Innovative Approaches to Improve Public Health Practice in the Eastern Mediterranean Region: Findings From the Sixth Eastern Mediterranean Public Health Network Regional Conference.

Public health professionals in the Eastern Mediterranean region (EMR) have limited access to continuing education, including workshops and conferences in public health. Held under the theme Innovative Approaches: Adapting to the Current EMR Context, the Eastern Mediterranean Public Health Network (EMPHNET) organized and conducted the Sixth EMPHNET Regional Conference from March 26 to 29, 2018. This paper summarizes the key activities including workshops, roundtable discussions, oral and poster presentations, keynote speeches, and side meetings. Before the opening, 5 preconference workshops were held: "Field Epidemiology Training Program (FETP) Accreditation," "Innovative Public Health Surveillance," "Human and Animal Brucellosis," "Rapid Response Teams," and "Polio Transition and Routine Immunization." The conference hosted 6 roundtable discussions: "Consolidation of the FETP Network," "One Health to Achieve Global Health Security," "Polio Eradication Efforts and Transition Planning for Measles Elimination," "Mobile Data Collection and Other Innovative Tools to Enhance Decision Making," "Confronting Candida auris: An Emerging Multidrug-resistant Global Pathogen," and "Functioning and Sustainable Country Public Health Emergency Response Operation Framework." One of the conference's key objectives was to provide a space for FETP residents, graduates, and public health professionals to showcase achievements. A total of 421 abstracts were submitted and after professional review, 34.9% (147/421) were accepted (111 for oral presentations and 36 for poster presentations) and published by Iproceeding. The conference met the primary objectives of showcasing the public health accomplishments and contributions of the EMR, encouraging the exchange of ideas and coordination among stakeholders, and engaging cross-sectoral workforce in producing recommendations for approaching regional and global health concerns. Moreover, the conference presented a unique opportunity for FETPs and other public health professionals from the Mediterranean region to present their significant scientific work and also facilitated networking among professionals. EMPHNET strives to continue to present similar exchange opportunities for public health professionals in the region.

Evaluation of the EpiCore outbreak verification system.

OBJECTIVE: To describe a crowdsourced disease surveillance project (EpiCore) and evaluate its usefulness in obtaining information regarding potential disease outbreaks. METHODS: Volunteer human, animal and environmental health professionals from around the world were recruited to EpiCore and trained to provide early verification of health threat alerts in their geographical region via a secure, easy-to-use, online platform. Experts in the area of emerging infectious diseases sent requests for information on unverified health threats to these volunteers, who used local knowledge and expertise to respond to requests. Experts reviewed and summarized the responses and rapidly disseminated important information to the global health community through the existing event-based disease surveillance network, ProMED. FINDINGS: From March 2016 to September 2017, 2068 EpiCore volunteers from 142 countries were trained in methods of informal disease surveillance and use of the EpiCore online platform. These volunteers provided 790 individual responses to 759 requests for information addressing unverified health threats in 112 countries; 361 (45%) responses were considered to be useful. Most responses were received within hours of the requests. The responses led to 194 ProMED posts, of which 99 (51%) supported verification of an outbreak, were published on ProMED and sent to over 87 000 subscribers. CONCLUSION: There is widespread willingness among health professionals around the world to voluntarily assist efforts to verify and provide supporting information on unconfirmed health threats in their region. By linking this member network of health experts through a secure online reporting platform, EpiCore enables faster global outbreak detection and reporting.

Key Ethical Issues Discussed at CDC-Sponsored International, Regional Meetings to Explore Cultural Perspectives and Contexts on Pandemic Influenza Preparedness and Response.

