Economía de la salud, modalidades de evaluación económica

La salud es un aspecto muy importante en la vida de cualquier persona, de forma que, al ocurrir cualquier contingencia que merma el estado de salud de un individuo o grupo de personas, se debe valorar estrictamente y en detalle las distintas alternativas destinadas a combatir la enfermedad. Esto se debe a que, la calidad de vida de los pacientes variará dependiendo de la alternativa elegida. La calidad de vida relacionada con la salud (CVRS) se entiende como el valor asignado a la duración de la vida, modificado por la oportunidad social, la percepción, el estado funcional y la disminución provocadas por una enfermedad, accidente, tratamiento o política (Sacristán et al, 1995). Para determinar el valor numérico asignado a la CVRS, ante una intervención, debemos beber de la teoría económica aplicada a las evaluaciones sanitarias para nuevas intervenciones. Entre los métodos de evaluación económica sanitaria, el método coste-utilidad emplea como utilidad, los años de vida ajustado por calidad (AVAC), que consiste, por un lado, tener en cuenta la calidad de vida ante una intervención médica, y por otro lado, los años estimados a vivir tras la intervención. Para determinar la calidad de vida, se emplea técnicas como el Juego Estándar, la Equivalencia Temporal y la Escala de Categoría. Estas técnicas nos proporcionan un valor numérico entre 0 y 1, siendo 0 el peor estado y 1 el estado perfecto de salud. Al entrevistar a un paciente a cerca de la utilidad en términos de salud, puede haber riesgo o incertidumbre en la pregunta planteada. En tal caso, se aplica el Juego Estándar con el fin de determinar el valor numérico de la utilidad o calidad de vida del paciente ante un tratamiento dado. Para obtener este valor, al paciente se le plantean dos escenarios: en primer lugar, un estado de salud con probabilidad de morir y de sobrevivir, y en segundo lugar, un estado de certeza. La utilidad se determina modificando la probabilidad de morir hasta llegar a la probabilidad que muestra la indiferencia del individuo entre el estado de riesgo y el estado de certeza. De forma similar, tenemos la equivalencia temporal, cuya aplicación resulta más fácil que el juego estándar ya que valora en un eje de ordenadas y abscisas, el valor de la salud y el tiempo a cumplir en esa situación ante un tratamiento sanitario, de forma que, se llega al valor correspondiente a la calidad de vida variando el tiempo hasta que el individuo se muestre indiferente entre las dos alternativas. En último lugar, si lo que se espera del paciente es una lista de estados de salud preferidos ante un tratamiento, empleamos la Escala de Categoría, que consiste en una línea horizontal de 10 centímetros con puntuaciones desde 0 a 100. La persona entrevistada coloca la lista de estados de salud según el orden de preferencia en la escala que después es normalizado a un intervalo entre 0 y 1. Los años de vida ajustado por calidad se obtienen multiplicando el valor de la calidad de vida por los años de vida estimados que vivirá el paciente. Sin embargo, ninguno de estas metodologías mencionadas consideran el factor edad, siendo necesario la inclusión de esta variable. Además, los pacientes pueden responder de manera subjetiva, situación en la que se requiere la opinión de un experto que determine el nivel de discapacidad del aquejado. De esta forma, se introduce el concepto de años de vida ajustado por discapacidad (AVAD) tal que el parámetro de utilidad de los AVAC será el complementario del parámetro de discapacidad de los AVAD Q^i=1-D^i. A pesar de que este último incorpora parámetros de ponderación de edad que no se contemplan en los AVAC. Además, bajo la suposición Q=1-D, podemos determinar la calidad de vida del individuo antes del tratamiento. Una vez obtenido los AVAC ganados, procedemos a la valoración monetaria de éstos. Para ello, partimos de la suposición de que la intervención sanitaria permite al individuo volver a realizar las labores que venía realizando. De modo que valoramos los salarios probables con una temporalidad igual a los AVAC ganados, teniendo en cuenta la limitación que supone la aplicación de este enfoque. Finalmente, analizamos los beneficios derivados del tratamiento (masa salarial probable) si empleamos la tabla GRF-95 (población femenina) y GRM-95 (población masculina).

