Problemas de la investigación psicofarmacológica clínica

Tras una breve referencia histórica a los comienzos de la psicofarmacologia moderna, se abordan 10s problemas mas importantes que ésta tiene planteados, tales como la dificultad de conseguir muestras homogéneas de catlfermos, problema derivado en parte de la imposibilidad de establecer diagnosticos exactos que estén sustentados no solo por el criterio clinico, sino en lrases objetivas y objetivables. Se analizan los criterios diagnósticos disponililes: clinico, escalas de evaluación y bases somáticas con especial referencia; i estas ultimas. Finalmente, se considera el problema de la evaluación y control de los efectos psicofarmacológicos, aspecto, por otro lado, estrechamente ligado al anterior.

¿Las patentes aceleran o retrasan la comercialización de nuevos medicamentos en los países en desarrollo?

Este trabajo analiza el impacto de las patentes en la dinámica de introducción de nuevos medicamentos en diferentes mercados nacionales. El estudio de un conjunto de mercados de medicamentos contra el VIH/SIDA en una muestra de países en desarrollo indica que las patentes sólo aceleran significativamente la introducción de los nuevos medicamentos después de que hayan pasado entre 1 y 4 años desde su lanzamiento mundial. Las patentes impiden que se introduzcan copias locales de los nuevos medicamentos comercializados por las grandes multinacionales, y la falta de competencia y los mayores precios de introducción resultantes ofrece a las multinacionales mayores ingresos en la comercialización de nuevos medicamentos mientras dura la patente. Sin embargo, el incentivo económico que debería acelerar la disponibilidad de nuevos medicamentos parece operar con cierto retraso

Drug price differentials caused by de-listing and price cap policies

This paper analyses the behaviour of pharmaceutical companies that face the threat of having their drugs excluded from reimbursement and the markets characterised also by price caps. We conclude that price elasticity of demand and cost differentials cause the price discounts which drug firms offer to health care organisations. Additionally, we conclude that price cap regulations affect the time path of prices, resulting in higher prices for new products and lower prices for old products.

Community pharmacist intervention in depressed primary care patients (PRODEFAR study): randomized controlled trial protocol.

Background: Treatment of depression, the most prevalent and costly mental disorder, needs to be improved. Non-concordance with clinical guidelines and non-adherence can limit the efficacy of pharmacological treatment of depression. Through pharmaceutical care, pharmacists can improve patients' compliance and wellbeing. The aim of this study is to evaluate the effectiveness and costeffectiveness of a community pharmacist intervention developed to improve adherence and outcomes of primary care patients with depression. Methods/design: A randomized controlled trial, with 6-month follow-up, comparing patients receiving a pharmaceutical care support programme in primary care with patients receiving usual care. The total sample comprises 194 patients (aged between 18 and 75) diagnosed with depressive disorder in a primary care health centre in the province of Barcelona (Spain). Subjects will be asked for written informed consent in order to participate in the study. Diagnosis will be confirmed using the SCID-I. The intervention consists of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring patients about side-effects and stressing the importance of carrying out general practitioners' advice. Measurements will take place at baseline, and after 3 and 6 months. Main outcome measure is compliance with antidepressants. Secondary outcomes include; clinical severity of depression (PHQ-9), anxiety (STAI-S), health-related quality of life (EuroQol-5D), satisfaction with the treatment received, side-effects, chronic physical conditions and sociodemographics. The use of healthcare and social care services will be assessed with an adapted version of the Client Service Receipt Inventory (CSRI). Discussion: This trial will provide valuable information for health professionals and policy makers on the effectiveness and cost-effectiveness of a pharmaceutical intervention programme in the context of primary care. Trial registration: NCT00794196

¿Las patentes aceleran o retrasan la comercialización de nuevos medicamentos en los países en desarrollo?

Este trabajo analiza el impacto de las patentes en la dinámica de introducción de nuevos medicamentos en diferentes mercados nacionales. El estudio de un conjunto de mercados de medicamentos contra el VIH/SIDA en una muestra de países en desarrollo indica que las patentes sólo aceleran significativamente la introducción de los nuevos medicamentos después de que hayan pasado entre 1 y 4 años desde su lanzamiento mundial. Las patentes impiden que se introduzcan copias locales de los nuevos medicamentos comercializados por las grandes multinacionales, y la falta de competencia y los mayores precios de introducción resultantes ofrece a las multinacionales mayores ingresos en la comercialización de nuevos medicamentos mientras dura la patente. Sin embargo, el incentivo económico que debería acelerar la disponibilidad de nuevos medicamentos parece operar con cierto retraso

Drug price differentials caused by de-listing and price cap policies

This paper analyses the behaviour of pharmaceutical companies that face the threat of having their drugs excluded from reimbursement and the markets characterised also by price caps. We conclude that price elasticity of demand and cost differentials cause the price discounts which drug firms offer to health care organisations. Additionally, we conclude that price cap regulations affect the time path of prices, resulting in higher prices for new products and lower prices for old products.

El conflicto ético

Es importante que tengamos en cuenta que las Declaraciones de Derechos, las Constituciones, la nueva Carta de Derechos Fundamentales de la Unión Europea, el Convenio de Derechos Humanos en Biomedicina, las nuevas Leyes de autonomía del paciente... todas hacen hincapié en los derechos de los pacientes, en los derechos de los incapacesde hecho y de los efectivamente incapacitados. Las normas vigentes concuerdan en que todos los pacientes -también los psiquiátricos¿- poseen, en principio, los mismos derechos, y que las limitaciones a su ejercicio tienen que ser siempre justificadas e interpretadas de manera restrictiva.

