Quines són les necessitats espirituals en els adolescents afectats de càncer en situació de malaltia avançada-terminal, en una unitat de cures pal·liatives?

En les cures pal·liatives pediàtriques es contemplen les dimensions essencials de la persona: la física, la psicològica, la social i l’espiritual. Tot i que s’han fet estudis sobre la dimensió espiritual, en la revisió bibliogràfica es mostra que és un àmbit poc desenvolupat. És important conèixer l’aspecte de creences i valors per tal que la infermera oncològica, juntament amb altres professionals, puguin proporcionar una atenció holística. L’objectiu d’aquest estudi és identificar les necessitats espirituals en adolescents (13 a 18 anys) malalts de càncer en situació avançada-terminal. S’utilitza la metodologia qualitativa. La mostra és de vuit adolescents, que són seleccionats d’acord amb els criteris d’inclusió. Aquests seran entrevistats per la infermera, la investigadora, la qual realitzarà entrevistes semiestructurades i un fotomuntatge depenent de la predisposició de l’adolescent. L’àmbit de realització d’aquest estudi és en un hospital de tercer nivell on es proporcioni atenció especialitzada amb pediatria oncològica i, concretament, en una unitat de cures pal·liatives pediàtriques. Per finalitzar, és important tenir en compte que les entrevistes i el fotomuntatge poden tenir les seves limitacions i que no sempre s’obtingui el resultat esperat.

Modeling usage of medical care services: the medical expenditure panel survey data, 1996-2000

We explore the determinants of usage of six different types of health care services, using the Medical Expenditure Panel Survey data, years 1996-2000. We apply a number of models for univariate count data, including semiparametric, semi-nonparametric and finite mixture models. We find that the complexity of the model that is required to fit the data well depends upon the way in which the data is pooled across sexes and over time, and upon the characteristics of the usage measure. Pooling across time and sexes is almost always favored, but when more heterogeneous data is pooled it is often the case that a more complex statistical model is required.

Hausman tests for inefficient estimators: application to demand for health care service (revised)

The Hausman (1978) test is based on the vector of differences of two estimators. It is usually assumed that one of the estimators is fully efficient, since this simplifies calculation of the test statistic. However, this assumption limits the applicability of the test, since widely used estimators such as the generalized method of moments (GMM) or quasi maximum likelihood (QML) are often not fully efficient. This paper shows that the test may easily be implemented, using well-known methods, when neither estimator is efficient. To illustrate, we present both simulation results as well as empirical results for utilization of health care services.

Preventive health care and payment systems to providers

Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We present, both the normative and the positive analyses of the change from independent providers to integrated services. We show the evaluation of that change to depend on the particular way payment to providers is done. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health care.

Likelihood-based approaches to modeling demand for medical care

We review recent likelihood-based approaches to modeling demand for medical care. A semi-nonparametric model along the lines of Cameron and Johansson's Poisson polynomial model, but using a negative binomial baseline model, is introduced. We apply these models, as well a semiparametric Poisson, hurdle semiparametric Poisson, and finite mixtures of negative binomial models to six measures of health care usage taken from the Medical Expenditure Panel survey. We conclude that most of the models lead to statistically similar results, both in terms of information criteria and conditional and unconditional prediction. This suggests that applied researchers may not need to be overly concerned with the choice of which of these models they use to analyze data on health care demand.

Selecting negotiation processes with Health Care

We address the question of how a third-party payer (e.g. an insurer) decides what providers to contract with. Three different mechanisms are studied and their properties compared. A first mechanism consists in the third-party payer setting up a bargaining procedure with both providers jointly and simultaneously. A second mechanism envisages the outcome of the same simultaneous bargaining but independently with every provider. Finally, the last mechanism is of different nature. It is the so-called "any willing provider" where the third-party payer announces a contract and every provider freely decides to sign it or not. The main finding is that the decision of the third-party payer depends on the surplus to be shared. When it is relatively high the third-party payer prefers the any willing provider system. When, on the contrary, the surplus is relatively low, the third-party payer will select one of the other two systems accor ing to how bargaining power is distributed.

Negotiation advantages of professional associations in health care

In several instances, third-party payers negotiate prices of health care services with providers. We show that a third-party payer may prefer to deal with a professional association than with the sub-set constituted by the more efficient providers, and then apply the same price to all providers. The reason for it is the increase in the bargaining position of providers. The more efficient providers are also the ones with higher profits in the event of negotiation failure. This allows them to ext act a higher surplus from the third-party payer.

Optimal regulation of specialized medical care in a mixed system

We study the optimal public intervention in setting minimum standards of formation for specialized medical care. The abilities the physicians obtain by means of their training allow them to improve their performance as providers of cure and earn some monopoly rents.. Our aim is to characterize the most efficient regulation in this field taking into account different regulatory frameworks. We find that the existing situation in some countries, in which the amount of specialization is controlled, and the costs of this process of specialization are publicly financed, can be supported as the best possible intervention.

Lectura de máquinas recreativas con terminal portátil

Servimatic S.L. utiliza un terminal electrónico, prácticamente obsoleto hoy en día, el cual lleva incorporado un lector de infrarrojos y una impresora integrada parcialmente. El problema se plantea cuando la empresa encargada de los componentes de infrarrojos y de las impresoras prevé, en un futuro próximo, el cierre del ciclo de vida de estos productos, dejando de dar soporte de mantenimiento y reparación de los mismos. Nuestra intención es realizar un sistema que nos permita automatizar el proceso de recaudación de máquinas recreativas, capaz de adaptarse a la gran variedad de fabricantes que conviven en el mercado y de sustituir el actual sistema.

