Decrecimiento económico como proyecto político: ¿Qué significaría para la Cooperación Internacional en África?

Partiendo de la hipótesis de que el decrecimiento económico podría ser considerado como una alternativa al modelo de desarrollo hegemónico derivado del sistema capitalista, se analiza de una forma crítica el sistema de cooperación internacional al desarrollo desde sus orígenes y lo que significaría el decrecimiento económico para la cooperación internacional al desarrollo en África Subsahariana. Análisis que evidencia las limitaciones teórico-prácticas de los modelos ortodoxos de cooperación, los cuales, hasta la fecha, han sido orientados a dar solución al subdesarrollo. Se postula, desde el decrecimiento económico, una reformulación sistémica de la cooperación internacional con miras a un Ajuste Estructural en el Norte que permita la sostenibilidad social y ecológica a nivel mundial, y por lo tanto, para los países subsaharianos.Starting from the hypothesis that the concept of “degrowth economics” could be considered as an alternative to the hegemonic development model derived from the capitalist system, this thesis starts by a critical analysis of the international development aid system and follows on to analyzing what the concept “degrowth economics” would mean (or what would the proposals) for the international aid system in Sub-Saharan Africa. This analysis presents evidence of the theoretical and practical limitations of the orthodox aid models, which have been designed to solve underdevelopment. From the degrowth economics perspective, a systemic reformulation of the international cooperation is proposed which entails a Structural Adjustment in the North, leading to a redress in the North-South imbalance and social and ecological sustainability worldwide

European consensus of criteria for the evaluation of good practices in chronic conditions

Los sistemas sanitarios reconocen las enfermedades crónicas como uno de sus grandes desafíos de salud del siglo XXI para los sistemas sanitarios. A pesar de ser en gran medida prevenibles, las enfermedades crónicas son importante causa de mortalidad y morbilidad en Europa. En 2015, más de 1,2 millones de personas en los países de la UE murieron por enfermedades y lesiones que podrían haberse evitado a través de políticas de salud pública más fuertes o de una atención médica más efectiva y menos fragmentada. La presente tesis doctoral reporta el desarrollo y resultados de una proceso de consenso internacional cuyo objetivo ha sido desarrollar criterios de evaluación para valorar el potencial de las prácticas clínicas e intervenciones y políticas sanitarias a la hora de disminuir la carga atribuible a las enfermedades crónicas en cuatro áreas de interés: Promoción de la salud y prevención primaria de condiciones crónicas; Intervenciones organizativas enfocadas al tratamiento de pacientes crónicos con condiciones clínicas múltiples; Intervenciones sobre el empoderamiento del paciente; e, Intervenciones y políticas orientadas a mejorar la diabetes (la diabetes se utiliza como condición paradigmática). Con objeto de acordar los criterios de evaluación y otorgarles relevancia distinta en función del dominio de interés, se desarrolló un consenso internacional mediante la técnica Delphi-modificada, en la que participaron 113 expertos de diferentes disciplinas procedentes de 23 países europeos. El proceso de consenso produjo 145 categoría de evaluación (28 categorías en el Delphi de Health promotion and primary prevention of chronic conditions, 50 en el de Organizational interventions aimed at dealing with complex chronic patients with multiple conditions, 28 en el de Patient empowerment interventions with chronic conditions y 39 categorías en el Delphi de diabetes as a case-study) orientadas a valorar cada uno de los citados dominios y ponderarlos en función de cada área de interés. El conjunto de criterios y categorías acordados para el caso paradigmático de Diabetes apoya la hipótesis de que los criterios de valoración son transferibles y aplicables a la evaluación de prácticas, intervenciones y políticas desarrolladas sobre otras condiciones crónicas. Consistentemente con lo observado en otras iniciativas europeas, en este consenso, los criterios relacionados con ‘diseño de la práctica’, ‘evaluación’, ‘sostenibilidad’ y ‘escalabilidad’ parecen ser componentes esenciales en el desarrollo e implementación de buenas prácticas en Europa. Por último, como virtualidad destacable de este proceso de consenso, el componente internacional de las decisiones consensuadas, apoya la posibilidad de que las prácticas evaluadas con los criterios y categorías acordados puedan ser transferidas a cualquier contexto europeo.<br /