Report on the 1995 stock assessment of the Douglas catchment

The River Douglas has a long industrial heritage beginning in the early 18th century with its use by boats carrying goods between Wigan and Tarleton. The River and its tributaries have also historically been, and to a certain extent are still, subject to polluting inputs from the urban, agricultural and industrialised areas located within its catchment. During the early stages in the production of the River Douglas Catchment Management Plan, it became apparent that very little data existed on the populations of coarse and salmonid fish species within the River Douglas system. The data that did exist was largely anecdotal, consisting of catch reports from anglers or water bailiffs, or of dead and distressed fish following pollution incidents. This study was initiated to assess the status of coarse and salmonid fish species within the River Douglas system and so address the lack of knowledge. Eighty two sites were surveyed by electric fishing, including 14 sites using an electric fishing punt and up to four anodes. The data was analysed according to a new National Fisheries Classification Scheme. This classified the sites by the fish stock s present and compared the results with a database containing information from sites around the country that have similar habitat types. A stocking experiment was also undertaken in the River Lostock using chub reared at the Leyland Hatchery. These were marked with an identifiable blue spot in the spring of 1995 and then released into three, previously surveyed, locations in the river. These sites were then resurveyed during the summer stock assessment. This report also Site Reports with details on monitored sites, habitat features and fishery classification.

River Ouse: fisheries drought report 1996

The basis for undertaking this study was to examine factors and potential impacts affecting fish and fishing in relation to low flow drought conditions and what other impacts may arise as a result of further reduced flows resulting from abstraction. The study formed the basis of a three year project to concentrate on effects relating to potable water abstractions at Moor Monkton by YWS. To fully evaluate the possible effects on fisheries the study set out to encompass fish population surveys from fry to adult stock, analysis of angler catch data, reports from anglers and river reports from Environment Agency Fisheries staff. In order to evaluate any effects of drought and abstraction a three year study was instigated to examine fish populations. Fish population surveys were conducted at six sites in which the triennial rolling programme formed the basis of site selection. Multi-method sampling techniques were carried out at several sites in order to evaluate capture efficiency. Roach were prolific above the weir at Linton-on-Ouse, with gudgeon, perch and small bream also well represented. Roach dominated catches on the R.Ouse below Linton, with perch and bleak also relatively abundant. Low flows were not thought to be directly correlated to successful recruitment of coarse fish, rather the associated high temperatures during drought conditions showing a strong positive effect with most species exhibiting growth rates above their long-term average. At this stage in the study there are no clear indications that the drought has caused any deleterious effects to coarse fish populations or marked changes in species composition, with evidence of good recruitment by several species, indicating that the higher temperatures have generally been beneficial to recruitment. However, the indication that dace did not benefit as well as other coarse fish under these conditions may suggest some species are affected more than others. The successful strong recruitment of most coarse fish suggests that, in future, fisheries will be supported by the 1995 year-class.

Report on an egg bioassay experiment

In October 1992, a fish population survey of the Swanside Beck system revealed that the densities of juvenile salmon present in the beck were generally poor. The survey highlighted that a potential reason for this may be due to a lack of spawning substrate resulting from siltation. Numerous workers have found that increased levels of A salmonid egg box experiment of Swanside Beck carried out in the spring of 1994, revealed that the survival rates in the majority of sites were good. While the in-site variability was relatively high, mean survival rates remained in excess of 70%. As a result egg survival rates were eliminated as the reason for low juvenile salmonid production. The only site with a relatively low survival rate was Swanside Beck downstream of Cowgill Beck. However, even at this site siltation was eliminated as the cause of the increased mortality rate. It is recommended that a salmonid stocking of Swanside Beck should be carried out this year. This should be followed by an electric fishing survey to evaluate juvenile salmonid survival rates.

1995 annual report on fisheries in the North west incorporating the annual summary of fishery statistics.

This fisheries report summarises national and regional developments focussing on the North West region of the Environment Agency. The North West region covers around 14,000 square km, from Cheshire in the south to its northern border with Scotland. The report provides statistics on fisheries finance, including income and expenditure, salmon and sea trout catches, including rod and line and net catches, and special projects, including fish stock assessments, and surveys. The appendix includes a summary of fish statistics for 1995.

