Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Foreign Direct Investment and Regional Growth: An Analysis of the Spanish Case

Bajo-Rubio O., Diaz-Mora C. and Diaz-Roldan C. Foreign direct investment and regional growth: an analysis of the Spanish case, Regional Studies. The massive increase in foreign direct investment (FDI) inflows following the Spanish integration with the now European Union in 1986 has been one of the most important features shaping the behaviour of the Spanish economy in the last 20 years. This paper assesses the impact of foreign direct investment on regional economic growth following Spain's entry into the European Union, using data for the 17 Spanish regions. The results support the important role played by foreign direct investment in promoting productivity growth over the period analysed, which proves to be robust to several alternative specifications. [image omitted] Bajo-Rubio O., Diaz-Mora C. et Diaz-Roldan C. Investissement etranger direct et croissance regional: une analyse du cas espagnol, Regional Studies. Le massif accroissement des entrees d'investissement etranger direct (IED) apres l'integration espagnole dans l'actuelle Union Europeenne (UE) en 1986, a ete l'un des principaux traits configurant l'evolution de l'economie espagnole des vingt dernieres annees. Dans cet article, nous essayerons d'evaluer l'impact de l'IED sur la croissance economique regionale apres l'entree de l'Espagne dans l'UE, en utilisant des donnees des 17 regions espagnoles. Les resultats confirment l'important role joue par l'IED en favorisant la croissance de la productivite tout au long de la periode analysee, ces resultats etant robustes a diverses specifications alternatives. Croissance economique Investissement etranger direct Regions Bajo-Rubio O., Diaz-Mora C. und Diaz-Roldan C. Auslandische Direktinvestitionen und regionales Wachstum: eine Analyse des Falls von Spanien, Regional Studies. Der massive Anstieg auslandischer Direktinvestitionen in Spanien nach der Integration des Landes in die heutige Europaische Union im Jahr 1986 war eines der wichtigsten Merkmale, die das Verhalten der spanischen Wirtschaft in den letzten zwanzig Jahren pragten. In diesem Beitrag versuchen wir, die Auswirkung der auslandischen Direktinvestitionen auf das regionale Wirtschaftswachstum nach dem EU-Beitritt Spaniens anhand von Daten fur die 17 spanischen Regionen zu bewerten. Die Ergebnisse bekraftigen die wichtige Rolle der auslandischen Direktinvestitionen bei der Forderung des Produktivitatswachstums uber den analysierten Zeitraum - ein Ergebnis, das sich auch in Verbindung mit mehreren alternativen Spezifikationen als robust erweist. Wirtschaftswachstum Auslandische Direktinvestitionen Regionen Bajo-Rubio O., Diaz-Mora C. y Diaz-Roldan C. Inversion extranjera directa y crecimiento regional: un analisis del caso espanol, Regional Studies. El masivo incremento de las entradas de inversion extranjera directa (IED) tras la integracion espanola en la actual Union Europea (UE) en 1986, ha sido uno de los rasgos mas importantes que configuran la evolucion de la economia espanola en los ultimos veinte anos. En este articulo trataremos de evaluar el impacto de la IED sobre el crecimiento economico regional tras la entrada de Espana en la UE, utilizando datos para las 17 regiones espanolas. Los resultados confirman el importante papel desempenado por la IED a la hora de favorecer el crecimiento de la productividad a lo largo del periodo analizado, siendo estos resultados robustos a diversas especificaciones alternativas. Crecimiento economico Inversion extranjera directa RegionesEconomic growth, Foreign direct investment (FDI), Regions,

Reduction in inappropriate hospital use based on analysis of the causes

<p>Abstract</p> <p>Background</p> <p>To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement.</p> <p>Methods</p> <p>Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain.</p> <p>Results</p> <p>Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease.</p> <p>Conclusions</p> <p>It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.</p

Human immunodeficiency virus/hepatitis C virus coinfection in Spain : Prevalence and patient characteristics

The purpose of this study was to assess the prevalence of anti-hepatitis C virus (HCV) antibodies (Abs) and active HCV infection in human immunodeficiency virus (HIV)-infected (HIV+) patients in Spain in 2015. This was a cross-sectional study.Methods. The study was performed in 41 centers in 2015. Sample size was estimated for an accuracy of 2%, the number of patients from each hospital was determined by proportional allocation, and patients were selected using simple random sampling. The reference population was 35 791 patients, and the sample size was 1867 patients. Hepatitis C virus serostatus was known in 1843 patients (98.7%). Hepatitis C virus-Abs were detected in 695 patients (37.7%), in whom the main route of HIV acquisition was injection drug use (75.4%). Of these 695 patients, 402 had HCV RNA, 170 had had a sustained viral response (SVR) after anti-HCV therapy, and 102 cleared HCV spontaneously. Hepatitis C virus-ribonucleic acid results were unknown in 21 cases. Genotype distribution (known in 367 patients) was 1a in 143 patients (39.0%), 4 in 90 (24.5%) patients, 1b in 69 (18.8%) patients, 3 in 57 (15.5%) patients, 2 in 5 (1.4%) patients, and mixed in 3 (0.8%) patients. Liver cirrhosis was present in 93 patients (23.1%) with active HCV infection and in 39 (22.9%) patients with SVR after anti-HCV therapy. The prevalence of HCV-Abs and active HCV infection in HIV+ patients in Spain is 37.7% and 22.1%, respectively; these figures are significantly lower than those recorded in 2002 and 2009. The predominant genotypes in patients with active HCV infection were 1a and 4. A high percentage of patients had cirrhosis. Cirrhosis is also common in patients with SVR after anti-HCV therapy