This review adds evidence supporting exercise interventions on Head and Neck Cancer population whose opportunities for successful recovery after medical treatment are more limited.

Frecuencia y factores de riesgo asociados a re-sangrado posterior a ligadura de várices esofágicas en pacientes con cirrosis hepática / Frequency and associated risk factors of rebleeding after esophageal varices ligation in patients with liver cirrhosis

INTRODUCCIÓN: El re-sangrado de várices esofágicas posterior a la ligadura de la misma, es una complicación frecuente, que eleva de manera significativa la morbi-mortalidad en este grupo de pacientes. El presente estudio tiene la finalidad de describir la frecuencia de re-sangrado por VE luego de la ligadura endoscópica, así como la frecuencia de ciertos factores y su asociación con el re-sangrado. MATERIALES Y MÉTODOS : Estudio observacional, descriptivo y de correlación, transversal. Participaron 179 pacientes a los que se les realizó ligadura endoscópica de varices esofágicas. Para el análisis de asociación se aplicó la prueba Chi 2, se obtuvo razón de prevalencia, con IC 95%. La información fue presentada por medio de tablas con frecuencias y porcentajes. RESULTADOS: El alcoholismo fue la principal causa de la cirrosis hepática en los pacientes con ligadura de varices esofágicas, con un porcentaje de 44.1%. La mayor parte de los casos se encontró dentro de la clase funcional Child Pugh Score B, con una frecuencia del 36.3%. La frecuencia de re-sangrado fue del 49.2% (IC 95% 41.55% ­ 56.76%), siendo más frecuente en varones mayores ≥ 65 años con el 58%, y en el sexo masculino (64.8%). Falleció el 43 % de la muestra, a causa de re-sangrado tras la ligadura. Hubo relación estadísticamente significante de el re-sangrado con factores como: TPT mayor a 33.3 (RP: 1.91, IC 95% 1.07 -3.39, valor p =0.00); anemia moderada, severa (RP: 1.43, IC 95% 1.05 ­ 1.96, valor p = 0.02) y transfusión sanguínea (RP: 2.23, IC 95% 1.37 ­ 3.65, valor p = 0.00). CONCLUSIÓN: La frecuencia de re-sangrado fue del 49.2% (tanto temprana como tardía), la mayoría de pacientes con re-sangrado fueron de sexo masculino y de 65 o más años. Se encontró relación estadísticamente significativa entre el re-sangrado y factores como: tiempo parcial de tromboplastina por encima de valores normales, anemia moderada o severa y el haber recibido transfusiones sanguíneas. La mortalidad por re-sagrando fue del 43% para toda la población de estudio.

BACKGROUND: Re-bleeding of esophageal varices after endoscopic ligation is a frequent complication, that significantly increases morbidity and mortality in this patients. This study aims to describe the frequency of rebleeding due to esophageal varices after endoscopic ligation, as well as the frequency of certain factors and their association with rebleeding. METHODS: Cross-sectional, descriptive and correlational, observational study. A total of 179 patients who underwent endoscopic ligation of esophageal varices participated. For the association analysis Chi2 test was applied, prevalence ratio was obtained, with 95% IC. Data was presented with charts, with frequencies and percentages. RESULTS: Alcoholism was the main cause of cirrhosis in patients that underwent ligation of esophageal varices (44.1%). Most of the cases were classified as Child Pugh Sore B functional class, with a frequency of 36.3%. The prevalence of rebleeding was 49.2% (95% CI 41.55%- 56.76%), it was more frequent in patients 65 years old and older (58%), and male patients (64.8%). Death rate due to rebleeding after ligation was 43%. We found significant statistical association of rebleeding with factors such as: TPT >33.3 (PR: 1.91, 95% CI 1.07-3.39, p value =0.00); moderate and severe anemia (PR: 1.43, 95% CI 1.05-1.96, p value =0.02), and blood transfusion (PR: 2.23. 95% CI 1.37-3.65, p value=0.00). CONCLUSION: Rebleeding frequency was 49.2% (early and late rebleeding), it was more common in male patients, and patients aged 65 or more. This study found statistical association between rebleeding and: elevated values of partial thromboplastin time, moderate and severe anemia, and blood transfusion. Mortality due to rebleeding was 43%.

