ABSTRACT
This paper presents the actions taken by the public health services in the city of Barcelona (Catalonia, Spain) to improve compliance with the requirements of the new 28/2005 tobacco control law. These were essentially informative at first, with a second phase where authority enforcement mechanisms were activated. In workplaces, educational settings and transport the law was incorporated without incidents nor relevant complaints, except for isolated incidents in some university or mass transport settings. In food establishments the process has been more complex. Estimating the frequency of related events, there are 17.5 formal citizen complaints for 100,000 person-years. Inspections generated by citizen complaints resulted in 3.3 administrative proceedings for 100,000 person-years, mostly for incurring in serious violations. Effectively enforcing the law required active information and communication policies, as well as the real enforcement by health authority. This caused an important workload to the public health services.
Subject(s)
Smoking Prevention , Smoking/legislation & jurisprudence , Humans , SpainABSTRACT
Se presentan las acciones de los servicios de salud públicaen Barcelona para conseguir un mejor cumplimiento de laLey 28/2005 de medidas sanitarias frente al tabaquismo. Éstasse concentran en una primera fase informativa y una segundaen la que se activan los mecanismos de ejercicio de la autoridadsanitaria.La implantación de la Ley en centros de trabajo, educativosy medios de transporte se saldó sin incidentes relevantes salvosucesos aislados en algún centro universitario o medio de transporte.En el sector alimentario el proceso ha sido más complejo.Se calculan 17,5 denuncias ciudadanas por 100.000 personas-año. Las inspecciones desencadenadas por denunciasciudadanas provocaron la apertura de 3,3 expedientes sancionadorespor 100.000 personas-año, en general por incluiral menos una falta grave.La implantación de la Ley ha precisado políticas activas decomunicación y el ejercicio real de la autoridad sanitaria. Estoha comportado una notable carga de trabajo para los serviciosde salud pública(AU)
This paper presents the actions taken by the public healthservices in the city of Barcelona (Catalonia, Spain) to improvecompliance with the requirements of the new 28/2005 tobaccocontrol law. These were essentially informative at first,with a second phase where authority enforcement mechanismswere activated.In workplaces, educational settings and transport the law wasincorporated without incidents nor relevant complaints, exceptfor isolated incidents in some university or mass transport settings.In food establishments the process has been more complex.Estimating the frequency of related events, there are 17.5formal citizen complaints for 100,000 person-years. Inspectionsgenerated by citizen complaints resulted in 3.3 administrativeproceedings for 100,000 person-years, mostly for incurringin serious violations.Effectively enforcing the law required active information andcommunication policies, as well as the real enforcement byhealth authority. This caused an important workload to the publichealth services(AU)
Subject(s)
Humans , Male , Female , Tobacco Smoke Pollution/legislation & jurisprudence , Tobacco Smoke Pollution/prevention & control , Public Health/legislation & jurisprudence , Public Health/methods , Health Surveillance/legislation & jurisprudence , Legislation as Topic , Smoke/prevention & control , Health Surveillance/organization & administration , Health Surveillance/statistics & numerical data , Health Surveillance/standardsABSTRACT
OBJECTIVE: Description of an outbreak of legionnaires' disease originating in one of the cooling towers of a hospital. PATIENTS AND METHODS: This study included patients with confirmed pneumonia caused by Legionella pneumophila serogroup 1 and related to the Vallcarca neighborhood of Barcelona (Spain) in August 2004. Exposure was determined by a standardized questionnaire. An environmental investigation was carried out to identify the source of the outbreak. A descriptive analysis including incidence rates estimation was performed, as well as molecular study to document the genetic identity among human and environmental strains. RESULTS: Thirty-three cases of L. pneumophila pneumonia were detected. Median age was 68 years and 70% of the affected patients were men. Incidence rate among residents in less than 200 meters of the source and older than 65 was 888.9 cases/100,000 inhabitants. Lethality rate was 6%. Four seasonal cooling towers that were not registered with the authorities were identified in a health care center. L. pneumophila was isolated from all four and at least one colony in each tower had the same genetic profile as the strains isolated from patients. CONCLUSIONS: An association was demonstrated between a community outbreak of legionellosis and unregistered seasonal cooling towers located in a hospital. All risk facilities should be registered and inspected to ensure that they fulfill current legislation requirements.
