Revista de sanidad e higiene publica最新文献

Background: The commercialization of breast milk substitutes has had great economic transcendence, sometimes without considering the sanitary and nutritional consequences for the customer. The sanitary authorities have been implied in this matter both in the International and European fields, issuing standards and regulations for the commercialization of breast milk substitutes which have been adopted by the Spanish Regulation. The aim of this paper is comment the regulations that affect foods for breast-feeding and short age children.

Methods: This report analyzes and comments on the contents of international, european and national regulation on infant and follow-on formula.

Results: The regulations about Infant formula and Follow-on formula, banning the term of "humanized milk" and remarking the preference for breast feeding, which could only be substituted by sanitary professionals. This regulation deals with the appropriate chemical composition of these products, qualitative and quantitative. It includes standards for correct labeling, which should contain the appropriate information without idealizing the product Drawings and pictures showing the correct preparation are allowed. It provides for distribution and sales, as well as for correct advertising, which should be under control. This regulation also bans free samples and any other donation to particular customers or sanitary institutions.

Conclusions: The present regulation on "Infant and Follow-on formulas" pursues the adequate nutrition of breast-feeding and short age children, being the protection of this kind of customers everyone's responsibility.

The increasing society demands for improved quality in health care are forcing the health care systems to evaluate their organizational performance. Quality activities were initially limited to inspection and final product control, whereas now they are implemented throughout the whole organisation as Total Quality Management. This approach applies specific methodologies which require valid and reliable daily activity data from everyone in the organisation units. A Total Quality Plan for the spanish health care system was set in motion in 1986. From 1986 to 1992 the First Phase of the Plan was carried out: firstly, an appropriate information system was established in order to generate and exploit valid data about activity and cost; secondly a cultural change towards Continuous Quality Improvement was initiated throughout training and implementation of methodologies and tools of Total Quality Management in the National Health Care system institutions. The implementation of a Continuous Improvement general policy as a second phase, requires the explicit commitment of the Health System top management.

Fundamentals: Disaster can be defined as an unusual event for which the impact exceeds the affected community ability to meet the effects using own resources. The aim of the study is review the recent disaster profile of Asturias and assess the applicability of current disaster definitions in our context.

Methods: We considered as disaster each event producing casualties and requiring intervention of the civil protection services during the period 1982-1993, excluding minor transit accidents with no participation of the civil protection services. Date, place, characteristics, mortality and morbidity impact were studied for each event and then analyzed. We studied also current availability health resources in case of disaster.

Results: 14 events were recorded yielding to 88 deceased and 3 injured people (6.28 deaths by event). Aviation accidents were the most frequent event (35.7%) followed by railway, mining, shipwrecks and floods. Shipwrecks had higher mortality impact (36.3% of the total deceased people). Only minor technological disasters has happened in Asturias. This prevalence pattern differs from the spanish one characterized by a double face (natural and technological disasters).

Conclusions: Traditional concept of major disaster cannot be applied to the Asturias context as the exam of our recent epidemiological prevalence pattern shows. Only mayor transit accidents (aviation, railway and shipwrecks) occur and its impact can be easily managed by the current relief community resources. However, an important potential risk of technological disasters exists and it requires have ready sectorial prevention plans.

This paper studies the proportion of the population reached by the programme of universal vaccination against Hepatitis B for children of 13 during the first year since its introduction in Extremadura (Spain). A reach of 96.04% is considered satisfactory and higher than that achieved in other pilot programmes, and even higher than that of other childhood vaccines. This is attributed to the energetic organization of the programme within those activities aimed at children of school age, to the information and participation by the various social and institutional bodies involved, to the work of the Extremaduran Health Education Board, and to the ongoing work of teams of health workers and doctors. There are no significant differences between urban and rural Health Clinics. These differences are to be found in those areas where the aforementioned teams and the traditional model have begun to operate. Given the existing health system in this country and the widespread nature of the illness, it is assumed that the most effective method of vaccination would be that aimed at the high-risk population, the children of mothers who are carriers, and universal vaccination of school-age children.

Background: The occurrence of an outbreak needs an immediate investigation, because on it depends the necessary measures to control the spread of the epidemic, and it is also the way of knowing the causal factor. We present the results of the investigation of two food poisoning outbreaks (outbreak A and outbreak B) occurred in Mora (Toledo). Both outbreaks were reported at the same time, the source of infection was the same and the total number of exposed people was 620.

Methods: A case-control study was carried out. A standardised questionnaire for food poisoning outbreaks was used to collect the data. Data were analysed using classic methods and also logistic regression models.

Results: A total of 236 individuals were interviewed (119 for outbreak A and 117 for outbreak B), 146 of them were cases (73 in each outbreak). The mean incubation period was of 26.18 (+/- 12.35) and 25.2 (+/- 19.9) hours respectively. The main symptoms were diarrhoea, fever and abdominal pain. The mean age of the cases was 43.42 (+/- 17.03) years old for outbreak A and 42.4 (+/- 19.9) for outbreak B. The statistical analysis showed a significant association between the intake of cake and the disease (adjusted odds ratio = 25.00; 95% confidence interval = 6,4996.15 for outbreak A and adjusted odds ratio = 64.62; 95% confidence interval = 8.10-515.3 for outbreak B). We also obtained a laboratory confirmation showing the presence of Salmonella Entérica I, Infantis 6.7:r:1.5 in samples of cases, cake and samples of the person who prepared the cake.

