Publications by authors named "Maria Aragon"

36 Publications

The sensitivity of hospital coding to prices: evidence from Indonesia.

Int J Health Econ Manag 2021 Sep 7. Epub 2021 Sep 7.

Centre for Health Economics, University of York, York, UK.

This study examines a newly introduced DRG system in Indonesia. We use secondary data for 2015 and 2017 from Jaminan Kesehatan Nasional (JKN), a patient level dataset for Indonesia created in 2014 to record public and private hospitals' claims to the national health insurance system to investigate whether there is an association between changes in tariffs paid and the severity of inpatient activity recorded in hospitals. We find a consistent small, positive and statistically significant correlation between changes in tariffs and changes in concentration of activity, indicating discretionary but limited coding behaviour by hospitals. The results indicate that reducing price differentials may mitigate discretionary coding, but that the benefits of this are limited and need to be compared to the potential risk of having to rebase all prices upwards.
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http://dx.doi.org/10.1007/s10754-021-09312-7DOI Listing
September 2021

Body mass index and risk of COVID-19 diagnosis, hospitalisation, and death: a cohort study of 2 524 926 Catalans.

J Clin Endocrinol Metab 2021 Jul 23. Epub 2021 Jul 23.

Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.

Context: A comprehensive understanding of the association between body mass index (BMI) and COVID-19 is still lacking.

Objective: To investigate associations between BMI and risk of COVID-19 diagnosis, hospitalisation with COVID-19, and death after a COVID-19 diagnosis or hospitalisation (subsequent death), accounting for potential effect modification by age and sex.

Design: Population-based cohort study.

Setting: Primary care records covering >80% of the Catalan population, linked to region-wide testing, hospital, and mortality records from March to May 2020.

Participants: Adults (≥18 years) with at least one measurement of weight and height.

Main Outcome Measures: Hazard ratios (HR) for each outcome.

Results: We included 2 524 926 participants. After 67 days of follow-up, 57 443 individuals were diagnosed with COVID-19, 10 862 were hospitalised with COVID-19, and 2467 had a subsequent death. BMI was positively associated with being diagnosed and hospitalised with COVID-19. Compared to a BMI of 22kg/m 2, the HR (95%CI) of a BMI of 31kg/m 2 was 1.22 (1.19-1.24) for diagnosis, and 1.88 (1.75-2.03) and 2.01 (1.86-2.18) for hospitalisation without and with a prior outpatient diagnosis, respectively. The association between BMI and subsequent death was J-shaped, with a modestly higher risk of death among individuals with BMIs ≤19kg/m 2 and a more pronounced increasing risk for BMIs ≥40kg/m 2. The increase in risk for COVID-19 outcomes was particularly pronounced among younger patients.

Conclusions: There is a monotonic association between BMI and COVID-19 diagnosis and hospitalisation risks, but a J-shaped one with mortality. More research is needed to unravel the mechanisms underlying these relationships.
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http://dx.doi.org/10.1210/clinem/dgab546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344917PMC
July 2021

Characteristics and Outcomes of Over 300,000 Patients with COVID-19 and History of Cancer in the United States and Spain.

Cancer Epidemiol Biomarkers Prev 2021 10 16;30(10):1884-1894. Epub 2021 Jul 16.

Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, Tennessee.

Background: We described the demographics, cancer subtypes, comorbidities, and outcomes of patients with a history of cancer and coronavirus disease 2019 (COVID-19). Second, we compared patients hospitalized with COVID-19 to patients diagnosed with COVID-19 and patients hospitalized with influenza.

Methods: We conducted a cohort study using eight routinely collected health care databases from Spain and the United States, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer were included: (i) diagnosed with COVID-19, (ii) hospitalized with COVID-19, and (iii) hospitalized with influenza in 2017 to 2018. Patients were followed from index date to 30 days or death. We reported demographics, cancer subtypes, comorbidities, and 30-day outcomes.

Results: We included 366,050 and 119,597 patients diagnosed and hospitalized with COVID-19, respectively. Prostate and breast cancers were the most frequent cancers (range: 5%-18% and 1%-14% in the diagnosed cohort, respectively). Hematologic malignancies were also frequent, with non-Hodgkin's lymphoma being among the five most common cancer subtypes in the diagnosed cohort. Overall, patients were aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 2% to 14% and from 6% to 26% in the diagnosed and hospitalized COVID-19 cohorts, respectively. Patients hospitalized with influenza ( = 67,743) had a similar distribution of cancer subtypes, sex, age, and comorbidities but lower occurrence of adverse events.

Conclusions: Patients with a history of cancer and COVID-19 had multiple comorbidities and a high occurrence of COVID-19-related events. Hematologic malignancies were frequent.

Impact: This study provides epidemiologic characteristics that can inform clinical care and etiologic studies.
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http://dx.doi.org/10.1158/1055-9965.EPI-21-0266DOI Listing
October 2021

Alpha-1 blockers and susceptibility to COVID-19 in benign prostate hyperplasia patients : an international cohort study.

medRxiv 2021 Mar 24. Epub 2021 Mar 24.

Alpha-1 blockers, often used to treat benign prostate hyperplasia (BPH), have been hypothesized to prevent COVID-19 complications by minimising cytokine storms release. We conducted a prevalent-user active-comparator cohort study to assess association between alpha-1 blocker use and risks of three COVID-19 outcomes: diagnosis, hospitalization, and hospitalization requiring intensive services. Our study included 2.6 and 0.46 million users of alpha-1 blockers and of alternative BPH therapy during the period between November 2019 and January 2020, found in electronic health records from Spain (SIDIAP) and the United States (Department of Veterans Affairs, Columbia University Irving Medical Center, IQVIA OpenClaims, Optum DOD, Optum EHR). We estimated hazard ratios using state-of-the-art techniques to minimize potential confounding, including large-scale propensity score matching/stratification and negative control calibration. We found no differential risk for any of COVID-19 outcome, pointing to the need for further research on potential COVID-19 therapies.
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http://dx.doi.org/10.1101/2021.03.18.21253778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010772PMC
March 2021

Implementation of the COVID-19 Vulnerability Index Across an International Network of Health Care Data Sets: Collaborative External Validation Study.

JMIR Med Inform 2021 Apr 5;9(4):e21547. Epub 2021 Apr 5.

Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.

Background: SARS-CoV-2 is straining health care systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate patients who require hospitalization from those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital for treatment of pneumonia or pneumonia proxies, has been developed and proposed as a valuable tool for decision-making during the pandemic. However, the model is at high risk of bias according to the "prediction model risk of bias assessment" criteria, and it has not been externally validated.

Objective: The aim of this study was to externally validate the C-19 index across a range of health care settings to determine how well it broadly predicts hospitalization due to pneumonia in COVID-19 cases.

Methods: We followed the Observational Health Data Sciences and Informatics (OHDSI) framework for external validation to assess the reliability of the C-19 index. We evaluated the model on two different target populations, 41,381 patients who presented with SARS-CoV-2 at an outpatient or emergency department visit and 9,429,285 patients who presented with influenza or related symptoms during an outpatient or emergency department visit, to predict their risk of hospitalization with pneumonia during the following 0-30 days. In total, we validated the model across a network of 14 databases spanning the United States, Europe, Australia, and Asia.

Results: The internal validation performance of the C-19 index had a C statistic of 0.73, and the calibration was not reported by the authors. When we externally validated it by transporting it to SARS-CoV-2 data, the model obtained C statistics of 0.36, 0.53 (0.473-0.584) and 0.56 (0.488-0.636) on Spanish, US, and South Korean data sets, respectively. The calibration was poor, with the model underestimating risk. When validated on 12 data sets containing influenza patients across the OHDSI network, the C statistics ranged between 0.40 and 0.68.

Conclusions: Our results show that the discriminative performance of the C-19 index model is low for influenza cohorts and even worse among patients with COVID-19 in the United States, Spain, and South Korea. These results suggest that C-19 should not be used to aid decision-making during the COVID-19 pandemic. Our findings highlight the importance of performing external validation across a range of settings, especially when a prediction model is being extrapolated to a different population. In the field of prediction, extensive validation is required to create appropriate trust in a model.
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http://dx.doi.org/10.2196/21547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023380PMC
April 2021

The natural history of symptomatic COVID-19 during the first wave in Catalonia.

Nat Commun 2021 02 3;12(1):777. Epub 2021 Feb 3.

Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.

The natural history of coronavirus disease 2019 (COVID-19) has yet to be fully described. Here, we use patient-level data from the Information System for Research in Primary Care (SIDIAP) to summarise COVID-19 outcomes in Catalonia, Spain. We included 5,586,521 individuals from the general population. Of these, 102,002 had an outpatient diagnosis of COVID-19, 16,901 were hospitalised with COVID-19, and 5273 died after either being diagnosed or hospitalised with COVID-19 between 1st March and 6th May 2020. Older age, being male, and having comorbidities were all generally associated with worse outcomes. These findings demonstrate the continued need to protect those at high risk of poor outcomes, particularly older people, from COVID-19 and provide appropriate care for those who develop symptomatic disease. While risks of hospitalisation and death were lower for younger populations, there is a need to limit their role in community transmission.
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http://dx.doi.org/10.1038/s41467-021-21100-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858639PMC
February 2021

Renin-angiotensin system blockers and susceptibility to COVID-19: an international, open science, cohort analysis.

Lancet Digit Health 2021 02 17;3(2):e98-e114. Epub 2020 Dec 17.

Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been postulated to affect susceptibility to COVID-19. Observational studies so far have lacked rigorous ascertainment adjustment and international generalisability. We aimed to determine whether use of ACEIs or ARBs is associated with an increased susceptibility to COVID-19 in patients with hypertension.

Methods: In this international, open science, cohort analysis, we used electronic health records from Spain (Information Systems for Research in Primary Care [SIDIAP]) and the USA (Columbia University Irving Medical Center data warehouse [CUIMC] and Department of Veterans Affairs Observational Medical Outcomes Partnership [VA-OMOP]) to identify patients aged 18 years or older with at least one prescription for ACEIs and ARBs (target cohort) or calcium channel blockers (CCBs) and thiazide or thiazide-like diuretics (THZs; comparator cohort) between Nov 1, 2019, and Jan 31, 2020. Users were defined separately as receiving either monotherapy with these four drug classes, or monotherapy or combination therapy (combination use) with other antihypertensive medications. We assessed four outcomes: COVID-19 diagnosis; hospital admission with COVID-19; hospital admission with pneumonia; and hospital admission with pneumonia, acute respiratory distress syndrome, acute kidney injury, or sepsis. We built large-scale propensity score methods derived through a data-driven approach and negative control experiments across ten pairwise comparisons, with results meta-analysed to generate 1280 study effects. For each study effect, we did negative control outcome experiments using a possible 123 controls identified through a data-rich algorithm. This process used a set of predefined baseline patient characteristics to provide the most accurate prediction of treatment and balance among patient cohorts across characteristics. The study is registered with the EU Post-Authorisation Studies register, EUPAS35296.

Findings: Among 1 355 349 antihypertensive users (363 785 ACEI or ARB monotherapy users, 248 915 CCB or THZ monotherapy users, 711 799 ACEI or ARB combination users, and 473 076 CCB or THZ combination users) included in analyses, no association was observed between COVID-19 diagnosis and exposure to ACEI or ARB monotherapy versus CCB or THZ monotherapy (calibrated hazard ratio [HR] 0·98, 95% CI 0·84-1·14) or combination use exposure (1·01, 0·90-1·15). ACEIs alone similarly showed no relative risk difference when compared with CCB or THZ monotherapy (HR 0·91, 95% CI 0·68-1·21; with heterogeneity of >40%) or combination use (0·95, 0·83-1·07). Directly comparing ACEIs with ARBs demonstrated a moderately lower risk with ACEIs, which was significant with combination use (HR 0·88, 95% CI 0·79-0·99) and non-significant for monotherapy (0·85, 0·69-1·05). We observed no significant difference between drug classes for risk of hospital admission with COVID-19, hospital admission with pneumonia, or hospital admission with pneumonia, acute respiratory distress syndrome, acute kidney injury, or sepsis across all comparisons.

Interpretation: No clinically significant increased risk of COVID-19 diagnosis or hospital admission-related outcomes associated with ACEI or ARB use was observed, suggesting users should not discontinue or change their treatment to decrease their risk of COVID-19.

