Region Of Catalonia Research Articles

The struggle for an alternative future: Anticipatory actions and socio-environmental movements in Alt Empordà (Catalonia)

This article describes the environmental practices and discourses of local actors in the Alt Empordà region in Catalonia and how they contribute to the production of a vision of the environmental future. Based on a political ecology of hope framework, it presents different anticipatory actions and strategies which have created this vision of the environmental future since the 1970s, presenting key historic moments and actions which are central to various strategies which have been elaborated in order to secure access to the land and its resources. For decades, different successful campaigns have nourished a particular outlook, aimed at creating an environmental future which is accessible, attainable, and pragmatic. The article then analyzes how recent environmental changes and the consequences of these changes for the different local environments are significantly changing the actors’ view of the environmental future. Different shades of darker futures are emerging, in which the clear gains from environmental struggles are less tangible. It is hoped that in these futures access to nature will be more inclusive and less oriented towards a modernist and developmentalist approach to the territory. This perspective favours a thriving nature, but does so by rethinking conventional conservation models in order to take into account the changing nature of the environment in a climate change context. It is hoped that the region's demographic structure will enable its inhabitants to maintain, occupy and live on the territory, rather than leaving it to consist of protected areas or tourist areas only, and to build a different relationship with energy and water consumption. Finally, we discuss how these transformations modify local perceptions of the future and may foster an “anticipated solastalgia” as an emerging category of environmental thought.

Sex differences in dementia diagnosis: a fourteen-year retrospective analysis of cases using the Registry of Dementia of Girona

Objective To evaluate the impact of sociodemographic and clinical sex/gender-associated factors on dementia severity at the time of diagnosis. Methods Retrospective, cross-sectional study using 2007–2020 data from the Registry of Dementia of Girona (ReDeGi), collecting information from new dementia diagnoses in the seven hospitals of the Health Region of Girona (Northeast region of Catalonia, Spain). Sociodemographic and clinical variables were compared by sex and dementia severity at diagnosis. A multivariate analysis stratified by sex evaluated the risk of having a moderate/severe dementia diagnosis. Results Of 9614 new dementia cases, 6040 (62.8%) were women, and 3574 (37.2%) were men. Women and men aged 75–85 years had 27.9% (p = .003) and 43.1% (p < .001) less risk of moderate/severe diagnosis, respectively, than those >85. Being institutionalized increased the risk of moderate/severe diagnosis more in women (159.9%; p < .001) than in men (114.8%; p = .030). Being single and having a higher education increased the risk of moderate/severe diagnosis by 76.2% (p = .039) and 69.8% (p = .021), respectively, only in women. Conclusions Age, education level, marital status, and place of residence were differentially associated with moderate/severe dementia at the time of diagnosis in women and men, indicating sex/gender differences in dementia severity at diagnosis, with an increased impact on women.

Re-evaluating the human remains from El Bosquet cave (Mont-ral, Tarragona, Spain): healed trauma and forgotten past.

During the early development of archaeology in Spain, many of the materials obtained from excavations were later forgotten in museum deposits. However, re-investigation of these collections with contemporary methodologies can still contribute valuable knowledge. This study presents the case of El Bosquet Cave (Mont-ral, Tarragona, Spain), located in the Northeastern Iberian Peninsula. This cave was excavated and documented in 1956 and the recovered materials were transferred, years later, to the Reus Museum, where they are currently located. Our results provide a more precise Middle Bronze Age chronology for the site in addition to bioarchaeological conclusions on the human remains from four individuals. Of note is a healed mandibular fracture in one of the individuals. Trauma observed in human skeletal remains reflect the conditions and risks of human groups in relation to daily activities or may be the result of interpersonal violence. In the Iberian Peninsula there are very few documented cases of mandibular fractures in prehistoric populations. This study contributes to the knowledge of the populations of the recent prehistory in the region of Catalonia and highlights the importance of reanalyzing the collections that are deposited and, in many cases forgotten, in the different museums of the territory.