Conclusions: The logistic regression model, used for the analysis was useful to detect and summarise data in a more efficient manner than simple stratified analysis. The collaboration of the Primary Health Care professionals contributed to the success of the investigation.

Background: The poor development of systems of occupational surveillance in Spain is an important obstacle for implementing effective occupational health programmes. The objective of this study is to evaluate the utility and feasibility of an occupational health surveillance system in a Health Area, using the available public sanitary resources, between 1991 and 1993.

Methods: The surveillance system is based on the identification of Sentinel Health Events (Rutstein and cols.) from registers or by notification, obtaining additional information through the procedure of interview. Distribution of cases by condition, level of response to the interviews, and distribution of cases according to its source of information are analysed. The evaluation is made on the following criteria: required elements, utility, representativeness, choice between sensibility and specificity, and limitations.

Results: 314 sentinel health events were identified, from which, in 33 cases, occupational exposure to causal agents was confirmed. The occupational diseases notified from compensation systems were 31. 3 cases of interstitial pneumonia were identified, that allowed the detection of an outbreak in textile workers.

Conclusions: The implementation of systems of occupational surveillance, in the actual spanish sanitary context, should take into account the following aspects: organizational flexibility, efficiency, and orientation towards intervention.

Background: Objective. 1. To know the primary and secondary chief complaints. 2. To obtain health problems incidence and prevalence rates of the population attended. 3. To evaluate the usefulness of a selective morbidity registry, of certain complaints in order to elaborate assistance quality indicators.

Methods:

Design: Descriptive cross-sectional study. Site: Health urban center (Nazaret, Valencia) for primary assistance.

Participants: Randomized sample of patients attended during a year (n = 2898). Age, sex and case history number were recorded as well as whether the complaint was chief, secondary, new or known.

Results: Among all the problems recorded, the bureaucratic ones (prescriptions) accounted for 11.6% (IC95%: 4.3 +/- 12.8), working disability certificates due to health being 5.1% (IC95%: 4.3 +/- 5.9). Among the patients attended there was an incidence rate of 10(5) year patients in the acute respiratory infections of 12584.3, acute bronchitis was 2516.8 showing the highest prevalence those regarding administrative sources and attention of chronic pathologies.

Conclusions: A morbidity record with the characteristics mentioned leads to the knowledge of the problems of the population attended and to assess some aspects of assistance quality (disease cases avoidable by vaccine, assistance administrative charge, health training activities during the consult ...), especially when these sampling are performed periodically.

Background: Several agents are able to produce lymphocytic meningitis, but sometimes it's not possible their identification. The viruses are the etiological agents more frequently found, especially enteroviruses, mumps virus and herpes simplex virus, with different epidemiological patterns depending on time and geographic location. Most of the infections caused by enteroviruses are asymptomatics. In general the viral meningitis have a good prognostic with an acute benign course and serious signs of neurological affectation are infrequent. From 1991 it has been observed an increase of nonpolio enteroviral meningitis outbreaks in our Country. Echovirus-4 was isolated in most of the outbreaks notified during that year. Echovirus-9 was not isolated in any of them.

Methods: We describe the epidemiological and clinical characteristics of a lymphocytic meningitis outbreak that took place from June to July of 1993 in Burgos.

Results: Forty-eight patients, most of them children, were hospitalized with fever, headache, vomits and stiff neck with an increase in the total cell count in cerebospinal fluid (CSF). Echovirus-9 was isolated from fecal samples in eight patients.

Conclusions: The etiology was attributed to Echovirus-9 because of microbiologic and epidemiologic findings. The incubation period can fluctuate between four an five days and fecal-oral transmission is the most probable mechanism.

Background: Of among the different measures systems of hospital production, we adopted the Diagnosis Related Groups (DRG) approach for the management of the cases series of the "Arnau de Vilanova" Hospital (Valencia, Spain). The use of hospital services makes it possible to establish the number of patients attended and in which services, while pathology distribution reflects the types of patients who makes us of the hospital.

Methods: A transverse study was made, reviewing the clinical histories of the hospitalized patients and applying an autoexcluding medical or surgical DRG designation. Patient inspection and comments with the healthcare staff afforded greater specifications. We included all patients hospitalized between May 11 and 24, 1992, i.e., 263 in total, corresponding to 2.53% of the annual hospitalizations in 1992.

Results: The most frequently employed services were Internal Medicine and General and Digestive Surgery. Hospital activity was defined by 90 DRGs, the GDRGs most associated to hospital (nosocomial) infection being HIV-positive individuals, those operated on for inguinal hernia, and oncological patients with laryngeal cancer.

Conclusions: Hospital activity was found to be concentrated in high volume DRGs--one of them being the Medical Type "non-groupable diseases due to clinical incompleteness of the management parameters, as a result of which this information remained undetermined.