What will future health workers be like?

Health

Allergies.

One of the most prevalent diseases in Spain.

Climate change and pollution.

Two of the main causes of the increase in allergies.

Can I eat anything?

Main causes of food allergies.

An interview with M. Carmen García. Allergist at the Hospital HLA Universitario Moncloa.

Cooperatives and social medicine

ASISA. The Group has increased its premiums and its assistance activity. On the other hand, the HLA group hospitals attended 2.5 million consultations in 2022.

Assistència Sanitària. The Hospital de Barcelona celebrates the success of the post-discharge follow-up program for ambulatory surgery patients and Assistència opens a new headquarters in Vic and announces new scholarships for health students.

Fundación Espriu. We highlight the approval by an absolute majority of the new Law on Cooperation for Sustainable Development and offer support to cooperatives in Ukraine.

In depth

Health professionals of the future. We analyze the current health sector in Spain and listen to some of the pioneers who are leading the main changes to glimpse what the profession will be like in the future.

Lifestyle

Destinations.

The new Seville.

Welfare. The benefits o board games.

Nutrition.

The importance of diet for bone health.

Flight mode. Enotherapy, using wine to tone the skin.

Staff

Compartir Healthcare cooperativism magazine www.compartir.coop compartir@fundacionespriu.coop

Editorial board:

Dr. Ignacio Orce, chairman of the Fundación Espriu and Assistència Sanitària

Dr. Enrique de Porres, CEO of ASISA-Lavinia

Teresa Basurte, former chairwoman of the Fundación Espriu

Dr. Oriol Gras, trustee of the Fundación Espriu

Dr. Carlos Zarco, general manager and trustee of the Fundación Espriu

Production: Factoría Prisma

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Tel. 934 926 667

www.factoriaprisma.com

Editor of Factoría Prisma:

Vanessa López Vidal

Coordination: Víctor Farradellas

Design: Xavi Menéndez

Printer: Centro Gráfico Ganboa SL

Legal deposit: B-46099-2003

ISSN: 2488-6394

Healthcare compass

Without a doubt, making predictions about the future is not an easy task, especially when uncertainty is the usual trend. Barely a century ago, in fact, few would have imagined the changes that the profession has undergone in such a short time. That is why the report in the In depth section starts from an x-ray of the current sector to project possible scenarios. Behind them we see a trend towards personalization and specialization. Health professionals manage more and more information, a volume of data that accumulates and that generates, in the words of neurologist Ignacio Hernández Medrano, an inflation of knowledge. It seems logical that in the future we can take advantage of the full potential of artificial intelligence to better use this huge amount of information for the benefit of patients and research. However, the use of increasingly advanced technologies in the healthcare sector has to remind us of the famous quote from the scientist and writer Arthur C. Clarke: “Any sufficiently advanced technology is indistinguishable from magic.” With this in mind, it will be the responsibility of the health workers of the future to maintain closeness with patients and society in general, ensuring clear and rigorous communication and disclosure. Another key point is that of mental health, also mentioned by Dr. Medrano: the doctors of the future must protect ourselves from stress and burnout.

On the other hand, in the Health section we explore allergic diseases through various articles, pathologies that increasingly affect a greater number of people. According to the WHO, by 2050 half of the world’s population will suffer from an allergic disease. Dr. M. Carmen García says, in the interview that you will find on the next pages, that the increase in cases responds to a genetic predisposition, but above all to environmental factors, such as pollution or lifestyle.

Aware of the importance of maintaining a healthy lifestyle, in the Lifestyle section we offer you a small guide to visit Seville, European Capital of Smart Tourism 2023; We talk about the benefits of playing board games and the best foods to strengthen the skeleton and finally we explore what wine therapy consists of.

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Tel.: 93 495 44 90

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We must not forget to maintain a clear and rigorous communication in the future.

Carlos Zarco General manager of the Fundación Espriu

Established in 1989, the Fundación Espriu integrates the entities using the cooperative healthcare model created by Dr. Josep Espriu: Autogestió Sanitària, SCIAS, Lavinia and ASISA, which make up the Assistència and ASISA Groups.

Allergies, a very prevalent disease

The World Health Organisation considers allergic diseases to be one of the six most frequent pathologies throughout the world. It is calculated that, a present, they could affect 25% of the population. In Spain, allergy is the most prevalent disease, with allergists most frequently treating cases of hay fever, asthma or allergy to medicines.

By Àngela Zorrilla

In Spain, one of every four people suffers from some kind of allergic disorder. The European Centre of the Foundation for Allergy Research now calculates that one out of every two babies born in Europe at present will have an allergy of some kind during their lifetime. The World Health Organisation estimates that 25% of the world population is currently affected by this disease, a pathology that in recent decades has increased its appearance. During the second half of the 20th century its prevalence has multiplied by five in developed countries. Amongst others, the reasons for this could be pollution or climate change. A study by the Barcelona Instituto de Salud Global affirms that 33% of new cases of childhood asthma in Europe,

for example, are caused by air pollution. Allergy diseases are also one of the most frequent pathologies in childhood. 4% of children suffer from atopic dermatitis and 5% from food allergies.

THE USUAL SUSPECTS

Any allergy starts in a person’s immune system, preventing tolerance to pathogens. The body responds as if these factors were viruses and in spite of their being inoffensive, it mistakenly sees them as a threat to the organism. The response or reaction is the allergy itself. The most common symptoms are sneezing, a runny nose, rashes, puffiness or asthma attacks. In Spain, it is the most common disease amongst the population, where the main pathologies treated by allergists are allergic hay fever – which affects 21% of Spaniards, asthma and allergy to medicines.

Allergies are caused by many factors or triggers, a fact that makes it difficult for many people to discover the source of their disease. Amongst the most common allergens pollen, dust mites, some cosmetics, mould, some fragrances or

medicines stand out, as well as some foods such as milk or dried fruit and nuts. The “suspects” can come into contact with the organism through the nose or mouth, but they also can be ingested or be injected, such as the case of insect bites. When treating all these cases, which can range from slight to serious, doctors prescribe medicines or injections; although prevention is the main tool. That is to say, the person should avoid the factor or substance that causes the allergy. •

= Hay fever, asthma and allergy to medicines are the main reasons for consulting allergists in Spain.

= One of every two newborn babies will have some kind of allergy during their lifetime.

The most common allergens

POLLEN

COSMETICS

DUST MITES

FRAGANCES

MOULD

MEDICINES

GLUTEN FOOD

Climate change, responsible for future allergies

By 2050 experts are warning that 50% of the world population will suffer from some kind of allergy. This situation is being caused, amongst others, by climate change and pollution, which are turning allergies into one of the most important non-contagious pandemics of our times.

by Àngela Zorrilla

The World Health Organisation has been warning about a very concerning figure for many years now: by 2050, half of the world population will suffer from some kind of allergy. And food, pollution and climate change will all be key elements in this problem, which far from being a future concern, is being shown to be something that

today’s society is already suffering from. In Europe, at present 33% of the new cases of childhood asthma are caused by air pollution. In fact, pollutants – caused by climate change, play a key role in the increase of pollen allergies, for example.

Pollution damages the air that we breathe, but it also harms the

earth and the sea that provide our basic food. Therefore, every day, people are exposed to toxic products that they eat without any knowledge and they breathe in dirty air that ends up irritating and causing reactions in the immune system. This relationship between allergies and pollution explains that, today, developed

The butterfly effect

Due to the global rise in temperatures and the high concentrations of carbon dioxide, plants and trees are producing 21% more pollen than 30 years ago.

= In comparison to 1990, today the pollen season starts 20 days earlier and ends 8 days later.

countries are precisely the ones showing most symptoms.

