SISTEMA NACIONAL DE SALUD ESPAÑOL. CARACTERÍSTICAS Y ANÁLISIS.

The Health General Law 14/1986 of April 25 made possible the step from the old Social Security model to the current Health National System model. Since then it has taken place deep changes of the system which culminate in 2002 in the total decentralization of the Comunidades Autonomas health competitions. The result of the current legislative frame is the competitions decentralization and budgets management whith a possible variability of the CCAA management models, which shows us the need to monitor a follow-up that make possible to evaluate the System competitions decentralization in the next ten years.La Ley General de Sanidad 14/1986 de 25 de Abril posibilitó el tránsito del antiguo modelo de Seguridad Social al actual modelo de Sistema Nacional de Salud (SNS).Desde entonces se han producido profundos cambios en el sistema que culminaron en el año 2002 con la descentralización total de competencias en materia de salud en las Comunidades Autónomas, resultando del actual marco legislativo la descentralización de competencias y gestión de los presupuestos con una posible variabilidad en los modelos de gestión de cada CCAA, que plantea la necesidad de monitorizar un seguimiento que permita evaluar en los próximos diez años el impacto de la descentralización de competencias del Sistema.

Planificación de la producción basada en control predictivo para plantas termosolares

[Resumen] Se presenta una estrategia basada en control predictivo para resolver la planificación de la producción en plantas termosolares con almacenamiento térmico participando en el mercado diario de electricidad. Mediante esta estrategia, la producción de electricidad es actualizada regularmente haciendo uso del estado actual de la planta y de las más recientes predicciones para el precio de la energía y el recurso solar. La estrategia propuesta se aplica, en un contexto de simulación, a una planta basada en colectores cilindro-parabólicos de 50 MW con almacenamiento térmico bajo las hipótesis de predicción perfecta de precios y participación en el mercado diario español. Se ha analizado un caso de estudio basado en un periodo de cuatro meses con el propósito de abarcar una gran variedad de condiciones meteorológicas. Se han empleado valores reales para los precios de la energía, los costes de penalización, el recurso solar y su predicción. Los resultados muestran una mejora económica significativa frente a la tradicional estrategia a un día vista.Ministerio de Economia y Competitividad; DPI2016-76493-C3-2-

On the Practical Limitations for the Generation of Gunn Oscillations in Highly Doped GaN Diodes

Planar Gunn diodes based on doped GaN active layers with different geometries have been fabricated and characterized. Gunn oscillations have not been observed due to the catastrophic breakdown of the diodes for applied voltages around 20-25 V, much below the bias theoretically needed for the onset of Gunn oscillations. The breakdown of the diodes has been analyzed by pulsed I-V measurements at low temperature, and it has been observed to be almost independent of the geometry of the channels, thus allowing to discard self-heating effects as the origin of the device burning. The other possible mechanism for the device failure is impact-ionization avalanche due to the high electric fields present at the anode corner of the isolating trenches. However, Monte Carlo simulations using the typical value of the intervalley energy separation of GaN, ε_(1-2)=2.2 eV, show that impact ionization mechanisms are not significant for the voltages for which the experimental failure is observed. But recent experiments showed that ε_(1-2) is lower, around 0.9 eV. This lower intervalley separation leads to a much lower threshold voltage for the Gunn oscillations, not far from the experimental breakdown. Therefore, we attribute the devices failure to an avalanche process just when Gunn domains start to form, since they increase the population of electrons at the high electric field region, thus strongly enhancing impact ionization mechanisms which lead to the diode failure

