Oil spill vulnerability assessment integrating physical, biological and socio-economical aspects: application to the Cantabrian coast (Bay of Biscay, Spain).

A methodology has been developed to carry out an integrated oil spill vulnerability index, V, for coastal environments. This index takes into account the main physical, biological and socio-economical characteristics by means of three intermediate indexes. Three different integration methods (worst-case, average and survey-based) along with ESI-based vulnerability scores, V(ESI), proposed for the Cantabrian coast during the Prestige oil spill, have been analyzed and compared in terms of agreement between the classifications obtained with each one for this coastal area. Results of this study indicate that the use of the worst-case index, V(R), leads to a conservative ranking, with a very poor discrimination which is not helpful in coastal oil spill risk management. Due to the homogeneity of this coastal stretch, the rest of the methods, V(I), V(M) and V(ESI), provide similar classifications. However, V(M) and V(I) give more flexibility allowing three indexes for each coastal segment and including socio-economic aspects. Finally, the V(I) procedure is proposed here as the more advisable as using this index promotes the public participation that is a key element in the implementation of Integrated Coastal Zone Management (IZCM).

La Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) / International Classification of Functioning, Disability and Health (ICF)

En el año 1993, la OMS inició el proceso de revisión de la Clasificación Internacional de Deficiencias, Discapacidades y Minusvalías (CIDDM). Tras largos trabajos, dicho proceso culminó con la aprobación en mayo de 2001 por parte de la Asamblea Mundial de la Salud, de la Nueva Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). Como objetivo fundamental, esta Clasificación nos aporta un marco conceptual, así como un lenguaje estandarizado y unificado, para describir la salud y los estados relacionados con la salud. Esta clasificación pertenece a la Familia de Clasificaciones Internacionales de la OMS y junto con la CIE (Clasificación Internacional de Enfermedades) son consideradas Clasificaciones de Referencia. Ambas nos ayudan a codificar toda la información relativa a la salud de las personas empleando un lenguaje unificado que facilita además el intercambio de información entre profesionales e incluso entre países. En este trabajo se describen los antecedentes de la CIF, su marco conceptual así como su estructura

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Towards an operational system for oil-spill forecast over Spanish waters: initial developments and implementation test.

The ESEOO Project, launched after the Prestige crisis, has boosted operational oceanography capacities in Spain, creating new operational oceanographic services and increasing synergies between these new operational tools and already existing systems. In consequence, the present preparedness to face an oil-spill crisis is enhanced, significantly improving the operational response regarding ocean, meteorological and oil-spill monitoring and forecasting. A key aspect of this progress has been the agreement between the scientific community and the Spanish Search and Rescue Institution (SASEMAR), significantly favoured within the ESEOO framework. Important achievements of this collaboration are: (1) the design of protocols that at the crisis time provide operational state-of-the-art information, derived from both forecasting and observing systems; (2) the establishment, in case of oil-spill crisis, of a new specialized unit, named USyP, to monitor and forecast the marine oceanographic situation, providing the required met-ocean and oil-spill information for the crisis managers. The oil-spill crisis scenario simulated during the international search and rescue Exercise "Gijón-2006", organized by SASEMAR, represented an excellent opportunity to test the capabilities and the effectiveness of this USyP unit, as well as the protocols established to analyze and transfer information. The results presented in this work illustrate the effectiveness of the operational approach, and constitute an encouraging and improved base to face oil-spill crisis.

Esquizofrenia: morbilidad, curso evolutivo y factores condicionantes / Schizophrenia: morbility, course and conditioning factors

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Diferencias lingüísticas en lengua española en el área de las discapacidades: la aplicación de métodos multifásicos interactivos de traducción / Linguistic differences within the Spanish language in the disability area: the aplication of polyphase interactive methods of translation

La Organización Mundial de la Salud ha emprendido la revisión de la Clasificación Internacional de Deficiencias, Discapacidades y Minusvalías (ICIDH), adoptada inicialmente por la Asamblea Mundial de la Salud en 1976, con el objeto de subsanar las deficiencias detectadas durante su utilización en las últimas dos décadas. En 1997 la OMS promovió la constitución de la Red de Habla/Cultura Hispana en Discapacidad (RHHD), con la intención de incorporar al proceso de revisión una representación más significativa del mundo y cultura de habla hispana. Esta red ha sido la responsable de los trabajos de traducción y análisis lingüístico de la versión española del borrador beta1 de la CIDDM-2. La RHHD ha utilizado 'el modelo multifásico interactivo de traducción', el cual es altamente recomendado cuando existen diferencias dialécticas significativas dentro de un mismo grupo lingüístico. En este trabajo se verificará la utilidad del modelo, se identificarán términos y conceptos que planteen problemas de traducción y se aportarán datos relevantes para la elaboración del siguiente borrador beta2 de la CIDDM-2 (AU)

[Spanish version of the new World Health Organization Disability Assessment Schedule II (WHO-DAS-II): initial phase of development and pilot study. Cantabria disability work group]. / Versión en lengua española de un nuevo cuestionario de evaluación de discapacidades de la OMS (WHO-DAS-II): fase inicial de desarrollo y estudio piloto. Grupo Cantabria en Discapacidades.

The aim of the present paper is to present the initial phases of the development of the Spanish version of the "World Health Organization Disablement Assessment Schedule II" WHO-DAS-II and also to describe the quantitative and qualitative methodological strategies used in the elaboration process of an instrument: i) compatible with the new International Classification of Functioning and Disability -ICIDH-2- of the World Health Organisation; ii) with criteria of cross-cultural applicability and; iii) to allow us to assess the disability in all its dimensions.

The classification of first episode schizophrenia: a cluster-analytical approach.

OBJECTIVE: This paper examines, using data from the Cantabria First Episode Schizophrenia Study, the usefulness of subdividing, using a cluster analysis technique, this schizophrenia population into subgroups with similar symptoms profiles in terms of SANS and SAPS. METHOD: Diagnostic characteristics were determined using the Present State Examination (PSE-9) and the SANS/SAPS. Premorbid adjustment was assessed using a scale developed combining the Gittelman and Klein's Scales, and the Goldstein's scales. Social Adjustment was evaluated using the WHO-DAS. In addition clinical histories were used to assess the patients' clinical course. RESULTS: Our schizophrenic patients could be subtyped into four categories: negative, positive non-paranoid, simple and disorganized schizophrenia. There is an absence of significant association between the majority of the variables investigated and the four-cluster model. CONCLUSION: Even though our sample could be subtyped into different categories, the model does not show predictive power according to the 3-year follow-up data.

Versión en lengua española de un nuevo cuestionario de evaluación de discapacidades de la OMS (WHO-DAS-II): fase inicial de desarrollo y estudio piloto / Spanish version of the new World Health Organization Disablement Assessment Schedule II (WHO-DAS-II): Initial phase of development and pilot study

El objetivo del presente trabajo es presentar las fases iniciales del desarrollo de la versión en lengua española del Cuestionario de Evaluación de Discapacidades de la OMS -WHO-DAS-II ('World Health Organization Disablement Assessment Schedule II'), así como realizar una descripción de las estrategias metodológicas, tanto cualitativas como cuantitativas, utilizadas para garantizar que dicho instrumento sea: i) compatible con el nuevo sistema de Clasificación de discapacidades de la OMS (Clasificación Internacional del Funcionamiento y de la Discapacidad- CIDDM-2); ii) aplicable transculturalmente, y; iii) adecuado para evaluar la discapacidad de un modo fiable y en todas sus dimensiones (AU)

La discapacidad: modelos interpretativos y su influencia en el nuevo sistema de clasificación de discapacidades de la Organización Mundial de la Salud (CIDDM-2) / Disability: Interpretative Models and their Influence in the New Classification System of Disabilities from the World Health Organisation (ICIDH-2)

Este artículo presenta los aspectos esenciales relativos a los modelos de discapacidad más significativos desarrollados hasta la fecha, así como su impacto sobre el proceso de revisión del sistema de Clasificación Internacional de Deficiencias, Discapacidades y Minusvalías -CIDDM- desarrollado por la Organización Mundial de la Salud. Se revisan, fundamentalmente, los modelos "Médico-Biológico" y "Social" para de esta forma introducir los modelos "Universal" y "Bio-Psico-Social" adoptados en dicho proceso de revisión. Este artículo describe, además, la estructura, contenidos y nuevas conceptualizaciones de la nueva Clasificación Internacional de Deficiencias, Discapacidades y Minusvalías de la OMS, que ha pasado a denominarse, al menos de forma provisional, Clasificación Internacional del Funcionamiento y la Discapacidad, -CIDDM-2. (AU)

Cantabria first-episode schizophrenia study: three-year follow-up.

BACKGROUND: We present the findings from the three-year follow-up of all first episodes of schizophrenia occurring during a two-year period in Cantabria (in Spain). AIMS: (a) To describe the clinical characteristics of the illness from the early stages of the disease, and (b) to study the long-term psychosocial adjustment and psychopathological evolution of these patients, identifying predictors for the course of the illness. METHOD: Of the original cohort of 86 patients, 76 (88.3%) were fully evaluated at three-year follow-up. Psychiatric assessment was performed (PSE-9 and SANS/SAPS). Social adjustment was evaluated using the Disability Assessment Schedule (DAS). Information regarding the clinical evolution and use of health resources was also gathered. RESULTS: The majority of patients with a first-contact diagnosis of schizophrenia failed to meet the criteria for a CATEGO diagnosis at follow-up. The SANS/SAPS assessments revealed a doubling in the proportion of patients with 'negative schizophrenia'. The pattern of clinical course was also evaluated, with 24 (31.5%) of the patients having a good outcome. Being male and having low social class tended to be associated with poor clinical outcome CONCLUSIONS: The outcome of schizophrenia is less pessimistic than was originally thought.

Sociodemographic and clinical variables as predictors of the diagnostic characteristics of first episodes of schizophrenia.

This paper examines the association of clinical and sociodemographic factors, including age and sex, with the diagnostic characteristics of first episodes of schizophrenia. The study included all patients with a first episode of schizophrenia who made contact with any of the public mental health services of the Autonomous Region of Cantabria in Northern Spain over a period of 2 years. Diagnostic characteristics were determined using the Spanish version of the Present State Examination (PSE-9), and the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS, respectively). The study confirms that the onset of schizophrenia tends to occur earlier in men than in women. However, neither sex nor age of onset were found to be associated with the clinical and psychopathological characteristics of the patients as established by the PSE-CATEGO-ID system. Furthermore, no other factors were found to be associated with these diagnostic characteristics. Being female, having a family history of mental illness, and a poor premorbid adjustment were found to predict negative symptoms as defined by SANS/SAPS scales.

Alcohol consumption in a rural area of Cantabria.

A two-stage cross-sectional survey was performed in a representative rural sample of the autonomous community of Cantabria, to investigate the social, medical and psychopathological factors associated with alcohol consumption. Alcohol consumption was investigated by means of a specific questionnaire. Mental and physical health was evaluated in the first-stage sample using: (1) the General Health Questionnaire, (2) the Cornell Medical Index. In the second stage all members of the sample were interviewed at home using the 140-item version of the Present State Examination (PSE-9). We found that 25.4% of males and 0.6% of females were consuming more than 63 alcohol units per week. Alcohol consumption was significantly associated with different social variables. Although it was possible to detect an increase in weekend drinking, especially in the heavy alcohol users, daily alcohol consumption, mainly around meals, was the predominant drinking pattern. We also found a significant inverse association between excessive alcohol consumption and the presence of physical or mental illness. Excessive alcohol use tended to be associated in males with depression and in females, with anxiety.

Patterns of positive and negative symptoms in first episode schizophrenia.

BACKGROUND: The aim is to examine, in first episodes of schizophrenia, the appropriateness of the simple two-dimensional model of schizophrenia ('negative' and 'positive' dimensions) and more complex variants. METHOD: All patients with a first episode of schizophrenia who, over a two-year period, made contact with any of the public mental health services of the autonomous region of Cantabria in northern Spain were investigated. The psychiatric evaluation included, among other instruments, the Present State Examination (PSE-9), and the scales for the assessment of the 'positive' and 'negative' symptoms of schizophrenia (SAPS and SANS respectively). The dimensionality of the SAPS/SANS item scores and sub-scales was examined throughout the use of principal component analysis. RESULTS: The principal component solution that best fits the data obtained with the initial SANS/SAPS sub-scales reflects the existence of three different ('negative', 'positive', 'disorganisation') factors. The strategy adopted of repeating the analysis after extracting the principal components of the original sub-scales, revealed that although the nature and item composition of the initial 'negative' and 'disorganisation' factors were in general confirmed, the 'positive' dimension presented a more complex structure with at least two 'positive' ('Non-Paranoid' and 'Paranoid') independent factors. CONCLUSION: The psychopathological structure of the early stages of schizophrenia, as evaluated by the SANS/SAPS, is characterised by the presence of four dimensions: two 'positive', one 'negative' and one 'disorganisation'.

Structural abnormalities of the brain in schizophrenia: sex differences in the Cantabria First Episode of Schizophrenia Study.

This paper examines structural brain abnormalities, as evaluated by the CT scan, in first episodes of schizophrenia and their association with sociodemographic, diagnostic and clinical variables. The investigation included all patients with a first episode of schizophrenia who, over a 2-year period, made contact with any of the public mental health services of the Autonomous Region of Cantabria in Northern Spain. Diagnostic and clinical characteristics were evaluated through the use of the Spanish version of the Present State Examination (PSE-9) and the Scales for the Assessment of Positive and Negative Symptoms (SANS and SAPS respectively). The study demonstrated the presence of structural brain abnormalities in this sample of first episode schizophrenics. These abnormalities were mainly expressed in the presence of larger VBR for schizophrenic patients than in the controls, these findings being more marked in women than in men. We failed to reveal, however, any evidence of an association of these brain abnormalities with diagnostic or clinical characteristics.

[Applicability of the Spanish version of the Belloc's Physical Status Inquiry-PSI: a perceived health status measurement scale]. / Aplicabilidad de la versión española del Cuestionario de Salud Física-PSI-de Belloc: una escala de medida del estado de salud percibida.

The objective of this work is to present the adaptation into Spanish of the Belloc's Physical Status Inventory-PSI-, and to describe the results of the preliminary validity of the Spanish version of this instrument. The process of translation and back-translation of the PSI revealed a high linguistic compatibility of the English and Spanish versions of the instrument. The construct validity was verified, on the same patients, by comparison of the PSI's data with the diagnostic categories and the presence of chronicity reported by the primary care practitioner, with the mental health status established by the GHQ-28, and with the utilization of health resources. We could say dat, in general, the PSI is a reliable measure of health status, being especially useful for its application on the general population and in patients in contact with medical agencies. It is thus justifiable to continue analyzing, by means of more specific methodological designs, the performance of this instrument in different Spanish populations.

The Cantabria first episode schizophrenia study: a summary of general findings.

This article describes the general findings of the initial cross-sectional stage of a prospective follow-up study of all first episodes of schizophrenia that occurred in the Autonomous Community of Cantabria over a 2-year period and that established contact with any mental health service. The project comprises: i) a 2-year cross-sectional stage, in which the sample was gathered and studied with structured psychiatric instruments such as the Present State Examination and the Scales for the Assessment of Negative and Positive Symptoms (SANS and SAPS), and; ii) a continuous follow-up. We detected, in the risk age ranged of 15-54 years, an incidence of 1.9 per 10,000 inhabitants per year for schizophrenia and of 1.3 per 10,000 inhabitants per year for the S+ CATEGO diagnosis, without any significant gender difference of morbidity. The mean age for the total schizophrenic population was 26 years, being significantly higher in women than in men. In contrast with what happens with marital status, type of household or urban/rural way of life, there was no gender difference in relation to the other sociodemographic variables. The way in which nosological and clinical variables are associated with first episodes of schizophrenia was also examined in this study. We found that 75% of patients reached a maximum CATEGO-ID level, 71% received a S+ CATEGO diagnosis, 59% presented first-rank symptoms of schizophrenia and that the percentage of a schizophrenic negative syndrome, as identified by the SANS and SAPS, was very low.(ABSTRACT TRUNCATED AT 250 WORDS)

[Development and verification of the Spanish version of the "scanning system" psychiatric interview ("Questionnaires for clinical evaluation in neuropsychiatry"]. / Desarrollo y verificación de la versión española de la entrevista psiquiátrica "sistema scan" ("cuestionarios para la evaluación clínica en neuropsiquiatria").

The SCAN System (Schedules for Clinical Assessment in Neuropsychiatry) represents the latest stage in a 30 year line of development. It is a set of instruments aimed at assessing, measuring and classifying the psychopathology and behaviour associated with the mayor psychiatric disorders of adult life. The SCAN System has several components: the SCAN interview, the Glossary of differential definitions, the CATEGO5 program and the CAPSE (Computer Assisted PSE versión). This latest element is a computerised versión of the System, combining the SCAN's interview, Glossary and CATEGO5. The SCAN interview has 3 components, the tenth edition of the Present State Examination (PSE10), the Item Group Checklist (IGC) and the Clinical History Schedule (CHS), whose main features are described in the paper. The CATEGO5 suite of computer programs consists in a set of utilities concerned with data entry and diagnosis. The Entry program is used to enter data recorded manually during a SCAN interview and the diagnosis programs derive diagnosis according to ICD-10 and DSM-III-R/DSM-IV criteria. This report analyses the main methods and results of the "Field Trials" that took place in 20 Centres of different countries. These studies showed that the diagnosis and symptoms scores have a high degree of reliability and that this is also applicable to the spanish version. In conclusion, we consider that the SCAN System is once of the more suitable psychiatric diagnostic instruments currently available.

Pathways to psychiatric care in Cantabria.

This article delineates the pathways taken in different health areas of Cantabria (Spain) by a series of newly referred patients to the mental health services and explores the influence of sociodemographic, medical and service-related factors on the delays in referral. The work forms part of an ongoing World Health Organization multicentre research programme aimed at exploring and optimizing the quality of mental health care in different centres of the world. We found that, in a rural health area, the majority of newly referred patients establish the first contact with the general practitioner and to a lesser extent with the hospital doctor and from there directly progress to the psychiatric services; in the urban health area there is a greater tendency to contact specialized medical and psychiatric services. Delays in these health areas are remarkably short and are comparable to the ones in other European centres. Our data also show that somatic symptoms are the main presenting problem both at the primary care and at the mental health level; and that, in general, psychotropic drug prescriptions are high both in hospital and in general medical settings, and that women were more often prescribed psychotropic medication than men.

[Factors implicated in the "routes of care" in mental health]. / Factores implicados en las "rutas asistenciales" en salud mental.

We analyze in this paper the way in which different sociodemographic and clinical factors influence, in different health areas of Cantabria (Spain), the pathways taken for patients suffering from "new psychiatric illness". The work is part of a Multicentric International Research Project developed by the World Health Organization aimed at evaluating and improving the quality of mental health care in different centres of the world. The general pathway to mental health services, in Cantabria, is dominated by the general practitioner (54.3%) and by the "hospital doctor/medical specialist" (26.4%), been therefore similar to the one found in other Spanish speaking centres, like Granada and Cuba; the differences are, however, much larger with the one found in Mexico city. It is also, possible to observe in our data that the pathways are influenced by clinical factors, among which the more relevant one is one related to the characteristics of the psychopathology. Thus in general we found that two factors like, the presence of "psycho-organic" syndromes and the severity of the psychopathology appears to influence: i) the degree of complexity of the pathway, which is higher in the "psycho-organic" and in the more severe forms of psychiatric disorders; ii) the protagonist which assumes, in detriment of the general practitioner, other "helping agencies" which is also increased in the "organic" and more severe disorders. We also found that other aspects like: the act of establishing "contact" with services, the delay in the obtention of help, and the prescription of psychotropic medicines, were also influenced by different sociodemographic, clinical and service related variables.