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Natalitat; COVID-19; Hospital comarcal Natalidad; COVID-19; Hospital comarcal Natality; COVID-19; Country hospital S'entén per natalitat el nombre de nascuts vius que es produeix en un territori. Aquesta dada unida a l'estadística de defuncions permet estimar el creixement de la població. A la comarca de l'Alt Empordà hi ha hagut un increment significatiu de la població immigrada en els últims anys, fins a situar-se actualment a prop del 25%. Aquest fet ha impactat tant en el creixement de la població com també en la natalitat en els darrers anys, una situació que s’ha alterat amb la COVID-19. L’objectiu d’aquest estudi va ser comparar el nombre de parts a la Fundació Salut Empordà (FSE) el 2022 respecte al període 2020-2021 i analitzar l’evolució de la taxa de naixements a la comarca de l’Alt Empordà durant el període 1998-2022.

Mortalitat; COVID-19; Hospital comarcal Mortalidad; COVID-19; Hospital comarcal Mortality; COVID-19; County hospital L’objectiu de l’estudi va ser conèixer les causes de mortalitat i la seva evolució en el període d’aparició de la COVID-19 en un hospital comarcal.

Demografia; Salut; Economia; Territori Demografía; Salud; Economía; Territorio Demographics; Health; Economy; Territory Indicadors Clau de l’Alt Empordà 2022 presenta una selecció de dades estadístiques sobre l’Alt Empordà i la demarcació de Girona. Aquestes dades s’emmarquen en l’àmbit municipal en tots aquells casos en què ha estat possible i, en altres en què no s’ha pogut obtenir informació prou detallada, es presenten en àmbit comarcal o provincial. En aquest document es vol aportar una visió general que faciliti conèixer l’estat del territori amb dades de l’any 2021 o les més recents editades, i veure quines són les tendències actuals. El recull inclou dades sociodemogràfiques, de salut, d’economia, de medi ambient i d’altres recursos del territori. En l’edició de 2022, com ja passava l’any anterior, s’objectiva la influència de l'epidèmia de COVID-19 en diversos indicadors i tendències. Indicadores Clave del Alt Empordà 2022 presenta una selección de datos estadísticos sobre el Alt Empordà y la demarcación de Girona. Estos datos se enmarcan en el ámbito municipal en todos aquellos casos en los que ha sido posible y, en los que no se ha podido obtener información lo suficientemente detallada, se presentan en ámbito comarcal o provincial. En este documento se quiere aportar una visión general que facilite conocer el estado del territorio con datos del año 2021 o más recientes editados, y ver cuáles son las tendencias actuales. La recopilación incluye datos sociodemográficos, de salud, de economía, de medio ambiente y otros recursos del territorio. En la edición de 2022, como ya pasaba el año anterior, se objetiva la influencia de la epidemia de COVID-19 en varios indicadores y tendencias. Key Figures on Alt Empordà 2022 presents a selection of statistics on Alt Empordà and the province of Girona. Whenever possible, this data is defined within the municipal scope, but in many cases, it has not been possible to obtain sufficiently detailed information, so the figures are for the whole area or provincial. This document aims to provide a general view to help us find out about the state of the area using 2021 data or the most recent data available and identifying current trends. This document includes data on demographics, socio-demographics, health, economy, the territory and its resources. As was the case last year, in the 2022 edition, the influence of the COVID-19 epidemic has been objectified in various indicators and trends.

Background: Current evidence suggests that mortality is considerably higher in individuals experiencing homelessness. The aim of this study was to analyze the mortality rate and the mortality risk factors in a sample of individuals experiencing homelessness in the city of Girona over a ten-year period. (2) Methods: We retrospectively examined the outcomes of 475 people experiencing homelessness with the available clinical and social data. Our sample was comprised of 84.4% men and 51.8% foreign-born people. Cox's proportional hazard models were used to identify mortality risk factors between origin groups. (3) Results: 60 people died during the ten-year period. The average age of death was 49.1 years. After adjusting for demographic characteristics and the duration of homelessness, the risk factors for mortality were origin (people born in Spain) (HR = 4.34; 95% CI = 1.89-10.0), type 2 diabetes (HR = 2.9; 95% CI = 1.62-5.30), alcohol use disorder (HR = 1.9; 95% CI = 1.12-3.29), and infectious diseases (HR = 1.6; 95% CI = 1.09-2.39). Our results show a high prevalence of infectious and chronic diseases. Type 2 diabetes emerges as an important risk factor in homelessness. The average age of death of individuals experiencing homelessness was significantly lower than the average age of death in the general population (which is greater than 80 years) (4). Conclusions: Foreign-born homeless people were generally younger and healthier than Spanish-born homeless people. Chronic diseases were controlled better in Spanish-born people, but this group showed an increased risk of mortality. DDEUIT

