La responsabilidad civil en el marco de los seguros de asistencia sanitaria

Este trabajo aborda la problemática compleja que se esconde detrás de los seguros de asistencia sanitaria, analizando y calificando las diversas relaciones jurídicas que lo componen a fin de encontrar una explicación de conjunto y coherente del fenómeno, en el marco de la coligación contractual. El enfoque es eminentemente práctico, y aporta una visión alternativa al letrado que tiene ante sí, el difícil reto de articular en demanda la pretensión resarcitoria del cliente que ha sufrido un daño a las resultas de la acción u omisión de un facultativo del cuadro médico de la compañía. Para ese fin se analizan temas tales como el problema de la asegurabilidad de la prestación sanitaria, la naturaleza jurídica de la responsabilidad de la compañía, el esquema de provisión de servicios a través del seguro, la naturaleza jurídica de la responsabilidad del facultativo o centro médico incluido en los cuadros médicos de las aseguradoras, las vías de acción del perjudicado o la legitimación pasiva de los diversos intervinientes en el proceso asistencial, además de la responsabilidad exigible a la compañía de seguros de asistencia sanitaria por productos defectuosos

La responsabilidad civil en el marco de los seguros de asistencia sanitaria

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Derecho, leída el 11-12-2015Este trabajo aborda la problemática compleja que se esconde detrás de los seguros de asistencia sanitaria, analizando y calificando las diversas relaciones jurídicas que lo componen a fin de encontrar una explicación de conjunto y coherente del fenómeno, en el marco de la coligación contractual. El enfoque es eminentemente práctico, y aporta una visión alternativa al letrado que tiene ante sí, el difícil reto de articular en demanda la pretensión resarcitoria del cliente que ha sufrido un daño a las resultas de la acción u omisión de un facultativo del cuadro médico de la compañía. Para ese fin se analizan temas tales como el problema de la asegurabilidad de la prestación sanitaria, la naturaleza jurídica de la responsabilidad de la compañía, el esquema de provisión de servicios a través del seguro, la naturaleza jurídica de la responsabilidad del facultativo o centro médico incluido en los cuadros médicos de las aseguradoras, las vías de acción del perjudicado o la legitimación pasiva de los diversos intervinientes en el proceso asistencial, además de la responsabilidad exigible a la compañía de seguros de asistencia sanitaria por productos defectuosos.This work studies the complex problem that lurks behind the healthcare insurance, analyzing and describing the different legal relationships part of it to find a comprehensive and coherent explanation of the phenomenon, inside contractual colligation. The approach is very practical, and provides to the lawyer an alternative vision about it, the difficult challenge of articulating in demand for damages claims of the customer who has suffered damage as a result of the act or omission from medical staff of health insurance companies. To reach the target we analize issues such as the problem of the insurability of health services provision by health insurance companies, the legal nature of the liability of the company, the scheme of providing insurance services, the legal nature of the responsibility of the physician included in the offer of health insurance companies, the courses of action of the damaged by medical act and the liability for defective products.Fac. de DerechoTRUEunpu

Delimitación entre el delito de estafa y el dolo civil como vicio del consentimiento

Civil law and criminal law are different branches of law. However, more than once, they have similar legal institutions. Such is the case of civil and criminal frauds. In many cases where a contractual figure and deceiving are used in economic relations between people, this two institutions may be confused. Therefore, it is important to compare and contrast this figures. With this objective, in the following pages, historical origins of these figures, as well as its current structure, doctrine, jurisprudence and comparative law, will be reviewed. Finally, we will review the doctrinal and jurisprudential positions that have been made to address this problem. After the described investigation, a position will be taken.El Derecho Civil y el Derecho Penal son ramas del Derecho distintas. Sin embargo, en más de una ocasión, tienen construcciones jurídicas similares. Tal es el caso del vicio del consentimiento dolo y la estafa que en muchos casos podrían llegar a confundirse ante su similitud, principalmente cuando estamos frente a las llamadas “estafas contractuales”. Ante estas situaciones, en el presente trabajo se busca delimitar el campo de aplicación de una y otra figura; así como también sus diferencias. Para esto revisaremos el origen histórico de estas figuras, así como también su estructura actual a partir de la doctrina, la jurisprudencia y el Derecho comparado. Finalmente, revisaremos las posturas doctrinarias y jurisprudenciales que se han hecho para abordar este problema, para entonces tomar una postura propia