A Mídia e o MST: heróis e vilões na trama do discurso jornalístico

A presente pesquisa visa refletir, sob a ótica do discurso, a cultura noticiosa a respeito do Movimento dos Trabalhadores Rurais Sem Terra (MST), no que se refere à cobertura jornalística dos jornais Zero Hora e Folha de S.Paulo das linhas políticas sobre as questões conjunturais apresentadas pelo Movimento em seus três últimos Congressos Nacionais (1995, 2000 e 2007), para comprovar o tratamento dado pela mídia ao MST e o modo como as formações discursivas em textualizações jornalísticas são indiciárias de permanente tensão em torno da luta pela terra, o que dificulta o diálogo do Movimento com a sociedade. Este trabalho pretende ainda debater qual a intervenção do MST na construção das agendas política e pública e por que o Movimento não consegue provocar mudanças em seu enquadramento noticioso e, assim, constatar o que o processo de saturação do discurso midiático, neste caso o do jornalismo impresso, é capaz de produzir sobre a sociedade, partindo da hipótese de que a mídia, em geral, funciona como aparelho político-ideológico, que elabora e divulga concepções de mundo, cumprindo a função de contribuir com orientações para exercer influência na compreensão dos fatos sociais. A mediação dos meios de comunicação de massa, em geral, produz um deslocamento na experiência pública e, ao mesmo tempo, dá forma aos saberes possíveis que essa experiência desenvolve sobre si mesma. Sabemos que as ideologias presentes nos discursos jornalísticos podem não produzir novos saberes sobre o mundo, mas produzem um reconhecimento do mundo tal como já aprendemos a apropriá-lo. Demonstrar-se-á que, na fase atual do capitalismo sistema que demanda maior valorização da informação , a reprodução ideológica se dá diretamente pelos meios de comunicação, por intermédio de pautas e agendas. Considerando o contexto apresentado pela pesquisa, o trabalho destaca também dois fios condutores para alcançar seus objetivos: a submissão da mídia à hegemonia neoliberal e a luta do MST pela reforma agrária diante da valorização do agronegócio latifundiário.

Annual report 1995

An account is given of the activities of the Institute during the year 1995, including also reports of various projects carried out by staff members, which concerned the following: pre-recruitment ecology of the freshwater sardine (Limnothrissa miodon) in Lake Kariba (Zimbabwe); hydroacoustic surveys of kapenta abundance in Lake Kariba and Lake Cahora Bassa (Mozambique); angler's tigerfish catches, tigerfish studies and gillnet sampling; inshore fish population studies in Lake Kariba; catch/effort data recording system; fishermen's training towards the establishment of a Fisheries Co-management approach on Lake Kariba; and, enforcement and compliance with fisheries regulations within the inshore fishery on Lake Kariba.

1995 fisheries statistics, Lake Kariba - Zimbabwe shore

The report provides catch records for the Kapenta and inshore fisheries in the Zimbabwean waters of Lake Kariba for the year 1995. Kapenta usually constitute about 90% of the total catch from Lake Kariba; for statistical purposes catches are recorded for the 5 hydrological basins - Mlibizi, Binga, Sengwa, Bumi and Kariba. Whereas kapenta represent a unit stock which is harvested by both Zimbabwe and Zambia, the artisanal fishery exploits inshore species which generally occupy water less than 10m deep along the shoreline, considered to be 2 separate stocks. The main species in the inshore fishery are Oreochromis mortimeri, Sargochromis codringtonii, Tilapia rendalli, Labeo altivelis, Hydrocynus vittatus, Mormyrus longirostris, Clarias gariepinus and Synodontis zambezensis.

River Wyre salmon and sea trout spawning habitat restoration / creation project. Gravel enhancement schemes.

