Mortality in Catalonia during the summer of 2022 and its relation with high temperatures and COVID-19 cases.

Purpose: To analyse the association between the mortality during the summer 2022 and either high temperatures or the COVID-19 wave with data from the Catalan Health Care System (7.8 million people). Methods: We performed a retrospective study using publicly available data of meteorological variables, influenza-like illness (ILI) cases (including COVID-19) and deaths. The study comprises the summer months of the years 2021 and 2022. To compare the curves of mortality, ILI and temperature we calculated the z-score of each series. We assessed the observed lag between curves using the cross-correlation function. Finally, we calculated the correlation between the z-scores using the Pearson correlation coefficient (R2). Results: During the study period, 33,967 deaths were reported in Catalonia (16,416 in the summer of 2021 and 17,551 in the summer of 2022). In 2022, the observed lag and the correlation between the z-scores of temperature and all-cause deaths was 3 days and R2 = 0.86, while between ILI and all-cause deaths was 22 days and R2 = 0.21. This high correlation between temperature and deaths increased up to 0.91 when we excluded those deaths reported as COVID-19 deaths, while the correlation between ILI and non-COVID-19 deaths decreased to -0.19. No correlation was observed between non-COVID deaths and temperature or ILI cases in 2021. Conclusion: Our study suggests that the main cause of the increase in deaths during summer 2022 in Catalonia was the high temperatures and its duration. The contribution of the COVID-19 seems to be limited.

Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain).

The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals. A composite 'textbook outcome' was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium-high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15-1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51-7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.

Smoking-attributable mortality in the autonomous communities of Spain, 2017.

INTRODUCTION AND OBJECTIVES: To estimate smoking-attributable mortality (SAM) in the regions of Spain among people aged ≥ 35 years in 2017. METHODS: SAM was estimated using a prevalence dependent method based calculating the population attributable fraction. Observed mortality was derived from the National Statistics Institute. The prevalence of smoking by age and sex was based on the Spanish National Health Survey for 2011 and 2017 and the European Survey for 2014. Relative risks were reported from the follow-up of 5 North American cohorts. SAM and population attributable fraction were estimated for each region by age group, sex, and causes of death. Cause-specific and adjusted SAM rates were estimated. RESULTS: Smoking caused 53 825 deaths in the population aged ≥ 35 years (12.9% of all-cause mortality). SAM ranged from 10.8% of observed mortality in La Rioja to 15.3% in the Canary Islands. The differences remained after rates were adjusted by age. The highest adjusted SAM rates were observed in Extremadura in men and in the Canary Islands in women. Adjusted SAM rates in men were inversely correlated with those in women. The percentage of total SAM represented by cardiovascular diseases in each region ranged from 21.8% in Castile-La Mancha to 30.3% in Andalusia. CONCLUSIONS: The distribution of SAM differed among regions. Conducting a detailed region-by-region analysis provides relevant information for health policies aiming to curb the impact of smoking.

Mental well-being of the general population: direct and indirect effects of socioeconomic, relational and health factors.

PURPOSE: The aim of this study was to analyse the association between individual mental well-being and social, economic, lifestyle and health factors. METHODS: Cross-sectional study on a representative sample of 13,632 participants (> 15y/o) from the Catalan Health Interview Survey 2013-2016 editions. Mental well-being was assessed with the Warwick-Edinburg Mental Well-being Scale (WEMWBS). Linear regressions were fitted to associate well-being and sociodemographic, relational, lifestyle and health variables according to minimally sufficient adjustment sets identified using directed acyclic graphs. Predictors entered the model in blocks of variable types and analysed individually. Direct and total effects were estimated. RESULTS: Health factors significantly contributed to mental well-being variance. Presence of a mental disorder and self-reported health had the largest effect size (eta2 = 13.4% and 16.3%). The higher individual impact from a variable came from social support (ß = - 12.8, SE = 0.48, eta2 = 6.3%). A noticeable effect gradient (eta2 = 4.2%) from low to high mental well-being emerged according to economic difficulties (from ß = 1.59, SE = 0.33 for moderate difficulties to ß = 6.02 SE = 0.55 for no difficulties). Younger age (ß = 5.21, SE = 0.26, eta2 = 3.4%) and being men (ß = 1.32, SE = 0.15, eta2 = 0.6%) were associated with better mental well-being. Direct gender effects were negligible. CONCLUSIONS: This study highlights health and social support as the most associated factors with individual mental well-being over socioeconomic factors. Interventions and policies aimed to these factors for health promotion would improve population mental well-being.

Natural outdoor environments and mental and physical health: relationships and mechanisms.

