Instituto Aragones Of Ciencias Of La Salud Ics

Zaragoza, Spain

Instituto Aragones Of Ciencias Of La Salud Ics

Zaragoza, Spain
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Andres E.,CIBER ISCIII | Cordero A.,Hospital Universitario Of San Juan | Magan P.,CIBER ISCIII | Alegria E.,Policlinica Guipuzcoa | And 4 more authors.
Revista Espanola de Cardiologia | Year: 2012

Introduction and objectives: Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140 000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. Methods: This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12 096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. Results: Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. Conclusions: Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs. © 2011 Sociedad Española de Cardiología. Published by Elsevier Españ a, S.L. All rights reserved.

Gonzalez-Rubio F.,Instituto Aragones Of Ciencias Of La Salud Ics | Gonzalez-Rubio F.,Institute Investigacion Sanitaria Aragon IIS Aragon | Calderon-Larranaga A.,Instituto Aragones Of Ciencias Of La Salud Ics | Poblador-Plou B.,Instituto Aragones Of Ciencias Of La Salud Ics | And 3 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2011

Purpose: This study evaluated the magnitude of underreporting of adverse drug reactions (ADRs) and investigated possible reporting patterns according to patient characteristics and the type of reaction based on the integration of information obtained from primary care electronic medical records (EMRs) and the Spanish Pharmacovigilance System. Methods: This investigation was a descriptive retrospective study analysing ADRs recorded in 2005 in the EMRs from six health centers in Zaragoza (Aragon, Spain) with a covered population of 126,838 subjects. The associations between the probability of reporting and the reaction and drug type were studied using logistic regression models adjusted by age and sex. Results: The total number of ADRs recorded in the EMRs was 543, of which 65.7% were reported to the Spanish Pharmacovigilance System. Positive associations were found between the probability of reporting an ADR and advanced age of patients (OR for ≥76years=2.0; 95%CI 1.1-3.6), involvement of the reproductive system (OR=7.9; 95%CI 1.02-60.2) and involvement of psychiatric disorders (OR=4.0; 95%CI 1.4-11.6). Negative associations were found between reporting an ADR and early age of patients (OR for 0-14years=0.2; 95%CI 0.1-0.6) and the use of antimicrobial drugs (OR=0.6; 95%CI 0.4-0.9). Conclusions: This study tackles an important public health problem directly related to patients' safety and highlights the utility of EMRs for investigating the current significance of ADR underreporting. It also makes us think that primary care physicians seem to have selective reporting patterns based on their familiarity with the reaction type and the drug causing the reaction as well as on the age of patients. © 2011 John Wiley & Sons, Ltd.

Catala-Lopez F.,Centro Superior Of Investigacion En Salud Publica Csisp | Catala-Lopez F.,Fundacion Institute Investigacion En Servicios Of Salud | Catala-Lopez F.,Spanish Medicines and Healthcare Products Agency AEMPS | Alonso-Arroyo A.,University of Valencia | And 8 more authors.
PLoS ONE | Year: 2012

Background: Cost-Effectiveness Analysis (CEA) has been promoted as an important research methodology for determining the efficiency of healthcare technology and guiding medical decision-making. Our aim was to characterize the collaborative patterns of CEA conducted over the past two decades in Spain. Methods and Findings: A systematic analysis was carried out with the information obtained through an updated comprehensive literature review and from reports of health technology assessment agencies. We identified CEAs with outcomes expressed as a time-based summary measure of population health (e.g. quality-adjusted life-years or disability-adjusted life-years), conducted in Spain and published between 1989 and 2011. Networks of coauthorship and institutional collaboration were produced using PAJEK software. One-hundred and thirty-one papers were analyzed, in which 526 authors and 230 institutions participated. The overall signatures per paper index was 5.4. Six major groups (one with 14 members, three with 7 members and two with 6 members) were identified. The most prolific authors were generally affiliated with the private-for-profit sector (e.g. consulting firms and the pharmaceutical industry). The private-for-profit sector mantains profuse collaborative networks including public hospitals and academia. Collaboration within the public sector (e.g. healthcare administration and primary care) was weak and fragmented. Conclusions: This empirical analysis reflects critical practices among collaborative networks that contributed substantially to the production of CEA, raises challenges for redesigning future policies and provides a framework for similar analyses in other regions. © 2012 Catalá-López et al.

Campayo A.,Hospital Clinico Universitario | Campayo A.,CIBER ISCIII | Campayo A.,Instituto Aragones Of Ciencias Of La Salud Ics | Gomez-Biel C.H.,Hospital Clinico Universitario | And 3 more authors.
Current Psychiatry Reports | Year: 2011

In a context of the potentially epidemic nature of both diabetes mellitus and depression, and the negative effects reported in cases of comorbidity, this review suggests that the association of the two conditions is multifaceted. Increased risks of prevalent depression and incident depression among diabetic patients have been reported in community studies. Even more consistent is the finding supporting psychosomatic hypotheses regarding the increased risk of diabetes among depressed patients. A recent relevant finding is the increased risk of diabetes reported in depression that is commonly found in the community, namely nonsevere, persistent, untreated depression. In view of the negative implications of the comorbidity of depression and diabetes, the suggestion that all clinically relevant cases of depression found in the community should be treated seems logical. However, new studies seem mandatory to document the efficacy of treatment of depression and the safety of antidepressant use in cases of comorbidity. © 2010 Springer Science+Business Media, LLC.

