E-government and Public Services : a Case Study of the Inter-administrative Portal CAT365. Research report (sythesis document)

Aquest estudi analitza els usos de les TIC a l'administració autonòmica catalana. De forma més específica, l'estudi se centra en la interacció entre l'ús d'un vessant concret de les TIC, la xarxa Internet, per part de l'administració pública, i determinats aspectes centrals d'aquest tipus d'institucions: la seva organització i estructura internes, la provisió de serveis públics o la relació amb altres agents socials. Hem analitzat, doncs, el fenomen del govern electrònic en el marc particular de la Generalitat de Catalunya, estudiant-ne el grau de desenvolupament i penetració, les seves característiques més remarcables i els problemes més importants que s'hi plantegen. El projecte de recerca es concreta en un estudi de cas sobre un projecte d'innovació específic però de gran abast, que es trobava en el moment de realització de l'estudi en la seva primera fase d'implementació: el projecte Administració Oberta de Catalunya (AOC). Concretament ens hem centrat en el vessant d'aquesta iniciativa pública que es concretava en la creació d'un portal interadministratiu a Internet, el portal www.cat365.net, destinat a proveir electrònicament serveis públics de totes les administracions que operen a Catalunya. L'estudi analitza les transformacions internes de l'administració que s'hi poden trobar associades i els elements que les condicionen, tant positivament com negativa. Igualment, intentem analitzem el que aquestes transformacions poden suposar per a la relació entre els ciutadans i les institucions públiques.

The effect of post-discharge educational intervention on patients in achieving objectives in modifiable risk factors six months after discharge following an episode of acute coronary syndrome, (CAM-2 Project): a randomized controlled trial

We investigated whether an intervention mainly consisting of a signed agreement between patient and physician on the objectives to be reached, improves reaching these secondary prevention objectives in modifiable cardiovascular risk factors six-months after discharge following an acute coronary syndrome. BACKGROUND: There is room to improve mid-term adherence to clinical guidelines' recommendations in coronary heart disease secondary prevention, specially non-pharmacological ones, often neglected. METHODS: In CAM-2, patients discharged after an acute coronary syndrome were randomly assigned to the intervention or the usual care group. The primary outcome was reaching therapeutic objectives in various secondary prevention variables: smoking, obesity, blood lipids, blood pressure control, exercise and taking of medication. RESULTS: 1757 patients were recruited in 64 hospitals and 1510 (762 in the intervention and 748 in the control group) attended the six-months follow-up visit. After adjustment for potentially important variables, there were, between the intervention and control group, differences in the mean reduction of body mass index (0.5 vs. 0.2; p < 0.001) and waist circumference (1.6 cm vs. 0.6 cm; p = 0.05), proportion of patients who exercise regularly and those with total cholesterol below 175 mg/dl (64.7% vs. 56.5%; p = 0.001). The reported intake of medications was high in both groups for all the drugs considered with no differences except for statins (98.1% vs. 95.9%; p = 0.029). CONCLUSIONS: At least in the short term, lifestyle changes among coronary heart disease patients are achievable by intensifying the responsibility of the patient himself by means of a simple and feasible intervention.

Physical activity, energy balance and obesity

Obesity appears when energy intake exceeds energy expenditure. The most important variable compound of energy expenditure is physical activity. The global epidemics of obesity seem closely related to reduced physical activity and sedentariness widely increasing nowadays. Once obesity has developed, caloric intake becomes similar to energy expenditure. To lose weight, besides decreasing energy intake, energy expenditure must be increased. The promotion of physical activity is difficult and so the results of treatment of obesity are discouraging for doctors, other health professionals and patients. Proactive efforts from patients and health providers with an intensive feedback between them may be extremely helpful. Nevertheless, more studies are needed to provide better approaches on the role of physical activity for the prevention and treatment of obesity and for long-term weight-loss maintenance.

