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West Nile virus (WNV) is an emerging arbovirus first recognized in Europe in the 1950s. Since then, outbreaks have been reported in several European countries. In 2010, the first WNV outbreak was recorded in Spain, affecting the southern part of the country. We conducted a seroprevalence study in the Catalonia region (northeastern Spain), an area considered at high risk of arbovirus transmission. A total of 800 serum samples from blood donors were collected and screened for antibodies against WNV by enzyme-linked immunosorbent assay (ELISA) and confirmed by a microneutralization assay. More than 50 samples tested positive by ELISA, but only one sample contained neutralizing antibodies against WNV and was obtained from a donor native of Pakistan. The low seroprevalence detected may serve as reference baseline data for monitoring WNV activity in our region in future years.

Introduction: The evidence suggest that shift from car to active transportation(AT)(cycling, walking) and public transport(PT) in daily life could improve health. Although a number of health impact...

BACKGROUND: A number of studies have associated natural outdoor environments with reduced mortality but there is no systematic review synthesizing the evidence. OBJECTIVES: We aimed to systematically review the available evidence on the association between long-term exposure to residential green and blue spaces and mortality in adults, and make recommendations for further research. As a secondary aim, we also conducted meta-analyses to explore the magnitude of and heterogeneity in the risk estimates. METHODS: Following the PRISMA statement guidelines for reporting systematic reviews and meta-analysis, two independent reviewers searched studies using keywords related to natural outdoor environments and mortality. DISCUSSION: Our review identified twelve eligible studies conducted in North America, Europe, and Oceania with study populations ranging from 1645 up to more than 43 million individuals. These studies are heterogeneous in design, study population, green space assessment and covariate data.We found that the majority of studies show a reduction of the risk of cardiovascular disease (CVD) mortality in areas with higher residential greenness. Evidence of a reduction of all-cause mortality is more limited, and no benefits of residential greenness on lung cancer mortality are observed. There were no studies on blue spaces. CONCLUSIONS: This review supports the hypothesis that living in areas with higher amounts of green spaces reduces mortality, mainly CVD. Further studies such as cohort studies with more and better covariate data, improved green space assessment and accounting well for socioeconomic status are needed to provide further and more complete evidence, as well as studies evaluating the benefits of blue spaces. This project was funded by the CERCA Institutes Integration Program (SUMA 2013) [promoted and managed by the Secretariat for Universities and Research of the Ministry Economy and Knowledge of the Government of Catalonia (SUR), the Agency for Management of University and Research Grants (AGAUR) and the CERCA Institute]. Payam Dadvand is funded by a Ramón y Cajal fellowship (RYC-2012-10,995) awarded by the Spanish Ministry of Economy and Competitiveness. Margarita Triguero-Mas is funded by a pre-doctoral grant from the Catalan Government (AGAUR FI-DGR-2013).

The objective of the study was to investigate the prevalence of immunoglobulin G (IgG) antibodies to hepatitis E virus (HEV) infection in a population sample from Catalonia and to analyze the demographic and clinical variables associated with the presence of these antibodies. A total of 1,280 subjects between 15 and 74 years of age were selected randomly from urban and rural areas. Data for sociodemographic and clinical variables were collected by using a questionnaire. IgG antibodies to HEV were determined by an immunoenzymatic method. The odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for studied variables. Multiple logistic regression analysis was used to determine which variables were independently associated with the prevalence of HEV infection. Anti-HEV antibodies were detected in 96 (7.3%) of the 1,280 samples analyzed. The prevalence of antibodies was greater among males (7.8%) than among women (7%) and increased with age for both sexes, from 3% among subjects 15 to 24 years of age to 12% among subjects ≥65 years of age. Bivariate analysis of the sociodemographic and clinical variables showed an association between the prevalence of hepatitis E virus infection and minor surgery (OR, 1.96; 95% CI, 1.24 to 3.11), abdominal surgery (OR, 1.74; 95% CI, 1.12 to 2.73), and, for women, being uniparous or multiparous (OR, 2.84; 95% CI, 1.19 to 6.79). The multivariate analysis showed an association with minor surgery only (OR, 1.68; 95% CI, 1.03 to 2.70). In conclusion, anti-HEV antibodies were detected in 7.3% of the Catalan population. The seroprevalence of anti-HEV antibodies increased with age and was associated with previous minor surgery.

Fundamento y objetivo Investigar un brote de gastroenteritis que afecto a los trabajadores y residentes (con diferentes grados de dependencia) de una residencia asistida. Pacientes y metodo El 25 de octubre de 2004 se detecto un brote en una residencia de Oliana (Lleida) con 52 trabajadores y 124 residentes. Se realizo un estudio de cohortes bidireccional, retrospectivo y prospectivo sobre el consumo de agua, alimentos, grado de dependencia y tipo de trabajo. Se tomaron muestras de agua y de 6 alimentos. Mediante la tecnica de reaccion en cadena de la polimerasa se determino la presencia del ADN de Norovirus en heces de 30 pacientes. La implicacion de cada factor se estudio con el riesgo relativo (RR) y su intervalo de confianza (IC) del 95%. Resultados Se entrevisto al 97,7% de los expuestos (172/176). La tasa de ataque global fue del 53,3% (92/172). La proporcion de sintomas fue la siguiente: diarrea en un 68,5% (63/92), vomitos en un 64,1% (59/92), nauseas en un 63% (58/92), fiebre en un 33,7% (31/92), dolor abdominal en un 28,3% (26/92) y cefalea en un 14,1% (13/92). La curva epidemica indico transmision durante 19 dias. Los factores asociados al riesgo de enfermar fueron: grados de dependencia alto (RR = 1,6; IC del 95%, 1,0-2,6) y medio (RR = 1,7; IC del 95%, 1,0-2,7), el mayor contacto de los trabajadores con los residentes (RR = 2,8; IC del 95%, 1,1-7,3) y realizar tareas de limpieza (RR = 2,8; IC del 95%, 1,0-8,0). Doce muestras de heces resultaron positivas a Norovirus. Los analisis de la muestra de agua y de los 6 alimentos fueron negativos. Conclusiones Se constato en una residencia asistida la existencia de un brote de Norovirus de transmision persona a persona, asociado al grado de dependencia de los residentes, al mayor contacto de los trabajadores con aquellos y a la realizacion de tareas de limpieza.

Resumen Objetivo Investigar la validez del antecedente de vacunacion antihepatitis B obtenido en la primera visita al tocologo de las mujeres embarazadas. Pacientes y metodo En una muestra representativa de mujeres embarazadas de Cataluna (n = 1.538), se ha comparado el antecedente de vacunacion antihepatitis B obtenido mediante interrogatorio durante la primera visita al tocologo con el obtenido mediante el analisis serologico de marcadores de vacunacion anti-HBs+ anti-HBc−. Resultados Las prevalencias de antecedente de vacunacion antihepatitis B obtenidas mediante interrogatorio fueron sensiblemente mas bajas que las obtenidas mediante analisis serologico en todos los grupos de edad. Las diferencias fueron especialmente importantes en las mujeres mas jovenes (odds ratio [OR] = 11,42, en el grupo de edad de 15 a 19 anos, y 2,17, en el de 20 a 24 anos). Conclusiones La evaluacion de la cobertutra vacunal antihepatitis B mediante el analisis de marcadores serologicos (anti-HBs+ y anti-HBc−) es mucho mas fiable que la realizada mediante interrogatorio.

Background: The objective of performance assessment is to provide governments and populations with appropriate information about the state of their health care system. The objective of this paper is to present the most recent developments in performance assessment and their application in urban contexts. Methods: Literature review in PubMed (1970-2004). We identified additional papers and grey literature from retrieved references. Results: Performance assessment initiatives were identified in Australia, Canada, the United Kingdom, and New Zealand. The World Health Report 2000 is one of the best known examples of a transnational approach to performance assessment. Conclusion: The best developed initiatives to date are those that define precise categories, criteria and indicators with which to analyse and assess health care systems, based on a solid conceptual framework. Performance assessment fits perfectly in urban contexts, as it is a useful tool for designing and monitoring policies, assessing the quality of the services provided, and measuring the health status of city dwellers. Barcelona and Montreal are currently collaborating together on a project to assess the performance assessment of their respective health care services.

