Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

[EN] Background This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed. Methods We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs. Results The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups. Conclusions Doctors working in the Spanish NHS seem to be sensitive to the price that can be afforded by patients when they fill in prescriptions, although alternative hypothesis could also explain the results found.

Visual scanning in sports actions: comparison between soccer goalkeepers and judo fighters

Visual search and oculomotor behaviour are believed to be very relevant for athlete performance, especially for sports requiring refined visuo-motor coordination skills. Modern coaches believe that a correct visuo-motor strategy may be part of advanced training programs. In this thesis two experiments are reported in which gaze behaviour of expert and novice athletes were investigated while they were doing a real sport specific task. The experiments concern two different sports: judo and soccer. In each experiment, number of fixations, fixation locations and mean fixation duration (ms) were considered. An observational analysis was done at the end of the paper to see perceptual differences between near and far space. Purpose: The aim of the judo study was to delineate differences in gaze behaviour characteristics between a population of athletes and one of non athletes. Aspects specifically investigated were: search rate, search order and viewing time across different conditions in a real-world task. The second study was aimed at identifying gaze behaviour in varsity soccer goalkeepers while facing a penalty kick executed with instep and inside foot. Then an attempt has been done to compare the gaze strategies of expert judoka and soccer goalkeepers in order to delineate possible differences related to the different conditions of reacting to events occurring in near (peripersonal) or far (extrapersonal) space. Judo Methods: A sample of 9 judoka (black belt) and 11 near judoka (white belt) were studied. Eye movements were recorded at 500Hz using a video based eye tracker (EyeLink II). Each subject participated in 40 sessions for about 40 minutes. Gaze behaviour was considered as average number of locations fixated per trial, the average number of fixations per trial, and mean fixation duration. Soccer Methods: Seven (n = 7) intermediate level male volunteered for the experiment. The kickers and goalkeepers, had at least varsity level soccer experience. The vision-in-action (VIA) system (Vickers 1996; Vickers 2007) was used to collect the coupled gaze and motor behaviours of the goalkeepers. This system integrated input from a mobile eye tracking system (Applied Sciences Laboratories) with an external video of the goalkeeper’s saving actions. The goalkeepers took 30 penalty kicks on a synthetic pitch in accordance with FIFA (2008) laws. Judo Results: Results indicate that experts group differed significantly from near expert for fixations duration, and number of fixations per trial. The expert judokas used a less exhaustive search strategy involving fewer fixations of longer duration than their novice counterparts and focused on central regions of the body. The results showed that in defence and attack situation expert group did a greater number of transitions with respect to their novice counterpart. Soccer Results: We found significant main effect for the number of locations fixated across outcome (goal/save) but not for foot contact (instep/inside). Participants spent more time fixating the areas in instep than inside kick and in goal than in save situation. Mean and standard error in search strategy as a result of foot contact and outcome indicate that the most gaze behaviour start and finish on ball interest areas. Conclusions: Expert goalkeepers tend to spend more time in inside-save than instep-save penalty, differences that was opposite in scored penalty kick. Judo results show that differences in visual behaviour related to the level of expertise appear mainly when the test presentation is continuous, last for a relatively long period of time and present a high level of uncertainty with regard to the chronology and the nature of events. Expert judoist performers “anchor” the fovea on central regions of the scene (lapel and face) while using peripheral vision to monitor opponents’ limb movements. The differences between judo and soccer gaze strategies are discussed on the light of physiological and neuropsychological differences between near and far space perception.

Advanced polymeric materials for applications in technical equipment for snow sports