In this study it was analysed the perception of different professionals working with persons experiencing homeless, specifically about the situation of homelessness institutions during the first weeks of the state of alarm as a consequence of the COVID-19 pandemic. The method employed was a qualitative analysis of thematic content. An ad hoc online questionary was designed including open questions about the perception of professionals about the management of the COVID-19 crisis in the services addressed to homeless people. A sample of 202 participants of almost all the autonomic communities of Spain was recruited (professionals of social education, social work, social integration and psychology). Main conclusions indicated that homelessness services had a lot of difficulties to adapt their circumstances to the confinement requirements. These circumstances influenced in the mental health of the professionals specially. Persons experiencing homelessness with mental health or addictions problems were persons that suffered more difficulties (highlighting situations of sheltering in temporary macro institutions as pavilions). Residential resources that limited the access of people and confine them, had less difficulties to manage the situation. A recapitulation of recommendations of the participants was included at the end of the paper just in case future epidemic situations could influence in these population En el presente estudio se analiza la percepción de distintos profesionales especialistas en el fenómeno del sinhogarismo, sobre la situación en las instituciones especializadas, durante las primeras semanas del estado de alarma consecuencia de la pandemia del COVID-19. El método empleado fue el análisis cualitativo de contenido temático. Se creó un cuestionario en línea ad hoc, con preguntas abiertas sobre la percepción de la gestión de la crisis del COVID-19 en los dispositivos dirigidos a personas en situación de sin-hogar. Se reclutó una muestra de 202 participantes, profesionales de la educación social, el trabajo social, la integración social y la psicología, de prácticamente todas las comunidades autónomas del estado español. Las principales conclusiones indican que los servicios tuvieron muchas dificultades para adaptarse a la situación de confinamiento, las cuales repercutieron especialmente en la salud mental de los y las profesionales. Las personas sin-hogar con problemas de salud mental y/o adicciones, especialmente aquellas que fueron confinadas en macroinstalaciones temporales, fueron las que sufrieron más dificultades. Los recursos residenciales de tamaño reducido, que limitaron su acceso y se confinaron, tuvieron más facilidad para gestionar la situación. El manuscrito finaliza con una recopilación de recomendaciones de las personas participantes, a tener en cuenta en caso de futuros rebrotes o epidemias que influyan en esta población

This study aims to analyse the use of an instant messaging app (WhatsApp®) as a means of communication for reaching people who inject drugs. An eight-week prospective longitudinal and observational study with three observations was designed for five addiction centres in Catalonia. The participants were 105 people who inject drugs, distributed in five intervention groups. The results of the Risk Assessment Battery (RAB) were compared in the three levels of analysis pre-test, post intervention and one month after the intervention. The main results indicate a significative reduction in RAB scores after the intervention. The main conclusion was that the WhatsApp® intervention has great potential for developing harm reduction interventions and to reduce the HIV contagion risk El presente estudio analiza el uso de una aplicación de mensajería instantánea (WhatsApp®) como canal de acceso a personas que se inyectan drogas. Se diseñó un estudio observacional longitudinal prospectivo de ocho semanas y tres observaciones en cinco centros de adicciones en Cataluña. Participaron 105 personas que consumían drogas por vía parenteral, distribuidas en cinco grupos de intervención grupal. Se compararon los resultados de la escala Risk Assessment Battery (RAB) (después de ser traducida al español y analizada su consistencia interna) en las tres fases de análisis pre test, post intervención y un mes después de la intervención. Los resultados indican una disminución significativa de las puntuaciones RAB tras la intervención a través de WhatsApp®. Se concluye que la intervención grupal a través de WhatsApp presenta grandes potencialidades para realizar intervenciones en reducción de daños y reducir el riesgo de contagio del VIH

