Province Of Gipuzkoa Research Articles

Design, Content and Ecological Validity and Reliability of the Physical Activity and Sport Habits Questionnaire for Children Aged 8-12 Years in the Province of Gipuzkoa (Spain).

Background/Objectives: This study aimed to develop a questionnaire to describe and diagnose the physical activity and sport (PAS) habits of 8-12-year-old schoolchildren, assessing its content, ecological validity and reliability, from a multidimensional perspective aligned with Global Matrix 4.0 indicators. Methods: The questionnaire design phase involved seven individuals from the university sector and sport managers from the Gipuzkoa Provincial Council. Seventeen experts later evaluated the questionnaire's content and ecological validity. For reliability testing, 276 schoolchildren aged 8 to 12 completed the questionnaire twice, with a time interval of two weeks to two months. Statistical analyses included the Wilcoxon test to compare expert ratings, effect size and percentage change calculations for magnitude assessment, and McNemar, McN-Bowker or Wilcoxon tests to compare differences between initial and repeat responses. Cohen's Kappa was used to assess agreement. Results: The initial battery of items, submitted to the validation process, comprised 31 items across 10 dimensions, derived from validated questionnaires and published works. Following content and ecological validity evaluations, modifications were made and nine items were removed due to improved wording, clarification of concepts, redundancy or lack of relevance. Expert quantitative analyses indicated improved overall questionnaire values. Reliability analysis revealed significant differences in five of the twenty-two items, though substantial agreement (from slight to almost perfect) was observed in twenty items. Conclusions: The study confirmed the questionnaire's validity and reliability as a suitable tool for assessing PAS practices among 8-12-year-old schoolchildren in Gipuzkoa, Spain, in both Basque and Spanish languages.

Centenarians of the Basque Country are resilient to cancer.

Cancer is one of the leading causes of death and its prevalence increases with age. While centenarians exhibit extreme longevity and potential to avoid or delay aging-related diseases, their response to cancer is still barely explored. Our study took advantage of the Electronic Health Records to retrospectively compare the severity of cancer in centenarians (n = 649) and non-centenarians (n = 62,753) in the Basque Country (province of Gipuzkoa), Spain, through analyzing all the recorded diagnoses throughout their lifetime. Descriptive statistics were applied to discern differences between the two population groups in terms of prevalence of tumor types, number of diagnoses, and treatments. Survival analysis was performed through Kaplan-Meier estimator. We found that centenarians had fewer cancer diagnoses (17.1%, n = 111) than non-centenarians (40.5%, n = 25,405), and notably avoided the most aggressive cancer types and did not develop metastasis. Furthermore, they barely had records of treatments or drugs and had extended survival both since the first and last diagnosis of cancer. These results suggest resilience of the centenarians against malignant cancers explaining, in part, their extended longevity.

A Woodland Management Protocol for the Conservation of a Locally Endangered Raptor Breeding in Timber Plantations

ABSTRACT Woodlands subjected to commercial exploitation can play an important role in the conservation of forest-dwelling birds, whether these species breed, forage, or spend all or part of their annual cycle in this habitat. Since 2016, the Administration of Gipuzkoa Province, Spain, has implemented a new protocol designed to preserve the nesting habitat of the Red Kite (Milvus milvus) population breeding within the region. This species is locally classified as endangered and therefore has conservation priority. The aim of our study was to evaluate the efficacy, demographic impact, and cost of this protocol. Over a period of 7 yr (2016–2022), implementation of the protocol preserved 23 nests (i.e., 15.2% of the total 151 nests). From these protected nests, 37 young fledged, which was 16% of all the young fledged within the region in this period. Relative to the financial cost of protecting nature in Gipuzkoa, implementation of this protocol was inexpensive, totalling <0.1% of the administration’s budget for managing natural habitats within the province.

