Brote de silicosis en trabajadores españoles de conglomerados de cuarzo / Outbreak of silicosis in Spanish quartz conglomerate workers

El objetivo del estudio es describir las características epidemiológicas y clínicas de un brote de silicosis ocupacional y las condiciones de trabajo asociadas. Se consideraron como casos a todos los hombres diagnosticados de silicosis entre julio de 2009 y mayo de 2012 por la unidad de neumología del Hospital Universitario de Puerto Real (Cádiz) que trabajaban en la industria del corte, tallado y acabado de la piedra. Para determinar el número potencial de trabajadores expuestos se elaboró un censo de los lugares de trabajo que utilizaban conglomerados de cuarzo. A los pacientes incluidos en el estudio se les realizó una encuesta telefónica sobre exposiciones ocupacionales y se revisaron sus historias clínicas. La silicosis se diagnosticó en 46 hombres, que tenían una edad mediana de 33 años y una mediana de 11 años trabajando en la fabricación de encimeras. De estos casos, el 91,3% fue diagnosticado de silicosis crónica simple con una tomografía axial computarizada de alta resolución (TACAR) anormal. Un paciente falleció durante el período de estudio. Se detectó tanto un incumplimiento frecuente de las medidas de prevención y control por parte del empleador, como fallas en los sistemas de protección ambientales e individuales. En conclusión, el uso de nuevos materiales de construcción tales como los conglomerados de cuarzo ha incrementado la incidencia de silicosis por exposiciones laborales intensivas en el contexto de una alta demanda impulsada por el auge en la construcción. Esta exposición generalizada representa un riesgo si no se toman medidas preventivas adecuadas

The aim of the study is to describe the epidemiological and clinical characteristics of an outbreak of occupational silicosis and the associated working conditions. Cases were defined as men working in the stone cutting, shaping, and finishing industry in the province of Cádiz, diagnosed with silicosis between July 2009 and May 2012, and were identified and diagnosed by the department of pulmonology of the University Hospital of Puerto Real (Cádiz). A census of workplaces using quartz conglomerates was carried out to determine total numbers of potentially exposed workers. A patient telephone survey on occupational exposures and a review of medical records for all participants were conducted. Silicosis was diagnosed in 46 men with a median age of 33 years and a median of 11 years working in the manufacturing of countertops. Of these cases, 91.3% were diagnosed with simple chronic silicosis, with an abnormal high-resolution computerized tomography (HRCT) scan. One patient died during the study period. Employer non-compliance in prevention and control measures was frequently reported, as were environmental and individual protection failures. In conclusion, the use of new construction materials such as quartz conglomerates has increased silicosis incidence due to intensive occupational exposures, in the context of high demand fuelled by the housing boom. This widespread exposure poses a risk if appropriate preventive measures are not undertaken

[Prostatic exfoliative cytology obtained from urine samples after massage. Initial results]. / Citología exfoliativa prostática obtenida en muestras de orina tras masaje. Primeros resultados.

INTRODUCTION: The same as the exfoliative cytology is a routine method to diagnose bladder tumour, the prostatic cytology obtained after massage may become a useful procedure to diagnose prostate cancer. OBJECTIVE: To obtain suitable prostatic cytologic material. To establish the role of the exfoliative cytology to diagnose cancer. MATERIAL AND METHODS: We made a prospective longitudinal descriptive study with 60 patients out of 150 (all of them with possible prostate cancer) for two years. We compared cytologic discoveries (urine after massage) with histological parameters (biopsies). RESULTS: When the cytology fulfills a series of requirements (a high number of prostatic cells, anisokariosis and antibodies Ki-67+) and these are compared with the histological data, we obtained a specificity of 100% and a sensibility of 67% for prostatic cancer. With this information the cytology reaches a predictive value of 100% and negative of 92%. CONCLUSIONS: It is possible to obtain prostatic cytologic material in a simple and easy way. The prostatic cytology may become a valid and useful method to diagnose the carcinoma of the prostate. Also this material can be used for multiple diagnostic, follow-up and research procedures.

