Relationship between efficiency and clinical effectiveness indicators in an adjusted model of resource consumption : a cross-sectional study

Background: Adjusted clinical groups (ACG®) have been widely used to adjust resource distribution; however, the relationship with effectiveness has been questioned. The purpose of the study was to measure the relationship between efficiency assessed by ACG® and a clinical effectiveness indicator in adults attended in Primary Health Care Centres (PHCs). Methods: Research design: cross-sectional study. Subjects: 196, 593 patients aged >14 years in 13 PHCs in Catalonia (Spain). Measures: Age, sex, PHC, basic care team (BCT), visits, episodes (diagnoses), and total direct costs of PHC care and co-morbidity as measured by ACG® indicators: Efficiency indices for costs, visits, and episodes (costs EI, visits EI, episodes EI); a complexity or risk index (RI); and effectiveness measured by a general synthetic index (SI). The relationship between EI, RI, and SI in each PHC and BCT was measured by multiple correlation coefficients (r). Results: In total, 56 of the 106 defined ACG® were present in the study population, with five corresponding to 44.5% of the patients, 11 to 68.0% of patients, and 30 present in less than 0.5% of the sample. The RI in each PHC ranged from 0.9 to 1.1. Costs, visits, and episodes had similar trends for efficiency in six PHCs. There was moderate correlation between costs EI and visits EI (r = 0.59). SI correlation with episodes EI and costs EI was moderate (r = 0.48 and r = −0.34, respectively) and was r = −0.14 for visits EI. Correlation between RI and SI was r = 0.29. Conclusions: The Efficiency and Effectiveness ACG® indicators permit a comparison of primary care processes between PHCs. Acceptable correlation exists between effectiveness and indicators of efficiency in episodes and costs

Colorectal cancer: immune response in laparoscopic versus open colorectal surgery

Introduction: Colorectal cancer is the second most frequent cause of deaths from cancer worldwide. Enhanced recovery protocols (ERPs) were developed in 90s to improve the recovery of these patients. Within ERPs, this work aims to compare immune responsebetweenopenandlaparoscopicprocedurestosupportthebestsurgicalapproach. Materialsandmethods:Theimmunestatus of 148 patients undergoing colorectal surgery (74 by laparoscopic and 74 by open surgery OS]) was studied in three moments: before surgery (POD0) and on the 1st and 3th post-operative days (POD1 and POD3). Results: Comparing to the laparoscopic group, in the OS group, C-reactive protein levels were significantly higher on POD1 and POD3 (p < 0.001), whereas lymphocyte levels were significantly lower (p = 0.006) and neutrophil levels were higher (p = 0.012) on POD1. On the other hand, higher levels of B cells (p = 0.023) were observed on POD1 in the laparoscopic group. Natural killer cell levels were significantly reduced (p = 0.034) in this group on POD3. Conclusions: Within the ERP, immune response pattern in both surgery approaches appears to be similar. Nevertheless, a greater inflammatory response of the OS is observed, whereas earlier recovery of the immune levels baseline seems to be a trend in the laparoscopic surgery

HE4 in endometriod and non- Endometrioid subtype of endometrial cancer does not mean the same

Objective: To study the association between the preoperative value of serum HE4 marker and poor histological prognostic factors depending on the subtype of endometrial cancer (EC): endometrioid and non-endometrioid tumors. Methods: Prospective and multicenter cohort study including patients with EC in Miguel Servet University Hospital of Zaragoza (Spain) and Hospital Clínico San Carlos of Madrid (Spain) from January 2017 to March 2020. Preoperative serum levels of HE4 were analyzed by clinical and pathological characteristics. Results: Overall, 190 patients were included. Of them, 158 were subtype I of EC and 32 were subtype II tumors. In endometrioid EC, a statistically significant association was found between the preoperative HE4 value and tumor size (p < 0.001), deep myometrial invasion (p = 0.001), lymphovascular space invasion (LVSI) (p = 0.002), cervical (p = 0.001), adnexal (p = 0.023), isthmus (p < 0.001) and parametrial involvement (p = 0.012), lymph node metastasis (p = 0.025) and FIGO stage (p < 0.001). On the contrary, no histological factors showed statistical association except LVSI (p = 0.025) in the non-endometrioid subtype. Conclusions: The preoperative value of HE4 is related differently with several established prognostic factors for EC according to the histological type of tumor. These results could be relevant in order to standardize a prognostic value of HE4 in EC

Can the nile generate output, income, and employment in Egypt? A mixed multiplier analysis

