Search Results (160)

Background/Objectives: Systemic treatment of advanced hepatocellular carcinoma (HCC) is based on combinations of immunotherapies (ITs) and lacks predictive markers of efficacy. Objectives: To define the prognostic value of the CRAFITY and RECA biological scores for overall survival (OS) before and during IT, and to evaluate the value of these two models for predicting the therapeutic response. Patients and methods: This was a multicenter retrospective analysis of 229 patients. OS was analyzed using Kaplan–Meier curves, log-rank tests, and Cox models, through which second-line therapy was modeled as a time-dependent covariate to avoid immortal time bias. The predictive capacity was assessed using univariate logistic regression. Validation was performed within two external Chinese cohorts. Results: Sixty-six percent of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (vascular invasion: 36.3%, metastases: 32.6%). After a mean follow-up of 14.9 (12.8) months, the median OS was 17.4 (6.9–38.0) months. The CRAFITY score distinguished only two different prognostic subgroups before treatment, but its prognostic value was confirmed with three different prognostic groups after 3 and 5 cycles and 6 months of treatment. The RECA score was strongly associated with OS before treatment and after 3 and 5 cycles and after 6 months of IT. Conversely, neither score had a discriminatory ability to predict early therapeutic response. The prognostic value of both models for OS was confirmed in the external cohorts. Conclusions: The RECA and CRAFITY scores have strong prognostic value for OS during IT. Beyond the models, the dynamic effects of systemic inflammation on IT reveal distinct clinical outcomes. Neither score has the ability to predict early therapeutic response, further supporting their use during treatment. Full article

Urban competitiveness and vulnerability have traditionally been studied as analytically distinct dimensions, grounded in the assumption that competitive performance necessarily strengthens urban structures. However, empirical evidence from tourist cities reveals a paradox, as high levels of tourism competitiveness may coexist with cumulative processes of structural fragilisation. This article introduces urban competitive vulnerability—an urban system’s propensity to competitive erosion driven by internal fragility accumulation, even during high performance. Using panel data from six major Spanish tourist cities (Barcelona, Madrid, Valencia, Palma, Seville, and Málaga) over 2014–2024, we develop an integrated framework with four dimensions: tourism competitiveness, sectoral specialisation, territorial pressure, and governance capacity. We construct the Urban Competitive Vulnerability Index (CVI) and test four hypotheses using panel-data models with fixed effects and interaction terms. Results confirm significant positive relationships between tourism competitiveness and structural vulnerability (β = 0.540, p < 0.001). Sectoral specialisation increases vulnerability both directly (β = 0.504, p < 0.001) and indirectly through competitiveness (65.8% mediated effect). Tourist housing intensity significantly increases housing prices (β = 0.288, p < 0.001) and evictions (β = 0.125, p < 0.05). Cities with high prior vulnerability experienced more severe COVID-19 impacts (β = −3.688, p < 0.05) and slower recovery. While limited to Spanish cities, this study provides the first urban-specific framework for competitive vulnerability with direct implications for urban tourism planning and governance. Full article

This study evaluates perceived facial aesthetics across different age groups (18–29 years, 30–55 years, >55 years) through a questionnaire incorporating modified profile photographs of a male and a female subject. These images were adjusted based on the position of the central incisor and the Barcelona line described by Hernández-Alfaro. Statistical analyses were primarily conducted by age group and secondarily by sex and prior studies, using the Shapiro–Wilk, Mann–Whitney U and Kruskal–Wallis tests. All analyses were performed with a significance level set at p < 0.05. Significant differences were observed in the evaluation of facial aesthetics across age groups, as well as between sexes and participants with varying level of education. Younger individuals showed greater acceptance of protrusive profiles, while women and participants with higher educational attainment tended to be more critical in their evaluations. Full article

Background: Waiting times for elective surgery are widely used as indicators of health system performance, particularly following the disruption caused by COVID-19. The objective of this study is to compare the waiting times for major elective surgeries in the Southern Barcelona Metropolitan Area before (2018–2019) and after (2022–2023) the pandemic, examining differences according to sociodemographic characteristics. Methods: A retrospective comparative study was conducted using data from the Southern Barcelona Metropolitan Area between 2018 and 2023. Adults registered on the waiting list for major elective surgical procedures were included. All analyses were stratified by sex. A stratified pre–post pandemic analysis was conducted to examine differences in waiting times by Socioeconomic Index. Waiting times were modelled using generalized linear models with a Gamma distribution and log link, adjusting for age and Socioeconomic Index quartiles. Interaction between period and Socioeconomic Index was tested. Results: The analysis included 73,055 individuals (50.5% women). Median waiting time decreased after the COVID-19 pandemic for both sexes (women: 128 to 121 days; men: 99 to 94 days). This reduction showed an inverse socioeconomic gradient. Adjusted analyses showed longer waits in the lowest versus highest Socioeconomic Index quartile after the pandemic (women: RR = 1.23; men: RR = 1.30). Conclusions: Waiting times for major elective surgery decreased after COVID-19. An exclusive focus on waiting time indicators may conceal structural barriers to access and contribute to inequalities. Equity-sensitive monitoring of elective care is essential to ensure a fair recovery of surgical services. Full article

