Benchmarking : Sistemas sanitarios, copago, urgencias

50 páginasProyecto Final Curso de Experto (Curso 20111/2012). Tutor: Juan José Sánchez Luque. En la actualidad este Sistema Nacional de Salud abarca una partida considerable del PIB español viniendo de una tendencia en las últimas décadas donde el gasto público en sanidad había crecido a mayor ritmo que el PIB (tendencia compartida en los países de la Unión Europea), trayectoria que se ha acentuado debido en parte a la recesión. En el caso español, el porcentaje del PIB ha ido evolucionando en los últimos años del 8,5% del PIB en 2007, al 9% en 2008 y hasta el 9,5% en 2009, aunque se espera una inversión drástica y existen estimaciones preocupantes que prevén un posible descenso del porcentaje del PIB destinado a sanidad que podría ser del 5,1% en 2015. Las trágicas consecuencias de la crisis económica en la que estamos inmersos ha obligado a buscar nuevas respuestas para viejas preguntas y en la búsqueda de posibles soluciones para frenar la tendencia creciente del gasto sanitario y la crisis de deuda actual se han buscado nuevas alternativas que modulen la demanda, siendo a este nivel el copago la principal herramienta para paliar el problema

Atención psicológica en grandes catástrofes : comparativa 11S-11M

66 páginasTrabajo de Curso de Experto Universitario en Atención al Trauma Grave (2012/13). Tutor: Jesús Miranda Páez. Una de las consecuencias de la globalización a la que nos estamos adaptando, es que están cambiando los biorritmos vitales de las sociedades que conforman este mundo global 2.0. Vivimos inmersos en el cambio, en la modernización y en el movimiento continuo que nos hace recorrer caminos, sin saber la dirección tomada en algunos de los casos. El rol de la medicina dentro de las grandes catástrofes bien merece este Trabajo Fin de Experto. Un papel controvertido ya que hay opiniones contrapuestas que defienden o atacan el papel inmediato de los abordajes psicológicos dentro de estas grandes catástrofes. La finalidad de este trabajo es hacer un recorrido de lo general a lo particular: plasmar las diferentes versiones existentes sobre las grandes catástrofes, abordar las teorías existentes en la bibliografía sobre dicho abordaje psicológico en estos trágicos episodios para continuar comparando los atentados del 11 de Septiembre (Torres Gemelas, Nueva York) y el 11 de Marzo (Estación Atocha, Madrid). Y terminar dando unas pinceladas sobre cómo se abordó recientemente el accidente del tren de Santiago, catástrofe que removió fantasmas del pasado y sacó de nuevo a primera plana la importancia de un buen abordaje psicológico en este tipo de situaciones

eSalud y las nuevas reglas del juego

52 páginasTrabajo de Curso de Experto Universitario en Abordaje del Paciente en Atención Primaria (2013-14). Director/Tutor: Juan José Sánchez Luque. En los últimos años, la Medicina está sufriendo un perfilamiento hacia un cambio que desde hace unos años es una realidad, y es que la sanidad del futuro al auspicio de las nuevas tecnologías dejó de ser una mera meta para empezar a ser una realidad. Un gran cambio que necesita la implicación de los profesionales y usuarios, tiempo para su desarrollo y paciencia para que la nueva realidad se asiente en el siglo XXI. La eSalud puede ser el cambio que el sistema sanitario necesita para cambiar el paradigma actual y llevar a cabo una serie de medidas que mejoren la atención. Que el ritmo al que se está desarrollando no es todo lo apremiado que las expectativas creadas es cierto, que quizás nos confabulamos en exceso sobre sus beneficios potenciales que aún no se han patentado es otra realidad, aunque despacio pero sin detenerse, la eSalud española sigue su avance quizás para interiorizar el cambio que indica que el futuro de la sanidad y la salud irá por los derroteros de la eSalud

The Role of Nrf2 Signaling in PPARβ/δ-Mediated Vascular Protection against Hyperglycemia-Induced Oxidative Stress

Hyperglycemia induces oxidative stress and plays a substantial role in the progression of vascular diseases. Here, we demonstrated the potentiality of peroxisome proliferator-activated receptor (PPAR)β/δ activation in attenuating high glucose-induced oxidative stress in endothelial cells and diabetic rats, pointing to the involvement of nuclear factor erythroid 2-related factor 2 (Nrf2). HUVECs exposed to high glucose showed increased levels of reactive oxygen species (ROS) and upregulated NOX-2, NOX-4, Nrf2, and NQO-1 effects that were significantly reversed by the PPARβ/δ agonists GW0742 and L165041. Both PPARβ/δ agonists, in a concentration-dependent manner, induced transcriptional and protein upregulation of heme oxygenase-1 (HO-1) under low- and high-glucose conditions. All effects of PPARβ/δ agonists were reversed by either pharmacological inhibition or siRNA-based downregulation of PPARβ/δ. These in vitro findings were confirmed in diabetic rats treated with GW0742. In conclusion, PPARβ/δ activation confers vascular protection against hyperglycemia-induced oxidative stress by suppressing NOX-2 and NOX-4 expression plus a direct induction of HO-1; with the subsequent downregulation of the Nrf2 pathway. Thus, PPARβ/δ activation could be of interest to prevent the progression of diabetic vascular complications.This work was supported by Grants from Ministerio de Economía y Competitividad and Fondo Europeo de Desar- rollo Regional (FEDER) (SAF2010-22066-C02-01, SAF2010-22066-C02-02, SAF2011-28150, SAF2014-55523- R), Junta de Andalucía (Proyecto de excelencia, P12-CTS- 2722), and Instituto de Salud Carlos III (RIC RD12/0042/ 0011), Spain

Mycophenolate mediated remodeling of gut microbiota and improvement of gut-brain axis in spontaneously hypertensive rats

This work was supported by Grants from Comisi´on Interministerial de Ciencia y Tecnología, Ministerio de Economía y competitividad (SAF2017-84894-R), Junta de Andalucía (CTS-164) with funds from the European Union, Ministerio de Economia y Competitividad, Instituto de Salud Carlos III (CIBER-CV), Spain. M.T. is a postdoctoral fellow of Instituto de Salud Carlos III (Sara Borrell Program). I.R.-V. is a predoctoral fellow of MINECO. The cost of this publication was paid in part with funds from the European Union (Fondo Europeo de Desarrollo Regional, FEDER, “FEDER una manera de hacer Europa”).Microbiota has a role in the host blood pressure (BP) regulation. The immunosuppressive drug mofetil mycophenolate (MMF) ameliorates hypertension. The present study analyzes whether MMF improves dysbiosis in a genetic model of hypertension. Twenty weeks old male spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY) were randomly divided into three groups: untreated WKY, untreated SHR, and SHR treated with MMF for 5 weeks. MMF treatment restored gut bacteria from the phyla Firmicutes and Bacteroidetes, and acetate- and lactate-producing bacteria to levels similar to those found in WKY, increasing butyrate-producing bacteria. MMF increased the percentage of anaerobic bacteria in the gut. The improvement of gut dysbiosis was associated with an enhanced colonic integrity and a decreased sympathetic drive in the gut. MMF inhibited neuroinflammation in the paraventricular nuclei in the hypothalamus. MMF increased the lower regulatory T cells proportion in mesenteric lymph nodes and Th17 and Th1 infiltration in aorta, improved aortic endothelial function and reduced systolic BP. This study demonstrates for the first time that MMF reduces gut dysbiosis in SHR. This effect could be related to its capability to improve gut integrity due to reduced sympathetic drive in the gut associated to the reduced brain neuroinflammation.Comision Interministerial de Ciencia y Tecnologia, Ministerio de Economia y competitividad SAF201784894RJunta de Andalucia CTS-164European CommissionSpanish GovernmentInstituto de Salud Carlos III (CIBERCV) , SpainEuropean Union (Fondo Europeo de Desarrollo Regional, FEDER, "FEDER una manera de hacer Europa"

