Descriptive and predictive analysis identify centenarians' characteristics from the Basque population

BackgroundCentenarians exhibit extreme longevity and have been postulated, by some researchers, as a model for healthy aging. The identification of the characteristics of centenarians might be useful to understand the process of human aging.MethodsIn this retrospective study, we took advantage of demographic, clinical, biological, and functional data of deceased individuals between 2014 and 2020 in Guipúzcoa (Basque Country, Spain) taken from the Basque Health Service electronic health records data lake. Fifty characteristics derived from demographic, clinical, pharmaceutical, biological, and functional data were studied in the descriptive analysis and compared through differences in means tests. Twenty-seven of them were used to build machine learning models in the predictive analysis and their relevance for classifying centenarians was assessed.ResultsMost centenarians were women and lived in nursing homes. Importantly, they developed fewer diseases, took fewer drugs, and required fewer medical attendances. They also showed better biological profiles, exhibiting lower levels of glucose, hemoglobin, glycosylated hemoglobin, and triglycerides in blood analysis compared with non-centenarians. In addition, machine learning analyses revealed the main characteristics of the profiles associated with centenarians' status as being women, having fewer consultations, having fewer diagnoses of neoplasms, and having lower levels of hemoglobin.ConclusionsOur results revealed the main characteristics linked to centenarians in the Basque Country using Computational Biology programs. These results expand the knowledge on the characterization of the centenarian population and hence of human longevity

Cost-effectiveness analysis of vaccines for COVID-19 according to sex, comorbidity and socioeconomics status: a population study

Background and Objective Coronavirus disease 2019 (COVID-19) vaccines are extremely effective in preventing severe disease, but their real-world cost-effectiveness is still an open question. We present an analysis of the cost-effectiveness and economic impact of the initial phase of the COVID-19 vaccination rollout in the Basque Country, Spain. Methods To calculate costs and quality-adjusted life years for the entire population of the Basque Country, dynamic modelling and a real-world data analysis were combined. Data on COVID-19 infection outcomes (cases, hospitalisations, intensive care unit admissions and deaths) and population characteristics (age, sex, socioeconomic status and comorbidity) during the initial phase of the vaccination rollout, from January to June of 2021, were retrieved from the Basque Health Service database. The outcomes in the alternative scenario (without vaccination) were estimated with the dynamic model used to guide public health authority policies, from February to December 2020. Individual comorbidity-adjusted life expectancy and costs were estimated. Results By averting severe disease-related outcomes, COVID-19 vaccination resulted in monetary savings of €26.44 million for the first semester of 2021. The incremental cost-effectiveness ratio was €707/quality-adjusted life year considering official vaccine prices and dominant real prices. While the analysis by comorbidity showed that vaccines were considerably more cost effective in individuals with pre-existing health conditions, this benefit was lower in the low socioeconomic status group. Conclusions The incremental cost-effectiveness ratio of the vaccination programme justified the policy of prioritising high-comorbidity patients. The initial phase of COVID-19 vaccination was dominant from the perspective of the healthcare payer

Incidence of mental disorders in the general population aged 1–30 years disaggregated by gender and socioeconomic status

Purpose The objective of this study was to estimate the incidence and age of onset of mental disorders diagnosed by gender and socioeconomic status (SES) in children, adolescents, and young adults up to 30 years of age in the whole population of the Basque Country (Spain). Methods All mental health diagnoses documented in Basque Health Service records from 1 January 2003 to 31 December 2018, were classified into eight clusters: anxiety, attention deficit hyperactivity disorder (ADHD), conduct disorders, depression, psychosis/personality disorders, substance use, eating disorders, and self-harm. We calculated incidence and cumulative incidence for each cluster, disaggregated by gender, and socioeconomic status (SES). Poisson regression analyses were performed. Results Overall, 9,486,853 person-years of observation were available for the 609,281 individuals included. ADHD and conduct disorders were diagnosed in the first decade, anxiety and depression disorders in the second and third decades, and psychosis/personality and substance use in the third. The cumulative incidence at 18 years of age for any type of disorder was 15.5%. The group with low SES had a statistically significantly higher incidence of all eight clusters. The incidence of ADHD, conduct disorders, depression, psychosis/personality disorders, and substance use was higher in males and that of anxiety, eating disorders and self-harm was higher in females. Conclusions The incidence of mental disorders is high among children, adolescents, and young adults in the Basque Country underlining the need for preventive interventions. Marked differences by gender and SES highlight mental health inequalities, especially for depression and psychosis in low SES males.This work is included within the UPRIGHT project, which is funded by the European Union Horizon 2020 Research and Innovation programme under grant agreement No. 754919. This paper reflects only the views of the authors, and the European Union is not responsible for any use that may be made of the information it contains. The funding body has had no role in the study design, writing of the protocol or the decision to submit the paper for publication