BACKGROUND: Evidence is growing for the beneficial impacts of natural outdoor environments on health. However, most of the evidence has focused on green spaces and little evidence is available on health benefits of blue spaces and about possible mediators and modifiers of such impacts. We investigated the association between natural outdoor environments (separately for green and blue spaces) and health (general and mental) and its possible mediators and modifiers. METHODS: Cross-sectional data from adults interviewed in Catalonia (Spain) between 2010 and 2012 as part of the Catalonia Health Survey were used. The collected data included sociodemographic characteristics, self-perceived general health, mental health, physical activity and social support. Indicators of surrounding greenness and access to natural outdoor environments within 300 m of the residence and degree of urbanization were derived for residential addresses. Associations were estimated using logistic regression and negative binominal models. RESULTS: Green spaces were associated with better self-perceived general health and better mental health, independent of degree of urbanization. The associations were more consistent for surrounding greenness than for access to green spaces. The results were consistent for different buffers, and when stratifying for socioeconomic status. Slightly stronger associations were found for women and residents of non-densely populated areas. No association was found between green spaces and social contacts and physical activity. The results for blue spaces were not conclusive. CONCLUSION: Green spaces are associated with better general and mental health across strata of urbanization, socioeconomic status, and genders. Mechanisms other than physical activity or social support may explain these associations.

Differential item and test functioning methodology indicated that item response bias was not a substantial cause of country differences in mental well-being.

OBJECTIVES: Establishing the cross-cultural equivalence of the mental well-being construct, as measured with the Warwick-Edinburg Mental Well-being Scale (WEMWBS), by studying potential construct validity biases in two countries with previously reported score differences. STUDY DESIGN AND SETTING: We compared the WEMWBS total scores and item responses in Scotland (N = 779) and Catalonia (N = 1,900) general population samples. To assess whether the questionnaire spuriously favored higher scores in Catalonia, we tested for differential item functioning (DIF) by applying ordinal logistic regression on Item Response Theory scores. DIF was tested with likelihood ratio tests and standard effect measures (McFadden Pseudo R(2), >0.13; relative parameter change, >5%), and differential test functioning (DTF) was tested by plotting differences between full-test and purified (i.e., without DIF items) score estimates. RESULTS: Catalonia showed higher levels of mental well-being than Scotland (Cohen d = 0.84). Three of 14 WEMWBS items showed small amounts of DIF. DIF did not accrue to DTF, as shown by intraclass correlation coefficient (ICC, 0.999) and case-by-case differences (maximum, 0.12 SD) between total and purified scores. Population differences remained mainly constant across sociodemographics and health outcomes. CONCLUSION: The WEMWBS measures a distinct well-being construct that is stable across countries, implying that Scotland and Catalonia populations are effectively different in the distribution of mental well-being. This result adds to previous psychometric information and supports WEMWBS as a valid unbiased measures for individual and cross-cultural comparisons.

The Spanish version of the Warwick-Edinburgh mental well-being scale (WEMWBS) is valid for use in the general population.

PURPOSE: Mental well-being has aroused interest in Europe as an indicator of population health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed in the United Kingdom showing good face validity and has been previously adapted into Spanish. The aim of this study is to assess the validity and reliability of the Spanish version of WEMWBS in the general population. METHODS: Cross-sectional home face-to-face interview survey with computer-assisted personal interviewing was administered with the 2011 Catalan Health Interview Survey Wave 3, which is representative of the non-institutionalized general population of Catalonia, Spain. A total of 1,900 participants 15+ years of age were interviewed. The Spanish version of WEMWBS was administered together with socioeconomic and health-related variables, with a hypothesized level of association. RESULTS: Similar to the original, confirmatory factor analysis fits a one-factor model adequately (CFI = 0.974; TLI = 0.970; RMSEA = 0.059; χ (2) = 584.82; df = 77; p < .001) and has a high internal consistency (Cronbach's alpha = 0.930; Guttman's lambda 2 = 0.932). The WEMWBS discriminated between population groups in all health-related and socioeconomic variables, except in gender (p = 0.119), with a magnitude similar to that hypothesized. Overall, mental well-being was higher for the general population of Catalonia (average and whole distribution) than that for Scotland general population. CONCLUSIONS: The Spanish version of WEMWBS showed good psychometric properties similar to the UK original scale. Whether better mental well-being in Catalonia is due to methodological or substantive cultural, social, or environmental factors should be further researched.