The Chemotherapeutic Drug 5-Fluorouracil Promotes PKR-Mediated Apoptosis in a p53-Independent Manner in Colon and Breast Cancer Cells

The chemotherapeutic drug 5-FU is widely used in the treatment of a range of cancers, but resistance to the drug remains a major clinical problem. Since defects in the mediators of apoptosis may account for chemo-resistance, the identification of new targets involved in 5-FU-induced apoptosis is of main clinical interest. We have identified the ds-RNA-dependent protein kinase (PKR)as a key molecular target of 5-FU involved in apoptosis induction in human colon and breast cancer cell lines. PKR distribution and activation, apoptosis induction and cytotoxic effects were analyzed during 5-FU and 5-FU/IFNalpha treatment in several colon and breast cancer cell lines with different p53 status. PKR protein was activated by 5-FU treatment in a p53-independent manner,inducing phosphorylation of the protein synthesis translation initiation factor eIF-2alpha and cell death by apoptosis. Furthermore, PKR interference promoted a decreased response to 5-FU treatment and those cells were not affected by the synergistic antitumor activity of 5-FU/IFNalpha combination. These results, taken together, provide evidence that PKR is a key molecular target of 5-FU with potential relevance in the clinical use of this drug.

Variability of indication criteria in knee and hip replacement: an observational study

BACKGROUND. Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. METHODS. The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated.The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. RESULTS. The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate. CONCLUSIONS. A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.

Diagnostic accuracy, effectiveness and cost for cognitive impairment and dementia screening of three short cognitive tests applicable to illiterates

BACKGROUND Illiteracy, a universal problem, limits the utilization of the most widely used short cognitive tests. Our objective was to assess and compare the effectiveness and cost for cognitive impairment (CI) and dementia (DEM) screening of three short cognitive tests applicable to illiterates. METHODS Phase III diagnostic test evaluation study was performed during one year in four Primary Care centers, prospectively including individuals with suspicion of CI or DEM. All underwent the Eurotest, Memory Alteration Test (M@T), and Phototest, applied in a balanced manner. Clinical, functional, and cognitive studies were independently performed in a blinded fashion in a Cognitive Behavioral Neurology Unit, and the gold standard diagnosis was established by consensus of expert neurologists on the basis of these results. Effectiveness of tests was assessed as the proportion of correct diagnoses (diagnostic accuracy [DA]) and the kappa index of concordance (k) with respect to gold standard diagnoses. Costs were based on public prices at the time and hospital accounts. RESULTS The study included 139 individuals: 47 with DEM, 36 with CI, and 56 without CI. No significant differences in effectiveness were found among the tests. For DEM screening: Eurotest (k = 0.71 [0.59-0.83], DA = 0.87 [0.80-0.92]), M@T (k = 0.72 [0.60-0.84], DA = 0.87 [0.80-0.92]), Phototest (k = 0.70 [0.57-0.82], DA = 0.86 [0.79-0.91]). For CI screening: Eurotest (k = 0.67 [0.55-0.79]; DA = 0.83 [0.76-0.89]), M@T (k = 0.52 [0.37-0.67]; DA = 0.80 [0.72-0.86]), Phototest (k = 0.59 [0.46-0.72]; DA = 0.79 [0.71-0.86]). There were no differences in the cost of DEM screening, but the cost of CI screening was significantly higher with M@T (330.7 ± 177.1 €, mean ± sd) than with Eurotest (294.1 ± 195.0 €) or Phototest (296.0 ± 196. 5 €). Application time was shorter with Phototest (2.8 ± 0.8 min) than with Eurotest (7.1 ± 1.8 min) or M@T (6.8 ± 2.2 min). CONCLUSIONS Eurotest, M@T, and Phototest are equally effective. Eurotest and Phototest are both less expensive options but Phototest is the most efficient, requiring the shortest application time.

Plan d'accouchement et de naissance régime de santé public d'Andalousie

En la cub.: Plan de parto y nacimiento.

