Estimates of patient costs related with population morbidity: Can indirect costs affect the results?

A number of health economics works require patient cost estimates as a basic information input. However the accuracy of cost estimates remains in general unspecified. We propose to investigate how the allocation of indirect costs or overheads can affect the estimation of patient costs in order to allow for improvements in the analysis of patient costs estimates. Instead of focusing on the costing method, this paper proposes to highlight changes in variance explained observed when a methodology is chosen. We compare three overhead allocation methods for a specific Spanish population adjusted using the Clinical Risk Groups (CRG), and we obtain different series of full-cost group estimates. As a result, there are significant gains in the proportion of the variance explained, depending upon the methodology used. Furthermore, we find that the global amount of variation explained by risk adjustment models depends mainly on direct costs and is independent of the level of aggregation used in the classification system.Patient costs, Clinical Risk Groups, Variation explained, Overhead allocation

Thermal Analysis of Healthy and Ecological Friendly Flame Retardants for Textiles

Flame Retardants (FR) are a group of anthropogenic environmental contaminants used at a relatively high concentration in many applications. Currently, the largest marked group of FRs is halogenated FR, and many of them are considered toxic, persistent and bio accumulative. Non-halogenated alternatives are a possible solution for the problem, but there is a lack of knowledge concerning environmental impact, health risks during the production process and final use. The main objective of the LIFE-FLAREX project that supports this work, is the mitigation of the environmental and human health impact of flame retardants used in textiles, looking for new efficient more ecological and healthy alternatives, able to replace the most common FR’s that include toxic compounds like halogens, formaldehyde and antimony.  The aim of this work   is to determine the effect of conventional and ecological flame retardants on cotton and polyester fabrics by the application of differential scanning calorimetry DSC and thermogravimetric analysis TGA. Results have been compared with those given by the best FR applied to cotton/polyester blended fabric. The application of DSC up to 550°Cand TGA up to 600°C in N2 and O2 atmospheres give results that are in accordance with those yielded by the micro-scale combustion calorimeter. Onset temperatures  of decomposition, steps of loss of mass by temperature and final residues, enable to evaluate the thermal efficiency of the different flame retardants. Results have been compared with those given by the application of ammonium polyphosphate and guanidine phosphate on cotton/polyester 50/50 blend. Keywords: Thermal Analysis, Flame retardant, Cotton, Polyeste

Laccases stabilization with phosphatidylcholine liposomes

In recent years, there has been an upsurge of interest in enzyme treatment of textile fibres. Enzymes are globular proteins whose catalytic function is due to their three dimensional structure. For this reason, stability strategies make use of compounds that avoid dismantling or distorting protein 3D structures. This study is concerned with the use of microencapsulation techniques to optimize enzyme stabilization. Laccases were embedded in phophatidylcholine liposomes and their encapsulation capacity was assessed. Their enzymatic activity and stability were analyzed, comparing free-enzymes, enzymes in liposomes, and the lipid fraction separated from the aqueous fraction. An increase in their encapsulation efficiency was found at higher lipid/laccase ratios. Relative activity of enzyme-containing vesicles has also been shown to be retained much more than that of free native enzymes. The loss of activity of laccases entrapped in the vesicles in the total stability process is lower than 10% compared with 40% to 60% of loss of free-laccases after heating the samples for 3 days. Laccase stabilization could be of interest to future textile or cosmetic applications because of their potential for environmentally friendly oxidation technologies

Predicción del riesgo individual de alto coste sanitario para la identificación de pacientes crónicos complejos

ResumenObjetivoConstruir y validar un modelo predictivo del riesgo de consumo de recursos sanitarios elevado, y evaluar su capacidad para identificar pacientes crónicos complejos.MétodosEstudio transversal realizado en una organización sanitaria integrada sobre datos individuales de residentes 2 años consecutivos (88.795 personas). Variable dependiente: coste sanitario real superior al percentil 95 (P95), incluyendo todos los servicios de la organización sanitaria integrada y las recetas de farmacia. Variables predictoras: edad, sexo, morbilidad (según los clinical risk groups [CRG]) y datos seleccionados de utilización previa (uso de hospitalización, uso de medicación hospitalaria ambulatoria, gasto en recetas de farmacia). Análisis univariado descriptivo. Construcción de un modelo de regresión logística con nivel de confianza del 95%; análisis de validez mediante sensibilidad, especificidad, valor predictivo positivo (VPP) y área bajo la curva ROC (AUC).ResultadosLas personas con coste >P95 acumulan el 44% del coste sanitario total y se concentran en las categorías ACRG3 (aggregated CRG level 3) de enfermedades crónicas múltiples o graves. La carga de morbilidad aumenta con la edad. En el modelo, todas las variables fueron estadísticamente significativas excepto el sexo. Se obtuvo una sensibilidad del 48,4% (intervalo de confianza [IC]: 46,9%-49,8%), una especificidad del 97,2% (IC: 97,0%-97,3%), un VPP del 46,5% (IC: 45,0%-47,9%) y un AUC de 0,897 (IC: 0,892-0,902).ConclusionesEl consumo sanitario elevado se relaciona con la morbilidad crónica compleja. Un modelo basado en la edad, la morbilidad y la utilización previa es válido para predecir el riesgo de alto consumo, y así identificar la población diana de estrategias de atención proactiva para pacientes crónicos complejos.AbstractObjectiveTo develop a predictive model for the risk of high consumption of healthcare resources, and assess the ability of the model to identify complex chronic patients.MethodsA cross-sectional study was performed within a healthcare management organization by using individual data from 2 consecutive years (88,795 people). The dependent variable consisted of healthcare costs above the 95th percentile (P95), including all services provided by the organization and pharmaceutical consumption outside of the institution. The predictive variables were age, sex, morbidity—based on clinical risk groups (CRG)—and selected data from previous utilization (use of hospitalization, use of high-cost drugs in ambulatory care, pharmaceutical expenditure). A univariate descriptive analysis was performed. We constructed a logistic regression model with a 95% confidence level and analyzed sensitivity, specificity, positive predictive values (PPV), and the area under the ROC curve (AUC).ResultsIndividuals incurring costs >P95 accumulated 44% of total healthcare costs and were concentrated in ACRG3 (aggregated CRG level 3) categories related to multiple chronic diseases. All variables were statistically significant except for sex. The model had a sensitivity of 48.4% (CI: 46.9%-49.8%), specificity of 97.2% (CI: 97.0%-97.3%), PPV of 46.5% (CI: 45.0%-47.9%), and an AUC of 0.897 (CI: 0.892 to 0.902).ConclusionsHigh consumption of healthcare resources is associated with complex chronic morbidity. A model based on age, morbidity, and prior utilization is able to predict high-cost risk and identify a target population requiring proactive care

