The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study

It is well known that hospital malnutrition is a highly prevalent condition associated to increase morbidity and mortality as well as related healthcare costs. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regional or even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown in Spain. The PREDyCES® (Prevalence of hospital malnutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs. Some aspects made this study unique: a) It was the first study in a representative sample of hospitals of Spain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System.

Clinical management and burden of bipolar disorder: a multinational longitudinal study (WAVE-bd Study)

BACKGROUND: Studies in bipolar disorder (BD) to date are limited in their ability to provide a whole-disease perspective--their scope has generally been confined to a single disease phase and/or a specific treatment. Moreover, most clinical trials have focused on the manic phase of disease, and not on depression, which is associated with the greatest disease burden. There are few longitudinal studies covering both types of patients with BD (I and II) and the whole course of the disease, regardless of patients' symptomatology. Therefore, the Wide AmbispectiVE study of the clinical management and burden of Bipolar Disorder (WAVE-bd) (NCT01062607) aims to provide reliable information on the management of patients with BD in daily clinical practice. It also seeks to determine factors influencing clinical outcomes and resource use in relation to the management of BD. METHODS: WAVE-bd is a multinational, multicentre, non-interventional, longitudinal study. Approximately 3000 patients diagnosed with BD type I or II with at least one mood event in the preceding 12 months were recruited at centres in Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela. Site selection methodology aimed to provide a balanced cross-section of patients cared for by different types of providers of medical aid (e.g. academic hospitals, private practices) in each country. Target recruitment percentages were derived either from scientific publications or from expert panels in each participating country. The minimum follow-up period will be 12 months, with a maximum of 27 months, taking into account the retrospective and the prospective parts of the study. Data on demographics, diagnosis, medical history, clinical management, clinical and functional outcomes (CGI-BP and FAST scales), adherence to treatment (DAI-10 scale and Medication Possession Ratio), quality of life (EQ-5D scale), healthcare resources, and caregiver burden (BAS scale) will be collected. Descriptive analysis with common statistics will be performed. DISCUSSION: This study will provide detailed descriptions of the management of BD in different countries, particularly in terms of clinical outcomes and resources used. Thus, it should provide psychiatrists with reliable and up-to-date information about those factors associated with different management patterns of BD. TRIAL REGISTRATION NO: ClinicalTrials.gov: NCT01062607.

Clinical management and burden of bipolar disorder: a multinational longitudinal study (WAVE-bd Study)

BACKGROUND: Studies in bipolar disorder (BD) to date are limited in their ability to provide a whole-disease perspective--their scope has generally been confined to a single disease phase and/or a specific treatment. Moreover, most clinical trials have focused on the manic phase of disease, and not on depression, which is associated with the greatest disease burden. There are few longitudinal studies covering both types of patients with BD (I and II) and the whole course of the disease, regardless of patients' symptomatology. Therefore, the Wide AmbispectiVE study of the clinical management and burden of Bipolar Disorder (WAVE-bd) (NCT01062607) aims to provide reliable information on the management of patients with BD in daily clinical practice. It also seeks to determine factors influencing clinical outcomes and resource use in relation to the management of BD. METHODS: WAVE-bd is a multinational, multicentre, non-interventional, longitudinal study. Approximately 3000 patients diagnosed with BD type I or II with at least one mood event in the preceding 12 months were recruited at centres in Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela. Site selection methodology aimed to provide a balanced cross-section of patients cared for by different types of providers of medical aid (e.g. academic hospitals, private practices) in each country. Target recruitment percentages were derived either from scientific publications or from expert panels in each participating country. The minimum follow-up period will be 12 months, with a maximum of 27 months, taking into account the retrospective and the prospective parts of the study. Data on demographics, diagnosis, medical history, clinical management, clinical and functional outcomes (CGI-BP and FAST scales), adherence to treatment (DAI-10 scale and Medication Possession Ratio), quality of life (EQ-5D scale), healthcare resources, and caregiver burden (BAS scale) will be collected. Descriptive analysis with common statistics will be performed. DISCUSSION: This study will provide detailed descriptions of the management of BD in different countries, particularly in terms of clinical outcomes and resources used. Thus, it should provide psychiatrists with reliable and up-to-date information about those factors associated with different management patterns of BD. TRIAL REGISTRATION NO: ClinicalTrials.gov: NCT01062607.

