2025 The International Year of Cooperatives

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Healthcare cooperatives and social medicine magazine | No. 19 – JANUARY 2025

C o m pa r t i r THE INTERNATIONAL YEAR OF COOPERATIVES

The impact of healthcare cooperativism on the world

HEALTH IN WINTER

How to get more vitamin D during this season

ACTIVE LIFE

What should we take into account before starting to run?

TRENDS

The films that have defined 2024

Staff

Compartir Healthcare cooperativism magazine www.compartir.coop compartir@fundacionespriu.coop Editorial board: Dr. Ignacio Orce, chairman of the Fundacion Espriu and Assistencia Sanitaria Dr. Enrique de Porres, CEO of ASISA-Lavinia Dr. Oriol Gras sponsor of the Fundacion Espriu Dr. Carlos Zarco, General Manager and sponsor of the Fundacion Espriu

Publication: Factoría Prisma Diagonal 662-664 08034-Barcelona Tel. 639 213 710 www.factoriaprisma.com Manager of Factoria Prisma: Angi González Vives Coordination: Laura Martos Design: Xavi Menéndez Printer: Centro Gráfico Ganboa SL Legal Deposit: B-46099-2003 ISSN: 2488-6394 ISSN (Internet): 2696-3833 Fundación Espriu Av. de Josep Tarradellas, 123-127 4.ª planta 08029 Barcelona Juan Ignacio Luca de Tena, 12, 3.ª 28027 Madrid NIF: G-59117887 Tel.: 934 954 490 fundacionespriu@fundacionespriu.coop www.fundacionespriu.coop

Established in 1989, the Fundacion Espriu integrates the bodies that practice the cooperative healthcare model created by Dr. Josep Espriu: Augtogestió Sanitària, SCIAS, Lavinia and ASISA, which form the Assistència Group and the ASISA Group.

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Summary

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NEWS

Precision nutrition or games for autistic children: some of the clinical trials that will make medicine stand out in 2025.

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HEALTH IN WINTER Vitamin D is mainly synthesised through the sun. How can we regulate it during the winter months?

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ACTIVE LIFE

HEALTHCARE COOPERATIVISM

IN DEPTH

Dr. Franchek Drobnic reveals the ten preliminary steps to take into account before putting running into our routine.

The global conference of the International Cooperative Alliance is hosting the first social economy think tank in New Delhi.

Brazil, Panama, Uganda, Greece and Japan: these are some of the success stories of healthcare cooperatives around the world.

Editorial

A year for building a better world We are starting off 2025

with a challenge before us: raising awareness and expanding the work carried out by cooperatives and in particular, healthcare cooperatives.

The Fundación Espriu was present at the launch of the International Year of Cooperatives, held in New Delhi. The global conference of the International Cooperative Alliance also took place there, which included events such as the presentation of the first think tank on social economy and the conference on digitalisation in the healthcare field.

These meetings brought together representatives from many countries in a joint effort to innovate and strengthen the sector.

The healthcare cooperativism model – on which our organisation is based and in which we place our trust as a solution to reach accessible healthcare with universal quality, currently provides medical coverage to over one hundred million households around the world. In this first issue of the year we want to present some inspiring examples of cooperatives that share our mission. We invite you to read our “In Depth” report, where you will discover how these initiatives are transforming both lives and communities.

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DESTINATIONS

TRENDS

The city of Essaouira is a small cosmopolitan oasis, located just three hours from the densely-populated, chaotic city of Marrakesh.

We review the important films that have left their mark in 2024 and that will be awarded prizes over the next few months.

Amongst the pages of this issue you will also find some advice about how to face up to the winter in your best condition. With the collaboration of Dr. Paula Giménez Rodríguez, a neurophysiologist at the ASISA Sleep Clinic, and Dr. Franchek Drobnik, a doctor at the sports medicine centre belonging to Assistència Sanitària, we offer you a medical outlook about sleep problems linked to using screens before going to sleep, an increasingly common practice, in addition to a decalogue for those who wish to start running regularly.

I would like to take this opportunity to wish you a Happy New Year.

Carlos Zarco

General Manager of the Fundacion Espriu

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News

One out of every five adults in the world has a genital herpes infection, according to the WHO

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recent report estimates that around the world, 846 million people between the ages of 15 and 49 years live with genital herpes infections, affecting more than one out of every five people in this age range. Every second, at least one person contracts a new infection, which is the equivalent of 42 million new cases every year.

Genital herpes does not only cause recurring sores, but it can also generate serious complications, such as neonatal herpes, particularly when the mother catches the virus at the end of the pregnancy. Currently, there is no cure for herpes, but anti-viral treatments help to control the symptoms and reduce the propagation. Infections by the herpes simplex virus type 2 (HSV-2), responsible for 90% of the symptomatic cases, are particularly linked to a greater risk of catching HIV, which underscores

The disadvantages of eating more calories from five o’clock in the afternoon onwards A study carried out by the Universitat Oberta de Catalunya (UOC) and the University of Columbia have shown that eating more than 45% of the daily calorie intake after five o’clock in the afternoon can significantly raise the blood glucose levels, regardless of the body weight or the fat.

This discovery, based on an analysis of 26 participants between the ages of 50 and 70 with prediabetes or type 2 diabetes, compared the metabolic effects amongst those who ate most of their calories earlier or later in the evening. The results indicated that late eaters tolerated glucose worse and tended to consume more carbohydrates and fats at night, which can increase the risk of type 2 diabetes, cardiovascular diseases and chronic inflammation.

The study emphasises that the time of the meals, more than the amount or quality of the foods, has a direct impact on the glucose metabolism. According to Diana Díaz Rizzolo, leader of the research, it is preferable to concentrate calorie intake during sunlight hours, with a greater emphasis on breakfast and lunch. Although more studies will be needed to go into this line of research in greater depth, as the discovery redefines nutritional personalisation to include when to eat as a key factor to improve metabolic health.

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World Cancer Day Globally, cancer continues to be one of the main threats to human health, with a significant effect on millions of lives. According to the WHO, in 2023, 19.9 million new cases were registered, along with 10 million deaths due to this disease. The predictions are concerning: over the next two decades, a 60% increase is expected in the cancer load, which will place an increasing pressure on health systems, deeply affecting people and communities all over the world. For 2044, the new diagnoses are forecasted to reach 30 million per year, with the countries with low and medium incomes being the ones most hit by this increase.

Faced with this reality, the fight against cancer is not only a medical challenge, but a global priority. Every 4th of February, the PAHO/ WHO joins the Union for International Cancer Control to intensify prevention work, to promote healthy lifestyles and improve the quality of life of those who are facing this disease.

This day is used as a reminder of the commitment by the medical and scientific community, who tirelessly work to move forward in the research of new ways to extend the lives of people who have been diagnosed with this disease.

Inspiring quotes

“Our bodies are our gardens, to the which our wills are gardeners.”

William Shakespeare, writer and playwright

the urgent need for new preventive tools, such as vaccines and advanced treatments. In line with its health strategies for 2022-2030, the WHO is working to make people aware of genital herpes, improving access to medicines and promoting research in innovative treatments and vaccines.

The report estimates that around 846 million people between the ages of 15 and 49 years live with genital herpes infections.

Additionally, the economic implications of the virus are significant: a recent study revealed that the global cost of genital herpes rises to 35,000 million dollars a year, owing to medical expenses and loss of productivity. This data strengthens the importance of doubling the efforts to mitigate its impact both socially and on healthcare, supported by the World Health Organisation (WHO) recommending the correct use of condoms, abstention from sexual contact during active outbreaks and access to HIV tests and preventive steps, such as prophylaxis prior to exposure.

The incidence of bowel cancer is increasing amongst young people in western countries Bowel cancer is responsible for almost one million deaths every year —it is the second most deadly cancer globally, only exceeded by lung cancer— and since 2019 an increase in cases in patients under the age of fifty years has been observed in at least nineteen countries, whilst the incidence in older patients has remained stable. This is the conclusion of a study published in The Lancet Oncology based

on data from the World Health Organisation from fifty nations and it adds that this global trend is linked to factors such as unhealthy diet, physical inactivity and overweight, which present greater challenges than those associated to smoking (the main cause of several types of cancer.) Spain, however, is a prominent exception, as at present no significant increase is being seen in the cases amongst young people.

