Government of Catalonia

COPD is a heterogeneous condition characterised by persistent, poorly reversible airflow obstruction. While some patients experience accelerated decline in forced expiratory volume in 1 s (FEV1), others remain stable. We hypothesised that unsupervised analysis of chest computed tomography (CT) scans using machine learning-derived radiomic features may identify endophenotypes associated with distinct clinical and biological characteristics and FEV1 decline trajectories. We analysed 101 radiomic features from 1759 chest CT scans of COPD patients in the ECLIPSE study. Unsupervised consensus clustering identified six mutually exclusive radiomic clusters, and we derived six corresponding average patient score clusters (APSC1-6). Random coefficient models assessed associations between each APSC and baseline clinical characteristics, FEV1 and its 3-year change, adjusting for relevant covariates. Associations with baseline gene expression in sputum and blood were also evaluated. Radiomic scores were associated with multiple baseline clinical features. Higher APSC2 (-5.3 mL·year-1; 95% CI -9.5- -1.0; p=0.01) and APSC6 (-5.5 mL·year-1; 95% CI -9.6- -1.3; p=0.01) predicted greater FEV1 decline, whereas higher APSC3 was associated with slower decline (+5.2 mL·year-1; 95% CI 0.8-9.6; p=0.02). APSC6 was associated with increased sputum expression of genes enriched in respiratory infection pathways, relevant COPD loci such as TRIM38 and IFIT3, and higher blood neutrophil counts. Unsupervised CT radiomic analysis identifies distinct COPD endophenotypes associated with variability in FEV1 decline and biological markers, supporting potential stratified treatment.

BackgroundDigital health technologies promise to democratize health care access yet often exacerbate existing inequalities when developed through traditional top-down approaches that prioritize technology implementation and exclude end users from design processes. The COVID-19 pandemic accelerated digital transformation while simultaneously exposing how technology can both bridge and widen gaps in health care access. Understanding how to systematically integrate equity considerations into digital health transformation across entire health systems has become increasingly urgent.ObjectiveThis study aims to cocreate actionable design principles for equitable digital health transformation through a large-scale participatory human-centered design (PHCD) process involving diverse stakeholders across Catalonia’s health care ecosystem (northeast Spain), with the aim of establishing guidelines for information systems that support a person-centered, integrated, and longitudinal care delivery model.MethodsWe conducted a qualitative PHCD research study involving 265 participants representing diverse stakeholder groups: citizens and informal caregivers (n=106), health care professionals (n=83), health care managers and leaders (n=50), and experts representing various domains of digital health innovation (n=26). Through two sequential rounds of participation between June 2024 and April 2025, we used design thinking methodologies and cocreation tools in 24 sessions across Catalan geography and 7 topic-specific expert sessions. Data collection used innovative visual tools, including journey mapping, care model animations, future scenario storyboarding, and facilitated ideation techniques. Analysis followed an inductive-deductive approach combining affinity mapping, thematic synthesis, and participant validation to transform stakeholder proposals into actionable design principles.ResultsParticipants identified critical barriers to digital health equity, including digital literacy gaps, fragmented information systems, a lack of user involvement in design, and insufficient consideration of vulnerable populations' needs. The cocreation process yielded 10 fundamental principles: (1) the person and their care circle at the center, (2) health for everyone, everywhere, (3) tools for more compassionate care, (4) a better professional experience, (5) an active role of the population, (6) personalized and proactive care, (7) systematic use of data for decision-making, (8) integrated quality data working for health, (9) an information system that builds trust, and (10) collaboration as a driver of innovation.ConclusionsThis study shows how large-scale, rigorously conducted PHCD can uncover and address equity barriers in health information systems. Beyond producing 10 actionable design principles, it highlights how engaging diverse stakeholders can turn complex inequities into practical guidance for equitable digital transformation. The resulting principles provide a framework for creating person-centered systems that are robust, inclusive, and accessible to all, while underscoring the need for enduring partnerships among public institutions, researchers, design experts, and communities as a foundation for sustainable and equitable digital health innovation.

