Association between the Increase in Body Mass Index and Medical Absenteeism in a Peruvian Mining Population.

BACKGROUND: Obesity and overweight are associated with work absenteeism of medical cause. However, there is little knowledge on the relationship between incremental body mass index (BMI) and absenteeism. OBJECTIVE: To assess the effect of annual increase in BMI on amount of prolonged absenteeism. METHODS: Data from a longitudinal historical cohort of workers of a mining camp in Peru between 2006 and 2014 were used for the analysis. Prolonged absenteeism of 30 days or more in one year was chosen as the dependent variable; annual increase in BMI was considered as the explanatory variable. Regression analysis with generalized estimating equation was used to determine the relative risk adjusted for age, sex and type of work. RESULTS: There were 1347 cases of medical leave reported with a median of 6 days. Of all cases of medical leave, 11% of those who had an annual increase in BMI and 6% of those who maintained their BMI were cases of prolonged absenteeism. Prolonged absenteeism significantly increased in workers who had an annual increment in BMI (adj RR 1.16, 95% CI 1.05 to 1.29). CONCLUSION: The annual increase in BMI was marginally associated with prolonged absenteeism. Temporal increment in BMI, regardless of the baseline BMI, may be an independent determinant of the work absenteeism of medical cause.

Accidentes laborales reportados a un hospital de la seguridad social en Piura-Perú, 2010-2012 / Work accidents reported to a social security hospital in Piura-Perú, 2010-2012

Objetivo: Determinar factores asociados a la referencia inmediata a un hospital de la seguridad social luego de un accidente laboral. Métodos: Estudio transversal analítico de los datos de accidentes laborales atendidos en el Hospital III "José Cayetano Heredia" - Piura, entre los años 2010-2012. Se evaluó las características del trabajador, de su puesto de trabajo, del accidente y su repercusión. Se usó la variable referencia inmediata a la institución de salud como dependiente, considerando como categoría de interés si se acudió a un establecimiento de salud como primer lugar post accidente de trabajo. Se calcularon las razones de prevalencia crudas (RPc) y ajustadas (RPa) con los modelos lineales generalizados, usando la familia binomial y la función de enlace log. Resultados: Se notificaron 2251 accidentes de trabajo en los tres años, siendo el domicilio de los trabajadores el primer lugar a donde acudió el 59% (1317), entre las 10 am-12 m fue el período del día con más accidentes. En el análisis multivariado, los operarios y los accidentes que generaron heridas no acudieron inmediatamente al hospital post accidente en 24% (IC95%: 19-33%) y 36% (IC95%: 12-35%), respectivamente. En cambio, aquellos accidentes que fueron causados por agentes físicos tuvieron un 25% (IC95%: 1-55%) más referencia inmediata al hospital. Conclusión: Según los datos analizados, se encontró una elevada frecuencia de no reporte inmediato a la institución hospitalaria de accidentes laborales, esto debe ser tomado en cuenta por las autoridades responsables para mejorar la situación que va contra la ley (AU)

Objective: To determine the social and occupational characteristics of the occupational injuries reported to a Social Security hospital in Piura. Methods: A cross-sectional analytical study of a database of occupational injuries reported to "José Cayetano Heredia" Hospital in Piura, Peru, between 2010 and 2012 was performed. Characteristics of workers including job position, type of injury and repercussion were examined. The variable ‘immediate referral to a medical facility of the Social Security System’ was used as dependent variable, considering as category of interest whether the first destination after an occupational injury was any outpatient clinic or medical facility. The non-adjusted (RP) and adjusted prevalence rates (aPR) were calculated with generalized lineal models, using the binomial family and log link function. Results: a total of 2251 occupational injuries were notified, with 59% (1317) of workers that went home as first destination after being injured. Most accidents occurred between 10 am and 12 pm. In the multivariate analysis, the blue collar workers and the accidents did not go immediately to the medical facility after the event in 24% (IC95%: 19-33%) and 36% (IC95%: 12-35%), respectively. However, injuries that were caused by physical agents had a rate of 25% (IC95%: 1-55%) of immediate referral to an outpatient clinic. Conclusion: according to the analyzed data, a high frequency of not-immediate report of occupational injuries to the hospital was found. This has to be taken into account by the authorities to improve this situation, which goes against the law (AU)

Experiencia en la gestión de la somnolencia de conductores mineros peruanos a gran altitud, 2008-2014 / Experience in somnolence management of Peruvian high altitude mining drivers between 2008-2014

Todas las organizaciones asumen la responsabilidad de gestionar los riesgos laborales a los que están expuestos sus trabajadores, independiente de su actividad económica. De este modo, las organizaciones planifican, ejecutan, verifican y revisan sistemáticamente su gestión para alcanzar el bienestar de los trabajadores y de sus familias. Por lo expuesto, resultó oportuno desarrollar un programa que gestione la somnolencia en conductores que realizan turnos en una empresa minera ubicada en gran altitud. El objetivo de la presente contribución especial fue describir los elementos necesarios para la gestión de la somnolencia en población laboral de riesgo, teniendo en cuenta la experiencia del autor (AU)

Regardless of their economic activity, all organizations assume responsibility for managing the risks to their exposed workers. Therefore, organizations plan, implement, verify and systematically review its management to achieve the welfare of workers and their families. For these reasons, was necessary to develop a program to manage sleepiness among shift drivers engaged in a mining at high altitude. The main objective of our special contribution was show the basic elements to manage the somnolence, like a risk in exposed workers, according with the experience of author (AU)

[Hemoglobin changes (Hb) in miners exposed to high altitude and associated factors]. / Cambios en la hemoglobina (Hb) de trabajadores mineros expuestos a gran altura y factores asociados.

