Epidemiologic surveillance in the local health system

This is a qualitative study, which aims at analyzing the organization of Epidemiological Vigilance (EV) in the local health system of Feira de Santana-BA, from 1997 to 2001 > in this study the following aspects were considered: organizational structure, resources available (human and material ones), planning, execution, intra and interinstitutional and intersectional articulations, considering the insertion of the city in the "Basic assistance Program". The collection of data was carried out in 3 stages: documental analysis, semi-structured interviews and direct observation with the VE. team. Results revealed that there are frequent changes in the management positions of VE. The structure, centralized in the SMS, prioritizes programmatic actions which are not articulated to the network of services offered. Advances can be noticed in the infrastructure, despite the lack of equipment and the deficiency in the qualification the human resources. The transformation of the model of health assistance is possible if health professionals, managers and users have political interest in changing it the practices in health services.     

Epidemiologic surveillance and evaluation of meningitis hospital care

OBJECTIVE: To analyze the clinical-epidemiological profile and in-hospital death predictors of infectious meningitis patients admitted to a public hospital. METHODS: There were studied 694 cases of meningitis notified and investigated by a public hospital's epidemiology service from 1986 to 2002, using the National Information System of Notifiable Diseases (SINAN) as part of the local routine of epidemiologic surveillance. Statistics analysis included multivariate logistic regression. RESULTS: The most frequent etiologies were: cryptococcal (12.3%; case-fatality =37.7%); meningococcal (8.7%; fatality =13.3%); pneumococcal (7.2%; fatality =46%); tuberculous (6.1%; fatality =40.5%); staphylococcal (5.2%; fatality =38.9%), viral (5.5%; fatality =7.9%); Haemophilus (2.9%; fatality =20%). The proportion of cases of non-specified etiology was 38.8% (fatality =36%) and 17.3% were associated to HIV infection. It was found that 27.1% were nosocomial meningitis and 9.2% of the surviving cases had sequelae. The logistic regression model identified the following death predictors of infectious meningitis: etiology (reference: viral category) -- tuberculous, cryptococcal, staphylococcal, meningococcal, non-specified, other Gram-negative, Candida and pneumococcal; HIV co-infection; coma. Fever, vomiting and neck stiffness were associated to a lower odds of death. CONCLUSIONS: The high proportion of non-specified etiology and high case-fatality may reflect problems in the hospital care process and/or case selection. The epidemiologic surveillance system operating at the hospital level was able to feedback the services with clinical indicators. The use of SINAN at the local level was considered useful and pertinent.     

Epidemiologic surveillance for the prevention and control urban violence]

Violence prevention policies should be based on information, follow-up, research, and analysis, all of which increase the chances of success and make it easier to evaluate interventions. This implies, in turn, that there is a need to create surveillance, research, and prevention models for violence within the sphere of public health and epidemiology, a task that constitutes an integral part of the Pan American Health Organization's Regional Plan of Action Health and Violence. This article describes the objectives of epidemiologic surveillance systems and explains their purpose and scope, along with the barriers that stand in the way of their implementation. It also examines a number of variables and their definitions, the types of analyses and reports that should be generated, and the decisions that can be made on the basis of these reports. Finally, it discusses ethical criteria and describes the experiences of the program known as Desarrollo, Seguridad y Paz (DESEPAZ) in Cali and Santa Fe de Bogota, Colombia, where an epidemiologic surveillance system against violence has been implemented.     

先天畸形影响因素的流行病学研究

目的 探讨先天畸形的影响因素及其作用强度和交互作用，为提出主要干预措施提供依据。方法 在山东省范围内随机抽取374例先天畸形病例进行1：1配比病例对照研究。数据采用单因素和多因素条件Logistic回归分析。结果 先天畸形主要的影响因素为：先天畸形家族史、孕妇知孕周数、孕早期发热、孕期服药、孕早期接触有害物、母亲化程度、孕早期营养、负性事件刺激，OR值分别为3．987，2．483，3．881，3．038，2．968，0．648，0．325，1．252；先天畸形阳性家族史与其它因素之间存在广泛的交互作用。结论 先天畸形的影响因素具有多元性。先天畸形家族史和环境因素间存在正或负相加模型的交互作用。     

Epidemiologic surveillance for primary prevention of malignant mesothelioma: the Italian experience

