Region Of Catalonia Research Articles

Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine.

IntroductionDigital therapeutics (DTx) can be a valuable contribution to the successful scale up of P5 Medicine (personalized, participatory, predictive, preventive, precision medicine) as they offer powerful means of delivering personalization and active patient participation in disease self-management. We investigated how the approval and adoption of DTx within health systems have been approached in five selected European countries and regions, with a view to proposing success factors scaling up their adoption.MethodologyPreliminary research established best countries or region candidates as being Germany, UK, France, Belgium, and the Spanish Region of Catalonia. The research was informed by a literature review, interviews with public bodies and industry, and a multi-stakeholder workshop to validate the findings and fill in existing gaps.ResultsTo authorize the use of digital technologies, the countries and regions passed legislation and developed policy instruments, appointed bodies to assess and certify the products and formalized mechanisms for permitting reimbursement. While DTx is not a commonly used nomenclature, there are digital health technology types defined that have similar requirements as DTx. Assessment and certification frameworks are usually built around the Medical Device Regulation with additional criteria. Reimbursement considerations often observe reimbursement of therapeutic devices and/or medicines. To be integrated into reimbursement systems, countries require manufacturers to demonstrate clinical value and cost-effectiveness. As there are currently very few DTx approved in practice, there is resistance toward clinical acceptance and organizational change, and change management is highly needed to integrate DTx into healthcare systems. The integration and secondary use of DTx data is not encountered in daily practice. Although some enablers exist, there remain technical and legal barriers.DiscussionDTx strategies should be considered as an integral part of digital health strategies and legislation, and specific DTx pathways with clear and transparent assessment and guidelines that balance regulation and innovation should be defined. To help manufacturers, countries should recommend and list methods that are widely accepted and ensure scientific robustness, aligned to the MDR requirements to support transfer of relevant and comparable data across countries. To facilitate rapid uptake of innovation, countries should add flexibility to the framework by allowing temporary market authorization to enable data collection that can support the clinical and socio-economic evaluation and data gathering phase. Certification should trigger rapid price setting and reimbursement mechanisms, and dynamic ways to adjust price and reimbursement levels in time should be established. Relevant stakeholders should be approached on the potential impacts of DTx through transparent communication and change management strategies should be considered. These findings should be validated with a wider range of stakeholders.

Use of Virtual Reality in the Reduction of Pain After the Administration of Vaccines Among Children in Primary Care Centers: Protocol for a Randomized Clinical Trial.

BackgroundPain and anxiety caused by vaccination and other medical procedures in childhood can result in discomfort for both patients and their parents. Virtual reality (VR) is a technology that is capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions.ObjectiveWe aim to publish the protocol of a clinical trial for the reduction of pain and anxiety after the administration of 2 vaccines in children aged 3 to 6 years.MethodsWe will conduct a randomized, parallel, controlled clinical trial with 2 assigned groups. The intervention group will wear VR goggles during the administration of 2 vaccines, while the control group will receive standard care from a primary care center for the procedure. Randomization will be carried out by using the RandomizedR computer system—a randomization tool of the R Studio program. This trial will be an open or unblinded trial; both the subjects and the investigators will know the assigned treatment groups. Due to the nature of the VR intervention, it will be impossible to blind the patients, caregivers, or observers. However, a blind third-party assessment will be carried out. The study population will include children aged 3 to 6 years who are included in the patient registry and cared for in a primary care center of the region of Central Catalonia. They will receive the following vaccines during the Well-Child checkup: the triple viral+varicella vaccine at 3 years of age and the hepatitis A+diphtheria-tetanus-pertussis vaccine at 6 years of age.ResultsThe study is scheduled to begin in January 2022 and is scheduled to end in January 2023, which is when the statistical analysis will begin. As of March 2022, a total of 23 children have been recruited, of which 13 have used VR during the vaccination process. In addition, all of the guardians have found that VR helps to reduce pain during vaccination.ConclusionsVR can be a useful tool in pediatric procedures that generate pain and anxiety.International Registered Report Identifier (IRRID)PRR1-10.2196/35910

Effect of excise tax on sugar-sweetened beverages in Catalonia, Spain, three and a half years after its introduction

