Estimating lifetime healthcare costs with morbidity data.

BACKGROUND: In many developed countries, the economic crisis started in 2008 producing a serious contraction of the financial resources spent on healthcare. Identifying which individuals will require more resources and the moment in their lives these resources have to be allocated becomes essential. It is well known that a small number of individuals with complex healthcare needs consume a high percentage of health expenditures. Conversely, little is known on how morbidity evolves throughout life. The aim of this study is to introduce a longitudinal perspective to chronic disease management. METHODS: Data used relate to the population of the county of Baix Empordà in Catalonia for the period 2004-2007 (average population was N = 88,858). The database included individual information on morbidity, resource consumption, costs and activity records. The population was classified using the Clinical Risk Groups (CRG) model. Future morbidity evolution was simulated under different assumptions using a stationary Markov chain. We obtained morbidity patterns for the lifetime and the distribution function of the random variable lifetime costs. Individual information on acute episodes, chronic conditions and multimorbidity patterns were included in the model. RESULTS: The probability of having a specific health status in the future (healthy, acute process or different combinations of chronic illness) and the distribution function of healthcare costs for the individual lifetime were obtained for the sample population. The mean lifetime cost for women was €111,936, a third higher than for men, at €81,566 (all amounts calculated in 2007 Euros). Healthy life expectancy at birth for females was 46.99, lower than for males (50.22). Females also spent 28.41 years of life suffering from some type of chronic disease, a longer period than men (21.9). CONCLUSIONS: Future morbidity and whole population costs can be reasonably predicted, combining stochastic microsimulation with a morbidity classification system. Potential ways of efficiency arose by introducing a time perspective to chronic disease management.

[An analysis of the diabetic population in a Spanish rural are: morbidity profile, use of resources, complications and metabolic control]. / Análisis de la población diabética de una comarca: perfil de morbilidad, utilización de recursos, complicaciones y control metabólico.

OBJECTIVE: To describe the characteristics of a diabetic population, morbidity profile, resource consumption, complications and degree of metabolic control. DESIGN: Cross-sectional study during 2010. LOCATION: Four Health Areas (91.301 people) where the integrated management organization Serveis de Salut integrated Baix Empordà completely provide healthcare assistance. PARTICIPANTS: 4.985 diabetic individuals, identified through clinical codes using the ICD-9-MC classification and the 3M? Clinical Risk Groups software. MAIN MEASUREMENTS: Morbidity profile, related complications and degree of metabolic control were obtained for the target diabetic population. We analyzed the consumption of healthcare resources, pharmaceutical and blood glucose reagent strips. All measurements obtained at individual level. RESULTS: 99.3% of the diabetic population were attended at least once at a primary care center (14.9% of visits). 39.5% of primary care visits and less than 10% of the other scanned resources were related to the management of diabetes. The pharmaceutical expenditure was 25.4% of the population consumption (average cost ?1.014,57). 36.5% of diabetics consumed reagents strips (average cost ?120,65). The more frequent CRG are 5424-Diabetes (27%); 6144-Diabetes and Hypertension (25,5%) and 6143-Diabetes and Other Moderate Chronic Disease (17,2%). The degree of disease control is better in patients not consumers of antidiabetic drugs or treated with oral antidiabetic agents not secretagogues. CONCLUSIONS: Comorbidity is decisive in the consumption of resources. Just a few part of this consumption is specifically related to the management of diabetes. Results obtained provide a whole population approach to the main existing studies in our national and regional context.

Genotypic variability and persistence of Legionella pneumophila PFGE patterns in 34 cooling towers from two different areas.

Genotypic variability and clonal persistence are important concepts in molecular epidemiology as they facilitate the search for the source of sporadic cases or outbreaks of legionellosis. We studied the genotypic variability and persistence of Legionella pulsed-field gel electrophoresis (PFGE) patterns over time (period > 6 months) in 34 positive cooling towers from two different areas. In area A, radius of 70 km, 52 indistinguishable PFGE patterns were differentiated among the 27 cooling towers. In 13 cooling towers we observed >or= 2 PFGE patterns. Each cooling tower had its own indistinguishable Legionella PFGE pattern which was not shared with any other cooling tower. In area B, radius of 1 km, 10 indistinguishable PFGE patterns were obtained from the seven cooling towers. In four, we observed >or= 2 PFGE patterns. Three of these 10 indistinguishable PFGE patterns were shared by more than one cooling tower. In 27 of 34 cooling towers the same PFGE pattern was recovered after 6 months to up to 5 years of follow-up. The large genotypic diversity of Legionella observed in the cooling towers aids in the investigation of community outbreaks of Legionnaires' disease. However, shared patterns in small areas may confound the epidemiological investigation. The persistence of some PFGE patterns in cooling towers makes the recovery of the Legionella isolate causing the outbreak possible over time.

