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Ospain

Category: Arthritis

Description

Etodolac is used for the treatment of inflammation and pain caused by osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis.

Active Ingredient:

Etodolac (Ospain) as known as: Acudor, Articulan, Dolchis, Dualgan, Eccoxolac, Elderin, Eric, Etodin, Etodolaco, Etodolacum, Etogesic, Etolac, Etopan, Etopen, Flancox, Hisrack, Hypen, Jenac, Lacoxa, Lodine, Lonine, Niconas, Ospain, Osteluc, Paipelac, Raipeck, Sodolac, Tadolak, Todo, Todolac

Ospain diseases

Disease outbreak news
9 October 2014

On 6 October 2014, the World Health Organization (WHO) was informed of the first confirmed autochthonous case of Ebola virus disease (EVD) in Spain. This case represents the first human-to-human transmission of EVD outside Africa.

The case is a female healthcare worker with no travel history to West Africa but who participated in the medical care of an EVD case in a Spanish citizen, who had been infected in Sierra Leone and evacuated to Madrid, Spain on 22 September 2014 and who died on 25 September 2014. She was in contact with the repatriated EVD case twice; on 24 and 25 September 2014. On both occasions she is reported to have worn appropriate personal protection equipment (PPE).

Following the Spanish national protocol for EVD cases, the healthcare worker was considered a low risk contact and monitored accordingly. The female case developed a fever on 29 September 2014 and was admitted into isolation on 6 October 2014 at Alcorcon Hospital in Madrid. The case was then transferred to La Paz-Carlos III Hospital in Madrid and is being treated under isolation.

Samples were collected and sent for testing to the National Reference Laboratory on 6 October 2014. Results were positive for Ebola virus on the same day.

The Spanish public health authorities are conducting an investigation to elucidate the mode of transmission. Identification of close contacts for daily monitoring for 21 days after exposure is underway for the recent case and is continuing for contacts of the Spanish citizen who was treated in Spain.

WHO does not recommend any travel or trade restrictions to be applied by countries except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. Contacts do not include properly-protected health-care workers and laboratory staff.

Temporary recommendations from the Emergency Committee with regard to actions to be taken by countries can be found at:

Other articles

Ospain diseases

EULAR aims to be a central platform to facilitate and stimulate innovative basic and clinical research projects in rheumatic and musculoskeletal diseases.

EULAR aims to be a pre-eminent provider and facilitator of high-quality education offerings for physicians, health professionals in rheumatology, and people with rheumatic and musculoskeletal diseases.

EULAR aims to raise standards of care by elaborating and actively promoting, disseminating and implementing EULAR recommendations and criteria for the most common rheumatic and musculoskeletal diseases.

EULAR aims to have a significant influence on EU level, and assist actions on national level, towards improving research funding, social policy legislation and quality of care.

EULAR aims to raise its profile and visibility to people with rheumatic and musculoskeletal diseases and health care providers.

EULAR aims to have actively engaged all national societies as well as related organisations in key EULAR activities.

EULAR News EULAR On-line Courses EULAR Calendar EULAR Tweets

Conference Alerts - Country Listing

Ei Compendex & Scopus - 2016 7thInternational Conference on Environmental Science and Technology (ICEST 2016)
10th June 2016
Barcelona, Spain
ICEST 2016 will be published into International Proceedings of Chemical, Biological and Environmental Engineering (IPCBEE, ISSN: 2010-4618), which is indexed by EI Geobase(Elsevier), Chemical Abstracts Services, CABI, CNKI, WorldCat, Google Scholar.

ICBBT 2016 8th International Conference on Bioinformatics and Biomedical Technology - Embase, HINARI
10th June 2016
Barcelona, Spain
1?Conference chair: Prof. Bogdan Zygmunt, Gdansk Univ. of Technology, Poland 2?Publication: International Journal of Pharma Medicine and Biological Sciences (IJPMBS, ISSN: 2278-5221), which will be indexed by Embase, CAS, ICMJE, HINARI and NYU

2016 5th International Conference on Petroleum Industry and Energy (ICPIE 2016)--Ei Compendex and Scopus
10th June 2016
Barcelona, Spain
1.Publication: IJIII, ISSN: 2301-3745 // IJSGCE, ISSN: 2315-4462 2.Indexed: EI(INSPEC, IET) 3.Keynote speakers: Prof. Bogdan Zygmunt (Faculty of Chemistry, Gdansk University of Technology, Poland)

The Creativity Workshop in Barcelona - June 20 - 24, 2016
20th June 2016
Barcelona, United States of America
Discover How Creative You Really Are! For Professional Development. All disciplines including education, arts, business, creative writing, design, psychology, innovation, advertising, theatre, leadership, marketing. ExperientialConference Workshop.

IISES 3rd Teaching and Education Conference
28th June 2016
Barcelona, Spain
The International Institute of Social and Economic Sciences invites you to participate in the 3rd Teaching & Education Conference to be held in June 28 – July 1, 2016 in Barcelona, Spain, at Hotel H10 Casanova.

IISES 24th International Academic Conference
28th June 2016
Barcelona, Spain
The International Institute of Social and Economic Sciences invites you to participate in the 24th International Academic Conference to be held in June 28 – July 1, 2016 in Barcelona, Spain, at Hotel H10 Casanova.

The 3rd IEEE International Conference on Energy and Environment Research (ICEER 2016)--EI Compendex
9th September 2016
Barcelona, Spain
ICEER 2016 will be published by IEEE Conference Publication, which would be indexed by IEEE Xplore and EI Compendex. Speakers: Prof.Ziaul Huque, Prairie View A&M University, USA Prof. Carlos Felgueiras, CIETI/ISEP, Portugal

(IEEE Xplore, Ei) 2016 International Conference on Power and Energy Engineering (PEENG 2016)
9th September 2016
Barcelona, Spain
PEENG 2016 will be reviewed by the IEEE Conference Publication Program for IEEE Xplore and EiCompendex. Speakers Prof. Carlos Felgueiras, CIETI/ISEP, Portugal Prof.Nidia Caetano, School of Engineering (ISEP), Polytechnic of Porto (IPP), Portugal

Conferences in Spain

Listing 103 events (go back)

Multidrug-resistant (MDR) Aeromonas recovered from the metropolitan area of Valencia (Spain): diseases spectrum and prevalence in the environment

European Journal of Clinical Microbiology & Infectious Diseases 2015-01-01

Multidrug-resistant (MDR) Aeromonas recovered from the metropolitan area of Valencia (Spain): diseases spectrum and prevalence in the environment.

