Are there any differences between cosmetic and repairing surgery?
Truths and myths about protein diet
Kanazawa, a Japanese town packed full of Samurais and Geishas
The medicines that changed the world
Compartir
Healthcare cooperativism magazine www.compartir.coop compartir@fundacionespriu.coop
Editorial board:
Dr. Ignacio Orce, chairman of the Fundacion Espriu and of Assistencia Sanitaria
Dr. Enrique de Porres, CEO of ASISA-Lavinia
Dr. Oriol Gras sponsor of the Fundacion Espriu
Dr. Carlos Zarco, General Manager and sponsor of the Fundacion Espriu
Publication: Factoria Prisma
Diagonal 662-664
08034- Barcelona
Tel. 639 213 710 www.factoriaprisma.com
Director of Factoria Prisma: Angi Gonzalez 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
FIN: G-59117887
Tel.: 934 954 490
fundacionespriu@fundacionespriu.coop www.fundacionespriu.coop
Established in 1989, the Fundacion Espriu integrates the bodies that practice the cooperative healthcare model created by Dr. Josep Espriu: Augtogestió Sanitària, SCIAS, Lavinia and ASISA, which form the Assistència Group and the ASISA Group.
New research by the WHO reveals the main causes of maternal death in the world.
We talked to the Doctors Mario Secorun and Valentín Yusta about the differences between cosmetic and reparative surgery.
08 10 14 20
We have analysed some of the most popular myths about high protein diets with Doctor Jaume Gimenez.
We go over the achievements reached by our cooperatives in 2024 and the goals they propose to take on in 2025.
We look at some of the most important historical events in the pharmacological sector and their greatest challenges today.
Equality in access to healthcare continues to be a global challenge in which the integration of the pharmaceutical sector is a tangible sample of how the collaboration can transform the healthcare reality. In this context, healthcare cooperativism positions itself as a feasible alternative to guarantee a fairer distribution of medical resources, encouraging models that give priority to sustainability and accessibility. In this edition’s report, we analyse the role of pharmacology in the healthcare system and the possible cooperative alliances.
We also tackle some of the more relevant trends in the area of health, such as the boom in wearable electronic devices and their impact on the prevention and monitoring of illnesses; we demystify high protein diets separating scientific evidence from popular belief, and we reflect on the increase in the demand for plastic surgery, a speciality with a long historical record and an essential function in medicine, but that is subject to professional infiltration and misinformation.
Within the framework of the International Year of Cooperatives, in May, the Fundación Espriu will organise, in the Cooperatives and Mutuals Leadership Circle (CM50), a space promoted by the International Cooperative Alliance where the central points of the United Nations’ Second World Summit on Social Development will be debated.
Lastly, with the arrival of Spring, we recommend some mini-breaks to take advantage of the sunny days, as well as some proposals to enjoy at home when the weather is bad.
Kanazawa is the new fashionable destination in Japan, a town that still conserves a district of Samurais and one of Geishas.
These are the four essential main dishes and the two desserts making up the traditional Holy Week cuisine.
Espriu
Astudy published by the World Health Organisation (WHO) in The Lancet Global Health reveals that severe bleeding and hypertensive disorders, such as preeclampsia, continue being the main causes of maternal death. In 2020, these problems caused around 80,000 and 50,000 deaths, respectively, demonstrating the lack of access to essential healthcare services during and after pregnancy. On a global scale, it is estimated that during this year 287,000 women died due to complications related to pregnancy, which is the equivalent of a death every two minutes.
The report, which represents the first up-date by the WHO on this subject since 2015, also underlines that almost a quarter of the maternal deaths are linked to infectious and chronic diseases, such as HIV/Aids, malaria, anaemia and diabetes. Many of these affections are not detected or treated in time, which worsens
Air pollution is a key factor in climate change and one of the greatest threats to human health, causing around seven million deaths per year due to respiratory and cardiovascular diseases. In response to this crisis, 47 million healthcare professionals, civil organisations and citizens have signed an urgent call to action to reduce pollution and to protect public health.
This call was presented at the Second World Conference on Air Pollution and Health, which was held in Cartagena (Colombia) at the end of March. The event brought together political leaders, experts and representatives of civil society to define strategies that promote cleaner air and benefits both for public health and for sustainable development. With 2,100 million people exposed to domestic air pollution, the WHO considers this crisis a global priority in the fight towards a healthier planet.
Tuberculosis (TB) continues to be one of the main threats to global health, causing serious social and economic consequences. In 2023 alone, 10.8 million people became ill from tuberculosis and 1.25 million lost their lives due to this disease. However, international efforts for its prevention and treatment have managed to save 79 million lives since the year 2000.
World TB Day is held on the 24th of March every year, the date that commemorates the day in 1882 when Dr. Robert Koch discovered the bacteria that causes TB, making it possible to diagnose and cure the disease. This year’s slogan, Yes! We can end TB: Commit, Invest, Deliver, is a bold call to hope, urgent action and accountability.
Inspiring quotes
“Thosewhoseekdomoreformedicine thanthosewhoconclude.”
Ángeles Mastretta, Mexican journalist and writer.
In 2020, it is estimated that 287,000 women died in the world due to pregnancyrelated complications.
the complications during pregnancy. Additionally, other direct causes of death were identified, such as serious infections, pulmonary embolisms and complications derived from abortions performed in unsafe conditions.
The conclusions of the study emphasised the need to strengthen maternal care during all the different the stages. Detecting risks in early pregnancy, guaranteeing emergency obstetric care and carrying out controls during the postpartum period are key steps to reduce the death rate. However, according to the study, in many low-income countries a large proportion of women do not receive any follow up care in the days after the birth, which increases the risk of fatal complications. The improvement of preventive interventions could reduce the incidence of underlying diseases and contribute to saving lives, a recommendation that the WHO considers essential.
The Cabinet Meeting has given the go ahead for the bill on prevention of consumption of alcohol by minors, with the aim of delaying the age young people start to drink and reducing consumption in this group. The legislation is based on the presentation Minors withoutalcoholand it responds to alarming data from the ESTUDES Survey, which reflects that 75.9% of teenagers between the ages of 14 and 18 years have tried alcohol and 93% consider it easy to obtain.
Amongst the steps suggested awareness programmes in families stand out, along with the incorporation of preventive content in the educational curriculum and healthcare protocols to detect and look after minors with alcoholic poisoning.
The bill introduces urban restrictions to prevent the concentration of points of sale near educational centres and
it bans the consumption of alcohol in spaces to be used by minors. It also contemplates the possibility of replacing the fines for consumption with awareness or rehabilitation programmes.
The restrictions will also reach the advertising and marketing of alcohol, banning the display of these drinks in establishments aimed at minors and limiting their display in supermarkets.
A vaccine against kidney cancer that prevents its reproduction
A clinical trial with a personalised oncological vaccine has meant that nine patients with advanced kidney cancer and high risk of recurrence have not suffered from relapses almost three years after the treatment. The research, led by the Dana-Farber Oncological Institute (USA) and published in Nature, has shown that the vaccine generates long-lasting immune responses, remaining active for an average of 34.7 months after administration. The results consolidate the potential of this strategy to prevent the reappearance of the cancer after surgery.
The vaccine uses neoantigens, specific mutant proteins of the tumour cells, to train the immune system and only attack the cancer cells. After the removal of the tumour, the researchers personalise each vaccine, analysing the patient’s tumour tissue and using predictive algorithms to select the neoantigens with greater probability of inducing an immune response. In just three weeks, the vaccine multiples by 166 the number of specific T cells fighting against the tumour, achieving a sustained protection.
This therapy, previously successfully tested with melanoma, has also been shown to be effective on kidney cancer, in spite of the fact that these tumours show fewer mutations. All the participants in the study suffered from clear cell renal cell carcinoma in stage III or IV, and the vaccine achieved a powerful immune response that could mark a key advance in the fight against this type of cancer. These findings, therefore, open the door to new immune therapy strategies adapted to each patient.
Devices such as smart watches or activity bracelets have changed the way we look after our health, allowing us to compile body parameters in real time.
