Surviving in a multistressor world: Gene expression changes in earthworms exposed to heat, desiccation, and chemicals.

An investigation of the effects of anthropogenic stress on terrestrial ecosystems is urgently needed. In this work, we explored how exposure to heat, desiccation, and chemical stress alters the expression of genes that encode heat shock proteins (HSPs), an enzyme that responds to oxidative stress (CAT), hypoxia-related proteins (HIF1 and HYOU), and a DNA repair-related protein (PARP1) in the earthworm Eisenia fetida. Exposure to heat (31°C) for 24 h upregulated HSPs and hypoxia-related genes, suggesting possible acquired thermotolerance. Desiccation showed a similar expression profile; however, the HSP response was activated to a lesser extent. Heat and desiccation activated the small HSP at 24 h, suggesting that they may play a role in adaptation. Simultaneous exposure to endosulfan and temperature for 7 h upregulated all of the evaluated genes, implicating a coordinated response involving multiple biological processes to ensure survival and acclimation. These results highlight the relevance of multistress analysis in terrestrial invertebrates.

Prognostic factors of progressive fibrotic hypersensitivity pneumonitis: a large, retrospective, multicentre, observational cohort study.

Background: Fibrotic hypersensitivity pneumonitis (fHP) is an immune-mediated interstitial lung disease caused by sensitisation to chronic allergen inhalation. This study aimed to determine prognostic indicators of progression and mortality in fHP. Methods: This was a retrospective, multicentre, observational, cross-sectional cohort study of consecutive patients diagnosed with fHP from 1 January 2012 to 31 December 2021. Multivariate Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals for predictors of progression and survival. Results: A total of 403 patients were diagnosed with fHP: median (interquartile range) age 66.5 (14.0) years, 51.9% females and 55.1% never-smokers. The cause of fHP was mainly fungal (39.7%) or avian (41.4%). Lung biopsy was performed in 269 cases (66.7%). In the whole cohort the variables that were related to mortality or lung transplant were older age (HR 1.08; p<0.001), percentage predicted forced vital capacity (HR 0.96; p=0.001), lymphocytosis in bronchoalveolar lavage (BAL) (HR 0.93; p=0.001), presence of acute exacerbation during follow-up (HR 3.04; p=0.001) and GAP (gender, age and lung physiology) index (HR 1.96; p<0.01). In the group of biopsied patients, the presence of fibroblastic foci at biopsy (HR 8.39; p<0.001) stands out in multivariate Cox regression analyses as a highly significant predictor for increased mortality or lung transplant. GAP index (HR 1.26; p=0.009), lymphocytosis in BAL (HR 0.97; p=0.018) and age (HR 1.03; p=0.018) are also predictors of progression. Conclusions: The study identified several prognostic factors for progression and/or survival in fHP. The presence of fibroblastic foci at biopsy was a consistent predictor for increased mortality and the presence of lymphocytosis in BAL was inversely related to mortality.

What can we learn from general practitioners who left Spain? A mixed methods international study.

BACKGROUND: International mobility of health workforce affects the performance of health systems and has major relevance in human resources for health policy and planning. To date, there has been little research exploring the reasons why general practitioners (GPs) migrate. This mixed methods study aimed to investigate the reasons why Spain-trained GPs migrate and develop GP retention and recruitment health policy recommendations relevant to Spanish primary care. METHODS: The study followed an explanatory sequential mixed methods study design combining surveys with semi-structured interviews and focus groups with GPs who qualified in Spain and were living overseas at the time of the study. The survey data examined the reasons why GPs left Spain and their intention to return and were analysed using quantitative methods. The transcripts from interviews and focus groups centred on GPs' insights to enhance retention and recruitment in Spain and were analysed thematically. RESULTS: The survey had 158 respondents with an estimated 25.4% response rate. Insufficient salary (75.3%), job insecurity and temporality (67.7%), excessive workload (67.7%), poor primary care governance (55.7%), lack of flexibility in the workplace (43.7%) and personal circumstances (43.7%) were the main reasons for leaving Spain. Almost half of the respondents (48.7%) would consider returning to Spanish general practice if their working conditions improved. Interviews and focus groups with respondents (n = 24) pointed towards the need to improve the quality of employment contracts, working conditions, opportunities for professional development, and governance in primary care for effective retention and recruitment. CONCLUSION: Efforts to improve GP retention and recruitment in Spain should focus on salary, job security, flexibility, protected workload, professional development, and governance. We draw ten GP retention and recruitment recommendations expected to inform urgent policy action to tackle existing and predicted GP shortages in Spanish primary care.

Perturbed development of calb2b expressing dI6 interneurons and motor neurons underlies locomotor defects observed in calretinin knock-down zebrafish larvae.

Calcium binding proteins are essential for neural development and cellular activity. Calretinin, encoded by calb2a and calb2b, plays a role during early zebrafish development and has been proposed as a marker for distinct neuronal populations within the locomotor network. We generated a calb2b:hs:eGFP transgenic reporter line to characterize calretinin expressing cells in the developing spinal cord and describe morphological and behavioral defects in calretinin knock-down larvae. eGFP was detected in primary and secondary motor neurons, as well as in dI6 and V0v interneurons. Knock-down of calretinin lead to disturbed development of motor neurons and dI6 interneurons, revealing a crucial role during early development of the locomotor network. Primary motor neurons showed delayed axon outgrowth and the distinct inhibitory CoLo neurons, originating from the dI6 lineage, were absent. These observations explain the locomotor defects we observed in calretinin knock-down animals where the velocity, acceleration and coordination were affected during escapes. Altogether, our analysis suggests an essential role for calretinin during the development of the circuits regulating escape responses and fast movements within the locomotor network.

Environmentally Relevant Concentrations of the Insecticide Fipronil Modulated Molecular Response in Chironomus riparius.

Pesticides employed worldwide for crop protection easily reach aquatic systems, which act as the main reservoirs, and become a risk factor for aquatic fauna. Fipronil is a broad-spectrum insecticide acting on the insect nervous system; however, other effects and systems unrelated to this mechanism could be affected in non-target organisms. Thus, the present study aimed to assess the impact of fipronil on the suborganismal response (gene expression and enzymatic activity) of Chironomus riparius larvae as a model organism in ecotoxicology. To this end, short-term toxicity tests were carried out with fourth-instar larvae exposed to 0.001, 0.01, and 0.1 µg L-1 of fipronil for 24 and 96 h. Messenger RNA levels of 42 genes related to diverse metabolic pathways were analyzed by real-time polymerase chain reaction, complemented with catalase (CAT), glutathione S-transferase (GST), and acetylcholinesterase (AChE) activities. Few effects were observed at 24 h; however, after longer exposure (96 h), genes involved in the endocrine, detoxification, stress, and immune response pathways were altered. Moreover, fipronil at 96 h increased CAT and GST activity at 0.01 µg L-1 and AChE at the highest concentrations. The results demonstrate that even low environmentally relevant fipronil concentrations can modulate the molecular response of several cellular pathways in C. riparius after short-term exposure. These results bring new information about the underlying response of fipronil and its mode of action on a key aquatic invertebrate. Despite no effects on mortality, strong modulation at the suborganismal level emphasizes the advantage of biomarkers as early damage responses and the harmful impact of this pesticide on freshwater organisms. Environ Toxicol Chem 2024;43:405-417. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

History of exposure to copper influences transgenerational gene expression responses in Daphnia magna.

The establishment of transgenerational effects following chemical exposure is a powerful phenomenon, capable of modulating ecosystem health beyond exposure periods. This study assessed the transgenerational effects occurring due to copper exposure in the invertebrate D. magna at the transcriptional level, while evaluating the role of exposure history on such responses. Thus, daphnids acclimated for several generations in a copper vs. clean medium were then exposed for one generation (F0) to this metal, and monitored for the following non-exposed generations (F1, F2 and F3). Organisms differing in exposure histories showed remarkably different transcriptional profiles at the F0, with naïve organisms being more profoundly affected. These trends were confirmed for F3 treatments, which presented different transcriptional patterns for genes involved in detoxification, oxidative stress, DNA damage repair, circadian clock functioning and epigenetic regulation. Furthermore, regardless of exposure history, a great number of histone modifier genes were always found transcriptionally altered, thus suggesting the involvement of histone modifications in the response of Daphnia to metal exposure. Lastly, remarkably distinct transgenerational transcriptional responses were found between naïve and non-naïve organisms, thereby highlighting the influence of exposure history on gene expression and confirming the capacity of metals to determine transgenerational transcriptional effects across non-exposed generations.

[Highlights 56th SEPAR Congress]. / Highlights del 56° Congreso SEPAR.

The Spanish Society of Pneumology and Thoracic Surgery (SEPAR) has held its 56th congress in Granada from 8 to 10 June 2023. The SEPAR congress has established itself as the leading scientific meeting for specialists in medicine and respiratory care, reaching a record of participation this year with 2600 attendees. Our society thus demonstrates its leadership in the management of respiratory diseases, as well as its growth and progress in order to achieve excellence. In this review, we offer a summary of some notable issues addressed in six selected areas of interest: chronic obstructive pulmonary disease (COPD), asthma, interstitial lung diseases (ILDs), tuberculosis and respiratory infections, pulmonary circulation, and respiratory nursing.

Blind classification of e-scooter trips according to their relationship with public transport.

E-scooter services have multiplied worldwide as a form of urban transport. Their use has grown so quickly that policymakers and researchers still need to understand their interrelation with other transport modes. At present, e-scooter services are primarily seen as a first-and-last-mile solution for public transport. However, we demonstrate that 50% of e-scooter trips are either substituting it or covering areas with little public transportation infrastructure. To this end, we have developed a novel data-driven methodology that autonomously classifies e-scooter trips according to their relation to public transit. Instead of predefined design criteria, the blind nature of our approach extracts the city's intrinsic parameters from real data. We applied this methodology to Rome (Italy), and our findings reveal that e-scooters provide specific mobility solutions in areas with particular needs. Thus, we believe that the proposed methodology will contribute to the understanding of e-scooter services as part of shared urban mobility.

Prevention of neurotoxicity and cognitive impairment induced by zinc nanoparticles by oral administration of saffron extract.

The accumulation of relatively higher dose of zinc oxide nanoparticles in brain was reported to produce neurotoxicity. Indeed, nanoparticles have a high ability to penetrate biological membranes and be uptaken by cells, which may cause cell disorders and physiological dysfunctions. The aim of the current study was to evaluate, whether oral administration of saffron extract, in rats, can protect from neurotoxicity and behavioural disturbances induced by chronic administration of ZnO-NPs. Daily oral administration of ZnO-NPs was performed for 21 consecutive days to induce oxidative stress-like situation. Then after the saffron extract was concomitantly administrated in several rat groups to overcome the nanotoxicological effect induced by ZnO-NPs. In the frontal cortex, the hippocampus and the cerebellum, ZnO-NPs induced a H2 O2 -oxydative stress-like effect reflected in reduced enzymatic activities of catalase, superoxide dismutase and glutathione S-transferase, and decreased acetylcholinesterase activity. In addition, increased levels of proinflammatory interleukins IL-6 and IL-1-⍺ occurred in the hippocampus, reveal the existence of brain inflammation. The concomitant administration of saffron extract to animals exposed to ZnO-NPs prevented the enhanced anxiety-related to the behaviour in the elevated plus-maze test, the open field test and preserved spatial learning abilities in the Morris water maze. Moreover, animals exposed to ZnO-NPs and saffron showed abnormal activity of several antioxidant enzymes as well as acetylcholinesterase activity, an effect that may underly the preserved anxiety-like behaviour and spatial learning abilities observed in these animals. Saffron extract has a potential beneficial therapeutic effect: antioxidant, anti-inflammatory and neuroprotective agent.

Blockchain-Based Supply Chain Systems, Interoperability Model in a Pharmaceutical Case Study.

The main purpose of supply chain systems based on blockchain technology is to take advantage of technology innovations to ensure that a tracked asset's audit trail is immutable. However, the challenge lies in tracking the asset among different blockchain-based supply chain systems. The model proposed in this paper has been designed to overcome the identified challenges. Specifically, the proposed model enables: (1) the asset to be tracked among different blockchain-based supply-chain systems; (2) the tracked asset's supply chain to be cryptographically verified; (3) a tracked asset to be defined in a standardized format; and (4) a tracked asset to be described with several different standardized formats. Thus, the model provides a great advantage in terms of interoperability between different blockchain-driven supply chains over other models in the literature, which will need to replicate the information in each blockchain platform they operate with, while giving flexibility to the platforms that make use of it and maintain the scalability of those logistic platforms. This work aims to examine the application of the proposed model from an operational point of view, in a scenario within the pharmaceutical sector.

Low-Cost Pseudo-Anthropomorphic PVA-C and Cellulose Lung Phantom for Ultrasound-Guided Interventions.

A low-cost custom-made pseudo-anthropomorphic lung phantom, offering a model for ultrasound-guided interventions, is presented. The phantom is a rectangular solidstructure fabricated with polyvinyl alcohol cryogel (PVA-C) and cellulose to mimic the healthy parenchyma. The pathologies of interest were embedded as inclusions containing gaseous, liquid, or solid materials. The ribs were 3D-printed using polyethylene terephthalate, and the pleura was made of a bidimensional reticle based on PVA-C. The healthy and pathological tissues were mimicked to display acoustic and echoic properties similar to that of soft tissues. Theflexible fabrication process facilitated the modification of the physical and acoustic properties of the phantom. The phantom's manufacture offers flexibility regarding the number, shape, location, and composition of the inclusions and the insertion of ribs and pleura. In-plane and out-of-plane needle insertions, fine needle aspiration, and core needle biopsy were performed under ultrasound image guidance. The mimicked tissues displayed a resistance and recoil effect typically encountered in a real scenario for a pneumothorax, abscesses, and neoplasms. The presented phantom accurately replicated thoracic tissues (lung, ribs, and pleura) and associated pathologies providing a useful tool for training ultrasound-guided procedures.

Effects of wildfire ashes on aquatic invertebrates: First molecular approach on Chironomus riparius larvae.

The wildfire magnification in recent years has raised increasing concern about their adverse impacts on the environment. Wildfires are recognized as an important source of diffuse pollution for the nearby aquatic systems being potentially toxic to aquatic life. Albeit previous studies with wildfire runoff/ashes observed effects in aquatic organisms, to date, different severity origins of ashes and their impact at the sub-organismal level on aquatic biota have not been assessed. In this work, the molecular response of Chironomus riparius exposed to wildfire with low (LS) and high (HS) severity ashes from burnt Pine plantations was evaluated by employing an array of 42 genes related to crucial metabolic pathways by Real time-PCR. IV instar larvae were exposed for 72 h to aqueous extract of ashes (12.5 %, 25 %, 50 %, 75 % and 100 %) prepared from LS and HS ashes. Mn, Zn, and Pb were the metals found at highest concentration in both ash extracts, for HS notable Cd, Mn and Cr presence. From the 42 genes studied only 4 were not altered (22 genes modulated their response by LS and 38 genes in the case of HS) showing the opposite response at 100% with downregulated by LS and upregulated by HS. The 12.5 %, 25 %, 100 % HS and 25 % LS were the main modulators, confirmed by the integrative biomarkers response (IBR). Remarkable genotoxicity was generated by ashes even activating the apoptosis response, and endocrine disruption observed could modify the development. Moreover, detoxification and stress response were strongly activated, limiting the organism's future response to external aggressions. The employment of this novelty approach with molecular tools act as early alarm signal preventing greater damages. Overall, wildfire ashes showed to be a significant environmental disruptor to C. riparius even at lower concentration and the short exposure time employed, emphasizing the strong impact of wildfires on aquatic systems.