C Esteve, E Alcaide, M J Giménez

Abstract

Aeromonas infections are rare in Europe and often related to traveller's diarrhoea. A total of 185 Aeromonas isolates from river water, fish and clinical sources, recovered during a 1-year period, were used to investigate the disease spectrum and impact of multidrug-resistant (MDR) strains. They were all identified by biochemical tests and 25% of them were also identified by sequencing of the 16S rRNA gene. The minimum inhibitory concentrations (MICs) of 21 antimicrobials were determined for all isolates by broth microdilution/E-strips methods, and susceptibility was assessed according to the Clinical and Laboratory Standards Institute (CLSI). Strains pathogenicity was determined by using Swiss Webster mice as the animal model. Aeromonas diseases had an incidence of around 20 cases/million inhabitants in the metropolitan area of Valencia (Spain). Acute gastroenteritis in children with no history of travel abroad was the main pathology. These cases were related to A. caviae, A. veronii biovar sobria, A. hydrophila and A. dhakensis. A significant incidence of A. caviae in humans was found, while the other species were equally present in clinical and environmental origins. A. jandaei, A. bestiarum and A. media had mainly an environmental distribution. The prevalence of MDR Aeromonas was maximal in clinical samples, and resistance phenotypes were significantly related to this source. 7.2% of environmental Aeromonas was resistant to at least five drugs; most of them were moderately virulent for mice and, in addition, belonged to clinically significant species. The present study demonstrates a diseases spectrum similar to that reported in tropical countries, and also that pathogenic and heavily MDR Aeromonas are present in environmental reservoirs. MDR Aeromonas from any source analysed were susceptible to aztreonam, netilmicin, cefotaxime, ceftazidime, cefepime and fluoroquinolones.

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  • Intermedical Solutions

    Healthcare System in Spain

    The World Health Organization (WHO) has ranked the Spanish healthcare system as the 7th best in the world. Also, the same report informed that the Spanish people are ranked second, in regard to being satisfied with the quality of healthcare they receive.

    Spain has more than 750 hospitals serviced by 450,000 doctors and nurses offering 2.4 million surgeries per year. All of the hospitals in Spain are recognized and supervised by the Spanish Ministry of Health .

    The Spanish health industry holds an excellent reputation of the essential post operative care after any kind of surgery.

    Spanish physicians are trained for at least 6 to 7 years before they are qualified and receive their degrees. Specializations, such as those required for surgeons, require additional years of study and training before the doctors are certified as licensed.

    All of our hospital partners have English-speaking doctors and medical staff, who have undergone rigorous medical schooling and in-house training in institutions that are recognized in the European Union.

    One of the reasons why Spain has become a highly reputable medical community in Europe is due to its lower cost of living, yet the standard of living is much higher. Also, Spain offers a wide range of medical treatments equivalent to the best of the world. Also, Spain has an excellent network of hospitals.

    The Spanish medical system offers all medical specialties:

    • Orthopedic surgery
    • Cosmetic surgery
    • Eyesight surgery
    • Obesity surgery
    • Elective surgery
    • Dentistry
    Costs, Travel and Recovery

    Prices for medical treatment in Spain vary depending on the surgery or the corresponding treatment. However, patients can easily obtain up to 60% savings. Also, Spain’s healthcare system is ranked 1st in the European Union and offers prices at least 15% lower than the rest of the Union Members

    In Spain, we not only cure diseases, but also place special attention to full health rejuvenation. In this respect, Spain has made a name for itself through the numerous health clinics and resorts. Many of our hospitals are located in some of the most exotic areas of Spain providing a relaxed recovery after surgery.

    Another important factor to keep in mind is the fact that the Spanish are among the world’s healthiest people. They have the highest average life expectancy in the EU – 80 for women and 74 for men. Also, the Spain registers the lowest occurrences of heart diseases in the world. This is due to the Spanish Mediterranean Diet. Spain is one of the best places in the world for optimum patient recovery.

    Overview

    Spain, the 2nd most visited country in the world, is located in South Western Europe on the Iberian Peninsular sharing borders with Portugal, Gibraltar, Morocco, France, and Principality of Andorra. The Canary Islands in the Atlantic Ocean and Balearic Islands in the Mediterranean Sea also form part of Spain.

    Spain has one of the mildest climates in Europe with summer remaining mostly dry, sunny and hot with temperatures varying from 17C to 37C. Winters are usually windy, rainy and cool with temperatures between 2C and 18C.

    Spain has a very family orientated culture and the people are generally communicative. Compared to other countries, Spanish wages are generally lower but the cost of living is also less and therefore the general lifestyle also better. Spanish is the main language, although other regional languages are also prevalent. Many people in Spain speak English, predominantly on the coast and in hotels.

    One of the best things about Spain is the country’s food and wines. Provinces known for wine are ‘Rioja’ and surrounding areas; and almost all of Spain is famous for excellent fish and meat dishes. In addition, nightlife in Spain is vibrant and usually extends till dawn. Discos, music bars, night clubs, dinner / dancing venues and clubs can be found in the urban and semi-urban parts of the country.

    The Basque Country

    The Basque Country is located in the most eastern part of the Gulf of Biscay, the Basque Country has a surface of 7,234 km² and a population exceeding 2 million people, with a density of nearly 300 inhabitants per km². Vitoria-Gasteiz is the capital and it has two official languages: Basque and Spanish.

    With a per capita GDP of 125.6 (2005) only two countries of the European Union -Luxembourg and Ireland- have a per capita GDP superior to the Basque Country. Besides, the aforementioned economic development affects the employment positively, which shows downward trend since 1999 and was established in 4.1% in 2006, the lowest level in the last decade and within the average parameter in the European Union.

