Differences in performance for quality of care indicators for acute myocardial infarction (AMI) across various hospital categories in Texas

The study analyzed Hospital Compare data for Medicare Fee-for-service patients at least 65 years of age to determine whether hospital performance for AMI outcome and processes of care measures differ amongst Texas hospitals with respect to ownership status (for profit vs. not-for-profit), academic status (teaching vs. non-teaching) and geographical setting (rural vs. urban). ^ The study found a statistically significant difference between for-profit and not-for-profit hospitals in four process-of-care measures (aspirin at discharge, P=0.028; ACE or ARB inhibitor for LSVD, P=0.048; Smoking cessation advice: P=0.034; outpatients who got aspirin with 24 hours of arrival in the ED, P=0.044). No significant difference in performance was found between COTH-member teaching and non-teaching hospitals for any of the eight process-of-care measures or the two outcome measures for AMI. The study was unable to compare performance based on geographic setting of hospitals due to lack of sufficient data for rural hospitals. ^ The results of the study suggest that for-profit Texas hospitals might be slightly better than not-for –profit hospitals at providing possible heart attack patients with certain processes of care.^

Disparities in foodborne illness in Harris County, Texas, 2005--2010

Using a retrospective cross-sectional approach, this study quantitatively analyzed foodborne illness data, restaurant inspection data, and census-derived socioeconomic and demographic data within Harris County, Texas between 2005 and 2010. The main research question investigated involved determining the extent to which contextual and regulatory conditions distinguish outbreak and non-outbreak establishments within Harris County. Two groups of Harris County establishments were analyzed: outbreak and non-outbreak restaurants. STATA 11 was employed to determine the average profiles of each category across both the regulatory and socioeconomic (contextual) variables. Cross tabulations of all of the non-quantitative variables were also performed, and finally, a discriminant analysis was conducted to assess how well the variables were able to allocate the restaurants into their respective categories. Contextual and regulatory conditions were found to be minimally associated with the occurrence of foodborne outbreaks within Harris County. Across both the categories (outbreak and non-outbreak establishments), variables included were extremely similar in means, and when possible to observe, distributions. The variables analyzed in this study, both regulatory and contextual, were not found to significantly allocate the establishments into their correct outbreak or non-outbreak categories. The implications of these findings are that regulatory processes and guidelines in place in Harris County do not effectively to distinguish outbreak from non-outbreak restaurants. Additionally, no socioeconomic or racial/ethnic patterns are apparent in the incidence of foodborne disease in the county. ^

The cost of insuring the uninsured in the U.S.

