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Sanchez A, Pijoan JI, Sainz de Rozas R, Lekue I, San Vicente R, Quindimil JA, Rotaeche R, Etxeberria A, Mozo C, Martinez-Cengotitabengoa M, Monge M, Gómez-Ramírez C, Samper R, Ogueta Lana M, Celorrio S, Merino-Inda N, Llarena M, Gonzalez Saenz de Tejada M, García-Alvarez A, Grandes G. De-imFAR phase II project: a study protocol for a cluster randomised implementation trial to evaluate the effectiveness of de-implementation strategies to reduce low-value statin prescribing in the primary prevention of cardiovascular disease. BMJ Open 2024; 14:e078692. [PMID: 38631840 PMCID: PMC11029292 DOI: 10.1136/bmjopen-2023-078692] [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: 08/09/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION This study aims to reduce potentially inappropriate prescribing (PIP) of statins and foster healthy lifestyle promotion in cardiovascular disease (CVD) primary prevention in low-risk patients. To this end, we will compare the effectiveness and feasibility of several de-implementation strategies developed following the structured design process of the Behaviour Change Wheel targeting key determinants of the clinical decision-making process in CVD prevention. METHODS AND ANALYSIS A cluster randomised implementation trial, with an additional control group, will be launched, involving family physicians (FPs) from 13 Integrated Healthcare Organisations (IHOs) of Osakidetza-Basque Health Service with non-zero incidence rates of PIP of statins in 2021. All FPs will be exposed to a non-reflective decision assistance strategy based on reminders and decision support tools. Additionally, FPs from two of the IHOs will be randomly assigned to one of two increasingly intensive de-implementation strategies: adding a decision information strategy based on knowledge dissemination and a reflective decision structure strategy through audit/feedback. The target population comprises women aged 45-74 years and men aged 40-74 years with moderately elevated cholesterol levels but no diagnosed CVD and low cardiovascular risk (REGICOR<7.5%), who attend at least one appointment with any of the participating FPs (May 2022-May 2023), and will be followed until May 2024. We use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes. The main outcome will be the change in the incidence rate of PIP of statins and healthy lifestyle counselling in the study population 12 and 24 months after FPs' exposure to the strategies. Moreover, FPs' perception of their feasibility and acceptability, and patient experience regarding the quality of care received will be evaluated. ETHICS AND DISSEMINATION The study was approved by the Basque Country Clinical Research Ethics Committee and was registered in ClinicalTrials.gov (NCT04022850). Results will be disseminated in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04022850.
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Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Jose Ignacio Pijoan
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Clinical Epidemiology Unit, Osakidetza-Basque Health Service, Barakaldo, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Rita Sainz de Rozas
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Itxasne Lekue
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo San Vicente
- Zumarraga Health Center, Goierri-Alto Urola Integrated Health Organization, Osakidetza-Basque Health Service, Zumarraga, Spain
| | - Jose Antonio Quindimil
- Sestao Health Center, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Sestao, Spain
| | - Rafael Rotaeche
- Primary Care Research Unit of Gipuzkoa, Organization of Integrated Health Services of Gipuzkoa, Osakidetza-Basque Health Service, Biogipuzkoa Health Research Institute, Donostia-San Sebastian, Spain
| | - Arritxu Etxeberria
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Carmela Mozo
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Monica Martinez-Cengotitabengoa
- School of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
- Primary Care Pharmacy Unit, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Monica Monge
- Muskiz Health Center, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Muskiz, Spain
| | - Cristina Gómez-Ramírez
- Cardiology Department, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo Samper
- Corporate Pharmacy Service, Directorate of Healthcare Assistance, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Mikel Ogueta Lana
- Subdirectorate of Quality and Health Information Systems, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Sara Celorrio
- Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | | | - Marta Llarena
