Evaluation of contact tracing activities during the Ebola virus disease outbreak in Guinea, 2015.

Objectives: The objective of the study was to present the findings of an audit tool aimed at assessing contact tracing activities during an Ebola outbreak. Methods: The tool was based on Ebola guidelines and observations in the field. It was composed of 38 indicators covering contact tracing preparatives, resources, procedures and results. Results: All contact tracing teams were assessed in Boké and Conakry prefectures (24 supervisors, 22 community workers, 442 contacts) between 1 July and 10 August 2015. Contact lists had less than a 40% accomplishment rate. 7% of the contacts were not seen by community workers or supervisors. 'No touch policy' was fully respected. Conclusion: Audit checklist helped to systematically identify critical issues related to contact tracing.

Frequency and characteristics of occupational dental trauma.

BACKGROUND: Dental trauma at the workplace may have important clinical and occupational consequences, but little is known about its profile. AIMS: To describe the frequency and characteristics of work-related dental injuries. METHODS: For all patients with occupational dental trauma seen at the FREMAP Hospital of Barcelona (Spain) between January 2000 and December 2006, we recorded their characteristics, type of work and nature of the trauma, including cause of the accident, extent of trauma, reason for referral to a dentist, and days of sick leave. RESULTS: The frequency of dental trauma was 1.71 per 1000 occupational accidents attended and was related to the worker's occupation. In security services, it was 7.37 per 1000 and 2.01 in transport services. The frequency was similar in both genders. The most common causal mechanisms were direct impact (38%), traffic accidents (29%) and falls at the same level (16%). Causal mechanisms differed according to gender and type of job. Most injuries consisted of dental fracture (54%), and 67% of the patients required referral to a dental surgery. Injuries were limited to the mouth in 52% of cases, 8% of which required sick leave, with a mean duration of 23.0±21.8 days. CONCLUSIONS: The frequency of dental trauma in this working population was low and was related to the worker's occupation. Causal mechanisms differed according to gender and type of job. Most dental injuries were severe and required referral to a dental surgery. Frequency of sick leave was low.

Inhaled drugs as risk factors for community-acquired pneumonia.

The effect of inhaled drugs in community-acquired pneumonia (CAP) is unclear. This case-control study was designed to determine whether inhaled drugs were risk factors for CAP. All incident cases of confirmed CAP that occurred over 1 yr in patients with chronic bronchitis (CB), chronic obstructive pulmonary disease (COPD) or asthma were included, as well as CB, COPD and asthma controls. Risk factors for CAP and inhaled treatment were recorded during a personal interview. An effect of inhaled drugs on the risk of CAP was observed in COPD and asthma patients after adjusting for the effect of other respiratory diseases and their concomitant treatments. In COPD patients, inhaled steroids had a risk OR of 3.26 (95% CI 1.07-9.98) and in asthma patients inhaled anticholinergics had a risk OR of 8.80 (95% CI 1.02-75.7). In CB patients, no association with CAP was observed for any inhaler. These effects were independent of adjusting variables related to severity and other respiratory and non-respiratory risk factors for CAP, including vaccines. Inhaled ß(2)-adrenergic agonists did not show a significant effect on the risk of CAP in any of the respiratory diseases. Inhaled steroids may favour CAP in COPD patients, whereas anticholinergics may favour CAP in asthma patients. It is difficult to differentiate the effect of inhaled therapy from the effect of COPD or asthma severity on the risk of CAP, and these relationships may not be causal, but could call attention to inhaled therapy in COPD and asthma patients.

New evidence of risk factors for community-acquired pneumonia: a population-based study.

