Coste-efectividad del implante percutáneo de válvula aórtica con SAPIEN 3 en pacientes con bajo riesgo de mortalidad quirúrgica en España

España; Prótesis valvular cardiaca; Coste-efectividadSpain; Prosthetic heart valve; Cost-effectiveness analisyEspanya; Pròtesis valvular cardíaca; Cost-efectivitatIntroduction and objectives: Transcatheter aortic valve implantation (TAVI) was first introduced in 2007 as an alternative to open heart surgery to treat patients with severe symptomatic aortic stenosis (sSAS) with various indication expansions since that date. Recently, the PARTNER 3 study (Placement of aortic transcatheter valve) demonstrated clinical benefits with TAVI with the SAPIEN 3 valve vs surgical aortic valve replacement (SAVR) in selected low surgical mortality risk patients. We reviewed data from the PARTNER 3 and economic data from Spain to assess the cost-effectiveness ratio of TAVI vs SAVR in patients with sSAS and low surgical mortality risk. Methods: A 2-stage model was used to estimate direct healthcare costs and health-related quality of life data regarding TAVI with the SAPIEN 3 valve and SAVR. Early adverse events associated with TAVI from the PARTNER 3 were fed into a Markov model that captured longer-term outcomes after TAVI or SAVR. Results: TAVI with SAPIEN 3 improved quality-adjusted life years per patient (+ 1.00) with an increase in costs vs SAVR (€6971 per patient). This meant an incremental cost-effectiveness ratio/quality-adjusted life year of €6952 per patient. The results were robust with TAVI with the SAPIEN 3 valve remaining cost-effective across several sensitivity analyses. Conclusions: TAVI with the SAPIEN 3 valve is cost effective compared to SAVR in patients with sSAS and low surgical mortality risk. These findings can inform policymakers to facilitate policy development in Spain on intervention selection in this patient population.Introducción y objetivos: El implante percutáneo de válvula aórtica (TAVI) se introdujo en 2007 como una alternativa a la cirugía a corazón abierto para tratar a pacientes con estenosis aórtica grave sintomática, y desde entonces han aumentado las indicaciones autorizadas. Recientemente, el Placement of Aortic Transcatheter Valve Study (PARTNER) 3 ha demostrado beneficios clínicos con el TAVI con la válvula SAPIEN 3 frente al reemplazo quirúrgico de válvula aórtica (RVAo) en pacientes seleccionados con bajo riesgo de mortalidad quirúrgica. Utilizando los datos del PARTNER 3 junto con datos económicos de España, se evaluó la relación coste-efectividad del TAVI en comparación con el RVAo en pacientes con estenosis aórtica grave sintomática con bajo riesgo de mortalidad quirúrgica. Métodos: Se utilizó un modelo en dos etapas para estimar los costes directos sanitarios y los datos de calidad de vida relacionados con la salud para TAVI con la válvula SAPIEN 3 y RVAo. Los eventos adversos tempranos relacionados con TAVI del PARTNER 3 se incluyeron en un modelo de Markov, que capturó los resultados a más largo plazo tras TAVI o RVAo. Resultados: El TAVI con SAPIEN 3 mejoró los años de vida ajustados por calidad por paciente (+1,00), con un aumento en el coste frente al RVAo de 6.971 € por paciente. Esto representó una ratio coste-efectividad incremental por año de vida ganado ajustado por calidad de 6.952€ por paciente. Los resultados fueron robustos en los diversos análisis de sensibilidad realizados, en los que el TAVI con SAPIEN 3 se mantiene como una opción coste-efectiva. Conclusiones: El TAVI con SAPIEN 3 es coste-efectivo en comparación con el RVAo en pacientes con estenosis aórtica grave sintomática con bajo riesgo de mortalidad quirúrgica. Estos resultados pueden informar a los decisores políticos en España para facilitar el desarrollo de políticas sobre la selección de opciones terapéuticas en esta población de pacientes. Palabras clave: España. Implante percutáneo de válvula aórtica. Cirugía cardiaca. Prótesis valvular cardiaca. Reemplazo quirúrgico de válvula aórtica. Análisis coste-beneficio. Análisis coste-efectividad. Estenosis aórtica. Bajo riesgo.Edwards Lifesciences SA, Switzerland provided funding for the economic assessment and was involved in the analysis as well as in the drafting of this manuscript