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Marta Gonzalez Saenz de Tejada
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Arturo García-Alvarez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
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Artieta-Pinedo I, Paz-Pascual C, Espinosa M, García-Alvarez A, Group TEQ, Bully P. Coping strategies during pregnancy and their relationship with anxiety and depression. Women Health 2023; 63:296-307. [PMID: 36941108 DOI: 10.1080/03630242.2023.2188097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
How individuals perceive and cope with stressful situations may determine their level of anxiety or depression. The identification of coping strategies (CS) in pregnancy could help prevent depression and anxiety (D&A), and their consequent effects on the health of the mother and the baby. A cross-sectional descriptive correlational study was conducted to identify the CS most commonly used by pregnant women in a Spanish population and to evaluate the association of these CS with D&A. A consecutive sample of 282 pregnant women over 18 years of age were recruited when attended midwife consultations and through snowball sampling between December 2019 and January 2021 in the Basque public health system. CS were measured using the RevisedPrenatal Coping Inventory (NuPCI) questionnaire, assigning the score to an avoidant, preparatory or spiritual scale. Cutoff points were established to categorize anxiety and depressive symptomatology, using the STAI-S and EPDS scales. Multivariate logistic regression models were constructed to analyze the association between CS and D&A. The results show that the higher the score on the avoidance subscale, the higher the likelihood of having an anxiety disorder (OR: 8.88 (95 percent Confidence Interval [CI] 4.26-20.1), and depressive symptoms (OR: 8.29 (95 percent CI 4.24-17.4). Multiparous women are more likely to have anxiety (OR: 3.41 (95 percent CI 1.58-7.5) or depressive symptomatology (OR: 4.1 (95 percent CI 2.04-8.53) during pregnancy. These results highlight the need to consider the evaluation of CS used during pregnancy to tailor the care provided, but further studies on the implementation and effectiveness of interventions are needed.
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Affiliation(s)
- Isabel Artieta-Pinedo
- Primary Care Midwife OSI Barakaldo-Sestao Osakidetza Basque Health Service, Bizkaia, Spain
- Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain
- School of Nursing, University of the Basque Country, Bizkaia, Spain
| | - Carmen Paz-Pascual
- Primary Care Midwife OSI Barakaldo-Sestao Osakidetza Basque Health Service, Bizkaia, Spain
- Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain
- Midwifery Training Unit of Basque Country, Bilbao, Spain
| | - Maite Espinosa
- Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain
- Osakidetza Basque Health Service-OSI General Management, Bizkaia, Spain
| | - Arturo García-Alvarez
- Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain
- Osakidetza Basque Health Service-OSI General Management, Bizkaia, Spain
| | - The Ema-Q Group
- The ema-Q Group: Multidisciplinary Group of Midwives, Medical Professionals, Psychologists and Researchers of Osakidetza Basque Health Service and University of Basque Country, Bizkaia, Spain
| | - Paola Bully
- Methodological and Statistical Consulting, Bizkaia, Spain
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Capdevila Castillon J, Plana M, Castelo B, Iglesias L, Hernando J, Yaya Tur R, Baste N, Carmona-Bayonas A, Ruiz S, Trigo J, Lorenzo-Lorenzo I, Grande E, Lorente D, Ugidos L, Marquina G, García-Alvarez A, Taberna M, Villamayor J, Molina-Cerrillo J, Alonso-Gordoa T. 1645O Durvalumab (D) plus tremelimumab (T) for the treatment of patients with progressive, refractory advanced thyroid carcinoma: The DUTHY (GETNE-T1812) trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Baraibar Argota I, Garcia Rodriguez A, Salvà Ballabrera F, Ros Montana F, Saoudi Gonzalez N, Comas R, Castillo G, Sanchis M, Hernando Cubero J, García-Alvarez A, Capdevila Castillon J, Martí M, Landolfi S, Espin E, Nuciforo P, Vivancos A, Tabernero J, Elez Fernandez M. 332P Impact of the COVID-19 pandemic in the early-onset colorectal cancer (EOCRC). Ann Oncol 2022. [PMCID: PMC9472523 DOI: 10.1016/j.annonc.2022.07.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Espinosa Cifuentes M, Artieta-Pinedo I, Paz-Pascual C, Bully-Garay P, García-Alvarez A. EMAeHealth, a digital tool for the self-management of women's health needs during pregnancy, childbirth and the puerperium: protocol for a hybrid effectiveness-implementation study. BMJ Open 2022; 12:e055031. [PMID: 36575817 PMCID: PMC9438065 DOI: 10.1136/bmjopen-2021-055031] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION EHealth can help health service users take a more active role in decision-making and help health professionals guide the patient in this process. A digital tool has been designed to support maternal education (ME), and it is organised into four areas: (1) information, (2) communication, (3) health self-management and (4) clinical data. The main objective of the study is to evaluate the effectiveness of the EMAeHealth digital tool, and assess its usability and acceptability under routine conditions. METHODS AND ANALYSIS Hybrid implementation-effectiveness design: (1) A cluster randomised, prospective, longitudinal, multicentre clinical trial to evaluate the effectiveness of EMAeHealth in (A) improving health-related quality of life (primary outcome), (B) improving self-efficacy for labour and childbirth and self-efficacy in breast feeding and (C) reducing the number of visits to the obstetric emergency services and health centre in situations of 'non-pathological pregnancy', 'false labour pains' and 'non-pathological puerperium'. The EMAeHealth intervention plus usual care will be compared with receiving only usual care, which includes traditional ME. N=1080 participants, 540 for each study arm. Two measurements will be made throughout the pregnancy and three in the first 16 weeks post partum. (2) A mixed-method study to evaluate the usability and acceptability of the tool, barriers and facilitators for its use, and implementation in our health system: focus groups (women, professionals and agents involved) and a quantitative analysis of implementation indicators. ANALYSIS It will be carried out by intention to treat, using mixed models taking into account the hierarchical structure of the data and per protocol to evaluate the effectiveness of the express use of the digital tool. ETHICS AND DISSEMINATION Clinical Research Ethics Committee of Euskadi, Spain, (Ref: PI2020044) approved this study. The results will be actively disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04937049.
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Affiliation(s)
- Maite Espinosa Cifuentes
- Primary Care Subdirectorate, Osakidetza-Basque Health Service, Vitoria-Gazteiz, Spain
- Primary Health Care Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Isabel Artieta-Pinedo
- Primary Health Care Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Zuazo Primary Care Health Centre, Osakidetza-Basque Health Service, Bizkaia, Spain
- School of Nursing, University of the Basque Country, Barakaldo, Spain
| | - Carmen Paz-Pascual
- Primary Health Care Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Sestao Primary Care Health Centre, Osakidetza-Basque Health Service, Bizkaia, Spain
- Midwifery Training Unit, University of Basque Country, Barakaldo, Spain
| | | | - Arturo García-Alvarez
- Primary Care Subdirectorate, Osakidetza-Basque Health Service, Vitoria-Gazteiz, Spain
- Primary Health Care Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Hernando-Calvo A, García-Alvarez A, Villacampa G, Ortiz C, Bodet D, García-Patos V, Recio JA, Dienstmann R, Muñoz-Couselo E. Dynamics of clinical biomarkers as predictors of immunotherapy benefit in metastatic melanoma patients. Clin Transl Oncol 2020; 23:311-317. [PMID: 32562197 DOI: 10.1007/s12094-020-02420-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/07/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Baseline LDH, derived neutrophil-lymphocyte ratio (dNLR) and immune-related adverse events (irAEs) are associated with outcomes of patients with metastatic melanoma (MM). We hypothesized whether dynamic shifts in LDH, dNLR and incidence of irAEs may impact the prognosis of MM patients treated with anti-CTLA4 or anti-PD1 as single agents. METHODS Retrospective analysis of medical charts from MM patients with prospective monitoring of dNLR, LDH values and irAE incidence. Primary endpoint was overall survival (OS). RESULTS Patients switching from either high dNLR (≥2.5) to low dNLR (HR: 0.14; 0.03-0.74; p = 0.02) or high LDH (≥1.5 × ULN) to low LDH levels (HR: 0.08; 0.01-0.68; p = 0.02) had significantly better OS than those with high dNLR or LDH scores at the end of cycle 2. Longer OS was also observed in patients developing irAEs ≥ grade 2 as compared to no irAEs (HR: 0.2; 0.05-0.89; p = 0.03). CONCLUSIONS We found that major shifts in dNLR and LDH measures from baseline to cycle 2 measures and shifts from baseline to cycle 2 are significantly associated with OS in MM patients receiving single agent anti-PD1 therapy. Laboratory changes and clinical variables may help optimize prognostic estimates.
