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Introducción: en pacientes con enfermedades reumatológicas autoinmunes se recomienda la aplicación sistemática y secuencial de una serie de vacunas para la prevención de enfermedades transmisibles. El objetivo de este estudio fue estimar la proporción de pacientes con esclerosis sistémica (ES) que recibieron vacunación contra el coronavirus (SARS-CoV-2). Materiales y métodos: se envió una encuesta anónima por correo electrónico o contacto por WhatsApp desde mayo a septiembre de 2021, con preguntas para evaluar la adherencia al esquema de vacunación recomendado en pacientes con enfermedades reumatológicas, así como temores, preferencias y adherencia al esquema de vacunación contra el SARS-CoV-2. Resultados: se incluyeron 295 pacientes con ES. El 68,81% estaba vacunado contra el SARS-CoV-2 con al menos una dosis, de los cuales el 48,7% tenía dos dosis. El 84,75% refirió conversar con su médico sobre su esquema de vacunación general. Solo el 5,4% tenía las cuatro vacunas. El 93,56% manifestó voluntad de vacunarse contra el SARS-CoV-2; el 56,27% prefirió la vacuna Sputnik V. El 7,46% manifestó su voluntad de no vacunarse. Los factores que influyeron en la adherencia a la vacunación, con mayor frecuencia, fueron el miedo a contraer la infección por SARS-CoV-2 (86,1%) y las reacciones adversas (23,05%). Conclusiones: destacamos el hecho de que solo 6 meses después de que se dispusiera la vacunación contra el SARS-CoV-2, la mitad de los pacientes con ES tenía el esquema recomendado completo.
Introduction: in patients with autoimmune rheumatic diseases, the systematic and sequential application of a series of vaccines is recommended for the prevention of communicable diseases. The objective was to estimate the proportion of patients with systemic sclerosis (SSc) who received vaccination against coronavirus (SARS-CoV-2). Materials and methods: since may to september 2021, an anonymous survey was sent by email or messaging app, containing questions to assess adherence to the recommended vaccination schedule in patients with rheumatic diseases, as well as fears, preferences and adherence to vaccination schedule against SARS-CoV-2. Results: 295 patients with SSc were included. 68.81% were vaccinated for SARS-CoV-2 with at least one dose, 48.7% of this group had two doses. 84.75% reported talking to their doctor about their general vaccination schedule. Only 5.4% had all four vaccines. 93.56% expressed willingness to be vaccinated against SARS-CoV-2, 56.27% preferred the Sputnik V vaccine. 7.46% expressed their willingness to not be vaccinated. The factors that most frequently influenced adherence to vaccination were fear of contracting SARS-CoV-2 infection (86.1%) and adverse reactions (23.05%). Conclusions: we highlight the fact that only 6 months after vaccination against SARS-CoV-2 became available, half of the patients with SSc had the full recommended schedule.
ABSTRACT
Objetivo: O objetivo deste trabalho foi avaliar o impacto de custo total do tratamento de câncer de próstata com metástase óssea na perspectiva do Sistema de Saúde Suplementar (SSS) brasileiro. Métodos: Trata-se de um estudo retrospectivo de coorte conduzido de um banco de dados administrativos fornecidos pela empresa Orizon. A população consistiu em pacientes com registro de câncer de próstata com metástases ósseas, ou procedimentos relacionados, que foram registrados em entradas hospitalares ou ambulatoriais e receberam pelo menos um tipo de tratamento. A perspectiva da análise foi o SSS e o horizonte temporal, uma mediana de 181 dias. O desfecho primário foi o custo global, no qual foram contemplados gastos com exames, procedimentos, materiais e medicamentos. A partir do desfecho primário, foram calculados o custo por paciente, o número de atendimentos por paciente e o custo por atendimento. Adicionalmente foram analisados os custos relacionados aos diferentes subgrupos de tratamentos destinados à doença. Resultados: O custo global relacionado aos atendimentos foi de R$ 21.391.034 (n = 181), o custo médio resultou em R$ 118.183 por paciente, com média de 10,48 atendimentos por paciente e R$ 11.282 por atendimento. Pela análise isolada dos cenários, os custos nos ambientes hospitalar (R$ 11.452.496) e ambulatorial (R$ 9.938.537) demonstraram que houve mais gastos relacionados aos procedimentos hospitalares. Conclusões: O estudo demonstrou elevado impacto econômico de tratamento de câncer de próstata com metástases ósseas no SSS, devido principalmente a maior necessidade de quantidade de hospitalizações com mais tempo de permanência.