The Spanish long-term care system in transition: ten years since the 2006 Dependency Act

At the end of 2006, a new System for Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency (SAAD) was established in Spain through the approval of the Act 39/2006 of 14th December (the Dependency Act, DA). The DA acknowledged the universal entitlement of Spanish citizens to social services. The recent economic crisis added degrees of uncertainty to several dimensions of the SAAD implementation process. Firstly, the political consensus on which its foundation rested upon has weakened. Secondly, implementation of the SAAD was hampered by several challenges that emerged in the context of the economic crisis. Thirdly, the so-called “dependency limbo” (i.e. the existence of a large number of people eligible for benefits but who do not receive them) has become a structural feature of the system. Finally, contrary to the spirit of the DA, monetary benefits have become the norm rather than a last resort. High heterogeneity across regions regarding the number of beneficiaries covered and services provided reveal the existence of regional inequity in access to long-term care services in the country. Broadly, the current evidence on the state of the SAAD suggests the need to improve the quality of governance, to enhance coordination between health and social systems, to increase the system's transparency, to foster citizens’ participation in decision-making and to implement a systematic monitoring of the system

Spanish adaptation of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)

[Abstract] Aim. The stroke and aphasia quality of life scale-39 is an interviewer administered questionnaire that has been developed and validated in the United Kingdom to be applied to patients with chronic aphasia as a consequence of a stroke. The objective of this article was to translate the Stroke and Aphasia Quality of Life-39 Scale (SAQOL-39) into Spanish language, and evaluate its acceptability and reliability. Methods. The cross-cultural adaptation of the SAQOL- 39 into Spanish was carried out by following the translation and back-translation method. Twenty three patients with long-term aphasia due to stroke were tested. The patients were interviewed twice in a period from 2 to 12 days. The acceptability of the Spanish SAQOL- 39 was evaluated by examining the floor/ceiling effects and the missing data. The reliability was assessed by Cronbach’s alpha (internal consistence) and intraclass correlation coefficients (test-retest reliability) for the overall scale and its subdomains. Results. There were no difficulties to translate the original version into Spanish. There was good acceptability demonstrated by minimal missing data and floor/ceiling effects. Test-retest reliability for the overall score, and the subscales scores was 0.949 (0.854-0.944). Internal consistency analysis by Cronbach’s α was 0.950 (0.851-0.900). Conclusion. This small scale study provided preliminary evidence for the acceptability and reliability of the Spanish version of the SAQOL-39. Further testing in larger samples is needed to evaluate the validity of the scale, its sensitivity to change and to confirm its reliability

Evolución de las hospitalizaciones potencialmente evitables por condiciones crónicas en España

ResumenObjetivosAnalizar la evolución de las tasas de hospitalizaciones potencialmente evitables (HPE) que afectan a pacientes crónicos o frágiles en España durante el periodo 2002-2013.MétodosEstudio observacional, ecológico, sobre la evolución de las tasas estandarizadas de hospitalizaciones por seis condiciones clínicas, y su variación, en las 203 áreas sanitarias del Sistema Nacional de Salud.ResultadosEn el periodo estudiado hubo un descenso relativo del 35% en las tasas de HPE, pero la variación sistemática se mantuvo en cifras moderadas, alrededor de un 13% sobre lo esperado por azar. Las admisiones por angina experimentaron la mayor reducción, seguidas de las de asma y enfermedad pulmonar obstructiva crónica. Por el contrario, las hospitalizaciones por deshidratación doblaron su frecuencia.ConclusionesA pesar del descenso observado en las tasas de HPE, sigue existiendo una variación sistemática entre áreas, que apuntaría a un manejo diferencial de las condiciones crónicas que conduciría a resultados sanitarios distintos.AbstractObjectiveTo analyse the trend in potentially avoidable hospitalisations (PAH) in frail patients or those with chronic conditions in Spain during the period 2002-2013.MethodsAn observational, ecological study was conducted to analyse the trend in age-sex standardised rates of PAH affecting six clinical conditions, and their variation, in the 203 health care areas composing the publicly-funded health system in Spain.ResultsDuring the period 2002-2013, overall PAH standardised rates decreased by 35%, but systematic variation remained moderately high, around 13% above that expected by chance. Angina admissions showed the largest reduction, followed by those for asthma and chronic obstructive pulmonary disease. In contrast, the prevalence of admissions for dehydration doubled.ConclusionsDespite the decrease in PAH rates, systematic variation among areas remains, indicating differences in chronic care management that lead to distinct healthcare outcomes