Impact of copper and silver ionization on fungal colonization of the water supply in health care centers: implications for immunocompromised patients.

Copper and silver ionization is a well-recognized disinfection method to control Legionella species in water distribution systems in hospitals. These systems may also serve as a potential indoor reservoir for fungi. The prevalence of fungi was significantly lower in ionized than in nonionized water samples from health care facilities. The clinical consequences of this finding require further investigation.

Public transportation and pulmonary tuberculosis, Lima, Peru.

The association between public transportation for commuting and pulmonary tuberculosis (TB) was analyzed in workers in Lima, Peru. Traveling in minibuses was a risk factor for pulmonary TB. Preventive measures need to be taken by health services to prevent spread of this disease.

Reverse paintings on glass--a new approach for dating and localization.

Samples from 20 reverse paintings on glass from different regions have been analyzed by NAA with the aim to deduce the place and date of their origin. A separation of earlier and later paintings was due to different concentrations of K and Na, because a sodium-containing flux came into use after 1870. Since in southern Germany quartz sand, and in the eastern area quartz rock had been used for glass manufacture, specific impurities could be used to distinguish southern from eastern glasses.

Chromosome territory positioning of conserved homologous chromosomes in different primate species.

Interphase chromosomes form distinct spatial domains called chromosome territories (CTs). The position of CTs is known not to be at random and is related to chromosome size and gene density. To elucidate how CTs are arranged in primate proliferating fibroblasts and whether the radial position of CTs has been conserved during primate evolution, several specific CTs corresponding to conserved chromosomes since the Simiiformes (human 6, 12, 13, and 17 homologous CTs) have been studied in 3D preserved interphase nuclei from proliferant cells of two New World monkey species (Lagothrix lagothricha, Saimiri sciureus) and in human by three-dimensional fluorescent in situ hybridization (3D-FISH). Our results indicate that both gene-density and chromosome size influence chromosome territory arrangement in the nucleus. This influence is greater for chromosome-size than for gene-density in the three species studied. A comparison of the radial position of a given CT and its homolog in the species analyzed suggests similar CT distributions for homologous chromosomes. Our statistical analysis using the logit model shows that such homologous positionings cannot, however, be considered identical.

Análisis de la población diabética de una comarca: perfil de morbilidad, utilización de recursos, complicaciones y control metabólico / An analysis of the diabetic population in a Spanish rural are: morbidity profile, use of resources, complications and metabolic control

Objetivo: Describir las características de una población diabética, perfil de morbilidad, consumo de recursos, complicaciones y grado de control. Diseño: Estudio transversal durante 2010.EmplazamientoCuatro Áreas Básicas de Salud (91.301 personas) donde la organización sanitaria integrada Serveis de Salut Integrats Baix Empordà cubre la asistencia. Participantes: Se han identificado 4.985 diabéticos, utilizando la codificación clínica de los contactos mediante CIE-9-MC y Clinical Risk Groups. Mediciones principales: Perfil de morbilidad de los diabéticos, complicaciones y grado de control metabólico. Se analiza el consumo de recursos asistenciales, farmacéutico y de tiras reactivas de glucemia. Todas las mediciones a nivel individual. Resultados: El 99,3% de los diabéticos acudió al menos una vez al centro de salud (14,9% del total de visitas). El 39,5% de las visitas de atención primaria y menos del 10% del resto de recursos analizados se dedicaron a la gestión de la diabetes. El coste de farmacia representa el 25,4% del consumo total de la población (coste medio 1.014,57?). El 36,5% de los diabéticos consumió tiras reactivas (coste medio 120,65?). Los CRG base más comunes son 5424-Diabetes (27%); 6144-Diabetes and Hypertension (25,5%) y 6143-Diabetes and Other Moderate Chronic Disease (17,2%). El grado de control de la enfermedad es mejor en pacientes que no toman fármacos o toman antidiabéticos orales no secretagogos. Conclusiones: La comorbilidad es determinante en el consumo de recursos. Solo una parte de este consumo está dedicado al manejo de la diabetes. Los resultados obtenidos son consistentes y complementan desde un punto de vista poblacional los estudios existentes de ámbito estatal y autonómico (AU)

