Programs In Spain Research Articles

Eficacia de un programa intensivo de prevención secundaria de cardiopatía isquémica tras 5 años de intervención

Most evidence on the efficacy of intensive preventive programs of secondary prevention of coronary diseases comes from Anglo-Saxon countries and effectiveness remains controversial. We have scarce information about the efficacy of these types of programs in Spain. In the present analysis we show the results of the ICAR (Intervención en la Comunidad de Alto Riesgo coronario) study, aimed to analyze the efficacy of an intensive preventive program primary care based in reducing the cardiovascular recurrences and mortality in patients with coronary heart disease. We designed a randomized clinical trial, multicenter and community based, which included 23 health care areas in Catalonia, Spain. We followed for 5 years 2 cohorts of patients with coronary heart disease, aged 30-80 years. The intervention group was quarterly examined by their general practitioner, who adjusted treatments to control their cardiovascular risk factors thoroughly and reinforced life style behaviours. In order to do that, patient's weight and blood pressure were determined in each visit and laboratory test carried out twice a year. Patients in the control group received the usual care. In order to analyze the effect of the intervention cardiovascular recurrences and mortality were registered. We included 983 patients. Mean (standard deviation) age was 64 (10) and 74.5% were men. During the follow-up 235 patients suffered some non-fatal cardiovascular recurrence (109 vs 126 in the control and intervention group, respectively; p = 0.84), and 45 died from cardiovascular recurrences (23 vs 22, respectively; p = 0.57). Adjusted hazard ratio of cardiovascular event and total mortality, for the intervention group were 1.01 (95% confidence interval, 0.74-1.39), and 0.92 (95% confidence interval, 0.54-1.56), respectively. The implementation of an intensive secondary prevention program based on periodical reminds to patients with stable coronary heart disease to attend their general practitioners did not reduce either the cardiovascular recurrences or mortality at 5 years as compared with usual care.

Measuring and assessing researcher mobility from CV analysis: the case of the Ramón y Cajal programme in Spain

Relying on the international literature on CV-based indicators, we select a sample of CVs from researchers applying to the Spanish Ramón y Cajal programme to assess mobility patterns and look for evidence of links between mobility and research performance. Evidence is found that mobility patterns vary across disciplines and that most internationally mobile researchers seem to have better access to international funding sources and networks, which does not, however, imply that they are the most quantitatively productive as far as publications and patents are concerned. The results thus support the idea that the qualitative dimension of mobility impact is an important one to consider.

Análisis de coste-efectividad de la vacunación frente al virus del papiloma humano tipos 6, 11, 16 y 18 en España

ObjectivesA vaccine to prevent diseases due to human papillomavirus (HPV) types 6, 11, 16 and 18 is now available in Spain. The objective of this study was to assess the health and economic impact in Spain of implementing a four-valent HPV vaccine alongside existing screening versus screening alone. MethodsA Markov model of the natural history of HPV infection, incorporating screening and vaccination, was adapted to the Spanish context. A vaccine that would prevent 100% of HPV 6, 11, 16 and 18-associated diseases, with a lifetime duration and 80% coverage, given to girls at age 11 plus current screening was compared to screening alone. The analysis was made from the third-party payer perspective and therefore excluded indirect costs such as loss of productivity. ResultsThe incremental cost per life years gained (LYG) and per quality-adjusted life years (QALY) gained for the introduction of HPV vaccination alongside the Spanish cervical cancer screening programme was 8,657 € and 6,493 €, respectively. Sensitivity analyses demonstrated that the cost-effectiveness was stable, but was most sensitive to the discount rate used for costs and benefits. ConclusionsThese analyses demonstrate that adding a four-valent HPV vaccine to the current screening programme in Spain is a cost-effective strategy for reducing the burden of cervical cancer, pre-cancerous lesions and genital warts.