    Cultural experience

    You will be able to enjoy a few unforgettable and relaxing days, with top quality tourist facilities, an excellent climate, wonderful beaches and landscapes, history, culture, gastronomy and “fiesta!”.


    Spain International Therapist Directory

    Spain

    A listing of therapists, counselors, psychologists, and psychiatrists in Spain interested in providing culturally sensitive cross-cultural care for today’s international expat community.

    Peter Zelaskowski, UKCP registered psychotherapist
    Location: Barcelona, Spain
    Phone: (0034) 628 915 040
    Email: peterzelaskowski@gmail.com
    Website: www.groupworks.info
    Nationality: British
    Languages Spoken: English / Spanish
    Religious Affiliation: I am not religious (after a Catholic childhood) but I always seek to value and understand the part played by faith, no matter what religion, in forming people’s identity.
    Clinical Specialties: I am a group analytic and psychodynamic psychotherapist with over 20 years experience. I was trained in London University and Barts Hospital in the City of London. My approach sees relationships as the heart and soul of human experience and generally as the thing that needs attending to in therapy. My work is fundamentally centered, whether you work with me individually or in a group, on opening up communication in the many and varied relationships that go to make up our lives. I will engage you in an open, honest, self-reflective and supportive therapeutic relationship geared towards helping you feel more active, assertive and present in your world.
    Cross-Cultural Experience: In Barcelona I have worked with people from over 35 different nationalities. Additionally, as a lecturer in the field of the creative arts therapies in Barcelona I have worked with hundreds of students from all over the world. My background is culturally and linguistically mixed, something I truly value in myself and which I believe helps me in my work.

    Vickie Andrews, MS, Master in Clinical and Health Psychology
    Location: Madrid, Spain
    Phone: +34 91 700 1979
    Email: vandrews@sinews.es
    Website: www.sinews.es
    Nationality:
    Languages Spoken: English and Spanish
    Religious Affiliation:
    Clinical Specialties: Vickie Andrews has international training and experience in clinical psychology using a cognitive-behavioral focus in individual, group and couple’s therapy. Her clinical experience covers a wide variety of pathologies, from eating disorders to anxiety and mood disorders. Her main areas of interest include the difficulties of cultural adaptation, couple’s therapy and help with relationships or intimacy issues, psychological problems facing women, and working with young adults at the university age. At present, she combines her private practice at Sinews with her job as a therapist to the student body at Saint Louis University.
    Cross-Cultural Experience:

    Lidia Budziszewska, Psychologist
    Location: Madrid, Spain
    Phone: +34 91 700 1979
    Email: lidiab@sinews.es
    Website: www.sinews.es
    Nationality: Polish
    Languages Spoken: English, Polish and Spanish
    Religious Affiliation:
    Clinical Specialties: During her specialization in clinical psychology, she became interested in addictions (chemical and non-chemical), and carried out an intership in a treatment center. Subsequently she expanded her training with a Masters Degree from the Complutense University of Madrid in “Women and Health” where she studied the complexity of relationships, female sexuality and the difficulties inherent in the various stages of a woman’s life (psychological effects of fertility treatments, menopause, empty nest syndrome, etc.). She is studying another Masters degree in “contextual therapy” in the ACT Institute of Madrid. She currently combines her private practice in Sinews with her work as a psychologist in an association that provides support to immigrants.
    Cross-Cultural Experience:

    Itxaso Cembrero, MS, Master in Health and Clinical Psychology
    Location: Madrid, Spain
    Phone: +34 91 700 19 79
    Email: icembrero@sinews.es
    Website: www.sinews.es
    Nationality: Spanish
    Languages Spoken: English, Spanish
    Religious Affiliation:
    Clinical Specialties: As a therapist, Itxaso always knew that she wanted to work with children and adolescents. After a two year internship during her Master in Clinical Psychology from the Universidad Pontifica de Madrid and despite her young age, she was selected amongst her classmates to become part of the professional team at the Unidad de Intervención Psicosocial (UNINPSI). She completed her clinical training with two years of experience assisting patients with Eating Disorders in the Sanatorio Dr. Esquerdo, in Madrid. Itxaso has experience and training in areas ranging from enuresis (difficulty controlling urine), childhood anxiety, or the evaluation and diagnosis of Attention Deficit Hyperactivity Disorder, in English as well as in Spanish.
    Cross-Cultural Experience: Throughout her childhood, Itxaso has experienced several international moves (Germany, Switzerland, and France). She knows first-hand what it is like to adapt to a new culture, international school (British School of Paris, International School of Zug…) new friends, and the academic and personal efforts that both children and parents have to make.

    Lisa de Clar, Specialized in Couples therapy, qualified Integrative psychotherapist
    Location: Madrid, Spain
    Phone: 0034 626 435 242
    Email: lisasdc@yahoo.com
    Website: www.lisasdc.wix.com/psychotherapy
    Nationality: Irish
    Languages Spoken: English, Italian
    Religious Affiliation:
    Clinical Specialties: Couples therapy using a short term practical approach, helping couples change negative dynamics, and learn new ways of communicating and re-connecting. In individual therapy I bring an integrative set of tools, allowing the needs of the client to guide the approach.
    Cross-Cultural Experience: I began my psychotherapy practice in Dublin, later living and working in Italy for 10 years. I am currently practicing as a Therapist in Madrid.

