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PubMed2005

Tuberculosis deaths in countries with high HIV prevalence: what is their use as an indicator in tuberculosis programme monitoring and epidemiological surveillance?

Although the reduction of tuberculosis deaths is one of the aims of tuberculosis control, it has not always been a priority for National Tuberculosis Programmes (NTPs). The usual explanation is that death as a treatment outcome not associated with ongoing tuberculosis transmission is not relevant to the public health objective of cutting the cycle of disease transmission. However, death as an adverse outcome for tuberculosis patients and their families is an important indicator in NTP monitoring. Global health targets agreed as part of the Millennium Development Goals include the reduction of tuberculosis deaths. Tuberculosis deaths as an indicator of the impact of tuberculosis control measures are therefore important in the epidemiological surveillance of progress towards these targets. These considerations are particularly important in countries with high human immunodeficiency virus (HIV) prevalence where HIV has exacerbated the tuberculosis epidemic and is now the single best predictor of tuberculosis incidence. Tuberculosis deaths are also closely linked to HIV prevalence. Routine NTP data on tuberculosis cohort deaths are important in programme monitoring, and improvements in recording and reporting of deaths would help to overcome limitations in their accuracy. As routine NTP data on tuberculosis cohort deaths are insufficient as an indicator in epidemiological surveillance regarding the impact of NTPs on tuberculosis mortality, measuring progress towards targets for reduced tuberculosis deaths depends on improved national vital registration systems for a more accurate determination of tuberculosis mortality.

Environmental Monitoring↗
PubMedDate not supplied

[Air pollution, climate change and health].

Emissions into the atmosphere related to the climate change may further worsen the effects which air pollution has on the health of our citizens, not only indirectly due to the impact of weather phenomenon, but directly, due to the direct effects pollutants have on health. However, the efforts throughout most of the world have been aimed at dealing with these two problems separately for too many years. In fact, it is very often believed that the climate's health-safeguarding benefits would be achieved in the long term. To the contrary, what has become obvious over recent years is that the actions for reducing the emissions of polluting gases could redound in beneficial effects in the short term due to the reduction of the impact of air pollutants on the health of our citizens. This article presents the possible risks of the pollutants most closely related to climate changes, such as ozone and fine particles. Bearing in mind the uncertainties and unknowns related to this subject, the main implications for the policies related to this matter in Spain, as well as the needs for research are set out herein. In this regard, both from the standpoint of monitoring as well as research, it is considered necessary for an epidemiological monitoring system of the effects of air pollution and the relationship thereof to global changes to be established.

Air Pollutants↗
PubMed1995

Molecular epidemiology and human risk monitoring.

Molecular epidemiologic research involves the identification of relations between previous exposure to some putative causative agent and subsequent biological effects in a cluster of individuals in populations. There is intensive current research in the field of molecular epidemiology, and this research has a direct impact on risk assessment processes. Many of the challenges facing risk assessors today can be addressed by research focused on developing a better understanding of (a) exposure characteristics or assessment, (b) the relationship between exposure and dose, and (c) the ultimate exposure/dose effect response relationship. Results from this research can be used to design and implement preventive interventions in at risk populations. Thus, the application of research in exposure assessment and molecular epidemiology to risk assessment and preventive interventions makes this a core program for public health.

Animals↗
PubMed1995

Babesia divergens: an ELISA with soluble parasite antigen for monitoring the epidemiology of bovine babesiosis.

An enzyme linked immunosorbent assay (ELISA) for bovine babesiosis caused by Babesia divergens was developed to analyse the evolution of the serological status of cattle living in an enzootic area. The antigen used was a soluble extract of B. divergens obtained from in vitro culture. Specificity, evaluated with negative sera, was 96.6%. The ELISA was compared to indirect immunofluorescence analysis (IFA) on naturally or experimentally infected animals. It appeared that IFA was positive for at least seven or eight weeks; on the contrary, B. divergens-specific antibodies were only transitorily detected by ELISA. Furthermore, the ELISA was more sensitive than the IFA for the detection of post-infection antibody increases, particularly when infection-pressure was low. These results suggest that IFA and ELISA could be complementary tools in epidemiological surveys; indeed, this ELISA could be the most efficient tool to detect new infections in cohort monitoring.

Animals↗
PubMed1996

Quality assessment of a prenatal screening program.