Were ride-hailing fares affected by the COVID-19 pandemic? Empirical analyses in Atlanta and Boston.

Ride-hailing services such as Lyft, Uber, and Cabify operate through smartphone apps and are a popular and growing mobility option in cities around the world. These companies can adjust their fares in real time using dynamic algorithms to balance the needs of drivers and riders, but it is still scarcely known how prices evolve at any given time. This research analyzes ride-hailing fares before and during the COVID-19 pandemic, focusing on applications of time series forecasting and machine learning models that may be useful for transport policy purposes. The Lyft Application Programming Interface was used to collect data on Lyft ride supply in Atlanta and Boston over 2 years (2019 and 2020). The Facebook Prophet model was used for long-term prediction to analyze the trends and global evolution of Lyft fares, while the Random Forest model was used for short-term prediction of ride-hailing fares. The results indicate that ride-hailing fares are affected during the COVID-19 pandemic, with values in the year 2020 being lower than those predicted by the models. The effects of fare peaks, uncontrollable events, and the impact of COVID-19 cases are also investigated. This study comes up with crucial policy recommendations for the ride-hailing market to better understand, regulate and integrate these services.

Effect of Feeding Saccharomyces cerevisiae boulardii CNCM I-1079 to Sows and Piglets on Piglets' Immune Response after Vaccination against Actinobacillus pleuropneumoniae.

The aim of this study was to assess the effect that feeding Saccharomyces cerevisiae boulardii CNCM I-1079 (LSB) to lactating sows and their progeny has on inflammatory response and mucosal immunity after vaccination against Actinobacillus pleuropneumoniae. Sixty-seven Danbred sows were allotted into two treatments when they entered the farrowing room seven days before the expected farrowing date: control (CON: lactation diet) and LSB (CON + 12 × 109 colony forming units (CFU)/d until weaning). At weaning, piglets were equally allotted into two experimental diets according to sow diet: control (CON: 2-phase post-weaning diets) and LSB (CON + 2 × 109 CFU/kg and 1 × 109 CFU/kg in phases 1 and 2, respectively). The piglets were vaccinated at days 26 and 49 post-weaning. Growth performance and number of IgA producing cells and cytokine's gene expression in lung, lymph node, and intestine samples at day 70 post-weaning were assessed and analyzed in SPSS Statistics 26: performance with a general linear model with sex, room, sow diet, piglet diet, and their interactions as main effects, and immunity with a Kruskal−Wallis test for k unrelated samples. Piglets from LSB-fed sows displayed a higher average daily gain (ADG; p < 0.01) and a heavier body weight (BW; p < 0.05) during lactation, tended (p < 0.1) to be heavier at day 49, and to have a higher ADG between days 26 and 49; had fewer number of IgA producing cells in the lymph node (p < 0.05); and all the cytokines studied were significantly under-regulated (p < 0.05) in the lung. It is concluded that feeding Saccharomyces cerevisiae boulardii CNCM I-1079 to sows improved piglet performance during lactation and showed a clear reduction in the inflammatory status of the lungs after vaccination against A. pleuropneumoniae, suggesting that there was a maternal imprinting effect on mucosal protection and a cross-talk between the gut microbiota and the lung.

Analysis of Extended Information Provided by Bluetooth Traffic Monitoring Systems to Enhance Short-Term Level of Service Prediction.

