El impacto de los servicios sanitarios sobre la salud

This paper reviews what has increased medical-care spending bought in terms of health benefitswith longitudinal data from the U.S and, more limited, from Spain. Health services contributionto health has been positive in average, especially during the last 50 years for the U.S andthe last 30 years for Spain. This contribution differs among countries and is much greater forsome diseases (cardiovascular) than for others (cancer). Benefits from health care interventionscan be valued on basis on the social willin gness to pay, observed or declared on the process ofestablishing health policy priorities. 30.000 euros per Quality Adjusted Life Year could providean efficiency threshold for financing publicly health services in Spain: Consensus andlegitimacy of the political process of establishing health priorities becomes, however, moreimportant than any approximate number. Attention is paid finally to bridging the gap betweenefficacy (the possibilities given by innovation and resources devoted to health care) andeffectiveness (the distance to the frontier) of the everyday working of a health system with itsinappropriate care and limited application of the existing knowledge.

Informe sobre la segunda reunión del panel de expertos de dinámica de población de la anchoveta peruana

La segunda reunión del panel de expertos continua sus estudios sobre recursos pesqueros tomando como tema principal la anchoveta peruana. Esta investigación considera el trabajo realizado el año anterior en su primera reunión.

Drug utilization studies and data registries in primary care

This article reviews the methodology of the studies on drug utilization with particular emphasis on primary care. Population based studies of drug inappropriateness can be done with microdata from Health Electronic Records and e-prescriptions. Multilevel models estimate the influence of factors affecting the appropriateness of drug prescription at different hierarchical levels: patient, doctor, health care organization and regulatory environment.Work by the GIUMAP suggest that patient characteristics are the most important factor in the appropriateness of prescriptions with significant effects at the general practicioner level.

Tercera sesión del panel de expertos sobre la dinámica de la población de anchoveta peruana, julio de 1972

La tercera sesión del panel de expertos hace un reencuentro de las condiciones oceanográficas entre el año 1971 y 1972 respecto a la pesquería de la anchoveta.

Informe de la Cuarta sesión del panel de expertos de la evaluación del stock de anchoveta peruana

Se presenta una revisión de los sucesos de las pesquerías en el lapso desde la anterior reunión del Panel en Julio, 1972 y de lo que se piensa ha tenido lugar en el recurso y en su medio ambiente; se indican diversas líneas de investigación del stock. Se resume la evidencia colateral acerca de los stocks y de su medio ambiente; ésta se relaciona con el fenómeno de El Niño, con las aves guaneras, el aumento de las capturas de sardinas, el contenido graso de la anchoveta y los estadios de maduración de la misma. Cada una de estas entidades indican que recientemente han prevalecido condiciones especiales en el ambiente de la anchoveta, en la biota asociada y en ciertos aspectos de su fisiología. Se ha hecho una detallada revisión de varios tipos de investigación de las poblaciones de anchoveta y de las evidencias que, acerca del estado del recurso, pueden derivarse de tales investigaciones. Se examinó la evidencia obtenida del uso de equipo acústico en el estudio de la distribución de stocks y en la estimación de su abundancia; el trabajo se realizó mediante exploraciones de varias embarcaciones (exploraciones Eureka) y de exploraciones especiales con el barco de investigación SNP-1; también se hizo uso de equipo eco-integrador. Se discuten las fuentes de errores sistemáticos existentes en ese trabajo. Se llega a la conclusión que lo que ese trabajo indicó fue que en Febrero de 1973 existía alrededor de 4 millones de toneladas de anchoveta.

Segundo panel de expertos:informe sobre los efectos económicos de diferentes medidas regulatorias de la pesquería de la Anchoveta peruana

En el informe de su cuarta reunión el Panel de Expertos en Dinámica revisó los datos proporcionados por el Instituto del Mar del Perú sobre el presente estado del stock de la anchoveta. Estos datos mostraron, evidentemente, que el stock de ancho veta se encontraba en una crítica situación a comienzos de 1973. Los mejores cálculos indicaban que la mayor captura que podría obtenerse en 1973 sería alrededor de a millones de toneladas pero que sería conveniente mantencrla muy por debajo de este nivel, especialmente antes de la mayor temporada de desove en Agosto-Setiembre. En 1974 el reclutamiento podía ser muy bajo especialmente si el stock desovante seguía siendo agotado por la pesca, de modo que las capturas en 1974 podrían ser mucho más bajas del promedio aún en el caso de que no hubiera restricciones para la pesca.

