New therapeutic guidelines of who for HIV

29 07 2013

WHO publishes new recommendations on HIV which calls for treatment early

 

Antiretroviral treatment sooner, simple and secure can be achieved to the epidemic of HIV decline irreversibly

 

The new treatment guidelines of the World Health Organization (WHO) They recommended a more early initiation of antiretroviral therapy (TAR). Recent evidence suggests that a TAR earlier help those infected with HIV to live longer and in better health, In addition to substantially reduce the risk of transmission of the virus. This change may prevent 3 millions more deaths and 3,5 million more than new infections of HIV from here to the 2025.

The new recommendations are presented in a publication entitled who Guidelines unified on the use of antiretrovirals for the treatment and prevention of infection by HIV, at the same time that new data reveal that at the end of 2012 had 9,7 millions of people treated with these drugs that can save the life of patients.

«These guidelines represent another leap forward in the trend to set more ambitious objectives and to obtain achievements increasingly older», said the Director-General of who, DRA. Margaret Chan. «Now that there is about» 10 millions of people on antiretroviral treatment, something unthinkable just a few years ago, We can feed the necessary momentum to force the irreversible decline of the HIV epidemic."

 

Early start antiretroviral treatment

In the new recommendations is encouraged all countries to commence the treatment of adults infected by HIV when the number of CD4 lymphocytes is equal to or less than 500/mm³, that is to say, While the immune system is still strong. The previous who recommendation, established in 2010, It was to provide a treatment when such figure was equal to or less than 350/mm³. The 90% countries have adopted the recommendation of 2010, and some, as Algeria, Argentina or Brazil, are already offering treatment to patients with 500 cells/mm³.

WHO has based its recommendation on tests that reveal that early treatment with safe drugs, affordable and easier handling can keep healthy HIV-infected patients, In addition to reducing the amount of virus in the blood, which in turn reduces the risk of transmission to others. The report notes that if manage to integrate these changes into national HIV policies and support them with the necessary resources, countries will obtain significant benefits from the point of view of public health and individual health.

 

Provide treatment to children of 5 years and pregnant

In the new guidelines is also recommended to provide TAR all children of 5 years, all pregnant and lactating women with HIV infection, as well as all those infected whose partner is not infected, regardless of the number of CD4 lymphocytes. The Organization continues to recommend the administration of TAR to all those infected with HIV who also suffer from active tuberculosis or hepatitis B.

Another recommendation is that it is offered to all adults to begin to take TAR the possibility of receiving a single compressed Journal of same drug combo fixed-dose that is easier to take and more secure than the alternative combinations previously recommended, and that it can be used in adults, pregnant, teens and older children.

«Advances like this allow that children and pregnant women have access to treatment earlier and with greater security, and that move to the goal of a generation without AIDS», said Anthony Lake, Executive Director of UNICEF. «We must now intensify our efforts and invest in innovations that allow us to perform the tests more quickly in the newborn infants», in order to provide them a proper treatment so that they can start life in the best possible conditions."

 

Strengthen linkages with other health services

The organization also encourages countries to improve the way in which provide HIV-related services, for example by linking them more closely with other health services, such as those related to tuberculosis, the maternal and child health, sexual and reproductive health or drug addiction treatment.

«The new who guidelines are very appropriate taking into account the rapid advances we have made in the extension of the preventive and therapeutic programs», said the Director Executive of the Global Fund to fight against AIDS, Tuberculosis and Malaria, Dr. Mark Dybul. "This is an example of collaboration between who and the Global Fund to provide support to countries in the Elimination of HIV as a threat to public health." Since its creation in 2002, the Global Fund has supported more than 1000 programs that provide HIV treatment to 4,2 millions of people in 151 countries.

 

There are challenges to overcome

There are still challenges to overcome. In an update to the therapeutic progress made jointly by the who, UNAIDS and UNICEF identified areas requiring attention.

Although the number of children the TAR candidates receiving it has increased at a 10% between 2011 and 2012, This growth remains very sluggish in comparison with the 20% registered in adults. Another complication lies in the fact that many key populations, as injecting drug users, men with homosexual relations, transgender people or sex workers continue to face legal and cultural obstacles that prevent them from obtaining treatments that otherwise would be available more easily. Another problem to be solved is the large proportion of people who, for various reasons, they leave treatment.

 

Encouraging data

Despite this, the publication Global Update on HIV Treatment: Results, Impact and Opportunities It contains promising data that reinforce the viability of the new recommendation of the art who earlier, with which the global number of candidates to receive it would be of 26 millions of people.

Between 2011 and 2012 achieved the largest increase so far (1,6 millones) the number of people receiving art, with the total number of cases treated happened to 9,7 millonmillionddition, the increase in therapeutic coverage occurred in all the regions, particularly in Africa. The 80% those who began treatment in 2012 they lived in sub-Saharan Africa.

«Today there is close» 10 millions of people with access to this treatment that may save their lives. This represents a true triumph from the point of view of development», said the Executive Director of the United Nations joint programme on HIV/AIDS (UNAIDS), Michel Sidibé. «But now raises a new challenge: making the 26 millions of candidates for treatment, not one less, have access to it. All new HIV infection and all new death related to AIDS due to lack of access to antiretroviral treatment will be unacceptable."

WHO has made public the new recommendations today itself, at the opening of the Conference of the International AIDS society, 2013, being held in Kuala Lumpur. Among other attendees who have backed the new recommendations have been representatives of the countries in which the TAR earlier already part of national policy, as well as development agencies which are providing technical and financial support.

The Conference of the International AIDS society, biennial character, brings together the leading scientists, clinical, experts in public health and community leaders to examine the latest advances in HIV research and study how scientific advances can impact on the global response to HIV/AIDS.

 

Note for the editors

The recommended treatment consists of a combination of three antiretroviral drugs--tenofovir, lamivudine (or emtricitabine) and efavirenz - in a single Tablet, administered once daily.

Contacts for news media:

Glenn Thomas, head of communications, WHO Tel.: +41 22 791 3983Mobile: +41 79 509 0677E-mail: thomasg@who.int

 

 

Who.int [en línea] Geneva (CH): who.int, 29 in July of 2013 [REF. 30 in June of 2013] Available on Internet:http://www.who.int/mediacentre/news/releases/2013/new_hiv_recommendations_20130630/es/index.html



Memorial Sloan-Kettering Offers New Type of Lung Cancer Screening for Smokers

25 07 2013
This image shows a low-dose chest CT scan of a woman in her late 60s who smoked for 30 years. No lung cancer was detected.

This image shows a low-dose chest CT scan of a woman in her late 60s who smoked for 30 years. No lung cancer was detected.

Some people at high risk for lung cancer due to smoking now have the option of being screened with a powerful method that has been proven to save lives. Memorial Sloan-Kettering’s new Lung Cancer Screening Program offers low-dose CT screening to current and former smokers who fit specific criteria in order to detect the disease at its earliest stage.

“This is an extraordinary opportunity to improve some patients’ lives and even cure their disease by catching lung cancers early,” says thoracic surgeon Nabil P. Rizk, who led the team developing the screening program along with Michelle S. Ginsberg, Director of Cardiothoracic Imaging.

The Lung Cancer Screening Program provides low-dose CT screening for longtime smokers between the ages of 55 and 74. Eligible patients will receive an initial scan, then follow-up scans one and two years later. Low-dose CT scans use only about 20 percent of the radiation of conventional CT scans.

 

A Proven Approach

Eligibility is based on results from the National Lung Screening Trial, a groundbreaking study that found that lung cancer deaths in patients fitting these same criteria were decreased by 20 percent in people who had three low-dose CT scans over two years. Results from this study were reported in the New England Journal of Medicine in 2011.

“Many cancer screening efforts have had disappointing results when it came to actually saving lives,” Dr. Rizk says. “But this study gave us conclusive evidence that low-dose CT screening provides a clear benefit to certain people at high risk for lung cancer. We are among the first cancer centers to offer this type of screening but anticipate this approach will eventually be adopted nationwide.”

The scans are interpreted by Memorial Sloan-Kettering radiologists who are highly specialized in reading lung CT scans. Because the sensitive scans produce a significant number of false positives (detection of abnormalities that are noncancerous), it is essential that the medical team chooses an intervention that does not put the patient at unnecessary risk. If a scan detects an abnormality, Memorial Sloan-Kettering physicians can use minimally invasive techniques to take a biopsy and, if cancer is detected, stage the disease with great precision.

Many options exist to treat early-stage lung cancer while minimizing complications. Some patients can be treated with alternatives to surgery — such as destroying a tumor with tightly focused radiation, freezing it (cryotherapy), or using high-energy electromagnetic waves (radiofrequency ablation).

“For patients with a positive result, our specialists have the expertise to determine the best course of action for each individual case,” Dr. Rizk says. “If lung cancer is diagnosed, our multidisciplinary teams can provide effective therapies that clearly make a difference.”

 

 

 

mskcc.org [en línea] New York (USA): mskcc.org, 25 in July of 2013 [REF. 17 in June of 2013] Available on Internet:http://www.mskcc.org/blog/msk-offers-new-type-lung-screening-smokers



Secrets of trail-blazing bacteria revealed

22 07 2013

Bacteria in slimy biofilms are able to spread rapidly over surfaces such as catheters by building a transport network with DNA for tracks, say Australian researchers.

Microbiologist Associate Professor Cynthia Whitchurch from the University of Technology, Sydney and colleagues report their findings today in the journal Proceedings of the National Academy of Sciences.

Extracellular DNA (yellow) organises traffic flow of individual bacteria (blue) as a biofilm expands and spreads infection (Source: E. Gloag and L. Turnbull/The ithree institute and University of Technology Sydney)

Extracellular DNA (yellow) organises traffic flow of individual bacteria (blue) as a biofilm expands and spreads infection (Source: E. Gloag and L. Turnbull/The ithree institute and University of Technology Sydney)

“By following each other along this network and behaving the rules they can move quite efficiently through the system and out to the front of the biofilm,” says Whitchurch.

“We believe this is the equivalent to how a bacterial biofilm would expand up a catheter.”

Bacteria colonise the surfaces of our body, and the environment, in communities held together with slime.

These “biofilms” are a real problem because they make the bacteria resistant to antibiotics and disinfectants, and to the immune systems of organisms.

“They’re really resistant to everything we can throw at them, pretty much,” says Whitchurch.

“Probably half of hospital-acquired infections are due to biofilms forming on implanted medical devices … like catheters.”

If a biofilm establishes on a catheter, it can migrate and spread infection up to the bladder and kidneys, says Whitchurch.

To investigate how biofilms form and expand into new areas she and colleagues studied Pseudomonas aeruginosa, a bacteria that commonly causes urinary tract and respiratory infections.

 

Virtual tracking

The researchers used a technique called high-resolution phase-contrast time-lapse microscopy to track the movement of thousands of individual bacterial cells on computer.

“For the first time we could get quantitative data of individual cell movements during the process of biofilm expansion,” says Whitchurch. 

She and colleagues were able to show the cells lining up in co-ordinated fashion to blaze new trails.

Atomic force microscopy revealed that the advancing bacteria were forging furrows, which constituted the edges of the network.

Fluorescence microscopy revealed that DNA excreted by the bacteria provided the network “tracks” that organised the flow of bacterial traffic.

“You have long ropes of DNA that the bacteria are aligning themselves to,” says Whitchurch.

To demonstrate the role of the DNA the researchers used an enzyme to chew up the DNA.

“When we remove the DNA, the bacteria completely lose their ability to co-ordinate their behaviours. They start bouncing around as individual cells and end up in traffic jams and the whole rate of expansion of the biofilm seizes up.”

 

Bulldozing bacteria

Importantly, Whitchurch and colleagues also found that the DNA was also helping to glue together individual bacteria, called “bulldozer aggregates”, which collectively forged new furrows ahead of them. 

“They can’t move out into new territory individually. They have to act as a collective to do that,” says Whitchurch.

She says if this is indeed how bacterial biofilms colonise, it suggests ways of controlling biofilms on medical devices such as catheters.

“One opportunity is to build our own networks that tell the bacteria to go in a way that doesn’t enable their biofilm to expand,” says Whitchurch.

Whitchurch suggests it might be possible to insert small furrows on the devices using microfabrication that would limit the spread of the biofilm.

