Families’ degree of satisfaction with pediatric telehomecare: interventional prospective pilot study in Catalonia

Home health monitoring; Pediatrics; Telehomecare; Videoconferencing; Satisfaction with care; Remote sensing technology; TelehealthVigilància de la salut domiciliària; Pediatria; Teleassistència domiciliària; Videoconferència; Satisfacció amb la cura; Tecnologia de teledetecció; TelesalutVigilancia de la salud en el hogar; Pediatría; Teleasistencia domiciliaria; Videoconferencia; Satisfacción con la atención; Tecnología de teledetección; TelesaludBackground: Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children's care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. Objective: This study aimed to assess families' degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. Methods: A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children's characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. Results: A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. Conclusions: Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents.This study was conducted with the support of the Secretary of Universities and Research of the Department of Business and Knowledge of the Generalitat de Catalunya

The Prescription of Mobile Apps by Primary Care Teams: A Pilot Project in Catalonia

Mobile apps; Apps; MHealth; Primary health care; Telemedicine; TelemonitoringAplicacions mòbils; Aplicacions; Salut; Atenció primària; Telemedicina; TelemonitoritzacióAplicaciones móviles; Aplicaciones; MSalud; Atención primaria; Telemedicina; TelemonitoreoIn Catalonia, the Fundació TIC Salut Social's mHealth Office created the AppSalut Site to showcase to mobile apps in the field of health and social services. Its primary objective was to encourage the public to look after their health. The catalogue allows primary health care doctors to prescribe certified, connected apps, which guarantees a safe and reliable environment for their use. The generated data can be consulted by health care professionals and included in the patient's clinical history. This document presents the intervention and the major findings following a five-month pilot project conducted in the Barcelona area.This study was conducted with the support of the Secretary of Universities and Research of the Department of Business and Knowledge at the Generalitat de Catalunya

COVID-19 and the "Film Your Hospital" Conspiracy Theory: Social Network Analysis of Twitter Data

Background: During the COVID-19 pandemic, a number of conspiracy theories have emerged. A popular theory posits that the pandemic is a hoax and suggests that certain hospitals are “empty.” Research has shown that accepting conspiracy theories increases the likelihood that an individual may ignore government advice about social distancing and other public health interventions. Due to the possibility of a second wave and future pandemics, it is important to gain an understanding of the drivers of misinformation and strategies to mitigate it. Objective: This study set out to evaluate the #FilmYourHospital conspiracy theory on Twitter, attempting to understand the drivers behind it. More specifically, the objectives were to determine which online sources of information were used as evidence to support the theory, the ratio of automated to organic accounts in the network, and what lessons can be learned to mitigate the spread of such a conspiracy theory in the future. Methods: Twitter data related to the #FilmYourHospital hashtag were retrieved and analyzed using social network analysis across a 7-day period from April 13-20, 2020. The data set consisted of 22,785 tweets and 11,333 Twitter users. The Botometer tool was used to identify accounts with a higher probability of being bots. Results: The most important drivers of the conspiracy theory are ordinary citizens; one of the most influential accounts is a Brexit supporter. We found that YouTube was the information source most linked to by users. The most retweeted post belonged to a verified Twitter user, indicating that the user may have had more influence on the platform. There was a small number of automated accounts (bots) and deleted accounts within the network. Conclusions: Hashtags using and sharing conspiracy theories can be targeted in an effort to delegitimize content containing misinformation. Social media organizations need to bolster their efforts to label or remove content that contains misinformation. Public health authorities could enlist the assistance of influencers in spreading antinarrative content

Prescription and integration of accredited mobile Apps in catalan health and social care: protocol for the AppSalut site design

mHealth; Information integration; Telemedicine; Telemonitoring; Mobile phonemSalud; Integración de la información; Telemedicina; Televigilancia; Teléfono móvilmSalut; Integració de la informació; Telemedicina; Televigilància; Telèfon mòbilBackground: The use of new mobile technologies in the health and social welfare sectors is already a reality. The ICT Social Health Foundation, in accordance with the technology strategy of the Catalan government's Ministry of Health and its Ministry of Labour, Social Affairs and Families, is leading an initiative to create a public library of apps for its AppSalut Site. Objective: The objective of this paper is to present an account of the design of the project, with a global perspective, applied to the Catalan ecosystem, which can be divided into 3 areas: the framework governing the recommendation and prescription of apps, the subset of interoperability for mobile environments, and the data storage infrastructure. Methods: The security and credibility of the apps included in the catalog is ensured by submitting them to an accreditation process in the public domain that provides users with the guarantee that they are fit for purpose and trustworthy for the management and care of their health, while providing health care professionals with the possibility of recommending the apps in the doctor's surgery, as well as adding the information generated by the users' mobile devices to the information systems of the various organizations concerned. Results: An examination of the abovementioned areas suggests possibilities for improvements in the future. The experience obtained from the development of this element has shown the heterogeneity of the vocabularies used, as expected, due to the lack of awareness on the part of the developers regarding the need to standardize the information generated by the app, requiring the foundation to take on the role of consultant. Conclusions: The project has evolved in keeping with changes in the technological and social paradigm and responds very satisfactorily to the needs posed to it. It can be seen as a landmark experience in mobile strategies in the fields of health and welfare of any public health system. The experience has shown itself to be feasible in organizational terms, necessary in any attempt to integrate mobile technologies into public health practice, and a global pioneer in the field.This study was conducted with the support of the Secretary of Universities and Research of the Department of Business and Knowledge at the Generalitat de Catalunya

