Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers' Health Study.

The objective of this study is to describe the profile of primary preventive treatment for cardiovascular disease in adult males and to analyze the association between treatment profile and subclinical atherosclerosis. We selected male workers who had undergone ultrasound imaging and had no previous history of cardiovascular disease (n = 2138). Data on the consumption of primary cardiovascular drugs from the previous year were obtained. We performed bivariate analyses to compare patient characteristics according to cardiovascular treatment and the presence of subclinical atherosclerosis, and logistic regression models to explore the association between these two variables. Among participants with no personal history of cardiovascular disease, subclinical atherosclerosis was present in 77.7% and 31.2% had received some form of preventive treatment. Of those who received no preventive treatment, 73.6% had subclinical atherosclerosis. Cardiovascular preventive treatment was associated only with CACS > 0 (odds ratio (OR), 1.37; 95% confidence interval (95% CI), 1.06-1.78). Statin treatment was associated with a greater risk of any type of subclinical atherosclerosis (OR, 1.73) and with CACS > 0 (OR, 1.72). Subclinical atherosclerosis existed in almost 75% of men who had no personal history of cardiovascular disease and had not received preventive treatment for cardiovascular disease

Geomorphic process signatures reshaping sub‐humid Mediterranean badlands: 1. Methodological development based on high‐resolution topography

High‐resolution topography data sets have improved the spatial and temporal scales at which we are able to investigate the landscape through the analysis of landform attributes and the computation of topographic changes. Yet, to date, there have been only limited attempts to infer key geomorphic processes in terms of contributions to shaping the landscape. Highly erodible landscapes such as badlands provide an ideal demonstration of such an approach owing to the rapid changes observed over a relatively short time frame. In this technical note we present the Mapping Geomorphic Processes in the Environment (MaGPiE): a new algorithm that allows mapping of geomorphic process signatures through analysis of repeat high‐resolution topography data sets. The method is demonstrated in an experimental badland located in the southern central Pyrenees. MaGPiE is a geographic information system (GIS)‐based algorithm that uses as input: (a) terrain attributes (i.e. Slope, Roughness and Concentrated Runoff Index) extracted from digital elevation models (DEMs), and (b) a map of topographic changes (DEM of difference, DoD). Initial results demonstrate that MaGPiE allows the magnitude and the spatial distribution of the main geomorphic processes reshaping badlands to be inferred for the first time

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): A 6-months prospective observational study

<p>Abstract</p> <p>Background</p> <p>There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations.</p> <p>Methods</p> <p>Prospective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex.</p> <p>Results</p> <p>The percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure.</p> <p>Conclusion</p> <p>Pharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.</p

Geomorphic process signatures reshaping sub‐humid Mediterranean badlands: 2. Application to 5‐year dataset

Badland landscapes exhibit high erosion rates and represent the main source of fine sediments in some catchments. Advances in high‐resolution topographic methods allow analysis of topographic changes at high temporal and spatial scales. We apply the Mapping Geomorphic Processes in the Environment (MaGPiE) algorithm to infer the main geomorphic process signatures operating in two sub‐humid badlands with contrasting morphometric attributes located in the Southern Pyrenees. By interrogating a 5‐year dataset of seasonal and annual topographic changes, we examine the variability of geomorphic processes at multiple temporal scales. The magnitude of geomorphic processes is linked to landform attributes and meteorological variables. Morphometric differences between both adjacent badlands allow us to analyse the role of landform attributes in the main geomorphic process reshaping landscapes subjected to the same external forcing (i.e. rainfall and temperature). The dominant geomorphic process signatures observed in both badlands are different, despite their close proximity and the same rainfall and temperature regimes. Process signatures determining surface lowering in the gently sloping south‐facing badland, characterized by lower connectivity and more vegetation cover, are driven by surface runoff‐based processes, both diffuse (causing sheet washing) and concentrated (determining cutting and filling, rilling and gullying). The steeper, more connected north‐facing slopes of the other badland are reshaped by means of gravitational processes, with mass wasting dominating topographic changes. In terms of processes determining surface raising, both mass wasting and cutting and filling are most frequently observed in both badlands. There is a clear near‐balanced feedback between both surface‐raising and ‐lowering processes that becomes unbalanced at larger temporal scales due to the thresholds overcome, as the volume associated with surface lowering becomes higher than that associated with raising‐based processes. Rainfall variables control surface flow processes, while those variables associated with low temperature have a significant relation with mass movement‐based processes and other localized processes such as regolith cohesion loss. Finally, our results point out that morphometry (slope and connectivity) together with vegetation cover are key factors determining geomorphic processes and associated topographic changes

Framing the difficulties resulting from implementing a Participatory Management Model in a public hospital

Objective: This study aims to address difficulties reported by the nursing team during the process of changing the management model in a public hospital in Brazil. Methods: This qualitative study used thematic content analysis as proposed by Bardin, and data were analyzed using the theoretical framework of Bolman and Deal. Results: The vertical implementation of Participatory Management contradicted its underlying philosophy and thereby negatively influenced employee acceptance of the change. The decentralized structure of the Participatory Management Model was implemented but shared decision-making was only partially utilized. Despite facilitation of the communication process within the unit, more significant difficulties arose from lack of communication inter-unit. Values and principals need to be shared by teams, however, that will happens only if managers restructure accountabilities changing job descriptions of all team members. Conclusion: Innovative management models that depart from the premise of decentralized decision-making and increased communication encourage accountability, increased motivation and satisfaction, and contribute to improving the quality of care. The contribution of the study is that it describes the complexity of implementing an innovative management model, examines dissent and intentionally acknowledges the difficulties faced by employees in the organization.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2008/03775-5