Assuntos
Antibacterianos/uso terapêutico , Notificação de Doenças/normas , Prescrição Inadequada/estatística & dados numéricos , Doença de Lyme/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Ensaio de Imunoadsorção Enzimática/métodos , Ensaio de Imunoadsorção Enzimática/normas , Feminino , Humanos , Doença de Lyme/tratamento farmacológico , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Vigilância da População , Melhoria de Qualidade , Adulto JovemRESUMO
The COVID-19 illness can occur as an occupational disease or work-related accident. According to the German list of occupational diseases, recognition as an occupational disease 3101 requires occupational exposure of an insured person who has been exposed to an increased risk of infection compared to the general population as a result of their occupational activity in one of the four areas: (1) health service or (2) social welfare sector, (3) laboratory or (4) during activities with increased risk of infection comparable to (1) to (3). The insurance cover covers employees, self-employed people - if not exempted from insurance cover - and honorary workers. The COVID-19 disease is subject to legal notification, mostly in conjunction with a contemporary SARS-CoV-2 virus detection. Regarding insured people who are not included within the aforementioned areas (1) to (4), the COVID-19 illness can be acknowledged as an occupational accident if the intense and direct contact with infected people - not intended as in the case of occupational disease 3101 - but otherwise situationally results from the insured activity itself.
Assuntos
COVID-19/economia , COVID-19/etiologia , Cobertura do Seguro , Doenças Profissionais/economia , Doenças Profissionais/etiologia , SARS-CoV-2/isolamento & purificação , Notificação de Doenças/legislação & jurisprudência , Notificação de Doenças/normas , Alemanha , Ocupações em Saúde , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/normas , Laboratórios , Exposição Ocupacional , Fatores de Risco , Seguridade Social , VoluntáriosRESUMO
Reporting discrepancies between officially confirmed COVID-19 death counts and unreported COVID-19-like illness (CLI) death counts have been evident across the world, including Bangladesh. Publicly available data were used to explore the differences between confirmed COVID-19 death counts and deaths with possible COVID-19 symptoms between March 2, 2020 and August 22, 2020. Unreported CLI death counts totaled more than half of the confirmed COVID-19 death counts during the study period. However, the reporting authority did not consider CLI deaths, which might produce incomplete and unreliable COVID-19 data and respective mortality rates. All deaths with possible COVID-19 symptoms need to be included in provisional death counts to better estimate the COVID-19 mortality rate and to develop data-driven COVID-19 response strategies. An urgent initiative is needed to prepare a comprehensive guideline for reporting COVID-19 deaths.
Assuntos
COVID-19/epidemiologia , COVID-19/mortalidade , Notificação de Doenças/estatística & dados numéricos , Notificação de Doenças/normas , Bangladesh/epidemiologia , COVID-19/diagnóstico , HumanosAssuntos
Defesa Civil , Infecções por Coronavirus , Programas Governamentais/normas , Governo , Necessidades e Demandas de Serviços de Saúde , Pandemias , Pneumonia Viral , Responsabilidade Social , COVID-19 , Teste para COVID-19 , Lista de Checagem , Defesa Civil/métodos , Defesa Civil/organização & administração , Defesa Civil/normas , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Notificação de Doenças/economia , Notificação de Doenças/métodos , Notificação de Doenças/normas , Programas Governamentais/economia , Programas Governamentais/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Cooperação Internacional , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Vigilância da População , Melhoria de Qualidade , Projetos de Pesquisa , Inquéritos e Questionários , Organização Mundial da Saúde/economia , Organização Mundial da Saúde/organização & administraçãoAssuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Política de Saúde , Pneumonia Viral/epidemiologia , Brasil/epidemiologia , COVID-19 , Notificação de Doenças/normas , Monitoramento Epidemiológico , Sistemas de Informação em Saúde/organização & administração , Humanos , Programas de Rastreamento/organização & administração , Pandemias , SARS-CoV-2RESUMO
This article aims to analyze the completeness of the dengue fever notifications registered in a small municipality in Brazil, from 2007 to 2015. It involved a descriptive study with a quantitative approach, composed of the totality of records available in the National System of Notifiable Diseases. The absolute number and percentage of non-fulfillment of the key, mandatory and essential variables of the dengue notification forms were analyzed, and a score proposed by Romero e Cunha was used to assess the degree of non-completeness. The non-parametric linear correlation coefficient of Spearman (rs) was calculated, being preceded by the verification of the distribution of the data through the Kolmogorov Smirnov test. The proportion of information ignored was high for most of the variables and for some trends of non-completeness over the years were decreasing and statistically significant. The quality of the data was mostly classified as regular and very poor, making it imperative to establish strategies in the process of qualification of health teams that work in primary care, to raise awareness of the importance of quality in the registration of compulsory notifications.
