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Introduction: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. Methods: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. Results: We identified 36,044 patients with ischaemic stroke (mean age, 74.7 +/- 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was euro 3,230 the year before stroke, euro 11,060 for year one after stroke, euro 4,104 for year 2, and euro 3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. Conclusion: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services. (C) 2019 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.

This is the thirteenth of a series of miscellaneous contributions, by various authors, where hitherto unpublished data relevant to both the Med-Checklist and the Euro+Med (or Sisyphus) projects are presented. This instalment deals with the families Amaryllidaceae (incl. Alliaceae), Apocynaceae, Caryophyllaceae, Chenopodiaceae, Compositae, Crassulaceae, Cucurbitaceae, Gramineae, Hydrocharitaceae, Iridaceae, Labiatae, Liliaceae, Malvaceae, Meliaceae, Myrtaceae, Orobanchaceae, Oxalidaceae, Papaveraceae, Pittosporaceae, Primulaceae (incl. Myrsinaceae), Ranunculaceae, Rhamnaceae, Rubiaceae, Solanaceae and Umbelliferae. It includes new country and area records and taxonomic and distributional considerations for taxa in Allium, Anthemis, Atriplex, Centaurea, Chasmanthe, Chenopodium, Delphinium, Digitaria, Elodea, Erigeron, Eucalyptus, Hypecoum, Leptorhabdos, Luffa, Malvaviscus, Melia, Melica, Momordica, Nerium, Oxalis, Pastinaca, Phelipanche, Physalis, Pittosporum, Salvia, Scorzoneroides, Sedum, Sesleria, Silene, Spartina, Stipa, Tulipa and Ziziphus, new combinations in Cyanus, Lysimachia, Rhaponticoides and Thliphthisa, and the reassessment of a replacement name in Sempervivum.CitationFor the whole article:Raab-Straube E. von & Raus Th. (ed.) 2021: Euro+Med-Checklist Notulae, 13 [Notulae ad floram euro-mediterraneam pertinentes No. 42]. – Willdenowia 51: 141–168.For a single contribution (example):Kunev G. 2021: Allium melanogyne Greuter. – Pp. 142–143 in: Raab-Straube E. von & Raus Th. (ed.), Euro+Med-Checklist Notulae, 13 [Notulae ad floram euro-mediterraneam pertinentes No. 42]. – Willdenowia 51: 141–168.Version of record first published online on 30 April 2021 ahead of inclusion in April 2021 issue.

Psicosom��tica y Psiquiatr��a, N��m. 1 (2017): abril-mayo-junio

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.

Resumen Objetivo Analizar la distribución del gasto sanitario según el ámbito asistencial y las características de los pacientes, utilizando microdatos del uso de servicios sanitarios del total de la población de Cataluña (España). Método Se ha aplicado una tarifa o un gasto indirecto a todos los actos sanitarios financiados por CatSalut durante 2014, computando el gasto sanitario realizado por cada persona y sumando para todos los habitantes de Cataluña. Resultados La suma del gasto sanitario realizado por todos los habitantes de Cataluña representa el 97,0% del presupuesto de CatSalut. La mitad de la población origina el 3,6% del gasto sanitario total (71 € por persona); un 1% de la población gastó el 23% del gasto (22.852 € por persona). El gasto medio más elevado, tanto en mujeres como en hombres, se da entre los 80 y los 89 años de edad. La población con una enfermedad crónica tiene un gasto medio anual de 413 €; con cinco, de 2413 €; y con 10, de 9626€. El gasto medio varía según patologías, desde los 2854 € en los pacientes con depresión grave a los 8097 € de los pacientes con infección por el virus de la inmunodeficiencia humana/sida. Conclusiones Los resultados son sumamente útiles para la planificación de los servicios sanitarios y para la priorización de intervenciones de política sanitaria en los colectivos con más necesidades. Abstract Objective To analyse the distribution of the expenditure according to the healthcare services and characteristics of patients, using the microdata of the Catalan population's use of healthcare services. Methods A fee or an indirect cost has been applied to all healthcare activities financed by CatSalut during 2014, computing the health expenditure made up by each person and adding it all up for the inhabitants of Catalonia (Spain). Results The sum of the healthcare expenditure made by all the inhabitants of Catalonia represents 97.0% of the CatSalut budget. Half of the population accounts for 3.6% of total healthcare expenditure (71€ per person); 1% of the population spends 23% of the expenditure (22,852€ per person). The highest average expenditure, in both women and men, occurs between the age of 80 and 89. The population with a chronic disease has an average annual expenditure of 413€, with 5 of 2,413€, and 10 of 9,626€. The average cost varies according to pathologies, from 2,854€ in patients with severe depression to 8,097€ in patients with HIV-AIDS. Conclusions The results are extremely useful for healthcare planning and for the prioritization of health policy interventions in groups with most needs.

Background: Pituitary adenomas (PA) associated with pheochromocytomas/paragangliomas (Pheo/PGL), also known as "the three P association" or "3PAs" could be the results of coincidence, but new evidence supports a common pathogenic mechanism in some patients. Our aim is to report the clinical data, surgical outcome, genetic findings of a large case series and review the current knowledge on this topic. Methods and results: In a retrospective multicentre study, we compiled 10 patients with PAs (6 new unreported cases). Six patients were female with mean age of 51.6 +/- 18.0 years. PA were: 6 acromegaly, 3 prolactinoma and 1 non-functioning PA (NFPA). Among the Pheo/PGL, 7 patients had a single tumour (4 Pheo and 3 PGL) and 3 patients had multiple or bilateral disease (2 PGL and 1 Pheo). Patients with GH-secreting PA and NFPA underwent surgery, while patients with prolactinoma received medical treatment (one patient required surgery). Unilateral adrenalectomy was carried out in all single Pheo and a bilateral procedure was performed in the patient with bilateral tumour. A single tumour was resected in two patients with multiple PGL. We found 3 germline pathogenic mutations: 2 in SDHB (c.166-170delCCTCA and a gross deletion involving exon 1) and 1 SDHD (p.P81L exon 3). Two variants of uncertain significance: 1 in MEN1 (c.1618C > T; p.Pro540Ser) and 1 in RET (c.2556C > G, p.Ile852Met), and finally a RETM918T somatic mutation in a Pheo tissue. Conclusion: We actively suggest considering the possibility of hereditary disease in all cases with 3PA and performing a complete genetic study.

Background: To evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. Methods and results: We used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000–100,000€), low (