¿Conocen los usuarios sus deberes y derechos? Una evaluación posterior a una intervención

RESUMENIntroduccion: Los derechos y deberes de los enfermos son un factor fundamental en un sistema de salud y un indicador de la calidad del servicio, por tal motivo, las instituciones prestadoras de servicios de salud tienen la responsabilidad de promover su conocimiento, no sólo en el personal asistencial y administrativo, sino también en sus usuarios, a fin de que ellos puedan exigir el cumplimiento de los mismos.Objetivo: Determinar el nivel de conocimiento de los usuarios sobre sus derechos y deberes en una institución de salud de Tercer Nivel de atención. Materiales y métodos: Se realizó un estudio descriptivo de corte trasversal luego de la implementación de un proyecto educativo que buscaba socializar entre los usuarios sus derechos y deberes. Se calculó un tamaño muestral de 369 usuarios, con un nivel de confianza del 95,0%, poder estadístico del 80,0%, prevalencia esperada de buenos conocimientos del 50,0%, y un IC 95% (45,0-55,0%). Se realizó muestreo aleatorio simple. Se solicito consentimiento informado a todos los participantes.Resultados: El 54,7% de los usuarios tenía un nivel de conocimiento bueno, el 40,5% regular y el 4,8% deficiente. El nivel de conocimientos fue mayor, con respecto a una encuesta anterior. El 10,9% de los usuarios manifestaron que habían recibido información sobre sus derechos y deberes, y de estos el 40,4% la recibieron en la ESE-HUS.Conclusiones: En su mayoría, los usuarios tenían un buen nivel de conocimientos sobre derechos y deberes de los enfermos, a pesar de no haber recibidoinformación sobre el tema. Salud UIS 2011; 43(1): 11-19Palabras clave: Derechos de los enfermos, defensa del paciente, deberes de los enfermosABSTRACTIntroduction: Patients rights and responsibilities are a fundamental factor in on health system and a service quality indicator of the service, for that reason, health-care institutions have the responsibility to promote ther awareness not only among health-care and management staff, but also in their users, so that these could demond their compliance.Objective: To determine the users level of knowledge or awareness in terms of their rights and responsibilities in a Third-Level health-care institution.Materials and methods: A transversal cut descriptive study was conducted after implementation of an educational project aimed to socialize users rights and obligations among patient population. A sample group of 369 users was calculated, with 95.0%, trust level, 80.0% statistical power, 50.0% expected awareness prevalence, and 95.0% (45.0-55.0%) IC. Simple random sampling was conducted. Consent in writing was obtained from all participants.Results: Fifty four point seven (54.7%) of users had good awareness level, with 40.5% acceptable and 4.8% deficient. Awareness level was higher than that for a previous sampling. 10.9% of users stated having received information regarding their rights and responsibilities, of which 40.4% obtained their knowledge at the ESE-HUS.Conclusions: Most users showed good patients rights and responsibilities awareness levels, despite the fact that they had not received information in that respect. Salud UIS 2011; 43(1): 11-19Keywords: Patients rights, patient advocacy, patients’ obligation

¿Conocen los usuarios sus deberes y derechos? Una evaluación posterior a una intervención

