Investigación de una sospecha de brote de lipoatrofia semicircular en niños / Investigation of a suspected outbreak of lipoatrophia semicircularis in children

Antecedentes y objetivo: Los informes recientes sobre brotes de lipoatrofia semicircular (LS) en diversos países han generado debate acerca del papel potencial de las características ambientales de los puestos de trabajo en los nuevos edificios. El objetivo de este estudio fue investigar la sospecha de un brote de LS entre los niños de una guardería pública de Barcelona, lo cual generó una tremenda alarma. Métodos: Realizamos una valoración epidemiológica, incluyendo análisis descriptivo y de prevalencia, y una investigación ambiental seguida de una valoración psiquiátrica de acuerdo con los criterios de Small. Comparamos la prevalencia de LS y su intervalo de confianza del 95% entre los niños y entre el personal de la guardería en estudio, y con otros centros. Resultados: Entre los 86 niños que acudieron a la guardería detectamos 11 casos confirmados y 2 casos posibles de LS (15,1%), y entre los 41 niños que acudieron a otros centros identificamos 8 casos confirmados y 4 casos posibles (29,3%) (p=0,10). Entre el personal de la guardería, detectamos 8 casos de LS (66,7%), y entre las 19 mujeres que trabajaban en otros sitios identificamos 14 con la misma condición que el personal (73,7%) (p=0,98). Se clasificaron finalmente todas las lesiones como hendiduras con diferentes localizaciones. La evaluación ambiental no identificó ningún factor de riesgo con relación significativa con la aparición del brote. Dicho brote compartió 13 de los criterios de Small en relación con el trastorno somatoforme epidémico («histeria colectiva»). Conclusión: La presencia de hendiduras puede considerarse como una variante de la normalidad en las extremidades inferiores de los niños. El desarrollo característico del proceso nos conduce a la conclusión de que este brote fue un trastorno somatoforme epidémico (AU)

Background and objective: Recent reports of outbreaks of lipoatrophia semicircularis (LS) in various countries have generated discussion regarding the potential role of the environmental characteristics of office workplaces in new buildings. The objective of this study was to investigate a suspected outbreak of LS among children in a public school in Barcelona, which generated tremendous alarm. Methods: We performed an epidemiological assessment including descriptive and prevalence analyses, and an environmental investigation followed by a psychiatric assessment according to Small's criteria. We compared the prevalence of LS and its 95% confidence interval between children and staff attending the day-care centre under study and other centres. Results: Among 86 children attending a day-care centre we detected 11 confirmed and 2 possible cases of LS (15.1%) while among 41 children attending other day-care centres we identified 8 cases and 4 possible cases (29.3%) (P=.10). Among 12 day-care staff, we detected 8 cases of LS (66.7%) while among 19 women working different jobs we identified 14 with the same condition as the staff (73.7%) (P=.98). All lesions were finally classified as indentations with different locations. The environmental evaluation didn’t identify any exposure factors with a significant role in the onset of the outbreak. The outbreak shared 13 of Small's 16 criteria regarding epidemic somatoform disorder (‘mass hysteria’). Conclusion: The presence of indentations can be considered a normal variant in the lower extremities of children. The characteristic development of the process leads us to the conclusion that this outbreak was an epidemic somatoform disorder (AU)

Adaptación de los servicios de una organización de salud pública a la disminución de los recursos / Adapting the service portfolio of a public health organisation to shrinking resources

Este trabajo describe el proceso de revisión del catálogo de servicios de salud pública de la ciudad de Barcelona para responder a la reducción presupuestaria producida a partir de 2010 en las administraciones públicas en España. Se basó en un grupo de trabajo que revisó las diferentes líneas de actividad, teniendo en cuenta los gastos y los ingresos asociados y su razón de ser, valorando factores como la obligación legal de desempeño, la financiación finalista, la petición explícita por las administraciones fundadoras y la existencia o no de otros actores capaces de asumirla. Se describen los cambios y sus consecuencias. Se valora que el nuevo catálogo está consolidado y se considera ratificado por los órganos de gobierno, que se han renovado tras los relevos políticos. Creemos que esto es fruto de haberlo basado en el consenso profesional y los criterios de gestión, claves para el buen funcionamiento de un organismo autónomo ejecutivo de carácter público (AU)

