Life beyond cancer by Fundación Espriu

www.compartir.coop

Healthcare cooperatives and social medicine magazine | No. 15 – January 2024

C o m pa r t i r

HEALTH IN WINTER

Who should take more care with the change of season?

COOPERATIVISM

Moving towards an economy model that is inclusive and deep-rooted in Spain

DESTINATIONS

A trip around the most eccentric carnivals in the world

LIFE BEYOND CANCER

New horizons in diagnosis, prevention and treatments

Staff

Compartir Healthcare cooperativism magazine www.compartir.coop compartir@fundacionespriu.coop Editorial board: Dr. Ignacio Orce, Chairman of the Fundación Espriu and of Assistència Sanitària Dr. Enrique de Porres, CEO of ASISA-Lavinia Teresa Pasarte, former Chairwoman of the Fundación Espriu Dr. Oriol Gras, sponsor of Fundación Espriu Dr. Carlos Zarco, General Manager and sponsor of Fundación Espriu

Publication: Factoría Prisma Diagonal 662-664 08034-Barcelona Tel. 639 213 710 www.factoriaprisma.com Director of Factoría Prisma: Angi González Vives Coordination: Laura Martos Design: Xavi Menéndez Printer: Centro Gráfico Ganboa SL Legal deposit: B-46099-2003 ISSN: 2488-6394 ISSN (Internet): 2696-3833 Fundación Espriu Av. de Josep Tarradellas, 123-127 4.ª planta 08029 Barcelona Juan Ignacio Luca de Tena, 12, 3.ª 28027 Madrid NIF: G-59117887 Tel.: 934 954 490 fundacionespriu@fundacionespriu.coop www.fundacionespriu.coop

Established in 1989, Fundacion Espriu integrates the entities that follow the healthcare cooperative model created by Dr. Josep Espriu: Autogestió Sanitaria, SCIAS, Lavinia and ASISA, which make up the Assistencia Group and the ASISA Group.

Summary

TODAY’S MEDICINE A study reveals that eight out of every ten strokes could be prevented with healthy lifestyle habits.

HEALTH IN WINTER We talked to Dr. Javier Pérez to discover the risks of winter infections and how to prevent them.

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ACTIVE LIFE

HEALTHCARE COOPERATIVISM

IN DEPTH

Physical activity is essential for health, but not all sports bring us the same benefits. Which ones benefit us most?

The opening of new centres and the incorporation of specialised services are amongst the latest developments.

We analyse the medical evolution in cancer diagnosis and treatments that are being used to tackle the new reality of cancer.

Editorial

Keeping the patient at the centre of the healthcare system With the start of a new year, it is normal for us all to

think about our goals, resolutions and priorities. For this reason, it seems like a good moment for me to emphasise a fundamental value that must always be at the centre of any medical treatment: the patient. In a world that is constantly evolving, where technology and research move forward in leaps and bounds, it is essential to not put aside the most human part of the profession. In this first issue of the year we have devoted a report to cancer and to how this speciality has evolved over the last few decades. The fight against cancer has been a battlefield for both patients and doctors, with great advances and many different approaches. And now that we are clearly established in a new social and technological reality, we must review and up-date our perception regarding these different pathologies. However, our magazine goes way beyond this and therefore, alongside the regular health topics, you will also find resources for following an active, balanced lifestyle, articles on today’s medicine and news about healthcare cooperativism. We firmly believe that information and education are powerful tools to maintain and improve health, understanding it to be an integral aspect of our existence. Along these lines, you will also continue to find articles on culture and general interest topics to make your reading richer and more entertaining.

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DESTINATIONS

TRENDS

We travel around the most characteristic carnivals in the world, a festival that is a memorable event in any culture.

‘True crime’ was last year’s great audiovisual trend and these are the reasons behind its incredible success.

Finally, we feel we must continue to emphasise the effort made by Asistència Sanitaria and by Asisa to improve the care they give to their users every day. The opening of new centres and the incorporation of specialised services complete a comprehensive healthcare offer, based on a cooperative model in which the wellbeing of the patient is at the forefront in all the processes. Thank you for placing your trust in us as a source of information. We hope you enjoy this issue. Happy New Year!

Carlos Zarco

General Manager of Fundacion Espriu

Today’s news

Eight out of every ten strokes could be avoided by improving lifestyle habits

ne out of every four people will have a stroke at some point in their lives. It is the first cause of death in women and second in men, according to the data from the Spanish Neurology Society (Sociedad Española de Neurología –SEN), in addition to being the first cause of disability in both sexes as adults. Of the survivors, 30% become functional dependents due to the after effects. In Spain, the figures are reasonably alarming: over one hundred thousand people suffer from a stroke every year. It is an incidence that has doubled over the past 30 years and it is calculated that it will continue to rise. In fact, on a worldwide scale, it is expected that this figure will increase to almost 10 million people for 2050, as a study published by The Lancet neurology explains. But not all the news is bad. As the SEN explains, over 80% of the cases of stroke could be avoided

The United States approves the first treatment with genetic edition using CRISPR technology Developed by Vertex Pharmaceuticals and CRISPR Therapeutics, this treatment means an important commitment to tackling sickle cell anaemia, a genetic disease causing the deformation of red blood cells that affects almost six and a half million people all over the world. The American Food and Drugs Administration (FDA) has already approved this complex process that includes the extraction of blood stem cells to genetically modify them using CRISPR technology to cancel the genetic defect that causes the disease. The treatment, which has also been approved in the United Kingdom, is called Casgevy and it may be administered to adults and children from the age of 12 years with frequent pain. The therapy has been designed to be administered just once and it is estimated that the results will last for many years.

International day for:

Congenital Heart Defect Awareness Congenital heart defects are malformations that affect the heart and the large blood vessels. They have a genetic origin and can be detected during pregnancy or in the first months after birth, meaning that today’s treatments start very early on. This disease is the congenital pathology with the greatest incidence in Spain and it affects 8 out of every 1,000 children born, a figure that reaches 4,000 cases per year. Currently, the survival rate is very high; therefore we can now find teenagers, young people and adults whose organ develops with some special needs, with palliative or corrective surgeries, as well as drugs that contribute to the treatment.

Inspiring quotes

“The good physician treats the disease; the great physician treats the patient who has the disease.” William Osler, doctor

It is estimated that dietary interventions could decrease the risk of a stroke by up to 19%.

by changing small habits. Stopping smoking, limiting alcohol intake, controlling weight, exercising and reducing salt are the main recommendations, along with controlling blood pressure, cholesterol and sugar levels frequently, particularly from the age of sixty years onwards. It is also important to remember that rehabilitation in time is essential to recover independence in the first three months, therefore knowing about the way in which the stroke acts is also a key factor to ensure going to a hospital as soon as possible in the case of having a stroke. For this reason, the SEN recalls that the main symptoms that might alert someone in the first moments of suffering from this ailment are: headache, problems with sight in one or both eyes, loss of balance or of strength and of feeling in the limbs and difficulty in speaking and/or understanding. They add that these symptoms also usually appear suddenly.

The Santander Declaration is the star of the International Transplant Summit with the participation of 57 countries The National Transplant Organisation (Organización Nacional de Trasplantes – ONT) presented a new global pact at the International Transplant Summit, held last November, for the development of donation and transplant of organs, tissues and cells over the next ten years. This year’s summit, which is co-sponsored by the World Health Organisation (WHO), took place in Santander, the capital of Cantabria in honour of the donor figures in the autonomous region, which has been leading the sector in Spain every year since 2015. The document in question has been named the Santander Declaration and it has been signed by 183 experts from 57 countries. All of them coincide in the need to promote five important strategies related to organ donation: improvement in patient care, the sustainability of the transplant systems, transparency and safety,

Four AI tools that will be implemented in medicine Artificial intelligence (AI) is emerging as a crucial tool in the area of medical care and hospitals. Its importance lies in its capacity to revolutionise the way in which diseases are diagnosed, treated and managed, significantly improving the quality of the medical care and the efficiency of the hospital processes. These are some of the advances that will be applied in the immediate future:

Robot-assisted surgery. The first study on the use of robots in surgery, carried out in 2022 by Researchers from University College, London (UCL) and the University of Sheffield, affirmed that this practice is much safer, it reduces hospital stays and it accelerates patient recovery.