“We could build our own furrows and get the bacteria running around in futile circles instead of co-ordinating themselves to move along the device,” she says.

 

 

Abc.net.au [en línea] Sydney (AUS): ABC.NET.au, 22 in July of 2013 [REF. 25 in June of 2013] Available on Internet:http://www.abc.net.au/science/articles/2013/06/25/3788443.htm?topic=health



How to perform autopsies without smearing of blood

18 07 2013

Autopsies have traditionally been a complex issue for many unpleasant people.

La técnica consiste en la recostrucción del cuerpo en 3D a través de imágenes.

The technique consists of the reconstruction of the body in 3D through images.

 

 

Since weighing bodies to open bodies, find out how died a person can take a lot of time, accuracy and surgical procedures.

But now, Thanks to advances in imaging technology, be forensic doctor can become a profession “very clean”.

A team of Swiss scientists designed a technique that draws an internal map of the body through images, putting to expose the causes that led to the death to the person in question.

The technique is to perform a scan of the entire surface of the body in three dimensions, is made after a thorough scan with MRI (radio frequency waves under the effect of a magnetic field) and a CT scan (the realization of several x-ray images taken from different angles).

Advantages

It is not a final farewell to the traditional laboratories where the corpses are diseccionaban with a multitude of tools, but a very useful complement to find out the causes of the death of a person.

Points in favor of thevirtopsiathey imply a noticeable reduction of the risk of infection with any micro-organism of the body, high definition images that allow you to see details that the naked eye can be overlooked and, In addition, the acceptance of cultures or religions that do not support studiespost-mortemthat it involved mutilating the body.

It is also important if any inquiry related to a crime should be, as to keep the body in better condition, without any kind of invasion, enables subsequent analysis of the corpse.

In addition, the virtopsia can be a very useful and necessary for those who worship the body by making it possible to respect the physical integrity.

 

Bbc.co.uk [en línea] London (UK): bBBC.co.UK 19 de julio de 2013 [REF. 06 in July of 2013] Available on Internet:http://www.bbc.co.uk/mundo/noticias/2013/07/130705_autopsia_virtual_il.shtml



Found a mechanism of cell protection against cancer

15 07 2013

Discover the role of the non-coding RNA, 5S rRNA in the protection of the p53 tumor suppressor gene

More than the 50% tumors are related to mutations in this gene

 

Los investigadores George Thomas i Giulio Donati

The researchers George Thomas i Giulio Donati

 

Researchers from the Group of metabolism and Cancer of the Institute of biomedical research of Bellvitge (IDIBELL), of the Catalan Institute of Oncology (ICO) and of the University of Cincinnati, led by George Thomas, they have discovered the role of RNA ribosomal 5S in the formation of a complex that regulates p53 stability. Normally, p53 prevents healthy cells to become tumor. Maintaining low and stable levels when the cell working properly and makes them increase when there is damage in the cell.

The results of the study have been published in the online edition of the journal Cell Reports.

 

Cell growth

Cell growth is related to the amount of proteins that synthesize the cell Ribosomes, an intracellular machinery responsible for translating messenger RNA molecules, from DNA, in chains of amino acids, forming proteins). The malfunction in the formation of Ribosomes is related to disorders associated with aberrant as anemia and cancer cell growth

Activation of p53 induces the activation of a program of cell death that prevents cells that grow in aberrant way to develop a tumor. Under normal conditions, stays at low levels to avoid damaging healthy cells. The major protein in the maintenance of low levels of p53 is Hdm2, in normal cell growth conditions, degrades p53.

Ribosomes are composed of two subunits called 40S and 60S. In the formation of the subunit 60S involved different molecules, including L5, L11 and 5S rRNA, forming a pre-ribosomal complex before being incorporated into the 60S subunit. The laboratory of George Thomas has shown that when there is damage in the Ribosomes, or when the formation of Ribosomes is hiperactivada the pre-ribosomal complex l5/L11/5S rRNA deviates from its path to form Ribosomes and joins Hdm2 blocking its activity, allowing to increase the levels of p53 and induction of cell death.

Previously, the team of George Thomas had already proved that L5 and L11 regulates Hdm2. Have now discovered the existence of East pre-ribosomal complex formed by L5, L11 and also 5S rRNA and their role as suppressor of tumors. These results point to an ancient evolutionary link between biogenesis of Ribosomes and cancer

 

More than the 50% tumors

George Thomas has explained to understand how it works and how it regulates p53 is important because “more than the 50% tumors have mutations in p53 or overexpress Hdm2 or Hdm4, it blocks the activity of p53″. Thomas adds that “We are currently working on the design of a clinical trial, in colabroracion with the team of Ramon Salazar, based on activating the Hdm2-p53 control point to attack tumor cells".

 

 

The article reference

Donati G., Peddigari S., Mercer C.A. and Thomas G. 5S rRNA is an essential component of a nascent ribosomal precursor complex that regulates the Hdm2-p53 checkpoint. Cell Reports

 

 

idibell.cat [en línea] Barcelona (ESP): idibell.cat, 15 de julio de 2013 [REF. 03 in July of 2013] Available on Internet:http://www.idibell.cat/modul/noticias/es/586/descubren-el-papel-del-rna-no-codificante-5s-rrna-en-la-proteccion-del-gen-supresor-de-tumores-p53



Created human liver pluripotent stem cells

11 07 2013

Japanese scientists have developed a functional human liver from stem cells derived from skin and blood for the first time, What makes a path for the development of much needed organs for transplants, as the liver, It could be in a laboratory.

Induced pluripotent stem cells could be a useful source of human organs such as livers. STEVE GSCHMEISSNER/SCIENCE PHOTO LIBRARY

Induced pluripotent stem cells could be a useful source of human organs such as livers.
STEVE GSCHMEISSNER/SCIENCE PHOTO LIBRARY

Although that could take another ten years to get that livers grown in lab can be used to treat patients, Japanese scientists say that they now have a major test of the concept that paves the way for more ambitious experiments on the development of organs in laboratory.

“The promise of a liver available for transplant appears far closer to what could be expected just a year”, said Dusko Illic, expert in cells mother of King College of London, that it has not participated directly in the research, but he has praised its success.