Funding: Wellcome Trust, UK National Institute for Health Research, US National Institutes of Health, US Department of Veterans Affairs, Janssen Research & Development, IQVIA, South Korean Ministry of Health and Welfare Republic, Australian National Health and Medical Research Council, and European Health Data and Evidence Network.
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http://dx.doi.org/10.1016/S2589-7500(20)30289-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834915PMC
February 2021

Filling the gaps in the characterization of the clinical management of COVID-19: 30-day hospital admission and fatality rates in a cohort of 118 150 cases diagnosed in outpatient settings in Spain.

Int J Epidemiol 2021 01;49(6):1930-1939

Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.

Background: Currently, there is a missing link in the natural history of COVID-19, from first (usually milder) symptoms to hospitalization and/or death. To fill in this gap, we characterized COVID-19 patients at the time at which they were diagnosed in outpatient settings and estimated 30-day hospital admission and fatality rates.

Methods: This was a population-based cohort study.

Data were obtained from Information System for Research in Primary Care (SIDIAP)-a primary-care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) tests and hospital emergency, inpatient and mortality registers. We included all patients in the database who were ≥15 years old and diagnosed with COVID-19 in outpatient settings between 15 March and 24 April 2020 (10 April for outcome studies). Baseline characteristics included socio-demographics, co-morbidity and previous drug use at the time of diagnosis, and polymerase chain reaction (PCR) testing and results.

Study outcomes included 30-day hospitalization for COVID-19 and all-cause fatality.

Results: We identified 118 150 and 95 467 COVID-19 patients for characterization and outcome studies, respectively. Most were women (58.7%) and young-to-middle-aged (e.g. 21.1% were 45-54 years old). Of the 44 575 who were tested with PCR, 32 723 (73.4%) tested positive. In the month after diagnosis, 14.8% (14.6-15.0) were hospitalized, with a greater proportion of men and older people, peaking at age 75-84 years. Thirty-day fatality was 3.5% (95% confidence interval: 3.4% to 3.6%), higher in men, increasing with age and highest in those residing in nursing homes [24.5% (23.4% to 25.6%)].

Conclusion: COVID-19 infections were widespread in the community, including all age-sex strata. However, severe forms of the disease clustered in older men and nursing-home residents. Although initially managed in outpatient settings, 15% of cases required hospitalization and 4% died within a month of first symptoms. These data are instrumental for designing deconfinement strategies and will inform healthcare planning and hospital-bed allocation in current and future COVID-19 outbreaks.
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http://dx.doi.org/10.1093/ije/dyaa190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665572PMC
January 2021

Deep phenotyping of 34,128 adult patients hospitalised with COVID-19 in an international network study.

Nat Commun 2020 10 6;11(1):5009. Epub 2020 Oct 6.

Clinical Pharmacology Unit, Zealand University Hospital, Køge, Denmark.

Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.
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http://dx.doi.org/10.1038/s41467-020-18849-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538555PMC
October 2020

Trends in and drivers of healthcare expenditure in the English NHS: a retrospective analysis.

Health Econ Rev 2020 Jun 30;10(1):20. Epub 2020 Jun 30.

Centre for Health Economics, Alcuin A Block, University of York, York, YO10 5DD, UK.

Background: In England, rises in healthcare expenditure consistently outpace growth in both GDP and total public expenditure. To ensure the National Health Service (NHS) remains financially sustainable, relevant data on healthcare expenditure are needed to inform decisions about which services should be delivered, by whom and in which settings.

Methods: We analyse routine data on NHS expenditure in England over 9 years (2008/09 to 2016/17). To quantify the relative contribution of the different care settings to overall healthcare expenditure, we analyse trends in 14 healthcare settings under three broad categories: Hospital Based Care (HBC), Diagnostics and Therapeutics (D&T) and Community Care (CC). We exclude primary care and community mental health services settings due to a lack of consistent data. We employ a set of indices to aggregate diverse outputs and to disentangle growth in healthcare expenditure that is driven by activity from that due to cost pressures. We identify potential drivers of the observed trends from published studies.

Results: Over the 9-year study period, combined NHS expenditure on HBC, D&T and CC rose by 50.2%. Expenditure on HBC rose by 54.1%, corresponding to increases in both activity (29.2%) and cost (15.7%). Rises in expenditure in inpatient (38.5%), outpatient (57.2%), and A&E (59.5%) settings were driven predominately by higher activity. Emergency admissions rose for both short-stay (45.6%) and long-stay cases (26.2%). There was a switch away from inpatient elective care (which fell by 5.1%) and towards day case care (34.8% rise), likely reflecting financial incentives for same-day discharges. Growth in expenditure on D&T (155.2%) was driven by rises in the volume of high cost drugs (270.5%) and chemotherapy (110.2%). Community prescribing grew by 45.2%, with costs falling by 24.4%. Evidence on the relationship between new technologies and healthcare expenditure is mixed, but the fall in drug costs could reflect low generic prices, and the use of health technology assessment or commercial arrangements to inform pricing of new medicines.

Conclusions: Aggregate trends in HCE mask enormous variation across healthcare settings. Understanding variation in activity and cost across settings is an important initial step towards ensuring the long-term sustainability of the NHS.
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http://dx.doi.org/10.1186/s13561-020-00278-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325682PMC
June 2020

Renin-angiotensin system blockers and susceptibility to COVID-19: a multinational open science cohort study.

medRxiv 2020 Jun 12. Epub 2020 Jun 12.

Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK.

Introduction: Angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) could influence infection risk of coronavirus disease (COVID-19). Observational studies to date lack pre-specification, transparency, rigorous ascertainment adjustment and international generalizability, with contradictory results.

Methods: Using electronic health records from Spain (SIDIAP) and the United States (Columbia University Irving Medical Center and Department of Veterans Affairs), we conducted a systematic cohort study with prevalent ACE, ARB, calcium channel blocker (CCB) and thiazide diuretic (THZ) use to determine relative risk of COVID-19 diagnosis and related hospitalization outcomes. The study addressed confounding through large-scale propensity score adjustment and negative control experiments.

