EXTRACRANIAL STEREOTACTIC RADIOTHERAPY: CIRUGÍA OPERABLES EN PACIENTES ONCOLÓGICOS NO ALTERNATIVE.

31 01 2013

"Thanks to its effectiveness and excellent tolerance, the SBRT opens a wide range of possibilities in the treatment of cancer as an alternative to surgery in the local treatment of patients not operable and as in oligo-metastatic patients important treatment option, in which, along with other treatments such as chemotherapy or other biological therapies, It contributes to improve disease-free survival and improve their quality of life".

- In the majority of studies, the SBRT gets more local control rates of the 80 percent of the treated lesions, and with minimal toxicity, being already established as a treatment of choice in patients not operable, with lung cancer in early stages, and emerging as an interesting alternative to other local treatment in prostate cancer, liver tumors, liver metastases, bone, Lung, etc

- The course was organized by the increasing clinical interest that awakens this technique within the specialty, due to its excellent results, and because it is a technique of precision you need technological requirements and quality controls

- The meeting addressed many aspects of the SBRT, he delved into the definition of the technique, dosimetric and technological requirements and quality controls, and indications were also analyzed, results and evidence of clinical trials in lung cancer, liver tumors, patients oligometastasicos, prostate cancer and other indications

- In recent years, the SBRT has generated great interest and a very important development in Spain, that puts our country, from the professional and technological point of view, at the same level than many European or American centers, highlighting in techniques such as irradiation with gating of liver or lung injury

- Thanks to its efficiency and excellent tolerance, the SBRT opens a wide range of possibilities in the approach to cancer as an alternative to surgery in the local treatment of patients not operable and as in oligo-metastatic patients important treatment option

 

 

"Extracranial Stereotactic radiotherapy (SBRT) It is a very promising irradiation technique, Since in the majority of studies gets more local control rates of the 80 percent of the treated lesions, and with minimal toxicity, It is already established as a treatment of choice in patients not operable, with lung cancer in early stages and that, Although further studies are still needed, It emerges as an interesting alternative to other local treatments, that may benefit patients with prostate cancer, liver tumors, liver metastases, bone, Lung, etc".

This is the main conclusion of the first specific course of the Working Group of SBRT celebrated in Spain, According to the Dra. Carmen Rubio, jefa del Servicio de Oncología Radioterápica HM College Sanchinarro (HMS)-Comprehensive Cancer Center Clara Campal (CIOCC) and Co-Director of the day, next to the Dr. Miquel Macia.

This first course of SBRT which is organized within the Escuela Española de Oncología Radioterápica, held a few weeks ago in Barcelona, It arises from the growing clinical interest that awakens this technique within the specialty, "due to its excellent results, and because it is a technique of precision you need for your implementation of a series of technological requirements and quality controls that is necessary to establish", in the words of the expert.

Like this, aimed at both oncologists and physicists, the meeting addressed many aspects of the SBRT, he delved into the definition of the technique, dosimetric and technological requirements and quality controls, and indications were also analyzed, results and evidence of clinical trials in lung cancer, liver tumors, patients oligometastasicos, prostate cancer and other indications.

Quality controls and requirements

In terms of the technological requirements and quality controls to implement the SBRT defined in the day, the first could be grouped into three blocks: "The first includes adequate identification of the tumor or volume to radiate, for what it is to use imaging with CT, TAC 4 D, and in many cases resonance or PET; in the second place, they are necessary planning systems that enable to perform a dosimetry of high grade and high conformation as the 3D Conformal or intensity-modulated radiotherapy (IMRT) in order to manage high tumor dose and low-dose to surrounding healthy tissue", explains the Dra. Rubio, citing the need for "accelerators of last generation that incorporate imaging systems guided that verify and ensure the accuracy of the treatment in third place, even controlling the possible movement of the tumor during irradiation".

At last, for the Chief of radiation oncology of HMS-CIOCC, all of these essential requirements of the SBRT also require an "exhaustive and precise control to ensure the quality of these treatments".

Hipofraccionamiento, preparation, dosage and balance

The experts meeting in the course put on the table also the latest news the hipofraccionamiento, It is the radiobiological basis of the SBRT, Since it allows to manage safely, in one or a limited number of sessions, very high dose to the tumor.

"These high dose per fraction not only produce further direct destruction of the DNA of tumor cells - indicates the expert-, but they also produce molecular reactions that alter the Tumor Microenvironment, inducing apoptosis of endothelial cells and the destruction of other cellular subtypes". Therefore, "the biological equivalent dose of these high dose per fraction is greater than that produced by standard subdivisions, though more radiobiologicos studies that establish the fractionation schemes more appropriate depending on the type of tumor are needed, volume and location and their relationship to healthy structures", accurate.

In terms of preparation phases, Administration and verification of these treatments, the Dra. Rubio ensures that there is consensus among scholars about the requirements needed for each of the phases of the process of irradiation with SBRT, Although clarifies that there are different irradiation techniques that rely on computers and different ways to quantify and control the movement of the tumor, as the gating or tracking systems, you increase the precision of the injury, liver or lung SBRT, radiating less amount of tissue healthy but that force to place previously fiduciales internal markers.

Balance balance of these treatments as regards its toxicity is another advantage of the SBRT, because "its effectiveness is very high: local control of irradiated injuries is higher in most of the studies of the 80% a 2-3 years, and described toxicities are very low; results that make that this technique has a great clinical interest", in the words of the Co-Director of the day. However, It recognizes that the monitoring of some series is still short and require longer follow-ups that confirm longer term outcomes.

Protocols and international balance

The purpose of the meeting was not agreeing on protocols and indications of the different pathologies SBRT, but to describe the most relevant clinical studies protocols; However, the SBRT Spanish group has created sub-working groups whose objectives is precisely agree on protocols for SBRT for pathologies and raise national multicenter studies.

The same, the course brought together experts from Spain, France, Portugal, Belgium and United States, what enabled to analyze homogeneity of internationally in terms of the implementation and results of the SBRT, a recent technique but in the last five years it has generated great interest and a very important development in our country, What "puts us, from the professional and technological point of view, at the same level than many European or American centers, and despite the fact that our series are, in general, shorter and with less trails, We highlight techniques such as irradiation with gating of liver or lung injury", valued the expert.