BackgroundThe World Health Organisation urges countries to levy specific excise taxes on SSBs. Currently, more than 50 countries have introduced some type of tax on SSBs. In March 2017, the Autonomous Region of Catalonia approved the introduction of a tiered excise tax on SSBs for public health reasons. To evaluate the effect of the Catalonian excise tax on the price and purchase of sugar-sweetened beverages (SSBs) and their possible substitutes, i.e., non-sugar-sweetened beverages (NSSBs) and bottled water, three and half years after its introduction, and 1 year after the outbreak of the COVID-19 pandemic.MethodsWe analysed purchase data on soft drinks, fruit drinks and water, sourced from the Ministry of Agriculture food-consumption panel, in a random sample of 12,500 households across Spain. We applied the synthetic control method to infer the causal impact of the intervention, based on a Bayesian structural time-series model which predicts the counterfactual response that would have occurred in Catalonia, had no intervention taken place.ResultsAs compared to the predicted (counterfactual) response, per capita purchases of SSBs fell by 0.17 l three and a half years after implementing the SSB tax in Catalonia, a 16.7% decline (95% CI: − 23.18, − 8.74). The mean SSB price rose by 0.11 €/L, an 11% increase (95% CI: 9.0, 14.1). Although there were no changes in mean NSSB prices, NSSB consumption rose by 0.19 l per capita, a 21.7% increase (95% CI: 18.25, 25.54). There were no variations in the price or consumption of bottled water. The effects were progressively greater over time, with SSB purchases decreasing by 10.4% at 1 year, 12.3% at 2 years, 15.3% at 3 years, and 16.7% at three and a half years of the tax’s introduction.ConclusionsThe Catalonian SSB excise tax had a sustained and progressive impact over time, with a fall in consumption of as much as 16.7% three and half years after its introduction. The observed NSSB substitution effect should be borne in mind when considering the application of this type of tax to the rest of Spain.

The economic and social value of spa tourism: The case of balneotherapy in Maresme, Spain.

The aim of this article is to assess both the economic and social value of balneotherapy and spa tourism, being the first paper in carrying out this analysis. The study has been conducted in Maresme, a region of Catalonia, Spain. On the one hand, an Input-Output (IO) model with a Social Accounting Matrix (SAM) has been carried out to assess the economic value. On the other hand, a Cost-Benefit Analysis (CBA) has been used to monetise the social value in this region, taking into account, among other concepts, direct and indirect health profits, given that balneotherapy helps to alleviate various diseases. The results show that whereas the economic multiplier is 1.529 considering the direct and indirect effects and 1.712 taking into account also the induced effects, which are similar to health and medical tourism multipliers, social value generates additional positive value, given that the cost-benefit ratio is 1.858. The theoretical implications of the paper as well as the findings’ implications for policy so as to encourage investments in spa tourism are discussed.

On Catalan as a minority language: The case of Catalan laterals in Barcelonan Spanish

AbstractThis investigation examines the variable production of alveolar laterals in Barcelonan Spanish as a case study evidencing the effects of language contact between a majority language, Spanish, and a minority language, Catalan. The Catalan‐Spanish speech community constitutes a rather unique case of majority‐minority language contact, particularly within the Spanish‐speaking world, as Catalan, though a minority language in Spain, is characterized by such a high degree of linguistic vitality, linguistic capital, and social prestige in the autonomous region of Catalonia that its status as a minority language is to a degree, questionable. I account for sociophonetic variability in the production of Barcelonan Spanish /l/ by a set of linguistic (phonological context, cognate status) and social factors (gender, age, style, language dominance) that support an analysis of lateral velarization as contact‐induced and situate this case of language contact as a natural or otherwise predictable outcome of this community's sociolinguistic and sociodemographic history, notably concerning changes in immigration patterns, language ideologies, and language use in the last century. Additionally, I highlight how the gradient nature of select sociophonetic variables uniquely conditions nuanced social indexation in the speech community, specifically in the absence of any one singular or discrete, community‐wide acoustic variant.

Field Monitoring of Brine Pipeline Facility in the Central Region of Catalonia, Spain

AbstractThe potash mines located in the central region of Catalonia generate waste brines that are transported and discharged beneath the sea on the Catalan central coast through a pipeline facilit...

