Educación sanitaria al paciente sometido a pruebas diagnósticas osteoarticulares

En los últimos años las exploraciones de diagnóstico por la imagen han experimentado una importante transformación que las ha consolidado como una herramienta básica para el diagnóstico de la patología osteoarticular. En este contexto el papel de los enfermeros/as, como referente más próximo del paciente es básico para resolver las necesidades de información, consentimiento informado, preparación y posibles cuidados posteriores al procedimiento diagnóstico. El objetivo del presente artículo es proporcionar las herramientas para que los enfermero/as conozcan las pruebas diagnósticas en la enfermedad osteoarticular y puedan responder a las demandas de los pacientes. Esto facilitará una correcta preparación del paciente y permitirá conocer y prevenir las complicaciones posteriores derivadas de la técnica. Por una parte se recorren la pruebas diagnósticas: radiografía convencional, tomografía computarizada, resonancia magnética y ecografía; y además se abordan las técnicas en función de la zona corporal explorada: hueso, articulación y partes blandas.

Evidence on the role of ownership structure on firms' innovative performance

Based on the Knowledge Production Function framework given by Griliches -1979-, we slightly modify it so that the innovative output depends upon a set of factors related to the firm internal characteristics and are influenced by the environment. Specifically, regarding the firm internal determinants the effect of the concentration of the ownership, the composition of the boards of directors and the effect of the nature of the ownership (foreign and public) are analyzed. Additionally, in order to capture the determinants of the environment in which the firm operates other variables concerning the internationalization of market, the agglomeration economies and the regional knowledge externalities are also considered. In order to assess the impact of these determinants on the number of patents and models of use awarded by the firm, the discreteness of the latter variable has to be taken into account. We apply Poisson and Negative Binomial models for a more comprehensive evaluation of the hypothesis in a panel of Spanish manufacturing firms. The results show patenting activity is positively favoured by being located in an environment with a high innovative activity, due to the existence of knowledge spillovers and agglomeration economies.

Does social capital reinforce technological inputs in the creation of knowledge? Evidence from the Spanish regions

In this paper we seek to verify the hypothesis that trust and cooperation between individuals, and between them and public institutions, can encourage technological innovation and the adoption of knowledge. Additionally, we test the extent to which the interaction of social capital with human capital and R&D expenditures improve their effect on a region’s ability to innovate. Our empirical evidence is taken from the Spanish regions and employs a knowledge production function and longitudinal count data models. Our results suggest that social capital correlates positively with innovation. Further, our analysis reveals a powerful interaction between human and social capital in the production of knowledge, whilst the complementarity with R&D efforts would seem less clear.

ROS production is essential for the apoptotic function of E2F1 in pheochromocytoma and neuroblastoma cell lines

In this study we demonstrate that accumulation of reactive oxygen species (ROS) is essential for E2F1 mediated apoptosis in ER-E2F1 PC12 pheochromocytoma, and SH-SY5Y and SK-N-JD neuroblastoma stable cell lines. In these cells, the ER-E2F1 fusion protein is expressed in the cytosol; the addition of 4-hydroxytamoxifen (OHT) induces its translocation to the nucleus and activation of E2F1target genes. Previously we demonstrated that, in ER-E2F1 PC12 cells, OHT treatment induced apoptosis through activation of caspase-3. Here we show that caspase-8 activity did not change upon treatment with OHT. Moreover, over-expression of Bcl-xL arrested OHT-induced apoptosis; by contrast, over-expression of c-FLIP, did not have any effect on OHT-induced apoptosis. OHT addition induces BimL expression, its translocation to mitochondria and activation of Bax, which is paralleled by diminished mitochondrial enrichment of Bcl-xL. Treatment with a Bax-inhibitory peptide reduced OHT-induced apoptosis. These results point out the essential role of mitochondria on the apoptotic process driven by E2F1. ROS accumulation followed E2F1 induction and treatment with the antioxidant N-acetylcysteine, inhibited E2F1-induced Bax translocation to mitochondria and subsequent apoptosis. The role of ROS in mediating OHT-induced apoptosis was also studied in two neuroblastoma cell lines, SH-SY5Y and SK-N-JD. In SH-SY5Y cells, activation of E2F1 by the addition of OHT induced ROS production and apoptosis, whereas over-expression of E2F1 in SK-N-JD cells failed to induce either response. Transcriptional profiling revealed that many of the genes responsible for scavenging ROS were down-regulated following E2F1-induction in SH-SY5Y, but not in SK-N-JD cells. Finally, inhibition of GSK3β blocked ROS production, Bax activation and the down regulation of ROS scavenging genes. These findings provide an explanation for the apparent contradictory role of E2F1 as an apoptotic agent versus a cell cycle activator.