Exploring available landslide inventories for susceptibility analysis in Gipuzkoa province (Spain)

Similar to many mountainous regions of the world, landslides are a recurrent geological hazard in the Gipuzkoa province (northern Spain) that commonly cause damage to communication infrastructure, such as roads and railways. This geomorphological process also threatens buildings and human beings, albeit to a lesser degree. Over time, different institutions and academic research groups have individually collected crucial information on historic and ancient landslides in this region, resulting in various landslide inventories. However, these inventories have not been collectively assessed, and their suitability for landslide susceptibility modelling projects has often been assumed without comprehensive evaluation. In this study, we propose a simplified method to explore, describe, and compare the various landslide inventories in a specific study area to assess their suitability for landslide susceptibility modelling. Additionally, we present the results of an illustrative experiment that demonstrates the direct effect of using different inventories in landslide susceptibility modelling through a data-driven approach. We found that out of the five digitally available inventories in the study area, only three provide sufficient guarantees to be used as input data for susceptibility modelling. Furthermore, we observed that each individual inventory exhibited inherent biases, which directly influenced the resulting susceptibility map. We believe that our proposed methods can be easily replicated in other study areas where multiple landslide inventory sources exist, and that our work will induce other researchers to conduct preliminary assessments of their inventories as a critical step prior to any landslide susceptibility modelling project.

The Waste War: on the electoral costs of local sustainability policies

ABSTRACT Sometimes, environmentally successful policies fail, not because of personal attitudes or technical feasibility, but because of the electoral dispute. Using fixed effects, Difference-in-Difference estimators and opinion polls, this paper scrutinises the electoral cost of introducing a door-to-door (D-t-D) waste collection system in the Basque province of Gipuzkoa (Spain). D-t-D aimed to raise sorting rates in order to make the construction of an incinerator redundant. Separate collection improved significantly, but estimates show that the main opposition party increased its vote share by 12% points in the following municipal elections as a result of the policy. Seeking the reasons for the opposition’s success, opinion polls reveal that D-t-D was surrounded by controversy and lack of information that even led citizens to perceive it as environmentally less efficient. In this context, citizens were unwilling to accept the change in habits that the new waste collection system entailed if they saw their efforts diluted in the electoral dispute. The article concludes that not only the environmental performance, but also the perceived effectiveness of the policy, a climate of social trust and the provision of participation mechanisms are determinants for the electoral success of green policies.

Characterization of PCDD/F and dl-PCB levels in air in Gipuzkoa (Basque Country, Spain)

This research examines the levels and trends of pollutants, specifically 17 congeners of PCDD/Fs and 12 dl-PCBs, in the air measured in the province of Gipuzkoa (Basque Country, Spain). The study used PCDD/Fs, dl-PCB, and the sum of dioxin-like compounds as separate response variables. A total of 113 air samples were collected and analyzed using the method described in the European Standard (EN-1948:2006) from two industrial areas. The results were analyzed using non-parametric test to assess the variability of these pollutants based on different factors (year, season and day of the week) and General Linear Models to assess the weight of each factor. The study found that the toxic equivalents (TEQs) for PCDD/Fs were 12.29 fg TEQm−3 and for dl-PCBs were 1.63 fg TEQm−3, which were in a similar range or lower than those observed in other national and international studies in industrial areas. The results showed temporal variations, with higher levels of PCDD/Fs in autumn-winter than in spring-summer and higher levels of PCDD/Fs and dl-PCBs during weekdays than on weekends. The industrial area where the energy recovery plant (ERP) will be located had higher levels of air pollutants due to the presence of two PCDD/Fs emitting industries nearby, as indicated by the Spanish Registry of Polluting Emission Sources. Both industrial areas showed similar profiles of PCDD/Fs and dl-PCBs, with the PCDD/F profiles dominated by OCDD, 1,2,3,4,6,7,8-HpCDD, and 1,2,3,4,6,7,8-HpCDF in terms of concentrations and 1,2,3,7,8-PeCDD, 2,3,4,7,8-PeCDF, and 2,3,7,8-TCDD in terms of TEQs. The dl-PCB profiles were dominated by PCB 118, PCB 105, and PCB 77 in terms of concentrations and PCB 126 in terms of TEQs. The findings of this study can serve as an indicator of the potential impact of ERP on the health of the resident population and the environment.

A Comparison of Cartographic and Toponymic Databases in a Multilingual Environment: A Methodology for Detecting Redundancies Using ETL and GIS Tools

Toponymy, a transversal discipline for geography, linguistics, and history, finds one of its main supports in cartography. Due to exhaustiveness on the territory, cadastral cartography and its toponymy have the ideal characteristics to develop systematic geographical analyses. Moreover, cadastre and geographical names are part of the geographic reference data according to Annex 1 of the INSPIRE directive. This work presents the design, implementation, and application of a methodology based on Geographic Information Systems and Extract, Transform, and Load (ETL) tools for detecting coincidences between the cadastral geoinformation and the official gazetteer corresponding to the province of Gipuzkoa, Spain. Methodologically, this study proposes a solution to the issues raised by bilingualism in the study area. This problem is approached a priori, in the previous data treatment, and a posteriori, applying semantic criteria. The results show a match between the datasets of close to 40%. In this way, the uniqueness and richness of the analyzed source and its outstanding contribution to the potential integration of the official toponymic corpus are evidenced.