In short, for the Dra. Rubio, "thanks to its effectiveness and excellent tolerance, the SBRT opens a wide range of possibilities in the treatment of cancer as an alternative to surgery in the local treatment of patients not operable and as in oligo-metastatic patients important treatment option, in which, along with other treatments such as chemotherapy or other biological therapies, It contributes to improve disease-free survival and improve their quality of life".

 

 

Noticiasmedicas.es [en línea] Cadiz (ESP): noticiasmedicas.es, 31 in January of 2013 [REF. 12 in June of 2012] Available on Internet:http://www.noticiasmedicas.es/medicina/noticias/15254/1/La-radioterapia-estereotaxica-extracraneal-sbrt-es-una-tecnica-de-irradiacion-muy-prometedora-que-obtiene-tasas-elevadas-de-control-local-con-minima-toxicidad/Page1.html



EMBL-EBI researchers make DNA storage a reality

28 01 2013

Researchers at the EMBL-European Bioinformatics Institute (EMBL-EBI) have created a way to store data in the form of DNA – a material that lasts for tens of thousands of years. The new method, published in the journal Nature, makes it possible to store at least 100 million hours of high-definition video in about a cup of DNA.

Dr Nick Goldman of EMBL-EBI, looking at synthesized DNA in a phial. Photo credit: EMBL Photolab.

Dr Nick Goldman of EMBL-EBI, looking at synthesized DNA in a phial. Photo credit: EMBL Photolab.

There is a lot of digital information in the world – about three zettabytes’ worth (that’s 3000 billion billion bytes) – and the constant influx of new digital content poses a real challenge for archivists. Hard disks are expensive and require a constant supply of electricity, while even the best ‘no-power’ archiving materials such as magnetic tape degrade within a decade. This is a growing problem in the life sciences, where massive volumes of data – including DNA sequences – make up the fabric of the scientific record.

 

“We already know that DNA is a robust way to store information because we can extract it from wooly mammoth bones, which date back tens of thousands of years, and make sense of it,” explains Nick Goldman of EMBL-EBI. “It’s also incredibly small, dense and does not need any power for storage, so shipping and keeping it is easy.”

 

Reading DNA is fairly straightforward, but writing it has until now been a major hurdle to making DNA storage a reality. There are two challenges: First, using current methods it is only possible to manufacture DNA in short strings. Secondly, both writing and reading DNA are prone to errors, particularly when the same DNA letter is repeated. Nick and co-author Ewan Birney, Associate Director of EMBL-EBI, set out to create a code that overcomes both problems.

 

“We knew we needed to make a code using only short strings of DNA, and to do it in such a way that creating a run of the same letter would be impossible. So we figured, let’s break up the code into lots of overlapping fragments going in both directions, with indexing information showing where each fragment belongs in the overall code, and make a coding scheme that doesn’t allow repeats. That way, you would have to have the same error on four different fragments for it to fail – and that would be very rare.”

 

The new method requires synthesizing DNA from the encoded information: enter Agilent Technologies, Inc, a California-based company that volunteered its services. Ewan and Nick sent them encoded versions of: an .mp3 of Martin Luther King’s speech, “I Have a Dream”; a .jpg photo of EMBL-EBI; a .pdf of Watson and Crick’s seminal paper, “Molecular structure of nucleic acids”; a .txt file of all of Shakespeare’s sonnets; and a file that describes the encoding.

 

“We downloaded the files from the Web and used them to synthesise hundreds of thousands of pieces of DNA – the result looks like a tiny piece of dust,” explains Emily Leproust of Agilent. Agilent mailed the sample to EMBL-EBI, where the researchers were able to sequence the DNA and decode the files without errors.

 

“We’ve created a code that’s error tolerant using a molecular form we know will last in the right conditions for 10 000 years, or possibly longer,” says Nick. “As long as someone knows what the code is, you will be able to read it back if you have a machine that can read DNA.”

 

Although there are many practical aspects to solve, the inherent density and longevity of DNA makes it an attractive storage medium. The next step for the researchers is to perfect the coding scheme and explore practical aspects, paving the way for a commercially viable DNAstorage model.

 

Source Article: Toward practical high-capacity low-maintenance storage of digital information in synthesised DNA.Nature; DOI: 10.1038/nature11875. Published online 23 January 2013.

 

About EMBL-EBI

TheEMBL-European Bioinformatics Institute (EBI) is part of the European Molecular Biology Laboratory (EMBL) and is located on the Wellcome Trust Genome Campus in Hinxton near Cambridge, UK. The EBI grew out of EMBL’s pioneering work in providing public biological databases to the research community. It hosts some of the world’s most important collections of biological data, includingDNA sequences (ENA),protein sequences (UniProt), the genomes ofanimalsandplants, three-dimensionalmolecular structures, data fromgene expression experimentsprotein-protein interactionsandreactions and pathways. EMBl-EBI’s many research groups are continually developing new tools to support the biocomputing community. EMBL-EBI plays an important role in the 1000 Genomes Project and coordinates ELIXIR, the emerging research infrastructure for life science data in Europe. www.ebi.ac.uk

 

About EMBL

TheEuropean Molecular Biology Laboratoryis a basic research institute funded by public research monies from 20 member states (Austria, Belgium, Croatia, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom) and associate member state Australia. Research at EMBL is conducted by approximately 85 independent groups covering the spectrum of molecular biology. The Laboratory has five units: the main Laboratory in Heidelberg, and outstations in Hinxton (EMBL-EBI), Grenoble, Hamburg, and Monterotondo (near Rome). The cornerstones of EMBL’s mission are: to perform basic research in molecular biology; to train scientists, students and visitors at all levels; to offer vital services to scientists in the member states; to develop new instruments and methods in the life sciences and to actively engage in technology transfer activities. Around 190 students are enrolled in EMBL’s International PhD programme. Additionally, the Laboratory offers a platform for dialogue with the general public through various science communication activities such as lecture series, visitor programmes and the dissemination of scientific achievements.

