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Background and objective Hand eczema affects nearly 10% of the population. The condition becomes severe and chronic in 5% to 7% of cases and is refractory to topical corticosteroids in 2% to 4%. This study aimed to describe the current use of oral alitretinoin in treating Spanish national health system patients with hand eczema that is refractory to potent topical corticosteroids. Materials and methods Observational, descriptive, exploratory, cross-sectional study based on the retrospective analysis of records for patients with hand eczema treated with alitretinoin in the Spanish national health system. Results We reviewed the records for 62 patients in 13 hospitals in 5 different administrative areas (autonomous communities) of Spain. Alitretinoin was usually used at a dosage of 30 mg/d. In most cases the physician judged the clinical response to be satisfactory after a single cycle. The recorded adverse effects were foreseeable and of the type reported for systemic retinoids. The dermatologists agreed that the clinical benefits achieved with alitretinoin favored adherence to treatment and an early return to work. Conclusions The results show that oral alitretinoin is being used according to established recommendations and that response is good, with few adverse effects. The dermatologists agreed that the benefits favored adherence and improved the patients’ health related quality of life.

Resumen Introduccion El eczema de manos (ECM) afecta a cerca del 10% de la poblacion, presentandose entre el 5 y el 7% de los casos como una enfermedad cronica grave y siendo refractario al tratamiento con corticoides topicos entre el 2 y el 4% de las veces. El proposito del articulo es describir el uso de la alitretinoina oral en pacientes con ECM refractario a corticoides topicos potentes en el ambito sanitario publico espanol. Material y metodos Estudio observacional descriptivo, exploratorio, transversal, basado en la revision retrospectiva de historias clinicas de pacientes con ECM en tratamiento con alitretinoina en el ambito sanitario publico espanol. Resultados Se revisaron 62 historias clinicas de pacientes de 13 centros distribuidos en 5 comunidades autonomas del territorio espanol. Alitretinoina se utilizo predominantemente a dosis de 30 mg/dia, principalmente en un unico ciclo, tras el cual la mayoria de pacientes lograron una respuesta clinica satisfactoria segun el juicio medico. Los eventos adversos fueron todos previsibles y en linea con los tratamientos sistemicos con retinoides. Los dermatologos estuvieron de acuerdo en que los beneficios clinicos logrados con alitretinoina favorecian la adherencia al tratamiento y una reincorporacion mas rapida de los pacientes al trabajo. Conclusion Los resultados muestran un uso de alitretinoina oral en linea con las recomendaciones establecidas asi como la buena respuesta al tratamiento asociado y los pocos efectos adversos. Los dermatologos coinciden que los beneficios alcanzados favorecen la adherencia al tratamiento y mejoran la calidad de vida relacionada con la salud de los pacientes.

The impact of international trade on wages has received substantial attention in recent decades; but only recently the specific effects of exporting on wage inequality have been investigated in detail. This paper employs the unexpected 1999 Brazilian exchange rate devaluation to identify the effects of exporting on Brazilian manufacturing firm-level wages using employer–employee linked data. We find that this export shock increased the average wage gap between the high and low productivity firms. Most of this wage increase took the form of a larger wage premium, but increased sorting of workers also played a significant role. Further scrutiny at the occupation–firm level indicates that the wage increases of managerial white-collar occupations came solely from wage premium variations. Skilled blue-collar workers also exhibited wage gains, but these gains came in equal shares from increased wage premium and worker sorting; the remaining occupational categories saw no wage increase.

Resumen Objetivo Identificar los factores que explican cambios en el coste del paciente con diabetes mellitus tipo 2 (DM2) segun la literatura. Metodo Se consultaron bases de datos electronicas nacionales e internacionales para identificar articulos publicados entre enero de 2001 y diciembre de 2012 que estimasen el coste de la DM2 en Espana y Europa; y evaluasen los factores determinantes del coste. Resultados Se revisaron 26 publicaciones de las 1.530 identificadas; 9 estimaban el coste de la DM2 en Europa y 17 evaluaban los factores que determinaban cambios en los costes. Las complicaciones y las hipoglucemias incrementan hasta 4 veces el coste, mientras que la optimizacion de la adherencia y del control del peso lo reduce. Las complicaciones explican el 71,4% del coste directo en Espana. Conclusiones Estrategias terapeuticas asociadas a una menor frecuencia de hipoglucemias y a una mejor adherencia y un optimo control del peso permitirian reducir el coste de la DM2.