The aim of the present study was to identify risk factors for community-acquired pneumonia (CAP), with special emphasis on modifiable risk factors and those applicable to the general population. A population-based, case-control study was conducted, with a target population of 859,033 inhabitants aged >14 yrs. A total of 1,336 patients with confirmed CAP were matched to control subjects by age, sex and primary centre over 1 yr. In the univariate analysis, outstanding risk factors were passive smoking in never-smokers aged >65 yrs, heavy alcohol intake, contact with pets, households with >10 people, contact with children, interventions on the upper airways and poor dental health. Risky treatments included amiodarone, N-acetylcysteine and oral steroids. Influenza and pneumococcal vaccine, and visiting the dentist were protective factors. Multivariable analysis confirmed cigarette smoking, usual contact with children, sudden changes of temperature at work, inhalation therapy (particularly containing steroids and using plastic pear-spacers), oxygen therapy, asthma and chronic bronchitis as independent risk factors. Interventions for reducing community-acquired pneumonia should integrate health habits and lifestyle factors related to household, work and community, together with individual clinical conditions, comorbidities and oral or inhaled regular treatments. Prevention would include vaccination, dental hygiene and avoidance of upper respiratory colonisation.

[Usefulness of the Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) in identifying the causes of chronic cough]. / Eficacia de la normativa SEPAR en la identificación de las causas de tos crónica.

OBJECTIVE: The usefulness of the recently published guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on the diagnosis and treatment of chronic cough has not yet been demonstrated. The objectives of the present study were a) to evaluate the usefulness of the SEPAR guidelines for identifying the possible causes of chronic cough, and b) to determine the most frequent causes of chronic cough treated by primary care physicians. METHODS: We carried out a prospective descriptive study that included 57 consecutive patients (mean age, 62 years) seeking medical attention for chronic cough in a primary health care area. The patients were evaluated using the algorithm proposed in the SEPAR guidelines, whereby the diagnostic procedure is divided into 3 phases in function of complexity. Phase I was carried out at the primary care level, and phases II and III at a hospital pneumology department. RESULTS: For 56 patients (98%), the potential cause of cough was identified: for 52 (91%) in phase I; for 3 (5%), in phase II; and for 1 (2%), in phase III. In 30 patients (53%), a single cause was identified; in 20 (36%), 2 causes; and in 6 (11%), more than 2 causes. Considered individually, the most common causes were postnasal drip in 26 cases (46%), the use of cough-inducing drugs (10 of them attributable to angiotensin-converting enzyme inhibitors) in 16 (28%), asthma in 15 (27%), infection in 13 (23%), gastroesophageal reflux in 12 (21%), and others in 9 (16%). CONCLUSIONS: The application of the SEPAR guidelines on chronic cough is useful for the identification of its causes. The use of angiotensin-converting enzyme inhibitors is a frequent cause of coughs diagnosed at the level of primary outpatient health care.

[Pain in the hospital: from prevalence to quality standards]. / El dolor en el hospital: de los estándares de prevalencia a los de calidad.

OBJECTIVES: Pain diminishes the quality of life of patients and a high prevalence of pain calls into question the quality of health care being delivered. The present study analyzes the prevalence of pain in one hospital, by departments and by therapeutic approach used. PATIENTS AND METHODS: This cross-sectional study was carried out in a representative sample of 309 patients admitted to a tertiary care hospital. Information was gathered by patient interviews and by reviewing hospital records for personal characteristics, clinical situation, pain characteristics and analgesic treatment. RESULTS: The prevalence of pain was 54.7% overall. The prevalence of pain eligible for treatment (intensity >2 on a visual analog scale) was 43.5%. The prevalence of pain that was moderate to intense (>3) was 34.7%. No analgesia was prescribed for 18.7% of the patients eligible, and analgesia was effective for 47.3%. Analgesia was provided on demand (63.2%) in most clinic protocols, usually with nonsteroidal antiinflammatory drugs, acetaminophen, opioids and special techniques, administered in combination to half the patients. The prevalence and intensity of pain and the prescription protocols varied from one hospital department to another. Analgesic treatment was adequate for 67.1% of the patients. CONCLUSIONS: The results suggest that the prevalence of pain in the hospital is high and that it is possible to improve quality of clinical approach, in agreement with studies that have been appearing since the 1980s. The persistence of the problem of pain in health care centers requires action on all levels of the health care system.