MORE POLLEN, MORE SNEEZES

Amongst other aspects, climate change is affecting the life cycle of plants and animals. In 2021, the scientific magazine Proceedings of the National Academy of Sciences (PNAS), the official publication by the United States National Academy of Sciences, was already warning: in comparison to the year 1990, today the pollen season starts almost 20 days earlier, and it ends a week later. This means that plants and trees are producing 21% more pollen and therefore, the allergy season is worsening and becoming more intense. Consequently, people with pollen allergy will start their dreaded allergy season earlier and the symptoms will last longer. This situation affects between an estimated 10% and 40% of the population who suffer from

allergic hay fever due to exposure to pollen. In addition, while the pollen life cycle is approximately two hours long, its capacity to cause an allergic reaction is indefinite.

The author of this American report also explains that, due to the global rise in temperatures and the high concentrations of carbon dioxide in the air, plants are producing even more pollen. But this greater concentration of pollen does not only affect people with allergies. This increase of the allergens in the air is promoting the appearance of new allergies. Furthermore, apart from the proliferation of pollen, climate change is also causing many plants to alter their distribution. The lack of water or extreme temperatures are meaning some plants are looking for homes in better climates, forcing re-dispersal and even, the extinction of some species. This makes the allergens “travel” and spread their symptoms. •

Can I eat anything?

Food allergies are one of the most common types of allergies. The most usual allergens are milk, eggs, fruit or dried fruit and nuts. In fact, almost 45% of allergies in Spain are linked to fruit and vegetables. But is it possible to have an allergic reaction just by touching the article in question?

by Àngela Zorrilla

Around the world, nearly 520 mi- llion people could be suffering from food allergies. According to the World Allergy Organisation, no country has reported a decrease in food allergies over the past 10 years. In Spain, two million citizens suffer from some kind offood allergy, specifically, around 8% of

children under the age of 14 and 2-3% of adults. M. Carmen García, allergist from the Hospital Universitario HLA Moncloa, defines a food allergy as a reaction of the immune system that happens soon after having eaten a certain food or minimum amounts of it, or even after having touched or inhaled it.

Food allergy, she adds, varies according to age. “In the paediatric age group, the most common allergens are milk, eggs, fish and dried fruit and nuts. In adults, they are mainly fruit, vegetables and dried fruit and nuts,” she explains. Almost 45% of the allergies in our country are caused by fruit and vegetables. In fact, in Spain many people are sensitive to peaches.

RISK FACTORS

Some allergic reactions to food occur immediately and others take hours to appear and cause symptoms such as abdominal pain, nausea, colic and diahrroea. The seriousness of a reaction will depend on many factors, linked both to the food allergy and to the person themself. For this reason, García believes that “the intensity of the aller-

gic reaction is unforeseeable.” In many cases, the allergy is due to a genetic alteration, but even so, it can be prevented.

The most common treatment is usually to avoid eating or coming into contact with the food in question, but apart from this precaution, a series of co-factors have been identified, which, associated with eating the specific food, can induce the appearance of an allergic reaction or make it worse. Amongst these co-factors are “performing moderate-high intensity physical exercise after eating the food, prolonged fasting, menstruation or the prior or simultaneous drinking of alcohol or taking of anti-inflammatory medicines,” the allergist from the Hospital Universitario HLA Moncloa comments.

Finally, many people confuse food allergy with food intolerance. The main difference between the two is that the intolerance arises in the digestive tract, while the immune system is the main cause of an allergy. •

Beware of these symptoms!

• Itching and redness of the skin

• Appearance of hives

• Nausea and vomiting

• Stomach pain

• Rashes

• Swelling and dryness of lips, tongue and/or throat

• Diarrhoea

• Runny nose

• Asthma

• Drop in blood pressure

• Weakened pulse

• Anaphylactic shock

= Two million Spaniards suffer from some kind of food allergy which, in children is usually caused by milk, eggs or fish

Dra. M. Carmen García, allergist at the Hospital Universitario HLA Moncloa

“Allergy is the main cause in 80% of children with asthma”

The prevalence of allergies is on the rise, particularly in developed countries. Why?

It is true that there is a progressive increase in people suffering from a more or less serious allergic disease - this could be due to genetic factors, but also more particularly to environmental factors that encourage the development of these pathologies: life style, diet and environmental pollution, amongst others.

What are the most common allergies in Spain?

According to the latest data, the most frequent reasons for allergology consultations were hay fever (54%), bronchial asthma (23%) and allergy to medicines (17%). At times, allergy symptoms can overlap and cannot be distinguished from other non-allergic diseases, causing both patients and the specialists themselves to become confused. For this reason, it is very important to carry out a good medical record to detect the frequency and length of the symptoms, possible allergens that trigger the symptoms, personal background and family members with atopy, response to the treatments administered to date, etc.

Do all allergies appear in the same way?

Allergic disease can begin at any time in your life and it can take on different forms. It can affect the respiratory tract, causing rhino conjunctivitis and bronchial asthma; or the skin, producing

allergic contact atopic dermatitis, hives or angiooedema. There are also allergies that affect the digestive tract; and when they affect more than two organs or systems, this can cause the most serious case: anaphylaxis. The allergens responsible for these symptoms are also very varied.

Which of these allergies are most complicated to treat?

From my point of view, the most serious case regarding immediate reactions, which are the ones that occur a few minutes after exposure to the allergen, is anaphylaxis or anaphylactic shock to a food, medicine or sting by a hymenoptera. These are unpredictable reactions and they appear suddenly, with no warning.

How are allergies treated?

The most important element in an allergic disease is to identify the causal agent of the symptoms in order to completely avoid them. But this is not always possible to do, and this is when a symptomatic treatment must be carried out, either at the specific moment of the reaction, or over an extended period of time. In some very specific cases, desensitization to a food or medicine may be carried out, which consists of progressive administration of the allergen in order to become tolerant to it. There are also new groundbreaking therapies such as biological drugs that can be useful for diseases such as serious asthma, chronic hives and atopic dermatitis.

How have diagnosis techniques progressed?

The diagnosis of allergic diseases by way of a patient’s skin test dates back to 1873. In recent years, new in vitro diagnosis techniques that do not endanger the patient have been fostered; the best known method is the determination of the specific IgE antigen, quantifying an individual’s degree of allergy.

Does technology play an important role in allergist consultations?

Technology and health have been growing and moving forward together to make our lives increasingly easier. Technological development has helped to create new drugs and treatments, improving medical research and simplifying processes. Technology is important in medicine, not only due to the development of these types of tools, but also due to the benefits that it brings with it, such as an increase in accessibility to medical care.

Can allergies be prevented using genetic components?

Allergic diseases have a clear hereditary component. Several studies have confirmed that children of parents who suffer from allergic diseases (food, asthma, allergic hay fever or eczema) have a greater risk of suffering from this type of disease. This predisposition must be encouraged by environmental factors that push the balance towards tolerance or towards allergy. In

Dra. M. Carmen García Avilés Graduate in Medicine from the University of Alicante. Is a specialist in Allergology and Clinical Immunology and a member of the Allergy to Medicines Committee of the SEAIC. She currently works at the Hospital Universitario HLA Moncloa (Madrid).

the United States, in recent years, several studies have been performed with children who have a high risk of suffering from peanut allergy where they have tried to implement steps to prevent this allergy. Although it could seem shocking, exposing these babies to peanuts can have a favourable effect for the development of a tolerance to the food.

How should allergy sufferers face up to the challenge of spring?

Once a patient knows that they have an allergy to a certain type of pollen, preventive steps are usually effective. In addition, people must think ahead and always keep the medicines, both preventive and symptomatic, recommended by the allergist at hand.

What steps or habits can help an allergy sufferer to make their symptoms milder?