As part of an overall desire to maintain and improve the migratory salmonid population in the River Wyre, a project was commissioned to investigate remedial action which may improve and enhance spawning success and lead to an eventual improvement in the status of adult stocks. The report, titled "River Wyre Salmon and Sea Trout Spawning Habitat Restoration/Creation Project", concluded that usable spawning gravels appeared to be in short supply in the River Wyre catchment and may be the limiting factor influencing the returning adult stock, as juvenile nursery habitat was not found to be limiting. This report looks at gravel enhancement schemes to improve River Wyre salmon and sea trout spawning habitat restoration. It examines methods for gravel enhancement schemes: mechanical cleaning and construction of gravel addition structures. Includes sites figures of sites identified for enhancement.

Central area fisheries annual report 1995

The purpose of this report is to record key events and achievements of the NRA Central Area Fisheries Function in 1995. Rivers include the Ribble, Hodder and Lune. The report looks at Hydrological and meteorological data, site visits made during the year, communications and reports, Capital works and purchases, Stock assessment, monitoring and specific investigations, Fisheries Management advice, Fish kills and rescues, Fish rearing and stocking. It also looks at rod and net catches for salmon and sea trout, micro-tag returns, the drought, the results of the 1995 objectives set the year before and the key objectives for 1996.

Witcherwell hatchery husbandry regime

Witcherwell like most new hatcheries has gone through a honeymoon period during which no major fish health problems have occurred. However, in 1994, there was an outbreak of Bacterial Gill Disease which caused high mortalities. This has emphasised the importance of developing and maintaining optimum husbandry practices for Witcherwell. These may also be applicable to other fish culture units in Central Area and the NW. To avoid the reoccurence of bacterial gill disease or other health problems and to ensure that stock of good health and quality are produced good husbandry practices must be followed. This report inculdes information on stock, disinfection, cross-contamination, cleaning, feed rates, flow rates, screening, treatments and possible problems.

Note d'épigraphie hispanique: á propos de HAEP. 2523 et AE, 1995, 858

Un primer trabajo sobre estas inscripciones se presentó en la SFER, París, el 20 de junio de 1998.

A identidade regional do Brasil: o sul-americanismo nos governos de Fernando Henrique Cardoso e de Lula da Silva (1995-2010)

A presente dissertação destina-se a analisar o processo de emergência da identidade sul-americana, cuja primeira manifestação remonta à década de 1990, acentuando-se após a I Reunião de Presidentes da América do Sul (2000). A imersão histórica de longa duração do primeiro capítulo, que nos remete à segunda década do século XIX, oferece-nos um instrumental analítico complementar ao arcabouço teórico utilizado, de modo a apresentar a identidade latino-americana principal concorrente da sul-americana como elemento criado a partir de estímulos vinculados a uma conjuntura específica. Desconstruídas supostas naturalidades identitárias, o segundo capítulo concentra-se na análise das principais iniciativas da diplomacia brasileira para a edificação dos diversos modelos de regionalismo no âmbito sul-americano, destacando-se a reunião proposta por Fernando Henrique Cardoso. Ato contínuo, o terceiro capítulo busca verificar as principais ações da gestão Lula da Silva para a região, tendo em vista que esta última foi alçada à condição de prioridade da política externa durante seu governo. Nesse sentido, levantamos os argumentos que embasam e estruturam a identidade sul-americana na virada do século XX para o XXI, trazendo à tona divergências paradigmáticas atinentes às agremiações partidárias que polarizam o cenário político nacional e, por conseguinte, apresentam convicções distintas no que tange ao aprofundamento dessa nova vertente identitária.

Catches in ghost-fishing octopus and fish traps in the northeastern Atlantic Ocean (Algarve, Portugal)

Ghost fishing is the term used to describe the continued capture of fish and other living organisms after a fisherman has lost all control over the gear. Traps may be lost for a variety of reasons including theft, vandalism, abandonment, interactions with other gear, fouling on the bottom (i.e., traps and ropes are caught on rocky substrate), bad weather, and human error (Laist, 1995). Annual trap loss can be as high as 20% to 50% of fished traps in some fisheries (Al-Masroori et al., 2004). Because lost traps can continue to fish for long periods, albeit with decreasing efficiency over time (e.g., Smolowitz, 1978; Breen, 1987, 1990; Guillory, 1993), ghost fishing is a concern in fisheries worldwide.