Perfil de pacientes con cronicidad avanzada y necesidades paliativas: un cambio que no llega / Profile of patients with advanced chronic conditions in need of palliative care: a change that doesn’t come

Objetivo: estudiar los posibles cambios en el perfil de pacientes con cronicidad avanzada entre dos cohortes en el momento de su inclusión en un equipo de soporte de atención paliativa domiciliaria (ESAPD) en el marco de la implementación de estrategias de cronicidad. Método: estudio observacional retrospectivo con enfoque analítico de pacientes no oncológicos derivados a un ESAPD de la Comunidad de Madrid, divididos en dos cohortes (2014 y 2019) definidas por el momento de inclusión en programa. Las variables principales fueron: tiempo de permanencia en programa (TPP), carga sintomática (CS) y situación funcional (SF). Se recogieron variables sociodemográficas y clínicas. Se comparó globalmente y por sexo el efecto de la cohorte (bruto y ajustado) sobre las variables principales mediante LogRank y Cox para el TPP, t-Student para la CS y SF y Modelo Lineal Generalizado para la SF. Resultados: las cohortes 2014 y 2019 constaron, respectivamente, de 98 y 116 pacientes, 63% y 52% de mujeres, 48% y 35% del ámbito rural y 43% y 27% de institucionalizados, con una media de edad y lugar de fallecimiento similares. En el TPP no se evidenciaron diferencias entre ambas cohortes (p=0,098); el análisis de Cox tampoco mostró asociación (HR = 1,01 [0,75; 1,36]). En la CS no se encontraron diferencias clínicamente relevantes. No se observaron diferencias en la SF una vez ajustada por las variables edad, sexo e institucionalización. Conclusión: no se observaron diferencias en el perfil de pacientes con cronicidad avanzada incluidos en el programa del ESAPD entre los años 2014 y 2019 en el marco de la implementación de estrategias de cronicidad.(AU)

Objective: to study possible changes in the profile of patients with advanced chronic conditions between two cohorts at the time of their inclusion in a palliative-care-home care support team (PCHCST) in the framework of implementation of chronicity strategies. Method: A retrospective, observational analytical study was performed on non-oncological patients referred to a PCHCST in Madrid, divided into two cohorts (2014 and 2019) defined by the time of inclusion in the programme. The main variables were time spent in the programme (TSP), symptom burden (SB) and functional status (FS). Sociodemographic and clinical variables were collected. The effect of the cohort (crude and adjusted) on the main variables was compared overall and by sex using LogRank and Cox for TSP, student t test for SB and FS and Generalized Linear Models for FS. Results: The 2014 and 2019 cohorts consisted respectively of 98 and 116 patients, 63% and 52% female, 48% and 35% rural and 43% and 27% nursing home residents, with similar mean age and place of death. For TSP, no statistically significant differences were detected between the two cohorts (P = 0.098); Cox analysis did not reveal any association either (HR = 1.01 [0.75; 1.36]). No clinically relevant differences were found for SB. No differences were observed for FS adjusted for age, sex and nursing home residence. Conclusion: No differences were observed in the profile of patients with advanced chronic conditions included in the PCHCST between 2014 and 2019 in the framework of implementation of chronicity strategies.(AU)

Epidemiology and clinical characteristics of scrub typhus based on 680 unexplained fever patients in Hainan / 中国热带医学

@#Abstract: Objective　To analyze the epidemiological characteristics of scrub typhus in 680 patients with unexplained fever in Hainan Island and provide guidance for local scrub typhus prevention and control. Methods　Blood samples from patients with clinically diagnosed unexplained fever in the First Affiliated Hospital of Hainan Medical University, Second Affiliated Hospital of Hainan Medical University, Haikou Municipal People's Hospital and Central South University Xiangya Medical College Affiliated Hospital, People's Hospital of Qiongzhong Li Miao Autonomous County were collected between 2018 and 2021, then samples were tested for Orientia tsutsugamushi specific IgM, IgG antibodies and Orientia tsutsugamushi 56kD-specific antigen genes using colloidal gold immunochromatography and PCR methods. The clinical and epidemiological information of the samples were also collected. Epidemiological analysis was carried out on the obtained sample information and test results. Results　A total of 680 samples from patients with clinically unknown fever were collected. The positive rates of scrub typhus IgM antibody, IgG antibody, PCR were 23.97% (163/680), 36.62% (249/680), 20.88% (142/680), respectively, and eschar or rash was observed in 12.06% (82/680) of all patients. According to the diagnostic criteria, 223 patients were finally diagnosed with scrub typhus. Among them, there were 111 males (49.78%) and 109 females (48.88%); the average age was (53.14±15.12) years old, and the 40-<60 years old was the main incidence group (98 cases, accounting for 43.95%). The ethnicity of the patient with scrub typhus was mainly Han ethnicity (136 cases, accounting for 60.99%). Farmers were the main morbidity group (93 cases, 41.70%). The patient with scrub typhus distributed throughout the island except for Sanya and Wuzhishan, with Haikou and Qiongzhong show the highest number of cases. The number of cases in autumn was the highest (114 cases, 51.12%). The clinical manifestations of infected patients were mainly non-specific symptoms and signs, 36.77% of patients developed skin-specific ulcers or eschars, which were mainly distributed in the shoulder and neck, armpits, elbow fossa, chest and abdomen, back, buttocks, groin, scrotum and other joints and skin folds of the upper and lower limbs. Conclusions　Hainan Island is the foci of scrub typhus and the epidemic time has obvious seasonality. Its prevention should focus on rural areas in autumn, and its clinical features are mainly high fever and eschar or ulceration.