Extremal principle of entropy production in the climate system

Paltridge found reasonable values for the most significant climatic variables through maximizing the material transport part of entropy production by using a simple box model. Here, we analyse Paltridge's box model to obtain the energy and the entropy balance equations separately. Derived expressions for global entropy production, which is a function of the radiation field, and even its material transport component, are shown to be different from those used by Paltridge. Plausible climatic states are found at extrema of these parameters. Feasible results are also obtained by minimizing the radiation part of entropy production, in agreement with one of Planck's results, Finally, globally averaged values of the entropy flux of radiation and material entropy production are obtained for two dynamical extreme cases: an earth with uniform temperature, and an earth in radiative equilibrium at each latitudinal point

The significance of distributive effects in social assessment of health care

In this paper we address the importance of distributive effects in the social valuation of QALY's. We propose a social welfarefunction that generalises the functions traditionally used in the health economic literature. The novelty is that, depending on the individual health gains, our function can representeither preferences for concentrating or preferences for spreading total gain or both together, an issue which has notbeen addressed until now. Based on an experiment, we observe that this generalisation provides a suitable approximation tothe sampled social preferences.

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

Welfare is a rather vague term whose meaning depends on ideology, values andjudgments. Material resources are just means to enhance people s well-being, butgrowth of the Gross Domestic Production is still the standard measure of thesuccess of a society. Fortunately, recent advances in measuring social performanceinclude health, education and other social outcomes. Because what we measureaffects what we do it is hoped that social policies will change. The movementHealth in all policies and its associated Health Impact Assessment methodologywill contribute to it. The task consists of designing transversal policies thatconsider health and other welfare goals, the short term and long-term implicationsand intergenerational redistributions of resources. As long as marginalproductivity 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 politicalresponse is needed.Unless we reduce the well-documented inefficiencies in our current health caresystems the welfare states will fail to consolidate and the overall economic wellbeingcould be in serious trouble. In this article we sketched some policy solutionssuch as pricing according to net benefits of innovation and public encouragementof radical innovation besides the small type incremental and market-ledinnovation. We proposed an independent agency, the National Institute forWelfare Enhancement to guarantee long term fair and efficient social policies inwhich health plays a central role.

Cost efficiency in primary care contracting: A stochastic frontier cost function approach

The principal aim of this paper is to estimate a stochastic frontier costfunction and an inefficiency effects model in the analysis of the primaryhealth care services purchased by the public authority and supplied by 180providers in 1996 in Catalonia. The evidence from our sample does not supportthe premise that contracting out has helped improve purchasing costefficiency in primary care. Inefficient purchasing cost was observed in thecomponent of this purchasing cost explicitly included in the contract betweenpurchaser and provider. There are no observable incentives for thecontracted-out primary health care teams to minimise prescription costs, whichare not explicitly included in the present contracting system.

Book production and the onset of modern economic growth

Endogenous growth theory suggests that human capital formation plays a significant role for the wealth and poverty of nations. In contrast to previous studies which denied the role of human capital as a crucial determinant of for really long-term growth, we confirm its importance. Indicators of human capital like literacy rates are lacking for the period of 1450-1913; hence, we use per capita book production as a proxy for advanced literacy skills. This study explains how, and to what extent, growth disparities are a function of human capital formation.

The impact of Economics on health policy and management in Spain

BackgroundDespite 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.MethodsThe 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.ResultsThe 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 thedaily events.ConclusionsHE 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.

Market structure and hospital efficiency: Evaluating potential effects of deregulation in a national health service

In this article we examine the potential effect of market structureon hospital technical efficiency as a measure of performance controlled byownership and regulation. This study is relevant to provide an evaluationof the potential effects of recommended and initiated deregulation policiesin order to promote market reforms in the context of a European NationalHealth Service. Our goal was reached through three main empirical stages.Firstly, using patient origin data from hospitals in the region of Cataloniain 1990, we estimated geographic hospital markets through the Elzinga--Hogartyapproach, based on patient flows. Then we measured the market level ofconcentration using the Herfindahl--Hirschman index. Secondly, technicaland scale efficiency scores for each hospital was obtained specifying aData Envelopment Analysis. According to the data nearly two--thirds of thehospitals operate under the production frontier with an average efficiencyscore of 0.841. Finally, the determinants of the efficiency scores wereinvestigated using a censored regression model. Special attention waspaid to test the hypothesis that there is an efficiency improvement in morecompetitive markets. The results suggest that the number of competitors inthe market contributes positively to technical efficiency and there is someevidence that the differences in efficiency scores are attributed toseveral environmental factors such as ownership, market structure andregulation effects.