In this sense, admits that, Although the technique appears “very promising” and represents a major step forward, “There is much to investigate, and it will be years before it can be applied to regenerative medicine”.

A Japanese team of the city school of Medicine of the University of Yokohama in Japan it has used iPS cells to develop three types of different cells that are normally combined into the natural formation of a human liver in a developing embryo (endoderm cells liver, endothelial cells and mesenchymal stem cells) and combined them together to see if they were getting would be a growth.

They discovered that cells did not grow, but that began to form three-dimensional structures called “outbreaks of liver”, that it constituted a collection of liver cells with the potential to become a full body.

When transplanted them in mice, the researchers found that these “outbreaks” they matured human liver, human blood vessels were connected to the blood vessels of the host mouse and began to perform many of the functions of the human liver cells mature.

“Far as we know, This is the first work that shows the generation of a functional human body from pluripotent stem cells”, researchers have highlighted in the magazine ‘Nature‘.

Researchers around the world have been studying stem cells from various sources for more than one decade hoping to capitalize on their ability to transform into a variety of other types of cells to treat various diseases.

There are two main types of stem cells: embryonic stem cells, that they get from embryos, and the reprogrammed cells or induced pluripotent stem cells (iPS), It gets especially skin or blood.

 

DEVELOP NEW DRUGS

The severe shortage of donor organs for the treatment of patients with liver failure, the kidneys, the heart and other organs affect many countries, so the scientists are very aware of the need to find new ways of obtaining organs for transplant, independent of the donation.

Malcolm Allison, expert on stem cells in the Queen Mary, London University, that it has not participated in the research, He explains that the results of the study offer “the clear possibility of being able to create mini-higados from the cells of the skin of a patient with liver failure” and transplanting them to boost the organ that fails.

Takanori Takebe, who directed the study, explained in a teleconference that it is so encouraged by the success of this work which plans a similar research in other organs, such as the pancreas and the lungs.

A team of U.S. researchers, It said in April that they had created a kidney of rats in a laboratory that was capable of working as one natural, but his method uses a structure of “scaffolding” a kidney to build a new organ.

And in May of last year, British researchers said that the skin cells had become to hit the heart tissue that someday might be able to be used for the treatment of heart failure.

That those livers and other organs may one day be developed from iPS cells is a possibility “exciting”, said Matthew Smalley, of the Institute of research of the University of Cardiff European Cancer Stem Cell. “This study holds real promise for a viable alternative approach to human organ transplantation”, said.

Chris Mason, expert in regenerative medicine of University College of London, He explained that the greatest impact of these “outbreaks” cells liver iPS may be in use to improve drug development.

“Today to study metabolism and toxicology of new potential drugs are used human cadaver liver cells, and unfortunately, These are only available in very limited quantities”, It has an Apostille.

The promise of this new study is that mice transplanted with human liver outbreaks iPS cells could be used to test new drugs for human liver would like to deal with them and if you can have side effects such as liver toxicity.

 

 

Europapress.es [en línea] London (UK): europapress.es, 11 de julio de 2013 [REF. 03 in July of 2013] Available on Internet:http://www.europapress.es/salud/salud-bienestar/noticia-cientificos-japoneses-crean-higado-humano-partir-celulas-madre-piel-sangre-20130703194312.html



ECONOMIC CRISIS and II: LOST OPPORTUNITY?

8 07 2013

 

Agustín Bassols Borrell

ADE graduated from the University of Barcelona

MBA ESADE FT

 

 

The last few weeks we are witnessing to return to our lives in the risk premium, the Troika, etc..., and turns to talk of financial markets and the duties that we have to do as a country, But what are and what they want "financial markets" and what can we do to plant them face.

Financial markets, they would be the people or institutions that channel billions and billions of euros or dollars from one place to another in the world looking for profitability, and they would be mainly represented by various funds (pension, investment, sovereigns, etc...), big banks, some mega-billionaires and other institutions. His only concern is their interest and recover the loans made and therefore, brings them carelessly unemployment, the labor reform, pensions or any other right or economic magnitude, provided it does not harm its aim.

This approach, It is absolutely lawful in the sense that one, When making a loan, you have every right to ask to be returned to you along with the interests of the same. The problem comes when you reach the point where is Spain for a few years and that is the not being able to pay. At this point is of course that the debtor has managed bad economy (in this case the country), but it is also evident that the creditor has made a mistake as it is the grant a loan to someone who, for the reason that it was, It has reached a situation of insolvency. It is therefore, It makes sense in a case so would be a burden-sharing in which the country and its citizens must make sacrifices to restructure and make viable economy and creditors, in minor cases, they should take some losses from a restructuring of the debt for having erred in granting credit.

The prevailing feeling in the country today is that they are only paying mistakes a part of the citizens of the country. I.e., are only paying citizens standing while the politicians and their environments have not assumed any responsibility, the banks are being saved, the institutions of the State are still not be reformed and creditors are imposing their conditions in collusion with politicians and bankers basically thinking about their short-term interests, but our politicians elected to carry out the counterweight that would correspond to in defense of our interests.

And hence the situation we're living with pension cuts, education, sanidad, labour, and many others, as well as with tax hikes, VAT, Income tax and rates several that all you are getting is sinking every day a little more the Spanish economy. That Yes, religiously paying principal and interest on the debt.

The problem we have is that every day that passes, We're losing negotiating capacity. If a couple of years ago, We had a lot of money as a country to foreign banks (mainly German and French), several investment funds, etc..., implies that two years ago, These funds and banks had a great concern for the situation of Spain as well as a lot of interest in that the situation is recondujese. During these years, all banks and funds who wanted to have able to go reducing their exposure to Spanish sovereign debt, given that they have been getting patches different complicated situations that have appeared (elections in Italy, sections of rescue and elections in Greece, Cyprus crisis, among others) but do not give a definitive solution to the problem.

As a simple observer of a foot of the situation, I see that individuals and companies had and have many debts with Spanish banks, that in turn were and are heavily indebted with German banks, Austrian, funds several and others. When Spanish companies and the Spanish in general run into trouble to return their credits by decreases in sales, dismissals, etc..., We ask the banks that they refinance our debts and mortgages, and these in turn, having no savings in the box, they need to seek refinancing to its creditors, that is to say, external financial markets.

