José Luis Navarro-Espigares

Normalization of widespread pressure pain hypersensitivity after total hip replacement in patients with hip osteoarthritis is associated with clinical and functional improvements

OBJECTIVE To evaluate the relevance of ongoing nociceptive joint inputs to the maintenance of widespread pain hypersensitivity in patients with hip osteoarthritis (OA) and to determine whether a reversal in the widespread pressure hypersensitivity together with an improvement in pain and function occurs after total hip replacement in these patients. METHODS Forty patients with hip OA participated. Twenty patients underwent total hip replacement, and the other 20 patients were assigned to a waiting list. Pressure-pain thresholds (PPTs) over the second metacarpal bone and the gluteus medius, vastus medialis, vastus lateralis, and tibialis anterior muscles were assessed bilaterally with a pressure algometer before and 3 months after total hip replacement surgery. Assessments of pain intensity (by visual analog scale [VAS]), physical function (by the Western Ontario and McMaster Universities Osteoarthritis Index), and health status (by the Short Form 12 health survey and the EuroQol 5-domain index) were also performed. RESULTS Patients who underwent total hip arthroplasty exhibited a reduction in widespread pressure pain hyperalgesia (increases in PPTs) over local and distant pain-free areas, as compared with before surgery and as compared with the patients assigned to the waiting list. PPTs were related to hip pain intensity, and significant correlations were found between higher VAS scores and lower average PPTs over all points assessed (-0.409 < r < -0.306, P < 0.05). Patients who underwent total hip arthroplasty exhibited a greater decrease in pain intensity and greater increases in function and health status than did those who were on the waiting list. Changes in the intensity of hip pain were moderately associated with changes in pressure pain sensitivity in the hip arthroplasty group. CONCLUSION Normalization of widespread pressure pain hyperalgesia was found after successful hip joint replacement in patients with hip OA. Altered pain processing seems to be driven by ongoing peripheral joint pathology, which stresses the importance of reducing pain in OA.

Diagnostic accuracy, effectiveness and cost for cognitive impairment and dementia screening of three short cognitive tests applicable to illiterates.

Background Illiteracy, a universal problem, limits the utilization of the most widely used short cognitive tests. Our objective was to assess and compare the effectiveness and cost for cognitive impairment (CI) and dementia (DEM) screening of three short cognitive tests applicable to illiterates. Methods Phase III diagnostic test evaluation study was performed during one year in four Primary Care centers, prospectively including individuals with suspicion of CI or DEM. All underwent the Eurotest, Memory Alteration Test (M@T), and Phototest, applied in a balanced manner. Clinical, functional, and cognitive studies were independently performed in a blinded fashion in a Cognitive Behavioral Neurology Unit, and the gold standard diagnosis was established by consensus of expert neurologists on the basis of these results. Effectiveness of tests was assessed as the proportion of correct diagnoses (diagnostic accuracy [DA]) and the kappa index of concordance (k) with respect to gold standard diagnoses. Costs were based on public prices at the time and hospital accounts. Results The study included 139 individuals: 47 with DEM, 36 with CI, and 56 without CI. No significant differences in effectiveness were found among the tests. For DEM screening: Eurotest (k = 0.71 [0.59–0.83], DA = 0.87 [0.80–0.92]), M@T (k = 0.72 [0.60–0.84], DA = 0.87 [0.80–0.92]), Phototest (k = 0.70 [0.57–0.82], DA = 0.86 [0.79–0.91]). For CI screening: Eurotest (k = 0.67 [0.55–0.79]; DA = 0.83 [0.76–0.89]), M@T (k = 0.52 [0.37–0.67]; DA = 0.80 [0.72–0.86]), Phototest (k = 0.59 [0.46–0.72]; DA = 0.79 [0.71–0.86]). There were no differences in the cost of DEM screening, but the cost of CI screening was significantly higher with M@T (330.7±177.1€, mean±sd) than with Eurotest (294.1±195.0€) or Phototest (296.0±196.5€). Application time was shorter with Phototest (2.8±0.8 min) than with Eurotest (7.1±1.8 min) or M@T (6.8±2.2 min). Conclusions Eurotest, M@T, and Phototest are equally effective. Eurotest and Phototest are both less expensive options but Phototest is the most efficient, requiring the shortest application time.

Efficiency and quality in health services: a crucial link

The relationship between quality and efficiency in the health sector is influenced by various conditions. The objective of this paper is to analyse the evolution of efficiency and quality in the Andalusian Hospitals during the years 1997–2004 and to study the association between efficiency and quality indicators. Hospital performance is analysed using data envelopment analysis and the Malmquist productivity index. Technical efficiency as well as healthcare quality increased during the analysed period. A weak association between efficiency and quality indicators exists. The results obtained rule out the existence of an efficiency–quality trade-off.

The role of the service sector in regional economic resilience

The ability of regional economies to adjust their temporal dynamics to changing circumstances is a phenomenon recently included within the concept of resilience. This paper attempts to verify whether the relative weight of the service sector in the production structure of Spanish regions has a decisive influence on their reaction to the economic crisis. To test the hypothesis about the influence of the service sector in Spanish regional economic resilience, we use a time series of gross value added and employment for the 17 Spanish regions during the period 1986–2009. Besides the descriptive analysis, we utilise Time Series Regression with ARIMA Noise, Missing Observations and Outliers to forecast the evolution of series in 2010.

Public--private partnership and regional productivity in the UK

In this paper, the authors are particularly interested in revealing the relationship between public–private partnership (PPP) investments and regional productivity. The main data sources are the database provided by the UK Her Majestys Treasury on private finance initiative projects and the regional economic performance indicators published by the Department for Business Enterprise & Regulatory Reform. Regarding the regional distribution of projects, we are interested in determining whether this distribution is stable regardless of the authority promoting the projects. In addition, we utilise an econometric panel data model to evaluate the statistical association between PPP investment and regional productivity.

Body Mass Index as Predictor of Health-Related Quality-of-Life Changes After Total Hip Arthroplasty: A Cross-Over Study

The objective of this study was to examine the contribution of patient weight and other preoperative variables to improvements in the general physical health of patients undergoing total hip arthroplasty (THA). Data were prospectively collected on 63 THA patients (28 males and 35 females). The primary outcome measure was the improvement in general health (Short Form-12 Health Survey questionnaire) at three months post-THA. Patients with body mass index >28kg/m(2) showed greater improvements in function and in the physical component of general health after THA. Stepwise regression analyses revealed that the BMI and WOMAC general index were independent and significant predictors of physical function and together explained 34.2% of the variance in physical function scores. These findings suggest that the body mass index before surgery and improvements in hip function are relevant contributors to post-THA improvements in general health.

Ageing-related services as a key element for social cohesion

The aim of this article is to carry out an empirical analysis of certain factors related to dependence in Spain and additionally to study the intensity of the use of health resources by dependents. Age appears to be the main socio-demographic factor related to dependence, which confirms the need for measures to deal with the demographic changes taking place. Thus, providing services to cover long-term care could become an important instrument for social cohesion. Multivariate analysis does not reveal a strong link between the use of healthcare services and dependence that would justify the joint management of the two systems. This means that self-regulating management of dependence and healthcare systems may be adequate except in the case of severe dependency.

Sustainable development as an opportunity for innovation in the management model of public organisations

The literature recognises the great influence that environmental spending exerts on implementing LA21. But some authors raise doubts about the firm commitment of local government. Thus the main objective of this paper is to verify the authenticity of political commitment towards meeting the objectives of sustainable development by means of the budgetary support to these policies. To accomplish this verification, we apply the Difference in Differences technique for the period 2002-2012 in the Spanish municipalities. Results obtained confirmed the initial hypothesis and show that local governments that adhered to LA21 increased their environmental expenses to a greater degree.