There are several steps to minimise the harmful effects of pollen in the springtime, such as avoiding going outside when the pollen is at its greatest concentration, keeping windows closed or

using sunglasses to protect your eyes from the pollen. Clothing should also be dried inside the house and if using a car, the windows must be kept closed.

Can pollution make it more possible for a person to suffer an allergy attack?

The particles eliminated in diesel engine combustion and heating systems in cities create an unfavourable environment in plants which, to defend themselves, produce “stress proteins” that make their pollen more aggressive, with a greater potential for allergenicity. The high urban pollution levels also prevent the pollen from leaving the atmosphere, generating an “allergenic cloud,” increasing the exposure time in urban areas.

Asthma is one of the most common diseases seen in Spanish allergist consulting rooms.

Asthma is a disease caused by the link between genetic factors and environmental factors. A large amount of environmental stimuli can cause asthma or trigger an

attack. Hereditary elements or atopy (predisposal to suffer from diseases such as hay fever, conjunctivitis or atopic dermatitis) are among the risk factors. Viral infections of the upper respiratory tract or the inhalation of high concentrations of aeroallergens are amongst the triggers. Some medicines can also trigger an asthma attack, along with physical exercise, cold air, environmental pollution, tobacco smoke or stress, amongst others.

So, what is the link between asthma and allergy?

In over half of adults with asthma, and in 80% of children, allergy is the main cause of bronchial asthma. Allergy can cause bronchial asthma in certain people, but not everyone who suffers from an allergy develops bronchial asthma. •

= Several studies have confirmed that children of parents with allergies have a greater risk of suffering from this type of disease.

150 years of history. The English doctor Charles Harrison Blackley started using skin tests to diagnose allergic disease in 1873.

tips for beating allergies 4

Here we share some mechanisms for alleviating the most annoying symptoms of allergic diseases or steps to take to avoid the more serious crises.

1Isolate. To minimise the symptoms linked to allergic diseases caused by outdoor allergens, such as pollen, it is advisable to remain in closed places during the most intense pollination periods, use face masks, clean the filters in your car, wash your hands and face frequently, take special care on stormy and windy days, ventilate the house for a short time, preferably at midday and do not hang the washing to dry outside.

The most important tip when you think you might be suffering from an allergy is to visit an allergist. However, the variety of this type of disease may be overwhelming. Spring is usually a complicated time for those who suffer from pollen allergies, an ailment that affects almost 8 million Spaniards. People living in urban areas suffer most, as pollution accentuates the effect. Here we offer some tips that could be useful if you suffer from any allergic disease, caused by indoor, outdoor or food allergens. •

2

Hygiene. If you suffer from an allergic disease caused by indoor allergens, such as dust mites or animal epithelium, it is important to follow certain hygiene guidelines. Regularly removing dust, not having ornaments that could collect dust, changing bed linen and curtains frequently or using vacuum cleaners with HEPA filter may all be effective measures.

3Prevention. People who suffer from food allergies must be very aware of what they eat and drink. If you have suffered from a serious reaction previously, it is advisable to wear a medical warning bracelet or necklace that allows others to know that you have a food allergy. This will be useful if you suffer a reaction and cannot communicate this fact at the time.

4Medication. Antihistamines counteract the symptoms of allergic diseases, but they are not considered to “cure” them. Therefore, it seems logical to take them “on demand” in terms of the allergic symptoms. However, many allergic diseases, such as hay fever or hives can last over a long period of time and may benefit from continuous treatment. Consequently, the decision to indicate a treatment will ultimately depend on the doctor.

The company reached a figure of 1,425.82 million euros in premium volume and the care companies, led by the HLA Group, invoiced 588.9 million euros

In 2022 the ASISA Group grew and increased its invoicing both in the insurance area, where it obtained a premium volume of 1,425.82 million euros, 7% more than in 2021, and in the care area, where it grew by 10%, reaching 588.9 million euros. With these results, which in both cases mean historic records in invoicing, the ASISA Group continued developing its main strategic goal for 2022: to continue growing and strengthening its capacity to

look after the health and well-being of more families and companies.

The 2022 results were presented at the Advisory Board Meeting of ASISA, which, under the slogan “Mejor ASISA” (better ASISA), brought together the top executives from the company to analyse the evolution of the different business areas and to establish their strategy for the next few years. In the short term, the ASISA Group’s priority will be to strengthen its commercial capacity to continue growing and improving its results; continue strengthening its care capacity through the development of its own network; and to promote a new, more ambitious, comprehensive sustainability strategy, in line with the company’s corporate goals and business. •

The HLA Group’s centres attended 2.5 million consultations in 2022

The HLA Hospital Group attended over 2.5 million patients during 2022; 5.7% more than in 2021. The extension of the care network and of the human team has allowed the care figures to grow exponentially, reaching pre-pandemic levels for many indicators.

Over the past year, 3,500 babies were born in HLA hospitals and 600,000 patients passed through the Accident and Emergency services, 18% more than in 2021. Over 150,000 operations were carried out, with 220,000 admissions in the Group’s centres. The image diagnosis equipment carried out over 880,000 tests and the network’s laboratories completed over 18.7 million laboratory determinations, 1.3 million more than in 2021. •

The ASISA Group has increased its premiums by 7% and its care activity by 10%

Doctor Enrique de Porres, CEO of the ASISA Group.

Brief news

• The ASISA Group has started up an ESG Committee (Environment, Social and Governance) to push forward a new sustainability strategy. The company is promoting an environmental plan to reduce the impact of its activity, limiting its emissions and reducing the use of resources of all kinds in its hospitals, medical and specialisation centres and offices (energy, single-use plastics, paper, food waste, etc). This initiative generates added value for the activity developed by the ASISA Group, as it produces a positive impact on the environment, a central element when looking after people’s health.

HLA Perpetuo Socorro has invested over 10 million euros in its new installations

The hospital has renewed its fourth and fifth floors, which will house the new surgical zone, the childbirth area and sterilisation unit

The HLA Clinic Perpetuo Socorro in Lerida has opened its new installations, in which it has invested 10.3 million euros. The Mayor of Lerida, Miquel Pueyo, visited the new fourth and fifth floors during the opening ceremony along with other prominent personalities, such as Doctor Francisco Ivorra, the Chairman of the ASISA Group. The Lerida hospital, belonging to the HLA Group, is in the middle of expanding and refurbishing its installations. In this first phase the main building has been extended, multiplying its capacity and building a new surgical zone, with a new Intensive Care Unit and a childbirth area. After the extension and the construction of the new areas, the

hospital now has 7,500m2, housing five operating theatres equipped with state-of-the-art technology, eight post-surgery resuscitation booths, an area for endoscopies and out-patient surgery, a new sterilisation zone, as well as two delivery rooms. In a second phase, the refurbishment and renewal of the current hospitalisation area is planned, as well as the accident and emergency area, outpatient consulting rooms and imaging diagnosis service. •

The UR Group is celebrating its 40th anniversary

• ASISA has signed an agreement with mediQuo, a leading start-up in tele-medicine in Spain, to extend its tele-medicine services and to continue developing its commitment to offer its policy holders the most complete, comprehensive care possible. Present in Brazil, Mexico, Ecuador and Argentina, mediQuo offers patients the chance to talk with doctors by chat or video call and receive an immediate answer.

