Evaluating Application of Knowledge and Skills: The Use of Consensus Expert Review to Assess Conference Abstracts of Field Epidemiology Training Participants

Background: Often evaluations of training programs are limited — with many focusing on the aspects that are easy to measure (e.g., reaction of trainees) without addressing the important outcomes of training, such as how trainees applied their new knowledge, skills, and attitudes. Numerous evaluations fail to measure training’s effect on job performance because few effective methods are available to do so. Particularly difficult is the problem of evaluating multisite training programs that vary considerably in structure and implementation from one site to another. Purpose: NA Setting: NA  Intervention: NA Research Design: We devised a method of a consensus expert review to evaluate the quality of conference abstracts submitted by participants in Field Epidemiology Training Programs – an approach that can provide useful information on how well trainees apply knowledge and skills gained in training, complementing data obtained from other sources and methods. This method is practical, minimally intrusive, and resource-efficient, and it may prove useful for evaluation practice in diverse fields that require training. Data Collection and Analysis: NA Findings: NA

Detección de un brote de hepatitis A en Ceuta a través del sistema de información microbiológica

ResumenAntecedentesEl Servicio de Vigilancia Epidemiológica de Ceuta 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.MétodosSe 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.ResultadosSe 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 inspeccionados disponía de control de facturas ni albaranes.ConclusionesSe confirmó un brote de hepatitis A asociado al consumo de navajas en domicilios y restaurantes. El SIM fue la herramienta fundamental para su detección.AbstractBackgroundThe 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.MethodsA 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.ResultsNineteen 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 inspected restaurants had public health authorization or records of food purchase histories.ConclusionsWe 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

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

Investigación de una agregación de casos de cáncer en las proximidades de una antena de telefonía móvil

Se presenta la investigación de un cluster de casos de cáncer en un área urbana que los vecinos asociaban con la presencia de una antena de telefonía móvil y un transformador eléctrico. Se diseñó un estudio de cohorte retrospectivo; el área de estudio fueron los edificios colindantes a la antena y al transformador en los que se habían denunciado casos de cáncer; la información se obtuvo mediante encuesta domiciliaria. Las localizaciones tumorales más frecuentes fueron mama, colonrecto y pulmón. Se calculó la Razón de Incidencia Estandarizada (RIE) entre los casos observados y los casos esperados para todas las localizaciones y para las localizaciones tumorales más frecuentes. Los intervalos de confianza de las RIEs siempre incluían el valor nulo. Conclusión: no se ha encontrado un aumento significativo de casos de cáncer en la cohorte y las localizaciones tumorales identificadas son las que se espera que aparezcan en la población de estudio

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

Gastroenteritis outbreak in tourists: limitations of information and response

[ES] Se presentan los resultados de los distintos estudios realizados en la investigación de un brote de gastroenteritis y se exponen las dificultades y las limitaciones que condicionaron su estudio. Se diseñaron varios estudios analíticos: un estudio de cohortes y un estudio de casos y controles con diferente tamaño muestral. De los 189 participantes, el 43% respondió el cuestionario. Se identificaron 45 casos. Los factores que se asociaron significativamente con la enfermedad fueron: la cena del día 11 de diciembre en uno de los restaurantes del complejo, tanto en el estudio de cohortes como en el de casos y controles, y la excursión a una isla cercana en el de cohortes. Se confirmó la existencia de un brote, aunque debido a la baja tasa de respuesta y las dificultades para entrevistar a los participantes del viaje, no fue posible identificar la vía de transmisión. [EN] We present the results of different studies performed in the investigation of a gastroenteritis outbreak and we describe the difficulties and limitations encountered during its study. Several analytical studies were designed: one cohort study and one case-control study with different samples sizes. Of the 189 trip participants, 43% answered the questionnaire. Forty-five cases were identified. The factors significantly associated with the disease were: dinner in one of the restaurants of the resort on December 11 in all analytical studies and the excursion to a nearby island in the cohort study. The outbreak was confirmed however due to the low response rate and the problems encountered to interview the participants in the trip, it was not possible to identify the route of transmission.S

Vigilancia de la tuberculosis en las Islas Baleares y caracterización de los casos infradeclarados entre los años 2005 y 2007

ResumenEstudio descriptivo de los casos de tuberculosis detectados por el Sistema de Vigilancia Epidemiológica en Baleares, en el trienio de 2005 a 2007. El objetivo fue caracterizar los casos infradeclarados en términos sociodemográficos y de su contacto con la atención primaria de salud. Globalmente, la infradeclaración de la tuberculosis se sitúa en torno al 20%. Las características que resultan significativas en el análisis multivariado 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 la tuberculosis extrapulmonar (ORa:5,5 [3,2-9,6]). Se recomienda reforzar la notificación de los especialistas hospitalarios mediante la adecuación informática de la historia clínica hospitalaria, y se observa que la información obtenida desde la informatización de la historia en atención primaria resulta de utilidad para mejorar la vigilancia epidemiológica de la tuberculosis.AbstractWe 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

[Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 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

Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003-2006: analysis of a time series.

In this study, we aimed to describe the evolution of three cholera epidemics that occurred in Lusaka, Zambia, between 2003 and 2006 and to analyse the association between the increase in number of cases and climatic factors. A Poisson autoregressive model controlling for seasonality and trend was built to estimate the association between the increase in the weekly number of cases and weekly means of daily maximum temperature and rainfall. All epidemics showed a seasonal trend coinciding with the rainy season (November to March). A 1 degrees C rise in temperature 6 weeks before the onset of the outbreak explained 5.2% [relative risk (RR) 1.05, 95% CI 1.04-1.06] of the increase in the number of cholera cases (2003-2006). In addition, a 50 mm increase in rainfall 3 weeks before explained an increase of 2.5% (RR 1.02, 95% CI 1.01-1.04). The attributable risks were 4.9% for temperature and 2.4% for rainfall. If 6 weeks prior to the beginning of the rainy season an increase in temperature is observed followed by an increase in rainfall 3 weeks later, both exceeding expected levels, an increase in the number of cases of cholera within the following 3 weeks could be expected. Our explicative model could contribute to developing a warning signal to reduce the impact of a presumed cholera epidemic

Valoracion del listado de enfermedades de declaracion obligatoria como reflejo de los principales problemas de salud de EspaNa

Centro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEESSpai