Use of healthcare REsources and associated COsts in controlled versus uncontrolled carcinoid SYndrome in patients with neuroendocrine tumours: the RECOSY study.

PURPOSE: To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. METHODS: A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. RESULTS: Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean €5511.59 vs €1457.22; P = 0.028) and ED costs (€161.25 vs €14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). CONCLUSION: This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.

Impacts of irrigation network sectoring as an energy saving measure on olive grove production.

In recent years, improving water use efficiency has been one of the most important challenges for the agricultural sector. However, such improvements have led to the installation of pressurized irrigation systems which generally require more energy to operate, especially in plantations on sloping and mountainous lands. Thus, the reduction of energy use in these systems has also become a major issue. Irrigation network sectoring has been proposed as one of the most effective energy saving measures. Typically, however, the potential benefits of this management strategy have been evaluated by means of theoretical approaches in networks that were originally designed to supply water on demand and not after water application in real irrigation districts designed following sectoring strategies. In this work, this measure is applied to an irrigation district devoted to olive grove production in a mountainous area that was designed according to this management strategy. With this aim, the WEBSO (Water and Energy Based Sectoring Operation) algorithm, which was developed in a previous work, has been modified in order to take into account the specific characteristics of the irrigation district and its actual management, as well as to analyze sensitivity to several irrigation water depths in terms of both energy demand and yields. An economic analysis of the potential benefits of this management strategy is also carried out. The results show that this measure has lead to a nearly 30% reduction in energy consumption, while increasing farmers' profits by 13% compared to traditional on-demand operations.

[Health promotion by sports and physical activity: politics, behavior and infrastructures in a European comparison]. / Gesundheitsförderung durch Sport und körperliche Aktivität: Politik, Verhalten und Infrastrukturen im europäischen Vergleich.

OBJECTIVES: The focus of physical activity promotion is moving from measures to increase health-enhancing physical activity on the individual level to higher-level strategies including policy and environmental approaches. Scientific evidence, traditionally related to individual-based strategies, calls for adaptation and refinement when environmental and policy changes become more relevant. METHODS: This paper investigates differences in physical activity promotion and public policy among six European countries. Data from a European study on public health promotion policy and health behaviours (MAREPS) is analysed to study behaviour, community-based opportunities for physical activity, and populations' perception of the effectiveness of their national policies in promoting physical activity. RESULTS: Analyses show significant differences in both involvement in and perceived opportunities for physical activity among the investigated countries. Populations in Finland, Switzerland, and The Netherlands show comparably higher participation and, at the same time, perceive better opportunities for physical activity within the residential environment than people in East Germany, Belgium, and Spain. Moreover, respondents from the former group of nations report considerably greater contribution of health policy in their country to the promotion of physical activity than respondents from the latter group. CONCLUSIONS: In conclusion, the results provide empirical support for the significance of environmental and policy approaches with regard to physical activity. Opportunities created by implementing such approaches may enable populations to develop more active lifestyles conducive to health. Further research employing longitudinal designs could be especially helpful to explore the causalities of the relationship between policy, environment and physical activity.

Nontraumatic lower extremity amputations in diabetic and non-diabetic subjects in Madrid, Spain.

The purpose of this study was to determine the incidence of non-traumatic lower extremity amputations (LEAs) in diabetic and non-diabetic subjects in Madrid, Spain, and their direct cost. All patients who underwent LEAs between the 1st of January 1994 and the 31st of December 1996, and who had lived in area 7 of the city (569,307 inhabitants) for at least the last 6 months, were identified through operating theatre records cross-checked with Vascular Surgery Department discharge records. In addition, the direct cost of LEAs per year was estimated, taking into account the length of the hospital stay, the period of rehabilitation in the outpatient clinic after discharge, and the use of artificial limbs and their maintenance. The incidence of LEAs was 1.6 (95% CI: 1.1-2.2) per 10(5) non-diabetic subjects and 46.1 (95% CI: 34.5-57.6) per 10(5) diabetic patients. Relative risk was 28. Total direct costs associated with LEAs per year were US$ 56,131 in the diabetic population and US$ 30,765 in the non-diabetic population. Thus, potential cost savings associated with excess amputations in the diabetic population was estimated at US$ 541,353 per year of US$ 94,736 per 10(5) inhabitants. It is concluded that the incidence of LEAs in both diabetic and non-diabetic populations in area 7 is the lowest reported in European countries. The potential cost savings per 10(5) inhabitants and per year is estimated at US$ 94,736.

Use of social indicators in assessment of local community alcohol and other drug dependence treatment needs within Chicago.

The State Systems Development Program of the US Center for Substance Abuse Treatment supports needs assessment studies conducted through state authorities. This article reports results of a social indicator study funded through this program of alcohol and other drug dependence (AODD) treatment needs specific to communities in Chicago, Illinois. Purposes of study analyses were: identify theoretical factors underlying a large set of social indicators, determine degree to which resultant factor scale scores predict community resident admissions to publicly-funded AODD treatment, and explore usefulness of factor scale scores in grouping communities into planning regions. Cautions and limitations in interpretation of results are discussed.

[An analysis of drug advertising in non-specialty medical journals]. / Análisis de la publicidad medicamentosa en revistas médicas no especializadas.

It has been evaluated drug advertisement in four medical journals during 1989. A questionnaire allows us to evaluate pharmacological and advertising data. The main results obtained are the following: amoxicillin + clavulanic acid was the more advertising drug; the ratio publicity/pharmacological information was 3:1; 60% of the advertising products were new drugs, and only a 6% were essentials drugs according to WHO; slogans were acceptable; generally, aspects such as dosage and toxicology are referred. However, it is necessary to improve information about drug use in elderly patients, patients with impaired renal functional, as well as the necessary information in adverse drug reactions.

Multivariate effects of demand characteristics on the analogue assessment of heterosocial competence.

The present study assessed the effects of a contextual demand manipulation (pretreatment assessment versus experiment) and an instructional demand manipulation (high demand for competent behavior versus neutral demand) on the analogue assessment of heterosocial competence. Also assessed was the interaction between each demand manipulation and subject characteristics (high-frequency dating/low heterosocially anxious versus low-frequency dating/high heterosocially anxious college males). Students were assigned randomly to one of four groups receiving differential information and instructions. Students completed a battery of five standard paper-and-pencil questionnaires, responded out loud to 10 taped social situations, and conversed with a female confederate while being videotaped for five minutes. Multivariate analyses revealed highly significant differences between subject groups and between contextual manipulation groups. Univariate analyses revealed that only 3 of the 16 dependent measures, including 2 of the self-reports, were significantly affected by the contextual demand. Results are discussed in light of previous studies of phobic behavior and social skills. Various avenues for future research were presented.