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Pinilla J, López-Valcárcel BG, Bernal-Delgado E. Unravelling risk selection in Spanish general government employee mutual funds: evidence from cancer hospitalizations in the public health network. Eur J Health Econ 2024:10.1007/s10198-024-01671-5. [PMID: 38376648 DOI: 10.1007/s10198-024-01671-5] [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] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
Government employees in Spain are covered by public Mutual Funds that purchase a uniform basket of benefits, equal to the ones served to the general population, from private companies. Companies apply as private bidders for a fixed per capita premium hardly adjusted by age. Our hypothesis is that this premium does not cover risks, and companies have incentives for risk selection, which are more visible in high-cost patients. We focus on a particularly costly disease, cancer, whose prevalence is similar among government employees and the general population. We compare hospitalisations in the public hospitals of the government employees that have chosen public provision and the general population. We analysed a database of hospital discharges in the Valencian Community from 2010 to 2015 (3 million episodes). Using exact matching and logistic models, we find significant risk selection; thus, in hospitalised government employees, the likelihood for a solid metastatic carcinoma and non-metastatic cancer to appear in the registry is 31% higher than in the general population. Lymphoma shows the highest odds ratio of 2.64. We found quantitatively important effects. This research provides indirect evidence of risk selection within Spanish Mutual Funds for government employees, prompting action to reduce incentives for such a practice. More research is needed to figure out if what we have observed with cancer patients occurs in other conditions.
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Affiliation(s)
- Jaime Pinilla
- Department of Quantitative Methods for Economics and Management, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, Campus de Tafira, 34-35017, Las Palmas de Gran Canaria, Spain.
| | - Beatriz G López-Valcárcel
- Department of Quantitative Methods for Economics and Management, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, Campus de Tafira, 34-35017, Las Palmas de Gran Canaria, Spain
| | - Enrique Bernal-Delgado
- Data Science for Health Services and Policy Research Group, Aragon Health Sciences Institute, Institute for Health Sciences (IACS), San Juan Bosco 13 (CIBA Building), 50009, Zaragoza, Spain
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Abstract
Research question We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain.
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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Puig-Codina L, Pinilla J, Puig-Junoy J. The impact of taxing sugar-sweetened beverages on cola purchasing in Catalonia: an approach to causal inference with time series cross-sectional data. Eur J Health Econ 2021; 22:155-168. [PMID: 33247366 DOI: 10.1007/s10198-020-01246-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
Sugar-sweetened beverage (SSB) taxes related to the quantity of sugar have appeared as a popular regulatory tool around the world during the last decade showing important variations in their implementation and impact. We evaluated the impact of a new SSB tax implemented in Catalonia since May 1, 2017 on the purchased quantities and penetration rates of taxed and untaxed cola beverages. We use aggregate time series of cola beverages purchases in all 17 Spanish Autonomous Communities before and after the implementation of the SBB tax in Catalonia, from January 2013 to June 2019. A comparison between two different types of causal inference methods was conducted: a two-way fixed effects difference in differences model and a modified synthetic control model. Regular cola purchases decreased 12.1% and their penetration rate decreased by 1.27 points during the two post-intervention years using the preferred model. Diet cola purchases increased 17.0% and their penetration rate also increased by 1.65 points. Only regular cola results were robust to all placebo test checks. The SSB tax implemented in Catalonia in 2017 significantly reduced the volume and penetration rates of regular colas with no robust evidence for the substitution effect on diet colas.
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Affiliation(s)
- Lluc Puig-Codina
- Dep. de Fundamentos del Análisis Económico, Universidad de Alicante, Alicante, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Jaume Puig-Junoy
- Barcelona School of Management, Pompeu Fabra University (BSM-UPF), C/Balmes 132-134, 34-08008, Barcelona, Catalonia, Spain.
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Puig-Junoy J, Pinilla J. Free prescriptions for low-income pensioners? The cost of returning to free-of-charge drugs in the Spanish National Health Service. Health Econ 2020; 29:1804-1812. [PMID: 32931075 DOI: 10.1002/hec.4161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 07/29/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
This study estimated the impact of reducing a capped low coinsurance rate for outpatient medicines to nil for low-income pensioners and disabled individuals in the Valencian Community (Spain). This reduction was implemented in January 2016 as a regional reform which modified the national cost-sharing reform adopted in July 2012. The impact of this intervention on the number of monthly prescriptions dispensed between July 2012 and December 2018 was estimated using two different approaches of the synthetic control method, the classical method and the method based on Bayesian structural time series. The estimates from both methods were similar, showing significant overall increases of 6.34% and 6.70% [95% credible interval: 4.05, 9.47], respectively in the number of prescriptions dispensed in this region. These results are similar to those of the previous studies indicating that reducing price from a small amount to zero discontinuously boosts demand. This evidence indicates that the impact of this intervention on the budget of the regional health service is far greater than the amount of the subsidy in the public budget. These results are useful for making accurate budgetary projections for similar eliminations of charges for low-income pensioners in the Spanish National Health Service.
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Affiliation(s)
- Jaume Puig-Junoy
- Barcelona School of Management (BSM-UPF), Pompeu Fabra University, Barcelona, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods, University of Las Palmas (ULPGC), Las Palmas de Gran Canaria, Spain
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Tomaino L, Pinilla J, Rodríguez-Mireles S, González López-Valcárcel B, Barber-Pérez P, Sierra A, La Vecchia C, Serra-Majem L. Impact of sandstorm and carnival celebrations on SARS-CoV-2 spreading in Tenerife and Gran Canaria (Canary Islands, Spain). Gac Sanit 2020; 35:565-568. [PMID: 33139083 DOI: 10.1016/j.gaceta.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We address the hypothesis that the extraordinary sandstorm occurred on 22-24 February 2020 might have a role in the different cumulated incidence of COVID-19 cases between the islands of Tenerife and Gran Canaria, since it obliged to reduce significantly air traffic and forced to suspend all major carnival street events in all most locations. METHOD We performed a retrospective analysis of COVID-19 cases as to 1 April 2020 according to symptoms onset, weather-related data and Carnival events in Tenerife and Gran Canaria. RESULTS The sandstorm occurred on February 22-24, 2020, forced air traffic to close, reducing the influx of tourists to the Canary Islands and suspending carnival events in most places, except in Santa Cruz de Tenerife. Cumulated incidence as to 1 April was 132.81/100,000 in Tenerife, and 56.04/100,000 in Gran Canaria. CONCLUSIONS The suspension of Carnival events due to the sandstorm in the Canary Islands contributed to reduce differently the SARS-CoV-2 spread in Tenerife and Gran Canaria.
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Affiliation(s)
- Laura Tomaino
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas, Spain; Department of Clinical and Community Sciences (DISCCO), Università degli Studi di Milano, Milan, Italy; COVIDCAN, COVID-19 Study and Analysis Group, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Jaime Pinilla
- COVIDCAN, COVID-19 Study and Analysis Group, University of Las Palmas de Gran Canaria, Las Palmas, Spain; Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Silvia Rodríguez-Mireles
- COVIDCAN, COVID-19 Study and Analysis Group, University of Las Palmas de Gran Canaria, Las Palmas, Spain; Admission and Clinical Documentation Service, Hospital Universitario de Gran Canaria Dr. Negrín, Canary Health Service, Las Palmas, Spain
| | - Beatriz González López-Valcárcel
- COVIDCAN, COVID-19 Study and Analysis Group, University of Las Palmas de Gran Canaria, Las Palmas, Spain; Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain; Scientific Advisory Group of the COVID-19 Committee of the Government of the Canary Islands, Las Palmas, Spain
| | - Patricia Barber-Pérez
- COVIDCAN, COVID-19 Study and Analysis Group, University of Las Palmas de Gran Canaria, Las Palmas, Spain; Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Antonio Sierra
- Department of Preventive Medicine and Public Health, University of La Laguna, La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
| | - Carlo La Vecchia
- Department of Clinical and Community Sciences (DISCCO), Università degli Studi di Milano, Milan, Italy
| | - Lluís Serra-Majem
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas, Spain; COVIDCAN, COVID-19 Study and Analysis Group, University of Las Palmas de Gran Canaria, Las Palmas, Spain; Scientific Advisory Group of the COVID-19 Committee of the Government of the Canary Islands, Las Palmas, Spain; Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canary Health Service, Las Palmas, Spain.
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Pinilla J, López-Valcárcel BG. Income and wealth as determinants of voluntary private health insurance: empirical evidence in Spain, 2008-2014. BMC Public Health 2020; 20:1262. [PMID: 32814549 PMCID: PMC7437046 DOI: 10.1186/s12889-020-09362-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/27/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have quantitatively estimated the income elasticity of demand of voluntary private health insurance (VPHI) in countries with a universal National Health Service. Most studies to date have uses cross-sectional data. METHODS In this paper we used a longitudinal database from the Bank of Spain to analyse the financial behaviour of approximately six thousand families per wave. We used three waves (2008, 2011 and 2014). We estimated income and wealth semi-elasticities of VPHI in Spain considering personal and family characteristics (age, sex, level of health, education, composition of the household), i.e. changes in the probability of buying VPHI as result of 1% change in income or wealth. We estimated cross-sectional models for each wave and longitudinal models for families remaining for at least two waves, taking account of possible selection bias due to attrition. RESULTS Cross-sectional models suggest that the income effect on the probability of buying a VPHI increased from 2008 to 2014. The positive impact was observed for, wealth. In 2008 a 1% increase in income is associated with an increase in the probability of having VPHI of 0.064 [95%-CI: 0.023; 0.104] - on the probability scale (0.1) - whereas in 2014, this effect is of 0.116 [95%-CI, 0.094; 0.139]. In 2011 and 2014 the wealth effect is not significant at 5%. The estimation of the longitudinal model leads to different results where both, income and wealth are associated with non- significant results. CONCLUSION Our three main conclusions are: 1) Cross-sectional estimates of semi-elasticities of VPHI might be biased upwards; 2) Wealth is alongside income are economic determinants, of the decision to buy VPHI in high-income countries; 3) The effects of income and wealth on the probability of buying VHPI are neither linear nor log-linear. There are no significant differences among 60% of the most disadvantaged families, while the families of the two upper wealth quintiles show clearly differentiated behaviour with a higher probability of insurance.