Connexins 43 and 26 are differentially increased after rat bladder outlet obstruction.

To evaluate the regulation of connexin expression by fluid pressure, we have studied the effects of elevated transmural urine pressure on Connexin43 (Cx43) and Cx26. We chose to focus on these two proteins out of the five connexins (Cx26, 43, 40, 37, and 45) which we found by RT-PCR to be expressed in the rat bladder, since in situ hybridization and immunofluorescence showed that Cx43 is the predominant connexin expressed by smooth muscle cells (SMC), whereas Cx26 is abundantly expressed only in the latter cell type. To evaluate whether these connexins are affected by changes in transmural urine pressure, we used a rat model of bladder outlet obstruction, in which a ligature is placed around the urethra. Under conditions of increased fluid pressure due to urine retention, we observed that the expression of both Cx43 and Cx26 increased at both transcript and protein levels, reaching a maximum 7-9 h after the ligature. Further analysis revealed that these changes were accounted for by a fourfold increase in Cx43 mRNA of SMC but not urothelial cell and by a fivefold increase in Cx26 mRNA of urothelium. Scrape-loading of propidium iodide showed that the latter change was paralleled by a twofold increase in coupling between urothelial cells. The data show that Cx43 and Cx26 are differentially regulated during bladder outlet obstruction and contribute to the response of the bladder wall to increased voiding pressure, possibly to control its elasticity.

Informe de la primera sesión del panel internacional de expertos para evaluación de la población de la merluza peruana. Marzo 2003

Presentan los resultados del trabajo del panel siguiendo la secuencia establecida en los términos de referencia: estimar el estatus del stock de la merluza peruana, Proveer proyecciones del rendimiento y desarrollo del stock, bajo un escenario pesquero apropiado para el stock de la merluza peruana, comentar sobre medidas administrativas apropiadas de corto y mediano plazo, para la merluza peruana.

Informe de la segunda sesión del panel internacional de expertos para evaluación de la población de la merluza peruana. Marzo 2004

Evalua los resultados del trabajo del Panel de acuerdo con los términos de referencia: actualizar la evaluación y estimar el estatus del stock de la merluza peruana, evaluar el stock desovante y la ojiva de madurez, proponer una cuota para el año 2004, revisar los datos de los cruceros para determinar si existe merluza fuera del área geográfica muestreada, proveer proyecciones del rendimiento y desarrollo del stock bajo esquemas pesqueros apropiados para la merluza peruana.

V panel internacional de expertos en evaluación de la Anchoveta Peruana (Engraulis ringens Jenyns)

Estudia la información sobre los procesos biológicos de la anchoveta y su dinámica poblacional frente a la variabilidad ambiental, en el marco de un enfoque ecosistémico, que permita caracterizar el rol actual de la anchoveta en el Ecosistema de Afloramiento frente al Perú, proporcionando mayores elementos para el desarrollo sustentable de su pesquería.