By María Pérez
In recent years wearable technology has managed to become almost unnoticeably integrated into our daily lives. Thanks to their discreet, convenient design, these electronic devices, present in accessories and clothing, allow their prolonged use without causing any inconvenience or drawing any attention. What to begin with looked like a passing fashion has managed to become consolidated as a market that is constantly growing, with proposals that range from smart bracelets, earphones, glasses or watches, to clothing and running shoes, and even technological rings, a gadget that is virtually undetected and that is now reaching the general public.
ture. As the technology advances, the capacities of the wearables continue to extend and it is predicted that in the near future these devices will be able to measure blood sugar levels, a milestone that would revolutionise diabetes control.
Currently, wearables have many functionalities, with the data being stored in the cloud for remote access. Amongst these the following stand out:
• Register of physical activity
• Heart rate monitoring
• Sleep monitoring
• Measurement of oxygen in blood
The use of wearables can aid the early detection of possible pathologies
In some areas, wearables have become an essential tool, as can be seen in the case of the healthcare sector. And the fact is that beyond presenting basic functions such as the receiving calls or geolocalisation, these devices have revolutionised the way in which we look after our health thanks to the continuous, personalised monitoring of our vital signs. Their use promotes a more proactive approach to well-being and they make patient monitoring easier; they also improve prevention and early detection of possible pathologies.
These devices, fitted with sensors such as pulse monitors, accelerometers, gyroscopes and thermometers, allow monitoring in real time of body parameters such as the heart rate, physical activity and body tempera-
• Measurement of body temperature
• Stress control
• Measurement of blood pressure
• Calorie control
In the not too distant future, it is predicted that these sensors will also be able to be integrated into contact lenses, false teeth and even epidermal tattoos, opening up a world of new possibilities.
Wearables empower the user, giving them a more active, responsible role in the care of their own health. These are some of the groups who could benefit most from this technology:
• Patients with chronic illnesses
As they are in a particularly vulnerable situation, immune-compromised patients need their state of health to be constantly monitored. Wearable devices can alert about changes in their vital signs, encouraging a rapid response when faced with any alteration, such as the appearance of high temperature or tachycardia.
This is also the case with patients with cardiovascular problems, as the evolution of these devices has allowed blood pressure and oxygen in blood to be measured constantly and even allowing arrhythmias to be detected. These functionalities allow a more accurate monitoring of the state of the heart to be carried out and ensuring acting in time in the case of a risk.
• People who are seeking to improve their lifestyle.
Los wearables ayudan a establecer hábitos saludables mediante el control de la actividad física. Gracias a su capacidad para registrar el gasto energético y los patrones de ejercicio, resultan una herramienta clave para quienes desean mejorar su calidad de vida. Wearables help to establish healthy habits using the control of physical activity. Thanks to their capacity to register the energy consumption and the exercise patterns, they are a key tool for those who wish to improve their quality of life. Furthermore, the
Wearable devices are equipped with sensors that allow the monitoring of body parameters.
advanced sensors incorporated into the wearables allow the quality and the amount of sleep to be measured, which makes the diagnosis of disorders such as apnoea or insomnia easier. They also offer useful information for developing personalised treatments.
• High performance athletes
Wearables provide precise metrics about the physical performance, such as the distance covered, the speed reached or the heart rate. Thanks to the analysis of this data, trainers can evaluate the progress and design personalised training sessions.
In spite of the advantages that wearables offer in health management, it is essential to recall that these devices do not replace periodic medical check-ups or the criteria of a professional. The data that they collect must be interpreted in the clinical context and always under the supervision of a specialist, who will be able to make a precise diagnosis and recommend the most suitable treatment.
In short, the wearable technology is redefining healthcare and well-being, offering people tools to carry out a more exhaustive control of their physical condition. However, their use must be understood as a supplement to traditional medical care, in this way guaranteeing comprehensive, effective monitoring.
Over the past ten years, plastic surgery operations have increased by 215%. In spite of the increase in the demand, this speciality continues to be a great unknown for the general population.
By Laura Martos
The term plastic, which comes from the Greek word plastikos, alludes to the action of shaping. The speciality of plastic surgery, therefore, is considered to be a generalised name for the discipline aimed at reshaping the tissues of the human body. It dates back to the beginning of the 19th century, when a German study written by Karl Ferdinand von Gräfe mentioned the term in his work on nasal reconstruction techniques based on Indian and Italian methods. Their research established the foundations of plastic surgery in Europe, which a century later would be divided up into two large sub-categories: reparative and cosmetic surgery.
Reparative medicine vs. cosmetic medicine
In general, while reparative medicine seeks to restore the function and appearance of congenital malformations or accidents, while cosmetic surgery focuses on improving the appearance without any medical need. At present, however, the limits of these two sub-specialities have merged, as often a cosmetic operation can also have functional benefits and vice versa. “A clear example is a rhinoplasty, which can be carried out both to improve facial harmony and to correct respiratory problems. The same occurs with breast surgery, where a breast reduction can improve aesthetics and it can also alleviate back problems,” Doctor Mario Secorun, the plastic surgeon at HLA Clínica Montpellier affirms.
The aim of plastic surgery is and has always been to improve the patient’s quality of life, be this functionally, aesthetically or psychologically. The debate, therefore, is rather a bureaucratic one: while reconstructive surgery is considered to be a public service, cosmetic surgery is practiced in private centres. In light of this division, the clinics carry out a categorisation in which the personalised treatment is key: “Plastic surgery must be recommended when there is a clear, realistic indication, after an exhaustive medical evaluation. In the case of cosmetic surgery, it is essential for the patient to have realistic
expectations and to ensure that the operation is carried out for personal reasons and not due to external pressure,” Secorun explains.
According to data from the SECPRE (Spanish Society of Reparative and Cosmetic Plastic Surgery), in Spain over 200,000 cosmetic operations are carried out every year. Of these, 85% are carried out on women and 15% on men, although an increase in the interest by men has occurred, as well as by young people in general. While women, above all, demand breast enlargement surgeries and liposuctions, amongst men blepharoplasty or eyelid surgery, rhinoplasty or gynecomastia all stand out.
The increase in demand responds to many factors, such as the development of new, less invasive techniques with shorter recovery times and the normalisation of this type of operation in the social environment. This increase, however, has also brought some alarming data with it: around 50% of cosmetic operations are not carried out by plastic surgeons. “Currently patients are completely unprotected in a situation like this. We are working on a series of legal modifications, particularly using the Sara Law as a starting point, which has allowed us to limit which types of cosmetic surgery can be carried out by each specialist, a necessary point to pursue professional intrusion,” Valentín Yuste, a surgeon from the Clínica Montpellier indicates. Yuste, who is also a member of the Spanish National Cosmetic and Reparative Plastic Surgery Commission, affirms that they are increasingly more meticulous in the preparation of exams and reviewing of qualifications by the people who apply to exercise the speciality in Spain.
Meanwhile, as both doctors mentioned, it is essential for this demand to be managed ethically and responsibly, avoiding passing trends or unnecessary operations that could compromise the patient’s health. To do this, a process that includes an initial consultation in which the patient’s clinical notes are evaluated, as well as a physical examination and an analysis of their expectations are essential factors. “It is important to guarantee that there is no external pressure. I particularly like to have an unhurried conversation with the patient in which I ask them to describe what the problem is, because this gives me a great deal of information about this person’s view of their reality,” Yuste explains. In the case of the Clínica Montpellier, they also request pre-operatory tests and if necessary, a psychological evaluation before giving the final approval.
Protein diets have become popular with the promise of helping to lose weight and gain muscle mass. But what is the truth behind these statements? We analyse this topic with Dr. Jaume Gimenez.
By Sílvia Cardona
Aprotein diet or a diet high in protein is considered to be one that provides more protein than proposed by the general recommendations; that is to say, over 15% of the overall intake. Some of these diets go way above these figures (even reaching 25-30% of the energy stemming from proteins) and they coincide in one factor: as the proportion of proteins increases, the amount of carbohydrates drops.