 

ebi.ac.uk [en línea] Hinxton (UK): ebi.ac.uk, 28 de enero de 2013 [REF. 23 in January of 2013] Available on Internet: http://www.ebi.ac.uk/Information/News/press-releases/press-release-01232013-DNA_storage.html

 

 



Characterization of health systems and health models

24 01 2013

For a long time people covered the treatment of their illnesses with own resources, attending the different alternatives that could be found. Historical events were profoundly changing the structure of the society, their customs, their culture and among them the concept of health; Hence, forge health professions and appearing various healthcare devices. Public authorities became aware of the necessity of establishing certain guarantees in favour of the population, which mainly concerned the development of hygienic measures, preventive medicine and environmental sanitation.

 

This situation resulted in different political and ideological visions with respect to health care in different countries, Depending on the conformation of the social characteristics, policies, Economic and historical of each one of them. Such characteristics gave rise to models like the Liberal, the Socialist and the mixed.

It is common in the literature that uses the concept of model and systems as a synonym. For this reason it is important to stress the difference between the two to not confuse them:

The Model It makes the scope of the policy and it can be defined as "the set of criteria or doctrinal and ideological foundations in which health care systems are built up", the aspects are determined as: receiving population, who finances the system, benefits that are going to give, performances and competencies of health public-health authority.

While the System It makes to the operability and execution of the Model, but at the time of defining it appear different ways of conceptualizing it own characteristics and complexities that saves.

The World Health Organization relates them with the concept of health in its broadest aspect "as a set of interrelated elements that contribute to health in homes, workplaces, public places and communities, as well as in the physical environment and psychosocial, and in the health sector and other related sectors".

Also, WHO displayed the different actors that compose it by explaining that "system is the set of all activities, officers or not, related to the provision of health services to a particular population, You must have appropriate access to the use of such services. Composed of all available health staff, the formation of this type of personnel procedures, sanitary facilities, professional associations, the economic resources that for any reason or source put at the service of health and existing official and unofficial device".

And it adds that "this whole must be harmonized in a homogeneous system that allows use of resources enabled for the achievement of the maximum satisfaction of the preset objectives: ensure the right to health not only as a universal right, but as a resource for social development, Economic and individual of a person".

Although all system is included in a larger one, the suprasistema, they are those who believe that health systems are a variant of social systems, and as such, they appear as one of the institutions and most consistent social functions and greater complexity in society.

From the sociology defined to the health care system as "the set of social mechanisms whose function is the transformation of resources widespread in specialized products in the form of health services in society".

A) Health care models

1. Liberal: Health in this model is considered as a consumer good, It does not necessarily have to be protected by the public authorities in their entirety. The responsibility of the State is summarized to serve groups most disadvantaged and vulnerable to the contingencies of illness, with minimal financial contribution to the system by the State.

The other population groups (medium and high) stick to private insurance companies or directly engaged in providing medical provider, without intermediaries. The use of the services is based on the law of supply and demand.

This model is present in the private system of United States, being the reference among other countries. Relevant aspects of the model:

  • Service providers develop their devices according to the approaches of economic profitability. High competitiveness existing among different providers to capture customers makes the technology, and cientifico-medica research move forward significantly and to attract the best professionals.
  • Some features of this system are being implemented in other health systems, as the analysis of costs per process (excessive use of complementary tests in Diagnostics and drugs excess) to make them more efficient.
  • Its financing rests on companies that co-finance a health insurance contract with private agencies, This situation generates disadvantages and inequalities for the different segments of the population. Two-thirds of employees receive this coverage. Self-employed workers, those in part-time or those who have small businesses must employ much more expensive individual policies, so it often reject them. Outside the company there are no rights. More retirees from 65 years are entitled to a minimum coverage,for those who do not fall into these categories: nothing.
  • A variant of the Liberal model is the Singapore model, that it has introduced the concept of individual capitalization in health systems. Funding is generated in a Central Provisora of funds (20% salary of the worker + 20 % entrepreneurs). Between the 6-8% going to an account. Each individual can withdraw money from that account to cover health expenses.

2. Socialist or statesman: its most significant feature is that benefits are given in conditions of equity, gratuity and universality for all segments of the population. It is funded entirely by General State budgets. The private sector is non-existent. From this model they derive two types:

a) Semashko model. It began in the former USSR and the countries of the Soviet bloc after World War II. From 1990 Russia and all the Communist countries of Europe have abandoned centralized system, fully controlled and operated by the State.

b) Unified model for public. Applied in Cuba and North Korea, in this system the State takes an important role in ensuring access to health funding and supplying health services directly through a single, integrated system vertically. The coverage is granted with criteria of fairness, gratuity and universality to the entire population. Prioritization of public health is through preventive medicine and health education to increase the levels of health at the expense of the creation of expensive medications and health care services, as well as investment in public services has been one of the features most relevant and imitated by other countries. This system is not very effective with regard to the individual, It excludes the options of benefits under the control of consumer and limits the effective representation of users in the Organization of the service.

3. Mixed. It is common in many European and Latin American countries. It is defined by the contribution that has public and private sector in the management of the system. Depending on the country, It differs from the participation of both sectors giving it its own characteristics in the financing, in the modes of provision and functionality, as well as different levels of assistance.

Two European models gave origin: Model security Social-Bismarck. It is the oldest and most advanced in the world, inspired by the social legislation of Germany in 1883.

  • The State guarantees benefits through mandatory fees.
  • The model ensures the assistance only to workers who paid the obligatory insurance, Bearing that constitute parallel networks of charities for workers who are not "traded".
  • Professionals are paid through medical Act and the hospital institutions receive a global budget.
  • The network of public health is in the hands of the State, It is also in health authority.
  • All the citizens of these countries currently enjoy a universal health, free and equitable.

Secondly the Model tax-Beveridge, inspired by the Beveridge report of 1942, that formalized the Organization adopted by Sweden in the Decade of 1930, and it gave rise to the national health system in different countries.