Liposome formation with wool lipid extracts rich in ceramides

Internal wool lipids (IWLs) are rich in cholesterol, free fatty acids, cholesteryl sulfate, and, mainly, ceramides. The repairing effect of these lipids structured as liposomes was demonstrated by reinforcing the skin-barrier integrity and increasing the water-holding capacity when applied onto the skin. This work was focused on the formation of liposomes with IWLs rich in ceramides, obtained at pilot plant level with organic solvent extraction by using methanol and acetone. The lipid composition of the two extracts was quantitatively analyzed. IWL extracts containing different amounts of sterol sulfate were used to form liposomes at physiologic pH. Vesicle size distribution, polydispersity index, and zeta potential of all liposomes were determined to characterize them and to study their stability. The results obtained showed that IWL extract composition, which was different depending on the extraction methodologies used, greatly influences the characteristics of the liposomes formed. Vesicular size and polydispersity index liposomes were smaller when the extract composition contained a higher proportion of either free fatty acids or sterol sulfate. Moreover, liposome stability was improved when some amount of sterol sulfate was added to the composition of methanol and acetone extracts. This natural mixture with keratinaceous origin could have a special interest for cosmetic or dermopharmaceutical companies.We acknowledge Mr. G. von Knorring for his expert technical assistance. We are also indebted to the DGICYT Program (PPQ 2002-94136-C02-01 and C02-02) for financial support

Prevalence of rheumatic diseases in Baix Empordà

Background: In Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Emporda according to healthcare coding records.Materials and methods: Observational, descriptive and cross-sectional study carried out on the popula-tion attended from 2016 to 2017 in SIBBE (Serveis de Salut Integrats del Baix Emporda), an organizational service that includes all the healthcare facilities in the Baix Emporda area with a unique information sys-tem. Patients >= 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthri-tis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: .with rheumatic disease,.p.ossible rheumatic diseaseand .without rheumatic disease..Results: In total, 71,785 patients were distributed as: 36.2% with rheumatic disease (n = 25,990); 6.1% with possible rheumatic disease (n = 4406) and 57.7% without rheumatic disease (n = 41,389). The group .with rheumatic diseases.howed a predominance of women (59.7% vs. 44.9%) and older age (59.1 +/- 17.7 vs. 45.1 +/- 16.2; p < .001) compared to the group .without rheumatic disease.. The presence of rheumatic disease increased progressively with age, being maximum in the group between 55-75 years.Conclusions: 36.2% of our population has some type of rheumatic disease. The estimated prevalence of some rheumatic diseases in the Baix Emporda population is partially consistent with that estimated by the EPISER 2016 study. Rheumatic disease affects women in a greater proportion and is more frequent in patients over 45 years of age

Asymptotic Expansions for Stationary Distributions of Perturbed Semi-Markov Processes

New algorithms for computing of asymptotic expansions for stationary distributions of nonlinearly perturbed semi-Markov processes are presented. The algorithms are based on special techniques of sequential phase space reduction, which can be applied to processes with asymptotically coupled and uncoupled finite phase spaces.Comment: 83 page

Enzymatic Synthesis of Phloretin alpha-Glucosides Using a Sucrose Phosphorylase Mutant and its Effect on Solubility, Antioxidant Properties and Skin Absorption

Glycosylation of polyphenols may increase their aqueous solubility, stability, bioavailability and pharmacological activity. Herein, we used a mutant of sucrose phosphorylase from Thermoanaerobacterium thermosaccharolyticum engineered to accept large polyphenols (variant TtSPP_R134A) to produce phloretin glucosides. The reaction was performed using 10% (v/v) acetone as cosolvent. The selective formation of a monoglucoside or a diglucoside (53% and 73% maximum conversion percentage, respectively) can be kinetically controlled. MS and 2D-NMR determined that the monoglucoside was phloretin 4¿-O-¿-D-glucopyranoside and the diglucoside phloretin-4¿-O-[¿-D-glucopyranosyl-(1¿3)-O-¿-D-glucopyranoside], a novel compound. The molecular features that determine the specificity of this enzyme for 4¿-OH phenolic group were analysed by induced-fit docking analysis of each putative derivative, using the crystal structure of TtSPP and changing the mutated residue. The mono- and diglucoside were, respectively, 71- and 1200-fold more soluble in water than phloretin at room temperature. The a-glucosylation decreased the antioxidant capacity of phloretin, measured by DPPH and ABTS assays; however, this loss was moderate and the activity could be recovered upon deglycosylation in vivo. Since phloretin attracts a great interest in dermocosmetic applications, we analyzed the percutaneous absorption of glucosides and the aglycon employing a pig skin model. Although the three compounds were detected in all skin layers (except the fluid receptor), the diglucoside was present mainly on superficial layers