Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'

The consolidation of a universal health system coupled with a process of regionaldevolution characterise the institutional reforms of the National Health System(NHS) in Spain in the last two decades. However, scarce empirical evidence hasbeen reported on the effects of both changes in health inputs, outputs andoutcomes, both at the country and at the regional level. This paper examinesthe empirical evidence on regional diversity, efficiency and inequality ofthese changes in the Spanish NHS using cross-correlation, panel data andexpenditure decomposition analysis. Results suggest that besides significantheterogeneity, once we take into account region-specific needs there is evidenceof efficiency improvements whilst inequalities in inputs and outcomes, althoughmore visible , do not appear to have increased in the last decade. Therefore,the devolution process in the Spanish Health System offers an interesting casefor the experimentation of health reforms related to regional diversity butcompatible with the nature of a public NHS, with no sizeable regionalinequalitiest.

Skin problems associated with pegylated liposomal doxorubicin-more than palmoplantar erythrodysesthesia syndrome.

Liposomal pegylated doxorubicin is an encapsulation form of doxorubicin, with an improved pharmacokinetic profile and the ability to selectively accumulate into tumor tissue. As a result, the tolerated dose of the drug can be increased, followed by a reduced incidence of neutropenia and cardiotoxicity in comparison to doxorubucin treatment. However, a common adverse dose-schedule limiting effect of the treatment is palmoplantar erythrodysesthesia syndrome. In this retrospective study we included six patients hospitalised in the University Hospital of Zurich during the last 2 years, in connection with side effects caused by pegylated liposomal doxorubicin. These patients received this chemotherapeutic agent for treatment of various malignancies such as breast cancer, ovarian cancer, mycosis fungoides and cutaneous B-cell lymphoma. Three of six patients in this study developed classical palmoplantar erythrodysesthesia, one developed palmoplantar erythrodysesthesia associated with extensive bullous disease, one developed eruption of lymphocyte recovery syndrome and one developed intertrigo like dermatitis with stomatitis. Pegylated liposomal doxorubicin induces various skin reactions including palmoplantar erythrodysesthesia syndrome. However, the exact clinical presentation might depend on pre-existing skin diseases.

Orthoptera assemblages associated with macrophytes of floodplain lakes of the Paraná River

Orthoptera assemblages associated with macrophytes of floodplain lakes of the Paraná River. The Orthoptera assemblage composition varies considerably, depending on habitat type. This study examines the spatiotemporal relationship between plant diversity, hydrometric level, environmental variables and the Orthoptera richness and abundance in floodplain lakes connected permanently or temporarily with the main channel of the Paraná River. The grasshoppers were collected fortnightly (April 2006May 2007). A total of 17 species were recorded and classified according to their frequency of occurrence in constant (7), accessory (4), or accidental (6) species. In the two lakes, the greater species richness and abundance was recorded in summer, thereby coinciding with the highest water level of the Paraná River. The most significant correlation between the orthopteran richness and abundance was with the water level. The aquatic plant richness was significantly different between the lakes, but the vegetation was dominated by Eichhornia crassipes (Mart.) Solms. (Liliales, Pontederiaceae). The lake, which was connected permanently, presented the highest values of diversity and abundance, proving to be a more diverse assemblage. The beta diversity was higher in the temporary connected lake than in the permanently connected one. The orthopterans assemblages were different between the lakes, Cornops aquaticum and Tucayaca gracilis were the species that contributed more to the level of dissimilarity. C. aquaticum was more representative in the lake temporarily connected, while T. gracilis in the permanent connected one. The water level of the Paraná River and the connectivity of the floodplain lakes play an important role to explain the abundance and richness of their orthopteran assemblages.

Mortality associated with diabetes mellitus in comparison with history of cardiovascular disease in older women.

BACKGROUND: Women with diabetes mellitus have an increased risk of cardiovascular disease (CVD) mortality and current treatment guidelines consider diabetes to be equivalent to existing CVD, but few data exist about the relative importance of these risk factors for total and cause-specific mortality in older women. METHODS: We studied 9704 women aged &#8805;65 years enrolled in a prospective cohort study (Study of Osteoporotic Fractures) during a mean follow-up of 13 years and compared all-cause, CVD and coronary heart disease (CHD) mortality among non-diabetic women without and with a prior history of CVD at baseline and diabetic women without and with a prior history of CVD. Diabetes mellitus and prior CVD (history of angina, myocardial infarction or stroke) were defined as self-report of physician diagnoses. Cause of death was adjudicated from death certificates and medical records when available (>95% deaths confirmed). Ascertainment of vital status was 99% complete. Log-rank tests for the rates of death and multivariate Cox hazard models adjusted for age, smoking, physical activity, systolic blood pressure, waist girth and education were used to compare mortality among the four groups with non-diabetic women without CVD as the referent group. Results are reported as adjusted hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: At baseline mean age was 71.7±5.3 years, 7.0% reported diabetes mellitus and 14.5% reported prior CVD. 4257 women died during follow-up, 36.6% were attributed to CVD. The incidence of CVD death per 1000 person-years was 9.9 and 21.6 among non-diabetic women without and with CVD, respectively, and 23.8 and 33.3 among diabetic women without and with CVD, respectively. Compared to nondiabetic women without prior CVD, the risk of CVD mortality was elevated among both non-diabetic women with CVD (HR=1.82, CI: 1.60-2.07, P<0.001) and diabetic women without prior CVD (HR=2.24, CI: 1.87-2.69, P<0.001). CVD mortality was highest among diabetic women with CVD (HR=3.41, CI: 2.61-4.45, P<0.001). Compared to non-diabetic women with CVD, diabetic women without prior CVD had a significantly higher adjusted HR for total and CVD mortality (P<0.001 and P<0.05 respectively). CHD mortality did not differ significantly between non-diabetic women with CVD and diabetic women without prior CVD. CONCLUSION: Older diabetic women without prior CVD have a higher risk of all-cause and CVD mortality and a similar risk of CHD mortality compared to non-diabetic women with pre-existing CVD. For older women, these data support the equivalence of prior CVD and diabetes mellitus in current guidelines for the prevention of CVD.

The Annual Condition of Education Report, 2007

The Annual Condition of Education Report includes an expanded Background Demographics section. This section contains information on population, economic, and social data, providing a comparison between Iowa, other states, and the Nation. Geographic Information System (GIS) maps are presented to allow the reader to easily compare between two or more geographies. In some instances, trends are also reported. Information displayed in this section was obtained from a variety of sources and is noted on each table or figure. In all areas, the most recent data available were used.

The Annual Condition of Education Report, 2008

The Annual Condition of Education Report includes an expanded Background Demographics section. This section contains information on population, economic, and social data, providing a comparison between Iowa, other states, and the Nation. Geographic Information System (GIS) maps are presented to allow the reader to easily compare between two or more geographies. In some instances, trends are also reported. Information displayed in this section was obtained from a variety of sources and is noted on each table or figure. In all areas, the most recent data available were used.

The Annual Condition of Education Report, 2009

The Annual Condition of Education Report includes an expanded Background Demographics section. This section contains information on population, economic, and social data, providing a comparison between Iowa, other states, and the Nation. Geographic Information System (GIS) maps are presented to allow the reader to easily compare between two or more geographies. In some instances, trends are also reported. Information displayed in this section was obtained from a variety of sources and is noted on each table or figure. In all areas, the most recent data available were used.

Entropy of a correlated system of nucleons

Realistic nucleon-nucleon interactions induce correlations to the nuclear many-body system, which lead to a fragmentation of the single-particle strength over a wide range of energies and momenta. We address the question of how this fragmentation affects the thermodynamical properties of nuclear matter. In particular, we show that the entropy can be computed with the help of a spectral function, which can be evaluated in terms of the self-energy obtained in the self-consistent Green's function approach. Results for the density and temperature dependences of the entropy per particle for symmetric nuclear matter are presented and compared to the results of lowest order finite-temperature Brueckner-Hartree-Fock calculations. The effects of correlations on the calculated entropy are small, if the appropriate quasiparticle approximation is used. The results demonstrate the thermodynamical consistency of the self-consistent T-matrix approximation for the evaluation of the Green's functions.

Characterization of the soil fertility and root system of restinga forests

The Restinga vegetation consists of a mosaic of plant communities, which are defined by the characteristics of the substrates, resulting from the type and age of the depositional processes. This mosaic complex of vegetation types comprises restinga forest in advanced (high restinga) and medium regeneration stages (low restinga), each with particular differentiating vegetation characteristics. The climate along the coast is tropical (Köppen). Of all ecosystems of the Atlantic Forest, Restinga is the most fragile and susceptible to anthropic disturbances. Plants respond to soil characteristics with physiological and morphological modifications, resulting in changes in the architecture (spatial configuration) of the root system. The purpose of this study was to characterize the soil fertility of high and low restinga forests, by chemical and physical parameters, and its relation to the root system distribution in the soil profile. Four locations were studied: (1) Ilha Anchieta State Park, Ubatuba; (2) two Ecological Stations of Jureia-Itatins and of Chauás, in the municipality of Iguape; (3) Vila de Pedrinhas in the municipality of Ilha Comprida; and (4) Ilha do Cardoso State Park, Cananeia. The soil fertility (chemical and physical properties) was analyzed in the layers 0-5, 0-10, 0-20, 20-40 and 40-60 cm. In addition, the distribution of the root system in the soil profile was evaluated, using digital images and the Spring program. It was concluded that the root system of all vegetation types studied is restricted to the surface layers, 0-10 and 10-20 cm, but occupies mainly the 0-10 cm layer (70 %); that soil fertility is low in all environments studied, with base saturation values below 16 %, since most exchange sites are occupied by aluminum; and that restinga vegetation is edaphic.

Solvable dynamics in a system of interacting random tops

A new solvable model of synchronization dynamics is introduced. It consists of a system of long range interacting tops or magnetic moments with random precession frequencies. The model allows for an explicit study of orientational effects in synchronization phenomena as well as nonlinear processes in resonance phenomena in strongly coupled magnetic systems. A stability analysis of the incoherent solution is performed for different types of orientational disorder. A system with orientational disorder always synchronizes in the absence of noise.

Postmortem pump-driven reperfusion of the vascular system of porcine lungs: towards a new model for surgical training.

PURPOSE: The objective of this experiment is to establish a continuous postmortem circulation in the vascular system of porcine lungs and to evaluate the pulmonary distribution of the perfusate. This research is performed in the bigger scope of a revascularization project of Thiel embalmed specimens. This technique enables teaching anatomy, practicing surgical procedures and doing research under lifelike circumstances. METHODS: After cannulation of the pulmonary trunk and the left atrium, the vascular system was flushed with paraffinum perliquidum (PP) through a heart-lung machine. A continuous circulation was then established using red PP, during which perfusion parameters were measured. The distribution of contrast-containing PP in the pulmonary circulation was visualized on computed tomography. Finally, the amount of leak from the vascular system was calculated. RESULTS: A reperfusion of the vascular system was initiated for 37 min. The flow rate ranged between 80 and 130 ml/min throughout the experiment with acceptable perfusion pressures (range: 37-78 mm Hg). Computed tomography imaging and 3D reconstruction revealed a diffuse vascular distribution of PP and a decreasing vascularization ratio in cranial direction. A self-limiting leak (i.e. 66.8% of the circulating volume) towards the tracheobronchial tree due to vessel rupture was also measured. CONCLUSIONS: PP enables circulation in an isolated porcine lung model with an acceptable pressure-flow relationship resulting in an excellent recruitment of the vascular system. Despite these promising results, rupture of vessel walls may cause leaks. Further exploration of the perfusion capacities of PP in other organs is necessary. Eventually, this could lead to the development of reperfused Thiel embalmed human bodies, which have several applications.

Estimating and explaining the effect of education and income on head and neck cancer risk : INHANCE consortium pooled analysis of 31 case-control studies from 27 countries

Low socioeconomic status has been reported to be associated with head and neck cancer risk. However, previous studies have been too small to examine the associations by cancer subsite, age, sex, global region, and calendar time, and to explain the association in terms of behavioural risk factors. Individual participant data of 23,964 cases with head and neck cancer and 31,954 controls from 31 studies in 27 countries pooled with random effects models. Overall, low education was associated with an increased risk of head and neck cancer (OR = 2·50; 95%CI 2·02- 3·09). Overall one-third of the increased risk was not explained by differences in the distribution of cigarette smoking and alcohol behaviours; and it remained elevated among never users of tobacco and non-drinkers (OR = 1·61; 95%CI 1·13 - 2·31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviours: in women than in men, in older than younger groups, in the oropharynx than in other sites, in South/Central America than in Europe/North America, and was strongest in countries with greater income inequality. Similar findings were observed for the estimated effect of low vs high household income. The lowest levels of income and educational attainment were associated with more than 2-fold increased risk of head and neck cancer, which is not entirely explained by differences in the distributions of behavioural risk factors for these cancers, and which varies across cancer sites, sexes, countries, and country income inequality levels. © 2014 Wiley Periodicals, Inc.

The Annual Condition of Education Report, 2010

The Annual Condition of Education Report includes an expanded Background Demographics section. This section contains information on population, economic, and social data, providing a comparison between Iowa, other states, and the Nation. Geographic Information System (GIS) maps are presented to allow the reader to easily compare between two or more geographies. In some instances, trends are also reported. Information displayed in this section was obtained from a variety of sources and is noted on each table or figure. In all areas, the most recent data available were used.

The Annual Condition of Education Report, 2011

The Annual Condition of Education Report includes an expanded Background Demographics section. This section contains information on population, economic, and social data, providing a comparison between Iowa, other states, and the Nation. Geographic Information System (GIS) maps are presented to allow the reader to easily compare between two or more geographies. In some instances, trends are also reported. Information displayed in this section was obtained from a variety of sources and is noted on each table or figure. In all areas, the most recent data available were used.

The Annual Condition of Education Report, 2012

The Annual Condition of Education Report includes an expanded Background Demographics section. This section contains information on population, economic, and social data, providing a comparison between Iowa, other states, and the Nation. Geographic Information System (GIS) maps are presented to allow the reader to easily compare between two or more geographies. In some instances, trends are also reported. Information displayed in this section was obtained from a variety of sources and is noted on each table or figure. In all areas, the most recent data available were used.