Bluetooth monitoring systems (BTMS) have opened a new era in traffic sensing, providing a reliable, economical, and easy-to-deploy solution to uniquely identify vehicles. Raw data from BTMS have traditionally been used to calculate travel time and origin-destination matrices. However, we could extend this to include other information like the number of vehicles or their residence times. This information, together with their temporal components, can be applied to the complex task of forecasting traffic. Level of service (LOS) prediction has opened a novel research line that fulfills the need to anticipate future traffic states, based on a standard link-based variable, accepted for both researchers and practitioners. In this paper, we incorporate BTMS's extended variables and temporal information to an LOS classifier based on a Random Undersampling Boost algorithm, which is proven to efficiently respond to the data unbalance intrinsic to this problem. By using this approach, we achieve an overall recall of 87.2% for up to 15-min prediction horizons, reaching 96.6% predicting congestion, and improving the results for the intermediate traffic states, especially complex given their intrinsic instability. Additionally, we provide detailed analyses on the impact of temporal information on the LOS predictor's performance, observing improvements up to a separation of 50 min between last features and prediction horizons. Furthermore, we study the predictor importance resulting from the classifiers to highlight those features contributing the most to the final achievements.

Data-driven analysis of the impact of COVID-19 on Madrid's public transport during each phase of the pandemic.

COVID-19 has become a major global issue with large social-economic and health impacts, which led to important changes in people's behavior. One of these changes affected the way people use public transport. In this work we present a data-driven analysis of the impact of COVID-19 on public transport demand in the Community of Madrid, Spain, using data from ticket validations between February and September 2020. This period of time covers all stages of pandemic in Spain, including de-escalation phases. We find that ridership has dramatically decreased by 95% at the pandemic peak, recovering very slowly and reaching only half its pre-pandemic levels at the end of September. We analyze results for different transport modes, ticket types, and groups of users. Our work corroborates that low-income groups are the most reliant on public transportation, thus observing significantly lower decreases in their ridership during pandemic. This paper also shows different average daily patterns of public transit demand during each phase of the pandemic in Madrid. All these findings provide relevant information for transit agencies to design responses to an emergence situation like this pandemic, contributing to extend the global knowledge about COVID-19 impact on transport comparing results with other cities worldwide.

[Management of Interstitial Lung Diseases (ILD) Associated with Autoimmune Diseases by the Pulmonologyst in the Differents ILD Units in Spain]. / Manejo de las enfermedades pulmonares intersticiales difusas (EPID) asociadas a enfermedades autoinmunes, por el neumólogo en las diferentes unidades de EPID en España.

Introduction: The aim of the study was to know the management of patients with diffuse interstitial lung disease (ILD) associated with a systemic autoimmune diseases (SAD) in pulmonology outpatient clinics in Spain. Methodology: The ILD work area of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) designed a self-completed questionnaire of 25 questions, on aspects related to the diagnosis and treatment of ILD-SAD. This was distributed among the attendees of the winter meeting of the ILD Area and later via e-mail to all the members of the ILD area of SEPAR. Participation was anonymous, voluntary and without consideration. Results: 74 pulmonologists from 58 hospitals participated. 77% had a specialized ILD consultation. All Units with SEPAR accreditation had a committee made up of pulmonologists and radiologists and a majority participation of pathologists and rheumatologists. In 75% of the centers there was a close collaboration with Rheumatology for the management of ILD-SAD. 85% considered that the frequency of ILD-SAD consults is increasing, the most frequent being ILD associated with rheumatoid arthritis. The treatment of ILD-SAD is decided by consensus between pulmonologist and rheumatologist in 91.3% of the cases. 67% of pulmonologists consider that immunosuppressants and biological therapies can slow down the progression of ILD-SAD. 51% use antifibrotics therapies in these pathologies. Conclusions: Almost all of the accredited Spanish ILD Units by SEPAR have established collaborations with Rheumatology for the adequate management of patients with ILD-SAD, this practice having been extended to units not yet accredited.

