Predicting chronic kidney disease progression with artificial intelligence.

BACKGROUND: The use of tools that allow estimation of the probability of progression of chronic kidney disease (CKD) to advanced stages has not yet achieved significant practical importance in clinical setting. This study aimed to develop and validate a machine learning-based model for predicting the need for renal replacement therapy (RRT) and disease progression for patients with stage 3-5 CKD. METHODS: This was a retrospective, closed cohort, observational study. Patients with CKD affiliated with a private insurer with five-year follow-up data were selected. Demographic, clinical, and laboratory variables were included, and the models were developed based on machine learning methods. The outcomes were CKD progression, a significant decrease in the estimated glomerular filtration rate (eGFR), and the need for RRT. RESULTS: Three prediction models were developed-Model 1 (risk at 4.5 years, n = 1446) with a F1 of 0.82, 0.53, and 0.55 for RRT, stage progression, and reduction in the eGFR, respectively,- Model 2 (time- to-event, n = 2143) with a C-index of 0.89, 0.67, and 0.67 for RRT, stage progression, reduction in the eGFR, respectively, and Model 3 (reduced Model 2) with C-index = 0.68, 0.68 and 0.88, for RRT, stage progression, reduction in the eGFR, respectively. CONCLUSION: The time-to-event model performed well in predicting the three outcomes of CKD progression at five years. This model can be useful for predicting the onset and time of occurrence of the outcomes of interest in the population with established CKD.

Cost-utility analysis of a palliative care program in Colombia.

BACKGROUND: The economic assessment of health care models in palliative care promotes their global development. The purpose of the study is to assess the cost-effectiveness of a palliative care program (named Contigo) with that of conventional care from the perspective of a health benefit plan administrator company, Sanitas, in Colombia. METHODS: The incremental cost-utility ratio (ICUR) and the incremental net monetary benefit (INMB) were estimated using micro-costing in a retrospective, analytical cross-sectional study on the care of terminally ill patients enrolled in a palliative care program. A 6-month time horizon prior to death was used. The EQ-5D-3 L questionnaire (EQ-5D-3 L) and the McGill Quality of Life Questionnaire (MQOL) were used to measure the quality of life. RESULTS: The study included 43 patients managed within the program and 16 patients who received conventional medical management. The program was less expensive than the conventional practice (difference of 1,924.35 US dollars (USD), P = 0.18). When compared to the last 15 days, there is a higher perception of quality of life, which yielded 0.25 in the EQ-5D-3 L (p < 0.01) and 1.55 in the MQOL (P < 0.01). The ICUR was negative and the INMB was positive. CONCLUSION: Because the Contigo program reduces costs while improving quality of life, it is considered to be net cost-saving and a model with value in health care. Greater availability of palliative care programs, such as Contigo, in Colombia can help reduce existing gaps in access to universal palliative care health coverage, resulting in more cost-effective care.

Self-perceived health status, gender, and work status.

This study analyzes the relationship between gender and self-perceived health status in Spanish retirees and housewives from a sample of 1,106 community-dwelling older adults. A multivariate linear regression model was used in which self-perceived health status was measured by the EQ-5D visual analogue scale and gender according to work status (retired men and women and housewives). Retired males reported a significantly better health status than housewives. Self-perceived health status was closely associated with physical, mental, and functional health and leisure activities. Finally, being a woman with complete dedication to domestic work is associated with a worse state of self-perceived health.

Factors associated with self-rated health status of older people with multimorbidity in Colombia: A cross-sectional study.

BACKGROUND AND OBJECTIVE: In Colombia, older adults (60 years and older) are expected to represent 15.5% of the overall population by 2025. Consequently, the demand for social and healthcare services will increase, especially because of the numerous medical conditions associated with aging. The purpose of the present study was to determine the patient's self-rated health status of older adults with multimorbidity and its determining factors based on gender in an insurance company of the Colombian health system. METHODOLOGY: A cross-sectional study was performed to analyze the sociodemographic and clinical characteristics of 438 patients older than 75 years as well as their self-rated health status (EQ-5D-3L questionnaire) during the first geriatric consultation of a comprehensive healthcare program. A multivariate linear regression analysis was performed to identify factors determining their self-rated health status. RESULTS: Women had a worse self-rated health status than men [mean (standard deviation) EQ-5D index score: 0.77 (0.20) vs. 0.65 (0.18); p<0.001]. In all sample, factors independently associated with self-rated health status were self-perception of weakness and dependency. In men, additional factors related to EQ-5D index were low levels of physical activity, recurrent falls, fecal incontinence, and auditory and visual disorders. In women, other health-determining factors were decrease in walking speed, and a medical history of depression/anxiety. CONCLUSIONS: Factors associated with the self-rated health status of older adults who were part of a comprehensive healthcare program in Colombia varied according to gender. This study will help in approaching health interventions in healthcare programs for older adults in a differentiated manner.

