The goal of the Dialysis Outcomes in Colombia (DOC) study was to compare the survival of patients on hemodialysis (HD) vs peritoneal dialysis (PD) in a network of renal units in Colombia. The DOC study examined a historical cohort of incident patients starting dialysis therapy between 1 January 2001 and 1 December 2003 and followed until 1 December 2005, measuring demographic, socioeconomic, and clinical variables. Only patients older than 18 years were included. As-treated and intention-to-treat statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazard model. There were 1094 eligible patients in total and 923 were actually enrolled: 47.3% started HD therapy and 52.7% started PD therapy. Of the patients studied, 751 (81.3%) remained in their initial therapy until the end of the follow-up period, death, or censorship. Age, sex, weight, height, body mass index, creatinine, calcium, and Subjective Global Assessment (SGA) variables did not show statistically significant differences between the two treatment groups. Diabetes, socioeconomic level, educational level, phosphorus, Charlson Co-morbidity Index, and cardiovascular history did show a difference, and were less favorable for patients on PD. Residual renal function was greater for PD patients. Also, there were differences in the median survival time between groups: 27.2 months for PD vs 23.1 months for HD (P=0.001) by the intention-to-treat approach; and 24.5 months for PD vs 16.7 months for HD (P<0.001) by the as-treated approach. When performing univariate Cox analyses using the intention-to-treat approach, associations were with age > or =65 years (hazard ratio (HR)=2.21; confidence interval (CI) 95% (1.77-2.755); P<0.001); history of cardiovascular disease (HR=1.96; CI 95% (1.58-2.90); P<0.001); diabetes (HR=2.34; CI 95% (1.88-2.90); P<0.001); and SGA (mild or moderate-severe malnutrition) (HR=1.47; CI 95% (1.17-1.79); P=0.001); but no association was found with gender (HR=1.03, CI 95% 0.83-1.27; P=0.786). Similar results were found with the as-treated approach, with additional associations found with Charlson Index (0-2) (HR=0.29; Cl 95% (0.22-0.38); P<0.001); Charlson Index (3-4) (HR=0.61; Cl 95% (0.48-0.79); P<0.001); and SGA (mild-severe malnutrition) (HR=1.43; Cl 95% (1.15-1.77); P<0.001). Similarly, the multivariate Cox model was run with the variables that had shown association in previous analyses, and it was found that the variables explaining the survival of patients with end-stage renal disease in our study were age, SGA, Charlson Comorbidity Index 5 and above, diabetes, healthcare regimes I and II, and socioeconomic level 2. The results of Cox proportional risk model in both the as-treated and intention-to-treat analyses showed that there were no statistically significant differences in survival of PD and HD patients: intention-to-treat HD/PD (HR 1.127; CI 95%: 0.855-1.484) and as-treated HD/PD (HR 1.231; CI 95%: 0.976-1.553). In this historical cohort of incident patients, there was a trend, although not stati...

♦ Background and Objective: Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. ♦ Patients and Methods: The present study was a multicenter cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. ♦ Results: A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 -US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. ♦ Conclusions: With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia. Perit Dial Int

BACKGROUND: Precarious employment conditions can influence the worker’s mental health; however, there is no consensus regarding the definition of precarious employment or the way it is measured. OBJECTIVE: The objective is to identify existing research of the conceptual framework, the ways to measure precarious employment and its impact on the mental health of workers. METHODS: A systematic review with the strategic search for observational-empirical and qualitative studies published between 2007 and 2020 in Embase, Scopus and PubMed, full text, in English and Spanish. Studies were selected and excluded, according to eligibility criteria. Two independent reviewers and one arbitrator evaluated the quality of selected papers with the STROBE guidelines for observational studies and SRQR for qualitative ones. RESULTS: 408 studies were obtained, 21 met inclusion criteria, in 14 studies precarious employment was measured one-dimensionally. Of these, 11 with the dimension of temporality and three with insecurity. Four studies it was measured in a multidimensional way, with the Employment Precariousness Scale (EPRES) and in three qualitative designs, with different categories of analysis. Mental health was measured with SF-36 (n = 4), GHQ-12 (n = 3) and CES-D (n = 3). CONCLUSIONS: The concept of precarious employment requires a multidimensional construct, although the tendency to measure precarious employment is one-dimensional. Regardless of how is measured, this has a negative impact on the mental health of workers. The outcomes related to this social determinant included depression, depressive symptoms, psychological distress, stress, and suicidal thoughts. Youths, women, people with low levels of education and immigrants are the groups that show the major precariousness.

