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Codina P, Vicente Gómez JÁ, Hernández Guillamet G, Ricou Ríos L, Carrete A, Vilalta V, Estrada O, Ara J, Lupón J, Bayés-Genís A, López Seguí F. Assessing the impact of haemodynamic monitoring with CardioMEMS on heart failure patients: a cost-benefit analysis. ESC Heart Fail 2024. [PMID: 38500304 DOI: 10.1002/ehf2.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
AIMS The objective of this study was to perform a cost-benefit analysis of the CardioMEMS HF System (Abbott Laboratories, Abbott Park, IL, USA) in a heart failure (HF) clinic in Spain by evaluating the real-time remote monitoring of pulmonary artery pressures, which has been shown to reduce HF-related hospitalizations and improve the quality of life for selected HF patients. Particularly, the study aimed to determine the value of CardioMEMS in Southern Europe, where healthcare costs are significantly lower and its effectiveness remains uncertain. METHODS AND RESULTS This single-centre study enrolled all consecutive HF patients (N = 43) who had been implanted with a pulmonary artery pressure sensor (CardioMEMS HF System); 48.8% were females, aged 75.5 ± 7.0 years, with both reduced and preserved left ventricular ejection fraction; 67.4% of them were in New York Heart Association Class III. The number of HF hospitalizations in the year before and the year after the sensor implantation was compared. Quality-adjusted life years gained based on a literature review of previous studies were calculated. The rate of HF hospitalizations was significantly lower at 1 year compared with the year before CardioMEMS implantation (0.25 vs. 1.10 events/patient-year, hazard ratio 0.22, P = 0.001). At the end of the first year, the usual management outperformed the CardioMEMS HF System. By the end of the second year, the CardioMEMS system is estimated to reduce costs compared with usual management (net benefits of €346). CONCLUSIONS Based on the results, we suggest that remote monitoring of pulmonary artery pressure with the CardioMEMS HF System represents a midterm and long-term efficient strategy in a healthcare setting in Southern Europe.
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Affiliation(s)
- Pau Codina
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - José Ángel Vicente Gómez
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Guillem Hernández Guillamet
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- eXiT Research Group-Control Engineering and Intelligent Systems (IIiA-UdG), Girona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Laura Ricou Ríos
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Andrea Carrete
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Estrada
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Jordi Ara
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Antoni Bayés-Genís
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Francesc López Seguí
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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2
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Roure S, Vallès X, Pérez-Quílez O, López-Muñoz I, Chamorro A, Abad E, Valerio L, Soldevila L, España S, Hegazy AHA, Fernández-Rivas G, Gorriz E, Herena D, Oliveira M, Miralles MC, Conde C, Montero-Alia JJ, Fernández-Pedregal E, Miranda-Sánchez J, Llibre JM, Isnard M, Bonet JM, Estrada O, Prat N, Clotet B. Male genitourinary schistosomiasis-related symptoms among long-term Western African migrants in Spain: a prospective population-based screening study. Infect Dis Poverty 2024; 13:23. [PMID: 38449032 PMCID: PMC10919049 DOI: 10.1186/s40249-024-01190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe. Male urogenital manifestations are often neglected. We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test. METHODS We carried out a prospective, community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain. Schistosoma serology tests and microscopic urine examinations were carried out, and clinical data were obtained from an electronic medical record search and a structured questionnaire. RESULTS We included 388 adult males, mean age 43.5 years [Standard Deviation (SD) = 12.0, range: 18-76]. The median time since migration to the European Union was 17 [Interquartile range (IQR): 11-21] years. The most frequent country of origin was Senegal (N = 179, 46.1%). Of the 338, 147 (37.6%) tested positive for Schistosoma. Parasite eggs were present in the urine of only 1.3%. Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results: pelvic pain (45.2%; OR = 1.57, 95% CI: 1.0-2.4), pain on ejaculation (14.5%; OR = 1.85, 95% CI: 1.0-3.5), dyspareunia (12.4%; OR = 2.45, 95% CI: 1.2-5.2), erectile dysfunction (9.5%; OR = 3.10, 95% CI: 1.3-7.6), self-reported episodes of infertility (32.1%; OR = 1.69, 95% CI: 1.0-2.8), haematuria (55.2%; OR = 2.37, 95% CI: 1.5-3.6), dysuria (52.1%; OR = 2.01, 95% CI: 1.3-3.1), undiagnosed syndromic STIs (5.4%), and orchitis (20.7%; OR = 1.81, 95% CI: 1.0-3.1). Clinical signs tended to cluster. CONCLUSIONS Urogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results. Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin. Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.
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Affiliation(s)
- Sílvia Roure
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain.
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain.
| | - Xavier Vallès
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Germans Trias i Pujol Research Institute, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Israel López-Muñoz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Anna Chamorro
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Elena Abad
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Lluís Valerio
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Laura Soldevila
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Sergio España
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Alaa H A Hegazy
- Microbiology Department, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, c/ Can Ruti s/n, 08916, Badalona, Spain
- Faculty of Medicine, University of Asyut, El Fateh, Assiut Governorate, 71515, Egypt
| | - Gema Fernández-Rivas
- Microbiology Department, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Ester Gorriz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Dolores Herena
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Mário Oliveira
- Department of Urology, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Maria Carme Miralles
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Indústria 23, 08420, Canovelles, Spain
| | - Carmen Conde
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Indústria 23, 08420, Canovelles, Spain
| | - Juan José Montero-Alia
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, Camí Ral el Ravalet 208, Mataró, 08302, Barcelona, Spain
| | - Elia Fernández-Pedregal
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Jose Miranda-Sánchez
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Josep M Llibre
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Mar Isnard
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Josep Maria Bonet
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Can Ruti S/N, 08916, Badalona, Spain
| | - Núria Prat
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Bonaventura Clotet
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- IrsiCaixa-AIDS Research Institute, Hospital Universitari Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Directorate, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Can Ruti S/N, 08916, Badalona, Spain
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Roure S, Vallès X, Pérez-Quílez O, López-Muñoz I, Chamorro A, Abad E, Valerio L, Soldevila L, Gorriz E, Herena D, Pedregal EF, España S, Serra C, Cera R, Rodríguez AM, Serrano L, Falguera G, Hegazy AHA, Fernández-Rivas G, Miralles C, Conde C, Alia JJM, Miranda-Sánchez J, Llibre JM, Isnard M, Bonet JM, Estrada O, Prat N, Clotet B. Female genitourinary schistosomiasis-related symptoms in long-term sub-Saharan African migrants in Europe: a prospective population-based study. J Travel Med 2024:taae035. [PMID: 38438139 DOI: 10.1093/jtm/taae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/19/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Sílvia Roure
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
| | - Israel López-Muñoz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
| | - Anna Chamorro
- Fight Infectious Diseases Foundation, Badalona, Spain
| | - Elena Abad
- Fight Infectious Diseases Foundation, Badalona, Spain
| | - Lluís Valerio
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
| | - Laura Soldevila
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ester Gorriz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
| | - Dolores Herena
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
| | - Elia Fernández Pedregal
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Sergio España
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Institut Català de la Salut, Badalona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Serra
- Sexual and Reproductive Health Care Program, Granollers branch, Barcelona North Metropolitan Primary Care Directorate
| | - Raquel Cera
- Sexual and Reproductive Health Care Program, Mataró branch, Barcelona North Metropolitan Primary Care Directorate
| | - Ana Maria Rodríguez
- Sexual and Reproductive Health Care Program, Granollers branch, Barcelona North Metropolitan Primary Care Directorate
| | - Lorena Serrano