RESUMENIntroduccion: Los derechos y deberes de los enfermos son un factor fundamental en un sistema de salud y un indicador de la calidad del servicio, por tal motivo, las instituciones prestadoras de servicios de salud tienen la responsabilidad de promover su conocimiento, no sólo en el personal asistencial y administrativo, sino también en sus usuarios, a fin de que ellos puedan exigir el cumplimiento de los mismos.Objetivo: Determinar el nivel de conocimiento de los usuarios sobre sus derechos y deberes en una institución de salud de Tercer Nivel de atención. Materiales y métodos: Se realizó un estudio descriptivo de corte trasversal luego de la implementación de un proyecto educativo que buscaba socializar entre los usuarios sus derechos y deberes. Se calculó un tamaño muestral de 369 usuarios, con un nivel de confianza del 95,0%, poder estadístico del 80,0%, prevalencia esperada de buenos conocimientos del 50,0%, y un IC 95% (45,0-55,0%). Se realizó muestreo aleatorio simple. Se solicito consentimiento informado a todos los participantes.Resultados: El 54,7% de los usuarios tenía un nivel de conocimiento bueno, el 40,5% regular y el 4,8% deficiente. El nivel de conocimientos fue mayor, con respecto a una encuesta anterior. El 10,9% de los usuarios manifestaron que habían recibido información sobre sus derechos y deberes, y de estos el 40,4% la recibieron en la ESE-HUS.Conclusiones: En su mayoría, los usuarios tenían un buen nivel de conocimientos sobre derechos y deberes de los enfermos, a pesar de no haber recibidoinformación sobre el tema. Salud UIS 2011; 43(1): 11-19Palabras clave: Derechos de los enfermos, defensa del paciente, deberes de los enfermosABSTRACTIntroduction: Patients rights and responsibilities are a fundamental factor in on health system and a service quality indicator of the service, for that reason, health-care institutions have the responsibility to promote ther awareness not only among health-care and management staff, but also in their users, so that these could demond their compliance.Objective: To determine the users level of knowledge or awareness in terms of their rights and responsibilities in a Third-Level health-care institution.Materials and methods: A transversal cut descriptive study was conducted after implementation of an educational project aimed to socialize users rights and obligations among patient population. A sample group of 369 users was calculated, with 95.0%, trust level, 80.0% statistical power, 50.0% expected awareness prevalence, and 95.0% (45.0-55.0%) IC. Simple random sampling was conducted. Consent in writing was obtained from all participants.Results: Fifty four point seven (54.7%) of users had good awareness level, with 40.5% acceptable and 4.8% deficient. Awareness level was higher than that for a previous sampling. 10.9% of users stated having received information regarding their rights and responsibilities, of which 40.4% obtained their knowledge at the ESE-HUS.Conclusions: Most users showed good patients rights and responsibilities awareness levels, despite the fact that they had not received information in that respect. Salud UIS 2011; 43(1): 11-19Keywords: Patients rights, patient advocacy, patients’ obligation

¿Conocen los usuarios sus deberes y derechos?: Una evaluación posterior a una intervención Do the users know their rights and responsibilities?: A post-intervention evaluation

Introducción: Los derechos y deberes de los enfermos son un factor fundamental en un sistema de salud y un indicador de la calidad del servicio, por tal motivo, las instituciones prestadoras de servicios de salud tienen la responsabilidad de promover su conocimiento, no sólo en el personal asistencial y administrativo, sino también en sus usuarios, a fin de que ellos puedan exigir el cumplimiento de los mismos. Objetivos: Determinar el nivel de conocimiento de los usuarios sobre sus derechos y deberes en una institución de salud de Tercer Nivel de atención. Materiales y métodos: Se realizó un estudio descriptivo de corte trasversal luego de la implementación de un proyecto educativo que buscaba socializar entre los usuarios sus derechos y deberes. Se calculó un tamaño muestral de 369 usuarios, con un nivel de confianza del 95,0&#37;, poder estadístico del 80,0&#37;, prevalencia esperada de buenos conocimientos del 50,0&#37;, y un IC 95&#37; (45,0-55,0&#37;). Se realizó muestreo aleatorio simple. Se solicito consentimiento informado a todos los participantes. Resultados: El 54,7&#37; de los usuarios tenía un nivel de conocimiento bueno, el 40,5&#37; regular y el 4,8&#37; deficiente. El nivel de conocimientos fue mayor, con respecto a una encuesta anterior. El 10,9&#37; de los usuarios manifestaron que habían recibido información sobre sus derechos y deberes, y de estos el 40,4&#37; la recibieron en la ESE-HUS. Conclusiones: En su mayoría, los usuarios tenían un buen nivel de conocimientos sobre derechos y deberes de los enfermos, a pesar de no haber recibido información sobre el tema. Salud UIS 2011; 43(1): 11-19<br>Introduction: Patients rights and responsibilities are a fundamental factor in on health system and a service quality indicator of the service, for that reason, health-care institutions have the responsibility to promote ther awareness not only among health-care and management staff, but also in their users, so that these could demond their compliance. Objectives: To determine the users level of knowledge or awareness in terms of their rights and responsibilities in a Third-Level health-care institution. Materials and methods: A transversal cut descriptive study was conducted after implementation of an educational project aimed to socialize users rights and obligations among patient population. A sample group of 369 users was calculated, with 95.0&#37;, trust level, 80.0&#37; statistical power, 50.0&#37; expected awareness prevalence, and 95.0&#37; (45.0-55.0&#37;) IC. Simple random sampling was conducted. Consent in writing was obtained from all participants. Results: Fifty four point seven (54.7&#37;) of users had good awareness level, with 40.5&#37; acceptable and 4.8&#37; deficient. Awareness level was higher than that for a previous sampling. 10.9&#37; of users stated having received information regarding their rights and responsibilities, of which 40.4&#37; obtained their knowledge at the ESE-HUS. Conclusions: Most users showed good patients rights and responsibilities awareness levels, despite the fact that they had not received information in that respect. Salud UIS 2011; 43(1): 11-19