Urban areas face rising risks from extreme heat due to climate change, intensifying thermal stress and exacerbating social inequalities. Urban climate refuges—cool, accessible indoor and outdoor public spaces that maintain their ordinary functions—are increasingly adopted as a local adaptation measure to protect vulnerable populations during heat events. This study aims to develop and test a SWOT–CAME analytical framework to evaluate and compare the maturity, equity, and implementation logic of urban climate refuge networks in three European cities with contrasting climates and governance traditions: Barcelona, Amsterdam, and Copenhagen. A qualitative multiple-case design is combined with a transparent indicator set (coverage, accessibility, and typology mix) derived from official municipal sources and planning documents. Results show differentiated pathways: Barcelona represents an institutionalized network model; Amsterdam illustrates an emerging coordinated public-health approach; and Copenhagen reflects an ecosystem-based orientation where green–blue infrastructure provides substantial passive cooling capacity but requires clearer heat-specific operational protocols. The discussion highlights the need for hybrid adaptation strategies that combine nature-based solutions with operational governance and targeted support for vulnerable groups. The paper concludes with a transferable framework for cities seeking to integrate climate refuges into resilience and climate-justice agendas. Full article

Background: Nurses’ teaching skills in the clinical setting are crucial to ensuring that students receive high-quality training. Despite the growing importance of competency frameworks, there is little research on the relationship between nurses’ teaching competence and sociodemographic, professional, training, and research variables. Methods: This was a cross-sectional, descriptive, and correlational study conducted at nine hospitals linked to the clinical placement subjects of the Bachelor of Nursing of the University of Barcelona. The study population comprised all nurses directly involved in clinical teaching. Participants’ level of self-reported teaching competence was evaluated using the Spanish version of the Capabilities of Nurse Educators (S-CONE) questionnaire, and the sociodemographic, professional, and academic variables were collected in an ad hoc questionnaire. Descriptive statistics, non-parametric tests, and linear and logistic regression models were used to analyse the associations between the S-CONE total score and the variables collected. Results: The mean age of the participants (n = 596) was 41.9 years (standard deviation: 8.82), and 85.6% of them were women (n = 510). The overall mean S-CONE score was 3.81 (SD: 0.73). Higher scores were observed in those with advanced academic degrees, formal teacher training, and participation in academic activities. Professionals with mixed roles (clinical mentor and academic tutor) self-reported significantly higher competence levels. Multivariate analyses identified participation in conferences, tutoring of undergraduate theses, and involvement in research or development projects as the main predictors of higher teaching competence as measured by the S-CONE questionnaire. The lowest-scoring factor was research and evidence, which points to a potential area for improvement. No significant associations were found with age, sex, or years of clinical experience. Conclusions: Participants had a high self-reported level of teaching competence and rated themselves as competent overall, especially in professional practice and curriculum design. However, we identified areas for improvement related to pedagogical innovation and the use of evidence. The findings reinforce the importance of professional development and academic involvement to strengthen teacher competence. Full article

Although self-administered antigen tests are widely available, anatomical knowledge of nasal anatomy in the general population is limited. Cerebrospinal fluid leakage has been reported in multiple cases following damage to the roof of the nasal cavity due to accidental penetration of the cribriform plate of the ethmoid bone. Methods: Images of anatomical prosections used for teaching in the Dissection Room of the Faculty of Medicine of the University of Barcelona were obtained to illustrate the viable pathway to the nasopharynx through the inferior meatus, below the inferior turbinate. Screenshots from publicly available videos produced by the author demonstrating perpendicular swab insertion were analyzed, and multiethnic illustrative images were taken from staff volunteers. Publicly available instructions for patients included in the first eight nasal antigen tests for self-diagnosis authorized in Spain in 2021 were reviewed. Results: Most of the initially authorized antigen tests (all but one) still recommended in 2025 a vertical swab insertion. However, successful insertion into the inferior meatus towards the nasopharynx can be achieved with a perpendicular approach. A schematic illustration for free use is provided. Conclusion: Swab instructions should indicate an insertion perpendicular to the face to access the inferior meatus safely and reduce the risk of injury to the ethmoidal cells. Full article