Exploring Pedagogical and Digital Practices in Vocational Education and Training: Comparing Teacher and Student Perspectives

This article investigates the pedagogical and digital practices of vocational education and training teachers, offering comparative insights from both teacher and student perspectives. To this end, two questionnaires were constructed for teachers and students and then validated by means of inter-judge procedures and expert review. The questionnaires were administered to representative samples of 158 teachers and 309 students in intermediate and higher vocational education and training programs in the Spanish region of Catalonia. Thanks to institutional collaboration, it was possible to obtain both samples by a non-probability sampling technique. The results obtained from the quantitative analyses performed show that while most vocational education and training teachers utilize a combination of active and lecture-based methods, less than a third incorporate online tools, prioritizing institutional platforms. Although both teachers and students acknowledge a diversity of teaching strategies, the latter, particularly female students and those in advanced years or on dual programs, tend to be more critical of the effectiveness of the teaching strategies employed compared to their teachers. The findings underscore the need for vocational education and training programs to enhance digital tool integration and address the varying perceptions of teaching effectiveness to better meet students’ expectations and needs.

Linked Data Generation Methodology and the Geospatial Cross-Sectional Buildings Energy Benchmarking Use Case

Cross-sectional energy benchmarking in the building domain has become crucial for policymakers, energy managers and property owners as they can compare an immovable property performance against its closest peers. For this, Key Performance Indicators (KPIs) are formulated, often relying on multiple and heterogeneous data sources which, combined, can be used to set benchmarks following normalization criteria. Geographically delimited parameters are important among these criteria because they enclose entities sharing key common characteristics the geometrical boundaries represent. Linking georeferenced heterogeneous data is not trivial, for it requires geographical aggregation, which is often taken for granted or hidden within a pre-processing activity in most energy benchmarking studies. In this article, a novel approach for Linked Data (LD) generation is presented as a methodological solution for data integration together with its application in the energy benchmarking use case. The methodology consists of eight phases that follow the best principles and recommend standards including the well-known GeoSPARQL Open Geospatial Consortium (OGC) for leveraging the geographical aggregation. Its feasibility is demonstrated by the integrated exploitation of INSPIRE-formatted cadastral data and the Buildings Performance Certifications (BPCs) available for the Catalonia region in Spain. The outcomes of this research support the adoption of the proposed methodology and provide the means for generating cross-sectional building energy benchmarking histograms from any-scale geographical aggregations on the fly.

Increase of pertussis cases in the Vallès region, Catalonia, Spain, September 2023 to April 2024.

We describe a pertussis outbreak in the Vallès region of Catalonia, from September 2023 to April 2024. Incidence was high in children aged 10-14 years compared with previous outbreaks. Limited impact in newborns could be explained by the high vaccination coverage during pregnancy and at 11 months of age in 2022, at 85% and 94.1 %, respectively. A third booster vaccine dose during preadolescence should be considered and vaccination coverage in pregnant women be improved to control future outbreaks.

Institutional environments for circular start-ups: Insights from an entrepreneurial European region

Circular start-ups (CSUs) are gaining popularity to radically rethink the linear resource flows of global production systems and adopt ambitious approaches towards a circular economy from inception. For CSUs, the institutional environment is particularly relevant; this is because the complex nature of sustainability challenges requires a deep engagement with institutions to drive transitions from linear to circular practices. This article analyses how and why institutional factors influence CSUs in the highly entrepreneurial region of Catalonia in Spain. Based on a multiple case study, our findings demonstrate that CSUs are affected by informal institutions through founder motivations, their ability to create opportunities and social values. Formal institutions influence CSUs regarding the previous experience of founders, accessible ecosystem actors and supportive laws and regulations. These findings are important for effective policymaking to develop adequate support mechanisms and understand the particular challenges and opportunities CSUs face compared to traditional start-ups.

Sustainability and the environmental impact of the tourism industry: An analysis of the hotel sector in Catalonia, Spain