O objetivo deste artigo é analisar a completude dos campos de notificações de dengue registradas em um município de pequeno porte no Brasil, no período de 2007 a 2015. Estudo descritivo com abordagem quantitativa, composto pela totalidade de registros disponíveis no Sistema Nacional de Agravos de Notificação. Analisou-se o número absoluto e o percentual de não preenchimento das variáveis chave, obrigatórias e essenciais das fichas de notificação de dengue e com a finalidade de avaliar os graus de não completude, adotou-se escore proposto por Romero e Cunha. Foi calculado o coeficiente não paramétrico de correlação linear de Spearman (rs), sendo precedido pela verificação da distribuição dos dados através do teste de Kolmogorov Smirnov. A proporção de informações ignoradas foi elevada para a maioria das variáveis e para algumas, as tendências de não completude no decorrer dos anos foram decrescentes e estatisticamente significantes. A qualidade dos dados foi, em sua maioria, classificada como regular e muito ruim, tornando-se imprescindível o estabelecimento de estratégias no processo de capacitação das equipes de saúde que atuam na atenção primária, para a sensibilização e conscientização da importância da qualidade no registro das notificações compulsórias.
Assuntos
Dengue/epidemiologia , Brasil , Notificação de Doenças/normas , Humanos , População UrbanaRESUMO
Resumo O objetivo deste artigo é analisar a completude dos campos de notificações de dengue registradas em um município de pequeno porte no Brasil, no período de 2007 a 2015. Estudo descritivo com abordagem quantitativa, composto pela totalidade de registros disponíveis no Sistema Nacional de Agravos de Notificação. Analisou-se o número absoluto e o percentual de não preenchimento das variáveis chave, obrigatórias e essenciais das fichas de notificação de dengue e com a finalidade de avaliar os graus de não completude, adotou-se escore proposto por Romero e Cunha. Foi calculado o coeficiente não paramétrico de correlação linear de Spearman (rs), sendo precedido pela verificação da distribuição dos dados através do teste de Kolmogorov Smirnov. A proporção de informações ignoradas foi elevada para a maioria das variáveis e para algumas, as tendências de não completude no decorrer dos anos foram decrescentes e estatisticamente significantes. A qualidade dos dados foi, em sua maioria, classificada como regular e muito ruim, tornando-se imprescindível o estabelecimento de estratégias no processo de capacitação das equipes de saúde que atuam na atenção primária, para a sensibilização e conscientização da importância da qualidade no registro das notificações compulsórias.
Abstract This article aims to analyze the completeness of the dengue fever notifications registered in a small municipality in Brazil, from 2007 to 2015. It involved a descriptive study with a quantitative approach, composed of the totality of records available in the National System of Notifiable Diseases. The absolute number and percentage of non-fulfillment of the key, mandatory and essential variables of the dengue notification forms were analyzed, and a score proposed by Romero e Cunha was used to assess the degree of non-completeness. The non-parametric linear correlation coefficient of Spearman (rs) was calculated, being preceded by the verification of the distribution of the data through the Kolmogorov Smirnov test. The proportion of information ignored was high for most of the variables and for some trends of non-completeness over the years were decreasing and statistically significant. The quality of the data was mostly classified as regular and very poor, making it imperative to establish strategies in the process of qualification of health teams that work in primary care, to raise awareness of the importance of quality in the registration of compulsory notifications.
Assuntos
Humanos , Dengue/epidemiologia , População Urbana , Brasil , Notificação de Doenças/normasRESUMO
Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space-time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the "test and treat" policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).
