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Fullaondo A, Erreguerena I, Keenoy EDM. Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain). BMC Health Serv Res 2024; 24:364. [PMID: 38515068 PMCID: PMC10958960 DOI: 10.1186/s12913-024-10810-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19. METHODS A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. RESULTS The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented. CONCLUSIONS The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.
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Affiliation(s)
- Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
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García-Lorenzo B, Gorostiza A, Alayo I, Castelo Zas S, Cobos Baena P, Gallego Camiña I, Izaguirre Narbaiza B, Mallabiabarrena G, Ustarroz-Aguirre I, Rigabert A, Balzi W, Maltoni R, Massa I, Álvarez López I, Arévalo Lobera S, Esteban M, Fernández Calleja M, Gómez Mediavilla J, Fernández M, del Oro Hitar M, Ortega Torres MDC, Sanz Ferrandez MC, Manso Sánchez L, Serrano Balazote P, Varela Rodríguez C, Campone M, Le Lann S, Vercauter P, Tournoy K, Borges M, Oliveira AS, Soares M, Fullaondo A. European value-based healthcare benchmarking: moving from theory to practice. Eur J Public Health 2024; 34:44-51. [PMID: 37875008 PMCID: PMC10843953 DOI: 10.1093/eurpub/ckad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. METHODS In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. RESULTS Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. CONCLUSIONS To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.
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Affiliation(s)
- Borja García-Lorenzo
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Barakaldo, Spain
| | - Ania Gorostiza
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Barakaldo, Spain
| | - Itxaso Alayo
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Barakaldo, Spain
| | - Susana Castelo Zas
- Osakidetza Basque Health Service, Ezkerraldea Enkarterri Cruces Integrated Health Organisation, Innovation and Quality Assistant Service, Barakaldo-Bizkaia, Spain
| | - Patricia Cobos Baena
- Osakidetza Basque Health Service, Ezkerraldea Enkarterri Cruces Integrated Health Organisation, Mammary Pathology Service, Barakaldo-Bizkaia, Spain
| | - Inés Gallego Camiña
- Osakidetza Basque Health Service, Ezkerraldea Enkarterri Cruces Integrated Health Organisation, Innovation and Quality Assistant Service, Barakaldo-Bizkaia, Spain
| | - Begoña Izaguirre Narbaiza
- Osakidetza Basque Health Service, Ezkerraldea Enkarterri Cruces Integrated Health Organisation, Analytical Accounting, Economic and Financial Directorate, Barakaldo, Spain
| | - Gaizka Mallabiabarrena
- Osakidetza Basque Health Service, Ezkerraldea Enkarterri Cruces Integrated Health Organisation, Mammary Pathology Service, Barakaldo-Bizkaia, Spain
| | - Iker Ustarroz-Aguirre
- Osakidetza Basque Health Service, Ezkerraldea Enkarterri Cruces Integrated Health Organisation, Economic Evaluation Unit, Economic and Financial Directorate, Barakaldo, Spain
| | - Alina Rigabert
- Fundación Andaluza Beturia para la Investigación en Salud (FABIS), Huelva, Spain
| | - William Balzi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Roberta Maltoni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Ilaria Massa
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Isabel Álvarez López
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Medical Oncology, Donostia, Spain
- Biodonostia, Donostia, Gipuzkoa, Spain
| | - Sara Arévalo Lobera
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Medical Oncology, Donostia, Spain
- Biodonostia, Donostia, Gipuzkoa, Spain
| | - Mónica Esteban
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Economic Resource Service, Donostia, Gipuzkoa, Spain
| | - Marta Fernández Calleja
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Mamary Pathology Service, Donostia, Gipuzkoa, Spain
| | - Jenifer Gómez Mediavilla
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Medical Oncology, Donostia, Spain
| | - Manuela Fernández
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Economic Resource Service, Donostia, Gipuzkoa, Spain
| | - Manuel del Oro Hitar
- Gynecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María del Carmen Ortega Torres
- Gynecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Luís Manso Sánchez
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Serrano Balazote
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carolina Varela Rodríguez
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mario Campone
- Institut de Cancérologie de l’Ouest, Angers-Nantes, France
| | - Sophie Le Lann
- Institut de Cancérologie de l’Ouest, Angers-Nantes, France
| | - Piet Vercauter
- Department of Pulmonary Medicine, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Kurt Tournoy
- Department of Pulmonary Medicine, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
- Faculty of Medicine and Life Sciences, Ghent University, Ghent, Belgium
| | | | | | - Marta Soares
- Instituto Português de Oncologia do Porto, Portugal
| | - Ane Fullaondo
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Barakaldo, Spain
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de Batlle J, Benítez ID, Moncusí-Moix A, Androutsos O, Angles Barbastro R, Antonini A, Arana E, Cabrera-Umpierrez MF, Cea G, Dafoulas GΕ, Folkvord F, Fullaondo A, Giuliani F, Huang HL, Innominato PF, Kardas P, Lou VWQ, Manios Y, Matsangidou M, Mercalli F, Mokhtari M, Pagliara S, Schellong J, Stieler L, Votis K, Currás P, Arredondo MT, Posada J, Guillén S, Pecchia L, Barbé F, Torres G, Fico G. GATEKEEPER's Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases. J Med Internet Res 2023; 25:e42187. [PMID: 37379060 PMCID: PMC10365628 DOI: 10.2196/42187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/31/2023] [Accepted: 02/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The World Health Organization's strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. OBJECTIVE We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. METHODS The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. RESULTS Seven European countries were selected, covering Europe's geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligence-based digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. CONCLUSIONS This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space.