On the other hand, to be in recession, State revenues down and shows a considerable deficit, It also seeks to refinance its debt and as banks and Spanish citizens they are already heavily indebted, no choice other that do well in foreign markets, so we have banks and the Spanish State asking for funding outside and a situation of major financial imbalances.

In this frame of mind, foreign financial markets which had financed the great Spanish bubble historically, practically they closed for Spain two years ago, unless exorbitant interests that had caused sooner or later pay, in case of staying many months, a default state.

Faced with this panorama, It should have been carried out a good long-term viability plan negotiating directly with Germany (It has become clear that it is who sends in Europe), the ECB, the EC and the IMF, and at that time (newcomer to the Government, Rajoy), We had the strength to do it since Spain put at risk the euro, and the German and European banks had many loans in Spain, but they did not do that, but that again opted for a patch to win time and Mr Draghi, also just arrived to the ECB that famous said "we will do whatever is necessary to preserve the euro" and injected billions of euros of liquidity into the market at an interest rate of the 1%, that he went to a large percentage to Spanish and Italian banks. In theory, These were to finance the economy, but they did not. Given that they were given money without conditions, what they did in the case of Spain was to cover some of their holes, pay foreign creditors and with the rest invest / Finance to the State to the 5% or more, or even dispose of the ECB to the 0% in the hope of what could happen or future maturity to attend. Of individuals and productive enterprises, in the real economy, not agreed nobody.

During these years, the Spanish sovereign debt historically in foreign hands has become, more and more, in the hands of the Spanish banks through the mechanism described above the ECB loans (We then miss us that want to keep the law of mortgages, etc...) or even own State agencies (I guess many know that the famous surplus or mattress of social security today is invested in a 99% in government debt).

This situation implies that foreign creditors each passing day recover more of their investment and on the other hand, they have time to go provisioned a possible loss and this result is that increasingly we have smaller capacity of negotiation. so they increasingly may require us more sacrifices we may oppose, Although many of them, as is being demonstrated, be counterproductive both short-term and long-term for our economy.

In summary, the time has come that the Spanish Government, discreet but firm way, requires a definitive solution that avoids the constant blackmail of demands or risk premium, day in day also, by senior European officials, more cuts or reforms. It is possible that a solution is the Bank Union, or maybe a possible greater capacity for action of the ECB independent from the dictates of the Bundesbank, But what is essential is to know where we are going and what we are asked to do so in order to be able to assess whether we are interested or not and avoid appearing new requirements as time passes.



European health systems compared: Please, what not toqueteen me more mine!

4 07 2013

 

It seems impossible that Spain is in the European Union from ago 26 years and, at least on health issues, We know so little about our European partners.

I can understand that the citizens and health professionals, little concerned by multiple problems look to Europe, but I can not much accept that public health experts, some authorities sanitary and much of journalists dedicated to the health are not too aware of what happens in the neighborhood.

This post was born from the reading of a story in a prestigious journal, The vanguard.

The news was dated the 28-3-12 and he said so:

Spain has become the second European country that spends more on private health, 26.697 million euros, which means a 26,4 per cent of total health expenditure, a percentage second only to Switzerland[1] .

In the same newspaper I could also read Spain spent in 2010 the 8,4% of their GDP on your system health public.

As well, both statements demonstrate a lack of knowledge of how things in Europe work.

Both news are based on an impossible comparison for two reasons: one that, In contrast to other countries of the European Union of the 15, Spain only spends a 6% of its GDP on public funds for health since the 2,4% remaining corresponds to private contributions that explain why our healthcare system with the miserable public investment has survived and justify that we have no choice but being second in private investment. It is as if not salary reached us at end of month and we had to find us an abominable moonlighting and over they called us wasteful; In short: Cuckold and to pay for the drinks!!

Taking advantage of that, for various reasons, I've kicked me most European health systems, I will bring my analysis (personal and therefore subjective) of them. For reasons of space, and to avoid that this post will be in the Bible of the smart patient, I gird for the comparison of some of the most representative systems of the 17 States that form the euro zone and Sweden, Denmark and Great Britain[2]. None of them is perfect, But how happens to parents regarding children, We want everyone to much.

 

Classification according to financing health systems: There is good and rich and there is good but less wealthy

The European health services have characteristics that economists make excluded them almost of the goods that the market can provide, both for reasons of efficiency (are not met the conditions for the existence of market), as equity. In fact, no developed country - not even the US health works almost as a market[3]- It leaves completely in the hands of the market the key aspects of health services.

In the European Union there are basically two forms of health financing, It served for European health systems can be classified into two types: (1) social security system (Bismarck model), funded by compulsory social contributions, and (2) tax-financed system (Beveridge model).

Countries with the first model, Germany is the historical reference from which the Chancellor Bismarck announced the creation of the system in 1881.

The international reference of the countries with the second model is the national health service (National Health Service, NHS) of Great Britain, created in 1948 by the Labour Government of Clement Atlee.

In any case, health financing of both models is essentially public.

 

SEuropean health systems by country:

No we can review them all since this chapter would be extended both as rallies of Fidel Castro.

I'll discuss the most important due to their size or those who have most peculiar characteristics.

 

Germany

With its more of 82 million inhabitants has a health expenditure of the 10,6(% of GDP.

Is one of the countries that has had to be reformed more your healthcare in recent decades since the unification with the former Republic Democratic German caused serious problems of organization and economic.

The health care system has a decentralized organization characterized by federalism and corporate non-governmental bodies. There are associations of physicians and dentists, on the one hand, and funding of disease and their associations on the other, structured both at federal and State level.

There are a total of 291 Sickness funds which negotiate their contracts with the various providers of health care services. There is freedom of choice of doctor, generalist or specialist. Coexists a co-pay for hospital stay in a shared room; by physiotherapy, medical transport and the 50% dental costs. The drugs have a co-pay as fixed amount, variable according to the cost of the drug. Most of the direct payments are used to drugs. In 2004 the co-payment for the consultations was introduced.

Relative to internationally, the German health system has so far had a high level of income and health resources. The population has enjoyed an equitable health system and easy access. However, the global crisis is forcing reforms agreed between the Government and the opposition, which if they materialize they deleted abundant benefits and will mean cuts as that patient may run with a 10% each service costs, that social security now will not pay dentures nor glasses (except for minor and severe cases) and it will also pay casualties prolonged sickness.