Neolithic expansion and the 17q21.31 inversion in Iberia: an evolutionary approach to H2 haplotype distribution in the Near East and Europe

The chromosomal region 17q21.31 harbors a 900 kb inversion polymorphism named after the microtubule-associated protein tau (MAPT) gene. Since no recombination occurs, two haplotypes are recognized: a directly oriented variant (H1) and an inverted variant (H2). The H2 haplotype features a distribution pattern with high frequencies in the Near East and Europe, medium levels in South Asia and North Africa, and low levels elsewhere. Studies of this genomic region are relevant owing to its likely association with numerous neurodegenerative diseases. However, the causes underlying the geographic distribution of the haplotype frequencies remain a bone of contention among researchers. With this work, we have intended to outline a plausible hypothesis on the origin of the high European H2 frequencies. To that end, we have analyzed an extensive population database (including three new Iberian populations) to explore potential clinal variations of H2 frequencies. We found a sigmoidal frequency cline with an upward trend from South Asia to Europe. The maximum value was detected in the Basques from Gipuzkoa province (0.494) with the curve’s inflection point in the Near East. From our results, we suggest that the most likely scenario for high H2 frequencies in Europe would be a founding event in the Near East during the late Paleolithic or early Neolithic. Subsequently, such H2 overrepresentation would have reached Europe with the arrival of the first Neolithic farmers. The current frequencies and geographic distribution of the 17q21.31 inversion suggest that the founding events mainly affected the H2D subhaplotype.

O6-5 Can the development of a physical activity counseling network help fostering effective local policies for the attention of inactive people? Mugiment Gipuzkoa

IssueIn the province of Gipuzkoa, 34.1% of women and 32.1% of men do not reach the minimum levels of healthy physical activity. On the other hand, there is an important influence of social determinants, the gap on physical activity between the richest 10% and the poorest 10% is 28 points.DescriptionMugiment Gipuzkoa is a multicomponent and multilevel initiative whose objective is the promotion of physical activity in the population. One of the main strategies is the development of a network of physical activity counseling services (PACS). In this network the autonomous, provincial and local government of different sectors such as health, sports, social services and education are called to act in coordination. The objective of the PACS network, is to cause the change of behavior in the inactive population, but also to reorient the policies of local entities regarding physical activity. The PACS connect sports services to the local services of different sectors, articulating referral protocols.ResultsAt the beginning of 2020 Gipuzkoa has 23 PACS in 16 municipalities. In 2018, 16 PACS corresponding to 12 municipalities have been evaluated. 778 people have attended to the services, the user profile is of an adult or aged woman, inactive, who came from the health center or autonomously. Most of them (73%), opted for autonomous physical activity. Pre-post methodology has been inplemented using a sample of 365 participants. Analized the clinical health history, we observe a positive trend on BMI, physical activity and less use of health resources at six months.LessonsCoordinated action between different levels of the administration and different sectors is key to the accompaniment of local entities when developing policies aimed at the inactive population. In the case of social and educational services, the experience of collaboration is limited, so it is necessary to deepen these sectors.Main messageThe establishment of a network of services for orientation to physical activity can serve to foster the development of effective local policies that focus on inactive people.

A resource-based view on SMEs regarding the transition to more sophisticated stages of industry 4.0

The integration of small and medium-sized enterprises (SMEs) within the concept Industry 4.0 represents one of its main challenges, as they play a vital part in industrial value chains that shall be digitized from suppliers to the end customer. However, what the implementation stages for Industry 4.0 in SMEs should be as well as the respective resources for achieving the next stage are scarcely understood. In response, this paper proposes a framework using a resource-based review for Industry 4.0 implementation according to the stage of development in SMEs, created between researchers, policy makers, and 354 manufacturing SMEs in the province of Gipuzkoa (Basque Country, Spain). The paper applies a mixed-method approach, combining qualitative (interviews) and quantitative elements (survey data). The results are used to develop a model with four stages of SMEs that are characterized by having distinct preconditions and conditions for Industry 4.0. Thereupon, the required measures to achieve the next stage of Industry 4.0 implementation are derived. This highlights Industry 4.0 for SMEs as a process with different stages toward achieving sustainable competitive advantage and offering insight into how the different resources operate. The high importance and advanced position regarding industrial value creation and SMEs in Gipuzkoa allows to generalize and transfer the findings to other European regions.

