Assessment of the impact of a clinical and health services research call in Catalonia

This article presents the ex-post assessment of a program of clinical and health services research and the evaluation of the social impact. The Catalan Agency for Health Information, Assessment, and Quality (CAHIAQ) promotes a biannual open, public, competitive extramural research call to conduct non-commercial clinical and health services research. Its aim is to address local needs of research (knowledge gaps) and to assess the implementation of innovation. Approximately 5.8 million Euros have been allocated to the call. To meet the Agency’s mission, a periodical ‘call for expressions of interest’ and topic prioritization is organized prior to the research call. The awarded projects are submitted to an ex-ante, ongoing, and ex-post assessment. Impact assessment of the research call on advancing knowledge and healthcare decision making is based on the Canadian Academy of Health Sciences framework (Panel on Return on Investment in Health Research, 2009). The methods used include bibliometric analysis, surveys to researchers and decision-makers, and a more in-depth case study of translation pathways. This includes a crossover of cases from 1996 to 2004. Some results are compared against other international health services research calls. The conclusion is that local agencies can significantly contribute to fill knowledge gaps in a specific context. Assessment of the complete research cycle provides opportunities for improving the entire research process (identification of knowledge needs, call for proposals, funding allocation, research completion, subsequent impact). Specifically, assessment of the different types of impact of research development on knowledge generation and decision making closes the evaluation cycle fulfilling the Agency's mission.Fil: Adam, Paula. Catalan Agency for Health Information; España. Epidemiologia y Salud Pública; EspañaFil: Solans Doménech, Maite. Catalan Agency for Health Information; España. Epidemiologia y Salud Pública; EspañaFil: Pons, Joan M. V.. Catalan Agency for Health Information; España. Epidemiologia y Salud Pública; España. Gobierno de Catalunya. Ministerio de Salud; EspañaFil: Aymerich, Marta. Gobierno de Catalunia. Ministerio de Salud; España. Universidad de Girona; EspañaFil: Berra, Silvina del Valle. Universidad Nacional de Córdoba. Facultad de Medicina. Escuela de Salud Pública; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Guillamon, Imma. Catalan Agency for Health Information; España. Epidemiologia y Salud Pública; EspañaFil: Sánchez, Emilia. Universitat Ramon Llull; EspañaFil: Permanyer Miralda, Gaieta. Catalan Agency for Health Information; España. Epidemiologia y Salud Pública; España. Universidad Autonoma de Barcelona. Hospital Vall D; Españ

Novel potential predictive markers of sunitinib outcomes in long-term responders versus primary refractory patients with metastatic clear-cell renal cell carcinoma

Background: several potential predictive markers of efficacy of targeted agents in patients with metastatic renal cell carcinoma (mRCC) have been identified. Interindividual heterogeneity warrants further investigation. Patients and methods: multicenter, observational, retrospective study in patients with clear-cell mRCC treated with sunitinib. Patients were classified in two groups: long-term responders (LR) (progression-free survival (PFS)≥22 months and at least stable disease), and primary refractory (PR) (progressive disease within 3-months of sunitinib onset). Objectives were to compare baseline clinical factors in both populations and to correlate tumor expression of selected signaling pathways components with sunitinib PFS. Results: 123 patients were analyzed (97 LR, 26 PR). In the LR cohort, overall response rate was 79% and median duration of best response was 30 months. Median PFS and overall survival were 43.2 (95% confidence intervals[CI]:37.2-49.3) and 63.5 months (95%CI:55.1-71.9), respectively. At baseline PR patients had a significantly lower proportion of nephrectomies, higher lactate dehydrogenase and platelets levels, lower hemoglobin, shorter time to and higher presence of metastases, and increased Fuhrman grade. Higher levels of HEYL, HEY and HES1 were observed in LR, although only HEYL discriminated populations significantly (AUC[ROC]=0.704; cut-off=34.85). Increased levels of hsa-miR-27b, hsa-miR-23b and hsa-miR-628-5p were also associated with prolonged survival. No statistical significant associations between hsa-miR-23b or hsa-miR-27b and the expression of c-Met were found. Conclusions: certain mRCC patients treated with sunitinib achieve extremely long-term responses. Favorable baseline hematology values and longer time to metastasis may predict longer PFS. HEYL, hsa-miR-27b, hsa-miR-23b and hsa-miR-628-5p could be potentially used as biomarkers of sunitinib response

Protocol per a l'atenció a la interrupció voluntària de l'embaràs a Catalunya

Avortament; Protocol; CatalunyaAborto; Protocolo; CataluñaAbortion; Protocol; CataloniaAquest protocol, incorpora nou coneixement, amplia el termini de gestació per la utilització del mètode farmacològic, proposa millores en l’acompanyament durant el procés i també inclou recomanacions per l’assessorament contraceptiu posterior a la intervenció. Les recomanacions incloses a aquest protocol s’apliquen tant a dones, que és el gènere majoritari en els casos que es realitza una IVE, com a persones gestants que volen interrompre voluntàriament l’embaràs, independentment del seu gènere