 

France

To health care for the most of 60 million inhabitants dedicates the 11,1 % of GDP.

As for the French health system-organizational structure, its health system is one of the most complex, combining factors of various models. Almost the entire population is covered by the compulsory social security which, However, only generates the 70% of expenditure on health. Doctors can or do not attend compulsory insurance patients.

The main health insurance scheme pays to public hospitals through prospective global budgets based on the GRD[4]. Lucrative private hospitals are paid through a fixed amount that covers all expenses except for physicians who are covered in free base. The not-for-profit private hospitals can choose between two payment systems.

Most of the services are provided through free self-employed doctors, in consultations and private hospitals. Patients pay directly for service and are then reimbursed by the statutory health insurance system. The national agreement between physicians and the funds specified a negotiated rate. There is a co-payment and the patient pays the 25% the cost of consultation (unless you have additional insurance). Pay the 65% the medical transport and the 40% physical therapy and laboratory tests. In hospitalization is paid per day, more a 20%. Certain chronic disease drugs are exempt from contribution, setting the co-payment for others among a 35 and a 65%.

But France has not remained oblivious to the global crisis. The reimbursement of medicines has been suppressed and increased the payment to the insured of a part of the medical consultations, treatment of functional re-education and transport by ambulance. The reforms underway could involve increased privatization of health financing in the coming years.

 

Austria

For a population of little more than 8 million inhabitants, the Austrians spend the 10,2 % of GDP. Your system is universal coverage, funded by taxes and insurance. The medical consultation is free or, Depending on the insurance, subsidized to the 80-90%. Visits to different of the insurer's doctors must be paid completely. Hospitalization is paid as a fixed amount or up to a 20% cost, Depending on the province and type of assurance, both acute processes such as chronic. There is a payment for prescription. Patients pay, altogether, the 21,5% pharmaceutical expenditure.

The Austrian health system is structured in a statutory health insurance (SHI) that covers to the 95% of the population in a compulsory mode.

At the level of primary care health care are made mostly by independent health professionals.

The generalized situation of financial crisis had barely had consequences up to 2009 on the economy and trade in Austria, However, now the Austrian economy starts to have problems which we hope will not impact on your health.

 

Belgium

With a population of over of 10,5 million inhabitants, Belgium dedicated the 10,4 % of GDP to health care.

In terms of the organizational structure, the Belgian healthcare system is based on a model of compulsory Social Security. The National Institute of insurance of disease controls the general health care system organization transferring funds directly to created non-profit funds and private services. Patients have free choice of provider, both doctor, as a hospital and as a sickness fund. The refund is carried out through these funds sickness individual that depend on the nature of the service provided; of the status legal services provider and the status of the insured.

Patients finance about the 20% costs of health mainly through direct payments and also the voluntary health insurance premiums.

The provision of primary care is carried out through private general practitioners and specialists.

The usual regime is the payment-by-Act with subsequent reimbursement by insurance, so much for the general practitioner as to the specialist, all elective. The first consultations are paid. Pharmacy co-payment varies between the 0 and 80%, paying the Belgians altogether a 33% pharmaceutical expenditure.

Belgium has a public deficit of 25.000 million euros and has already announced budget cuts in health care.

 

Holland

With a population of little more than 16,4 million invests the 9,4 % of GDP in health.

Holland has a mixed organisational structure with national health system structure but based funding so that insurance for the purposes of classification, we will consider it as Bismarck model. Coexist three parallel types of insurance. The sickness funds have a system of budgets in which negotiated with suppliers the quality, quantity and price of services. This funding provides flexibility and market competition.

Since the year 2000 Hospital payments are made according to a system based on the cost by GRDs. In addition, In addition, hospitals are additional structural expenditure budgets.

The provision of health services is carried out, at the level of primary care, by doctors in general medicine. Each patient in theory recruits in a doctor of general medicine (primary care physician), that acts as a controller and door entry or filter to the other system services (medical specialists and hospitalization). Most of the medical problems, two-thirds of outpatient processes, they are treated by family doctors is referrals to specialists and hospitals low.

Most of the specialized assistance is carried out through medical specialists, in hospitals with outpatient.

Coverage before a acute processes is for the 62% of the population, While other hires private insurance. The pharmacy co-payment is the excess over the reference price. There is a variable contribution by oral health, the rest of the services being free.

Neither Holland has been oblivious to the global crisis with its by 15 € 1 billion of deficit that predict inevitable cuts for health.

 

Great Britain

This country invests the 8,4% of GDP in its 60 million inhabitants. Although it remains outside of the euro zone, given its importance it requires a comparative analysis.

Within the structure of the health system are to theNational Health Service (NHS), funded by national General tax that provides public healthcare, through public providers, delegating the responsibilities of buying locally. Coverage is universal to all legal in the United Kingdom residents and residents of the European Union. Private health, by means of a supplementary health insurance, There is little, assuming around the 11,5% of the population.

The NHS is financed mainly through general taxation (direct taxes: VAT, PERSONAL INCOME TAX), In addition to local tax. Primary care is performed by means of general medicine doctors who are self-employed and from the 2004 their remuneration is based on a mixed system: capitation with an extra plus for quality. General practitioners act as filters, gatekeepers, for access to the rest of the system, requiring the citizen to a wheel of prescription of the assigned general practitioner specialist. Hospitals funded by contracts of activity through the analysis of the case-mix[5] and the GRDs.

The most radical feature is the possibility of purchasing of health care services by primary care physicians, What, at the same time, they may settle part of the healthcare shareholding (GP Fund holdinqs). Hospitals do not have more budgets that who can seek purchase of health services by the General, in application of the maxim «money follows the patient». The co-payment pharmacy has been climbing gradually, with quarterly or annual caps. In practice, However, few pay that amount, due to the exemptions and the fact that almost half of the medicines cost less, so it is cheaper to buy them without prescription. In hospitalization is paid a fee for private room. Oral after a certain age is paid in health.

