The First Gynandromorph of the Neotropical Bee Megalopta Amoena (Spinola, 1853) (Halictidae) with Notes on its Circadian Rhythm

Gynandromorphy is an anomaly that results in an organism phenotypically expressing both male and female characteristics. Here we describe the first gynandromorph of the bee species Megalopta amoena (Spinola, 1853) (Halictidae, Augochlorini) and the second record of this anomaly within the genus Megalopta. Additionally, we analyzed the bee’s circadian rhythm, which has never before been quantified for a gynandromorph. The gynandromorph showed a deviant activity pattern; it was intermediate between that of the male and female M. amoena. Our results imply that the brains of bilateral gynandromorphs may have mixed sex-specific signaling. Based on four days of recording, the gynandromorph circadian rhythm was shifted earlier in the day relative to the male and female M. amoena, and it exhibited intensity similar to the female

The social return on investment of a new approach to heart failure in the Spanish National Health System

Aims: We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. Methods and results: A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to €548m and yield a social return of €1932m, that is, €3.52 for each euro invested. Conclusions: The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF

The economic burden of disease of epithelial ovarian cancer in Spain: the OvarCost study

bjective: To assess the economic burden of epithelial ovarian cancer (EOC) in incident patients and the burden by disease stage in Spain. Methods: We developed a Markov model from a social perspective simulating the natural history of EOC and its four stages, with a 10-year time horizon, 3-week cycles, 3% discount rate, and 2016 euros. Healthcare resource utilization and costs were estimated by disease stage. Direct healthcare costs (DHC) included early screening, genetic counselling, medical visits, diagnostic tests, surgery, chemotherapy, hospitalizations, emergency services, and palliative care. Direct non-healthcare costs (DNHC) included formal and informal care. Indirect costs (IC) included labour productivity losses due to temporary and permanent leaves, and premature death. Epidemiology data and resource use were taken from the literature and validated for Spain by the OvarCost group using a Delphi method. Results: The total burden of EOC over 10 years was 3102 mill euros: 15.1% in stage I, 3.9% in stage II, 41.0% in stage III, and 40.2% in stage IV. Annual average cost/patient was 24,111 and it was 8,641; 14,184; 33,858, and 42,547 in stages I-IV, respectively. Of total costs, 71.2% were due to DHC, 24.7% to DNHC, and 4.1% to IC. Conclusions: EOC imposes a significant economic burden on the national healthcare system and society in Spain. Investment in better early diagnosis techniques might increase survival and patients' quality of life. This would likely reduce costs derived from late stages, consequently leading to a substantial reduction of the economic burden associated with EOC

Analysis of hospital efficiency by autonomous community in the National Health System Field

El objetivo principal de esta investigación es el de realizar un estudio de la eficiencia en los hospitales del Sistema Nacional de Salud por Comunidad Autónoma (CCAA). El estudio se realiza sobre los hospitales gestionados por cada Servicio de Salud Autonómico con más de 500 camas sobre la actividad desarrollada a lo largo del año 2008, a través del modelo DEA (Data Envelopment Analysis). Se ha trabajado con cinco casos de estudio, identificando cuatro grupos según el indicador de eficiencia, sin que los resultados difieran tanto desde la perspectiva input como output, con y sin el método de supereficiencia. Con este estudio se ha fijado la posición de cada Comunidad Autónoma sobre la frontera de eficiencia, identificando y creando un ranking de aquellas Comunidades Autónomas que han gestionado más eficientemente sus recursos aplicando las mejores prácticas.The main objective of this research is to carry out a study of efficiency in CCAA hospitals of NHS (National Health System). This study was performed on the hospitals managed by each regional Health Service with more than 500 beds throughout 2008 activity, with DEA model (Data Envelop-ment Analysis). We have worked with five different cases and we have identified four groups according to the efficiency indicator. The results show a minimum difference from both an input and an output point of view, with and without superefficiency method. This study has established the position of each CCAA on the efficient frontier, identifying and setting up a ranking of those CCAA that have manage more efficiently its resources by applying best practices

Análisis de la eficiencia hospitalaria por Comunidad Autónoma en el ámbito del Sistema Nacional de Salud

