Sexual health of ethnic minority MSM in Britain (MESH project): design and methods

Background Men who have sex with men (MSM) remain the group most at risk of acquiring HIV infection in Britain. HIV prevalence appears to vary widely between MSM from different ethnic minority groups in this country for reasons that are not fully understood. The aim of the MESH project was to examine in detail the sexual health of ethnic minority MSM living in Britain. Methods/Design The main objectives of the MESH project were to explore among ethnic minority MSM living in Britain: (i) sexual risk behaviour and HIV prevalence; (ii) their experience of stigma and discrimination; (iii) disclosure of sexuality; (iv) use of, and satisfaction with sexual health services; (v) the extent to which sexual health services (for treatment and prevention) are aware of the needs of ethnic minority MSM. The research was conducted between 2006 and 2008 in four national samples: (i) ethnic minority MSM living in Britain; (ii) a comparison group of white British MSM living in Britain; (iii) NHS sexual health clinic staff in 15 British towns and cities with significant ethnic minority communities and; (iv) sexual health promotion/HIV prevention service providers. We also recruited men from two "key migrant" groups living in Britain: MSM born in Central or Eastern Europe and MSM born in Central or South America. Internet-based quantitative and qualitative research methods were used. Ethnic minority MSM were recruited through advertisements on websites, in community venues, via informal networks and in sexual health clinics. White and "key migrant" MSM were recruited mostly through Gaydar, one of the most popular dating sites used by gay men in Britain. MSM who agreed to take part completed a questionnaire online. Ethnic minority MSM who completed the online questionnaire were asked if they would be willing to take part in an online qualitative interview using email. Service providers were identified through the British Association of Sexual Health and HIV (BASHH) and the Terrence Higgins Trust (THT) CHAPS partnerships. Staff who agreed to take part were asked to complete a questionnaire online. The online survey was completed by 1241 ethnic minority MSM, 416 men born in South and Central America or Central and Eastern Europe, and 13,717 white British MSM; 67 ethnic minority MSM took part in the online qualitative interview. In addition 364 people working in sexual health clinics and 124 health promotion workers from around Britain completed an online questionnaire. Discussion The findings from this study will improve our understanding of the sexual health and needs of ethnic minority MSM in Britain.

The Big-5 and the perceived effectiveness of love acts

The present research was implemented in order to determine whether or not the Big-5 personality dimensions relate to the perceived effectiveness of love acts discovered in prior research. An internet based questionnaire was utilized and college undergraduates and as well as non-college students were included in the sample. The Big-5 dimensions of Agreeableness, Openness to Experience, and Emotional Stability were expected to be related to the perceived effectiveness of the Love acts. Additionally, men and women were expected to rate Love acts signaling commitment and exclusivity as most effective. The results obtained were consistent with the hypotheses and are discussed in terms of prior research.

Sleep and wakefulness disturbances in Swiss pharmacy customers

BACKGROUND AND OBJECTIVE: Sleep disturbances are prevalent but often overlooked or underestimated. We suspected that sleep disorders might be particularly common among pharmacy customers, and that they could benefit from counselling. Therefore, we described the prevalence and severity of symptoms associated with sleep and wakefulness disorders among Swiss pharmacy customers, and estimated the need for counselling and treatment. METHODS: In 804 Swiss pharmacies (49% of all community pharmacies) clients were invited to complete the Stanford Sleep Disorders Questionnaire (SDQ), and the Epworth Sleepiness Scale (EPW). The SDQ was designed to classify symptoms of sleep and wakefulness into the four most prevalent disorders: sleep apnoea syndrome (SAS), insomnia in psychiatric disorders (PSY), periodic leg movement disorders/restless legs (RLS) and narcolepsy (NAR). Data were entered into an internet-linked database for analysis by an expert system as a basis for immediate counselling by the pharmacist. RESULTS: Of 4901 participants, 3238 (66.1%) were female, and 1663 (33.9%) were male. The mean age (SD) of females and males was 52.4 (18.05), and 55.1 (17.10) years, respectively. The percentages of female and male individuals above cut-off of SDQ subscales were 11.4% and 19.8% for sleep apnoea, 40.9% and 38.7% for psychiatric sleep disorders, 59.3% and 46.8% for restless legs, and 10.4% and 9.4% for narcolepsy respectively. The prevalence of an Epworth Sleepiness Scale score >11 was 16.5% in females, and 23.9% in males. Reliability assessed by Cronbach's alpha was 0.65 to 0.78 for SDQ subscales, and for the Epworth score. CONCLUSIONS: Symptoms of sleep and wakefulness disorders among Swiss pharmacy customers were highly prevalent. The SDQ and the Epworth Sleepiness Scale score had a satisfactory reliability to be useful for identification of pharmacy customers who might benefit from information and counselling while visiting pharmacies. The internet-based system proved to be a helpful tool for the pharmacist when counselling his customers in terms of diagnostic classification and severity of symptoms associated with the sleeping and waking state.

Anemia is associated with abdominal aortic aneurysm (AAA) size and decreased long-term survival after endovascular AAA repair

OBJECTIVE: Anemia is a common comorbid condition in various inflammatory states and an established predictor of mortality in patients with chronic heart failure, ischemic heart disease, and end-stage renal disease. The present study of patients with abdominal aortic aneurysm (AAA) undergoing endovascular repair (EVAR) assessed the relationships between baseline hemoglobin concentration and AAA size, as well as anemia and long-term survival. METHODS: Between March 1994 and November 2006, 711 patients (65 women, mean age 75.8 +/- 7.8 years) underwent elective EVAR. Anemia was defined as a hemoglobin level <13 g/dL in men and <12 g/dL in women. Post-EVAR mean follow-up was 48.3 +/- 32.0 months. Association of hemoglobin level with AAA size was assessed with multiple linear regression. Mortality was determined with use of the internet-based Social Security Death Index and the electronic hospital record. Kaplan-Meier survival curves of anemic and nonanemic patient groups were compared by the log-rank method. Multivariable logistic regression models were used to determine the influence of anemia on vital status after EVAR. RESULTS: A total of 218/711 (30.7%) of AAA patients undergoing EVAR had anemia at baseline. After adjustment for various risk factors, hemoglobin level was inversely related to maximum AAA diameter (beta: - .144, 95%-CI: -1.482 - .322, P = .002). Post-EVAR survival was 65.5% at 5 years and 44.4% at 10 years. In long-term follow-up, survival was significantly lower in patients with anemia as compared to patients without anemia (P < .0001 by log-rank). Baseline hemoglobin levels were independently related to long-term mortality in multivariable Cox regression analysis adjusted for various risk factors (adjusted HR: 0.866, 95% CI: .783 to .958, P = .005). Within this model, statin use (adjusted HR: .517, 95% CI: .308 to .868, P = .013) was independently related to long-term survival, whereas baseline AAA diameter (adjusted HR: 1.022, 95% CI: 1.009 to 1.036, P = .001) was an independently associated with increased mortality. CONCLUSIONS: Baseline hemoglobin concentration is independently associated with AAA size and reduced long-term survival following EVAR. Thus, the presence or absence of anemia offers a potential refinement of existing risk stratification instruments.

Do patients respect the line? Transgression of boundaries reported by Swiss general practitioners

OBJECTIVE: Transgression of boundaries in the relationship between physician and patient is commonly studied with patient as victim and physician as transgressor. A recent survey in the U.S. reported that almost 90% of physicians face transgression by patients over one year. Incidents happened mainly through verbal abuse, disregarding privacy, and overly affectionate behavior. Since this incidence seems to be alarmingly high, we were interested to analyze how often general practitioners in Switzerland experience transgression by patients. METHODS: 24% of the members of the Swiss Society of Internal Medicine (SGIM) and of the Swiss Society of General Medicine (SGAM) (n=675/2781) responded to an internet-based survey which asked for experiences of transgression by patients and for physicians' responses to transgression in the last 12 months. RESULTS: 81% of responding physicians experienced transgression over the period of one year. Analyzing the frequency of incidents per physician per year, the most common forms of transgression were 'use of physician's first name' (7.7/y), 'asking personal questions' (1.8/y), 'being verbally abusive' (1.5/y), and 'being overly affectionate' (1.4/y). Calculated incidence of transgression was 3 per 1000 patient contacts. 39% of physicians decided to ignore the incident, 37% discussed the event openly. Transgression led to dismissal of patients in 13% of events. CONCLUSION: Transgression even in mild and modest form is a rare phenomenon in Swiss practices. PRACTICE IMPLICATION: The Swiss data do not suggest that there is a specific risk for Swiss practitioners to be exposed to major transgression for which they should specifically be prepared for example in communication skills trainings.