Purpose: This research examines policies aimed at reducing the environmental impact of the hotel sector in Catalonia, Spain in 2020 and how they are communicated to stakeholders through corporate websites. It applies academic criteria to identify key aspects that are relevant to tourism.Design/Methodology: This study conducts a descriptive analysis of Catalonia's hotel sector in 2020, utilizing SABI (Iberian Balance Sheet Analysis System) data. It selects the top 48 companies in the hotel sector that are legally required to report their annual accounts in the regular format. The study then systematically evaluates their websites to assess the availability and transparency of information on environmental sustainability.Findings: Sustainable tourism, marked by non-financial indicators such as environmental impact, energy/water usage and waste generation, is a very important issue for stakeholders in the hotel industry, including governments, owners, investors, and customers. The sector's reporting methods are crucial for effectively communicating environmental policies to these parties. While many companies have implemented strategies to assess and reduce their environmental impact, there is still considerable room for improvement, particularly in communicating these efforts to the various stakeholders.Research limitations/implications: This research, while rigorous, has certain limitations that suggest directions for future studies. A primary constraint involves data reported at a group level by hotel companies, which complicates obtaining specific data for the Catalonia region, particularly for hotel groups with an international presence. Another significant limitation is the reliance on indirect data collection, based on the companies' self-reported environmental policies posted on their websites.Practical implications: By identifying and knowing the environmental policies of the hotel industry over the analyzed period, we can help the industry itself to improve the sustainability of its environmental efforts and make it more attractive to all stakeholders.Social implications: The study highlights the importance of environmental policies and the achievement of the UN Sustainable Development Goals (SDGs) in the hotel industry. This industry plays an important role in achieving the UN SDGs, which offer significant benefits for business, such as access to new markets, better risk management and long-term sustainability, as well as social benefits. This is increasingly expected by both consumers and investors.Originality/Value: This study examines the commitment and information transparency of the Costa Brava hotel sector in terms of environmental sustainability, as well as its communication strategies. This is achieved primarily through the analysis of corporate websites, comparing the information and indices to those of other entities in the sector. The relevance and value of this analysis stems from the recognition that, despite the efforts made to improve the sector, further progress needs to be made in order to make it more attractive to stakeholders.

Searching for the Traces of Greek Civilization in the Iberian Peninsula

The main aim of this study is to highlight the deep relationship between Greek and Spanish culture in order to form the basis for the development of future policies that will lead to the further strengthening of relations between the two countries. In the modern era, countries are increasingly focusing on the creation of specialized mechanisms to shape their cultural policies. The development of cultural policy is an area of countries’ foreign policy and is based on one of the pillars supporting their soft power: culture. The aim of this study is to search for traces of Greek civilization in the Iberian Peninsula starting from the 8th century B.C. when the Greeks were found in ancient Iberia for commercial reasons. Our research then led us to Catalonia, a region of Spain that bases its diversity on its Greek roots. One question we must answer is whether the historical past linking Catalonia and Greece has contributed to the formation of its national identity. Finally, the aim is to look at the dissemination of the Greek element in Spain today, focusing on the dynamics of the learning of the Greek language in Spain, mainly in the field of higher education, since language is an important element of a country’s culture. In this context, an analysis is presented based both on bibliographical research on the evolution of the Greek element in the Iberian Peninsula and primary research on the Greek element, especially in the region of Catalonia. The present study aims to capture the traces of Greek culture in Spain and the ties that unite the two countries from antiquity to the present day in order to lead to new initiatives in the future for the further strengthening of relations between the two peoples.

The forensic assessment of human trafficking víctims in Catalonia (Spain): characteristics and mental health status

IntroductionSystematic reviews show a high prevalence of mental distress among victims of human trafficking. In criminal proceedings in Spain, a forensic expert assessment of survivors may be ordered by the courts. Its aims are mainly, albeit not exclusively, to determine the consequences of trafficking on the physical, mental, and social health of the victims. The Institute of Legal Medicine and Forensic Sciences is the public institution providing psychiatric expert assessments in the autonomous region of Catalonia (Spain). Recently, a unit devoted to the forensic assessment of human trafficking victims has been created at the central headquarters of the Institute in Barcelona.ObjectivesTo describe the characteristics and the mental health status of trafficked people identified as victims in criminal proceedings.MethodsRetrospective study of case records of victims of human trafficking at the Institute of Legal Medicine and Forensic Sciences of Catalonia (2016-2023).ResultsCase records of 50 survivors were identified. 38 (76%) were female; mean age was 30,5 years (SD 10,42; range 17 to 69 years). All of them were foreigners, mainly from Latin America (24; 48%). Most of them were trafficked for sexual exploitation (32; 64%). 11 (22%) were assessed immediately after their rescue (emerging cases). Some of the victims had previous mental health problems, including intellectual disability (3; 6%). Among the non-emerging cases, the most frequently recorded mental disorders at the moment of the psychiatric expert assessment were post-traumatic stress disorder (PTSD; 21; 53,8%) and anxiety (12; 30,8%). Complex PTSD was observed in 1 case.ConclusionsThe majority of human trafficking survivors in the forensic setting suffer from persistent mental health problems as a consequence of their victimisation. A trauma-informed forensic psychiatric assessment is recommended.Disclosure of InterestNone Declared

The effect of copper reduction on the control of downy mildew in Mediterranean grapevines

