Suchergebnisse

En este artículo se utilizan las preguntas del Censo de 1940 sobre la fecundidad retrospectiva ?hijos nacidos vivos e hijos supervivientes en el momento censal? de las mujeres casadas al menos una vez para estimar los niveles de supervivencia de sus descendientes y, por tanto, de mortalidad en la infancia (hasta los 15 años), según un método propuesto por W. Brass. Los resultados muestran que la Guerra Civil empeoró los niveles de supervivencia en la infancia en prácticamente todas las provincias españolas, pero tuvo un impacto diferencial muy contrastado. Comparando los niveles de supervivencia antes y durante el conflicto bélico, se obtiene que fueron las provincias meridionales y levantinas las más afectadas, mientras que en Cataluña y la Meseta septentrional los niveles de mortalidad en la infancia parecen haber empeorado menos, pese a que mostraban posiciones extremas respecto a los niveles de supervivencia antes de la guerra. De esto se deduce que, a pesar de que debiera existir una cierta relación entre el nivel de desarrollo demográfico y la vulnerabilidad que muestran las provincias ante una coyuntura desfavorable, tales características no parecen jugar un papel significativo como factor explicativo de los niveles de supervivencia durante el conflicto bélico.

In this article the life, thought and works of the Majorcan writer, philosopher and missionary Ramon Llull (ca. 1232 - 1316) are presented in the context of his time: politics, academia, spirituality and currents of thought. Llull has often been portrayed as an extravagant, eccentric character but here he emerges as a coherent personality whose actions and work were fully integrated into the world in which he was called upon to live.

In this study, we analyzed the sources of ambient PM inorganic and organic components near a cement plant using fossil fuels as well as alternative fuels, such as sewage sludge and biomass. Source apportionment methodologies, i.e., principal component analysis (PCA) and multivariate curve resolution by alternating least squares (MCR-ALS), and carbon isotope analysis (δ13C) were used to determine the potential sources and their contributions. Four sources of PM10 main tracer compounds constituents were identified: Marine and secondary inorganic aerosol, cement plant/industrial, traffic and crustal. The contributions of those sources varied significantly depending on the period of the year. However, the inorganic tracer PM species in the area were mainly released by combustion sources, namely traffic and the activity of the cement plant, especially in winter months. The analyses of tracer organic compounds also indicated combustion sources, i.e., biomass burning and fossil fuel combustion, as the predominant contributors to ambient air PM (62, 59 and 69%, in PM10, PM2.5 and PM1, respectively). Organic dust was a significant source of PM10 (33%) while its contribution was found to be minor in the finest fractions (9 and 2% in PM2.5 and PM1, respectively). Results of δ13C corroborated a significant contribution of combustion sources, traffic or biomass fuel as well as a higher influence of mineral (calcite) powder in larger particles. © Taiwan Association for Aerosol Research. ; This study was financed by the Spanish Ministry of Economy and Competitiveness (MINECO), as part of the projects CTM2012-32778 (F. S?nchez-Sober?n received a doctoral scholarship as part of the project above mentioned), CTM2015-65303 and CGL2014-57215-C4-1-R, as well as by the Catalan Government, through the projects 2014SGR90 and 2014SGR1456. The authors also want to thank LAFARGE CEMENTOS SAU for their help during the sampling. ; Peer reviewed

A recent study has supported the efficacy of Attachment-Based Compassion Therapy (ABCT) compared to relaxation (REL) for the management of fibromyalgia (FM). The main objective of this paper is to examine the cost-utility of ABCT compared to REL in terms of effects on quality-adjusted life years (QALYs) as well as healthcare costs. Forty-two Spanish patients with FM received 8 weekly group sessions of ABCT or REL. Data collection took place at pre- and 3-month follow-up. Cost-utility of the two treatment groups (ABCT vs. REL) was compared by examining treatment outcomes in terms of QALYs (obtained with the EQ-5D-3L) and healthcare costs (data about service use obtained with the Client Service Receipt Inventory). Data analyses were computed from a completers, ITT, and per protocol approach. Data analysis from the healthcare perspective revealed that those patients receiving ABCT exhibited larger improvements in quality of life than those doing relaxation, while being less costly 3 months after their 8-week treatment program had ended (completers: incremental cost M, 95% CI = €−194.1 (−450.3 to 356.1); incremental effect M, 95% CI = 0.023 QALYs (0.010 to 0.141)). Results were similar using an ITT approach (incremental cost M, 95% CI = €−256.3 (−447.4 to −65.3); incremental effect M, 95% CI = 0.021 QALYs (0.009 to 0.033)). A similar pattern of results were obtained from the per protocol approach. This RCT has contributed to the evidence base of compassion-based interventions and provided useful information about the cost-utility of ABCT for FM patients when compared to relaxation. However, the small sample size and short follow-up period limited the generalizability of the findings ; This research is financed by a grant from the ISCIII, Spanish Ministry Economy and Competitiveness (PI19/00805) and the Network for Prevention and Health Promotion in primary Care (ISCIII; RD16/0007/0005), co-financed with European Union ERDF funds.

The aim of this study was to analyse the cost-utility of a group-based form of Acceptance and Commitment Therapy (GACT) in patients with fibromyalgia (FM) compared to patients receiving recommended pharmacological treatment (RPT) or on a waiting list (WL). The data were derived from a previously published study, an RCT that focused on clinical outcomes. Health economic outcomes included health-related quality of life and healthcare use at baseline and at 6-month follow-up using the EuroQol (EQ-5D-3L) and the Client Service Receipt Inventory (CSRI), respectively. Analyses included Quality-Adjusted Life Years (QALYs), direct and indirect cost differences, and incremental cost-effectiveness ratios (ICERs). A total of 156 FM patients were randomized (51 GACT, 52 RPT, 53 WL). GACT was related to significantly less direct costs over the 6 month study period compared to both control arms (GACT €824.2 ± 1,062.7 vs. RPT €1,730.7 ± 1,656.8 vs WL €2,462.7 ± 2,822.0). Lower direct costs for GACT in comparison to RPT were due to lower costs from primary care visits and FM-related medications. The ICERs were dominant in the completers' analysis and remained robust in the sensitivity analyses. In conclusion, ACT appears to be a cost-effective treatment in comparison to RPT in patients with FM. Perspective Decision-makers have to prioritise their budget on the treatment option that is the most cost-effective for the management of a specific patient group. From both government and healthcare perspective, this study shows that a group-based form of Acceptance and Commitment Therapy is more cost-effective than pharmacological treatment in management of fibromyalgia.

Mental disorders are highly prevalent in the general population, and people who experience them are frequently stigmatized. Stigma has a very negative impact on social, academic/professional, and personal life. Considering the high rates of mental disorders among children and adolescents (13.4%) and how critical this age is in the formation of nuclear beliefs, many campaigns to combat stigma have been developed in the last decade, with mixed results. The OBERTAMENT initiative has produced various anti-stigma campaigns in Catalonia (Spain). In the present study, the main objective was to report on the effectiveness of the OBERTAMENT "What's up!" intervention, a curricular intervention including education and social contact conducted by the teachers in the classroom with teenagers aged between 14 and 18. Prior to this, we examined the psychometric properties of the Youth Program Questionnaire (YPQ), our main outcome measure, in terms of dimensionality, reliability, and validity. A cluster non-randomized controlled trial was conducted to assess this intervention, which was tested in nine high schools situated in the Barcelona region. A convenience sample of 261 students formed the intervention group and 132 the control group (52% women, mean age = 14, SD = 0.47). The assignment to study conditions was conducted by Departament d'Ensenyament (Department of Education), Generalitat de Catalunya (Catalan Government). Participants were evaluated at baseline, post-intervention, and 9-month follow-up. The main outcome measure of this study was the YPQ. The Reported and Intended Behavior Scale (RIBS) was used as secondary outcome measure. The statistical analysis indicated that the YPQ possesses a two-factor structure (stereotypical attitudes and intended behavior) and sound psychometric properties. The multilevel mixed-effects models revealed statistically significant interactions for both study measures and post hoc intragroup analyses revealed a significant but small improvement in the YPQ and RIBS scores in the ...

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost-utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (FibroQoL) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost-utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (Delta QALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention ("FibroQoL") and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost–utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

This study investigates, for the first time, dual C-Cl isotope fractionation during anaerobic biodegradation of 1,2-dichloroethane (1,2-DCA) via dihaloelimination by Dehalococcoides and Dehalogenimonas-containing enrichment cultures. Isotopic fractionation of 1,2-DCA (εbulkC and εbulkCl) for Dehalococcoides (-33.0 ± 0.4‰ and -5.1 ± 0.1‰) and Dehalogenimonas-containing microcosms (-23 ± 2‰ and -12.0 ± 0.8‰) resulted in distinctly different dual element C-Cl isotope correlations (∇ = Δδ13C/Δδ37Cl ≈ εbulkC/εbulkCl), 6.8 ± 0.2 and 1.89 ± 0.02, respectively. Determined isotope effects and detected products suggest that the difference on the obtained ∇ values for biodihaloelimination could be associated with a different mode of concerted bond cleavage rather than two different reaction pathways (i.e., stepwise vs concerted). ∇ values of 1,2-DCA were, for the first time, determined in two field sites under reducing conditions (2.1 ± 0.1 and 2.2 ± 2.9). They were similar to the one obtained for the Dehalogenimonas-containing microcosms (1.89 ± 0.02) and very different from those reported for aerobic degradation pathways in a previous laboratory study (7.6 ± 0.1 and 0.78 ± 0.03). Thus, this study illustrates the potential of a dual isotope analysis to differentiate between aerobic and anaerobic biodegradation pathways of 1,2-DCA in the field and suggests that this approach might also be used to characterize dihaloelimination of 1,2-DCA by different bacteria, which needs to be confirmed in future studies. © 2017 American Chemical Society. ; We thoroughly thank four anonymous reviewers for their helpful comments on the manuscript. J.P. was supported by the University of Neuchatel via direct university funding. E.M-U is ̂ supported by the Spanish Ministry of Economy and Competitiveness and FEDER (project CTM2013-48545-C2- 1-R) and the Xarxa de Referencia en Biotecnologia de la ̀ Generalitat de Catalunya. MAG group is supported by Spanish Government REMEDIATION project (CGL2014-57215-C4-1- R) and the Catalan Government project 2014SGR-1456. S.H.M acknowledges support from the Ministry of Education Malaysia (SLAI-UMP Scholarship) for a predoctoral fellowship and M.R. a Ramon y Cajal contract (RYC-2012-11920). ; Peer reviewed