An exploratory survey and assessment of the hoverfly diversity (Diptera: Syrphidae) from the Pyrenees of Girona, Spain

Syrphidae are pollinators, pest predators and decomposers in European ecosystems. Camprodon (Girona province, Spain) is a valley with rich vegetation and high habitat diversity in the eastern Pyrenees. However, hoverfly biodiversity in this valley was poorly known. To explore the high potential of this area for Syrphidae, a survey with hand-net was undertaken in July/August 2020 in the valley. The list of Syrphidae species from the valley increases to 88, whilst that of the Girona province now extends to 119 species. Chrysotoxum lessonae Giglio-Tos, 1890 is reported for the first time from the Iberian Peninsula. The specimens of Xylota tarda Meigen, 1822 and Cheilosia hypena (Becker, 1894) represent the first documented records of these species for the Iberian Peninsula and Spain, respectively; i.e. these two species were known to occur in the Iberian Peninsula and Spain but without further locality details. A total of 19 species were new to the region of Catalonia and 23 to the Girona province. Cheilosia Meigen, 1822 was the genus with the highest number of species recorded, as expected from the combination of mountains, diversity of forest vegetation, and presence of rivers/streams of the Camprodon valley. Faunistic results from this fieldwork are relevant to knowledge of Diptera from Catalonia, a region of Spain where this insect family is understudied.

Efficiency of stroke networks for referral of mechanical thrombectomy: The more the better?

Endovascular therapy (EVT) has revolutionized stroke care with the publication of several landmark stroke trials since 2015.1 At the same time, EVT imposes major changes on systems of stroke care. While EVT is highly efficacious, its use is restricted to stroke patients with large vessel occlusion (LVO) and these form a minority of stroke patients only.

New record of Attulus saltator for Spain, with further 16 new regional spider records for Catalonia and Galicia (Araneae)

We present the first record of Attulus saltator (O. Pickard-Cambridge, 1868) for Spain. The single male was collected in Blanes, Catalonia. Additionally, we offer nine new records for the Spanish region of Galicia (province of Lugo) and seven for Catalonia (province of Girona), one of which is Cepheia longiseta (Simon, 1881), which represents the first record of the family Synaphridae in the region of Catalonia. Furthermore, a redescription of the male of Amaurobius occidentalis Simon, 1893 is provided.

The promise of living labs to the Quadruple Helix stakeholders: exploring the sources of (dis)satisfaction

ABSTRACT Despite the normative view that Quadruple Helix collaborations (with government, academia, industry and civil society) such as living labs are prescribed to enhance regional innovation performance, there is scarce knowledge of the sustainability of such collaborations from the perspective of the stakeholders who are supposed to engage in such initiatives. To address this gap, the purpose of this paper is to empirically explore the implementation of the Quadruple Helix for innovation from a stakeholder perspective, by understanding the expectations as well as the perceived benefits and challenges of the collaboration. Through a qualitative research design, this paper presents an in-depth case study of a living lab in the region of Catalonia. Our results challenge the normative view of Quadruple Helix approaches and of living labs; we also offer suggestions to manage future collaborations and to inform further evidence-based policy. On the whole, partnership leadership and coordination are critical to bridge the expectation-implementation gap towards stakeholder satisfaction and collaboration sustainability.

Multiple sclerosis is associated with higher comorbidity and health care resource use: A population-based, case-control study in a western Mediterranean region.