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Affiliation(s)
- Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
- Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
| | - Ivan D Benítez
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
- Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
| | - Anna Moncusí-Moix
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
- Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
| | - Odysseas Androutsos
- Lab of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | | | - Alessio Antonini
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | - Eunate Arana
- Biocruces Bizkaia Health Research Institute, Osakidetza, Barakaldo, Spain
| | - Maria Fernanda Cabrera-Umpierrez
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
| | - Gloria Cea
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
| | - George Ε Dafoulas
- E-health Department, Digital Cities of Central Greece, Trikala, Greece
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Frans Folkvord
- PredictBy, Barcelona, Spain
- Tilburg School of Humanities and Digital Sciences, Tilburg, Netherlands
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Francesco Giuliani
- Innovation and Research Department, Fondazione Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Hsiao-Ling Huang
- Department of Healthcare Management, Office of International and Cross-Strait Affairs, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Pasquale F Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- Warwick Medical School & Cancer Research Centre, University of Warwick, Coventry, United Kingdom
- Faculty of Medicine, Paris-Saclay University, Villejuif, France
| | - Przemyslaw Kardas
- Medication Adherence Research Centre, Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong, China
| | - Yannis Manios
- Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | | | | | - Mounir Mokhtari
- Scientific Direction, Institut Mines-Telecom, Paris, France
- National University of Singapore, Singapore, Singapore
| | - Silvio Pagliara
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lisa Stieler
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Konstantinos Votis
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Paula Currás
- Innova & European Projects Office, Integrated Health Solutions, Medtronic Ibérica S.A., Madrid, Spain
| | - Maria Teresa Arredondo
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jorge Posada
- Innova & European Projects Office, Integrated Health Solutions, Medtronic Ibérica S.A., Madrid, Spain
| | | | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
- Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
| | - Gerard Torres
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
- Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
| | - Giuseppe Fico
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
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Mar J, Larrañaga I, Ibarrondo O, González-Pinto A, Hayas CL, Fullaondo A, Izco-Basurko I, Alonso J, Zorrilla I, Fernández-Sevillano J, de Manuel E. Cost-utility analysis of the UPRIGHT intervention promoting resilience in adolescents. BMC Psychiatry 2023; 23:178. [PMID: 36932364 PMCID: PMC10022565 DOI: 10.1186/s12888-023-04665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND As mental health in adulthood is related to mental status during adolescence, school-based interventions have been proposed to improve resilience. The objective of this study was to build a simulation model representing the natural history of mental disorders in childhood, adolescence and youth to estimate the cost-effectiveness of the UPRIGHT school-based intervention in promoting resilience and mental health in adolescence. METHODS We built a discrete event simulation model fed with real-world data (cumulative incidence disaggregated into eight clusters) from the Basque Health Service database (609,381 individuals) to calculate utilities (quality-adjusted life years [QALYs]) and costs for the general population in two scenarios (base case and intervention). The model translated changes in the wellbeing of adolescents into different risks of mental illnesses for a time horizon of 30 years. RESULTS The number of cases of anxiety was estimated to fall by 5,125 or 9,592 and those of depression by 1,269 and 2,165 if the effect of the intervention lasted 2 or 5 years respectively. From a healthcare system perspective, the intervention was cost-effective for all cases considered with incremental cost-utility ratios always lower than €10,000/QALY and dominant for some subgroups. The intervention was always dominant when including indirect and non-medical costs (societal perspective). CONCLUSIONS Although the primary analysis of the trial did not did not detect significant differences, the UPRIGHT intervention promoting positive mental health was dominant in the economic evaluation from the societal perspective. Promoting resilience was more cost-effective in the most deprived group. Despite a lack of information about the spillover effect in some sectors, the economic evaluation framework developed principally for pharmacoeconomics can be applied to interventions to promote resilience in adolescents. As prevention of mental health disorders is even more necessary in the post-coronavirus disease-19 era, such evaluation is essential to assess whether investment in mental health promotion would be good value for money by avoiding costs for healthcare providers and other stakeholders.
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Affiliation(s)
- Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain.
- Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Igor Larrañaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Oliver Ibarrondo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Ana González-Pinto
- Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
- CIBER en Salud Mental (CIBERSAM), Madrid, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Carlota Las Hayas
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
- Health Services Research Group, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | | | - Jordi Alonso
- Health Services Research Group, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- CIBER en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Iñaki Zorrilla
- University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
- CIBER en Salud Mental (CIBERSAM), Madrid, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
- University of Deusto, Department of Medicine, Bilbao, Spain
| | - Jessica Fernández-Sevillano
- CIBER en Salud Mental (CIBERSAM), Madrid, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
- University of Deusto, Department of Medicine, Bilbao, Spain
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García-Lorenzo B, Gorostiza A, González N, Larrañaga I, Mateo-Abad M, Ortega-Gil A, Bloemeke J, Groene O, Vergara I, Mar J, Lim Choi Keung SN, Arvanitis TN, Kaye R, Dahary Halevy E, Nahir B, Arndt F, Dichmann Sorknæs A, Juul NK, Lilja M, Sherman MH, Laleci Erturkmen GB, Yuksel M, Robbins T, Kyrou I, Randeva H, Maguire R, McCann L, Miller M, Moore M, Connaghan J, Fullaondo A, Verdoy D, de Manuel Keenoy E. Assessment of the Effectiveness, Socio-Economic Impact and Implementation of a Digital Solution for Patients with Advanced Chronic Diseases: The ADLIFE Study Protocol. Int J Environ Res Public Health 2023; 20:3152. [PMID: 36833849 PMCID: PMC9966680 DOI: 10.3390/ijerph20043152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.
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Affiliation(s)
- Borja García-Lorenzo
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Ania Gorostiza
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Nerea González
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Osakidetza Basque Health Service, Barrualde-Galdakao, Integrated Health Organisation, 48960 Galdakao, Spain
| | - Igor Larrañaga
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Maider Mateo-Abad
