¿Es la cartera de servicios un instrumento útil para la asignación de recursos farmacéuticos en atención primaria?

ObjetivoConocer si en ciertos equipos de atención primaria ha existido asociación entre el grado de cobertura en determinados servicios y el gasto en fármacos para las patologías incluidas en ellos.DiseñoEstudio descriptivo, retrospectivo.EmplazamientoAtención primaria. INSALUD. Área 1, Huesca.Mediciones y resultados principalesUsando los datos de coberturas de cartera de servicios de 1999 y de gasto en farmacia por subgrupos terapéuticos durante el período enero-octubre del mismo año se analizó:–El servicio de atención a pacientes crónicos: hipercolesterolemia, y se comparó con el gasto en el subgrupo B04A (hipolipemiantes/antiateromatosos).–El servicio de atención a pacientes crónicos: diabetes, y se comparó con el gasto en los subgrupos A10A (insulinas) y A10B (antidiabéticos orales).El gasto se expresó como gasto ajustado por 100 asegurados, usando para el ajuste los coeficientes del INSALUD (coeficiente activos, 0,732; coeficiente pensionistas, 0,268).La relación entre ambas variables se representó gráficamente por una nube de puntos.La existencia de asociación entre ellas se midió utilizando el coeficiente de correlación de Pearson.No se ha encontrado asociación estadísticamente significativa entre el resultado en coberturas y el gasto en farmacia en estos subgrupos.Hipercolesterolemia/hipolipemiantescoeficiente de Pearson, 0,334; IC del 95%, −0,115 a 0,669.Diabetes/antidiabéticos orales e insulinacoeficiente de Pearson < 0,1.ConclusionesExtraemos dos conclusiones:–Las diferencias en coberturas de los servicios analizados no tienen relación directa con el gasto en fármacos.–La cartera de servicios no resulta un buen método en la asignación de recursos para el consumo de fármacos.ObjectiveTo find whether in certain primary care teams an association exists between the level of coverage in determined services and expenditure on drugs for pathologies included in these services.DesignRetrospective descriptive study.SettingPrimary care, INSALUD, Area 1, Huesca.Measurements and main resultsUsing the data on coverage of the service portfolio in 1999 and pharmacy expenditure by therapeutic sub-groups during January-October of the same year, the following was analysed:–The service caring for chronic patients: Hypercholesterolaemia and comparison with expenditure in sub-group B04A (lipid-lowerers/ anti-atheroma drugs).–The service caring for chronic patients: Diabetes and comparison with expenditure in sub-groups A10A (insulin) and A10B (oral antidiabetic drugs).Expenditure was expressed as cost adjusted per 100 insured persons, using the INSALUD coefficients for the adjustment (active person coefficient: 0.732; pensioner coefficient: 0.268). The relationship between the two variables was represented graphically by a cloud of dots. Association between them was measured by Pearson's correlation coefficient. No statistically significant correlation was found between coverage and pharmacy expenditure in these sub-groups. Hypercholesterolaemia/lipidlowerers: Pearson's coefficient=0.334, 95% CI (−0.115 to 0.669). Diabetes/oral diabetic drugs and insulin: Pearson's coefficient < 0.1.ConclusionsThe differences in coverage of the services analysed bear no direct relationship to pharmacy expenditure. The portfolio of services is not a good method of allocation of pharmaceutical resources

Preliminary results of UV measurements in the high-altitude station Formigal-Sarrios (Pyrenees)

Póster presentado en: WMO Technical Conference on Meteorological and Environmental Instruments and Methods of Observation celebrada del 8 al 11 de octubre de 2018 en Amsterdam

Measuring solid precipitation using heated tipping bucket gauges: an overview of performance and recommendations from WMO‐SPICE

Comunicación presentada en: TECO-2016 (Technical Conference on Meteorological and Environmental Instruments and Methods of Observation) celebrada en Madrid, del 27 al 30 de septiembre de 2016

Air temperature measurements using autonomous self-recording dataloggers in mountainous and snow covered areas

High mountain areas are poorly represented by official weather observatories. It implies that new instruments must be evaluated over snow-covered and strongly insolated environments (i.e. mid-latitude mountain areas). We analyzed uncertainty sources over snow covered areas including: 1) temperature logger accuracy and bias of two widely used temperature sensors (Tinytag and iButton); 2) radiation shield performance under various radiation, snow, and wind conditions; 3) appropriate measurement height over snow covered ground; and 4) differences in air temperature measured among nearby devices over a horizontal band. The major results showed the following. 1) Tinytag performance device (mean absolute error: MAE≈ 0.1–0.2°C in relation to the reference thermistor) was superior to the iButton (MAE≈ 0.7°C), which was subject to operating errors. 2) Multi-plate radiation shield showed the best performance under all conditions (> 90% samples has bias between ±0.5°C). The tube shield required wind (> 2.5ms⁠−1) for adequate performance, while the funnel shield required limited radiation (< 400Wm⁠−2). Snow cover causes certain overheating. 3) Air temperatures were found to stabilize at 75–100cm above the snow surface. Air temperature profile was more constant at night, showing a considerable cooling on near surface at midday. 4) Horizontal air temperature differences were larger at midday (0.5°C). These findings indicate that to minimize errors air temperature measurements over snow surfaces should be carried out using multi-plate radiation shields with high-end thermistors such as Tinytags, and be made at a minimum height above the snow covered ground.This study was funded by the research projects “El papel de la nieve en la hidrología de la peninsula ibérica y su respuesta a procesos de cambio global-HIDROIBERNIEVE-CGL2017-82216-R” and CLIMPY “Characterization of the evolution of climate and provision of information for adaptation in the Pyrenees” (FEDER-POCTEFA)