Assisted reading of mammograms. According to research published by The Lancet Oncology, mammogram interpretation aided by an artificial intelligence (AI) software programme allowed 20% more cases of cancer to be detected than the normal double reading method by two radiologists and it does not increase the amount of false positives. Precision medicine. The latest analysis by Health Futures at Microsoft Research on AI and the future of health indicates that artificial intelligence will improve the traditional models of medical care, giving priority to prevention, accurate therapy and connected care technologies.

3 the fight against human trafficking and innovation. Emphasis was also placed on the importance of increasing the number of countries that practice the asystole donation, which involves the use of organs and tissues from individuals whose death is confirmed after their cardio-respiratory functions stop, which is only practiced in 23 states.

Artificial Intelligence and the Internet of Things. The IoT (Internet of Things) is starting to be introduced, little by little, into healthcare, both for doctors and for patients. Ultrasound scans, thermometers, glucose monitors or electrocardiograms are all beginning to become connected, allowing patients to monitor their own health.

Health in winter

Prevention of diseases and

WINTER INFECTIONS

Now the last season of the year is on its way, classic diseases such as influenza or ‘flu, the common cold or pneumonia also appear. Small children and elderly adults have greater risks of becoming ill, and particularly, in suffering from more serious respiratory problems. But can they be avoided? By Ángela Zorrilla

D The common cold is usually caused by bacteria, and its main characteristic is the change in colour of the mucus 6

uring the winter months it is normal for doctors’ surgeries to become full of patients complaining about certain diseases. Many of these may be confused, and the fact is that infections that make it difficult for the patient to breathe correctly – the most common during these months, usually have similar symptoms. On the one hand, most seasonal respiratory viruses such as ‘flu or the common cold duplicate much faster and are much more resistant at this point of the year. According to the Spanish National Epidemiology Centre, the number of hospital admissions as a result of ‘flu can reach figures of over 52,000 people per year, or in other words, the equivalent to the population of Segovia. In addition, at this time of year, the immune system is usually weaker and less effective and the cold weather and few hours of sunlight mean that people spend more time in closed places, without ventilation and that at times are very crowded. For this reason, frequently, the increase in cases of ‘flu and other similar pathologies where infection rates are high, also rise. In nursing infants and babies, bronchiolitis or pneumonia are also added to the common pathologies, becoming a silent pandemic that causes the death of 700,000 children under the age of five years around the world every year, particularly in developing countries. But, in addition to the viral respiratory illnesses, the winter is also the favourite time for some stomach

viruses such as the norovirus, which is usually accompanied by sudden vomiting and diarrhoea. This virus is very contagious and it spreads through direct contact with an infected person or by touching contaminated surfaces such as door handles, shared utensils, etc.

Symptoms and vaccination, key aspects

The common cold, according to Javier Pérez Pallarés, an interventionist pulmonologist at the Hospital HLA La Vega, is usually caused by bacteria and one of the characteristic signs is the change in colour of the mucus. At times, he adds, bacterial and viral infections may be combined at

What are the most common diseases? Cold The common cold can be caused by different types of virus. Amongst its symptoms, nasal congestion, sore throat, cough, headache and sometimes a slight temperature stand out. Most colds become more intense from the third to the fifth day and they are usually completely better in one week.

Influenza At times, it can be confused with a common cold. The main difference is that ‘flu starts quickly with a high temperature, coughing, sore throat, headache and pains all over the body. It normally lasts 5 days.

Bronchiolitis Bronchiolitis is a viral disease that causes inflammation of the respiratory tract. This provokes nasal congestion, coughing, a slight temperature and wheezing. To begin with it seems like a common cold, but it becomes more serious and is accompanied by respiratory difficulties and dehydration.

Pharyngitis It is usually frequent in school-age children. It causes a sore throat, headache and stomach ache and in some cases, a high temperature or vomiting. It can also lead to frequent coughing fits, hoarseness and inflammation of the throat. Most cases are caused by viruses and only need analgesics for the pain. It is treated with antibiotics when it is caused by bacteria.

Pneumonia

the same time, making it difficult to differentiate between them. For this reason, it is important to pay attention to the symptoms and consult about the best treatment with specialist doctors, while keeping your vaccination calendar up to date. This last point is essential. It is estimated that, for example, the ‘flu vaccine could prevent up to 60% of cases of pneumonia. And in the case of COVID-19– the main cause of pneumonia over the past three years–, the booster jabs mean an increase in the protection values of up to 90% in the population over the age of 65 years.

This is also normal amongst children. It is caused by an infection in the lungs which can be bacterial, viral or even fungal, amongst other germs. The symptoms are similar to other respiratory pathologies, such as a high temperature, a runny nose or breathing difficulties. However, they vary in terms of the age. Young children lose their appetite, while older children may become shivery, with abdominal or chest pain.

Norovirus Also known as the winter vomiting virus, it is an extremely contagious stomach virus, as it can live in the atmosphere for up to four weeks. Often, its symptoms stop in two or three days, but it is important to drink enough liquid to prevent dehydration.

Health in winter

CHANGE OF SEASON,

Who should take more care alert? by Ángela Zorrilla

The head, neck, hands and feet are the body areas that get cold easiest 8

he drop in temperatures and spending more time in closes spaces encourage the appearance of colds, ‘flu and other respiratory infections which can also complicate other pre-existing pathologies. Therefore, it is important to take steps to avoid these typical illnesses more prevalent in the coldest months of the year, particularly if we are talking about the population at risk. And the fact is that although anyone can become ill, those over the age of 65 years, pregnant women, babies and small children, the homeless or people with chronic illnesses are more likely to suffer from one of

these seasonal pathologies or for it to become more complicated, turning into a more serious health problem.

Young children

During the winter, viruses affect many children and babies because their immune systems have yet to develop completely, in addition to the fact that they breathe through their mouths and they use their hands for playing. For this reason, when any symptom of a cold or another respiratory disease appears, it is important to avoid taking them to school or nursery in order to not spread the virus. It is also advisable to

not spend much time with them in closed places such as shopping centres. Children who are most susceptible to suffering from respiratory diseases in the wintertime are prematurely-born babies, asthmatics or who have asthma in the family and those suffering from allergies.

The elderly

Regarding people over the age of 65 years, close attention must be paid to their state of health and making sure that they are in the warmest rooms of the house. Another way of helping older people to warm up is to include hot food in their normal diet such as soups or broths, which provide them with calories and prevent dehydration. Being vaccinated against ´flu is also an important preventive step. When they go outside, they must wear warm clothing and protect their necks.

Pregnant women

The greater circulation of viruses in the winter should not affect pregnant women too much. It is important for women with high blood pressure caused by pregnancy or made worse during these months, to take care when becoming exposed to cold. In a pregnant woman, her blood pressure should be, approximately, 120/80. If this rises, the woman should keep a careful watch on it and consult with her doctor. In addition, this risk group should not come into contact with ill people and other people must avoid smoking in front of them. Vaccination against ‘flu is also recommended.

Chronic or immune-compromised patients

In order to ride out the cold and possible respiratory infections which, in chronic patients may lead to serious health problems, they must be vaccinated and particularly protect their heads, necks, hands and feet. These are the areas of the body that become cold due to heat loss. Additionally, when the thermometers plummet, it is always better to wear several layers of clothing than a single one, although this is thick. In this way, pockets of warm air are formed that insulate the organism against the cold. Tobacco smoke and excess steam in kitchens also affect those who suffer from any chronic respiratory or heart disease.

Dr. Javier Pérez Pallarés, Interventional Pulmonologist at the Hospital HLA La Vega

“A seasonal respiratory problem may cause an imbalance in other diseases” Is it possible to avoid catching a cold in the winter? The only reliable way of avoiding a cold in the winter would be to live in a bubble, which is not very feasible. What we can do is to keep our respiratory immune system as healthy as possible in order to be able to “defend ourselves” from the aggressions of the virus and bacteria that breed in the winter. The most efficient way is to avoid tobacco and any type of vapers that produce an inflammation of the respiratory mucus and a greater production of bronchial mucus. This mucus encourages the presence of germs in the respiratory tract and owing to the paralysis of the bronchial cilia, it is impossible to expulse the secretions. Therefore, these germs increase the probabilities of suffering from a bronchial infection. When suffering from a winter respiratory disease, should you continue to go to work or school? The decision about continuing to go to work or school does not depend on a pulmonologist, as it does not mean an added infectious risk for those around you. The primary care doctor is the person who should comment on this, always depending on the physical condition of each person in question. What is most concerning in doctors’ surgeries: young or elderly patients? In pulmonology surgeries we take care of patients from the age of 12 years, as the younger ones are looked after by paediatric pulmonologists. Our greatest concern lies with elderly patients who have other associated pathologies. Seasonal respiratory problems can cause an imbalance in other diseases, creating a risk for the patient.

