Trade-off between formal and informal care in Spain

The remarkable growth of older population has moved long term care to the front ranks of the social policy agenda. Understanding the factors that determine the type and amount of formal care is important for predicting use in the future and developing long-term policy. In this context we jointly analyze the choice of care (formal, informal, both together or none) as well as the number of hours of care received. Given that the number of hours of care is not independent of the type of care received, we estimate, for the first time in this area of research, a sample selection model with the particularity that the first step is a multinomial logit model. With regard to the debate about complementarity or substitutability between formal and informal care, our results indicate that formal care acts as a reinforcement of the family care in certain cases: for very old care receivers, in those cases in which the individual has multiple disabilities, when many care hours are provided, and in case of mental illness and/or dementia. There exist substantial differences in long term care addressed to younger and older dependent people and dependent women are in risk of becoming more vulnerable to the shortage of informal caregivers in the future. Finally, we have documented that there are great disparities in the availability of public social care across regions.

Frequency and Type of Side Effects of Immunomodulating Medication in the Swiss Inflammatory Bowel Disease Cohort

Background: Medical treatment of inflammatory bowel disease (IBD) is becoming more and more complex, as several classes of immuno-modulating drugs (IMD) are often used simultaneously. Thus, the probability of adverse effects is greatly increased. Most studies reporting on adverse effects focus on single therapy, and studies providing a global survey of side effects for multiple treatments are lacking. Aim: To assess the type and frequency of adverse events in IBD patients treated with single and multiple IMD therapy. Methods: Analysis of data from the Swiss IBD Cohort Study (SIBDCS) that collects data on a large sample of IBD patients from hospitals and private practices across Switzerland. The following IMD categories were analyzed: 5-ASA, azathioprine (Aza), 6-mercaptopurine (6-MP), methotrexate (MTX), anti-TNF (infliximab, adalimumab, certolizumab-pegol), cyclosporine, tacrolimus, and steroids. The following side effects were assessed: hepatitis, pancreatitis, leucopenia, thrombopenia, nephritis, allergic reaction, pneumonitis, infections (including tuberculosis), osteoporosis, abdominal pain/diarrhea (unrelated to IBD activity), cataract, diabetes, exanthema, hirsutism, lupus-like syndrome, myalgias, depression/psychosis, tumor development. Results: A total of 1,961 patients were analyzed (977 [50%] female, mean age 42.1 ± 14.4 years): 1,119 with Crohn's disease (CD), 800 with ulcerative colitis (UC), and 42 with indeterminate colitis (IC). Three-hundred eighteen (16.2%) patients were not treated with any of the above-mentioned medications, while 650 (33.2%), 569 (29%) and 424 (21.6%) patients had one-, two-, and three- or more- IMD therapy, respectively. Of the 1,643 patients treated with IMD, 535 (32.6%) patients reported at least one side effect. We found a significant correlation between the number of drugs used by a patient and the frequency of side effects (17.4% side effects for one drug, 29% for 2 drugs, and 60.6% for three or more drugs, p < 0.001). The frequency of side effects for the different IMD classes were as follows: 5-ASA (n = 980 treated patients) 10.8%, Aza/6-MP (n = 636) 51.9% (pancreatitis in 57 = 9%, hepatitis in 17 = 2.7% of treated patients), MTX (n = 146) 42.5% (hepatitis in 4 = 2.7% of treated patients), anti-TNF (n = 255) 23.1%, cyclosporine (n = 49) 10.2%, tacrolimus (n = 5) 20%, steroids (systemic or topical, n = 1,150) 9.6%. Conclusion: IBD treatment is associated with a significant number of side effects. A direct correlation between the number of IMD used simultaneously and the frequency of side effects was observed. The results of this study indicate that treating physicians should be vigilant for the occurrence of side effects in IBD patients under single and/or multiple drug therapy.

Current trends in illegal drug use and drug related health problems in Switzerland.