Epidemiologic monitoring is a process which uses data generated from the screened population as a quality control measure. Most commonly, laboratories monitor the percentage of women with screen positive test results, i.e., with test results falling at or above a specified multiple of the median (MoM) for open neural tube defect screening or, with a risk at or above a specified risk cut-off for Down's syndrome screening. These percentages are sensitive to inaccurate and imprecise assays, inappropriate reference data, and long term assay drift. In fetal Down's syndrome screening it is necessary to simultaneously monitor two or more assays, which is accomplished by monitoring the median MoM for each assay (which should be 1.0 within statistical limits) calculated using patient MoM values. Monitoring the median MoM can identify inappropriate adjustment factors for variables which affect the MoM such as maternal weight. Epidemiologic monitoring is a useful tool for identifying problems which are not readily apparent using traditional quality control measures.

Down Syndrome↗
PubMed1995

[Perspectives on fair legislation for the assurance of animal health in the countries of the European Union].

The paper provides an overview of Community legislation on the safeguarding of animal health and comments on topical amendments that are being discussed. Special attention is given to the amendment of Directive 64/432/EEC the content of which can be summarised as follows: 1. More stringent requirements for intra-Community-and from a date to be fixed-national trade in bovine animals for breeding and production. Approval of farms of origin shall be mandatory. Holdings are approved only if they participate in the epidemiological monitoring system agreed in the council. This means that the farm is regularly controlled by the "responsible veterinary surgeon" (= veterinary practitioner). 2. More stringent requirements for the intra-Community trade in pigs for breeding and production. The approval of farms and thus their participation in the monitoring systems shall be compulsory in the case, too. 3. Inclusion of carcass disposal plants in the system of epidemiological monitoring through the introduction of a mandatory reporting system if larger numbers of dead animals are removed. 4. More stringent hygiene requirements for all cattle and pig transports.

Animal Husbandry↗
PubMedDate not supplied

[The Madrid autonomous community epidemiological bulletin. A survey on its dissemination and opinion thereof on among primary care physicians for the year 2000].

BACKGROUND: The Autonomous Community of Madrid Epidemiological Bulletin is the main communications link between epidemiological monitoring system and health care professionals. The purpose of this study is that of ascertaining the dissemination and opinion of this Autonomous Community of Madrid Epidemiological Bulletin among primary care physicians for the purpose of adapting this publication to its readers' interests. METHOD: A telephone survey among primary care physicians in the Autonomous Community of Madrid, asking how often they read the Bulletin, the interest and usefulness of the information included in it. The sample size was estimated at 346 physicians. A two-stage sampling process was carried out-by cluster sampling in the first stage, randomly selecting 125 health care centers and 2.7 physicians per center, 17% being primary care team coordinators. A comparison is made of the results among physicians and coordinators by means of the Chi-square and Fisher's Exact Test method, with Epi-Info v.6. RESULTS: A total of 305 surveys were conducted (245 physicians and 60 coordinators). There was an awareness of the existence of the Autonomous Community of Madrid Epidemiological Bulletin on the part of 91.5% (CI 95%: 88.1-94.8), and 27.2% (CI 95%: 21.9-32.5) were familiar with more than 50% of the last issues published. A total of 92.4% (CI 95%: 89.4-95.8) considered the Bulletin to be interesting or highly interesting, grading its usefulness an average of 3.5 on a maximum scale of 5. Of the permanent sections, the most highly-valued was Epidemic Outbreaks, those reports related to meningococcal infection, tuberculosis and HIV/AIDS being the most highly-valued. CONCLUSIONS: The Autonomous Community of Madrid Epidemiological Bulletin is a publication which, although not widely-known by the primary care physicians in the Community, is well-valued when it is read, thus being a useful feedback tool within the Epidemiological Monitoring System.

Adult↗
PubMedDate not supplied

Prospective lung health monitoring in relation to a new power plant.