Why is it so important for health to not self-medicate? Any medical treatment must be prescribed by a person who is a graduate in medicine. During this time of year, many people fall into the error of self-medicating with antibiotics that have been left over at home, when they really have a viral infection that antibiotics will not have any effect on. On the other hand, they could create resistances and when antibiotics are really needed the bacteria will have become resistant to them. The opposite case may also occur, where the person minimises their symptoms and by not going to see the doctor, they could be not treating a serious infection. In addition to correct hand hygiene, which other habits should we have during these months as preventive methods? There is no infallible method to protect against a respiratory pathology during these months. But it is important, for example, to avoid sudden changes of temperature and for people who are allergic to dust – one of the most common allergies in Spain, special care must be taken in cleaning surfaces.

Active Life

360 SPORTS:

The most complete exercises to keep active

hysical activity, along with a good diet, is a basic element to guarantee good health. In fact, according to the World Health Organisation, regular, suitable physical exercise, including any corporal movement that requires energy, can reduce the risk of many diseases, such as high blood pressure, strokes, diabetes or depression. To do this, it is recommended carrying out a minimum of 150 minutes of moderate intensity physical activity each week. These 150 minutes per week bring many other essential benefits for people, such as an improvement in learning skills, the growth and development of healthy bones in young people or the prevention of injuries in the elderly; it reduces mortality by 33% compared to non-active people and it improves physical fitness, influencing self-esteem and a general feeling of well-being. To some extent, therefore, any sport directly benefits our health. However, each sport works different muscle groups and techniques. For this reason we must find an activity that adapts to our goals and physical condition. For example, while yoga is a good option to improve flexibility and relax the mind, football can put resistance and tactics into practice. But there are also disciplines that demand many of these elements and that work equally on the physical, mental and technical levels thanks to their combination of skills, meaning that these are the most complete sports.

Swimming • It works with many movements of the body at the same time as it needs continuous coordination skills and strength to move through the water. • It increases lung capacity and improves the respiratory system, as well as the circulation and cardiovascular system, due to the creation of resistance. • As it is carried out in water, it reduces muscle tension and the heart rate, contributing to the secretion of serotonin and dopamine.

Athletics • It boosts the use of the fatty acids as an energetic substrate to carry out the effort and it increases the metabolic activity during the days following the exercise. • It works the muscles directly due to aerobic exposure, stretching them and strengthening them, as well as improving their flexibility. • It improves the respiratory system and increases resistance and brain activity.

Climbing

Boxing

• It gives the core in depth training, at the same time as strengthening hands and forearms; biceps; shoulders; neck; trapezoidal muscle; higher back; dorsal, lumbar and abdominal muscles; thighs and buttocks.

• It revolves around three main elements: action, reaction and coordination. There is no movement in this discipline that does not mean activating a muscle, particularly the central ones, including the lumbar and lower back muscles.

• The movements that are carried out during this sport increase resistance and elasticity, as well as improving joint mobility. • Balance is also one of the most developed elements, along with concentration skills. According to the type of climbing, it also perfects other skills such as speed, coordination or isolated strength.

• The movements between arms, legs and head, as well as the en-guard, dodging and protecting positions, involve high reflex skills and constant balance. •O ne of its main indirect benefits is avoiding bone deterioration and improving blood circulation, allowing nutrients to be spread quicker, which turns it into a unique calorie burner.

Rugby • Psychomotor work is developed thanks to the coordination that the constant handling of the ball requires and the number of muscles that are exercised during the game. • It is a contact sport, but it also particularly concentrates on resistance, as the average game lasts 80 minutes. Stability and control of the body are essential, although speed is the element that is worked most, both physical and mental. • It depends directly on the strategy created jointly with the team, encouraging communication and social skills.

Emergencies

HOW TO BRING DOWN

a fever in children

Lody temperature varies throughout the day, but it generally is established at around 37 degrees and it is regulated through an internal structure called the hypothalamus. When this structure notes the presence of any type of infection (viral, bacterial and/or fungal) it activates a protection mechanism through the increase in body temperature to fight the infection, which usually reproduces and survives at stable temperatures. Fever is, therefore, what we call this response of the immune system to the reproduction of germs.

When to go to the doctor?

• • •

I f the patient is a baby under the age of three months. I f the child has an intense headache, repeated vomiting or has difficulty breathing. I f red marks appear on the skin that do not disappear when pressed.

What to do at home?

1. Remove clothing and ventilate the place where the patient is.

2. Apply wet cloths to the head, groin and

armpits. The child may also be bathed in warm water.

3. Have them drink fluids frequently. 4. If the pain persists, administer

paracetamol or ibuprofen, following the dosage recommended by a doctor.

It is important to remember Fever or a high temperature is not dangerous in itself, the danger lies in the infection it is responding to; therefore, it is more important to discover the type of microbe that is attacking the system. If there is no physical and/or emotional reaction shown by the infected child, we should not become obsessed with bringing the temperature down. The only goal should be to alleviate any symptom of pain.

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Cooperatives and social medicine

The HLA Group is expanding with the opening of two new centres in Barcelona and Seville

Two HLA hospitals in the TOP 20 by IQVIA The hospitals HLA Universitario Inmaculada in Granada and HLA La Vega in Murcia have received the prize for the best Overall Hospital Management in the TOP 20 organised by IQVIA, the leading company in the use of data, technology and advanced analytical techniques. With a tradition lasting over 20 years, the TOP 20 is the benchmark programme in the Spanish healthcare environment.

These are the group’s first international clinic located in Barcelona and a new medical-surgical centre in Seville.

The HLA Universitario Inmaculada, a reference centre in private healthcare in Granada, has been recognised within the group of medium-sized private hospitals. It is the second TOP 20 award it has received, after the Women’s Area category was given a prize in 2021.

Barcelona and Seville have opened new clinics belonging to the HLA Group, which has decided to invest almost fifty million euros in two innovative projects that have state-of-the-art equipment Its first challenge is the Above, the new HLA Clinica Internacional Barcleona; below, the HLA Ramón y Cajal in Seville. HLA Clínica International Barcelona, which four operating theatres, fitted with the has top level specialised units and a latest technology to offer care based on medical team formed by professionals of the most advanced diagnosis and treatrenowned prestige in over thirty specialiment techniques. ties. Amongst them, the Ophthalmologist Service stands out, managed by Oftalvist, The installations cover over 4,400 square or the Plastic Surgery and Aesthetic Medmetres and they house, amongst others, icine Service by Clínica Londres. the Radiology Unit, the Assisted Reproduction Unit and paediatric, otolarOn the other hand, the HLA Ramón y yngology, allergology and pneumology Cajal centre in Seville has around thirty services. multi-speciality consulting rooms, with

The HLA La Vega has managed to win a TOP 20 award for the first time, in this case within the group of private hospitals with reference specialities. Amongst the most ambitious investments is the new surgical block with eleven integrated operating theatres, a state-of-the-art vascular arm and a resuscitation area with seventeen beds.

Eduardo Reina and Dr. Pedro Mateo, Manager and Medical Director of HLA la Vega receive the award.

The UR Reproduction Group celebrates its 40th anniversary Since its founding in 1983 in the HLA Clinica Vistahermosa (Alicante), the UR Group, with entirely Spanish capital, has become a benchmark for reproductive medicine in Spain and every year it carries out over 14,000 assisted reproduction cycles with high success rates.

The UR Group brought together the professionals from its 17 clinics in Spain, Mexico and Nicaragua at its 5th Congress. 14

The UR Group, led by its manager, Dr. José Jesús López Gálvez, celebrated its anniversary with its 5th Congress, which has brought together the professional teams from its 17 fertility clinics over a two-day period in Alicante. The company’s specialists were able to attend specialised presentations from the embryology and reproductive genetics laboratories, as well as showing reports on activity and results, standardised protocols and assessment appraisals, aimed at optimising the services offered by the network.

The CGCOM and ASISA sign an agreement for medical associations Dr. Tomás Cobo Castro, Chairman of the General Board of Doctors in Spain (CGCOM), and Dr. Francisco Ivorra, Chairman of the insurance company ASISA, have signed a collaboration agreement with which they offer special healthcare insurance conditions for members, employees and family members of the CGCOM, as well as for all the medical associations in Spain. After the signing of the agreement, the Chairman of ASISA, Dr. Francisco Ivorra, emphasised the collaboration explaining that “this agreement will allow access with special conditions to quality healthcare through an extensive network of specialists and medical centres. “ Dr. Tomás Cobo acknowledged “the special consideration that ASISA has had with the group through this policy.”

ASISA incorporates a civil liability cover for pets

Above: Mar España, Director of the AEPD and Dr. Enrique de Porres, CEO of ASISA. Below: Dr. Enrique de Porres and Ana Caballero, Vice-chairwoman of the AETD.

Pacts for protection in the digital environment The two agreements in question are the Digital Pact for the Protection of People and the State Treaty for the Protection of Minors. ASISA has joined a proposal of two pacts aimed at protecting the privacy of the users on the network. In the case of the Digital Pact for the Protection of People, its goal is to promote a firm commitment to privacy in organisations’ sustainability policies and the business models. ASISA undertakes to assume a series of commitments such as implementing the principles defined in the Pact and to carry out awareness campaigns amongst employees, clients and users, regarding the value of privacy and the importance of processing personal data, both in the private and work areas. Likewise, the State Treaty proposal arose to bring awareness about the risks faced by children and teenagers on the internet and social media and that can affect their socialisation and promote possible mental health problems, such as anxiety and depression. To do this, the document includes a series of steps that underscore the training of professionals to ensure that all the agents involved take on their responsibility.

ASISA Pets, the veterinary healthcare insurance for dogs and cats, allows the additional guarantee of three possible civil liability capitals to be included, and now ASISA is planning to market an exclusive product of civil liability for pets. With this new guarantee, ASISA Mascotas adapts to the animal welfare law, which foresees the compulsory nature of taking out a civil liability insurance policy for dogs. ASISA’s pet insurance allows access to a network of over 440 veterinary clinics all over the country, with an average discount of over 40% compared to the rates for private customers. The insurance also includes free ordinary consultations and vaccinations and a 24 hour emergency service.

Promotional image from ASISA Mascotas

ASISA’s new campaign, premiered in theatre format The Teatro Infanta Isabel is the stage chosen by Mrs. Rushmore and ASISA to develop a new format through the Susto (Fright) campaign. During the show, spectators could enjoy a theatre version of the campaign, which lasts two exciting minutes in which advertising and drama are intertwined. For the first time, an audiovisual piece has been transferred live to the theatre stage, giving spectators the chance to witness a unique, surprising experience, which allows ASISA, in the worlds of Carlos Eiroa, “to continue innovating in its advertising formats and developing its own narrative.”

Cooperatives and social medicine

Assistència Sanitària celebrates International Doctor’s Day The organisation’s main goal is to guarantee that the profession is exercised in the fairest conditions possible On the 3rd of December, the annual day recognising health professionals, is a date that marks the difference and directly questions entities such as Assistència Sanitària, a company created managed, directed and recommended by doctors, which wanted to give this date the importance that it deserves. The occasion recalls the incalculable value of the health professionals and which, in the case of Assitència Sanitària, allows awareness of this difference to be seen. It is an organisation of doctors who, in their every day routine, understand health from the perspective of those who know it best. The main goal is to guarantee that the profession is exercised in fair conditions and to look out for the well-being of the population through personalised, top-level care. Dedication and experience are the basis of the medical excellence and care quality. In its daily essence, but also on days such as the one in last December,

Assistència Sanitària’s Home Emergency Service (SUD in its Spanish initials) is aimed at becoming a benchmark in home medical care and reaching the homes of its insured people, therefore, allowing a doctor to visit the home in a record time 24 hours a day, 365 days a year. The data from 2022 recorded over one hundred thousand calls attended and a historical maximum of 81,599 visits carried out, amongst adult patients (73.5%) and paediatric patients (26.5%), as the SUD is the only home emergency service in its area that provides specialised care for children. This trend indicates some similar rates at the end of 2023.

Assistència Sanitària, with snow sports

and even in its communication campaigns, Assistència Sanitària celebrates the commitment and passion that the doctors place in their work, day after day, and it champions private healthcare that defends their essential role.

Assisport starts up workshops and federation reviews Assistència Sanitària’s sports medicine centre is extending its offer of services with new workshops on stretching, physiotherapy and functional re-adaptation, an effective way of improving performance and health of insured people, who can exclusively access these services to integrate the learning through practice in monographic, reduced sessions led by specialists. In addition, given that the start of the competition sport season coincides with the annual medical check-ups, Assisport launched its federation check-ups campaign. In this way, policyholders can obtain the certificate of sports’ aptitude with a check-up that includes a complete medical evaluation, sport performance tests, analysis of corporal composition, nutritional assessment and personalised recommendations for the care and prevention of injuries.

The SUD exceeds 81,000 visits

With the arrival of the winter, the snow sport season starts with skiing and snowboarding as the indisputable stars. Once again this year, coinciding with the coldest months of the year, Assistència Sanitària launched its ski campaign to bring awareness to the importance of skiing in a healthy, safe way. To do this, they prepared a set of recommendations about training, warming up and stretching, steps to take with falls, hydration, protection, exposure to sunlight, etc. All the information is available on the company’s digital portal. Likewise, the prize draw was carried out with a prize of double ski passes amongst its policyholders.

Comprehensive renewal of the cardiac hemodynamic room at the Hospital de Barcelona The Hospital de Barcelona is improving its medical care by refurbishing the cardiac hemodynamic room with the acquisition of the latest generation angiograph, ARTIS, Siemens floor icon. This change has significantly improved the quality of patient care at the same time as providing the doctors with a more advanced diagnosis and treatment tool. The new angiograph can carry out a wide variety of vascular explorations, from diagnosis and therapeutic coronarygraphy (angioplasty and coronary stent) to the positioning of aortic valves or periphery vascular studies.

The new hospital units offer efficient, convenient alternatives, centred on patient well-being.

The Hospital de Barcelona moves forward towards innovation with hospital admission

Likewise, the cardiac hemodynamic and vascular room has been completely refurbished and extended, with the installation of a surgical level heating and air conditioning system to provide patients and personnel with a comfortable and safe environment. The refurbishment work on the vascular room was started in the summer and, after the installation and calibration of the system, it began operating normally in October.

Home hospitalisation and outpatient care were launched last November and mean a move forward in the personalised care sector. The Hospital de Barcelona had taken a significant step in the evolution of medical care with the launch of its new home hospitalisation service (HDOM) and the start up of the Medical Outpatient Care Hospital (HMED), which have both been up and running since the beginning of last November. HDOM seeks to provide active treatment for patients in the comfort of their own homes, looking after conditions which, in other circumstances, would require more intensive hospital treatments and care. This initiative is designed for the care of acute processes or early discharges, both medical and surgical, aimed at improving patient quality of life and that of their family and social surroundings. It is a care modality that allows an experienced team to provide active medical care for patients in their own homes for a specific period of time.

On the other hand, the services provided by HMED, located on the building’s fourth floor, range from administration of medicines to the performance of programmed complementary tests or other procedures in terms of the diagnosis or pathology. In addition, its rooms are designed with similar characteristics to conventional hospital rooms, ensuring that the patient’s comfort and privacy are maintained. With the launch of HDOM and HMED, the Hospital de Barcelona is reaffirming its commitment to innovation and continuous improvement in medical care, providing more flexible solutions, centred on the patient. As shown by similar experiences that are already in existence, these services will change the paradigm of conventional hospital admission and improve patient experience during their recovery process.

