Creación de un instrumento de medida de la comunicación médico-paciente. Validación para residentes

Crear y validar en nuestro país un Cuestionario base que permita su uso para el análisis de la comunicación medico-paciente que pueda ser utilizado en diferentes circunstancias. Validación para su uso en residentes con pacientes estandarizados (PE)

Family physicians' views on participating in prevention of major depression. The predictD-EVAL qualitative study

Background The predictD intervention, a multicomponent intervention delivered by family physicians (FPs), reduced the incidence of major depression by 21% versus the control group and was cost-effective. A qualitative methodology was proposed to identify the mechanisms of action of these complex interventions. Purpose To seek the opinions of these FPs on the potential successful components of the predictD intervention for the primary prevention of depression in primary care and to identify areas for improvement. Method Qualitative study with FPs who delivered the predictD intervention at 35 urban primary care centres in seven Spanish cities. Face-to-face semi-structured interviews adopting a phenomenological approach. The data was triangulated by three investigators using thematic analysis and respondent validation was carried out. Results Sixty-seven FPs were interviewed and they indicated strategies used to perform the predictD intervention, including specific communication skills such as empathy and the activation of patient resources. They perceived barriers such as lack of time and facilitators such as prior acquaintance with patients. FPs recognized the positive consequences of the intervention for FPs, patients and the doctor-patient relationship. They also identified strategies for future versions and implementations of the predictD intervention. Conclusions The FPs who carried out the predictD intervention identified factors potentially associated with successful prevention using this program and others that could be improved. Their opinions about the predictD intervention will enable development of a more effective and acceptable version and its implementation in different primary health care settings

Interactions between bacterial surfaces and milk proteins, impact on food emulsions stability

Bacteria possess physicochemical surface properties such as hydrophobicity, Lewis acid/base and charge which are involved in physicochemical interactions between cells and interfaces. Moreover, food matrices are complex and heterogeneous media, with a microstructure depending on interactions between the components in media (van der Waals, electrostatic or structural forces, etc.). Despite the presence of bacteria in fermented products, few works have investigated how bacteria interact with other food components. The objective of the present study was to determine the effects of the surface properties of lactic acid bacteria on the stability of model food emulsions. The bacteria were added to oil/water emulsions stabilized by milk proteins (sodium caseinate, whey proteins concentrate or whey proteins isolate) at different pH (from 3 to 7.5). The effect of bacteria on the emulsions stability depended on the surface properties of strains and also on the characteristics of emulsions. Flocculation and aggregation phenomena were observed in emulsion at pHs for which the bacterial surface charge was opposed to the one of the proteins. The effects of bacteria on the stability of emulsion depended also on the concentration of cations present in media such as Ca2+. These results show that the bacteria through their surface properties could interact with other compounds in matrices, consequently affecting the stability of emulsions. The knowledge and choice of bacteria depending on their surface properties could be one of the important factors to control the stability of matrices such as fermentation media or fermented products.Région Bourgogne, Agence Universitaire de la Francophonie

A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial

Background: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Methods: Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. Results: With a willingness-to-pay threshold of (sic)10, 000 ((sic)8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to (sic)30, 000 ((sic)25, 704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. Conclusions: Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated

Système de Modélisation en Environnement et Agronomie reliant Science et Société ( SEAMLESS): rapport sur les attributs des systèmes pour lesquels des indicateurs and valeurs-seuils ont été développés (PD 1.3.1). Rapport spécifiant les indicateurs et méthodes pour des analyses qualitatives en pre et post-modélisation (PD 1.3.5).

