Los costes socioeconómicos de la diabetes mellitus

ObjetivoEvaluar el impacto económico en términos de costes directos (costes de la asistencia sanitaria) y costes indirectos (efectos sobre la producción provocados por la mortalidad y morbilidad) de la diabetes mellitus (DM) en Canarias durante el año 1998.DiseñoEl enfoque que se ha utilizado es el método del coste de la enfermedad, considerando a las personas únicamente en una esfera productiva (capital humano). Los costes directos e indirectos se han estimado utilizando los costes de la prevalencia, es decir, los costes que se producen durante el año 1998.EmplazamientoLos costes directos se han desglosado en asistencia hospitalaria, atención primaria, consultas externas, fármacos y pruebas complementarias; los costes indirectos en mortalidad anticipada y bajas laborales.Mediciones y resultados principalesEl coste total de la DM ascendió a 6.468,76 millones de pesetas (38,88 millones de e) o el equivalente a 126.168 pesetas (758,28 e) anuales por cada paciente diabético conocido. El coste directo total atribuible a la DM fue de 4.011,51 millones de pesetas (24,11 millones de e), lo que supone el 2,13% del gasto sanitario en Canarias, o el equivalente a 78.240 pesetas (470,23 e) anuales por cada paciente diabético conocido. El coste directo de la asistencia sanitaria constituyó un 62% del coste total. El coste indirecto total fue de 2.457,25 millones de pesetas (14,77 millones de e), lo que constituye un 38% del coste totalConclusionesA pesar de haberse adoptado un enfoque conservador, dado que el estudio no incluye los costes asociados con el dolor y sufrimiento, invalidez permanente y la atención en el hogar por parte de los familiares, el elevado coste socioeconómico de los pacientes con DM abre un camino hacia estudios coste-efectividad que permitan un debate más transparente sobre este tema.ObjectiveTo evaluate the economic impact in terms of the direct costs (health care costs) and the indirect costs (effects on production caused by mortality and morbidity) of diabetes mellitus (DM) in the Canary Islands (Spain) during 1998.DesignThe approach used was to study the cost of the disease through looking only at people in the productive sphere (human capital). Direct and indirect costs were calculated by using costs of prevalence, i.e. the costs caused during 1998.SettingDirect costs were broken down into hospital care, primary care, out-patient consultations, drugs and further tests; indirect costs, into premature mortality and time off work.Measurements and main resultsThe total cost of DM amounted to 6468.76 million pesetas (38.88 millio e), or the equivalent of 126 168 pesetas (758.28 e) a year for each known diabetic patient. Total direct cost of DM was 4011.51 million pesetas (24.11 million e), which amounts to 2.13% of health expenditure in the Canaries; or the equivalent of 78 240 pesetas (470.23 e) a year for each known diabetic patient. Direct cost of health care was 62% of the total cost. Total indirect cost was 2457.25 million pesetas (14.77 million e), 38% of the total cost.ConclusionsDespite the conservatism of the approach, in that the study omitted costs linked to pain and suffering, permanent disability or home care by family members, the high social and economic cost of DM patients calls for cost-effectiveness studies that would permit a more transparent debate on this question

Influence of Ceramic Recycled Aggregates on the Properties of Prestressed Precast Concrete Elements

This work presents the results of an experimental study performed on the mechanical behavior of concrete manufactured with ceramic recycled aggregates (CRA), from precast ventilation ducts, that once made have been rejected by defective. The ultimate objective is to use these wastes to manufacture prestressed concrete joists used in building floors. The coarse fraction and the fine fraction have been considered. The work has been carried out in three phases: characterization of the material, characterization of concrete with CRA and manufacturing and testing of prestressed joists. With the results obtained it is determined the influence of the ceramic recycled aggregate on the properties analyzed. There are not enough studies about prestressed elements that include the replacement of the aggregate in the fine fraction. In view of the results obtained could both of fine and coarse fraction can be used in these applications

Hot-Moments of Soil CO2 Efflux in a Water-Limited Grassland

The metabolic activity of water-limited ecosystems is strongly linked to the timing and magnitude of precipitation pulses that can trigger disproportionately high (i.e., hot-moments) ecosystem CO2 fluxes. We analyzed over 2-years of continuous measurements of soil CO2 efflux (Fs) under vegetation (Fsveg) and at bare soil (Fsbare) in a water-limited grassland. The continuous wavelet transform was used to: (a) describe the temporal variability of Fs; (b) test the performance of empirical models ranging in complexity; and (c) identify hot-moments of Fs. We used partial wavelet coherence (PWC) analysis to test the temporal correlation between Fs with temperature and soil moisture. The PWC analysis provided evidence that soil moisture overshadows the influence of soil temperature for Fs in this water limited ecosystem. Precipitation pulses triggered hot-moments that increased Fsveg (up to 9000%) and Fsbare (up to 17,000%) with respect to pre-pulse rates. Highly parameterized empirical models (using support vector machine (SVM) or an 8-day moving window) are good approaches for representing the daily temporal variability of Fs, but SVM is a promising approach to represent high temporal variability of Fs (i.e., hourly estimates). Our results have implications for the representation of hot-moments of ecosystem CO2 fluxes in these globally distributed ecosystems

Análisis de costes y ahorros potenciales relacionados con la utilización de pruebas preoperatorias en los hospitales de Canarias

ResumenObjetivosEstimar el ahorro potencial que podría tener lugar en el Servicio Canario de Salud (SCS), a partir de una utilización apropiada científica de las pruebas preoperatorias, haciendo uso de la información obtenida de los 5 hospitales universitarios de la red pública.MétodosUn total de 55 anestesiólogos (60%) del SCS cumplimentaron un cuestionario. En éste se prestó especial atención a las pruebas preoperatorias más frecuentemente utilizadas, como la radiografía de tórax, el electrocardiograma, las pruebas de laboratorio y la espirometría. Los costes unitarios medios para las diferentes pruebas preoperatorias se obtuvieron de 2 hospitales participantes en el estudio. Para calcular los ahorros potenciales derivados del uso apropiado de las pruebas preoperatorias se han considerado varios escenarios caracterizados por diferentes hipótesis o grados de cumplimiento de un protocolo basado en el conocimiento científico, considerado como parámetro de referencia.ResultadosEn el caso ideal de que se cumpliera el protocolo científico recomendado en el 100% de los 16.179 pacientes considerados ASA I y II, la repercusión económica sería notable, pues supondría una liberación de recursos sensible que podría ser utilizada para otros programas de salud. Estas cifras podrían alcanzar aproximadamente los 1,02 millones de euros, sin considerar el coste de la estancia preoperatoria. Esta cifra podría incrementarse hasta, aproximadamente, los 2,13 millones de euros si incluimos un día de estancia preoperatoria, y hasta los 3,24 millones de euros incluyendo 2 días de estancia preoperatoria.ConclusionesLa revisión reciente de la literatura científica y los resultados proporcionados por el cuestionario aplicado en el SCS indican que las pruebas preoperatorias alcanzan los mayores beneficios para los pacientes y para la sociedad si se guían por el conocimiento científico. Es posible, además, liberar recursos a partir de una mejor selección y utilización de las pruebas preoperatorias.AbstractObjectiveTo estimate the potential cost savings that might take place in the Canary Islands Health Service (CHS) through the appropriate scientific use of preoperative tests, using information obtained from five public university hospitals.MethodsA questionnaire was completed by 55 anesthesiologists, representing 60% of the total in the CHS. The questionnaire paid special attention to the most frequently used preoperative tests: chest radiograph, electrocardiogram, laboratory tests, and spirometry. The mean unit costs for the various preoperative tests were obtained from the two hospitals participating in the study. To calculate the potential cost savings derived from the appropriate use of preoperative tests, several scenarios were considered. These were characterized by different hypotheses or degrees of fulfillment of a protocol based on scientific knowledge and considered as the gold standard.ResultsIn the ideal scenario in which the recommended scientific protocol was fulfilled in 100% of the 16 179 patients with an American Society of Anesthesiologists (ASA) grade of I-II, the economic impact would be notable, since it would free sensitive resources that could be used for other health programs. These figures could amount to approximately 1.02 million euros, without considering the cost of preoperative hospital stay. This figure could increase by up to approximately 2.13 million euros if one day of preoperative hospital stay were included and by up to 3.24 million euros if two days of preoperative hospital stay were included.ConclusionsThe recent literature review and the results of the questionnaire applied in the CHS indicate that preoperative tests are of greatest benefit to patients and to society if their use is guided by scientific knowledge. In addition, resources can be freed by better selection and utilization of preoperative tests