A population-based study of the costs of care for community-acquired pneumonia.

In a population-based study, the consumption of resources for treating adult patients with community-acquired pneumonia was determined. During a 2-yr period, all cases with a clinical and radiological suspicion of community-acquired pneumonia that occurred in patients aged > 14 yrs in a community of 74,610 inhabitants were investigated prospectively. Of 292 cases with a suspicion of community-acquired pneumonia, 224 were included (18.5% misdiagnoses). The mean number of visits per patient was 4.5 (72% in the primary care setting). Inpatient care was recommended in 59.8% of cases; after discharge, 44% of patients were managed in outpatient clinics. The mean direct cost of pneumonia treated in the hospital setting was [symbol: see text] (euros) 1,553, whereas the mean cost of cases treated as outpatients was [symbol: see text] 196. A total of 15.7% of admissions were considered inappropriate and the length of stay could have been reduced by 3.5 days in the most severe cases. A reduction in inappropriate admissions and lengths of hospital stay would result in a decrease in cost of 17.4%. Community-acquired pneumonia in Maresme, Spain, occurs at a low incidence, although with a high percentage of hospitalisations (in part inappropriate), resulting in considerable costs.

Myasthenia gravis: a higher than expected incidence in the elderly.

This 10-year (1991 to 2000) prospective study of MG in the county of Osona (Barcelona, Spain) reveals an annual incidence rate of 21.27 cases per million inhabitants (95% CI 13.89 to 31.16). Incidence increased from 5.03 x 10(6) in the age group of 0 to 14 years to 14.68 x 10(6) in the age group of 15 to 64 years and to 63.38 x 10(6) in the older population. These results, the highest reported to date, may be explained by the population aging.

Reliability of the mini nutritional assessment (MNA) in institutionalized elderly people.

OBJECTIVES: To measure the reliability of the Mini Nutritional Assessment (MNA) in institutionalized elderly people. DESIGN: 12 day interobserver reliability study. PARTICIPANTS AND SETTING: All subjects admitted to two long term geriatric units in Mataró (Barcelona, Spain) over 4 months during 1996 (n=67). MEASUREMENTS: in each center, different trained nurses independently administered the MNA on two separate occasions. RESULTS: Mean (standard deviation) scores for the two assessments of the MNA were 20.8 (5.4) and 21.3 (4.6) respectively. Internal consistency, estimated by the Cronbach's Alpha, were 0.83 and 0.74 for the first and second assessment respectively. Test-retest reliability, according to the intraclass correlation coefficient (ICC), was 0.89 for the total MNA score and higher than 0.89 for its continuous items. According to the Kappa index, test-retest reliability for the stratified total MNA was substantial (0.78); for the 18 ordinal or nominal items of the MNA it was 'almost perfect' or 'substantial' in 12 items, 5 were 'moderate' to 'fair' and in I item it was 'slight'. Subjective health evaluation, the number of glasses of liquids per day, and brachial circumference (this former with an ICC=0.91) were the items with the lowest Kappa indices. CONCLUSION: The MNA test has good levels of reliability, according to its internal consistency and its test-retest reproducibility. Some improvements can still be introduced by refining the categorization and content of some items with low reliability.

Epidemiology of community-acquired pneumonia in adults: a population-based study.

