La renta agraria en Castilla y León (1992-2011): estudio empírico mediante técnicas de regresión = Castile and Leon´s (Spain) farm income: a regression model study (1992-2011)

El sector primario, importante en cualquier economía, resulta relevante en España, y concretamente en Castilla y León, por su carácter estratégico y contribución a la economía: el Valor Agrario Bruto en Castilla y León representa el 13,5% sobre del total de España y contribuye al PIB con un 6%. Es el agrario un sector extenso y complejo por las actividades que lo componen: agricultura, ganadería, apicultura, acuicultura, caza, pesca y silvicultura. En Castilla y León, es la agricultura, los cultivos herbáceos concretamente, los que tienen el mayor peso. Además, desde el inicio de la crisis otros sectores (industria y construcción) han perdido peso a favor del sector agrario, que se ha visto reforzado por el incremento de la producción con la búsqueda de nuevos mercados como los energéticos. Precisamente, en 2011 fue Castilla y León el primer productor de grano de cereales para bio-combustible (54,71% de la producción nacional). En este contexto, este trabajo se plantea el estudio de una de las magnitudes más relevantes del sector: la Renta Agraria castellanoleonesa. Mediante el análisis de regresión se tratará de identificar los diferentes factores explicativos de la misma desde la aplicación de la Política Agraria Comunitaria hasta la actualidad (1992-2011

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Make EU trade with Brazil sustainable

Brazil, home to one of the planet's last great forests, is currently in trade negotiations with its second largest trading partner, the European Union (EU). We urge the EU to seize this critical opportunity to ensure that Brazil protects human rights and the environment