Social inequalities in the association between temperature and mortality in a South European context.

OBJECTIVES: To analyse social inequalities in the association between ambient temperature and mortality by sex, age and educational level, in the city of Barcelona for the period 1992-2015. METHODS: Mortality data are represented by daily counts for natural mortality. As a measure of socioeconomic position, we used the educational level of the deceased. We also considered age group and sex. We considered, as a measure of exposure, the daily maximum temperatures. Time-series Poisson regression with distributed lag non-linear models was fitted for modelling the relationship between temperature and mortality. RESULTS: Women had higher risk of mortality by hot temperatures than men. Temperature-mortality association (heat and cold) was evident for the elderly, except for heat-related mortality in women which was present in all age groups. Men with primary education or more were more vulnerable to moderate or extreme temperatures than those without studies. Finally, women were vulnerable to heat-related mortality in all educational levels while women without studies were more vulnerable to cold temperatures. CONCLUSIONS: Social and economic individual characteristics play an important role in vulnerability to high and low temperatures. It is important that decision-making groups consider identified vulnerable subgroups when redacting and implementing climate change resilience and adaptation plans.

Imported Zika Virus in a European City: How to Prevent Local Transmission?

Background: On February 1st 2016 the WHO declared the Zika Virus (ZIKV) infection a worldwide public health emergency because of its rapid expansion and severe complications, such as Guillain-Barré Syndrome or microcephaly in newborn. The huge amount of people traveling to endemic areas and the presence of Aedes albopictus in Barcelona increase the risk of autochtonous transmission. The objective of this study was to describe the first ZIKV cases diagnosed in our city and to analyze the surveillance, prevention, and control measures implemented to avoid autochthonous transmission. Methods: An observational cross-sectional population-based study in Barcelona, Spain was performed.An analysis of the socio-demographic, epidemiological, clinical characteristics, and mosquito control activities of the ZIKV cases detected between January 1st and December 2016 was carried out using a specific ZIKV epidemiological survey of the Barcelona Public Health Agency. Results: A total of 118 notifications of possible ZIKV infections were received, and 44 corresponded to confirmed cases in Barcelona residents.Amongst these, the median age was 35 years and 57% were women. All cases were imported, 48% were Spanish-born and 52% foreign-born. Dominican Republic was the most visited country amongst foreign-born patients and Nicaragua amongst Spanish-born. The most frequent symptoms were exanthema, fever, and arthralgia. Among the 24 diagnosed women, 6 (25%) were pregnant. There was one case of microcephaly outside Barcelona city. Entomological inspections were done at the homes of 19 cases (43.2% of the total) and in 34 (77.3%) public spaces. Vector activity was found in one case of the 44 confirmed cases, and 134 surveillance and vector control were carried out associated to imported ZIKV cases. In all cases prevention measures were recommended to avoid mosquito bites on infected cases. Conclusion: Epidemiological and entomological surveillance are essential for the prevention of autochthonous transmission of arbovirosis that may have a great impact on Public Health.The good coordination between epidemiologists, entomologists, microbiologists, and clinicians is a priority in a touristic city with an intense relationship with endemic countries to minimize the risk of local transmission by competent vectors.

[Confirmed Dengue, Chikungunya and Zika Cases during the Period 2014 to 2016 in Barcelona, Spain]. / Casos confirmados de Dengue, Chikungunya y Zika en Barcelona capital durante el período de 2014 al 2016.

OBJECTIVE: Arbovirus infections are a group of diseases whose incidence is increasing and that entail an important problem for public health. The aim of this study was to describe detected cases of arbovirosis in Barcelona, and surveillance and control actions performed in order to reduce the risk of transmission. METHODS: Descriptive cross-sectional study of confirmed dengue, chikungunya and Zika cases in Barcelona during 2014-2016 (1st trimester). Suspected cases detected in the city were notified to the Epidemiology Department of the Barcelona Public Health Agency, where an epidemiological survey is undertaken and, if appropriate, Urban Pests Surveillance and Control Department is contacted. They perform an entomological inspection and implement control and monitoring actions. We collected sociodemographical, epidemiological, clinical and entomological variables. RESULTS: In 2014, 50 chikungunya and 20 dengue cases were detected; 25 entomological inspections were carried out in residences and 38 in the street. In 2015, 47 chikungunya, 51 dengue and 2 Zika cases were detected; 27 inspections were carried out in residences and 80 in the street. In 2016, 17 chikungunya, 52 dengue and 48 Zika cases were detected; 50 inspections were carried out in residences and 103 in the street. No autochtonous case was detected. CONCLUSIONS: We observed an increasing incidence of arbovirosis cases during the 3-year study period. There was a progressive intensification of vector surveillance and control actions (inspections, sample collection…).

