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Resumen Antecedentes y objetivo Describir las caracteristicas clinicas de los pacientes tratados con evolocumab, las razones del inicio de la terapia y los efectos del tratamiento en la fase inicial de disponibilidad de evolocumab en las unidades de nefrologia de Espana. Material y metodos Estudio retrospectivo, observacional y multicentrico que incluye los pacientes que iniciaron tratamiento con evolocumab (desde febrero de 2016 a agosto de 2018) en 15 unidades de nefrologia en Espana. Se revisaron las caracteristicas demograficas y clinicas de los pacientes, el tratamiento hipolipemiante y la evolucion de los perfiles lipidicos entre 24 semanas antes y 12 ± 4 semanas despues del inicio de evolocumab. Resultados Se incluyeron 60 pacientes: 53,3% mujeres, edad media (DE) de 56,9 (12,8) anos, el 45,0% con hipercolesterolemia familiar (HF) (5,0% homocigota y 40,0% heterocigota) y el 65,0% con enfermedad cardiovascular aterosclerotica (ECVA) previa. El filtrado glomerular estimado (FGe) medio fue de 62,6 (30,0) ml/min/1,73 m2 (51,7% pacientes con FGe 2]), el 50,0% con proteinuria (> 300 mg/g) y el 10,0% con sindrome nefrotico. Otros factores de riesgo CV fueron: hipertension (75,0%), diabetes mellitus (25,0%) y habito tabaquico (21,7%). El 40,0% eran intolerantes a estatinas. Al inicio de evolocumab, el 41,7% tomaban estatinas de alta intensidad, el 18,3% estatinas de moderada intensidad y el 50,0% ezetimiba. Los niveles medios (DE) de c-LDL al inicio de evolocumab fueron de 179,7 (62,9) mg/dl (53,4% pacientes con c-LDL ≥ 160 mg/dl y 29,3% ≥ 190 mg/dl). Despues de 12 semanas del tratamiento con evolocumab se observo una reduccion de los niveles de c-LDL del 60,1%. A la semana 12, el 90,0% de los pacientes alcanzo niveles c-LDL Conclusiones En las unidades de nefrologia de Espana, evolocumab se ha prescrito principalmente en pacientes con HF, enfermedad renal cronica (ERC > 2) y prevencion secundaria, con niveles de c-LDL muy por encima de los recomendados por las guias. Evolocumab utilizado en practica clinica, redujo significativamente los niveles de c-LDL en todos los pacientes incluidos en el estudio.

This paper examines these elements in the context of South Africa and Indonesia– two middle-income countries with similar development levels yet different labour market characteristics. We employ a comparative cross-country methodology using long-term panel data.

En analysant le poids des processus géographiques à l’œuvre sur les inégalités interindividuelles d’accès à l’emploi dans ses différentes dimensions, ce chapitre recense une multiplicité de mécanismes socio-économiques confortés par une imposante littérature empirique tant en géographie, économie que sociologie. Ils interrogent et souvent réfutent la pertinence des hypothèses et les prédictions des principales formalisations théoriques.

El estudio microbiológico para evaluar patógenos en aguas residuales de la unidad Hospitalaria General Puyo se desarrolló en los laboratorios de análisis bioquímicos y bacteriológicos de la Facultad de Ciencias de la Escuela Superior Politécnica de Chimborazo. Durante tres meses se recolectó 6 muestras compuestas con sus respectivas réplicas antes y después de la Planta de tratamiento de Aguas Residuales (PTAR) realizando análisis físico – químico como: pH, Conductividad, salinidad, sólidos disueltos totales, turbiedad, color, DBO5, DQO, seguido de un análisis microbiológico mediante siembras de vertido en placa para la identificación y cuantificación de bacterias: Escherichia Coli, Staphylococcus aureus y Salmonellas spp .y finalmente se realizó la Tinción Gram previo a realizar las pruebas bioquímicas donde se identificaron una totalidad de Bacilos Gram negativos, las bacterias identificadas fueron de la familia Enterobacteriaceae. Identificando las siguientes familias, Escherichia coli, (50%), Klebsiella pneumoniae, (10%) Enterobacter cloacae (0,1%) Shigella dysenteriae, (10%) Salmonella spp (30 %), concluyendo así que las aguas residuales provenientes de esta unidad Hospitalaria tienen un porcentaje de toxicidad alta y los tratamientos convencionales de aguas residuales no eliminan la su toxicidad biológica

