[Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study]. / Factores asociados al ingreso hospitalario y evaluación de un programa de gestión de casos para trastorno mental grave mediante un estudio de cohortes históricas.

INTRODUCTION: People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain). METHODOLOGY: We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. RESULTS: In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78% belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study. CONCLUSIONS: It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness.

[Real time information. A necessary tool in epidemiological surveillance]. / La información en tiempo real. Una herramienta necesaria en vigilancia epidemiológica.

Since 2004 an electronic epidemiological surveillance system (AVE) has been developed and implemented for infectious diseases in the autonomous region of Valencia that allows data collection from notifiable diseases in real time concerning outbreaks and alerts, as well as analysis and dissemination of the information. Within the autonomous region of Valencia, the system is used by 17 epidemiology units, which act as the first level of specialized surveillance. The electronic surveillance system is used by all these units, as well as by physicians working in primary and specialized care, who can introduce information from the ambulatory information system while the patient is in the practice room. The system is able to capture the demographic data from the patient and the physician can add any other information that is considered important for the case detected. The system receives new laboratory test results overnight from the Microbiological Surveillance Network (RedMIVA). AVE can record outbreaks of notifiable diseases as well as any unusual clusters or changing patterns of any disease. The department of epidemiology has access to the whole system for analysis of the information and for quality control of the epidemiological surveillance. The system provides timely and comprehensive information to facilitate public health action in individual cases of infectious disease.