The prematurity fiesta The Hospital de Barcelona joined the celebration of the World Prematurity Day on the 17th of November, from an informational and recreational point of view. The main goal of the event was to underscore the need for a meticulous monitoring of prematurely born babies, showing the importance of the specialised care and attention that they require. The day started with the eleventh medical seminar on health in pregnancy and in the afternoon, the hospital opened its doors to the families, members of SCIAS and to the personnel of the centre to a party full of activities. This was a unique opportunity for the families to connect and share their experiences.

Cooperatives and social medicine

European Conference on Social Economy The debates hosted nearly six hundred representatives and experts in the sector.

Over the 13th and 14th of November, the city of San Sebastian was the setting for the European Conference on Social Economy: People, Planet, Action; held within the framework of the Spanish Presidency of the European Union. Almost six hundred experts in social economy and representatives of the governments of the European Union met up in San Sebastian and took part in the debates aimed at promoting and exporting this model of inclusive economy, deep-rooted in the region and that redistributes wealth. The participants analysed steps and proposals in order to continue delving into the implantation of a type of company that employs over 13.6 million people in Europe, 6.3% of the active population. The Spanish social economy, which means over 10% of the gross domestic product, is an

international benchmark and recently has reaffirmed its commitment to this economic model with the approval of the first resolution by the United Nations last April that backs the social economy or, more recently, the adoption in the Employment and Social Policy Council of a pioneer recommendation on social economy to motivate its effective implantation in the 27 countries of the European Union. During the summit, the San Sebastian Manifesto for Social Economy was presented, a document signed by representatives of 19 countries of the European Union that seeks to promote European policies that make the sector move forward. With the sights set on the debates that must be included on the agenda of the European Parliament and Commission during the next leg-

The European Commissioner Nicolas Schmitt receives the Denon Artea award from the hands of Paul Olabarria, Chairman of the Basque Country Higher Council of Cooperatives.

islature, the manifesto signed in San Sebastian intends to strengthen this way of understanding the economy that is completely in line with the 2030 Agenda goals and which has been turned into a guarantee for the teaching work, for innovation and for social cohesion. The conference also was the framework for acknowledging the leadership of the European Commission in the promotion of the social economy and the cooperatives with the Denon Artea award, which the Basque Country Higher Board of Cooperatives awarded to the European Commissioner for Employment and Social Rights, Nicolas Schmitt.

Health cooperatives and insurance

The IHCO is extending its network of associated cooperatives

Dr. Zarco emphasised the role played by cooperatives in the sustainable solutions format centred on the well-being of people.

Leaders from the insurance sector came together at the conference organised by the International Federation of Cooperatives and Insurance Mutual Insurance Companies from the 8th to the 10th of November in Belo Horizonte (Brazil) to debate on the innovations that will shape cooperative insurance in the near future. One of the prominent moments at the conference was the discussion panel in which Carlos Zarco, General Manager of the Fundacion Espriu took part. Alongside Helton Freitas, Chairman of Seguros Unimed and Frederico

Peret, Chariman of Unimed Belo Horizonte, they delved into the considerable advantages and strengths that the cooperative models offer in the area of health insurance. Dr. Zarco presented the journey that over the last half a century has turned Assistència Sanitària and ASISA into two leading cooperative companies in the Spanish health insurance sector. He also emphasised the fundamental role played by the cooperatives, not only when providing medical insurance, but also for promoting sustainable healthcare solutions exclusively centred on caring for

‘Compartir’ welcomes 2024 We are delighted to present the new version of our health and medical cooperativism magazine. We continue working to provide articles on current medicine, in-depth reports and the latest developments of our cooperatives, as well as cultural, trending content, all in a format fo-

cused on offering much more content. We are eager to share this journey that continues to be committed to the best information and resources in order to remain healthy and in harmony with the world around us.

people’s health and well-being. Along the same lines, in Paris, on the 6th of December a meeting of AMICE was held, the body that brings together the leaders of the insurance cooperative sector in Europe. Dr. Zarco intervened in a session that debated the digitalisation process in health insurance and the added value that the cooperatives provide when balancing the rights of citizens with the data requirements that the insurance companies require in order to be able to offer the health plans that best care for people.

The International Healthcare Cooperatives Organisation (IHCO) called its General Assembly on the 30th of November, bringing together delegates from 12 countries to deliberate and chart the course of the initiatives that the organisation will start up over the next few months. The Chairman, Carlos Zarco presented a detailed report to the assembly of the milestones and actions that the organisation has developed over the last year to promote cooperative solutions to healthcare in different countries.

The General Assembly promotes relations between organisations, based on inter-cooperation The delegates shared their most relevant activities and analysed how their business action has contributed to the fact that advances occurred in the results of the health in their communities. The delegates also welcomed Sermecoop, a health cooperative from Chile that became the twentieth full member of the organisation of IHCO. With this new incorporation, the IHCO is extending its international network and confirms the global growth of the cooperative healthcare model.

In depth

THERE IS INCREASINGLY

more life before, during and after cancer There are hundreds of diseases of this type that affect almost 300,000 people in Spain every year; figures that are now suggesting the concept of living with the disease. by Enric Ros

The word “cancer”

is one of the most feared by many patients who visit doctors and hospitals. The English expression ‘the C-word’ has been used to allude to a swear word in English, but also to refer to this disease, which has been turned into a virtually unmentionable taboo for a long time. However, increasingly, in our society we are aware that cancer no longer has to mean an end to life, but rather an unavoidable, complicated process that we must face up to and that it is possible, in a great many cases, to successfully overcome it. If we go over the situation of the past few decades, recently the magazine The European Journal of Epidemiology published a study that confirmed how life expectancy has increased over the past twenty-five years in European countries thanks to the progresses made in the treatment and prevention of cancer, as well as those for cardiovascular diseases. In September of this year, the economist Frank R. Lichtenberg also published research carried out in Spain between 1999 and 2016 in Value in Health that allows us to conclude that the life expectancy of cancer patients in our country has increased by 2.77 years during the period studied (in 96% of the cases, thanks to the treatments using new drugs.)

The right to forget cancer Cancer patients do not only face up to the physical and psychological impact caused by the disease, but also they often suffer from a loss of their rights as citizens. The cases of discrimination when taking out a bank product, for example, or insurance are frequent. As indicated by the report Young people and leukaemia: beyond survival, by the Fundación Josep Carreras, up to 80% of people between the ages of eighteen and thirty-five who have suffered from blood cancer find it difficult to take out these services. For Antoni Baena, professor of Health Science Studies at the UOC, the system must protect all these people to prevent “the fact of having suffered from a cancer from turning you into a disadvantaged citizen.” Fortunately, this is something that has started to change in recent times. In a resolution passed last year, the European Parliament imposed 2025 as a limit for establishing the right to forget cancer in its member countries, guaranteeing that financial and insurance organisations cannot take into account the medical history of cancer patients who are survivors ten years after the end of their treatment (and five years, for patients whose diagnosis was carried out before they turned eighteen). Today, most countries have legislation regarding this aspect. The Spanish Government has announced its interest in tackling this topic in the near future.

In depth

THE WILLINGNESS

to overcome moves mountains

ASISA joins the Pelayo Vida Challenge for the third year running, backing the promotion of prevention and early detection to fight against the different types of cancer that affect women. In 2015, the writer Eric Frattini

met up with his friend Luís Miguel Rocha in Brazil. The latter confessed that he had an intense stomach ache, which they did not take seriously at first. Rocha died of stomach cancer that same year. The night that his death was announced, Frattini saw a television interview with a woman who had suffered from breast cancer, made worse by morbid obesity. Her doctor recommended that she should exercise and the patient, based on her willpower, ended up running the New York marathon. This testimony lit the writer’s creative spark. “Why don’t we take women who have suffered from cancer to face up to high mountain challenges?” he said to himself. No sooner said than done. Frattini explained his idea – which was also a tribute to his departed friend, to Pelayo Seguros and they decided to support him in making his dream come true. And this is how a project came to be that has helped many women with cancer to recover their enthusiasm and to find a new goal in their lives.

through different treatments that had a serious impact on her health. “For me, it was essential to carry on doing sport,” she explains. Cerezo managed to be selected for the challenge along with another eighteen candidates for some intensive trials in Sierra Nevada. The five women selected came from this event, starting another 30-week training session led by Rocío Monteoliva. This mountain guide was delighted to join the project, convinced that “sport helps cancer patients a great deal: it regenerates on hormonal and psychological levels, making us segregate endorphins.”