The Barcelona Basic Model (BBM) is a well-established constitutive framework for describing the mechanical behaviour of unsaturated collapsible soils within the context of critical state soil mechanics. Despite its robustness, its application in engineering practice remains limited due to the complexity of its formulation and challenges associated with reliable parameter determination. This study presents a practical framework for the selection and calibration of BBM parameters for Jossigny silt, using laboratory test data reported in the literature, employing a sequential approach supported by engineering judgement and a clear understanding of the original model formulation. The calibrated parameters are implemented in PLAXIS to simulate laboratory tests with different stress paths, allowing for the evaluation of the model’s ability to reproduce observed soil behaviour compared with those reported in the literature through a benchmark exercise conducted using the same reference tests. The calibrated parameter set successfully reproduces soil response under different stress paths, capturing the mechanical behaviour by achieving average values of R² = 0.98, MAE = 0.01, and RMSE = 0.013. The proposed framework is intended to bridge the gap between advanced constitutive modelling and routine engineering analysis by providing a transparent, step-by-step calibration procedure readily implementable in commercial finite element software. Full article

Urban public spaces increasingly need to address inclusivity, adaptability, and resilience in the face of health, environmental, and social challenges. Urban policies also promote improving the relationship between schools and their surroundings to mitigate and adapt to climate and social risks. This article presents EDUS Point, an experimental prototype developed within the European project FURNISH and tested in Barcelona during the COVID-19 crisis. Conceived as an Urban Living Lab (ULL), the initiative explored how modular, digitally fabricated, and temporary structures could transform school environments into open, inclusive, and human-scale public spaces. Through an inter-scalar and interdisciplinary approach, the project implemented an urban strategy, a participatory community-building process, and a digital collective platform, alongside the design, fabrication, and testing of a pilot classroom device adaptable and replicable in other schools. A mixed-methods methodology combined tactical urbanism and co-design with fabrication feasibility assessments, social observations, and spatial impact analysis. Results demonstrate that EDUS Point fostered new socio-spatial dynamics among students, teachers, and residents, improved accessibility and usability of nearby public spaces, and validated the effectiveness of low-cost, rapidly deployable interventions in addressing urban needs. The findings propose actionable frameworks, tools, and design criteria for the socio-environmental integration of schools as catalysts for inclusive and resilient urban transformation. Full article

Background: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities. Full article

Background/Objectives: Sociocultural factors, including migration and acculturation, may influence the clinical profile and course of eating disorders (EDs). This study examined differences between immigrant and native-born Spanish patients with EDs in (1) clinical presentation and (2) treatment response. Methods: Consecutive outpatients from the Eating Disorders Unit at Bellvitge University Hospital (Barcelona, Spain) were assessed using the Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90-R (SCL-90-R), and Temperament and Character Inventory-Revised (TCI-R). Statistical analyses included chi-square tests, ANOVA, Cox regression for dropout, and logistic regression for predictors of poor outcome, adjusted for ED subtype. Results: The sample included 1104 patients (947 native-born; 157 immigrants). Immigrant patients showed a distinct clinical profile, with lower drive for thinness and body dissatisfaction but higher interpersonal distrust, maturity fears, perfectionism, anxiety-related symptoms, and self-transcendence. They also presented a worse treatment response, including higher dropout rates, poorer outcomes, and lower remission rates. Predictive models identified different risk factors for poor treatment response in each group: among native-born patients, younger age of ED onset, higher novelty seeking, and lower self-directedness were associated with worse outcomes, whereas among immigrant patients, greater ED severity, lower harm avoidance, and lower self-transcendence predicted poorer results. Conclusions: Immigrant patients with EDs exhibit a differentiated clinical presentation and less favorable treatment response compared to native-born patients. The differential predictors of poor outcome highlight the need for culturally informed and individually tailored interventions that consider both sociocultural context and personality-related vulnerabilities. Full article

Background: Abdominal ultrasound is prone to hepatocellular carcinoma (HCC) surveillance failure, particularly in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) or alcohol-associated liver disease (ALD), prompting growing interest in blood-based biomarkers as an alternative strategy. Methods: We conducted a case–control study evaluating two blood-based biomarker panels, GAAD and GALAD, for detection of early-stage HCC (Barcelona Clinic Liver Cancer (BCLC) stage 0 or A) in patients with MASLD or ALD cirrhosis. Blood specimens were collected within 6 months of HCC diagnosis (cases); controls were patients with cirrhosis but without HCC. GAAD and GALAD scores were measured using the Roche Elecsys platform, applying validated cutoffs of 2.57 and 2.47, respectively. Sensitivity and specificity were compared between the panels and versus ultrasound plus alpha fetoprotein (AFP) using McNemar’s chi square test. Results: Of 152 patients (56.6% men), 46.7% had HCC (54.9% BCLC 0/A) and 53.3% had cirrhosis without HCC. GAAD and GALAD each achieved a sensitivity of 87.2% for early-stage HCC, with specificities of 69.1% and 67.9%, respectively. In paired analyses (n = 90), GAAD had higher sensitivity for any-stage HCC (89.5% vs. 68.4%, p = 0.046) but lower specificity (71.8% vs. 93.0%, p = 0.006) than ultrasound plus AFP. GAAD and GALAD demonstrated consistently higher sensitivity than ultrasound plus AFP across subgroups by age, sex, cirrhosis etiology, and Child Pugh class. Conclusion: In this case–control study of patients with non-viral cirrhosis, GAAD and GALAD demonstrated high sensitivity for early-stage HCC. These findings highlight the potential of blood-based biomarkers to improve HCC surveillance in contemporary populations. Full article