  • The funding is public through taxes and State budgets.
  • The provision is given in terms of universality, equity, free and freedom of access of the entire population.
  • Planning and public health are in the hands of the State and taught in autonomous communities and municipalities that decide and measurable health plans developed and enforceable.
  • Comprehensive parliamentary control over the system.
  • The means of production are State although there is a part of the private sector, patients participating in the payment.

It has a global budget limited to hospitals.

In third place, is worth mentioning that in Latin America there were other similar models but with historical and social characteristics of the region.

1- Segmented model: It is the model most frequently used in Latin America. Coexist three sectors in the system:

Public sector: represented by the State, who deals with providing assistance to those excluded individuals on the market, i.e. those who belong to social groups more needy and vulnerable and without social security coverage. It is financed by fiscal resources which may come of General Finance or tax with affectation specific to this purpose. At the same time the State is service provider through its health network.

Social security sector: its organization is decentralized into non-governmental intermediary entities, but with high regulation by the State. The funding is effected through contribution of workers and employers contributions, resources that has the character of mandatory. By definition, It only covers to the contributors to the system and their family group.

Private sector: the provision of health services is carried out through private market providers. Performs financing the complaining user through the system called prepaid. In general insurance are contracted individually, Although they can be hired collectively. In Argentina what you must provide each user is calculated based on the risk of getting sick and ill (that is to say, through the rates of incidence and prevalence of different diseases) and the type of service.

These three sectors funded system, but two of them are also service providers: the public and private. The latter provides service to private insurance to social insurance.

The problems that presents this conformation imprint area of health a peculiar logic since it implies the coexistence of disjointed from each of these subsystems, I differ with respect to their target population, the services provided, the origin of the resources and decision at the system level. To this we must add the existence of serious fragmentation levels in each sector.

The economic interdependence of the three sectors, the duplicity of functions, inefficiency in resource management and provision of services important differences between various segments of population in relation to their coverage resulting lack of equity and discrimination in the provision of the system, i.e. marked inefficiencies.

2- Public contract (Brazil accounted for example of this mode)

• Public funding is combined with a growing private participation in the provision of health services, through the contracting of services.

• The population has expanded options and providers are more opportunities for autonomy and competition.

• The overall public budget is assigned to a plural set of suppliers according to criteria of productivity and quality.

• This model leads to the fragmentation of provision and complicates the quality control and costs.

3- Structured pluralism (It is a new modality that are transiting Colombia, Mexico, Argentina and Brazil)

It represents an intermediate point between the two poles (public and private) in which health systems have worked, What prevents the ends of the monopoly in the public sector and the atomization of the private sector. This new alternative search to the system is no longer organized by social sectors but by functions. They play here a role health ministries in each country assuming roles of stewardship and regulation of the system and ensuring the strategic driving, instead of being one provider of health services.

• Social security becomes the principal responsible for the financing and expands gradually to achieve a universal protection, guided by principles of public finance.

• The direct provision of services would remain open to all a pluralistic scheme of institutions, both public and private.

• In urban areas would foster competition among suppliers, and in rural areas other innovations to foster pluralism would be organized cooperatives and solidarity health companies. In any case, the challenge is to increase the options for consumers and providers, with clear rules that minimize potential conflicts between equity and efficiency.

In conclusion, It could be argued that all the models described synthetically have been varying in time and generating changes in search of new alternatives to be more efficient and save greater equity in the provision.

The following table shows the transition that at our discretion have been taking and where they are going:

 

 

The widespread perception is that no unique and pure concrete model allowing to solve all the problems of population health in our environment there is. The ideal health care model does not exist, any model you choose has supporters and detractors by its own characteristics and complexities. Health in its conception has an ethical dimension that relies on social values, political and religious crisscross with different ideological views and interests of all kinds that do not always have common assessments.

Health, objective of entire system, It is essential to life, for a country's economy and welfare. WHO argues that the Mission of all system is to increase levels of health in all aspects and the isolated individual situations and/or society, so is your operating condition to establish indicators of measurement of welfare and level of development of a society.

Health and health services are one public responsibility and a social right. The State must ensure their protection, promotion and access to an appropriate and timely way independent of their social class health services, income level, labour insertion, genre, ethnicity or age.

It is common to most of the described models define the policies of health beyond health ministries, since they consider them intersectoral encompassing all those actions aimed at improving the health.

(B)) Characteristics of health systems common to all models

• Health systems are operational instruments designed by the political authority of the various countries to comply with their health theoretical models.

• The most specific trait of all health systems is its professional character. The doctor is the hub of the system, the key decision maker (on behalf of the patient) with great autonomy in their decision-making.

• Medical health systems decisions determine the quality and efficiency of these.

• Health systems must be permanently aligned medical practice (with their incentives and interests) with the mission and values of the health system, articulating the administrative management with the collegiate clinical management based on the professional authority.

• The most important determinants of individual and collective health does not depend on the health sector. This has a limited ability to produce health, approximately a 11%, faced with the 89% (It comprises the genetic load, lifestyles and the environment).

• The health sector is increasingly important in a country's macroeconomic indicators, This amount of resources generates powerful interests in economic actors with great influence on health decisions. Example of this: Pharmaceutical industry, medical equipment, Professional, social security, etc.

• The health with respect to other types of employment employment growth, give the sector a great capacity for social and labour pressure, whose management is especially problematic. By ej.: nurses, assisted residences, socio-sanitary services, care of chronically ill, professionals concentrated in a same employer (hospitals), a mix of different occupational groups with different interests, among others.

Health systems in addition to being complex as described are characterized by being partially implicit by the large number of components and relationships between the parties are to compare, with the black box of a complex machine with unknown function.

Health systems, they are also open systems and therefore interact with other systems: the politician, the Prosecutor, educational and economic saving with these relations of interdependence, that is the health sector depends on the actions of these, any variation in any of them has strong impact on your exercise, such is the case of the tax system (fundraiser) the provider of financial resources or the lack of definition and support the political system leaves the health system without rectory on the whole health. The educational, cornerstone at the moment of join in educating the population prevention through its systematic and parasistematicos methods; and finally, Perhaps the most relevant economic system that produces strong impacts in different sectors when it has relevant imbalances as it is the case of the variations in employment (unemployment).