The cost of hospital care for HIV patients in Colombia: an insurer's perspective.

The aim of this study was to evaluate the cost derived from the hospitalization of people living with HIV (PLHIV) in Colombia between 2011 and 2015. This is an analysis of the direct cost of PLHIV hospitalization from the perspective of an insurer of the Colombian General Social Security System. The costs were calculated in Colombian pesos and corrected for inflation on the basis of the 2017 Consumer Price Index of the Bank of the Republic of Colombia. It was converted to US dollars at the Market Representative Exchange Rate of the same year. We analyzed 1129 hospitalizations in 612 PLHIV, of which 12% started with a diagnosis of HIV during the same hospitalization, with the majority in the AIDS stage (63%). The median overall cost of hospitalizations was US$1509 (25th and 75th percentiles: US$711-US$3254), being even higher in patients with AIDS and as the CD4 T lymphocyte count decreased. The cost derived from the medical care of PLHIV increases as the clinical control of the disease worsens, and it is a key indicator of the impact of the strategies implemented for the timely identification of the infection and subsequent management of the disease.

Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia.

OBJECTIVE: To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS: A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS: There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS: A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.

Determinants of adherence to continuous positive airway pressure therapy in adults with obstructive sleep apnea / Determinantes de adherencia a presión positiva continua de la via aérea en adultos con apnea del sueño

ASBTRACT Objectives Adherence to continuous positive airway pressure (CPAP) devices in patients with obstructive sleep apnea (OSA) determines the effectiveness of the treat-ment. Likewise, the assessment of the control of the disease must consider the information referred by the patient, among other value-based health measures related to the satisfaction of the intervention. The objectives of this study were a) Determine the factors related to adherence to CPAP devices in subjects with OSA affiliated to an insurance company of the healthcare system in Colombia. b) Assess symptom control associated to the disease from the individual's perspective and his/her satisfaction with the treatment received. Materials and Methods 1,501 subjects with OSA were surveyed by telephone to explore: sociodemographic factors, habits and lifestyles, use of CPAP and its adverse events, control of the disease, comorbidities, access to care and therapy satisfaction. Using multilevel logistic regression techniques, the influence of the various factors on adherence to CPAP was analyzed, using Stata 13 software. Results Adherence to CPAP therapy was of 58% and the control of symptoms was of 41.7%. The factors that determined the use of CPAP were knowledge on how the device operates, and the disturbances during sleep due to the mask or nasal pad. The-rapy satisfaction was predominantly very good or good. Conclusion Even with moderate adherence values and a good experience with CPAP therapy, symptomatic control of the disease is poor. Many of the factors that affect the use of CPAP are modifiable with a proper approach by the devices' service provider.

RESUMEN Objetivos La adherencia a los dispositivos de presión positiva continua de la vía aérea (CPAP) en pacientes con síndrome de apnea obstructiva del sueño (SAOS) define la efectividad del tratamiento. Los objetivos de este estudio fueron: a) Determinar los factores relacionados con la adherencia al CPAP en pacientes con SAOS de una aseguradora del Sistema General de Seguridad Social en Salud colombiano y b) evaluar el control de los síntomas de la enfermedad desde la perspectiva del individuo y su satisfacción con la terapia. Materiales y Métodos Mediante encuesta telefónica a 1 501 pacientes con SAOS se exploraron factores sociodemográficos, hábitos y estilos de vida, uso del CPAP y eventos adversos relacionados, control de la enfermedad, comorbilidad, acceso a la atención y satisfacción con la terapia. Utilizando técnicas de regresión logística mul-tinivel, se analizó la influencia de los distintos factores sobre la adherencia al CPAP mediante el software Stata 13. Resultados La adherencia al CPAP fue del 58% y el control de los síntomas del 41,7%. Los factores que determinaron el uso del CPAP fueron el conocimiento del funcionamiento del equipo y la dificultad para dormir debida a la mascarilla o la almohadilla nasal. La satisfacción con la terapia fue buena o muy buena predominantemente. Conclusiones Aún con valores de adherencia moderados y una buena experiencia con la terapia CPAP, el control sintomático de la enfermedad es pobre, pues varios de los factores afectan el uso del CPAP. Dichos factores se pueden intervenir con un adecuado abordaje por parte del prestador de servicios del dispositivo.

Quality of life by proxy and mortality in institutionalized older adults with dementia.