The social value of health programs: Is age a relevant factor?

In cost-effectiveness analysis (CEA) it is usually assumed that a QALY is of equal value to everybody, irrespective of the patient's age. However, it is possible that society assigns different social values to a QALY according to who gets it. In this paper we discuss the possibility of weighting health benefits for age in CEA. We also examinethe possibility that age-related preferences depend on the size of the health gain. An experiment was performedto test these hypotheses. The results assessing suggest that the patient's age is a relevant factor when assessing health gains.

Projecte executiu d'una instal·lació de climatització i control d'un habitatge unifamiliar

Moltes vegades l’usuari d’una instal•lació de climatització o calefacció, no dóna la suficient importància al sistema que l’hi ha de proporcionar un millor confort amb el màxim rendiment. Aquest confort és un factor determinant, entre molts d’altres, de la “qualitat de vida”. Mentre que el rendiment és un factor important a nivell econòmic i ecològic. Tot i tenir prevalença els aspectes d’estalvi energètic, aquests no impliquen haver de renunciar a un confort tèrmic i a un estalvi econòmic. Un dels aspectes que es centra el projecte és promoure l’ús racional de les fonts energètiques (solar, biomassa) per a la correcta climatització dels habitatges. El projecte es desenvolupa en l’àmbit domèstic, concretament correspon a un habitatge unifamiliar. Aquest està situat a la població de Roda de Ter, província de Barcelona. L’objectiu principal del projecte és l’elecció del sistema de climatització i el seu dimensionament, per tal de donar el màxim confort als usuaris que habitin a la vivenda. Criteris ambientals i eficients han estat objecte a considerar pel disseny constructiu de l’habitatge. Una de les mesures importants presses en el projecte, ha estat l’elecció de les diferents parts que formen la instal•lació de climatització. Es fa referència als aïllaments dels tancaments, el sistema solar de recolzament, equips de producció de fred i calor, entre d’altres. En el projecte, s’ha dut a terme un estudi dels diferents tancaments de l’habitatge, tot determinat per a cada un d’ells, el seu coeficient de transmissió tèrmica. Per seleccionar l’equipament més adequat s’ha partit de les condicions climatològiques del municipi de Roda de Ter i s’ha realitzat el càlcul de les necessitats tèrmiques de l’edifici. L’habitatge incorpora una instal•lació de captació solar tèrmica. Aquesta aportarà un suport energètic a tot el sistema de producció de calor, ja sigui per la producció d’aigua calenta sanitària com per el calefactat de la vivenda. La col•locació dels panells a la façana sud tindrà una doble funció: a més de proporcionar energia solar tèrmica, serviran d’elements de protecció solar en la temporada d’estiu. La caldera usada per donar recolzament tèrmic utilitzarà com a combustible el “pellet”. El “pellet” és un tipus de biomassa llenyosa que consta d’un derivat de la fusta en format granulat. Es defineix i es detalla el consum energètic en biomassa, electricitat i cost econòmic anual que ocasionarà la instal.lació dissenyada. El sistema de terra radiant adoptat permetrà el refrescament en èpoques estivals i el calefactat en èpoques hivernals. Aquest donarà el confort tèrmic necessari a cada estança de l’habitatge. En el projecte també es marquen les pautes bàsiques pel control de la instal•lació solar així com el control dels grups de bombament i la mescla d’aigua del terra radiant.

In defense of the "tunneling" wave function of the universe

The tunneling approach to the wave function of the Universe has been recently criticized by Bousso and Hawking who claim that it predicts a catastrophic instability of de Sitter space with respect to pair production of black holes. We show that this claim is unfounded. First, we argue that different horizon size regions in de Sitter space cannot be treated as independently created, as they contend. And second, the WKB tunneling wave function is not simply the inverse of the Hartle-Hawking one, except in very special cases. Applied to the related problem of pair production of massive particles, we argue that the tunneling wave function leads to a small constant production rate, and not to a catastrophe as the argument of Bousso and Hawking would suggest.