Many protein diets have become popular in recent years, with a large number of followers and detractors, and a series of beliefs around this nutrition model. Below, we will go over some them with Dr. Jaume Gimenez, a nutritionist and head of the Nutrition and Nutritional Coaching Service at Assistència Sanitària to find out whether they are fact or fiction.
All protein sources are the same.
There are different protein sources that we can place in two large groups according to their origin: animal and vegetable. Animal protein is considered to have higher quality, as it contains all the essential amino acids in suitable amounts and it is easier to absorb. It is present in meats and poultry, fish and seafood, eggs and dairy products. However, the World Health Organisation (WHO) recommends limiting the consumption of red meat (it is not recommended more than 1 or 2 times a week) and processed meat.
Vegetable protein can be found in legumes (chickpeas, lentils, beans, soy and its derivatives such as tofu), dried fruit and nuts (walnuts, pistachios, almonds, cashew nuts, etc), seeds (hemp, linseed,
sesame, etc.) and wholemeal cereals (quinoa, buckwheat, millet, etc.).
A high protein diet to help with weight loss.
As Dr. Gimenez explains, “high protein diets can contribute to weight loss, as by increasing the satiating effect, they can help to reduce a person’s calorie intake. Additionally, the digestion and the metabolism of proteins need more energy, increasing the energy consumption.”
In the consensus by the Spanish Federation of Nutrition, Alimentation and Diet Societies (FESNAD) and the Spanish Society for the Study of Obesity (SEEDO) on the role of diet in the prevention and treatment of overweight and obesity in adults, it declares that a hyper-protein diet does not induce greater weight loss in the long term compared to a conventional diet. When following this type of diet, in fact, the recommendation is to limit the consumption of animal protein as a high consumption of meat and its derivatives can increase weight gain and abdominal perimeter.
A protein-rich diet can damage the kidneys or the liver in the long term.
This subject is usually controversial and it is a good idea to qualify certain points. Some studies indicate that, in obese people, the following of animal protein-rich diets can increase the risk of kidney diseases. Likewise, the consumption of proteins is usually limited in people who already suffer from any type of kidney damage. However, a moderate increase of the protein in the diet should not mean a problem in the healthy population. “A meta analysis of twenty-eight studies concluded that there is no evidence that links
high protein intake with deterioration in the kidney function in people without any pre-existing diseases of this type,” Doctor Gimenez underscores.
This is the same case that occurs with the impact of protein diets on the liver. Today there is not enough scientific evidence to affirm that there is a cause-effect relation between a high- protein diet and liver damage. Mind you, there are other risks associated with an excessive intake of protein. For example, ammonia accumulation, which could overload these organs and cause consequences that are harmful to health.
You must follow a protein diet to increase muscle mass. The recommendation by the European Food Safety Authority (EFSA) to maintain muscle mass in adults
0.83 grams of protein per kilogram of body weight is recommended every day
is 0.83 grams of protein per kilogram of body weight per day. And it proposes higher levels for those people who follow an active lifestyle, habitually carrying out physical exercise, reaching up to 1.6 grams of protein per kilogram of weight every day. From all this, we can deduce that, to obtain an increase in muscle mass, it is necessary to increase the amount of protein in the diet above the general recommendations. However, as Doctor Gimenez comments, “if suitable stimulation is not generated through training or physical exercise, the increase in protein intake by itself will not be enough for a significant increase in muscle mass.” In addition to this, “it is necessary to combine it with strength exercise, a rest and a suitable intake of other nutrients with certain vitamins, minerals and fatty acids such as omega 2.”
Gastroenteritis is an inflammation of the digestive tract, usually of the stomach and the intestines. Its main symptoms are diarrhoea (when accompanied by blood it may be indicative of a bacterial infection), high temperature, dehydration, persistent vomiting and abdominal pain, which can persist for up to seven days in some cases, or it can get better in just 24-48 hours, according to the origin of the illness.
• Viral infections: These are the most frequent cause, with the norovirus in adults standing out.
• Bacterial infections: Some of the most usual ones are Escherichia coli, Salmonella, Campylobacter and Shigella. They can be contracted through food poisoning.
• Parasites: These are frequent in regions with bad healthcare conditions and food contamination. The best known ones are Giardia lamblia, Entamoeba histolytica and Cryptosporidium.
• Other causes: Some inflammatory diseases (such as ulcerative colitis), food intolerances (to lactose, for example) or the reaction to some drugs can also cause these symptoms.
Gastroenteritis is usually self-limiting, but its effects can be very uncomfortable and weakening. Follow these recommendations to alleviate the symptoms and get back to normal as quick as possible.
1. Constant hydration: Take little sips of water, infusions and broths. Avoid drinks containing caffeine, soft drinks with large amounts of sugar or alcohol.
2. A progressive diet: Introduce mild foods little by little. First, clear liquids; then foods such as rice, toast, boiled potatoes, blue fish… Avoid dairy products and very fatty foods.
3. Adequate rest: Feeling completely washed out is normal. Rest will help the body to invest energy in fighting the infection.
4. Hygiene: Disinfect the surfaces and avoid sharing utensils with other people to avoid any possible contagions. Wash your hands thoroughly after going to the toilet.
5. Medication: Avoid self-medicating, particularly in the case of antibiotics, which can produce resistances and anti-diarrheal medicines, which can be counterproductive in cases of bacterial infection.
ASISA’s commercial transformation and the diversification of its activity continue to move forward to promote the company’s growth and profitability.
The ASISA Group continued to grow in 2024 in its main areas of activity. In the insurer field, it reached a volume of premiums of 1,542.19 million euros, after growing by 4.3%; while in the assistance area its invoicing reached 676.4 million euros, 10.4% higher than the previous year.
The capacity for reinvestment has allowed the ASISA Group to create the largest assistance network in Spain belonging to an insurance company, which continued to grow in 2024, incorporating new centres and developing a portfolio of specialised, high quality health services in different fields. In total, in 2024, the assistance companies belonging to the ASISA Group invoiced 676.4 million euros, 10.4% higher than in 2023, led by the HLA Group, one of the benchmark hospital groups in Spanish private healthcare, which attended over 3.2 million consultations.
In the internationalisation area, the ASISA Group continued to strengthen its presence in Portugal where it started its activity in 2018. It is present in life and non-life insurance, and it has started up two dental clinics in Lisbon and
Porto that are leading lights in medical-dental care. ASISA Portugal has experienced a constant growth, climbing positions in the ranking of the largest insurance groups operating in Portugal. The insurer has consolidated its organisational structure and its internal teams to guarantee excellent service to clients and their distributors.
In 2024, the ASISA Group continued promoting different projects for the reorganisation of its management systems and in this way making the most of the advantages provided by technology. Amongst these, the deployment of a new CRM, the development of a new policy
management system and the incorporation of artificial intelligence (AI) all stand out to improve customer services.
Finally, in 2024 the ASISA Group consolidated the ESG commitment (environmental, social and governance) in all the areas where the company acts and it continued developing its ESG strategy for the 2023-2030 period. The goal is to multiply the positive impact that the group’s activity, both as an insurer and as a healthcare provider, generates in society, and to contribute to its aim of improving people’s lives, protecting them and looking after their well-being and that of their surroundings.
The HLS Jerez Puerta del Sur hospital holds a commemorative event for its 25th anniversary
The HLA Jerez Puerta del Sur hospital celebrated its 25 years looking after the health of the people of Jerez and working to become a benchmark for healthcare in the province of Cadiz.
Over these years, it has opted for investment in equipment and in the best professionals to offer advanced healthcare to its patients, which has turned it into a modern centre, with the latest cutting-edge techniques and the implementation of strict quality
regulations that have meant it has won different national and international certificates.
The cloisters of the Convent of Santo Domingo hosted the central event of the commemoration, held under the slogan 25 years getting ready for the future, with the presence of over one hundred guests, amongst whom were representatives from different sectors, such as healthcare, public administration, business and civil society.
Over the last year HLA attended 600,000 emergency cases and carried out over 166,000 surgical operations.