Bloodstream Infections Among Transplant Recipients: Results of a Nationwide Surveillance in Spain1

Bloodstream infections (BSIs) are a major cause of morbidity and mortality in transplant recipients. The aim of this study is to describe the incidence, microbiology and outcomes of BSIs in transplant recipients in Spain. The Spanish Network for Research on Infection in Transplantation (RESITRA) is formed by 16 centers with transplant program in Spain. The incidence and characteristics of BSIs in transplant patients were obtained prospectively from the cohort. We included 3926 transplant recipients (2935 solid organ and 991 hematopoietic stem cell transplants). Overall, 730 episodes of BSIs were recorded with an incidence rate ranging from 3 episodes per 10 000 transplant days in kidney recipients to 44 episodes per 10 000 transplant days in allogeneic hematopoietic stem cell transplantation (HSCT). The most frequent sources were intravascular catheters and the most frequent microorganisms isolated were coagulase-negative staphylococci. Crude mortality of BSIs was 7.8%, being highest in liver recipients (16%). Multidrug resistant nonfermentative gram-negative BSIs had significantly worse prognosis than those caused by their susceptible counterparts (p = 0.015), but no differences were found between resistant and susceptible gram-negative enteric bacilli, S. aureus or Candida spp. BSIs are still a major concern in transplant recipients. The increasing isolations of multiresistant microorganisms represent a challenge for the next years.

Six cycles of S1 recurrent selection in two Spanish maize synthetics

European flint x US dent is the most common heterotic pattern used in early maize (Zea mays L.) breeding programs in Spain. Two synthetic maize populations, EZS1 (formed from four Spanish flint populations), and EZS2 (formed from four American dent populations), were developed in Zaragoza, Spain. These synthetics, which showed heterotic behaviour, were subjected to six cycles of S1 recurrent selection for increased grain yield and reduced lodging. The aim of this study was to investigate the effectiveness of selection on these and other agronomic traits in both synthetics. The original populations, EZS1C0 and EZS2C0, and the six cycles of selection of both, were evaluated at two locations over two years. Over the six selection cycles, the average yield of EZS1 and EZS2 increased by 0.82 Mg/ha and 0.93 Mg/ha per cycle respectively, while lodging decreased by 2.76% and 2.44% per cycle respectively. Changes due to selection were significant for all test traits in both synthetics. It was concluded that S1 selection is effective in improving the yield of, and reducing lodging in, both synthetics.

Use of Highly Discriminating Morphological Characters and Isozymes in the Study of Spanish Chestnut Cultivars

Morphological characters (six traits) and isozymes (four systems, five loci) were used to discriminate between Spanish chestnut cultivars (Castanea sativa Mill.) from the Iberian Peninsula. A total of 701 accessions (representing 168 local cultivars) were analyzed from collections made between 1989 and 2003 in the main chestnut growing areas: 31 were from Andalucía (12 cultivars), 293 from Asturias (65 cultivars), 25 from Castilla-León (nine cultivars), four from Extremadura (two cultivars) and 348 from Galicia (80 cultivars). Data were synthesized using multivariate analysis, principal component analysis, and cluster analysis. A total of 152 Spanish cultivars were verified: 58 cultivars of major importance and 94 of minor importance, of which 18 had high intracultivar variation. Thirty-seven cultivars were clustered into 14 synonymous groups. Six of these were from Galicia, one from Castilla-León (El Bierzo), four from Asturias, one from Asturias and Castilla-León (El Bierzo), and two from Asturias, Castilla-León (El Bierzo), and Galicia. The chestnut cultivars from Galicia and Asturias were undifferentiated in genetic terms, indicating that they are not genetically isolated. Overall, chestnut cultivars from southern Spain showed the least variation. Many (58%) of Spanish cultivars produced more than 100 nuts/kg; removing this low market-value character will be a high priority. The data obtained will be of use in chestnut breeding programs in Spain and elsewhere.

The Meropenem Yearly Susceptibility Test Information Collection antimicrobial susceptibility program in Spain: a 5-year analysis

The Meropenem Yearly Susceptibility Test Information Collection program is a global study providing in vitro surveillance data on antimicrobial susceptibility in centers prescribing meropenem. This study summarizes data on the activity of meropenem and 5 comparators against 4022 clinical isolates from 7 centers in Spain (1999–2003). Those bacteria intrinsically resistant to meropenem were excluded. Among Enterobacteriaceae, 100% of Enterobacter spp., Citrobacter spp., and Serratia spp. were susceptible to meropenem. Escherichia coli and Klebsiella pneumoniae susceptibilities to carbapenems were 100% and ≥98%, respectively. Extended-spectrum β-lactamase–producing Enterobacteriaceae were 3.8% of isolates, and all of them were susceptible to meropenem. Ciprofloxacin resistance in E. coli was around 20%. Meropenem and piperacillin/tazobactam were the most active agents against Pseudomonas aeruginosa. Acinetobacter baumannii were 61–90% susceptible to carbapenems, but only 6–21% susceptible to ciprofloxacin. In this period, around 100% of oxacillin-susceptible staphylococci were susceptible to meropenem. There was no significant decrease in susceptibility to the carbapenems throughout the 5-year period. The clinical use of meropenem in 7 Spanish centers did not increase bacterial resistance to this agent in the microorganisms evaluated.

Mammography use and factors associated with its use after the introduction of breast cancer screening programmes in Spain

The aim of this study was to measure the use of mammography and the factors associated with testing among Spanish women, after the introduction of screening programmes in Spain. We conducted a cross-sectional population survey of a representative sample of women aged 40-70 (2409 women). Data collection took place in October 2000, using a questionnaire addressing the dependent variable (mammography use) and the independent variables (socio-demographic and socio-health factors, and women's knowledge and attitudes). Mammography use was defined as having received at least one screening test in the previous 2 years. Data analysis consisted of univariate and multivariate analyses. 48.1% (95% confidence interval (CI) 46.0-50.2) of women had received screening mammography. The main factors associated with testing were: mammography invitation from the screening programme (odds ratio (OR) 4.81; 95% CI 3.85-6.01); gynaecologist visit (OR 4.32; 95% CI 3.45-5.41); and intention to have a mammogram (OR 2.94; 95% CI 2.00-4.32). Other test-related factors were: not rejecting test for discomfort or fear of cancer; mammography perceived as necessary; age 56-65; upper/upper-middle socio-economic status. In conclusion, after the introduction of screening programmes, almost half of Spanish women aged 40-70 had received mammography. Invitation to screening, gynaecologist visit and women's attitudes are the main reasons for undergoing testing. Women over 65 years of age and/or those in a lower socio-economic level warrant special attention.

City as Text © Applied to an Honors Study Abroad Program: Exploring Madrid

The purpose of this paper is to discuss, evaluate, and illustrate the experiences of a City‐as‐Text © exploration in partial fulfillment of the requirements of an honors study abroad program in Spain. First, the nature and procedures of City as Text © as a learning tool are explained, followed by a list of necessary conditions for its application. Then the honors college in question is introduced, along with its special study abroad programs, and the experiences of various explorations are discussed and evaluated.

La introducción de la renta básica en España

As a result of a first experience in the Basque Country, in the 90’s the introduction of programs of income support becomes general in Spain, along the line of the French minimum income for insertion (RMI). Trying to solve the problems entailed by these programs, in the last years some new proposals were outlined. These proposals suggest sustaining the system of income support, more than on traditional welfare benefits, on a universal, individual and unconditional grant. This paper analyses the economic implications of the development of a basic income program in Spain. It concludes with the presentation of a concrete proposal of income support program inspired on the principles of the basic income.

Molecular Characterization of Three Comercial Cultivars and a New Pollinator in Kiwifruit

We investigated the characterization of genotypes of Actinidia deliciosa (Chev.) Liang and Ferguson var. deliciosa by using isozymatic and molecular techniques [randomly amplified polymorphic DNA (RAPD), amplified fragment-length polymorphism (AFLP), standard AFLP, and modified AFLP]. Four genotypes were tested, the female cultivar `Hayward', the traditional New Zealand pollinizers `Matua' and `Tomuri', and a new pollinizer named clone A selected in a breeding program in Spain. PGI and PGM were the only isozymes that allowed us to distinguish the kiwifruit genotypes, although the accessions of `Matua' presented two different banding patterns for both isozymes. All three molecular markers differentiated between the genotypes of kiwifruit tested, although RAPD markers did not allow us to establish differences between accessions of `Matua', while both standard and modified AFLP did. These results, along with those of isozymes, support the hypothesis that the male kiwifruit genotypes present in Europe belong to different clones. None of the markers used showed differences between accessions of `Hayward', which would suggest that it is a uniform cultivar. On the other hand, clone A was a seedling derived from `Hayward' and an unknown pollinizer. The results obtained using AFLP markers strongly suggest that `Tomuri' may have been the male parent of clone A. A specific protocol for kiwifruit characterization based on a modified AFLP technique is also presented, that gave rise to the highest percentage of polymorphism while scoring the lowest number of bands. This, together with the technical features of modified AFLP markers, make them very useful for identifying propagated kiwifruit plant material in commercial nurseries.

