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Campillo-Artero C.,Servei de Salut de les Illes Balears | Bernal-Delgado E.,Instituto Aragones Of Ciencias Of La Salud
Gaceta Sanitaria | Year: 2013

During the economic crisis, the pressure to reduce health services expenditure as an isolated measure is greater than measures intended to increase the efficiency of these services. Information, methods and experiences to improve health outcomes with limited resources are available and a number of countries have been applying measures to achieve this goal. One of these measures is disinvestment. Given that this tactic is necessary but also intricate, allergenic and confusing, this article tries to clarify its meaning, place it in its correct context, and describe the methods and criteria used to identify and prioritize candidate medical technologies for disinvestment. The experiences of Spain, New Zealand, Australia, Canada, the United Kingdom and Italy in this endeavor are reviewed, as well as the obstacles faced by these countries when disinvesting and their mid-term perspectives. Ignorance does not excuse its application, regardless of whether there is a crisis or not. Efforts to improve social efficiency are a permanent obligation of the national health system. © 2011 SESPAS. Source

Figueiredo C.,University of Porto | Garcia-Gonzalez M.A.,Instituto Aragones Of Ciencias Of La Salud | Machado J.C.,University of Porto
Helicobacter | Year: 2013

Gastric carcinogenesis is a complex and multifactorial process, in which infection with Helicobacter pylori plays a major role. Additionally, environmental factors as well as genetic susceptibility factors are significant players in gastric cancer (GC) etiology. Gastric cancer development results from the accumulation of multiple genetic and epigenetic changes during the lifetime of the cancer patient that will activate oncogenic and/or inactivate tumor-suppressor pathways. Numerous studies published last year provided new insights into the molecular phenotypes of GC, which will be the main focus of this review. This article also reviews the recent findings on GC tumor-suppressor genes, including putative novel genes. The understanding of the basic mechanisms that underlie gastric carcinogenesis will be of utmost importance for developing strategies of screening, early detection, and treatment of the disease, as most GC patients present with late-stage disease and have poor overall survival. © 2013 John Wiley & Sons Ltd. Source

Gilaberte Y.,Instituto Aragones Of Ciencias Of La Salud | Carrascosa J.M.,Hospital Universitari Germans Trias y Pujol
Actas Dermo-Sifiliograficas | Year: 2014

One of the main goals of all skin cancer prevention campaigns is to protect children from ultraviolet radiation. However, little is known about how sun exposure risks differ between adults and children or about how these risks are best managed. Children's skin is more susceptible to sun damage for a number of reasons, including certain anatomical and functional aspects in children under 2 years of age and habits that predispose to greater sun exposure during the first 2 decades of life. Oil-based emulsions containing inorganic filters appear to be safest sunscreens for children, although the addition of certain organic filters is necessary to achieve a sun protection factor of 50. Oxybenzone, and probably also octocrylene, should be avoided in sunscreens for children. Sunscreen use should be part of an overall sun protection strategy that includes avoidance of exposure to midday sun and the use of protective clothing and hats. The above considerations justify the implementation of primary prevention campaigns focused on sun protection education for children and the continuation of basic and epidemiological research into specific sun protection strategies and sunscreens for each age group. © 2013 Elsevier España, S.L. y AEDV. Todos los derechos reservados. Source

Giraldo P.,Instituto Aragones Of Ciencias Of La Salud
Medicina Clinica | Year: 2011

Gaucher's disease (GD) is an inborn error of metabolism of the lysosomal enzyme beta-glucosidase, which induces the deposition of undegraded glycolipid material in organs rich in mononuclear macrophage system including liver, spleen and bone marrow. Beta-glucosidase is suspected in patients with evidence of liver and/or spleen enlargement, anemia and/or thrombocytopenia not attributable to other causes, or bone crisis especially in children. In scarce cases GD is associated with neurological involvement. The diagnosis confirmation is performed by analysis of beta-glucosidase activity in peripheral blood leukocytes or fibroblasts. It is necessary to identify genetic mutations that cause GD. It is also advisable to identify biomarkers including chitotriosidase activity and plasma CCL-18/PARC concentration. The use of a protocol for assessing the intensity of the deposit is mandatory to establish the indication for treatment, especially in rare diseases. Nowadays there are several options for treatment of GD: enzyme replacement therapy and substrate reduction therapy. Regular assessments are needed to establish the response and the degree of achievement of the therapeutic goals recommended through expert consensus. © 2011 Elsevier España S.L. All rights reserved. Source

Agency: Cordis | Branch: FP7 | Program: CP-FP | Phase: HEALTH-2009-3.2-2 | Award Amount: 3.40M | Year: 2010

ECHO, European Collaboration for Healthcare Optimization, gathers the interests for Healthcare Performance Measurement of different Academic and Research Institutions from six European countries and an International Body for Healthcare Policy Analysis. Designed as a 48 months project, it has been conceived as a pilot study based on available administrative databases. It aims at describing the actual performance of six different Healthcare Systems at hospital, healthcare area, regional and country level. To tackle performance measurement in this project, two different methodological approaches will be used: [a] a population geographical-based, responding the question: Is the access to a diagnostic or surgical procedure dependant on the place where a person lives? And, [b] a provider-specific, answering the question: Is the risk for a patient to access high quality care -and have better health outcomes- different regarding the provider in which he or she is admitted? Utilization, equity in access and allocative efficiency will be analysed as performance measures in the former approach; and, healthcare outcomes and associated costs will be measures in the latter one. ECHO has been envisaged as a five work packages project. The first two work packages are devoted to prepare the core work package (WP#3) Performance Measurement and Report; so, the WP#1 is committed with the creation of the ECHO Data Warehouse and the second one is dedicated to the Methodological foundations of the project. Work packages #4 (web-based tools development) and #5 (dissemination) are carefully thought to ease the diffusion of our findings to decision-makers; in the former, a web-based analytical tool will allow advanced users to replicate methods and analysis; in the latter, local key agents like policy decision-makers and managers, will feed the findings making them transferable to their own decision-making process.

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