About Mònica L. Ferrado

Science journalist. Head of science for the newspaper Ara

Josep Maria Antó: “Our health and that of the environment go together”

A sword of Damocles hangs over the head of today’s generations: the deterioration of the environment and climate change. The impact on human health of all this environmental turbulence also has enormous costs: economic factors must not serve as an excuse to postpone the necessary protection measures; in fact, quite the contrary.

Photo: Pere Virgili

Doctor Josep Maria Antó (Cornellà de Llobregat, 1952) works in the field of respiratory health and the environmental factors that affect it. Having graduated in Medicine from the Universitat Autònoma de Barcelona in 1975 and completed his Ph.D. in 1990, Antó switched to epidemiology in the 1980s. As Head of Epidemiology and Public Health at what is now the Hospital del Mar Institute for Medical Research (IMIM), which he joined in 1987, he played a leading role, alongside Doctor Jordi Sunyer, in the discovery of the link between the unloading of soya bean at the port of Barcelona and the epidemics of acute asthma that had already been getting media coverage for a few years. The epidemic ceased when they put the appropriate filters on the silos where the crop was stored.

Since then, he has continued to conduct research in this area and created a training centre at the Environmental Epidemiology Research Centre (CREAL), which he led and which merged with the Barcelona Institute of Global Health (ISGlobal) in June to form one of Europe’s largest health research centres. He is currently the Director of Science for this organisation, a role that he combines with teaching at the Universitat Pompeu Fabra (UPF), where he is a Professor of Medicine. In September, he gave a talk on climate change and its impact on health as part of the “Futur(s)” lecture series organised by the Ateneu Barcelonès and the Social Observatory of “La Caixa” bank.

What is the impact of climate change on health?

The most obvious one is heatwaves. For the last 30 years we have seen evidence that when we have a run of hot days, the mortality rate increases. The heatwave of August 2003 in Europe caused 20,000 more deaths than usual (15,000 in France and 3,000 in Spain). Similarly, we know that mortality also increases with cold weather. We must also take into account the consequences of extreme weather events, such as flooding and fires, that create particle pollution. In other words, there is a second line of indirect effects, because the climate has a multiplying effect on common problems.

We’re not talking about future risks but rather about very present ones, right?

Around the world, about seven million people die who would otherwise live if air pollution were to remain at the levels accepted by the World Health Organisation (WHO). Sixty per cent of this pollution is caused by road traffic. Climate change brings a rise in temperatures and possibly a rise in episodes of air stagnation. When the two phenomena coincide, their effects multiply each other. Another example is the diseases transmitted by vectors such as the mosquito. Climate change affects the geographical distribution of these vectors and this may also lead to changes in the distribution of disease, as is the case with malaria and dengue fever.

Can climate change have other unexpected effects on our health?

The most worrying are the systemic and complex effects about which we are not yet aware. For example, what impact climate change has on biodiversity, on the array of animal and plant species that are around us and with which we coexist. In my field, we are seeing more and more evidence of the impact of climate change on the number of plant species and bacteria (the microbiome). This biological diversity influences our immune system. Because they are such complex systems, even a small change can have disproportionate effects. There is evidence – albeit still incipient – that with less biodiversity the rate of asthma is higher. Another type of very important, complex effect is that of species migration.

And yet the emissions cuts that we need are still not being applied.

Our generation is living with a sword of Damocles hanging over our heads and we need to take urgent measures. The international agreement made at the Paris Climate Summit (COP21) is a first important step in the reduction of emissions of CO₂ and other greenhouse gases. But it is still difficult to predict what its scope will be.

The economic cost of these measures tends to be used as the main argument against them. How can one persuade society that protecting the environment is also positive from an economic perspective?

The impact of climate change on health has astronomical costs in terms of GDP. Policies that protect the environment generate wealth because they save lives and because they remove some of the burden on the health system. We need to think of the environment as another economic factor. In addition, an environmentally sustainable economy can create new types of products and services and generate wealth.

