Wave energy to power a desalination plant in the north of Gran Canaria Island: Wave resource, socioeconomic and environmental assessment.

The Canary Islands are recognized as an area of particular interest to exploit and to promote the use of renewable energies as a way to reduce its energy dependence on fossil fuels and ultimately reach energy self-sufficiency and sustainability. A common major problem in mid-latitude small and remote islands is the low annual precipitation rate and the associated freshwater scarcity, leading to the installation of desalination plants powered by oil. In this context, the assessment of wave energy potential along with socioeconomic and environmental factors in a selected area at the north side of Gran Canaria Island shows that wave power availability is adequate for its exploitation and there are no sources of potential conflicts that prevent the installation of wave energy converters. In particular, the harvesting of wave energy to power existing seawater desalination plants, fully based in the use of oil, is considered as a viable, appealing and advantageous alternative over the direct injection to the electric network.

Migrant women living with HIV in Europe: are they facing inequalities in the prevention of mother-to-child-transmission of HIV?: The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord.

Background: In pregnancy early interventions are recommended for prevention of mother-to-child-transmission (PMTCT) of HIV. We examined whether pregnant women who live with HIV in Europe and are migrants encounter barriers in accessing HIV testing and care. Methods: Four cohorts within the European Pregnancy and Paediatric HIV Cohort Collaboration provided data for pooled analysis of 11 795 pregnant women who delivered in 2002-12 across ten European countries. We defined a migrant as a woman delivering in a country different from her country of birth and grouped the countries into seven world regions. We compared three suboptimal PMTCT interventions (HIV diagnosis in late pregnancy in women undiagnosed at conception, late anti-retroviral therapy (ART) start in women diagnosed but untreated at conception and detectable viral load (VL) at delivery in women on antenatal ART) in native and migrant women using multivariable logistic regression models. Results: Data included 9421 (79.9%) migrant women, mainly from sub-Saharan Africa (SSA); 4134 migrant women were diagnosed in the current pregnancy, often (48.6%) presenting with CD4 count <350 cells/µl. Being a migrant was associated with HIV diagnosis in late pregnancy [OR for SSA vs. native women, 2.12 (95% CI 1.67, 2.69)] but not with late ART start if diagnosed but not on ART at conception, or with detectable VL at delivery once on ART. Conclusions: Migrant women were more likely to be diagnosed in late pregnancy but once on ART virological response was good. Good access to antenatal care enables the implementation of PMTCT protocols and optimises both maternal and children health outcomes generally.

A MSFD complementary approach for the assessment of pressures, knowledge and data gaps in Southern European Seas: The PERSEUS experience.

PERSEUS project aims to identify the most relevant pressures exerted on the ecosystems of the Southern European Seas (SES), highlighting knowledge and data gaps that endanger the achievement of SES Good Environmental Status (GES) as mandated by the Marine Strategy Framework Directive (MSFD). A complementary approach has been adopted, by a meta-analysis of existing literature on pressure/impact/knowledge gaps summarized in tables related to the MSFD descriptors, discriminating open waters from coastal areas. A comparative assessment of the Initial Assessments (IAs) for five SES countries has been also independently performed. The comparison between meta-analysis results and IAs shows similarities for coastal areas only. Major knowledge gaps have been detected for the biodiversity, marine food web, marine litter and underwater noise descriptors. The meta-analysis also allowed the identification of additional research themes targeting research topics that are requested to the achievement of GES.

Substitution rate and milk yield response to corn silage supplementation of late-lactation dairy cows grazing low-mass pastures at 2 daily allowances in autumn.

Feed costs in dairy production systems may be decreased by extending the grazing season to periods such as autumn when grazing low-mass pastures is highly probable. The aim of this autumn study was to determine the effect of corn silage supplementation [0 vs. 8 kg of dry matter (DM) of a mixture 7:1 of corn silage and soybean meal] on pasture intake (PI), milk production, and grazing behavior of dairy cows grazing low-mass ryegrass pastures at 2 daily pasture allowances (PA; low PA=18 vs. high PA=30 kg of DM/cow above 2.5 cm). Twelve multiparous Holstein cows were used in a 4 × 4 Latin square design with 14-d periods. Pre-grazing pasture mass and pre-grazing plate meter pasture height averaged 1.8 t of DM/ha (above 2.5 cm) and 6.3 cm, respectively. The quality of the offered pasture (above 2.5 cm) was low because of dry conditions before and during the experiment (crude protein=11.5% of DM; net energy for lactation=5.15 MJ/kg of DM; organic matter digestibility=61.9%). The interaction between PA and supplementation level was significant for PI but not for milk production. Supplementation decreased PI from 11.6 to 7.6 kg of DM/d at low PA and from 13.1 to 7.3 kg of DM/d at high PA. The substitution rate was, therefore, lower at low than at high PA (0.51 vs. 0.75). Pasture intake increased with increasing PA in unsupplemented treatments, and was not affected by PA in supplemented treatments. Milk production averaged 13.5 kg/d and was greater at high than at low PA (+1.4 kg/d) and in supplemented than unsupplemented treatments (+5.2 kg/d). Milk fat concentration averaged 4.39% and was similar between treatments. Milk protein concentration increased from 3.37 to 3.51% from unsupplemented to supplemented treatments, and did not vary according to PA. Grazing behavior parameters were only affected by supplementation. On average, daily grazing time decreased (539 vs. 436 min) and daily ruminating time increased (388 vs. 486 min) from 0 to 8 kg of supplement DM. The PI rate was 6g of DM/min lower in supplemented than in unsupplemented treatments (17 vs. 23 g of DM/min). The high milk yield response to supplementation may be related to a cumulative effect of the low-mass pasture (low PI) and the low quality of the pasture, which strongly limited energy supply in unsupplemented cows.

[Is Cinacalcet a cost-effective treatment in severe secondary hyperparathyroidism in patients on hemodialysis?]. / Es el cinacalcet un tratamiento coste-efectivo en el hiperparatiroidismo secundario severo en pacientes en hemodiálisis?

BACKGROUND: A previous study using cinacalcet, as compared to vitamin D alone, showed a better reduction response of PTH levels and a significant diminution of secondary effects. The objective of present study was to evaluate the additional cost of adding cinacalcet to the standard treatment of patients with severe secondary hyperparathyroidism (SHPT) taking into account the treatment goals achieved. METHODS: 12 month prospective study of 23 patients with severe SHPT. Two treatment regimens were considered: standard treatment (m 0) and standard treatment plus cinacalcet (m 12). Four consequences of inadequate control of SHPT were registered: parathiroid hormone (PTH), Calcium (Ca), Phosphorus (P) and the Ca x P product serum levels. Treatment effectiveness was measured as percentage of patients who achieved treatment goal according to each indicator: PTH < 800 pg/mL, PTH between 150 and 300 pg/mL, Calcium < 9.5 mg/dL, Phosphorus < 5.5 mg/dL, and Ca x P product < 55. Annual and monthly costs were calculated for both treatment regimens using Spanish 2007 tariffs, and taking into account the dose reduction in some other treatments. Results are presented as incremental costs and cost per patient who achieved treatment goal. RESULTS: At 12 month it was observed a higher percentage of patients who achieved simultaneously the 4 therapeutic goals with respect to basal moment, from 0% to 52.1%. Cinacalcet allowed to save costs in concomitant drugs, achieving a total saving of 149 euros per patient and month. At 12 month, Cinacalcet achieved a reduction of percentage of patients with PTH > 800 pgr/mL with half of costs than standard treatment (651.35 euros vs 1363.68 euros). It was not possible to calculate the cost for PTH indicator since at the study onset, there was no patient who achieved a level between 150 and 300 pg/mL. Cinacalcet allowed reaching treatment goals in Calcium, Phosphorus and Ca x P product in a more cost-effective way (2164.2 euros vs 2684.8 euros). CONCLUSIONS: Although Cinacalcet is expensive,p atients treated with Cinacalcet showed a minor cost per patient who achieved treatment goal than patients without Cinacalcet. The ability of cinacalcet to reduce PTH secretion, along with the reductions in the serum Ca, P, and Ca x P product, provides an alternative to the traditional treatment paradigm, and should be a welcomed addition in the management of SHPT.

[Economic analyses of olanzapine in the treatment of schizophrenia and bipolar disorder]. / Análisis económico de la olanzapina en el tratamiento de la esquizofrenia y el trastorno bipolar.