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Affiliation(s)
| | | | - G Villacampa
- Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - C Ortiz
- Vall D'Hebron University Hospital, Barcelona, Spain
| | - D Bodet
- Vall D'Hebron University Hospital, Barcelona, Spain
| | | | - J A Recio
- Vall D'Hebron University Hospital, Vall D'Hebron Research Institute (VHIR), Barcelona, Spain
| | - R Dienstmann
- Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Cid D, García-Alvarez A, Domínguez L, Fernández-Garayzábal JF, Vela AI. Pasteurella multocida isolates associated with ovine pneumonia are toxigenic. Vet Microbiol 2019; 232:70-73. [PMID: 31030847 DOI: 10.1016/j.vetmic.2019.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/15/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 02/04/2023]
Abstract
The P. multocida toxin (PMT), a dermonecrotic protein encoded by the toxA gene, is the major virulence factor of capsular type D P. multocida strains causing progressive atrophic rhinitis (PAR) in pigs. A high frequency of P. multocida isolates harboring the toxA gene has been found among ovine pneumonic isolates, although the ability of these isolates to express PMT has never been examined. In this study we have investigated the ability of ovine toxA+ P. multocida isolates (n = 57) to express a functional toxin by detection of PMT toxin antigen using an ELISA test and its cytopathic effect in a Vero cell assay. PMT antigen was expressed in the great majority (54/57; 94.7%) of toxA+ isolates. Moreover, the 100% toxA+ ovine isolates analyzed produced a cytopathic effect in Vero cells within 24-48 h post-inoculation, identical to that described for porcine toxigenic P. multocida isolates. These results show for the first time that, in addition to isolates associated with PAR, isolates of P. multocida associated with pneumonia in sheep are also toxigenic. In addition, we found a total agreement (Kappa = 1; C.I. 0.75-1.25) between the detection of the toxA gene and the toxigenic capability of P. multocida isolates, indicating the PCR detection of toxA would be a suitable predictive marker of the toxigenic fitness of P. multocida.
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Affiliation(s)
- D Cid
- Animal Health Department, Veterinary School, Universidad Complutense de Madrid, Spain.
| | - A García-Alvarez
- Animal Health Department, Veterinary School, Universidad Complutense de Madrid, Spain
| | - L Domínguez
- Animal Health Department, Veterinary School, Universidad Complutense de Madrid, Spain; Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, Madrid, Spain
| | - J F Fernández-Garayzábal
- Animal Health Department, Veterinary School, Universidad Complutense de Madrid, Spain; Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, Madrid, Spain
| | - A I Vela
- Animal Health Department, Veterinary School, Universidad Complutense de Madrid, Spain; Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, Madrid, Spain
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Orueta JF, García-Alvarez A, Aurrekoetxea JJ, García-Goñi M. FINGER (Forming and Identifying New Groups of Expected Risks): developing and validating a new predictive model to identify patients with high healthcare cost and at risk of admission. BMJ Open 2018; 8:e019830. [PMID: 29858409 PMCID: PMC5988109 DOI: 10.1136/bmjopen-2017-019830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Predictive statistical models used in population stratification programmes are complex and usually difficult to interpret for primary care professionals. We designed FINGER (Forming and Identifying New Groups of Expected Risks), a new model based on clinical criteria, easy to understand and implement by physicians. Our aim was to assess the ability of FINGER to predict costs and correctly identify patients with high resource use in the following year. DESIGN Cross-sectional study with a 2-year follow-up. SETTING The Basque National Health System. PARTICIPANTS All the residents in the Basque Country (Spain) ≥14 years of age covered by the public healthcare service (n=1 946 884). METHODS We developed an algorithm classifying diagnoses of long-term health problems into 27 chronic disease groups. The database was randomly divided into two data sets. With the calibration sample, we calculated a score for each chronic disease group and other variables (age, sex, inpatient admissions, emergency department visits and chronic dialysis). Each individual obtained a FINGER score for the year by summing their characteristics' scores. With the validation sample, we constructed regression models with the FINGER score for the first 12 months as the only explanatory variable. RESULTS The annual FINGER scores obtained by patients ranged from 0 to 57 points, with a mean of 2.06. The coefficient of determination for healthcare costs was 0.188 and the area under the receiver operating characteristic curve was 0.838 for identifying patients with high costs (>95th percentile); 0.875 for extremely high costs (>99th percentile); 0.802 for unscheduled admissions; 0.861 for prolonged hospitalisation (>15 days); and 0.896 for death. CONCLUSION FINGER presents a predictive power for high risks fairly close to other classification systems. Its simple and transparent architecture allows for immediate calculation by clinicians. Being easy to interpret, it might be considered for implementation in regions involved in population stratification programmes.
