Lien entre durée de séjour et réadmissions en chirurgie et en obstétrique: étude de deux procédures à partir des données du PMSI = Using administrative data to assess the impact of length of stay on readmissions: study of two procedures in surgery and obstetrics

Position du problème: La mise en place de la tarification à l'activité pour les hôpitaux de court séjour pourrait entraîner une diminution des durées de séjour pour raisons financières. L'impact potentiel de ce phénomène sur la qualité des soins n'est pas connu. Les réadmissions identifiées à l'aide des données administratives hospitalières sont, pour certaines situations cliniques, des indicateurs de qualité des soins valides. Méthode: Étude rétrospective du lien entre la durée de séjour et la survenue de réadmissions imprévues liées au séjour initial, pour les cholécystectomies simples et les accouchements par voie basse sans complication, à partir des données du programme de médicalisation des systèmes d'information de l'Assistance publique-Hôpitaux de Paris des années 2002 à 2005. Résultats: Pour les deux procédures, la probabilité de réadmission suit une courbe en " J ". Après ajustement sur l'âge, le sexe, les comorbidités associées, l'hôpital et l'année d'admission, la probabilité de réadmission est plus élevée pour les durées de séjour les plus courtes : pour les cholécystectomies, odds ratio : 6,03 [IC95 % : 2,67-13,59] pour les hospitalisations d'un jour versus trois jours ; pour les accouchements, odds ratio : 1,74 [IC95 % : 1,05-2,91] pour les hospitalisations de deux jours versus trois jours. Conclusion: Pour deux pathologies communes, les durées de séjour les plus courtes sont associées à des probabilités de réadmission plus élevées. L'utilisation routinière des données du programme de médicalisation des systèmes d'information peut permettre d'assurer le suivi de la relation entre la réduction de la durée de séjour et les réadmissions. The prospective payment system for the French short-stay hospitals creates a financial incentive to reduce length of stay. The potential impact of the resulting decrease in length of stay on the quality of healthcare is unknown. Readmission rates are valid outcome indicators for some clinical procedures. Methods: Retrospective study of the association between length of stay and unplanned readmissions related to the initial stay, for two procedures: cholecystectomy and vaginal delivery. Data: Administrative diagnosis-related groups database of "Assistance publique-Hopitaux de Paris", a large teaching hospital, for years 2002 to 2005. Results: The risk of readmission according to length of stay, taking age, sex, comorbidity, hospital and year of admission into account, followed a J-shaped curve for both procedures. The probability of readmission was higher for very short stays, with odds ratios and 95% confidence intervals of 6.03 [2.67-13.59] for cholecystectomies (1- versus 3-night stays), and of 1.74 [1.05-2.91] for vaginal deliveries (2- versus 3-night stays). Conclusion: For both procedures, the shortest lengths of stay are associated with a higher readmission probability. Suitable indicators derived from administrative databases would enable monitoring of the association between length of stay and readmissions.

Irak y el club europeo: ¿cuál de ellos?

El pasado 27 de enero, el Consejo de Asuntos Generales y de Relaciones Exteriores de la Unión tomó una decisión altamente significativa para el desarrollo del papel exterior de la Unión: su primera operación militar. Las páginas de la prensa dedicaban, sí lo hacían, unas pocas líneas a la operación de mantenimiento de la paz que la UE llevará a cabo en Macedonia a partir de la próxima primavera. La una de la prensa estaba ocupada por el hecho de que los Quince estaban más desunidos que nunca, a causa de la actual crisis internacional. De ahí que en la misma reunión tan sólo hubieran sido capaces de producir una declaración relativa a la situación en Irak de “minimísimo común denominador”, cuyo eje central son dos temas indiscutibles: la obligación de Irak de cooperar con los inspectores y el papel del Consejo de Seguridad como responsable del matenimiento de la paz y de la seguridad...

Impacte econòmic de les relacions entre Taiwan i la República Popular de la Xina (1987-2010)

El treball es centra en analitzar els efectes generats per la relació política entre Taiwan i la Xina sobre la seva relació econòmica i comercial durant el període comprés entre 1987 i 2010.