BACKGROUND: Recognizing the importance of having a broad exploration of how cultural perspectives may shape thinking about ethical considerations, the Centers for Disease Control and Prevention (CDC) funded four regional meetings in Africa, Asia, Latin America, and the Eastern Mediterranean to explore these perspectives relevant to pandemic influenza preparedness and response. The meetings were attended by 168 health professionals, scientists, academics, ethicists, religious leaders, and other community members representing 40 countries in these regions. METHODS: We reviewed the meeting reports, notes and stories and mapped outcomes to the key ethical challenges for pandemic influenza response described in the World Health Organization's (WHO's) guidance, Ethical Considerations in Developing a Public Health Response to Pandemic Influenza: transparency and public engagement, allocation of resources, social distancing, obligations to and of healthcare workers, and international collaboration. RESULTS: The important role of transparency and public engagement were widely accepted among participants. However, there was general agreement that no "one size fits all" approach to allocating resources can address the variety of economic, cultural and other contextual factors that must be taken into account. The importance of social distancing as a tool to limit disease transmission was also recognized, but the difficulties associated with this measure were acknowledged. There was agreement that healthcare workers often have competing obligations and that government has a responsibility to assist healthcare workers in doing their job by providing appropriate training and equipment. Finally, there was agreement about the importance of international collaboration for combating global health threats. CONCLUSION: Although some cultural differences in the values that frame pandemic preparedness and response efforts were observed, participants generally agreed on the key ethical principles discussed in the WHO's guidance. Most significantly the input gathered from these regional meetings pointed to the important role that procedural ethics can play in bringing people and countries together to respond to the shared health threat posed by a pandemic influenza despite the existence of cultural differences.

[Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007]. / Vigilancia de la tuberculosis en las Islas Baleares y caracterización de los casos infradeclarados entre los años 2005 y 2007.

We performed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance System in the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported cases in sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosis was approximately 20%. Significant factors in multivariate analysis were social marginality (consisting of alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR: 3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengthening notification by hospital specialists through the use of hospital electronic records. Our findings show that the information obtained from the primary care computerized history is helpful in improving the epidemiological surveillance of tuberculosis.

Vigilancia de la tuberculosis en las Islas Balearesy caracterización de los casos infradeclarados entre los a˜nos 2005 y 2007 / Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007

Estudio descriptivo de los casos de tuberculosis detectados por el Sistema de Vigilancia Epidemiológicaen Baleares, en el trienio de 2005 a 2007. El objetivo fue caracterizar los casos infradeclarados en términossociodemográficos y de su contacto con la atención primaria de salud. Globalmente, la infradeclaraciónde la tuberculosis se sitúa en torno al 20%. Las características que resultan significativas en el análisismultivariado son la marginalidad social (alcoholismo, usuarios de drogas por vía parenteral o indigencia)(odds ratio ajustada [ORa] : 2,6 [1,2-5,3]), el contacto con la atención primaria (ORa : 3,2 [1,4-7,1]) y latuberculosis extrapulmonar (ORa : 5,5 [3,2-9,6]). Se recomienda reforzar la notificación de los especialistashospitalarios mediante la adecuación informática de la historia clínica hospitalaria, y se observa quela información obtenida desde la informatización de la historia en atención primaria resulta de utilidadpara mejorar la vigilancia epidemiológica de la tuberculosis (AU)

Weperformed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance Systemin the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported casesin sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosiswas approximately 20%. Significant factors in multivariate analysis were social marginality (consistingof alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR:3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengtheningnotification by hospital specialists through the use of hospital electronic records. Our findings showthat the information obtained from the primary care computerized history is helpful in improving theepidemiological surveillance of tuberculosis (AU)

[Detection of a hepatitis A outbreak in Ceuta (Spain) through a microbiological surveillance system]. / Detección de un brote de hepatitis A en Ceuta a través del sistema de información microbiológica.