Maintain a balance in the interactions of these systems leads to the maintenance of the system and to improve the standard of health producing the expected results in the population that is covered in a country.

At the same time, social and environmental systems (suprasistemas) they contain to the health system and interact permanently conditioning in its operation in terms of the impact that generate, as well as its capacity to respond to the constant demands that presents the medium, by measuring their ability to feedback in terms of effectiveness and efficiency, that is to say, produce the best results (prolong the life, minimizing diseases, disabilities, promote well-being- internal satisfaction, etc.), ultimately the satisfaction of users. See graph (PowerPoint presentation that accompanies this work)

(C)) Functions and components of health systems

The components might be defined as internal parts of the system, that in his actions he determine the operating balance of the system. The components are:

 

The parties are related through functions: financing, Regulation (legislation), provision and management (planning and control system).

(D)) Health care organizational structure of health systems

The Organization of medical care is the result of the socio-political and economic structure of society in which it operates. (Modelo-Sistema).

In European countries the health care is in the form of assistive device, submitted directly to the power of the State and managed by authorities and bodies representing saying power, It is what has been called national health service. In this system the services are structured within the scheme of assistance integrated with an overall state planning, both in terms of the geographical distribution of the assistive device and in the definition of benefits and in the modalities of action of health personnel, that it be regulated by detailed regulations. Government action involves the definition of the jobs needed in the health field and the creation of health centres and their trim levels, and it is aimed at the extension of benefits to the whole population.

The socialist countries adopted this scheme in General for its health devices, but also some other countries like Latin Americans  they have structured schemes somewhat similar shared with the private sector.

Such is the case that because of economic rationalization and the increasing evolution of the assistance measures have allowed that in recent years, in many European countries offered medical care-oriented part of the population by private health centres, generating an important development of private medical insurance and giving rise to the change of vision sustained for many years of the national health system.

Obviously in almost all countries is progressing towards mixed models described previously by varying some of them in the form of management, This is, different participation of public and private financing and provision of services.

We can say that there is a great diversity in relation to the organizational structure of the health, which are the result of combining the two basic elements that constitute all health systems:

1. Sources of funding: economic resources

2. Providers: medical, hospitals, pharmacies, etc.

The health care structure common to most systems is:

Despite the therapeutic advances, the steady increase in the cost of health, the massive demand for assistance, repeated reforms and inequalities in health care are still the order of the day, both between countries and inside them. Many factors influence this: environment, power and work, Customs, among others. But health systems and modes of financing also generate consequences that unlike the previous can be improved by intervening in its defects, such as bureaucratization, the absence of regulation, the lack of equity - accessibility, efficiency both micro and macroeconomic; in final "health systems that ensure the satisfaction of the population with regard to the promotion, Prevention, protection and restoration of the health of individuals and communities in a country" (WHO).

In conclusion this document has attempted to make a conceptual and general description of the different models and systems in force in most of the countries; describe common characteristics and complexities of the system considered the most complex of all social systems.

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Entrepreneurs; 1998. Bulletin 63.

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- Research Web sites for international analysis comparative health systems are, among others: The European Observatory on Health Systems and Policies (http://www.euro.who.int/observatory) driven by the who, several institutions and European Governments (among them Spain); the International Network Health Policy & Reform (http://www.healthpolicymonitor.org/) It has an excellent system of monitoring and analysis of health reforms; the OECD (www.OECD.org) whose data on the health sector are the standard of reference for international comparisons.

 

 

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Politicaspublicas.UNCU.edu.ar [en línea] Mendoza (ARG): politicaspublicas.UNCU.edu.ar, 24 in January of 2013 [REF. 26 in July of 2011] Available on Internet:http://www.politicaspublicas.uncu.edu.ar/articulos/index/caracterizacion-de-modelos-sanitarios-y-sistemas-sanitarios

 



Developed a new method for diagnosing hereditary ovarian and breast cancer

21 01 2013

It's an algorithm of mass sequencing and analysis bioinformatics which allows very efficiently detect genetic mutations related to disease

Equipo de investigación de la Dra. Conxi Lázaro, responsable del estudio.

Research team of the Dra. Conxi Lazarus, Head of the study.

 

Researchers from the Catalan Institute of Oncology (ICO) at the Bellvitge Biomedical Research Institute (IDIBELL) have been developed and validated a new method to diagnose the syndrome of breast and ovarian cancer hereditary based on massive sequencing of the genes BRCA1 and BRCA2. The model is based on a genetic analysis and bioinformatics which has been proven very effective. The new Protocol has been described in an article published in the magazine European Journal of Human Genetics.

In recent years new advances in sequencing techniques have behaved develop new platforms for the sequencing of nucleic acids, so-called mass sequencing or next-generation sequencing platforms. These technological improvements have brought a revolution in biomedical research, in the field of genetics and genomics. The appearance of sequencers for the new generation and the possibility of combining different patient samples, using IDs has allowed to adapt these new technologies in the field of genetic diagnosis.

Through the use of a massive next-generation sequencing platform, the team led by researcher Conxi Lazarus, ICO and the IDIBELL hereditary Cancer program, He has developed a complete protocol that allows sequencing all coding regions and adjacent regions of the genes BRCA1 and BRCA2, responsible for the hereditary ovarian and breast cancer.

 

Massive sequencing algorithm

“This approach has allowed to identify all point mutations and small deletions and insertions analyzed, even in regions of high technical difficulty, such as the homopolimericas regions”, explains the researcher at the IDIBELL-ICO. The developed protocol is an algorithm of mass sequencing and analysis own bioinformatics which has proved to be very efficient in the detection of all existing mutations and to eliminate false positives.

The validation of this algorithm for diagnosing hereditary breast and ovarian cancer syndrome has shown a sensitivity and specificity of the 100% in the analyzed samples, In addition to reducing costs and getting the results.

Also, the research team led by Lazarus is implementing the use of this approach by the genes responsible for hereditary colorectal cancer, as the polyposis and Lynch syndrome.

Up to ten percent of cancers are hereditary, which means that they are transmitted from parents to children genetic mutations that predispose to suffer various types of tumors. The identification of these mutations is very important to prevent the development of tumors in people who have familial predisposition.