Personal stigma in psychosis, encompassing perceived and internalised stigma, poses a significant barrier to recovery and well-being. This study investigates the effectiveness of Individualised Metacognitive Training (MCT+) in reducing personal stigma among individuals with recent-onset psychosis, with a focus on sex-specific outcomes and the predictive roles of self-certainty, self-esteem and quality of life (QoL). A randomised controlled trial was conducted across multiple Spanish clinical sites, comparing MCT+ with treatment as usual. Participants were assessed at baseline, post-treatment and 6-month follow-up using validated measures of stigma, cognitive insight, QoL and self-esteem. Robust linear mixed models revealed that MCT+ significantly reduced perceived stigma over time, with QoL emerging as a strong predictor of perceived stigma levels. However, no significant effects were observed for internalised stigma, although self-certainty was positively associated with its severity. Exploratory analyses suggested potential sex differences in stigma trajectories, with males showing greater improvements in internalised stigma. These findings highlight the nuanced impact of metacognitive interventions on stigma and underscore the importance of tailoring treatments to individual psychosocial and cognitive profiles. Future research should explore gender-sensitive adaptations of MCT+ and the inclusion of targeted self-stigma modules to enhance intervention efficacy.

Abstract The spread of invasive mosquitoes Aedes albopictus, Aedes aegypti and Aedes japonicus in Spain represents an increasing public health risk due to their capacity to transmit arboviruses such as dengue, Zika and chikungunya among others. Traditional field entomological surveillance remains essential for tracking their spread, but it faces limitations in terms of cost, scalability and labor intensity. Since 2014, the Mosquito Alert citizen science project has enabled public participation in the surveillance through the submission of geolocated images via a mobile app, which are identified using AI in combination to expert validation. While field surveillance provides high accuracy, citizen science offers low-cost, large-scale real-time data collection aligned to open data managment principles. It is particularly useful for detecting long-distance dispersal events and has contributed up to one-third of the municipal detections of invasive mosquito species since 2014. This study assesses the value of integrating both surveillance systems to capitalize on their complementary strengths while compensating weaknesses in the areas of taxonomic accuracy, scalability, spatial detection patterns, data curation and validation systems, geographic precision, interoperability and real-time output. We present the listing of municipal detections of these species from 2004 to 2024, integrating data from both sources. Spain’s integrated approach demonstrates a pioneering model for cost-effective, scalable vector surveillance tailored to the dynamics of invasive species and emerging epidemiological threats. Simple Summary Spain, with its diverse ecological and climatic landscapes, represents a key area for the introduction and establishment of invasive mosquito species, posing threats to public health due to their capacity to transmit human diseases. Field entomological surveillance conducted by experts remains the primary tool for tracking their spread, though it is limited by geographical scales and cost factors. Advances in smartphone technology allows citizen science strategies of data collection such as submitting mosquito photos via the Mosquito Alert app. This type of information is of a different nature from the field sampling and still needs expert interpretation, but offers significantly broader and faster geographical coverage. Two decades have passed since the first detection of the Asian tiger mosquito in Spain in 2004, and following the Mosquito Alert creation in 2014, citizen science has contributed with one-third of the 1,807 new discoveries of this species at the municipal level in Spain. We discuss integration of both approaches in order to harness their respective strengths while compensating their drawbacks, to develop faster and more powerful early warning surveillance systems, and also returning value to the society by empowering citizenship.

Horses have inhabited Iberia (present-day Spain and Portugal) since the Middle Pleistocene, shaping a complex history in the region. Iberia has been proposed as a potential domestication centre and is renowned for producing world-class bloodlines. Here, we generate genome-wide sequence data from 87 ancient horse specimens (median coverage = 0.97X) from Iberia and the broader Mediterranean to reconstruct their genetic history over the last ~26,000 years. Here, we report that wild horses of the divergent IBE lineage inhabited Iberia from the Late Pleistocene, while domesticated DOM2 horses, native from the Pontic-Caspian steppes, already arrived ~1850 BCE. Admixture dating suggests breeding practices involving continued wild restocking until at least ~350 BCE, with IBE disappearing shortly after. Patterns of genetic affinity highlight the far-reaching influence of Iberian bloodlines across Europe and north Africa during the Iron Age and Antiquity, with continued impact extending thereafter, particularly during the colonization of the Americas.