RESUMEN
BACKGROUND: From around the year 2000, Northern Europe experienced a rise in impetigo caused by Staphylococcus aureus resistant to fusidic acid. A single clone of S. aureus was found to be the bacterial pathogen involved in the impetigo outbreak in Norway, Sweden, the UK and Ireland, termed 'the epidemic European fusidic acid-resistant impetigo clone' (EEFIC). We have followed the incidence of impetigo during the years 2001-2012 based on all patients in general practice in the island community of Austevoll, Western Norway. We previously reported a marked decline of impetigo incidence in Austevoll, from 0.0260 cases per person-year in 2002 to 0.0038 in 2009. This article explores indications of an end to the impetigo epidemic caused by the EEFIC clone. METHODS: All four general practitioners (GPs) in the community (mean population = 4400) were asked to diagnose impetigo in a uniform way and to take bacterial specimens from all impetigo cases. Phenotypic characteristics of specimen bacteria were determined for the whole period and molecular analyses were performed on isolates in the period 2008-2012. RESULTS: We observed a further decline in incidence of impetigo in Austevoll in the study period. The proportion of fusidic acid-resistant S. aureus isolates decreased during the period 2002-2012, with a mean of 80% in the epidemic years of 2002-2004, 55% in 2005-2009, and 6% in 2010-2012. In total, 44 S. aureus isolates from impetigo were subject to molecular analyses in the period 2008-2012, and 11 were found to be related to the EEFIC. All EEFIC isolates were found in 2008-2009, with no new isolates in 2010-2012. CONCLUSION: There is an apparent end to the impetigo epidemic related to the EEFIC in this population in Western Norway.
Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Ácido Fusídico/uso terapéutico , Impétigo/epidemiología , Staphylococcus aureus/aislamiento & purificación , Adulto , Estudios de Cohortes , Epidemias , Femenino , Humanos , Impétigo/microbiología , Incidencia , Masculino , Persona de Mediana Edad , Tipificación Molecular , Noruega/epidemiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/genéticaRESUMEN
BACKGROUND: Priority grade assessment according to urgency level of the patients (triage) is considered vital in emergency medicine casualties. Little is known of the experiences of pre-hospital emergency medicine triage performed by General Practitioners (GPs) in the community. In this study we bring such experiences from a Norwegian island community, with special emphasis on over- and undertriage. METHODS: In the island municipality of Austevoll, Western Norway, where the GPs and the ambulance services both take part in all medical emergency cases, all these cases were recorded during a 2-year period (2005-2007). We compared the triage of the patients at the stage of the telephone reception of the incident, and the subsequent revision of the triage at the first personal examination of the patient. RESULTS: 236 emergency medical events were recorded, comprising 240 patients. Of these, 42% were downgraded between the stages (i.e. initially overtriaged), 11% were upgraded (i.e. initially undertriaged) and 47% remained in unchanged priority group. Of the diagnostic groups, acute abdominal cases had the highest probability of being upgraded between stages, while the aggregated diagnostic group of syncopes, seizures, intoxications and traumas had the highest probability of being downgraded. The principal reason for upgrading was lack of necessary information at the stage of call. In a minority of cases the upgrading was due to real patient deterioration between stages. CONCLUSIONS: In pre-hospital triage of emergency patients, downgrading happens between notification of events and actual patient examination in a substantial proportion. Upgradings of cases are considerably fewer, but the potential serious implications of upgrading warrants individual scrutiny of such cases.
Asunto(s)
Servicios Médicos de Urgencia , Medicina General , Hospitales Rurales , Pautas de la Práctica en Medicina , Triaje/clasificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Intervalos de Confianza , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Noruega , Oportunidad Relativa , Control de Calidad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: To document clinical characteristics of influenza-like illness, reported use of health preventive measures and attitudes towards vaccination among patients with influenza-like illness in general practice during the influenza pandemic in 2009. METHODS: Cross-sectional survey in general practice. Patients, who were identified as having influenza-like illness during the peak of the influenza pandemic activity in Norway, were eligible for inclusion in the study. A questionnaire was sent 2-4 weeks after the patients visit to the GP with influenza-like illness diagnosis during October to December 2009, from general practices in Norway. A sample of responders >18 years also had a blood test to check for serological response to the pandemic H1N1 virus. RESULTS: Questionnaires were sent to 1324 patients, and 357 (27%) were returned. Fever (91% versus 49%, P < 0.01), cough (85% versus 73%, P = 0.016) and gastrointestinal symptoms (58% versus 38%, P < 0.01) were more frequent in the age group <18 years compared to older patients. Serological H1N1 responses were analysed in 72 patients; 34 (47%) were positive (haemagglutination inhibition assay titres ≥ 40). There were no statistically significant differences in symptoms between seropositive and seronegative patients. Women reported better adherence to personal protective measures, such as hand washing and cough etiquette than men. Women were also more concerned about possible adverse effects of the pandemic influenza vaccine than men. CONCLUSIONS: Discrimination between influenza and other viral upper respiratory tract infections is difficult in daily clinical practice, even during an influenza pandemic. A gender difference was found in reported precautions to prevent influenza.