BACKGROUND: The Public Health Department of Ceuta informed the Spanish National Epidemiology Center of an increase in hepatitis A cases detected by the microbiological surveillance system. We conducted a study to confirm the outbreak and to initiate control measures. METHODS: A descriptive study and a case-control study were performed. A standardized telephone questionnaire was used to collect information on demographic characteristics, symptoms, and risk factors. RESULTS: Nineteen cases of hepatitis A were identified. Univariate analysis revealed an association between infection and eating raw vegetables (OR = 9.3; 95%CI: 1.5-57.6) or razor-shell (OR = 55; 95%CI: 4.3-703.4). In the logistic regression model, only razor-shell consumption remained a significant risk factor (OR = 36.1; 95%CI: 2.45-530.4). None of the 3 inspected restaurants had public health authorization or records of food purchase histories. CONCLUSIONS: We confirmed a hepatitis A outbreak associated with consumption of contaminated razor-shell in homes and restaurants. The microbiological surveillance system was the main means of detecting this outbreak.

Detección de un brote de hepatitis A en Ceuta a través del sistema de información microbiológica / Detection of a hepatitis A outbreak in Ceuta [Spain] through a microbiological surveillance system

Antecedentes: El Servicio de Vigilancia Epidemiológica deCeuta comunicó al Centro Nacional de Epidemiología un aumento de casos de hepatitis A, detectado por el sistema de información microbiológica (SIM). Se investigó la posible existencia de un brote y se instauraron las medidas de control oportunas.Métodos: Se realizó un estudio descriptivo y otro de casos y controles. La información sociodemográfica, clínica y sobre factores de riesgo se obtuvo mediante un cuestionario cumplimentado por vía telefónica.Resultados: Se identificaron 19 casos. En el estudio univariante se encontró una asociación entre enfermar y el consumo de verduras crudas (odds ratio [OR] = 9,3; intervalo de confianza [IC] del 95%: 1,5-57,6) y de navajas (OR = 55; IC del 95%: 4,3-703,4). En el análisis multivariante sólo se mantuvo la asociación con el consumo de navajas (OR = 36,1; IC del 95%: 2,4-530,4). Ninguno de los 3 restaurantes inspeccionadosdisponía de control de facturas ni albaranes.Conclusiones: Se confirmó un brote de hepatitis A asociado al consumo de navajas en domicilios y restaurantes. El SIM fue la herramienta fundamental para su detección

Background: The Public Health Department of Ceuta informed the Spanish National Epidemiology Center of an increase in hepatitis A cases detected by the microbiological surveillance system. We conducted a study to confirm the outbreak and to initiate control measures.Methods: A descriptive study and a case-control study were performed. A standardized telephone questionnaire was used to collect information on demographic characteristics, symptoms, and risk factors.Results: Nineteen cases of hepatitis A were identified. Univariate analysis revealed an association between infection and eating raw vegetables (OR = 9.3; 95%CI: 1.5-57.6) or razorshell (OR = 55; 95%CI: 4.3-703.4). In the logistic regression model, only razor-shell consumption remained a significant risk factor (OR = 36.1; 95%CI: 2.45-530.4). None of the 3 inspectedrestaurants had public health authorization or records of food purchase histories.Conclusions: We confirmed a hepatitis A outbreak associated with consumption of contaminated razor-shell in homes and restaurants. The microbiological surveillance system was the main means of detecting this outbreak

[The Spanish Epidemological Surveillance Services webpages as an information dissemination tool in 2006]. / Las páginas web de los servicios de vigilancia epidemiológica como instrumento de difusión de la información en 2006.

BACKGROUND: Taking into account that one of the Spanish National Epidemological Surveillance Network's missions is that of providing information for taking action, it is then absolutely essential that its information be disseminated in a timely manner. This study is aimed at ascertaining what information is being published on the National Epidemology Center webpages and on those of the Municipal and Autonomous Community Epidemiological Surveillance Services and assessing the timeliness of the information published. METHODS: A review was conducted of the contents of the Surveillance Services webpages of April 3 - May 5, 2006. The information was considered to be "timely" if the information read on the webpage during Week 17 provided the epidemological week 15 bulletin. RESULTS: A total of ninety percent (90%) of the Services have a webpage, fifty percent (50%) of which provide the listing of the compulsorily reportable disease and the case definition, a total of 44% having protocols for taking action and 11% having dynamic tables. The epidemological bulletins can be accessed via eight-three percent (83%) of the pages, six percent of which are updated in a timely manner. A total of seventy-seven (77%) of the pages provide weekly influenza information, seventy-eight percent (78%) in week 15. A total seventy-two percent (72%) have a search system as well as links to other Surveillance Services. CONCLUSIONS: The information provided by the Epidemological Surveillance Services has been found to vary to a certain degree. Influenza information is being disseminated in a timely manner, this however not being the case for the Epidemiological Bulletin.