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Biodonostia Health Research Institute, Paseo Dr. Begiristain s/n, 20014 Donostia, Basque Country, Spain
| | - Ana Ortega-Gil
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | | | - Oliver Groene
- OptiMedis, Burchardstrasse 17, 20095 Hamburg, Germany
| | - Itziar Vergara
- Biodonostia Health Research Institute, Paseo Dr. Begiristain s/n, 20014 Donostia, Basque Country, Spain
| | - Javier Mar
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Unidad de Investigación AP-OSIs, Hospital Alto Deba, 20500 Arrasate-Mondragón, Gipuzkoa, Spain
- Instituto de Investigación Sanitaria Biodonostia, 20014 San Sebastián, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 48960 Galdakao, Spain
- Unidad de Gestión Sanitaria, Hospital Alto Deba, 20500 Arrasate-Mondragón, Gipuzkoa, Spain
| | - Sarah N. Lim Choi Keung
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
| | - Theodoros N. Arvanitis
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Rachelle Kaye
- Assuta Medical Centre Ashdod, Ashdod 7747629, Israel
| | | | - Baraka Nahir
- Assuta Medical Centre Ashdod, Ashdod 7747629, Israel
- Maccabi Healthcare Services Southern Region, Omer 8496500, Israel
| | - Fritz Arndt
- Gesunder Werra-Meißner-Kreis GmbH, 37269 Eschwege, Germany
| | - Anne Dichmann Sorknæs
- Internal Medical & Emergency Department M/FAM, OUH, Svendvorg Hospital, Baagøes Allé 15, Indgang 51, 5700 Svendborg, Denmark
| | - Natassia Kamilla Juul
- Internal Medical & Emergency Department M/FAM, OUH, Svendvorg Hospital, Baagøes Allé 15, Indgang 51, 5700 Svendborg, Denmark
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, 901 87 Umeå, Sweden
| | - Marie Holm Sherman
- R&D Project Office, Region Jämtland Härjedalen, 831 30 Östersund, Sweden
| | | | - Mustafa Yuksel
- SRDC, ODTU Teknokent Silikon Blok Kat: 1 No: 16 Cankaya, Ankara 06800, Turkey
| | - Tim Robbins
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Ioannis Kyrou
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Harpal Randeva
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Roma Maguire
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Lisa McCann
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Morven Miller
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Margaret Moore
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - John Connaghan
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Dolores Verdoy
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Esteban de Manuel Keenoy
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
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Mar J, Larrañaga I, Ibarrondo O, González-Pinto A, Las Hayas C, Fullaondo A, Izco-Basurko I, Alonso J, Zorrilla I, Vilagut G, Mateo-Abad M, de Manuel E. Incidence of mental disorders in the general population aged 1-30 years disaggregated by gender and socioeconomic status. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02425-z. [PMID: 36692520 PMCID: PMC9872752 DOI: 10.1007/s00127-023-02425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE The objective of this study was to estimate the incidence and age of onset of mental disorders diagnosed by gender and socioeconomic status (SES) in children, adolescents, and young adults up to 30 years of age in the whole population of the Basque Country (Spain). METHODS All mental health diagnoses documented in Basque Health Service records from 1 January 2003 to 31 December 2018, were classified into eight clusters: anxiety, attention deficit hyperactivity disorder (ADHD), conduct disorders, depression, psychosis/personality disorders, substance use, eating disorders, and self-harm. We calculated incidence and cumulative incidence for each cluster, disaggregated by gender, and socioeconomic status (SES). Poisson regression analyses were performed. RESULTS Overall, 9,486,853 person-years of observation were available for the 609,281 individuals included. ADHD and conduct disorders were diagnosed in the first decade, anxiety and depression disorders in the second and third decades, and psychosis/personality and substance use in the third. The cumulative incidence at 18 years of age for any type of disorder was 15.5%. The group with low SES had a statistically significantly higher incidence of all eight clusters. The incidence of ADHD, conduct disorders, depression, psychosis/personality disorders, and substance use was higher in males and that of anxiety, eating disorders and self-harm was higher in females. CONCLUSIONS The incidence of mental disorders is high among children, adolescents, and young adults in the Basque Country underlining the need for preventive interventions. Marked differences by gender and SES highlight mental health inequalities, especially for depression and psychosis in low SES males.
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Affiliation(s)
- Javier Mar
- Osakidetza Basque Health Service, Research Unit, Debagoiena Integrated Health Organisation, Hospital 'Alto Deba', Unidad de Gestión Sanitaria, Avenida Navarra 16, 20500, Arrasate-Mondragón, Spain.
- Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.
- REDISSEC (Health Services Research on Chronic Patients Network), Bilbao, Spain.
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Igor Larrañaga
- Osakidetza Basque Health Service, Research Unit, Debagoiena Integrated Health Organisation, Hospital 'Alto Deba', Unidad de Gestión Sanitaria, Avenida Navarra 16, 20500, Arrasate-Mondragón, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Oliver Ibarrondo
- Osakidetza Basque Health Service, Research Unit, Debagoiena Integrated Health Organisation, Hospital 'Alto Deba', Unidad de Gestión Sanitaria, Avenida Navarra 16, 20500, Arrasate-Mondragón, Spain
| | - Ana González-Pinto
- Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- UPV/EHU-University of the Basque Country, Vitoria-Gasteiz, Spain
- CIBERSAM, CIBER en Salud Mental, Madrid, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | | | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | | | - Jordi Alonso
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- CIBERESP, CIBER en Epidemiología y Salud Pública, Madrid, Spain
- UPF-Pompeu Fabra University, Barcelona, Spain
| | - Iñaki Zorrilla
- Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- UPV/EHU-University of the Basque Country, Vitoria-Gasteiz, Spain
- CIBERSAM, CIBER en Salud Mental, Madrid, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Gemma Vilagut
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- CIBERESP, CIBER en Epidemiología y Salud Pública, Madrid, Spain
- UPF-Pompeu Fabra University, Barcelona, Spain
| | - Maider Mateo-Abad
- REDISSEC (Health Services Research on Chronic Patients Network), Bilbao, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
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7
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Mar J, Larrañaga I, Ibarrondo O, González-Pinto A, Hayas CL, Fullaondo A, Izco-Basurko I, Alonso J, Mateo-Abad M, Manuel ED. Socioeconomic and gender inequalities in mental disorders among adolescents and young adults. Revista de Psiquiatría y Salud Mental 2022. [DOI: 10.1016/j.rpsm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Las-Hayas C, Mateo-Abad M, Vergara I, Izco-Basurko I, González-Pinto A, Gabrielli S, Mazur I, Hjemdal O, Gudmundsdottir DG, Knoop HH, Olafsdottir AS, Fullaondo A, González N, Mar-Medina J, Krzyżanowski D, Morote R, Anyan F, Ledertoug MM, Tidmand L, Arnfjord UB, Kaldalons I, Jonsdottir BJ, de Manuel Keenoy E. Relevance of well-being, resilience, and health-related quality of life to mental health profiles of European adolescents: results from a cross-sectional analysis of the school-based multinational UPRIGHT project. Soc Psychiatry Psychiatr Epidemiol 2022; 57:279-291. [PMID: 34417859 PMCID: PMC8379563 DOI: 10.1007/s00127-021-02156-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe. METHODS Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles. RESULTS Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification. CONCLUSION Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.
