Peritoneal ultrafiltration in older adult patients with advanced heart failure.

Advanced heart failure (HF) with congestive symptoms refractory to diuretic treatment worsens the patient's prognosis and quality of life. Peritoneal ultrafiltration (PUF) attempts to improve symptoms and reduce HF-related events. This study analyzes the impact of PUF on older adult patients with significant comorbidity and advanced HF. Eighteen patients with advanced HF attended to in the Internal Medicine HF Unit of the Lucus Augusti University Hospital of Lugo, Spain, who started PUF between 2014 and 2021 were analyzed. The number of admissions and instances in which diuretic rescue treatment was used in the year before and after starting PUF were compared. The evolution of renal function, complications secondary to the technique, and survival were also analyzed. The median age was 80 (SD 5.8) years and 72.2% were men. Comparing the year after starting PUF to the year before starting PUF, hospital admissions due to HF (4 vs 20, p = 0.01) and the use of intravenous diuretic rescue treatment declined (4 vs 118, p < 0.001). There was no significant deterioration in renal function during the first year of follow-up or major complications associated with the technique. Survival was 72% at 1 year. In older adult patients with comorbidity, advanced HF, and refractory congestive symptoms, PUF reduced hospital admissions and the use of intravenous diuretic rescue treatment, without major complications.

Assessment of Post-COVID Symptoms Using the C19-YRS Tool in a Cohort of Patients from the First Pandemic Wave in Northwestern Spain.

Introduction: The emergence or persistence of symptoms after acute SARS-CoV-2 infection has made it necessary to develop tools to detect them and assess their impact on patients' quality of life. One of these tools is the COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) scale. We present the results of this tool in a cohort of first pandemic wave patients. Methods: A cross-sectional study of patients with confirmed SARS-CoV-2 infection from March to May 2020 in Lugo (northwestern Spain). C19-YRS was administered via phone 10 months after the acute infection to both former inpatients and outpatients. Electronic medical records were reviewed and relevant data from the acute episode were collected. The main outcome was the presence of impairment in different areas measured by the C19-YRS scale. Results: The answer rate was 63.2%. The mean age was 54 ± 16 years, 38.4% were male and 190 (42.9%) had some comorbidity. Eighty-seven patients (19.6%) required hospitalization and 10 (2.3%) required intensive care unit admission. Ten (3.5%) patients lost their job due to the pandemic. Two hundred seventy-six patients (62.3%) related any symptoms; fatigue (37.2%) and exertional dyspnea (33.4%) were the most common with significant worsening in both cases compared with the situation before the infection. Subgroup analysis showed that more symptom domains were impaired in women than men. Older patients, those with comorbidity and those who needed hospital admission, demanded more health resources after the acute infection. Discussion: C19-YRS is useful for the detection and quantification of symptoms after COVID-19 and provides relevant social, health, and occupational information.

Psychological Well-Being during the COVID-19 Lockdown: Labour Market and Gender Implications.

In the Spring of 2020, a great number of countries introduced different restrictive measures in order to cope with the COVID-19 pandemic. This article examines the labour market transitions of individuals brought about by some of those measures, and the effect of such transitions on psychological well-being. The fact that it has been possible to distinguish between unemployment transitions before the pandemic began and those resulting from the lockdowns is worth highlighting. Evidence is provided showing that unemployment due to the lockdown had a greater negative impact on psychological well-being than furloughs and teleworking. Gender differences confirm that women experienced greater adverse effects as compared to men. Specifically, women working at home exhibited greater negative effects when compared with those on furlough, probably due to a combination of work disruption and increased family obligations. Finally, on the contrary to men, women living in areas with more rigorous restrictions show a reduced probability of worse PWB when compared to those residing in areas without restrictions. This finding suggests that women are willing to sacrifice freedom of movement as long as restrictions protect their at-risk relatives.

The Effect of Being Unemployed on Mental Health: The Spanish Case.

BACKGROUND: The lack of work appeared to be linked to several symptoms related to poor mental health. Likewise, the reverse relationship, namely the influence of poor mental health on the risk of job loss, has also been analysed, i.e. distress could lead to a poorer work performance culminating in potential job loss. Thus, the bidirectional nature of the relationship between unemployment and mental health makes the accurate estimation of causal relationships a complex matter, leaving room for additional research on the subject. AIMS OF THE STUDY: The aim of this research is to analyse the influence that unemployment could have on mental health taking into account the bidirectional nature that exists between both concepts. METHODS: In order to tackle the causal effect of being unemployed on mental health, we present a biprobit model taking into account the presence of dummy endogenous regressors and we compare these results with those obtained from a standard univariate probit. Our identification strategy exploits geographical information on the unemployment rates as instrument. We use Spanish cross-sectional data from the 2006, 2011 and 2017 years. RESULTS: Based on the results, the paper concludes that unemployed persons in Spain could be subject to a 5.4% higher probability of suffering symptoms related to a common mental disorder (versus 11% obtained using a standard probit). DISCUSSION: The results obtained confirm a negative impact of unemployment situation on mental health. In other words, the probability of unemployed people suffering a mental disorder seems superior to that for individuals with a job. Moreover, the marginal effect obtained from a univariate probit model without the possibility of controlling the mental health selection effects, proves the existence of a problem of simultaneity that would have overestimated the effect of being unemployed on mental health. IMPLICATIONS FOR HEALTH CARE PROVISION: It is hoped that the conclusions obtained here prove useful in the implementation of specific mental health care provision aimed at unemployed people. In this context, the evidence obtained should result in the incorporation of health assistance as an essential part in response to the needs of this collective. IMPLICATIONS FOR HEALTH POLICIES: These special needs of unemployed people should be contemplated not only from a health care provision but also as part of a broader system that incorporates the mental health care of unemployed persons as part of more general public health policies. Finally, these results suggest that mental health-related objectives should be considered when planning, implementing, and evaluating active labour market policies for the unemployed. IMPLICATIONS FOR FURTHER RESEARCH: The length and severity of the last recession, together with the risks associated with the global crisis resulting from COVID-19, reiterate the obvious concerns about the consequences of economic crises and unemployment on personal mental health. In this context, our study could be a step forward in the study of the causal relationships between unemployment and mental health when new data are available.

The contribution of resident physicians to hospital productivity.

Resident physicians play a double role in hospital activity. They participate in medical practices and thus, on the one hand, they should be considered as an input. Also, they are medical staff in training and, on the other hand, must be considered as an output. The net effect on hospital activities should therefore be empirically determined. Additionally, when considering their role as active physicians, a natural hypothesis is that resident physicians are not more productive than senior ones. This is a property that standard logarithmic production functions (including Cobb-Douglas and Translog functional forms) cannot verify for the whole technology set. Our main contribution is the development of a Translog modification, which implies the definition of the input "doctors" as a weighted sum of senior and resident physicians, where the weights are estimated from the empirical application. This modification of the standard Translog is able, under suitable parameter restrictions, to verify our main hypothesis across the whole technology set while determining if the net effect of resident physicians in hospitals' production should be associated to an output or to an input. We estimate the resulting output distance function frontier with a sample of Spanish hospitals. Our findings show that the overall contribution of resident physicians to hospitals' production allows considering them as an input in most cases. In particular, their average productivity is around 37% of that corresponding to senior physicians.

Air pollution and life expectancy in Europe: Does investment in renewable energy matter?

This study examines the relationship between health and air pollution using a novel approach that allows differentiation between potential and observed health. It also permits an analysis of those factors that may contribute towards reducing any differences between the latter concepts. To this end, a panel data from 29 European countries for the periods 2005 and 2018 is used. Results indicate that the main pollutants affecting European countries, namely NOx, PM10 and PM2.5 have a negative impact on life expectancy at birth, while investment in renewable energies has a positive effect. Several conclusions can be drawn from these results. Firstly, if the aim is to minimize the detrimental effects of the global production of goods and services on air quality, a greater investment in renewable energies as compared to other more polluting ones, is called for. In turn, this would contribute to an improvement in the general health of citizens and the planet thereby increasing overall potential life expectancy. Secondly, NOx gases seem to be the ones that most affect the population's mean potential life expectancy. Results indicate that with regard to particulate matters, those with a diameter of less than 2.5 µm, are the ones that have the greatest impact on the health of European citizens, more so than larger particles (with a diameter between 10 and 2.5 µm).