In this prospective study, the authors assessed the incidence, aetiology, and outcome of patients with community-acquired pneumonia in the general population. From December 1993 to November 1995, a study was performed in a mixed residential-industrial urban population of the "Maresme" region in Barcelona, Spain. All subjects > or =14 yrs of age (annual average population size 74,368 inhabitants) with clinically suspected community-acquired pneumonia were registered. All cases were re-evaluated by chest radiographs on the 5th day of illness and at monthly intervals until complete recovery. Urine and blood samples were obtained for culture and antigen detection. When lower respiratory tract secretions were obtained, these were also cultured. There were 241 patients with community-acquired pneumonia, with an annual incidence rate of 1.62 cases (95% confidence interval, 1.42-1.82) per 1,000 inhabitants. Incidence rates increased by age groups and were higher in males than in females. Of 232 patients with aetiological data, 104 had an identifiable aetiology. A total of 114 pathogens were found (single pathogen 94, two pathogens 10). There were 81 episodes of bacterial infection and 33 of viral infection. The most common pathogens were Streptococcus pneumoniae, Chlamydia pneumoniae, and influenza A and B viruses. No case of Hantavirus infection was found. The rate of hospital admission was 61.4% with a mean+/-SD length of 11.7+/-10.1 days, a mean period of 23.0+/-14.3 days inactivity, and an overall mortality rate of 5%. The high rate of hospital admission, prolonged stay in hospital, and long period of inactivity all continue to constitute a social and health care burden of community-acquired pneumonia.

Short-term prognostic value of lipid measurements in patients with angina pectoris. The ECAT Angina Pectoris Study Group: European Concerted Action on Thrombosis and Disabilities.

We studied the role of various markers of lipid metabolism, hemostasis and inflammation in a two year follow-up of 3,000 patients with angina pectoris, during which time 106 patients experienced myocardial infarction or sudden coronary death. Low levels of high density lipoprotein (HDL) cholesterol and of apolipoprotein (apo) A-I were most strongly associated with increased coronary risk. The relative risk per standard deviation increase was 0.68 for HDL cholesterol (95% confidence interval 0.55 to 0.84) and 0.66 for apoA-I (0.54 to 0.81). These associations were independent of other coronary risk factors, other lipid measurements, hemostatic factors, and C-reactive protein (CRP). The associations of total and LDL cholesterol, triglycerides, apoB, and lipoprotein(a) with coronary events were not independent of HDL cholesterol or hemostatic factors. We conclude that HDL cholesterol or apoA-I, hemostatic risk factors, and CRP are important prognostic markers of coronary events in secondary prevention.

Proportion of community-acquired pneumonia cases attributable to tobacco smoking.

STUDY OBJECTIVES: To assess the population-attributable risk (PAR) of smoking and the effect of tobacco smoking on the development of community-acquired pneumonia (CAP) in adults. DESIGN: A population-based case-control study. Information on history of smoking and other risk factors was obtained by a questionnaire administered by interview. SETTING: Mixed residential-industrial area having 74,610 adult inhabitants in Barcelona, Spain. PARTICIPANTS: Two hundred five male and female patients (age, 15 to 74 years old) with CAP diagnosed between 1993 and 1995. They were matched to 475 control subjects randomly selected from the municipal census. RESULTS: Smoking any type of tobacco had an odds ratio (OR) of CAP of 2.0 for ever smokers (95% confidence interval [CI], 1.24 to 3.24); 1.88 for current smokers (95% CI, 1.11 to 3.19); and 2.14 for ex-smokers (95% CI, 1.26 to 3.65). A positive trend for increased risk of CAP was observed for an increase in the duration of the habit, the average number of cigarettes smoked daily, and cumulative cigarette consumption. Former smokers had a 50% reduction in the OR 5 years after the cessation of smoking. The risk of CAP attributable to the consumption of any type of tobacco in this population was 32.4% of cases (95% CI, 14.8 to 50.1%). In subjects without a history of COPD, the PAR of tobacco was 23.0% (95% CI, 3.3 to 42.7%). CONCLUSION: This study gives better quantitative and qualitative evidence about the effects of tobacco smoking on the occurrence of pneumonia in the adult community.

[Determinants associated wtih the presence of risk behaviors in HIV infected patients]. / Determinantes asociados al mantenimiento de comportamientos de riesgo para la transmisión del VIH en pacientes ya infectados.

