Etiologija virusnih okužb dihal pri oskrbovancih in zaposlenih v domu starejših občanov

Gorišek Miksić, Nina

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Naslov:	Etiologija virusnih okužb dihal pri oskrbovancih in zaposlenih v domu starejših občanov
Avtorji:	ID Gorišek Miksić, Nina (Avtor) ID Strle, Franc (Mentor) Več o mentorju... ID Petrovec, MIroslav (Komentor)
Datoteke:	DOK_Gorisek_Miksic_Nina_2016.pdf (3,15 MB) MD5: 60C58DB14AF0809483232CC8DC894A74
Jezik:	Slovenski jezik
Vrsta gradiva:	Doktorsko delo/naloga
Organizacija:	MF - Medicinska fakulteta
Opis:	S staranjem prebivalstva se veča število oseb s kroničnimi obolenji, upadom mentalnih in motoričnih funkcij ter posledično potrebo po institucionaliziranem varstvu. V Sloveniji prebiva v domovih starejših občanov (DSO) okoli 5% prebivalcev. Zaradi starostnega upada imunskih zmožnosti, pridruženih obolenj in bivalnih posebnosti (bivanja večjega ranljivih števila oseb v skupnih prostorih) predstavljajo okužbe v DSO poseben problem. Okužbe dihal (AOD) so med najpogostejšimi okužbami v DSO, predstavljajo tretjino vseh okužb v DSO, povezane so z največjim številom bolnišničnih obravnav in tudi z najvišjo smrtnostjo. Vodijo lahko v trajni upad fizičnih zmogljivosti starostnikov. Četudi pogostost virusnih AOD s starostjo pada, lahko te potekajo s težjim kliničnim potekom - z znaki akutne okužbe spodnjih dihal (AOSD). Prepoznavanje AOD je lahko pri starostnikih v DSO, zaradi pogosto neznačilne klinične slike, težavno. Poznavanje virusne etiologije in incidence AOD v DSO je pomembno, saj omogoča smiselno na rtovanje ukrepov za zmanjšanje obolevnosti oskrbovancev. Bolniki in metode V 6-mesečno prospektivno raziskavo smo vključili 90 oskrbovancev DSO ter 42 zaposlenih v enem izmed DSO-jev v mariborski regiji. Opazovali smo pojav AOD v obdobju od 5.decembra 2011 do 31. maja 2012 pri oskrbovancih DSO in osebju. AOD smo definirali po McGeer-ovih kriterijih. AOD so dnevno prepoznavale naučene medicinske sestre in potrdila zdravnica ob viziti pri obolelih oskrbovancih. Pridobili smo osnovne podatke, podatke o pridruženih obolenjih ter o cepljenju proti gripi pri vseh sodelujočih v raziskavi. Ob začetku in zaključku raziskave smo vsem sodelujočim odvzeli bris nosnega dela žrela za mikrobiološke preiskave, prav tako tudi ob vsaki epizodi AOD, kjer smo zabeležili tudi klinične simptome in znake obolenja. V brisu nosnega dela žrela smo s pomočjo molekularne preiskave določili prisotnost genoma virusov gripe A in B, parainfleunce 1-3, rinovirusov, respiratomega sincicijskega virusa, človeškega metapnevmovirusa, koronavirusov, adenovirusov, človeškega bokavirusa in enterovirusov. Prav tako smo v 6 mesečnem obdobju raziskave beležili tedensko število obiskovalcev v sobah sodelujočih oskrbovancev DSO. V statistični analizi smo uporabljali naslednje metode: 6-mesečno incidenčno stopnjo AOD, akutnih okužb zgornjih dihal (AOZD) in AOSD smo podali kot število AOD (oz. AOSD in AOZD) na 1000 oskrbnih dni; kategorične spremenljivke smo primerjali s pomočjo hi-kvadrat testa ali Fisherjevega eksaktnega testa; korelacijo med spremenljivkama smo preučili s pomočjo korelacijskega koeficienta Kendall τ; s pomočjo multivariantne Poissonove analize smo preučili vpliv različnih neodvisnih spremenljivk na incidenčno stopnjo AOD pri posameznem oskrbovancu DSO. Povezanost med številom obiskovalcev pri posameznih oskrbovancih in pojavom AOD pri le-teh smo preučevali s pomočjo Poissonove regresije. Kot statistično značilne smo upoštevali rezultate, pri katerih je bil p < 0,05. Rezultati V 6-mesečnem opazovalnem obdobju je bila incidenčna stopnja AOD 3,8/1000 oskrbnih dni pri oskrbovancih in 5,9/1000 oskrbnih pri zaposlenih, razlika je statistično pomembna. Starostniki so pogosteje obolevali z AOSD (73%), kot z AOZD (27%), med tem ko so zaposleni obolevali skoraj izključno za AOZD (97%). S pomočjo multivariantne Poissonove analize smo ugotovili, da nobena od vključenih neodvisnih spremenljivk (starost, cepilni status - cepljenje proti gripi, pomičnost in pridružena kronična obolenja (sladkorna bolezen, srčno-žilna, možgansko-žilna obolenja, kronična pljučna obolenja, demenca) ne vpliva na pojav AOD pri oskrbovancih, z izjemo demence. Dementni bolniki so kar 2,5 krat redkeje obolevali z AOD. Prav tako število obiskovalcev ni vplivalo na pojav AOD pri oskrbovancih. Ugotovili smo korelacijo med tedensko incidenčno stopnjo AOD pri zaposlenih in oskrbovancih. Viruse smo dokazali pri 60,7 % epizod AOD pri oskrbovancih DSO in pri 47,7 % epizod AOD pri zaposlenih. Pri os
Ključne besede:	akutna okužba dihal, dom starejših občanov, respiratorni virusi, gripa, incidenčna stopnja
Kraj izida:	Maribor
Leto izida:	2016
PID:	20.500.12556/DKUM-53872
COBISS.SI-ID:	283337472
NUK URN:	URN:SI:UM:DK:HJ20K9IQ
Datum objave v DKUM:	10.02.2016
Število ogledov:	2792
Število prenosov:	431
Metapodatki:
Področja:	MF
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Sekundarni jezik