Immunotherapy at any line of treatment improves survival in patients with advanced metastatic non-small cell lung cancer (NSCLC) compared with chemotherapy (Quijote-CLICaP).

BACKGROUND: To compare survival outcomes of patients with advanced or metastatic non-small cell lung cancer (NSCLC) who received immunotherapy as first-, second- or beyond line, versus matched patients receiving standard chemotherapy with special characterization of hyperprogressors. METHODS: A retrospective cohort study of 296 patients with unresectable/metastatic NSCLC treated with either, first-, second-, third- or fourth-line of immunotherapy was conducted. A matched comparison with a historical cohort of first-line chemotherapy and a random forest tree analysis to characterize hyperprogressors was conducted. RESULTS: Median age was 64 years (range 34-90), 40.2% of patients were female. A total of 91.2% of patients had an Eastern Cooperative Oncology Group (ECOG) performance score ≤ 1. Immunotherapy as first-line was given to 39 patients (13.7%), second-line to 140 (48.8%), and as third-line and beyond to 108 (37.6%). Median overall survival was 12.7 months (95% CI 9.67-14 months) and progression-free survival (PFS) of 4.27 months (95% CI 3.97-5.0). Factors associated with increased survival included treatment with immunotherapy as first-line (P < 0.001), type of response (P < 0.001) and PD-L1 status (P = 0.0039). Compared with the historical cohort, immunotherapy proved to be superior in terms of OS (P = 0.05) but not PFS (P = 0.2). A total of 44 hyperprogressors were documented (19.8%, [95% CI 14.5-25.1%]). Leukocyte count over 5.300 cells/dL was present in both hyperprogressors and long-term responders. CONCLUSIONS: Patients who receive immune-checkpoint inhibitors as part of their treatment for NSCLC have better overall survival (OS) compared with matched patients treated with standard chemotherapy, regardless of the line of treatment.

Characterization of workers covered by a risk insurance company inColombia who suffered amputation / Caracterización de trabajadores amputados atendidos en una aseguradora de riesgos laborales en Colombia

| Background: Scarcity of information on the sociodemographic, occupational and clinical characteristics of workers who suffer upper limb amputation hinders planning and implementing actions to improve their living and working conditions. Objective: To investigate the sociodemographic, occupational and clinical characteristics of workers covered by a risk insurance company in Colombia who suffered upper limb amputations and investigate their association with risk categories. Methods: Exploratory, descriptive, retrospective and analytical study of data relative to workers covered by a risk insurance company in Colombia who suffered upper limb amputation in the period from 1982 and 2017. Following approval by School of Medicine, CES University, and a risk insurance company, we developed a checklist to collect data on the variables of interest. We performed descriptive and bivariate analysis with 95% of confidence and error of 5%. Results: The largest proportion of workers who suffered amputation were men aged 36 to 55 years old and residing in the Andean region of Colombia. Amputations mainly followed incidents during the performance of tasks, particularly in jobs in the secondary economic sector and classified as with type 3 risk. Conclusion: We were able to identify some characteristics associated with accidents, including age, risk class, economic sector, care received and disability duration. The results point to the need for appropriate interventions for the benefit of workers and risk insurance companies

| Introducción: La escasa información sobre las características sociodemográficas, laborales y clínicas de trabajadores que sufren amputaciones de miembro superior dificultan planear y adelantar acciones que aporten al mejoramiento de sus condiciones de vida y de salud. Objetivos: Determinar las características sociodemográficas, laborales y clínicas de trabajadores con amputaciones en miembros superiores atendidos en una aseguradora de riesgos laborales colombiana, para establecer una asociación con el tipo de riesgo. Métodos: Estudio exploratorio, descriptivo y retrospectivo con intención analítica. Se tomaron registros de la base de datos de pacientes con amputaciones de miembro superior atendidos en una aseguradora colombiana entre los años 1982 y 2017. Se aplicó una lista de chequeo, previa aprobación del proyecto por parte de la Facultad de Medicina de la Universidad CES y una aseguradora de riesgos laborales colombiana, para identificar las variables en estudio. Se realizaron análisis descriptivos y bivariados utilizando pruebas estadísticas con una confianza del 95% y un error del 5%. Resultados: Se observó que una mayor proporción de los trabajadores amputados fueron hombres entre 36 y 55 años de edad, residentes y trabajadores en la región andina. Las amputaciones fueron derivadas fundamentalmente de accidentes propios de su labor, particularmente para aquellos del sector secundario, clasificados como riesgo tipo 3. Conclusión: Se observaron algunas características asociadas a la accidentalidad laboral como edad, clasificación de riesgo, sector económico, tipo de atención hospitalaria requerida y días de incapacidad, evidenciando la importancia de intervenir adecuadamente para el beneficio de los pacientes y la aseguradora de riesgos laborales.