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

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Residències d'avis; Taxes de mortalitatCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Hogares de ancianos; Tasas de mortalidadCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Nursing homes; Death ratesThe 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.The authors(s) received to specific funding for this work

Evaluating Person-Centred Integrated Care to People with Complex Chronic Conditions: Early Implementation Results of the ProPCC Programme

Introduction: The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain. Methods: We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay. Findings: 264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05). Conclusion: Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (–37.2%) and hospital stays (–38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of –46.3%

Poètiques de resistència/resiliència

La brutal realitat de la pandèmia i el que en deriva ens força –ens obliga– a replantejar els principis i fonaments de l’art en una societat que desapareix per moments: més que líquida, descobrim ara una societat volatilitzada, críptica, desesperada. La desigualtat que creix de manera desmesurada i el canvi climàtic, que ja es mesura en catàstrofes. Les violències, directes o estructurals, derivades de diferències mal enteses. Cada vegada més descosits, ens cal emparar-nos en valors positius i transformadors. Com a noves persones creadores, els i les artistes novells han de presentar percepcions del món que els hi ha tocat habitar –viure– amb llenguatges que adrecin aquestes problemàtiques. Amb propostes artístiques que deixin de banda prejudicis impostats, han de buscar el diàleg amb el públic per generar confluències i complicitats

Essays on digital health interventions : the digitalization of the Catalan public healthcare system: an opportunity for economic appraisal

In the Catalan public health system, the provision of services through the use of digital health tools has gone hand in hand with the increasing digitalization of society as a whole. Since these services are often implemented on an experimental basis in a search for innovation, and in the absence of a rule governing the adoption of public policies, they may be exempt from a comprehensive analysis of their pros and cons (an economic evaluation). However, digitalization involves the generation of objective evidence: information stored in databases which can be analysed. There has never been so much information of such good quality. As a result, this dissertation aims to evaluate digital health interventions undertaken by the public health system of Catalonia to analyse evidence regarding its efficiency. The compendium of articles, the main part of this document, consists of the evaluation of three interventions (interconsultation, teleconsultation and telemonitoring). It is concluded that certain digital health tools appear to be cost-effective, and it is recommended that they be supported and promoted; others require further evaluation before a decision can be taken as to whether they ought to be included in the provision of public services.Al sistema públic de salut de Catalunya, la provisió de serveis mitjançant eines de salut digital ha anat en paral·lel a la creixent digitalització de l’àmbit personal dels ciutadans. En la mesura que aquests sovint s’implementen amb una voluntat experimental i des de l’òptica de la innovació, i en absència d’una regla d’adopció de polítiques públiques, poden quedar exempts de l’anàlisi integral dels seus pros i contres (l’avaluació econòmica). La digitalització, però, implica la generació d’una evidència objectiva: informació que queda inevitablement emmagatzemada en bases de dades susceptibles de ser analitzades. Mai hi havia hagut tanta i tan bona informació. En aquest context, aquesta tesi té com a objectiu avaluar intervencions de salut digital promogudes pel sistema públic de salut de Catalunya per aportar evidències respecte de la seva eficiència. El compendi d’articles, nucli d’aquest document, es conforma de l’avaluació de tres intervencions (interconsulta, teleconsulta i telemonitorització). Es conclou que algunes eines de salut digital semblen provar ser cost-efectives i es recomana defensar-les i promoure-les; d’altres s’hauran de seguir avaluant per incorporar-les o no en la prestació de serveis públics d’acord amb els seus resultats

Schistosomiasis screening in non-endemic countries from a cost perspective: knowledge gaps and research priorities: the case of African long-term residents in a Metropolitan Area, Spain

Background: Imported schistosomiasis is an emerging issue in European countries as a result of growing global migration from schistosomiasis-endemic countries, mainly in sub-Saharan Africa. Undetected infection may lead to serious long-term complications with an associated high cost for public healthcare systems especially among long-term migrants. Objective: To evaluate from a health economics perspective the introduction of schistosomiasis screening programs in non-endemic countries with high prevalence of long-term migrants. Methodology: We calculated the costs associated with three approaches—presumptive treatment, test-and-treat and watchful waiting—under different scenarios of prevalence, treatment efficacy and the cost of care resulting from long-term morbidity. Costs were estimated for our study area, in which there are reported to reside 74,000 individuals who have been exposed to the infection. Additionally, we methodically reviewed the potential factors that could affect the cost/benefit ratio of a schistosomiasis screening program and need therefore to be ascertained. Results: Assuming a 24% prevalence of schistosomiasis in the exposed population and 100% treatment efficacy, the estimated associated cost per infected person of a watchful waiting strategy would be €2,424, that of a presumptive treatment strategy would be €970 and that of a test-and-treat strategy would be €360. The difference in averted costs between test-and-treat and watchful waiting strategies ranges from nearly €60 million in scenarios of high prevalence and treatment efficacy, to a neutral costs ratio when these parameters are halved. However, there are important gaps in our understanding of issues such as the efficacy of treatment in infected long-term residents, the natural history of schistosomiasis in long-term migrants and the feasibility of screening programs. Conclusion: Our results support the roll-out of a schistosomiasis screening program based on a test-and-treat strategy from a health economics perspective under the most likely projected scenarios, but important knowledge gaps should be addressed for a more accurate estimations among long-term migrants