Ignacio Gutiérrez Garitano

Abstract: Objectives. The aim of data presented is to increase knowledge about the morbidity and impact of mental disorders in Spanish psychiatry. The objective is to describe, based on real practice conditions, the most prevalent mental disorders in a sample of Spanish patients treated in outpatient Psychiatry centers. Material and Method. Epidemiological, naturalistic, prospective, cross-sectional study, carried out in the outpatient psychiatry setting in Spain in 2006. Mental disorders were assessed using the International Neuropsychiatric Interview (MINI). Results. A total of 1,436 patients, 72% of whom were women, mean age of 49.2 ± 13.3 years, were included. According to the MINI assessment, 90.3 % of the patients were diagnosed of at least one mental disorder. The most prevalent mental disorders were: recurrent major depressive episode (27.2%, 353 patients); only current major depressive episode (2 weeks) (25.9%, 336 patients); current dysthymic disorder (last 2 years) (25.9%, 336 patients); current major depressive episode with melancholy symptoms (18.7%, 243 patients); current generalized anxiety disorder (16.6 %, 215 patients). Conclusions. The study results show the prevalence of mental disorders in a sample representative of the Spanish population, treated in outpatient specialized Psychiatry centers. Mood and generalized anxiety disorders were the most prevalent disorders Key words: Epidemiology, Mental disorders, Psychiatry, Mood disorders.

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Abstract: Op 13 november 2009 kreeg de dienst Infectieziektebestrijding van Vlaams-Brabant een melding van verschillende gevallen van Shigella sonnei in een openbare instelling. Via een matched case-controle studie werd nagegaan of er een verband was tussen het oplopen van de shigellose en de consumptie van kantinevoedsel. Drinkwaterstalen uit het gebouw en stoelgangstalen van voedselbereiders werden geanalyseerd. Het referentielaboratorium typeerde de retrospectief verzamelde shigellastammen. Er werden tweeënvijftig gevallen gevonden, die geclusterd waren in ruimte (25/35 departementen) en tijd (2 maanden). De onderzoekers vonden een matched odds ratio van 3,84 (95% BI 1,02-14,44)voor wat betreft de consumptie van kantinevoedsel. Eén van de voedselbereiders verbleef kort voor de detectie van het eerste laboratoriumbevestigde geval in Marokko. De stoelgangstalen van de voedselbereiders en de waterstalen waren negatief op Shigella. Bevestigde gevallen vertoonden met pulsed field gel electrophoresis profielen die sterk overeenkwamen met gearchiveerde stammen in Marokko. Vermoedelijk trad er transmissie op via het voedsel in de kantine na besmetting door de voedselbereider.

Abstract: In Europe, different studies have identified immigrant women coming from developing countries as a risk group for maternal death. In Spain, an ecological study showed higher maternal mortality rates among foreign mothers compared with Spanish mothers during 2003-04. To examine whether the maternal death risk among foreign mothers in Spain is increased, we performed a population-based matched case-control study. Each case of maternal death during 1999-2006 was matched with four mothers who had given birth during the same year the case occurred. The National Statistics Institute provided the data. The variables in the study were maternal age and country of origin. We used a conditional logistic regression analysis. Adjusted by age, the risk of maternal death was 87% higher among foreign mothers. This study confirms that there is an increased risk of maternal death among foreign mothers in Spain. It would be desirable to analyse the socio-economic and healthcare circumstances surrounding the deaths.

Abstract: SUMMARYOn 13 November 2009, the authorities of Flemish Brabant, Belgium, received an alert concerning a potential outbreak of Shigella sonnei at a public institution. A study was conducted to assess the extent, discover the source and to implement further measures. We performed a matched case-control study to test an association between shigellosis and canteen-food consumption. Water samples and food handlers' faecal samples were tested. The reference laboratory characterized the retrospectively collected Shigella specimens. We found 52 cases distributed over space (25/35 departments) and time (2 months). We found a matched odds ratio of 3·84 (95% confidence interval 1·02-14·44) for canteen-food consumption. A food handler had travelled to Morocco shortly before detection of the first laboratory-confirmed case. Water samples and food handlers' faecal samples tested negative for Shigella. Confirmed cases presented PFGE profiles, highly similar to archived isolates from Morocco. Foodborne transmission associated with the canteen was strongly suspected.