Background Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). Methods PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicenter, open-cohort study of 966 adult patients with non-dialyzed CKD stages 4-5 enrolled from 12 centers in Spain. Associations between levels of serum calcium (Ca) (corrected for albumin), phosphate (P), and intact parathyroid hormone (iPTH) with all-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical values collected every 6 months for 3 years. Results After a median follow-up of 29 months (IQR: 13-36 months) there were 181 deaths (19%). The association of calcium with all-cause mortality was J-shaped, with an increased risk for all-cause mortality at levels > 10.5 mg/dL. For phosphate and iPTH levels, the association was U-shaped. The serum values associated with the minimum risk of mortality were 3.8 mg/dL for phosphate and 70 pg/mL for iPTH, being the lowest risk ranges between 2.8 and 5.0 mg/dL, and between 38 and 112 pg/mL for phosphate and iPTH, respectively. Conclusions Our study provides evidence on the non-linear association of serum calcium, phosphate and iPTH levels with mortality in stage 4 and 5 CKD patients, and suggests potential survival benefits for controlling bone mineral parameters in this population, as previously reported for dialysis patients.

Background Hyperkalaemia is a common condition in patients with comorbidities such as chronic kidney disease (CKD) or congestive heart failure (HF). Moreover, severe hyperkalaemia is a potentially life-threatening condition that is associated with a higher risk of adverse clinical events such as ventricular arrhythmias and sudden cardiac death. Currently, data regarding the prognostic implications of chronic hyperkalaemia are available; however, information about the long-term clinical consequences after an episode of severe hyperkalaemia remains scarce. The objective of this study was to evaluate the association between the trajectory of potassium measurements in patients with acute hyperkalaemia and long-term all-cause mortality. Methods This is a retrospective observational study that included patients with acute severe hyperkalaemia [potassium (K) >6 mEq/L] without haemolysis in the emergency room of Dr Peset University Hospital in Valencia, Spain searching the lab database from January 2016 to March 2017. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modelling. Results We found 172 episodes of acute hyperkalaemia in 160 patients in the emergency room. The mean ± standard deviation age of the sample was 77 ± 12 years and 60.5% were males. The most frequent comorbidities were CKD (71.2%), HF (35%) and diabetes mellitus (56.9%). Only 11.9% of the patients were on chronic dialysis. A quarter of the patients did not have previous CKD, making hyperkalaemia an unpredictable life-threatening complication. During the acute episode, mean potassium and estimated glomerular filtration rate (eGFR) were 6.6 ± 0.6 (range 6.1–9.2) mEq/L and 23 ± 16 (range 2–84) mL/min/1.73 m2, respectively. After a median (interquartile range) follow-up of 17.3 (2.2–23.7) months, 68 patients died (42.5%). Recurrences of hyperkalaemia (K >5.5 mEq/L) were detected in 39.5% of the patients who were monitored during follow-up. We found that previous potassium levels during an acute severe hyperkalaemia episode were not predictors of mortality. Conversely, the post-discharge longitudinal trajectories of potassium were able to predict all-cause mortality (overall P = 0.0015). The effect of transitioning from hyperkalaemia to normokalaemia (K >5.5 mEq/L to K ≤5.5 mEq/L) after the acute episode was significant, and inversely associated with the risk of mortality. Conclusions Potassium levels prior to a severe hyperkalaemic event do not predict mortality. Conversely, following an episode of acute severe hyperkalaemia, serial kinetics of potassium trajectories predict the risk of death. Further evidence is needed to confirm these findings and clarify the optimal long-term management of these patients.

Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. Materials and Methods: 612 NDD 3‒5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110 patients (18%). Serum phosphate levels (OR 0.719, 95% CI 0.532 to 0.972, p = 0.032), ankle-brachial index &lt, 0.9 (OR 1.694, 95% CI 1.056‒2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876‒16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17‒37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score &gt, 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009‒3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3‒5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis

La Garantie europeenne pour la jeunesse (ou Garantie jeunesse) apparait comme une politique du marche du travail innovante. Elle a ete promue dans un contexte ou se faisait sentir le besoin d’une reponse urgente face aux consequences durablement prejudiciables du chomage de longue duree. Cet article examine les donnees empiriques sur l’efficacite des experiences anterieures de mesures ciblees sur les jeunes, ainsi que les evaluations existantes de la Garantie jeunesse, afin d’identifier les facteurs qui s’averent decisifs pour sa reussite. Il determine ensuite si ces facteurs cles de reussite sont integres dans les plans de mise en œuvre elabores par les pays europeens et regarde dans quelles mesures les objectifs fixes ont ete atteints dans la pratique. La plupart des pays ont etabli des criteres d’eligibilite clairs ainsi que des cadres institutionnels appropries et proposent un ensemble complet de mesures ; cependant, bon nombre d’entre eux ont encore des difficultes a atteindre les objectifs fixes en termes d’intervention precoce et a mettre en place des mecanismes d’execution efficaces. Enfin, bien que les sommes effectivement investies par les Etats dans les programmes nationaux de Garantie jeunesse aient souvent depasse les depenses initialement prevues, les allocations de ressources se sont souvent averees insuffisantes par rapport aux recommandations.

Summary This paper examines the impact of the program Seguro de Capacitacion y Empleo (SCE) implemented to provide support in skills upgrading, job seeking, and job placement to eligible beneficiaries of the Argentinian conditional cash transfer program Plan Jefes. The SCE is an example of a growing trend observed in Latin America, where labor activation components have been increasingly included into cash transfers programs to support beneficiaries in finding more stable income opportunities. Despite this growing trend, not enough is known regarding the effectiveness of these components, especially on job quality. In this context, this paper sheds light on whether the provision of a comprehensive package of active labor market measures contributes to a successful labor market integration of cash transfers beneficiaries. Taking advantage of the panel structure of the Permanent Household Survey and exploiting the time variation in the assignment of the program as identification strategy, we apply difference-in-difference estimators to measure the impact on a number of labor market indicators. We find that the program affects positively the job quality of participants by increasing the probability of having a formal job and raising hourly wages. Moreover, the intervention is associated with a lower probability of having a low-paid job and working an excessive number of hours. These effects are, however, not homogeneous across all groups of participants. While the program is more successful among the younger beneficiaries, it does not contribute to an improvement in the labor market conditions of female beneficiaries, who in fact are the majority of SCE participants. Our results suggest that reducing dependency on monetary transfers through programs, such as the SCE, that are rich in activation components is beneficial for participants’ labor market trajectories and therefore, it constitutes a satisfactory exit strategy to more universal cash transfer programs.

This paper assesses the magnitude and nature of fiscal consolidation policies and their impact on employment. In particular, in an attempt to address fiscal imbalances in the near term, countries have been faced with the delicate challenge of doing so without damaging recovery prospects and thus, counter to their original aim, worsening further public finances. In this regard, the paper reviews recent austerity measures adopted by governments and discusses how prolonging fiscal consolidation measures in their current form could be counterproductive for guaranteeing debt sustainability. Moreover, the article shows how poorly designed fiscal cuts – directly or indirectly affecting labour – seem to have been dampening job prospects. The paper sheds light on how fiscal and employment goals can be achieved together. More specifically, it finds that a fiscally-neutral change in the expenditure and revenue composition of fiscal consolidation can boost job creation. In this sense, the paper shows that it ...

There is an increasing recognition in the policy debate of the importance of providing support to unemployed individuals through a combination of income support and active labour market policies. However, very little evidence exists on the effectiveness of this policy approach (and possible trade-offs) beyond developed economies. We provide one of the first evaluations of these schemes in the context of an emerging economy by looking at a public works programme implemented in Uruguay between 2005 and 2007 as part of a comprehensive cash transfer intervention that reached around 10 per cent of households in the country during a major recession. Exploiting specific eligibility criteria for participation in the cash transfer programme, we use rich administrative data of panel nature to study the effects of (i) participating in the public works programme (active component), (ii) receiving the cash transfer (income-support component) and, (iii) of benefiting of both the active and income-support programmes. We find that participation in the active programme has positive (albeit only marginally significant) effects on the employment probability, but non-significant effects on the quality of the job found. The positive employment effect does not generate displacement effects from participants to non-participants within the same household. However, the effect fades away when participants receive the cash transfer. Finally, the programme did not have any effect on measures of civic engagement and social integration.