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Affiliation(s)
- Jaime Pinilla
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus de Tafira sn, 35017, Las Palmas de Gran Canaria, Spain. .,Centre for Research in Health Economics, University Pompeu Fabra, Barcelona, Spain.
| | - Beatriz G López-Valcárcel
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus de Tafira sn, 35017, Las Palmas de Gran Canaria, Spain.,Centre for Research in Health Economics, University Pompeu Fabra, Barcelona, Spain
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Abstract
BACKGROUND Mental health disorders are highly prevalent across countries. They increase over time and impose a severe burden on individuals and societies. OBJECTIVE This paper examines the evolution of mental health over a period of 15 years, paying special attention on the impact of the most recent economic downturn and subsequent recovery, in Spain. METHOD We use data coming from the National Health Surveys of 2006/2007, 2011/2012 and 2016/2017. Mental health is proxied by two measures, doctor-diagnosed mental disorder and psychological distress (based on the 12-item General Health Questionnaire). To account for the relationship between the two mental health indicators, we estimate a bivariate probit model. The potential endogeneity of unemployment status is considered. RESULTS We observe different patterns of the two mental health indicators over time. Psychological distress in men increased during recession years, but slightly decreased among women. Diagnosed mental disorders declined during the peak years of the crisis. Unemployment is a major risk factor for mental distress. Irrespective of the economic conditions, belonging to a higher social class acts as a buffer against psychological distress for women, but not for men. The remaining determinants acted as expected. Women declared worse psychological health than men, and were also more often diagnosed with mental disorders. Having a partner had a protective impact, while providing intensive care to a dependent relative exerted the opposite effect. Education acted as buffer against the onset of psychological distress in women. CONCLUSION Even though the need for mental healthcare increased during the recession, the fact that fewer people were diagnosed suggests that barriers to accessing mental healthcare may be aggravated during the crisis. Policies aiming to tackle the challenges posed by the high prevalence of mental disorders have to be particularly attentive to changes in individuals' socioeconomic situation, including education, unemployment and social class.
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Affiliation(s)
- Alexandrina Stoyanova
- Department of Economics, Faculty of Economics and Business Administration, Universitat de Barcelona, BEAT and CAEPS, 08034, Barcelona, Spain.
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, Universidad de Las Palmas de Gran Canaria, 35017, Las Palmas de Gran Canaria, Spain
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Negrín MA, Pinilla J, Abásolo I. Horizontal equity in access to public GP services by socioeconomic group: potential bias due to a compartmentalised approach. Int J Equity Health 2019; 18:187. [PMID: 31791347 PMCID: PMC6889353 DOI: 10.1186/s12939-019-1091-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/12/2019] [Indexed: 12/01/2022] Open
Abstract
Background Horizontal equity in access to public general practitioner (GP) services by socioeconomic group has been addressed econometrically by testing the statement “equal probability of using public GP services for equal health care needs, regardless of socioeconomic status”. Based on survey data, the conventional approach has been to estimate binomial econometric models in which when the respondent reports having visited a public GP, it counts as 1, otherwise it counts as 0. This is what we call a compartmentalised approach. Those respondents who did not visit a public GP but visited instead another doctor (specialist or private GP) would count as 0 (despite having used instead other modes of health care), thus conclusions of the compartmentalised approach might be biased. In such cases, a multinomial econometric model -that we called comprehensive approach- would be more appropriate to analyse horizontal equity in access to public GP services. The objective of this paper is to test for this potential bias by comparing a compartmentalised and a comprehensive approach, when analysing horizontal equity in access to public GP. Methods Using data from the 2016/17 Spanish National Health Survey, we estimate the probability of visiting a public GP as determined by socioeconomic status, health care need and demographic characteristics. We use binomial and multinomial logit and probit models in order to highlight the potential differences in the conclusions regarding socioeconomic inequities in access to public GP services. Socioeconomic status is proxied by education level, social class and employment situation. Results Our results show that conclusions are sensitive to the approach selected. Particularly, the horizontal inequity favouring individuals with lower education that resulted from the compartmentalised approach disappears under a comprehensive approach and only a social class effect remains. Conclusion An analysis of horizontal equity in access to a particular health care service (like public GP services) undertaken following a compartmentalised approach should be compared with a comprehensive approach in order to test that there is no bias as a consequence of considering as zeros the utilisation of other types of health care.
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Affiliation(s)
- M A Negrín
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - J Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - I Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos. Instituto Universitario de Desarrollo Regional, Universidad de La Laguna, Facultad de Economía, Empresa y Turismo, Campus de Guajara, 38071, La Laguna, Santa Crus de Tenerife, Spain.
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Pinilla J, Negrín MA, Abásolo I. Trends in horizontal inequity in access to public health care services by immigrant condition in Spain (2006-2017). Int J Equity Health 2019; 18:185. [PMID: 31783864 PMCID: PMC6883664 DOI: 10.1186/s12939-019-1092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/20/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this research is to analyse trends in horizontal inequity in access to public health services by immigration condition in Spain throughout the period 2006–2017. We focus on “economic immigrants” because they are potentially the most vulnerable group amongst immigrants. Methods Based on the National Health Surveys of 2006–07 (N = 29,478), 2011–12 (N = 20,884) and 2016–17 (N = 22,903), hierarchical logistic regressions with random effects in Spain’s autonomous communities are estimated to explain the probability of using publicly-financed health care services by immigrant condition, controlling by health care need and other socioeconomic and demographic variables. Results Our results indicate that there are several horizontal inequities, though they changed throughout the decade studied. Regarding primary care services, the period starts (2006–07) with no global evidence of horizontal inequity in access (although the analysis by continent shows inequity that is detrimental to Eastern Europeans and Asians), giving way to inequity favouring economic immigrants (particularly Latin Americans and Africans) in 2011–12 and 2016–17. An opposite trend happens with specialist care, as the period starts (2006–07) with evidence of inequity that is detrimental to economic immigrants (particularly those from North of Africa) but this inequity disappears with the economic crisis and after it (with the only exception of Eastern Europeans in 2011–12, whose probability to visit a specialist is lower than for natives). Regarding emergency care, our evidence indicates horizontal inequity in access that favours economic immigrants (particularly Latin Americans and North Africans) that remains throughout the period. In general, there is no inequity in hospitalisations, with the exception of 2011–12, where inequity in favour of economic immigrants (particularly those from Latin America) takes place. Conclusions The results obtained here may serve, firstly, to prevent alarm about negative discrimination of economic immigrants in their access to public health services, even after the implementation of the Royal Decree RD Law 16/2012. Conversely, our results suggest that the horizontal inequity in access to specialist care that was found to be detrimental to economic immigrants in 2006–07, disappeared in global terms in 2011–12 and also by continent of origin in 2016–17.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Miguel A Negrín
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos, Instituto Universitario de Desarrollo Regional, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain. .,Facultad de Economía, Empresa y Turismo, Campus de Guajara, 38071, La Laguna, Santa Cruz de Tenerife, Spain.
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López-Valcárcel BG, Pinilla J, Barber P. Dying at home for terminal cancer patients: differences by level of education and municipality of residence in Spain. Gaceta Sanitaria 2019; 33:568-574. [DOI: 10.1016/j.gaceta.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/04/2018] [Accepted: 06/10/2018] [Indexed: 11/25/2022]
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Pinilla J, Rodriguez-Caro A. Differences in healthcare utilisation between users and non-users of homeopathic products in Spain: Results from three waves of the National Health Survey (2011-2017). PLoS One 2019; 14:e0216707. [PMID: 31083699 PMCID: PMC6513046 DOI: 10.1371/journal.pone.0216707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/26/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare the differences in the use of healthcare services: visits to the doctor and hospitalisation, performance of routine tests, and preventive influenza vaccination, between users and non-users of homeopathic products. METHODS We used the microdata for adults over 15 years old from three waves of the Spanish National Health Survey, corresponding to the years 2011, 2014 and 2017. We proposed a comparative design of a quasi-experimental type, considering as the treatment group the respondents who said that they had used homeopathic products in the past two weeks; and another group, for control, comprising respondents who said that they had not used this type of products, but only conventional medicines, with observable characteristics similar to those of the treatment group. We used a model for rare events logistics regression (relogit) to estimate the probability of using homeopathy. From the propensity score and a vector of control variables, we used techniques of genetic matching to match individuals from the treatment group with similar individuals belonging to the control group. RESULTS There are no statistically significant differences between users and non-users of homeopathy in visits to the general practitioner (P>|z| 0.387), to the specialist (P>|z| 0.52), in hospitalisations (P>|z| 0.592) or in the use of emergency services (P>|z| 0.109). Nor were there any statistically significant differences in the performance of routine tests, except for the faecal occult blood test, which is more prevalent in users of homeopathic products. 20.9% of users of homeopathy had done this test compared with 15.3% of non-users (P>|z| 0.022). There are also significant differences in vaccination against influenza with 12.6% of homeopathy users stating that they had been vaccinated in the last influenza campaign, against 21.0% of non-users (P>|z| <0.001). The health conditions which homeopathy users reported were constipation (OR: 1.65 CI: 1.16-2.36), malignant tumour (OR: 1.60 CI: 1.09-2.36) osteoporosis (OR: 1.49 CI: 1.05-2.10), varicose veins (OR: 1.35 CI: 1.05-1.74) and allergy (OR: 1.35 CI: 1.06-1.72). CONCLUSIONS Differences in the use of healthcare resources between users and non-users of homeopathic products have not been found to be statistically significant in Spain. It has been shown that most homeopathic products are used as a complement to treatment with conventional medicine. Nevertheless, our results highlight some warning signs which should raise the attention of healthcare authorities. The use of these therapies in patients with malignant tumours and the rejection of vaccines are warning signs of a possible health hazard in the long term.
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Affiliation(s)
- Jaime Pinilla
- Department of Quantitative Methods, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Centre for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Alejandro Rodriguez-Caro
- Department of Quantitative Methods, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- * E-mail:
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Wu JSY, Pinilla J, Watson M, Verma S, Olivotto IA. Medical assistance in dying for cancer patients one year after legalization: a collaborative approach at a comprehensive cancer centre. ACTA ACUST UNITED AC 2018; 25:e486-e489. [PMID: 30464701 DOI: 10.3747/co.25.4118] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medical assistance in dying (maid) is a new medical service in Canada. Access to maid for patients with advanced cancer can be daunting during periods of declining health near the end of life. In this report, we describe a collaborative approach between the centralized coordination service and a regional cancer centre as an effective strategy for enabling interdisciplinary care delivery and enhancing patient-centred care at the end of the patient's cancer journey.
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Affiliation(s)
- J S Y Wu
- Department of Oncology, University of Calgary, Calgary, AB.,Tom Baker Cancer Centre, Calgary, AB
| | - J Pinilla
- Tom Baker Cancer Centre, Calgary, AB
| | - M Watson
- Department of Family Medicine, University of Calgary, Calgary, AB
| | - S Verma
- Department of Oncology, University of Calgary, Calgary, AB.,Tom Baker Cancer Centre, Calgary, AB
| | - I A Olivotto
- Department of Oncology, University of Calgary, Calgary, AB.,Tom Baker Cancer Centre, Calgary, AB
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Pinilla J, López-Valcárcel BG, González-Martel C, Peiro S. Pinocchio testing in the forensic analysis of waiting lists: using public waiting list data from Finland and Spain for testing Newcomb-Benford's Law. BMJ Open 2018; 8:e022079. [PMID: 29743333 PMCID: PMC5942457 DOI: 10.1136/bmjopen-2018-022079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/10/2022] Open
Abstract
OBJECTIVE Newcomb-Benford's Law (NBL) proposes a regular distribution for first digits, second digits and digit combinations applicable to many different naturally occurring sources of data. Testing deviations from NBL is used in many datasets as a screening tool for identifying data trustworthiness problems. This study aims to compare public available waiting lists (WL) data from Finland and Spain for testing NBL as an instrument to flag up potential manipulation in WLs. DESIGN Analysis of the frequency of Finnish and Spanish WLs first digits to determine if their distribution is similar to the pattern documented by NBL. Deviations from the expected first digit frequency were analysed using Pearson's χ2, mean absolute deviation and Kuiper tests. SETTING/PARTICIPANTS Publicly available WL data from Finland and Spain, two countries with universal health insurance and National Health Systems but characterised by different levels of transparency and good governance standards. MAIN OUTCOME MEASURES Adjustment of the observed distribution of the numbers reported in Finnish and Spanish WL data to the expected distribution according to NBL. RESULTS WL data reported by the Finnish health system fits first digit NBL according to all statistical tests used (p=0.6519 in χ2 test). For Spanish data, this hypothesis was rejected in all tests (p<0.0001 in χ2 test). CONCLUSIONS Testing deviations from NBL distribution can be a useful tool to identify problems with WL data trustworthiness and signalling the need for further testing.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria - Campus de Tafira, Las Palmas de Gran Canaria, Spain
| | - Beatriz G López-Valcárcel
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria - Campus de Tafira, Las Palmas de Gran Canaria, Spain
| | - Christian González-Martel
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria - Campus de Tafira, Las Palmas de Gran Canaria, Spain
| | - Salvador Peiro
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), València, Spain
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Pinilla J, Abásolo I. The effect of policies regulating tobacco consumption on smoking initiation and cessation in Spain: is it equal across socioeconomic groups? Tob Induc Dis 2017; 15:8. [PMID: 28149259 PMCID: PMC5273787 DOI: 10.1186/s12971-016-0109-4] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/27/2016] [Indexed: 01/30/2023] Open
Abstract
Background In Spain, the Law 28/2005, which came into effect on January 2006, was a turning point in smoking regulation and prevention, serving as a guarantee for the progress of future strategies in the direction marked by international organizations. It is expected that this regulatory policy should benefit relatively more to lower socioeconomic groups, thus contributing to a reduction in socioeconomic health inequalities. This research analyzes the effect of tobacco regulation in Spain, under Law 28/2005, on the initiation and cessation of tobacco consumption, and whether this effect has been unequal across distinct socioeconomic levels. Methods Micro-data from the National Health Survey in its 2006 and 2011 editions are used (study numbers: 4382 and 5389 respectively; inventory of statistical operations (ISO) code: 54009), with a sample size of approximately 24,000 households divided into 2,000 census areas. This allows individuals’ tobacco consumption records to be reconstructed over five years before the initiation of each survey, as well as identifying those individuals that started or stopped smoking. The methodology is based on “time to event analysis”. Cox’s proportional hazard models are adapted to show the effects of a set of explanatory variables on the conditional probability of change in tobacco consumption: initiation as a daily smoker by young people or the cessation of daily smoking by adults. Results Initiation rates among young people went from 25% (95% confidence interval (CI), 23–27) to 19% (95% CI, 17–21) following the implementation of the Law, and the change in cessation rates among smokers was even greater, with rates increasing from 12% (95% CI, 11–13) to 20% (95% CI, 19–21). However, this effect has not been equal by socioeconomic groups as shown by relative risks. Before the regulation policy, social class was not a statistically significant factor in the initiation of daily smoking (p > 0.05); however, following the implementation of the Law, young people belonging to social classes IV-V and VI had a relative risk of starting smoking 63% (p = 0.03) and 82% (p = 0.02) higher than young people of higher social classes I-II. On the other hand, lower social class also means a lower probability of smoking cessation; however, the relative risk of cessation for a smoker belonging to a household of social class VI (compared to classes I-II) went from 24% (p < 0.001) lower before the Law to 33% (p < 0.001) lower following the law’s implementation. Conclusion Law 28/2005 has been effective, as after its promulgation there has been a decrease in the rate of smoking initiation among young people and an increase in the rate of cessation among adult smokers. However, this effect has not been equal by socioeconomic groups, favoring relatively more to those individuals belonging to higher social classes.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión (Universidad de Las Palmas de Gran Canaria). Facultad de Economía, Empresa y Turismo. Campus Universitario de Tafira, 35017 Las Palmas de Gran Canaria, Spain
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos; Instituto Universitario de Desarrollo Regional (Universidad de La Laguna). Facultad de Economía, Empresa y Turismo. Universidad de La Laguna, Campus de Guajara, 38071 La Laguna, Tenerife Spain
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Pinilla J, Lopez-Valcarcel BG, Urbanos-Garrido RM. Estimating direct effects of parental occupation on Spaniards' health by birth cohort. BMC Public Health 2017; 17:26. [PMID: 28056954 PMCID: PMC5217274 DOI: 10.1186/s12889-016-3997-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/20/2016] [Accepted: 12/23/2016] [Indexed: 11/17/2022] Open
Abstract
Background Social health inequalities in adult population are partly due to socioeconomic circumstances in childhood. A better understanding of how those circumstances affect health during adulthood may improve the opportunities for reducing health disparities. The objective of this study is to investigate the effect of parental socioeconomic status, which is proxied by occupation, on adult Spaniards’ health by birth cohort. The analysis will allow checking not only the direct impact of parental occupation on their offspring’s health, but also whether inherited inequality has been reduced over time. Methods We use data from the Bank of Spain’s Survey of Household Finances on Spanish households from 2002 to 2008. Sequential models were used to estimate the influence of the father’s and mother’s occupation on their offspring’s health, trying to disentangle direct from indirect effects. With a sample of 26,832 persons we consider effects for four different cohorts by birth periods ranging from 1916 to 1981. Results The results show that parental occupation has a significant direct impact on individuals’ health (p < 0.01). The effect of father’s occupation exceeds that of mother’s. For those born before 1936, the probability of reporting a good health status ranges from 0.31 (95% confidence interval (CI) 0.14–0.48), when fathers were classified as unskilled elementary workers, to 0.98 (95% CI 0.98–0.99) when they were managers or mid-level professionals. For those born during the period 1959–1975, those probabilities are 0.49 (95% CI 0.39–0.59) and 0.97 (95% CI 0.96–0.98), respectively. Therefore, health inequalities linked to parental socioeconomic status have been noticeably reduced, although discrimination against unskilled workers persists over time. Conclusions Great progress has been made in the health area during the twentieth century, so that the impact of parental socioeconomic status on individuals’ health has been significantly tempered for those at the bottom of the social scale. However, more efforts focused on the improvement of living conditions for most socioeconomically disadvantaged are needed in order to further reduce social inequalities in health.
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Affiliation(s)
- Jaime Pinilla
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Beatriz G Lopez-Valcarcel
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Rosa M Urbanos-Garrido
- Department of Public Finance, School of Economics, Complutense University of Madrid, Campus de Somosaguas s/n, 28223, Pozuelo de Alarcón, Spain.