Assuntos
Atenção à Saúde/estatística & dados numéricos , Notificação de Doenças/estatística & dados numéricos , Malária/epidemiologia , Animais , Teorema de Bayes , Burkina Faso/epidemiologia , Pré-Escolar , Atenção à Saúde/economia , Atenção à Saúde/normas , Notificação de Doenças/normas , Feminino , Política de Saúde , Humanos , Incidência , Lactente , Masculino , Modelos EstatísticosAssuntos
Humanos , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Política de Saúde , Brasil/epidemiologia , Programas de Rastreamento/organização & administração , Notificação de Doenças/normas , Pandemias , Monitoramento Epidemiológico , Sistemas de Informação em Saúde/organização & administraçãoRESUMO
BACKGROUND: In Asia, over 50% of patients with symptoms of tuberculosis (TB) access health care from private providers. These patients are usually not notified to the National TB Control Programs, which contributes to low notification rates in many countries. METHODS: From January 1, 2011 to December 31, 2012, Karachi's Indus Hospital - a private sector partner to the National TB Programme - engaged 80 private family clinics in its catchment area in active case finding using health worker incentives to increase notification of TB disease. The costs incurred were estimated from the perspective of patients, health facility and the program providing TB services. A Markov decision tree model was developed to calculate the cost-effectiveness of the active case finding as compared to case detection through the routine passive TB centers. Pakistan has a large private health sector, which can be mobilized for TB screening using an incentivized active case finding strategy. Currently, TB screening is largely performed in specialist public TB centers through passive case finding. Active and passive case finding strategies are assumed to operate independently from each other. RESULTS: The incentive-based active case finding program costed USD 223 per patient treated. In contrast, the center based non-incentive arm was 23.4% cheaper, costing USD 171 per patient treated. Cost-effectiveness analysis showed that the incentive-based active case finding program was more effective and less expensive per DALY averted when compared to the baseline passive case finding as it averts an additional 0.01966 DALYs and saved 15.74 US$ per patient treated. CONCLUSION: Both screening strategies appear to be cost-effective in an urban Pakistan context. Incentive driven active case findings of TB in the private sector costs less and averts more DALYs per health seeker than passive case finding, when both alternatives are compared to a common baseline situation of no screening.
Assuntos
Setor Privado/economia , Tuberculose/prevenção & controle , Adolescente , Adulto , Análise Custo-Benefício , Árvores de Decisões , Notificação de Doenças/economia , Notificação de Doenças/normas , Diagnóstico Precoce , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Motivação , Paquistão , Tuberculose/economia , Conduta Expectante/economia , Adulto JovemRESUMO
BACKGROUND: We sought to assess reporting in China's Pneumonia of Unknown Etiology (PUE) passive surveillance system for emerging respiratory infections and to identify ways to improve the PUE surveillance system's detection of respiratory infections of public health significance. METHODS: From February 29-May 29, 2016, we actively identified and enrolled patients in two hospitals with acute respiratory infections (ARI) that met all PUE case criteria. We reviewed medical records for documented exposure history associated with respiratory infectious diseases, collected throat samples that were tested for seasonal and avian influenza, and interviewed clinicians regarding reasons for reporting or not reporting PUE cases. We described and analyzed the proportion of PUE cases reported and clinician awareness of and practices related to the PUE system. RESULTS: Of 2619 ARI admissions in two hospitals, 335(13%) met the PUE case definition; none were reported. Of 311 specimens tested, 18(6%) were seasonal influenza virus-positive; none were avian influenza-positive. < 10% PUE case medical records documented whether or not there were exposures to animals or others with respiratory illness. Most commonly cited reasons for not reporting cases were no awareness of the PUE system (76%) and not understanding the case definition (53%). CONCLUSIONS: Most clinicians have limited awareness of and are not reporting to the PUE system. Exposures related to respiratory infections are rarely documented in medical records. Increasing clinicians' awareness of the PUE system and including relevant exposure items in standard medical records may increase reporting.