espanolLa competitividad en Espana se deterioro drasticamente a lo largo de la ultima decada, motivada principalmente por una caida en la productividad laboral. No obstante, desde el comienzo de la actual crisis economica, han empezado a observarse ciertos signos de recuperacion en la productividad laboral que acompanados de las politicas correctas podrian desembocar en una mejora sostenible de la competitividad. El objetivo de este articulo es arrojar luz sobre los principales factores que explicaron el deterioro de la competitividad en Espana y describir los acontecimientos re-cientes que nos permiten pensar en una trayectoria diferente de la del crecimiento anterior a la crisis. Finalmente, el articulo presenta una serie de recomendaciones de politica que Espana deberia tener en cuenta para alcanzar una me-jora sostenible en la productividad laboral y, por lo tanto, lograr una transformacion estructural hacia un crecimiento economico mas equilibrado. EnglishCompetitiveness in Spain has deteriorated dramatically over the past decade driven mainly by a decrease in labour productivity. Since the onset of the current crisis, however, there were some signs of recovery in labour productivity, which accompanied by well design policies could lead to a sustainable improvement in competitiveness. The purpose of this paper is to shed light on the main factors that lead to the deterioration in Spain's competitiveness and describe some of the recent developments that lead us to believe that there are early signs of a departure from pre-crisis growth patterns. Finally, the paper discusses a number of policy shortcomings that Spain will need to address in order to attain a sustainable improvement in labour productivity and, therefore, make a structural transformation towards a more ba-lanced economic growth.

We present a systematic collection and assessment of impact evaluations of active labour market programmes (ALMP) in Latin America and the Caribbean (LAC). The paper delineates the strategy to compile a novel meta database and provides a narrative review of 51 studies. Based on these studies, the quantitative analysis extracts a sample of 296 impact estimates, and uses meta regression models to analyse systematic patterns in the data. In addition to analysing earnings and employment outcomes as in previous meta analyses, we also code and investigate measures of job quality, such as the effects on hours worked and formality. We find that ALMPs in LAC are particularly effective in increasing the probability of having a formal job, compared to other outcomes. Our results also show that training programmes are slightly more effective than other types of interventions. Moreover, when looking at the sample of training programmes alone, we observe that formal employment is also the outcome category that is most likely to be impacted positively by these programmes. In terms of targeting, we find that ALMPs in the region work better for women than for men, and for youth compared to prime-age workers. Finally, medium-run estimates are not more likely to be positive than short-run estimates, while programmes of short duration (4 months or less) are significantly less likely to produce positive effects compared to longer interventions.

Background and objectives Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed. Design, setting, participants, & measurements The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3–5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop >30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models. Results VC was present in 79% of patients and prominent in 47% (AS≥3 or KS>6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P 6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event–free period (HR, 1.14; 95% CI, 1.06 to 1.22; P Conclusions VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.

Youth continue to face important labour market challenges today, often significantly greater than their adult counterparts. While unemployment rates have fallen in recent years, long-term unemployment remains persistently high as does the share of youth neither in employment nor in education or training. This raises concerns about the consequences of a prolonged joblessness among youth and the role of labour market policies in addressing these challenges. In this context, this chapter presents first, an overview of global youth labour market trends since the economic crisis, focusing on the developments in Europe. Second, the chapter examines the consequences of the current situation in Europe along several dimensions, notably the risk of detachment from the labour market and concerns about job quality. Finally, this chapter discusses valuable lessons learned on the effectiveness of youth labour market policies, using the European Youth Guarantee as a framework for the analysis of more specific measures.

We present a systematic collection and assessment of impact evaluations of active labour market programmes (ALMP) in Latin America and the Caribbean (LAC). The paper delineates the strategy to compile a novel meta database and provides a narrative review of 51 studies. Based on these studies, the quantitative analysis extracts a sample of 296 impact estimates, and uses meta regression models to analyse systematic patterns in the data. In addition to analysing earnings and employment outcomes as in previous meta analyses, we also code and investigate measures of job quality, such as the effects on hours worked and formality.We find that ALMPs in LAC are particularly effective in increasing the probability of having a formal job, compared to other outcomes. Our results also show that training programmes are slightly more effective than other types of interventions. Moreover, when looking at the sample of training programmes alone, we observe that formal employment is also the outcome category that is most likely to be impacted positively by these programmes. In terms of targeting, we find that ALMPs in the region work better for women than for men, and for youth compared to prime-age workers. Finally, medium-run estimates are not more likely to be positive than short-run estimates, while programmes of short duration (4 months or less) are significantly less likely to produce positive effects compared to longer interventions.

