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Heras-Mosteiro J.,Hospital Universitario Ramon y Cajal | Sanz-Barbero B.,Institute Salud Carlos III | Sanz-Barbero B.,CIBER ISCIII | Otero-Garcia L.,CIBER ISCIII | Otero-Garcia L.,University Autoenoma Of Madrid
International Journal of Health Services | Year: 2016

The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health. © The Author(s) 2016. Source


Calvo L.,University Autoenoma Of Madrid | Gilarranz M.A.,University Autoenoma Of Madrid | Casas J.A.,University Autoenoma Of Madrid | Mohedano A.F.,University Autoenoma Of Madrid | Rodriguez J.J.,University Autoenoma Of Madrid
Industrial and Engineering Chemistry Research | Year: 2010

The catalytic reduction of nitrates with hydrogen in aqueous phase was studied in a trickle bed reactor using different activated carbon-supported metallic catalysts. Continuous experiments were performed at ambient conditions (25 °C and 1 atm) at different space-time values in the range of 25.8-103.3 kgcat h/mol. The activity of monometallic catalysts based on Pd, Rh, Cu, and Ni was low in all the cases, yielding nitrate conversions below 15%. The introduction of a second metal produced a synergistic effect, improving the catalytic activity and the selectivity toward N2. That increase in activity was more pronounced when using Pd or Rh combined with Cu, reaching nitrate conversions above 80% in the case of Pd-Cu catalysts. The catalyst with a Pd/Cu mass ratio of 2:1 (Pd050Cu025) also showed the lowest selectivity to nitrite and the highest to N2. Metal leaching was always below detection limits for Pd and Rh, whereas in the case of Cu and Ni, significant metal concentrations were found in the reaction effluent, the leaching of Ni being higher. The initial pH significantly affected both activity and selectivity of the bimetallic catalysts, the maximum activity being achieved within the 6-7 range, which also led to the lowest Cu leaching. The use of a two-step reaction system was checked using two different catalysts, a bimetallic Pd-Cu in the first and a monometallic Pd catalyst in the second. With this two-step system, an important reduction of the nitrite originating in the first stage was observed, and the formation of N2 at the expense of ammonium was favored. © 2010 American Chemical Society. Source

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