Critical Role of the Interaction Gut Microbiota – Sympathetic Nervous System in the Regulation of Blood Pressure

Association between gut dysbiosis and neurogenic diseases, such as hypertension, has been described. The aim of this study was to investigate whether changes in the gut microbiota alter gut-brain interactions inducing changes in blood pressure (BP). Recipient normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR) were orally gavaged with donor fecal contents from SHR and WKY. We divided the animals into four groups: WKY transplanted with WKY microbiota (W-W), SHR with SHR (S-S), WKY with SHR (W-S) and SHR with WKY (S-W). Basal systolic BP (SBP) and diastolic BP (DBP) were reduced with no change in heart rate as a result of fecal microbiota transplantation (FMT) from WKY rats to SHR. Similarly, FMT from SHR to WKY increased basal SBP and DBP. Increases in both NADPH oxidase-driven reactive oxygen species production and proinflammatory cytokines in brain paraventricular nucleus linked to higher BP drop with pentolinium and plasmatic noradrenaline (NA) levels were found in the S-S group as compared to the W-W group. These parameters were reduced by FMT from WKY to SHR. Increased levels of pro-inflammatory cytokines, tyrosine hydroxylase mRNA levels and NA content in the proximal colon, whereas reduced mRNA levels of gap junction proteins, were found in the S-S group as compared to the W-W group. These changes were inhibited by FMT from WKY to SHR. According to our correlation analyses, the abundance of Blautia and Odoribacter showed a negative correlation with high SBP. In conclusion, in SHR gut microbiota is an important factor involved in BP control, at least in part, as consequence of its effect on neuroinflammation and the sympathetic nervous system activity.This work was funded by grants from Comisión Interministerial de Ciencia y Tecnología, Ministerio de Economía y Competitividad (MINECO) (SAF2017-8489-R, AGL2015-67995- C3-3-R, and SAF2014-55523-R), Junta de Andalucía (Proyecto de Excelencia P12-CTS-2722 and CTS-164) with support from the European Union, and Ministerio de Economía y Competitividad, Instituto de Salud Carlos III (CIBER-CV, CIBER-EHD), Spain. MS is a postdoctoral fellow of Junta de Andalucía. MR is postdoctoral fellow of University of Granada. IR-V is a predoctoral fellow of MINECO. The cost of this publication was paid in part with FEDER funds

Equipment for the continuous measurement and identification of gamma radioactivity on aerosols

© 20xx IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.This paper describes an equipment for continuous measurement and identification of gamma radioactivity in aerosols developed by the Nuclear Engineering Research Group (NERG) at the Technical University of Catalonia (UPC) and Raditel Serveis i Subministraments Tecnològics, Ltd. A spectrometric analysis code has been specially designed for it. Spectrum analysis identifies and determines activity concentration of aerosol emitters captured by a fiberglass paper filter. This new equipment is currently operating in three radioactivity monitoring stations of the Environmental Radiological Surveillance Network of the Generalitat of Catalunya (local Catalan government): two near Ascó and Vandellòs Nuclear Power Plants in the province of Tarragona and one in the city of Barcelona. Two more monitors are expected to be deployed at Roses, Girona, Spain, and Puigcerdà, Barcelona, Spain. Measurements and evolution analysis results of emitters identified at these stations were also provided.Postprint (author's final draft

A new code for spectrometric analysis for environmental radiological surveillance on monitors focused on gamma radioactivity on aerosols

© 20xx IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.This paper presents a new code for the analysis of gamma spectra generated by an equipment for continuous measurement of gamma radioactivity in aerosols with paper ¿lter. It is called pGamma and has been developed by the Nuclear Engineering Research Group at the Technical University of Catalonia - Barcelona Tech and by Raditel Serveis i Subministraments Tecnològics, Ltd. The code has been developed to identify the gamma emitters and to determine their activity concentration. It generates alarms depending on the activity of the emitters and elaborates reports. Therefore it includes a library with NORM and arti¿cial emitters of interest. The code is being adapted to the monitors of the Environmental Radiological Surveillance Network of the local Catalan Government in Spain (Generalitat de Catalunya) and is used at three stations of the Network.Postprint (author's final draft

Pluronic®/casein micelles for ophthalmic delivery of resveratrol: in vitro, ex vivo, and in vivo tests

Ocular health may strongly benefit from the supply of antioxidant agents that counteract free radicals and reactive oxygen species responsible for long-term eye diseases. Additionally, natural antioxidants like resveratrol can inhibit bacteria growth and restore natural microbiota. However, their use is hindered by limited solubility, fast degradation, and low ocular permeability. This work aimed to overcome these limitations by preparing single and mixed micelles of Pluronic® F127 and casein that serve as resveratrol nanocarriers. Single and mixed (0.1 % casein) micelles (0.0 to −17.0 mV; 2.4 to 32.7 nm) increased 50-fold resveratrol solubility, remained stable for one month at 4 °C, withstood fast dilution, underwent sol-to-gel transitions in the 23.9–27.1 °C range, and exhibited potent antioxidant properties. All formulations successfully passed the HET-CAM assay but showed Pluronic®-casein dose-dependent toxicity in the zebrafish embryo model. Resveratrol-loaded single and mixed micelles (10–15 mM Pluronic® F127) displayed antimicrobial activity against S. aureus and P. aeruginosa. The micelles favored resveratrol accumulation in cornea and sclera, but mixed micelles showed larger lag times and provided lower amount of resveratrol permeated through sclera. In vivo (rabbit) tests confirmed the safety of resveratrol-loaded single micelles and their capability to supply resveratrol to anterior and posterior eye segmentsThe work was supported by MCIN/AEI/10.13039/501100011033 [PID 2020-113881RB-I00 to A.C. and C.A.-L., and PID2020-115121GB-I00 to L.S. and A.B.-I.], Spain, Xunta de Galicia [ED431C 2020/17], and FEDER. M. Vivero-Lopez acknowledges Xunta de Galicia (Consellería de Cultura, Educación e Ordenación Universitaria) for a predoctoral research fellowship [ED481A-2019/120]S

Gut Microbiota Has a Crucial Role in the Development of Hypertension and Vascular Dysfunction in Toll-like Receptor 7-Driven Lupus Autoimmunity

Our group has investigated the involvement of gut microbiota in hypertension in a murine model of systemic lupus erythematosus induced by Toll-like receptor (TLR)-7 activation. Female BALB/c mice were randomly assigned to four experimental groups: an untreated control (CTR), a group treated with the TLR7 agonist imiquimod (IMQ), IMQ-treated with vancomycin, and IMQtreated with a cocktail of broad-spectrum antibiotics. We carried out faecal microbiota transplant (FMT) from donor CTR or IMQ mice to recipient IMQ or CTR animals, respectively. Vancomycin inhibited the increase in blood pressure; improved kidney injury, endothelial function, and oxidative stress; and reduced T helper (Th)17 infiltration in aortas from IMQ-treated mice. The rise in blood pressure and vascular complications present in IMQ mice were also observed in the CTR mice recipients of IMQ microbiota. Reduced relative populations of Sutterella and Anaerovibrio were associated with high blood pressure in our animals, which were increased after stool transplantation of healthy microbiota to IMQ mice. The reduced endothelium-dependent vasodilator responses to acetylcholine induced by IMQ microbiota were normalized after interleukin-17 neutralization. In conclusion, gut microbiota plays a role in the TLR7-driven increase in Th17 cell, endothelial dysfunction, vascular inflammation, and hypertension. The vascular changes induced by IMQ microbiota were initiated by Th17 infiltrating the vasculature.Comisión Interministerial de Ciencia y Tecnología, Ministerio de Economía y competitividad (MINECO) (SAF2017-84894-R, PID2020-116347RBI00)Junta de Andalucía (CTS 164, P20_00193) with funds from the European Union, and by the Ministerio de Economia y Competitividad, Instituto de Salud Carlos III (CIBER-CV)Instituto de Salud Carlos III (Sara Borrell Program)MINECOEuropean Union (Fondo Europeo de Desarrollo Regional, FEDER