Schizophrenia generates important costs for society both direct, as a consequence of hospitalization and outpatient treatment, and indirect; related to loss of productivity. The atypical antipsychotics, such as olanzapine, have supposed an important advance in the treatment of schizophrenia. The greater cost of atypical antipsychotics with respect to conventional drugs has led to the conduction of pharmacoeconomic studies to determine its efficiency. This article reviews the complete pharmacoeconomic studies that compare olanzapine with haloperidol and risperidone in the treatment of schizophrenia. Cost analyses comparing olanzapine and haloperidol show that the former drug does not add increased cost to therapy, and even contributes to lessen expenses fundamentally as a result of a decrease in hospitalizations. In the economic evaluations comparing olanzapine and risperidone, the results are not conclusive, and in general, the total costs associated with both treatments were similar. In the treatment of bipolar disorder, although few studies have estimated the economic impact of olanzapine, it has been observed a reduction of hospitalization costs associated to the treatment with olanzapine.

[What is an efficient health technology in Spain?]. / Qué es una tecnología sanitaria eficiente en España?

INTRODUCTION: Despite the growing recognition of the potential applications of cost-effectiveness assessments, a criterion to establish what is an efficient health technology does not exist in Spain. The objective of this work is to describe the limits and the criteria used in Spain to recommend the adoption of health interventions. METHOD: A review of the economic evaluations of health technologies published in Spain from 1990 to 2001 was conducted. Complete economic assessments in which the cost-effectiveness ratio was expressed as cost per life-year gained (LYG), cost per quality-adjusted-life-year (QALY) or cost per saved live were selected. Those interventions in which the authors established recommendations (adoption or rejection) and the criteria used were analyzed. RESULTS: Twenty (20%) of the 100 complete economic evaluations fulfilled the selection criteria. In16 studies, the results were expressed as cost per LYG, in 6 studies as cost per QALY and in 1 as cost per saved live. A total of 82 health interventions were assessed and some kind of recommendation was established in 44 of them. All technologies with a cost-effectiveness ratio lower than 30,000 euros (5 million pesetas) per LYG were recommended for adoption by the authors. Up to that limit there was no a clear tendency. CONCLUSIONS: Although the results must be interpreted with much precaution, given the limitations of the study, the limits of cost-effectiveness presented in this work could be a first reference to which would be an efficient health intervention in Spain.

Performance of a perceived health measure in different groups of the population: a comprehensive study in Spain.

The metric properties of health-related quality of life measures are typically evaluated on selected samples and assumed to hold across different population groups. We assessed the extent to which the measurement properties of the Spanish version of the Nottingham Health Profile (NHP) were stable across sociodemographic, clinical and geographical characteristics. We collected information from all available studies using the NHP in Spain (1986-1995), and obtained data from 9419 individuals. We examined data completeness and distribution, as well as reliability and construct validity. The percentage of missing dimensions was lower than 5%, but increased with age and poor health status. Large ceiling effects in scores were observed for social isolation and energy dimensions, being largest for younger ages and individuals reporting "very good/good" health. Reliability was higher than 0.7 in all population groups considered, except for social isolation and energy dimensions in some subgroups. Mean NHP scores correlated with self-rated overall health (r = 0.48), but they varied substantially by age among those rating their health as "very good/good." We conclude that NHP is adequate for all Spanish populations. Nevertheless, some caution is needed because the reliability of dimension scores is not sufficient for individual purposes. And also, because a non-negligible high ceiling effect renders the instrument inefficient to measure changes over time among healthy populations.

Rasch measurement in the Assessment of Growth Hormone Deficiency in adult patients.

The Assessment of Growth Hormone Deficiency in Adults (AGHDA) questionnaire was previously designed, translated and validated in several European countries to evaluate the impact of the disease on Quality of Life. This study aimed to test the metric properties of the Spanish version by means of Rasch analysis. A sample of 356 consecutive adult patients with untreated GHD was included in the study. Patients responded to the questionnaire at baseline and 12 months apart. Answers were analyzed following the dichotomous logistic response model. Parameter estimates, model-data fit and separation statistics were computed. The invariance of the item parameters across time was tested in the follow-up. Rasch results were additionally employed to ascertain score changes through the calculation of the Reliable Change Index (RCI). Items varied in severity from 8.3 -16.8 units (SE= 0.4-0.5) and fit to define a unidimensional variable. The item separation index (SI)(5.2) indicates a good and reliable (0.9) separation of items along the variable that they define. Moreover, results showed the AGHDA conforms to the model expectation of item parameter invariance between administrations. The substantial (2.3) and reliable (0.8) person SI also suggests the sample was well targeted by the questionnaire. According to the RCI, 84% of the patients did not show a significant transition in their measures. Results denote the items of the AGHDA succeeded in defining a scale characterized by the interval-level of its measures, suggesting the questionnaire could be a useful complement of the clinical evaluation of GHD patients at both group and individual level.