The HLA Hospital Group attended over 3.2 million consultations in 2024, exceeding the previous year’s figure. In this way, the Group is continuing its expansion strategy with the opening of new centres and new units, its commitment to technological innovation and the incorporation of new professionals in different specialities, which has allowed it to ensure that its assistance data has grown again over the last year.
Over the year 2024, the HLA Group attended almost 600,000 emergency cases and over 200,000 hospital admissions. Likewise, during this period, over 166,000 surgical operations were carried out, along with 19 million laboratory determinations and over one million medical imaging tests.
Additionally, HLA continued with its expansion strategy, opening two medical centres that strengthen the group’s national presence: in Alicante, HLA Vistahermosa 77 has been added to the existing facilities, extending the offer that the group has in this province. With over 4,400 square metres and 40 consulting rooms fitted with state-of-the-art equipment to attend patients in a dozen medical specialities. In Extremadura, HLA has opened its first centre: HLA Centro Medico Cáceres, which has a high technology operating theatre and a multidisciplinary team devoted to offering personalised medical care.
Both these new centres are added to the ones opened by the HLA Group in 2023: the inauguration of the HLA Clínica Internacional Barcelona, in Catalonia and HLA Centro Médico-Quirúrgico Ramón y Cajal de Sevilla, in Andalusia.
ASISA has decided to renew its participation in the agreement with Muface to continue giving healthcare to its mutual society members during the years 2025, 2026 and 2027. It did this after analysing in detail the initial documents and the latest modifications in the conditions that the mutual society has presented and after weighing up all the factors, which in the insurer’s opinion, are decisive for being able to maintain the quality of the care. “We appreciate the effort that the Administration has made to improve the funding and introduce some elements that add equality to the model. Once the continuity of the model in the short term has been guaranteed, we are confident we will be able to initiate a dialogue as soon as possible with the Administration to promote this transformation process,” the insurer has declared.
ASISA has started a comprehensive programme to support first-time parents
ASISA has started up the Programa Familias Primerizas ASISA (First-time Parents Programme), aimed at families who are expecting or have just had their first child, with which it offers information about pregnancy, delivery and the first months of the baby’s life. This programme is accessible through the ASISA Blog and it also allows policy holders to carry out consultations with medical professionals through the ‘Chat Médico’ app integrated into Asisa LIVE, the insurer’s telemedicine platform.
HLA Universitario Moncloa, at the forefront in image diagnosis
The HLA Universitario Moncloa Hospital is promoting the service portfolio of its Radiology area incorporating a new MRI machine of 1.5 Teslas, an Ingenia Evolution from the company Philips with Smart Workflow Premium functionality.
Doctor Javier García Prado, Head of the Radiology Area at the HLA Universitario Moncloa, explains that regarding the assistance activity, “the new equipment allows examination times to be shortened, as all the steps in the process have been optimised, from the planning of the studies to the reconstruction of the image, passing through greater power in the image acquisition.”
Amongst the characteristics of this new equipment most valued by patients, are “the shorter length of the studies; the diameter of the tube, which is roomier inside; the design of the examination table, with a visco-elastic surface and the reconfiguration of the room. All of this is translated into greater comfort and a friendlier experience for the patient,” García Prado affirms.
Technological advances, computer-related crime, sustainability and regulating pressure have brought new challenges to insurance companies in 2024.
Assistència Sanitària has intensified its actions to strengthen its operational resilience and to promote sustainable strategies in order to guarantee excellence, along with the continuity of its services and compliance with the legislation. Furthermore, the entity has implemented new tools to improve its operational resilience and to adapt itself to the Digital Operational Resilience Act (DORA), implemented since January, 2025.
This regulation is aimed at guaranteeing the safety of the financial services against operational interruptions, such as cyberattacks, technological faults and any unforeseen circumstances. With DORA, Assistència Sanitària, which has always stood out due to the quality of its services and systems, has strengthened its framework for managing technological risks with periodical audits, resilience trials and rapid response mechanisms.
Parallel to this, in addition to strengthening its information systems, Assistència Sanitària has taken on
an active role in the promotion of a sustainable business model. Over the past year, the entity has emphasised its responsible investment, juggling social and environmental criteria with pure economic returns. This strategy not only reduces the financial risks linked to climate change, but it also promotes a more ethical corporate culture, in line with the expectations of policyholders and doctors.
During 2023 and 2014, Assistència Sanitària has avoided investing in controversial sectors, such as arms and has supported initiatives with a positive impact, such as medical research or university training that it backs with its scholarship programme. It has also devoted funds to foundations such as Galatea, Catalònia and Ateneu Sant Roc, and to the Spanish Red Cross to help the victims of the floods in November, 2024 in Eastern Spain. The entity is backing a sustainable future, establishing close relations with policyholders and suppliers, and adapting its services to the changing needs of the population.
A new Assistència Sanitària campaign that puts the spotlight on young football stars
Marc Casadò, Alejandro Balde, Pau Cubarsí, Gavi and Fermín López, five benchmark players from FC Barcelona’s first men’s team, trained in the club’s football school, highlight value of the local talent and the commitment to quality and proximity in Assistència Sanitària’s new advertising campaign.
With the slogan “Always with our local players” and with prominent presence on buses and billboards on the public roads, the campaign has been devised to take over the streets of Barcelona, where the entity was created almost 70 years ago. The initiative, which gives importance to Assistència Sanitària’s roots, uses five of today’s young benchmark football players who are an example of effort, constancy and success, values shared by the club and by the medical insurance company.
The meeting point designed for the members of SCIAS to be able to share moments, get to know their cooperative better and to prepare the annual assemblies closed 2024 with rising participation figures, both in
its in-person activity and in the service it offers remotely. For 2025, it is continuing with a stable programme of courses and workshops in different disciplines (courses for learning languages, choral singing, sessions of Pilates, Tai Chi or Yoga, coaching, etc), which it combines with specific proposals, amongst which the cookery workshops and the conferences on history, music and literature or the cultural trips and excursions to the countryside stand out.
The group held an event that emphasises the successful track record of a pioneer project in comprehensive healthcare cooperativism, consolidated as an international reference.
SCIAS held an event that acknowledged and emphasised the successful track record of a pioneer project in comprehensive healthcare cooperativism, consolidated as an international reference.
Held on the 19th of March of this year, the event was attended by 500 people, mainly members of SCIAS as well as the governing and management organs of the cooperative, representatives from the cooperative, along with those from the heal-
thcare area and different authorities. The performance of the Barcelona Guitar Trio & Dance and the following cocktail reception were preceded by the talks given by the Chairman of the cooperative, Andreu Obis; the General Manager of Cooperatives and Social Economy, David Bonvehí; the Secretary for Healthcare and Participation from the Department of Health, Gloria Gálvez and the President of the Parliament of Catalonia, Josep Rull.
2024 was a year marked by the promotion of new initiatives, acknowledgements and advances in all the areas of activity of the Hospital de Barcelona, which has been consolidated year after year as a reference in private healthcare in the city thanks to its diverse, transforming activity. Over the last twelve months over 155,000 cases were treated, of which over 30,200 involved conventional hospital admission or outpatient consultation; 15,500 patients required a surgical operation, 67% without hospital admission; the emergency servi-
ce attended over 54,600 cases; and the home-visit emergency service made over 71,400 visits.
The institutional actions reinforced the centre’s presence in the sector, while the offer of care services was marked by the extension of the clinical laboratory to serve the entire population covered by Assistència Sanitària insurance policies. Likewise, the training continued growing and a special spotlight was put on the outreach activities open to the public and on the sustainability of the installations.
In addition to the congratulations offered for this journey, during the event the fact that SCIAS has reached its half a century of life with an enviable health and a solid vision of the future was highlighted. The cooperative has been a key figure in the shaping of a collaborative, non-profit making healthcare model, demonstrating that the self-management shared by users and doctors can guarantee top quality, sustainable healthcare with the highest standards of excellence in the sector and in the area around it.
SCAS was established in 1975 as the result of the ideas and drive of Dr. Josep Espriu in a context of economic reactivation, important collective needs and a wish for freedom. His model made it possible, within private healthcare, to organise healthcare with a non-profit making management in which the returns obtained were reinvested in better care, and doctors and users taking part in the entity’s decision-making processes.