Comorbidities are common in multiple sclerosis (MS), and have been associated with worse outcomes and increased health care resource usage. We studied the frequency of comorbidities and adverse health behaviors (AHBs) in MS patients in the Mediterranean region of Catalonia. This population-based, case-control study used primary health care information covering 80% of Catalonia's population. Cases were matched by age/sex with randomly chosen controls (ratio = 1:5). Demographic information, comorbidities, AHBs, annual visits, sick leave days, and medication dispensing were studied. The association of comorbidities with MS and the profile of comorbidities according to sex within MS cases were assessed with multivariate logistic regression models, after adjusting for confounding variables. Health care resource usage was analyzed in MS cases compared to controls, and within MS cases in those with compared to those without comorbidities. Five thousand five hundred forty-eight MS cases and 27,710 controls (70% female, mean age = 48.3years) were included. Stroke (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.17-1.99), epilepsy (OR = 2.46, 95% CI = 1.94-3.10), bipolar disorder (OR = 1.67, 95% CI = 1.17-2.36), and depression (OR = 1.83, 95% CI = 1.70-1.98) were more frequent in MS. Cases were more prone to smoking but less to alcohol intake. Among cases, psychiatric comorbidities were more frequent in women, whereas cardiovascular diseases and AHBs were more frequent in men. MS patients, particularly with comorbidities, had higher health care resource usage than controls. Psychiatric comorbidities, stroke, epilepsy, and AHBs are more common in MS patients than in the general population in the western Mediterranean region of Catalonia. The presence of comorbidities increases the health care resource usage in MS patients.

Clinical characteristics of COVID-19 in older adults. A retrospective study in long-term nursing homes in Catalonia.

The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p<0.01 for all variables). Results suggest that density in the nursing homes did not account for differences in the incidence of the infection within the facilities. This study provides insights into the natural history of the disease in older adults with high dependency living in long-term nursing homes during the first pandemic wave of March-May 2020 in the region of Catalonia, and suggests that some comorbidities and symptoms have a strong predictive value for mortality.

Assessing the functional relationship between the formal and informal waste systems: A case-study in Catalonia (Spain).

The present study draws from data collected with informal recyclers in the autonomous region of Catalonia in northeastern Spain. The purpose of the investigation is to determine the relationship between the formal and informal recycling sectors in Catalonia and determine how each of their activities impacts the other. From the case study in the city of Granollers, it was determined that from the spring of 2018 to the fall of 2019, the informal recyclers had the potential to collect roughly 44% of the cardboard in their geographical area, helping to meet the environmental goals of the region, but receiving no recognition for their work nor acknowledgement regarding their role in the waste management system. This investigation also analyzed the economic relationship between the formal and informal systems, and the effects that international events, such as China's National Sword policy, had on that relationship. It was determined that the embeddedness of waste systems and global waste markets affect not only the formal system, but their relationship with the informal system as well.

Ants as Bioindicators of Riparian Ecological Health in Catalonian Rivers

In this study, we assess the potential of ants as bioindicators of riparian ecological health in two river types (upland and lowland type) located in the Catalonian region. We proposed to understand to what extent do metrics based on ant responses provide useful information that cannot be presented by traditional biophysical assessments while attempting an approach to creating an ant-based multimetric index (ant-based MMI) of the riparian ecological health. A total of 22 ant species were identified, and 42 metrics related to ant foraging activity, species richness, and functional traits were evaluated as potential core metrics of the index. Riparian features and proximal land use land cover (LULC) were used to distinguish disturbed from less disturbed sites. We found that ant communities strongly responded to human disturbance. When compared with an exclusively physical-based index for the assessment of the riparian health, the ant-based MMI was more sensitive to human disturbance, by also reacting to the effects of the surrounding LULC pressure. This study provides a preliminary approach for an ant-based assessment tool to evaluate the health of riparian corridors although additional research is required to include other river types and a wider stressor gradient before a wider application.

Determination of Limit Deposition Velocity and Viscosity in Waste Brines Transported in Pipelines

AbstractThe wastewater generated in the potash mines of the Bages region in Catalonia (Spain) was experimentally tested at the Paterson & Cooke slurry test facility in Cape Town, South Africa, to d...

Propuestas para el abordaje de la violencia machista en el ámbito de la salud. Un análisis cualitativo

ObjectiveIdentify improvement proposals for approaching violence against women through the evaluation of 2009s Protocol for approaching Violence Against Women in Health Care in Cataluña (PAVIM). DesignQualitative ethnographic study, 2019. SettingPublic Health Care in Catalonia. ParticipantsOne hundred eighty one participants, of which: 104 health care professionals, 43 women's associations and/or experts in violence against women and 34 experts on health and violence against women. MethodIntentional sampling. Eighteen focus groups and 34 semi-structured interviews. Evaluation with a gender and intersectional perspective. ResultsResults are structured along PAVIM's phases. Prevention: mandatory and institutionally recognized training for the whole professional team, with a gender and intersectional perspective. Detection: diagnostic code standardization for violence against women and improve coordination between primary care, emergency service, pediatrics and Assistance to Sexual and Reproductive Health. Care and recovery: territorial equity in the applied resources on cases of violence against women care (in the 9 sanitary regions of Catalonia) and improves communication between health and associative fields. ConclusionsThe improvement proposals identified are those that have generated a greater consensus among participants and are the most interesting to primary care. As limitations, stand out the temporality and heterogeneity of the Catalan territory.

