Papers by Jordi De Batlle
Jmir mhealth and uhealth, Jan 14, 2021
Background: Integrated care can generate health and social care efficiencies through the defragme... more Background: Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results: A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions: The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs,
BMC Public Health, Jun 1, 2020
Background: The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated... more Background: The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015. Methods: An analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated. Results: Over the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall-18.8% in women and 9.6% in men-and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long halflife BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%). Conclusion: The dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.
International Journal of Cancer, Jan 27, 2017
Epidemiological studies have reported inconsistent findings for the association between B vitamin... more Epidemiological studies have reported inconsistent findings for the association between B vitamins and breast cancer (BC) risk. We investigated the relationship between biomarkers of folate and vitamin B12 and the risk of BC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Plasma concentrations of folate and vitamin B12 were determined in 2,491 BC cases individually matched to 2,521 controls among women who provided baseline blood samples. Multivariable logistic regression models were used to estimate odds ratios by quartiles of either plasma B vitamin. Subgroup analyses by menopausal status, hormone receptor status of breast tumors (ER, PR, and HER2), alcohol intake, and MTHFR polymorphisms (677C>T and 1298A>C) were also performed. Plasma levels of folate and vitamin B12 were not significantly associated with the overall risk of BC or by hormone receptor status. A marginally positive association was found between vitamin B12 status and BC risk in women consuming above the median level of alcohol (ORQ4-Q1 = 1.26; 95% CI 1.00-1.58; Ptrend = 0.05). Vitamin B12 status was also positively associated with BC risk in women with plasma folate levels below the median value (ORQ4-Q1 = 1.29; 95% CI 1.02-1.62; Ptrend = 0.03). Overall, folate and vitamin B12 status was not clearly associated with BC risk in this prospective cohort study. However, potential interactions between vitamin B12 and alcohol or folate on the risk of BC deserve further investigation.
The Lancet Regional Health - Europe
Archivos de Bronconeumología
B57. CUTTING EDGE COVID RESEARCH, May 1, 2022
Frontiers in Medicine
The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have n... more The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5–24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (<60%), and 53.7%...
Frontiers in Medicine
IntroductionObstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). Th... more IntroductionObstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and its consequences in cardiovascular diseases (CVDs). Deleterious effects of OSA have been suggested to influence the prognosis of specific endotypes of patients with acute coronary syndrome (ACS). We aim to identify respiratory polygraphy (RP) patterns that contribute to identifying the risk of recurrent cardiovascular events in patients with ACS.MethodsPost hoc analysis of the ISAACC study, including 723 patients admitted for a first ACS (NCT01335087) in which RP was performed. To identify specific RP patterns, a principal component analysis (PCA) was performed using six RP parameters: AHI, oxygen desaturation index, mean and minimum oxygen saturation (SaO2), average duration of events and percentage of time with SaO2 < 90%. An independent HypnoLaus population-based cohort was used to validate the RP c...
Annals of the American Thoracic Society
RATIONALE Obstructive sleep apnea (OSA) is prevalent in acute coronary syndrome (ACS) patients an... more RATIONALE Obstructive sleep apnea (OSA) is prevalent in acute coronary syndrome (ACS) patients and is a cause of secondary hypertension. OBJECTIVE To explore the long-term effects of OSA and CPAP treatment on blood pressure (BP) in ACS patients. METHODS Post-hoc analysis of the ISAACC study included 1803 patients admitted for ACS (NCT01335087). Patients with OSA (apnea-hypopnea index (AHI) ≥15 events/h) were randomly assigned to receive either CPAP or/and usual care and followed up for one to 5 years. Office BP was determined at each visit. RESULTS We included 596 patients without OSA, 978 patients in the usual care/poor CPAP adherence group and 229 patients in the good CPAP adherence group. At baseline, 52% of the patients were diagnosed with hypertension. Median age and body mass index were 59 [52.0;67.0] years and 28.2 [25.6;31.2] kg/m2, respectively. After a median [25th;75th percentile] follow-up of 41.2 [18.3;59.6] months, BP changes were similar between OSA and non-OSA groups. However, we observed an increase in BP in the third tertile of the AHI (AHI>40 events/h) with a maximum difference in mean BP of +3.3 mmHg at 30 months. OSA patients with good CPAP adherence (≥4 hours/night) reduced mean BP after 18 months compared to usual care/poor CPAP adherence patients, maximum mean difference (95% CI) of -4.7 (-6.7,-2.7) mmHg. In patients with severe OSA we observed a maximum mean difference of -7.1 (-10.3,-3.8) mmHg. CONCLUSIONS In patients with ACS, severe OSA is associated with a long-term increase in BP, which is reduced by good CPAP adherence.
International Journal of Integrated Care, 2017
BACKGROUND It is widely accepted that the increasing number of the population aged > 65 years may... more BACKGROUND It is widely accepted that the increasing number of the population aged > 65 years may suffer frequent unexpected hospital admissions or emergency room visits because of clinical or social circumstances triggering adverse outcomes.
In this paper, we focus on the implementation studies performed in the Lleida region under the um... more In this paper, we focus on the implementation studies performed in the Lleida region under the umbrella of the H2020 EU project CONNECARE. In particular, we refer the overall experience of the users (patients and carers) of the SMS, a self-management system that allows monitoring patients and provides engagement, rewards, and warnings. It monitors: physical activity, health status, self-reported questionnaires, rehabilitation tasks, sleeping pattern, and drugs intake. First, we present the underlying context regarding the implementation studies performed in Lleida. Subsequently, we focus on the strategies of UX (User Experience) that have been performed in two different moments of the project and with different actors. Results are then presented for each of the approaches. A discussion focused on the lessons learnt ends the paper.
A34. SCREENING, DIAGNOSIS, AND TREATMENT IN SLEEP DISORDERS, 2019
10.01 - Respiratory infections and bronchiectasis
JNCI Journal of the National Cancer Institute, 2014
Background: There is limited evidence on the association between dietary folate intake and the ri... more Background: There is limited evidence on the association between dietary folate intake and the risk of breast cancer (BC) by hormone receptor expression in the tumors. We investigated the relationship between dietary folate and BC risk using data from the European Prospective Investigation into Cancer and Nutrition (EPIC).
BMC pulmonary medicine, Jan 17, 2015
Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics a... more Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD. The PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004-2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined "undiagnosed COPD" by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment. Undiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%,…
International Journal of Cancer, 2015
receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2), first f... more receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2), first fullterm pregnancy (FFTP), body mass index (BMI). Article category: Epidemiology Novelty and impact: Recent studies suggested alcohol intake before first full-term pregnancy (FFTP) to be associated with breast cancer (BC) risk. Using a prospective study with 11,576 incident BC cases we confirmed that women who started drinking before their FFTP have higher risk of BC than women who started afterwards. Moreover, although alcohol has been shown to act through the estrogen pathway, our results suggest that non-hormonal pathways are likely to act and need to be further investigated.
Revista Portuguesa de Pneumologia (English Edition), 2012
Introduction: OSAS (obstructive sleep apnea syndrome) is defined by recurrent episodes of upper a... more Introduction: OSAS (obstructive sleep apnea syndrome) is defined by recurrent episodes of upper airway obstruction during sleep, causing multiple clinical consequences. Literature review suggests that OSAS induces a spectrum of abnormalities in neural, hormonal and vascular regulation that contribute to the development of ED (erectile dysfunction). The aims of this study were to estimate the prevalence of ED in OSAS patients and evaluate its determinants. Methods: 62 patients from Hospital S. João Sleep Laboratory with newly diagnosed OSAS were included in the study and answered the IIEF-5 (international index erectile function 5 item version) questionnaire. Results: The prevalence of ED in OSAS patients was 64.4%. Age and diabetes constituted themselves as independent risk factors for more severe degrees of ED:
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Papers by Jordi De Batlle