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Earlier activities on health technology assessment (HTA) started in Spain around 1984, with the creation of a National Advisory Board on HTA, and the development of national and regional HTA organizations in the early 1990s. In 2012, the Spanish Health Ministry established the Spanish Network for Health Technology Assessment of the National Health System (RedETS); funded at national level and including all public HTA organizations at national and regional levels. RedETSis focused on the assessment of nondrug health technologies to inform the revision (approval and funding or disinvestment) of the Benefit Portfolio of the Spanish NHS. In parallel with European Network for Health Technology Assessment (EUnetHTA), RedETS has been setting-up and sharing common procedures and methodological guidelines to ensure effective cooperation and mutual recognition of the scientific and technical production in HTA. The output of RedETS is fifty to sixty annual reports, including the production of full HTA reports, Clinical Practice Guidelines, methodological guidance reports, relative effectiveness assessments, tools to support shared decision making between patients and healthcare professionals, and monitoring studies. The HTA assessments requested by the Regional Health Authorities are the biggest component of the annual RedETS working plan. These assessment needs are identified according to a yearly process and prioritized by a Commission composed of representatives from all Spanish regions with the aid of the PRITEC tool. The objectives of this study are to report and update the normative and organizational state of HTA in Spain; describing noteworthy advances witnessed over the past 10 years, as well as discussing existing challenges.
Conclusions and recommendations of health technology assessment (HTA) reports have an impact on all relevant actors involved in the health system (health authorities, administrators, health professionals, patients, citizens and industry). The involvement of all those relevant stakeholders in the HTA process facilitates making valid and informed decisions and an efficient allocation of resources. Improving communication, participation and transparency among all agents will lead to more efficient evaluation and decision-making processes.
To review key aspects of the relations between HTA agencies and health industries, two process were carried out: a narrative review of literature searched in Medline, PubMed, Embase, CINAHL and WOS (2007-2017) and a review of websites of international HTA agencies. References and webs with information on the framework, objectives, methodologies, impact or results of the relationships were included.
A total of 1961 references were located and forty-five were selected. From the synthesis of the selected references the following key aspects of the relationships between HTA and industry were identified: (i) the importance of early dialogues with industry to align HTA objectives with the generation of evidence; (ii) challenges of the bias in the evidence produced by industry; (iii) difficulties in industry engagement in HTA processes; and (iv) industry interest in HTA. The review of six agency websites provided information on industry involvement in strategic activities, early dialogues, provision of documentation, management of industry clarifications, review of the report/allegations and other forms of relationship.
Both the review of the literature and the contents of the web pages of international agencies with experience in relations with industry show that the interest is in the creation of collaborative frameworks between regulatory authorities that decide on authorization and price and reimbursement and HTA agencies, while both try to maintain an early, transparent and systematic interaction with the healthcare industry.
In considering the cognitive notion of informativeness, variants of the Spanish first-person singular object a mí ‘to me’, ‘myself’ convey different meanings. These meanings are used to pursue communicative goals in discursive interactions. A qualitative examination of specific examples of first-person singular object a mí variants (omitted, preverbal, and postverbal) as well as a quantitative analysis of these variants across different socio-professional affiliations of speakers was conducted to ascertain how these variants contribute to the construction of communicative styles based on the cognitive dimension of subjectivity. This article demonstrates that these forms and their meanings are unevenly distributed across the socio-professional affiliations of speakers; thus, it may be concluded that variation of first-person singular object a mí shape different communicative styles.
The peseta was the Spanish currency for more than a century and, during this time, it played a remarkable role in adjusting the balance of payments. This paper presents a chronology of the moments when the adjustment was crucial, which, consistent with the macro-trilemma, coincided with periods of external openness. Moreover, this paper provides empirical support to the thesis that links the exceptionality of a floating peseta during the gold standard with fiscal profligacy.
The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.
Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.
From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.
Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.
Salema, Sarpa salpa is a commercial exploited species in the Atlantic Ocean with little available information for the essential population parameters, such as age, growth and reproduction. The present study aims to describe these parameters for S. salpa obtained off the coast of Portugal. Ages were estimated from the whole otolith readings; the minimum and the maximum ages observed were 0 and 14 years, respectively, corresponding to 5.2 and 41.4 cm of total length (TL). Whole otolith readings and back-calculation approaches were used to estimate the parameters of the von Bertalanffy growth function and the Akaike's information criterion value suggested that the second approach was the best one to describe the growth of salema: L∞ = 45.07 cm, k = 0.14 year−1 and t0 = −1.43 year. The species is a protandric hermaphrodite and the sex change process occurred between 28.6 and 40.9 cm TL. A short spawning season was identified, extending from September to November. The estimated length at first maturity for males was 24.5 cm TL, corresponding to an age of 2 years at first maturity. This species exhibited a determinate fecundity type and the relative annual fecundity varied between 462 and 2662 oocytes per gram of gutted weight.