    Rocío Fernández Cosme, MS, Master in Family and Couples Therapy and a Specialist in Clinical and Psychanalytic Psychotherapy
    Location: Madrid, Spain
    Phone: +34 91 700 19 79
    Email: rfernandez@sinews.es
    Website: www.sinews.es
    Nationality: Spanish
    Languages Spoken: English, Spanish
    Religious Affiliation:
    Clinical Specialties: Rocio’s professional experince began in the Dominican Republic where she worked at the Rober Reid Cabral children’s hospital. There, she worked with children under 5 years of age and focused on the diagnosis and use of game therapy as an instrument to improve the quality of attachment that occurs between children and their parents. In Spain she worked during her internship for her Master in two Mental Health Centers with families to improve communication and manage clinical problems. Later, she worked in a private center in Madrid helping little ones through group therapy to identify, understand, and manage their feelings and to train their social skills through group games. Her areas of special interest are problems in bonding, family therapy, and autism. Her previous experience as a teacher of English as a foreign language adds a special sense of understanding in regards to the educational needs of bilingual children.
    Cross-Cultural Experience:

    Gabriel Fibla, MS, Psychologist
    Location: Madrid, Spain
    Phone: +34 91 700 1979
    Email: gfibla@sinews.es
    Website: www.sinews.es
    Nationality:
    Languages Spoken: English, Hebrew and Spanish
    Religious Affiliation:
    Clinical Specialties: Adult, adolescent and couples therapist specializing in cognitive-behavioral therapy. Gabriel has extensive experience covering a wide range of pathologies, including anxiety disorders (phobias, generalized anxiety, panic attacks…), mood disorders (depression, grief…), couples therapy and conflicts associated with adolescence.
    Cross-Cultural Experience: After completing 14 years of bilingual schooling at the Lycée Français de Madrid, Gabriel studied English Literature in Israel where he lived for six years. Once he finished his first degree there, he began his studies in psychology completing his degree at the Universidad Autonoma de Madrid. He then continued his training by doing two Masters degrees aimed at developing his psychotherapeutic techniques and acquiring knowledge in the field of legal psychology. Since then, his professional career has focused on private practice. His experience of living abroad, together with his bicultural marriage and his bilingual family make him particularly sensitive to the problems encountered by those persons not living in their country of origin or those that form part of a mixed couple.

    Nereida Gómez, MS, Master in Clinical, Legal and Forensic Psychology, Graphologist
    Location: Madrid, Spain
    Phone: + 34 659 50 26 88
    Email: n.gomez@iridio-sl.com
    Website:
    Nationality: Spanish
    Languages Spoken: English and Spanish
    Religious Affiliation:
    Clinical Specialties: Cognitive-Behavioral Psychotherapy, Humanistic Therapy, Hypnotherapy, and Graphotherapy for adults, adolescents and couples. I cover a wide range of pathologies, including mood disorders, anxiety, depression, addictions, self-esteem, phobias, obssessive-compulsive disorders, relationships, marriage and family counceling, etcetera.
    Cross-Cultural Experience: My name is Nereida Gómez. I studied at the American School of Madrid for 12 years and at the American School of Paris during one year. After graduating in 1990, I went to the U.K. where I lived for seven years and studied first a degree in Psychology of Human Communications and later completed the degree in Psychology. Back in Madrid, I decided to continue studying a Master in Clinical, Legal and Forensic Psychology and a course in Rational and Psychographologic Graphology. I also learned hypnosis techniques aimed at therapy. Having lived in different countries, always surrounded by people belonging to different cultures, I fully understand the struggles “moving” people may encounter concerning adaptation and sense of belonging, as well as the emotional stress behind it. As a private therapist, my approach is always focused on positive cognition and complete empathy and support toward my patients.

    Dr. Isobel Horn, Clinical Psychologist, M.A. Oxon, D.Clin.Psych. C. Psychol.
    Location: Madrid, Spain
    Phone: +34 646 857 484
    Email: info@isobelhorn.com
    Website: www.isobelhorn.com
    Nationality: British
    Languages Spoken: English, Spanish
    Religious Affiliation: All-inclusive
    Clinical Specialties: Cognitive behaviour therapy (CBT) and Enhanced Approaches; Specialist Eating Disorders; Depression, Anxiety and Panic symptoms; Relationship problems; Work stress; Life transitions. Isobel is a Clinical Psychologist with 16 years’ experience in general Adult Mental Health and highly specialist experience and training in Eating Disorders. She has assessed and treated more than 500 clients with depression and anxiety and over 250 clients with eating disorders/problems. From the outset, Isobel will work directly on the symptoms or life situation you want to target and change. Within a couple of sessions she will clarify other important aspects so you can achieve lasting improvement. These could include: Improving low self-esteem, Addressing isolation, Working with perfectionism, Standing up to your inner-critic, Expressing anger safely, Increasing your tolerance of negative emotions and Empowering yourself in relationships. Isobel works carefully with your barriers to change. An early task in therapy is to understand what is going on at a subtle level which is maintaining the problem. Once we know that, we know exactly the work we need to do.
    Cross-Cultural Experience: Isobel’s education, training and places she has lived have resulted in a unique approach to working with people. She studied psychology at Oxford University and at the Institute of Psychiatry, Kings College, London. She has lived in five different countries and has worked with people from diverse national, cultural and religious backgrounds.

    Christopher Neill Bsc psychology (member of the British psychological asoc No.272885) Master in Cognitive Behavioural Therapy.
    Location: Madrid, Spain
    Phone: 0034 600636785
    Email: chrisneill@counsellingtherapistmadrid.com
    Website: www.counsellingtherapistmadrid.com
    Nationality: British
    Languages Spoken: English, Spanish
    Religious Affiliation:
    Clinical Specialties:
    Cross-Cultural Experience: My name is Chris Neill and have a BSc in Psychology and am a member of the British Psychological Society. I am British, but have lived in Madrid Spain for over 18 years where I work as a Psychologist in substance abuse and addiction services within the Public Health Network and in Prisons. I have a full understanding of Spanish culture and can help you and your family adjust to a new life in Spain. Other things I can help with include: Substance Abuse and Addiction, Anxiety, Self Esteem, Depression, Obsessive Compulsive Disorders, Phobias, Relationship difficulties

