Willingness to pay and conjoint analysis to determine women's preferences for ovarian stimulating hormones in the treatment of infertility in Spain.

BACKGROUND: Despite many advances in assisted reproductive techniques (ART), little is known about preferences for technological developments of women undergoing fertility treatments. The aims of this study were to investigate the preferences of infertile women undergoing ART for controlled ovarian stimulation (COS) treatments; to determine the utility values ascribed to different attributes of COS treatments; and to estimate women's willingness to pay (WTP) for COS. METHODS: A representative sample of ambulatory patients ready to receive, or receiving, COS therapies for infertility were recruited from seven specialized private centres in six autonomous communities in Spain. Descriptive, inferential and conjoint analyses (CA) were used to elicit preferences and WTP. Attributes and levels of COS treatments were identified by literature review and two focus groups with experts and patients. WTP valuations were derived by a combination of double-bounded (closed-ended) and open questions and contingent ranking methods. RESULTS: In total, 160 patients [mean (standard deviation; SD) age: 35.8 (4.2) years] were interviewed. Over half of the participants (55.0%) had a high level of education (university degree), most (78.8%) were married and half (50.0%) had an estimated net income of >€1502 per month and had paid a mean (SD) €1194.17 (€778.29) for their most recent hormonal treatment. The most frequent causes of infertility were related to sperm abnormalities (50.3%). In 30.6% of cases, there were two causes of infertility. The maximum WTP for COS treatment was €800 (median) per cycle; 35.5% were willing to pay an additional €101-€300 for a 1-2% effectiveness gain in the treatment. Utility values (CA) showed that effectiveness was the most valued attribute (39.82), followed by costs (18.74), safety (17.75) and information sharing with physicians (14.93). CONCLUSIONS: WTP for COS therapies exceeds current cost. Additional WTP exists for 1-2% effectiveness improvement. Effectiveness and costs were the most important determinants of preferences, followed by safety and information sharing with physicians.

Multigene family of ribosomal DNA in Drosophila melanogaster reveals contrasting patterns of homogenization for IGS and ITS spacer regions. A possible mechanism to resolve this paradox.

The multigene family of rDNA in Drosophila reveals high levels of within-species homogeneity and between-species diversity. This pattern of mutation distribution is known as concerted evolution and is considered to be due to a variety of genomic mechanisms of turnover (e.g., unequal crossing over and gene conversion) that underpin the process of molecular drive. The dynamics of spread of mutant repeats through a gene family, and ultimately through a sexual population, depends on the differences in rates of turnover within and between chromosomes. Our extensive molecular analysis of the intergenic spacer (IGS) and internal transcribed spacer (ITS) spacer regions within repetitive rDNA units, drawn from the same individuals in 10 natural populations of Drosophila melanogaster collected along a latitudinal cline on the east coast of Australia, indicates a relatively fast rate of X-Y and X-X interchromosomal exchanges of IGS length variants in agreement with a multilineage model of homogenization. In contrast, an X chromosome-restricted 24-bp deletion in the ITS spacers is indicative of the absence of X-Y chromosome exchanges for this region that is part of the same repetitive rDNA units. Hence, a single lineage model of homogenization, coupled to drift and/or selection, seems to be responsible for ITS concerted evolution. A single-stranded exchange mechanism is proposed to resolve this paradox, based on the role of the IGS region in meiotic pairing between X and Y chromosomes in D. melanogaster.

Patterns of variation in the intergenic spacers of ribosomal DNA in Drosophila melanogaster support a model for genetic exchanges during X-Y pairing.

Detailed analysis of variation in intergenic spacer (IGS) and internal transcribed spacer (ITS) regions of rDNA drawn from natural populations of Drosophila melanogaster has revealed contrasting patterns of homogenization although both spacers are located in the same rDNA unit. On the basis of the role of IGS regions in X-Y chromosome pairing, we proposed a mechanism of single-strand exchanges at the IGS regions, which can explain the different evolutionary trajectories followed by the IGS and the ITS regions. Here, we provide data from the chromosomal distribution of selected IGS length variants, as well as the detailed internal structure of a large number of IGS regions obtained from specific X and Y chromosomes. The variability found in the different internal subrepeat regions of IGS regions isolated from X and Y chromosomes supports the proposed mechanism of genetic exchanges and suggests that only the "240" subrepeats are involved. The presence of a putative site for topoisomerase I at the 5' end of the 18S rRNA gene would allow for the exchange between X and Y chromosomes of some 240 subrepeats, the promoter, and the ETS region, leaving the rest of the rDNA unit to evolve along separate chromosomal lineages. The phenomenon of localized units (modules) of homogenization has implications for multigene family evolution in general.

Long-term fiscal implications of funding assisted reproduction: a generational accounting model for Spain.

The aim of this study was to assess the lifetime economic benefits of assisted reproduction in Spain by calculating the return on this investment. We developed a generational accounting model that simulates the flow of taxes paid by the individual, minus direct government transfers received over the individual's lifetime. The difference between discounted transfers and taxes minus the cost of either IVF or artificial insemination (AI) equals the net fiscal contribution (NFC) of a child conceived through assisted reproduction. We conducted sensitivity analysis to test the robustness of our results under various macroeconomic scenarios. A child conceived through assisted reproduction would contribute €370,482 in net taxes to the Spanish Treasury and would receive €275,972 in transfers over their lifetime. Taking into account that only 75% of assisted reproduction pregnancies are successful, the NFC was estimated at €66,709 for IVF-conceived children and €67,253 for AI-conceived children. The return on investment for each euro invested was €15.98 for IVF and €18.53 for AI. The long-term NFC of a child conceived through assisted reproduction could range from €466,379 to €-9,529 (IVF) and from €466,923 to €-8,985 (AI). The return on investment would vary between €-2.28 and €111.75 (IVF), and €-2.48 and €128.66 (AI) for each euro invested. The break-even point at which the financial position would begin to favour the Spanish Treasury ranges between 29 and 41 years of age. Investment in assisted reproductive techniques may lead to positive discounted future fiscal revenue, notwithstanding its beneficial psychological effect for infertile couples in Spain.

A race-specific insertion of transposable element IS801 in Pseudomonas syringae pv. phaseolicola.

The isolation and cloning of a random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) band specific for Pseudomonas syringae pv. phaseolicola race 1 allowed us to design a pair of primers that amplify 1.2-kb race 1-specific and 2.7-kb race 2-specific fragments, providing a rapid method for the identification of races by standard PCR methods. Restriction analysis revealed identical endonuclease sites in both fragments but the race 2 fragment contains a 1.5-kb insertion, identified as transposable element IS801 by sequence comparison. One complete and one partial open reading frame (ORF), each with a high probability of encoding a protein, have been identified in the 1.2-kb fragment common to both race 1 and race 2 sequences. As IS801 disrupts the partial ORF in the race 2 fragment, the complete sequence of this ORF has been obtained as well as its promoter region. The possibility that it may encode an avirulence gene is discussed as well as the role of transposable elements in pathogen evolution.

Synthesis of ecteinascidin ET-743 and phthalascidin Pt-650 from cyanosafracin B.

An efficient new process is described for the synthesis of ecteinascidin ET-743 (1) and phthalascidin (2), starting from readily available cyanosafracin B (3).

Burden of illness attributable to subclinical hypothyroidism in the Spanish population.

INTRODUCTION: Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. PATIENTS AND METHODS: Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. RESULTS: In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. CONCLUSION: SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective.

Characterization of selective antibacterial peptides by polarity index.

In the recent decades, antibacterial peptides have occupied a strategic position for pharmaceutical drug applications and became subject of intense research activities since they are used to strengthen the immune system of all living organisms by protecting them from pathogenic bacteria. This work proposes a simple and easy statistical/computational method through a peptide polarity index measure by which an antibacterial peptide subgroup can be efficiently identified, that is, characterized by a high toxicity to bacterial membranes but presents a low toxicity to mammal cells. These peptides also have the feature not to adopt to an alpha-helicoidal structure in aqueous solution. The double-blind test carried out to the whole Antimicrobial Peptide Database (November 2011) showed an accuracy of 90% applying the polarity index method for the identification of such antibacterial peptide groups.

The structure of the rDNA intergenic spacer of Avena sativa L.: a comparative study.

The sequence of the 18S-25S ribosomal RNA gene intergenic spacer (IGS) of Avena sativa was determined. DNA was cloned after polymerase chain reaction amplification of the IGS. The spacer of 3980 bp is composed of non-repeated sequences and five tandem arrays of repeated sequences, named A to E. Homology between oats IGS and other grass species was found. Tandem arrays D and E seem to be originated by duplication from single-copy sequences in related species. A transcription initiation site and putative sites of termination, processing and methylation were detected by computer-aided search. These sites resemble motifs conserved in the IGS of plant species.

Assessment of verbal memory in Spanish-speaking elders: development of two frequency-matched list learning tests.

Because the percentage of the population speaking Spanish primarily or exclusively has increased steadily in recent years, the need for neuropsychological measures to assess cognition in these individuals also has grown. We describe two frequency-matched, semantically categorized word lists that were designed to assess verbal memory in Spanish-speakers. The testing procedure consists of five immediate free recall trials and a single delayed free recall trial. These list learning tests were administered to healthy older adults (mean age: 75 years) and preliminary normative data are provided. These measures are likely to be useful in the assessment of verbal memory in Spanish-speaking individuals.

A comparative study of the structure of the rDNA intergenic spacer of Lens culinaris Medik., and other legume species.

As part of a project on lentil molecular genetics, the sequence of the 18S-25S ribosomal RNA gene intergenic spacer (IGS) of Lens culinaris Medik. was determined. DNA was cloned after polymerase chain reaction (PCR) amplification. The spacer of 2939 bp was composed of nonrepetitive sequences and four tandem arrays of repeated sequences, named A to D. C and D arrays were formed by the repetition of very short consensus sequences. Similarity was found between lentil and other legume species, in particular those of the Vicieae tribe. A transcription initiation site, putative sites of termination and processing, and promoter-enhancer sequences were detected by computer-aided searches. These sites resemble motifs conserved in the IGS sequences of other plant species. The conservation of motifs in the otherwise highly variable plant IGS sequences points to the relevance of these motifs as functional sequences.