BACKGROUND: Determinants associated with risk behaviours are evaluated in a known HIV-infected population not belonging to the great metropolitan nuclei. PATIENTS AND METHODS: 110 unselected HIV+ patients were interviewed, including 77 variables. Their association with sharing needles, and unprotected sex is analysed. RESULTS: Sharing needles was associated to: low academic achievement (p = 0.045), no children (p = 0.045), any physical limitation (p = 0.004), previous admission to detoxification unit (p = 0.014), and depression. With unprotected sex were associated: low academic achievement (p = 0.005), lesser time of HIV infection (p = 0.009), no family support (p = 0.005), and scanty information about HIV transmission (p = 0.018). CONCLUSIONS: A cohort of HIV-infected subjects who persist with risk practices is remaining. Some easily recognizable variables may be useful for their early recognition.

Risk factors for community-acquired pneumonia in adults: a population-based case-control study.

Although community-acquired pneumonia (CAP) remains a major cause of hospitalization and death, few studies on risk factors have been performed. A population-based case-control study of risk factors for CAP was carried out in a mixed residential-industrial urban area of 74,610 adult inhabitants in the Maresme (Barcelona, Spain) between 1993 and 1995. All patients living in the area and clinically suspected of having CAP at primary care facilities and hospitals were registered. In total, 205 patients with symptoms, signs and radiographic infiltrate compatible with acute CAP participated in the study. They were matched by municipality, sex and age with 475 controls randomly selected from the municipal census. Risk factors relating the subject's characteristics and habits, housing conditions, medical history and treatments were investigated by means of a questionnaire. In the univariate analysis, an increased risk of CAP was associated with low body mass index, smoking, respiratory infection, previous pneumonia, chronic lung disease, lung tuberculosis, asthma, treated diabetes, chronic liver disease, and treatments with aminophiline, aerosols and plastic pear-spacers. In multivariate models, the only statistically significant risk factors were current smoking of >20 cigarettes x day(-1) (odds ratio (OR)=2.77; 95% confidence interval (CI) 1.14-6.70 compared with never-smokers), previous respiratory infection (OR=2.73; 95% CI 1.75-4.26), and chronic bronchitis (OR=2.22; 95% CI 1.13-4.37). Benzodiazepines were found to be protective in univariate and multivariate analysis (OR=0.46; 95% CI 0.23-0.94). This population-based study provides new and better established evidence on the factors associated with the occurrence of pneumonia in the adult community.

[Impact of the primary health care reform on the use of the hospital emergency services]. / El impacto de la reforma de la atención primaria en la utilización de servicios de urgencias hospitalarios.

BACKGROUND: The overutilization of the hospital emergency areas (HEA) in recent years has been related to an inadequate functioning of the primary health care and can be corrected by the implementation of the primary health care reform. MATERIAL AND METHODS: Home interview of a sample of residents of the city of Mataró (Barcelona, Spain), where the primary health care reform affects to four of the seven basic health areas. Collection of information on health care utilization and attitudes to its use. RESULTS: Of the 1,974 studied subjects 27% (CI 95%, 25-29) reported to have used the HEA in the former year, and the frequency of visits was 0.48 (CI 95%, 0.44-0.54) per person. For the 1880 beneficiaries of the national health system, these results were somewhat lower between the users of reformed centres (27%, 0.46) than those of non-reformed centres (30%, 0.50) (p = NS); differences were attributed mainly to adult women. Users of reformed centres expressed more preference for the ambulatory in case of a non-severe emergency (37% and 17%; p < 0.0001) and consulted more often before going to the HEA (17 and 10%; p = 0.03). Among the reasons to go to the HEA, users of the reformed model perceived less necessity of an immediate action (43 and 52%; p = 0.05) and greater time barriers with the basic health areas (23 and 15%; p = 0.04). CONCLUSIONS: In spite of the lack of overall differences in the use of HEA between users of reformed centres and non-reformed centres we observed a lower utilization in some age and sex groups from reformed centres. Some elements of the demand of the HEA are more appropriate and attributed to the primary health care reform. However, the reasons prompting to use the HEA show that an unjustified utilization is still done, independently of the primary health care model.