Five clinical trials that will mark medicine in 2025 Nature Medicine magazine has selected promising clinical trials that could transform medicine in 2025, tackling global challenges such as cancer, obesity, mental health, malnutrition and the effects of extreme heat. These are some of the most outstanding projects:

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Precision nutrition. The Nutrition for a Precision Health project, led by the National Health Institutes, studies why weight loss diets do not affect everyone in the same way, considering factors such as genetics, microbiome and lifestyle. With over 8,000 participants, it seeks to personalise dietetic guidelines using advanced models, with the first results expected in 2025.

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Chatbot for detecting cervical cancer. The ALIMUS project, led by the International Centre for Cancer Research in Lyon (France), uses an AI chatbot to promote participation in cervical cancer screening, particularly amongst women from underprivileged areas.

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Gene therapy for prion disease. A scientist from the Broad Institute at the MIT has promoted the development of ION-717, a treatment for prion disease, a neurodegenerative disorder that affects 1 out of every 6,000 people, which inhibits the production of prion protein. The global clinical trial will evaluate its safety with initial results expected in 2025.

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Breast cancer screening. The MyPeBS trial evaluates personalised screening for breast cancer according to individual risk factors (such as genetics, lifestyle, family background and mammary density), compared to the current standard method.

With 53,000 participants, its results in 2025 could transform prevention.

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Learning games for people with autism.

Stanford University leads this trial with games using mobile phone applications to improve communication and reduce anxiety in children with autism between the ages of 2 and 8 years, relieving parental stress and encouraging carer-child interaction.

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Health in winter

HOW TO GET MORE

VITAMIN D

during the winter Vitamin D is mainly synthesised in the skin thanks to sunlight, although it can also be obtained through certain foods and pharmacological supplements.

By Silvia Cardona

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itamin D is a fat-soluble vitamin that plays a key role in many of the organism’s functions. It contributes to the absorption and regular use of calcium and phosphorous, that is to say, to bone health and to the correct functioning of the muscles and the immune system.

During the winter, there is a higher prevalence of vitamin D deficiency, a condition that affects many people due to a lack of exposure to sunlight. The combination of shorter days, cloudy skies and the use of clothing that covers a large part of the body make it more difficult for the organism to synthesise this vitamin.

There is a relationship between low vitamin D levels in blood and a greater risk of suffering from osteoporosis, depression or heart problems 6

The Spanish Academy of Dermatology and Venereology (AEDV) affirms that in Spain, from January to March it is necessary to increase the time of exposure to sunlight by up to four times compared to the time necessary for obtaining healthy vitamin D levels in the summer. However, there are different alternative strategies to obtain more vitamin D during the colder months of the year.

How is this vitamin synthesised?

Vitamin D can be synthesised either endogenously or exogenously. Endogenously refers to the cutaneous synthesis of vitamin D in sunlight and it means the main way it is obtained. On the other hand, exogenous synthesis is achieved through eating certain vegetable origin foodstuffs that contain vitamin 2 (ergocalciferol) and/or eating animal origin foods that contain vitamin D3 (cholecalciferol).

A person’s vitamin D levels can be measured by a blood analysis. Insufficiency is talked about when the values for vitamin D25OH (calcidiol) are between 10-30 ng/mL. The deficiency of this vitamin (below 10 ng/mL) is generally caused by not receiving enough sunlight, decreasing its cutaneous synthesis. High skin pigmentation, as well as advanced age, are considered to be risk factors that can contribute to a deficiency.

Different studies have found links between low vitamin D levels in the blood and a higher risk of developing certain diseases. Amongst these are osteoporosis, depression and some cardiovascular diseases.

Although there is not always a direct cause and effect relationship, these discoveries suggest that maintaining adequate levels of this vitamin could play a protecting or modulating role in general health.

Amongst the symptoms of a lack of vitamin D, we can identify a feeling of fatigue, muscular pains, a lack of strength and a low mood. However, this de-

ficiency does not always produce symptoms. In children, the most serious form of vitamin D deficiency can produce rickets, a disease that causes skeletal deformities due to the weakening of the bones. In adults, on the other hand, the low bone mineralisation increases the risk of osteoporosis and fractures.

What is an adequate vitamin D intake?

An adequate intake (AI) is understood to be the average intake level of a nutrient that is adequate for the needs of the population. In the case f this vitamin, its AI is 15 micrograms a day.

The strategies that can help to increase vitamin D include nutritional recommendations, exposure to sunlight and supplements when required. To improve the levels through food, the consumption of nutrients that contain the aforementioned vitamin must be guaranteed. Amongst these are the following: •F ish. Particularly oily fish. For example, salmon,

anchovies, cod liver oil, sardines, mackerel, etc.

The adequate intake of vitamin D is 15 micrograms per day and it can be regulated through foods such as fish, full-fat dairy products as well as eggs.

•W hole-fat dairy products. This includes milk

and derived products, such as cheese and yoghurt.

Skimmed versions do not contain as much vitamin D. •E ggs. Particularly the yolks.

•D ehydrated mushrooms. Sun-dried mushrooms of all types.

• Foodstuffs enriched in vitamin D. Today there are several options such as milks, vegetable drinks and cereals that are enriched with this vitamin.

There are some lifestyle habits that also can help to maintain some adequate levels, even in the winter, for example, carrying out physical exercise in the open air. And finally, in cases where the vitamin levels are way below the established limits, a professional may consider prescribing vitamin supplement. Supplements can be prescribed as drops, pills or soft capsules. In these cases, of course, it is important to respect the recommended dose to avoid toxicity problems.

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Wellness

THE EFFECT OF SCREENS

ON SLEEP

Screens are a great ally today, but they can also be responsible for some health problems. One of the most common ones is the difficulty in falling asleep.

By Àngela Zorrilla

Insomnia is a sleep disorder that affects between 25 and 35% of the adult population in Spain 8

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oday, most of the population spends hours and hours interacting with different screens: computers, tablets, mobile phones, videogame consoles or televisions form part of virtually everyone’s daily life. And with this exponential increase in use, we should ask ourselves: what effect do they have on our health? Can they be harmful?

Accordingly, several studies have already warned that being exposed to screens before sleep is harmful. Consulting social media or emails before going to bed can result in insomnia, amongst other sleep disorders, causing a lack of quality rest, which is necessary for our organism to function correctly.

Sleep and screens: an impossible balance

While a person sleeps, their organism recovers from the day. This is its mechanism for getting ready physically, emotionally and cognitively for the following

day. “Sleep helps to consolidate the memory, it regulates moods, it allows the recovery of the cardiovascular system, it regulates the body temperature, it manufactures certain hormones, etc.,” according to Doctor Paula Giménez Rodríguez, a specialist in clinical neurophysiology and provincial delegate of ASISA. Screens of electronic devices issue blue-white light, a light spectrum that influences the human biological clock, located in the suprachiasmatic nucleus in the hypothalamus, and that “regulates the frequency of certain body functions, amongst which is sleep.”

In order to function correctly, this biological clock needs some external synchronisers, of which light is the most important. “When our brain, through the retinas, perceives this blue-white light, it receives the signal that it is daytime and it manufactures the chemical substances that keep us awake (cortisol,

histamine, serotonin,…) and it inhibits the manufacture of melatonin, which is the sleep hormone,” doctor Giménez explains. That is to say, if a person uses these screens two hours before going to bed, in reality, they are telling their brain —mistakenly— that it is daytime.

Additionally, the use of screens implies an over-stimulation of the brain, completely the opposite of the attitude of relaxation which, according to the expert, is needed for a good rest. And here is where insomnia appears, a sleep disorder that in Spain already affects between 25% and 35% of the adult population in a temporary way and between 10% and 15% chronically, according to data from the Spanish Neurology Society (SEN).

The main problem that Doctor Giménez warns about is the rise in this night-time habit, which is becoming increasingly widespread amongst the younger popu-

The blue-white light sends signals to the hypothalamus that inhibit the production of melatonin, the sleep hormone.

lation. And the fact is that a lack of sleep or bad quality sleep is linked, amongst other problems, “to low school or work performance, to mood swings (anxiety or depression), to having headaches, accidents and in the longer term, to metabolic and cardiovascular diseases,” she underscores.

How to guarantee a repairing sleep

Avoiding insomnia and all the health problems linked to it, demands irrevocably putting the focus on how and when screens are used. The experts openly recommend putting all the electronic devices to one side, at least, one or two hours before going to bed. A good, relaxing book is always better than blue light and the stimulation of viral videos. But not only this: the doctor recalls that to rest properly you must also “leave your problems and worries for the following day” and “follow a routine of regular meal times and sleep times, going to bed and getting up at the same time every day.”

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Active life What to take into account before

STARTING TO RUN

Running has become fashionable, but joining this trend without a medical check-up or preliminary preparation can compromise our health. Identifying pathologies and following personalised guidelines is essential for safe running.