Fundamento: Obtener y difundir información de la opinión pública acerca de un proyecto de regulación permite hacer visible el apoyo social silencioso y facilita el proceso, que con frecuencia debe afrontar resistencias por las partes interesadas. Este trabajo presenta una encuesta de opinión sobre el proyecto de regulación del tabaquismo en los últimos tramos del proceso y sus resultados, y se formulan algunas consideraciones sobre el uso de este tipo de información en procesos de cambio. Métodos: Estudio descriptivo transversal. En diciembre de 2005 se realizó una encuesta telefónica breve mediante cuestionario precodificado a una muestra de la población de 18 o más años (n=830) de Cataluña. El cuestionario explora la opinión acerca de las propuestas de regulación en discusión. Se presenta el grado de acuerdo y la valoración con nueve medidas regulatorias, estratificando según el patrón de uso de tabaco de los respondientes. Resultados: El 26,3% de la población entrevistada son fumadores diarios. El grado de conocimiento y aceptación de la regulación es muy elevado. Los aspectos con mayor apoyo son la prohibición de la venta a menores (97,3%), la prohibición de fumar en lugares públicos cerrados (92,8%) y centros de trabajo (89%), y la prohibición de la publicidad (90,8%). El aspecto con menor apoyo es la prohibición de fumar en bares y cafeterías (80,2%). Conclusiones: La regulación recibe el apoyo mayoritario de la población. Aunque expresen menos apoyo, las medidas son mayoritariamente aceptadas por los fumadores: son rechazadas mayoritariamente sólo las limitaciones en bares y cafeterías.

Fundamento: Los efectos de la contaminación atmosférica sobre la salud han sido objeto en los últimos años de numerosos estudios que han permitido cuantificar la asociación entre ambas El objetivo de este trabajo es llevar a cabo la Evaluación del Impacto en Salud (EIS) calculando los beneficios que se obtendrían al cumplir los objetivos establecidos por la Directiva 1999/30/CE en relación con las partículas en suspensión. Métodos: Se ha valorado el impacto en salud de la contaminaci ón atmosférica por partículas en suspensión, para lo que se han utilizado dos indicadores distintos: Humos Negros (HN) (Barcelona, Bilbao, Valencia) y partículas en suspensión menores de 10 mm (PM10) (Bilbao, Madrid y Sevilla). Los indicadores de salud fueron la mortalidad por todas las causas, por causa respiratoria y por causa cardiovascular, e ingresos hospitalarios urgentes por causa respiratoria y cardiovascular. El EIS se ha realizado mediante el cálculo de la fracción atribuible a la contaminación por partículas. En el caso de PM10 se ha calculado el impacto debido a efectos de la contaminaci ón a corto plazo, los acumulados hasta 40 días después, y a largo plazo. Para HN únicamente se han calculado efectos a corto plazo. Resultados: Los niveles diarios de PM10 por encima de 50 µg/m3 en Bilbao, Madrid y Sevilla son responsables de 1,4 muertes prematuras por 100.000 habitantes y año debido a sus efectos a corto plazo y de 2,8 muertes/100.000 en un periodo de hasta 40 días tras la exposición. A largo plazo, el número de muertes prematuras atribuibles a la contaminación media anual de PM10 por encima de 20 µg/m3 es 68/100.000. Conclusiones: El impacto en salud de los niveles actuales de contaminación atmosférica es cuantificable y no despreciable. APHEIS y las evaluaciones de impacto pueden ayudar a la planificaci ón sanitaria y a las políticas medioambientales.

OBJECTIVE: To study the differential distribution of transportation injury mortality by educational level in nine European settings, among people older than 30 years, during the 1990s. METHODS: Deaths of men and women older than 30 years from transportation injuries were studied. Rate differences and rate ratios (RR) between high and low educational level rates were obtained. RESULTS: Among men, those of low educational level had higher death rates in all settings, a pattern that was maintained in the different settings; no inequalities were found among women. Among men, in all the settings, the RR was higher in the 30-49 age group (RR 1.46, 95% CI 1.32 to 1.61) than in the age groups 50-69 and > or = 70 years, a pattern that was maintained in the different settings. For women for all the settings together, no differences were found among educational levels in the three age groups. In the different settings, only three had a high RR in the youngest age group, Finland (RR 1.33, 95% CI 1.01 to 1.74), Belgium (RR 1.38; 95% CI 1.13 to 1.67), and Austria (RR 1.49, 95% CI 0.75 to 2.96). CONCLUSION: This study provides new evidence on the importance of socioeconomic inequalities in transportation injury mortality across Europe. This applies to men, but not to women. Greater attention should be placed on opportunities to select intervention strategies tailored to tackle socioeconomic inequalities in transportation injuries.

Aim To systematically examine gender sensitivity in the policies formulated in the health plans of the various Autonomous Communities in Spain in which these plans are available. We defined gender sensitivity as the extent to which the health plans took gender into account as a relation category and developed interventions to ameliorate gender-related inequalities. Material and methods A questionnaire with a structure similar to that of the health plans, which were based on the World Health Organization's proposal, was designed. The questionnaire consisted of an introductory section, which we called the symbolic content, and described the general objectives and values of the health plan. In the other section, which we called the operative content of the health plan, the specific objectives and the interventions to achieve them were expressed in concrete terms. A gender sensitivity symbolic index and gender sensitivity operative index were constructed. Results Thirteen health plans were analyzed. Those of the Basque Country, the Valencian Community and the Canary Islands showed high symbolic content, which did not always match their subsequent operative implementation. The health plans of the Basque Country, Catalonia and Galicia showed the greatest operative gender sensitivity. Conclusions Gender sensitivity in health plans varies widely among Autonomous Communities. Some channels for action would be to set up partnerships and networks for health professionals and collectives in order to raise awareness of the problem and build on the experience of the Autonomous Communities whose initiatives are carried out with the greatest gender sensitivity.

Many studies conducted during the last decade suggest the mental health benefits of green and blue spaces. We aimed to systematically review the available literature on the long-term mental health benefits of residential green and blue spaces by including studies that used standardized tools or objective measures of both the exposures and the outcomes of interest. We followed the PRISMA statement guidelines for reporting systematic reviews and meta-analysis. In total 28 studies were included in the systematic review. We found limited evidence for a causal relationship between surrounding greenness and mental health in adults, whereas the evidence was inadequate in children. The evidence was also inadequate for the other exposures evaluated (access to green spaces, quality of green spaces, and blue spaces) in both adults and children. The main limitation was the limited number of studies, together with the heterogeneity regarding exposure assessment. Given the increase in mental health problems and the current rapid urbanization worldwide, results of the present systematic review should be taken into account in future urban planning. However, further research is needed to provide more consistent evidence and more detailed information on the mechanisms and the characteristics of the green and blue spaces that promote better mental health. We provide recommendations for future studies in order to provide consistent and evidence-based recommendations for policy makers.

Background: Although in the last 20 years, the WHO ‘Health for All’ principles have been widely used in national, regional and local health policy documents, there is still a gap in the literature regarding how to appraise or compare them, which weakens the social accountability process. Methodology: A new, rapid approach to analyse the formulation of health policies is proposed. It is based on the selection of a small number of tracers and the development of a gold standard to be completed with input from a review of the literature, and opinions of expert panel members. This methodology has been empirically applied to the health strategies of two Spanish regions (Catalonia and Valencia). Results: A framework for analysis was produced containing three dimensions: timing (early or late policy options), action level (individuals or social focus) and equity (social class, gender and ethnic groups). The health problems selected as tracers were HIV/AIDS, traffic injuries and ageing-related disabilities. In the two regions studied, the policies formulated for HIV/AIDS and age-related disabilities provide interventions late in the evolution of the health problem. The strategy established in the region of Valencia is more community-oriented than in Catalonia. Neither region had implemented specific policies regarding social class, gender or ethnic groups. Interpretation: The methodology proposed here makes it possible to map the formulation of Health Strategies, compare different geographical areas and even forecast the policies’ usefulness. The simplicity of the method, together with the fact that citizens and politicians alike can easily understand its results are major advantages. For the framework to be fully useful, it will be necessary to build evidence-based policy databases.