Assessment of the effectiveness, socio-economic impact and implementation of a digital solution for patients with advanced chronic diseases : the ADLIFE study protocol

Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Economic Evaluation of an Integrated Health and Social Care Program for Heart Failure Through 2 Different Modeling Techniques

Introduction: An integrated health and social care program for patients with heart failure (HF) was implemented at the Friuli-Venezia Giulia deployment site as part of the SmartCare European project. The objective of this study was to validate 2 different decision modeling techniques used to perform the economic evaluation. Methods: Data were collected during the SmartCare project which enrolled 108 patients with HF and followed for more than 6 months. The techniques used were Markov and discrete event simulation models. In both cases, a cost-effectiveness analysis and a budget impact analysis were carried out. The former was used to assign priority to the intervention and the latter to assess its sustainability. Analyses were conducted from the perspective of the Regional Health Authority. Results: Results were similar with both types of model. Cost-effectiveness analysis found no significant differences in quality of life, but the intervention generated significant cost savings, becoming the dominant option. Data extrapolation showed no benefits in terms of mortality or hospital admissions, but budget impact analysis also predicted annual savings, as a significant number of in-hospital days were avoided. In budget analysis, both models predicted early, increasing and cumulative annual savings. Discussion: The integrated program was dominant as it provided better outcomes and lower total costs, and thus, decision-makers should prioritize it. Besides, the work demonstrates the capacity of decision modeling to become a complementary tool in managing integrated health and social care models

Parametric Optimisation of a Direct Liquid Cooling–Based Prototype for Electric Vehicles Focused on Pouch-Type Battery Cells

In this work, a numerical optimisation process is applied to improve the fluid dynamical aspect of an innovative direct liquid cooling strategy for lithium-ion–based HEV/EV. First, the thermofluidic numerical model of the battery cell defined by means of CFD computational tools was validated with experimental tests. Then, a comparison between different flow patterns was developed to analyse the influence of the fluid distribution geometry. Finally, a parametric multi-objective optimisation process was implemented arranged by a two-level full factorial design. Considering as input variables the height of the fluid, the number of cooling channels, the number of distributors, and the flow rate, the optimal relationship between the thermal performance of the battery cell, the volumetric energy density of the system, and the power consumption of the strategy was obtained. As a result, the energy density of the system was maximised, and the power consumption was reduced while keeping the cell temperature within the optimal range

Impacto de la identificación de pacientes en un programa de cuidados paliativos del País Vasco