By María Pérez

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unning is more popular than ever. More than just the physical activity, going running has become a social phenomenon that for many is now a lifestyle; a chance to meet people, to train together or to take part in multitudinous races, where the bib numbers run out in record time. Its popularity is partially due to the release of endorphins, known as “happy hormones”, which turn running into an addictive activity that helps us to beat anxiety, keep fit and to socialise.

However, although more and more people are joining this trend, many do so without any consideration for the preliminary steps and the risks that this entails. Dr. Franchek Drobnic, a doctor at Assistència Sanitària’s sports medicine centre, emphasises the importance of “carrying out a medical checkup before starting to ensure there are no latent health prob-

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lems that the patient does not know about, such as for example, an anomaly that is vascular, heart, respiratory or metabolic that the sport could bring to the surface.” Not knowing about any of these problems could be really dangerous.

For this reason, from a medical point of view, it is essential to follow certain steps before starting to run. According to Dr. Drobnic, ideally “ruling out any underlying ailment, understanding the structure of the athlete to help them to choose good footwear and clothing, and encouraging them to start training in an orderly way with someone who monitors them and controls their evolution.” Ignoring these recommendations could have consequences: “If the exercise carried out is outside the parameter that corresponds to the individual’s age recovery, that is to say, they are going to run too much, too often or too far, they could become injured or discouraged because they do not reach their desired goal.”

10 tips for starting to run 1. Study of sporting background.

The first step is to go to a specialist, who will carry out a valuation of skills based on the sporting background. The main aim of this analysis is to understand the impact that the sport has had on a person’s physical development.

2. Valuation of the clinical notes.

The doctor will assess the clinical notes and will analyse the medical and family background to identify any possible basic cardiovascular, respiratory or metabolic pathologies. Although some of these conditions could be incompatible with unsupervised running, often the sport can be beneficial if it is carried out using specific guidelines and with a focus that is adapted to each person’s needs.

6. Understanding the characteristics of the sport that is to be practiced and the environment.

Running in the gym is not the same as in the street or in the mountains. If it is carried out in isolated areas, you must take into account that if a complication arises there will be no access for emergency care, which could mean a risk for your life. In the same way, it is important to have the correct footwear and clothing for the environment.

7. Choosing good footwear.

There are many options on the market; however, bad guidance regarding footwear could cause muscular and joint injuries due to overload. Posture, the support of the feet and whether the use of insoles might be necessary should be evaluated.

3. Medical check-up.

8. Training plan.

The doctor will carry out a sports medicine evaluation prior to exercise, with a stress test that will detect any underlying health problem that has not been diagnosed.

Starting an activity from scratch is not the same as starting out from an active sporting life. The goals must be adapted to each individual’s physical conditions. Ideally, you should have a trainer who guides you and monitors your progress.

4. Structural analysis.

Once all the internal checks have been passed, the doctor will analyse whether there might be any structural problems, for example, if they suspect that there might be a postural alteration, they will request additional tests, such as a gait analysis. In this way, any possible injuries to the knees, ankles, hips or back may be avoided in the case of having a cavus or valgus foot...

9. Nutritional plan.

5. Initial nutritional valuation.

10. Knowing the warning signs and paying attention to them.

It is advisable to undergo a valuation of nutritional intake before starting to practice a sport. If you wish to start running just for fun, but competitively (adapted to level and age) it is highly recommended for this initial study to be complemented with a complete nutritional plan (point 9).

The nutritional plan is prepared in terms of the person, the weight, the size and the daily metabolic rate. The energy contribution and the training plan should also be considered. Assistència Sanitària’s sports medicine centre, for example, has a team of sports nutritionists who are experts on the subject.

The greatest warning sign is not feeling well when carrying out a physical activity. In this case, the cause must be evaluated, whether it is muscular or bone discomfort, or, on the other hand, if you experience a disproportionate fatigue and a bad recovery.

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Emergencies

ICTUS

code A

n ictus (or stroke) occurs when a blood vessel breaks or is blocked by a clot, leaving the area without blood flow and as a result, without oxygen. When this happens, the nerve cells stop working after a few minutes. An ictus is one of the diseases with the greatest impact worldwide. Annually, around 1.1 million Europeans suffer from this medical event and around 220,000 people die. In Spain, the figure is around 120,000 people affected, of which around 25,000 die, according to official data from the Ministry of Health.

How does the ictus code work?

There are two types of ictus: ischemic and haemorrhagic. The first case occurs due to an important, sudden drop in the blood flow to the brain, while the second is a sudden haemorrhage in the brain tissues and/or its ventricles. According to the type, treatments aimed at recovering the vascular reperfusion are evaluated, using thrombolysis or thrombectomy and, in exceptional circumstances, resorting to surgery The ictus code is the pre-hospital action procedure used to classify the symptoms aimed at giving priority to the transfer and care necessary to improve the prognosis and any possible consequences.

Generally, an image diagnosis method is used, called computerised tomography, to rule out a haemorrhagic ictus —in which case the code will not be used and the patient will be moved to the ictus unit (IU) and the seriousness of the event will be evaluated though the ASPECTS scale. This study allows the volume of tissue that is potentially recoverable to be distinguished.

The application of the code can be carried out if the time from the first symptom until the arrival at the hospital does not exceed two hours, and it takes other characteristics into account, according to the patient’s clinical notes.

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First aid: how to identify a possible ictus

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A lack of coordination or of strength is one of the main symptoms. Ask the person to lift both arms up at the same time. You can do the same with the legs, while they are lying down.

F acial paralysis is related to strokes and it can be accompanied by a feeling of pins and needles. Make the person smile to detect whether the lips are only twisted towards one side.

L oss of speech includes symptoms such as faltering speech, giving inconsistent explanations, changing the order of the words or pronouncing them badly. Ask the patient about the characteristics of an object or action that is happening nearby.

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Cooperatives and social medicine

The ASISA Group, awarded at the ‘Sustainability Day 24’ for its ESG strategy The ASISA Group’s commitment to sustainability and responsible development has been considered of one of the best Sustainability Actions 2024.

The ASISA Group received recognition “for the advances made in ESG strategy in order to become a carbon neutral company in 2025.”

“It is an acknowledgement of the effort that the company has been carrying out for years to reduce the greenhouse effect gases created by its activity, while maintaining the care quality. This is only possible thanks to the commitment and professionalism of all the people who make up the organisation,” Aline Gómez-Acebo, Sustainability Manager for the ASISA Group indicates.

The award was given out during Sustainability Day, a benchmark forum for sustainability, organised by the communication group Custommedia, which was held at the Reina Sofia Museum in Madrid. This is a day devoted to sharing the most inspiring actions on the subject of sustainability. Within this context, the ASISA Group’s commitment to sustainability and sustainable development was considered to be one of the best Sustainability Actions in 2024.

The fourth edition of the Sustainability Day, held under the slogan “Hacia un futuro sostenible” (“Towards a sustainable future”),

The Assistant Manager for Sustainability at the ASISA Group, Lorena Tirados, collected the award at the Reina Sofia Museum in Madrid.

brought together over 35 experts in sustainability to share challenges and initiatives of ESG impact, good business practices, plans of action, inspiring targets and actions that contribute to driving towards a healthier and more sustainable world.

Lorena Tirados, Assistant Manager for Sustainability at the ASISA Group, took part in the debate Accion climatica y descarbonizacion: desafios y oportunidades para el medioambiente alongside Goretti Hidalgo, the Communications, Shared Value and Sustainability Manager at Chiesi España & Portugal; Raquel Millán, Environmental Responsibility Risks Manager at AEON, and Germán Granda, General Man-

ager of Forética, who moderated the debate.

In her speech, Lorena Tirados underscored the main lines of action that the company is implementing aimed at becoming carbon neutral in 2025 in scopes 1 and 2: “We have defined a greenhouse effect gas (GEG) transition and reduction plant for the decarbonisation of our activity. We are opting for an energy model that is low in emission, reducing the dependence on fossil fuels, promoting auto-consumption and the use of energy from sources that are 100% renewable. The technology, the circular economy and the incorporation of sustainable alliances with suppliers are playing key roles in the decarbonisation of our entire chain of value.”

Seven centres from the HLA Group acknowledged amongst the private hospitals with the best reputation in Spain

HLA Universitario Moncloa is the hospital with the best MRS ranking and one of the 10 public and private centres with the best healthcare reputation in the plastic surgery speciality.

