Caregivers of people with disorders of consciousness: Relationship continuity and rupture

ObjectivesThis study seeks to better understand caregivers’ experience of the support their loved ones, with disorders of consciousness, receive in a dedicated unit.MethodsThe focus here is on the qualitative component of a larger study that also includes a quantitative component. An inductive and iterative approach was privileged, i.e., one similar to grounded theory; a thematic analysis was used to analyze 20 comprehensive semi-structured interviews.ResultsThree main themes emerged: the discovery of a new world by a patient's loved ones, i.e., the disorders of consciousness; the psychological and somatic impact on loved ones; and the relationships between family caregivers and professionals of the dedicated unit.DiscussionThe new living situation of people in an disorders of consciousness state of consciousness requires caregivers to engage in an intense psychological process. First, this is necessary to understand the situation and its consequences. Second, it allows them to cope with the reorganization of the emotional and relational ties between the patient and the caregiver, and in the entire family dynamic. Lastly, healthcare professionals consider that caregivers are also the witnesses of the patient's past life, capable of linking the past and present, and often the interpreters of patients’ emotional reactions according to their former personality.ConclusionCaregivers are affected by the frailty and somatic dependence of their loved ones, and they also bear the history and psychological continuity of patients. Professionals must take into account this double burden, which helps explain families’ psychological exhaustion and their need for help. Understanding these phenomena is crucial for improving patient care in dedicated units.     

Impact of pentavalent rotavirus vaccine against severe rotavirus diarrhoea in The Gambia

IntroductionRotavirus vaccines protect against the leading cause of severe childhood diarrhoea, and have been introduced in many low-income African countries. The Gambia introducedRotateq® (RV5) into their national immunization program in 2013. We revieweddata from an active rotavirus sentinel surveillancesitefor early evidence of vaccine impact.MethodsWe compared rotavirus prevalence in diarrhoeal stool in children< 5 years of age admittedat the Edward Francis Small Teaching Hospital sentinel surveillance site before (2013) andafterRV5 introduction (2015–2016) in the Gambia. The rotavirus-percent positive was separately compared for all diarrhoealhospitalizations and for hospitalizations with severe symptoms. Rotavirus prevalence was compared annually for the pre-vaccine year of 2013 with post-vaccine years of 2015 and 2016 using chi-square or Fisher’s exact tests and the p-value to establish significant relationship was set at p < 0.05. All analyses were completed in SAS 9.3 (SAS Analytics, North Carolina).ResultsRotavirus prevalence among all diarrhoeahospitalizations decreased from 22% in 2013 to 11% in 2015 (p = 0.04), while remaining unchanged in 2016 (18%, p = 0.56). For hospitalizations that were clinically severe and/or treated with intravenous fluids (mean of 46 per year), the rotavirus prevalence decreased from 33% in 2013 to 8% in 2015 (p = 0.04), and to 15% in 2016 (p = 0.08). The children with age <1 year accounted for 45% the population infected with rotavirus in both pre and post rotavirus vaccination periods.ConclusionsRotavirus vaccine introduction in the Gambia could be among factors resulting in decreased diarrhea hospitalizations among children at the Edward Francis Small Teaching Hospital, particularly those with severe disease. These results support the continuation of rotavirus vaccine and additional monitoring of rotavirus hospitalization trends in the country.     

Cost-effectiveness of dengue vaccination in ten endemic countries

Following publication of results from two phase-3 clinical trials in 10 countries or territories, endemic countries began licensing the first dengue vaccine in 2015. Using a published mathematical model, we evaluated the cost-effectiveness of dengue vaccination in populations similar to those at the trial sites in those same Latin American and Asian countries. Our main scenarios (30-year horizon, 80% coverage) entailed 3-dose routine vaccinations costing US$20/dose beginning at age 9, potentially supplemented by catch-up programs of 4- or 8-year cohorts. We obtained illness costs per case, dengue mortality, vaccine wastage, and vaccine administration costs from the literature. We estimated that routine vaccination would reduce yearly direct and indirect illness cost per capita by 22% (from US$10.51 to US$8.17) in the Latin American countries and by 23% (from US$5.78 to US$4.44) in the Asian countries. Using a health system perspective, the incremental cost-effectiveness ratio (ICER) averaged US$4,216/disability-adjusted life year (DALY) averted in the five Latin American countries (range: US$666/DALY in Puerto Rico to US$5,865/DALY in Mexico). In the five Asian countries, the ICER averaged US$3,751/DALY (range: US$1,935/DALY in Malaysia to US$5,101/DALY in the Philippines). From a health system perspective, the vaccine proved to be highly cost effective (ICER under one times the per capita GDP) in seven countries and cost effective (ICER 1–3 times the per capita GDP) in the remaining three countries. From a societal perspective, routine vaccination proved cost-saving in three countries. Including catch-up campaigns gave similar ICERs. Thus, this vaccine could have a favorable economic value in sites similar to those in the trials.     

Budgetary Impact and Cost Drivers of Drugs for Rare and Ultrarare Diseases

Objectives

To review recent studies reporting health care expenditures (budgetary impact) for orphan medicinal products (OMPs) in Europe and to contribute to our understanding of the cost drivers of nononcological OMPs by means of an empirical analysis in Germany.

