Surveillance of Flea-Borne Typhus in California, 2011-2019.

Flea-borne typhus (FBT), also referred to as murine typhus, is an acute febrile disease in humans caused by the bacteria Rickettsia typhi. Currently, cases of FBT are reported for public health surveillance purposes (i.e., to detect incidence and outbreaks) in a few U.S. states. In California, healthcare providers and testing laboratories are mandated to report to their respective local public health jurisdictions whenever R. typhi or antibodies reactive to R. typhi are detected in a patient, who then report cases to state health department. In this study, we characterize the epidemiology of flea-borne typhus cases in California from 2011 to 2019. A total of 881 cases were reported during this period, with most cases reported among residents of Los Angeles and Orange Counties (97%). Demographics, animal exposures, and clinical courses for case patients were summarized. Additionally, spatiotemporal cluster analyses pointed to five areas in southern California with persistent FBT transmission.

Humanizando el aislamiento durante la pandemia por COVID-19: Programa “Acortando Distancias” / Humanizing the isolation during the COVID-19 pandemic: The “Shortening Distances” Program

El virus SARS-CoV-2 llevó a la puesta en marcha de medidas de aislamiento extremas en pa-cientes hospitalizados, con la consecuente prohibición de visitas de familiares, y de la libre circulación del personal no sanitario dentro del hospital. La hospitalización como entrada a un lugar extraño y hostil, puede generar diferentes sensaciones en los pacientes, entre ellas temor e incertidumbre. El presente trabajo describe el desarrollo e implementación de un programa asistencial para responder la necesidad de comunicación entre pacientes y fami-liares, durante su ingreso hospitalario por COVID-19. El programa se estructuró en tres fases (pre-llamada, llamada/videollamada y post-llamada). Se realizaron 451 intervenciones. La mayor demanda de intervención para comunicación fue procedente de salas de hospitali-zación convencional con un 56,74% y un 43,25% de salas de críticos. El programa puso de manifiesto situaciones relacionadas con la hospitalización y el aisla-miento; rápidamente se activó un programa para humanizar el proceso asistencial durante la pandemia por COVID-19 y mantener el contacto de pacientes y familiares de utilizando las nuevas tecnologías de la comunicación. (AU)

The SARS-CoV-2 virus led to the implementation of extreme isolation measures in hospi-talized patients, with the consequent prohibition of family visits, and the f ree movement of non-health personnel within the hospital. Hospitalization as an entrance to a strange and hostile place could generate different emotions in patients, including fear and un-certainty. This article describes the development and implementation of a program to respond to the need for communication between patients and their families, during their hospitalization due to COVID-19. The program was structured in three phases (pre-call, call/video call and post-call). 451 interventions were carried out. The highest demand for intervention for communication came f rom conventional hospital wards with 56.74% and 43.25% f rom critical wards.The program revealed situations related to hospitalization and isolation; A program was quickly activated to humanize the care process during the COVID-19 pandemic and maintain contact with patients and families using new communication technologies. (AU)

INFOSA-DEM: programa dirigido a figuras cuidadoras de personas con demencia / INFOSA-DEM: a programme targeted to caregivers of persons with dementia

OBJETIVO: evaluar el impacto del Programa Informativo, Formativo y de Apoyo Social para figuras cuidadoras de personas con demencia (INFOSA-DEM), en relación al bienestar emocional, evaluando el tiempo de permanencia del efecto del programa a los tres y seis meses post-intervención. MÉTODO: se llevó a cabo un diseño cuasi-experimental, multicéntrico, no aleatorizado con grupo intervención (GI) y grupo control (GC). La asignación al GI y GC se realizó a través de muestreo no probabilístico, de asignación intencional, teniendo en cuenta la disponibilidad de las figuras cuidadoras para asistir a las sesiones del proprama diseñado. La recogida de datos fue efectuada por medio de entrevistas personales con la cuidadora o cuidador en el domicilio de la persona con demencia, antes de la intervención y a los tres y seis meses de seguimiento. Se recogieron variables de bienestar emocional y calidad de vida, entre otras. Se llevó a cabo análisis descriptivo y comparativo en los tres momentos de medida. RESULTADOS: participaron 160 figuras cuidadoras, 74 en GC y 86 en GI. A los tres meses se observó un efecto positivo en el bienestar emocional en el GI en comparación con un pequeño efecto negativo entre los controles. Teniendo en cuenta las tres visitas se comprobó que la mejora en dimensión salud relacionada con el bienestar emocional de los cuidadores del GI se mantuvo incluso después de seis meses, aunque las diferencias no fueron estadísticamente significativas. CONCLUSIÓN: los programas educativos dirigidos a cuidadores informales basados en terapias psicoeducativas y teorías cognitivo-conductuales parecen tener efectos positivos en la mejora del bienestar emocional de los cuidadores, y mejora la calidad del rol de la figura cuidadora

OBJECTIVE: to evaluate the impact of the Information, Training and Social Support programme for caregivers of persons with dementia (INFOSA-DEM) in terms of emotional wellbeing, evaluating the duration of the effect of the program at three and six months after the intervention. METHOD: a multicenter and non-randomized study was conducted, with quasi-experimental design, and with an Intervention Arm (IA) and a Control Arm (CA). Participants were allocated to IA or CA though non-probabilistic sample, with intentional allocation, taking into account the availability of the caregivers to attend the sessions of the programme designed. Data were collected through personal interviews with the caregiver at the home of the person with dementia, before the intervention and at three and six months of follow-up. Emotional wellbeing and quality of life variables were collected, among others. Descriptive and comparative analysis was conducted at the three points of measurement. RESULTS: the study included 160 caregivers, 74 in the CA and 86 in the IA. At three months, a positive effect was observed in the emotional wellbeing of the Intervention Arm, vs. a slight negative effect among Control participants. Taking into account all three visits, it was confirmed that the improvement in the dimension health associated with the emotional wellbeing of caregivers in the Intervention Arm was sustained even after six months; however, differences were not statistically significant. CONCLUSION: educational programs targeted to informal caregivers and based on psychoeducational therapies and cognitive-behavioural theories seem to have positive effects in terms of an improvement in the emotional wellbeing of caregivers, and there is an improvement in the quality of the caregiver role

Three Rotavirus Outbreaks in the Postvaccine Era - California, 2017.

Before the introduction of rotavirus vaccine in 2006, rotavirus was the most common cause of severe diarrhea among U.S. children (1). Currently, two rotavirus vaccines are licensed for use in the United States, both of which have demonstrated good field effectiveness (78%-89%) against moderate to severe rotavirus illness (2), and the use of these vaccines has substantially reduced the prevalence of rotavirus in the United States (3). However, the most recent national vaccine coverage estimates indicate lower full rotavirus vaccine-series completion (73%) compared with receipt of at least 3 doses of vaccines containing diphtheria, tetanus, and pertussis antigens (95%), given on a similar schedule to rotavirus vaccines (4). In the postvaccine era in the United States, rotavirus activity persists in a biennial pattern (3). This report describes three rotavirus outbreaks that occurred in California in 2017. One death was reported; however, the majority of cases were associated with mild to moderate illness, and illness occurred across the age spectrum as well as among vaccinated children. Rotavirus vaccines are designed to mimic the protective effects of natural infection and are most effective against severe rotavirus illness (2). Even in populations with high vaccination coverage, some rotavirus infections and mild to moderate illnesses will occur. Rotavirus vaccination should continue to be emphasized as the best means of reducing disease prevalence in the United States.

Remediation therapy in patients with alcohol use disorders and neurocognitive disorders: A Pilot Study. / Terapia de rehabilitación cognitiva en pacientes con trastorno por consumo de alcohol y trastorno neurocognitivo. Estudio piloto.

Many alcohol-dependent patients suffer from cognitive impairment of variable severity, manifested by alterations in retrograde and anterograde memory, visuospatial processing, cognitive abilities and attention, some of which are reversible. In this context, cognitive remediation therapies could significantly improve patients' performance; therefore, these are considered a valuable alternative. The aim of this study was to implement cognitive remediation therapy in patients with alcohol dependence and cognitive impairment and evaluate its viability and effectiveness. The participants were sixteen abstinent, alcohol-dependent patients (mean age of 59 years, 63% males) from the Addictive Behaviours Unit of a tertiary hospital. Over 6 months, a nurse led 1-hour weekly sessions (24 sessions in total) during which exercises for improving functional, social and cognitive performance were completed. Patients were assessed at baseline, at the end of the study and 6 months later, using the Mini-Mental State Examination (MMSE) and the Memory Alteration Test (M@T). Their respective scores were 26.4 (SD 3.16), 29 (SD 1.67) and 27 (SD 3.1) for the MMSE and 38.7 (SD 6.81), 45.7 (SD 5.6) and 41.1 (SD 7.86) for the M@T. Changes were assessed with both Friedman and Wilcoxon signed-rank tests, with mostly statistically significant differences (p < 0.05). Assistance and satisfaction were high. Therefore, the therapy was viable, widely accepted and effective.