Josep Garre-Olmo,1–3 Anna Ponjoan,1,4–5 José Maria Inoriza,6,7Jordi Blanch,4 Inma Sánchez-Pérez,6 Rafel Cubí,4 Rosa de Eugenio,7 Oriol Turró-Garriga,1,2Joan Vilalta-Franch On behalf of the Registry of Dementia of Girona Study Group (ReDeGi Study Group)11Research Group on Ageing, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Catalonia, Spain; 2Registry of Dementia of Girona, Health Assistance Institute, Catalonia, Spain; 3Department of Medical Sciences, School of Medicine, University of Girona, Catalonia, Spain; 4Vascular Health Research Group (ISV-Girona), Foundation University Institute for Primary Health Care Research Jordi Gol I Gurina, Catalonia, Spain; 5Autonomous University of Barcelona, Catalonia, Spain; 6Research Group on Health Services and Health Outcomes (GRESSIRES), Integrated Health Services Baix Empordà (SSIBE), Catalonia, Spain; 7Hospital de Palamós, Integrated Health Services Baix Empordà (SSIBE), Catalonia, SpainBackground: Knowledge on survival after diagnosis is important for all stakeholders. We aimed to estimate the survival and life expectancy after a dementia diagnosis, and to quantify the impact of dementia subtypes on mortality.Methods: Retrospective matched cohort study using a linkage between a dementia-specific registry and two primary care electronic medical records databases. Between 1 January 2007 and 31 December 2015 there were 5,156 subjects aged 60years and over registered by the Registry of Dementia of Girona and matched to 15,468 age-sex and comorbidity individuals without dementia attended by general practitioners in the province of Girona (Catalonia, Spain).Results: The median survival was 5.2years (95% CI 5.0 to 5.4), the median life expectancy was 74.7years (95% CI 71.9 to 76.5), and there were differences by gender. The mortality rate was 127.1 per 1,000 person-years (95% CI 121.6 to 132.7), and the hazard ratio for mortality in persons with dementia ranged between 1.63 (95% CI 1.52 to 1.76) for Alzheimer’s disease and 2.52 (95% CI 1.90 to 3.35) for Parkinson-plus syndromes. There was one death per year attributable to dementia for every 18.6 persons with dementia, and for every 2.4 persons with dementia who die, one death was attributable to dementia.Conclusion: The prognosis after dementia diagnosis is conditioned by demographic and clinical features. Although survival is larger for women, they also experience a higher number of years of life lost. Parkinson-plus syndromes and dementia due to multiple etiologies are among the most malignant subtypes regarding mortality.Keywords: epidemiology, diagnosis, dementia, mortality

With the start of the great economic recession in 2007, homelessness increased five- fold in some regions of southern Europe. Larger numbers of people experiencing homelessness, compounded by a lowered capacity for social and health services to respond to their needs, precipitated an increase in so-called 'chronic homelessness'. The aim of this study was to establish the presence of chronic homelessness in a defined geographical area of Spain, and to determine the prevalence of diagnosed mental disorders within both the chronic and non-chronic homeless population. A prospective and descriptive study was designed to monitor a cohort of 826 indi- viduals experiencing homelessness who constituted the entire identified homeless population in the relevant territory in 2006. This sample was followed until 2016 and sociodemographic as well as clinical information was collected, including the time spent homeless. The results obtained indicated that one in 10 participants met the criteria for chronic homelessness, a rate that is lower than in the US, where the definition of chronicity that was applied originates from. Alcohol use disorder was the most common mental health disorder that contributed to the chronicity asso- ciated with homelessness. Being born in the country (Spain) where the study was conducted and being older were the main other variables associated with chronicity. People defined as chronically homeless in Spain were on average younger than in the US, but women were present in the chronic subgroup at a similar rate. We also reflect on the limitations of the study and in particular the appropriateness of the concept of chronicity as applied to homelessness

Informe sobre les necessitats específiques que cal atendre en els familiars cuidadors de persones malaltes d'Alzheimer o amb demència en general a la Regió Sanitària de Girona Aquest informe és el fruit de la feina feta a partir de la concessió d’un accèssit a la beca de l’Agrupació de Ciències Mèdiques de Girona i de la Salut (ACMG) durant la XXXIII jornada de cloenda del curs acadèmic 2016-2017

