Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Obstructive Sleep Apnea Severity and Overnight Body Fluid Shift before and after Hemodialysis.

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea is associated with significantly increased cardiovascular morbidity and mortality. Fluid overload may promote obstructive sleep apnea in patients with ESRD through an overnight fluid shift from the legs to the neck soft tissues. Body fluid shift and severity of obstructive sleep apnea before and after hemodialysis were compared in patients with ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Seventeen patients with hemodialysis and moderate to severe obstructive sleep apnea were included. Polysomnographies were performed the night before and after hemodialysis to assess obstructive sleep apnea, and bioimpedance was used to measure fluid overload and leg fluid volume. RESULTS: The mean overnight rostral fluid shift was 1.27±0.41 L prehemodialysis; it correlated positively with fluid overload volume (r=0.39; P=0.02) and was significantly lower posthemodialysis (0.78±0.38 L; P<0.001). There was no significant difference in the mean obstructive apnea-hypopnea index before and after hemodialysis (46.8±22.0 versus 42.1±18.6 per hour; P=0.21), but obstructive apnea-hypopnea index was significantly lower posthemodialysis (-10.1±10.8 per hour) in the group of 12 patients, with a concomitant reduction of fluid overload compared with participants without change in fluid overload (obstructive apnea-hypopnea index +8.2±16.1 per hour; P<0.01). A lower fluid overload after hemodialysis was significantly correlated (r=0.49; P=0.04) with a lower obstructive apnea-hypopnea index. Fluid overload-assessed by bioimpedance-was the best predictor of the change in obstructive apnea-hypopnea index observed after hemodialysis (standardized r=-0.68; P=0.01) in multivariate regression analysis. CONCLUSIONS: Fluid overload influences overnight rostral fluid shift and obstructive sleep apnea severity in patients with ESRD undergoing intermittent hemodialysis. Although no benefit of hemodialysis on obstructive sleep apnea severity was observed in the whole group, the change in obstructive apnea-hypopnea index was significantly correlated with the change in fluid overload after hemodialysis. Moreover, the subgroup with lower fluid overload posthemodialysis showed a significantly lower obstructive sleep apnea severity, which provides a strong incentive to further study whether optimizing fluid status in patients with obstructive sleep apnea and ESRD will improve the obstructive apnea-hypopnea index.

Localized prostate cancer in Norway, the United States, and Spain: between-country differences of variables before treatment among patients eligible for curative treatment

Between-country differences in medical and sociodemographic variables, and patient-related outcomes (PROs) before treatment might explain published variations of side effects after radical prostatecomy (RP) or radiotherapy (RAD) for prostate cancer (PCa). This hypothesis was tested among 1908 patients from the United States, Spain, and Norway. Significant between-country differences were observed for most factors investigated before treatment. The observations should be considered in comparison of the frequency and severity of internationally published studies. Background: In men with PCa, large variations of PROs after RP or high-dose RAD might be related to betweencountry differences of medical and sociodemographic variables, and differences in PROs before treatment in the sexual and urinary domains. Patients and Methods: In 1908 patients with localized PCa from Norway, the United States, or Spain, the relation between medical (prostate-specific antigen, Gleason score, cT-category) and sociodemographic variables (age, education, marital status) before treatment was investigated. Using the Expanded Prostate Cancer Index Composite questionnaire, PROs before treatment within the sexual and urinary domains were also considered. Results: Compared with the European patients, American patients were younger, fewer had comorbid conditions, and more had a high education level. Fifty-three percent of the US men eligible for RP had low-risk tumors compared with 42% and 31% among the Norwegian and the Spanish patients, respectively. Among the Spanish RAD patients, 54% had had low-risk tumors compared with 34% of the American and 21% of the Norwegian men planned for RAD, respectively. Compared with the European patients, significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups, the number of patients with sexual or urinary dysfunction exceeded that of patients with bother related to the reported dysfunction. Conclusion: Statistically significant between-country differences were observed in medical and sociodemographic variables, and in PROs before treatment within the sexual and urinary domains. Large differences between reported dysfunction and related problems within the sexual and urinary domains indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, might in part explain the large variation of side effects after treatment evident in the medical literature

The Role of Railways in Export-Led Growth: The Case of Uruguay, 1870-1913

The social saving literature has highlighted the indispensable role that railways played before 1914 in several Latin American export-oriented economies, such as Mexico, Brazil and Argentina. The article analyses the case of Uruguay, a country that, by 1914, had built one of the densest railway networks in Latin America. The article shows that, in contrast to what happened in other economies of the region, the resource saving effects of the Uruguayan railways during the first globalisation were tiny due to the small share that railway output accounted for within the country's gross domestic product (GDP). Three complementary reasons are suggested to explain that result, namely: the geographical structure of the country; its sectoral specialisation; and the small scale of the Uruguayan economy. Due to these three characteristics, Uruguay was unable to benefit from railways in the way that other export-oriented Latin American economies did during the first period of globalisation. This conclusion draws attention to the geographic-specific character of railway technology.

A subalpine rangeland bird community before and after fire: prescribed burning in the Eastern Pyrenees

High mountain rangelands host important populations of threatened bird species, but can be affected by extensive changes in land use. I studied the breeding bird community of two shrubland plots at 1,850–2,100 m a.s.l. in the Pyrenees. Breeding territories were mapped for four years, before and after the prescribed burning, the aim of which was to increase the grazing value of the study area. The most abundant species (reaching ≥3 breeding pairs/10 ha in at least one plot and one year) were Dunnock Prunella modularis, Dartford Warbler Sylvia undata, Stonechat Saxicola torquatus, Rock Bunting Emberiza cia and Ortolan Bunting E. hortulana. The open-shrubland plot contained a similar number of breeding species (10 vs.9), but a lower overall density (23 vs. 28 breeding pairs/10 ha) than the dense-shrubland plot. Most breeding species alsooccurred in winter. After fire, the number of bird species, overall density and conservation value (an index that takes into account all species’ densities and their categories of conservation concern in Europe) decreased, but tended to recover afterwards. These results may help understand the composition and dynamics of bird assemblages in managed mountain areas

Anxiety, depression, and attachment before and after the first-trimester screening for Down syndrome: comparing couples who undergo ART with those who conceive spontaneously.

OBJECTIVES: This study's aim was to describe the emotional status of parents to be before and after the first-trimester combined prenatal screening test. METHODS: One hundred three couples participated, of which 52 had undergone an in vitro fertilization/intracytoplasmic sperm injection treatment [assisted reproductive technology (ART)] and 51 had conceived spontaneously. Participants completed the state scale of the State-trait Anxiety Inventory, the Edinburgh Depression Scale, and the Maternal and Paternal Antenatal Attachment Questionnaire before the first-trimester combined prenatal screening test at around 12 weeks of gestational age (T1) and just after receiving the results at approximately 14 weeks of gestational age (T2). RESULTS: We observed a significant decrease in anxiety and depression symptoms and a significant increase in attachment from T1 to T2. Results showed no differences between groups at either time point, which suggests that ART parents are more similar to than different from parents conceiving spontaneously. Furthermore, given the importance of anxiety during pregnancy, a subsample of women with clinical anxiety was identified. They had significantly higher rates of clinical depression and lower attachment. CONCLUSIONS: These results indicate that, regardless of whether conception was through ART or spontaneous, clinical anxiety in women over the prenatal testing period is associated with more vulnerability during pregnancy (i.e. clinical depression and less attachment to fetus). © 2015 John Wiley & Sons, Ltd.

Policy learning in Europe : social policy and labour market reforms in 11 countries

This report compares policy learning processes in 11 European countries. Based on the country reports that were produced by the national teams of the INSPIRES project, this paper develops an argument that connects problem pressure and politicization to learning in different labor market innovations. In short, we argue that learning efforts are most likely to impact on policy change if there is a certain problem pressure that clearly necessitates political action. On the other hand, if problem pressure is very low, or so high that governments need to react immediately, chances are low that learning impacts on policy change. The second part of our argument contends that learning impacts on policy change especially if a problem is not very politicized, i.e. there are no main conflicts concerning a reform, because then, solutions are wound up in the search for a compromise. Our results confirm our first hypothesis regarding the connection between problem pressure and policy learning. Governments learn indeed up to a certain degree of problem pressure. However, once political action becomes really urgent, i.e. in anti-crisis policies, there is no time and room for learning. On the other hand, learning occurred independently from the politicization of problem. In fact, in countries that have a consensual political system, learning occurred before the decision on a reform, whereas in majoritarian systems, learning happened after the adoption of a policy during the process of implementation.

Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care.

UNLABELLED: The aim of this study was to compare perceived barriers to and the most preferred age for successful transition to adult health care between young people with chronic disorders who had not yet transferred from pediatric to adult health care (pre-transfer) and those who had already transferred (post-transfer). In a cross-sectional study, we compared 283 pre-transfer with 89 post-transfer young people, using a 28-item questionnaire that focused on perceived barriers to transition and beliefs about the most preferred age to transfer. Feeling at ease with the pediatrician was the most important barrier to successful transition in both groups, but was rated significantly higher in the pre-transfer compared to the post-transfer group (OR = 2.03, 95 %CI 1.12-3.71). Anxiety and lack of information were the next most important barriers, rated equally highly by the two groups (OR = 0.67, 95 %CI 0.35-1.28 and OR = 0.71, 95 %CI 0.36-1.38, respectively). More than 80 % of the respondents in both groups reported that 16-19 years was the most preferred age to transfer; more than half of all the respondents reported 18-19 years and older as the most preferred age. CONCLUSION: Better transition planning through the provision of regular and more detailed information about adult health-care providers and the transition process could reduce anxiety and contribute to a more positive attitude to overcome perceived barriers to transition from young people's perspective. Young people's preferences about transferring to adult health care provide a challenge to those children's hospitals that transfer to adult health care at a younger age.

Impact of strong psychologically stressful events on the development of Alzheimer disease: a possible role of epigenetic?

Alzheimer disease (AD) is the most common neurodegenerative dementia. It leads to a progressive loss of cognitive functions, especially memory. Most of AD cases are sporadic, resulting from the interplay of genetic and environmental factors which get involved in the regulation of expression of thousands of genes, a mechanism called epigenetic. Epigenetic modifications, by modifying genes transcription, help to orchestrate the phenotypical changes linked to development, aging or even diseases and cancer. In AD, recent studies showed rapid, dynamic and persistent epigenetic mutations that are believed to have consequences on brain functions. One of the earliest biomarker of AD is amylo ̈ıd-beta (Aβ) deposition in the brain. According to current studies, deposition of amylo ̈ıd-beta begins approximately 20 years before the first symptoms linked to the disease which questions us about what could have happened around or before that time. In this exploratory study, we searched if there could be any correlation between the experience of a strong psychologically stressful event in life, which could have lead to several epigenetic changes and therefore the occurrence of Mild Cognitive Impairment (MCI) or AD approximately 30 years later, and to see if there is a difference in the delay between amnestic MCI and AD patients.

Intraregional trade in South America, 1913-50. Economic linkages before institutional agreements

Dejando de lado NAFTA, la integración comercial en América Latina sigue siendo muy moderada hoy en día, representando alrededor del 20% del comercio total. Lo sorprendente es que estos valores eran más altos en 1945. Esto constituye un hecho paradoxal: la integración comercial alcanzó su récord antes de la firma de acuerdos de integración comercial. En el presente trabajo se estudia el comercio intrarregional a lo largo del período de entreguerras (1913-1950) a través del análisis de cinco casos: Argentina, Bolivia, Brasil, Chile y Peru. El análisis de la integración comercial en este período representa una novedad en la literatura, ya que los trabajos sobre América Latina, específicos de comercio intraregional, se centran en el período a partir de la década de 1960. El documento destaca dos conclusiones principales: a) con la excepción de los períodos de las guerras mundiales, el comercio intraregional ha sido muy modesto desde 1913 hasta la actualidad, b) en general, el comercio intrarregional repitió la especialización del comercio mundial: una alta concentración en productos de bajo valor añadido.

Intraregional trade in South America, 1913-50. Economic linkages before institutional agreements

Dejando de lado NAFTA, la integración comercial en América Latina sigue siendo muy moderada hoy en día, representando alrededor del 20% del comercio total. Lo sorprendente es que estos valores eran más altos en 1945. Esto constituye un hecho paradoxal: la integración comercial alcanzó su récord antes de la firma de acuerdos de integración comercial. En el presente trabajo se estudia el comercio intrarregional a lo largo del período de entreguerras (1913-1950) a través del análisis de cinco casos: Argentina, Bolivia, Brasil, Chile y Peru. El análisis de la integración comercial en este período representa una novedad en la literatura, ya que los trabajos sobre América Latina, específicos de comercio intraregional, se centran en el período a partir de la década de 1960. El documento destaca dos conclusiones principales: a) con la excepción de los períodos de las guerras mundiales, el comercio intraregional ha sido muy modesto desde 1913 hasta la actualidad, b) en general, el comercio intrarregional repitió la especialización del comercio mundial: una alta concentración en productos de bajo valor añadido.