Early intervention in pertussis outbreak with high attack rate in cohort of adolescents with complete acellular pertussis vaccination in Valencia, Spain, April to May 2015.

Forty-three pertussis cases reported in May 2015 in Valencia were linked to a school outbreak where 90% of the students had been vaccinated. Cases were diagnosed upon paediatrician consultation and in hospital emergency units. Approximately half of the cases were students born in 2002, the first age cohort with complete shift to acellular pertussis vaccine. Public health intervention, visiting school premises to conduct interviews, sample collection and early antibiotic prophylaxis stopped further spread in the community.

Calidad de vida en la enfermedad de Alzheimer / Quality of life in Alzheimer´s disease

Introducción. La calidad de vida es un concepto de creciente interés cuya evaluación complementa la valoración clínica tradicional, de interés fundamentalmente en ámbitos de organización de la asistencia. Presentamos un estudio de calidad de vida en la enfermedad de Alzheimer y su relación con medidas cognitivas y funcionales. Pacientes y métodos. Se evalúa la calidad de vida mediante la escala EQ-5D en una muestra de casos de enfermedad de Alzheimer diagnosticados con criterios del National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association que han donado muestra de sangre para el Banco Nacional de ADN, en los que se ha determinado también el estadio de la escala de deterioro global, y se ha efectuado un test de fluencia verbal y el test minimental de Folstein. Se realizó un análisis clásico, contraste de variables mediante chi al cuadrado para las proporciones y t de Student para las medias,y estimación de r para los modelos de regresión en las variables cuantitativas. Se determinó la tarifa social mediante el programa SPSS v. 11. Resultados. Se analizan 141 casos, con una relación de 2 a 1 entre mujer y varón, y una edad media de 76,2 años. Los aspectos de cuidado personal, actividad y, en menor medida, motilidad se ven afectados en la enfermedad de Alzheimer, pero no parecen hacerlo los aspectos de dolor y ansiedad. Existe relación entre calidad de vida, escalas funcionales y escalas cognitivas. Los aspectos funcionales se correlacionan mejor que los cognitivos con la calidad de vida. Conclusiones. La calidad de vida se evalúa en la enfermedad de Alzheimer mediante escalas generales, como EQ-5D. Los aspectos cognitivos no parecen aportar información relevante en relación con la calidad de vida que no se aporte ya por los aspectos funcionales (AU)

Introduction. Quality of life is a concept that is receiving increasing amounts of attention; its assessment complements the traditional clinical evaluation, which is of special interest in areas related with healthcare organisation. Here, we present a study on quality of life in Alzheimer’s disease and its relationship with cognitive and functional measures. Patients and methods. Quality of life was evaluated by means of the EQ-5D scale in a sample of cases of Alzheimer’s disease (diagnosed according to criteria established by the National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) that donated blood samples for the National DNA Bank. The status of the global deterioration scale was determined and a verbal fluency test and the Folstein minimental test were also carried out. A classic analysis, variable contrast by means of chi-square for proportions and Student’s t test for measurements were conducted, as well as estimation of r for the regression models in the quantitative variables. The social rate was determined using the software application SPSS v. 11. Results. Altogether 141 cases were analysed, with a male to female ratio of 2:1, and a mean age of 76.2 years. Aspects such as personal hygiene, activity and, to a lesser extent, motility are affected in Alzheimer’s disease, but pain and anxiety aspects do not seem to be affected. There is a relationship between quality of life, functional scales and cognitive scales. Functional aspects correlate with quality of life better than cognitive ones. Conclusions. Quality of life is evaluated in Alzheimer’s disease using general scales, such as EQ-5D. Cognitive aspects do not appear to provide relevant information about quality of life that is not already provided by the functional aspects (AU)

[Quality of life in Alzheimer's disease]. / Calidad de vida en la enfermedad de Alzheimer.

