This study analyses gender differences in the complexity observed in palliative home care through a multicentre longitudinal observational study of patients with advanced disease treated by ...palliative home care teams in Catalonia (Spain). We used the HexCom model, which includes six dimensions and measures three levels of complexity: high (non-modifiable situation), medium (difficult) and low. Results:
= 1677 people, 44% women. In contrast with men, in women, cancer was less prevalent (64.4% vs. 73.9%) (
< 0.001), cognitive impairment was more prevalent (34.1% vs. 26.6%;
= 0.001) and professional caregivers were much more common (40.3% vs. 24.3%;
< 0.001). Women over 80 showed less complexity in the following subareas: symptom management (41.7% vs. 51,1%;
= 0.011), emotional distress (24.5% vs. 32.8%;
= 0.015), spiritual distress (16.4% vs. 26.4%;
= 0.001), socio-familial distress (62.7% vs. 70.1%;
= 0.036) and location of death (36.0% vs. 49.6%;
< 0.000). Men were more complex in the subareas of "practice" OR = 1.544 (1.25-1.90
= 0.000) and "transcendence" OR = 1.52 (1.16-1.98
= 0.002). Observed complexity is related to male gender in people over 80 years of age. Women over the age of 80 are remarkably different from their male counterparts, showing less complexity regarding care for their physical, psycho-emotional, spiritual and socio-familial needs.
Despite improvements in children's health due to a reduction in infections, trauma continues to cause many deaths among adolescents. Strategies to mitigate morbidity and mortality from trauma include ...severity scores to classify and refer patients to the appropriate hospitals to provide better management; however, these strategies have not been assessed in Colombian children. This study aimed to describe the characteristics and outcomes of injured children and evaluate the performance of the Pediatric Trauma Score (PTS) in predicting survival at a major trauma centre in a Colombian city.
This was a retrospective cohort study of children aged <18 years who were treated for injuries at a hospital in Colombia. The primary outcome was 30-day mortality. A simple logistic regression model was used with PTS as the predictor variable and vital status at discharge as the outcome variable. PTS performance was assessed by discrimination using the area under the receiver-operating characteristic (AUROC) curve and by calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test.
A total of 1047 children were admitted. The median age was 12 years (interquartile range IQR=5-15); 73·7% were male, and 66·1% had blunt trauma. The most frequent cause of injury was traffic accident (31·5%) followed by assaults (29%). Mortality was 5·9%; 61·3% of these deaths occurred in adolescents between 15 and 17 years of age and 71% of deaths in this age group were due to injuries from a firearm. The PTS had a median of 7 (IQR=5-9), an AUROC of 0·93, and good calibration (HL=7·97,
= 0·33).
The highest proportion of trauma and death occurred among adolescents. Interpersonal violence was the most frequent cause of death in this age group. The PTS showed good predictive power for survival, with excellent discrimination and good calibration.
None.
Purpose: To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. Design and Methods: ...Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. Inclusion criteria: Identifying oneself as principal CG of a dependent relative with dementia or any other disability, and having performed this task for at least 6 months. CGs were randomized to an intervention group (cognitive-behavioral treatment for managing dysfunctional thoughts about caregiving and training in self-help techniques) or to a control group (care as usual). CG mental health (General Health Questionnaire GHQ-12), dysfunctional thoughts about caregiving, quality of life, and burden were measured. Results: The intervention group showed improvement in mental health: A mean reduction in GHQ-12 score of -3.33 points was recorded in the intervention group vs. the control group (95% CI: -5.95 to -0.70; p = 0.01; Cohen d = 0.55). Improvement was also recorded in dysfunctional thoughts about caregiving: (-5.84; 95% CI: -10.60 to -1.09; p = 0.01; Cohen d = 0.62). Among the CGs that completed the initial and final assessments, a mean of 4.77 (SD 2.68) attended a maximum of 8 sessions. Men attended more often (5.00 sessions with SD 2.68) than women (4.70 sessions with SD 2.45; p less than 0.001). Implications: Psychological group intervention in the context of PHC, aimed at the CGs of dependent persons with dementia and other disabilities, has improved mental health condition in CGs.