Results: Following over 1.1 million antihypertensive users identified between November 2019 and January 2020, we observed no significant difference in relative COVID-19 diagnosis risk comparing ACE/ARB vs CCB/THZ monotherapy (hazard ratio: 0.98; 95% CI 0.84 - 1.14), nor any difference for mono/combination use (1.01; 0.90 - 1.15). ACE alone and ARB alone similarly showed no relative risk difference when compared to CCB/THZ monotherapy or mono/combination use. Directly comparing ACE vs. ARB demonstrated a moderately lower risk with ACE, non-significant for monotherapy (0.85; 0.69 - 1.05) and marginally significant for mono/combination users (0.88; 0.79 - 0.99). We observed, however, no significant difference between drug- classes for COVID-19 hospitalization or pneumonia risk across all comparisons.

Conclusion: There is no clinically significant increased risk of COVID-19 diagnosis or hospitalization with ACE or ARB use. Users should not discontinue or change their treatment to avoid COVID-19.
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http://dx.doi.org/10.1101/2020.06.11.20125849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310640PMC
June 2020

Deep phenotyping of 34,128 patients hospitalised with COVID-19 and a comparison with 81,596 influenza patients in America, Europe and Asia: an international network study.

medRxiv 2020 Jun 28. Epub 2020 Jun 28.

Background In this study we phenotyped individuals hospitalised with coronavirus disease 2019 (COVID-19) in depth, summarising entire medical histories, including medications, as captured in routinely collected data drawn from databases across three continents. We then compared individuals hospitalised with COVID-19 to those previously hospitalised with influenza. Methods We report demographics, previously recorded conditions and medication use of patients hospitalised with COVID-19 in the US (Columbia University Irving Medical Center [CUIMC], Premier Healthcare Database [PHD], UCHealth System Health Data Compass Database [UC HDC], and the Department of Veterans Affairs [VA OMOP]), in South Korea (Health Insurance Review & Assessment [HIRA]), and Spain (The Information System for Research in Primary Care [SIDIAP] and HM Hospitales [HM]). These patients were then compared with patients hospitalised with influenza in 2014-19. Results 34,128 (US: 8,362, South Korea: 7,341, Spain: 18,425) individuals hospitalised with COVID-19 were included. Between 4,811 (HM) and 11,643 (CUIMC) unique aggregate characteristics were extracted per patient, with all summarised in an accompanying interactive website (http://evidence.ohdsi.org/Covid19CharacterizationHospitalization/). Patients were majority male in the US (CUIMC: 52%, PHD: 52%, UC HDC: 54%, VA OMOP: 94%,) and Spain (SIDIAP: 54%, HM: 60%), but were predominantly female in South Korea (HIRA: 60%). Age profiles varied across data sources. Prevalence of asthma ranged from 4% to 15%, diabetes from 13% to 43%, and hypertensive disorder from 24% to 70% across data sources. Between 14% and 33% were taking drugs acting on the renin-angiotensin system in the 30 days prior to hospitalisation. Compared to 81,596 individuals hospitalised with influenza in 2014-19, patients admitted with COVID-19 were more typically male, younger, and healthier, with fewer comorbidities and lower medication use. Conclusions We provide a detailed characterisation of patients hospitalised with COVID-19. Protecting groups known to be vulnerable to influenza is a useful starting point to minimize the number of hospital admissions needed for COVID-19. However, such strategies will also likely need to be broadened so as to reflect the particular characteristics of individuals hospitalised with COVID-19.
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http://dx.doi.org/10.1101/2020.04.22.20074336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239064PMC
June 2020

Clinical effectiveness of 13-valent and 23-valent pneumococcal vaccination in middle-aged and older adults: The EPIVAC cohort study, 2015-2016.

Vaccine 2020 01 20;38(5):1170-1180. Epub 2019 Nov 20.

Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain.

Background: Clinical benefits using the 23-valent pneumococcal polysaccharide vaccine (PPsV23) or the 13-valent pneumococcal conjugate vaccine (PCV13) in adults are controversial. This study investigated clinical effectiveness for both PPsV23 and PCV13 in preventing pneumonia among middle-aged and older adults.

Methods: Population-based cohort study involving 2,025,730 persons ≥50 years in Catalonia, Spain, who were prospectively followed between 01/01/2015 and 31/12/2016. Primary outcomes were hospitalisation from pneumococcal or all-cause pneumonia and main explanatory variable was PCV13/PPsV23 vaccination status. Multivariable Cox regression models were used to estimate vaccination effectiveness adjusted for age and baseline-risk conditions.

Results: Cohort members were followed for 3,897,151 person-years (17,496 PCV13 vaccinated and 1,551,502 PPsV23 vaccinated), observing 3259 pneumococcal pneumonias (63 in PCV13 vaccinated, 2243 in PPsV23 vaccinated) and 24,079 all-cause pneumonias (566 in PCV13 vaccinated, 17,508 in PPsV23 vaccinated). Global incidence rates (per 100,000 person-years) were 83.6 for pneumococcal pneumonia (360.1 in PCV13 vaccinated, 144.6 in PPsV23 vaccinated) and 617.9 for all-cause pneumonia (3235.0 in PCV13 vaccinated, 1128.5 in PPsV23 vaccinated). In the multivariable analyses, the PCV13 appeared significantly associated with an increased risk of pneumococcal pneumonia (hazard ratio [HR]: 1.52; 95% confidence interval [CI]: 1.17-1.97; p = 0.002) and all-cause pneumonia (HR: 1.76; 95% CI: 1.61-1.92; p < 0.001) whereas the PPsV23 did not alter the risk of pneumococcal pneumonia (HR: 1.08; 95% CI: 0.98-1.19; p = 0.132) and slightly increased the risk of all-cause pneumonia (HR: 1.17; 95% CI: 1.13-1.21; p < 0.001). In stratified analyses focused on specific target population subgroups (i.e., elderly people, at-risk and high-risk individuals), protective effects of vaccination did not emerge either.

Conclusion: Data does not support clinical benefits from pneumococcal vaccination (nor PCV13 neither PPsV23) against pneumonia among Catalonian adults in the current era of universal PCV's childhood immunisation.
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http://dx.doi.org/10.1016/j.vaccine.2019.11.012DOI Listing
January 2020

Statin use and the risk of colorectal cancer in a population-based electronic health records study.