In recent years, there has been an increase in the incidence of respiratory illnesses. According to WHO forecasts, cancer rates could increase by 75 per cent by the year 2030.

That’s right, and cardiovascular and mental illnesses and allergies have increased too. In general, the frequency of chronic diseases has risen. Why is this? On the one hand, our life expectancy is growing, but we are at greater risk of getting ill because many of these illnesses are linked to ageing. But there are multiple reasons for this increase in disease, including environmental ones. For example, in the field of respiratory diseases we have seen a substantial increase in the incidence of chronic obstructive pulmonary disease (COPD), which was quite rare 30 years ago. This increase is clearly linked to smoking. We also know that air pollution increases the risk of serious episodes and of death in COPD patients. When it comes to the higher incidence of chronic diseases, we know where we’re going wrong: an unbalanced diet that’s too high in calories, smoking, an increasingly sedentary lifestyle and, in particular, social inequalities, which constitute the underlying structural cause.

Are the areas that have more polluted air also the ones with the worst health?

One can often not establish geographical patterns for a single cause of a disease. For example, in Spain there is a clear pattern of death from bladder cancer, with greater incidence in some areas of Andalusia and Catalonia, where there has been industrial and mining activity. The increased mortality from bladder cancer in areas of El Vallès strongly suggests a correlation with the presence of the textile industry. Another very clear example is the increase in cases of cancer – such as mesothelioma – that are related to workplace or environmental exposure to asbestos. In Barcelona, there is a clear, indisputable pattern, and it’s to do with social inequality. The difference in life expectancy between the wealthier neighbourhoods and the poorest ones is ten years, a fact that explains the majority of diseases. In the poorest neighbourhoods, the housing, nutrition and working conditions are worse; there is more stress about life, people smoke more, and so on. In Sarrià, Sant Gervasi or Pedralbes, people live longer than in Ciutat Vella. This is a common phenomenon seen in all cities.

And are poorer neighbourhoods also more exposed to pollution?

No, in Barcelona air pollution from traffic is no worse in the poor neighbourhoods. There are neighbourhoods with high purchasing power and a lot of traffic, where people are clearly more exposed to pollution and where there may be even more noise. The market may not have internalised this yet, but it will eventually.

Do we often exceed the thresholds of admissible air pollution?

There are two important thresholds: one is based on health criteria and is set by the WHO, which we exceed by a long shot, and the other is the legal threshold set by the European Union, which is more lax, putting economic and political criteria ahead of health.

Is there a correlation between pollution and hospital emergency cases?

Hundreds of studies demonstrate that the more air pollution there is, the more health problems there are. Reducing pollution by 20 per cent would prevent 2.8 per cent of deaths and emergency admissions for respiratory and cardiovascular cases, according to studies our centre has conducted. We have even seen an increase in hospital admissions on days when the levels of pollution were below WHO guidelines, so these recommendations are also questionable. No matter how little pollution there is, it still has effects. And although individually those effects may be small, when they accumulate in areas with millions of people, they have a big impact.

How many deaths could be avoided if air quality were improved?

A 2007 study by CREAL showed that in the metropolitan area of Barcelona particle pollution could be attributed to the premature deaths of 3,500 people over the age of thirty each year. In one of our more recent studies, Professor Mark Nieuwenhuijsen examined the relationship between deaths and the following five factors: exposure to air pollution, sedentary lifestyle, noise, heat and the lack of green spaces. Barcelona could prevent up to 20 per cent of deaths and the average life expectancy would increase by a year if we followed international recommendations on each of these factors.

How can the Government help?

With better urban and transport planning. Barcelonians only do around 77 minutes of physical activity a week, when the recommended amount is 150. The air holds an average of 16.6 micrograms of particulate matter per cubic metre, when according to international guidelines it should be below 10 micrograms. We also suffer from very high noise levels: Barcelona exceeds the healthy limit, which WHO recommendations set at 55 decibels, by 10 decibels. When it comes to heat, the city centre can sometimes be eight degrees warmer than the temperature at the outskirts. And a third of inhabitants live far from a green space.