Interpretation of primary care physicians' attitude regarding rotavirus immunisation using diffusion of innovation theories

To evaluate primary care physicians' attitude towards implementation of rotavirus (RV) immunisation into the Swiss immunisation schedule, an eight-question internet-based questionnaire was sent to the 3799 subscribers of InfoVac, a nationwide web-based expert network on immunisation issues, which reaches >95% of paediatricians and smaller proportions of other primary care physicians. Five demographic variables were also inquired. Descriptive statistics and multivariate analyses for the main outcome "acceptance of routine RV immunisation" and other variables were performed. Diffusion of innovation theory was used for data assessment. Nine-hundred seventy-seven questionnaires were returned (26%). Fifty percent of participants were paediatricians. Routine RV immunisation was supported by 146 participants (15%; so called early adopters), dismissed by 620 (64%), leaving 211 (21%) undecided. However, when asked whether they would recommend RV vaccination to parents if it were officially recommended by the federal authorities and reimbursed, 467 (48.5%; so called early majority) agreed to recommend RV immunisation. Multivariate analysis revealed that physicians who would immunise their own child (OR: 5.1; 95% CI: 4.1-6.3), hospital-based physicians (OR: 1.6; 95% CI: 1.1-2.3) and physicians from the French (OR: 1.6; 95% CI: 1.2-2.3) and Italian speaking areas of Switzerland (OR: 2.5; 95% CI: 1.1-5.8) were more likely to support RV immunisation. Diffusion of innovation theory predicts a >80% implementation if approximately 50% of a given population support an innovation. Introduction of RV immunisation in Switzerland is likely to be successful, if (i) the federal authorities issue an official recommendation and (ii) costs are covered by basic health care insurance.

Using Dynamic Programming Decomposition for Revenue Management with Opaque Products

Opaque products enable service providers to hide specific characteristics of their service fulfillment from the customer until after purchase. Prominent examples include internet-based service providers selling airline tickets without defining details, such as departure time or operating airline, until the booking has been made. Owing to the resulting flexibility in resource utilization, the traditional revenue management process needs to be modified. In this paper, we extend dynamic programming decomposition techniques widely used for traditional revenue management to develop an intuitive capacity control approach that allows for the incorporation of opaque products. In a simulation study, we show that the developed approach significantly outperforms other well-known capacity control approaches adapted to the opaque product setting. Based on the approach, we also provide computational examples of how the share of opaque products as well as the degree of opacity can influence the results.

Internetbasierte psychologische Behandlung bei Depressionen

Depression ist die häufigste psychische Erkrankung, aber nur ein geringer Anteil der Betroffenen erhält eine angemessene Behandlung. Internetbasierte Interventionen stellen eine vielversprechende Ergänzung zu traditionellen Behandlungsformen dar, denn über das Internet können breite Bevölkerungsschichten mit wenig Aufwand erreicht werden. Die vorliegende Übersicht stellt den aktuellen Forschungsstand zu internetbasierten Interventionen bei Depressionen dar. Mehrere randomisierte kontrollierte Studien, Metaanalysen und Reviews legen nahe, dass mit strukturierten internetbasierten Interventionen, die regelmäßige Kontakte mit Therapeuten beinhalten (z.B. geleitete Selbsthilfeansätze, E-Mail- oder Chat-Therapien), Effekte erzielt werden können, die mit den Effekten von traditionellen Psychotherapien vergleichbar sind. Ungeleitete Selbsthilfeprogramme sind typischerweise mit hohen Abbrecherquoten und geringeren Effekten verbunden. Die zukünftige Forschung sollte sich vermehrt mit der Frage beschäftigen, wie internetbasierte Interventionen bei Depressionen optimal in die psychosoziale Versorgung integriert werden können. Mögliche Einsatzbereiche und die Einbettung internetbasierter Interventionen in das Versorgungssystem werden dargestellt und diskutiert.