Furloughs, Teleworking and Other Work Situations during the COVID-19 Lockdown: Impact on Mental Well-Being.

As a consequence of the Spring 2020 lockdown that occurred in Spain due to the COVID-19 pandemic, many people lost their jobs or had to be furloughed. The objective of this study is to analyse the influence of the latter changes in labour market status on psychological well-being. For this purpose, an ad-hoc questionnaire featuring socio-demographic and mental health criteria was created. Granted that the pandemic can be viewed as an exogenous shock, the bias caused by the bidirectional problems between the work situation and mental well-being can be tackled. Results indicate that the lockdown exerted a greater negative effect on the self-perceived well-being of unemployed and furloughed persons than on those in employment. Moreover, among those in continuous employment, teleworkers experienced a lesser degree of self-perceived well-being post lockdown as compared to those people remaining in the same work location throughout the COVID-19 crisis. Finally, the lockdown provoked worse effects on the self-perceived well-being of women as compared to men, a result that appears to be related to gender differences in household production. In conclusion, these results could be especially relevant given that the evolution of the pandemic is having ongoing effects on employment and, therefore, on the mental health of workers.

Pandemia por Covid19: otras consecuencias / Covid 19 pandemic: other consequences

Objetivo: Describir la evolución de la demanda en los servicios de urgencias, y los ingresos hospitalarios subsiguientes, en el área médica de un hospital general durante las fases iniciales de la pandemia por COVID19 y tras la declaración del estadio de alarma. Métodos: Estudio observacional de todas las visitas al Servicio de Urgencias de adultos, y de todos los ingresos en los servicios médicos que se generaron, entre los días 1 y 31 de marzo de los años 2017, 2018, 2019 y 2020 en un hospital general. Consideramos las 00.00 horas del día 14 de marzo como el inicio del estado de alarma, y punto de corte entre dos periodos: pre-estado de alarma (días 1 a 13 de marzo) y estado de alarma (días 14 a 31 de marzo). Resultados: Tras la declaración del estado de alarma la asistencia a Urgencias disminuyó un 65,1% y, entre estos pacientes, el porcentaje de ingresos se incrementó un 93,8%. A pesar de ello, el promedio de ingresos por día se redujo un 33%. Sin embargo Medicina Interna (incluyendo área COVID19) tuvo un promedio diario de 10,5 (SD 6,3) pacientes, levemente superior al registrado en años previos. Conclusiones: En las primeras semanas tras la instauración del estado de alarma por la pandemia por COVID19 disminuyó en casi dos tercios la frecuentación a las urgencias hospitalarias y en un tercio los ingresos en todas las áreas de un hospital general. Por el contrario, Medicina Interna (que incluyó ingresos por COVID19) mantuvo los mismos promedios. (AU)

Objective: Describe the evolution of the Emergency Department and the hospital admissions in the medical area of a general hospital during the initial phases of the COVID19 pandemic and after the state of alarm established in Spain. Methodology: Observational study of the patients who were admitted in the Emergency Department and the admissions in medical services from 1st to 31th of March in 2017, 2018, 2019 and 2020 in a general hospital. The beginning of the state of alarm was considered at 00.00 on March 14th of 2020 and a cut-off point is also taken into account between two periods: before the state of alert (March 1st-13th) and the state of alert (March 14th-31th). Results: After the state of alarm, the admission of patients decrease in the Emergency Department by 65.1% and the income in medical areas was increased in 93.8%. Despite this, the average of incomes per day decreased by 33%. However, Internal Medicine (including COVID19 area) had a daily average of 10.5 (SD 6.3) patients, slightly higher than the one registered in previous years. Conclusions: In the first weeks after the state of alarm due to COVID19 pandemic, the attendance in the Emergency Department decreased about two thirds and the incomes in medical areas decreased a third in all areas of a general hospital. On the other hand, Internal Medicine (included COVID-19 area) maintained the same averages. (AU)

Usefulness of a Telemedicine Tool TELEA in the Management of the COVID-19 Pandemic.