The systems that SEAMLESS aims to assess the impact of different policy options are today seen as more complex and it was not only one but several systems that the project will have to assess. Consequently the initial framework that was promised to be produced in WP 1 PD 1.2.1 could not be produced at that early point. In chapter 2 several general components of these systems has been identified Based on the ideas forwarded in WP1 and on literature reviews WP 2 has also developed two suggestions for how a SEAMLESS framework could look like. One is a framework based on themes and issues. This is a well known approach by policy makers but it risks creating a long list of indicators and have problems with the aggregation between the different dimensions of SD. The second proposal is a systems approach. This approach is more complex and less known by policy maker but it can serve as a basis for aggregation between SD dimensions. In chapter 3 the main methodologies that WP2 will be using for the purpose of specifying indicators, indicator calculation, calculation and qualification is outlined. This chapter also discusses the steps that have to be taken in order to translate a policy question into an indicator. The development of different methodologies for the specification of qualitative and quantitative indicators for Seamless will need a continued input form the scientific side. However as pointed out throughout the chapter the continuous interaction with stakeholders and end-users will be crucial for the success of the tool. In chapter 4 the PICA model is discussed. PICA is the institutional ingredient in the Seamless-IF. PICA is a model which will serve as a tool for analysing the plausibility of implementing a policy from data (pre modelling) and from output from the quantitative models (post-modelling). Pre-modelling analysis will be used to test whether a certain policy will be implemented or whether the institutional constraints will result in prohibitive transaction costs making it less probable that the policy will reach its objectives. In this case the analysis will be based on data i.e, there is no need to run, e.g., bio-physical farm models. The PICA model can also function as a post-model analysis for other models. In that sense, it facilitates the linking of models. In brief, PICA is a flexible tool. The results can serve for a qualitative pre-and post model analysis. The PICA model itself can have different places within the model chain depending on the issue under scrutiny. This PD has shown that WP2 has an accumulated knowledge related to indicator frameworks, indicator specification, user selection of indicators and methodologies for qualitative pre and post model analysis. However to make this knowledge useful for the SEAMLESS project is important that this knowledge is adjusted to the specific context of SEAMLESS. Throughout the PDs it has been concluded that to proceed in the development of these methodologies interaction with stakeholders is crucial. For the success of the developed tool it is important to define at which points and to which degrees interaction is needed. WP 7 has provided the methodologies for such an interaction and PD 2.6.1 as well as this PD has listed issues on which interaction with stakeholders is important. Preferably the issues for interaction should be divided in two stages, the pre-modelling stage and the post modelling stage. Two suggestions for future steps are to; 1. Produce a chronological list of these issues which is consulted and reduced by WP3- WP4-WP5-WP2 based on their needs and limitations 2. Build up a close cooperation between WP2-6-7 to develop the content of the written material that should be the basis for the stakeholder consultation as well as the time schedule of this consultation. Moreover, a few issues which seems to have fallen outside the responsibility of a WP or that have been disregarded have been identified: 1) The visualisation of indicators 2) The development of policy scenarios (which are relevant for the area of assessment of SEAMLESS). 3) The flexibility of the selection of indicators 4) The role and place of qualitative models in SEAMLESS-IF The suggestion for point 1 and 2 is that a special task force with members form relevant WP is created and that the points is taken into consideration when writing the new action plan. As for point 3 a discussion is necessary throughout the project. WP 2 suggests that this discussion is held relatively soon based on the existing draft of D 2.1.1. The suggestion for point 4 is that slightly more attention is given to the qualitative aspects of SEAMLESS IF. It is natural at this stage in the project when the first Prototype soon is to be delivered that more attention is given to SEAMFRAME. A discussion of the qualitative aspects of SEAMLESS IF would probably also clarify the possibilities as well as limitations of the quantitative models in SEAMFRAME in relation to the goal of the final SEAMLESS tool to take into consideration all dimensions of SD

La production fruitière intégrée en Italie : regards critiques sur une conversion réussie

L'Italie est le principal concurrent de la France sur les marchés européens de fruits tempérés. Elle fait valoir de longue date son avantage sur le créneau de la production intégrée (pratiques respectueuses de l'environnement). L'avantage est souvent décrié par les professionnels de l'arboriculture française, sans que l'on puisse faire la part de ce qui relève de l'analyse critique objective, et de ce qui est plutôt du dénigrement. Pour lever l'ambiguïté, l'équipe du projet INRA "Production fruitière intégrée-PFI" a conduit une mission pluridisciplinaire dans les deux principales régions productrices de pommes et de pêches (Trentin et Emilie Romagne). Le rapport fait l'historique du développement de la PFI en Italie, analyse les stratégies des producteurs et de leurs organisations vis-à-vis de la PFI, l'encadrement des pratiques et le rôle des institutions régionales. Il répond en conclusion aux deux questions initiales des similarités/différences avec la France et de l'existence d'un modèle italien de production intégrée

Health-economic evaluation of psychological interventions for depression prevention: Systematic review

Psychological interventions have been proven to be effective to prevent depression, however, little is known on the cost-effectiveness of psychological interventions for the prevention of depression in various populations. A systematic review was conducted using PubMed, PsycINFO, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Econlit, NHS Economic Evaluations Database, NHS Health Technology Assessment and OpenGrey up to January 2021. Only health-economic evaluations based on randomized controlled trials of psychological interventions to prevent depression were included. Independent evaluators selected studies, extracted data and assessed the quality using the Consensus on Health Economic Criteria and the Cochrane Risk of Bias Tool. Twelve trial-based economic evaluations including 5929 participants from six different countries met the inclusion criteria. Overall, the quality of most economic evaluations was considered good, but some studies have some risk of bias. Setting the willingness-to-pay upper limit to US$40,000 (2018 prices) for gaining one quality adjusted life year (QALY), eight psychological preventive interventions were likely to be cost-effective compared to care as usual. The likelihood of preventive psychological interventions being more cost-effective than care as usual looks promising, but more economic evaluations are needed to bridge the many gaps that remain in the evidence-base. Ethics: As this systematic review is based on published data, approval from the local ethics committee was not required

The economic costs and benefits of a participatory project to conserve maize landraces on farms in Oaxaca, Mexico*

Conventional methods were used to assess the benefits and costs of an unconventional project whose purpose was to test whether participatory crop improvement can encourage Mexican farmers to continue growing maize landraces by enhancing their current use value. Findings suggest that farmers as a group earned a high benefit-cost ratio from participating, though from the perspective of the private investor the returns were low. The project also generated social benefits, but these would be difficult (and costly) to measure. There was a gender bias in both participation and benefits distributions, though there is some evidence of a welfare transfer to maize deficit households. Application of other valuation approaches will be necessary in order to assess both the private and social benefits of similar projects. © 2003 Elsevier B. V. All rights reserved

A goal oriented indicator framework to support integrated assessment of new policies for agri-environmental systems

The goal oriented framework (GOF) for indicators has been developed as part of a comprehensive research project developing computerised tools for integrated assessment of the effects of new policies or technologies on agricultural systems (SEAMLESS-IF). The ambition has therefore been to create an indicator framework where the environmental, economic and social dimensions of sustainable development can be related to each other in a consistent way. Integrated assessment tools rely on such frameworks to capture and visualise trade-offs (antagonisms or synergies) among indicators between and within the three dimensions of sustainable development. The specific aims of this paper are to (i) present the GOF (ii) present how the GOF can be used to select indicators within the integrated assessment framework SEAMLESS-IF and (iii) discuss the advantages and limitations with the proposed approach. We show that the GOF has several advantages. Its major rewards are its relative simplicity and the possibility to link indicators to policy goals of each dimension of sustainability and thereby facilitate the comparison of the impacts of the new policy on the different dimensions. Another important feature of the GOF is its multi-scale perspective, which will enable the comparison of effects of a new policy between scales. Yet, as typical for all indicator frameworks, the GOF has also biases either instigated by the issues the included models cover or by the stakeholders¿ selection of indicators. However, due to the way the GOF and its indicators are technically implemented in SEAMLESS-IF, it can easily be extended and include new indicators to increase and update its policy relevance