Internetbasierte geleitete Selbsthilfeansätze bei Angststörungen und Depressionen

Das Spektrum internetbasierter psychologischer Behandlungsangebote bei psychischen Problemen und Erkrankungen bewegt sich zwischen webbasierten Selbsthilfeprogrammen, die das Internet als Informationsmedium verwenden, und Email-, Chat- und Video-Therapien, in welchen das Internet zu Kommunikationszwecken zwischen Hilfesuchenden und Professionellen genutzt wird. Dieser Beitrag fokussiert auf eine Beratungs- und Therapieform, die die Möglichkeiten des Internets als Informations- und Kommunikationsmedium in sogenannten geleiteten Selbsthilfeansätzen kombiniert. Internetbasierte geleitete Selbsthilfeansätze, in welchen Klienten während der Bearbeitung eines Selbsthilfeprogramms von Therapeuten via Internet (z.B. Email) unterstützt werden, wurden in den letzten Jahren intensiv erforscht. Im Bereich von Angststörungen und Depressionen liegen besonders viele Studien vor. Verschiedene Forschergruppen haben hier in der Regel große Behandlungseffekte gefunden, die mit der Wirkung von Face-to-Face-Therapien vergleichbar sind. In diesem Beitrag wird der geleitete Selbsthilfeansatz dargestellt und die empirische Evidenz diskutiert.

Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe†‡

OBJECTIVES To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch. METHODS All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly. RESULTS The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement. CONCLUSIONS These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approaches.

OSCAR – ein internetbasiertes Unterstützungsprogramm für Angehörige von Menschen mit einer Hirnverletzung: Pilotstudie

Erhöhte Depressivität und Ängstlichkeit sowie ein erhöhtes subjektives Belastungserleben sind bei Angehörigen von Menschen mit einer Hirnverletzung häufig. Die vorliegende Pilotuntersuchung widmet sich der Evaluation einer neuartigen Intervention, dem OSCAR Online-Coaching, einer internetbasierten Mehrkomponentenintervention. In einer randomisierten, kontrollierten Pilotstudie mit 35 TeilnehmerInnen wurde ein 16-wöchiges therapeutengeleitetes Selbsthilfeprogramm mit einer Wartekontrollgruppe verglichen. Als primäre Ergebnismasse wurde der Perceived Stress Questionnaire und das Zarit Burden Interview eingesetzt. Intention-to-treat-Analysen der unmittelbaren Effekte direkt nach der Intervention zeigten keine signifikanten Gruppenunterschiede auf den primären und auf sekundären Ergebnismassen. Im 6-Monate Follow-up, nach Zugang der Kontrollgruppe zur Intervention, wurde in der Gesamtstichprobe eine signifikante Reduktion des Caregiver Burden, depressiver Symptome, der Angst, sowie eine Zunahme positiver Emotionen gefunden. Die Zufriedenheit mit dem Programm war gut.

Experiences with a voluntary surveillance system for early detection of equine diseases in Switzerland

Clinical observations made by practitioners and reported using web- and mobile-based technologies may benefit disease surveillance by improving the timeliness of outbreak detection. Equinella is a voluntary electronic reporting and information system established for the early detection of infectious equine diseases in Switzerland. Sentinel veterinary practitioners have been able to report cases of non-notifiable diseases and clinical symptoms to an internet-based platform since November 2013. Telephone interviews were carried out during the first year to understand the motivating and constraining factors affecting voluntary reporting and the use of mobile devices in a sentinel network. We found that non-monetary incentives attract sentinel practitioners; however, insufficient understanding of the reporting system and of its relevance, as well as concerns over the electronic dissemination of health data were identified as potential challenges to sustainable reporting. Many practitioners are not yet aware of the advantages of mobile-based surveillance and may require some time to become accustomed to novel reporting methods. Finally, our study highlights the need for continued information feedback loops within voluntary sentinel networks.

The Role of Patents in the Advent of Web 2.0

Given the significant impact of Web 2.0-related innovations on new Internet-based initiatives, this paper seeks to identify to what extent the main developments are protected by patents and whether patents have had a leading role in the advent of Web 2.0. The article shows that the number of patent applications filed is not that important for many of the Web 2.0 technologies in frequent use and that, of those filed, those granted are even less. The conclusion is that patents do not seem to be a relevant factor in the development of the Web 2.0 (and more generally in dynamic markets) where there is a high degree of innovation and low entry barriers for newcomers.

A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study

BACKGROUND: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. METHODOLOGY: We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. FINDINGS: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. CONCLUSIONS: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. TRIAL REGISTRATION: Clinical-Trials.gov: NCT01117675.