SCIAS’ experience has been an inspiration for similar initiatives all over the world and it strengthens the role of cooperativism in the health sector - even more so in 2025, which has been designated as International Year of Cooperatives by the General Assembly of the United Nations.
In short, with this event SCIAS reaffirms its commitment to its social foundations and to the community, underscoring the values of cooperation, solidarity and innovation that have guided its journey over the last 50 years.
initiative is aimed at strengthening the presence of cooperative companies.
The international cooperative movement has taken a decisive step with the creation of the Cooperatives and Mutuals Leadership Circle (CM50), a global network of presidents and executives from cooperative companies promoted by the International Cooperative alliance (ICAA). This forum seeks to strengthen the presence of cooperative companies in the global economy and on the international political agenda, with particular emphasis on its impact during the International Year of Cooperatives 2025 and its participation in the Second World Summit on Social Development of the UN, which will be held in Doha, Qatar, in November, 2025.
The CM50 brings together executives from some of the most influential cooperatives in the world, with a prominent representation from sectors such as insurance, healthcare, banking and finance. In the healthcare area, the Chairman of Assistència Sanitària, Dr, Ignacio Orce and the Chairman of Asisa, Dr. Francisco Ivorra are taking part, bringing their extensive experience in the management of healthcare cooperative models.
At its first meeting, held on the 22nd of January, 2025, 35 leaders from over 20 countries coincided in the urgency of strengthening the visibility of the
cooperative model in a global context marked by economic inequalities and social crises. Jeroen Douglas, Director General of the ICA, emphasised that the CM50 could become the “Davos of the cooperatives.”
Amongst its strategic goals, the CM50 will work on the creation of a letter of commitment and a plan of action, which will be presented at the Doha Summit. These documents will establish the specific lines of action to increase the impact of the cooperatives in key sectors and to guarantee a greater legislative and financial backing by governments.
The Fundación Espriu will host the group in Madrid on the 22nd of May, at a key meeting to finalise the documents that will be presented at the Doha Summit. This meeting will consolidate the action strategies of the CM50 and will reinforce the inter-cooperation.
The CM50’s initiative seeks to show that the cooperative business model is not only feasible, but rather it is necessary to build an economy that is fairer, sustainable and people-orientated. Through inter-cooperation, innovation and leadership, this forum is projected as a relevant agent in the transformation of the global economic system.
In India, where millions of women workers face up to many economic and social obstacles, the cooperative Lok Swasthya emerged as a pioneer model to guarantee their access to healthcare. Founded in 1990, it is the first cooperative in the country exclusively managed by women and it seeks to offer accessible and affordable healthcare services to women workers from the informal economy.
This initiative was established within the SEWA movement (self-employed women’s association), a trade union organisation founded in 1972 in Ahmadabad by the lawyer Ela Bhatt. At that time, in India there were no trade unions for self-employed women, meaning that the registration of SEWA was a milestone. When Bhatt tried to formalise it, the authorities asked her: Who are they going to protest against? Her reply was clear: We have no employer, but we do have many problems to resolve.” With this declaration, she
laid the foundations for a movement that today brings together 3 million women in 18 states around the country.
Within SEWA, health was identified as one of the main vulnerabilities of the workers. Without any access to a social security system, many women had to pay for their medical services out of their own pockets, which generated prohibitive debts. In response, Lok Swasthya was created, a cooperative that operates using a self-management model,
The social economy has become an essential pillar for sustainable development in the European Union. With over 4-3 million entities and a work force that exceeds 11.5 million people, it represents 6.3% of the total employment in the region. Cooperatives, mutual societies, associations and foundations make up this ecosystem that not only generates wealth, but it also strengthens the social cohesion and the generation of stable, quality employment.
The financial impact of the social economy is undeniable. AccordingtothereportBenchmarkingtheSocio-EconomicPerformanceoftheEUsocialEconomy, recently published by the European Commission, the invoicing by the sector reached 912,900 million euros, with France, Italy, Spain and Finland leading its development. Its contribution is not limited to the economic activity, but it has also been shown to be a key element in moments of crisis. During the COVID-19 pandemic, these entities played an essential role in the provision of essential services and support to vulnerable groups, a fact that reaffirms their capacity of adaptation and commitment to social well-being.
Amongst the findings made by the study, the fact that healthcare is one of the sectors of the social economy that has taken on greater relevance. Over 3.3 million people work in health and social care entities linked to
this model, with Spain, France, Germany and Portugal as references in its implementation. Healthcare cooperatives, mutual societies and foundations are essential in the management of hospitals and health centres, offering accessible, quality services. They have also promoted innovation in patient-orientated care models, preventive care and the use of emerging technologies to improve the efficiency of the healthcare system.
The report also underscores the need to improve the visibility and recognition of the social economy within the European Union. Amongst the main recommendations the importance of compiling more data and statistics that reflect its real impact stands out, as well as the development of some regulation frameworks that encourage its growth and sustainability. Digitalisation and innovation must also hold priority positions on the agenda, particularly in essential sectors such as healthcare.
Likewise, the urgency of strengthening the collaboration between entities of the social economy and the public administrations is being proposed to maximize its impact on society.
In a context of economic uncertainty, the social economy is a feasible and necessary alternative. Its capacity to combine business activity with social impact turns it into a key model for the future of Europe.
In the area of health, its role will continue being decisive to guarantee a fair, quality access, which reaffirms the importance of public policies that promote its consolidation and development.
where the women, as well as users, are also owners and managers of the entity.
With head offices in Ahmadabad, a city located around 700 kilometres to the south-west of the capital, New Delhi, Lok Swasthya has developed a network of medical care, including pharmacies that are open 24 hours a day and a production centre of Ayurvedic medicines. Its pharmacies do not only distribute medicines, but they also work as healthcare information points for the community.
The Lok Swasthya model has been
recognised on a national and international level. For 25 years running, its audits by the Indian government have given it an A classification, the highest level of excellence. Its impact has gone beyond its immediate community, inspiring public policies such as the integration of pharmacies in the governmental healthcare services and collaborations with the World Health Organisation in tuberculosis control programmes.
Within the framework of the International Year of Cooperatives, Lok Swasthya is a clear example of how healthcare cooperatives can transform people’s lives.
From the first remedies by healers and botanists from primitive cultures to laboratory synthesis of monoclonal antibodies, pharmacology has experienced a spectacular evolution that has helped to save millions of lives.
By Enric Ros
Scientific advances have meant progression in the designing of increasingly precise drugs, the efficiency of which has been tested in strict clinical analyses. But this was not always the case. There were times gone by when even the most educated citizens showed their reluctance about the products that health professionals dispensed to their patients. In his interesting book Historia de los medicamentos (History of medicines), Alfredo Jácome Roca includes the worlds spoken by the philosopher Voltaire when he found out that one of his nephews wanted to study Medicine: “You wretch! How dare you study an art that consists of administering poisons about which you know nothing to organisms about which you know even less!”
However, the first steps that were taken by the healers from primitive cultures, the botanists, the first doctors and pharmacists or even alchemists were essential to establish the foundations of future scientific research. A good example of this, back in the 17th century was that cinchona bark was used to treat fevers in general and malaria in particular. Finally, in 1820 Joseph Caventou and Pierre Pelletier managed to isolate quinine, a natural alkaloid that was used to treat malaria until it was replaced by other more effective synthetic medicines.
opium poppy or laudanum. The origin of the use of an analgesic, antipyretic and anti-inflammatory as popular as aspirin, in turn, goes back to the times of Ancient Egypt, where they had already discovered the medicinal properties of the white willow bark. But the truth is that it was at the end of the 19th century when acetylsalicylic acid was synthesised, ending up being marketed by the Bayer laboratories.
Another of the most significant steps was the discovery in 1921 of insulin, the hormone that plays a decisive role in the regulation of the glucose levels in the body, by the Canadian scientists Frederick Banting and Charles Best. Thanks to them, currently millions of people can control their diabetes, avoiding many serious complications.