Asunto(s)
Actitud Frente a la Salud , Subtipo H1N1 del Virus de la Influenza A , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Gripe Humana/epidemiología , Gripe Humana/psicología , Masculino , Noruega/epidemiología , Pandemias , Cooperación del Paciente , Factores Sexuales , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: In April 2009 the World Health Organization (WHO) declared that spreading of a new influenza A(H1N1) virus had reached epidemic proportions, and on June 11, 2009 they declared that the world was in fact facing a pandemic. In Norway the influenza pandemic was the cause of much activity from health authorities and all levels of the health services. This report concerns pandemic-related work within clinical and community medicine in a municipality in western Norway. MATERIAL AND METHODS: All contacts between the general practitioners (GPs) and patients with influenza-like disease in Austevoll municipality were recorded for the second half of 2009. The lead public health nurse recorded vaccination activity systematically. Absence from secondary school in the municipality was recorded and the Medical Health Officer recorded all pandemic-related activities. RESULTS: 141 patients living in the municipality (3.2 % of the population) contacted the GP for influenza-like disease. Most cases occurred during weeks 43-47. A large majority of the encounters with the GP during these weeks were with patients below 20 years of age, whereas the age distribution was much more diverse at other points in time. Absence from secondary school was also highest in weeks 43-47. 54 % of the municipality's inhabitants were vaccinated. At the end of the main wave of the epidemic, vaccination coverage had reached 28 %. The Medical Health Officer had a large workload, especially during the main wave. INTERPRETATION: The influenza epidemic in 2009 hit Austevoll municipality in weeks 43-47. Mass vaccination was started too late to have a major influence on the epidemic. Systematic mapping of the epidemic on a municipal level is a useful supplement to the national surveillance.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Pandemias , Adolescente , Adulto , Niño , Control de Enfermedades Transmisibles , Historia del Siglo XXI , Humanos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunación Masiva , Persona de Mediana Edad , Noruega/epidemiología , Pandemias/historia , Pandemias/prevención & controlRESUMEN
OBJECTIVES: From around year 2000, impetigo caused by fusidic acid-resistant Staphylococcus aureus was observed in countries of Northern Europe. The bacteria were found to represent a clone, the epidemic European fusidic acid-resistant impetigo clone (EEFIC). This study reports longitudinal data on the incidence and bacteriology of impetigo in a Norwegian island community during the years 2001-09. PATIENTS AND METHODS: All encounters with general practitioners regarding impetigo were registered. Bacterial swabs were taken in a high percentage of cases. Annual incidence was calculated. Phenotypic characteristics of the bacteria were determined for the whole period, and in 2008 and 2009 we also performed PFGE and spa typing. RESULTS: Outbreaks of impetigo were observed in 2002, 2003 and 2004, but since then the incidence decreased greatly. S. aureus was cultured from the impetigo site in the majority of cases. The proportion of S. aureus isolates resistant to fusidic acid decreased from 80% in 2002-04 to 45% in 2008-09. For 28 S. aureus isolates analysed by molecular methods in 2008-09, we found that nearly all cases of fusidic acid resistance were due to the presence of the EEFIC. CONCLUSIONS: S. aureus resistance to fusidic acid in relation to impetigo is now less frequent in this population than at the start of the century. At present, most S. aureus bacteria resistant to fusidic acid in impetigo belong to the EEFIC.
