Els Itineraris educatius dels joves extutelats a Europa

Dins del 7è Programa marc de la Unió Europea, s'ha endegat un estudi, que va del 2008 al 2010 a cinc països –Regne Unit, Dinamarca, Hongria, Suècia i Espanya (centrat a Catalunya)– que té per objectiu explorar els factors que afavoreixen i ajuden els joves tutelats i extutelats a continuar els seus estudis després de l'escolaritat obligatòria. Cada equip de recerca esta duent a terme un estudi de casos que consisteixen a fer, d'una banda, entrevistes amb responsables de serveis socials i de protecció a la infància, i, d'altra banda, entrevistes en profunditat amb joves d'entre 19 i 21 anys que han estat tutelats almenys un any de la seva vida i que ho estaven a l'edat de 16 anys, i, finalment, entrevistes amb educadors, acollidors o persones que han estat claus a les seves vides. Els joves seleccionats seran entrevistats de nou un any més tard per veure en quina mesura s'han pogut fer els seus plans. L'objectiu del present article és doble: d'una banda, aportar algunes de les dades que s'han obtingut de la primera fase ja conclosa sobre revisió dels estudis existents en aquest àmbit i, de l'altra, obrir un debat, poc present encara al nostre país, que pot culminar el proper març del 2010 amb motiu d'unes jornades a Catalunya on es podran presentar, compartir i debatre els primers resultats de la investigació

Neglected risks, financial innovation, and financial fragility

We present a standard model of financial innovation, in which intermediaries engineer securities with cash flows that investors seek, but modify two assumptions. First, investors (and possibly intermediaries) neglect certain unlikely risks. Second, investors demand securities with safe cash flows. Financial intermediaries cater to these preferences and beliefs by engineering securities perceived to be safe but exposed to neglected risks. Because the risks are neglected, security issuance is excessive. As investors eventually recognize these risks, they fly back to safety of traditional securities and markets become fragile, even without leverage, precisely because the volume of new claims is excessive.

Cost-effectiveness analysis of cardiac resynchronization therapy in patients with NYHA I and NYHA II heart failure in Spain

Objectives: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain. Methods: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient"s management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum. Results: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were 18,431 per LYG and 21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years. Conclusions: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.