The application of copper-based fungicides has led to the problematic accumulation of copper in the soil of many European vineyards. In this work, we tested the effectiveness of downy mildew control strategies that considerably reduce the amount of copper, through the application of other non-toxic compounds. The study took place in three different regions of Catalonia, by combining smaller and larger-scale trials for two growing seasons. Although variations among experiments were detected, the treatments used here may reduce the applied copper content by up to 77 percent. The cooper reduction-strategies, which alternated standard copper application of copper oxychloride with applications of products based on Equisetum arvense L., or with applications of products with heptagluconic acid (an alternative formulation with a very low-rate of copper), provided the most consistent protection against downy mildew. Moreover, these treatments reduced copper inputs by 63 and 47 percent as compared to conventional treatments based on repeated applications of copper oxychloride. This work underlines the possibility of reducing the amount of copper applied to control downy mildew in Mediterranean vineyards, through the use of newly-developed formulations.

Hydrogen-Rich Syngas Production from Gasification of Sewage Sludge: Catalonia Case

The continuous tightening of legislation regulating the agricultural usage of sewage sludge in the province of Catalonia (Spain) leads us to propose its gasification to produce hydrogen-rich syngas. A thermodynamic equilibrium model was developed using Aspen Plus® to simulate the air and steam gasification of sewage sludge from a wastewater treatment plant in Catalonia. The syngas generated is analyzed in terms of composition and lower heating value (LHV), as a function of equivalence ratio (ER), gasification temperature (Tgas), steam-to-biomass ratio (SBR), and moisture content (MC). Results show that air-blown gasification finds the highest LHV of 7.48 MJ/m3 at 1200 °C, ER of 0.2, and MC of 5%. Using steam as the gasifying agent, an LHV of 10.30 MJ/m3 is obtained at SBR of 0.2, MC of 5%, and 1200 °C. A maximum of 69.7% hydrogen molar fraction is obtained at 600 °C, MC of 25%, and SBR of 1.2. This study suggests using steam as a gasifying agent instead of air since it provides a higher LHV of the syngas as well as a hydrogen-richer syngas for the implementation of gasification as an alternative method to sewage sludge treatment in the region of Catalonia. Since the economic aspect should also be considered, in this regard, our sensitivity analysis provided important data demonstrating that it is possible to reduce the gasification temperature without significantly decreasing the LHV.

Predictive modeling of severe weather impact on individuals and populations using Machine Learning

In this work, Machine Learning (ML) techniques are used to develop tools capable of accurately predicting the impact of severe weather events. We use readily accessible predictors, including daily meteorological data, basic demographics, geographic and terrain features, along with the number of daily meteorological incidents reported to the emergency services. The model was built using disaggregated data from the 947 municipalities from the region of Catalonia between January 1, 2015 and June 30, 2021. Catalonia’s region is situated in the northeastern part of Spain along the Mediterranean Basin, and frequently experiences storms with strong winds and intense rainfall. In 2020, such weather events resulted in 64 injuries and damages amounting to approximately 70 million USD. The ML-based model presented in this study shows a predictive capacity for extreme weather risk superior to that of the daily meteorological warning system of the Meteorological Service of Catalonia. In addition, the model has been used to estimate how urbanization modifies the extreme weather impact. Given the expected increase in the intensity, frequency, and duration of extreme weather events in the context of global warming, the methodology presented in this work could be helpful in developing tools to assist emergency service managers and policy makers in making rapid and effective decisions.

Analysis of climate change impacts on the biogeographical patterns of species-specific productivity of socioeconomically important edible fungi in Mediterranean forest ecosystems

In Mediterranean forests, many species of fungi produce fruiting bodies every autumn, some of which are of great social and economic interest as NTFPs. In addition, these fungi are an essential part of the biodiversity network that ensures the proper functioning of natural ecosystems and that is currently in check due to global change. Therefore, understanding the biogeographic patterns of species-specific fungal productivity is fundamental to anticipate possible changes in the socioeconomic value of our forests and to understand the role they play in the functioning of ecosystems in terms of mitigation and adaptation to climate change. In this study we estimate the future impact of climate change (in Catalonia region, between 2023 and 2100) on five fungal species with high socioeconomic interest in a broad bioclimatic gradient representative of the Mediterranean basin using high resolution at the landscape scale. To achieve this, we use predictive models based on machine learning algorithms and a fungal database resulting from the sampling of more than 100 permanent sampling plots over 20 years. We estimate that current and future productivity patterns differ among species, under different climate change scenarios and bioclimatic regions. Our results suggest that optimal productivity areas may be shifted to higher elevations, making those species with higher productivity at higher elevations the most affected by climate change. This would mean that some species with high socioeconomic value, such as Lactarius deliciosus and Boletus edulis, could be negatively affected in their total productivity in the study area. This study highlights the need to anticipate the potential effects of climate change on fungal productivity and in particular on high socioeconomic value species and to develop management policies oriented to maintain the important role of fungi in natural ecosystems.