Assuntos
Notificação de Doenças , Necessidades e Demandas de Serviços de Saúde , Pneumonia/epidemiologia , Pneumonia/etiologia , Vigilância da População , Adulto , China/epidemiologia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Diagnóstico Diferencial , Notificação de Doenças/métodos , Notificação de Doenças/normas , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Hospitalização , Humanos , Influenza Humana/epidemiologia , Masculino , Notificação de Abuso , Testes Obrigatórios/normas , Pessoa de Meia-Idade , Projetos Piloto , Pneumonia/diagnóstico , Vigilância da População/métodos , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Avaliação de Programas e Projetos de Saúde , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Engajamento no TrabalhoRESUMO
Paratuberculosis, a chronic disease affecting ruminant livestock, is caused by Mycobacterium avium subsp. paratuberculosis (MAP). It has direct and indirect economic costs, impacts animal welfare and arouses public health concerns. In a survey of 48 countries we found paratuberculosis to be very common in livestock. In about half the countries more than 20% of herds and flocks were infected with MAP. Most countries had large ruminant populations (millions), several types of farmed ruminants, multiple husbandry systems and tens of thousands of individual farms, creating challenges for disease control. In addition, numerous species of free-living wildlife were infected. Paratuberculosis was notifiable in most countries, but formal control programs were present in only 22 countries. Generally, these were the more highly developed countries with advanced veterinary services. Of the countries without a formal control program for paratuberculosis, 76% were in South and Central America, Asia and Africa while 20% were in Europe. Control programs were justified most commonly on animal health grounds, but protecting market access and public health were other factors. Prevalence reduction was the major objective in most countries, but Norway and Sweden aimed to eradicate the disease, so surveillance and response were their major objectives. Government funding was involved in about two thirds of countries, but operations tended to be funded by farmers and their organizations and not by government alone. The majority of countries (60%) had voluntary control programs. Generally, programs were supported by incentives for joining, financial compensation and/or penalties for non-participation. Performance indicators, structure, leadership, practices and tools used in control programs are also presented. Securing funding for long-term control activities was a widespread problem. Control programs were reported to be successful in 16 (73%) of the 22 countries. Recommendations are made for future control programs, including a primary goal of establishing an international code for paratuberculosis, leading to universal acknowledgment of the principles and methods of control in relation to endemic and transboundary disease. An holistic approach across all ruminant livestock industries and long-term commitment is required for control of paratuberculosis.
Assuntos
Paratuberculose/epidemiologia , Paratuberculose/prevenção & controle , Criação de Animais Domésticos , Animais , Animais Selvagens/microbiologia , Notificação de Doenças/normas , Incidência , Mycobacterium avium subsp. paratuberculosis/isolamento & purificação , Paratuberculose/economia , Ruminantes/microbiologiaRESUMO
OBJECTIVE: To analyze the discourses of health professionals about the obstacles in the process of detection and reporting of tuberculosis cases in Mozambique. METHOD: Qualitative exploratory study with a theoretical-methodological approach of Discourse Analysis of French matrix. The study was conducted in Mozambique in 2014 at three levels: central, provincial and district. The study included 15 health professionals, 4 physicians, 6 technicians and 5 nursing professionals, who worked in the National Tuberculosis Control Program, with more than 1 year of experience. RESULT: The following discursive blocks emerged: Detection of tuberculosis cases in laboratories; Underreporting of tuberculosis cases; Obstacles to detect cases of tuberculosis: long distances and lack of transport; and Reporting of cases for decision making. FINAL CONSIDERATIONS: The discourses analyzed point to the ideological affiliation that includes the lack of investment policies in the health sector and the political commitment as basic obstacles in the detection and reporting of tuberculosis cases.
Assuntos
Notificação de Doenças/normas , Pessoal de Saúde/psicologia , Tuberculose/diagnóstico , Adulto , Atitude do Pessoal de Saúde , Notificação de Doenças/métodos , Feminino , Política de Saúde , Humanos , Entrevistas como Assunto , Masculino , Programas de Rastreamento/legislação & jurisprudência , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Moçambique , Pesquisa QualitativaRESUMO
OBJECTIVES: To assess how invasive meningococcal disease (IMD) records held by the Irish Meningitis & Sepsis Reference Laboratory (IMSRL) compare to records of IMD notifications reported on the national integrated electronic Computerised Infectious Disease Reporting (CIDR) system. STUDY DESIGN: We assessed the completeness, data quality and timeliness of IMD notifications and reference laboratory records for the period between 01 July 1999 and 30 June 2015 by identifying discrepant and/or missing data items in a matched case data set and by measuring the timeliness of case reporting. METHODS: We matched anonymised cases notified to CIDR to records based at the IMSRL using birth, reporting and onset dates with gender and laboratory parameters of meningococcal strain characteristics and method of confirmation. Completeness, data quality and the timeliness of notifications were assessed by a stratified sensitivity-based technique and by calculating the average difference between IMSRL and CIDR reporting dates. RESULTS: CIDR recorded a total of 3163 notifications, of which 2759 (87.2%) were matched to IMSRL records. Completeness of IMD case classification as confirmed was estimated to be >99%. Examining the levels of discrepant or missing data in both matched CIDR and IMSRL records as a measure of data quality, recording of demographic items and meningococcal group showed least differences, recording of laboratory case confirmation method and meningococcal strain characteristics were less well recorded, with detail on clinical presentation/diagnosis least well recorded. Overall average annual difference between CIDR and IMSRL recording dates was 3.2 days (95% confidence interval 2.6-3.8). CONCLUSIONS: A high quality of IMD surveillance in Ireland was demonstrated, but scope for improvements in timeliness and capture of enhanced surveillance data regarding date of onset and strain-specific characteristics were identified.
Assuntos
Notificação de Doenças/normas , Infecções Meningocócicas/epidemiologia , Vigilância da População/métodos , Feminino , Humanos , Irlanda/epidemiologia , Laboratórios , Masculino , Infecções Meningocócicas/diagnóstico , Neisseria meningitidis/isolamento & purificação , Registros , Estudos Retrospectivos , Fatores de TempoRESUMO
ABSTRACT Objective: To analyze the discourses of health professionals about the obstacles in the process of detection and reporting of tuberculosis cases in Mozambique. Method: Qualitative exploratory study with a theoretical-methodological approach of Discourse Analysis of French matrix. The study was conducted in Mozambique in 2014 at three levels: central, provincial and district. The study included 15 health professionals, 4 physicians, 6 technicians and 5 nursing professionals, who worked in the National Tuberculosis Control Program, with more than 1 year of experience. Result: The following discursive blocks emerged: Detection of tuberculosis cases in laboratories; Underreporting of tuberculosis cases; Obstacles to detect cases of tuberculosis: long distances and lack of transport; and Reporting of cases for decision making. Final considerations: The discourses analyzed point to the ideological affiliation that includes the lack of investment policies in the health sector and the political commitment as basic obstacles in the detection and reporting of tuberculosis cases.
RESUMEN Objetivo: Analizar los discursos de los profesionales de salud acerca de las barreras en el proceso de detección y notificación de los casos de tuberculosis en Mozambique. Método: Estudio exploratorio cualitativo con abordaje teórico-metodológico del Análisis de Discurso de matriz francesa. El estudio fue realizado en Mozambique, en el año 2014, en tres niveles: central, provincial y distrital. Quince profesionales de la salud participaron en el estudio, siendo 4 médicos, 6 técnicos y 5 profesionales de enfermería, que actuaban en el Programa Nacional de Control de la Tuberculosis, con más de 1 año de experiencia. Resultado: Los siguientes bloques discursivos emergieron: Detección de los casos de la tuberculosis en laboratorios; Subnotificación de los casos de la tuberculosis; Barreras para la detección de los casos de la tuberculosis: largas distancias y falta de transporte; Y notificación de los casos para la toma de decisión. Consideraciones finales: Los discursos analizados apuntan a la filiación ideológica que comprende la falta de políticas de inversión en el sector de la salud y del compromiso político como barreras básicas en la detección y notificación de los casos de la tuberculosis.
RESUMO Objetivo: Analisar os discursos dos profissionais de saúde acerca das barreiras no processo de detecção e notificação dos casos de tuberculose em Moçambique. Método: Estudo exploratório qualitativo com abordagem teórico-metodológica da Análise de Discurso de matriz francesa. O estudo foi realizado em Moçambique, no ano de 2014, em três níveis: central, provincial e distrital. Fizeram parte do estudo 15 profissionais de saúde, sendo 4 médicos, 6 técnicos e 5 profissionais de enfermagem, que atuavam no Programa Nacional de Controle da Tuberculose, com mais de 1 ano de experiência. Resultado: Emergiram os seguintes blocos discursivos: Detecção dos casos da tuberculose em laboratórios; Subnotificação dos casos da tuberculose; Barreiras para detecção de casos de tuberculose: longas distâncias e falta de transporte; e Notificação dos casos para a tomada de decisão. Considerações finais: Os discursos analisados apontam para a filiação ideológica que compreende a falta de políticas de investimento no setor da saúde e do comprometimento político como barreiras basilares na detecção e notificação dos casos da tuberculose.