The main objective of this research is to carry out a study of efficiency in CCAA *** hospitals of NHS (National Health System). This study was performed on the hospitals managed by each regional Health Service with more than 500 beds throughout 2008 activity, with DEA model (Data Envelopment Analysis). We have worked with five different cases and we have identified four groups according to the efficiency indicator. The results show a minimum difference from both an input and an output point of view, with and without superefficiency method. This study has established the position of each CCAA on the efficient frontier, identifying and setting up a ranking of those CCAA that have manage more efficiently its resources by applying best practices.El objetivo principal de esta investigación es el de realizar un estudio de la eficiencia en los hospitales del Sistema Nacional de Salud por Comunidad Autónoma (CCAA). El estudio se realiza sobre los hospitales gestionados por cada Servicio de Salud Autonómico con más de 500 camas sobre la actividad desarrollada a lo largo del año 2008, a través del modelo DEA (Data Envelopment Analysis). Se ha trabajado con cinco casos de estudio, identificando cuatro grupos según el indicador de eficiencia, sin que los resultados difieran tanto desde la perspectiva input como output, con y sin el método de supereficiencia. Con este estudio se ha fijado la posición de cada Comunidad Autónoma sobre la frontera de eficiencia, identificando y creando un ranking de aquellas Comunidades Autónomas que han gestionado más eficientemente sus recursos aplicando las mejores prácticas

The impact of obesity on health-related quality of life in Spain

Abstract Background It is well documented that obesity is strongly associated with mortality and morbidity, but less is known about its impact on functional status and health-related quality of life (HRQOL). The purpose of this study was to calculate the impact of the Body Mass Index (BMI) on the HRQOL of the Spanish adult population, with special emphasis on BMI ≥ 35. Methods We used the Spanish National Health Survey (SNHS) 2011–2012 to assess the statistical association between HRQOL, measured through the EuroQol-5D-5L questionnaire, and the BMI. We conducted linear regression analysis for the EuroQol-5D-5L Visual Analogue Scale (VAS) and probit regressions for each of the five dimensions of the EuroQol-5D-5L. Results Self-perceived problems in the five dimensions of the EuroQol-5D-5L increased along the BMI, especially in the mobility and pain/discomfort dimensions. Having a BMI ≥ 35 reduced HRQOL even in the absence of chronic diseases. After controlling for comorbidities, severe obesity decreased the VAS score by an average of 1.9 points and increased the probability of reporting any HRQOL problem in mobility (11.8%), self-care (2.2%), usual activities (4.3%) and pain/discomfort (7.4%). No association was found between obesity and mental problems. All the parameters analysed suggest that HRQOL in women and people aged 65 years and over was significantly worse than average. Conclusions BMI is an explanatory factor of self-perceived quality of life. Obesity is associated with a worse HRQOL, especially in women and people aged over 64 years. These results may be useful for designing prevention or treatment health policies to target obesity among the Spanish population

Cost of vitamin K antagonist anticoagulant treatment in patients with metallic prosthetic valve in mitral position

Background: The initiation of oral anticoagulation therapy after valve replacement surgery requires strict monitoring because these patients are at high risk for the development of thrombotic complications and present an increased risk of bleeding. Objectives: The aim of this study was to examine the total healthcare costs of oral anticoagulant treatment with vitamin K antagonists in patients with metallic prosthetic valves in the mitral position. Methods: Data from clinical records were used in the study including international normalized ratio results, number of medical visits, type of anticoagulant, use of rescue medication and hospital admissions from related complications. The drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included in the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the diagnosis-related group price for each case. Results: We collected data from 151 patients receiving oral anticoagulation therapy with vitamin K antagonist who were diagnosed with mitral prosthesis (n = 90), mitro-aortic prosthesis (n = 57), and mitral and tricuspid prosthesis (n = 4). The total direct healthcare cost was €15302.59, with a mean total cost per patient per year of €1558.15 (±2774.58) consisting of 44.38 (±42.30) for drug cost, €71.41 (±21.43) for international normalized ratio monitoring, €429.52 (±126.87) for medical visits, €26.31 (±28.38) for rescue medication and €986.53 (±2735.68) for related complications. Conclusion: Most direct healthcare costs associated with the sampled patients arose from the specialist-care monitoring required for treatment. Good monitoring is inversely related to direct healthcare costs

The first gynandromorph of the Neotropical bee Megalopta amoena (Spinola, 1853) (Halictidae) with notes on its circadian rhythm

Gynandromorphy is an anomaly that results in an organism phenotypically expressing both male and female characteristics. Here we describe the first gynandromorph of the bee species Megalopta amoena (Spinola, 1853) (Halictidae, Augochlorini) and the second record of this anomaly within the genus Megalopta. Additionally, we analyzed the bee’s circadian rhythm, which has never before been quantified for a gynandromorph. The gynandromorph showed a deviant activity pattern; it was intermediate between that of the male and female M. amoena. Our results imply that the brains of bilateral gynandromorphs may have mixed sex-specific signaling. Based on four days of recording, the gynandromorph circadian rhythm was shifted earlier in the day relative to the male and female M. amoena, and it exhibited intensity similar to the female