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.

Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design

INTRODUCTION: We present the protocol of a large population-based case-control study of 5 common tumors in Spain (MCC-Spain) that evaluates environmental exposures and genetic factors. METHODS: Between 2008-2013, 10,183 persons aged 20-85 years were enrolled in 23 hospitals and primary care centres in 12 Spanish provinces including 1,115 cases of a new diagnosis of prostate cancer, 1,750 of breast cancer, 2,171 of colorectal cancer, 492 of gastro-oesophageal cancer, 554 cases of chronic lymphocytic leukaemia (CLL) and 4,101 population-based controls matched by frequency to cases by age, sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) and from 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociodemographic factors, environmental exposures, occupation, medication, lifestyle, and personal and family medical history. In addition, participants completed a self-administered food-frequency questionnaire and telephone interviews. Blood samples were collected from 76% of participants while saliva samples were collected in CLL cases and participants refusing blood extractions. Clinical information was recorded for cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals. Genotyping was done through an exome array enriched with genetic markers in specific pathways. Multiple analyses are planned to assess the association of environmental, personal and genetic risk factors for each tumor and to identify pleiotropic effects. DISCUSSION: This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancers and will promote cancer research and prevention in Spain.

Public and student awareness science: recreational science as a catalyst

When discussing the traditional and new missions of higher education (1996 Report to UNESCO of the International Commission on Education for the 21st Century) Jacques Delors stated that "Excessive attraction to social sciences has broken equilibrium of available graduates for workforce, thus causing doubts of graduates and employers on the quality of knowledge provided by higher education". Likewise, when discussing the progress of science and technology, the 1998 UNESCO World Conference on Higher Education concluded that "Another challenge concerts the latest advancements of Science, the sine qua non of sustainable development"; and that “with Information Technology, the unavoidable invasion of virtual reality has increased the distance between industrial and developing countries". Recreational Science has a long tradition all over the Educational World; it aims to show the basic aspects of Science, aims to entertain, and aims to induce thinking. Until a few years ago, this field of knowledge consisted of a few books, a few kits and other classical (yet innovative) ways to popularize the knowledge of Nature and the laws governing it. In Spain, the interest for recreational science has increased in the last years. First, new recreational books are being published and found in bookstores. Second the number of Science-related museums and exhibits is increasing. And third, new television shows are produced and new short science-based, superficial sketches are found in variety programs. However, actual programs in Spanish television dealing seriously with Science are scarce. Recreational Science, especially that related to physical phenomena like light or motion, is generally found at Science Museums because special equipment is required. On the contrary, Science related mathematics, quizzes and puzzles use to gather into books, e.g. the extensive collections by Martin Gardner. However, lately Science podcasts have entered the field of science communication. Not only traditional science journals and television channels are providing audio and video podcasts, but new websites deal exclusively with science podcasts, in particular on Recreational Science. In this communication we discuss the above mentioned trends and show our experience in the last two years in participating at Science Fairs and university-sponsored events to attract students to science and technology careers. We show a combination of real examples (e.g., mathemagic), imagination, use of information technology, and use of social networks. We present as well an experience on designing a computational, interactive tool to promote chemistry among high school, prospective students using computers ("Dancing with Bionanomolecules"). Like the concepts related to Web 2.0, it has been already proposed that a new framework for communication of science is emerging, i.e., Science Communication 2.0, where people and institutions develop new innovative ways to explain science topics to diverse publics – and where Recreational Science is likely to play a leading role

The need of sustainable buildings construction in the Kingdom of Bahrain

This thesis is aimed to initiate implementing sustainable building construction in the kingdom of Bahrain, i.e. Building-Integration PhotoVoltaic (BIPV) or Wind Energy (BIWE). It highlights the main constrains that discourage such modern concept in building and construction. Three groups have been questioned using a questionnaire. These are the policy and decision makers, the leading consultants and the contractors. The main constrains of the dissemination of BIVP and BIWE, according to the policy and decision makers, are: lack of knowledge and awareness of the public in sustainable technology, low cost of electricity, low cost of gas and oil and difficulty in applying local environmental taxes. The consultants had attributed the constrains to ignorance of life cycle cost of PV and Wind turbines systems, lack of education and knowledge in sustainable design, political system, shortage of markets importing sustainable technologies and client worries in profitability and pay-back period. The contractors are found to be very enthusiastic and ready to take over any sustainable building project and prefer to have a construction manger to coordinate between the design and contracting team. Design and Build is found the favorable procurement method in Bahrain for conducting BIPV or BIWE projects.

Exposing the myth of the 1:5:200 ratio relating initial cost, maintenance and staffing costs of office buildings

In an attempt to focus clients' minds on the importance of considering the construction and maintenance costs of a commercial office building (both as a factor in staff productivity and as a fraction of lifetime staff costs) there is an often-quoted ratio of costs of 1:5:200, where for every one pound spent on construction cost, five are spent on maintenance and building operating costs and 200 on staffing and business operating costs. This seems to stem from a paper published by the Royal Academy of Engineering, in which no data is given and no derivation or defence of the ratio appears. The accompanying belief that higher quality design and construction increases staff productivity, and simultaneously reduces maintenance costs, how ever laudable, appears unsupported by research, and carries all the hallmarks of an "urban myth". In tracking down data about real buildings, a more realistic ratio appears to depend on a huge variety of variables, as well as the definition of the number of "lifetime" years. The ill-defined origins of the original ratio (1:5:200) describing these variables have made replication impossible. However, by using published sources of data, we have found that for three office buildings, a more realistic ratio is 1:0.4:12. As there is nothing in the public domain about what comprised the original research that gave rise to 1:5:200, it is not possible to make a true comparison between these new calculations and the originals. Clients and construction professionals stand to be misled because the popularity and widespread use of the wrong ratio appears to be mis-informing important investment and policy decisions.

Roman public libraries

This thesis aims to investigate the development and functions of public libraries in Rome and the Roman world. After a preface with maps of libraries in Rome, Section I discusses the precursors for public library provision in the private book collections of Republican Rome, and their transfer into the public domain with the first public libraries of Asinius Pollio and Augustus. Section II contains three 'case studies' of public libraries' different roles. The Augustan library programme is used in Ch.II.l to examine the role of imperial public libraries in literary life and the connections between Rome's libraries and those of Alexandria. Chapter II.2 concentrates on the libraries of Trajan's Forum to explore the intersection of imperial public libraries and monumental public architecture. This chapter responds to an important recent article by arguing for the continued identification of the Forum's libraries with twin brick buildings at its northern end, and suggests a series of correspondences between these libraries and its other monumental components. The conclusions of this chapter are important when considering the public libraries of the wider empire, several of which seem to have been inspired by the Trajanic libraries. Chapter II.3 considers imperial public libraries and leisure by looking at the evidence for libraries within bath-house complexes, concluding that their presence there is consistent with the archaeological and epigraphic evidence and fits in well with what we know of the intellectual and cultural life of these structures. Section III examines various aspects of the practical function of Roman public libraries: their contents (books and archives), division into Latin and Greek sections, provisions for shelving and cataloguing, staff, usership, architectural form, decoration, and housing of works of art. The picture that emerges is of carefully designed and functional buildings intended to sustain public, monumental, and practical functions. Section IV uses a variety of texts to examine the way in which libraries were viewed and used. Ch. IV. 1 discusses the evidence for use of libraries by scholars and authors such as Gellius, Galen, Josephus, and Apuleius. Ch. IV.2 examines parallels between library collections and compendious encyclopaedic elements within Roman literature and considers how library collections came to be canon-forming institutions and vehicles for the expression of imperial approval or disapproval towards authors. The channels through which this imperial influence flowed are investigated in Ch. IV.3, which looks at the directors and staff of the public libraries of Rome. The final section (V) of the thesis concerns public libraries outside the city of Rome. Provincial libraries provide a useful case study in 'Romanisation': they reveal a range of influences and are shown to embody local, personal, and metropolitan imperial identities. There follows a brief conclusion, and a bibliography. There are also five appendices of numismatic and epigraphic material discussed in the text. This material has not been adequately or completely gathered elsewhere and is intended to assist the reader; where appropriate it includes illustrations, transcriptions, and translations.

Decision making process: a comparison between the public and private sector

The problem of decision making, its mechanisms and consequences is the very core of management, it is virtually impossible to separate the act of manage from this knowledge area. As defined by Herbert Simon – "decision making" as though it were synonymous with "managing". A decision is a selection made by an individual regarding a choice of a conclusion about a situation. This represents a course of behavior pertaining to what must be done or what must not be done. A decision is the point at which plans, policies and objectives are translated into concrete actions. Our behavior during decisive moments is closely linked with our brain dominance profile. Over the years, our decision-making processes develop a consistent pattern, which can be described as a decision-making style. Our style is grounded in our preferences, which arise from our brain dominance characteristics […]. The importance of understanding the impact of our thinking preferences and how to improve the effectiveness as a leader of organizations are the main justifications for this thesis; the main problem addressed is the behavioral profile diversity in a selective Master’s cohort formed by students from several different countries. The research methodology approach has been quantitative, through questionnaire administration using the HBDI (Herrmann Brain Dominance Instrument), a validated framework developed by William "Ned" Herrmann when he was the leader of General Electric's Crotonville facility. This questionnaire has been administered in hundreds of thousands professional, enabling the possibility to establish correlations between a certain group and several historical databases. The selected group of analysis is the first cohort (23 students) from the CIM (Corporate International Master's), a joint program between Georgetown University (USA), ESADE (Spain) and FGV (Brazil). Besides decision preferences, the obtained profile enables the discussion on leadership style, heuristic's pitfalls and a base to compare with future cohorts. The fundamental research question is: how diverse is the dominant decision-making profile for the CIM students?

Indoor Air quality related to occupancy at an air-conditioned public building

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Barbados: public-private sector partnership

Includes bibliography

Public policies for the information society: a shared vision?

Includes bibliography

The privatization of public water utilities

Includes bibliography

Report of the AD HOC Expert Group meeting on social exclusion, poverty, inequality, crime and violence: Towardsa research agenda for informed public policy for Caribbean SIDS

The Economic Commission for Latin America and the Caribbean (ECLAC), Subregional Headquarters for the Caribbean convened an expert group meeting on Social Exclusion, Poverty, Inequality – Crime and Violence: Towards a Research Agenda for informed Public Policy for Caribbean SIDS on Friday 4 April 2008, at its conference room in Port of Spain. The meeting was attended by 14 experts drawn from, the University of the West Indies (UWI), St. Augustine, Trinidad and Tobago; and Mona Campus, Jamaica; the St. Georges University, Grenada; the Trinidad and Tobago Crime Commission and the Ministry of Social Development, Government of Trinidad and Tobago and representative of Civil Society from Guyana. Experts from the United Nations System included representatives from the United Nations Fund for Women (UNIFEM), Barbados; the United Nations Development Programme (UNDP), Port of Spain and UNDP Barbados/SRO and the Organisation of Eastern Caribbean States (OECS). The list of participants appears as an annex to this report. The purpose of the meeting was to provide a forum in which differing theories and methodologies useful to addressing the issues of social exclusion, poverty, inequality, crime and violence could be explored. It was expected that at the end of the meeting there would be consensus on areas of research which could be pursued over a two to four-year period by the ECLAC Subregional Headquarters for the Caribbean and its partners, which would lead to informed public policy in support of the reduction of the growing violence in Caribbean society.

Frances Lander Spain Papers - Accession 4

The Frances Lander Spain Papers consists of correspondence, clippings, photographs, memorabilia, and copies of her publications relating to her involvement with professional library organizations such as the American Library Association; her library work in Thailand as a Fulbright and Rockefeller Foundation grantee (1951-1952 and 1964-1965); and her work as coordinator of children’s services at the N.Y. Public Library (1953-1961). Correspondents include librarian Louis Round Wilson. There is also a family history which includes the family names Chambers, Collier, Cook, Crossland, Dantzler, Gran, Hardeman, Lander, McDaniel, McPherson, Miller, Pearce, Pierce, Schenk, Snead, Spain, Sparks, Warlick and Zimmerman.

Risk Factors Associated With the Prevalence of Tuberculosis-Like Lesions in Fenced Wild Boar and Red Deer in South Central Spain

In recent decades the management of large game mammals has become increasingly intensive in south central Spain (SCS), resulting in complex epidemiological scenarios for disease maintenance, and has probably impeded schemes to eradicate tuberculosis (TB) in domestic livestock. We conducted an analysis of risk factors which investigated associations between the pattern of tuberculosis-like lesions (TBL) in wild boar (Sus scrofa) and red deer (Cervus elaphus) across 19 hunting estates from SCS and an extensive set of variables related to game management, land use and habitat structure. The aggregation of wild boar at artificial watering sites was significantly associated with an increasing risk of detecting TBL in both species, which probably relates to enhanced opportunities for transmission. Aggregation of wild boar at feeding sites was also associated with increased risks of TBL in red deer. Hardwood Quercus spp. forest availability was marginally associated with an increased risk of TB in both species, whereas scrubland cover was associated with a reduced individual risk of TBL in the wild boar. It is concluded that management practices that encourage the aggregation of hosts, and some characteristics of Mediterranean habitats could increase the frequency and probability of both direct and indirect transmission of TB. These findings are of concern for both veterinary and public health authorities, and reveal tuberculosis itself as a potential limiting factor for the development and sustainability of such intensive game management systems in Spanish Mediterranean habitats.

For God'sake! Lift the embargo to Spain

Intorno alla metà degli anni trenta la Spagna diventò il centro dell’attenzione del mondo e tutte le grandi potenze internazionali, vecchie e nuove, vennero coinvolte, in misura diversa, nella guerra civile. Già nell’agosto del 1936, un mese dopo l’esplosione del conflitto, tutti gli Stati più rappresentativi caldeggiavano l’ipotesi di una politica comune di “non intervento”. Il ruolo guida in tal senso venne assunto dal governo inglese, capace di dissuadere, in tempi estremamente rapidi, il governo frontista francese di Leon Blum dall’intento di sostenere economicamente e militarmente il legittimo governo repubblicano spagnolo. La preoccupazione che il conflitto potesse degenerare in uno scontro più generale fu quindi la ragione principale per la quale qualche settimana dopo nacque il “Comitato di Non Intervento”, cui aderirono ben ventisette nazioni europee tra cui Francia, Inghilterra, URSS, Italia, Germania e Portogallo. Il mio progetto di ricerca dottorale esamina il ruolo, le scelte ed i relativi dibattiti in merito all’unica grande potenza, gli Stati Uniti d’America, che, pur scegliendo di rimanere neutrale, si astenne dal partecipare al suddetto Comitato. In ambito statunitense particolare rilievo assumono due aspetti del dibattito politico sulla Spagna: il primo maturato in seno all’Amministrazione Roosevelt, il secondo elaborato dalla componente Liberal della coalizione del New Deal attraverso i settimanali, “The Nation” e “The New Republic”. Il confronto pubblico acceso dalla guerra civile spagnola fu infatti l’occasione per la società civile americana per dibattere apertamente e francamente circa l’opportunità e la capacità della nazione di assumere o meno un ruolo internazionale corrispondente al prestigio socio-economico in via di acquisizione a livello mondiale. Approfondire ed esaminare il dibattito sulla guerra civile spagnola negli USA significa dunque andare alla ricerca delle radici culturali di quello che sarà uno dei più vasti ed articolati confronti politici e teorici del ventesimo secolo: l’internazionalismo americano.