La hipotermia terapéutica (HTT) es el único tratamiento que ha demostrado aumentar la posibilidad de supervivencia libre de secuelas en los recién nacidos (RNs) afectos de encefalopatía ...hipóxico-isquémica (EHI), recomendándose iniciarla lo antes posible. Lo más frecuente es que los pacientes tributarios de HTT no nazcan en los centros de referencia (CR) .requiriendo ser transportados.
Estudio observacional descriptivo prospectivo de RNs con EHI moderada-grave trasladados en hipotermia terapéutica no servo-controlada por los dos equipos de transporte neonatal y pediátrico terrestres de Cataluña (abril 2018-noviembre 2019).
51 pacientes. Mediana de tiempo de estabilización 68 minutos (p25-75, 45 – 85min), traslado 30 minutos (p25-75, 15 – 45min). Media de edad a la llegada al CR 4 horas y 18 minutos (DE 96min). Medidas terapéuticas adoptadas: apagar la incubadora 43 (84,3%), bolsas de hielo 11 (21,6%) y ambas 11 (21,5%) pacientes. Se consiguió la temperatura rectal (TR) diana en 19 (37,3%) pacientes. No hubo diferencias en el sobre-enfriamiento según las medidas usadas para la aplicación de la HTT no servo-controlada (HTTnc). La duración del traslado no se relacionó con diferencias en la estabilización de la temperatura ni en la consecución de la temperatura objetivo.
La monitorización de la TR en el centro emisor es un pilar fundamental en la estabilización del paciente y la aplicación de la HTTnc. Existe una clara área de mejora en la eficacia de la HTTnc durante el transporte. La HTT servo-controlada sería una opción para poder ofrecer las mismas posibilidades terapéuticas a los RNs extramuros de los CR.
Therapeutic hypothermia (TH) improves survival and neurological prognosis in hypoxic-ischemic encephalopathic (HIE) babies, being better the sooner TH is implemented. HIE babies are born more frequently in a non-cooling centre and need to be referred.
Prospective-observational study (April 18–November 19). Newborns (≥34 weeks of gestational age (GA) and >1800g) with moderate/severe HIE on non-servocontrolled therapeutic hypothermia by the two neonatal transport teams in Catalonia.
51 newborns. The median stabilisation and transport time were 68min (p25–75, 45–85min) and 30min (p25–75, 15–45min), respectively. The mean age at arrival at the receiving unit was 4h and 18min (SD 96.6). The incubator was set off in 43 (84%), iced-packs 11 (21.5%) and both (11, 21.5%). Target temperature was reached in 19 (37.3%) babies. There was no differences in the overcooling in relation to the measures applied. The transport duration was not related with temperature stabilisation or target temperature reachiness.
Rectal temperature monitorisation is compulsory for the stabilisation and the application of non-servocontrolled hypothermia during transport. There is still time for improving in the administration of this treatment during transport. Servo-controlled hypothermia would be a better alternative to improve the management of HIE babies.
Abstract Intimate partner violence (IPV) is a human rights violation and a serious global public health problem. This study investigated factors associated with IPV in female survivors in Colombia. ...Four focus group discussions with female survivors of IPV and 15 key informant interviews with professionals from psychological, social and legal services and community leaders were conducted in Cali and Tuluá. Participant recruitment was via purposive sampling. Transcripts were analysed manually taking a social constructivist standpoint and a content analysis approach. Factors associated with IPV were divided into four themes: cultural beliefs, jealousy, alcohol abuse, and personal history of IPV. The first theme was divided into: patriarchy, gender roles, normalisation of violence, and unawareness of rights, economic dependence, and ‘men own women’. The sub-themes were all inter-related and underpinned by patriarchal values. IPV was described as a sociocultural construction formed by patriarchal values ingrained in community and societal norms and individual processes. Therefore, academia, governmental and non-governmental bodies and society are urged to together, create preventative, context specific strategies for individuals, communities and societies.
