From November 1996 through March 1997, presumptive active pulmonary tuberculosis (TB) was detected in 44 health care workers (HCWs) at a university hospital in Lima, Peru. To further assess the magnitude of the outbreak and determine risk factors for occupational Mycobacterium tuberculosis transmission, we identified HCWs in whom active pulmonary TB was diagnosed from January 1994 through January 1998, calculated rates by year and hospital work area, and conducted a tuberculin skin test (TST) survey. Thirty-six HCWs had confirmed active pulmonary TB. The rate of TB was significantly higher among the 171 HCWs employed in the laboratory than among HCWs employed in all other areas. In multivariate analysis, the only independent risk factor for HCW M. tuberculosis infection in HWCs employed in the laboratory was the use of common staff areas. Very high rates of active pulmonary TB were detected among HCWs at this hospital, and occupational acquisition in the laboratory was associated with HCW-to-HCW transmission.

Las cardiopatías congénitas han cobrado importancia en las últimas décadas, no solo por su relevancia clínica sino también por su incremento como problema de salud pública. En nuestro país, pese a los avances en el manejo médico, no se ha realizado estudios que determinen la importancia epidemiológica de este grupo de problemas. Objetivo: Determinar la importancia epidemiológica de las cardiopatías congénitas. Diseño: Sistematización de estudios epidemiológicos. Lugar: Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina de San Fernando, UNMSM. Materiales: Estudios epidemiológicos e información demográfica. Procedimiento: Mediante una recopilación bibliográfica de estudios epidemiológicos e información demográfica, se realizó estimaciones de la incidencia de casos en nuestro país, para el quinquenio 2006-2010. Principales medidas de resultados: Cardiopatías congénitas. Resultados: Se estima que en el 2006 existieron 3 925 cardiopatías, de las cuales 83,5% fueron no cianóticas. Las cifras serían similares anualmente hasta el 2010. También, se estima que representarían el 2,5% del total de razón de años de vida potencialmente perdidos por cada mil habitantes. Conclusiones: Las cardiopatías congénitas son un problema de salud pública que debe ser tomada en cuenta para preparar a los servicios nacionales de salud. Asimismo, debe emprenderse estudios epidemiológicos sobre este problema.

A829Generalized linear regression models were used to examine associations between the total cost of hospitalization and various sociodemographic and clinical variables. Results: 301 patients were included; age 75.3 ± 11.8 years; 37% female; 57% with depressed ejection fraction; 46% of coronary artery disease. The blood pressure on admission was 129.8 ± 29.7 mmHg; renal function 26.2 ± 57.9 ml / min / 1.73 m2. In-hospital mortality was 7%. The length of stay was 7.82 ± 7.06 days (median 5.69), more prolonged in patients with renal impairment (8.59 vs. 8.18; p = 0.0329) and shorter in those with elevated blood pressure on admission (6.08 ± 4.03; p = 0.009). The average cost per patient was AR $ 68,861 ± 96,066 (US $ 8,071 ± 11,259; US $ 1 = AR $ 8.7928); 71% attributable to hospital stay, 20% for therapeutic procedures (mainly aortic valve surgery, implanted defibrillator and coronary angioplasty) and 6.7% for diagnostic studies (mainly radiology, laboratory and echocardiogram). In multivariate analysis, depressed ejection fraction, valve antecedent and impaired renal function at admission were associated with higher costs. ConClusions: Resource use and costs associated hospitalizations for heart failure are high, and the highest proportion is attributable to the costs of hospital stay.

A133hospitalized for ≥ 2 days (hospitalized patients; HPs), or using emergency room (ER) or observation for 1 day (emergency room patients; ERPs). Reimbursements were based on claims and inflated to 2010 USD; costs were derived from 2010 Premier data. Net reimbursement was analyzed by MS-DRG and length of stay (LOS). The risk of all-cause hospitalization and factors correlated with LOS were determined using regression modeling. Results: Across all study years, the median age was 71 for HPs, 65 for ERPs. Median Charlson Comorbidity Index (CCI) was 4 for HPs and 2 for ERPs. HPs had more cellulitis on the leg or surgical infection; ERPs had more cellulitis on the face, trunk, or arm. Median HP LOS was 4 days; 33% of patients had LOS > 6 days. Age, race, and history of bacterial infection were correlated with LOS. Median all-cause, ABSSSI-related and index event costs during the index quarter for patients with a principle ABSSSI diagnosis were $9,930, $6,123 and $5,604 for HPs and $1,127, $108 and $100 for ERPs respectively. ConClusions: HPs were older and sicker than ERPs, with more cellulitis on the leg and post-operative infections. Further research and analysis may help determine whether treating some hospitalized patients with less comorbidity in the ambulatory setting might result in lower costs per patient after controlling for these factors.