A new power plant has been in operation in Ashkelon since the end of 1990. In order to record the effect of the environmental changes on lung health, a prospective monitoring system was established during the planning and construction phase of the plant. Data about lung health in the general population as well as the sensitive population (asthma patients) are recorded, and air pollution is monitored by seven monitoring stations located within a 5-25 km radius of the power plant. The lung health monitoring system includes: (1) A record of all visits to the local emergency room. (2) A record of visits to ten representative outpatient clinics related to cardiac and pulmonary symptoms. (3) A close follow-up of 200 asthmatic children enrolled in the local pediatric pulmonary clinic. This includes spirometry four times yearly, an annual winter check-up by a pediatric pulmonologist, and daily symptoms diary filled in by each patient for two weeks after the spirometry. (4) Spirometry and health questionnaires filled out by the parents of the 3600 studied children once in three years. (5) Mortality rate monitoring, relying on the Ministry of Health death registration. This system has been in operation since 1988, collecting base line data; the follow-up is planned to be operating for ten years. A dynamic interaction of the environmental and epidemiological monitoring systems will facilitate more efficient control of the emmissions from the power plant and better protection of the health of the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed2003

Questionnaires, spirometry and PEF monitoring in epidemiological studies on elderly respiratory patients.

Questionnaires are the most used subjective instrument of measurement in respiratory epidemiology. The standardisation of the questionnaires aims to limit bias by maximising validity and reliability, and comparability. Within the European Union project BIOMED1, a compendium of respiratory standard questionnaires (CORSQ) was developed for adults covering 18 topics from general information to early life events, through environmental risk factors and respiratory symptoms and diseases. Reliable spirometry data needs a rigorous quality control programme, as in the "Salute Respiratoria nell'Anziano" (Sa.R.A.) project, Italian for "Respiratory Health in the Elderly". Reproducibility rates were 95.8% for forced expiratory volume in one second (FEV1). Male sex and age were independent risk factors for a poorer reproducibility, as well as cognitive and physical impairment (shorter 6-min walking distance) and lower educational level for a poorer acceptability. Reference values for people aged 65-85 yrs have been produced; these results suggest that the effect of aging should be corrected for physical and mental disability. A revision of interpretative strategies included in current guidelines is needed. Peak expiratory flow monitoring has several methodological problems: reliability and sensitivity of the measurement in order to detect changes in airway calibre; compliance with long-term monitoring; choice of the best variability index; difference between asthmatic and nonasthmatic subjects; age-related differences. Despite these methodological problems, peak expiratory flow monitoring has been successfully used in the evaluation of the effects of air pollution in normal and asthmatic subjects, and in the elderly.

Adult↗
PubMedDate not supplied

[Detection of epidemics from the Compulsory Disease Report. The case of measles in Las Palmas].

The system of Compulsory Disease Reports (CDR) is an epidemiological monitoring regarding cases of contagious diseases which has been in use in Spain for over forty years. In 1982, new additions were made to the list of diseases for which a report is to be filed and, since that time, it was insisted upon that the centers falling under the National Health Institute be included among those having to file said reports. Nevertheless, many physicians question the need for this system and its usefulness. The cases of measles for which reports were filed in the province of Las Palmas from 1983 to 1988 were studied. Two waves of epidemics, occurring in early 1983 and in mid-1988, were observed, being patently distinguished from the noise of the reports between. Both waves of epidemics coincide with the hospitalization of cases of measles-related pneumonia in the pediatric hospital of that province. Based on these waves of epidemics, the importance of carrying out accurate measles vaccination studies for immunizing the populations against this disease is implied. The epidemiological importance of this CDR system is discussed both from a historic point of view and from that of epidemiological monitoring, and the need of drawing up and using operational definitions for each one of the diseases which is to be reported is reiterated. In conclusion, a positive evaluation of the usefulness of the CDR system, in spite of its current limitations, is provided, for which reason the importance of continuing to improve this system is stressed.

Communicable Disease Control↗
PubMedDate not supplied

[Human immunodeficiency virus infection and AIDS in Aquitaine. 10 years' experience of a hospital information system, 1985-1995. Le Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA)].

OBJECTIVES: To describe the hospital-based information system developed by the GESCA (Clinical epidemiology group on AIDS in Aquitaine) and evaluate the main results obtained over the last 10 years, specifically data related to epidemiological monitoring, medico-economic analysis and clinical research in HIV infection. METHODS: Inclusion criteria were HIV-1 seropositivity confirmed by Western blot, age over 13 years, consultation or hospitalization is one of the 18 participating units. Follow-up data were collected at each hospital visit. RESULTS: On December 31, 1995, 4268 subjects had been registered in the GECSA system, including 25.7% women. Contamination categories were homosexuals 33.4%, intravenous drug abusers 32.8%, heterosexuals 13.9%. A clear drop in the number of new cases in intravenous drug abusers and an increase in the number with heterosexual transmission was observed after 1988. The medico-economic analysis showed that patients followed in the system were in a more advanced stage at registry since 1992. More than half of the subjects are now taking antiretroviral therapy and prophylaxis for opportunistic infections. Clinically, after adjusting data for the major known prognosis factors, the risk of progression to AIDS is higher in homosexuals and intravenous drug abusers than in heterosexuals. Transmission route does not however have any significant effect on survival after development of AIDS. There is no significant difference in outcome of HIV infection between men and women and pregnancy is not associated with poorer outcome. CONCLUSION: This regional registry provides valuable data for epidemiological monitoring, medico-economic analysis, hospital management and clinical research.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Influence of set-up conditions of exposure indicators on the estimate of short-term associations between urban pollution and mortality.