Following trade liberalization, several developing countries experienced a sharp increase in the share of informal manufacturing employment. In this paper, I examine the impacts of trade liberalization on the labor markets of a small open economy, in an environment in which tariffs affect firms' payroll tax compliance decisions. I demonstrate that a reduction in domestic import tariffs reduces the average formal wage and show that the direction of the effect on the share of informal employment depends on the initial labor market conditions. A cut in trading partner import tariffs decreases the share of domestic informal employment and increases the average formal wage. I confirm the model's principal findings empirically, using data from the 1989–2001 Brazilian trade liberalization episode. I find the results robust to endogeneity and self-selection concerns, which are addressed, respectively, using instrumental variable and switching regression approaches.

The correlation between structural distortion and emergence of magnetism in graphene containing a single vacancy was investigated using first-principles calculations based on density functional theory (DFT). Our results have shown that a local distortion is formed around the vacancy, with reconstruction of two atomic bonds and with a dangling bond remaining at the third atom adjacent to the vacancy. A systematic investigation of the possible out-of-plane displacement of this third atom was then carried out, in order to ascertain its effects on the magnetic features of the system. The ground state was definitely found to be magnetic and planar, with spin-resolved σ and π bands contributing to the total magnetic moment. However, we have also found that metastable solutions can be achieved if an initial shift of the third atom above a minimum threshold from the graphene plane is provided, which leads to a nonplanar geometry and a nonmagnetic state.

The elasticity of intertemporal substitution (EIS) is one of the key parameters in the Economics and Finance literature. It is usually estimated by means of the consumer’s Euler Equation using an instrumental variable approach, and the estimates are usually zero or close to zero. Nevertheless, such attempts present two major problems: first, the use of weak instruments, and second, the absence of a rate of return that is representative of the agent’s asset portfolio. The latter has been addressed by using the return of a synthetic mutual fund (SMF), which is a weighted combination of the returns of all assets held by the average household. The use of SMF returns led to EIS estimates of about 0.2 for the US economy. In this paper, we first investigate whether the EIS estimates using the SMF returns for the US suffer from the weak instrument problem. Next, we conduct robustness analyses using different estimators and instrument sets. Our findings show that estimates using SMF returns are plagued by weak instruments, but in some cases partially robust estimators were able to deliver a positive and statistically significant EIS estimate. Furthermore, we found that the Treasury Bill return does not suffer from weak instruments, but the EIS is not precisely estimated and seems to be close to zero.

Objective To appraise economic evaluations of health technologies that included quality-adjusted life-years (QALYs) as an outcome measure conducted over the past 20 years in Spain. Methods A systematic review of the literature was conducted. Economic evaluations that included QALYs as an outcome measure, conducted in Spain and published between January 1990 and December 2009 were identified. Primary and gray literature sources were reviewed. Results A total of 60 articles and 4 health technology assessment reports were included. Key findings were 1) the vast majority of articles (77.1%) referred to therapeutic interventions; 2) 63.2% dealt with pharmaceutical products and much fewer with preventive strategies, medical devices, or diagnostic interventions; 3) most evaluations referred to cardiovascular- (19.8%), respiratory- (16.3%), and cancer- (13.0%) related processes; 4) 80.3% were based on a theoretical model, most commonly Markov models (71.4%); 5) 67.3% adopted the National Health System perspective; 6) information on the methods used to describe the health states was given in 45.1% of studies; 7) 40.3% used the EuroQoL-5D to elicit preferences, whereas 66.1% gave no details on the methods applied to determine patients' choices; 8) it was possible to state who completed the questionnaires in only 17.7% of studies; 9) 77.1% of the interventions assessed were below the €30,000/QALY suggested affordable threshold in Spain. Conclusions An increasing number of economic evaluations using QALYs had been conducted. Most of them relied on theoretical models. Several methodological issues remain unsolved. Great disparity exists regarding the reporting of the methods used to determine health states and utility values.

