Differences on IA use between groups of different women seem to be related to vulnerability (economic, social, knowledge and use of healthcare services). There is a different situation among immigrants of differing nationalities.
Health sentinel networks are being increasingly used in the study of health-related problems. The present article aims to provide a methodological guide - designed by regional sentinel network managers and based on the results of a Delphi study - that can be used to set up and develop a health sentinel network. The main topics in the guide are the following: definition of a health sentinel network; network description: aims and structure; methods for the selection of sentinel participants; description of health processes suitable for study through this methodology: incidence, case definition, exclusion and inclusion criteria; description of the target population: the denominator for incidence rates estimates; quality indicators; periodicity of data collection; dissemination of the information: periodicity and methods, and incorporation of the participants in the decision-making process through multidisciplinary commissions. This guide aims to contribute to the development of sentinel networks in the autonomous communities by providing a common methodology, which could be highly useful when introducing new networks in Spain. Finally, we conclude that it is important to raise awareness of the concept of health sentinel networks, disseminate the information generated, and promote its use by public health administration.
An outbreak of acute gastroenteritis occurred in a nursing home for elderly in Majorca between 4 and 23 February 2008. To know its aetiology and mechanism of transmission a retrospective cohort study was conducted with a fixed cohort including 146 people (96 residents and 50 employees). The data were collected from clinical histories and through a survey by questionnaire. In total 71 cases were identified (53 residents, 18 employees), corresponding to an overall attack rate (AR) of 48.6%. The consumption of tap water, adjusted by age, sex and consumption of meals provided at the nursing home, presented a relative risk (RR) of 4.03 (95%CI, 1.4-11.4). The microbiological analyses confirmed the presence of norovirus and/or rotavirus in five of the seven stool samples submitted. The slow appearance of cases at the beginning of the outbreak is characteristic of a person to person transmission, while the sudden peak in the middle of the month suggests a common source such as the tap water. We therefore concluded that the outbreak likely originated from two sources: an infected employee of the nursing home and the tap water. The high number of dependent residents most probably facilitated the spread of the outbreak.
Since the eighties, health sentinel networks have been active in our country, but with a variety of objectives, methods and different development levels in the autonomous communities. The necessity of standardising the management and harmonising the indicators has concluded in a research project on the Spanish health sentinel networks, one of whose objectives is to establish a guide for work principles and methods. A panel of 23 experts has made a study using the Delphi method to agree, in three consecutive phases, a definition of sentinel network, the objectives and the management principles and other aspects related to the organisation and functioning. Altogether, 41 questions were gathered from a previous draft which needed 80% of consensus in the first phase and 70% in the second. All the experts participated in the first phase, 22 in the second and 20 in the third. A consensus was achieved on 36 questions in the first phase and in 4 of the remaining ones in the second. In the third phase the shape of the guide document was given. The Delphi consensus method has been extremely useful in the resolution of discrepancies and divergences. The experts who were selected outside of the sentinel networks contributed with a wider vision on the objectives and applicability of the health sentinel networks in Spain.
We describe investigation into an outbreak of norovirus gastroenteritis associated with oyster consumption. A survey was conducted in 346 exposed persons, 266 of whom were cases. Only 14 feces samples from patients were sent to the National Microbiology Laboratory. Oysters collected at the production site were sent to the National Food Center. The oysters met the microbiological quality standard required before sale, which did not include virus investigation. Epidemiological analysis showed an association between gastroenteritis and consumption of oysters (OR = 60.4; 95% CI: 26.2-139.3) and razor shells (OR = 3.13; 95% CI: 1.4-6.9). Microbiological analysis confirmed norovirus in affected individuals but not in the oysters that had been tested after a longer purification period than those consumed. Food with a special risk of norovirus transmission should be strictly monitored. Investigators should dispose of the necessary laboratory resources to study food-borne norovirus outbreaks.
Ser vei de Pro mo ció de la Sa lut i Epi de mio lo gia. Con se lle ria de Sa ni tat i Con sum. Go vern de les Illes Ba lears. (2) Cen tre Insu lar de Me nor ca. Con se lle ria de Sa ni tat i Con sum. Go vern de les Illes Ba l ears. (3) Cen tre Insu lar d'Ei vis sa i For men te ra. Con se lle ria de Sa ni tat i Con sum. Go vern de les Illes Ba lears. (*) Tra ba jo rea li za do con una beca de la Con se lle ria d'Educació i Cul tu ra del Go vern de les Illes Ba lears. RESUMEN Fun da men tos: Para un buen de sa rro llo de los pro gra mas de va cu na ción es pri mor dial co no cer la co ber tu ra de va cu nación. En las Islas Ba lea res la co ber tu ra no ti fi ca da era muy in ferior a la del res to de Espa ña. El ob je ti vo de este tra ba jo es la esti ma ción de la co ber tu ra de las va cu nas in clui das en el ca len dario re co men da do has ta los 18 me ses de edad (4 do sis de po lio oral, té ta nos y dif te ria; 3 de tos fe ri na; 1 de sa ram pión, ru beo la y pa ro ti di tis). Mé to dos: Estu dio des crip ti vo, trans ver sal, de base po blacio nal. Se cal cu la ron los es ti ma do res pun tua les de dis tri bu ción de fre cuen cias y los in ter va los de con fian za al 95% (IC95%) co rres pon dien tes, so bre una mues tra de la po bla ción re si den te en Ba lea res de dos años de edad (na ci da en 1995), se lec cio na da por mues treo alea to rio por con glo me ra dos en una sola eta pa a par tir de las sec cio nes cen sa les. Se con sul tan los re gis tros de va cu nas de Sa ni dad y de los cen tros de sa lud del Insa lud, se pide te le fó ni ca men te a las fa mi lias los da tos del do cu men to de va cu na ción y a los pe dia tras pri va dos los de la his to ria clí ni ca. Re sul ta dos: La mues tra in cluía 606 ni ños. Pudo ob te ner se la in for ma ción com ple ta de 532. Se con si guió la in for ma ción com ple ta de 377 ca sos (62%) a par tir de los re gis tros del sec tor pú bli co. La co ber tu ra más baja fue la de la va cu na an ti dif té ri ca, 518 ni ños com plen ta men te va cu na dos, el 96,8% (IC95% = 94,8-98,1) y la más alta la de la va cu na an ti per tus sis, 537 niños, el 98,9% (IC95% = 97,5-99,5). Con clu sio nes: En las Islas Ba lea res exis te una bue na cober tu ra de la va cu na ción, si mi lar a lo que se vie ne es ti man do en Espa ña en su to ta li dad. Se cum ple el ob je ti vo in clui do en el Plan de Erra di ca ción de la Po lio. La in for ma ción re co gi da desde el sec tor pú bli co es es ca sa. Pa la bras cla ve: Va cu nas. Po lio mie li tis. Dif te ria. Té ta nos. Tos fe ri na. Sa ram pión. Ru beo la. Pa ro ti di tis.
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