Health Department Surveillance Research Articles

Risk factors for tuberculosis-related death among adults with drug-sensitive pulmonary tuberculosis in Selangor, Malaysia from 2013 to 2019: a retrospective cohort study using surveillance data

ObjectivesDue to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB)...

Organização da atenção e vigilância em saúde na atenção primária frente à COVID-19 em municípios do Nordeste brasileiro

Abstract The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration.

Engaging Black or African American and Hispanic or Latino Men Who Have Sex With Men for HIV Testing and Prevention Services Through Technology: Protocol for the iSTAMP Comparative Effectiveness Trial.

Gay, bisexual, and other men who have sex with men (MSM), particularly Black or African American MSM (BMSM) and Hispanic or Latino MSM (HLMSM), continue to be disproportionately affected by the HIV epidemic in the United States. Previous HIV self-testing programs have yielded high testing rates, although these studies predominantly enrolled White, non-Hispanic MSM. Mobile health tools can support HIV prevention, testing, and treatment. This protocol details an implementation study of mailing free HIV self-tests (HIVSTs) nested within a randomized controlled trial designed to assess the benefit of a mobile phone app for increasing the uptake of HIV prevention and other social services. This study was a comparative effectiveness trial of innovative recruitment and testing promotion strategies intended to effectively reach cisgender BMSM and HLMSM. We evaluated the use of a mobile app for increasing access to care. Study development began with individual and group consultations that elicited feedback from 3 core groups: HIV care practitioners and researchers, HIV service organization leaders from study states, and BMSM and HLMSM living in the study states. Upon completion of the formative qualitative work, participants from 11 states, based on the observed areas of highest rate of new HIV diagnoses among Black and Hispanic MSM, were recruited through social networking websites and smartphone apps. After eligibility was verified, participants consented and were randomized to the intervention arm (access to the Know@Home mobile app) or the control arm (referral to web resources). We provided all participants with HIVSTs. The evaluation of the efficacy of a mobile phone app to support linkage to posttest prevention services that included sexually transmitted infection testing, pre-exposure prophylaxis initiation, antiretroviral treatment, and acquisition of condoms and compatible lubricants has been planned. Data on these outcomes were obtained from several sources, including HIVST-reporting surveys, the 4-month follow-up survey, laboratory analyses of dried blood spot cards returned by the participant, and data obtained from the state health department surveillance systems. Where possible, relevant subgroup analyses were performed. During the formative development phase, 9 consultations were conducted: 6 in-depth individual discussions and 3 group consultations. From February 2020 through February 2021, we enrolled 2093 MSM in the randomized controlled trial from 11 states, 1149 BMSM and 944 HLMSM. This study was designed and implemented to evaluate the effectiveness of recruitment strategies to reach BMSM and HMSM and of a mobile app with regard to linkage to HIV prevention or treatment services. Data were also obtained to allow for the analyses of cost and cost-effectiveness related to study enrollment, HIV testing uptake, identification of previously undiagnosed HIV, sexually transmitted infection testing and treatment, and linkage to HIV prevention or treatment services. ClinicalTrials.gov (NCT04219878); https://clinicaltrials.gov/ct2/show/NCT04219878. DERR1-10.2196/43414.

Impact of molecular sequence data completeness on HIV cluster detection and a network science approach to enhance detection

Detection of viral transmission clusters using molecular epidemiology is critical to the response pillar of the Ending the HIV Epidemic initiative. Here, we studied whether inference with an incomplete dataset would influence the accuracy of the reconstructed molecular transmission network. We analyzed viral sequence data available from ~ 13,000 individuals with diagnosed HIV (2012–2019) from Houston Health Department surveillance data with 53% completeness (n = 6852 individuals with sequences). We extracted random subsamples and compared the resulting reconstructed networks versus the full-size network. Increasing simulated completeness was associated with an increase in the number of detected clusters. We also subsampled based on the network node influence in the transmission of the virus where we measured Expected Force (ExF) for each node in the network. We simulated the removal of nodes with the highest and then lowest ExF from the full dataset and discovered that 4.7% and 60% of priority clusters were detected respectively. These results highlight the non-uniform impact of capturing high influence nodes in identifying transmission clusters. Although increasing sequence reporting completeness is the way to fully detect HIV transmission patterns, reaching high completeness has remained challenging in the real world. Hence, we suggest taking a network science approach to enhance performance of molecular cluster detection, augmented by node influence information.