The WMO SPICE snow-on-ground intercomparison: an overview of sensor assessment and recommendations on best practices

Comunicación presentada en: TECO-2016 (Technical Conference on Meteorological and Environmental Instruments and Methods of Observation) celebrada en Madrid, del 27 al 30 de septiembre de 2016.One of the objectives of the WMO Solid Precipitation Intercomparison Experiment (SPICE) was to assess the performance and capabilities of automated sensors for measuring snow on the ground (SoG), including sensors that measure snow depth and snow water equivalent (SWE). The intercomparison focused on five snow depth sensors (models SHM30, SL300, SR50A, FLS-CH 10 and USH-8) and two SWE sensors (models CS725 and SSG1000) over two winter seasons (2013/2014 and 2014/2015). A brief discussion of the measurement reference(s) and an example of the intercomparisons are included. Generally, each of the sensors under test operated according to the manufacturer’s specifications and compared well with the site references, exhibiting high correlations with both the manual and automated reference measurements. The use of natural and artificial surface targets under snow depth sensors were examined in the context of providing a stable and representative surface for snow depth measurements. An assessment of sensor derived measurement quality and sensor return signal strength, where available as an output option, were analysed to help explain measurement outliers and sources of uncertainty with the goal of improving data quality and maximizing the sensor capabilities. Finally, where possible, relationships are established between the gauge measurement of solid precipitation and the measurement of snow on the ground. This paper will provide a brief summary of these results with more detail included in the WMO SPICE Final Report

Long term measurement of the 222Rn concentration in the Canfranc Underground Laboratory

We report the results of 6 years (2013–2018) of measurements of 222Rn air concentration, relative humidity, atmospheric pressure and temperature in the halls A, B and C of the Canfranc Underground Laboratory (LSC). We have calculated all the Pearson correlation coefficients among these parameters and we have found a positive correlation between the 222Rn concentration and the relative humidity. Both correlated variables show a seasonal periodicity. The joint analysis of laboratory data and 4 years (2015– 2018) of the meteorological variables outside the laboratory shows the correlation between the 222Rn concentration and the outside temperature. The collected information stresses the relevance of designing good Rn-mitigation strategies in current and future experiments at LSC; in particular, we have checked for two years (2017–2018) the good performance of the mitigation procedure of the ANAIS-112 experiment. Finally, we have monitored (2019–2021) for 2 years of live time, the radon-free air provided by the radon abatement system installed in the laboratory.This research was funded by MCIN/AEI/10.13039/501100011033 under Grant PID2019-104374GB-I00; by MINECO-FEDER under Grants FPA2017-83133-P, and FPA2014-55986-P; by MICINN-FEDER under Grants FPA2011-23749; by CONSOLIDER-Ingenio 2010 Programme under Grants MultiDark CSD2009-00064 and CPAN CSD2007-00042; by the University of Zaragoza under Grant UZ2017-CIE-09; by the Spanish Meteorological Agency (AEMET), the Gobierno de Aragón (Group in Nuclear and Astroparticle Physics, ARAID Foundation and I. Coarasa predoctoral grant), the European Social Fund and by the LSC consortium

The extreme snow accumulation in the western Spanish Pyrenees during winter and spring 2013

4 páginasPeer reviewe

Tratamiento endovascular de aneurisma en aloinjerto femoropoplíteo. A propósito de un caso

Introducción. La aparición de aneurismas en los injertos vasculares de vena umbilical humana se describió por primera vez en 1982. El tratamiento más habitual ha sido la cirugía. La llegada de las técnicas endovasculares ha incrementado las posibilidades terapéuticas que podemos ofrecer al paciente así como ha minimizado las complicaciones de la cirugía. Caso clínico. Paciente de 76 años con isquemia crónica de extremidades inferiores, intervenido en varias ocasiones (simpatectomía lumbar izquierda, bypass femoropoplíteo izquierdo a primera porción con politetrafluoroetileno en 1989 y bypass femoropoplíteo izquierdo a tercera porción con bioprótesis homóloga en 1994). Durante el seguimiento apareció dilatación aneurismática en aloinjerto diagnosticado mediante eco-Doppler. Se completó el estudio con tomografía axial computarizada (TAC) y angiografía por resonancia magnética. Como tratamiento, se implantó stent recubierto Viabahn de 8 × 100 mm, quedando el aneurisma completamente excluido. A los seis meses de seguimiento no se aprecian endofugas ni migración, y permanece permeable según eco-Doppler y TAC. Conclusión. El avance en las técnicas endovasculares permite un tratamiento rápido y sencillo de los aneurismas de injertos infrainguinales, especialmente útil en pacientes técnicamente complicados o de alto riesgo quirúrgico

Temps d'educació

Resumen de los autores en catalánEn el presente estudio se describe la experiencia de la implantación de los PGS en la comunidad de Castilla-La Mancha, partiendo de un marco conceptual en el que se describen las modalidades y características de programas. Se detallan los datos obtenidos a través de un estudio empírico que ofrece información sobre los diferentes agentes (profesorado, alumnos, familias) que concurren en dichos Programas de Garantía Social.CataluñaES