Strengthening primary health care in Europe with digital solutions

This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania’s adoption of remote consultations, Spain’s use of risk stratification solutions, and theNetherlands’ advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC inEurope

Limitaciones de los parámetros de las funciones de predación. Implicaciones para la iniciación de las proliferaciones de fitoplancton

Phytoplankton blooms are events of production and accumulation of phytoplankton biomass that influence ecosystem dynamics and may also have effects on socio-economic activities. Among the biological factors that affect bloom dynamics, prey selection by zooplankton may play an important role. Here we consider the initial state of development of an algal bloom and analyse how a reduced grazing pressure can allow an algal species with a lower intrinsic growth rate than a competitor to become dominant. We use a simple model with two microalgal species and one zooplankton grazer to derive general relationships between phytoplankton growth and zooplankton grazing. These relationships are applied to two common grazing response functions in order to deduce the mathematical constraints that the parameters of these functions must obey to allow the dominance of the lower growth rate competitor. To assess the usefulness of the deduced relationships in a more general framework, the results are applied in the context of a multispecies ecosystem model (ERSEM).Las proliferaciones de fitoplancton son eventos de producción y acumulación de biomasa de fitoplancton que tienen una fuerte influencia tanto en la dinámica del ecosistema como en actividades socioeconómicas. Entre los factores biológicos que afectan la dinámica de las proliferaciones fitoplanctónicas, la selección de presas por el zooplancton puede jugar un papel importante. En este trabajo consideramos el estado inicial de desarrollo de una proliferación algal considerando que la presión de la predación puede permitir a una especie de algas con una menor tasa de crecimiento intrínseco que un competidor, ser dominante. Utilizamos un modelo sencillo con dos especies de microalgas y un herbívoro (zooplancton) para deducir relaciones generales entre el crecimiento del fitoplancton y la predación. Estas relaciones se aplican a dos funciones de respuesta de predación para deducir las limitaciones matemáticas que los parámetros de estas funciones deben obedecer. Para evaluar la utilidad de las relaciones deducidas en un marco más general, los resultados se aplican a un modelo de múltiples especies del ecosistema marino (ERSEM)

Two-phase linear hybrid reluctance actuator with low detent force

In this paper, a novel two-phase linear hybrid reluctance actuator with the double-sided segmented stator, made of laminated U cores, and an interior mover with permanent magnets is proposed. The permanent magnets are disposed of in a way that increases the thrust force of a double-sided linear switched reluctance actuator of the same size. To achieve this objective, each phase of the actuator is powered by a single H-bridge inverter. To reduce the detent force, the upper and the lower stator were shifted. Finite element analysis was used to demonstrate that the proposed actuator has a high force density with low detent force. In addition, a comparative study between the proposed linear hybrid reluctance actuator, linear switched reluctance, and linear permanent magnet actuators of the same size was performed. Finally, experimental tests carried out in a prototype confirmed the goals of the proposed actuator.Peer ReviewedPostprint (published version

Retrospective analysis of hospitalization costs using two payment systems: the diagnosis related groups (DRG) and the Queralt system, a newly developed case-mix tool for hospitalized patients

BackgroundHospital services are typically reimbursed using case-mix tools that group patients according to diagnoses and procedures. We recently developed a case-mix tool (i.e., the Queralt system) aimed at supporting clinicians in patient management. In this study, we compared the performance of a broadly used tool (i.e., the APR-DRG) with the Queralt system.MethodsRetrospective analysis of all admissions occurred in any of the eight hospitals of the Catalan Institute of Health (i.e., approximately, 30% of all hospitalizations in Catalonia) during 2019. Costs were retrieved from a full cost accounting. Electronic health records were used to calculate the APR-DRG group and the Queralt index, and its different sub-indices for diagnoses (main diagnosis, comorbidities on admission, andcomplications occurred during hospital stay) and procedures (main and secondary procedures). The primary objective was the predictive capacity of the tools; we also investigated efficiency and within-group homogeneity.ResultsThe analysis included 166,837 hospitalization episodes, with a mean cost of 4,935 (median 2,616; interquartile range 1,011-5,543). The components of the Queralt system had higher efficiency (i.e., the percentage of costs and hospitalizations covered by increasing percentages of groups from each case-mix tool) and lower heterogeneity. The logistic model for predicting costs at pre-stablished thresholds (i.e., 80th, 90th, and 95th percentiles) showed better performance for the Queralt system, particularly when combining diagnoses and procedures (DP): the area under the receiver operating characteristics curve for the 80th, 90th, 95th cost percentiles were 0.904, 0.882, and 0.863 for the APR-DRG, and 0.958, 0.945, and 0.928 for the Queralt DP; the corresponding values of area under the precision-recall curve were 0.522, 0.604, and 0.699 for the APR-DRG, and 0.748, 0.7966, and 0.834 for the Queralt DP. Likewise, the linear model for predicting the actual cost fitted better in the case of the Queralt system.ConclusionsThe Queralt system, originally developed to predict hospital outcomes, has good performance and efficiency for predicting hospitalization costs

Data acquisition system development for EGIM on EMSODEV EU Project

Garcia, O. ... et al.-- 7th International Workshop on Marine Technology – Martech Workshop 2016, 26-28 October 2016, Barcelona.-- 2 pages, 5 figuresThe EMSODEV1 (European Multidisciplinary Seafloor and water-‐ column Observatory DEVelopment) is a UE project whose general objective is to set up the full implementation and operation of the EMSO distributed Research Infrastructure (RI), through the development, testing and deployment of an EMSO Generic Instrument Module (EGIM). The EGIM module will measure various ocean parameters in a long-term consistent, accurate and comparable manner. These measurements are critical to respond accurately to the social and scientific challenges such as climate change, changes in marine ecosystems, and marine hazards. Here we present the current status of the EGIM data acquisition system developmentThis study benefited from H2020 INFRADEV- ‐3- ‐2015 EMSODEV Project n°676555Peer Reviewe

Impact of the COVID-19 Pandemic on the Incidence of Suicidal Behaviors: A Retrospective Analysis of Integrated Electronic Health Records in a Population of 7.5 Million

The COVID-19 pandemic has caused remarkable psychological overwhelming and an increase in stressors that may trigger suicidal behaviors. However, its impact on the rate of suicidal behaviors has been poorly reported. We conducted a population-based retrospective analysis of all suicidal behaviors attended in healthcare centers of Catalonia (northeast Spain; 7.5 million inhabitants) between January 2017 and June 2022 (secondary use of data routinely reported to central suicide and diagnosis registries). We retrieved data from this period, including an assessment of suicide risk and individuals' socioeconomic as well as clinical characteristics. Data were summarized yearly and for the periods before and after the onset of the COVID-19 pandemic in Spain in March 2020. The analysis included 26,458 episodes of suicidal behavior (21,920 individuals); of these, 16,414 (62.0%) were suicide attempts. The monthly moving average ranged between 300 and 400 episodes until July 2020, and progressively increased to over 600 episodes monthly. In the postpandemic period, suicidal ideation increased at the expense of suicidal attempts. Cases showed a lower suicide risk; the percentage of females and younger individuals increased, whereas the prevalence of classical risk factors, such as living alone, lacking a family network, and a history of psychiatric diagnosis, decreased. In summary, suicidal behaviors have increased during the COVID-19 pandemic, with more episodes of suicidal ideation without attempts in addition to younger and lower risk profiles

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

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