Comprehensive tobacco action plan for Andalusia 2005-2010 [Recurso electrónico] : Andalusian Public Health System

Es versión en inglés del Plan Integral de Tabaquismo de Andalucía. Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Ciudadanía / Quiénes somos / Planes y Estrategias)

II Comprehensive Mental Health Plan For Andalusia 2008-2012 : Andalusian Public Health System

A Comprehensive Plan is a medium-term planning instrument. Its development alone does not guarantee the achievement of the goals laid out in it, but by defining the goals, establishing priorities and setting out courses of action and concrete activities it will allow for an overall vision of the objectives being aimed towards and the tasks that will need to be carried out. The first Comprehensive Mental Health Plan for Andalusia 2003-2007 (I PISMA, Plan Integral de Salud Mental de Andalucía) was developed using this approach. Nine courses of action were covered in this Plan, which over its duration lead to noticeable progress in various fields.The assessment of the I PISMA and the experience gained from its development have channelled into this second Comprehensive Mental Health Plan for Andalusia 2008-2012 (II PISMA). The main principles for this second Plan are quality improvements, equality and efficiency of health services, aimed at public awareness of mental health in the Andalusian population, prevention of the illnesses and improvements to the care of patients and their families.

Childbirth and labour plan Andalusian public health System

En la cub.: Plan de parto y nacimiento. Publicado en la página web de la Consejería de Salud y Bienestar Social: www.juntadeandalucia.es/salud (Consejería de Salud y Bienestar Social / Ciudadanía / Inicio / Nuestra salud / Vida sana / Embarazo y salud)

Comprehensive heart disease action plan for Andalusia 2005-2009 : Andalusian Public Health System

The Comprehensive Heart Disease Action Plan for Andalusia 2005-2009 has been prepared within the framework of the presentations made both in the 3rd Andalusian Health Action Plan and in the Quality Plan of the Public Health System. Consequently, as with these two referral instruments, the improvement in the health results for the citizens of Andalusia continues to be sought without wavering, specifically with regard to meeting the needs and expectations of the population affected by health problems in this area.

Acute respiratory and cardiovascular admissions after a public smoking ban in geneva, Switzerland.

BACKGROUND: Many countries have introduced legislations for public smoking bans to reduce the harmful effects of exposure to tobacco smoke. Smoking bans cause significant reductions in admissions for acute coronary syndromes but their impact on respiratory diseases is unclear. In Geneva, Switzerland, two popular votes led to a stepwise implementation of a state smoking ban in public places, with a temporary suspension. This study evaluated the effect of this smoking ban on hospitalisations for acute respiratory and cardiovascular diseases. METHODS: This before and after intervention study was conducted at the University Hospitals of Geneva, Switzerland, across 4 periods with different smoking legislations. It included 5,345 patients with a first hospitalisation for acute coronary syndrome, ischemic stroke, acute exacerbation of chronic obstructive pulmonary disease, pneumonia and acute asthma. The main outcomes were the incidence rate ratios (IRR) of admissions for each diagnosis after the final ban compared to the pre-ban period and adjusted for age, gender, season, influenza epidemic and secular trend. RESULTS: Hospitalisations for acute exacerbation of chronic obstructive pulmonary disease significantly decreased over the 4 periods and were lowest after the final ban (IRR = 0.54 [95%CI: 0.42-0.68]). We observed a trend in reduced admissions for acute coronary syndromes (IRR = 0.90 [95%CI: 0.80-1.00]). Admissions for ischemic stroke, asthma and pneumonia did not significantly change. CONCLUSIONS: A legislative smoking ban was followed by a strong decrease in hospitalisations for acute exacerbation of chronic obstructive pulmonary disease and a trend for reduced admissions for acute coronary syndrome. Smoking bans are likely to be very beneficial for patients with chronic obstructive pulmonary disease.