Factors associated with PrEP knowledge and intention to use PrEP among HIV-negative men and trans women sex workers in Spain.

Lack of data regarding knowledge and intention to use pre-exposure prophylaxis (PrEP) among sex workers exists in Spain. We conducted a cross-sectional analysis based on data from SexCohort study, which included male (MSW) and trans women sex workers (TWSW), aged ≥18 and recruited in two community-based centres in Barcelona, Spain. Of 116 TWSW and 79 MSW, 49.1% and 58.2% had factual knowledge of PrEP, and 40.3% and 70.1% had the intention to use PrEP, respectively. In the multivariable analyses, we found that education and condomless anal sex with stable partners were associated with PrEP knowledge. Regarding intention to use PrEP, TWSW were less likely than MSW to report an intention to use it (aOR = 0.35, 95% CI: 0.16-0.74). Furthermore, intention to use PrEP was associated with being foreign-born, practicing chemsex, and visiting a medical service in the last 12 months. The results of this study inform future trans-specific guidance for PrEP to be effectively implemented in Spain.

Assessment of badland susceptibility and its governing factors using a random forest approach. Application to the Upper Llobregat River Basin and Catalonia (Spain).

Badlands are considered hotspots of sediment production, contributing to large fractions of the sediment budget of catchments and river basins. The erosion rates of these areas can exceed 100 t ha-1 y-1, leading to significant environmental and economic impacts. This research aims to assess badland susceptibility and the relevance of its governing factors at different spatial scales using the well-known machine learning approach random forest (RF). The Upper Llobregat River Basin (ULRB, approx. 500 km2) and Catalonia (approx. 32,000 km2) have been selected as study areas. Previous studies stated that the RF approach is successful at making predictions for the same area where it has been trained, but the results of testing it in a different area remains unexplored. This work aims to evaluate the feasibility of upscaling to the large region of Catalonia a RF model trained in the small ULRB area. Two badland datasets of both small and large regions and a total of eleven governing factors have been used to determine the areas susceptible to badlands. Models performance has been analyzed through three different evaluation metrics: overall accuracy, kappa coefficient and area under receiver operating characteristic curve (AUC). The outcomes of this work confirmed that RF is a powerful tool for badland susceptibility analysis, specially when predictions are made in the same scale and spatial context where the model has been trained. Upscaling a RF model defined in the ULRB to the large area of Catalonia has been possible, but improved results have been obtained when the training of the models has directly been performed in the large region. Our final RF modelling results have facilitated the development of a large scale (32,000 km2) Badland Susceptibility Map for the full extension of Catalonia with a predictive overall accuracy of 97%, which strongly emphasizes lithology and Normalized Difference Vegetation Index (NDVI) as the main conditioning factors of badland distribution.

Food Waste and Power Relations in the Agri-Food Chain. The Fruit Sector in Lleida (Catalonia, Spain).

Studies of food waste claim that its main causes are technological and logistical deficiencies in the first stages of the agri-food chain. The present article discusses this statement using a specific case as a starting point: the production of fruit in Lleida (Catalonia, Spain). Since the 1980s, fruit production in this region has undergone a process of innovation and development. However, the agents who participate in the sector claim that the wasted volume of edible foodstuffs is greater than in previous times. This article argues that studies of food waste do not consider the power relations existing within the agri-food chain. When these relations are asymmetrical, technological innovation and logistics optimisation do not improve the efficiency of the system; rather, they help the hegemonic players to monopolise the commercial margin and transfer some of their running costs to the weaker agents. The ethnographic data for the study were obtained between 2017 and 2019 using qualitative research techniques.

Effect of Hepatitis E Virus RNA Universal Blood Donor Screening, Catalonia, Spain, 2017‒2020.

