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This paper studies the relationship between test scores and cognitive skills using two longitudinal data sets that track student performance on a national standardized exam in grades 6, 9, and 12 and post-secondary school outcomes in Mexico. Using a large sample of twins, the analysis finds that primary school test scores are a strong predictor of secondary education outcomes and that this association is mainly driven by the relationship between test scores and cognitive skills, as opposed to family background and other general skills. Using a data set that links results in the national standardized test to later outcomes, the paper finds that secondary school test scores predict university enrollment and hourly wages. These results indicate that, despite their limitations, large-scale student assessments can capture the skills they are meant to measure and can therefore be used to monitor learning in education systems.

This paper studies the relationship between test scores and cognitive skills using two longitudinal data sets that track student performance on a national standardized exam in grades 6, 9, and 12 and post-secondary school outcomes in Mexico. Using a large sample of twins, the analysis finds that primary school test scores are a strong predictor of secondary education outcomes and that this association is mainly driven by the relationship between test scores and cognitive skills, as opposed to family background and other general skills. Using a data set that links results in the national standardized test to later outcomes, the paper finds that secondary school test scores predict university enrollment and hourly wages. These results indicate that, despite their limitations, large-scale student assessments can capture the skills they are meant to measure and can therefore be used to monitor learning in education systems.

Twitter is a microblog that allows users to interact about a topic in online discussion. This makes it an interesting interactive tool with possibilities to increase student engagement and learning performance through active collaboration in an informal learning environment. However, few articles take a quantitative approach to investigate the creation of student engagement using this social networking site. To address this gap, we propose a series of activities conducted through Twitter to analyse the engagement generation process in a sample of 110 students in the first year of a business and administration degree at a large Spanish university. The results show that the engagement process is created through active collaborative learning and enjoyment, and that engaged students are more satisfied with the activity and perceive greater learning performance. This leads us to recommend teachers to encourage active and collaborative activities to make students more engaged and satisfied, and improve their performance. Implications for practice or policy: • Course leaders can use social networking sites to enhance learning performance and student engagement in collaborative learning activities. • Encouraging the engagement generation process in e-learning experiences positively affects students' satisfaction with these experiences and their learning performance. • Group activities are useful to promote student engagement in Twitter-based learning experiences. • Activities consisting of applying the concepts studied in class to practical environments, and activities where students browse for online information and take part in a debate, are more enjoyable.

A randomized control trial was conducted to study whether providing 10th grade students with information about the returns to upper secondary and tertiary education, and a source of financial aid for tertiary education, can contribute to improve student performance. The study finds that the intervention had no effects on the probability of taking a 12th grade national standardized exam three years after, a proxy for on-time high school completion, but a positive and significant impact on learning outcomes and self-reported measures of effort. The effects are larger for girls and students from households with a relatively high income. These findings are consistent with a simple model where time discount determines the increase in effort and only students with adequate initial conditions are able to translate increased effort into better outcomes.

This paper studies the relationship between test scores and cognitive skills using two longitudinal data sets that track student performance in a national standardized exam in grades 6, 9, and 12 and post-secondary school outcomes in Mexico. Exploiting a large sample of twins to control for all between-family differences in school, household, and neighborhood inputs, we find that primary school test scores are a strong predictor of secondary education outcomes. Using a data set that links results in the national standardized test to later outcomes, we find that secondary school test scores predict university enrollment and hourly wages. These results indicate that, despite their limitations, large-scale student assessments can capture the skills they are meant to measure and can therefore be used to monitor student learning in developing countries.

The National Institute for Environmental Health Sciences has called for targeted efforts to engage underserved youth in environmental education programs that support environmental literacy and contribute to the development of a diverse workforce pipeline for environmental science-related occupations. Evidence suggests that career knowledge among low income and minority youth is more likely to be incompatible with post-secondary educational opportunities than other racial and ethnic groups. One approach to attenuating discordant college and career expectations among underserved youth is building networks for information sharing between secondary and post-secondary students. The purpose of this commentary is to describe the development and implementation of a high school curriculum on environmental science and environmental justice by Texas A&M University in collaboration with community engagement partners, students, and teachers at Furr High School, an innovative XQ Super School in Houston, Texas.

Working with the Mexican Ministry of Education, this study piloted a scalable program to reduce high school dropout rates by focusing on socio-emotional skill development and mathematics tutoring. The intervention was evaluated through a randomized field experiment with more than 5,000 youths at 20 upper secondary schools in Mexico City. An intention-to-treat analysis finds some evidence that exposure to the Opportunities and Development to Avoid Risks Program increases socio-emotional skills, but no evidence that it improves math outcomes or future attendance. Likely explanations for these null results include low take-up and other process factors, which are document qualitatively, as well as heterogeneous treatment effects. In particular, an inverse-probability-weighted matching model is suggestive of an effect whereby some students participate actively in the program and drop out of school less often, while other students choose not to participate when given the option and actually drop out more as a result.