Estimation of the prevalence and incidence of motor neuron diseases in two Spanish regions: Catalonia and Valencia

According to the degree of upper and lower motor neuron degeneration, motor neuron diseases (MND) can be categorized into amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS) or progressive muscular atrophy (PMA). Although several studies have addressed the prevalence and incidence of ALS, there is a high heterogeneity in their results. Besides this, neither concept has been previously studied in PLS or PMA. Thus, the objective of this study was to estimate the prevalence and incidence of MND, (distinguishing ALS, PLS and PMA), in the Spanish regions of Catalonia and Valencia in the period 2011–2019. Two population-based Spanish cohorts were used, one from Catalonia and the other from Valencia. Given that the samples that comprised both cohorts were not random, i.e., leading to a selection bias, we used a two-part model in which both the individual and contextual observed and unobserved confounding variables are controlled for, along with the spatial and temporal dependence. The prevalence of MND was estimated to be between 3.990 and 6.334 per 100,000 inhabitants (ALS between 3.248 and 5.120; PMA between 0.065 and 0.634; and PLS between 0.046 and 1.896), and the incidence between 1.682 and 2.165 per 100,000 person-years for MND (ALS between 1.351 and 1.754; PMA between 0.225 and 0.628; and PLS between 0.409–0.544). Results were similar in the two regions and did not differ from those previously reported for ALS, suggesting that the proposed method is robust and that neither region presents differential risk or protective factors.

Efficiency analysis of Catalonia’s construction industry pre- and post-financial crisis: a data envelopment analysis (DEA) approach

By employing a non-parametric technique rooted in economic production theory—i.e., Data Envelopment Analysis (DEA)—this study evaluates the efficiency level of construction businesses operating in the Spanish region of Catalonia. The empirical application considers a dataset including information for more than 1000 construction businesses from Catalonia during the period 2005-2016. The empirical results reveal that the efficiency level in the Catalan construction industry drastically fell during the period of economic downturn (2009-2012). Also, the findings show that efficiency in the industry improves after 2013; however, the speed of recovery is heterogeneous across businesses. A further analysis highlights that business size is a relevant factor explaining efficiency differences among the sampled businesses: efficiency is evidently lower in micro businesses compared to the figures reported for small and medium and large construction firms

Implementing Mobile Health-Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study.

BackgroundIntegrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care.ObjectiveThe aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients.MethodsAs part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER).ResultsA total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program.ConclusionsThe implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care.

The impact of modelling choices on modelling outcomes: a spatio-temporal study of the association between COVID-19 spread and environmental conditions in Catalonia (Spain).

The choices that researchers make while conducting a statistical analysis usually have a notable impact on the results. This fact has become evident in the ongoing research of the association between the environment and the evolution of the coronavirus disease 2019 (COVID-19) pandemic, in light of the hundreds of contradictory studies that have already been published on this issue in just a few months. In this paper, a COVID-19 dataset containing the number of daily cases registered in the regions of Catalonia (Spain) since the start of the pandemic to the end of August 2020 is analysed using statistical models of diverse levels of complexity. Specifically, the possible effect of several environmental variables (solar exposure, mean temperature, and wind speed) on the number of cases is assessed. Thus, the first objective of the paper is to show how the choice of a certain type of statistical model to conduct the analysis can have a severe impact on the associations that are inferred between the covariates and the response variable. Secondly, it is shown how the use of spatio-temporal models accounting for the nature of the data allows understanding the evolution of the pandemic in space and time. The results suggest that even though the models fitted to the data correctly capture the evolution of COVID-19 in space and time, determining whether there is an association between the spread of the pandemic and certain environmental conditions is complex, as it is severely affected by the choice of the model.