- Sexual and Reproductive Health Care Program, Granollers branch, Barcelona North Metropolitan Primary Care Directorate
| | - Gemma Falguera
- Sexual and Reproductive Health Care Program, Mataró branch, Barcelona North Metropolitan Primary Care Directorate
| | - Alaa H A Hegazy
- Microbiology Department, Hospital Universitari Germans Trias i Pujol University Hospital, and Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Badalona, Spain
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Institut Català de la Salut, Granollers, Spain
| | - Gema Fernández-Rivas
- Microbiology Department, Hospital Universitari Germans Trias i Pujol University Hospital, and Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carmen Miralles
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Institut Català de la Salut, Granollers, Spain
| | - Carmen Conde
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Institut Català de la Salut, Granollers, Spain
| | - Juan José Montero Alia
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), Barcelona North Metropolitan Health Directorate, Institut Català de la Salut, Mataró, Spain
| | - Jose Miranda-Sánchez
- Barcelona North Metropolitan Primary Care Directorate, Institut Català de la Salut, Sabadell, Spain
| | - Josep M Llibre
- Fight Infectious Diseases Foundation, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mar Isnard
- Barcelona North Metropolitan Primary Care Directorate, Institut Català de la Salut, Sabadell, Spain
| | - Josep Maria Bonet
- Barcelona North Metropolitan Primary Care Directorate, Institut Català de la Salut, Sabadell, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, Barcelona North Metropolitan Health Directorate, Institut Català de la Salut, Badalona, Spain
| | - Núria Prat
- Barcelona North Metropolitan Primary Care Directorate, Institut Català de la Salut, Sabadell, Spain
| | - Bonaventura Clotet
- IrsiCaixa-Institut de Recerca de La SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Direcció Territorial Malalties Infeccioses, Barcelona North Metropolitan Health Directorate, Institut Català de la Salut, Badalona, Spain
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4
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Mas MÀ, Miralles R, Ulldemolins MJ, Garcia R, Gràcia S, Picaza JM, Fernández MN, Rocabayera MA, Rivera M, Relaño N, Asensio MT, Laporta P, Morcillo C, Nadal L, Hervás R, Fuguet D, Alba C, Banqué NM, Jimenez S, Moreno MM, Nogueras C, Navarro HM, López R, Hernández G, López-Seguí F, Ríos LR, Pons A, Prat N, Rey JAD, Estrada O. Evaluating Person-Centred Integrated Care to People with Complex Chronic Conditions: Early Implementation Results of the ProPCC Programme. Int J Integr Care 2023; 23:18. [PMID: 38107836 PMCID: PMC10723011 DOI: 10.5334/ijic.7585] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain. Methods We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay. Findings 264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05). Conclusion Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (-37.2%) and hospital stays (-38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of -46.3%.
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Affiliation(s)
- Miquel À. Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Maria J. Ulldemolins
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
| | - Ria Garcia
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Sant Roc i Equip d’Atenció Primària Gorg, Badalona, Catalonia, Spain
| | - Sonia Gràcia
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Sant Roc i Equip d’Atenció Primària Gorg, Badalona, Catalonia, Spain
| | - Josep M. Picaza
- Equip PADES Badalona, Institut Català de la Salut, Badalona, Catalonia, Spain
| | - Mercedes Navarro Fernández
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Sant Adriàde Besòs, Sant Adriàde Besòs, Catalonia, Spain
| | - Maria A. Rocabayera
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Sant Adriàde Besòs, Sant Adriàde Besòs, Catalonia, Spain
| | - Montserrat Rivera
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Llefià, Badalona, Catalonia, Spain
| | - Núria Relaño
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Llefià, Badalona, Catalonia, Spain
| | - Mireia Torres Asensio
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Llefià, Badalona, Catalonia, Spain
| | - Pilar Laporta
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Llefià, Badalona, Catalonia, Spain
| | - Celia Morcillo
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Bufalà, Badalona, Catalonia, Spain
| | - Laura Nadal
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Badalona Centre-Dalt de la Vila, Badalona, Catalonia, Spain
| | - Ramona Hervás
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Badalona Centre-Dalt de la Vila, Badalona, Catalonia, Spain
| | - Dolors Fuguet
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària Badalona Centre-Dalt de la Vila, Badalona, Catalonia, Spain
| | - Cristina Alba
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Equip d’Atenció Primària El Masnou, El Masnou, Catalonia, Spain
| | | | - Sònia Jimenez
- Unitat de Treball Social, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Miriam Moreno Moreno
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Carmen Nogueras
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Helena Manjón Navarro
- Servei d’Atenció Primària Barcelonès Nord, Institut Català de la Salut, Catalonia, Spain
- Unitat d’Hospitalitzacióa Domicili, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Rosa López
- Direcció d’Organitzaciói Sistemes d’Informació, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Guillem Hernández
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Research Group on Innovation, Health Economics and Digital Transformation (IGTP), Barcelona, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
- eXiT Research group –trol Engineering and Intelligent Systems (IIiA –UdG), Girona, Spain
| | - Francesc López-Seguí
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Research Group on Innovation, Health Economics and Digital Transformation (IGTP), Barcelona, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
| | - Laura Ricou Ríos
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Research Group on Innovation, Health Economics and Digital Transformation (IGTP), Barcelona, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
| | - Arnau Pons
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
| | - Nuria Prat
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Jordi Ara Del Rey
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Oriol Estrada
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
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5
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Roure S, López F, Oliva I, Pérez-Quílez O, March O, Chamorro A, Abad E, Muñoz IL, Castillo A, Soldevila L, Valerio L, Lozano M, Masnou H, Oliveira M, Cañas L, Gibrat M, Chuecos M, Montero JJ, Colmenares K, Falguera G, Bonet JM, Isnard M, Prat N, Estrada O, Clotet B, Vallès X. Schistosomiasis screening in non-endemic countries from a cost perspective: Knowledge gaps and research priorities. The case of African long-term residents in a Metropolitan Area, Spain. PLoS Negl Trop Dis 2023; 17:e0011221. [PMID: 37014919 PMCID: PMC10104311 DOI: 10.1371/journal.pntd.0011221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 04/14/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Imported schistosomiasis is an emerging issue in European countries as a result of growing global migration from schistosomiasis-endemic countries, mainly in sub-Saharan Africa. Undetected infection may lead to serious long-term complications with an associated high cost for public healthcare systems especially among long-term migrants. OBJECTIVE To evaluate from a health economics perspective the introduction of schistosomiasis screening programs in non-endemic countries with high prevalence of long-term migrants. METHODOLOGY We calculated the costs associated with three approaches-presumptive treatment, test-and-treat and watchful waiting-under different scenarios of prevalence, treatment efficacy and the cost of care resulting from long-term morbidity. Costs were estimated for our study area, in which there are reported to reside 74,000 individuals who have been exposed to the infection. Additionally, we methodically reviewed the potential factors that could affect the cost/benefit ratio of a schistosomiasis screening program and need therefore to be ascertained. RESULTS Assuming a 24% prevalence of schistosomiasis in the exposed population and 100% treatment efficacy, the estimated associated cost per infected person of a watchful waiting strategy would be €2,424, that of a presumptive treatment strategy would be €970 and that of a test-and-treat strategy would be €360. The difference in averted costs between test-and-treat and watchful waiting strategies ranges from nearly €60 million in scenarios of high prevalence and treatment efficacy, to a neutral costs ratio when these parameters are halved. However, there are important gaps in our understanding of issues such as the efficacy of treatment in infected long-term residents, the natural history of schistosomiasis in long-term migrants and the feasibility of screening programs. CONCLUSION Our results support the roll-out of a schistosomiasis screening program based on a test-and-treat strategy from a health economics perspective under the most likely projected scenarios, but important knowledge gaps should be addressed for a more accurate estimations among long-term migrants.