Casos e óbitos por COVID-19 e tabagismo nas capitais e regiões brasileiras: estudo ecológico

Objetivo: Analisar a relação entre casos e óbitos por COVID-19 e o percentual de tabagistas nas capitais e regiões do Brasil. Métodos: Realizou-se estudo ecológico nas regiões brasileiras do número de casos e óbitos por COVID-19, de março a dezembro de 2020, e a prevalência de tabagismo em 2019, a partir dos bancos de dados do Painel Coronavírus da Secretaria de Vigilância em Saúde e do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL – 2019). Com informações extraídas em janeiro de 2021, calcularam-se os coeficientes de incidência e mortalidade por COVID-19 por capital brasileira e região, bem como se utilizou a correlação de Pearson para verificar a relação entre as variáveis do estudo. Adotou-se nível de significância de 5%. Resultados: Análises bivariadas mostraram correlações positivas entre tabagistas do sexo feminino e coeficiente de incidência de COVID-19 nas capitais da região do Centro-Oeste (r=0,957; p=0,043), e entre fumantes do sexo masculino e coeficiente de mortalidade de COVID-19 nas capitais do Nordeste (r=0,706; p=0,034). Conclusão: O tabagismo teve impacto na incidência de casos e óbitos por COVID-19 em diversas capitais brasileiras, alertando que o fumo pode ser fator de predisposição e agravamento do estado clínico dos pacientes.

Integration among national health information systems in Brazil: the case of e-SUS Primary Care.

ABSTRACTOBJECTIVE:To measure the degree of integration of the Electronic Citizen’s Record (PEC - Prontuário Eletrônico do Cidadão) of the e-SUS Primary Care Strategy (e-SUS AB - Estratégia e-SUS Atenção Básica) in the view of other Brazilian´s National Health Information Systems (SNIS - Sistemas Nacionais de Informação em Saúde), relating to the internal political-organizational structure of the Brazilian Ministry of Health (MH).METHODS:This is a qualitative case study. Data collection was carried out through document analysis and semi-structured interviews. In the first stage, we sought to clarify how many SNIS were in use in the Primary Care (PC) of the Unified Health System between 2013 and 2017. Then, we defined as criterion the maintenance of data collection interfaces by the Ministry of Health even after the implementation of the PEC/e-SUS Primary Care in order to measure the integration.RESULTS:31 SNIS were identified in Primary Care. We observed that 12 of them were completely integrated and 15 presented no unification of interfaces related to PEC/e-SUS Primary Care. Another 4 have partial integration. By correlating these data with the political-organizational structure of the MS, we observed a greater integration with the systems managed by the Department of Primary Care and a persisted fragmentation in SNIS, especially those under the management of the Health Surveillance Department (Secretaria de Vigilância em Saúde). The disparity between the integration of the PEC/e-SUS Primary Care with the Health Surveillance SNIS is a sign of the persistence of the division and the false dichotomy between Health Care and Health Surveillance practices and processes in the Ministry of Health – even 30 years after the foundation of the SUS and unification of the state structures of social security hospital care and federal public health in MH.CONCLUSION:Although still insufficient, the systems integration carried out by the e-SUS Primary Care Strategy, which focuses on reducing user interfaces, can be considered a new fact on the SUS information and information policy agenda.

Profile of the structure, team and work of Health Surveillance in the VI Health Region of Pernambuco

Introdução: A descentralização e a municipalização da Vigilância Sanitária são preceitos do sistema único de saúde, pois sabe-se que as condições de gestão que os municípios vivenciam podem interferir nas ações a serem realizadas. Objetivo: Descrever o perfil da Vigilância Sanitária da VI Região de Saúde de Pernambuco. Método: Trata-se de um estudo com abordagem quantitativa descritiva, com dados secundários. Os dados fazem parte de um questionário elaborado e aplicado pelo departamento de Vigilância em Saúde da VI Gerência Regional de Saúde. Os dados foram analisados por estatística descritiva e apresentados em tabela. Resultados: Todos os municípios possuem coordenador, sendo a maioria efetivos e com curso superior da área de saúde. Estão com a equipe incompleta, contudo grande parte possui capacitação no Curso Básico de Vigilância Sanitária. Realizam reunião de equipe mensal, planejamento anual de ações e também avaliação de indicadores próprios. Não participam dos gastos do Programa de Qualificação das Ações de Vigilância em Saúde. Trabalham com sistema de vigilância sanitária, emitem licença de funcionamento, não trabalham com código sanitário e suas principais atividades são as inspeções. Possuem espaço físico adequado, com os materiais necessários e a maior dificuldade é o transporte. Conclusões: Entender o perfil da Visa municipal é essencial para que haja crescimento e eficácia na gestão. A Visa ainda passa por situações desfavoráveis devido a descentralização, mas as informações evidenciadas no estudo demonstram um avanço.