OBJETIVO: Las infecciones por arbovirus son un grupo de enfermedades cuya incidencia está aumentando y que suponen un problema importante para la salud pública. El objetivo de este estudio fue describir los casos detectados de arbovirosis en la ciudad de Barcelona y las actuaciones de vigilancia y control realizadas para reducir el riesgo de transmisión. METODOS: Estudio descriptivo transversal de casos confirmados de dengue, chikungunya y Zika en Barcelona durante el período de 2014 al 2016. Los casos sospechosos detectados en la ciudad se notificaron al Servicio de Epidemiología de la Agencia de Salud Pública de Barcelona (ASPB), donde se realizó una encuesta epidemiológica y, si procedía, se contactaba con el Servicio de Vigilancia y Control de Plagas Urbanas. Desde allí se realizó la inspección entomológica y se llevaron a cabo acciones de control y seguimiento. Se recogieron variables sociodemográficas, epidemiológicas, clínicas y entomológicas de los casos. RESULTADOS: En 2014 se detectaron 50 casos de virus chikungunya y 20 de dengue, realizándose 25 inspecciones entomológicas en domicilios y 38 en la vía pública. En 2015 se detectaron 47 casos de chikungunya, 51 de dengue y 2 de Zika, realizándose 27 inspecciones entomológicas en domicilios y 80 en vía pública. En 2016 se detectaron 17 casos de chikungunya, 52 de dengue y 48 de Zika, realizándose 50 inspecciones entomológicas en domicilio y 103 en vía pública. No se detectó ningún caso autóctono. CONCLUSIONES: Se observó un aumento creciente de los casos de arbovirosis durante los 3 años de estudio. Se intensificaron progresivamente las actuaciones de vigilancia y control vectorial (inspecciones, muestras recogidas…).

Casos confirmados de Dengue, Chikungunya y Zika en Barcelona capital durante el período de 2014 al 2016 / Confirmed Dengue, Chikungunya and Zika cases during the period 2014 to 2016 in Barcelona, Spain

Fundamentos: Las infecciones por arbovirus son un grupo de enfermedades cuya incidencia está aumentando y que suponen un problema importante para la salud pública. El objetivo de este estudio fue describir los casos detectados de arbovirosis en la ciudad de Barcelona y las actuaciones de vigilancia y control realizadas para reducir el riesgo de transmisión. Métodos: Estudio descriptivo transversal de casos confirmados de dengue, chikungunya y Zika en Barcelona durante el período de 2014 al 2016. Los casos sospechosos detectados en la ciudad se notificaron al Servicio de Epidemiología de la Agencia de Salud Pública de Barcelona (ASPB), donde se realizó una encuesta epidemiológica y, si procedía, se contactaba con el Servicio de Vigilancia y Control de Plagas Urbanas. Desde allí se realizó la inspección entomológica y se llevaron a cabo acciones de control y seguimiento. Se recogieron variables sociodemográficas, epidemiológicas, clínicas y entomológicas de los casos. Resultados: En 2014 se detectaron 50 casos de virus chikungunya y 20 de dengue, realizándose 25 inspecciones entomológicas en domicilios y 38 en la vía pública. En 2015 se detectaron 47 casos de chikungunya, 51 de dengue y 2 de Zika, realizándose 27 inspecciones entomológicas en domicilios y 80 en vía pública. En 2016 se detectaron 17 casos de chikungunya, 52 de dengue y 48 de Zika, realizándose 50 inspecciones entomológicas en domicilio y 103 en vía pública. No se detectó ningún caso autóctono. Conclusiones: Se observó un aumento creciente de los casos de arbovirosis durante los 3 años de estudio. Se intensificaron progresivamente las actuaciones de vigilancia y control vectorial (inspecciones, muestras recogidas…) (AU)

