Results from the first 12 months of the national surveillance of healthcare associated outbreaks in Germany, 2011/2012.

BACKGROUND: In August 2011, the German Protection against Infection Act was amended, mandating the reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany via local public health authorities and federal states to the Robert Koch Institute (RKI). OBJECTIVE: To describe the reported HAI-outbreaks and the surveillance system's structure and capabilities. METHODS: Information on each outbreak was collected using standard paper forms and notified to RKI. Notifications were screened daily and regularly analysed. RESULTS: Between November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks, between 7 and 116 outbreaks per month. The main causative agent was norovirus (n = 414/578; 72%). Among the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%) bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards (16%). CONCLUSION: The mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus research and preventive measures. Increasing the sensitivity and reliability of the data collection further will facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures to interrupt their propagation.

Identifying victims: child abuse and death in Canadian families.

This study examines the murder and abuse of children in Canada in the context of the commonplace of much violence and death and explores the shifting response of observers over more than a century. A review of the cases of three children who died at the hands of their caregivers in the late 20th century exposes mainstream and official preoccupation with the failures of individuals and of welfare systems rather than with the systemic disadvantage experienced by mothers and children alike.

[Historical development of health reporting on the community level--an academic void]. / Die historische Entwicklung der kommunalen Gesundheitsberichterstattung--eine Forschungslücke.

In the literature health reporting is often placed within the context of new public health. By doing so, health reporting is viewed as a historically new development distinct from the "old" medical statistics. This point of view, however, only holds true with a view to the medical statistics of the German postwar period in the 20th century. There is also a forgotten health reporting enrooted in the so-called "medical topographies" with a history reaching back more than 200 years. Part of this latter tradition are the Bavarian medical district reports ("Physikatsberichte") from the 19th century. These reports depicted the way of life and state of health of a population in combination with a social medical analysis with a strong action orientation. The demise of these forms of health reports began with the advent of bacteriology.

Disease surveillance in Guam: a historical perspective.

Passive, active, and syndromic disease surveillance, together with disease registries and surveys, are undertaken by the Guam Department of Public Health and Social Services to provide a rational basis for decision making by health care officials. Each of these activities serves a unique purpose in the process of detecting and confirming or disproving the presence or extent of disease on the island and evaluating the effectiveness of control measures.

Ethics seminars: physician complicity in the Holocaust: historical review and reflections on emergency medicine in the 21st century, part II.

Part I of this seminar in ethics reviewed the participation of German physicians and the German medical establishment in carrying out Nazi policies and listed eight moral failures that could be attributed to doctors during the dark period of history known as the Holocaust. The collective acts that occurred during this period have, arguably, become a benchmark for abject ethical collapse on the part of mankind. Part II contemplates a variety of contemporary issues through the prism of the Holocaust. This article reviews and categorizes ethical pitfalls encountered by physicians during the Nazi era and examines them in relationship to several current issues. It also focuses on ethical concerns and challenges that confront contemporary emergency practitioners, some of which have parallels, though certainly not direct comparators, in the Nazi era.