Biotechnological production of taxanes: a molecular approach

Plant cell cultures constitute a promise for the production of a high number of phytochemicals, although the majority ofbioprocesses that have been developed so far have not resultedcommercially successful. An overview indicates that most of theresearch carried out until now is of the empirical type. For this reason,there is a need for a rational approach to the molecular and cellularbasis of metabolic pathways and their regulation in order to stimulatefuture advances.The empirical investigations are based on the optimization of theculture system, exclusively considering input factors such as theselection of cellular lines, type and parameters of culture, bioreactordesign and elicitor addition, and output factors such as cellular growth,the uptake system of nutrients, production and yield. In a rationalapproach towards the elucidation of taxol and related taxaneproduction, our group has studied the relationship between the taxaneprofile and production and the expression of genes codifying forenzymes that participate in early, intermediate and late steps of theirbiosynthesis in elicited Taxus spp cell cultures. Our results show that elicitors induce a dramatic reprogramming of gene expression in Taxus cell cultures, whichlikely accounts for the enhanced production of taxol and related taxanes and we have alsodetermined some genes that control the main flux limiting steps. The application ofmetabolic engineering techniques for the production of taxol and taxanes of interest is also discussed.

Phylogenetic studies in Gnaphalieae (Compositae): The genera Phagnalon Cass. and Aliella Qaiser & Lack

The precise generic delimitation of Aliella andPhagnalon, and their closest relatives within the Gnaphalieae are discussed in this review. Among the main results obtained, wehave found that the genera Aliella and Phagnalon are nested withinthe “Relhania clade” and Anisothrix, Athrixia and Pentatrichia aretheir closest relatives. Macowania is also part of the “Relhaniaclade”, whereas the subtribal affinities of Philyrophyllum liewithin the “crown radiation clade”. The monophyly of Aliellaand Phagnalon is not supported statistically. In addition,Aliella appears to be paraphylethic in most of the analysesperformed. The resulting phylogeny suggests an African origin forthe ancestor of Aliella and Phagnalon and identifies three mainclades within Phagnalon that constitute the following naturalgroups on a geographic basis: (1) the Irano-Turanian clade; (2) the Mediterranean-Macaronesian clade; and (3) the Yemen-Ethiopian clade. Some endemics to Yemen and Ethiopia appeared merged in the Mediterranean-Macaronesian clade, providing new evidence of the phytogeographical links betweenMacaronesia, Eastern Africa and Southern Arabia. Incongruities between thechloroplast and nuclear molecular data and the lack of resolution in some clades mayindicate that hybridization could have played an important role in the evolution anddiversification of both Phagnalon and Aliella.

Evaluation of reclamation technologies for wastewater reuse

Reclamation and reuse of wastewater require the use of tools that minimize risks to health and natural ecosystems. There are various types of such tools, among which HACCP (hazardanalysis and critical control points) and barrier systems are gainingimportance. The research reported here aims to determine andevaluate the most efficient combinations of different treatmentsystems—barriers—for the reclamation of secondary effluentsfrom urban sewage treatment plants, and for obtaining water ofsufficient quality for reuse in accordance with existing legislation,in which water disinfection has become one of the keys tocompliance. Several conventional and non-conventional reclamationtechnologies are evaluated. The results lead us to recommendtreatment lines for the different reclaimed water uses established inthe Spanish legislation.

The effect of recombination in Aeromonas

Although several approaches have been attempted, the estimation of recombination frequencies in natural populations ofbacteria remains challenging. Previous studies have demonstrated awide variety of situations among bacterial species, ranging from theclonal diversification of Salmonella or Escherichia coli, which aremainly due to mutation, to the frequent recombination found inNeisseria gonorrhoeae or Helicobacter pylori. Most of the populationstudies done with bacterial species suggest that recombination occursin nature but that it is infrequent compared to mutation. Consequently,bacterial populations consist largely of independent clonal lineages.Our research suggests little or null influence of recombination in thegenetic structure of "Aeromonas hydrophila Species Complex", despite the presence of some strains with recombinant gene fragments.

Is leishmaniosis spreading to northern areas of the Iberian Peninsula? The examples of Lleida (NE Spain) and Andorra

The entomological and canine leishmaniosis surveyscarried out in the northwest of Catalonia and in Andorra in thecontext of the European project Emerging Diseases in a changing European eNvironment (EDEN) are summarized. The aim of the study was to obtain data on the presence of leishmaniosis in these areas and the spatial distribution of their vectors.

New strategies in the modulation of fatty acid oxidation as a treatment for obesity

Strategies that enhance fat degradation or reduce caloricfood intake could be considered therapeutic interventions to reduce notonly obesity, but also its associated disorders. The enzyme carnitinepalmitoyltransferase 1 (CPT1) is the critical rate-determining regulatorof fatty acid oxidation (FAO) and might play a key role in increasingenergy expenditure and controlling food intake. Our group has shownthat mice overexpressing CPT1 in liver are protected from weight gain,the development of obesity and insulin resistance. Regarding foodintake control, we observed that the pharmacological inhibition ofCPT1 in rat hypothalamus decreased food intake and body weight.This suggests that modulation of CPT1 activity and the oxidation offatty acids in various tissues can be crucial for the potential treatmentof obesity and associated pathologies.