Carga de la enfermedad atribuible al hipotiroidismo subclínico en la población española / Burden of illness attributable to subclinical hypothyroidism in the Spanish population

Introducción. El hipotiroidismo subclínico (HS) se ha asociado a enfermedades cardiovasculares, pero se desconoce la pérdida de salud que conlleva. Hemos evaluado la carga de enfermedad del HS en España. Pacientes y métodos. A partir de la prevalencia del HS en España obtenida de estudios internacionales, se llevó a cabo un modelo teórico que calculó los años de vida ajustados por discapacidad (AVAD), los años de vida perdidos (AVP), y las pérdidas de salud por discapacidad (AVD) asociados al HS. Las prevalencias de los factores de riesgo, el riesgo de mortalidad coronaria, y de episodios coronarios asociados al HS se obtuvieron de una revisión de la literatura. El análisis se llevó a cabo según la metodología de la Organización Mundial de la Salud, utilizando fuentes oficiales españolas (registro de altas hospitalarias: conjunto mínimo básico de datos [CMBD], registro de mortalidad hospitalaria, etc.). Resultados. En España hay aproximadamente 2.767.124 personas con HS (1.949.820 con niveles de TSH entre 4,5 y 6,9mUI/l [70,5%], 538.988 con TSH entre 7 y 9,9mUI/l [19,5%], y 278.317 con TSH entre 10 y 19,9mUI/l [10%]). Estas personas con HS podrían sufrir 12.608 episodios cardiacos y 1.388 muertes cardiacas anuales, lo que representa 30.550 AVAD (13.124 AVP y 17.426 AVD). El HS puede representar entre el 1,6 y el 7,3% de los AVAD cardiovasculares. Conclusión. El HS es una condición silente que determina una enorme carga de enfermedad. La valoración del HS, al menos en los pacientes pertenecientes a grupos de riesgo, podría ser coste-efectiva (AU)

Introduction. Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Patients and methods. Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. Results. In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. Conclusion. SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective (AU)

Estudio de los enfermos colecistectomizados por patologia biliar benigna en el Hospital de San Carlos entre 1972 Y 1981. / Choledochostomized patients for benign biliary disease at the Hospital of San Carlos 1972-1981

Se analizan las caracteristicas de una muestra representativa de 1.557 pacientes colecistectomizados por patologia benigna en el Hospital de San Carlos en el decenio comprendido entre 1972 y 1981. Se destaca el predominio de las mujeres sobre los hombres en proporcion de 5 a 1. Se describen algunos detalles de tecnica quirurgica Se hace hincapie en el hecho que la patologia vesicular aguda represento el 35,4% de los casos; que se hizo coledocostomia en el 15,8% de ellos; que la litiasis coledociana se comprobo en el 10,4% del grupo total y en el 65,6% de los coledocostomizados. Se enumeran las principales complicaciones postoperatorias inmediatas y alejadas. La mortalidad global fue de 0,9% y la de los casos de colecistitis aguda de 3%

Reacción periapical a la aplicación del formocresol diluido en pulpotomias en perros / Periapical reaction to the diluted formocresol application as pulpotomy agents in dogs

Este estudio fue realizado para valorar la reacción periapical producida con el uso de formocresol diluido 1:5 por cuatro minutos en pulpotomías de premolares temporales en perros, después de 45 días. Se tomaron 32 dientes, a 16 de los cuales se les colocó formocresol diluido 1:5 por cuatro minutos y la otra mitad fue utilizado como grupo de control. Se realizaron Cortes histológicos a nivel periapical, los cuales fueron evaluados a doble ciego, encontrando una marcada reacción inflamatoria a nivel periapical en el grupo experimental.

Valores hematicos al nacer y a los 30 dias en ninos productos de partos normales y distocicos. / Hematologic values at birth and at 30 days of life in newborn infants products of normal and dystocic deliveries

Se estudiaron los valores hematicos en recien nacidos a termino de partos eutocicos y distocicos, al momento de nacer, a los 15 y 30 dias de edad. No se encontro diferencias significativas entre los eutocicos y distocicos.El valor promedio para la Hb fue de 16.99 g%, 13.4 g% de 11 g%, al nacer, 15 y 30 dias de edad respectivamente. El valor promedio del Ht fue de 51%, 42.3% y 36.9% en las edades de 1, 15 y 30 dias. Los valores medios de G.R.fueron 5.4, 4.5 y 3.3 millones/mm3 en las edades senaladas y los de G.B. fueron 9, 7 y 9 mil. El diferencial al nacer mostro predomino de polinucleares, y al mes predominio de linfocitos. Los valores de Hb a los 15 y 30 dias fueron mas bajos que en otros estudios, senalandose la posibilidad de que factores nutricionales en la madre sean las responsables.Se recomienda que el cordon umbilical de nuestros ninos sea atado mas tardiamente