Efectes de la pesca d'arrossegament en els sediments dels canyons submarins catalans.

Bottom trawling is a nonselective commercial fishing technique whereby heavy nets and gear are pulled along the seafloor, modifying the physical properties of seafloor sediments and altering natural sediment fluxes. Most studies addressing the physical disturbances of trawl gear on the seabed have been undertaken in coastal and shelf environments, where the capacity of trawling to modify the seafloor sediments coexists with high-energy natural processes driving sediment erosion, transport and deposition. Recent studies conducted on the Catalan margin have demonstrated that on continental slopes where the sediment dynamics is less energetic the reworking of the deep seafloor by bottom trawling produces periodic resuspension of surface sediments, and ultimately modifies the shape of the submarine landscape over large spatial scales. Trawling-induced sediment displacement and removal from fishing grounds causes the morphology of the deep seafloor to become smoother over time, reducing its original complexity. These results suggest that during the last decades, following the industrialization of fishing fleets, bottom trawling has become an important driver of deep seascape evolutio

Ploughing the deep sea floor

Bottom trawling is a non-selective commercial fishing technique whereby heavy nets and gear are pulled along the sea floor. The direct impact of this technique on fish populations1,2 and benthic communities3,4 has received much attention, but trawling can also modify the physical properties of seafloor sediments, water-sediment chemical exchanges and sediment fluxes5,6. Most of the studies addressing the physical disturbances of trawl gear on the seabed have been undertaken in coastal and shelf environments7,8, however, where the capacity of trawling to modify the seafloor morphology coexists with high-energy natural processes driving sediment erosion, transport and deposition9. Here we show that on upper continental slopes, the reworking of the deep sea floor by trawling gradually modifies the shape of the submarine landscape over large spatial scales. We found that trawling-induced sediment displacement and removal from fishing grounds causes the morphology of the deep sea floor to become smoother over time, reducing its original complexity as shown by high-resolution seafloor relief maps. Our results suggest that in recent decades, following the industrialization of fishing fleets, bottom trawling has become an important driver of deep seascape evolution. Given the global dimension of this type of fishery, we anticipate that the morphology of the upper continental slope in many parts of the world's oceans could be altered by intensive bottom trawling, producing comparable effects on the deep sea floor to those generated by agricultural ploughing on land

Frailty degree and illness trajectories in older people towards the end-of-life:a prospective observational study

Objectives To assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival.Methods Prospective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014–2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test.Results Of the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p<0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p<0.01 for all the coefficients).Conclusions All older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory

Excess mortality among older adults institutionalized in long-term care facilities during the COVID-19 pandemic: a population-based analysis in Catalonia

Objectives: To assess excess mortality among older adults institutionalized in nursing homes within the successive waves of the COVID-19 pandemic in Catalonia (north-east Spain).Design: Observational, retrospective analysis of population-based central healthcare registries.Setting and participants: Individuals aged >65 years admitted in any nursing home in Catalonia between January 1, 2015, and April 1, 2022.Methods Deaths reported during the pre-pandemic period (2015-2019) were used to build a reference model for mortality trends (a Poisson model, due to the event counting nature of the variable mortality), adjusted by age, sex, and clinical complexity, defined according to the adjusted morbidity groups. Excess mortality was estimated by comparing the observed and model-based expected mortality during the pandemic period (2020-2022). Besides the crude excess mortality, we estimated the standardized mortality rate (SMR) as the ratio of weekly deaths' number observed to the expected deaths' number over the same period.Results: The analysis included 175,497 older adults institutionalized (mean 262 days, SD 132), yielding a total of 394,134 person-years: 288,948 person-years within the reference period (2015-2019) and 105,186 within the COVID-19 period (2020-2022). Excess number of deaths in this population was 5,403 in the first wave and 1,313, 111, -182, 498, and 329 in the successive waves. The first wave on March 2020 showed the highest SMR (2.50; 95% CI 2.45-2.56). The corresponding SMR for the 2nd to 6th waves were 1.31 (1.27-1.34), 1.03 (1.00-1.07), 0.93 (0.89-0.97), 1.13 (1.10-1.17), and 1.07 (1.04-1.09). The number of excess deaths following the first wave ranged from 1,313 (2nd wave) to -182 (4th wave). Excess mortality showed similar trends for men and women. Older adults and those with higher comorbidity burden account for higher number of deaths, albeit lower SMRs.Conclusion: Excess mortality analysis suggest a higher death toll of the COVID-19 crisis in nursing homes than in other settings. Although crude mortality rates were far higher among older adults and those at higher health risk, younger individuals showed persistently higher SMR, indicating an important death toll of the COVID-19 in these groups of people

Excess mortality among older adults institutionalized in long-term care facilities during the COVID-19 pandemic: a population-based analysis in Catalonia

