RESUMO
AIM: The aim of the study is to assess which factors are associated with self-efficacy for making these decisions in surrogates of end-stage kidney disease patients. MATERIALS AND METHODS: Cross-sectional study conducted in the hemodialysis clinic of a private hospital in Mexico City. A total of 124 surrogates of patients in hemodialysis were included in the study. Self-efficacy for decision-making was assessed with the Family Decision-Making Self-Efficacy Scale. As factors related to decision-making self-efficacy, sociodemographic data, health information, and professional help received for dealing with end-of-life issues were assessed in both patients and surrogates. Functional status and advanced directives of the patient as well as prior experience in decision-making of the surrogates were also included. Logistic regression models were used to establish the associations. RESULTS: The mean age of participants was 49.4 years (standard deviation: 14). Factors associated to decision-making self-efficacy were awareness of the surrogate about the terminal disease of the patient (P < 0.001), prior conversation between the surrogate and the patient about end-of-life preferences (P = 0.037), time between the patient was told dialysis was required and accepting it inferior to 1 month (P = 0.016), and visual impairment of the patient (0.040). CONCLUSIONS: This study provides information of which factors are associated with self-effectiveness in surrogates of terminally ill renal patients so that strategies based on these considerations might be implemented in the future.
RESUMO
The first report of chikungunya virus (CHIKV) in Mexico was in may 2014, in Jalisco, and has disseminated along the country in such a way that now is considered a relevant emergent vector-transmitted infection. It is clinically diagnosed by abrupt onset fever, asthenia, arthralgias, myalgias, headache and rash. In the clinical case, we described a women from Guerrero that had pulmonary symptomatology associated to CHIKV, which is an atypical clinical presentation that has been reported only in a hundred cases worldwide. In the epidemiological context the only known tool that we have to prevent the disease is the eradication of vectors because we lack population immunity, thus the importance of avoiding water accumulation and using protective gear. In Mexico we are acting through media advertisements in order to avoid, in first place the acute infection, which in severe cases can cause death, and in second place the chronic complications.
El primer caso de infección por virus chikunguña (CHIKV) en México ocurrió en Jalisco, en mayo de 2014 y se ha ido diseminando a lo largo del país, por lo que hoy en día se considera una infección emergente transmitida por vectores. Se caracteriza por fiebre de inicio abrupto, astenia intensa, artralgias múltiples, simétricas, bilaterales y debilitantes, de predominio en brazos y piernas, mialgias, cefalea y rash maculopapular. En el caso expuesto describimos a una mujer originaria del estado de Guerrero, la cual presentó sintomatología pulmonar asociada a infección por CHIKV, lo que representa una manifestación atípica de esta enfermedad, ya que solo ha sido reportada en cerca de 100 casos a nivel mundial. En el contexto epidemiológico se sabe que la única herramienta que se tiene disponible en estos momentos es la erradicación de los vectores que promueven su transmisión, ya que carecemos de inmunidad poblacional, por lo que es de vital importancia evitar el estancamiento de agua y alentar el uso de ropa de protección. Por último, se debe hacer énfasis en la forma en la que se actúa en México, por medio de la difusión de información, para evitar, en primer lugar, la infección aguda que puede llevar a la muerte en casos extremos, y en segundo término, salvar las complicaciones crónicas.
