RESUMO
Improving immunisation coverage for older adults is a public health issue. Since 2008, nurses have been authorised to vaccinate this population against influenza without a medical prescription. One study examined the opinions of a sample of 78 private duty nurses in Martinique on influenza and anti-tetanus vaccination of elderly populations. The majority of nurses said they were not in favour of vaccination.
Assuntos
Vacinas contra Influenza , Influenza Humana , Idoso , Atitude do Pessoal de Saúde , Humanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Martinica , Enfermeiras e Enfermeiros , VacinaçãoAssuntos
Febre de Chikungunya/epidemiologia , Vírus Chikungunya , Consenso , Surtos de Doenças , Guadalupe , Humanos , Martinica , Índias OcidentaisRESUMO
OBJECTIVE: The primary objective was to identify predictive factors of inhospital death in a population of patients aged 65 years or older hospitalised with Chikungunya virus (CHIKV) infection. The secondary aim was to develop and validate a predictive score for inhospital death based on the predictors identified. DESIGN: Longitudinal retrospective study from January to December 2014. SETTING: University Hospital of Martinique. PARTICIPANTS: Patients aged ≥65 years, admitted to any clinical ward and who underwent reverse transcription PCR testing for CHIKV infection. OUTCOME: Independent predictors of inhospital death were identified using multivariable Cox regression modelling. A predictive score was created using the adjusted HRs of factors associated with inhospital death. Receiver operating characteristic curve analysis was used to determine the best cut-off value. Bootstrap analysis was used to evaluate internal validity. RESULTS: Overall, 385 patients aged ≥65 years were included (average age: 80±8 years). Half were women, and 35 (9.1%) died during the hospital stay. Seven variables were found to be independently associated with inhospital death (concurrent cardiovascular disorders: HR 11.8, 95% CI 4.5 to 30.8; concurrent respiratory infection: HR 9.6, 95% CI 3.4 to 27.2; concurrent sensorimotor deficit: HR 7.6, 95% CI 2.0 to 28.5; absence of musculoskeletal pain: HR 2.6, 95% CI 1.3 to 5.3; history of alcoholism: HR 2.5, 95% CI 1.1 to 5.9; concurrent digestive symptoms: HR 2.4, 95% CI 1.2 to 4.9; presence of confusion or delirium: HR 2.1, 95% CI 1.1 to 4.2). The score ranged from 0 to 25, with an average of 6±6. The area under the curve was excellent (0.90; 95% CI 0.86 to 0.94). The best cut-off value was a score ≥8 points, with a sensitivity of 91% (82%-100%) and specificity of 75% (70%-80%). CONCLUSIONS: Signs observed by the clinician during the initial examination could predict inhospital death. The score will be helpful for early management of elderly subjects presenting within 7 days of symptom onset in the context of CHIKV outbreaks.
Assuntos
Febre de Chikungunya/complicações , Febre de Chikungunya/mortalidade , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Delírio/etiologia , Feminino , Humanos , Masculino , Martinica/epidemiologia , Análise Multivariada , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Análise de SobrevidaRESUMO
OBJECTIVES: We aimed to determine whether the presentation of Chikungunya virus (CHIKV) infection differs between older and younger adults with regard to clinical form during the acute phase defined by the World Health Organization: acute clinical, atypical, and severe acute. DESIGN: Cross-sectional, retrospective. SETTING: University Hospital of Martinique. PARTICIPANTS: Individuals aged 65 and older (n = 267, mean age 80.4 ± 87.9) who attended the emergency department with a positive biological diagnosis of CHIKV (reverse transcriptase polymerase chain reaction) between January and December 2014 and a randomly selected sample of individuals younger than 65 (n = 109, mean age 46.2 ± 12.7). RESULTS: Typical presentation was present in 8.2% of older adults and 59.6% of younger individuals (P < .001), atypical presentation in 29.6% of older adults and 5.6% of younger individuals (P < .001), and severe presentation in 19.5% of older adults and 17.4% of younger individuals (P = .65). One hundred fourteen (42.7%) of the older group and 19 (17.4%) of the younger group could not be classified in any category (absence of fever, absence of joint pain, or both) (P < .001). CONCLUSION: Only 8.2% of the older adults presenting in the acute phase of CHIKV have typical forms, suggesting that the most-frequent clinical presentation of CHIKV in older adults differs from that in younger individuals.
Assuntos
Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Vírus Chikungunya/isolamento & purificação , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artralgia/virologia , Estudos Transversais , Feminino , Febre de Causa Desconhecida/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de RiscoRESUMO
BACKGROUND: This study aimed to derive and validate a score for Chikungunya virus (CHIKV) infection screening in old people admitted to acute care units. METHODS: This study was performed in the Martinique University Hospitals from retrospective cases. Patients were aged 65+, admitted to acute care units for suspected CHIKV infection in 2014, with biological testing using Reverse Transcription Polymerase Chain Reaction (RT-PCR). RT-PCR was used as the gold standard. A screening score was created using adjusted odds ratios of factors associated with positive RT-PCR derived from a multivariable logistic regression model. A ROC curve was used to determine the best cut-off of the score. Bootstrap analysis was used to evaluate its internal validity. RESULTS: In all, 687 patients were included, 68% with confirmed CHIKV infection, and 32% with laboratory-unconfirmed CHIKV infection. Mean age was 80±8 years, 51% were women. Four variables were found to be independently associated with positive RT-PCR (fever: 3 points; arthralgia of the ankle: 2 points; lymphopenia: 6 points; absence of neutrophil leucocytosis: 10 points). The best cut-off was score ≥12; sensitivity was 87% (83%-90%) and specificity was 70% (63%-76%). CONCLUSION: This score shows good diagnostic performance and good internal validation and could be helpful to screen aged people for CHIKV infection.