You have concluded in various studies that traffic pollution affects children in school. What legacy will we leave our children if we don’t take action?

The research group led by Jordi Sunyer, who is head of the child health programme at CREAL, has demonstrated that traffic pollution affects children’s cognitive development and their academic performance. Using a sample of more than 2,600 primary school pupils from 39 schools in Barcelona, and an average age of eight and a half, they analysed the effects of particulate matter (PM) in the air inside the schools. An increase of 4 micrograms per cubic metre of particles less than 2.5 microns in diameter – the ones that present the greatest risk to health – is associated with a 22 per cent reduction in working memory.

And no measures are being taken.

We have a political tradition that tends to ignore scientific evidence. In Catalonia, we’ve been working with the Catalan Regional Government’s Department of Health to incorporate the evidence into health planning, but the response is always very slow. In the case of schools, the appropriate measure would be to restrict traffic around them. In the Nordic countries there are regulations regarding the location of schools, based on air pollution.

Another important project at CREAL is the INMA programme on Childhood and the Environment, which involves groups of mothers and children that you’ve been following for more than ten years to see how they are affected by pollution.

Air pollution affects a baby’s birth weight, which is lower the more that mothers have been exposed to pollution during pregnancy. We found that for every additional 10 micrograms of nitrogen dioxide (NO₂) or volatile compounds per cubic metre of air that the mother was exposed to, the baby’s weight was 91 grams lower. These studies are very important and the Government should take them into account.

Is it possible that PM can end up interfering in the way the whole body functions, in addition to the lungs?

These types of tiny particulates are the most worrying because they get right to the bottom of the lung and from there they get into the bloodstream, join the atheroma, cause chronic inflammation and spread around the entire organism. They can move from the olfactory bulb to the brain. We are certain that this is no exaggeration; in fact, quite the opposite: there are phenomena that are still little known and the problems may be even more serious. Only now are we starting to see the relationship with Alzheimer’s or diabetes.

They say that we are driving our cars less than we used to.

Levels of air pollution have fallen because we use our cars less, owing to the recession. But because there’s no money to buy new ones, the vehicles are getting older and cause more pollution. Up to now, nothing concrete has been done to reduce vehicle use: this is one of the most urgent measures that we have yet to take. We all need to walk more, cycle more and use more public transport.

Photo: Pere Virgili

Are superblocks a good public health policy?

They aim to decrease the total volume of traffic and, therefore, of polluting gases. They also provide another benefit: an increase in “walkability”. Physical exercise helps to reduce obesity and this has an even bigger impact on health. Excess weight and air pollution are directly related. For all the limitations of the superblocks project, it is a unique opportunity that Barcelona must not overlook. The days are numbered for the health of the planet if we do not work together to change the current model of development. Superblocks could make a major contribution.

At CREAL you’ve also been studying contamination from chemicals.

Diet is the main source of this. Fish contaminated by mercury has an impact on children’s neurocognitive development and has led to the establishment of dietary guidelines for pregnant women. We’ve also carried out studies on endocrine disruptors – dioxins – that are very persistent and poorly regulated.

All in all, it sometimes makes you wonder how we’re still alive?

Our organism has an incredible ability to adapt. We probably use more than 80,000 different chemicals, of which very few, perhaps one or two thousand, have been studied. The majority of them can be found in our bodies, albeit in tiny quantities, and we don’t know what effects they have… yet.

You are doing some uncomfortable research. Difficult studies on issues that some groups do not want clear conclusions from.

Yes, it is a disquieting science. Part of our research is often not to the liking of the big industrial corporations and they do everything they can to negate the studies or to undermine them. In Europe, this direct pressure is not as strong as it is in the United States, where it can happen that, if you publish an article that is very negative toward a particular industry, they sue you. They do it to scare off other researchers, to keep you busy defending yourself so you can’t work. A classic example is tobacco; the industry has used immoral strategies to try to hinder research and its application.

