Clinical characteristics and outcome of patients with pandemic 2009 Influenza A(H1N1)v virus infection admitted to hospitals with different levels of health-care.

BACKGROUND: The outcome of patients with influenza A 2009 (H1N1)v virus infection taking into account hospital type has not been elucidated. OBJECTIVES: To compare risk factors, clinical features and outcome of patients admitted to 3 public hospitals with different levels of health-care. METHODS: Prospective study of all non-pregnant adult patients admitted to 3 hospitals with pandemic H1N1 infection, from June 1 to December 31 and followed up until 1 month after discharge. RESULTS: During the study period, 111 patients with a mean age of 49 years (15-89) were hospitalized: 52 in hospital 1 (900-bed tertiary-teaching-hospital), 33 in hospital 2 (315-beds secondary-hospital) and 26 in hospital 3 (150-beds primary-care-hospital).Overall 80% of patients had at least 1 comorbid condition with no differences between hospitals. Symptoms or signs on admission were similar except for cough (P=0.01) more frequent in patients in hospital 1 and dyspnea (P=0.05), myalgia, arthralgia (P=0.04) and hypoxemia (P=0.009) present in more patients in hospital 2. In-hospital mortality rates were not statistically different between hospitals. In the stepwise analysis, independent predictors of mortality were pneumonia on admission (adjusted OR=8.68, 95%CI 1.0-82.43) and cardiac complications during hospitalization (adjusted OR=13.2, 95%CI 1.67-103.98). CONCLUSIONS: Mortality of patients with pandemic H1N1 infection was influenced by patients underlying conditions, severity of disease (pneumonia) on admission and complications during hospitalization. Hospital-characteristics do not appear to have influenced severe outcome.

Clinical characteristics and outcome of patients with pandemic 2009 Influenza A(H1N1)v virus infection admitted to hospitals with different levels of health-care

Introducción. La evolución de los pacientes con infección por el virus de la influenza A (H1N1)v 2009, teniendo en cuenta el tipo de hospital donde ingresan no ha sido estudiada. Objetivos. Comparar las características clínicas y la evolución de los pacientes con infección por el virus pandémico influenza A (H1N1)v 2009, teniendo en cuenta el tipo de hospital donde ingresan. Métodos. Estudio prospectivo de todos los pacientes que ingresaron en 3 hospitales públicos con diferentes niveles de atención de salud con infección por el virus pandémico influenza A (H1N1)v entre el 1 de junio y el 31 de diciembre de 2009. Se excluyeron las mujeres embarazadas. Resultados. Durante el período de estudio ingresaron 111 pacientes (edad media de 49 años; rango: 15-89): 52 en el hospital 1 (hospital universitario de 900 camas), 33 en el hospital 2 (315 camas) y 26 en el hospital 3 (150 camas). El 81% de los pacientes tenían al menos 1 enfermedad de base. Los síntomas o signos al ingreso fueron similares, excepto para la tos (P=0,01) más frecuente en los pacientes ingresados en el hospital 1 y disnea (P=0,05), mialgia, artralgia (P=0,04) e hipoxemia (P=0,009) presentes en más pacientes en el hospital 2. No hubo diferencias estadísticamente significativas en la tasa de mortalidad entre los pacientes ingresados en los 3 hospitales. En el análisis multivariante la neumonía al ingreso (OR ajustada=8,68; CI95% 1,0-82,43) y las complicaciones cardiacas durante la hospitalización (OR ajustada=13,2; CI95% 1,67-103,98) fueron predictores independientes de mortalidad. Conclusiones. La mortalidad de los pacientes con infección por el virus de la gripe nueva (H1N1)v 2009 se relacionó la comorbilidad de los pacientes, la gravedad de la enfermedad (neumonía) al ingreso y las complicaciones durante la hospitalización. Las características del hospital donde ingresaron los pacientes no influyeron en su evolución(AU)

Background. The outcome of patients with influenza A 2009 (H1N1)v virus infection taking into account hospital type has not been elucidated. Objectives. To compare risk factors, clinical features and outcome of patients admitted to 3 public hospitals with different levels of health-care. Methods: Prospective study of all non-pregnant adult patients admitted to 3 hospitals with pandemic H1N1 infection, from June 1 to December 31 and followed up until 1 month after discharge. Results. During the study period, 111 patients with a mean age of 49 years (15-89) were hospitalized: 52 in hospital 1 (900-bed tertiary-teaching-hospital), 33 in hospital 2 (315-beds secondary-hospital) and 26 in hospital 3 (150-beds primary-care-hospital).Overall 80% of patients had at least 1 comorbid condition with no differences between hospitals. Symptoms or signs on admission were similar except for cough (P=0.01) more frequent in patients in hospital 1 and dyspnea (P=0.05), myalgia, arthralgia (P=0.04) and hypoxemia (P=0.009) present in more patients in hospital 2. In-hospital mortality rates were not statistically different between hospitals. In the stepwise analysis, independent predictors of mortality were pneumonia on admission (adjusted OR=8.68, 95%CI 1.0-82.43) and cardiac complications during hospitalization (adjusted OR=13.2, 95%CI 1.67-103.98). Conclusions. Mortality of patients with pandemic H1N1 infection was influenced by patients underlying conditions, severity of disease (pneumonia) on admission and complications during hospitalization. Hospital-characteristics do not appear to have influenced severe outcome(AU)

Eliminación de las barreras linguísticas en el consultorio médico: relación médico-intérprete-paciente / Overcoming the languaje barrier in the medical clinic: physician-interpret-patient relation

Se presentan las principales dificultades a las que se enfrenta el trabajador de la salud que depende de una tercera persona para establecer la comunicación con el paciente. Se destaca la importancia del intérprete en el consultorio médico y se ofrecen dos métodos de interpretación que contribuirán a la eliminación de las barreras lingüísticas en la relación médico-paciente-interprete. Se brindan otras recomendaciones útiles para alcanzar este fin