Resumo A violência por parceiro íntimo (VPI) é uma violação dos direitos humanos e um grave problema de saúde pública global. Este estudo investigou fatores associados à VPI em mulheres sobreviventes na Colômbia. Quatro discussões de grupos focais com mulheres sobreviventes de VPI e 15 entrevistas com informantes-chave com profissionais de serviços sócio-médico-legais foram realizadas usando amostragem intencional nas cidades de Cali e Tuluá. As transcrições foram analisadas manualmente, sob um ponto de vista construtivista social e uma abordagem de análise de conteúdo. Os fatores associados à VPI foram divididos em 4 temas: crenças culturais, ciúmes, abuso de álcool e história pessoal da VPI. O primeiro tema foi dividido em: patriarcado, papéis de gênero, normalização da violência, desconhecimento de direitos, dependência econômica e ‘homens possuem mulheres’. VPI foi descrita como uma construção sociocultural formada por valores patriarcais e processos individuais. A VPI é causada por uma complexa interação de diferentes fatores nos níveis do indivíduo, relacionamentos, comunidade e social. Os órgãos governamentais e não governamentais e a sociedade são instados a criar juntos estratégias preventivas e específicas no contexto.
describir la experiencia de uso de la terapia de infusión de antibióticos domiciliaria mediante bombas de infusión elastoméricas, administrada a pacientes ingresados en la unidad de hospitalización a ...domicilio de un hospital de tercer nivel durante 3 años y analizar la evolución clínica y la mortalidad.
estudio observacional retrospectivo mediante la revisión de las historias clínicas de los pacientes incluidos. Se obtuvo información sobre antecedentes personales, terapia antimicrobiana recibida y evolución clínica. Análisis estadístico realizado mediante el software SPSS® 19.
se incluyeron 81 pacientes, 61,7% hombres, con una media de edad de 73,5 ± 17,5 años. Las comorbilidades más frecuentes fueron diabetes mellitus (30,9%) y enfermedad renal crónica (28,4%). Los pacientes recibieron de media 11,9 ± 8,5 días de antibiótico en bombas de infusión elastoméricas. El principal foco infeccioso fue el respiratorio (27,2%), seguido de bacteriemia (16%) e infecciones de la piel y las partes blandas (12,3%). El 65,4% de las infecciones fueron monomicrobianas, siendo la Pseudomonas aeruginosa el principal microorganismo implicado (39,6%). El antimicrobiano más utilizado fue piperacilina/tazobactam (33,3%). El 85,2% de los pacientes presentó buena evolución clínica, pero la tasa de mortalidad en los 30 días posteriores a la finalización del tratamiento fue de 24,7%. En el análisis univariante, se asociaron a una peor evolución clínica los antecedentes de neoplasia en los últimos 5 años (p = 0,01) y haber recibido menos días de antiobioterapia previo al inicio del tratamiento antibiótico domiciliario en infusor (p = 0,04). La edad mayor de 80 años se asoció a mejor evolución (p = 0,03). Se asoció a mayor mortalidad el diagnóstico de insuficiencia cardiaca (p = 0,026) y a menor mortalidad los pacientes procedentes de servicios quirúrgicos (p = 0,047). En el análisis multivariante, la presencia de neoplasia se asoció a una evolución desfavorable (p = 0,012) y la insuficiencia cardiaca, a una mayor mortalidad (p = 0,027).
la terapia antibiótica domiciliaria en bombas de infusión elastoméricas es una alternativa en pacientes que necesitan tratamiento intravenoso prolongado, sin ser condicionante para la inclusión en estos programas la edad. No obstante, la presencia de ciertas comorbilidades puede afectar negativamente a la evolución clínica y mortalidad de los pacientes.
To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalization Unit of a tertiary hospital for three years and to analyse clinical evolution and mortality.
Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software.
Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome.
Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027).
Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalisation Unit of a tertiary hospital for 3 years ...and to analyse clinical evolution and mortality.
Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received, and clinical evolution. Statistical analysis was performed using SPSS® 19 software.
81 patients were included, 61.7% men, with a mean age of 73.5±17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9±8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p=.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p=.04) were associated with worse clinical outcome.
Age over 80 years was associated with better outcome (p=.03). The diagnosis of heart failure was associated with higher mortality (p=.026) and patients from surgical services, with lower mortality (p=.047). In the multivariate analysis, the presence of neoplasia was associated with unfavourable evolution (p=.012) and heart failure with higher mortality (p=.027).
Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
Describir la experiencia de uso de la terapia de infusión domiciliaria de antibióticos mediante bombas de infusión elastoméricas, administrada a pacientes ingresados en la Unidad de Hospitalización a Domicilio de un hospital de tercer nivel durante tres años y analizar evolución clínica y mortalidad.
Estudio observacional retrospectivo mediante revisión de las historias clínicas de los pacientes incluidos. Se obtuvo información sobre antecedentes personales, terapia antimicrobiana recibida y evolución clínica. Análisis estadístico realizado mediante el software SPSS® 19.
Se incluyeron 81 pacientes, 61,7% hombres, con una media de edad de 73,5 ± 17,5 años. Las comorbilidades más frecuentes fueron diabetes mellitus (30,9%) y enfermedad renal crónica (28,4%). Los pacientes recibieron de media 11,9 ± 8,5 días de antibiótico en bombas de infusión elastoméricas. El principal foco infeccioso fue el respiratorio (27,2%), seguido de bacteriemia (16%) e infecciones de piel y partes blandas (12,3%). El 65,4% de las infecciones fueron monomicrobianas, siendo la Pseudomonas aeruginosa el principal microorganismo implicado (39,6%). El antimicrobiano más utilizado fue piperacilina/tazobactam (33,3%). El 85,2% de los pacientes presentó buena evolución clínica pero la tasa de mortalidad en los 30 días posteriores a la finalización del tratamiento fue de 24,7%. En el análisis univariante, se asociaron a peor evolución clínica los antecedentes de neoplasia en los últimos 5 años (p = 0,01) y haber recibido menos días de antibioterapia previo al inicio del tratamiento antibiótico domiciliario en infusor (p = 0,04). La edad mayor de 80 años se asoció a mejor evolución (p = 0,03). Se asoció a mayor mortalidad el diagnóstico de insuficiencia cardíaca (p = 0,026) y a menor mortalidad los pacientes procedentes de servicios quirúrgicos (p = 0,047). En el análisis multivariante, la presencia de neoplasia se asoció a evolución desfavorable (p = 0,012) y la insuficiencia cardíaca, a mayor mortalidad (p = 0,027).
La terapia antibiótica domiciliaria en bombas de infusión elastoméricas es una alternativa en pacientes que necesitan tratamiento intravenoso prolongado, sin ser condicionante para la inclusión en estos programas la edad. No obstante, la presencia de ciertas comorbilidades puede afectar negativamente a la evolución clínica y mortalidad de los pacientes.
Violence is an important public health problem and one of the main causes of deaths worldwide. The mental health consequences of surviving intimate partner violence (IPV) include depression, anxiety ...and post-traumatic stress disorder. Previous studies have identified that there is a relationship between depression and level of disability in female survivors of IPV. Estimating the direct, indirect or total effect of an exposure on an outcome makes it possible to identify mediating effects between a group of variables. Detecting mediation effects is useful for identifying casual pathways that generate a final outcome and provides a rationale for designing interventions to target the mediator, which in turn positively affects the outcome. The objective was to identify the mediating role of depressive symptoms on the relationship between IPV and disability.
This was a cross-sectional study of 94 women over the age of 18 who were survivors of IPV by men. They were recruited from two public hospitals in Cali and Tuluá in southwest Colombia. An analysis of casual relationships was performed using structural equation modelling that was made up of: four exogenous observed variables (age, current relationship status in a relationship or single, level of schooling, and history of an impairment), intermediate endogenous variables (violence and depressive symptoms), and the main endogenous variable (disability). The analyses were carried out in Stata14.2.