Characterization of workers covered by a risk insurance company in Colombia who suffered amputation.

BACKGROUND: Scarcity of information on the sociodemographic, occupational and clinical characteristics of workers who suffer upper limb amputation hinders planning and implementing actions to improve their living and working conditions. OBJECTIVE: To investigate the sociodemographic, occupational and clinical characteristics of workers covered by a risk insurance company in Colombia who suffered upper limb amputations and investigate their association with risk categories. METHODS: Exploratory, descriptive, retrospective and analytical study of data relative to workers covered by a risk insurance company in Colombia who suffered upper limb amputation in the period from 1982 and 2017. Following approval by School of Medicine, CES University, and a risk insurance company, we developed a checklist to collect data on the variables of interest. We performed descriptive and bivariate analysis with 95% of confidence and error of 5%. RESULTS: The largest proportion of workers who suffered amputation were men aged 36 to 55 years old and residing in the Andean region of Colombia. Amputations mainly followed incidents during the performance of tasks, particularly in jobs in the secondary economic sector and classified as with type 3 risk. CONCLUSION: We were able to identify some characteristics associated with accidents, including age, risk class, economic sector, care received and disability duration. The results point to the need for appropriate interventions for the benefit of workers and risk insurance companies.

INTRODUCCIÓN: La escasa información sobre las características sociodemográficas, laborales y clínicas de trabajadores que sufren amputaciones de miembro superior dificultan planear y adelantar acciones que aporten al mejoramiento de sus condiciones de vida y de salud. OBJETIVOS: Determinar las características sociodemográficas, laborales y clínicas de trabajadores con amputaciones en miembros superiores atendidos en una aseguradora de riesgos laborales colombiana, para establecer una asociación con el tipo de riesgo. MÉTODOS: Estudio exploratorio, descriptivo y retrospectivo con intención analítica. Se tomaron registros de la base de datos de pacientes con amputaciones de miembro superior atendidos en una aseguradora colombiana entre los años 1982 y 2017. Se aplicó una lista de chequeo, previa aprobación del proyecto por parte de la Facultad de Medicina de la Universidad CES y una aseguradora de riesgos laborales colombiana, para identificar las variables en estudio. Se realizaron análisis descriptivos y bivariados utilizando pruebas estadísticas con una confianza del 95% y un error del 5%. RESULTADOS: Se observó que una mayor proporción de los trabajadores amputados fueron hombres entre 36 y 55 años de edad, residentes y trabajadores en la región andina. Las amputaciones fueron derivadas fundamentalmente de accidentes propios de su labor, particularmente para aquellos del sector secundario, clasificados como riesgo tipo 3. CONCLUSIÓN: Se observaron algunas características asociadas a la accidentalidad laboral como edad, clasificación de riesgo, sector económico, tipo de atención hospitalaria requerida y días de incapacidad, evidenciando la importancia de intervenir adecuadamente para el beneficio de los pacientes y la aseguradora de riesgos laborales.

Controlling infectious disease outbreaks in low-income and middle-income countries.

When an infectious disease outbreak is detected or suspected, a healthcare facility's infection control personnel should be notified and an outbreak control team formed that is pertinent to the size and severity of the outbreak and healthcare facility. Management of an infectious disease outbreak in a middle- or low-income country is challenging. Cost-effective recommendations that are easy to carry out and that have been stratified according to the type of infection and prevention and control intervention used are provided in this paper and constitute basic practices.