Mediating effect of soluble B-cell activation immune markers on the association between anthropometric and lifestyle factors and lymphoma development

Sustained B-cell activation is an important mechanism contributing to B-cell lymphoma (BCL). We aimed to validate four previously reported B-cell activation markers predictive of BCL risk (sCD23, sCD27, sCD30, and CXCL13) and to examine their possible mediating effects on the association between anthropometric and lifestyle factors and major BCL subtypes. Pre-diagnostic serum levels were measured for 517 BCL cases and 525 controls in a nested case-control study. The odds ratios of BCL were 6.2 in the highest versus lowest quartile for sCD23, 2.6 for sCD30, 4.2 for sCD27, and 2.6 for CXCL13. Higher levels of all markers were associated with increased risk of chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), and diffuse large B-cell lymphoma (DLBCL). Following mutual adjustment for the other immune markers, sCD23 remained associated with all subtypes and CXCL13 with FL and DLBCL. The associations of sCD23 with CLL and DLBCL and CXCL13 with DLBCL persisted among cases sampled > 9 years before diagnosis. sCD23 showed a good predictive ability (area under the curve = 0.80) for CLL, in particular among older, male participants. sCD23 and CXCL13 showed a mediating effect between body mass index (positive) and DLBCL risk, while CXCL13 contributed to the association between physical activity (inverse) and DLBCL. Our data suggest a role of B-cell activation in BCL development and a mediating role of the immune system for lifestyle factors

Model de relació entre l’atenció primària i comunitària i l’atenció hospitalària ambulatòria

Atenció primària; Atenció hospitalària; PacientAtención primaria; Atención hospitalaria; PacientePrimary care; Hospital care; PatientL’objectiu del present document és definir un model de relació entre l’atenció primària i comunitària i l’atenció hospitalària ambulatòria que doni una resposta resolutiva, equitativa i de qualitat durant tot el procés assistencial. A tal fi es defineix el diagrama del procés assistencial pel qual els metgesa especialistes de medicina de família i comunitària (MFiC) sol·liciten l’atenció, mitjançant l’ordre clínica, dels seus homòlegs d’atenció hospitalària ambulatòria (MAH). A més, s’estableixen un seguit de recomanacions relatives a la relació que s’estableix entre l’MFiC i el MAH a l’hora de contribuir a la millora de la salut de la persona atesa

Organitzacions saludables: fem salut, fem ioga

Organitzacions saludables; Ioga; Salut públicaOrganizaciones saludables; Yoga; Salud públicaHealthy organizations; Yoga; Public healthAmb l’objectiu de dissenyar un programa fonamentat en la promoció d’organitzacions saludables a través d’una intervenció específica de ioga, es va crear la Comunitat de Pràctica (CoP) Fem salut, fem ioga. Perquè una organització esdevingui saludable ha de permetre als treballadors conciliar la vida laboral amb la familiar, promoure horaris raonables, difondre la cura de la salut amb l’exemple, facilitar un bon ambient laboral i fer prevaldre el treball en equip inter i multidisciplinari i la cooperació per assolir les fites establertes, en alineació amb els objectius de l’empresa. També ha d’animar els treballadors a participar en obres socials i fer educació en salut, tant per als empleats com per als grups amb què es relaciona. Una de les maneres més habituals de promocionar una organització saludable és crear programes adreçats als treballadors que continguin accions concretes, com pot ser, per exemple, la implementació d’un programa de pràctica de ioga. Les malalties causades pels entorns laborals acostumen a estar relacionades amb problemes osteoarticulars (cervicàlgies, lumbàlgies...) i amb la gestió de l’estrès5,6. La pràctica del ioga pot ajudar a prevenir aquest tipus de problemes o a minimitzar-ne els efectes. Com a resultat final es va definir, implementar i avaluar una intervenció pilot de ioga a l’entorn laboral (en aquest cas, institucions governamentals) per a fomentar organitzacions saludables.Con el objetivo de diseñar un programa fundamentado en la promoción de organizaciones saludables a través de una intervención específica de yoga, se creó la Comunidad de Práctica (CoP) Hacemos salud, hacemos yoga. Para que una organización sea saludable debe permitir a los trabajadores conciliar la vida laboral con la familiar, promover horarios razonables, difundir el cuidado de la salud con el ejemplo, facilitar un buen ambiente laboral y primar el trabajo en equipo inter y multidisciplinar y la cooperación para alcanzar las metas establecidas, en alineación con los objetivos de la empresa. También debe animar a los trabajadores a participar en obras sociales y hacer educación en salud, tanto para los empleados como para los grupos con los que se relaciona. Una de las formas más habituales de promocionar una organización saludable es crear programas dirigidos a los trabajadores que contengan acciones concretas, como puede ser, por ejemplo, la implementación de un programa de práctica de yoga. Las enfermedades causadas por los entornos laborales suelen estar relacionadas con problemas osteoarticulares (cervicalgias, lumbalgias...) y con la gestión del estrés5,6. La práctica del yoga puede ayudar a prevenir este tipo de problemas o minimizar sus efectos. Como resultado final se definió, implementó y evaluó una intervención piloto de yoga en el entorno laboral (en este caso, instituciones gubernamentales) para fomentar organizaciones saludables.In order to design a program based on the promotion of organizations health through a specific yoga intervention, the Community of Practice (CoP) We do health, we do yoga. For an organization to be healthy, it must allow workers to reconcile work and family life, promote reasonable hours, disseminate health care by example, facilitate a good work environment, and prioritize inter and multidisciplinary teamwork and cooperation. to achieve the established goals, in alignment with the objectives of the company. It should also encourage workers to participate in social projects and health education, both for employees and for the groups with which they are related. One of the most common ways to promote a healthy organization is to create programs aimed at workers that contain specific actions, such as, for example, the implementation of a yoga practice program. Illnesses caused by work environments are usually related to osteoarticular problems (neck pain, low back pain...) and stress management5,6. The practice of yoga can help prevent these types of problems or minimize their effects. As a final result, a pilot yoga intervention was defined, implemented and evaluated in the work environment (in this case, government institutions) to promote healthy organizations

