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Incidence of post-acute COVID-19 symptoms across healthcare settings in seven countries: an international retrospective cohort study using routinely-collected data
No full textBackground: The World Health Organisation (WHO) has identified a range of symptomatic manifestations to aid in the clinical diagnosis of post-COVID conditions, herein referred to as post-acute COVID-19 symptoms. We conducted an international network cohort study to estimate the burden of these symptoms in North American, European, and Asian populations. Methods: A federated analysis was conducted including 10 databases from the United Kingdom, Netherlands, Norway, Estonia, Spain, France, South Korea, and the United States, between September 1st 2020 and latest data availability (which varied from December 31st 2021 to February 28th 2023), covering primary and secondary care, nationwide registries, and claims data, all mapped to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM). We defined two cohorts for the main analyses: a SARS-CoV-2 infection cohort [positive polymerase chain reaction (PCR) or rapid lateral flow test (LFT) result or clinical COVID-19 diagnosis] and a general population cohort. Individuals with less than 365 days of prior history or 120 days of follow-up were excluded. We estimated incidence rates (IRs) of the 25 WHO-proposed post-acute COVID-19 symptoms, considering symptoms that occurred ≥90 and ≤365 days after index date, excluding individuals with the respective symptoms 180 days prior to the index event. Stratified analyses were conducted by age and sex. Incidence rate ratios (IRRs) were calculated comparing rates in the infected cohort versus the general population. Results from the different databases were combined using random-effects meta-analyses. Findings: 3,019,408 individuals were included in the infection cohort. 1,585,160 of them were female and 1,434,248 of them male. 929,351,505 individuals were included in the general population group. 461,195,036 of them were female and 466,022,004 of them male. The 1-year IR of any post-acute COVID-19 symptom in the COVID-19 infection cohort varied significantly across databases, from 4.4 (95% CI 3.8-5.1) per 100 person-years to 103.9 (95% CI 103.2-104.7). The five most common symptoms were joint pain (from 1.6 (95% CI 1.3-1.9) to 14.3 (95% CI 14.1-14.6)), abdominal pain (from 0.3 (95% CI 0.1-0.5) to 9.9 (95% CI 9.7-10.1)), gastrointestinal issues (from 0.6 (95% CI 0.4-0.9) to 13.3 (95% CI 13.1-13.6)), cough (from 0.3 (95% CI 0.2-0.5) to 9.1 (95% CI 8.9-9.3)), and anxiety (from 0.8 (95% CI 0.6-1.2) to 11.4 (95% CI 11.2-11.6)); whereas muscle spasms (from 0.01 (95% CI 0.008-0.2) to 1.7 (95% CI 1.6-1.8)), pins and needles (from 0.05 (95% CI 0.03-0.0.9) to 1.5 (95% CI 1.4-1.6)), memory issues (from 0.03 (95% CI 0.02-0.06) to 0.8 (95% CI 0.7-0.8)), cognitive dysfunction (from 0.007 (95% CI 0.004-0.01) to 0.6 (95% CI 0.4-0.8)), and altered smell and/or taste (from 0.04 (95% CI 0.03-0.04) to 0.7 (95% CI 0.6-0.8)) were least common. Incidence rates of any post-acute COVID-19 symptoms generally increased with age, with certain symptoms peaking in middle-aged adults (anxiety, depressive disorders, headache, altered smell and taste) and others in pre-school children (gastrointestinal issues and cough). Females had higher incidence rates for most symptoms. Based on the random-effects model, the infected cohort had a higher incidence of any post-acute COVID-19 symptom than the general population, with a meta-analytic incidence rate ratio (meta-IRR) of 1.4 (1-2). A similar pattern was seen for all individual symptoms. The highest meta-IRRs were depressive disorder, 2.6 (1.7-3.9); anxiety, 2.3 (1.4-3.8); allergy, 2.1 (1.7-2.8) and sleep disorders, 2.1 (1.5-2.6). The meta-IRR for altered smell and/or taste was 1.9 (1.3-2.8). Interpretation: Post-acute COVID-19 symptoms, as listed by the WHO, were commonly observed following COVID-19 infection. However, even after standardising research methods, there was significant heterogeneity in the incidence rates from different healthcare settings and geographical locations. This is the first international study of the epidemiology of post-acute COVID-19 symptoms using the WHO-listed symptoms. Its findings contibute to understand the epidemiology of this condition from a multinational approach. Limitations of this study include the lack of consensus of the post-acute COVID-19 definition, as well as the difficulty to capture the impact on daily life of the post-acute COVID-19 symptoms in the available datasets. Funding: This work has been funded by the European Health Data Evidence Network (EHDEN) through an Evidence Generation Fund Grant and by the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre (BRC).This work has been funded by the European Health Data Evidence Network (EHDEN) through an Evidence Generation Fund Grant. EHDEN has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 806968. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA
Hegemony and international alignment
No full textThis article explores the interplay between economic hegemony and political alignment. Using theoretical and empirical insights from Broner et al. (2024), we posit that hegemonic states, like the United States, foster political alignment, which enhances globalization. We use UN voting data to proxy for international alignment and show that hegemons induce alignment. These data have shortcomings, however. UN voting only covers the post-WWII period, refers to a narrow set of issues, and displays little time variation. As for military alliances, they were not widely used before the mid-twentieth century. We propose an alternative measure of alignment based on international treaties.Broner and Martin acknowledge financial support from the Spanish Ministry of Science and Innovation (PID2021-125741NB-I00/MCIN/ AEI / 10.13039/501100011033), through the Severo Ochoa Programme for Centres of Excellence in R&D (CEX2019-000915-S), and from the Generalitat de Catalunya through CERCA and SGR Programmes (2017-SGR-1393 / 2021-SGR-01123). Martin acknowledges financial support from the European Research Council under the European Union’s Horizon Europe research and innovation program (101052964–MACROTRENDS_FINANCE), as does Trebesch (101087838–GREAT.POWER.FINANCE)
Risk-adapted breast screening for women at low predicted risk of breast cancer: an online discrete choice experiment
No full textBackground
A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values.
Objectives
To elicit and quantify preferences for low-risk screening options.
Methods
Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated.
Results
Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52).
Conclusions
A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer
Los requisitos de la buena fe y de la previa inscripción del artículo 34 de la ley hipotecaria en la jurisprudencia del tribunal supremo
No full textTreball de Fi de Grau en Dret. Curs 2024-2025Tutor: Nicolás Nogueroles PeiroEste trabajo analiza los requisitos de la buena fe y la previa inscripción contemplados en el artículo 34 de la Ley Hipotecaria española, y su interpretación en la jurisprudencia del Tribunal Supremo. Se realiza un recorrido histórico desde la Ley Hipotecaria de 1861 hasta la vigente de 1944, examinando las sucesivas reformas que han moldeado el principio de fe pública registral. A través del estudio comparativo de sentencias clave, como la STS 255/2007, 5 de marzo y la STS 621/2024, 8 de mayo, se profundiza en el debate sobre el momento en que debe concurrir la buena fe (adquisición vs. inscripción) y se analiza el papel de la diligencia y la ética en su configuración. El trabajo también examina la exigencia del requisito de la previa inscripción del derecho del transmitente como condición para la protección registral. Finalmente, se reflexiona sobre la evolución doctrinal y jurisprudencial del artículo 34 LH, y se plantean sus implicaciones teóricas y prácticas para la seguridad jurídica en el tráfico inmobiliario
Desigualtats socials en salut en la població infantil a Catalunya: situació actual i perspectives d'acció
No full textLa present tesi descriu i analitza les desigualtats socials i econòmiques en la salut de la població infantil. Posa especial èmfasi en aquelles patologies més rellevants i en grups de població amb alt risc clínic. Altrament, s’ha inclòs la perspectiva de gènere en els estudis, incorporant el sexe de l’infant i les interseccions amb altres eixos de desigualtats en els anàlisis. Les dades utilitzades del Sistema de Salut públic de Catalunya han permès obtenir informació dels contactes als serveis sanitaris de tots els infants residents a Catalunya (més d’1,5 milions), generant evidència amb dades del món real. Els resultats obtinguts proporcionen una visió àmplia, transversal i actual de la càrrega de patologia en cadascun dels nivells socioeconòmics de la població infantil a Catalunya. Es destaca el nivell socioeconòmic com un factor estructural en la creació i distribució de la patologia en els diferents estrats socials, essent tota la població infantil partícip del gradient social en salut. Alhora, els resultats alerten que les polítiques públiques en els últims anys no han reeixit en la reducció de les desigualtats en salut, ans al contrari, s’estima un escenari a l’alça.La presente tesis descrive y analiza las desigualdades sociales i económicas en la salud de la población infantil. Pone especial énfasis en aquellas patologías más relevantes y en grupos de población con alto riesgo clínico. Por otra parte, la perspectiva de género ha sido una constante en los estudios, incorporando el sexo y las intersecciones con otros ejes de desigualdades en los análisis. Los datos utilizados del Sistema de Salud público de Cataluña han permitido obtener información de los contactos en los servicios sanitarios de todos los niños residentes en Cataluña (más de 1,5 millones), generando evidencia con datos del mundo real. Los resultados obtenidos proporcionan una visión amplia, transversal y actual de la carga de patología en cada uno de los niveles socioeconómicos de la población infantil en Cataluña. Se destaca el nivel socioeconómico como factor estructural en la creación y distribución de la patología en los diferentes estratos sociales, siendo toda la población infantil partícipe del gradiente social en salud. Asimismo, los resultados alertan de que las políticas públicas en los últimos años no han logrado la reducción de las desigualdades en salud, al contrario, se estima un escenario al alza.This thesis describes and analyses social and economic inequalities in the health of the child population. It places special emphasis on the most relevant pathologies and on population groups with high clinical risk. On the other hand, the gender perspective has been considered in all the studies, incorporating sex and the intersections with other axes of inequalities in the analyses. The data used from the public health system in Catalonia have allowed us to obtain information on contacts in the health services of all children living in Catalonia (more than 1.5 million), generating evidence with real-world data. The results provide a broad, cross-sectional and current view of the burden of pathology in each of the socioeconomic levels of the child population in Catalonia. The socioeconomic level is highlighted as a structural factor in the creation and distribution of pathology in the different social strata, with the entire child population participating in the social gradient in health. Likewise, the results warn that public policies in recent years have not managed to reduce health inequalities; on the contrary, a scenario is estimated to be on the rise.Programa de Doctorat en Biomedicin
Tactical workforce sizing and scheduling decisions for last-mile delivery
No full textWe tackle the problems of workforce sizing and shift scheduling of a logistic operator delivering parcels in the last-mile segment of the supply chain. Our working hypothesis is that the relevant decisions are affected by two main trade-offs: workforce size and shift stability. A large workforce can deal with demand fluctuations but incurs higher fixed costs; by contrast, a small workforce might require excessive outsourcing to third-party logistic providers. Stable shifts, i.e., with predictable start times and lengths, improve worker satisfaction and reduce turnover; at the same time, they might be less able to adapt to an unsteady demand. We test these assumptions through an extensive computational campaign based on a novel mathematical formulation. We find that extreme shift stability is, indeed, unsuitable for last-mile operations. At the same time, introducing a very limited amount of flexibility achieves similar effects as moving to a completely flexible system while ensuring a better work-life balance for the workers. Several recent studies in the social sciences have warned about the consequences of precarious working conditions for couriers and retail workers and have recommended -among other things- stable work schedules. Our work shows that it is possible to offer better working conditions in terms of shift stability without sacrificing the company's bottom line. Thus, companies prioritising profitability (as is often the case) can improve workers' well-being and increase retention with a negligible cost impact
Molecular design principles for bipolar spindle organization by two opposing motors
No full textDuring cell division in animal cells, a bipolar spindle assembles to segregate the chromosomes. Various motor proteins with different properties are essential for spindle self-organization. The minimal set of components required to organize dynamic microtubules into a bipolar network remains however unknown. Here, we use computer simulations to explore whether two types of microtubule-crosslinking motors with opposite directionality can organize dynamic microtubules into bipolar spindles in three-dimensional space around a local microtubule nucleation source. We find that two motors are indeed sufficient, provided their properties resemble the main human spindle motors kinesin-5 and dynein, revealing the core mechanism of spindle self-organization. It is based on the synergistic interplay of a slow plus-directed symmetric motor and a fast minus-directed asymmetric motor. A hypothetical symmetric minus-directed motor can also support spindle formation together with kinesin-5, but only in a limited and unphysiological parameter range. In agreement with its accessory role in human cells, a minus motor with human kinesin-14 properties does not assemble stable bipolar spindles together with kinesin-5. These results reveal fundamental principles for the self-organization of dynamic bipolar microtubule architectures and highlight how distinct molecular designs of mitotic motors are optimized for their task.Simulations were performed on the high-performance computing cluster at the Centre for Genomic Regulation in Barcelona, Spain. We acknowledge support of the Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa (CEX2020-001049-S, MCIN/AEI/10.13039/501100011033), and the Generalitat de Catalunya through the CERCA programme. This project received funding from the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 951430; F.N. and T.S.) and received support from the Spanish Ministry of Science and Innovation, the State Research Agency and FEDER (grant PID2022-142927NB-I00/MCIN/AEI/10.13039/501100011033/FEDER, UE; T.S.). W.-X.C. was supported by a Human Frontier Science Program fellowship (HFSP LT000682/2020-C). F.N. was supported by the Gatsby Charitable Foundation. We thank Zoë Geraghty, Wei Ming Lim, and Aritra Sen for comments on the manuscript
El impacto de la vivienda cooperativa en la salud de las personas: compartir para vivir
No full textEl objetivo principal de esta tesis ha sido profundizar y ampliar en el conocimiento sobre la vivienda cooperativa y su impacto en la salud de las personas. Para alcanzar este objetivo, se han diseñado y llevado a cabo tres estudios.
El primer estudio recoge y sintetiza la literatura existente sobre la relación entre la vivienda cooperativa y la salud de las personas. Los resultados muestran los pocos estudios existentes que analizan los efectos directos en salud. La mayoría de los estudios han encontrado un impacto positivo en la salud entre las personas que viven en una vivienda cooperativa. Los estudios explican esta asociación a través de algunos determinantes psicosociales de la salud, como el apoyo social, el sentido de comunidad y seguridad, y el aislamiento social. El segundo estudio cualitativo identifica los mecanismos implicados, tanto psicosociales como materiales, en la relación entre la vivienda cooperativa y la salud. Los hallazgos indican que el modelo impacta en la salud y calidad de vida a través de los siguientes aspectos: 1) vivir alineada con las propias motivaciones políticas; 2) aspectos legales y económicos; 3) vivir en comunidad; 4) gobernanza, toma de decisiones y participación compartida; y 5) aspectos materiales de la vivienda. Por último, el tercer estudio ha cuantificado el impacto en la salud de las personas que viven en proyectos de vivienda cooperativa en régimen de cesión de uso en Cataluña antes y después de entrar a vivir en una vivienda cooperativa. Se ha evidenciado una mejora en la salud física y mental al año de entrar a vivir, siendo más notable en la salud física y en los hombres. También se observó una mejora en las condiciones materiales de la vivienda, la satisfacción y el apego a la vivienda, y el apoyo social. La vivienda cooperativa en cesión de uso es un modelo de vivienda que se está extendiendo en Cataluña, la evidencia generada a partir de estos estudios demuestra que dicho modelo tiene efectos positivos en la salud y calidad de vida de las personas que participan en él. Sin embargo, al ser un modelo relativamente reciente, especialmente en este contexto, se requiere continuar investigando para generar más evidencia al respecto.The main objective of this thesis has been to deepen and expand the knowledge about cooperative housing and its impact on people's health. Three studies have been designed and carried out to achieve this goal.
The first study collects and synthesizes the existing literature on the relationship between cooperative housing and people's health. The results show that few existing studies have analyzed the direct effects on health. Most studies have found a positive impact on people's health living in cooperative housing. The studies explain this association through some psychosocial determinants of health, such as social support, a sense of community and security, and social isolation. The second qualitative study identifies the involved mechanisms, both psychosocial and material, in the relationship between cooperative housing and health. The findings indicate that the model impacts health and life quality through the following aspects: 1) living aligned with political motivations; 2) legal and economic aspects; 3) communal living; 4) governance, decision-making, and shared participation; and 5) material aspects of the dwelling. Finally, the third study quantified the impact on the health of people living in cooperative housing projects under a grant-of-use model in Catalonia before and after moving into a cooperative housing project. An improvement in physical and mental health was evidenced one year after moving in, being more notable in physical health and men. Another improvement was observed in the material conditions of the housing, satisfaction, attachment to the housing, and social support. Cooperative housing under a grant-of-use model is an expanding housing model in Catalonia, and the evidence generated from these studies demonstrates that this model has positive effects on the health and quality of life of the people involved. However, as it is a relatively recent model, especially in this context, further research is required to generate more evidence.Programa de Doctorat en Biomedicin
multistrap: boosting phylogenetic analyses with structural information
No full textIn a phylogeny, trustworthy reliability branch support estimates are as important as the tree itself. We show that reliability support values based on bootstrapping can be improved by combining sequence and structural information from proteins. Our approach relies on the systematic comparison of homologous intra-molecular structural distances. These variations exhibit less saturation than sequence-based Hamming distances and support the computation of tree-like distance matrices resolvable into phylogenetic trees using distance-based methods such as minimum evolution. These trees bear strong similarities to their sequence-based counterparts and allow the estimation of bootstrap support values, but they are sufficiently distinct so that their information content may be combined. The combined sequence and structure bootstrap support values yield improved discrimination between correct and incorrect branches. In this work we show that our approach, named multistrap, is suitable for the improvement of bootstrap branch support values using both predicted and experimental 3D structures.The research leading to these results has received funding from the Spanish Ministry of Science and Innovation (PRE2018-085039 funds for predoctoral contract funded by MICIU/AEI/10.13039/501100011033 and by the FSE invest in your future (L.M.), PRE2021-097947 funds for predoctoral contract funded by MICIU/AEI/10.13039/501100011033 and by FSE+ (L.S.)). We acknowledge support of the Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa (CEX2020-001049-S, MCIN/AEI /10.13039/501100011033), and the Generalitat de Catalunya through the CERCA programme (C.N.). O.G. is supported by the Paris Artificial Intelligence Research Institute (PRAIRIE, ANR-19-P3IA-0001). We are grateful to the CRG Core Technologies Programme for their support and assistance in this work. The authors are also very grateful to Edward L. Braun who extensively reviewed the manuscript and proposed very useful edits and suggestions, especially with respect to the saturation analysis
Understanding the process of acceptance within the nurse-patient therapeutic relationship in mental health care: a grounded theory
No full textBackground/Objective: Deepening knowledge about the meaning of acceptance in the context of the nurse-patient relationship will help us to understand the importance and value that people with mental health challenges attach to this attribute in the process of the therapeutic relationship. The objective of this study was to understand the process of acceptance as part of the therapeutic relationship between nurses and patients in the field of mental health. Methods: This study employed a qualitative research design using Strauss and Corbin's grounded theory approach. Using theoretical sampling, data were collected through unstructured interviews with mental health nurses and with people with mental health challenges. Results: Acceptance is a complex and dynamic process that takes place when both patients and nurses feel and make the other feel like an individual human being. Acceptance is not an automatic process; rather, it requires awareness on behalf of both parties involved in the therapeutic relationship. The creation of a non-hierarchical caring environment is fundamental for fostering mutual acceptance and engagement in the therapeutic process. Conclusions: Nurses must develop self-awareness and reflect on their attitudes and biases to provide person-centered care. Nurse training and personal development are essential requirements for achieving an effective therapeutic relationship and empowering patients in their recovery process