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Affiliation(s)
- Juan F Orueta
- Centro de Salud de Astrabudua (Primary Health Care Center of Astrabudua), OSI Uribe, Osakidetza (Basque Health Service), Erandio, Spain
| | | | - Juan J Aurrekoetxea
- Department of Preventative Medicine and Public Health, University of the Basque Country (UPV/EHU), Bizkaia, Spain
- Biodonostia Health Research Institute, San Sebastian, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Manuel García-Goñi
- Department of Applied and Structural Economics & History, Faculty of Economics and Business, Universidad Complutense de Madrid, Madrid, Spain
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Candel FJ, García-García AB, Peñuelas M, García-Alvarez A, Chiarella F, López-González L, García-Salguero C, Lejárraga C, Rodríguez-Avial I. [Update in Infectious Diseases 2016]. Rev Esp Quimioter 2016; 29 Suppl 1:1-5. [PMID: 27608304] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Antimicrobial resistance increases it health, social and economic impact. in all areas (state, regional and local), initiatives to try to contain the problem of resistance arise. In the update of this year 2016, we study microbiological, epidemiological and clinical aspects of multi-resistant bacteria, as well as resources for therapeutic approach, from ancient to modern drugs from therapeutic combinations to optimization Stewardship programs. In the case of fungal infection, we analyze clinical scenarios with different species in yeast or new clinical settings in filamentous fungi. Taking paediatric population, homologies and differences with adults in invasive fungal infection were compared. Finally in the field of parasitology, treatment of severe malaria imported or that resistant to antimalarial drugs were reviewed.
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Affiliation(s)
- F J Candel
- Francisco Javier Candel González. Servicio de Microbiología Clínica. Hospital Clínico San Carlos. Universidad Complutense. Madrid. Avda Doctor Martín Lágos s/n28040 Madrid, Spain.
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Orueta JF, García-Alvarez A, Grandes G, Nuño-Solinís R. The Origin of Variation in Primary Care Process and Outcome Indicators: Patients, Professionals, Centers, and Health Districts. Medicine (Baltimore) 2015; 94:e1314. [PMID: 26252315 PMCID: PMC4616568 DOI: 10.1097/md.0000000000001314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Healthcare providers are often evaluated by studying variability in their indicators. However, the usefulness of this analysis may be limited if we do not distinguish the variability attributable to health professionals and organizations from that associated with their patients.Our objectives are to describe the main process and outcome indicators of primary healthcare services, analyzing the contribution to variability in these indicators from different levels: individual, health professional, health center, and health district.This is a cross-sectional study that includes all.All the individuals covered by the public Basque Health Service (children [age 0-13], n = 247,493; adults [≥14 years old], n = 1,959,682) over a 12-month period.We calculated the number of visits to primary care doctors, number of referrals, prescription costs, and potentially avoidable hospitalizations for ambulatory care sensitive conditions (ACSCs). Using multilevel analysis, we determined the percentage of variance attributable to each level.After adjusting for the characteristics of patients (demographic, socioeconomic, and morbidity), doctors (panel size), health center (size, staff satisfaction, demographic structure of the community), and health district, the variance in the indicators was mainly attributable to differences between patients, independently of the attending health professional, the center, or the healthcare organization, both in children (94.21% for visits to the doctor; 96.66% for referrals; 98.57% for prescription costs; 90.02% for potentially avoidable hospitalizations for ACSCs) and in adults (88.10%; 96.26%; 97.92%; and 93.77%, respectively).The limited contribution of health professionals and organizations to variability in indicators should be taken into account when performing evaluations and planning quality improvement strategies.