Gendered networks and Mexican migration

In this paper, we investigate how the gendered origin of migrant networks (i.e. matrilineal vs. patrilineal) is associated with aspirations to migrate and subsequent migration behavior. Using longitudinal data from the Mexican Family Life Survey (MxFLS), we follow 3,923 married couples across 139 municipalities over the 2002-2005 period. We find that the networks of both the individual and her/his spouse are associated with aspiring to migrate to the United States. However, one’s own network matters most (i.e. matrilineal networks for women and patrilineal networks for men). On the other hand, in terms of behavior, only matrilineal networks predict a subsequent move to the U.S. for men and women/couples, who are assessed jointly. These findings suggest that our understanding of the role of migrant networks in perpetuating male-centered, labor migration does not necessarily translate once a union has formed. We make the case that future work would do well to account for not only the presence and composition of networks, but also their origin, which in certain circumstances may be the most relevant factor.

The interaction of ownership structure and customer satisfaction as determinants of brand equity

In this paper we study the interaction between ownership structure and customer satisfaction, and their impact on a firm's brand equity. We find that customer satisfaction has a positive direct effect on brand equity but an indirect negative one, through reductions in ownership concentration. This latter effect emerges when managers are focused mainly on satisfying customers. It gives out a warning signal that highlights the perverse effect of implementing policies focused excessively on satisfying customers at the expense of shareholders, on a firm's brand equity. We demonstrate our theoretical contention, empirically, making use of an incomplete panel data comprising 69 firms from 11 different nations for the period 2002-2005.

Análise da Cobertura Vacinal em Crianças Menores de Um ano na Ilha de Santiago -Cabo Verde

O Programa Alargado de Vacinação em Cabo Verde foi iniciado em 1977, com apoio da Organização Sueca para a Proteção das Crianças ( Rädda Barnen). Desde o ano 2000, a meta a ser atingida em cobertura vacinal para as crianças menores de um ano, tem sido de 90%, mas os resultados têm-se revelado aquém do estipulado (dados administrativos) com oscilações nas taxas de cobertura para todas as vacinas. Esta pesquisa surgiu devido a inquietação quanto a cobertura para cada vacina, não corresponder aos parâmetros estabelecido pelo Programa Alargado de Vacinação, dando origem a este estudo que tem como objetivo analisar a cobertura vacinal numa tendência temporal, 2006 – 2010, e comparar os resultados dos dados administrativos e os obtidos, pelos inquéritos de cobertura vacinal realizados nos anos de 1999, 2002, 2005, 2009 e 2011, na ilha de Santiago – Cabo Verde. Quanto a metodologia trata-se de uma pesquisa quantitativa, descritiva e retrospetiva, de análise documental, que levará em conta as taxas de cobertura vacinal em crianças menores de um ano de 2006 a 2010 na Ilha de Santigo em Cabo Verde e compara os resultados por diferentes fontes: o método administrativo com dados de rotina do Programa Alargado de Vacinação, usando os denominadores das Projeções demográficas do Instituto Nacional de Estatísticas de Cabo Verde, e o método de amostras por conglomerados adotado pela Organização Mundial da Saúde. Os resultados obtidos deverão ser utilizados na implementação de estratégias a adotar para a melhoria dos processos de recolha, tratamento e análise dos dados de cobertura vacinal, do Programa Alargado de Vacinação.

Ownership structure, customer satisfaction and brand equity

This paper studies the interaction between ownership structure, taken as a proxy for shareholders commitment, and customer satisfaction - the main driver of consumer loyalty - and their impact on a firm s brand equity. The results show that customer satisfaction has a positive direct effect on brand equity but an indirect negative one because of reductions in ownership concentration. This latter effect emerges when managers are mainly customer-oriented. Such result gives out a warning signal that highlights the perverse effect of implementing policies, focused excessively on satisfying customers at the expense of shareholders, on a firm s brand equity. The empirical analysis uses an incomplete panel data comprising 69 firms from 11 nations, for the period 2002-2005.

Iowa Plan for Brain Injury, 2007-2010

Traumatic Brain Injury (TBI) impacts the lives of thousands of Iowans every year. TBI has been described as the “Silent Epidemic” because so often the scars are not visible to others. The affects of brain injury are cognitive, emotional, social, and can result in physical disability. In addition to the overwhelming challenges individuals with brain injury experience, families also face many difficulties in dealing with their loved one’s injury, and in navigating a service delivery system that can be confusing and frustrating. In 1998, the Iowa Department of Public Health (IDPH) conducted a comprehensive statewide needs assessment of brain injury in Iowa. This assessment led to the development of the first Iowa Plan for Brain Injury, “Coming Into Focus.” An updated state plan, the Iowa Plan for Brain Injuries 2002 – 2005, was developed, which reported on progress of the previous state plan, and outlined gaps in service delivery in Iowa. Four areas of focus were identified by the State Plan for Brain Injuries Task Force that included: 1) Expanding the Iowa Brain Injury Resource Network (IBIRN); 2) Promoting a Legislative and Policy Agenda, While Increasing Legislative Strength; 3) Enhancing Data Collection; and, 4) Increasing Funding. The IDPH utilized “Coming Into Focus” as the framework for an application to the federal TBI State Grant Program, which has resulted in more than $900,000 for plan implementation. Iowa continues to receive grant dollars through the TBI State Grant Program, which focuses on increasing capacity to serve Iowans with brain injury and their families. Highlighting the success of this grant project, in 2007 the IDPH received the federal TBI Program’s “Impacting Systems Change” Award. The Iowa Brain Injury Resource Network (IBIRN) is the product of nine years of TBI State Grant Program funding. The IBIRN was developed to ensure that Iowans got the information and support they needed after a loved one sustained a TBI. It consists of a hospital and service provider pre-discharge information and service linkage process, a resource facilitation program, a peer-to-peer volunteer support network, and a service provider training and technical assistance program. Currently over 90 public and private partners work with the IDPH and the Brain Injury Association of Iowa (BIA-IA) to administer the IBIRN system and ensure that families have a relevant and reliable location to turn for information and support. Further success was accomplished in 2006 when the Iowa legislature created the Brain Injury Services Program within the IDPH. This program consists of four components focusing on increasing access to services and improving the effectiveness of services available to individuals with TBI and their families, including: 1) HCBS Brain Injury Waiver-Eligible Component; 2) Cost Share Component; 3) Neuro-Resource Facilitation; and, 4) Enhanced Training. The Iowa legislature appropriated $2.4 million to the Brain Injury Services Program in state fiscal year (SFY) 2007, and increased that amount to $3.9 million in SFY 2008. The Cost Share Component models the HCBS Brain Injury Waiver menu of services but is available for Iowans who do not qualify functionally or financially for the Waiver. In addition, the Neuro-Resource Facilitation program links individuals with brain injury and their families to needed supports and services. The Iowa Plan for Brain Injury highlights the continued need for serving individuals with brain injury and their families. Additionally, the Plan outlines the paths of prevention and services, which will expand the current system and direct efforts into the future.

Intégrer le genre dans la formation médicale prégraduée: peut-on transférer l'expérience néerlandaise sur sol suisse ? Etude exploratoire menée au sein de l'École de médecine de l'Université de Lausanne (FBM/UNIL) pour l'année académique 2009-2010

[Table des matières] Résumé. Zusammenfassung. 1. Introduction. 2. Intégrer le genre dans les études de médecine : la " Success Story " néerlandaise. 2.1 En amont du projet national de 2002-2005. 2.1.1 L'étude pilote menée à l'Université Radboud à la fin des années 1990. 2.2 Integrating Gender into the Core Curriculum: le déroulement du projet national (2002-2005). 3. Enseignement prégradué en médecine à Lausanne: quelle place pour le genre ? Etat des lieux pour l'année académique 2009-2010. 3.1 Inventaire: quelques fleurs dans le désert ? 3.2 La situation lausannoise à l'aune des exigences du projet néerlandais. 3.3 L'organisation de l'enseignement à l'École de médecine de Lausanne suite à la réforme des années 2000. 3.4 Le développement des études genre à l'Université de Lausanne et en Suisse: quel impact sur la médecine ? 4. Inclure le genre dans les études prégraduées de médecine : le cadre au niveau suisse. 4.1 Quelles possibilités de soutien au niveau des instruments nationaux de pilotage de la formation médicale prégraduée ? 5. Quelles possibilités de transfert ? Des questions pour l'avenir. 5.1 Comment transférer l'expérience néerlandaise? 5.2 Quelles activités pourraient être entreprises au niveau national ? 6. Annexes.

Cobertura y desamparo: garantías jurídicas de los españoles en el Perú (1870-1945) = Coverage and helplessness: legal guarantees of the spanish in Peru (1870-1945)

The archives of the Prefecture of the Peruvian Ministry of Foreign Affairs provide a perspective from which to reconstruct the broad range of legal circumstances in which Spanish residents in various regions of the country find themselves immersed (assets of relatives who have died without wills or family in Peru, political conflicts, legal problems -whether criminal or civil as a result of business activities- or the requested intervention ofconsular authorities when decisions considered detrimental to their compatriots are made by prefects and sub-prefects). The legal framework protecting Spanish nationals in Peru is analysed to understand the mechanisms of immigration in the country and the mechanisms that led them to keep their Spanish nationality, even after establishing wide-reaching family and business interests

Summer ozone cycles in the Lisbon metropolitan area and its relation to some meteorological variables

The aim of this work is to study the tropospheric ozone concentrations and daily peak cycles in the Lisbon MetropolitanArea (LMA) during the summer season (June, July and August, JJA) covering the 4-yr study period 2002-2005. Theresults show that all the stations have the same pattern: a minimum in the early morning followed by an increase at 1000UTC reaching to a peak at 1300-1400 UTC, dropped again to minimum values 1800 UTC but with different concentrationsdue to regional and local wind circulations and complex dynamic interactions. We identified in Lisbon city the ozone “weekendeffect”. Finally, we studied an episode of very high levels of tropospheric ozone and related daily ozone concentrationswith some meteorological variables.

Variabilidade genética da raça Brahman no Brasil detectada por meio de análise de pedigree

O objetivo deste trabalho foi analisar a variabilidade genética da raça Brahman no Brasil, por meio da análise de 15.851 pedigrees. O arquivo de dados foi dividido em dois períodos: 1998-2001 e 2002-2005. A variabilidade genética foi avaliada por parâmetros baseados na probabilidade de origem do gene: número efetivo de ancestrais, número efetivo de fundadores, número efetivo de genomas remanescentes e coeficientes de parentesco e de endogamia. Os valores encontrados quanto ao número de fundadores mostraram que a população está em expansão, embora o número efetivo de fundadores tenha diminuído de um período para outro. Os resultados foram diferentes em relação ao número de ancestrais e genomas remanescentes, que apresentaram crescimento de 23% nos períodos avaliados. O coeficiente de endogamia diminuiu nos períodos estudados, porém o coeficiente de parentesco "inter se" cresceu. Poucos ancestrais apresentaram grande contribuição genética para a população, o que evidencia a utilização de poucos indivíduos na reprodução. A raça Brahman, no Brasil, encontra-se em expansão, caracterizada pela diminuição do coeficiente de endogamia e aumento nos números efetivos de fundadores e de genótipos remanescentes. Entretanto, a variabilidade genética da raça mostra aumento do parentesco "inter se" e grande concentração do patrimônio genético de poucos indivíduos na população.

Uso del fuego prescrito para la creación de rodales cortafuegos: estudio del caso de Las Mesas de Ana López, Vega de San Mateo, Gran Canaria (España)

Los regímenes de fuegos forestales están cambiando en Gran Canaria y los grandes incendios forestales son más probables que antiguamente. Esto es un cambio importante en el régimen de perturbaciones y una grave amenaza a la biodiversidad. El Plan de Prevención de Incendios Forestales de Gran Canaria, año 2002 dejó clara la obligación de cambiar las estructuras de vegetación de la Isla en dos ámbitos: paisaje y protección de zonas sensibles. El uso de fuego prescrito (años 2002-2005) ha resultado ser una herramienta especialmente eficiente en este ámbito y muy adecuada para compatibilizar las acciones de prevención de incendios con el mantenimiento de los procesos ecológicos. Estas primeras experiencias en Gran Canaria muestran la idoneidad de los tratamientos para establecer rodales resistentes al paso del fuego en zonas estratégicas (deducidas tras simulación con Farsite y FlamMap). Y revelan lo conveniente que es que estos rodales resistentes estén distribuidos por nuestros montes de modo que los incendios potencialmente grandes encuentren zonas en las que sea factible controlar los perímetros. Este control se pudo hacer eficientemente en el incendio de las Mesas de 17 de agosto de 2004.

Asia Central: regímenes políticos y contexto socioeconómico

El objeto del presente artículo es analizar los sistemas políticos y sociales de las cinco repúblicas independientes que constituyen Asia Centra1, tomada como un todo, pero haciendo hincapié cuando sea pertinente en las peculiaridades de cada situación. Dividimos el trabajo en tres grandes partes, relativas respectivamente a la caracterización de los regímenes políticos de estos países, su situación socioeconómica y la orientación de sus relaciones exteriores.