Expression of apoptosis and survival genes in human memory T cell populations

RESUME Introduction: Les cellules T mémoires humaines sont classées en trois sous-populations sur la base de l'expression d'un marqueur de surface cellulaire, CD45RA, et du récepteur aux chimiokines, CCR7. Ces sous-populations, nommées cellules mémoires centrales (TcM), mémoires effectrices (TEM) et mémoires effectrices terminales (ITEM), ont des rôles fonctionnels distincts, ainsi que des capacités de prolifération et de régénération différentes. Cependant, la génération de ces différences reste encore mal comprise et on ignore les mécanismes moléculaires impliqués. Matériaux et Méthodes: Des cellules mononucléaires humaines du sang périphérique ont été séparées par cytométrie de flux selon leur expression de CD4, CD8, CD45RA et CCR7 en sous-populations de cellules CD4+ ou CD8+ naïves, TcM, TEM ou ITEM. Dans chacune de ces sous-populations, 14 gènes impliqués dans l'apoptose, la survie ou la capacité proliférative des cellules T ont été quantifiés par RT-PCR en temps réel, relativement à l'expression d'un gène de référence endogène. L'ARN provenant de 450 cellules T a été utilisé par gène et par sous-population. Les gènes analysés (cibles) comprenaient des gènes de survie (BAFF, APRIL, BAFF-R, BCMA, TACI, IL-15Rα, IL-7Rα), des gènes anti-apoptotiques (Bcl-2, BclxL, FLIP), des gènes pro-apoptotiques (Bad, Bax, Fast) et le gène anti-prolifératif, Tob. A l'aide de la méthode comparative delta-delta-CT, le taux d'expression des gènes cibles de chaque sous-population des cellules T mémoires CD4+ et CD8+, à été comparée à leur taux d'expression dans les cellules T naïves CD4+ et CD8+. Résultats: Dans les cellules CD8+, les gènes pro-apoptotiques Bax et Fast étaient surexprimés dans toutes les sous-populations mémoires, tandis que l'expression des facteurs anti-apoptotiques et de survie comme Bcl-2, APRIL et BAFF-R, étaient diminués. Ces deux tendances étaient particulièrement accentuées dans les sous-groupes des cellules mémoires TEM et TTEM. A noter que malgré le fait que leur expression était également diminuée dans les autres cellules mémoires, le facteur de survie IL-7Ra, était sélectivement surexprimé dans la sous-population de cellules TcM et l'expression d'IL-15Ra était sélectivement augmentée dans les TEM. Dans les cellules CD4+, le taux d'expression des gènes analysés était plus variable entre les sujets étudiés que dans les cellules CD8+, ne permettant pas de définir un profil d'expression spécifique. L'expression du gène de survie BAFF par contre, a été significativement augmentée dans toutes les sous-populations mémoire CD4+. Il en va de même pour l'expression d' APRIL et de BAFF-R, bien que dans moindre degré. A remarquer que l'expression du facteur anti-apoptotique Fast a été observée uniquement dans la souspopulation des TTEM. Discussion et Conclusions: Cette étude montre une nette différence entre les cellules CD8+ et CD4+, en ce qui concerne les profils d'expression des gènes impliqués dans la survie et l'apoptose des cellules T mémoires. Ceci pourrait impliquer une régulation cellulaire homéostatique distincte dans ces deux compartiments de cellules T mémoires. Dans les cellules CD8+ l'expression d'un nombre de gènes impliqués dans la survie et la protection de l'apoptose semblerait être diminuée dans les populations TEM et TTEM en comparaison à celle des sous-populations naïves et TEM, tandis que l'expression des gènes pro-apoptotiques semblerait être augmentée. Comme ceci paraît être plus accentué dans les TTEM, cela pourrait indiquer une plus grande disposition à l'apopotose dans les populations CCR7- (effectrices) et une perte de survie parallèlement à l'acquisition de capacités effectrices. Ceci parlerait en faveur d'un modèle de différentiation linéaire dans les cellules CD8+. De plus, l'augmentation sélective de l'expression d'IL-7Ra observée dans le sous-groupe de cellules mémoires TEM, et d'IL-15Ra dans celui des TEM, pourrait indiquer un moyen de sélection pour des réponses immunitaires mémoires à long terme par une réponse distincte à ces cytokines. Dans les cellules CD4+ par contre, aucun profil d'expression n'a pu être déterminé; les résultats suggèrent même une résistance relative à l'apoptose de la part des cellules mémoires. Ceci pourrait