INTRODUCTION: Quality of life is a concept that is receiving increasing amounts of attention; its assessment complements the traditional clinical evaluation, which is of special interest in areas related with healthcare organisation. Here, we present a study on quality of life in Alzheimer's disease and its relationship with cognitive and functional measures. PATIENTS AND METHODS: Quality of life was evaluated by means of the EQ-5D scale in a sample of cases of Alzheimer's disease (diagnosed according to criteria established by the National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) that donated blood samples for the National DNA Bank. The status of the global deterioration scale was determined and a verbal fluency test and the Folstein minimental test were also carried out. A classic analysis, variable contrast by means of chi-square for proportions and Student's t test for measurements were conducted, as well as estimation of r for the regression models in the quantitative variables. The social rate was determined using the software application SPSS v. 11. RESULTS: Altogether 141 cases were analysed, with a male to female ratio of 2:1, and a mean age of 76.2 years. Aspects such as personal hygiene, activity and, to a lesser extent, motility are affected in Alzheimer's disease, but pain and anxiety aspects do not seem to be affected. There is a relationship between quality of life, functional scales and cognitive scales. Functional aspects correlate with quality of life better than cognitive ones. CONCLUSIONS: Quality of life is evaluated in Alzheimer's disease using general scales, such as EQ-5D. Cognitive aspects do not appear to provide relevant information about quality of life that is not already provided by the functional aspects.

[Outbreak of shigellosis in a lower-class district]. / Brote de shigellosis en un barrio de nivel social bajo.

BACKGROUND: The outbreaks of Shigella sonnei in our environment frequently involve day care centers and elementary schools. An outbreak of shigellosis in a lower-class district is reported. The purpose of this study is that of pinpointing the center of infection, the means of contagion, the characteristics of those infected and of assessing the suitability of the measures taken. METHODS: For monitoring the outbreak over time, a combined observational timeline study was conducted within a territory the bounds of which were marked by means of the conventional epidemiological monitoring variables (time, place and individual). The infectivity of the center of infection (contagion rate) is analyzed by age, gender and school; rate ratio and percentage attributable thereto. RESULTS: On a time-related basis, the outbreak in question started on week 46/97 and ended on week 8/98. This outbreak involved 218 individuals (110 males and 108 females) totaling 5.46% of the district. The highest frequency was found among the 0-4 age group (43.6%), 29.4% in day care (70.32% contagion rate) with a relative risk of 3.9 (95% CI: 2.57-5.93) and 74.36% attributable percentage. The rate ratio between day care and the schools in the district in question is 5.62 (95% CI: 4.33-7.31). Stool cultures were taken and analyzed in 84 cases (38.5%), Shigella sonnei being detected in 38 cases (17.4%). Antibacterial treatment (amoxicillin-clavulan) was set out and individual and group health and safety measures were employed. CONCLUSIONS: The long communicability period and the small number of viable microorganisms necessary for causing this disease fostered its being passed on from one person to another at school and in the home. The measures employed effectively confined the contagion of the infectious agent at the schools.

[School failure in a cohort of adolescents]. / Fracaso escolar en una cohorte de adolescentes.

OBJECTIVE: To evaluate a cohort of adolescents as to whether their personal characteristics and/or determined habits of health and social relations bore any relation to the state of their studies two years later. DESIGN: A prospective study following a cohort of adolescents. PARTICIPANTS AND SETTING: Third-year ESO (aged c. 14) adolescents from the four state secondary schools in Puerto de Sagunto. INTERVENTIONS: Once the cohort (n = 551) was defined, in November 1995 the students themselves filled in a questionnaire on health and relationship habits. Two years afterwards they were located through school registers and classified as good if they were in the appropriate year, repeat if they were repeating a year and disappeared if they had left school. These last two categories were both considered school failures (SF). MEASUREMENTS AND RESULTS: 222 students were classed as SF (40%). 118 of these (21.4%) had left and 104 (18.9%) were repeating a year. There were statistically significant differences in the following characteristics measured at the start of the study: greater SF among boys than girls (46.4%/35.6%): the disappeared had a higher average age than the good students (14.98/14.17), higher average number of siblings (2.73/2.26), and higher average of nights they went out during the week (1.65/0.84). Mean family income was lower in the repeat group (1926087/2475436 pesetas); the money students received weekly was higher in both SF groups (over 900/641 pesetas). Students whose fathers have university degrees made up only 7.4% of SF; and no student whose mother had a university degree was SF. 17.5% of those who said they spent their free time with their family were SF, whereas 53% of those who devoted their free time basically to enjoying themselves were SF. On drug consumption, those who replied they never smoked had 27.2% SF, never consumed alcohol 25.8% SF, never took marihuana 35.3% SF, and never consumed other drugs 39.5% SF. Students who said their relationships with family and teachers was bad had 70% and 62.2% of SF, respectively. 70% of those who felt depressed were SF. CONCLUSIONS: This study confirms that a favourable family atmosphere is important in preventing school failure. It also makes clear that young people's social relationships and health habits are closely associated to their being a standard student or a school failure.