Campylobacter-associated hospitalisations in an Australian provincial setting

BackgroundCampylobacter spp. infections are a globally important cause of enterocolitis, causing substantial morbidity. Capturing accurate information on hospitalisations is challenging and limited population-level data exist to describe the clinico-epidemiological characteristics of hospitalised cases.MethodsHospital administrative and laboratory datasets were linked to identify Campylobacter-associated hospitalisations between 2004 and 2013. Accuracy of morbidity coding was assessed using laboratory diagnosis as a gold standard, with health department surveillance data used to calculate population-based rates. Additional patient-level data were collected via review of medical records. Descriptive statistics were used to assess changes in rates and proportions and to assess relationships between key variables including age, length of stay, comorbidity and complications.ResultsIn total 685 Campylobacter-associated hospital admissions were identified, with the sensitivity of morbidity coding 52.8% (95% CI 48.9–56.7%). The mean annual rate of hospitalisation was 13.6%. Hospitalisation rates were higher for females across most age-groups, while for both genders marked increases were observed for those aged ≥60 years. Median admission age was 39.5 years, with an average length of stay of 3.5 days. Comorbidities were present in 34.5% (237/685) of admissions, with these patients more likely to develop electrolyte disturbances, hypotension, renal impairment or acute confusion (all p < 0.001). Bacteraemia and acute kidney injury were observed in 4.1% (28/685) and 3.6% (23/685) of admissions, respectively. Inpatient mortality was low (0.15%).ConclusionUnder reporting of Campylobacter-associated hospitalisations is substantial but can be improved through data linkage. We observed demographic differences among those hospitalised but further work is needed to determine risk factors and predictors for hospitalisation.

Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance.

This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that comprises the 2020 Clinical Protocol and Therapeutic Guidelines (PCDT) for Comprehensive Care for People with STI, published by the Health Surveillance Department of the Brazilian Ministry of Health. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women, and congenital syphilis. The 2020 PCDT-IST was elaborated grounded on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, and health service managers' guidelines regarding programmatic and operational management of these diseases are presented. Guidelines for health professionals on screening, diagnosing, and treating people with STI and their sex partners, in addition to strategies for surveillance, prevention, and control actions, are also published.

Correlated prevalence of hydrocele and microfilaremia in Amazon (Belém, 1951-2005).

For decades, the city of Belém in Brazil's eastern Amazon was the second city in the country with highest prevalence of cases of filariasis due to Wuchereria bancrofti infection. However, this prevalence decreased over time until reaching null records, concomitantly with a decrease in frequency of recorded hydrocele cases. In this context, we analyzed cross-sectional data to evaluate the degree of correlation between prevalence of positive blood microfilariae results during surveillance screening occurred along 54 years (1951-2005) and prevalence of hydrocele cases recorded in the same time period. The dataset regarding hydrocele cases was obtained from two local hospitals. The Endemic Diseases Control Division of the Health Surveillance Department of the Municipal Health Department of Belém provided dataset regarding positive blood microfilariae cases. Prevalence calculus and linear correlation statistics were performed. Both positive blood microfilariae and hydrocele cases are well correlated statistically in absolute frequency (r = 0.871, 95%CI = 0.788 to 0.923, R2 = 0.759, p < 0.0001) and in prevalence (r = 0.835, 95%CI = 0.732 to 0.901, R2 = 0.698, p < 0.0001). We have concluded that blood microfilariae detection and hospitalized hydrocele cases are well correlated in our dataset. In addition, these results support the hypothesis that hydrocele prevalence can be useful to filariasis surveillance and control in endemic areas. However, limitations to hydrocele prevalence as an epidemiological indicator of filariasis are evidenced.