[The impact of primary health care reform in the utilization of medical and nursing services. Working Group on the Utilization of of Health Services]. / El impacto de la reforma de la atención primaria en la utilización de servicios médicos y de enfermería. Grupo de Trabajo sobre la Utilización de Servicios Sanitarios.

OBJECTIVES: To describe the use of medical and nursing services and changes attributable to the Primary Care reform. DESIGN: A crossover study based in the community. SETTING: The city of Mataró (Barcelona), divided into seven Health Districts, four of which are reformed. PATIENTS AND OTHER PARTICIPANTS: A representative sample of 1,880 beneficiaries of the public health service. INTERVENTIONS: A home survey (February to June 1994). MEASUREMENTS AND MAIN RESULTS: The annual rate of use of the doctor was 78.9% and the frequency of attendance was 7.74 visits per person per year. Both rates were higher among women and increased with age, the 0 to 14-year old group being exceptional. The rate of use was greater in the reformed Districts as against the non-reformed ones; with the difference in frequency of visits not reaching statistical significance. Reformed Health District users stated they made less administrative visits and more prevention or follow-up attendances. Nursing services were used in the 2 weeks before the interview by 6.3%. CONCLUSIONS: In both Primary Care models, factors meaning greater demand on both doctors and nurses are advanced age and being female.

Benzodiazepines in primary health care: a survey of general practitioners prescribing patterns.

This paper presents the results of a survey carried out to investigate the benzodiazepine (BZD) prescribing patterns of the general practitioners (GP) in the catchment area of a Drug Dependence Unit located in a general hospital in Mataro (Barcelona, Spain). The aims of the survey were: (i) to obtain descriptive information on the knowledge of the GPs about BZD and its potential for dependence; (ii) to study the frequency of their prescribing; and (iii) to examine different factors linked to their prescribing. The study was carried out using a combination of a personal interview and a self-administered questionnaire. A total of 68 doctors (88.3%) completed the questionnaire. The results show that the GPs have, in general, correct knowledge about the therapeutic indications for BZD prescribing, but are far less aware of their potential to induce dependence and how to manage withdrawal. The rate of prescribing seems to be high. Furthermore, the results of the external check of validity point out that doctors tend to underestimate the number of prescriptions. The majority of GPs express the need for alternative resources to BZD prescribing. No significant associations have been found between doctor's characteristics, such as postgraduate training and type of practice, and their knowledge about BZD and frequency of their prescribing. In our view, a more accurate knowledge about BZD and alternatives to its use, both factors closely linked to training, together with the availability of non-pharmacological resources, are likely to improve the quality of doctors prescribing habits, thus preventing risks such as dependence of BZD.

Dose-response relationships of serum lipid measurements with the extent of coronary stenosis. Strong, independent, and comprehensive. ECAT Angina Pectoris Study Group.

Serum lipids, lipoproteins, and more recently apolipoproteins and lipoprotein(a) [Lp(a)] have been shown to be independent risk factors for coronary vessel disease and its prognosis. However, the relationships between serum lipid levels and the extent of coronary artery disease (CAD) have not been consistently shown. Twenty-five hundred male and female patients with suspected angina pectoris were recruited from 18 European medical centers. The independent relations of total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apo A-I and B, and Lp(a) with the presence and extent of CAD, as assessed by coronary angiography, were investigated. All of the lipid measures showed strong relations P < .0001) with the presence of CAD, defined by the existence of at least one > or = 50% coronary vessel stenosis. Total cholesterol, LDL cholesterol, apo B, triglycerides, and Lp(a) were substantially higher and HDL cholesterol and apo A-I lower in patients with CAD. The odds ratio of CAD, in the high-risk tertile of each lipid's distribution compared with the low-risk tertile, was in the range 1.5 to 2.3. Each of total cholesterol (or LDL cholesterol or apo B), HDL cholesterol (or apo A), and Lp(a) had an independent effect in predicting the presence of CAD. In addition, all lipids showed a strong association (P = .0006 for triglycerides, P < .0001 otherwise) with the extent of CAD as defined by the number of stenosed coronary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)