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OBJECTIVES: To describe the demographic features, reasons for hospital admission and factors associated with hospital mortality in patients admitted to intensive care in Colombia. METHOD: A cohort study of patients admitted to intensive care units (ICUs). Of 89 ICUs identified in Colombia, 20 in ten cities were invited to gather information on 200 consecutive patients admitted to each ICU. RESULTS: Three thousand sixty-six patient cases were available for analysis. The mean age was 53 years and 43% were women (men vs. women, p < 0.001). The most frequent cause of admission was medical (63.9%), acute myocardial infarction patients (7.1%) comprising the largest group. Severity of disease measured as APACHE II and III was a mean 14.0 (SD 6.9) and 48.3 (SD 23.5), respectively. Multivariate analysis, independent of adjustment for severity (APACHE II or III), showed that the factors associated with hospital death were the need for mechanical ventilation, pupillary response, transfer from a medical ward, and management by the ICU team prior to admission (p < 0.01). CONCLUSION: The most common reason for admission to an ICU in Colombia was myocardial infarction. Besides severity of disease, other variables related to medical care in Colombia are associated with hospital mortality, such as invasive ventilation. Although these variables may be artifacts related to disease severity, they are more likely to be related to quality of care.
Assuntos
APACHE , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colômbia , Interpretação Estatística de Dados , Feminino , Humanos , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Probabilidade , Prognóstico , Qualidade da Assistência à Saúde , Inquéritos e QuestionáriosRESUMO
PURPOSE: To illustrate and to discuss some ethical challenges encountered during pharmacoepidemiological research in a developing country (Colombia), as well as the decisions made to solve them. METHODS: The authors in Bogotá describe three recent studies. The first one collected data from clinical records to evaluate the prescriptions patterns in recently graduated physicians. The second used an interrupted time series design, with a set of observations prior and after a combined intervention, to assess whether it improved the quality of intravenous antibiotic prescribing practices in a university-based hospital. The third evaluated pharmacists' advice in childhood acute respiratory infection and acute diarrhea through a community survey, followed by focus groups and in-depth interviews of key informers. RESULTS: The ethical issues raised by these studies include the need for obtaining informed consent from participants (physicians in Study 1 and drug sellers in Study 3), deciding when to intervene in case of gross prescription mistakes detected during the collection of data as part of the time series assessment (Study 2), the use of simulated clients to collect data in the community survey, and the use of study resources to buy, in some cases, useless medications (Study 3). CONCLUSION: Although ethical challenges in pharmacoepidemiology in non-industrialized countries like Colombia may be different from those in developed nations, ethical principles that guide research remain the same. The processes to safeguard these principles in Colombia for virtually all research are also universal in nature, and include the ethical review committee, subject privacy, informed consent, and disclosure of funding sources.
Assuntos
Bioética , Farmacoepidemiologia/normas , Antibacterianos/uso terapêutico , Colômbia/epidemiologia , Enganação , Humanos , Consentimento Livre e Esclarecido , Erros de Medicação , Farmacêuticos/normas , Pesquisa/normasRESUMO
MAIN OBJECTIVE: To quantify prescribing patterns of physicians during their year of social work in health centers of Bogotá, Colombia, for three tracer conditions: acute respiratory infection (ARI), systemic hypertension (SH) and acute diarrhea (AD). DESIGN: Cross-sectional survey. SETTING: Primary Care Health Centers in the city of Bogotá. STRATEGY: The Health District Department of Bogotá (Secretaria Distrital de Salud) provided the sampling frame of SILOS (Local Health System) and UPAS (primary health service units) with a physician in the social work year. Samples of patient-physician encounters for the three tracer conditions within UPAS were examined, and detailed information collected on prescription indicators. RESULTS: Information was collected on a total of 1099 patient-physician encounters. Results show that 61% (95% CI: 58.6-63.1) of prescriptions in these settings are non-generic, and only 62% (95% CI: 59.5-64.0) are from the Colombian essential drug list. Number of medications prescribed per encounter were higher with ARI, as well as prescriptions for non-generic forms, antibiotics, and medications outside of the Colombian essential drug list. Inappropriate prescriptions were seen in 31% (95% CI: 28.1-33.7) of all encounters. DISCUSSION: Inadequacy of prescriptions (based on diagnosis) suggest that the teaching of rational prescribing patterns should be targeted with much more emphasis in schools of medicine. Interventions focused on the outstanding deficiencies should be designed and properly evaluated.
RESUMO
OBJECTIVE: To investigate if exposure to firewood smoke and other indoor pollutants is a potential risk factor for obstructive airways disease (OAD) among women in Bogota in whom cigarette smoking and other known risk factors may not be the most frequent. DESIGN AND SETTING: We conducted a hospital-based case-control study to identify risk factors for OAD among women in Bogota. An interview was conducted using a modified questionnaire recommended by the American Thoracic Society for epidemiologic studies. PATIENTS: We compared 104 OAD cases with 104 controls matched by hospital and frequency matched by age. ANALYSIS: The odds ratio (OR) was used as the basic statistic to evaluate risk. Multivariate analysis (MA) was conducted by the Mantel-Haenszel procedure and by logistic regression. MAIN RESULTS: Univariate analysis showed that tobacco use (OR = 2.22; p < 0.01), wood use for cooking (OR = 3.43; p < 0.001), passive smoking (OR = 2.05; p = 0.01), and gasoline use for cooking (OR = 0.52; p = 0.02) were associated with OAD. Trends for years of tobacco use and years of wood cooking were present (p < 0.05). After MA, variables remained significant except gasoline use. CONCLUSIONS: This study showed that among elderly women of low socioeconomic status in Bogota, woodsmoke exposure is associated with the development of OAD and may help explain around 50% of all OAD cases. The role of passive smoking remains to be clarified. This work may set the basis for interventional studies in similar settings.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar em Ambientes Fechados/efeitos adversos , Exposição Ambiental , Pneumopatias Obstrutivas/etiologia , Fumaça/efeitos adversos , Madeira , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Colômbia , Culinária , Feminino , Gasolina/efeitos adversos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Fumar/efeitos adversos , Classe Social , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
The aim of this study was to identify factors associated with Multiple Organ Failure (MOF), and assess possible interactions between the risk factors identified as such. We studied 40 MOF cases and 120 controls, out of all the surgery and trauma patients who needed intensive care at our institution in a 24-month period. The univariate analyses showed that age, hypovolemic shock, massive volume administration (MVA), sepsis, and time of evolution before arriving to the hospital (TE) were significantly associated with MOF. Logistic regression analysis showed that neither age nor MVA were independently associated with MOF after adjusting for all of the other variables. Interactions seemed to be present between age, sepsis, and shock. We conclude that in our surgery and trauma ICU adult patient population, hypovolemic shock, sepsis, and TE are independent risk factors for MOF. The importance of the association between shock and sepsis is discussed, as well as the possible relevance of TE as a risk factor.