Historically, pain was treated with opiates such as the opium poppy or laudanum and later on, with morphine.
For centuries, pain was treated with morphine, an opiate drug the history of which could be traced back to the
Given that it would be impossible to cover all the milestones that pharmacology has achieved since then in depth, we will limit ourselves to going over some greatly transforming moments. In 1928, Alexander Fleming discovered penicillin, which was used to treat bacterial infections and also for the development of other antibiotics. Almost thirty years later, specifically in 1955, the vaccine against poliomyelitis, developed by Jonas Salk was revealed. This same year, Paracetamol was put on sale in North America, a drug with analgesic and antipyretic properties that would virtually become a part of our daily lives.
For decades, the availability of pharmacological treatments has been limited to certain countries, a situation that has improved considerably thanks to initiatives such as the creation of the WHO’s List of Essential Medicines.
Do you know what it consists of?
For a long time, health treatments have depended, in many societies, on economic means and social class. Today, fortunately, more and more healthcare systems around the world guarantee universal access to the so-called essential medicines
As the World Health Organisation (WHO) informs, these drugs are the ones in charge of treating the priority needs on the subject of the population’s healthcare. For this reason, they must be available, affordable and have a guaranteed quality at all times.
Since 1977, WHO has published, every two years, a list of essential medicines. The first one included around 200 drugs. The last one, published in 2023, includes over 500 (amongst them, 361 for children). The purpose is to orientate countries in their work of preparing and up-dating their respective national lists. At present, 150 countries around the world have this type of document based on the WHO model.
As explained by Fernando Antezana and Xavier Seuba in the essay Medicamentos esenciales. Historia de un desafío (Essential medicines. The History of a challenge), after immunisation and the promotion of healthy habits, the lists of this type of essential drugs have been one of the most effective steps for improving public health. At the same time, this policy based on establishing some criteria about which drugs are essential
is born, partially, as a response to the overabundance of products that we can find on the market, in many cases just different trade names of medicines that are virtually the same.
Be that as it may, the truth is that the number of patented drugs that are on the model list has increased over the years, going from 17 out of a total of 319 (5%) in 2003 to 82 out of a total of 502 (16%) in 2023.
In response to the increasing threat emerging due to resistance to antibiotics, the WHO guide introduced the AWaRe classification (Access, Watch and Reserve), which gives guidance about the empiric use of essential antibiotics for over 30 clinical infections in community and hospital settings. This classification has been the foundation for some wider guidelines regarding the prescription and consumption of antibiotics, which has contributed to optimising their use.
The fight for universality continues
In spite of these advances, several difficulties to access essential drugs still persist. Availability and affordabi-
Scan the QR to consult the WHO’s AWaRE Guide for the use of antibiotics.
lity are some of the most prominent problems. Treatments against cancer and other non-transmissible disease have a high cost that can even bring the health systems themselves into difficulties.
According to data from the Global Health Observatory corresponding to the period of 2010-2019, medicines represent between 20% and 60% of the expenditure in health of developing countries. Almost 90% of this population must acquire them paying their cost, which means they become the main expense of families after food.
In view of this, the WHO recommends introducing or strengthening policies “that reduce the expense from patients’ own pockets on medicines and health technologies.” It also invites policies to be developed that ensure the maintenance of sufficient reserves of essential products, improving structures in the acquisition and the supply chain; a question that is essential particularly in global healthcare crisis situations, such as the one we experienced with the outbreak of the COVID-19 pandemic.
The use of medicines has revolutionised modern medicine, improving the quality of life of millions of people. But mass access to these substances is a double-edged sword.
Medicines have produced extraordinary benefits in our lives. According to Thomas Hager, the author of Ten Drugs: How Plants, Powders and Pills Have Shaped the History of Medicine, around two hundred years ago, life expectancy was approximately half of what it is now. However, they have also generated some risks such as over medication, something that is particularly obvious in the most capitalist societies or where there is a larger pharmaceutical industry. Hager affirms, on this point, that “no country in all the history of mankind has taken as many drugs or has spent so much money to obtain them as the United States at present.”
Self-medication and the habit of fighting the slightest discomfort with some kind of medicine can end up resulting in new health problems. For this reason, last year the Generalitat de Cataluña started up a campaign called Pastillas, solo las necesarias (Pills, just the necessary ones) which informed about the responsible, suitable use of drugs as well-known as Paracetamol. More recently, the same Regional Administration has promoted another informative project to reduce unsuitable use in polymedicated people.
At the same time, the Internet can be a spur for this type of irresponsible behaviour. Ana Ibáñez’s doctorate thesis, published last year at the University of Alicante, warned about the danger of self-medication in digital society, where the risk of over information lives alongside the lack of information. The healthcare education of citizens is, therefore, more necessary than ever, in a setting in which access to drugs and information that should be interpreted by specialists, could become a risk factor.
The society of discomfor
The modern world, with its relentless rhythm of living, has seen the percentages for anxiety and depression increase, along with other mental illnesses.
Consumption of antidepressants has increased by 52% amongst young people between the ages of 20 and 24 years.
Antidepressants, anxiolytics or mood stabilisers can be useful to treat mental disorders. However, their abuse has started to become a global medical problem.
The difficulty in offering an effective solution to complex social questions that distress citizens (and that can act as triggers for possible mental illnesses) mean that a solution is tried to be found using healthcare tools. As Belen Gonzalez, commissioner for Public Health from the Ministry of Health explained last May, “we know, for example, that in our country the diagnosis of schizophrenia is twelve times more frequent in low income families than in families with higher earnings, or that the use of antidepressants is approximately four times higher according to the social class. This does not mean that social problems can be resolved from the consulting rooms of psychologists and psychiatrists. We often identify that a patient really needs a labour lawyer, rather than a psychologist. Faced with the impotence of not being able to do anything and the lack of time to generate a narrative that is more adapted to social problems, they opt for prescribing psychotropic drugs.”
Spain is now the second European country with the highest consumption of anxiolytics, behind Portugal and the fourth in the consumption of antidepressants. The prescriptions for this type of drug have not stopped increasing since registers were first made. This rise is particularly concerning amongst the younger population. Between the ages of 20 to 24 years, the consumption of antidepressants has increased by 52% since 2017 and amongst the group of 25-29 years it has risen by 40.4%. Against this backdrop, the Government has announced a new plan of action, which should come into force this year, to measure the mental suffering derived from work, fighting against suicide and curbing over-prescription.
“Everyone must have access to the same treatment”
The Spanish model of pharmaceutical care is based on equality in access to medicines. For this, a system based on the solidarity of pharmaceutical cooperatives has been established. We talked about their characteristics to Dr. Antonio Mingorance, Chairman of Bidafarma, a social economy healthcare company that groups together twelve cooperatives from different regions.
Dr. Antonio Mingorance
Graduate in Pharmacy, Optics and a specialist in clinical analysis, he is currently the Chairman of Bidafarma and of the Andalusian Board of Official Colleges of Pharmacists (CACOF).
How did the pharmaceutical cooperative model start in Spain?
In this country we have a network of 22,000 pharmacies, which are essential to guarantee equality in access to medicines. To ensure that this was possible, pharmaceutical cooperatives were created and the first one was in Catalonia, which was formed in 1929. This was followed by the cooperative in Seville in 1930 and the one in Granada the next year.
What is the mission of the association you preside over?
Bidafarma is the result of the joining together of twelve cooperatives from different regions that have agreed to create synergies, be efficient and serve patients better. Our model does not seek to make a profit or give out dividends, but to guarantee the service. For this reason, we always reinvest what we earn, with the intention of becoming more efficient. Currently, we provide drugs to around ten thousand pharmacies up to twice a day, based on a supportive model. This allows us to supply villages that have less than 200 inhabitants with the medicines that they need at all times. We are a company that always puts society’s interest before any other motivation. This has been the case since our foundation.
What do pharmacists contribute to society?
We are all clear that without science, there is no future. Research is essential as is the connection with the industry, but we must always be clear that at the end of this entire process are the patient’s needs. Every day around 2.5 million people visit our country’s pharmacies, hoping to find solutions to their health problems. As pharmacists we are in charge of safeguarding the medicines necessary for this and also for providing the correct attention for these citizens. Medicines are a highly complex technology and the pharmacist is the specialist in how to handle them.
