Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.

Implementation Feasibility of a Digital Nervous System for the Construction Industry: For Efficient and Effective Information Management across the Project Lifecycle

The construction industry has long been considered as highly fragmented and non-collaborative industry. This fragmentation sprouted from complex and unstructured traditional coordination processes and information exchanges amongst all parties involved in a construction project. This nature coupled with risk and uncertainty has pushed clients and their supply chain to search for new ways of improving their business process to deliver better quality and high performing product. This research will closely investigate the need to implement a Digital Nervous System (DNS), analogous to a biological nervous system, on the flow and management of digital information across the project lifecycle. This will be through direct examination of the key processes and information produced in a construction project and how a DNS can provide a well-integrated flow of digital information throughout the project lifecycle. This research will also investigate how a DNS can create a tight digital feedback loop that enables the organisation to sense, react and adapt to changing project conditions. A Digital Nervous System is a digital infrastructure that provides a well-integrated flow of digital information to the right part of the organisation at the right time. It provides the organisation with the relevant and up-to-date information it needs, for critical project issues, to aid in near real-time decision-making. Previous literature review and survey questionnaires were used in this research to collect and analyse data about information management problems of the industry – e.g. disruption and discontinuity of digital information flow due to interoperability issues, disintegration/fragmentation of the adopted digital solutions and paper-based transactions. Results analysis revealed efficient and effective information management requires the creation and implementation of a DNS.

Fortification and Frontier: The Project Drawn up by Juan Martín Zermeño for Puebla de Sanabria in 1766

Following the death of engineer General Jorge Próspero de Verboom in 1744 and after a few years of transition in the management of Spanish fortifications, Juan Martín Zermeño took on the role, initially with a temporary mandate, but then definitively during a second period that ran from 1766 until his death in 1772. He began this second period with a certain amount of concern because of what had taken place during the last period of conflict. The Seven Years War (1756–1763) which had brought Spain into conflict with Portugal and England in the Caribbean had also lead to conflict episodes along the Spanish–Portuguese border. Zermeño’s efforts as a planner and general engineer gave priority to the northern part of the Spanish–Portuguese border. After studying the territory and the existing fortifications on both sides of the border, Zermeño drew up three important projects in 1766. The outposts that needed to be reinforced were located, from north to south, at Puebla de Sanabria, Zamora and Ciudad Rodrigo, which is where he is believed to have come from. This latter township already had a modern installation built immediately after the war of the Spanish Succession and reinforced with the Fort of La Concepción. However, Zamora and Puebla de Sanabria had some obsolete fortifications that needed modernising. Since the middle of the 15th century Puebla de Sanabria had had a modern castle with rounded turrets, that of the counts of benavente. During the 16th and 17th centuries it had also been equipped with a walled enclosure with small bastions. During the war of the Spanish Succession the Portuguese had enlarged the enclosure and had erected a tentative offshoot to the west. In order to draw up the ambitious Puebla de Sanabria project Zermeño had the aid of some previous reports and projects, such as those by the count of robelin in 1722, the one by Antonio de Gaver in 1752, and Pedro Moreau’s report dated June 1755. This study includes a technical analysis of Zermeño’s project and its strategic position within the system of fortifications along the Spanish–Portuguese border.

Engineer Leandro Badarán’s project to safeguard the fortresses of Alicante in 1794

After the construction of the San Carlos bastion in Alicante in the final decade of the seventeenth century, and the great trench which the English built around the district of San Francisco during their years of dominance in the War of Succession, the waters of the San Blas gully caused serious damage to these fortifications of the city and to the trade buildings of the port. In 1772, the diversion canal was built. It was designed to divert the riverbed of the gully and send the waters directly to the sea. The project had been initially designed by the Engineer General, Jorge Próspero de Verboom in 1721. This unique work of engineering had some defects, principally in the breakwater which prevented the waters from flowing down the former river course. On several occasions, the water returned to its original riverbed due to the weakness of the breakwater, the narrowness of the channel’s bed and its lack of regularisation, causing serious damage to the bastion, the Babel-facing façade, the traders’ warehouses and other buildings. This study describes the project that the military engineer Leandro Badarán carried out in 1794 in order to technically improve this canal and examines his report on the state of the fortifications. Similar works built in Spain are also explained. It also analyses the repeated disputes between the war department and the port throughout these years over finding a technical solution to the problem.

Tiburzio Spannocchi’s project for the fortifications of Fuenterrabía in 1580

Fuenterrabía (Hondarribia) is a town located on the Franco-Spanish border. Between the 16th and 19th centuries it was considered to be one of the most outstanding strongholds in the Basque Country due to its strategic position. The bastion system of fortification was extremely prevalent in this stronghold. It was one of the first Spanish towns to adopt the incipient Renaissance designs of the bastion. The military engineers subsequently carried out continuous fortification projects that enabled the structure to withstand the advances being made in artillery and siege tactics. After the construction of the citadel of Pamplona had begun in 1571, following the design of the prestigious military engineer, Jacobo Palear Fratín and being revised by Viceroy Vespasiano Gonzaga, the aforementioned engineer undertook an ambitious project commissioned by Felipe II to modernise the fortifications of Fuenterrabía. Neither the plans nor the report of this project have been conserved, but in the year 2000, César Fernández Antuña published the report written by Spannocchi on the state of the fortifications of Fuenterrabía when he arrived to the Spanish peninsula, discovered in the Archivo Histórico Provincial de Zaragoza. This document conducts an in-depth analysis of Spannocchi’s project and how it was related to Fratín’s previous project. It concludes that this project encountered problems in updating the new bastions at the end of the 16th century, and identifies the factors which prevented the stronghold from being extended as was the case in Pamplona after Fratín’s project.