Sci Rep 2019 09 19;9(1):13560. Epub 2019 Sep 19.

Programa d'Analítica de Dades en Oncologia, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain.

There is extensive debate regarding the protective effect of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) on colorectal cancer (CRC). We aimed to assess the association between CRC risk and exposure to statins using a large cohort with prescription data. We carried out a case-control study in Catalonia using the System for Development of Primary Care Research (SIDIAP) database that recorded patient diseases history and linked data on reimbursed medication. The study included 25 811 cases with an incident diagnosis of CRC between 2010 and 2015 and 129 117 frequency-matched controls. Subjects were classified as exposed to statins if they had ever been dispensed statins. Analysis considering mean daily defined dose, cumulative duration and type of statin were performed. Overall, 66 372 subjects (43%) were exposed to statins. There was no significant decrease of CRC risk associated to any statin exposure (OR = 0.98; 95% CI: 0.95-1.01). Only in the stratified analysis by location a reduction of risk for rectal cancer was observed associated to statin exposure (OR = 0.87; 95% CI: 0.81-0.92). This study does not support an overall protective effect of statins in CRC, but a protective association with rectal cancer merits further research.
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http://dx.doi.org/10.1038/s41598-019-49877-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753123PMC
September 2019

Pneumococcal vaccination coverages by age, sex and specific underlying risk conditions among middle-aged and older adults in Catalonia, Spain, 2017.

Euro Surveill 2019 Jul;24(29)

Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain.

BackgroundRecent published data on pneumococcal vaccination coverages among adults are scarce.AimTo update on pneumococcal vaccination uptakes among middle-aged and older adults in Catalonia.MethodsWe conducted a population-based retrospective observational study including 2,057,656 individuals ≥ 50 years old assigned to primary care centres managed by the Catalonian Health Institute on 1 January 2017 (date of data collection). An institutional clinical research database (SIDIAP) was used to classify persons by vaccination status for both 23-valent pneumococcal polysaccharide (PPsV23) and 13-valent pneumococcal conjugate (PCV13) vaccines, as well as to identify underlying risk conditions.ResultsOverall, 796,879 individuals (38.7%) had received PPsV23 and 13,607 (0.7%) PCV13. PPsV23 coverage increased with age: 9.2% (95,409/1,039,872) in 50-64 year olds, 63.1% (434,408/688,786) in 65-79 year olds and 81.2% (267,062/328,998) in ≥ 80 year olds (p < 0.001). PCV13 coverage also increased with age, although percentages were smaller in all age strata (4,250/1,039,872: 0.4%; 6,005/688,786: 0.9% and 3,352/328,998: 1.0%, respectively; p < 0.001). By sex, no substantial coverage differences were observed. Considering publically funded target groups for PPsV23 vaccination in Catalonia (i.e. < 65 year olds with at least one risk factor, plus all adults aged ≥ 65 years), PPsV23 coverage reached 52.8% (771,722/1,462,261) in our study population. Regarding PCV13 publicly funded targets (i.e. all-age immunocompromised persons), PCV13 coverage was 3.3% (6,617/202,348). By risk conditions, the highest PPsV23 coverage appeared in congestive heart failure (51,909/63,596; 81.6%), chronic renal disease (122,791/158,726; 77.4%) and chronic bronchitis/emphysema (96,453/132,306; 72.9%). Maximum PCV13 coverage appeared in cirrhosis (294/7,957; 3.7%), chronic renal disease (5,633/158,726; 3.5%) and chronic bronchitis/emphysema (2,859/132,306; 2.2%).ConclusionPneumococcal vaccination coverages in Catalonian adults are suboptimal, especially for PCV13.
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http://dx.doi.org/10.2807/1560-7917.ES.2019.24.29.1800446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6652112PMC
July 2019

Prospective payment systems and discretionary coding-Evidence from English mental health providers.

Health Econ 2019 03 27;28(3):387-402. Epub 2018 Dec 27.

Department of Health Sciences, University of York, York, UK.

Reimbursement of English mental health hospitals is moving away from block contracts and towards activity and outcome-based payments. Under the new model, patients are categorised into 20 groups with similar levels of need, called clusters, to which prices may be assigned prospectively. Clinicians, who make clustering decisions, have substantial discretion and can, in principle, directly influence the level of reimbursement the hospital receives. This may create incentives for upcoding. Clinicians are supported in their allocation decision by a clinical clustering algorithm, the Mental Health Clustering Tool, which provides an external reference against which clustering behaviour can be benchmarked. The aims of this study are to investigate the degree of mismatch between predicted and actual clustering and to test whether there are systematic differences amongst providers in their clustering behaviour. We use administrative data for all mental health patients in England who were clustered for the first time during the financial year 2014/15 and estimate multinomial multilevel models of over, under, or matching clustering. Results suggest that hospitals vary systematically in their probability of mismatch but this variation is not consistently associated with observed hospital characteristics.
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http://dx.doi.org/10.1002/hec.3851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491985PMC
March 2019

Funding approaches for mental health services: Is there still a role for clustering?

BJPsych Adv 2018 Nov 10;24(6):412-421. Epub 2018 Aug 10.

Research Fellow, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

Funding for mental health services in England faces many challenges including operating under financial constraints where it is not easy to demonstrate the link between activity and funding. Mental health services need to operate alongside and collaborate with acute hospital services where there is a well-established system for paying for . The funding landscape is shifting at a rapid pace and we outline the distinctions between the three main options - block contracts, episodic payment and capitation. Classification of treatment episodes via clustering presents an opportunity to demonstrate activity and reward it within these payment approaches. We have been engaged in research to assess how well the clustering system is performing against a number of fundamental criteria. Clusters need to be reliably recorded, to correspond to health needs, and to treatments that require roughly similar resources. We find that according to these criteria, clusters are falling short of providing a sound basis for measuring and financing services. Yet, we argue, it is the best available option and is essential for a more transparent funding approach for mental health to demonstrate its claim on resources, and that, as such, clusters should be a starting point for evolving a better funding system.
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http://dx.doi.org/10.1192/bja.2018.34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217930PMC
November 2018

Evaluating clinical effectiveness of 13-valent pneumococcal conjugate vaccination against pneumonia among middle-aged and older adults in Catalonia: results from the EPIVAC cohort study.

