Mortality in Catalonia during the summer of 2022 and its relation with high temperatures and COVID-19 cases.

Purpose: To analyse the association between the mortality during the summer 2022 and either high temperatures or the COVID-19 wave with data from the Catalan Health Care System (7.8 million people). Methods: We performed a retrospective study using publicly available data of meteorological variables, influenza-like illness (ILI) cases (including COVID-19) and deaths. The study comprises the summer months of the years 2021 and 2022. To compare the curves of mortality, ILI and temperature we calculated the z-score of each series. We assessed the observed lag between curves using the cross-correlation function. Finally, we calculated the correlation between the z-scores using the Pearson correlation coefficient (R2). Results: During the study period, 33,967 deaths were reported in Catalonia (16,416 in the summer of 2021 and 17,551 in the summer of 2022). In 2022, the observed lag and the correlation between the z-scores of temperature and all-cause deaths was 3 days and R2 = 0.86, while between ILI and all-cause deaths was 22 days and R2 = 0.21. This high correlation between temperature and deaths increased up to 0.91 when we excluded those deaths reported as COVID-19 deaths, while the correlation between ILI and non-COVID-19 deaths decreased to -0.19. No correlation was observed between non-COVID deaths and temperature or ILI cases in 2021. Conclusion: Our study suggests that the main cause of the increase in deaths during summer 2022 in Catalonia was the high temperatures and its duration. The contribution of the COVID-19 seems to be limited.

Unravelling the role of the mandatory use of face covering masks for the control of SARS-CoV-2 in schools: a quasi-experimental study nested in a population-based cohort in Catalonia (Spain).

OBJECTIVE: To assess the effectiveness of mandatory use of face covering masks (FCMs) in schools during the first term of the 2021-2022 academic year. DESIGN: A retrospective population-based study. SETTING: Schools in Catalonia (Spain). POPULATION: 599 314 children aged 3-11 years attending preschool (3-5 years, without FCM mandate) and primary education (6-11 years, with FCM mandate). STUDY PERIOD: From 13 September to 22 December 2021 (before Omicron variant). INTERVENTIONS: A quasi-experimental comparison between children in the last grade of preschool (5 years old), as a control group, and children in year 1 of primary education (6 years old), as an interventional group. MAIN OUTCOME MEASURES: Incidence of SARS-CoV-2, secondary attack rates (SARs) and effective reproductive number (R*). RESULTS: SARS-CoV-2 incidence was significantly lower in preschool than in primary education, and an increasing trend with age was observed. Six-year-old children showed higher incidence than 5 year olds (3.54% vs 3.1%; OR 1.15 (95% CI 1.08 to 1.22)) and slightly lower but not statistically significant SAR (4.36% vs 4.59%; incidence risk ratio 0.96 (95% CI 0.82 to 1.11)) and R* (0.9 vs 0.93; OR 0.96 (95% CI 0.87 to 1.09)). Results remained consistent using a regression discontinuity design and linear regression extrapolation approaches. CONCLUSIONS: We found no significant differences in SARS-CoV-2 transmission due to FCM mandates in Catalonian schools. Instead, age was the most important factor in explaining the transmission risk for children attending school.

Flood impact on the Spanish Mediterranean coast since 1960 based on the prevailing synoptic patterns.

In a changing climate and in social context, tools and databases with high spatiotemporal resolution are needed for increasing the knowledge on the relationship between meteorological events and flood impacts; hence, analysis of high-resolution spatiotemporal databases with detailed information on the frequency, intensity, and impact of floods is necessary. However, the methodological nature of flood databases hinders relating specific flood events to the weather events that cause them; hence, methodologies for classifying flood cases according to the synoptic patterns that generate them are also necessary. Knowing which synoptic patterns are likely to generate risk situations allows for a probabilistic approach with high spatial resolution regarding the timing of occurrence, affected area, and expected damage from floods. To achieve these objectives, we use the SMC-Flood Database, a high-resolution spatiotemporal flood database covering the 1960-2015 period for all municipalities along the Spanish Mediterranean coast. To relate floods with the synoptic conditions that generated them, we used a multivariate analysis method on the corrected daily anomalies of the surface pressure fields, 850 hPa temperature, and 500 hPa geopotential height, all of which were obtained from the 20th Century Reanalysis Project V2. Results show that 12 atmospheric synoptic patterns can statistically explain the 3608 flood cases that occurred in the study area between 1960 and 2015. These flood cases were classified into 847 atmospherically induced flood events. These results reduce the uncertainty during decision making because of the classification of potential risk situations. The Mediterranean Basin is a region where floods have serious socioeconomic impacts; hence, this work helps improving prevention measures and providing information for policymakers, mainly regarding land use planning and early warning systems.