Objective: To analyse the role of individual and contextual variables in injury mortality inequalities from a small area analysis perspective, looking at the data for the city of Barcelona (Spain) for 1992–98. Setting: Barcelona (Spain). Methods: All injury deaths in residents older than 19, which occurred in the period 1992–98 were included (n=4393). Age and sex specific mortality rates were calculated for each educational level and each cause of death (traffic injuries, falls, drug overdose, suicide, other injuries). The contextual variables included were the proportion of men unemployed, and the proportion of men in jail, in each neighbourhood. Multilevel Poisson regression models were fitted using data grouped by age, educational level, and neighbourhood for each sex. Results: Death rates were higher in males, at the extremes of the age distribution (under 44 and over 74 years), and for lower educational levels. The results of the Poisson multilevel models indicate that inequalities by educational level follow a gradient, with higher risks for the population with no schooling, after having adjusted for the contextual variables of the neighbourhood. Such inequalities were more important in the youngest age group (20–34 years), as relative risk of 5.41 (95% confidence interval (CI) 3.9 to 7.4) for all injury causes in males and 4.38 (95% CI 2.3 to 8.4) in females. The highest relative risks were found for drug overdose. There was a contextual neighbourhood effect (the higher the deprivation, the higher the mortality) after having taken into account individual variables. Conclusion: The findings underscore the need to implement injury prevention strategies not only at the individual level taking into account socioeconomic position, but also at the neighbourhood level.

OBJECTIVE—In recent decades, in most European countries young adult mortality has risen, or at best has remained stable. The aim of this study was to describe trends in mortality attributable to the principal causes of death: AIDS, drug overdose, suicide and motor vehicle traffic accidents, among adults aged between 15 and 34 years in three European cities (Barcelona, Bologna and Munich), over the period 1986 to 1995. METHODS—The population studied consisted of all deaths that occurred between 1986 and 1995 among residents of Barcelona, Bologna and Munich aged from 15 to 34 years. Information about deaths was obtained from mortality registers. The study variables were sex, age, the underlying cause of death and year of death. Causes of death studied were: drug overdose, AIDS, suicide and motor vehicle traffic accidents. Age standardised mortality rates (direct adjustment) were obtained in all three cities for the age range 15-34. To investigate trends in mortality over the study period Poisson regression models were fitted, obtaining the average relative risk (RR) associated with a one year increment. RESULTS—Young adult mortality increased among men in Barcelona and Bologna (RR per year: 1.04, 95% confidence intervals (95%CI): 1.03, 1.06 in Barcelona and RR:1.03, 95%CI:1.01, 1.06 in Bologna) and among women in Barcelona (RR:1.02, 95%CI: 1.01, 1.04), with a change in the pattern of the main causes of death attributable to the increase in AIDS and drug overdose mortality. In Munich, the pattern did not change as much, suicides being the main cause of death during the 10 years studied, although they have been decreasing since 1988 (RR:0.92, 95%CI:0.88, 0.96 for men and 0.81, 95%CI: 0.75-0.87 for women). CONCLUSION—The increase in AIDS mortality observed in the three European cities in the mid-80s and mid-90s has yielded to substantial changes in the pattern of the main causes of death at young ages in Barcelona and Bologna. Munich presented a more stable pattern, with suicide as the main cause of death. Keywords: young adult mortality; AIDS; drug overdose; suicide; traffic accidents

Data on traffic injury cases that includes both the crash circumstances and the health outcome is a key tool for creating appropriate motor-vehicle injury prevention policies. The aim of this study was to explore the feasibility of the probabilistic linkage of police and emergency department data relating to motor-vehicle injury cases in Barcelona. A probabilistic linkage process was performed using local police reports (n = l2,481) and hospital emergency department data (n = 16,733) for all traffic injury cases that occurred in 1997. In almost two out of every three matched pairs for the injured person, at least five of the seven variables coincided, and in 7.3% of the cases all variables coincided. This work has allowed the empirical development of combined methods for the linkage of police and healthcare sources of information at the local level, which are the preliminary steps towards the construction of a data base that would include full information on the circumstances and the consequences of motor...

Objectives: To describe the characteristics of motor-vehicle (MV) injury cases admitted to Emergency departments (ED), and to assess factors related to injury severity and hospital admission. Setting: Subjects were MV injury patients, aged 16 or more, admitted to four EDs in the city of Barcelona (Spain), from July 1995 to June 1996. Methods: Cross-sectional design. The data analyzed were obtained from the information routinely transmitted from the EDs to the Municipal Institute of Health, based on the processing of ED logs. Severity was assessed with the Abbreviated Injury Scale and the Injury Severity Score. Univariate and bivariate descriptive statistical analyses were performed, as well as multiple logistic regressions. Results: For the 3791 MV-injury cases included in the study period, a larger contribution of cases was noted for males (63.1%), for cases younger than 30 years (55.3%) and for motorcycle or moped occupants (47.1%). After adjusting for age, sex and the presence of multiple injuries, pedestrians, followed by moped and motorcycle occupants were at a higher risk of a more severe injury (OR: 1.77, 1.61 and 1.50 respectively). Correspondingly, these user groups also showed a higher likelihood of a hospital admission (OR: 2.03, 1.92 and 2.00 respectively), when attended to in an ED. Injury cases attended to in the ED during night hours (OR: 2.06) were also at a higher risk of a hospital admission. Conclusions: In Barcelona, pedestrians and two-wheel MV occupants, besides accounting for two-thirds of MV injury cases, are the user groups with a greater risk of a more severe injury, as well as a higher chance of a hospital admission, independently of demographic and health care factors.

Most of the studies of inequalities in mortality carried out in Spain have been ecological, due to the difficulty of obtaining good quality socioeconomic information at individual level. The objective of this study was to describe inequalities in mortality by social class, based on occupation, among men residents of Barcelona in 1993. A representative sample was obtained of men residents of Barcelona who died during the year 1993, aged between 15 and 65 years. It was a retrospective interview given to relatives of the deceased, or other closely related persons. The variables analysed were: age, education level, underlying cause of death, and social class based on occupation (manual and non-manual workers). Rates, relative risks (RRs) and their 95% confidence intervals (95% CIs) are presented by age groups and cause of death. The main results show that among young people, the excess of mortality due to infectious diseases is notable (RR: 1.9; 95% CI: 1.6-2.2), and also due to external causes (RR: 2.1; 95% CI: 1.8-2.4) among manual workers with respect to non-manual workers, mainly due to AIDS and drug overdose. No significant differences were found in mortality due to tumours. For respiratory and cardiovascular causes, there is an increase in mortality in the less favoured social classes, as also occurs for mortality due to diseases of the digestive system, particularly among young manual workers, with an RR: 2.6 (95% CI: 1.5-3.6) compared to non-manual workers. This study shows that it is necessary to continue exploring inequalities in health, but above all it is necessary to implement efficient preventive measures addressed mainly at young people in situations of disadvantage, in order to avoid the excess of avoidable mortality which is found.

The results of the evaluation of use of low-cost video conferencing systems (VCSs) in telemedicine is presented. Applications sharing, a new feature of these systems, recently has allowed high-quality computer-supported collaborative work (CSCW). The video conferencing (VCing) equipment used was Intel ProShare 200 v2.0a. It is representative of other low-cost VCSs. The areas of application are epidemiology and telemedicine (orthopaedics and radiology). Potential end users filled out 58 evaluation questionnaires concerning user profiles, contents and benefits of the sessions, organizational aspects, user friendliness, user acceptance, cost effectiveness, technical and multipoint related aspects. Although the end users had a lot of computer experience, their knowledge in VCSs was rather limited. The users assessed the system capable of being integrated into routine work, despite a high organizational impact. The VCS is user friendly, application sharing being used in almost every session. Audio quality was not always sufficient. The remote video was sufficient, as was the quality of medical images such as CT, MRI or X-ray. The user acceptance of the system was high. Multipoint sessions require a structured protocol to be effective. Some technical problems with MCUs (Multipoint Control Units) occurred. The use of low-cost standard VCSs in telemedicine is advisable and is a good substitute for real meetings.