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Ortún V, G López-Valcárcel B, Pinilla J. Tax on sugar sweetened beverages in Spain. Rev Esp Salud Publica 2016; 90:e1-e13. [PMID: 27735891] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/11/2016] [Indexed: 06/06/2023] Open
Abstract
This article provides a critical review about the challenges that taxes on sugary drinks as an instrument of health policy must face to reverse the trend of the current epidemics of obesity. We analyzed the experiences of the leading countries, particularly Mexico, and reflect on the counterweight exerted by the industry against obesity policies, and on the power of lobbyists. Those tax policies for public health have to overcome the enormous strength of the industry, which is exerted in several-science and research, brand reputation, influence on regulators-levels. We suggest that a specific tax on sugary drinks has enough potential to reduce noncommunicable diseases and risk -diabetes, Hypertriglyceridemia, hyperholesterolemia LDL, hypertension- via reduced consumption thanks to the high price elasticity of those drinks. Furthermore, the effects are amplified even in the medium term, once established new habits to healthier eating. These taxes could encourage business innovation without inflicting costs of lost jobs and contribute to reducing the social gradient in obesity.
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Affiliation(s)
- Vicente Ortún
- Departamento de Economía y Empresa.Centro de Investigación en Economía y Salud (CRES).Universidad Pompeu Fabra.Barcelona. España.
| | - Beatriz G López-Valcárcel
- Departamento de Métodos Cuantitativos en Economía y Gestión. Universidad de Las Palmas de Gran Canaria. Las Palmas de Gran Canaria. España
| | - Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria. España
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Roig P, Kalenderian E, Pinilla J. The importance of leadership and management skills in dental practices to attract and retain patients in periods of economic recession. Joralres 2015. [DOI: 10.17126/joralres.2015.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pinilla J, Negrín-Hernández MA, Abásolo I. Time trends in socio-economic inequalities in the lack of access to dental services among children in Spain 1987-2011. Int J Equity Health 2015; 14:9. [PMID: 25636711 PMCID: PMC4316659 DOI: 10.1186/s12939-015-0132-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/06/2015] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Adult oral health is predicted by oral health in childhood. Prevention improves oral health in childhood and, consequently in adulthood, so substantial cost savings can be derived from prevention. The burden of oral disease is particularly high for disadvantaged and poor population groups in both developing and developed countries. Therefore, an appropriate and egalitarian access to dental care becomes a desirable objective if children's dental health is to be promoted irrespective of socioeconomic status. The aim of this research is to analyse inequalities in the lack of access to dental care services for children in the Spanish National Health System by socio-economic group over the period 1987-2011. METHODS Pooled data from eight editions of the Spanish National Health Survey for the years 1987-2011, as well as contextual data on state dental programmes are used. Logistic regressions are used to examine the related factors to the probability of not having ever visited the dentist among children between 6 and 14 years old. Our lack of access variable pays particular attention to the socioeconomic level of children's household. RESULTS The mean probability of having never been to the dentist falls considerably from 49.5% in 1987 to 8.4% in 2011. Analysis by socioeconomic level indicates that, in 1987, the probability of not having ever gone to the dentist is more than two times higher for children in the unskilled manual social class than for those in the upper non-manual social class (odds ratio 2.35). And this difference is not reduced significantly throughout the period analysed, rather it increases as in 1993 (odds of 2.39) and 2006 (odds of 3.03) to end in 2011 slightly below than in 1987 (odds ratio 1.80). CONCLUSION There has been a reduction in children's lack of access to dentists in Spain over the period 1987-2011. However, this reduction has not corrected the socioeconomic inequalities in children's access to dentists in Spain.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Miguel A Negrín-Hernández
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos, Facultad de Economía, Empresa y Turismo and IUDR, Universidad de La Laguna, Campus de Guajara, 38071 La Laguna, Tenerife, Spain.
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García-Altés A, Pinilla J, Marí-Dell'Olmo M, Fernández E, López MJ. Economic Impact of Smoke-Free Legislation: Did the Spanish Tobacco Control Law Affect the Economic Activity of Bars and Restaurants? Nicotine Tob Res 2015; 17:1397-400. [PMID: 25586775 DOI: 10.1093/ntr/ntu346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/29/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The potential of smoke-free bans to negatively impact the hospitality business has been an argument of the hospitality and tobacco industry against such legislation. A partial smoke-free legislation was introduced in Spain in 2006 allowing smoking in most bars and restaurants due to the pressure of the hospitality sector. However, this partial ban was later amended in 2011 to include all the hospitality premises without exceptions. The stepped Spanish process permits to evaluate whether the entry into force of the smoke-free legislation had any effect on the economic activity of the hospitality sector. METHODS We employed a pooled time series cross-sectional design, with national data over 6 years (2006-2011). The dependent variable used was the total number of bars and restaurants per 100,000 inhabitants. The explanatory variables used were the average amount of spending per household in bars and restaurants, and the total unemployment rate in Spain by regions. RESULTS For every 1% increase in the unemployment rate there was a 0.05% decrease in the number of bars and restaurants. In 2007, the number of bars and restaurants was significantly reduced by 13.06% (all others factors being held constant), 4.87% in 2008, and 10.42% in 2009. No statistically significant effect of the smoke-free legislation emerged from 2010 (6.76%) to 2011 (7.69%). CONCLUSION The new Spanish smoke-free legislation had no effect on the number of bars and restaurants.
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Affiliation(s)
- Anna García-Altés
- Fundación Instituto de Investigación en Servicios Sanitarios (IISS), València, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marc Marí-Dell'Olmo
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Maria José López
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
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Labarga P, Fernandez-Montero JV, Barreiro P, Pinilla J, Vispo E, de Mendoza C, Plaza Z, Soriano V. Changes in liver fibrosis in HIV/HCV-coinfected patients following different outcomes with peginterferon plus ribavirin therapy. J Viral Hepat 2014; 21:475-9. [PMID: 24750394 DOI: 10.1111/jvh.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 09/08/2013] [Indexed: 12/15/2022]
Abstract
There is scarce information about the impact of antiviral treatment on subsequent progression of liver fibrosis in HIV-infected patients with chronic hepatitis C who experience different outcomes following peginterferon-ribavirin therapy. We conducted a retrospective study of a cohort of HIV/HCV-coinfected patients with longitudinal assessment of liver fibrosis using elastometry. Patients were split out into four groups according to the prior peginterferon-ribavirin response: sustained virological response (SVR), relapse (R), partial response (PR) and null response (NR). A group of untreated, coinfected patients was taken as control. Significant liver fibrosis progression (sLFP) was defined as a shift from baseline Metavir estimates ≤ F2 to F3-F4, or by >30% increase in liver stiffness in patients with baseline F3-F4. Conversely, significant liver fibrosis regression (sLFR) was defined as a shift from baseline Metavir estimates F3-F4 to ≤ F2, or by >30% reduction in liver stiffness in patients that kept on F3-F4. A total of 498 HIV/HCV-coinfected patients were examined. They were classified as follows: 138 (27.7%) SVR, 40 (8%) R, 61 (12.2%) PR, 71 (14.3%) NR and 188 (37.8%) naive. After a mean follow-up of 53.3 months, sLFP occurred less frequently in patients with SVR (7.2%) compared with R (25%; P = 0.002), PR (23%; P = 0.002), NR (29.6%; P < 0.001) and naïve (19.7%; P = 0.002). Conversely, sLFR was 26.1% in SVR compared with 10% in R (P = 0.03), 14.8% in PR (P = 0.06), 16.9% in NR (P = 0.07) and 10.6% in naïve (P < 0.001). Sustained clearance of serum HCV-RNA following a course of antiviral treatment is the major determinant of liver fibrosis regression in HIV/HCV-coinfected patients.
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Affiliation(s)
- P Labarga
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
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Abásolo I, Negrín-Hernández MA, Pinilla J. Equity in specialist waiting times by socioeconomic groups: evidence from Spain. Eur J Health Econ 2014; 15:323-334. [PMID: 23907706 DOI: 10.1007/s10198-013-0524-x] [Citation(s) in RCA: 13] [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] [Received: 04/24/2013] [Accepted: 07/17/2013] [Indexed: 06/02/2023]
Abstract
In countries with publicly financed health care systems, waiting time--rather than price--is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients' socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients' reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.
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Affiliation(s)
- Ignacio Abásolo
- Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Facultad de Ciencias Económicas y Empresariales, Universidad de La Laguna, Campus de Guajara, 38071, La Laguna, Tenerife, Spain,
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Stoneham G, Burbridge B, Pinilla J, Gourgaris A, Astrope V, Gordon H. Pneumoperitoneum post-fluoroscopic percutaneous gastrojejunostomy insertion: computed tomography and clinical evaluation. Can Assoc Radiol J 2012; 63:S33-6. [PMID: 22277803 DOI: 10.1016/j.carj.2011.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/13/2011] [Accepted: 04/14/2011] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION To assess the incidence and clinical significance of pneumoperitoneum after radiologic percutaneous gastrojejunostomy (PGJ) tube insertion. METHODS Sixteen subjects were prospectively assessed after imaging-guided PGJ tube insertion to discern the incidence of pneumoperitoneum related to specific clinical signs and symptoms. Computed tomography of the abdomen and the pelvis was performed immediately after PGJ insertion. A clinical evaluation, including history, general and abdominal physical examination, temperature, complete blood cell count, abdominal pain, and abdominal tension, was performed on days 1 and 3, and at the discretion of the nutritional support team on day 7 after PGJ insertion. RESULTS Fifteen of the 16 subjects demonstrated imaging findings of pneumoperitoneum after the PGJ-tube insertion. Only a small amount of pneumoperitoneum was demonstrated in 10 of the subjects, whereas a large volume of gas was detected in 2 of the subjects. The only altered clinical findings encountered were increased white blood cell count and fever. These abnormal clinical data were most frequently seen immediately after feeding-tube placement. DISCUSSION Pneumoperitoneum was a common finding after PGJ-tube placement in our study population. There were no statistically significant abnormal clinical parameters, in the presence or absence of pneumoperitoneum, for any of the subjects after PGJ-tube insertion. Conservative management of pneumoperitoneum after PGJ is warranted.