As part of the evaluation of the Confederation's measures to reduce drug related problems, a review of available data on drug use and drug related problems in Switzerland has been conducted. Source of data included: population surveys (adults and teenagers), surveys among drug users, health statistics (drug related and AIDS related deaths, HIV case reporting, drug treatments) police statistics (denunciations for consumption). The aims of reducing the number of dependent hard drug users have been achieved where heroin is concerned. In particular, there seems to have been a decrease in the number of people becoming addicted to this substance. For all other illegal substances, especially cannabis, the trend is towards an increased use, as in many European countries. As regards dependent drug users, especially injecting drug users, progress has been made in the area of harm reduction and treatment coverage. This epidemiological assessment can be used in the discussions currently engaged about the revision of the Law governing narcotics and will be a baseline for future follow up of the situation.

Appraising and selecting strategies to combat and mitigate desertification based on stakeholder knowledge and globalbest practices in Cape Verde Archipelago

Cape Verde is considered part of Sahelian Africa, where drought and desertification are common occurrences. The main activity of the rural population is rain-fed agriculture, which over time has been increasingly challenged by high temporal and spatial rainfall variability, lack of inputs, limited land area, fragmentation of land, steep slopes, pests, lack of mechanization and loss of top soil by water erosion. Human activities, largely through poor farming practices and deforestation (Gomez, 1989) have accelerated natural erosion processes, shifting the balance between soil erosion and soil formation (Norton, 1987). According to previous studies, vegetation cover is one of the most important factors in controlling soil loss (Cyr et al., 1995; Hupy, 2004; Zhang et al., 2004; Zhou et al., 2006). For this reason, reforestation is a touchstone of the Cape Verdean policy to combat desertification. After Independence in 1975, the Cape Verde government had pressing and closely entangled environmental and socio-economic issues to address, as long-term desertification had resulted in a lack of soil cover, severe soil erosion and a scarcity of water resources and fuel wood. Across the archipelago, desertification was resulting from a variety of processes including poor farming practices, soil erosion by water and wind, soil and water salinity in coastal areas due to over pumping and seawater intrusion, drought and unplanned urbanization (DGA-MAAP, 2004). All these issues directly affected socio-economic vulnerability in rural areas, where about 70% of people depended directly or indirectly on agriculture in 1975. By becoming part of the Inter- State Committee for the Fight against Drought in the Sahel in 1975, the government of Cape Verde gained structured support to address these issues more efficiently. Presentday policies and strategies were defined on the basis of rational use of resources and human efforts and were incorporated into three subsequent national plans: the National Action Plan for Development (NDP) (1982–1986), the NDP (1986–1990) and the NDP (1991–1995) (Carvalho

Killing by lung cancer or by diabetes? The trade-off between smoking and obesity

As the prevalence of smoking has decreased to below 20%, health practitioners interest has shifted towards theprevalence of obesity, and reducing it is one of the major health challenges in decades to come. In this paper westudy the impact that the final product of the anti-smoking campaign, that is, smokers quitting the habit, had onaverage weight in the population. To these ends, we use data from the Behavioral Risk Factors Surveillance System,a large series of independent representative cross-sectional surveys. We construct a synthetic panel that allows us tocontrol for unobserved heterogeneity and we exploit the exogenous changes in taxes and regulations to instrumentthe endogenous decision to give up the habit of smoking. Our estimates, are very close to estimates issued in the 90sby the US Department of Health, and indicate that a 10% decrease in the incidence of smoking leads to an averageweight increase of 2.2 to 3 pounds, depending on choice of specification. In addition, we find evidence that the effectovershoots in the short run, although a significant part remains even after two years. However, when we split thesample between men and women, we only find a significant effect for men. Finally, the implicit elasticity of quittingsmoking to the probability of becoming obese is calculated at 0.58. This implies that the net benefit from reducingthe incidence of smoking by 1% is positive even though the cost to society is $0.6 billions.

Survey of ear flies (Diptera, Ulidiidae) in maize (Zea mays L.) and a new record of Euxesta mazorca Steyskal in Brazil

Survey of ear flies (Diptera, Ulidiidae) in maize (Zea mays L.) and a new record of Euxesta mazorca Steyskalin Brazil. Species of Euxesta (Diptera, Ulidiidae), known as silk flies or ear flies, are becoming increasingly important as maize insect pests in South America, although very little is known about them in Brazil. The larvae of some species of this genus initially damage female reproductive tissues, and then the developing kernels on the ear. As a result of feeding, fermentation and associated odors cause complete loss of the grain because it is no longer fit for human or livestock consumption. The main objective of this work was to evaluate the incidence of Euxesta spp. in Brazilian maize fields and to determine the most prevalent species using two different hydrolyzed protein foods attractants, BioAnastrepha® (hydrolyzed maize protein) and Torula, placed inside McPhail traps. The two species identified were E. eluta Loew and E. mazorca Steyskal, the latter being a new record from Brazil. Between the two species, E. eluta was the more abundant in maize fields. Both attractants were efficient in capturing the two species. However, BioAnastrepha® captured significantly more insects than Torula.

