Reason for immigration and immigrants' health.

OBJECTIVES: The existing literature on the health trajectories of the UK immigrants has mainly focussed on the relationship between ethnicity and health. There is little information on the role of immigration status and no previous information on the role of reason for immigration to the country. This study fills this gap in the literature by analysing the heterogeneity of immigrant-native differences in health by reason for immigration. STUDY DESIGN: Analysis of cross-sectional quarterly data from the UK Labour Force Survey covering the period of 2010 (quarter 1) to 2017 (quarter 2). The sample includes 345,086 observations. The dependent variables of interest include suffering from a long-lasting condition, the link between long-lasting conditions and labour market performance and the prevalence of 12 specific health conditions. METHODS: Data were analysed using linear probability models to adjust for differences in age, education, gender, ethnicity, local authority of residence and year of survey. The analysis also explores the role of length of stay in the UK and the percentage of current lifetime spent in the UK (duration in the UK/age). RESULTS: Results indicate that, in general, immigrants are less likely than natives to report suffering from a long-lasting (1 year or more) health problem. This pattern generally remains the same when we consider the specificity of the long-lasting health problem. However, there are key differences across the immigrant groups by reason for immigration. Those who migrated for employment, family and study reasons report better health outcomes than natives, while those who migrated to seek asylum report worse health outcomes than natives. There is convergence to natives' health outcomes over time for those who migrated for non-asylum reasons, but not for those who migrated to seek asylum. CONCLUSIONS: The findings show that the prevalence of health problems differs not only between natives and immigrants but also across groups of immigrants who moved to the UK for different reasons.

Indirect costs associated with glioblastoma: Experience at one hospital. / Costes indirectos asociados al glioblastoma. Experiencia en un centro.

INTRODUCTION: Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. MATERIAL AND METHOD: We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. RESULTS: We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was €11 080 762 (2015). Mean indirect cost per patient was €111 926 (2015). DISCUSSION: Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease.

A direct assessment of realized seed and pollen flow within and between two isolated populations of the food-deceptive orchid Orchis mascula.

Gene flow can counteract the loss of genetic diversity caused by genetic drift in small populations. For this reason, clearly understanding gene flow patterns is of the highest importance across fragmented landscapes. However, gene flow patterns are not only dependent upon the degree of spatial isolation of fragmented populations, but are also dependent upon the life-history traits of the species. Indeed, habitat fragmentation effects appear especially unpredictable for food-deceptive orchid species, because of their highly specialised seed and pollen dispersal mechanisms. In this study we used amplified fragment length polymorphism markers and subsequent parentage and spatial autocorrelation analysis to quantify the extent and the patterns of realized gene flow within and between two adjacent fragmented populations of the food-deceptive Orchis mascula. We observed considerable gene flow between both populations, occurring mainly through pollen dispersal. Seed dispersal, on the other hand, was mainly limited to the first few meters from the mother plant in both populations, although at least one among-population seed dispersal event was observed. This, in turn, resulted in a significant spatial genetic structure for both populations. Although genetic diversity was high in both populations and mainly outcrossing occurred, reproductive output was strongly skewed toward a limited number of successful adult plants. These observed patterns are likely due to the different pollinator behaviour associated with food-deceptive plants. We conclude that these populations can be considered viable under their current fragmented state.

[Assessment of nutritional risk among in-school adolescents from Cantabria]. / Evaluación del riesgo nutricional de los adolescentes escolarizados en Cantabria.

OBJECTIVE: To analyse nutritional risk, by age and sex, among primary and secondary education adolescents from Cantabria. METHODOLOGY: a cross-sectional study was carried out, analysing a sample of 1101 adolescents: 568 (51.6%) were men and 533 (48.4%) were women, aged 12 to 17, attending 16 different primary and secondary education centres in Cantabria, by means of a Krece Plus questionnaire. RESULTS: A high percentage of adolescents with a high nutritional risk (35%) can be observed. Men show a high nutritional risk slightly higher than women (37.8% male vs 32.1% female). Moreover, the high nutritional risk experiences a notable increase as young people get older. Significant statistical differences can be seen both in male and female groups, and as a global group. In all three cases, the nutritional risk distribution in the youngest group is very similar (35.2-35.8% in male, 27.9-29.7% in female, 31.7-32.7% in the global group); whereas in elder adolescents, those values are practically doubled (57.1% in male, 69.0% in female, y 62.2% in the global group). CONCLUSIONS: Results are alarming mainly given the high percentage of adolescents with a high nutritional risk. Men and older adolescents are the groups in which high nutritional risk is more evident.

Objetivo: Evaluar el riesgo nutricional, por edad y sexo, que presentan los adolescentes escolarizados en la Comunidad Autónoma de Cantabria. Sujetos: Se realizó un estudio transversal, analizando una muestra de 1101 adolescentes, de los que 51,6% eran varones y 48,4% fueron mujeres de edades comprendidas entre los 10 y los 17 años, escolarizados en centros de enseñanza pública, mediante el cuestionario Krece Plus. Resultados: Se observa un elevado porcentaje de adolescentes que presentan un riesgo nutricional elevado (35%). Los varones presentan un riesgo nutricional alto en un porcentaje ligeramente superior a las mujeres (37,8 % vs 32,1%). Además, el riesgo nutricional alto sufre un notable incremento a medida que la edad de los jóvenes aumenta. Se aprecian diferencias estadísticamente significativas tanto en los grupos de edad de los varones (p = 0,024), de las mujeres (p < 0,001) como en el grupo global (p = 0,001). En los tres casos, la distribución del riego nutricional en los grupos de menor edad es muy similar (entre 35,2 y 35,8% en los h, entre 27,9 y 29,7% en las m, y entre 31,7 y 32,7% en el grupo total). Mientras que en el grupo de mayor edad estos valores prácticamente se duplican (57,1% en los h, 69,0% en las m, y 62,2 % en el grupo total). Conclusión: Los resultados obtenidos muestran una realidad preocupante debido, principalmente, al elevado porcentaje de adolescentes que presentan un riesgo nutricional elevado. Siendo los varones y los adolescentes de mayor edad los sectores en los que este riesgo nutricional elevado es superior.

[Identifying and prioritising adverse episodes and failures related to patient safety in Pain Treatment Units]. / Identificación y priorización de episodios adversos y fallos relacionados con la seguridad del paciente en las Unidades de Tratamiento del Dolor.

OBJECTIVES: An expert group coordinated by the Andalusian School of Public Health identified the most serious and frequent adverse events in Pain Treatment Units (PTU), as well the failures and underlying causes, as a prior step to preparing preventive actions. The aims of the project were to identify potential adverse events in Pain Treatment Units, identify failures and their underlying causes, and prioritise these failures according to a failure modes and effects analysis (FMEA) tool. MATERIAL AND METHODS: The method employed consisted of a literature search, the selection of an expert group with experience in PTU, creating a catalogue of adverse events using the generation of ideas technique, and putting the FMEA and Risk Priority Index tools into practice. RESULTS: Up to 66 types of adverse events were identified associated with; medication (30), invasive techniques (15), care process (10), patient information and education (6), and clinical practice (5). It was found that up to 101 failures could be triggered by these adverse events, and that 242 causes could lead to these failures. CONCLUSIONS: The results indicated the need to work principally in two directions, improving the care process in the PTU (the health care organisation), and the professional work, this latter having two aspects, improving the clinical practice, and increase professional skills by means of specific training. Communication, whether inter-professional or inter-department, or with the patient and their family, is identified as a key aspect for improvement.

[Cost analysis of the diagnosis and treatment of soft tissue sarcomas in reference centres]. / Análisis de los costes de diagnóstico y tratamiento de los sarcomas de partes blandas en centros de referencia.

OBJECTIVE: To determine the diagnostic and treatment costs in patients referred to a reference centre with a suspected soft tissue sarcoma. MATERIAL AND METHODS: The study consisted of a historic cohort of 48 consecutive patients who were diagnosed with soft tissue sarcomas and treated in our centres between the years 2009 and 2011, both prior to and after performing the biopsy. The cost per procedure was taken from the official list of prices published in the year 2009. A comparative study of the data was performed using the Mann-Whitney U and Wilcoxon tests. RESULTS: The mean cost per patient was 14,427.58€. In those referred before the biopsy, the overall mean cost was 11,818.67€, and in those referred afterwards, it was 6,456.74€ (p=.0073). There were no significant differences in the diagnostic costs between the groups. However, the mean cosy of the treatment per patient was higher in the second group (p=.0121). DISCUSSION: The referral to centres with experienced multidisciplinary teams in this disease is a common fact highlighted in many articles, where the financial savings have also been demonstrated. CONCLUSIONS: This study shows that, as well as improving the care aspect of the patients when they are referred to a specialist centre prior to the biopsy, there is also a lower health care cost.

[Pharmacoeconomics: basic concepts and applications to clinical anesthesia]. / Fundamentos de farmacoeconomía y su aplicación en anestesia clínica.

The economic evaluation of medications and health care technology has gained importance in recent years. Health care resources are limited and their use must be optimized so that we can take the greatest possible advantage. Pharmacoeconomics seeks to analyze the best therapeutic drug choices to obtain the desired outcome in specific cases or in populations. The 4 approaches used in pharmacoeconomics are cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis. This review examines the characteristics of each type of study using examples from anesthesiology, a field in which pharmacoeconomics is beginning to play a role.

[Cost-utility analisys of multiple sclerosis treatment with glatiramer acetate or interferon beta in Spain]. / Análisis coste utilidad del tratamiento de la esclerosis múltiple remitente-recidivante con acetato de glatiramero o interferón beta en España.

OBJECTIVE: To carry out a cost-utility analysis of the treatment of relapsing-remitting multiple sclerosis (RRMS) with glatiramer acetate (copaxone) or interferon beta (all, avonex, rebif and betaferon). METHODS: A pharmacoeconomic Markov model was used to compare treatment options by simulating the life of a hypothetical cohort of women aged 30, from the societal perspective. The transition probabilities, utilities, resource utilisation and costs (direct and indirect) were obtained from Spanish sources and from bibliography. Univariant sensitivity analyses of the base case were performed. RESULTS: In the base case analysis, the average cost per patient (euro in 2001) for a lifetime treatment, considering a life expectancy of 53 years, would be 1,243,906 euros (euro), 1,818,149 euros, 1,763,263 euros, 1,987,153 euros and 1,704,031 euros with copaxone, all interferons, avonex, rebif and betaferon, respectively. Therefore, the saving with copaxone would range between 460,000 and 737,000 euros approximately. The quality-adjusted life years (QALY) obtained with copaxone or interferons would be 10.977 and 6.917, respectively, with an average gain of 4.060 QALY patient with copaxone. The sensitivity analyses confirmed the robustness of the base case. The interferons would only be superior to copaxone in the unlikely hypothetical case that they delay the progression of the illness by 20% more than that actually observed in clinical trials. CONCLUSIONS: For a typical patient with RRMS, treatment with copaxone would be more efficient than interferons and would dominate (would be more efficacious with lower costs) interferon beta.

Data from amplified fragment length polymorphism (AFLP) markers show indication of size homoplasy and of a relationship between degree of homoplasy and fragment size.