Scheduling of straddle carriers in a container terminal

Report for the scientific sojourn at the University of California at Berkeley between September 2007 to February 2008. The globalization combined with the success of containerization has brought about tremendous increases in the transportation of containers across the world. This leads to an increasing size of container ships which causes higher demands on seaport container terminals and their equipment. In this situation, the success of container terminals resides in a fast transhipment process with reduced costs. For these reasons it is necessary to optimize the terminal’s processes. There are three main logistic processes in a seaport container terminal: loading and unloading of containerships, storage, and reception/deliver of containers from/to the hinterland. Moreover there is an additional process that ensures the interconnection between previous logistic activities: the internal transport subsystem. The aim of this paper is to optimize the internal transport cycle in a marine container terminal managed by straddle carriers, one of the most used container transfer technologies. Three sub-systems are analyzed in detail: the landside transportation, the storage of containers in the yard, and the quayside transportation. The conflicts and decisions that arise from these three subsystems are analytically investigated, and optimization algorithms are proposed. Moreover, simulation has been applied to TCB (Barcelona Container Terminal) to test these algorithms and compare different straddle carrier’s operation strategies, such as single cycle versus double cycle, and different sizes of the handling equipment fleet. The simulation model is explained in detail and the main decision-making algorithms from the model are presented and formulated.

Health care utilization among immigrants and native-born populations in 11 European countries. Results from the Survey of Health, Ageing and Retirement in Europe

Objective: This study examines health care utilization of immigrants relative to the native-born populations aged 50 years and older in eleven European countries. Methods. We analyzed data from the Survey of Health Aging and Retirement in Europe (SHARE) from 2004 for a sample of 27,444 individuals in 11 European countries. Negative Binomial regression was conducted to examine the difference in number of doctor visits, visits to General Practitioners (GPs), and hospital stays between immigrants and the native-born individuals. Results: We find evidence those immigrants above age 50 use health services on average more than the native-born populations with the same characteristics. Our models show immigrants have between 6% and 27% more expected visits to the doctor, GP or hospital stays when compared to native-born populations in a number of European countries. Discussion: Elderly immigrant populations might be using health services more intensively due to cultural reasons.

Creació d'un media center amb software lliure

Treball de recerca realitzat per un alumne d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. L’objectiu d’aquest treball de recerca és la creació d’un dispositiu encarregat de centralitzar totes les necessitats multimèdia de casa nostra i distribuir aquest contingut a tots els terminals de la xarxa local d’una manera senzilla i automatitzada. Aquest dispositiu s’ha dissenyat per estar connectat a una televisió d’alta definició, que permetrà la reproducció i l’organització de tot el nostre multimèdia d’una manera còmoda i fàcil. El media center s’encarrega de gestionar la nostra filmoteca, fototeca, biblioteca musical i sèries de TV de manera transparent i automàtica. A més a més, l’usuari pot accedir a tot el multimèdia emmagatzemat al media center des de qualsevol dispositiu de la xarxa local a través de protocols com CIFS o UPnP, en un intent de replicar el cloud computing a escala local. El dispositiu ha estat dissenyat per a suportar tot tipus de formats i subtítols, assegurant la compatibilitat total amb arxius lliures de DRM. El seu disseny minimalista i silenciós el fa perfecte per a substituir el reproductor de DVD de la sala. Tot això sense oblidar el seu baix consum, de l’ordre d’un 75% inferior al d’un PC convencional.

Technological adoption in health care

This paper addresses the impact of payment systems on the rate of technology adoption. We present a model where technological shift is driven by demand uncertainty, increased patients' benefit, financial variables, and the reimbursement system to providers. Two payment systems are studied: cost reimbursement and (two variants of) DRG. According to the system considered, adoption occurs either when patients' benefits are large enough or when the differential reimbursement across technologies offsets the cost of adoption. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin of new vs. old technology reimbursement under DRG. Having larger patient benefits favors more adoption under the cost reimbursement payment system, provided that adoption occurs initially under both payment systems.

Prediction of the economic cost of individual long-term care in the Spanish population

Pensions together with savings and investments during active life are key elements of retirement planning. Motivation for personal choices about the standard of living, bequest and the replacement ratio of pension with respect to last salary income must be considered. This research contributes to the financial planning by helping to quantify long-term care economic needs. We estimate life expectancy from retirement age onwards. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. The expected individual cost of long-term care from an onset of dependence is estimated separately for men and women. Assumptions on the mortality of the dependent people compared to the general population are introduced. Parameters defining eligibility for various forms of coverage by the universal public social care of the welfare system are addressed. The impact of the intensity of social services on individual predictions is assessed, and a partial coverage by standard private insurance products is also explored. Data were collected by the Spanish Institute of Statistics in two surveys conducted on the general Spanish population in 1999 and in 2008. Official mortality records and life table trends were used to create realistic scenarios for longevity. We find empirical evidence that the public long-term care system in Spain effectively mitigates the risk of incurring huge lifetime costs. We also find that the most vulnerable categories are citizens with moderate disabilities that do not qualify to obtain public social care support. In the Spanish case, the trends between 1999 and 2008 need to be further explored.