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Affiliation(s)
- Sílvia Roure
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Fight and Infectious Diseases Foundation, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Francesc López
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Grup de Recerca en Innovació, Economia de la Salut i Transformació Digital (Institut de Recerca Germans Trias i Pujol-IGTP), Badalona, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Irene Oliva
- Grup de Recerca en Innovació, Economia de la Salut i Transformació Digital (Institut de Recerca Germans Trias i Pujol-IGTP), Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Oriol March
- Grup de Recerca en Innovació, Economia de la Salut i Transformació Digital (Institut de Recerca Germans Trias i Pujol-IGTP), Badalona, Spain
| | - Anna Chamorro
- Fight and Infectious Diseases Foundation, Badalona, Spain
| | - Elena Abad
- Fight and Infectious Diseases Foundation, Badalona, Spain
| | - Israel López Muñoz
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Amaia Castillo
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Laura Soldevila
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lluís Valerio
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Manolo Lozano
- Neurology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Helena Masnou
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mario Oliveira
- Urology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Laura Cañas
- Nephrology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Gibrat
- Primary Health Care Unit Canovelles, North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Granollers, Spain
| | - Marta Chuecos
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Badalona, Spain
| | - Juan José Montero
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Badalona, Spain
| | - Karen Colmenares
- Unitat de Suport Assistencial i Avaluació (USUAiA), Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Gemma Falguera
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Josep Maria Bonet
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Mar Isnard
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Núria Prat
- North Metropolitan Primary Care Directorate, Instiut Català de la Salut, Sabadell, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Health Region, Institut Català de la Salut, Badalona, Spain
| | - Bonaventura Clotet
- Fight and Infectious Diseases Foundation, Badalona, Spain
- IrsiCaixa-Institut de Recerca de La SIDA, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Direcció Territorial Malalties Infeccioses, North Metropolitan Territorial Health Region, Institut Català de la Salut, Badalona, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Fight and Infectious Diseases Foundation, Badalona, Spain
- Institut de Recerca Germans Trias i Pujol, Badalona, Spain
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López-Muñoz I, Torrella A, Pérez-Quílez O, Castillo-Zuza A, Martró E, Bordoy AE, Saludes V, Blanco I, Soldevila L, Estrada O, Valerio L, Roure S, Vallès X. SARS-CoV-2 Secondary Attack Rates in Vaccinated and Unvaccinated Household Contacts during Replacement of Delta with Omicron Variant, Spain. Emerg Infect Dis 2022; 28:1999-2008. [PMID: 36037811 PMCID: PMC9514368 DOI: 10.3201/eid2810.220494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We performed a prospective, cross-sectional study of household contacts of symptomatic index case-patients with SARS-CoV-2 infection during the shift from Delta- to Omicron-dominant variants in Spain. We included 466 household contacts from 227 index cases. The secondary attack rate was 58.2% (95% CI 49.1%-62.6%) during the Delta-dominant period and 80.9% (95% CI 75.0%-86.9%) during the Omicron-dominant period. During the Delta-dominant period, unvaccinated contacts had higher probability of infection than vaccinated contacts (odds ratio 5.42, 95% CI 1.6-18.6), but this effect disappeared at ≈20 weeks after vaccination. Contacts showed a higher relative risk of infection (9.16, 95% CI 3.4-25.0) in the Omicron-dominant than Delta-dominant period when vaccinated within the previous 20 weeks. Our data suggest vaccine evasion might be a cause of rapid spread of the Omicron variant. We recommend a focus on developing vaccines with long-lasting protection against severe disease, rather than only against infectivity.
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7
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Soldevila L, Prat N, Mas MÀ, Massot M, Miralles R, Bonet-Simó JM, Isnard M, Expósito-Izquierdo M, Garcia-Sanchez I, Rodoreda-Noguerola S, Moreno N, Badia E, López G, Sevilla J, Estrada O, Vallès X. The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents. BMC Geriatr 2022; 22:123. [PMID: 35164680 PMCID: PMC8842505 DOI: 10.1186/s12877-022-02779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/12/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.
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Affiliation(s)
- Laura Soldevila
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - Núria Prat
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Miquel À Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Massot
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josep M Bonet-Simó
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Mar Isnard
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | | | - Irene Garcia-Sanchez
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Sara Rodoreda-Noguerola
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Nemesio Moreno
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Esther Badia
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Genís López
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Javier Sevilla
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Oriol Estrada
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain.
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.
- Institut per la Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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8
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López F, Català M, Prats C, Estrada O, Oliva I, Prat N, Isnard M, Vallès R, Vilar M, Clotet B, Argimon JM, Aran A, Ara J. A Cost-Benefit Analysis of COVID-19 Vaccination in Catalonia. Vaccines (Basel) 2021; 10:59. [PMID: 35062719 PMCID: PMC8780175 DOI: 10.3390/vaccines10010059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: In epidemiological terms, it has been possible to calculate the savings in health resources and the reduction in the health effects of COVID vaccines. Conducting an economic evaluation, some studies have estimated its cost-effectiveness; the vaccination shows highly favorable results, cost-saving in some cases. (2) Methods: Cost-benefit analysis of the vaccination campaign in the North Metropolitan Health Region (Catalonia). An epidemiological model based on observational data and before and after comparison is used. The information on the doses used and the assigned resources (conventional hospital beds, ICU, number of tests) was extracted from administrative data from the largest primary care provider in the region (Catalan Institute of Health). A distinction was made between the social perspective and the health system. (3) Results: the costs of vaccination are estimated at 137 million euros (€48.05/dose administered). This figure is significantly lower than the positive impacts of the vaccination campaign, which are estimated at 470 million euros (€164/dose administered). Of these, 18% corresponds to the reduction in ICU discharges, 16% to the reduction in conventional hospital discharges, 5% to the reduction in PCR tests and 1% to the reduction in RAT tests. The monetization of deaths and cases that avoid sequelae account for 53% and 5% of total savings, respectively. The benefit/cost ratio is estimated at 3.4 from a social perspective and 1.4 from a health system perspective. The social benefits of vaccination are estimated at €116.67 per vaccine dose (€19.93 from the perspective of the health system). (4) Conclusions: The mass vaccination campaign against COVID is cost-saving. From a social perspective, most of these savings come from the monetization of the reduction in mortality and cases with sequelae, although the intervention is equally widely cost-effective from the health system perspective thanks to the reduction in the use of resources. It is concluded that, from an economic perspective, the vaccination campaign has high social returns.
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Affiliation(s)
- Francesc López
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
- Centre for Research in Health and Economics, Pompeu Fabra University, 08002 Barcelona, Spain
- Fight AIDS and Infectious Diseases Foundation, 08916 Barcelona, Spain;
| | - Martí Català
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Barcelona, Spain; (M.C.); (C.P.)
| | - Clara Prats
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Barcelona, Spain; (M.C.); (C.P.)