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

BACKGROUND: Obsessive-compulsive disorder (OCD) is common in clozapine-treated patients although the actual prevalence, phenomenology and risk factors remain unclear. The aim of the present study was to address the three aforementioned questions. METHODS: The electronic records of a large cohort of clozapine-medicated schizophrenia patients routinely screened for OCD were used. The Obsessive Compulsive Inventory Revised version (OCI-R) was available from 118 cases and a 21 points cut-off threshold for OCD was defined. RESULTS: OCD prevalence was 47%, higher in patients on poly-pharmacy than on monotherapy (64% vs 31%; p = 0.001). Two OCI-R factors had significantly higher scores and distinct risk factors: checking behaviour (mean = 5.1; SD = 3.6) correlated with length of clozapine treatment (r = 0.21; p = 0.026), and obsessing factor (mean = 4.8; SD = 3.6) correlated with psychosis severity (r = 0.59; p = 0.001). These factors along with total OCI-R, did not correlate with either clozapine dose or plasma levels, after correcting for psychosis severity. CONCLUSIONS: Screening for OCD in clozapine patients, and probably in those treated with structurally similar drugs with potent antiserotoninergic properties, should be widely adopted by clinicians. Further research is needed to understand the pathophysiology underlying repetitive behavior onset in clozapine-treated patients

Abnormal glycemic homeostasis at the onset of serious mental illnesses: A common pathway

Objective: Patients with serious mental illnesses exhibit a reduced lifespan compared with the general population, a finding that can not solely rely on high suicide risk, low access to medical care and unhealthy lifestyle. The main causes of death are medical related pathologies such as type 2 diabetes mellitus and cardiovascular disease; however pharmacological treatment might play a role. Material and methods: We compared a two hour glucose load in naïve patients at the onset of a serious mental illness (N = 102) (84 patients with a first episode of schizophrenia and related disorders, 6 with a first episode of bipolar I disorder and 12 with a first episode of major depression disorder) with another psychiatric diagnose, adjustment disorder (N = 17) and matched controls (N = 98). Results: Young patients with serious mental illness showed an increased two hour glucose load compared with adjustment disorder and the control group. Mean two hour glucose values [±standard deviation] were: for schizophrenia and related disorders 106.51 mg/dL [±32.0], for bipolar disorder 118.33 mg/dL [±34.3], for major depressive disorder 107.42 mg/dL [±34.5], for adjustment disorder 79.06 mg/dL[±24.4] and for the control group 82.11 mg/dL [±23.3] (p < 0.001). Conclusions: Our results reflect an abnormal metabolic pathway at the onset of the disease before any pharmacological treatment or other confounding factors might have taken place. Our results suggest a similar glycemic pathway in serious mental illnesses and the subsequent need of primary and secondary prevention strategies

Guía de práctica clínica para el tratamiento de la patología dual en población adulta

En este editorial se avanza el futuro contenido de la Guía de Práctica Clínica para el Tratamiento de la Patología Dual. Entendiendo la patología dual como la coexistencia de un trastorno por uso de sustancias (TUS) psicoactivas con otros diagnósticos psiquiátricos, que más comúnmente se conoce como «diagnóstico dual o patología dual». Sin embargo, este término ha adquirido múltiples connotaciones, pudiendo significar en su sentido más puro que ambos diagnósticos son independientes y ocurren de forma simultánea (Lehman et al., 1989), y también que el síndrome psiquiátrico puede haber sido inducido por sustancias o que el TUS es secundario a un trastorno psiquiátrico (Sáiz Martínez et al., 2014)

CO2 footprint reduction and efficiency increase using the dynamic rate in overhead power lines connected to wind farms