Resumen: Objetivo: Evaluar el proceso y el impacto económico de un programa integrado de cuidados paliativos. Diseño: Estudio transversal comparativo. Emplazamiento: Organizaciones Sanitarias Integradas Alto Deba y Goierri Alto-Urola, País Vasco. Participantes: Pacientes fallecidos (oncológicos y no oncológicos) en 2012 (grupo control) y 2015 (grupo intervención) susceptibles de necesitar cuidados paliativos según la estimación mínima de McNamara. Intervenciones: Identificación de pacientes con el código de cuidados paliativos en atención primaria, uso de rutas asistenciales conjuntas en atención primaria y hospitalaria e impartición de cursos formativos. Mediciones principales: Cambio en el perfil de uso de recursos del paciente durante sus últimos 3 meses de vida. Se utilizó el genetic matching para evitar sesgos. Mediante análisis univariante se compararon los grupos y mediante regresiones logísticas y modelos lineales generalizados se analizaron las relaciones entre variables. Resultados: Se identificaron 1.023 pacientes en 2012 y 1.142 en 2015. En 2015 aumentó al doble la probabilidad de ser identificado como paliativo en pacientes oncológicos (19-33%) y no oncológicos (7-16%). La prescripción de opiáceos subió (25-68%) y el fallecimiento en hospital se mantuvo estable. Los contactos por paciente con atención primaria y hospitalización a domicilio aumentaron, mientras que las hospitalizaciones tradicionales disminuyeron. El coste por paciente aumentó un 26%. Conclusiones: El modelo integrado incrementó la identificación de la población diana. La relación entre variables mostró que la identificación repercutió positivamente en la prescripción de opiáceos, fallecimiento fuera del hospital y extensión a enfermedades no oncológicas. Aunque también disminuyeron los ingresos, el coste aumentó debido al uso de hospitalización a domicilio. Abstract: Objective: Evaluate the process and the economic impact of an integrated palliative care program. Design: Comparative cross-sectional study. Location: Integrated Healthcare Organizations of Alto Deba and Goierri Alto-Urola, Basque Country. Participants: Patients dead due to oncologic and non-oncologic causes in 2012 (control group) and 2015 (intervention group) liable to need palliative care according to McNamara criteria. Interventions: Identification as palliative patients in primary care, use of common clinical pathways in primary and secondary care and arrange training courses for health professionals. Main measures: Change in the resource use profile of patients in their last 3 months. Propensity score by genetic matching method was used to avoid non-randomization bias. The groups were compared by univariate analysis and the relationships between variables were analysed by logistic regressions and generalized linear models. Results: One thousand and twenty-three patients were identified in 2012 and 1,142 patients in 2015. In 2015 doubled the probability of being identify as palliative patient in deaths due to oncologic (19-33%) and non-oncologic causes (7-16%). Prescriptions of opiates rise (25-68%) and deaths in hospital remained stable. Contacts per patient with primary care and home hospitalization increased, while contacts with hospital admissions decreased. Cost per patient rise 26%. Conclusions: The integrated palliative care model increased the identification of the target population. Relationships between variables showed that the identification had a positive impact on prescription of opiates, death outside the hospital and extension to non-oncologic diseases. Although the identification decreased admissions in hospital, costs per patient had a slight increase due to home hospitalizations. Palabras clave: Cuidados paliativos, Programas integrados, Coste, Calidad de atención, Criterios McNamara, Keywords: Palliative care, Integrated program, Cost, Quality of care, McNamara criteri

Harnessing Deep-Hole Drilling to Fabricate Air-Structured Polymer Optical Fibres

The performance of a precisely controlled drilling technique is critical in the fabrication process of microstructured polymer optical fibres. For the creation of a holey preform, adequate drilling bits with large length-to-diameter ratios provide the ability of machining preforms with complex structures and large lengths in a relatively short time. In this work, we analysed different drilling bits and techniques that can be employed for the creation of such preforms, and key parameters characterising the quality of the drilled holes, such as surface rugosity, diameter deviation, coaxiality and cylindricity were measured. For this purpose, based on theoretical simulations, four rings of air holes arranged in a hexagonal pattern were drilled in the preforms with different drill bits, and the experimental results for the above mentioned parameters have been presented. Additionally, optical power distribution of the fabricated microstructured polymer optical fibres was theoretically calculated and experimentally measuredThis work was supported in part by the Fondo Europeo de Desarrollo Regional (FEDER), in part by the Ministerio de Economia y Competitividad under Project RTI2018-094669-B-C31, in part by the Gobierno Vasco/Eusko Jaurlaritza under Projects IT933-16, and in part by ELKARTEK under Grants KK-2018/00078 GERTURA, KK-2019/00101 mu 4Indust and KK-2019/00051 SMARTRESNAK