The social return on investment of a new approach to heart failure in the Spanish National Health System

AIMS: We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. METHODS AND RESULTS: A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to euro548m and yield a social return of euro1932m, that is, euro3.52 for each euro invested. CONCLUSIONS: The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF

Novel CYP4F22 mutations associated with autosomal recessive congenital ichthyosis (ARCI). Study of the CYP4F22 c.1303C>T founder mutation

Mutations in CYP4F22 cause autosomal recessive congenital ichthyosis (ARCI). However, less than 10% of all ARCI patients carry a mutation in CYP4F22. In order to identify the molecular basis of ARCI among our patients (a cohort of ninety-two Spanish individuals) we performed a mutational analysis using direct Sanger sequencing in combination with a multigene targeted NGS panel. From these, eight ARCI families (three of them with Moroccan origin) were found to carry five different CYP4F22 mutations, of which two were novel. Computational analysis showed that the mutations found were present in highly conserved residues of the protein and may affect its structure and function. Seven of the eight families were carriers of a highly recurrent CYP4F22 variant, c.1303C>T; p.(His435Tyr). A 12Mb haplotype was reconstructed in all c.1303C>T carriers by genotyping ten microsatellite markers flanking the CYP4F22 gene. A prevalent 2.52Mb haplotype was observed among Spanish carrier patients suggesting a recent common ancestor. A smaller core haplotype of 1.2Mb was shared by Spanish and Moroccan families. Different approaches were applied to estimate the time to the most recent common ancestor (TMRCA) of carrier patients with Spanish origin. The age of the mutation was calculated by using DMLE and BDMC2. The algorithms estimated that the c.1303C>T variant arose approximately 2925 to 4925 years ago, while Spanish carrier families derived from a common ancestor who lived in the XIII century. The present study reports five CYP4F22 mutations, two of them novel, increasing the number of CYP4F22 mutations currently listed. Additionally, our results suggest that the recurrent c.1303C>T change has a founder effect in Spanish population and c.1303C>T carrier families originated from a single ancestor with probable African ancestry

Contested Cornerstones of Nonviolent National Self-Perception in Costa Rica: A Historical Approach

Huhn S. Contested Cornerstones of Nonviolent National Self-Perception in Costa Rica: A Historical Approach. GIGA Working Papers. Vol 101. Hamburg: GIGA; 2009.Crime, violence, and insecurity are perceived as society’s biggest problems in contemporary Costa Rica. This degree of priority is especially remarkable because the country has always been considered the peaceful exception in the violent Central American region. In this paper I analyze four cornerstones of the nonviolent national self-perception in the 1940s and 1980s as the fundamental basis for the current talk of crime: the civil war, the abolition of the military, the proclamation of neutrality, and the peace plan for Central America and the subsequent granting of the Nobel Peace Prize. The result of the analysis is the determination that these historical cornerstones were not publicly discussed as expressions of the nonviolent identity for which they are today cited as evidence

Error Cascades in Observational Learning: An Experiment on the Chinos Game

The paper reports an experimental study based on a variant of the popular Chinos game, which is used as a simple but paradigmatic instance of observational learning. There are three players, arranged in sequence, each of whom wins a fixed price if she manages to guess the total number of coins lying in everybody?s hands. Our evidence shows that, despite the remarkable frequency of equilibrium outcomes, deviations from optimal play are also significant. And when such deviations occur, we find that, for any given player position, the probability of a mistake is increasing in the probability of a mistake of her predecessors. This is what we call an error cascade, which we which we measure by way of two alternative models.positional learning, error cascades

Plan de ordenamiento territorial participativo para la microcuenca del r?o Sesesmiles, Honduras

3 ilus. 4 tab. 10 ref.Se elabor? el plan de ordenamiento territorial participativo (POTP) para la microcuenca del r?o Sesesmiles, Honduras, con la participaci?n de actores locales de di?z comunidades asentadas en la microcuenca. El trabajo se inici? con el diagn?stico territorial participativo que permiti? generar informaci?n base para la evaluaci?n de conflictos de uso de suelos en los escenarios actual y tendencial en la zona. Como base para la formulaci?n del POTP se plante? un escenario propuesto, el cual fue sometido a consenso en talleres de consulta con los actores locales. El POTP, como marco de referencia temporal, considera un horizonte de 20 a?os y consta de siete ejes estrat?gicos: desarrollo forestal, desarrollo agropecuario, protecci?n hidrol?gica, conservaci?n, manejo de riesgos, desarrollo urbano e infraestructura vial. Se plantea la ejecuci?n de 24 proyectos para el ordenamiento de la microcuenca adem?s, se proponen estrategias para la implementaci?n del Plan en colaboraci?n con los actores locales. A participative land ordering plan (PLOP) was designed for the Sesesmiles River watershed, Honduras, in collaboration with local stakeholders from ten rural communities located in the watershed. As a first step, a participative land diagnosis was carried out to generate base information for evaluating land use conflicts for both current and expected scenarios in the zone. For PLOP definition, a proposed scenario was discussed with local actors. The PLOP is framed within a 20 year horizon, and it consists of seven strategic axes: forest development, agricultural development, hydrological protection, conservation, risk management, urban development and road infrastructure. It also proposes 24 development projects for land ordering, and some strategies for its implementation along with local actors

Evaluaci?n y manejo cl?nico de las autolesiones en la adolescencia: protocolo basado en la evidencia

Las autolesiones se han convertido en un importante problema de salud p?blica en la adolescencia. El t?rmino autolesi?n o lesi?n autoinfligida, se ha definido como un acto llevado a cabo por una persona con el objetivo de hacerse da?o a s? mismo. Independientemente de las consecuencias que la autolesi?n pueda tener para la salud f?sica o mental, puede asociarse a distintos niveles de intencionalidad suicida. En el caso de que esta no existiera se denomina autolesi?n no suicida. El incremento de las autolesiones en la adolescencia ha sido progresivo en las ?ltimas d?cadas, con un incremento exponencial en los 10 ?ltimos a?os. Adem?s, en la actualidad se ha detectado un incremento notorio de las autolesiones en la poblaci?n adolescente, en parte, relacionado con el estr?s psicol?gico y distanciamiento social causado por la pandemia por COVID-19. El objetivo general de este documento es elaborar un documento basado en la evidencia cient?fica que permita favorecer una mejor evaluaci?n y manejo cl?nico de las autolesiones en la adolescencia. En la actualidad, las autolesiones constituyen un grave problema en la poblaci?n adolescente y, por ello, es relevante establecer los mecanismos que permitan su adecuada detecci?n y manejo cl?nico. El presente documento sintetiza la evidencia m?s relevante, as? como recoge las principales actuaciones en atenci?n primaria y atenci?n especializada, con el objetivo de guiar a los profesionales y favorecer la toma de decisiones compartida. Tambi?n se proponen indicadores para la monitorizaci?n de la pr?ctica cl?nica y se ha desarrollado un documento para adolescentes, familias y profesionales de la educaci?n. La investigaci?n futura deber? centrarse en evaluar la efectividad de las diferentes intervenciones y dise?ar nuevos enfoques preventivos y terap?uticos