Hepatitis E virus (HEV) is the major cause of acute viral hepatitis in several countries in Europe. HEV is acquired mainly by consumption of contaminated pork but can also be transmitted through blood transfusion. HEV infection is usually self-limited but can become persistent in immunocompromised persons. During the first 30 months of HEV RNA universal screening of blood donations in Catalonia, Spain, we identified 151 HEV RNA-positive donations (1/4,341 blood donations). Most infected donors reported consumption of pates and sausages, and 58% were negative for HEV IgM and IgG. All HEV isolates belonged to genotype 3. All infected donors spontaneously resolved the infection, and no neurologic symptoms and reinfections were observed after 1 year of follow-up. Since the implementation of HEV RNA universal screening, no new cases of transfusion-transmitted HEV infection were reported. Our data indicate HEV screening of blood donations provides safer blood for all recipients, especially for immunosuppressed persons.

Effect of COVID-19 Pandemic on Invasive Pneumococcal Disease in Children, Catalonia, Spain.

We analyzed the effect of COVID-19 on healthcare demand and invasive pneumococcal disease in children in Catalonia, Spain. Compared with 2018-2019, we noted large reductions in healthcare activities and incidence of invasive pneumococcal disease in 2020. These changes likely resulted from nonpharmaceutical measures implemented during the COVID-19 pandemic.

Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain.

We compared hospital-acquired catheter-related bacteremia (CRB) episodes diagnosed at acute care hospitals in Catalonia, Spain, during the COVID-19 pandemic in 2020 with those detected during 2007-2019. We compared the annual observed and predicted CRB rates by using the negative binomial regression model and calculated stratified annual root mean squared errors. A total of 10,030 episodes were diagnosed during 2007-2020. During 2020, the observed CRB incidence rate was 0.29/103 patient-days, whereas the predicted CRB rate was 0.14/103 patient-days. The root mean squared error was 0.153. Thus, a substantial increase in hospital-acquired CRB cases was observed during the COVID-19 pandemic in 2020 compared with the rate predicted from 2007-2019. The incidence rate was expected to increase by 1.07 (95% CI 1-1.15) for every 1,000 COVID-19-related hospital admissions. We recommend maintaining all CRB prevention efforts regardless of the coexistence of other challenges, such as the COVID-19 pandemic.

Effect of excise tax on sugar-sweetened beverages in Catalonia, Spain, three and a half years after its introduction.

BACKGROUND: The World Health Organisation urges countries to levy specific excise taxes on SSBs. Currently, more than 50 countries have introduced some type of tax on SSBs. In March 2017, the Autonomous Region of Catalonia approved the introduction of a tiered excise tax on SSBs for public health reasons. To evaluate the effect of the Catalonian excise tax on the price and purchase of sugar-sweetened beverages (SSBs) and their possible substitutes, i.e., non-sugar-sweetened beverages (NSSBs) and bottled water, three and half years after its introduction, and 1 year after the outbreak of the COVID-19 pandemic. METHODS: We analysed purchase data on soft drinks, fruit drinks and water, sourced from the Ministry of Agriculture food-consumption panel, in a random sample of 12,500 households across Spain. We applied the synthetic control method to infer the causal impact of the intervention, based on a Bayesian structural time-series model which predicts the counterfactual response that would have occurred in Catalonia, had no intervention taken place. RESULTS: As compared to the predicted (counterfactual) response, per capita purchases of SSBs fell by 0.17 l three and a half years after implementing the SSB tax in Catalonia, a 16.7% decline (95% CI: - 23.18, - 8.74). The mean SSB price rose by 0.11 €/L, an 11% increase (95% CI: 9.0, 14.1). Although there were no changes in mean NSSB prices, NSSB consumption rose by 0.19 l per capita, a 21.7% increase (95% CI: 18.25, 25.54). There were no variations in the price or consumption of bottled water. The effects were progressively greater over time, with SSB purchases decreasing by 10.4% at 1 year, 12.3% at 2 years, 15.3% at 3 years, and 16.7% at three and a half years of the tax's introduction. CONCLUSIONS: The Catalonian SSB excise tax had a sustained and progressive impact over time, with a fall in consumption of as much as 16.7% three and half years after its introduction. The observed NSSB substitution effect should be borne in mind when considering the application of this type of tax to the rest of Spain.

