Patson Approach versus the Standard Approach for increasing breast reconstruction rates in women undergoing mastectomy. A randomized, controlled, open-label clinical trial

Breast cancer is the most prevalent neoplasm among women in the majority of countries worldwide. Breast cancer treatment include mastectomy which is associated to strong impact in women. Breast reconstruction is an option for many women to re-establish their body image and also to decrease psychological impact. However, breast reconstruction rates are low and many factors are involved in not undergoing breast reconstruction. Patient involvement in the decision-making process increases breast reconstruction rates and is associated to higher satisfaction and less anxiety and depression symptoms. More physician-patient relation and more education in terms of breast reconstruction are needed to achieve our objective. A new approach of medical care, called Patson Approach, is created in order to meet our goal with more patient involvement, as well as, physician and psychological counsellingObjective: to increase breast reconstruction rates in women who are candidates for breast reconstruction after mastectomy and are included in the Patson Approach compared to women included in the Standard ApproachMethods: the study design will be a randomized, controlled, open-label clinical trial. 62 patients will be recruited during two years and randomly divided in two groups, 31 will be included in the Standard Approach and 31 will be included in the Patson Approach. Preoperative and postoperative appointments are established in order to do a follow-up of the patients and collect all the data

Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design

INTRODUCTION: We present the protocol of a large population-based case-control study of 5 common tumors in Spain (MCC-Spain) that evaluates environmental exposures and genetic factors. METHODS: Between 2008-2013, 10,183 persons aged 20-85 years were enrolled in 23 hospitals and primary care centres in 12 Spanish provinces including 1,115 cases of a new diagnosis of prostate cancer, 1,750 of breast cancer, 2,171 of colorectal cancer, 492 of gastro-oesophageal cancer, 554 cases of chronic lymphocytic leukaemia (CLL) and 4,101 population-based controls matched by frequency to cases by age, sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) and from 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociodemographic factors, environmental exposures, occupation, medication, lifestyle, and personal and family medical history. In addition, participants completed a self-administered food-frequency questionnaire and telephone interviews. Blood samples were collected from 76% of participants while saliva samples were collected in CLL cases and participants refusing blood extractions. Clinical information was recorded for cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals. Genotyping was done through an exome array enriched with genetic markers in specific pathways. Multiple analyses are planned to assess the association of environmental, personal and genetic risk factors for each tumor and to identify pleiotropic effects. DISCUSSION: This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancers and will promote cancer research and prevention in Spain.

Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain)

Background: Assessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service. Methods: A retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type. Results: A total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages. Conclusions: This study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

Material flow accounting of Spain

Material throughput is a means of measuring the so-called social metabolism, or physical dimensions of a society’s consumption, and can be taken as an indirect and approximate indicator of sustainability. Material flow accounting can be used to test the dematerialisation hypothesis, the idea that technological progress causes a decrease in total material used (strong dematerialisation) or material used per monetary unit of output (weak dematerialisation). This paper sets out the results of a material flow analysis for Spain for the period from 1980 to 2000. The analysis reveals that neither strong nor weak dematerialisation took place during the period analysed. Although the population did not increase considerably, materials mobilised by the Spanish economy (DMI) increased by 85% in absolute terms, surpassing GDP growth. In addition, Spain became more dependent on external trade in physical terms. In fact, its imports are more than twice the amount of its exports in terms of weight.

Societal metabolism of societies: the bifurcation between Spain and Ecuador

This paper presents an application of the Multiple-Scale Integrated Assessment of Societal Metabolism to the recent economic history of Ecuador and Spain. Understanding the relationship between the Gross Domestic Product (GDP) and the throughput of matter and energy over time in modern societies is crucial for understanding the sustainability predicament as it is linked to economic growth. When considering the dynamics of economic development, Spain was able to take a different path than Ecuador thanks to the different characteristics of its energy budget and other key variables. This and other changes are described using economic and biophysical variables (both extensive and intensive referring to different hierarchical levels). The representation of these parallel changes (on different levels and describable only using different variables) can be kept in coherence by adopting the frame provided by MSIASM.