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Affiliation(s)
- Juan F Orueta
- From the Centro de Salud de Astrabudua (Primary Health Care Center of Astrabudua), Osakidetza (Basque Health Service), Erandio (Bizkaia), Spain (JFO); Primary Care Research Unit-Bizkaia, Osakidetza, Bilbao, Spain (AG-A, GG); and Deusto Business School Health, University of Deusto, Bilbao, Spain (RN-S)
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Orueta JF, García-Alvarez A, Grandes G, Nuño-Solinís R. Variability in potentially preventable hospitalisations: an observational study of clinical practice patterns of general practitioners and care outcomes in the Basque Country (Spain). BMJ Open 2015; 5:e007360. [PMID: 25986637 PMCID: PMC4442212 DOI: 10.1136/bmjopen-2014-007360] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explain the variability in the frequency of potentially preventable hospitalisations (ambulatory care sensitive conditions, ACSCs) based on factors at multiple levels (individual, health professional, health centre and health district), and specifically using resource efficiency indicators for general practitioners (GPs). DESIGN Cross-sectional study. We analysed primary care electronic health records and hospital discharge data using multilevel mixed models. SETTING Primary care network of the Basque Health Service (Spain). PARTICIPANTS All the residents in the Basque Country ≥14 years of age, covered by the public healthcare system (n=1,959,682), and all the GPs (n=1193) and health centres (n=130). MAIN OUTCOME MEASURES Individuals admitted for ACSCs, over a 12- month period. RESULTS Admissions for ACSCs were less frequent among patients who were female, middle-aged or from the highest socioeconomic classes. The health centre variables considered and GP list size were not found to be significant. After adjusting for the variables studied including morbidity, the risk of hospital admission was higher among individuals under the care of GPs with greater than expected numbers of patient visits and prescribing costs (OR=1.27 (95% CI 1.18 to 1.37); 1.16 (1.08 to 1.25)), and who make fewer referrals than the mean among their colleagues (OR=1.33 (1.22 to 1.44)). CONCLUSIONS When assessing activities and procedure indicators in primary care, we should also define outcome-based criteria. Specifically, GPs who are repeatedly visited by their patients, have higher prescribing costs and are more reluctant to refer patients to specialists obtain poorer outcomes.
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Affiliation(s)
- Juan F Orueta
- Head of Centro de Salud de Astrabudua (Primary Health Care Center of Astrabudua), Osakidetza (Basque Health Service), Erandio, Bizkaia, Spain
| | | | - Gonzalo Grandes
- Primary Care Research Unit-Bizkaia, Osakidetza, Bilbao, Spain
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Orueta JF, Nuño-Solinís R, García-Alvarez A, Alonso-Morán E. Prevalence of multimorbidity according to the deprivation level among the elderly in the Basque Country. BMC Public Health 2013; 13:918. [PMID: 24088559 PMCID: PMC3852493 DOI: 10.1186/1471-2458-13-918] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 12/28/2012] [Accepted: 09/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multimorbidity is clearly a major challenge for healthcare systems. However, currently, its magnitude and impact on healthcare expenditures is still not well known. The objective of this paper is to present an overview of the prevalence of multimorbidity by deprivation level in the elderly population of the Basque Country. METHODS We conducted a cross-sectional analysis that included all the inhabitants of the Basque Country aged 65 years and over (N = 452,698). This was based on data from primary care electronic medical records, hospital admissions, and outpatient care databases, for a 4-year period. The health problems of the patients were identified from their diagnoses and prescriptions. Multimorbidity was defined as the presence of two or more chronic diseases out of a list of 47 of the most important and common chronic conditions consistent with the literature. In addition, we explored socio-economic and demographic variables such as age, sex, and deprivation level. RESULTS Multimorbidity was found in 66.13% of the population aged 65 and over and increases with age until 80 years. The prevalence of multimorbidity was higher in deprived (69.94%) than better-off (60.22%) areas. This pattern of differences between the most and least disadvantaged areas was observed in all age groups and more marked in female (70.96-59.78%) than in male (68.54-60.86%) populations. In almost all diseases studied (43 out of 47), 90% of patients had been diagnosed with at least one other illness. It was also frequent the coexistence of mental and physical health problems in the same person and the presence of multiple physical diseases is higher in patients with mental disease than in the rest of population (74.97% vs. 58.14%). CONCLUSION Multimorbidity is very common among people over 65 years old in the Basque Country, particularly in unfavourable socioeconomic environments. Given the ageing population, multimorbidity and its consequences should be taken into account in healthcare policy, organization of care and medical research. Administrative health databases are readily available sources of a range of information that can be useful for such purposes.
