Technical efficiency in primary health care: does quality matter?

The accuracy required in the measurement of output is an issue that has as yet still not been satisfactorily addressed in empirical research on efficiency in primary health care. We exploit information retrieved from a newly constructed database (APEX06) for the Spanish region of Extremadura. The richness of our dataset allows us to consider original synthetic measures of output that take into account both the quantity and the quality of services provided by 85 primary care centres (PCCs) in 2006. We provide evidence that neglecting the issue of properly accounting for the quality of health services can lead to misleading results. Our main finding is that adjusting output for quality influences efficiency analysis in three senses. First, inefficiency now explains relatively more of the deviation from the potential output. Second, the average technical efficiency in the sector is lower, while its dispersion among PCCs is significantly higher. And third, the efficiency ranking of the PCCs is also affected.Primary Health Care; Stochastic Frontier Analysis; Technical Efficiency; Quality

The Use of Parametric and Non Parametric Frontier Methods to Measure the Productive Efficiency in the Industrial Sector. A Comparative Study

Parametric frontier models and non-parametric methods have monopolised the recent literature on productive efficiency measurement. Empirical applications have usually dealt with either one or the other group of techniques. This paper applies a range of both types of approaches to an industrial organisation setup. The joint use can improve the accuracy of both, although some methodological difficulties can arise. The robustness of different methods in ranking productive units allows us to make an comparative analysis of them. Empirical results concern productive and market demand structure, returns-to-scale, and productive inefficiency sources. The techniques are illustrated using data from the US electric power industry.Productive efficiency; parametric frontiers; DEA; industrial sector

The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography.

Pocket-size imaging devices are a completely new type of echo machines which have recently reached the market. They are very cheap, smartphone-size hand-held echo machines with limited technical capabilities. The aim of this European Association of Echocardiography (EAE) position paper is to provide recommendations on the use of pocket-size imaging devices in the clinical arena by profiling the educational needs of potential users other than cardiologists experts in echo. EAE recommendations about pocket-size imaging devices can be summarized in: (1) pocket-size imaging devices do not provide a complete diagnostic echocardiographic examination. The range of indications for their use is therefore limited. (2) Imaging assessment with pocket-size imaging devices should be reported as part of the physical examination of the patient. Image data should be stored according to the applicable national rules for technical examinations. (3) With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended for all users. The certification should be limited to the clinical questions that can potentially be answered by pocket-size devices. (4) The patient has to be informed that an examination with the current generation of pocket-size imaging devices does not replace a complete echocardiogram.Peer reviewe

Lipoblastoma retroperitoneal en un lactante. Caso clínico

ResumenIntroducciónEl lipoblastoma es una neoplasia benigna del tejido adiposo, de presentación infrecuente y casi exclusiva en niños menores de 3 años. Usualmente se presenta en las extremidades como una masa indolora de crecimiento progresivo, estableciéndose su diagnóstico definitivo mediante análisis histológico y citogenético.ObjetivoPresentar un caso clínico de lipoblastoma de ubicación inhabitual en una lactante y revisar la literatura al respecto.Caso clínicoLactante mayor de 16 meses, con aumento de volumen abdominal de 6 meses de evolución, asociado a una ingesta alimentaria disminuida, sin otros síntomas. El estudio de imagen reveló una imagen de aspecto lipoideo que comprometía casi la totalidad de la cavidad abdominal, muy sugerente de lipoblastoma, realizándose la resección de un tumor retroperitoneal de 18cm de diámetro que rechazaba los órganos vecinos. El análisis histológico fue suficiente para confirmar el diagnóstico. En el seguimiento no hubo recidiva.ConclusiónTomando en cuenta la baja frecuencia de esta afección y su inusual presentación, se reporta el caso de esta paciente, para considerarlo dentro del diagnóstico diferencial de masa abdominal en un lactante.AbstractIntroductionLipoblastoma is a benign neoplasia of the adipose tissue. It is a rare conditionand almost exclusively presents in children under 3 years old. It usually occurs in extremities as a painless volume increase of progressive growth, with the definitive diagnosis being established by pathological and cytogenetic analysis. The treatment of choice is complete resection, and follow-up period of up to five years is recommended due to a recurrence of up to 25%.ObjectiveTo present an unusual location of this uncommon condition in an infant, and review the related literature.Case reportA sixteen-month child with an increase in abdominal growth of six-months progression, associated with a decreased food intake, and with no other symptoms. The imaging study revealed a lipoid-like image compromising almost the entire abdominal cavity, very suggestive of lipoblastoma. A resection was performed on an 18cm diameter retroperitoneal tumour that rejected the adjacent organs. Histological analysis was enough to confirm diagnosis without the need for cytogenetic analysis. The follow-up showed no recurrence of the disease.ConclusionGiven the rarity of this disease and its unusual presentation, we communicate this clinical case, in order to be considered in the differential diagnosis of abdominal mass in chilhood

Determination of genotoxicity of classical swine fever vaccine in vitro by cytogenetic and comet tests

Chromosome damage in lymphocyte cultures induced by live virus vaccine against classical swine fever (CSF) has been observed in previous studies. In vivo cytogenetic tests were made with several doses of vaccines used in Argentina to control the disease. These studies have shown that genotoxic effects increased with dose. In the present study, two different in vitro assays were performed by recording the frequency of cells with chromosome alterations and by assessing the ability of the vaccine to damage DNA, using the single cell gel microelectrophoretic assay (comet test). Frequencies of cells with chromosomal alterations increased significantly when compared with controls and were dose (μl/ml) dependent: 0 = 1.23, 5 = 2.29, 10 = 5.42 and 20 = 11.71%. In the comet assay the variables measured, tail length (TL) and tail moment (TM), also increased. For control cultures TL was 2.32 μm, whereas with concentrations of 20 and 100 μl/ml TL were 12.47 and 42.3 μm, respectively. TM of control cultures was 0.18, whereas with vaccine concentrations of 20 and 100 μl/ml TM were 5.52 and 24.52, respectively. Comet frequency distributions differed significantly among treatments. These results agree with previous in vivo observations. Regarding CSF pathogeny, our results support a direct effect of CSF vaccinal virus on lymphocyte DNA. Genotoxicity of CSF vaccine was corroborated in vitro at the cytogenetic and molecular levels.Instituto de Genética Veterinari