Effects of air pollution on the potential transmission and mortality of COVID-19: A preliminary case-study in Tarragona Province (Catalonia, Spain).

The number of studies published on COVID-19 in recent months is certainly impressive. However, there are still important gaps to know a great number of characteristics of this disease. Among these, some potential ways of transmission of the SARS-CoV-2 and the different reasons for the severity of the disease in different people. Various studies have suggested that certain air pollutants could be increasing the transmission of the coronavirus, as well as the risks of COVID-19 incidence and mortality. In the present preliminary case-study conducted in Tarragona Province (Catalonia, Spain), we studied the potential association of COVID-19 with PM10, NO2 and O3, as well as the differences in the incidence and lethality of this disease. This Province is divided into two "health regions": Camp de Tarragona, with an important industrial complex, and Terres de l'Ebre, with a great agricultural component. In spite of the notable limitations of the current study, our preliminary findings indicate that the industrialized/urban areas of Tarragona Province show a higher incidence and mortality of COVID-19 than the agricultural/rural zones. These - and previous - results would highlight the importance of conducting specific investigations focused on directly assessing whether air pollutants such as particulate matter can act as carriers of the SARS-CoV-2. If confirmed, the recommendation on keeping the "social distance" (1.5-2 m) might need to be adapted to this situation.

Environmental levels and human health risks of metals and PCDD/Fs near cement plants co-processing alternative fuels in Catalonia, NE Spain: a mini-review.

This paper was aimed at reviewing recent studies related with the impact on environment and human health of metals and PCDD/Fs near cement plants. It has been particularly focused on the impact of cement plants located in Catalonia, Spain, which have been monitored by our research for more than ten years. Environmental monitoring studies were performed under different cement plant conditions. While some of our studies examined temporal trends of the levels of the above indicated pollutants, the main goal of other surveys was to assess the impact of implementing alternative fuels in the facilities. Even one of the studies was performed before and after the cement plant temporally ceased its industrial activity. The impact of cement plants burning alternative fuels on the emissions of metals and PCDD/Fs elsewhere was also reviewed. Regarding the cement plants in Catalonia, no significant differences were found, neither in the long-term follow-up studies, nor when alternative fuels are used, nor when a cement plant temporally stopped its activity. These results are in agreement with those reported for several stack emissions of other cement plants working under different conditions. We conclude that emissions of metals and PCDD/Fs by cement plants working with the best available techniques (BAT), should not cause a significant negative impact neither on the surrounding environment, nor on the human health of the population living in the neighborhood.

Chasing the ghost of infection past: identifying thresholds of change during the COVID-19 infection in Spain.

One of the largest nationwide bursts of the first COVID-19 outbreak occurred in Spain, where infection expanded in densely populated areas through March 2020. We analyse the cumulative growth curves of reported cases and deaths in all Spain and two highly populated regions, Madrid and Catalonia, identifying changes and sudden shifts in their exponential growth rate through segmented Poisson regressions. We associate these breakpoints with a timeline of key events and containment measures, and data on policy stringency and citizen mobility. Results were largely consistent for infections and deaths in all territories, showing four major shifts involving 19-71% reductions in growth rates originating from infections before 3 March and on 5-8, 10-12 and 14-18 March, but no identifiable effect of the strengthened lockdown of 29-30 March. Changes in stringency and mobility were only associated to the latter two shifts, evidencing an early deceleration in COVID-19 spread associated to personal hygiene and social distancing recommendations, followed by a stronger decrease when lockdown was enforced, leading to the contention of the outbreak by mid-April. This highlights the importance of combining public health communication strategies and hard confinement measures to contain epidemics.

Impact of an excise tax on the consumption of sugar-sweetened beverages in young people living in poorer neighbourhoods of Catalonia, Spain: a difference in differences study.

