[Trichinellosis outbreaks in Aragón (1998-2017)]. / Brotes epidémicos de triquinosis ocurridos en Aragón durante el periodo 1998 ­ 2017.

OBJECTIVE: In Aragon, official veterinary controls to detect the presence of Trichinella in meat products have allowed trichinosis to be a low-incidence disease in the form of outbreaks associated with family consumption of meat products that are not sanitarily controlled. The aim of the work was to describe the epidemiological characteristics of the trichinosis outbreaks that occurred in Aragon during the study period and the action measures carried out, which served as a basis for redesigning and strengthening prevention and control measures. METHODS: Descriptive study of the characteristics of time, place, person, food implicated, etiological agent and control measures implemented in the outbreaks identified by the Epidemiological Surveillance Network of Aragón from 01/01/1998 to 31/12/2017. For the descriptive analysis, the mean with its standard deviation and proportions were calculated. RESULTS: During the study period (from 01/01/1998 until 31/12/2017) there were 7 family outbreaks with 294 exposed, 103 cases (Attack Rate 35%), of which 29 were hospitalized (28.1%). The case fatality rate was 1%. The average age of the cases was 43.3 years (standard deviation 15.9). 70.8% of the cases were male. Outbreaks were concentrated between December and May. Five outbreaks originated after consumption of wild boar. The etiological agent identified in meat and/or biological samples from the cases was Trichinella spiralis in four outbreaks and Trichinella britovi in two other outbreaks, while the agent could not be identified in one outbreak. In all outbreaks, actions were carried out in accordance with the recommendations established by the National Epidemiological Surveillance Network (RENAVE). CONCLUSIONS: Trichinosis in Aragon takes the form of sporadic family outbreaks coinciding with the time of wild boar hunting and home slaughtering of pigs and is associated with the consumption of meat products not controlled sanitarily, so it is necessary to strengthen health education and intersectoral collaboration in the development and implementation of prevention and control strategies.

OBJETIVO: En Aragón, los controles oficiales veterinarios para detectar la presencia de triquina en productos cárnicos, han permitido que la triquinosis sea una enfermedad de baja incidencia, que se presenta en forma de brotes, asociados al consumo familiar de productos cárnicos no controlados sanitariamente. El objetivo del trabajo fue describir las características epidemiológicas de los brotes de triquinosis ocurridos en Aragón durante el periodo de estudio y las medidas de actuación llevadas a cabo, lo que sirvió de base para rediseñar y fortalecer las medidas de prevención y control. METODOS: Estudio descriptivo de las características tiempo, lugar, persona, alimentos implicados, agente etiológico y medidas de control implementadas en los brotes identificados por la Red de Vigilancia Epidemiológica de Aragón desde el 01/01/1998 al 31/12/2017. Para el análisis descriptivo se calcularon la media con su desviación estándar y las proporciones. RESULTADOS: Durante el periodo de estudio (desde el 01/01/1998 hasta el 31/12/2017) se declararon 7 brotes familiares con 294 expuestos, 103 casos (Tasa de Ataque 35%), de los que 29 fueron hospitalizados (28,1%). La tasa de letalidad fue del 1%. La media de edad de los casos fue de 43,3 años (desviación típica 15,9). El 70,8% de los casos fueron varones. Los brotes se concentraron entre diciembre y mayo. Cinco brotes se originaron tras el consumo de jabalí. El agente etiológico aislado en muestras cárnicas y/o muestras biológicas procedentes de los casos, fue Trichinella spiralis en cuatro brotes y Trichinella britovi en otros dos brotes. En todos los brotes las actuaciones se realizaron conforme a las recomendaciones establecidas por la Red Nacional de Vigilancia Epidemiológica (RENAVE). CONCLUSIONES: La triquinosis en Aragón se presenta en forma de brotes familiares esporádicos coincidentes con la época de caza de jabalí y matanza domiciliaria del cerdo y se asocia al consumo de productos cárnicos no controlados sanitariamente, por lo que es necesario reforzar la educación para la salud y la colaboración intersectorial en la elaboración e implantación de estrategias de prevención y control.

Missed opportunities in the diagnosis of human immunodeficiency virus infection in the Region of Aragon. Late diagnosis importance. / Oportunidades perdidas en el diagnóstico de la infección por el virus de inmunodeficiencia humana en la Comunidad de Aragón. Importancia del diagnóstico tardío.

INTRODUCTION: Late Diagnosis (LD) of Human Immunodeficiency Virus (HIV) infection (CD4 lymphocytes <350/µl at diagnosis of the disease), deteriorates the condition of those affected and increases the probability of transmission. The objective of the present study was to analyse the prevalence of LD, to identify missed diagnostic opportunities (MDO) and to find out which level of the health care delivery system they took place. METHODS: Retrospective, observational and descriptive study of the population diagnosed with infection of HIV/AIDS in the period 2011-2015 in Aragon. MDO were identified during the 3 years prior to diagnosis of the disease in all levels of the health care delivery system as well as frequentation of consultations. The indicator conditions (IC) that generated more MDO were analysed according to the latest recommendations for early diagnosis of HIV in the health care setting. RESULTS: 435 newly diagnosed HIV/AIDS cases were analysed. 45.1% were diagnosed in Primary Healthcare (PH). 49.4% presented criteria of LD and 61.1% were infected through heterosexual contact. The majority of MDO (68.5%) were given in PH. The IC that generated the most MDO were seborrheic dermatitis/exanthema (19.4%) and fever of unknown origin (10.3%). However, the IC that were associated with higher LD were pneumonia acquired in the community and unjustified weight loss. CONCLUSION: In Aragon, prevalence of LD is high, the main route of infection is heterosexual and most of MDO go unnoticed in PH. The dissemination of current guidelines for requesting IC guided HIV testing and HIV screening across the preoperative period will result in an effective measure to decrease the LD.

Illness behavior: prediction by symptoms, the Grossarth-Maticek and Eysenck Personality Types, neuroticism, life events, coping, health locus of control, social support, and attribution style.

A study was carried out with 501 persons to analyze the predictive capacity of various psychosocial variables-symptom perception, neuroticism, Personality Types 2 and 4 of Grossarth-Maticek and Eysenck, beliefs about health, social support, or certain coping styles-on two health-related behaviors: the frequency of visits to the doctor and self-medication. The results were analyzed by two structural equation models that revealed that some of the variables have direct effects on the behaviors, whereas other variables, such as attribution style, coping styles, or the impact of the stressors, have indirect effects via the reported symptoms or neuroticism. In addition, self-medication and the frequency of health service visits are independent of each other, which shows that their determinants are different. It is concluded that to address these factors in the two health indicators, it is also necessary to take in account the psychosocial variables considered herein.