Characterization of COVID-19's Impact on Mobility and Short-Term Prediction of Public Transport Demand in a Mid-Size City in Spain.

COVID-19 has dramatically struck each section of our society: health, economy, employment, and mobility. This work presents a data-driven characterization of the impact of COVID-19 pandemic on public and private mobility in a mid-size city in Spain (Fuenlabrada). Our analysis used real data collected from the public transport smart card system and a Bluetooth traffic monitoring network, from February to September 2020, thus covering relevant phases of the pandemic. Our results show that, at the peak of the pandemic, public and private mobility dramatically decreased to 95% and 86% of their pre-COVID-19 values, after which the latter experienced a faster recovery. In addition, our analysis of daily patterns evidenced a clear change in the behavior of users towards mobility during the different phases of the pandemic. Based on these findings, we developed short-term predictors of future public transport demand to provide operators and mobility managers with accurate information to optimize their service and avoid crowded areas. Our prediction model achieved a high performance for pre- and post-state-of-alarm phases. Consequently, this work contributes to enlarging the knowledge about the impact of pandemic on mobility, providing a deep analysis about how it affected each transport mode in a mid-size city.

Experiencia comunitaria: la importancia de las redes comunitarias en el proceso de vacunación a pacientes dependientes en el Centro de Salud de Andorra (Teruel) / The importance of community networks in vaccinating dependent patients in health centres in Andorra

El objetivo del artículo ha sido explicar la metodología utilizada para organizar el proceso de vacunación de la COVID-19 a pacientes dependientes en el Centro de Salud de Andorra. Durante la pandemia ha destacado de forma notable la colaboración de redes comunitarias, tanto en el ámbito nacional como local, llevando a cabo las acciones y actividades necesarias para paliar y resolver los problemas derivados de la crisis sanitaria. En esta ocasión, debido a las limitaciones de la vacuna, que no puede movilizarse una vez diluida, se ha recurrido de nuevo a los recursos locales de la zona para organizar el proceso y transportar a los pacientes dependientes, la mayoría de ellos con movilidad reducida y con problemas para llegar al centro de salud para poder vacunarse debido a las barreras arquitectónicas que dificultan el acceso. En primer lugar, se ha seleccionado a los pacientes dependientes priorizando por grado de dependencia, según el índice de Barthel obtenido, teniendo en cuenta el número de dosis que se iban a recepcionar en los 2 días programados para vacunar. Se ha contactado con ellos y/o sus familiares/cuidadores para saber si acudirían por medios propios o a través del transporte adaptado y de este modo planificar horarios. En esta fase, y tras analizar los datos registrados de cada paciente, se ha observado un porcentaje alto del total de personas dependientes vacunadas en solo 2 días. Además, se ha conocido el alto grado de satisfacción tanto de los pacientes como de sus familiares con la organización y la colaboración de las redes comunitarias. (AU)

The aim of the article was to explain the methodology used to organize the COVID-19 vaccination process for dependent patients in Andorra Health Centre. During the pandemic, the collaboration of Community Networks both at national and local levels was notable. The actions and activities necessary to relieve and solve problems arising from the health crisis were performed. On this occasion, due to vaccine limitations which cannot be used once diluted, local resources in the area were again used to organize the process and transport dependent patients - most with reduced mobility and architectural barriers that hinder access to the Health Centre - to be vaccinated. First, dependent patients were selected prioritizing by degree of dependency, according to the Barthel Index obtained. The number of doses to be received in the two days scheduled to vaccinate were taken into account. Patients and/or their family member/caregiver were contacted to find out whether they would come by their own means or using adapted transport and thus plan schedules. In this phase and after analyzing the data recorded for each patient, a high percentage of all dependent patients vaccinated in just two days was observed. In addition, the high degree of satisfaction of both patients and their families with the organization and collaboration of community networks was ascertained. (AU)