And the electromagnetic fields created by mobiles, how do they affect us?

At CREAL, studies by Elisabeth Cardis, Professor of Research in Radiation Epidemiology, has helped to get the International Agency for Research on Cancer (IARC) to classify the use of mobile phones as potentially carcinogenic. To reach conclusions such as this one, a panel is formed with groups of experts that assess the scientific evidence and the industry also participates as an observer. The problem is that when the IARC publishes this, lots of media organisations and experts cast doubt on the evidence and claim that the results have no meaning. But they do.

So once again, we should be taking measures that we’re not taking.

The authorities in charge should take a serious look at the recommendations made in these studies. Many countries tend to just take preventive measures, like advising us to use our mobiles less, to use hands-free systems, to keep our devices away from vital organs…

Leaders in big data and biomedicine

By Mònica L. Ferrado.

Research in biomedicine would not be possible without the massive use of data. It is the only way to find solutions in the fight against cancer, to explain how millions of neurons give structure to our brains or to carry out virtual trials for drugs. Big data ensures that medicine can move forward by leaps and bounds.

Catalonia is playing an important role in some of the most ambitious projects on big data and biomedicine, such as the Cancer Genome Project (specifically looking at leukaemia), the Human Brain Project and the ENCODE Consortium, which aims to shed light on the parts of our genome we know least about. Many more projects are under way which require enormous quantities of data to test molecules that are candidates for use in drugs. Sorting between the many candidate compounds and using a virtual environment to simulate their effects leads to faster progress and greater confidence in results before starting clinical trials.

More than eight hundred scientists are working in the field of bioinformatics in Catalonia, some of them internationally renowned experts. Catalonia is also home to state-of-the-art facilities for storage, analysis and production of data such as the Barcelona Supercomputing Center (BSC), where the MareNostrum supercomputer was recently upgraded and equipped to store and analyse much larger amounts of data, and the National Centre for Genome Analysis (CNAG), which has cutting-edge sequencing machinery.

Genetic data mining

Big data is nothing new to biomedicine. “The first massive databases were built in the 1950s, when storage of protein sequences began”, explains Roderic Guigó. He is coordinator of the bioinformatics programme at the Centre for Genomic Regulation (CRG) and has been recognised as one of the world’s leading experts on bioinformatics since the first human genome was obtained in 2000 (he was one of the few Europeans involved). However, it was not until the 1980s, when early computers became widely available, that it was possible to take advantage of the first electronic databases. “In 1983, data mining led to the first oncogene being found”, recalls Guigó. The three billion base pairs in one human genome take up three gigabytes. “It doesn’t seem like much, but with lots of them it quickly adds up”, he points out.

Nowadays research in biomedicine would be inconceivable without big data, something that, according to Guigó, means two major challenges: the power needed for complex calculations and storage capacity. In Europe, Catalonia plays a key role in both of these areas. It is no coincidence that the European Bioinformatics Institute (EBI) was fully confident about setting up the headquarters for the European Genome-phenome Archive (EGA) in Barcelona, led by the CRG. This archive stores the genetic data of a hundred thousand patients who have taken part in over seven hundred scientific studies on cancer, diabetes, cardiovascular and autoimmune diseases and numerous other pathologies.

There is only one other genetic database in the world of a similar size, led by the National Institutes of Health (NIH) in the United States. The Catalan archive contains data from work conducted with both healthy and sick people in trials at around two hundred sites across the globe. The EGA safeguards genomes (genetic data) and phenomes (phenotypic data, which range from hair or eye colour to the types of conditions suffered by the people taking part in the trials).

Researchers from all around the world – including those working in non-profit organisations – have access to these data. In just the first four months of 2014, data stored by the EGA were downloaded more than two hundred thousand times by almost five thousand research groups on every continent. Among the many prize assets held in the Barcelona EGA headquarters is the data from one of the most ambitious projects ever undertaken to study seven complex diseases, carried out by the Wellcome Trust using data from over five thousand people. Scientists have free access to this project.