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The Healthcare Reputation Monitor (MRS in Spanish) prepared every year by the consultancy company, MERCO has included seven hospitals from the HLA Group amongst the best in the country in private healthcare: HLA Universitario Moncloa in Madrid; HLA Universitario Inmaculada in Granada; HLA Vistahermosa in Alicante; HLA Jerez Puerta del Sur in Jerez de la Frontera (Cadiz); HLA Universitario El Ángel in Malaga; HLA Montpellier in Zaragoza and HLA La Vega in Murcia. Additionally, the HLA Universitario Moncloa appears among the ten private and public hospitals

with the best healthcare reputation in the plastic surgery speciality.

In line with this ranking, several hospitals from the HLA Group are the best positioned in private healthcare in their regions: HLA Montpellier leads the ranking of private hospitals with the best reputation in Aragon and HLA La Vega, does the same in the Region of Murcia. On the other hand, HLA Vistahermosa, HLA Jerez and HLA Universitario Inmaculada are the best in private healthcare in Alicante, Cadiz and Granada respectively.

The Universidad Europea renews its collaboration with ASISA The company and the university have signed an agreement to continue training students in Medicine and Nursing.

The ASISA Group and the Universidad Europea have signed a new framework agreement to renew and promote the collaboration that both institutions hold for training and research in the field of health sciences. The agreement was signed by the Chairman of the ASISA Group, Dr. Francisco Ivorra and the CEO of Europa Education, Otilia de la Fuente, during an event held at ASISA’s head offices.

The new framework agreement signed by the ASISA Group and the Universidad Europea will allow a reinforcement of the collaboration between the two organisations, which began in 2006. Since then, around fifteen agreements have been signed, centred on the training of students of Medicine and Nursing in the hospitals of the HLA Group, in addition to facilitating the access of professionals from the ASISA Group and of their family members to higher education at the Universidad Europea and encouraging the development of different research projects.

The Universidad Europea will also continue placing its trust in the Hospital HLA Universitario Moncloa (Madrid) for training students in the last three years of the Medicine degree, of the clinical cycle. To date, nine years have graduated having received theory and practical training at the hospital, given by the professionals from the centre.

Furthermore, the ASISA Group and the Universidad Europea will continue developing the activities of the ASISA Chair of Health Sciences, which was created in 2006 and that this year has celebrated the 15th edition of its awards. These awards were established in 2010 to recognise academic excellence in the area of health, as well as to promote professional development through postgraduate studies.

The CEO of Europa Education, Otilia de la Fuente, and the Chairman of the ASISA Group, Dr. Francisco Ivorra, signed the agreement at an event held at the head offices of ASISA.

Marketing and Communication Awards in the Insurance Sector 2024 ASISA has obtained two prizes at the 14th Marketing and Communication Awards in the Insurance Sector: the campaign Normalicemos la menopausia (Let’s normalise menopause) obtained the Jury’s Special Award and the campaign Susto (Fright), won the Award for the Best Corporate Campaign.

These prizes, convened by INESE Carlos Eiroa, Brand, Advertising and Sponsorship Manager at ASISA received and MKsite, at the 2024 edition the awards at the gala. analysed 37 campaigns developed by 36 companies from the sector to choose the most outstanding ones from the last year. The awards acknowledge the creativity and they take other aspects into account, such as the fact that they have reached their goals, notoriety, innovation and the capacity to transmit the presented campaigns to the public.

Healthcare and pet insurance, integrated into the family care offer ASISA has launched the ASISA New Families pack, which combines health and pet insurance aimed at offering a comprehensive protection for families that have pets amongst their members. With this plan, ASISA takes another step towards adapting to families who have incorporated animals as new members of the group, which also hold an increasingly important place.

Traditionally, pet insurance was integrated into house policies, treating them as insurable objects. With this new proposal, ASISA redefines this approach, declaring pets as living beings who form part of the family and who require specific care.

The ‘Corre con ASISA‘team successfully finishes the Lisbon Marathon After months of preparation, the ‘Corre con ASISA’ team has successfully finished the Lisbon Marathon, which was held on the 6th of October in the Portuguese capital city.

The Run with ASISA group successfully completed the Lisbon Marathon, a race which started in Cascaes and reached Praça do Comércio.

The team, formed by 30 employees and clients of ASISA from Spain and Portugal, underwent a physical preparation programme for the race, with a team of professionals from ASISA specialised in different areas (sports medicine, nutrition, etc.), who advised the athletes individually to improve their running techniques and to prevent injuries during the preparation and the race, both for the marathon and the half marathon.

The Lisbon Marathon is now considered one of the best races in the world and it forms part of the official calendar of the International Amateur Athletics Federation/ World Athletics (IAAF). This year it hosted over 30,000 runners of all nationalities. The race is also one of the most attractive ones due to its route, starting in Cascaes and finishing in the Praça do Comércio.

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Cooperatives and social medicine Assistència Sanitària is consolidating its senior strategy In line with its unique care model and the result of a reflection upheld by recent demographic data, Assistència Sanitària has increased its specific services for the older population, consolidating an offer based on responding to the health requirements of any person at any age. Unlike other organisations, they have a solid commitment that opts for differentiated, quality healthcare support.

Assistència Sanitària collaborates in the comprehensive response plan after the ‘DANA’ The plan, lead by the Spanish Red Cross, uses three key phases, applying their own methodology based on orientation towards people, children’s rights and the elderly.

Aimed at supporting those affected by the devastating effects of last autumn’s cut-off low, Assistència Sanitària has made a charitable donation to the Spanish Red Cross, reaffirming the company’s commitment to solidarity and social responsibility, specifically to people and communities in situations of emergency, joining the comprehensive response plan developed by the NGO. The plan is based on three key phases: immediate response, recovery and strengthening of the resilience. The initial phase is centred on guaranteeing the safety and survival of the people affected by the distribution of food, drinking water, warm clothing, hygiene products and medical support. Provisional shelters are set up and actions such as the psychosocial intervention and bringing family members back into contact with each other. They also establish disease control steps and safe spaces for the emotional well-being of children.

In the second phase, focused on recovery, they work to re-establish normality in people’s households and means of living. This includes assistance for the rehabilitation of housing, community psychosocial support and accompanying people with the paperwork to access rights and aid, as well as the

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With some specific needs in the senior group, Assistència Sanitària has designed special services to accompany them in a personalised way and give a comprehensive approach that takes them into account at all times. Assissenior and the care programme for chronicle illness PAPPA are two of the most outstanding examples of this determination.

improvement in the energy efficiency of the houses being rebuilt. Aid for educational centres is also given priority with teaching material and emotional support for both pupils and teachers.

Designed exclusively for people over the age of 75 years, Assissenior offers a space in the heart of Barcelona where each patient has a reference doctor, in addition to complete monitoring of their pathologies.

This continuous care not only provides a specialised treatment for chronic illnesses, but it also offers a fast, efficient care for acute and minor situations, always adapted to the patient.

The third phase opts for the strengthening of the communities, developing individual and group skills to face up to future emergencies. They promote activities such as training in climate resilience, community participation in environmental management and the creation of emotional support groups.

They also promote working itineraries that help the people affected to rebuild their life projects.

The system used by Assissenior is particularly innovative in the way in which it organises the care for the elderly: each person has centralised, computerised clinical notes that allow any medical speciality that the patient might need to be coordinated with the greatest flexibility. In addition, the reference doctor is in charge of giving a comprehensive, proximate view in each case, establishing a relationship of trust with their patients. Therefore, each visit does not only solve a specific medical aspect, but it works on the patient as a whole for the person’s overall quality of life.

The Spanish Red Cross applies its own methodology based on proximity, orientation towards people, the gender perspective and the rights of children and the elderly. Its coordination capacity and efficiency guarantees that the resources provided reach the most vulnerable groups, including the elderly, children, disabled people and isolated rural communities in each situation.

Thanks to this donation, Assistència Sanitària contributes to a coordinated and effective response, aimed not only at immediate response, but also in the long term, helping to build a safer and more resilient future for the affected communities.

Quality presides over the sales convention of Assistència Sanitària In an atmosphere of collaboration and learning, the organisation held the convention successfully, with the participation of 21 regional branches from Barcelona.

Last September, Assistència Sanitària held a sales convention that brought together the teams from 21 regional branches of the organisation, from all the main towns in the province of Barcelona. The slogan and key point of the event was “Commitment to quality,” a declaration of intentions that synthesises one of the organisation’s

most distinguishing features. Aimed at analysing strategies and strengthening the service, those attending revalidated the focus on accompanying and responding to any need of the insured people combining face-to-face appointments with digital tools and innovative solutions aimed at global and transversal care.