Solución para la delegación de identidad en Sistemas de Gestión de Identidad paneuropeos basada en infraestructuras de certificación y lenguajes formales de asertos de seguridad

La estrategia i2010 de la UE tiene como objetivo garantizar el liderazgo europeo en materia de TIC y poner los beneficios de la Sociedad de la Información al servicio de la economía, la sociedad y la calidad de vida personal, teniendo presente que los éxitos de Europa hasta la fecha se han basado en favorecer la competencia leal en los mercados de las telecomunicaciones y crear un mercado sin fronteras para contenidos y medios de comunicación digitales. En esta línea, la Comisión Europea ha establecido que los distintos estados miembros deben contribuir activamente al desarrollo y uso seguro de los servicios telemáticos entre sus ciudadanos. Más concretamente, atribuye a las Administraciones Públicas, tanto a nivel nacional, regional como local, un papel dinamizador de la Sociedad de la Información que les obliga a ofrecer paulatinamente todos los actos administrativos a los ciudadanos a través de Internet. Como primer paso para el uso seguro de los servicios telemáticos que ofrecen las instituciones públicas se hace preciso dotar a los ciudadanos de una identidad digital que les permita identificarse ante un Proveedor de Servicio o ante otros ciudadanos de manera inequívoca. Por esta razón, la mayoría de países europeos – y otros en el resto del mundo – están promoviendo, sistemas fiables de gestión de identidad electrónica (eIDM), de tal manera que los ciudadanos, las empresas y departamentos gubernamentales (incluso en Estados miembros diferentes) pueden identificar y certificar sus operaciones con precisión, rapidez y sencillez. Sin embargo, la gestión de esta identidad por las Administraciones Públicas supone un importante desafío, acentuado cuando se hace necesaria la interoperabilidad entre Administraciones de diferentes países, puesto que personas y entidades tienen credenciales de identificación diferentes en función de su propio marco jurídico nacional. Consciente del problema, en la Unión Europea se han puesto en marcha una serie de proyectos con el objetivo de conseguir la interoperabilidad de los eIDMs entre las instituciones públicas de diferentes Estados miembros. A pesar de ello, las soluciones adoptadas hasta la fecha son insuficientes porque no prevén todos los posibles casos de interacción del usuario con las instituciones. En concreto, no tienen en cuenta un aspecto muy importante que se ofrece en los distintos sistemas jurídicos nacionales, a saber, la delegación de la identidad, mediante la cual un ciudadano puede autorizar a otro para que actúe en su nombre para acceder a determinados servicios prestados por las instituciones públicas. En esta tesis se realizan un conjunto de aportaciones que dan solución a distintos aspectos de los problemas planteados y que, de forma conjunta, permiten la interoperabilidad y la delegación de identidad en determinados Sistemas de Gestión de Identidad aplicados al entorno de las Administraciones Públicas. En el caso de la delegación, se ha definido un sistema de delegación dinámica de identidad entre dos entidades genéricas que permite solucionar el problema del acceso delegado a los servicios telemáticos ofrecidos por las Administraciones Públicas. La solución propuesta se basa en la generación de un token de delegación, constituido a partir de un Certificado Proxy, que permite a la entidad que delega establecer la delegación de identidad en otra entidad en base a un subconjunto de sus atributos como delegador, estableciendo además, en el propio token de delegación, restricciones en el conjunto de servicios accesibles a la entidad delegada y el tiempo de validez de la delegación. Adicionalmente, se presentan los mecanismos necesarios tanto para poder revocar un token de delegación como para comprobar sin un token de delegación ha sido o no revocado. Para ello se propone una solución para la identificación unívoca de tokens de delegación y la creación de una nueva entidad denominada Autoridad de Revocación de Tokens de Delegación. Entre las características del sistema de delegación propuesto destaca el que es lo suficientemente seguro como para ser utilizado en el entorno de la Administración Pública, que no requiere el uso de mecanismos off‐line para la generación de la delegación y que se puede realizar la delegación de forma instantánea y sin la necesidad de trámites complejos o la participación de un elevado número de entidades. Adicionalmente, el token de delegación propuesto es perfectamente integrable en las infraestructura de clave pública actual lo que hace que, dado que gran parte de las Administraciones Públicas europeas basan sus sistemas de identidad digital en el uso de la PKI y certificados de identidad X.509, la solución pueda ser puesta en marcha en un entorno real sin necesidad de grandes cambios o modificaciones de comportamiento. En lo referente a la interoperabilidad, se realiza un análisis exhaustivo y la correspondiente evaluación de las principales propuestas de Sistemas de Gestión de Identidad orientados a conseguir la interoperabilidad realizadas hasta la fecha en el marco de la Unión Europea y se propone, a alto nivel, una arquitectura de interoperabilidad para la gestión de identidad en las Administraciones Públicas. Dicha arquitectura es lo suficientemente genérica como para poder ser aplicada tanto en el entorno pan‐Europeo como en los entornos nacionales, autonómicos y locales, de tal forma que la interoperabilidad en la gestión de la identidad esté garantizada en todos los niveles de la Administración