In 2023, the ninth edition of the Pelayo Vida Challenge took five women who have beaten the disease to Patagonia. In addition, ASISA has once again sponsored this initiative, which seeks to make society and institutions aware of the importance of investing in research and promoting early detection and screening. Amongst those making the ascent is Yolanda Cerezo, an architect who was diagnosed with breast cancer when she was a fortnight away from reaching the age of fifty. As her cancer had a complicated prognosis, she had to get

Laura Villa, had just come out of her fourth operation when she reached Sierra Nevada. The challenge meant that the health of this school teacher recovered almost miraculously. As she herself explains, “I went from hell to paradise in a few months. I was getting out of breath going up the stairs and in Patagonia my mind found my body.” She was only thirty-five years old, with two children when she was diagnosed with cancer. Her first obsession was to look after those close to her. But during the challenge, she was able to give herself a moment for herself and share

The five women selected carried out a high mountain training course lasting thirty weeks

The five stars of the 9th edition Anna Blanco, 45 years, from Ontinyent, but residing in Gandia (Valencia). In a normal annual gynaecological check-up, some altered cells were detected. It was an adenocarcinoma with infiltration in the uterus. She went through two operations. A journalist and communicator, she is the mother of two children and she loves the mountains. “When cancer gave me this second chance, I learnt to give priority to what is really important and to smile at every good moment.” Yolanda Cerezo, 53 years, from Madrid. An architect, married and the mother of three children. In July, 2020, in the middle of the pandemic she had a breast cancer detected. Her father was also diagnosed with cancer at the same time, although he died from this disease. Sport and running was her lifeline during her treatment. “Running, the endorphins, nature… for me was the way to see that my body had not abandoned me.” Laura Villa, 39 years, from Teruel. In 2020, at the age of 36,

experiences with other women who had passed through experiences that were similar to hers. For Cerezo this has been “an unrepeatable life experience. I have been lucky to take part in something marvellous, creating closer links with my colleagues to transmit hope to other people,” she tells us. She compares the cancer process to climbing a mountain: “It is a tough route, along which there are moments of pain; a pain that at the same time reminds you that you are alive. You have to carry on, kilometre by kilometre, to be able to reach the summit.” Villa is convinced that having journeyed over mountains and glaciers at extreme temperatures has been very useful to launch an important message to society: “There is life before cancer and after cancer; and there is also a great deal of life during cancer.” She now admits that she lives every moment with greater intensity than before the appearance of the disease. As she says, “my cancer doesn’t keep me awake at night. I am not frightened of a relapse. What makes me more frightened is going through life without living it completely.”

she noticed a lump in her breast that tests confirmed was a very aggressive carcinoma. She has had four operations, chemotherapy and immunotherapy. A special needs teacher for infants and primary school children, she became interested in the challenge when a friend sent her a video of the Pelayo Vida Challenge just before her first operation. “Life is made up of moments and you should not wait until you are well to be happy.”

Sonia Saiz, 38 years, from Santander. In January, 2015, having just reached the age of 30, a very aggressive breast cancer was detected. She went through chemotherapy and radiotherapy, as well as a mastectomy. A surgical nurse, she practices mountain sports, caving and Dragon Boat, a sport that is recommended for preventing lymphatic obstruction and discomfort in her shoulder. “The experience of pushing our ability to overcome obstacles to the limit seems incredible to me.” Inmaculada ‘Kica’ Echanove, 46 years, from Toledo. Life has often tested her resilience. She is the mother of two children and she was widowed when they were 3 and 7 years old. As a geriatric nurse, she had to face up to the incredibly tough COVID pandemic and how this decimated the elderly. She had a breast cancer detected in May, 2021 and the disease made her see that “I had spent my entire life looking after others, but I didn’t know how to look after myself.”

In depth

THE IMPORTANCE

of putting the patient at the centre Prevention, diagnosis and treatment are the three pillars on which today’s medical system works, without putting to one side the need for active, personalised listening in each case.

An essential factor for any patient is to have an early diagnosis 24

Fortunately, science

is transforming our view of cancer. Therapy innovation allows precision treatments to be designed that offer new survival possibilities. At the same time, drugs are appearing that help to alleviate the many side effects and, little by little, recover quality of life. But in order to continue moving forward, it is also very important to listen to those who are facing up to their disease every day. As Carina Escobar, the Chairwoman of the Platform of Patient Organisations clearly explains, it is essential “to always put the patient at the centre of everything. The organisations that make up the platform take part in the research and we bring our experience to contribute to the fact that there is a more multi-disciplinary care and a more humane treatment in serious diseases, such as cancer.” Today in Spain, 42% of people, after diagnosis, return home without having completely understood the information and without knowing what they are going to do from this moment onwards, Escobar underscores. Only 10% of patients will take decisions shared with the healthcare professionals.

For this reason, it is essential “to have a reference doctor in this process, with whom we can consult any queries we might have. There must be a monitoring process, ensuring that someone leads us by the hand until we can finally walk alone,” she adds.

Early diagnosis and treatments are essential

Escobar is clear that the essential factor for any patient is, “in the first place, having an early diagnosis. Following this, access to the correct treatment is needed. Along with learning to manage the uncertainty and fear. We are never ready to face up to a disease like cancer. While we are trying to take in this news, we are still worried about work, family, the mortgage… for this reason, the best way to be able to manage all of this is to be correctly informed and instructed and to have psychological help when necessary.”

In recent decades, unavoidably, the risk of suffering from these diseases has increased, but the good news is that the survival rate for cancer patients has also risen significantly. A study carried out by public health professionals in Navarra indicates that people with tumours diagnosed between 2008 and 2016 registered a survival rate of 61.7%, five years on.

Testimonies from patients such as the participants in the Pelayo Vida Challenge show that the combination of science with information and the will to overcome the disease are managing to radically transform our view of cancer, offering us new hopes for leaving the disease behind and managing to completely reconnect with life.

According to the abovementioned study, the reasons for the continued survival of a growing number of cancer patients are many: earlier diagnoses, the fast referral circuits when there is suspicion of the disease, the early detection programmes (particularly successful in breast, bowel and rectal cancer) as well as the creation of multidisciplinary teams for the harmonised, joint taking of therapy decisions. Significant increases in survival rates with chronic myeloid leukaemia and tumours in the oral cavity and pharynx have also been confirmed. And to a lesser extent, the response to tumours in the pancreas, prostate, bladder, stomach, liver or breast are improving (the latter now reaches a survival rate of 87%).

In depth

EUGENI SAIGÍ GRAU

Head of the Cancer Service at Assistència Sanitària “Cancer is a disease that has a very important impact on a person’s life, even for those who recover from it” by Laura Martos

“Ensuring that the process

is carried out in the best way possible and having a team that is as human as possible” are the two main goals followed by Doctor Saigí on the Cancer floor at the Hospital de Barcelona. He was trained in this speciality and he started his career as head of floor at the Hospital de Granollers. He later became Director of Oncology at the Hospital Universitario de Parc Taulí de Sabadell whilst, at the same time, he started working with Assistència Sanitària. Currently, he coordinates the Assitència Cancer Service, located in the Hospital de Barcelona, a project (he has emphasised on several occasions) which has put in depth specialisation on the patient with personalised programmes, a day centre and individualised therapy to cover all the requirements, going way beyond just the diagnosis alone. The Spanish Medical Cancer Society (SEOM), of which he is a member, estimates that in 2040 cancer cases will increase by 50% compared to today. What is the situation of cancer today? At present, cancer is on the rise for several reasons: one is because we live longer; ultimately, the mechanism by which a cell transforms and may become a neoplastic or tumour cell, is because over time mistakes accumulate in its division process. These accumulated mistakes reach a moment that gives rise to the appearance of a transformation of the cell, losing the division and substitution characteristics attached to the natural biological order and this is when a malignant tumour appears. If you live longer, it is more likely that these errors accumulate in your cells. This is one reason, but on the other hand, lifestyle habits also have an impact,

