The Black Box of Business Dynamics

Research in business dynamics has been advancing rapidly in the last years but the translation of the new knowledge to industrial policy design is slow. One striking aspect in the policy area is that although research and analysis do not identify the existence of an specific optimal rate of business creation and business exit, governments everywhere have adopted business start-up support programs with the implicit principle that the more the better. The purpose of this article is to contribute to understand the implications of the available research for policy design. Economic analysis has identified firm heterogeneity as being the most salient characteristic of industrial dynamics, and so a better knowledge of the different types of entrepreneur, their behavior and their specific contribution to innovation and growth would enable us to see into the ‘black box’ of business dynamics and improve the design of appropriate public policies. The empirical analysis performed here shows that not all new business have the same impact on relevant economic variables, and that self-employment is of quite a different economic nature to that of firms with employees. It is argued that public programs should not promote indiscriminate entry but rather give priority to able entrants with survival capacities. Survival of entrants is positively related to their size at birth. Innovation and investment improve the likelihood of survival of new manufacturing start-ups. Investment in R&D increases the risk of failure in new firms, although it improves the competitiveness of incumbents.Industrial dynamics, industrial policy, creative destruction, business demography.

Putting health in all policies: The National Institute for Welfare Enhancement

Welfare is a rather vague term whose meaning depends on ideology, values and judgments. Material resources are just means to enhance people’s well-being, but growth of the Gross Domestic Production is still the standard measure of the success of a society. Fortunately, recent advances in measuring social performance include health, education and other social outcomes. Because “what we measure affects what we do” it is hoped that social policies will change. The movement Health in all policies and its associated Health Impact Assessment methodology will contribute to it. The task consists of designing transversal policies that consider health and other welfare goals, the short term and long-term implications and intergenerational redistributions of resources. As long as marginal productivity on health outside the healthcare system is higher than inside it, efficiency needs cross-sectoral policies. And fairness needs them even more, because in order to reduce social inequalities in health, a wide social and political response is needed. Unless we reduce the well-documented inefficiencies in our current health care systems the welfare states will fail to consolidate and the overall economic wellbeing could be in serious trouble. In this article we sketched some policy solutions such as pricing according to net benefits of innovation and public encouragement of radical innovation besides the small type incremental and market-led innovation. We proposed an independent agency, the National Institute for Welfare Enhancement to guarantee long term fair and efficient social policies in which health plays a central role.Public health policies; Health Impact Assessment; Welfare; Health in All Policies.

Effect of disinfectant benzalkonium chloride on freshwater microalgae "Scenedesmus quadricauda" (Turpin) Brebisson

[Resumen] El cloruro de benzalconio es utilizado frecuentemente como producto de limpieza y desinfección. Su uso intensivo puede provocar la contaminación de los medios acuáticos. Esto nos ha llevado a investigar su potencial efecto toxico sobre la microalga dulceacuícola S. quadricauda. Para este objetivo, se estudió el crecimiento, la concentración de pigmentos fotosintéticos y la actividad celular para detectar la toxicidad de cinco concentraciones del desinfectante comprendidas entre 0.25-4 mg L-1 en cultivos discontinuos. Los resultados obtenidos muestran que la tasa de crecimiento de S. quadricauda disminuye significativamente en presencia de cloruro de benzalconio, y se obtiene un valor de EC50 de 3.75 mg L-1 después de 192 horas de exposición. El contenido celular de pigmentos también está afectado negativamente, decreciendo significativamente en cultivos expuestos a concentraciones superiores a 1 mg L-1; esto puede ser debido al mecanismo de acción del desinfectante sobre las membranas tilacoidales. La actividad celular también se ha visto afectada por la presencia del desinfectante.[Abstract] Benzalkonium chloride is often used as a cleaning and desinfecting product. The intensive use of this disinfectant may cause pollution of aquatic environments. Therefore, the potenctial toxic effect of benzalconium chloride on the freshwater microalgae S. quadricauda was investigated. Growth, photosynthetic pigments content and cellular activity were assayed with five disinfectant concentrations between 0.25-4 mg L-1 on batch cultures. Control cultures withouth disinfectant were also included. Growth rate of S. quadricauda significantly decreased in presence of benzalkonium chloride, and the EC50 was 3.75 mg L-1 after 192 hours of exposure. Photosynthetic pigments content was also adversely affected, decreasing significantly in cultures exposed to concentrations above 1 mg L- 1. This decrease may be due to the mechanism of action of the disinfectant on thylakoid membranes. Cellular activity was also affected by the presence of the disinfectant.Traballo fin de grao (UDC.CIE). Bioloxía. Curso 2014/201

Quantification of mitochondrial DNA in plasma in Human Immunodeficiency Virus (HIV) infected patients