Potential contribution of distant sources to airborne Betula pollen levels in Northeastern Iberian Peninsula.

Betula (birch) pollen is one of the most important causes of respiratory allergy in Northern and Central Europe. While birch trees are abundant in Central, Northern, and Eastern Europe, they are scarce in the Mediterranean territories, especially in the Iberian Peninsula (IP), where they grow only in the northern regions and as ornamental trees in urban areas. However, the airborne birch pollen patterns in Catalonia (Northeastern IP) show abrupt high concentrations in areas with usually low local influence. The intensity of the derived health problems can be increased by outbreaks due to long-range pollen transport. The present work evaluates the different potential contributions to Catalonia from the main source regions: Pyrenees, Cantabria, and the forests of France and Central Europe. To this end, we computed the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) back trajectories of air masses associated with the main Betula pollen peaks occurring simultaneously over different Catalan monitoring stations, and we studied their provenance over a 15-year period. The Vielha aerobiological station on the northern slopes of the Central Pyrenees was used to identify the dates of the pollen season in the Pyrenean region. In order to better understand the role of the Pyrenees, which is the nearest of the four birch forested regions, we classified the pollen peaks in the other Catalan stations into three groups based on the relationship between the peak and the pollen season in the Pyrenees. Our analysis of back-trajectory residence time, combined with the associated pollen concentration, reveals that two principal routes other than the Pyrenean forest sustain the northerly fluxes that enter Catalonia and carry significant concentrations of Betula pollen. This study has also allowed quantifying the differentiated contributions of the potential source regions. In addition, the Weather Research Forecast (WRF) mesoscale model has been used to study three specific episodes. Both models, HYSPLIT and WRF, complement each other and have allowed for better understanding of the main mechanisms governing the entry of birch pollen to the region.

Schools as a Framework for COVID-19 Epidemiological Surveillance of Children in Catalonia, Spain: A Population-Based Study.

Objective: We describe and analyze the childhood (<18 years) COVID-19 incidence in Catalonia, Spain, during the first 36 weeks of the 2020-2021 school-year and to compare it with the incidence in adults. Methods: Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were obtained from the Catalan Agency for Quality and Health Assessment. Overall, 7,203,663 SARS-CoV-2 tests were performed, of which 491,819 were positive (6.8%). We collected epidemiological data including age-group incidence, diagnostic effort, and positivity rate per 100,000 population to analyze the relative results for these epidemiological characteristics. Results: Despite a great diagnostic effort among children, with a difference of 1,154 tests per 100,000 population in relation to adults, the relative incidence of SARS-CoV-2 for <18 years was slightly lower than for the general population, and it increased with the age of the children. Additionally, positivity of SARS-CoV-2 in children (5.7%) was lower than in adults (7.2%), especially outside vacation periods, when children were attending school (4.9%). Conclusions: A great diagnostic effort, including mass screening and systematic whole-group contact tracing when a positive was detected in the class group, was associated with childhood SARS-CoV-2 incidence and lower positivity rate in the 2020-2021 school year. Schools have been a key tool in epidemiological surveillance rather than being drivers of SARS-CoV-2 incidence in Catalonia, Spain.

Community Risk Factors in the COVID-19 Incidence and Mortality in Catalonia (Spain). A Population-Based Study.

