100 casos de derecho de daños (2004-2009)

InDret presenta, por sexto año consecutivo, una selección de veinte sentencias sobre responsabilidad civil dictadas por el Tribunal Supremo que tratan cuestiones centrales del derecho de daños. El lector también encontrará en este trabajo las selecciones de 2004, 2005, 2006, 2007 y 2008 publicadas en números anteriores.

Emergency hospital services utilization in Lleida (Spain): a cross-sectional study of immigrant and Spanish-born populations

Background: The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain). Methods: Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population. Results: Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts. Conclusion: In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): a 6-months prospective observational study

Background: There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations. Methods: Prospective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex. Results: The percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure. Conclusion: Pharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective.

BACKGROUND: The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania. METHODS: A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker's perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified. RESULTS: In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient's trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices. CONCLUSIONS: The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.

How to identify and recruit nurses to a survey 14 and 24 years after graduation in a context of scarce data : lessons learnt from the 2012 nurses at work pilot study on nurses' career paths

Nursing workforce data are scarce in Switzerland, with no active national registry of nurses. The worldwide nursing shortage is also affecting Switzerland, so that evidence-based results of the nurses at work project on career paths and retention are needed as part of the health care system stewardship; nurses at work is a retrospective cohort study of nurses who graduated in Swiss nursing schools in the last 30 years. Results of the pilot study are presented here (process and feasibility). The objectives are (1) to determine the size and structure of the potential target population by approaching two test-cohorts of nursing graduates (1988 and 1998); (2) to test methods of identifying and reaching them 14 and 24 years after graduation; (3) to compute participation rates, and identify recruitment and participation biases.

Influência da adubação orgânica no crescimento de tangerineira cv Clemenules e nos atributos químicos e microbiológicos do solo

O estudo objetivou avaliar o efeito de adubos orgânicos de diferentes origens, empregados como fontes de nitrogênio, sobre a atividade vegetativa das plantas de tangerineira (cv Clemenules/Poncirus trifoliata) durante a fase inicial de desenvolvimento e atributos químicos e microbiológicos do solo, nas condições pedológicas e climáticas da região de Pelotas-RS. O experimento foi conduzido durante dois anos (2002-2003), utilizando-se de plantas de 18 meses de idade, em vasos de 35 kg de capacidade, irrigadas por gotejamento, com seis repetições, sendo cada unidade experimental constituída por uma planta. Os tratamentos confrontados foram os seguintes: Controle (sem adubação); Adubação mineral (AM); Vermicomposto (VC); Vermicomposto + sangue bovino seco (VC + SB) e Resíduo da indústria de transformação de sucos cítricos (RITC). Ao final de cada estação vegetativa, foram avaliados os seguintes parâmetros biométricos: área de seção do porta-enxerto, altura da copa, número de brotações, folhas totais produzidas por planta e massa fresca e seca das folhas. Ao fim do experimento, três plantas de cada tratamento foram desplantadas, separados os principais órgãos, determinando-se a área total das folhas produzidas, a massa fresca e seca dos ramos principal e secundários e das raízes, separadas em grossas e finas. Na mesma época, amostras de solo de cada vaso foram coletadas e utilizadas para as análises químicas e microbiológicas. Em ambos os anos, foram coletadas folhas avaliando-se a concentração dos macronutrientes. Os efeitos mais marcantes sobre o desenvolvimento das plantas foram observados naquelas em que, além do vermicomposto (VC), foi fornecido periodicamente sangue seco (VC + SB). No solo desses tratamentos, também foi observado aumento do teor de nitrogênio total e da atividade microbiana do solo, avaliada pela respiração basal. O aporte de sangue seco (VC + SB) supriu satisfatoriamente as necessidades de N ocorrido nas plantas fertilizadas com adubo orgânico mesmo que estas últimas tenham recebido, no biênio de experimentação, cerca de 40% a menos de nitrogênio em relação às plantas adubadas com a fonte mineral (AM). Por isso, os tratamentos VC e RITC induziram um efeito limitado no desenvolvimento das plantas, enquanto, provavelmente, estas duas últimas fontes, e nas quantidades utilizadas, não forneceram suficientemente nitrogênio disponível para suprir a demanda das plantas. De maneira geral, a concentração dos macronutrientes foliares foi adequada em relação ao P, K, Ca e Mg e abaixo do normal para o N, demonstrando a elevada exigência desse nutriente na fase inicial de crescimento e desenvolvimento de tangerineiras cv. Clemenules.

Prevalence of cerebral amyloid pathology in persons without dementia: a meta-analysis.

IMPORTANCE: Cerebral amyloid-β aggregation is an early pathological event in Alzheimer disease (AD), starting decades before dementia onset. Estimates of the prevalence of amyloid pathology in persons without dementia are needed to understand the development of AD and to design prevention studies. OBJECTIVE: To use individual participant data meta-analysis to estimate the prevalence of amyloid pathology as measured with biomarkers in participants with normal cognition, subjective cognitive impairment (SCI), or mild cognitive impairment (MCI). DATA SOURCES: Relevant biomarker studies identified by searching studies published before April 2015 using the MEDLINE and Web of Science databases and through personal communication with investigators. STUDY SELECTION: Studies were included if they provided individual participant data for participants without dementia and used an a priori defined cutoff for amyloid positivity. DATA EXTRACTION AND SYNTHESIS: Individual records were provided for 2914 participants with normal cognition, 697 with SCI, and 3972 with MCI aged 18 to 100 years from 55 studies. MAIN OUTCOMES AND MEASURES: Prevalence of amyloid pathology on positron emission tomography or in cerebrospinal fluid according to AD risk factors (age, apolipoprotein E [APOE] genotype, sex, and education) estimated by generalized estimating equations. RESULTS: The prevalence of amyloid pathology increased from age 50 to 90 years from 10% (95% CI, 8%-13%) to 44% (95% CI, 37%-51%) among participants with normal cognition; from 12% (95% CI, 8%-18%) to 43% (95% CI, 32%-55%) among patients with SCI; and from 27% (95% CI, 23%-32%) to 71% (95% CI, 66%-76%) among patients with MCI. APOE-ε4 carriers had 2 to 3 times higher prevalence estimates than noncarriers. The age at which 15% of the participants with normal cognition were amyloid positive was approximately 40 years for APOE ε4ε4 carriers, 50 years for ε2ε4 carriers, 55 years for ε3ε4 carriers, 65 years for ε3ε3 carriers, and 95 years for ε2ε3 carriers. Amyloid positivity was more common in highly educated participants but not associated with sex or biomarker modality. CONCLUSIONS AND RELEVANCE: Among persons without dementia, the prevalence of cerebral amyloid pathology as determined by positron emission tomography or cerebrospinal fluid findings was associated with age, APOE genotype, and presence of cognitive impairment. These findings suggest a 20- to 30-year interval between first development of amyloid positivity and onset of dementia.

Relation between plaque type, plaque thickness, blood shear stress, and plaque stress in coronary arteries assessed by X-ray Angiography and Intravascular Ultrasound

Purpose: Atheromatic plaque progression is affected, among others phenomena, by biomechanical, biochemical, and physiological factors. In this paper, the authors introduce a novel framework able to provide both morphological (vessel radius, plaque thickness, and type) and biomechanical (wall shear stress and Von Mises stress) indices of coronary arteries. Methods: First, the approach reconstructs the three-dimensional morphology of the vessel from intravascular ultrasound(IVUS) and Angiographic sequences, requiring minimal user interaction. Then, a computational pipeline allows to automatically assess fluid-dynamic and mechanical indices. Ten coronary arteries are analyzed illustrating the capabilities of the tool and confirming previous technical and clinical observations. Results: The relations between the arterial indices obtained by IVUS measurement and simulations have been quantitatively analyzed along the whole surface of the artery, extending the analysis of the coronary arteries shown in previous state of the art studies. Additionally, for the first time in the literature, the framework allows the computation of the membrane stresses using a simplified mechanical model of the arterial wall. Conclusions: Circumferentially (within a given frame), statistical analysis shows an inverse relation between the wall shear stress and the plaque thickness. At the global level (comparing a frame within the entire vessel), it is observed that heavy plaque accumulations are in general calcified and are located in the areas of the vessel having high wall shear stress. Finally, in their experiments the inverse proportionality between fluid and structural stresses is observed.

« Ecrire, c'est entrer en scène »: la littérature en personne»

Leçon inaugurale à l'Université de Lausanne (Suisse).

Salomé o la tentación irresistible

Salomé es la danza, la tentación irresistible. La hija de Herodías se convierte en un personaje literario universal gracias al arte de Flaubert y, sobre todo, al de Óscar Wilde. Al comienzo de su pieza trágica, la figura de Salomé se funde con la de la luna, ávida de muerte. La obra se tradujo y se representó en España a comienzos del siglo XX, y en 1910 se puso en escena la ópera de Strauss inspirada en ella. Esa circunstancia permite ver la relación existente entre la Salomé de Wilde y la luna, bailarina mortal, del primer romance del Romancero gitano de García Lorca. A su vez Alberti se inspiraría en este poema para crear su «madrigal dramático de Ardiente - y - fría», de Marinero en tierra. Los grandes creadores, como abejas, liban en las flores de sus lecturas para crear su propia miel.