El deterioro cognitivo es común en los pacientes alcohólicos. Éste se manifiesta por alteraciones en la memoria anterógrada y retrógrada, el procesamiento visual-espacial, y en las habilidades cognitivas y la atención, siendo algunas reversibles. Las terapias de rehabilitación cognitiva podrían mejorar el rendimiento de los pacientes, siendo una alternativa terapéutica de interés. El objetivo de este estudio piloto fue evaluar la implementación, viabilidad y efectividad de la terapia de rehabilitación cognitiva en pacientes con dependencia al alcohol y deterioro cognitivo asociado. Se trata de un estudio piloto con 16 pacientes (63% hombres, edad media de 59 años) seguidos en la Unidad de Conductas Adictivas de un hospital de tercer nivel. Siendo la abstinencia un requisito para la inclusión, durante 6 meses una enfermera realizó sesiones semanales de una hora (24 sesiones), realizándose ejercicios de psico-estimulación para la mejora del rendimiento cognitivo, funcional y social. Se evaluó a los pacientes al inicio, al final y pasados 6 meses, mediante las escalas MMSE (test Mini-mental de Lobo) y T@M (test de Alteración de Memoria). Sus puntuaciones medias respectivas fueron 26.4 (DE 3,16), 29 (DE 1,67) y 27 (DE 3,1) para MMSE y 38,7 (DE 6,81), 45,7 (DE 5,6) y 41,1 (DE 7,86) para T@M. Los datos se analizaron mediante la prueba de Friedman y se comparon los distintos periodos temporales mediante la prueba de rangos con signo de Wilcoxon, siendo la mayoría de comparaciones significativas (p < 0,05). La asistencia y la satisfacción fueron elevadas. Así pues, la terapia fue viable, ampliamente aceptada y mostró ser efectiva.

Terapia de rehabilitación cognitiva en pacientes con trastorno por consumo de alcohol y trastorno neurocognitivo. Estudio piloto / Remediation therapy in patients with alcohol use disorders and neurocognitive disorders: A Pilot Study

El deterioro cognitivo es común en los pacientes alcohólicos. Éste se manifiesta por alteraciones en la memoria anterógrada y retrógrada, el procesamiento visual-espacial, y en las habilidades cognitivas y la atención, siendo algunas reversibles. Las terapias de rehabilitación cognitiva podrían mejorar el rendimiento de los pacientes, siendo una alternativa terapéutica de interés. El objetivo de este estudio piloto fue evaluar la implementación, viabilidad y efectividad de la terapia de rehabilitación cognitiva en pacientes con dependencia al alcohol y deterioro cognitivo asociado. Se trata de un estudio piloto con 16 pacientes (63% hombres, edad media de 59 años) seguidos en la Unidad de Conductas Adictivas de un hospital de tercer nivel. Siendo la abstinencia un requisito para la inclusión, durante 6 meses una enfermera realizó sesiones semanales de una hora (24 sesiones), realizándose ejercicios de psico-estimulación para la mejora del rendimiento cognitivo, funcional y social. Se evaluó a los pacientes al inicio, al final y pasados 6 meses, mediante las escalas MMSE (test Mini-mental de Lobo) y T@M (test de Alteración de Memoria). Sus puntuaciones medias respectivas fueron 26.4 (DE 3,16), 29 (DE 1,67) y 27 (DE 3,1) para MMSE y 38,7 (DE 6,81), 45,7 (DE 5,6) y 41,1 (DE 7,86) para T@M. Los datos se analizaron mediante la prueba de Friedman y se comparon los distintos periodos temporales mediante la prueba de rangos con signo de Wilcoxon, siendo la mayoría de comparaciones significativas (p < 0,05). La asistencia y la satisfacción fueron elevadas. Así pues, la terapia fue viable, ampliamente aceptada y mostró ser efectiva

Many alcohol-dependent patients suffer from cognitive impairment of variable severity, manifested by alterations in retrograde and anterograde memory, visuospatial processing, cognitive abilities and attention, some of which are reversible. In this context, cognitive remediation therapies could significantly improve patients' performance; therefore, these are considered a valuable alternative. The aim of this study was to implement cognitive remediation therapy in patients with alcohol dependence and cognitive impairment and evaluate its viability and effectiveness. The participants were sixteen abstinent, alcohol-dependent patients (mean age of 59 years, 63% males) from the Addictive Behaviours Unit of a tertiary hospital. Over 6 months, a nurse led 1-hour weekly sessions (24 sessions in total) during which exercises for improving functional, social and cognitive performance were completed. Patients were assessed at baseline, at the end of the study and 6 months later, using the Mini-Mental State Examination (MMSE) and the Memory Alteration Test (M@T). Their respective scores were 26.4 (SD 3.16), 29 (SD 1.67) and 27 (SD 3.1) for the MMSE and 38.7 (SD 6.81), 45.7 (SD 5.6) and 41.1 (SD 7.86) for the M@T. Changes were assessed with both Friedman and Wilcoxon signed-rank tests, with mostly statistically significant differences (p < 0.05). Assistance and satisfaction were high. Therefore, the therapy was viable, widely accepted and effective

Effective Strategy for Evaluating Tactile Enrichment Devices for Singly Caged Macaques.

Since the mandate for providing environmental enrichment for nonhuman primates was included in the Animal Welfare Act, numerous articles and suggestions have been put forth covering tactile devices and creative cage arrangements. For larger primate facilities and research programs environmental enrichment evaluation is usually accomplished by enrichment technicians or behaviorists. However, for the smaller facilities or programs, the ability to formulate and document an enrichment program can be very difficult due to budget or personnel constraints. We present a simple, yet effective, tactile device scoring system used with singly caged macaques indicating that creating and documenting enrichment ideas can be accomplished without a large personnel and budgetary commitment. We believe this strategy will help programs meet the regulatory requirements with relative ease.