Economic ideas and economists in the Parliament in the liberal age: The attempt to implement a tax on incomes in Spain in 1868-1869

[spa] El estudio de la presencia de ideas económicas en los debates parlamentarios se ha convertido recientemente en un objeto importante dentro de la investigación sobre el proceso de institucionalización de la economía política en Europa Occidental en la llamada era liberal. En este marco general, este artículo se centra en el análisis de un caso de particular interés: La relevancia del pensamiento económico y el papel jugado por los economistas en los debates parlamentarios que siguieron a la creación de un nuevo impuesto que trataba de captar la renta personal, que fue lanzado por el ministro de Hacienda Laureano Figuerola en 1868. El artículo intenta demostrar, en primer lugar, que las ideas económicas jugaron efectivamente un papel relevante en las discusiones sobre el impuesto sobre la renta y que la presencia e influencia de los economistas en el Legislativo en este tiempo fue notable. En segundo lugar, que este fue un intento serio de modernizar la estructura fiscal española llevado a cabo por el Gobierno Provisional, el cual trató de diseñar un sistema impositivo capaz de fomentar el crecimiento económico del país.

The reform of the European Energy Tax Directive reform : effect on prices

[spa] Para hacer frente a los riesgos relacionados con la contaminación atmosférica, es ampliamente aceptada la necesidad de instrumentos de política encaminados a reducir las emisiones. La intervención tiene por objeto reducir las conductas contaminantes y incentivar una conducta más respetuosa y el uso de tecnologías más eficientes. La Unión Europea cuenta con dos importantes mecanismos económicos para el control de emisiones a escala europea: la directiva sobre los impuestos energéticos, un instrumento de fiscalidad ambiental aprobado en 2003 que afecta el precio de los productos energéticos, y el sistema de comercio de los derechos de emisiones, introducido en 2005, que afecta directamente a la cantidad de emisiones de CO2. En 2011, la Comisión Europea propuso una nueva versión de la directiva sobre los impuestos energéticos. El objetivo principal de la propuesta es aumentar la eficacia del instrumento a través de una mayor presión fiscal sobre los productos energéticos y de coordinar este instrumento de fiscalidad medioambiental con el sistema de comercio de los derechos de emisiones, para establecer una señal de precio de CO2 coherente para todos los sectores. Sin embargo, en mayo de 2012 el Parlamento Europeo bloqueó la propuesta de la nueva versión del impuesto, y el proceso de actualización se detuvo. La preocupación principal parecía ser el efecto de dicha propuesta en la competitividad, en particular para los sectores que serían los más afectados dado el uso intensivo de los productos energéticos, como el sector del transporte. El objetivo de este estudio es analizar el efecto que la reforma de la directiva sobre los impuestos energéticos podría tener sobre el nivel de precios, en particular en los países de la Unión Europea donde esta reforma implicaría un aumento de los impuestos energéticos. Utilizando datos del proyecto “World Input-Output Database”, la principal conclusión es que el nuevo sistema de impuestos energéticos tendría un impacto muy bajo sobre los precios. Por lo tanto, dado que los precios no serían fuertemente afectados por la reforma, no habrá inconvenientes para la competitividad y implicaciones en términos de distribución, pero, por otro lado, este resultado también implica una baja capacidad de esta reforma para provocar cambios en el consumo y la producción hacia menos presiones ambientales.

Economic ideas and economists in the Parliament in the liberal age: The attempt to implement a tax on incomes in Spain in 1868-1869

[spa] El estudio de la presencia de ideas económicas en los debates parlamentarios se ha convertido recientemente en un objeto importante dentro de la investigación sobre el proceso de institucionalización de la economía política en Europa Occidental en la llamada era liberal. En este marco general, este artículo se centra en el análisis de un caso de particular interés: La relevancia del pensamiento económico y el papel jugado por los economistas en los debates parlamentarios que siguieron a la creación de un nuevo impuesto que trataba de captar la renta personal, que fue lanzado por el ministro de Hacienda Laureano Figuerola en 1868. El artículo intenta demostrar, en primer lugar, que las ideas económicas jugaron efectivamente un papel relevante en las discusiones sobre el impuesto sobre la renta y que la presencia e influencia de los economistas en el Legislativo en este tiempo fue notable. En segundo lugar, que este fue un intento serio de modernizar la estructura fiscal española llevado a cabo por el Gobierno Provisional, el cual trató de diseñar un sistema impositivo capaz de fomentar el crecimiento económico del país.