Dr. Eugení Saigí. In 2015 he joined Assistència Sanitària’s Cancer Service project, centralised in the Hospital de Barcelona, where he has created and coordinates the centre’s team of specialists along with the Cancer Outpatient Care.

exposure to toxic substances that could help the appearance of a cancer, environmental pollution and all these external factors that mean that at a specific moment and in a specific molecular and genetic structure, an exposed person may also develop a cancer. What is the arbitrary percentage in cancer? It depends on the type of factor that we are considering. We know that, for example, diet is a factor that can intervene in 30% of cancers, particularly of the digestive type and habits related to tobacco are directly related to lung or bladder cancer. Therefore, there are certain factors that intervene in a very specific way in certain tumours or cancers, taking into account that it is not a single disease, but rather a set of multiple diseases that have completely different development and genesis mechanisms. In addition, the selection is increasingly more specific, even in the variables of one cancer. At present when we talk about a triple negative breast

What questions are patients frightened of asking and that are the ones that should be asked? The “how long have I got left?” is the first one that comes to mind. But the fact of asking it is not as important as the reply they get to it. I mean: the patient asks it with the idea that the answer will be: “Don’t worry, we will see how it goes,” and not that you will say “you have three months left”. The fact that you, as a professional, have the information makes you responsible for its use. You have to try not only to be completely truthful, but also to ensure that that you really contribute something to the patient. Management of the information is complicated and although under no circumstances should we lie, there are many nuances in the truth. I imagine that another question that might come up after recovery is “why am I okay and another person isn’t?” It is true that the likelihood of relapse after the first five years is lower and therefore patients become much calmer after this time. There are longer spaces between visits to the doctor’s surgery, they become yearly and at a specific time, the patient may even be discharged. But it is also true that a person who has gone through a cancer and has recovered, statistically is more likely to suffer from a second one than a person who never has suffered from cancer, due to their genetic composition. But in any case, there is always a window open to return to the surgery, because there are many concerns and queries that can arise along the way and there is no point in not having access to be able to talk about them.

cancer in which genetics plays an important role, we relate it in a way and with some etiologic factors that are very different to luminal type breast cancer, which is more related to older women, who have already gone through maternity, etc. At your consulting rooms, how do you work with the concept of death and the fear of dying? Unfortunately we don’t have a handbook of steps for dealing with the subject of death. Each person is different and knowing their level of need is essential in order to be able to help them. In any of the cases, generating a space for communication is essential because at times, neither the family and nor patient dare to express their queries. There has to be the ability to be able to manage these spaces for dialogue and talk about any concerns they might have. And this, obviously, requires a great deal of tact, transparency and vision to create these spaces in time.

“Considerable tact, transparency and vision is needed in the consulting rooms to create spaces for dialogue”

Apart from physician-centred work, what other aspects of the medical oncology system can be influenced to make it more effective? Research, prevention and care, together with the social aspects related to this field. Cancer is a disease that has a major impact on a person’s life, even on those who are cured. If you have had cancer and you go to the bank to ask for a loan to buy a flat, you may be discriminated against. Governmental organisations need to work to offer legal proposals that do not hinder, for example, the incorporation of these people into the labour market. And not only that: resources must be available to deal with the physical and psychological consequences of the specific therapies that cancer represents, because sometimes it is difficult for them to cope with them. This includes adequate psychological support, too, and taking care of the education of the professional who deals directly with the patient, and here I am speaking particularly of nursing, which has a fundamental role in the care of cancer patients. These would be the essentials.

Destinations

Around the world in

7 CARNIVALS

From the exuberantly sensual display of Rio de Janeiro to the giant lemon sculptures in Menton, we invite you to discover how this festival is experienced at other latitudes. by Neus Duran

arnem levare −say goodbye to meat before entering the Lenten period of abstinence in the Catholic tradition–, is the Latin term from which the word Carnival originates. Its origin however is estimated to go back much further, dating back to the festivals carried out honouring the bull Apis in Ancient Egypt. Lust, overflowing joyfulness and all kinds of excesses characterised these celebrations, which were also reproduced in the ones devoted to the gods Bacchus and Saturn in the Roman Empire.

Permissiveness and “misrule”

Lust, overflowing joyfulness and all kinds of excesses have characterised this celebration over history, the most brazen event on the calendar 28

Little by little, the custom of annually celebrating this festival spread throughout Europe, and since the Middle Ages, it also became a period of permissiveness and “misrule” in which, for a few days, scathing criticism of the authorities and religious moral were allowed. Subsequently, Spanish and Portuguese sailors reached America, where over time some of the most spectacular carnivals that can be seen today were developed. To experience a great carnival first hand, you don’t need to go very far, because Spain has several that play in the first division. Amongst the most popular are the Tenerife carnival, where feathers and glitter are the stars of the processions of floats, along with the choosing of the Queen of the Carnival; or the one in Cadiz, where the famous ‘chirigotas’ compete in wit to ironically dissect current affairs in song. In Las Palmas, the eye-catching Drag Queen Gala stands out, one of the first in the world dedicated to a group that also plays a leading role in Sitges, where under the slogan Per Carnaval tot s’hi val (At Carnival time, everything goes) one of the most groundbreaking carnivals takes place. However, in this article we propose travelling further away to discover how this festival is experienced in other places. Glamorous ones such as the Venice carnival, exuberant and monumental festivals such as the one in Rio, curiosities such as the one in Menton or ancient celebrations such as the ones in Guinea-Bissau: there are carnivals for all tastes. Accompany us around the world, discovering some of the most attractive ones.

Afro-Caribbean rhythm in Notting Hill British reserve turns into Caribbean abandon every year in London when the weekend of the Notting Hill Carnival arrives which, unlike all the other carnivals around the world, takes place in August. The massive celebration fills this London district with boisterous parades, dances and cultural diversity over two days, the first more devoted to families and the second, a much wilder celebration. Over a million Britons and tourists visit this event every year, which the British Afro-Caribbean community has been organising since the 1960s to vindicate their rich cultural heritage.

Rio, ‘o rei’ of the carnivals All the figures evoked by the most famous Carnival in the world are overwhelming: 5 million visitors; up to 5,000 dancers from each large samba school and no less than 77 million condoms, which the authorities have given out in recent editions to tackle the craziness of the celebration. Without any doubt, the most outstanding event of the festival is the parade around the Carioca Sambodrome that takes place over five evenings. Every night six samba schools perform in performances that last just over an hour and offer what could be considered the greatest show in the world.

Destinations The Mardi Gras: colour, mystery and craziness The martedi grasso (‘fat Tuesday’), referring to the last banquet celebrated before the period of fasting and abstinence, gives its name to the mythical Mardi Gras of New Orleans. A parade of floats where the mysterious imagination of Louisiana plays a leading role and where the troupes (krewes) throw out tonnes of necklaces with plastic beads and take to the streets of the city. The famous, picturesque French Quarter does not form part of the route, as its streets are too narrow, but the area overflows with music, masks and an unforgettable atmosphere during these days.

The Serenissima gets all dressed up Citrus fruits turned into art in Menton One hundred years ago, the French town of Menton was the main lemon producer on the European continent. To attract and entertain tourists in the winter, an hotelier had the great idea of organising an exhibition of citrus fruits and flowers that was the beginning of what today has become one of the most curious carnivals in Europe. The peculiarity that makes it unique is the amazing collection of floats and sculptures covered in citrus fruits, mainly lemons and oranges, which invade the Bioves gardens, turning them into a spellbinding world of yellows and oranges. At the end of the festival, which has a different topic every year, the fruit is sold off at low prices.

What in other places is a burst of sensuality, in Venice is elegance, mystery and glamour. It is one of the oldest carnivals on the planet and, along with Rio, the most mythical in common fantasy. And the fact is that there is no city that can compete as a stage with the Serenissima, where the participants parade through its squares, alleyways and canals. They do this dressed in outfits inspired by aristocratic garments from the 17th century, many of them very elaborately made and with the beautiful masks that have become a symbol of the city.