The Vaccine Training Barometer: Assessing healthcare providers’ confidence to answer vaccine-related questions and their training needs

Healthcare providers (HCP) are seen by the public as the most trustworthy source of information about vaccination. While HCPs could be a valuable partner to increase vaccine confidence in general, it is not clear whether they feel confident themselves to address questions concerning vaccination. In the context of the EU Joint Action on Vaccination (EU-JAV), the Vaccine Training Barometer, an online survey tool, was developed to assess how frequently HCPs receive questions about vaccination, how confident they feel to answer these questions, and to what extent they are willing to follow extra training. After a pilot test in Flanders, Belgium, the Barometer was launched and completed by 833 HCPs in Flanders and 291 HCPs in the Spanish regions of Catalonia, Navarre and Valencian Community from November 2020 until January 2021, during the COVID-19 pandemic, just before and during the start of the first COVID-19 vaccination campaigns. In both countries, HCPs frequently received questions about vaccination (mostly on a daily or weekly basis), and about two thirds of them indicated that the frequency of questions had increased during the three months prior to completing the survey. Most questions were about the side effects and safety of vaccines. In both countries, a considerable proportion of HCPs did not feel confident to answer vaccine-related questions (31.5% felt confident in Flanders, 21.6% in Spain). A large proportion of HCPs received questions in the last three months before the survey that they could not answer (52.4% of respondents in Flemish sample, 41.5% in Spanish sample). Only 11.4% (Flanders) and 11.3% (Spain) of the respondents felt they gained sufficient knowledge through their standard education to be able to answer questions about vaccination. Almost all respondents were willing to follow extra training on vaccination (Flanders: 95.4%, Spain: 96.6%). The Vaccine Training Barometer is thus a useful tool to monitor HCPs’ confidence to answer questions about vaccination and to capture their training needs.

Association between of vitamin B12 status during pregnancy and probable postpartum depression: the ECLIPSES study

ABSTRACT Background B12 vitamin is essential for the functioning of the nervous system and the production of mood-related neurotransmitters. However, information on its association with postpartum depression (PPD) is limited. Objective To examine the effect of serum vitamin B12 levels during pregnancy on PPD, in healthy pregnant women from the Mediterranean region of Catalonia, Spain. Method This longitudinal study included a subsample of women at 54 days (7.7 weeks) postpartum (n = 336), who participated in the ECLIPSES Study conducted out in Tarragona, Spain. Maternal concentrations of vitamin B12 were determined in the first and third trimester of pregnancy and sociodemographic, nutritional, and psychological data were collected. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Results The prevalence of probable PPD was 21%. After adjusting for sociodemographic, lifestyle, biochemical parameters, and postpartum characteristics the regression model showed a negative association between EPDS scores and the highest quartile of serum vitamin B12 (first quartile (reference) vs. fourth quartile), (β = -1.267, 95% CI = -2.461, −0.073, p = 0.038). Conclusion Maintaining a normal-high level of vitamin B12 during early pregnancy can contributes to preventing PPD.

Real-world testing of an artificial intelligence algorithm for the analysis of chest X-rays in primary care settings

Interpreting chest X-rays is a complex task, and artificial intelligence algorithms for this purpose are currently being developed. It is important to perform external validations of these algorithms in order to implement them. This study therefore aims to externally validate an AI algorithm’s diagnoses in real clinical practice, comparing them to a radiologist’s diagnoses. The aim is also to identify diagnoses the algorithm may not have been trained for. A prospective observational study for the external validation of the AI algorithm in a region of Catalonia, comparing the AI algorithm’s diagnosis with that of the reference radiologist, considered the gold standard. The external validation was performed with a sample of 278 images and reports, 51.8% of which showed no radiological abnormalities according to the radiologist's report. Analysing the validity of the AI algorithm, the average accuracy was 0.95 (95% CI 0.92; 0.98), the sensitivity was 0.48 (95% CI 0.30; 0.66) and the specificity was 0.98 (95% CI 0.97; 0.99). The conditions where the algorithm was most sensitive were external, upper abdominal and cardiac and/or valvular implants. On the other hand, the conditions where the algorithm was less sensitive were in the mediastinum, vessels and bone. The algorithm has been validated in the primary care setting and has proven to be useful when identifying images with or without conditions. However, in order to be a valuable tool to help and support experts, it requires additional real-world training to enhance its diagnostic capabilities for some of the conditions analysed. Our study emphasizes the need for continuous improvement to ensure the algorithm’s effectiveness in primary care.