Protection of the rights of people in situations of violence

Abstract The Municipal Health Department of the city of Diadema, São Paulo, Brazil, has the Health Promotion and Violence Prevention Center focused on prevention, reception and protection of the rights of people in situations of violence. Articulation of the epidemiological, health and health surveillance actions of the worker with the psychosocial care network (in the field of mental health). What is the role of the Health Surveillance in the network of attention and protection for people in situations of violence? What is the health status of the places that shelter people in mental distress? How to intervene in situations of psychological violence at work? Violence is an important public health problem, considering the impact it has on the lives of people, families and communities. Violence is a complex, multifactorial phenomenon that can leave deep marks. From the users-guide were produced new arrangements in the production of care involving the surveillance teams, in intra and intersectoral interlocution, analyzing the situations, unfolding in the construction of other work processes and qualified interventions. In Diadema, the three health surveillance departments (Epidemiology, Reference Center in Occupational Health and the Health Surveillance department) developed strategies aimed at the qualification of comprehensive attention to people and integrating the Network of Psychosocial Care (RAPSI). The users in violence were treated with priority by the health services and the intervention was immediate. We observed that health services are more sensitive to dealing with cases of violence. The intervention requires the establishment of a network of attention and care for people in situations of violence. The interventions contributed to the prevention of violence and the promotion of health and the exchange of comprehensive care practices for people living in situations of violence and population segments at risk. Key messages The articulation of a network of protection for people in situations of violence exposes institutional violence and social vulnerabilities in order to intervene in the determinants. The compulsory notification of situations of interpersonal and self-harm inflicted violence is the basis for the action of care, prevention of violence and promotion of health.

Can Machine Learning Help Identify Patients at Risk for Recurrent Sexually Transmitted Infections?

A substantial fraction of sexually transmitted infections (STIs) occur in patients who have previously been treated for an STI. We assessed whether routine electronic health record (EHR) data can predict which patients presenting with an incident STI are at greatest risk for additional STIs in the next 1 to 2 years. We used structured EHR data on patients 15 years or older who acquired an incident STI diagnosis in 2008 to 2015 in eastern Massachusetts. We applied machine learning algorithms to model risk of acquiring ≥1 or ≥2 additional STIs diagnoses within 365 or 730 days after the initial diagnosis using more than 180 different EHR variables. We performed sensitivity analysis incorporating state health department surveillance data to assess whether improving the accuracy of identifying STI cases improved algorithm performance. We identified 8723 incident episodes of laboratory-confirmed gonorrhea, chlamydia, or syphilis. Bayesian Additive Regression Trees, the best-performing algorithm of any single method, had a cross-validated area under the receiver operating curve of 0.75. Receiver operating curves for this algorithm showed a poor balance between sensitivity and positive predictive value (PPV). A predictive probability threshold with a sensitivity of 91.5% had a corresponding PPV of 3.9%. A higher threshold with a PPV of 29.5% had a sensitivity of 11.7%. Attempting to improve the classification of patients with and without repeat STIs diagnoses by incorporating health department surveillance data had minimal impact on cross-validated area under the receiver operating curve. Machine algorithms using structured EHR data did not differentiate well between patients with and without repeat STIs diagnosis. Alternative strategies, able to account for sociobehavioral characteristics, could be explored.

Incidence of acute hepatitis C in Brazil: temporal trend of cases notified between 2007 and 2018

Introduction: With the improvement of biosafety and quality of blood products, hepatitis C virus (HCV) transmission decreased in Brazil. Analyzing temporal trends in the incidence of acute cases may indicate how current HCV circulation is. Objective: To analyze the temporal trend of acute hepatitis C cases from 2007 to 2018. Methods: Analysis of reported cases of acute hepatitis C, using data from the National System of Notifiable Diseases (Sistema Nacional de Agravos de Notificação – SINAN) and the Health Surveillance Department, Ministry of Health. The non-parametric Cusick test was applied to analyze temporal trend. Results: 6,199 cases of acute HCV were reported between 2007 and 2018. The annual incidence rate ranged from 0.17 cases per 100,000 inhabitants in 2007 at 0.28 (2018) (p=0.005). Regarding the age group, the trend of increased notifications was significant in individuals 40 years (p=0.008) of age. Conclusion: Despite the few acute cases reported annually, there has been an increase in recent years, especially in age extremes. Cases in &gt;40 years may mean that some of them are not new, but chronic infections, or because of the growing importance of sexual transmission as a consequence of relaxation in safe sex. Despite possible inconsistencies and weaknesses in the notification systems, these numbers are of concern, justifying efforts to review cases for better classification and clarification of contagion routes.

