Spanish adaptation of the Burden Assessment Scale in family caregivers of people diagnosed with borderline personality disorder.

BACKGROUND: Caregiving is a strong source of stress and leads the family caregiver to experience the burden of being responsible for the care of a severely mentally ill family member. The Burden Assessment Scale (BAS) assesses burden in family caregivers. This study aimed to analyze the psychometric properties of the BAS in a sample of family caregivers of people diagnosed with Borderline Personality Disorder (BPD). METHODS: Participants were 233 Spanish family caregivers (157 women and 76 men aged between 16-76 years old, M = 54.44, SD = 10.09) of people diagnosed with BPD. The BAS, the Multicultural Quality of Life Index, and the Depression Anxiety Stress Scale-21 were used. RESULTS: An exploratory analysis resulted in a three-factor 16-item model (Disrupted Activities; Personal and Social Dysfunction; Worry, Guilt, and Being Overwhelmed) with an excellent fit (χ2(101) = 56.873, p = 1.000, CFI = 1.000, TLI = 1.000, RMSEA = .000, SRMR = .060), good internal consistency (ω = .93), a negative correlation with quality of life, and a positive correlation with anxiety, depression, and stress. CONCLUSION: The model obtained for the BAS is a valid, reliable, and useful tool for assessing burden in family caregivers of relatives diagnosed with BPD.

The global flood protection savings provided by coral reefs.

Coral reefs can provide significant coastal protection benefits to people and property. Here we show that the annual expected damages from flooding would double, and costs from frequent storms would triple without reefs. For 100-year storm events, flood damages would increase by 91% to $US 272 billion without reefs. The countries with the most to gain from reef management are Indonesia, Philippines, Malaysia, Mexico, and Cuba; annual expected flood savings exceed $400 M for each of these nations. Sea-level rise will increase flood risk, but substantial impacts could happen from reef loss alone without better near-term management. We provide a global, process-based valuation of an ecosystem service across an entire marine biome at (sub)national levels. These spatially explicit benefits inform critical risk and environmental management decisions, and the expected benefits can be directly considered by governments (e.g., national accounts, recovery plans) and businesses (e.g., insurance).

Safety of Outpatient Implantation of the Implantable Cardioverter-defibrillator.

INTRODUCTION AND OBJECTIVES: Strategies are needed to reduce health care costs and improve patient care. The objective of our study was to analyze the safety of outpatient implantation of cardioverter-defibrillators. METHODS: A retrospective study was conducted in 401 consecutive patients who received an implantable cardioverter-defibrillator between 2007 and 2012. The rate of intervention-related complications was compared between 232 patients (58%) whose implantation was performed in the outpatient setting and 169 patients (42%) whose intervention was performed in the inpatient setting. RESULTS: The mean age (standard deviation) of the patients was 62 (14) years; 336 (84%) were male. Outpatients had lower left ventricular ejection fraction and a higher percentage had an indication for primary prevention of sudden death, compared to inpatients. Only 21 outpatients (9%) required subsequent hospitalization. The rate of complications until the third month postimplantation was similar for outpatients (6.0%) and inpatients (5.3%); P = .763. In multivariate analysis, only previous anticoagulant therapy was related to the presence of complications (odds ratio = 3.2; 95% confidence interval, 1.4-7.4; P < .01), mainly due to an increased rate of pocket hematomas. Each outpatient implantation saved approximately €735. CONCLUSIONS: Outpatient implantation of implantable cardioverter-defibrillators is safe and reduces costs. Close observation is recommended for patients receiving chronic anticoagulation therapy due to an increased risk of complications.

[Economic evaluation and budget impact analysis of the Endeavor drug-eluting stent in Spain]. / Evaluación económica e impacto presupuestario del stent recubierto Endeavor en España.

OBJECTIVES: Endeavor is a drug-eluting stent (DES) with superior results to the bare metal stent (BMS) and similar efficacy to other DES in terms of revascularization. The aim of this study was to assess the costs and benefits of Endeavor, other DES, BMS and coronary artery bypass grafts (CABG) in Spain. METHODS: A Markov model with a 5-year time was used to reflect the management of patients with de novo coronary artery lesions in Spain. Model probabilities were derived from systematic reviews and randomized controlled trials of Endeavor. Health resources and costs were obtained from local data and were validated by experts. Effectiveness was measured as the number of revascularizations avoided, the major adverse coronary events (MACE) avoided and the quality adjusted life-years (QALYs) gained. RESULTS: Endeavor had higher total costs than the BMS. The cost per revascularization avoided with Endeavor was 6,851 euro (at 1 year) and 10,831 euro (at 5 years). In terms of cost per MACE avoided with Endeavor, the results were 7,003 euro and 11,322 euro, respectively, and in terms of costs of QALY gained were 132,877 euro, 34,229 euro and 10,505 euro at 1, 2, and 5 years, respectively. The budget impact of the progressive introduction of Endeavor would be practically null, representing 0.4% of the total cost of percutaneous coronary interventions at 5 years. CONCLUSIONS: The use of the Endeavor stent compared with BMS and CABG represents efficient resource use in patients with coronary artery disease, with cost-effectiveness results below the threshold of efficiency defined in Spain.

Potencialidades de los recursos geográficos para la investigación en salud / Potentiality of geographic resources for health research

El mapa es el lenguaje de la geografía. Es un medio que como recurso de análisis convierte los datos espaciales en información espacial. Al mapa le sigue el análisis, que utiliza las categorías de espacio, territorio y lugar. En un sistema de información geográfico los mapas o bases gráficas adquieren un valor agregado mayor ya que a estos se les asocian otros datos, que pueden ser alfanuméricos, en forma de tablas, imágenes, videos y textos. El propósito de esta comunicación es proponer la fundamentación y acciones concretas que el desarrollo de los sistemas de información geográficos logrados por GEOCUBA ofrecen al Sistema de Salud