José Adelantado

Cushing's disease and pregnancy: Report of six cases

We describe six pregnancies in five patients with Cushings disease --four had undergone transsphenoidal surgery, with improvement but no cure of their hypercortisolism; the other woman became pregnant during initial work up. At conception, none of the patients were receiving specific treatment for hypercortisolism. Mean free urinary cortisol (FUC) prior to pregnancy was 430 nmol/24 h (normal range: 51-280). In two patients, FUC throughout pregnancy increased significantly, but no clinical progression was observed. FUC measured in 20 healthy pregnant women was found to rise above the normal non-pregnant range ( < 280 nmol/24 h) in the second (mean +/- 2 S.D. = 463 +/- 256 nmol/24 h; P < 0.01) and third trimester (424 +/- 210 nmol/24 h; P < 0.05). However, in the Cushing patients values were higher. Two pregnancies ended in spontaneous abortions, one resulted in an ectopic pregnancy, and the remaining three were followed to term of which one developed third trimester gestational diabetes, and her baby developed neonatal sepsis which resolved uneventfully. We conclude that despite high abortion and ectopic pregnancy rates, a remarkably uneventful and uncomplicated outcome with no clinical progression of cushingoid symptoms, was observed in two of the three pregnancies followed to term, despite significant increases in FUC.

Globalization and the welfare state: the same strategies for similar problems?

This paper analyses the recent evolution of public expenditure, social protection expenditure, income inequality and the risk of poverty in the European Union. It argues that some of the pressures derived from globalization have been translated into a relative reduction on the efforts devoted to public expenditure and social protection expenditure compared to growth in the GDP, resulting in a negative impact both on income distribution in the low-income population, and on the risk of poverty. Our hypothesis is that this relative reduction in spending in welfare states has come about through a general dynamic of convergence, albeit with ‘deviant’ cases. The countries that used to allocate the most resources to public expenditure and social protection expenditure are those that have cut back the most, and where income inequality and the risk of poverty have increased the most. Conversely, the countries that used to allocate the fewest resources are those that have increased expenditure and where income inequality and the risk of poverty have fallen the most.

Globalización y estados del bienestar: ¿respuestas semejantes a problemas parecidos?

This paper analyses the evolution of magnitudes like public expenditure, social protection expenditure, income inequalities and poverty risks in the European Union. The article shows that these magnitudes have shown a tendency towards convergence. The article also analyses the evolution of social transfers showing that in the recent past there has been a reduction of monetary transfers different from pensions and their relationship with the persistence of poverty risks.

La dimensión simbólica, sustantiva y operativa en las políticas autonómicas de servicios sociales en España (1982-2008)

Este articulo analiza la evolucion de las politicas autonomicas de servicios sociales en Espana entre 1982 y 2008 en su dimensiones simbolica (?en que direccion han cambiado los valores y objetivos?), sustantiva (?que necesidades se cubren y con que intensidad?) y operativa (?como se proveen, organizan y gestionan los servicios?). La elevada homogeneidad discursiva existente en la definicion normativa de esta politica se sustenta a traves de procesos de difusion y, en la dimension sustantiva, por la tendencia expansiva del sector privado (con y sin animo de lucro) en la prestacion de servicios, y por la involucracion de los beneficiarios en la definicion de su plan individual de contrapartidas y en la financiacion (copago). En cambio, las disparidades afectan mas a las opciones sustantivas, pues, debido a la inexistencia de un minimo comun obligatorio para todas las comunidades autonomas, ni el nivel de gasto ni las tasas de intensidad o cobertura parecen responder a criterios objetivos de necesidades