Breast cancer and hereditary ovarian syndrome is one of the types of hereditary cancer that affects more people. The disease is caused by mutations in the BRCA1 and BRCA2 genes. Estas mutaciones también están relacionadas con otros tipos de cánceres.

 

The article reference

Feliubadaló L, Lopez-Doriga A, Castellsagué E, del Valle J, Menéndez M, Tornero E, Montes E, Cuesta R, Gómez C, Campos O, Pineda M,González S, Moreno V, Brunet J, Blanco I, Serra E, Capellá G, Lázaro C. Next-generation sequencing meets genetic diagnostics: development of a comprehensive workflow for the analysis of BRCA1 and BRCA2 genes. European Journal of Human Genetics. Dec 19. DOI: 10.1038/ejhg.2012.270. [Epub ahead of print].

 

idibell.cat [en línea] Barcelona (ESP): idibell.cat, 21 de enero de 2013 [REF. 16 in January of 2013] Available on Internet:http://www.idibell.cat/modul/noticias/es/468/desarrollado-un-nuevo-metodo-para-diagnosticar-cancer-de-mama-y-ovario-hereditario



Boots the ' project code Sepsis’

17 01 2013

 

Societies scientific, clinical, nursing personnel, public administrations, industry, economists, journalists and patients participated in the ‘ I National meeting code Sepsis: a problem of public health ’, organized by the Federation of associations scientific medical Spanish (FACME) and the Ministry of health and consumption of the Balearic Islands, in collaboration with Novartis.

In this multidisciplinary meeting, held in the Hospital Son Llàtzer in Palma de Mallorca, the main agents associated with this clinical process could discuss and exchange views to improve handling, identification, treatment and monitoring of severe sepsis in Spain.

Sepsis or septicaemia is a disease of high frequency and potentially deadly which can occur when the body reacts to infection. Its incidence increases around a 2 percent every year due to various factors, include the ageing of the population, the increase in the life expectancy of pluripatológicos patients, the increase in the number of immunocompromised patients and the increasingly frequent realization of aggressive surgery and chemotherapy treatments.

In Spain are detected daily between one to two new cases of severe sepsis per each 100.000 inhabitants and a mortality rate, in the case of ‘ shock’ septic, ascends to the 50 per cent, figures that have motivated the launch of the ‘ project code Sepsis ’. “This initiative aims to “create a transversal and multi-disciplinary clinical process that can be applied in daily clinical practice and adapted to the different characteristics of the hospitals”, pointed out the national coordinator of the Project code Sepsis and Sepsis Grave of the Hospital are Llàtzer multidisciplinary unit chief says, Márcio Borges.

Although there are initiatives European and Spanish prior to this project, as the ‘ Survival Sepsis Campaign’ or Bell ‘ Edusepsis ’, According to the Chief of service microbiology of the clinical University Hospital (Madrid) and President of the Spanish society of chemotherapy, Juan Picazo, the difference is that the ‘ project code Sepsis’ intends to implement education and awareness about this process between the collective health and also on the general population, “giving it a dimension more global, with scientific implications, socio-political and economic”.

While this clinical response to infection by bacteria, virus, fungi or parasites can be very weak, You can also develop a serious systemic box, so early diagnosis is crucial.

“Soon we begin to treat the disease, less organic dysfunctions will be developed, decreasing mortality and costs of sepsis, that currently ranges between the 18.000 and the 20.000 euros per episode in Spain”, commented on Borges.

Public administrations, scientific societies and pharmaceutical companies like Novartis have developed a ‘ consensus document’ interdisciplinary on initial and integral management of sepsis which aims to be a reference tool in the Spanish health system for the early detection and therapeutic measures home.

 

Europapress.es [en línea] Madrid(ESP): europapress.es, 17 in January of 2013 [REF. 27 November of 2012] Available on Internet: http://www.europapress.es/salud/politica-sanitaria-00666/Noticia-Empresas-arranca-proyecto-Codigo-sepsis-Objetivo-reducir-Incidencia-Mortalidad-septicemia-20121127174705.html



The 10 progress and setbacks in health which left the 2012

14 01 2013

Eggs against infertility, mental strength against the paralysis and implant it reversed blindness are some of them.

1 The most dangerous virus
The 2012 It began with an international dispute about whether they should be published or not two investigations which had created versions of the lethal virus of influenza avian, the H5N1, with the ability to spread easily between humans. For fear that the virus could be used as a terrorist weapon, the United States Government requested two scientific journals in that country to not publish the details of investigations. At last, After months of controversy, He won the transparency and both studies were published.

2 Eggs against infertility
In February of 2012, scientists at the Massachusetts General Hospital in Boston, United States, They identified stem cells capable of producing new eggs spontaneously and throughout life.
The researchers said that with the finding it may potentially have a “unlimited amount” ova for fertilization treatments and to the “rejuvenation” the mature egg to help women to have more children later in life. And in October it was reported that scientists from Kyoto University, in Japan, they managed to create with stem cells in the laboratory ovules that later were implanted to produce healthy and fertile mice which in turn had children.

3 Implant that blindness reversing
In May of 2012, British scientists were able to restore the vision of two patients with a microchip pioneer that is implanted in the retina. The two individuals, He had lost his sight due to retinitis pigmentosa, a genetic disorder that causes permanent blindness, they were able to see light and forms weeks post-operation. Researchers from the University of Oxford and King's College of London said that the results “they exceeded all expectations”.

4 Mental strength against paralysis
In may, researchers in the United States. UU. they revealed that two patients with quadriplegia were able to control a robotic arm with thought and a drink without assistance for the first time in 15 years. The technique involves the use of a sensor implanted in the brain to, linked to a computer, translate electric signals into instructions.

5 Medicines for obesity
In 2012, an issue that did not give truce in health news was obesity in the world, It is already considered a pandemic by the who. In June and after 13 years, the first prescription drug for weight loss was approved in United States, Belviq, While two years earlier had refused the license due to possible side effects. Then the authorities in that country adopted a second drug to lose weight: Qsymia.