The aim of the current study was to asses the effect of goat or cow milk-based diets, either normal or Fe-overloaded and folic acid supplement on some aspects of hepatic physiology, enzymatic antioxidant defence and lipid peroxidation in liver, brain and erythrocyte of control and anaemic rats after chronic Fe repletion. 160 male Wistar rats were placed on 40 d in two groups, a control group receiving normal-Fe diet and the Fe-deficient group receiving low Fe diet. Lately, the rats were fed with goat and cow milk-based diets during 30 d, with normal-Fe content or Fe-overload and either with normal folic or folic acid supplemented. Fe-overload increased plasma alanine transaminase and aspartate transaminase levels when cow milk was supplied. Dietary folate supplementation reduced plasma transaminases levels in animals fed goat milk with chronic Fe overload. A remarkable increase in the superoxide dismutase activity was observed in the animals fed cow milk. Dietary folate supplement lead to a decrease on the activity of this enzyme in all the tissues studied with both milk-based diets. A concomitant increment in catalase was also observed. The increase in lipid peroxidation products levels in rats fed cow milk with Fe-overload, suggest an imbalance in the functioning of the enzymatic antioxidant defence. In conclusion, dietary folate-supplemented goat milk reduces both plasma transaminases levels, suggesting a hepatoprotective effect and has beneficial effects in situation of Fe-overload, improving the antioxidant enzymes activities and reducing lipid peroxidation.
Dietary habits vary widely among regions and cultural groups, and FFQ need to be designed for specific populations. The objectives of the present study were to develop and test the repeatability and relative validity of a medium-length semi-quantitative FFQ for measuring the energy and macronutrient intakes of a specific population and to contribute a methodological framework for this procedure.
Palestinian families in the Hebron area.
After a preliminary survey of a subgroup of homemakers using 3 d diet recall, stepwise multiple regression analysis was used for selected nutrients to choose foods for inclusion in the FFQ.
The FFQ was administered to a study population of 169 women representing the same number of families.
The Wilcoxon test and Bland–Altman plots were used to compare the FFQ results with the mean 3 d diet recall results. A high level of concordance was found, validating the FFQ. In this population, the mean consumption of SFA was above recommendations and the intakes of vitamin D, folic acid, Ca, Fe and K were deficient.
The availability of diet assessment instruments designed for specific populations and cultures is of immense value to researchers and policy makers. The study describes a simple and effective method to develop and validate an FFQ for a given population of interest.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
This study examined the relationship between medical advice to engage in physical activity with type of demand required by physical activity and demographic variables. A cross-sectional study was developed, featuring a questionnaire on physicians’ advice, and type of demand. The questionnaire was completed by a probability and nationwide sample of older adults in Spain (n = 933, M = 74.1, range 65–93), randomly selected using multistage sampling. More physically active older adults have, more often than the less active, received physicians’ advice to engage in physical activity. There is a significant relationship between medical advice and type of demand (p < .01) and age (p < .05). However, no relationship was found between physician medical advice and gender, social class, or income. Physicians can effectively promote physical activity among sedentary older adults through appropriate advice. Consequently, health authorities should promote physicians’ advising older patients to pursue physical activity.
Geomorphic mapping and stratigraphic analysis of a lake core document the late Quaternary glacial history of the Central and Eastern Massifs of the Picos de Europa, northwestern Spain. The distribution of glacial deposits indicates that at their most advanced positions glaciers occupied 9.1 km2, extended as far as 7 km down-valley and had an estimated equilibrium-line altitude (ELA) ranging between 1666 and 1722 m. Radiocarbon dating of sediment deposited in a lake dammed by moraines of this advance show that the maximum glacial extent was prior to 35,280 ± 440 cal yr BP. This advance was followed by two subsequent but less extensive late Pleistocene advances, recorded by multiple moraines flanking both massifs and sedimentary characteristics in the lake deposits. The last recognized glacial episode is the 19th-century maximum extent of small Little Ice Age glaciers in the highest cirques above 2200 m.
Ageing is an important determinant of atherosclerosis development rate, mainly by the creation of a chronic low-grade inflammation. Diet, and particularly its fat content, modulates the inflammatory response in the fasting and postprandial states. Our aim was to study the effects of dietary fat on the expression of genes related to inflammation (NF-κB, monocyte chemoattractant protein 1 (MCP-1), TNF-α and IL-6) and plaque stability (matrix metalloproteinase 9, MMP-9) during the postprandial state of twenty healthy, elderly people who followed three diets for 3 weeks each: (1) Mediterranean diet (Med Diet) enriched in MUFA with virgin olive oil; (2) SFA-rich diet; and (3) low-fat, high-carbohydrate diet enriched in n-3 PUFA (CHO-PUFA diet) by a randomised crossover design. At the end of each period, after a 12-h fast, the subjects received a breakfast with a composition similar to the one when the dietary period ended. In the fasting state, the Med Diet consumption induced a lower gene expression of the p65 subunit of NF-κB compared with the SFA-rich diet (P = 0·019). The ingestion of the Med Diet induced a lower gene postprandial expression of p65 (P = 0·033), MCP-1 (P = 0·0229) and MMP-9 (P = 0·041) compared with the SFA-rich diet, and a lower gene postprandial expression of p65 (P = 0·027) and TNF-α (P = 0·047) compared with the CHO-PUFA diet. Direct plasma quantification mostly reproduced the findings. Our data suggest that consumption of a Med Diet reduces the postprandial inflammatory response in mononuclear cells compared with the SFA-rich and CHO-PUFA diets in elderly people. These findings may be partly responsible for the lower CVD risk found in populations with a high adherence to the Med Diet.
This paper adopts an unbiased approach to the evolution of Spanish foreign trade (1869–1999). It aims to characterize the long-run performance of the Spanish external sector by applying a statistical analysis to the new series presented by Prados (2003). We identify two well-defined, clearly distinguished stages separated by a period of transition. The first stage, until 1935, was one of unpredictable trade and little connection with national income. The transition, a volatile period, lasted until 1960. This year marks the beginning of a second stage, characterized by a mature, predictable trade strongly linked with income.
Amorphous Silica is one of candidate materials for both final focusing optics of lasers for NIF and future inertial fusion reactors and diagnostics of the Safety and Control Systems of the ITER machine as well as DEMO magnetic fusion reactors. In operation, these materials will be exposed to high neutron irradiation fluxes and it can result in point defect and vary the optical absorption, that is, degradation of the optical properties. In this paper we present molecular dynamic simulation of displacement cascade due to energetic recoils in amorphous silica without hydrogen atoms and with 1% of hydrogen atoms trying to identify defects formation. We have made a statistics of the different kind of defects at different energy of primary knock-on atoms (PKA). The range of studied PKA energies are from 400 eV to 3.5 keV and it is made to both component of this material Silicon and Oxygen.
This paper compares two methods to estimate the position of a mobile robot in an indoor environment using only odometric calculus and the WiFi energy received from the wireless communication infrastructure. In both cases we use a well-known probabilistic method based on the Bayes rule to accumulate localization probability as the robot moves on with an experimental WiFi map, and with a theoretically built WiFi map. We will show several experiments made in our university building to compare both methods using a Pioneer robot. The two major contributions of the presented work are that the self-localization error achieved with WiFi energy is bounded, and that no significant degradation is observed when the expected WiFi energy at each point is taken from radio propagation model, instead of an a priori experimental intensity map of the environment.
The system of multiple exchange rates for the peseta, in force between 1948 and 1959, has posed many problems for Spanish historiography, in that it implies that the price at which foreign transactions were carried out is unknown, being hidden in the dense foliage of special exchange rates. In this paper we estimate the various average exchange rates series for all the Balance of Payments of these years, thus filling the vacuum that the post-Civil War period represents in the history of the peseta. We also calculate the real effective exchange rate, concluding that the important devaluations of 1949–1951 and 1957–1959 were insufficient in order to achieve equilibrium between Spanish relative prices and those of its main trading partners, so that the peseta remained continuously over-valued throughout the 1940's and 1950's.
Desde hace ya años la economía española en la época de la Restauración borbónica está siendo un objeto de interés preferente entre los investigadores. Como cabia esperar —desde la optimista actitud del creyente en el progreso intelectual—, una concentración de esfuerzos semejante ha acabado por producir una cierta convergencia en los juicios sobre el período.
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