Background: Arbovirus infections are a group of diseases whose incidence is increasing and that entail an important problem for public health. The aim of this study was to describe detected cases of arbovirosis in Barcelona, and surveillance and control actions performed in order to reduce the risk of transmission. Methods: Descriptive cross-sectional study of confirmed dengue, chikungunya and Zika cases in Barcelona during 2014-2016. Suspected cases detected in the city were notified to the Epidemiology Department of the Barcelona Public Health Agency, where an epidemiological survey is undertaken and, if appropriate, Urban Pests Surveillance and Control Department is contacted. They perform an entomological inspection and implement control and monitoring actions. We collected sociodemographical, epidemiological, clinical and entomological variables. Results: In 2014, 50 chikungunya and 20 dengue cases were detected; 25 entomological inspections were carried out in residences and 38 in the street. In 2015, 47 chikungunya, 51 dengue and 2 Zika cases were detected; 27 inspections were carried out in residences and 80 in the street. In 2016, 17 chikungunya, 52 dengue and 48 Zika cases were detected; 50 inspections were carried out in residences and 103 in the street. No autochtonous case was detected. Conclusions: We observed an increasing incidence of arbovirosis cases during the 3-year study period. There was a progressive intensification of vector surveillance and control actions (inspections, sample collection…) (AU)

Tuberculosis e inmigración en España. Revisión bibliográfica / Tuberculosis and immigration in Spain. Scoping review

Fundamentos: La inmigración es un fenómeno bastante reciente en España y aún existen pocas publicaciones científicas sobre tuberculosis (TB) e inmigración. El objetivo de este estudio fue describir las características diferenciales de la tuberculosis en inmigrantes respecto a los sujetos autóctonos. Métodos: Revisión bibliográfica de artículos originales escritos en español o inglés y publicados entre 1998-2012, sobre TB en poblaciones inmigrantes. Se incluyeron las publicaciones con las palabras clave tuberculosis, inmigrante y España. La búsqueda bibliográfica se realizó en las bases de datos Medline y MEDES. Resultados: Se encontró un total de 72.087 artículos publicados sobre TB a escala mundial y en el 6% de éstos se trataba el tema inmigración. En relación a España se encontraron 2.917 artículos, que representaban el 4% de los publicados a escala mundial, y 219 (7,5%) consideraban además la inmigración. De los 219 artículos, el 48% fueron publicados en revistas españolas y el 52% restante en revistas anglosajonas. El 93,5% de las personas inmigrantes con TB tenían menos de 51 años, mientras que en los nativos este porcentaje es del 64,9%. Las resistencias al tratamiento se da en el 7,8% de la población inmigrante frente al 3,8 de la autóctona. Conclusiones: Los inmigrantes con tuberculosis se caracterizan por ser más jóvenes que los autóctonos con tuberculosis, presentan más resistencias farmacológicas y proceden sobretodo de América Latina, Europa del Este, África y Asia. La no disponibilidad de la tarjeta sanitaria puede ser un problema (AU)

Background: Immigration is a fairly recent phenomenon in Spain and there are still few scientific publications on tuberculosis (TB) and immigration. Therefore, the aim of this study is to describe the differential characteristics of TB in the immigrant population with respect to natives in Spain. Methods: Literature review of original articles written in Spanish or English and published 1998-2012 about TB among immigrant population. The articles with the key words "Tuberculosis", "immigrants" and "Spain" were included. Literature search was performed in Medline and MEDES. Results:Atotal of 72,087 articles on TBwere detectedworldwide, 6% of themdealt with the immigration issue. Regarding Spain we found 2,917 articles representing 4% of the papers published worldwide, and in 219 (7.5%) immigration was considered. Of the 219 articles, 48%were published in Spanish journals and the 52% remaining in Anglo-Saxon journals. 93.5% of immigrants with TB were younger than 51, whereas this percentage was 64.9% in natives. Drug resistance can be seen in 7.8% of the immigrant population but in only 3.8%of natives. It was also detected that the unavailability of a health card could be a problem. Conclusion: Immigrants with TB were characterized by being younger and having more drug resistance and coming mostly from LatinAmerica, Eastern Europe,Africa andAsia. It was also detected that the unavailability of a health card could be a problem (AU)

[Tuberculosis and immigration in Spain: scoping review]. / Tuberculosis e inmigración en España: revisión bibliográfica.