Objective: To describe the characteristics of a diabetic population, morbidity profile, resource consumption, complications and degree of metabolic control. Design: Cross-sectional study during 2010.Location: Four Health Areas (91.301 people) where the integrated management organization Serveis de Salut integrated Baix Empordà completely provide healthcare assistance. Participants: 4.985 diabetic individuals, identified through clinical codes using the ICD-9-MC classification and the 3M? Clinical Risk Groups software. Main measurements: Morbidity profile, related complications and degree of metabolic control were obtained for the target diabetic population. We analyzed the consumption of healthcare resources, pharmaceutical and blood glucose reagent strips. All measurements obtained at individual level. Results: 99.3% of the diabetic population were attended at least once at a primary care center (14.9% of visits). 39.5% of primary care visits and less than 10% of the other scanned resources were related to the management of diabetes. The pharmaceutical expenditure was 25.4% of the population consumption (average cost ? 1.014,57). 36.5% of diabetics consumed reagents strips (average cost ?120,65). The more frequent CRG are 5424-Diabetes (27%); 6144-Diabetesand Hypertension (25,5%) and 6143-Diabetes and Other Moderate Chronic Disease (17,2%). The degree of disease control is better in patients not consumers of antidiabetic drugs or treated with oral antidiabetic agents not secretagogues. Conclusions: Comorbidity is decisive in the consumption of resources. Just a few part of this consumption is specifically related to the management of diabetes. Results obtained provide a whole population approach to the main existing studies in our national and regional context (AU)

Efectos del entrenamiento mediante danza aeróbica con subida a banco sobre la capacidad de generar fuerza en mujeres sanas de mediana edad / No diponible

Introducción y objetivos: El propósito del presente estudiofue examinar el efecto de 8 semanas de entrenamientomediante danza aeróbica con subida a banco sobre la capacidadde generar fuerza del tren inferior en mujeres de medianaedad.Métodos: Se emplearon los datos de 30 mujeres con edadescomprendidas entre los 46 y los 64 años divididas en ungrupo experimental (n = 15) y en un grupo control (n = 15).El grupo experimental participó en sesiones de danza aeróbicacon subida a banco de 60 min/día, 3 días por semanadurante 8 semanas. El grupo control fue instruido para quelos sujetos no modificaran ninguno de sus hábitos de vida nide práctica fisicodeportiva.Resultados: Tras el período de entrenamiento, el grupo experimentalincrementó de forma significativa el rendimientoen el salto vertical y el test Up and Go respecto al grupocontrol un 24,6 y un 19,8%, respectivamente. Además, el momentode fuerza isocinético máximo a la velocidad angularde 180°/s aumentó significativamente en el grupo experimentalrespecto al grupo control durante el post-test.Conclusiones: Los resultados del presente estudio demostraronque la práctica sistemática de danza aeróbica con subidaa banco durante un período de 8 semanas en mujeresde mediana edad incrementa la fuerza dinámica del tren inferior(AU)

Introduction and Aims: The aim of the present studywas to examine the effects of 8-weeks of systematic aerobicdance with bank practice on lower limbs force generationcapacity in middle-aged women.Methods: Thirty women with age ranged between 46-64-years old were selected. This sample was divided into anexperimental (n = 15) and a control (n = 15) group. Theexperimental group participated in aerobic dance with banksessions of 60 min duration, three times per week during8-weeks. The control group was instructed to continuetheir habitual diet and physical activity.Results: After the period of training, the experimentalgroup — with respect to the control group — enhancedsignificantly its performance in vertical jump and in the “Upand Go” test a 24.6 and a 19.8 %, respectively. Moreover,the maximum isokinetic knee extension peak torque at theangular velocity of 180°/s increased significantly in the experimentalgroup with respect to the control group duringthe post-test.Conclusions: The results of the present study showedthat the systemic practice of ADB during a period of 8-wksin middle-aged women enhance the dynamic strength of thelower limbs(AU)

Podemos...! : manual de autocuidados para personas que viven con VIH y SIDA / Podemos...! : manual de autocuidados para personas que viven con VIH y SIDA / We can...! : selfcare handbook for persons who live with VIH and AIDS

Contenido: v.1. La infeccion por VIH y el SIDA. -- v.2. Las respuestas ante la infeccion por VIH. -- v.3. La vida diaria y el VIH. -- v.4. La nutricion y el VIH. -- v.5. El VIH y las enfermedades oportunistas. -- v.6. Mujer, maternidad, infancia y VIH. -- v.7. Viviendo con VIH: conciencia y responsabilidad