Postnatally Acquired Zika

Research Article| September 01 2019 Postnatally Acquired Zika AAP Grand Rounds (2019) 42 (3): 33. https://doi.org/10.1542/gr.42-3-33 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Postnatally Acquired Zika. AAP Grand Rounds September 2019; 42 (3): 33. https://doi.org/10.1542/gr.42-3-33 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: zika virus, zika virus infections Source: Lindsey NP, Porse CC, Potts E, et al. Postnatally acquired Zika virus disease among children, United States, 2016–2017. Clin Infect Dis. 2019 11 March [published online ahead of print]; doi: https://doi.org/10.1093/cid/ciz195Google Scholar Investigators from multiple institutions conducted a case series to describe the clinical signs and symptoms of children with postnatally acquired Zika virus disease. Cases were defined as those who met the national surveillance definition for confirmed or probable disease, had illness onset in 2016 or 2017, were reported to the national arboviral disease surveillance system, and resided in 1 of 10 participating US states. Investigators abstracted demographic, clinical, and laboratory data for each case from local health department surveillance data obtained from medical records, health care providers, and patients and guardians. Investigators grouped pediatric cases (age <18 years) into 2 age strata (1–11 and 12–17 years) and compared clinical information and outcomes between the 2 age groups by using chi-square tests. Investigators also matched each pediatric case 1:1 to an adult case (18–49 years old) by state of residence and case status (ie, confirmed or probable). Characteristics of pediatric cases were compared to those of matched adult cases by using logistic regression. There were 141 identified pediatric cases, 64% of which were in children 12–17 years old. Nearly all (N=139) acquired Zika during travel outside of the United States, with the most common countries being Mexico (N=28) and the Dominican Republic (N=26). The 4 most common signs and symptoms of Zika virus disease in children were rash (94%), fever (74%), arthralgia (48%), and conjunctivitis (36%); 18% of children had all 4 signs and symptoms. No children had neurological signs or symptoms consistent with meningitis, encephalitis, or Guillain-Barré syndrome. Significantly more children 12–17 years old had fever, arthralgia, and myalgia than did children 1–11 years old, and significantly more adults had arthralgia, arthritis, edema, and myalgia than did children. Only 1 child was hospitalized, and 20% of children were treated in the ED. No children died. The authors conclude that postnatally acquired Zika virus disease appears to be a mild illness in children that often manifests with rash, fever, and/or arthralgia. Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The authors conclude that postnatally acquired Zika virus infection resembles other common viral exanthema, including rubella, measles, adenovirus, and enterovirus.1 All of these infections may be associated with maculopapular rashes. Both measles and rubella are preventable with vaccine, so asking about immunization status is important. Although postnatally acquired rubella is extremely rare,2 1,109 confirmed measles cases have been reported in the United States between January 1 and July 3, 2019.3 Some of these cases have been linked to travelers who brought measles back from countries where large measles outbreaks were occurring. A second important question to ask is where the child has traveled. In 2015, Zika virus was identified for the first... You do not currently have access to this content.

Incidence of American Tegumentary Leishmaniosis in the Municipality of Rondoland - MT in the Period 2010 to 2018

American tegumentary leishmaniasis (ACL) is an infectious, non-contagious disease that causes ulcers on the skin and mucous membranes. The disease is caused by protozoa of the genus Leishmania. The objective of the research was to verify the incidence of American cutaneous leishmaniasis in the municipality of Rondolândia - MT from 2010 to 2018. The methodology and of the transversal, documental, descriptive and quantitative type, the information will be obtained from the analysis of epidemiological data provided by health surveillance of the municipality of Rondolândia - MT, who were attended at the Hueverton basic health unit Bruno da Silva Rabelo, who will be separated through a questionnaire carried out by the researchers themselves containing 4 basic questions based on the SINAN compulsory notification form. It was verified that 40 cases of American tegumentary leishmaniasis were reported in the municipality of Rondolândia-MT between 2010 and 2018, 90.0% being male and 10.0% female in the age group with the highest incidence 18 to 59 years of age to 85.0% of the reports and 45.0% of the patients were brown, 95.0% of the patients presented skin lesions and were classified as new cases. The patients' diagnoses were confirmed by 85.0% laboratory, 90.0% of the patients were treated with pentavalent antimonial and 90.0% of the patients were from the rural area of the municipality of Rondolândia-MT. It is concluded that the incidence of cases of American tegumentary Leishmaniasis in the municipality of Rondolândia-MT has been increasing over the years, that is, approximately 1 case per 100 inhabitants, thus, the annual average of these cases corresponding to 5 cases of the annual disease. An urgent action is required by the health surveillance department of the municipality to carry out disease control, since if it continues without prevention in the municipality, this annual index may suffer a great increase over the years.

