¿Es posible reducir el gasto sanitario a través del subsidio a los seguros sanitarios privados? La doble cobertura sanitaria en Catalunya. Estimación de patrones de utilización de servicios sanitarios y simulación de costes asociados a la asistencia

The objective of this study consists in quantifying in money terms the potential reduction in usage of public health care outlets associated to the tenure of double (public plus private) insurance. In order to address the problem, a probabilistic model for visits to physicians is specified and estimated using data from the Catalonian Health Survey. Also, a model for the marginal cost of a visit to a physician is estimated using data from a representative sample of fee-for-service payments from a major insurer. Combining the estimates from the two models it is possible to quantify in money terms the cost/savings of alternative policies which bear an impact on the adoption of double insurance by the population. The results suggest that the private sector absorbs an important volume of demand which would be re-directed to the public sector if consumers cease to hold double insurance.Insurance, health, care

Vegetació i fauna de la gran bassa del parc urbà de Can Solei i Ca l’Arnús (Badalona): una introducció a la biodiversitat ciutadana

El parc de Can Solei i Ca lArnús és un parc urbà de làrea metropolitana de Barcelona, situat a la ciutat de Badalona. Al parc hi trobem una bassa daigua permanent, de grans dimensions i amb una elevada cobertura vegetal, la qual té un gran potencial com a reservori de biodiversitat. Aquest punt calent de biodiversitat al mig de la ciutat té un gran valor tant per mantenir lequilibri de lecosistema com pel que fa als serveis ecosistèmics als quals ens permet accedir, com pot ser loportunitat que ofereix per dur a terme educació ambiental a diferents nivells, estant en contacte amb la natura, la flora i la fauna que ens envolta. Així doncs, en aquest treball sha estudiat tant la vegetació com la fauna de la bassa, a partir duna sèrie dobservacions al parc per conèixer si la bassa és realment un punt calent de biodiversitat dins duna zona urbana, i quins són els principals impactes que poden limitar el seu potencial. Daltra banda, també shan dissenyat una sèrie de diorames i recursos divulgatius a partir dels resultats de lestudi de la fauna i la flora, que shan elaborat amb lobjectiu de proporcionar eines perquè la ciutadania conegui la gran diversitat dorganismes que existeixen en aquesta zona i, daquesta manera, sen fomenti la seva conservació. Els resultats obtinguts mostren lelevada biodiversitat que hi ha a la zona de la bassa del parc i, en conseqüència, la necessitat de conservar i gestionar adequadament lespai pel seu alt valor ecològic i ambiental dins la ciutat.The park of Can Solei and Ca lArnús is an urban park in the metropolitan area of Barcelona, located in the city of Badalona. In the park there is a large pond with permanent water and a high vegetation cover, which has great potential as a reservoir of biodiversity. This biodiversity hotspot in the middle of the city has great value in maintaining the balance of the ecosystem. It also has a great value in terms of the ecosystem services it allows us to access and the opportunity it offers to provide environmental education at different levels, by being in contact with the nature, flora and fauna that surrounds us. Therefore, this research has studied both the vegetation and fauna of the pond, based on a series of observations in the park to find out whether the pond is really a biodiversity hotspot in an urban area, and what are the main impacts that may limit its potential. On the other hand, a series of dioramas and informative resources have also been designed based on the results of the study of the fauna and flora, which have been developed with the aim of providing tools for the public to learn about the great diversity of organisms that exist in this area and, in this way, to promote their conservation. The results obtained show the high biodiversity that exists in the parks pond area and, consequently, the need to conserve and manage the space properly due to its high ecological and environmental value within the city

Large monolithic silica-based macrocellular foams with trimodal pore system

Silica-based materials with hierarchical pore systems at three different length scales (small mesopores–large mesopores–macropores) have been prepared through a nanotectonic approach by using mesoporous nanoparticles as building blocks; the resulting materials present a highly accessible foam-like architecture and can be prepared as large monoliths.Huerta Morillo, Lenin Jose, [email protected] ; Latorre Saborit, Julio, [email protected] ; Beltran Porter, Aurelio, [email protected] ; Beltran Porter, Daniel, [email protected] ; Amoros del Toro, Pedro Jose, [email protected]

Tuning the pore size from micro- to meso-porous in thermally stable aluminophosphates