Hepatitis B virus (HBV) is classified into eight major genotypes, A-H, which are geographically distributed worldwide. The aim of this work was to describe the clinical characteristics associated with the HBV genotypes circulating in Buenos Aires city. The study included 139 patients infected with HBV, whose clinical courses were classified as acute symptomatic self-limiting hepatitis, inactive carrier state and chronic active hepatitis (HBV e-antigen (HBeAg)-positive and HBeAg-negative). The HBV genotypes were determined in 128 patients by PCR–restriction fragment length polymorphism and phylogenetic analysis. Biochemical, virological, clinical and histological features were analysed. A differential distribution of genotypes between acute symptomatic and chronic infections was found. Among the acute cases, genotype F was predominant (65.2%, 30/46) and genotype D was rare (4.3%, 2/46), whereas among the chronic infections, a homogeneous distribution of genotypes A (26.8%, 22/82), D (31.7%, 26/82) and F (36.6%, 30/82), with an unusual presence of genotypes B (1.2%, 1/82) and C (3.7%, 3/82), was observed. Regarding the liver histology of chronically infected patients, genotype F tended to display higher histological activity indexes. Mutations related to HBV surface antigen immunoreactivity, antiviral resistance and HBeAg-negative status were studied. This work constitutes, to our knowledge, the first description of the clinical characteristics related to HBV genotypes in Argentina, where the distribution of genotypes in patients with acute infection has not been reported previously. Finally, it was established that genotype F is the prevalent genotype among the acute symptomatic infections in Buenos Aires city, and that it shows a tendency to cause an adverse disease outcome among the chronic cases.

The effects of maternal depression on neonatal neurodevelopment in MA exposed neonates have not been well characterized.To determine the neurobehavioral effects of maternal depressive symptoms on neonates exposed and not exposed to methamphetamine (MA) using the NICU Network Neurobehavioral Scale (NNNS).The purpose of the IDEAL study is to determine the effects of prenatal MA exposure on child outcome. IDEAL screened 13,808 subjects, 1632 were eligible and consented and 176 mothers were enrolled. Only biological mothers with custody of their child at the one-month visit (n=50 MA; n=86 comparison) had the Addiction Severity Index (ASI) administered. The NNNS was administered to the neonate by an examiner blinded to MA exposure within the first five days of life. General Linear Models tested the effects of maternal depression and prenatal MA exposure on NNNS outcomes, with and without covariates. Significance was accepted at p.05.After adjusting for covariates, regardless of exposure status, maternal depressive symptoms were associated with lower handling and arousal scores, elevated physiological stress scores and an increased incidence of hypotonicity. When adjusting for covariates, MA exposure was associated with lower arousal and higher lethargy scores.Maternal depressive symptoms are associated with neurodevelopmental patterns of decreased arousal and increased stress. Prenatal MA exposure combined with maternal depression was not associated with any additional neonatal neurodevelopmental differences.

In this paper the design of the architecture of a programmable cell, belonging to a filter bank to be implemented in an FPGA, is described. The cell is made up of a modulating stage and a filtering stage, in which a moving average filter (FIR filter) is used. The user is able to program the quantity of samples corresponding to the carrier signal, as well as the amount of delays of the moving average filter. This study was performed considering the chip area used by the design and the maximum working frequency. Cell implementation was performed on an FPGA Virtex XCV100 (100.000 gates) made by Xilinx. The cell is capable of working at a maximum clock frequency of 53.6 MHz occupying an area of 438 Slices.

Resumen Apartir de los anos ochenta y ante la gran divergencia de criterios respecto a cual de las tecnicas ofrecia mejores beneficios, la cirugia "a la demanda" se abre un espacio. El objetivo de este trabajo es determinar los resultados audio-quirurgicos en los pacientes con aticoantromastoidectomia a demanda con reconstruccion de pared posterior o relleno de cavidad mastoidea y mostrar los resultados a los tres anos de evolucion. Se realiza estudio prospectivo y descriptivo de 22 pacientes que se les realizo una mastoidectomia a demanda utilizando cartilago autologo para la reconstruccion de la pared posterior, y polvo de hueso obtenido del fresado quirurgico, para el relleno de la cavidad mastoidea