[Resumen:] Objetivos: Evaluar los niveles de ADN mitocondrial (ADNmt) circulante en plasma en pacientes con infección por VIH y su posible implicación como biomarcador del estado inmunológico-virológico. Métodos: Estudio observacional realizado en una cohorte de pacientes con infección crónica por VIH, en seguimiento clínico en el Complejo Hospitalario Universitario de A Coruña (CHUAC). El ADNmt se aisló a partir de plasma usando DNAeasy blood & tissue kit. Los niveles de ADNmt se midieron empleando un ensayo cuantitativo de reacción en cadena de la polimerasa (PCR) a tiempo real analizando el número de copias de gen ribosómico 12S mitocondrial. Además, se evaluó la carga viral del VIH (ARN-VIH) y el recuento de linfocitos T-CD4+ de cada una de las muestras. Se incluyeron variables epidemiológicas y clínicas de los pacientes para el análisis. Resultados: Se incluyeron 235 pacientes con infección por VIH. El 31,9% eran naïve a tratamiento antirretroviral (TAR) mientras que el resto de los pacientes recibían TAR. Dentro de este último grupo presentaban: el 20,9% niveles de ARN-VIH entre 20-200 copias/mL, el 23% niveles inferiores a 20 copias/mL (detectable no cuantificable, DNQ) y el 24,2% viremia no detectable (ND). Los niveles de ADNmt en los diferentes grupos de pacientes fueron: 217±656 copias/μl en pacientes naïve, 149±440 copias/μL en pacientes con ARN-VIH entre 20-200 copias/mL, 265±723 copias/μL en DNQ y 643±1310 copias/μL en ND (p = 0,045). Los niveles plasmáticos de ADNmt entre los pacientes ND y los naïve presentaron diferencias significativas (p = 0,010). Los niveles de ADNmt se asociaron de forma inversa con los niveles de ARN-VIH (Spearman's rho -0,191, p = 0,003) y de forma directa con el recuento de linfocitos T-CD4+ (Spearman's rho 0,131, p = 0,046). Conclusión: Los pacientes VIH que habían alcanzado la supresión virológica con TAR tenían niveles más altos de ADNmt que los pacientes naïve. Por otra parte, los niveles plasmáticos elevados de ADNmt se asociaron con menores niveles de ARN-VIH y mayor recuento de linfocitos T-CD4+. Estos datos sugieren que los niveles de ADNmt podrían ser un marcador de la replicación del VIH.[Abstract:] Objective: To evaluate plasma mitochondrial DNA (mtDNA) levels among HIV-patients and its potential role as biomarker of immune-virological status. Methods: An observational study performed in a cohort of patients with chronic HIV infection in follow-up at the Hospital Complex of A Coruña. DNA was isolated from plasma using DNAeasy blood&tissue kit (Qiagen, Germany) and mtDNA levels were assessed using a quantitative Real-Time PCR assay by measuring the copy number of mitochondrial 12S ribosomal RNA gene. In addition, HIV-RNA and lymphocytes T-CD4+ counts were evaluated in the same blood sample. Results: A total of, 235 HIV-patients were included. Overall, 31,9% were naïve while the remaining patients were under ART: 20,9% with 20-200 copies/mL of HIV-RNA, 23% had HIV-RNA <20 copies/mL (detected not quantified-DNQ) and 24,2% had HIV-RNA not-detected (ND). Mean plasma mtDNA was 149±440 copies/μL for 20-200 copies/mL of HIV-RNA, 217±656 copies/μL for naïve, 265±723 copies/μL for DNQ, and 643±1310 copies/μL for ND (p=0,045). In addition, differences were observed between plasma mtDNA levels among ND HIV-patients compared with naïve (p=0,010) and also with 20-200 copies/mL of HIV-RNA under ART (p=0,057). Interestingly, mtDNA levels were inversely associated with HIV-RNA levels (Spearman´s rho -0,191, p=0,003) and directly associated with lymphocytes T-CD4+ count (Spearman´s rho 0,131, p=0,046). Conclusions: HIV-patients with a complete virological suppression under ART had significant higher mtDNA levels than naïve patients. Moreover, Increased plasma mtDNA levels are associated with lower HIV-RNA levels and higher lymphocytes T-CD4+ count. These data suggest that plasma mtDNA levels could be a surrogate marker of HIV replication.Traballo fin de mestrado (UDC.CIE). Biotecnoloxía avanzada. Curso 2016/201

Patentes, regulación de precios e innovación en la industria farmacéutica

The trade-off between property rights/price regulation and innovation depends on country characteristics and drug industry specificities. Access to drugs and innovation can be reconciled by seven ways that, among others, include: public health strengthening in the countries with the largest access problems (those among the poor with the weakest institutions); public and private aid to make attractive R&D on neglected diseases; price discrimination with market segmentation; to require patent owners to choose either protection in the rich countries or protection in the poor countries (but not both). Regarding price regulation, after a review of theoretical arguments and empirical evidence, seven strategies to reconcile health and industrial considerations are outlined, including: mitigation of the medical profession dependence on the pharmaceutical industry; consideration of a drug as an input of a production process; split drug authorization from public funding decisions; establish an efficiency minimum for all health production inputs; and stop the European R&D hemorrhagia.I+D farmacéutico, acceso a medicamentos, patentes, regulación de precios, política industrial, política sanitaria