Las páginas web de los servicios de vigilancia epidemiológica como instrumento de difusión de la información en 2006 / The spanish epidemological surveillance services webpages as an information dissemination tool in 2006

Fundamento: Teniendo en cuenta que una de las misiones de laRed Nacional de Vigilancia Epidemiológica es aportar informaciónpara la acción, se hace imprescindible su difusión en tiempo oportuno.El objetivo de este trabajo es conocer el contenido de las páginasweb del Centro Nacional de Epidemiología y de los Servicios deVigilancia Epidemiológica de las Ciudades y Comunidades Autónomasy evaluar su oportunidad en el tiempo.Métodos: Se realizó una revisión del contenido de las páginasweb de los Servicios de Vigilancia durante el período del 3 de abril al5 de mayo de 2006. La difusión de la información se consideró «entiempo oportuno» si la consulta durante la semana 17 ofrecía el boletínde la semana epidemiológica 15.Resultados: El 90% de los Servicios de Vigilancia epidemiológicatiene página web. El 50% ofrece el listado de las enfermedadesde declaración obligatoria y la definición de caso. Protocolos deactuación el 44% y tablas dinámicas el 11%. En el 83% de las páginasse tiene acceso a los boletines epidemiológicos, el 6% está actualizadoen tiempo oportuno. El 77% de las páginas ofrece la informaciónsemanal de la gripe y de ellas el 78% en la semana 15. El 72%tiene un sistema de búsqueda, así como enlaces con otros Serviciosde Vigilancia.Conclusiones: La información difundida por los Servicios deVigilancia Epidemiológica a través de las páginas web es variable.Es oportuna la difusión de la información de la gripe, no así para elBoletín Epidemiológico(AU)

Background: Taking into account that one of the SpanishNational Epidemological Surveillance Network's missions is thatof providing information for taking action, it is then absolutelyessential that its information be disseminated in a timely manner.This study is aimed at ascertaining what information is beingpublished on the National Epidemology Center webpages and onthose of the Municipal and Autonomous Community EpidemiologicalSurveillance Services and assessing the timeliness of theinformation published.Methods: A review was conducted of the contents of the SurveillanceServices webpages of April 3 - May 5, 2006. The informationwas considered to be "timely" if the information read on the webpageduring Week 17 provided the epidemological week 15 bulletin.Results: A total of ninety percent (90%) of the Services have awebpage, fifty percent (50%) of which provide the listing of thecompulsorily reportable disease and the case definition, a total of44% having protocols for taking action and 11% having dynamictables. The epidemological bulletins can be accessed via eight-threepercent (83%) of the pages, six percent of which are updated in atimely manner. A total of seventy-seven (77%) of the pages provideweekly influenza information, seventy-eight percent (78%) in week15. A total seventy-two percent (72%) have a search system as wellas links to other Surveillance Services.Conclusions: The information provided by the EpidemologicalSurveillance Services has been found to vary to a certain degree.Influenza information is being disseminated in a timely manner, thishowever not being the case for the Epidemiological Bulletin(AU)

Evaluación de un sistema de devolución de información en Salud Pública: Experiencia en el Área 2 de la Comunidad de Madrid / Evaluation of a system to feedback information on public health: the experience of Area 2 of the Community of Madrid