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Affiliation(s)
- Carlota Las-Hayas
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
| | - Maider Mateo-Abad
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
- REDISSEC (Health Services Research On Chronic Patients Network), Barakaldo, Basque Country Spain
| | - Itziar Vergara
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
- REDISSEC (Health Services Research On Chronic Patients Network), Barakaldo, Basque Country Spain
- Biodonostia Health Research Institute, San Sebastián, Spain
| | - Irantzu Izco-Basurko
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
| | - Ana González-Pinto
- Osakidetza Basque Health Service, Araba University Hospital, Vitoria - Gasteiz, Basque Country Spain
- University of the Basque Country UPV/EHU, Leioa, Spain
- CIBERSAM (CIBER of Mental Health Area), Madrid, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Silvia Gabrielli
- Bruno Kessler Foundation, Via Santa Croce 77, 38122 Trento, Italy
| | - Iwona Mazur
- Daily Centre for Psychiatry and Speech Disorders, Wrocław, Poland
- Wroclaw Medical University, Wrocław, Poland
| | - Odin Hjemdal
- Norwegian University of Science and Technology, Hogskoleringen 1, 7491 Trondheim, Norway
| | | | - Hans Henrik Knoop
- Aarhus University, Nordre Ringgade 1, C 8000 Aarhus, Denmark
- Optentia Research Focus Area, North-West University, P O Box 1174, Vanderbijlpark, 1900 South Africa
| | | | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
| | - Nerea González
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
- REDISSEC (Health Services Research On Chronic Patients Network), Barakaldo, Basque Country Spain
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Galdakao, Spain
| | - Javier Mar-Medina
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
- REDISSEC (Health Services Research On Chronic Patients Network), Barakaldo, Basque Country Spain
- Biodonostia Health Research Institute, San Sebastián, Spain
- Research Unit, Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Arrasate-Mondragón, Spain
| | - Dominik Krzyżanowski
- Division of Medical Social Science, Wroclaw Medical University, Wrocław, Poland
- Department of Health, Lower Silesia Voivodeship Marshal Office, Wrocław, Poland
| | - Roxanna Morote
- Norwegian University of Science and Technology, Hogskoleringen 1, 7491 Trondheim, Norway
- Catholic University of Peru, Avenida Universitaria s/n, 18, Lima, Peru
| | - Frederick Anyan
- Norwegian University of Science and Technology, Hogskoleringen 1, 7491 Trondheim, Norway
| | | | - Louise Tidmand
- Aarhus University, Nordre Ringgade 1, C 8000 Aarhus, Denmark
| | - Unnur Björk Arnfjord
- School of Education, University of Iceland, Saemundargotu 2, 101 Reykjavik, Iceland
| | - Ingibjorg Kaldalons
- School of Education, University of Iceland, Saemundargotu 2, 101 Reykjavik, Iceland
| | | | - Esteban de Manuel Keenoy
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country Spain
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Mateo-Abad M, González N, Fullaondo A, Merino M, Azkargorta L, Giné A, Verdoy D, Vergara I, de Manuel Keenoy E. Impact of the CareWell integrated care model for older patients with multimorbidity: a quasi-experimental controlled study in the Basque Country. BMC Health Serv Res 2020; 20:613. [PMID: 32620116 PMCID: PMC7333301 DOI: 10.1186/s12913-020-05473-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
Background Older patients with multimorbidity have complex health and social care needs, associated with elevated use of health care resources. The aim of this study is to evaluate the impact of CareWell integrated care model for older patients with multimorbidity in the Basque Country. Methods The CareWell program for older patients with multimorbidity, based on the coordination between health providers, home-based care and patient empowerment, supported by information and communication technology tools. The program was deployed in four healthcare areas in the Basque Country. The control group was formed by two organizations in which the program had not been deployed and regular care procedures were applied. Participants, older patients (aged ≥65) with two or more chronic conditions (at least one being chronic obstructive pulmonary disease, chronic heart failure, or diabetes mellitus), categorized as complex according to a risk stratification algorithm, were followed up to 12 months. The impact of the program on the use of health resources, clinical effectiveness, and satisfaction was evaluated using a mixed-method approach. Semi-structured interviews were performed to assess satisfaction with the newly deployed model and mixed regression models to measure the effect of the intervention throughout the follow-up period. Results Two hundred patients were recruited (101 intervention and 99 control), mostly males (63%) with a mean age of 79 years and age-adjusted Charlson Comorbidity Index of 9.7 on average. Relevant differences between the groups were observed for all dimensions. In the intervention group, the number of hospitalizations and visits to emergency centers was reduced, and the number of primary care contacts increased. Clinical changes were also observed, such as a decrease in the body mass index and blood glucose levels. The satisfaction level was high for all stakeholders. Conclusion The implementation of CareWell integrated care model changed the profile of health resource utilization, strengthening the key role of primary care and reducing the number of emergency visits and hospitalizations. The satisfaction with this model of care was high. Trial registration ClinicalTrials.gov, NCT03042039. Registered 3 February 2017 - Retrospectively registered.
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Affiliation(s)
- Maider Mateo-Abad
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, Spain.
| | - Nerea González
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, Spain.,Osakidetza Basque Health Service, Hospital Galdakao-Usansolo, Galdakao, Basque Country, Spain
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
| | - Marisa Merino
- Osakidetza Basque Health Service, Tolosaldea Integrated Health Care Organization, Tolosa, Basque Country, Spain.,Biodonostia Health Research Institute, Economic Evaluation of Chronic Diseases Group, Donostia, Basque Country, Spain
| | - Lierni Azkargorta
- Osakidetza Basque Health Service, Tolosaldea Integrated Health Care Organization, Tolosa, Basque Country, Spain
| | - Anna Giné
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
| | - Dolores Verdoy
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
| | - Itziar Vergara
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, Spain.,Biodonostia Health Research Institute, Primary Care Group, Donostia, Basque Country, Spain
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10
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Palmer K, Carfì A, Angioletti C, Di Paola A, Navickas R, Dambrauskas L, Jureviciene E, João Forjaz M, Rodriguez-Blazquez C, Prados-Torres A, Gimeno-Miguel A, Cano-del Pozo M, Bestué-Cardiel M, Leiva-Fernández F, Poses Ferrer E, Carriazo AM, Lama C, Rodríguez-Acuña R, Cosano I, Bedoya-Belmonte JJ, Liseckiene I, Barbolini M, Txarramendieta J, de Manuel Keenoy E, Fullaondo A, Rijken M, Onder G. A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS. Int J Environ Res Public Health 2019; 16:ijerph16245044. [PMID: 31835691 PMCID: PMC6950053 DOI: 10.3390/ijerph16245044] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 11/16/2022]
Abstract
Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis—“strengths, weaknesses, opportunities, threats” (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings.
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Affiliation(s)
- Katie Palmer
- Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00136 Rome, Italy;
- Correspondence:
| | - Angelo Carfì
- Centro di Medicina dell’Invecchiamento, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00136 Rome, Italy
| | - Carmen Angioletti
- Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore and Centro di Medicina dell’Invecchiamento, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00136 Rome, Italy;
| | - Antonella Di Paola
- Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00136 Rome, Italy;
| | - Rokas Navickas
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (R.N.); (L.D.); (E.J.)
- Department of Biomedical Research, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Laimis Dambrauskas
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (R.N.); (L.D.); (E.J.)
- Department of Biomedical Research, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Elena Jureviciene
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (R.N.); (L.D.); (E.J.)
- Department of Biomedical Research, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Maria João Forjaz
- National School of Public Health and REDISSEC, Carlos III Institute of Health, ES-28029 Madrid, Spain;
| | - Carmen Rodriguez-Blazquez
- National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, ES-28029 Madrid, Spain;
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, REDISSEC, 50009 Zaragoza, Spain; (A.P.-T.); (A.G.-M.)