The Medical Association recognises the PAPPA On the 25th of November, the team from the Programme of Care for Multiple Pathology Patients from Assistència Sanitària (PAPPA in its Spanish initials) collected the Prize for Excellence form the Barcelona Medical Association at a formal ceremony. The prize rewards pioneer care work in Catalonia that offers comprehensive care in the home for an increasing segment of the population.

The PAPPA is a service developed by the teams from the Hospital de Barcelona exclusively for people insured in Assistència Sanitària that cares for patients with multiple chronic illnesses in their own homes, avoiding unnecessary, complicated transportation. This programme is formed by a multidisciplinary team of family doctors, geriatricians and nurses in collaboration with the Home Emergency Service (SUD in its Spanish initials).

The recognition by the Medical Association underscores the importance of the PAPPA programme and other similar services, particularly for multiple pathology patients. This home-care model represents a step forward in healthcare, as it not only contributes to improving the quality of life of both the patients and their families, but it also has become an efficient response to the needs of an ageing population with chronic illnesses.

Innovación tecnológica y de formación en el Hospital de Barcelona In November, the Hospital de Barcelona hosted two important scientific meetings, underscoring its commitment to continuous training and innovation in the healthcare area.

On the 15th of November, the 12th Seminar on Health during Pregnancy was held, which this year centred its attention on two highly relevant obstetrical topics: preeclampsia and postpartum haemorrhaging. On the 22nd, it was the turn of Oncological surgery, with the presentation of

carcinopdia.org, a pioneer multimedia educational platform dedicated to peritoneal carcinomatosis.

At the same time, the hospital has taken a decisive step towards digitalisation, with the implementation of one of the first Wi-Fi 7 high density multi-gigabit networks in a hospital in Spain, reaffirming their technological leadership and commitment to care quality.

This network, which will be up and running in 2025, promises to

revolutionise medical services by allowing ultra-fast, reliable connectivity. Healthcare personnel will be able to access critical data in real time, optimising diagnoses and treatments, while patients will enjoy a more connected experience,

including advanced digital services and better communication with family members. The network also supports IdC devices, improving processes such as remote monitoring of patients and automated resource management.

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Cooperatives and social medicine

ASETT, the first global social economy think tank The project is inspired by the cooperative business model Last November, during the global conference of the International Cooperative Alliance held in New Delhi, ASETT, Arizmendiarrieta Social Economy Think Tank was presented, the first international laboratory for ideas about social economy.

The initiative, which is promoted by the Confederación Empresarial Española de la Economía Social (CEPES – the Spanish Social Economy Business Confederation), and the Ministry of Work and Social Economy is seeking to promote the creation of social economy companies to transform society. Inspired by the cooperative business model that combines economic democ-

racy and social justice, the think tank intends to study the role of companies in the reduction of inequality and in social and work inclusion. It will also develop a prospective institute to analyse future trends in the business world and a social laboratory to promote group enterprise and to adapt consolidated successful cases to other regions.

This project seeks to create a global network that connects universities, social economy companies and public institutions with the aim of sharing knowledge and adapting innovative solutions related to the social economy to the specific needs of different communities.

Digitalisation in health: the view of the cooperatives During the global conference of the ICA different successful cases of cooperatives that have implemented digital solutions to improve access to health were presented.

Delegates participating in the IHCO assembly.

Healthcare cooperativism meets up in New Delhi On the 28th of November the annual assembly of the International Healthcare Cooperatives Organisation (IHCO), was held in New Delhi, presided over by Carlos Zarco, General Manager of the Fundación Espriu.

After several years of being held telematically, the assembly allowed experiences and impressions to be exchanged in person with the representatives from healthcare cooperatives from different countries and to design the lines of action for the International Year of Cooperatives, which will be held in 2025.

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The International Healthcare Cooperative Organisation (IHCO) held an international seminar Digital health centred on people: the cooperative approach within the framework of the global conference of the International Cooperative Alliance (ICA).

This event brought together leaders from the health sector, experts in technology and cooperative members from different parts of the world to debate and share experiences about how cooperatives are tackling the digital transformation in healthcare.

During the seminar, different successful cases were presented of cooperatives that have implemented digital solutions to improve access to health. Carlos Zarco, the General Manager of the Fundación Espriu, displayed the digital platform Green Cube, developed by the ASISA Group, which uses comprehensive management for users to make their relations with medical services easier, while at the same time increasing the efficiency of the healthcare professionals.

Lyman Manzanares, an executive from the healthcare cooperative 1COOPHEALTH,

from the Philippines, displayed the organisation’s digital transformation process, emphasising the use of technologies such as ‘lightning wallet’ to make access to the medical services easier for its policy holders.

On the other hand, Susan Thomas, National Manager of SEWA, a union of cooperatives from India that is empowering women workers from the black economy, presented a solution based on block chain economy that allows the creation of secure digital identities, helping self-employed women to access governmental health programmes and to manage their healthcare information in an independent and transparent way.

From Italy, the Chairman of Confcooperative Sanità, Giuseppe Milanese, showed several projects based on digital technologies that are aimed at improving health and quality of life for vulnerable groups.

Another innovative experience was presented by Marisol Ng de Lee, a Director of the Cooperativa Profesionales de Panamá, which has incorporated the

Relevant companies in social economy Social economy companies continue growing and showing their relevance in the Spanish production system. According to the latest data from 2022, the sector has 74,606 companies that generate a total of 2,505,607 jobs. This was revealed in the latest report by the Spanish Business Confederation of Social Economy (CEPES), which analyses a sample of 3,715 organisations.

Acto de presentación en la embajada española en Nueva Delhi.

According to the study, these companies generate a total of 406,223 jobs and invoice over 72,355 million euros. The 12% growth in the number of companies analysed compared to the previous year stands out, which reflects the vitality and dynamism of this business model.

Cooperatives are the main agents, with over 2,300 organisations analysed. However, the report also underscores the presence of other models, such as for example, workforce-owned companies, insertion companies and special employment centres, which contribute to the diversity of the sector.

The group of companies that drive the Fundación Espriu stands out by being in the fifth position with the largest invoicing, which shows the important role played by cooperatives in the health sector.

digitalisation in all its management and relation processes with cooperative members.

level of technological literacy, which could mean a barrier in accessibility to the services.

The participants coincided in the fact that cooperatives, with their approach centred on people and on the community, are an ideal structure to guarantee that the digital solutions are implemented in the health field fairly, taking into account socioeconomic factors, geographical location or the

Another relevant conclusion taken from the seminar was the need to strengthen the training of healthcare professionals in order that they may use the digital tools effectively and avoid problems related to resistance to change and lack of skills, which could hinder digitalisation.

Debating panel for the seminar on ‘Digital health centred on people: the cooperative approach.’

The report may be consulted using this link:

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In depth

HEALTHCARE COOPERATIVES to build a better world

In the International Year of Cooperatives, this model, applied to the field of medicine, has confirmed its efficiency, contributing to guarantee universal access to healthcare and promoting the association of healthcare professionals.

By Enric Ros

“Cooperatives

build a better world.” This is the slogan chosen by the United Nations Organisation (UN) to celebrate the International Year of Cooperatives (IYC). The intention behind the events that will take place during 2025 is to be able to put the spotlight on the cooperative model as a fundamental solution for mankind to be able to successfully face up to the many challenges worldwide, particularly regarding the necessary speeding up of the tasks to be undertaken to reach the Sustainable Development Goals (SDG) promoted by the United Nations for 2030.

Cooperatives provide healthcare coverage for over one hundred million households around the planet

This is the second time that this type of recognition for cooperatives has taken place, after the previous CoopsYear, back in 2012.

As indicated by Li Junhua, the Assistant General Secretary of the Department of Economic and Social Affairs of the UN, this new celebration “will be an opportunity to mobilise all the parties interested in supporting and expanding cooperatives,” as a way of contributing to building a better future for the human race as a whole.

Social and economic well-being

This organisation model takes on special importance in the health area. Last July, 2024, Dr. Carlos Zarco, the Medical Director at the Hospital Universitario Moncloa, General Manager of the Fundación Espriu and Chairman of the International Healthcare Cooperative Organisation (IHCO), took part in the presentation ceremony of the IYC at the head offices of the UN in New York.

There, he underscored the work carried out by cooperatives to

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guarantee the universal access to medical services, providing healthcare coverage to over one hundred million households around our planet.