BACKGROUND: Sugar-sweetened beverage consumption is contributing to the obesity epidemic. On 28 March 2017, Catalonia enacted a law levying an excise tax on sugar-sweetened beverages for public health reasons. The purpose of this study is to assess the impact of the tax on the consumption of sugar-sweetened beverages in Catalonia (Spain). METHODS: Before-and-after study to assess changes in the prevalence of consumption of sugar-sweetened beverages among 1929 persons aged 12 to 40 years residing in low-income neighbourhoods of Barcelona (intervention) and Madrid (control). Beverage consumption frequency was ascertained via a validated questionnaire administered during the month prior to the tax's introduction (May 2017) and again at 1 year after it had come into force. The effect of the tax was obtained using Poisson regression models with robust variance weighted using propensity scores. RESULTS: While the prevalence of regular consumers of taxed beverages fell by 39% in Barcelona as compared to Madrid, the prevalence of consumers of untaxed beverages remained stable. The main reason cited by more than two-thirds of those surveyed for reducing their consumption of sugar-sweetened beverages was the increase in price, followed by a heightened awareness of their health effects. CONCLUSIONS: The introduction of the Catalonian excise tax on sugar-sweetened beverages was followed by a reduction in the prevalence of regular consumers of taxed beverages.

Determinants of health literacy in the general population: results of the Catalan health survey.

BACKGROUND: Health Literacy (HL) is the knowledge and competence to access, understand, appraise, and apply health information for health judgment. We analyze for the first time HL level of Catalonia's population. Our objective was to assess HL of population in our area and to identify social determinants of HL in order to improve the strategies of the Healthcare Plan, aimed at establishing a person-centered system and reducing social inequalities in health. METHODS: This was a cross-sectional study based on the Health Survey for Catalonia (ESCA, Enquesta de Salut de Catalunya), which included the 16 items of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The statements in the questionnaire cover three different health literacy domains: Health Care, Disease Prevention, and Health Promotion. HL was categorized in three levels: Sufficient, Problematic and Inadequate. Chi-square tests were performed to compare the percentages of subjects with adequate or inadequate HL across sociodemographic and health-related variables. Variables showing significant differences were included in a stepwise logistic regression to predict inadequate HL level. RESULTS: The questionnaire was administered to 2433 subjects aged between 15 and 98 years old (mean of 45.9 years, SD 18.0). Overall, 2059 subjects (84.6%) showed sufficient HL, 250 (10.3%) inadequate HL, and 124 (5.1%) problematic HL, with no significant differences between men and women (p = 0.070). A logistic regression analysis showed that low health literacy is associated with a lower level of education (OR 2.08, CI 95% 1.32-3.28, p = 0.002), low socioeconomic status (OR 2.11, CI 95% 1.42-3.15, p <  0.001) and a physical limitation to perform everyday activities (OR 2.50, CI 95% 1.34-4.66, p = 0.004). We also found a more modest association with low physical activity, having a self-perceived chronic disorder and performing preventive activities. CONCLUSIONS: Catalonia has a high percentage of subjects with sufficient HL. Education level, socioeconomic status and physical limitations were the factors with the strongest contribution to inadequate or problematic health literacy. Although these results are likely to be country-specific, the factors identified will allow policymakers of areas with similar socioeconomic profiles to identify groups with high risk of problematic or inadequate HL, which is essential for a successful patient-centered model of care.

Towards a comprehensive wildfire management strategy for Mediterranean areas: Framework development and implementation in Catalonia, Spain.