The UR International Reproduction Group, one of the most important assisted reproduction providers in the country, is celebrating its 40th anniversary. With 100% Spanish capital, the group has achieved 14,000 assisted reproduction cycles in Spain, with successful in vitro fertilisation reaching a rate of 90% or 95% in egg donation, figures that are above the annual standards published by the Spanish Fertility Society (SEF). It has 13 clinics in Spain, two in

Mexico and one in Managua (Nicaragua). “We started our work in the world of reproductive medicine with a strong, innovative commitment towards the patients. Since 1983, when we opened our first semen bank in the Valencian Community, the work in our units has been growing constantly and exponentially every year in reproduction cycles, success rates, technology, number of centres, as well as in the growth of the professional teams that make up the

group. At present, we have 16 clinics and the opening of another two in Barcelona and Seville is planned for 2023,” affirms Doctor José Jesús López Gálvez, Manager of the UR Group. •

The inauguration ceremony was attended by Dr. Francisco Ivorra, president of the ASISA Group, and Miquel Pueyo, mayor of Lleida.

Doctor José Jesús López Gálvez, director of the UR Group.

A new branch of Assistència Sanitària has

been opened in Vic

The installations are located in the city centre shopping area

Aimed at continuing to strengthen its implantation in Vic and its area of influence, Assistència Sanitària has opened a completely refurbished branch in the city centre shopping area. The opening ceremony of the new office was attended by the Mayoress of the city, Anna Erra, and the Chairman of Assistència Sanitària, Dr. Ignacio Orce.

According to Erra, as has become obvious during the implantation time of Assistència Sanitària in the area, “Vic needs an initiative which, after 60 years, is growing and improving.” Accordingly, the city, which has a long history of commitment to knowledge and this year will see its first graduates in Medicine from its University, has been designated to promote health

care and social innovation projects to improve the health and quality of life of its citizens. Dr. Orce emphasises the organisation’s roots in a region that has its own unique point:

the large number of people who place their trust in the company to look after their health and the new location of the branch, central and in an emblematic building that gives priority to convenience and accessibility.

The spaces in the branch will be used for the usual administrative steps (information, operation and contracts) and they are the result of a new open-plan design that is more functional, up-to-date, designed to optimise the activity and improve accessibility, flexibility, convenience and ease of use. This new model is marking out the guidelines for future operations on the organisation’s network, which has 21 customer service points around the area where it develops its activity. •

Success of the post-discharge telephone monitoring programme for out-patient surgery at the Hospital de Barcelona

In recent years, we have seen an increase of larger operations within outpatient surgery and many of the short stay operations are now carried out without hospital admission. In view of this fact, in 2018 the personnel from the Outpatient Surgery Unit at the Hospital de Barcelona started a telephone monitoring service of the evolution of the patients when they had been discharged and returned home.

Patients who have had general surgery (hernioplasty and proctology), paediatrics, otolarngology and breast surgery, orthopaedic or shoulder surgery are included in the post-surgery control.

The post-outpatient surgery control is carried out by a telephone call by the nurse to the patient in order to evaluate different parameters related to pain,

fulfilment of the analgesic guidelines, general condition, problems in the surgical area and detection of warning signs, at the same time as taking advantage of the call to resolve any queries that the patient might have.

The results of the monitoring allow new requirements in the post-operatory period to be detected and to implant steps such as the adaptation of the analgesia guidelines. The study of the data collected from October, 2021 to October, 2022 shows that, according to the 352 calls made during this period, 84% of the patients gave a highly positive valuation to the initiative. Likewise, a total of 67incidences were detected, mainly related to the pain during the first hours, for which an adaptation of the analgesia

guideline was given by the doctor in charge, both prior to discharge and once at home. •

The branch is located at Rambla Hospital, 1, a few meters from the iconic Plaça Major.

Assistència Sanitària opens its scholarship application period for health professionals

The aid for students covers 50% of the registration fees and the training offer includes almost 500 masters and postgraduate courses

During this 2022-23 academic year, Assistència Sanitària is presenting the 15th edition of its scholarship programme for a value of 30,000 euros in third cycle studies at Catalan universities. The aid covers 50% of the registration fees and the training offer includes almost 500 masters and postgraduate courses in the health field.

The candidates must present their applications following the procedure described under the heading of scholarships on the Assistència Sanitària website, where the details about the information to be provided to complete the form and the applicable legislation are specified. The deadline date for presenting an application is the 12th of May, 2023.

As an organisation made up of doctors, Assistència Sanitària’s main goal is, on the one hand, to ensure that they can exercise their profession in the best possible conditions, and on the other, to offer quality health care. The scholarships allow health professionals to boost their careers, which is the reason behind the praise received over these fifteen years from the medical and university communities. •

High levels in specialities at the Hospital de Barcelona’s medical seminars

The Hospital de Barcelona has prestigious professionals and it takes charge of the scientific dissemination and the up-dating of knowledge of the medical community is concentrated around it. Likewise, in addition to its educational programme, on an annual basis, it holds meetings on current issues aimed at a professional audience. Now, back to an on-site format, in 2023 two top level sessions have already been scheduled.

The 7th Seminar on Orthopaedic Surgery and Traumatology (21st of April, 2023), this edition devoted to vertebral osteoporotic fracture, is the prelude to the 11th Seminar on Pregnancy Health (16th of June, 2023), which will cover different subjects such as sport, diet, breast feeding and even post-cae-

sarean rehabilitation. In the case of both seminars, an audience made up of doctors, nurses and other health care professionals will take advantage of these opportunities to up-date their knowledge and ongoing training. •

• Assissenior is an exclusive medical centre, for people over the age of 75 years, which is aimed at improving the care quality and ease of access to specialised monitoring. The centre is located in a large area of 1,400 m2 in the heart of Barcelona, within the Assistència Group medical centre.

• In line with other actions carried out in the Hospital de Barcelona building, the speciality consulting rooms have been moved to the fourth floor. CAIVAS (comprehensive traveller care), CERI (high risk pregnancy), CLIGUR (genitourinary and rectal infection) and CLIO (osteoarticular infection) have their own new spaces equipped with a patient care desk and waiting rooms.

• To mark Women’s Day, Assistència Sanitària and the Hospital de Barcelona presented several activities, amongst which the interview with Dr. Roser Cid Pañella for the YouTube channel (see QR code) and the opening of the conference cycle Health with a gender perspective to analyse and make visible the inequalities in the health care area stood out.

Third cycle students from Catalan universities can benefit from the aid.

Social economy as an agent for sustainable development

The Law on cooperation for sustainable development was passed by overall majority in the Congress.

Social economy, understood as all the economic and business activities that pursue general interest as a whole, is present in many sectors of activity. It may also be found in the field of development cooperation, where principles such as the primacy of people over capital, transparency, democracy, solidarity and social cohesion, endow this business model with an added value.

This is acknowledged in the Law on sustainable development and global solidarity, recently passed by the Congress of Deputies by overall majority. Once again, Spanish legislation is a pioneer in the designing of public policies to

support the social economy, such as the one that back in 2011 established the first law on the social economy in Europe. Companies in the social economy are commi-

Support to Ukraine cooperatives

The consequences of the war in Ukraine are catastrophic, from the human point of view, as well as economically and socially. After many months of armed conflict, the country’s network of cooperative companies has also suffered drastic effects.

COOP Ukraine, the national entity that groups the sector together, reveals the serious problems that companies are suffering from in order to develop their activity. In the most conflictive areas, many buildings and business installations have been destroyed or are in a precarious condition. Additionally, the instability of the energy sources and power cuts, hinder communications or food refrigeration activities, amongst many others.

“In the liberated territories, our people are returning to work,” explains Illia Gorokhovskyi, president of the employers’ cooperative of Ukraine, “in spite of the danger and the difficulties, we are trying to provide the local population with the basic necessities.” The president of the employers underscores a specific need for companies: electricity generators with a capacity of between 4 and 10 kilowatts.