BACKGROUND: The Italian National Mesothelioma Registry (ReNaM) was set up at the National Institute for Occupational Safety and Health (ISPESL) to estimate Italian incidence of malignant mesothelioma (MM), define modalities of asbestos exposures, assess impact and diffusion of MM, identify underestimated sources of environmental contamination. OBJECTIVES: To describe ReNaM activity, database dimension and epidemiological characteristics of the caselist. METHODS: Regional Operating Centers (COR) in 16 Italian regions were set up to identify and investigate all cases of MM diagnosed in each region, applying national guidelines. COR collect cases in health care institutions. Occupational history, lifestyle and residence are obtained by direct interview using a standard questionnaire. Exposure modalities are classified by industrial hygienists, evaluating whether work, private life or any particular environmental condition could have involved asbestos exposure. RESULTS: Data refer to 3,446 cases collected in 9 Italian regions during 1993-2001. Pleural mesothelioma affected 94% cases, pleural/peritoneal ratio was 16:1. Gender ratio (M/F) was 2.7:1 (1.3:1 for peritoneum). There was a variety of occupational exposures, some already known as high risk sectors and others unexpected. The most common exposures occurred in building and construction, metallurgy and steel, shipbuilding, and railway stock. High risk categories were encountered such as bricklayers, plumbers, carpenters, electricians, welders, installers and maintenance workers in metallurgy and the steel industry, general labourers, tool makers and painters in shipbuilding/repair/demolition. CONCLUSIONS: Despite some ReNam's limitations, identification of MM cases and analysis of modality of exposure, with standardized criteria, are a fundamental tool for primary prevention of asbestos related diseases.     

The use of data set of the Hungarian case-control surveillance of congenital abnormalities for evaluation of birth outcomes beyond birth defects

AIMS: To use the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) for the evaluation of birth outcomes beyond congenital abnormalities and to show as example the study of 49 antimicrobial drugs used in Hungary for the reduction of preterm births. METHODS: The population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996, included 38,151 newborn infants without birth defects and this sample represented 1.8% of Hungarian births. Medically recorded gestational age at delivery and birthweight, in addition the rate of preterm births and low birthweight newborns born to mothers with or without different antimicrobial drugs used at least by ten pregnant women were analysed. RESULTS: Of 49 antimicrobial drugs, two: ampicillin (adjusted POR with 95% CI: 0.8, 0.7-0.9) and clotrimazole (0.8, 0.7-0.9) showed a preterm birth preventive effect. This preterm preventive effect was found mainly after the use of ampicillin and clotrimazole during the first trimester of pregnancy. CONCLUSIONS: Ampicillin and clotrimazole may be effective for the reduction of preterm births due to infectious diseases of pregnant women in general but particularly caused by genital infections. However, the limitation of the data set did not allow the appropriate evaluation of some antimicrobial drugs (e.g. clindamycin).     

Clinical classification of congenital limb abnormalities

Limb developmental defects are well-known, conspicuous abnormalities. Until this day, the background has still not been completely revealed, however, the development of scientific methods provides more and more opportunities which may help to understand developmental processes and defects of this compound system. Considering these aspects, following data collection from patients with limb developmental defects, we began a study with the purpose of finding/establishing a classification system that is suitable for morphological and clinical distinctions, besides considering developmental aspects, and may help to indicate adequate genetic examinations. To classify 195 patients included in our database, we chose a worldwide accepted table from Swanson. Based upon our observations we proposed some alterations, which finally lead to a table, suitable for patient classification based upon morphology and clinical features. Furthermore it allows comparisons concerning developmental aspects, gives reasonable background for genetic studies and is suitable for everyday clinical usage.     

On surveillance methods for congenital malformations

This paper presents an 'optimal' procedure for the use of the 'sets' method, a system proposed for surveillance of congenital malformations. Comparisons over a number of examples shows that the given procedure represents a clear improvement over the one originally proposed, and, in some conditions, is more efficient than the cusum scheme.     

烧伤病房铜绿假单胞菌的流行性分析

目的监测不同来源、不同时期铜绿假单胞菌(PAE)的同源性,明确PAE在烧伤科的流行情况,以指导临床合理应用抗菌药物。方法采用重复序列聚合酶链反应(REP-PCR)技术,对烧伤科32株临床分离到的PAE进行基因分型,并用K-B纸片扩散法进行药物敏感试验。结果 32株PAE共分为7个基因型,其中A型13株,B型7株、C型6株、D和E型各2株、F和G型各为1株,A和C型菌株在不同来源、不同时期均分离到;32株PAE中,23株为多药耐药、8株为泛耐药菌株,对庆大霉素、哌拉西林、哌拉西林/他唑巴坦、氨曲南、头孢哌酮、头孢哌酮/舒巴坦、头孢吡肟、美罗培南的耐药率均>90.0%,对头孢他啶和环丙沙星的耐药率最低为25.0%。结论烧伤病房多年来存在PAE多型菌株流行,其对常用抗菌药物呈多药耐药或泛耐药,头孢他啶和环丙沙星是目前烧伤患者PAE感染的首选药物。     