We investigate the distribution of sizes of fragments obtained from the amplified fragment length polymorphism (AFLP) marker technique. We find that empirical distributions obtained in two plant species, Phaseolus lunatus and Lolium perenne, are consistent with the expected distributions obtained from analytical theory and from numerical simulations. Our results indicate that the size distribution is strongly asymmetrical, with a much higher proportion of small than large fragments, that it is not influenced by the number of selective nucleotides nor by genome size but that it may vary with genome-wide GC-content, with a higher proportion of small fragments in cases of lower GC-content when considering the standard AFLP protocol with the enzyme MseI. Results from population samples of the two plant species show that there is a negative relationship between AFLP fragment size and fragment population frequency. Monte Carlo simulations reveal that size homoplasy, arising from pulling together nonhomologous fragments of the same size, generates patterns similar to those observed in P. lunatus and L. perenne because of the asymmetry of the size distribution. We discuss the implications of these results in the context of estimating genetic diversity with AFLP markers.

Growth, hedgehog and the price of GAS.

Embryonic development in a given species is orchestrated by genes regulating growth and differentiation in a stereotyped and conserved manner, resulting in embryos of consistent size and shape. Several signaling pathways, including that of Sonic Hedgehog (SHH), have been implicated in these processes. Recent experiments with Gas1 indicate that it may act as a growth-inducing gene, challenging its previous function as a gene specifically involved in growth arrest. Moreover, GAS1, a GPI-linked membrane protein, can bind SHH, suggesting an interacting link between growth and patterning through SHH and GAS1.

Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment.

Controlled intervention studies carried out in families of schizophrenia patients have been shown to have a positive impact in relapse prevention, but it remains to be seen whether different forms of family intervention affect outcomes other than relapse and hospital readmission in different ways. This study compared the outcome profile of relevant clinical variables after two different family intervention strategies for schizophrenia patients in public health care in a Spanish sample. We conducted a randomized controlled study comparing (1) a relatives group (RG) and (2) a single-family behavioral family therapy (BFT), both offered as standard treatment in one catchment area in Valencia. All randomized patients were included in the main analysis, and all cases remained in the therapy group to which they were originally assigned regardless of whether they suffered a relapse. The relapse rate at 12 months for the 87 cases studied was not significantly different in the two groups, but the two approaches did affect outcomes other than relapse and rehospitalization (such as social functioning, dose of antipsychotic medication, "delusions" and "thought disorder") in different ways. The BFT approach offered more advantages than the RG approach. The results suggest that these approaches should always be implemented in a clinical environment in a Mediterranean setting.

Variation in surgical rates: a population study.

OBJECTIVES: The objective of this study was to compare the use of certain surgical services by physicians to three other professional groups (architects, lawyers, and nurses) and to the general population. To meet this objective, variations in six surgical procedures were studied: appendectomy, tonsillectomy, herniorrhaphy, cholecystectomy, cesarean section, and hysterectomy. METHODS: This was a cross-sectional study in the city of Valencia (Spain) from September 1992 to September 1993. The surveys were carried out by mail questionnaire. Two thousand ninety-six subjects were recruited by simple random sampling for each of the groups. The questionnaire contained questions referring to the interviewee and to each family member (spouse or partner and up to a maximum of four children). The proportion of subjects who stated that they had undergone a particular type of surgery was compared among the professional groups. The population denominator was the whole Valencia population. RESULTS: The global response rate was 83.7%. With the exception of herniorrhaphy, the rates of surgical procedures obtained for each procedure for the different groups were not significantly different. The frequency of operations for each group differed according to sex and age. The risk of undergoing tonsillectomy was significantly higher among the general population when there were no medical friends or relatives than when there were. CONCLUSIONS: Barriers against access to surgical care did not seem to have played an important role in the use of surgical services. The frequency of operations for the best informed consumers with the most access to these services, that is, physicians, was very similar to that for other population groups.

Benzodiazepine use in Chile: impact of availability on use, abuse, and dependence.

This study tested the hypothesis whether over-the-counter benzodiazepine availability influenced patterns of benzodiazepine use, abuse, and dependence in Chile. If over-the-counter availability represents a major risk factor leading to benzodiazepine substance use disorders, rates of abuse, and dependence would be significantly higher among over-the-counter benzodiazepine users than among prescription drug users. The study was a household survey of a stratified sample (N = 1,500) of the Santiago (Chile) population performed by trained interviewers. Data were collected by structured questionnaires on demographic characteristics, drug use, psychoactive substance use disorders, and other psychosocial variables. Past-year prevalence of benzodiazepine use was 31.4%, daily use of benzodiazepines for > or = 12 months, 5.9%, and subjects who met DSM-III-R criteria for dependence, 3.3%. Seventy-four percent of subjects obtained the benzodiazepine over-the-counter (always 45%; sometimes 29%). No subject acknowledged recreational benzodiazepine use or met criteria for benzodiazepine abuse. Use, long-term use, and dependence occurred equally frequently among both over-the-counter and prescription benzodiazepine users. Results suggest that although over-the-counter availability increases benzodiazepine use, it is not a major risk factor that leads to benzodiazepine abuse and/or dependence.

[Factors associated with the use of gynecology services by climacteric women: a case-control study]. / Factores asociados a la utilización de servicios de ginecología por la mujer climatérica: un estudio de casos y controles.

BACKGROUND: The data and concepts described in the literature on menopausic women are based on observations and studies carried out in menopausic women attending medical or gynecological consultations and contrast greatly with the results obtained in women from a general population. METHODS: In a case-control study 505 women between 45-55 years of age, 142 having attended a gynecological consultation (cases) and 363 taken from a randomized sample of the general population (controls) were evaluated. Information concerning sociodemography, climacteric phase, psychic morbidity and psychosocial factors as stressing events, social support and adjustment and satisfaction with roles was collected in a personal interview. The odds ratio (OR) was used as the means of association and multiple regression analysis was performed to control possible confusing factors. RESULTS: The cases were fundamentally young women in a premenopausic phase of a high social class belonging principally to a group of widows, separated or divorcees and a group of married women with high levels of association (OR = 14.7; OR 12.14). The women attending a gynecological consultation were characterized by having greater risk of lacking social support (OR = 8.94), presenting a greater frequency of vital severely stressing events over the previous year (OR = 2.55), and demonstrating greater insatisfaction in social adjustment (OR = 2.42) particularly in their sexual and matrimonial relations. CONCLUSIONS: Women attending medical, specially gynecological, consultations during climacteric years are not representative of the population of women in these years as a whole. Purely pharmacologic management, principally substitutive hormonal therapy, was the most wide-spread treatment of preventive character should be reestablished in accordance with the results with the most manifold and multifactorial orientations and foci.

Influence of the assessment of the severity on the frequency of adverse drug reactions (ADRs).

Sometimes it is difficult to compare data coming from different drug monitoring studies because of differences in methods, training of the monitors and other reasons. Many algorithms have been designed for permitting the objective and reproducible assessment of the causality of ADRs, but there is a lack of this kind of assessment for the severity of ADRs. This work was developed in order to show how important the standardized assessment of the severity of ADRs could be. For that purpose the same drug surveillance data were used for obtaining the frequency, characteristics and predisposing factors of ADRs, first considering all definite and probable ADRs--independently of their severity (study I)--and excluding after those considered as mild (study II). By means of an intensive prospective drug surveillance program, 2,559 patients hospitalized at the Medicine Service of the Clinical Hospital of the University of Chile were surveyed. The found frequencies of ARDs were 34.2% and 20.6% for study I and II, respectively. In both studies gastrointestinal and metabolic systems were the most ADRs-affected systems but some differences on adverse signs and/or symptoms were observed. For example, in study I the three most frequent reactions were hyponatremia, hypochloremia and hypokalemia while in study II the three commonest reactions were hypokalemia, vomiting and hypochloremia. In both studies similar characteristics of beginning and probability of ADRs were found, and the highest part of the reactions was dose-dependent. But when mild reactions were excluded (study II) an increase on the proportion of dose-independent ADRs was observed.(ABSTRACT TRUNCATED AT 250 WORDS)