Simulation of Marine Towing Cable Dynamics Using a Finite Elements Method

A numerical model to study the towing maneuver for floating and submerged bodies has been developed. The proposed model is based on the dynamic study of a catenary line moving between two bodies, one body with imposed motion, and the other free to move. The model improves previous models used to study the behavior of mooring systems based on a finite element method by reducing the noise of the numerical results considering the Rayleigh springs model for the tension of the line. The code was successfully validated using experimental results for experimental data from different authors and experiments found in the literature. Sensitivity analysis on the internal damping coefficient and the number of elements has been included in the present work, showing the importance of the internal damping coefficient. As an example of the application of the developed tool, simulations of towing systems on a real scale were analyzed for different setups. The variation of the loads at the towed body and the position of the body were analyzed for the studied configurations. The reasonable results allow us to say that the proposed model is a useful tool with several applications to towing system design, study or optimizationThe authors are grateful to the Spanish Ministry of Economy, Industry and Competitiveness for funding ACOPLE- Analysis of the dynamic behavior of floating wind platforms for design optimization in deep waters (ENE2017-89716-R), within the National Programme for Research, Development and Innovation Aimed at the Challenges of Society (Call 2017). Raúl Guanche also acknowledges financial support from the Ramon y Cajal Program (RYC-2017-23260) of the Spanish Ministry of Science, Innovation and Universities

Severo Ochoa, enzimólogo y fundador de la biología molecular

[ES] Escribir sobre Severo Ochoa, su enorme y significada trayectoria científica y los grandes resultados alcanzados en química fisiológica, enzimología y biología molecular, es una labor sencilla y compleja a la vez. De una parte, porque él mismo trazó su autobiografía en 1980 y porque en su centenario se publicaron dos libros de alcance que recogían datos biográficos más personales (Gómez Santos, 2005) o más científicos (Santesmases, 2005). Además, también varios bioquímicos españoles, discípulos directos e indirectos, han reflejado la personalidad e investigación del Premio Nobel, incluyendo sus impresiones personales. La complejidad, por supuesto, radica en el compendio de toda esta información, el espigado de la misma y su presentación en el espacio establecido para este artículo

Factors associated with hospitalisations in chronic conditions deemed avoidable: Ecological study in the Spanish healthcare system

Objectives: Potentially avoidable hospitalisations have been used as a proxy for primary care quality. We aimed to analyse the ecological association between contextual and systemic factors featured in the Spanish healthcare system and the variation in potentially avoidable hospitalisations for a number of chronic conditions. Methods: A cross-section ecological study based on the linkage of administrative data sources from virtually all healthcare areas (n=202) and autonomous communities (n=16) composing the Spanish National Health System was performed. Potentially avoidable hospitalisations in chronic conditions were defined using the Spanish validation of the Agency for Health Research and Quality (AHRQ) preventable quality indicators. Using 2012 data, the ecological association between potentially avoidable hospitalisations and factors featuring healthcare areas and autonomous communities was tested using multilevel negative binomial regression. Results: In 2012, 151 468 admissions were flagged as potentially avoidable in Spain. After adjusting for differences in age, sex and burden of disease, the only variable associated with the outcome was hospitalisation intensity for any cause in previous years (incidence risk ratio 1.19 (95% CI 1.13 to 1.26)). The autonomous community of residence explained a negligible part of the residual unexplained variation (variance 0.01 (SE 0.008)). Primary care supply and activity did not show any association. Conclusions: The findings suggest that the variation in potentially avoidable hospitalisations in chronic conditions at the healthcare area level is a reflection of how intensively hospitals are used in a healthcare area for any cause, rather than of primary care characteristics. Whether other non-studied features at the healthcare area level or primary care level could explain the observed variation remains uncertain