ABSTRACT
Las enfermedades raras (ER) constituyen un verdadero problema de salud pública tanto en atención primaria como en atención hospitalaria. Revisamos someramente los mecanismos generadores de hipótesis diagnósticas basándonos en metáforas como «el ruido de cascos no siempre significa que vengan caballos, a veces son cebras las que se acercan» o aquella otra del anticuario que reconoce una pieza de museo paseando por «El Rastro». Los «Blitzdiagnosen» (diagnósticos relámpago) de Skoda son un antecedente histórico importante. Es muy sensata la aspiración de la profesora Greenhalgh de unir la medicina basada en la evidencia y el diagnóstico intuitivo. Exponemos también unas reglas de epidemiología clínica que ayudarán al médico de familia/pediatra a afianzarse en este campo. La formación ha de ser específica en sus contenidos y diferenciada para profesionales de hospital y de centros de salud. Es necesario el conocimiento de los signos patognomónicos clásicos. Los mapas conceptuales son útiles para el diagnóstico de ER en atención primaria(AU)
Rare diseases are a real public health problem for hospitals and also for primary care. We describe some metaphor-based diagnosis procedures, such as: "When you hear hoof beats don't always think horses, sometimes they could be zebras", or that one about the antiquarian who recognised a museum masterpiece while walking in the Rastro (Madrid). The "lightning diagnoses" by Skoda are an important historic record.T. Greenhalgh has tried to cover the gap between evidence based medicine and the intuitive diagnosis. We point out some clinical epidemiology rules in order to improve their early detection by family practitioners and paediatricians. In our opinion, the training in the diagnosis of rare diseases has to be different for primary care level and for hospital doctors. Concept maps are useful for diagnosis in primary care clinics(AU)
Subject(s)
Humans , Rare Diseases/diagnosis , Epidemiologic Methods , Diagnostic Techniques and Procedures/trends , Rare Diseases/epidemiology , Primary Health Care/methodsABSTRACT
Rare diseases are a real public health problem for hospitals and also for primary care. We describe some metaphor-based diagnosis procedures, such as: "When you hear hoof beats don't always think horses, sometimes they could be zebras", or that one about the antiquarian who recognised a museum masterpiece while walking in the Rastro (Madrid). The "lightning diagnoses" by Skoda are an important historic record. T. Greenhalgh has tried to cover the gap between evidence based medicine and the intuitive diagnosis. We point out some clinical epidemiology rules in order to improve their early detection by family practitioners and paediatricians. In our opinion, the training in the diagnosis of rare diseases has to be different for primary care level and for hospital doctors. Concept maps are useful for diagnosis in primary care clinics.
Subject(s)
Rare Diseases/diagnosis , Humans , Mental ProcessesABSTRACT
In April 2009, in response to the WHO's alert due to the existence of human infection cases with a new AH1N1 influenza virus, known as swine flu, Andalusian Health Authorities trigger an specific action plan. The surveillance actions developped provided us with appropriate clinical, epidemiological and virological characteristics of the disease. During the first few days, contingency plans were set up based on epidemiological surveillance and outbreak control measures were adopted through early alert and rapid response systems. After phase 6 was declared, influenza sentinel and severe cases surveillance were used in order to plan healthcare services, to reduce transmission and to identify and protect the most vulnerable population groups. Behaviour of pandemic influenza in Andalusia was similar to that observed in the rest of the world. Atack rate was similar to a seasonal flu and the peak was reached at the 46th/2009 week. Most of them were mild cases and affected particularly to young people. The average age of hospitalised patients was 32. Prior pulmonary disease, smoking and morbid obesity (BMI > 40) were the most common pathologies and risk factors in severe cases. An impact scenario of pandemic wave in Andalusia, with an expected attack rate from 2 to 5%, was prepared considering watt observed in the southern hemisphere. Characteristics of the epidemic concerning its extent, severity and mortality rate were adjusted to this scenario.
Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics , Adolescent , Adult , Aged , Child , Child, Preschool , Humans , Infant , Middle Aged , Population Surveillance , Spain/epidemiology , Time Factors , Young AdultABSTRACT
AIM: To describe an outbreak with symptoms of respiratory tract irritation reported in a village located on the Almerian coast in August 2006, as well as the etiological research performed. METHODS: We performed a descriptive case-control study. The village was divided into three areas (from 1 to 3) according to the distance from the sea. Symptomatology was subjectively assessed on an ascending severity scale (from 1 to 3). Attack rates (AR) were estimated. To correlate symptom severity by areas and type of exposure, odds ratios (OR) with 95% confidence intervals were estimated. The chi-square test and Fisher's exact test were used. Environmental research was performed. RESULTS: Fifty-seven cases and 26 controls were surveyed. An AR of 69% was estimated. The most frequent symptom was sneezing (87.7%). Residents in area 1 had a higher risk of more severe symptoms than those in area 3 (OR = 46.7; 95%CI: 4.7-2,067.4). Residents who reported having spent more time outside had a higher risk of more severe symptoms (OR = 12.2; 95%CI: 1.1-615.1). A concentration of dinoflagellates Ostreopsis of 1200 cells/l was determined in sea water. CONCLUSIONS: An outbreak with respiratory symptoms and with differing severity depending on the distance of housing from the sea occurred. According to the environmental and epidemiological research, the symptoms were probably related to the presence of Ostreopsis toxic microalgae.
Subject(s)
Dinoflagellida , Disease Outbreaks , Marine Toxins/poisoning , Respiration Disorders/chemically induced , Respiration Disorders/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Case-Control Studies , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Spain , Young AdultABSTRACT
Objetivos: Describir un brote con clínica de irritación de lasvías respiratorias, notificado en una localidad de la costa almerienseen agosto de 2006, así como la investigación etiológicarealizada.Métodos: Estudio descriptivo y de casos y controles. Se dividióla localidad en 3 zonas según su mayor o menor cercaníaal mar (de 1 a 3). La sintomatología fue valorada subjetivamentede menor a mayor gravedad (1 a 3). Se estimaronlas tasas de ataque (TA). Para relacionar la gravedad de lossíntomas por zonas y el tipo de exposición se calcularon lasodds ratio (OR) y sus intervalos de confianza del 95% (IC95%).También se utilizó la prueba de la 2 y el test exacto de Fisher.Se realizó una investigación ambiental.Resultados: Se encuestó a 57 casos y 26 controles. Se estimóuna TA del 69%. El síntoma más frecuente fue el estornudo(87,7%). Los individuos de la zona 1 presentaron mayorriesgo de padecer sintomatología de más gravedad que losde la zona 3 (OR = 46,7; IC95%: 4,7-2.067,4). Los que indicaronuna mayor permanencia fuera de la vivienda tuvieronmayor riesgo de enfermar (OR = 12,2; IC95%: 1,1-615,1). Enagua de mar se detectaron 1.200 células/l de dinoflageladosOstreopsis.Conclusiones: Se trata de un brote con sintomatología respiratoria,con distinto grado de afectación según la cercaníaal mar de la vivienda. Según la investigación epidemiológicay ambiental, lo más probable es que se haya debido a la presenciade microalgas tóxicas Ostreopsis(AU)
Aim: To describe an outbreak with symptoms of respiratorytract irritation reported in a village located on the Almerian coastin August 2006, as well as the etiological research performed.Methods: We performed a descriptive case-control study. Thevillage was divided into three areas (from 1 to 3) accordingto the distance from the sea. Symptomatology was subjectivelyassessed on an ascending severity scale (from 1 to 3).Attack rates (AR) were estimated. To correlate symptom severityby areas and type of exposure, odds ratios (OR) with95% confidence intervals were estimated. The chi-square testand Fishers exact test were used. Environmental research wasperformed.Results: Fifty-seven cases and 26 controls were surveyed.An AR of 69% was estimated. The most frequent symptomwas sneezing (87.7%). Residents in area 1 had a higher riskof more severe symptoms than those in area 3 (OR = 46.7;95%CI: 4.7-2,067.4). Residents who reported having spentmore time outside had a higher risk of more severe symptoms(OR = 12.2; 95%CI: 1.1-615.1). A concentration of dinoflagellatesOstreopsis of 1200 cells/l was determined in sea water.Conclusions: An outbreak with respiratory symptoms and withdiffering severity depending on the distance of housing fromthe sea occurred. According to the environmental and epidemiologicalresearch, the symptoms were probably related tothe presence of Ostreopsis toxic microalgae(AU)