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Affiliation(s)
- Juan F Orueta
- O+berri, Basque Institute for Healthcare Innovation, Plaza Asua 1, 48150 Sondika, Spain.
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Orueta JF, Nuño-Solinís R, García-Alvarez A, Alonso-Morán E. Prevalence of multimorbidity according to the deprivation level among the elderly in the Basque Country. BMC Public Health 2013. [PMID: 24088559 DOI: 10.1186/1471‐2458‐13‐918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multimorbidity is clearly a major challenge for healthcare systems. However, currently, its magnitude and impact on healthcare expenditures is still not well known. The objective of this paper is to present an overview of the prevalence of multimorbidity by deprivation level in the elderly population of the Basque Country. METHODS We conducted a cross-sectional analysis that included all the inhabitants of the Basque Country aged 65 years and over (N = 452,698). This was based on data from primary care electronic medical records, hospital admissions, and outpatient care databases, for a 4-year period. The health problems of the patients were identified from their diagnoses and prescriptions. Multimorbidity was defined as the presence of two or more chronic diseases out of a list of 47 of the most important and common chronic conditions consistent with the literature. In addition, we explored socio-economic and demographic variables such as age, sex, and deprivation level. RESULTS Multimorbidity was found in 66.13% of the population aged 65 and over and increases with age until 80 years. The prevalence of multimorbidity was higher in deprived (69.94%) than better-off (60.22%) areas. This pattern of differences between the most and least disadvantaged areas was observed in all age groups and more marked in female (70.96-59.78%) than in male (68.54-60.86%) populations. In almost all diseases studied (43 out of 47), 90% of patients had been diagnosed with at least one other illness. It was also frequent the coexistence of mental and physical health problems in the same person and the presence of multiple physical diseases is higher in patients with mental disease than in the rest of population (74.97% vs. 58.14%). CONCLUSION Multimorbidity is very common among people over 65 years old in the Basque Country, particularly in unfavourable socioeconomic environments. Given the ageing population, multimorbidity and its consequences should be taken into account in healthcare policy, organization of care and medical research. Administrative health databases are readily available sources of a range of information that can be useful for such purposes.
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Affiliation(s)
- Juan F Orueta
- O+berri, Basque Institute for Healthcare Innovation, Plaza Asua 1, 48150 Sondika, Spain.
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González-Arriaga P, Pascual T, García-Alvarez A, Fernández-Somoano A, López-Cima MF, Tardón A. Genetic polymorphisms in MMP 2, 9 and 3 genes modify lung cancer risk and survival. BMC Cancer 2012; 12:121. [PMID: 22455335 PMCID: PMC3350430 DOI: 10.1186/1471-2407-12-121] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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: 11/29/2011] [Accepted: 03/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Matrix metalloproteases (MMPs) are proteolytic enzymes that contribute to all stages of tumour progression, including the later stages of invasion and metastasis. Genetic variants in the MMP genes may influence the biological function of these enzymes and change their role in carcinogenesis and progression. We have investigated the association between the -735 C/T, the -1171 5A/6A, and the -1562 C/T polymorphisms in the MMP2, MMP3 and MMP9 genes, respectively, and the risk and survival of lung cancer. Methods The case-control study includes 879 lung cancer patients and 803 controls from a Caucasian population in Spain (CAPUA study). Genotypes were determined by PCR-RFLP. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression. The Kaplan-Meier method, long-rank test and Cox's were used for the survival analysis. Results The MMP9 -1562 T/T genotype was associated with a statistically significant decreased risk of developing lung cancer (OR = 0.23; 95% CI: 0.06-0.85), whereas no association was found for the MMP2 -735 C/T and MMP3 -1171 5A/6A polymorphisms. The MMP2 -735 T/T genotype was statistically significantly associated with a decreased survival in non-small cell lung cancer (NSCLC) patients, identified as an independent prognosis factor of survival (hazard ratio (HR) = 1.79; 95% CI: 1.00-3.20). In contrast, no association was found between the MMP3 -1171 5A/6A and the MMP9 -1562 C/T polymorphisms and survival. Conclusions These findings support the hypothesis that the MMP9 -1562 C/T polymorphism is associated with a protective effect against the development of lung cancer and suggest that the MMP2 -735 C/T polymorphism modify the length of survival in NSCLC patients.