- BIOCOM-SC, Physics Department, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
| | - Irene Oliva
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
- Centre for Research in Health and Economics, Pompeu Fabra University, 08002 Barcelona, Spain
| | - Núria Prat
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Mar Isnard
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Roser Vallès
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Marc Vilar
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Bonaventura Clotet
- Fight AIDS and Infectious Diseases Foundation, 08916 Barcelona, Spain;
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, 08916 Barcelona, Spain
| | | | - Anna Aran
- Catalan Health Service, Ministry of Health, 08007 Barcelona, Spain;
| | - Jordi Ara
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
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9
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Mas MÀ, Miralles R, Heras C, Ulldemolins MJ, Bonet JM, Prat N, Isnard M, Pablo S, Rodoreda S, Verdaguer J, Lladó M, Moreno-Gabriel E, Urrutia A, Rocabayera MA, Moreno-Millan N, Modol JM, Andrés I, Estrada O, Ara Del Rey J. Designing a Person-Centred Integrated Care Programme for People with Complex Chronic Conditions: A Case Study from Catalonia. Int J Integr Care 2021; 21:22. [PMID: 34899101 PMCID: PMC8622001 DOI: 10.5334/ijic.5653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/25/2020] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The prevalence of people with complex chronic conditions is increasing. This population's high social and health needs require person-centred integrated approaches to care. METHODS To collect data about experiences with the health system and identify priorities for care, we conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients' associations. To design the programme, we combined this information with evidence-based recommendations from local healthcare and social care professionals. RESULTS Patients' and caregivers' main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care. CONCLUSION We developed an evidence-based integrated care programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals.
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Affiliation(s)
- Miquel À. Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Consol Heras
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Maria J. Ulldemolins
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Servei d’Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Catalonia, Spain
| | - Josep M. Bonet
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Núria Prat
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Mar Isnard
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Sara Pablo
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Sara Rodoreda
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Servei d’Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Catalonia, Spain
| | - Joaquim Verdaguer
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Servei d’Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Catalonia, Spain
| | - Magdalena Lladó
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Servei d’Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Catalonia, Spain
| | - Eduard Moreno-Gabriel
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
- Servei d’Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Catalonia, Spain
| | - Agustín Urrutia
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Maria A. Rocabayera
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Nemesio Moreno-Millan
- Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Josep M. Modol
- Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Isabel Andrés
- Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Oriol Estrada
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Jordi Ara Del Rey
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - ProPCC-Badalona Group
- (members in alphabetical order):Salvador Altimir, Margarita Álvaro, Alba Barranco, Gloria Bonet, Montserrat Bonet, Montserrat Bret, Anna Champer, Beatriz Díaz, Mar Domingo, Ria Garcia, Sonia Gracia, Carme Grau, Jaume Guitart, Maria Heras, Eva Hernández, Ramona Hervás, Sonia Jiménez, Yolanda López, Natalia Maella, Helena Manjón, Alicia Marín, Josefina Martínez, Montserrat Mas, Sonia Mimoso, Núria Miralles, Celia Morcillo, Núria Moreno, Xavier Muntada, Laura Nadal, Mercedes Navarro, Carme Nogueras, Raquel Nuñez, Cristina Pacho, Lidia Pedrejón, Carmen Pereira, Josep M. Picaza, María Puertas, Carmen Rios, Laura Rodríguez, Mercè Serrano, Antonia Segura, Boris Trenado, Julia Trigueros, Tathiana Vértiz, Daniel Vilar, Mario Vinardell*All members affiliated to Institut Català de la Salut except Margarita Álvaro, affiliated to Institut Català d’Oncologia
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10
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Mas MÀ, Mesquida MM, Miralles R, Soldevila L, Prat N, Bonet-Simó JM, Isnard M, Expósito-Izquierdo M, Garcia-Sanchez I, Rodoreda-Noguerola S, Moreno N, Badia E, López G, Sevilla J, Estrada O, Vallès X. Clinical Factors Related to COVID-19 Outcomes in Institutionalized Older Adults: Cross-sectional Analysis from a Cohort in Catalonia. J Am Med Dir Assoc 2021; 22:1857-1859. [PMID: 34375654 PMCID: PMC8289628 DOI: 10.1016/j.jamda.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Miquel Àngel Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain; Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Massot Mesquida
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain; Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Laura Soldevila
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Núria Prat
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Josep M Bonet-Simó
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Mar Isnard
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | | | - Irene Garcia-Sanchez
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Sara Rodoreda-Noguerola
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Nemesio Moreno
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Esther Badia
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Genís López
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Javier Sevilla
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Oriol Estrada
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain; Institut per la Recerca en Ciències en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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11
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Soldevila L, Valerio-Sallent L, Roure S, Pérez-Quílez O, Mas MÀ, Miralles R, López-Muñoz I, Estrada O, Vallès X. Drug exposure may have a substantial influence on COVID-19 prognosis among residents of long-term care facilities: an exploratory analysis. Int J Infect Dis 2021; 109:192-194. [PMID: 34242767 PMCID: PMC8260494 DOI: 10.1016/j.ijid.2021.07.007] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives To explore the association between drug exposure and SARS-CoV-2 prognosis among elderly people living in long-term care facilities (LTC) Design We carried out a cross-sectional study among old people living in LTC that had a proven SARS-CoV-2 infection, including socio-demographic data, comorbidities and drug intake at the moment of the diagnosis. The study was focused on ACE2 inhibitors, ARA-II blockers, inhaled bronchodilators, oral corticoids, platelet antiaggregants, oral anti-coagulants, statins and Vitamin D. Results 1 306 individuals were included, with a mean age of 86.7 years, and 72.3% were females. The case fatality rate was 24.4%. Among the studied exposures platelet antiaggregants were the most prevalent (24.7%). After adjusting for propensity score, the intake of inhaled corticoids (OR 0.73; p=0.03) and statins (OR 0.65; p=0.03) were found to be protective factors of death, whereas ACE2 inhibitor showed an almost significant association (OR 0.73, p=0.07). Conclusions Considering the high prevalence of drug intake among elderly people, drug exposure may be an important Covid-19 disease modifier in LTC residents and should be considered when exploring prognostic risk factors associated to Covid-19.
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Affiliation(s)
- Laura Soldevila
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Lluís Valerio-Sallent
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Sílvia Roure
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Miquel Àngel Mas
- Direcció Clínica Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain; Geriatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain; Geriatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Israel López-Muñoz
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Oriol Estrada
- Gerència Territorial, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain; Institut per la Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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12
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Suñer C, Ouchi D, Mas MÀ, Lopez Alarcon R, Massot Mesquida M, Prat N, Bonet-Simó JM, Expósito Izquierdo M, Garcia Sánchez I, Rodoreda Noguerola S, Teixidó Colet M, Verdaguer Puigvendrelló J, Henríquez N, Miralles R, Negredo E, Noguera-Julian M, Marks M, Estrada O, Ara J, Mitjà O. A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain. ACTA ACUST UNITED AC 2021; 1:579-584. [PMID: 37117802 DOI: 10.1038/s43587-021-00079-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries1, and different risk factors for mortality have been identified in this setting2-5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively.