The entity led by Gorokhovskyi has created a solidarity fund to receive the international aid intended for the affected cooperatives and it has designed the necessary protocols to ensure the transparency of the process and to guarantee that the funds reach the areas where they are needed most. •

tted to the 2030 United Nations Agency and they are characterised by their economic and social transformation capacity in line with the Sustainable Development Goals (SDG). This transforming vocation is extended to developing third countries through the start up of development cooperation projects or business internationalisation.

Following the recommendations by international organisms, such as the European Union, the International Labour Organisation or the Organisation for Economic Cooperation and Development, the new law includes “promoting public-private alliances with social economy entities in order to fulfil the SDGs in member countries and the dissemination of good practices in sustainability” amongst its goals. •

The banking data to contribute with Ukraine cooperatives is:

Ukrainian Central Union of Consumer Societies

IBAN: UA423052990000026002016718688

SWIFT: PBANUA2X

JSC CB “PRIVATBANK”, 1D HRUSHEVSKOHO STR., KYIV, 01001, UCRANIA

A consolidated sector over the past 20 years, over 160 cooperation projects have been performed in 46 countries, according to a report by CEPES.

What will future health workers be like?

Personalisation, specialisation, cooperation, artificial intelligence… These are some of the concepts that appear in analysts’ predictions. Let us X-ray the sector, looking for answers.

by Víctor Farradellas

The health care profession is evolving at great speed, in line with the changes that are occurring in different areas of society. Health care professionals have been witnesses and have played leading roles in the development of diagnosis methods, treatments and technological advances in recent decades. A changing scenario that affects different generations of professionals. Faced with this uncertain backdrop, can we see what future health care professionals will be like?

A good tool for making a prediction of how future health care professionals will work consists of seeing how they are developing their work today and the challenges they are facing. This X-ray of today’s health care sector has been made using the latest data published by the Spanish National Statistics Institute (INE). According to this independent organism, the number of registered health care professionals in Spain reached 923,207 in 2021; 2.8% more than in the previous year. The data also shows the prevalence of women in the profession with 633,941 women compared to 289,266 men. In 2021, there were more women registered than men in 13 of the 15 professions analysed. The groups with the highest percentage of women were: speech therapists (93.5% were women), occupational therapists (90.4%) and nursing (84.2%).

Therefore, a first conclusion that we can reach is that in the near future most health care professionals will be women. Specifically, 70% of new doctors are women, which is a new development compared to previous generations. Both in the practical field and in the research area, female prevalence could bring new methodologies and leadership methods to the sector.

If we analyse data from the INE report in detail, we can see that within the group of health care professionals, the largest group is of nurses (330,745, making up 35.83% of the total), followed by doctors (283,811 –meaning 30.74% of the total) and that of pharmacists (78,128, with 8.46% of the total). If we compare this data with figures from the previous year, we see that in 2021, 7,619 new doctors, 5,727 new nurses and 1,307 new pharmacists were registered. It is significant to observe that the

largest increase in professionals compared to previous data occurred in biologists specialising in health care (625, a 16.6% rate of change compared to 2020), occupational therapists (6,782, a 15,5% rate of change compared to 2020) and chiropodists (9,049, a 9.9% rate of change compared to 2020).

Another interesting piece of information offered by the INE is the proportion of registered health care professionals by age. The largest percentages of health care professionals under the age of 45 years are found in occupational therapists (91.1%), physiotherapists (81.0%) and chiropodists (72.9%). On the other hand, the health care profession with the lowest rate for people under the age of 45 years is medicine. What is more, this group includes the highest percentage of professionals over the age of 60 years (21.8%).

GENERATION SHIFT

This data shows other evidence: in a few years’ time the medical profession will face a generational shift, as the jobs of the retiring professionals will have to be covered. However, this does not mean that the new doctors will all be young. In recent years, we have seen a growing trend of mobility of health care professionals between countries. In 2021, over 4,000 Spanish graduates applied for the certificate to be able to work abroad, at the same time as 4,293 non-EU doctors arrived in Spain. Depending on the evolution of the sector’s funding and the legislation regarding the homologation of qualifications, we could see an increase of professionals from other countries, while Spain’s own talent drain continues to travel to other climes.

Finally, if we look at the rate of registered professionals in relation to the number of inhabitants, we can see that the rate of registered doctors was 5.99 per 1,000 inhabitants and 6.98 nurses per 1,000 inhabitants. The highest rates of registered doctors appeared in Aragon (7.25 per 1,000 inha-

Distribution of health personnel

The latest data published by the National Institute of Statistics on the number of registered health professionals in Spain correspond to 2021. We reproduce the most significant, which offer a portrait of the profession today and allow us to project the near future.

Registered health professionals by age. Year 2021.

Doctors by communities. Year 2021.

Collegiate health professionals by profession. Year 2021.

Registered health professionals. Year 2021(rates per 1,000 inhabitants)

by communities. Year 2021.

70% of new doctors are women, who are also the majority in 13 of the 15 healthcare professions analysed.

Evolution of the offer of Specialized Health Training (FSE) places

10.246

10.626

11.171

9.539

2019202020212022

bitants), the Community of Madrid (7.13) and the Principality of Asturias (7.00); while the highest rates of registered nurses per 1,000 inhabitants were recorded in Navarra (11.15), Cantabria (8.82) and Extremadura (8.13).

Although the ratio of doctors per inhabitant puts Spain in a good position (amongst the top 15 in the world according to the World Bank), this does not mean that these doctors are working in optimum conditions. All the countries in the European Region of the WHO are currently facing serious challenges related to health and care personnel. According to the Health and Care Workforce in Europe Report: Time to Act, it is essential for European countries to invest more and better in the health care sector, as the cutbacks in recent years have caused difficulties when attracting and retaining talent, increasing the international mobility of professionals and it has contributed to generating imbalances in the teams and inefficient organisation systems, which are translated into bad planning strategies.

PRIVATE MEDICINE

A reduction in public funding combined with an increase in demand due to the aging of the population and the high prices of pharmacy expenses are determining factors that affect the public health system. Accordingly, between 2018 and 2021 private health care professionals increased by 7%. If this situation is not reversed, the proportion of professionals and patients who opt for private health care is going to grow over the next few years. This case is particularly obvious with regard to mental health, where private psychology consultations have increased exponentially when people are faced with the impossibility of gaining access to public psychologists within a reasonable time period.

Beyond the statistic data collected by the INE, there is no register of doctors in Spain, something that professional associa -

The first operation using an anaesthetic

The ancient Chinese texts ‘Records of the Three Kingdoms’ and ‘Book of the Later Han’ record the feat by the doctor Hua Tuo, who it seems carried out several surgical operations without causing any pain to his patients. To do this he used an anaesthetic called mafeisan, made from herbs, probably with cannabis amongst them, and wine. His renown spread like wildfire in the China of the Han dynasty (2nd century) and his great influence overshadowed the following generations of doctors.

5 milestones in the health care profession throughout history

John II of Aragon’s cataract operation

Although Egyptians, Babylonians and Indians had already carried out eye operations, the first famous, documented case of a cataract operation in Europe can be found in the 15th century. Specifically In 1468, when King John II of Aragon, also known as John the Faithless, decided to undergo an operation to recover his sight. For many years, he had suffered from virtually complete blindness and he visited the Jewish doctor based in Lleida, Cresques Aviatar (or Abiatar, according to other sources). The doctor used a needle to move the lenses of the king’s eyes… without using any anaesthetic. John II recovered the sight in both eyes.

tions of health care workers have been demanding in recent years. In this context, another source that provides information on the trends within the sector is the offer of places for Specialised Health Care Training (FSE), which gives access to residencies in several health science specialities (biology, biochemistry, nursing, pharmacy, physics, medicine, psychology and chemistry).