The direct effect of IPV severity on the level of disability was not statistically significant (β=0.09; P=0.63). However, the indirect effect of IPV severity on disability mediated by depressive symptoms was (β=0.39; P<0.01). The total effect of IPV severity on the level of disability was even greater (β=0.48; P=0.01).
This study found a complete mediating role of depressive symptoms on the relationship between the severity of IPV and the level of disability for the female participants in this study. The results of this research contribute to defining strategies to prevent and address intimate partner violence, depressive symptoms and disability in this population.
La violencia es un importante problema de salud pública y una de las principales causas de muerte en todo el mundo. Las consecuencias para la salud mental de sobrevivir a la violencia de la pareja íntima incluyen depresión, ansiedad y trastorno de estrés postraumático. Estudios previos han identificado que existe una relación entre la depresión y el nivel de discapacidad en mujeres sobrevivientes a violencia de pareja íntima. La estimación del efecto directo, indirecto o total de una exposición en un resultado permite identificar efectos mediadores en un grupo de variables. La detección de los efectos de la mediación es útil para identificar vías causales que generan un resultado final y proporciona una justificación para diseñar intervenciones dirigidas al mediador, lo que a su vez afecta positivamente al resultado. El objetivo es identificar el efecto mediador de los síntomas de depresión en la relación entre gravedad de la violencia y el nivel de discapacidad de las mujeres víctimas de violencia de pareja.
Estudio transversal que incluyó a 94 mujeres de 18 o más años víctimas de violencia de pareja, identificadas en 2 instituciones públicas de salud de Cali y Tuluá, en el suroccidente de Colombia. Se realizó un análisis de rutas causales mediante un modelo de ecuaciones estructurales (SEM), en Stata® 14.
El efecto directo de la gravedad de la violencia en la discapacidad no es significativo (β=0,09; p=0,63); sin embargo, el efecto indirecto mediado por los síntomas de depresión incrementa su magnitud y es significativo (β=0,39; p <0,01). El efecto total es mayor y significativo (β=0,48; p=0,01).
Existe un papel mediador de los síntomas depresivos entre la exposición a violencia de pareja y el nivel de discapacidad en las mujeres del suroccidente colombiano. Así, tratar los síntomas de depresión es fundamental para mejorar la funcionalidad de las mujeres víctimas de la violencia de pareja. Los resultados de esta investigación contribuyen a definir estrategias para prevenir y abordar la violencia de pareja, los síntomas depresivos y la discapacidad en esta población.
The purpose of this study was to detect coronavirus disease 2019 (COVID-19) cases with persistent positive reverse transcription-PCR (RT-PCR) results for severe acute respiratory syndrome coronavirus ...2 (SARS-CoV-2), for which viable virus can be inferred due to the presence of subgenomic (SG) viral RNA, which is expressed only in replicating viruses. RNA remnants purified from diagnostic nasopharyngeal specimens were used as the templates for RT-PCR-specific detection of SG E gene RNA. As controls, we also detected viral genomic RNA for the E gene and/or a human housekeeping gene (RNase P). We assessed the samples of 60 RT-PCR-positive cases with prolonged viral SARS-CoV-2 shedding (24 to 101 days) since the first diagnostic RT-PCR. SG viral RNA was detected in 12/60 (20%) of the persistent cases, 28 to 79 days after the onset of symptoms. The age range of the cases with prolonged viral shedding and the presence of SG RNA was quite wide (40 to 100 years), and the cases were equally distributed between males (42%) and females (58%). No case was HIV positive, although seven were immunosuppressed. According to the severities of the COVID-19 episodes, they were mild (40%), intermediate (20%), and severe (40%). In a percentage of persistent SARS-CoV-2 PCR-positive cases, the presence of actively replicating virus may be inferred, far beyond diagnosis. We should not assume a universal lack of infectiousness for COVID-19 cases with prolonged viral shedding.
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