Asunto(s)
Técnicas de Tipificación Bacteriana , Farmacorresistencia Bacteriana , Ácido Fusídico/farmacología , Impétigo/epidemiología , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/efectos de los fármacos , Antibacterianos/farmacología , Brotes de Enfermedades , Electroforesis en Gel de Campo Pulsado , Humanos , Impétigo/microbiología , Incidencia , Tipificación Molecular , Noruega/epidemiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
BACKGROUND: Training of lay first responder personnel situated closer to the potential victims than medical professionals is a strategy potentially capable of shortening the interval between collapse and start of cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest. In this study we trained lay first responders personnel in basic life support (BLS) and defibrillation for cases of cardiac arrest and suspected acute myocardial infarction (AMI). METHODS: Forty-two lay first responders living in remote areas or working in industries in the island community of Austevoll, Western Norway, were trained in CPR and defibrillation. We placed particular emphasis on the first responders being able to defibrillate a primary ventricular fibrillation (PVF) in patients with AMI. The trainees were organised in four teams to attend victims of AMI and cardiac arrest while awaiting the arrival of the community emergency medical services. The purpose of the study was to find out whether the teams were able to function during the five-year study project, and to examine whether lives could be saved. The first responders completed questionnaires each year on their experiences of participation. Data on the medical actions of the teams were also collected. RESULTS: By the end of the project all groups were functioning. The questionnaires evidenced a reasonable degree of motivation and self-evaluated competence in both types of group organisation, but in spite of this attrition effects in the first responders were considerable. The first responders were called out on 24 occasions, for a total of 17 patients. During the study period no case of PVF occurred after the arrival of the first responders, and the number of AMIs was very low, strongly deviating from what was anticipated. No lives were saved by the project. CONCLUSIONS: The teams were sustained for almost five years without any significant deterioration of self-reported stress or mastering, but still showed attrition effects. Evaluated as a medical project the intervention was not successful, but the small scale prevents us from drawing firm conclusions on this aspect.
Asunto(s)
Reanimación Cardiopulmonar , Auxiliares de Urgencia/psicología , Grupo de Atención al Paciente , Servicios de Salud Rural , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: A comprehensive study of medical emergency situations in a rural community in Norway has been undertaken for the first time. Some results from this study are presented; i.e. data on events (types and management) that occur in medical emergency situations. MATERIAL AND METHODS: Austevoll is an island community in western Norway, with about 4400 inhabitants. Data on all events in medical emergency situations were recorded during two years. The following information was recorded: degree of urgency at the time of the emergency call and at patient examination (as assessed by the doctor), treatment measures and the relationship between doctors' and ambulance personnel's assessments. RESULTS: 236 medical emergency events were recorded. The doctors downgraded the seriousness of the event (from emergency call to actual examination of the patient) in 43 % of cases, while the event was upgraded in 11 %. For alarms dispatched from the emergency medical communication centres, the doctors downgraded the evaluation of seriousness in the time span alarm-examination in 67 % of cases, while the ambulance personnel downgraded seriousness in 85 %. Home dwelling was the initial location of treatment in 63 % of patients. The procedures performed most frequently were: venous cannulation, airway handling (including administration of oxygen), ECG-recording and/or monitoring of cardiac rhythm, and parenteral administration of drugs. INTERPRETATION: For emergency medicine work general practitioners should focus on training fundamental practical skills. The doctors and the ambulance personnel have complementary roles in handling of medical emergency events. Ability of obtaining an adequate overall view of the patient's condition is an important aspect of the doctor's role.
Asunto(s)
Servicios Médicos de Urgencia , Servicios de Salud Rural , Enfermedad Aguda , Ambulancias , Competencia Clínica , Servicios Médicos de Urgencia/estadística & datos numéricos , Medicina de Emergencia/educación , Medicina de Emergencia/normas , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/estadística & datos numéricos , Humanos , Noruega/epidemiología , Rol del Médico , Médicos de Familia/educación , Servicios de Salud Rural/estadística & datos numéricos , Índices de Gravedad del Trauma , Recursos Humanos , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/epidemiología , Heridas y Lesiones/terapiaRESUMEN
BACKGROUND: Certain aspects (frequency and management) of medical emergencies in Norwegian communities are not adequately documented. Previous studies indicate an annual case incidence rate of about 10 per 1000 inhabitants. This article presents results of a recording of medical emergencies (during a 2-year period) in the Norwegian island community Austevoll (4400 citizens) south of Bergen (without a mainland connection). MATERIAL AND METHODS: Data on a variety of aspects were recorded on medical emergencies, defined as incidents where the doctor found it necessary to take immediate action. Data on these occurrences were recorded into questionnaires by all doctors and ambulance personnel in Austevoll in the period 1 October 2005 to 30 September 2007. RESULTS: 236 medical emergencies were documented. This corresponds to 27 incidents per 1000 inhabitants per year. 84 % of the emergencies were acute illnesses and 16 % were accidents. The emergencies occurred in the patients' home or other dwelling in 71 % of the cases. In Austevoll, the doctor is the first personnel category to reach to the patient in 52 % of cases. INTERPRETATION: This study estimates a higher incidence of medical emergencies than previous records. A likely reason is that the municipal medical services have been the point of observation in our study, while previous studies have counted incidents recorded in the emergency medical communication centres.
