Medicina, Epidemiología y Humanismo antes y después de la COVID-19 / Medicine, epidemiology and humanism before and after COVID-19

La rápida propagación del SARS-CoV-2 requiere la generación de evidencia para ayudar a mitigar su daño global. La medición precisa con los indicadores clínicos y epidemiológicos apropiados asociados con COVID-19 es un paso necesario para reducir la carga individual y poblacional de la pandemia en curso. Estos tiempos sin precedentes han planteado un desafío para los epidemiólogos de enfermedades crónicas, y requirió de un enfoque práctico "para hacer algo para ayudar durante este desastre". Las opciones incluían regresar a la clínica asistencial o recurrir a libros de texto y recursos en línea para un curso acelerado sobre investigación de brotes. Sin embargo, ser consciente de la magnitud del sufrimiento individual soportado por tantos, incluyendo muchos colegas estimados y cercanos, se erige como un desafío personal de enormes proporciones. Se prevé que las artes y otras formas de Humanidades pueden ayudar a restablecer el equilibrio, tanto durante la pandemia, como especialmente después

The rapid propagation of SARS-CoV-2 requires the generation of evidence to help mitigate its global damage. The precise measurement with the appropriate clinical and epidemiological indicators associated with COVID-19 is a necessary step in reducing the individual and population burden of the current pandemic. These unprecedented times have raised a challenge for epidemiologists of chronic diseases and have required a practical approach “to do something to help during this disaster". The options include returning to clinical care or resorting to online textbooks and resources for accelerated courses on the research of outbreaks. However, being aware of the magnitude of individual suffering endured by so many, including many esteemed and close colleagues, becomes a personal challenge of enormous proportions. The arts and other forms of humanities can help re-establish equilibrium, both during the pandemic and especially after it

Trends in catastrophic health expenditure in India: 1993 to 2014.

OBJECTIVE: To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition. METHODS: We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-of-pocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. FINDINGS: Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993-1994 expenditure survey (12.4%) and the 2011-2012 expenditure survey (18.2%) and 2.24-fold between the 1995-1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76-3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31-2.89), with a female head (aOR: 1.32; 95% CI: 1.19-1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20-1.35). CONCLUSION: The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure.

A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis.

BACKGROUND AND OBJECTIVES: Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp. METHODS: Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later. RESULTS: The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects. LIMITATIONS: We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample. CONCLUSIONS: The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes.

Transferencia de los dedos del pie a la mano en una amputación total de los dedos: a propósito de un caso / Transfer of toe to fingers in total finger amputation of one hand: a case report

La mano catastrófica es aquella que ha sufridouna lesión compleja con pérdida de tejido y deteriorofuncional importante. La amputación de varios dedos deuna mano ocasiona importantes limitaciones para la fuerzade prensión y la pinza. En el caso de manos catastróficas enlas que no es posible el reimplante de dedos, una buenaopción terapéutica es la transferencia de dedos del pie a lamano.Presentamos un caso de amputación traumática de loscinco dedos de la mano izquierda a nivel de las articulacionesmetacarpofalángicas.Se realizó una transferencia en una primera cirugía delprimer dedo del pie izquierdo a la posición de primer dedode la mano izquierda y en una segunda cirugía una transferenciadel segundo y tercer dedo del pie derecho a laposición de cuarto y quinto dedo de la mano izquierda. Elpaciente, a los cuatro meses de la cirugía, presenta una manofuncional y útil para las actividades de la vida diaria. Realiza lapinza y tiene sensibilidad en el pulpejo del primer dedo que lepermite discriminar dos puntos separados a 1,5 cm(AU)

The catastrophic hand is one with severeinjury with loss of tissue and significant functional impairment.Amputation of several fingers of one hand results insignificant limitations to the grip and pinch strength. In theevent of a catastrophic hand in which it is not possible toreimplant fingers, a good therapeutic option is the transferof toes to the hand.We report a case of traumatic amputation of the fivefingers of the left hand at the joints metacarpal.In the first surgery, first toe is transferred from his leftfoot to position of first finger of his left hand and in a secondsurgery it is transferred second and third toe right footto position fourth and fifth finger left hand. The patient afterfour months from the surgery has a functional hand foractivities of daily life. Patient performs grip and pinch andhas sensibility in pulp of first finger that allows discriminatingtwo points separated 1.5 cm(AU)

The long-term acute care hospital: a new option for ventilator-dependent individuals.

Improved health care and sophisticated medical technology have improved the outcome for many people who suffer a critical illness. One group of people who have benefited are ventilator-dependent individuals (VDIs), as evidenced by the increased number of children and adults requiring long-term mechanical ventilation. Significant changes in this nation's health care reimbursement structure have made a substantial negative impact on the availability of traditional long-term care options for these patients. In response, a new health care environment has emerged. Now available are specialty hospitals providing general hospital services, which allow for long-term acute care intervention. The Vencor Corporation has successfully established this innovative care environment in a cost-effective manner. There are currently nine Vencor hospitals specializing in providing long-term acute care to VDIs and other catastrophically ill patients.