Objectives: This study included two overarching objectives. Through a systematic review of the literature published between 1990 and 2012, the first objective aimed to assess whether insuring the uninsured would result in higher costs compared to insuring the currently insured. Studies that quantified the actual costs associated with insuring the uninsured in the U.S. were included. Based upon 2009 data from the Medical Expenditure Panel Survey (MEPS), the second objective aimed to assess and compare the self-reported health of populations with four different insurance statuses. The second part of this study involved a secondary data analysis of both currently insured and currently uninsured individuals who participated in the MEPS in 2009. The null hypothesis was that there were no differences across the four categories of health insurance status for self-reported health status and healthcare service use. The alternative hypothesis was that were differences across the four categories of health insurance status for self-reported health status and healthcare service use. Methods: For the systematic review, three databases were searched using search terms to identify studies that actually quantified the cost of insuring the uninsured. Thirteen studies were selected, discussed, and summarized in tables. For the secondary data analysis of MEPS data, this study compared four categories of health insurance status: (1) currently uninsured persons who will become eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA) healthcare reforms in 2014; (2) currently uninsured persons who will be required to buy private insurance through the PPACA health insurance exchanges in 2014; (3) persons currently insured under Medicaid or SCHIP; and (4) persons currently insured with private insurance. The four categories were compared on the basis of demographic information, health status information, and health conditions with relatively high prevalence. Chi-square tests were run to determine if there were differences between the four groups in regard to health insurance status and health status. With some exceptions, the two currently insured groups had worse self-reported health status compared to the two currently uninsured groups. Results: The thirteen studies that met the inclusion criteria for the systematic review included: (1) three cost studies from 1993, 1995, and 1997; (2) four cost studies from 2001, 2003, and 2004; (3) one study of disabilities and one study of immigrants; (4) two state specific studies of uninsured status; and (5) two current studies of healthcare reform. Of the thirteen studies reviewed, four directly addressed the study question about whether insuring the uninsured was more or less expensive than insuring the currently insured. All four of the studies provided support for the study finding that the cost of insuring the uninsured would generally not be higher than insuring those already insured. One study indicated that the cost of insuring the uninsured would be less expensive than insuring the population currently covered by Medicaid, but more expensive to insure than the populations of those covered by employer-sponsored insurance and non-group private insurance. While the nine other studies included in the systematic review discussed the costs associated with insuring the uninsured population, they did not directly compare the costs of insuring the uninsured population with the costs associated with insuring the currently insured population. For the MEPS secondary data analysis, the results of the chi-square tests indicated that there were differences in the distribution of disease status by health insurance status. As anticipated, with some exceptions, the uninsured reported lower rates of disease and healthcare service use. However, for the variable attention deficit disorder, the uninsured reported higher disease rates than the two insured groups. Additionally, for the variables high blood pressure, high cholesterol, and joint pain, the currently insured under Medicaid or SCHIP group reported a lower rate of disease than the two currently insured groups. This result may be due to the lower mean age of the currently insured under Medicaid or SCHIP group. Conclusion: Based on this study, with some exceptions, the costs for insuring the uninsured should not exceed healthcare-related costs for insuring the currently uninsured. The results of the systematic review indicated that the U.S. is already paying some of the costs associated with insuring the uninsured. PPACA will expand health insurance coverage to millions of Americans who are currently uninsured, as the individual mandate and insurance market reforms will require. Because many of the currently uninsured are relatively healthy young persons, the costs associated with expanding insurance coverage to the uninsured are anticipated to be relatively modest. However, for the purposes of construing these results, it is important to note that once individuals obtain insurance, it is anticipated that they will use more healthcare services, which will increase costs. (Abstract shortened by UMI.)^

Description and analysis of variation in dairy product and concomitant nutrient purchases between Hispanic and non -Hispanic households using a panel of shoppers' purchase records

The purpose of this research was development of a method of estimating nutrient availability in populations as approximated by supermarket purchase records. Demographic information describing 12,516 panel households was obtained from a marketing and advertising program operated by H. E. Butt Grocery Company of San Antonio, Texas. A non-probability sample of 2,161 households meeting expenditure criteria was selected and all purchases of dairy products for this sample of households were organized into a database constructed to facilitate the retrieval, aggregation, and analysis of dairy product purchases and their nutrient contents. Two hypotheses were tested: (1) no difference would be found between Hispanic and non-Hispanic purchases of dairy product categories during the study period and (2) no difference would be found between Hispanic and non-Hispanic purchases of nutrients contained in those dairy products during the thirteen-week study period.^ Food purchase records were used to estimate nutrient exposure on a weekly, per capita basis for Hispanic and non-Hispanic households by linking some 40,000 dairy purchase Universal Product code (UPC) numbers with food composition values contained in USDA Handbook 8-1. Results of this study suggest Hispanic sample households consistently purchased fewer dairy products than did non-Hispanic sample households and consequently had fewer nutrients available from dairy purchases. While weekly expenditures for dairy products among the sample households remained relatively constant during the study period, shifts in the types of dairy products purchased were observed. The effect of ethnicity on dairy product and nutrient purchases was significant over the thirteen-week period. A database consisting of customer, household, and purchase information can be developed to successfully associate food item UPC numbers with a standard reference of food composition to estimate nutrient availability in a population over extended periods of time. ^