favoriser l'existence d'un modèle de différentiation plus flexible avec des possibilités d'interaction multiples. Ainsi, la surexpression sélective de BAFF, APRIL et BAFF-R dans les sous-populations individuelles des cellules mémoires pourrait être un indice de l'interaction de ces sous-groupes avec des cellules B. ABSTRACT Introduction: Based on their surface expression of the CD45 isoform and of the CCR7 chemokine receptor, memory T cells have been divided into the following three subsets: central memory (TAM), effector memory (TEM) and terminal effector memory (ITEM). Distinct functional roles and different proliferative and regenerative capacities have been attributed to each one of these subpopulations. The molecular mechanisms underlying these differences; however, remain poorly understood. Materials and Methods: According to their expression of CD4, CD8, CD45RA and CCR7, human peripheral blood mononuclear cells were sorted by flow-cytometry into CD4+ or CD8+ naïve, TAM, TEM and ITEM subsets. Using real-time PCR, the expression of 14 genes known to be involved in apoptotis, survival or proliferation of T cells was quantified separately in each individual subset, relative to an endogenous reference gene. The RNA equivalent of 450 T cells was used for each gene and subset. The target gene panel included the survival genes BAFF, APRIL, BAFF-R, BCMA, TACI, IL-15Rα and IL-7Rα, the anti-apoptotic genes Bcl2, Bcl-xL and FLIP, the pro-apoptotic genes Bad, Bax and Fast, as well as the antiproliferative gene Tob. Using the comparative CT-method, the expression of the target genes in the three memory T cell subsets of both CD4+ and CD8+ T cell populations was compared to their expression in the naïve T cells. Results: In CD8+ cells, the pro-apoptotic factors Bax and Fast were found to be upregulated in all memory T cell subsets, whereas the survival and anti-apoptotic factors Bcl-2, APRIL and BAFF-R were downregulated. These tendencies were most accentuated in TEM and TTEM subsets. Even though the survival factor IL-7Rα was also downregulated in these subsets, interestingly, it was selectively upregulated in the CD8+ TAM subset. Similarly, IL-15Rαexpression was shown to be selectively upregulated in the CD8+ TEM subset. In CD4+ cells, the expression levels of the analyzed genes showed a greater inter-individual variability than in CD8+ cells, thus suggesting the absence of any particular expression pattern for CD4+ memory T cells. However, the survival factor BAFF was found to be significantly upregulated in all CD4+ memory T cell subsets, as was also the expression of APRIL and BAFF-R, although to a lesser extent. Furthermore, it was noted that the pro-apoptotic gene Fast was only expressed in the TTEM CD4+ subset. Discussion and Conclusions: Genes involved in apoptosis and survival in human memory T cells have been shown to be expressed differently in CD8+ cells as compared to CD4+ cells, suggesting a distinct regulation of cell homeostasis in these two memory T cell compartments. The present study suggests that, in CD8+ T cells, the expression of various survival and antiapoptotic genes is downregulated in TEM and TTEM subsets, while the expression of proapoptotic genes is upregulated in comparison to the naïve and the TAM populations. These characteristics, potentially translating to a greater susceptibility to apoptosis in the CCR7- (effector) memory populations, are accentuated in the TTEM population, suggesting a loss of survival in parallel to the acquisition of effector capacities. This speaks in favour of a linear differentiation model in CD8+ T memory cells. Moreover, the observed selectively increased expression of IL-7Rα in CD8+ TAM cells - as that of IL-15Rα in CD8+ TEM cells -suggest that differential responsiveness to cytokines could confer a selection bias for distinct long-term memory cell responses. Relative to the results for CD8+ T cells, those for CD4+ T cells seem to indicate a certain resistance of the memory subsets to apoptosis, suggesting the possibility of a more flexible differentiation model with multiple checkpoints and potential interaction of CD4+ memory cells with other cells. Thus, the selective upregulation of BAFF, APRIL and BAFF-R in individual memory subsets could imply an interaction of these subsets with B cells.