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, REDISSEC, 50009 Zaragoza, Spain; (A.P.-T.); (A.G.-M.)
| | - Mabel Cano-del Pozo
- General Directorate of Healthcare, Health Department, 50017 Zaragoza, Spain; (M.C.-d.P.); (M.B.-C.)
| | - María Bestué-Cardiel
- General Directorate of Healthcare, Health Department, 50017 Zaragoza, Spain; (M.C.-d.P.); (M.B.-C.)
| | - Francisca Leiva-Fernández
- Málaga-Guadalhorce Primary Care Teaching Unit, IBIMA, Andalusian Health Service, 29009 Málaga, Spain;
| | - Elisa Poses Ferrer
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Government of Catalonia, 08005 Barcelona, Spain;
| | - Ana M Carriazo
- Regional Ministry of Health and Families of Andalusia (CSFJA), E-41020 Seville, Spain; (A.M.C.); (C.L.)
| | - Carmen Lama
- Regional Ministry of Health and Families of Andalusia (CSFJA), E-41020 Seville, Spain; (A.M.C.); (C.L.)
| | | | - Inmaculada Cosano
- San José de la Rinconada-Los Carteros Primary Care Center, Andalusian Health Service (Servicio Andaluz de Salud, SAS), E-41300 Seville, Spain
| | - Juan José Bedoya-Belmonte
- Tiro de Pichón Primary Care Center, Andalusian Health Service (Servicio Andaluz de Salud, SAS), E-29006 Málaga, Spain;
| | - Ida Liseckiene
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania;
| | | | - Jon Txarramendieta
- Kronikgune Institute for Health Services Research, 48902 Basque Country, Spain; (J.T.); (E.d.M.K.); (A.F.)
| | - Esteban de Manuel Keenoy
- Kronikgune Institute for Health Services Research, 48902 Basque Country, Spain; (J.T.); (E.d.M.K.); (A.F.)
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, 48902 Basque Country, Spain; (J.T.); (E.d.M.K.); (A.F.)
| | - Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), 3513 CR Utrecht, The Netherlands;
- Department of Health and Social Management, University of Eastern Finland, FI-70210 Kuopio, Finland
| | - Graziano Onder
- Department of Cardiovascular, Metabolic and Aging Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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11
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Las Hayas C, Izco-Basurko I, Fullaondo A, Gabrielli S, Zwiefka A, Hjemdal O, Gudmundsdottir DG, Knoop HH, Olafsdottir AS, Donisi V, Carbone S, Rizzi S, Mazur I, Krolicka-Deregowska A, Morote R, Anyan F, Ledertoug MM, Tange N, Kaldalons I, Jonsdottir BJ, González-Pinto A, Vergara I, González N, Mar Medina J, de Manuel Keenoy E. UPRIGHT, a resilience-based intervention to promote mental well-being in schools: study rationale and methodology for a European randomized controlled trial. BMC Public Health 2019; 19:1413. [PMID: 31664974 PMCID: PMC6820972 DOI: 10.1186/s12889-019-7759-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Adolescence is crucial period for laying the foundations for healthy development and mental well-being. The increasing prevalence of mental disorders amongst adolescents makes promotion of mental well-being and prevention interventions at schools important. UPRIGHT (Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers) is designed as a whole school approach (school community, students and families) to promote a culture of mental well-being and prevent mental disorders by enhancing resilience capacities. The present article aims at describing the rationale, conceptual framework, as well as methodology of implementation and evaluation of the UPRIGHT intervention. METHODS UPRIGHT project is a research and innovation project funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No. 754919 (Duration: 48 months). The theoretical framework has been developed by an innovative and multidisciplinary approach using a co-creation process inside the UPRIGHT Consortium (involving seven institutions from Spain, Italy, Poland, Norway, Denmark, and Iceland). Resulted is the UPRIGHT programme with 18 skills related to 4 components: Mindfulness, Coping, Efficacy and Social and Emotional Learning. Among the five Pan-European regions, 34 schools have been currently involved (17 control; 17 intervention) and around 6000 adolescents and their families are foreseen to participate along a 3-year period of evaluation. Effectiveness of the intervention will be evaluated as a randomized controlled trial including quantitative and qualitative analysis in the five Pan-European regions representative of the cultural and socioeconomic diversity. The cost-effectiveness assessment will be performed by simulation modelling methods. DISCUSSION We expect a short- to medium-term improvement of mental well-being in adolescents by enhancing resilience capacities. The study may provide robust evidence on intrapersonal, familiar and social environmental resilience factors promoting positive mental well-being. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03951376 . Registered 15 May 2019.
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Affiliation(s)
- Carlota Las Hayas
- Kronikgune Institute for Health Services Research, Torre del BEC, Ronda de Azkue 1, 48902, Barakaldo, Bizkaia, Basque Country, Spain.
| | - Irantzu Izco-Basurko
- Kronikgune Institute for Health Services Research, Torre del BEC, Ronda de Azkue 1, 48902, Barakaldo, Bizkaia, Basque Country, Spain
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Torre del BEC, Ronda de Azkue 1, 48902, Barakaldo, Bizkaia, Basque Country, Spain
| | | | - Antoni Zwiefka
- Lower Silesia Voivodeship Marshal Office, Wrocław, Poland
| | - Odin Hjemdal
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | | | | | | | - Iwona Mazur
- Daily Centre for Psychiatry and Speech Disorders, Wrocław, Poland
- Wroclaw Medical University, Wrocław, Poland
| | | | - Roxanna Morote
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Frederick Anyan
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | | | - Ana González-Pinto
- University Hospital Alava-Santiago, Spanish Society of Biological Psychiatry (CIBERSAM), Vitoria, Spain
| | | | - Nerea González
- Kronikgune Institute for Health Services Research, Torre del BEC, Ronda de Azkue 1, 48902, Barakaldo, Bizkaia, Basque Country, Spain
- Hospital Galdakao-Usansolo, Health Services Research on Chronic Patients Network- REDISSEC, Galdakao, Spain
| | | | - Esteban de Manuel Keenoy
- Kronikgune Institute for Health Services Research, Torre del BEC, Ronda de Azkue 1, 48902, Barakaldo, Bizkaia, Basque Country, Spain
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12
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Larrañaga I, Stafylas P, Fullaondo A, Apuzzo GM, Mar J. Economic Evaluation of an Integrated Health and Social Care Program for Heart Failure Through 2 Different Modeling Techniques. Health Serv Res Manag Epidemiol 2018; 5:2333392818795795. [PMID: 30547054 PMCID: PMC6287322 DOI: 10.1177/2333392818795795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/27/2018] [Indexed: 01/07/2023] Open
Abstract
Introduction An integrated health and social care program for patients with heart failure (HF) was implemented at the Friuli-Venezia Giulia deployment site as part of the SmartCare European project. The objective of this study was to validate 2 different decision modeling techniques used to perform the economic evaluation. Methods Data were collected during the SmartCare project which enrolled 108 patients with HF and followed for more than 6 months. The techniques used were Markov and discrete event simulation models. In both cases, a cost-effectiveness analysis and a budget impact analysis were carried out. The former was used to assign priority to the intervention and the latter to assess its sustainability. Analyses were conducted from the perspective of the Regional Health Authority. Results Results were similar with both types of model. Cost-effectiveness analysis found no significant differences in quality of life, but the intervention generated significant cost savings, becoming the dominant option. Data extrapolation showed no benefits in terms of mortality or hospital admissions, but budget impact analysis also predicted annual savings, as a significant number of in-hospital days were avoided. In budget analysis, both models predicted early, increasing and cumulative annual savings. Discussion The integrated program was dominant as it provided better outcomes and lower total costs, and thus, decision-makers should prioritize it. Besides, the work demonstrates the capacity of decision modeling to become a complementary tool in managing integrated health and social care models.