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13
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Vallès X, Roure S, Valerio L, López-Muñoz I, Pérez-Quílez O, Soldevila L, Martín-Cano L, Estrada O, Palacín MD, Blanco I, Orozco J, Esquerrà A, Villanova X. SARS-CoV-2 contact tracing among disadvantaged populations during epidemic intervals should be a priority strategy: results from a pilot experiment in Barcelona. Public Health 2021; 195:132-134. [PMID: 34111802 PMCID: PMC8106905 DOI: 10.1016/j.puhe.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/09/2021] [Accepted: 04/29/2021] [Indexed: 12/13/2022]
Abstract
Objectives The aim of this study was to trace contacts of coronavirus disease 2019 (COVID-19) hospitalised patients and determine the risk factors of infection in urban areas. Study design Longitudinal analysis of contacts identified from index cases. Methods A contact tracing study was carried out in the Northern Metropolitan area of Barcelona, Spain, during the inter-epidemic lapse of May to July 2020, a period of low SARS-CoV-2 incidence. Index cases were notified from the referral hospital. Contacts were traced and followed up for 14 days. Reverse transcription polymerase chain reaction was performed on day 0 and day 14 for contacts. Results In total, 368 contacts were identified from 81 index cases (median of seven contacts per index case), from which 308 were traced successfully. The median age of contacts was 28 years, 62% (223 of 368) were men. During the follow-up period, 100 contacts tested positive for COVID-19 (32.5% [95% confidence interval {CI} = 27.3–38.0]), with a secondary infection rate of 48.3% (95% CI = 40.8–55.9) among housemates. Clusters of index and respective contacts tended to aggregate within disadvantaged neighbourhoods (P < 0.001), and non-national index cases (N = 28, 34.1%) resulted in higher secondary infection rates compared with nationals (51.0% [95% CI = 41.0–60.9] vs 22.3% [95% CI = 16.8–28.8]; P < 0.001). Conclusions Disadvantaged communities experience a disproportionate burden of COVID-19 and may act as infection reservoirs. Contact tracing with a cross-cutting approach among these communities is required, especially during inter-epidemic periods.
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Affiliation(s)
- X Vallès
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain.
| | - S Roure
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain; Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut Català de la Salut, C/ Canyet s/n, 08018, Badalona, Catalonia, Spain
| | - L Valerio
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain
| | - I López-Muñoz
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain
| | - O Pérez-Quílez
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain
| | - L Soldevila
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain; Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut Català de la Salut, C/ Canyet s/n, 08018, Badalona, Catalonia, Spain
| | - L Martín-Cano
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain
| | - O Estrada
- Directorate of Innovation, North Metropolitan Health Area from Barcelona, Institut Català de la Salut, C/Canyet s/n, 08018, Badalona, Catalonia, Spain
| | - M D Palacín
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain
| | - I Blanco
- Microbiology Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut Català de la Salut, C/Canyet s/n, 08018, Badalona, Catalonia, Spain
| | - J Orozco
- Emergency Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut Català de la Salut, C/Canyet s/n, 08018, Badalona, Catalonia, Spain
| | - A Esquerrà
- Internal Medicine Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut Català de la Salut, C/Canyet s/n, 08018, Badalona, Catalonia, Spain
| | - X Villanova
- North Metropolitan International Health Program, Primary Care Unit, Universitat Autònoma de Barcelona, Institut Català de la Salut, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain
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14
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Barallat J, Fernández-Rivas G, Quirant-Sánchez B, González V, Doladé M, Martinez-Caceres E, Piña M, Matllo J, Estrada O, Blanco I. Seroprevalence of SARS-CoV-2 IgG specific antibodies among healthcare workers in the Northern Metropolitan Area of Barcelona, Spain, after the first pandemic wave. PLoS One 2020; 15:e0244348. [PMID: 33370363 PMCID: PMC7769254 DOI: 10.1371/journal.pone.0244348] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background The rapid spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) around the world has caused a global pandemic, infecting millions of individuals, with an unprecedented impact in health care systems worldwide. Healthcare workers are one of the risk groups that need to be well protected, due to their strategic role in patient management, presently and in prevention of healthcare needs for future outbreaks. Here, we present the results of the first SARS-CoV-2 seroprevalence study in the Northern Metropolitan Area of Barcelona, Spain. Methods IgG SARS-CoV-2 antibodies were analyzed in serum samples from 7563 healthcare workers of the Northern Metropolitan Area of Barcelona. Samples were collected after the first pandemic wave (from May 4th to May 22nd, 2020) and were analyzed by automated chemiluminescence assays. All samples were tested for IgG anti-S1/S2. Participant samples with negative or equivocal results but with analytical signals above the limit of detection and/or previously confirmed COVID-19 diagnosis were also tested for IgG anti-Nucleocapsid. Results A total of 779 of 7563 (10.3%) healthcare workers were positive for anti-SARS-CoV-2 IgG (specific for either S1/S2 or N antigens). No significant differences were observed between those working at primary care or at the reference hospital. Interestingly, among 341 participants with a confirmed COVID-19 diagnosis, 36 (10.55%) tested negative for SARS-CoV-2 IgG (both S1/S2 and recombinant N antigen). Conclusion Seroprevalence of anti-SARS-CoV-2 IgG in the healthcare workers of the North Metropolitan Area of Barcelona was higher than in the general population in the same geographical area. Safety measures have to be stressed in order to protect these essential workers from future pandemic waves.
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Affiliation(s)
- Jaume Barallat
- Servei d’Anàlisis Clínics i Bioquímica, Laboratori Clínic de la Metropolitana Nord, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Gema Fernández-Rivas
- Servei de Microbiologia, Laboratori Clínic de la Metropolitana Nord, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bibiana Quirant-Sánchez
- Servei d’Immunologia, Laboratori Clínic de la Metropolitana Nord, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Departament de Biologia Celular, Fisiologia i Immunologia, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Victoria González
- Servei de Microbiologia, Laboratori Clínic de la Metropolitana Nord, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Doladé
- Servei d’Anàlisis Clínics i Bioquímica, Laboratori Clínic de la Metropolitana Nord, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Eva Martinez-Caceres
- Servei d’Immunologia, Laboratori Clínic de la Metropolitana Nord, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Departament de Biologia Celular, Fisiologia i Immunologia, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Monica Piña
- Unitat Bàsica de Prevenció, Direcció Atenció Primària, Gerencia Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Joan Matllo
- Unitat Bàsica de Prevenció, Hospital Germans Trias i Pujol, Gerencia Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Oriol Estrada
- Direcció d’innovació i processos transversals, Gerencia Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Ignacio Blanco
- Servei de Genètica Clínica, Laboratori Clínic de la Metropolitana Nord, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Departament de Cirurgia, Universitat Autònoma Barcelona, Barcelona, Spain
- * E-mail:
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15
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Arias-de la Torre J, Zioga EAM, Macorigh L, Muñoz L, Estrada O, Mias M, Estrada MD, Puigdomenech E, Valderas JM, Martín V, Molina AJ, Espallargues M. Differences in Results and Related Factors Between Hospital-at-Home Modalities in Catalonia: A Cross-Sectional Study. J Clin Med 2020; 9:jcm9051461. [PMID: 32414161 PMCID: PMC7361969 DOI: 10.3390/jcm9051461] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/02/2022] Open
Abstract
Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered—admission avoidance (n = 7214; 75.1%) and early assisted discharge (n = 2387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities.
