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In March 2014, after an increase of notifications of domestically acquired hepatitis A virus infections, an outbreak investigation was launched in Norway. Sequenced-based typing results showed that these cases were associated with a strain that was identical to one causing an ongoing multinational outbreak in Europe linked to frozen mixed berries. Thirty-three confirmed cases with the outbreak strain were notified in Norway from November 2013 to June 2014. Epidemiological evidence and trace-back investigations linked the outbreak to the consumption of a berry mix cake. Identification of the hepatitis A virus outbreak strain in berries from one of the implicated cakes confirmed the cake to be the source. Subsequently, a cluster in Germany linked to the cake was also identified.

In May 2014, a cluster of Yersinia enterocolitica (YE) O9 infections was reported from a military base in northern Norway. Concurrently, an increase in YE infections in civilians was observed in the Norwegian Surveillance System for Communicable Diseases. We investigated to ascertain the extent of the outbreak and identify the source in order to implement control measures. A case was defined as a person with laboratory-confirmed YE O9 infection with the outbreak multilocus variable-number tandem repeat analysis (MLVA)-profile (5-6-9-8-9-9). We conducted a case–control study in the military setting and calculated odds ratios (OR) using logistic regression. Traceback investigations were conducted to identify common suppliers and products in commercial kitchens frequented by cases. By 28 May, we identified 133 cases, of which 117 were linked to four military bases and 16 were civilians from geographically dispersed counties. Among foods consumed by cases, multivariable analysis pointed to mixed salad as a potential source of illness (OR 10.26; 95% confidence interval (CI): 0.85–123.57). The four military bases and cafeterias visited by 14/16 civilian cases received iceberg lettuce or radicchio rosso from the same supplier. Secondary transmission cannot be eliminated as a source of infection in the military camps. The most likely source of the outbreak was salad mix containing imported radicchio rosso, due to its long shelf life. This outbreak is a reminder that fresh produce should not be discounted as a vehicle in prolonged outbreaks and that improvements are still required in the production and processing of fresh salad products.

Resumen Objetivos Explorar la fiabilidad y validez del cuestionario adaptado SERVPERF en el ambito de atencion primaria y obtener una medida de la calidad de atencion en salud desde la perspectiva de los pacientes en un centro de salud (C. S.). Diseno Estudio descriptivo transversal. Participantes Del total de los pacientes que acudieron a consultas al centro de salud durante una semana de marzo de 2010 se selecciono de forma sistematica uno de cada 5, hasta completar el tamano muestral requerido. Mediciones principales: Para medir la calidad de atencion en salud percibida se utilizo la encuesta adaptada SERVPERF, con 22 items medidos en escala Likert (1-7), a la que se anadieron 3 preguntas abiertas y variables personales. Resultados Participaron un total de 132 pacientes con una edad media de 50 anos (rango 16-89), el 67% eran mujeres. La encuesta con los 22 items mostro una consistencia interna α-Cronbach= 0,90 (IC 95%: 0,87-0,93) y en cada una de las 5 dimensiones este valor estuvo entre (0,71-0,90). El analisis factorial senalo 5 factores que explicaron un 69,83% de la varianza. La puntuacion total media obtenida fue de 123,22 ± 16,95, el item mejor valorado fue el «Seguimiento individualizado por el medico de cada paciente» con una media de 6,66 ± 0,79 (IC: 6,53-6,79). Conclusiones El cuestionario utilizado (SERVPERF adaptado) se mostro fiable y valido para medir percepcion de calidad de la atencion sanitaria en atencion primaria. Los pacientes consideraron que el servicio de atencion sanitaria que recibieron fue de buena calidad.

On 7 March 2014, an increase in hepatitis A virus (HAV) infections was identified in Norway. As of 12 April, 19 cases of HAV infection with a virus strain identical to an ongoing European outbreak have been identified. Six probable cases are currently under investigation. On 11 April, a frozen berry mix cake imported from another European country was found as the likely source of the outbreak; the importer has withdrawn the product in Norway.

The aim of this study is to explore the reliability and validity of the adapted questionnaire SERVPERF in primary care and to obtain a measure of perceived quality from the patient point of view in an urban health centre.A cross-sectional descriptive study.One in five of all the patients who visited the health centre during one week in March 2010 were systematically selected until completing the required sample size.Personal data were collected (age, sex, nationality, marital status, level of studies, working status and their own perception on their health status). To measure the perceived quality the adapted questionnaire SERVPERF was used, with 22 items measured using a Likert scale (1-7), to which was added three open questions.Out of a total of 132 patients, 67% of those who completed the questionnaire were women. All the interscale correlations were positive and significant. The overall statistical value for Cronbach́s-α was equal to 0.90 (95% CI: 0.87-0.93), and in all domains this value ranged from 0.71 to 0.90. The factor analysis identified 5 factors that explained 69.8% of the total variance. Of the studied items, the "Individualized follow up of each patient by the doctor", with an average of 6.66 ± 0.79 (95% CI: 6.53-6.79), was the best valued.The questionnaire (adapted SERVPERF) is reliable and valid for measuring perceived quality in primary care, and patients felt that the service offered is of good quality.