The heterogenous distribution of both COVID-19 incidence and mortality in Catalonia (Spain) during the firsts moths of the pandemic suggests that differences in baseline risk factors across regions might play a relevant role in modulating the outcome of the pandemic. This paper investigates the associations between both COVID-19 incidence and mortality and air pollutant concentration levels, and screens the potential effect of the type of agri-food industry and the overall land use and cover (LULC) at area level. We used a main model with demographic, socioeconomic and comorbidity covariates highlighted in previous research as important predictors. This allowed us to take a glimpse of the independent effect of the explanatory variables when controlled for the main model covariates. Our findings are aligned with previous research showing that the baseline features of the regions in terms of general health status, pollutant concentration levels (here NO2 and PM10), type of agri-food industry, and type of land use and land cover have modulated the impact of COVID-19 at a regional scale. This study is among the first to explore the associations between COVID-19 and the type of agri-food industry and LULC data using a population-based approach. The results of this paper might serve as the basis to develop new research hypotheses using a more comprehensive approach, highlighting the inequalities of regions in terms of risk factors and their response to COVID-19, as well as fostering public policies towards more resilient and safer environments.

Robust estimation of diagnostic rate and real incidence of COVID-19 for European policymakers.

Policymakers need clear, fast assessment of the real spread of the COVID-19 epidemic in each of their respective countries. Standard measures of the situation provided by the governments include reported positive cases and total deaths. While total deaths indicate immediately that countries like Italy and Spain had the worst situation as of mid-April, 2020, reported cases alone do not provide a complete picture of the situation. Different countries diagnose differently and present very distinctive reported case fatality ratios. Similar levels of reported incidence and mortality might hide a very different underlying pictures. Here we present a straightforward and robust estimation of the diagnostic rate in each European country. From that estimation we obtain a uniform, unbiased incidence of the epidemic. The method to obtain the diagnostic rate is transparent and empirical. The key assumption of the method is that the infection fatality ratio of COVID-19 in Europe is not strongly country-dependent. We show that this number is not expected to be biased due to demography nor to the way total deaths are reported. The estimation protocol is dynamic, and it has been yielding converging numbers for diagnostic rates in all European countries as from mid-April, 2020. Using this diagnostic rate, policy makers can obtain Effective Potential Growth updated every day, providing an unbiased assessment of the countries at greater risk of experiencing an uncontrolled situation. The method developed has been and will be used to track possible improvements in the diagnostic rate in European countries as the epidemic evolves.

The extreme floods in the Ebro River basin since 1600 CE.

Reliable and complete knowledge of the historical floods is necessary for understanding the extreme hydrological dynamics of the rivers, their natural variability and anthropic changes. In this work we reconstruct the most important floods of the Ebro basin during the last 400 years in different areas of the basin. The analysis is based on four different areas: the Ebro River at Zaragoza, the Cinca River at Fraga, the Segre River at Lleida, and the Ebro River near its mouth at Tortosa. Based on a documentary research, we have first obtained relevant information about the initial conditions (rainfall duration and distribution, snow cover influence) and the maximum flood heights that allow to reconstruct the maximum peak flows by using hydraulic models and to calculate the subbasins contributions. The results show four main types of extreme floods: a) those affecting simultaneously all the subbasins with the highest peak discharges (Ebro at Tortosa in 1787: 0.15 m3 s-1 km-2); b) those originated at the western basin, upstream from Zaragoza, with an Atlantic origin, presenting moderate maximum peak flows, caused by persistent winter rainfall and where snowmelt significantly contributes to the flood; c) those originating at the central Pyrenean subbasins, with Mediterranean origin, occurring, with high peak discharges. These mainly occur during autumn as a consequence of rainfalls of different duration (between 3 days and 1 month), and without significant snow thawing and d) finally, less frequent but very intense flash floods events centered in the Lower Ebro area with low peak flows. In terms of frequency, two different periods can be distinguished: from 1600 until 1850, the frequency of events is low; since 1850 the frequency of events is clearly higher, due to an increase of the climatic variability during last stages of the Little Ice Age. From the 1960's reservoirs construction modifies discharges regime.

Are the Pyrenees a barrier for the transport of birch (Betula) pollen from Central Europe to the Iberian Peninsula?