[The evolution of health and relationship habits of an adolescent cohort of Puerto de Sagunto (1995-1996)]. / Evolución de hábitos de salud y de relación de una cohorte de adolescentes de Puerto de Sagunto (1995-1996). Grupo de Trabajo TBC-3. Valencia.

OBJECTIVE: To know the prevalence of tobacco consumption, alcohol and marihuana as well as the habits of relationship, in an adolescents cohort of 3rd of Obligatory Secondary Teaching (ESO), that accede for the first time to one of the four secondary school of Puerto de Sagunto and the evolution of these habits after a year of follow-up. DESIGN: Transverse observational study with data withdrawal in two moments. Site. In the four secondary school of Puerto de Sagunto (Valencia). PATIENT AND OTHERS PARTICIPANTS: Adolescent of 3rd of ESO that accede for the first time to the four secondary school of Puerto de Sagunto in the course 95-96. INTERVENTIONS: A self-fully validated habits poll of health and of relationship was given to the pupils of 3rd of ESO (n = 573), and a year after was given the same poll, to the pupils already in 4th of ESO (n = 395). MEASUREMENTS AND RESULTS: On health habits, were found meaningful statistic differences in various variables: in tobacco consumption several times to the month passes of the 30% to the 40%, in alcohol consumption more than proven passes of the 35% to the 52%, in have you intoxicated the response never passes of the 67% to the 57%, in the paragraph of marihuana consumption, the response never passes of the 82% to the 72%. On the habits of relationship were found significant statistic differences with respect to number of nocturnal exists during the week that goes from 1.07 to 1.33, the return hour before 10 passes of the 23% to the 8%, as well as the type of associations to those which belong, sports club passes of the 38% to the 46%. In the paragraph of relationship to their teachers, the response good passes of the 89% to the 93%. CONCLUSIONS: The step of 14 to 15 years supposes in this population an increase in alcohol consumption, tobacco and marihuana, they go out more days at night and return later to house, are associated more in sports clubs and have better relationships to their teachers. The knowledge of these habits permits the intervention with preventive programs, that attempt to change attitudes toward these toxic habits and to promote the healthiest.

[The evolution of pulmonary tuberculosis in health area no 4 in Valencia during the period 1988-1993]. / Evolución de la tuberculosis pulmonar en el área de salud 4 de Valencia durante el peródo 1988-1993.

BACKGROUND: Morbidity from Pulmonary tuberculosis, detected by the system EDO in the Autonomous Community of Valencia, shows an increasing trend and differential behaviour in relation with age and constitutes, with no doubt, a Public Health problem involving a joint action of multiple clinical care and preventive units. METHODS: In our study, the cases of notified and confirmed pulmonary tuberculosis over the period 1988-1993 in the Health Area number 4 (Region Camp de Morvedre 167.744 inhabitants) are analyzed by estimating the evolution of incidence, the diagnosis time and place where this diagnosis was made in accordance with the conventional variables of ecological studies and excluding from our registry the cases of those patients with co-infection by virus VIH. RESULTS: The growing evolution of incidence, the mean rate for the period (49.95.10(5) h.), the rate differential per age-groups during the period and the concentration of cases in the young age-groups (15-39 years) constitute, together with the diagnosis time (75.6 days in Primary Health Care; 74.3 in Hospital), the most outstanding results. Nevertheless, the prolongation of the diagnosis time for order age-groups (140-168 days in people older than 54 years) and the absence of a previous known contact, suggest the presence of undetected cases of TBC and dissemination ways other than the interfamily ones. CONCLUSIONS: An improved notification and identification of cases from hospital sources involves the necessity of reducing the mean diagnosis time and the research on the ways of transmission other than the interfamily ones; this explains a limited part of the incidence.

[Huntington disease: clinical and genetic study in a Spanish population]. / Enfermedad de Huntington: estudio clínico y genético en una población española.

Clinical and genetic data of 18 unrelated patients diagnosed of Huntington's disease were studied. We examined age of onset, form of presentation, years of evolution and scores on the Shoulson-Fahn function scale, the Myers disability scale and the mini-mental state examination. The 3 clinical parameters show a linear correlation with years of disease duration. The mini-mental test was most sensitive to progression and was most closely correlated (r = 0.75, p = 0.001). Molecular analysis of the IT15 gene for all 18 patients and 96 control chromosome was performed; the range of CAG repeats was 9-29 for controls and 36-69 for patients. The correlation decreased exponentially with age of onset of symptoms and number of CAG repeats.