Thermally stable porous aluminophosphates (ICMUV-3) with P/Al molar ratios in the range 0.15 <= P/Al <= 0.75 and showing continuously adjustable pore sizes from 13 to 37 Å have been prepared through a surfactant-assisted procedure without changing the surfactant length and/or addition of organic expansors.Cabrera Medina, Saul, [email protected] ; El Haskouri, Jamal, [email protected] ; Beltran Porter, Aurelio, [email protected] ; Beltran Porter, Daniel, [email protected] ; Amoros del Toro, Pedro Jose, [email protected]

Towards the Loewenstein limit (Si/Al = 1) in thermally stable mesoporous aluminosilicates

The use of complexing agents to generate polynuclear precursor species containing both Al and Si allows the synthesis of thermally stable mesoporous aluminosilicates including solely tetrahedrally coordinated aluminium, in which the Si/Al ratio can be modulated down to a minimum Si/Al value of 1.06(4).Cabrera Medina, Saul, [email protected] ; El Haskouri, Jamal, [email protected] ; Latorre Saborit, Julio, [email protected] ; Beltran Porter, Aurelio, [email protected] ; Beltran Porter, Daniel, [email protected] ; Amoros del Toro, Pedro Jose, [email protected]

Silica-based powders and monoliths with bimodal pore systems

Porous pure and doped silicas with pore sizes at two length scales (meso/macroporous) have been prepared and shaped both as powders and monoliths through a one-pot surfactant assisted procedure by using a simple template agent and starting from atrane complexes as inorganic precursors.El Haskouri, Jamal, [email protected] ; Latorre Saborit, Julio, [email protected] ; Beltran Porter, Aurelio, [email protected] ; Beltran Porter, Daniel, [email protected] ; Amoros del Toro, Pedro Jose, [email protected]

Synthesis of monoclinic Celsian from coal fly ash by using a one-step solid-state reaction

Monoclinic (Celsian) and hexagonal (Hexacelsian) Ba1−xSrxAl2Si2O8 solid solutions, where x = 0, 0.25, 0.375, 0.5, 0.75 or 1, were synthesized by using Coal Fly Ash (CFA) as main raw material, employing a simple one-step solid-state reaction process involving thermal treatment for 5 h at 850–1300 °C. Fully monoclinic Celsian was obtained at 1200 °C/5 h, for SrO contents of 0.25 ≤ x ≤ 0.75. However, an optimum SrO level of 0.25 ≤ x ≤ 0.375 was recommended for the stabilization of Celsian. These synthesis conditions represent a significant improvement over the higher temperatures, longer times and/or multi-step processes needed to obtain fully monoclinic Celsian, when other raw materials are used for this purpose, according to previous literature. These results were attributed to the role of the chemical and phase constitution of CFA as well as to a likely mineralizing effect of CaO and TiO2 present in it, which enhanced the Hexacelsian to Celsian conversion

COVID-19 outbreaks in a transmission control scenario: challenges posed by social and leisure activities, and for workers in vulnerable conditions, Spain, early summer 2020

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

The socioeconomic determinants of health: economic growth and health in the OECD countries during the last three decades

In times of economic crisis, most countries face the dual challenge of fighting unemployment while restraining social expenditures and closing budget deficits. The spending cuts and lack of employment affect a large number of decisions that have a direct or indirect impact on health. This impact is likely to be unevenly distributed among different groups within the population, and therefore not only health levels may be at risk, but also their distribution. The main purpose of this paper is to explore links between unemployment, economic growth, inequality, and health. We regress a measure of health, the Health Human Development Index (HHDI), against a set of explanatory variables accounting for the countries’ economic performance (GDP growth, unemployment, and income inequality), and some institutional factors related to welfare spending and the nature of the health systems for the past three decades. In addition, we explore the causes for different results obtained using an inequality-adjusted HHDI, vs. the unadjusted HHDI. We describe a panel data model, estimated by random effects, for 32 countries from 1980–2010, in five-year intervals. Our conclusion is that the high economic growth observed in the last decades, together with an increase in the levels of income inequality and/or poverty, explain the observed changes of our index, particularly when this indicator is weighted by health inequality. The remaining institutional variables (the share of social spending, health care expenditure, and the type of health systems) show the expected sign but are not statistically significant. A comment on the methodological pitfalls of the approach completes the analysis