Promoting interculturality in Spain: assessing the use of the Jigsaw classroom method

This note examines the effectiveness of a program in Spain that uses the Jigsaw learning technique as an educational intervention. We used a quasi‐experimental research design with two groups, two measures and an independent variable (the program). Use of the Jigsaw technique is shown to have been fairly effective on a series of measures.

Impact and effectiveness of meningococcal C conjugate vaccine following its introduction in Spain

This study describes the epidemiological impact of meningococcal C conjugate vaccine on age groups targeted by this vaccination programme in Spain, and estimates high short-term vaccine effectiveness values under field conditions in the 4 years following its introduction. Meningococcal C conjugate vaccine has led to a substantial reduction in incidence of meningococcal serogroup C disease in Spain among age groups targeted for intervention nationwide. Disease surveillance in the 4 years since the vaccine was introduced has enabled vaccine effectiveness (VE) to be estimated. The vaccine registered high short-term VE values but there has been some loss of VE with time. Four years after vaccination, vaccine protection levels exceeded 94% in cohorts immunised during the campaign. Among children vaccinated in routine childhood immunisation programmes, however, long-term VE loss was greater. Accordingly, there is a need for ongoing re-evaluation of VE and ascertainment of long-term vaccine protection. The findings reported would allow to decide on the advisability of revising current vaccination guidelines.

Family Risk Factors for Adolescent Drug Misuse in Spain

ABSTRACT The main objective of this research was to analyze the influence and the differential weight of certain family factors in Spanish adolescent substance abuse. A representative sample of 1,680 students of both sexes from all over Spain took part in the study. The results show that the variables associated with drug consumption are: male, one-parent-family background, family conflict, poor parent-child relationships, few shared activities, permissive parenting style, permissive attitudes to drugs in the family, and parents' drug consumption. Moreover, risk factors specific to drugs have greater influence than general risk factors. These results have very important implications for the design of family drug-prevention programs in Spain.

Community Based Learning in Rural Guatemala

In June of 2003, fourteen university students and two faculty completed the pilot for an alternative study abroad program in Guatemala that focused on Community Based Learning in rural Guatemalan schools. The pilot was highly successful for the participating students and schools. The program immerses students in Guatemalan culture while providing intensive language instruction and community service experience. The participating Guatemalan schools receive classroom assistance, physical improvement of their facilities, and educational supplies. The program's mission is to promote global citizenship by establishing an international relationship between educational communities in Guatemala and the U.S. The program will soon include a teaching exchange between Guatemalan and American schoolteachers. I took my first job as an assistant professor of Spanish literature in 2001. Since my specialty is Nineteenth- and Twentieth-Century Spanish literature, I expected that my work would in clude directing or teaching in a study-abroad program in Spain. Last spring a colleague offered me the opportunity to co-direct a program in Guatemala focusing on community service in rural Mayan schools. That was very different from what I had imagined myself doing, but our institution is a national leader in Service Learning or Community Based Learning (CBL), and I have found that our students are increasingly attracted to applying their foreign language skills in the community. The students responded very enthusiastically to the possibility of combining service learning with study abroad, and I found the professional experience much more satisfying than I had expected. This program was launched by my colleague because of the growing demand at our institu tion for language programs that serve students from disciplines other than foreign languages, that provide international experience, and that respond to community needs. She has been on study abroad programs as a student and has considerable experience serving the marginalized in Guatemala. She has participated in, designed, and directed community service courses and now coordinates the community outreach programs in our Foreign Languages and Literatures Depart ment. While serving Guatemalan street children in 1997, she began developing the contacts that would make this CBL program possible. My role in the program was to organize the intellectual component of the course, guide students through their selected readings, lead lectures, and help them understand their experiences within the context of U.S.-Latin American relations. Our university students were required to work outside of their areas of preparation. They were majoring in fields as varied as arts and letters, political science, international studies, and geology. Given this variety of interests, it was essential that the program should have an interdisciplinary approach and that the students reflect upon and share their experiences within a critical context informed by readings and lectures from multiple perspectives.

The Homestay Component of Study Abroad: Three Perspectives

Abstract: Although the “homestay” has long been considered a key factor in the study abroad experience, it is one of the least examined components of foreign study. In an effort to explore this issue from various perspectives, this study targeted several programs in Spain and Mexico with interviews of host families, students, and housing directors. Each group's perspective on key issues such as adjustment, common problems, and the “homestay advantage” was probed via on‐site interviews and questionnaires. Results showed that the majority of the information reported by one group was normally corroborated by the other two, and all groups felt the homestay enhanced the study abroad experience.

W15.425 Preliminary results of a dyslipemia prevention programme in Spain

W15.425 Preliminary results of a dyslipemia prevention programme in Spain

W15.425 Preliminary results of a dyslipemia prevention programme in Spain

W15.425 Preliminary results of a dyslipemia prevention programme in Spain

A Pharmacoeconomic Evaluation of Seven-Valent Pneumococcal Conjugate Vaccine in Spain

Background Streptococcus pneumoniae is a leading cause of illness in children. Seven-valent pneumococcal conjugate vaccine (PCV-7), recently approved in the United States, is the first vaccine to provide protective immunity against pneumococcal disease in children under the age of 2. PCV-7 is nearly 100% effective in preventing invasive pneumococcal infections and has been shown to significantly decrease the incidence of pneumonia and otitis media. Objective The objective of this study was to evaluate the health outcomes, costs, and cost-effectiveness of vaccination with PCV-7, compared with no vaccination for children in Spain. Methods A health state model was used to determine the health and economic outcomes in vaccinated and unvaccinated groups among children less than 5 years old. This analysis was conducted for a 10-year time horizon, beginning with initial vaccinations. Information on the burden of pneumococcal disease, in terms of data on the incidence and seroprevalence of disease, was collected from published and unpublished records, supplemented, and verified by Spanish pediatric and infectious disease experts. The efficacy of PCV-7 was based on updated findings of the Kaiser Permanente Efficacy Study. A cost-of-illness estimate for each pneumococcal disease was determined using decision tree analysis that considered direct and indirect costs. A birth cohort analysis compared the expected cost of vaccinated populations to age-matched unvaccinated populations. Results Implementing a PCV-7 vaccine program in Spain in a birth cohort of 360,000 is expected to save approximately 16 lives and 132,000 cases of pneumococcal disease over 10 years, resulting in total savings estimated at €81 million (ESP13.5 billion), of which €43.5 million (ESP7.1 billion) are direct medical savings. At a vaccine cost up to €56.87 per dose (ESP9,462, the total cost of vaccinating a birth cohort of 360,000 will be offset by the total savings owing to reduced morbidity. Conclusions Implementing a universal PCV-7 vaccination program in Spain will significantly decrease the mortality and morbidity associated with pneumococcal infections in young children. At an assumed cost of €48.56 (ESP8,080) per dose, PCV-7 vaccination of Spanish children under the age of 5, followed over a 10-year period, is cost saving from the societal perspective and cost-effective from the payer perspective at €22,500 per LYG (ESP3,734,713), comparing favorably with other preventive programs in Spain.

Pediatric intestinal transplantation

Aim Analyze the results of a paediatric intestinal transplantation (IT) program in Spain. Patients During an 5-year period, 18 children were included as candidates for IT. The causes for intestinal failure (IF) were short bowel syndrome ( n = 13), motility disorders ( n = 3), and congenital epithelial disorders ( n = 2). Nine children were admitted for a combined liver-small bowel transplant (LSBT), seven for an isolated intestinal transplantation (IIT) and two for a multivisceral transplantation (MVT). In three of the candidates for IIT the indication had to be changed to LSBT because of progression of the liver damage. Results Eight candidates are on the waiting list: four for LSBT, two for IIT, and two for MVT. Four children died before transplantation. All were children under 1 year and candidates for LSBT. One child died during an attempted MVT. Five children underwent transplantation. Grafts were IIT in two and LSBT in three. Of these children, two are on a normal diet (respective follow-up times: 40 and 18 months), two died, both with functioning liver and intestinal grafts (hemorrage after liver biopsy and lymphoproliferative disease), and one developed an untreatable rejection that lead to loss of the intestinal graft; currently, she is on the waiting list for LSBT. Conclusions The morbidity and mortality of IT are high, but it is the only possible treatment for children in IF who cannot be adequately managed with parenteral nutrition. A severe problem is the the scarcity of suitable donors for the very low weight children who are candidates for LSBT.