High philopatry rates of Yellow-legged Gulls in the southeastern part of the Bay of Biscay

BackgroundPhilopatry rate is one of the main factors shaping population dynamics in colonial seabirds. Low rates of philopatry are linked to populations with high dispersal, while high rates are linked to populations with a very high spatial structure pattern (i.e., metapopulations). The Cantabrian Yellow-legged Gull (Larus michahellis) population is considered to be resident, with relatively low dispersal rates. Precise estimations of its philopatry rates are however still lacking. Here, we aimed to estimate philopatry rates in the main Yellow-legged Gull colonies of the province of Gipuzkoa, in the southeastern part of the Bay of Biscay.MethodsWe analysed 734 resightings, during the breeding season at the colonies of Getaria, Santa Clara and Ulia, relative to a total of 3245 individuals ringed at birth in these same colonies during a period of 13 years. These data were analysed using Multi-State Recapture models in MARK.ResultsAfter controlling survival and resighting probability, the average dispersal rate among colonies was 4% (± SD = 2%) when individuals are immature, decreasing to 1 ± 1%) for adult breeding gulls (i.e., philopatry rate was 99%). Annual survival rates were assessed to be 0.27 ± 0.02 for birds in their first year of life and 0.87 ± 0.01 for older individuals. The probability of observing immature birds in the colonies was 0.08 ± 0.01, as compared to 0.21 ± 0.02 in adult birds.ConclusionsWe obtained evidence of extremely high local philopatry rates, clearly within the upper limit found in gulls. A high philopatry favour a speciation in these species who are vulnerable to obtain the main food source (landfills and fishing discard) which are transforming under new ecological process.

Digitalisation of Creative Industries Fostered by Collaborative Governance: Public Innovation Labs in Gipuzkoa

This article analyses the promotion of digitalisation in the creative economy through collaborative governance in the province of Gipuzkoa (Basque Country, Spain). In order to understand this initiative, two public innovation labs located in San Sebastian that influence audiovisual production in Basque and digital gastronomy, respectively, are used as case studies: 2deo–Basque Language Audiovisual Lab and LABe–Digital Gastronomy Lab. Based on sectoral contexts of fragmentation, public and private efforts to consolidate synergies and accelerate processes for the coordination of value chains, attraction of talent, experimentation, and innovation. The analysis has relied on qualitative methodologies, consisting of interviews with key actors and desk research. The results show the implications of a sub-regional collaborative governance model as a means to contribute to a regional Smart Specialisation Strategy. Although the initiative faces a consolidation process, public innovation labs in Gipuzkoa foster sectoral articulation and digitalisation in gastronomy and audiovisual production in the Basque language. Additionally, the acceleration of innovation and the involvement of quadruple helix agents in management tasks have been explored.

Applied brocade in Spain

The lack of thorough studies of the significant number of examples of applied brocade found in the last two decades in Spain, originated in 2009 a European PhD thesis with Honours. This investigation presents an analysis and classification of the patterns, making procedures and combinations of materials of the applied brocades of the wooden altarpieces of the Basque province of Gipuzkoa, Northern Spain. Further studies have focused on the use of other analytical techniques that have completed the previous results and more recently, are being examined patterns of applied brocades belonging to the altarpieces sited in the other two provinces of the Basque Country.

El acceso a la función pública docente en Educación Infantil, Primaria y Secundaria

The research presented below aims to describe and analyse the teaching strategies and supports obtained by teachers in the province of Gipuzkoa who sit competitive examinations to access the teaching civil service in Infant, Primary and Secondary Education. This study opted for a sequential explanatory design with 469 candidates. Teachers who have passed the official examinations placed special emphasis on the first test (theoretical part and practical exercise), took into account the criteria of evaluation of the examinations and prioritised issues such as attention to diversity, evaluation, the competence of learning to learn, self-regulation of learning and the design of teaching units. In addition, they received valuable help from relatives, people linked to teaching with whom they have a close relationship, and work colleagues.