The thesis is divided in three chapters, each one covering one topic. Initially, the thermo-mechanical and impact properties of materials used for back protectors have been analysed. Dynamical mechanical analysis (DMTA) has shown that materials used for soft-shell protectors present frequency-sensitive properties. Furthermore, through impact tests, the shock absorbing characteristics of the materials have been investigated proving the differences between soft and hard-shell protectors; moreover it has been demonstrated that the materials used for soft-shell protectors maintain their protective properties after multi-impacts. The second chapter covers the effect of the visco-elastic properties of the thermoplastic polymers on the flexural and rebound behaviours of ski boots. DMTA analysis on the materials and flexural and rebound testing on the boots have been performed. A comparison of the results highlighted a correlation between the visco-elastic properties and the flexural and rebound behaviour of ski boots. The same experimental methods have been used to investigate the influence of the design on the flexural and rebound behaviours. Finally in the third chapter the thermoplastic materials employed for the construction of ski boots soles have been characterized in terms of chemical composition, hardness, crystallinity, surface roughness and coefficient of friction (COF). The results showed a relation between material hardness and grip, in particular softer materials provide more grip with respect to harder materials. On the contrary, the surface roughness has a negative effect on friction because of the decrease in contact area. The measure of grip on inclined wet surfaces showed again a relation between hardness and grip. The performance ranking of the different materials has been the same for the COF and for the slip angle tests, indicating that COF can be used as a parameter for the choice of the optimal material to be used for the soles of ski boots.

Untersuchung der Auswirkungen verschiedener Variationsbereiche des differenziellen Lernens und Lehrens im weiten Sinn auf ausgewählte technische Grundfertigkeiten im Hallenhockey

Die Frage wie großmotorische Bewegungen gelernt werden beschäftigt nicht nur Sportler, Trainer und Sportlehrer sondern auch Ärzte und Physiotherapeuten. Die sportwissenschaftlichen Teildisziplinen Bewegungs- und Trainingswissenschaft versuchen diese Frage sowohl im Sinne der Grundlagenforschung (Wie funktioniert Bewegungslernen?) als auch hinsichtlich der praktischen Konsequenzen (Wie lehrt man Bewegungen?) zu beantworten. Innerhalb dieser Themenfelder existieren Modelle, die Bewegungslernen als gezielte und extern unterstützte Ausbildung zentralnervöser Bewegungsprogramme verstehen und solche, die Lernen als Selbstorganisationsprozess interpretieren. Letzteren ist das Differenzielle Lernen und Lehren (Schöllhorn, 1999) zuzuordnen, das die Notwendigkeit betont, Bewegungen durch die Steigerung der Variationen während der Aneignungsphase zu lernen und zu lehren. Durch eine Vielzahl an Variationen, so die Modellannahme, findet der Lernende ohne externe Vorgaben selbstorganisiert ein individuelles situatives Optimum. Die vorliegende Arbeit untersucht, welchen Einfluss Variationen verschiedener Art und Größe auf die Lern- und Aneignungsleistung großmotorischer Bewegungen haben und in wie fern personenübergreifende Optima existieren. In zwei Experimenten wird der Einfluss von räumlichen (Bewegungsausführung, Bewegungsergebnis) und zeitlichen Variationen (zeitliche Verteilung der Trainingsreize) auf die Aneignungs- und Lernleistung großmotorischer sportlicher Bewegungen am Beispiel zweier technischer Grundfertigkeiten des Hallenhockeys untersucht. Die Ergebnisse der Experimente stützen die bisherige Befundlage zum Differenziellen Lernen und Lehren, wonach eine Zunahme an Variation in der Aneignungsphase zu größeren Aneignungs- und Lernleistungen führt. Zusätzlich wird die Annahme bestätigt, dass ein Zusammenhang von Variationsbereich und Lernrate in Form eines Optimaltrends vorliegt. Neu sind die Hinweise auf die Dynamik von motorischen Lernprozessen (Experiment 1). Hier scheinen individuelle Faktoren (z. B. die Lernbiografie) als auch die Phase im Lernprozess (Aneignung, Lernen) Einfluss zu haben auf den Umfang und die Struktur eines für die optimale Adaptation notwendigen Variationsbereichs. Darüber hinaus weisen die Befunde auf verschiedene Aneignungs- und Lerneffekte aufgrund alleiniger Variation der zeitlichen Verteilung bei ansonsten gleichen Trainingsreizen hin (Experiment 2). Für zukünftige Forschungsarbeiten zum Erlernen großmotorischer Bewegungen und für die sportliche Praxis dürfte es daher erkenntnisreich sein, die Historie der intrinsischen Dynamik der lernenden Systeme stärker zu berücksichtigen. Neben Fragestellungen für die Grundlagenforschung zum (Bewegungs-)Lernen ließen sich hieraus unmittelbar praxisrelevante Erkenntnisse darüber ableiten, wie Bewegungslernprozesse mittels verschiedener Variationsbereiche strukturiert und gesteuert werden könnten.