Mercury, cadmium, and lead levels in human placenta: a systematic review

BACKGROUND: Placental tissue may furnish information on the exposure of both mother and fetus. Mercury (Hg), cadmium (Cd), and lead (Pb) are toxicants of interest in pregnancy because they are associated with alterations in child development. OBJECTIVES: The aim of this study was to summarize the available information regarding total Hg, Cd, and Pb levels in human placenta and possible related factors. METHODS: We performed a systematic search of PubMed/MEDLINE, EMBASE, Lilacs, OSH, and Web of Science for original papers on total Hg, Cd, or Pb levels in human placenta that were published in English or Spanish (1976-2011). Data on study design, population characteristics, collection and analysis of placenta specimens, and main results were extracted using a standardized form. RESULTS: We found a total of 79 papers (73 different studies). Hg, Cd, and Pb levels were reported in 24, 46, and 46 studies, respectively. Most studies included small convenience samples of healthy pregnant women. Studies were heterogeneous regarding populations selected, processing of specimens, and presentation of results. Hg concentrations > 50 ng/g were found in China (Shanghai), Japan, and the Faroe Islands. Cd levels ranged from 1.2 ng/g to 53 ng/g and were highest in the United States, Japan, and Eastern Europe. Pb showed the greatest variability, with levels ranging from 1.18 ng/g in China (Shanghai) to 500 ng/g in a polluted area of Poland. CONCLUSION: The use of the placenta as a biomarker to assess heavy metals exposure is not properly developed because of heterogeneity among the studies. International standardized protocols are needed to enhance comparability and increase the usefulness of this promising tissue in biomonitoring studies.We thank the librarians of the Móstoles Hospital and of the National Health Sciences Library (ISCIII).S

ESPACIO EUROPEO DE EDUCACIÓN SUPERIOR. Situación actual. Marco legislativo.

Nowadays the number of nursing schools including in their study plans the Practicum subjects are increasing. These subjects are devoted to clinical practice and the majority of practical credits belonging to clinical subjects are concentrated on them. The reasons for it are that these subjects link the learning methodology proposed by the European Space for Higher Education. In the present work, which is a continuation of a previous one published in this journal, we propose a Teaching Project to give the Medical-Surgical Nursing clinical practicum of the study plans for the Registered Nursing degree. Following the same structure of our previous work, we propose a methodology based on the teaching of competences. The program and the system of credits are in line with the ancient Law of University Reform but they are also compatible with convergent method of the European Space for Higher Education. In the same way, we chose this subject on the grounds of its high credit load on the current study plans (being clinical the majority of them). All this make that steps to achieve convergence for this subject could be used for other nursing subject.El objetivo de este artículo es realizar un análisis de la legislación actual y la repercusión del cambio ya iniciado en algunas titulaciones como es el caso de Enfermería en el marco académico de la Educación Superior, reforma importante del Sistema Universitario Español. Para ello se revisa el contenido y análisis de la documentación publicada en el Ministerio de Educación relativa a Educación Superior; la legislación vigente española y la legislación Comunitaria con objeto de aproximar la legislación al marco de los estudios de enfermería

New horizons in geriatric medicine education and training: the need for pan-European education and training standards

The ageing population ought to be celebrated as evidence for the efficacy of modern medicine, but the challenge that this demographic shift presents for 21st century healthcare systems, with increasing numbers of people living with multi-morbidity and frailty, cannot be ignored. There is therefore a need to ensure that all healthcare professionals grasp the basic principles of care of older people. In this paper, we make a case for the development of pan-European education and training standards for the field of geriatric medicine. Firstly, the challenges which face the implementation and delivery of geriatric medicine in a systematic way across Europe are described – these include, but are not limited to; variance in geriatric medicine practice across Europe, insecurity of the specialty in some countries and significant heterogeneity in geriatric medicine training programs across Europe. The opportunities for geriatric medicine are then presented and we consider how engendering core geriatric medicine competencies amongst nongeriatricians has potential to bridge existing gaps in service provision across Europe. Finally, we consider how work can proceed to teach sufficient numbers of doctors and health professionals in the core knowledge, skills and attitudes required to do this. To safeguard the future of the specialty across Europe, we contend that there is a need to strive towards harmonisation of post-graduate geriatric medicine training across Europe, through the establishment of pan-European education and training standards in the specialty

Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

<p>Abstract</p> <p>Background</p> <p>There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC) utilisation patterns between immigrants and the native population with regard to their morbidity burden.</p> <p>Methods</p> <p>This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain). Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System^®).</p> <p>Results</p> <p>The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p < 0.05; adults: IRR = 0.73, p < 0.05). After adjusting for morbidity burden, this difference decreased among children (IRR = 0.94, p < 0.05) and disappeared among adults (IRR = 1.00). Further analysis considering the PC health service and type of visit revealed higher usage of routine diagnostic tests among immigrant children (IRR = 1.77, p < 0.05) and a higher usage of emergency services among the immigrant adult population (IRR = 1.2, p < 0.05) after adjusting for age, sex and case mix.</p> <p>Conclusions</p> <p>Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.</p

Congruence of tissue expression profiles from Gene Expression Atlas, SAGEmap and TissueInfo databases

BACKGROUND: Extracting biological knowledge from large amounts of gene expression information deposited in public databases is a major challenge of the postgenomic era. Additional insights may be derived by data integration and cross-platform comparisons of expression profiles. However, database meta-analysis is complicated by differences in experimental technologies, data post-processing, database formats, and inconsistent gene and sample annotation. RESULTS: We have analysed expression profiles from three public databases: Gene Expression Atlas, SAGEmap and TissueInfo. These are repositories of oligonucleotide microarray, Serial Analysis of Gene Expression and Expressed Sequence Tag human gene expression data respectively. We devised a method, Preferential Expression Measure, to identify genes that are significantly over- or under-expressed in any given tissue. We examined intra- and inter-database consistency of Preferential Expression Measures. There was good correlation between replicate experiments of oligonucleotide microarray data, but there was less coherence in expression profiles as measured by Serial Analysis of Gene Expression and Expressed Sequence Tag counts. We investigated inter-database correlations for six tissue categories, for which data were present in the three databases. Significant positive correlations were found for brain, prostate and vascular endothelium but not for ovary, kidney, and pancreas. CONCLUSION: We show that data from Gene Expression Atlas, SAGEmap and TissueInfo can be integrated using the UniGene gene index, and that expression profiles correlate relatively well when large numbers of tags are available or when tissue cellular composition is simple. Finally, in the case of brain, we demonstrate that when PEM values show good correlation, predictions of tissue-specific expression based on integrated data are very accurate

An Essential Role for Diet in Exercise-Mediated Protection against Dyslipidemia, Inflammation and Atherosclerosis in ApoE-/- Mice

Diet and exercise promote cardiovascular health but their relative contributions to atherosclerosis are not fully known. The transition from a sedentary to active lifestyle requires increased caloric intake to achieve energy balance. Using atherosclerosis-prone ApoE-null mice we sought to determine whether the benefits of exercise for arterial disease are dependent on the food source of the additional calories.Mice were fed a high-fat diet (HF) for 4.5 months to initiate atherosclerosis after which time half were continued on HF while the other half were switched to a high protein/fish oil diet (HP). Half of each group underwent voluntary running. Food intake, running distance, body weight, lipids, inflammation markers, and atherosclerotic plaque were quantified. Two-way ANOVA tests were used to assess differences and interactions between groups. Exercised mice ran approximately 6-km per day with no difference between groups. Both groups increased food intake during exercise and there was a significant main effect of exercise F((1,44) = 9.86, p<0.01) without interaction. Diet or exercise produced significant independent effects on body weight (diet: F(1,52) = 6.85, p = 0.012; exercise: F(1,52) = 9.52, p<0.01) with no significant interaction. The combination of HP diet and exercise produced a greater decrease in total cholesterol (F(1, 46) = 7.9, p<0.01) and LDL (F(1, 46) = 7.33, p<0.01) with a large effect on the size of the interaction. HP diet and exercise independently reduced TGL and VLDL (p<0.05 and 0.001 respectively). Interleukin 6 and C-reactive protein were highest in the HF-sedentary group and were significantly reduced by exercise only in this group. Plaque accumulation in the aortic arch, a marker of cardiovascular events was reduced by the HP diet and the effect was significantly potentiated by exercise only in this group resulting in significant plaque regression (F1, 49 = 4.77, p<0.05).In this model exercise is beneficial to combat dyslipidemia and protect from atherosclerosis only when combined with diet