Objective: The objective of this study was to evaluate the total cost impact of treatment of prostate cancer with bone metastasis under the Brazilian Private Healthcare System (SSS) perspective. Methods: This is a retrospective cohort study conducted from an administrative database provided by Orizon. The population consisted in patients with prostate cancer with bone metastasis registry, or related procedures, who were registered at hospital or ambulatory admission, and received at least one type of treatment. The perspective of the analysis was SSS and the time horizon was a median of 181 days. The primary outcome was global cost, considering expenses with exams, procedures, materials and drugs. From the primary outcome, cost per patient, number of visits per patient, and visit cost were calculated. Additionally, the costs related to the different subgroups of disease treatments were analyzed. Results: The global cost related to visits was R$ 21,391,034 (n = 181), the average cost resulted in R$ 118,183 per patient, with an average of 10.48 visits per patient and R$ 11,282 per visit. By the isolated analysis of the scenarios, the costs in the hospital (R$ 11,452,496) and ambulatory (R$ 9,938,537) environment demonstrated more expenses related to hospital procedures. Conclusions: The study demonstrated elevated budget impact of prostate cancer with bone metastasis treatment on the SSS, mainly due to greater need for the number of hospitalizations with a longer stay.
Subject(s)
Humans , Prostatic Neoplasms , Costs and Cost Analysis , Supplemental Health , Neoplasm MetastasisABSTRACT
INTRODUCCIÓN: La hospitalización de un hijo es una situación que produce un alto nivel de estrés en padres/madres, especialmente en Unidades de Cuidados Intensivos Pediátricos (UCIP). OBJETIVO: Determinar cuáles son los principales estresores percibidos por los padres/madres de niños/as en UCIP y qué variables se asocian. PACIENTES Y MÉTODO: Estudio cuantitativo, trasversal y correlacional, contempla el análisis secundario de datos del proyecto de Investigación Docente Asistencial # 201403 de Escuela de Enfermería UC: Validación de "The Parental Stressor Scale Infant Hospitalization al español" (PSSIH modificado). El muestreo fue no probabilístico por conveniencia, con 217 padres de niños/as en la UCIP de un hospital universitario, quienes contestaron un cuestionario demográfico y el instrumento PSSIH modificado para medir estresores en el ambiente de la UCIP. RESULTADOS: Se identificaron 3 dimensiones de estresores: Clínica, Emocional y Comunicación con el equipo profesional. La dimensión clínica fue la más estresante, con los factores imágenes o sonidos, procedimientos e intervenciones y el aspecto del hijo, las dimensiones relacionadas con la conducta y la comunicación con el equipo resultaron menos estresantes. Además, se asocian a una mayor percepción de estrés para las distintas dimensiones, tener: experiencias previas en UCIP, ingreso programado, ingreso por patología cardiaca, hijo único, mayor nivel educacional y no tener pareja. CONCLUSIONES: El instrumento PSSIH modificado permitió determinar principales estresores percibidos por los padres/ madres de niños/as en UCIP, siendo la dimensión Clínica, el mayor estresor. Estos resultados son útiles para desarrollar programas de intervención local según características particulares de las UCIP.