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Affiliation(s)
- Igor Larrañaga
- AP-OSI Research Unit, Alto Deba Integrated Healthcare Organisation, Mondragón, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Kronikgune, Baracaldo, Spain
| | - Panos Stafylas
- Health Information Management SL, Barcelona, Spain.,HealThink-Medical Research & Innovation LP, Thessaloniki, Greece
| | | | | | - Javier Mar
- AP-OSI Research Unit, Alto Deba Integrated Healthcare Organisation, Mondragón, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
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13
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Soto-Gordoa M, de Manuel E, Fullaondo A, Merino M, Arrospide A, Igartua JI, Mar J. Impact of stratification on the effectiveness of a comprehensive patient-centered strategy for multimorbid patients. Health Serv Res 2018; 54:466-473. [PMID: 30467846 DOI: 10.1111/1475-6773.13094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The objective of this work was to assess the effectiveness of a population-level patient-centered intervention for multimorbid patients based on risk stratification for case finding in 2014 compared with the baseline scenario in 2012. DATA SOURCE Clinical and administrative databases. STUDY DESIGN This was an observational cohort study with an intervention group and a historical control group. A propensity score by a genetic matching approach was used to minimize bias. Generalized linear models were used to analyze relationships among variables. DATA COLLECTION We included all eligible patients at the beginning of the year and followed them until death or until the follow-up period concluded (end of the year). The control group (2012) totaled 3558 patients, and 4225 patients were in the intervention group (2014). PRINCIPAL FINDING A patient-centered strategy based on risk stratification for case finding and the implementation of an integrated program based on new professional roles and an extensive infrastructure of information and communication technologies avoided 9 percent (OR: 0.91, CI: 0.86-0.96) of hospitalizations. However, this effect was not found in nonprioritized groups whose probability of hospitalization increased (OR: 1.19, CI = 1.09-1.30). CONCLUSIONS In a before-and-after analysis using propensity score matching, a comprehensive, patient-centered, integrated care intervention was associated with a lower risk of hospital admission among prioritized patients, but not among patients who were not prioritized to receive the intervention.
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Affiliation(s)
- Myriam Soto-Gordoa
- AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Kronikgune Group, Barakaldo, Spain.,Biodonostia Health Research Institute, San Sebastian-Donostia, Spain.,Kronikgune, Barakaldo, Spain
| | | | | | - Marisa Merino
- Biodonostia Health Research Institute, San Sebastian-Donostia, Spain.,Tolosaldea Integrated Health Care Organization, Tolosa, Spain
| | - Arantzazu Arrospide
- AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Kronikgune Group, Barakaldo, Spain.,Biodonostia Health Research Institute, San Sebastian-Donostia, Spain
| | | | - Javier Mar
- AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Kronikgune Group, Barakaldo, Spain.,Biodonostia Health Research Institute, San Sebastian-Donostia, Spain.,Clinical Management Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain
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14
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Infante A, Gago A, de Eguino GR, Calvo-Fernández T, Gómez-Vallejo V, Llop J, Schlangen K, Fullaondo A, Aransay AM, Martín A, Rodríguez CI. Prelamin A accumulation and stress conditions induce impaired Oct-1 activity and autophagy in prematurely aged human mesenchymal stem cell. Aging (Albany NY) 2014; 6:264-80. [PMID: 24753226 PMCID: PMC4032794 DOI: 10.18632/aging.100651] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/03/2014] [Indexed: 12/22/2022]
Abstract
Aging, a time-dependent functional decline of biological processes, is the primary risk factor in developing diseases such as cancer, cardiovascular or degenerative diseases. There is a real need to understand the human aging process in order to increase the length of disease-free life, also known as "health span". Accumulation of progerin and prelamin A are the hallmark of a group of premature aging diseases but have also been found during normal cellular aging strongly suggesting similar mechanisms between healthy aging and LMNA-linked progeroid syndromes. How this toxic accumulation contributes to aging (physiological or pathological) remains unclear. Since affected tissues in age-associated disorders and in pathological aging are mainly of mesenchymal origin we propose a model of human aging based on mesenchymal stem cells (hMSCs) which accumulate prelamin A. We demonstrate that prelamin A-accumulating hMSCs have a premature aging phenotype which affects their functional competence in vivo. The combination of prelamin A accumulation and stress conditions enhance the aging phenotype by dysregulating the activity of the octamer binding protein Oct-1This experimental model has been fundamental to identify a new role for Oct-1 in hMSCs aging.
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Affiliation(s)
- Arantza Infante
- Stem Cells and Cell Therapy Laboratory, BioCruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
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15
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Rumbo-Feal S, Gómez MJ, Gayoso C, Álvarez-Fraga L, Cabral MP, Aransay AM, Rodríguez-Ezpeleta N, Fullaondo A, Valle J, Tomás M, Bou G, Poza M. Whole transcriptome analysis of Acinetobacter baumannii assessed by RNA-sequencing reveals different mRNA expression profiles in biofilm compared to planktonic cells. PLoS One 2013; 8:e72968. [PMID: 24023660 PMCID: PMC3758355 DOI: 10.1371/journal.pone.0072968] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/15/2013] [Indexed: 11/18/2022] Open
Abstract
Acinetobacterbaumannii has emerged as a dangerous opportunistic pathogen, with many strains able to form biofilms and thus cause persistent infections. The aim of the present study was to use high-throughput sequencing techniques to establish complete transcriptome profiles of planktonic (free-living) and sessile (biofilm) forms of A. baumannii ATCC 17978 and thereby identify differences in their gene expression patterns. Collections of mRNA from planktonic (both exponential and stationary phase cultures) and sessile (biofilm) cells were sequenced. Six mRNA libraries were prepared following the mRNA-Seq protocols from Illumina. Reads were obtained in a HiScanSQ platform and mapped against the complete genome to describe the complete mRNA transcriptomes of planktonic and sessile cells. The results showed that the gene expression pattern of A. baumannii biofilm cells was distinct from that of planktonic cells, including 1621 genes over-expressed in biofilms relative to stationary phase cells and 55 genes expressed only in biofilms. These differences suggested important changes in amino acid and fatty acid metabolism, motility, active transport, DNA-methylation, iron acquisition, transcriptional regulation, and quorum sensing, among other processes. Disruption or deletion of five of these genes caused a significant decrease in biofilm formation ability in the corresponding mutant strains. Among the genes over-expressed in biofilm cells were those in an operon involved in quorum sensing. One of them, encoding an acyl carrier protein, was shown to be involved in biofilm formation as demonstrated by the significant decrease in biofilm formation by the corresponding knockout strain. The present work serves as a basis for future studies examining the complex network systems that regulate bacterial biofilm formation and maintenance.