Epistatic interaction of ERAP1 and HLA-B in Behçet disease: a replication study in the Spanish population

Behçet's disease (BD) is a multifactorial disorder associated with the HLA region. Recently, the ERAP1 gene has been proposed as a susceptibility locus with a recessive model and with epistatic interaction with HLA-B51. ERAP1 trims peptides in the endoplasmic reticulum to optimize their length for MHC-I binding. Polymorphisms in this gene have been related with the susceptibility to other immune-mediated diseases associated to HLA class I. Our aim was, the replication in the Spanish population of the association described in the Turkish population between ERAP1 (rs17482078) and BD. Additionally, in order to improve the understanding of this association we analyzed four additional SNPs (rs27044, rs10050860, rs30187 and rs2287987) associated with other diseases related to HLA class I and the haplotype blocks in this gene region. According to our results, frequencies of the homozygous genotypes for the minor alleles of all the SNPs were increased among patients and the OR values were higher in the subgroup of patients with the HLA-B risk factors, although differences were not statistically significant. Moreover, the presence of the same mutation in both chromosomes increased the OR values from 4.51 to 10.72 in individuals carrying the HLA-B risk factors. Therefore, although they were not statistically significant, our data were consistent with an association between ERAP1 and BD as well as with an epistatic interaction between ERAP1 and HLA-B in the Spanish population

Contribution of Cytochrome P450 and ABCB1 Genetic Variability on Methadone Pharmacokinetics, Dose Requirements, and Response

Although the efficacy of methadone maintenance treatment (MMT) in opioid dependence disorder has been well established, the influence of methadone pharmacokinetics in dose requirement and clinical outcome remains controversial. The aim of this study is to analyze methadone dosage in responder and nonresponder patients considering pharmacogenetic and pharmacokinetic factors that may contribute to dosage adequacy. Opioid dependence patients (meeting Diagnostic and Statistical Manual of Mental Disorders, [4th Edition] criteria) from a MMT community program were recruited. Patients were clinically assessed and blood samples were obtained to determine plasma concentrations of (R,S)-, (R) and (S)- methadone and to study allelic variants of genes encoding CYP3A5, CYP2D6, CYP2B6, CYP2C9, CYP2C19, and P-glycoprotein. Responders and nonresponders were defined by illicit opioid consumption detected in random urinalysis. The final sample consisted in 105 opioid dependent patients of Caucasian origin. Responder patients received higher doses of methadone and have been included into treatment for a longer period. No differences were found in terms of genotype frequencies between groups. Only CYP2D6 metabolizing phenotype differences were found in outcome status, methadone dose requirements, and plasma concentrations, being higher in the ultrarapid metabolizers. No other differences were found between phenotype and responder status, methadone dose requirements, neither in methadone plasma concentrations. Pharmacokinetic factors could explain some but not all differences in MMT outcome and methadone dose requirements

Model de relació en la derivació de pacients entre l’àmbit d’atenció primària i l’àmbit d'atenció hospitalària ambulatòria

Atenció primària; Atenció hospitalària; PacientAtención primaria; Atención hospitalaria; PacientePrimary care; Hospital care; PatientL’objectiu del present document és definir un model de relació entre l’atenció primària i comunitària i l’atenció hospitalària ambulatòria que doni una resposta resolutiva, equitativa i de qualitat durant tot el procés assistencial. A tal fi es defineix el diagrama del procés assistencial pel qual els metgesa especialistes de medicina de família i comunitària (MFiC) sol·liciten l’atenció, mitjançant l’ordre clínica, dels seus homòlegs d’atenció hospitalària ambulatòria (MAH). A més, s’estableixen un seguit de recomanacions relatives a la relació que s’estableix entre l’MFiC i el MAH a l’hora de contribuir a la millora de la salut de la persona atesa