Southern European countries rely largely on fire suppression and ignition prevention to manage a growing wildfire problem. We explored a more wholistic, long-term approach based on priority maps for the implementation of diverse management options aimed at creating fire resilient landscapes, restoring cultural fire regimes, facilitating safe and efficient fire response, and creating fire-adapted communities. To illustrate this new comprehensive strategy for fire-prone Mediterranean areas, we developed and implemented the framework in Catalonia (northeastern Spain). We first used advanced simulation modeling methods to assess various wildfire exposure metrics across spatially changing fire-regime conditions, and these outputs were then combined with land use maps and historical fire occurrence data to prioritize different fuel and fire management options at the municipality level. Priority sites for fuel management programs concentrated in the central and northeastern high-hazard forestlands. The suitable areas for reintroducing fires in natural ecosystems located in scattered municipalities with ample lightning ignitions and minimal human presence. Priority areas for ignition prevention programs were mapped to populated coastal municipalities and main transportation corridors. Landscapes where fire suppression is the principal long-term strategy concentrated in agricultural plains with a high density of ignitions. Localized programs to build defensible space and improve self-protection on communities could be emphasized in the coastal wildland-urban interface and inner intermix areas from Barcelona and Gerona. We discuss how the results of this study can facilitate collaborative landscape planning and identify the constraints that prevent a longer term and more effective solution to better coexist with fire in southern European regions.

Pulmonary Infections with Nontuberculous Mycobacteria, Catalonia, Spain, 1994-2014.

In Spain, systematic reporting of pulmonary infections with nontuberculous mycobacteria is not mandatory. Therefore, to determine trends, we retrospectively identified cases for January 1994-December 2014 in Catalonia. Over the 21 years, prevalence increased and was associated with being male. Mycobacterium avium complex and M. abscessus prevalence increased; M. kansasii prevalence decreased.

Molecular investigation of vector-borne parasites in wild micromammals, Barcelona (Spain).

Information about the role of micromammals in the epidemiology of Leishmania infantum and Babesia sp. in southern Europe is scarce. Wild micromammals were captured in natural areas in the Barcelona province (NE Spain) in 2011 and analysed by real-time PCR for the presence of DNA of Piroplasmida (n = 253) and Leishmania infantum (n = 166). The wood mouse (Apodemus sylvaticus) was the most abundant species, but all specimens tested negative for L. infantum, for which two out of 15 (13.3%) white-toothed shrews (Crocidura russula) and one out of 23 (4.3%) Algerian mice (Mus spretus) resulted positive. No individual was positive for Piroplasmida DNA. The role of wild micromammals in the epidemiology of these parasites in the study area seems negligible.

Norovirus in Bottled Water Associated with Gastroenteritis Outbreak, Spain, 2016.

In April 2016, an outbreak of gastrointestinal illness (4,136 cases) occurred in Catalonia, Spain. We detected high levels of norovirus genotypes I and II in office water coolers associated with the outbreak. Infectious viral titer estimates were 33-49 genome copies/L for genotype I and 327-660 genome copies/L for genotype II.

Six-year surveillance of Newcastle disease virus in wild birds in north-eastern Spain (Catalonia).

Given that Newcastle disease (ND) is one of the major threats for the poultry industry, testing of Newcastle disease virus (NDV) has been carried out since 2010 in cases of mortality in wild birds (passive surveillance) in Catalonia. The objective is to provide an early warning system to prevent the infection of poultry. Since 2010, 35 episodes of mortality in wild birds were attributed to NDV infection. Throughout this period there was a progressive expansion of NDV to new areas, with an increase in the episodes of mortality, although it is not clear whether they were the result of the spread of the virus, or of the improvement of the surveillance. Phylogenetic analyses indicate that two distinct sublineages of NDV, 4a and 4b, were circulating in Catalonia. Both sublineages seem to be endemic in the wild bird population, affecting mainly Eurasian-collared doves, with a clear pattern in relation to its spatial distribution (coincident with the distribution of this species), and its temporal distribution (with the majority of cases between September and February). So far, endemicity in wild birds has not resulted in ND outbreaks in poultry. However, there are still many uncertainties about, for example, whether NDV may expand to new areas of Catalonia (with higher poultry density), or about the threat that the apparently more novel sublineage 4a may represent. Hence, efforts should be made so that measures to prevent infection of poultry farms (particularly in high-risk areas and periods) are encouraged, and surveillance is maintained.

Roma Never Die Alone.