Pública. Por último, mediante la integración de la solución de delegación dinámica de identidad y la arquitectura de interoperabilidad propuestas se presenta una solución al problema de la delegación en un escenario pan‐Europeo de gestión de identidad, dando lugar a una arquitectura global de interoperabilidad pan‐Europea con soporte a la delegación de identidad. SUMMARY The i2010 European Union Plan aims to ensure European leadership in ICT and to promote the positive contribution that information and communication technologies can make to the economic, social and personal quality of life, bearing in mind that, to date, success in Europe has been based on promoting fair competition in telecommunications markets and on creating a borderless market for contents and digital media. In this line, the European Commission has established that the different member states should contribute actively to the development and secure use of telematic services among their citizens. More specifically, it is attributed to national, regional and local Public Administrations to have a supportive role of the Information Society, requiring them to gradually provide the citizens with Internet‐based access to all administrative procedures acts. As a first step for the secure use of telematic services offered by public institutions, it is necessary to provide the citizens with a digital identity to enable them to identify themselves unequivocally to a Service Provider or to other citizens. For this reason, most European countries ‐ and others in the rest of the world ‐ are promoting reliable systems for managing electronic identity (eIDM), so that citizens, businesses and government departments (even in different Member States) can identify and certify their operations with precision, speed and simplicity. However, the identity management by Public Administrations is a major challenge that becomes more difficult when interoperability between administrations of different countries is needed, due to the fact that individuals and entities have different identification credentials according to their own national legal framework. Aware of the problem, the European Union has launched a series of projects with the aim of achieving interoperability of eIDMs between public institutions of different Member States. However, the solutions adopted to date are insufficient because they do not foresee all possible cases of user interaction with the institutions. In particular, solutions do not take into account a very important aspect that is offered in different national legal systems, namely, the delegation of identity, by which a citizen can authorize another to act on his/her behalf to access certain services provided by public institutions. In this thesis a collection of contributions that provide solution to different aspects of the aforementioned problems are carried out. The solutions, in global, enable interoperability and identity delegation in some of the Identity Management Systems applied to Public Administration environment. In the case of delegation, a dynamic identity delegation system between generic entities is defined. This system makes it possible to solve the problem of delegated access to telematic services offered by Public Administrations. The proposed solution is based on the generation of a piece of information called delegation token. This delegation token, derived from a Proxy Certificate, allows the establishment of identity delegation by an entity that delegates (delegator) in other entity (delegatee) making use of a subset of delegator attributes. It also establishes restrictions on services that can be used by the delegated entity and the expiry date of delegation. In addition to this, the mechanisms necessary to revoke and check the revocation status of a delegation token are presented. To do this, a solution to univocally identify delegation tokens and the creation of a completely new entity, called Token Delegation Revocation Authority, are proposed. The most remarkable characteristics of the proposed delegation system are its security, enough for it to be used in the Public Administration environment, the fact that it does not require off‐line processes in order to generate the delegation, and the possibility of performing the delegation instantaneously and without neither complex processes nor the intervention of a large number of entities. The proposed delegation token can be completely incorporated into current Public Key Infrastructure (PKI). Thus, since most of the European Public Administrations base their digital identity systems on PKI and X.509 identity certificates, the solution can be adopted in a real environment without great changes or performance modifications. Regarding interoperability, an exhaustive analysis and evaluation of most significant proposals on Identity Management Systems that aim to achieve interoperability carried out in the European Union framework until now are performed. A high level identity management interoperability architecture for Public Administrations is also proposed. This architecture is sufficiently generic to be applied to both pan‐European environment and national, regional or local environments, thus interoperability in identity management at all Public Administration levels is guaranteed. Finally, through the integration of the proposed dynamic identity delegation solution and the high level interoperability architecture, a solution to the problem of identity delegation in a pan‐European identity management environment is suggested, leading to a pan‐European global interoperability architecture with identity delegation support.