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Affiliation(s)
- Grant Stoneham
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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García-Altés A, Pinilla J, Ortún V. The evolution of health status and chronic conditions in Catalonia, 1994-2006: the paradox of health revisited using the Blinder - Oaxaca decomposition. BMC Health Serv Res 2011; 11:116. [PMID: 21605384 PMCID: PMC3117686 DOI: 10.1186/1472-6963-11-116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 07/20/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006. METHODS Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied. RESULTS Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect. CONCLUSIONS The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions.
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Affiliation(s)
- Anna García-Altés
- Agència de Salut Pública de Barcelona, Spain
- Fundación Instituto de Investigación en Servicios de Salud, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Centre de Recerca en Economia i Salut, Universitat Pompeu Fabra, Spain
| | - Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Spain
| | - Vicente Ortún
- Departament d'Economia i Empresa, Universitat Pompeu Fabra, Spain
- Centre de Recerca en Economia i Salut, Universitat Pompeu Fabra, Spain
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Kantarjian H, Giles F, Bhalla K, Pinilla J, Larson RA, Gattermann N, Ottmann OG, Gallagher NJ, Baccarani M, leCoutre P. Nilotinib in chronic myeloid leukemia patients in chronic phase (CML-CP) with imatinib (IM) resistance or intolerance: Longer follow-up results of a phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7029 Background: Nilotinib is a potent and highly selective BCR-ABL inhibitor approved for the treatment of Ph+ CML patients (pts) in CP or accelerated phase who are resistant or intolerant to prior therapy including IM. This study evaluated the efficacy and safety of nilotinib (400 mg bid) in CML-CP pts resistant or intolerant to IM. Methods: Primary endpoint was major cytogenetic response (MCyR). Secondary endpoints included complete cytogenetic response (CCyR), complete hematological response (CHR), MCyR duration, overall survival (OS), and safety. Results: CML-CP pts (n = 321, 70% IM-resistant, 30% IM-intolerant with resistance) with a minimum follow-up of 19 months (mos) were evaluated; 72% were treated with ≥600 mg/day IM prior to enrollment. Median duration of prior IM treatment was 32 (<1–94) mos. Median dose intensity of nilotinib (790 mg/day; range 151–1,110 mg/day) closely approximated the planned dose. Nilotinib led to rapid and durable CHR and MCyR. CHR was observed in 94% of pts. 59% achieved an MCyR (2.8 mos median time to MCyR; 56% in IM-resistant, and 65% in IM-intolerant pts), including 73% of pts with a baseline CHR and 44% achieved a CCyR (41% in IM-resistant; 51% in IM-intolerant pts). Responses were durable, with 78% pts maintaining MCyR at 24 mos. Estimated OS rate was 88% at 24 mos. Safety profile did not change with longer follow-up. Most frequent grade (gr) 3/4 biochemical laboratory abnormalities were elevated lipase (17%), hypophosphataemia (16%), hyperglycemia (12%), and total bilirubin (8%) which were transient and clinically asymptomatic. Gr 3/4 non-hematologic AEs were infrequent: rash, headache, and diarrhea occurred in 2% of pts. Most common gr 3/4 hematological laboratory abnormalities were neutropenia (31%), thrombocytopenia (31%), and anemia (10%). Brief dose interruptions were successful in management of most AEs. Pleural or pericardial effusions (gr 3/4) were uncommon (< 1%). Conclusions: These results demonstrate that nilotinib was highly effective, with rapid and durable responses in CML-CP pts failing prior therapy due to resistance or intolerance. Nilotinib was well tolerated with favorable risk/benefit. [Table: see text]
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Affiliation(s)
- H. Kantarjian
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - F. Giles
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - K. Bhalla
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - J. Pinilla
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - R. A. Larson
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - N. Gattermann
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - O. G. Ottmann
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - N. J. Gallagher
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - M. Baccarani
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
| | - P. leCoutre
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Institute for Drug Development, CTRC, San Antonio, TX; Medical College of Georgia Cancer Center, Augusta, GA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; University of Chicago, Chicago, IL; Heinrich-Heine University, Dusseldorf, Germany; University Hospital of Frankfurt, Frankfurt, Germany; Novartis Pharma AG, Basel, Switzerland; University of Bologna, Bologna, Italy; Charité - Humboldt-Universitat, Campus Virchow, Berlin,
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Pinilla J, González B. Exploring changes in dental workforce, dental care utilisation and dental caries levels in Europe, 1990-2004. Int Dent J 2009; 59:87-95. [PMID: 19489288] [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: 05/27/2023] Open
Abstract
OBJECTIVES To provide a conceptual framework of the relationships between dental health and dental care utilisation with socio-economic factors, human resources and the finance and organisation of dental healthcare systems in European countries from 1990 to 2004. METHODS Bivariate relations and longitudinal analysis using time series cross-sectional regression models. Data were obtained from published papers and official publications. RESULTS We found no evidence that greater access to dental healthcare professionals has contributed to improving dental health among 12-year-old children. The main parameters influencing oral health and its evolution are income and educational levels within countries. The greater number of dentists and a relatively young adult population have a positive effect on the utilisation of dental services. CONCLUSIONS The improvement in dental health obtained among European children over the last 15 years does not seem to be attributable to policies aimed at improving access to oral health services. What has been achieved is a higher rate of utilisation by adults, due in part to the greater relative numbers of dental healthcare personnel in European countries between 1990 and 2004.
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Affiliation(s)
- Jaime Pinilla
- University of Las Palmas de Gran Canaria, Department of Quantitative Methods, School of Economics, Las Palmas de Gran Canaria, Spain.
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Abstract
We investigate the main sources of heterogeneity in regional efficiency. We estimate a translog stochastic-frontier production function in the analysis of Spanish regions in the period 1964–96, to attempt to measure and explain changes in technical efficiency. Our results confirm that regional inefficiency is significantly and positively correlated with the ratio of public capital to private capital. The proportion of service industries in private capital, the proportion of public capital devoted to transport infrastructures, the industrial specialization, and spatial spillovers from transport infrastructures in neighbouring regions significantly contributed to improving regional efficiency.
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Affiliation(s)
- Jaume Puig-Junoy
- Department of Economics and Business, Pompeu Frabra University, C/Trias Fargas 25-27, 34-08005 Barcelona, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods, University of Las Palmas, Campus de Tafira, 34-35017 Las Palmas de Gran Canaria, Spain
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Abstract
OBJECTIVES This article estimates the costs and benefits of changes in ischemic heart disease (IHD) care in Spain from 1980 to 2003. METHODS We use joinpoint regression to identify trends in the standardized rates of mortality and hospitalization for IHD in general and acute myocardial infarction (AMI) in particular. We estimate also logistic regression models for the probability of in-hospital death of patients admitted for AMI. To measure costs and benefits between 1980 and 2003 we use the microdata from Spanish Hospital Morbidity Survey, and the reports of the Cardiac Catheterization and Coronary Intervention Registry of the Spanish Society of Cardiology. RESULTS Mortality from IHD in Spain has been substantially reduced in the past 25 years. Medical advances have saved lives of many patients admitted to hospitals. If the patients with AMI admitted in 2003 had been treated with 1980 procedures the rate of hospital mortality for AMI would have doubled. The estimated benefits in 2003 are the lives of the 5326 patients saved. The unit real costs have increased from euro2143 to euro4550 per AMI admission. If this cost increase is applied to the 57,842 Spanish AMI inpatients admitted in 2003, one could say that advances in medical technology from 1980 to 2003 carry a cost of euro26,140 per life saved. CONCLUSIONS In Spain advances in hospital technology for the treatment of IHD since 1980 are well worth the cost.
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Diez M, Diaz A, Bleda MJ, Aldamiz M, Camafort M, Camino X, Cepeda C, Costa A, Ferrero O, Geijo P, Iribarren JA, Moreno S, Moreno ME, Labarga P, Pinilla J, Portu J, Pulido F, Rosa C, Santamaria JM, Telenti M, Trapiella L, Trastoy M, Viciana P. Prevalence of M. tuberculosis infection and tuberculosis disease among HIV-infected people in Spain. Int J Tuberc Lung Dis 2007; 11:1196-1202. [PMID: 17958981] [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: 05/25/2023] Open
Abstract
OBJECTIVE To study the prevalence of Mycobacterium tuberculosis infection (MTBI) and past/current tuberculosis (TB) among human immunodeficiency virus (HIV) infected persons in Spain. DESIGN Longitudinal study conducted between 2000 and 2003 at 10 HIV hospital-based clinics. Data were drawn from clinical records. Associations were measured using odds ratios (ORs) and their 95% confidence intervals (95%CI). RESULTS Of the 1242 persons who met the eligibility criteria, most were male (75%), aged <40 years (75%) and unemployed (40%). HIV infection occurred through intravenous drug use (53%), heterosexual sex (29%) and sex between men (16%). In the initial evaluation, 315 subjects had evidence of MTBI: 84 (6.8%) had a history of TB, 23 (1.8%) current TB and 208 (16.8%) latent tuberculosis infection (LTBI). MTBI was associated with male sex, age 30-49 years, contact with a TB case, homelessness, poor education, and negatively with CD4 <100 cells/mm(3). Among subjects with MTBI, past/current TB was associated with retirement/disability (OR 6, 95%CI 1.6-22.5), CD4 <200 cells/mm(3) (OR 9.7, 95%CI 3.8-24.6), viral load >55,000 copies (OR 5.3, 95%CI 1.4-20.0), and negatively, with skilled work (OR 0.4, 95%CI 0.1-1.0) or administrative/managerial/professional work (OR 0.05, 95%CI 0.01-0.4). CONCLUSION Social context has an impact on the effectiveness of HIV and TB control programmes even in industrialised countries with free access to health care.
