Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals

Background: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (3742 weeks) singleton births. Results: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.

Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals

Background: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (3742 weeks) singleton births. Results: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.

Un estudio transversal sobre la percepción de la vitalidad etnolingüística en jóvenes y adultos de Catalunya = A cross-sectional study on ethnolinguistic vitality perception in young and adulthood people from Catalonia

El estudio utiliza un diseño transversal en el campo de la percepción de la vitalidad etnolingüística. Es el primero que compara la percepción de la vitalidad etnolingüística, así como los factores asociados, entre adultos jóvenes y adultos, en relación con los grupos castellanohablantes y catalanohablantes de la Comunidad Autónoma de Cataluña. Para ello, se aplicó el 'Cuestionario de vitalidad etnolingüística subjetiva' (CVS) a una muestra de 527 participantes, 268 jóvenes y 259 adultos, de los cuales se seleccionó una submuestra de individuos que tenían el catalán como lengua materna y se identificaban como catalanes (n=301). En ambas muestras se aduce una tendencia a descriminar favorablemente la vitalidad percibida por el grupo catalán, aspecto que se acentúa significativa en el grupo de jóvenes estudiados en relación al grupo de edad de los adultos. Se discuten los resultados según las repercusiones teóricas y pragmáticas de los estudios realizados en el ámbito de la comunicación intergrupal

El plan de lengua y cohesión social en Catañunya: primeros datos de una investigación = Language and Social Cohesion Plan in Catalonia: Initial research data

Los programas de inmersión lingüística han constituido y constituyen dentro del Sistema Educativo catalánla principal forma para que el alumnado de lengua familiar no-catalana aprenda una nueva lengua, el catalán,sin que, en su proceso de aprendizaje, vea mermado ni el desarrollo de su propia lengua ni su rendimientoacadémico. El éxito de la inmersión lingüística en las décadas anteriores ha sido frecuentemente utilizado comouno de los argumentos orientativos para justificar la política lingüística que se sigue en la escolarización de lainfancia extranjera. Sin embargo, los resultados obtenidos por investigaciones recientes parece que no avalanempíricamente dicho argumento. Este artículo analiza dichos resultados y expone, a partir del Plan para laLengua y Cohesión Social puesto en marcha por el Departamento de Educación de la Generalitat de Cataluña,cuáles son los retos que se presentan a su Sistema Educativo dentro del nuevo marco que supone el aumento de ladiversidad cultural y lingüística en la actual sociedad catalana

Implementing a Cancer Fast-track programme between primary and specialised care in Catalonia(Spain): amixed methods study

BACKGROUND: The Cancer Fast-track Programme's aim was to reduce the time that elapsed between well-founded suspicion of breast, colorectal and lung cancer and the start of initial treatment in Catalonia (Spain). We sought to analyse its implementation and overall effectiveness. METHODS: A quantitative analysis of the programme was performed using data generated by the hospitals on the basis of seven fast-track monitoring indicators for the period 2006-2009. In addition, we conducted a qualitative study, based on 83 semistructured interviews with primary and specialised health professionals and health administrators, to obtain their perception of the programme's implementation. RESULTS: About half of all new patients with breast, lung or colorectal cancer were diagnosed via the fast track, though the cancer detection rate declined across the period. Mean time from detection of suspected cancer in primary care to start of initial treatment was 32 days for breast, 30 for colorectal and 37 for lung cancer (2009). Professionals associated with the implementation of the programme showed that general practitioners faced with suspicion of cancer had changed their conduct with the aim of preventing lags. Furthermore, hospitals were found to have pursued three specific implementation strategies (top-down, consensus-based and participatory), which made for the cohesion and sustainability of the circuits. CONCLUSION: The programme has contributed to speeding up diagnostic assessment and treatment of patients with suspicion of cancer, and to clarifying the patient pathway between primary and specialised care.

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.

Yield in double cropping system as affected by N fertilization rate with pig slurry in a Catalonia dryland region

Intensive swine production is an important agricultural and economical activity in Europe. The high availability of pig slurry (PS) lead to attractive fertilization strategy to reduce costs, therefore is mainly applied as fertilizer in agricultural systems. The optimization N fertilization in these areas should be taken in into to avoid nitrates losses by lixiviation and to achieve maximum efficiency in crop nutrition. Many studies have shown that PS applications can achieve satisfactory yields in different crops by partially or completely replacing synthetic fertilizers. In addition, for the last years, in Northeast Spain (Catalonia) has been widely extended the double-cropping forage system.