Serial defaults, serial profits: Returns to sovereign lending in Habsburg Spain, 1566-1600

Philip II of Spain accumulated debts equivalent to 60% of GDP. He also defaulted four times onhis short-term loans, thus becoming the first serial defaulter in history. Contrary to a commonview in the literature, we show that lending to the king was profitable even under worst-casescenario assumptions. Lenders maintained long-term relationships with the crown. Lossessustained during defaults were more than compensated by profits in normal times. Defaultswere not catastrophic events. In effect, short-term lending acted as an insurance mechanism,allowing the king to reduce his payments in harsh times in exchange for paying a premium intranquil periods. © 2010 Elsevier Inc. All rights reserved.

Orofacial dysfunction in Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) affects orofacial function. Our aim was to evaluate certain characteristics of orofacial function in DMD and relate possible deteriorations to the age of the patients and to the diminished internal structure quality of the masseter muscle. Bite force and finger force were measured in 16 DMD patients (6-20 years old) and 16 age matched controls. The thickness and internal structure quality of the masseter muscle were evaluated ultrasonographically. We found reduced mouth opening but no signs of masticatory muscle tenderness. Bite force values were lower for DMD patients. Masseter thickness showed no significant differences between the two groups, but poorer internal muscle structure quality characterised the elder, non-walking DMD patients explaining their low bite force values. In conclusion, the masseter muscle follows the general progress of the disease. Orofacial function in DMD patients is becoming ever more important as their life expectancy increases.

Assessment and mapping the sensitive areas to desertification in an insular Sahelian mountain region Case study of the Ribeira Seca Watershed, Santiago Island - Cabo Verde

This paper presents the assessment and mapping of the Ribeira Seca catchment, an insular Sahelian mountain region sensitive to desertification, located on the island of Santiago, Cabo Verde. Desertification is a threat to the global environment, representing a serious ecological problemin Cabo Verde. To successfully combat desertification, an evaluation of desertification consequences is required and the building of cartography of the sensitivity for arid and semi-arid ecosystems is required as a first step. The MEDALUS model was the basis for this study in which six quality indicators were used: climate, soil, vegetation, land management, erosion and social factors. Several parameters were defined for each indicator with weights varying between 1 (very low) and 2 (very high). The geometric mean of each of the six quality indicators was employed to produce a map of areas sensitive to desertification. The results of this study show that more than 50% of the watershed show clear evidence of becoming a desertified area.

Draft environmental report on Cape Verde

Faced with recurrent drought and famine during five centuries of human occupation, the small and densely populated Cape Verde Islands have a history of severe environmental problems. The arid climate and steep, rocky terrain provide scant resources for traditional subsistance farming under the best conditions, and in years of low rainfall the failure of rainfed crops causes massive food shortages. Agricultural use of steep slopes where rainfall is highest has led to soil erosion, as has removal of the island's vegetation for fuel and livestock. Pressure on the vegetation is particularly severe in dry years. International aid can provide relief from famine, and the introduction of modern agricultural and conservation techniques can improve the land and increase yield, but it is unlikely that Cape Verde can ever be entirely self -sufficient in food. Ultimately, the solution of Cape Verde's economic and environmental problems will probably require the development of productive urban jobs so the population can shift away from the intensive and destructive use of land for subsistance farming. In the meantime, the people of Cape Verde can best be served by instituting fundamental measures to conserve and restore the land so that it can be used to its fullest potential. The primary environmental problems in Cape Verde today are: 1. Soil degradation. Encouraged by brief but heavy rains and steep slopes, soil erosion is made worse by lack of vegetation. Soils are also low in organic matter due to the practice of completely removing crop plants and natural vegetation for food, fuel or livestock feed. 2. Water shortage. Brief and erratic rainfall in combination with rapid runoff makes surface water scarce and difficult to use. Groundwater supplies can be better developed but capabilities are poorly known and the complex nature of the geological substrate makes estimation difficult. Water is the critical limiting factor to the agricultural capability of the islands. 3. Fuel shortage. Demand for fuel is intense and has resulted in the virtual elimination of native vegetation. Fuelwood supplies are becoming more and more scarce and costly. Development of managed fuelwood plantations and alternate energy sources is required. 4. Inappropriate land use. Much of the land now used for raising crops or livestock is too steep or too arid for these purposes, causing erosion and destruction of vegetation. Improving yield in more appropriate areas and encouraging less damaging uses of the remaining marginal lands can help to alleviate this problem.