Normas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de Cataluña / Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population

Fundamento y objetivo: El cuestionario de salud SF-12 es una versión reducida del SF-36. La estrategia principal de interpretación de estos cuestionarios de calidad de vida relacionada con la salud (CVRS) es la utilización de normas poblacionales. Este estudio pretende obtener las normas de referencia para la versión española del SF-12 versión 2 (SF-12v2), evaluar su validez de constructo y comparar los métodos de puntuación estándar y específico. Sujetos y método: Se analizó una submuestra de la Encuesta de Salud de Cataluña (n=4.261), representativa de la población general no institucionalizada. Se calculó la media y percentiles para las 8 dimensiones y los componentes sumarios, estratificando por sexo y edad. La validez de constructo se evaluó mediante la comparación de grupos conocidos aplicando la prueba de ANOVA. Resultados: Los resultados apoyaron las hipótesis establecidas a priori para los grupos conocidos (p<0,001): peor salud física en las personas con problemas de movilidad (EQ-5D) (37,8 frente a 52), con mayor restricción en actividades (41,8 frente a 51,2) y con mayor número de trastornos crónicos (43,2 frente a 53,9); y peor salud mental en las personas con problemas de ansiedad/depresión (EQ-5D) (42,2 frente a 51,9). Las puntuaciones obtenidas con ambos métodos de puntuación fueron similares, excepto en Salud General y Vitalidad. Conclusiones: El SF-12v2 es un instrumento válido para medir CVRS en nuestro entorno. Las normas obtenidas facilitan la interpretación de sus puntuaciones en la práctica clínica, la investigación y la gestión sanitaria. Se recomienda el método específico para comparaciones de CVRS a nivel nacional y el estándar para las internacionales (AU)

Background and objective: The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. Subjects and methods: We analyzed a subsample of the Catalan Health Interview Survey (n = 4,261),representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. Results: The results for the known groups analysis supported the hypothesis established a priori(P < .001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9);and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scoresobtained by the 2 different methods of calculation were similar, except for General Health and Vitality. Conclusions: The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison (AU)

Importancia de los problemas reumáticos en la población de Cataluña: prevalencia y repercusión en la salud percibida, restricción de actividades y utilización de recursos sanitarios / Importance of chronic musculoskeletal problems in the population of Catalonia (Spain): prevalence and effect on self-perceived health, activity restriction and use of health services

Objetivo Conocer la importancia de las enfermedades reumáticas en la población adulta de Cataluña y su repercusión en la salud autopercibida, la restricción de actividades y el uso de servicios sanitarios. Métodos Encuesta poblacional a 15.926 adultos. Muestreo estratificado polietápico. Variables recogidas: características sociodemográficas, problemas de salud, salud autopercibida, restricción de actividades y uso de recursos sanitarios. Los problemas musculoesqueléticos se clasificaron en cuatro categorías: artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis. Resultados El 77,4% declara problemas crónicos de salud. La dorsalgia-lumbalgia, la cervicalgia crónica y el grupo artrosis-artritis o reumatismo, por este orden, son los más frecuentemente declarados. Tras ajustar por la edad, el sexo femenino incrementa el riesgo de declarar artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis (odds ratio [OR]=2,6, 1,5, 2,3 y 5,3, respectivamente). La prevalencia es más alta en los grupos de mayor edad con gradiente social. Tras ajustar por edad, sexo, clase social y obesidad, la percepción de la salud es peor en las personas afectadas (42,7% frente a 11%), que también declaran una mayor restricción de la actividad en el último año y en los últimos 15 días (OR=2,70 y 2,32, respectivamente), y un uso de los servicios sanitarios significativamente superior. Conclusiones Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor en las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios (AU)

Objective To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services. Methods A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis. Results Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services. Conclusiones Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios (AU)

[Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population]. / Normas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de Cataluña.

BACKGROUND AND OBJECTIVE: The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. SUBJECTS AND METHODS: We analyzed a subsample of the Catalan Health Interview Survey (n=4,261), representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. RESULTS: The results for the known groups analysis supported the hypothesis established a priori (P<.001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9); and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scores obtained by the 2 different methods of calculation were similar, except for General Health and Vitality. CONCLUSIONS: The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison.

[Importance of chronic musculoskeletal problems in the population of Catalonia (Spain): prevalence and effect on self-perceived health, activity restriction and use of health services]. / Importancia de los problemas reumáticos en la población de Cataluña: prevalencia y repercusión en la salud percibida, restricción de actividades y utilización de recursos sanitarios.

OBJECTIVE: To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services. METHODS: A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis. RESULTS: Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services. CONCLUSIONS: Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios.

Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey.