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Affiliation(s)
- Jorge Arias-de la Torre
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Instituto de Biomedicina (IBIOMED). Universidad de León, 24004 León, Spain;
- Correspondence:
| | | | - Lizza Macorigh
- Departamento de Medicina Interna, Hospital de Granollers, 08402 Barcelona, Spain;
| | - Laura Muñoz
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28029 Madrid, Spain
| | - Oriol Estrada
- Dirección de Procesos Asistenciales y Alianzas. Gerencia Territorial Metropolitana Nord, Institut Català de la Salut, 08007 Barcelona, Spain;
| | - Montse Mias
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
| | - Maria-Dolors Estrada
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Elisa Puigdomenech
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28029 Madrid, Spain
| | - Jose M. Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter EX2 4TE, UK;
| | - Vicente Martín
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Instituto de Biomedicina (IBIOMED). Universidad de León, 24004 León, Spain;
| | - Antonio J. Molina
- Instituto de Biomedicina (IBIOMED). Universidad de León, 24004 León, Spain;
| | - Mireia Espallargues
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28029 Madrid, Spain
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16
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Sanroma P, Muñoz P, Mirón-Rubio M, Aguilera A, Estrada O, García D, González-Ramallo VJ, Pajarón M, Sgaramella GA, González CR, Mujal A, Abad A, Solé A, González S, Escalada C, Vitoria I, Gómez MJ, Parra JJ, Sampedro I, Pereda I. Effectiveness and safety of ertapenem used in hospital-at-home units: data from Spanish Outpatient Parenteral Antimicrobial Therapy Registry. Future Microbiol 2018; 13:1363-1373. [PMID: 30238769 DOI: 10.2217/fmb-2018-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIM To evaluate the effectiveness and safety of ertapenem in patients hospitalized at home. PATIENTS & METHODS Retrospective analysis of data from Spanish Outpatient Parenteral Antimicrobial Therapy (OPAT) registry. RESULTS Data from 1428 patients (median age 70 years; 5.4% institutionalized) and 1547 infectious processes (24% self-administration) were analyzed. Clinical cure or improvement was achieved in 93.8% of cases. Rate of related readmissions was 4.2%, of clinically important complications -3.9%, and of adverse drug reactions -3.2%. High comorbidity burden, contagion in nursing home and certain types of infection were associated with worse prognosis. Self-administration was effective and safe, except in case of nursing home-acquired infections. CONCLUSION Ertapenem OPAT was effective and safe. Caregivers in nursing homes should be better trained in OPAT-related procedures.
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Affiliation(s)
- Pedro Sanroma
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
| | - Pedro Muñoz
- Teaching unit, Cantabria Health Care Service, Santander, Spain
| | - Manuel Mirón-Rubio
- Hospital-at-Home unit, Torrejon Hospital, Torreján de Ardoz, Madrid, Spain
| | - Ana Aguilera
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
| | - Oriol Estrada
- Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Dora García
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
| | | | - Marcos Pajarón
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
| | | | | | - Abel Mujal
- Hospital-at-Home unit. Department of Internal Medicine. Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Aquilino Abad
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
| | - Anna Solé
- Arnau de Vilanova University Hospital, Lleida, Spain
| | | | - Carmen Escalada
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
| | | | | | - Juan J Parra
- Family Medicine Resident, Valdecilla Hospital, Santander, Spain
| | - Isabel Sampedro
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
| | - Iliana Pereda
- Hospital-at-Home unit, Valdecilla Hospital, Santander, Spain
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Candel FJ, Borges Sá M, Belda S, Bou G, Del Pozo JL, Estrada O, Ferrer R, González del Castillo J, Julián-Jiménez A, Martín-Loeches I, Maseda E, Matesanz M, Ramírez P, Ramos JT, Rello J, Suberviola B, Suárez de la Rica A, Vidal P. Current aspects in sepsis approach. Turning things around. Rev Esp Quimioter 2018; 31:298-315. [PMID: 29938972 PMCID: PMC6172679] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The incidence and prevalence of sepsis depend on the definitions and records that we use and we may be underestimating their impact. Up to 60% of the cases come from the community and in 30-60% we obtain microbiological information. Sometimes its presentation is ambiguous and there may be a delay in its detection, especially in the fragile population. Procalcitonin is the most validated biomarker for bacterial sepsis and the one that best discriminates the non-infectious cause. Presepsin and pro-adrenomedullin are useful for early diagnosis, risk stratification and prognosis in septic patients. The combination of biomarkers is even more useful to clarify an infectious cause than any isolated biomarker. Resuscitation with artificial colloids has worse results than crystalloids, especially in patients with renal insufficiency. The combination of saline solution and balanced crystalloids is associated with a better prognosis. Albumin is only recommended in patients who require a large volume of fluids. The modern molecular methods on the direct sample or the identification by MALDI-TOF on positive blood culture have helped to shorten the response times in diagnosis, to optimize the antibiotic treatment and to facilitate stewardship programs. The hemodynamic response in neonates and children is different from that in adults. In neonatal sepsis, persistent pulmonary hypertension leads to an increase in right ventricular afterload and heart failure with hepatomegaly. Hypotension, poor cardiac output with elevated systemic vascular resistance (cold shock) is often a terminal sign in septic shock. Developing ultra-fast Point-of-Care tests (less than 30 minutes), implementing technologies based on omics, big data or massive sequencing or restoring "healthy" microbiomes in critical patients after treatment are the main focuses of research in sepsis. The main benefits of establishing a sepsis code are to decrease the time to achieve diagnosis and treatment, improve organization, unify criteria, promote teamwork to achieve common goals, increase participation, motivation and satisfaction among team members, and reduce costs.
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Affiliation(s)
| | - Marcio Borges Sá
- Multidisciplinar Sepsis Unit. Intensive Care Unit. Hospital Son Llatzer. Palma de Mallorca
| | - Sylvia Belda
- Department of Intensive Pediatrics. Maternal and Child Health and Development Network. Hospital 12 de Octubre. Madrid
| | - Germán Bou
- Clinical Microbiology Department. Complejo Hospitalario Universitario. La Coruña
| | - José Luis Del Pozo
- Clinical Microbiology and Infectious Diseases Department. Clinica Universitaria Navarra
| | - Oriol Estrada
- Clinical Innovation Management, Germans Trias i Pujol University Hospital. Barcelona
| | - Ricard Ferrer
- Department of Intensive Care. Shock, Organ Dysfunction and Resuscitation Research Group. CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | | | | | - Ignacio Martín-Loeches
- Multidisciplinary Intensive Care Research Organization. CIBERES Instituto de Salud Carlos III. Department of Intensive Care Medicine. St James’s Hospital. Trinity Centre for Health Sciences. Dublin. Ireland
| | - Emilio Maseda
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz. Madrid
| | - Mayra Matesanz
- Department of Internal Medicine. Hospital Clínico San Carlos. Madrid
| | - Paula Ramírez
- Critical Care Department. University Hospital la Fe. Valencia
| | - José Tomás Ramos
- José T. Ramos. Department of Public and Mother-Child Health. Hospital Clínico San Carlos, IdISSC Health Research Institute. Universidad Complutense. Madrid
| | - Jordi Rello
- Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS). CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | - Borja Suberviola
- Critical Care Department. Hospital Universitario Marqués de Valdecilla. Santander
| | | | - Pablo Vidal
- Intensive Care Unit. Complexo Hospitalario Universitario de Ourense
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18
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González-Ramallo VJ, Mirón-Rubio M, Mujal A, Estrada O, Forné C, Aragón B, Rivera AJ. Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain. Int J Antimicrob Agents 2017; 50:114-118. [PMID: 28499957 DOI: 10.1016/j.ijantimicag.2017.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain.
