Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain

<p>Abstract</p> <p>Background</p> <p>Although some studies indicate that bipolar disorder causes high health care resources consumption, no study is available addressing a cost estimation of bipolar disorder in Spain. The aim of this observational study was to evaluate healthcare resource utilization and the associated direct cost in patients with manic episodes in the Spanish setting.</p> <p>Methods</p> <p>Retrospective descriptive study was carried out in a consecutive sample of patients with a DSM-IV diagnosis of bipolar type I disorder with or without psychotic symptoms, aged 18 years or older, and who were having an active manic episode at the time of inclusion. Information regarding the current manic episode was collected retrospectively from the medical record and patient interview.</p> <p>Results</p> <p>Seven hundred and eighty-four evaluable patients, recruited by 182 psychiatrists, were included in the study. The direct cost associated with healthcare resource utilization during the manic episode was high, with a mean cost of nearly €4,500 per patient, of which approximately 55% corresponded to the cost of hospitalization, 30% to the cost of psychopharmacological treatment and 10% to the cost of specialized care.</p> <p>Conclusions</p> <p>Our results show the high cost of management of the patient with a manic episode, which is mainly due to hospitalizations. In this regard, any intervention on the management of the manic patient that could reduce the need for hospitalization would have a significant impact on the costs of the disease.</p

METODOLOGÍA DE SELECCIÓN DE POZOS CANDIDATOS PARA TRATAMIENTOS DE CONFORMANCE QUÍMICO

La canalización generalmente es consecuencia de la heterogeneidad del yacimiento, especialmente por grandes variaciones de permeabilidad, ocasionando reducción en la eficiencia volumétrica como producto de la recirculación del fluido inyectado en procesos de recobro secundario y/o mejorado (EOR). Con el objetivo de mejorar el perfil vertical de inyección y reducir la recirculación de agua inyectada, en Colombia se han implementado, desde el año 2008 a 2020, 33 tratamientos de control de canalización y conformance químico profundo en nueve campos con el objetivo de aumentar la eficiencia de barrido volumétrico para incrementar el factor de recuperación de petróleo. El resultado de los tratamientos reportados es de hasta 3 barriles de petróleo incremental por cada barril de gel rígido inyectado. Sin embargo, la cantidad de tratamientos de conformance es baja en comparación con el número de pozos inyectores en el país de aproximadamente 1400). Por lo tanto, Ecopetrol adaptó una metodología de selección de pozos candidatos para tratamientos de conformance químico que tiene en cuenta continuidad de los yacimientos, determinación y caracterización de la heterogeneidad, estudio de movimiento de fluidos, determinación de conectividad del patrón de inyección, distribución vertical y areal de los fluidos inyectados y producidos, generación de gráficos diagnósticos en software Sahara para finalmente identificar los pozos candidatos y realizar el diseño del tratamiento de conformance. La generación de los gráficos diagnóstico base de la metodología tiene como punto de partida la distribución vertical de producción secundaria realizada por el método IWR de alocación de producciones de malla ponderando caudales, en el cual la producción de un pozo es distribuida entre los inyectores que lo afectan, y esta producción es asociada a cada inyector. Con respecto a la distribución areal se toman elementos de flujo creando mallas dinámicas centradas en inyector y se pondera utilizando la distribución angular. La distribución de producción secundaria tiene en cuenta los ILT/PLT realizados históricamente en los pozos inyectores/ productores, mallado y coeficientes de distribución de los patrones de inyección en el tiempo. En el presente trabajo se hace una descripción y aplicación de la metodología integrada que permite identificar la producción de petróleo y agua por yacimiento en cada patrón de inyección, así como la eficiencia del agua inyectada para mapear acciones de mejoramiento de la producción de petróleo y disminución de la producción de agua, con el objetivo de identificar los sectores con menor desempeño y que requieren optimización del proceso secundario y/o mejorado. La metodología se validó y complementó con información de trazadores interwell (IWTT) y simulación numérica en líneas de flujo (streamline). En ese sentido, se vienen aplicando tratamientos de conformance desde el año 2021 en 23 nuevos pozos con resultados prometedores de producción incremental de petróleo. La selección de pozos candidatos para tratamientos de conformance químico amplían las expectativas de masificación de estas tecnologías en diferentes campos del país y se convierten en pieza fundamental para apalancar la consecución de reservas y una disminución de la huella de carbono debido principalmente a que con el mismo caudal de fluido inyectado se incrementa la producción de petróleo y en algunos tratamientos puede disminuir la producción de agua, asegurando menor consumo de energía (CO2) por cada barril de petróleo extraído

Abdominal obesity and low physical activity are associated with insulin resistance in overweight adolescents: a cross-sectional study

