Beatriz González López-Valcárcel

Online Customer Reviews of Hotels As Participation Increases, Better Evaluation Is Obtained

Customer reviews posted on the web and through social media (electronic word of mouth [eWOM]) have grown in importance for tourism businesses, but most studies have examined the effects of the content of reviews, particularly negative reviews (i.e., their valence). This study considers both the valence and the volume of eWOM using a broad and varied sample of 16,680 hotels in 249 tourist areas. The study found a relationship between valence and volume, in the sense that early reviews of a business tend to be disproportionately negative. As the number of reviews increases, the valence becomes more balanced, and the negative effect is mitigated. Moreover, the study agrees with other findings that positive comments are more common than negative reviews. Whether or not hotels actively respond to negative reviews, one implication of this study is that hoteliers should try to increase the number of reviews they receive to balance the positive and negative representations of their property (in addition to investigating and correcting the causes of negative comments). Those promoting tourist destinations should follow a similar strategy of facilitating access to customer review sites to obtain a balance of negative and favorable ratings.

The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain

AbstractObjectives To estimate the impact of (particularly long-term) unemployment on the overall and mental health of the Spanish working-age population and to check whether the effects of unemployment on health have increased or been tempered as a consequence of the economic crisis. MethodsWe apply a matching technique to cross-sectional microdata from the Spanish Health Survey for the years 2006 and 2011–2012 to estimate the average treatment effect of unemployment on self-assessed health (SAH) in the last year, mental problems in the last year and on the mental health risk in the short term. We also use a differences-in-differences estimation method between the two periods to check if the impact of unemployment on health depends on the economic context.ResultsUnemployment has a significant negative impact on both SAH and mental health. This impact is particularly high for the long-term unemployed. With respect to the impact on mental health, negative effects significantly worsen with the economic crisis. For the full model, the changes in effects of long-term unemployment on mental problems and mental health risk are, respectively, 0.35 (CI 0.19–0.50) and 0.20 (CI 0.07–0.34).ConclusionsAnxiety and stress about the future associated with unemployment could have a large impact on individuals’ health. It may be necessary to prevent health deterioration in vulnerable groups such as the unemployed, and also to monitor specific health risks that arise in recessions, such as psychological problems.

Crisis económica y salud

Se considera que una economı́a entra en recesión técnica cuando ha experimentado por dos trimestres consecutivos un crecimiento negativo del producto interior bruto (PIB). Las crisis económicas, con frecuencia precedidas por crisis financieras, aumentan el desempleo y el empobrecimiento de las familias. Los economistas estudian con gran atención la dinámica de los ciclos económicos desde que Kondratiev definiera en la Unión Soviética de los años 1920 los ciclos largos de la economı́a. La teorı́a sobre los ciclos de los negocios y el papel de la innovación desarrollada por Schumpeter recogió el testigo de Kondratiev, y desde entonces es el estudio de los ciclos un tema recurrente en la disciplina, en particular durante las crisis económicas. Recientemente, en 2004, Kydland y Prescott recibieron el Nobel de Economı́a por su contribución a la dinámica de los ciclos y a la mejora del papel de la polı́tica económica para cambiar el curso natural de las recesiones. Siguiendo esa larga tradición, hoy se registran las crisis económicas de Estados Unidos igual que se registran los terremotos. Según el Fondo Monetario Internacional, desde 1970 hasta finales de 2008 se han producido en el mundo 447 crisis financieras nacionales (124 crisis bancarias, 208 de devaluación de la moneda, 63 de la deuda externa del paı́s, 42 dobles y 10 triples). Lo que diferencia la crisis actual de las anteriores es que afecta de lleno a Estados Unidos (motor económico del mundo), su alcance como crisis global y su intensidad, y el haberse contagiado entre paı́ses y a la economı́a real rápidamente. En nuestro paı́s, el Banco de España anunció en enero de 2009 que habı́amos entrado oficialmente en recesión dado que el cuarto trimestre de 2008 fue el segundo consecutivo de caı́da intertrimestral del PIB. En el momento de escribir estas lı́neas, también se hayan en recesión Alemania, Reino Unido, Italia, Irlanda, Finlandia, Suecia y Dinamarca. Importa saber cómo y cuánto influyen las crisis económicas sobre la salud de las poblaciones, y especialmente sobre ciertos grupos especı́ficos (niños, ancianos, etc.); qué tienen en común las crisis y si la que estamos viviendo es especial. A lo largo del texto se conceptualizan los mecanismos y efectos esperados de las crisis económicas sobre la salud, por una parte, y se revisan los análisis empı́ricos de algunas crisis del pasado y algunos datos de la actual.

Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme

BackgroundExcessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.MethodsGPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.ResultsA total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.ConclusionA multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

Forecasting the need for medical specialists in Spain: application of a system dynamics model

BackgroundSpain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities.MethodsWe created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method.ResultsIn the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology.ConclusionsThe model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America.

Is there much variation in variation? Revisiting statistics of small area variation in health services research

BackgroundThe importance of Small Area Variation Analysis for policy-making contrasts with the scarcity of work on the validity of the statistics used in these studies. Our study aims at 1) determining whether variation in utilization rates between health areas is higher than would be expected by chance, 2) estimating the statistical power of the variation statistics; and 3) evaluating the ability of different statistics to compare the variability among different procedures regardless of their rates.MethodsParametric bootstrap techniques were used to derive the empirical distribution for each statistic under the hypothesis of homogeneity across areas. Non-parametric procedures were used to analyze the empirical distribution for the observed statistics and compare the results in six situations (low/medium/high utilization rates and low/high variability). A small scale simulation study was conducted to assess the capacity of each statistic to discriminate between different scenarios with different degrees of variation.ResultsBootstrap techniques proved to be good at quantifying the difference between the null hypothesis and the variation observed in each situation, and to construct reliable tests and confidence intervals for each of the variation statistics analyzed. Although the good performance of Systematic Component of Variation (SCV), Empirical Bayes (EB) statistic shows better behaviour under the null hypothesis, it is able to detect variability if present, it is not influenced by the procedure rate and it is best able to discriminate between different degrees of heterogeneity.ConclusionThe EB statistics seems to be a good alternative to more conventional statistics used in small-area variation analysis in health service research because of its robustness.

Risk factors for potential drug interactions in general practice

Objective: To identify patient- and practice-related factors associated with potential drug interactions. Methods: A register analysis study in general practices in the county of Funen, Denmark. Prescription data were retrieved from a population-based prescription database (Odense University Pharmacoepidemiologic Database, OPED) covering prescriptions to all inhabitants in the county of Funen, Denmark. All individuals exposed to concurrent use of two or more drugs (polypharmacy) were identified. Combinations of drugs with potential interactions were registered and classified as major, moderate, or minor, depending on the severity of outcome and the quality of documentation. A two-level random coefficient logistic regression model was used to investigate factors related to potential drug interactions. Results: One-third of the population was exposed to polypharmacy, and 6% were exposed to potential drug interactions during 1 year. Patient factors associated with increased risk of potential drug interactions were high age, a high number of concurrently used drugs, and a high number of prescribers. Practice factors associated with potential drug interactions were a high percentage of elderly patients and a low percentage of female patients listed. Conclusion: Prescription data may be useful in quality-improvement programmes to identify groups of patients and practices at increased risk of drug interactions.

Economic and Cultural Impediments to University Education in Spain

Abstract An analysis by logit models shows that access to university education in Spain is significantly affected by family income. An even more determinant factor is the cultural and educational level of the family of the potential student. Scholarships cushion the impact of low incomes on education, but not the impact of the cultural and educational level of the family. [ JEL I21]

Asymmetric peer effects in the analysis of cigarette smoking among young people in the United States, 1992-1999.

We extend the recent literature on peer effects to test the possible role of asymmetric social influences in the determination of youth smoking. We analyzed cigarette smoking among people aged 15-24 in approximately 90,000 households in the 1992-1999 U.S. Current Population Surveys. The presence of additional smoking sibling in a household, we estimated, raised a young persons probability of smoking by 7.6%, while each non-smoking sibling lowered the probability by an estimated 3.5%. Moreover, the overall deterrent effect of an increase in cigarette price on the probability of smoking was approximately 60% greater than the estimated effect when peer influences were held constant. The concept of asymmetric social influence may have applications in other fields, including labor economics, education, crime prevention, and group dynamics.

Evaluation of Alternative Functional Designs in an Emergency Department by Means of Simulation

We evaluate the efficiency of different functional structures, reorganization patterns and alternative allocation of eventual new resources in a hospital emergency department. This department was simulated as a queue system in a process approach with SIMSCRIPT II.5. The data adjustment to statistical distributions of probability was made with UNIFIT II. The network containing the intermediate service circuit of the patients, from their arrival to their leaving, was modelled through nine interconnected queue systems. Actual operations as well as eight different alternative scenarios were simulated and compared. Changes in human resources, arrival rates and service times of auxiliary diagnostics equipment were simulated. We conclude that the medical classifying service should not be potentiated at the expense of the second level (general emergency doctors). Monitoring arrival times is also suggested. Collapses and saturation levels would occur if the arrival time were 12 patients per hour, being now almost 11 at some fixed times of the day. Expenditure in additional human resources would be more efficient socially than investment in auxiliary services equipment (Laboratory or X-Ray).