What is the european social model? an aproximation based on Spanish case

The public perception of the EU in Spain varies greatly. The most positive aspects of Spanish membership are associated with the consolidation of democracy, economic growth, the introduction of the euro, the growth in employment and structural and cohesion funds, the increase in the female participation rate, and the equal opportunities policies. The analysts are in favour of common objectives in the employment policy and multi-level government. The less positive aspects of the EU are the risks of losing social protection and loss of employment in some sectors due to mergers of multinationals and delocalization of companies towards Eastern Europe. The continuous demands for reform of the welfare state, the toughening of the conditions of access to social benefit and the reform of the labour market are also seen as problematic issues. Risks of competitive cuts and social dumping.

The effect of structural fund spending on the spanish regions: an assessment of the 1994-99 objective 1 CSF

This paper analyzes the growth and employment effects of the 1994-99 Community Support Framework (CSF) for the Objective 1 Spanish regions using a simple supply-side model estimated with a panel of regional data. The results suggest that the impact of the Structural Funds in Spain has been quite sizable, adding around a percentage point to annual output growth in the average Objective 1 region and 0.4 points to employment growth. Over the period 1994-2000, the Framework has resulted in the creation of over 300,000 new jobs and has eliminated 20% of the initial gap in income per capita between the assisted regions and the rest of the country.

Economic growth and atmospheric pollution in Spain: discussing the environmental Kuznets curve by hypothesis

The environmental Kuznets curve (EKC) hypothesis posits an inverted U relationship between environmental pressure and per capita income. Recent research has examined this hypothesis for different pollutants in different countries. Despite certain empirical evidence shows that some environmental pressures have diminished in developed countries, the hypothesis could not be generalized to the global relationship between economy and environment at all. In this article we contribute to this debate analyzing the trends of annual emission flux of six atmospheric pollutants in Spain. The study presents evidence that there is not any correlation between higher income level and smaller emissions, except for SO2 whose evolution might be compatible with the EKC hypothesis. The authors argue that the relationship between income level and diverse types of emissions depends on many factors. Thus it cannot be thought that economic growth, by itself, will solve environmental problems.

Employment and public capital in spain

This paper analyses the e¤ects on employment of increasing the stock of public capital. To this end, we derive a wage equation so that wages are endogenized. This allows us to show that, by means of a higher elasticity of labour demand with respect to wages, a rise in public capital increases employment. The estimation of a structural model for the Spanish private sector tests and con…rms empirically this relationship. The results show that an increase in public capital has a significant and positive direct influence on employment, and indirect e¤ects derived from lower wages and higher economic growth. Finally, we undertake a simulation exercise to assess the long run efects on employment and economic growth of increasing public capital.

The Difficult and tortuous path of agricultural cooperative networks in spain, 1890-1935

The rural associationism developed from the last decades of the XIX century could be consider as an answer of the agriculturists to the increasing integration of agriculture in the market, and to the effects of the Great Depression. In the case of Spain, the initiatives in this sense arose with certain delay in relation to the countries of Western Europe. The beginning of the Spanish cooperativism is closely bound to the Law of 1906. It granted the agrarian cooperatives with fiscal exemptions and other types of supports to the associates, although the process did not really accelerate until the promulgation of the law regulation in 1908.

The Total fiscal cost of indirect taxation: an approximation using Catalonia's recent input-output table

In this note we quantify to what extent indirect taxation influences and distorts prices. To do so we use the networked accounting structure of the most recent input-output table of Catalonia, an autonomous region of Spain, to model price formation. The role of indirect taxation is considered both from a classical value perspective and a more neoclassical flavoured one. We show that they would yield equivalent results under some basic premises. The neoclassical perspective, however, offers a bit more flexibility to distinguish among different tax figures and hence provide a clearer disaggregate picture of how an indirect tax ends up affecting, and by how much, the cost structure.

Comparing Governmental Agendas: Evolution of the Prioritization of Issues in the USA and Spain

This paper is the first step in a long term project investigating policy stability and change in Spain from an agenda setting perspective and comparing the Spanish policy agenda to that of other advanced democracies. Here we begin to compare the allocation of issue attention in Spain and the USA by comparing the substance of annual President and Prime Minister speeches from 1982 to 2005. Existing research argues that the public agenda has become more crowded, competitive and volatile in recent years. We find that in both countries there has been a transformation of the political agenda towards an increasing diversity of issues. However, most of the volatility in executive attention seems to be explained by salient events rather than by issue crowding. We conclude by discussing some limitations of executive speeches as a measure of governmental issue attention and directions for future research.

Entrepreneurial intention, cognitive social capital and culture: empirical anaylisis for Spain and Taiwan

The main purpose of this paper is building a research model to integrate the socioeconomic concept of social capital within intentional models of new firm creation. Nevertheless, some researchers have found cultural differences between countries and regions to have an effect on economic development. Therefore, a second objective of this study is exploring whether those cultural differences affect entrepreneurial cognitions. Research design and methodology: Two samples of last year university students from Spain and Taiwan are studied through an Entrepreneurial Intention Questionnaire (EIQ). Structural equation models (Partial Least Squares) are used to test the hypotheses. The possible existence of differences between both sub-samples is also empirically explored through a multigroup analysis. Main outcomes and results: The proposed model explains 54.5% of the variance in entrepreneurial intention. Besides, there are some significant differences between both subsamples that could be attributed to cultural diversity. Conclusions: This paper has shown the relevance of cognitive social capital in shaping individuals’ entrepreneurial intentions across different countries. Furthermore, it suggests that national culture could be shaping entrepreneurial perceptions, but not cognitive social capital. Therefore, both cognitive social capital and culture (made up essentially of values and beliefs), may act together to reinforce the entrepreneurial intention.

Car ownership and access to jobs in Spain

This study analyses the impact that job accessibility in public transport has on car ownership. An ordered probit explaining the number of cars per household is estimated as a function of head of household characteristics, household characteristics and job accessibility. The data used in the analysis come from the Microcensus of year 2001 of the Spanish Institute of Statistics for the areas of Barcelona and Madrid. Our results show a significant effect of accessibility on car ownership. Additionally, we carried out simulation exercises in which the expected number of vehicles decreases as accessibility improves. For instance, in the case of households living outside the central city, an improvement of accessibility up to the average level of the central city would offset the effect of the number of working adults on the expected number of vehicles.

An empirical analysis of wealth taxation: equity Vs.tax compliance

Capital taxation is currently under debate, basically due to problems of administrative control and proper assessment of the levied assets. We analyze both problems focusing on a capital tax, the annual wealth tax (WT), which is only applied in five OECD countries, being Spain one of them. We concentrate our analysis on top 1% adult population, which permits us to describe the evolution of wealth concentration in Spain along 1983-2001. On average top 1% holds about 18% of total wealth, which rises to 19% when tax incompliance and under-assessment is corrected for housing, the main asset. The evolution suggests wealth concentration has risen. Regarding WT, we analyze whether it helps to reduce wealth inequality or, on the contrary, it reinforces vertical inequity (due to especial concessions) and horizontal inequity (due to the de iure and to de facto different treatment of assets). We analyze in detail housing and equity shares. By means of a time series analysis, we relate the reported values with reasonable price indicators and proxies of the propensity to save. We infer net tax compliance is extremely low, which includes both what we commonly understand by (gross) tax compliance and the degree of under-assessment due to fiscal legislation (for housing). That is especially true for housing, whose level of net tax compliance is well below 50%. Hence, we corroborate the difficulties in taxing capital, and so cast doubts on the current role of the WT in Spain in reducing wealth inequality.