Demographic and clinical characteristics of deaths associated with influenza A(H1N1) pdm09 in Central America and Dominican Republic 2009-2010.

BACKGROUND: The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm09 infection during 2009-2010, in seven countries in the American tropics. METHODS: We used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records. RESULTS: During May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18-46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset. CONCLUSIONS: The pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.

Percepción del paciente sobre el cuidado recibido por las enfermeras de un hospital de segundo nivel de atención / The patient´s perception regarding the healthcare provided by nurses in a secondary care hospital

El cuidado que proporciona la enfermera debe ser un proceso interactivo, con una actitud reflexiva,de integración de creencias, de valores, de respeto y sentimientos, como una prioridad en su práctica.Objetivo: Determinar la percepción que tienen los pacientes hospitalizados sobre la atención que leproporcionan las enfermeras.Metodología: Es una investigación de tipo descriptivo, que utilizó una muestra aleatoria de 96pacientes hospitalizados en salas de cirugía, medicina, gineco-obstetricia y observación, en un hospital de tercernivel de atención. Se utilizó para la recolección de los datos el instrumento llamado “Cuidado deComportamiento Profesional”, para medir la percepción de los pacientes; su confiabilidad en el idiomaespañol es de 0.80 a través del Coeficiente de Alfa de Conbrach.Resultados: la puntuación global, obtenida en el instrumento de cuidado de comportamiento profesional,obtuvo como media 69,0 puntos, con una desviación típica de 4,8 puntos, una puntuación máxima de 82,0puntos y mínima de 56, de un total de 112 puntos como máximo y 28 puntos como mínimo que contaba elinstrumento. El factor de mayor puntuación fue el de cortesía, con un 90,0%, seguido del factor de relacióncon un 83,0%, mientras que el factor de “interacción con la familia”, obtuvo la puntuación más baja de 57,0%.Conclusiones: la enfermera necesita para establecer una relación con el paciente, además deconocimientos y habilidades, un proceso de comunicación, que la capacite para percibir, responder yapreciar el holismo del ser humano como elementos importantes en esta relación persona a persona. Esteresultado indica que las acciones encaminadas a promover la atención a los pacientes y familiares tienenmayor probabilidad de éxito, si existe cierta predisposición por parte de las enfermeras hacia el cambioconceptual que supone incluir a los familiares en las dinámicas del paciente para su efectiva y prontarecuperación.

The care provided by a nurse should be an interactive process, which includes as a priority in its practice, areflective attitude, an integration of beliefs, values, respect and sensitivity.Objective: To determine the perception hospitalized patients have regarding the care provided by nurses.Methodology: This is a descriptive research based on a random sample of 96 patients hospitalized insurgery, medicine, obstetrics and observation rooms in a secondary care hospital. To collect the data, an instrumentcalled “Healthcare Professional Behavior” was used to measure the patient’s perception. Its reliabilityin the Spanish language is 0.80 by means of the Cronbach's Alpha coefficient.Results: The overall score gathered in the instrument of healthcare professional behavior obtained an averageof 69.0 points with a standard deviation of 4.8 points, a maximum score of 82.0 points and a minimumscore of 56, from a total of 112 points maximum and 28 points minimum the instrument had. The factor withthe highest score was courtesy with a 90.0%which was followed by the relationship factor with a score of 83.0%,while the factor of interaction with family obtained a low score of 57.0 %.Conclusion: The nurse needs, beside knowledge and skill, to establish a communicative relationship with thepatient to enable her to perceive, respond and appreciate the holism of the human being as important elementsin this person to person relationship. This result shows that the actions aimed at promoting assistance topatients and relatives have a higher probability of success if there is a degree of willingness on the nurse’sbehalf towards a conceptual change that would include the patient’s relatives in the process for it to beeffective on the patient’s prompt and effective recovery.