ResumenObjetivosDescubrir las desigualdades sociales en mortalidad a nivel de las Áreas Básicas de Salud de Barcelona y analizar los diferentes patrones de desigualdades sociales en salud.MétodosSe incluyeron todas las defunciones de residentes de Barcelona del período 1989-1993. El diseño fue un estudio ecológico transversal (unidad de análisis: área básica de salud). Se estudiaron indicadores socioeconómicos e indicadores de mortalidad global y las principales causas de mortalidad. Se realizó un análisis descriptivo y se calcularon medidas de asociación entre los indicadores socioeconómicos y la mortalidad, mediante modelos de regresión de Poisson.ResultadosTanto la distribución socioeconómica como la de mortalidad fue desigual entre las áreas de estudio, existiendo una peor situación en la zona centro, norte y litoral de la ciudad. Se halló una asociación estadísticamente significativa entre la situación socioeconómica desfavorecida y la mortalidad global (RR = 1,48), así como con la mortalidad específica: cáncer de pulmón (RR = 1,64, hombres), cirrosis (RR = 2,33, hombres), sida (RR = 3,42, ambos sexos), sobredosis (RR = 5,18, ambos sexos), bronquitis, enfisema y asma (RR = 1,41, hombres), tuberculosis (RR = 6,3, ambos sexos) y causas externas (RR = 2,29, hombres). El incremento de riesgos según el empeoramiento de la situación socioeconómica fue lineal para cirrosis y bronquitis, enfisema y asma, y casi lineal para cáncer de pulmón. Para sida, sobredosis y tuberculosis el incremento de riesgos no fue lineal, sino que aumentaba de forma importante para los niveles de desempleo más altos.ConclusionesLas causas de muerte que se han asociado con desigualdades sociales están todas relacionadas con estilos de vida (tabaquismo, consumo excesivo de alcohol y uso de drogas por vía parenteral). Se evidencian dos patrones de desigualdades sociales en salud, destacando el sida, sobredosis y tuberculosis como patologías asociadas a niveles extremos de situación socioeconómica desfavorable, donde probablemente hay condiciones que favorecen la marginalidad y los problemas de salud asociados a ella.SummaryBackgroundThe aims of this study were to describe social inequalities in mortality amongst Basic Health Areas in Barcelona Spain and to analyze the patterns of social inequalities in health.MethodsThis is an ecological study of all deaths of residents in Barcelona in 1989-93. The unit of analysis was the Basic Health Area. Socio-economic and mortality indicators (overall mortality and the main causes of death) were studied. Relative risk estimates between socio-economic and mortality indicators were calculated through Poisson regression models.ResultsAn unequal socioeconomical and mortality distribution was observed between areas. The following variables were found to be associated with lower socio-economic conditions: overall mortality (RR = 1,48, males), specific mortality: malignant neoplasm of trachea, bronchus and lung (RR = 1,64, males), chronic liver disease and cirrhosis (RR = 2,33, males), AIDS (RR = 3,42, males and females), drug overdose (RR = 5,18, males and females), tuberculosis (RR = 6,3, males and females), pneumonia, bronchitis, emphysema and asthma (RR = 1,41, males), and external causes (RR = 2,29, males). The increase in risk with deteriorating socioeconomic situation was linear for cirrhosis and bronchitis, emphysema and asthma, and close to linearity for malignant neoplasm of trachea, bronchus and lung. For AIDS, drug overdose, and tuberculosis, the increase in risk was not linear, being much higher for those areas with higher levels of unemployment.ConclusionsAll causes of death that have been found to be associated with social inequalities are related with life-styles (smoking, excessive alcohol consumption and parenteral drug use). There are two patterns of social inequalities in health: AIDS, drug overdose and tuberculosis stand out as pathologies associated to extreme unfavourable socioeconomic situation, for which it is likely that there are some conditions favouring health problems associated with margination.

ObjetivosDescribir la actividad física de ocio, a los niveles que se consideran más beneficiosos para la salud, y analizar su asociación con variables sociodemográficas y otros comportamientos relacionados con la salud, en la población mayor de 14 años residente en la ciudad de Barcelona.MétodosLa muestra estuvo constituida por 4.171 personas adultas que contestaron la Encuesta de Salud de Barcelona de 1992. Se consideraron inactivas en el tiempo libre las personas que habían realizado en la semana previa menos de tres veces (de 20 minutos como mínimo) de ejercicio moderado y/o intenso. El análisis de la asociación de la actividad física de ocio con las diferentes variables fue bivariado y multivariado mediante regresión logística.ResultadosUn 80,7% de la población mayor de 14 años de Barcelona realizó menos de tres veces de actividad física moderada o intensa a la semana, en el tiempo libre, y un 20% no realizó ningún tipo de ejercicio. La inactividad fue mayor en las mujeres, aumentó de forma significativa con la edad y al disminuir el nivel socioeconómico. En los hombres con estudios primarios incompletos la ORa (odds ratio ajustada) de inactividad fue 1,8 (intervalo de confianza (IC) al 95%: 1,2–2,9) y en las mujeres fue 1,5 (IC 95%:1,0–2,4), con respecto a los que tenían estudios superiores. En los hombres que trabajan ocho o más horas en jornada partida la ORa de inactividad con respecto a los que trabajan menos de ocho horas en jornadas continua fue de 1,9 (IC 95%: 1,2–2,9). En los hombres fumadores el riesgo de inactividad fue mayor que en los no fumadores.ConclusionesEstos resultados sugieren que los programas de promoción de la actividad física en los adultos de Barcelona deberían facilitar la incorporación de mayores, mujeres, trabajadores y personas de bajo nivel socioeconómico, además de reforzar los hábitos deportivos en los más jóvenesObjectivesTo describe leisure-time physical activity at the levels considered more benefitial for health and to analize the association with sociodemographic variables and other health behaviors, among the population older than 14 years in Barcelona, Spain.MethodsA sample of 4,171 adults answered the Health Interview Survey of Barcelona in 1992. Those who had participed less than three times (20 minutes at least) in moderate and/or intense exercise in the week before to the interview were considered inactive. Bivariate and multivariate analyse using logistic regression were used to study the association of leisuretime physical activity and the study variables.Results80.7% of population older than 14 years in Barcelona participated less than three times in moderate and/or intense leisure-time physical activity and 20% did not participate in any exercise. Inactivity was higher in women, and increased significantly with age and in people with a low socioeconomic level. Men and women with incomplete primary studies were more likely to be inactive than people with graduate studies (ORa -ajusted odds ratio-1.8, 95% confidence interval – CI-: 1.1–2.9 and 1.5, 95% CI: 1.0–2.4 respectively). For men working eight or more hours with interruption per day the ORa for inactivity was 1.9 (95% CI: 1.2–2.9) with respect to men working less than eight hours without interruption. Smoking men were more inactive than non smokers.ConclusionsThese result suggest that health promotion programmes to promote physical activity for adult in Barcelona should facilitate the incorporation of older people, women, people with low socioeconomic level and the working population, besides reinforcing sports habits among the youngest population.