Nile water availability is one of the major constraints for agricultural development in Egypt. This study conducts a mixed multiplier analysis, under water and land constraints, to identify the seasonal agricultural activities with high output and income multipliers. It uses a 2008/09 SAM for Egypt with a detailed rep-resentation of Nile-related production factors employed by agricultural activities across irrigation seasons. The results demonstrate the significance of addressing Nile water constraints, not only for agriculture, but also for the overall economy. Policies that enhance water productivity, particularly in the winter season, generate outstanding increases in output, income, and employment through sizable multiplier effects. © 2021, Bononia University Press. All rights reserved

Relationship between Salmonella shedding at the slaughter and pig Salmonella status during the fattening period

In this study, the pig’s risk of shedding at slaughter with regard to its previous Salmonella status was estimated. A total of 133 pigs were serologically monitored monthly to determine their Salmonella status during the fattening period. Mesenteric lymph nodes (MLN) and faecal (FEC) samples were collected further at slaughter for bacteriology. Pigs were grouped as non-infected pigs (group A); animals likely infected at the end of the fattening period (B); and animals infected at least two weeks before the end of the fattening period (C). The probability of shedding in group A was high (36.5%) and likely related to Salmonella exposure during transport or lairage, but also to possible false-negative bacteriological results. The odds of shedding for groups B and C was 3.1 (95%CI=1.1-9.2) and 8.2 (1.4-48.6) times higher, respectively, when compared to group A. Overall most of the infected pigs from groups B and C showed same serotype in MLN and FEC samples (61% and 77%, respectively) and PFGE analysis confirmed majority were genetically related. In conclusion, the control of Salmonella infection along the fattening period appears to be of utmost importance to prevent slaughter contamination

Prevalence of severe atopic dermatitis in adults in 3 areas of Spain

The study was sponsored by Sanof

Salmonella Shedding in Slaughter Pigs and the Use of Esterified Formic Acid in the Drinking Water as a Potential Abattoir-Based Mitigation Measure

Pigs shedding Salmonella at slaughter are considered a source of carcass contamination and human infection. To assess this potential risk, the proportion of Salmonella shedders that arrive for slaughter was evaluated in a population of 1068 pigs from 24 farms. Shedding was present in 27.3% of the pigs, and the monophasic variant of Salmonella Typhimurium, an emerging zoonotic serotype, was the most prevalent (46.9%). Antimicrobial resistance (AMR) in Salmonella isolates was common, but few isolates showed AMR to antimicrobials of critical importance for humans such as third-generation cephalosporins (5%), colistin (0%), or carbapenems (0%). However, AMR to tigecycline was moderately high (15%). The efficacy of an esterified formic acid in the lairage drinking water (3 kg formic acid/1000 L) was also assessed as a potential abattoir-based strategy to reduce Salmonella shedding. It was able to reduce the proportion of shedders (60.7% in the control group (CG) vs. 44.3% in the treatment group (TG); p < 0.01). After considering clustering and confounding factors, the odds of shedding Salmonella in the CG were 2.75 (95% CI = 1.80–4.21) times higher than those of the TG, suggesting a potential efficacy of reduction in shedding as high as 63.6%. This strategy may contribute to mitigating the burden of abattoir environmental contamination

Salmonella infection in nursery piglets and its role in the spread of salmonellosis to further production periods

Few studies have focused on assessing Salmonella infection in the nursery and its role in further pig production periods. Mesenteric lymph nodes, intestinal content, and meat juice from 389 6-week-old male piglets intended for human consumption from five breeding farms and 191 pooled floor fecal samples from gilt development units (GDU) from the same farms were analyzed to estimate and characterize (by pulsed-field gel electrophoresis and antimicrobial resistance analyses) Salmonella infection. The prevalence of infection and shedding among piglets was 36.5% and 37.3%, respectively, shedding being significantly associated with infection (Odds Ratio = 12.7; CI 7.3–22.0). Salmonella Rissen; S. 4, [5], 12:i:-; and S. Derby were the most common serotypes. A low level of Salmonella-specific maternal antibodies at the beginning of the nursery period suggested it was a period of high risk of infection. Resistance to 3rd-and 4th-generation cephalosporins was detected in piglet isolates although the piglets never received antibiotics, indicating they could be vectors of antimicrobial resistance. The same Salmonella clones were detected in piglet and GDU isolates, suggesting that infected piglets play a significant role in the infection of gilts and consequently of finishing pigs in the case of production farms. The control of Salmonella infection in nursery piglets may decrease the risk of abattoir and carcass contamination