This paper describes the review process of the Agency of Public Health of Barcelona's service portfolio in response to the budget cuts introduced since 2010 in the public administrations in Spain. A working group reviewed the different business activities, taking into account their costs and generated revenue and their justification, assessing factors such as the existence of legal constraints, tied funding, explicit demands from the founding administrations and other actors that may be capable of undertaking particular activities. The changes and their consequences are described. The new service portfolio has been consolidated and is considered ratified by the Agency board, which was renewed after political changes. We conclude that this is because it was based on professional consensus and management criteria, which are key for the smooth operation of a public autonomous executive organization (AU)

Investigation of a suspected outbreak of lipoatrophia semicircularis in children. / Investigación de una sospecha de brote de lipoatrofia semicircular en niños.

BACKGROUND AND OBJECTIVE: Recent reports of outbreaks of lipoatrophia semicircularis (LS) in various countries have generated discussion regarding the potential role of the environmental characteristics of office workplaces in new buildings. The objective of this study was to investigate a suspected outbreak of LS among children in a public school in Barcelona, which generated tremendous alarm. METHODS: We performed an epidemiological assessment including descriptive and prevalence analyses, and an environmental investigation followed by a psychiatric assessment according to Small's criteria. We compared the prevalence of LS and its 95% confidence interval between children and staff attending the day-care centre under study and other centres. RESULTS: Among 86 children attending a day-care centre we detected 11 confirmed and 2 possible cases of LS (15.1%) while among 41 children attending other day-care centres we identified 8 cases and 4 possible cases (29.3%) (P=.10). Among 12 day-care staff, we detected 8 cases of LS (66.7%) while among 19 women working different jobs we identified 14 with the same condition as the staff (73.7%) (P=.98). All lesions were finally classified as indentations with different locations. The environmental evaluation didn't identify any exposure factors with a significant role in the onset of the outbreak. The outbreak shared 13 of Small's 16 criteria regarding epidemic somatoform disorder ("mass hysteria"). CONCLUSION: The presence of indentations can be considered a normal variant in the lower extremities of children. The characteristic development of the process leads us to the conclusion that this outbreak was an epidemic somatoform disorder.

[Adapting the service portfolio of a public health organisation to shrinking resources]. / Adaptación de los servicios de una organización de salud pública a la disminución de los recursos.

This paper describes the review process of the Agency of Public Health of Barcelona's service portfolio in response to the budget cuts introduced since 2010 in the public administrations in Spain. A working group reviewed the different business activities, taking into account their costs and generated revenue and their justification, assessing factors such as the existence of legal constraints, tied funding, explicit demands from the founding administrations and other actors that may be capable of undertaking particular activities. The changes and their consequences are described. The new service portfolio has been consolidated and is considered ratified by the Agency board, which was renewed after political changes. We conclude that this is because it was based on professional consensus and management criteria, which are key for the smooth operation of a public autonomous executive organisation.

[Drinking water quality and safety]. / La calidad sanitaria del agua de consumo.