 

Recently been abolished free medical transportation and the economic crisis has forced to consider reforms in coverage and health benefits that have opened a public debate of great depth. If the British Government achieves the objectives that have been flagged, the National Health Service It will be a system of delegation and provision of services of State-owned and will be transformed into a system in which the assistance is to various public and private organizations, largely autonomous, within a health care market

 

Sweden

With a population scarcely exceeding the 9,1 million dedicated the 9,2% of GDP to health. The organizational structure of the Swedish health care system is a system based on taxes and mandatory giving coverage to the entire population (Universal). Voluntary insurance are very limited and provide only supplementary to the public system coverage. The health system is primarily regional and public, being organized at three levels: National, regional (en 21 counties or provinces) and localinen 290 municipalities)

They use the GRDs as risk adjustment system for hospital payments. The majority of the workforce is public employee. Doctors receive a monthly salary in charge of the region and an additional capitation payment.

The provision of primary care services is made at primary care centers where are preventive and curative processes through such local health centres, What are public, and through the outpatient hospitals and private clinics. General medicine physicians act as gatekeepers System.

The patient pays the local authority (not a doctor, except in private consultations) per visit. Physical therapy is also paid, psychotherapy. etc. Care in emergency admissions has an additional cost. The hospital also pays a both/day (even retirees). Dental services have a co-pay of between the 25 and the 60%. Since July of 1995 for each first recipe is paid a fixed, with another extra amount for each additional prescription.

But even Sweden, the country that has further development of its welfare State, faced with the need for austerity in health policies.

 

Denmark

It has a population of 5,5 million inhabitants and dedicated the 9,5% of GDP to health care. Your system is universal coverage financed mainly through taxes. There is free at the time of use of the services with the exception of Pharmacy (co-payment between the 50 and 100%), Dentistry, physical therapy and Podiatry (is paid 2/5 of the invoice). Is there a cost for a single hospital room.

The remuneration of doctors in general medicine is mixed, making payment capitativos (30% compensation) and fee-for-service. The doctors charge for medical act. The staff public hospitals receive fixed monthly wages.

Denmark with a higher public deficit to the 4.000 million euros also confronts the dilemma of health reforms to the health care crisis.

 

Italy

Has a population of 58,2 million people requiring the 9 % of GDP. Although its national health care system provides universal coverage, there are great differences in terms of health care and health resources and health expenditure between the different Italian regions.

Is there a copay so that private payments share costs for public services for diagnostic tests, Pharmacy and specialist consultations. From 1993 the patients have to pay for outpatient follow-up to a stipulated maximum. Co-payments for drugs and outpatient specialists also have co-payment. In 1996 copayments were the 4,8 % of the total income of the Italian system, but this fell to the 2,9% in the year 2002 After the deletion of the co-payment of drugs at national level. Approximately the 15% the population has a private supplementary health insurance, either individual or collective through your company.

Tertiary hospitals have status foundations and enjoy important financial freedoms. Public secondary and regional hospitals enjoy some financial autonomy but remain under the control of the LHU (local units). Hospital level is implanted through the GRDs prospective payment system for hospital patients. Hospital doctors are salaried permanent staff. Is paid to general medicine and Pediatrics physicians according to a capitation system. Lately they have been launched reforms to apply additional incentives for some specific treatments and to achieve goals of health cost containment.

Orthopaedic are not covered, even if the transport. Paid a 40% the cost of diagnostic tests. The visit to the general practitioner is taxed with a stop/year, and the specialist also.

Italy is facing the need to cut back on 79.000 million its public deficit by what they have proposed drastic cuts as the increase in health care co-payment where patients attending medical visits will have to pay 10 euros every time and 25 When they come to the emergency room and do not require hospital admission.

 

Spain

With their 46 million inhabitants, Spain is the country that less public money devoted to health (6% of GDP) Although citizens provide a 2,4% additional.

Until the Royal Decree 16/2012, the Spanish national health system was a system of universal coverage (including irregular migrants), funded through taxation and that operated mainly in the public sector. The services were free at the point of delivery, with the exception of the prescriptions to minors of 65 years of age, who should participate in the payment with a contribution from the 40% retail price, with a few exceptions. Competences in the field of health were transferred in its entirety to the autonomous communities since the end of 2002; This decentralization gave rise to 17 health departments (ministries or departments of health) you have primary jurisdiction over the Organization and delivery of health services within its territory.

However the cited Decree substantially changed the philosophy of public health to exclude immigrants in an irregular situation of public provision and include the co-payment for previously free services.

Health departments responsible for the territorial organization of health services under its jurisdiction: the designation of areas of health and basic health areas and the establishment of the degree of decentralisation, that is to say, the powers attributed to the management structures in charge of each one of them. The most frequent model comprises two distinct managements, for primary care and specialty care (ambulatory and hospital care), in every area of health. However, the health services of the autonomous communities are putting up increasingly more frequently unique area managements that they integrate primary care and specialty. Basic health zones are the smaller size of the organizational structure of the health care unit. Normally, they are organized in lathe to a single primary care team which is the gateway to the system. With regard to the possibilities of choice of patients, choice of specialist and hospital is relatively little developed (with some differences between regions) in primary care. In any case, to access specialized health care necessary pediatrician or family physician to refer to the patient to the same.

The public system traditionally subcontracted with private hospital care (with or without profit) between the 15% and the 20% about the provision of specialized health services. In general, This formula is used for the acquisition of certain services of diagnosis, high resolution of outpatient surgical procedures in the framework of the management of waiting lists.

Voluntary private insurance have (or they had before the Decree) a role relatively minor in the Spanish health system. These voluntary private insurance are independent of the public system (It is not possible to give up public health coverage for exclusively private benefits) and complementarity (on many occasions, engage themselves to access services for which there are waiting lists in the public system, as a specialized health care, or services such as adult oral care, It included very limited in the benefits catalogue). These insurances cover approximately to the 13% of the population, While there are considerable regional variations.

The global crisis has prompted reforms in health care cuts that have not been agreed with the opposition but implemented by Royal Decree without social dialogue. These cuts could blur the national health system, to turn health care into a privilege only to policyholders instead of a basic citizen's right.

 

European health systems: very varied but none perfect

Be a Spanish European, Swedish, British, French, Italian or Danish, you will notice that the landscape of the health systems in Europe is of diverse cultures. Meets what he affirmed John f.. Kenedy: If not we can end our differences, contribute to the world to be a place for them.