Background: The usefulness of telemedicine in the management of the coronavirus disease 2019 (COVID-19) pandemic has not been evaluated. Methods: We conducted a descriptive study of the process of recruitment and follow-up of patients using a telemedicine tool (TELEA) in the management of patients at risk, in a rural environment with a dispersed population in Lugo in north western Spain. Results: A large number of patients diagnosed with COVID-19 infection (N = 545) were evaluated. Of this group, 275 had comorbidities and were enrolled in the program, with a mean age of 57.6 ± 16.3 years, 43.1% male. The risk factors were hypertension (38%), diabetes (16%), asthma (9.5%), heart disease (8.8%), and immunosuppression (5.1%). Patients were followed through the platform with daily control of symptoms and vital signs. Only 8% were admitted to the hospital, 5.1% on a scheduled basis and 2.9% through the emergency room. Conclusion: The telemedicine tool TELEA is useful for the management of high-risk patients with COVID-19.

Pleuritis por Cryptococcus neoformans en paciente inmunocompetente / Cryptococcus neoformans pleuritis in an immunocompetent patient

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Pronóstico del síndrome de hipoventilación-obesidad con y sin síndrome de apnea obstructiva asociado / Prognosis of Obesity Hypoventilation Syndrome With and Without Concomitant Obstructive Sleep Apnea Syndrome

No disponible

The impact of health on wages: evidence for Europe.

This paper analyses the effects of health on wages in sixteen European countries using production frontier methodology. It is assumed that workers have a potential income/productivity which basically depends on their human capital, but due to several health problems, situations could exist where workers fail to reach their potential income frontier. The estimation of a true-random-effects model allows us to conclude that the potential hourly wage of workers is significantly influenced by their level of education and their job experience. However, health problems, especially those strongly influencing work activities, contribute towards an individual not attaining the potential income which would otherwise be guaranteed by their human capital endowment. Suffering a strong limitation reduces gross wage per hour by 6.1%. This wage reduction is also observed in the case of a weak limitation, but here the wage difference with respect to workers without any limitation is 2.6%. Additionally, other factors, such as being a woman, the economic cycle or having a temporary contract, appear to distance an individual from their wage frontier.

Making a distinction between the effect of initial stock and investment in health determinants.

The objective of this paper was to propose a health production model that distinguishes between the initial stock of health determinants and the subsequent investment in them, with a view to providing information to policy-makers regarding the effects of determinant-aimed policies. In this sense, the main contributions of the paper stem from the development of a theoretical and empirical model that distinguishes between the effect of the initial stock and that of investment in health determinants. To do this, we estimated the health production function using a stochastic frontier model. We present an empirical example using data for the years 2002 and 2008. The results support our decision to analyse the effects of the initial values attributable to health determinants separately from those arising following investment in the period. Concretely, we find significant differences for the determinants EMPLOY, SOCIALCLASS and NON-DRINKER. The results seem to indicate that, for variables labelled with the behavioural aspects of health such as NON-DRINKER, the effect over time of a change in investment in health is significantly greater than that resulting from a variation in initial values. In contrast, for socioeconomic variables such as SOCIAL CLASS or EMPLOY, for which effects on health tend to be more long-term in nature, the opposite occurs, with the effect of the investment during the time period proving significantly lower than the effect of the initial provision.

Reserve capacity of public and private hospitals in response to demand uncertainty.