6 Forward and reverse in Alzheimer's
In July of the 2012 reported in Nature of the discovery of a mutation that protects against Alzheimer's. It is a Variant that prevents plaque formation of protein in the brain that is believed are responsible for disease. The finding, They said scientists, It could lead to the development of drugs that simulate this effect and prevent disorder. But there was also disappointing news: in August, two pharmaceutical giants, Pfizer and Johnson & Johnson, they announced that they would stop the large clinical trial of a drug, bapineuzumab, that he had presented as a promising drug.

7 New enemy: tuberculosis
In August, an international study revealed a “alarming increase in” available drug-resistant tuberculosis.Research in The Lancet said that the increase of disease around the world was worrying and increasingly will be more difficult to treat disease. The study, carried out in eight countries, found resistance levels of almost 44% to the available drugs.

8 Hantavirus in the United States. UU.
In September, a virus in a United States National Park provoked an international warning, because it was feared that tens of thousands of people could have been exposed to the pathogen: a hanta virus that is spread in the feces of infected rodents. At the end, eight cases and three deaths were confirmed.

9 AIDS: Fewer cases in Africa
In 2012 There was a reduction of the 50% new infections in Africa, According to the UN. But the annual figures published in other countries showed that new infections of the virus are increasing, particularly among young people and homosexual males: There are 34 millions of people living with HIV in the world.

10 The great killer
More extensive research has been done on the incidence, mortality and burden of disease revealed that the disorder that kills more people in the world is the hypertension: 9 millions of people die each year from this cardiovascular disorder. Behind this there are other two large killers: tobacco and alcohol. In Latin America, the main threat to health is obesity. (BBC).

lasegunda.com [en línea] Santiago of Chile (CHI): lasegunda.com, 14 de enero de 2013 [REF. 01 in January of 2013] Available on Internet: http://www.lasegunda.com/Noticias/Impreso/2013/01/810651/los-10-avances-y-retrocesos-en-salud-que-dejo-el-2012



Found the path of HIV cells that perpetuate it

10 01 2013

IrsiCaixa researchers identified molecules that prevent cure AIDS

Detection can lead to a new family of drugs against infection

 

 

Una investigadora en el laboratorio contra el sida IrsiCaixa, de Badalona. RICARD CUGAT

A researcher in the laboratory against AIDS IrsiCaixa, Badalona. RICARD CUGAT

 

The human immunodeficiency virus (VIH), which gives rise to the AIDS, It has achieved up to now survive the twenty of drugs it slow down its multiplication. Although these treatments reduce the presence of HIV in the blood to levels that cannot be quantified, his tenure is evident and manifests shortly after that the infected stops treatment. The multiple combination of steps that follows the virus to succeed in his aim of making indestructible has just lost a fundamental link thanks to the identification of the molecule in which is hidden from the infecting the CD4 T cells of the immune system. The finding, managed by the team of researchers Javier Martinez-Picado, Lab IrsiCaixa, of Badalona, publishes it the scientific journal today PLoS Biology.

 


 

Identified molecule allows HIV to enter in dendritic cells, You should activate CD4, the body's natural defenses, with which facilitates the spread of infection. And not only that: These cells allow HIV to live hidden and inaccessible to the drugs in one sufficient proportion to restart its multiplication. The finding, What, in principle it should allow the design of a new family of drugs that block the spread of HIV, It also links up with the strategy that seeks to compose a therapeutic vaccine against AIDS, the investigation remain in unison IrsiCaixa and Hospital Clínic on the HIVACAT project, that you protect the Conselleria de Salut and Esteve lab.

LOCK AND KEY

«This new result, know what the molecule of dendritic cells that HIV uses to initiate its spread, It has solved an enigma - yesterday said Martinez-Picado-. We had the key and now we have found infection lock. We are already working on the development of a drug that blocks this access door».

The protein that acts as a lock in the spread of HIV could also be the path to the blood of other viruses, noted researcher Nuria left Useros. «This finding may also lead to the treatment of other infections that spread in the same way as HIV», added.

 

In a person it heals, When a virus or a bacteria enter the blood dendritic cells exert a fundamental function, since they activate the immune system's response. They are responsible for pursuing bloodborne infectious microorganisms, and when get it they chopped them and move them to the lymph nodes, where is subjected them to their destruction. None of this happens when these dendritic cells contain the virus itself that should be eliminated, HIV.

 

ANGELS GALLARDO

Elperiodico.com [en línea]Barcelona (ESP): elperiodico.com, 10 in January of 2013 [REF. 19 November of 2012] Available on Internet: http://www.elperiodico.com/es/noticias/sociedad/investigadores-irsicaixa-identifican-las-moleculas-que-impiden-curar-sida-2276445



Dr Frangi: Do move of tyrants without destroying the tyranny?

7 01 2013

Dr. Alejandro Frangi
Director Center for research in image technologies and biomedical simulation (CISTIB)

We started a new year! It is perhaps time for balances and reflections background, thoughts that guide and give sense to our activity... A researcher is, above all, a thinker, a good search engine, truth and beauty. You can not evade the question of why the daily in its research effort and the impact this has on their environment.

In recent weeks I got a phrase that made me think. Mariano Moreno is, one of the heroes of the independence of my country of origin, Argentina, of those that valuing the heritage received from Spain expressed its commitment to bring it to maturity. Men with personality itself but open to European ideas of the era and not afraid to apply them to create a free future for America.

Mariano Moreno (Buenos Aires, Viceroyalty of the Río de la Plata, 23 de septiembre de 1778 – high seas, 4 March of 1811), According to tells us Wikipedia, was a lawyer, journalist and politician of the United Provinces of the Río de la Plata. He played a major role in the events that led to the may revolution and decisive action as Secretary of the Primera Junta, resulting from the same. Moreno was the ideologist of this revolution, defence counsel for the rights of Indians. He was always faithful to his ideals of liberation and ideology roussoniana learned in the most prestigious University of the region at the time, the University of Chuquisaca. There he read the books of Montesquieu, Voltaire, Denis Diderot, Jean-Jacques Rousseau and other European thinkers of the period. Also, He studied the English language and the French to understand the authors who write in these languages, What also served as translator. One of the works that resulted was the book “The social contract” Rousseau. With his writings and exhibitions, Moreno contributed to the development of free trade in the Río de la Plata. In addition, in July of 1810 the Board appointed him so that he drafted a Plan of operations and the political strategy of the revolution project, due to the large capacity that Moreno had with writing and oratory. He died poisoned in high seas, on the way to a diplomatic mission in London.