[Development of the ECOS-16 clinical questionnaire for the assessment of the quality of life in patients with osteoporosis]. / Desarrollo del cuestionario clínico ECOS-16 para la evaluación de la calidad de vida en pacientes con osteoporosis.

BACKGROUND: The use of currently validated instruments to measure the health-related quality of life (HRQoL) of patients with osteoporosis in daily clinical practice is not feasible due to the length of time needed to be administered. The objective of the present study was to develop a new, short questionnaire for women with vertebral fractures due to osteoporosis. PATIENTS AND METHODS: The administration of two disease-specific questionnaires (OQLQ and QUALEFFO) and the generic SF-36 questionnaire to 338 women with vertebral fracture due to osteoporosis allowed the development of a new questionnaire in 5 stages: i) search for a common structure in both questionnaires; ii) independent reduction of items in the OQLQ and QUALEFFO using Rasch analysis; iii) aggregation of remaining items in both questionnaires into distinct dimensions; iv) quantitative reduction of redundant items in aggregated dimensions; v) qualitative item reduction in aggregated scales. RESULTS: The methodology of the study allowed the development of a 16 item questionnaire (ECOS-16), with 4 items taken from the OQLQ and 12 from the QUALEFFO. The items are grouped into 4 categories: physical functioning (5 items), illness-related fears (2 items), psychosocial functioning (4 items), and pain (5 items). CONCLUSIONS: The ECOS-16 will be a promising alternative, once it is validated, to generic questionnaires and to the specific questionnaires from which its content was extracted, particularly for patients with osteoporotic vertebral fracture in daily clinical practice.

Exploring health preferences in sociodemographic and health related groups through the paired comparison of the items of the Nottingham health profile.

BACKGROUND: Preference weighted measures of health related quality of life are necessary for cost effectiveness calculations involving quality of life adjustment. There are conflicting data about the influence of factors such as sociodemographic and health related variables on health preferences. STUDY OBJECTIVE: The relative values attached to the items of the Spanish version of the Nottingham Health Profile (NHP) were assessed to make comparisons across social and health subgroups. DESIGN AND PARTICIPANTS: Preference values were obtained in sets of 250 to 253 persons (total n=1258) using the method of paired comparisons after all possible pairs of NHP items had been presented to respondents for judgement of severity. chi(2) Tests and Spearman's correlations among item ranks were calculated. MAIN RESULTS: Findings show that preferences elicited with the method of paired comparisons are consistent and independent of the sample from which they are obtained (mean correlation coefficients across subgroups range from 0.87 to 0.96). Conclusion-The evaluation of health did not seem to be related to sociodemographic variables (gender, age, social class) or to the health status of the respondents, suggesting that health preferences are stable across different populations.

The QoL-AGHDA: an instrument for the assessment of quality of life in adults with growth hormone deficiency.

Several studies have shown that growth hormone deficiency in adults leads to poor well-being and other clinical consequences, and that these improve when the hormone is replaced. However, the studies employed generic measures of health status that miss important aspects of the patients' experience and that have inadequate reliability and responsiveness. This paper describes the European development and testing of the Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA), a condition-specific quality of life measure for use in clinical trials and for the routine monitoring of patients. The instrument was produced in five languages; English, Swedish, Italian, German and Spanish. Each language version is shown to have good reliability, internal consistency and construct validity. The QoL-AGHDA is currently included in an international database monitoring the long-term efficacy and safety of growth hormone replacement therapy and in clinical trials in a number of countries.

Testing the measurement properties of the Spanish version of the SF-36 Health Survey among male patients with chronic obstructive pulmonary disease. Quality of Life in COPD Study Group.

