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Predicting COVID-19 progression from diagnosis to recovery or death linking primary care and hospital records in Castilla y Leon (Spain).

ABSTRACT: This paper analyses COVID-19 patients' dynamics during the first wave in the region of Castilla y León (Spain) with around 2.4 million inhabitants using multi-state competing risk survival models. From the date registered as the start of the clinical process, it is assumed that a patient can progress through three intermediate states until reaching an absorbing state of recovery or death. Demographic characteristics, epidemiological factors such as the time of infection and previous vaccinations, clinical history, complications during the course of the disease and drug therapy for hospitalised patients are considered as candidate predictors. Regarding risk factors associated with mortality and severity, consistent results with many other studies have been found, such as older age, being male, and chronic diseases. Specifically, the hospitalisation (death) rate for those over 69 is 27.2% (19.8%) versus 5.3% (0.7%) for those under 70, and for males is 14.5%(7%) versus 8.3%(4.6%)for females. Among patients with chronic diseases the highest rates of hospitalisation are 26.1% for diabetes and 26.3% for kidney disease, while the highest death rate is 21.9% for cerebrovascular disease. Moreover, specific predictors for different transitions are given, and estimates of the probability of recovery and death for each patient are provided by the model. Some interesting results obtained are that for patients infected at the end of the period the hazard of transition from hospitalisation to ICU is significatively lower (p < 0.001) and the hazard of transition from hospitalisation to recovery is higher (p < 0.001). For patients previously vaccinated against pneumococcus the hazard of transition to recovery is higher (p < 0.001). Finally, internal validation and calibration of the model are also performed.

SUBMITTER: Alvarez-Esteban PC

PROVIDER: S-EPMC8451995 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThis study aimed to estimate potential undetected cancers over the first 2 years of the COVID-19 pandemic in Catalonia.MethodsCancer incidence was compared between pre-pandemic (2019) and pandemic (March 2020-January 2022) periods in the Catalan Pathology Registry (CPR) according to sex, age, and tumor site. The correlation between cancer diagnosis and COVID-19 health care workload was also evaluated by means of the Pearson's correlation coefficient (R). The expected incident cancers (E) during the pandemic were estimated by applying 2019 CPR cancer incidence specific rates by sex and 5-year age groups to the 2020 and 2021 Catalan population pyramids. CPR incident cancers were considered observed (O). Standardized incidence ratios (SIR) and 95% confidence intervals (CIs) were calculated using the O/E ratio.ResultsAfter two pandemic years, cancer diagnosis decreased by 12% (SIR 0.88, 95% CI 0.87-0.89), or ∼7700 undetected cancers (13 000 with nonmelanoma skin cancer). Without nonmelanoma skin cancer, 72% of the cancer underdiagnosis was generated in 2020. Diagnoses decreased more in men (whole pandemic -14%; 2020 -21%; 2021 -8%) than in women (-9%, -19%, -3%, respectively), dropping significantly overall in all pandemic waves but the fifth (first -37%, second -16%, third -8%, fourth -6%, fifth -2%, sixth -6%), and across all adult age groups. In the first wave, CPR cancer diagnosis was inversely correlated with COVID-19 caseload in primary care (R -0.91, 95% CI -0.97 to -0.75) and occupancy in conventional hospital wards (R -0.91, 95% CI -0.99 to -0.48) and intensive care (R -0.91, 95% CI 95% -0.98 to -0.70).ConclusionsOur study evaluated the overall pandemic impact on cancer diagnosis on a large scale and with minimal selection bias, showing that as of February 2022, cancer detection in Catalonia had not yet recovered to pre-pandemic levels. Pending cancer incidence data from population-based cancer registries, early CPR data could inform the development of Spanish cancer control plans.

Project description:The lithic assemblage of Barranco León (BL), attributed to the Oldowan techno-complex, contributes valuable information to reconstruct behavioral patterning of the first hominins to disperse into Western Europe. This archaic stone tool assemblage comprises two, very different groups of tools, made from distinct raw materials. On the one hand, a small-sized toolkit knapped from Jurassic flint, comprising intensively exploited cores and small-sized flakes and fragments and, on the other hand, a large-sized limestone toolkit that is mainly linked to percussive activities. In recent years, the limestone macro-tools have been the center of particular attention, leading to a re-evaluation of their role in the assemblage. Main results bring to light strict hominin selective processes, mainly concerning the quality of the limestone and the morphology of the cobbles, in relation to their use-patterning. In addition to the variety of traces of percussion identified on the limestone tools, recurrences have recently been documented in their positioning and in the morphology of the active surfaces. Coupled with experimental work, this data has contributed to formulating hypothesis about the range of uses for these tools, beyond stone knapping and butchery, for activities such as: wood-working or tendon and meat tenderizing. The abundance of hammerstones, as well as the presence of heavy-duty scrapers, are special features recognized for the limestone component of the Barranco León assemblage. This paper presents, for the first time, another characteristic of the assemblage: the presence of polyhedral and, especially, subspheroid morphologies, virtually unknown in the European context for this timeframe. We present an analysis of these tools, combining qualitative evaluation of the raw materials, diacritical study, 3D geometric morphometric analysis of facet angles and an evaluation of the type and position of percussive traces; opening up the discussion of the late Oldowan beyond the African context.

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Predicting COVID-19 progression from diagnosis to recovery or death linking primary care and hospital records in Castilla y Leon (Spain).

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