© Albert Armengol
Roderic Guigó, coordinator of the bioinformatics program at the Centre for Genomic Regulation (CRG) and one of the principal experts in bioinformatics worldwide.

The complete map of leukaemia

The EGA also holds the genetic data of thousands of genomes sequenced as part of the International Cancer Genome Consortium, an ambitious worldwide project which seeks to build a complete genetic map of every type of cancer. The consortium was launched in 2008 and studies more than forty types of cancer; the work is divided into a number of different projects, one of which is set in Barcelona. Each project studies a minimum of five hundred patients.

Participants in Barcelona include the National Centre for Genome Analysis, the Barcelona Supercomputing Center and researchers from the Hospital Clínic. Elías Campo, head of the research team on human and experimental functional oncomorphology for the IDIBAPS research institute at the Hospital Clínic, codirects one section of this macro-project, the Spanish Chronic Lymphocytic Leukaemia Genome Consortium (CLL). The team has completed the genome of one hundred and fifty people and the exome of four hundred. The exome is made up of areas in the genome containing genes that provide code, forming the messenger RNA that, when transcribed by cellular mechanisms, creates proteins. It is the most important functional part of the genome as it determines the organism’s final constitution.

The whole brain in one supercomputer

Every year around sixty thousand high quality scientific articles are published on the brain. However, none of them tells more than one part of the story. As a result, despite all these efforts the brain remains a relatively impregnable black box. There are scientists that dream of bringing all these data together to form one great virtual brain in which each neuron, each electrical pulse, each neurotransmitter and each brain circuit could be recreated. This could provide understanding on the activity that happens when, for example, a thought occurs or a decision is made. Details could also be uncovered regarding what goes wrong in the more than five hundred brain-related diseases that affect a third of the European population, many of which currently have no cure.

Work on making this dream a reality has already begun at more than eighty research centres around the world (mostly European) that are participating in the Human Brain Project (HBP). This ambitious scheme is led by the Swiss Federal Institute of Technology Lausanne (EPLF), and there are two Catalan research centres involved, the Barcelona Supercomputing Center (BSC) and Barcelona’s Institute for Research in Biomedicine (IRB Barcelona).

The BSC and the IRB are researching modelling the molecular complexity established between two neurons. “A neuron is like a switch”, explains Modesto Orozco, who is head of the project at the IRB which provides the BSC with the mathematical data to use in the modelling. “Our goal is to simulate interactions between neurons on an atomic scale. That would enable us to model studies of drugs that could change synaptic transmission properties.”

It involves making mathematical models of the electric potentials and the generation of molecules between one neuron and another. One of the areas of study will be ion channels, complex protein mechanisms that open and close to allow or prevent the circulation of ions between neurons. “We want to visualise and model how synapses work, and how their effect can be blocked or increased”, says Orozco. These channels can be altered by external factors, such as drug abuse, the side effects of some medications or some diseases.

Based on the models that are to be created, data will be gathered to explain, for example, why some people suffering depression respond to drugs while others do not, and why some experience significant side effects while others feel them much less. In addition, it will make it possible to gain a better understanding of other diseases such as schizophrenia and Alzheimer’s. “We’ll be able to reconstruct the architecture of memory”, says Orozco, “and essentially, at a molecular level, understand what makes us human”.

Technologies for improving logistics and travels

By Mònica L. Ferrado.

The port’s smart dimension is starting to turn every movement into valuable information. It is more than fifteen years since the port of Barcelona first applied the pioneering initiatives that have enabled more efficient and competitive services with reduced environmental impact. Better mobility planning through smart technologies is also one of the current challenges for the metropolitan transport manager.

Each day between 1,500 and 1,800 lorries enter the port of Barcelona terminals to load and unload goods. That means jobs for 20,000 workers. Orchestrating all the operations interwoven in each and every one of these journeys requires a great deal of collective intelligence. Information technologies are key. It is more than fifteen years since Port de Barcelona first applied the pioneering initiatives that have enabled the generation of more efficient and competitive services with reduced environmental impact.

