Josep M. Jansà

Salud e inmigración: nuevas realidades y nuevos retos

The new social and demographic framework in Spain that has appeared since the arrival of new migrant populations, raises the need to improve the knowledge of their health status and to identify preventive measures and priorities in heath services. A bibliographic review of the available information on migration and health in Spain is performed, together with an analysis of their contents from a Public Health point of view. The high proportion of new borns from foreign mothers, the mental needs, deficits in oral and dental health, and the increase of tuberculosis in migrants, together with limited vaccine coverage in children, define the main health needs of these populations. The analysis of health services, reveals a high use of pediatric, obstetric and gynecologic resources by migrant populations. Conclusions; although no particular health needs have been identified for migrants, special attention for tuberculosis, mother and child health and health promotion and prevention, have to be funded for specific migrant populations. Health resources and services have to be reinforced with health agents, human resources, and specialized education for health professionals.

Tuberculosis importada: una enfermedad emergente en países industrializados

Fundamento Describir las caracteristicas de la tuberculosis importada en Barcelona durante 1999 y 2000. Material y metodo Encuesta epidemiologica. Resultados En el ano 2000 se detectaron449 casos de tuberculosis en poblacion autoctona(incidencia 29,5/100.000) y 121 eninmigrantes (incidencia 555,9/100.000).Entre 1999 y 2000 la tuberculosis ha disminuidoun 7,9% en la poblacion autoctonade Barcelona, mientras que ha aumentadoun 47,2% en inmigrantes. Hubo tres brotesepidemicos: una comunidad hindu (11 casos),dos familias dominicanas (4 casos) yuna escuela (dos casos) cuyo caso indice fueuna cooperante. Las cepas de Mycobacteriumtuberculosis del primer brote fueron sensiblesa todos los farmacos, las del segundo resistentesa los de primera linea y las del terceroresistentes a isoniacida. Conclusiones La evolucion de la tuberculosisen Barcelona en el ultimo bienio confirma laemergencia de casos importados que demandanuna revision de las medidas de control.

Inmigración y envejecimiento, nuevos retos en salud pública

Foreign migration in Spain is at present a priority in the so- cial and demographic context the country. At a worldwide level, trends in the evolution of population and social, political and economical indicators, appear to maintain for the coming years, the present trends on migrations from poor countries to the rich ones. In the health area, considering migration as a relatively re- cent phenomena in Spain, and considering that is mainly cons- tituted by young and healthy population, there are not still data available on the main health needs of migrants related to aging. Data from other countries with a longer migrant tradition, shows mental health disorders and social and cultural barriers for adaptation, as basic health determinants for older migrants. Related to the effects in the health system, the inclusion of the aging factor in general population and migrant needs, offer an optimistic panorama for future planning. Migrant aging in Spain, despite of its middle and long term perspective, do require a progressive adaptation of knowled- ge and resources to cover future needs. Considering this co- ming future, health professionals do need to be trained in in- tercultural skills and knowledge.

Geographic variation in HIV infection among injecting drug users within Barcelona

In response to a high incidence of AIDS among injecting drug users in Barcelona, Spain, the city established a program in four geographically distinct centers for assistance and surveillance. The centers provided testing, counseling, and monitoring of infectious diseases. In 1991-92, HIV rates were 33% in the northwest center, 39% in the western center, 39% in the east, and 71% in the south. Differences between the rates in the southern center when compared with those in the other centers were very significant (P < or = .001). These data show geographic variation of HIV infection within one city and substantiate the need to provide expanded medical care in the drug misuse treatment setting.