The purpose of drinking water legislation is to guarantee the quality and safety of water intended for human consumption. In the European Union, Directive 98/83/EC updated the essential and binding quality criteria and standards, incorporated into Spanish national legislation by Royal Decree 140/2003. This article reviews the main characteristics of the aforementioned drinking water legislation and its impact on the improvement of water quality against empirical data from Catalonia. Analytical data reported in the Spanish national information system (SINAC) indicate that water quality in Catalonia has improved in recent years (from 88% of analytical reports in 2004 finding drinking water to be suitable for human consumption, compared to 95% in 2014). The improvement is fundamentally attributed to parameters concerning the organoleptic characteristics of water and parameters related to the monitoring of the drinking water treatment process. Two management experiences concerning compliance with quality standards for trihalomethanes and lead in Barcelona's water supply are also discussed. Finally, this paper presents some challenges that, in the opinion of the authors, still need to be incorporated into drinking water legislation. It is necessary to update Annex I of Directive 98/83/EC to integrate current scientific knowledge, as well as to improve consumer access to water quality data. Furthermore, a need to define common criteria for some non-resolved topics, such as products and materials in contact with drinking water and domestic conditioning equipment, has also been identified.

Distribution of blood concentrations of persistent organic pollutants in a representative sample of the population of Catalonia.

BACKGROUND: Although virtually all populations worldwide are commonly exposed to numerous persistent organic pollutants (POPs) and human concentrations vary widely, only a few countries conduct nationwide surveillance programs of POP concentrations in representative samples of the general population. OBJECTIVE: To evaluate the distribution of serum concentrations of nineteen POPs and their main predictors in a representative sample of the general population of Catalonia. METHODS: Participants in the Catalan Health Interview Survey aged 18-74 years were interviewed face-to-face, gave blood, and underwent a physical exam. Graphs (including "POP Geoffrey Rose curves") were used to represent the full population distribution of each POP in the 919 participants. Through multivariate statistical models we analyzed the influence on POP concentrations of sex, age, body mass index (BMI), socioeconomic status and, in women, parity. RESULTS: We detected dichlorodiphenyltrichloroethane (p,p'-DDT), dichlorodiphenyldichloroethane (p,p'-DDE), polychlorinated biphenyls (PCBs) congeners 118, 138, 153 and 180, hexachlorobenzene (HCB) and beta-hexachlorocyclohexane (beta-HCH) in more than 85% of the subjects. p,p'-DDE, HCB and beta-HCH showed the highest concentrations (median=399, 159 and 92 ng/g lipid, respectively). Distributions were highly skewed and interindividual differences were up to 7700-fold. POP levels differed significantly by gender, age, BMI, educational level, and parity. CONCLUSIONS: In Catalonia, an advanced European society, exposure to POPs remains common, a vast majority of the population has much lower blood concentrations than a relative minority, and the population distributions of POP are hence highly skewed to the right. Shifting distributions towards lower concentrations requires more energetic policies and population strategies.

Biomonitoring perfluorinated compounds in Catalonia, Spain: concentrations and trends in human liver and milk samples.