Working with the Mexican Ministry of Education, this study piloted a scalable program to reduce high school dropout rates by focusing on socio-emotional skill development and mathematics tutoring. The intervention was evaluated through a randomized field experiment with more than 5,000 youths at 20 upper secondary schools in Mexico City. An intention-to-treat analysis finds some evidence that exposure to the Opportunities and Development to Avoid Risks Program increases socio-emotional skills, but no evidence that it improves math outcomes or future attendance. Likely explanations for these 0 results include low take-up and other process factors, which are document qualitatively, as well as heterogeneous treatment effects. In particular, an inverse-probability-weighted matching model is suggestive of an effect whereby some students participate actively in the program and drop out of school less often, while other students choose not to participate when given the option and actually drop out more as a result.

Based on an RCT, we evaluate a scholarship program in Mexico (PROBEMS) aimed at improving graduation rates and test scores among upper secondary school students from poor backgrounds. We find that, on average, the program has no impact either on graduation rates or on Math and Spanish test scores. We point to two possible reasons for this failure: a. the program was badly targeted, with many of the recipients being from less disadvantaged families than intended; b) the prior academic achievement of those eligible was often insufficient for completing successfully the academic requirements of upper secondary school. This points to accumulated achievement deficits that could be addressed by interventions targeting learning at an earlier stage.

This paper studies the impact of PROBEMS, a scholarship program in Mexico aimed at improving graduation rates and test scores among upper secondary school students from poor backgrounds. The identification strategy is the random allocation into the program, which took place in 2009. The strategy allows measurement of the effects of PROBEMS on test scores and graduation rates three years later in 2012. The paper finds that, on average, the program has no discernible impact on graduation rates or math or Spanish test scores. The size of the sample allows investigation of the reasons for this disappointing result. The paper finds that the program is substantially mis-targeted, with the majority of the recipients not coming from the most disadvantaged families. However, the most plausible explanation for the absence of positive impacts is that many eligible students do not seem to have the minimum learning level to face successfully the academic requirements of upper secondary school. An important policy implication is that a well-targeted scholarship program should be complemented with a remedial education intervention.

This paper studies the impact of PROBEMS, a scholarship program in Mexico aimed at improving graduation rates and test scores among upper secondary school students from poor backgrounds. The identification strategy is the random allocation into the program, which took place in 2009. The strategy allows measurement of the effects of PROBEMS on test scores and graduation rates three years later in 2012. The paper finds that, on average, the program has no discernible impact on graduation rates or math or Spanish test scores. The size of the sample allows investigation of the reasons for this disappointing result. The paper finds that the program is substantially mis-targeted, with the majority of the recipients not coming from the most disadvantaged families. However, the most plausible explanation for the absence of positive impacts is that many eligible students do not seem to have the minimum learning level to face successfully the academic requirements of upper secondary school. An important policy implication is that a well-targeted scholarship program should be complemented with a remedial education intervention.

This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services.

Este artículo explora las principales dificultades que debieron afrontar las organizaciones políticas en el exilio durante la década de los años cuarenta del siglo XX. En ese periodo, los partidos y organizaciones sindicales debieron digerir la derrota republicana y la pérdida de expectativas de un retorno factible a corto plazo. El exilio republicano se vio sometido a tensiones internas y externas que condicionaron su proceso de integración en los países de origen y sus expectativas de regreso a España. Para comprender este proceso, el artículo se centra en la evolución política del exilio en su conjunto, atendiendo a sus principales puntos de fricción durante esta década clave en su devenir histórico. La hipótesis de partida del trabajo trata de mostrar cómo la profunda disparidad de criterios existentes en el seno de las organizaciones a la hora de configurar una respuesta coordinada y unitaria frente al franquismo contribuyó a debilitar las opciones de influir en una acción de lucha eficaz contra la dictadura. Para ello, analizaremos esta pluralidad, así como los factores internacionales que condicionaron la lucha antifranquista desde el exilio en el periodo abordado.

Los procesos de enseñanza aprendizaje se reestructuran según la necesidad del contexto social donde se desarrolle, sus enfoques o tendencias dan relevancia a las tecnologías emergentes como potencializadoras de sus objetivos, permitiendo la resignificación sobre la construcción conceptual aunada a la praxis de lo aprendido en ambientes reales. La investigación en desarrollo pretende incorporar los beneficios de la tecnología emergente bajo entorno didáctico, soportado en la construcción de dispositivo móvil como medio interactivo de difusión y aprendizaje de conceptos fundamentales, prevención y cuidado, de una problemática de salud pública vigente en nuestro país: La Infección Respiratoria Aguda (IRA). Este proceso es desarrollado en primera instancia, mediante estudio de producciones científicas sobre evolución e impacto del uso de tecnologías móviles en alfabetización informacional, así como sus avances dentro del campo médico y contexto actual, posteriormente se realiza el análisis de requerimientos tanto de contenido como de diseño para la construcción de una herramienta de teleducación sobre IRA, dirigida a madres y familiares responsables de menores de 5 años, derivado de resultados de encuestas en la población referida, seguido de la recolección e implementación del contenido temático mediante fuentes validadas y revisión de expertos. Los resultados obtenidos precisarán el análisis del aplicativo en funcionamiento, como herramienta de teleeducación.