All the policies, services, programmes and actions aimed at reducing the negative effects of drug consumption when the consumer does not wish to quit consumption, are called harm reduction. Historically, most of these interventions have been aimed at parenteral drug users. This is due to the epidemic nature of illnesses such as Acquired Immune Deficiency Syndrome, or the Hepatitis C Syndrome, whose main contagion mechanism is sharing injecting material, and also the risk of overdose associated to this type of consumption. The groups which are more vulnerable to suffering addiction issues and their related harm are the people experiencing homelessness. In the investigation conducted in order to design more efficient preventive interventions, it has been observed that there exist great opportunities to use Smartphones to develop distance interventions among homeless people with mental disorders, including those related to substance abuse. This work explores the possibilities of developing an on line intervention to reduce the principal harm associated to injected drug consumption among homeless people, in particular through the Whatsapp application for mobile phones. The reading of scientific literature indicates that the main advantages associated to this type of intervention are the improvement in the access to services, due to the inherent barriers to institutions and also to those associated to users, and the possibilities in the management of communication with intervention agents. There exist great possibilities to develop this proposal of intervention from specialised public services El conjunto de políticas, servicios, programas y acciones cuyos objetivos tratan de reducir los efectos nocivos de los consumos de drogas cuando la persona que las consume no desea o no consigue abandonarlos, se denominan reducción de daños. La mayor parte de este tipo de intervenciones se ha dirigido históricamente a usuarios de drogas por vía parenteral. Esto se debe tanto al carácter epidémico de enfermedades como el Virus de la Inmunodeficiencia Humana o el virus de la Hepatitis C, cuyo principal mecanismo de contagio es el compartir material de inyección, como al riesgo de muerte por sobredosis que se asocia a este tipo de consumo. Uno de los colectivos más vulnerables de padecer adicciones y los daños que se les asocian, son las personas que experimentan una situación de sinhogarismo. En la investigación para diseñar intervenciones preventivas más eficaces, se ha descubierto que existen grandes oportunidades en el uso del teléfono inteligente para desarrollar intervenciones a distancia con población sin hogar con patología mental, incluidas las relacionadas con el abuso de sustancias. Este trabajo explora las posibilidades de desarrollar una intervención en línea para reducir los principales daños asociados al consumo de drogas inyectado en población sin hogar, concretamente a través de la aplicación WhatsApp para dispositivos móviles. La revisión realizada de la literatura científica indica que las principales ventajas que se asocian a este tipo de intervención son la mejora en el acceso a los servicios, debido tanto a las barreras inherentes a las instituciones como las que se asocian a los usuarios, y las posibilidades en la gestión de la comunicación con los agentes de la intervención. Existen grandes posibilidades para desarrollar esta propuesta de intervención desde los servicios públicos especializados

Patients with anosognosia have been presented more dangerous behaviours and difficulties with treatment adherence, leading to increased burden on caregivers(Conde-Sala et al., 2015). Anosognosia Questionnaire for Dementia (AQ-D; Migliorelli et al., 1995) has been used to collect patients and caregivers'perceptions about anosognosia.

Objective: To determine the prevalence of tuberculosis, AIDS and Hepatitis C in a representative sample of homeless people in Girona, and set the connections with the main factors related to sociodemographic and health habit aspects. Methods: Transversal, observational and analytic study, CHI square, and multivariate regressive logistics. Results: There is a prevalence of tuberculosis infection of 40.2% and tuberculosis of 5.2%, both factors related to socioeconomic factors. The rate of VIH was 7.2% and VHC was 11.7%. Those people who had consumed drugs through parenteral ways were the ones with the highest infection risk of both VIH (p=0.002) and VHC (p

Objectives: Neuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. Methods: A baseline sample of 221 patients and caregivers was followed up over 24 months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia Questionnaire-Dementia (AQ-D), Quality of Life-Alzheimer's Disease (QoL-AD), and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. Results: In the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24 months (p < 0.001), and with more negative ratings among caregivers, especially at baseline (p < 0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p < 0.001), and it also had a smaller negative effect on patients' self-ratings (p = 0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. Conclusion: Neuropsychiatric symptoms and anosognosia have differential effects on patient and caregiver ratings of the quality of life of patients with Alzheimer's disease. Key words: Alzheimer's disease, quality of life, anosognosia, neuropsychiatric symptoms, caregivers, patients.