对头颈癌放疗患者实施营养相关症状管理教育的效果研究

目的 探讨症状管理教育对头颈癌放疗患者营养相关症状水平和营养状况的影响。 方法 将128例头颈癌放疗患者按不同病区分为对照组与干预组各64例;对照组实施放疗常规护理,干预组在对照组基础上增加分阶段持续性症状管理教育。分别在放疗第1、4、7周和放疗后1个月应用头颈患者症状清单进行营养相关症状评估,同时测量体质量、血清白蛋白及血红蛋白。 结果 干预组不同时间点营养相关症状总分及疼痛、恶心和抑郁严重程度显著低于对照组,体质量、血清白蛋白、血红蛋白显著高于对照组（干预主效应均P＜0.05）。 结论 分阶段持续性症状管理教育能够提高头颈癌放疗患者的症状管理能力,有效减轻患者营养相关症状负荷,改善患者营养状况。     

脑卒中影响量表的测试研究

目的探讨应用汉化的脑卒中影响量表（SIS）的可行性。方法使用汉化的SIS量表对130例中老年首发脑卒中患者发病后1个月时的生存质量进行评定，并对其中的105例患者在发病后进行为期3个月的随访评定。根据结果对该量表的信度、效度、反应度和可行性进行全面分析。结果SIS量表8个分量表和总量表中表示内部一致性的克朗巴赫α系数（Cronbach’s α）均〉0．8，重测结果的组内相关系数ICC（intraclasscorrelation coefficients，IOC）值均〉0．7（P〈0．05）。各分量表的Pearson相关系数均〉0．5（P〈0．05）。因子分析法提取的8个因子总共解释总体变量的80％。情绪、ADL／IADL、移动能力、参与4个方面及总分方面的变化差异有显著性（P〈0．05）。结论汉化SIS量表具有良好的信度、效度、反应度和可行性，可应用于临床和社区护士对中老年脑卒中患者的生存质量和护理效果的评定。     

Socio‐economic impact of Foot‐and‐Mouth Disease outbreaks and control measures: An analysis of Mongolian outbreaks in 2017

Mongolia is a large landlocked country in Central Asia and has one of the highest per capita livestock ratios in the world. During 2017, reported foot‐and‐mouth disease (FMD) outbreaks in Mongolia increased considerably, prompting widespread disease control measures. This study estimates the socio‐economic impact of FMD and subsequent control measures on Mongolian herders. The analysis encompassed quantification of the impact on subsistence farmers’ livelihoods and food security and estimation of the national‐level gross losses due to reaction and expenditure during 2017. Data were collected from 112 herders across eight provinces that reported disease. Seventy of these herders had cases of FMD, while 42 did not have FMD in their animals but were within quarantine zones. Overall, 86/112 herders reported not drinking milk for a period of time and 38/112 reduced their meat consumption. Furthermore, 55 herders (49.1%) had to borrow money to buy food, medicines and/or pay bills or bank loans. Among herders with FMD cases, the median attack rate was 31.7%, 3.8% and 0.59% in cattle, sheep and goats, respectively, with important differences across provinces. Herders with clinical cases before the winter had higher odds of reporting a reduction in their meat consumption. National‐level gross losses due to FMD in 2017 were estimated using government data. The estimate of gross economic loss was 18.4 billion Mongolian‐tugriks (US$7.35 million) which equates to approximately 0.65% of the Mongolian GDP. The FMD outbreaks combined with current control measures have negatively impacted herders’ livelihoods (including herders with and without cases of FMD) which are likely to reduce stakeholder advocacy. Possible strategies that could be employed to ameliorate the negative effects of the current control policy were identified. The findings and approach are relevant to other FMD endemic regions aiming to control the disease.     

Psychological distress in ethnic minority parents of preschool children with burns

BackgroundLiterature indicates that children from ethnic minorities are at increased risk of sustaining burns. Moreover, parents may experience more psychological distress but why this is the case is poorly investigated.MethodsA prospective study including 120 mothers and 106 fathers of preschool children, of which 23 mothers and 24 fathers had an ethnic minority background, investigated levels of parental feelings of guilt, depressive and posttraumatic stress symptoms and compared Dutch parents with parents from different ethnic backgrounds on these outcomes. A qualitative study with 46 parents, 24 Dutch and 22 from different ethnic minority backgrounds, explored how they coped with the consequences of the burns.ResultsResults revealed more symptoms of posttraumatic stress and depression in ethnic minority parents. Ethnic minority fathers also had more guilt feelings. Lower social support, medical communication hampered by language barriers, lower health literacy and passive communication styles, (aspects of) religious coping and barriers to psychosocial care may partly explain the differences.ConclusionsParents with an ethnic minority background are at risk to experience increased distress after their child’s burn injury. By exploring the aforementioned factors, health care professionals may increase the family’s wellbeing. It may provide a starting point to offer tailored help.     

持续护理质量控制对住院糖尿病患者发生压疮的影响

目的探析持续护理质量控制对住院糖尿病患者发生压疮的影响作用。方法选取2010年12月—2013年8月期间入院诊治的糖尿病住院患者100例,随机分为实验组（50例）和对照组（50例）。其中对照组应用常规护理办法,执行医嘱,并根据患者具体病情进行级别护理;实验组则在对照组的基础上,成立压疮质量控制小组,对患者发生压疮的危险因素进行分级评分,告知患者压疮的危险因素,制定具体的压疮控制办法并严格执行。观察比较两组患者在住院期间压疮的发生情况、护理质量以及出院后的生活质量。结果实验组压疮发生3例、发生率为6.00%,对照组压疮发生9例、发生率为18.00%,两组差异显著（P〈0.05）。护理质量评价中,实验组优者17例,良者29例,优良率为92.00%,对照组优者12例,良者24例,优良率为72.00%,两组差异显著（P〈0.05）。实验组护理后在总体健康、积极感受等方面的生活质量显著高于对照组（P〈0.05）。结论应用持续护理质量控制管理办法,可显著降低糖尿病住院患者压疮的发生率,提升护理质量及患者预后的生活质量。