AIM: This study aimed at analyzing the effect of quality of life (QoL) on mortality in older adults with dementia living in long-term care facilities. METHODS: A prospective observational cohort study was carried out on 412 residents aged older than 60 years, diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Besides assessment of QoL (EQ-5D index by proxy) and perceived health status (EQ-VAS), baseline measurements included severity of dementia (Clinical Dementia Rating Scale [CDR]), comorbidity (number of self-reported chronic conditions), disability evaluation (Barthel Index), cognitive state (Mini Examen Cognoscitivo, a validated and modified Spanish version of the Mini-Mental State Examination) and depression (Cornell Depression Scale for Dementia). Sociodemographic and clinical variables were analyzed as potential effect modifiers and confounders in the relationship between QoL and mortality using a multivariate logistic regression analysis. RESULTS: After an 18-month follow up, 138 residents had died. Adjusting for CDR and Barthel Index, the odds of mortality were multiplied by 0.25 (95% CI 0.09-0.70) and 0.79 (95% CI 0.26-2.42) for every unit of change in the EQ-5D index in the residents with Cornell score <6 and ≥ 6, respectively. CONCLUSION: The present study suggests that the effect of QoL on mortality in institutionalized adults with dementia should take into account the presence or absence of depression. In addition, residents with a greater disability and more advanced dementia should be a target for interventions in rehabilitation care.

Self-perceived health and quality of life by activity status in community-dwelling older adults.

AIM: The present study aimed at analyzing whether activity status is associated with self-perceived health status and quality of life (QoL) in community-dwelling older adults. METHODS: We used a cross-sectional design based on a semi-structured QoL questionnaire in a representative sample of 1106 community-dwelling adults aged 60 years and older in Spain. Logistic regression models were used to explain the association of activity status with self-perceived health status and QoL, assessed by means of the EQ-5D-3L index, controlling for the influence of sociodemographic, social and support network variables, and health indicators. RESULTS: The mean age ± standard deviation was 72.1 ± 7.8 years. For the activity status, 8.5% were working people, 53.7% retirees, 30.6% homemakers and 7.2% pensioners. All homemakers and 93.6% pensioners were women. In the model to assess perceived health status, when controlling for sociodemographic, social and support network variables, we found that working people rated their health better than the retired group. In this model, pensioners rated their health status worst, whereas homemakers did not show any significant difference compared with the retired group. However, there were no differences in the model of QoL by activity status. CONCLUSION: Activity status was associated with self-perceived health status, but not with QoL. This study draws attention to the need of considering the activity of older adults for actions aimed at maintaining and improving their health.

Which factors are associated with mortality in institutionalized older adults with dementia?

Residential facilities are increasingly used as a resource for dependent older adults and a high percentage of patients with dementia die there. Information about the leading medical causes and exposures to risk factors of mortality in institutionalized older patients with dementia could guide the development of clinical management interventions. The data of 387 institutionalized adults aged over 60, diagnosed with dementia, was analyzed retrospectively. Information about sociodemographic, comorbidities, quality of life and leisure and free time variables was collected in a survey answered by caregivers; after 19 months, information was collected on the result variable (living vs. deceased). A multivariate logistic regression model was created to determine the factors associated with mortality, which were: age (odds ratio (OR)=1.986; 95% confidence interval (CI): 1.229-3.209); diabetes (OR=2.322; 1.350-3.996); hypertension (OR=1.695; 1.044-2.752); diseases of the genitourinary system (OR=2.455;1.419-4.248), worsening of health over last twelve months (OR=1.653; 1.018-2.685) and not performing passive (OR=1.616; 0.968-2.700) or social (OR=2.242; 1.170-4.299) leisure activities. Besides age, the number of comorbid illnesses and the inability to perform leisure activities predicted mortality in institutionalized adults with dementia. These predictors might be useful clinical markers for identifying patients at increased risk for mortality.

Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia

ABSTRACT OBJECTIVE To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.

[Trends in the prevalence of extended-spectrum beta-lactamase-producing gram-negative bacilli in a teaching hospital in Madrid, Spain]. / Tendencia de la prevalencia de bacilos gramnegativos productores de betalactamasas de espectro extendido en un hospital universitario de Madrid.

BACKGROUND AND OBJECTIVE: The pprevalence of extended-spectrum beta-lactamase (ESBL) producing gram-negative bacilli has increased in recent years. The aim of this study is to estimate the prevalence of infection/colonization due to theses microorganisms per 100 admissions and its trend during the period 2007-2010. PATIENTS AND METHODS: Prospective observational study of all patients admitted from January 2007 to December 2010 infected or colonized with ESBL-producing gram-negative bacilli at Hospital Universitario Ramón y Cajal. The prevalence of infection/colonization of ESBL-producing gram-negative rods was calculated according to the recommendations for metrics for multidrug-resistant organisms in healthcare settings of The Society for Healthcare Epidemiology of America and the Healthcare Infection Control Practices Advisory Committee. To analyse trends, Poisson regression was used (Joinpoint Regression Program Version 3.4.3, U.S. National Institutes of Health). RESULTS: Through the study period there was an upward trend of prevalence of all the ESBL-producing gram-negative bacilli. The Poisson trend analysis indentified a significant inflection point in August 2009 (p=0.014). CONCLUSION: The inflection point in the prevalence of the ESBL-producing gram-negative bacilli trend can be explained by a slowdown in the prevalence of some microorganisms such as ESBL-producing Klebsiella pneumoniae.