Background: With the increasing prevalence of chronic diseases, partly due to the increase in life expectancy and the aging of the population, the complexity of the approach faced by the structures, dynamics, and actors that are part of the current care and attention systems is evident. The territory of Bages (Catalonia, Spain) presents characteristics of a highly complex ecosystem where there is a need to develop new, more dynamic structures for the various actors in the health and social systems, aimed at incorporating new actors in the technological and business field that would allow innovation in the management of this context. Within the framework of the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS), the aim is to address these challenges through various entities that will develop 7 interrelated operations. Of these, the operation of the IDIAP Jordi Gol-Catalan Health Institute focuses on the creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions in the Bages region, in the form of a database that will collect the most relevant information from the different environments that affect the management of chronic conditions and dependence: health, social, economic, and environment. Objective: This study aims to create a laboratory for statistical, dependence, and chronic condition analysis in the Bages region, to determine the chronic conditions and conditions that generate dependence in the Bages area, in order to propose products and services that respond to the needs of people in these situations.Methods: PECT BAGESS originated from the Shared Agenda initiative, which was established in the Bages region with the goal of enhancing the quality of life and fostering social inclusion for individuals with chronic diseases. This study presents part of this broader project, consisting of the creation of a database. Data from chronic conditions and dependence service providers will be combined, using a unique identifier for the different sources of information. A thorough legal analysis was conducted to establish a secure data sharing mechanism among the entities participating in the project. Results: The laboratory will be a key piece in the structure generated in the environment of the PECT BAGESS, which will allow relevant information to be passed on from the different sectors involved to respond to the needs of people with chronic conditions and dependence, as well as to generate opportunities for products and services. Conclusions: The emerging organizational dynamics and structures are expected to demonstrate a health and social management model that may have a remarkable impact on these sectors. Products and services developed may be very useful for generating synergies and facilitating the living conditions of people who can benefit from all these services. However, secure data sharing circuits must be considered.

Objectives: To investigate prospectively the impact of physical activity during pregnancy on infant neurodevelopment, considering relevant confounding factors, physical activity intensity and the trimester of pregnancy in which it is performed.
Methods: Prospective follow-up study of 791 pregnant women from the first trimester of pregnancy to 40 days postpartum. Three intensity levels of physical activity were assessed in each trimester of pregnancy by the International Physical Activity Questionnaire (IPAQ). Infant neuro development was assessed at 40 days postpartum by the third edition of the Bayley Scales for Infant Development-Third Edition (BSID-III). Analysis adjusted by sociodemographics, anxiety symptoms, lifestyle habits, quality of diet, body mass index, postpartum depressive symptoms and mother-infant attachment.
Results: ANCOVA analysis have shown that 40 days old infants of mothers in the moderate and high PA groups in the third trimester obtained 3.2 and 3.8 points higher scores respectively in the language total scale; and 4.1 and 5.1 points higher scores respectively in the motor total scale than infants of mothers in the low PAgroup.
Conclusion: Moderate to high intensity physical activity during pregnancy has a positive impact on infant neurodevelopment. More specific recommendations must be incorporated in international guidelines and into maternal education sessions to improve infants’ neurodevelopment.

Background: Tobacco consumption during pregnancy is one of the most modifiable causes of morbidity and mortality for both pregnant smokers and their foetus. Even though pregnant smokers are conscious about the negative effects of tobacco consumption, they also had barriers for smoking cessation and most of them continue smoking, being a major public health problem. The aim of this study is to determine the effectiveness of an application (App) for mobile devices, designed with a gamification strategy, in order to help pregnant smokers to quit smoking during pregnancy and in the long term.Methods: This study is a multicentre randomized community intervention trial. It will recruit pregnant smokers (200 participants/group), aged more than 18 years, with sporadically or daily smoking habit in the last 30 days and who follow-up their pregnancy in the Sexual and Reproductive Health Care Services of the Camp de Tarragona and Central Catalonia Primary Care Departments. All the participants will have the usual clinical practice intervention for smoking cessation, whereas the intervention group will also have access to the App. The outcome measure will be prolonged abstinence at 12 months after the intervention, as confirmed by expired-carbon monoxide and urinary cotinine tests. Results will be analysed based on intention to treat. Prolonged abstinence rates will be compared, and the determining factors will be evaluated using multivariate statistical analysis.Discussion: The results of this study will offer evidence about the effectiveness of an intervention using a mobile App in smoking cessation for pregnant smokers, to decrease comorbidity associated with long-term smoking. If this technology is proven effective, it could be readily incorporated into primary care intervention for all pregnant smokers.

BACKGROUND: The changes in shield strategies, treatments, emergence variants, and healthcare pathways might shift the profile and outcome of patients hospitalized with COVID-19 in successive waves of the outbreak. METHODS: We retrospectively analysed the characteristics and in-hospital outcomes of all patients admitted with COVID-19 in eight university hospitals of Catalonia (North-East Spain) between Feb 28, 2020 and Feb 28, 2021. Using a 7-joinpoint regression analysis, we split admissions into four waves. The main hospital outcomes included 30-day mortality and admission to intensive care unit (ICU). FINDINGS: The analysis included 17,027 subjects admitted during the first wave (6800; 39.9%), summer wave (1807; 10.6%), second wave (3804; 22.3%), and third wave (4616; 27.1%). The highest 30-day mortality rate was reported during the first wave (17%) and decreased afterwards, remaining stable at 13% in the second and third waves (overall 30% reduction); the lowest mortality was reported during the summer wave (8%, 50% reduction). ICU admission became progressively more frequent during successive waves. In Cox regression analysis, the main factors contributing to differences in 30-day mortality were the epidemic wave, followed by gender, age, diabetes, chronic kidney disease, and neoplasms. INTERPRETATION: Although in-hospital COVID-19 mortality remains high, it decreased substantially after the first wave and is highly dependent of patient’s characteristics and ICU availability. Highest mortality reductions occurred during a wave characterized by younger individuals, an increasingly frequent scenario as vaccination campaigns progress. FUNDING: This work did not receive specific funding.