Methods for nurses to measure body composition

Among the methods available for assessing body composition, traditional methods like hydrodensitometry and skin-fold measurements are well known. In this review, we focus on the impedance and interactance methods, which use systems that are usually inexpensive, easily transportable and simple to operate. We also discuss the usefulness of dual energy X-ray absorptiometry, particularly for the measurement of fat distribution. Nurses need to be skilled in the use of the equipment and familiar with the techniques.Entre los métodos disponibles para la determinación de la composición corporal, los tradicionales como la hidrodensitometría y la valoración de pliegues corporales son bien conocidos. En esta revisión nos centramos en los métodos basados en la impedancia y en la interactancia, caracterizados por la utilización de equipos económicos, fáciles de transportar y manejar. También discutimos la utilidad de la absorciometría dual de rayos-X, particularmente para la determinación de la distribución de la grasa corporal. Es importante que el personal de enfermería adquiera competencias en el uso de estos equipamientos y también se familiarice con las técnicas descritas.Entre os métodos disponíveis para a determinação da composição corporal, os tradicionais, como a hidrodensitometria e a avaliação de pregas corporais, são bem conhecidos. Para esta revisão, centrou-se nos métodos baseados na impedância e a interactância, caracterizados pela utilização de equipamentos econômicos, fáceis de transportar e manobrar. Também discutiu-se a utilidade da absorciometria dual de raios X, especialmente para a determinação da distribuição da gordura corporal. É importante que o pessoal de enfermagem adquira conhecimentos sobre o uso desse equipamento, bem como que se familiarize com as técnicas descritas

Recycling Organic Fraction of Municipal Solid Waste: Systematic Literature Review and Bibliometric Analysis of Research Trends

The authors appreciate the support of the research group TEP-968 (Technologies for Circular Economy) of the University of Granada.The organic fraction is usually the predominant fraction in municipal solid waste, so its recycling is a potential alternative to disposal in landfill sites, as well as helping to reach targets included in the European Circular Economy Package. The existing body of knowledge in this research field is very large, so a comprehensive review of the existing scientific literature has been considered of interest to provide researchers and professionals with a detailed understanding of the status quo and predict the dynamic directions of this field. A systematic literature review and bibliometric analysis have been performed to provide objective criteria for evaluating the work carried out by researchers and a macroscopic overview of the existing body of knowledge in this field. The analysis of 452 scientific articles published from 1980 to 2019 has shown that the application of composting technologies is relevant, especially since 2014, when policies aimed at reducing emissions to the atmosphere were increased and focused on the use of this waste fraction to produce biogas. Nevertheless, the scientific field is still evolving to impose a model of a circular economy; in fact, emerging studies are being conducted on the production of biomethane, contributing to the decarbonised energy system.Research group TEP-968 (Technologies for Circular Economy) of the University of Granad

Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: A Euro-CCAD study.

Background and aimsAlthough much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score.MethodsFrom the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CT scanning for CAC scoring.ResultsAmong all patients, male sex (OR = 4.85, p<0.001) and diabetes (OR = 2.36, p<0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p<0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively.ConclusionIn addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes

Héðinsdalsjökull, northern Iceland: geomorphology recording the recent complex evolution of a glacier

The objective of this work is to conduct a detailed mapping of the Héðinsdalsjökull foreland, northern Iceland (65°39′N, 18°55′W). This cirque currently shows a variety of glacial and periglacial landforms derived from a complex deglaciation. Mapping was performed combining traditional hand-drawn and digital mapping. A hand-drawn sketch was georeferenced in ArcMap 10.7.1, supported on an aerial photograph (year 2000). Its vectorization, symbolization and final design were done in the computer-aided design (CAD) software MicroStation Connect. Complementary high-resolution Digital Surface Models were obtained from historical aerial photographs and ground-view field photographs through the application of Structure from Motion (SfM) photogrammetry. To improve the topographic expression of the geomorphological map, a photorealistic 3D view has been generated. The final map highlights the complexity of the foreland and the coexistence existence of a range of different units and landforms. The map will ease future studies on the transformation of receding glaciers.info:eu-repo/semantics/publishedVersio

Relationships between physical activity frequency and self-perceived health, self-reported depression, and depressive symptoms in spanish older adults with diabetes: a cross-sectional study

Diabetes is one of the most prevalent noncommunicable diseases in the world. This disease can affect both physical and mental health in the population. This study analyzed the prevalence of Self-Perceived Health (SPH), self-reported depression, and depressive symptoms in comparison with the Physical Activity Frequency (PAF) reported by Spanish older adults with diabetes. A cross-sectional study was carried out with data from 2799 self-reported diabetic participants, all of whom were residents of Spain, aged 50–79 years, and included in the European Health Surveys carried out in Spain (EHIS) both in 2014 and 2020. The relationships between the variables were analysed with a chi-squared test. A z-test for independent proportions was performed to analyze differences in proportions between the sexes. A multiple binary logistic regression was carried out on the prevalence of depression. Linear regressions were performed on depressive symptoms and SPH. Dependent relationships were found between the SPH, self-reported depression, and depressive symptoms with PAF. Most of the very active participants reported a higher prevalence of self-reported depression. Physical inactivity increased the risk of depression, major depressive symptoms, and negative SPH.info:eu-repo/semantics/publishedVersio