Fundamento: En enero del año 2000 el Servicio de Salud Pública del Área Sanitaria 2 de la Comunidad de Madrid, inició la edición semanal de una Hoja de Información en Salud Pública (HISP) dirigida a los profesionales de la salud del Área. El presente trabajo tiene como objetivo estimar el conocimiento, aceptabilidad, utilidad y difusión de la HISP durante el año 2000. Métodos: Se realizó una encuesta por correo a una muestra de profesionales sanitarios del Área 2. Tras un análisis descriptivo se investigó, mediante análisis multivariante, qué factores explicaban que un profesional del Área conociera la HISP. Se utilizó el programa Epi Info 2000. Resultados: La tasa de respuesta fue del 79,7 por ciento. El apartado mejor valorado fue el de alertas en salud pública. Se encontró una asociación entre conocer la HISP y conocer el Boletín Epidemiológico de la Comunidad de Madrid (OR=9,3, IC 95 por ciento=2,9-29,5), y entre ser médico y recibir información de salud pública (OR=4,3, IC:1,5-12,6, p=0,005). Conclusiones: La HISP ha tenido buena aceptación entre los profesionales sanitarios del Área 2 que valoran más los contenidos relacionados con situaciones estresantes. Es necesario mejorar la difusión de la información de salud pública entre los profesionales de enfermería. (AU)

Background: In January 2000 the Public Health Service of Area 2, in the Region of Madrid, began to publish a weekly sheet on epidemiological and public health information (HISP) addressed to health professionals working in the Area. The aim of the present study was to estimate to how extend the "HISP" was known among health professionals of Area 2, and also to estimate the suitability and usefulness of its contents, during 2000. Methods: A postal survey was carried out among a random sample of professionals working in Area 2. A descriptive analysis of main variables was done, variables associated to the knowledge of the "HISP" were investigated. Epi Info 2000 program was used for the analysis. Results: The response rate was 79,7%. The best evaluated content was that related to epidemic outbreaks. An association between knowing the "HISP" and knowing the regional epidemiological bulletin (Boletín Epidemiológico de la Comunidad de Madrid) was found (OR=9,3, IC 95%=2,9-29,5), and also an association between knowing the "HISP" and being a physician (OR=4,3, IC: 1,5-12,6, p=0,005). Conclusions: The "HISP" has a good acceptance among health professionals of Area 2. They were more interested in contents related to stressful situations. It is necessary to improve the diffusion of information on public health among nursing professionals (AU)

[A study of whooping cough epidemic outbreak in Castellon, Spain]. / Estudio de un brote epidémico de tos ferina en Castellón.

BACKGROUND: Based on the report of several cases at one school, a study of an epidemic outbreak was started for the purpose of characterizing this outbreak from the person, place and time standpoint, calculating the effectiveness of the immunization and the concordance of the cases with the positive result of the serological study. METHODS: A "case" is defined as being that individual who has a cough fasting for two weeks. A study is made of the spread of the disease by means of the epidemic curve and the effectiveness of the pertussis vaccine. The concordance of the cases and the positive serology is evaluated by way of the Kappa index. RESULTS: From among the students at several schools and those with whom they were living at the time, a total of 130 individuals were surveyed, 94 of whom fit the "case" definition. The average age of the cases was 10.5 years of age, 42.6% being males and 84% school age children, 71.3% showing signs of recent infection (positive IgM), the average length of time since the last whooping cough immunization being 8.25 years. The effectiveness of the whooping cough booster is 66%. The concordance between the cases and the positive results of the serology reveals a Kappa = 0.45. No B. Pertussis was isolated in the 25 throat swab samples. CONCLUSIONS: Classrooms and the family environment are a factor in spreading this disease. The including of a booster at 18 months improves the effectiveness of the whooping cough immunization. The isolation of B. Pertussis is not very frequent, and the serology may be an alternative when this disease is clinically suspected.

