Institute for Health science

San Juan de Moró, Spain

Institute for Health science

San Juan de Moró, Spain
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Gutacker N.,University of York | Bloor K.,University of York | Cookson R.,University of York | Gale C.P.,University of Leeds | And 4 more authors.
Health Services Research | Year: 2017

Objective: To estimate a safe minimum hospital volume for hospitals performing coronary artery bypass graft (CABG) surgery. Data Source: Hospital data on all publicly funded CABG in five European countries, 2007–2009 (106,149 patients). Design: Hierarchical logistic regression models to estimate the relationship between hospital volume and mortality, allowing for case mix. Segmented regression analysis to estimate a threshold. Findings: The 30-day in-hospital mortality rate was 3.0 percent overall, 5.2 percent (95 percent CI: 4.0–6.4) in low-volume hospitals, and 2.1 percent (95 percent CI: 1.8–2.3) in high-volume hospitals. There is a significant curvilinear relationship between volume and mortality, flatter above 415 cases per hospital per year. Conclusions: There is a clear relationship between hospital CABG volume and mortality in Europe, implying a “safe” threshold volume of 415 cases per year. © Health Research and Educational Trust


Kromhout D.,Health Council of the Netherlands | Spaaij C.J.K.,Health Council of the Netherlands | De Goede J.,Health Council of the Netherlands | Weggemans R.M.,Health Council of the Netherlands | And 11 more authors.
European Journal of Clinical Nutrition | Year: 2016

The objective of this study was to derive food-based dietary guidelines for the Dutch population. The dietary guidelines are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and food patterns and the risk of 10 major chronic diseases: coronary heart disease, stroke, heart failure, diabetes, breast cancer, colorectal cancer, lung cancer, chronic obstructive pulmonary disease, dementia and depression. The committee also selected three causal risk factors for cardiovascular diseases or diabetes: systolic blood pressure, low-density lipoprotein cholesterol and body weight. Findings were categorized as strong or weak evidence, inconsistent effects, too little evidence or effect unlikely for experimental and observational data separately. Next, the committee selected only findings with a strong level of evidence for deriving the guidelines. Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospective cohort studies. Plausible evidence was based on strong evidence from prospective cohort studies only. A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated. There are 10 new guidelines on legumes, nuts, meat, dairy produce, cereal products, fats and oils, tea, coffee and sugar-containing beverages. Three guidelines on vegetables, fruits, fish and alcoholic beverages have been sharpened, and the 2006 guideline on salt stayed the same. A separate guideline has been formulated on nutrient supplements. Completely food-based dietary guidelines can be derived in a systematic and transparent way. © 2016 Macmillan Publishers Limited. All rights reserved.


Kaufman J.,Brandeis University | Kaufman J.,Harvard University | Liu Y.,Ministry of Health | Fang J.,Institute for Health science
Global Public Health | Year: 2012

China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts. © 2012 Copyright Taylor and Francis Group, LLC.


Moyo D.,Institute for Health science | Tanthuma G.,Institute for Health science | Mushisha O.,Institute for Health science | Kwadiba G.,Institute for Health science | And 7 more authors.
South African Medical Journal | Year: 2014

Background. There is little in the literature on HIV and diabetes mellitus (DM) in sub-Saharan Africa. Objective. To assess the characteristics of HIV and DM in patients receiving antiretroviral therapy (ART) in Botswana. Methods. A retrospective case-control study was conducted at 4 sites. Each HIV-infected patient with DM (n=48) was matched with 2 HIV-infected controls (n=108) by age (±2 years) and sex. Primary analysis was conditional logistic regression to estimate univariate odds and 95% confidence intervals (CIs) for each characteristic. Results. There was no significant association between co-morbid diseases, tuberculosis, hypertension or cancer and risk of diabetes. DM patients were more likely to have higher pre-ART weight (odds ratio (OR) 1.09; 95% CI 1.04 - 1.14). HIV-infected adults >70 kg were significantly more likely to have DM (OR 12.30; 95% CI 1.40 - 107.98). Participants receiving efavirenz (OR 4.58; 95% CI 1.44 - 14.57) or protease inhibitor therapy (OR 20.7; 95% CI 1.79 - 240.02) were more likely to have DM. Neither mean pre-ART CD4 cell count (OR 1.0; 95% CI 0.99 - 1.01) nor pre-ART viral load >100 000 copies/ml (OR 0.71; 95% CI 0.21 - 2.43) were associated with a significant risk of diabetes. Conclusions. These findings suggest a complex interrelation among traditional host factors and treatment-related metabolic changes in the pathogenesis of DM inpatients receiving ART. Notably, pre-ART weight, particularly if >70 kg, is associated with the diagnosis of diabetes in HIV-infected patients in Botswana.


