Modelling trends of CD4 counts for patients on antiretroviral therapy (ART): a comprehensive health care clinic in Nairobi, Kenya

Background In resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. In this study, we quantified trends on CD4 counts in patients on highly active antiretroviral therapy (HAART) in a comprehensive health care clinic in Kenya between 2011 and 2017. We evaluated the rate of change in CD4 cell count in response to antiretroviral treatment. We further assessed factors that influenced time to treatment change focusing on baseline characteristics of the patients and different initial drug regimens used. This was a retrospective study involving 432 naïve HIV patients that had at least two CD4 count measurements for the period. The relationship between CD4 cell count and time was modeled using a semi parametric mixed effects model while the Cox proportional hazards model was used to assess factors associated with the first regimen change. Results Majority of the patients were females and the average CD4 count at start of treatment was 362.1 $$cell/mm^3$$ c e l l / m m 3 . The CD4 count measurements increased nonlinearly over time and these trends were similar regardless of the treatment regimen administered to the patients. The change of logarithm CD4 cell count rises fast for in the first 450 days of antiretroviral initiation. The average time to first regimen change was 2142 days. Tenoforvir (TDF) based regimens had a lower drug substitution(aHR 0.2682, 95% CI:0.08263- 0.8706) compared to Zidovudine(AZT). Conclusion The backbone used was found to be associated with regimen changes among the patients with fewer switches being observed, with the use of TDF when compared to AZT. There was however no significant difference between TDF and AZT in terms of the rate of change in logarithm CD4 count over time.

Indian Laws during COVID-19 Pandemic: Implications to Health and Management

Introduction: 2019 corona virus disease (COVID-19), a respiratory disease caused by a new corona virus (SARS corona virus 2, also known as novel corona virus) in China, has spread and attracted worldwide attention. The WHO declared the outbreak of COVID-19 a global public health emergency on January 30, 2020. Following the 2002 corona virus (SARS-Corona Virus) and the 2012 MERS Corona Virus, the virus SARS corona is the third most infectious disease and the largest corona virus that caused human outbreaks in the 20th century. Aim: To assess the Indians law that affects or supports the Indian citizen with present scenario of Pandemic. Conclusion: Coronavirus has called for a mixed response in India. The answer includes a host of regulations, guidelines, services, and administrative structures, as well as public and government warnings. As the demands of government action grow, the Passivence Sicknesses Act has become a topic of discussion. Instead of establishing a comprehensive health care system, the Pestilence Infections Act allows states to take special measures in response to serious infectious diseases. The law gives the public a broad mandate to participate in oppressive actions against citizens within this limited framework.

Evidências de cuidado do enfermeiro aos homens com câncer de próstata: revisão integrativa

Objetivo: Avaliar evidências das necessidades de suporte de cuidados aos homens com câncer de próstata em seguimento e tratamento atendidos por enfermeiros. Método: Revisão integrativa da literatura nas bases de dados: PubMed e CINAHL, em inglês, português e espanhol, publicados entre 2009 a 2019, com o cruzamento dos descritores “Prostatic Neoplasms”, “Masculinity”, “Health Services Needs and Demand”, “Needs assessment”, “Nursing Care”, “Comprehensive Health Care”, “Oncology Nursing”. Encontrados 2425 artigos e atenderam aos critérios de inclusão seis artigos. Para a extração e análise dos dados, utilizaram-se instrumentos validados. Resultados: As intervenções educativas, o planejamento individual coparticipativo e o acompanhamento longitudinal foram as principais ações desenvolvidas pelos enfermeiros, valorizados pelos cuidados oferecidos. Conclusão: A síntese do conhecimento direciona para a importância do enfermeiro no cuidado ao homem com câncer de próstata e para a elaboração de planos de cuidados inovadores e compartilhados, fundamentados nas necessidades e nas melhores evidências.

Entre lo que se dice y lo que se calla: visitando el concepto de empatía en la atención integral a la salud del adulto mayor

La atención integral a la salud del adulto mayor es considerada una de las tareas más dinámicas y complejas para los sistemas públicos de salud y de asistencia social. Esta revisión narrativa constituye un ensayo crítico-analítico, de reflexión gerontológica sobre la práctica empática en la producción de actos de salud direccionados a resolver los problemas socio-sanitarios del segmento poblacional envejecido. Con tal visión, se propone una comprensión conceptual y práctica de la empatía, a través de la identificación de sus potencialidades y limitaciones en el contexto de la clínica geriátrica-gerontológica. Comprehensive health care for older adults is considered one of the most dynamic and complex tasks for public health and social care systems. This narrative review constitutes a critical-analytical essay of gerontological reflection on the empathic practice in the production of health acts aimed at solving the socio-health problems of the aging population segment. With such view, a conceptual and practical understanding of empathy is proposed, through the identification of its potentialities and limitations in the context of the geriatric-gerontological clinic. A atenção integral à saúde do idoso é uma das tarefas mais dinâmicas e complexas dos sistemas de saúde pública e de assistência social. Esta revisão narrativa constitui um ensaio crítico-analítico, de reflexão gerontológica sobre a prática empática na produção de atos de saúde dirigidos a resolver os problemas sócio-sanitários do segmento populacional envelhecido. Com tal visão, propõe-se uma compreensão conceitual e prática da empatia, através da identificação das suas potencialidades e limitações no contexto da clínica geriátrico-gerontológica.

Attention to the spiritual and religious needs of patients by healthcare personnel. A model based on spiritual accompaniment.

During the past decades, spirituality and religion have regained their importance in health care, not only as a way of respecting the decision-making autonomy of the patient but as an element that influences the clinical evolution and quality of life of the sick patient and allowing to provide comprehensive health care. The latter has resulted in many countries guaranteeing spiritual care during hospitalizations by law. However, on the one hand, attention to spiritual and religious needs is usually reserved only for terminal cancer patients and/or patients with catastrophic diseases. On the other hand, attention to these needs has gradually become considered part of the obligations of the health teams, not without their reluctance and without a clear indication of how this task must be carried out. This work aims to present the importance of spirituality and religion inpatient care and a care model based on spiritual accompaniment. Know all the theories, master all the techniques, but as you touch a human soul be just another human soul. Carl Jung

O Serviço Social no âmbito hospitalar em tempos de pandemia da COVID-19

O presente artigo tem como objetivo de analisar a atuação do assistente social no âmbito hospitalar no período da pandemia da COVID-19. O método utilizado foi a revisão da literatura. A procura na literatura foi realizada nas seguintes bases de dados: ScientificElectronic Library Online (SciELO) Web of Science e National Library of Medicine (PubMed/Medline), Biblioteca Virtual em Saúde (BVS) e Google Acadêmico. Para a escolha dos artigos foram considerados os seguintes descritores em saúde (decs.bvs.br) combinados com operadores booleanos: COVID-19 AND Primary Health Care OR Health Education OR Prevention&Control OR Comprehensive Health Care. Após a busca, 27 artigos foram contados e 17 foram excluídos. Os resultados encontrados foram que o espaço do hospital é um dos âmbitos prioritário para a atuação e fazer profissional do assistente social. Por ser a porta de entrada do sistema de saúde e pela proposta do SUS, está de acordo com a ética política do serviço social e se baseia na refração das questões sociais, neste caso a refração é o processo de saúde. As conclusões apontam que o trabalho do assistente social seja pouco reconhecido nos hospitais, é um trabalho que exige responsabilidade e é insubstituível, sendo dever do estado garantir o mínimo dos direitos e reconhecimento à profissão.