Desigualdad y salud

Sin resume

Design and Analysis of Health Products and Services: An Example at a Specialized COPD Unit

Health care demands have increased dramatically in recent decades. With the introduction of major changes in the management of health problems, health care costs have spiralled. Today, in the interests of cost control, medicine is geared towards outpatient care whenever possible

Financiación capitativa, articulación entre niveles asistenciales y descentralización de las organizaciones sanitarias

Public organisations are subjected to weak incentives for competition. Therefore, institutional Darwinism cannot apply. Regulation and performance monitoring is required to protect the public interest. This is particularly the case of organisations in the health care arena, since strong incentives may risk the whole supply of public health services. Regarding to the path dependence of the Spanish public health institutions with respect to the international experience and the observed health technological changes, this paper tries to ground some theoretical bases for the organisational change in our health system. We do this by building our argument from the very basic public goal: the improvement of the health status of the Spanish population. This requires a better integration of health care services. To this regard, capitation in finance shows some comparative advantages: it takes an integral view for the care of the population, it allows for a better decentralisation ('deconcentration') of risks to health providers and favours managed care under a global perspective, replacing partial payment to different providers. However, the paper shows some potential limitations for this purpose and the need of a gradual strategy for its implementation.The Spanish health system, capitation financing, incentives in health care management

Padres Competentes, Hijos Protegidos: Evaluación de Resultados del Programa “Viviendo en Familia”

Resumen“Viviendo en Familia” es un programa dirigido a fortalecer una parentalidad positiva y bientratante, que aborda situaciones de maltrato infantil, negligencia y violencia intrafamiliar desde el enfoque Ecosistémico de la Resiliencia Familiar. El estudio evaluó los resultados del programa en 543 casos atendidos entre enero 2008 y julio 2010; usando mediciones pre-post intervención con la Escala de Evaluación Familiar de Carolina del Norte, NCFAS (Valencia y Gómez, 2010). Todos los indicadores de protección infantil mostraron una mejoría estadísticamente significativa (p<.001), salvo violencia de pareja; con mayores resultados en maltrato emocional y negligencia parental. En los indicadores globales NCFAS (entorno, competencias parentales, interacciones familiares, seguridad familiar y bienestar del niño), hubo un desplazamiento significativo (p<.001) hacia el rango de fortaleza. De 31 variables evaluadas, las familias promediaron 5,9 problemas moderado/graves al ingreso, disminuyendo a 2,2 al finalizar (p<.001). De los casos que completaron la intervención, la tasa acumulativa de reingreso a programas de la red SENAME fue 3,4% a 6 meses, 4,7% a 12 meses y 6,5% a los 18 meses de seguimiento. Se obtuvo mayores niveles de logro en función del grado de fidelidad de los equipos al diseño, siendo un desafío a considerar.Abstract“Viviendo en Familia” is a program aimed at strengthening a positive and well-treating parenting, which addresses situations of child abuse, neglect and domestic violence, from the ecosystem approach of Family Resilience. The study evaluated the program results in 543 cases treated between January 2008 and July 2010; using pre-post intervention measurements with the North Carolina Family Assessment Scale, NCFAS (Valencia & Gómez, 2010). All child protection indicators showed a statistically significant improvement (p<.001), except couple violence, with greater outcomes in emotional abuse and parental neglect. In NCFAS global dimensions (environment, parental competencies, family interactions, family safety and child well-being), there was a significant shift (p<.001) to the range of strength. Of the 31 variables evaluated, families averaged 5.9 moderate/serious problems at admission, decreasing to 2.2 at discharge (p<.001). Of the cases that completed the intervention, the cumulative rate of relapse to SENAME network programs was 3.4% at 6 months, 4.7% at 12 months and 6.5% at 18 months follow up. We obtained higher levels of achievement based on the degree of staff's fidelity to the program design, being a challenge to consider

The impact of Economics on health policy and management in Spain

Background Despite the intrinsic value of scientific disciplines, such as Economics, it is appropriate to gauge the impact of its applications on social welfare, or at least –Health Economics’ (HE) case- its influence on health policy and management. Methods The three relevant features of knowledge (production, diffusion and application) are analyzed, more from an ‘emic’ perspective –the one used in Anthropology relying on the experience of the members of a culture- than from an ‘etic’ approach seated on material descriptions and dubious statistics. Results The soundness of the principles and results of HE depends on its disciplinary foundations, whereas its relevance –than does not imply translation into practice- is more linked with the problems studied. Important contributions from Economics to the health sphere are recorded. HE in Spain ranks seventh in the world despite the relatively minor HE contents of its clinical and health services research journals. HE has in Spain more presence than influence, having failed to impregnate sufficiently the daily events. Conclusions HE knowledge required by a politician, a health manager or a clinician is rather limited; the main impact of HE could be to develop their intuition and awareness.Health Economics, Health Policy and Management, Spain