What services can the pharmacist provide us with?
I always say that it is very important to make a rational use of drugs and also a “rational use” of the pharmacist as a person. We must be capable of visiting these trained professionals who will listen to us and give us good advice whenever necessary. Their work has an
unquestionable social and humanitarian value. Often, the pharmacists end up providing support to people who are experiencing difficult situations such as loneliness or who suffer from serious problems, such as gender-based violence, who need a first orientation about what to do or where to go. Doctors and pharmacists share the same table of values. This became particularly obvious during the COVID-19 pandemic. During this time, pharmacists collaborated intensely whenever we could, distributing vaccines and face masks completely free of charge. We are also particularly satisfied about having reached achievements such as the electronic prescription, which have allowed us to be able to dispense medicines in these difficult moments, without the patient having to visit their health centre.
What is your opinion of the Spanish health system?
The pharmacists are firmly committed to our health system. We believe that it is worth looking after it, cos-
“Currently we provide drugs for around ten thousand pharmacies up to twice a day”
seting it and defending it. We have the conviction that cooperatives are a good way of doing this, but we must also make sure that all the professionals, particularly those who are in small towns are able to move forward using this system.
How has pharmacology changed in recent years?
Pharmacology and medicine have experienced a revolution in many aspects, such as genetic modification therapies or the new ways of fighting illnesses such as obesity, diabetes, strokes, cholesterol, etc. This has an unavoidable repercussion on the sustainability of the health systems. At the same time, we cannot give up a very important aspect: all people must have access to the same treatment, regardless of their social and economic position. The universality in the treatments that guarantee our health is essential because we can all become ill at some point in our lives. This is the essence of our work.
This
attractive enclave on the coast
of the Sea of Japan contains several districts from the Edo period that conserve all their historical charm.
By Neus Duran
Although most of the areas with working Geishas are located in Kyoto, they are also present in other regions of Japan. One of these is the historic city of Kanazawa, an attractive enclave on the coast of the Sea of Japan that has seen its popularity shoot up in recent years thanks to the arrival of the bullet train, which connects it to Tokyo in just two and a half hours. The city, located in the prefecture of Ishikawa, has three different Geisha districts: Hagashi Chaya, Nishi Chaya and Kazuemachi. In the Edo period (1603-1868), all of them contained a large number of tea houses in which the “butterflies of the night” entertained the merchants and nobles.
Currently they maintain the aesthetics and ambience of those times: streets flanked by tea houses with wooden trellises on the façades and little porches jutting out from the second floors where the guest rooms are located, with tatami mats and exquisite decoration. In Higashi Chaya you can, for example, visit the Kaikaro tea house, which is over two hundred years old, and have a matcha green tea. But only during the day: it is not open to tourists at night-time, because it hosts banquets with Geishas. Very popular amongst international visitors is the Shima tea house, converted into a thematic museum over one of the most refined rooms in the ‘neighbour-
Higashi Chaya is the most important Geisha district in Kanazawa. The other, smaller ones are Nishi Chaya and Kazeumachi.
From November to March, Japanese people from all over the country come to Kanazawa to enjoy the unique flavour of the snow crabs.
hood of pleasure’. Today however, most of the old tea houses have become restaurants, cafes or small shops where you can acquire all kinds of articles (–even ice creams!), decorated with gold leaf, a historic tradition in this town. The craftsmen may also be observed working with this material, or you can take part in one of their workshops.
The ancient Samurai district of Nagamachi also dates back to the Edo period, maintaining all its historical charm with its narrow streets, winding canals and
many bukeyashiki (traditional Samurai residences), perfectly conserved and protected by stone walls. Some of them, such as the Namura house or the ancient home of the Takada family are open to the public and allow visitors to understand how these mythical warriors lived.
Very close to the Samurai district are the Kenrokuen gardens, considered to be some of the most beautiful gardens in Japan. In order to make the experience more unique, it is possible to hire a kimono in some of the nearby specialised businesses and walk through the park dressed in it. Those who are fascinated by these eye-catching garments can also visit the Kaga Yuzen Kimono Centre, a stone’s throw from the gardens, to carry out a technical dyeing course or observe how the skilful craftsmen paint kimonos following traditional techniques.
Essential visits in the area include the Kanazawa castle, with its imposing walls and moats and the Oyama Jinja sanctuary, with a history going back over three hundred years and considered to be the city’s protector. The neighbouring district of Katamachi should also not be missed, a charming network of alleyways – the most famous one being Chuo Mishokugai, full of tiny bars of the izakaya type, which
Very close to the Samurai district are the Kenrokuen gardens, considered to be some of the most beautiful ones in Japan.
are usually frequented by the Japanese after work. If we wish to enjoy the gastronomy along with the locals, we must also visit the Omicho market, which since 1721 has provided the city’s inhabitants with fresh produce. Some of the stands have tables where you can sit and sample the grilled meat, fish or seafood. From November to March, many Japanese people travel to Kanazawa to enjoy the flavour of the snow crabs, a coveted crustacean that is obtained along the nearby coasts o f the Sea of Japan.
Another local star product is the sake. The Ishikawa prefecture is famous for having both crystal clear water and high quality rice, meaning that the sake that is prepared there is highly renowned all over Japan. In addition to the many bars that offer tastings of the endless varieties of this drink, distilleries may be visited, such as the Koganei, a historical factory where this liqueur has been produced for over two hundred years.
Those with a sweet-tooth will not be able to resist trying the Japanese sweets (wagashi) , prepared with rice, red beans and sugar, as along with Kyoto and Matsue, Kanazawa is considered to be one of the best destinations to try them, owing to its long tradition of the tea ceremony. A real temptation to which more than one person will happily surrender.
Torre Loizaga is a spectacular, reconstructed medieval castle, surrounded by nature, which houses the most important Rolls-Royce collection in Europe.
By Enric Ros
Visitors can travel through beautiful countryside, surrounded by mountains, until they come to a halt in the district of Galdames, in the province of Vizcaya. There, suddenly an important tower, whose origins date back to the 14th century rises before them. But it holds another surprise: inside, we find the truly impressive Museum of Classic and Old Cars, which has the most complete collection of Rolls-Royce cars on the European continent.
As María López-Tapia de la Vía the person in charge of Communications for Torre Loizaga and niece of its founder states, “this was my uncle’s great dream, his particular fantasy.” Miguel de la Vía, a businessman and collector from Galdames, proposed restoring this ancient defensive stronghold belonging to the Ochoa García de Loyzaga lineage, which at that time had become a ruin.
Del a Vía “started to rebuild the tower in 1985, virtually from scratch,” according to López-Tapia. For decades he continued with this herculean task: “An artisanal labour that led him first to build the four walls and then to build a terrace over the ceiling of the rooms. His idea was to recreate a castle, which is why he added a moat and the ramparts.”
“From his early childhood, De la Vía was a car enthusiast. His business went well. This allowed him “to buy his first Silver Shadow Rolls-Royce. He then acquired a second one, a Silver Cloud. With the third, he decided to make the complete collection of the
Torre Loizaga is one of only three places in the world housing the complete series of the Phantom models
vehicles produced under the British brand name,” López-Tapia explains. The jewel of the crown was obtaining the six models of the Phantom series, the brand’s most iconic series, which were only produced until 1972. Today, there are only three places in the world where this complete series can be seen and Torre Loizaga is one of them.
The tour through the museum’s six halls allows visitors to enjoy some of the great jewels of the car industry. At the same time, it offers an extensive selection showing the evolution in the design of these cars, passing through almost one hundred years of history, from the oldest model, the 1910 Silver Ghost, to a Silver Spur from the nineteen nineties.