Estudio de un brote epidémico de tos ferina en Castellón / A study of a whooping cough epidemic outbreak in Castellon, Spain

Fundamento: A partir de la declaración de varios casos en un centro escolar se inicia el estudio de brote con el objetivo de caracterizar éste desde el punto de vista de persona, lugar y tiempo; se calcula la efectividad de la vacuna, y se estudia la concordancia entre los casos y el resultado positivo del estudio serológico. Métodos: Se define caso a la persona que presenta tos persistente de dos semanas de duración. Se realiza estudio de la difusión de la enfermedad a través de la curva epidémica, y de la efectividad de la dosis de refuerzo de la vacuna antipertussis. La concordancia entre los casos y la serología positiva se evalúa por el índice Kappa. Resultados: Entre los alumnos de varios centros escolares y sus convivientes se encuesta a 130 personas, de los que 94 entran en la definición de caso. La media de edad de los casos es 10,5 años, un 42,6 per cent son varones, el 84 per cent escolares, el 71,3 per cent muestra signos de infección reciente (IgM positiva), y el tiempo medio desde la última dosis de vacuna antipertussis es de 8,25 años. La efectividad de la dosis de refuerzo de la vacuna es del 66 per cent. La concordancia entre los casos y el resultado positivo de la serología muestra un Kappa igual a 0,45. No se aisló B. Pertussis en las 25 muestras de frotis faríngeo. Conclusiones: Las aulas y el medio familiar son un factor de difusión de la enfermedad. La inclusión de una dosis de refuerzo a los 18 meses mejora la efectividad de la vacuna antipertussis. El aislamiento de la B. Pertussis es poco frecuente, y la serología, puede ser una alternativa ante la sospecha clínica de la enfermedad (AU)

[Nosocomial epidemic outbreak of acute gastroenteritis by Norwalk-like virus]. / Estudio de un brote epidémico nosocomial de gastroenteritis aguda por virus Norwalk-like.

BACKGROUND: From the notification of an acute gastroenteritis outbreak in a nursing home, an epidemiological study was started to determine the characteristics of the outbreak and its spreading pattern and to identify determining factors. PATIENTS AND METHOD: A study of historic cohorts was performed and the case was defined by the presence of diarrhea and vomiting. Spatial aggregation in double rooms was analyzed by a binomial distribution and temporal aggregation was analyzed by a relative risks model. The variables in the study allowed us to calculate the adjusted relative risk; the odds ratio was calculated in relation to the meal on day January 30. RESULTS: We studied 95.9% residents. The total attack rate was 28.7% (31.8% employees, 30.1% permanent residents and 15.2% day residents). The attack rate in rotation health personnel was 45.2%. Spatial and temporal spread in double rooms was negative. There was a significant association with the disease in rotator employees (RR = 3.22; CI 95%, 1.30-7.99; p = 0.02). No association was found between eating and disease (OR = 1.5; CI 95%, 0.4-6.1; p = 0.46). Norwalk-like virus was isolated in four faecal samples. CONCLUSIONS: This epidemic outbreak had the characteristic of a nosocomial infection with a likely person-to-person transmission mechanism. The main factor contributing to the spread of the infection was the existence of employees in permanent contact with residents with an important physical and mental impairment, hence highly dependent on the care provided by these health workers.

Estudio de un brote epidémico nosocomial de gastroenteritis aguda por virus Norwalk-like / Nosocomial epidemic outbreak of acute gastroenteritis by Norwalk-like virus