ObjectivesTo estimate the prevalence of disabling chronic pain (DCP) in Spanish adults, to analyse its characteristics, to determine its multimorbidity and to identify its associated factors.Settings2011 Andalusian Health Survey, a cross-sectional population survey based on face-to-face home interviews.Participants6507 people aged 16 years or older and living in Andalusia, Spain.OutcomesThe response variable was disabling chronic pain. Multivariate multinomial logistic regression models were used to analyse the association of factors with disabling chronic pain. The sample design was considered throughout the statistical analysis.ResultsThe prevalence of disabling chronic pain in the Spanish adult population was 11.36% (95% CI 11.23 to 11.49), while that of non-disabling chronic pain was 5.67% (95% CI 5.57 to 5.77). Disabling chronic pain was associated with high multimorbidity (especially in women (51%) and in the elderly (70%) with three or more additional chronic diseases), as well as with disadvantaged social status (such as female gender (OR=2.12), advanced age (OR10-year increase=1.28), unemployment (OR=1.33), manual work (OR=1.26), low income (OR=1.14) and reduced emotional social support (OR=1.04)). Other influential factors were tobacco consumption (OR=1.42), sleeping ≤7 hours (OR=1.2)], environmental or work conditions (OR=1.16) and quality of life (ORmental=1.21, ORphysical=2.37).ConclusionsThe population with disabling chronic pain was associated with multimorbidity, vulnerable social status and an impaired quality of life. In contrast, the population with non-disabling chronic pain showed almost no differences when compared with the population without chronic pain. The association between DCP and mental disorders highlights the need for psychosocial services in the management of chronic pain.

This paper constructs two longitudinal datasets that record students' test scores in a national standardized exam in Mexico and track students from the end of primary (Grade 6) to the end of lower (Grade 9) and upper (Grade 12) secondary school, then to university and labor market participation up to two years after graduation from upper secondary. The results show that test scores are a strong predictor of future education and labor market outcomes. Using a large sample of twins in the data, the paper shows that the relationship between Grade 6 test scores and future education outcomes goes beyond family background. Finally, the paper exploits the within-individual correlation between subject test scores and finds evidence that this standardized assessment captures in a meaningful way the specific skills that it is designed to measure. These results show that, despite their limitations, large-scale standardized tests can capture skills that are important for future individual wellbeing.

This paper constructs two longitudinal datasets that record students' test scores in a national standardized exam in Mexico and track students from the end of primary (Grade 6) to the end of lower (Grade 9) and upper (Grade 12) secondary school, then to university and labor market participation up to two years after graduation from upper secondary. The results show that test scores are a strong predictor of future education and labor market outcomes. Using a large sample of twins in the data, the paper shows that the relationship between Grade 6 test scores and future education outcomes goes beyond family background. Finally, the paper exploits the within-individual correlation between subject test scores and finds evidence that this standardized assessment captures in a meaningful way the specific skills that it is designed to measure. These results show that, despite their limitations, large-scale standardized tests can capture skills that are important for future individual wellbeing.