    Orlanda Varela González, M.D. Ph.D. Psychiatrist
    Location: Madrid, Spain
    Phone: +34 91 700 1979
    Email: ovarela@sinews.es
    Website: www.sinews.es
    Nationality: Spain
    Languages Spoken: English and Spanish
    Religious Affiliation:
    Clinical Specialties: Adult, child and adolescent psychiatry. Dr. Orlanda Varela practices general psychiatry and has training in a wide range of psychiatric and behavioral disorders. She has experience treating adults, adolescents and children. Her areas of expertise range from alcohol-related problems (Certificate of specialization from the Autonoma University of Madrid) to Anxiety and Mood disorders (Certificate from the Universities of Maastricht, Tel Aviv, Bristol and Florence), as well as Dementia (degree from the University of Amsterdam), Epilepsy and Attention Deficit and Hyperactivity Disorder in children. The focus of her professional experience has been private practice. However, she also works as a Consultant Psychiatrist to Saint Louis University Madrid Campus and to the prison system where her primary responsibilities include the evaluation and prevention of suicide risk. Dr. Varela also collaborates professionally with the Ministry of Justice as a psychiatric expert.
    Cross-Cultural Experience:

    Drs Suzy Quix MSc. Licensed Psychotherapist & Certified Couples and Family Therapist
    Location: Marbella, Spain
    Phone: +34 646051435
    Email: reencounterconsult@gmail.com
    Website: www.re-encounter.es. www.couplesretreatmarbella.com
    Nationality: Dutch
    Languages Spoken: English, Dutch
    Religious Affiliation: not specific
    Clinical Specialties: Couples Counselling, Couples Therapy, Certified Emotionally Focused Therapist and Supervisor (www.ICEEFT.com )
    Cross-Cultural Experience: I have fifteen plus years experience in treating couples with a wide range of problems, with different sexual orientations and from various cultures. I teach and assist various Emotionally Focused Therapy (EFT) training courses in Europe as well as in the United States.

    Kevin J. Fleming, Ph.D.
    Location: Spain (and worldwide: travels to client countries)*
    * Grey Matters International is a “one stop shop” global psychological consulting firm that leverages powerful neuroscience technologies and methods for ex-pats and their families. We work in a ‘we come to you’ fashion and can help all your personal,relationship and family/children mental health needs quickly and effectively.
    Phone: 1-877-606-6161 (if calling from outside USA: 1-918-949-1972)
    Email: info@greymattersintl.com
    Website: www.greymattersintl.com
    Nationality: USA
    Languages Spoken: English
    Religious Affiliation: Open to All Religious/Spiritual Orientations
    Clinical Specialties: Mood disorders, stress/burnout, relationship conflict, addiction, OCD, ADD/ADHD, brain injury, trauma, sleep concerns, high performance and career counseling
    Cross-Cultural Experience: Worked with clients on 5 continents on their private mental health needs and have advised many multi-cultural “professionals, executives, leaders” on their culture change needs affecting many employees and their unique values

    PLOS ONE: Cost of Disorders of the Brain in Spain

    Cost of Disorders of the Brain in Spain Cost of Disorders of the Brain in Spain Abstract Background

    Brain disorders represent a high burden in Europe and worldwide. The objective of this study was to provide specific estimates of the economic costs of brain disorders in Spain, based on published epidemiological and economic evidence.

    Methods

    A cost-of-illness study with a societal perspective of 19 brain disorders was carried out. Cost data published between 2004 and 2012 was obtained from a systematic literature review. Direct healthcare, direct non-medical and indirect costs were considered, prioritizing bottom-up information. All costs were converted to Euro and to year 2010. The missing values were imputed with European estimates. Sensitivity analyses based on qualitative assessment of the literature and on a Monte Carlo simulation were performed.

    Results

    The review identified 33 articles with information on costs for 11 disorders (8 neurological, 3 mental). The average per–patient cost ranged from 36,946 € for multiple sclerosis to 402 € for headache. The societal cost of the 19 brain disorders in Spain in 2010 was estimated in 84 € billion. Societal costs ranged from 15 € billion for dementia to 65 € million for eating disorders. Mental disorders societal cost were 46 € billions (55% of the total), while neurological disorder added up to 38 € billion. Healthcare costs represented 37% of the societal costs of brain disorders, whereas direct non-medical constituted 29% and indirect costs 33%.

    Conclusion

    Brain disorders have a substantial economic impact in Spain (equivalent to almost 8% of the country's GDP). Economic data on several important brain disorders, specially mental disorders, is still sparse.

    Citation: Parés-Badell O, Barbaglia G, Jerinic P, Gustavsson A, Salvador-Carulla L, Alonso J (2014) Cost of Disorders of the Brain in Spain. PLoS ONE 9(8): e105471. doi:10.1371/journal.pone.0105471

    Editor: Guglielmo Foffani, Hospital Nacional de Parapléjicos, Spain

    Received: March 21, 2014; Accepted: July 24, 2014; Published: August 18, 2014

    Copyright: © 2014 Parés-Badell et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License. which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are available within the paper.

    Funding: The author(s) received no specific funding for this work. Co-author Anders Gustavsson is employed by Quantify Research, Stockholm. Quantify Research, Stockholm provided support in the form of salary for author AG, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section.

    Competing interests: The authors declare the affiliation of Anders Gustavsson to be Quantify Research, Stockholm. This does not alter their adherence to all PLOS ONE policies on sharing data and materials. There are no restrictions on sharing data or materials.

    Introduction

    Brain disorders, that is, mental and neurological disorders, constitute 10.4% of the global burden of disease [1] and are projected to represent 14.4% in 2030 [2]. According to the World Health Organization, they accounted for 3.3% of the global deaths of individuals aged 15–49 years in 2010 [3]. In Europe, brain disorders contributed with about one quarter to the total burden of disease, a much greater proportion in comparison with other regions of the world [4]. Societal costs were estimated to be 798 € billion [5]. In Spain, in 2008, 1.5 million DALYs were lost due to brain disorders [6]. The vast majority of that burden is caused by the years lost due to disability (93.1% of the total DALYs) other than years of life lost [7] .

    Similarly to other Southern European countries, Spain has had high levels of social cohesion, and reliance on informal care, in contrast to some northern European countries. Such characteristics are associated with relatively low rates of people living alone and may cause lower rates of healthcare costs for residential care [9]. But family's ability to carry most of the burden may be limited due to several sociodemographic changes, such as smaller family size, increasing female participation in the labour market and higher divorce rates [10]. At the same time, societal expectations about a longer and more functional life expectancy are also increasing [8]. The economic cost of diseases is becoming an ever more important determinant for health policies and decision making [11] and thus solid Spanish specific estimates are needed. Cost-of-illness studies are of particular interest as they describe costs of every item related to disease, accordingly exposing the main factors that contribute to the societal costs of diseases.

    Aims of the study

    Two previous systematic reviews concerning cost-of-illness of brain disorders in Europe included estimates for Spain: the EBC2005 [12] and the EBC2010 (Cost of disorders of the brain in Europe 2010) [5]. [11]. In both cases the amount of literature found specifically containing cost information for Spain was scarce. We undertook a new Spanish-specific systematic review, with a broader dates span and the use of more databases, combined with the use of methods and data retrieved from the Cost of Disorders of the Brain in Europe 2010 study (EBC2010) [5] .

    The primary objective of our study was to provide the most updated and complete estimates of the economic costs of brain disorders in Spain, based on published epidemiological and economic evidence. Specific objectives were to estimate the societal cost per disorder and the per-patient cost; specifying direct and indirect costs in Spain for the year 2010.

    Methods

    A systematic review of the literature was performed in order to obtain economic data inputs for a cost-of-illness study. A societal perspective and a bottom-up approach were used to estimate the cost of each of the 19 brain disorders (Table 1 ). Societal and per-patient costs were calculated taking into account three categories of costs. Finally, two sensitivity analysis were performed.

    Cost data - Systematic review

    A literature search was carried out using the databases PubMed (MEDLINE), ISI Web of Science and SCOPUS. A filter by publication date was applied. All papers published between 1 st of January 2004 and 1 st June 2012 were included. The search terminology included strings for dates, Spain [13] and each of the 19 brain disorders. The search was conducted on September 2012.

    Studies were included if the following criteria was met: to incorporate descriptive information about cost or resource use; to report data of at least one type of cost; to study at least one of the brain disorders (Table 1 ); to include cost information form Spain; and to be written in English, Spanish or Catalan. Studies were excluded if economic data was available but could not extrapolated into a monetary form or could not be extrapolated to yearly per-patient costs. Articles reporting costs of patients in clinical trials were excluded.

    Title, abstract and full text review was performed by two reviewers. Title review was performed applying a low-threshold review method. Abstract and full text review inconsistences between reviewers were solved by a third reviewer. Data was extracted by two reviewers and differences were solved by consensus. Data concerning methodology, costs and specific disease were extracted. Methodology information included, among others, the perspective, the time scope, the currency and the year of costing. All per-patient costs stated in the included articles were extracted, but classified according to the categorization used in EBC2010. Two authors were contacted and provided additional data on identified articles [14]. [15] .

    A grey literature review was performed using the databases Google, Tripdatabase, Teseo and Tesis Doctorals en Xarxa. The main strings of the systematic search were used. An e-mail was sent to 24 investigators identified in the scientific literature review inquiring for unrevealed grey literature. Four of them answered our request for relevant documents.

    Epidemiological data

    The number of patients with brain disorders in Spain was retrieved from the EBC2010 study epidemiological review, as reported elsewhere [4]. The prevalence data was stratified by age, gender and disease severity.

    Methodological approach: Cost-of-illness

    This study follows the cost-of-illness methodology used in the EBC2010 enabling to assign a monetary value to a disease cost using the epidemiological and economic information available for Spain [16]. A societal perspective is presented, taking a comprehensive approach to estimating direct and indirect costs [17]. The bottom-up method (identifying patients with the disease and collecting their individual cost) was prioritized over top-down method for cost collection.

    The per-patient cost is the average of the resource consumption of individual patients with a given disorder in a given time period. In this study, per-patient costs of each disorder, retrieved from the systematic review, were considered in three categories: (1) direct health care costs included inpatient care, outpatient care, drugs and medical procedures and devices costs; (2) direct non-medical costs comprised informal care, adaptation costs and transportation costs; and (3) indirect costs were restrained to permanent or temporal absence from work and early retirement. Indirect costs due to premature mortality, intangible costs and costs of crime were excluded because of lack of data or valuable methods. Indirect costs were valued using the human capital approach. Costs related to research were also excluded.

    A year-prevalence approach was used to estimate the costs of the total number of cases of each disorder in the year 2010, in other words, the societal costs, that reflect the resource consumption of the overall population imputable to a disorder, in a given time period. As published elsewhere [5]. the prevalence estimates where based in population aged 18 years and above in most disorders. For addictive disorders and anxiety disorders the age span went from 14 to 65 years and for child and adolescent disorders from 2 to 17 years. In the case of dementia only people over 65 years were considered.

    Data analysis

    The consumer price index (CPI) for all-items [18] was used for adjustment by inflation when costs data obtained in the systematic review did not concern the year 2010. Estimates presented in currencies other than Euro were converted to Euro using nominal exchange rates from the European Central Bank [19] .

    Whenever cost information of a particular disorder was impossible to obtain from our literature review, the European median from EBC2010 [5] was imputed to our data. European medians had been adjusted for income, health care expenditure and wage level across countries.

    The prevalence ratios were multiplied by the number of inhabitants in Spain in order to calculate the number of patients with each disorder. According to Eurostat, Spain had almost 46 million inhabitants in 2010 [20]. The number of patients with each disorder was multiplied by the specific estimates of the per-patient cost. Indirect costs were only applied to the working population (between 18 and 65 years) unless the indirect costs estimates were actually presented as an average of the total population of all ages.

    Finally, our analysis included the calculation of the un-weighted mean of every cost whenever there were multiple studies for one disorder. The estimates of each type of costs were added up to obtain the per-patient cost of each disorder. Per-patient cost was multiplied by the number of patients with the disorder, for every one of the 19 disorders, to calculate the total societal cost. In addition, the distribution by types of cost was calculated by adding up all disorders direct healthcare costs, direct non-medical costs and indirect costs separately. This was performed for all disorders and stratified by mental and neurological disorders.

    Sensitivity analysis

    Two sensitivity analyses were performed separately. First, a questionnaire [21] was used to assess the quality of the 33 papers included. Five items were evaluated: (1) Is the perspective of the analysis clearly specified? (2) Is the choice of study design properly justified? (3) Are all relevant costs and effects included? (4) Are they assessed and measured adequately? (5) Is uncertainty assessed using a sensitivity analysis or other techniques? Quality assessment was performed by two reviewers and solved by consensus. Sensitivity analysis was based on the replication of the analysis using only the articles that were considered to provide high quality information.

    A second sensitivity analysis consisted in a Monte Carlo simulation [22] to control for the uncertainty generated by obtaining the cost data from different studies, allowing to make probabilistic estimates of the costs. Monte Carlo simulation is based in (1) the selection of the probabilistic distribution that best fit the variables and (2) a large number of random samples obtained from these distributions; yielding a statistical output. For our specific analysis we assumed triangular distributions that included the maximum, the minimum and the median observations of every type of cost (direct healthcare, direct non-medical and indirect costs) for the 7 disorders (dementia, epilepsy, headache, mood disorders, multiple sclerosis, and Parkinson's disease) that had more than one article included. For every disorder and cost, the minimum and the maximum were the lowest and the highest costs provided by any of the articles included in the review. The mean per-patient cost between the articles was fixed as the most probable value in the triangular distribution. One thousand iterations (random samples) were used to obtain the statistical outputs.

    Results Systematic review

    The search and screening process is summarised in Figure 1. The cost data literature review resulted in 33 relevant cost studies identified for 11 disorders (Table 2 ): anxiety disorder [23]. dementia [24] –[31]. epilepsy [32]. [33]. headache [15]. [34]. [35]. mood disorders [36] –[40]. multiple sclerosis [14]. [41] –[43]. Parkinson's disease [24]. [44]. psychotic disorders [45]. [46]. stroke [24]. [47] –[50] and neuromuscular diseases [51]. Two articles were excluded from de model because they presented outlier estimations for stroke [52]. [53] and traumatic brain injury [52] .

    Table 3. Number of people, per-patient cost and societal cost by type of costs for all disorders in Spain 2010.

    Societal costs

    The societal cost of brain disorders in Spain 2010 was estimated at 84 € billion. Based on a total number of citizens in Spain of almost 46 million, the average cost of brain disorders per inhabitant per year in Spain was 1,725 €. Societal costs by disorder and cost type are shown in Figure 3 (distribution) and Table 3 (numerals). The most costly brain disorder in Spain was dementia with 15,402 € million.

    Figure 3. Societal cost by disorder and types of costs in Spain (€ million, 2010).

    Distribution of the type of costs

    Mental disorders accounted for 46 € billion, representing 55% of the societal costs of all brain disorders considered. Societal costs of neurological disorders added up to 38 € billion (45% of the total). Dementia was the most costly disorder, accounting for almost 20% of the societal costs.

    Overall, the majority of the estimated costs of brain disorders (Figure 4 ) were direct healthcare costs (37%) while direct non-medical costs constituted 29% and indirect costs 33%. Within neurological disorders direct non-medical costs constituted 50% of the costs, indicating a high dependence on informal care. On the contrary, mental disorders were driven mainly by indirect costs (47%), followed by direct healthcare costs (41%).

    Figure 4. Distribution of types of costs in brain disorders, neurological disorders and mental disorders.

    Sensitivity analyses Quality assessment.

    Among the articles included in the review, 15 were deemed to be high quality articles. For psychotic disorders no high quality information was found, whereas for epilepsy and neuromuscular disorders all articles included were considered high quality articles. For five disorders costs were recalculated using only the high quality articles stated: dementia [24]. [30]. [31]. headache [15]. [35]. mood disorders [36]. multiple sclerosis [14]. [41]. [42]. Parkinson's disease [24] and stroke [47]. [48]. [50] .

    Costs were recalculated using the same methods but only high quality articles for six disorders, of which five resulted in higher estimates. Societal costs estimations increased in 509 € million for dementia; 6,827 € million for mood disorders; 109 € million for multiple sclerosis 33 € million for Parkinson's disease and 245 € million for stroke. A diminish of the estimation was only observed in headache, with a decrease of 1,562 € million. Taking all disorders into account, societal costs for brain disorders were estimated to be 86 € million, an increase of 6,161 € million, an additional 8%. In terms of per-patient cost, the increase was an average of 179 € per patient.

    Monte Carlo simulation.

    The Monte Carlo simulation outputs were meant to show the inherent uncertainty of our estimations, driven by the use of different articles as our data source on cost information. Following, with a probability of 90%, the distribution of the per-patient costs for each disorder is shown: dementia 31,787 € (90% CI: 25,697 – 39,119); epilepsy 7,180 € (90% CI: 6,517 – 7,821); headache 432 € (90% CI: 317 – 566); mood disorders 4,238 € (90% CI: 2,763 – 5,999); multiple sclerosis 39,929 € (90% CI: 32,401 – 48,814); Parkinson's disease 23,091 € (90% CI: 22,810 – 23,371) and stroke 17,072 € (90% CI: 9,547 – 25,948). When the 7 disorders were analysed together, the Monte Carlo simulation showed that with a probability of 90% the median per-patient cost ranged from 1,696 € to 4,392 €. The probability of a median per-patient cost above 3,000 € was 36.5%. In comparison with the mean observed costs, the ones obtained through simulation were a 14.8% higher.

    Conclusion Main study findings

    The present study shows that the economic burden of brain disorders in Spain was almost 84 € billion, mental disorders accounted for 46€ billon and neurological disorders for 38€ billion. This total figure corresponds to nearly 8% of the gross domestic product of Spain and surpasses the public healthcare expenditure of Spain, which was about 64 € billion in 2010 [54]. Brain disorders had a societal cost of about ten times higher than that of cardiovascular diseases (estimated at 7 € billion in Spain in 2003 [55] ) or diabetes (close to 8 € billion in 2009 [56] ). Although caution is needed due to differences in costing methodologies, brain disorders exceeded the economical weight of two of the most burdensome diseases in Spain.

    Strengths and weaknesses of the study

    Our estimates were obtained through a previously tested method that permits the use of all evidence even if the articles included in the review used different methodologies or if only partial information was available. Our method offers comparable estimates across brain disorders and types of costs [5] .

    On the other hand, a number of limitations must be taken into account. First, double counting is likely to have occurred. This is reflected on the total number of individuals with one brain disorder, which was a sum of the number of patients for every disorder but did not take into account that some of these disorders coexist in the same individual. While we did not consider overlap between any pair of disorders, the original articles did evaluate the excess cost of a given disorder to the extent possible, linking expenditures to a singular disorder and taking into account the additional cost that a person with the disorder causes, irrespective of whether they have any other disorders or not. Second, the costs reported by the articles included in this review are dependent on the sampling of patients. Samples should be representative of the general population in the proportion of mild and severe cases. In this review, costs were obtained by the un-weighted mean of the costs stated in the original articles, but our data included a relatively small number of studies for some diagnostic categories with, sometimes, small number of patients. Thus, the relative distribution of mild and severe cases in each disorder may be exaggerating cost differences across disorders. Third, we did not find any information about the costs of 9 disorders, so we had to impute the European median values [5]. Such values may not correspond to the real costs for Spain, although it is unclear whether they would be higher or lower. Fourth, there are no international guidelines for cost-of-illness analyses, which hampers the use of quality standards for the assessment of available literature and the international comparison in contrast with other areas of health economics such as cost-effectiveness analysis.

    Conversely, we are certain that our results systematically underestimate the costs of brain disorders, based on a number of considerations. One is that there were no estimates for Spain neither from any European country on direct non-medical costs for brain tumors, headaches, psychotic disorders, sleep disorders and somatoform disorders, and on indirect costs for intellectual disability. These concepts could not be included in the final estimates, resulting in an underestimation of the total costs. Also, indirect costs for disorders in children and adolescents as well as for dementia were assumed to be null because we presumed affected people were not part of the working population. We also underestimated the societal costs of brain disorders since intangible, crime related and mortality costs were not assessed. And also because some less prevalent (but sometimes more costly) disorders [5] could not be included in our study due to lack of data. In conclusion, our results provide a conservative estimate of the costs of brain disorders in Spain, as supported by the results of our sensitivity analyses.

    Comparison with previous studies

    Our societal costs estimates of 83,749 € million due to brain disorders in Spain are consistent but an 8% higher than the estimates for our country provided by the EBC2010 estimates for Spain [5]. Higher estimates in our study are attributable to the inclusion of more recent articles in the review that take into account the increase of medical, pharmacological and informal care costs over the years. Specifically, our review identified 20 relevant studies for Spain that were not taken into account in EBC2010. Also of notice is the fact that European and Spanish costs distribution diverge. In Spain direct non-medical costs were proportionally more important than in Europe, while indirect costs tended to be lower. A previous study [57] estimated the socioeconomic costs of mental illness in Spain to total 7,018 € million in 2002. Our estimation was sixfold higher, 45,986 € million. That study used a top-down approach using administrative data from only the Canary Islands not disaggregated by disorder. It is likely that methodological differences on the types of costs and number of disorders considered explain results differences.

    Specific estimates for other European countries have been published using the same methodology of ours [58] –[60] and results differ somewhat. The most (dementia) and least (headache) costly disorders are concordant across countries, but the societal costs vary. For instance, the mean per-patient cost of brain disorders in Spain was 2,440 € while in Switzerland it was 2,624 €. This difference is consistent with the higher health expenditure of Switzerland.

    Policy implications

    Despite limitations, the results of this study should be useful for policymakers. One of the “grand challenges” [61] for brain disorders is to reduce the cost of effective medication and to provide effective and affordable community-based care and rehabilitation. To compare future policies for the reduction of costs associated with mental and neurological disorders with the present policies will only be possible if economic evaluation studies have been endorsed. While cost-of-illness studies have been criticized for not permitting to establish whether a country is spending too much or too little on a disease, they can help to inform decisions concerning allocation of funding. They can do so by providing a measure of the economic burden of particular health problems [55]. They can neither predict if higher resource allocation entails higher health earnings, but they enable a global vision of what is currently being spent, and what kind of costs are more relevant, being a useful tool for financial planning. Several regional health authorities in Spain have recently shown interest in including costs-of-illness studies to support planning of their health budgets [62]. In addition, the Spanish Ministry of Health has included within its disease management plans estimations of the cost-of-illness for diabetes mellitus, ischemic heart disease and cancer [57]. It has also funded cost studies of neurological diseases but not of mental diseases. These studies have not even been considered in the national mental health strategy which may explain the unbalance of available information between mental and neurological disorders in Spain [63] .

    Further research

    The vast economic burden of brain disorders and the policy implications emphasize the need of increased efforts in research. Gaps on knowledge on cost-of-illness of mental disorders and some neurological disorders should be addressed in the near future, when costs are likely to increase due to the aging population and the higher prevalence of degenerative disorders and associated disability. Moreover, as many other national health systems, the Spanish healthcare system is under restructuration through a new legislation [64]. changes in organization and structures [65] and the effects of the economic crisis. Cost-of-illness studies on brain disorders with different societal, healthcare system and patient perspectives, as well as their distribution within the Spanish society should be accomplished for a better evaluation of policy changes.

    Acknowledgments

    The authors would like to thank Elena Olariu, Mireia Espallargues and Elisa Sicuri for their valuable help in the sensitivity analyses and the review and Anna García-Altés for appreciated comments on the manuscript. We would also like to thank the European Brain Council and the EBC2010 study group for making their data available to the authors.

    Author Contributions

    Conceived and designed the experiments: OPB GB JA AG LSC. Performed the experiments: OPB GB JA. Analyzed the data: OPB PJ GB JA. Contributed reagents/materials/analysis tools: OPB GB PJ JA LSC AG. Contributed to the writing of the manuscript: OPB GB PJ JA LSC AG.

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    Etodolac (Ospain) Delivery

    You can order delivery of a Etodolac (Ospain) to the United States, Netherlands, Switzerland or any other country in the world. Residents of the USA can order Etodolac (Ospain) to any city, to any address, for example to Houston, Arlington, Detroit or Chicago.