Without any doubt, cooperatives fulfil an important social function, but they also generate economic growth and progress. In his speech, Dr. Zarco also did not hesitate to indicate that “the world economy cannot be understood without the over 3 million cooperatives that exist all over the world and in which 12% of the world population participate as cooperative members. Cooperatives give employment to 10% of the population and the 300 largest ones alone make a total invoicing volume of 2.4 billion dollars.”

What is a healthcare cooperative?

The United Nations described cooperatives specialising in health and well-being as independent organisations that manage and operate medical institutions and health centres, carrying out many activities that benefit many people. In most cases, their creation involves the need to resolve access to healthcare by different population groups, either due to geographical, economic reasons or the provision of medical products and services.

Additionally, this model has shown its capacity to combine economic efficiency with social commitment, reinvesting a large part of its profits in policies that contribute to strengthening the different healthcare systems and extend the coverage of services to which citizens may gain access.

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In depth

STRENGTH THROUGH UNITY:

the advantages of cooperativism Through shared institutions, these organisations have shown their capacity to promote significant changes in areas such as employment, health and social wellbeing.

Cooperatives are companies that belong to the professionals themselves

and to the consumers (users, clients…) This means, in practice, a type of empowerment that makes it easier for them to achieve their goals. This model is not only be used to create solid, sustainable jobs, as confirmed by the study Cooperatives and Employment: a Global Report, but it also gives back to society as a whole.

The International Cooperative Alliance (ICA) is today one of the largest non-governmental organisations in the world, which groups together over one thousand million members from three million cooperatives all over the world. Its foundation dates back to the 19th of August, 1895, at the first Cooperative Congress in London. However, the origins of the first organisation based on the cooperative model takes us even further back, to 1761, when a group of craftsmen who worked in cotton factories in Fenwick (Scotland) created the Fenwick Weavers’ Society.

Shared experiences

In the health area, the union amongst these types of associations has allowed alliances to be created that have boosted the improvement in the working conditions of the professionals, along with their capacity to attend citizens. As explained by Noriaki Taguchi, the Secretary of the Japanese Federation of Health and Well-being Cooperatives- one of the organisations which, alongside Fundacion Espriu or Unimed, have contributed to the creation of the IHCO, since the first International Forum of Healthcare Cooperatives held in Tokyo in 1992 – this association is the result “of the recognition of the need for an international exchange amongst cooperatives.”

“At that moment, women and children’s healthcare in many developing countries was threatened by poverty. Meanwhile, the more developed countries were fighting against the aging of the population, a fact that had an impact on social security policies. The solutions provided by health cooperatives were used to generate a greater awareness regarding all these topics,” Taguchi adds.

An organisation such as the IHCO also allows its members to be able to learn from each other, sharing achievements and experiences. In the words of Taguchi, “having the chance to visit health cooperatives and take part in exchanges with a country like Spain can provide us with valuable information. I think that these interactions contribute to promoting a mutually beneficial relationship.”

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The first organisation based on the cooperative model dates back to 1761 with the creation of the Fenwick Weavers’ Society

An effective model against important challenges Can cooperatives help to provide solutions to global problems, such as discrimination in access to health services or the fight against climate change?

The truth is that these types of organisations have worked in depth to extend their work in regions that are often difficult to reach, helping to make healthcare and the availability of treatments and drugs universal.

Amongst the topics on the respective agendas of this type of associations – and also of the umbrella organisations such as the IHCO, we can underscore the climate emergency, energy efficiency, the promotion of healthy habits and life styles, the fight against poverty and abuse or the improvement in decent economic conditions for health professionals.

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In depth

A company model that is extending all around

THE WORLD

Let us review some successful cases that show the advantages offered by healthcare cooperative models.

The solidity of the Unimed system Brazil has the largest cooperative of doctors in the world. As described by Dr. Fabio Leite Gastal, Manager of Strategy, Management and Innovation at Seguros Unimed, the organisation “was started in 1968, within the context of the Brazilian social and industrial revolution.” This promoted the fact that many companies contracted healthcare services. “At this moment,” he affirms, “as doctors we realised that we had to organise ourselves to offer an ethical alternative that placed value on the doctor-patient inter-relationship.”

The health system in his country underwent an important transformation from the nineteen eighties onwards. “The democratic process brought the prioritisation of the right to health along with it,” Leite Gastal explains, which helped Unimed to continue growing. Today, it is now formed by 340 medical work cooperatives present in nine out of every ten municipalities in the country. They have twenty million

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health insurance customers and they offer around 30,000 services under contract.

The cooperative also has its own network of 163 hospitals and around 120,000 cooperative doctors. It has also extended its activity to other insurance areas, such as life or retirement, which to begin with were created to take care of the needs of the professionals themselves.

In Brazil, around 150 million inhabitants are only covered by the national health system, while private healthcare takes care of another 50 million users. One of the peculiarities of its model is that “when the user buys healthcare insurance or their company does this, the citizen leaves the public health service. This means that the private offer must guarantee them all the services that they could have in the public service,” Leite Gastal adds. Thanks to Unimed, the doctors managed to improve their conditions; at the same time, the healthcare system itself has also evolved, bringing increasingly better quality to the services.

Cooperativa de Profesionales de Panamá: a multifactorial service As Dr. Marisol Ng de Lee, a director on the Board of Directors of the Cooperativa de Profesionales de Panamá tells us, this association was founded when a group of doctors and dentists decided to come together to “provide a decent retirement for healthcare professionals, once they had left the work system.” To begin with, they centred on encouraging savings and giving credits, but they then started to administrate medical insurance, which led them to build their own professional hospital.

The intention was to offer, in a country with a considerably expensive healthcare system, “our members, third parties and to the population in general, the possibility of being cared for in a hospital with high technology, at reasonable prices and seeking the stabilisation of our health plans,” adds Dr. Ng de Lees. This cooperative model has led them to request, through the organisations they belong to, such as the IHCO, “support to discover the experiences of these important models, and to be able to identify the pros, the contras, the advantages, the technology they have or the administration model, in order to maximise our processes.” The Cooperativa de Profesionales de Panamá has been used, according to this prestigious professional, to create “a multifactorial healthcare model, based on evaluation, diagnosis, treatment and monitoring; in short, a project that contributes to improving the quality of life of the patients, who we look after quickly, accurately and with some fair costs.”

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In depth

Uganda: healthcare for the underprivileged KAMACOS (Kampala Medical and Allied Health Workers Cooperative Society) is a small cooperative which, since 2019 has grouped together the healthcare professionals from the capital city of Uganda. Dr. Atuwaire Kagaha Dan, its Chairman, explains that its main mission is to “provide services through medical camps and extension programmes that can reach the rural communities.” In one of these camps, which usually remains in one place for a week, they take care of between two and five thousand patients.

Since its creation, KAMACOS has already helped over 80,000 people all over the country. They usually mobilise resources from the Government, civil society and

the private sector to reduce the costs of the medical care, particularly in the case of the most vulnerable people. As Kagaha Dan explains, “for this we use doctors who are usually also members of the cooperative. At the same time, they represent us in the regions.” They also work “closely with the Government, often using their own installations.”

When we ask him if the cooperative model is essential to guarantee affordable access to healthcare in his country, the Chairman of KAMACOS does not hesitate to affirm: “The answer is yes, yes and yes. It is a truly very effective, responsible and democratic system which, also displays accountability.”

The cooperative of pharmacies in Greece Pharmaceutical cooperatives are very usual in Mediterranean countries such as Spain, Italy or Turkey, reaching market shares of over 50%. The Cooperative of Pharmacies of Greece is a good example of this. As its Chairman, Vasilis Birlirakis explains, its history dates back to the nineteen thirties.

“The association was founded to cover the needs of active principles and also of some of the first medicines of the industry. Thanks to the cooperative, the pharmacies that were members could have the necessary drugs available in their community.” In

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The Japanese model, promoted by the users The Japanese Federation of Health and Well-being Cooperatives, a network that groups together over one hundred healthcare cooperatives formed by around 40,000 employees, has a singularity: originally, the cooperative members were the users themselves, not the medical professionals.

As Noriaki Taguchi, Secretary of the institution explains, often these organisations were formed “when the residents in remote regions or that were difficult to reach, which did not have any medical installations, decided to invite doctors and other professionals to set up in these places.”

The cooperatives are, in the end, the result “of the collaborative effort amongst the citizens and the professionals to be able to carry out social and commercial activities in an effective way,” he adds.