INTRODUCTION: The hospitalization of a child is a situation that produces a high level of stress on parents, especially at the Pediatric Intensive Care Unit (PICU). OBJECTIVE: To determine which are the main stressors perceived by the parents of children hospitalized at PICU and the associated variables. PATIENTS AND METHOD: A quantitative, cross-sectional and correlational study, which considers the secondary analysis of data from the IDA project # 201403 of UC School of Nursing: Validation of "The parental stressor scale infant hospitalization in Spanish" (PSSIH modified). Sampling was non probabilistic by convenience, with 217 parents of children at the PICU of a University hospital, who answered a demographic questionnaire and the modified PSSIH instrument to measure stressors in the PICU environment. RESULTS: Three dimensions of stressors were identified: Clinical, Emotional and Communication with the professional team. The clinical dimension was the most stressful, with the factors images or sounds, procedures and interventions and the aspect of the child, dimensions related to behavior and communication with the team were less stressful. In addition, it is associated with a greater perception of stress in the different dimensions, when having: previous experiences in PICU, programmed admission, admission due tocardiac pathology, single child, higher educational level and no partner. CONCLUSIONS: The modified PSSIH instrument made it possible to determine the main stressors perceived by the parents of children in the PICU, the Clinical dimension being the major stressor. These results are useful for developing local intervention programs according to the particular characteristics of the PICU.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Parents/psychology , Stress, Psychological/etiology , Intensive Care Units, Pediatric , Stress, Psychological/diagnosis , Stress, Psychological/psychology , Cross-Sectional StudiesABSTRACT
Describir las recomendaciones sobre el manejo de las complicaciones pulmonares reportadas en las guías de práctica clínica de buena calidad según AGREE II, con el objetivo de disminuir el desarrollo de morbilidades y mejorar la calidad de vida de los pacientes.Metodología: Se revisaron las guías de práctica clínica de fibrosis quística en inglés y español publicadas entre 2005 y 2013, utilizando el instrumento AGREE II para evaluar su calidad.Resultados. La búsqueda arrojó un total de 126 guías, se evaluaron 6, y 4 de ellas obtuvieron una puntuación en los dominios de rigor e independencia≥60% según AGREE II. De estas se tomaron las recomendaciones para el manejo de las exacerbaciones pulmonares porPseudomonas aeruginosa, de la vía aérea, neumotórax, hemoptisis y aspergilosis broncopulmonar alérgica.Conclusiones: El mejor antibiótico inhalado para uso crónico es la tobramicina. La dornasa alfa es el mejor mucolítico. El uso de corticoides es controvertido, pero es útil en pacientes que cursan con asma y/o aspergilosis broncopulmonar alérgica. La guía de práctica clínica de mejor calidad hasta la fecha es la de Ecuador...
Cystic fibrosis is an autosomal recessive disease caused by mutations in chromosome 7, and compromises multiple organs. One of the most common complications is the respiratory tract infection due to Pseudomonas aeruginosa.Objectives: To present the recommendations on the management of the pulmonary complications reported in clinical practice guidelines, of good quality according to AGREE II, with the aim of reducing morbidity and improving the quality of life of the patients.Methods: A review was performed on cystic fibrosis clinical practice guidelines, in English and Spanish, published between 2005 and 2013, using the AGREE II tool to evaluate their quality.Results: The search produced a total of 126 guidelines, of which 6 were evaluated, and 4 obtained a score≥60% in the rigour and independence domain according to the AGREE II. The recommendations for the management of pulmonary exacerbations due to Pseudomonas aeruginosa were taken from these, as well as those for those of the airways, pneumothorax, haemoptysis, and allergic bronchopulmonary aspergillosis.Conclusions: The best inhaled antibiotic for chronic use is tobramycin. Dornase alpha is the best mucolytic. The use of corticosteroids is controversial, but is useful in patients who suffer from asthma and/or allergic bronchopulmonary aspergillosis. The best quality clinical practice guidelines are currently from Ecuador...
Subject(s)
Humans , Male , Female , Adult , Lung Diseases , Cystic Fibrosis , Lung Diseases/complications , Practice Guidelines as TopicABSTRACT
El onfalocele es un defecto congénito de la pared abdominal, de presentación infrecuente, que puede asociarse con otro tipo de malformaciones genéticas. El manejo es quirúrgico y consiste en la reducción de las vísceras herniadas para cerrar la fascia y la piel, aunque el onfalocele gigante representa un problema mayor debido al tamaño del defecto, por lo cual el cierre primario con frecuencia debe diferirse. Se presenta un recién nacido con diagnóstico prenatal de onfalocele gigante a quien se realiza manejo médico con sulfadiazina de plata para epitelizar el saco con adecuado éxito, logrando diferir el manejo quirúrgico...
Omphalocele is a rare birth defect of the abdominal wall which may be associated to other genetic abnormalities. It is managed surgically by reducing the herniated organs followed by closure of the fascia and skin. However, giant omphalocele represents a greater problem due to the size of the defect, for which the final closure must be delayed. We present an infant with a prenatal diagnosis of giant omphalocele initially treated with silver sulfadiazine coverage allowing epithelialization of the sac constituting a bridge to delayed surgical closure...
Subject(s)
Humans , Male , Infant, Newborn , Hernia, Umbilical , Abdominal Wall/abnormalities , Infant, Newborn , Silver SulfadiazineABSTRACT
Os autores fazem uma breve revisão da literatura sobre a síndrome de "cárie de mamadeira", abordando a etiologia e os meios preventivos para evitar-se o seu aparecimento. Enfatizam a responsabilidade profissional quanto à orientação dos pais e finalmente apresentam e discutem um caso clínico