Moyo D.,Institute for Health science | Tanthuma G.,Institute for Health science | Cary M.S.,University of Pennsylvania | Mushisha O.,Institute for Health science | And 8 more authors.
Diabetes Research and Clinical Practice | Year: 2014

We conducted a retrospective cohort study assessing the association between diabetes mellitus (DM) and immune recovery in HIV-infected adults. Immune reconstitution after initiating antiretroviral therapy was more rapid in DM patients (120.4. cells/year) compared to non-DM patients (94.2. cells/year, p< 0.023). Metformin use was associated with improved CD4 recovery (p= 0.034). © 2014 Elsevier Ireland Ltd.


Bouras T.,General Hospital Agios Andreas | Repantis T.,General Hospital Agios Andreas | Fennema P.,Institute for Health science | Korovessis P.,General Hospital Agios Andreas
European Journal of Orthopaedic Surgery and Traumatology | Year: 2014

Abstract: A recent comparative study reported lower revision rate and higher survival in ceramic-on-ceramic (CoC) than in metal-on-metal (MoM) coupling in Zweymüller-Plus THA. We retrospectively studied 87 consecutive patients (94 hips), who primarily received Zweymüller-Plus THA (SL-Plus stem, ceramic 28-mm ball head, Bicon cup) with third-generation CoC bearing surfaces for osteoarthritis. Survival, revision and osteolysis rate were studied and compared to those observed in historical series from this institution with the same THA and MoM articulation. The mean ± SD follow-up was 7.4 ± 1.7 years (range 6–10 years). Four hips (4 %) in four patients were revised 1–6 years following primary implantation: one (1 %) for aseptic loosening of SL-Plus stem and Bicon 5 years after index surgery; one (1 %) for malpositioning of the Bicon and recurrent dislocations 1 year following implantation; and two (2 %) for septic loosening 1 and 6 years postoperatively. Intraoperatively on inspection, there were neither findings for impingement in the revised hips, nor fracture of the Bicon ceramic inlay and ball head. Expansile osteolysis was shown around SL-Plus stem and Bicon in the revised for aseptic loosening hip. With revision of any component for aseptic loosening as the endpoint, the survival was 99 % (95 % CI 91–100 %), while for revision for any reason, it was 95 % (95 % CI 87–98 %) at 10 years. Zweymüller-Plus THA with CoC bearings showed, at mid-term follow-up, high survival and low revision rate for aseptic loosening. These rates were better than the historical series of the same THA with MoM articulation performed by the same surgeon.Level of evidence: Level IV. © 2013, Springer-Verlag France.


Hongmei P.,Institute for Health science | Yulan S.,University of Kentucky | Lishi Z.,University of Sichuan
Toxicology and Industrial Health | Year: 2011

Thyroid is a frequent target for endocrine effects of pesticides. Thyroglobulin (TG) and iodide uptake are crucial to thyroid hormone synthesis and may be targets of thyroid-disrupting chemicals. In our study, thyroid follicular FRTL-5 cells were treated with amitrole, an inhibitor of the thyroid peroxidase (TPO), and the effects on TG and total iodide uptake were observed. The results showed that 1-100 mg/L amitrole had no marked effects on FRTL-5 cell proliferation and DNA synthesis. However, it significantly increased the transcription of tg gene and inhibited the total iodide uptake. And 10-100 mg/L amitrole significantly decreased TG in the culture medium. The data suggests amitrole may disrupt the expression and secretion of TG and iodide uptake. © The Author(s) 2011.


