Effectiveness of a palliative care outpatient programme in improving cancer-related symptoms among ambulatory Brazilian patients.

The focuses of palliative care are to provide symptom relief and improve quality of life through an interdisciplinary approach. Previous studies conducted to evaluate the effectiveness of palliative care in reducing symptom distress among outpatients confirmed the importance of the palliative care approach. To our knowledge, there is no published information from Brazil regarding the impact of a palliative care outpatient programme in reducing symptom distress. Symptom scores from 232 patients were measured using Edmonton Symptom Assessment System scales in two consecutive consults. Changes in symptoms at follow-up visit were analysed using Wilcoxon signed-rank paired test. The symptom subtraction indices (SSI) (follow-up scores minus baseline scores) were calculated and then analysed with Spearman's correlation. Edmonton Symptom Assessment System median scores at follow-up visits were statistically significant reduced in all symptoms evaluated. All the SSI positively correlated with well-being-SSI. Other important SSI correlations were: fatigue-SSI and anxiety-SSI, and fatigue-SSI and dyspnoea-SSI. Our palliative care outpatient programme was able to provide a significant improvement in the symptoms evaluated. The well-being-SSI was positively correlated with all the SSI, verifying that the control of symptoms in palliative care is essential for the patient well-being. Adequate/inadequate control of specifically symptoms seems to indirectly improve/worsen other symptoms.

Retrospective analysis of post-exposure to human anti-rabies treatment in Botucatu, São Paulo State, Brazil

This analysis aimed to identify characteristics of accidents that would, probably, provoke rabies infection. A total of 14,409 survey questionnaires for surveillance of human rabies from the Brazilian Information System for Disease Notification (SINAN), from 2000 to 2005, were analyzed. Regarding demographics, it was observed that 7,377 (51.5 percent) of the victims were white, 4,458 (30.93 percent) were children and 8,008 (55.58 percent) were males. Urban cases were prevalent (88.10 percent) while dogs were the animals most frequently involved in accidents, in 11,700 cases (81.19 percent). Bites (84.35 percent) and scratches (19.15 percent) were the most prevalent exposure types, and occurred predominantly on victims' extremities (38.79 percent). The prophylactic measure taken in 6,179 cases comprised anti-rabies vaccine; of these victims, 421 (2.92 percent) showed systemic reactions while 693 (4.80 percent) reported no response. The importance of developing awareness in professionals that should correctly report post-exposure immunoprophylaxis cases is emphasized given the high number of individuals who receive this type of treatment annually.