Two Neolithic structures at the archaeological site of Casa Garrido Nord II (Moixent, Valencia)

Es presenten les restes de cronologia neolítica documentades a les obres de canalització de gas a la vall de Montesa. Concretament, dues sitges del Neolític II de la seqüència regional, aparegudes al jaciment de Casa Garrido Nord, al terme municipal de Moixent. Encara que els materials són poc significatius, es tracta de les primeres estructures de cronologia neolítica, de les quals tenim constància, en què s’ha realitzat una excavació arqueològica sistemàtica a la comarca de la Costera. Paraules clau: Casa Garrido Nord II. Sitja. Neolític II. La Costera. Assentaments en pla.Es presenten les restes de cronologia neolítica documentades a les obres de canalització de gas a la vall de Montesa. Concretament, dues sitges del Neolític II de la seqüència regional, aparegudes al jaciment de Casa Garrido Nord, al terme municipal de Moixent. Encara que els materials són poc significatius, es tracta de les primeres estructures de cronologia neolítica, de les quals tenim constància, en què s’ha realitzat una excavació arqueològica sistemàtica a la comarca de la Costera. Paraules clau: Casa Garrido Nord II. Sitja. Neolític II. La Costera. Assentaments en pla.Herewith we submit the remains of Neolithic chronology found at the gas piping works performed at the Valley of Montesa (Valencia). They are specifically two Neolithic II underground storage places of a regional sequence, which appeared at the Casa Garrido Nord archaeological site, within the Moixent municipal borough (in the province of Valencia). Although the materials are not very meaningful, they represent the first structures of Neolithic chronology known to us, and therefore we have carried out a systematic archaeological excavation in the area of La Costera (Valencia). Key words: Casa Garrido Nord II. Silo. Neolithic II. La Costera. Settlements on flat lands

Preliminary data on cold-water corals and large sponges by-catch from Spanish/EU bottom trawl groundfish surveys in NAFO Regulatory Area (Divs. 3LMNO) and Canadian EEZ (Div. 3L): 2005-2007 period

Since 2005, by-catch of vulnerable invertebrates, such as cold-water corals and large sponges, has been studied with special attention in the Spanish/EU bottom trawl groundfish surveys in Northwest Atlantic (NAFO Divs. 3LMNO). Based on this research, twenty-nine different taxa of cold-water corals have been preliminarily identified in the study area: five alcyonaceans, ten gorgonaceans, ten pennatulaceans, three solitary scleractinians and one antipatharian. No colonial scleractinians were recorded during these surveys and reef structures are unlikely to occur in the study area. The main large sponges found belong to the family Geodiidae. The volume of cold-water corals and large sponges in the by-catches was generally low in the regularly-used fishing grounds studied. Most of the by-catches were recorded in hauls carried out in areas outside of regular fishing grounds for the bottom trawlers. By-catches of large gorgonians were recorded in three small areas located in Divs. 3LM (two in Div. 3L and one in Div. 3M), indicating that Vulnerable Marine Ecosystems (VMEs) could occur there. Pennatulaceans, solitary scleractinians, alcyonaceans and antipatharians were also observed as part of bycatch in some hauls carried out in Divs. 3LMO, but it is not clear if these by-catches indicate presence of VMEs in the area sampled. Highest diversity of coral species was found in Div. 3M. Large sponges occurred in deep waters, in a narrow band along Northern slope of the Grand Banks (Div. 3N) and Southern Flemish Pass (Div. 3L) as well as in several patches located in North-eastern and Eastern Flemish Cap. The preliminary information presented here, derived solely from bottom trawl survey by-catch records, it is not enough for identification of VMEs accurately, but it is very valuable to give a general view of where VMEs like to occur or not occur. Previous experience from other North Atlantic high-seas fishing grounds (e.g. NEAFC Regulatory Area) suggests that additional geohabitat mapping and information on fishery footprint will be needed for the accurate delineation of VMEs and for the subsequent adoption of suitable habitat conservation measures such as Marine Protected Areas (MPAs) to preserve cold-water corals and large sponges in NAFO Area