FundamentoDescribir la actividad física habitual según variables sociodemográficas y estado de salud, considerando la población trabajadora y la que no lo es, en la población de 16 o más años residente en la ciudad de Barcelona.MétodosLa muestra estuvo constituida por 1.885 hombres y 2.196 mujeres adultas que contestaron la Encuesta de Salud de Barcelona de 1992. Se consideró que habían realizado actividad física habitual los que realizaron un esfuerzo físico importante o desplazamiento a pie frecuentemente. El análisis de la asociación de la actividad física habitual con las diferentes variables en la población ocupada y en la que no lo estaba, fue bivariado y multivariado mediante el ajuste de modelos de regresión logística.ResultadosEI 55,9% de los adultos realizaron actividad física habitualmente. La población ocupada fue menos activa que la no ocupada, aunque es la que realizó mayor esfuerzo físico (14,5% en los hombres y 8,0% en las mujeres). Los factores asociados a la realización de actividad física habitual fueron la ocupación y el nivel de estudios en los hombres ocupados y la ocupación en las mujeres ocupadas. En la población no ocupada la actividad física fue menor en las personas de salud regular o malo respecto a las que lo tenían muy bueno o bueno (razón de odds ajustada en los hombres de 0,2 —intervalo de confianza al 95% (IC 95%): 0,1–0,5— y en las mujeres de 0,5 (IC 95%: 0,3–0,8).ConclusionesMás de la mitad de la población de Barcelona realiza actividad física habitual. En la población ocupada esta actividad viene determinada fundamentalmente por la realizada en el trabajo. Las personas no ocupadas con mal estado de salud percibido realizan menos actividad física habitual.ObjectivesTo describe the sociodemographic distribution of habitual physical activity and to analyse its relationship with self-perceived health status and occupational status, among the population older that 16 years of age in the city of Barcelona, Spain.MethodsA sample of 1,885 adult men and 2,196 women answered the Health Interview Survey of Barcelona in 1992. Those whose habitual activity required high physical exertion or walking were considered as active. Bivariate and multivariate analyses adjusting logistic regression models were used to study the relationship between habitual physical activity and the rest of variables, for each occupational situation.ResultsFifty six percent of adults reported being physically active. Physical activity was lower among workers than non workers, although workers reported more physical exertion (14,5% in men and 8,0% in women). Physical activity was associated with occupation and educational level among male workers, but only with occupation among female workers. In the non working population, physical activity was lower among those who perceived their health status as fair or poor, compared with those that described it as good or very good, (ORa in men was 0.2, 95% confidence interval = 0.1–0.5; ORa in women was 0.5, 95% confidence interval = 0,3–0,8).ConclusionsMore than half of the Barcelona population were physically active in an habitual manner. Among workers, this activity was mainly determined by the occupation. Non-workers with a poor self-perceived health status did less physical activity.

Fundamento y objetivo Evaluar el grado de proteccion inmunitaria conseguida con la vacuna oral antipoliomielitica en la poblacion escolar de 6-12 anos de Cataluna. Sujetos y metodo Se ha investigado la prevalencia de anticuerpos frente al virus de la polio 1, 2 y 3 mediante la tecnica de seroneutralizacion en una muestra representativa (n = 197) de la poblacion escolar de 6-12 anos de Cataluna obtenida en el ano 2001. Resultados Se obtuvo una prevalencia de anticuerpos del 94,4% para el virus de la polio 1, del 98,5% para el virus de la polio 2 y del 73,1% para el virus de la polio 3. El 93,4% de las muestras estudiadas presentaba un grado protector de anticuerpos frente al virus de la polio 1 y 2; el 70,6% frente al virus de la polio 1 y 3, y el 69,5% frente al virus de la polio 1, 2 y 3. Ninguna variable sociodemografica se asociaba con la prevalencia de anticuerpos. La prevalencia de anticuerpos frente al virus de la polio 3 fue significativamente mayor en los escolares que habian completado la vacunacion (5 dosis) que en los que no la habian completado (4 dosis o menos): el 75,4 frente al 50,0% (p Conclusiones Los resultados de este estudio muestran que el 29,6% de la poblacion escolar de 6-12 anos no presenta anticuerpos frente al poliovirus 3 con la vacuna oral antipoliomielitica, por lo que es necesario desarrollar un programa de vacunacion con la vacuna de la polio inactivada.

The aim of this study was to estimate the incidence of morbidity and mortality due to injuries in the population over the age of 14 years in Barcelona, Spain. Injury distribution according to sex, age, external cause, place of occurrence of the injury and severity was also obtained. A one-year survey was conducted in the emergency departments of the six main hospitals in Barcelona, based on a multistage sampling. Information was collected prospectively in emergency services by specially trained non-staff interviewers. Mortality data were drawn from death certificates. The incidence rate was 74.7 injury cases per 1,000 person-years over 14 years of age, higher in males than in females. Injury rates were highest in the youngest age-group and progressively lower until people over 75 years of age. Main external causes of injury were falls, being struck or caught by objects, and traffic-related injuries. The leading specific causes of injury mortality were traffic injuries, suicides and poisonings. While the overall admission incidence was 3.34 cases per 1,000 inhabitants, the proportion of hospitalized cases was 45.0 per 1,000 injury cases admitted to emergency rooms, higher for females, for traffic injuries and in the elderly population. Ninety-six percent of injury cases had an ISS value of 8 or less, mean ISS being highest for traffic injuries and falls. Injury morbidity and mortality amongst residents of Barcelona follow sex, age and cause of injury patterns which are, overall, comparable to those observed in other industrialized countries, suggesting that similar etiologic factors might be operating in those areas. The results should enable the orientation of injury prevention policies in the urban environment targeted on the young and the elderly population.

The purpose of the study was to assess the one-year incidence of traffic injuries among residents 14 years of age and older, as well as their distribution by age, gender, road-user category, place of occurrence, and severity of the injury. A one-year survey was conducted in the emergency departments in Barcelona, Spain, based on a multistage cluster sampling of 8-hour shifts stratified by time of the year, day of the week, and time of day. All death certificates (E810-829) for residents in this same age group were also included. Information was collected prospectively in EDs by specially trained nonstaff interviewers. The baseline estimate of incidence of injuries was 1,037 per 100,000 population. The highest incidence was for ages 20-24 and 15-20 years. Incidence rank-ordered road-use categories were: motorbike occupants, passenger car occupants and pedestrians, the first category accounting for almost half of all injuries. There were 108 admissions and 15 deaths per 1,000 incident cases. Case-admissions ratios increased with age and were highest for pedestrians, who also accounted for the highest case-fatality ratios and ISS mean scores. The study offers the first description of the epidemiology of traffic injuries in a large southern-European city. Although overall age and gender incidence patterns were similar to those described in other western countries, the striking contribution of motorcycle injuries has not been previously pointed out, underscoring the urgent need to implement effective strategies to reduce injury risk associated with motorcycles and mopeds.

H ace unos anos una Carta al Director de Gaceta Sanitaria presentaba un «ejercicio» sobre la evolucion reciente del factor de impacto bibliografico (FI) en el campo de la salud publica y la epidemiologia1

Pandemics require an assessment of its severity. The objective was to determine the characteristics of pandemic influenza in Catalonia.We conducted a surveillance study on the incidence of ILI and severe cases between June 2009 and May 2010. A network of 55 doctors reported influenza-like illness and collected nasopharyngeal swabs. The severity of the pandemic was assessed through severe cases confirmed.We calculated the lethality and incidence rates and mortality. The differences are studied with the relative risk (RR) with confidence intervals (CI) of 95%.The incidence of ILI was much higher in the 5 to 14 and from 0 to 4 years old (1227.8 and 1048.4, respectively, in the week of maximum incidence). Of positive samples, 52.4% (477/916) were positive for influenza virus and the majority, 456 (95.6%) were the pandemic influenza virus (H1N1) 2009.The incidence of severe cases was 10.3 per 10(5) and was higher in children (14,5) and adults under 65 years (10,2) (p0.0001). Overall mortality was 0.7 per 10(5) and was also higher in children and adults under 65 but the differences were not statistically significant. The fatality rate was estimated at 0.03% and was much higher in the 15 to 44 years (0,03%) (RR = 3.1, 95% CI 1.2 to 8.3), 45 to 64 years (0,11%) (RR = 11.9 95% CI 4.3 to 32.7) and over 64 years (0,73%) (RR = 79.6, 95% CI 25.3 to 250.9) compared to group 5 to 14 years (0,01%).The incidence of severe hospitalized cases was similar to or lower than that observed in the southern hemisphere. The lower risk of hospitalization in people over 64 years suggests the relative protection of this age group against the pandemic virus.

Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU).A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model.We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8).This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination.

A population-based register of cases of listeriosis admitted to acute-care hospitals has been established in Barcelona, Spain, in order to estimate the basal incidence of sporadic cases and to facilitate epidemiological surveillance of potential epidemics. Eleven acute-care hospitals reported all cases of listeriosis to a central unit following a standardized protocol. During 1990, 31 patients with listeriosis were identified, 18 of whom were residents of the city, resulting in an annual incidence of 10.95 cases per million inhabitants. Twelve of the 31 cases occurred in the period from July to September 1990, ten of them being community-acquired. The incidence of listeriosis was higher in elderly (≥ 65 years) and immunosuppressed persons. Forty-two percent of the cases were considered to be nosocomial infections. The overall mortality rate was 51.6 %. The incidence of listeriosis in the present study is one of the highest reported in the literature. A high sensitivity of the reporting system with good case identification techniques, or demographic and environmental characteristics related toListeria monocytogenes infection in our area, might be possible reasons for this geographic variation.

ResumL'objectiu d'aquest estudi és el de comparar les dades de mortalitat al districle de Ciutal Vella (el districte més deprimit sòcio-econòmicament de la ciutat de Barcelona) amb les de tota ia ciutat, utilizant les dades de les defuncions dels anys 1983–87.Les dades procedeixen del Butlletí Estadístic de Defunció. S'han calculat les taxes crues, les taxes especíliques per edat, sexe i causa, l'es-perança de vida, els Anys Potencials de Vida Perduts (APVP), la Raó de Mortalitat Comparativa (RMC) i la mortalitat evitable.Tots els indicadors han destacat el fet que s'ha produit una mortalitat més elevada a Ciutat Vella. L'esperança de vida al districte ha estat de 73 anys (4 anys menys que a tot Barcelona) i la mortalitat infantil ha estat de 15,6 per 1.000 nascuts (a Barcelona 9 per 1.000). La RMC ha estat de 129,0 (amb un interval de confiança al 95% de 126,2—131,8) i la raó d'APVP ha eslat de 182,1 (amb un interval de confiança al 95% de 173,1–191,1), sobretot degut a l'augment de la luberculosi, la cirrosi, els homicidis i les morts relacionades amb les drogues. El percentatge de morts evitables a Ciutat Vella ha estat de 9,5%, comparai amb un 8,23% a tot Barcelona.Aquestes dades suggereixen que s'ha de continuar fent programes d'intervenció al districte, i al mateix temps han de ser un primer pas en l'estudi de les desigualtats de mortalitat en àrees geogràfiques més petites (barris i àrees bàsiques de salut).SummaryThe purpose of this study is to compare mortality indicators in the district of Ciutat Vella (the more socio-economically deprived in Barcelona) with the entire city, for the 1983–87 period, Crude death rates, as well as age, sex and cause-specific deaths rates were calculated from vital statistics data; life expectancy, years of potential life lost (YPLL), the Comparative Mortality Figure (CMF) and avoidable mortality rates were also computed.All indicators point out at an excess of mortality In Ciutat Vella, when compared to the whole city. Life expectancy was 73 years (4 years less than for Barcelona as a whole); infant mortality was 15.6 per 1.000 births (as opposed to 9 for Barcelona). The CMF was 129 (95% confidence interval: 126.2–131.8), while the YPLL ratio was 182.1 (95% confidence interval: 173.1–191.8), mainly attributed to excess mortality due to tuberculosis, cirrhosis and to homicides and drug-related deaths. The percentage of avoidable deaths was 9.5% in Ciutat Vella compared with 8.23% for Barcelona as a whole.These data confirm the need to actively pursue intervention programs to improve health in Ciutat Vella, although further small-area analysis at the level of neighbourhood and of health care areas would be advisable.

We describe the evolution of the organization of public health services in the city of Barcelona (Catalonia, Spain) until the creation of the Barcelona Public Health Agency. This Agency is a consortium created by the Barcelona City Council and the Government of Catalonia as the sole entity responsible for regional and local public health services in the city. The underlying logic for the Agency's design, as well as its mission, vision and value statements, strategy, services' portfolio, and the role of leadership in the process, are analyzed. Aspects related to the Agency's quality and communication plans, as well as the design of its processes, and its policy in terms of alliances for research and training in public health, are discussed. Finally, the main challenges for the future are described.

AimThe promotion of a healthy and active lifestyle among the population is essential for the prevention of numerous chronic diseases. Physical activity measurement and surveillance is crucial for understanding and evaluating campaigns to promote its practice.ObjectiveTo evaluate the 10-year trends in physical activity habits in the Catalan population.DesignTwo cross-sectional nutritional surveys were carried out within a 10-year interval in the population of Catalonia. Data on physical activity include leisure-time physical activity, occupational physical activity and walking activity and regular stair climbing.SubjectIn all, 2344 individuals participated in the ENCAT 1992–93 study and 2055 individuals in the ENCAT 2002–03 survey, aged 10 to 75 years.ResultsInactivity related to occupation increased (from 53% in 1992–93 to 56% in 2002–03 of the Catalan population having sedentary work-related activities). In both genders, the percentage of people who walked to work at least 30 min decreased (from 19% to 16% in men and from 25% to 19% in women). There was a decrease in the percentage of people who were completely sedentary during leisure time (from 59% to 56%), and an increase in the percentage of people who did at least 2 days of vigorous activity (from 39% to 46% in men and from 26% to 32% in women).ConclusionsThe physical activity related to work and transportation has decreased during the period observed. Although a slight improvement has been noted, the percentage of people who are sedentary during leisure time is still high among both men and women.

Objective: To analyse trends in food habits and food consumption from 1992 to 2003. Design: Two consecutive cross-sectional nutrition surveys were carried out on random samples of the Catalan population (Evaluation of Nutritional Status in Catalonia (ENCAT) 1992–93 and ENCAT 2002–03). Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days and a food frequency questionnaire was used to ascertain tendencies in the frequency of food consumption. Setting: Catalonia region, Northeastern Spain. Subjects: Analysis is based on a total of 4701 individuals: 2641 from ENCAT 1992–93 (1210 men and 1431 women) and 2060 from ENCAT 2002–03 (954 men and 1106 women), aged 10–75 years. Results: The trends from 1992 to 2003 showed an increase in eating between meals and outside the home. There was also an upsurge in consumers for fast food, especially among young adults. Notable decreases in fruit consumption (from 301 to 224 g day 21 ) as well as in vegetables, potatoes, meat (red meat and chicken), fish (whitefish and seafood) and offals were observed. In contrast, there was an increase in dairy product consumption, in general (from 255 to 312 g day 21 ), as well as low fat and skim milk derivatives. Fruit juice, nuts and olive oil consumption also increased, the latter being consumed daily by 96% of the population. Little variation was observed for the rest of the food groups in the period studied. Overall, Catalonia is characterised by a model of consumption that is quite favourable, inherent to Mediterranean countries but with important differences according to age. Conclusion: Based on the food consumption trends observed in Catalonia, an increase in the consumption of fruits and vegetables, as well as wholegrain cereals and fish, should be promoted, along with a reduction in the consumption of meat and sausages.

Summary Aim To investigate the impact of a mass hepatitis A vaccination programme in preadolescents seven years after introduction in terms of its effectiveness and the prevented fraction. Setting The age distribution of notified cases and incidence rates in Catalonia (Spain) in the periods before (1992-1998) and after (1999-2005) introduction of the vaccination programme were compared. Main results The incidence rates in the whole population were 5.51 per 100,000 person-years in the 1992-1998 period and 2.98 in the 1999-2005 period. The rate reduction in the 10-19 years age group was 72.43% and was more than 45% in the 5-9 years and 20-29 years age groups. The effectiveness of the vaccination programme was 99.04 (95% CI: 93.11-99.88) and the prevented fraction in the 12-19 years age group was 90.13% (95% CI: 84.47-90.89). Conclusions The universal vaccination programme of preadolescents has had an important impact on hepatitis A in Catalonia, not only in vaccinated cohorts but also in non-vaccinated age groups due to a herd immunity effect.