Impacts of climate change on water resources in the Mediterranean basin : a case study in Catalonia, Spain

Most climate change projections show important decreases in water availability in the Mediterranean region by the end of this century. We assess those main climate change impacts on water resources in three medium-sized catchments with varying climatic conditions in north-eastern Spain. A combination of hydrological modelling and climate projections with B1 and A2 IPCC emission scenarios is performed to infer future stream flows. The largest reduction (22-48% for 2076-2100) of stream flows is expected in the headwaters of the two wettest catchments, while lower decreases (22-32% for 2076-2100) are expected in the drier one. In all three catchments, autumn and summer are the seasons with the most notable projected decreases in stream flow, 50% and 34%, respectively (2076-2100). Thus, ecological flows might be noticeably impacted by climate change in the catchments, especially in the headwaters of those wet catchments.

Estimation of alluvial recharge in the semiarid

In areas where there is irrigated agriculture, the recuperation of water reserves in alluvial aquifers may occur preferentially due to precipitation. Recharging can be evaluated from variation information of water depth measured in piezometers or observation wells. Thus, the aim of this research is to study the recharge in the alluvial aquifer formed by the Mimoso temporary stream in the semiarid region of Pernambuco (PE), Brazil, using the method of the fluctuation of the water level. This system is typical on the Brazilian Northeast semiarid region, using groundwater for domestic supply and for irrigation on small scale agriculture. Monthly potentiometric levels and rainfall data were used. The selected period for the study, from January 2002 to October 2009, involved extreme events of flooding and droughts as well as regular years, providing a better understanding of the behavior of the alluvial recharge. It was found that the system responds significantly to precipitation events. It was also observed that even with different soil textures in the study area, recharge factors were not significantly different. The study provided a better understanding of the behavior of aquifer recharge and its relationship with the soil and the rainfall events in the region.

Patterns of litter production in a secondary alluvial Atlantic Rain Forest in southern Brazil

Above-ground litter production is one of the most accessible ways to estimate ecosystem productivity, nutrient fluxes and carbon transfers. Phenological patterns and climatic conditions are still not fully explained well for tropical and subtropical forests under less pronounced dry season and non-seasonal climates, as well as the interaction of these patterns with successional dynamics. Monthly litterfall was estimated for two years in a 9 to 10 year old secondary alluvial Atlantic Rain forest. Total litterfall was higher in the site with more developed vegetation (6.4 ± 1.2 ton ha-1 year-1; 95% confidence interval) as compared to the site with less developed vegetation (3.0 ± 1.0 ton ha-1 year-1). The monthly production of 11 litter fractions (eight fractions comprising the leaf litter of the seven main species of the community and other species; reproductive parts, twigs £ 2 cm diameter, and miscellaneous material) were correlated with meteorological variables making possible to identify three patterns of deposition. The main pattern, dominated by leaf-exchanging species, consisted of a cycle with the highest litterfall at the beginning of the rainy season, preceding by basically three months the peaks of the annual cycles of rainfall and temperatures. Other two patterns, dominated by brevi-deciduous species, peaked at the end of the rainy season and at the end of the non-rainy season. Tropical and subtropical dry forests that present the highest leaf fall gradually earlier than rain forests (as the studied sites) are possibly related to the start of senescence process. It seems that such process is triggered earlier by a more severe hydric stress, besides other factors linked to a minor physiological activity of plants that result in abscission.

La Selva Viajera: Rutas del chamanismo ayahuasquero entre Europa y América

Este texto explora una dimensión particular des las prácticas religiosas en migración. El fenómeno chamánico constituye actualmente un paisaje multipolar, atravesado por desplazamientos regulares de expertos en rituales y de practicantes, a la vez que por la mobilidad y la constante reconfiguración de las prácticas rituales. Estas itinerancias y estancias transcontinentales marcan a las comunidades locales, llevándolas hacia una reformulación de sus propios rituales de uso interno o regional. El chamanismo en su versión transcontinental se estructura según un continuum organizacional en diversas escalas que abre, enmarca, y reproduce los itinerarios que relacionan a los territorios del chamanismo habitualmente llamado "étnico" con las recomposiciones urbanas tanto a nivel nacional como internacional. Este continuum se sitúa efectivamente en el cruce de los "chamanismos urbanos" nacionales e internacionales que se construyen alrededor de la doble figura del "indígena" y de la "selva", en cuanto recursos simbólicos revalorizados. Por ende, este texto se propone analizar el papel central de la capacidad chamánica, reclasificada como "saber", para la reformulación el replanteamiento de las jerarquías simbólicas de validez nacional e internacional, instituidas durante la colonización.

Comparison of Model-Based Flow Rate Estimation Methods in Frequency-Converter-Driven Pumps and Fans

Fluid handling systems such as pump and fan systems are found to have a significant potential for energy efficiency improvements. To deliver the energy saving potential, there is a need for easily implementable methods to monitor the system output. This is because information is needed to identify inefficient operation of the fluid handling system and to control the output of the pumping system according to process needs. Model-based pump or fan monitoring methods implemented in variable speed drives have proven to be able to give information on the system output without additional metering; however, the current model-based methods may not be usable or sufficiently accurate in the whole operation range of the fluid handling device. To apply model-based system monitoring in a wider selection of systems and to improve the accuracy of the monitoring, this paper proposes a new method for pump and fan output monitoring with variable-speed drives. The method uses a combination of already known operating point estimation methods. Laboratory measurements are used to verify the benefits and applicability of the improved estimation method, and the new method is compared with five previously introduced model-based estimation methods. According to the laboratory measurements, the new estimation method is the most accurate and reliable of the model-based estimation methods.

An examination of NHL fans' reactions to the cancelled 2004-2005 season

AN EXAMINATION OF NHL FANS' REACTIONS TO THE CANCELLED 2004- 2005 SEASON Chad Asselstine Faculty of Applied Health Sciences, Brock University Gary Bettman, the Commissioner of the National Hockey League (NHL) stepped in front of the worldwide media on February 16, 2005 to announce that there would be no NHL games played during the 2004-2005 season. Two sides were prominent during the labour dispute; the NHL owners and the NHLP A, however a third side that became the forgotten party was the fans (NHLF A, 2005). The fans are the consumers of the NHL and all the brands associated with its franchises, they are the people who provide the revenues that allow owners to pay the players' salaries. The present study is situated within the sport marketing framework, particularly within the fan loyalty literature to provide an understanding of the impact of the 2004- 2005 lockout on the forgotten party, NHL fans. This study examines 16 fans' experiences in four stages: becoming a fan of the NHL, being a fan prior to the lockout, being a fan during the lockout including their anticipated reaction to the return of the NHL, and their actual reaction to the return of the NHL. Data was collected using face-to-face interviews with each ofthe participants, resulting in 16 fans' stories of how the lockout impacted them specifically. Through analysis of the data themes began to emerge including the fans' understanding that there was a need to restructure game play, the business operations of the NHL, a desire for service recovery strategies which would exceed fans' expectations, 4 and the desire for alternative forms of consumption including alternative hockey leagues as well as the growing popularity of poker playing. The study summarizes the effects that the NHL lockout had on the relationship between 16 individual fan~ and their favourite teams, and concludes with Suggestions for Future Research and Implications for Sport Marketers that emerged from this unique case in the history of North American professional sport.

A Study of Nonfans and Fans of the National Lacrosse League's Edmonton Rush

The National Lacrosse League (NLL) is floundering. In an attempt to understand why NLL fans attend games and other sport fans do not, the NLL’s Edmonton Rush were studied. To best address the NLL’s attendance woes, two primary research questions were developed: 1) Why do fans of the Oilers and Oil Kings choose not to attend Edmonton Rush games? 2) Why do fans of the Edmonton Rush attend games? To answer these questions an online focus group along with a document analysis of Rush media, and a telephone interview were used to collect data. The data collection methods mentioned above assisted in answering the primary and secondary research questions, which allowed three major themes along with sub-themes to inductively emerge. The nonfans of the Rush do not attend Rush games because of the connection they have with hockey and the disconnection they have with lacrosse, some are simply not interested or were not entertained, as well as the lack of exposure the Rush receive. The Rush fan participants attend Rush games because of Edmonton community pride, the entertainment value they get out of attending a game, it is a great alternative new sport experience and it either is a substitute or a compliment to hockey. Both the nonfan and fan participants of this study believe that different marketing approaches can be utilized in order to attract nonfans to attend games.

A Study of Female Sport Fans with Respect to Fantasy Sport Participation

Female sport fans make up ~40% of all North American big league sport fans. However, female sport fans make up only 20% of all fantasy sport participants. This study asked: why is there an under-representation of female participation in fantasy sports? In order to answer this question, 35 female sport fans who do not participate in fantasy sports were separated into five focus groups to provide the data necessary for this study. Seven themes emerged to explain why there is an under-representation of female participation in fantasy sports: lack of time, their friends do not play, negative associations, control versus escape, sport statistics, team versus player allegiances, and males acting as gatekeepers. Finally, four recommendations were made for those marketing fantasy sports to female sport fans: increase the overall awareness of fantasy sports, promote the social aspects of fantasy sports, streamline fantasy sports, and promote the ease of use.