BACKGROUND, AIM AND SCOPE: Perfluorinated compounds (PFCs) are global environmental pollutants that bioaccumulate in wildlife and humans. Laboratory experiments have revealed toxic effects such as delayed development, humoral suppression, and hepatotoxicity. Although numerous human blood levels have been reported, little is known about distribution in the human body. Knowledge about PFC distribution and accumulation in the human body is crucial to understanding uptake and subsequent effects as well as to conduct risk assessments. The present study reports PFC levels in human liver and breast milk from a general population living in Catalonia, Spain. Liver and milk levels are compared to previously reported levels in blood from the same geographic area as well as to other existing reports on human liver and milk levels in other countries. MATERIALS AND METHODS: Human liver (n = 12) and milk (n = 10) samples were collected in 2007 and 2008 in Catalonia, Spain. Liver samples were taken postmortem from six males and six females aged 27-79 years. Milk samples were from healthy primipara women (30-39 years old). Both liver and milk were analyzed by solid-phase extraction and ultra-performance liquid chromatography tandem mass spectrometry. RESULTS: Six PFCs were detected in liver, with perfluorooctanesulfonate (PFOS, 26.6 ng/g wet weight) being the chemical with the highest mean concentration. Other PFCs such as perfluorohexanesulfonate (PFHxS), perfluorooctanoic acid (PFOA), and acids with chain lengths up to C11 were also detected, with mean levels ranging between 0.50 and 1.45 ng/g wet weight. On the other hand, PFOS and PFHxS were the only PFCs detected in human milk, with mean concentrations of 0.12 and 0.04 ng/mL, respectively. DISCUSSION: While milk concentrations were similar to reported levels from other countries, liver samples contained more PFCs above quantification limits and higher PFOS concentrations compared to the only two other reports found in the literature. Differences between the results of the present study and those concerning previous investigations can be due to declining levels of some PFCs, which have been reported for the USA. The relationship between PFC concentrations in human liver, milk, and blood was assessed using blood concentrations previously determined in Catalonia. Those levels resulted in liver/serum ratios of 1.7:1, 1.4:1, and 2.1:1 for PFOS, perfluorodecanoic acid, and perfluoroundecanoic acid, respectively. Accumulation in liver is suggested for PFOS and the perfluorocarboxylic acids with carbon chain lengths C9, C10, and C11. For PFOA and PFHxS, fivefold and 14-fold higher concentrations, respectively, were seen in serum as compared to liver. The mean concentration of PFOS and PFHxS in milk was only 0.8% and 0.6% of the reported mean serum level, respectively. CONCLUSIONS: The results of the present study show that several PFCs could be detected in human liver samples of subjects living in Tarragona. Concerning human milk, the mechanism by which PFCs are transferred from mother's blood to breast milk is still unclear. Considering that PFCs are strongly bound to the protein fraction in blood, the possibility of PFCs entering the milk and accumulating to levels observed in maternal plasma is limited. RECOMMENDATIONS AND PERSPECTIVES: Interestingly, the potential accumulation difference for PFCs with different chain lengths might be of great importance for risk assessment. Continuing studies on the distribution of different PFCs in human tissue are therefore justified.

Levels of perfluorinated chemicals in municipal drinking water from Catalonia, Spain: public health implications.

In this study, the concentrations of 13 perfluorinated compounds (PFCs) (PFBuS, PFHxS, PFOS, THPFOS, PFHxA, PFHpA, PFOA, PFNA, PFDA, PFUnDA, PFDoDA, PFTDA, and PFOSA) were analyzed in municipal drinking water samples collected at 40 different locations from 5 different zones of Catalonia, Spain. Detection limits ranged between 0.02 (PFHxS) and 0.85 ng/L (PFOA). The most frequent compounds were PFOS and PFHxS, which were detected in 35 and 31 samples, with maximum concentrations of 58.1 and 5.30 ng/L, respectively. PFBuS, PFHxA, and PFOA were also frequently detected (29, 27, and 26 samples, respectively), with maximum levels of 69.4, 8.55, and 57.4 ng/L. In contrast, PFDoDA and PFTDA could not be detected in any sample. The most contaminated water samples were found in the Barcelona Province, whereas none of the analyzed PFCs could be detected in two samples (Banyoles and Lleida), and only one PFC could be detected in four of the samples. Assuming a human water consumption of 2 L/day, the maximum daily intake of PFOS and PFOA from municipal drinking water would be, for a subject of 70 kg of body weight, 1.7 and 1.6 ng/kg/day. This is clearly lower than the respective Tolerable Daily Intake set by the European Food Safety Authority. In all samples, PFOS and PFOA also showed lower levels than the short-term provisional health advisory limit for drinking water (200 ng PFOS/L and 400 ng PFOA/L) set by the US Environmental Protection Agency. Although PFOS and PFOA concentrations found in drinking water in Catalonia are not expected to pose human health risks, safety limits for exposure to the remaining PFCs are clearly necessary, as health-based drinking water concentration protective for lifetime exposure is set to 40 ng/L for PFOA.

Exposure to perfluorinated compounds in Catalonia, Spain, through consumption of various raw and cooked foodstuffs, including packaged food.