The goal is to promote the consolidation of a society where people can live long, healthy lives. To do this, the Secretary of the Federation observes, it is necessary to take care of the health of all the people who form part of the community, as well as the environment that surrounds them.

recent years, the organisation has adopted a much more clinical profile, which has led it to build specific structures. In the worlds of Birlirakis, “the Cooperative of Pharmacies has made different contributions to the country. It has improved the quality of the products, guaranteeing their storage in optimum conditions. It has also provided transport and a streamlined, fast supply, showing its capacity to reach the furthest village in the country.”

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Destinations

ESAUIRA, a more relaxing side of Morocco This small cosmopolitan oasis, just three hours from Marrakesh, with a climate tempered by the Atlantic, is ideal for an exotic get-away.

By Neus Duran

T

he background noise of seagulls cawing and a strong trade wind that invigorates and brings aromas of grilled fish, saltpetre and spices form the welcoming committee that usually receives travellers reaching Essaouira. The town that was Mogador for the Portuguese has always received many travellers, as it was on the caravan route of the merchants loaded with salt, ivory – or slaves, on their way to European lands from Timbuktu. Less welcome were other visits, such as those by pirates and corsairs, which forced the inhabitants to fortify their city..

Blown by the north-eastern winds, it is a refreshing alternative to dense, chaotic Marrakesh

For the past fifty years, painters, sculptors, musicians, surfers and writers have been arriving from all over the world – with a high predominance of French and Belgians, who have found refuge in this city that is a relevant fishing port and a centre for craftsmen and women and tourists. Waves to surf, inspiration, or perhaps just themselves: in Essaouira everyone is seeking something. Many visitors just come on a day trip from the neighbouring Marrakesh, just 173 km away; the breath of fresh air of the relaxed fishing port coming from the frantic Red City makes more than one traveller regret not spending the night there.

The culture of the ancient Mogador is a fusion of Arabic, Berber, Jewish, French and Portuguese influences.

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A complete day might start waking up in many of its charming riads and gaining energy with a delicious breakfast on the patio or on the terrace with pancakes with honey and local cheese, Berber bread, dates… and, above all, one of the really fresh orange juices that can be found here. The best idea is to forget your map – along with your car, which is just a nuisance here, and set off to visit the Medina, a UNESCO world heritage site since 2001 and surrounded by imposing stone gates (babs).

An ancient district, full of artists

of the customer amongst smoke and the watchful eyes of thousands of cats and seagulls, waiting to jump and steal a piece. For a few euros you can fill yourself up with fish and you will be pleasantly surprised to find that the street vendors are much less insistent than in Marrakesh. On the extensive beaches, full of surfers, you can spend an afternoon on a camel ride, or take a small boat to discover the city from the sea, travelling around the Iles Purpuraires, where there is a bird reserve with seagulls and Eleonora’s falcons, which may be seen from April to October.

Strolling around the alleyways, which is full of eye-catching, colourful pictures where the Fauvist style predominates, with contrasting whites and blues and the engraved doors of the houses of the old town, travellers will find many art galleries, because important sculptors and painters from the all over the country live in the city and many of them exhibit their work in the streets. Carts pulled by mules move around everywhere, pushing their way forward amongst the people. At midday the best idea is to go to the port to try the grilled or fried fish, which are cooked in front

If you prefer to leave the city, there are routes through the surrounding dunes by quad or you can sign up for a daytrip to the vineyards of the Val d’Argan to taste the dozen wines that are produced there, and even travel around the vineyards on horseback, enjoying a traditional Moroccan meal in some of the wine cellars.

At the end of the day, the colours of the sunset may be enjoyed from the top of the city walls.

‘Gladiator’, ‘Game of Thrones’ and ‘Othello’ are just some of the productions that have brought Essaouira to the big screen.

canons that historically protected the city. If you also wish to spend time shopping, the rosé and white wines are some of the city’s most coveted specialities. Argan oil, silverwork, with pieces that combine mother-ofpearl, bone and ebony, along with rugs full of intriguing drawings on a deep red background also all stand out. Another option for those who wish to take it easy is to have a cup of tea while listening to gnawa music, enjoying shows by local artists or eating an unforgettable seafood banquet.

We will find a lot of art galleries because artists from all over the country live there

If you choose the Sqala du Port, in addition to the inland views, you will also find the ancient bronze

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Trends

THE FILMS

‘CHALLENGERS’ Tashi (Zendaya and Patrick (Josh O’Connor) face up to their own desires.

that have marked 2024

(and that you should know about for 2025) Let’s go over the essential film titles of a very mixed year, from ‘biopics’ and family tragicomedies to science fiction epics and a hilarious musical about the mafia that will leave nobody unmoved.

By Salomé Lagares and Laura Martos

T

he array of award ceremonies that occur during the last and first months of each year, which is usually known as the award season and that is topped by the Oscars, gives us a perfect chance to go over the important film titles of 2024 and that, in line with all the forecasts, will win prizes over the next few weeks.

The first great premiere of the year was the long-awaited second part of Dune. Since its publication in 1965, many have described this cult science fiction work as an “inadaptable” novel, but as the director Denis Villeneuve showed with his first part, the only element necessary was a vision that was sufficiently ambitious to move the sands of Arrakis to the large screen. Obviously, he did not manage this on his own: he was helped by a cast that shines both individually and together, with outstanding performances by Rebecca Ferguson, Austin Butler and, of course, Timothée Chalamet and Zendaya.

But this is not the American actress’s only box office hit this year. Just a few months after Dune: Part II swept across the world, Zendaya played Tashi Duncan in Challengers, the passionate sporting drama by Luca Guadagnino. Zendaya is just one corner of the love triangle that the film narrates: on each side of Tashi are Art (Mike Faist), her husband, who she coaches in tennis after an injury means she cannot play professionally, and Patrick (Josh O’Connor), Art’s old best friend and Tashi’s

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‘CASA EN FLAMES’ (House on fire).

The family spend a chaotic weekend in a house in Cadaques, on the Costa Brava.

ex-lover, who reappears in their lives when the ashes of both relationships seem to have died out.

Records, awards and nominations

Anora was another of the important titles in 2024.

This kind of modern, overwhelming, chaotic, neon-tinted story, signed by the indie filmmaker Sean Baker won the Palme d’Or at Cannes and Mikey Madison, who plays the leading role, is the bookies’ favourite for different awards for best actress. Almost nothing at all! The race, however, is very close with other surprising performances, such as the case of Karla Sofía Gascón, the star of the musical drama by Jacques Audiard, Emilia Pérez. The film tells the story of the head of a Mexican drug cartel who decides to disappear off the map, turning into

‘A COMPLETE UNKNOWN’ Elle Fanning completes the cast playing Sylvie Russo, Bob’s first love.

(Margaret Qualley). And at the end of the summer, the Venice Film Festival left us open-mouthed giving the Golden Lion to Pedro Almodóvar for his first film in English, The Room Next Door. Far from following his own clichés, the “latest” Almodóvar film explores – more for himself than for the public, the ordinariness of a dialogue with death from two opposite points of view: Martha (Tilda Swinton), a war correspondent, has decided to end her life after the diagnosis of a terminal cancer and asks her friend Ingrid (Julianne Moore), a novelist, to accompany her in her final days. An elegant, intimate story that does not leave Almodovar’s normal melodramatic tone behind, as the story itself demands it.

The mark left by Spanish films this year on the red carpets has also had a Catalan accent. El 47 —a drama directed by Marcel Barrena that follows the trade union adventures of Manuel Vital (Eduard Fernández) has made history and has become the most seen film in Catalan of the last forty years, beating the previous record by Casa en flames —a family tragicomedy directed by Dani de la Orden that had beaten the same record a few months earlier.

Ending with a lap of honour

the woman he always wanted to be with the help of a lawyer (Zoe Saldaña), tired of giving in to the corruption of their country. Unlike their character, the Spanish actress was more visible than ever, turning into the first trans women to win an award at Cannes with the best female performance and they seem to have every chance of winning the gold statue in March.

The Cannes jury also gave a price to The Substance, a macabre satire about aesthetic pressure where the most obscene body horror moments are offset with a refreshing touch of humour: Elisabeth (Demi Moore), a television star whose producer has got rid of her for being too old, is driven to trying an illegal serum that generates a “better” version of herself

‘DUNE: PART II’ Rebecca Ferguson plays Lady Jessica, Bene Gesserit and mother of Paul Atreides.