Catala-Lopez F.,Centro Superior Of Investigacion En Salud Publica Csisp | Catala-Lopez F.,Fundacion Institute Investigacion En Servicios Of Salud | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp | Peiro S.,Fundacion Institute Investigacion En Servicios Of Salud | And 5 more authors.
BMC Psychiatry | Year: 2012

Background: Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed neuropsychiatric disorder in childhood, but the frequency of the condition is not well established in many countries. The aim of the present study was to quantify the overall prevalence of ADHD among children and adolescents in Spain by means of a systematic review and meta-analysis.Methods: PubMed/MEDLINE, IME, IBECS and TESEO were comprehensively searched. Original reports were selected if they provided data on prevalence estimates of ADHD among people under 18 years old in Spain and were cross-sectional, observational epidemiological studies. Information from included studies was systematically extracted and evaluated. Overall pooled-prevalence estimates of ADHD were calculated using random-effects models. Sources of heterogeneity were explored by means sub-groups analyses and univariate meta-regressions.Results: Fourteen epidemiological studies (13,026 subjects) were selected. The overall pooled-prevalence of ADHD was estimated at 6.8% [95% confidence interval (CI) 4.9 - 8.8%] representing 361,580 (95% CI 260,550 - 467,927) children and adolescents in the community. There was significant heterogeneity (P < 0.001), which was incompletely explained by subgroup analyses and meta-regressions.Conclusions: Our findings suggest that the prevalence of ADHD among children and adolescents in Spain is consistent with previous studies conducted in other countries and regions. This study represents a first step in estimating the national burden of ADHD that will be essential to building evidence-based programs and services. © 2012 Catalá-López et al.; licensee BioMed Central Ltd.

PubMed | Ottawa Hospital Research Institute and Instituto Aragones Of Ciencias Of La Salud Ics
Type: | Journal: Atencion primaria | Year: 2017

To examine the relationship between the funding source of cost-effectiveness analyses of healthcare interventions published in Spain and study conclusions.Descriptive cross-sectional study.Scientific literature databases (until December 2014).Cohort of cost-effectiveness analysis of healthcare interventions published in Spain between 1989-2014 (n=223) presenting quality-adjusted life years (QALYs) as the outcome measure.The relationship between qualitative conclusions of the studies and the type of funding source were established using Fishers exact test in contingency tables. Distributions of the incremental cost-effectiveness ratios by source of funding in relation to hypothetical willingness to pay thresholds between 30,000-50,000 per QALY were explored.A total of 136 (61.0%) studies were funded by industry. The industry-funded studies were less likely to report unfavorable or neutral conclusions than studies non-funded by industry (2.2% vs. 23.0%; P<.0001), largely driven by studies evaluating drugs (0.9% vs. 21.4%; P<.0001). The incremental cost-effectiveness ratios in studies funded by industry were more likely to be below the hypothetical willingness to pay threshold of 30,000 (73.8% vs. 56.3%; P<.0001) and 50,000 (89.4% vs. 68.2%; P<.0001) per QALY.This study reveals a potential sponsorship bias in cost-effectiveness analyses of healthcare interventions. Studies funded by industry could be favoring the efficiency profile of their products.

Calderon-Larranaga A.,Instituto Aragones Of Ciencias Of La Salud Ics | Gimeno-Feliu L.A.,Instituto Aragones Of Ciencias Of La Salud Ics | Gimeno-Feliu L.A.,San Pablo Primary Health Care Center | MacIpe-Costa R.,Instituto Aragones Of Ciencias Of La Salud Ics | And 4 more authors.
BMC Public Health | Year: 2011

Background: There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC) utilisation patterns between immigrants and the native population with regard to their morbidity burden. Methods. This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain). Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System). Results: The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p < 0.05; adults: IRR = 0.73, p < 0.05). After adjusting for morbidity burden, this difference decreased among children (IRR = 0.94, p < 0.05) and disappeared among adults (IRR = 1.00). Further analysis considering the PC health service and type of visit revealed higher usage of routine diagnostic tests among immigrant children (IRR = 1.77, p < 0.05) and a higher usage of emergency services among the immigrant adult population (IRR = 1.2, p < 0.05) after adjusting for age, sex and case mix. Conclusions: Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain. © 2011 Calderón-Larrãaga et al; licensee BioMed Central Ltd.