In this study, the role that some food processing and packaging might play as a source of perfluorinated compounds (PFCs) through the diet was assessed. The levels of PFCs were determined in composite samples of veal steak (raw, grilled, and fried), pork loin (raw, grilled, and fried), chicken breast (raw, grilled, and fried), black pudding (uncooked), liver lamb (raw), marinated salmon (home-made and packaged), lettuce (fresh and packaged), pate of pork liver, foie gras of duck, frankfurt, sausages, chicken nuggets (fried), and common salt. Among the 11 PFCs analyzed, only PFHxS, PFOS, PFHxA, and PFOA were detected in at least one composite sample, while the levels of the remaining PFCs (PFBuS, PFHpA, PFNA, PFDA, PFUnDA, and PFDoDA) were under their respective detection limits. PFOS was the compound most frequently detected, being found in 8 of the 20 food items analyzed, while PFHxA was detected in samples of raw veal, chicken nuggets, frankfurt, sausages, and packaged lettuce. According to the results of the present study, it is not sufficiently clear if cooking with non-stick cookware, or packaging some foods, could contribute to a higher human exposure to PFCs.

[Innovating the service management of public health: the experience of the Barcelona Public Health Agency (Spain)]. / Innovar en la gestión de servicios de salud pública: la experiencia de la Agencia de Salud Pública de Barcelona.

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.

Innovar en la gestión de servicios de salud pública: la experiencia de la Agencia de Salud Pública de Barcelona / Innovating the service management of public health: the experience of the Barcelona Public Health Agency [Spain]

Se describe la evolución de la prestación de servicios de salud pública en la ciudad de Barcelona hasta la creación de la Agència de Salut Pública de Barcelona. La Agencia es un ente consorcial del Ayuntamiento de Barcelona y la Generalitat de Catalunya, como único gestor de las competencias locales y autonómicas en salud pública para la ciudad. Se analiza la lógica de su construcción, su definición de misión, visión y valores,estrategia y catálogo de servicios, así como el rol dela dirección en el conjunto del proceso. Se detallan aspectos de los planes de comunicación y calidad, la estructuración por procesos, y su política de alianzas en los terrenos de docencia e investigación en salud pública, para acabar enumerando los principales retos de futuro que para esta organización se presentan

We describe the evolution of the organization of publichealth 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 underlyinglogic 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 forresearch and training in public health, are discussed. Finally, the main challenges for the future are described

[Pesticides in the diet: adding pieces to the puzzle]. / Plaguicidas en la dieta: aportando piezas al rompecabezas.

OBJECTIVES: To improve information on exposure to pesticides through diet in Spain by reporting the results on 88 pesticide parameters in 1,109 food samples obtained between 1998 and 2003 as part of the Barcelona program for research on the health quality of foods. MATERIAL AND METHOD: The results are presented by food groups. For fruits and vegetables, the results were compared with those for the previous period. Statistical comparisons were performed using the chi2 test. RESULTS: Of the 1,109 samples, 116 were positive for pesticides (10.5%). Persistent chlorinated compounds were detected in 1.5% and other compounds were found in 14.4%. Positive results were concentrated in fruits, vegetables, spices, cereals and their derivatives. There were no positive results among vegetable oils, eggs or fish products, and almost none in dairy products and meats. Fruits contained the greatest number of pesticides but none were persistent. Vegetables contained fewer pesticides, but some of these were persistent chlorinated compounds. Comparison of the results for fruits and vegetables with those of the 1989-97 period revealed no significant trends. CONCLUSIONS: Although a considerable number of samples contained pesticides, most of these were not persistent chlorinated compounds. The number of pesticides in fruits was notable.

Plaguicidas en la dieta: aportando piezas al rompecabezas / Pesticides in the diet: adding pieces to the puzzle

Objetivos: Mejorar la informacion sobre la exposicion a plaguicidas mediante la dieta en nuestro pais con la presentación de los resultados de deteccion de 88 parametros de (..) (AU)

Objectives: To improve information on exposure to pesticides through diet in Spain by reporting the results on 88 pesticide parameters in 1,109 (AU)