Demand for pharmaceutical drugs: A choice modelling experiment

Despite the importance of supplier inducement and brand loyalty inthe drug purchasing process, little empirical evidence is to be foundwith regard to the influence that these factors exert on patients decisions. Under the new scenario of easier access to information,patients are becoming more demanding and even go as far asquestioning their physicians prescription. Furthermore, newregulation also encourages patients to adopt an active role in thedecision between brand-name and generic drugs. Using a statedpreference model based on a choice survey, I have found evidenceof how significant physicians prescription and pharmacists recommendation become throughout the drug purchase process and,to what extent, brand loyalty influences the final decision. Asfar as we are aware, this paper is the first to explicitlytake consumers preferences into account rather than focusingon the behavior of health professionals.

Reverse logistics in the editorial sector: An exploratory study

Nowadays, the Reverse Logistics field is becoming very important. On one hand, laws areimposing companies to be responsible for the contamination made by their products. On theother hand, companies have discovered the profits derived from a good Reverse Logisticsprocess. This paper is the result of the work done by a group of companies from the SpanishEditorial sector to understand and improve their Reverse Logistics process. The paperdescribes the characteristics of the Reverse Logistics process in this sector and theimprovements identified by the work group .

Development of the immature stages of Culex (Culex) saltanensis Dyar (Diptera, Culicidae) under laboratory conditions

Development of the immature stages of Culex (Culex) saltanensis Dyar (Diptera, Culicidae) under laboratory conditions. Culex (Culex) saltanensis Dyar, 1928 is becoming frequent and abundant in natural and artificial breeding sites in urban and rural areas of Brazil. This study contributes to the knowledge of the biology of a Brazilian strain of C. saltanensis. The development of specimens reared individually or grouped was observed. The study was conducted at a constant temperature of 27 ± 2°C, 14L:10D photoperiod and 80 ± 5% relative humidity. The immature stages were observed every 6 hours until adult emergence, which occurred in 12.29 days among individually reared specimens and in 13.12 days among group-reared specimens. Egg rafts for the experiment were obtained from the laboratory and field. Eggs hatched at a rate of 97.48 ± 2.32%. More eggs per egg raft were obtained from the field than from the laboratory. Males from individually reared specimens emerged in 12.29 ± 1.11 days and females in 13.12 ± 1.58 days. The male-female ratio was 1:1. Larval survival rate was higher than 85% for larvae reared isolated and higher than 95% for group-reared larvae. The Culex saltanensis life cycle was completed within 12 to 14 days, where larval instars I and IV took the most time to develop and the pupae, the shortest.

Rôle de l'imagerie dans le diagnostic et le suivi de la polyarthrite rhumatoïde [Role of imaging in the diagnosis and follow-up of rheumatoid arthritis].

Cross-sectional imaging techniques such as magnetic resonance imaging and ultrasound are becoming essential tools not only for making an early diagnosis of rheumatoid arthritis, but also to help clarify the prognosis of the disease and better assess the response to various therapies. This article summarises the recommendations established in 2013 by the European League Against Rheumatism on the role of imaging in the diagnosis and follow-up of rheumatoid arthritis, while adding comments and emphasising on our Swiss experience with the use of ultrasound.

General Use of Face-Masks and Respirators to Prevent Novel Influenza A (H1N1, May 1, 2009

During this outbreak of swine influenza, many people have questions regarding the best way to protect themselves from becoming ill with the virus and, if you are ill, how to prevent spread of the disease to others.