ObjectiveTo analyse the degree of compliance with the nutrition objectives and population-based food guides and to indicate possible recommendations for their development within the framework of a Nutrition and Health Policy in Catalonia.DesignUsing data derived from the latest Catalan Nutrition Survey (ENCAT 2002–03) conducted by the Department of Health, compliance was analysed with respect to the recommendations derived as a result of a previously conducted Survey. In addition, compliance to the recommendations elaborated by the Spanish Society of Community Nutrition (SENC) was also evaluated.SettingCatalonian region located in the Northeast of Spain.SubjectsAnalysis is based on a total of 2160 individuals (996 males and 1164 females) aged 10–80 years interviewed in 2002–03.ResultsThe analysis of compliance with the recommendations established in 1995 showed: (a) recommendation to maintain and increase consumption of fruits and vegetables was not achieved; (b) continued use of olive oil as the dietary fat of choice was met; (c) incomplete compliance with maintaining the Mediterranean diet traditions, especially in the younger cohorts; (d) compliance with the recommendation to decrease consumption of red meat and sausages, but non-compliance with guidance to maintain or increase fish consumption and (e) compliance with partially substituting whole milk and dairy for low-fat products.Compliance with the SENC Healthy Eating Guide revealed that those food groups with the worst results were meat and sausages (excessive), pulses (below recommendations) and fruits and vegetables (below recommendations).ConclusionsCompliance with dietary guidelines is low in Catalonia, and reflects the need for an effective nutrition policy in the region defined by the Autonomous Government as the Plan for the Promotion of Physical Activity and Healthy Eating (PAAS).

Objective: The purpose of this study was to assess the 10-year trend in lipid and antioxidant vitamin levels in the Catalan population from 1992 to 2003. Design: Two cross-sectional surveys were carried out in Catalonia, Spain, during 1992–93 and 2002–03. A subsample of the individuals participating in the surveys agreed to undergo a biochemical evaluation. Subjects: Eight hundred and eighty individuals (393 males and 487 females) in the 1992–93 nutritional survey and 429 individuals (205 males and 224 females) in the 2002–03 nutritional and health survey. The subjects’ ages ranged from 18 to 74 years. Results: Mean total cholesterol decreased from 5.3 to 5.1 mmol l 21 (P , 0.005), and the prevalence of hypercholesterolaemia decreased, especially in males (from 23% to 10% in males from 50 to 64 years old, P , 0.05). Mean cholesterol high-density lipoprotein (HDL) values decreased in the entire sample (from 1.4 to 1.3 mmol l 21 , P , 0.001) and there was an increase in the percentage of population with low values of HDL (from 10% to 19%, P , 0.001). An increase in the percentage of the population with values of a-tocopherol at marginal risk levels (from 6% to 9%) and with low values of b-carotene (from 59% to 66%) was observed. The mean values for retinol increased in both males (from 1.99 to 2.44 mmmol l 21 , P , 0.001) and females (from 1.69 to 2.29, P , 0.001). Conclusion: Although there was a decrease in the percentage of population with hypercholesterolaemia, the decrease in HDL cholesterol worsened the lipid profile of the Catalan population. The increase in the values of some antioxidant vitamins did not affect the entire population since an increase in the number of individuals with marginal values was observed.

Objectives: To analyse trends in energy and nutrient intakes and nutritional adequacy from 1992 to 2003. Design: Two consecutive cross-sectional studies carried out on random samples of the Catalan population ENCAT 1992–93 and ENCAT 2002–03. Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days. Spanish food consumption tables were used. Energy and nutrient data were adjusted for intraindividual variability, and the Spanish recommend nutrient intakes (RNIs) were used in the analysis. Setting: Catalonia region, North Eastern Spain. Subjects: Analysis is based on a total of 4701 individuals; 2641 from ENCAT 1992–93 (1210 men and 1431 women) and 2060 from ENCAT 2002–03 (954 men and 1106 women), aged 10–75 years. Results: No relevant changes in energy intake trends were observed, although a decrease was observed in the daily consumption of proteins (27 g), cholesterol (256 mg), potassium (2245 mg), vitamin A (2283 RE mg), retinoids (271 mg), carotenoids (21520 mg), niacin (229 mg), folates (215 mg), vitamin B12 (21.6 mg) vitamin D (20.5 mg), fibre and iron, and an increase in the consumption of calcium (157 mg) and a slight increase in lipids and fatty acids (% energy). In general, the most outstanding trends were those of vitamin A (as a result of the decreased consumption of offal), proteins, vitamin D and B12 (due to the decreased consumption of meat and fish) and calcium (as a consequence of the increased consumption of dairy products). Conclusion: No changes were observed in the energy intake of males or females; therefore, the obesity changes may possibly be attributed to changes in physical activity patterns. However, an increase in energy sources of a poorer nutritional profile has been identified, especially for between meal snacks.

Fundamento: El objetivo de este estudio es analizar los cambios producidos en los habitos alimentarios y el estado nutricional de la poblacion catalana, a lo largo de 10 anos a partir de la informacion procedente de las dos Encuestas Nutricionales de Cataluna desarrolladas en 1992-93 y 2002-03. Metodo: 2641 individuos en 1992-93 y 2060 en 2002-03 de 10 a 75 anos participaron en las encuestas. Se utilizaron dos recordatorios de 24 horas, un cuestionario de frecuencia de consumo y un cuestionario general sobre actividad fisica, conocimientos y actitudes sobre alimentacion y uso de suplementos alimentarios. Se midio el peso (kg), la talla (cm) y el perimetro de la cintura (PC) (cm). Se realizo un analisis bioquimico en una submuestra de la poblacion. Se evaluaron colesterol total, colesterol HDL, colesterol LDL, trigliceridos y s-caroteno, alfa-tocoferol y retinol. Resultados: Se observa un descenso en la ingesta de fruta, verdura y patata, carne y pescado, y un aumento en el consumo de derivados lacteos y comida rapida (especialmente entre los jovenes). Se produce un ascenso en el valor medio de indice de masa corporal (IMC) en hombres y de PC en hombres y mujeres. El valor de IMC desciende entre las mujeres (excepto entre las mas jovenes). La prevalencia de obesidad aumenta en hombres (de 9,9% a 16,6%), pero no en mujeres. Desciende la colesterolemia media, a expensas del valor de HDL colesterol. Disminuye el porcentaje de poblacion sedentaria en el tiempo libre. Conclusiones: Es necesaria una politica de nutricion que sea efectiva en la promocion de una alimentacion acorde con las recomendaciones nutricionales y la dieta mediterranea.

Objective The objective of this study was to determine the prevalence of antibodies against varicella-zoster virus (VZV) in pregnant women in Catalonia (Spain). Setting The prevalence of antibodies against VZV was assessed in a representative sample (n= 1522) of pregnant women of Catalonia obtained in 2003. Method The sample was obtained including all women attended for childbirth, during 2 months of 2003, in 27 randomly selected hospitals with maternity clinics. Main outcome measures Varicella-zoster antibodies were determined using the enzyme-linked immunosorbent assay test. Results The total number of women included in the study was 1522, corresponding to a participation rate of 83%. The prevalence of varicella-zoster antibodies in pregnant women was 96.1% (95% CI 95.1–97.1). The prevalence of antibodies was 94% in pregnant women aged 15–24 years, 95% in those aged 25–29 years and >95% in those aged 30–49 years. The prevalence of antibodies was not associated to the place of birth, place of residence (urban or rural), educational level and social class. The study showed that 6% of pregnant women aged 15–24 years and 5% of those aged 25–29 years were susceptible to varicella-zoster infections in Catalonia (Spain). Conclusion The study showed that a varicella-zoster vaccination programme aimed at women of childbearing age could be necessary in Catalonia to prevent all varicella-zoster infections during pregnancy.