During the 2022-2023 academic year, a total of 11,171 FSE places were offered, amongst which there were 8,550 places in medicine; 1,961 in nursing and 308 in pharmacy, amongst other specialities. In overall figures, the number of places increased by 5% compared to the previous year and is 39%

more than five years before.

With regard to university studies, health is the branch most requested by students. According to the CYD 2021/2022 report, during the academic year of 2021-2022, there were five applicants for every place in this field, reaching 12.7 applications per place in medicine.

If we look at the profile of the university students in health care disciplines, their high level of knowledge stands out (in general,

»

In Europe, the number of patients and professionals who opt for private medicine has grown in recent years due to the collapse of public health systems.

Miraculous ointments

The historian Sharon T. Strocchia writes in Forgotten Healers (Yale University Press) that in Renaissance Florence, apothecary nuns were an essential element of the health care culture. The preparation of remedies required knowledge of the theoretic treaties and carrying out practical adaptations according to the nature of the patients. A skill and knowledge that had to live alongside an unwavering endurance, as often they had to bear the foul odours that their preparations emitted. Their work was essential for relieving pain for the incurable diseases that proliferated in plague-ridden times.

The birth of modern nursing

After serving in the Crimean war as a nurse, Florence Nightingale led a campaign to improve the quality of this discipline in military hospitals. Her determination led to the creation of a military medical university In 1857. Four years later, she managed to raise the money to found the first nursing educational institution: the Nightingale school and house for nurses at St Thomas’ Hospital in London.

A revolutionary fungus

The world we know today would not be the same without antibiotics. The history of these drugs that are used to treat infections dates back to 1928, when Alexander Fleming discovered penicillin. The Scottish doctor and scientist observed how a sample of the fungus Penicillium completely stopped the growth of a bacteria. 10 years later, Howard Florey and Ernst Chain continued with the research and the use of penicillin against infections became extended from the 2nd World War onwards. In 1945 Fleming, Florey and Chain were acknowledged with the Nobel Prize for Physiology and Medicine for the discovery of penicillin.

they must pass high cut-off marks to get a place) and their good preparation in specific competences. The demands of the sector (both due to density of knowledge and to the dedication in hours it requires) mean that not all families can take on the costs of this extended training. Accordingly, the scholarship programme by Assistència Sanitaria, aimed at third cycle students in Catalan universities and that covers up to 50% of the registration fees, is trying to democratise access to the profession. It is one of the few study aid programmes in the health field, consolidated and funded completely by a private institution in Spain as a whole. Since its creation in 2008, 3,758 applications have been received,

with 434 grants being given out and awarding almost 410,000 euros. According to the report ‘The inevitable change: anticipating a new scenario for the medical profession’ prepared by the consulting firm Luzán Cinco, the university plays an essential role in the development of the medicine of the future, as it must operate a change in the study plans to strengthen and broaden subjects related to statistics, computation, humanism

or bioethics. Basic knowledge in areas such as genetics, proteomics, biomics or computing will all be essential. Therefore, health care professionals will have to train in these new competences, which must necessarily be incorporated to the teaching programmes. Interaction skills with other professionals will also be a key element: team work, communication and leadership skills, as contact with other types of professionals will be much more common: physicists, engineers, biologists, computer scientists… They will all have to acquire languages and skills to understand each other.

SWithout any doubt, technology, which has been conquering spaces in all areas of society, will be a leading player in future

When the technological advances seem bound to turn health care upside down, we should go over some of the milestones from the past in which advances were made that contributed to the profession.

»For the health workers of the future, it will be key to acquire new skills and acquire languages to understand each other with other professionals: physicists, engineers, biologists, computer scientists...

In depth

health care. The application of technological advances will allow the doctors of the future to improve their management of the information and be more practical. To do this, adaptation skills will be essential to master the possibilities of artificial intelligence, portable devices, precision medicine and virtual care.

Along these lines, the neurologist, businessman and speaker, Ignacio Hernández Medrano, considers that: “Medical information is accumulating fast; we are generating more and more medical information and we have created something that we could call knowledge inflation. We generate more than we can absorb.” Medrano is one of the founders of Savana, a company that uses technology, artificial intelligence and big data to take advantage of the information from patient clinical notes and put it at the disposal of doctors and researchers. “The digital health that seems so innovative today is going to cause enormous democratisation; we are going to raise health standards a great deal more than the experts can anticipate.”

However, according to the neurologist not everything is going to be positive: “All of this is going to have a cost: stress. We are going to pay very close attention to our health, our illnesses, our vital signs, just as today we are hooked to our mobile phones. I think that the era of hypochondriacs is on the way.”

Without any doubt, the trend is showing a move towards a faster, inexhaustible and stressed society, a breeding ground that favours stress, anxiety and burnout in which both doctors and patients must learn to protect and look after their physical and above all, mental health.

Medrano explains that “what is going to change now is that, to a certain extent, we can apply very powerful algorithms to anticipate the occurrence of an illness. Using this predictive model, when something changes in your organism, although you may not have noticed it, it will be recorded and the

professionals can act accordingly.”

The other concept that Medrano underscores is personalisation: “Each person has a genome, a set of genes and a microbiome, a set of bacteria that live inside us. All of this determines our response to the environment or even to drugs. In the future, we will be able to apply precise medicine, individualised to each patient’s requirements. We are no longer going to prescribe paracetamol to everyone who has a headache, but rather a much more personalised medication. And this is not a dream, it is already happening in some disciplines and the rest will follow over the next few years.”

ARTIFICIAL INTELLIGENCE

Another pioneer initiative has been started up by the Portuguese entrepreneur, Luis Valente, CEO and co-founder of iLof, a start-up that is using AI to build a digital library of disease biomarkers. The information obtained can help to reduce the cost and time invested in the development of medicines and speed up clinical trials. Valente explains that: “after carrying out over one hundred interviews with world experts in pharmaceutical and biotechnological companies, my colleagues and I saw that the potential of AI could be used to speed up the selection of patients in clinical trials and, in the future, allow the right medicine to be chosen for each one.” Valente continues: “Over the last centuries, new treatments have been developed based on the idea that medicines work the same for everyone. Unfortunately, as we well know, this is not the case, leading to millions of patients having to continue living with complicated, heterogeneous and incurable diseases.”

iLoF’s aim, in the words of its founders: is to be “a world reference in the democratisation of access to personalised medicine and to do this we have created a platform based on automatic learning algorithms (machine learning and deeplearning) that make use of optic

signals to allow the detection and identification of nanostructures dispersed in biological fluids.” In 2020, the start-up had raised 2.4 million dollars and the same year, Valente and his partner, Joana Paiva, were included on the Forbes 30 under 30 list in the science and health sector, which distinguishes the 30 most promising entrepreneurs under the age of 30 in Europe.

The health care professionals of the future will have to incorporate technology as a work tool, but they

»According to the neurologist Ignacio Hernández Medrano, thanks to the use of artificial intelligence, healthcare workers of the future can anticipate the occurrence of a patient’s disease.

must also be able to uphold the human side of the profession. Beyond the fact that artificial intelligence will become a normal tool, both for doctors and patients, the role of the doctor will be to take decisions and know how to communicate them and explain them to the patients and their families. The health care professional of the future will have to handle much more sophisticated equipment and devices, which will require a greater specialisation in some fields of knowledge. These people will be super-specialised, but at the same time, they will be knowledgeable about each patient’s circumstances for a correct coordination of the care that will be more multidisciplinary than ever before.

Finally, within the context of managing a large amount of in -

In first person

”We will be able to get ahead of complications because the data analysis will be more automated and more complete. But I have no doubt that the essence of the health care profession will be the same: the figure of the professional who helps and gives hope will still be necessary”.