Jezik:	Angleški jezik
Naslov:	Acute viral respiratory infections among nursing home residents and members of staff
Opis:	The life expectancy has been increasing significantly in the last decades. People aged over 65 represented 17% of population of Slovenia and 5% of the elderly (about 19,500) resided in 96 long-term care facilities and nursing homes (NH). Ageing parallels with a decline of many functions and is accompanied by the increasing frequency of chronic illnesses, impaired mobility and the need for assistance in daily living. The inability to take care of oneself is a rather common reason for a decision to become a NH resident. Acute respiratory infections (ARI) are common among NH residents, representing about 1/3 of all infections, and are the most frequent reason for hospital admittance, and a significant cause of mortality. Nevertheless, the knowledge of infections with respiratory viruses in NH residents is incomplete. More information is available for the epidemic rather than for sporadic type of infections. Due to daily visitors and NH staff viral infections from the community can be introduced into the NH and affect residents with chronic illnesses, impaired consciousness, impaired mobility etc. In addition, scarce clinical symptoms combined with limited diagnostic facilities hamper the recognition of infections and consequently lead to delayed introduction of preventive measures. Participants and methods We accomplished a 6-months prospective surveillance study from 5 December 2011 to 31 May 2012 in a part of 208-bed three-floor NH in north-eastern Slovenia that encompassed 90 (43.3%) residents (i.e., 90/97 residents living in one of the sections of the NH), and 42/53 (79.2%) nursing care workers, who provided signed informed consent for participation. Nasopharyngeal swabs for virology studies were collected from all participants at the time of enrolment (5 December 2012) and at the end of the study (31 May 2012), as well as from each participant who developed ARI within the period of the study. Cases of ARI were defined according to McGeer criteria for infection surveillance in long-term care facilities. During the 6-months study period the detection of ARI was carried out daily by trained study nurses and the diagnosis was confirmed by a physician who conducted a physical examination in case of illness. Daily number of visitors (adults, schoolchildren and pre-school children, respectively) in each participant’s room was recorded during study period. Real-time PCR and real-time RT-PCR were performed detecting influenza A/B, adenovirus, parainfluenza viruses 1, 2 and 3, human rhinoviruses, respiratory syncytial virus, human metapneumovirus, human coronaviruses, human bocavirus in nasopharyngeal swab samples. Results were statistically analysed using chi-square test, Fisher exact test. Correlations were expressed using the Kendall Tau coefficient. Multivariate Poisson regression model was used for estimating the influence of independent variables on ARI incidence-rate. Results During the 6-months observational period 100 episodes of ARI were observed, 56 among residents and 44 among staff. The calculated incidence rate was 3.8 ARI/ 1000 persons-days for residents and 5.9 ARI/ 1000 persons-days for staff members. The weekly incidence rate of ARI in NH residents correlated with the weekly ARI incidence rate in NH staff. Using a multivariate Poisson model for the number of ARI occurrences, including age, influenza vaccination, mobility of residents and chronic underlying diseases as explanatory variables and controlling the length of exposure, we estimated that the relative incidence-rate ratio of ARI for patients without dementia was 2.5 times larger than that for patients with dementia; the other covariates were not statistically significantly associated with the number of ARI episodes. Respiratory viruses were detected in 55 out of 100 ARI episodes (55%): in 34/56 (60.7%) episodes of ARI in residents and in 21/44 (47.7%) cases of ARI in staff. Of 56 NH residents with ARI 41 (73.5%) fulfilled criteria for lower respiratory tract
Ključne besede:	acute respiratory infection, nursing home, respiratory viruses, influenza, incidence rate

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