1. Garcia-Ruiz AJ et al. ISPOR 15th Annual European Congress (November, 2012), Berlin, Germany. 2. Clyde E and Markowitz MD. Am J Manag Care 2010; 16: s211-18. 3. Steinber SC et al. Clin Drug Investig 2010; 30(2):89-100. 4. Tan H, et al. Adv Ther 2011; 28(1):51-61.5. Ivanova JI et al. J Med Econ 2012; 15(3):601-9. 6. Oleen-Burkey et al. J Med Econ 2011; 14(6):739-47. 7. Verdun di Cantogno E et al. Patient Prefer Adherence 2011; 5:173-8.8. Swinburn P et al. ISPOR 17th Annual International Meeting (June, 2012), Washington DC, USA. Treatment adherence and costs in multiple sclerosis: a narrative review of the literature

A simultaneous method for extracting residual bisphenol A diglycidyl ether (BADGE) and m -xylylenediamine ( m -XDA) from finished epoxy resins cured with different equivalent ratios of these raw materials (1:1, 1:2 and 1:3) has been developed. Extraction is based on refluxing epoxy—amine formulations in a chloroform—methanol (25:75) mixture for 10 h and quantification is carried out by reversed-phase high-performance liquid chromatography with fluorescence detection, directly for BADGE and previous precolumn derivatization with fluorescamine for m -XDA. The relative standard deviation for BADGE chromatography at 200 μg/l was 3.4% and for m -XDA derivatization—chromatography 5.7%, the detection limit 5 μg/l for BADGE and 20 μg/l for m -XDA and the recovery for six spiked concentrations of 200 μg/l was 98.9 ± 6.5% for BADGE and 89.3 ± 6.0% for m -XDA.

Objetivo Evaluar la efectividad clinica de un programa de automanejo de la artrosis en pacientes de atencion primaria. Diseno Ensayo clinico aleatorizado y controlado. Emplazamiento Un total de 74 consultas de atencion primaria en el Reino Unido. Poblacion Se incluyeron en el estudio, y se efectuo un seguimiento durante 12 meses, a 812 pacientes de 50 anos o mas con diagnostico de artrosis de rodilla, cadera o ambas, durante al menos un ano, y con dolor, limitacion funcional o ambos durante el mes previo. Se excluyo a los pacientes con indicacion de intervencion quirurgica, con escasa movilidad, que no comprendian el idioma ingles o que presentaban un deterioro cognitivo. Intervencion Un programa norteamericano para el automanejo de la artrosis se adapto para ser utilizado en el Reino Unido. Este programa esta basado en la teoria cognitiva social: un mayor conocimiento acerca de la enfermedad y su automanejo deben proporcionar efectos beneficiosos y una autopercepcion mas positiva sobre el control de la enfermedad. Un total de 812 pacientes fueron aleatoriamente asignados a recibir 6 sesiones del programa de automanejo junto con un manual educativo (grupo de intervencion, n = 406) o a recibir solo un manual educativo (grupo control, n = 406). No completaron el estudio112 pacientes del grupo intervencion y 81 del grupo control. Medicion del resultado La variable principal de estudio fue la calidad de vida relacionada con la salud medida con el SF-36. La segunda variable mas importante fue el automanejo de la enfermedad con la Arthritis Self Efficacy (ASE) Scale. El dolor, la rigidez articular y la funcionalidad fisica se midieron con el WOMAC Ostheoarthritis Index, y la ansiedad y depresion se evaluaron con la Hospital Anxiety and Depresion (HAD) Scale. Se empleo un cuestionario que los pacientes cumplimentaron al inicio (basal), a los 4 y a los 12 meses de seguimiento. Se realizo un analisis por intencion de tratar de todas las variables consideradas, y ademas un analisis por protocolo de los pacientes que habian asistido a 4 (considerado el minimo numero de asistencias clinicamente significativo) o mas sesiones del programa educativo. Resultados principales No se hallaron diferencias significativas entre los 2 grupos en la variable principal, aunque los parametros de salud mental medidos con el SF-36 tendieron a mejorar en el grupo de intervencion. Tampoco hubo diferencias significativas en los 3 componentes del WOMAC, aunque en el grupo de intervencion todos los parametros tendieron a mejorar, especialmente a los 12 meses de seguimiento. En el grupo de intervencion, la ansiedad se redujo significativamente a los 12 meses (–0,62; intervalo de confianza [IC] del 95%, –1,08 a –0,16), asi como la depresion medida a los 4 meses (–0,40; IC del 95%, –0,76 a –0,03), aunque esta ultima tendencia se perdio al ano. El dolor se redujo significativamente a los 4 meses (1,63; IC del 95%, 0,83-2,43) y a los 12 meses (0,98; IC del 95%, 0,07-1,89). Los resultados del analisis por protocolo fueron similares a los obtenidos con el analisis por intencion de tratar. Conclusion El programa de automanejo de la artrosis reduce la ansiedad y mejora la percepcion de los pacientes sobre su capacidad de automanejo de los sintomas. No modifica el dolor o la funcionalidad fisica

Objetivo Evaluar la eficacia y la seguridad terapeuticas en el tratamiento agudo de la migrana de un comprimido combinado de sumatriptan (85 mg) y naproxeno (500 mg). Diseno Dos ensayos clinicos paralelos multicentricos, duplicados, aleatorizados y doble ciego. Emplazamiento Un total de 118 centros sanitarios de Estados Unidos, incluidos los de atencion primaria, neurologia y clinicas especializadas. Poblacion Se definieron estrictos criterios de inclusion (p. ej., edad entre 18 y 65 anos; antecedentes de migrana de al menos 6 meses de evolucion con y sin aura; 2-6 episodios migranosos moderados-graves por mes como promedio durante los 3 meses previos a la visita de valoracion para ingresar en el ensayo; saber diferenciar episodios migranosos de otros tipos de cefaleas) y exclusion (p. ej., mujeres embarazadas y lactantes; hipertension arterial no controlada; enfermedad cardiovascular o cerebrovascular sospechada o confirmada; migrana basilar o hemiplejica), asi como de seguimiento durante el estudio. Un total de 1.768 pacientes (ensayo clinico 1) y 1.875 (ensayo clinico 2) fueron invitados a participar; 307 pacientes (ensayo clinico 1) y 380 (ensayo clinico 2) fueron excluidos, principalmente por falta de cumplimiento de la medicacion. Intervencion Un total de 1.461 (ensayo clinico 1) y 1.495 (ensayo clinico 2) pacientes ambulatorios con dolor moderado-persistente fueron aleatoriamente asignados a recibir durante 6 semanas una de las 4 posibilidades siguientes: un comprimido de dosis fijas de sumatriptan-naproxeno, 85 mg de sumatriptan, 500 mg de naproxeno, o placebo. Los pacientes debian registrar detalladamente las caracteristicas, las circunstancias y el comportamiento del episodio migranoso antes y despues de ingerir la medicacion estudiada. La eficacia clinica se determino en funcion de la reduccion del dolor, la fotofobia, la fonofobia y las nauseas a las 2 h, asi como por la duracion de la respuesta, entendida como periodo libre de sintomas a las 24 h de ingerido el farmaco de estudio. La seguridad clinica se estimo por la aparicion o no de efectos adversos conocidos. Medicion del resultado Se estimo el porcentaje de pacientes con alivio de la cefalea, ausencia de fotofobia, de fonofobia y de nauseas a las 2 h despues de recibir la medicacion, y el porcentaje de pacientes con alivio sostenido del dolor a las 24 h con cada uno de los esquemas terapeuticos estudiados. Resultados principales La combinacion de sumatriptan y naproxeno en dosis fijas, en un comprimido unico, fue mas efectiva que placebo en el alivio del evento migranoso agudo (el 65 frente al 28%, y el 57 frente al 29%, en el ensayo 1 y 2, de forma respectiva, ambos estadisticamente significativos), asi como en el alivio de la fotofobia y la fonofobia. En el alivio de las nauseas, los resultados difieren entre los 2 ensayos. El alivio sostenido del dolor a las 24 h fue mayor con el comprimido combinado de sumatriptan y naproxeno respecto a sumatriptan aislado, naproxeno aislado y placebo. Los efectos adversos fueron escasos entre los grupos que recibieron tratamiento, aunque mas frecuentes que entre quienes recibieron placebo. Conclusion La dosis de 85 mg de sumatriptan combinada con 500 mg de naproxeno en un comprimido unico fue mas efectivo que cada farmaco por separado y que placebo en el alivio de la migrana aguda, con un aceptable perfil terapeutico.

Objetivo Comparar los efectos secundarios gastrointestinales a largo plazo del inhibidor selectivo de la ciclooxigenasa-2 (COX-2), etoricoxib, con el antiinflamatorio no esteroideo (AINE) diclofenaco, en pacientes que, por sus antecedentes de riesgo, reciben inhibidores de la bomba de protones (IBP) o dosis bajas de aspirina. Diseno Tres ensayos clinicos (MEDAL, EDGE y EDGE II) multicentricos prospectivos, aleatorizados, doble ciego, cuyo objetivo principal era comparar los efectos secundarios tromboticos de etoricoxib y diclofenaco en el tratamiento del dolor articular cronico. Este articulo analiza los datos sobre los efectos secundarios gastrointestinales, que eran objetivos secundarios de los ensayos clinicos mencionados. Emplazamiento Un total de 1.380 centros sanitarios de 46 paises diferentes. Poblacion Un total de 34.701 pacientes que cumplian los siguientes criterios de inclusion: edad ≥ 50 anos, clinica de osteoartritis en la rodilla, la cadera, la mano o la columna vertebral, o al menos 4 de los 7 criterios diagnosticos revisados de artritis reumatoide (Asociacion Americana de Reumatismo, 1987), y que requieran tratamiento cronico con AINE a juicio del investigador. Intervencion Se asigno aleatoriamente 24.913 pacientes con osteoartritis y 9.787 con artritis reumatoide a recibir etoricoxib o diclofenaco durante un promedio de 18 meses. Se recomendaron dosis bajas de aspirina como profilaxis en los pacientes con un riesgo cardiovascular establecido. Se usaron gastroprotectores o IBP en pacientes con alto riesgo de eventos del tracto gastrointestinal superior (edad > 65 anos, antecedents de ulcera o hemorragia, uso concomitante de esteroides o anticoagulantes o terapia antiplaquetaria) de complicaciones gastrointestinales mayores. Medicion del resultado Se estimaron las complicaciones gastrointestinales menores (ulcera gastrica o duodenal no complicada y hemorragia digestiva no complicada) y mayores (hemorragia digestiva complicada, perforacion gastrica o duodenal, y obstruccion gastrica, pilorica o duodenal, ambas de causa no maligna) para cada 100 pacientes tratados por ano con un intervalo de confianza (IC) del 95%. El riesgo acumulado de sufrir complicaciones gastrointestinales con el tiempo (metodo de Kaplan-Meier) se estimo hasta que el numero de pacientes en riesgo fue inferior a 500 (36 meses). Resultados principales Etoricoxib y diclofenaco fueron igualmente eficaces en el tratamiento de ambas afecciones reumatologicas. En general, los efectos secundarios gastrointestinales fueron significativamente menores con etoricoxib que con diclofenaco (riesgo relativo [RR] = 0,69; IC del 95%, 0,57-0,83). Fueron mas frecuentes las complicaciones gastrointestinales menores, pero los pacientes tratados con etoricoxib presentaron un menor numero de eventos significativos (RR = 0,57; IC del 95%, 0,45-0,74). Las complicaciones gastrointestinales mayores fueron similares (el 0,45% con etoricoxib frente al 0,47% con diclofenaco) y no significativas (RR = 0,91; IC del 95%, 0,67-1,24) con los dos medicamentos. La asociacion de dosis bajas de aspirina, con o sin IBP, no aumento significativamente las complicaciones gastrointestinales, y su incidencia fue menor con etoricoxib. La dispepsia fue la causa mas frecuente de interrupcion del tratamiento y su aparicion fue significativamente menor con etoricoxib. Conclusion La utilizacion de etoricoxib en pacientes con osteoartrirtis o artritis reumatide, tratados con IBP o dosis bajas de aspirina, reduce el riesgo de complicaciones gastrointestinales menores y de dispepsia comparado con diclofenaco.

Yttrium-iron-garnet (YIG) particles have been synthesized using the microemulsion technique. A comparison of ferrite powders obtained by this method and those prepared by sol-gel and solid state reactions is reported. We have studied both the magnetic and structural properties and have found a dependence on annealing temperatures.

Fine particles of BaFe12O19 have been successfully prepared using a combustion method and annealed at 700, 750, 850 and 1000°C to obtain particles with average diameter in the range 50–200 nm. The structural properties observed by X-ray diffraction in conjunction with the hyperfine characteristics estimated from room temperature Mossbauer spectra explain well the magnetic behavior of the small particles.