ObjectivesTo assess excess mortality among older adults institutionalized in nursing homes within the successive waves of the COVID-19 pandemic in Catalonia (north-east Spain).DesignObservational, retrospective analysis of population-based central healthcare registries.Setting and participantsIndividuals aged >65 years admitted in any nursing home in Catalonia between January 1, 2015, and April 1, 2022.MethodsDeaths reported during the pre-pandemic period (2015–2019) were used to build a reference model for mortality trends (a Poisson model, due to the event counting nature of the variable “mortality”), adjusted by age, sex, and clinical complexity, defined according to the adjusted morbidity groups. Excess mortality was estimated by comparing the observed and model-based expected mortality during the pandemic period (2020–2022). Besides the crude excess mortality, we estimated the standardized mortality rate (SMR) as the ratio of weekly deaths’ number observed to the expected deaths’ number over the same period.ResultsThe analysis included 175,497 older adults institutionalized (mean 262 days, SD 132), yielding a total of 394,134 person-years: 288,948 person-years within the reference period (2015–2019) and 105,186 within the COVID-19 period (2020–2022). Excess number of deaths in this population was 5,403 in the first wave and 1,313, 111, −182, 498, and 329 in the successive waves. The first wave on March 2020 showed the highest SMR (2.50; 95% CI 2.45–2.56). The corresponding SMR for the 2nd to 6th waves were 1.31 (1.27–1.34), 1.03 (1.00–1.07), 0.93 (0.89–0.97), 1.13 (1.10–1.17), and 1.07 (1.04–1.09). The number of excess deaths following the first wave ranged from 1,313 (2nd wave) to −182 (4th wave). Excess mortality showed similar trends for men and women. Older adults and those with higher comorbidity burden account for higher number of deaths, albeit lower SMRs.ConclusionExcess mortality analysis suggest a higher death toll of the COVID-19 crisis in nursing homes than in other settings. Although crude mortality rates were far higher among older adults and those at higher health risk, younger individuals showed persistently higher SMR, indicating an important death toll of the COVID-19 in these groups of people

Protocol de prescripció d’oxigenoteràpia per a pacients en situació aguda domiciliària, en l’àmbit de l’atenció primària: document de consens

Oxigenoteràpia; Prescripció; Pacients en situació aguda domiciliària; Atenció primàriaOxigenoterapia; Prescripción; Pacientes en situación aguda domiciliaria; Atención primariaOxygen therapy; Prescription; Patients in an acute situation at home; Primary careL’oxigenoteràpia en els pacients adults comprèn el conjunt d’intervencions d’assistència sanitària, tècnica i de formació realitzades de manera coordinada per diferents professionals que configuren un equip interdisciplinari, limitades en el temps i orientades a facilitar el tractament domiciliari de la insuficiència respiratòria aguda i a evitar els ingressos hospitalaris i els desplaçaments als serveis d’urgència evitables. Amb aquest protocol es vol contribuir a la disminució de la morbimortalitat dels pacients amb insuficiència respiratòria aguda, tributaris de tractament amb oxigenoteràpia domiciliària; i a millorar la qualitat de vida de les persones que estan en situació de final de vida i que pateixin un esdeveniment agut

Ruta assistencial de complexitat 2.0 (PCC/MACA) a Catalunya: definició de la ruta i proposta de desplegament

Ruta assistencial; Pacients crònics complexos; DesplegamentVia clínica; Pacientes crónicos complejos; DespliegueClinical pathway; Complex chronic patients; DeploymentLes rutes assistencials s’orienten a donar una millor resposta a les persones amb patologies i problemes de salut crònics i de més prevalença; permeten millorar-ne el maneig, organitzar l’atenció dels professionals partint d’un model d’atenció integrada i proactiva, adequar la prestació de serveis a un model d’atenció compartida entre els diferents àmbits d’atenció, així com definir mecanismes per a la individualització del pla d’atenció i l’adequació en la utilització de recursos. En aquest document es presenta la ruta assistencial de complexitat (PCC/MACA) i es proporcionen instruments i eines per fer-ne el desplegament al territori

Compassionate communities: design and preliminary results of the experience of Vic (Barcelona, Spain) caring city

yesBackground: A program of Compassionate City or Community (CC) has been designed and developed in the City of Vic (43,964 habitants, Barcelona, Spain), based on The Compassionate City Charter and other public health literature and experiments, with the joint leadership of the City Council and the Chair of Palliative Care at the University of Vic, and as an expansion of a comprehensive and integrated system of palliative care. Methods: The program started with an assessment of needs of the city as identified by 48 social organizations with a foundational workshop and a semi-structured survey. After this assessment, the mission, vision, values and aims were agreed. The main aims consisted in promoting changes in social and cultural attitudes toward the end of life (EoL) and providing integrated care for people with advanced chronic conditions and social needs such as loneliness, poverty, low access to services at home, or conflict. The selected slogan was “Living with meaning, dignity, and support the end of life”. Results: The program for the first year has included 19 activities (cultural, training, informative, and mixed) and followed by 1,260 attendants, and the training activities were followed by 147 people. Local and regional sponsors are funding the initiative. After a year, a quantitative and qualitative evaluation was performed, showing high participation and satisfaction of the attendants and organizations. In the second year, the care for particular vulnerable people defined as targets (EoL and social factors described before) will start with volunteers with more organizations to join the project. Conclusions: The key identified factors for the initial success are: the strong joint leadership between social department of the Council and the University; clear aims and targets; high participation rates; the limited size of the geographical context; which allowed high participation and recognition; and the commitment to evaluate results

Consens d’escales i eines per a la valoració multidimensional de les persones a Catalunya

Model d'atenció integral; Valoració multidimensional; DiagnòsticModelo de atención integral; Valoración multidimensional; DiagnósticoComprehensive care model; Multidimensional valuation; DiagnosisActualment no existeix a Catalunya un consens sobre quin hauria de ser el mínim comú denominador d’escales i eines d’elecció per a la valoració de les diferents dimensions de les persones grans amb multimorbiditat, fragilitat, cronicitat complexa o avançada. Aquest escenari fa evident la necessitat de disposar d’escales i eines consensuades i compartides que facilitin l’aproximació multidimensional a aquestes persones de forma objectiva i pragmàtica, amb l’objectiu d'ajudar els professionals en aquest procés d’individualització de l’atenció. És per aquest motiu que, impulsat per la Direcció General de Planificació i Recerca en Salut i per l’oficina eSalut, s’ha promogut i desenvolupat aquest consens i es vol assegurar que la proposta pugui ser suportada en l’entorn digital