Background: The objective of the study was to determine the prevalence of rubella antibodies in representative samples of pregnant women in Catalonia. Methods: A representative sample of pregnant women in Catalonia was obtained by random sampling by clusters (hospitals with maternity units) stratified by provinces. Blood was obtained from the umbilical cord at childbirth in 1538 women (of whom 308 were immigrants) and was tested for rubella antibodies by ELISA (Enzime-linked immunosorbent assay). Results: The global prevalence of antibodies was 93.4% [95% confidence interval (CI): 93.3–93.5] and was significantly higher in indigenous women (94.9;95%CI:93.3–95.9) compared with immigrants [89.0; 95%CI: 85.5–92.5 ( P < 0. 0001)] with crude Odds ratio (OR) of 2.15 (95%CI: 1.40–3.32).The prevalence was higher in women living in rural habitats (97%) and those in higher social classes (96.3%); OR 2.54 (95%CI: 1.22–5.30) and 2.17 (95%CI: 1.24–3.81), respectively. Conclusion: Fertile female immigrants from countries with no vaccination or where vaccination coverage is low should be actively approached for vaccination to reduce the risk of infection and congenital rubella.

Objective: To evaluate the trends of overweight and obesity prevalences in the population of Catalonia, Spain, aged 18–75 years, and the influence of socio-economic determinants on these prevalence trends. Design: Analysis based on data from two representative population-based cross-sectional surveys. Setting: Data from the two Evaluations of Nutritional Status in Catalonia (ENCAT 1992–93 and ENCAT 2002–03), Spain. Weights and heights were obtained by direct measurement in standardised conditions by trained interviewers. Overweight and obesity were defined using body mass index (BMI) and waist circumference (WC), categorised according to WHO criteria. Subjects: In total, 1015 men and 1233 women from ENCAT 1992–93, and 791 men and 924 women from ENCAT 2002–03. Results: Mean BMI and mean WC were higher in males in 2002–03 as compared to 1992–93, while for females mean BMI was lower except for the youngest group, and mean WC was higher. In men, overall BMI overweight prevalence remained stable (from 44.1% to 43.7%), while obesity increased (from 9.9% to 16.6%); total WC overweight remained stable (from 21.7 to 23.8%), while WC obesity increased (from 13.1% to 24.4%). In women, overall BMI overweight increased (from 29.1% to 30.1%), whereas BMI obesity remained stable (from 15.0% to 15.2%); total WC overweight decreased (from 21.8% to 17.7%), while WC obesity increased (from 24.5% to 31.1%). The socio-economic and education variables had an influence on BMI and WC overweight and obesity rates mainly on females in both surveys and on the youngest men only in the 1992–93 survey. Conclusions: Ten-year trends indicate that Catalan males are getting bigger overall (BMI) and around the waistline (WC), while Catalan females only have bigger waistlines (WC). BMI male obesity prevalence has overtaken that of females. WC obesity continues to be more prevalent among females than males.

The aim of this study was to conduct an investigation into an outbreak of gastroenteritis among health workers and residents (with different grades of dependence) at a nursing home.We detected an outbreak of gastroenteritis in a group of 52 health workers and 124 residents at a nursing home in Oliana, Lleida (Spain). A bidirectional prospective and retrospective cohort study was conducted into the consumption of water, food, grade of dependence (high, medium and low), and specific job. We studied the water supply and six food items. Faecal specimens from 30 patients were cultured and examined for Norovirus by polymerase chain reaction-reverse transcription. The possible implication of different factors associated with gastroenteritis was assessed by relative risk (RR) at 95% confidence intervals (CI).We interviewed 97% of the patients (172/176). The overall attack rate was 53.3% (92/172). The symptoms were: diarrhoea 68.5% (63/92), vomiting 64.1% (59/92), nausea 63.0% (58/92), fever 33.7% (31/92), abdominal pain 28.3% (26/92), and headache 14.1% (13/92). The epidemic curve highlighted transmission for 19 days. The risk factors associated with gastroenteritis were high (RR = 1.6; 95% CI, 1.0-2.6) and medium (RR = 2.8; 95% CI, 1.0-8.0) levels of dependence, health worker with high level of contact with residents (RR = 2.8; 95% CI, 1.1-7.3) and those doing cleaning work (RR = 2.8; 95% CI, 1.0-8.0). Bacterial cultures were negative for samples of food and water. Also, cultures were negative for bacteria in faecal samples but tests were positive for Norovirus in 12 faecal samples.We showed a Norovirus outbreak in a nursing home, person-to-person spread, associated to high and medium grades of dependence among residents, health worker with high level of contact with them and with those doing cleaning work.

To evaluate the immunity level achieved with oral polio vaccine in schoolchildren aged 6-12 years of Catalonia (Spain).The prevalence of antibodies against poliovirus 1, 2 and 3 was investigated using the neutralizing technique in a representative (n = 197) sample of schoolchildren aged 6-12 years of Catalonia (Spain) obtained in 2001.The prevalence of antibodies was 94.4% for poliovirus 1; 98.5% for poliovirus 2, y 73.1% for poliovirus 3. 93.4% of serum samples had antibodies against poliovirus 1 and 2; 70.6% against poliovirus 1 and 3, and 69.5% against poliovirus 1, 2 and 3. The prevalence of antibodies was similar in different socio-demographic groups. Schoolchildren who had been vaccinated (5 doses) had a higher level of antibodies against poliovirus 3 than those who had not completed vaccination (4 or less doses): 75.4% vs 50.0% (p0.05). The prevalence of antibodies against poliovirus 1 and 2 was similar in schoolchildren completing and not completing vaccination.Results obtained in this study show that 26.9% of schoolchildren aged 6-12 years do not have an adequate immunity level against poliovirus 3 with the oral polio vaccine, being it necessary to develop an immunization program using the inactivated polio vaccine.

Determination of antibody levels against vaccine-preventable diseases is of great value to assess immunization programmes. The objective of this study was to determine the prevalence of measles, rubella, and mumps antibodies in representative samples of the child and adult population of Catalonia and compare the findings to those obtained in 1996. A representative sample of the child and adult (or=15 years) population of Catalonia was studied. Enzyme-linked immunosorbent assay techniques were used to determine the presence of antibodies. Equivocal results for antibodies against measles and rubella were tested using an immunofluorescence technique. To compare proportions, the chi-square test and the Fisher's exact test were used. Statistical significance was set at 0.05. Adjusted odds ratios were calculated using multiple logistic regression analysis. Samples from 2,619 people were analyzed. The global prevalence of antibodies was 98.3% for measles, 91.1% for mumps, and 98.1% for rubella. The prevalence of rubella antibodies was higher in women than in men (98.8 vs. 97.2%, respectively). Compared with the results obtained in the 1996 seroprevalence study, only the prevalence of rubella antibodies showed a statistically significant increase in men (97.2 vs. 94.6%; p=0.002) and, in particular, in women (98.8 vs. 95.3%; p0.001). The low prevalence of susceptible subjects has already led to the elimination of indigenous measles in Catalonia and should allow the elimination of indigenous rubella by 2005. The level of antibodies necessary to interrupt the transmission of mumps has still not been reached in all age groups.

To ascertain why people attend hospital emergency departments (ED) for low complexity health problems.A phenomenological, interactionist, qualitative study was performed. A theoretical sample that selected one urban and one rural area from Catalonia (Spain) was designed. In each setting, persons (n = 36) who had used the ED or a primary care emergency service 1 month before the beginning of the study were chosen. Data were obtained through 8 focus groups. An interpretative content analysis was performed, and emergent categories were constructed through research triangulation.Five categories emerged: symptoms, whether or not self-diagnosis was involved, perception of needs, awareness of the health services available, and the overall context of the person. Symptoms generated feelings of failing health and thus initiated care seeking. Self-diagnosis determined perceived need and the type of care sought. People contrasted their self-perception of need with their own opinion about the health services available. The decision to go to one or other service was made as a result of this contrast, but the individual's family, work, and social situations also played a part. Informants were more familiar with the service provided by the ED than with that provided by primary care. Time consumption also figured heavily in decision making.The presence or absence of self-diagnosis is a determining factor in attendance at EDs. Other factors that influence demand are the level of awareness of the health services available, previous experiences, and the life situation of the individual.