PURPOSE: To compare the EQ-5D, SF-6D, and SF-12 in terms of their capacity to discriminate between groups defined by relevant socio-demographic and health characteristics in a general population survey. METHODS: Data were obtained from the 2006 Catalan Health Interview Survey, a representative sample (n = 4,319) of the general population of Catalonia (Spain). Effect sizes (ES) and Receiver Operating Characteristic (ROC) curves were calculated to evaluate the instruments' capacity to distinguish between groups based on socio-demographic variables, recent health problems, perceived health, psychological distress, and selected chronic conditions. RESULTS: All instruments showed a similar discriminative capacity between groups based on socio-demographic variables, recent medical visit (ES = 0.47-0.55), activity limitations (ES = 0.92-0.98), perceived health (ES = 0.97-1.33), and psychological well-being (ES = 1.17-1.57). Effect sizes between respondents with and without any of fourteen selected chronic conditions were large (0.76-1.04) for 4, moderate (0.55-0.74) for 8, and small (0.17-0.39) for two on the EQ-5D index. A similar pattern was observed for the SF-12 but ES were predominantly moderate (7 conditions) or small (6 conditions) on the SF-6D. CONCLUSIONS: The EQ-5D and SF-12 were largely comparable in estimating the health burden of chronic conditions, recent health problems, and social inequalities. The SF-6D was less sensitive than the EQ-5D index and SF-12, particularly for physical chronic conditions.

Análisis del desempeño de los servicios sanitarios de Cataluña: evaluación de los primeros resultados del proyecto demostrativo / Performance assessment of health services in Catalonia (Spain): Evaluation of initial results of the Catalan healthcare service project

La medida del desempeño de los servicios sanitarios está recibiendo una mayor atención debido al aumento del gasto sanitario y de las expectativas de la población, y a la necesidad de obtener el máximo rendimiento de los recursos invertidos. En Cataluña, en el año 2005, aprovechando la experiencia previa de la Agència de Salut Pública de Barcelona y del Consorci Sanitari de Barcelona comparando los servicios sanitarios de Barcelona y Montreal, una beca de investigación de la Agència d’Avaluació de Tecnologia i Recerca Mèdiques, y el interés de planificación sanitaria del Departament de Salut, se puso en marcha el proyecto de análisis del desempeño de los servicios sanitarios de Cataluña. El objetivo de este artículo es presentar el desarrollo del proyecto, mostrar algunos ejemplos que ilustran el tipo de información que se ha podido obtener y el tipo de análisis que esta información permite, exponer posibles explicaciones de los resultados presentados y discutir algunas limitaciones e implicaciones. De hecho, el valor añadido de este proyecto es que permite conocer el desempeño del sistema sanitario en la consecución de sus objetivos, establecer un conjunto de indicadores homogeneizados de referencia y ser una pieza clave en el desarrollo de la Central de Resultats del Departament de Salut de la Generalitat de Catalunya (AU)

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d’Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005.This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya(AU)

[Performance assessment of health services in Catalonia (Spain): evaluation of initial results of the Catalan healthcare service project]. / Análisis del desempeño de los servicios sanitarios de Cataluña: evaluación de los primeros resultados del proyecto demostrativo.

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d'Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005. This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya.

Estrategia «Salud en los barrios»: actuaciones focalizadas en territorios de especial necesidad social y de salud / The ''neighbourhood health'' strategy: actions focused on areas with special social and health needs

Con la Ley 2/2004 de mejora de barrios, áreas urbanas y villas que requieren atención especial, el Gobierno de Cataluña creó un fondo de financiación de proyectos de mejora integral de barrios, elaborados por los ayuntamientos. El Departamento de Salud se sumó a la estrategia mediante el programa «Salud en los barrios», que es una prioridad de política sanitaria. Estructuras de salud y municipales cooperan a nivel del barrio en todas las fases de un proyecto de intervención comunitaria (análisis y detección de necesidades, priorización de los problemas detectados, definición y reparto de actuaciones). Se utilizan técnicas como el grupo nominal. Se han identificado cuatro colectivos vulnerables con mayor carga de enfermedad, comorbilidad, situaciones de riesgo, etc. (menores, gente de edad avanzada, mujeres y población de reciente inmigración). Posteriormente, se intensifican y priorizan las actuaciones de todos los agentes implicados, entre ellas las propias del Departament de Salut y se desarrolla una cartera de servicios de salud pública específica

Through the Law 2/2004 on improving neighbourhoods, urban areas and towns requiring special attention, the Government of Catalonia set up a fund for financing projects prepared by town/city councils for theintegral improvement of neighbourhoods. The Ministry of Health signed on to the strategy with “The Neighbourhood Health Programme”, which was a healthcare policy priority. Healthcare and municipal structurescooperate at neighbourhood level in all of the phases of the community intervention project (analysis and detection of needs, prioritisation of the problems detected, definition and distribution of actions). Techniques such as the nominal group are used. Four vulnerable groups have been identified with higher levels of illness, co-morbidity, situations ofrisk, etc. (the young, the elderly, women and recent immigrants). The actions of all the agents involved, among them those from the Ministry of Health itself, are then intensified and prioritised and a specific portfolioof public health services is prepared

[The ''neighbourhood health'' strategy: actions focused on areas with special social and health needs]. / Estrategia "Salud en los barrios": actuaciones focalizadas en territorios de especial necesidad social y de salud.