AIM: To determine the variation of hemoglobin (Hb) in two groups of miners working at different altitudes. METHODOLOGY: A longitudinal study conducted in a private company. Hb was obtained from entrance exams and annual checks of workers at two locations: at sea level and at Peruvian highlands (4,100 m), taken by trained staff and equipment calibrated to environmental conditions. We analyzed variations in the course of the years with the PA-GEE statistical test; p values were obtained. RESULTS: Of the 376 workers, 89% (322) were men, the median age was 32 years (range 20-57) and 84% (304) were at high altitude. In multivariate analysis, male sex (p < 0.001), body mass index (BMI; p = 0.021) and working at high altitude (p < 0.001) were associated with the greatest variation of Hb in time, adjusted for age, length, and type of work. DISCUSSION: These findings should be considered for health surveillance of workers exposed to similar conditions to prevent chronic mountain sickness. CONCLUSION: The change in Hb of miners was associated with male sex, BMI, and work at high altitude.

Tecnología de información y adhesión de guías de práctica clínica en el nivel de atención asistencial primario: experiencia privada, 2013-2014 / Information technology and adherence to clinical practice guidelines in primary assistant care level: Private Experience, 2013-2014

Objetivo: Se describió la variación de la adherencia de las Guías de Práctica Clínica (GPC), luego de la implementación del módulo "terapéutica sugerida" en el sistema informático asistencial de un establecimiento de salud privado en La Libertad. Material y métodos: Se comparó el nivel de adherencia trimestral de las GPC antes y después de la intervención, mediante auditoría de la información asistencial. Resultados: El nivel de adherencia de las GPC antes de las modificaciones estuvo entre 63% y 65%, observándose un incremento hasta 75% posterior a la implementación del módulo "terapéutica sugerida". Conclusión: La implementación de módulos facilitadores de la acción asistencial en el sistema informático podría mejorar la adhesión a las GPC, lo que sugiere la necesidad de replicar otros estudios

Objective: The variation of the adhesion of the Guidelines of Clinical Practice (GPC), after the implementation of the "suggested therapeutic" module in the computer system of a private health facility in La Libertad was described. Material and methods: The level of quarterly adherence of GPC was compared before and after the intervention, by an audit of healthcare information. Results: The level of adherence of GPC before the amendments was between 63% and 65%, with an increase to 75% after the implementation of the "suggested therapeutic" module. Conclusion: Use of facilitator's modules of healthcare assistance in the information system could improve adherence to GPC, which suggest the need to replicate other studies

Edad como factor de riesgo para desarrollar síndrome metabólico en trabajadores mineros a gran altura / Age as a risk factor for developing metabolic syndrome in mine workers at high altitude

Objetivo: Determinar el riesgo de adquirir síndrome metabólico (SM) según los años de edad y otros factores asociados en trabajadores de una minera de la serranía peruana. Metodología: Estudio analítico longitudinal, de los datos obtenidos entre 2007 y 2010 en trabajadores de un campamento minero. Se consideró que los trabajadores tenían SM si cumplían los criterios de la Federación Internacional de Diabetes (diámetro de cintura ≥ 94 cm en hombres o ≥ 80 cm en mujeres, más ≥ 2 parámetros alterados: glucemia, presión arterial, colesterol HDL o triglicéridos). Se obtuvo los riesgos relativos ajustados con la regresión PAGEE, para determinar el riesgo de adquirir el SM en el tiempo (según el año del examen médico-ocupacional). Resultados: De las 1.198 mediciones de los trabajadores, el 93%(1109) fueron hombres, la mediana de edad fue de 33 años. El 36% (428) tuvo el parámetro de cintura alterado, y de ellos el 100% tuvo entre 2 o más parámetros adicionales alterados para el diagnóstico de SM. Al realizar la estadística multivariada, ajustada por el tiempo y el valor del índice de masa corporal, se encontró que por cada año de edad que aumentaban los trabajadores se incrementaba en un 2% (intervalo de confianza del 95%: 1-4%) el riesgo de tener SM. Discusión: En los trabajadores evaluados, la edad fue un factor de riesgo para presentar SM; este parámetro y otros de relevancia deben ser vigilados por las empresas para generar las políticas de estilo de vida saludable, que prevengan problemas de enfermedades crónicas con potenciales repercusiones en los trabajadores, la empresa y la sociedad.

Objective: To determine the risk of getting metabolic syndrome (MS) according to years old and others associated factors in workers mining of the Peruvian highlands. Methodology: Longitudinal study of data collected between 2007-2010 in a mining camp workers. It was considered that workers had MS if they met the criteria of the International Diabetes Federation (≥94 cm waist circumference in men or women ≥80 cm more ≥2 altered parameters: blood glucose, blood pressure, HDL cholesterol or triglycerides). Adjusted relative risk with the PA-GEE regression were obtained to determine the risk of acquiring the SM over the time (depending on the year of occupational medical examination). Results: Of the 1198 measurements workers, 93% (1109) were men, the median age was 33 years. 36% (428) had a parameter altered waist, and 100% of them had between 2 or more additional parameters altered for the diagnosis of metabolic syndrome. When performing multivariate statistics, adjusted for the time value of body mass index was found that for each year of age increased workers increased by 2% (95%CI: 1-4%) the risk of MS. Discussion: workers evaluated age was a risk factor for MS, this parameter and other relevant should be monitored by companies to generate policies for healthy lifestyle, to prevent chronic disease problems with potential implications workers, the company and society.

Embarazo abdominal, a propósito de un caso / Abdominal pregnancy. A case report

We present a case of primary abdominal pregnancy that represented a diagnostic and therapeutic challenge because its inespecific clinical presentation. Knowledge of the differential diagnosis and the complications of abdominal pregnancy is required to avoid the mistakes that could be life threatening for the mother.