Ethnic comparisons of adolescent sexual risk -taking and preventive behavior

For adolescents, unprotected sexual intercourse is the primary cause of sexually transmitted disease (STD), including Human Immunodeficiency Virus (HIV) infection (virus which causes Acquired Immunodeficiency Syndrome (AIDS)), and pregnancy. Although many studies on adolescent sexual behavior have addressed racial/ethnic differences, few studies have examined the relation between race/ethnicity while controlling for other sociocultural and psychosocial variables. The purpose of this study is to examine the relationship between racial/ethnic categories and selected sociocultural and psychosocial variables, with reported adolescent sexual risk-taking and preventive behavior.^ A self-administered questionnaire was used to collect information from 3132 students in a Texas school district (Section 3.5.2). The instrument contained approximately 100 questions on demographic characteristics, sexual behavior, and psychosocial determinants of sexual behavior. Based on the findings of this study, the following major conclusions are made: (1) There are differences in reported sexual risk-taking and preventive behavior among Black, Hispanic and White adolescents in this study. The stratified analysis by gender further suggests significant gender differences in reported sexual behavior among the three racial/ethnic groups. (2) Gender, living arrangement, academic grades, and language spoken at home modified the association between reported sexual risk-taking and preventive behavior and race/ethnicity in this study. This suggests that these sociocultural variables should be considered in future research and practice involving multicultural populations. (3) There are differences in selected psychosocial determinants among the three racial/ethnic groups and between males and females. These differences were consistent with the reported sexual risk-taking and preventive behaviors among race/ethnicity and gender for adolescents in this study. The findings support the consideration of psychosocial determinants in research and interventions addressing adolescent sexual behavior among different racial/ethnic groups.^ Based on the results of this study, two recommendations for practice are made. First, health professionals developing interventions for adolescents from different cultural backgrounds and gender need to be familiar with the specific sociocultural and psychosocial factors which will reduce risky sexual behavior, and promote protective behavior. Second, the need for immediate, realistic, and continuous HIV/STD and pregnancy prevention programs for children and adolescents should be considered. ^

Subprograma de salud bucal "El hospital y los chicos" : del diagnóstico del estado dental a la priorización de programas necesarios

Los objetivos de este trabajo fueron determinar el estado dental de la población bajo estudio, detectar subgrupos de riesgo específico para enfermedades bucales y proponer estrategias de intervención apropiadas para la promoción de la salud bucal para ellos. Método: sobre la base de datos del subprograma de salud bucal "El hospital y los chicos" se efectuó un estudio descriptivo del estado dental sobre 277 niños entre 2 meses y 13 años de edad asistentes al CDlF Nº11, Guaymallén, Mendoza. Se registraron: ceod, CPOD, ceos CPOS, índice de Necesidad de tratamiento de caries, índice de Paca de Silness y Loe, ICDAS II, y datos demográficos. Además, como parte del programa, se llevó a cabo la enseñanza de Técnicas de Higiene Bucal adecuada a la edad, dirigidas a madres y niños, y una topicación de flúor profesional siguiendo protocolos específicos según edad del niño. Resultados: la población libre de caries fue del 31,4%, mientras que el 68,6% tuvo experiencia de caries pasada o presente. La media de la sumatoria de ceod+ cpod fue 4,91 = 5, con una carga de enfermedad muy alta denotada por un componente c+C de 4.25=4.55. Presentó un valor para ceos+CPOS de 9,22+11 96 y de c+CS de 6.8918 61. En cuanto a la severidad de las lesiones de caries expresadas con las categorías de ICDAS II del 2 al 6, se observó que las medias mayores corres- , ponden al nivel 6 (x2 Friedman= 20,999, p= 0,000). La media de necesidad de tratamiento de caries fue de 5,74, pero los niveles 8 y más abarcan al 33.2% de la población de estudio Se observó un aumento progresivo de estos indicadores en la primera infancia comenzando en la primera franja etaria con una media de ceod+CPOD de 0.8811,92, de 3, 93t4.65a los tres años, de 6,38+6,36 a los 5 años, y de 8,40+5,47 a los 7 años, siendo esta población la que presentó el mayor valor del indicador (x2 Kruskall Wallis= 104,637, p=O,OO). El índice CPOD fue de 1,35~1,34 a los 7 años y de 4.65+3 99 a los 9 ( x2 Kruskall Wallis =17,609 y p=0,001) Conclusiones~ este grupo de niños de alto riesgo social presentó elevados índices de caries y de necesidad de tratamiento, que requerirán de un sistema de salud que pueda contenerlos. Al observar las medias de ceod+CPOD según las categorías de edad se pone de manifiesto una tendencia a agravarse el estado dentario en la primera infancia, llegando a valores muy por encima de la media general para los 5, 6 ,7 y 8 años El CEOD también tiende a aumentar con la edad, poniendo en evidencia la susceptibilidad de caries de los molares permanentes erupcionados Las tendencias de los indicadores permitieron reconocer dos subgrupos de riesgo para desarrollar programas preventivos' el de niños de O a 3 años, y el de 6 a 12, es decir niños escolares. Se sugieren dos programas prioritarios Materno- infantil y Protección de 1er molar permanente.