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Background: Porcine epidemic diarrhea (PED) is an infectious disease that mainly affects neonatal piglets with a morbidity rate of 80%–100% and a mortality rate of 50%–90%. Prior to March 2014, PED was an exotic disease in Colombia with no historical epidemiological data and this study was conducted at the beginning of the spread of the virus in the country. The aim of the present study was to determine the prevalence and factors associated with porcine epidemic diarrhea virus (PEDV) contamination in pig transportation to slaughterhouses in Colombia through a cross-sectional study involving a sample of 518 pig trucks visiting the 32 main slaughterhouses authorized by the regulatory agency of the govern, the INVIMA. Samples were obtained using proportional allocation stratified sampling of pig trucks entering and leaving slaughterhouses for the diagnosis of PEDV through RT-PCR, as well as conducting a survey of the drivers of the sampled trucks. The sampling was performed from June to November 2014, during the first outbreak. Results: The prevalence of PEDV at the time of entry of the plant was 71.8% (CI 95%: 70.8–72.8) versus 70.5% (CI 95%: 69.5–71.5) on exit (p=0.375). Associated factors found to increase the possibility of contamination included: the type of slaughterhouse either national (OR 15.9, CI 95%: 4.9–51.85) or national–exportation (OR 9.0, CI 95%: 2.20–36.91), the zone of highest slaughter (OR 9.05, CI 95%: 2.9–27.63), the non-exclusive use of vehicles for the transport of pigs (OR 3.75, CI 95%: 1.55–9.08) and visiting animal feed plants (OR 13.5, CI 95%: 4.1–44.12). Factors identified to reduce the possibility of contamination included: the cleaning of vehicles, the use of disinfectants on the vehicle and the exclusive of the vehicle for pig transportation. Conclusions: The results showed that the high degree of truck mobilization, with poor biosafety compliance and dissemination characteristics of the virus, facilitated the spread of PEDV throughout the national territory. These factors contributed to establishing the disease as an endemic problem in Colombia. Keywords: coronavirus, epidemiology, PEDV, prevalence, swine.

Porcine epidemic diarrhea virus (PEDV) causes acute diarrhea, dehydration, and high mortality in newborn piglets and has caused high economic impact in the swine industry in the United States and Asia. Until March 2014, PED was an exotic disease in Colombia. This study was carried out at the beginning of the spread of PEDV in the country, and its main objective was to determine the prevalence and factors associated to the contamination of PEDV in the transportation of pigs to the slaughterhouses in Colombia through environmental samples analyzed by RT-PCR. 518 pig trucks in the 32 main slaughterhouses, were sampled and the drivers of the trucks fulfilled a questionnaire. The prevalence of PEDV at the entrance of the slaughterhouses was 71.8% (CI 95%: 70.8-72.8) versus 70.5% (CI 95%: 69.5-71.5) at the slaughterhouse exit, and there was no evidence of significant differences between both rates. (McNemar value p: 0.375). The factors that increased the possibility of truck contamination were: vehicles that visit national slaughterhouses (OR 15.9 95% CI: 4.9–51.85) and that visit national –export type (OR 9.0 95% CI: 2.20–36.91), trucks with mobility in area of ​​greatest slaughter (OR 9.05 95% CI: 2.9-27.63), the non-exclusive use of vehicles to transport pigs (OR 3.75 95% CI: 1.55-9.08) and visit animal feed mills (OR 13.5 95% CI: 4.1– 44.12). The factors identified that reduce the possibility of contamination were cleanliness of the body truck (OR 0.089 95% CI: 0.03-0.23) and the cabin (OR 0.16 95%CI: 0.08-0.31), use of disinfectant (OR 0.32 95% CI:0.16-0.62), pressurized water (OR 0.38 95% CI:0.15-0.95), and back pump (OR 0.17 95% CI:0.08-0.35) and the exclusive use of the vehicle for pig transportation (OR 0.36 95% CI: 0.19-0.70). The results showed that the high grade of mobilization of the trucks to points of concentration, failures in biosecurity and virus survival characteristics, enabled the spread of PEDV, turning it into an endemic disease in Colombia; however, the measures implemented by the farmers mitigated the impact of the disease. We evidenced the need of standardizing and regulating biosecurity protocols for slaughterhouses, pig transportation and farms.

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Introducción: el mercurio circula por el aire; persiste en suelos, sedimentos y agua, y causa efectos en la salud humana. Las mujeres en edad fértil y los neonatos son la población más vulnerable. Objetivo: analizar las evidencias sobre la carga de enfermedad ocasionada por la exposición a mercurio, así como el impacto económico sobre el sistema de salud. Metodología: revisión de alcance de la literatura, de las bases de datos PUBMED y EPISTEMONIKOS, búsqueda manual de documentos técnicos de entidades oficiales de diferentes continentes. Resultados: se identificaron 311 registros en bases de datos y 4 en búsqueda manual en entidades oficiales; 19 artículos fueron incluidos. Discusión: predomina la afectación del desarrollo neurológico y cognitivo en niños de madres expuestas y lactantes. Los costos se midieron por la pérdida del coeficiente intelectual. Conclusión: efectos en salud por la exposición a metilmercurio se traducen en gastos para la sociedad y los sistemas de salud.