Abstract: Abstract BACKGROUND: Socio-economic differences are a major determinant of perinatal outcomes. The impact of low socio-economic status on the risk of stillbirth, and the association between socio-economic status and stillbirth by maternal country of origin at a national level in Spain are unknown. We aimed to analyse the effect of maternal socio-economic status on the risk of stillbirth by maternal country of origin in Spain for the years 2007 and 2008. METHODS: We designed a population-based observational study that included 970 740 live births and 2464 stillbirths from 2007 to 2008. Univariate risk ratios (RRs) of stillbirth were calculated by maternal education, country of origin, age, parity, and gestational age. Adjusted stillbirth RRs were calculated using a generalized linear model with the Poisson family. Then, adjusted attributable risks and aetiological fractions in the population were calculated as measures of impact. RESULTS: Stillbirth rate ranged from 1.0 to 4.7 deaths per 1000 births. The stillbirth risk among mothers having secondary or lower education was double than that of mothers with a tertiary education with an adjusted RR of 2.13 [95% confidence interval (CI): 1.74-2.60]. African mothers, compared with mothers from Spain, showed an adjusted stillbirth RR of 1.75 (95% CI: 1.54-2.00). Discussion: This study confirms the differences of stillbirth risk by maternal socio-economic status. Regardless of socio-economic status, African mothers had the highest risk of stillbirth. These results point out the necessity to reduce factors related to social and health inequalities in perinatal mortality in Spain, and more specifically, to take into consideration the special vulnerability of African mothers.

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Abstract: Introduction In September 2009, as part of the surveillance during the Influenza A(2009) pandemic, Belgium introduced a web-based surveillance system aimed at recording hospitalisations and deaths attributable to Influenza in real time. Methods We present the web-based application developed for the pandemic as well as a descriptive analysis of Severe Acute Respiratory Infection (SARI) cases reported through this system. Results From 1 September to 31 December 2009, 1723 SARI-related hospitalisations potentially due to influenza were reported in Belgium. The median age of the patients was 29 years (range: < 1 year-99 years). Among SARI-hospitalised patients 68% were aged less than 45 years, 10.6% were vaccinated with the seasonal influenza vaccine and 7.5% with the pandemic influenza vaccine. No deaths were recorded. Conclusions This first experience showed the feasibility of getting real-time information from hospitals during a public health crisis. However, the absence of death detected through the system highlighted the importance of better defining the severity of the hospital cases.

Abstract: On 6 July 2009 the Belgian enhanced surveillance system for influenza-like illness among travellers returning from influenza A(H1N1)v affected areas detected a case linked to a rock festival which took place on 2-5 July. The health authorities implemented communication and control measures leading to the detection of additional cases. This paper describes the outbreak and its impact on the management of the influenza pandemic in Belgium.

Abstract: In response to the ongoing influenza A(H1N1)v pandemic, first detected in North America in April 2009, Belgium has set up an active surveillance system for influenza-like illness among travellers returning from affected areas. This communication describes the clinical and epidemiological features of the first 43 laboratoryconfirmed cases in Belgium.

Abstract: The increase of trips to developing countries increases the possibility of importing infectious diseases to our setting and requires the Primary Care physician and those in emergency services to have a high index of suspicion and basic knowledge on the most common tropical diseases in the patient who has traveled in recent months. It is fundamental in all patient to obtain information on the trips they have made. Every patient should be asked about the background of previous trials and what country, zone they went to, type of activity carried out and preventive measures used. The most frequent consultations are fever, diarrhea and skin lesions.

Abstract: Tungiasis is a parasitosis due to Tunga penetrans, that is endemic in several countries and that is seen more and more in Europe, due to tourism, and to a lesser degree, due to immigrants. The lesion usually appears on the sole and back of the feet and interdigital spaces. The appearance of a small inflammatory papule with a black central point that becomes a whitish nodule with time is typical. The diagnosis is made by clinical history and appearance and is confirmed with analysis by microscope. Treatment consists in local cleaning and extraction of the nodule content. In complicated forms, drugs such as niridazole or thiabendazole are used. We should always take tropical parasitosis into account in travelers.