围产儿先天性畸形的监测研究

目的 了解深圳市宝安区围产儿先天性畸形的发病情况和分布特征,为进一步研究提供参考。方法 对宝安区1997年1月1日～1999年12月31日住院分娩的围产儿进行了先天性畸形监测研究。结果 宝安区 1997～1999年3a围产儿先天性畸形总发生率为77.72/万。年发生率(1/万)1997～1999分别为66.58、81.86和82.29,常住和流动户口的围产儿分别为69.65和80.33,活产及死产儿分别为51.61和2310.23,两者差异非常显著(x~2=3374.95,P=0.001);性别发生率男(75.25)高于女(73.75),差异无显著性(x~2=0.026,P=0.873);年龄以孕母<20岁者为最高(129.31),不同孕母年龄差异非常显著(x~2=40.88,P=0.001);孕母职业以工人为最高(168.69),不同孕母职业差异非常显著(x~2=10331.87,P=0.001);城区(86.43)高于非城区(63.34),不同地区差异非常显著(x~2=278.68,P=0.001);季节以夏(89.12)、冬(92.22)季较高,不同季节差异非常显著(x~2=11.517,P=0.009)。发生率居前5位的畸形依次为:大腹儿(18.23)、短肢或缺肢畸形(8.42)、先天性脑积水(7.84)、唇裂合并腭裂(6.41)和唇裂(6.41)。结论 宝安区围产儿先天性畸形的发生率比国内部分地区监测的结果要高,且发生有自己的特点,值得进一步研究。     

Evaluation of the impact of Chernobyl on the prevalence of congenital anomalies in 16 regions of Europe. EUROCAT Working Group

BACKGROUND: Surveillance data from population-based congenital anomaly registers in 16 regions of Europe (mainly Western Europe) were analysed to assess the impact of the Chernobyl accident on the prevalence of selected congenital anomalies. METHODS: Three cohorts of pregnancies were defined: those exposed during the first month following Chernobyl (External Exposure Cohort), the first year (Total Exposure Cohort) and the two subsequent years (Control Cohort). Expected numbers of congenital anomalies in these cohorts were calculated from 1980-1985 baseline rates. Registries were grouped into three exposure categories according to first-year exposure estimates. RESULTS: There was no overall or dose-related increase in prevalence in the two exposed cohorts for Down's Syndrome, neural tube defects, other central nervous system defects or eye defects. There was a statistically significant overall 22% (95% CI: 13-31%) excess of Down's Syndrome in the Control Cohort, with no dose-response relationship. CONCLUSIONS: Chernobyl had no detectable impact on the prevalence of congenital anomalies in Western Europe, suggesting that in retrospect the widespread fear in the population about the possible effects of exposure on the unborn fetus was not justified. An increasing prevalence of Down's Syndrome in the 1980s, probably unrelated to Chernobyl, merits further investigation.     

The Epidemiologic Surveillance Project: a computer-based system for disease surveillance

The Epidemiologic Surveillance Project (ESP) is a computer-based surveillance system for the rapid transmission and analysis of national morbidity data. These data are transmitted weekly by state health department computers to the Centers for Disease Control (CDC), using a commercial electronic mail facility (MINET). Participating state health departments transmit data through existing computer systems using a standard record and data transmission protocol. State and national data are rapidly analyzed at the CDC, and reports of these analyses are transmitted through MINET to the states. Maps based on these data and other tabular displays of demographic and epidemiologic characteristics of the diseases being tracked are periodically prepared and distributed. Because the efficiency, speed, and uniformity of tabulation of this system are greater than those of systems that use protocol and telephonic reports of case totals, the ESP may be a model for future surveillance systems.     

Methods for maternal age-standardization of the incidence of congenital abnormalities

In order to compare the birth incidences of particular congenital abnormalities in different populations, it is often necessary to allow for the effects of maternal age. Three age-adjusted indices are defined, based on analogous indices from the literature on mortality studies, namely, the Standardized Mortality Ratio, the Comparative Mortality Figure and Kerridge's Inverse Method. In most practical situations the differences between them are likely to be trival. However, the first index is maximally efficient under multiplicative risk models and is easily adjusted for incomplete data. The second is the only one to provide valid comparisons under additive, as well as multiplicative, models. The third has the advantage that it does not require a knowledge of the maternal age distribution of all births in the population. The use of the three indices is illustrated with published data on Down's syndrome.