Dra. Sandra Mechó, Radiologist

»“The technological, scientific advances, artificial intelligence and digital health are directing us towards a more predictive, preventive, participative and personalised medicine. The medicine of the future will be more precise and safe, but this will probably be at the expense of the profession’s humanistic values”.

Dr. Pedro Barrios, Cancer surgeon

formation that is generated at top speed, scientific communication will have to be more solid than ever to fight against fake news and misinformation. This is a lesson we have learnt from the pandemic, as in the words of the Public Health professor from the UB, Antoni Trilla, “If people believe things that are not true, they could take on a type of treatment that does nothing, or stop doing things that are fully recommended. In this situation, I think that as never before in history, due to the time and amount of people involved, we have attended this conflict, so to speak, surrounded by proven information, information that still could be doubtful and information that is relatively or completely false”. •

»“In the future it will be normal to print medicines with 3D printers. The drugs will be prepared with the exact dosage and components required by a patient with a specific ailment”.

Marta Cuenca, Pharmacist

»”As a child I saw doctors as venerable white-coated gentlemen who treated my ailments in a pleasant manner, calming my parents; I think that was the point I decided to become a doctor. Society is constantly evolving and I fear that in the future little of nothing of the humanistic side of medicine will remain”.

Dr. Ferrán de Vargas Solé, General practitioner

The new SEVILLE

An impressive heritage that has been brought up to date, works of art in 3D, new cultural spaces and even space tourism: the city has reinvented itself to make travellers fall in love with it more than ever before.

by Neus Duran

island, is an invitation to immerse yourself in exciting stories of sailors. You should not miss the views from its lookout tower..

With an incredibly rich architectural heritage, an unbeatable folklore and a city full of perfectly instagrammable charming nooks and crannies, Seville could easily have decided to live off the rent guaranteed by its undeniable attractions. Nothing is further from the truth: many years ago it decided to look to the future and reinvent itself with innovative proposals and a defined green spirit.

A commitment that has already given fruit, as it has become the third most visited city in Spain and the one that is seeing the greatest boom in tourism, as well as being

the host for the Goya Awards and important sporting events. As if this were not enough, it has been chosen to house the central offices for the Spanish Space Agency and honours and awards are being bestowed on the city left, right and centre; the latest being the distinction of European Capital of Smart Tourism 2023 by the European Commission.

Amongst the merits that have made it deserving of this award, its increasingly bike-friendly nature stands out, with an extensive network of bike lanes covering over 180 kilometres, benefitting from the city’s privileged weather and

terrain. There are many guided visits for groups of cyclists, but we can also pedal around any of the tourist routes designed by the city council on our own. On two wheels, we will discover some the city’s greatest attractions, such as the iconic ‘Torre del Oro’, on the banks of the Guadalquivir river, where the gold that came from the Americas was stored and that now houses the Seville Naval Museum, or the ‘Palacio de San Telmo’ which has recently been restored and opened to the public.

American history

The largest gothic cathedral in the world cannot be left off this route, where Christopher Columbus lies, as well as the Archive of the Indies, which houses over 8,000 maps and manuscripts by Columbus, Hernán Cortés or Pizarro.

We can also ride our bikes around two of the most emblematic districts of the city: Triana, with its pottery workshops and flamenco singing shows or ‘tablaos’, or San-

The ‘Pabellón de la Navegación’, on the Cartuja

ta Cruz, full of typical Andalusian patios, colourful flowerpots and picturesque nooks and crannies.

One of the spaces that will become a new spotlight for tourists is the house where Velázquez was born. The house where the artist was born in 1599, at the time when trading with the Americas was in full swing, has been conserved next to the Cristo de Burgos square. This year, coinciding with the four hundredth anniversary of the painter being called to the Royal Court, it

From Seville to space

Space travel without having to be an astronaut? Space tourism is planned to start in 2024 from Seville. Organised by EOS-X, the flights in pressurised capsules will rise 40 km above the Earth, with a cost of 150,000 euros and lasting five hours.

will become an interactive cultural centre, which, using latest generation technology, will take us closer to some of his paintings and will invite us to discover them from a very special point of view.

Another of the long-awaited openings this year is without any doubt that of the ‘Centro Magallanes de Industrias Culturales y Creativas’ (ICC – Magallanes Centre for Cultural and Creative Industries), which will open to the public coinciding with another important date: the five hundredth anniversary of the first around the world journey. With 10,000 square me-

Las Setas, the largest wooden structure in the world; on the right, tourists on bicycles in front of the remodeled Palacio de San Telmo; below, the alley of the Inquisition.

tres, it takes up half of the space in the historic Royal Artillery Factory of Seville and it will have an agenda full of cultural activities.

Gastro bar with a view

These new spaces have been added to others opened in recent years and that have become icons of the Andalusian capital city, such as the Metropol or Las Setas, the largest wooden structure in the world. A good example of how the city is combining historic heritage with fashionable proposals. In its lower part, amongst others, it houses the Antiquarium, with Roman remains and on the upper part, a gastro bar with panoramic views.

Fans of Game of Thrones will enjoy a visit to the Royal Alcazar of Seville, with all the charm of the Mudejar art of Al-Andalus, where they will be able to visit the ‘Patio of the Maidens (Patio de las Doncellas) or the gardens, which were used as the fictional region of Dorne in the television series. •

THE BENEFITS OF BOARD GAMES

by V. F.

As well as being just a pastime or a leisure option, board games are a good ally for improving wellbeing and slowing down cognitive deterioration.

The Dutch historian Johan Huizinga wrote that playing is a necessary prerequisite for generating culture in any human society. An expert in Indo-European languages and medieval history, in 1938 Huizinga published Homo ludens, an essay in which he defended the importance of games as a backbone activity in the education of any individual and in the configuration of any advanced culture. His thesis would seem to be plausible if we think about how children start to understand the world and their limitations through simulation and trial and error, two characteristics that are intrinsic to games and playing.

History offers us dozens of examples that show the close link between games and civilisation. Archaeologists who have worked on sites in the Middle East have uncovered objects from 8,000 years ago that very probably were game boards. The Egyptian game senet goes back to 3100 B.C. In the Far East, weiqi (China) or Go (Japan) have also been played for time immemorial. Without forgetting the origins of chess, which are lost in the mists of Indian history.

But in addition to their close links to culture, board games have

been shown to be a good ally when improving our emotional and social well-being. The clinical psychologist Antonio Gata emphasises that board games test the capacity of children, teenagers, as well as adults when solving problems, making decisions, managing frustration and dealing with mistakes. In fact, board games can be used to work on all areas of learning, virtually without this being realised. In one way or another, both children and adults develop our cognitive, affective, social and psychomotor capacities during each game.

Enjoying games in company will allow us to disconnect from screens and strengthen links with our loved ones. Work, school or everyday duties can raise obstacles when spending time with the people who mean most to us. Young children socialise by playing; therefore sitting down around a table to play a game can be an attractive proposal for them. It is an option that does not need planning and that can bring great benefits. In addition to strengthening social connections, each participant has the chance to work on their memory, logic and reasoning, as well as encouraging their concentration capacity over a short period of time.

Catan: the game that changed everything

In 1995 a game was launched that marked a before and after: Catan. With over 22 million copies sold all over the world today, this game has been translated into over 35 languages and has published over 40 expansion packs and special editions... They have even marketed socks, t-shirts and cuddly toys from the game.

Klaus Teuber is behind Catan’s success, a dental technician who worked in a dental surgery on the outskirts of Darmstadt, Germany. A fan of both board games and fantasy literature, he thought up an ingenious system of hexagonal tiles which, once joined together, formed the board. Each of these tiles showed a different landscape on which the players could collect resources: wood from the

Jenga, a game of skill patented by Leslie Scott, challenges us to remove wooden blocks from a structure and place them back on top without it falling over.

forests; stone from the mines; clay from the hills; sheep’s wool from the pastures and wheat from the grain fields. With these resources, players build roads, settlements, cities and different forms of development in which cooperation and negotiation between rivals is essential. The goal behind all of this is to reach a winning 10 points.