The reform of the European Energy Tax Directive reform : effect on prices

[spa] Para hacer frente a los riesgos relacionados con la contaminación atmosférica, es ampliamente aceptada la necesidad de instrumentos de política encaminados a reducir las emisiones. La intervención tiene por objeto reducir las conductas contaminantes y incentivar una conducta más respetuosa y el uso de tecnologías más eficientes. La Unión Europea cuenta con dos importantes mecanismos económicos para el control de emisiones a escala europea: la directiva sobre los impuestos energéticos, un instrumento de fiscalidad ambiental aprobado en 2003 que afecta el precio de los productos energéticos, y el sistema de comercio de los derechos de emisiones, introducido en 2005, que afecta directamente a la cantidad de emisiones de CO2. En 2011, la Comisión Europea propuso una nueva versión de la directiva sobre los impuestos energéticos. El objetivo principal de la propuesta es aumentar la eficacia del instrumento a través de una mayor presión fiscal sobre los productos energéticos y de coordinar este instrumento de fiscalidad medioambiental con el sistema de comercio de los derechos de emisiones, para establecer una señal de precio de CO2 coherente para todos los sectores. Sin embargo, en mayo de 2012 el Parlamento Europeo bloqueó la propuesta de la nueva versión del impuesto, y el proceso de actualización se detuvo. La preocupación principal parecía ser el efecto de dicha propuesta en la competitividad, en particular para los sectores que serían los más afectados dado el uso intensivo de los productos energéticos, como el sector del transporte. El objetivo de este estudio es analizar el efecto que la reforma de la directiva sobre los impuestos energéticos podría tener sobre el nivel de precios, en particular en los países de la Unión Europea donde esta reforma implicaría un aumento de los impuestos energéticos. Utilizando datos del proyecto “World Input-Output Database”, la principal conclusión es que el nuevo sistema de impuestos energéticos tendría un impacto muy bajo sobre los precios. Por lo tanto, dado que los precios no serían fuertemente afectados por la reforma, no habrá inconvenientes para la competitividad y implicaciones en términos de distribución, pero, por otro lado, este resultado también implica una baja capacidad de esta reforma para provocar cambios en el consumo y la producción hacia menos presiones ambientales.

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.

Incumbent audit firm-provided tax services and the clients with low financial reporting quality

This study investigates whether incumbent audit firm-provided tax services enhance or impair the likelihood of acknowledging client companies’ low financial reporting quality. In particular, we examine the association between tax-related fees and the likelihood of timely restatements, and internal control weakness disclosures among a sample of US companies that all have misstatements in financial information. The empirical findings indicate that companies paying higher tax-related fees are less likely to disclose SOX 404 internal control weakness disclosures, implying that underlying control problems are unacknowledged when incumbent audit firm provided tax-related fees are higher. However, the findings suggest that just providing both audit and tax-related services does not have an impact on audit quality per se, but rather it is the magnitude of the tax-related fees in particular that counts. We also find some evidence suggesting that companies paying higher tax-related fees have higher likelihood of restatement lags, whereas companies paying smaller tax-related fees to their audit firm restate financial statements in a timelier manner. Overall, the findings suggest that audit scrutiny of client companies with low quality financial reporting is weaker when the magnitude of tax-related fees is higher.

The burden of disease in Spain: results from the global burden of disease study 2010

BackgroundWe herein evaluate the Spanish population¿s trends in health burden by comparing results of two Global Burden of Diseases, Injuries, and Risk Factors Studies (the GBD studies) performed 20 years apart.MethodsData is part of the GBD study for 1990 and 2010. We present results for mortality, years of life lost (YLLs), years lived with disability, and disability-adjusted life years (DALYs) for the Spanish population. Uncertainty intervals for all measures have been estimated.ResultsNon-communicable diseases accounted for 3,703,400 (95% CI 3,648,270¿3,766,720) (91.3%) of 4,057,400 total deaths, in the Spanish population. Cardiovascular and circulatory diseases were the main cause of mortality among non-communicable diseases (34.7% of total deaths), followed by neoplasms (27.1% of total deaths). Neoplasms, cardiovascular and circulatory diseases, and chronic respiratory diseases were the top three leading causes for YLLs. The most important causes of DALYs in 2010 were neoplasms, cardiovascular and circulatory diseases, musculoskeletal disorders, and mental and behavioral disorders.ConclusionsMortality and disability in Spain have become even more linked to non-communicable diseases over the last years, following the worldwide trends. Cardiovascular and circulatory diseases, neoplasms, mental and behavioral disorders, and neurological disorders are the leading causes of mortality and disability. Specific focus is needed from health care providers and policy makers to develop health promotion and health education programs directed towards non-communicable disorders.