A common characteristic of Roma as a cultural group is that they do not allow their elderly to die alone. Nevertheless, rooted in a mainstream cultural perspective of health provision services, public institutions usually do not allow Roma people to be with their loved ones in their last moments. Following the communicative methodology, we conducted a communicative case study on the death of the most relevant female Roma leader in Catalonia. She was accompanied by more than two hundred family members and friends in her room and corridor at an important hospital in Barcelona. We performed our research in the 2 years following her death to obtain the reflections of the Roma members involved. These reflections revealed the egalitarian dialogue forged between these Roma members and the hospital personnel, which enabled the former to embrace their culture and support their loved ones before death. Because this dialogue was possible and fruitful, the acknowledgment of cultural diversity and the improvement of the quality of services offered to Roma might also be possible in other health institutions.

Drug utilization in patients with OA: a population-based study.

OBJECTIVE: Patients with OA use different drugs in their search for relief. We aimed to study the prevalence of use and combinations of different medications for OA in a population-based cohort of OA patients in Catalonia, Spain, while characterizing users of each of the drugs available, with a particular focus on cardiovascular risk factors. METHODS: Data were obtained from the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) database, which includes electronic medical records and pharmacy invoice data for >5 million people from Catalonia. Study participants were those with a clinical diagnosis of OA in 2006-10. Drugs studied included oral and topical NSAIDs, analgesics (paracetamol, metamizole), opioids (tramadol, fentanyl), cyclooxygenase 2 (COX-2) inhibitors and symptomatic slow-acting drugs in OA. Drug utilization was described using medication possession ratios (MPRs), equivalent to the proportion of days covered with the drug of interest. The annual incidence of new users in the first year after OA diagnosis from 2006 to 2010 was estimated for all studied drugs among newly diagnosed OA patients using Poisson regression. RESULTS: We identified 238 536 study participants. The most common regimen of treatment consisted of at least three drugs (53.9% of patients). The drugs most frequently used regularly (MPR ≥50%) were chondroitin (21.2%), glucosamine (15.8%) and oral NSAIDs (14.4%). The incidence of the use of opioids, COX-2 inhibitors and chondroitin increased over the 5 year period, whereas all others decreased. CONCLUSION: Drug combinations are common in the treatment of OA patients, who are thus exposed to potential drug interactions, with unknown impacts on their health. The increasing use of opioids and COX-2 inhibitors is noteworthy because of the potential impact on safety and costs.

Early (1-year) Discontinuation of Different Anti-osteoporosis Medications Compared: A Population-Based Cohort Study.

Although a number of reports suggest very low persistence with oral bisphosphonates, there is limited data on persistence with other anti-osteoporosis medications. We compare rates of early discontinuation (in the first year) with all available outpatient anti-osteoporosis drugs in Catalonia, Spain. We conducted a population-based retrospective cohort study using data from the SIDIAP database. SIDIAP contains computerized primary care records and pharmacy dispensing data for >80 % of the population of Catalonia (>5 million people). All SIDIAP participants starting an anti-osteoporosis drug between 1/1/2007 and 30/06/2011 (with 2 years wash-out) were included. We modelled persistence as the time between first prescription and therapy discontinuation (refill gap of at least 6 months) using Fine and Gray survival models with competing risk for death. We identified 127,722 patients who started any anti-osteoporosis drug in the study period. The most commonly prescribed drug was weekly alendronate (N = 55,399). 1-Year persistence ranges from 40 % with monthly risedronate to 7.7 % with daily risedronate, and discontinuation was very common [from 49.5 % (monthly risedronate) to 84.4 % (daily risedronate)] as was also switching in the first year of therapy [from 2.8 % (weekly alendronate) to 10 % (daily alendronate)]. Multivariable-adjusted models showed that only monthly risedronate had better one-year persistence than weekly alendronate and teriparatide equivalent, whilst all other therapies had worse persistence. Early discontinuation with available anti-osteoporosis oral drugs is very common. Monthly risedronate, weekly alendronate, and daily teriparatide are the drugs with the best persistence, whilst daily oral drugs have 40-60 % higher first-year discontinuation rates compared to weekly alendronate.