Socio-epidemiological characterization of human leptospirosis in the Federal District, Brazil, 2011-2015.

Human leptospirosis (HL) in the Federal District (DF), Brazil, is endemic and requires studies to characterize the socio-epidemiological profile of the vulnerable population. Seventy-nine autochthonous cases of HL between 2011-2015 were analyzed based on the databases of the Epidemiological and Environmental Health Surveillance Department, DF. The male population aged 31-45 years represented 86% of the leptospirosis cases; most belonged to the social classes D and E. In the DF, preventive measures should be concentrated on economically active male adults of social classes C, D, and E with the aim of promoting health.

Epidemic forecasts as a tool for public health: interpretation and (re)calibration

Objective:Recent studies have used Bayesian methods to predict timing of influenza epidemics many weeks in advance, but there is no documented evaluation of how such forecasts might support the day‐to‐day operations of public health staff. Methods:During the 2015 influenza season in Melbourne, Australia, weekly forecasts were presented at Health Department surveillance unit meetings, where they were evaluated and updated in light of expert opinion to improve their accuracy and usefulness. Results:Predictive capacity of the model was substantially limited by delays in reporting and processing arising from an unprecedented number of notifications, disproportionate to seasonal intensity. Adjustment of the predictive algorithm to account for these delays and increased reporting propensity improved both current situational awareness and forecasting accuracy. Conclusions:Collaborative engagement with public health practitioners in model development improved understanding of the context and limitations of emerging surveillance data. Incorporation of these insights in a quantitative model resulted in more robust estimates of disease activity for public health use. Implications for public health:In addition to predicting future disease trends, forecasting methods can quantify the impact of delays in data availability and variable reporting practice on the accuracy of current epidemic assessment. Such evidence supports investment in systems capacity.

Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients.

Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF. This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure. In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF.

Risk Factors of Dizziness among Institutionalized Elderly Persons: A Case Control Study

Introduction: Institutionalized elderly people suffer from balance disorders, such as dizziness, that may result in falls and health debilitation. The aims of this study were to describe the institutionalized elderly population with dizziness and to determine the risk factors for dizziness related to the institution, lifestyle and health status of the elderly. Method: A case control study was performed in 12 Nursing Homes regulated by the Health Surveillance department. A hundred and twenty-three elderly persons who possessed a satisfactory cognitive level measured by the Pfeiffer test and the ability to walk were eligible. Of these, 102 elderly persons were selected half of whom (n=51) had suffered dizziness in the previous year. The other half (n = 51) were used as controls, and the two groups were matched for sex and age. Variables relating to the characteristics of the facility, lifestyle and health status of the elderly were analyzed. The Chi-squared and Fisher’s Exact tests were used for statistical analysis, with a significance level set at 5%, and multivariate model by logistic regression, with magnitude of the association calculum between variables measured by Odds Ratio. Results: The risk factors for dizziness were the presence of three or more pathologies per elderly person and the use of a gastro-protective drug, as a proxy of polypharmacy adjusted by systemic arterial hypertension and smoking. Conclusion: Risk factors associated with dizziness were the number of comorbidities higher than three and a gastro-protective drug adjusted in the multivariate model by hypertension and smoking

Prevalência de vestibulopatia em idosos institucionalizados de Natal - RN - Brasil

Resumo: OBJETIVO: aferir a prevalência de vestibulopatia e seus fatores associadosem idosos institucionalizados por meio do exame clínico de cabeceira. MÉTODOS: trata-se de um estudo transversal realizado nas 12 Instituições de longa permanência para idosos de Natal-Brasil, regulamentadas pela Vigilância Sanitária. Foram eleitos os idosos com bom nível cognitivo e capazes de deambular, totalizando 115 indivíduos. Os idosos foram questionados sobre a presença de tontura no último ano, e quando a resposta era positiva, eram submetidos a questionário e exame físico específico para diagnóstico de vestibulopatia, segundo o protocolo de Johnson e Lalwani (2004). Para a análise estatística, utilizou-se o teste do Qui-quadrado ou exato de Fisher para um nível de significância de 5% e cálculo da razão de prevalência. RESULTADOS: a prevalência de vestibulopatia foi de 10,56%e foram associados a osteoartrose e o etilismo. CONCLUSÃO: a vestibulopatia apresenta baixa prevalência nos idosos institucionalizados de Natal-Brasil.