Introduction: The progressive rise in dementia prevalence increases the need for rapid methods that complement population-based prevalence studies. Objective: To estimate the prevalence of dementia in the population aged 65 and older based on use of cholinesterase inhibitors and memantine. Methods: Descriptive study of use and prescription of cholinesterase inhibitors and/or memantine in 2011 according to 2 databases: Farm@drid (pharmacy billing records for the Region of Madrid) and BIFAP (database for pharmacoepidemiology research in primary care, with diagnosis and prescription records). We tested the comparability of drug use results from each database using the chi-square test and prevalence ratios. The prevalence of dementia in Madrid was estimated based on the dose per 100 inhabitants/day, adjusting the result for data obtained from BIFAP on combination treatment in the general population (0.37%) and the percentage of dementia patients undergoing treatment (41.13%). Results: Cholinesterase inhibitors and memantine were taken by 2.08% and 0.72% of Madrid residents aged 65 and older. Both databases displayed similar results for use of these drugs. The estimated prevalence of dementia in individuals aged 65 and older is 5.91% (95% CI%, 5.85-5.95) (52 287 people), and it is higher in women (7.16%) than in men (4.00%). Conclusions: The estimated prevalence of dementia is similar to that found in population-based studies. Analysing consumption of specific dementia drugs can be a reliable and inexpensive means of updating prevalence data periodically and helping rationalise healthcare resources. Resumen: Introducción: El aumento progresivo de la demencia hace conveniente disponer de métodos rápidos que complementen los estudios poblacionales de prevalencia. Objetivo: Estimar la prevalencia de demencia en la población mayor de 65 años a partir del consumo de anticolinesterásicos y memantina. Métodos: Estudio descriptivo del uso de anticolinesterásicos y/o memantina en 2011 en 2 bases de datos: Farm@drid, con registro de facturación en farmacias de la Comunidad Autónoma de Madrid (CAM) y Base de Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), con registros sobre diagnóstico y prescripción. Se analizó la comparabilidad de resultados sobre utilización de fármacos de ambas bases mediante χ2 de Pearson y razón de prevalencias. La prevalencia de demencia en la CAM se estimó a partir de la dosis por 100 habitantes/día, ajustando el resultado con los datos obtenidos en la BIFAP sobre tratamiento combinado en población general (0,37%) y proporción de pacientes con demencia en tratamiento (41,13%). Resultados: El consumo de anticolinesterásicos y memantina entre la población > 65 años de la CAM fue del 2,08 y el 0,72% respectivamente. Ambas bases muestran resultados con similar uso de estos medicamentos. La prevalencia estimada de demencia en > 65 años en la CAM es del 5,91% (IC del 95%, 5,85-5,95) (52.287 personas), mayor en mujeres (7,16%) que en hombres (4,00%). Conclusiones: La prevalencia estimada de demencia es similar a la encontrada en estudios poblacionales. El análisis del consumo de fármacos específicos para la demencia puede ser una herramienta fiable que actualice periódicamente esta prevalencia sin gran coste, ayudando en la planificación de recursos sociosanitarios. Keywords: Dementia, Prevalence, Cholinesterase inhibitors, Memantine, Drug utilisation, Pharmacoepidemiology, Palabras clave: Demencia, Prevalencia, Anticolinesterásicos, Memantina, Uso de fármacos, Farmacoepidemiología

BACKGROUND The determination of competency of trainees in programs performing bronchoscopy is quite variable. Some programs provide didactic lectures with hands-on supervision, other programs incorporate advanced simulation centers, whereas others have a checklist approach. Although no single method has been proven best, the variability alone suggests that outcomes are variable. Program directors and certifying bodies need guidance to create standards for training programs. Little well-developed literature on the topic exists. METHODS To provide credible and trustworthy guidance, rigorous methodology has been applied to create this bronchoscopy consensus training statement. All panelists were vetted and approved by the CHEST Guidelines Oversight Committee. Each topic group drafted questions in a PICO (population, intervention, comparator, outcome) format. MEDLINE data through PubMed and the Cochrane Library were systematically searched. Manual searches also supplemented the searches. All gathered references were screened for consideration based on inclusion criteria, and all statements were designated as an Ungraded Consensus-Based Statement. RESULTS We suggest that professional societies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. Bronchoscopy training programs should incorporate multiple tools, including simulation. We suggest that ongoing quality and process improvement systems be introduced and that certifying agencies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. We also suggest that assessment of skill maintenance and improvement in practice be evaluated regularly with ongoing quality and process improvement systems after initial skill acquisition. CONCLUSIONS The current methods used for bronchoscopy competency in training programs are variable. We suggest that professional societies and certifying agencies move from a volume-based certification system to a standardized skill acquisition and knowledge-based competency assessment for pulmonary and thoracic surgery trainees.

Despite the recent growth in the number of large-scale student assessments, there is little evidence on their potential to inform improvements in school management and classroom instruction in developing countries. This study conducted an experiment in the Province of La Rioja Argentina, that randomly assigned 105 public primary schools to: (a) a “diagnostic feedback” group in which standardized tests were administered in math and reading comprehension at baseline and two follow-ups and the results were made available to the schools through userfriendly reports; (b) a “capacity-building” group for which schools were provided with the reports and also workshops and school visits for supervisors, principals, and teachers; or (c) a control group, in which the tests were administered only at the second follow-up. After two years, diagnostic feedback schools outperformed control schools by .34 and .36 standard deviations (SD) in third grade math and reading, and by .28 and .38 SD in fifth grade math and reading. The principals at these schools were more likely to report using assessment results for management decisions, and students were more likely to report that their teachers engaged in more instructional activities and improved their interactions with them. Capacity-building schools saw more limited impacts due to lower achievement at baseline, low take up, and little value-added of workshops and visits. However, in most cases the results cannot discard the possibility that both interventions had the same impact.

Despite the recent growth in the number of large-scale student assessments, there is little evidence on their potential to inform improvements in school management and classroom instruction in developing countries. This study conducted an experiment in the Province of La Rioja Argentina, that randomly assigned 105 public primary schools to: (a) a "diagnostic feedback" group in which standardized tests were administered in math and reading comprehension at baseline and two follow-ups and the results were made available to the schools through user-friendly reports; (b) a “capacity-building” group for which schools were provided with the reports and also workshops and school visits for supervisors, principals, and teachers; or (c) a control group, in which the tests were administered only at the second follow-up. After two years, diagnostic feedback schools outperformed control schools by .34 and .36 standard deviations (SD) in third grade math and reading, and by .28 and .38 SD in fifth grade math and reading. The principals at these schools were more likely to report using assessment results for management decisions, and students were more likely to report that their teachers engaged in more instructional activities and improved their interactions with them. Capacity-building schools saw more limited impacts due to lower achievement at baseline, low take up, and little value-added of workshops and visits. However, in most cases the results cannot discard the possibility that both interventions had the same impact.