Through the Law 2/2004 on improving neighbourhoods, urban areas and towns requiring special attention, the Government of Catalonia set up a fund for financing projects prepared by town/city councils for the integral improvement of neighbourhoods. The Ministry of Health signed on to the strategy with The Neighbourhood Health Programme, which was a healthcare policy priority. Healthcare and municipal structures cooperate at neighbourhood level in all of the phases of the community intervention project (analysis and detection of needs, prioritisation of the problems detected, definition and distribution of actions). Techniques such as the nominal group are used. Four vulnerable groups have been identified with higher levels of illness, co-morbidity, situations of risk, etc. (the young, the elderly, women and recent immigrants). The actions of all the agents involved, among them those from the Ministry of Health itself, are then intensified and prioritised and a specific portfolio of public health services is prepared.

[Mortality due to dementias in Catalonia, Spain: an emergent health problem]. / Mortalidad por demencia en Cataluña: un problema de salud emergente.

BACKGROUND: The aims of this study were to describe the trends of mortality from dementias according to gender and age in Catalonia (Spain) and to estimate their evolution from 1979 to 2003. MATERIAL AND METHOD: The dementia death data (ICD-9: 290-290.9 298.9, 294.9, 331.0, and 331.2) between 1979 and 1998 come from the Catalonian Mortality Register of the Department of Health as well as the official population census, lineal estimations and projections made by the Institute of Statistics of Catalonia. For the calculation of trend and mortality projections up to 2003, a Poisson regression model was adjusted for each gender, using the variables age, period and birth cohort. RESULTS: Dementia mortality rate moved from 2.14 per 100,000 inhabitants during 1979-1983 to 41.95 during 1994-1998. With regard to the period 1989-1998, the average percentage of the annual variation of mortality is estimated to be 7.5% for males and 9.6% for females. The increase is in part due to population aging and also to a cohort effect of people born before 1925. The expected annual mean number of dementia deaths during 1999-2003 is estimated at 4,594. CONCLUSIONS: Mortality from dementias in Catalonia has experienced a substantial increase over the last 20 years. Given the health and social impact of this group of diseases and the future perspectives, dementias should be considered as an emergent problem in public health.

Mortalidad por demencia en Cataluña: un problema de salud emergente / Mortality due to dementias in Catalonia, Spain: an emergent health problem

FUNDAMENTO: El objetivo de este estudio fue analizar las tendencias de mortalidad por demencias en Cataluña por sexo y edad, entre 1979 y 1998, y estimar su evolución hasta el 2003.MATERIAL Y MÉTODO: Las defunciones por demencias (CIE-9: 290-290.9, 298.9, 294.9, 331.0 y 331.2) de los años 1979 al 1998 proceden del Registro de Mortalidad de Cataluña del Departament de Sanitat i Seguretat Social y la población de los censos y padrones oficiales, estimaciones lineales entre éstos y proyecciones elaboradas por el Institut d'Estadística de Catalunya. Para el cálculo de la tendencia y la proyección de la mortalidad hasta 2003 se ajustó un modelo de regresión de Poisson para cada sexo, con las variables edad, período y cohorte de nacimiento. RESULTADOS: La tasa bruta de mortalidad por demencias ha pasado de 2,14 por 100.000 habitantes en el período 1979-1983, a 41,95 en el 1994-1998. El porcentaje de cambio anual se estima del 7,5 por ciento en los varones y del 9,6 por ciento en las mujeres durante el período 1989-1998. Este incremento es debido en parte al envejecimiento de la población, pero también al efecto cohorte de los nacidos antes de 1925. El número medio anual de muertes esperadas para el período 1999-2003 se estima en 4.594. CONCLUSIONES: La mortalidad por demencia en Cataluña ha experimentado un substancial aumento en los últimos 20 años. Dado el impacto sanitario y social de estas enfermedades y las perspectivas de futuro, las demencias deberían considerarse un problema emergente en salud pública. (AU)