Since the first wind farms began operating in the early 1980s, several important factors have changed in the overall picture of energy politics worldwide. The total renewable wind energy capacity of Spain currently accounts for more than 20% of the total installed capacity, which makes integration into the grid challenging for wind farm owners as well as electricity transportation and distribution companies. The smart-grid concept, which focuses on real-time monitoring and dynamic rating operation of power lines, is an important component in the solution to these new challenges. This paper explains how a more efficient operation of energy-generating activities via dynamic rating of the electric grid due to a better knowledge of the main parameters contributes to more clean, renewable energy and decreases the CO2 footprint. The dynamic rating operation of a Spanish overhead power line is analysed, and different scenarios are studied. The dynamic rate achieved in 2015 has saved more than 1100 tonnes of CO2 and has generated over 240,000 € of extra income. This dynamic rating operation also increased the actual annual energy generated from 231.5 GW h to 834.7 GW h with only a 2% greater loss along the line due to Joule and magnetic effects.This work was supported by the Spanish Government under the R+D initiative INNPACTO with reference IPT-2011-1447-920000, the Spanish R+D initiative with reference ENE-2013-42720-R and RETOS RTC-2015-3795-3. The authors also acknowledge support from Viesgo

Distributed vs. spot temperature measurements in dynamic rating of overhead power lines

The increase of global energy demand and new ways of electricity production are two of the main challenges for the power sector. The electric market has to address the addition of new and renewable sources of energy to the energy mix and to be able to integrate them into the grid, while maintaining the principles of robustness, security and reliability. All of these changes point to the creation of smart grids, in which advanced generation, information and communication technologies are needed. An accurate knowledge of the electric grid state is crucial for operating the line as efficiently as possible and one of the most important grid parameters to be measured and controlled is the temperature of the overhead conductors due to their relation with the maximum allowable sag of the line and its thermal limit (annealing). This paper presents the results of real-time monitoring of an overhead power line using a distributed temperature sensing system (DTS) and compares these results with spot temperature measurements in order to estimate the loss of accuracy of having less thermal information. This comparison has been carried out in a 30 km long distributed temperature sensing system with fiber optic inside a LA-455 conductor and 6 weather stations placed along the line. An area of influence is defined for each weather station corresponding to the orography of the surroundings. The spot temperatures are obtained from the DTS in the nearest point from the weather stations assuming these six locations to be the ones where the spot temperature measurement equipment would be located. The main conclusion is that, in the case of study, spot measurements are enough to obtain a good approximation of the average temperature of the line conductor

Antipsychotic switching in bipolar disorders: a systematic review.

With the increasingly widespread use of antipsychotics in bipolar disorder (BD), switching among these agents and between antipsychotics and mood stabilizers has become more common, in particular, since the introduction of the novel atypical antipsychotics with mood stabilizer properties. This systematic review aims to provide a comprehensive update of the current literature in BD about the switching of antipsychotics, among them and between them and mood stabilizers, in acute and maintenance treatment. We conducted a comprehensive, computerized literature search using terms related to antipsychotic switching in BD in the PubMed/Medline, PsycINFO, CINAHL database; the Cochrane Library and; the Clinicaltrials.gov web up to January 9th, 2013 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search returned 4160 articles. After excluding duplications, reviews, case reports and studies that did not fulfil the selection criteria, 8 studies were included. Not only have few articles on antipsychotic switching been published but also recruitment in most studies included mixed samples of patients. In general, antipsychotic switching, regardless of the route of drug administration, was well tolerated and no interference was shown in antipsychotic effectiveness during the interchange of drugs. Metabolic improvement was perceived when the switch involved antipsychotics with a low metabolic risk profile. The evidence-base for antipsychotic switching in BD is scant, and little controlled data is available. Switch from quetiapine to lithium and from risperidone to olanzapine has proven successful. Switching to antipsychotics with low metabolic risk had some positive impact on several safety measures. In stabilized patients, the plateau cross-taper switch may be preferred. PsycINFO, CINAHL database; the Cochrane Library and; the Clinicaltrials.gov web up to January 9th, 2013 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search returned 4160 articles. After excluding duplications, reviews, case reports and studies that did not fulfil the selection criteria, 8 studies were included. Not only have few articles on antipsychotic switching been published but also recruitment in most studies included mixed samples of patients. In general, antipsychotic switching, regardless of the route of drug administration, was well tolerated and no interference was shown in antipsychotic effectiveness during the interchange of drugs. Metabolic improvement was perceived when the switch involved antipsychotics with a low metabolic risk profile. The evidence-base for antipsychotic switching in BD is scant, and little controlled data is available. Switch from quetiapine to lithium and from risperidone to olanzapine has proven successful. Switching to antipsychotics with low metabolic risk had some positive impact on several safety measures. In stabilized patients, the plateau cross-taper switch may be preferred