Beyond the historical constraints, the dispute of the conquest and the subsequent independence of Latin America, There are significant and perhaps recurring elements in the history of the countries that can illuminate our current and socio-economic-political moment in Catalonia; my land by adoption and has seen four of our seven children were born. At every moment of history, in all places of the Earth, man craves freedom, beauty, welfare but these are only achieved at the cost of a personal effort of knowledge, overcoming and resignation without which these cravings are nothing more than changing illusions.

Mariano Moreno expressed in the preface to the translation of the "Social Contract" of edited Russeau in 1810 in the Gazette: «If the peoples are not illustrated, If your rights are not vulgarizan, If every man does not know what it is worth, What can and what is owed, new hopes will happen to the old, and after hesitating sometime between thousand uncertainties, «It will be perhaps our luck moving of tyrants without destroying the tyranny».

Perhaps the worst tyrannies, as soon as that most unnoticed by common, they are those resulting from the lack of education, of misunderstanding or little critical thinking, a limited suction that limited welfare to the apparent or material. It is relevant to talk about education in societies so advanced and modern as the European? Unfortunately Yes!

Maybe don't miss access to elementary education or even access to university education as it can lend to miss in other lands. But the worst ignorance is the believe know enough without knowing in depth or complete form, who denies the existence of universal principles, knowledge of the outside world without discovering the interiority, the live without response to the deepest human questions, a life adrift of relativism or that denies the existence of any natural law. Our time meant many times by critical mind criticism of the big social problems without responsibility for putting, as inconsequential, solutions that are really within our reach. The critical spirit we confuse with being majority and see straw in neighbouring ignoring our beam. The true critical spirit, seems to me, It is that begins by oneself and airs on changes humble but real and constant in the environment in which we live. At last, the aspiration for well-being goes beyond material things. The human experience is full of experiences that recognize the existence of other horizons than the merely tangible: the need for affection and the esteem of others, the need to contribute to the success of others, work and learn about teamwork, of freedom to live in harmony with the environment without betraying the personal principles, be able to enrich each other valuing diversity without demagoguery.

In sum, become researchers is to be open to knowledge and, in that sense, every man has some research vocation, that confidence in the ability to apprehend and not settle for the status quo of his momentary understanding, be open to new horizons, progress in personal development and put at the service of their peers. And this, Here are the key, We can do it to the extent that we take the reins of our intelligence and our willingness to. We can do it even in the midst of difficulties of all kinds, in the midst of economic problems, in the midst of the prevailing socio-political disorientation and its consequences.

Viktor Frankl (n. Vienna; 26 March of 1905 – m. ibid.; 2 de septiembre de 1997) was a neurologist and Austrian psychiatrist, founder of logotherapy. It survived since 1942 up 1945 in several Nazi concentration camps, including Auschwitz and Dachau. Frankl wrote "everything can be taken from a man", least the last of human freedoms: Choose your attitude in a given set of circumstances, Choose your own path. Do we cannot change the situation? If you are not in your hands change a situation that causes you pain, You can always choose the attitude with which you meet that suffering". His profession and research were fed from your personal experience forming the third school of Viennese Psychiatry. Nelson Mandela, He used to repeat a verse of the poem Invictus of woman. Henley during the 27 years which lasted his incarceration on Robben Island: "No matter how narrow is the road", how charged with punishment the judgment. I am the master of my destiny; I am the captain of my soul".

At last, There is a text that read teenager and who personally inspires me to move forward in confidence not only in the faith that I have received from my parents but also in human capabilities, inheritance that I share with every man: "Endowed with intelligence and freedom, the man is responsible for its growth, as well as of your salvation. Helped, and sometimes clogged, Why educate it and surround, each one always remains, whatever those inflows that are exercised upon him, the main architect of its success or its failure: for only the effort of his intelligence and his will, each man can grow in humanity, worth more, be more..." (Populorum Progressio, n. 15).

Perhaps we should return to the beginning of this article: 2013, a new year! A new blank sheet, a new opportunity to write our history. Thinking about the illusion that each of my children begins a drawing when I give them a blank sheet, I think of the opportunity afforded by this new year: the researchers of profession, Yes, but also to every man who shares the essentials of the research which is the search for truth, the good and the beautiful. Search that will allow us to liberate us deeply and authentically of all tyranny. Best wishes for this search that begins today! Happy new year 2013!



Nina Tandon: Could tissue engineering mean personalized medicine?

3 01 2013

Each of our bodies is utterly unique, which is a lovely thought until it comes to treating an illness — when every body reacts differently, often unpredictably, to standard treatment. Tissue engineer Nina Tandon talks about a possible solution: Using pluripotent stem cells to make personalized models of organs on which to test new drugs and treatments, and storing them on computer chips. (Call it extremely personalized medicine.)

 

Nina Tandon studies electrical signaling in the context of tissue engineering, with the goal of creating “spare parts” for human implantation and/or disease models. After receiving a bachelor’s degree in electrical engineering from Cooper Union, Nina worked on an electronic nose used to “smell” lung cancer as a Fulbright scholar in Rome. She studied electrical stimulation for cardiac tissue engineering at MIT and Columbia, and now continues her research on electrical stimulation for broader tissue-engineering applications. Tandon was a 2011 TED Fellow and a 2012 Senior Fellow.

“I love pointing out to my students that the cable equations we use to analyze transmission along nerves are the same ones developed for the transatlantic cable.”

Nina Tandon

 

Ted.com [en línea] New York (USA): ted.com, 03 in January of 2013 [REF. December of 2012] Available on Internet:
 http://www.ted.com/talks/nina_tandon_could_tissue_engineering_mean_personalized_medicine.html