This work provides a first assessment of the possible barrier effect of the Pyrenees on the atmospheric transport of airborne pollen from Europe to the North of the Iberian Peninsula. Aerobiological data recorded in three Spanish stations located at the eastern, central and western base of the Pyrenees in the period 2004-2014 have been used to identify the possible long range transport episodes of Betula pollen. The atmospheric transport routes and the origin regions have been established by means of trajectory analysis and a source receptor model. Betula pollen outbreaks were associated with the meteorological scenario characterized by the presence of a high-pressure system overm over Morocco and Southern Iberian Peninsula. France and Central Europe have been identified as the probable source areas of Betula pollen that arrives to Northern Spain. However, the specific source areas are mainly determined by the particular prevailing atmospheric circulation of each location. Finally, the Weather Research and Forecasting model highlighted the effect of the orography on the atmospheric transport patterns, showing paths through the western and easternmost lowlands for Vitoria-Gasteiz and Bellaterra respectively, and the direct impact of air flows over Vielha through the Garona valley.

A mixed-methods evaluation of school-based active living programs.

BACKGROUND: School-based programs to combat childhood obesity often lack resources to incorporate strong evaluation components. This paper describes a collaborative evaluation conducted by partners implementing Active Living by Design (ALbD) programs at one Chicago elementary school. PURPOSE: To assess ALbD program outcomes by triangulating various forms of evidence gathered while implementing these programs. METHODS: An exploratory, mixed-methods design was used to collect and analyze data from numerous physical activity initiatives implemented at the school from 2004 to 2009. The researchers triangulated quantitative (student BMI data, student standardized test and discipline data, classroom physical activity logs, and student physical activity knowledge surveys) and qualitative (classroom physical activity logs and open-ended teacher surveys questions) findings to assess outcomes. RESULTS: Students continuously enrolled at this school from Grades 1 through 4, those most exposed to ALbD activities over time, had significantly lower BMI after 4 years, compared with peers who transferred to the school after Grade 1. Student achievement on standardized tests improved between 2004 (prior to initiating ALbD activities) and 2008. Visits to the Disciplinary Office dropped dramatically over the 4-year period. Teacher interviews and surveys and classroom Take 10! Program activity logs revealed that the program was implemented enthusiastically by all grades. The Physical Activity Knowledge Survey revealed a significant increase in physical activity knowledge after instituting these activities. CONCLUSIONS: Collaborative efforts to amass and analyze a variety of data demonstrated the effects of implementing a variety of health promotion activities in one school, documenting the growth of a "culture of health" in that school community.

Solução protética para implantes mal posicionados: relato de caso clínico / Prosthetic solution for misplaced implants: a case report

Reabilitações protéticas sobre implantes ainda é um desafio para Odontologia. Existem situações em que os implantes são colocados em locais não compatíveis com o posicionamento dos dentes no arco, sendo necessário utilizar compensações protéticas capazes de corrigir essa dificuldade. Este trabalho tem como objetivo, relatar um caso clínico que apresenta uma opção protética para compensar o mau posicionamento dos implantes, pelo uso de uma mesoestrutura metálica. O paciente apresentava uma deformação óssea na região anterior de maxila onde foram instalados quatro implantes, posicionados de tal forma que os acessos aos parafusos protéticos ocorriam em áreas estética e biomecanicamente desfavoráveis. Portanto, foi planejado a confecção de uma mesoestrutura metálica, alterando a região de acesso aos parafusos protéticos, o que proporcionou ótimo resultado estético e satisfação do paciente.

Prosthetic rehabilitation on implants is still a challenge for Dentistry. There are situations where the implants are placed in locations that are not compatible with the positioning of the teeth in the arch, prosthetic compensation is necessary to be able to fix this problem. This study aims, report a clinical case that presents a prosthetic option to compensate the poor positioning of implants, by using a metallic mesostructure.The patient had a bone deformation in the anterior maxilla where four implants were installed, positioned so that access to prosthetic screws occurred in areas aesthetics and biomechanically unfavorable. So it was planned the construction of a metallic mesostructure, changing the area of access to prosthetic screws, which provided excellent aesthetic results and patient satisfaction.