Background: Hospital-at-home (HAH) programs deliver hospital-level care in patients’ homes, improving satisfaction and optimizing resource use. While widely adopted in adults, pediatric HAH remains limited. At Sant Joan de Déu Hospital (Barcelona, Spain), the pediatric HAH program for acutely ill children has expanded to include more clinically complex cases. Family involvement is essential, as caregivers are trained to administer treatments, monitor clinical status, and support telematic follow-ups, supporting the healthcare team’s workload. Objective: To identify patient characteristics influencing healthcare workload and develop a predictive model to enhance resource allocation. Methods: This single-center, prospective cohort study included all patients admitted to the pediatric HAH program for one year. Primary variables were caregiver training time, home visiting time, patient age, type of care provided, and clinical complexity. Secondary variables included referral specialty and team composition. Data were collected using digital time-tracking, manual records, and clinical databases. Analyses included Kruskal–Wallis and Dunn’s multiple comparison tests. Results: All variables showed significant differences in training and visiting times. Training time ranged from 19 to 157 min; visiting time from 6.2 to 157 min. A predictive model using five key variables estimated visiting time, and another model based on care type estimated training time were created. Conclusions: Patient characteristics and caregiver involvement significantly affect direct care workload. These findings can inform strategies to optimize staffing and scale pediatric HAH programs effectively. Full article

This study validates the Sustainable Tourism Attitude Scale (SUS-TAS) in four major Spanish cities—Madrid, Barcelona, Bilbao, and Seville—assessing residents’ perceptions of tourism sustainability. A quantitative approach was used, with data collected from 660 residents via an online survey. Exploratory Factor Analysis (EFA) with Varimax rotation confirmed a seven-factor structure, and ANOVA tests revealed significant perceptual differences across cities. Results show that residents in Barcelona report the highest perceived social costs, while Bilbao shows greater support for long-term planning, reflecting varying levels of tourism maturity. The study confirms that sociodemographic variables—especially sex and education—shape sustainability attitudes, while age has no significant effect. Findings support the need for context-sensitive policies that integrate resident voices into sustainable tourism planning. This research fills a gap by validating SUS-TAS in mature European destinations, offering a reliable tool for urban tourism governance. Full article

Background/Objectives: Late presentations of advanced hepatocellular carcinoma (HCC) indicate a lack of detection of underlying cirrhosis and a need to identify clinical and socioeconomic risk factors contributing to early-stage HCC recognition. This study tested associations between early diagnostics of HCC and demographic, socioeconomic, clinical, and healthcare-related indicators. Methods: A retrospective analysis of clinical data accumulated between February 2018 and February 2024 was completed at a quaternary care centre (South Australia). Results: We identified 388 cases of newly diagnosed HCC during a six-year period. There were 131 (33.7%) patients with early-stage (Barcelona clinic liver cancer (BCLC) stage 0–A) and 257 (66.3%) patients with late-stage (BCLC B–D) HCC. Late-stage HCC was found in 66.3% of patients, with half of the cohort not having a diagnosis of cirrhosis at the time of HCC detection. A retrospectively calculated Fibrosis Index (FIB-4) of >3.25 was present in nearly half of patients with newly diagnosed HCC with no prior diagnosis of cirrhosis. Engagement with healthcare (p < 0.05), a history of liver cirrhosis (p < 0.001), and gastroenterologist-led care with surveillance programmes (p < 0.001) was associated with early-stage presentation and curative treatment. Late-stage HCC was associated with male sex (p = 0.041), failing to attend appointments (p < 0.001), and liver function tests ordered by general physicians (p = 0.002) or non-gastroenterologist specialists (p = 0.023). Logistic regression analysis indicated that engaging in a surveillance programme, assessment by a gastroenterologist, and Model for End-Stage Liver Disease scores were important factors contributing to early detection of HCC; the area under the curve for this model on the ROC analysis was 0.892 (95% CI 0.855–0.929). Conclusions: Better cirrhosis detection is required, given that 60% of patients had a retrospectively calculated FIB-4 > 3.25. Routine use of non-invasive scores by all healthcare providers may increase engagement with surveillance and improve HCC screening. Full article