BMC Infect Dis 2018 04 27;18(1):196. Epub 2018 Apr 27.

Department of Laboratory and Microbiology, Hospital Sant Joan de Reus, Tarragona, Spain.

Background: Benefits using the 13-valent pneumococcal conjugate vaccine (PCV13) in adults are controversial. This study investigated clinical effectiveness of PCV13 vaccination in preventing hospitalisation from pneumonia among middle-aged and older adults.

Methods: Population-based cohort study involving 2,025,730 individuals ≥50 years in Catalonia, Spain, who were prospectively followed from 01/01/2015 to 31/12/2015. Primary outcomes were hospitalisation for pneumococcal or all-cause pneumonia and death from any cause. Cox regression models were used to evaluate the association between PCV13 vaccination and the risk of each outcome, adjusting for age, sex and major comorbidities/underlying risk conditions.

Results: Cohort members were observed for a total of 1,990,701 person-years, of which 6912 person-years were PCV13 vaccinated. Overall, crude incidence rates (per 100,000 person-years) were 82.8 (95% confidence interval [CI]: 77.7-88.1) for pneumococcal pneumonia, 637.9 (95% CI: 599.0-678.7) for all-cause pneumonia and 2367.2 (95% CI: 2222.8-2518.7) for all-cause death. After multivariable adjustments we found that the PCV13 vaccination did not alter significantly the risk of pneumococcal pneumonia (multivariable-adjusted hazard ratio [mHR]: 1.17; 95% CI: 0.75-1.83; p = 0.493) and all-cause death (mHR: 1.07; 95% CI: 0.97-1.18; p = 0.190), although it remained significantly associated with an increased risk of all-cause pneumonia (mHR: 1.69; 95% CI: 1.48-1.94; p < 0.001). In stratified analyses focused on middle-aged or elderly persons and immunocompromised or immunocompetent subjects, PCV13 vaccination did not appear effective either.

Conclusion: Our data does not support clinical benefits of PCV13 vaccination against pneumonia among adults in Catalonia. It must be closely monitored in future studies involving more vaccinated person-time at-observation.
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http://dx.doi.org/10.1186/s12879-018-3096-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921259PMC
April 2018

How do time trends in inhospital mortality compare? A retrospective study of England and Scotland over 17 years using administrative data.

BMJ Open 2018 02 21;8(2):e017195. Epub 2018 Feb 21.

Centre for Health Economics, University of York, York, UK.

Objectives: To examine the trends in inhospital mortality for England and Scotland over a 17-year period to determine whether and if so to what extent the time trends differ after controlling for differences in the patients treated.

Design: Analysis of retrospective administrative hospital data using descriptive aggregate statistics of trends in inhospital mortality and estimates of a logistic regression model of individual patient-level inhospital mortality accounting for patient characteristics, case-mix, and country-specific and year-specific intercepts.

Setting: Secondary care across all hospitals in England and Scotland from 1997 to 2013.

Population: Over 190 million inpatient admissions, either electively or emergency, in England or Scotland from 1997 to 2013.

Data: Hospital Episode Statistics for England and the Scottish Morbidity Record 01 for Scotland.

Main Outcome Measures: Separately for two admission pathways (elective and emergency), we examine aggregate time trends of the proportion of patients who die in hospital and a binary variable indicating whether an individual patient died in hospital or survived, and how that indicator is influenced by the patient's characteristics, the year and the country (England or Scotland) in which they were admitted.

Results: Inhospital mortality has declined in both countries over the period studied, for both elective and emergency admissions, but has declined more in England than Scotland. The difference in trend reduction is greater for elective admissions. These differences persist after controlling for patient characteristics and case-mix.

Conclusions: Comparing data at country level suggests questions about the roles performed by or functioning of their healthcare systems. We found substantial differences between Scotland and England in regard to the trend reductions in inhospital mortality. Hospital resources are therefore being deployed increasingly differently over time in these two countries for reasons that have yet to be explained.
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http://dx.doi.org/10.1136/bmjopen-2017-017195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855481PMC
February 2018

Analgesic Use and Risk for Acute Coronary Events in Patients With Osteoarthritis: A Population-based, Nested Case-control Study.

Clin Ther 2018 02 3;40(2):270-283. Epub 2018 Feb 3.

Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut d'Investigació d'Atenció Primària Jordi Gol, Barcelona, Spain. Electronic address:

Purpose: Recent controversies on the safety profiles of opioids and paracetamol (acetaminophen) have led to changes in clinical guidance on osteoarthritis (OA) management. We studied the existing association between the use of different OA drug therapies and the risk for acute coronary events.

Methods: A cohort of patients with clinically diagnosed OA (according to ICD-10 codes) was identified in the SIDIAP database. Within the cohort, cases with incident acute coronary events (acute myocardial infarction or unstable angina) between 2008 and 2012 were identified using ICD-10 codes and data from hospital admission. Controls were matched 3:1 to acute coronary event-free patients matched by sex, age (±5 years), geographic area, and years since OA diagnosis (±2 years). Linked pharmacy dispensation data were used for assessing exposure to drug therapies. Multivariate conditional logistic regression models were fitted to estimate adjusted odds ratios of acute coronary events.

Findings: Totals of 5663 cases and 16,989 controls were studied. Previous morbidity and cardiovascular risk were higher in cases than in controls, with no significant differences in type or number of joints with OA. Multivariate adjusted analyses showed increased risks (odds ratio; 95% CI) related to the use of diclofenac (1.16; 1.06-1.27), naproxen (1.25; 1.04-1.48), and opioid analgesics (1.13; 1.03-1.24). No significant associations were observed with cyclooxygenase-2 selective NSAIDs, topical NSAIDs, glucosamine, chondroitin sulfate, paracetamol, or metamizole.

Implications: In patients with clinically diagnosed OA, the use of nonselective NSAIDs or opioid analgesics is associated with an increased risk for acute coronary events. These risks should be considered when selecting treatments of OA in patients at high cardiovascular risk.
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http://dx.doi.org/10.1016/j.clinthera.2017.12.011DOI Listing
February 2018

[Antipneumococcal vaccination in Catalonian adults: Vaccine coverages and adequacy to distinct guideline recommendations].