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Affiliation(s)
- V J González-Ramallo
- Hospital at Home Unit, Department of Internal Medicine, Gregorio Marañón Hospital, Madrid, Spain.
| | - M Mirón-Rubio
- Hospital at Home Unit, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - A Mujal
- Hospital at Home Unit, Department of Internal Medicine, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - O Estrada
- Northern Metropolitan Area, Catalan Health Institute (ICS), Badalona, Barcelona, Spain
| | - C Forné
- Department of Health Economics and Outcomes Research, Oblikue Consulting, Barcelona, Spain
| | - B Aragón
- Merck Sharp & Dohme Corp., Madrid, Spain
| | - A J Rivera
- Merck Sharp & Dohme Corp., Madrid, Spain
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19
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Estrada O, Pulido L, Admella C, Hidalgo LA, Clavé P, Suñol X. Sentinel lymph node biopsy as a prognostic factor in non-metastatic colon cancer: a prospective study. Clin Transl Oncol 2016; 19:432-439. [PMID: 27541595 DOI: 10.1007/s12094-016-1543-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/06/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Around a third of node-negative patients with colon cancer experience a recurrence after surgery, suggesting poor staging. Sentinel lymph node techniques combined with immunochemistry could improve colon cancer staging. We prospectively assessed the effect of Sentinel node mapping on staging and survival in patients with non-metastatic colon cancer. METHODS An observational and prospective study was designed. 105 patients with colon cancer were selected. Patients were classified according to node involvement as: N1, with node invasion detected by the conventional techniques; up-staged, with node invasion detected only by sentinel node mapping; and N0, with negative lymph node involvement by both techniques. Five-year survival and disease-free survival rates were analysed. Multivariate regression analyses were performed to identify prognostic factors for disease-free and overall survival. RESULTS Sentinel node mapping was successfully applied in 78 patients: 33 % were N1; 24.5 % were up-staged (18 patients with isolated tumour cells and 1 patient with micrometastases); and 42.5 % were N0. N1 patients had the poorest overall 5-year survival (65.4 %) and 5-year disease-free survival (69.2 %) rates compared with the other two groups. No significant 5-year survival differences were observed between N0 patients (87.9 %) and up-staged patients (84.2 %). CONCLUSIONS Patients up-staged after sentinel node mapping do not have a poorer prognosis than patients without node involvement. Detection of isolated cancer cells was not a poor prognosis factor in these patients.
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Affiliation(s)
- O Estrada
- General Surgery Department, Colorectal Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain.
| | - L Pulido
- General Surgery Department, Colorectal Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - C Admella
- Pathology Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - L-A Hidalgo
- General Surgery Department, Colorectal Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - P Clavé
- General Surgery Department, Colorectal Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - X Suñol
- General Surgery Department, Colorectal Unit, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
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20
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Berdún S, Bombuy E, Estrada O, Mans E, Rychter J, Clavé P, Vergara P. Peritoneal mast cell degranulation and gastrointestinal recovery in patients undergoing colorectal surgery. Neurogastroenterol Motil 2015; 27:764-74. [PMID: 25677271 DOI: 10.1111/nmo.12525] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/14/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Degranulation of peritoneal mast cells (MCs) induced by intestinal manipulation has been proposed as a pathophysiological factor in postoperative ileus (POI). We aimed to explore the relationship between peritoneal and colonic MC degranulation and gastrointestinal (GI) recovery following colectomy. METHODS Patients undergoing elective laparoscopic cholecystectomy (using a laparoscope and small abdominal incisions, n = 14), and elective laparoscopic (n = 32) or open partial colectomy (through a large abdominal incision, n = 10) were studied. MC protease tryptase and chymase were studied in peritoneal fluid at the beginning, middle, and end of each surgical intervention. Density of MCs in colectomy samples were examined and oro-caecal transit time by breath test, GI function recovery by clinical composite endpoint GI-2 and association between MC proteases and clinical recovery. KEY RESULTS Open and laparoscopic colectomy caused greater peritoneal release of tryptase and chymase (323.0 ng/mL [IQR: 53.05-381.4] and 118.6 ng/mL [IQR: 53.60-240.3]), than cholecystectomy (41.64 ng/mL [IQR: 11.17-90.93]) at the end of the surgical intervention. However, there were no differences between laparoscopic and open colectomy. Increased peritoneal protease release during surgery was observed in patients who developed POI after colectomy. CONCLUSIONS & INFERENCES Colorectal surgery causes protease release from peritoneal MCs. Protease release does not differ between both types of colectomy (laparoscopy vs laparotomy). However, MC activation is increased in colectomy patients developing POI. Therefore, degranulation of peritoneal MCs as a factor contributing to human POI after colectomy might be considered in future studies as a target to avoid POI.
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Affiliation(s)
- S Berdún
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Bombuy
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Estrada
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Mans
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Rychter
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - P Clavé
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - P Vergara
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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21
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Del Mar Saniger-Alba M, Gonzalez Duarte MA, Estrada O, Chiquete E, Rodriguez-Balaguer R. Cryptococcal Meningitis in HIV-Negative Patients with Systemic Connective Tissue Diseases (P01.249). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Gayol MDC, Font A, Casas I, Estrada O, Domínguez MJ, Pedro-Botet ML. Utilidad de la escala de MASCC en el tratamiento de la neutropenia febril inducida por quimioterapia en pacientes con neoplasia sólida. Med Clin (Barc) 2009; 133:296-9. [DOI: 10.1016/j.medcli.2008.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 12/03/2008] [Indexed: 11/16/2022]
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23
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Estrada O, Alvarado-Castillo C, Fernandez A, Lopez M, Romero-Vecchione E, Vasquez J, Mendez J, Conde D, Cardozo A. Pomolic Acid Isolated from the Leaves of Licania pittieri Inhibits ADP-and Epinephrine-Induced Platelet Aggregation and has Hypotensive Effect on Rats. ACTA ACUST UNITED AC 2009. [DOI: 10.2174/157340709789054786] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Abstract
Fournier's gangrene is a potentially fatal necrotizing fasciitis affecting the perineum and genital area. The usual treatment includes prompt surgical debridement and, in many cases, a diverting colostomy. We present two cases of Fournier's gangrene that were treated with extensive local debridement and rectal diversion with a new device for faecal matter management, avoiding the need for a colostomy.
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Affiliation(s)
- O Estrada
- Surgery Hospital de Mataró, Cerretra de Cirera s/n, Barcelona, Spain.