FUNDAMENTO: A partir de la declaración de un brote de gastroenteritis aguda en una residencia de ancianos (27 de enero-12 de febrero de 2001) se inició el estudio epidemiológico con el objetivo de caracterizar el brote, conocer la difusión de la enfermedad e identificar los factores que determinaron su aparición. PACIENTES Y MÉTODO: Se realizó un estudio de cohortes históricas, y se definió caso por la presencia de diarrea o vómitos. Se analizó la agregación espacial en habitaciones dobles por una distribución binomial, así como la agregación temporal por un modelo de riesgos relativos. Con las variables a estudio se calcula el riesgo relativo (RR) ajustado y con la comida del día 30 de enero, la odds ratio (OR). RESULTADOS: Se estudió al 95,9 por ciento de la población de la residencia, la tasa de ataque global fue del 28,7 por ciento (31,8 por ciento en trabajadores, 30,1 por ciento en internos y 15,2 por ciento en la residencia de día) y para los trabajadores sanitarios rotatorios, del 45,2 por ciento. La difusión espacial y temporal en las habitaciones dobles fue negativa. Se observó asociación significativa con la enfermedad en los trabajadores rotatorios (RR = 3,22; intervalo de confianza [IC] del 95 por ciento, 1,30-7,99; p = 0,02). No se observó asociación significativa entre la ingesta de alimentos y la enfermedad (OR = 1,5; IC del 95 por ciento, 0,4-6,1; p = 0,46). Se aisló virus Norwalk en 4 muestras de heces. CONCLUSIONES: Se trata de un brote epidémico que presenta las características de una infección nosocomial, cuyo mecanismo de transmisión más probable sería el contacto persona-persona, habiendo contribuido como factores determinantes la existencia de trabajadores en permanente contacto con personas con un gran deterioro físico y psíquico, y por tanto muy dependientes de los cuidados proporcionados por este personal. (AU)

[Evaluation of a system to feedback information on Public Health: the experience of Area 2 of the Community of Madrid]. / Evaluación de un sistema de devolución de información en salud pública: experiencia en el Area 2 de la Comunidad de Madrid.

BACKGROUND: In January 2000 the Public Health Service of Area 2, in the Region of Madrid, began to publish a weekly sheet on epidemiological and public health information (HISP) addressed to health professionals working in the Area. The aim of the present study was to estimate to how extend the "HISP" was known among health professionals of Area 2, and also to estimate the suitability and usefulness of its contents, during 2000. METHODS: A postal survey was carried out among a random sample of professionals working in Area 2. A descriptive analysis of main variables was done, variables associated to the knowledge of the "HISP" were investigated. Epi Info 2000 program was used for the analysis. RESULTS: The response rate was 79.7%. The best evaluated content was that related to epidemic outbreaks. An association between knowing the "HISP" and knowing the regional epidemiological bulletin (Boletin Epidemiológico de la Comunidad de Madrid) was found (OR = 9.3, IC 95% = 2.9-29.5), and also an association between knowing the "HISP" and being a physician (OR = 4.3, IC: 1.5-12.6, p = 0.005). CONCLUSIONS: The "HISP" has a good acceptance among health professionals of Area 2. They were more interested in contents related to stressful situations. It is necessary to improve the diffusion of information on public health among nursing professionals.

Brote de gastroenteritis en una residencia de ancianos de Albacete / Outbreak of gastroenteritis at an old people's home in Albacete

Fundamento: Se describe el estudio de un brote de gastroenteritis aguda de inicio explosivo y probable origen hídrico, en una residencia de ancianos de Albacete, en el mes de noviembre de 1999 y que afectó a 104 residentes y a 35 trabajadores. El cuadro clínico se caracterizó por la presentación de vómitos y diarrea como síntomas dominantes. Métodos: Se diseñó un estudio de casos y controles. Se realiza un análisis descriptivo de datos y cruce de variables mediante tablas simples. El análisis multivariante se realiza mediante modelos de regresión logística para la fase explosiva y de transmisión de persona a persona. Resultados: La tasa de ataque fue del 45,8 por ciento para residentes y de 33,7 por ciento en trabajadores. Se encontró asociación entre la utilización del comedor principal de la residencia y el inicio explosivo del brote así como entre la presencia inicial de un caso en habitaciones compartidas y la transmisión de persona a persona. Se aisló virus Norwalk-like en heces de 4 enfermos. Conclusiones: El análisis de las características clínicas y epidemiológicas, así como los resultados de laboratorio confirman la implicación del virus Norwalk-like como agente causal en este brote (AU)