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Affiliation(s)
- Patricia González-Arriaga
- Departamento de Medicina, Unidad de Epidemiología Molecular del Cáncer del Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Spain.
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Adonina T, Gonzalez-Arriaga P, Lopez-Cima M, Fernandez-Somoano A, García-Alvarez A, Pascual T. 88 Genetic polymorphisms in the MMP2 and MMP9 genes decreased lung cancer risk. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Piedra Buena A, García-Alvarez A, Díez-Rojo MA, Ros C, Fernández P, Lacasa A, Bello A. Use of pepper crop residues for the control of root-knot nematodes. Bioresour Technol 2007; 98:2846-51. [PMID: 17098424 DOI: 10.1016/j.biortech.2006.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 09/27/2006] [Accepted: 09/27/2006] [Indexed: 05/12/2023]
Abstract
The biofumigant effect of pepper crop residues (PCR) for controlling Meloidogyne incognita populations was evaluated. Under laboratory conditions, 0, 5, 10 and 20 g PCR were applied to 500 g nematode infested soil, with four replicates per treatment. After 20 days at 25 degrees C, PCR reduced significantly M. incognita populations and root galling indices in susceptible tomato cv. Marmande, and increased K, N and organic C in soil. In the field, biofumigation with PCR combined with fresh animal manures (with and without plastic cover), methyl bromide, and a control were evaluated through root galling indices on a pepper crop. Each treatment, except for the control, had a grafted and non-grafted susceptible pepper sub-treatment, with three replicates. Root galling indices were lower, and yields higher, on grafted plants, biofumigation with PCR and plastic cover, with similar values as MB treatment, suggesting that biofumigation with PCR is an efficient non-chemical alternative to control M. incognita populations, especially when applied with plastic cover, nitrogen-rich organic matter and followed by grafting on resistant pepper.
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Affiliation(s)
- A Piedra Buena
- Dpto Agroecología, Centro de Ciencias Medioambientales-Consejo Superior de Investigaciones Científicas, c/Serrano, 115 dpdo, 28006 Madrid, Spain.
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Alonso-Fresán MU, García-Alvarez A, Salazar-García F, Vázquez-Chagoyán JC, Pescador-Salas N, Saltijeral-Oaxaca J. Prevalence of Cryptosporidium spp. in asymptomatic sheep in family flocks from Mexico State. ACTA ACUST UNITED AC 2005; 52:482-3. [PMID: 16364025 DOI: 10.1111/j.1439-0450.2005.00889.x] [Citation(s) in RCA: 11] [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: 11/29/2022]
Abstract
To determine Cryptosporidium spp. prevalence in faeces from asymptomatic sheep, 37 family flocks in Mexico State were sampled. Data were collected by the interview method and Ziehl-Neelsen stain of faecal samples for Cryptosporidium identification. The independent group proportion hypothesis test was used for differences in prevalences between sheep farms. A 34.3% general prevalence was found, and prevalence in herds with >100 animals was significantly higher (40.6%). Correlation was found between flock size and Cryptosporidium spp. presence (odds ratio, OR, 2.57; confidence interval, IC(95%), 1.84-3.60).
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Affiliation(s)
- M U Alonso-Fresán
- Centro de Investigación y Estudios Avanzados en Salud Animal, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma del Estado de México, Mexico.
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Criado MT, De Juana P, Hillman N, Koning A, Del Olmo D, Vázquez C, García-Alvarez A. [Nutritional management of radiation-induced enteritis: apropos of a case]. NUTR HOSP 1999; 14:138-41. [PMID: 10424130] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
We present a case of a 46-year-old woman who is hospitalized in March of 1997 for a picture of severe mixed malnutrition. We describe the clinical history since the diagnosis of an endometrium carcinoma in 1995, treated with radiation therapy, with the aim of determining the etiology of the severe malnutrition picture, as well as the different complications she presented in the course of her hospitalization that justify the decisions made in the choice of the nutritional support.
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Affiliation(s)
- M T Criado
- Servicio de Farmacia, Hospital Severo Ochoa, Leganés, Madrid, España
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