Asunto(s)
Servicios Médicos de Urgencia , Servicios de Salud Rural , Accidentes/estadística & datos numéricos , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ambulancias , Niño , Preescolar , Competencia Clínica , Servicios Médicos de Urgencia/estadística & datos numéricos , Tratamiento de Urgencia/métodos , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Rol del Médico , Servicios de Salud Rural/estadística & datos numéricos , Encuestas y Cuestionarios , Índices de Gravedad del Trauma , Recursos Humanos , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/epidemiología , Heridas y Lesiones/terapia , Adulto JovenRESUMEN
BACKGROUND: In Norway, every year more than 3000 persons suffer sudden cardiac death caused by ventricular fibrillation. The present recommendations of international expert committees are that the use of public-access defibrillators should be encouraged, including training of non-medical personnel. MATERIAL AND METHOD: In order to evaluate the validity of such recommendations, we performed searches in Medline on relevant keywords and evaluated articles thus identified and their references. We selected studies on countries, cities, public access defibrillator projects, and on epidemiology of cardiac arrest and ventricular fibrillation. RESULTS: Studies of the public-access defibrillation strategy reported the highest frequencies of survival. Studies from cities gave highly variable results; those for entire countries poor results. Different populations have different results of survival, and commonly used predictor models do not comprehensibly explain these findings. Over time there is a falling frequency of ventricular fibrillation as the cause of cardiac arrest. INTERPRETATION: Application of the strategy of public-access defibrillators will not result in significantly improved survival from cardiac arrest in Norway.
Asunto(s)
Cardioversión Eléctrica , Servicios Médicos de Urgencia , Paro Cardíaco/terapia , Reanimación Cardiopulmonar/educación , Reanimación Cardiopulmonar/instrumentación , Cardioversión Eléctrica/instrumentación , Servicios Médicos de Urgencia/provisión & distribución , Accesibilidad a los Servicios de Salud , Paro Cardíaco/mortalidad , Humanos , Análisis de SupervivenciaRESUMEN
Patients suspected of having an acute myocardial infarction (AMI) constitute a group with particularly high risk of developing cardiac arrest caused by ventricular fibrillation (VF). It is conceivable that a strategy of shortening the interval until defibrillation skills are brought to the patient can be more fruitful in rural areas than the now prevailing recommendations of obtaining rapid defibrillation after cardiac arrest is manifest. A project is being organized in a Norwegian rural municipality, where laymen are being trained in the use of automated external defibrillators (AEDs), and are organized in groups according to place of residence or work. Their main task is to bring the AED to patients with suspected AMI and be prepared to use the AED if cardiac arrest should supervene. The main objective of a planned five-year study is to gather information as to what degree of mastering and what degree of stress the participants of the project experience, and to see if it is possible to maintain an organisation like this over a longer period of time. Preliminary results from the first half-year of the project indicate that the participants are entering the project with a reasonable degree of individual self-confidence and have even greater confidence in the group to which they belong. This might suggest that it is an advantage for participants in AED projects to be organised in groups in which mutual support is experienced.
Asunto(s)
Reanimación Cardiopulmonar/educación , Cardioversión Eléctrica/instrumentación , Servicios Médicos de Urgencia/métodos , Paro Cardíaco/terapia , Infarto del Miocardio/terapia , Servicios de Salud Rural , Reanimación Cardiopulmonar/instrumentación , Servicios Médicos de Urgencia/organización & administración , Paro Cardíaco/mortalidad , Humanos , Capacitación en Servicio , Infarto del Miocardio/mortalidad , Noruega , Servicios de Salud Rural/organización & administración , Encuestas y CuestionariosRESUMEN
BACKGROUND: Rising numbers of bullous impetigo caused by Staphylococcus aureus resistant to fucidic acid have been seen in Norway over the last few years. MATERIAL AND METHODS: We present a population-based cohort study of an epidemic in an island community in western Norway with approximately 4450 people. The district's doctors agreed upon guidelines for regimes of antibiotic treatment; taking specimens for bacteriological examination was made routine procedure. The patients included in the study were identified from all patient files from all consultations with all doctors in the district. Clinical, therapeutical and bacteriological variables were registered. A comparison with the present Norwegian guidelines developed by a conference of experts is made. RESULTS: 108 patients were diagnosed as having bullous impetigo (2.4% of the population). Bacteriological swabs were taken from 95 (88%) patients. Staphylococcus aureuswas the bacteriologic aetiology in 79 (83%) of these and were found to be resistant to fusidic acid in 67 (85%) isolates. DISCUSSION: Our findings support the hypothesis that the rising numbers of impetigo might be caused by a clone of Staphylococcus aureus that is resistant to fusidic acid.