Catala-Lopez F.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Sanfelix-Gimeno G.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Ridao M.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Ridao M.,Instituto Aragones Of Ciencias Of La Salud Ics | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio
PLoS ONE | Year: 2013

Background:We examined sponsorship of published cost-effectiveness analyses of statin use for cardiovascular (CV) prevention, and determined whether the funding source is associated with study conclusions.Methods and Findings:We searched PubMed/MEDLINE (up to June 2011) to identify cost-effectiveness analyses of statin use for CV prevention reporting outcomes as incremental costs per quality-adjusted life years (QALY) and/or life years gained (LYG). We examined relationships between the funding source and the study conclusions by means of tests of differences between proportions. Seventy-five studies were included. Forty-eight studies (64.0%) were industry-sponsored. Fifty-two (69.3%) articles compared statins versus non-active alternatives. Secondary CV prevention represented 42.7% of articles, followed by primary CV prevention (38.7%) and both (18.7%). Overall, industry-sponsored studies were much less likely to report unfavourable or neutral conclusions (0% versus 37.1%; p<0.001). For primary CV prevention, the proportion with unfavourable or neutral conclusions was 0% for industry-sponsored studies versus 57.9% for non-sponsored studies (p<0.001). Conversely, no statistically significant differences were identified for studies evaluating secondary CV prevention (0% versus 12.5%; p=0.222). Incremental costs per QALY/LYG estimates reported in industry-sponsored studies were generally more likely to fall below a hypothetical willingness-to-pay threshold of US $50,000.Conclusions:Our systematic analysis suggests that pharmaceutical industry sponsored economic evaluations of statins have generally favored the cost-effectiveness profile of their products particularly in primary CV prevention. © 2013 Catalá-López et al.

Marijuan P.C.,Instituto Aragones Of Ciencias Of La Salud Ics | Navarro J.,Instituto Aragones Of Ciencias Of La Salud Ics | del Moral R.,Instituto Aragones Of Ciencias Of La Salud Ics
BioSystems | Year: 2010

The adaptive relationship with the environment is a sine qua non condition for any intelligent system. Discussions on the nature of cellular intelligence, however, have not systematically pursued yet the question of whether there is a fundamental way of sensing the environment, which may characterize prokaryotic cells, or not. The molecular systems found in bacterial signaling are extremely diverse, ranging from very simple transcription regulators (single proteins comprising just two domains) to the multi-component, multi-pathway signaling cascades that regulate crucial stages of the cell cycle, such as sporulation, biofilm formation, dormancy, pathogenesis or flagellar biosynthesis. The combined complexity of the environment and of the cellular way of life is reflected as a whole in the aggregate of signaling elements: an interesting power-law relationship emerges in that regard. In a basic taxonomy of bacterial signaling systems, the first level of complexity corresponds to the simplest regulators, the "one-component systems" (OCSs), which are defined as proteins that contain known or predicted input and output domains but lack histidine kinase and receiver domains. They are evolutionary precursors of the "two-component systems" (TCSs), which include histidine protein-kinase receptors and an independent response regulator, and are considered as the central signaling paradigm within prokaryotic organisms. The addition of independent receptors begets further functional complexity: thus, "three-component systems" (ThCSs) should be applied to those two-component systems that incorporate an extra non-kinase receptor to activate the protein-kinase. Further, the combined information processing functions (cross-talk) and integrative dynamics that OCS, TCS and ThCS may achieve together in the prokaryotic cell have to be depicted, as well as the relationship of these informational functions with the life cycle organization and its checkpoints. Finally, the extent to which formal models would capture the ongoing relationship of the living cell with its medium has to be gauged, in the light of both the complexity of molecular recognition events and the impredicative nature of living systems. © 2009 Elsevier Ireland Ltd. All rights reserved.

Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp | Librero J.,Centro Superior Of Investigacion En Salud Publica Csisp | Librero J.,Instituto Aragones Of Ciencias Of La Salud Ics | Ridao M.,Centro Superior Of Investigacion En Salud Publica Csisp | And 2 more authors.
Gaceta Sanitaria | Year: 2010

Objective: The aims of this study were to estimate the rate of hospital emergency services (HES) visits per health area, the associated percentage of admissions and the standardized HES utilization ratio, and to analyze their relationship with hospital resources. Methods: We performed an ecological study that combined information from distinct sources (Survey of Health Care Hospitalization Establishments 2006 and Minimum Data Set 2006) to estimate the rate of HES visits and the percentage of associated emergency admissions in 164 health areas in 14 autonomous communities (AC). Results: Among 35.3 million inhabitants in the 164 areas examined, there were 16.2 million visits to the HES (45.75 per 100 inhabitants); more than 2 million (12.6%) were hospitalized. Excluding 5% of extreme areas, rates oscillated between 31.60 and 78.69 HES visits/100 inhabitants, and the percentage of admissions was between 7.6% and 27.9%. These differences were not attenuated after standardization. The AC factor explained 29% of variance in HES visits and 82% of variance in admissions. The rate of visits was not associated with the number of beds or staff physicians but did correlate with the number HES doctors, and smaller and non-teaching hospitals. Conclusions: There is wide variability in the rates of HES visits and emergency admissions in the different areas of the Spanish National Health System. This variability seems to be associated with a differential use for minor problems. © 2009 SESPAS.

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