Effects of employment protection and product market regulations on the Italian labor market

Labor market regulations have often being blamed for high and persistentunemployment in Europe, but evidence on their impact remains mixed. Morerecently, attention has turned to the impact of product market regulationson employment growth. This paper analyzes how labor and product marketregulations interact to affect turnover and employment. We present a matchingmodel which illustrates how barriers to entry in the product market mitigatethe impact of labor market deregulation. We, then, use the Italian SocialSecurity employer-employee panel to study the interaction between barriersto entry and dismissal costs. We exploit the fact that costs for unjustdismissals in Italy increased for firms below 15 employees relative to biggerfirms after 1990. We find that the increase in dismissal costs after 1990decreased accessions and separations in small relative to big firms,especially for women. Moreover, consistent with our model, we find evidencethat the increase in dismissal costs had smaller effects on turnover for womenin sectors faced with strict product market regulations.

Convergence in panel data: Evidence from the skipping estimation

This paper demonstrates that, unlike what the conventional wisdom says, measurement error biases in panel data estimation of convergence using OLS with fixed effects are huge, not trivial. It does so by way of the "skipping estimation"': taking data from every m years of the sample (where m is an integer greater than or equal to 2), as opposed to every single year. It is shown that the estimated speed of convergence from the OLS with fixed effects is biased upwards by as much as 7 to 15%.

Intergenerational mobility and the informative content of surnames

We propose an alternative method for measuring intergenerational mobility. Measurements obtained fromtraditional methods (based on panel data) are scarce, difficult to compare across countries and almost impossible to get across time. In particular, this means that we do not know how intergenerational mobility is correlated with growth, income or the degree of inequality.Our proposal is to measure the informative content of surnames in one census. The more information thesurname has on the income of an individual, the more important is her background in determining her outcomes; and thus, the less mobility there is.The reason is that surnames provide information about family relationships because the distribution ofsurnames is necessarily very skewed. A large percentage of the population is bound to have a very unfrequent surname. For them the partition generated by surnames is very informative on family linkages.First, we develop a model whose endogenous variable is the joint distribution of surnames and income.There, we explore the relationship between mobility and the informative content of surnames. We allow for assortative mating to be a determinant of both.Second, we use our methodology to show that in large Spanish region the informative content of surnamesis large and consistent with the model. We also show that it has increased over time, indicating a substantial drop in the degree of mobility. Finally, using the peculiarities of the Spanish surname convention we show that the degree of assortative mating has also increased over time, in such a manner that might explain the decrease in mobility observed.Our method allows us to provide measures of mobility comparable across time. It should also allow us tostudy other issues related to inheritance.

Dessalinização da Água do Mar Através da Energia Solar - Caso de Estudo Salamansa – Cabo Verde

principal objectivo deste trabalho é o estudo da viabilidade técnica e económica da dessalinização da água do mar, utilizando a energia solar, tomando como caso de aplicação uma pequena comunidade rural de Cabo Verde, a vila piscatória de Salamansa, local onde há graves problemas com a disponibilidade de água potável. No entanto, a proximidade do mar e a disponibilidade de energia solar sugerem a dessalinização como processo para mitigar a falta de água. A dessalinização da água do mar pode ser obtida através de diversas técnicas que podem ser agrupadas de acordo com os princípios em que estes processos se baseiam: processos de dessalinização térmica (destilação solar, destilação multi-estágio, destilação multi-efeito, etc.) e processos de dessalinização por membranas (electrodiálise e osmose inversa). A destilação solar passiva foi a tecnologia de dessalinização estudada neste trabalho e que se pode vir a tornar uma alternativa promissora para um fornecimento regular de água. Por outro lado, o uso de fontes alternativas de energia, como a solar, apresenta-se como uma solução para viabilizar a dessalinização em meios semi-áridos como o deste caso de estudo. Fez-se uma modelação matemática da unidade de destilação solar proposta utilizando o Engineering Equation Solver (EES) como ferramenta para ajudar a resolver as equações de balanço térmico. O projecto do destilador solar proposto poderá atender às necessidades de água doce para consumo de 18 famílias constituídas por 5 agregados (92 pessoas) e apresenta uma eficiência média diária de aproximadamente 78% no Verão e 77% no Inverno.