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Affiliation(s)
- Soraya Rumbo-Feal
- Department of Microbiology, Biomedical Research Institute, University Hospital, A Coruña, Spain
| | - Manuel J. Gómez
- Department of Molecular Evolution, Center for Astrobiology, INTA-CSIC, Madrid, Spain
| | - Carmen Gayoso
- Department of Microbiology, Biomedical Research Institute, University Hospital, A Coruña, Spain
| | - Laura Álvarez-Fraga
- Department of Microbiology, Biomedical Research Institute, University Hospital, A Coruña, Spain
| | - María P. Cabral
- Department of Microbiology, Biomedical Research Institute, University Hospital, A Coruña, Spain
| | - Ana M. Aransay
- Genome Analysis Platform, CIC bioGUNE & CIBERehd, Derio, Spain
| | - Naiara Rodríguez-Ezpeleta
- Genome Analysis Platform, CIC bioGUNE & CIBERehd, Derio, Spain
- Marine Research Division, AZTI, Tecnalia, Sukarrieta, Spain
| | - Ane Fullaondo
- Genome Analysis Platform, CIC bioGUNE & CIBERehd, Derio, Spain
| | - Jaione Valle
- Department of Microbial biofilms, Agrobiotechnology Institute, Navarra, Spain
| | - María Tomás
- Department of Microbiology, Biomedical Research Institute, University Hospital, A Coruña, Spain
| | - Germán Bou
- Department of Microbiology, Biomedical Research Institute, University Hospital, A Coruña, Spain
- * E-mail: (MP); (GB)
| | - Margarita Poza
- Department of Microbiology, Biomedical Research Institute, University Hospital, A Coruña, Spain
- * E-mail: (MP); (GB)
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16
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Ruiz de Eguino G, Infante A, Schlangen K, Aransay AM, Fullaondo A, Soriano M, García-Verdugo JM, Martín AG, Rodríguez CI. Sp1 transcription factor interaction with accumulated prelamin a impairs adipose lineage differentiation in human mesenchymal stem cells: essential role of sp1 in the integrity of lipid vesicles. Stem Cells Transl Med 2012. [PMID: 23197810 DOI: 10.5966/sctm.2011-0010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Lamin A (LMNA)-linked lipodystrophies may be either genetic (associated with LMNA mutations) or acquired (associated with the use of human immunodeficiency virus protease inhibitors [PIs]), and in both cases they share clinical features such as anomalous distribution of body fat or generalized loss of adipose tissue, metabolic alterations, and early cardiovascular complications. Both LMNA-linked lipodystrophies are characterized by the accumulation of the lamin A precursor prelamin A. The pathological mechanism by which prelamin A accumulation induces the lipodystrophy associated phenotypes remains unclear. Since the affected tissues in these disorders are of mesenchymal origin, we have generated an LMNA-linked experimental model using human mesenchymal stem cells treated with a PI, which recapitulates the phenotypes observed in patient biopsies. This model has been demonstrated to be a useful tool to unravel the pathological mechanism of the LMNA-linked lipodystrophies, providing an ideal system to identify potential targets to generate new therapies for drug discovery screening. We report for the first time that impaired adipogenesis is a consequence of the interaction between accumulated prelamin A and Sp1 transcription factor, sequestration of which results in altered extracellular matrix gene expression. In fact, our study shows a novel, essential, and finely tuned role for Sp1 in adipose lineage differentiation in human mesenchymal stem cells. These findings define a new physiological experimental model to elucidate the pathological mechanisms LMNA-linked lipodystrophies, creating new opportunities for research and treatment not only of LMNA-linked lipodystrophies but also of other adipogenesis-associated metabolic diseases.
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Affiliation(s)
- Garbiñe Ruiz de Eguino
- Stem Cells and Cell Therapy Laboratory, BioCruces, Hospital Universitario Cruces, Barakaldo, Spain
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17
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Fullaondo A, Lee SY. Identification of putative miRNA involved in Drosophila melanogaster immune response. Dev Comp Immunol 2012; 36:267-273. [PMID: 21641929 DOI: 10.1016/j.dci.2011.03.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 05/27/2023]
Abstract
MicroRNAs (miRNAs) are small endogenous non-coding RNAs that post-transcriptionally regulate gene expression in eukaryotes. They are known to play diverse roles in physiological processes such as homeostasis, development, cancer and immune response. In Drosophila melanogaster up to 176 miRNAs have been identified; yet, their biological functions remain unknown. Here, we describe an in silico screening strategy to identify miRNAs involved in a specific immune signaling pathway that is based on: (i) the potential capability of miRNAs to target mRNAs of a given pathway; (ii) the sequence conservation of miRNAs across species and (iii) the expression profile of miRNAs. Using this strategy, we have defined a subset of seven Drosophila miRNAs that are likely to participate in the immune response. Interestingly, some of these miRNAs target peptidoglycan receptor proteins (PGRPs) for which no regulators are known yet. miRNA-mediated regulation may explain how PGRPs are controlled in the immune signaling pathway.
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Affiliation(s)
- Ane Fullaondo
- Genome Analysis Platform, CIC bioGUNE, Parque Tecnológico de Bizkaia, Derio, Spain
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18
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Fullaondo A, Lee SY. Regulation of Drosophila-virus interaction. Dev Comp Immunol 2012; 36:262-266. [PMID: 21925207 DOI: 10.1016/j.dci.2011.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 08/19/2011] [Accepted: 08/20/2011] [Indexed: 05/31/2023]
Abstract
Drosophila melanogaster is a useful model system for deciphering mammalian biological processes including development, innate immunity and cancer. Most genetic studies conducted in Drosophila have focused on the immune response against microbial infection and the results obtained have been extrapolated to other organisms. During the last decade the issue of the antiviral response attracted a great deal of interest. In this review we highlight recent discoveries in the role of RNA interference pathway in antiviral response in Drosophila with a focus on the role of miRNAs as both host defense elements and helpers of viral replication.
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Affiliation(s)
- Ane Fullaondo
- Genome Analysis Platform, CIC bioGUNE, Biscay Technology Park, Derio, Spain
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19
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Garrett M, Fullaondo A, Troxler L, Micklem G, Gubb D. Identification and analysis of serpin-family genes by homology and synteny across the 12 sequenced Drosophilid genomes. BMC Genomics 2009; 10:489. [PMID: 19849829 PMCID: PMC2770083 DOI: 10.1186/1471-2164-10-489] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 10/22/2009] [Indexed: 12/16/2022] Open
Abstract
Background The Drosophila melanogaster genome contains 29 serpin genes, 12 as single transcripts and 17 within 6 gene clusters. Many of these serpins have a conserved "hinge" motif characteristic of active proteinase inhibitors. However, a substantial proportion (42%) lacks this motif and represents non-inhibitory serpin-fold proteins of unknown function. Currently, it is not known whether orthologous, inhibitory serpin genes retain the same target proteinase specificity within the Drosophilid lineage, nor whether they give rise to non-inhibitory serpin-fold proteins or other, more diverged, proteins. Results We collated 188 orthologues to the D. melanogaster serpins from the other 11 Drosophilid genomes and used synteny to find further family members, raising the total to 226, or 71% of the number of orthologues expected assuming complete conservation across all 12 Drosophilid species. In general the sequence constraints on the serpin-fold itself are loose. The critical Reactive Centre Loop (RCL) sequence, including the target proteinase cleavage site, is strongly conserved in inhibitory serpins, although there are 3 exceptional sets of orthologues in which the evolutionary constraints are looser. Conversely, the RCL of non-inhibitory serpin orthologues is less conserved, with 3 exceptions that presumably bind to conserved partner molecules. We derive a consensus hinge motif, for Drosophilid inhibitory serpins, which differs somewhat from that of the vertebrate consensus. Three gene clusters appear to have originated in the melanogaster subgroup, Spn28D, Spn77B and Spn88E, each containing one inhibitory serpin orthologue that is present in all Drosophilids. In addition, the Spn100A transcript appears to represent a novel serpin-derived fold. Conclusion In general, inhibitory serpins rarely change their range of proteinase targets, except by a duplication/divergence mechanism. Non-inhibitory serpins appear to derive from inhibitory serpins, but not the reverse. The conservation of different family members varied widely across the 12 sequenced Drosophilid genomes. An approach considering synteny as well as homology was important to find the largest set of orthologues.
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Affiliation(s)
- Matthew Garrett
- Department of Genetics, Downing Street, Cambridge, CB2 3EH, UK.
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20
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Bernales I, Fullaondo A, Marín-Vidalled MJ, Ucar E, Martínez-Taboada V, López-Hoyos M, Zubiaga AM. Innate immune response gene expression profiles characterize primary antiphospholipid syndrome. Genes Immun 2007; 9:38-46. [PMID: 17960154 DOI: 10.1038/sj.gene.6364443] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Primary antiphospholipid syndrome (PAPS) is a systemic autoimmune disorder characterized by thromboembolic episodes and pregnant morbidity with an increasing clinical importance. To gain insight into the pathogenesis of PAPS, we have investigated the gene expression profiles that characterize peripheral blood mononuclear cells derived from PAPS patients. We show that the transcriptional activity of genes involved in innate immune responses, such as toll-like receptor 8 and CD14, as well as downstream genes of this pathway, such as STAT1, OAS2, TNFSF13 and PLSCR1 are significantly increased in PAPS patients. In addition, the expression of monocyte-specific cytokines is also elevated in PAPS mononuclear cells stimulated in vitro with lipopolysaccharide. Taken together, these results reveal a 'response to pathogen' signature in PAPS, which could reflect an altered monocyte activity. Finally, microarray analyses also revealed a reduced expression of genes coding for proteins involved in transcriptional control. Interestingly, a significant proportion of them exhibit E2F-binding sites in their promoter, suggesting that a deregulated RB/E2F activity could play a role in the pathogenesis of antiphospholipid syndrome.
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Affiliation(s)
- I Bernales
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country, Bilbao, Spain
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21
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Agirregabiria M, Blanco FJ, Berganzo J, Arroyo MT, Fullaondo A, Mayora K, Ruano-López JM. Fabrication of SU-8 multilayer microstructures based on successive CMOS compatible adhesive bonding and releasing steps. Lab Chip 2005; 5:545-52. [PMID: 15856093 DOI: 10.1039/b500519a] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This paper describes a novel fabrication process based on successive wafer-level bonding and releasing steps for stacking several patterned layers of the negative photoresist EPON SU-8. This work uses a polyimide film to enhance previous low temperature bonding technology. The film acts as a temporary substrate where the SU-8 is photopatterned. The poor adhesion between the polyimide film and SU-8 allows the film to be released after the bonding process, even though the film is still strong enough to carry out photolithography. Using this technique, successive adhesive bonding steps can be carried out to obtain complex 3-D multilayer structures. Interconnected channels with smooth vertical sidewalls and freestanding structures are fabricated. Unlike previous works, all the layers are photopatterned before the bonding process yielding sealed cavities and complex three-dimensional structures without using a sacrificial layer. Adding new SU-8 layers reduces the bonding quality because each additional layer decreases the thickness uniformity and increases the polymer crosslinking level. The effect of these parameters is quantified in this paper. This process guarantees compatibility with CMOS electronics and MEMS. Furthermore, the releasing step leaves the input and the output of the microchannels in contact with the outside world, avoiding the usual slow drilling process of a cover. Hence, in addition to the straightforward integration of electrodes on a chip, this fabrication method facilitates the packaging of these microfluidic devices.
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Affiliation(s)
- M Agirregabiria
- MEMS/MST Department, IKERLAN S. Coop. P J.M. Arizmendiarrieta N 2, Mondragon, Spain.
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Fullaondo A, Vicario A, Aguirre A, Barrena I, Salazar A. Quantitative analysis of two-dimensional gel electrophoresis protein patterns: a method for studying genetic relationships among Globodera pallida populations. Heredity (Edinb) 2001; 87:266-72. [PMID: 11737273 DOI: 10.1046/j.1365-2540.2001.00847.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A method based in two-dimensional protein gel electrophoresis has been developed in order to improve the analysis of genetic relationships among populations of Globodera. It has been used to estimate genetic divergence among nine Globodera pallida nematode populations. Sixty-one anonymous polypeptide spots were resolved using silver-stained high-resolution 2D gels and they were quantified in each population to establish genetic variation among G. pallida populations. The results of this analysis were compared with those obtained after a study of allelic frequency variation, which was carried out using seven previously described loci. Genetic distances among populations were calculated by means of both studies, the quantitative analysis and the allelic frequency variation, and phylogenetic trees were constructed for each type of analysis. A correlation analysis between the two distance matrices was carried out and a bootstrap analysis was performed to determine the strength of the clusters obtained with each method. The results obtained support the idea that quantitative protein analysis can be successfully applied to phylogenetic analysis of G. pallida populations.
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Affiliation(s)
- A Fullaondo
- Department of Animal Biology and Genetics, University of Basque Country, Campus de Leioa, Leioa CP 48940, Bizkaia, Spain.
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