BACKGROUND: Immigration is a fairly recent phenomenon in Spain and there are still few scientific publications on tuberculosis (TB) and immigration. Therefore, the aim of this study is to describe the differential characteristics of TB in the immigrant population with respect to natives in Spain. METHODS: Literature review of original articles written in Spanish or English and published 1998-2012 about TB among immigrant population. The articles with the key words "Tuberculosis", "immigrants" and "Spain" were included. Literature search was performed in Medline and MEDES. RESULTS: A total of 72,087 articles on TB were detected worldwide, 6% of them dealt with the immigration issue. Regarding Spain we found 2,917 articles representing 4% of the papers published worldwide, and in 219 (7.5%) immigration was considered. Of the 219 articles, 48% were published in Spanish journals and the 52% remaining in Anglo-Saxon journals. 93.5% of immigrants with TB were younger than 51, whereas this percentage was 64.9% in natives. Drug resistance can be seen in 7.8% of the immigrant population but in only 3.8% of natives. It was also detected that the unavailability of a health card could be a problem. CONCLUSION: Immigrants with TB were characterized by being younger and having more drug resistance and coming mostly from Latin America, Eastern Europe, Africa and Asia. It was also detected that the unavailability of a health card could be a problem.

Indicadores para la gestión de los servicios de salud pública / Indicators for the management of public health services

Objetivos Se pretende definir indicadores apropiados para la gestión de los distintos servicios de una organización que presta servicios integrales de salud pública a una población y territorio definidos.Métodos Análisis de la actividad y discusión con los responsables de los diversos servicios para buscar indicadores de obtención viable que recojan de la mejor forma tres aspectos: su actividad, su cobertura, calidad o efectividad, y su coste.Resultados Se obtienen indicadores cuantitativos para todos los servicios productivos de salud pública relacionados en el catálogo de servicios, pero en algunas líneas de trabajo no parece factible cubrir los tres ámbitos. Además, para las actividades de coordinación y enlace los indicadores son a menudo menos cuantitativos y poco sensibles a cambios. Se ha podido cuantificar el coste para las grandes líneas de trabajo productivo y los 47 servicios o productos, y los costes indirectos se han estimado en un 14%.Conclusiones Es factible desarrollar un sistema de información de gestión para los servicios de salud pública que permita comparaciones a lo largo del tiempo o entre territorios, con indicadores de actividad para todas las líneas de trabajo productivo. Los indicadores que reflejan la cobertura, calidad o impacto de los servicios plantean las mayores dificultades. Para algunas líneas de trabajo se pueden obtener indicadores de coste por unidad de producto con sentido, y para otras es más difícil. En todos los casos, el coste por habitante y año es un buen indicador sintético del coste de los servicios de salud pública (AU)

Objectives To define a set of indicators for the management of the various services of an agency responsible for comprehensive public health in a defined area and population. Methods We analyzed the agency’s activity and held discussions with those responsible for the distinct services to define indicators whose estimation is viable and which optimally describe three aspects: the services’ activity, coverage, quality or effectiveness, and cost. Results Quantitative indicators were defined for all the productive public health services inventoried in the agency’s services portfolio, but not all three aspects could be covered in all areas. In addition, for coordination and liaison services, the indicators were often less quantitative and less sensitive to change. Costs were estimated for the main areas of productive activity and for the 47 services or products, with indirect costs being estimated as 14% of expenditure.Conclusions We defined a system of indicators for management control, allowing comparisons over time and with other geographical areas, and with activity indicators covering all production areas. Defining indicators reflecting coverage, quality or impact for all services is more difficult. Cost can be estimated by unit of production for some services, but less successfully for others. The yearly cost by population is always a good synthetic indicator of the cost of public health services (AU)

[Indicators for the management of public health services]. / Indicadores para la gestión de los servicios de salud pública.

OBJECTIVES: To define a set of indicators for the management of the various services of an agency responsible for comprehensive public health in a defined area and population. METHODS: We analyzed the agency's activity and held discussions with those responsible for the distinct services to define indicators whose estimation is viable and which optimally describe three aspects: the services' activity, coverage, quality or effectiveness, and cost. RESULTS: Quantitative indicators were defined for all the productive public health services inventoried in the agency's services portfolio, but not all three aspects could be covered in all areas. In addition, for coordination and liaison services, the indicators were often less quantitative and less sensitive to change. Costs were estimated for the main areas of productive activity and for the 47 services or products, with indirect costs being estimated as 14% of expenditure. CONCLUSIONS: We defined a system of indicators for management control, allowing comparisons over time and with other geographical areas, and with activity indicators covering all production areas. Defining indicators reflecting coverage, quality or impact for all services is more difficult. Cost can be estimated by unit of production for some services, but less successfully for others. The yearly cost by population is always a good synthetic indicator of the cost of public health services.

[The Balanced Scorecard as a management tool in a public health organization]. / El Cuadro de Mando Integral como instrumento de dirección en una organización de salud pública.