The aim of this article is to evaluate the measurement properties of the Spanish version of the SF-36 Health Survey (SF-36). In total, 321 male chronic obstructive pulmonary disease (COPD) patients attending hospital outpatient or primary health clinics were cross-sectionally administered the SF-36, the St. George's Respiratory Questionnaire (SGRQ), and a dyspnea scale. A clinical measure of respiratory function, the proportion of the predicted Forced Expiratory Volume in 1 second (%FEV1) was also obtained. Internal consistency, central tendency, and dispersion statistics of scores were calculated, as well as the percentage of respondents with the highest and lowest scores for each scale and correlations between health status and clinical measures. All patients completed the SF-36 questionnaire, and less than 1% of items were missing. The proportion of patients with the worst possible score (floor effect) ranged from 0.9-20.1% among the different scales. The proportion of patients achieving the best possible score (ceiling effect) ranged from 0-61%. Cronbach's alpha coefficients were above 0.75 except for one scale (Social Functioning, alpha = 0.55). SF-36 scores were moderate to highly correlated with SGRQ scores (coefficients ranged from -.41 to -.79). Correlations were moderate to high with dyspnea and lower but statistically significant with %FEV1. A clear gradient of SF-36 scores was found according to dyspnea levels and disease staging based on %FEV1 impairment, the gradient being more marked for the Physical Functioning, Role-Physical, and General Health scales. Data presented suggest that the Spanish version of the SF-36 is acceptable, valid, and reliable in COPD patients. Although more studies are needed, this version is adequate in international comparisons of health outcomes.

The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.

The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population surveys (n = 1771 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to test the algorithms used to score physical and mental component summary measures (PCS-36/MCS-36) based on the SF-36 Health Survey. Scoring coefficients for principal components were estimated independently in each country using identical methods of factor extraction and orthogonal rotation. PCS-36 and MCS-36 scores were also estimated using standard (U.S.-derived) scoring algorithms, and results were compared. Product-moment correlations between scores estimated from standard and country-specific scoring coefficients were very high (0.98 to 1.00) for both physical and mental health components in all countries. As hypothesized for orthogonal components, correlations between physical and mental components within each country were very low (0.00 to 0.12) for both estimation methods. Mean scores for PCS-36 differed by as much as 3.0 points across countries using standard scoring, and mean scores for MCS-36 differed across countries by as much as 6.4 points. In view of the high degree of equivalence observed within each country, using standard and country-specific algorithms, we recommend use of standard scoring algorithms for purposes of multinational studies involving these 10 countries.

Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population surveys (n = 1483 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to cross-validate the selection of questionnaire items for the SF-12 Health Survey and scoring algorithms for 12-item physical and mental component summary measures. In each country, multiple regression methods were used to select 12 SF-36 items that best reproduced the physical and mental health summary scores for the SF-36 Health Survey. Summary scores then were estimated with 12 items in three ways: using standard (U.S.-derived) SF-12 items and scoring algorithms; standard items and country-specific scoring; and country-specific sets of 12 items and scoring. Replication of the 36-item summary measures by the 12-item summary measures was then evaluated through comparison of mean scores and the strength of product-moment correlations. Product-moment correlations between SF-36 summary measures and SF-12 summary measures (standard and country-specific) were very high, ranging from 0.94-0.96 and 0.94-0.97 for the physical and mental summary measures, respectively. Mean 36-item summary measures and comparable 12-item summary measures were within 0.0 to 1.5 points (median = 0.5 points) in each country and were comparable across age groups. Because of the high degree of correspondence between summary physical and mental health measures estimated using the SF-12 and SF-36, it appears that the SF-12 will prove to be a practical alternative to the SF-36 in these countries, for purposes of large group comparisons in which the focus is on overall physical and mental health outcomes.

Rasch measurement for reducing the items of the Nottingham Health Profile.

The present study aimed to develop a short form of the Spanish version of the Nottingham Health Profile (NHP) by means of Rasch analysis. Data from several Spanish studies that included the NHP since 1987 were collected in a common database. Forty-five different studies were included, covering a total of 9,419 subjects both from the general population and with different clinical pathologies. The overall questionnaire (38 items) was simultaneously analyzed using the dichotomous response model. Parameter estimates, model-data fit and separation statistics were computed. The items of the NHP were additionally regrouped into two different scales: Physical (19 items) and Psychological (19 items). Separated Physical and Psychological parameter estimates were produced using the simultaneous item calibrations as anchor values. Misfitting items were deleted, resulting in a 22 item final short form (NHP22)-11 Physical and 11 Psychological-. The evaluation of the item hierarchies confirmed the construct validity of the new questionnaire. To demonstrate the invariance of the NHP22 item calibrations, Rasch analyses were performed separately for each study included in the sample and for several sociodemographic and health status variables. Results confirmed the validity of using the NHP22 item calibrations to measure different groups of people categorized by gender, clinical and health status.