Heim N.,Leiden University | Rolden H.,Institute for Health science | van Fenema E.M.,Leiden University | Weverling-Rijnsburger A.W.E.,Diaconessenhuis Leiden | And 11 more authors.
Age and Ageing | Year: 2016

Background: fragmented healthcare systems are poorly suited to treat the increasing number of older patients with multimorbidity.Objective: to report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients.Methods: the programme was drafted in co-creation with organisations representing older adults, care providers and knowledge institutes. Conducting an action research project, the incidence of adverse outcomes within 3 months after hospital admission, and long-term care expenses (LTCE) were compared between samples in 2010-11 (pre-programme) and 2012-13 (post-programme) in frail and non-frail patients. Hospitalised patients aged ≥70 years were included in four hospitals in the targeted region.Results: developed innovations addressed (i) improved risk management; (ii) delivery of integrated, function-oriented care; (iii) specific geriatric interventions; and (iv) optimisation of transfers. The incidence of adverse outcomes was compared in 813 and 904 included patients respectively in the two samples. In frail patients, the incidence of adverse outcomes decreased from 49.2% (149/303) in the pre-programme sample to 35.5% (130/366) in the post-programme sample. The risk ratio (RR), adjusted for heterogeneity between hospitals, was 0.72 (95% CI: 0.60-0.87). In non-frail patients the incidence of adverse outcomes remained unchanged (RR: 1.02, 95% CI: 0.76-1.36). LTCE were similar in the two samples.Conclusions: by involving stakeholders in designing and developing the transitional care programme, commitment of healthcare providers was secured. Feasible innovations in integrated transitional care for frail older patients after hospitalisation were sustainably implemented from within healthcare organisations. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.


PubMed | Rijnland Hospital, Copenhagen University, Leiden University, Diaconessenhuis Leiden and 2 more.
Type: Journal Article | Journal: Age and ageing | Year: 2016

fragmented healthcare systems are poorly suited to treat the increasing number of older patients with multimorbidity.to report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients.the programme was drafted in co-creation with organisations representing older adults, care providers and knowledge institutes. Conducting an action research project, the incidence of adverse outcomes within 3 months after hospital admission, and long-term care expenses (LTCE) were compared between samples in 2010-11 (pre-programme) and 2012-13 (post-programme) in frail and non-frail patients. Hospitalised patients aged 70 years were included in four hospitals in the targeted region.developed innovations addressed (i) improved risk management; (ii) delivery of integrated, function-oriented care; (iii) specific geriatric interventions; and (iv) optimisation of transfers. The incidence of adverse outcomes was compared in 813 and 904 included patients respectively in the two samples. In frail patients, the incidence of adverse outcomes decreased from 49.2% (149/303) in the pre-programme sample to 35.5% (130/366) in the post-programme sample. The risk ratio (RR), adjusted for heterogeneity between hospitals, was 0.72 (95% CI: 0.60-0.87). In non-frail patients the incidence of adverse outcomes remained unchanged (RR: 1.02, 95% CI: 0.76-1.36). LTCE were similar in the two samples.by involving stakeholders in designing and developing the transitional care programme, commitment of healthcare providers was secured. Feasible innovations in integrated transitional care for frail older patients after hospitalisation were sustainably implemented from within healthcare organisations.


PubMed | Institute for Health science
Type: Journal Article | Journal: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde | Year: 2014

There is little in the literature on HIV and diabetes mellitus (DM) in sub-Saharan Africa.To assess the characteristics of HIV and DM in patients receiving antiretroviral therapy (ART) in Botswana.A retrospective case-control study was conducted at 4 sites. Each HIV-infected patient with DM (n=48) was matched with 2 HIV-infected controls (n=108) by age (2 years) and sex. Primary analysis was conditional logistic regression to estimate univariate odds and 95% confidence intervals (CIs) for each characteristic.There was no significant association between co-morbid diseases, tuberculosis, hypertension or cancer and risk of diabetes. DM patients were more likely to have higher pre-ART weight (odds ratio (OR) 1.09; 95% CI 1.04 - 1.14). HIV-infected adults >70 kg were significantly more likely to have DM (OR 12.30; 95% CI 1.40 - 107.98). Participants receiving efavirenz (OR 4.58; 95% CI 1.44 - 14.57) or protease inhibitor therapy (OR 20.7; 95% CI 1.79 - 240.02) were more likely to have DM. Neither mean pre-ART CD4 cell count (OR 1.0; 95% CI 0.99 - 1.01) nor pre-ART viral load >100 000 copies/ml (OR 0.71; 95% CI 0.21 - 2.43) were associated with a significant risk of diabetes.These findings suggest a complex interrelation among traditional host factors and treatment-related metabolic changes in the pathogenesis of DM inpatients receiving ART. Notably, pre-ART weight, particularly if >70 kg, is associated with the diagnosis of diabetes in HIV-infected patients in Botswana.

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