This has been a year of anticipated returns, such as the case of Francis Ford Coppola with his long-awaited (and probably last) production, Megapolis, conceived in 1977, which he ended up subsidising himself at his age of 85 years. This fable puts us in a utopian New York devastated by a catastrophe, where an architect (Adam Driver) who has the power to control time at his whim, tries to rebuild the city, using ancient Rome as his inspiration. The second part of Gladiator is full of epic and historical references. The sequel to the film starring Russell Crowe breaks away from the historical truth that led Ridley to win five gold statues in 2001; it takes place sixteen years after the death of Marco Aurelio, when his grandson Lucio Vero (Paul Mescal) is captured as a gladiator and trained to fight in the Coliseum. A déjà vu with better (and also too many ) special effects.

And finally, the year has said goodbye with an unbeatable 3-way bet for the most nostalgic of us: the film adaptation of the fantastic musical Wicked: part one, which in turn is based on the 1995 novel by Gregory Maguire. Cynthia Erivo is also a favourite for best actress for her performance as Elphaba; A Complete Unknown, a biopic about the iconic American of folk music, Bob Dylan, starring Timothée Chalamet (he is unstoppable!); and the final remake of Nosferatu, a deliberate copy of Bram Stoker’s Dracula in which Robert Eggers brings Count Orlock back to life in the great horror film of 2024.

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Leisure

THIRTY YEARS A

of passion and ‘otaku’ culture

What started out as a small meeting of fans of an art that was still marginal has managed to become an essential international event. The Manga Barcelona (previously Salón del Manga) is celebrating its thirtieth anniversary, aware of its inter-generational value and the distance it has covered.

By Joan Miquel Mas Salom

t the anniversary of its 30th edition, the Manga Barcelona has been crowned with a great success. Over 157,000 visitors —a historic record for the fair, congregated over four days at the Fira Barcelona Gran Via, consolidating the event not only as the most important one of its category in Spain, but also as a global reference in the spreading of the Japanese culture, comparable to the Paris Japan Expo or the Anima Expo in Los Angeles (USA). With these figures we can see the magnitude of the anime phenomenon and how far it has come from the 80s and 90s, when it was still seen as a lesser culture, aimed at children and a niche audience.

“At this edition it has been shown that anime has now become mainstream,” Oriol Estrada, the organiser of the event emphasises. “People of all ages and from many different places visit us. At this edition, in fact, less than half of the visitors were from Catalonia. Obviously, people who are fans of a group or a specific author have come from the rest of Spain, but also from France, England or the United States, as well as the accredited press from many countries.”

The visit of creators such as Naoki Urasawa, the legendary Mangaka responsible for successes such as Monster or Pluto; Hisato Murasaki, author of the adaptation of Persona 5, or Yumiko Igarashi, creator of Candy Candy, made it obvious how the international collaborations are transforming the manga and anime industry, which is progressively changing from belonging exclusively to Japanese culture, turning into a global phenomenon. Thousands of followers approached its panels, seeking the chance to meet and listen to their reflections on the impact of manga on global society.

But if Manga Barcelona has achieved this consideration and importance, it is exactly due to the impact that anime has had on Catalan culture. A fact that was promoted at this edition, bringing together different generations of fans. With the arrival of Dragon Ball and Dragon Ball Z to the platform Som3Cat, as well as the premier of the documentary series LLum, foc,

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analyse the current position of manga and anime, an industry that is expanding rapidly. The platform Crunchyroll, a benchmark in anime content, as well as the veteran Selecta Vision projected some titles expected in 2025 such as Ghost Cat Anzu and the Colors Within. The contact with their audience and the constant search for titles that might surprise people has meant that both companies hold a central, essential role for the expansion of anime in our territory.

Regarding manga, publishers such as Planeta Cómic launched exclusive editions by national and international authors, such as the continuation of their famous series of One Piece in a 3 in 1 edition; My Hero Academia or the manga special Dragon Ball Legend, which commemorates the 30 years of work by Akira Toriyama. They also announced the arrival of the series Gokurakugai, which is currently causing a sensation in Japan and its extension to works from other areas of the Asian continent with the publication of Korean Manhwas such as A Business Proposal. In their commitment to local talent, the publication of Mientras Yubooh duerme (While Yubooh sleeps) and Alter Ego stand out. Accordingly, we also can see in the comic world an expansion of genres, origins and audiences, showing how manga has now left the Japanese borders to spread around the world.

destrucció!, the event wanted to vindicate the cultural impact of this phenomenon. Within this context, the fair offered talks using the iconic voices of the cartoons dubbed into Catalan, such as Marc Zanni (Son Goku) and Joan Sanz (Vegeta), who shared anecdotes and recalled how these productions marked an entire generation.

“At the last editions we have been able to see how the parents who accompanied their children did not do so because the youngsters were fans, but often because the parents themselves are the fans. Particularly when dealing with workshops or events about iconic series, we find many adults aged between 30 to 40 who also want to celebrate their hobby,” Oriol explains.

Manga and anime today: a global phenomenon

In addition to the intergenerational component, Manga Barcelona wanted to look at the present and

At the event the longawaited premieres of ‘Ghost Cat Anzu’ and ‘the Colors Within’ were shown

But if one aspect stands out in the manga phenomenon it is its integration with other forms of entertainment, such as videogames and music, as well as the promotion of the Japanese culture and way of life. “This might still be more of a niche area, but it is inevitable that, if you delve deeply into the world of manga, you end up being attracted by other forms of Japanese culture,” Oriol concludes and he points out: “Although curiously, at Manga Barcelona, the activities such as workshops on writing or martial arts or fashion exhibitions are usually the most attractive for the visitors who are not the greatest fans of manga and anime as such.”

Therefore, with this edition of Manga Barcelona it reaffirms it cultural and international relevance as an event that brings generations together, promoting cultural dialogue and expanding the limits of creativity. After three decades of success, it continues to be an example of how passion for manga and anime can go beyond borders and enrich society, with the clear awareness of what has gone before, but with the sights always placed on the next step.

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Disconnection

Did you know...?

A doctor from the 19th century discovered that there was a link between post-partum deaths and hand washing

Books

Nobel Literature Prize 2024 Yeonghye had been a diligent, discreet wife. But everything changes when some bloody nightmares start to wake her up at night and she feels the need to get rid of all the meat in her fridge. Set in South Korea, The Vegetarian is the story of a radical metamorphosis in a patriarchal and ultra-capitalist society.

The vegetarian. Han Kang. Penguin Books

Premio Planeta 2024 With the end of the Second World War, Victoria survives singing in a Berlin club every night. Unscrupulous blackmailing by the Russians will force Victoria to travel alone to the United States, where she will enjoy the unconditional love of Captain Norton, but she will also discover a society full of racism and injustices.

O

bstetrics have evolved over history in a significant way, changing from knowledge based on experience to a scientific discipline, backed by technology.

Thanks to discoveries such as the caesarean section, the invention of forceps or the use of ether as an anaesthetic, deliveries began to be carried out attended by people who were trained in the medical aspects.

One of the names that has passed into history due to his contribution is Doctor Ignaz Semmelweis, who, in the middle of the 19th century discovered the infectious origin of the puerperal fever. Commonly known as the “mother saver”, he managed to decrease maternal mortality drastically by introducing hand washing with a calcium hypochlorite solution.

This proposal arose after observing that there was a great difference in the deaths due to puerperal fever between two clinics in Vienna: one attended by obstetricians and the other attended

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by midwives. After many trials and observation, he concluded that in the clinic in which the pregnant women were attended by doctors (mainly students who came from carrying out autopsies and practice work on dead bodies) cadaveric material was passed on during the delivery operations, causing important infections.

The scientific society responsible for analysing the problem rejected Semmelweis’ theory in spite of the studies carried out and the successful results –puerperal fever dropped from 10% to 2% and they even ended up removing him from his position in 1849.

His research was taken up again decades later with the studies by Louis Pasteur and Robert Koch, who explained the mechanism of transmission of infections scientifically.

However, it was not until the nineteen forties that there was a great reduction in deaths due to postpartum infection, thanks to the generalised use of antibiotics.

Victoria. Paloma Sánchez-Garnica. Ed.Planeta

The most intimate novel Gabriel, Dario and Carmen, three siblings with very different lives, suddenly have to take on a new task: taking care of their father, Antonio, who is facing the final phase of his life, ill and without any kind of independence. How do the members of a family face up to the inevitable decline and death of parents?

Los siguientes (The next ones). Pedro Simón. Espasa

The perfect thriller Alicia Berenson is a successful artist that shoots five bullets into her husband’s head and never speaks again. Theo Faber, an ambitious forensic psychotherapist, is determined to unravel the mystery of what happened that fatal night and he obtains a place in The Grove, the high security unit where she is interned.

The silent patient. Alex Michaelides. Alfaguara Negra

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