The impact of new national guidance for the public health management of enteric fever in England.

OBJECTIVES: New guidance was published in England in February 2012 to support the public health management of enteric fever and reduce the risks of secondary transmission. The new guidance was evaluated to assess: STUDY DESIGN: Quantitative and qualitative evaluation of the implementation of new public health guidance. METHODS: A qualitative review of all non-travel-related cases from February 2010 to January 2014 to compare the risk of secondary transmission before and after the guidance introduction; an audit of clearance sampling for each case and their contacts reported in London from February 2012-January 2015 to compare with a previous London audit; and an online user survey in November 2014. RESULTS: The proportions of non-travel cases reported before and after the introduction of the new guidance were similar, 6% in 2010-2012 compared to 7% in 2012-2014 (P = 0.33). There was a 32% reduction in the number of clearance samples required for cases and the estimated period of exclusion from work or school was reduced from 54 days to 16 days. Compliance in case clearance improved from 53% to 90% and contact screening compliance improved from 42% to 80%. The targeted screening of contacts led to a significantly higher positive yield (3.6% from 1.5%, P = 0.003). All symptomatic co-travellers presented to a healthcare professional, suggesting that screening could be restricted to those in risk groups for transmission. Feedback from users highlighted additional areas, such as management of large organised groups of co-travellers and those diagnosed abroad, which has informed the update of the national guidance. CONCLUSIONS: The new guidance has not led to an increase in secondary transmission of enteric fever in England and findings have been used to inform an update of the guidance. The new guidance also represents a reduced burden of investigation and thus a likely reduced cost to patients, healthcare professionals, laboratories and environmental health officers.

[Health education and environmental education: an integrated experience]. / Educação em saúde e educação ambiental: uma experiência integradora.

This paper reports on work with elementary school teachers from different types of Brazilian municipalities, from the coast to the interior and from capitals to small towns. With the larger purpose of facilitating teachers' perception of the identity between environmental education and health education, the study focuses on local issues related to quality of life, as well as local teachers' concepts concerning health and the environment. Finally, the study analyzes the importance of intersectorial cooperative programs facilitating long-term educational projects.

Guidelines for the public health management of typhoid and paratyphoid in England: practice guidelines from the National Typhoid and Paratyphoid Reference Group.

OBJECTIVES: The Typhoid and Paratyphoid Reference Group (TPRG) was convened by the Health Protection Agency (HPA) and the Chartered Institute of Environmental Health (CIEH) to revise guidelines for public health management of enteric fever. This paper presents the new guidelines for England and their rationale. METHODS: Methods include literature reviews including grey literature such as audit data and case studies; analysis of enhanced surveillance data from England, Wales and Northern Ireland; review of clearance and screening schedules in use in other non-endemic areas; and expert consensus. RESULTS: The evidence and principles underpinning the new guidance are summarised. Significant changes from previous guidance include: • Algorithms to guide risk assessment and management, based on risk group and travel history; • Outline of investigation of non-travel cases; • Simplified microbiological clearance schedules for cases and contacts; • Targeted co-traveller screening and a "warn and inform" approach for contacts; • Management of convalescent and chronic carriers. CONCLUSIONS: The guidelines were launched in February 2012. Feedback has been positive: the guidelines are reported to be clear, systematic, practical and risk-based. An evaluation of the guidelines is outlined and will add to the evidence base. There is potential for simplification and consistency between international guidelines.

Education for science and science for education: more than a play upon words.

In the celebration of the Oswaldo Cruz Institute centenary, we wanted to stress our concern with the relationship between two of its missions: research and education. What are the educational bases required for science and technology activities on health sciences for the future years? How can scientists collaborate to promote the popularization of academic knowledge and to improve a basic education for citizenship in an ethic and humanistic view? In this article we pointed out to need of commitment, even in the biomedical post-graduation level, of a more integrated philosophy that would be centered on health education, assuming health as a dynamic biological and social equilibrium and emphasizing the need of scientific popularization of science in a cooperative construction way, instead of direct transfer of knowledge, preserving also macro views of health problems in the development of very specific studies. The contemporary explosion of knowledge, particularly biological knowledge, imposes a need of continuous education to face the growing illiteracy. In order to face this challenge, we think that the Oswaldo Cruz Institute honors his dialectic profile of tradition and transformation, always creating new perspectives to disseminate scientific culture in innovator forms.