No abstract

El Tumor Phyllodes (Fibroadenoma Intracanalicular Gigante) es un tipo de tumor de mama que presenta en los últimos años un incremento en su incidencia en algunos países planteando diversas interrogantes epidemiológicas. El objetivo del siguiente estudio es realizar un análisis exploratorio de las características epidemiológicas de este tumor basándonos en 53 casos presentados en el Hospital IPSS Edgardo Rebagliatti Martins en el período 1989-1995. Dentro de las características más relevantes se encontró un promedio de edad de 43.45 años. Asimismo se observó que el 67.9% de los casos se presentaron en pacientes premenopáusicas. Dentro de las características ocupacionales se halló una mayor frecuencia en empleadas, en especial profesoras (24.5%). El 39.6% de las pacientes eran naturales de Lima y el 69.8% de ellas residían en la ciudad al momento del diagnóstico. Respecto a los tipos histológicos, predominan las formas benignas con un 81.13%. El tipo histológico maligno es el menos frecuente y se presenta en mayores de 30 años de edad. En términos generales los hallazgos revelan que el Tumor Phyllodes se presenta en la etapa reproductiva de la mujer. Los hallazgos revelan que cuanto mayor es el número de gestaciones el tumor es poco frecuente. Asimismo no se encuentran evidencias de exposición industrial o de labores de alta exposición a agentes cancerígenos. Un hallazgo que consideramos relevante, es que el cambio de residencia (migración a Lima) estuvo asociado a una menor edad de la paciente al momento de presentación del tumor, lo que plantea un indicio de aparición del tumor con una exposición al ecosistema urbano. Los hallazgos hacen presumir que diversos factores gineco-obstétricos relacionados con la etapa reproductiva juegan un papel importante en la programación de este tumor, consideramos sin embargo que el rol de los factores ambientales amerita mayores investigaciones.

A125patients with type 2 diabetes mellitus (T2DM). This study explored the association of race/ethnicity and gender with complications severity, HRU, and costs among Medicare Advantage patients. Methods: A retrospective cohort study was performed using medical and pharmacy claims of 333,576 Medicare members enrolled from 1/1/2010 to 12/31/2011, aged 18 to 89, and with ≥ 1 medical claim with primary diagnosis or ≥ 2 medical claims with secondary diagnosis of T2DM (ICD-9-CM 250. x0 or 250.x2). Complications severity was assessed with the Diabetes Complications Severity Index, with scores of 0 (no complications) through 5+ (five or more). HRU was reported by mean (standard deviation [SD]) number of outpatient, inpatient, and emergency room [ER] visits. Costs were reported as means (SD) of medical, pharmacy and total health care costs evaluated. Associations of race/ethnicity and gender with the three outcomes were evaluated using generalized linear regression models. Results: The sample was older (70.81 ±8.8 years) and 80% White. Being Hispanic, Black, or male was associated with a higher prevalence of more severe T2DM complications; this disparity was more pronounced among females, with the odds of having more severe complications being higher for Hispanic and Black females compared to White females (Hispanic v. White odds ratio [OR], 1.40; 95% confidence interval [CI], 1.32-1.48), and (Black v. White OR, 1.22; 95% CI, 1.19-1.25). Regardless of gender, Blacks had more ER visits than Whites. Whites, particularly females, incurred the highest total annual health care costs,

Objectives: Incremental health care resource utilization associated with autosomal dominant polycystic kidney disease (ADPKD) was estimated across two subgroups; individuals with ADPKD and end-stage renal disease (ESRD) and those with ADPKD but without ESRD. MethOds: Study data were from a large administrative claims and enrollment database. Individuals 18 y/o or older, enrolled in tracked health plans for 12 months from April 1, 2011 through March 31, 2012, and with an ICD-9-CM diagnosis code for "polycystic kidney, autosomal dominant" (753.13) or for "polycystic kidney, unspecified type (753.12) were identified as having ADPKD, and linked one-to-one with individuals without ADPKD on age and gender. ESRD was identified by presence of ICD-9-CM code 585.6. Zero-inflated negative binomial models estimated incremental hospitalizations, hospital days, outpatient visits, and emergency room visits for each sub-group, adjusting for age, gender, Charlson co-morbidity index, cardiovascular disease, diabetes and geographical region. Results: A total of 3,844 individuals with ADPKD who satisfied selection criteria were linked one-to-one with 3,844 individuals without ADPKD. Among persons with ADPKD, 644 had a diagnosis of ESRD. The sample was 53% female and 55% were between 45 to 64 years old. Incremental mean (standard error) resource utilization associated with ADPKD with ESRD as compared to persons without ADPKD was 0.35 (0.052) or 35 additional hospitalizations per 100 patients, 2.5 (0.42) or 250 hospital days per 100 patients, and 24.0 (1.2) or 2,400 outpatient visits per 100 patients. Incremental mean (standard error) resource utilization associated with ADPKD but without ESRD as compared to persons without ADPKD was 0.065 (0.028) or 6.5 additional hospitalizations per 100 patients, 0.5 (0.091) or 50 hospital days per 100 patients, and 4.4 (0.41) or 440 outpatient visits per 100 patients. cOnclusiOns: ADPKD was associated with incrementally greater health care resource utilization even before patients reached ESRD.