At first glance of Sweden might seem the most advanced, nor is it the panacea.

It is clear that you cannot speak of a European health system as such, Since differences in coverage, funding and service provision are remarkable among countries. They reflect very different realities with regard to rights of patients and to means of financing, being varied the formulas adopted to reduce their health debt and make more sustainable their public health: copay, health policy centime, ticket moderator.

The border between public and private health seems more and more diluted. Seems as if European politicians continue to strictly the famous phrase of William Shakespeare:  Seeking the best we often spoil what is right.

And that is what it seems because la most States are including greater payment for drugs, payment queries, complementary tests and days of hospitalization to moderate spending, tax food in hospitals, payment for single room, collect from patients who come to the emergency room with problems that could be assessed as non-urgent, the ambulance levy, payment for nursing or no basic fee.

However, We hope that Governments will remember its commitment, laid down in the Maastricht Treaty, move towards the universalization and equity in European health systems.

 

References

[1] Vanguardia.com/health. Accessible by http://www.lavanguardia.com/salud/20120328/54278766414/espana-segundo-pais-europa-mas-gasta-sanidad-privada.html

[2] The European Central Bank It is the entity responsible for the monetary policy of the 17 States forming the euro area. These are: Germany, Austria, Belgium, Cyprus, Slovakia, Slovenia, Spain, Estonia, Finland, France, Greece, Ireland, Italy, Luxembourg, Malta, Netherlands and Portugal.

[3] May not know that it is not so in all countries of our continent, Neither,much less, in the United States.UU - where health care is a disaster, a separate chapter which does not deserve many more comments - because there health care follows the rules of the free market, that is a business. Is like those TVs in hotels in the 1980s that only worked if you missed them coins.

[4] By diagnosis related groups (GRD) they constitute a system of classification of patients that allow to relate different types of patients treated in a hospital (that is to say, their casuistry), with the cost that represents your assistance. Currently three major versions of DRGS are used

[5] The concept of case - mix It refers to the composition of cases or various kinds of patients who are treated and diagnosed in the hospital (casuisticahospitalaria).

6. Abbing HD. Social justice and healthcare systems in Europe. EUR J Health Law. 2010 Jun;17(3):217-22.

7. A QUIÉN. Using the health for all framework to explore the development of health policy in the European Region of WHO. WHO Reg Publ Eur be. 2000;86:1-24.

8. Legemaate J. Integrating health law and health policy: a European perspective. Health Policy. 2002 May;60(2):101-10.

9. Ter Meulen R, Jotterand F. Individual responsibility and solidarity in European health care: further down the road to two-tier system of health care. J Med Philos. 2008 Jun;33(3):191-7.

10. Ritsatakis A, Barnes R, Harrington P. An overview of experience in the European Region. WHO Reg Publ Eur be. 2000;86:271-346.

11. Kluge EH. Comparing healthcare systems: outcomes, ethical principles, and social values. MedGenMed. 2007 Nov 7;9(4):29

12. Schreyögg J. Justice in health care systems from an economic perspective]. Gesundheitswesen. 2004 Jan;66(1):7-14.

 

 

Elpacienteinteligente.blogspot.com.es [en línea] Barcelona (ESP): elpacienteinteligente.blogspot.com.es, 04 in July of 2013 [REF. 11 in May of 2012] Available on Internet:http://elpacienteinteligente.blogspot.com.es/2012/05/los-sistemas-sanitarios-europeos.html



ECONOMIC CRISIS I: DIVISION OF POWERS

1 07 2013

Agustín Bassols Borrell

ADE graduated from the University of Barcelona

MBA ESADE FT

 

 

 

Everyone is aware that during the 15 years prior to the crisis the Governments of Aznar and Zapatero fueled bubbles Spanish real estate, financial and debt without any of the institutions that should sound the alarm, as the Bank of Spain, the CNMV, senior officials of the State, etc..., did so despite having data that show the situation.

It is clear that the connivance of many addresses of these institutions with political parties as well as others such as the CGPJ or TC has led many citizens to the conclusion that we are in a State where there really is a division of powers. Hence, as a result the abysmal management carried out both by Governments on the right and left, not only the political class has been discredited but, by extension, most of the institutions of the State.

In addition, over the past years, deep with a crisis plaguing the citizens, We have seen how a few and others, they have not done, nor do amendment and have attended performances as the prosecutors exercising certain personalities lawyers, different Governments pardons characters who could be described as their "caste", political tactismos of the different parties to cover cases of corruption, several policies based on the "... and more...", demagogues by minority parties, election manifestos of major parties that have been cleaned the back the next day to win elections.

None of the significant politicians of the past years has made a real exercise of self-criticism to the citizens. Is more, in the majority of cases we have been accused to citizens themselves to be makers and even the feckless have borrowed more than necessary, but none of them has raised a real separation of powers, None of them has been a model of direct election-open mailing lists, None of them raised a concrete reform of the Senate, None of them has made self-criticism for the abuses that have been and still are committed (Preferred, Mortgage law, Clauses soil, …).

On the contrary, we see as our politicians and institutions (with honorable exceptions custom in many cases judges ranging for free) van carrying out the instructions provided them marked since the TROIKA (European Commission, ECB and IMF), who in turn are a simple tool called "financial markets".

This entire situation is putting out that we live in a State that still maintains a high level of lack of democracy so taking advantage of that now it is speaking for several reasons the convenience of constitutional reform, should not lose the opportunity of, In addition to point out and denounce everything that does not work, proposals to be included in the Magna Carta in order to improve. Allow me to make two that I think that surely lay according to a vast majority of citizens and on the other hand, given the recent history, They seem to be fundamental:

-Establish a true separation of powers Executive, legislative and judicial, preventing nominations to finger by political leaders of various institutions of the State, both regulatory and judicial, as well as the prohibition of future labour relations of political related regulated activities and companies in those sectors.

-Direct election by the citizens of our representatives without being forced to go through the lists of the parties. This would allow access to policy relevant people from all walks, with proven competence and which does not have dedicated themselves to servility and "lick asses" (Sorry for the expression) the list of party heads out in the photo. The idea is that politicians serve the people and not their parties as it is the case today.