All the wild magic of the Colombian Caribbean Two decades have passed since the UNESCO proclaimed the Barranquilla Carnival as oral and intangible World Heritage, acknowledging its role as a promoter of the cultural wealth of the Colombian Caribbean. The celebration, which brings together over two million participants every year, moves to the rhythm of ‘merecumbé’, cumbias and salsa and its costumes inspired by the animals that inhabit the region’s rich mythology stand out, such as the magical jaguar or the alligator-man. The queen of the carnival, the Momo king and the black ‘bollongas’ – street hawkers with hats full of fruit and buns on their heads, are other characters that are always visible at this event.

Mysticism and ancient tradition in Guinea-Bissau Dressed with costumes and masks that pay tribute to their sacred animals, such as the hippopotamus, the hammerhead shark or the bull, the participants of the carnival on the Bissagos Islands dance to the rhythm of drums and bamboo instruments; elaborate dances that have remained unaltered during centuries. The festival is held on many of the eighty-eight islets that make up the archipelago, but it is particularly spectacular in the capital, Bissau, where the ethnic majorities compete with parades that allow the authenticity and mysticism of the ancient traditions to be enjoyed.

Trends

‘TRUE CRIME’:

a fascination for dark plots

The perfect crime doesn’t exist. In particular, because, if it were to exist, we would never discover it. And this is, the key to the success of ‘True Crime’, a trending genre that goes over the most resounding crimes of history to analyse them in depth. by Laura Martos

ithin the human condition, the profile of a murderer is one of the most historically controversial. From conceptions such as evil, betrayal or madness, the limits that separate moral and psychopathological behaviour, at the very least, awaken curiosity. And often, we seek to explore the motives that drive people to cross these boundaries. For this reason, the two characteristics that any true crime should meet are its narrative, based on a real crime retold by close relatives and professionals who were linked to the case and its media coverage. This second element is even more important, because it recovers the point of view from which it was told and the influence this had on the court proceedings. And the fact is that this genre does

not only put the spotlight on the investigation, but also on the parallel conspiracy theories, the media circus or the criticisms of the institutions and the judicial system.

From Capote to Berlinger

It is difficult to talk about a specific origin for true crime. Many specialists in the genre affirm that between 1500 and 1700 there were already publications that informed readers about capital crimes, a predecessor of the incidents columns that continue in some newspapers today. However, the first incident dealt with in an informative way could be read in the masterpiece in which Truman Capote narrated the murder of the Clutter family in Holcomb, Kansas, at the hands of Dick Hickock and Perry Smith. In Cold Blood, a journalistic-literary work that

covered both the facts that took place in 1965 and the terror that invaded the neighbours and relatives of the victims, was the birth of a new way of understanding and, above all, consuming crime. Following this, the United States has become the cradle of this documentary genre. The reason is obvious: it is by far, the country with the most serial killers in the world, ranging from the case of Lizzie Borden, in 1892, to Ted Bundy, Jeffrey Dahmer or Ed Gein, who inspired Thomas Harris for his novel The Silence of the Lambs or Robert Bloch for Psycho. Joe Berlinger, therefore, was not the first producer who became interested in the police investigations with most media coverage, but he was the person who made the murderer’s testimony available to the public, responding to the question that usually impregnates any crime: Why did they do what they did? In any event, it is obvious that the success of this genre could be explained by itself: the list of incidents that have terrified the world –Amanda Know, the Watts case, Tiger King, The Tindler Swindler, Bad Vegan…, or in Spain, El caso Asunta, Alcàsser, Las últimas horas de Mario Biondo, ¿Dónde está Marta?...– is so long that production of documentaries and films has not stopped since the phenomenon of The Jinx or the podcast Serial. And now, people such as Berlinger or Carles Porta have crossed the thresholds into all our homes, inviting spectators to relive incidents that seriously question human behaviour and activate a seriously primary survival instinct in all of us.

Four essential documentaries in this genre Making a murderer This documentary series analyses the story behind the case of Steven Avery, a young American who was accused and sentenced to prison in 1982 for sexually attacking Penny Beerntsen. Eighteen years later, new DNA evidence showed his innocence and pointed towards Gregory Allen, meaning that Avery was released. Three years later another woman went missing, Teresa Halbach and after two years of investigations, Avery was sentenced for her rape and murder. Can eighteen years in prison create a murderer?

The Alcàsser case The disappearance of Desirée Hernández, Miriam García and Antonia Gómez in 1992, three fourteen-year-old girls who were on their way to a high school party near to the town of Alcácer (Valencia), marked a before and after in media coverage of incidents in Spain. In 2019, Netflix premiered a documentary series that once again questioned all the unknown factors behind this rape and group murder that incriminated Antonio Anglés and Miguel Ricart. This was the first Spanish documentary series that the platform added to its film archive, not only due to the repercussions it had at the time, but also to the trail of unanswered questions that it left behind it.

Conversations with a Killer The true crime format steps in and its maximum essence can be found in the series of documentaries by Joe Berlinger, which collected the testimonies of serial killers in the interviews carried out during their respective trials. The first series in 2019 was starred by one of the most famous murderers in the United States, Ted Bundy. In 2022 a second part came out that dealt with the case of John Wayne (known as the Clown), and a few months later, all the Jeffrey Dahmer tapes, which complemented the fiction series launched on the same platform about the serial killer.

‘Crims’, con Carles Porta

Joe Berlinger was the first producer to make a murderer’s testimony available to the public

Carles Porta is the epitome of a Spanish journalist that has formed part of the current true crime concept. Originally a radio programme on Catalunya Ràdio, his programme moved to the small screen using Porta’s voice-over as the narrative thread, submerging spectators in the four seasons in which he explained many crimes, both resolved and unresolved from the Catalan police files. After its resounding success, in 2023 he launched a documentary series centred on the media coverage of the case dealing with the Urban Police Force Crime for Netflix, as well as a project about another two media cases on Movistar.

Disconnection

¿Did you know...?

The first caesarean in history wasn’t carried out by a doctor

Book

A family divided by the revolution This novel, based on a true story, relates the account of a Hungarian family living in Budapest in the times of the Soviet rule and the 1956 uprising, when the mass entry of Russian tanks took place. The main characters would be forced to separate and flee the country, meeting up again on a journey full of encounters and adversities that will take them to the United States or Spain, amongst other destinations. A historic journey full of human values that submerges the reader in the most conflictive years of the Soviet Union and the political and social consequences, which would start to show the cracks in the communist system.

La historia que había que contar. Francisco Coronel. Círculo Rojo, 2023

he word cesarean is referred to in several different historical origins. The most widespread reverence dates back to the birth of Julius Caesar, who, according to Pliny the Elder acquired his name due to the sectioned uterus of his mother. In any event, the word comes from the Latin verb caedere, which refers to its main function, which is to cut the abdominal walls of the mother to forcefully remove the baby. It was a regular practice in Ancient Rome, when the mother died during the birth, before the baby had been born and by law the incision was carried out to try to save the foetus. The first caesarean that was carried out on a live woman, however, does not appear until 1500, specifically in Siegerhausen, Switzerland. The person who carried it out was Jakob Nufer, who rather than having any medical

knowledge, was a pork butcher and who carried out a caesarean on his wife, who had been in fruitless labour for several days and was on the edge of death. Nufer decided to try to extract the child at home, having obtained the necessary permission from the authorities and he proceeded with the operation. It is worth remembering that there were still almost four hundred years to go before anaesthesia was invented, meaning that no medicines were used in the operation. In spite of this, and of the lack of hygiene at that time, the child not only was removed after the first incision with no injury, but both mother and child survived. The child lived, as registered by the anatomist Caspar Bauhin, to the age of seventy-seven years and the mother gave birth naturally another five times. Bauhin was, therefore, the first person to leave a written record of the first successful case of a caesarean on live woman.

Series

A kitchen full of conflict Starring Jeremy Allen White and Ayo Edebiri, the series The Bear follows the successes and failures of a chef who takes over a family-run sandwich restaurant after the death of his brother. In the first season we saw how the kitchen team was formed, with special attention on the relationship woven between Sidney and Carmy, both in and outside the kitchen. Now, in the second season, we will see how the filthy venue is turned into an haute cuisine restaurant, accompanied by many administrative, labour and culinary nightmares. At the same time, we will continue discovering the ins and outs of the Berzatto family through several flashback episodes, while Carmy flees from all the memories coming from that past.

The Bear. Disponible en Disney+

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