L’anosognòsia és un trastorn associat a la MA que es defineix globalment com un dèficit de consciència de malaltia, de l’afectació i el grau d’aquesta. L’objectiu d’aquesta recerca va ser determinar la prevalença d’anosognòsia en la MA, establir la comorbilitat clínica amb altres característiques dels pacients, comparar dues metodologies d’avaluació i analitzar l’efecte sobre la qualitat de vida de pacients i sobre la càrrega dels familiars cuidadors. La mostra de l’estudi va estar formada per pacients i cuidadors procedents de l’Hospital Santa Caterina de Salt i de l’Hospital universitari de Bellvitge. La presència d’anosognòsia es va determinar mitjançant l’Anosognosia Questionnaire in Dementia (AQ-D). La prevalença d’anosognòsia global va ser de 46.7%, 28,4% en casos lleus i en casos moderats i greus va ser 64,6% i 91,4%, respectivament. L’anàlisi comparativa entre l’avaluació clínica i l’AQ-D va demostrar bona correlació (índex kappa = 0,7). Les diferències observades es van atribuir a l’amplitud de valoració que inclou l’AQ-D (capacitats físiques i trastorns de conducta). La presència d’anosognòsia s’ha associat als trastorns d’apatia, desinhibició i irritabilitat i a la depressió de forma inversa. La valoració de la qualitat de vida en els pacients va mantenir-se estable mentre els cuidadors la van puntuar pitjor a major anosognòsia. Alhora, els cuidadors de pacients amb anosognòsia van presentar major sobrecàrrega física i aïllament social, desgast emocional i sentiments de dependència. L’anàlisi de l’anosognòsia pot prevenir una mala adherència als tractaments, limitar conductes de risc i facilitar les tasques assistencials dels cuidadors, reduir el consum de recursos i, per tant, millorar la qualitat de vida de pacients i cuidadors, i retardant la institucionalització., Anosognosia is a common disorder in Alzheimer disease (AD), and is defined as an overall lack of awareness of the disease and the degree of involvement of this. The aim of this research was to determine the prevalence of anosognosia in AD patients, establishing the comorbidities with other patient’s clinical characteristics, compared two methodologies for assessing anosognosia and analyzing the consequences on the quality of life (QOL) of patients and on burden of family caregivers. The study sample was comprised of patients and caregivers from Sta. Caterina's Hospital in Salt (Girona) and from Hospital Universitari de Bellvitge (Barcelona). The presence of anosognosia was mainly determined by Anosognosia in Dementia Questionnaire (AQ-D). The prevalence of anosognosia was 46.7%, 28.4% in mild cases, 64.6% in moderate and 91.4% in severe cases. The comparative analysis between clinical assessment of anosognosia and AQ-D score showed good correlation (kappa = 0.7). These observed differences were attributed to the breadth of assessment includes on the AQ-D (physical abilities and behavioural disorders). The presence of anosognosia was associated with increased disorders as apathy, disinhibition and irritability; and decreased depression. Assessing QOL in patients remained stable while the caregivers scored worse at higher anosognosia. Moreover, caregivers of patients with anosognosia showed greater burden expressed as social isolation, emotional exhaustion and feelings of dependency. The presence of anosognosia is associated with dementia’s severity but it is already present in early stages. The analysis of anosognosia can prevent risk behaviors, can facilitate the work of careers, and improve the quality of life of patients and caregivers.

Introducción. La anosognosia y la depresión pueden influir en la valoración sobre la calidad de vida del paciente (QoL-p) con la enfermedad de Alzheimer (EA). Objetivo. Explorar la evolución de la QoL-p en la EA y la influencia de anosognosia y depresión en la percepción de la QoL-p en pacientes y sus cuidadores. Pacientes y métodos. Estudio observacional, analítico y longitudinal de 12 meses. Muestra consecutiva de 221 pacientes atendidos ambulatoriamente. La media de edad fue de 77,8 años (DE = 7,3) y 140 fueron mujeres (63,3%). Instrumentos: Quality of Life in AD, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Mini-Mental State Examination y Global Deterioration Scale. Se calculó el tamaño del efecto en las diferencias entre dos medias y se realizó un análisis de regresión lineal con los factores asociados a la percepción de la QoL-p. Resultados. Los pacientes con anosognosia presentaron puntuaciones menores en depresión y mayores en la QoL-AD, al contrario que los pacientes sin anosognosia, e independientemente del tratamiento farmacológico antidepresivo. Los cuidadores puntuaron más negativamente la QoL-p. En la regresión lineal, las mayores discrepancias entre pacientes y cuidadores respecto a la QoL-p, estuvieron asociadas a la anosognosia (β = 0,48, p < 0,001) depresión (β = -0,20, p < 0,001) y capacidad funcional (β = -0,21, p < 0,001), explicando el 35,3 %, 7,9% y 11,3 % de la varianza. Conclusiones. La anosognosia estuvo asociada a una menor depresión y mejor percepción de la calidad de vida en los pacientes