Macroinvertebrate abundance and proportion of trait categories in river biotopes across England and Wales

There is a long tradition of river monitoring using macroinvertebrate communities to assess environmental quality in Europe. A promising alternative is the use of species life-history traits. Both methods, however, have relied on the time-consuming identification of taxa. River biotopes, 1-100 m**2 'habitats' with associated species assemblages, have long been seen as a useful and meaningful way of linking the ecology of macroinvertebrates and river hydro-morphology and can be used to assess hydro-morphological degradation in rivers. Taxonomic differences, however, between different rivers had prevented a general test of this concept until now. The species trait approach may overcome this obstacle across broad geographical areas, using biotopes as the hydro-morphological units which have characteristic species trait assemblages. We collected macroinvertebrate data from 512 discrete patches, comprising 13 river biotopes, from seven rivers in England and Wales. The aim was to test whether river biotopes were better predictors of macroinvertebrate trait profiles than taxonomic composition (genera, families, orders) in rivers, independently of the phylogenetic effects and catchment scale characteristics (i.e. hydrology, geography and land cover). We also tested whether species richness and diversity were better related to biotopes than to rivers. River biotopes explained 40% of the variance in macroinvertebrate trait profiles across the rivers, largely independently of catchment characteristics. There was a strong phylogenetic signature, however. River biotopes were about 50% better at predicting macroinvertebrate trait profiles than taxonomic composition across rivers, no matter which taxonomic resolution was used. River biotopes were better than river identity at explaining the variability in taxonomic richness and diversity (40% and <=10%, respectively). Detailed trait-biotope associations agreed with independent a priori predictions relating trait categories to near river bed flows. Hence, species traits provided a much needed mechanistic understanding and predictive ability across a broad geographical area. We show that integration of the multiple biological trait approach with river biotopes at the interface between ecology and hydro-morphology provides a wealth of new information and potential applications for river science and management.

Migration and Wellbeing at the Lower Echelons of the Economy: A Study of Delhi Slums

This paper based on a primary survey of households (2004-05) in the slum clusters of Delhi examines whether migrants are likely to experience upward mobility in their place of destination or alternatively, if they merely transfer their poverty from rural areas to large cities. First, a simple bifurcation of population in terms of poor and non-poor sub-groups is examined along with the incidence of poverty across different categories of occupations and non-workers. Then, an explanation of the variations in per capita expenditure across households is provided, and a binomial logit model (poor/non-poor) is developed identifying the variables which raise (or reduce) the probability of being non-poor (or poor). Next, an estimate of the wellbeing (deprivation) index is derived from factor analysis of a large number of variables including demographic and economic aspects of households. Empirical findings suggest that while duration of migration and the wellbeing index do not have a definite relationship, migrant households who have been in the city for a very long time have a higher wellbeing index on average than those who migrated in the last ten years. This tends to support the view that migrants do not merely transfer rural poverty to urban areas, and further that population mobility yields improvement in the living standard, if only in the very long term. Implementation of "employment-cum-shelter" support schemes in the urban areas may contribute to their wellbeing.

Análisis de los factores determinantes de la repetición del proceso de compra en el comercio electrónico entre empresas y consumidores finales. Aplicación al mercado español

Las Tecnologías de la Información y la Comunicación en general e Internet en particular han supuesto una revolución en nuestra forma de comunicarnos, relacionarnos, producir, comprar y vender acortando tiempo y distancias entre proveedores y consumidores. A la paulatina penetración del ordenador, los teléfonos inteligentes y la banda ancha fija y/o móvil ha seguido un mayor uso de estas tecnologías entre ciudadanos y empresas. El comercio electrónico empresa–consumidor (B2C) alcanzó en 2010 en España un volumen de 9.114 millones de euros, con un incremento del 17,4% respecto al dato registrado en 2009. Este crecimiento se ha producido por distintos hechos: un incremento en el porcentaje de internautas hasta el 65,1% en 2010 de los cuales han adquirido productos o servicios a través de la Red un 43,1% –1,6 puntos porcentuales más respecto a 2010–. Por otra parte, el gasto medio por comprador ha ascendido a 831€ en 2010, lo que supone un incremento del 10,9% respecto al año anterior. Si segmentamos a los compradores según por su experiencia anterior de compra podemos encontrar dos categorías: el comprador novel –que adquirió por primera vez productos o servicios en 2010– y el comprador constante –aquel que había adquirido productos o servicios en 2010 y al menos una vez en años anteriores–. El 85,8% de los compradores se pueden considerar como compradores constantes: habían comprado en la Red en 2010, pero también lo habían hecho anteriormente. El comprador novel tiene un perfil sociodemográfico de persona joven de entre 15–24 años, con estudios secundarios, de clase social media y media–baja, estudiante no universitario, residente en poblaciones pequeñas y sigue utilizando fórmulas de pago como el contra–reembolso (23,9%). Su gasto medio anual ascendió en 2010 a 449€. El comprador constante, o comprador que ya había comprado en Internet anteriormente, tiene un perfil demográfico distinto: estudios superiores, clase alta, trabajador y residente en grandes ciudades, con un comportamiento maduro en la compra electrónica dada su mayor experiencia –utiliza con mayor intensidad canales exclusivos en Internet que no disponen de tienda presencial–. Su gasto medio duplica al observado en compradores noveles (con una media de 930€ anuales). Por tanto, los compradores constantes suponen una mayoría de los compradores con un gasto medio que dobla al comprador que ha adoptado el medio recientemente. Por consiguiente es de interés estudiar los factores que predicen que un internauta vuelva a adquirir un producto o servicio en la Red. La respuesta a esta pregunta no se ha revelado sencilla. En España, la mayoría de productos y servicios aún se adquieren de manera presencial, con una baja incidencia de las ventas a distancia como la teletienda, la venta por catálogo o la venta a través de Internet. Para dar respuesta a las preguntas planteadas se ha investigado desde distintos puntos de vista: se comenzará con un estudio descriptivo desde el punto de vista de la demanda que trata de caracterizar la situación del comercio electrónico B2C en España, poniendo el foco en las diferencias entre los compradores constantes y los nuevos compradores. Posteriormente, la investigación de modelos de adopción y continuidad en el uso de las tecnologías y de los factores que inciden en dicha continuidad –con especial interés en el comercio electrónico B2C–, permiten afrontar el problema desde la perspectiva de las ecuaciones estructurales pudiendo también extraer conclusiones de tipo práctico. Este trabajo sigue una estructura clásica de investigación científica: en el capítulo 1 se introduce el tema de investigación, continuando con una descripción del estado de situación del comercio electrónico B2C en España utilizando fuentes oficiales (capítulo 2). Posteriormente se desarrolla el marco teórico y el estado del arte de modelos de adopción y de utilización de las tecnologías (capítulo 3) y de los factores principales que inciden en la adopción y continuidad en el uso de las tecnologías (capítulo 4). El capítulo 5 desarrolla las hipótesis de la investigación y plantea los modelos teóricos. Las técnicas estadísticas a utilizar se describen en el capítulo 6, donde también se analizan los resultados empíricos sobre los modelos desarrollados en el capítulo 5. El capítulo 7 expone las principales conclusiones de la investigación, sus limitaciones y propone nuevas líneas de investigación. La primera parte corresponde al capítulo 1, que introduce la investigación justificándola desde un punto de vista teórico y práctico. También se realiza una breve introducción a la teoría del comportamiento del consumidor desde una perspectiva clásica. Se presentan los principales modelos de adopción y se introducen los modelos de continuidad de utilización que se estudiarán más detalladamente en el capítulo 3. En este capítulo se desarrollan los objetivos principales y los objetivos secundarios, se propone el mapa mental de la investigación y se planifican en un cronograma los principales hitos del trabajo. La segunda parte corresponde a los capítulos dos, tres y cuatro. En el capítulo 2 se describe el comercio electrónico B2C en España utilizando fuentes secundarias. Se aborda un diagnóstico del sector de comercio electrónico y su estado de madurez en España. Posteriormente, se analizan las diferencias entre los compradores constantes, principal interés de este trabajo, frente a los compradores noveles, destacando las diferencias de perfiles y usos. Para los dos segmentos se estudian aspectos como el lugar de acceso a la compra, la frecuencia de compra, los medios de pago utilizados o las actitudes hacia la compra. El capítulo 3 comienza desarrollando los principales conceptos sobre la teoría del comportamiento del consumidor, para continuar estudiando los principales modelos de adopción de tecnología existentes, analizando con especial atención su aplicación en comercio electrónico. Posteriormente se analizan los modelos de continuidad en el uso de tecnologías (Teoría de la Confirmación de Expectativas; Teoría de la Justicia), con especial atención de nuevo a su aplicación en el comercio electrónico. Una vez estudiados los principales modelos de adopción y continuidad en el uso de tecnologías, el capítulo 4 analiza los principales factores que se utilizan en los modelos: calidad, valor, factores basados en la confirmación de expectativas –satisfacción, utilidad percibida– y factores específicos en situaciones especiales –por ejemplo, tras una queja– como pueden ser la justicia, las emociones o la confianza. La tercera parte –que corresponde al capítulo 5– desarrolla el diseño de la investigación y la selección muestral de los modelos. En la primera parte del capítulo se enuncian las hipótesis –que van desde lo general a lo particular, utilizando los factores específicos analizados en el capítulo 4– para su posterior estudio y validación en el capítulo 6 utilizando las técnicas estadísticas apropiadas. A partir de las hipótesis, y de los modelos y factores estudiados en los capítulos 3 y 4, se definen y vertebran dos modelos teóricos originales que den respuesta a los retos de investigación planteados en el capítulo 1. En la segunda parte del capítulo se diseña el trabajo empírico de investigación definiendo los siguientes aspectos: alcance geográfico–temporal, tipología de la investigación, carácter y ambiente de la investigación, fuentes primarias y secundarias utilizadas, técnicas de recolección de datos, instrumentos de medida utilizados y características de la muestra utilizada. Los resultados del trabajo de investigación constituyen la cuarta parte de la investigación y se desarrollan en el capítulo 6, que comienza analizando las técnicas estadísticas basadas en Modelos de Ecuaciones Estructurales. Se plantean dos alternativas, modelos confirmatorios correspondientes a Métodos Basados en Covarianzas (MBC) y modelos predictivos. De forma razonada se eligen las técnicas predictivas dada la naturaleza exploratoria de la investigación planteada. La segunda parte del capítulo 6 desarrolla el análisis de los resultados de los modelos de medida y modelos estructurales construidos con indicadores formativos y reflectivos y definidos en el capítulo 4. Para ello se validan, sucesivamente, los modelos de medida y los modelos estructurales teniendo en cuenta los valores umbrales de los parámetros estadísticos necesarios para la validación. La quinta parte corresponde al capítulo 7, que desarrolla las conclusiones basándose en los resultados del capítulo 6, analizando los resultados desde el punto de vista de las aportaciones teóricas y prácticas, obteniendo conclusiones para la gestión de las empresas. A continuación, se describen las limitaciones de la investigación y se proponen nuevas líneas de estudio sobre distintos temas que han ido surgiendo a lo largo del trabajo. Finalmente, la bibliografía recoge todas las referencias utilizadas a lo largo de este trabajo. Palabras clave: comprador constante, modelos de continuidad de uso, continuidad en el uso de tecnologías, comercio electrónico, B2C, adopción de tecnologías, modelos de adopción tecnológica, TAM, TPB, IDT, UTAUT, ECT, intención de continuidad, satisfacción, confianza percibida, justicia, emociones, confirmación de expectativas, calidad, valor, PLS. ABSTRACT Information and Communication Technologies in general, but more specifically those related to the Internet in particular, have changed the way in which we communicate, relate to one another, produce, and buy and sell products, reducing the time and shortening the distance between suppliers and consumers. The steady breakthrough of computers, Smartphones and landline and/or wireless broadband has been greatly reflected in its large scale use by both individuals and businesses. Business–to–consumer (B2C) e–commerce reached a volume of 9,114 million Euros in Spain in 2010, representing a 17.4% increase with respect to the figure in 2009. This growth is due in part to two different facts: an increase in the percentage of web users to 65.1% en 2010, 43.1% of whom have acquired products or services through the Internet– which constitutes 1.6 percentage points higher than 2010. On the other hand, the average spending by individual buyers rose to 831€ en 2010, constituting a 10.9% increase with respect to the previous year. If we select buyers according to whether or not they have previously made some type of purchase, we can divide them into two categories: the novice buyer–who first made online purchases in 2010– and the experienced buyer: who also made purchases in 2010, but had done so previously as well. The socio–demographic profile of the novice buyer is that of a young person between 15–24 years of age, with secondary studies, middle to lower–middle class, and a non–university educated student who resides in smaller towns and continues to use payment methods such as cash on delivery (23.9%). In 2010, their average purchase grew to 449€. The more experienced buyer, or someone who has previously made purchases online, has a different demographic profile: highly educated, upper class, resident and worker in larger cities, who exercises a mature behavior when making online purchases due to their experience– this type of buyer frequently uses exclusive channels on the Internet that don’t have an actual store. His or her average purchase doubles that of the novice buyer (with an average purchase of 930€ annually.) That said, the experienced buyers constitute the majority of buyers with an average purchase that doubles that of novice buyers. It is therefore of interest to study the factors that help to predict whether or not a web user will buy another product or use another service on the Internet. The answer to this question has proven not to be so simple. In Spain, the majority of goods and services are still bought in person, with a low amount of purchases being made through means such as the Home Shopping Network, through catalogues or Internet sales. To answer the questions that have been posed here, an investigation has been conducted which takes into consideration various viewpoints: it will begin with a descriptive study from the perspective of the supply and demand that characterizes the B2C e–commerce situation in Spain, focusing on the differences between experienced buyers and novice buyers. Subsequently, there will be an investigation concerning the technology acceptance and continuity of use of models as well as the factors that have an effect on their continuity of use –with a special focus on B2C electronic commerce–, which allows for a theoretic approach to the problem from the perspective of the structural equations being able to reach practical conclusions. This investigation follows the classic structure for a scientific investigation: the subject of the investigation is introduced (Chapter 1), then the state of the B2C e–commerce in Spain is described citing official sources of information (Chapter 2), the theoretical framework and state of the art of technology acceptance and continuity models are developed further (Chapter 3) and the main factors that affect their acceptance and continuity (Chapter 4). Chapter 5 explains the hypothesis behind the investigation and poses the theoretical models that will be confirmed or rejected partially or completely. In Chapter 6, the technical statistics that will be used are described briefly as well as an analysis of the empirical results of the models put forth in Chapter 5. Chapter 7 explains the main conclusions of the investigation, its limitations and proposes new projects. First part of the project, chapter 1, introduces the investigation, justifying it from a theoretical and practical point of view. It is also a brief introduction to the theory of consumer behavior from a standard perspective. Technology acceptance models are presented and then continuity and repurchase models are introduced, which are studied more in depth in Chapter 3. In this chapter, both the main and the secondary objectives are developed through a mind map and a timetable which highlights the milestones of the project. The second part of the project corresponds to Chapters Two, Three and Four. Chapter 2 describes the B2C e–commerce in Spain from the perspective of its demand, citing secondary official sources. A diagnosis concerning the e–commerce sector and the status of its maturity in Spain is taken on, as well as the barriers and alternative methods of e–commerce. Subsequently, the differences between experienced buyers, which are of particular interest to this project, and novice buyers are analyzed, highlighting the differences between their profiles and their main transactions. In order to study both groups, aspects such as the place of purchase, frequency with which online purchases are made, payment methods used and the attitudes of the purchasers concerning making online purchases are taken into consideration. Chapter 3 begins by developing the main concepts concerning consumer behavior theory in order to continue the study of the main existing acceptance models (among others, TPB, TAM, IDT, UTAUT and other models derived from them) – paying special attention to their application in e–commerce–. Subsequently, the models of technology reuse are analyzed (CDT, ECT; Theory of Justice), focusing again specifically on their application in e–commerce. Once the main technology acceptance and reuse models have been studied, Chapter 4 analyzes the main factors that are used in these models: quality, value, factors based on the contradiction of expectations/failure to meet expectations– satisfaction, perceived usefulness– and specific factors pertaining to special situations– for example, after receiving a complaint justice, emotions or confidence. The third part– which appears in Chapter 5– develops the plan for the investigation and the sample selection for the models that have been designed. In the first section of the Chapter, the hypothesis is presented– beginning with general ideas and then becoming more specific, using the detailed factors that were analyzed in Chapter 4– for its later study and validation in Chapter 6– as well as the corresponding statistical factors. Based on the hypothesis and the models and factors that were studied in Chapters 3 and 4, two original theoretical models are defined and organized in order to answer the questions posed in Chapter 1. In the second part of the Chapter, the empirical investigation is designed, defining the following aspects: geographic–temporal scope, type of investigation, nature and setting of the investigation, primary and secondary sources used, data gathering methods, instruments according to the extent of their use and characteristics of the sample used. The results of the project constitute the fourth part of the investigation and are developed in Chapter 6, which begins analyzing the statistical techniques that are based on the Models of Structural Equations. Two alternatives are put forth: confirmatory models which correspond to Methods Based on Covariance (MBC) and predictive models– Methods Based on Components–. In a well–reasoned manner, the predictive techniques are chosen given the explorative nature of the investigation. The second part of Chapter 6 explains the results of the analysis of the measurement models and structural models built by the formative and reflective indicators defined in Chapter 4. In order to do so, the measurement models and the structural models are validated one by one, while keeping in mind the threshold values of the necessary statistic parameters for their validation. The fifth part corresponds to Chapter 7 which explains the conclusions of the study, basing them on the results found in Chapter 6 and analyzing them from the perspective of the theoretical and practical contributions, and consequently obtaining conclusions for business management. The limitations of the investigation are then described and new research lines about various topics that came up during the project are proposed. Lastly, all of the references that were used during the project are listed in a final bibliography. Key Words: constant buyer, repurchase models, continuity of use of technology, e–commerce, B2C, technology acceptance, technology acceptance models, TAM, TPB, IDT, UTAUT, ECT, intention of repurchase, satisfaction, perceived trust/confidence, justice, feelings, the contradiction of expectations, quality, value, PLS.

Multi-component assessment of chronic obstructive pulmonary disease : an evaluation of the ADO and DOSE indices and the global obstructive lung disease categories in international primary care data sets

Funding The International Primary Care Respiratory Group (IPCRG) provided funding for this research project as an UNLOCK group study for which the funding was obtained through an unrestricted grant by Novartis AG, Basel, Switzerland. The latter funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Database access for the OPCRD was provided by the Respiratory Effectiveness Group (REG) and Research in Real Life; the OPCRD statistical analysis was funded by REG. The Bocholtz Study was funded by PICASSO for COPD, an initiative of Boehringer Ingelheim, Pfizer and the Caphri Research Institute, Maastricht University, The Netherlands.