ABSTRACT: Background: Previous studies have assessed the metabolic changes and lifestyles associated with overweight adolescents. However, these associations are unclear amongst overweight adolescents who have already developed insulin resistance. This study assessed the associations between insulin resistance and anthropometric, metabolic, inflammatory, food consumption, and physical activity variables amongst overweight adolescents. Methods: This cross-sectional study divided adolescents (n = 120) between 10 and 18 years old into 3 groups: an overweight group with insulin resistance (O + IR), an overweight group without insulin resistance (O-IR), and a normal-weight control group (NW). Adolescents were matched across groups based on age, sex, pubertal maturation, and socioeconomic strata. Anthropometric, biochemical, physical activity, and food consumption variables were assessed. Insulin resistance was assessed using homeostatic model assessment (HOMA Calculator Version 2.2.2 from ©Diabetes Trials Unit, University of Oxford), and overweight status was assessed using body mass index according to World Health Organization (2007) references. A chi-square test was used to compare categorical variables. ANOVAs or Kruskal-Wallis tests were used for continuous variables. Multiple linear regression models were used to calculate the probability of the occurrence of insulin resistance based on the independent variables. Results: The risk of insulin resistance amongst overweight adolescents increases significantly when they reach a waist circumference > p95 (OR = 1.9, CIs = 1.3-2.7, p = 0.013) and watch 3 or more hours/day of television (OR = 1.7, CIs = 0.98-2.8, p = 0.033). Overweight status and insulin resistance were associated with higher levels of inflammation (hsCRP ≥1 mg/L) and cardiovascular risk according to arterial indices. With each cm increase in waist circumference, the HOMA index increased by 0.082; with each metabolic equivalent (MET) unit increase in physical activity, the HOMA index decreased by 0.026. Conclusions: Sedentary behaviour and a waist circumference > p90 amongst overweight adolescents were associated with insulin resistance, lipid profile alterations, and higher inflammatory states. A screening that includes body mass index, in waist circumference, and physical activity evaluations of adolescents might enable the early detection of these alterations

Brain derived neurotrophic factor (BDNF) polymorphisms and memory in healthy adults with university education

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Methicillin-Resistant Staphylococcus aureus USA300 Latin American Variant in Patients Undergoing Hemodialysis and HIV Infected in a Hospital in Bogotá, Colombia.

We aimed to determine the prevalence of MRSA colonization and examine the molecular characteristics of colonizing isolates in patients receiving hemodialysis and HIV-infected in a Colombian hospital. Patients on hemodialysis and HIV-infected were prospectively followed between July 2011 and June 2012 in Bogota, Colombia. Nasal and axillary swabs were obtained and cultured. Colonizing S. aureus isolates were identified by standard and molecular techniques. Molecular typing was performed by using pulse-field gel electrophoresis and evaluating the presence of lukF-PV/lukS-PV by PCR. A total of 29% (n = 82) of HIV-infected and 45.5% (n = 15) of patients on hemodialysis exhibited S. aureus colonization. MSSA/MRSA colonization was observed in 28% and 3.6% of the HIV patients, respectively and in 42.4% and 13.3% of the hemodialysis patients, respectively. Staphylococcal cassette chromosome mec typing showed that four MRSA isolates harbored the type IV cassette, and one type I. In the hemodialysis group, two MRSA isolates were classified as belonging to the USA300-LV genetic lineage. Conversely, in the HIV infected group, no colonizing isolates belonging to the USA300-Latin American Variant (UDA300-LV) lineage were identified. Colonizing isolates recovered from the HIV-infected group belonged to the prevalent hospital-associated clones circulating in Latin America (Chilean [n = 1] and Pediatric [n = 2]). The prevalence of MRSA colonization in the study groups was 3.6% (HIV) and 13.3% (hemodialysis). Surveillance programs should be implemented in this group of patients in order to understand the dynamics of colonization and infection in high-risk patients

General characteristics of dialysis patients evaluated in this study.

<p><i>Notes</i>: <i>HD</i>: <i>Hemodialysis</i>, <i>AVF</i>: <i>Arteriovenous fistula</i>.</p><p><i>Time in renal Unit</i>: <i>71 months (ca</i>. <i>6 years) is the average time that most patients</i></p><p><i>spend in the dialysis unit before they have complications including death</i></p><p>General characteristics of dialysis patients evaluated in this study.</p

Characteristics of MRSA strains isolated from the two populations evaluated.

<p>OXA: oxacillin, ERY: erythromycin, GEN: gentamicin, CIP: ciprofloxacin, SXT: trimethoprim-sulfamethoxazole, VAN: vancomycin, CHL: chloramphenicol, RIF: rifampin, LIN: linezolid</p><p>Characteristics of MRSA strains isolated from the two populations evaluated.</p

General characteristics of HIV-infected patients evaluated in this study.

<p>General characteristics of HIV-infected patients evaluated in this study.</p