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Affiliation(s)
- M Diez
- Instituto de Salud Carlos III, Unidad de Epidemiología del VIH/Sida, Madrid, Spain.
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García-Altés A, Pinilla J, Peiró S. Aproximación a los pesos de calidad de vida de los «años de vida ajustados por calidad» mediante el estado de salud autopercibido. Gaceta Sanitaria 2006; 20:457-64. [PMID: 17198624 DOI: 10.1157/13096526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To estimate quality of life weights in Spain for 1987, 1993 and 2001, based on self-assessed health status reported in the National Health Survey. MATERIAL AND METHODS Quality of life weights were estimated using an ordered probit model. In this model, self-assessed health status was related to the presence of chronic diseases, demographic characteristics, and a random error. Quality of life weights were derived by normalizing the regressors obtained. RESULTS Quality of life values related to chronic diseases varied depending on the diseases. Pain, limitations, and diseases in the previous 12 months had a greater negative impact on quality of life than did chronic diseases. Quality of life decreased as age increased, and increased as educational level increased. For the same disease and adjusted for age, sex, and educational level, quality of life weights were greater for 1993 and 2001 than for 1987. CONCLUSIONS The proposed methodology allows quality of life weights to be calculated from health survey data, which has direct application in economic assessment, analysis of socioeconomic health inequalities, and health capital estimation.
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Affiliation(s)
- Anna García-Altés
- Fundación Instituto de Investigación en Servicios de Salud, y Agència de Salut Pública de Barcelona, Barcelona, España.
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Pinilla J, González B. Equity in children's utilization of dental services: effect of a children's dental care programme. Community Dent Health 2006; 23:152-7. [PMID: 16995563] [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: 05/11/2023]
Abstract
OBJECTIVES To evaluate the long term impact on fairness of children's dental care programmes. METHODS Data were taken from the Health Module of the Spanish Disability Interview Survey in 1999 (n=8,049). The probability of visit to a dentist and the number of visits are estimated with binary logistic models and count data models in order to compare the regions with consolidated dental care programmes, PADI regions, with the rest of Spanish regions. The effects of family income, residential status and living in small village settings on dental care access for both regions are investigated and compared. RESULTS The scope of the dental care programme (PADI) makes a very significant difference. Regions with consolidated PADI are by far more equitable than the rest. Once the other explanatory factors have been controlled, the percentage of users is by far larger in PADI regions, odds ratio 3.47 (95% CI 2.38 to 5.07). In PADI regions family income doesn't have any significance in the probability of visits to the dentist, odds ratio 1.9 (95% confidence interval 0.92 to 1.81). In non PADI regions poorer families have less probability of visiting a dentist, odds ratio 1.68 (95% CI 1.50 to 1.88). In addition, in each region, inequalities discriminating against those children that live in small villages cannot be found in PADI regions. CONCLUSIONS PADI regions have more equity in access to dental care. The PADI programme managed to drop any income base discrimination in access and succeeded in equalizing access in small villages and in urban areas. The use of dental services is very unequal among the population. Public dental care programmes for children equalize utilization and strongly contribute to improving children's oral health.
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Affiliation(s)
- Jaime Pinilla
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canariy Islands, Spain.
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Caballero-Hidalgo A, González B, Pinilla J, Barber P. [Analysis of factors related to smoking initiation and continued smoking in young adolescents]. Gac Sanit 2006; 19:440-7. [PMID: 16483521 DOI: 10.1016/s0213-9111(05)71394-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyse the determining of the acquisition and later consolidation of the tobacco consumption in young adolescents. MATERIAL AND METHOD Longitudinal study of three years of duration (2000-2002). Subjects were students of secondary education between 13 and 14 years old at the beginning of the study. The research was performed in Gran Canaria Island with a final sample of 745 subjects. Models of conditional binary election were considered for longitudinal data where the dependent variable reflects decisions of the adolescents through time, with regard to the probability of beginning to smoke, "beginning model", and the probability of being occasional or habitual smoker, "experimentation model". RESULTS In the last year, 57% of the young teenagers surveyed use tobacco, a 25% more than in the first year, some of them, 9% on a daily basis. In the "beginning model" the determining of the tobacco consumption are interest in studies (odds ratio [OR] = 0.27; 95% confidence interval (CI), 0.08-0.87 and OR = 0.14; 95% CI, 0.03-0.58 for the students having enough and much interest in studies, respectively), to have a smoker as the best friend (OR = 7.44; 95% CI, 2.59-21.4), the alcohol consumption (OR = 11.82; 95% CI, 4.96-28.2 and OR=15.42; 95% CI, 4.68-50.7 for youngs who drink alcohol occasionally or frequently) and having more pocket money (euros per week) (OR = 1.13; 95% CI, 1.07-1.19). For the "experimentation model", to have a smoker as the best friend (OR = 7.01; 95% CI, 2.96-16.5), the alcohol consumption (OR = 5.71; 95% CI, 1.98-16.4 and OR = 5.22; 95% CI, the 1.56-17.5 for youngs who drink alcohol occasionally or frequently) and the number of years since the student started smoking (OR = 1.44; 95% IC, 1.11-1.86). CONCLUSIONS Our study emphasizes, peer group effect, drinking alcoholic beverages and lack of interest in studies as factors associated to the tobacco consumption.
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Affiliation(s)
- Araceli Caballero-Hidalgo
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
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Pinilla J, Murillo C, Carrasco G, Humet C. Case-control analysis of the financial cost of medication errors in hospitalized patients. Eur J Health Econ 2006; 7:66-71. [PMID: 16369841 DOI: 10.1007/s10198-005-0332-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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
The cost of medication errors (MEs), and by extension their impact on the running of hospitals, is generally unknown to hospital managers. This study estimated the financial costs involved in the additional use of hospital resources as a result of MEs. For this we used a database covering 20,014 hospital admissions, with clinical and personal information about each patient, the costs related to his/her stay, and physicians' prescriptions. Analyses were carried out using cases and control techniques to calculate the additional cost of MEs. During the study period, 2001, the analysis indicated that the MEs analyzed caused an additional 303 days of hospital stay, with an overall annual cost of nearly 6,000 euros. Our study confirms that MEs are a costly reality. The presence of MEs doubled the cost per patient.
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Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2005; 20:843-8. [PMID: 15474870 DOI: 10.1016/j.nut.2004.06.003] [Citation(s) in RCA: 360] [Impact Index Per Article: 18.9] [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: 02/06/2023]
Abstract
OBJECTIVE Nutritional support is part of the standard of care for the critically ill adult patient. In the average patient in the intensive care unit who has no contraindications to enteral nutrition (EN) or parenteral nutrition (PN), the choice of route for nutritional support may be influenced by several factors. Because EN and PN are associated with risks and benefits, we systematically reviewed and critically appraised the literature to compare EN with PN the critically ill patient. METHODS We searched computerized bibliographic databases, personal files, and relevant reference lists to identify potentially eligible studies. Only randomized clinical trials that compared EN with PN in critically ill patients with respect to clinically important outcomes were included in this review. In an independent fashion, relevant data on the methodology and outcomes of primary studies were abstracted in duplicate. The studies were subsequently aggregated statistically. RESULTS There were 13 studies that met the inclusion criteria and, hence, were included in our meta-analysis. The use of EN as opposed to PN was associated with a significant decrease in infectious complications (relative risk = 0.64, 95% confidence interval = 0.47 to 0.87, P = 0.004) but not with any difference in mortality rate (relative risk = 1.08, 95% confidence interval = 0.70 to 1.65, P = 0.7). There was no difference in the number of days on a ventilator or length of stay in the hospital between groups receiving EN or PN (Standardized Mean Difference [SMD] = 0.07, 95% confidence interval = -0.2 to 0.33, P = 0.6). PN was associated with a higher incidence of hyperglycemia. Data that compared days on a ventilator and the development of diarrhea in patients who received EN versus PN were inconclusive. In the EN and PN groups, complications with enteral and parenteral access were seen. Four studies documented cost savings with EN as opposed to PN. CONCLUSION The use of EN as opposed to PN results in an important decrease in the incidence of infectious complications in the critically ill and may be less costly. EN should be the first choice for nutritional support in the critically ill.
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Affiliation(s)
- Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract
This paper contributes to the empirical knowledge of determinants of smoking initiation in adolescents. The instrument we used was a structural equation model, which is a powerful tool to analyze causal relationships in nonexperimental studies. We used a school-based sample of 1198 teenagers from Spain. We measured the attitude of the adolescents towards tobacco. Attitudes and smoking status are related. Attitudes become more favorable to smoking, as experimentation with cigarettes progresses and pupils become older. Teenagers who have tried at least one cigarette are on average more favorable to smoking than those who had never smoked. The study's limitations were noted.