The port’s smart dimension is starting to turn every movement into valuable information. “Capturing movements with sensors is the best way of identifying and integrating them,” explains Catalina Grimalt, the information systems director at Port de Barcelona. When a lorry arrives, a sensor reads the number plate. This seemingly simple operation, which only lasts a second, allows the recovery and integration of all the information about the vehicle. “The Port Community System is a system of intelligent messages that has substituted many of the previous procedures. Operations that took minutes are instantaneous, reducing queues and waiting times, and also, therefore, CO₂ emissions,” adds Grimalt.

In the past, all these procedures took a lot of time and paperwork, but the amount spent on paper dropped dramatically some time ago. There is yet another benefit: the cameras that read the number plates are directly connected to the Civil Guard.

The space sensors are also useful for predicting storms. “A system of sensors and algorithms gives a 24-hour warning of any inclement weather. This makes the logistics of moving vessels to other ports much easier, which is especially important from the point of view of safety in the case of cruise ships: if there are going to be strong easterly winds we can dock the cruise liner in a safer place,” explains Grimalt. Each year, 2.6 million cruise passengers pass through the port of Barcelona.

The port also has a system that, by detecting mobile phones, can help collect data on the number of people present and their location. As well as this, they are developing a system to receive signals from the ships that pass through – radar and AIS – to prevent incidents.

The efficiency and savings that this information management is responsible for also translate into increased competitiveness with other ports. “These are services that benefit people and also make us more efficient and competitive,” confirms Jordi Torrent, head of strategy at Port de Barcelona. “Thanks to ICTs we have all kinds of information available that we can then provide to our people. They are indicators that may be useful to suppliers and are incorporated into the Efficiency Network, the quality brand for operators specialised in container goods.”

The ecological footprint

Exporting a container from Geneva, Switzerland, to Jedah, Saudi Arabia, via the port of Barcelona, including overland lorry and rail transport, generates 910 kilograms of CO₂ emissions. If this same container travelled through Antwerp, one of ports that competes with Barcelona, the emissions would be much higher: 1.5 tonnes. That means transporting goods through Barcelona results in a 41% saving in CO₂ emissions, as well as saving on fuel, obviously.

That calculation is possible thanks to the Ecocalculator, an online tool (www.portdebarcelona.cat/ecocalculadora) that provides exact data on the ecological footprint of any merchandise. It plots the routes on Google Maps and generates a report that makes choosing easier.

Beyond the environmental impact, the tool shows that the port of Barcelona is very competitive and efficient, especially as a gateway to Europe from Asia. Goods from China destined for central Europe take three or four days less by boat if they are unloaded in Barcelona.

TMB’s commitment to personal mobility

Bus stops that interpret the tastes of the waiting public, offer customised advertising and even allow people to make purchases with a smartphone. A place for videoconferencing in metro stations where you can communicate face-to-face with service staff. Apps for planning routes, giving timetables and knowing whether the unexpected has occurred. These are only some of the services that Transports Metropolitans de Barcelona (TMB) is working on as a key part of shaping a smart city. Other services, such as providing real-time information through screens, are already here.

© Vicente Zambrano
Presentation of the bi-articulated hybrid bus for the H12 line at the Smart City Tour of 2013. The bus was one of the first to offer travellers different kinds of information accessible from screens or with QR codes, Wi-Fi service and mobile payment.

Every day close to two million people move around Barcelona on public transport. The importance of transport for the general public is enormous and information is paramount in facilitating their daily movements. “For this reason customer service policies are very important. We are obliged to find solutions,” says Jordi Nicolás, chief executive of the Chair’s Office at TMB, the organisation which, in 2008, developed the first technology master plan. “At that moment the crisis and the emergence of new technologies coincided. We had to reduce communication costs and the introduction of all these measures means that now we spend five times less and we also know, from the surveys we have carried out, that user satisfaction has increased.”