Aten Primaria 2018 11 17;50(9):553-559. Epub 2018 Jan 17.

Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP), Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, España.

Objectives: To know antipneumococcal vaccination coverages among Catalonian adults and evaluate the adequacy of vaccine use according to 3 distinct current vaccination guidelines.

Design: Population-based cross-sectional study.

Setting: Primary Health Care. Catalonia, Spain.

Participants: A total of 2,033,465 individuals≥50 years-old registered in the Catalonian Health Institute.

Main Measurements: Vaccination status for the 23-valent pneumococcal polysaccharide vaccine (PPV23) and/or the 13-valent pneumococcal conjugate vaccine (PCV13) was revised at 1/01/2015. Adequacy of vaccination status was determined according to 3 distinct vaccination recommendation guidelines: Spanish Ministry of Health (basically coinciding with Catalonian Health Institute's recommendations), Spanish Society of Family Physicians (semFYC) and Centers for Disease Control and Prevention (CDC).

Results: Overall, 789,098 (38.8%) persons had received PPV23 and 5,031 (0.2%) had received PCV13. PPV23 coverage largely increased with increasing age (4.8% in 50-59 years, 35.5% in 60-69 years, 71.9% in 70-79 years and 79.5% in≥80 years; P<.001), whereas PCV13 coverage was very small in all age groups. Considering the 3 analysed vaccine guidelines a 46.1% of the overall study population were adequacy vaccinated according to Spanish Ministry's recommendations, 19.3% according to semFYC's recommendations and 4.6% according to CDC's recommendations.

Conclusion: PPV23 coverage among Catalonian adults may be considered as intermediate, but PCV13 coverage is very small. The institutional recommendations (Spanish Ministry) are more followed than corporative (semFYC) or less local (CDC) recommendations in clinical practice.
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http://dx.doi.org/10.1016/j.aprim.2017.05.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837116PMC
November 2018

Insight into the Electrochemical Sodium Insertion of Vanadium Superstoichiometric NASICON Phosphate.

Inorg Chem 2017 Oct 13;56(19):11845-11853. Epub 2017 Sep 13.

Departamento de Química Inorgánica e Ingeniería Química, Instituto Universitario de Investigación en Química Fina y Nanoquímica, Universidad de Córdoba , Campus de Rabanales, Edificio Marie Curie, E-14071 Córdoba, Spain.

A slight deviation of the stoichiometry has been introduced in NaV(PO) (0 ≤ x ≤ 0.1) samples to determine the effect on the structural and electrochemical behavior as a positive electrode in sodium-ion batteries. X-ray diffraction and XPS results provide evidence for the flexibility of the NASICON framework to allow a limited vanadium superstoichiometry. In particular, the NaV(PO) formula reveals the best electrochemical performance at the highest rate (40C) and capacity retention upon long cycling. It is attributed to the excellent kinetic response and interphase chemical stability upon cycling. The electrochemical performance of this vanadium superstoichiometric sample in a full sodium-ion cell is also described.
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http://dx.doi.org/10.1021/acs.inorgchem.7b01846DOI Listing
October 2017

End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported.

Health Aff (Millwood) 2017 07;36(7):1211-1217

Elaine Kelly is a senior research economist at the Institute for Fiscal Studies, in London.

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.
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http://dx.doi.org/10.1377/hlthaff.2017.0174DOI Listing
July 2017

Induced Rate Performance Enhancement in Off-Stoichiometric Na V (PO ) with Potential Applicability as the Cathode for Sodium-Ion Batteries.

Chemistry 2017 May 8;23(30):7345-7352. Epub 2017 May 8.

Departmento de Química Inorgánica e Ingeniería Química, Instituto Universitario de Química Fina y Nanoquímica, University of Córdoba, Marie Curie Building. Campus de Rabanales, 14071, Córdoba, Spain.

Off-stoichiometric Na V (PO ) samples have been prepared by a sol-gel route. X-ray diffraction and XPS revealed the flexibility of the NASICON framework to accommodate these deviations of the stoichiometry; at least for low x values. X-ray photoelectron spectra evidenced the presence of Na P O impurities. The synergic combination of the structural deviations and the presence of Na P O impurities induce a significant improvement of the electrochemical performance and cycling stability at high rates, as compared to the stoichiometric Na V (PO ) sample. The fast kinetic response provided by the induced off-stoichiometry involves a decrease of the cell resistance.
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http://dx.doi.org/10.1002/chem.201700716DOI Listing
May 2017

Improved Surface Stability of [email protected](PO) Prepared by Ultrasonic Method as Cathode for Sodium-Ion Batteries.

ACS Appl Mater Interfaces 2017 Jan 4;9(2):1471-1478. Epub 2017 Jan 4.

Inorganic Chemistry, University of Córdoba , Marie Curie Building Campus de Rabanales, 14071 Córdoba, Spain.

Coated [email protected](PO) samples containing 1.5% or 3.5% wt. of MO (AlO, MgO or ZnO) have been synthesized by a two-step method including first a citric based sol-gel method for preparing the active material and second an ultrasonic stirring technique to deposit MO. The presence of the metal oxides properly coating the surface of the active material is evidenced by XPS and electron microscopy. Galvanostatic cycling of sodium half-cells reveals a significant capacity enhancement for samples coated with 1.5% of metal oxides and an exceptional cycling stability as evidenced by Coulombic efficiencies as high as 95.9% for [email protected] NaV(PO). It is correlated to their low surface layer and charge transfer resistance values. The formation of metal fluorides that remove traces of corrosive HF from the electrolyte is checked by XPS spectroscopy. The feasibility of sodium-ion batteries assembled with [email protected](PO) is further verified by evaluating the electrochemical performance of full cells. Particularly, a Graphite//[email protected] NaV(PO) battery delivers an energy density as high as 260 W h kg and exhibits a Coulombic efficiency of 89.3% after 115 cycles.
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http://dx.doi.org/10.1021/acsami.6b12688DOI Listing
January 2017

Na3V2(PO4)3/C Nanorods with Improved Electrode-Electrolyte Interface As Cathode Material for Sodium-Ion Batteries.

ACS Appl Mater Interfaces 2016 Sep 25;8(35):23151-9. Epub 2016 Aug 25.

Inorganic Chemistry, University of Córdoba , Marie Curie Building, Campus de Rabanales. 14071 Córdoba, Spain.

Na3V2(PO4)3/C nanocomposites are synthesized by an oleic acid-based surfactant-assisted method. XRD patterns reveal high-purity samples, whereas Raman spectroscopy evidence the highly disordered character of the carbon phase. Electron micrographs show submicron agglomerates with a sea-urchin like morphology consisting of primary nanorods coated by a carbon phase. The electrode material was tested in half and full sodium cells. The electrochemical performance is clearly improved by this optimized morphology, particularly at high C rates. Thus, 76.6 mA h g(-1) was reached at 40C for Na3V2(PO4)3/C nanorods. In addition, 105.3 and 96.7 mA h g(-1) are kept after 100 cycles at rates as high as 5 and 10C. This exceptional Coulombic efficiency can be ascribed to the good mechanical stability and the low internal impedance at the electrode-electrolyte interphase.
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http://dx.doi.org/10.1021/acsami.6b07950DOI Listing
September 2016

Missed opportunities for HIV testing of patients diagnosed with an indicator condition in primary care in Catalonia, Spain.

Sex Transm Infect 2016 08 17;92(5):387-92. Epub 2016 Feb 17.

Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT)-Public Health Agency of Catalonia (ASPC), Badalona, Spain CIBER Epidemiología y Salud Pública, Barcelona, Spain Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.

Objective: To estimate the prevalence of HIV testing among patients diagnosed with an indicator condition (IC) for HIV, seen in primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients.

Design: Cross-sectional and population-based study in patients aged between 16 and 65 diagnosed with an IC within PC in Catalonia.

Methods: Data used in this study were extracted from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP). All participants registered in SIDIAP from 1 January 2010 to 31 August 2012 and with a diagnosis of an IC were screened to identify those with an HIV test within the following 4 months.

Results: 99 426 patients were diagnosed with an IC during the study period. In these patients, there were 102 647 episodes in which at least one IC was diagnosed. An HIV test was performed within 4 months in only 18 515 of the episodes in which an IC was diagnosed (18.5%). The prevalence of HIV infection was 1.46%. Women (OR 1.35, 95% CI 1.30 to 1.39), people aged 50 or over (OR 2.85, 95% CI 2.69 to 3.00) and patients having a single IC (OR 3.59. 95% CI 3.20 to 4.03) had the greatest odds of not having an HIV test.

Conclusions: The study highlights the persistence of missed opportunities for HIV testing within PC in Catalonia. Urgent engagement with PC professionals is required in order to increase HIV testing and prevent late HIV diagnoses.
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http://dx.doi.org/10.1136/sextrans-2015-052328DOI Listing
August 2016

High Performance Full Sodium-Ion Cell Based on a Nanostructured Transition Metal Oxide as Negative Electrode.

Chemistry 2015 Oct 25;21(42):14879-85. Epub 2015 Aug 25.

Inorganic Chemistry Laboratory, University of Cordoba, Campus of Rabanales, Marie Curie Building, Cordoba 14071 (Spain).

A novel design of a sodium-ion cell is proposed based on the use of nanocrystalline thin films composed of transition metal oxides. X-ray diffraction, Raman spectroscopy and electron microscopy were helpful techniques to unveil the microstructural properties of the pristine nanostructured electrodes. Thus, Raman spectroscopy revealed the presence of amorphous NiO, α-Fe2 O3 (hematite) and γ-Fe2 O3 (maghemite). Also, this technique allowed the calculation of an average particle size of 23.4 Å in the amorphous carbon phase in situ generated on the positive electrode. The full sodium-ion cell performed with a reversible capacity of 100 mA h g(-1) at C/2 with an output voltage of about 1.8 V, corresponding to a specific energy density of about 180 W h kg(-1) . These promising electrochemical performances allow these transition metal thin films obtained by electrochemical deposition to be envisaged as serious competitors for future negative electrodes in sodium-ion batteries.
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http://dx.doi.org/10.1002/chem.201502050DOI Listing
October 2015

Host and environmental factors influencing respiratory secretion of pro-wheezing biomarkers in preterm children.

Pediatr Allergy Immunol 2012 Aug 3;23(5):441-7. Epub 2012 May 3.

Servicio de Pediatría, Hospital Clínico Universitario, SACYL, Valladolid, Spain.

Cytokines are actively secreted by the respiratory mucosa of preterm children and participate in the pathogenesis of wheezing. This study aimed to identify the factors that could potentially influence respiratory secretion of cytokines in these children. A nasopharyngeal aspirate (NPA) was collected from 77 preterm children 1 yr after birth. NPAs from 14 healthy, 1-yr-old term children were collected in parallel. 27 cytokines were measured in the NPAs using a multiplex assay. Multivariate stepwise regression analysis with Bonferroni correction evidenced that the variable [daycare attendance] was associated with higher levels of [monocyte chemoattractant protein-1 (MCP-1), IL-6, vascular endothelial growth factor (VEGF), IL-1β, IL-10, tumor necrosis factor (TNF)-α]; [male sex] with higher levels of (MCP-1, VEGF, and IL-1β); [smokers at home] was associated with higher levels of MCP-1 (p < 0.0013). In turn, [prophylaxis with palivizumab] was associated with lower levels of (IL-6, IL-7) (p < 0.0013). All these mediators participate in the pathogenesis of asthma and recurrent wheezing. Preterm children secreted higher levels of chemokines (interferon-gamma inducible protein-10, macrophage inflammatory protein-1α, Eotaxin, MCP-1), growth factors (platelet-derived growth factor-bb, VEGF, fibroblast growth factor-basic, granulocyte macrophage colony-stimulating factor), Th1 (IL12, interferon-γ), Th2 (IL-9, IL-13), Th17 (IL-6, IL-17) cytokines, and immunomodulatory mediators (IL1RA and granulocyte colony-stimulating factor) than term children. In conclusion, we have identified for the first time a group of individual and environmental factors influencing respiratory secretion of cytokines in preterm children at the long term after birth. To know these factors could help to prevent the instauration of conditions linked to the appearance of chronic respiratory diseases such as wheezing or asthma.
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http://dx.doi.org/10.1111/j.1399-3038.2012.01269.xDOI Listing
August 2012
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