Synthesis and characterization of titanium(IV) complexes containing the diphenylphosphino- and diphenylthiophosphoryl-functionalized cyclopentadienyl ligand. Crystal and molecular structure of Ti(η5-C5H4PPh2)Cl3

The trimethylsilyl cyclopentadiene derivative C5H4(SiMe3)PPh2 (1) was treated with TiCl4 to give the air- and moisture-sensitive mono(cyclopentadienyl) compound Ti(η5-C5H4PPh2)Cl3 (4). Reaction of 4 with Mg(CH2C6H5)2(THF)2 gave Ti(η5-C5H4PPh2)(CH2C6H5)3 (5). Reactions of the lithium and thallium derivatives M{C5H4P(S)Ph2} (M=Li (2), Tl (3)) with one equiv. of TiCl4 afforded the mono(cyclopentadienyl) complex Ti{η5-C5H4P(S)Ph2}Cl3 (6), whereas reaction with 0.5 equiv. of TiCl4 gave the bis(cyclopentadienyl) complex Ti{η5-C5H4P(S)Ph2}2Cl2 (8). Compound 6 was also isolated as a minor product from the reaction of Ti{η5-C5H4P(S)Ph2}2Cl2 (8) with one equiv. of TiCl4. The major product was identified as an inseparable mixture of two compounds [Ti{η5-C5H4P(S)Ph2}2Cl2·TiCl4]n (7a and 7b). Reaction of Ti(η5-C5H5)Cl3 with 3 afforded the ‘mixed-ring’ bis(cyclopentadienyl) complex Ti{η5-C5H4P(S)Ph2}(η5-C5H5)Cl2 (9). Compounds 6–9 are very moisture-sensitive and easily decompose to form the cyclopentadiene C5H5P(S)Ph2. Structural data of these complexes indicate η5-coordination of the substituted cyclopentadienyl ligands and this coordination mode was confirmed by X-ray crystal structure analysis of compound 4.We gratefully acknowledge financial support by DGICYT (ref. no. PB-97-0776), Iberdrola, and the Fonds der Chemischen Industrie

Transition period between vegetation growth and senescence controls interannual variability of C fluxes in a Mediterranean reed wetland

Wetlands are crucial ecosystems modulating climate change due to their great potential to capture carbon dioxide (CO2), emit methane (CH4) and regulate local climate through evapotranspiration (ET). Common reed wetlands are particularly interesting given their high productivity, abundance and highly efficient internal gas-transport mechanism. However, little is known about the interannual behavior and dominant controlling factors of Mediterranean reed wetlands, characterized by seasonal flooding and remarkable weather variability. After 6 years of ecosystem carbon and ET flux measurements by eddy covariance (3 years for CH4 fluxes), this study shows the functional vulnerability of such wetlands to climate variability, switching between carbon (CO2+CH4) sink (660 g CO2-eeq m-2 y -1 , in 2014) and source (360 g CO2-eq m-2 y -1 , in 2016) in short periods of time. According to our analyses, the great interannual variability appeared to mainly depend on the behavior of reed growth dynamics during the transition to senescence period, what is confirmed through the Enhanced Vegetation Index as a proxy of photosynthetic activity. Additionally, a similar behavior of seasonal and daily patterns of carbon fluxes and ET was found compared with other wetlands under different climates

Formación continuada en un equipo de atención primaria: análisis de las sesiones docentes 1996-1998