In the past few years many studies on air pollution and health based on time series have been carried out. Yet, this approach does not assess exposure to air pollution at an individual level but it is based on ambient concentrations measured by air quality monitoring networks. Questions on the estimates of exposure to pollutants have been raised, in particular the fact that background measuring stations only have been considered in the set up of pollution indicators. To assess the impact of exposure indicator characteristics on the results of time series analysis, two series (black smoke and sulfur dioxide, respectively) of exposure indicators to urban air pollution were set up taking into account a growing part of proximity measures (industrial sources) available in the studied urban area (Le Havre, France). For each pollutant, indicators distributions were almost similar, especially for black smoke. Whatever the pollutant, the most obvious heterogeneity could be observed between the 100% background indicator and the indicator including the arithmetic mean for all the stations (50% background stations and 50% proximity stations). Then the sensitivity of the associations between mortality and air pollution to these indicators was studied. These indicators did not show statistically significant differences in the estimated excess risk. Yet, confidence intervals were more statistically significant as the contribution of proximity stations was more substantial, in particular for SO2. To conclude, the use of proximity measurements did not influence dramatically on the mean estimates of the association between air pollution and mortality indicators in Le Havre. Therefore it does not seem relevant to include the data provided by the proximity stations in the urban exposure indicators within the context of the epidemiology monitoring system.

Air Pollutants↗
PubMed1994

Staphylococcus aureus phage typing, antimicrobial susceptibility patterns and patient data correlated using a personal computer: advantages for monitoring the epidemiology of MRSA.

Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA) is an important nosocomial pathogen. A problem encountered in the control of staphylococcal nosocomial infection is the difficulty correlating data available from antimicrobial susceptibility patterns (usually available locally) with phage typing patterns which are generally determined in a reference laboratory. Data problems are exaggerated because many patients have numerous samples taken over long periods of time. This paper describes the use of a database, 'DataEase', on a personal computer to correlate available data with patient demographics and to present the resulting information in whatever format is required. The information might be presented as the phage pattern of each isolate from patients in a particular unit per month or as a combination of the phage types and antimicrobial susceptibility patterns of isolates from a particular unit. The system can be used to generate a list of all isolates for phage typing in a format that allows the phage typing pattern to be recorded directly onto the list worksheet. In addition to providing clinically relevant reports, the system simplifies the collation of epidemiological information, data from which showed that since 1987 the incidence of MRSA has been rising in the group of hospitals served by this laboratory; MRSA of phage type 83A became a problem during 1990 and 1991; the incidence of gentamicin-sensitive phage type non-typable MRSA increased fourfold between 1988 and 1991; and the incidence of gentamicin-resistant MRSA rose sharply in 1992.

Bacteriophage Typing↗
PubMed2004

Use of molecular epidemiology to monitor the nosocomial dissemination of methicillin-resistant Staphylococcus aureus in a university hospital from 1991 to 2001.

Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period I, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.

Brazil↗
PubMedDate not supplied

Significance of the positivity of some ELISA tests different as concerning the antigenic source in interpreting the western blot indeterminate sera in monitoring the epidemiology of high risk populations.

The paper analyses 50 pairs of sera pre-elevated within the "sentinel" epidemiological surveillance in a population exposed to a high risk at a 2 months interval. At the first determination all these sera showed an indeterminate Western Blot pattern; after 2 months, 93.7% revealed the occurrence of a certainly positive pattern. The paper is an analysis of the way in which different ELISA kits diagnosed at the first determination the Western Blot indeterminate sera. The purpose of the paper is to adopt a methodology of accurately diagnosing HIV infections in a population exposed to a high risk within an epidemiological surveillance of the "sentinel" type where the receiving of a second serum sample is quite difficult.

AIDS Serodiagnosis↗