¿Afecta el copago sanitario a la equidad?

En un entorno de crisis económica y signos de agotamiento financiero del sistema sanitario, analizamos una de las medidas que con mayor insistencia se propone para su sostenibilidad: el copago, y estudiamos si su implantación afecta a los principios de bioética, en particular a la equidad, comprendida en el principio de justicia. Hemos encontrado relación causa/efecto entre la medida y la lesión de la equidad, sin que, por otra parte quede claro que el copago puede convertirse en un instrumento de peso para el mantenimiento financiero del sistema. Además, de todo lo estudiado y observado, no parece evidente que el sistema nacional de salud español esté en quiebra ya que sus dificultades financieras son solventables sin tener que renunciar a los beneficios para la población de un modelo público que ha contribuido –y lo hará, seguro, en el futuro- de forma innegable a la mejora de la salud de los ciudadanos de nuestro país.Considering the current environment of economic crisis and signs of financial exhaustion of the Spanish health system, it has been analyzed one of the most insistently proposed measure for economic sustainability: the copayment. It has been studied whether its implementation affects the bioethical principles, particularly equity, within the principle of social justice. A cause and effect relationship between the co-payment measure and equity damage has been found. However, it is clear that copayment can become an appropriate instrument for the financial sustainability of the health system. Furthermore, from our study it can be concluded that the Spanish national health system is not in bankrupt and that its financial difficulties can be solved without having to give up the social benefits of a public health model for the population. This health system has contributed-and will, sure, in future, continue to improving the health of the citizens of the country

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Background: Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods: A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results: Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions: This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Number and types of fishing gears in San Miguel Bay: Trends over time and space

A bay wide census was conducted at 79 barangays in 7 coastal municipalities bordering San Miguel Bay in the Bicol Region to determine the current number and types of fishing gear used in the bay. The results were compared with data obtained in previous assessments in 1980, 1992 and 1995 to identify important factors influencing temporal trends in use patterns of the fisheries resources in the bay. Results show that a total of 6,712 gear units distributed to at least 33 distinct gear types under 13 major types were employed in the bay. The major types of gear include 8 variants of gillnets, several types of trawl, based on size, hook and line, scissor nets, and longline. The most widely used gears in the bay were the bottom-set gillnet, crab gillnet, shrimp gillnet, mini trawl, hook and line, bottom-set longline, hunting gillnet, plain gillnet, and filter net. More than 85% of the total number of gears was based in 4 of 7 municipalities, namely, Mercedes, Siruma, Calabanga and Tinambac. The present number of fishers in the bay stands at 7,033 and translate into densities of I fisher per 16 hectares of fishing ground. The analysis of the temporal trend showed that the number of gears reported in 1995 was highly questionable and inconsistent with the rate of population growth in the coastal municipalities. When this data was disregarded, the temporal trend of the total number of gears consistently and steadily increased from I 980 to 200 I at an annual average of 3.32%, a rate consistent with population growth rates for the area. Trends in the use patterns of fisheries resources in the bay indicate a shift towards smaller gears such as increases in the number of smaller trawls, scissor nets, hook and line, and longlines in the past decade

Escritura de convenio otorgada por Gustavo de Gispert de una parte y José Oriol Estruch, Gabriel Cañadó y Luciano Pondevida en calidad de comisionador de los acrehedores [sic] de la empresa del Teatro del Liceo, que comenzó en 4 de abril de 1847, autorizada por Francisco Javier Moreu, notario, 16 de febrero de 1858

Inclou document de venda davant de Mariano Homar, notari, 11 de març 185