ObjetivoDescribir las sesiones docentes de un equipo de atención primaria en el trienio 1996-1998. Identificar los profesionales que las realizaron, así como estudiar las áreas del conocimiento abordadas.DiseñoEstudio descriptivo transversal, retrospectivo.EmplazamientoCentro de salud docente perteneciente a una zona de salud rural.ParticipantesTotal de sesiones docentes realizadas durante el trienio estudiado (n = 249).IntervencionesDe la hoja de registro mensual del programa de formación continuada de nuestra gerencia, se extrajeron las siguientes variables: fecha actividad, duración, número de asistentes, tipo de sesión, profesional docente y contenido de actividad (clasificada por patología según órganos y sistemas para sesión bibliográfica, clínica y con experto; cartera servicios de atención primaria-INSALUD 1996 para sesión sobre programa; informática).Mediciones y resultados principalesSesiones por mes: media 6,9 (DE, 4,8). Media asistentes: 9,3 (DE, 3,01). Duración media: 36,5 minutos (DE, 11,0). Tipo de sesión: bibliográfica, 65,2%; sobre programa, 18; sesión con experto, 7,2; informática, 5,6; clínica, 4. Responsables docentes: médico residente, 39,4%; médico de familia tutor, 34,9; médico de familia no tutor, 7,2; ATS, 6,4; médico hospitalario, 4; médico de familia sustituto, 3,6; farmacéutico, 2,8; pediatra, 1,2; fisioterapeuta, 0,4. Contenido actividades más frecuentes: patología general inespecífica, 16,1%; enfermedades de la piel, 8,8, y enfermedades del sistema endocrino, 7,6%.ConclusionesBaja frecuencia de sesiones clínicas. Los responsables docentes fueron mayoritariamente médicos de familia tutores y médicos residentes, siendo escasa la participación del resto de personal.ObjectivesTo describe the teaching sessions of a primary care team in the three-year period 1996-1998. To identify the professionals who ran them and study the areas of knowledge tackled. Design. A retrospective, cross-over, descriptive study.SettingTeaching health centre belonging to a rural health district.ParticipantsAll the teaching sessions that took place during the three-year period (n = 249). Interventions. The following variables were extracted from the monthly register sheet of the ongoing training programme of our management: date of activity, duration, number attending, type of session, teaching professional and contents of activity (classified by pathology according to organs and systems for bibliographic, clinical and expert sessions; portfolio of 1996 Primary Care- INSALUD services for session on programme; computer studies).Measurements and main resultsMean sessions per month: 6.9 (SD: 4.8). Mean attendance: 9.3 persons (SD: 3.01). Mean length: 36.5 minutes (SD: 11.0). Type of session: bibliographic 65.2%, on programme 18%, session with expert 7.2%, computer studies 5.6%, clinical 4%. Responsible for teaching: intern 39.4%; family doctor tutor 34.9%; family doctor not a tutor 7.2%; nurse 6.4%; hospital doctor 4%; locum family doctor 3.6%; pharmacist 2.8%; paediatrician 1.2%; physiotherapist 0.4%. Most common contents: non-specific general pathology (16.1%), skin diseases (8.8%), diseases of the endocrine system (7.6%).ConclusionsLow frequency of clinical sessions. The teachers in charge were mainly family doctor tutors and interns, with the rest of the staff participating little

Bicellar systems to modify the phase behaviour of skin stratum corneum lipids

Bicellar systems are a fascinating category of versatile lipid assemblies that comprise bilayered disk-shaped nanoaggregates formed in water by long and short alkyl chain phospholipids. Bicelles bridge the gap between micelles and lipid vesicles by combining the attractive properties of both systems. These structures have recently been proposed in dermatological, cosmetic and pharmaceutical applications. Two new binary bicellar systems composed of cholesterol sulphate (SCHOL) and long-chain phospholipids (dimyristoyl- phosphatidylcholine, DMPC, or dipalmitoyl-phosphatidylcholine, DPPC) are characterised herein by differential scanning calorimetry, fluorescence spectroscopy, X-ray scattering and microscopy. Additionally, a comparative study on skin treated with the new SCHOL systems (DMPC/SCHOL and DPPC/SCHOL) and classic DHPC systems (DMPC/DHPC and DPPC/DHPC) was performed. These studies were conducted to determinate how deeply bicelles penetrate into the skin and the extension of their effect on the phase behaviour of stratum corneum (SC) lipids using attenuated total reflectance-Fourier transform infrared spectroscopy and two-photon excitation fluorescence microscopy. Our results show that SCHOL modified the typical discoidal morphology and the phase behaviour of the systems, inducing coexistence of two phases, liquid-ordered and ripple phases. The effect of the systems on SC lipids depends on their composition and is related to the fluidity of the SC lipid alkyl chains. Thus, systems with DMPC induced more disorder in SC lipids than systems with DPPC, and SCHOL did not modify the lipid arrangement. Perdeuterated systems in the infrared spectroscopy technique supported a different distribution in the tissue for every system. DMPC systems were primarily at the first layers of the SC, whereas DPPC systems were more widely distributed. Systems with SCHOL had enhanced distribution and penetration of bicellar systems throughout the SC. This journal is © 2012 the Owner Societies