espanolA partir de la afirmacion freudiana que dice que educar, psicoanalizar y gobernar son profesiones imposibles, este trabajo recorre los aportes de dos libros, Freud antipedagogo de Catherine Millot (1990) y ?Freud pedagogo? de Mireille Cifali (2003), con el proposito de examinar los desarrollos freudianos sobre las relaciones entre psicoanalisis y pedagogia. Planteado como una conversacion entre textos se tratara de situar la enunciacion propia de cada autora. EnglishOn the basis of Freudian statement that educating, psychoanalyzing and governing are im-possible professions, Freud antipedagogo by Cathe-rine Millot and?Freud pedagogo? by Mireille Cifali are traced back to explore Freudian ideas in this field. The dialogue between these two texts does not involve making them answer each other or ma-king their temporal appearance reveal an absolute truth.

This Chapter shows how an approach that balances macroeconomic and employment goals, while at the same time taking social impacts into account, is necessary to achieve a sustainable and inclusive recovery. Moving towards such an approach requires attention to be paid to a number of policy areas, including macroeconomic, labour market and social protection policies. In addition, this Chapter highlights a wide range of recent initiatives that have made an effort to achieve this kind of rebalancing.

Es un estudio de 25 anos (1990-2015) que toma como unidad de analisis al FREPASO y al Frente para la Victoria-kirchnerismo realizando una comparacion implicita entre ambos, asi como al interior del kirchnerismo entre las etapas de liderazgo de Nestor Kirchner y Cristina Fernandez de Kirchner, y cuenta con un trasfondo comparativo donde se observa al kirchnerismo en perspectiva comparada con los casos del Partido de los Trabajadores (PT) en Brasil y el Partido Socialista Unido de Venezuela (chavismo). Los tres casos comparten su posicionamiento contrario al neoliberalismo. El mismo titulo de la tesis encierra parte de los objetivos e hipotesis de este trabajo: ubicar al Frente para la Victoria-kirchnerismo como perteneciente al espacio politico de la centroizquierda, o izquierda reformista, en Argentina, al ocupar, en razon del desplazamiento ideologico-programatico que se produjo en el peronismo bajo el liderazgo de Nestor Kirchner, el lugar que dejo vacante el fracaso de la otra fuerza politica objeto de estudio en este trabajo: el FREPASO. De esta forma el FpV va mas alla del espacio clasico del “peronismo de izquierdas”, pues consigue rearticular una parte de militancia y voto que en su momento fue representada por el FREPASO, integrando izquierda peronista y no peronista. La dirigencia y militancia frepasista paso mayoritariamente a formar parte del espacio kirchnerista. El kirchnerismo se inscribiria en las corrientes de la denominada nueva izquierda en America Latina, que surgieron para dar respuesta a las consecuencias de las politicas neoliberales que se habian implementado en estos paises en la decada del noventa. Durante la etapa kirchnerista, el campo politico y social argentino se dividio en dos bloques antagonicos (en lo que puede observarse como la estrategia populista amigo/enemigo) . Dicha division resignifico el eje peronismo/anti-peronismo. El nuevo antagonismo se encontraria en el caracter ideologico de izquierda que adopto el kirchnerismo (peronista, populista y de izquierda). Es por ello que en el bloque anti-kirchnerista encontramos sectores del Partido Justicialista (PJ). El kirchnerismo paso a ser el punto de referencia para ubicarse en la politica argentina Para las tradiciones de izquierda que formaron parte del espacio kirchnerista la construccion de una fuerza autonoma a la estructura del PJ implicaba no estar cautivos a los desplazamientos programatico-ideologicos de este. En este punto distinguimos dos peronismos: uno ideologizado (de derecha y de izquierda) y otro pragmatico, centrista que se situa segun los desplazamientos programatico-ideologicos de quien ejerza la conduccion del partido y fundamentalmente ocupe los cargos ejecutivos en el Estado (nacional, provincial). En este sector del peronismo los incentivos selectivos (cargos en el estado, obra publica) juegan un rol central a la hora de ingresar, permanecer o abandonar la coalicion. .

AIM: To evaluate thresholds for serum 25(OH)D concentrations in relation to death, kidney progression and hospitalization in non-dialysis chronic kidney disease (CKD) population. METHODS: Four hundred and seventy non-dialysis 3-5 stage CKD patients participating in OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into 3 groups according to 25(OH)D levels at enrollment (less than 20 ng/mL, between 20 and 29 ng/mL, and at or above 30 ng/mL), considering 25(OH)D between 20 and 29 ng/mL as reference group. Association between 25(OH)D levels and death (primary outcome), and time to first hospitalization and renal progression (secondary outcomes) over a 3-year follow-up, were assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. To identify 25(OH)D levels at highest risk for outcomes, receiver operating characteristic (ROC) curves were performed. RESULTS: Over 29 ± 12 mo of follow-up, 46 (10%) patients dead, 156 (33%) showed kidney progression, and 126 (27%) were hospitalized. After multivariate adjustment, 25(OH)D < 20 ng/mL was an independent predictor of all-cause mortality (HR = 2.33; 95%CI: 1.10-4.91; P = 0.027) and kidney progression (HR = 2.46; 95%CI: 1.63-3.71; P < 0.001), whereas the group with 25(OH)D at or above 30 ng/mL did not have a different hazard for outcomes from the reference group. Hospitalization outcomes were predicted by 25(OH) levels (HR = 0.98; 95%CI: 0.96-1.00; P = 0.027) in the unadjusted Cox proportional hazards model, but not after multivariate adjusting. ROC curves identified 25(OH)D levels at highest risk for death, kidney progression, and hospitalization, at 17.4 ng/mL [area under the curve (AUC) = 0.60; 95%CI: 0.52-0.69; P = 0.027], 18.6 ng/mL (AUC = 0.65; 95%CI: 0.60-0.71; P < 0.001), and 19.0 ng/mL (AUC = 0.56; 95%CI: 0.50-0.62; P = 0.048), respectively. CONCLUSION: 25(OH)D < 20 ng/mL was an independent predictor of death and progression in patients with stage 3-5 CKD, with no additional benefits when patients reached the levels at or above 30 ng/mL suggested as optimal by CKD guidelines. Abbott and the Spanish Society of Nephrology

This chapter assesses the magnitude and nature of the fiscal consolidation challenge. Indeed, while fiscal unbalances need to be addressed in the near term, countries are facing the challenge of doing so without damaging further recovery prospects and in turn public finances. In this regard, the chapter examines the evolution of fiscal balances and the recent build-up of public debt. In addition, it provides an analysis of the sustainability of public debt, putting emphasis on the medium-term effects. Moreover, the chapter looks at the recent austerity measures governments are taking with a view to consolidating public finances, so as to illustrate the manner in which governments intend to raise revenue and how they attempt to reduce expenditures during 2012. Finally, the chapter assesses the important employment and social implications of poorly designed fiscal cuts to shed light on how fiscal and employment goals can be achieved together.

Dividends, investment and their link to employment creation. Financial policies and the link to productive investment and employment.

This paper examines the effectiveness of active labour market policies (ALMP) in improving labour market outcomes, especially of low-skilled individuals. The empirical analysis consists of an aggregate impact approach based on a pooled cross country and time-series database for 31 advanced countries during the period 1985–2010. A novelty of the paper is that the analysis includes aspects of the delivery system to see how the performance of ALMP is affected by different implementation characteristics. Among the notable results, the paper finds that ALMP matters at the aggregate level. Training, employment incentives, supported employment and direct job creation measures show the most favourable results, both, in terms of reduced unemployment, but also in terms of increased employment and participation. Interestingly, start-up incentives are more effective in reducing unemployment than other ALMP policies. Moreover, the positive effects seem to be particularly beneficial for the low-skilled. In terms of implementation, the paper finds that the most favourable aspect is the allocation of resources to programme administration. Finally, a disruption of policy continuity is associated with negative effects for all labour market variables analysed.

This article identifies the macro and microeconomic determinants of youth unemployment and inactivity rates. It finds that although the size of the youth cohort does have significant implications for the status of youth in the labour market, aggregate labour market conditions have a greater influence. The article also finds a large gap between the youth and the overall employment elasticities in the country. This implies that fostering economic growth and ensuring economic sustainability, important as these factors are, will not be sufficient to address youth challenges. Efforts will need to be focused on improving the youth employment content of growth. In this regard, results from the microeconometric analysis find that boosting tertiary school attendance and providing targeted vocational training to young people (particularly women) would be the most effective measures for improving youth employability in the country.

Background. Growing evidence indicates that vitamin D receptor activation may have antiproteinuric effects. We aimed to evaluate whether vitamin D supplementation with daily cholecalciferol could reduce albuminuria in proteinuric chronic kidney disease (CKD) patients. Methods. This 6-month prospective, controlled, intervention study enrolled 101 non-dialysis CKD patients with albuminuria. Patients with low 25(OH) vitamin D [25(OH)D] and high parathyroid hormone (PTH) levels (n = 50; 49%) received oral cholecalciferol (666 IU/day), whereas those without hyperparathyroidism (n = 51; 51%), independent of their vitamin D status, did not receive any cholecalciferol, and were considered as the control group. Results. Cholecalciferol administration led to a rise in mean 25(OH)D levels by 53.0 ± 41.6% (P < 0.001). Urinary albumin-to-creatinine ratio (uACR) decreased from (geometric mean with 95% confidence interval) 284 (189–425) to 167 mg/g (105–266) at 6 months (P < 0.001) in the cholecalciferol group, and there was no change in the control group. Reduction in a uACR was observed in the absence of significant changes in other factors, which could affect proteinuria, like weight, blood pressure (BP) levels or antihypertensive treatment. Six-month changes in 25(OH)D levels were significantly and inversely associated with that in the uACR (Pearson's R = −0.519; P = 0.036), after adjustment by age, sex, body mass index, BP, glomerular filtration rate and antiproteinuric treatment. The mean PTH decreased by −13.8 ± 20.3% (P = 0.039) only in treated patients, with a mild rise in phosphate and calcium–phosphate product [7.0 ± 14.7% (P = 0.002) and 7.2 ± 15.2% (P = 0.003), respectively]. Conclusions. In addition to improving hyperparathyroidism, vitamin D supplementation with daily cholecalciferol had a beneficial effect in decreasing albuminuria with potential effects on delaying the progression of CKD.

OSERCE is a multi-centre and cross-sectional study with the aim of analysing the biochemical, clinical, and management characteristics of bone mineral metabolism alterations and the level of compliance with K/DOQI guideline recommendations in patients with chronic kidney disease (CKD) not on dialysis. The study included a total of 634 patients from 32 different Spanish nephrology units, all with CKD, estimated glomerular filtration rates60 ml/min/1.73 m(2), and not on dialysis (K/DOQI stage: 33% stage 3, 46% stage 4, and 21% stage 5). In 409 of these patients, laboratory parameters were also measured in a centralised laboratory, including creatinine, calcium, phosphorous, intact parathyroid hormone (PTH), 25-OH-vitamin D, and 1,25-OH2-Vitamin D levels. The rates of non-compliance with the K/DOQI objectives for calcium, phosphorous, intact PTH, and calcium x phosphate product among these patients were 45%, 22%, 70%, and 4%, respectively. Of the 70% of patients with intact PTH levels outside of the target range established by the K/DOQI guidelines, 55.5% had values above the upper limit and 14.5% had values below the lower limit. Of the 45% of patients with calcium levels outside of the target range, 40% had values above the upper limit and 5% had values below the lower limit. Of the 22% of patients with phosphorous levels outside of the target range, 19% had values above the upper limit, and 3% had values below the lower limit. Finally, 4% of patients also had values for the calcium x phosphate product that were outside of the recommended range. Only 1.8% of patients complied with all four K/DOQI objectives. The values detected in centralised laboratory analyses were not significantly different from those measured in the laboratories at each institution. In addition, 81.5% of patients had a deficiency of calcidiol (25-OH-D3) (30 ng/ml); of these, 35% had moderate-severe deficiency (15 ng/ml) and 47% had mild deficiency (15-30 ng/ml). Calcitriol (1,25-OH2-D3) levels were deficient in 64.7% of patients. Whereas the calcidiol deficiency was not correlated with the CKD stage, calcitriol deficit were more pronounced at more advanced stages of CKD. The results of the OSERCE study confirm the difficulty in reaching the target values recommended by the K/DOQI guidelines in patients with CKD not on dialysis, in particular in the form of poor control of secondary hyperparathyroidism and vitamin D deficiency. With this in mind, we must review strategies for treating bone mineral metabolism alterations in these patients, and perhaps revise the target parameters set by current guidelines.