¿Conocen los usuarios sus deberes y derechos?: Una evaluación posterior a una intervención

Introducción: Los derechos y deberes de los enfermos son un factor fundamental en un sistema de salud y un indicador de la calidad del servicio, por tal motivo, las instituciones prestadoras de servicios de salud tienen la responsabilidad de promover su conocimiento, no sólo en el personal asistencial y administrativo, sino también en sus usuarios, a fin de que ellos puedan exigir el cumplimiento de los mismos. Objetivos: Determinar el nivel de conocimiento de los usuarios sobre sus derechos y deberes en una institución de salud de Tercer Nivel de atención. Materiales y métodos: Se realizó un estudio descriptivo de corte trasversal luego de la implementación de un proyecto educativo que buscaba socializar entre los usuarios sus derechos y deberes. Se calculó un tamaño muestral de 369 usuarios, con un nivel de confianza del 95,0%, poder estadístico del 80,0%, prevalencia esperada de buenos conocimientos del 50,0%, y un IC 95% (45,0-55,0%). Se realizó muestreo aleatorio simple. Se solicito consentimiento informado a todos los participantes. Resultados: El 54,7% de los usuarios tenía un nivel de conocimiento bueno, el 40,5% regular y el 4,8% deficiente. El nivel de conocimientos fue mayor, con respecto a una encuesta anterior. El 10,9% de los usuarios manifestaron que habían recibido información sobre sus derechos y deberes, y de estos el 40,4% la recibieron en la ESE-HUS. Conclusiones: En su mayoría, los usuarios tenían un buen nivel de conocimientos sobre derechos y deberes de los enfermos, a pesar de no haber recibido información sobre el tema. Salud UIS 2011; 43(1): 11-1

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Global COVID-19 lockdown highlights humans as both threats and custodians of the environment

The global lockdown to mitigate COVID-19 pandemic health risks has altered human interactions with nature. Here, we report immediate impacts of changes in human activities on wildlife and environmental threats during the early lockdown months of 2020, based on 877 qualitative reports and 332 quantitative assessments from 89 different studies. Hundreds of reports of unusual species observations from around the world suggest that animals quickly responded to the reductions in human presence. However, negative effects of lockdown on conservation also emerged, as confinement resulted in some park officials being unable to perform conservation, restoration and enforcement tasks, resulting in local increases in illegal activities such as hunting. Overall, there is a complex mixture of positive and negative effects of the pandemic lockdown on nature, all of which have the potential to lead to cascading responses which in turn impact wildlife and nature conservation. While the net effect of the lockdown will need to be assessed over years as data becomes available and persistent effects emerge, immediate responses were detected across the world. Thus initial qualitative and quantitative data arising from this serendipitous global quasi-experimental perturbation highlights the dual role that humans play in threatening and protecting species and ecosystems. Pathways to favorably tilt this delicate balance include reducing impacts and increasing conservation effectiveness

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk