The evolution of inequity in the access to health care in Spain: 1987-2001

This paper reports an analysis of the evolution of equity in access to health care in Spain over the period 1987-2001, a time span covering the development of the modern Spanish National Health System. Our measures of access are the probabilities of visiting a doctor, using emergency services and being hospitalised. For these three measures we obtain indices of horizontal inequity from microeconometric models of utilization that exploit the individual information in the Spanish National Health Surveys of 1987 and 2001. We find that by 2001 the system has improved in the sense that differences in income no longer lead to different access given the same level of need. However, the tenure of private health insurance leads to differences in access given the same level of need, and its contribution to inequity has increased over time, both because insurance is more concentrated among the rich and because the elasticity of utilization for the three services has increased too.

One hundred issues of Revista Española de Financiación y Contabilidad (REFC)-insights into trends in the Spanish academic community

From the year of its foundation, until the foundation of Revista deContabilidad in 1997, REFC has been the only referred accounting journalin Spain. Published by the Spanish Association for Accounting and BusinessAdministration (AECA), this journal is at the heart of the emergence ofa distinctly Spanish academic accounting community.Our study is based on:1. An analysis of 100 issues of REFC covering the period from 1985 to 1999.2. A questionnaire to Spanish accounting academics on their perceptionsand experience of the journal.Key points emerging from this study include:a) A move away from interest in accounting concepts and rules, as wellas accounting history, and towards positive accounting theory, the impactof accounting information on capital markets, and financial analysis.b) The emergence of a small number of universities as the driving forcein Spanish accounting research.c) Spanish academics rate REFC highly compared to other Spanish journalsfor publication status, as a support for research, and as a support forteaching. A number of English language journals are rated more highly forboth publication status and as a support for teaching.

Hierarchical location-allocation models for congested systems

In this paper we address the issue of locating hierarchical facilities in the presence of congestion. Two hierarchical models are presented, where lower level servers attend requests first, and then, some of the served customers are referred to higher level servers. In the first model, the objective is to find the minimum number of servers and theirlocations that will cover a given region with a distance or time standard. The second model is cast as a Maximal Covering Location formulation. A heuristic procedure is then presented together with computational experience. Finally, some extensions of these models that address other types of spatial configurations are offered.

Metaheuristics for the bus-driver scheduling problem

We present new metaheuristics for solving real crew scheduling problemsin a public transportation bus company. Since the crews of thesecompanies are drivers, we will designate the problem by the bus-driverscheduling problem. Crew scheduling problems are well known and severalmathematical programming based techniques have been proposed to solvethem, in particular using the set-covering formulation. However, inpractice, there exists the need for improvement in terms of computationalefficiency and capacity of solving large-scale instances. Moreover, thereal bus-driver scheduling problems that we consider can present variantaspects of the set covering, as for example a different objectivefunction, implying that alternative solutions methods have to bedeveloped. We propose metaheuristics based on the following approaches:GRASP (greedy randomized adaptive search procedure), tabu search andgenetic algorithms. These metaheuristics also present some innovationfeatures based on and genetic algorithms. These metaheuristics alsopresent some innovation features based on the structure of the crewscheduling problem, that guide the search efficiently and able them tofind good solutions. Some of these new features can also be applied inthe development of heuristics to other combinatorial optimizationproblems. A summary of computational results with real-data problems ispresented.

Phylogeography of Mabuya maculilabris (Reptilia) from São Tomé Island (Gulf of Guinea) inferred from mtDNA sequences

The pattern of genetic variation of the lizard Mabuya maculilabris from São Tomé Island (Gulf of Guinea) was investigated using a combination of three mitochondrial DNA gene fragments. Forty-eight haplotypes were recovered among 66 individuals covering the whole island. The genealogy inferred from the most parsimonious network of haplotypes allows us to detect two main and long branches departing from the putative group of oldest haplotypes. The tips of these branches exhibit star-like phylogenies, which may indicate of recently expanded populations, most probably from a small number of founders. A nested clade analysis suggests a complex pattern of past events that gave rise to the extant geographical pattern found in the haplotype distribution: past and allopatric fragmentation, range expansion, restricted gene Xow and long-distance dispersal. These results are consistent with the complex geological history of the island where important volcanic activity with extensive lava Xows has occurred during several periods. Mismatch- distribution analysis and AMOVA also support these conclusions. Substantial genetic structuring among these lizards was detected as well as high levels of diVerentiation between the southern edge populations (particularly those from the Rolas Islet) and the remaining ones. However, variation is low relative to the geological age of the island. Our results indicate that patterns of variation observed in reptiles in other oceanic islands are not indicative of those observed in the islands of the Gulf of Guinea.

Modeling complex wells with the multi-scale finite-volume method

In this paper, an extension of the multi-scale finite-volume (MSFV) method is devised, which allows to Simulate flow and transport in reservoirs with complex well configurations. The new framework fits nicely into the data Structure of the original MSFV method,and has the important property that large patches covering the whole well are not required. For each well. an additional degree of freedom is introduced. While the treatment of pressure-constraint wells is trivial (the well-bore reference pressure is explicitly specified), additional equations have to be solved to obtain the unknown well-bore pressure of rate-constraint wells. Numerical Simulations of test cases with multiple complex wells demonstrate the ability of the new algorithm to capture the interference between the various wells and the reservoir accurately. (c) 2008 Elsevier Inc. All rights reserved.

Transepithelial transport of HIV-1 by M cells is receptor-mediated.

Human colon carcinoma Caco-2 cell monolayers undergo conversion into cells that share morphological and functional features of M cells when allowed to interact with B lymphocytes. A lymphotropic (X4) HIV-1 strain crosses M cell monolayers and infects underlying CD4(+) target cells. Transport requires both lactosyl cerebroside and CXCR4 receptors, which are expressed on the apical surface of Caco-2 and M cells. Antibodies specific for each receptor block transport. In contrast, a monotropic (R5) HIV-1 strain is unable to cross M cell monolayers and infect underlying monocytes, despite efficient transport of latex beads. Caco-2 and M cells do not express CCR5, but transfection of these cells with CCR5 cDNA restores transport of R5 virus, which demonstrates that HIV-1 transport across M cells is receptor-mediated. The follicle-associated epithelium covering human gut lymphoid follicles expresses CCR5, but not CXCR4, and lactosyl cerebroside, suggesting that HIV-1 infection may occur through M cells and enterocytes at these sites.

Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne): implementation of an early intervention programme for psychosis in Switzerland.

AIM: In a survey conducted in the Lausanne catchment area in 2000, we could estimate on the basis of file assessment that first-episode psychosis (FEP) patients had psychotic symptoms for more than 2 years before treatment and that 50% did not attend any outpatient appointment after discharge from hospital. In this paper, we describe the implementation of a specialized programme aimed at improving engagement and quality of treatment for early psychosis patients in the Lausanne catchment area in Switzerland. METHOD: The Treatment and Early Intervention in Psychosis Program-Lausanne is a comprehensive 3-year programme composed of (i) an outpatient clinic based on assertive case management; (ii) a specialized inpatient unit; and (iii) an intensive mobile team, connected for research to the Center for Psychiatric Neuroscience. RESULTS: Eight years after implementation, the programme has included 350 patients with a disengagement rate of 9% over 3 years of treatment. All patients have been assessed prospectively and 90 participated in neurobiological research. Based on this experience, the Health Department funded the implementation of similar programmes in other parts of the state, covering a total population of 540 000 people. CONCLUSION: Programmes for early intervention in psychosis have a major impact on patients' engagement into treatment. While development of mobile teams and assertive case management with specific training are crucial, they do not necessitate massive financial support to be started. Inclusion of a research component is important as well, in terms of service planning and improvement of both quality of care and impact of early intervention strategies.

Service Quality Analysis in the Five Stars Resort Hotels of Cape Verde

The objective of this study was the identification of the attributes and dimensions of service quality affecting the service performance of the five stars resort hotels located in the Cape Verde Islands. The reason boosting the initiative to do this research was the paramount role of the resort hotels in the development of the travel and tourism sector in Cape Verde, and the impact that today this sector has had in the economy of that country. The research opens with a literature review on the service quality theory in the hotel industry, starting from the middle of the 1980s with the classic model of service quality and SERVQUAL instrument to the analysis of recent models of service quality measurement in the hotel industry, as it is an example the scale of items developed in 2003 in the Lodging Quality Index (LQI). Furthermore, the study elaborates an analysis on the importance of the travel and tourism activities in the Cape Verde Islands, and it evidences the enormous importance of those activities in the performance of the Cape Verdean hotel industry. In sequence the study analyzes in details the hotel industry of Cape Verde and it identifies the market size of the five stars resort hotels and their current operators in that market. Moreover, the research develops with an online questionnaire elaborated and sent through the platforms of travel websites and communities to the guests whom have experienced the service of the five stars resort hotels located in the Cape Verde Islands. The scope of the questionnaire was to assess the attributes and dimensions of service quality in the five stars resort hotels of Cape Verde. The results of the questionnaire were in sequence analyzed through descriptive and applied statistics, using Microsoft Excel and the Statistical Package for Social Science (SPSS). Content validity analysis, factor analysis, and reliability analysis of the factors were made to purify an initial scale of 47 items of service quality. An instrument with three dimensions covering twenty four attributes of service quality assessment in the five stars resort hotels of Cape Verde was finally created. The three dimensions found were: staff competence; food and entertainment; and physical facilities. This study on the service in the five stars resort hotels of Cape Verde ends with brief comments on the status of service quality according to the identified dimensions and their attributes. In the conclusion, the study summarizes the whole work and gives some directions for future research.

Recent decrease in the prevalence of congenital heart defects in europe.

OBJECTIVES: To examine trends in the prevalence of congenital heart defects (CHDs) in Europe and to compare these trends with the recent decrease in the prevalence of CHDs in Canada (Quebec) that was attributed to the policy of mandatory folic acid fortification. STUDY DESIGN: We used data for the period 1990-2007 for 47 508 cases of CHD not associated with a chromosomal anomaly from 29 population-based European Surveillance of Congenital Anomalies registries in 16 countries covering 7.3 million births. We estimated trends for all CHDs combined and separately for 3 severity groups using random-effects Poisson regression models with splines. RESULTS: We found that the total prevalence of CHDs increased during the 1990s and the early 2000s until 2004 and decreased thereafter. We found essentially no trend in total prevalence of the most severe group (group I), whereas the prevalence of severity group II increased until about 2000 and decreased thereafter. Trends for severity group III (the most prevalent group) paralleled those for all CHDs combined. CONCLUSIONS: The prevalence of CHDs decreased in recent years in Europe in the absence of a policy for mandatory folic acid fortification. One possible explanation for this decrease may be an as-yet-undocumented increase in folic acid intake of women in Europe following recommendations for folic acid supplementation and/or voluntary fortification. However, alternative hypotheses, including reductions in risk factors of CHDs (eg, maternal smoking) and improved management of maternal chronic health conditions (eg, diabetes), must also be considered for explaining the observed decrease in the prevalence of CHDs in Europe or elsewhere.

Molecular and isotopic characterization of organic samples from the wreck of the Saint-Etienne merchant ship (XVIIIth century): Identification of pitch, fat, hair and sulfur

The wreck U Pezzo, excavated within the Saint Florent Gulf in northern Corsica was identified as the pink, Saint Etienne, a merchant ship which sank on January 31, 1769. In order to determine the composition of organic materials used to coat the hull or to waterproof different parts of the pink, a study of several samples, using molecular biomarker and carbon isotopic analysis, was initiated. The results revealed that the remarkable yellow coat, covering the outside planks of the ship's bottom under the water line, is composed of sulfur, tallow (of ox and not of cetacean origin) and black pitch which corresponds to a mixture called ``couroi'' or ``stuff'. Onboard ropes had been submitted to a tarring treatment with pitch. Hairs mixed with pitch were identified in samples collected between the two layers of the hull or under the sheathing planking. The study also provides a key model for weathering of pitch, as different degrees of degradation were found between the surface and the heart of several samples. Accordingly, molecular parameters for alteration were proposed. Furthermore novel mixed esters between terpenic and diterpenic alcohols and the free major fatty acids (C(14:0), C(16:0), C(18:0)) were detected in the yellow coat. (C) 2009 Elsevier Ltd. All rights reserved.

Dosimetric aspects of a national survey of diagnostic and interventional radiology in Switzerland.

The effective dose delivered to the patient was determined, by modeling, for 257 types of examinations covering the different modalities of diagnostic and interventional radiology. The basic operational dosimetric quantities considered were obtained from the parameters of the examinations on the basis of dosimetric models. These models required a precise characterization of each examination. The operational dosimetric quantities were converted into doses to organs and effective doses using appropriate conversion factors. The determination of the collective effective dose to the Swiss population requires a number of corrections to account for the variability of several parameters: sensitivity of the detection system, age, gender, and build of the patient. The use of various dosimetric models is illustrated in this paper for a limited number of examination types covering the different radiological modalities, for which the established typical effective doses are given. With regard to individual doses, the study indicated that the average effective doses per type of examination can be classified into three levels: (a) the weakly irradiating examinations (less than 0.1 mSv), which represent 78% of the examinations and 4% of the collective dose, (b) the moderately irradiating examinations (between 0.1 mSv and 10 mSv), which represent 21% of the examinations and 72% of the collective dose, (c) the strongly irradiating examinations (more than 10 mSv), which represent 1% of the examinations and 24% of the collective dose.

Correlates of frailty, prediction of functional decline and preventative approaches - selected results from the lausanne cohort 65+ (lc65+) study (Switzerland) (Lausanne) and the longitudinal urban cohort ageing study (Lucas) (Germany)

Overall introduction.- Longitudinal studies have been designed to investigate prospectively, from their beginning, the pathway leading from health to frailty and to disability. Knowledge about determinants of healthy ageing and health behaviour (resources) as well as risks of functional decline is required to propose appropriate preventative interventions. The functional status in older people is important considering clinical outcome in general, healthcare need and mortality. Part I.- Results and interventions from lucas (longitudinal urban cohort ageing study). Authors.- J. Anders, U. Dapp, L. Neumann, F. Pröfener, C. Minder, S. Golgert, A. Daubmann, K. Wegscheider,. W. von Renteln-Kruse Methods.- The LUCAS core project is a longitudinal cohort of urban community-dwelling people 60 years and older, recruited in 2000/2001. Further LUCAS projects are cross-sectional comparative and interventional studies (RCT). Results.- The emphasis will be on geriatric medical care in a population-based approach, discussing different forms of access, too. (Dapp et al. BMC Geriatrics 2012, 12:35; http://www.biomedcentral.com/1471-2318/12/35): - longitudinal data from the LUCAS urban cohort (n = 3.326) will be presented covering 10 years of observation, including the prediction of functional decline, need of nursing care, and mortality by using a self-filling screening tool; - interventions to prevent functional decline do focus on first (pre-clinical) signs of pre-frailty before entering the frailty-cascade ("Active Health Promotion in Old Age", "geriatric mobility centre") or disability ("home visits"). Conclusions.- The LUCAS research consortium was established to study particular aspects of functional competence, its changes with ageing, to detect pre-clinical signs of functional decline, and to address questions on how to maintain functional competence and to prevent adverse outcome in different settings. The multidimensional data base allows the exploration of several further questions. Gait performance was exmined by GAITRite®-System. Supported by the Federal Ministry for Education and Research (BMBF Funding No. 01ET1002A). Part II.- Selected results from the lausanne cohort 65+ (Lc65 + ) Study (Switzerland). Authors.- Prof Santos-Eggimann Brigitte, Dr Seematter-Bagnoud Laurence, Prof Büla Christophe, Dr Rochat Stéphane. Methods.- The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934-1938) in the non-institutionalized population of Lausanne (Switzerland). Results.- Information is collected about life course social and health-related events, socio-economics, medical and psychosocial dimensions, lifestyle habits, limitations in activities of daily living, mobility impairments, and falls. Gait performance are objectively measured using body-fixed sensors. Frailty is assessed using Fried's frailty phenotype. Follow-up consists in annual self-completed questionnaires, as well as physical examination and physical and mental performance tests every three years. - Lausanne cohort 65+ (Lc65 + ): design and longitudinal outcomes. The baseline data collection was completed among 1422 participants in 2004-2005 through self-completed questionnaires, face-to-face interviews, physical examination and tests of mental and physical performances. Information about institutionalization, self-reported health services utilization, and death is also assessed. An additional random sample (n = 1525) of 65-70 years old subjects was recruited in 2009 (birth year 1939-1943). - lecture no 4: alcohol intake and gait parameters: prevalent and longitudinal association in the Lc65+ study. The association between alcohol intake and gait performance was investigated.

Paper 4: EUROCAT statistical monitoring: identification and investigation of ten year trends of congenital anomalies in Europe.

BACKGROUND: As part of EUROCAT's surveillance of congenital anomalies in Europe, a statistical monitoring system has been developed to detect recent clusters or long-term (10 year) time trends. The purpose of this article is to describe the system for the identification and investigation of 10-year time trends, conceived as a "screening" tool ultimately leading to the identification of trends which may be due to changing teratogenic factors.METHODS: The EUROCAT database consists of all cases of congenital anomalies including livebirths, fetal deaths from 20 weeks gestational age, and terminations of pregnancy for fetal anomaly. Monitoring of 10-year trends is performed for each registry for each of 96 non-independent EUROCAT congenital anomaly subgroups, while Pan-Europe analysis combines data from all registries. The monitoring results are reviewed, prioritized according to a prioritization strategy, and communicated to registries for investigation. Twenty-one registries covering over 4 million births, from 1999 to 2008, were included in monitoring in 2010.CONCLUSIONS: Significant increasing trends were detected for abdominal wall anomalies, gastroschisis, hypospadias, Trisomy 18 and renal dysplasia in the Pan-Europe analysis while 68 increasing trends were identified in individual registries. A decreasing trend was detected in over one-third of anomaly subgroups in the Pan-Europe analysis, and 16.9% of individual registry tests. Registry preliminary investigations indicated that many trends are due to changes in data quality, ascertainment, screening, or diagnostic methods. Some trends are inevitably chance phenomena related to multiple testing, while others seem to represent real and continuing change needing further investigation and response by regional/national public health authorities.

Chemical changes in argisols under irrigated grape production in the central São Francisco river valley, Brazil

This study compares the chemical composition of the solution and exchange complex of soil in a 3-year-old irrigated vineyard (Vitis vinifera L., Red Globe cultivar) with that of adjacent clearing in the native hyperxerophyllic 'caatinga' vegetation. The soils are classified as Plinthic Eutrophic Red-Yellow Argisol; according to Soil Taxonomy they are isohyperthermic Plinthustalfs. Detailed physiographic characterization revealed an impermeable gravel and cobble covering the crystalline rocks; the relief of this layer was more undulating than the level surface. Significant higher concentrations of extractable Na, K, Mg and Ca were observed within the vineyard. Lower soil acidity, higher Ca/Mg ratios, as well as lower sodium adsorption and Na/K ratios reflected additions of dolomitic lime, superphosphate and K-bearing fertilizers. As the water of the São Francisco River is of good quality for irrigation (C1S1), the increases in Na were primarily attributed to capillary rise from the saline groundwater table. None of the soil in the study area was found to be sodic. About 62% of the vineyard had an Ap horizon with salinity levels above 1.5dSm-1 (considered detrimental for grape production); according to average values for this horizon, a potential 13% reduction in grape production was predicted. Differences in chemical composition in function of distance to the collector canals were observed in the clearing, but not in the vineyard. The influence of differences in the elevations of the surface and impermeable layers, as well as pediment thickness, was generally weaker under irrigation. Under irrigation, soil moisture was greater in points of convergent surface waterflow; the effect of surface curvature on chemical properties, though less consistent, was also stronger in the vineyard.