A feature of hospitals is that they face uncertain demand for the services they offer. To cover fluctuations in demand, they need to maintain reserve service capacity in the form of beds, equipment, personnel, etc. to minimize the probability of excess queuing or turning away patients, creating a trade-off between reserve service capacity and economic costs. Using a simple theoretical framework, we show how the reserve capacity established depends on institutional characteristics that can affect the objective of the hospital. In particular, we show that private and public hospitals may provide different levels of reserve capacity. In an empirical application using a panel data set of Spanish hospitals over the period 1996-2006, we model reserve service capacity using a distance frontier approach. Our results show that private hospitals generally react to a lesser extent to demand uncertainty than public hospitals.

Discovery of Potent Dual PPARα Agonists/CB1 Ligands.

This letter describes the synthesis and in vitro and in vivo evaluation of dual ligands targeting the cannabinoid and peroxisome proliferator-activated receptors (PPAR). These compounds were obtained from fusing the pharmacophores of fibrates and the diarylpyrazole rimonabant, a cannabinoid receptor antagonist. They are the first examples of dual compounds with nanomolar affinity for both PPARα and cannabinoid receptors. Besides, lead compound 2 proved to be CB1 selective. Unexpectedly, the phenol intermediates tested were equipotent (compound 1 as compared to 2) or even more potent (compound 3 as compared with 4). This discovery opens the way to design new dual ligands.

The effects of stochastic demand and expense preference behaviour on public hospital costs and excess capacity.

The literature to date on the effect of demand uncertainty on public hospital costs and excess capacity has not taken into account the role of expense preference behaviour. Similarly, the research on expense preference behaviour has not taken demand uncertainty into account. In this paper, we argue that both demand uncertainty and expense preference behaviour may affect public hospital costs and excess capacity and that ignoring either of these effects may lead to biased parameter estimates and misleading inference. To show this, we extend the analysis of Rodríguez-Alvarez and Lovell (Health Econ. 2004; 13: 157-169) by incorporating demand uncertainty into the technology to account for the hospital activity of providing standby capacity or insurance against the unexpected demand. We find that demand uncertainty in Spanish public hospitals affects hospital production decisions and increases costs. Our results also show that overcapitalization in these hospitals can be explained by hospitals providing insurance demand when faced with demand uncertainty. We also find evidence of expense preference behaviour. We conclude that both stochastic demand and expense preference behaviour should be taken into account when analysing hospital costs and production.

[Hospital and primary care emergency services in Asturias [Spain]: variations among health areas and trends between 1994-2001]. / Urgencias hospitalarias y de atención primaria en Asturias: variaciones entre áreas sanitarias y evolución desde 1994 hasta 2001.

OBJECTIVE: To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability. METHODS: Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics. RESULTS: Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period. CONCLUSIONS: Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts.

Urgencias hospitalarias y de atención primaria en Asturias: variaciones entre áreas sanitarias y evolución desde 1994 hasta 2001 / Hospital and primary care emergency services in Asturias [Spain]: variations among health areas and trends between 1994-2001

Objetivo: Describir la frecuencia de utilización de los servicios de urgencias en las áreas sanitarias de Asturias desde 1994 a 2001 y analizar su variabilidad. Métodos: Se estimó la demanda de urgencias hospitalarias y de atención primaria en las 8 áreas sanitarias de Asturias, y se analizó su evolución y las diferencias entre áreas, usando la estandarización indirecta y estadísticos de variabilidad. Resultados: Entre 1994 y 2001 se realizaron casi 6,5 millones de urgencias (un 43,8% en hospitales), con un crecimiento medio anual del 6,2% (un 7,8% en atención primaria y un 5,1% en hospitales) con gran heterogeneidad entre áreas. La variabilidad fue mayor en atención primaria y disminuyó en el período estudiado (coeficientes de variación: 0,38 y 0,27 para 1994 y 2001 en atención primaria, y 0,14 y 0,11 en hospitales, respectivamente). Conclusiones: La utilización de las urgencias creció en el período estudiado y se observa una gran variabilidad entre áreas sanitarias

Objective: To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability. Methods: Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics. Results: Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period. Conclusions: Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts