The length of time it takes to experimentally make one-sided choppers, as found in the fossil record, bears a linear relationship to the knapping process of fabricating them. In addition, this temporal frame appears to be related to human heart rates measured as beats per minute, which act as a physiological metronome. We achieved these observations, assuming that any paleolithic one-sided chopper has the information needed to estimate, quantitatively, the number of strikes on it. The experimental data allow us to establish the total timing needed for the standard fabricating of any one-sided chopper. We discuss issues derived from these experimental results, showing the evolution of human neurological abilities from 2.4 million years ago to the Modern period via the duration of time needed for making one chopper to that needed to play a 19th-century music score on a piano. Given that the neuronal and physiological distance between both actions differs by a factor of 6, we propose the concept of "technome" to measure human evolution by using methodological homogeneous metrics applied to these two human technologic objects: the chopper and the piano.
Javier Mar1,2, Isabel Larrañaga3, Arantzazu Arrospide1, José María Begiristain31Research Unit, Hospital Alto Deba, Navarra 16, Mondragón, Spain; 2Clinical Management Unit, Hospital Alto Deba, Navarra 16, Mondragón, Spain; 3Gipuzkoa Health Authority, Basque Government, Sancho El Sabio 35, Donostia-San Sebastián, SpainAbstract: The relationship between disability and health related quality of life (HRQL) is complex because of the role that function plays in the measurement, and certain points need to be dealt with in greater detail when the analysis is applied to the different dimensions of HRQL. The purpose of this study was to assess the impact of disability on different domains of quality of life. Variables were drawn from the 2002 Basque Country Health Survey. Logistic regression models were constructed to measure the adjusted effect of disability on quality of life as determined by the SF-36 questionnaire. The models were adjusted for sociodemographic variables and the presence of comorbidity. The greatest difference between disabled and nondisabled subjects was found in the physical components of the questionnaire. Odds Ratios (ORs) for a suboptimal level of quality of life as determined by functional status were much higher for the physical than for the mental dimensions. Adjustment for different variables showed a decrease in ORs in the physical, mental, and social dimensions. This study establishes a significant relationship between disability and the loss of quality of life in both physical and mental dimensions of SF-36, irrespective of the associated disease.Keywords: quality of life, disability, health status, SF-36
In March 2020, a multidisciplinary task force (so-called Basque Modelling Task Force, BMTF) was created to assist the Basque health managers and Government during the COVID-19 responses. BMTF is a modelling team, working on different approaches, including stochastic processes, statistical methods and artificial intelligence. Here we describe the efforts and challenges to develop a flexible modeling framework able to describe the dynamics observed for the tested positive cases, including the modelling development steps. The results obtained by a new stochastic SHARUCD model framework are presented. Our models differentiate mild and asymptomatic from severe infections prone to be hospitalized and were able to predict the course of the epidemic, providing important projections on the national health system's necessities during the increased population demand on hospital admissions. Short and longer-term predictions were tested with good results adjusted to the available epidemiological data. We have shown that the partial lockdown measures were effective and enough to slow down disease transmission in the Basque Country. The growth rate [Formula: see text] was calculated from the model and from the data and the implications for the reproduction ratio r are shown. The analysis of the growth rates from the data led to improved model versions describing after the exponential phase also the new information obtained during the phase of response to the control measures. This framework is now being used to monitor disease transmission while the country lockdown was gradually lifted, with insights to specific programs for a general policy of "social distancing" and home quarantining.
Background: Breast cancer screening in the Basque Country has shown 20 % reduction of the number of BC deaths and an acceptable overdiagnosis level (4 % of screen detected BC). The aim of this study was to evaluate the breast cancer early detection programme in the Basque Country in terms of retrospective cost-effectiveness and budget impact from 1996 to 2011. Methods: A discrete event simulation model was built to reproduce the natural history of breast cancer (BC). We estimated for lifetime follow-up the total cost of BC (screening, diagnosis and treatment), as well as quality-adjusted life years (QALY), for women invited to participate in the evaluated programme during the 15-year period in the actual screening scenario and in a hypothetical unscreened scenario. An incremental cost-effectiveness ratio was calculated with the use of aggregated costs. Besides, annual costs were considered for budget impact analysis. Both population level and single-cohort analysis were performed. A probabilistic sensitivity analysis was applied to assess the impact of parameters uncertainty. Results: The actual screening programme involved a cost of 1,127 million euros and provided 6.7 million QALYs over the lifetime of the target population, resulting in a gain of 8,666 QALYs for an additional cost of 36.4 million euros, compared with the unscreened scenario. Thus, the incremental cost-effectiveness ratio was 4,214€/QALY. All the model runs in the probabilistic sensitivity analysis resulted in an incremental cost-effectiveness ratio lower than 10,000€/QALY. The screening programme involved an increase of the annual budget of the Basque Health Service by 5.2 million euros from year 2000 onwards. Conclusions: The BC screening programme in the Basque Country proved to be cost-effective during the evaluated period and determined an affordable budget impact. These results confirm the epidemiological benefits related to the centralised screening system and support the continuation of the programme. ; This study was funded by the grant 2010111007 from the Health Department of the Basque Government.
Javier Mar,1–4 Arantzazu Arrospide,2–4 Myriam Soto-Gordoa,5 Álvaro Iruin,4,6 Mikel Tainta,7,8 Andrea Gabilondo,4,6 Lore Mar-Barrutia,9 Montserrat Calvo,10 Maider Mateos,10 Oliver Ibarrondo2,41Clinical Management Unit, OSI Alto Deba, Arrasate-Mondragón, España; 2AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, España; 3Economic Evaluation Department, Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain; 4Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; 5Departamento de Ingeniería de Organización, Mondragón Unibertsitatea, Arrasate-Mondragón, España; 6Psychiatry Service, Gipuzkoa Mental Health Network, Donostia-San Sebastián, España; 7Psychiatry Service, CITA Alzheimer Foundation, Donostia-San Sebastián, España; 8Neurology Service, OSI Goierri-Alto Urola, Zumárraga, España; 9Psychiatry Service, Hospital Bellvitge, Hospitalet de Llobregat, España; 10Health Department, Basque Government, Vitoria-Gasteiz, EspañaBackground: Dementia-related neuropsychiatric symptoms (NPS) are the main determinant of family stress and institutionalization of patients. This study aimed to identify inequalities by gender and socioeconomic status in the management of NPS in patients diagnosed with dementia.Methods: An observational study was carried out to study all the cases of dementia in the corporate database of the Basque Health Service (29,864 patients). The prescription of antipsychotics and antidepressants and admission to a nursing home were used to establish the presence of NPS. The socioeconomic status of individuals was classified by a deprivation index. Logistic regressions were used to identify drivers for drug prescriptions and institutionalization.Results: NPS are poorly recorded in the clinical databases (12%). Neuropsychiatric symptoms were severe enough in two thirds of patients with dementia to be treated with psychoactive medication. Institutionalization showed an increase from those who did not receive medication to those who had been prescribed antidepressants (OR: 1.546), antipsychotics (OR: 2.075) or both (OR: 2.741). The resulting inequalities were the increased prescription of antidepressant drugs in women and more nursing-home admissions for women who were the least socioeconomically deprived and men who were the most deprived.Conclusions: In large clinical databases, psychoactive drugs prescriptions can be useful to underscore the considerable burden of dementia-related NPS. Specific tools are needed to monitor social and health care programs targeted to dementia-related NPS from a population perspective. Programs aimed at reducing the family burden of care of dementia patients at home become the key elements in reducing inequalities in these patients' care. Socioeconomic status is the most important driver of inequality, and gender inequality may simply be hidden within the social environment. Integrated programs boosting the continuity of care are an objective for which compliance could be measured according to the NPS coding in the electronic health record.Keywords: neuropsychiatric symptoms, prevalence, dementia, antidepressant drugs, antipsychotic drugs, nursing home, inequalities, deprivation index