Positive mental health and sense of coherence among emergency medical service professionals.

Positive mental health (PMH) is a construct used to define and evaluate health from a positive perspective. Healthcare professionals in the emergency ambulance service are more likely to experience mental health disorders than the overall population. The demographic and occupational variables and Sense of Coherence (SOC) can act as predictors of PMH and can serve as protective elements against stress and demanding situations in the work environment. This study aimed to evaluate PMH and its relationship with demographic and occupational variables and determine if SOC is a predictive variable for PMH in health professionals working in the emergency ambulance service. A descriptive, cross-sectional, and correlational study was conducted with a sample of 406 healthcare professionals from the emergency ambulance service in eight health regions of Catalonia, Spain. The following variables were analyzed: Age, biological sex, household members, dependents family members, professional category, type of contract, job satisfaction and sense of collaboration with other institutions. The following assessment instruments were used: Positive Mental Health Questionnaire and Sense of Coherence scale. High scores were obtained in Positive Mental Health (PMH). Study participants who reported feeling completely satisfied in their work also showed a significant relationship with all PMH factors: greater satisfaction with their personal life, in their helpful prosocial attitude toward others, in their capability to deal effectively with stress and navigate conflict scenarios, in their ability to solve problems and self-realization, greater empathy and ability to understand the feelings of others, greater ability to establish interpersonal relationships. Comprehensibility, as a dimension of SOC, was identified as a predictor for some factors of PMH: a greater personal satisfaction, self-control, autonomy, interpersonal skills and total PMHQ. More than 43% of positive mental health in health professionals is explained by higher Meaningfulness and Comprehensibility values of the SOC, the absence of dependent family members and having a non-graduate background. Healthcare workers in the emergency ambulance service had high PMH. Meaningfulness (ME) and Comprehensibility (C), dimensions of SOC, were identified as model predictors of greater PMH, showing higher scores in most of PMH factors. To enhance SOC as a mental health promotion measure, resilience programs should be implemented to help professionals develop skills to face and overcome adverse situations. Educating in stress management thought networks are key elements to strengthen SOC. Managers in emergency medical services play a key role in transforming healthcare work environments to promote positive outcomes in the mental health of their healthcare workers.

Exploring student and family concerns and confidence in BigTech digital platforms in public schools

The use of commercial digital platforms in public schools like Google and Microsoft, which was exacerbated during the pandemic, requires analysis to encourage a safer and more appropriate educational use. The research objective behind this article was to analyse the concerns of school students in obligatory primary and secondary education in public schools within the Autonomous Region of Catalonia (Spain) together with the opinions of their families regarding the use of digital platforms offered by large technology companies (BigTech) in schools. This is a mixed design study, consisting of eight discussion groups with pupils (n = 56) and a questionnaire issued to 2,330 family members. The results show that both students and families are concerned about the lack of knowledge surrounding the data they generate when using these digital platforms, and their effect on democratic school governance and the reproduction of gender stereotypes. In conclusion, the study suggests it is necessary to create greater critical awareness among children, adolescents and families at all socio-economic levels, particularly in those who are most vulnerable.

Toward Sustainable Adoption of Integrated Care for Prevention of Unplanned Hospitalizations: A Qualitative Analysis.

Complex chronic patients are prone to unplanned hospitalizations leading to a high burden on healthcare systems. To date, interventions to prevent unplanned admissions show inconclusive results. We report a qualitative analysis performed into the EU initiative JADECARE (2020-2023) to design a digitally enabled integrated care program aiming at preventing unplanned hospitalizations. A two-phase process with four design thinking (DT) sessions was conducted to analyse the management of complex chronic patients in the region of Catalonia (ES). In Phase I, Discovery, two DT sessions, October 2021 and February 2022, were done using as background information: i) the results of twenty structured interviews (five patients and fifteen professionals), ii) two governmental documents on regional deployment of integrated care and on the Catalan digital health strategy, respectively, and iii) the results of a cluster analysis of 761 hospitalizations. In Phase II, Confirmation, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two additional DT sessions conducted in November and December 2022. The qualitative analysis identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during the period 2024-2025, was generated. A digitally enabled adaptive case management approach to foster collaborative work and personalization of care, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations.