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Over the years, I have heard a lot of people talk absolute bollocks about the issue of hooliganism and in particular, the reasons why certain individuals behave as they do.
The pathetic hand-wringing and 'it never went away' type drivel which inevitably follows an incident of trouble inside a ground -be it racism or violence related- all too often leaves me shaking my head in amazement. It genuinely baffles me how supposedly intelligent people can be both blinkered and stupid at the same time.
This week however, has surpassed the lot.
Events in Manchester were terrible, that is true. The fact that a premiership footballer was almost blinded by a coin thrown from amongst rival supporters is something everyone involved with the game should be ashamed of just as we should be ashamed of the coins and missiles which were being thrown all the way through that game in much the way as they are at games up and down the country on a far too regular basis. Not just at players, but at rival fans, stewards and the police although this seems to have been largely forgotten (or ignored) by the back page mafia.
Yet what has amazed me has been the nature of the response to this particular incident. Not least the idea that to prevent such a thing happening again, we should hang nets from the front of every terrace roof in the land. Nets… for fucks sake.
Yes, a physical barrier of some description between fans and pitch would certainly minimise the risk of players being hit but let's be practical shall we? Let's think about this sensibly and talk about why it is quite possibly the most stupid idea to combat crowd problems since Ken Bates and his electric fence.
First, it wouldn't work. You'd still get things thrown at the pitch only this time those that didn't make it through the gaps in the mesh would bounce back onto the crowd. The legal consequences in the 'duty of care' sense would be immense.
Second, it would have no impact on missiles being thrown at rival fans.
Third, have you ever stood and watched a sporting event from behind mesh when the rain is pelting down? I have, and it's like watching through fog. And what happens if it starts to sleet? Or you are required to evacuate the stand in a hurry? Or it falls onto the crowd?
The argument of course, is that such things would be considered during 'development' of any such system. Yeah right. Goal line technology, safe standing… how long have these things been being 'considered' and just how close are we having to either appearing in an English football ground?
Fourth, and possibly most importantly, if you put up a physical barrier you also put up a visible one. In this case, it would be akin to a flashing neon sign which might as well say 'Hooliganism: 40 years on and we're back where we started.' You can almost sense the victims of Heysel and Hillsborough spinning in their graves at the very suggestion.
Fifth and finally, the idea completely misses the point. For instead of finding a way of stopping missiles hitting players, why not consider the revolutionary concept of addressing the mentality of those who think throwing them is a good idea?
That of course, is the obvious thing to do. But of course football has been trying to do that since the 70's and…. oh no, that's right, it hasn't. Because footballs answer to deal with the problem of hooliganism was to get the police to shove it out of the grounds, tell everyone things are better than it was in the 80's (how many times have you heard that this week?) and hope the boys in blue would solve it. Which they didn't because Old Bill's job is not actually to change attitudes it is to enforce the law of the land. Something they continue to do and with some vigour whilst at the same time using football as quite possibly the best real-time crowd-control training facility any police force anywhere in the world has ever had.
That's another debate entirely (read Barmy Army and Kicking Off if you want to know more about my views on the policing of football) but the fact remains that despite its claim to the contrary, the game as an entity has actually done little or nothing to combat hooliganism since the problem first began to show its fangs.
The coin which bounced off Rio Ferdinand's forehead proved that conclusively and that is without a doubt the most shameful aspect of this whole sorry saga. (And before anyone mails me asking 'so what would you do?' I'll be blogging about that very thing in a day or so.)
Thanks to everyone who has downloaded Wings of a Sparrow this week. Sales are even better than I could have hoped for and the reviews thus far have been amazing. I certainly never thought my writing would be compared to the legendary Tom Sharpe!
If you haven't read it yet, I hope you will get around to it soon and if you have please leave a review somewhere and help me to spread the word.
In these days of digital books, word of mouth is the best advertising any book can have which is why authors such as myself are so keen to get those who read our work involved in the publishing process.
After all, current thinking is that a self-published author needs to spend 20% of their time writing and 80% of their time self-promoting! With at least two books to write, I'd rather have that the other way round but only you guys can help me with that.
So come on… get on with it!


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Earlier today, we ran an excerpt from Damien Echols's new book, Life After Death, about his time on death row following his wrongful conviction in the murder of three 8-year-old boys. If you haven't yet, be sure to give it a read. The book is available on Amazon.
How running an NFL team is like running a restaurant | Chef Emeril Lagasse
Now Damien is here to talk with all of you. He'll be in the discussion section below answering your questions. Feel free to ask him about anything, but he wanted us to mention that he is a huge fan of the WWE and the Boston Red Sox, so he's up for some sports talk, too.
UPDATE 4:00 p.m.: OK, Damien had to run. He enjoyed everyone's questions, and we thank him for taking the time to talk with us.

subset: commoncrawl


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Alysia Montano will have a heck of a story to tell her first child.
Thirty-four weeks pregnant, Montano ran the 800 meters Thursday in the U.S. Track and Field Championships. The five-time national champion finished in 2 minutes, 32.13 seconds — nearly 35 seconds slower than her personal best of 1:57.34 in 2010 in Monaco.
"I've been running throughout my pregnancy and I felt really, really good during the whole process," Montano said after the qualifying heat.
That the 28-year-old former University of California star finished last in her heat didn't matter one bit to the crowd gathered at Hornet Stadium. Trailing the lead pack by more than 120 meters for most of the race, Montano received a rousing ovation as she finished her first lap and the cheering grew louder when she finally crossed the finish line.
"I just didn't want to get lapped and be the first person to get lapped in the 800," said Montano, the 800 national champion the past four years.
She was never close to being lapped, taking a nice relaxed pace from the start and maintaining it throughout.
That was according to the plan Montano laid out after consulting with her physician. Not only did doctors give Montano the OK to run, they encouraged her.
"That took away any fear of what the outside world might think about a woman running during her pregnancy," Montano said. "What I found out mostly was that exercising during pregnancy is actually much better for the mom and the baby. ... I did all the things I normally do ... I just happened to be pregnant. This is my normal this year."


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Screenshots - Use Case Private Banking
Use Case Private Banking
Digital, Personal & Agile : What Else?
This Use Case targets Private Banking and consists of the following dimensions:
- Internal Organization and Projects : B2E
- Business with Private Clients : B2C
- Business with Intermediaries, Global Custody : B2B
B2C & B2B interoperate with B2E the multidimensional way.
The role of our products at the Center of your Digital Workplace
Our products (refer to Social Toolset) are serving as:
- Multidimensional visual navigator by people, agile organization structures of any type and their relationships
- Central point for interaction and communication
- Bridge between players within all dimensions
The benefits
Our products are designed to improve networking, foster collaboration, streamline digital experience, get insights, implement agility from the real world, bring clients closer to people they interact with and more!
Existing applications like phonebook, line, project, business area or cost center organization charts can be decommissioned and aligned.
Communication means like Skype for business, Cisco Jabber are directly integrated.
CRM systems are completed or integrated in B2C/B2B.
How the implementation is done
This page is the entry point to the three parts - B2E for employees by intranet-, B2C for all client segments by internet- and B2B for partners by extranet-access.
Each part consists of typical organization units and their members. Each of them has its own page.
There is a classification system to support understanding, orientation and data digging. Thus, organization nodes are attached to categories derived from the classification system.
There are stories we are telling, in each part. The stories - we call them scenarios - provide page links to typical situations. Our products are embedded in these pages. Buttons provide actions to featured requests. They act as shortcuts for actions contained in context menus.
How to discover this Use Case
Dive into each part, follow the stories, click the buttons to get insights instantly. It is as simple as it sounds.
Interaction in Social Graph provides digital customer experience
In steady competition for a USP, situation appropriate expert participation in a personalized digital client experience offers the decisive differentiation. Social Graph serves as platform for direct interaction focussing on client centricity!
Provider like Avaloq or Crealogix deliver the infrastructure by APIs within their Open Banking philosophy to enable niche players like Enterprise Know How AG to offer add-on tools to banks for their own customer service optimization. Data sovereignty is guaranteed by access restrictions and no export to third parties.
All toolset benefits are not limited to B2C Client- and B2B Partner-Relations but also allow line independent agile bundling of resources within internal (B2E) multidimensional networks.
The sustainable digital experience represents a giant step in the strategic business, if not even the business model.
Read complete article "The Digital Customer Experience via Open Banking APIs: Interaction in Social Graph!"
Apps by Enterprise Know How AG, contained in Social Toolset:
- Agile Org Designer: Assists you to design different organization models such as Line, Project, Matrix, Adhocracy, Holacracy, Meritocracy and flat community.
- Social Graph: Social Graph provides an overview of your business network. Recognize relationships and benefit from instant access and direct interaction. Social Graph fosters networking and enables working most efficiently in any agile enterprise or community.
- Social Map: Organizations and users come straight to the point with Social Map. This app is based on Google Maps and provides tailor-made maps for organization and user pages, adds direct interaction and geographic representation of Social Graph nodes.
What is meant by dimensions?
- B2E: organization structure from internal perspective, Intranet
- B2C: Private clients, Internet
- B2B: Partner network (intermediaries, global custody services), Extranet


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Visit the Gratitude Railroad Website & Follow us on Twitter & LinkedIn
The page you are requesting from this event is no longer available. To find out information about upcoming events, feel free to contact the planner directly. To learn more about using Cvent for your next event, visit http://www.cvent.com.


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|App Name
|Accounting App - Zoho Books v5.23.19
|Apps, Business
|Latest Version
|Get it On
|Package Name
|( 6060 )
Here is the file to Download The Latest MOD Version of Accounting App – Zoho Books MOD, A popular game on the play store For Android.
Download Now!
Zoho Books is a simple, easy-to-use accounting app that tracks the money coming in and going out of your business. With Zoho Books, you can always stay up-to-date on your business finance and make decisions instantly.
Key Features
★ Sales – Manage Money Coming In
You can create and send estimates and invoices on the move. You can choose invoices that match your business identity and accept payments from your customers online!
★ Purchases – Manage Money Going Out
Record expenses and bills and categorize them right from your Android devices. Get to know how much you owe and always pay your bills on time. When your vendor supplies goods/services to you on credit, you're sent an invoice that details the amount of money you owe him. You can record this as a bill in Zoho Books and track it until it's paid.
★ Banking
Once you add your bank or credit card account from the list of banks available in our web application, bank feeds will be automatically enabled by default. You can view these feeds in Zoho Books Android app. Also, you can record money in / out manual entries for your offline transactions for your bank or credit card accounts. These transactions can be Categorized or Matched with the Zoho Books Expense, Invoice / Vendor payments transactions, etc.,
★ Tax Exclusive / Tax Inclusive rates
Mark your line item rates as either Tax Inclusive / Tax Exclusive while you create bills and invoices.
★ Purchase Order
Raise purchase order to your vendor on the go using Zoho Books accounting app!.
★ Invoice Templates
Choose your desired template from Template Gallery and send professional Invoices to your customers.
★ Your Accountant is never far away
With the Zoho Books Android app, your accountant is never far away to advise you. You can collaborate with your employees and accountants. Invite your trusted advisor to review your numbers right from the comfort of his home or office.
★ Get Business Insights In Your Pocket
Do you have enough cash for payroll and paying supplier bills? How much do your customers owe? What are your top expenses? Answers to these are just a tap away.
★ Track time accurately
Get to track the time you spend on your projects and bill them right from the app.
★ Go Global
Zoho Books supports transactions in multiple currencies and is precision personified.
★ Download and Print Reports
With our Zoho Books Android app, you can download and print Profit and Loss, Cash flow statement, Balance sheet, Sales, Customer Balances, Invoice Aging summary, Expenses, and many more reports.
★ Client Portal
Client portal lets your clients stay up to date on all the transactions that are happening between them and your business. You can skip the lengthy email threads and collaborate better with your clients using the portal.
★ Accept Online Payment
Use online payment gateways to receive quick payments. Zoho Books is integrated with these major online payment gateways to help you receive payments for your invoices online. This ensures faster and hassle-free receipt of payments
★ Add Attachments and Receipts
Upload a picture of the receipt or share it from your device and attach it to the corresponding expense instantly. Add file attachments to Expenses, Invoices, Estimates, and emails that you send to your customers.
★ Quick widgets
Add a widget on your home screen and create Invoices, Estimates, expenses or log time sheet entries instantly.
★ Taxes
You can apply multiple taxes to your transactions.
Our mobile app is a supplement to our web-based Zoho Books application ( https://books.zoho.com ). This accounting app is free to download. You can sign up for a 14-day free trial. After the trial, you can subscribe to the plan that best suits your business needs.
Here are some easy steps from which you can install this game on your Android.
Like in the picture below
If you are facing any issue in downloading or installation ,please comment below , so we can solve issue ASAP, Thanks.
Copyright© 2020 APKEver - Download APK for Android


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The most wonderful and horrible thing about film franchises is that where they begin and where they end up usually have little to do with one another. Take the Alien series, now collected in an exhaustive, smartly assembled, nine-disc box set. (Smartly assembled, that is, apart from the designers' apparent ignorance of the word "tetralogy.") The product of a chance collaboration between a bunch of guys working on a never-to-be-filmed version of Dune and a commercial director with only one feature under his belt, Alien has led to three markedly different sequels–each, like the first, a receptacle for anxiety about technology, corporate ethics, military might, and the human body. Released in 1979 at the tail end of a wave of science-fiction films, Ridley Scott's Alien filled the future with a monster borrowed from the oldest reaches of the psyche, a pitiless creature dedicated only to devouring and reproducing, designed by H.R. Giger for maximum Freudian implication. Scott has said he set out to make a cross between 2001 and The Texas Chainsaw Massacre, and his wish is reflected in the result: a nightmare set in the chill of a disappointing future. On one of the many supplemental documentaries spread across the box set, Alien: Resurrection screenwriter Joss Whedon comments that each sequel is notable for its failure to live up to the original. Some would argue that 1986's Aliens more than lives up to Alien, but Whedon is still partially right. Sequels are defined by the expectations of pleasure created by their sources, and most of what makes the Alien series so compelling is the way it skirts those expectations. The core elements remain the same from film to film, as does the anchor, star Sigourney Weaver. But unlike, say, the conservatively programmed James Bond series, each Alien film offers a distinct directorial vision, and each plays out as a variation on existing themes rather than a chapter in a longer saga. For James Cameron, Aliens was a chance to portray a hard-won motherhood in the form of an old-fashioned war story, and the combination worked remarkably well, thanks to the director's trademark psychological and physical intensity. In 1992's Alien 3, it's possible to see a lot of the director who would go on to make Seven and Fight Club. Making an ill-starred debut, David Fincher took control of the film after the studio scaled back the ambition of the original project. In Fincher's hands, Alien 3 became an excursion into nihilism on a dilapidated, claustrophobic prison planet populated by celibate fundamentalists. Any sequel that begins by not only killing off the endearing survivors of its predecessor, but also subjecting one to a gruesome autopsy, has a lot from which to recover, and Alien 3 never quite pulls it off. It does win points for stylistic bravado and the courage to take the series' darkest turns, but it loses those points by being unforgivably dull. (But then, based on the production stories from Alien 3's surprisingly frank making-of documentaries, it's a minor miracle that the film is watchable at all.) The most recent and weakest of the batch, 1997's Alien: Resurrection plays like a collection of intriguing, half-formed ideas joined to the incongruous imagination of French fabulist Jean-Pierre Jeunet. Still, when considered as part of a whole, and even with Winona Ryder as a robot, Resurrection maintains an odd integrity. It's perfectly in keeping with a series that began by simply putting a monster on a spaceship, then gave itself the creative freedom to explore what that monster and that spaceship really meant. Stumbles and all, the series makes for a box set whose scope matches the heft of its packaging.
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Here's Patrick Stewart's biggest regret, according to Patrick Stewart


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Gaceta Sanitaria
versión impresa ISSN 0213-9111
Gac Sanit vol.26 no.1 Barcelona ene./feb. 2012
The local burden of emotional disorders. An analysis based on a large health survey in Catalonia (Spain)
La carga local de los trastornos emocionales. Un análisis basado en una encuesta de salud poblacional en Cataluña, España
Ramón Sabes-Figueraa, Martin Knappa,b, Murielle Bendeckc, Anna Mompart-Peninad y Luis Salvador-Carullae
aCentre for the Economics of Mental Health, Health Services Research Department, Institute of Psychiatry, King's College, London, UK
bPersonal Social Services Research Unit, London School of Economics and Political Science, London, UK
cInGenis Consulting Group, Barcelona, Spain
dServei del Pla de Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
eAsociación Científica PSICOST, Cádiz, Spain
For this study funding was provided by the Department of Health (Departament de Salut) of the Government of Catalonia, the Althaia Foundation (Fundació Althaia), Parc Sanitari Sant Joan de Déu and the Catalan Hospital Consortium (Consorci Hospitalari de Catalunya).
Objective: Mental health conditions are associated with a significant burden on individuals. Using data from a large population health survey, the present study aimed to quantify the burden of emotional disorders (depression and anxiety) on health-related quality of life (HRQoL) in the region of Catalonia (Spain) for evidence-informed policy making.
Methods: Regression models were used to estimate the impact of emotional disorders on HRQoL, controlling by socioeconomic factors and somatic health problems. The rate of emotional disorders was based on the General Health Questionnaire (GHQ-12) and quality of life scores were based on the EQ-5D.
Results: The impact of emotional disorders on HRQoL was equal to a reduction of 0.17 in the EQ-5D score. Translation of this individual impact to population figures yielded a total loss of 78,742 quality-adjusted life years (QALYs) for 2006. This strong impact highlights the need for global policies aiming to reduce this burden.
Conclusion: The negative relation between emotional disorders and the HRQoL of individuals was confirmed and quantified for the population of Catalonia. The use of quality of life scales such as the SF or EQ-5D, combined with data on quasi-specific health conditions provides substantial information for prioritizing and planning health programs.
Key words: Mental health policy. Burden. Health related quality of life. Emotional disorders. Depression. Anxiety.
Objetivo: Los trastornos mentales suponen una importante carga sobre los individuos. A partir de los datos de una encuesta de salud poblacional, el presente estudio cuantifica la carga que suponen los trastornos emocionales (depresión y ansiedad) sobre la calidad de vida relacionada con la salud (CVRS) en Cataluña (España) para una política basada en evidencia informada.
Método: Se utilizó un modelo de regresión para evaluar el impacto de los trastornos depresivos y de ansiedad sobre la CVRS, controlando por factores socioeconómicos y por otras condiciones de salud. La prevalencia de los trastornos mentales se basó en el Cuestionario de Salud General (GHQ-12), y para obtener la valoración de la calidad de vida se empleó el cuestionario EQ-5D.
Resultados: El impacto de los trastornos emocionales en la CVRS equivale a una reducción de 0,17 en la puntuación del EQ-5D. Este impacto individual, cuando se traslada a cifras poblacionales, equivale a una pérdida de 78.742 años de vida ajustados por calidad para el año 2006. Esta importante cifra señala la necesidad de políticas globales que tengan como objetivo la reducción de esta carga.
Conclusión: Este estudio confirma y cuantifica para la población de Cataluña la relación negativa entre los trastornos emocionales y la CVRS. El empleo de escalas de calidad de vida, como el SF y el EQ-5D, combinadas con información sobre condiciones de salud, proporciona datos relevantes para la priorización y la planificación de programas sanitarios.
Palabras clave: Políticas de salud mental. Carga. Calidad de vida relacionada con la salud. Trastornos emocionales. Depresión. Ansiedad.
The epidemiological transition from acute to chronic illness has stimulated a change in outcome measurement in healthcare. Mortality figures alone are inadequate to accurately reflect the burden of distinct health conditions. Consequently, outcome measures based on functioning, disability and health-related quality of life (HRQoL) have been proposed.1,2
Mental health conditions are associated with a significant burden on individuals, reducing their quality of life and impairing their capacity to fulfil their individual potential. Consequently, the burden of these conditions on individuals and populations is better assessed with disability and quality of life measures, rather than with mortality data alone. The World Health Organization (WHO) assessed the burden of disease of several health conditions based on epidemiological data of disease prevalence and on estimates of the impact of distinct conditions on individuals' health2 and found that depression was the third greatest cause of health disability worldwide and the second in the developed world.3 Projections suggest that depression will be the main cause of health disability (6.2% of the global burden of disease) in 2030, more than that associated with ischemic heart diseases or road traffic accidents.
Another approach to estimate the burden of mental health conditions relies on analyzing individual data to estimate the impact of these disorders on HRQoL.4 Individual data allows the marginal effect of mental health conditions on HRQL to be estimated, controlling by comorbid factors and other variables that might also affect the outcome measure.
Evidence-informed care is a new approach to health policy making that incorporates various sources of local information apart from traditional evidence-based research.5,6 Local evidence (e.g. regional information) is critical for making decisions about health policies, and periodic national and regional health surveys constitute a major tool for evidence-informed policy making. However the interpretation of data on psychiatric disorders and emotional distress in general health surveys poses additional challenges to planning and priority setting, mainly due to the inherent nosological complexity of these disorders, especially that of the construct of emotional disorders (depression/anxiety)7; interpretation is also hampered by problems of the reliability and validity of brief assessment measures used in these surveys.
To generate an informed evidence base for planning and priority setting, in 2008 the Catalan Department of Health commissioned a series of related studies on the burden and costs of depression in Catalonia (COSTDEP8). The cost of illness analysis confirmed the major impact of depression on both the health sector and employment.9 This analysis also demonstrated the difficulties of disaggregating information on anxiety and depression outside specialized care, due to the proportion of mixed anxiety and depression in primary care as well as in disability pension records.
The present study aimed to quantify the burden of emotional distress (depression and anxiety) in the region of Catalonia, one of the seventeen autonomous regions in Spain, using a large population health survey. A further aim was to assess the utility of this database for mental health planning and priority setting.
This study formed part of the COSTDEP project.8 The organizations involved in this project included the Catalan Department of Health, the London School of Economics and Political Science, and the research association PSICOST. An expert panel, which included researchers, clinicians, providers, decision makers and managers of health databases relevant for depression in Catalonia, also participated.9 The expert panel consisted of two groups; the first group (group A) was formed by nine experts in the distinct topics related to the study (epidemiology, use of services, resources management, costs) while the second group (group B) was composed of nine officers and health decision makers from various units of the Catalan Department of Health and other official entities, as well as the managers of databases or related studies and programs (names are provided in the acknowledgements section). Group A held two meetings with a mean length of 3hours while group B undertook three work meetings.
The data source for all of the analyses was the Catalonian Health Survey of 200610 (Encuesta de Salud de Catalunya 2006, ESCA), a cross-sectional survey that collected information about morbidity, health status, health-related behaviors, use of health care services, and sociodemographic data from a representative sample of the non-institutionalized population of Catalonia. In total, 18,126 persons (15,926 aged 15 years or over, and 2,200 under 15 years) were randomly selected using a multiple-stage process and were interviewed at home by trained interviewers. All interviews were conducted between December 2005 and July 2006.10 For this analysis, only data from individuals aged 15 years or over were selected.
The ESCA 2006 provides information on the mental health status of individuals, based on the 12-item version of the General Health Questionnaire (GHQ-12). This instrument is a screening questionnaire designed for use in consulting settings and aimed at detecting individuals with a diagnosable psychiatric disorder.11 The GHQ-12 can be used to provide an indication of the proportion of "emotional distress"12 or as a screening instrument in epidemiological studies of mental disorders.13 The validated cut-off point for the Spanish version of the GHQ-12 is equal to a score of 2/3,14 implying that individuals with a score of 3 and higher are considered likely to have a psychiatric disorder. Nevertheless, this cut-off point is usually used in double-phase screening studies. In this analysis, to determine the optimal cut-off point to establish that an individual had an emotional disorder (depressive and/or anxiety disorder),7 a consultation round was made with the main experts in the use of GHQ in Spain. Finally a conservative approach was adopted to reduce the possible number of false positive results and this option was agreed by the COSTDEP expert panel. Therefore, for this analysis, individuals with a score of 4 or higher were considered to probably have an emotional disorder.
HRQoL is that part of an individual's quality of life that can potentially be influenced by health and healthcare. In the ESCA 2006, HRQoL was measured with the widely used EQ-5D.15 This tool measures health status across five dimensions (mobility, self-care, usual activities, pain or discomfort and anxiety or depression) and each dimension has three grades of severity corresponding to no, moderate or extreme problems; consequently, the EQ-5D can capture 243 different health states. Each of these health states is assigned a utility score elicited from the general population's preferences, with a value of 1 corresponding to perfect health and a value of 0 to death; health states can be valued as being worse than death and are assigned negative scores. The utility scores used have been validated for the Spanish population, obtained through the time trade-off method.16 Usually, these health utilities are combined with the duration of the health states to obtain quality adjusted life years (QALYs).1 However, the ESCA 2006 is a cross-sectional survey and therefore, in this study, when QALYs were calculated, their values only reflected the impact of poor health on quality of life, rather than on the duration of life.
The socioeconomic factors included in the analysis were age, sex, living arrangements (living alone, with a partner or with other people) and educational attainment (primary education not completed, primary education, secondary education and higher education). The variable of social class, based mainly on last professional occupation,17 was also included as a proxy of individuals' incomes. ESCA 2006 contains information on somatic health problems, which was used in the analysis. Participants were asked (separately for each condition) whether they were suffering or ever had suffered from a list of chronic health conditions including heart and pulmonary diseases, cancer, diabetes and back pain, among others.
The impact of emotional disorders (depression and anxiety) on HRQoL was analyzed through a regression model, with the socioeconomic factors and chronic somatic conditions as covariates. The dependent variable, the HRQoL measure, has a ceiling effect, with 57% of the sample scoring full health on the EQ-5D in the ESCA sample. Therefore, a multiple regression model for censored data, the Tobit model,18 was used. The marginal effect of the variable of depressive and anxiety disorders for the unconditional expected value of the HRQoL score, evaluated at the means of the explanatory variables,19 was interpreted as the change in HRQoL score associated with the mental health condition. The loss of HRQoL, or the burden due to this condition for the Catalan population, was then estimated by multiplying this individual effect of the mental health conditions on HRQoL by the prevalence of the conditions.4 This figure, measured in QALYs, is the impact of depressive and anxiety disorders on the Catalan population's HRQoL for 2006, without considering the effect of these disorders on mortality.
Sensitivity analyses
The same method was employed for two other approaches to estimate the rate of emotional disorders. First, a score of 3 or higher was used as the cut-off value in the GHQ-12 (the validated cut-off point for the Spanish version of the instrument) to categorize individuals as having emotional disorders. Second, the rate of these disorders was based on the individuals who reported that they were suffering or had suffered from emotional disorders in response to the survey question on chronic health conditions.
ESCA weights were used to ensure that the results of the analyses would be representative of the Catalan population. Analyses were performed using SPSS version 15 for Windows (SPSS Inc., Chicago, USA) and Stata version 10 for Windows (Stata Corp., College Station).
The socioeconomic characteristics of the (weighted) sample are shown in table 1 , along with the rate of emotional disorders (GHQ=4 or higher) by sociodemographic categories.
The whole sample rate of these disorders was 7.8% with 4.7% among men and 10.9% among women. Higher rate figures were found among persons with lower educational attainment and those living alone. The mean EQ-5D score was statistically significantly lower in individuals with a GHQ score of 4 or higher. The regression model estimated the marginal effect of the variables for the unconditional expected value of the HRQoL score, evaluated at the means of the explanatory variables. These values and their 95% confidence intervals are shown in table 2.
After controlling for socioeconomic factors and chronic somatic disorders, the regression results show that the impact of depressive and anxiety disorders on HRQoL was equal to a reduction of 0.17 in the EQ-5D score, the factor with by far the highest impact among those comprising the model, including all other health conditions reported by survey respondents. The translation of this individual impact to population figures gave a total loss for 2006 of 78,742 QALYs due to depressive and anxiety disorders (without considering mortality), among the non-institutionalized Catalan adult population. This loss equated to a burden of 1,312 QALYs per 100,000 inhabitants (Table 3).
Sensitivity analyses
The rate of emotional disorders among the Catalan population, when evaluated using the GHQ-12 cut-off point of a score of 3 or higher, was 11.6%, with values of 7.6% for men and 15.5% for women. The other alternative, using self-reported data on suffering or having suffered from emotional disorders, resulted in rate figures for the whole sample of 17.5% overall (11% for men and 23.8% for women). These rate figures were higher than those found in the main analysis and the individual impact of these disorders on health utility was lower. Nevertheless, total population losses of QALYs were higher as a result of larger proportions of individuals suffering from emotional disorders (Table 3).
Previous studies20,21 have shown that depressive and anxiety disorders have a strong impact on HRQoL. This study confirms these findings from a health policy perspective and stresses that the associated burden reached substantial values even when the impact on mortality was not measured. The sensitivity analyses generated distinct results but do not alter the broad message that these disorders substantially impair quality of life.
The relevance of these findings on the effect of these mental health conditions on individuals' lives is reinforced by the fact that the analysis controls for the influence of sociodemographic variables and chronic health conditions on HRQoL. The representativeness and soundness of the findings are supported by the data employed: the individual characteristics of almost 16,000 individuals, providing a representative sample of the population of Catalonia.
These results highlight the need for global policies, not just from the mental health field, aiming to reduce this burden. The Mental Health Plan of Catalonia in 200622 recognized this need and interventions with this objective (e.g. mental health promotion programs in schools, suicide prevention programs, and improvement of early detection and treatment of depression in primary care) are being implemented.
The negative relationship found in this study between HRQoL and depressive and anxiety disorders has previously been shown using large health survey data.23 A specific relationship has also been found between GHQ-12 scores and HRQoL measured with the EQ-5D in a Spanish population.24 Studies employing similar methods have found slightly higher marginal impacts of depressive and anxiety disorders on HRQoL than found in the present study.4,25 Nevertheless, in these studies, the prevalence of depression and anxiety disorders was assessed through psychiatric interviews and therefore the individuals identified as having these disorders may have had more severe disturbance than subjects in the present study. Indeed, in the other study with a general population sample4 the prevalence of the mental health conditions analyzed was lower.
The factor with the highest impact on HRQoL among those included in the model was emotional disorders. The presence of chronic lumbar or dorsal back pain implied a reduction of 0.058 in the EQ-5D score and the figure for chronic cervical pain was 0.038 compared with 0.167 for emotional disorders. However, the prevalence rate of these conditions was higher, with almost 30% of the sample reporting they suffered or had suffered from each of them (29.6% and 27.4%, respectively). This finding is reflected by figures and comparisons of population impact, with chronic lumbar or dorsal back pain implying a burden of 1,730 QALYs per 100,000 inhabitants and chronic cervical pain a burden of 1,053 compared with the result of 1,312 QALYs per 100,000 inhabitants for emotional disorders.
Comparison with similar studies highlights the main limitation of this analysis: the method of assessing individuals as having emotional disorders in the general health surveys in Spain. The GHQ-12 was initially developed to screen for general mental disorders but proved to be more effective in screening for depression and anxiety than other psychiatric disorders.13 This instrument has also proven to be a good proxy measure of emotional distress.12 Nevertheless, the GHQ-12 has become a broadly accepted measure of psychological distress/psychiatric disorders in health surveys in Europe. However, analysis of data from the GHQ-12 for policy decision making is controversial, particularly in countries where the specific predictive validity of this instrument for assessing emotional disorders has yet to be published, as is the case in Spain.
The GHQ-12 and the Mental Health Index (MHI-5 derived from the SF-36) are the main short-form scales for the assessment of general mental status in health surveys.26 The MHI-5 has been used in the Eurobarometer 58.2,27 while the GHQ-12 is also the standard measure for the assessment of mental health in national and regional health surveys in Europe23 and is included in all regional health surveys in Spain.24 The two scales have shown a high correlation.26,28 However, there are major differences in the use of the two instruments, as the GHQ-12 has proven psychometric properties that go beyond its use as a generic mental health status measure. On the one hand, the GHQ-12 has shown a three-dimensional structure in its Spanish validation: self-esteem, stress and successful coping.29 On the other hand, this instrument can be used to identify psychiatric caseness.
These findings have led to distinct strategies to analyze depression/anxiety: the GHQ-12 and HRQoL data from health surveys for policy decision making in Spain.
One strategy has been to use a series of survey questions related to depression and anxiety despite the low reliability of this method. The following questions have been considered: 1) "Have you suffered from depression or anxiety over the previous 12 months?"; 2) "Has your physician confirmed the diagnosis?"; 3) "Have you taken antidepressants prescribed by your physician over the last 2 weeks?"; and 4) "Have you taken anxiolytics prescribed by your physician over the last 2 weeks?". Participants who gave positive answers to questions 1, 2, and 3 or to all questions were considered "depression sufferers" and those giving positive answers to questions 1, 2, and 4 were considered "anxiety sufferers".30
Another strategy has been to use only data from HRQoL instruments such as the SF-3628 or EQ-5D16; but this option misses the additional information provided by the GHQ. A further option, previously used in the Catalan Health Survey of 1994, was to rank the order of probability of being a psychiatric case according to the GHQ-12 rating, by using a logistic regression analysis31 but, according to the officers of the Catalan Department of Health, the information obtained with this option was of limited utility for informed policy making. The combined use of the GHQ-12 and EQ5-D has previously been used in the Canary Islands and the findings enabled health-state values to be derived from GHQ-12 scores for populations in which utilities had not, or could not, be measured directly.24
Criticisms of the combined use of both measures are based on the low reliability and predictive validity of the diagnosis of depression and anxiety disorders in health surveys and the inadequate use of screening instruments in these surveys. Based on these criticisms, GHQ information provided in annual health surveys in Spain, both nationally and regionally, should not be used to generate information relevant for policy making. These criticisms overlook the fact that levels of accuracy are related to the aim of the analyses. Obviously, if the analysis is intended to select among treatment alternatives, high accuracy and focus on specific childhood categories (e.g. major depression, generalized anxiety disorder) are required. However when the analysis is related to general priority setting32 broader parent categories may be more useful (e.g. emotional disorders), and lower levels of accuracy are admissible insofar as the same measures and scales are used to compare distinct conditions and/or population groups.
In this scenario, estimation of the annual ratio of emotional disorders as a proxy measure of the combined prevalence of anxiety and depressive disorders may be highly relevant when combined with EQ-5 data to estimate the relative burden of this grouping of psychiatric disorders in relation to groupings of other health conditions. The predictive validity and ROC curves of the GHQ-12 have recently been produced for psychiatric screening in Spain.33 In this study, the 3/4 cut-off score was selected instead of the cut-off for double phase prevalence studies in Spain (2/3). This decision was made in agreement with the experts who standardized the Spanish GHQ scales in Spain,14 as the cut-off point is not a fixed value and can be adjusted depending on the aim of the study, in the present case to reduce false-positives and to increase specificity in order to provide a conservative estimate of the comparative burden of emotional disorders in Catalonia. This approach may improve the combined analysis of results from short-form scales and QoL scales in health survey studies.
The use of quality of life scales such as the SF or EQ-5D,34 combined with data on quasi-specific health conditions, and calculation of global indexes such as QALYs provides substantial information to rank health priorities and either support or dismiss health policy programs in highly complex areas such as mental health. This regional and/or local information is critical to complement global information to fix priority setting and support informed health policy.6
A more refined way of evaluating the rate of physical health conditions would be to improve the analysis. The self-reported measures used include past and present health problems, a method that most probably has lower validity than a physical examination by a health professional. Additionally, the analysis was based on a survey that did not collect information on institutionalized individuals or on the impact of the conditions analyzed on mortality. Finally, cross-sectional data were used and therefore the method employed relies on the assumption that the results are representative for the 12-month period.
In conclusion, the present study used data from more than 15,000 individuals and highlights the substantial impact of emotional disorders on the lives of affected individuals; this negative association was confirmed and quantified for the population of Catalonia. Health policy makers should consider this impact when developing strategies to reduce the burden of health conditions on individuals and society.
What is known about this topic?
Mental health conditions are associated with a significant burden on individuals, reducing their quality of life and impairing their capacity to fulfil their individual potential. The quantification of this burden for the population of Catalonia using a large population health survey can be used for evidence-informed policy making.
What does the study add to the literature?
The present study confirms and quantifies the substantial negative impact of emotional disorders on the lives of affected individuals, using data from Catalonia. The results highlight the need for global policies, not just from the mental health field, aiming to reduce this burden.
Author's contributions
R. Sabes-Figuera performed the data analysis, participated in the interpretation of the data and drafted the manuscript. M. Knapp, M. Bendeck and L. Salvador-Carulla reviewed the analysis, participated in the interpretation of the data and in the drafting of the manuscript. A. Mompart-Penina reviewed the analysis and participated in the interpretation of the data. All authors have read and approved the final manuscript.
Conflict of interest
None declared.
We would like to thank the contributions of the members of the COSTDEP Group and the technical units of the Department of Health. We also thank Cristina Molina and Esther Jorda of the Catalan Department of Health, Juan Cabases and Eduardo Sánchez-Iriso of the Public University of Navarre, Pilar García-Gómez of the Erasmus University, Rotterdam, Delphine Capdevielle of the University of Montpellier and Pedro Enrique Muñoz of PSICOST. The contributions of the members of the following expert groups were invaluable. Experts group A: Pere Bonet, Antoni Bulbena, Miquel Casas, Josep M. Haro, Josefina Jardí, Diego Palao, Víctor Pérez, Josep Ramos and Antoni Serrano. Expert group B: Constança Alberti, Pilar Brugulat, Elena Calvo, Mercè Mercader, Anna Moral, Alba Prat, María J. Pueyo and Roser Vicente (one of the authors of the study, A. Mompart, was also member of this group).
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(R. Sabes-Figuera).
Received 1 December 2010
Accepted 11 May 2011


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Wednesday, August 16, 2006
Recipes you can do ahead make for a quick dinner!
These Parmesan Bacon Biscuit Sticks have an Italian flare from the seasonings that are used. The dough is flavored with Parmesan, oregano, basil and garlic. Using very cold butter makes blending easy and results in extremely flaky sticks. Salty crisp bacon is crumbled and added into the dough when you add the milk for another depth of flavor. As you add the milk, leave some behind as you might not need all of it. When mixing and rolling, try to handle the dough as little as possible to help keep the biscuits nice and tender. Once the dough is cut into sticks, a quick brush of milk and a shower of Parmesan tops the biscuits and gives them a rich golden color as they bake.
The biscuit sticks went well as a side to tonight's dinner, Spinach-Quinoa Salad with Cherries and Almonds. Ever since we tried quinoa for the first time, I'm always keeping my eye out for recipes using it. This salad was light, but very filling with generous amounts of all ingredients. Combined with the cooked spiral shaped quinoa are ample amounts of toasted almonds, dried cherries, chickpeas, chiffonades of spinach, refreshing chunks of cucumbers and onions. The salad is then dressed with a fresh and zesty dressing made from plain yogurt, olive oil, lemon juice and minced garlic cloves. If you don't have quinoa on hand, or can't find it, couscous or bulgur would be a fine substitution. Once nice thing about this dish - it is best when made ahead so the flavors have plenty of time to meld together! I will have to remember this one when we need to bring a dish for a picnic; this would be a great veggie addition!
9 comments:
I just can't get into the "Q"...I just want it to be something else whenever I eat it.ReplyDelete
Joe, your quinoa salad looks incredible! I'll have to snag your recipe and make it myself sometime soon.ReplyDelete
Wheresmymind, do you rinse your quinoa well before you cook it? I had a similar reaction to quinoa for a long time, until one day I decided to finally follow the directions and rinse it . . . then I loved it!
I have yet to try quinoa and I have seen plenty of recipes that contain it. I might have to try it. This recipes looks like a great start.ReplyDelete
I love quinoa too. I found a "dark" quinoa which the box said is an heirloom variety, at Whole Foods once. It has a more intense flavor on its own, but mixed with regular quinoa, it was great and a nice change of pace.ReplyDelete
Yumm, I love quinoa, it has such a nice flavor and texture to it!ReplyDelete
Your salad looks greta!
Yumm, I love quinoa, it has such a nice flavor and texture to it!ReplyDelete
Your salad looks great!
Hey, just an FYI. I read about a good thai restaurant in your town. I think its called Thai rice or something like that.ReplyDelete
Hey, just an FYI. I read about a good thai restaurant in your town. I think its called Thai rice or something like that.ReplyDelete
Wheresmymind - I had the same question as Catherine, rinsing does make a difference!ReplyDelete
Catherine - Hope you enjoy it if you get a chance!
Linda - Do give it a try!
Julie - I actually noticed a box of red quinoa a few weeks ago - I was tempted to buy it, but I still have a bunch to go through first!
Ana - Thanks!
Randi - We don't eat out often, but I will definitely look the place up for when we do!


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Facts about Muammar Gaddafi
Muammar Gaddafi Biography
Muammar Gaddafi ruled Libya as the African country's dictator for more than four decades before he was overthrown and killed in 2011. Born a Bedouin tribesman, Muammar Gaddafi attended military college and almost immediately set about plotting to overthrow Libya's ruler, King Idris I. He succeeded in 1969, taking power in a bloodless coup. Muammar Gaddafi was 27. He took the title of colonel, and in the 1970s he seemed to have philosophical pretentions, publishing his so-called Green Book of political philosophy and leading Libya in a path of "Islamic socialism" while ruthlessly suppressing dissent. But in the 1980s he tangled with the United States and President Ronald Reagan; Reagan called Gaddafi "the mad dog of the Middle East" and ordered U.S. Air Force bombings in Tripoli in 1986 that killed Gaddafi's daughter. The 1988 bombing of a Pan Am passenger airplane over Lockerbie, Scotland, was blamed on Libyan terrorists, which led to international sanctions on Libya throughout the 1990s. Libya took responsibilty for the bombings in 2003, easing the sanctions and leading to better relations with the West. Throughout all, Muammar Gaddafi remained firmly in power and built a reputation as a shrewd, if eccentric, dictator. In 2011, he attacked protesters in his own country, leading to a full armed rebellion in Libya. An allied group of Arab and Western countries supported the rebellion by attacking Libyan air defenses and establishing a "no-fly zone" over Libya. The rebel forces overran Tripoli in August of 2011. Gaddafi escaped, but two months later he was wounded in battle after being cornered near his home town of Sirte; he reportedly was captured and then died of his wounds shortly thereafter.
Extra credit
Muammar Gaddafi was born in the desert, so no specific place of birth can be listed; the BBC and other sources say it was near the town of Sirte… His son, Seif al-Islam el-Gaddafi, was widely seen as his successor before the public protests of 2011 ended Gaddafi's rule… His Arabic name has been translated variously as Quaddafi, Qaddafi, and Khaddafi as well as Gaddafi and al-Gaddafi… He was famous for his all-female contingent of bodyguards, and for his habit of receiving visitors in a Bedouin-style tent.
Related Biography
Something in Common with Muammar Gaddafi
3 Good Links
- The Guardian provides regular notes and updates
- A full profile from 2009, two years before his overthrow
- The Straight Dope tackles the question of English spellings of his name