RESUMEN
INTRODUCCIÓN: En 2019, surgió un nuevo coronavirus que causó una pandemia mundial. Durante 2020, se desarrollaron vacunas con aceptable seguridad y eficacia para disminuir complicaciones y muertes. El presente trabajo se propuso investigar la relación entre la vacunación y el contagio entre convivientes. MÉTODOS: Se analizaron datos del Registro Federal de Vacunación Nominalizado y los casos confirmados en provincia de Santa Fe registrados en el Sistema Integrado de Información Sanitaria Argentina desde 1 de enero hasta 30 de junio de 2021 en personas de 18 a 65 años. Se constituyeron 5291 pares de un caso índice y un caso secundario, cuyos domicilios coincidían y cuyas fechas de inicio de síntomas se hallaban en un rango de 2 a 14 días. Se seleccionaron los pares en los que una persona estaba vacunada y la otra no, con un total de 494 pares. RESULTADOS: El promedio de edad de los casos índice fue de 40,8 años y el de los secundarios fue de 40,5 años. Se hallaron 234 personas vacunadas entre los casos índice y 386 entre los secundarios. De los 494 pares con una persona vacunada y una no vacunada, el caso índice fue la persona vacunada en 179 pares, y en 315 pares el índice fue la persona no vacunada. DISCUSIÓN: El análisis sugiere que, en los contagios intradomiciliarios, donde se involucran personas vacunadas y no vacunadas, es más frecuente que sea la persona no vacunada quien constituya el caso índice. Esto señala la importancia de vacunar a los convivientes de las personas con factores de riesgo.
Asunto(s)
Transmisión de Enfermedad Infecciosa , Vacunas contra la COVID-19 , COVID-19RESUMEN
The article proposes a critical reflection on issues that appeal to the conscience clause as part of end of life care can produce and what can guarantee freedom of conscience, self-determination of those involved and respect for the dignity of the sick person. After a philosophical and normative analysis, the article is organized on the basis of two important documents for discussion: a position paper of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) signed by several scientific societies "Grandi insufficienze d'organo end stage: cure intensive o cure palliative?" and the Design of Law currently being debated "Norme in materia di consenso informato e di disposizioni anticipate di trattamento". In particular, the conscience clause has been discussed in the light of advance care planning (ACP), which represents the instrument to guarantee the shared planning of care and the shared-decision making. In this context, recourse to the clause of conscience brings out critical ethical and deontological issues that the article discusses, using the position paper SIAARTI and the text of law currently being debated, both built on the assumptions of a shared care relationship, where patient has a key-role in medical decisions.
Asunto(s)
Conciencia , Toma de Decisiones , Cuidado Terminal/psicología , Humanos , Autonomía PersonalRESUMEN
One of the priorities of personalized medicine regards the role of early integration of palliative care with cancer-directed treatments, called simultaneous care. This article, written by the Italian Association of Medical Oncology (AIOM) Simultaneous and Continuous Care Task Force, represents the position of Italian medical oncologists about simultaneous care, and is the result of a 2-step project: a Web-based survey among medical oncologists and a consensus conference. We present the opinion of more than 600 oncologists who helped formulate these recommendations. This document covers 4 main aspects of simultaneous care: 1) ethical, cultural, and relational aspects of cancer and implications for patient communication; 2) training of medical oncologists in palliative medicine; 3) research on the integration between cancer treatments and palliative care; and 4) organizational and management models for the realization of simultaneous care. The resulting recommendations highlight the role of skills and competence in palliative care along with implementation of adequate organizational models to accomplish simultaneous care, which is considered a high priority of AIOM in order to grant the best quality of life for cancer patients and their families.
Asunto(s)
Oncología Médica , Cuidados Paliativos , Sociedades Médicas , Humanos , ItaliaRESUMEN
BACKGROUND: Early integration of palliative care in oncology practice ("simultaneous care", SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. PATIENTS AND METHODS: A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. RESULTS: Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. CONCLUSION: SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field.