Assuntos
Humanos , Masculino , Feminino , Adulto , Tuberculose/diagnóstico , Pessoal de Saúde/psicologia , Notificação de Doenças/normas , Atitude do Pessoal de Saúde , Programas de Rastreamento/legislação & jurisprudência , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Entrevistas como Assunto , Notificação de Doenças/métodos , Pesquisa Qualitativa , Política de Saúde , Pessoa de Meia-Idade , MoçambiqueRESUMO
Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2-14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14's active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions.
Assuntos
Vacinas contra Dengue , Dengue/epidemiologia , Dengue/prevenção & controle , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controle , Adolescente , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Dengue/virologia , Vacinas contra Dengue/administração & dosagem , Vacinas contra Dengue/efeitos adversos , Notificação de Doenças/normas , Notificação de Doenças/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Estudos Prospectivos , Dengue Grave/virologia , Avaliação de SintomasRESUMO
With an increasing burden on public sector budgets, increased responsibility and cost sharing mechanisms for animal diseases are being considered. To achieve this, fiscal and non-fiscal intervention policies need to be designed such that they consistently promote positive disease risk management practices by animal keepers. This paper presents a review of the available evidence towards whether and how the level and type of funding mechanism affects change within biosecurity behaviours and the frequency of disease reporting. A Nuffield Health Ladder of Interventions approach is proposed as a way to frame the debate surrounding both current compensation mechanisms and how it is expected to change behaviour. Results of the review reveal a division between economic modelling approaches, which implicitly assume a causal link between payments and positive behaviours, and socio-geographic approaches which tend to ignore the influence of compensation mechanisms on influencing behaviours. Generally, economic studies suggest less than full compensation rates will encourage positive behaviours, but the non-economic literature indicate significant variation in response to compensation reflecting heterogeneity of livestock keepers in terms of their values, goals, risk attitudes, size of operation, animal species and production chain characteristics. This may be of encouragement to Western Governments seeking to shift cost burdens as it may induce greater targeting of non-fiscal mechanisms, or suggest more novel ways to augment current compensation mechanisms to both increase responsibility sharing and reduce this cost burden. This review suggests that a range of regulatory, fiscal and nudging policies are required to achieve socially optimal results with respect to positive behaviour change. However, the lack of directly available evidence which proves these causal links may hinder progress towards this optimal mixture of choice and non-choice based interventions.
Assuntos
Doenças dos Animais/economia , Notificação de Doenças/normas , Monitoramento Epidemiológico/veterinária , Conhecimentos, Atitudes e Prática em Saúde , Doenças dos Animais/epidemiologia , Doenças dos Animais/prevenção & controle , Animais , Modelos Econômicos , Gestão de RiscosAssuntos
Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Notificação de Doenças/normas , Notificação de Doenças/estatística & dados numéricos , Humanos , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Gestão de Riscos/normas , Gestão de Riscos/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: Periodic assessment of surveillance systems is recommended to verify whether they are appropriately monitoring the public health problem under surveillance. The aim of this study was to evaluate timeliness, data quality and representativeness of data reported to the Italian Integrated Epidemiological System for Acute Viral Hepatitis (SEIEVA). STUDY DESIGN: Cross-sectional analysis of surveillance data. METHODS: Quantitative indicators were used to evaluate representativeness of reported cases, data quality, and timeliness between surveillance steps, for reports of acute viral hepatitis cases with date of onset of symptoms from 2009 to 2012 (N = 4516). RESULTS: Representativeness was 75%. Over 95% of records reported information on age, sex, city of residence, risk factors for hepatitis A and vaccination status. Information on risk factors for hepatitis B and C were reported less consistently (83%), as was information on early outcome (60%). Wide delays were found between surveillance steps. CONCLUSIONS: The system collects high quality data on acute viral hepatitis cases in Italy. Timeliness was found to be the main limit and needs to be improved by optimizing web-based reporting procedures, increasing communication with participating centres, improving feedback and increasing dissemination of surveillance results. The study highlights the importance of reporting timeliness to detect outbreaks of acute viral hepatitis.