The 45 units that make up the Rolls-Royce collection are complemented with around thirty American and European vehicles that show the technological advances and the impact that cars have had on culture
and society over the last two centuries. Therefore, as an example, in the first room, nick-named “The Veterans”, we can find the models that competed with Rolls-Royce, such as the Italian Isotta Fraschini, the French Delaunay Belleville and the Spanish Hispano-Suiza. And in the second room, we can find other gems such as a Mercedes 190 SL, a BMW 635 CSI, a Lancia Aprilia or a Porsche 911, which live alongside an imposing Merryweather fire engine from 1939.
Since the year 2000, the museum may be visited on Sundays without booking and the rest of the week on request. Additionally, Torre Loizaga, with its beautiful natural surroundings, medieval architecture, extensive gardens filled with 100-year-old olive trees and its interior rooms, which cover over 1,500 m2 , is the ideal setting for holding weddings, gala dinners and other events. This was confirmed by the inauguration dinner of the Guggenheim museum which was held here in 1997, the spectacular great Indian
The Torre Loizaga museum covers almost one hundred years of history of the automobile, with 45 Rolls-Royce cars and 30 American and European vehicles.
wedding in 2015 or the High Motors Show, which takes place every year.
López-Tapia is very clear that Torre Loizaga is much more than a collection of unique cars. “The county of Las Encartaciones is probably the least known in Vizcaya. Everyone who visits us is surprised that such an incredible place as this is located in the middle of the countryside and just thirty kilometres from Bilbao.”
Today, Torre Loizaga is unanimously renowned as one of the treasures of Basque cultural heritage. Here, the medieval legacy merges with the great symbols of mechanics and progress, managing to make nature, architecture and technology live together in harmony. And all of this thanks to the inspiration of a visionary who knew how to envisage the potential that the ruins had to become a majestic architectonic complex that houses a collection of classic cars to which he devoted his whole life.
The Holy Week festivities are accompanied by a culinary heritage that has lasted for centuries: simple, traditional recipes that merge their symbolism with modernity.
By Gal·la Torres Munté
With the arrival of the month of April, it is time to bring out the typical recipe book for this period: Holy Week is about to arrive. The festivity is not only a Christian celebration of faith and devotion; it is also accompanied by a feast of culinary traditions that have lasted for centuries until the present day.
Although it is a period for reflection and taking up decisions, marked by solemnity and abstention, it also celebrates gastronomic pleasure though its typical dishes and recipes, which still form part of the culinary heritage of many regions. For this reason, gastronomy takes on a highly revenant place at this time, characterised by recipes that generally exclude meat, as dictated by the religious precepts. Fish, vegetables and other products such as eggs, milk and honey take on leading roles in its place.
Holy Week has given rise to a cuisine full of symbolism, where each dish reflects the history and identity of the different areas. With a simple, family-orientated and authentic recipe book, it manages to merge tradition with the new culinary creations and trends. From succulent stews to delicious sweets, these are some of the flavours that make up the typical menu for celebrations that are on the way.
You can’t have Holy Week without a legume stew. In a restaurant or at your grandmother’s house, vigil chickpea stew is the best example for this period. It is a broth that dates back to medieval times containing chickpeas and cod, without forgetting the traditional touches of hard-boiled egg and spinach. It is usually served on Fridays in Lent and its name comes from the dates that are commonly known as vigilias(vigils), alluding to the Catholic practice of abstaining from eating meat.
Any festival menu must start with a good aperitif to whet the appetite. Marinated dogfish is a classic tapa from Andalusian cuisine which pays tribute to its common name: bienmesabe (tasting good to me). This homemade delight is made from dogfish, a member of the shark family. It is relatively easy to prepare, requiring few ingredients and the dogfish only needs to be marinated, chopped and fried. The result is a fish that is golden on the outside and very juicy on the inside.
With a crunchy texture on the outside and creamy inside, cod croquettes are the perfect morsel to accompany the celebrations, following the tradition of making the most of the cod, an essential ingredient in the cuisine for these dates. With a quality product, an exquisite, versatile dish is obtained, and one of the most important foods on the table.
If one dish characterises Holy Week it must be its typical desserts. One of the stars is the torrija, or bread soaked in milk, which in times gone by was eaten to use up the bread left over during the days of abstinence. Today, there is a wide range of possibilities for preparing this succulent bread, going from the more traditional preparations to modern, original versions. It commonly contains cinnamon, but torrijas of custard, chocolate, coffee, vanilla, as well as vegan versions may also be found.
Another classic representative of these festivities is Castellana or garlic soup, an authentic, simple recipe. It is made using stale bread, garlic, paprika and egg and it is the speciality of the Community of Castilla y Leon. It is a clear example of the cooking that uses up all the leftovers that is characteristic of Lent and in some establishments it is still served in clay bowls, as the tradition demands.
Traditionally, this spongy sweet was made using a sweet brioche dough, crowned with hardboiled eggs and other ingredients used in traditional Holy Week cuisine. Over the years, the eggs have changed and have become made from chocolate, and along with coloured feathers and felt chicks, they have become the essence of this tradition. They are usually eaten at a family meal on Easter Sunday and Monday, representing the end of Lent and abstinence. As with torrijas, there is a wide variety of Easter Monas, from very large chocolate eggs to an endless amount of creations made in the shape of cartoon characters, houses, boats or animals.
These body movements are mainly involuntary responses of the organism to some kind of stimulus, and they are essentially for our survival. The main characteristic of them is that we cannot completely control them; that is to say, we cannot stop them or avoid them voluntarily. But, what function do they have and why can’t we avoid them?
In the case of coughing, it is a protective reflex that helps to clear the airways when they detect mucus or strange bodies. It is unleashed through some sensors that send signals to the respiratory centre, located in the brain stem, which coordinates a response divided into two phases: closing the airways through inhaling and expelling the irritating agents with a sudden expulsion of air.
Sneezing follows a similar process to coughing, with the difference that, when detecting the irritating agents in the upper part of the airways, the sensors send signals to the brain, causing the violent expulsion of air through the nose and mouth. .
Along the same lines, we can also find the reflex action of scratching ourselves, which can be caused by ex-
ternal stimuli (such as for example, insect bites) or internal conditions (such as allergies or skin diseases). Scratching is the result of a motor response that seeks to eliminate the strange agent or to interfere in the signal being sent by the nervous system regarding the itch.
Hiccoughs , another common involuntary reflex that happens when the diaphragm contracts suddenly and repetitively, causes the response of a fast inhalation of air followed by the abrupt closing of the vocal chords, originating in the typical sound of this movement. Its causes vary greatly: ranging from having ingested something too fast, to a response to stressful situations or sudden emotional excitement that alters the nervous control of the diaphragm.
Finally, yawning is the least known of these stimuli. Unlike all the previous ones, it is not related to the expulsion of irritating agents. Its exact function is unknown, although there are several theories related to the regulation of the brain temperature, oxygenation or even the adaptation of an animal physiological response that transmits the need for activity or preparation for a change of state.
With this fiction-free novel, Javier Cercas returns to his most personal line, in which he manages to tackle the role of the spiritual and transcendental side in human life, the place religion holds in it and the craving for immortality. This is also the first time that the Vatican has opened its doors wide to a writer.
EllocodeDiosenelfindelmundo.Javier Cercas. Random House
Primera memoria (Firstmemory) narrates the story of the passage from childhood to youth of Matia and her cousin Borja. A melancholic elegy of the perversion of innocence, with the Civil War as its backdrop. This novel, which was awarded the 1959 Nadal Prize, is without any doubt, one of Ana María Matute’s best works.
Primeramemoria. Ana María Matute. Austral
For many years Haruki Murakami ran a jazz club, called Peter Cat, before devoting his time completely to writing. The Japanese writer’s passion for jazz led him, without any doubt, to write this book composed of fifty five portraits of musicians, accompanied by an illustration by the Japanese artist, Makoto Wada.
PortraitinJazz. Haruki Murayami y Makoto Wada. Verve books
An engineering student reaches the local sanatorium in search of a cure for his tuberculosis, where he coincides with other patients from all over Europe. In the evenings, while slightly intoxicated with alcohol, the guests talk about divinity and humanity. And meanwhile, in this idyllic setting troubling things start to happen.
TheEmpusium. Olga Tokarczuk. Riverhead Books