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Affiliation(s)
- Patricia Barber
- Department of Quantitative Methods, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
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Burbridge B, Stoneham G, Pinilla J. Experience with a modified Gray-St. Louis catheter for percutaneous gastrojejunostomy. Can Assoc Radiol J 2003; 54:51-5. [PMID: 12625085] [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: 03/01/2023] Open
Abstract
PURPOSE To determine if design modifications to the Gray-St. Louis gastrojejunostomy catheter would improve its deployment and utilization characteristics. METHODS A modified catheter and the Gray-St. Louis catheter were alternately inserted in consecutive patients requiring gastrojejunostomy. At the time of insertion, the anatomic locations of the fenestrated end of the catheter and the Cope retention loop were recorded. At the time of removal or exchange, catheters were assessed for the position of the fenestrated end and the retention loop, the presence of catheter tears, leakage of injected contrast medium and evidence of catheter blockage. RESULTS Of the 250 catheters we assessed in a 3-year period, 141 (56%) were modified catheters and 109 (44%) were Gray-St. Louis catheters. At insertion, the retention loop of the modified catheter was in the duodenum in 132 (94%) patients, whereas the retention loop of the Gray-St. Louis Catheter reached the duodenum in 29 (27%) (p < 0.05). At the time of catheter removal or exchange, the retention loop of the modified catheter was in the duodenum in 72 (60%) patients, whereas the retention loop of the Gray-St. Louis catheter was in the duodenum in 13 (14%) (p < 0.05). CONCLUSION The design modifications to the Gray-St. Louis catheter improved the likelihood of the retention loop residing in the duodenum, while continuing to allow the fenestrated portion of the catheter to reside in the jejunum.
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Affiliation(s)
- Brent Burbridge
- Department of Medical Imaging, Royal University Hospital, 103 Hospital Dr., Saskatoon, SK S7N 0W8.
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Abstract
BACKGROUND In adolescents aged 12-14, we measured attitudes to tobacco advertising. Our purpose is to understand the relation of these attitudes to tobacco use and identify the groups most influenced by the advertising. METHODS Survey of adolescents on Gran Canaria Island, Spain, about aspects of family, school, peers, tobacco consumption, and tobacco advertising. The subjects of the double-stratified cluster sample were 1910 students at the same grade level in 33 schools; 86.6% were 13 or 14 years old, and 51.2% were boys. We generated measures for attitudes to tobacco advertising from replies to seven questions with ordinal scales by an analysis of categorical principal components. To relate attitude to tobacco advertising and the profiles of these adolescents, we used multiple regression and logistic regression models. RESULTS Attitudes to tobacco advertising are related to some home and school factors, but most significantly to tobacco and alcohol consumption, to amount of time at home without adults, and to peer influence. CONCLUSIONS It is possible to draw up profiles of the students most vulnerable to tobacco advertising, and to cluster them in two groups, the "vitalists" and the "credulous." The effect of cigarette ads is different between these groups. This study can help to orientate smoking prevention.
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Amenábar JJ, García López F, Robles NR, Saracho R, Pinilla J, Gentil MA, Castilla J, Gutiérrez JA, Martín-Martínez E, Alonso R, Bernabéu R, Lorenzo V, Vega N, Escallada R, Sierra T, Clèries M, Vela E, Tallón S, Cancho B, Vázquez C, Sánchez-Casajús A, Torralbo A, Ripoll J, Asín JL, Magaz A, García MJ, Zurriaga O. [Dialysis and transplantation report of the Spanish Nephrology Society and Autonomous Registries for the year 2000]. Nefrologia 2002; 22:310-7. [PMID: 12369121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Abstract
This paper analyzes the extent to which an increase in tobacco taxes affects the demand for tobacco products, especially for cigarettes. Comparison of the studies reviewed revealed that higher tobacco taxes result in higher tobacco prices. The price-elasticity of cigarette demand in low- and middle-income countries is about double that in high-income countries, about 0.4. Furthermore, because of the addictive nature of tobacco use, demand for tobacco products is more elastic in the long run than in the short run. The effect of higher tobacco taxes is greater on the young, among whom demand is more sensitive to price than among adults. The empirical evidence for Spain estimates the price elasticity of cigarette demand in the short run to be in the range of 0.5 to 0.3, a result which is similar to other studies. These results do not suggest that tax policy is an effective tool for tobacco control, although taxes are useful for their revenue generating potential and for compensating the external costs generated by tobacco consumption. Furthermore, when the possibilities of substitutions among brands and the strategies of the tobacco industry to compensate for the effects of taxes (lowering prices and encouraging cigarette smuggling) are considered, the panorama is even more pessimistic
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Affiliation(s)
- J Pinilla
- Universidad de Las Palmas de Gran Canaria. Spain.
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Abstract
STUDY OBJECTIVE To understand the context for tobacco smoking in young adolescents, estimating the effects of individual, family, social, and school related factors. DESIGN Cross sectional analysis performed by multilevel logistic regression with pupils at the first level and schools at the second level. The data came from a stratified sample of students surveyed on their own, their families' and their friends' smoking habits, their schools, and their awareness of cigarette prices and advertising. SETTING The study was performed in the Island of Gran Canaria, Spain. PARTICIPANTS 1877 students from 30 secondary schools in spring of 2000 (model's effective sample sizes 1697 and 1738). MAIN RESULTS 14.2% of the young teenagers surveyed use tobacco, almost half of them (6.3% of the total surveyed) on a daily basis. According to the ordered logistic regression model, to have a smoker as the best friend increases significantly the probability of smoking (odds ratio: 6.96, 95% confidence intervals (CI) (4.93 to 9.84), and the same stands for one smoker living at home compared with a smoking free home (odds ratio: 2.03, 95% CI 1.22 to 3.36). Girls smoke more (odds ratio: 1.85, 95% CI 1.33 to 2.59). Experience with alcohol, and lack of interest in studies are also significant factors affecting smoking. Multilevel models of logistic regression showed that factors related to the school affect the smoking behaviour of young teenagers. More specifically, whether a school complies with antismoking rules or not is the main factor to predict smoking prevalence in schools. The remainder of the differences can be attributed to individual and family characteristics, tobacco consumption by parents or other close relatives, and peer group. CONCLUSIONS A great deal of the individual differences in smoking are explained by factors at the school level, therefore the context is very relevant in this case. The most relevant predictors for smoking in young adolescents include some factors related to the schools they attend. One variable stood out in accounting for the school to school differences: how well they enforced the no smoking rule. Therefore we can prevent or delay tobacco smoking in adolescents not only by publicising health risks, but also by better enforcing no smoking rules in schools.
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Affiliation(s)
- J Pinilla
- Department of Quantitative Methods, University of Las Palmas de Gran Canaria, Canary Islands, Spain
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Abstract
ASCT1 protein is a member of the glutamate transporter superfamily, which shows system ASC selectivity and properties and has been characterized as a Na+-dependent neutral amino-acid exchanger. Here, by using ASCT1-expressing oocytes, the uptake of alanine and glutamate was measured to investigate ASCT1's ability to mediate a concentrative transport of alanine, ASCT1's sodium dependence, and the influence of pH on the mutual inhibition between alanine and glutamate. Alanine uptake was measured after 30 min incubation. Kinetic analysis of the Na+ dependence of alanine uptake showed an apparent K0.5 (affinity constant) value for Na+ of 23.1 ± 4.3 mM (mean ± SE). Concentration dependence of alanine uptake was tested at 100 and 1 mM Na+, with apparent K0.5 values of 0.16 ± 0.04 and 1.8 ± 0.4 mM, respectively, at pH 7.5, and 0.21 ± 0.06 and 1.9 ± 0.3 mM at pH 6. Vmax was not modified between 100 and 1 mM Na+ at either pH. ASCT1 actively transports alanine and accumulates it in the cytosol even when the Na+ concentration in the medium was as low as 13 mM. 22Na uptake studies revealed that Na+ transport was stimulated by the presence of alanine in the medium. Our results demonstrate that ASCT1 is able to mediate a concentrative transport of alanine, which is Na+-dependent but not coupled to the Na+ gradient.Key words: ASCT1, sodium, Xenopus laevis oocytes, concentrative transport, alanine.
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Pinilla J, Barber A, Lostao MP. Active transport of alanine by the neutral amino-acid exchanger ASCT1. Can J Physiol Pharmacol 2001; 79:1023-9. [PMID: 11824937] [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: 02/23/2023]
Abstract
ASCT1 protein is a member of the glutamate transporter superfamily, which shows system ASC selectivity and properties and has been characterized as a Na+-dependent neutral amino-acid exchanger. Here, by using ASCT1-expressing oocytes, the uptake of alanine and glutamate was measured to investigate ASCT1's ability to mediate a concentrative transport of alanine, ASCT1's sodium dependence, and the influence of pH on the mutual inhibition between alanine and glutamate. Alanine uptake was measured after 30 min incubation. Kinetic analysis of the Na+ dependence of alanine uptake showed an apparent K0.5 (affinity constant) value for Na+ of 23.1 +/- 4.3 mM (mean +/- SE). Concentration dependence of alanine uptake was tested at 100 and 1 mM Na+, with apparent K0.5 values of 0.16 +/- 0.04 and 1.8 +/- 0.4 mM, respectively, at pH 7.5, and 0.21 +/- 0.06 and 1.9 +/- 0.3 mM at pH 6. Vmax was not modified between 100 and 1 mM Na+ at either pH. ASCT1 actively transports alanine and accumulates it in the cytosol even when the Na+ concentration in the medium was as low as 1-3 mM. 22Na uptake studies revealed that Na+ transport was stimulated by the presence of alanine in the medium. Our results demonstrate that ASCT1 is able to mediate a concentrative transport of alanine, which is Na+-dependent but not coupled to the Na+ gradient.
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Affiliation(s)
- J Pinilla
- Departamento de Fisiología y Nutrición, Universidad de Navarra, Pamplona, Spain
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Abstract
The consumption of tobacco has become by far the main avoidable cause of disease and premature death in Spain. There is a trend towards picking up the tobacco habit at an earlier age for both males and females. The number of women smokers is rising, particularly in the younger age groups (45% of women between the ages of 16 and 22 claim to be smokers) almost equalling male levels, which are remaining constant. The objective of this study is to profile current smokers, former smokers and never smokers among Spanish men and women, based on subject characteristics, and compare the profiles estimated for 1993, 1995 and 1997. We use a two-level nested logistic regression model to model the adoption and cessation processes of the smoking habit. The first level or branch discriminates between persons who have never been smokers and people who have been smokers or who are smokers at present. The second level is to discriminate between present smokers and former smokers (succeeded in the cessation process). The results show that the variables which define the profile of smokers include so-called stress-related factors, if the individual is separated or divorced, whether she is unemployed. The cessation process accelerates with age and is stimulated by the diagnosis of chronic disease, particularly heart disease. Our results, which are fairly stable from 1993 to 1997, should provide guidelines in the development of prevention and control of tobacco consumption health policies.