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25
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Farré R, Aulí M, Lecea B, Estrada O, Suñol X, Clavé P. Mechanisms controlling function in the clasp and sling regions of porcine lower oesophageal sphincter. Br J Surg 2007; 94:1427-36. [PMID: 17542040 DOI: 10.1002/bjs.5831] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/05/2022]
Abstract
BACKGROUND Characterization of functional differences between lower oesophageal sphincter (LOS) clasp and sling muscles might aid the development of more specific pharmacological and surgical approaches for the treatment of motility disorders. METHODS Circular LOS strips from 25 adult pigs were studied in organ baths to compare the physiology of clasp and sling fibres. RESULTS Sling strips developed greater tone than clasp fibres (mean(s.e.m.) 7.59(0.89) versus 4.72(0.67) g; P = 0.017). LOS tone was more dependent on extracellular calcium in clasp strips and on the activity of cholinergic enteric motor neurones (EMNs) in sling strips. The amplitude of maximal relaxation caused by electrical field stimulation (EFS, 3Hz) of EMNs was greater in clasp strips (mean(s.e.m.) 74.5(2.3) versus 58.1(2.2) per cent of tone; P < 0.001). EFS-induced relaxation was reduced in clasp fibres and fully blocked in sling fibres by nitrergic blockade with 10 micromol/l 1H-[1,2,4]oxadiazole-[4,3-alpha]quinoxalin-1-one (ODQ). The amplitude of EFS cholinergic responses was significantly greater in sling fibres. In the clasp region, relaxation caused by stimulation of EMNs with 100 micromol/l nicotine was reduced by ODQ. In sling fibres, nicotine induced relaxation at rest and cholinergic contraction following ODQ. CONCLUSION Clasp and sling fibres of the porcine LOS show marked intrinsic functional differences. This should be considered when developing more specific approaches to human LOS motility disorders.
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Affiliation(s)
- R Farré
- Dr Francisco Vilardell Foundation of Gastroenterology and Research Group for the Study of Gastrointestinal Motility, Autonomous University of Barcelona, Bellaterra, Spain
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26
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Abstract
BACKGROUND AND OBJECTIVE The Hospital at Home Unit (HHU) is a medical care model effective in different fields of medical and surgical conditions. The objective of the study was to analyse the utility of moving acute nephrologic patients to a HHCU. PATIENTS AND METHOD We review the Nephrology Service requests to move patients to the HHU the last 3 years. The results were compared with those obtained from the rest of patients admitted at the HHU during the same period. RESULTS The requests number was 85 and 79 (93%) patients were included for the study. Patients had high comorbidity (Charlson index mean, 3.75) and acute medical problems. The length of stay at the HHU was 12.65 days. The total intervention rate was 1.23 interventions/day. In 71 cases (89.9%) the hospital discharge was at the patient's home. In 8 cases the readmission at the hospital was required to solve the medical process. Hospital readmissions after the HHCU discharge before 30 days was 6.3%. No statistical differences were found between nephrology patients and the rest of HHU patients when comparing the intervention rates, the percentage of home discharges and the hospital readmissions. CONCLUSIONS The moving of nephrologic acute patients to a HHU is a save choice and well accepted by patients and their families.
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Affiliation(s)
- Jordi Ara
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
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27
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Estrada O, Bonet G, Riera C, Cuxart A. Tratamiento de las neumonías extrahospitalarias y hospitalización a domicilio. Enferm Infecc Microbiol Clin 2005; 23:109. [PMID: 15743585 DOI: 10.1157/13071617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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28
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Jiménez G, Hasegawa M, Rodríguez M, Estrada O, Méndez J, Castillo A, Gonzalez-Mujica F, Motta N, Vásquez J, Romero-Vecchione E. Biological screening of plants of the Venezuelan Amazons. J Ethnopharmacol 2001; 77:77-83. [PMID: 11483381 DOI: 10.1016/s0378-8741(01)00271-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A total of 21 extracts derived from 17 different plant species collected in Venezuelan Amazons have been tested for the following biological activities: cardiovascular activity, brine shrimp lethality, and inhibitory effects on the hydrolysis of glucose-6-phosphate in intact and disrupted microsomes. Eight extracts diminished rat blood pressure with or without changes in heart rate. The fruit extract of Swartzia leptopetala and the leaf and twig extract of Connarus lambertii resulted in death of experimental animals. The majority of extracts (17 extracts) showed significant toxicity against Artemia salina. Concerning the hydrolysis of glucose-6-phosphate, better inhibitory effects were observed in intact microsomes than in disrupted ones for all the extracts, suggesting that these extracts intervene with variable potency in glucose-6-phosphate transport through the microsomal membrane.
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Affiliation(s)
- G Jiménez
- Laboratorio de Productos Naturales, Centro de Química Orgánica, Escuela de Química, Facultad de Ciencias, Universidad Central de Venezuela, Apartado Postal 47102, Caracas 1020A, Venezuela
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29
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Rego MJ, Urrutia A, Estrada O, Rey-Joly C. [Pleural effusion associated to gynecological laparoscopy for an ovaric endometrioma]. Med Clin (Barc) 2000; 115:677-8. [PMID: 11141421] [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: 02/18/2023]
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30
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Tudela P, Rego MJ, Tor J, Estrada O, Mòdol JM, Sahuquillo JC. [Analysis of internal notices to the emergency team of the medical area at a general hospital]. Med Clin (Barc) 2000; 114:730-1. [PMID: 10919126 DOI: 10.1016/s0025-7753(00)71416-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 11/21/2022]
Abstract
OBJECTIVE To study the frequency and characteristics of the hospitalized patients medical emergencies. PATIENTS AND METHODS We have collected daily the notice to the emergency room from patients hospitalized and we have analyzed the clinical and epidemiological characteristics. RESULTS Three hundred forty-one notices were recorded. The daily mean was higher on holidays. There were mostly medical problems (78%). Complementary explorations were performed in the 44% of the patients, and in the 77% the treatment was changed. CONCLUSIONS The in-patient emergencies account for an important charge of work for the emergency team and involve important diagnosis and therapeutic decisions.
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Affiliation(s)
- P Tudela
- Unidad de Urgencias, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona
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31
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Estrada O, Romeu J, Giménez G, Raventós A, Sirera G, Clotet B. [Bronchogenic carcinoma in patients with human immunodeficiency virus infection]. Med Clin (Barc) 1996; 106:661-4. [PMID: 8691913] [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: 02/01/2023]
Abstract
The diagnosis of bronchogenic carcinoma (BC) in patients with HIV infection is infrequent. Five cases are described and the existing references reviewed. The incidence, risk factors, clinical manifestations, histology, age of onset, diagnosis and survival in HIV positive patients with BC were analyzed. The clinical histories of 2,586 patients with HIV infection seen in the authors' center were reviewed. Five cases in whom BC was detected were found. Sixty-nine cases published in the international literature were collected in a reference search by the MEDLINE system between 1982-1994. The patients with BC and HIV infection have an early age of presentation (mean age: 42 years) and a lower survival with respect to those without infection. No differences were observed with regard to the smoking habit, procedures for achieving diagnosis or clinical manifestation. The predominant histologic subtype was adenocarcinoma. A higher incidence of BC was observed in patients with HIV infection with respect to the control groups on elimination of the bias for age and risk factors for BC. Given its low incidence, BC should be considered in the differential diagnosis of pulmonary disease in patients with HIV infection in cases presenting a history of smoking, once the most common opportunistic infections have been discarded.
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Affiliation(s)
- O Estrada
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
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32
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Estrada O, Martín-Romero F. [Asthenia, weight loss, and left supraclavicular tumor in a 31-year-old male]. Med Clin (Barc) 1995; 105:669-76. [PMID: 8558968] [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: 01/31/2023]
Affiliation(s)
- O Estrada
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
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