НОВЫЕ ВОЗМОЖНОСТИ ВЗАИМОДЕЙСТВИЙ НА ОБЩЕСТВЕННОЙ АРЕНЕ: УРОКИ ГИПУСКОА

The difficulties that European Welfare States are experiencing in order to respond to emerging social needs are making a re-configuration of the welfare system inevitable. In this sense, spheres such as the third sector are gaining special attention due to their role in the provision of welfare. This paper qualitatively addresses the interaction between public administration and the third sector using the example of welfare provision in the Province of Gipuzkoa. Specifically, our research focuses on the existing instruments for this interaction and the existing spaces for representation and interaction between both. By means of a participatory approach based on qualitative techniques, professionals from the public administration and the third sector were given voice. Semi-structured interviews were carried out with nine participants considered by the research team as references in the field of the third sector. To complement and advance in the understanding of the information obtained, three discussion groups were also set up: two were formed by participants who are in charge of third sector organizations; and the third was made up of technicians from the Provincial Council of Gipuzkoa. Altogether, the results obtained illustrate much confusion between both actors concerning how their relationships should be built, as traditional ways seem insufficient. Although the creation of the civil dialogue table seems like an alternative, it presents several difficulties in terms of ensuring the representation of all third sector organizations.

Narrativas y etnografías para el escenario post-ETA: una lectura de la película Gazta Zati Bat

En este trabajo realizo una lectura antropológica etnográficamente informada de la intertextualidad simbólica de la película Gazta Zati Bat. Este documental vasco estrenado en el año 2012 narra una serie de historias personales y políticas encadenadas en torno de un movimiento social que nace cinco años antes en un pequeño pueblo guipuzcoano, cuyos miembros trabajan por la autodeterminación a través de producir e incorporar contenido al “Derecho a decidir” inspirados por el modelo escocés. El artículo focaliza en la construcción de agencia política considerando la creación de un nuevo escenario soberanista pacífico y argumenta que iniciativas como esta producción cultural permiten repensar ejes analíticos acerca del conflicto vasco.

Molecular epidemiology of G12 rotavirus strains during eight consecutive epidemic seasons in the Basque Country (North of Spain), 2010–2018

G12 rotaviruses were first detected in Spain (Gipuzkoa province) in December 2004. After four years with no detections, G12 strains re-emerged in the 2010–2011 epidemic season, when the first European epidemic circulation of this genotype was observed in Gipuzkoa. G12 rotaviruses were also the dominant strains in 2011–2012, 2014–2015 and 2015–2016 epidemic seasons and were sporadically detected in the remaining periods (2012–2014 and 2016–2018). The most frequently detected G-type between 2010 and 2018 was G12 (29.9%) rather than G1 rotavirus (17.8%), which historically had been the dominant genotype in our setting (1989–2009 period) and globally. Phylogenetic analysis of the VP4 and VP7 genome segments showed chronologically ordered clades, which spanned between two to four consecutive seasons. Overall, the circulating G12 rotavirus strains in Gipuzkoa between 2010 and 2018 belonged to four clades, which emerged in early 2009 potentially due to at least four importations from other regions followed by local evolution. Whole genome analysis of 16 G12 strains detected from 2010 to 2018 revealed a Wa-like genotype constellation, G12-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1, and also showed that G12 strains from Gipuzkoa were similar to those identified in other countries. These findings suggest circulation of G12 rotavirus strains in different parts of the world leading to high genetic diversity.

Does Basque Have a Future? Implications of Hegemonic Languages for Audiovisual Consumption by Adolescents

This article analyses the consumption of audiovisual content in the Basque language by adolescents in the Basque province of Gipuzkoa and the influence of hegemonic languages on two levels: Spanish as the dominant language in a bilingual society, in which linguistic competence in Basque does not translate into its use; and an audiovisual industry in which English and Spanish are the dominant languages. For this study, surveys were completed by 2,426 students in the compulsory secondary school system (ages 12 -16) enrolled in either the “Model B” language stream (half in Basque and half in Spanish) or the “Model D” language stream (Basque as the language of instruction) at 60 schools across the province. Cluster sampling was used, stratified with proportional allocation in order to obtain data on the seven regions of Gipuzkoa. Audiovisual consumption was examined mainly in five significant areas: cinema, television, news, sports and the Internet. Special attention was also given to the use of subtitles when viewing fiction content. The study found that adolescents in Gipuzkoa consume audiovisual content mainly in Spanish, although not all to the same degree, as there is considerable variation between regions. Affectivity in relation to the language is a key aspect for interpreting the results of this research.