BACKGROUND Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. METHODS AND FINDINGS The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values-as well as the dynamic clusters and networks that they tend to form-were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. CONCLUSIONS By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.

Context Patients and caregivers participate in decision-taking, and their views should be considered in the preparation of Clinical Practice Guidelines (CPGs). We involved them in the development of a CPG on the safe use of major opioids. Objective To identify the values and preferences of patients and caregivers on the use of opioids and the desired outcomes, to investigate motives for the acceptance/rejection of opioid therapy, and to evaluate their beliefs and information about these drugs. Methods A qualitative study was conducted using semi-structured interviews in an Andalusian population of terminal patients and caregivers (N = 42). Study variables included the role, diagnosis, and adherence to treatment. Content and validity analyses were performed. Results Less than one-third of participants recognized the term opioid. Among these, false beliefs were held related to the addictive nature of these drugs, their exclusive use in terminal cases and at the end of life, and their association with premature death. The information received was very general: it was known that they are “useful for pain,” and some were informed about the administration route, composition, and habituation. Participation in decision making was usually limited to reporting symptoms to the physician. Conclusion These patients and caregivers demonstrated a preference for pain alleviation by opioid treatment and gave negative assessments on adverse digestive effects that can cause this treatment to be abandoned. They expressed interest in receiving more information and in participating in therapeutic decision making, and they reported erroneous beliefs and a lack of information about the effects of these drugs.

a b s t r a c t Objective: To determine whether an association exists between the presence of rheumatoid nodules and thickening of the intima-media and plaque of the carotid artery, which is evidence of atherosclerosis. Materials and methods: Observational, cross-sectional study of 124 patients with rheumatoid arthritis from a University Hospital clinic from 2005 to 2006. We divided the patients into 2 groups, 62 with rheumatoid nodules and 62 without rheumatoid nodules, matched for age and sex. Medical history, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, and a high resolution doppler ultrasound of the carotid arteries were performed. Results: Women comprised 89.5% of the patients. The prevalence of a carotid plaque was 57% in our population. The presence of a plaque was associated with age, arterial hypertension and abdominal circumference. Average intima-media thickness (IMT) in patients with a plaque was 0.085 cm (±0.02). There was no correlation between laboratory parameters and thickening of the intima-media of the carotid artery. Subcutaneous nodules were present in 33 (47%) of the 70 patients with a carotid plaque and in 29 (54%) of patients without a carotid plaque (p = .471). Conclusions: We did not find an association between rheumatoid nodules and the presence of a carotid plaque and thickening of the intima-media of the carotid in patients with rheumatoid arthritis. © 2012 Elsevier Espana, S.L. All rights reserved.

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, NCT02866799 Publisher PDF

Urban sprawl is a natural process of the cities‘ growth as consequence population growth. The population need a food, water and housing for survival and for its species to continue populating the land. The literature existing about urban sprawl considers a population growth causes impacts on people’s quality of life because they consume more food, water, electricity, transport for their locomotion, and other products and services. The fact is the urban sprawl and population growth are directly linked and can not be separated in any study on the subject. Sprawl is the process in which the spread of development across the landscape far outpaces population growth. This is article show the process Urban sprawl and consequences of poorly managed expansion the city São Paulo – Brazil. The phenomenon of sprawl there are several common characteristics pervading time in history from development the city of São Paulo. The phenomenon of sprawl the city of São Paulo is a common the any big city, the result of a complex set of interrelated socioeconomic and cultural forces. For example, land value is often considered the main driver of socioeconomic development patterns. However, at any time in the current or ancient history, land value is lower on the periphery and very expensive in urban centers. Other factors contribute to the occupation of land on the outskirts of large cities: existence of water and the quality of land for agriculture, the cost of keeping the dwelling lower when compared to the cost of the city center, the size of the land is larger at the beginning of the occupation.

Using all the household survey data available in Latin America during the period 1992 to 2013, this paper estimates that in 2015, 20 million youth ages 15 to 24 years in the region were out of school and not working (making them ninis, for "ni estudian ni trabajan"). The share of out-of–school, out-of-work youth in Latin America, at about 19 percent, is roughly equal to the global average of 22 percent. Although women make up over two-thirds of the ninis in the region, the number of male ninis grew by 46 percent between 1992 and 2010. As a result, the absolute number of ninis rose over the two-decade period, even as women's education and employment rates were improving. Global comparisons show that Latin America is the region of the world with the largest concentration of ninis among households in the bottom 40 percent of the income distribution. Coupled with the long-lasting harm it causes to the youth's future labor-market outcomes, the high incidence of ninis among the poorest households tends to lock in income disparities from one generation to the next, obstructing social mobility and poverty reduction in the region.

Using all the household survey data available in Latin America during the period 1992 to 2013, this paper estimates that in 2015, 20 million youth ages 15 to 24 years in the region were out of school and not working (making them ninis, for "ni estudian ni trabajan"). The share of out-of-school, out-of-work youth in Latin America, at about 19 percent, is roughly equal to the global average of 22 percent. Although women make up over two-thirds of the ninis in the region, the number of male ninis grew by 46 percent between 1992 and 2010. As a result, the absolute number of ninis rose over the two-decade period, even as women's education and employment rates were improving. Global comparisons show that Latin America is the region of the world with the largest concentration of ninis among households in the bottom 40 percent of the income distribution. Coupled with the long-lasting harm it causes to the youth's future labor-market outcomes, the high incidence of ninis among the poorest households tends to lock in income disparities from one generation to the next, obstructing social mobility and poverty reduction in the region.

This paper seeks to understand what drove the trends in learning outcomes in Argentina between 2000 and 2012, using data from four rounds of the Program for International Student Assessment. A year-specific education production function is estimated and its results used to decompose the changes in learning outcomes into changes in inputs, parameters, and residuals via microsimulations. Estimates of the production function show the importance of socioeconomic status, gender, school autonomy, and teacher qualifications to determine learning outcomes. Despite an important increase in the level of resources invested in public education, learning outcomes in public schools decreased vis-à-vis private schools. According to the results presented here, the increase in the number of teachers in the system, pushing the pupil-teacher ratio in Argentina to 11, had no effect on learning outcomes. The microsimulation further confirms that changes in the system’s ability to transform inputs into outcomes accounted for most of the changes in test scores. Overall, the study shows the ineffectiveness of input-based education policies to improve learning outcomes in Argentina.

A randomized control trial was conducted to study whether providing 10th grade students with information about the returns to upper secondary and tertiary education, and a source of financial aid for tertiary education, can contribute to improve student performance. The study finds that the intervention had no effects on the probability of taking a 12th grade national standardized exam three years after, a proxy for on-time high school completion, but a positive and significant impact on learning outcomes and self-reported measures of effort. The effects are larger for girls and students from households with a relatively high income. These findings are consistent with a simple model where time discount determines the increase in effort and only students with adequate initial conditions are able to translate increased effort into better outcomes.

A randomized control trial was conducted to study whether providing 10th grade students with information about the returns to upper secondary and tertiary education, and a source of financial aid for tertiary education, can contribute to improve student performance. The study finds that the intervention had no effects on the probability of taking a 12th grade national standardized exam three years after, a proxy for on-time high school completion, but a positive and significant impact on learning outcomes and self-reported measures of effort. The effects are larger for girls and students from households with a relatively high income. These findings are consistent with a simple model where time discount determines the increase in effort and only students with adequate initial conditions are able to translate increased effort into better outcomes.

A randomized control trial was conducted to study whether providing 10th grade students with information about the returns to upper secondary and tertiary education, and a source of financial aid for tertiary education, can contribute to improve student performance. The study finds that the intervention had no effects on the probability of taking a 12th grade national standardized exam three years after, a proxy for on-time high school completion, but a positive and significant impact on learning outcomes and self-reported measures of effort. The effects are larger for girls and students from households with a relatively high income. These findings are consistent with a simple model where time discount determines the increase in effort and only students with adequate initial conditions are able to translate increased effort into better outcomes.

In 2009, the Mexican state of Colima implemented a low-stakes accountability intervention with diagnostic feedback among 108 public primary schools with the lowest test scores in the national student assessment. A difference-in-difference and a regression discontinuity design are used to identify the effects of the intervention on learning outcomes. The two alternative strategies consistently show that the intervention increased test scores by 0.12 standard deviations only a few months after the program was launched. When students, teachers, and parents in a school know that their scores are low, and this triggers a process of self-evaluation and analysis, the process itself may lead to an improvement in learning outcomes. Information on quality, without punitive measures but within a supportive and collaborative environment, appears to be sufficient to improve learning outcomes.

In 2009, the Mexican state of Colima implemented a low-stakes accountability intervention with diagnostic feedback among 108 public primary schools with the lowest test scores in the national student assessment. A difference-in-difference and a regression discontinuity design are used to identify the effects of the intervention on learning outcomes. The two alternative strategies consistently show that the intervention increased test scores by 0.12 standard deviations only a few months after the program was launched. When students, teachers, and parents in a school know that their scores are low, and this triggers a process of self-evaluation and analysis, the process itself may lead to an improvement in learning outcomes. Information on quality, without punitive measures but within a supportive and collaborative environment, appears to be sufficient to improve learning outcomes.

Findings are presented from research examining the relationship between shame traits and acculturation status (i.e., Mexican, Anglo, and Bicultural orientations, level/type) of Chicano students (N = 90). Six out of twenty-four shame traits were significantly related to acculturation status; one descriptive-acculturation trait (awareness of ethnic background) lowered shame scores, and place of birth of parents and grandparents affected self-esteem scores. A major consideration in this paper is for educators to evaluate shame and acculturation traits of college students and utilize experiential, adult learning, and strengths-centered approaches to structure teaching in the context of these traits. This study has implications for advancing knowledge on these subjects through replication with diverse student and probability samples.

The summer phytoplankton population in the Arcos reservoir (Spain), an oligotrophic/mesotrophic waterbody, was dominated by the cyanobacterium Aphanizomenon ovalisporum, accompanied by Planktothrix cf. agardhii and smaller proportions of other cyanobacterial species. The bloom remained for approximately 1 month in the summer of 2004. The Arcos reservoir had moderate conductivity, up to 1756 µS cm−1, and relatively high nutrient concentrations. Planktonic biomass collected during the bloom period was found to be toxic by the Artemia salina bioassay. Analytical procedures based on high-performance liquid chromatography (HPLC) indicated the absence of microcystins and anatoxin-a but clearly demonstrated the presence of cylindrospermopsin (CYN), suggesting that CYN from Aphanizomenon ovalisporum was the compound responsible for the toxicity in the bioassay. Measurements indicate that up to 9.4 µg CYN l−1 were present in the sestonic fraction. This is the first report of high concentrations of this cyanotoxin ...

Objective Our objective was to investigate the predisposing factors in patients with acute myocardial infarction (AMI) treated with thrombolysis and complicated by intracranial hemorrhage (ICH), as well as the factors associated with death for patients whose conditions were complicated by ICH. Design A retrospective study. Setting An intensive care/critical care unit. Patients All patients with AMI listed in the Spanish ARIAM register. Interventions None. Measurements and main results The study period was from June 1996 to December 2003. The follow-up period was limited to the time spent in the intensive care unit/coronary care unit. Associations with the development of ICH were studied by univariate analysis. Another univariate analysis was used to evaluate the differences between patients affected by AMI complicated by ICH who died and those who survived. Two multivariate analyses were also used: one to evaluate the factors related to the development of ICH and the other to evaluate the factors associated with the death of patients with ICH. A total of 17,111 patients with AMI were included in the study. ICH occurred in 151 (0.9%) of these patients during their stay in the intensive care unit/coronary care unit. The multivariate analysis showed that the variables associated with ICH development were smoking (odds ratio [OR], 0.684; 95% confidence interval [CI], 0.478-0.979); oral b-blockers (OR, 0.488; CI, 0.337-0.706); angiotensin-converting enzyme (ACE) inhibitors (OR, 0.480; CI, 0.340-0.678); arterial hypertension (OR, 4.900; CI, 2.758-8.705); age of 55-64 yrs (OR, 2.253; CI, 1.117-4.546); age of 65-74 yrs (OR, 4.240; CI, 2.276-7.901); age of 75-84 yrs (OR, 4.450; CI, 2.319-8.539); and age of >84 yrs (OR, 2.997; CI, 1.039-8.647). The mortality rate among patients with ICH was 48.3%, vs. 8.3% among patients without ICH. The multivariate study showed that the mortality rate among patients with ICH was associated with age (OR, 1.086; CI, 1.033-1.143), arterial hypertension cardiovascular risk factor (OR, 2.773; CI, 1.216-6.324), and the need for mechanical ventilation (OR, 4.324; CI, 1.665-11.230) or cardiopulmonary resuscitation (OR, 12.258; CI, 1.268-118.523). However, the administration of b-blockers (OR, 0.369; CI, 0.136-0.997) or ACE inhibitors (OR, 0.367; CI, 0.149-0.902) was associated with a reduction in the mortality rate. Conclusions Factors associated with the development of ICH in our population were age and arterial hypertension, whereas smoking and the administration of b-blockers or ACE inhibitors were associated with a reduction in incidence. Among patients with AMI complicated by ICH, mortality was associated with age, arterial hypertension, cardiopulmonary resuscitation, and the use of mechanical ventilation, whereas the administration of oral b-blockers and ACE inhibitors could be associated with a reduction in mortality.

QOL measurement is being reported with increasing frequency in the surgical literature. The authors have found, as have others, that the use ofa generic instrument such as the SF36 in combination with a disease-specific instrument will provide the most comprehensive information. GERD isa significant health problem that primarily affects the QOL of a large segment of the population. New therapies for GERD continue to be developed and introduced into clinical practice. QOL assessment should bean important part of the evaluation of these new therapies.

Objectives The paradoxical effect of smoking after acute myocardial infarction (AMI) is a phenomenon consisting of a reduction in the mortality of smokers compared to nonsmokers. However, it is not known whether the benefit of this reduction in mortality is due to smoking itself or to other covariables. Despite acceptance of the paradoxical effect of smoking in AMI, it is not known whether a similar phenomenon occurs in unstable angina. The objective of this study was to investigate the paradoxical effect of smoking in AMI and unstable angina, and to study specifically whether smoking is an independent prognostic variable. Methods and results The study population was selected from the multicentric ARIAM (Analisis del Retraso en el Infarto Agudo de Miocardio [analysis of delay in AMI]) Register, a register of 29,532 patients with a diagnosis of unstable angina or AMI. Tobacco smokers were younger, presented fewer cardiovascular risk factors such as diabetes or hypertension, fewer previous infarcts, a lower Killip and Kimball class, and a lower crude and adjusted mortality in AMI (odds ratio, 0.774; 95% confidence interval, 0.660 to 0.909; p=0.002). Smokers with unstable angina were younger, with less hypertension or diabetes. In the multivariate analysis, no statistically significant difference in mortality was found. Conclusions The reduced mortality observed in smokers with AMI during their stay in the ICU cannot be explained solely by clinical covariables such as age, sex, other cardiovascular factors, Killip and Kimball class, or treatment received. Therefore, smoking may have a direct beneficial effect on reduced mortality in the AMI population. The lower mortality rates found in smokers with unstable angina are not supported by the multivariate analysis. In this case, the difference in mortality can be explained by the other covariables.

Catastrophism is a variable of great importance in the study of pain. Catastrophism refers to a negative and exaggerated compared to the experience of pain, both real and anticipated mental perception (Sullivan, Bishop and Pivik, 1995; Sullivan et al., 2001). The current study to compare the levels of catastrophism in patients with and without fibromialgia. This study is cross-cutting and comparative. Twenty participants (M: 47.20; SD: 12.11) distributed as the following way:– group 1: patients with fibromyalgia previously diagnosed through the American College of Rheumatology criteria (n = 10);– group 2: Clinical depression, defined according to the DSM-5 (n = 5);– group 3: healthy patients (n = 5) paired by age with the group of Fibromyalgia.The PCS, a self-administered, was used to measure Catastrophism. Responses were summed to yield three different subscales: Rumination, Magnification and Helplessness. This instrument is validated in both experimental and clinical population (Van Damme, Crombez, Bijttebier, Gouber and Van Houdenhove, 2002; Edwards et al., 2006). A comparison among the three groups was established using one-way factor ANOVA. The results point out that patients with fibromyalgia have higher levels of magnification controls with depression and healthy group (P < 0.05). In contrast, although the average level of Catastrophism total presented a greater tendency in fibromyalgia patients no statistically significant differences were found. This is discussed in relation to the literature, a higher level of magnification to explain pain and maintaining the chronicity of the disease. It is important to consider the component catastrophism to have a multidimensional view of pain.Disclosure of interestThe authors have not supplied their declaration of competing interest.

This paper seeks to understand what drove the trends in learning outcomes in Argentina between 2000 and 2012, using data from four rounds of the Program for International Student Assessment. A year-specific education production function is estimated and its results used to decompose the changes in learning outcomes into changes in inputs, parameters, and residuals via microsimulations. Estimates of the production function show the importance of socioeconomic status, gender, school autonomy, and teacher qualifications to determine learning outcomes. Despite an important increase in the level of resources invested in public education, learning outcomes in public schools decreased vis-à-vis private schools. According to the results presented here, the increase in the number of teachers in the system, pushing the pupil-teacher ratio in Argentina to 11, had no effect on learning outcomes. The microsimulation further confirms that changes in the system’s ability to transform inputs into outcomes accounted for most of the changes in test scores. Overall, the study shows the ineffectiveness of input-based education policies to improve learning outcomes in Argentina.

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel–patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients’ life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.

Smoking is the leading cause of preventable death. The prevalence of smoking in the United States remains above 20 % despite intensive cessation programs and awareness of the risks of smoking by the general population. Smoking cessation programs that include counseling and pharmacotherapy have been proven to be effective in achieving long standing abstinence. In lung cancer patients, smoking cessation is associated with significant improvements in quality of life, all cause mortality, life expectancy and postoperative complications. Preoperative smoking cessation prior to a variety of surgical interventions including pulmonary resection reduces the risk of total, respiratory and wound complications. A team approach and adherence to the guidelines for smoking cessation including ongoing assessment, education, pharmacotherapy and referral for additional counseling should become an integrated part of preparing patients for all forms of lung cancer treatment including surgery.

Introduction Cardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter. Results We point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education. Conclusion We establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion.

This paper identifies and estimates the reduction in poverty attributable to the improved opportunities that international trade integration offered to women in Honduras. The expansion of the export-oriented maquila sector has brought gender equality both in terms of employment and labour earnings. A simulation exercise shows that, at a given point in time, poverty in Honduras would have been 1.5 percentage points higher had the maquila sector not existed. Of this increase in poverty, 0.35 percentage points is attributable to the wage premium paid to maquila workers, 0.1 percentage points to the wage premium received by women in the maquila sector, and 1 percentage point to employment creation.