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Affiliation(s)
- J Pinilla
- University of Las Palmas de G.C., Department of Quantitative Methods, Campus de Tafira, 35017 Las Palmas, Spain
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Cook D, McMullin J, Hodder R, Heule M, Pinilla J, Dodek P, Stewart T. Prevention and diagnosis of venous thromboembolism in critically ill patients: a Canadian survey. Crit Care 2001; 5:336-42. [PMID: 11737922 PMCID: PMC83855 DOI: 10.1186/cc1066] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [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: 09/07/2001] [Accepted: 09/10/2001] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) confers considerable morbidity and mortality in hospitalized patients, although few studies have focused on the critically ill population. The objective of this study was to understand current approaches to the prevention and diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE) among patients in the intensive care unit (ICU). DESIGN Mailed self-administered survey of ICU Directors in Canadian university affiliated hospitals. RESULTS Of 29 ICU Directors approached, 29 (100%) participated, representing 44 ICUs and 681 ICU beds across Canada. VTE prophylaxis is primarily determined by individual ICU clinicians (20/29, 69.0%) or with a hematology consultation for challenging patients (9/29, 31.0%). Decisions are usually made on a case-by-case basis (18/29, 62.1%) rather than by preprinted orders (5/29, 17.2%), institutional policies (6/29, 20.7%) or formal practice guidelines (2/29, 6.9%). Unfractionated heparin is the predominant VTE prophylactic strategy (29/29, 100.0%) whereas low molecular weight heparin is used less often, primarily for trauma and orthopedic patients. Use of pneumatic compression devices and thromboembolic stockings is variable. Systematic screening for DVT with lower limb ultrasound once or twice weekly was reported by some ICU Directors (7/29, 24.1%) for specific populations. Ultrasound is the most common diagnostic test for DVT; the reference standard of venography is rarely used. Spiral computed tomography chest scans and ventilation-perfusion scans are used more often than pulmonary angiograms for the diagnosis of PE. ICU Directors recommend further studies in the critically ill population to determine the test properties and risk:benefit ratio of VTE investigations, and the most cost-effective methods of prophylaxis in medical-surgical ICU patients. INTERPRETATION Unfractionated subcutaneous heparin is the predominant VTE prophylaxis strategy for critically ill patients, although low molecular weight heparin is prescribed for trauma and orthopedic patients. DVT is most often diagnosed by lower limb ultrasound; however, several different tests are used to diagnose PE. Fundamental research in critically ill patients is needed to help make practice evidence-based.
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Affiliation(s)
- D Cook
- Department of Medicine, McMaster University, Hamilton, Canada.
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Canales MA, Pinilla J, Mateos P, Martínez Zapico R, Alvarez T, Jiménez VM, Quintana M, Villar A, Hernández Navarro F, Magallón M. Human parvovirus B19 antibodies are less frequent among patients treated with factor IX concentrate inactivated by ultrafiltration: a report from a single Spanish institution. Vox Sang 2000; 74:260-1. [PMID: 9691409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M A Canales
- Haemophilia Unit, Department of Haematology, Hospital La Paz, Madrid, Spain
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Casado JL, Arrizabalaga J, Montes M, Martí-Belda P, Tural C, Pinilla J, Gutierrez C, Portu J, Schuurman R, Aguirrebengoa K. Incidence and risk factors for developing cytomegalovirus retinitis in HIV-infected patients receiving protease inhibitor therapy. Spanish CMV-AIDS Study Group. AIDS 1999; 13:1497-502. [PMID: 10465073 DOI: 10.1097/00002030-199908200-00009] [Citation(s) in RCA: 40] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the incidence and risk factors for cytomegalovirus (CMV) retinitis in HIV-infected patients who initiated protease inhibitor-containing antiretroviral therapy. DESIGN AND SETTING Prospective, multicentre study. PATIENTS A cohort of 172 HIV-infected patients with a CD4 cell count below 100x10(6) cells/l at the time of protease inhibitor introduction. MAIN OUTCOME MEASURES Confirmed CMV retinitis and mortality, according to CD4 cell count, HIV load, and CMV viraemia. RESULTS The cumulative incidence of CMV retinitis was 5% at 1 year and 6% at 2 years. Only a positive CMV polymerase chain reaction (PCR) test at therapy initiation was significantly associated with the development of disease (relative hazard, 4.41; 95% confidence interval, 2.12-8.93; P<0.00001). The 12-month Kaplan-Meier CMV retinitis event rate was 38% in patients who were CMV PCR-positive compared with 2% in those who were CMV PCR-negative (P<0.001). Mean CMV load was significantly higher in those individuals who went on to develop CMV retinitis (3700 versus 384 copies/ml, P = 0.002). Only 2% of patients remained CMV PCR-positive after 3 months of protease inhibitor therapy, and CMV viraemia was not associated with a worse therapy response or shorter survival. Transient CMV positivity without a higher risk of disease was observed in 7% of patients at the first month on therapy. CONCLUSIONS Protease inhibitor-containing antiretroviral therapy significantly reduces the incidence of CMV viraemia and disease. Although a positive CMV PCR test identifies those patients on therapy at highest risk of CMV retinitis, it is not associated with an increased risk of death or a worse response to protease inhibitor therapy.
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Affiliation(s)
- J L Casado
- Infectious Diseases Unit, Hospital Ramon y Cajal, Madrid, Spain
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Del Pozo MA, Arias JR, Pinilla J, Labarga P, Alcoba M, Martinez de la Cruz FJ, Anton F, Carro JA, Perez MR, Echevarria S, Garrote E, Moreno-Otero R. Interferon alpha treatment of chronic hepatitis C in HIV-infected patients receiving zidovudine: efficacy, tolerance and response related factors. Hepatogastroenterology 1998; 45:1695-701. [PMID: 9840131] [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: 02/09/2023]
Abstract
BACKGROUND/AIMS In our area most of the human immunodeficiency virus (HIV) infected patients are intravenous drug users; HIV and hepatitis C virus infections often coexist in these patients. Due to the repercussions of both infections, we designed a trial to evaluate the efficacy, response-related factors and tolerance during an eight-month regime of recombinant interferon alpha-2b on hepatitis C virus infection. METHODOLOGY We included 79 patients in an open, prospective and multicentric trial with zidovudine and interferon alpha-2b. Response to interferon treatment was evaluated by biochemical and histopathological criteria. RESULTS A complete response (alanine aminotransferase normalization) was obtained in 57.4% of patients. The significant response-related factors were: degree of histopathological activity, CD4+ cell number and initial leukocyte number. CONCLUSIONS Recombinant interferon therapy seems to be effective for chronic hepatitis C in HIV infected patients; the best response was in those with active chronic hepatitis and CD4+ cell counts > or = 200/mm3. General tolerance was variable, although side effects were not different from those seen in non-HIV patients. The most common side effect was flu-like syndrome (constitutional manifestations), with no interference on treatment continuity; however, hematological toxicity prevents the indiscriminate use of interferon.
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Affiliation(s)
- M A Del Pozo
- Unit of Infectious Diseases, Hospital Clinico Universitario, Valladolid, Spain
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Pinilla J. Cost minimization analysis of high-dose-rate versus low-dose-rate brachytherapy in endometrial cancer. Gynecology Tumor Group. Int J Radiat Oncol Biol Phys 1998; 42:87-90. [PMID: 9747824 DOI: 10.1016/s0360-3016(98)00194-1] [Citation(s) in RCA: 16] [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: 11/23/2022]
Abstract
PURPOSE Endometrial cancer is a common, usually curable malignancy whose treatment frequently involves low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy. These treatments involve substantial resource commitments and this is increasingly important. This paper presents a cost minimization analysis of HDR versus LDR brachytherapy in the treatment of endometrial cancer. METHODS AND MATERIALS The perspective of the analysis is that of the payor, in this case the Ministry of Health. One course of LDR treatment is compared to two courses of HDR treatment. The two alternatives are considered to be comparable with respect to local control, survival, and toxicities. Labor, overhead, and capital costs are accounted for and carefully measured. A 5% inflation rate is used where applicable. A univariate sensitivity analysis is performed. RESULTS The HDR regime is 22% less expensive compared to the LDR regime. This is $991.66 per patient or, based on the current workload of this department (30 patients per year) over the useful lifetime of the after loader, $297,498 over 10 years in 1997 dollars. CONCLUSION HDR brachytherapy minimizes costs in the treatment of endometrial cancer relative to LDR brachytherapy. These results may be used by other centers to make rational decisions regarding brachytherapy equipment replacement or acquisition.
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Affiliation(s)
- J Pinilla
- Department of Radiation Oncology, Tom Baker Cancer Center, Calgary, Alberta, Canada
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Pizarro A, García-Tobaruela A, Pinilla J. Bronchiolitis obliterans, Castleman's disease, and a bullous disease: pemphigus vulgaris or paraneoplastic pemphigus? Hum Pathol 1998; 29:657-8. [PMID: 9635692 DOI: 10.1016/s0046-8177(98)80024-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pinilla J, Quintana M, Magallon M. High-dose and long-term therapy of alpha interferon in hemophiliac patients with chronic C virus hepatitis. Blood 1998; 91:727-8. [PMID: 9427735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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