There are teams of professionals dedicated exclusively to managing all of the communication channels. From MouTV (MoveTV), with 1,800 screens, to social networks – 60,000 people follow TMB on Facebook and Twitter – and QR codes. “They are a good tool for collecting and monitoring user feedback,” explains Monica Jimenez, manager of digital information and customer care at TMB. “We believe that in the future much of this information will go through mobile phones, from everything offered by a smartquesina – smart, sustainable bus stops that were presented to great acclaim during the Mobil World Congress – to apps.”

Currently, metro and bus stops already have devices announcing how long a vehicle will be. The mobile apps TMB Maps and TMB Virtual already have more than 300,000 downloads. A big step has even been taken towards creating TMB Open Data, a space to make the city’s transport data available to everyone, particularly professionals working on new technologies. “We are making metro and bus information available to the developers that want to incorporate it into their apps,” points out Nicolás.

Doctor Smart on the phone

By Mònica L. Ferrado.

Chronic illnesses account for between 70% and 80% of the cost of public health in OECD countries. New communication technologies will enable improvements in care and a reduction in expenses.

Currently, in Barcelona and the wider world, there are several pilot eHealth projects underway, using communication technologies in medicine for administrative, educational and clinical purposes. Here, Hospital Clínic de Barcelona and Barcelona Digital Centre Tecnològic have joined forces to develop new applications through the Barcelona Virtual Health Practice programme. “A chronic patient has very specific needs; we want to increase contact and reduce face-to-face visits,” explains Joan Escarrabill, director of the chronic care programme at Hospital Clinic.

The routine monitoring of chronic patients (with diabetes, heart failure or respiratory diseases, etc.) can be undertaken through mobile apps or internet consultations. Engineers from Barcelona Digital and doctors from Hospital Clinic have created an app for prescribing for and monitoring these kinds of patients, who do controlled exercises, like walking or going up and down stairs, with sensors connected to their mobile phones. The exercise data that doctors receive gives them an accurate picture of the patient’s physical performance. The app also plays a part in motivation: it sets up virtual routes and proposes activities suited to each patient. There is even “a little figure that is happy or sad, depending on what they do during the day”, explains Felip Miralles, head of health R+D in Barcelona Digital Centre Tecnològic. Although it seems simple, keeping the figure happy is motivating for the patients, the majority of whom are elderly. So far a pilot scheme has been run involving ten people, with really good results. “It increases the percentage of patients that do exercise: without the app 30% do; among those who had the app 70% stuck to it,” says Miralles. “Technology itself does not solve the problem, but it is useful within the context of a care package,” observes Escarrabill.

eConsult

eConsult, a pioneering scheme for virtual consultations carried out by twenty doctors and seventeen nurses in twelve primary healthcare centres (CAPs) in Barcelona, allows the consultations to take place via a digital platform created specifically for the project that guarantees data confidentiality. Medical staff receive an email alert for each new consultation and have 48 hours to respond. At the moment, however, response time is around nine hours.

In 2010, in collaboration with Telefònica, the Hospital del Mar started up a telemedicine project to monitor high-risk heart failure patients who are unable to go to the hospital or the CAP. At home, the patient has a touchscreen, a webcam, scales for weighing themselves and a blood pressure monitor. The data arrives at the hospital for monitoring and the visit takes place through videoconferencing. The nurse does 80% of the visits, according to the algorithms of the European guidelines, and leaves the cardiologist to do the validation and make the more sophisticated decisions. According to the preliminary results of the project, this device reduces mortality by 34%, decreases the cost per patient by 68% and patient satisfaction is much higher.

Shared medical records also enable alternative patient information management, in a way that could lead to comprehensive treatments, and even the early detection of some diseases. The nephrology service at the Vall d’Hebron University Hospital has developed a pioneering project, EPIRHOS, which, through a computer application integrated into the patient information management network, among other things, enables the detection of possible, previously undetected cases of kidney disease. It is calculated that between 10% and 15% of the population have undetected kidney disease.