Polycyclic aromatic hydrocarbons (PAHs) in air associated with particles PM2.5 in the Basque Country (Spain)

The polycyclic aromatic hydrocarbons (PAHs) are a group of persistent pollutants that are globally distributed. The objectives of this study are as follows: (1) to analyze the levels of the priority PAHs in the PM2.5 fraction of air: naphthalene, acenaphthene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benzoanthracene, chrysene, benzo(b)fluoranthene, benzo(k)fluoranthene, benzo(a)pyrene, dibenzoanthracene, benzo(g,h,i)perylene, indenepyrene, acenaphthylene, in two urban industrial areas of the province of Gipuzkoa (Basque Country, Spain), (2) to describe seasonal variation, and (3) to identify the source of PAHs. The ∑PAH concentrations ranged from 0.85 to 9.86 ng/m3. We found statistical differences between sites of sampling (p < 0.05), with higher values in Azpeitia. The median value of benzo(a)pyrene was 0.05 ng/m3 (ranged from 0.05 to 1.12 ng/m3), lower than the threshold set by the European legislation. Statistical differences were found (p < 0.05) in relation to seasonal variation, with the highest levels registered in winter and in autumn. PAH ratios and principal component analysis (PCA) revealed that probably the vehicular emissions are the predominant source of PAHs.

Multipronged management strategy for patients with complex needs using an integrated organizational model

Introduction : The Basque healthcare system is facing an overwhelming problem due to chronicity and an aging population. In our setting (San Sebastian, Gipuzkoa province, Basque Country) more than 25% of the population (400,000) will be over 65 years old in the next decade out of which 10,000 people will be multi-pathological. Traditionally, these patients have been managed without a coordinated strategy, leading to multiple hospital admissions, patient discomfort and a large economic impact. Description of practice change implemented : A multipronged management strategy for patients with complex needs using an integrated organizational model that included liaison nurse, call center and new technologies (web/ app-based monitoring). Aim : Improving quality of life and perceived quality of health assistance Training patients and healthcare providers Reducing length of stay and Emergency Department (ED) visits Respecting patients’ will on intensity of treatment and place of care provision Target population : - Multi-pathological patients with high readmission rates - Home-dependent patients - Nursing home residents - End of life patients Timeline : 2003: New Evidence-based practice unit started within Internal Medicine Dpt. 2005: Prediction rule development and validation for readmission risk 2006: Before and after study with a multipronged strategy (PAMI) targeting patients with high readmission rates. 2009: Creation of a management unit for chronic patients. 2010: Comparative study of telemedicine vs PAMI 2010: Cluster randomized clinical trial of PAMI in nursing homes 2012: Creation of a diabetes pathway 2012: Creation of an integrated health organization (OSI) Highlights : - Development of a single electronic medical record - Stratification of the population and tagging of chronic patients. - Conciliation of treatment with an e-prescription tool. - Conciliation of information (hospital/primary care meetings, communication tools) - Case management of complex patients (PAMI programme) with process-specific questionnaires, liaison nurse, call center and web/app monitoring activating changes in prescription, GP appointments or direct hospital admission. With 4,200 patients followed within this programme, we have achieved 30-50% of direct admissions (avoiding ED visit). Days spent at the hospital were reduced by 25% for nursing home residents, 55% for home-dependents, 58% for heart failure patients, and 25% for patients with COPD. The number of ED visits made by each group was also reduced by 58%, 70%, 70% and 45% respectively. 80-100% found the level of training satisfactory, 90-100% rated the hospital accessibility “excellent” and 90-100% perceived significant improvements in the global management of the process. -Integration of the primary care-internal medicine and nursing home-internal medicine pathway -Improvement on the social care with a calculator of social support needs. Sustainability : Cost-effectiveness of the management of these patients improved Transferability : The technology and protocols are available to all in the Basque Country. Geographical differences exist in hospital accessibility. Conclusions : This strategy improved perceived quality of life and length of stay while avoiding many ED visits. Integration of levels and IT tools are essential to make it possible. Discussion : Integration specially benefits multi-pathological and complex patients, offering opportunities for case management strategies. Lessons learned : The anticipation of problems, new technologies and integrated assistance focused on the user will be the keys of the future care.