OBJECTIVE: The Balanced Scorecard is a tool for strategic planning in business. We present our experience after introducing this instrument in a public health agency to align daily management practice with strategic objectives. METHODS: Our management team required deep discussions with external support to clarify the concepts behind the Balanced Scorecard, adapt them to a public organization in the health field distinct from the business sector in which the Balanced Scorecard was designed, and adopt this instrument as a management tool. This process led to definition of the Balanced Scorecard by our Management Committee in 2002, the subsequent evaluation of the degree to which its objectives had been reached, and its periodic redefinition. In addition, second-level Balanced Scorecards were defined for different divisions and services within the agency. The adoption of the Balanced Scorecard by the management team required prior effort to clarify who are the stockholders and who are the clients of a public health organization. The agency's activity and production were also analyzed and a key processes model was defined. Although it is hard to attribute specific changes to a single cause, we believe several improvements in management can be ascribed, at least in part, to the use of the Balanced Scorecard. CONCLUSION: The systematic use of the Balanced Scorecard produced greater cohesion in the management team and the entire organization and brought the strategic objectives closer to daily management operations. The organization is more attentive to its clients, has taken steps to improve its most complex cross-sectional processes, and has developed further actions for the development and growth of its officers and its entire personnel. At the same time, its management team is more in tune with the needs of the agency's administrative bodies that compose its governing board.

El Cuadro de Mando Integral como instrumento de dirección en una organización de salud pública / The Balanced Scorecard as a management tool in a public health organization

Objetivos: El Cuadro de Mando Integral (CMI, o Balanced Scorecard) es un instrumento para la planificación estratégica de las empresas. Adoptamos su uso en una organización de salud pública para alinear la práctica cotidiana de la dirección con los objetivos más estratégicos. Métodos: Nuestro equipo directivo requirió de discusiones con apoyo externo para clarificar los conceptos subyacentes en el CMI, adaptarlos a una organización sanitaria pública distinta del medio empresarial para el que se diseñó inicialmente y adoptarlo como instrumento de dirección. Esto llevó a la construcción de un CMI por el Comité de Dirección en el año 2002, a la posterior evaluación y a su reformulación periódica. Además, se han formulado CMI de segundo nivel para diversas direcciones y servicios de la organización. La adopción del CMI por el equipo directivo comportó un esfuerzo previo de clarificación sobre quiénes son los accionistas y los clientes de una organización pública como la nuestra. También llevó a realizar un análisis de la actividad realizada y de su producción, así como un modelo de procesos. Aunque es difícil atribuir determinados cambios a una causa concreta, creemos que diversas mejoras de gestión introducidas se pueden relacionar, al menos parcialmente, con su uso. Conclusión: El uso sistemático del CMI ha permitido cohesionar mejor el equipo de dirección y el conjunto de la organización, e impregnar la gestión cotidiana con los objetivos más estratégicos. La organización ha integrado mejor los elementos relacionados con sus clientes, ha iniciado acciones para mejorar los procesos internos transversales más complejos, y ha desarrollado de manera más sistemática y general los elementos orientados al crecimiento y desarrollo de sus cuadros y de todo el personal. Al mismo tiempo, los directivos han pasado a tener más presentes las necesidades de las administraciones titulares de la agencia que conforman sus órganos de gobierno

Objective: The Balanced Scorecard is a tool for strategic planning in business. We present our experience after introducing this instrument in a public health agency to align daily management practice with strategic objectives. Methods: Our management team required deep discussions with external support to clarify the concepts behind the Balanced Scorecard, adapt them to a public organization in the health field distinct from the business sector in which the Balanced Scorecard was designed, and adopt this instrument as a management tool. This process led to definition of the Balanced Scorecard by our Management Committee in 2002, the subsequent evaluation of the degree to which its objectives had been reached, and its periodic redefinition. In addition, second-level Balanced Scorecards were defined for different divisions and services within the agency. The adoption of the Balanced Scorecard by the management team required prior effort to clarify who are the stockholders and who are the clients of a public health organization. The agency's activity and production were also analyzed and a key processes model was defined. Although it is hard to attribute specific changes to a single cause, we believe several improvements in management can be ascribed, at least in part, to the use of the Balanced Scorecard. Conclusion: The systematic use of the Balanced Scorecard produced greater cohesion in the management team and the entire organization and brought the strategic objectives closer to daily management operations. The organization is more attentive to its clients, has taken steps to improve its most complex cross-sectional processes, and has developed further actions for the development and growth of its officers and its entire personnel. At the same time, its management team is more in tune with the needs of the agency's administrative bodies that compose its governing board