Citología exfoliativa prostática obtenida en muestras de orina tras masaje. Primeros resultados / Exfoliative prostatic cytology obtained in urine samples after massage. First results

INTRODUCCIÓN: Al igual que la citología exfoliativa es un método de rutina en el diagnóstico del cáncer vesical, la citología prostática obtenida tras masaje puede llegar a ser un procedimiento de utilidad diagnóstica en el cáncer prostático. OBJETIVOS: Obtener material citológico prostático adecuado. Establecer el papel de la citología exfoliativa prostática en el diagnóstico del cáncer. MATERIAL Y MÉTODOS: Llevamos a cabo un estudio descriptivo, longitudinal y prospectivo, del que presentamos los resultados preliminares, sobre 60 pacientes de un total de 150, con sospecha de cáncer prostático, en un periodo de dos años. Comparamos hallazgos citológicos (orina tras masaje) con parámetros histológicos (biopsias).RESULTADOS: Cuando la citología cumple una serie de requisitos (elevado número de células prostáticas, anisocariosis y anticuerpo Ki-67 +) y estos se comparan con los datos histológicos, obtenemos para el cáncer prostático una específicidad del 100 per cent y una sensibilidad de 67 per cent. Con este tamaño de muestra la citología alcanza un valor predictivo del 100 per cent y negativo del 92 per cent. CONCLUSIONES: Es posible la obtención de material citológico prostático de forma simple y sencilla. La citología prostática puede llegar a ser un método útil y válido en el diagnóstico del carcinoma de la próstata. Este material además se puede utilizar para múltiples procedimientos diagnósticos, de seguimiento y de investigación (AU)

[Comparative study of a neonatology unit by means of 2 patient grouping technics]. / Estudio comparativo de una sección de neonatología a través de dos técnicas de agrupación de pacientes.

In this study we make a measurement of the case-mix of the neonatology section in Hospital Puerta del mar in Cadiz during the year 1990, through two methods: Diagnosis Related Groups (GRDs), and Patient Management Categories (PMCs). We compare this case-mix with other hospitals. We compare this case mix with other hospitals. We also compare both methods between themselves through a multiple lineal regression. The results point out that the complexity of casuistry attended in Cadiz was lower to those attended in other control hospitals, and that these ones worked more efficiently. As for comparison of both technics, the GRDs demonstrated to have a superior capacity than the PMCs to discriminate the casuistry.

[Data envelopment analysis: its use to assess efficiency of hospital preventive medicine services of Andalusia]. / Análisis envolvente de datos: aplicación en la medida de la eficiencia en los servicios de Medicina Preventiva hospitalarios de Andalucía.

BACKGROUND: The evaluation of hospital units efficiency is a major matter of health services management. Among the techniques to measure efficiency. The Data Envelopment Analysis (DEA) can be used in multiple resources units (inputs) obtaining multiple products (outputs). The objective of this study is the evaluation of Hospital Preventive Medicine Services in Andalucia, using the technique DEA. METHODS: The Preventive Medicine Services from seven hospitals of Andalucia were selected. DEA is technique, based on a linear programming, which finds the weights, which make a Service efficient in relation with the rest. The relative efficiency of seven units was calculated. The unit with the best practice was found by means of cross efficiency matrixes. With regard to the inefficient services, their necessity of increasing activities to achieve efficiency was identified. RESULTS: Two efficiency assumptions were elaborated. In the first one, 4 services were efficient (Efficiency = 1) in relation with the rest. In the second one, the Service S.1 was inefficient. Among the efficient units, S.2 shown the highest average efficiency in both assumptions and appeared as the reference unit for all the inefficient ones. CONCLUSIONS: In the evaluation of Preventive Medicine Services efficiency, at least, three of them shown some kind of inefficiency. The Service S.2 was the point of reference for inputs and outputs selected.