Subject(s)
Air Microbiology , Community-Acquired Infections/epidemiology , Hospitals, Urban , Legionella pneumophila/isolation & purification , Legionnaires' Disease/epidemiology , Refrigeration , Water Microbiology , Aerosols , Aged , Aged, 80 and over , Building Codes , Community-Acquired Infections/etiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/transmission , Disease Notification , Disease Outbreaks , Environmental Exposure , Female , Hospitals, Urban/legislation & jurisprudence , Humans , Incidence , Legionnaires' Disease/etiology , Legionnaires' Disease/transmission , Male , Middle Aged , Spain/epidemiology , Urban HealthABSTRACT
Objetivo. Describir la investigación de un brote comunitario de legionelosis originado en unas torres de refrigeración de un hospital. Pacientes y métodos. Pacientes diagnosticados de neumonía por Legionella pneumophila serogrupo 1 (L. pneumophila) asociados con el barrio de Vallcarca (Barcelona) en agosto de 2004. La exposición se determinó mediante una encuesta estandarizada. Se llevó a cabo una investigación ambiental para identificar el foco emisor. Se realizó un análisis descriptivo con cálculo de tasas de incidencia, así como el estudio molecular para documentar la identidad genética entre las cepas humanas y ambientales aisladas. Resultados. Se detectaron 33 casos de neumonía por L. pneumophila. La edad media fue de 68 años y el 70% de los afectados eran varones. La tasa de incidencia en los mayores de 65 años residentes a una distancia menor o igual a 200 m del foco emisor fue de 888,9 casos/100.000 habitantes. La tasa de letalidad fue del 6%. Se identificaron cuatro torres de refrigeración estacionales no censadas ubicadas en un centro sanitario. En todas se aisló L. pneumophila y al menos una colonia de cada instalación compartía perfil genético con las cepas aisladas en los pacientes. Conclusiones. Se muestra la asociación de un brote comunitario de neumonía por Legionella y las torres de refrigeración de un centro sanitario que no estaban censadas. Se remarca la necesidad de notificar cualquier instalación de riesgo y de realizar un seguimiento para asegurar que cumplen con la legislación (AU)
Objective. Description of an outbreak of legionnaires disease originating in one of the cooling towers of a hospital. Patients and methods. This study included patients with confirmed pneumonia caused by Legionella pneumophila serogroup 1 and related to the Vallcarca neighborhood of Barcelona (Spain) in August 2004. Exposure was determined by a standardized questionnaire. An environmental investigation was carried out to identify the source of the outbreak. A descriptive analysis including incidence rates estimation was performed, as well as molecular study to document the genetic identity among human and environmental strains. Results. Thirty-three cases of L. pneumophila pneumonia were detected. Median age was 68 years and 70% of the affected patients were men. Incidence rate among residents in less than 200 meters of the source and older than 65 was 888.9 cases/100,000 inhabitants. Lethality rate was 6%. Four seasonal cooling towers that were not registered with the authorities were identified in a health care center. L. pneumophila was isolated from all four and at least one colony in each tower had the same genetic profile as the strains isolated from patients. Conclusions. An association was demonstrated between a community outbreak of legionellosis and unregistered seasonal cooling towers located in a hospital. All risk facilities should be registered and inspected to ensure that they fulfill current legislation requirements (AU)
Subject(s)
Humans , Legionnaires' Disease/epidemiology , Legionella pneumophila/pathogenicity , Pneumonia/epidemiology , Disease Outbreaks , Community-Acquired Infections/epidemiology , Refrigeration , Health SurveysABSTRACT
Implementing health authority is a basic public health service. Part of the responsibility of public health managers is to ensure compliance with regulations. These are developed when certain risks are considered inadmissible. Mostly, the exercise of health authority deals with the routine application of detailed norms, although there is always some uncertainty, as shown by the frequent use of cautionary measures by health officers during inspections. However, epidemiologic surveillance periodically involves situations in which human health is damaged and there is no reference regulation; in these situations, health authorities must act according to their own criteria, weighing the risks of intervention against those of nonintervention. In this article, we present 3 such scenarios: using coercion in the treatment of patients with smear-positive tuberculosis, regulation of activities with soy beans posing asthma risks, and setting limits to the professional activity of an HIV-positive physician.
Subject(s)
Mandatory Programs , Public Health/legislation & jurisprudence , SpainABSTRACT
El ejercicio de la autoridad sanitaria es un servicio básico de la salud pública. Parte de la responsabilidad de los gestores de la salud pública es hacer cumplir normas. Éstas se desarrollan cuando se dan circunstancias que llevan a considerar inadmisibles ciertos riesgos. El grueso del ejercicio de la autoridad sanitaria se basa en la aplicación relativamente sistemática de normativas detalladas de referencia, aunque siempre hay cierta incertidumbre, ejemplificada en la frecuente adopción de medidas cautelares por un inspector sanitario aplicando el principio de precaución. Pero la vigilancia epidemiológica plantea de forma intermitente situaciones de afectación de la salud humana sin normas de referencia, en las que la autoridad sanitaria debe actuar según su criterio, contrapesando los riesgos de intervenir con los de no actuar. En este manuscrito presentamos 3 casos de este tipo: la coerción en el tratamiento de enfermos con tuberculosis bacilífera; la regulación de actividades con haba de soja que plantean riesgos de asma; y la limitación del ejercicio profesional de un médico infectado por el virus de la inmunodeficiencia humana
Implementing health authority is a basic public health service. Part of the responsibility of public health managers is to ensure compliance with regulations. These are developed when certain risks are considered inadmissible. Mostly, the exercise of health authority deals with the routine application of detailed norms, although there is always some uncertainty, as shown by the frequent use of cautionary measures by health officers during inspections. However, epidemiologic surveillance periodically involves situations in which human health is damaged and there is no reference regulation; in these situations, health authorities must act according to their own criteria, weighing the risks of intervention against those of nonintervention. In this article, we present 3 such scenarios: using coercion in the treatment of patients with smear-positive tuberculosis, regulation of activities with soy beans posing asthma risks, and setting limits to the professional activity of an HIV-positive physician
Subject(s)
Humans , Health Surveillance/methods , 32477 , Sanitary Management , Tuberculosis/drug therapy , Asthma/etiology , HIV Infections/transmission , Pattern Recognition, AutomatedABSTRACT
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.
Subject(s)
Management Audit/methods , Management Information Systems , Public Health Administration/methods , Forms and Records Control , Humans , Institutional Management Teams , Models, Theoretical , Planning Techniques , Program Evaluation , SpainABSTRACT
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