Cultivo do mirtilo: atualizações e desempenho inicial de variedades de baixa exigência em frio no Estado de Säo Paulo

A produção comercial de mirtilos na América do Sul tem passado por mudanças importantes nos últimos anos, em função do aumento da oferta de frutos frescos dos principais países produtores, causando forte queda de preços em plena safra, entre os meses de dezembro e fevereiro. Uma alternativa para esta situação é a produção de mirtileiros de maturação precoce ou muito tardia, fora da época de meia-estação, caracterizada pelos menores preços da fruta. Em 2010, foram introduzidas no Brasil novas variedades de mirtileiros de baixa exigência em frio desenvolvidas pela Universidade da Flórida, que podem ser cultivadas em regiões quentes e apresentam uma frutificação mais precoce, quando comparadas com as variedades tradicionalmente cultivadas no Brasil. Essas novas variedades apresentam grande potencial para a produção precoce de mirtilos no País em regiões sem frio hibernal, aumentando significativamente a rentabilidade da cultura. Para viabilizar esta produção, é necessário validar estratégias de manejo para estas variedades, devido à falta de informação técnica sobre seu cultivo nas condições edafoclimáticas brasileiras. Atualmente, estäo sendo conduzidas as primeiras pesquisas fitotécnicas no Estado de Säo Paulo para avaliar o crescimento e a produção destas variedades na ausência total de frio, situação de ocorrência particular em poucos países produtores do mundo.

CoDiab-VD: protocol of a prospective population-based cohort study on diabetes care in Switzerland.

BACKGROUND: Diabetes represents an increasing health burden worldwide. In 2010, the Public Health Department of the canton of Vaud (Switzerland) launched a regional diabetes programme entitled "Programme cantonal Diabète" (PcD), with the objectives to both decrease the incidence of diabetes and improve care for patients with diabetes. The cohort entitled CoDiab-VD emerged from that programme. It specifically aimed at following quality of diabetes care over time, at evaluating the coverage of the PcD within this canton and at assessing the impact of the PcD on care of patients with diabetes. METHODS/DESIGN: The cohort CoDiab-VD is a prospective population-based cohort study. Patients with diabetes were recruited in two waves (autumn 2011--summer 2012) through community pharmacies. Eligible participants were non-institutionalised adult patients (≥ 18 years) with diabetes diagnosed for at least one year, residing in the canton of Vaud and coming to a participating pharmacy with a diabetes-related prescription. Women with gestational diabetes, people with obvious cognitive impairment or insufficient command of French were not eligible. Self-reported data collected, included the following primary outcomes: processes-of-care indicators (annual checks) and outcomes of care such as HbA1C, (health-related) quality of life measures (Short Form-12 Health Survey--SF-12, Audit of Diabetes-Dependent Quality of Life 19--ADDQoL) and Patient Assessment of Chronic Illness Care (PACIC). Data on diabetes, health status, healthcare utilisation, health behaviour, self-management activities and support, knowledge of, or participation to, campaigns/activities proposed by the PcD, and socio-demographics were also obtained. For consenting participants, physicians provided few additional pieces of information about processes and laboratory results. Participants will be followed once a year, via a mailed self-report questionnaire. The core of the follow-up questionnaires will be similar to the baseline one, with the addition of thematic modules adapting to the development of the PcD. Physicians will be contacted every 2 years. DISCUSSION: CoDiab-VD will allow obtaining a broad picture of the care of patients with diabetes, as well as their needs regarding their chronic condition. The data will be used to evaluate the PcD and help prioritise targeted actions. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, identifier NCT01902043, July 9, 2013.

Standardized evaluation methodology and reference database for evaluating IVUS image segmentation

This paper describes an evaluation framework that allows a standardized and quantitative comparison of IVUS lumen and media segmentation algorithms. This framework has been introduced at the MICCAI 2011 Computing and Visualization for (Intra)Vascular Imaging (CVII) workshop, comparing the results of eight teams that participated. We describe the available data-base comprising of multi-center, multi-vendor and multi-frequency IVUS datasets, their acquisition, the creation of the reference standard and the evaluation measures. The approaches address segmentation of the lumen, the media, or both borders; semi- or fully-automatic operation; and 2-D vs. 3-D methodology. Three performance measures for quantitative analysis have been proposed. The results of the evaluation indicate that segmentation of the vessel lumen and media is possible with an accuracy that is comparable to manual annotation when semi-automatic methods are used, as well as encouraging results can be obtained also in case of fully-automatic segmentation. The analysis performed in this paper also highlights the challenges in IVUS segmentation that remains to be solved.