Catan was a commercial and cultural success. Klaus Teuber’s design was the spearhead of the so-called modern board game, a reflection of society at the end of the 20th and the beginning of the 21st centuries. An explosion of creativity, both in the game mechanics and in the art that decorates them, seducing millions of people all over the world.

According to data from the Spanish Neurology Society (SEN), in Spain there are over half a million people suffering from dementia, a figure that could reach over a million in 2050 if we take into account the latest estimates. Several studies confirm that taking part in board game sessions can delay the advance of cognitive deterioration. A study by the Institute of Biomechanics of Valencia found that the risk of dementia was 15% lower in board game-players than in non-playing people over a period of 20 years, concluding that stimulant leisure activities are considered as possible protecting factors against dementia and cognitive deterioration.

Strengthening the mind

Furthermore, many games test the creative and analytical thinking processes, activating both hemispheres of the brain. Even the simple fact of learning the rules and playing a new game can help to strengthen the mind, according to the Central Connecticut State University. This impulse in the intellectual capacity has also been confirmed by a study by the University of Wisconsin-Madison, in which the participants taking part in cognitive activities, such as card games, showed greater brain volume in specific regions, in comparison to the other participants who played fewer or no games.

The variety of options within the universe of board games means that each person can find topics and mechanics that they feel more comfortable with. Beyond the classic proposals (chess, cards, Scrabble, Risk, Monopoly, etc.), the sector has experienced a true revolution in recent years that has brought hundreds of new titles to the shelves of specialised shops. A small victory of cardboard and wood in the era of technology boom. •

THE IMPORTANCE OF DIET FOR BONE HEALTH

by Laura Martos

When we are young, our diet is based on dairy products, which contain proteins with high biological value and they are the main dietary source of calcium, necessary for a correct growth and development. But, should we continue to supply calcium to our body on reaching adulthood?

Our bones fulfil some of our body’s most important vital functions. They support us and help us to move, but they also protect our organs and they store the nutrients and minerals that keep us alive. Maintaining good bone health, therefore, contributes to preventing pain, fractures or serious physical ailments that could restrict a person’s mobility.

At birth, calcium is the main nutrient that carries out this function, which we ingest through breast milk. In fact, although the amount of calcium that we must eat depends on factors such as age and sex, once the age of four years is reached, it stabilises at between 1000 and 1500 mgal per day, depending on each stage of life.“The main role of calcium

once we have reached a developed phase, is to provide stability and strength to the skeleton in order to maintain a correct functional structure. It is also necessary for carrying out regulating functions; allowing muscle contraction, cellular metabolism, nerve transmission, blood flow or the production of hormones and enzymes for different functions of the body,” Sonia Vallés, a nutritionist from the Hospital de Barcelona explains.

Vallés adds that in spite of the fact that the adult diet should not focus on calcium absorption, some minimum parameters should be met.

We are talking about 1000mg that must be included in our daily intake

Alternatives to dairy products

The main source of calcium in the diet is milk and its derivatives. However, there are other foods that we can also incorporate into our diet as complementary items (and even as replacements in the case of lactose intolerance). This is the case of fish, particularly small fish with edible bones such as sardines; green-leafed vegetables, such as cabbage, Swiss chard, leeks, etc; legumes, dried fruit and nuts and even some fresh or dehydrated fruits. There are also some calcium-enriched products currently on the market which, along with an input of vitamin D, allow their properties to be absorbed effectively.

to ensure that a minimum, (normally between 30 and 40% of the calcium consumed) may be absorbed and fulfil its strengthening and protecting functions. “We recommend that this dose is consumed through dairy products, as they are an easily accessible source of calcium and the presence of dairy foods encourages the absorption of this mineral, although some vegetables and other foods are also sources of calcium,” the doctor affirms.

UNABSORBED CALCIUM IS EXPELLED

According to a report by the International Osteoporosis Foundation, currently almost three million people suffer from osteoporosis in Spain, of which 79.2% are women.

In this context there are two factors that determine bone health, particularly on reaching the age of fifty years: physical activity and diet. The WHO recommends 150 minutes of moderate aerobic activity per week and Vallés recalls the importance of a controlled diet.

“The diet should provide, above all, an optimum amount of calcium, vitamin D, vitamins from the B group, magnesium, phosphorus and proteins. For this reason, it is important to follow a varied and balanced diet, which should include milk and dairy products, green-leafed vegetables such as broccoli, rocket or cabbage, dried fruit and nuts, seeds, legu-

mes, eggs, fish and a smaller proportion of red meat. All of this is based on a controlled intake of salt in the diet and the consumption of caffeine, in addition to not exceeding the intake of protein from animal products, which will modify the food’s bioavailability. “It is a phenomenon that in layman’s terms we could say is “robbing” our calcium. This refers to the fact that some foods prevent the correct absorption of the nutrients that can be used in the different functions of the organism. Salt, the caffeine and alcohol are the main enemies, although the intake of foods with high fat levels, very rich in fibre or substances such as oxalates, phytates or tannins should also be monitored. Smoking also has a lateral affect on calcium absorption, causing a higher percentage of expulsion through stools and urine.

On the other hand, it is important to take into account that there are nutrients that allow us to increase the effectiveness in the absorption process, which is just as necessary as calcium itself. Vitamin D, for example, is the best ally for a good absorption and we can find it in foods such as oily fish (tuna fish or salmon), in fish oil, liver, cheese, egg yolk and in some derivatives, such as enriched cereals. Vitamin B12 is also a good option and may usually be found in animal products in general.

Finally, just the right amount of protein provides a source of essential amino acids that are necessary to sustain bone development; therefore an intake of up to around 1.5 grams per kg of body weight per day is highly recommended. •

ANTIOXIDANT POWER

Enotherapy, using wine to tone the skin

This therapy uses products based on the grape fermentation to create antioxidant treatments that care for and tone the skin.

Wine has always been a cultural and religious symbol closely related to the concept of giving life. In the Bible, in fact, it is considered a symbol of prosperity that is even equated to the blood of Christ. When we talk about wine therapy, we are also

DISCONNECTION

Reinas sin reglas

Bàrbara Munar, Grijalbo

During menopause and the climacteric, the woman’s hormonal system is altered and causes physical and psychological changes that can be better or worse depending on the habits that are taken. Reinas sin reglas. Claves nutricionales para la salud femenina a partir de los 40 años answers the most frequently asked questions about weight, energy, hot flashes or sexual desire at these stages of a woman’s life.

referring to the use of wine and its antioxidant substances to counteract the effects of aging. This too has some historical tradition, going back to 17th century wine therapy in France, where the use of wine to bring out the rosy color of the cheeks became fashionable. Centuries later, there are many beauty products that use its compounds to hydrate the skin, improve circulation and, above all, tone it through its active antioxidants; a therapy for the skin that is carried out based on natural elements. •

The Good Lawyer

ABC TV

After the worldwide success of the six seasons of The Good Doctor, the story of a surgeon with autism who moves to a prestigious surgery department in the city of San José, California, ABC TV has premiered its long-awaited spin-off. Its title is now The Good Lawyer and it tells the story of a twenty-something lawyer with OCD who comes across the lives of the protagonists of the series.

Heartify iOS

One of the improved basics of iOS is, without a doubt, this application that controls heart health through the mobile device’s camera, being able to track it thanks to HRV technology. In addition, the application offers a summary of the daily activity and the possibility of sharing the metrics with the community.